gms | German Medical Science

27. Deutscher Krebskongress

Deutsche Krebsgesellschaft e. V.

22. - 26.03.2006, Berlin

Quality of Life assessment in oncology - what's the real benefit for the patient?

Meeting Abstract

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27. Deutscher Krebskongress. Berlin, 22.-26.03.2006. Düsseldorf, Köln: German Medical Science; 2006. DocIS065

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Veröffentlicht: 20. März 2006

© 2006 Küchler.
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Despite significant progress long-term survival is still disappointing for many tumor sites. Hence there is more than just academic interest in the contribution of quality-of-life-research in modern oncology.

About 1990 “Quality of Life” (QoL) emerged as a new outcome parameter in (german) oncology. The interest in this new concept was directly related to the development of reliable and valid instruments to assess QoL. Since than the sheer number of publications exploded: from 1995 to 2005 about 55.000 QoL-publications can be found, 17.000 of these in the area of oncology. Even limitating the search to “major topics” brings up about 4.200 papers, further down to clinical trials 671, about half of it RCT’s. At the same time there are almost no significant trials with QoL as a primary endpoint. Hence it is not astonishing, that a direct impact of QoL-based results on treatment regimens is difficult to detect.

Do we have to state, that QoL-research became a selfenergizing field of producing data in abundance, leading just to more research but to no real benefit for the patient? Such a rather pessimistic view can be enhanced looking at german guidelines: there is almost no guideline that doesn’t mention QoL, but the statements are typically vague and nonpractical: ”Da (hier) kein kurativer Ansatz zur Verfügung steht sollte sich die Therapie an der Lebensqualität der Patienten orientieren”. Compared to 10 years ago this looks like a progress that might satisfy the ‘QoL-community’, but is it a real benefit for the patient? Aaronson (2005) taperecorded the communication between oncologists and patients on palliative chemotherapy and showed that QoL had very little impact on treatment decisions such as modification or discontinuation of therapy.

But there is an other, a bit more optimistic view on the role of QoL in oncology: first there is enough evidence that incorporating QoL aspects no matter how (in doctor-patient-communication, by using interviews or most commonly QoL questionnaires) improves QoL of cancer patients, at least the emotional components. Second there is a slow but certain shift of acceptance in many oncologists regarding the significance of QoL of their patients. This trend can at least be described as a significant change of “atmosphere”, with impact for the patient. And last: the more we learn, that QoL itself is predictive for survival in some cancer sites the more it will become a serious target in oncological research as in daily practice.