Does palliative care improve the quality of life for cancer patients in three tertiary hospitals in South Africa?

Abstract

Background: Quality of life (QoL) is a crucial treatment outcome for cancer patients, who often experience significant symptom burden and distress. Despite its benefits, access to palliative care remains limited in many settings, including South Africa. This study assessed changes in QoL before and after palliative care interventions and examined factors associated with QoL improvements.

Methods: A retrospective cohort study was conducted among cancer patients referred for palliative care at three tertiary hospitals in Johannesburg, South Africa. Interdisciplinary teams provided palliative care, and patient data on sociodemographic and clinical characteristics were collected. QoL was measured using the World Health Organization Quality Of Life-BREF (WHOQOL BREF) tool at baseline and follow-up. Paired t-tests compared mean QoL scores, and mixed regression analysis identified factors associated with QoL improvements. Data were analyzed using Stata version 18 SE.

Results: Among 724 patients (68.51% female, mean age 51.78 years, SD: 16.62), the most common cancers were breast (29.83%), gastrointestinal/hepatobiliary (21.27%), and cervical (16.71%). Baseline QoL mean (SD) scores were low across all domains. Following palliative care, significant improvements (p < 0.001) were observed: general health improved from 43.64 (26.17) to 66.28 (26.71); physical health from 48.46 (15.45) to 53.42 (15.08); psychological health from 57.54 (17.39) to 65.44 (18.75); environmental health from 60.97 (19.90) to 71.49 (18.84) and social health from 59.26 (25.60) to 71.08 (23.54) (all p < 0.001). HIV-negative status was associated with better outcomes across all domains, with coefficients ranging from 0.19 to 0.46 (p < 0.05) compared to those living with HIV.

Conclusions: Palliative care significantly improved QoL across all measured domains among cancer patients at tertiary hospitals in Johannesburg. These findings highlight the need to integrate palliative care into routine oncology treatment to enhance patient well-being.