Quality of life near the end-of-life: the relationship between self-rated overall health and the five EQ-5D domains

Previous studies have assessed how self-reported health varies between individuals and within individuals with aging. Here we use longitudinal data to assess how self-rated overall health, as measured by the EuroQol-visual analogue scale (EQ-VAS), changes with the EQ-5D domains for patients with advanced cancer as they near the end-of-life. We find that self-rated overall health falls near the end-of-life with a more rapid decline in the final few months of life independently of the five EQ-5D domains. The relationship between the EQ-5D domains and the EQ-VAS is not constant with proximity to death. While “severe” problems with pain and discomfort are more frequent near the end-of-life, the EQ-VAS associated with “severe problems” relative to “some problems” in the EQ-5D pain and discomfort domain is relatively constant, whilst that associated with “no problems” falls sharply in the final few months of life. The probability of a level 3-domain response in all other EQ-5D domains (self-care, usual activities, anxiety, and mobility) rises near the end-of-life with “no problems” becoming the least likely. In addition, the incremental overall health rating placed upon these domain levels is reduced as patients near death. We show that individuals are able to account for their different proximity to death when self-rating their overall health while their actual time-to-death remains unknown to them at the time of self-report.