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

Abstract

Context The symptom burden in the last week of life of patients with advanced cancer has not been well characterized. Objectives 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). Methods We systematically documented the Edmonton Symptom Assessment System (ESAS) daily and 15 symptoms twice daily on consecutive advanced cancer patients admitted to APCUs at M.D. Anderson Cancer Center (USA) 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 backwards. Results 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), and 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). Conclusion Despite intensive management in APCUs, some cancer patients continue to experience high symptom burden as they approached death.

The Relation between the Severity of Pain and Common Symptoms in Patients with Metastatic Cancer

“…Cancer patients near end of life report more severe symptoms than other cancer patients 4 . Hui et al found that patients in the last week of life still suffer from high symptom burden mainly dyspnea, fatigue and drowsiness; and according to them, these symptoms may be unavoidable in this group of patients in spite of high quality supportive care 5 . The prevalence of pain in cancer patients varies significantly between studies.…”

A Review of Non-Pharmacological Pulmonary Rehabilitation for Patients Receiving Palliative Care

“…Patients with cancer diagnoses were the next studied population of focus (n=13), [38][39][40][41][42][43][44][45][46][47][48][49][50] followed by patients with interstitial lung disease (n=8), [51][52][53][54][55][56][57][58] and lastly one study focussed on patients with Huntington's disease (Table 1) Page S35…”

Physical problems and needs of patients in palliative care center

“…22 In another study done by Hui et al, 74-83% of patients in palliative care units had anorexia. 30 Anorexia may be because of the direct effect on oral intake due to dysphagia, early satiety, xerostomia, nausea/ vomiting, taste disturbance, mucositis, constipation, bowel obstruction, dental issue, etc., or, because of indirect effect on oral intake due to delirium, drowsiness, dyspnea, depression, etc. Inflammatory response and neurohormonal changes may also cause loss of appetite.…”

“…31 Refractory cachexia is seen in the last days of life due to inflammatory response, hyper metabolism and overall catabolic state with muscle loss. 30 Cancer related cachexia is seen in 50-80% of cancer patients with advanced and metastatic disease. 32 Cachexia weakens the body and promotes further spread of cancer.…”