title: Quality of life at the end of life: trends in patients with metastatic prostate cancer.
abstract: OBJECTIVE
  To identify the rates of decline in health-related quality of life during the year before death in men with prostate cancer.
  
  
  METHODS
  We studied men in a subset analysis within a longitudinal, observational cohort of patients with metastatic prostate cancer at the University of California, Los Angeles, Center for Health Sciences. The analysis included 23 patients who died and had submitted at least two health-related quality-of-life surveys in the final months before death. The outcomes were measured with the RAND 36-Item Health Survey, an established, validated instrument that includes physical and emotional domains. To gauge the effect of marital status, education, and income, we dichotomized these demographic variables.
  
  
  RESULTS
  Most domains showed declines, many of them substantial. Patients who had a slower rate of decline in the physical domains tended to be married, better educated, and more affluent. We noted a trend toward a slower deterioration in the mental composite scores among patients who had less than a college degree and an annual household income of $30,000 or less.
  
  
  CONCLUSIONS
  Patients dying of metastatic prostate cancer appear to experience declines in health-related quality of life during their final year of life. Further investigation may help identify specific patient characteristics associated with more rapid declines; this will help focus attention on enhancing patients' quality of life as death approaches.
authors.affiliation: Department of Urology,University of California, Los Angeles, School of Medicine, Los Angeles, California 90095-1738, USA.
authors.forename: Gil Y
authors.initials: GY
authors.lastname: Melmed
authors.forename: Lorna
authors.initials: L
authors.lastname: Kwan
authors.forename: Kristen
authors.initials: K
authors.lastname: Reid
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018450:Disease Progression; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D017533:Marital Status; D010043:Outcome and Process Assessment, Health Care; D011471:Prostatic Neoplasms / Q000401:mortality / Q000503:physiopathology; D011788:Quality of Life; D012959:Socioeconomic Factors