• INTERNATIONAL JOURNAL OF PHARMACEUTICAL MEDICINE 2000, 14:98-99 98

ORIGINAL ARTICLE

Summary of the symposium:important issues regarding qualityof life in cancer patientsPeter Harper

Guy's Hospital, Oncology, St. Thomas Street, London SE1 9RT, UK

Received 4 February 2000; accepted 9 February 2000

Introduction

Cancer and chemoradiotherapy have a significant adverseimpact on the quality of life (QOL) of cancer patients. Withthe advent of new and more effective cancer therapies, patientswith cancer are surviving longer than in the past. This has led toincreased importance for maintaining good QOL in cancerpatients. Therefore, a great emphasis has been placed on QOLassessments in cancer clinical trials and in clinical practicethrough the administration of QOL instruments such as theEuropean Organization for Research and Treatment of Cancer(EORTC) and the Functional Assessment of Chronic IllnessTherapy (FACIT) instruments.

QOL instruments

Development of both the EORTC and FACIT assessment toolsis a rigorous process that is required to address the multi­dimensional aspect of QOL in cancer patients. In general, theQOL instruments should address the physical, functional, social,and emotional aspects of QOL. Further information can beobtained by having disease- and symptom-specific questions. Allthe items in a questionnaire should be tested for validity andreliability through field testing, including translations to assurecross-cultural equivalence.

The value of QOL assessment in cancer clinical trials isbecoming increasingly appreciated as a means of raisingawareness among healthcare professionals about a patient'sconcerns and the impact that diagnosis and treatment has ondomains other than just the physical aspects of the disease.However, QOL instruments have been underutilized in clinicalpractice due to a number of physician concerns and misconcep­tions. Clinicians generally feel that clinical judgment is sufficientin making QOL assessment without the need for formalinstruments. Certain clinicians have reported that the ques­tionnaires are too time consuming and may upset the patientwhen inquiring about symptoms or issues that the patient may

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not be experiencing. Furthermore, clinicians may not be familiarwith the types of questionnaires that should be used in a givenpatient population, or with the methods of analyzing andinterpreting the data. Such concerns are not being adequatelyaddressed, and the use of QOL instruments is still veryinfrequent.

QOL measurement tools can help to accurately report theeffects of disease and treatment on patient QOL. To do this theymust be reliable, valid, cross-culturally consistent and able todetect clinical changes. They also must be patient-reported,brief, and encompass the many facets of QOL. Physicians mustalso be properly trained in the administration and analysis of theassessment tool.

Despite their concerns, physicians need to increase their useof QOL instruments in both clinical trials and clinical practicesince much important additional information about patientneeds and concerns can be obtained through QOL assessments.For example, QOL assessment can help clinicians evaluateoutcomes of various treatment options in clinical trials, facilitatedecision-making about treatments, identify patient populationsmost likely to benefit from supportive interventions, and aid inmaking policy decisions and resource allocations. Specifically,QOL assessment can help clinicians reveal potential differencesbetween treatments despite the presence of toxicity and absenceof tumor regression. It can also be useful as a prognostic tool inidentifying patients more likely to benefit from treatment.Therefore, QOL can be rigorously and accurately measured inboth clinical trials and practice allowing clinicians to obtainimportant patient-related information that may not be availablethrough other measures.

Improving patient's QOLQOL in cancer patients can be adversely affected by a number ofdisease- and symptom-specific deficits, including pain, fatigue,alopecia, nausea and vomiting, anaemia, and depression.Fatigue is the most commonly reported symptom in cancerpatients, and it is the most difficult symptom to treat. The

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anaemia associated with cancer and cancer treatment is animportant factor in the etiology of this fatigue. Successfultreatment of the underlying anaemia can improve patient QOL.Recently, the focus has shifted from gaining physiologicalimprovement, which involves maintaining haemoglobin (Hb)levels above 8 g/dL, to functional improvement, which relates toimprovement in patient function with Hb levels up to andincluding 12 g/dL. Clinical trials and community-based studieshave shown that epoetin alfa can significantly increase Hb levels,and therefore reduce transfusion requirements. In addition, ithas been shown significantly to improve QOL parameters,including energy and activity levels, which correlate withincreases in Hb levels independent of tumour response.

Pain is also commonly reported in cancer patients; however, itis often undertreated despite the availability of analgesictherapies that can provide adequate pain control. This under­treatment is due to inadequate pain assessment, poor knowledgeregarding pain management, and reluctance to administer

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SUMMARY OF THE SYMPOSIUM 99

proper analgesics. Pain can significantly impair patients' abilityto enjoy life and participate in routine activities. Pain control canbe maximized with improved pain assessment, which allows forappropriate choice of analgesic therapy.

Conclusions

In contrast to past limitations, it is now possible accurately tomeasure QOL in cancer patients. This presents the physicianwith the opportunity accurately to measure aspects of treatment,which were not previously quantifiable. This development hasbeen particularly important when viewed alongside the trend ofincreasing survival times of cancer patients. Adequate QOLassessment can ultimately help clinicians provide patients withimproved QOL.

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