Stable longitudinal symptom intensity in cancer patients during end-of-life palliative care at home: prospective cohort study.

Abstract

Objectives: This study aimed to investigate the trajectory of symptom burden and quality of life in palliative cancer patients receiving home-based care in Sweden. The focus was on identifying key symptoms and their changes over time to evaluate the impact of palliative care teams.

Methods: A cohort of 240 cancer patients enrolled in palliative home-care teams across three Swedish municipalities participated in this study. Symptoms were assessed using the Edmonton Symptom Assessment System at enrolment and at 1 month, 3 months and 6 months thereafter. Demographic data, symptom ratings and place of death were recorded. Statistical analyses included descriptive statistics, correlation assessments and Wilcoxon tests to identify symptom changes over time.

Results: The most reported symptoms with moderate or severe intensity were lack of energy, reduced quality of life and lack of appetite. Symptom levels remained stable over time, with pain and lack of security showing temporary increases at 1 month and 3 months before returning to baseline at 6 months. Significant gender and living arrangement differences were observed: men reported higher energy deficits, while patients living alone experienced more insecurity. Correlation analysis revealed strong interconnections between symptoms, particularly well-being and quality of life.

Conclusion: This study underscores the effectiveness of palliative home-care teams in maintaining symptom stability despite the progressive nature of cancer. While overall symptom burden did not worsen, specific areas, such as pain management and providing emotional security, may require targeted interventions. The findings highlight the importance of structured, patient-centred palliative care in improving end-of-life outcomes for cancer patients.