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Changes in health-related quality of life and quality of care among terminally ill cancer patients and survival prediction: Multicenter prospective cohort study

Published online by Cambridge University Press:  05 September 2014

Myung Kyung Lee ,
Woo Jin Lee ,
Young Rok Do ,
Keun Seok Lee ,
Kyung Hae Jung ,
Dae Seog Heo ,
Sam Yong Kim ,
Sang Yoon Park ,
Hyun Sik Jeong  and
Jung Hun Kang
...Show all authors
Myung Kyung Lee
Affiliation:
College of Nursing, Kyungpook National University, Daegu, Republic of Korea
Woo Jin Lee
Affiliation:
Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
Young Rok Do
Affiliation:
Division of Hematooncology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
Keun Seok Lee
Affiliation:
Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
Kyung Hae Jung
Affiliation:
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Dae Seog Heo
Affiliation:
Cancer Research Institute, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
Sam Yong Kim
Affiliation:
Division of Hematooncology, Department of Internal Medicine, Chungnam University School of Medicine, Daejeon, Republic of Korea
Sang Yoon Park
Affiliation:
Division of Hematooncology, Department of Internal Medicine, Chungnam University School of Medicine, Daejeon, Republic of Korea
Hyun Sik Jeong
Affiliation:
Department of Internal Medicine, Sunlin Hospital, Pohang, Republic of Korea
Jung Hun Kang
Affiliation:
Division of Hematooncology, Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Republic of Korea
Si-Young Kim
Affiliation:
Department of Internal Medicine, Kyunghee University Hospital, Seoul, Republic of Korea
Sook Ryun Park
Affiliation:
Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
Young Ho Yun*
Affiliation:
Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
*
Address correspondence and reprint requests to: Young Ho Yun, Department of Biomedical Science, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Korea. E-mail: lawyun08@gmail.com
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Abstract

Objective:

This study examined changes in health-related quality of life (HRQoL) and quality of care (QoC) as perceived by terminally ill cancer patients and a stratified set of HRQoL or QoC factors that are most likely to influence survival at the end of life (EoL).

Method:

We administered questionnaires to 619 consecutive patients immediately after they were diagnosed with terminal cancer by physicians at 11 university hospitals and at the National Cancer Center in Korea. Subjects were followed up over 161.2 person-years until their deaths. We measured HRQoL using the core 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and QoC using the Quality Care Questionnaire–End of Life (QCQ–EoL). We evaluated changes in HRQoL and QoC issues during the first three months after enrollment, performing sensitivity analysis by using data generated via four methods (complete case analysis, available case analysis, the last observation carried forward, and multiple imputation).

Results:

Emotional and cognitive functioning decreased significantly over time, while dyspnea, constipation, and pain increased significantly. Dignity-conserving care, care by healthcare professionals, family relationships, and QCQ–EoL total score decreased significantly. Global QoL, appetite loss, and Eastern Cooperative Oncology Group Performance Status (ECOG–PS) scores were significantly associated with survival.

Significance of results:

Future standardization of palliative care should be focused on assessment of these deteriorated types of quality. Accurate estimates of the length of life remaining for terminally ill cancer patients by such EoL-enhancing factors as global QoL, appetite loss, and ECOG–PS are needed to help patients experience a dignified and comfortable death.

Keywords

Health-related quality of lifeQuality of careTerminally ill cancer patientsSurvival
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 4 , August 2015 , pp. 1103 - 1111
Copyright
Copyright © Cambridge University Press 2014 

