• INTERNATIONAL JOURNAL OF PHARMACEUTICAL MEDICINE 2000, 14:69 69

ORIGINAL ARTICLE

Quality of life in cancer patientsProceedings of a conference held in Vienna, September1999, under the auspices of the Society of PharmaceuticalMedicine: Introduction

David Khayat

Cancer and cancer therapies, including chemotherapy, radio­therapy, and surgery, all have a significant impact on the qualityof life (QOL) of a patient. Poor QOL can jeopardize completionof the cancer treatment regimen since it may influence thepatient's willingness to continue with cancer therapy. Whethertreatment is intended as palliative or curative, it is important todesign treatments where there is an acceptable tradeoff betweenprobability of cure and QOL, or between survival time andQOL. These considerations are becoming increasingly importantsince newer potent therapeutic therapies have not only improvedcure rates for many types of cancer, but have also greatlyprolonged survival times for incurable cancers. For thesereasons, QOL measurements have become increasingly impor­tant when determining efficacy of treatments in clinical trials.This conference was organized to review and discuss the issuesrelating to QOL in cancer patients.

There can be a variety of causes of QOL deficits in cancerpatients, including pain, depression, anaemia, and fatigue. Theincreased use of adjuvant chemotherapy and radiotherapy andtheir associated side effects (i.e. nausea and vomiting) havecaused increased concern regarding QOL. Moreover, the longersurvival times of patients with incurable cancers have increasedthe need to improve the palliative care they receive. Theestablishment of standardized QOL assessment tools willfacilitate the use of QOL as an efficacy measure. In addition,the increased use of QOL measures addresses the growingawareness that it is important to treat the whole patient, not justthe disease.

The need for accurate instruments to measure QOL had ledto the development of the European Organization for Researchand Treatment of Cancer (EORTC) QOL questionnaire and theFunctional Assessment of Chronic Illness Therapy (FACIT)QOL measurement system. The conference, entitled 'Quality ofLife in Cancer Patients', included a thorough discussion of thefactors that need to be considered for proper implementation ofthe QOL questionnaires and interpretation of the data. Thesefactors included language issues, cross-cultural sensitivity of thequestionnaire, and the degree of disease severity. Methods onassuring validity and reliability of the questionnaire were alsodiscussed.

The discussion then moved on to potential barriers to effectiveutilization of QOL assessments. Despite the advances made inQOL instrument development, many clinicians are not comfor­table with the use of these tools. Fundamental misunderstand­ings regarding the use of these instruments include improperadministration, analysis and interpretation of the data. Appro­priate strategies to overcome these barriers were then discussed.The conference also included an overview of the recent progressin improving QOL in cancer patients. Areas such as depression,pain, fatigue and nausea were discussed. Special attention waspaid to anaemia and fatigue as well as pain. Fatigue is a commonsymptom of cancer patients and is quite often the result ofanaemia. Several large studies assessing the QOL benefits ofepoetin alfa treatment in anaemic cancer patients werereviewed. Despite the development of guidelines for paintreatment in cancer patients, pain is still undertreated in analarmingly high percentage of patients. Barriers to effective painmanagement were reviewed with a discussion on ways toovercome them.

In summary, the following articles will highlight the impor­tance of QOL assessment in both clinical trials and practicewhen treating cancer patients. It will also provide helpfulinformation on the development and use of questionnaires, aswell as methods to analyse and achieve proper interpretation ofthe collected QOL data. Clinicians may also find usefulinformation on overcoming the obstacles to effective use ofQOL assessment in clinical practice, particularly for themanagement of anaemia and pain.

AcknowledgementsThe material in these articles was presented at the 'Quality ofLife in Cancer Patients' conference held in September 1999 inVienna, Austria. The conference was sponsored by the Societyof Pharmaceutical Medicine and was supported by an unrest­ricted educational grant from Janssen-Cilag

The opinions or views expressed in these articles are those ofthe authors and do not necessarily reflect the opinions orrecommendations of Janssen-Cilag.

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