Clinical Factor Associated with 1-week and 1-month Mortality in Palliative Hepatobiliary Cancer Patients
Keywords:
Hepatobiliary cancer, short-term mortality, Palliative careAbstract
Background: Hepatobiliary cancers have high mortality rates, and palliative care plays a crucial role in symptom management and quality-of-life support. Identifying factors associated with short-term mortality (1 ‑week and 1 ‑month) is essential for care planning and clinical decision-making.
Objectives: To examine clinical factors associated with 1-week and 1-month mortality among patients with hepatobiliary cancer receiving palliative care.
Methods: This retrospective cohort study reviewed medical records of patients receiving palliative care at the Karunruk Palliative Care Center, Srinagarind Hospital, from 1 October 2021 to 31 January 2024. Demographic data, clinical characteristics, Palliative Performance Scale (PPS) scores, and key symptoms were collected. Descriptive statistics and logistic regression analyses were performed to identify factors associated with short-term mortality, with statistical significance set at p < 0.05.
Results: Among 396 deceased patients, 43.4% died within 1 week and 61.4% within 1 month. After adjustment, PPS 10–20, PPS 30, and fatigue were significantly associated with 1-week mortality (adjusted OR: 10.39, 95% CI: 1.25–86.71; 3.09, 95% CI: 1.66–5.74; and 2.03, 95% CI: 1.30–3.20, respectively). For 1-month mortality, PPS 10–30, fatigue, and cognitive impairment remained significant factors (adjusted OR: 4.36, 95% CI: 2.03–9.38; 2.42, 95% CI: 1.52–3.86; and 3.25, 95% CI: 1.18–8.94, respectively). All patients presenting with dyspnea died within 1 month.
Conclusions: Low PPS scores, fatigue, cognitive impairment, and dyspnea are key factors associated with short-term mortality in hepatobiliary cancer. Recognition of these indicators can support prognostication, care planning, and preparation for end-of-life care.
Downloads
References
Srivatanakul P. Epidemiology of Liver Cancer in Thailand. Asian Pac J Cancer Prev 2001; 2(2): 117-121.
Giannini EG, Farinati F, Ciccarese F, Pecore A, Rapaccini GL, Marco MD, et al. Prognosis of untreated hepatocellular carcinoma. Hepatology 2015; 61(1): 184-190. doi: 10.1002/hep.27443
Grove MK, Hermann RE, Vogt DP, Broughan TA. Role of radiation after operative palliation in cancer of the proximal bile ducts. Am J Surg 1991; 161(4): 454-458. doi: 10.1016/0002-9610(91)91111-u
Nghiem V, Wood S, Ramachandran R, Williams G, Outlaw D, Kim YI, et al. Short- and Long-Term Survival of Metastatic Biliary Tract Cancer in the United States From 2000 to 2018. Cancer Control 2023; 30: 10732748231211764. doi: 10.1177/10732748231211764
Ahalt C, Walter LC, Yourman L, Eng C, Pérez-Stable EJ, Smith AK. “Knowing is better”: preferences of diverse older adults for discussing prognosis. J Gen Intern Med 2012; 27(5): 568-575. doi: 10.1007/s11606-011-1933-0
Wright AA, Zhang B, Ray A, Mack JM, Balboni T, Mitchell SL, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 2008; 300(14): 1665-1673. doi: 10.1001/jama.300.14.1665
Yount S, Cella D, Webster K, Heffernan N, Chang C, Odom L, et al. Assessment of patient-reported clinical outcome in pancreatic and other hepatobiliary cancers: the FACT Hepatobiliary Symptom Index. J Pain Symptom Manage 2002; 24(1): 32-44. doi: 10.1016/s0885-3924(02)00422-0
Le DC, Nguyen TM, Nguyen DH, Nguyen DT, Nguyen LTM. Survival Outcome and Prognostic Factors Among Patients With Hepatocellular Carcinoma: A Hospital-Based Study. Clin Med Insights Oncol 2023; 17: 11795549231178171. doi: 10.1177/11795549231178171
Wang Y, Yang H, Shen C, Luo J. Cholangiocarcinoma: prognostic factors after surgical resection in China. Int J Clin Exp Med 2015; 8(4): 5506-5512.
