Quality of life in palliative cancer care: results from a cluster randomized trial.
OBJECTIVE
To assess the impact of comprehensive palliative care on patients' quality of life. The intervention was based on cooperation between a palliative medicine unit and the community service and was compared with conventional care.


METHODS
A cluster randomized trial was carried out, with community health care districts defined as the clusters. Patients from these districts who had malignant disease and survival expectancy between 2 to 9 months were entered onto the trial. The main quality-of-life end points were physical and emotional functioning, pain, and psychologic distress assessed monthly by using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) questionnaire and Impact of Event scale (IES). In total, 235 intervention patients and 199 controls were included.


RESULTS
During the initial 4 months of follow-up, the compliance was good (72%) and comparable among treatment groups. No significant differences on any of the quality-of-life scores were found. At later assessments and for scores that were made within 3 months before death, there was also no consistent tendency in favor of any treatment group on the main outcomes or other EORTC QLQ-C30 scales/items.


CONCLUSIONS
A general program of palliative care may be important to ensure flexibility and to meet the needs of terminally ill patients. However, to achieve improvements on a group level of the various dimensions of quality of life, specific interventions directed toward specific symptoms or problems may have to be defined, evaluated, and included in the program.
Jordhøy
M S
MS
Palliative Medicine Unit, Department of Oncology and Radiotherapy, University Hospital of Trondheim, Trondheim, Norway. mjordhoy@online.no
Fayers
P
P
Loge
J H
JH
Ahlner-Elmqvist
M
M
Kaasa
S
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services; D005260:Female; D006748:Hospital Departments; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D009664:Norway; D010166:Palliative Care; D010349:Patient Compliance; D011788:Quality of Life; D018434:Sickness Impact Profile; D013727:Terminal Care; D013997:Time Factors