Purpose:This study aimed to assess the current status of clinical practice of refractory cancer pain (RCP) among a sample of physicians specializing in cancer pain management in Shanghai.Methods:From 2019 to 2021, a questionnaire survey was conducted among physicians engaged in diagnosis and treatment of cancer pain through the questionnaire WJX network platform in Shanghai, China.Results:A total of 238 responses participated in the survey. This survey reports physicians' understanding and incidence rate of breakthrough cancer pain (BTCP). The choice of analgesics and satisfaction of analgesic effect were investigated. We also investigated doctors' knowledge of the diagnostic criteria for RCP and their tendency to choose analgesics. Oral immediate-release morphine and intravenous or subcutaneous morphine injection have been the common treatment approach for transient cancer pain exacerbations. The main barriers to pain management are lack of standardized treatment methods for RCP, lack of knowledge related to RCP, and single drug dosage form. Doctors believe the most necessary measures to improve the current situation of poor cancer pain control include improving medical staff's understanding and treatment techniques for RCP, updating treatment techniques and methods, and improving the configuration of drug types in medical institutions. Clinicians expect to improve understanding and treatment techniques through systematic training.Conclusion:Despite multiple available analgesic measures, the treatment of RCP remains challenging. Improving the understanding of medical staff towards RCP, improving treatment techniques, and increasing the accessibility of multiple drug types are important ways to improve the satisfaction of cancer pain management in the future.

OBJECTIVE:To prospectively study the accuracy of the palliative prognostic index (PPI) survival prediction model combined with Traditional Chinese Medicine (TCM) syndrome differentiation. METHODS:The PPI survival prediction model was used to predict survival time. Patients' real survival time was recorded. The survival time was calculated using the Kaplan-Meier method, and the logrank method was used to test the difference. RESULTS:The average PPI survival prediction score of 227 patients was 5.83 (95% CI: 5.29-6.37). There was a significant difference in the real-life period between the different PPI groups (P < 0.05). PPI group I (predicted survival of > 6 weeks) showed the highest predictive sensitivity and PPI group II (predicted survival of 3-6 weeks) showed the highest predictive specificity. According to TCM syndrome differentiation, 82 cases (36% ) were diagnosed with liver and kidney Yin deficiency (type IV). The actual survival time of type IV patients was significantly shorter than that of other types of patients (mean: 21.85 vs 28.70, P = 0.007). In group I, the median survival time of type IV patients and other types was 25 and 34 d, respectively (P < 0.001). The sensitivity and specificity of PPI prediction were improved in group II by TCM syndrome differentiation. For patients in group III whose predicted survival time was < 3 weeks, the specificity of PPI survival prediction was higher in type IV patients. CONCLUSION:This study shows that the PPI predictive tool for survival rate has important value. TCM syndrome differentiation and typing has certain significance for further classification and survival prediction.

LncRNA ELF3-AS1 has been characterized as an oncogenic lncRNA in bladder cancer and oral cancer, whereas its role in nonsmall cell lung cancer (NSCLC) is unknown. In this study, the authors observed that ELF3-AS1 was upregulated in NSCLC tissues in comparison with that in paired nontumor tissues collected from 68 NSCLC patients. High expression levels of ELF3-AS1 predicted the poor survival of NSCLC patients. Expression levels of miR-212 were inversely and significantly correlated with the expression levels of ELF3-AS1 across NSCLC tissue samples. In NSCLC cells, overexpression of ELF3-AS1 led to downregulated miR-212 and increased methylation of miR-212 gene. In addition, overexpression of ELF3-AS1 inhibited the role of miR-212 in suppressing cancer cell invasion and migration. Therefore, ELF3-AS1 is upregulated in NSCLC and promotes cancer cell invasion and migration by downregulating miR-212 through methylation.

Vasculogenic mimicry (VM) refers to a new tubular network of the blood supply system with abundant extracellular matrix. VM is similar to capillaries but does not involve endothelial cells. As a traditional herbal medicine commonly used in China, baicalein possesses anti-inflammatory and lipoxygenase activities. However, the effects of baicalein on the process of VM formation in non-small cell lung cancer (NSCLC) and the underlying mechanisms have remained poorly understood. In this study, baicalein was found to inhibit the viability and motility of A549 cells and induced the breakage of the cytoskeletal actin filament network. In addition, baicalein significantly decreased the formation of VM and downregulated the expressions of VM-associated factors, such as VE-cadherin, EphA2, MMP14, MMP2, MMP9, PI3K and LAMC2, similar to the effects of ROCK inhibitors. Indeed, baicalein inhibited RhoA/ROCK expression in vitro and in vivo, suggesting the underlying mechanisms of reduced VM formation. Collectively, baicalein suppressed the formation of VM in NSCLC by targeting the RhoA/ROCK signaling pathway, indicating that baicalein might serve as an emerging drug for NSCLC.

