Enhancing the Quality of Life

Cancer end of life and quality of life issues explored

(RxWiki News) We don't like to talk about dying. But it happens. Cancer takes the breath away. So how can the quality of life be enhanced at the end of life? A new study looked into this important issue.

People don't want to spend their last days and hours in a hospital or intensive care unit (ICU).

Instead, they want to have time to release their worries, meditate, pray, visit with clergy and be treated as a whole person by their physicians.

"Do you have a living will?"

This is what a recent Dana-Farber Cancer Institute study discovered in working with people with advanced cancer and their caregivers.

"The aim of this study was to identify the best set of predictors of quality of life (QOL) of patients in their final week of life. By doing so, we identify promising targets for healthcare interventions to improve QOL of dying patients," the authors wrote.

The study, led by Baohui Zhang, MS, formerly of the Dana-Farber Cancer Institute, involved nearly 400 patients. It was part of the Coping with Cancer study. The average age of the individuals was about 59 years.

Researchers found these nine factors impacted quality of life as life was slipping away:

  • ICU stays in the last week of life
  • Dying in the hospital
  • Patient worry
  • Religious practice - prayer or meditation
  • Site of cancer care
  • Use of feeding tubes
  • Chemotherapy in the last week
  • Pastoral care at hospital or clinic
  • Whole person treatment

"Two of the most important determinants of poor patient QOL at the end of life (EOL) were dying in a hospital and ICU stays in the last week of life. Therefore, attempts to avoid costly hospitalizations and to encourage transfer of hospitalized patients to home or hospice might improve patient QOL at the EOL," the authors wrote.

Eliminating worry was also critical in enhancing end of life quality.

"By reducing patient worry, encouraging contemplation, integrating pastoral care within medical care, fostering a therapeutic alliance between patient and physician that enables patients to feel dignified, and preventing unnecessary hospitalizations and receipt of life-prolonging care, physicians can enable their patients to live their last days with the highest possible level of comfort and care," the authors conclude.

"What people really want is a sense of connection," Christina Puchalski, MD, FACP told dailyRx in an interview. "Without emphasizing the doctor-patient relationship, I think we're going down the wrong path," said Dr. Puchalski, founder and director of the George Washington Institute for Spirituality and Health (GWish),

"This is an important study. I know it's about end of life, but I think it has important ramifications for care in general," Dr. Pulchalski said.

In an invited commentary, Alan B. Zonderman, PhD, and Michele K. Evans, MD, of the National Institute on Aging, National Institutes of Health, wrote that more of this sort of research, is needed.

"It is surprising at this stage in the development and implementation of complex multi-modal cancer treatment strategies that the factors most critical in influencing the quality of the EOL are not clearly defined and considered along the entire timeline beginning with cancer diagnosis," they wrote.

This research was published July 9 in the Archives of Internal Medicine.

It was supported by the National Institute of Mental Health, the National Cancer Institute, and the Center for Psychosocial Epidemiology and Outcomes Research at the Dana-Farber Cancer Institute.

The authors declared no conflicts of interest existed.

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Review Date: 
July 9, 2012