Impact of nurse-led supportive care intensity on quality of life and symptom burden in patients undergoing palliative chemotherapy: A prospective cohort study

Nurse-led supportive care is integral to palliative oncology, yet the intensity of nursing contact is rarely quantified, and its clinical relevance remains incompletely defined. We prospectively examined the association between supportive care intensity (SCI) and patient-reported outcomes and survival in patients receiving palliative chemotherapy. This prospective observational cohort study enrolled adults with advanced solid tumors undergoing palliative chemotherapy. All participants received routine physician-led oncology care and standard chemotherapy nursing, while additional supportive services were delivered according to usual clinical practice and were not protocolized as part of the study exposure. Patients were followed for 24 weeks for patient-reported outcomes, with survival follow-up until data lock. SCI was quantified based on the frequency and depth of nurse-delivered supportive care encounters, encompassing symptom assessment, patient education, coping support, self-management coaching, caregiver engagement, and remote follow-up. Outcomes included quality of life (European Organization for Research and Treatment of Cancer QLQ-C30), symptom burden, coping (Brief COPE), self-management capability, existential well-being, and overall survival. Linear mixed-effects models and Cox proportional hazards models were applied with adjustment for key clinical and demographic covariates. A total of 180 patients were included. Baseline demographic, clinical, and patient-reported characteristics were generally similar across SCI quartiles, although modest imbalance was observed in selected clinical variables, particularly Eastern Cooperative Oncology Group performance status. Higher SCI was associated with significantly greater improvements in global QOL over 24 weeks (P < .001), showing a graded association across SCI levels. Improvements were most pronounced in physical and role functioning, while fatigue, appetite loss, and constipation showed the largest symptom reductions. Higher SCI was associated with a greater likelihood of achieving a clinically meaningful ≥10-point improvement in global QOL (adjusted odds ration [OR] 1.46, 95% confidence interval [CI] 1.12-1.90), lower Edmonton Symptom Assessment System scores (β - 2.21, P < .001), more adaptive coping strategies, higher self-management capability (adjusted OR 1.82, P < .001), and better existential well-being. In exploratory survival analyses, higher SCI was associated with lower adjusted mortality risk (adjusted hazard ration [HR] 0.68, 95% CI 0.48-0.96), with a possible contact-frequency pattern observed for ≥8 nurse-led supportive care encounters (adjusted HR 0.61, P = .018). Within routine oncology care, greater intensity of nurse-led supportive care was associated with multidimensional improvements in QOL, symptom burden, coping, and self-management, and showed a favorable exploratory association with lower adjusted mortality risk.