Trajectories of physical symptom burden and psychological distress during the last year of life in patients with a solid metastatic cancer

Objective To delineate the trajectories of physical symptoms and psychological distress among patients with a solid metastatic cancer during the last year of life. Methods We used data of 345 decedents from a prospective cohort of 600 patients with a Stage IV solid cancer. Using group-based trajectory modelling, we assessed (a) demographic (age, gender, education, cancer site) predictors of trajectory membership, (b) shift in trajectories associated with planned and unplanned hospitalizations, emergency room visits and chemotherapy, and (c) the association between trajectory membership and place of death. Results We identified three trajectories of physical symptoms-persistent mild (56%), progressive moderate (36%), and progressive severe (8%), and two for psychological distress-persistent mild (72%) and progressive distress (28%). Females (beta = 1.40 [SE = 0.55], p-value = 0.01) and highly educated patients (beta = 1.46 [SE = 0.62], p-value = 0.02) were more likely to experience progressive severe symptoms compared to persistent mild symptoms. Older patients were less likely (beta = -1.01 [SE = 0.33], p-value = 0.003), while those with gynecological cancers (beta = 1.51 [SE = 0.65], p-value = 0.02) were more likely to experience progressive distress compared to persistent mild distress. Planned and unplanned hospitalizations, emergency room visits, and chemotherapy were associated with a worsening in trajectories. Patients with higher distress were more likely to die in a hospice compared to a hospital. Conclusions Interventions to improve physical symptoms and distress can focus on patients at risk of being in worse trajectories and at critical time points in the last year of life-hospitalizations, emergency room visits, and chemotherapy.

Automated summary

The study identified three trajectories of physical symptoms and two trajectories of psychological distress among patients with advanced metastatic cancer. Factors such as gender, age, and education influenced the development of these trajectories, while hospitalizations, emergency room visits, and chemotherapy were associated with the worsening of symptoms and distress trajectories. Patients with higher distress levels were more likely to die in a hospice setting compared to hospital.