Background: Although timely communication between visiting nurses and primary care physicians is a key component of care coordination in home healthcare, few studies have examined how communication methods contribute to the timeliness of information-sharing. This study examined the association between the communication methods used by these professionals and physicians’ perceived timeliness of information-sharing in Japanese home healthcare. Methods: We conducted a multicenter cross-sectional study in 2024 involving patients receiving home visits from physicians. Patient-related data were collected using questionnaires completed by physicians. The outcome was physician-reported perceived timeliness of information-sharing for each patient, measured on a seven-point Likert scale (1 = not at all timely, 7 = extremely timely). Because communication methods were not mutually exclusive, they were entered simultaneously into a multivariable linear mixed-effects model with facility- and physician-level random intercepts. Results: Overall, 363 patients were included in the analysis. The mean timeliness score was 5.4 (standard deviation 1.2). In multivariable linear mixed-effects models, using an information and communication technology (ICT)-based system was significantly associated with higher timeliness scores compared with non-use (adjusted mean difference 0.95, 95% confidence interval [CI]: 0.69-1.20). Face-to-face interaction and telephone communication were also independently associated with significantly higher scores (0.61 [95% CI: 0.39-0.83] and 0.49 [95% CI: 0.28-0.71], respectively). Conclusions: Physicians reported higher timeliness of information-sharing when ICT-based systems, face-to-face interaction, or telephone communication were used, compared with non-use. Although confidence intervals overlapped, ICT-based systems showed the largest point estimate, highlighting their potential contribution to timely collaboration alongside traditional communication methods.

BACKGROUND:Clinical guidelines recommend naldemedine for opioid-induced constipation in patients with cancer, either with conventional laxatives or as a first-choice option. Making prophylactic naldemedine a new standard treatment for opioid-induced constipation requires a demonstration of its value for money. OBJECTIVES:We aimed to evaluate the cost-effectiveness of prophylactic naldemedine in patients with cancer initiating strong opioid therapy. DESIGN:We conducted a cost-effectiveness analysis of prophylactic naldemedine replacing standard, nonprophylactic use from the payer's perspective, using a decision tree model based on data from a multicenter, double-blind, randomized controlled trial in Japan. SETTING/SUBJECTS:The study population included patients aged ≥20 years and initiating strong opioid therapy for the first time. RESULTS:The incremental cost-effectiveness ratio of prophylactic naldemedine for opioid-induced constipation was 1,445,276 Japanese yen (¥) or 9,635 United States dollars (USD) with an exchange rate of 1 USD = 150 ¥ per quality-adjusted life year. Using the official value of social willingness-to-pay threshold in Japan of 5 million ¥ or 33,333 USD per quality-adjusted life year gained, prophylactic naldemedine was found to be cost-effective. CONCLUSIONS:This is the first global cost-effectiveness analysis of prophylactic naldemedine in patients with cancer. Prophylactic naldemedine for opioid-induced constipation in patients with cancer initiating strong opioid therapy could be justifiable as an efficient use of finite health care resources.

BACKGROUND:Several studies have suggested that naldemedine may reduce opioid-induced constipation (OIC) as well as opioid-induced nausea and vomiting (OINV). This study aimed to investigate prophylactic effects of naldemedine on OINV in patients initiating regular, oral, strong opioids for cancer pain. METHODS:In this preplanned secondary analysis of a multicenter, double-blind, randomized, placebo-controlled trial investigating the preventive effects of naldemedine on OIC, eligible patients were randomized in a 1:1 ratio to receive either naldemedine 0.2 mg or placebo once daily for 14 days. The primary endpoint was the complete response (CR) rate, defined as the proportion of patients with no vomiting episodes and no use of rescue antiemetics within the first three days of opioid initiation. The secondary endpoint was the nausea and vomiting score of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL). RESULTS:Of the 103 patients, 48 and 47 patients in each group started protocol treatment, respectively. The CR rate was significantly higher in the naldemedine group than in the placebo group (81.3% vs 38.3%, P < .001). Nausea and vomiting scores on the QLQ-C15-PAL at weeks 1 and 2 were significantly better in the naldemedine group (means 7.1 and 6.4) versus placebo (means 44.6 and 35.3; both P < .001). Within the total effect of naldemedine on the QLQ-C15-PAL nausea and vomiting scores at week 2, the proportion mediated through OIC reduction was 21.9%. CONCLUSIONS:Naldemedine may have intrinsic antiemetic potency to prevent both OIC and OINV. TRIAL REGISTRATION:https://jrct.niph.go.jp/ (Japan Registry of Clinical Trials) Identifier: jRCTs031200397.

