Symptoms and survival in patients with advanced disease.

Predicting survival in patients with advanced disease is challenging for health care providers. Accurate survival estimation using symptom assessment may assist physicians and patients in determining treatment options. This report analyzes prospective studies in adult patients with a median/mean survival of 6 months or less and identifies symptoms that are associated with decreased survival. To be included in this analysis, a study needed to have at least one symptom associated with decreased survival in a univariate or multivariate analysis. Twenty-two studies were identified and 15 symptoms were associated with decreased survival. Anorexia, delirium, and dyspnea were associated with decreased survival in most studies. Delirium and anorexia (but not dyspnea) were associated with decreased survival in most studies that included patients with a median survival of 30 days or less. More research is needed to investigate any associations between symptom characteristics and survival in patients with advanced disease. Short assessment tools using symptoms identified in this report, with a focus on symptoms that were found in multiple studies, need to be developed to better predict survival and guide patient treatment.