Prevalence and severity of symptoms and signs in patients with advanced cancer in the last days of life: the East Asian collaborative cross-cultural study to elucidate the dying process (EASED)

Abstract

Purpose Few large-scale studies have focused on the prevalence of symptoms and signs during the last days of patients diagnosed with advanced cancer. Identifying the patterns of speci c symptoms according to cancer type is helpful to provide end-of-life care for patients with advanced cancer. We investigated the prevalence and severity of symptoms and signs associated with impending death in patients with advanced cancer. Methods In this secondary analysis of an international multicenter cohort study conducted in three East Asian countries, we compared the severity of symptoms and signs among dying patients 3 days before death according to the type of primary cancer using one-way analysis of variance (ANOVA). Post hoc analysis was conducted for multiple comparisons of each symptom according to the type of primary cancer. Results We analyzed 2131 patients from Japan, Korea and Taiwan. Fatigue, dry mouth, drowsiness and dyspnea were present in nearly half of the patients, and edema of lower extremities was the most common sign in all dying patients. According to cancer type, edema of lower extremities was the most common symptom and fatigue/ ascites were the most severe symptoms in digestive tract cancer. For lung cancer, respiratory secretion was the most prevalent and dyspnea/ respiratory secretion were the most severe symptoms. Conclusion We demonstrated the prevalence and severity of symptoms and signs associated with impending death of patients with advanced cancer in East Asia. Our study can enable clinicians to recognize the speci c symptoms and signs at the very end of life.

Prognostic evaluation in patients with advanced cancer in the last months of life: ESMO Clinical Practice Guideline

“…A recent study ( N = 2131) conducted in 38 palliative care units in three East Asian countries observed patients in the last 3 days of life. 76 The authors reported that fatigue, dry mouth, drowsiness and dyspnoea were the most frequent symptoms and lower body oedema was the most common sign as death approached. In a study of palliative cancer patients ( N = 178), ‘death rattle’ was found to be a prognostic factor for death within 48 h with a PPV of 74% and NPV of 77%; altered level of consciousness was less predictive (PPV of 64% and NPV of 67%).…”

Knowledge and Practice Behaviors Toward the Care of the Dying Among Chinese Oncology Nurses

“…7 Actively dying patients with advanced cancer typically experience multiple sources of suffering and symptoms that significantly affect their quality of life, such as pain, fatigue, breathlessness, nausea, constipation, diarrhea, anxiety, depression, insomnia, and confusion. 8 In addition, cancer has been regarded as a family disease, affecting not only the patients but also their family members who are required to provide support and care, including assistance with personal care, symptom management, treatment monitoring, and emotional, financial, and spiritual support. 9 Therefore, cancer patients in their final days require careful symptom management, and families need support and coaching as death approaches.…”

The feasibility and effects of a pharmacological treatment algorithm for cancer patients with terminal dyspnea: A multicenter cohort study

“…algorithm, cancer, dyspnea, feasibility, palliative care 1 The comprehensive pharmacological treatment algorithm for terminal cancer dyspnea patients. RASS, Richmond Agitation-Sedation Scale algorithm for patients with terminal dyspnea.…”

“…Dyspnea is among the most frequent and deteriorating symptoms in the terminal phase of life of cancer patients (“terminal dyspnea”) 1–3 . Previous research indicated the efficacy of opioids as the first‐line therapy for terminal dyspnea patients 4–8 .…”

“…Dyspnea is among the most frequent and deteriorating symptoms in the terminal phase of life of cancer patients (“terminal dyspnea”). 1 , 2 , 3 Previous research indicated the efficacy of opioids as the first‐line therapy for terminal dyspnea patients. 4 , 5 , 6 , 7 , 8 The international guidelines also recommend that parenteral opioids and benzodiazepines be considered for patients with terminal dyspnea.…”