Nine Factors Found to Play Key Role in Quality of Life for Dying Cancer Patients
When a cure for
cancer is no longer an option, the focus of care often shifts from prolonging life to promoting the quality of life
July 9, 2012 - Better quality of life at the end of life for patients with advanced cancer was associated with avoiding
hospitalizations and the intensive care unit, worrying less, praying or meditating, being visited by a pastor in a hospital or clinic, and
having a trusting alliance with their physician, according to a report published Online First by Archives of Internal Medicine, a JAMA Network
When treatments to cure a patient’s cancer are no longer an option, the focus of care often shifts from prolonging life
to promoting the quality of life (QOL) at the end of life (EOL). But researchers note in their study background that there has been a gap in
data on the strongest predictors of higher QOL at the EOL.
“The aim of this study was to identify the best set of predictors of QOL of patients in their final week of life. By
doing so, we identify promising targets for health care interventions to improve QOL of dying patients,” the authors note.
The study by Baohui Zhang, M.S., formerly of the Dana-Farber Cancer Institute, Boston, and colleagues included 396
patients with advanced cancer and their caregivers as part of the Coping with Cancer study. The average age of patients was almost 59 years.
A set of nine factors explained the most variance in patients’ QOL at the EOL:
1. intensive care stays in the final week,
2. in hospital deaths,
3. patient worry at baseline,
4. religious prayer or meditation at baseline,
5. site of cancer care,
6. feeding tube use in the final week,
7. pastoral care within the hospital or clinic,
8. chemotherapy in the final week, and
9. a patient-physician therapeutic alliance where the patient felt they were treated as a “whole person.”
“Two of the most important determinants of poor patient quality QOL at the EOL were dying in a hospital and ICU stays in
the last week of life. Therefore, attempts to avoid costly hospitalizations and to encourage transfer of hospitalized patients to home or
hospice might improve patient QOL at the EOL,” the authors comment.
Patient worry at baseline also was “one of the most influential predictors of worse QOL at the EOL,” the authors note.
“These results suggest that physicians who are able to remain engaged and ‘present’ for their dying patients - by
inviting and answering questions, and by treating patients in a way that makes them feel that they matter as fellow human beings - have the
capacity to improve a dying patient's QOL,” the researchers write.
“By reducing patient worry, encouraging contemplation, integrating pastoral care within medical care, fostering a
therapeutic alliance between patient and physician that enables patients to feel dignified, and preventing unnecessary hospitalizations and
receipt of life-prolonging care, physicians can enable their patients to live their last days with the highest possible level of comfort and
care,” the authors conclude.
This research was supported in part by grants from the National Institute of Mental Health, the National Cancer
Institute, and the Center for Psychosocial Epidemiology and Outcomes Research, Dana-Farber Cancer Institute.
Invited Commentary: Improving Patients’ Quality of Life at End of Life
“This study highlights the scarcity of research in an area that can give us important tools in further refining coherent
treatment strategies for patients throughout the timeline of cancer treatment and disease trajectory,” says an “invited commentary” in the
“It is surprising at this stage in the development and implementation of complex multimodal cancer treatment strategies
that the factors most critical in influencing the quality of the EOL are not clearly defined and considered along the entire timeline
beginning with cancer diagnosis,” write Alan B. Zonderman, Ph.D., and Michele K. Evans, M.D., of the Intramural Research Program, National
Institute on Aging, National Institutes of Health, Baltimore.
“This work as well as the American Society of Clinical Oncology statement support early introduction of palliative care
for advanced cancer patients,” the authors conclude.