Annals of palliative medicine · 2025
Symptom prevalence in palliative care patients admitted to the emergency department: are there differences between patients with cancer and non-cancer illness?
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Cotogni Paolo, Costantini Elisa, Macchi Giorgia, Scarmozzino Antonio
Аннотация
BACKGROUND: The rising prevalence of serious illnesses has increased the demand for emergency department (ED) services. Patients with advanced chronic conditions frequently present to the ED with distressing symptoms. Although symptom prevalence has been well described in oncology populations, fewer studies have assessed non-cancer illnesses, particularly in the ED. This study aimed to compare symptom prevalence in patients with cancer and non-cancer illness awaiting hospitalization after ED admission and referred to the hospital palliative care (PC) team.
METHODS: We conducted a prospective, observational, cohort study over 2 years [2023-2024] at a tertiary university hospital. Adults with serious illness referred from the ED to the hospital PC team were eligible if they had ≥1 symptom scoring ≥4 in a numeric rating scale (NRS) ranging from 0 to 10. Thirteen symptoms were evaluated, encompassing physical, psychological, and spiritual domains. Prevalence was analyzed descriptively and compared between cancer and non-cancer groups using Fisher's exact test.
RESULTS: Among 542 patients screened, 416 met eligibility criteria: 141 (34%) with cancer and 275 (66%) with non-cancer illness. Nearly all patients reported at least one symptom ≥4. Compared to non-cancer patients, those with cancer more often experienced pain (49% vs. 31%, P<0.001), fatigue (84% vs. 75%, P=0.02), appetite loss (54% vs. 32%, P<0.001), nausea (22% vs. 13%, P=0.02), vomiting (16% vs. 6%, P=0.004), and diarrhea (11% vs. 4%, P=0.01). In contrast, dyspnea was significantly higher in non-cancer illness (62% vs. 35%, P<0.001). Several symptoms were common in both groups without significant differences.
CONCLUSIONS: This study shows that seriously ill patients presenting to the ED experience substantial symptom burden, but with distinct profiles between cancer and non-cancer conditions. In this sample, pain, fatigue, and gastrointestinal symptoms predominate in cancer, while dyspnea characterizes non-cancer illness. These findings underscore the need for systematic symptom screening and early PC referral in the ED to ensure equitable, timely, and effective symptom relief across all serious illnesses.
METHODS: We conducted a prospective, observational, cohort study over 2 years [2023-2024] at a tertiary university hospital. Adults with serious illness referred from the ED to the hospital PC team were eligible if they had ≥1 symptom scoring ≥4 in a numeric rating scale (NRS) ranging from 0 to 10. Thirteen symptoms were evaluated, encompassing physical, psychological, and spiritual domains. Prevalence was analyzed descriptively and compared between cancer and non-cancer groups using Fisher's exact test.
RESULTS: Among 542 patients screened, 416 met eligibility criteria: 141 (34%) with cancer and 275 (66%) with non-cancer illness. Nearly all patients reported at least one symptom ≥4. Compared to non-cancer patients, those with cancer more often experienced pain (49% vs. 31%, P<0.001), fatigue (84% vs. 75%, P=0.02), appetite loss (54% vs. 32%, P<0.001), nausea (22% vs. 13%, P=0.02), vomiting (16% vs. 6%, P=0.004), and diarrhea (11% vs. 4%, P=0.01). In contrast, dyspnea was significantly higher in non-cancer illness (62% vs. 35%, P<0.001). Several symptoms were common in both groups without significant differences.
CONCLUSIONS: This study shows that seriously ill patients presenting to the ED experience substantial symptom burden, but with distinct profiles between cancer and non-cancer conditions. In this sample, pain, fatigue, and gastrointestinal symptoms predominate in cancer, while dyspnea characterizes non-cancer illness. These findings underscore the need for systematic symptom screening and early PC referral in the ED to ensure equitable, timely, and effective symptom relief across all serious illnesses.