Early symptom signals preceding end-of-life decline in outpatient palliative oncology.

Abstract

12053 Background: Timely recognition of clinical decline is challenging in palliative oncology. Symptom trajectories that precede global deterioration are unclear. We aimed to characterize longitudinal changes in total and domain-specific Integrated Palliative Outcome Scale (IPOS) scores and identify early indicators of decline in outpatient palliative oncology care (OPOC). Methods: We conducted a longitudinal study within an OPOC embedded in Brazil. Adults with advanced cancer enrolled for ≥6 months were included. IPOS was assessed at baseline, 3 months, 6 months, and the month of death. Paired comparisons evaluated changes in total IPOS scores and individual domains between baseline-3 months and 6 months-month of death. Clinically relevant decline was defined as worsening between 6 months and death. Logistic regression examined associations between IPOS decline, chemotherapy use near death, and place of death. Results: Among 126 patients (mean age 64.1 [SD 14.4]; 62.7% women), gastrointestinal (33.3%), breast (19.8%), and lung cancers (11.1%) were most common. At program entry, mean PPS was 65 (SD 13.5). Total IPOS scores improved from baseline to 3 months (mean difference 2.69, p=0.007). However, a marked deterioration occurred between 6 months and the month of death (mean difference -3.98, p<0.001). Domain-level analyses demonstrated early improvement in appetite loss (mean 1.56 to 1.28, p=0.020) and weakness (1.91 to 1.64, p=0.034) from baseline to 3 months, followed by significant worsening as death approached (appetite: 1.42 to 1.75, p=0.006; weakness: 1.94 to 2.25, p=0.003). Anxiety increased significantly between 6 months and the month of death (1.99 to 2.23, p=0.008), whereas pain and depressive symptoms remained relatively stable over time. Neither chemotherapy use in the last 30 days of life (OR 0.78, p=0.58) nor place of death (OR 0.56, p=0.21) was associated with clinically relevant IPOS decline. Conclusions: OPOC is associated with early symptom stabilization, followed by a predictable phase of accelerated deterioration near death. Appetite loss and weakness emerge as early and clinically meaningful indicators of decline within the terminal trajectory, independent of treatment or place of death. Routine longitudinal IPOS monitoring may facilitate earlier recognition of impending decline and support more proactive, patient-centered palliative care.