Exploring "good days" with advanced cancer: A pilot daily diary study

Background: People with Stage IV cancer face physical and emotional challenges impacting quality of life. Conventional quality of life measures do not capture daily fluctuations in patient well-being.Aim: This pilot study used daily diaries to explore the concept of a "good day" living with advanced cancer and to identify activities associated with "good days" as well as associations between daily "goodness" and conventional quality of life measures.Design: Twenty participants with Stage IV cancer completed daily diaries on a mobile app over a 14-day period. Participants rated each day's "goodness" and documented daily activities. Statistical analyses examined associations between daily "goodness" ratings, activities, and baseline quality of life measures from the Patient-Reported Outcomes Measurement Information System (PROMIS).Setting/participants: Participants were recruited from oncology clinics and online research registries. Inclusion criteria included age over 18 years old, having Stage IV cancer, and owning a smartphone.Results: Analysis of 178 completed surveys from 18 participants revealed overall average "goodness" ratings exhibited more within-person than between-person variability. Average goodness was positively related to the PROMIS domain of Ability to Participate in Social Roles/Activities and negatively related to PROMIS domains of Anxiety and Depression. Participants reported better days when they engaged in leisure activities and worse days when they spent time managing physical symptoms.Conclusions: This study highlights the importance of understanding day-to-day quality of life in individuals with advanced cancer. Further research is needed to assess quality of life longitudinally and to develop personalized supportive and palliative care interventions in this population.