Evolution of quality of life (QoL) and symptom burden (SB) in patients receiving inpatient palliative care (PC) following one week of care in a specialized palliative care unit (PCU): A comparison of two groups, with one receiving specialized outpatient palliative care prior to admission.
Authors: Hanna Salm, Florian Doberschütz, Franziska Hallmann, Philipp Munzert, Johannes Rahm, Sarah Uhlig, Daniel Pink
Journal: Journal of Clinical Oncology (2024)

e23160 Background: This study sought to investigate changes in QoL and SB among PC Pt undergoing one week of inpatient care in a specialized PCU. The Pt population was stratified into two groups (Gp), with one Gp pretreated from pre-admission PC provided by an outpatient multidisciplinary PC team, while the other Gp did not receive such support prior to admission. Although the average duration of treatment at a PCU in Germany is 1-2 weeks, the question also arises as to whether a significant improvement in SB/QoL can be expected after just one week of PC in a PCU. Methods: PC Pt with various cancer entities were prospectively included in a non-randomized study. Pt in Gp 1 received outpatient specialized PC prior to admission, while Pt in Gp 2 did not. Over an 8-month period, we gathered data from one academic cancer center, utilizing the EORTC QLQ-C30, one of the most widely used Pt reported outcome (PRO) instruments to assess health-related QoL in cancer Pt. Pt completed the QLQ-C30 at T0 (admission) and T1 (day 7), enabling the assessment of potential changes in their QoL and SB over time. Results: A total of 103 pt (51.5% male) were enrolled (Gr 1: 42%, Gr 2: 58%). At T0, there were no significant differences regarding QLQ-C30 scores between Gp 1 and 2. Over the course of one week several significant and clinically relevant changes in QoL and SB were found: Emotional functioning demonstrated an uplift in both Gp (Gp 1: mean (M) 41.5 IQR 33 vs. 53.1 IQR 50, p 0.014, Gp 2: M 48.2 IQR 46 vs. 56.8 IQR 58, p 0.029), as did the global health status (Gp 1: M 20.7 IQR 17 vs. 36.2 IQR 33, p &lt; 0.001, Gp 2: M 25.6 IQR 25 vs. 35.3 IQR 33, p &lt; 0.001). Nausea and vomiting showed a reduction (Gp 1: M 29.9 IQR 17 vs. 6.8 IQR 0, p &lt; 0.001, Gp 2: M 22.6 IQR 17 vs. 8.2 IQR 0, p &lt; 0.001), along with a notable decline in pain (Gp 1: M 67.4 IQR 67 vs. 25.3 IQR 17, p &lt; 0.001, Gp 2: M 73.1 IQR 83 vs. 29.7 IQR 17, p &lt; 0.001). A decrease was observed in insomnia (Gp 1: M 63.6 IQR 67 vs. 27.6 IQR 33, p &lt; 0.001, Gp 2: M 60.1 IQR 67 vs. 27.6 IQR 33, p &lt; 0.001). There were no significant differences between Gp 1 and 2 in the extent of improvement in the various symptom scales from T0 to T1, except for cognitive functioning, where Gp 1 exhibited an increase while Gp 2 demonstrated a decrease (p 0.044). Conclusions: The findings of our study demonstrate that QoL and several symptoms prevalent in cancer Pt cared for in the PCU experienced significant enhancement over the span of just one week of PCU care. Both Gp, Pt receiving specialized outpatient PC prior to admission and those without, equally benefited from inpatient PC. All mentioned changes from T0 to T1 are considered not only significant, but clinically relevant.