Background: Outpatient palliative care effectively alleviates symptom burden in advanced
cancer patients, yet data from Central-Eastern Europe remain scarce. This retrospective
study examined changes in revised Edmonton Symptom Assessment Scale (ESAS) scores
from initial outpatient palliative consultation to first follow-up in Hungarian cancer
patients, assessing clinically meaningful improvement and inter-symptom associations.
Methods: Revised ESAS scores from 119 patients attending an outpatient palliative
care clinic (2017-2020) were analyzed using paired baseline and first follow-up assessments
(7-30 days). Symptom changes (Time 2-Time 1) were evaluated using Wilcoxon signed-rank
tests. Clinically meaningful improvement was assessed with minimal clinically important
difference thresholds (0.5× baseline SD). Sankey diagrams visualized symptom transitions,
and multivariable linear regression examined inter-symptom associations. Results:
Baseline pain was highest (mean 6.29, median 7), followed by fatigue, sleep disorder,
and impaired well-being. At follow-up, significant reductions were observed in pain
(mean 4.52, p = 0.001), nausea, dyspnea, constipation, sleep disorder, depression,
and anxiety (all p < 0.05). Sankey diagrams showed shifts from severe to mild/moderate
pain (50% to 24%) and constipation. Clinically meaningful improvement occurred in
pain, nausea, and constipation, with 59-65% achieving ≥1-point pain reduction. Regression
analyses showed that pain reduction was associated with concurrent improvements in
sleep disorder (β = 0.31), depression (β = 0.20), fatigue (β = 0.20), and anxiety
(β = 0.14), while dyspnea reduction was associated with concurrent improvements in
depression (β = 0.22) and anxiety (β = 0.14). Conclusions: Outpatient palliative care
in Hungarian cancer patients resulted in clinically meaningful symptom reductions,
particularly pain and dyspnea. Improvements in these core symptoms were associated
with concurrent improvements in other symptom domains, underscoring the clinical relevance
of inter-symptom associations and supporting early, integrated outpatient palliative
care and symptom cluster-based management.
