Trajectory of psychosocial symptoms among home care patients with cancer at end-of-life
Menée au Canada à partir de données portant sur 27 295 patients décédés d’un cancer, cette étude de cohorte observationnelle analyse l’évolution de leurs symptômes psychosociaux et leurs besoins en soins à domicile pendant les 6 derniers mois de vie
Purpose : Understanding the end?of?life psychosocial needs of cancer patients at home is a knowledge gap. This study describes the trajectory of psychosocial symptoms in the last six months of life among cancer decedents who were receiving home care. Methods : Observational population?based cohort study of cancer decedents who were receiving home care services between 2007 and 2014. Decedents had to have at least 1 home care assessment in the last six months of life for inclusion. Outcomes were the presence of psychosocial symptoms (i.e. anxiety, loneliness, depression, social decline, caregiver distress, and cognitive decline) at each week before death. Results : Our cohort included 27,295 unique cancer decedents (30,368 assessments), of which 58% died in hospital. Fifty?six percent were older than 74 and 47% were female. The prevalence of all symptoms increased approaching death, except loneliness. Social decline (48% to 78%) was the most prevalent psychosocial symptom, though loneliness was reported in less than 10% of the cohort. Caregiver distress rose over time from 15% to 27%. A third of the cohort reported issues with cognitive impairment. Multivariate regression showed that physical symptoms such as uncontrolled pain, impairment in Independent Activities of Daily Living, and a high level of health instability all significantly worsened the odds of having a psychosocial symptom in the last 3 months of life. Conclusion : In this large home care cancer cohort, trajectories of psychosocial symptoms worsened close to death. Physical symptoms, such as uncontrolled pain, were associated with having worse psychosocial symptoms at end of life.
Psycho-Oncology 2020