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Diagnostic models for impending death in terminally ill cancer patients: A multicenter cohort study
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 inpa...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8607266/ https://www.ncbi.nlm.nih.gov/pubmed/34586714 http://dx.doi.org/10.1002/cam4.4314 |
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author | Mori, Masanori Yamaguchi, Takuhiro Maeda, Isseki Hatano, Yutaka Yamaguchi, Takashi Imai, Kengo Kikuchi, Ayako Matsuda, Yosuke Suzuki, Kozue Tsuneto, Satoru Hui, David Morita, Tatsuya |
author_facet | Mori, Masanori Yamaguchi, Takuhiro Maeda, Isseki Hatano, Yutaka Yamaguchi, Takashi Imai, Kengo Kikuchi, Ayako Matsuda, Yosuke Suzuki, Kozue Tsuneto, Satoru Hui, David Morita, Tatsuya |
author_sort | Mori, Masanori |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8607266 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-86072662021-11-29 Diagnostic models for impending death in terminally ill cancer patients: A multicenter cohort study Mori, Masanori Yamaguchi, Takuhiro Maeda, Isseki Hatano, Yutaka Yamaguchi, Takashi Imai, Kengo Kikuchi, Ayako Matsuda, Yosuke Suzuki, Kozue Tsuneto, Satoru Hui, David Morita, Tatsuya Cancer Med Clinical Cancer Research 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. John Wiley and Sons Inc. 2021-09-29 /pmc/articles/PMC8607266/ /pubmed/34586714 http://dx.doi.org/10.1002/cam4.4314 Text en © 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Clinical Cancer Research Mori, Masanori Yamaguchi, Takuhiro Maeda, Isseki Hatano, Yutaka Yamaguchi, Takashi Imai, Kengo Kikuchi, Ayako Matsuda, Yosuke Suzuki, Kozue Tsuneto, Satoru Hui, David Morita, Tatsuya Diagnostic models for impending death in terminally ill cancer patients: A multicenter cohort study |
title | Diagnostic models for impending death in terminally ill cancer patients: A multicenter cohort study |
title_full | Diagnostic models for impending death in terminally ill cancer patients: A multicenter cohort study |
title_fullStr | Diagnostic models for impending death in terminally ill cancer patients: A multicenter cohort study |
title_full_unstemmed | Diagnostic models for impending death in terminally ill cancer patients: A multicenter cohort study |
title_short | Diagnostic models for impending death in terminally ill cancer patients: A multicenter cohort study |
title_sort | diagnostic models for impending death in terminally ill cancer patients: a multicenter cohort study |
topic | Clinical Cancer Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8607266/ https://www.ncbi.nlm.nih.gov/pubmed/34586714 http://dx.doi.org/10.1002/cam4.4314 |
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