Quality of life in cancer patients

Abstract

Cancer and cancer therapies, including chemotherapy, radiotherapy, and surgery, all have a significant impact on the quality of life (QOL) of a patient. Poor QOL can jeopardize completion of the cancer treatment regimen since it may influence the patient's willingness to continue with cancer therapy. Whether treatment is intended as palliative or curative, it is important to design treatments where there is an acceptable tradeoff between probability of cure and QOL, or between survival time and QOL. These considerations are becoming increasingly important since newer potent therapeutic therapies have not only improved cure rates for many types of cancer, but have also greatly prolonged survival times for incurable cancers. For these reasons, QOL measurements have become increasingly important when determining efficacy of treatments in clinical trials. This conference was organized to review and discuss the issues relating to QOL in cancer patients. There can be a variety of causes of QOL deficits in cancer patients, including pain, depression, anaemia, and fatigue. The increased use of adjuvant chemotherapy and radiotherapy and their associated side effects (i.e. nausea and vomiting) have caused increased concern regarding QOL. Moreover, the longer survival times of patients with incurable cancers have increased the need to improve the palliative care they receive. The establishment of standardized QOL assessment tools will facilitate the use of QOL as an efficacy measure. In addition, the increased use of QOL measures addresses the growing awareness that it is important to treat the whole patient, not just the disease. The need for accurate instruments to measure QOL had led to the development of the European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaire and the Functional Assessment of Chronic Illness Therapy (FACIT) QOL measurement system. The conference, entitled 'Quality of Life in Cancer Patients', included a thorough discussion of the factors that need to be considered for proper implementation of the QOL questionnaires and interpretation of the data. These factors included language issues, cross-cultural sensitivity of the questionnaire, and the degree of disease severity. Methods on assuring validity and reliability of the questionnaire were also discussed. The discussion then moved on to potential barriers to effective utilization of QOL assessments. Despite the advances made in QOL instrument development, many clinicians are not comfortable with the use of these tools. Fundamental misunderstandings regarding the use of these instruments include improper administration, analysis and interpretation of the data. Appropriate strategies to overcome these barriers were then discussed. The conference also included an overview of the recent progress in improving QOL in cancer patients. Areas such as depression, pain, fatigue and nausea were discussed. Special attention was paid to anaemia and fatigue as well as pain. Fatigue is a common symptom of cancer patients and is quite often the result of anaemia. Several large studies assessing the QOL benefits of epoetin alfa treatment in anaemic cancer patients were reviewed. Despite the development of guidelines for pain treatment in cancer patients, pain is still undertreated in an alarmingly high percentage of patients. Barriers to effective pain management were reviewed with a discussion on ways to overcome them. In summary, the following articles will highlight the importance of QOL assessment in both clinical trials and practice when treating cancer patients. It will also provide helpful information on the development and use of questionnaires, as well as methods to analyse and achieve proper interpretation of the collected QOL data. Clinicians may also find useful information on overcoming the obstacles to effective use of QOL assessment in clinical practice, particularly for the management of anaemia and pain.