Distinctive trajectories of symptom burden, activities of daily living, and self-efficacy among patients with advanced cancer receiving care in an acute palliative care unit: a pilot longitudinal study.

PURPOSE: Patients with advanced cancer experience progressive deterioration in symptom burden, activities of daily living (ADLs), and self-efficacy as they approach the end of life. This pilot longitudinal study aimed to examine the trajectories of these indicators in a palliative care setting and to identify factors associated with survival time.

METHODS

We conducted a prospective observational study of 70 patients with advanced cancer admitted to an acute palliative care unit (APCU) between November 2019 and March 2022. Outcomes included symptom burden, ADLs, and self-efficacy. Scores were reported by the patients or providers during admissions or ambulatory visits. Generalized linear mixed models and generalized additive models were used to analyze trajectories. Multiple regression was used to identify factors associated with time until death.

RESULTS

A total of 227 assessments were performed. Symptom burden followed a U-shaped trajectory, with temporary relief followed by deterioration. ADLs and symptom coping efficacy (SCE) showed a cubic curve pattern, with a stable phase between 15 and 7 weeks. A delayed decline in SCE was observed after symptom worsening. SOB was the only significant predictor of weeks to death (standardized β = -0.251).

CONCLUSION

Distinctive trajectories were observed in symptom burden, ADLs, and self-efficacy, including a temporary stable phase and a delayed decline in SCE. These findings suggest that behavioral support in the APCU may help maintain patient functioning and guide timely care transitions.