Terminal Stage Of Cancer Research Articles

The Meaning of Hope for Polish Male Patients Dying from Cancer Depending on Their Age: An Interdisciplinary Study with the Use of Osgood's Semantic Differential Method.

Background/Objectives: The subject of this article is the reflection on hope-one of the most important predictors and motivators of human actions. Hope is our response to a threat, and it is also the emotion that allows us to overcome hopelessness and to reduce suffering. Hoping is a human capacity with varying cognitive, emotional, and functional dimensions. Psychological, pedagogical (particularly in the framework of special-needs pedagogy and thanatological pedagogy), and theological reflection on hope can be helpful for dying people. The objective of this study was to characterize hope in the semantic space of individuals in the terminal stage of cancer and to verify whether age is a variable that determines this hope. Methods: To complete the study, the Osgood semantic differential method was applied, as modified by Polish psychologist Dr. Boguslaw Block (the DSN-3 test). The research technique consisted of a therapeutic conversation. Results: Research results show that, in general, those in the terminal stage have positive associations with hope. In all three aspects of the used test, namely the cognitive, emotional, and functional aspects, the highest scores assigned to the perception of hope were obtained from men up to 35 years of age. Depending on the ages of patients, one could observe certain semantic shifts, but they did not prove to be statistically significant. Conclusions: Polish males surveyed at the end of life due to cancer generally perceived hope as a supportive force. Therefore, hope can provide emotional support to patients in the terminal stage of cancer and improve their quality of life.

Pathological characteristic of the eye changes within dogs ophthalmopathy associated with paraneoplastic syndrome

Ophthalmopathy associated with parneoplastic syndrome is a poorly studied pathology of the dogs eye. They occur as a result of the malignant neoplasm’s systematic exposure on the animal's body. They appear in the form of non-specific clinical signs. Main objective of the study – to study the pathomorphological changes in the dog’s eyes with malignant neo-plasms. The material for the study were 30 eyeballs enucleated in dogs in the terminal stage of cancer. Autopsy material obtained from animals was subjected to standard histological processing. As a result of histological studies, pathomorphological changes in eyeball structures associated with Patnaik G2 and G3 mastocytomas (28.6% of cases), liver and kidney carcinomas (28.6%), lymphoma (28.6%) and spleen hemangiosarcoma (14.2%) were revealed in 46.7% of cases. The main histopathological changes were thickening of the iris due to inflammatory cellular infiltration (57.1%) and vasodilation of blood vessels (42.9%), the presence of fibrinous hemorrhagic exudate in the anterior chamber of the eye (28.6%), edema and inflammatory infiltration of the vascular membrane proper (42.9%), thinning, loss of layering and weak retinal atrophy (42.9%). The revealed histological changes indicate the predominant involvement in the pathological process of the vascular membrane of the eye with a violation of the hematophthalmic barrier, as the main pathogenetic mechanism for the development of endogenous uveitis against the background of malignant neoplasm in the animal body.

Comparison between Rapid and Standard procedure Pleurodesis outcome in Malignant Pleural Effusion

Background: The terminal stage of cancer with distant metastasis often concurrent with malignant pleural effusion (MPE), which is the complication in lung cancer cases. Pleurodesis was performed by inserting a sclerosing agent through the thoracal drain after the pleural fluid was evacuated. Objective: to determine whether rapid pleurodesis is more efficient and effective than the standard procedure pleurodesis in MPE patients. Methods: This experimental study using randomized posttest-only control group design and divided into two groups (standard procedure pleurodesis group and rapid pleurodesis group). All of the samples were inpatient with MPE requiring pleurodesis and eligible with the inclusion criteria as samples. Pleurodesis procedure was performed by inserting a sclerosing agent through the thoracic drain after fluid well evacuated using talc slurry, and evaluated 1 month after pleurodesis procedure. All data were analyzed using SPSS software. Results: A total of 25 samples were included in this study. Our study suggests that standard procedure findings were the same as the rapid group (90.9% vs. 81.81%; p = 0.30). But the rapid group was had a shorter length of stay compared with the standard group (24.62 vs. 29.08 days; p = 0.42) and cheaper (USD 1,700 vs. USD 1,876; p = 0.98). Pain and fever were common complications in both groups. Conclusions: Rapid and standard pleurodesis groups showed the same efficiency and effectivity rates in treating MPE patients. However, the rapid pleurodesis group has a shorter length of stay and cheaper, but there was no statistically difference.

