The End Stage Cancer Patient: Terminal Common Pathway

Abstract
Measures of symptom prevalence, awareness, physical function and quality of life associated with terminal cancer were collected during the National Hospice Study. Symptoms were common in terminal patients: pain 60%, dyspnea 64%, fever 35%, nausea or vomiting 44%, constipation 52%, diarrhea 27%, weight loss 84%, and anorexia 90%, and virtually no one was asymptomatic. The prevalence of fever, dyspnea, anorexia and weight loss increased by 12 to 15% during the last six weeks of life while pain, nausea or vomiting, constipation, and diarrhea changed very little. Only 12% experienced complete mental incapacitation, however a progressive deterioration of ability to function and decline in quality of life were observed in a much larger proportion of patients. When specific types of cancers or selected anatomic sites of cancer involvement were considered, only small deviations from average symptom prevalence rates were noted, suggesting a terminal common pathway for all cancers. The findings are important because they confirm the notion that terminal cancer patients require a substantial amount of palliative care to suppress or alleviate any discomfort caused by symptoms of advanced cancer.