%0 Journal Article
%T Cancer Trajectories at the End of Life: is there an effect of age and gender?
%A Massimo Costantini
%A Monica Beccaro
%A Irene J Higginson
%J BMC Cancer
%D 2008
%I BioMed Central
%R 10.1186/1471-2407-8-127
%X In a mortality follow-back survey (the Italian Survey of the Dying of Cancer ¨C ISDOC) a random sample of 1,271 lay caregivers were interviewed, at a mean of 234 days after bereavement. The main outcome was number of days before death when the patient experienced a permanent functional decline.1,249 (98%) caregivers answered the question about patient's function. The probability to be free from a functional disability was high (94%) 52 weeks before death, but was lower for older age groups (15% for those aged 85 or more) and women (8%). It remained stable until 18 weeks before death, then fell to 63% at 12 weeks and 49% at 6 weeks before death (among those aged 85 or more the figures were 50% and 41%). The pattern was consistent across sub-groups, except for patients affected by Central Nervous System tumors who experienced a longer, slower functional decline.This study provides empirical support for the declining trajectory in cancer, and suggests that the decline commences at around 12 weeks in all age groups, even among patients over 85 years.Although functional status is a well know prognostic indicator in cancer [1-3], the pattern of decline is less well understood. In 2003, Lunney et al. proposed a model of theoretical patterns of functional decline at the end of life, showing four main trajectories, sudden death, terminal illness, organ failure and frailty [4]. The authors analysis, and a previous study [5], suggested most people dying from cancer fell into the category of 'terminal illness', which showed high function early in their final year, but marked more disability three months prior to death. These results, derived from cross-sectional studies, have not yet been re-tested in other research with different designs. The trajectories are now being used to underpin government strategies in many countries to help determine eligibility for hospice and palliative care services. Following USA trends, European Clinicians are being encouraged to use changing func
%U http://www.biomedcentral.com/1471-2407/8/127