CONTEXT:Prognostic information is crucial for end-of-life decision-making. While survival predictions are common, the impact on family members remains unclear. There is also a need to understand the role of discussions about functional prognosis. OBJECTIVES:This study aimed to explore (1) the frequency of discussion about life expectancy and functional prognosis in family members and (2) the impact of the discussion on family outcomes. METHODS:This pre-planned analysis of a nationwide post-bereavement survey examined communication regarding life expectancy and functional prognosis. The study included bereaved family members of cancer patients who died in palliative care units between May and January of 2024. Complicated grief, depression, and unfinished business were measured using validated scales. It compared outcomes between those with and without these discussions. RESULTS:Of the 988 questionnaires sent, 582 were analyzed. Regarding discussions with clinicians, 85.7% of family members discussed life expectancy, while 68.0% of family members discussed functional prognosis. Family members experienced better scores on measures of grief and depression. All subscales of "unfinished business" showed better outcomes in the groups that had these discussions. CONCLUSION:Discussions about life expectancy were more prevalent than discussions about functional prognosis for family members. These discussions were linked to reduced grief, depression and unfinished business for family members.

Abstract Background The quality of palliative care in non-designated cancer hospitals, where approximately 70% of deaths of patients with cancer occur, remains unevaluated. This study aimed to clarify the quality of palliative care in these hospitals by comparing patient characteristics and evaluating the quality of palliative care provided by bereaved families. Methods A questionnaire survey was conducted among bereaved family members of patients with cancer who died in 2018 at designated and non-designated cancer hospitals (excluding palliative care units). We compared the two groups regarding patient and bereaved family characteristics, quality assessment of palliative care (including Memorial Symptom Assessment Scale [MSAS]), care satisfaction, and the presence of end-of-life discussions. Results In total, 27,944 bereaved family members agreed to participate. The mean age at death was 73.2 (±11.9) and 79.7 (±10.9) years for designated and non-designated cancer hospitals, respectively (p < 0.001, Effect Size [ES] = 0.55). The mean MSAS total score (symptom intensity) was significantly higher for designated cancer hospitals than for non-designated cancer hospitals, even after adjusting for patient characteristics (p < 0.001, ES = 0.39). Conversely, the mean adjusted overall satisfaction was significantly higher in non-designated cancer hospitals (p < 0.001, ES = 0.21) than in designated cancer hospitals. Conclusions Non-designated cancer hospitals had older and less symptomatic patients than designated cancer hospitals. However, there was no significant clinical difference in the quality of palliative care, as assessed by the bereaved families.

Background:Despite its clinical importance in primary care, the prevalence and levels of multimorbidity among patients receiving home-based medical care remain poorly characterized, and its potential impact on emergency home visits is unclear. This study described the prevalence and levels of multimorbidity among patients receiving physician-led home care in Japan and examined the association between multimorbidity level and emergency home visits. Methods:A multicenter cross-sectional study was conducted in 2024 using physician-completed questionnaires derived from medical records. Multimorbidity was defined as the presence of two or more chronic conditions. Based on prior literature, multimorbidity level was categorized as low (2-3 conditions), medium (4-5 conditions), or high (≥ 6 conditions). The primary outcome was the occurrence of an emergency home visit within the preceding month. Results:Among 506 included patients, 94.7% met criteria for multimorbidity, and 13.2% required an emergency home visit. In multivariable generalized linear mixed-effects models with a logit link, higher multimorbidity levels were independently associated with increased odds of emergency home visits, with adjusted odds ratios of 2.16 (95% CI, 1.09-4.31) for the medium-level group and 2.72 (95% CI, 1.19-6.19) for the high-level group compared with the low-level group. Conclusions:Multimorbidity was highly prevalent among Japanese patients receiving home care, exceeding prior domestic estimates while aligning with international reports. Higher levels of multimorbidity were associated with an increased likelihood of emergency home visits, suggesting that assessment of multimorbidity level may, if confirmed in future studies, inform risk stratification and policy planning for home-based care services. Trial Registration:UMIN000056282.

