Clinical indicators for the improvement of palliative care in patients with cancer – Factors influencing the period of abstention from food before death

Background & Aims: In cancer palliative care, nutritional interventions that address the main complaints of patients are necessary, but there are no scientific reports of nutritional interventions that take into account tumor location and therapeutic drugs. In this study, we investigated the relationship between the period of abstention from food before death and clinical indicators. Methods: Data of inpatients who died in the Shizuoka Cancer Center Palliative Care Ward between April 2019 and March 2024 were analyzed to determine the association between the period of abstention from food before death (i.e., the number of days without food prior to death, counting backwards from the day of death) and clinical indicators such as tumor localization, distress symptoms, and medicines administered (multivariable logistic regression analysis). The fasting period before death was counted as the number of days from the day the patient or their family requested or agreed to cessation of food provision until the day of death. The medical professionals never discontinued food provision without consent. Results: Overall, 2,319 deceased patients (1,334 men and 945 women) were included. The median age was 73 (25th–75th percentile: 20–96) years and average period of abstention from food before death was 5 (range: 1–20) days. The average length of stay in the palliative care unit was 18 (range: 9–36) days. A longer period of abstention from food was significantly associated with tumor localization in the brain, head and neck, upper gastrointestinal tract, and peritoneum; nausea/vomiting; and antibacterial agent use. A shorter period of abstention was significantly associated with age (≥75 years), tumor localization in the lung pleura and liver, difficulty in breathing, and opioid or steroid administration. No significant associations were observed between the period of abstention and sex; tumor localization in the pancreaticobiliary tract, lower gastrointestinal tract, urinary tract, uterine appendages, and bone; pain; abdominal bloating; and delirium. Conclusions: Our results suggest the presence of factors indicative of cancer cachexia progression with anorexia. However, the observation that non-nutritional factors may influence fasting duration is worth further exploration.