Quality of Life Among Thai Patients With Advanced Cancer: Findings From the APPROACH Study

To examine quality of life (QoL), including physical, social, functional, and emotional well-being, and depressive symptoms among Thai patients with advanced cancer and their association with demographics, self-blame, perceived stigma, and quality of care.

We screened 392 medical records for patients seeking care at the National Cancer Institute in Thailand to achieve the APPROACH study target of 200 patients with Stage IV cancer per site. We surveyed participants using the APPROACH questionnaire, which comprised validated instruments (FACT-G, CES-D) and items developed by study investigators. We used multivariable regression models to examine associations.

Participants rated QoL more favorably than other APPROACH participants in Asia, and consistent with levels found in Singapore and the United States. Likewise, perceived cancer-related stigma (3%) was uncommon. However, self-blame (67%) was prevalent, a quarter of participants (27%) reported symptoms suggestive of clinical depression, and many (62%) expressed interest in mental health services, though prior use was minimal (n = 3). When associations with QoL were considered, characterological self-blame was negatively associated with overall QoL (β = -7.09, p = 0.026), physical (-3.69, p < 0.001), and functional (-0.91, p = 0.009) well-being, while high quality of care ratings were associated with better overall QoL (5.56, p < 0.001), enhanced physical (1.95, p < 0.001), functional (1.66, p < 0.001), and emotional (1.59, p < 0.001) well-being, and fewer depressive symptoms (-2.59, p < 0.001).

Despite relatively high QoL ratings, the pervasiveness of self-blame and its association with reduced QoL, the large proportion at risk for clinical depression, and the strong interest in mental health services suggest that many Thai patients with late-stage cancer may not be receiving sufficient mental health support at the end of life. Efforts to integrate mental health care into oncology services and comprehensive palliative care should be considered.