Trajectories of Activities of Daily Living for Patients with Advanced Cancer Beyond the Last Eight Weeks of Life. Implications for Palliative Rehabilitation

Soeda et al.1 are to be commended for their retrospective study on Activities of Daily Living trajectories of people with advanced cancer in the past eight weeks of life.1 We agree there is an imperative to understand characteristics of functional decline to inform tailored patient care. This study highlights the absence of trajectory studies that enable identification of gradual functional changes and used the functional independence measure (FIM) to measure functional decline in their study.
An earlier study published in Palliative Medicine2 about trajectories of functional decline measured prospectively over the past four months of life (n = 55,548) used the Australia-modified Karnofsky Performance Status (AKPS) scale3 to measure function or Activities of Daily Living abilities. We identified only two trajectories of functional decline:
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Trajectory 1: Cancer, solid organ failure, and cardiovascular disease (requiring sustained moderate assistance with Activities of Daily Living); and
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Trajectory 2: Dementias and other neurological conditions (requiring sustained maximal assistance with Activities of Daily Living).