Date: 30 Mar 2010
Determinants of quality of life in patients with advanced cancer
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Improving health-related quality of life (HRQL) is the main goal of palliative care and an important outcome for oncology trials. This study examines medical and sociodemographic determinants of HRQL in outpatients with advanced cancer.
Patients with metastatic gastrointestinal, genitourinary, breast, lung or gynecological cancer, ECOG 0-2, and clinical prognosis of 6 months to 2 years were recruited from outpatient medical oncology clinics. HRQL was measured using the FACT-G questionnaire and the FACIT-Sp meaning and peace (existential) subscale. The influence of demographic and medical characteristics on HRQL was determined using t tests and analysis of variance, with Tukey’s correction for multiple comparisons. Multivariate linear regression was used to determine independent predictors.
Of 285 patients, 57% were female and the median age was 61 years; 44% were alive at latest follow-up; and of those deceased, the mean survival time was 10 months. The strongest determinants of overall HRQL were increased age (p < 0.001), good performance status (PS; p < 0.001) and survival time >6 months (p = 0.001). Compared to patients receiving cancer treatment, those awaiting new treatment had worse emotional well-being (p < 0.001), while those on surveillance or whose treatment had been stopped had worse existential well-being (p = 0.03). Male gender predicted better emotional and physical well-being and lower income predicted worse social well-being.
Age, PS, survival time, and treatment status are important determinants of HRQL in patients with advanced cancer. Decision aids, open communication, and involvement of supportive care specialists may improve emotional and existential distress associated with changing or stopping cancer treatment.
This research is funded by the Canadian Cancer Society (CCS Grant #017257 and #020509; CZ). Results of this study were previously published/presented in part at the Multinational Association of Supportive Care in Cancer, 21st International Symposium, June 26-28, 2008, Houston, Texas.
World Health Organization. WHO definition of palliative care. Available from URL: http://www.who.int/cancer/palliative/definition/en. 2002. Accessed 23 Oct 2009
Hjermstad MJ, Fayers PM, Bjordal K, Kaasa S (1998) Health-related quality of life in the general Norwegian population assessed by the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire: the QLQ = C30 (+ 3). J Clin Oncol 16:1188–1196PubMed
Lundh HC, Seiger A, Furst CJ (2006) Quality of life in terminal care—with special reference to age, gender and marital status. Support Care Cancer 14:320–328CrossRef
Katzman R, Brown T, Fuld P, Peck A, Schechter R, Schimmel H (1983) Validation of a short Orientation-Memory-Concentration Test of cognitive impairment. Am J Psychiatry 140:734–739PubMed
Jordhoy MS, Fayers P, Loge JH, Ahlner-Elmqvist M, Kaasa S (2001) Quality of life in palliative cancer care: results from a cluster randomized trial. J Clin Oncol 19:3884–3894PubMed
Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A et al (1993) The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol 11:570–579PubMed
Statistics Canada. Ethnic Origin. http://www12.statcan.ca/english/census01/Products/Reference/dict/pop040.htm. 2002. Accessed 23 Dec 2009
Feinstein AR (1996) Multivariable analysis: an introduction. Yale University Press, New Haven
Exley C, Letherby G (2009) Managing a disrupted lifecourse: issues of identity and emotion work. Health 5:112–132
Hopwood P, Stephens RJ (2000) Depression in patients with lung cancer: prevalence and risk factors derived from quality-of-life data. J Clin Oncol 18:893–903PubMed
Carlson LE, Angen M, Cullum J, Goodey E, Koopmans J, Lamont L et al (2004) High levels of untreated distress and fatigue in cancer patients. Br J Cancer 90:2297–2304PubMed
Pascoe S, Edelman S, Kidman A (2000) Prevalence of psychological distress and use of support services by cancer patients at Sydney hospitals. Aust NZ J Psychiatry 34:785–791
Redeker NS, Lev EL, Ruggiero J (2000) Insomnia, fatigue, anxiety, depression, and quality of life of cancer patients undergoing chemotherapy. Sch Inq Nurs Pract 14:275–290PubMed
- Determinants of quality of life in patients with advanced cancer
Supportive Care in Cancer
Volume 19, Issue 5 , pp 621-629
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Quality of life
- Palliative care
- Advanced cancer
- Treatment status
- Performance status
- Survival time
- Industry Sectors
- Author Affiliations
- 1. Division of Medical Oncology and Hematology, Department of Medicine, Toronto, Canada
- 3. Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, 610 University Ave., 16-712, Toronto, Ontario, Canada, M5G 2M9
- 4. Department of Medical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Canada
- 2. Department of Psychiatry, University of Toronto, Toronto, Canada