Integrating quality of life into clinical practice

The European Society for Medical Oncology (ESMO) defines survivorship as follows: “survivorship focuses on health and the physical, psychological, social and economic issues affecting people after the end of the primary treatment for cancer”⁽¹⁾.

The quality of life is also one of the para­me­ters used in evaluating the results of clinical trials. According to the Berkeley Well-Being Institute, the quality of life represents the degree to which an individual is healthy, has relative comfort, and he is able to participate in or enjoy life events. The authors of the definition note, however, that the term quality of life is inherently ambiguous, since it can refer both to the experience that an individual has of his own life and to the living conditions in which individuals find themselves. Therefore, the quality of life is highly subjective. While one person may define the quality of life in terms of wealth or satisfaction with life, another person may define it in terms of capabilities (for example, having the ability to live a good life in terms of emotional and physical well-being). A person with disabilities may report a high quality of life, while a healthy person who has recently lost a job may report a low quality of life.

In the field of healthcare, the quality of life is viewed as multidimensional, encompassing emotional, physical, material and social well-being. Academic interest in quality of life grew after World War II, when there were a growing awareness and recognition of social inequalities. This provided the impetus for research on social indicators and, subsequently, research on subjective well-being and quality of life. The patient’s view of his/her own health has long played a role in medical consultation; however, in the medical literature, researchers did not begin to collect and report these data systematically until the 1960s⁽²⁾.

The study conducted by Anna Lewandow­ska on the quality of life of cancer patients who are treated with chemotherapy led to the following conclusions:

1. Cancer undoubtedly has a negative impact on the quality of life of patients, which is related to the disease process itself, the treatment used, and the duration of the disease. The necessity of frequent hospitalizations, negative emotions, and numerous somatic ailments that change over time significantly reduce the quality of life of cancer patients.

2. Somatic symptoms accompany patients at every stage of the disease and are associated with increased disability and reduced quality of life. The factors that significantly influence the occurrence of symptoms depend on the phase of the disease, the cycles of chemotherapy, and the duration of the disease.

3. To achieve the best possible quality of life despite disease, it is important to regularly assess the quality of life of patients to quickly assess the problems of each sphere of life, which will enable the identification of high-risk patients and allow for early intervention, depending on the identified needs or deficits. Undetected and untreated disorders threaten the results of cancer therapies, reduce the patients’ quality of life, and increase the healthcare costs⁽³⁾.

As a conclusion to our presentation on the issue of quality of life, we must recognize that it cannot be estimated through the current way of working in Romania. The doctor’s working time must be better quantified, teamwork must be stimulated, doctors specialized in palliative care must be introduced into hospitals, and even centers for integrating medical oncology with palliative care must be created, according to the ESMO recommendation. Teamwork is mandatory in the treatment of cancer, which is particularly complex. And last but not least, there must be a national scientific society that unites all cancer specialists and contributes to achieving real collaboration between doctors.