title: Depressive symptoms in the last days of life of patients with cancer: a nationwide retrospective mortality study.
abstract: OBJECTIVE
  Depressive symptoms are common in patients with cancer and tend to increase as death approaches. The study aims were to examine the prevalence of depressive symptoms in patients with cancer in their final 24 h, and their association with other symptoms, sociodemographic and care characteristics.
  
  
  METHODS
  A stratified sample of deaths was drawn by Statistics Netherlands. Questionnaires on patient and care characteristics were sent to the physicians (N=6860) who signed the death certificates (response rate 77.8%). Adult patients with cancer with non-sudden death were included (n=1363). Symptoms during the final 24 h of life were assessed on a 1-5 scale and categorised as 1=no, 2-3=mild/moderate and 4-5=severe/very severe.
  
  
  RESULTS
  Depressive symptoms were registered in 37.6% of the patients. Patients aged 80 years or more had a reduced risk of having mild/moderate depressive symptoms compared with those aged 17-65 years (OR 0.70; 95% CI 0.50 to 0.99). Elderly care physicians were more likely to assess patients with severe/very severe depressive symptoms than patients with no depressive symptoms (OR 4.18; 95% CI 1.48 to 11.76). Involvement of pain specialists/palliative care consultants and psychiatrists/psychologists was associated with more ratings of severe/very severe depressive symptoms. Fatigue and confusion were significantly associated with mild/moderate depressive symptoms and anxiety with severe/very severe symptoms.
  
  
  CONCLUSIONS
  More than one-third of the patients were categorised with depressive symptoms during the last 24 h of life. We recommend greater awareness of depression earlier in the disease trajectory to improve care.
authors: European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
authors: Elene
authors: E
authors: Janberidze
authors: Department of Public and Occupational Health, VU University Medical Center, and EMGO+ Institute for Health and Care Research, VUmc Expertise Center for Palliative Care, Amsterdam, Netherlands.
authors: Sandra Martins
authors: SM
authors: Pereira
authors: European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Regional Centre for Excellence in Palliative Care, South Eastern Norway, Oslo University Hospital, Oslo, Norway.
authors: Marianne Jensen
authors: MJ
authors: Hjermstad
authors: European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
authors: Anne Kari
authors: AK
authors: Knudsen
authors: European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
authors: Stein
authors: S
authors: Kaasa
authors: Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Agnes
authors: A
authors: van der Heide
authors: Department of Public and Occupational Health, VU University Medical Center, and EMGO+ Institute for Health and Care Research, VUmc Expertise Center for Palliative Care, Amsterdam, Netherlands.
authors: Bregje
authors: B
authors: Onwuteaka-Philipsen
mesh_terms: D000369:Aged, 80 and over; D003863:Depression / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D019452:Terminally Ill / Q000523:psychology*
keywords: Cancer; Depressive symptoms; End-of-life; Palliative care