INTRODUCTION:Opioid-induced nausea and vomiting (OINV) in patients with cancer imposes a substantial clinical burden and may compromise adherence to opioid therapy. Naldemedine, a peripheral μ-opioid receptor antagonist, is currently approved for the treatment of opioid-induced constipation. Recent evidence suggests similar benefits for the treatment of OINV. This study aims to evaluate the preventive effect of naldemedine on OINV in patients with cancer pain initiating opioid analgesics. METHODS AND ANALYSIS:This multicentre, double-blind, randomised, placebo-controlled, parallel-group comparison trial will be conducted across 20 hospitals and clinics in Japan. An estimated 120 patients with cancer scheduled to initiate opioid analgesic therapy will be recruited and randomly assigned (1:1) to receive either naldemedine or placebo on day 1 (visit 1). From days 1 to 7, patients will receive blinded study medication concurrently with opioid analgesics and will be followed for 8 days. The primary endpoint will be the proportion of patients achieving a complete response (CR) on day 5, defined as no vomiting and no use of rescue antiemetics for up to 120 hours after initiation of opioid analgesics. Key secondary endpoints will include the proportion of patients achieving CR on days 1, 2, 3 and 7; changes in Numerical Rating Scale scores from baseline; duration of nausea; proportion of patients who experience vomiting; proportion of patients using rescue antiemetics and frequency of rescue antiemetic use. Additionally, the incidence of adverse events and serious adverse events will be recorded throughout the observation period. ETHICS AND DISSEMINATION:This study has been reviewed and approved by the Hattori Clinic Certified Review Board (approval number: CRB3180027). Written informed consent will be obtained from all participating patients before study commencement. The results of the study will be presented at academic conferences in Japan or overseas and submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER:NCT07038551 and jRCTs031250128.

OBJECTIVE:To compare patient characteristics and end-of-life treatment between designated cancer care hospitals and non-designated hospitals, focusing on non-designated hospitals. METHODS:We used the National Database from 2013 to 2015, provided by the Ministry of Health, Labor and Welfare. RESULTS:We analyzed 491 964 patients of cancer descendants (designated hospitals, 164 063 and non-designated hospitals, 327 901). Non-designated hospitals treated older patients, specifically aged 85 years or older (non-designated hospitals: 26% vs designated hospitals: 11%), and fewer patients without comorbidities (32% vs 45%). Regarding end-of-life treatment in the last two weeks, non-designated hospitals had lower palliative care team fees (1% vs 11%; Relative Risk = 0.14), slightly lower use of strong opioids (53% vs 65%; RR = 0.81), and less use of antipsychotics (23% vs 37%; RR = 0.63). Non-designated hospitals used anticancer drugs less frequently (5% vs 10%; RR = 0.51), however, the use of intravenous hydration over 250 mL/day was higher (55% vs 37%; RR = 2.27). In non-designated hospitals, although ICU admission was less frequent (1% vs 5%; RR = 0.27), there was no difference in cardiopulmonary resuscitation (5% vs 5%; RR = 1.02). CONCLUSIONS:Non-designated hospitals treat more complex patients. In addition, non-designated hospitals had low palliative care team fees, low opioid and other essential drug prescriptions; however, the frequency of artificial hydration was higher. Although non-designated hospitals provided a lower frequency of end-of-life aggressive treatment, no difference was observed in life-sustaining treatments.

