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Depressive symptoms in the last days of life of patients with cancer: a nationwide retrospective mortality study
  1. Elene Janberidze1,2,
  2. Sandra Martins Pereira3,
  3. Marianne Jensen Hjermstad1,4,
  4. Anne Kari Knudsen1,2,
  5. Stein Kaasa1,2,
  6. Agnes van der Heide5 and
  7. Bregje Onwuteaka-Philipsen3
  8. on behalf of EURO IMPACT
    1. 1European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
    2. 2Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
    3. 3Department of Public and Occupational Health, VU University Medical Center, and EMGO+ Institute for Health and Care Research, VUmc Expertise Center for Palliative Care, Amsterdam, Netherlands
    4. 4Regional Centre for Excellence in Palliative Care, South Eastern Norway, Oslo University Hospital, Oslo, Norway
    5. 5Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
    1. Correspondence to Dr Elene Janberidze, European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Kunnskapssenteret 4. etg., St. Olavs Hospital, Trondheim N-7006 Norway; elene.janberidze{at}


    Objectives Depressive symptoms are common in patients with cancer and tend to increase as death approaches. The study aims were to examine the prevalence of depressive symptoms in patients with cancer in their final 24 h, and their association with other symptoms, sociodemographic and care characteristics.

    Methods A stratified sample of deaths was drawn by Statistics Netherlands. Questionnaires on patient and care characteristics were sent to the physicians (N=6860) who signed the death certificates (response rate 77.8%). Adult patients with cancer with non-sudden death were included (n=1363). Symptoms during the final 24 h of life were assessed on a 1–5 scale and categorised as 1=no, 2–3=mild/moderate and 4–5=severe/very severe.

    Results Depressive symptoms were registered in 37.6% of the patients. Patients aged 80 years or more had a reduced risk of having mild/moderate depressive symptoms compared with those aged 17–65 years (OR 0.70; 95% CI 0.50 to 0.99). Elderly care physicians were more likely to assess patients with severe/very severe depressive symptoms than patients with no depressive symptoms (OR 4.18; 95% CI 1.48 to 11.76). Involvement of pain specialists/palliative care consultants and psychiatrists/psychologists was associated with more ratings of severe/very severe depressive symptoms. Fatigue and confusion were significantly associated with mild/moderate depressive symptoms and anxiety with severe/very severe symptoms.

    Conclusions More than one-third of the patients were categorised with depressive symptoms during the last 24 h of life. We recommend greater awareness of depression earlier in the disease trajectory to improve care.

    • End-of-life
    • Cancer
    • Palliative care
    • Depressive symptoms

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