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GUEST EDITORIAL
Year : 2010  |  Volume : 47  |  Issue : 3  |  Page : 237-238
 

Clinical importance of quality of life measures in head and neck cancer


1 Head and Neck Unit, Royal Marsden NHS Hospital, Fulham Road, London, SW3 6JJ, United Kingdom
2 ENT Department, Grant Medical College, B.R. Ambedkar road, Byculla, Mumbai - 400 008, India

Date of Web Publication28-Jun-2010

Correspondence Address:
R Kazi
Head and Neck Unit, Royal Marsden NHS Hospital, Fulham Road, London, SW3 6JJ
United Kingdom
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.64705

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How to cite this article:
Kazi R, Sayed S, Dwivedi R C. Clinical importance of quality of life measures in head and neck cancer. Indian J Cancer 2010;47:237-8

How to cite this URL:
Kazi R, Sayed S, Dwivedi R C. Clinical importance of quality of life measures in head and neck cancer. Indian J Cancer [serial online] 2010 [cited 2019 Jul 18];47:237-8. Available from: http://www.indianjcancer.com/text.asp?2010/47/3/237/64705


Length of survival alone is an unsatisfactory measure of the success of treatment; the quality of survival needs to be evaluated. [1] Morton and Izzard have defined quality of life (QOL) as, "QOL is the perceived discrepancy between the reality of what a person has and the concept of what the person wants, needs or expects." [2],[3],[4],[5] The World Health Organization defines QOL as "an individual's perception of their position in life, in the context of the culture and value systems in their life and in relation to their goals, expectations, standards and concerns." [6],[7] Despite major advances in cancer biology and therapeutics, cancer and its treatment continue to cause devastating suffering, not only for the many patients who die from their illness but also for those who are successfully treated. This is especially true for head and neck cancer (HNC) that causes a disproportionately severe impact on the patient's QOL. [2] Patients with HNC are rendered vulnerable to severe psychosocial problems because social interactions and emotional expression depends, to a great extent, on the structural and functional integrity of the head and neck region. [1] While laboratory and clinical tests can give important information about the disease, it is often not possible to separate the disease from an individual's personal and social context. This is because no illness exists in a vacuum and cancer sufferers often experience multiple physical, psychological and social problems concurrently. [1] Length of survival alone is an incomplete measure of the success of treatment; the functional status and quality of survival need to be evaluated. Because the consequences of cancer therapy for the patient can be debilitating and may depend on the modality of treatment, increasing attention has been given in recent years to measures of outcome such as QOL. The evaluation of QOL and performance outcomes in cancer is critical to optimal patient care, comprehensive evaluation of treatment alternatives and development of informed rehabilitative services and patient education. [1],[2],[3] QOL measures have now become a vital part of health outcomes appraisal and an effective way of capturing the personal and social context of patients. Importance of QOL Measures in HNC Clinical Practice

When considered alongside mortality and morbidity data, QOL studies provide additional information and data by considering hitherto neglected physical, psychological and social problems as experienced by the patient. QOL measures have a number of potential uses in three key areas, namely aiding routine clinical practice, governance and audit. Clinicians and researchers can use QOL measures to facilitate communication between themselves and patients, screen, identify and prioritize problems, identify preferences, monitor changes or response to treatment, train new staff and develop informed rehabilitative and patient education services. While some of these are of immediate value in the clinical setting, the remaining contribute to training, reviewing and improving care for the future. [1],[2],[3],[4],[10]