Background:Bereavement is a known risk factor for depression; however, the prevalence of depression and its associated factors among family members who provided home care for terminally ill cancer patients remains unclear. Objectives:This study aimed to investigate the prevalence of probable depression and associated factors among bereaved family members of cancer patients who died at home in Japan. Design:A multicenter cross-sectional study within a prospective cohort using a self-administered questionnaire survey of bereaved family members. Setting/Subjects:Twenty facilities across Japan participated. Bereaved family members of adult cancer patients who died at home were surveyed. Measurements:Depression was assessed using the Japanese version of the Patient Health Questionnaire-9, with probable depression defined as a total score of ≥ 10. Results:Among 195 bereaved family members, 23 (11.8%; 95% CI: 7.3-16.3%) screened positive for probable depression. Factors significantly associated with depression included unpreparedness for death (OR 11.0; 95% CI 2.8-43.8), caregiver's poor physical condition while providing care (OR 7.4; 95% CI 1.4-39.2), patient dyspnea within one week before death (OR 4.5; 95% CI 1.3-15.6), and use of antipsychotics at the start of home care (OR 6.3; 95% CI 1.2-32.2). Conclusions:A substantial minority of bereaved family members screened positive for probable depression after providing home care. In addition to effective symptom management, especially for dyspnea and addressing neuropsychiatric instability (as indicated by the need for antipsychotics), during home care, ensuring that family members are adequately informed about the patient's condition and addressing their physical well-being may help reduce the risk of depression in bereaved family members.

Background: Treatment outcomes of children with cancer have improved significantly in recent decades. Despite this, cancer remains the leading cause of mortality among children aged 5-9 years in Japan. The precise trends over time and the changing locations of deaths for pediatric cancer patients in Japan are not clearly elucidated.Objectives: This study aimed to validate the annual change in the number and location of deaths in children with cancer in Japan.Methods: A retrospective study was conducted using vital statistics (2005, 2010, 2015, 2020, and 2021) and detailed Japanese death records (2018). We sampled patients aged under 15 years who died of cancer, analyzing trends based on demographic characteristics, cause of death, location of death, and place of residence.Results: Over the 15-year period (2005-2020), cancer-related deaths declined, with hematological malignancies falling by approximately one-third. Concurrently, the proportion of home deaths increased significantly, rising by 30 percentage points for cancer-related deaths. This was highest for brain tumors, where more than half of the associated deaths occurred at home. Regional disparity was evident; the proportion of home deaths was higher in densely populated areas but lower in sparsely populated regions. Furthermore, only 20% of children died at designated core hospitals, while 50% died at collaborating hospitals, mostly near their residence.Conclusion: Japan has seen a decrease in pediatric cancer deaths alongside a growing trend toward home deaths. This shift indicates increased support for patient- and family-centered end-of-life care but highlights the need to strengthen collaboration in regions with fewer medical resources.

AIM:As aging populations shift health care from hospitals to communities, Japan has implemented policies to promote home health care. This study explored regional differences in home health care recipients among older adults and related factors. METHODS:We used nationwide data from 2020 to describe the proportion of older adults receiving regular home visits and the medical institutions utilized across secondary medical areas: urban, middle and depopulated areas. We examined factors associated with the proportion of patients receiving regular home visits. Exposures included each secondary medical area's medical and long-term-care (LTC) resources, adjusted for the older adult population; proportion of single-person households; and regional factors. We performed a multivariate negative binomial distribution analysis. RESULTS:A total of 333 secondary medical areas were included. Urban areas had more patients receiving regular home visits, primarily from enhanced home care support clinics/hospitals (HCSCs). Fewer patients received regular home visits in depopulated areas, and conventional HCSCs were more common. Multivariate analysis revealed that the number of conventional HCSCs (coefficient, 0.17 [95% confidence intervals (CI), 0.08 to 0.26]), enhanced HCSCs (coefficient, 0.21 [95% CI, 0.14 to 0.29]) and population density (coefficient, 0.10 [95% CI, 0.02 to 0.19]) were positively associated with higher home-visit rates. Beds in LTC welfare facilities (coefficient, -0.10 [95% CI, -0.19 to -0.01]) and beds in LTC health facilities (coefficient, -0.09 [95% CI, -0.17 to 0.00]) were negatively associated. CONCLUSIONS:Policies to promote home health care have led to high home-visit rates in urban areas. Medical and LTC resources and regional factors influence disparities. As Japan's population ages, it is crucial to recognize these disparities and develop medical and LTC systems tailored to each region's characteristics. Geriatr Gerontol Int 2024; 24: 1350-1361.

