Palliative care in pancreatic cancer: effects on symptom burden, survival, and place of death.

[BACKGROUND] Pancreatic cancer is often diagnosed at advanced stages with limited treatment options. Although palliative care (PC) improves symptom control and end-of-life outcomes, referrals are frequently delayed. We evaluated changes in symptom intensity and analyzed survival and place of death among patients referred to PC.

[METHODS] We conducted a retrospective study of adults diagnosed with pancreatic cancer between 2011 and 2024 at a tertiary care hospital. Patients were grouped by referral to PC. Data were extracted from electronic records. Symptom intensity was assessed using the Edmonton Symptom Assessment System (ESAS) at the first and second PC visits. Survival was analyzed with Kaplan-Meier curves, and alluvial plots illustrated changes in symptom burden.

[RESULTS] Among 489 patients (median age 67), 69.5% were referred to PC. Only 8.8% had resectable tumors, and 49.7% had metastases, more common in the PC group (54.7% vs. 14.8%; p < 0.001). Pain and fatigue were the most intense symptoms at admission. Anxiety, depression, and nausea demonstrated a significant improvement in intensity at the second PC assessment. In locally advanced unresectable cancer, PC referral was associated with longer survival (188 vs. 58 days; p = 0.022). Patients receiving PC more often died at home (80.2% vs. 25.0%; p < 0.001).

[CONCLUSION] Our findings demonstrate a reduction in symptom intensity-particularly pain and fatigue-after PC admission. Patients referred to PC were more likely to have advanced, unresectable disease. These results underscore the need to integrate PC earlier in the treatment course to provide more comprehensive, individualized, and compassionate care.