Incidence and associated factors of sudden unexpected death in advanced cancer patients: A multicenter prospective cohort study

Abstract

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Exploring Risk Factors of Unexpected Death, Using Palliative Care Outcomes Collaboration (PCOC) Measures, among Terminal Patients Receiving Palliative Care in Taiwan

“…Our results were different from those reported by two previous studies that explored breathlessness as an associated factor for unexpected death [ 4 , 6 ]. However, our results revealed that patients experiencing shortness of breath were less likely to die unexpectedly.…”

“…The definition of unexpected death or sudden death among terminally ill patients is another important issue to be discussed. Multiple studies have researched the associated factors surrounding unexpected death [ 4 , 6 ]. Although PCOC is commonly utilized in palliative care services in Australia, Ireland, and Taiwan [ 33 ], few studies have used PCOC data.…”

“…However, any sudden or unexpected death may still occur in palliative care settings, where an unexpected death refers to one which happened earlier than what was anticipated by the physician. From a previous study, sudden unexpected death occurs in a range of 6.4% to 16.8% in inpatient palliative care units [ 4 ]. Unexpected death disallows patients the opportunity to spend their remaining time as planned, while also causing significant and complicated grief to bereaved caregivers [ 5 ].…”

“…Unexpected death disallows patients the opportunity to spend their remaining time as planned, while also causing significant and complicated grief to bereaved caregivers [ 5 ]. In recent studies, associated factors surrounding sudden death included male gender, older age, lung cancer, cancer with liver metastasis, malignant skin lesions, and symptoms of dyspnea and fatigue [ 4 , 6 ]. However, the associated factors regarding the unexpected death of patients receiving assistance from multiple palliative care services were never explored.…”

Prognostication of the Last Days of Life

“…So far, four major definitions of sudden unexpected death have been utilized in the palliative care literature: rapid decline death (i.e., a sudden death preceded by functional decline over 1–2 days) [ 46 ], surprise death (i.e., the primary responsible physicians answered “yes” to the question, “Were you surprised by the timing of death?”) [ 9 ], unexpected death (i.e., a death that occurred earlier than the physician had anticipated) [ 9 ], and performance status–defined sudden death (i.e., a death that occurred within 1 week of functional status assessment with an Australia-modified Karnofsky performance status ≥ 50) [ 47 ]. Using these four definitions, Ito et al [ 13 ] prospectively followed 1,896 PCU patients, and found that the incidence of rapid decline death was the highest (30-day cumulative incidence: 16.8%), followed by surprise death (9.6%), unexpected death (9.0%) [ 46 , 48 ], and performance status–defined sudden death (6.4%) [ 13 ]. These findings were generally consistent with the IPOD study, which found that approximately 10% of PCU deaths were unexpected by physicians and nurses based on the “surprise” and “unexpected death” questions [ 9 ].…”