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Symptoms, performance status and phase of illness in advanced cancer: multicentre cross-sectional study of palliative care unit admissions
  1. Hironori Ohinata1,2,
  2. Maho Aoyama1,
  3. Yusuke Hiratsuka3,4,
  4. Masanori Mori5,
  5. Ayako Kikuchi6,
  6. Hiroaki Tsukuura7,
  7. Yosuke Matsuda8,
  8. Kozue Suzuki9,
  9. Hiroyuki Kohara10,
  10. Isseki Maeda11,
  11. Tatsuya Morita5 and
  12. Mitsunori Miyashita1
  1. 1Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
  2. 2Department of Nursing, International University of Health and Welfare, Narita, Japan
  3. 3Department of Palliative Medicine, Tohoku University, Sendai, Japan
  4. 4Department of Palliative Medicine, Takeda General Hospital, Aizuwakamatsu, Japan
  5. 5Department of Palliative and Supportive Care, Seirei Mikatahara Hospital, Hamamatsu, Japan
  6. 6Department of Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan
  7. 7Akari Home Care Clinic, Edogawa-ku, Japan
  8. 8Department of Palliative Medicine, Tokyo Kyosai Hospital, Meguro-ku, Japan
  9. 9Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Japan
  10. 10Department of General Internal Medicine, Hatsukaichi Memorial Hospital, Hatsukaichi, Japan
  11. 11Department of Palliative Care, Senri Chuo Hospital, Toyonaka, Japan
  1. Correspondence to Hironori Ohinata, Palliative Nursing Health Sciences, Tohoku University, Sendai, 980-8577, Japan; hinata{at}iuhw.ac.jp

Abstract

Objectives To clarify the relationship between Phase of Illness at the time of admission to palliative care units and symptoms of patients with advanced cancer.

Methods This study was a secondary analysis of the East Asian collaborative cross-cultural Study to Elucidate the Dying process. Palliative physicians recorded data, including Phase of Illness, physical function and the Integrated Palliative care Outcome Scale. We used multinomial logistic regression to analyse ORs for factors associated with Phase of Illness. Twenty-three palliative care units in Japan participated from January 2017 to September 2018.

Results In total, 1894 patients were analysed—50.9% were male, mean age was 72.4 (SD±12.3) years, and Phase of Illness at the time of admission to the palliative care unit comprised 177 (8.9%) stable, 579 (29.2%) unstable, 921 (46.4%) deteriorating and 217 (10.9%) terminal phases. Symptoms were most distressing in the terminal phase for all items, followed by deteriorating, unstable and stable (p<0.001). The stable phase had lower association with shortness of breath (OR 0.73, 95% CI 0.57 to 0.94) and felt at peace (OR 0.73, 95% CI 0.56 to 0.90) than the unstable phase. In the deteriorating phase, weakness or lack of energy (OR 1.20, 95% CI 1.02 to 1.40) were higher, while drowsiness (OR 0.82, 95% CI 0.71 to 0.97) and felt at peace (OR 0.81, 95% CI 0.71 to 0.94) were significantly lower.

Conclusion Our study is reflective of the situation in palliative care units in Japan. Future studies should consider the differences in patients’ medical conditions and routinely investigate patients’ Phase of Illness and symptoms.

Trial registrarion number UMIN000025457

  • Clinical assessment
  • Symptoms and symptom management
  • Terminal care

Data availability statement

Data from this study are not available to the public in accordance with the ethical approval of the study.

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Data availability statement

Data from this study are not available to the public in accordance with the ethical approval of the study.

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Footnotes

  • Twitter @HironoriOhinata

  • Contributors HO: conceptualisation, data curation, formal analysis, methodology, project administration, writing-original draft, and writing-review and editing. MA: supervision and writing-review and editing. YH: investigation, supervision, and writing-review and editing. MaM: conceptualisation, investigation, project administration, resources, supervision, and writing-review and editing. AK: investigation and writing-review and editing. HT: investigation and writing-review and editing. YM: investigation and writing-review and editing. KS: investigation and writing-review and editing. HK: investigation and writing-review and editing. IM: investigation and writing-review and editing. TM: investigation and writing-review and editing. MiM: conceptualisation, methodology, supervision and writing-review and editing. All authors reviewed and gave final approval of the version to be published. HO is responsible for the overall content as guarantor.

  • Funding This work was supported in part by a grant-in-aid from the JSPS KAKENHI (grant number 18K10266).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.