“I just received the copy of Oncology & Hematology Review in the mail – it looks great!”
Traditionally, end-points in healthcare are assessed through treatment effectiveness outcomes using indicators such as mortality rates and survival indices. However, with the modernisation of health technologies such health outcomes no longer suffice. In many countries, the number of expected lifeyears is increasing. In addition, many treatment programmes have little or no impact on mortality rates. With the World Health Organization (WHO) redefinition of health, which includes social and psychological wellbeing, alternative approaches to measuring health outcomes now include an analysis of the patient’s quality of life (QoL), which is an all-encompassing term connoting the overall wellbeing of a person at a given period of time. Of particular interest is the attainment or maintenance of QoL of an individual who is diagnosed with cancer. What is the overall QoL of Filipino cancer patients? What are the best indicators of QoL among this population? Are there significant differences in terms of age, gender, level of education, civil status, stage of cancer and type of treatment?
Cancer management is one area where clinical decision-making becomes a critical and perplexing activity. Routinely, better response or remission rates and prolonged survival are used as a gauge for cancer treatment effectiveness. However, both the disease and the various care modalities can place tremendous strain on the patient’s social, emotional and physical wellbeing. Pain has been explicated to be the single most important distress variable among cancer patients and impairs a person’s actual and perceived ‘life role’, which consequently has a cumulative negative effect on distress over and above the effects of pain.1 Furthermore, the prevalence of fatigue among patients after cancer treatment was about 61%.2 Other studies indicate a relationship between lung cancer and symptom distress, fatigue and decline in functional status.3 Cancer therapies such as surgery can be mutilating, resulting in physical and psychological trauma. In their study of patients who underwent surgery for oral and pharyngeal cancer, Langius et al.4 found that psychological and physical functioning, sleep, recreation, work, eating and home management were impaired two to four months and 12 months after treatment. Brasilis et al.5 showed that in sexual functioning, continence and hardship, QoL scores of patients with prostate cancer deteriorated 12 months after radical prostatectomy. Studies on women with breast cancer have demonstrated that general psychological distress, marital satisfaction and religious outlook did not differ when mastectomy and was compared with breast conservation, although those who underwent surgical removal rated their body image more poorly.6 Cancer patients experienced a significant increase in fatigue over a five- to sixweek course of radiotherapy.7 Chemotherapy causes considerable toxicity resulting in hair loss, nausea, vomiting, fatigue and emotional problems. Women with breast cancer who underwent chemotherapy had more sexual dysfunction, a poorer body image and more psychological distress than women who underwent hormonal therapy and radiotherapy. Fatigue was also common over 14 days following treatment with chemotherapy.2