BACKGROUND For patients with metastatic cancer, treatment with palliative chemotherapy can lead to more aggressive end-of-life (EOL) care. This retrospective study aimed to assess the time from the last chemotherapy treatment to death and investigate the variables associated with the delivery of palliative chemotherapy near the end of life. METHODS Data from patients who died from metastatic cancer after receiving palliative chemotherapy from April 2007 to June 2019 at the Department of Integrated Therapy of Fudan University, Shanghai Cancer Center were analyzed. Statistical analysis was performed to evaluate variables including the patient's age, Charlson comorbidities, caregivers, and the type of cancer. RESULTS A total of 605 patients were included in the analysis, of whom 335 (58.7%) were treated with palliative chemotherapy during their last year of life and 16.2% were treated in their last month of life. Treatment with palliative chemotherapy in the last month was independently associated with age (P<0.001). In the last year of life, treatment with palliative chemotherapy differed significantly according to caregivers and age (P<0.001). The interval between the last chemotherapy treatment and death was the shortest for patients whose caregivers were adult children or those aged ≤50 years. CONCLUSIONS In this study, palliative chemotherapy was used to treat 58.7% of patients in their last year, and 16.2% of patients in their last month, which is in line with international recommendations. In the last month, palliative chemotherapy was independently associated with age (P<0.001), whereas patients were more likely to receive palliative chemotherapy in their last year if their caregivers were adult children or if they were aged ≤50 years. Significant variations in EOL treatment strategies were observed according to caregivers and patient age during the last year of life.

BACKGROUND:The American Society of Clinical Oncology recently recommends patients with metastatic non-small cell lung cancer (NSCLC) should be offered palliative care services earlier. We sought to investigate the timing of palliative care referral of Chinese patients with NSCLC in our center.METHOD:Retrospective medical data including demographic characteristics and referral information were collected for analysis. Overall survival (OS) was calculated as the time since cancer diagnosis till patient's death. The time interval from palliative care (PC) referral to a patient's death (PC-D) was calculated. The PC-D/OS ratio was calculated to illustrate the comparison of the duration of PC in the overall length of disease.RESULTS:The mean age of 155 patients with advanced NSCLC was 62.83 years. Before referral to PC, 128 patients received anticancer treatment including surgeon (46.5%). Sixty-three (40.6%) patients died in palliative care unit. The median OS of 144 patients with end cutoff was 19 months (mean = 31.49, 95% confidence interval [CI] = 25.86-37.12). The median PC-D was 41 days (mean = 73.84, 95% CI = 60.37-87.40). The mean interval of PC-D/OS of 144 patients with definitely death time was 0.22 (SD: 0.27, 95% CI: 0.17-0.26). The median interval was 0.089. More than half of patients (n = 75, 51.8%) underwent PC less than 1% time (PC-D/OS < 0.1) of their whole disease course. Patients who were indigenous to Shanghai (P = .013) and who had brain metastasis (P = .072) had the potential longer PC-D/OS ratio. A high proportion of patients reported loss of appetite (92.8%) and fatigue (91.4%) at the initial of referral to PC.CONCLUSION:This retrospective study, in a population of patients with advanced NSCLC, gave detailed information about PC services in a tertiary cancer center.

