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Measuring the Quality of Life of Patients with Cancer
HRQoL. This trial compared WBRT with observation following either
surgery or radiosurgery of a limited number of brain metastases in
patients with stable solid tumours. Patients who received WBRT
reported lower scores for global health status, physical/cognitive
functioning and fatigue, and showed that WBRT following surgery or
radiosurgery of a limited number of brain metastases may negatively
impact HRQoL; observation with close monitoring by MRI instead of
WBRT did not harm HRQoL. 4
Patient-reported Outcomes versus Proxy
Assessment – HRQoL Research in a Novel Area
Assessing HRQoL in patients with brain tumours is challenging. As
one would imagine, a commonly reported symptom of patients with
gliomas is cognitive deficits, and these also hamper adequate reporting
of HRQoL by the patient. Exclusion of patients with cognitive deficits
from analysis obviously leads to underreporting of such problems as
concentration, memory, reading/writing, … in the evaluation of HRQoL
during experimental treatment.
In EORTC trial 26091, a currently open trial assessing the significance
of bevacizumab in recurrent grade II and grade III gliomas, two EORTC
HRQoL instruments are being used to assess patient QoL through their
caregivers or relatives (proxies). The assessments reported by the
patients will then be compared with those reported by their proxies.
It would be interesting to find out if the proxies can represent patient
views and to what extend the two are in agreement. If proxies have a
different perspective, the next question would be which reports the
more accurate information.
Meta-analysis of HRQoL data has been proven clinically informative and,
despite the challenges of funding HRQoL research and the complexities
of pooling data together, EORTC supports the development the new
methods of electronic assessment of PROs and storage in the central
EORTC database. Such efforts increase the volume of HRQoL dataset and
stimulate numerous efficiency comparisons that can inform clinicians,
policy makers, health care payers, etc.
A further development that EORTC is pursuing is the use of HRQoL
data collection via computer systems instead of the classic paper
questionnaires. Such electronic systems would have several
advantages, both for the patient (automatic language selection,
adaptive display format …) as well as the researchers (automatic
data transfer, real-time updates on compliance …). In order to have a
machine-independent system, EORTC is developing an online version
that will run in all common web-browsers and does not require any
local software installation. Once validated, this can be extended to
handheld devices and to introduce the questionnaires that can be
adapted according to the clinical status of the patient or tailored to his/
her previous answers.
About the EORTC
The EORTC brings together European cancer clinical research experts
from all disciplines for trans-national collaboration.
Both multinational and multidisciplinary, the EORTC Network comprises
more than 2,000 collaborators from all disciplines involved in cancer
treatment and research in more than 300 hospitals in over 30 countries.
Through translational and clinical research, the EORTC offers an
The patient’s perspective has consistently been considered important in
palliative and curative EORTC trials, and recent findings have altered clinical
practice and provide data needed to support major recommendations
and future improvements. Clinicians, regulatory bodies and industry
representatives acknowledge the value of the patient perspective, and
the EORTC will continue to include HRQoL endpoints where appropriate.
integrated approach to drug development, drug-evaluation programmes
and medical practices.
EORTC Headquarters, a unique pan-European independent clinical
research infrastructure, is based in Brussels, Belgium, from where its
various activities are coordinated and run (visit www.eortc.org). n
1. Quinten C, Coens C, Mauer M, et al., Baseline quality of life as a prognostic indicator of survival: a meta-analysis of individual patient data from EORTC clinical trials, Lancet Oncol, 2009;10(9):865–71.
2. Eggermont AM, Suciu S, Santinami M, et al., Adjuvant therapy with pegylated interferon alfa-2b versus observation alone in resected stage III melanoma: final results of EORTC 18991, a randomised phase III
trial, Lancet, 2008;372(9633):117–26.
3. Bottomley A, Coens C, Suciu S, et al., Adjuvant therapy with pegylated interferon alfa-2b versus observation in resected stage III melanoma: a phase III randomized controlled trial of health-related quality of
life and symptoms by the European Organisation for Research and Treatment of Cancer Melanoma Group, J Clin Oncol, 2009;27(18):2916–23.
4. Soffietti R, Kocher M, Abacioglu UM, et al., A European Organisation for Research and Treatment of Cancer phase III trial of adjuvant whole-brain radiotherapy versus observation in patients with one to three
brain metastases from solid tumors after surgical resection or radiosurgery: quality-of-life results, J Clin Oncol, 2013;31(1):65–72.
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