The burden of symptoms at the end of life of COVID-19 patients and helpful treatments

COVID-19 patients may show symptoms such as breathlessness or delirium at the end of life. The goal of palliative medicine is to relieve such symptoms with specific treatments. Treatments can be drugs, for example opioids, or non-drugs, such as breathing techniques or relaxation. 

What was the aim of our review?

To explore how well different interventions (drugs and non-drugs) work for the treatment of palliative symptoms in COVID-19 patients at the end of life. We included patients of all ages and with all comorbidities (additional medical conditions). 

What type of studies did we search for?

We searched selected medical databases and trial registries until 23 March 2021. We included studies looking at how well different palliative treatments work to relieve COVID-19-associated symptoms at the end of life. We wanted to compare studies investigating different medicines or therapies, but we only found studies without a comparison group. Only one study reported the specific drugs used for individual symptoms.

Key results

We found four studies that were published in five papers. Individual papers included between 61 and 2105 participants, and two papers partially reported on the same participants. All of the included studies investigated different drug treatments for palliative symptom management in people with COVID-19.

Drugs for symptom control at the end of life

All of the included studies reported on the effectiveness of palliative care for symptom relief. In all studies, clinicians or nursing staff rated symptom relief rather than the patients themselves. Since the quality of the evidence was very low, we do not know the true effect of drug treatments on symptom relief and have very low confidence in the results of the studies. We did not find any data on quality of life; symptom burden; satisfaction of patients, caregivers, and relatives; or safety of the drug treatments.

Non-drug therapies for symptom control at the end of life

We did not find any data on the benefits and harms of non-drug therapies for symptom control of COVID-19 patients at the end of life.

Conclusions

Based on our findings, we could not draw any conclusions on palliative symptom control of people with COVID-19. Future studies need to be designed better so that we can determine which treatments work for symptom control in people with COVID-19.

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