Background：This study is to analyze the occurrence and clinical characteristics of cancer pain in advanced non-small cell lung cancer (NSCLC) patients who referral to palliative care treatment, as well as correlation between pain performance and clinical characteristics, laboratory indicators, and previous treatment.Methods ：Advanced NSCLC patients referred to the Palliative Care Unit (PCU) from January of 2016 to December of 2018 were included in our study. The Brief Pain Inventory (BPI) was used to evaluate cancer pain (CP). Results: Of 54 (56.7%) patients reported with pain, there were 23 patients (42.6%) who suffered from severe pain (score >=7) at the admission. There was a significant difference in the frequency of pain between patients with and without bone metastasis (p= 0.006), between patients with more than two sites and non-more than two sites metastasis (p=0.032). Patients received epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKI) had lower pain prevalence (p=0.033). Patients with bone metastases (p=0.005), with more than two metastases (p=0.022) and those with higer C-reactive protein (CRP) index (p= 0.012) had higher mean scores of pain, with significant differences. Conclusions:Our study showed the general characteristics, pain performance and related factors of advanced NSCLC patients who referral to palliative care service. This study confirmed that these patents’ clinical manifestations of pain were correlated with bone metastasis, metastasis with more than two sites, elevated CRP, and the EGFR-TKI usage. Whether there is a certain potential connection between these factors deserves further study.

Background: Long noncoding RNA SNHG10 has been reported to promote the development of liver cancer, while by analyzing The Cancer Genome Atlas (TCGA) dataset we observed the downregulation of SNHG10 in non-small cell lung cancer (NSCLC). This study aimed to investigate the roles of SNHG10 in NSCLC. Materials and Methods: This study included 60 pairs of NSCLC and nontumor tissue samples collected from 60 NSCLC patients (males and females, 39-66 years, 50.9 ± 5.5 years). Gene expression was detected by quantitative polymerase chain reaction and western blot. Overexpression experiments were used to analyze gene interactions. Effects of cell transfections on cell proliferation were analyzed by performing CCK-8 cell proliferation assays. Results: We confirmed the downregulation of SNHG10 in NSCLC. In addition, low expression level of SNHG10 predicted the poor survival of NSCLC patients. SNHG10 can directly interact with miR-543, while overexpression of miR-543 failed to downregulate SNHG10. However, SNHG10 overexpression led to upregulation of sirtuin 1 (SIRT1), a downstream target of miR-543. Cell proliferation assay showed that SNHG10 and SIRT1 overexpression led to the decreased proliferation rate of NSCLC cells. In contrast, miR-543 over-expression played an opposite role and reduced the effects of SNHG10 and SIRT1 overexpression. Conclusions: In conclusion, SNHG10 sponges miR-543 to upregulate tumor suppressive SIRT1 in NSCLC to suppress cell proliferation.

Although palliative care has been accepted throughout the cancer trajectory, accurate survival prediction for advanced cancer patients is still a challenge. The aim of this study is to identify pre-palliative care predictors and develop a prognostic nomogram for overall survival (OS) in mixed advanced cancer patients. A total of 378 consecutive advanced cancer patients were retrospectively recruited from July 2013 to October 2015 in one palliative care unit in China. Twenty-three clinical and laboratory characters were collected for analysis. Prognostic factors were identified to construct a nomogram in a training cohort (n = 247) and validated in a testing cohort (n = 131) from the setting. The median survival time was 48.0 (95% CI: 38.1–57.9) days for the training cohort and 52.0 (95% CI: 34.6–69.3) days for the validation cohort. Among pre-palliative care factors, sex, age, tumor stage, Karnofsky performance status, neutrophil count, hemoglobin, lactate dehydrogenase, albumin, uric acid, and cystatin-C were identified as independent prognostic factors for OS. Based on the 10 factors, an easily obtained nomogram predicting 90-day probability of mortality was developed. The predictive nomogram had good discrimination and calibration, with a high C-index of 0.76 (95% CI: 0.73–0.80) in the development set. The strong discriminative ability was externally conformed in the validation cohort with a C-index of 0.75. A validated prognostic nomogram has been developed to quantify the risk of mortality for advanced cancer patients undergoing palliative care. This tool may be useful in optimizing therapeutic approaches and preparing for clinical courses individually.

