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Trajectories of Suffering in the Last Year of Life Among Patients With a Solid Metastatic Cancer.

Publication ,  Journal Article
Malhotra, C; Malhotra, R; Bundoc, F; Teo, I; Ozdemir, S; Chan, N; Finkelstein, E
Published in: J Natl Compr Canc Netw
September 7, 2021

BACKGROUND: Reducing suffering at the end of life is important. Doing so requires a comprehensive understanding of the course of suffering for patients with cancer during their last year of life. This study describes trajectories of psychological, spiritual, physical, and functional suffering in the last year of life among patients with a solid metastatic cancer. PATIENTS AND METHODS: We conducted a prospective cohort study of 600 patients with a solid metastatic cancer between July 2016 and December 2019 in Singapore. We assessed patients' psychological, spiritual, physical, and functional suffering every 3 months until death. Data from the last year of life of 345 decedents were analyzed. We used group-based multitrajectory modeling to delineate trajectories of suffering during the last year of a patient's life. RESULTS: We identified 5 trajectories representing suffering: (1) persistently low (47% of the sample); (2) slowly increasing (14%); (3) predominantly spiritual (21%); (4) rapidly increasing (12%); and (5) persistently high (6%). Compared with patients with primary or less education, those with secondary (high school) (odds ratio [OR], 3.49; 95% CI, 1.05-11.59) education were more likely to have rapidly increasing versus persistently low suffering. In multivariable models adjusting for potential confounders, compared with patients with persistently low suffering, those with rapidly increasing suffering had more hospital admissions (β=0.24; 95% CI, 0.00-0.47) and hospital days (β=0.40; 95% CI, 0.04-0.75) during the last year of life. Those with persistently high suffering had more hospital days (β=0.70; 95% CI, 0.23-1.17). CONCLUSIONS: The course of suffering during the last year of life among patients with cancer is variable and related to patients' hospitalizations. Understanding this variation can facilitate clinical decisions to minimize suffering and reduce healthcare costs at the end of life.

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Published In

J Natl Compr Canc Netw

DOI

EISSN

1540-1413

Publication Date

September 7, 2021

Volume

19

Issue

11

Start / End Page

1264 / 1271

Location

United States

Related Subject Headings

  • Terminal Care
  • Prospective Studies
  • Oncology & Carcinogenesis
  • Neoplasms, Second Primary
  • Neoplasms
  • Humans
  • Death
  • Anxiety
  • 4203 Health services and systems
  • 3211 Oncology and carcinogenesis
 

Citation

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Malhotra, C., Malhotra, R., Bundoc, F., Teo, I., Ozdemir, S., Chan, N., & Finkelstein, E. (2021). Trajectories of Suffering in the Last Year of Life Among Patients With a Solid Metastatic Cancer. J Natl Compr Canc Netw, 19(11), 1264–1271. https://doi.org/10.6004/jnccn.2021.7014
Malhotra, Chetna, Rahul Malhotra, Filipinas Bundoc, Irene Teo, Semra Ozdemir, Noreen Chan, and Eric Finkelstein. “Trajectories of Suffering in the Last Year of Life Among Patients With a Solid Metastatic Cancer.J Natl Compr Canc Netw 19, no. 11 (September 7, 2021): 1264–71. https://doi.org/10.6004/jnccn.2021.7014.
Malhotra C, Malhotra R, Bundoc F, Teo I, Ozdemir S, Chan N, et al. Trajectories of Suffering in the Last Year of Life Among Patients With a Solid Metastatic Cancer. J Natl Compr Canc Netw. 2021 Sep 7;19(11):1264–71.
Malhotra, Chetna, et al. “Trajectories of Suffering in the Last Year of Life Among Patients With a Solid Metastatic Cancer.J Natl Compr Canc Netw, vol. 19, no. 11, Sept. 2021, pp. 1264–71. Pubmed, doi:10.6004/jnccn.2021.7014.
Malhotra C, Malhotra R, Bundoc F, Teo I, Ozdemir S, Chan N, Finkelstein E. Trajectories of Suffering in the Last Year of Life Among Patients With a Solid Metastatic Cancer. J Natl Compr Canc Netw. 2021 Sep 7;19(11):1264–1271.

Published In

J Natl Compr Canc Netw

DOI

EISSN

1540-1413

Publication Date

September 7, 2021

Volume

19

Issue

11

Start / End Page

1264 / 1271

Location

United States

Related Subject Headings

  • Terminal Care
  • Prospective Studies
  • Oncology & Carcinogenesis
  • Neoplasms, Second Primary
  • Neoplasms
  • Humans
  • Death
  • Anxiety
  • 4203 Health services and systems
  • 3211 Oncology and carcinogenesis