Quantifying the Need for Specialist Palliative Care Management in Patients With Systemic Sclerosis

Abstract

ObjectiveThe importance of early integration of palliative care in the management of complex multi‐system diseases has been recognised. In this study, we aimed to quantify the need for specialist palliative care in systemic sclerosis (SSc).MethodsUsing data from 875 patients enrolled in the Australian Scleroderma Cohort Study, we defined need for palliative care as a high symptom burden at ≥2 consecutive study visits, ≥50% of overall study visits or at the study visit immediately prior to death. Symptoms of interest included breathlessness, fatigue, pain, depression, anxiety, constipation, and diarrhoea. Logistic regression analyses evaluated the association between individual symptoms and SSc manifestations. Linear regression analysis evaluated the relationship between palliative care needs and quality of life (QoL) and function.ResultsAlmost three‐quarters (72.69%) of patients met the threshold for specialist palliative care needs. Severe fatigue (54.17%) was most common, followed by breathlessness (23.66%) and severe constipation (21.14%). Concurrent severe symptoms were frequently observed. Severe breathlessness (coef ‐7.95, p<0.01) and pain (coef ‐7.70, p<0.01) were associated with the largest reductions in physical QoL. Severe mood symptoms were associated with the greatest reduction in mental QoL (coef ‐12.91, p<0.01). Severe pain (coef 0.56, p<0.01), breathlessness (coef 0.49, p<0.01) and mood symptoms (coef 0.40, p<0.01) had a significant impact on function.ConclusionSSc is frequently associated with multiple severe symptoms that may be amenable to palliative care intervention. Given the strong association between symptom burden and impaired QoL targeted, effective symptom management in parallel with standard‐of‐care treatments may improve overall patient outcomes.