title: Changes in health-related quality of life and quality of care among terminally ill cancer patients and survival prediction: Multicenter prospective cohort study.
abstract: OBJECTIVE
  This study examined changes in health-related quality of life (HRQoL) and quality of care (QoC) as perceived by terminally ill cancer patients and a stratified set of HRQoL or QoC factors that are most likely to influence survival at the end of life (EoL).
  
  
  METHODS
  We administered questionnaires to 619 consecutive patients immediately after they were diagnosed with terminal cancer by physicians at 11 university hospitals and at the National Cancer Center in Korea. Subjects were followed up over 161.2 person-years until their deaths. We measured HRQoL using the core 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and QoC using the Quality Care Questionnaire-End of Life (QCQ-EoL). We evaluated changes in HRQoL and QoC issues during the first three months after enrollment, performing sensitivity analysis by using data generated via four methods (complete case analysis, available case analysis, the last observation carried forward, and multiple imputation).
  
  
  RESULTS
  Emotional and cognitive functioning decreased significantly over time, while dyspnea, constipation, and pain increased significantly. Dignity-conserving care, care by healthcare professionals, family relationships, and QCQ-EoL total score decreased significantly. Global QoL, appetite loss, and Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scores were significantly associated with survival.
  
  
  CONCLUSIONS
  Future standardization of palliative care should be focused on assessment of these deteriorated types of quality. Accurate estimates of the length of life remaining for terminally ill cancer patients by such EoL-enhancing factors as global QoL, appetite loss, and ECOG-PS are needed to help patients experience a dignified and comfortable death.
authors.affiliation: College of Nursing, Kyungpook National University,Daegu,Republic of Korea.
authors.forename: Myung Kyung
authors.initials: MK
authors.lastname: Lee
authors.affiliation: Research Institute and Hospital,National Cancer Center,Goyang,Republic of Korea.
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Lee
authors.affiliation: Division of Hematooncology,Department of Internal Medicine,Dongsan Medical Center,Keimyung University School of Medicine,Daegu,Republic of Korea.
authors.forename: Young Rok
authors.initials: YR
authors.lastname: Do
authors.affiliation: Research Institute and Hospital,National Cancer Center,Goyang,Republic of Korea.
authors.forename: Keun Seok
authors.initials: KS
authors.lastname: Lee
authors.affiliation: Department of Oncology,Asan Medical Center,University of Ulsan College of Medicine,Seoul,Republic of Korea.
authors.forename: Kyung Hae
authors.initials: KH
authors.lastname: Jung
authors.affiliation: Cancer Research Institute,Department of Internal Medicine,Seoul National University Hospital,Seoul,Republic of Korea.
authors.forename: Dae Seog
authors.initials: DS
authors.lastname: Heo
authors.affiliation: Division of Hematooncology,Department of Internal Medicine,Chungnam University School of Medicine,Daejeon,Republic of Korea.
authors.forename: Sam Yong
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Division of Hematooncology,Department of Internal Medicine,Chungnam University School of Medicine,Daejeon,Republic of Korea.
authors.forename: Sang Yoon
authors.initials: SY
authors.lastname: Park
authors.affiliation: Department of Internal Medicine,Sunlin Hospital,Pohang,Republic of Korea.
authors.forename: Hyun Sik
authors.initials: HS
authors.lastname: Jeong
authors.affiliation: Division of Hematooncology,Department of Internal Medicine,College of Medicine, Gyeongsang National University,Jinju,Republic of Korea.
authors.forename: Jung Hun
authors.initials: JH
authors.lastname: Kang
authors.affiliation: Department of Internal Medicine,Kyunghee University Hospital,Seoul,Republic of Korea.
authors.forename: Si-Young
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Research Institute and Hospital,National Cancer Center,Goyang,Republic of Korea.
authors.forename: Sook Ryun
authors.initials: SR
authors.lastname: Park
authors.affiliation: Cancer Research Institute, Seoul National University College of Medicine,Seoul,Republic of Korea.
authors.forename: Young Ho
authors.initials: YH
authors.lastname: Yun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000523:psychology; D011446:Prospective Studies; D011787:Quality of Health Care / Q000592:standards*; D011788:Quality of Life / Q000523:psychology*; D056910:Republic of Korea; D011795:Surveys and Questionnaires; D019452:Terminally Ill / Q000523:psychology*
keywords: Health-related quality of life; Quality of care; Survival; Terminally ill cancer patients