A population-based study of pain and quality of life during the year before death in men with prostate cancer

Abstract

In order to explore how health-related quality of life changes towards the end of life, a questionnaire including the EuroQOl form and the Brief Pain Inventory form was sent to all men with prostate cancer in the county of Ö stergö tland, Sweden, in September 1999. Responders who had died prior to 1 January 2001 were later identified retrospectively. Of the 1442 men who received the questionnaire, 1243 responded (86.2%). In the group of responders, 167 had died within the study period, 66 of prostate cancer. In multivariate analysis, pain as well as death within the period of study were found to predict decreased quality of life significantly. Of those who died of prostate cancer, 29.0% had rated their worst pain the previous week as severe. The same figure for those still alive was 10.5%. On a visual analogue scale (range 0 -100), the mean rating of quality of life for those who subsequently died of prostate cancer was 54.0 (95% confidence interval 75.2) and those still alive was 70.0 (71.2). In conclusion, health-related quality of life gradually declines during the last year of life in men with prostate cancer. This decline may partly be avoided by an optimised pain management. (2004) In recent years, health-related quality of life has become one of the most important end points for studies on men with prostate cancer, especially men with cancer at an advanced stage. Caring for cancer patients in the last years of life requires a good understanding of how health-related quality of life can be improved when efforts to prolong life become increasingly futile. Adequate pain and symptom management, avoidance of inappropriate prolongation of the dying process, achievement of a sense of control, relief of burdens, and the strengthening of relations with loved ones have been found to be the most important domains from the patient's perspective of palliative treatment (Singer et al, 1999). Of all factors affecting health-related quality of life, however, pain is usually considered the most prominent factor for patients approaching death (Elliott, 1997). British Journal of CancerAlthough pain management is fundamental in terminal care (Steinhauser et al, 2000;Wrede-Seaman, 2001), it is often undertreated (Perron and Schonwetter, 2001). According to the World Health Organisation's guidelines for the stepwise management of pain in cancer, the potency of the analgesia provided, ranging from non-opioids and opioids for moderate pain (e.g. dextropropoxyphene, codeine and tramadol) to opioids for severe pain (e.g. morphine, cetobemidone and fentanyl), should be adjusted to the patient's experienced level of pain (WHO, 1986). If this is implemented consistently and proper palliative approaches are maximised, it has been claimed that effective pain control may be achieved in 80% of cancer patients (Perron and Schonwetter, 2001). However, despite the widespread acceptance of this strategy, more than 40% of prostate cancer patients in routine practice settings report the presence of pain (Greenwald et al, 1987;Portenoy, 1989;L...

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