A longitudinal study of palliative care

Abstract

BACKGROUND The current article evaluated the course of patient‐assessed symptomatology in specialized palliative care and tested for bias due to patient attrition in measures of initial symptomatology and treatment outcome. METHODS Over 2 years, 267 consecutive, eligible patients were referred to a department of palliative care. Upon arrival, 201 patients consented to participate in a questionnaire‐based evaluation of quality of life (QOL). Of these, 175 patients participated, and 142, 119, and 95 participated in the study at 1, 2, and 3 weeks, respectively. Weekly, participants completed the self‐assessment questionnaires European Organization for Research and Treatment of Cancer QLQ‐C30, Edmonton Symptom Assessment System, Hospital Anxiety and Depression Scale, and Multidimensional Fatigue Inventory. Physicians used the Mini Mental State Examination to evaluate cognitive function. Changes from the initial symptom scores for each week were calculated. Initial scoring and change after 1 week were tested for association with completion level, i.e., whether the patient completed questions at 1, 2, 3, or 4 time points. RESULTS High initial symptom intensity and significant improvements over time were observed for pain, lack of appetite, nausea/vomiting, sleeplessness, constipation, and overall QOL/well‐being. For some symptoms, initial scores were significantly higher in patients who dropped out, but the changes over the first week were not significantly different between completion levels for any symptom. CONCLUSIONS Improvement in symptom intensity was identified. Dropout was associated with higher initial symptomatology but not with poorer outcome of palliative treatment. Cancer 2005. © 2005 American Cancer Society.

Expectations to and evaluation of a palliative home-care team as seen by patients and carers

“…Many participants in our study experienced reduction in the severity of the patients' symptoms. This is very encouraging and supports the results from a longitudinal questionnaire study from our department, which showed significant alleviation of: pain, lack of appetite, nausea/vomiting, insomnia and constipation and improvement in overall quality of life [65].…”

“…Papers regarding evaluation of palliative care have focussed on symptom control [19, 23-26, 64, 65], quality of life [6,19,23,25,59,65], 'quality of death' [25,55], satisfaction with care [19, 23-25, 35, 45, 68], help to carers [22], use of health resources [19,23,28] and participants' experiences with care [4,17,30,32,33,47,57,58,60]. Studies specifically focussing on palliative home care have additionally focussed on place of death [3,18,55,66], reasons for hospitalisation despite palliative home care [5,9,27] and carers' experiences of caring for a patient at home [7,21,29,41,46,48,54,56,61,67].…”

The prognostic factors and trajectory of HRQOL in patients with pancreatic cancer who received psychiatric intervention

“…The response rate for the questionnaire decreased with disease progression and exacerbation of physical condition, as in previous studies. 10,18 At 3 months prior to death, only half the questionnaires were completed. Missing data with disease progression is often seen in studies in a palliative setting, and it is a concern that these missing data may bias the results.…”

“…9 A study of HRQOL in patients with advanced cancer at 1, 2, and 3 weeks after starting palliative care concluded that this care improved HRQOL. 10 Another evaluation of HRQOL in patients with advanced cancer during the last year of life showed that most aspects of QOL were substantially impaired and that certain aspects declined rapidly in the 3 months prior to death, indicating the importance of longitudinal assessment of HRQOL.…”

Health-related quality of life during the last three months of life in patients with advanced cancer

“…Several clinical studies have been undertaken to evaluate the effect of palliative care programmes; most of which have failed to show any improvement in HRQL [9,15,32]. It has been suggested that this may be due to difficulties in demonstrating significant effects at group level due to sample heterogeneity or variation in symptom presentation and gradual deterioration before death.…”