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References

REFERENCES

Addington-Hall, J.M., MacDonald, L.D. & Anderson, H.R. (1990). Can the Spitzer Quality of Life Index help to reduce prognostic uncertainty in terminal care? British Journal of Cancer, 62(4), 695–699.Google Scholar
Chang, V.T., Thaler, H.T., Polyak, T.A., et al. (1998). Quality of life and survival. Cancer, 83(1), 173–179.3.0.CO;2-T>CrossRefGoogle ScholarPubMed
Charalambous, H. (2013). End-of-life care: Where does the standard oncology care fail our patients and what do we, as oncologists, need to do differently? JAMA Internal Medicine, 173(6), 474–475.Google Scholar
Clayton, J.M., Hancock, K.M., Butow, P.N., et al. (2007). Clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers. The Medical Journal of Australia, 186(Suppl. 12), S77, S79, S83–S108.Google Scholar
de Goeij, M.C., van Diepen, M., Jager, K.J., et al. (2013). Multiple imputation: Dealing with missing data. Nephrology, Dialysis, Transplantation, 28(10), 2415–2420.CrossRefGoogle ScholarPubMed
Elmqvist, M.A., Jordhoy, M.S., Bjordal, K., et al. (2009). Health-related quality of life during the last three months of life in patients with advanced cancer. Supportive Care in Cancer, 17(2), 191–198.CrossRefGoogle ScholarPubMed
Fayers, P.M. (2001). Interpreting quality of life data: Population-based reference data for the EORTC QLQ–C30. European Journal of Cancer, 37(11), 1331–1334.CrossRefGoogle ScholarPubMed
Fearon, K., Strasser, F., Anker, S.D., et al. (2011). Definition and classification of cancer cachexia: An international consensus. The Lancet Oncology, 12(5), 489–495.Google Scholar
Friedrichsen, M. & Erichsen, E. (2004). The lived experience of constipation in cancer patients in palliative hospital-based home care. International Journal of Palliative Nursing, 10(7), 321–325.Google Scholar
Giesinger, J.M., Wintner, L.M., Oberguggenberger, A.S., et al. (2011). Quality of life trajectory in patients with advanced cancer during the last year of life. Journal of Palliative Medicine, 14(8), 904–912.CrossRefGoogle ScholarPubMed
Glare, P., Sinclair, C., Downing, M., et al. (2008). Predicting survival in patients with advanced disease. European Journal of Cancer, 44(8), 1146–1156.CrossRefGoogle ScholarPubMed
Grande, G.E. & Todd, C.J. (2000). Why are trials in palliative care so difficult? Palliative Medicine, 14(1), 69–74.Google Scholar
Haukoos, J.S. & Newgard, C.D. (2007). Advanced statistics: Missing data in clinical research, part 1: An introduction and conceptual framework. Academic Emergency Medicine, 14(7), 662–668.CrossRefGoogle ScholarPubMed
Little, R.J. (2005). Missing data. Encyclopedia of statistics in behavioral science. New York: John Wiley & Sons.Google Scholar
Llobera, J., Esteva, M., Rifa, J., et al. (2000). Terminal cancer: Duration and prediction of survival time. European Journal of Cancer, 36(16), 2036–2043.Google Scholar
Lundh Hagelin, C., Seiger, A. & Furst, C.J. (2006). Quality of life in terminal care: With special reference to age, gender and marital status. Supportive Care in Cancer, 14(4), 320–328.Google Scholar
Maltoni, M., Caraceni, A., Brunelli, C., et al. (2005). Prognostic factors in advanced cancer patients: Evidence-based clinical recommendations: A study by the steering committee of the European Association for Palliative Care. Journal of Clinical Oncology, 23(25), 6240–6248.Google Scholar
Mercado, C., Zingmond, D., Karlan, B.Y., et al. (2010). Quality of care in advanced ovarian cancer: The importance of provider specialty. Gynecologic Oncology, 117(1), 18–22.Google Scholar
Minagawa, H., Uchitomi, Y., Yamawaki, S., et al. (1996). Psychiatric morbidity in terminally ill cancer patients. A prospective study. Cancer, 78(5), 1131–1137.Google Scholar
Peppercorn, J.M., Smith, T.J., Helft, P.R., et al. (2011). American Society of Clinical Oncology statement: Toward individualized care for patients with advanced cancer. Journal of Clinical Oncology, 29(6), 755–760.CrossRefGoogle Scholar
Pereira, J., Hanson, J. & Bruera, E. (1997). The frequency and clinical course of cognitive impairment in patients with terminal cancer. Cancer, 79(4), 835–842.Google Scholar
