Quality-of-life trajectories at the end of life: assessments over time by patients with and without cancer
To compare quality-of-life (QOL) ratings of terminally ill patients with and without cancer over time. DESIGN: Secondary analysis of prospective data from a randomized clinical trial.
Trial conducted with terminally ill patients in Seattle, Washington, testing the efficacy of massage and guided meditation in improving patients' QOL.
One hundred sixty-seven trial participants, of whom 127 provided follow-up data and died before data analysis.
At enrollment, participants reported demographic characteristics, symptom distress, QOL, and primary life-limiting diagnosis. At enrollment and at follow-up interviews after every two study-provided treatment sessions, participants rated their perceived quality of life on a scale from 0 (no quality of life) to 10 (perfect quality). At the end of the study, the investigators added measures of patient's survival status, number of days between study enrollment and death, and receipt of hospice services to the data set.
Multilevel models showed significantly steeper QOL declines for patients with cancer than for those without after adjustment for time between study enrollment and death. Over a 4-month before-death period, the average patient without cancer was estimated to experience a QOL decline of approximately 0.6 on a scale from 0 to 10, compared with a 1.2-point decline for patients with cancer.
Patients with cancer face more-precipitous end-of-life challenges to quality of life than do other terminally ill persons. Therefore, clinicians must address QOL issues-not just symptom burden and distress. By introducing and discussing expected QOL declines at the end of life, clinicians may help to prepare, support, and reassure patients and their families.