Factors Influencing the Quality of Life (QOL) of Advanced Cancer Patients in Home-based Palliative Care (HBPC): A Systematic Review.

CONTEXT

Despite the widespread recognition of the need for new palliative care models to better serve advanced cancer patients at the end of life, little importance is given to assessing the effectiveness of homecare models.

OBJECTIVE

This systematic review aims to summarize factors influencing the quality of life (QOL) of advanced cancer patients in home-based palliative care (HBPC) being adopted worldwide.

METHODS

Following the PRISMA guidelines, electronic databases such as MEDLINE, Cochrane, EMBASE, and Scopus databases from 2000 to February 2024 were systematically searched using predetermined search terms of "quality of life", "home-based palliative care" as well as "advanced cancer". Studies with less than ten subjects, scoping reviews, conference abstracts, and that adopted poorly validated QOL questionnaires were excluded.

RESULTS

Twenty-two (22) studies from both developed and developing countries were included in the narrative synthesis. 45.4% were cross-sectional, 27.2% were prospective cohort studies, 13.6% were retrospective cohort studies, and 18.1% were RCTs or quasi-experimental studies. Around 33 QOL factors were studied with 16 different types of QOL instruments. Advanced cancer patients who practiced spirituality, female gender, were married, had satisfaction with care, and preferred home as a place of death showed higher QOL scores. Older patients, aware of cancer diagnosis, poor performance status, high pain score, symptom distress, and psychological distress were associated with a poor QOL.

CONCLUSION

Various factors affect QOL among cancer patients in HBPC. Hence it shows the importance of interventions to improve QOL and their rigorous implementation. With the widespread adoption of multi-disciplinary home care palliative programs, palliative care services to advanced cancer patients can be delivered readily which may be cost-effective.