Survival and quality of life: Comparing end points in oncology

Abstract

In recent years we have observed a growing interest among the international scientific community in the quality of life of cancer patients. The number of papers and conferences dedicated to this matter is increasing. Some countries, including Italy, have focused on this problem in their national health policy. Patient quality of life is affected by several factors, related to their disease and treatment characteristics. Quality of life is and should be a primary goal in oncology, comparable to other main objectives, such as survival. There are different priorities and problems for different cancers or different stages of disease of the same tumour. For patients affected with curable disease, such as malignant lymphoma or testicular cancer, the primary aim is survival. Thus, the problems are mostly related to the quality of life after cure. In advanced lung cancer patients, issues about the quality of life are focused on palliation of cancer-relate d symptoms and treatmentinduced toxicity. In the last few years, very little progress has been made in the treatment of patients affected by advanced solid tumors in terms of their increased survival. As a consequence, the effect of the treatment on the quality of patient's life has progressively become more important. A consensus has been reached that a number of elements thought to determine quality of life (symptom status, as well as physical, emotional, role and social functioning) should be measured. Assessing multiple health-related quality of life provides a more detailed account of the specific effects of cancer treatment on patient functioning. Nowadays, we are able to measure quality of life using such validated tools as questionnaires or diary cards [1]. Therefore, quality of life is often proposed as the end point of controlled clinical trials. However, many methodological problems have arisen, relating, in particular, to the quality of the clinical trials and the reproducibility of the tools, data analysis and results evaluation [2,3]. Improving our knowledge of the impact of available treatment on patient quality of life is a mandatory issue that can only be addressed through well-planned and conducted prospective clinical trials. In October 1999, we launched a project on the quality of life of cancer patients and instituted seven boards of experts consisting of medical oncologists, radiotherapists, surgeons and psychologists for the following seven categories: lung cancer, gastrointestinal tumors, urogenital neoplasms, breast cancer, gynecological tumors, head and neck cancer, cancer in the elderly. The objectives of each board for each kind of cancer were to define the concept of 'quality of life' and the end points of a treatment that is concerned with this concept; to analyze the tools available to measure the quality of life and the related methodological and evaluation problems; to analyze the literature on using quality of life as an end point in clinical trials; and to integrate survival and quality of life data. The results of this work were presented at a conference entitled, 'Survival and Quality of Life: Comparing End Points in Oncology' held in Naples, Italy, 24-25 February 2000. The conference also included a session dedicated to general methodological issues. This supplement to Annals of Oncology represents the main report from this conference.