Identification of patients with incurable cancer and palliative care needs by screening

The German S3 guideline on palliative care requires that symptoms and needs of patients with incurable cancerous diseases should be regularly assessed, irrespective of the tumor-specific treatment. Self-report questionnaires for palliative medicine are available for screening, such as the Edmonton Symptom Assessment Scale (ESAS), which is used in oncology centers in Canada in the context of a quality management initiative. Implemention of the ESAS as a screening method for patients with metastases in lung cancer centers, colorectal cancer centers, in centers for neuro-oncological cancer and in the skin cancer center at the Mainfranken Comprehensive Cancer Center. From a total of 839 patient sceened, 79.6 % patients reported at least 1 out of 10 symptoms with moderate or severe intensity (ESAS item score aeyen4), which indicates the need for a more detailed clinical assessment or intervention. The most prevalent symptoms were impairment of general well-being, fatigue and exhaustion, loss of appetite and dyspnea. Of the patients 40.4 % showed at least 1 symptom with severe intensity (ESAS score aeyen7) with an ensuing need for an intervention. A large proportion of patients reported a significant symptom burden. It should be further discussed whether clinical assessment and subsequent interventions can be provided by general palliative care teams and at what stage the inclusion of specialized teams is necessary.