A Case of Brain Tumor with Impaired Consciousness Due to Hypoglycemia in the Terminal Stage of Cancer

A Case of Brain Tumor with Impaired Consciousness Due to Hypoglycemia in the Terminal Stage of Cancer

TEKIBEN --- DIGITAL DISIMPACTION AT HOME CARE IN JAPAN

Abstract Though this may not be the case worldwide, in Japan, digital disimpaction (Tekiben in Japanese) is one of the most frequently performed care procedures done by home-visit nurses. This study aimed to clarify the status of digital disimpaction at home care in Japan by interviewing nurses skilled in disimpaction. The interviews were conducted during the process of developing a simulator for digital disimpaction training and were conducted with seven nurses who provide home care. The interviews lasted between 50 and 75 minutes each. The interview data were transcribed, and descriptions of the frequency and target audience for digital disimpaction were extracted. The frequency with which each nurse performed digital disimpaction ranges from 10 to 30 times per month. The clients who require digital disimpaction include those who require the procedure regularly due to conditions such as cerebral infarction or neuropathy, as well those who are in the terminal stages of cancer or other conditions and require the procedure when assessed as necessary. Digital disimpaction techniques are not taught in educational courses at universities or vocational schools but are learned through on-the-job training at hospitals or in-home nursing. The reason for performing routine digital disimpaction is that it is difficult for family members to assist with defecation. The importance of passing stool at the time of digital disimpaction is pointed out, as it is difficult for family members to handle bowel movements in the absence of a nurse.

The Cognitive Aspect of Hope in the Semantic Space of Male Patients Dying of Cancer.

The aim of this study is to characterize the cognitive aspect of the semantic space of hope in patients in the terminal stage of cancer. This was confirmed in the research on hope by C. R. Snyder and B. Schrank. Hope is of great importance in all the great world religions and belief systems, both as regards a personal God or impersonal deities. Hoping is a human capacity with varying affective, cognitive and behavioral dimensions. Psychological, pedagogical (particularly in the framework of special needs pedagogy and thanatological pedagogy) and theological reflection on hope can provide support for dying people. In order to conduct the research, the semantic differential research method was selected. The research technique employed was a therapeutic conversation, and the research tool was the B.L. Block's DSN-3 test. The DSN-3 test allows one to assess hope in the semantic space in three aspects: cognitive, emotional and functional. For the purposes of this study, only the cognitive aspect was taken into account. The study was begun on 1 April 2010 and ended in the last days of December 2020. It included 110 male patients in the terminal stage of cancer. The youngest respondent was 19 years old and the oldest was 94 years old. The surveyed men most often perceived hope in the semantic space in the cognitive aspect as more true, wise, meaningful and real than false, stupid, meaningless and deceptive. Their attitude to hope was, therefore, more affirmative than negative. The research did not reveal the importance of the age of the respondents on the degree of affirmation/negation of hope in the cognitive aspect in the semantic space; however, men in the period of late maturity and professional activity expressed the lowest level of the affirmation of hope. It is worthwhile to conduct further research concerning hope in other aspects (especially emotional and functional) in the semantic space in order to use the obtained results to consider what to take into account when providing patients in the terminal stage of cancer with better personalized holistic care than before.

Palliative arthroscopic debridement with continuous irrigation forinfected total knee arthroplastyin high mortality riskpatients.

This study aimed to evaluate the infection control rate of palliative arthroscopic debridement, antibiotics, and implant retention (DAIR) for the high mortality risk or terminal cancer stage patients. From March 2018 to August 2021, 21 patients met the following inclusion criteria: old age of more than 80, diagnosed as a terminal stage of cancer, high risk of mortality and morbidity representing as Charlson comorbidity index (CCI) ≥ 5, low daily activity with disabled extremity, and re-infection after two-stage revision. Each patient underwent arthroscopic DAIR and additional continuous irrigation for 48hours. The need for subsequent re-arthroscopic DAIR or two-stage revision was determined by the post-operative trends of C-reactive protein (CRP) levels. Infection control was defined as continuing controlled status of infection based on clinical and laboratory results by one or two times of arthroscopic DAIR within initial two months. Treatment failure was defined as more than three times arthroscopic debridement, two-stage revision surgery, or expired due to uncontrolled infection. Arthroscopic DAIR controlled the infection in 19 (90.5%) of the 21 cases. The other knee underwent a total of three times of re-arthroscopic DAIR and the other one underwent two-stage revision. Although five patients expired during the follow-up period due to worsening medical problems or terminal cancer, there were no deaths from uncontrolled infection, sepsis, or surgery-related complications. Arthroscopic debridement with continuous irrigation for the infection TKA with high mortality risk or terminal cancer patients showed a 90.5% infection control rate. For high-risk patients, arthroscopic debridement with continuous irrigation can be an alternative treatment to improve the quality of life during survival.