Background: The C-reactive protein/albumin (CRP/Alb) ratio has been reported as a prognostic factor of survival for patients with a variety of cancers. However, its prognostic impact for advanced cancer patients receiving palliative care remains presently unknown. Objective: The present study assessed the prognostic value of the CRP/Alb ratio, and compared this with that of the Glasgow Prognostic Score (GPS) and Palliative Prognostic Index (PPI) in a cohort of advanced cancer patients receiving palliative therapy. Methods: The medical records of 262 eligible patients who died of advanced cancer from February 1, 2013 to December 30, 2017 in the palliative care unit of the Fudan University Shanghai Cancer Center were retrospectively reviewed for the analysis. Results: The present results revealed that a CRP/Alb ratio >= 1.31 (hazard ratio [HR], 2.33 [1.78-3.05], p < 0.001) can predict poor prognosis through univariate analysis. In addition, the multivariate analysis revealed that CRP/Alb (HR, 2.09 [1.54-2.84], p < 0.001), GPS (HR, 1.81 [1.07-3.07], p < 0.001), and PPI (HR, 3.35 [2.25-4.99], p < 0.001) were all independent prognosis factors. To compare the discriminatory performance of the CRP/Alb ratio with that of other established prognostic indexes in palliative care settings, the c-statistics, integrated discriminatory improvement index, net reclassification index, and receiver operating characteristic curves were generated, and it was demonstrated that the CRP/Alb ratio (c-statistics, 0.64 [0.61-0.68]) was able to discriminate advanced cancer patients with different survivals, with analogous discriminatory ability as GPS (c-statistics, 0.63 [0.59-0.66]) and PPI (c-statistics, 0.64 [0.60-0.68]). Notably, the combination of multiple prognostic indexes exerted higher discriminatory ability, compared with any single predictive index (c-statistics, 0.69 [0.66-0.73], p < 0.001). Conclusions: The present study suggests that the CRP/Alb ratio is a promising prognostic factor in predicting cancer patient survival in palliative care settings. Incorporating both objective parameters and the subjective index may improve the prediction accuracy of prognosis.

Objective To study the characteristic of 1H-magnetic resonance spectroscopy (～1H-MRS) on hippocampus in patients with postpartum depression (PPD). Methods 63 patients with PPD and 30 volunteers were scanned on a 1.5 T magnetic resonance scanner. The region of interest was placed on the hippocampus bilaterally, and the value of NAA/Cr, Cho/Cr was counted. Results The bilateral hippocampus NAA/Cr ratio was lower in moderate and severe PPD group compared with healthy control subjects and mild PPD group respectively (P＜0.05). There was no statistically significant difference on Cho/Cr ratio between the normal group, the mild PPD group and the moderate and severe PPD group (P＞0.05). Conclusion The change of NAA level in hippocampus is closely related to the occurrence of postpartum depression.

Background and purpose: Traditional Chinese Medicine (TCM) syndrome has different characteristics from symptom management of Western medicine. This study was focused on the characteristics of TCM syndrome in advanced cancer patients, and to study the correlation between TCM syndrome and Western medicine symptoms and their correlation with the survival time of patients. Methods: The symptom distribution and intensity of the patients were collected through MD Anderson Symptom Inventory-Chinese (MDASI-C). TCM syndrome was correlated by four ways of Chinese diagnosis (looking, listening, questioning and feeling the pulse). SPSS Statistical software package was used to analyze and process the data. Descriptive analysis was applied to the analysis of demographic and clinical characteristics. The t test and χ2 test were performed for patients with syndrome differentiation type Ⅳ and other groups. The survival time was calculated using Kaplan-Meier method, and log-rank test was performed to measure the difference. Results: According to TCM syndrome differentiation, 82 cases (36%) were diagnosed with liver and kidney Yin deficiency. Compared with the other 5 types, the frequency and intensity of fatigue and dyspnea were higher in patients with liver and kidney Yin deficiency. There was significant difference in survival time between type Ⅳ patients and other 5 type patients (P<0.05). Eastern Cooperative Oncology Group (ECOG) score and type Ⅳ TCM syndrome were the survival prognostic factors in advanced cancer patients. Conclusion: Through this study, we have enhanced the identification of TCM syndrome differentiation in the survival of patients with advanced cancer, and improved the accuracy of predicting the survival of patients with advanced cancer. In clinical work, TCM syndrome can be used to assist in the detection of disease changes. It may help clinicians to assess survival prognosis.