Let us consider these uses step by step. QOL scales can help HNC patients to communicate their problems effectively to the treating clinician in a busy practice by drawing attention to the severity of their problems and, thereby, help focus on the main concerns and issues. [1],[2] We know very well that HNC patients often have multiple related and unrelated psychosocial and physical issues at the core of their problems. As QOL measures and records information on a wide range of issues, the clinician can identify which problems are most important and prioritize accordingly. This is especially important in patients with multiple problems, as often encountered in HNC practice, and patients can utilize scales to report the most pressing issue. They can help identify the patient's preferred outcome or treatment goals and help monitor changes/responses to treatment. [3] If these are not known, then the treatment may not meet the patient's expectations, which may affect adherence to treatment, results and, ultimately, the patient's satisfaction with care. Additionally, these measures can be used to capture information that, on the surface, may appear to have no clinical relevance but might explain disease severity or coping (also called response shift-change in internal standards over time). Sometimes, a patient may find it easier to bring attention to his existing psychological and social problems in a QOL scale than face to face with a carer. [1],[3] QOL data can help train staff to be more responsive to the needs and concerns of the patients. QOL instruments allow patients to prioritize which life domains are most important to them by providing levels of information not always supplied by traditional outcome measures. This is important as it may be that the patient places more emphasis upon restoring family relationships or being able to engage in leisure activities than the reduction of severity of his symptoms, as believed by the clinician. [1],[2] By incorporation of the feedback and information obtained in the QOL scales, they can help in governance, audit and development of effective patient liaison services. [2],[3] In addition, QOL data can provide information that can help shape public policy and health care decisions made by governmental and private institutions. [5],[8],[9] Various cancer bodies like the National Cancer Institute (NCI), National Institute of Health (NIH), American Cancer Society (ACS), NICE, American Society of Clinical Oncology (ASCO) and the US FDA have widely incorporated QOL data in their strategic and research initiatives. [4],[11] QOL data can also be used to guide the research agenda of pharmaceutical companies and cooperative groups. QOL studies put the patient at the center rather than at the periphery of assessing the effectiveness of treatment interventions. The evaluation of QOL and performance outcome in HNC is critical to optimal patient care, comprehensive evaluation of treatment alternatives and development of informed rehabilitative services and patient education. [12] With the knowledge of existing data, clinicians already have the potential to improve not just survival figures but also the QOL for the patients.

 
 » References Top

1.Kazi R, De Cordova J, Kanagalingam J, Venkitaraman R, Nutting CM, Clarke P, et al. Quality of life following total laryngectomy: Assessment using the UW-QOL scale. ORL J Otorhinolaryngol Relat Spec 2007;69:100-6.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.Morton RP, Izzard ME. Quality-of-life outcomes in head and neck cancer patients. World J Surg 2003;27:884-9  Back to cited text no. 2      
3.Murphy BA, Ridner S, Wells N, Dietrich M. Quality of life research in head and neck cancer: A review of the current state of the science. Crit Rev Oncol Hematol 2007;62:251-67  Back to cited text no. 3      
4.National Institute for health and Clinical Excellence. Guidelines. Available from: http://www.nice.org.uk/guidance/index.jsp?action=byTopicando=7172 . [accessed on 2009 Jan13].  Back to cited text no. 4      
5.Burckhardt CS, Anderson KL. The Quality of Life Scale (QOLS): Reliability, validity, and utilization. Health Qual Life Outcomes 2003;1:60.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]  
6.Farquhar M. Definitions of quality of life: A taxonomy. J Adv Nurs 1995;22:502-8.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]  
7.World Health Organization. WHO Health Promotion Glossary 1998. WHO/HPR/HEP/98.1, World Health Organization, Geneva, 1994. Retrieved 27-12-2008 Available from: http://208.164.121.55/reference/SOME/Outlines/world_health_organization.htm. [accessed on 2010 Apr 25].  Back to cited text no. 7      
8.Calman, K. Definitions and dimensions of quality of life, in the quality of life of cancer patients. In: Aaronson N, Beckman J, editors. Quality of Life of Cancer Patients. New York : Raven Press; 1987. p. 1-9.  Back to cited text no. 8      
9.Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA 1995;273:59-65.  Back to cited text no. 9  [PUBMED]    
10.Higginson IJ, Carr AJ. Measuring quality of life: Using quality of life measures in the clinical setting. BMJ 2001;322:1297-300.   Back to cited text no. 10  [PUBMED]  [FULLTEXT]  
11.Lipscomb J, Gotay CC, Snyder CF. Patient-reported outcomes in cancer: A review of recent research and policy initiatives. CA Cancer J Clin 2007;57:278-300  Back to cited text no. 11      
12.Terrell JE, Ronis DL, Fowler KE, Bradford CR, Chepeha DB, Prince ME, et al. Clinical predictors of quality of life in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 2004;130:401-8.  Back to cited text no. 12  [PUBMED]  [FULLTEXT]  



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