Skip to main content
Log in

Quality of Life Measures in Cancer Chemotherapy

Methodology and Implications

  • Review Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Summary

Quality of life has been an implied outcome of medical care since ancient times, yet only recently have tools become available to measure quality of life in a systematic fashion. Cancer is one of the chronic diseases where quality of life outcomes have been particularly salient.

Currently, there are a wide variety of generic and cancer-specific instruments that are being used to evaluate the impact of cancer chemotherapy on the patient’s quality of life. Most of these instruments rely on patient self-report rather than expert evaluation.

The addition of quality-of-life (QOL) assessment to pharmacological investigations o f cancer chemotherapy may enhance evaluation of clinical outcomes, as well as identify unsuspected drug toxicities. Clinicians, researchers and pharmaceutical companies are more frequently incorporating these measures into the design of cancer treatment protocols. Data on the performance of these tools should become more widely available in the near future, leading to refinements in the selection and use of specific instruments for different purposes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Aaronson NK. Quality of life: what is it? How should it be measured? Oncology 2: 69–74, 1988

    PubMed  CAS  Google Scholar 

  • Aaronson NK, Acquadro C, Alonso J, et al. International Quality of Life Assessment (IQOLA) Project. Quality of Life Research 1: 349–351, 1992

    Article  PubMed  CAS  Google Scholar 

  • Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer quality of lifeQC30: a quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute 85: 365–376, 1993

    Article  PubMed  CAS  Google Scholar 

  • Aaronson NK, Bullinger M, Ahmedzai S. A modular approach to quality-of-life assessment in cancer clinical trials. Recent Results in Cancer Research 111: 231–249, 1988

    Article  PubMed  CAS  Google Scholar 

  • Andrews FM, Withey SB. Social indicators of well being: Americans’ perception of life quality. Plenum, New York, 1976

    Book  Google Scholar 

  • Bergner M, Bobbin RA, Carter WB, Gilson BS. The Sickness Impact Profile. Development and final revision of a health status measure. Medical Care 19: 787–806, 1981

    Article  PubMed  CAS  Google Scholar 

  • Bergner M, Bobbin RA, Pollard WE. Sickness Impact Profile. Validation of a health status measure. Medical Care 14: 57–61, 1976

    Article  PubMed  CAS  Google Scholar 

  • Breslow L. A quantitative approach to the World Health Organization definition of health: physical, mental and social well-being. International Journal of Epidemiology 1: 347–355, 1972

    Article  PubMed  CAS  Google Scholar 

  • Brook RH, Ware Jr JE, Davies-Avery A, et al. Overview of adult health status measures fielded in RAND’s Health Insurance Study. Medical Care 17(Suppl.): 1–131, 1979

    Google Scholar 

  • Campbell A. Subjective measures of well-being. American Psychologist 31: 117–124, 1974

    Article  Google Scholar 

  • Campbell A. The sense of well-being in America: recent patterns and trends. McGraw-Hill, New York, 1981

    Google Scholar 

  • Canales S, Ganz PA, Schag CAC. Translation and validation of a quality of life instrument for Hispanic American cancer patients: methodological considerations. Quality of Life Research, in press, 1994

    Google Scholar 

  • Cella DF, Cherin EA. Quality of life during and after cancer treatment. Comprehensive Therapy 14(5): 69–75, 1988

    PubMed  CAS  Google Scholar 

  • Cella DF, Tulsky DS. Measuring quality of life today: methodological aspects. Oncology 4(Suppl. 5): 29–38, 1990

    PubMed  CAS  Google Scholar 

  • Cella DF, Tulsky DS. Quality of life in cancer: definition, purpose, and method of measurement. Cancer Investigation 11(31): 327–336, 1993

    Article  PubMed  CAS  Google Scholar 

  • Cella DF, Tulsky DS, Gray G, et al. The functional assessment of cancer therapy (FACT) scale. Development and validation of the general measure. Journal of Clinical Oncology 11: 570–579, 1993