Impacting Outcomes in the Hospitalized Oncology Patient: Evidence-Informed Quality and Safety Project to Implement Routine Screening for Delirium

Background: Delirium can occur in cancer patients during an acute hospitalization or in the terminal stages of cancer. Iatrogenic delirium can complicate hospital stays for over 2.6 million older persons by increasing fall risk, restraint use, length of stay, postacute placement, and costs. The purpose of this evidence-based quality improvement project was to implement routine screening for delirium with a consistent instrument and adopt an interprofessional plan of care for delirium. Methods: This project was identified as an interprofessional improvement initiative. The project leader identified a deficiency in the screening for delirium, convened stakeholders, evaluated evidence, reviewed screening instruments, and developed a plan of care for delirium management. Practice changes incorporated routine delirium screening across the inpatient units. A delirium interprofessional plan of care was integrated into the electronic health record for ease of adoption and workflow modification. Results: Routine screening for delirium and early interprofessional interventions reduced length of stay by 2.27 days for patients screening positive for delirium. The percentage of inpatient falls that were linked to an episode of delirium during hospitalization reduced from 23.4% to 17%. Discussions: Routine screening and targeted interventions are a first step in prevention and identification of those inpatients at risk of developing delirium. Delirium prevention is the goal for potential associated iatrogenic conditions.

Relationship Between Physical Inactivity and Obesity in the Urban Slums of Lahore

IntroductionThere are several factors such as physical inactivity, sedentary lifestyle, and diet that can be responsible for weight gain or obesity. Regular physical activity is important for better physical and emotional well-being. The objective of the study is to observe the prevalence of obesity or over-weight and how lack of physical activity contributes to weight gain and other health issues.MethodsThis cross-sectional study was conducted in Shalamar Town, Lahore on 646 participants. Data was collected using the WHO STEPS instrument. The inclusion criteria were a minimum age of 30 years and residents of Shalimar Town, Lahore for more than five years. The exclusion criteria were participants with comorbid conditions like HIV, TB, and terminal stage of cancer. Test of association and binary logistic regression analysis was performed to observe a significant association between demographic variables and non-communicable diseases among the participants involved in performing physical exercise.ResultsAbout 22.1% of the participants had normal BMI, 5.3% were underweight whereas 34.2% of the participants were overweight and 32.4% obese. Male participants were found to be more physically active compared to females. Hypertension and diabetes were statistically significantly associated with physical activity. BMI and waist-hip ratio were found to be associated with moderate physical exercise.ConclusionMost of the participants were not involved in moderate physical activity. Overall, an alarming 66.6% of the participants were either overweight or obese. In general, males were found to participate more in intense physical activity.

Effects of Antibiotics on Respiratory Symptoms in Terminally Ill Cancer Patients With Pneumonia: A Multicenter Cohort Study.

Patients in the terminal stages of cancer are frequently affected by infection, especially pneumonia; but the effects of antibiotics on respiratory symptoms and factors associated with improvement are still unclear. This study aimed to clarify the effects of antibiotics on respiratory symptoms of terminally ill cancer patients with pneumonia, and to explore factors associated with the improvement. This was a prospective cohort study in which we consecutively recruited terminally ill cancer patients diagnosed with pneumonia and treated with antibiotics at one of 23 palliative care units across Japan. At the baseline and Day 3, primarily responsible palliative care specialists recorded patient backgrounds, the results of physical and laboratory examination, and patient symptoms using the Support Team Assessment Schedule. Improvement was defined as improvement of dyspnea, cough, and sputum production on Day 3. Among all 1896 patients admitted during the study periods, 137 patients (7.2%) were enrolled into this study. Improvement was achieved in 65 patients (47.4%; 95% confidence intervals, 39-56). Univariate analyses revealed that the Palliative Prognostic Index (PPI), respiratory rate (RR), and oxygen requirement were significantly associated with the improvement. A multiple logistic regression analysis identified that PPI score of ≤ 6 and RR of <20 were independently associated with the improvement (odds ratios, 4.4 [1.6-12] and 2.5 [1.1-5.5], respectively). Antibiotics may relieve respiratory symptoms from pneumonia in approximately half of the terminally ill cancer patients. PPI and respiratory rate are useful to identify the patients who received benefits of antibiotics.

