Which symptoms and problems do advanced cancer patients admitted to specialized palliative care report in addition to those included in the EORTC QLQ-C15-PAL? A register-based national study

  • Leslye Rojas-ConchaEmail author
  • Maiken Bang Hansen
  • Morten Aagaard Petersen
  • Mogens Groenvold
Original Article



Patients in palliative care are willing to answer short questionnaires, like the EORTC QLQ-C15-PAL; however, patients may suffer from other symptoms and problems (S/Ps) not covered by such questionnaires. Therefore, to identify which other S/Ps patients experience, in addition to those already included in the EORTC QLQ-C15-PAL, we developed a brief instrument to supplement this questionnaire named WISP (Write In three Symptoms/Problems), permitting patients to report 1–3 additional S/Ps and their severity. We aim to investigate the nature, prevalence, and severity of S/Ps reported on WISP.


A register-based study with data obtained from the Danish Palliative Care Database. This study included adults with advanced cancer admitted to specialized palliative care in Denmark, who reported S/Ps on WISP. S/Ps were categorized qualitatively, and their prevalence and severity were calculated.


Of the 5447 patients who completed the EORTC QLQ-C15-PAL, 1788 (32.8%) reported at least one symptom/problem using WISP. In total, 2796 S/Ps were reported; 24.8% were already covered by EORTC QLQ-C15-PAL; 63.6% were new, 10.1% were diagnoses and 1.6% could not be coded. S/Ps already covered and new were grouped into 61 categories. The most prevalent S/Ps reported were (in decreasing order) pain, edema, dizziness, impaired physical or emotional function, cough, and sweats. Overall, 85% of the S/Ps were rated as moderate to severe.


The WISP instrument strongly improves the recognition of S/Ps by combining standardization with individualization. We recommend its use for comprehensive symptom assessment alongside the EORTC QLQ-C15-PAL, and potentially also alongside the EORTC QLQ-C30.


EORTC QLQ-C15-PAL Advanced cancer Palliative care Symptom assessment Prevalence 


Compliance with ethical standards

Conflict of interest

The authors declared that they have no conflict of interest.

Ethical approval

This study was based only on registers from the Danish Palliative Care Database requested through the Danish Clinical Registries - RKKP; therefore, it had not impact on any individual’s care and not required Scientific Ethics Committee approval according to Danish law. The study was conducted following the approval from the Danish Data Protection Agency ( 2012-58-0004/local BFH-2017-064 I-Suite no. 05590).


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.The Research Unit, Department of Palliative Medicine, Bispebjerg HospitalCopenhagen University HospitalCopenhagenDenmark
  2. 2.Department of Public HealthUniversity of CopenhagenCopenhagenDenmark

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