Quality of Life at the End of Life

OBJECTIVES: To identify the rates of decline in health-related quality of life during the year before death in men with prostate cancer. METHODS: The authors 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, they 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. The authors 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.