Considering the role of multifunctional long-term care in small group home and home-visit nursing in the terminal stage of cancer : Case reports

Considering the role of multifunctional long-term care in small group home and home-visit nursing in the terminal stage of cancer : Case reports

Nutritional Status Assessment of Selected Male Cancer Patients In Cochin, Kerala

The study was conducted for the assessment of nutritional, functional status and, Quality of Life (QoL) of selected male cancer patients undergoing cancer therapy. A purposive sampling method was adopted and an interview schedule was used to elicit data. The nutritional status assessment was conducted by incorporating modified Subjective Global Assessment (SGA), QoL, and functional status of the patients. The findings suggested that head and neck cancer was the leading type of cancer followed by lung, stomach and oesophagus cancer and a vast majority of patients were in the terminal stages of cancer. The Subjective Global Assessment (SGA) revealed that majority of the patients belonged to mildly-moderately nourished category. Majority study subjects had an inadequate nutrient intake with respect to energy, protein, fat, calcium and iron. A statistically significant difference was observed between the actual and suggested nutrient intake. The mean values of physical, social/family, emotional and functional well-being using the FACT-G scale were computed to be 29,26.5, 24, and 175.5, respectively showing that QoL was poor among study subjects, thus impacting cancer therapy. The assessment of nutritional status and physical, social, emotional and functional well-being in cancer patients is crucial for early detection of malnutrition and poor well-being thus facilitating further deterioration and improving the outcome of cancer therapy.

Characteristics of Online Crowdfunding Campaigns for Urological Cancers in the United States.

We examined the characteristics and financial outcomes of online crowdfunding campaigns for patients with major urological cancers in the U.S. This cross-sectional study analyzed publicly available data from GoFundMe, the largest online medical crowdfunding service, via automated web scraping. Online campaigns from 2010 to 2018 with the following primary cancer types were included: kidney, prostate, bladder and testicular. Financial outcomes were compared using Kruskal-Wallis and Wilcoxon rank-sum tests. Multivariable analyses were utilized to identify predictors of campaign financial outcomes. Kidney cancers were the most frequent online campaign type (478), followed by prostate (379), bladder (202) and testicular (175) malignancies. Urological cancer campaign recipients frequently requested funding for medical expenses (71%) during active treatment (57%). After adjustment, testicular cancer and children's cancer campaigns generated more donations than other urological and adult cancer campaigns (p <0.05). Family and friend-authored campaigns generated more donations and average donation amounts than self-authored campaigns (p <0.05). Campaign narratives focused on disheartening circumstances received fewer donations than narratives focused on the recipient's high moral character or contributions to society (p <0.05), and unclear narratives received the smallest donation amounts (p <0.05). Urological cancer crowdfunding in the U.S. is primarily used to finance uncovered costs associated with medical care during active treatment. Crowdfunding financial outcomes are likely related to the campaign recipient's age, malignancy type, social network and primary appeal of the narrative. Urologists should be aware of trends in medical crowdfunding in order to better understand the financial burden this patient population faces.

Prognostication in patient with terminal stage of cancer

Prognosis is one of the most critical factors affecting clinical decision in medical practice. In terminal illness where patients are only less than months to live, prognostication is essential to provide an appropriate plan, particularly to avoid futile treatment and to arrange palliative care referral. Prognostication is a process of foreseeing and foretelling, which enable the health care team, patients and family to be involved in the decision making. Determining prognosis is a challenge for doctors as lack of knowledge and skills and fear of the response of the patients and their families. Prognostication is essential in decision making among terminally ill patients, as the risks of adverse effects, energy, time and cost potentially outweighs the benefit of survival, quality of life, functional gain and hope. The benefit of prognostication is not only for the doctors, but particularly to the patients, their families, as well as to institution and health care system. In daily practice a subjective judgment made by doctor based on clinical assessment is usually overoptimistic. A tool is needed to make a better prognostication. Palliative Prognostic Index (PPI) and Palliative Prognostic Score (PaP score) are the most common tools used in palliative care setting.

