Elsevier

Urology

Volume 59, Issue 1, January 2002, Pages 103-109
Urology

Adult urology
Quality of life at the end of life: trends in patients with metastatic prostate cancer

https://doi.org/10.1016/S0090-4295(01)01457-1Get rights and content

Abstract

Objectives. 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.

Section snippets

Patients

Eighty-one men were diagnosed with metastatic prostate cancer at the University of California, Los Angeles, from November 1993 through June 1996, of whom 78 agreed to be included in a longitudinal, observational cohort. Metastasis was confirmed with whole-body nuclear bone scanning. Patients completed confidential HRQOL questionnaires at baseline (before beginning androgen ablation therapy), at 3-month intervals for the first year, and subsequently at 6-month intervals for up to 5 years. For

Results

Table I lists the clinical characteristics of our study sample. At baseline, the mean age was 73.8 ± 4.4 years (range 67 to 82), with 16 patients aged 70 years or older. Most patients were white (75%), married or living with a partner (73%), and unemployed or retired (80%). Only 35% had at least a college degree, and 45% had an annual household income over $30,000. Seventy percent of patients reported comorbidities. Prior radical prostatectomy or external beam irradiation were each reported by

Comment

Our study has two important findings. First, marital status appears to be associated with rates of decline in the physical and emotional domains of the HRQOL in different ways toward the end of life. Married men tended to decline in the physical domains at a slower rate than did single men. The declines in the emotional domains, however, appear unrelated to marital status; both married and unmarried men have reason to become depressed toward the end of life. Loneliness may have a significant

Acknowledgements

To Laura Abraham and Kellie Ma, who assisted with data collection and management, for their vigilant work.

References (17)

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