Multidisciplinary Palliative Care and Its Impact on Symptom Burden and Quality of Life in Advanced Cancer Patients in Ethiopia: A Pre–Post Quasi-Experimental Study

Abstract

Purpose: This study implemented a multidisciplinary team (MDT) palliative care and assessed its impact on symptom burden and health-related quality of life (HRQoL) among patients with advanced-stage cancer at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methods: This non-randomized pre–post quasi-experimental study (without a concurrent control group) enrolled 192 adult patients with cancer. The intervention was the introduction of MDT palliative care delivered by palliative-care–trained healthcare professionals. Outcomes were assessed before and after MDT implementation using the African Palliative Outcome Scale (APCA POS), EQ-5D-5L (Ethiopian value set) with EQ-VAS, and EORTC QLQ-C15-PAL. Within-patient changes were evaluated in the matched alive cohort (n=167) using paired-sample t-tests, with effect sizes quantified using Cohen’s d. Factors associated with changes in HRQoL were examined using ANCOVA-of-change linear regression. Results: All APCA POS domains, except social/communication, improved significantly, and the overall patient score decreased by 3.71 points (Cohen’s d = − 0.662, p < 0.001). The EQ-5D-5L utility index score increased by 0. 0.286 (Cohen’s d=0.668, p < 0.001). The EORTC global HRQoL increased by 14.62 points (Cohen’s d = 0.909, p < 0.001), exceeding the conventional 10-point minimal clinically important difference. In the multivariable model, each one-level reduction in patient-rated pain severity was associated with a 4.22-point gain in HRQoL ( p < 0.001), and approximately 31.2% of marginal HRQoL improvement was associated with concurrent pain reduction. Patients with a poor performance status (ECOG 2– 4) showed greater HRQoL improvement than those with a better performance status (β = 2.81, p =0.031). Conclusion: MDT palliative care was associated with clinically meaningful improvements in symptom burden and HRQoL, with the largest gains observed in patients with the greatest symptom burden at baseline. To maximize the population-level impact, ensuring the integration of MDT palliative care into Ethiopia’s national cancer and palliative care strategies is recommended. Keywords: cancer, ethiopia, low-income countries, palliative care, multidisciplinary team, symptom burden, quality of life