Cancer Research and Treatment

Special Article

Management of Physical Symptoms in Patients with Advanced Cancer during the Last Weeks and Days of Life: Ahsan Azhar, David Hui; Cancer Res Treat. 2022;54(3):661-670. Published online June 30, 2022; DOI: https://doi.org/10.4143/crt.2022.143

Patients with advanced cancer are faced with many devastating symptoms in the last weeks and days of life, such as pain, delirium, dyspnea, bronchial hypersecretions (death rattle) and intractable seizures. Symptom management in the last weeks of life can be particularly challenging because of the high prevalence of delirium complicating symptom assessment, high symptom expression secondary to psychosocial and spiritual factors, limited life-expectancy requiring special considerations for prognosis-based decision-making, and distressed caregivers. There is a paucity of research involving patients in the last weeks of life, contributing to substantial variations in clinical practice. In this narrative review, we shall review the existing literature and provide a practical approach to in-patient management of several of the most distressing physical symptoms in the last weeks to days of life.

Citations

Citations to this article as recorded by

Nursing Practice for Patients with Cancer Pain with Predicted Prognosis of Months or Weeks: A Multicenter Cross-Sectional Study in Japan
Miharu Morikawa, Masamitsu Kobayashi, Kohei Kajiwara, Kimiko Nakano, Yusuke Kanno, Yoshinobu Matsuda, Jun Kako
Palliative Medicine Reports.2025; 6(1): 129. CrossRef
Comparing the use of aggressive end-of life care among frail and non-frail patients with cancer using a claims-based frailty index
Rishi Sachdev, Galen Shearn-Nance, Long Vu, Wyatt P. Bensken, Sara L. Douglas, Siran M. Koroukian, Johnie Rose
Journal of Geriatric Oncology.2024; 15(2): 101706. CrossRef

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Review Article

Prognostication of the Last Days of Life: Masanori Mori, Tatsuya Morita, Eduardo Bruera, David Hui; Cancer Res Treat. 2022;54(3):631-643. Published online March 30, 2022; DOI: https://doi.org/10.4143/crt.2021.1573

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Accurate prediction of impending death (i.e., last few days of life) is essential for terminally-ill cancer patients and their families. International guidelines state that clinicians should identify patients with impending death, communicate the prognosis with patients and families, help them with their end-of-life decision-making, and provide sufficient symptom palliation. Over the past decade, several national and international studies have been conducted that systematically investigated signs and symptoms of impending death as well as how to communicate such a prognosis effectively with patients and families. In this article, we summarize the current evidence on prognostication and communication regarding the last days of life of patients with cancer, and future directions of clinical research.

