Table 3.
Monthly Proportion of Use of Palliative Care and Concurrent Cancer-Directed Therapy, Overall and Six Months Before Death (N = 14,343)
| Month Before Death | ||||||||
|---|---|---|---|---|---|---|---|---|
| Symptom | Medication | EOL-6 | EOL-5 | EOL-4 | EOL-3 | EOL-2 | EOL-1 | Change (EOL-6-EOL-1) |
| Dyspnea | Any | 61.1 | 62.4 | 63.2 | 65.4 | 68.9 | 80.1 | 19 |
| Inhaled bronchodilators or corticosteroids | 29.7 | 30.0 | 30.3 | 30.8 | 31.9 | 39.9 | 10.2 | |
| Diuretics | 18.1 | 18.3 | 18.9 | 19.6 | 20.2 | 32.2 | 14.1 | |
| Oral COPD/asthma | 3.9 | 3.9 | 4.1 | 4.4 | 4.4 | 6.1 | 2.2 | |
| Secretion management | 0.2 | 0.1 | 0.1 | 0.1 | 0.2 | 0.7 | 0.6 | |
| Pain | Any | 42.6 | 42.9 | 44.3 | 46.4 | 50.7 | 63.3 | 20.7 |
| Opioids | 34.5 | 35.0 | 36.2 | 38.6 | 43.7 | 55.7 | 21.2 | |
| Short-acting opioids | 31.6 | 32.8 | 34.1 | 36.3 | 41.0 | 52.5 | 21 | |
| Long-acting opioids | 4.3 | 5.2 | 5.8 | 6.7 | 8.0 | 16.7 | 12.4 | |
| Nonopioid | 15.9 | 15.8 | 16.3 | 16.8 | 17 | 23.8 | 7.8 | |
| NSAIDs | 6.2 | 5.8 | 6.1 | 6.3 | 6.3 | 8.4 | 2.3 | |
| Local anesthetics | 2.3 | 2.3 | 2.3 | 2.3 | 2.7 | 4.0 | 1.8 | |
| Adjuvant | 9.1 | 9.2 | 9.6 | 9.9 | 9.9 | 14.7 | 5.6 | |
| Antiepileptics | 7.7 | 7.8 | 8.3 | 8.6 | 8.6 | 13.1 | 5.4 | |
| Selected antidepressantsa | 1.6 | 1.6 | 1.5 | 1.6 | 1.5 | 2.2 | 0.5 | |
| Emotional distress | Any | 37.8 | 37.8 | 37.9 | 37.8 | 38.7 | 48.9 | 11.1 |
| Antidepressants | 16.9 | 17.5 | 17.9 | 18.6 | 19.8 | 28.9 | 12 | |
| Anxiolytics/sedatives | 25.2 | 24.7 | 24.3 | 23.6 | 23.7 | 28.4 | 3.1 | |
| Antipsychotics | 2.4 | 2.5 | 2.5 | 2.6 | 2.7 | 4.8 | 2.4 | |
| Fatigue | Any | 13.0 | 14.1 | 14.7 | 15.6 | 16.3 | 20.8 | 7.8 |
| Other—methylphenidate | 0.3 | 0.2 | 0.2 | 0.3 | 0.3 | 0.6 | 0.3 | |
| Transfusions (RBC) | 6.4 | 7.2 | 7.7 | 8.8 | 10.1 | 16.5 | 10.2 | |
| ESAs | 7.9 | 8.4 | 8.6 | 8.7 | 8.1 | 6.1 | −1.8 | |
| Anorexia | Appetite stimulant | 5.1 | 5.8 | 6.5 | 7.6 | 9.2 | 17.3 | 12.2 |
| Nausea/vomiting | Any | 10.0 | 10.5 | 11.5 | 12.7 | 15.0 | 19.6 | 9.7 |
| Serotonin (5-HT3) antagonists | 6.5 | 6.7 | 7.5 | 8.4 | 9.5 | 11.4 | 5 | |
| Neurokinin-1 antagonist | 0.5 | 0.4 | 0.6 | 0.6 | 0.5 | 0.4 | −0.1 | |
| Compazine/promethazine | 3.5 | 3.6 | 3.9 | 4.2 | 5.1 | 7.3 | 3.8 | |
| Cannabinoid | 0.2 | 0.3 | 0.4 | 0.5 | 0.6 | 1.4 | 1.1 | |
| Other—metoclopramide | 1.1 | 1.1 | 1.3 | 1.4 | 1.7 | 3 | 1.9 | |
| Oral corticosteroids | Oral corticosteroids | 10.3 | 11.0 | 12.1 | 14.1 | 17.6 | 30.1 | 19.8 |
EOL = end of life; COPD = chronic obstructive pulmonary disease; NSAIDS = nonsteroidal anti-inflammatory drugs; RBC = red blood cell; ESAs = erythropoietin-stimulating agents; 5-HT3 = 5-hydroxytryptamine 3.
a
Includes amitriptyline, desipramine, and nortriptyline. All changes in the percentage receiving medications from EOL-6 to EOL-1 are significant at P < 0.001.
Source: Surveillance, Epidemiology, and End Results–Medicare database, 2007–2013.