Calitatea vieții pacienţilor cu cancer în timpul tratamentului oncologic activ şi în cadrul îngrijirilor paliative

1. Generalities

The World Health Organization (WHO) defined health as not only the absence of disease or illness, but also the presence of physical, mental and social well-being. The quality of life (QoL) defined in 1948 by WHO started from this definition of health.

“The World Health Organization explains QoL today as a subjective evaluation of one's perception of reality relative to one’s goals as observed through the lens of one's culture and value system”⁽¹⁾.

Examples of general cancer specific measures include the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30-Items (EORTC-QLQ-C30) and the Functional Assessment of Cancer Therapy-General Scale (FACT-G)^(2,3) – Figure 1^(2,3).

2. Quality of life during the active treatment for cancer

We consider the discussion of the use of quality-of-life measures in clinical practice and in clinical trials in the same paragraph because the assessment of this measurement would ideally be mandatory in both situations.

Nowadays, patients’ quality of life has become a major objective of cancer care, considered by some authors to be the leading patient-reported outcomes for all treatment in this field.

Regarding the importance of quality of life in active antitumor therapy, the study by Sibeoni et al. (2018)⁽⁴⁾ seems relevant to me, and I will summarize it below.

Methodology. The authors conducted a multicenter qualitative study based on 30 semi-structured interviews. Patients’ enrollment was done respecting the data saturation criterion. Patients had various types of cancer and had started treatment at least six months before the interview. The data were examined by thematic analysis. Two themes were identified: (1) what negatively affected the patients’ quality of daily life during the treatment period, and this theme was covered by the patients by referring to the side effects of the treatment; and (2) what positively affected their quality of daily life during the treatment period. This second theme had three aspects: a) the interest in having a support object (defined as an object, relationship or activity of the patients that made them feel good and made the cancer and its treatment bearable); b) the subjective perception of the effectiveness of the antitumor treatment; (3) the positive effects of relationships with friends and family, as well as with their doctor. In conclusion, the authors state that patients must be involved in their care, if they are to be able to endure the course of treatment and find ways to overcome the difficult experience of oncological care. The element or object of support represents an important therapeutic element that can be used by oncologists⁽⁴⁾.

In clinical trials, the assessment of quality of life in pharmacological investigations of anticancer chemotherapy can lead to a better understanding of clinical outcomes. In this context, drug toxicities that were not suspected until the time of the study can be better identified. In general, in clinical practice, but especially in research, methods for measuring patients’ quality of life during treatment are frequently used by clinicians, researchers and pharmaceutical companies, in tracking the tolerability of experimental drugs and in designing cancer treatment protocols⁽⁵⁾.

We present one of the most widely used quality-of-life questionnaires, developed by EORTC, QLQ-C30 (Figure 2 a, b).

EORTC subsequently developed numerous quality-of-life questionnaires for various situations encountered in clinical trials:

• EORTC QLQ-BM22 – EORTC Quality of Life Questionnaire – Bone Metastases Module.
• EORTC QLQ-STO22 – EORTC Quality of Life Questionnaire – Gastric Cancer Module.
• EORTC QLQ-OES18 – EORTC Quality of Life Questionnaire – Esophageal Cancer Module.
• EORTC QLQ-PAN26 – EORTC Quality of life Questionnaire – Pancreatic Cancer Module.
• EORTC QLQ-BN20 – EORTC Quality of Life Questionnaire – Brain Cancer Module.
• EORTC QLQ-C15-PAL – EORTC Quality of Life Questionnaire – Palliative Cancer Care.
• EORTC QLQ-CIPN20 – EORTC Quality of Life – Chemotherapy-Induced Peripheral Neuropathy.
• EORTC QLQ-CX24 – EORTC Quality of Life Questionnaire – Cervical Cancer Module.
• EORTC QLQ-EN24 – EORTC Quality of Life Questionnaire – Endometrial Cancer Module.
• EORTC QLQ-HCC18 – EORTC Quality of Life Questionnaire – Hepatocellular Carcinoma/Primary Liver Cancer Module.
• EORTC QLQ – BRECON23 – EORTC Quality of Life Questionnaire – Breast Reconstruction.
• EORTC QLQ-CAX24 – EORTC Quality of Life Questionnaire – Cancer Cachexia.
• EORTC QLQ-ANL27 – EORTC Quality of Life Questionnaire – Anal Cancer.
• EORTC QLQ-COMU26 – EORTC Quality of Life Questionnaire – Communication.
• EORTC QLQ-BR42 – EORTC Quality of Life Questionnaire – Breast Cancer.
• EORTC QLQ-MEL38 – EORTC Quality of Life Questionnaire – Melanoma.

3. Quality of life in palliative care

In a review by Jocham et al.⁽⁶⁾, it is stated that most clinicians and researchers agree that the main goal of palliative care is to optimize the quality of life of patients with advanced incurable diseases by controlling physical symptoms and paying attention to the psychological, social and spiritual needs of the patient. The goal of palliative care is, therefore, to achieve the “best quality of life possible for patients and their families”⁽⁶⁾.

Shahidi et al., in a review of the quality-of-life assessment instruments in palliative care, concluded with the other authors that the McGill (Figure 3 a, b, c, d) Quality-of-Life Questionnaire had the best measurement properties⁽⁷⁾. However, given the complexity of the notion of quality of life, some aspects appreciated by the patient, such as quality of care and financial aspects, are missing from this instrument. No instrument has proven to be exhaustive in terms of assessing quality of life^(6,7).

4. Conclusions

The assessment of quality of life in oncology includes various aspects related to the timing of administering quality-of-life questionnaires, namely: during curative therapy or palliative therapy. Exploring quality of life has also an important role in research. Most clinical trials have as one of their main objectives the assessment of quality of life. The existing questionnaires cannot cover the entire complexity of defining the quality of life of oncological patients, therefore the use of several questionnaires is recommended. It is also recommended to use questionnaires specific to each cancer location. Further studies are needed to find the most appropriate instruments for measuring the quality of life, using mathematical models and artificial intelligence.

Autor corespondent: Alexandru C. Grigorescu E-mail: alexgrigorescu2004@yahoo.com

CONFLICT OF INTEREST: none declared.

FINANCIAL SUPPORT: none declared.

This work is permanently accessible online free of charge and published under the CC-BY.