Frequently encountered symptoms in patients with an advanced serious and/or life-threatening illness include pain, dyspnea, fatigue, dry mouth, dysphagia and aspiration, loss of appetite and weight, nausea/vomiting, constipation, edema, depression, anxiety, demoralization, and delirium.

• Patient descriptions and symptom ratings are the primary data for overall assessment. The use of different dimensions (severity, frequency, distress, interference) may help when patients and families get stuck on trying to describe the impact of a symptom.
• The patient’s assessment of symptom relief is important and may differ from that of the health professional.
• Performance status is a key indicator of prognosis in individuals with advanced terminal disease and is associated with symptom severity. For patients with advanced, serious, life-threatening diseases, such as those referred to palliative care programs, the presence or absence of certain symptoms, particularly dyspnea, may help clinicians provide a more refined estimate of patient survival.
• A number of validated symptom assessment tools may be useful in palliative care settings, including those that evaluate multiple symptoms, such as the revised Edmonton Symptom Assessment Scale (ESAS) . Many symptom-specific tools are available, such as the Brief Pain Inventory (BPI). Multisymptom assessment tools definitely yield a higher number of symptoms, and they can be used as checklists.
• Physical examination and diagnostic investigations should not be performed on patients who are frail and at the end of life unless the result is expected to change management of a symptom complex.

Karnosfoky performance scale in palliative care

• 100 – Normal; no complaints; no evidence of disease.
• 90 – Able to carry on normal activity, minor signs or symptoms of disease.
• 80 – Normal activity with effort; some signs or symptoms of disease.
• 70 – Cares for self; unable to carry on normal activity or to do active work.
• 60 – Requires occasional assistance but is able to care for most of their personal needs.
• 50 – Requires considerable assistance and frequent medical care.
• 40 – Disabled; requires special care and assistance.
• 30 – Severely disabled; hospital admission is indicated although death not imminent.
• 20 – Very sick; hospital admission necessary; active supportive treatment necessary.
• 10 – Moribund; fatal processes progressing rapidly.
• 0 – Dead possibly

ECOG/WHO/Zubrod score for performance

The Eastern Cooperative Oncology Group (ECOG) score (published by Oken et al. in 1982), also called the WHO or Zubrod score (after C. Gordon Zubrod), runs from 0 to 5, with 0 denoting perfect health and 5 death: Its advantage over the Karnofsky scale lies in its simplicity.

• 0 – Asymptomatic (Fully active, able to carry on all predisease activities without restriction)
• 1 – Symptomatic but completely ambulatory (Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature. For example, light housework, office work)
• 2 – Symptomatic, <50% in bed during the day (Ambulatory and capable of all self care but unable to carry out any work activities. Up and about more than 50% of waking hours)
• 3 – Symptomatic, >50% in bed, but not bedbound (Capable of only limited self-care, confined to bed or chair 50% or more of waking hours)
• 4 – Bedbound (Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair)
• 5 – Death