Hazards of quality-of-life data for clinical decision making.

Abstract

Article Tools SPECIAL DEPARTMENTS Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2001.19.2.594 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 11208857 Hazards of Quality-of-Life Data for Clinical Decision Making Mark SomerfieldxMark SomerfieldSearch for articles by this author Aminah JatoixAminah JatoiSearch for articles by this author , Phuong L. NguyenxPhuong L. NguyenSearch for articles by this author , Shaji KumarxShaji KumarSearch for articles by this author , Jeff SloanxJeff SloanSearch for articles by this author , Charles L. LoprinzixCharles L. LoprinziSearch for articles by this author Show More American Society of Clinical Oncology, Alexandria, VA, NOTE. The opinions expressed herein are those of the author and do not necessarily reflect those of the American Society of Clinical Oncology.Mayo Clinic, Rochester, MNThe University of Minnesota Medical School, Minneapolis, MNMayo ClinicMayo ClinicMayo Clinic https://doi.org/10.1200/JCO.2001.19.2.594 First Page Full Text PDF Figures and Tables © 2001 by American Society of Clinical OncologyjcoJ Clin OncolJournal of Clinical OncologyJCO0732-183X1527-7755American Society of Clinical OncologyResponse15012001In Reply:We thank Dr Somerfield for his comments. He makes a critical point with eloquence: global measures of quality of life should sometimes be supplemented with symptom-specific ones. He draws on the article by Brenner et al on cataract surgery to discuss proximal and distal measures of quality of life.1 Somerfield suggests a range of quality-of-life tools that might be used in cancer symptom control research, as shown in Fig 1. Fig 1. Quality-of-life (QOL) tools for use in cancer symptom control research.We believe our review of 15 placebo-controlled trials of megestrol acetate in cancer patients illustrates Somerfield’s point well.2 Improvement in appetite, a proximal measure, occurred in 13 of 15 of these studies, whereas improvement in global quality of life, a distal measure, occurred in only one (see Table 1 in Jatoi et al2). Had these 13 studies not measured this proximal symptom, justification for prescribing megestrol acetate for cancer-associated anorexia would be sparse.Although we agree with Somerfield’s comments on methods of measurement, we ourselves continue to struggle with the meaning behind these measurements. As alluded to in the article by Brenner et al,1 cataract surgery allows individuals to drive, read, and look people in the eye. The meaning of such proximal quality-of-life measurements is obvious. In contrast, appetite stimulation in patients with advanced cancer carries limited consequences. Patients may eat more, but they do not live longer, tolerate chemotherapy better, or become more functional. As discussed in our article,2 it is from Meares’ article,3 as well as from Holden’s,4 that we begin to find meaning behind these proximal measurements: “Food, from time immemorial, is part of the nurturing process ... .”Somerfield’s comments remind us of the challenge of measuring quality of life in cancer clinical trials and of the challenge of including both proximal and distal measures in cancer symptom control research. Yet, there is another part to that challenge: finding meaning behind these measurements. Therein lies the art of oncology.1. Brenner MH, Curbow B, Legro MW: The proximal-distal continuum of multiple health outcome measures: The case of cataract surgery. Med Care 33:: AS236,1995-AS244, Medline, Google Scholar2. Jatoi A, Kumar S, Sloan JA, et al: On appetite and its loss. J Clin Oncol 18:: 2930,2000-2932, Link, Google Scholar3. Meares CJ: Primary caregiver perceptions of intake cessation in patients who are terminally ill. Oncol Nurs Forum 24:: 1751,1997-1757, Medline, Google Scholar4. Holden CM: Anorexia in the terminally ill cancer patient: The emotional impact in the patient and the family. Hosp J 7:: 73,1991-84, Crossref, Medline, Google Scholar