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Open AccessArticle

Trajectory of End-of-Life Pain and Other Physical Symptoms among Cancer Patients Receiving Home Care

1
Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada
2
Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada
3
Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada
4
Department of Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada
5
Department of Family Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
6
School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
7
Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
8
Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada
9
Canadian Centre for Applied Research in Cancer Control, Vancouver, BC V5Z 1L3, Canada
10
British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
11
Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
12
Division of Biostatistics, University of Toronto, Toronto, ON M5S 1A1, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2021, 28(3), 1641-1651; https://doi.org/10.3390/curroncol28030153
Received: 16 March 2021 / Revised: 15 April 2021 / Accepted: 23 April 2021 / Published: 28 April 2021
Purpose: To describe the trajectory of physical symptoms among cancer decedents who were receiving home care in the six months before death. Patients and Methods: An observational cohort study of cancer decedents in Ontario, Canada, who received home care services between 2007 and 2014. To be included, decedents had to use at least one home care service in the last six months of life. Outcomes were the presence of pain and several other physical symptoms at each week before death. Results: Our cohort included 27,295 cancer decedents (30,368 assessments). Forty-seven percent were female and 56% were age 75 years or older. The prevalence of all physical symptoms increased as one approached death, particularly in the last month of life. In the last weeks of life, 69% of patients reported having moderate–severe pain; however, only 20% reported that the pain was not controlled. Loss of appetite (63%), shortness of breath (59%), high health instability (50%), and self-reported poor health (44%) were also highly prevalent in the last week of life. Multivariate regression showed that caregiver distress, high health instability, social decline, uncontrolled pain, and signs of depression all worsened the odds of having a physical symptom in the last 3 months of life. Conclusion: In this large home care cancer cohort, trajectories of physical symptoms worsened close to death. While presence of moderate–severe pain was common, it was also reported as mostly controlled. Covariates, such as caregiver distress and social decline, were associated with having more physical symptoms at end of life. View Full-Text
Keywords: home care; cancer; symptoms; end of life; palliative home care; cancer; symptoms; end of life; palliative
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MDPI and ACS Style

Seow, H.; Guthrie, D.M.; Stevens, T.; Barbera, L.C.; Burge, F.; McGrail, K.; Chan, K.K.W.; Peacock, S.J.; Sutradhar, R. Trajectory of End-of-Life Pain and Other Physical Symptoms among Cancer Patients Receiving Home Care. Curr. Oncol. 2021, 28, 1641-1651. https://doi.org/10.3390/curroncol28030153

AMA Style

Seow H, Guthrie DM, Stevens T, Barbera LC, Burge F, McGrail K, Chan KKW, Peacock SJ, Sutradhar R. Trajectory of End-of-Life Pain and Other Physical Symptoms among Cancer Patients Receiving Home Care. Current Oncology. 2021; 28(3):1641-1651. https://doi.org/10.3390/curroncol28030153

Chicago/Turabian Style

Seow, Hsien; Guthrie, Dawn M.; Stevens, Tara; Barbera, Lisa C.; Burge, Fred; McGrail, Kimberlyn; Chan, Kelvin K.W.; Peacock, Stuart J.; Sutradhar, Rinku. 2021. "Trajectory of End-of-Life Pain and Other Physical Symptoms among Cancer Patients Receiving Home Care" Curr. Oncol. 28, no. 3: 1641-1651. https://doi.org/10.3390/curroncol28030153

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