Symptom burden assessment with the Edmonton Symptom Assessment System (ESAS) has been widely studied among patients in outpatient palliative care (OPC), but fewer reports in home-based palliative care (HBPC), and none has assessed the prognostic value of ESAS scores in HBPC. This retrospective cohort study compares symptom burden and its prognostic value in adult patients receiving OPC and HBPC services between January 1, 2019, and June 30, 2021. Patients completed the ESAS at the first OPC consultation ( = 4086) and at admission to HBPC ( = 4087). OPC patients were younger, more likely to have cancer, less likely to have had a recent hospitalization, and had higher adjusted median ESAS scores (28.1 vs. 22.9) compared with HBPC patients (all < 0.001). ESAS was prognostic of survival in both settings (Hazard ratio 1.18-1.64, < 0.01). Symptom burden is an independent prognosticator of survival in HBPC and OPC in this community-based setting.
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