title: Symptom Burden and Performance Status among Community-Dwelling Patients with Serious Illness.
abstract: BACKGROUND
  Predicting when burdensome symptoms will arise or worsen is important to preserving quality of life in patients with serious illness.
  
  
  OBJECTIVE
  We explored the relationship between prevalence and severity of symptoms and underlying performance status.
  
  
  METHODS
  We performed a retrospective cohort analysis of patients receiving community palliative care, investigating relationships between symptom burden and performance status. Patient data were obtained from the Carolinas Palliative Care Consortium Database, a central registry of community consultation data for research and quality improvement. We measured symptom prevalence and severity using the McCorkle Symptom Distress Scale and performance status using the Palliative Performance Scale.
  
  
  RESULTS
  We analyzed data of 4994 patients, most (90%) with noncancer, serious illnesses. Thirty percent had one or more moderate/severe symptoms. In addition to identifying the high prevalence of fatigue and pain, we found distinct groupings of symptoms with high burden associated with different levels of performance status. This includes high prevalence of fatigue, anorexia, and dyspnea in patients with high performance. Patients with low performance status, however, reported more pain, depression, and constipation.
  
  
  CONCLUSIONS
  Bothersome symptoms change as patients' performance status worsens. Using performance status as a common language, both medical professionals and informal caregivers can monitor impending changes in symptom burden. This should inform development of community-based delivery systems to detect and manage distress in patients with palliative care needs.
authors: 1Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina.
authors: Arif H
authors: AH
authors: Kamal
authors: 2Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
authors: Ryan D
authors: RD
authors: Nipp
authors: 3Four Seasons, Flat Rock, North Carolina.
authors: Janet
authors: J
authors: Bull
authors: 4Novant Health, Forsyth Medical Center Palliative Care, Winston-Salem, North Carolina.
authors: Charles S
authors: CS
authors: Stinson
authors: 1Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina.
authors: Amy P
authors: AP
authors: Abernethy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000855:Anorexia / Q000453:epidemiology; D003248:Constipation / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D004417:Dyspnea / Q000453:epidemiology; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000453:epidemiology; D010147:Pain Measurement; D010166:Palliative Care; D015995:Prevalence; D011788:Quality of Life; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D063189:Symptom Assessment