Citations

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Case report: Poor prognosis or poor prognostication?
Jacqueline Tschanz, Rida Khan, Eduardo Bruera
Palliative and Supportive Care.2025;[Epub] CrossRef
Effectiveness of palliative postural care in alleviating pain and psychological distress in terminal cancer patients
Jia Fu, Yu Liu, Mei Zhang, Lili He
Asian Journal of Surgery.2025; 48(5): 3253. CrossRef
Determining timeframes to death for imminently dying patients: a retrospective cohort study
Tricia O’Connor, Wai-Man Liu, Juliane Samara, Joanne Lewis, Karen Strickland, Catherine Paterson
BMC Palliative Care.2025;[Epub] CrossRef
High specificity clinical signs of impending death: A scoping review
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International Journal of Nursing Studies.2025; 164: 105015. CrossRef
Antibiotics at life’s end: key role in treating end-of-life pneumonia?
Thibaut Fraisse, Alain Putot, Emmanuel Forestier, Gaëtan Gavazzi, Petra Vayne-Bossert, Claire Roubaud-Baudron, Virginie Prendki
Expert Review of Respiratory Medicine.2025; 19(4): 279. CrossRef
Prevalence of Triggers and Patient Harm Identified by Global Trigger Tool in Specialized Palliative Care
Olav Magnus S. Fredheim, Espen Klingenberg, Anne Karin Lindahl
Journal of Palliative Medicine.2024; 27(6): 742. CrossRef
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Matteo Moroni, Massimo Melo, Raffaella Antonione, Massimo Fantoni, Roberto Luzzati, Massimiliano Lanzafame, Rita Murri, Fabio Gilioli, Francesco Dentali, Dario Manfellotto, Biancamaria Fraccaro, Luigi Patil
Italian Journal of Medicine.2024;[Epub] CrossRef
Using Performance Status to Identify Risk of Acute Care Transfer in Inpatient Cancer Rehabilitation
Keara McNair, Amanda Botticello, Michael D. Stubblefield
Archives of Physical Medicine and Rehabilitation.2024; 105(5): 947. CrossRef
Indian Society of Critical Care Medicine and Indian Association of Palliative Care Expert Consensus and Position Statements for End-of-life and Palliative Care in the Intensive Care Unit
Sudeep Gupta, Arun Kumar, Roli Mathur, Roop Gursahani, Sushma Bhatnagar, Jayita Deodhar, Prashant Nasa, Raj Kumar Mani, Naveen Salins, Priyadarshini Kulkarni, Srinagesh Simha, Jigeeshu V Divatia, Sheila N Myatra, Dhvani Mehta, Rajani S Bhat, Savita Butola
Indian Journal of Critical Care Medicine.2024; 28(3): 200. CrossRef
Comparison of Prognostic Abilities of Palliative Prognostic Index, Laboratory Prognostic Score, and Palliative Prognostic Score
Norihiro Yuasa, Natsuko Kawai, Junichi Takamizawa
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Management of Infections in Palliative Care Patients at the End-of-Life and Active Process of Death: A Brazilian Retrospective Study
Isabela Fernandes de Aguiar Tonetto, Angelita Maria Stabile, Dieyeni Yuki Kobayasi, Rita de Cássia Quaglio, Ana Carolina de Souza, Fabiana Bolela
Palliative Medicine Reports.2024; 5(1): 324. CrossRef
Fatores Associados ao Karnofsky Performance Status e sua Trajetória no Último Mês de Vida em Pacientes com Câncer Terminal
Andrezza Helena Regadas Muniz, Karla Santos da Costa Rosa, Juliana Miranda Dutra de Resende, Simone Garruth dos Santos Machado Sampaio, Livia Costa de Oliveira
Revista Brasileira de Cancerologia.2023;[Epub] CrossRef
‘It’s not just about me’: a qualitative study of couples’ narratives about home death when one of the partners is dying of cancer
Margareta Aurén-Møkleby, Lisbeth Thoresen, Anne Marit Mengshoel, Kari N. Solbrække, Gunvor Aasbø
Palliative Care and Social Practice.2023;[Epub] CrossRef
Appetite and its association with mortality in patients with advanced cancer – a Post-hoc Analysis from the Palliative D-study
Charlotte Goodrose-Flores, Stephanie E. Bonn, Caritha Klasson, Maria Helde Frankling, Ylva Trolle Lagerros, Linda Björkhem-Bergman
BMC Palliative Care.2023;[Epub] CrossRef
Overtreatment in end-of-life care: how can we do better?
Linda Björkhem-Bergman
Acta Oncologica.2022; 61(12): 1435. CrossRef

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637 Download
12 Web of Science
15 Crossref

Original Article

Frequency and Outcome of Neuroleptic Rotation in the Management of Delirium in Patients with Advanced Cancer: Seong Hoon Shin, David Hui, Gary Chisholm, Jung Hun Kang, Julio Allo, Janet Williams, Eduardo Bruera; Cancer Res Treat. 2015;47(3):399-405. Published online November 24, 2014; DOI: https://doi.org/10.4143/crt.2013.229

Abstract PDF PubReader ePub

Purpose
The response to haloperidol as a first-line neuroleptic and the pattern of neuroleptic rotation after haloperidol failure have not been well defined in palliative care. The purpose of this study was to determine the efficacy of haloperidol as a first-line neuroleptic and the predictors associated with the need to rotate to a second neuroleptic. Materials and Methods We conducted a retrospective review of the charts of advanced cancer patients admitted to our acute palliative care unit between January 2012 and March 2013. Inclusion criteria were a diagnosis of delirium and first-line treatment with haloperidol. Results Among 167 patients with delirium, 128 (77%) received only haloperidol and 39 (23%) received a second neuroleptic. Ninety-one patients (71%) who received haloperidol alone improved and were discharged alive. The median initial haloperidol dose was 5 mg (interquartile ranges [IQR], 3 to 7 mg) and the median duration was 5 days (IQR, 3 to 7 days). The median final haloperidol dose was 6 mg (IQR, 5 to 7 mg). A lack of treatment efficacy was the most common reason for neuroleptic rotation (87%). Significant factors associated with neuroleptic rotation were inpatient mortality (59% vs. 29%, p=0.001), and being Caucasian (87% vs. 62%, p=0.014). Chlorpromazine was administered to 37 patients (95%) who were not treated successfully by haloperidol. The median initial chlorpromazine dose was 150 mg (IQR, 100 to 150 mg) and the median duration was 3 days (IQR, 2 to 6 days). Thirteen patients (33%) showed reduced symptoms after the second neuroleptic. Conclusion Neuroleptic rotation from haloperidol was only required in 23% of patients with delirium and was associated with inpatient mortality and white race.

