Dying trajectory in the last year of life: does cancer trajectory fit other diseases?

Abstract

To examine differences in the pattern of functional decline among persons dying of cancer and other leading noncancer causes of death. Mortality followback survey of next of kin listed on death certificate. Probability sample of all deaths in the United States. Next of kin for 3,614 decedents that represented 914,335 deaths. Days of difficulty with activities of daily living and mobility in the last year of life. Relative to other decedents, patients with cancer experienced an increased rate of functional impairment beginning as late as 5 months prior to death. For example, only 13.9% of patients with cancer had difficulty getting out of bed or a chair 1-year prior to death. This increased from 22.2% to 63.0% in the last five months of life. In contrast, decedents from other diseases had higher rates of functional impairment 1 year prior to death (approximately 35% had difficulty getting out of bed or chair) and they manifested a more gradual increase in the level of functional decline (approximately 50% had difficulty getting out of bed). Precipitous functional decline was associated with hospice involvement and dying at home. Persons dying of cancer experienced sharp functional decline in the last months of life whereas other decedents' have a more gradual decline. The more precipitous functional decline was associated with hospice involvement and dying at home.