Quality Of Life In Cancer Patients Research Articles

The Burden of Anaemia in Patients with Cancer

Anaemia is highly prevalent in patients with cancer, and its incidence and severity depend on many factors, such as type of anti-cancer therapy. The decreased oxygen capacity of blood resulting from anaemia affects virtually every organ and tissue system in the body, manifesting in numerous signs and symptoms that include fatigue, dyspnoea, palpitations, tachycardia, asthenia, anorexia, cold hypersensitivity and general weakness. Anaemia related to cancer may also cause cognitive dysfunction, leading to decreased mental alertness, poor concentration and memory problems. There is a close association between anaemia and overall quality of life (QoL) variables, and anaemia is an adverse prognostic factor in patients with cancer. Since anaemia can seriously compromise the QoL of cancer patients and is associated with decreased overall survival time, there is a strong need for effective and well-tolerated treatment strategies. Erythropoietic agents have been proven to be safe, well-tolerated and effective in the management of anaemia in patients with cancer. Epoetin therapy reduces transfusion requirements and increases haemoglobin levels in patients with solid tumours and haematological malignancies.

Effect of megestrol acetate, cyproheptadine, and their combination on appetite, body weight and quality of life (QOL) in cancer patients: A double-blind placebo-controlled clinical trial

8141 Background: This study aimed to evaluate effect of progestinal agent and cyproheptadine on Anorexia-cachexia syndrome and QOL in cancer patients. Methods:This study is a double-blind placebo-controlled clinical trial. Eligible cases were non-hormone dependent cancer patients with history of appetite loss or significant weight loss (> 5%) between ages 18–75 years who completed informed consent. Patients stratified according to: 1) >5%below IBW / IBW ± 5% or >5% above IBW 2) Complete or Partial response / stable or progressive disease 3) Cisplatin / Non-Cisplatin based chemotherapy and assigned (by minimization method) to four treatment arms: Megestrol Acetate (320mg/d, BID) + Placebo (MP), Cyproheptadine (8mg/d, BID) + Placebo (CP), Megestrol Acetate + Cyproheptadine (MC) and Placebo + Placebo (PP) for a period of one month. QOL evaluated by EORTC-QLQ-C30 for cancer studies. Results: During 1999 to 2003, 161 cancer patients included and 98 cases (60.9%) completed treatment period (85.4 % in stages III - IV). During study, 75.6 % of cases received chemotherapy and 6 % undergone radiation. Stratified parameters were balanced between treatment arms. Appetite, body weight and QOL changes evaluated at entrance and after one month that their results are summarized in the table below. Conclusions: Appetite and body weight improvements occurred at most in megestrol acetate treatment group (MP) but its difference with other groups was not significant. QOL parameters were not different between treatment arms (P values > 0.05). Considering the short treatment period and difficulties in follow-up of end-stage cancer patients, qualified large-scale clinical trials is needed for defining therapeutic role of these medications. No significant financial relationships to disclose.

Effect of megestrol acetate, cyproheptadine, and their combination on appetite, body weight and quality of life (QOL) in cancer patients: A double-blind placebo-controlled clinical trial

8141 Background: This study aimed to evaluate effect of progestinal agent and cyproheptadine on Anorexia-cachexia syndrome and QOL in cancer patients. Methods:This study is a double-blind placebo-controlled clinical trial. Eligible cases were non-hormone dependent cancer patients with history of appetite loss or significant weight loss (> 5%) between ages 18–75 years who completed informed consent. Patients stratified according to: 1) >5%below IBW / IBW ± 5% or >5% above IBW 2) Complete or Partial response / stable or progressive disease 3) Cisplatin / Non-Cisplatin based chemotherapy and assigned (by minimization method) to four treatment arms: Megestrol Acetate (320mg/d, BID) + Placebo (MP), Cyproheptadine (8mg/d, BID) + Placebo (CP), Megestrol Acetate + Cyproheptadine (MC) and Placebo + Placebo (PP) for a period of one month. QOL evaluated by EORTC-QLQ-C30 for cancer studies. Results: During 1999 to 2003, 161 cancer patients included and 98 cases (60.9%) completed treatment period (85.4 % in stages III - IV). During study, 75.6 % of cases received chemotherapy and 6 % undergone radiation. Stratified parameters were balanced between treatment arms. Appetite, body weight and QOL changes evaluated at entrance and after one month that their results are summarized in the table below. Conclusions: Appetite and body weight improvements occurred at most in megestrol acetate treatment group (MP) but its difference with other groups was not significant. QOL parameters were not different between treatment arms (P values > 0.05). Considering the short treatment period and difficulties in follow-up of end-stage cancer patients, qualified large-scale clinical trials is needed for defining therapeutic role of these medications. No significant financial relationships to disclose.

