Depressive symptoms in the last days of life of patients with cancer: A nationwide retrospective mortality study

Elene Janberidze, Sandra Martins Pereira, Marianne Jensen Hjermstad, Anne Kari Knudsen, Stein Kaasa, Agnes van der Heide, Bregje Onwuteaka-Philipsen, Luc Deliens, Lieve Van den Block, Zeger De Groote, Joachim Cohen, Koen Pardon, Anneke Francke, Roeline Pasman, Richard Harding, Irene J. Higginson, Sarah Brearley, Sheila Payne, Augusto Caraceni, FondazioneGuido Miccinesi, Sophie Pautex, Karen Linden

Research output: Contribution to journalArticlepeer-review


Objectives Depressive symptoms are common in patients with cancer and tend to increase as death approaches. The study aims were to examine the prevalence of depressive symptoms in patients with cancer in their final 24 h, and their association with other symptoms, sociodemographic and care characteristics. Methods A stratified sample of deaths was drawn by Statistics Netherlands. Questionnaires on patient and care characteristics were sent to the physicians (N=6860) who signed the death certificates (response rate 77.8%). Adult patients with cancer with non-sudden death were included (n=1363). Symptoms during the final 24 h of life were assessed on a 1-5 scale and categorised as 1=no, 2-3=mild/moderate and 4-5=severe/very severe. Results Depressive symptoms were registered in 37.6% of the patients. Patients aged 80 years or more had a reduced risk of having mild/ moderate depressive symptoms compared with those aged 17-65 years (OR 0.70; 95% CI 0.50 to 0.99). Elderly care physicians were more likely to assess patients with severe/very severe depressive symptoms than patients with no depressive symptoms (OR 4.18; 95% CI 1.48 to 11.76). Involvement of pain specialists/palliative care consultants and psychiatrists/psychologists was associated with more ratings of severe/very severe depressive symptoms. Fatigue and confusion were significantly associated with mild/moderate depressive symptoms and anxiety with severe/very severe symptoms. Conclusions More than one-third of the patients were categorised with depressive symptoms during the last 24 h of life. We recommend greater awareness of depression earlier in the disease trajectory to improve care.

Original languageEnglish
Pages (from-to)201-209
Number of pages9
JournalBMJ Supportive and Palliative Care
Issue number2
Publication statusPublished - Jun 1 2016

ASJC Scopus subject areas

  • Medical–Surgical
  • Oncology(nursing)
  • Medicine (miscellaneous)


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