Survival Time Difference Between High and Low Symptom Burden Considering Physical and Emotional Symptoms Among...

Although symptom assessment is fundamental to palliative care, its independent impact on survival remains unclear. This study addresses survival time differences between high and low symptom burden, assessed using the Edmonton Symptom Assessment System (ESAS), among terminal cancer patients (PPS ≤ 30) at Naresuan University Hospital.

A bidirectional observational cohort study was conducted from October 1, 2019, to January 31, 2024. Patients were categorized into high or low symptom distress groups based on ESAS physical, emotional, and total symptom scores. Multivariable models adjusted for age, sex, BMI, Charlson Comorbidity Index, and metastatic sites. Survival impact was quantified using restricted mean survival time (RMST) and hazard ratios (HR).

A total of 143 terminal cancer patients were included; 76 were males (53.15%) and the average age was 66.17 ± 12.11 years. HRs for high physical, emotional, and total symptom distress scores (TSDS) were 1.50 (95% CI: 1.02-2.20), 1.02 (95% CI: 0.64-1.63), and 1.34 (95% CI: 0.91-1.97), respectively. Only the physical domain remained significant after adjustment. RMST demonstrated that patients with high physical burden experienced a significant survival reduction of 3.70 days (95% CI: -7.17 to -0.23) within a 28-day follow-up period.

High physical symptom burden is significantly associated with shorter survival in terminal cancer patients. These findings highlight the prognostic importance of physical symptoms, emphasizing the need for effective symptom management to optimize remaining survival time.