title: Age differences in the last week of life in advanced cancer patients followed at home.
abstract: A retrospective analysis of a consecutive sample of patients admitted to a home care program was performed. Data were recorded in the last week through a backward analysis from the day before death as follows: 1 week before dying (-1W), 3 days before death (-3D), and the day before dying (-1D). Data to be collected included the Edmonton Symptom Assessment System (ESAS), background pain intensity, the prevalence of breakthrough pain, the use of opioids in the last week, and the need for palliative sedation, with indications, duration, and drugs used. Patients were distributed according to the following age ranges: adults (<65 years, A) and aged (≥65 years, O). Of the latter group, three subgroups were assessed: old (65-74 years, O1), very old (75-84 years, O2), and the oldest (≥85 years, O3). Four hundred eleven patients were assessed. At -W1, no statistical differences in intensity of ESAS items ≥4 among the age subgroups were found. For ESAS values at -1W, -3D, and -1D, no statistical differences were found unless for anorexia at -1W (p = 0.000) (more likely), depression at -3D (p = 0.000) (less likely), depression (p = 0.000), and dyspnea (p = 0.01) (less likely) at -1D in the oldest group (O3). No differences in pain intensity among the groups were found (p = 0.54). Opioid doses increased in time and were significantly lower in older patients (p = 0.000). The subcutaneous route was more frequently used at -3D and -1D in older patients. No differences in opioid switching were found among the groups (p = 0.56). Adult patients required more often palliative sedation (p = 0.003). Older patients have problems relatively similar to adult patients in the last week of life, unless for some symptoms. Older patients had also a lower opioid consumption, a more frequent use of the subcutaneous route, and a lower need for palliative sedation.
authors.affiliation: Anesthesia and Intensive Care & Pain Relief and Supportive Care, La Maddalena Cancer Center and University of Palermo, Palermo, Italy. terapiadeldolore@lamaddalenanet.it.|Anesthesia & Intensive Care Unit and Pain Relief & Palliative Care Unit, La Maddalena Cancer Center, Via San Lorenzo 312, 90146, Palermo, Italy. terapiadeldolore@lamaddalenanet.it.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Mercadante
authors.affiliation: "L'Aquila per la Vita" Home Care Unit and Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Aielli
authors.affiliation: Department of Applied Clinical Sciences and Biotechnology, Section of Clinical Epidemiology and Environmental Medicine, University of L'Aquila, L'Aquila, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Masedu
authors.affiliation: Department of Applied Clinical Sciences and Biotechnology, Section of Clinical Epidemiology and Environmental Medicine, University of L'Aquila, L'Aquila, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Valenti
authors.affiliation: "L'Aquila per la Vita" Home Care Unit and Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy.
authors.forename: Lucilla
authors.initials: L
authors.lastname: Verna
authors.affiliation: "L'Aquila per la Vita" Home Care Unit and Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy.
authors.forename: Giampiero
authors.initials: G
authors.lastname: Porzio
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care / Q000379:methods*; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods*
keywords: Cancer pain; End of life; Last week; Opioids; Palliative sedation; Symptoms