SPIRITUAL ISSUES AND QUALITY OF LIFE ASSESSMENT IN CANCER CARE

Being diagnosed with cancer forces most human beings to face their own death. The comfortable sense of both invulnerability and immortality is shattered, making the patient thoroughly aware that life is finite and limited. Approaching death, cancer patients commonly embark on an inner journey involving a search for meaning as well as a reordering of priorities involving physical, psychological, social, and spiritual needs. Although interest in the role of spirituality, relating to both adjustment to cancer and the overall quality of life of cancer patients, has increased in recent years, most of the commonly used quality of life (QOL) instruments in oncology typically do not include spiritual issues. In this article, it is argued that assessing QOL effectively should involve all aspects of the personality, including mind, body, and spirit as well. This article also reviews recent studies, which have shown that spiritual well-being, although a many-sided and difficult construct to define, is closely related to the QOL of cancer patients. It is also suggested that further research is needed to understand how the new focus on spirituality can contribute to a more comprehensive assessment of patient's QOL in cancer care.

Contribution of the rest–activity circadian rhythm to quality of life in cancer patients

Quality of life (QoL) is estimated from patients scores to items related to everyday life, including rest and activity. The rest–activity rhythm reflects endogenous circadian clock function. The relation between the individual rhythm in activity and QoL was investigated in 200 patients with metastatic colorectal cancer. Patients wore a wrist actigraph (Ambulatory Monitoring Inc., New York, NY) for 3–5 d before chronotherapy, and completed a QoL questionnaire developed by the European Organization for Research and Treatment of Cancer (QLQ-C30) plus the Hospital Anxiety and Depression Scale. The rest–activity circadian rhythm was characterized by the mean activity level (m), autocorrelation coefficient at 24h (r24), and the dichotomy index (I<O), a ratio between the amount of activity while in and out of bed. The distribution of the rest–activity cycle parameters and that of QoL scores was independent of sex, age, primary tumor, number of metastatic sites, and prior treatment. Both the 24h rhythm indicators were positively correlated with global QoL score as well as physical, emotional, and social functioning. Negative correlations were found between m, r24, or I<O and fatigue, appetite loss, and nausea. The rest–activity circadian rhythm appeared to be an objective indicator of physical welfare and QoL. This analysis suggests that circadian function may be one of the biological determinants of QoL in cancer patients.

Unsolved problems in evaluating the quality of life of cancer patients

The current means of evaluating the quality of life (QoL) of cancer patients, generally employ a multidimensional approach involving validated self-administered questionnaires. In measuring QoL, as well as in interpreting the results of an assessment, the patient, questionnaire, and setting of administration may all give rise to problems. Based on our experience and review of a large number of published papers, the most relevant problems in evaluating QoL of cancer patients are highlighted. The difficulties that patients have with the most frequently used psychometric questionnaires are demonstrated by the fact that more than 10% of patients who gave their consent to be enrolled in a longitudinal study measuring QoL did not fill out the first questionnaire. This percentage is higher among older patients having a low level of education. in patients with disseminated disease, and among those with a low performance status. Moreover, in longitudinal studies, there is a very high incidence of drop-outs, often correlated with the progression of disease, so that the results are sometimes inconsistent. Quality of life, depending not only on the type and stage of disease, and the administered treatment, but also on patient characteristics, should be assessed only in a randomised clinical trial. In any case, the most relevant problem is connected to the selection bias due to drop-outs. Reasons for this should be sought in the apparent complexity of the questionnaire and inadequate information given to the patient. Simpler instruments, which can be filled out in a shorter period of time, and specific training by research nurses could help minimize this excessive phenomenon.

Quality of life in cancer patients

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.

