Versluis Moyke A J, Raijmakers Natasja J H, Baars Arnold, van den Beuken-van Everdingen Marieke H J, de Graeff Alexander, Hendriks Mathijs P, de Jong Wouter K, Kloover Jeroen S, Kuip Evelien J M, Mandigers Caroline M P W, Sommeijer Dirkje W, van der Linden Yvette M, van de Poll-Franse Lonneke V
Research & Development, The Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.
Graduate School of Social & Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
Cancer. 2024 Feb 15;130(4):609-617. doi: 10.1002/cncr.35060. Epub 2023 Oct 13.
Support for health-related quality of life (HRQOL) is an essential part of cancer care in the final stages of life, yet empirical guidance regarding HRQOL and symptom trajectories is lacking.
To assess the change in HRQOL and symptom burden in the last year of life in patients with advanced cancer and its association with health care-related factors, cancer-specific treatment, and comorbidity.
A prospective, multicenter, observational study in patients with advanced cancer (eQuiPe). Three monthly questionnaires included European Organization for Research and Treatment of Cancer Quality of Life-C30 and reported continuity of care. Multivariable mixed-effects analysis was used to assess the association between HRQOL and health care-related factors.
A total of 762 deceased patients were included with a mean age of 66 (SD, 10) years and 52% were male. The most common primary tumors were lung (29%), colorectal (20%), and breast cancer (13%). Mean overall HRQOL decreased in the last 9 months of life, with the greatest decrease in the last 3 months (β -16.2). Fatigue, pain, appetite loss, dyspnea, constipation, and nausea worsened significantly in the last year of life. Multimorbidity (β -7.5) and a better reported continuity of care (β 0.7) were both significantly associated with the trajectory of HRQOL.
Mean overall HRQOL begins to decline 9 months before death, highlighting the need for early identification and (re)assessment of different symptoms as aspects of HRQOL follow different trajectories. Multimorbidity and reported continuity of care may be associated with the trajectory of HRQOL.
支持与健康相关的生活质量（HRQOL）是癌症终末期护理的重要组成部分，但目前缺乏关于HRQOL和症状轨迹的实证指导。
评估晚期癌症患者生命最后一年的HRQOL变化和症状负担，及其与医疗相关因素、癌症特异性治疗和合并症的关联。
一项针对晚期癌症患者的前瞻性、多中心观察性研究（eQuiPe）。每三个月进行一次问卷调查，包括欧洲癌症研究与治疗组织生活质量问卷-C30，并报告护理连续性。采用多变量混合效应分析评估HRQOL与医疗相关因素之间的关联。
共纳入762例死亡患者，平均年龄66岁（标准差10岁），52%为男性。最常见的原发肿瘤是肺癌（29%）、结直肠癌（20%）和乳腺癌（13%）。生命最后9个月平均总体HRQOL下降，最后3个月下降幅度最大（β-16.2）。疲劳、疼痛、食欲减退、呼吸困难、便秘和恶心在生命最后一年显著恶化。合并症（β-7.5）和报告的护理连续性较好（β0.7）均与HRQOL轨迹显著相关。
平均总体HRQOL在死亡前9个月开始下降，这凸显了早期识别和（重新）评估不同症状的必要性，因为HRQOL的各个方面遵循不同的轨迹。合并症和报告的护理连续性可能与HRQOL轨迹相关。