Anti-VEGFR therapy is one of the healing inhibitors of antiresorptive-related osteonecrosis of the jaw

Antiresorptive-related osteonecrosis of the jaw (ARONJ) is a rare but serious adverse event associated with bone-modifying agents (BMAs) and affects patients in the terminal stages of cancer. Molecular targeting drugs (MTDs), anti-vascular endothelial growth factor receptor (VEGFR), and anti-epidermal growth factor receptor (EGFR) drugs are essential in various cancer treatments, although MTDs are risk factors for ARONJ. However, the mechanism through which MTDs affect treatment prognosis of ARONJ remains unclear. Therefore, we investigated the potential inhibitory factors for healing in the conservative therapy of ARONJ with a focus on MTDs. Sixty patients who were administered BMAs for the treatment of malignancies and who underwent conservative treatment for ARONJ were assessed. The healing rate of ARONJ for each risk factor was retrospectively evaluated. Among the 60 patients, 27 were male and 33 were female. The median age was 67years, and the median follow-up period was 292 (range 91-1758) days. The healing rate was lower in those treated with both zoledronic acid (Za) and denosumab (Dmab) than in those treated with Za or Dmab alone (0% vs. 28.8%, p = 0.03). Regarding the administration of MTDs, the treatment rate with anti-VEGFR drugs was 7.1% (p = 0.04), anti-EGFR drugs was 12.5% (p = 0.18), and without MTDs was 36.8%. In the conservative treatment of ARONJ, the administration of several BMAs and anti-VEGFR drugs was the factor contributing to the inhibition of healing.

1607P - Deprescribing potentially inappropriate medication in cancer patients

BackgroundDue to their advanced age many cancer patients with unfavorable prognosis suffer from comorbidities, and thus the risk of consuming potentially inappropriate medication (PIM). It is vital to deprescribe drugs with potential harmful effects or no short-term benefit for lowering pill.Hence, we examined the degree of deprescription of potentially inappropriate medication (PIM) in patients suffering from cancer. MethodsRetrospective, register-based study of all patients with newly diagnosed breast, prostate, pancreatic, and lung cancer, diagnosed at a hospital in the Capital Region of Denmark (1.8 million inhabitants) from 2012-2014. Patients with insufficient staging information or other malignancy except non-melanoma skin-cancer were excluded. Information about medication, comorbidity and mortality was extracted from the electronic health records.PIM were defined as: acetylsalicylic acid, calcium channel blockers, statins, thiazides, and bisphosphonates. The study was approved by the Danish Patient Safety Authority (No. 3-3013-1884/1/) and the Danish Data Protection Agency (No. BFH-2016-058). ResultsTable1607PTableBreast (n=3,959)/prostate cancer (n=3,535) (total n=7,494)Lung (n=2,824)/pancreatic cancer (n=617) (n=3,441)Gender (Women)52%50%Age mean (sd)65 (12)70 (10)1-year Survival97%46%Metastatic disease6.7%52%Co-morbiditiesDiabetes4.0 %9.7 %Hypertension12 %23 %Atrial fibrillation4.7 %8.7 %Ischemic heart disease6.4 %11.6 %Heart failure2.2 %5.6 %Ischemic stroke1.5 %2.8 %Medication1-year deprescription/total treated§Acetylsalicylic acid250/1,443 (17%)398/928 (43%)Calcium channel blockers135/1,048 (13%)284/659 (43%)Statins187/1,769 (11%)501/1,066 (47%)Thiazide diuretics175/954 (18%)259/534 (49%)Bisphosphonates26/319 (8.2%)64/171 (37%)(Patients not surviving 1 year and treatment continuing until death does not count towards deprescribed)§Deprescribed during the first year after cancer-diagnosis/total number of patients treated ConclusionsOur findings show that oncologists and physicians have a rational approach to deprescription in patients suffering from cancer with short-term (pancreatic and lung cancer) respectively long-term (breast and prostate cancer) survival rates. However, several patients were continuing potential inappropriate medications in the terminal stage of cancer. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

The Loneliness of Patients in the Pre-Terminal and Terminal Stages of Cancer, the Social Dimension of Dying.