    PubMed  CAS  Google Scholar 

  • Coates A, Gebski V, Bishop JF, et al. Improving the quality of life during chemotherapy for advanced breast cancer. A comparison of intermittent and continuous treatment strategies. New England Journal of Medicine 317: 1490–95, 1987

    Article  PubMed  CAS  Google Scholar 

  • Coates A, Gebski V, Signorini D, et al. Prognostic value of quality-of-life scores during chemotherapy for advanced breast cancer. Journal of Clinical Oncology 10: 1833–1838, 1992

    PubMed  CAS  Google Scholar 

  • De Haes JCJM. Quality of life: conceptual and theoretical considerations. In Watson et al. (Eds). Psychosocial Oncology, pp. 61–70, Pergamon Press, Oxford, 1988

    Google Scholar 

  • De Haes JCJM, Raatgever JW, van der Burg MEL, et al. Evaluation of the quality of life of patients with advanced ovarian cancer treated with combination chemotherapy. In Aaronson & Beckmann (Eds). The quality of life of cancer patients, pp. 215–226, Raven Press, New York, 1987

    Google Scholar 

  • De Haes JCJM, Van Knippenherg FCE. The quality of life of cancer patients: a review of the literature. Social Science and Medicine 20: 809–817, 1985

    Article  PubMed  Google Scholar 

  • De Haes JCJM, van Knippenberg FCE. Quality of life instruments for cancer patients: ‘Babel’s tower revisited’. Journal of Clinical Epidemiology 42: 1239–1241, 1989

    Article  PubMed  Google Scholar 

  • De Haes JCJM, Van Knippenberg FCE, Neijt JP. Measuring psychological and physical distress in cancer patients: structure and application of the Rotterdam Symptom Checklist. British Journal of Cancer 62: 1034–1038, 1990

    Article  PubMed  Google Scholar 

  • Dean HE. Political and ethical implications of using quality of life as an outcome come measure. Seminars in Oncology Nursing 6(4): 303–308, 1990

    Article  PubMed  CAS  Google Scholar 

  • Derogatis LR, Lopez M. PAIS and PAIS-SR. Administration, scoring and procedures manual-I, Clinical Psychometric Research, Baltimore, 1983

    Google Scholar 

  • Donovan K, Sanson-Fisher RW, Redman S. Measuring quality of life in cancer patients. Journal of Clinical Oncology 7: 959–968, 1989

    PubMed  CAS  Google Scholar 

  • Feeny DH, Torrance GW. Incorporating utility-based quality-of-life assessment measures in clinical trials. Medical Care 27: S190–S204, 1989

    Article  PubMed  CAS  Google Scholar 

  • Ferrell B, Wisdom C, Wenzl C, et al. Effects of controlled-release morphine on quality of life for cancer pain. Oncology Nursing Forum 16: 521–526, 1989

    PubMed  CAS  Google Scholar 

  • Finkelstein DM, Cassileth BR, Bonomi PD, et al. A pilot study of the Functional Living Index-Cancer (FLIC) scale for the assessment of quality of life for metastatic lung cancer patients. American Journal of Clinical Oncology 11: 630–633, 1988

    Article  PubMed  CAS  Google Scholar 

  • Fishman B, Pasternak S, Wallenstein SL, et al. The memorial pain assessment card. Cancer 60: 1151–1158, 1987

    Article  PubMed  CAS  Google Scholar 

  • Ganz PA, Day R, Ware Jr JE, Redmond C, Fisher B. Measuring quality of life in the breast cancer prevention trial. Presented at the American Society of Preventive Oncology Annual Meeting, Tucson, Arizona, March 20-23, 1993

  • Ganz PA, Haskell CA, Figlin RA, et al. Estimating the quality of life in a clinical trial of patients with metastatic lung cancer using the Karnofsky Performance Status and the Functional Living Index-Cancer. Cancer 61: 849–856, 1988

    Article  PubMed  CAS  Google Scholar 

  • Ganz PA, Lee JJ, Siau J. Quality of life assessment: an independent prognostic variable for survival in lung cancer. Cancer 67: 3131–3135, 1991

