Symptom Expression in the Last Seven Days of Life Among Cancer Patients Admitted to Acute Palliative Care Units

The symptom burden in the last week of life of patients with advanced cancer has not been well characterized. To examine the frequency, intensity, and predictors for symptoms in the last seven days of life among patients who were able to communicate and died in an acute palliative care unit (APCU)....

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Vydáno v:Journal of pain and symptom management Ročník 50; číslo 4; s. 488 - 494
Hlavní autoři: Hui, David, dos Santos, Renata, Chisholm, Gary B., Bruera, Eduardo
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States Elsevier Inc 01.10.2015
Témata:
Adolescent
Adult
Aged
Aged, 80 and over
Anesthesia
Anorexia
death
deglutition disorders
depression
Disease Progression
dyspnea
Female
Humans
Linear Models
Longitudinal Studies
Male
Middle Aged
neoplasms
Neoplasms - mortality
Neoplasms - physiopathology
Neoplasms - therapy
pain
Pain Medicine
Palliative Care
Severity of Illness Index
symptom assessment
Terminal Care
Time Factors
Treatment Outcome
urinary incontinence
Young Adult
symptom assessment
Anorexia
pain
death
dyspnea
depression
neoplasms
palliative care
urinary incontinence
deglutition disorders
ISSN:0885-3924, 1873-6513, 1873-6513
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Shrnutí:The symptom burden in the last week of life of patients with advanced cancer has not been well characterized. To examine the frequency, intensity, and predictors for symptoms in the last seven days of life among patients who were able to communicate and died in an acute palliative care unit (APCU). We systematically documented the Edmonton Symptom Assessment System (ESAS) daily and 15 symptoms twice daily on consecutive advanced cancer patients admitted to APCUs at MD Anderson Cancer Center (U.S.) and Barretos Cancer Hospital (Brazil) from admission to death or discharge in 2010/2011. We examined the frequency and intensity of the symptoms from death backward. A total of 203 of 357 patients died. The proportion of patients able to communicate decreased from 80% to 39% over the last seven days of life. ESAS anorexia (P = 0.001 in longitudinal analyses), drowsiness (P < 0.0001), fatigue (P < 0.0001), poor well-being (P = 0.01), and dyspnea (P < 0.0001) increased in intensity closer to death. In contrast, ESAS depression (P = 0.008) decreased over time. Dysphagia to solids (P = 0.01) and liquids (P = 0.005) as well as urinary incontinence (P = 0.0002) also were present in an increasing proportion of patients in the last few days of life. In multivariate analyses, female sex, non-Hispanic race, and lung cancer were significantly associated with higher ESAS symptom expression (odds ratio > 1). Despite intensive management in APCUs, some cancer patients continue to experience high symptom burden as they approached death.
Bibliografie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:0885-3924
1873-6513
1873-6513
DOI:10.1016/j.jpainsymman.2014.09.003