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.
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