Can a Good Death and Quality of Life Be Achieved for Patients with Terminal Cancer in a Palliative Care Unit?

Abstract

Lack of evidence supporting the claim that palliative care can improve quality of life and promote good death in patients with terminal cancer. This study was designed to evaluate the change of quality of life and quality of death over time and between patients of long and short survival in a palliative care unit. Patient demography, cancer sites, Eastern Cooperative Oncology Group (ECOG) status were collected at admission. Quality of life, including physical and psychological symptoms, social support, and spirituality was assessed daily after admission. Quality of death was assessed by a Good Death Scale (GDS) at admission and retrospectively for 2 days before death. A total of 281 patients (52% women) were admitted and died in the study period. One hundred forty-five patients (51.6%) died within 3 weeks. Although those with short survival (<3 weeks) had more physical symptoms during the first week, there was no difference in quality of life dimensions at admission, at 1 week, and at 2 days before death between survival groups. Physical conditions deteriorated with time but other dimensions continued to improve until death. GDS and subdimensions continued to improve until death. Although those with long survival (≥3 weeks) have better scores for awareness, acceptance, timeliness, comfort, and GDS at admission, there was no difference between the two groups at 2 days before death. Under comprehensive palliative care, patients with terminal cancer can have good quality of life and experience a good death even with short survival.