Identification of distinct symptom-functional states and evaluation of their changes in terminally ill cancer patients last year of life and their impact on survival

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Siew Tzuh Tang, Fur-Hsing Wen, Jen-Shi Chen, Wen-Chi Chou, Wen-Cheng Chang, Chia-Hsun Hsieh and Ming-Mo Hou

Chang Gung University, Taiwan

: J Nurs Patient Care

Abstract

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Statement of the Problem: Considerable heterogeneity in the individual trajectory of symptom distress and functional declines toward death was observed for a sizable minority of cancer patients but identification and courses of conjoint symptomfunctional states over cancer patients’ last year have never been examined nor their impact on survival. Our study addressed this gap of current knowledge. Method: Identification of and changes in the distinct symptom-functional states between consecutive time points over 317 cancer patients’ last year was examined using a transition model by hidden Markov modeling. Multivariate cox regression models were used to evaluate the impact of the lagged distinct symptom-functional states on post-enrollment survival. Result: Five conjoint symptom-functional states were identified as: (1) Mild symptom distress with high functioning, (2) moderate symptom distress with mild functional declines, (3) severe symptom distress with moderate functional declines, (4) moderate symptom distress with severe functional declines and (5) profound symptom distress and functional declines. Changes of prevalence of these five states differ substantially. Participants at states 1-4 had substantially lower risk of subsequent death than those in state 5 (adjusted hazard ratios [95% CI] ranged from 0.048 [0.028, 0.081] to 0.434 [0.316, 0.579]). Conclusion: Our identification of the five distinct symptom-functional states, their unique transition patterns and impact on mortality can provide all stake holders with guides for end-of-life care. Changes goals of care towards a palliative care approach and effective symptom management should be implemented for those with at least moderate symptom distress and substantial impairment in functioning to achieve high quality end-of-life care.

Biography

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Siew Tzuh Tang has completed her PhD from Yale University, New Haven, CT, USA and her research work focused on end-of-life care, decision conflict and caregiving burden of family caregives, bereavement outcomes, end-of-life care family caregiving secondary data analysis. She has received New Investigator Award in 2007 from Oncology Nursing Foundation.

E-mail: sttang@mail.cgu.edu.tw