Summary of the symposium: important issues regarding quality of life in cancer patients

Cancer and chemoradiotherapy have a significant adverse impact on the quality of life (QOL) of cancer patients. With the advent of new and more effective cancer therapies, patients with cancer are surviving longer than in the past. This has led to increased importance for maintaining good QOL in cancer patients. Therefore, a great emphasis has been placed on QOL assessments in cancer clinical trials and in clinical practice through the administration of QOL instruments such as the European Organization for Research and Treatment of Cancer (EORTC) and the Functional Assessment of Chronic Illness Therapy (FACIT) instruments.

Recent progress in improving quality of life in cancer patients

The importance of assessing and maintaining quality of life (QOL) in cancer patients is now well appreciated. The development of standardized instruments, such as the measurement system from the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, the Functional Assessment of Chronic Illness Therapy (FACIT) scale and the various anaemia-specific questionnaires for quantifying patients’ QOL, has led to the emergence of QOL measures in clinical studies to aid in assessing new treatments. Recommendations for appropriate management of common cancer-related symptoms, such as pain, depression, fatigue, and nausea and vomiting, are described in this paper. Depression may be difficult to diagnose due to the overlap of symptoms from the cancer as well as cancer therapy, but it does respond well to treatment. However, the single most important cause of QOL deficit in cancer patients is fatigue. This is clearly multifactorial, but we are now able to assess the component associated with anaemia and its relief can lead to improvements in QOL in cancer patients. There are many potential causes of QOL deficit in cancer patients and it is prudent that clinicians frequently monitor QOL during the course of the disease and treatment, while actively preventing and treating the relevant symptoms.

Aplicación de un programa conductual de afrontamiento en pacientes cancerosos

Cancer patients display a wide variety of behaviours due to the sudden and unexpected nature of their condition. Among them, the inability to handle most situations generated by their disease is a relevant example. Within Health Psycho- logy, these situations are named lifestyle changes. This study applied coping programmes in order to improve or mantain cancer patients quality of life. There is empirical evidence that points to the possibility of treating coping and/ or problem solving deficits with specific programmes. The programme employs a structured approach based on problem solving strategies and coping skills in order to help cancer patients. Coping emphasizes initially the confrontation or clarifying of the problem, followed by the presentation of alternative behaviours. Patients learn to recognize, confront and solve the disease related problems that he/she will find. We worked with six non metastatic, non hospitalized stomach cancer patients over 12 sessions (once a week, one hour each).

Chemotherapy-induced anemia in adults: incidence and treatment.

Anemia is a common complication of myelosuppressive chemotherapy that results in a decreased functional capacity and quality of life (QOL) for cancer patients. Severe anemia is treated with red blood cell transfusions, but mild-to-moderate anemia in patients receiving chemotherapy has traditionally been managed conservatively on the basis of the perception that it was clinically unimportant. This practice has been reflected in the relative inattention to standardized and complete reporting of all degrees of chemotherapy-induced anemia. We undertook a comprehensive review of published chemotherapy trials of the most common single agents and combination chemotherapy regimens, including the new generation of chemotherapeutic agents, used in the treatment of the major nonmyeloid malignancies in adults to characterize and to document the incidence and severity of chemotherapy-induced anemia. Despite identified limitations in the grading and reporting of treatment-related anemia, the results confirm a relatively high incidence of mild-to-moderate anemia. Recent advances in assessing the relationships of anemia, fatigue, and QOL in cancer patients are providing new insights into these closely related factors. Clinical data are emerging that suggest that mild-to-moderate chemotherapy-induced anemia results in a perceptible reduction in a patient's energy level and QOL. Future research may lead to new classifications of chemotherapy-induced anemia that can guide therapeutic interventions on the basis of outcomes and hemoglobin levels. Perceptions by oncologists and patients that lesser degrees of anemia must be endured without treatment may be overcome as greater emphasis is placed on the QOL of the oncology patient and as research provides further insights into the relationships between hemoglobin levels, patient well-being, and symptoms.