    Article  PubMed  CAS  Google Scholar 

  • Ganz PA, Schag CAC, Lee JJ, et al. The CARES: a generic measures of health-related quality of life for patients with cancer. Quality of Life Research 1: 19–29, 1992a

    Article  PubMed  CAS  Google Scholar 

  • Ganz, PA, Schag CAC, Lee JJ, Polinsky ML, Tan S-J. Breast conservation versus mastectomy: is there a difference in psychological adjustment or quality of life in the year after surgery? Cancer 69: 1729–1738, 1992b

    Article  PubMed  CAS  Google Scholar 

  • Gelber RD, Goldhirsch A. A new endpoint for the assessment of adjuvant therapy in postmenopausal women with operable breast cancer. Journal of Clinical Oncology 4: 1771–1779, 1986

    Google Scholar 

  • Gelber RD, Goldhirsch A, Cavalli F. Quality-of-life-adjusted evaluation of adjuvant therapies for operable breast cancer. Annals of Internal Medicine 114: 621–628, 1991

    PubMed  CAS  Google Scholar 

  • Goldhirsch A, Gelber RD, Simes RJ, et al. Costs and benefits of adjuvant therapy in breast cancer: a quality-adjusted survival analysis. Journal of Clinical Oncology 7: 36–44, 1989

    PubMed  CAS  Google Scholar 

  • Gotay CC, Korn EL, McCabe MS, Moore TD, Cheson BD. Building quality of life assessment into cancer treatment studies. Oncology 6(6): 25–28, 1992

    PubMed  CAS  Google Scholar 

  • Grant M, Padilla GV, Ferrell BR, Rhiner M. Assessment of quality of life with a single instrument. Seminars in Oncology Nursing 6(4): 260–270, 1990

    Article  PubMed  CAS  Google Scholar 

  • Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Annals of Internal Medicine 118: 622–629, 1993

    PubMed  CAS  Google Scholar 

  • Hays RD, Stewart AL, Sherbourne CD, Marshall GN. The ‘states versus weights’ dilemma in quality of life measurement. Quality of Life Research 2: 167–168, 1993

    Article  PubMed  CAS  Google Scholar 

  • Heithoff KA, Lohr KN (Eds). Effectiveness and outcomes in health care. National Academy Press, Washington, D.C., 1990

    Google Scholar 

  • Hollandsworth Jr JG. Evaluating the impact of medical treatment on the quality of life: a five year update. Social Science and Medicine 26: 425–434, 1988

    Article  PubMed  Google Scholar 

  • Hunt S, McKenna SP, McEwen J, et al. The Nottingham Health Profile: subjective health status and medical consultations. Social Science and Medicine 15: 221–229, 1981

    CAS  Google Scholar 

  • Johnson JR, Temple R. Food and drug administration requirements for approval of new anticancer drugs. Cancer Treatment Reports 69: 1155–1157, 1985

    PubMed  CAS  Google Scholar 

  • Kaplan RM, Anderson JP. The quality of well-being scale: rationale for a single quality of life index. In Walker & Rosser (Eds) Quality of life: assessment and application, pp. 51–77, MTP Press Limited, Lancaster, 1988

    Google Scholar 

  • Kaplan RM, Anderson JP, Wu AW, et al. The quality of well-being scale. Application in AIDS, cystic fibrosis, and arthritis. Medical Care 27(Suppl. 3): S27–43, 1989

    Article  PubMed  CAS  Google Scholar 

  • Kaplan RM, Bush JW. Health-related quality of life measurement for evaluation research and policy analysis. Health Psychology 1: 61–80, 1982

    Article  Google Scholar 

  • Kamofsky DA, Burchenal JH. The clinical evaluation of chemotherapeutic agents in cancer. In Macleod (Ed.) Evaluation of chemotherapeutic agents, pp. 199–205, Columbia University Press, New York, 1949

    Google Scholar 

  • Kornblith AB, Anderson J, Cella DF, et al. Quality of life assessment in Hodgkin’s disease survivors: a model for clinical cooperative clinical trials. Oncology 4(5): 93–101, 1990

