Depressive symptoms in cancer patients’ last days of life: a nation-wide retrospective mortality study

Introduction and aims: Reported prevalence rates of depression in cancer vary considerably, and few studies distinguish between depressive symptoms and a depression diagnosis. Study aims were to study the prevalence of depressive symptoms at the last days, their relation with other symptoms and patient and care characteristics. Methods: A stratified sample of all deaths in 2005 was drawn by Statistics Netherlands. Questionnaires on patient and care characteristics of the last phase of life were sent to the physicians (N=6860) who signed the death certificates (response 77.8%). We selected adult cancer patients with non-sudden death and who were conscious until death (n=1521). Depressive and other symptoms were scored for the last 24 hours before death from 1 to 5, recoded to 1=no, 2-3=moderate and 4-5=severe. Multivariate multinominal regressions were used to examine which characteristics were associated with depressive symptoms. Results: 72% were 65 years or above, 43% were females. The prevalence of moderate and severe depressive symptoms was 32% and 6% respectively. The regression analysis showed no relationship between moderate and severe depressive symptoms and gender, pain, dyspnoea, and involvement of a spiritual caregiver. Moderate depressive symptoms were associated with older age and having anxiety, confusion, and fatigue (P< 0.05). Severe depressive symptoms were associated with having anxiety, involvement of a psychologist or psychiatrist, involvement of a palliative care consultant/ pain specialist, and not being attended by a physician working in elderly care. Conclusions: One third of the patients experienced moderate depressive symptoms according to attending physicians in the last 24 hours before death. Anxiety was associated with both moderate and severe depressive symptoms. Symptom distress at the end-of-life calls for special attention.