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Quality of Life in Palliative Cancer Care: Results From a Cluster Randomized Trial

From the Palliative Medicine Unit, Department of Oncology and Radiotherapy, University Hospital of Trondheim, and Unit of Applied Clinical Research, Norwegian University of Science and Technology, Trondheim, Norway.

Address reprint requests to Marit S. Jordhøy, MD, Unit of Applied Clinical Research, Norwegian University of Science and Technology, 5etg Kreftbygget, University Hospital of Trondheim, N-7006 Trondheim, Norway; email: mjordhoy{at}online.no

PURPOSE: To assess the impact of comprehensive palliative care on patients’ quality of life. The intervention was based on cooperation between a palliative medicine unit and the community service and was compared with conventional care.

PATIENTS AND METHODS: A cluster randomized trial was carried out, with community health care districts defined as the clusters. Patients from these districts who had malignant disease and survival expectancy between 2 to 9 months were entered onto the trial. The main quality-of-life end points were physical and emotional functioning, pain, and psychologic distress assessed monthly by using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) questionnaire and Impact of Event scale (IES). In total, 235 intervention patients and 199 controls were included.

RESULTS: During the initial 4 months of follow-up, the compliance was good (72%) and comparable among treatment groups. No significant differences on any of the quality-of-life scores were found. At later assessments and for scores that were made within 3 months before death, there was also no consistent tendency in favor of any treatment group on the main outcomes or other EORTC QLQ-C30 scales/items.

CONCLUSION: A general program of palliative care may be important to ensure flexibility and to meet the needs of terminally ill patients. However, to achieve improvements on a group level of the various dimensions of quality of life, specific interventions directed toward specific symptoms or problems may have to be defined, evaluated, and included in the program.

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