Health-Related Quality of Life in Cancer Patients—More Answers but Many Questions Remain

Abstract

Patient-reported outcomes, including health-related quality of life, symptoms, and functional status are well established in oncology. They can describe the clinical course of cancer, aid in the selection of optimal treatment, or allow comparison of cancer patient populations with those with other diseases and with the general population. In this issue of the Journal, two reports ( 1 , 2 ) provide new insight into different aspects of health-related quality of life in cancer patients. The Medical Outcomes Survey Short Form 36 (MOS SF-36) ( 3 ) quality-of-life questionnaire was used in both reports; it is a well-validated, reliable, generic quality-of-life instrument that can be used in both medically ill and healthy populations in a valid fashion; it provides information on several aspects of functioning and yields two composite scores — physical and mental. The MOS SF-36 was supplemented with additional patient-reported outcomes in both studies. Reeve et al. ( 1 ) studied individuals aged 65 years or older who did or did not develop cancer during a 2-year period. They evaluated change in these two groups, matching or adjusting for key variables associated with quality of life, including age, comorbidity, education, sex, race or ethnicity, marital status, smoking status, and circumstances of questionnaire administration. Not unexpectedly, those who developed one of several common malignancies (prostate, breast, bladder, colorectal, kidney, and lung cancer and nonHodgkin lymphoma) experienced a statistically signifi cantly greater reduction in physical functioning than those who did not develop cancer. This difference was clinically signifi cant (>0.5 SD) in patients with non-Hodgkin lymphoma and kidney and non – small cell lung cancer. Having cancer was also associated with a reduced ability to perform many activities of daily living, although specifi c impacts differed across cancer types. Only lung cancer patients experienced statistically signifi cant increases in bodily pain and statistically and clinically signifi cant reductions in mental health scores. Reductions in social functioning and vitality were cancer specifi c. The demonstration that a diagnosis of cancer adversely impact quality of life relative to the general population is an important one