A case for including spirituality in quality of life measurement in oncology

Most of the commonly used quality of life (QOL) instruments in oncology do not include spirituality as a core domain. However, previous research suggests that spirituality might be an important aspect of QOL for cancer patients and that it may, in fact, be especially salient in the context of life-threatening illness. This study used a large (n=1610) and ethnically diverse sample to address three questions relevant to including spirituality in QOL measurement: (1) Does spirituality demonstrate a positive association with QOL?; (2) Is this association unique?; and (3) Is there clinical utility in including spirituality in QOL measurement? Spirituality, as measured by the Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being (FACIT-Sp), was found to be associated with QOL to the same degree as physical well-being, a domain unquestioned in its importance to QOL. The significant association between spirituality and QOL was unique, remaining after controlling for core QOL domains as well as other possible confounding variables. Furthermore, spiritual well-being was found to be related to the ability to enjoy life even in the midst of symptoms, making this domain a potentially important clinical target. It is concluded that these results support the move to the biopsychosocialspiritual model for QOL measurement in oncology. Copyright © 1999 John Wiley & Sons, Ltd.

A case for including spirituality in quality of life measurement in oncology.

Most of the commonly used quality of life (QOL) instruments in oncology do not include spirituality as a core domain. However, previous research suggests that spirituality might be an important aspect of QOL for cancer patients and that it may, in fact, be especially salient in the context of life-threatening illness. This study used a large (n=1610) and ethnically diverse sample to address three questions relevant to including spirituality in QOL measurement: (1) Does spirituality demonstrate a positive association with QOL?; (2) Is this association unique?; and (3) Is there clinical utility in including spirituality in QOL measurement? Spirituality, as measured by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp), was found to be associated with QOL to the same degree as physical well-being, a domain unquestioned in its importance to QOL. The significant association between spirituality and QOL was unique, remaining after controlling for core QOL domains as well as other possible confounding variables. Furthermore, spiritual well-being was found to be related to the ability to enjoy life even in the midst of symptoms, making this domain a potentially important clinical target. It is concluded that these results support the move to the biopsychosocialspiritual model for QOL measurement in oncology.

The quality of life of cancer patients participating in phase I clinical trials using SEIQoL-DW.

The nature of phase I clinical trials in cancer patients raises many ethical issues. An area of major importance is the quality of life (QoL) of these patients. However, there is limited information available concerning the impact of phase I clinical trials on the QoL of patients with cancer. The primary aim of this study was to examine the QoL of cancer patients participating in phase I clinical trials. A descriptive triangulation approach was employed. The secondary aim was to determine the acceptability of the Schedule for the Evaluation of Individual Quality of Life - Direct Weighting (SEIQoL-DW) within this group of patients. SEIQoL-DW is a relatively new tool which investigates the areas identified by individual patients as important to their QoL. Cancer patients (n=15) participating in phase I clinical trials were interviewed using the SEIQoL-DW tool. During this interview patients nominated the areas of life important to them and rated their relative weighting and current status. Cues nominated were described and results analysed using non-parametric statistical tests. The results showed that health and family were particularly important to patients in relation to their QoL. The importance of an individualized approach in the measurement of QoL was evident. SEIQoL-DW was found to be acceptable and practical to use in cancer patients participating in phase I clinical trials. Recommendations for practice were drawn and suggestions made for further research.

RECOVERY OF HEALTH RELATED QUALITY OF LIFE IN THE YEAR AFTER RADICAL PROSTATECTOMY: EARLY EXPERIENCE

We determined the temporal course of patient return to baseline quality of life after treatment with radical prostatectomy for early stage prostate cancer. After establishing a longitudinal observational database of men undergoing radical retropubic prostatectomy we used established, validated quality of life questionnaires (RAND 36-Item Health Survey and University of California, Los Angeles Prostate Cancer Index) to document changes in general and disease specific health related quality of life (HRQOL). We assessed 90 patients at baseline before surgery and then at 3-month intervals for 1 year postoperatively. Logistic regression was used to explore predictors of the return to baseline. After prostatectomy patients had a significant decrease in all domains of HRQOL. Return to baseline was rapid in the general and bowel domains with at least two-thirds to three-fourths of patients reaching pretreatment levels within 6 months of surgery. Return to baseline was slower in the urinary and sexual function domains with 61 and 31% of the men, respectively, reaching pretreatment levels by 1 year after surgery. Of those who reached baseline the average intervals for the bowel, sexual and urinary domains were 5, 6 and 7 months, respectively. Married and white patients were more likely to achieve a return to baseline HRQOL during year 1 postoperatively. However, education level was inversely associated with the likelihood of returning to baseline. During the year after radical prostatectomy for early stage prostate cancer patient quality of life steadily improved. By 3 months postoperatively 30 to 40% of the patients had already recovered baseline levels of physical, mental and social functioning, and by 6 months more than 70% had reached baseline in the general HRQOL domains. By 12 months after surgery 86 to 97% of the patients had returned to baseline levels in each domain. Each domain continued to improve throughout the year. For the patients who reached baseline general HRQOL during followup average recovery time was 5 to 6 months.

