Quality of life and psychological distress are differentially associated with distinct symptom-functional states in terminally ill cancer patients' last year of life

Fur Hsing Wen, Jen Shi Chen, Wen Chi Chou, Chia Hsun Hsieh, Wen Cheng Chang, Wen Chi Shen, Siew Tzuh Tang*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

16 Scopus citations

Abstract

Objective: Quality of life (QOL) and psychological distress at end of life (EOL) heavily depend on symptom distress and functional impairment, which may not deteriorate synchronously at EOL. Methods: Using multivariate hierarchical linear modeling, we simultaneously evaluated the differential association of 5 previously identified, worsening conjoint symptom-functional states with QOL, anxiety symptoms, and depressive symptoms over 317 terminally ill cancer patients' last year of life. Quality of life, anxiety symptoms, and depressive symptoms were measured by the McGill Quality of Life Questionnaire and the Hospital Anxiety and Depression Scale, respectively. Results: Quality of life, anxiety symptoms, and depressive symptoms deteriorated significantly more for patients in the 4 worst symptom-functional states (states 2-5) than in the best state (state 1). Quality of life did not differ significantly among patients in states 2 to 5. However, patients in state 4 had significantly lower anxiety-symptom levels than patients in states 2, 3, and 5, whose anxiety-symptom levels did not differ significantly. In contrast, depressive-symptom levels differed significantly between participants in any 2 of the worst symptom-functional states, except between participants in states 3 and 5 as well as between those in states 2 and 4. Conclusion: The 5 distinct symptom-functional states contributed to worsening QOL, anxiety symptoms, and depressive symptoms, but each was negatively and uniquely associated with psychological well-being in terminally ill cancer patients' last year of life. Clinical Implications: The psychological well-being and QOL of high-risk patients in states 3 and 5 may be improved at EOL by targeting them with appropriate symptom management interventions and facilitating their functioning.

Original languageEnglish
Pages (from-to)2111-2118
Number of pages8
JournalPsycho-Oncology
Volume27
Issue number9
DOIs
StatePublished - 09 2018

Bibliographical note

Publisher Copyright:
© 2018 John Wiley & Sons, Ltd.

Keywords

  • anxiety and depressive symptoms
  • functional impairment
  • oncology
  • quality of life
  • symptom distress
  • terminally ill cancer

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