Trajectories of Suffering in the Last Year of Life Among Patients With a Solid Metastatic Cancer

Background: Reducing suffering at the end of life is important. Doing so requires a comprehensive understanding of the course of suffering for patients with cancerduring their last year of life. This study describes trajectories of psychological, spiritual, physical, and functional suffer-ing in the last year of life among patients with a solid metastatic cancer. Patients and Methods: We conducted a prospective cohort study of 600 patients with a solid metastatic cancer between July 2016 and December 2019 in Singapore. We assessed patients' psychological, spiritual, physical, and functional suffering every 3 months until death. Data from the last year of life of 345 decedents were analyzed. We used group-based multitrajectory modeling to delineate trajectories of suffering during the last year of a patient's life. Results: We identified 5 trajectories representing suffering: specialIntscript persistently low (47% of the sample); specialIntscript slowly increasing (14%); specialIntscript predominantly spiritual (21%); specialIntscript rapidly increasing (12%); and specialIntscript persistently high (6%). Compared with patients with primary or less education, those with secondary (high school) (odds ratio [OR], 3.49; 95% CI, 1.05-11.59) education were more likely to have rapidly increasing versus persistently low suf-fering. In multivariable models adjusting for potential confounders, compared with patients with persistently low suffering, those with rap-idly increasing suffering had more hospital admissions (beta=0.24; 95% CI, 0.00-0.47) and hospital days (beta=0.40; 95% CI, 0.04-0.75) during the last year of life. Those with persistently high suffering had more hospital days (beta=0.70; 95% CI, 0.23-1.17). Conclusions: The course of suffering during the last year of life among patients with cancer is variable and related to patients' hospitalizations. Understanding this variation can facilitate clinical decisions to minimize suffering and reduce health-care costs at the end of life.

Automated summary

This study observed 600 patients with solid metastatic cancer and identified five trajectories of suffering in the last year of life, including persistently low, slowly increasing, predominantly spiritual, rapidly increasing, and persistently high. Patients with higher education were more likely to experience rapidly increasing suffering. The severity of suffering in the last year of life was associated with hospital admissions.