    PubMed  CAS  Google Scholar 

  • Levine MN, Guyatt GH, Ghent M, et al. Quality of life in stale II breast cancer: an instrument for clinical trials. Journal of Clinical Oncology 6: 1798–1810, 1988

    PubMed  CAS  Google Scholar 

  • List MA, Ritter-Sterr C, Lansky SB. A performance status scale for head and neck cancer patients. Cancer 66: 564–569, 1990

    Article  PubMed  CAS  Google Scholar 

  • Llewellyn-Thomas HA, Sutherland HJ, Thiel EC. Do patients’ evaluations of a future health state change when they actually enter that state? Medical Care 31: 1002–1012, 1993

    Article  PubMed  CAS  Google Scholar 

  • Maunsell E, Brisson J, Deschennes L. Psychological distress after initial treatment for breast cancer: a comparison of partial and total mastectomy. Journal of Clinical Epidemiology 42: 765–771, 1989

    Article  PubMed  CAS  Google Scholar 

  • McCorkle R, Benoliel JG. Symptom distess, current concerns and mood disturbance after diagnosis of life-threatening disease. Social Science and Medicine 17: 431–438, 1983

    Article  PubMed  CAS  Google Scholar 

  • McCorkle R, Young K. Development of a symptom distress scale. Cancer Nursing 1: 373–378, 1978

    Article  PubMed  CAS  Google Scholar 

  • Moinpour CM, Feigl P, Metch B, et al. Quality of life end points in cancer clinical trials: review and recommendations. Journal of the National Cancer Institute 81: 485–495, 1989

    Article  PubMed  CAS  Google Scholar 

  • Mor V, Greer DS, Kastenbaum R (Eds). The hospice experiment, Johns Hopkins University Press, Baltimore, 1988

    Google Scholar 

  • Morrow GR. A patient report measure for the quantification of chemotherapy induced nause and emesis: psychometric properties of the Morrow assessment of nausea and emesis (MANE). British Journal of Cancer 19(Suppl): S72–74, 1992

    PubMed  CAS  Google Scholar 

  • Morrow GR, Lindke J, Black P. Measurement of quality of life in patients: psychometric analyses of the functional living index-cancer (FLIC). Quality of Life Research 1: 287–296, 1992

    Article  PubMed  CAS  Google Scholar 

  • Nayfield SG, Ganz PA, Moinpour CM, Cella DF, Hailey BJ. Report from a National Cancer Institute (USA) workshop on quality of life assessment in cancer clinical trials. Quality of Life Research 1: 203–210, 1992

    Article  PubMed  CAS  Google Scholar 

  • Nayfield SG, Hailey BJ, McCabe M. Quality of life assessment in Cancer Clinical Trials. Report of the Workshop on quality of life research in cancer clinical trials, July 16-17, 1990. Bethesda, MD, US Department of Health and Human Services, 1991

    Google Scholar 

  • Padilla GV, Presant C, Grant MM, et al. Quality of life index for patients with cancer. Research in Nursing Health 6: 117–126, 1983

    Article  PubMed  CAS  Google Scholar 

  • Patrick DL, Deyo RA. Generic and disease-specific measures in assessing health status and quality of life. Medical Care 27: S217–S232, 1989

    Article  PubMed  CAS  Google Scholar 

  • Patrick DL, Erickson P. Assessing health-related quality of life for clinical decision making. In Walker & Rosser (Eds). Quality of life: assessment and application, pp. 9–49, MTP Press Limited, Lancaster, 1988

    Google Scholar 

  • Rapp E, Pater J, Willan A, et al. Chemotherapy can prolong survival in patients with advanced non small cell lung cancer: report of a Canadian multicenler randomized trial. Journal of Clinical Oncology 6: 633–641, 1988

    PubMed  CAS  Google Scholar 

  • Razavi D, Delvaux N, Farvacques C, et al. Prevention of adjustment disorders and anticipatory nausea secondary to adjuvant chemotherapy: a double-blind, placebo-controlled study assessing the usefulness of alprazolam. Journal of Clinical Oncology 11: 1384–1390, 1993