BACKGROUND:Although palliative chemotherapy during end-of-life (EOL) care is used to relieve symptoms in patients with metastatic cancer, chemotherapy may lead to more aggressive EOL care. We evaluated the use of and variables associated with chemotherapy at EOL.METHODS:This study included data from patients who died from advanced cancer and underwent palliative chemotherapy between April 2007 and May 2017 at the Department of Palliative Care of Fudan University, Shanghai Cancer Center. Data were collected from hospital medical records. Univariate and multivariate analyses were conducted to identify the variables that independently predicted the use of palliative chemotherapy.RESULTS:Among the 542 patients in the study, 85 (15.7%) underwent palliative chemotherapy during the last month and 28 (5.2%) underwent it during the last 2 weeks of life. Age <59 years (odds ratio [OR] = 1.82, 95% confidence interval [CI]: 1.51-2.61), performance status <3 (OR = 3.73, 95% CI: 1.46-4.67), and cardiopulmonary resuscitation (OR = 3.88, 95% CI: 3.01-5.34) were independently associated with the use of chemotherapy. The use of palliative chemotherapy during the last year of life differed significantly by patient age ( P < .001).CONCLUSION:The observed chemotherapy rates of 15.7% during the last month of life and 5.2% during the last 2 weeks of life are in line with international recommendations. This study showed that palliative chemotherapy is associated with more aggressive EOL care and indicates that younger patients and those with lower performance status are more likely to receive palliative chemotherapy. Significant variations in EOL treatment strategies among different age groups during the last year of life were also identified.

The lymphocytes played an important role in the natural history of cancer. The aim of this study was to explore the prognostic value of lymphocyte count and percentage for survival in advanced cancer patients receiving palliative care.

BACKGROUND:Administration of chemotherapy and radiotherapy near the end of life is a frequently discussed issue nowadays. We have evaluated the factors associated with the use of chemotherapy and radiotherapy at the end of life among terminally ill patients in China.METHODS:This study included the data from patients who had died from advanced cancer who underwent palliative chemotherapy and radiotherapy between January 2007 and December 2013 at the Department of Palliative Care of Fudan University, Shanghai Cancer Center. Data were collected from hospital medical records. Univariate and multivariate analyses were conducted to identify the factors independently associated with the use of chemo- and radiotherapy.RESULTS:Among the 410 patients included (median age, 68 years; range, 18-93; 53% males), 47 (11.5%) underwent palliative chemotherapy and 28 (6.8%) underwent radiotherapy in the last 30 days. Age <65 years (odds ratio [OR]: 1.33, 95% confidence interval [CI]: 1.06-2.88), performance status <3 (OR: 3.95; 95% CI: 1.56-5.07), and cardiopulmonary resuscitation (OR: 4.09, 95% CI: 2.66-5.34) were independently associated with the use of chemotherapy. Performance status <3 (OR: 4.06, 95% CI: 2.17-5.83) and cardiopulmonary resuscitation (OR: 5.28, 95% CI: 3.77-7.21) were independently associated with the use of radiotherapy.CONCLUSION:The findings indicate that younger patients with a lower performance status who do not have complications are more likely to opt for chemo- or radiotherapy. Further, the use of palliative chemo- and radiotherapy should be considered carefully in terminally ill patients with cancer, as they seem to indicate a higher risk of cardiovascular complications requiring resuscitation.

女,40岁,双下肢肌力进行性减退1周,小便失禁1 d. 下肢感觉减退,MRI发现L2~4椎管内占位性病变,考虑皮样囊肿可能(图1a~1e). 查体:GCS15. 双瞳直径2.5 mm,等大圆,光敏.神经系统检查阴性.下肢病理征阳性,双侧巴氏征.肢体活动差,右侧下肢肌力Ⅱ度,左侧Ⅲ度,四肢肌张力不高.手术记录:经腰背部后正中入路,切开皮肤,分离椎旁肌,暴露L2~4椎板,咬除L2~3椎板,打开硬膜,其下囊性病灶,内为脓性液体,囊壁后与蛛网膜及马尾神经紧密粘连,仔细分离,脊髓低位,被挤压于左侧,囊壁与脊髓无明确分界,囊壁基本全切,术野止血,反复庆大霉素加生理盐水冲洗,缝合硬膜,双氧水加庆大霉素盐水冲洗,分层缝合肌层、皮肤.

