Prospective symptom burden assessment in patients with cancer and non-cancer advanced diseases

The November 2025 issue of Annals of Palliative Medicine featured 4 Editorials, 3 Original Articles, 1 Study Protocol Article, 3 Review Articles, 1 Case Report, and 1 Editorial Commentary. That issue also features articles on the most downloaded articles published in Annals of Palliative Medicine in 2024 and the top reviewers for the journal in 2024, each of which are worthy of special highlighting. This Message From the Editor-in-Chief focuses on one of the Original Articles.

Cotogni and colleagues from Molinette Hospital and University of Turin and Martini Hospital in Turin, Italy assess symptom prevalence in palliative care patients admitted to the emergency department, and they compare differences in those symptoms between patients with cancer and non-cancer illness (1).

Patients with advanced illnesses or chronic medical conditions often present to the emergency department with acute or worsening symptoms and have high rates of hospitalizations (2,3). Such symptom burdens, along with resulting need for emergency department care, often increase in frequency and intensity during the final year of life (4). While symptom burdens of patients with cancer and patients with other non-cancer related illnesses have previously been reported, this analysis is unique in comparing symptom prevalence in patients awaiting hospitalization after emergency department admission who are referred to the hospital palliative care service. Additionally, many prior studies combining patients with and without cancer have focused on pain burden, but less is known on other commonly encountered symptoms in patients with chronic illnesses, including fatigue, anorexia, dyspnea, depression, nausea, and anxiety (5,6).

Cotogni and colleagues prospectively assessed adult patients with serious illnesses over a 2-year period at a tertiary university hospital who were referred from the emergency department to the hospital palliative care service and had at least one symptom scored at least a 4 in a numeric rating scale (NRS) ranging from 0 to 10. The investigators assessed 13 symptoms across physical, psychological, and spiritual domains.

Among the 416 evaluable patients assessed, they were a median age of 74 years, and 34% had cancer and 66% had non-cancer illnesses with a cardiorespiratory preponderance. Across medical conditions, fatigue was the most reported symptom. Furthermore, most patients experienced multiple concurrent symptoms, with fatigue, dyspnea, pain, and appetite loss commonly co-associating in this patient cohort.

Patients with cancer more often reported 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) and vomiting (16% vs. 6%, P=0.004), and diarrhea (11% vs. 4%, P=0.01). In contrast, patients with non-cancer illnesses were more likely to report dyspnea (62% vs. 35%, P<0.001). Insomnia, constipation, drowsiness, anxiety, and depression were commonly seen across chronic conditions and did not significantly differ in frequency among those with or without cancer.

The authors should be commended for performing a novel prospective cohort study in a area with limited data to date. Their study builds on the retrospective findings previously reported in Annals in Palliative Medicine on symptom and need differences between cancer and non-cancer patients (7,8), and it provided more information in a prospective manner as to the symptoms faced by patients with cancer, while expanding the more limited literature on such symptoms and need for emergency department care in the non-cancer population. The differences in symptom burdens identified in this study can help to tailor emergency department symptom assessments and corresponding interventions. Additionally, the findings of Cotogni et al. highlight the importance of systematic symptom screening of patients in the emergency room to ensure early recognition of those with high symptom burdens, and the importance of early palliative care referral for those being admitted to optimize symptom management and potentially reduce future emergency department visits and hospitalizations. Better recognizing and managing symptoms is key to reducing emergency department visits and hospitalizations, as well as improving the quality of life for patients.

Acknowledgments

None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Palliative Medicine. The article did not undergo external peer review.

Funding: None.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://apm.amegroups.com/article/view/10.21037/apm-2026-01/coif). C.B.S. II serves as the co-Editor-in-Chief of Annals of Palliative Medicine from April 2014 to April 2027. The author has no other conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

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