{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:14:05Z","timestamp":1771373645466,"version":"3.50.1"},"reference-count":14,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T00:00:00Z","timestamp":1747612800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objective: Survival prediction in the advanced cancer care setting plays a vital role in treatment planning and patients\u2019 arrangements. The aim of this study was to examine the association of the global Edmonton Symptom Assessment System (GESAS) and Karnofsky scale (KPS) with overall survival (OS) in patients with advanced cancers admitted to an acute palliative care unit (APCU). The second aim was to assess if GESAS changes after comprehensive palliative treatment could influence OS. Methods: This is a prospective planned sub-analysis of advanced cancer patients. A consecutive sample of 521 patients admitted to an APCU. Patients with available survival in follow-up phone calls, having complete ESAS, and discharged alive were selected. KPS and GESAS were measured at admission and after seven days of individual comprehensive palliative care. Results: Two hundred forty-three of 521 screened patients were assessed according to inclusion criteria. The mean age was 67.1 years (SD 11.5), and 121 patients were male. The mean KPS was 43.5 (SD 9.3). The mean OS was 74.6 (SD 136.2) days. Significant changes in GESAS were observed after one week. Univariate linear regression analysis showed that KPS and GESAS at T0 and at T7 were correlated with OS (p &lt; 0.0005; p = 0.020; p &lt; 0.0005, respectively). At multivariate analysis, OS was correlated with KPS and GESAS at discharge (B = 3.349, 95% CI = 1.560\u20135.137; B = \u22122.430, 95% CI = \u22123.831\u2013\u22121.029). Discussion: KPS and poor response to intensive treatment, maintaining high GESAS scores, can be considered predictive factors of shorter OS. Further studies should confirm whether a specialized intervention in other settings can improve OS.<\/jats:p>","DOI":"10.3390\/cancers17101704","type":"journal-article","created":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T11:54:26Z","timestamp":1747655666000},"page":"1704","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Symptom Burden Poorly Responsive to Palliative Care Intervention and Karnofsky Predict Survival in an Acute Palliative Care Unit"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9859-6487","authenticated-orcid":false,"given":"Sebastiano","family":"Mercadante","sequence":"first","affiliation":[{"name":"Main Regional Center of Pain Relief and Supportive\/Palliative Care, La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasmine","family":"Grassi","sequence":"additional","affiliation":[{"name":"Main Regional Center of Pain Relief and Supportive\/Palliative Care, La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5581-4114","authenticated-orcid":false,"given":"Alessio","family":"Lo Cascio","sequence":"additional","affiliation":[{"name":"Main Regional Center of Pain Relief and Supportive\/Palliative Care, La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5676-9535","authenticated-orcid":false,"given":"Alessandra","family":"Casuccio","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1089\/jpm.2010.0438","article-title":"Edmonton symptom assessment scale as a prognosticative indicator in patients with advanced cancer","volume":"14","author":"Zeng","year":"2011","journal-title":"J. Palliat. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e2117295","DOI":"10.1001\/jamanetworkopen.2021.17295","article-title":"Association of Edmonton Symptom Assessment System Global Distress Score with Overall Survival in Patients with Advanced Cancer","volume":"4","author":"Subbiah","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e1256","DOI":"10.1136\/spcare-2022-003562","article-title":"Performance status and survival in cancer patients undergoing palliative care: Retrospective study","volume":"14","author":"Bruera","year":"2024","journal-title":"BMJ Support. Palliat. Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e70","DOI":"10.1016\/j.jpainsymman.2024.10.010","article-title":"Should an Acute Palliative Care Unit be Mandatory for Cancer Centers and Tertiary Care Hospitals?","volume":"69","author":"Mercadante","year":"2025","journal-title":"J. Pain Symptom. Manag."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1016\/j.jpainsymman.2016.10.370","article-title":"The Edmonton Symptom Assessment System 25 Years Later: Past, Present, and Future Developments","volume":"53","author":"Hui","year":"2017","journal-title":"J. Pain Symptom. Manag."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e319","DOI":"10.3747\/co.25.3935","article-title":"Baseline Edmonton Symptom Assessment System and survival in metastatic renal cell carcinoma","volume":"25","author":"Graham","year":"2018","journal-title":"Curr. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e91","DOI":"10.1016\/j.cllc.2017.05.018","article-title":"The Impact of Baseline Edmonton Symptom Assessment Scale Scores on Treatment and Survival in Patients with Advanced Non-small-cell Lung Cancer","volume":"19","author":"Zhang","year":"2018","journal-title":"Clin. Lung. Cancer"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"7107","DOI":"10.1002\/cam4.3374","article-title":"The impact of routine Edmonton symptom assessment system (ESAs) use on overall survival in cancer patients: Results of a population-based retrospective matched cohort analysis","volume":"9","author":"Barbera","year":"2020","journal-title":"Cancer Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.jval.2020.10.017","article-title":"Patient-Reported outcomes as independent prognostic factors for survival in oncology: Systematic review and meta-analysis","volume":"24","author":"Efficace","year":"2021","journal-title":"Value Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e735","DOI":"10.1136\/bmjspcare-2022-003572","article-title":"Edmonton symptom assessment system global distress score and overall survival among patients with advanced cancer receiving early palliative care","volume":"13","author":"Bandieri","year":"2024","journal-title":"BMJ Support. Palliat. Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1001\/jama.2017.7156","article-title":"Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment","volume":"318","author":"Basch","year":"2017","journal-title":"JAMA"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Mercadante, S., Adile, C., Caruselli, A., Ferrera, F., Costanzi, A., Marchetti, P., and Casuccio, C. (2016). The Palliative-Supportive Care Unit in a Comprehensive Cancer Center as Crossroad for Patients\u2019 Oncological Pathway. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0157300"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e1661","DOI":"10.1200\/OP.22.00163","article-title":"Clinical Outcomes of Operating an Acute Palliative Care Unit at a Comprehensive Cancer Center","volume":"18","author":"Jung","year":"2022","journal-title":"JCO Oncol. Pract."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1177\/107327481502200415","article-title":"Prognostication of Survival in Patients with Advanced Cancer: Predicting the Unpredictable?","volume":"22","author":"Hui","year":"2015","journal-title":"Cancer Control"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/10\/1704\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:35:19Z","timestamp":1760031319000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/10\/1704"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,19]]},"references-count":14,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["cancers17101704"],"URL":"https:\/\/doi.org\/10.3390\/cancers17101704","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,19]]}}}