Dying trajectory in the last year of life: does cancer trajectory fit other diseases?

J Palliat Med. 2001 Winter;4(4):457-64. doi: 10.1089/109662101753381593.


Purpose: To examine differences in the pattern of functional decline among persons dying of cancer and other leading noncancer causes of death.

Design: Mortality followback survey of next of kin listed on death certificate.

Setting: Probability sample of all deaths in the United States.

Participants: Next of kin for 3,614 decedents that represented 914,335 deaths.

Measurements: Days of difficulty with activities of daily living and mobility in the last year of life.

Results: Relative to other decedents, patients with cancer experienced an increased rate of functional impairment beginning as late as 5 months prior to death. For example, only 13.9% of patients with cancer had difficulty getting out of bed or a chair 1-year prior to death. This increased from 22.2% to 63.0% in the last five months of life. In contrast, decedents from other diseases had higher rates of functional impairment 1 year prior to death (approximately 35% had difficulty getting out of bed or chair) and they manifested a more gradual increase in the level of functional decline (approximately 50% had difficulty getting out of bed). Precipitous functional decline was associated with hospice involvement and dying at home.

Conclusion: Persons dying of cancer experienced sharp functional decline in the last months of life whereas other decedents' have a more gradual decline. The more precipitous functional decline was associated with hospice involvement and dying at home.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Data Collection
  • Death Certificates
  • Death*
  • Diabetes Mellitus / mortality
  • Diabetes Mellitus / physiopathology
  • Disease Progression*
  • Heart Failure / mortality
  • Heart Failure / physiopathology
  • Hospice Care / statistics & numerical data
  • Humans
  • Neoplasms / mortality*
  • Neoplasms / physiopathology*
  • Prognosis
  • Pulmonary Disease, Chronic Obstructive / mortality
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Stroke / mortality
  • Stroke / physiopathology
  • United States / epidemiology