A recent study published by Yong et al in Value in Health may help clarify the intricate interplay between the quality-of-life and survival preferences of patients with advanced cancer.
Limited access to palliative care services may contribute to suffering, particularly among patients with cancer who reside in low- and middle-income countries. Only 14% of hospice and palliative care needs are met across the world, with most unmet needs concentrated in these countries. Within the Malaysian health system, over 63% of patients with cancer were diagnosed in advanced stages—yet, access to palliative care was available to less than 10% of the population.
Study Methods and Findings
In the new analysis, the investigators focused on palliative care access in Malaysia and quantified patients’ preferences for quality-of-life outcomes against survival.
The investigators found that patients with advanced cancer assigned significantly higher value to quality-of-life improvements than 1-year survival. The patients reported that life extension only brought value to them when they could maintain at least moderate levels of function. They considered the importance of physical function and having good pain management a priority. After a follow-up of 3 months, the patients demonstrated increased significance of these priorities.
The patients were also invited to participate in interviews to gain deeper insights into their experiences and the impact of care accessibility on their preferences. Many of the patients recounted enduring debilitating side effects of treatments—which they described as “destroying the remaining days” of their lives.
In addition to physical impairments and a reduced ability to work, younger patients expressed emotional distress when they could not fulfill their household responsibilities such as housekeeping and caring for children.
Conclusions
The investigators suggested that more resources and attention may be required to strengthen supportive and palliative care services in cancer care while simultaneously ensuring access to novel technologies for life-extending treatments.
Disclosure: For full disclosures of the study authors, visit valueinhealthjournal.com.