The purpose of this study was to evaluate the count and percentage of neutrophils as prognostic indicators in advanced cancer patients undergoing palliative care. 378 consecutive patients receiving treatment at the palliative care unit of Fudan University Shanghai Cancer Center between July 2013 and October 2015 were reviewed. In 106 of these patients, the data were extended during the follow-up. The cut-off values selected for the neutrophil count and percentage were 8.0×109/L and 85%, respectively. Both a high pretreatment neutrophil count (HR = 1.828, 95% CI: 1.409∼2.371, P<0.001) and a high pretreatment neutrophil percentage (HR = 1.475, 95% CI: 1.106∼1.967, P=0.008) were independent prognostic factors for decreased overall survival. Furthermore, in the follow-up cohort of readmitted patients (n = 106), patients with a newly increased neutrophil count or percentage were respectively, 1.837 (95% CI: 1.096∼3.079) and 3.268 (95% CI: 1.848∼5.778) times more likely to have a poor prognosis compared with patients with low neutrophil conditions (P=0.021, P<0.001). In conclusions, both high pretreatment or newly increased count and percentage of neutrophils were confirmed as independent prognostic factors for adverse outcomes. These parameters may be used as stratification factors in identifying advanced cancer patients with poor prognosis in palliative care settings.

Background Oncologists` knowledge and attitudes to palliative care (PC) and end of life (EOF) should be highlighted in order to give them effective education. This study is intended to provide a descriptive analysis of oncologists’ knowledge, attitudes and practice toward PC and EOF issues in Mainland China. Methods The questionnaire survey with 24 items investigating oncologists’ demographic information, knowledge and attitudes toward PC and EOF issues was conducted among Chinese Oncology clinicians. Results The participants had a mean of 10.10 years practice in oncology. 43 (31.2 %) participants had received PC education. 73.9 % of the participants believed that PC should be considered when patients were not suitable to take surgery, radiotherapy, chemotherapy and other anti-cancer therapies. 72.5 % of the participants believed that early PC integration can improve the quality of life in patients. Most of the oncology clinicians (73.9 %) believed that the doctor-in-charge was the appropriate person to inform patients of the diagnosis. However, only 11 participants chose to inform the diagnosis and disease prognosis to the patients, whereas 39.9 % of the participants chose to disclose it to Family/Caregivers first. Besides, Chinese oncologists were obviously unfamiliar with the concepts of euthanasia and related issues. Conclusions This study indicated the insufficient knowledge toward PC and related issues of the Chinese oncologists. More attention should be paid on the education of PC among Oncologists in Mainland China.

The objective of this study was to investigate the prognostic value of pretreatment NLR and its dynamic changes responsive to palliative care in advanced cancer patients. The study was retrospectively assessed in 378 consecutive advanced cancer patients receiving palliative care and in an extended follow-up study of 106 of those patients. The cutoff value of pretreatment NLR was determined to be 3.0. In the 378 advanced cancer patients, 89 had pretreatment NLR ≤ 3 and 289 had an NLR > 3. Univariate and multivariate analyses showed that tumor stage, palliative care, albumin level and pretreatment NLR (HR: 1.514, 95% CI: 1.125~2.038, P = 0.006) were independent prognostic indicators of OS. Moreover, in the follow-up cohort of 106 readmitted patients, 43 patients achieved a decreased NLR after palliative care, while the remaining 63 patients showed an increased NLR. Univariate and multivariate analyses showed that an increase in NLR was significantly associated with a poor survival (HR: 2.506, 95% CI: 1.474~4.261, P = 0.001). In conclusion, pretreatment NLR and changes in NLR independently predicted OS in advanced cancer patients undergoing palliative care. Incorporating NLR into clinical practice may better inform the prognosis and therapy decisions of advanced cancer patients in palliative settings.

Background This study was carried out to investigate the prognostic value of baseline and dynamic changes in anxious emotion in advanced cancer patients undergoing palliative care. Methods The association between anxious emotion and survival was investigated in a retrospective sample of 377 consecutive advanced cancer patients receiving palliative care from August 2013 to October 2015 and in an extended follow-up study of 106 of those patients. Results The prevalence of anxious emotion was 24.93% (94/377) overall, 22.48% (47/209) in men and 27.97% (47/168) in women. Significant associations between baseline anxious emotion and overall survival (OS) were not found in the whole sample or in women. However, univariate and multivariate analyses showed that anxious emotion was an independent prognostic indicator of OS in men (hazard ratio [HR]: 1.811, P =.003). Moreover, findings showed that newly developed anxious emotion was significantly associated with poor OS in all readmitted patients (HR: 5.568, P <.001), in men (HR: 5.104, P =.006) and women (HR: 5.820, P =.004). Conclusions Our study suggests that anxious emotion, especially dynamic changes in anxious emotion, needs to be monitored in advanced cancer patients; whether targeted interventions would prolong survival requires further studies.