The impact of providing taped consultations and communicative behaviors on cancer patients quality of life, satisfaction, recall and coping

The impact of providing taped consultations and communicative behaviors on cancer patients quality of life, satisfaction, recall and coping

1342 Aromatherapy massage—does it improve cancer patients quality of life?

The use of aromatherapy in cancer care is increasing. There is little research to illustrate its effectiveness. A study was set-up to evaluate: The effectiveness of massage and aromatherapy in improving the quality of life for patients with advanced cancer. 51 patients were randomly allocated to either 3 weekly full body massages with either carrier oil and essential or carrier oil only. All patients completed—The Rotterdam Symptom Checklist (RSCL) pre & post therapy, the Spielberger State/Trait Anxiety Inventory (STAI) and a semi-structured questionnaire. The data were analysed using SPSSX. The post test RSCL scores improved for both groups and were statistically significant for the aromatherapy group on the physical (P = 0.003) and quality of life sub-scale (P = 0.005). Patients perceived massage and aromatherapy massage to be very beneficial in reducing tensions, anxiety and pain.

Long-term quality of life after ablative intraoral tumour surgery

The aim of the present retrospective study was to determine the long-term quality of life of patients who had undergone intraoral tumour resection. 135 patients with a malignant tumour located in the floor of the mouth and the adjacent area were enrolled in the study. A standard questionnaire was used to determine the physical functional status, the psychological status and social functioning of cancer patients (Schipper et al., 1984). The results were related to the T-stage, the size and the location of the intraoral soft tissue defect, the mode of reconstruction and the postoperative interval. The results showed a significant correlation of the Functional Living Index-Cancer (FLIC) score with the Karnowsky-Index. The values were significantly lower in the higher T-stages. The location of the soft tissue defect, the type of soft tissue reconstruction and discontinuity resections of the mandible were crucial for postoperative quality of life, inasmuch as bilateral defects with loss of mandibular continuity and myocutaneous flap reconstructions showed significantly lower FLIC values. Reconstruction of mandibular continuity did not contribute to an increase in FLIC values. Dysphagia, reflux of food through the lips and nose during meals, decreased appetite and persistent pain significantly decreased the FLIC scores. It is concluded, that the FLIC is suitable for the determination of life quality in cancer patients since the score has shown the potential to reflect differences in postoperative life quality with regard to surgical procedures and functional sequelae.

The European Organization for Research and treatment of cancer approach to quality of life assessment: guidelines for developing questionnaire modules

The EORTC Study Group on Quality of Life (the Study Group) has adopted a modular approach to quality of life (QOL) assessment in cancer clinical trials. A 'core' instrument-the QLQ-C30-has been designed to cover a range of QOL issues relevant to a broad spectrum of cancer patients. It is intended that this QLQ-C30 be supplemented by more specific subscales ('modules') to assess aspects of QOL of particular importance to specific subgroups of patients. Since individual members of the Study Group were to be involved in module development, guidelines were required to standardize the module development process in order to ensure uniformly high quality across modules. These guidelines are presented in this paper. The term 'module' is defined, the composition of modules is outlined, and the criteria used to develop modules are specified. The module development process, consisting of four phases (generation of relevant QOL issues, operationalization of the QOL issues into a set of items, pretesting the module questionnaire, and large-scale field-testing) is described in detail. Further, issues related to cross-cultural instrument development, and the need for monitoring the module development process from within the Study Group are discussed. Finally, experiences with developing two site-specific modules (i.e., for head and neck, and breast cancer), are presented and the extent to which the guidelines meet practical requirements is discussed. The guidelines appear to provide a practical tool for module construction, that can facilitate the development of a comprehensive system for assessing the QOL of cancer patients internationally.

What Constitutes Quality of Life?: A Conceptualization of the Dimension of Life Quality in Cancer Patients

Those who look after patients with cancer should understand the principles of methods for evaluating quality of life. This is important in helping individual patients with their continuing treatment and in assessing the results of clinical controlled trials and can be used to help patients to choose between various forms of therapy.