Trajectories of Health-related quality of life in patients with Advanced Cancer during the Last Year of Life: findings from the COMPASS study

Abstract

Background Patients with advanced cancer prioritise health-related quality of life (HrQoL) in end-of-life care, however an understanding of pre-death HrQoL trajectories is lacking. We aimed to delineate and describe the trajectories of physical, social, emotional and functional HrQoL during last year of life among advanced cancer patients. We assessed associations between these trajectories and patient socio-demographic characteristics, healthcare use and place of death. Methods We used data from 345 decedents from a prospective cohort study of 600 patients with a solid advanced cancer receiving secondary care at public hospitals in Singapore. Patients were surveyed every three months until death and HrQoL was assessed using the Functional Assessment of Cancer Therapy – General (FACT-G) questionnaire. Interviews were conducted between July 2016 and December 2019. Group-based multi-trajectory modelling was used to assess potential heterogeneity in the four HrQoL dimensions during patients’ last year of life. Results We identified four distinct trajectories of HrQoL − (1) overall high HrQoL (47% of sample), (2) progressively decreasing HrQoL (32%), (3) asymmetric decline in HrQoL (13%), (4) overall low HrQoL (8%). Compared to patients with secondary or above education, those with primary education or less (β = 1.39, SE = 0.55, p-value = 0.012) were more likely to have “progressively decreasing HrQoL” or “overall low HrQoL” in contrast to “overall high HrQoL”. Compared to patients with ‘overall high HrQoL’, those with ‘overall low HrQoL’ had longer length of hospital stay during the last year of life (β = 0.47, SE = 0.21, p-value = 0.026) and were more likely to die in a hospice/care home (β = 1.86, SE = 0.66, p-value = 0.005). Conclusion Our results showed heterogeneity in deterioration of HrQoL among patients with advanced cancer in the last year of life. Systematic monitoring of HrQoL, early identification and referral of high-risk patients to palliative care may provide timely relief and mitigate the steep decline in their HrQoL. Trial Registration : NCT02850640.

Trajectories of Quality of Life Following Pelvic Exenteration: A Latent Class Growth Analysis

“…These findings are valuable for shared decisionmaking and decision on postoperative pathways of care. 13 To our knowledge, no study has investigated individual quality-of-life trajectories (classes) in a large prospective cohort study of patients undergoing pelvic exenteration. 11 Furthermore the identification of patient characteristics, surgical outcomes, and survival outcomes associated with distinct quality-of-life classes may enhance the decision-making process and the long-term impact of pelvic exenteration.…”

“…These findings are valuable for shared decision-making and decision on postoperative pathways of care. 13…”

Quality of life and affecting factors in myelofibrosis patients

“…The focus on quality of life means that patient care has shifted from disease-centered to more person-centered (23). Advanced cancer patients often have a decreased quality of life, and healthcare providers need to identify and manage high-risk patients early while continuously monitoring their condition (24). In particular, myeloproliferative neoplasm patients have di culty with psychosocial adjustment during the diagnosis and treatment process, resulting in a decrease in quality of life (25) and a life-threatening condition if it progresses (26).…”