J Chron Dis Vol. 39, No. I. pp. 47-62. 19X6 Printed m Great Rntain. All rights reserved 0021-968 136 $3.00 + 1).00 CopyrIght c 19X6 Pergamon Prw l.td LAST DAYS: A STUDY OF THE QUALITY OF LIFE OF TERMINALLY ILL CANCER PATIENTS* JOHN N. MORRIS,’ SAMY SUISSA,’ SYLVIA SHERWOOD,’ SUSAN M. WRIGHT’ and DAVID GREER~ ‘Department of Social Gerontological Research, Hebrew Rehabilitation Center for Aged. 1200 Centre Street, Boston (Roslindale), MA 02131, U.S.A. ?Department of Epidemiology and Biostatistics. McGill University and Division of Clinical Epidemiology, Montreal General Hospital, Montreal. Quebec, Canada and ‘Brown University Center for Health Care Research, Box G, Providence. RI 02912. U.S.A (Received in reGsed ,form 26 June 1985) Abstract-Behavior of a number of Quality of Life measures gathered from two samples of terminal cancer patients over the last weeks of their lives are reported. Samples represent patients in the 26 hospices participating in a nationwide U.S. demonstration project and patients in the palliative care units of two Montreal hospitals. The U.S. data reported are quality of life measures made by a lay principal care person (PCP) or trained interviewer; the Montreal measures were made by both an attending doctor and an attending nurse. The general finding, as expected, is one of increasing deterioration in quality of life, with accelerated deterioration between 3 and I week of death. Pain follows a somewhat different pattern than other measures. More patients are in either of the extreme categories at an earlier point in time than found for other measures. and there are fewer changes as death is approached. Finally, about 20% of the patients do not fall into extremely IOU quality of life categories, even in the week prior to death. INTRODUCTION THE GROWTH of the hospice movement has served as a reminder to physicians that they have a responsibility to provide care even for those whom they cannot cure. Of course, the needs of terminally ill patients are quite different from the needs of those who can recover from their illnesses. When there is hope of a cure, efforts focus on treatment aimed at arresting the disease, even if such treatment may impair quality of life. In the terminal phase of illness, however, the character of the brief time remaining to the patient is likely to be more important than its exact length. In such cases, the physician’s purpose is to help make these last days as meaningful and comfortable as possible. A variety of supportive and palliative measures may be employed to achieve this goal. The question is whether and to what extent such measures are effective. In order to answer this question adequately, it is necessary to understand what the quality of the dying process is really like. The pioneering studies described in this paper used a variety of quality 01 life measures-some newly developed-in order to be able to provide systematic descrip- tions of the last days of the terminally ill. The pattern that emerged should be a valuable guide for clinicians and family. Data were gathered from two samples of terminal cancer patients for up to the last 13 weeks of their lives. One sample consisted of terminal cancer patients followed in hospital-based palliative care units in Montreal, Canada as part of a controlled study by the McGill Cancer Centre in Montreal. The other sample followed terminal cancer patients in the United States (most of whom were community residents) participating in the National Hospice Study (NHS) demonstration funded by the Health Care Financing *Supported in part by the National Hospice Study, funded by DHHS/HCFA Grant No. 99-P-97793; I-O. grants from the Robert Wood Johnson Foundation and the John A. Hartford Foundation and Hospice Patient Outcomes and Quality of Care funded by DHHS/HCFA Grant No. I8-C-98615/l-01.