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Observational Study
. 2022 Oct 14;21(1):183.
doi: 10.1186/s12904-022-01075-3.

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

Jonathan Lee  1 , Mahham Shafiq  1 , Rahul Malhotra  1   2   3 , Semra Ozdemir  1   2 , Irene Teo  1   2   4 , Chetna Malhotra  5   6
Affiliations
Observational Study

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

Jonathan Lee et al. BMC Palliat Care. .

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.

Keywords: Cancer; Health-related quality of life; Neoplasms; Oncology; Palliative Care; Prospective study; Singapore; Surveys and questionnaires.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Joint trajectories of social, physical, functional and emotional health related quality of life (HrQoL) during last year of life (N = 345)
See this image and copyright information in PMC

References

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    1. Malhotra C, Farooqui MA, Kanesvaran R, Bilger M, Finkelstein E. Comparison of preferences for end-of-life care among patients with advanced cancer and their caregivers: A discrete choice experiment. Palliat Med. 2015;29(9):842–50. doi: 10.1177/0269216315578803. - DOI - PubMed

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