The Netherlands Comprehensive Cancer Organisation (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands.
Department of Medical Oncology, Radboud MC, Nijmegen, The Netherlands.
Support Care Cancer. 2018 Oct;26(10):3397-3404. doi: 10.1007/s00520-018-4181-6. Epub 2018 Apr 16.
The aim of this study was to assess health-related quality of life (HRQoL) in the last year of life of cancer patients stratified by four periods of time before death.
Between 2008 and 2015, cancer patients were invited to participate in PROFILES (Patient Reported Outcomes Following Initial Treatment and Long-term Evaluation of Survivorship) registry studies. Patients were eligible for inclusion in this secondary analysis if they had been invited to complete the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) in their last year of life (N = 892). Four hundred fifty-eight patients (51%) responded. Descriptive statistics were used to describe the HRQoL of cancer patients in the last 3 months of life (N = 61), the last 3-6 months (N = 110), the last 6-9 months (N = 138), or the last 9-12 months of their life (N = 129).
Patients in the last 3 months report a significant lower HRQoL, lower functioning, and higher symptom burden of fatigue and appetite loss compared to patients in different time periods before death (p < 0.008). Clinical relevance of the differences for global QoL, cognitive, and social functioning was large. Patients' HRQoL in the last year of life was significantly lower than that of the normative population (p < 0.001).
All aspects of HRQoL are considerably impaired in patients with advanced cancer, with a marked lower HRQoL in the final months of life. This marked decline of HRQoL in the final months of life may be an indicator of approaching death and serve as an important trigger for end-of-life communication and decision-making about subsequent treatment and supportive care.
本研究旨在评估癌症患者临终前四个时间段的健康相关生活质量（HRQoL）。
2008 年至 2015 年期间，邀请癌症患者参加 PROFILES（初始治疗和长期生存随访患者报告结局）登记研究。如果患者在生命的最后一年被邀请完成欧洲癌症研究与治疗组织生活质量问卷（EORTC QLQ-C30），则有资格纳入本二次分析（N=892）。458 名患者（51%）作出回应。使用描述性统计来描述生命最后 3 个月（N=61）、最后 3-6 个月（N=110）、最后 6-9 个月（N=138）或最后 9-12 个月（N=129）的癌症患者的 HRQoL。
生命最后 3 个月的患者报告 HRQoL、功能显著降低，疲劳和食欲丧失症状负担更高，与死亡前不同时间段的患者相比（p<0.008）。全球 QoL、认知和社会功能差异的临床相关性较大。癌症患者生命最后一年的 HRQoL明显低于正常人群（p<0.001）。
晚期癌症患者的 HRQoL 各个方面都受到严重损害，生命最后几个月的 HRQoL 明显降低。生命最后几个月 HRQoL 的显著下降可能是接近死亡的指标，并作为生命末期沟通和后续治疗及支持性护理决策的重要触发因素。