Ruijs CDM, Kerkhof AJFM, van der Wal G, Onwuteaka-Philipsen BD. Symptoms, unbearability and the nature of suffering in terminal cancer patients dying at home: a prospective primary care study. BMC Fam Pract 2013; 14: 201. doi: 10.1186/1471-2296-14-201
World Health Organization. Palliative care [Internet]. 2020 [cited 2025 Dec 3]. Available from: https://www.who.int/news-room/fact-sheets/detail/palliative-care
Prompantakorn P, Angkurawaranon C, Pinyopornpanish K, Chutarattanakul L, Aramrat C, Pateekhum C, et al. Palliative Performance Scale and survival in patients with cancer and non-cancer diagnoses needing a palliative care consultation: a retrospective cohort study. BMC Palliat Care 2021; 20(1): 74. doi: 10.1186/s12904-021-00773-8
Renteria Ramirez DE, Knøfler LA, Kirkegård J, Fristrup CW, Stander Mt, Nielsen SD, et al. Prognosis related to treatment plan in patients with biliary tract cancer: A nationwide database study. Cancer Epidemiol. 2024; 93: 102688. doi: 10.1016/j.canep.2024.102688
Vigano A, Donaldson N, Higginson IJ, Bruera E, Mahmud S, Suarez-Almazor M. Quality of life and survival prediction in terminal cancer patients: a multicenter study. Cancer 2004; 101(5): 1090-1098. doi: 10.1002/cncr.20472
Gripp S, Moeller S, Bölke E, Schmitt G, Matuschek C, Asgari S, et al. Survival prediction in terminally ill cancer patients by clinical estimates, laboratory tests, and self-rated anxiety and depression. J Clin Oncol 2007; 25(22): 3313-3320. doi: 10.1200/JCO.2006.10.5411
Liu Y, Xi QS, Xia S, Zhuang L, Zheng W, Yu S. Association between symptoms and their severity with survival time in hospitalized patients with far advanced cancer. Palliat Med. 2011; 25(7): 682-690. doi: 10.1177/0269216311398301
Singer AE, Meeker D, Teno JM, Lynn J, Lunney JR, Lorenz KA. Symptom trends in the last year of life, 1998-2010: A cohort study. Ann Intern Med 2015; 162(3): 175-183. doi: 10.7326/M13-1609
de la Cruz M, Ransing V, Yennu S, Wu J, Liu D, Reddy A, et al. The Frequency, Characteristics, and Outcomes Among Cancer Patients With Delirium Admitted to an Acute Palliative Care Unit. Oncologist 2015; 20(12): 1425-1431. doi: 10.1634/theoncologist.2015-0115
Yoong SQ, Bhowmik P, Kapparath S, Porock D. Palliative prognostic scores for survival prediction of cancer patients: a systematic review and meta-analysis. J Natl Cancer Inst 2024; 116(6): 829-857. doi: 10.1093/jnci/djae036
Australian Government Department of Health D and A. Palliative Care Outcomes Collaboration (PCOC). [internet] 2025. [cited 2025 October 27] https://www.health.gov.au/our-work/palliative-care-outcomes-collaboration-pcoc
Bischoff KE, Patel K, Boscardin WJ, O’Riordan DL, Pantilat SZ, Smith AK. Prognoses Associated With Palliative Performance Scale Scores in Modern Palliative Care Practice. JAMA Netw Open 2024; 7(7): e2420472. doi: 10.1001/jamanetworkopen.2024.20472
Marmor S, Cohen S, Fujioka N, Cho LC, Bhargava A, Misono S. Dysphagia prevalence and associated survival differences in older patients with lung cancer: A SEER-Medicare population-based study. J Geriatr Oncol 2020; 11(7): 1115-1117. doi: 10.1016/j.jgo.2020.02.015
Tapper EB, Parikh ND, Sengupta N, Mellinger J, Ratz D ,Lok AS-F et al. A risk score to predict the development of hepatic encephalopathy in a population-based cohort of patients with cirrhosis. Hepatology 2018; 68(4): 1498-1507. doi: 10.1002/hep.29628
Orman ES, Roberts A, Ghabril M, Nephew L, Desai AP, Patidar K, et al. Trends in Characteristics, Mortality, and Other Outcomes of Patients With Newly Diagnosed Cirrhosis. JAMA Netw Open 2019; 2(6): e196412. doi: 10.1001/jamanetworkopen.2019.6412
Wong PY, Xia V, Imagawa DK, Hoefs J, Hu KQ. Clinical presentation of hepatocellular carcinoma (HCC) in Asian-Americans versus non-Asian-Americans. J Immigr Minor Health 2011; 13(5): 842-848. doi: 10.1007/s10903-010-9395-8
Bohra A, Worland T, Hui S, Terbah R, Farrell A, Robertson M. Prognostic significance of hepatic encephalopathy in patients with cirrhosis treated with current standards of care. World J Gastroenterol 2020; 26(18): 2221-2231. doi: 10.3748/wjg.v26.i18.2221
Fang Z, Zhang Q. Association between cognitive impairment and cardiovascular mortality in mature and older adults: A meta-analysis. Exp Gerontol. 2024; 192: 112440. doi: 10.1016/j.exger.2024.112440
Shin J, Kober K, Wong ML, Yates P, Miaskowski C. Systematic review of the literature on the occurrence and characteristics of dyspnea in oncology patients. Crit Rev Oncol Hematol 2023; 181: 103870. doi: 10.1016/j.critrevonc.2022.103870
Frostad A. Association between respiratory symptom score and 30-year cause-specific mortality and lung cancer incidence. Clin Respir J 2008; 2 Suppl 1: 53-58. doi: 10.1111/j.1752-699X.2008.00084.x
Seow H, Barbera L, Sutradhar R, Howell D, Dudgeon D, Atzema C, et al. Trajectory of performance status and symptom scores for patients with cancer during the last six months of life. J Clin Oncol 2011; 29(9): 1151-1158. doi: 10.1200/JCO.2010.30.7173
Campbell ML, Kiernan JM, Strandmark J, Yarandi HN. Trajectory of Dyspnea and Respiratory Distress among Patients in the Last Month of Life. J Palliat Med 2018; 21(2): 194-199. doi: 10.1089/jpm.2017.0265
Maltoni M, Pirovano M, Scarpi E, Marinari M, Indelli M, Arnoldi E, et al. Prediction of survival of patients terminally ill with cancer. Results of an Italian prospective multicentric study. Cancer 1995; 75(10): 2613-2622. doi: 10.1002/1097-0142(19950515)75:10<2613::aid-cncr2820751032>3.0.co;2-1.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Community Health Development Quarterly Khon Kaen University
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles in this journal are copyrighted by the x may be read and used for academic purposes, such as teaching, research, or citation, with proper credit given to the author and the journal.use or modification of the articles is prohibited without permission.
statements expressed in the articles are solely the opinions of the authors.
authors are fully responsible for the content and accuracy of their articles.
other reuse or republication requires permission from the journal."
