Promoting quality of life and care of advanced cancer patients: What factors matter most?


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Holly Prigerson
Dana-Farber Cancer Institute, Boston, USA

Abstract

This presentation will describe a series of studies conducted under the rubric of the Coping with Cancer Study that have sought to determine the most important influences on the quality of life and quality of care of terminally ill cancer patients. Coping with Cancer is a US NCI-funded, multi-institutional, longitudinal prospective cohort study that followed advanced cancer patients through their death, evaluated the patients quality of life and care in the last week of life, and assessed the family caregivers six months into bereavement. Study sites included Yale Cancer Centre, Memorial Sloan-Kettering Cancer Centre, New Hampshire Oncology and Hematology, Dana-Farber/Harvard Cancer Centre and the University of Texas South-western Medical Centre. Results demonstrate the importance of what we refer to as "demand side" psychosocial influences on medical care received near death, over and above "supply side" healthcare resources influences. These include discussion of curability, prognosis and goals of care, religious views, practices and coping, receipt of pastoral care visits, ethnic influences, the role of patient cognitive impairment and psychological adjustment to illness and family caregivers on determining medical care received near death. Findings also show that intensive life-prolonging care, hospitalizations, trial enrolment, therapeutic alliance between cancer patients and their oncology providers matter most for patients' quality of life in the final week. We will conclude with the implications for clinical care and healthcare policy as well as directions for future research.