Symptom Expression in the Last Seven Days of Life Among Cancer Patients Admitted to Acute Palliative Care Units  David Hui, MD, MSc, Renata dos Santos, MD, Gary B. Chisholm, MS, Eduardo Bruera, MD  Journal of Pain and Symptom Management  Volume 50, Issue 4, Pages 488-494 (October 2015) DOI: 10.1016/j.jpainsymman.2014.09.003 Copyright © 2015 American Academy of Hospice and Palliative Medicine Terms and Conditions

Fig. 1 The proportion of patients who were able to communicate decreased near death. The total number of study patients on each day is plotted from death backward. The number of patients on each day varied because of the different lengths of admission. Journal of Pain and Symptom Management 2015 50, 488-494DOI: (10.1016/j.jpainsymman.2014.09.003) Copyright © 2015 American Academy of Hospice and Palliative Medicine Terms and Conditions

Fig. 2 Changes in ESAS in the last seven days of life. a) The average ESAS intensity was plotted from death backward for patients who were able to communicate. The P-values for longitudinal trend using a generalized linear mixed model are anorexia (P = 0.001), drowsiness (P < 0.0001), fatigue (P < 0.0001), poor well-being (P = 0.01), dyspnea (P < 0.0001), depression (P = 0.008), anxiety (P = 0.09), insomnia (P = 0.31), pain (P = 0.15), and nausea (P = 0.53). b) The proportion of patients with ESAS ≥4/10 was plotted from death backward. The P-values for longitudinal trend using generalized estimating equation are drowsiness (P = 0.03), fatigue (P = 0.006), poor well-being (P = 0.19), dyspnea (P = 0.006), pain (P = 0.42), anorexia (P = 0.16), anxiety (P = 0.30), depression (P = 0.78), insomnia (P = 0.35), and nausea (P = 0.07). ESAS = Edmonton Symptom Assessment System. Journal of Pain and Symptom Management 2015 50, 488-494DOI: (10.1016/j.jpainsymman.2014.09.003) Copyright © 2015 American Academy of Hospice and Palliative Medicine Terms and Conditions

Fig. 3 Symptom profile over time. The proportion of patients with constipation, cough, dysphagia to liquids, dysphagia to solids, fecal incontinence, myoclonus, sweating, and urinary incontinence was plotted from death backward. The frequencies of epistaxis, upper GI bleed, lower GI bleed, diarrhea, hematuria, vaginal bleed, and vaginal discharge were consistently below 10% and were not included in this diagram. GI = gastrointestinal. Journal of Pain and Symptom Management 2015 50, 488-494DOI: (10.1016/j.jpainsymman.2014.09.003) Copyright © 2015 American Academy of Hospice and Palliative Medicine Terms and Conditions