Quality of life in men with metastatic prostate cancer in their final years before death 
Maja Holm,1; Sandra Doveson 1, 2; Agneta Wennman-Larsen,1, 2 & Per Fransson,3, 4
1.	Department of Nursing Sciences. Sophiahemmet University.
2.	Division of Insurance Medicine, Department of Clinical Neuroscience. Karolinska Institutet. 
3.	Department of Nursing. Umeå University
4.	Cancercentrum, Norrland University Hospital
 
Background: Metastatic prostate cancer (mPC) is a life-threatening illness with potentially severe symptoms and reduced functioning, and hence, a palliative care approach may be beneficial to this group. Over time, new life-prolonging treatments have been developed for men with mPC. However, in this late phase of the disease; it is also important to consider the balance between quality of life (QoL) and life prolongation, particularly because there may be side effects involved with life-prolonging treatments. 
Aim: The aim of this study was to evaluate QoL, functioning and symptoms in men with mPC during their final years before death.
Methods: In total, 190 deceased men with metastatic prostate cancer were included from a larger, long-term prospective study. Validated questionnaires asking about participants’ QoL, functioning and symptoms were retrospectively analysed after the patient’s death. The men were stratified into three groups, based on how much time that had passed between completion of the last questionnaire and their death; <6 months, 6–18 months and >18 months before death. The men’s results were compared to established clinically significant threshold values.  Further, ratings were compared between men who died before and after 2006 respectively. 
Results: Men with mPC reported low QoL before death compared to threshold values as well as low functioning and high levels of symptoms like pain and fatigue. The group of men that were <6 months before death rated their QoL, functioning and symptoms significantly worse than the two other groups. Men that died after the year 2006 reported lower QoL and functioning and more pain and fatigue than those who died before 2006.
Conclusion: Men with mPC have unmet needs with regards to QoL and symptoms. A palliative care approach, alongside possible life-prolonging treatments, that focuses on QoL and symptom relief, may serve as an important frame to give the best support to these men in their final years of life.

Quality of Life in Men with Metastatic Prostate Cancer in their Final Years before Death