The author declares she has no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 3. 4. 2019 Accepted: 18. 4. 2019.

MDA-9/Syntenin: An emerging global molecular target regulating cancer invasion and metastasis.

With few exceptions, metastasis is the terminal stage of cancer with limited therapeutic options. Metastasis consists of numerous phenotypic and genotypic alterations of cells that are directly and indirectly induced by multiple intrinsic (cellular) and extrinsic (micro-environmental) factors. To metastasize, a cancer cell often transitions from an epithelial to mesenchymal morphology (EMT), modifies the extracellular matrix, forms emboli and survives in the circulation, escapes immune surveillance, adheres to sites distant from the initial tumor and finally develops a blood supply (angiogenesis) and colonizes in a secondary niche (a micrometastasis). Scientific advances have greatly enhanced our understanding of the precise molecular and genetic changes, operating independently or collectively, that lead to metastasis. This review focuses on a unique gene, melanoma differentiation associated gene-9 (also known as Syntenin-1; Syndecan Binding Protein (sdcbp); mda-9/syntenin), initially cloned and characterized from metastatic human melanoma and shown to be a pro-metastatic gene. In the last two decades, our comprehension of the diversity of actions of MDA-9/Syntenin on cellular phenotype has emerged. MDA-9/Sytenin plays pivotal regulatory roles in multiple signaling cascades and orchestrates both metastatic and non-metastatic events. Considering the relevance of this gene in controlling cancer invasion and metastasis, approaches have been developed to uniquely and selectively target this gene. We also provide recent updates on strategies that have been successfully employed in targeting MDA-9/Syntenin resulting in profound pre-clinical anti-cancer activity.

O acompanhante do paciente oncológico em fase terminal: percepção do técnico de enfermagem

Objetivo: compreender a percepção dos técnicos de enfermagem em relação aos acompanhantes dos pacientes oncológicos em fase terminal.Metodologia: trata-se de uma pesquisa descritivo-exploratória de natureza qualitativa, desenvolvida em um hospital referência para o tratamento do câncer em Belo Horizonte, Minas Gerais. A coleta de dados ocorreu entre os meses de setembro e outubro de 2016. Utilizou-se a Análise de Conteúdo fundamentada em Bardin para a avaliação das entrevistas.Resultados: a partir da análise das entrevistas, emergiram duas categorias empíricas: O conviver cotidiano do técnico de enfermagem e o acompanhante do paciente oncológico em fase terminal e Fatores dificultadores da interação da enfermagem com os acompanhantes, focando-se na interação dos profissionais com o acompanhante e os fatores de conflito entre as partes.Conclusão: foi evidenciada a importância do acompanhante pelo técnico de enfermagem nesse processo de terminalidade, na medida em que podem proporcionar segurança e acolhimento ao paciente. No entanto, a ausência de uma comunicação adequada entre os acompanhantes e o profissional foi o fator preponderante na geração de conflitos. A enfermagem requer, por parte da instituição assim como do acompanhante, de espaços nos quais possam expressar suas angústias e anseios, fazendo que esse percurso seja um momento de acolhimento e de criação de vínculos entre os envolvidos.

Decline of Physical Activity in Terminally Ill Patients Could Be Useful for Predicting Short-Term Survival.

Although it is recommended that all terminally ill patients receive advance care planning (ACP), this is occasionally challenging because of the difficulty in predicting survival. There are some indexes for predicting survival, but few are accurate, especially at the terminal stages of illness. Twenty-two patients at the terminal stages of cancer were retrospectively analyzed. We assessed their physical activity and condition using activities of daily living (ADL) scores for 1 month before the death. The ADL scores included 7 items: walking, bathing, grooming, dressing, eating, transferring, and toileting. Survival time after the first decline of physical activity was calculated (median: 13 days, 95% confidence interval [95% CI]: 5.6-20.4 days). Survival time after the second (median: 5 days, 95% CI: 0-10.9 days), third (median: 5 days, 95% CI: 0-13.4 days), and fourth (median time: 1 day, 95% CI: not applicable due to small size) decline of physical activity was also calculated. Change in physical activity seems helpful for estimating survival time, especially at the end of life, and this index could be useful for coordinating final ACP.