Make palliative care available to Parkinson's patients

By Sarah Guy, medwireNews Reporter

A modified version of the Edmonton Symptom Assessment System Scale (ESAS) is quick and effective at assessing patients with late-stage Parkinson's disease (PD), and reveals that they have similar levels of symptoms as their peers with metastatic cancer, show study results from Canada.

The findings also indicate that PD patients respond to palliative care in a similar way to individuals with metastatic cancer, leading the researchers to suggest that these patients should have access to the same palliative services.

"Optimally, these programs should include a neurologist working in conjunction with existing palliative care teams to provide true interdisciplinary care," say Janis Miyasaki and co-researchers (University of Toronto, Ontario) in Parkinsonism and Related Disorders.

The team adapted the ESAS to include symptoms of constipation, difficulty swallowing, stiffness, and confusion in addition to the standard symptoms of pain, nausea, and shortness of breath.

Patient assessment with the modified scale also included a discussion involving family members regarding a treatment plan, the patient's wishes for end-of-life care, and whether they wanted to sign a Do Not Resuscitate order.

A total of 65 PD patients underwent more than one assessment with the ESAS-PD at least 3 months apart. They were aged an average of 68 years with an average of 10 years duration of illness.

The mean ESAS-PD score was 56 out of a maximum 140 for patients' initial palliative care assessment, and 40 for their second, a significant difference, report Miyasaki and colleagues.

Previous studies involving ESAS assessment of metastatic cancer patients show a mean score of 47.8, which is not significantly different from the current PD population, adds the team.

Symptoms most frequently reported by the current study cohort were pain, tiredness, depression, anxiety, drowsiness, poor feeling of wellbeing, stiffness, constipation, dysphagia, and confusion.

The symptoms that responded most to intervention, as indicated by an decrease in ESAS-PD score between the first two assessments, included dysphagia, which fell from a mean score of 3.8 to 2.9, constipation, from 4.7 to 3.6, and anxiety, from 3.6 to 2.8. Also, pain decreased from a mean score of 5.2 to 4.0, drowsiness from 5.4 to 4.5, and other from 1.6 to 1.3.

"ESAS-PD is easily administered and the scale highlights the symptoms requiring investigations, treatment and referral to other healthcare providers," conclude the researchers.

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