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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
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

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.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2014 

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