Symptom Management and Support in Dying Patients with Cancer and Coronavirus Disease-19-A Register-Based Study

J Palliat Care. 2023 Jul;38(3):261-267. doi: 10.1177/08258597231157622. Epub 2023 Feb 15.


Objective: Little is known to what extent access to specialist palliative care (SPC) for cancer patients dying with coronavirus disease-2019 (COVID-19) affects the occurrence of breakthrough symptoms, symptom relief, and overall care, compared to hospital deaths. Our aim was to include patients with both COVID-19 and cancer and compare those dying in hospitals with those dying in SPC with reference to the quality of end-of-life care.

Methods: Patients with both cancer and COVID-19 who died in hospitals (n = 430) and within SPC (n = 384) were identified from the Swedish Register of Palliative Care. The hospital and SPC groups were compared regarding the quality of end-of-life care, including the occurrence of 6 breakthrough symptoms during the last week in life, symptom relief, end-of-life care decisions, information, support, and human presence at death.

Results: Breakthrough of breathlessness was more common in the hospital patients compared to the SPC patients (61% and 39%, respectively; p < .001), while pain was less common (65% and 78%, respectively; p < .001). Breakthrough of nausea, anxiety, respiratory secretions, or confusion did not differ. All 6 symptoms, except for confusion, were more often completely relieved in SPC (p = .014 to p < .001 in different comparisons). In SPC, a documented decision about the goal being end-of-life care and information about this were more common than in hospitals (p < .001). Also, to have family members present at the time of death and for family members to be offered a follow-up talk afterward was more common in SPC (p < .001).

Conclusion: More systematic palliative care routines may be an important factor for better symptom control and higher quality of end-of-life care in hospitals.

Keywords: COVID-19; cancer; end-of-life care; hospital care; palliative care; symptoms.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • COVID-19* / complications
  • COVID-19* / mortality
  • COVID-19* / therapy
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Neoplasms* / complications
  • Neoplasms* / mortality
  • Neoplasms* / therapy
  • Palliative Care*
  • Quality of Health Care*
  • Registries
  • Specialization
  • Sweden / epidemiology
  • Terminal Care*