Quality of Life in Radiation Oncology of Lung Cancer

Abstract

In the last decade, there has been a growing interest in the evaluation of the quality of life (QoL) of patients suffering from lung cancer. Traditionally, the primary goal of treatment in lung cancer patients is to achieve prolonged survival, long-term local-regional tumor control and/or tumor regression. However, taking into account the relatively poor prognosis in the majority of cases, researchers and clinicians, as well as patients, are increasingly concerned about the impact of standard and novel treatment approaches not only on these traditional endpoints, but also on QoL. There are a number of reasons for this increasing interest in QoL issues. First, more and more patients will be treated with combined modality strategies (e.g., chemotherapy and radiation therapy). Most of these novel approaches are associated with increased morbidity that sometimes lasts for several months, especially when the treatments are given concomitantly. Conversely, advances in radiotherapy (e.g., intensity-modulated radiotherapy), and the availability of more adequate staging techniques (e.g., PET), enable radiation-oncologists to administer a high dose to the tumor and to high-risk areas, while reducing signifi cantly the impact on surrounding at-risk organs. This results in a lower probability of early and late radiation-induced morbidity. Despite the improvements achieved with these newer approaches, the gain in terms of life expectancy remains relatively small. The result is that, for many patients, QoL is an important consideration when selecting among the available treatment options. This is especially the case in very advanced and metastatic disease where QoL issues are particularly salient since treatment does not offer cure and may have a signifi cant impact on the patient’s daily functioning and sense of well-being. In the subset of patients where cure is possible, QoL considerations also remain important. Most patients are willing to undergo very aggressive forms of therapies, in order to be cured of their disease (Jansen et al. 2001). Even in the absence of alternative treatment approaches, assessment of QoL in these circumstances may yield unexpected and important information for the development of future therapeutic directions. Finally, QoL information may help in identifying the residual psychosocial problems of long-term survivors of lung cancer, which can be of use in the planning and development of appropriate rehabilitation programs. The Oncology Division of the Food and Drug Administration (FDA) has advocated the inclusion of QoL outcomes as part of the drug approval process (Johnson and Temple 1985, Beitz et al. 1996). Similarly, organizations involved in cancer clinical research such as the European Organization for Research and Treatment of Cancer (EORTC), the U.K. Medical Research Council (MRC), and the National Cancer Institute (NCI) of Canada have incorporated QoL assessments in many of their clinical trials. The CONTENTS