Initial quality of life and influencing factors in patients with advanced cancer receiving home hospice care: A propensity score-matched analysis stratified by survival period

Abstract

Objective: Quality of life (QoL) is increasingly recognized as an important prognostic indicator and has been identified to be associated with reduced survival in patients with advanced cancer during the last months of life. This study aimed to compare the initial QoL and influencing factors of patients with advanced cancer receiving home hospice care with less than 3-month survival period.

Methods: A secondary data analysis study was conducted using the data from a Fujian provincial home hospice center, in China, between 2010 and 2020. Propensity score matching was performed in 2761 cases to match patients with a less than 1 month survival period and those with a 1-3 months survival period. Differences in QoL between the two groups were analyzed using the ANOVA or Wilcoxon Mann-Whitney test, and the influencing factors were analyzed using multiple linear regression analysis.

Results: No significant differences in QoL were identified between cancer patients with a 1-3 month survival period and those with a survival period of less than 1 month. However, a significant difference was detected after the propensity score matching adjustment (P ​< ​0.05). Sources of living, awareness of disease, and performance status commonly affected the QoL of patients with different survival periods (P ​< ​0.05). Chemotherapy, weight loss, anorexia, and tumor type only affected the QoL of patients with a survival period of less than 1 month (P ​< ​0.05).

Conclusions: The QoL of patients with advanced cancer receiving home hospice care is poor but does not necessarily deteriorate continuously during the last 3 months. Notably, the complexity of factors influencing QoL increases significantly as patients approach death.

Keywords: Advanced cancer; Hospice care; Propensity score matching; Quality of life; Retrospective observational cohort.