(P 185) ADDRESSING THE GAP FOR SYMPTOM CONTROL THROUGH THE IMPLEMENTATION OF ENHANCED SUPPORTIVE CARE AT THE LONDON SARCOMA SERVICE

Objective: Sarcomas are a complex group of tumours with increased potential for a large symptom burden, aggressive clinical behaviour and limited prognosis. Patients require intensive clinical treatment and management is challenging with unpredictable outcomes. At University College Hospitals London (UCLH), symptom control was formerly managed by nursing and medical professionals, with adhoc intervention from the palliative care team. In 2020 an Enhanced Supportive Care (ESC) was established within outpatient clinics to support the sarcoma team in providing consistent specialist input to manage complex symptom control. The aim of this study was to evaluate the impact of establishing this outpatient ESC model on sarcoma patient care and experience and to optimise future delivery in this tumour group.

Methods: This retrospective descriptive study analysed 100 consecutive sarcoma patient referrals to ESC between June 2022 and September 2023. The referral criteria for ESC included patients over 25 years old with non-curable disease. Demographic and clinical data, as well as patient-reported outcome measures — including the Australia-modified Karnofsky Performance Status (AKPS) and the Integrated Palliative Care Outcome Scale (IPOS) —were obtained from participants' electronic clinical records within the hospital information system. Additionally, feedback was collected via surveys from clinicians, nurses, and the broader sarcoma team. Patient feedback was also gathered through a patient experience survey.

Results: From one hundred patient referrals to ESC, there were ninety-four patients, median age was 54 years (range 25-85), 56 (60%) were female. A total of 67 patients (71%) had soft tissue sarcoma, 20 patients bone sarcoma (21%) and 7 GIST (7%). The median time from diagnosis of incurable disease to referral to ESC was 8 months (0-124). At referral, 56 patients (56%) were not on active treatment and of 84 patients with an AKPS available, the mean was 80 (SD 40-100). The commonest symptom to prompt referral from 90 patients with an initial visit reported IPOS was pain (71, 79%).
ESC provided 979 patient support consultations with average of 10 contacts per patient. The majority 686 (70%) were conducted by phone, 266 (27%) face to face and 27 (3%) online. Patients were followed by ESC for a median of 54 days, 32% were linked into community palliative care, 31% were discharged when symptoms controlled and 22% were admitted to hospital. Of those patients referred to ESC, 56 patients have died with a median OS of 177 days (7-669) from referral to death.

Conclusion: Integrating an ESC service within sarcoma clinics offers specialist symptom control for patients with incurable diseases, extending beyond those nearing end of life. This multidisciplinary outpatient care model eases the clinic workload for oncology teams and enhances connections between sarcoma patients and community support. An ongoing patient experience survey supports these findings.
The ESC service within sarcoma clinics significantly alleviates patient symptoms, especially pain, improves communication with community services, and enhances holistic care for patients with incurable diseases. This shared care model highlights the importance of biopsychosocial assessments and personalised care.