the trajectory of symptom scores and performance status during the last months of life, an important issue is missed. More than 80% of patients with advanced cancer can develop delirium in the last days before death, and delirium is present in 26% to 44% of patients at the time of admission to an acute care hospital or palliative care unit. 2 If a patient is cognitively impaired, or for other reasons cannot participate in the symptom assessment, the Edmonton Symptom Assessment System (ESAS) is completed by the caregiver or professional. In that case, the subjective symptom scales (depression, anxiety, tiredness, and well-being) are left blank. 3 Seow et al states, "Scores were reported by the patient (ESAS) or provider (PPS [Palliative Performance Scale]) during visits to the cancer center or the home." If all of the ESAS were completed by the patient, we can deduce that a number of patients with delirium had to be excluded. It would be interesting to know if screening for delirium was performed, what tool was used, and how many patients were excluded for this reason.