Purpose: To evaluate the outcome of palliative care based on patientassessed outcome and investigate associations between symptom prioritization, initial symptom scoring, and treatment outcome.
Patients and Methods: Over two years, 267 consecutive, eligible patients were referred to our department of palliative medicine and asked to participate in a questionnaire-based evaluation of quality of life (QOL). On arrival, 175 patients participated in the study and 142, 119, and 95 also participated at 1, 2, and 3 weeks, respectively. Every week, participants named and prioritized their five most important symptoms and completed the self-assessment questionnaires European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), Edmonton Symptom Assessment System (ESAS), Hospital Anxiety and Depression Scale (HADS), and Multidimensional Fatigue Inventory (MFI-20). The doctor assessed cognitive status using the Mini Mental State Examination (MMSE). Changes from the initial symptom scores for each week were calculated and compared with prioritization of the particular symptom.
Results: The patients presented with high initial symptom intensity. Significant improvements were seen over 1, 2, and 3 weeks for many symptoms. The five most frequently prioritized symptoms were pain, fatigue, physical function, appetite, and nausea/vomiting. Patient symptom priority was associated with initial scoring for pain, appetite, nausea/vomiting, dyspnea, depression, constipation, and anxiety and also with the change in scoring over time for pain, appetite, and constipation.
Conclusion: A positive effect of palliative treatment was identified. For many symptoms, the symptom prioritization was associated with quantitative symptom self-assessment and for some also with the change in scoring over time.