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24
Table 1: Demographics and clinical characteristics of 1896 study patients.
No. or
% or
Median
Range
74
25-100
Men
965
50.9
Women
931
49.1
Esophagus, stomach, small intestine, colon, and rectum
519
27.4
Pancreas, liver, bile duct, gall bladder
363
19.1
Lung
319
16.8
Breast
131
6.9
Ovary, uterus
119
6.3
Kidney, urinary tract, bladder
101
5.3
Head and neck
76
4.0
Hematological
56
3.0
Prostate
40
2.1
Unknown
35
1.8
Brain
30
1.6
Bone, Soft tissue
21
1.1
Characteristics
Age, years (median, range)
Sex
Site of primary cancer
Others
86
4.5
Anywhere
1605
84.7
Liver
730
38.5
Lung
708
37.3
Bone
501
26.4
Brain
263
13.9
Cerebral vascular disease
127
6.7
Diabetes with any of the three major complications
43
2.3
Liver failure (Cirrhosis with portal hypertension)
48
2.5
Renal failure (Cre ≧3mg/dl)
30
1.6
≧50
572
30.2
30-40
979
51.6
10-20
345
18.2
0-1
26
1.4
156
8.2
785
41.4
929
49.0
Site of metastasis
Comorbidity
Karnofsky Performance Scale
ECOG Performance Status
Body temperature (°C, median, range, n=1864)
36.8
34.6-40.9
Chemotherapy in the previous month
172
9.1
Digestive tract obstruction
257
13.6
1206
63.6
Oral morphine equivalent daily dose (mg, median, range, n=1201)
30
0.5-1200
Antipsychotics
429
22.6
Benzodiazepine
324
17.1
Antidepressant
77
4.1
Anticholinergics
69
3.6
Anticonvulsants
35
1.8
Total bilirubin (mg/dl, n=1577)
0.6
0-40.8
C-reactive protein (mg/dl, n=1581)
5.15
0-42.45
Serum sodium (mEq/l, n=1617)
136
101-187
Serum potassium (mEq/l, n=1614)
4.4
2.1-8.0
Corrected calcium (mg/dl, n=1403)
8.5
4.0-17.4
19
18-20
Concurrent medical interventions
Opioids
Laboratory (median, range)
Survival of patients discharged due to death (median days, 95%CI,
n=1633)
Table 2: Prevalence of each orphan symptom on admission and in the three days before death
On admission (n=1896)
In the three days before death (n=1633)
Symptom
Prevalence (%)
95% CI 1(%)
Prevalence (%)
95% CI 1(%)
Myoclonus
25
1.3
0.9-1.9
87
5.3
4.3-6.5
Sweating
35
1.8
1.3-2.6
66
4.1
3.1-5.1
Pruritus
66
3.5
2.7-4.4
41
2.5
1.8-3.4
Hiccup
21
1.1
0.7-1.7
30
1.8
1.2-2.6
Tenesmus
13
0.7
0.4-1.2
15
0.9
0.5-1.5
Confidence interval
Table 3: Characteristics of each orphan symptom on admission and in the three days before death
On admission (n=1896)
Symptom
Myoclonus
25
Ratio1 (%)
95% CI 2 (%)
In the three days before death (n=1633)
Ratio1 (%)
95% CI2 (%)
87
once/10 sec
14
56
35 - 76
58
67
56 - 76
2-3 times/10 sec
36
18 - 58
19
22
14 - 32
4-9 times/10 sec
1 - 26
4 - 17
≧10 times/10 sec
0.3 - 8
35
66
Sweating
Nocturnal
21
60
42 - 76
30
46
33 - 58
Persistent
14
40
24 - 58
36
55
42 - 67
Pruritus
41
66
Intermittent
40
61
48 - 72
23
56
40 - 72
Persistent
26
39
28 - 52
18
44
29 - 60
Hiccup
Occasional
21
30
38
18 - 62
16
53
34 - 72
13
62
38 - 82
13
43
26 - 63
0.1 - 17
Tenesmus
13
15
Rectal
Vesical
Both
47
21 - 73
Protracted
(≧48 hours, <1 month)
Continuous
(≧1 month)
Proportion of each characteristic in each symptom
Confidence interval
15
2 - 45
Table 4: Factors associated with orphan symptoms
Myoclonus (n=25)
Sweating (n=35)
Odds ratio
95%CI
0.42
1.46
0.74-2.88
0.28
0.29-1.76
0.55
0.65
0.3-1.35
0.24
2.69
1.15-6.30
0.0222*
1.17
0.48-2.84
0.73
56
N/A1
N/A1
N/A1
0.97
0.13-7.18
0.97
Cerebral vascular disease
127
1.21
0.28-5.21
0.79
1.31
0.4-4.35
0.66
Liver failure (Cirrhosis with portal hypertension)
48
0-6.26
2.39
0.56-10.3
0.24
Renal failure (Cre ≧3mg/dL)
30
2.65
0.35-20.2
0.35
1.86
0.25-14.0
0.55
Diabetes with any of the three major complications
43
1.81
0.24-13.7