Background: Potentially inappropriate medications (PIMs) pose a significant burden on patients with advanced cancer approaching the end of life. However, trends in the prescription of PIMs and the factors associated with deprescribing PIMs in these patients remain unclear. Objective: To describe trends in the prescription of PIMs and explore the factors associated with the deprescribing of PIMs in patients with advanced cancer in Japan. Design: Retrospective cohort study using medical claims data. Methods: We analyzed patients aged >65 years who were diagnosed with cancer 6 months before death and died between December 2017 and August 2023 in the city of Mito, Ibaraki prefecture, Japan. Sociodemographic, clinical, and prescription data were collected at 6 months (M6), 3 months (M3), and 1 month (M1) before death. PIMs were assessed according to the OncPal Deprescribing Guidelines. Results: The mean age of 1269 patients was 80.6 years, and 62.2% were male. PIMs were prescribed to 77.0% at M6, 76.4% at M3, and 70.0% at M1 ( p < 0.001, M6 to M1). The factors associated with deprescribing at least one PIM from M6 to M1 included female sex, number of medications at M6, number of comorbidities, admission to a palliative care unit, and admission to a general ward. Conclusion: In patients with advanced cancer, PIM use decreased as they approached death. Deprescribing PIMs was more common in females, patients with polypharmacy and comorbidities, and patients admitted to hospitals, especially palliative care units.

BACKGROUND:Family conflict is a common problem in palliative care and has been identified as a potential barrier to providing appropriate care. Several demographic factors associated with family conflict have been reported; however, associated clinical factors, including symptoms, treatments, and communication, remain to be elucidated. AIMS:The aim of this study was to identify symptoms, treatments, and communication factors associated with family conflict in palliative care units (PCUs). METHODS:We used matched data for deceased patients from a prospective cohort study conducted between January 2017 and December 2017 of cancer patients admitted to PCUs and their bereaved families from a nationwide cross-sectional questionnaire survey in Japan. We assessed family conflict using the Outcome-Family Conflict Scale. RESULTS:We sent out 667 questionnaires, of which 443 (66.4%) were returned. We excluded 81 family members who refused to participate; therefore, we analyzed 362 (81.7%) responses. The mean age of the patients who died of cancer was 73.9 ± 11.3 years, and 51.9% were men. Multivariate logistic regression revealed a significant association between rapid deterioration of the patient's condition, resulting in death within 1-2 days, and family conflict about what is meant by "a good death" (p = 0.044, odds ratio: 2.66), and the presence of family members who insulted or yelled at other family members (p = 0.005, OR: 3.22). In addition, a significant association was found between the confirmation of the family's wishes regarding CPR during hospitalization and family conflicts about healthcare decisions for their relative (p = 0.013, OR: 0.46), about the way a member was treating their relative (p = 0.014, OR: 0.43), and about what is meant by "a good death" (p = 0.028, OR: 0.38). CONCLUSIONS:Our findings suggest that abrupt clinical deterioration is associated with family conflict. Confirming patients' and families' wishes regarding CPR during hospitalization may help reduce family conflict in PCUs.

ABSTRACT Introduction Systemic opioids are recommended as a pharmacological treatment for dyspnea, and antipsychotics are widely used for delirium. Because little is known about optimal palliative pharmacological strategies for dyspnea in patients with delirium, this study explored the symptom course in such cases, including the use of opioids and antipsychotics. Methods This was a secondary analysis of a multicenter prospective and observational study. We consecutively enrolled adult patients with advanced cancer at palliative care units in Japan. The eligibility criteria for their participation were a dyspnea Integrated Palliative care Outcome Scale (IPOS) score ≥ 2 and the presence of delirium. We investigated pharmacological strategies, IPOS for dyspnea, and delirium symptoms using item 9 of the Memorial Delirium Assessment Scale. Results Of the 1896 patients, 141 were found eligible and were analyzed. Eighty‐two (58%) patients had agitated delirium, and the median survival period was 4 days. Regarding pharmacological strategy, 31 (22%) received opioid initiation or dose escalation, whereas 92 (65%) used regular antipsychotics. Although mean dyspnea IPOS scores significantly decreased from Day 1 to Day 2 (0.44, 95% CI: 0.24–0.64), the proportion of responders (IPOS score ≤ 1) was 21% (30/141). In the agitated delirium group, the proportion of remaining agitation symptoms at Day 2 was 74% (61/82). Conclusions The combined distressing symptoms of dyspnea and delirium during the last days of life are likely to be refractory suffering, which shows a poor response to pharmacological interventions, including opioids and antipsychotics.

