Patients with advanced cancer who are reaching the end of their lives have a better quality of life if they are not hospitalized, are not in an intensive care unit, are being visited by a pastor if they are hospitalized or in a clinic, can worry less, have the opportunity to meditate or pray, and have a therapeutic alliance with their doctor, say researchers from the Dana-Farber Cancer Institute, Boston, in a report published in Archives of Internal Medicine.

When curative treatments no longer work, or are not an option any more, the medical team shifts the focus from prolonging life to optimizing the patients QOL (quality of life) at the end of life (EOL).

As background information to their report, the authors explained that there is a lack of data regarding the strongest predictors of higher quality of life at the end of life.

The authors set out to identify what factors had the best impact on quality of life during the final weeks of life for a patient with advanced cancer.

Baohui Zhang, M.S., wrote:

“By doing so, we identify promising targets for health care interventions to improve QOL of dying patients.”

Zhang and team’s study involved 396 advanced cancer patients and their caregivers – they were all part of the Coping with Cancer study. The average age of the patients was 59 years.

Nine factors explained the biggest differences in patients’ quality of life at their end of life:

  • Intensive care stays during the final week of their life
  • Hospital deaths
  • Level of patient worry at the start of the study
  • Meditation or religious prayer at baseline
  • Where the cancer care took place
  • The use of feeding tubes during their last week
  • Pastoral care inside the clinic or hospital
  • Chemotherapy during their last week of life
  • The patient-doctor therapeutic alliance where the patient felt they were being treated as a whole person

The authors wrote:

“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.”

One of the most influential predictors of worse quality of life during the patients final weeks was patient worry at baseline, the researchers found.

The team concluded:

“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.”

B. Zonderman, Ph.D., and Michele K. Evans, M.D., of the Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Md., wrote:

“The concept of quality of the EOL [end of life] in cancer patients has been under examined in cancer medicine in the quest to develop newer, more advanced, and effective modalities of interventional cytotoxic therapies. 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.

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.

This work as well as the American Society of Clinical Oncology statement support early introduction of palliative care for advanced cancer patients.”

When serious illness strikes, or takes over, what is the best way to talk to that person about his/her prognosis and quality of life? Surprisingly, researchers from the University of Rochester Medical Center found that none one had really studied that question. So, they audio-recorded 71 palliative care discussions. Link to article.

Written by Christian Nordqvist