0.56
2.69
0.62-11.6
0.18
901
2.05
0.59-5.7
0.19
0.76
0.23-2.49
0.64
Opioids
1206
1.82
0.73-4.59
0.2
3.49
1.35-9.05
0.00994*
Opioid morphine-equivalent daily dose≧120mg
220
2.35
0.80-6.94
0.12
2.58
1.05-6.31
0.0385*
Morphine
363
1.06
0.39-2.83
0.91
2.89
1.45-5.74
0.00245*
Antipsychotics
429
1.54
0.66-3.59
0.32
2.2
1.11-4.37
0.0237*
Benzodiazepine
324
0.92
0.32-2.71
0.88
0.81
0.31-2.09
0.66
Antidepressant
77
0.98
0.13-7.37
0.99
1.44
0.34-6.12
0.62
Anticholinergics
69
1.1
0.15-8.28
0.92
0-2.96
0.64
Odds ratio
95%CI
Sex (male)
965
1.45
0.61-3.64
Age (≧75)
901
0.73
Brain (primary or/and metastasis)
286
Hematological
P value
P value
Tumor site
Comorbidity
Complication
Fever (≧37.5° C)
Medication
Pruritus (n=66)
Odds ratio
95%CI
Sex (male)
965
1.61
0.97-2.67
Age (≧75)
901
0.999
Brain (primary or/and metastasis)
286
Esophagus
Hiccups (n=21)
P value
Odds ratio
95%CI
P value
0.07
9.33
2.17-40.1
0.00271*
0.98-1.02
0.92
0.99
0.95-1.02
0.36
0.66
0.30-1.46
0.3
0.28
0.04-2.09
0.21
62
N/A1
N/A1
N/A1
1.49
0.2-11.3
0.70
Stomach
203
N/A
N/A
N/A
2.65
0.96-7.3
0.06
Liver (primary or/and metastasis)
775
2.29
1.39-3.79
0.00122*
2.37
0.98-5.75
0.0557
Bile duct,Gall bladder
72
3.22
1.42-7.33
0.00526*
1.27
0.17-9.60
0.82
Pancreas
202
0.84
0.36-1.95
0.68
2.66
0.97-7.34
0.0587
Hematological
56
1.03
0.25-4.31
0.97
N/A
N/A
N/A1
Cerebral vascular disease
127
1.15
0.45-2.91
0.77
1.47
0.34-6.40
0.61
Liver failure (Cirrhosis with portal hypertension)
48
2.62
0.91-7.52
0.07
1.94
0.26-14.8
0.52
Renal failure (Cre ≧3mg/dL)
30
2.01
0.50-8.63
0.34
6.94
1.54-31.2
0.0116*
Diabetes with any of the three major complications
43
4.85
1.97-11.9
0.00059*
7.65
2.16-27.0
0.00158*
Skin lesions
156
1.57
0.74-3.35
0.25
N/A1
N/A1
N/A1
Cholestasis ( T-Bil>10.0mg/dl)
65
7.84
3.88-15.80
0.00000000925*
N/A1
N/A1
N/A1
Digestive tract obstruction
257
N/A1
N/A1
N/A1
4.02
1.65-9.79
0.00222*
Opioids
1206
0.876
0.53-1.45
0.61
0.63
0.26-1.48
0.29
Opioid morphine-equivalent daily dose≧120mg
220
0.569
0.18-1.83
0.34
0.6
0.08-4.53
0.62
Morphine
363
1.14
0.63- 2.09
0.66
0.44
0.05-1.84
0.4
Antipsychotics
429
1.43
0.84-2.45
0.19
1.02
0.37-2.79
Benzodiazepine
324
1.2
0.65-2.22
0.57
1.14
0.38-3.42
0.81
Antidepressant
77
0.73
0.18-3.04
0.67
0-4.58
Anticholinergics
69
1.27
0.40-4.16
0.69
0-5.15
Tumor site
Comorbidity
Complication
Medication
Vesical tenesmus (n=10)
Rectal tenesmus (n=5)
Odds ratio
95%CI
0.24
1.45
0.24-8.69
0.69
0.38
0.955
0.90-1.02
0.14
3.76
0.42-33.9
0.24
0.0151*
3.13
0.35-28.1
0.31
5.18
0.57-46.9
0.14
0.49-7.44
0.35
6.72
1.12-40.4
0.0373*
3.52
0.74-16.8
0.11
3.5
0.39-31.6
0.06
48
0-17.6
0-43.0
Renal failure (Cre ≧3mg/dL)
30
0-29.0
0-70.2
Diabetes with any of the three major complications
43
0-19.8
0-48.2
901
1.1
0.25-4.82
5.43
0.45-47.7
0.1
Opioids
1206
1.34
0.35-5.19
0.68
0.858
0.14-5.15
0.87
Antipsychotics
429
4.93
1.38-17.5
0.0138*
2.17
0.36-13.0
0.4
Benzodiazepine
324
3.26
0.92-11.6
0.07
3.25
0.54-19.5
0.2
Antidepressant
77
0-10.7
0-26.1
Anticholinergics
69
6.78
1.41-32.6
6.7
0.74-60.7
Odds ratio
95%CI
Sex(Male)
965
2.26
0.58-8.77
Age(≧75)
901
1.03
0.97-1.08
Gynecological
119
0-6.71
Urinary
141
5.43
1.39-21.2
Rectal
88
0-9.27
Pelvic cavity (gynecological + urinary + rectal)
348
1.91
Cerebral vascular disease
127
Liver failure (Cirrhosis with portal hypertension)
P value
P value
Tumor site
Comorbidity
Complication
Fever (≧37.5° C)
Medication
not applicable: Factors not associated with symptoms were not included in the formula
0.0167*
0.09
...
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