Baohui Zhang1, Matthew E Nilsson, Holly G Prigerson. 1. Center for Psychosocial Epidemiology and Outcomes Research and Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Dana 1134, 450 Brookline Ave, Boston, MA, USA.
Abstract
BACKGROUND: When curative treatments are no longer options for patients dying of cancer, the focus of care often turns from prolonging life to promoting quality of life (QOL). Few data exist on what predicts better QOL at the end of life (EOL) for advanced cancer patients. The purpose of this study was to determine the factors that most influence QOL at the EOL, thereby identifying promising targets for interventions to promote QOL at the EOL. METHODS: Coping With Cancer is a US multisite, prospective, longitudinal cohort study of 396 advanced cancer patients and their informal caregivers who were enrolled from September 1, 2002, through February 28, 2008. Patients were followed up from enrollment to death a median of 4.1 months later. Patient QOL in the last week of life was a primary outcome of Coping With Cancer and the present report. RESULTS: The following set of 9 factors, preceded by a sign indicating the direction of the effect and presented in rank order of importance, explained the most variance in patients' QOL at the EOL: 1 = (-) intensive care unit stays in the final week (explained 4.4% of the variance in QOL at the EOL), 2 = (-) hospital deaths (2.7%), 3 = (-) patient worry at baseline (2.7%), 4 = (+) religious prayer or meditation at baseline (2.5%), 5 = site of cancer care (1.8%), 6 = (-) feeding-tube use in the final week (1.1%), 7 = (+) pastoral care within the hospital or clinic (1.0%), 8 = (-) chemotherapy in the final week (0.8%), and 9 = (+) patient-physician therapeutic alliance at baseline (0.7%). The vast majority of the variance in QOL at the EOL, however, remained unexplained. CONCLUSION: Advanced cancer patients who avoid hospitalizations and the intensive care unit, who are less worried, who pray or meditate, who are visited by a pastor in the hospital/clinic, and who feel a therapeutic alliance with their physicians have the highest QOL at the EOL.
BACKGROUND: When curative treatments are no longer options for patients dying of cancer, the focus of care often turns from prolonging life to promoting quality of life (QOL). Few data exist on what predicts better QOL at the end of life (EOL) for advanced cancerpatients. The purpose of this study was to determine the factors that most influence QOL at the EOL, thereby identifying promising targets for interventions to promote QOL at the EOL. METHODS: Coping With Cancer is a US multisite, prospective, longitudinal cohort study of 396 advanced cancerpatients and their informal caregivers who were enrolled from September 1, 2002, through February 28, 2008. Patients were followed up from enrollment to death a median of 4.1 months later. Patient QOL in the last week of life was a primary outcome of Coping With Cancer and the present report. RESULTS: The following set of 9 factors, preceded by a sign indicating the direction of the effect and presented in rank order of importance, explained the most variance in patients' QOL at the EOL: 1 = (-) intensive care unit stays in the final week (explained 4.4% of the variance in QOL at the EOL), 2 = (-) hospital deaths (2.7%), 3 = (-) patient worry at baseline (2.7%), 4 = (+) religious prayer or meditation at baseline (2.5%), 5 = site of cancer care (1.8%), 6 = (-) feeding-tube use in the final week (1.1%), 7 = (+) pastoral care within the hospital or clinic (1.0%), 8 = (-) chemotherapy in the final week (0.8%), and 9 = (+) patient-physician therapeutic alliance at baseline (0.7%). The vast majority of the variance in QOL at the EOL, however, remained unexplained. CONCLUSION: Advanced cancerpatients who avoid hospitalizations and the intensive care unit, who are less worried, who pray or meditate, who are visited by a pastor in the hospital/clinic, and who feel a therapeutic alliance with their physicians have the highest QOL at the EOL.
Authors: J B Williams; M Gibbon; M B First; R L Spitzer; M Davies; J Borus; M J Howes; J Kane; H G Pope; B Rounsaville Journal: Arch Gen Psychiatry Date: 1992-08
Authors: Harvey Max Chochinov; Linda J Kristjanson; William Breitbart; Susan McClement; Thomas F Hack; Tom Hassard; Mike Harlos Journal: Lancet Oncol Date: 2011-07-06 Impact factor: 41.316
Authors: Alaka Ray; Susan D Block; Robert J Friedlander; Baohui Zhang; Paul K Maciejewski; Holly G Prigerson Journal: J Palliat Med Date: 2006-12 Impact factor: 2.947
Authors: Matthew E Nilsson; Paul K Maciejewski; Baohui Zhang; Alexi A Wright; Elizabeth D Trice; Anna C Muriel; Robert J Friedlander; Karen M Fasciano; Susan D Block; Holly G Prigerson Journal: Cancer Date: 2009-01-15 Impact factor: 6.860
Authors: Daneng Li; Ghassan K Abou-Alfa; Aaron D Viny; Meredith Cammarata; Ali Shamseddine; Ashwaq Al-Olayan; Hibah Osman; Ali Haydar; Ghassan Kanazi; Mohamed Naghy; Eileen M O'Reilly; Andrew S Epstein Journal: J Gastrointest Oncol Date: 2015-10
Authors: Melissa M Garrido; Tracy A Balboni; Paul K Maciejewski; Yuhua Bao; Holly G Prigerson Journal: J Pain Symptom Manage Date: 2014-12-11 Impact factor: 3.612