Context:  When curative treatments are no longer options for dying cancer patients, the focus of care often turns from prolonging life to promoting quality-of-life (QOL). Limited data exist on what predicts better QOL at the end-of-life (EOL) for advanced cancer patients.

Objective:  To determine the factors that most influence QOL at the EOL, thereby, identifying promising targets for interventions to promote EOL QOL.

Design, Setting, Participants:  Coping with Cancer (CwC1) is a US multi-site, prospective, longitudinal cohort study of advanced cancer patients (n=396 patients) and their informal caregivers, who were enrolled between September 2002 and February 2008. Patients were followed from enrollment to death a median of 4.1 months later.

Main Outcome Measure:  Patient QOL in the last week of life was the primary outcome of both CwC1 and the present report.

Results:  The following set of 9 factors, preceded by a sign indicating the direction of the effect and presented in rank-order of importance, explained the most variance in patients’ EOL QOL: #1=(−) ICU stays in the final week (explained 4.40% of the variance in EOL QOL), #2 = (−) hospital deaths (2.70%), #3 =(−) patient worry at baseline (2.70%), #4 = (+) religious prayer or meditation at baseline (2.50%), #5 = site of cancer care (1.80%), #6 = (−) feeding-tube use in the final week (1.10%), #7 = (+) pastoral care within the hospital/clinic (1.10%), #8 = (−) chemotherapy in the final week (0.90%), and #9 = (+) patient-physician therapeutic alliance (0.70%) at baseline. Most of the variance in EOL QOL, however, remained unexplained (82.3%).

Conclusions:  Advanced cancer patients who avoid hospitalizations and intensive care, who are not worried, who pray or meditate, who are visited by a pastor in the hospital/clinic, and who feel a therapeutic alliance with their physicians have the highest QOL at the EOL.