Symptom prevalence in the last week of life

Conill, Carlos; Verger, E.; Henrı́quez, I.; Saiz, Neus; Espier, Montserrat; Lugo, F.; Garrigos, Andreu

doi:10.1016/s0885-3924(97)00263-7

Cited by 158 publications

(100 citation statements)

References 6 publications

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“…Most extant longitudinal research has been conducted with individuals receiving hospice or palliative care and has assessed symptoms only in the last weeks or months before death (6,(25)(26)(27). These studies report that there was a worsening of symptom distress in the last month or weeks before death.…”

Section: Discussionmentioning

confidence: 99%

Symptom Experience in the Last Year of Life Among Individuals with Cancer

Doorenbos

Given

et al. 2006

Journal of Pain and Symptom Management

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Individuals with cancer often experience many symptoms that impair their quality of life at end of life. This study examines symptom experience at end of life among individuals with cancer, and determines if symptom experience changes with proximity to death, or differs by depressive symptomatology, sex, site of cancer, or age. A secondary analysis of data from three prospective, descriptive, longitudinal studies (n = 174) was performed, using a three-level hierarchical linear model. Fatigue, weakness, pain, shortness of breath, and cough were the five most prevalent symptoms in the last year of life. The symptom experience in the last year of life was significantly associated with site of cancer, depressive symptomatology, dependencies in activities of daily living, and independent activities of daily living at the start of the study. These findings shed light on the symptom experience in the last year of life for individuals with cancer. With greater understanding of the symptom experience, intervention strategies can be targeted to achieve the desired outcome of increased quality of life at end of life.

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Section: Discussionmentioning

confidence: 99%

Symptom Experience in the Last Year of Life Among Individuals with Cancer

Doorenbos

Given

et al. 2006

Journal of Pain and Symptom Management

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“…57,92 Foranemiainpatientsundergoingcancerchemotherapy,treatment with erythropoietin has been found to be effective in improving functional status and quality of life, independent of tumorresponse. [93][94][95] Althoughtreatmentofanemiahasbeenshown to decrease fatigue of patients receiving chemotherapy, 92,93 correction of anemia in advanced cancer patients at the end of life wasfoundtohavelimitedimpactontheintensityoffatigue, 14,96,97 likely due to the multifactorial contributors to their fatigue. Until recently, energy conservation was the most frequently recommended treatment for fatigue in palliative care.…”

Section: Palliative Management Of Fatigue At the Close Of Lifementioning

confidence: 99%

Palliative Management of Fatigue at the Close of Life

Yennurajalingam

Bruera²

2007

JAMA

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Fatigue is the most common chronic symptom associated with cancer and other chronic progressive diseases. The assessment and treatment of fatigue at or near the end of life can be complex. Some of the challenges include its subjective nature, with great variability in its source, how it is expressed, and how it is perceived, requiring treatment to be based on patient report of frequency and severity; its multidimensional character; and the limited understanding of its pathophysiology. Using the case of an 82-yearold retired nurse with fatigue that could be explained by a number of concurrent conditions, including anemia, weight loss, depression and isolation, dyspnea, deconditioning, and medications, the authors illustrate the clinical approach to assess and treat fatigue at the end of life.

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“…Usually, these ultra-short tests formed part of symptom checklists and were not validated against an accepted standard (Miller and Walsh, 1991;Donnelly et al, 1995;Conill et al, 1997;Brunelli et al, 1998;Edmonds et al, 1998;Ng and von Gunten, 1998;Pratheepawanit et al, 1999). At the same time, simple (non-verbal) visual-analogue methods of assessing depression, anxiety or distress were developed, exemplified by the NCCN Distress Thermometer and Edmonton Symptom Assessment (Hürny et al, 1996;Vignaroli et al, 2006).…”

mentioning

confidence: 99%

Are one or two simple questions sufficient to detect depression in cancer and palliative care? A Bayesian meta-analysis

Mitchell

2008

Br J Cancer

106

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The purpose of this study is to examine the value of one or two simple verbal questions in the detection of depression in cancer settings. This study is a systematic literature search of abstract and full text databases to January 2008. Key authors were contacted for unpublished studies. Seventeen analyses were found. Of these, 13 were conducted in late stage palliative settings. (1) Single depression question: across nine studies, the prevalence of depression was 16%. A single 'depression' question enabled the detection of depression in 160 out of 223 true cases, a sensitivity of 72%, and correctly reassured 964 out of 1166 non-depressed cancer sufferers, a specificity of 83%. The positive predictive value (PPV) was 44% and the negative predictive value (NPV) 94%. (2) Single interest question: there were only three studies examining the 'loss-of-interest' question, with a combined prevalence of 14%. This question allowed the detection of 60 out of 72 cases (sensitivity 83%) and excluded 394 from 459 non-depressed cases (specificity of 86%). The PPV was 48% and the NPV 97%. (3) Two questions (low mood and low interest): five studies examined two questions with a combined prevalence of 17%. The two-question combination facilitated a diagnosis of depression in 138 of 151 true cases (sensitivity 91%) and gave correct reassurance to 645 of 749 non-cases (specificity 86%). The PPV was 57% and the NPV 98%. Simple verbal methods perform well at excluding depression in the non-depressed but perform poorly at confirming depression. The 'two question' method is significantly more accurate than either single question but clinicians should not rely on these simple questions alone and should be prepared to assess the patient more thoroughly.

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Symptom prevalence in the last week of life

Cited by 158 publications

References 6 publications

Symptom Experience in the Last Year of Life Among Individuals with Cancer

Symptom Experience in the Last Year of Life Among Individuals with Cancer

Palliative Management of Fatigue at the Close of Life

Are one or two simple questions sufficient to detect depression in cancer and palliative care? A Bayesian meta-analysis

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