ABSTRACT
Objective: To examine the trajectory of activities of daily living (ADL) in cancer patients from 6 weeks before death using the Functional Independence Measure (FIM). Method: This study was a retrospective observational study. The participants were cancer patients aged 18 years or older who died and were discharged from the palliative care unit in Tsurumaki-onsen Hospital. Six weeks of FIM data were collected from the patients’ medical records from 6 weeks before death to the time immediately before death (week 0). Results: Fifty-five participants were included in the study. FIM scores declined from 55 points at 6 weeks before death to 25 points immediately before death. Functional independence was higher for cognitive items on the FIM than for motor items, and both cognitive and motor functioning significantly declined just before death. Within the motor subscale, the patients were more independent with regard to eating, grooming, and bladder management compared to other activities until just before death. Within the cognitive subscale, the patients showed greater independence with regard to expression and social interaction. Discussion: A support for ADL needs to be considered to assist out-of bed activities in a safe and comfort manner until two weeks before death. Patients’ activities on the bed can also be continued for independence until just before death.
ABSTRACT
Objective: To explore the trajectories of hematologic data and palliative performance scale (PPS) scores among patients with terminal-stage cancer. Method: This was a retrospective observational study. We recruited all adult patients with solid cancer who received care from palliative care specialists and died in Komaki City Hospital between January and December 2016. Among these patients, we extracted hematologic data from the last 12 weeks and when 2 weeks passed since the last anti-cancer treatment, and PPS scores on the day of the hematologic tests. We calculated the means of weekly hematologic data and PPS scores, and explored their trajectories. Results: We recruited 204 patients (mean age, 70.9 years; women, 44.1%) and acquired 1157 hematological datasets. Albumin and C-reactive protein levels gradually decreased from 12 weeks and increased from 5 weeks, respectively, before death. White blood cell and lymphocyte counts respectively increased and decreased from 5 weeks. Creatinine and bilirubin levels rapidly increased from 3 weeks. Potassium levels increased from 1 week. PPS scores decreased from 4 weeks before death. Discussion: Deteriorations in nutrition or inflammatory status and white blood cell counts could antedate deterioration in PPS scores, and deterioration of visceral data and PPS scores could indicate prognosis on a weekly basis.