    PubMed  CAS  Google Scholar 

  • Ruckdeschel JC, Piantadosi S, and the Lung Cancer Study Group. Quality of life assessment in lung surgery for bronchogenic carcinoma. Journal of Thoracic Surgery 6: 201–205, 1991

    Google Scholar 

  • Schag CAC, Heinrich RL. Development of a comprehensive quality of life measurement tool: CARES. Oncology 4(5): 135–138, 1990

    PubMed  CAS  Google Scholar 

  • Schag CAC, Ganz PA, Heinrich RL. Cancer rehabilitation evaluation system - short form (CARES-SF): a cancer specific rehabilitation and quality of life instrument. Cancer 68: 1406–1413, 1991

    Article  PubMed  CAS  Google Scholar 

  • Schag CAC, Ganz PA, Polinsky ML, Fred C, Hirji K, et al. Characteristics of women at risk for psychosocial distress in the year after breast cancer. Journal of Clinical Oncology 11: 783–793, 1993

    PubMed  CAS  Google Scholar 

  • Schag CC, Heinrich RL, Aadland R, Ganz PA. Assessing problems of cancer patients: psychometric properties of the cancer inventory of problem situations. Health Psychology 9: 83–102, 1990

    Article  PubMed  CAS  Google Scholar 

  • Schag CC, Heinrich RL, Ganz PA. Cancer inventory of problem situations: an instrument for assessing cancer patients’ rehabilitation needs. Journal of Psychosocial Oncology 1: 11–24, 1983

    Article  Google Scholar 

  • Schipper H, Clinch J, McMurray A, Levitt M. Measuring the quality of life of cancer patients: the functional living index-cancer: development and validation. Journal of Clinical Oncology 2: 472–483, 1984

    PubMed  CAS  Google Scholar 

  • Schipper H, Levitt M. Measuring quality of life: risks and benefits. Cancer Treatment Reports 69: 1115–1123, 1985

    PubMed  CAS  Google Scholar 

  • Selby PJ, Chapman JAW, Etazadi-Amoli J, Dalley D, Boyd NF. The development of a method for assessing the quality of life of cancer patients. British Journal of Cancer 50: 13–22, 1984

    Article  PubMed  CAS  Google Scholar 

  • Slevin ML, Plant H, Lynch D, et al. Who should measure quality of life, the doctor or the patient? British Journal of Cancer 57: 109–112, 1988

    Article  PubMed  CAS  Google Scholar 

  • Spitzer WO, Dobson AJ, Hall J, et al. Measuring the quality of life of cancer patients. Journal of Chronic Diseases 34: 585–597, 1981

    Article  PubMed  CAS  Google Scholar 

  • Sprangers MA, Cull A, Bjordal K, Groenvold M, Aaronson NK. The European Organization for Research and Treatment of Cancer approach to quality of life assessment: guidelines for developing questionnaire modules. EORTC Study Group on Quality of Life. Quality of Life Research 2: 287–295, 1993

    Article  PubMed  CAS  Google Scholar 

  • Stewart AL, Hays RD, Ware Jr JE. The MOS short-form general health survey. Reliability and validity in a patient population. Medical Care 26: 724–735, 1988

    Article  PubMed  CAS  Google Scholar 

  • Stewart AL, Ware Jr JE (Eds). Measuring functioning and well-being. The medical outcomes study approach, Duke University Press, Durham, 1992

    Google Scholar 

  • Tchekmedyian NS, Hickman M, Siau J, Greco A, Aisner J. Treatment of cancer anorexia with megestrol acetate: impact on quality of life. Oncology 4(5): 185–192, 1990

    PubMed  CAS  Google Scholar 

  • Ware Jr JE. Conceptualizing disease impact and treatment outcomes. Cancer 53(Suppl.): 2316–2323, 1984

    PubMed  Google Scholar 

  • Ware Jr JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care 30: 473–483, 1992

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ganz, P.A. Quality of Life Measures in Cancer Chemotherapy. Pharmacoeconomics 5, 376–388 (1994). https://doi.org/10.2165/00019053-199405050-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-199405050-00004

Keywords

Navigation