TY - JOUR
T1 - Diagnostic models for impending death in terminally ill cancer patients
T2 - A multicenter cohort study
AU - EASED collaborators
AU - Mori, Masanori
AU - Yamaguchi, Takuhiro
AU - Maeda, Isseki
AU - Hatano, Yutaka
AU - Yamaguchi, Takashi
AU - Imai, Kengo
AU - Kikuchi, Ayako
AU - Matsuda, Yosuke
AU - Suzuki, Kozue
AU - Tsuneto, Satoru
AU - Hui, David
AU - Morita, Tatsuya
N1 - Funding Information:
Grant‐in‐Aid from the Japan Hospice Palliative Care Foundation, JSPS KAKENHI (JP16K15418, 18H02736).
Funding Information:
Grant-in-Aid from the Japan Hospice Palliative Care Foundation, JSPS KAKENHI (JP16K15418, 18H02736). We sincerely appreciate all the EASED investigators. We also appreciate Shih-Wei Chiu, PhD at the Division of Biostatistics, Tohoku University Graduate School of Medicine for his advice on statistics.
Publisher Copyright:
© 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
PY - 2021/11
Y1 - 2021/11
N2 - Background: Accurately predicting impending death is essential for clinicians to clarify goals of care. We aimed to develop diagnostic models to predict death ≤3 days in cancer patients. Methods: In this multicenter cohort study, we consecutively enrolled advanced cancer patients admitted to 23 inpatient hospices in 2017. Fifteen clinical signs related to impending death were documented daily from the day when the Palliative Performance Scale (PPS) declined to ≤20–14 days later. We conducted recursive partitioning analysis using the entire data set and performed cross-validation to develop the model (prediction of 3-day impending death-decision tree [P3did-DT]). Then, we summed the number of systems (nervous/cardiovascular/respiratory/musculoskeletal), where any sign was present to underpin P3did score (range = 0–4). Results: Data following PPS ≤20 were obtained from 1396 of 1896 inpatients (74%). The mean age was 73 ± 12 years, and 399 (29%) had gastrointestinal tract cancer. The P3did-DT was based on three variables and had four terminal leaves: urine output (u/o) ≤200 ml/day and decreased response to verbal stimuli, u/o ≤200 ml/day and no decreased response to verbal stimuli, u/o >200 ml/day and Richmond Agitation-Sedation Scale (RASS) ≤−2, and u/o >200 ml/day and RASS ≥−1. The 3-day mortality rates were 80.3%, 53.3%, 39.9%, and 20.6%, respectively (accuracy = 68.3%). In addition, 79.6%, 62.9%, 47.2%, 32.8%, and 17.4% of patients with P3did scores of 4, 3, 2, 1, and 0, respectively, died ≤3 days. Conclusion: We successfully developed diagnostic models for death ≤3 days. These may further help clinicians predict impending death and help patients/families prepare for their final days.
AB - Background: Accurately predicting impending death is essential for clinicians to clarify goals of care. We aimed to develop diagnostic models to predict death ≤3 days in cancer patients. Methods: In this multicenter cohort study, we consecutively enrolled advanced cancer patients admitted to 23 inpatient hospices in 2017. Fifteen clinical signs related to impending death were documented daily from the day when the Palliative Performance Scale (PPS) declined to ≤20–14 days later. We conducted recursive partitioning analysis using the entire data set and performed cross-validation to develop the model (prediction of 3-day impending death-decision tree [P3did-DT]). Then, we summed the number of systems (nervous/cardiovascular/respiratory/musculoskeletal), where any sign was present to underpin P3did score (range = 0–4). Results: Data following PPS ≤20 were obtained from 1396 of 1896 inpatients (74%). The mean age was 73 ± 12 years, and 399 (29%) had gastrointestinal tract cancer. The P3did-DT was based on three variables and had four terminal leaves: urine output (u/o) ≤200 ml/day and decreased response to verbal stimuli, u/o ≤200 ml/day and no decreased response to verbal stimuli, u/o >200 ml/day and Richmond Agitation-Sedation Scale (RASS) ≤−2, and u/o >200 ml/day and RASS ≥−1. The 3-day mortality rates were 80.3%, 53.3%, 39.9%, and 20.6%, respectively (accuracy = 68.3%). In addition, 79.6%, 62.9%, 47.2%, 32.8%, and 17.4% of patients with P3did scores of 4, 3, 2, 1, and 0, respectively, died ≤3 days. Conclusion: We successfully developed diagnostic models for death ≤3 days. These may further help clinicians predict impending death and help patients/families prepare for their final days.
KW - advanced cancer
KW - diagnostic models
KW - impending death
KW - recursive partitioning analysis
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UR - http://www.scopus.com/inward/citedby.url?scp=85116442985&partnerID=8YFLogxK
U2 - 10.1002/cam4.4314
DO - 10.1002/cam4.4314
M3 - Article
C2 - 34586714
AN - SCOPUS:85116442985
SN - 2045-7634
VL - 10
SP - 7988
EP - 7995
JO - Cancer medicine
JF - Cancer medicine
IS - 22
ER -