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Abstract Details

Activity Number: 510
Type: Contributed
Date/Time: Wednesday, August 1, 2012 : 10:30 AM to 12:20 PM
Sponsor: Biometrics Section
Abstract - #304421
Title: A Terminal Decline Model for Quality of Life and Survival in Palliative Care Studies
Author(s): Zhigang Li*+ and Tor Tosteson and Marie Bakitas
Companies: Dartmouth Medical School and Dartmouth Medical School and Dartmouth Medical School
Address: One Medical Center Drive,7927 Rubin Bldg, Lebanon, NH, 03756, United States
Keywords: end of life ; joint modeling ; palliative care ; quality of life ; survival ; terminal decline

Palliative care is a specialized area of healthcare that focuses on helping to relieve and prevent the suffering of patients facing life-threatening illness. It is known that quality of life (QOL) of patients with advanced cancer decreases as death approaches, this association is generally not taken into account when inferences of the effect of an intervention on quality of life or survival times are made in previous clinical trials. We develop a new joint modeling approach: terminal decline model to study the trajectory of repeated measurements for palliative care studies having cancer patients. This approach takes that association into account by modeling the QOL retrospectively from death. For those patients whose death times are censored, marginal likelihood is used to incorporate them into the analysis. Our approach has two submodels: a piecewise (two pieces) random intercept model with serially correlation and measurement error for the retrospective trajectory of QOL and a piecewise exponential model for the survival distribution. MLE of the parameters are obtained by maximizing the closed-form expression of log-likelihood function.

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