Plunkett, T.A., Chrystal, K.F. & Harper, P.G. (2003). Quality of life and the treatment of advanced lung cancer. Clinical Lung Cancer, 5(1), 28–32.Google Scholar
Price, M.A., Bell, M.L., Sommeijer, D.W., et al. (2013). Physical symptoms, coping styles and quality of life in recurrent ovarian cancer: A prospective population-based study over the last year of life. Gynecologic Oncology, 130(1), 162–168.Google Scholar
Prigerson, H.G., Zhang, B. & Nilsson, M.E. (2013). End-of-life care: Where does the standard oncology care fail our patients and what do we, as oncologists, need to do differently? A reply. JAMA Internal Medicine, 173(6), 475.Google Scholar
Ringdal, G.I. & Ringdal, K. (2000). A follow-up study of the quality of life in cancer patients with different prognoses. Quality of Life Research, 9(1), 65–73.Google Scholar
Ripamonti, C.I., Santini, D., Maranzano, E., et al. (2012). Management of cancer pain: ESMO clinical practice guidelines. Annals of Oncology, 23(Suppl. 7), vii139–vii154.Google Scholar
Rivadeneira, D.E., Evoy, D., Fahey, T.J. 3rd, et al. (1998). Nutritional support of the cancer patient. CA: A Cancer Journal for Clinicians, 48(2), 69–80.Google ScholarPubMed
Sloan, J.A., Loprinzi, C.L., Laurine, J.A., et al. (2001). A simple stratification factor prognostic for survival in advanced cancer: The good/bad/uncertain index. Journal of Clinical Oncology, 19(15), 3539–3546.CrossRefGoogle ScholarPubMed
Smith, T.J., Temin, S., Alesi, E.R., et al. (2012). American Society of Clinical Oncology provisional clinical opinion: The integration of palliative care into standard oncology care. Journal of Clinical Oncology, 30(8), 880–887.CrossRefGoogle Scholar
Stromgren, A.S., Goldschmidt, D., Groenvold, M., et al. (2002 a). Self-assessment in cancer patients referred to palliative care: A study of feasibility and symptom epidemiology. Cancer, 94(2), 512–520.Google Scholar
Stromgren, A.S., Groenvold, M., Pedersen, L., et al. (2002 b). Symptomatology of cancer patients in palliative care: Content validation of self-assessment questionnaires against medical records. European Journal of Cancer, 38(6), 788–794.CrossRefGoogle ScholarPubMed
Temel, J.S., Greer, J.A., Muzikansky, A., et al. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. The New England Journal of Medicine, 363(8), 733–742.Google Scholar
Vigano, A., Dorgan, M., Buckingham, J., et al. (2000). Survival prediction in terminal cancer patients: A systematic review of the medical literature. Palliative Medicine, 14(5), 363–374.Google Scholar
Vigano, A., Donaldson, N., Higginson, I.J., et al. (2004). Quality of life and survival prediction in terminal cancer patients: A multicenter study. Cancer, 101(5), 1090–1098.CrossRefGoogle ScholarPubMed
von Gruenigen, V.E., Frasure, H.E., Reidy, A.M., et al. (2003). Clinical disease course during the last year in ovarian cancer. Gynecologic Oncology, 90(3), 619–624.CrossRefGoogle ScholarPubMed
Wood, A.M., White, I.R., Hillsdon, M., et al. (2005). Comparison of imputation and modeling methods in the analysis of a physical activity trial with missing outcomes. International Journal of Epidemiology, 34(1), 89–99.Google Scholar
Yun, Y.H., Park, Y.S., Lee, E.S., et al. (2004). Validation of the Korean version of the EORTC QLQ–C30. Quality of Life Research, 13(4), 863–868.Google Scholar
Yun, Y.H., Kim, S.-H., Lee, K.-M., et al. (2006). Patient-reported assessment of quality care at end of life: Development and validation of Quality Care Questionnaire–End of Life (QCQ–EoL). European Journal of Cancer, 42(14), 2310–2317.Google Scholar
Yun, Y.H., Lee, M.K., Kim, S.Y., et al. (2011 a). Impact of awareness of terminal illness and utilization of hospice palliative care or intensive care unit on the survival of terminally ill cancer patients: Prospective cohort study. Journal of Clinical Oncology, 29(18), 2474–2480.Google Scholar
Yun, Y.H., Lee, M.K., Park, S., et al. (2011 b). Use of a decision aid to help caregivers discuss terminal disease status with a family member with cancer: A randomized controlled trial. Journal of Clinical Oncology, 29(36), 4811–4819.Google Scholar