The change in prevalence of symptoms in homecare visits of advanced cancer patients during the final week of life

Background: Approximately ۱۰ million patients died from cancer in ۲۰۲۰ around the world. Since the popularity of end-of-life homecare is increasing, understanding dynamics of the clinical symptoms near death in this setting enhances the quality of palliative interventions. Though previous studies have revealed the changes in the symptoms in relevance to death, the view of such changes in a daily resolution remains absent. Thus, the purpose of this study is to compare the frequency of symptoms observed during the last ۷ days of life in these patients.Methods: We retrospectively analyzed the data from homecare visit of ۱۴۱۸ cancer patients who were registered in Iranian Cancer Control Center (MACSA) and had at least ۱ homecare visit during the last week of life. the patients were visited during ۲ years from February ۱, ۲۰۲۰ and their symptoms were assessed using the Memorial Symptom Assessment Scale - Short Form (MSAS-SF). The data for visits in last ۸ days was categorized into ۸ groups based on the interval to death in a daily manner. The demographic information, health status and the frequency of symptoms compared between the ۸ groups using suitable statistical tests.Results: Among the ۳۲ symptoms, ۲۷ had no statistically significant alteration in any of the time frames, (Bonferroni adjusted p value <۰.۰۰۶). In total, feeling drowsy (۲۲.۸%), difficulty concentrating (۱۶.۵%), and sweats (۴.۶%) were increased as getting closure to death. The frequency of difficulty sleeping (۱۵.۱%), and dizziness (۴.۴%) was identified additionally.Conclusion: Our findings underscore the changes of symptoms in final week of life in advanced cancer patients enrolled in homecare palliative service. The findings can be used to assess the prognosis of patients close to the time of death. These results also provide insights the pattern of alteration in patients’ needs as they approach the end of life.

کلیدواژه ها:

End-of-life care ، symptom dynamics ، imminent death ، palliative care ، homecare