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For people with advanced cancer, quality of life at the end of life—sometimes referred to as “a good death”—may have less to do with medical treatment and more to do with a therapeutic alliance with their physicians, according to the results of a study published in the Archives of Internal Medicine.

When curative treatment is no longer an option for individuals with advanced cancer, the focus often shifts toward palliative care, which refers to care that is intended to provide comfort with no intention of prolonging survival or providing a cure. Palliative care is important for reducing pain and discomfort. For individuals in the final stages of cancer, the focus shifts from prolonging life to promoting quality of life.

To evaluate what constitutes “a good death”, researchers conducted a multi-center, prospective, longitudinal cohort study called the Coping with Cancer study. The study included 396 patients with advanced cancer and their informal caregivers. Participants were enrolled between 2002 and 2008 and were followed from enrollment to death, which was a median of 4.1 months later. The primary outcome of the study was quality of life during the last week of life.

There were nine factors that affected quality of life at end of life: intensive care unit stays, hospital deaths, patient worry, prayer/meditation, site of cancer care, feeding tube use, pastoral care, chemotherapy in the final week, and a therapeutic alliance between patient and physician.

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Not surprisingly, the results indicated that patients who were treated in the intensive care unit (ICU) or who died in the hospital had a lower quality of life and were more burdened by their symptoms in the week before their death compared to other patients. In contrast, patients who prayed, meditated, were visited by a pastor, or had a good rapport with their doctor had a higher quality of life.

The researchers concluded that a therapeutic alliance—an emotional connection—between doctors and patients could be critical to quality of life at the end of life. They found that patients with advanced cancer who avoid hospitalizations and the ICU, who are less worried, and who pray, meditate, or are visited by a pastor have the highest quality of life at the end of life.


Zhang B, Nilsson ME, Prigerson HG. Factors important to patients’ quality of life at the end of life. Archives of Internal Medicine. Published early online July 2012. doi:10.1001/archinternmed.2012.2364

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