When cancer treatments are no longer an option, the focus of a patient’s care often shifts from prolonging life to promoting the quality of life (QOL) at the end of life (EOL).
In a recent report, better QOL at the EOL for patients with advanced cancer were associated with avoiding hospitalizations and the intensive care unit, being visited by a pastor in a hospital or clinic, having a therapeutic alliance with their physician, worrying less, and praying or meditating. The report was published online in Archives of Internal Medicine.
Baohui Zhang, MS, formerly of the Dana-Farber Cancer Institute, Boston, and colleagues studied 396 patients with advanced cancer and their caregivers as part of the Coping with Cancer study. The average age of patients was approximately 59 years.
According to the study, most discrepancies in patients’ QOL at the EOL was attributed to a set of 9 factors: intensive care stays in the final week, hospital deaths, patient worry at baseline, religious prayer or meditation at baseline, site of cancer care, feeding tube use in the final week, pastoral care within the hospital or clinic, chemotherapy in the final week, and a patient-physician therapeutic alliance where patients felt they were treated as a “whole person.”
“Two of the most important determinants of poor patient QOL at the 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 said.
Patient worry at baseline was “one of the most influential predictors of worse QOL at the EOL,” the authors noted.
“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 concluded.
Source: The JAMA Network.