What leads to better quality of life at the end of life?

Abstract

9040 Background: When curative treatments are no longer options for dying cancer patients, the focus of care turns from prolonging life to promoting the best possible quality of life (QOL). Determining the factors that most enhance or detract from advanced cancer patients’ QOL will help to identify targets for interventions to improve patients’ QOL at the end-of-life (EOL). Methods: Coping with Cancer (CwC) is an NCI/NIMH-funded multi-site, prospective longitudinal study of advanced cancer patients. Baseline interviews with 393 patients and 393 caregivers assessed patients’ medical status, psycho-social characteristics, mental health, treatment preferences and patient-oncologist relationships. Post-mortem caregiver and clinician assessments conducted within one month of the patient’s death captured the QOL and care received by patients in the last week of life. Multiple regression models estimated associations between patient QOL and baseline characteristics and types of EOL care received. Akaike’s Information Criteria, which balances model fit and parsimony, determined the best model in the prediction of QOL in the last week of life. Results: In the final adjusted model, younger patients, White patients, patients with caregivers with generalized anxiety disorder, patients without a DNR order, and patients who stayed in the ICU during the last week of life were significantly (p<.05) more likely to have worse QOL in the last week of life. Patients who at baseline reported a sense of inner peace and harmony and who thought their oncologist saw them as a whole person were significantly (p<.05) more likely to have better QOL. Conclusions: Avoiding aggressive treatments in the last week of life (e.g., by completing a DNR order), having oncologists whom patients perceive as caring about them, promoting patients’ peacefulness and reducing anxiety among afflicted family caregivers are practical ways to improve patients’ EOL outcomes.