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Risk factors of sudden unexpected death in patients with advanced cancer near the end of life

Abstract Background The definition of sudden unexpected death (SUD) in patients with advanced cancer near the end of life (EOL) was unclear. Methods This study was conducted as a single-center retrospective analysis. We analyzed 1,282 patients who died of advanced cancer from August 2011 to August 2019 retrospectively. We divided into patients who died within 24 h after the acute change of general condition or others and analyzed risk factors by a multiple logistics method. The reason for SUD was found, the reason is detected by using an electronic medical record retrospectively. The risk factors in SUD were analyzed using age, sex, EOL symptom and treatment, the primary site of cancer, metastatic site of cancer, comorbidly, chemotherapy, and Eastern Cooperative Oncology Group Performance Status. The primary endpoint was to identify the frequency and risk factors of SUD in patients with advanced cancer near the EOL. Results As a background, the median age is 73 years old, 690 males, 592 females, 227 gastroesophageal cancers, 250 biliary pancreatic cancers, 54 hepatocellular carcinomas, 189 colorectal cancer, 251 lung cancers, 71 breast cancers, 58 urological malignancies, 60 gynecological malignancies, 47 head and neck cancer, 31 hematological malignancies, and 22 sarcomas. The number of patients who died suddenly was 93 (7.2%) at EOL. In a multivariate analysis, Age (ORs 0.619), sex (ORs 1.700), patients with EOL delirium (ORs 0.483), nausea and vomiting (ORs 2.263), 1L or more infusion (ORs 3.479), EOL opioids (ORs 0.465), EOL sedations (ORs 0.339), and with cardiac comorbidity (ORs 0.345) were independent risk factors. Conclusions The frequency of patients who died suddenly was 7.2% (n = 93) at EOL. Age, sex, EOL symptom, EOL treatment, and cardiac comorbidity were independent risk factors in patients with advanced cancer near the EOL. Information on these risk factors is useful to explaining their EOL in advance.