More recent research on AD in advanced cancer has focussed on its prognostic significance; a small number of studies have identified a relationship between AD and shorter survival in advanced cancer [12-14]. Cardiovascular autonomic neuropathy has been shown to be

a risk factor for falls in older adults with dementia [15]. We conducted a prospective study of the risk factors for falls in patients with advanced cancer. In view of the reported high prevalence of AD in patients with advanced cancer we elected to include tests of cardiovascular autonomic function in our research Inhibitors,research,lifescience,medical assessment. Autonomic function is most commonly MLN8237 supplier measured by the application of a group of clinical tests, which aim to measure sympathetic Inhibitors,research,lifescience,medical and parasympathetic activity, by measuring end-organ responses to physiological perturbations [16]. Ewing et al devised a battery of four tests which generate three outcome measures of parasympathetic activity and two of sympathetic activity, the results of which can be used to grade the severity of autonomic dysfunction [17]. In this paper we specifically report our findings in relation to the frequency and clinical correlates of AD, highlight and evaluate the difficulties experienced in measuring autonomic

function in patients with advanced cancer, and make recommendations Inhibitors,research,lifescience,medical regarding the direction of future research in this area. Methods Setting and participants Eligible patients who were admitted consecutively to the palliative care services provided by Our Lady’s Hospice and Care Services (November 24, 2008 – Dec 24, 2010) were invited to participate. Inhibitors,research,lifescience,medical The palliative care services consist of inpatient Inhibitors,research,lifescience,medical care provided in a 36-bed inpatient unit (IPU), a day hospice service and a home care service. Patients aged 18 years or older with a diagnosis of metastatic or loco-regionally advanced cancer were eligible for inclusion. Exclusion criteria were as follows: being unable to stand and mobilize unassisted, actively dying or considered too unwell by the admitting and research

teams, registered blind, using continuous oxygen, and almost being aphasic or unable to converse in English. Eligible patients received written information on the study at the time of admission to services. Enrolment of patients with impaired cognition (Short Orientation-Memory Concentration Test (SOMCT) score greater than 11) required the assent of the patient in addition to consent from their proxy. The SOMCT error score ranges from 0-28; the normal score range is 0-6 [18]. All other participants provided informed consent. The study was approved by St. Vincent’s University Health Group Ethics Committee. Data collection Demographic details, comorbidities and medications were transcribed from admission notes and verified at patient interview.