In many cases, when cancer patients are left with no further options to treat their disease, the focus shifts from prolonging life to promoting the quality of life (QOL) at the end of life (EOL). Now, researchers have identified factors that influence better QOL at EOL.

According to the researchers: “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 study, conducted by Baohui Zhang, M.S., formerly of the Dana-Farber Cancer Institute, Boston, and colleagues, is published Online First by Archives of Internal Medicine.

The researchers found that better QOL at EOL for advance cancer patients was associated with:

  • avoiding the intensive care unit
  • avoiding being hospitalized
  • praying
  • meditating
  • worrying less
  • having a therapeutic alliance with their physician
  • being visited by a pastor in a hospital or clinic

The study involved 396 patients suffering from advanced cancer and their caregivers. The average age of study participants was almost 59 years.

The study revealed that patients QOL at the end of life could be explained by nine factors, including: intensive care stays in the final week, hospital deaths, patient worry, religious prayer or meditation at baseline, site of cancer care, feeding tube use in the final week, pastoral care within the hospital or clinic, chemotherapy in the final week, and a patient-physician therapeutic alliance where patients felt they were treated as a “whole person”.

The researchers explained: “Two of the most important determinants of poor patient 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.”

In addition, the team found that patient worry at baseline was also “one of the most influential predictors of worse QOL at the EOL.”

The researchers conclude: “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.”

In an associated comment, 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, M.D., said:

“The concept of quality of the EOL 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.”

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

Written by Grace Rattue