Citations

Citations to this article as recorded by

Naming racism as a root cause of inequities in palliative care research: a scoping review
Kavita Algu, Joshua Wales, Michael Anderson, Mariam Omilabu, Thandi Briggs, Allison M. Kurahashi
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Management of Physical Symptoms in Patients with Advanced Cancer during the Last Weeks and Days of Life
Ahsan Azhar, David Hui
Cancer Research and Treatment.2022; 54(3): 661. CrossRef
Chlorpromazine as Treatment for Refractory Agitation Associated with Pediatric Delirium
Shin Young Kim, Shari Simone, Omayma A. Kishk, Ana Lia Graciano, Hyunuk Seung, Sarah Edwards
The Journal of Pediatric Pharmacology and Therapeutics.2022; 27(8): 725. CrossRef
Pharmacological and non-pharmacological treatment of delirium in an oncological hospital service: an integrative review
Luciana Aparecida Vieira Louro, João Francisco Possari, Antônio Fernandes Costa Lima
Revista Brasileira de Enfermagem.2021;[Epub] CrossRef
Neuroleptic strategies for terminal agitation in patients with cancer and delirium at an acute palliative care unit: a single-centre, double-blind, parallel-group, randomised trial
David Hui, Allison De La Rosa, Annie Wilson, Thuc Nguyen, Jimin Wu, Marvin Delgado-Guay, Ahsan Azhar, Joseph Arthur, Daniel Epner, Ali Haider, Maxine De La Cruz, Yvonne Heung, Kimberson Tanco, Shalini Dalal, Akhila Reddy, Janet Williams, Sapna Amin, Terri
The Lancet Oncology.2020; 21(7): 989. CrossRef
A Scoping Review to Map Empirical Evidence Regarding Key Domains and Questions in the Clinical Pathway of Delirium in Palliative Care
Peter G. Lawlor, Nicole A. Rutkowski, Alistair R. MacDonald, Mohammed T. Ansari, Lindsey Sikora, Franco Momoli, Salmaan Kanji, David K. Wright, Erin Rosenberg, Annmarie Hosie, Jose L. Pereira, David Meagher, Jill Rice, John Scott, Shirley H. Bush
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Prevalencia de delirium mediante la escala Memorial Delirium Assessment Scale (MDAS) en pacientes oncológicos avanzados ingresados en una Unidad de Cuidados Paliativos. Factores de riesgo, reversibilidad y tratamiento recibido
Verónica Díaz García, Miriam López Pérez, Yolanda Zuriarrain Reyna
Medicina Paliativa.2018; 25(4): 245. CrossRef
Clinical Assessment and Management of Delirium in the Palliative Care Setting
Shirley Harvey Bush, Sallyanne Tierney, Peter Gerard Lawlor
Drugs.2017; 77(15): 1623. CrossRef
Delirium Management: Diagnosis, Assessment, and Treatment in Palliative Care
Min Seok Seo, Yong Joo Lee
The Korean Journal of Hospice and Palliative Care.2016; 19(3): 201. CrossRef
Neuroleptics in the management of delirium in patients with advanced cancer
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Current Opinion in Supportive & Palliative Care.2016; 10(4): 316. CrossRef
Acute symptomatic complications among patients with advanced cancer admitted to acute palliative care units: A prospective observational study
David Hui, Renata dos Santos, Suresh Reddy, Maria Salete de Angelis Nascimento, Donna S Zhukovsky, Carlos Eduardo Paiva, Shalini Dalal, Everaldo Donizeti Costa, Paul Walker, Heloisa Helena Scapulatempo, Rony Dev, Camila Souza Crovador, Maxine De La Cruz,
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