title: Consciousness levels one week after admission to a palliative care unit improve survival prediction in advanced cancer patients.
abstract: BACKGROUND
  Consciousness is an important factor of survival prediction in advanced cancer patients. However, effects on survival of changes over time in consciousness in advanced cancer patients have not been fully explored.
  
  
  OBJECTIVE
  This study evaluated changes in consciousness after admission to a palliative care unit and their correlation with prognosis in terminal cancer patients.
  
  
  METHODS
  This is a prospective observational study. From a palliative care unit in Taiwan, 531 cancer patients (51.8% male) were recruited. Consciousness status was assessed at admission and one week afterwards and recorded as normal or impaired.
  
  
  RESULTS
  The mean age was 65.28±13.59 years, and the average survival time was 23.41±37.69 days. Patients with normal consciousness at admission (n=317) had better survival than those with impaired consciousness at admission (n=214): (17.0 days versus 6.0 days, p<0.001). In the analysis on survival within one week after admission, those with normal consciousness at admission had a higher percentage of survival than the impaired (78.9% versus 44.3%, p<0.001). Patients were further classified into four groups according to consciousness levels: (1) normal at admission and one week afterwards, (2) impaired at admission but normal one week afterwards, (3) normal at admission but impaired one week afterwards, and (4) impaired both at admission and one week afterwards. The former two groups had significantly better survival than the latter two groups: (median survival counted from day 7 after admission), 25.5, 27.0, 7.0, and 7.0 days, respectively.
  
  
  CONCLUSIONS
  Consciousness levels one week after admission should be integrated into survival prediction in advanced cancer patients.
authors.affiliation: 1 Hospice and Palliative Care Unit, Department of Family Medicine, College of Medicine and Hospital, National Taiwan University , Taipei, Taiwan .
authors.forename: Jaw-Shiun
authors.initials: JS
authors.lastname: Tsai
authors.forename: Chao-Hsien
authors.initials: CH
authors.lastname: Chen
authors.forename: Chih-Hsun
authors.initials: CH
authors.lastname: Wu
authors.forename: Tai-Yuan
authors.initials: TY
authors.lastname: Chiu
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.forename: Chin-Hao
authors.initials: CH
authors.lastname: Chang
authors.forename: Shou-Hung
authors.initials: SH
authors.lastname: Hung
authors.forename: Ya-Ping
authors.initials: YP
authors.lastname: Lee
authors.forename: Ching-Yu
authors.initials: CY
authors.lastname: Chen
mesh_terms: D000368:Aged; D003243:Consciousness / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000145:classification* / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D010166:Palliative Care / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D013624:Taiwan; D013997:Time Factors