Prospective Assessment of Quality of Life and Quality of Death of Patients With Advanced Cancer

Abstract

Background: Advanced disease and its treatment contribute to a compromised lifespan of any patient. The treatment in cases of advanced disease is aimed toward managing physical symptoms and providing supportive care, whereas the extent to which the treatment achieves the given purpose, thereby improving the quality of life in India, is underexplored. As advanced cancer patients have a compromised lifespan, the quality of life during their survival will be a major factor that influences their quality of death. Aim: This present study was carried out with the aim of assessing the QoL of patients with advanced cancer, prospectively and exploring the quality of death of those patients who had expired. Methods: A total of 46 patients above 18 years of age, with advanced solid malignancies, after the failure of 1 or more than 1 line of therapy with curative intent were enrolled and were assessed for their QoL and other symptoms for baseline. As patients expired during the phase of the study, only 23 and 12 patients were assessed for the following 2nd and 3rd prospective assessments, respectively. Quality of death was assessed using caregiver ratings of patients' physical and mental distress on a scale of 0-10, for 31 patients, who had expired during the study. Descriptive statistics, t-test, repeated measure of analysis of variance and χ2 test were used for analyzing the data. Results: Patients, irrespective of the site of the diagnosis or the treatment received, were found to be moderately distressed, thus leading to a low global QoL. Although not significantly, the overall distress of the patients has decreased overtime with the mean scores being 6.04, 4.82 and 4.12 during the 1st, 2nd and 3rd assessments, respectively. The pain level of the patients found to differ significantly overtime (F= 4.128; P = 0.049), decreasing during the second assessment and increasing thereafter. A significant reduction in the levels of depression was observed during the prospective assessments (F= 18.293; P = 0.000). Similarly, the concerns about the financial difficulties also decreased eventually (F= 6.563; P = 0.015). The demographics were found to have a significant impact over the physical symptoms namely anxiety, pain, role functioning, fatigue, appetite, nausea and dyspnea. The quality of death analysis revealed a poor physical, whereas moderate psychological health and overall quality of life. The most commonly reported physical sufferings of the patients who had expired, by their caregivers were lack of appetite, pain, immobility and difficulty in breathing, while psychological concerns were anticipation about survival and worsening of physical symptoms. Conclusion: Even with efficient treatment modalities targeted toward managing symptoms during end-of-life, patients with advanced cancers have a compromised quality of life and subsequently compromised quality of death, as a result of their poor physical health.