Clinical burden of terminal phase in cancer patients

Symptoms, palliative applications and terminal phase (TP) duration mainly constitute clinical burden of TP in cancer. The aim of this study was to describe palliative issues and determine factors that might influence the clinical burden during TP.

We retrospectively studied 125 terminally ill cancer patients, of median age 70 years and ECOG performance status (PS) 4, at their TP entry, who died over a 3-year period, 90 (72%) in hospital (group 1) and 35 at home (group 2).

During TP, the 10 most prevalent symptoms were anorexia, pain, dyspnoea, cachexia, fever (infectious or not), constipation, ascites, agitation and vomiting. The 10 most frequent palliative applications were administration of i.v. fluids/drugs, oxygen and enemas administration, bladder catheter and central venous (CV) line care, transfusions, gastric, pleural and peritoneal fluid drainage, endoscopic or percutaneous biliary tract decompression, and radiotherapy. In total, TP represented 8% of the whole disease duration, causing 17% of admissions and 28% of hospital stay. Tumor complications and treatment toxicities caused death and shortened TP in 70% of the cases, more frequently in group 1 (p=0.027). Long disease active phase (AP) duration (from initial diagnosis of cancer to TP entry) predicted PS<4 at TP entry (p=0.008). Predictors of TP duration were AP duration (p=0.010), PS <4 (p=0.000) and number of clinical features (p=0.012).

TP represents a small percentage of patients' total disease duration, but it constitutes a considerable part of the entire hospital patients' in-stay and professional practice. PS at TP entry predicted TP duration. AP influenced PS at TP entry and predicted TP duration. AP is an easily measurable clinical parameter and may be considered as an additional prognostic factor of TP duration.