Poor Appetite and Survival in Patients Admitted to an Acute Palliative Care Unit for Comprehensive Palliative Care

Loss of appetite is a common symptom in patients with advanced cancer, and may contribute to patient deterioration. There is a lack of information about this issue, particularly in patients with advanced cancer admitted to an acute palliative care unit. The aims of this study were to assess appetite loss in patients admitted to an APCU and to investigate whether changes following comprehensive palliative care treatment are associated with survival.

A consecutive sample of 520 patients admitted to the APCU was assessed. Patient characteristics and Edmonton Symptom Assessment Scale (ESAS) were measured at admission (T0) and after one week of comprehensive palliative care treatment (T7).

Of 381 patients screened, 208 (54.6%) had a poor appetite rating (≥4/10). Following comprehensive palliative care (T7), the number of patients with poor appetite significantly decreased to 116 (30%) (p < 0.0005). A multivariate regression analysis revealed that nausea (p = 0.002), weakness (p = 0.006), poor well-being (p = 0.017), and total ESAS score were correlated with poor appetite at T0. At T7, pain (p = 0.018), anxiety (p = 0.001), depression (p = 0.014), poor sleep (p = 0.047), drowsiness (p = 0.035), nausea (p = 0.018), weakness (p < 0.0005), poor well-being (p < 0.0005), and total ESAS score (p < 0.0005) were correlated with poor appetite. Survival was associated with a low Karnofsky (OR = 3.217(1.310-5.124), p = 0.001) and the presence of poor appetite at T7 (OR = -7.772(-14.662--882), p = 0.027).

A large proportion of patients admitted to an APCU present moderate-to-severe poor appetite. Clinical improvement of poor appetite is associated with improved survival.