To identify the main factors that influence QOL at EOL, Baohui Zhang, of the Dana-Farber Cancer Institute in Boston, and associates conducted a multisite, prospective, longitudinal study involving 396 patients with advanced cancer and their informal caregivers. Participants were followed from enrollment in September 2002 through February 2008 to death, a median of 4.1 months later.

While the majority of variance in QOL at EOL was unexplained, the researchers identified a set of nine factors that explained some of the variance. Factors that had a negative effect on QOL included: intensive care unit stays, which explained 4.4 percent of the variance; hospital deaths (2.7 percent); patient worry at baseline (2.7 percent); feeding tube use in the final week (1.1 percent); and chemotherapy in the final week (0.8 percent). The following factors had a positive impact on QOL: religious prayer or meditation at baseline (2.5 percent); pastoral care (1.0 percent); and patient-physician therapeutic alliance at baseline (0.7 percent). The site of cancer care explained 1.8 percent of the variance in QOL.

"By reducing patient worry, encouraging contemplation, integrating pastoral care within medical care, fostering a therapeutic alliance between patient and physician that enables patients to feel dignified, and preventing unnecessary hospitalizations and receipt of life-prolonging care, physicians can enable their patients to live their last days with the highest possible level of comfort and care," the authors write.

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