Early palliative care for patients with oral cancer in Sri Lanka: A quasi-experimental study

ObjectivesOral cancer is prevalent among Sri Lankan men and compromises their quality of life (QOL). Limited research exists on providing early palliative care in low- to middle-income countries. We assessed the effectiveness of an early palliative care intervention in improving psychological distress and QOL among patients with oral cancer in Sri Lanka. DesignA quasi-experimental study SettingThe study took place at three tertiary care units providing oral cancer treatment in Sri Lanka: the oral and maxillofacial wards at the National Dental Hospital, Colombo (Teaching); the oral and maxillofacial wards at Colombo South (Teaching) Hospital, Karapitiya; and the onco-surgery wards at the National Cancer Institute Maharagama (Apeksha Hospital). ParticipantsThe study participants were patients with oral cancer whose definitive diagnosis had been communicated to the patient and had psychological distress (score of [≥]4 after screening with the Sinhala version of the Distress Thermometer); awaiting surgery as the first treatment modality; and married with children, including at least one family caregiver with the ability to communicate and read well in Sinhalese. Exclusion criteria were, recurrent oral cancer; a formal psychiatric diagnosis; and receiving or having received any early palliative care intervention. They were divided to 55 controls and 55 cases based on the availability of an accessible Public Health Nursing Officer. InterventionsThe early palliative care package, comprising six components, was delivered in three sessions by the principal investigator (PI) and Public Health Nursing Officers. Outcome measuresThe effectiveness was assessed by the level of psychological distress using the Sinhala version of the Distress Thermometer and Level of quality of life using EORTC QLQ 30 with module H&N 35 at baseline (T0), post-intervention (T1), one month (T2), and three months (T3). ResultsIn the intervention group, Distress Thermometer scores significantly decreased from baseline (T0) to three months post-intervention (T3) (6.9 vs. 3.5, p=0.0001). The QOL dimensions improved at all time points for both groups, with the intervention group showing a significantly higher improvement (p=0.0001). ConclusionThe novel early palliative care intervention improved the psychological distress and quality of life of patients with oral cancer.