Symptom Burden and Survival in Patients Receiving Outpatient and Home-Based Palliative Care.

Abstract

<b><i>Background:</i></b> Symptom burden assessment with the Edmonton Symptom Assessment System (ESAS) has been widely studied among patients in outpatient palliative care (OPC), but fewer reports in home-based palliative care (HBPC), and none has assessed the prognostic value of ESAS scores in HBPC. <b><i>Methods:</i></b> This retrospective cohort study compares symptom burden and its prognostic value in adult patients receiving OPC and HBPC services between January 1, 2019, and June 30, 2021. <b><i>Results:</i></b> Patients completed the ESAS at the first OPC consultation (<i>n</i> = 4086) and at admission to HBPC (<i>n</i> = 4087). OPC patients were younger, more likely to have cancer, less likely to have had a recent hospitalization, and had higher adjusted median ESAS scores (28.1 vs. 22.9) compared with HBPC patients (all <i>p</i> < 0.001). ESAS was prognostic of survival in both settings (Hazard ratio 1.18-1.64, <i>p</i> < 0.01). <b><i>Conclusion:</i></b> Symptom burden is an independent prognosticator of survival in HBPC and OPC in this community-based setting.