Background In Japan, about 70%-80% of cancer deaths occur in hospitals. The actual number of cancer patients who die in hospitals where palliative care is available is not clear. This study aimed to examine whether hospitals where cancer patients died offered palliative care.Methods Patients aged >= 20 who died of cancer in 2018 were included. We used the Japanese death records and publicly available data on hospital functions. Cancer death numbers and hospitals were summarized according to hospital function and age group. Logistic regression analysis was performed to examine the death influence in patients with cancer in designated cancer hospitals.Results The study included 302 511 patients, and 168 835 patients (55.8%) died in hospitals with palliative care. In hospitals without palliative care, those with 100-199 and 200-499 beds had more deaths than hospitals not in these ranges of beds. Their median number of deaths per year was 17 and 26, respectively. Categorized by the death numbers per hospital without palliative care, hospitals with 20-49 cancer deaths were common. In the designated cancer hospitals, younger patients aged 20-29 had a higher odds ratio (OR) for death (4.28) than those aged 70-79. Blood cancer had a higher OR (2.36) than colorectal and rectal cancer.Conclusion Our findings suggest that outreach of palliative care to hospitals with 100-199 or 200-499 beds and 20-49 deaths lacking palliative care could effectively improve end-of-life cancer care. Over half of hospital cancer deaths occurred in facilities offering palliative care. Outreach to hospitals with 100-499 beds and 20-49 cancer deaths may enhance end-of-life care efficiently.

Background: Few studies investigated the clinical implications of C-reactive protein-albumin ratio (CAR) in palliative care. Objectives: To determine the association of CAR with overall survival among terminally ill patients with cance. Design: Datasets were obtained through two multicenter prospective cohort studies. Setting/Subjects: Patients newly referred to palliative care. Measurements: Physicians recorded measures at the baseline. Patients were followed up to their death or observed for 6 months. The patients in cohort 2 were divided using the CAR cutoffs detected using a piecewise linear hazards model in cohort 1. We performed time-to-event analyses using the Kaplan-Meier method and log-rank tests and univariate and multivariate Cox regression analyses for patients in cohort 2. Results: A total of 1554 patients in cohort 1 and 1517 patients in cohort 2 were eligible. The cutoffs were 0.1, 1.2, and 6.4. The patients in cohort 2 were divided into four categories (<0.1 [n = 103], 0.1-1.2 [n = 433], 1.2-6.4 [712], and ≥6.4 [n = 269]). The adjusted p values of the log-rank tests were <0.001. Significantly higher risks of mortality were observed in the Cox proportional hazard model for the higher categories than in the lowest category (CAR 0.1-1.2: adjusted hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.18-1.89; CAR 1.2-6.4: adjusted HR 2.08, 95% CI 1.65-2.62; CAR ≥6.4: adjusted HR 2.94, 95% CI 2.29-3.79). Conclusions: Patients with a higher CAR had significantly higher risks of mortality than those with a lower CAR.

