Cross-Cutting Symptom Burden and Health-Related Quality of Life in Hospitalized Patients With Chronic Illness: A Cross-Sectional Study.

Abstract

IntroductionChronic illnesses pose significant global and individual health challenges, with patients experiencing high symptom burden that adversely affects health-related quality of life (HRQoL). Despite this, symptoms are underreported, and many patients with substantial needs do not receive palliative care. This study aimed to assess symptom burden and HRQoL of hospitalized adults with diverse chronic conditions at tertiary centers in Nepal, and examine their association.MethodsA descriptive cross-sectional study was conducted from September to October 2023 among 164 adult patients admitted to selected tertiary hospitals. Participants were recruited using non-probability purposive sampling. Data was collected through face-to-face interviews using the ESAS-r and the SF-36. Descriptive statistics (frequency, percentage, median, interquartile range) and inferential tests (chi-square, continuity correction, Fisher's exact test, and Spearman's rank correlation) were applied, with significance set at P < 0.05.ResultsThe median age was 55.5 years (IQR 40-57.5), and 56.7% were male. Nearly 30% had chronic kidney disease, and 62.8% had comorbidities. Median duration since diagnosis was 2 years (IQR 1-2). Overall, 92.1% reported high symptom burden (median 50.5; IQR 40-57.5), 95% CI [48.00-53.00], with fatigue the most severe symptom (68.3%). Poor HRQoL was reported by 65.9% (median 44.29; IQR 33.63-55.50; 95% CI [39.75-47.25]). Among heart failure patients, 57.1% experienced severe symptoms, and all reported diminished HRQoL. Symptom burden was significantly associated with comorbidities and hospital admissions (P < 0.05). HRQoL was significantly associated with sex, education, employment, marital status, family type, disease duration, and comorbidities (P < 0.05). A strong negative correlation was found between symptom burden and HRQoL (r_s= -0.620, 95% CI [-0.941 to -0.641], P < 0.001).ConclusionPatients with diverse chronic illnesses experience substantial symptom burden strongly related to reduced HRQoL, which is hypothesis-generating rather than causal. This underscores the need for routine assessment, referral for symptom management, and integrated palliative care.