Wish to Hasten Death in Advanced Cancer Patients Receiving Palliative Care. A Cross-Sectional Study in a Latin American Setting

Background: The wish to hasten death (WTHD) is a recognized expression of suffering in advanced illness, yet remains systematically underexplored in Latin America, where data are virtually absent. Objectives: To determine the prevalence of the WTHD, and identify associated factors and predictors in advanced cancer patients receiving palliative care in Argentina. Design: Cross-sectional descriptive study. Setting/Subjects: One hundred consecutive patients with stage IV cancer under active palliative care follow-up at a university hospital in Argentina were enrolled between January 2024 and December 2025. Measurements: WTHD was assessed using the AFEDD interview; it was identified in 35% of patients based on a positive screening response with severity scores among these patients ranging from 2 to 7 (median = 5). Symptom burden was measured with the revised Edmonton Symptom Assessment System (ESAS-r); total scores were calculated both with and without the additional item “feeling like a burden to others.” Demoralization was assessed using the Demoralization Scale-II (DS-II), with a cutoff score of ≥10. Results: WTHD was identified in 35% of patients that scored between 2 and 7 (median = 5). Among those, most scored at the lower end of the clinical continuum (⥶ x ), without active planning. Patients who scored high in WTHD (⥸ x ) showed significantly higher symptom burden (median ESAS-r 41.0 vs. 31.0; p < 0.001) and demoralization rates (62.9% vs. 23.1%; p < 0.001). In multivariate logistic regression, demoralization was the only independent predictor of WTHD (OR = 6.56; 95% CI: 2.47–18.53; p < 0.001). Conclusions: Demoralization is the key factor associated with the WTHD in this Latin American palliative care sample. Proactive, multidimensional assessment addressing meaning, dignity, and relational suffering is essential for comprehensive end-of-life care.