Introduction: Hospital admissions often result in functional decline for patients with dementia, yet evidence on the impact of cancer treatments in this population during hospitalization is limited. We aimed to examine the association between dementia and functional decline after cancer treatment in patients with non-small cell lung cancer (NSCLC). Materials and Methods: A total of 30,213 patients aged 65 years or older hospitalized for NSCLC treatment, from a dataset of 366 acute care hospitals in Japan, were eligible for this study. The primary outcome was activities of daily living (ADL) at discharge, assessed using the Barthel Index, with a total score ranging from 0 to 100, and the secondary outcome was the length of hospital stay. We conducted causal mediation analysis by cancer treatment within a counterfactual framework using the g-formula approach with direct counterfactual imputation. Bias- corrected and adjusted bootstrapped 95 % confidence intervals (CIs) were calculated based on 100 bootstrap samples. Dementia status served as the exposure, ADL scores at admission as the mediator, and ADL scores at discharge as the outcome. Covariates measured at admission were used to adjust for dementia status. Subgroup analyses were performed by treatment group including surgery. Results: Compared with patients with NSCLC who did not have dementia, those with dementia exhibited lower ADLs at discharge across most cancer treatments, regardless of ADL scores at admission. Patients with dementia who underwent chemotherapy had prolonged hospital stays of 2.90 days longer (95 % CI, 1.27 to 4.52) and lower ADL scores at discharge than their counterparts without dementia (-9.77 [95 % CI,-12.55 to-7.00]). Similarly, patients with dementia who received radiotherapy experienced lower ADL scores at discharge compared with those without dementia (-15.06 [95 % CI,-19.59 to-10.54]), with no difference in the length of hospital stay (-0.54 [95 % CI,-2.84 to 1.75] days). Similar findings were observed from the total effects after adjusting for potential confounders. Discussion: Patients with comorbid cancer and dementia consistently displayed lower ADL scores at discharge following various cancer treatments. Understanding the effects of dementia on functional decline may aid in making optimal treatment choices for inpatient care for patients with NSCLC.

Accurate prognostic information is crucial for guiding end-of-life (EOL) decision-making in advanced cancer care. Although the European Society for Medical Oncology (ESMO) recommends using clinicians' prediction of survival (CPS) as an initial reference, CPS alone often lacks precision. This review synthesizes current prognostic models and the dialog surrounding EOL survival prediction. For patients with an expected survival of months, several validated prognostic tools are available, including measures such as the Eastern Cooperative Oncology Group Performance Status, the modified Glasgow Prognostic Scale, and comprehensive models such as the Supportive and Palliative Care Indicator Tool and the adaptable prognosis prediction model. When survival is expected to be weeks, the Palliative Performance Scale serves as a key assessment tool, while models such as the Palliative Prognostic Index and Prognosis in Palliative Care Study models are helpful. In the final days of life, clinicians primarily rely on observable physical indicators, including decreased consciousness and specific breathing patterns, whereas the surprise question has demonstrated limited predictive utility in this context. While most patients with advanced cancer express a desire for prognostic information, cultural considerations-particularly in Asia-necessitate nuanced communication approaches. Serious illness conversations have been shown to improve patient well-being; however, further research is needed to optimize these discussions, address unfinished business, and promote equitable access to prognostic dialog, particularly for vulnerable populations. Enhancing prognostic communication is critical for facilitating shared decision-making and improving the quality of EOL care.

OBJECTIVES:To examine differences in quality of dying (QOD) between patients with cancer receiving no anticancer treatment (untreated group) and those receiving chemotherapy in the last 3 months of life (late chemotherapy group), and to explore socioeconomic characteristics by treatment status. METHODS:This observational study used data from a Japanese nationwide mortality follow-back survey, restricted to cancer decedents. Questionnaires were mailed to their bereaved family members. The primary outcome was family-reported QOD, and the exploratory outcomes included symptom burden, end-of-life (EOL) discussions and socioeconomic factors. Analyses were stratified by age (<60, 60-79, ≥80 years). RESULTS:Of 48 124 eligible responses, 12 563 were untreated. The proportion untreated increased with age (4.9%<60 years, 42.4% ≥80 years). Untreated patients had shorter survival times and more hepatobiliary or pancreatic cancer. The QOD was not poorer in untreated patients. Of untreated patients <60 years, 42.9% were free from physical distress versus 28.9% in the late chemotherapy group (difference: 14.0 points; 95% CI 5.5 to 22.5). Among untreated patients aged 60-79 years, 51.0% reported life completion versus 41.7% in the late chemotherapy group (difference: 9.3 points; 95% CI 6.9 to 11.7). More families of untreated patients reported EOL discussions with their physicians. Younger, untreated patients were more likely to be from lower-income households. CONCLUSION:The absence of anticancer treatment was not associated with a poorer QOD in untreated patients. Socioeconomic disparities among younger patients highlight the need for equitable access to cancer care and support for value-based EOL decision-making.