The Quality of Life in Cancer Patients

Abstract

Cancer is a disease mainly caused by uncontrolled division of body cells in any part in the human body. Cancer is epidemiologically one of major non communicable disease and considered to be main health issue in the community across the world. In medicine, we are often interested in how disease or its treatment affects quality of life (QOL), which is generally considered health-related quality of life. All cancer patients should be subjected to attain all dimensions of quality of life i.e. Physical, Mental, Social & Functional Health. QOL is not easy to measure but despite this, there are many models and scales available to assess & ensure QOL among cancer patients. Good QOL also ensures more life expectancy among cancer patients and they can live more social & productive life. Maintenance of good QOL must be integral part of all cancer prevention & treatment.

1. Introduction

Cancer is a disease mainly caused by uncontrolled division of body cells in any part in the human body. Normally the cell growth remains under control by the body’s immune system. It is the time, when these cells start dividing uncontrollably, forming lumps or growths, that Cancer is caused. Growths like this are called tumors. There are two types of tumors malignant and benign [1].

2. Burden of cancer

Needless to mention that Non-communicable diseases (NCDs) are now well known leading cause of morbidity and mortality worldwide, accounting for approximately 36 million deaths annually around the world, with a rapidly rising prevalence due to population growth and fast changing socio demographic characteristics including aging of population. Moreover, chronically ill patients often suffer from multiple co- morbidities, which can be defined as the co-occurrence of several chronic conditions within one person & one patient [2].

Cancer is epidemiologically one of major non communicable disease and very rapidly becoming to be main health issue in the community around the world. Around the world, cancer is becoming one of the most common causes for morbidity and mortality. Data from GLOBOCAN year 2012 mentions that around 14.1 million new patients were diagnosed with cancer and approximately 8.2 million deaths occurred due to cancer and it is estimated to rise approximately 70% by the year of 2030 [3].

3. What is quality of life (QOL)?

We all have a rolling question all the time that, what is meant by the phrase “quality of life.” We know that being free is better than being imprisoned, being healthy is better than being sick, and being relaxed is better than being stressed. There are people who choose to live in the city because they give value access to cultural and social offerings. On the other hand some people choose to live in rural areas because they value the slower pace, lack of traffic, and access to nature. These features affect the inherent goodness of our lives, or our wellbeing, referred to in the medical and scientific arenas as quality of life.

In medicine, we are often interested in how disease or its treatment affects quality of life, which is generally considered health-related quality of life. Health-related quality of life, also abbreviated as HRQOL or HRQL, has evolved over the time into a broad, multidimensional concept that includes both physical and mental health, and also includes social factors.

Quality of life information can be used in different ways in medical practice. Decision of Cancer treatment making is one of the major areas in where quality of life considerations are applied in cancer. For example, a patient and his or her physician may be attempting to decide between two treatments that show virtually no differences in survival or other disease-related outcomes. Quality of life over the time has become deciding factor in selecting one treatment over another. Alternatively, patients may also be provided autonomy to choose two different types of cancer treatment based on the expected toxicity, convenience, or other factors that impact quality of life (Table 1).

Treatment decision making	Quality of life considerations can often be important in selecting between two or more treatment options.
Preparing for treatment experience	Information about how treatment affects quality of life can help patients prepare for and help them cope with the treatment experience
Identifying and prioritizing problems	If patients have multiple problems, quality of life reporting may help their providers to identify which are the most significant.
Facilitating communication	Quality of life measures may help patients communicate problems to healthcare providers and help staff focus on concerns that are most important to patients
Screening for hidden problems	Quality of life information can help identify problems such as depression or sexual dysfunction that may otherwise be overlooked.
Facilitating shared clinical decision making	Quality of life measures can identify patient goals, outcomes, and expectations; healthcare providers can address whether treatment is likely to meet patient expectations and discuss discrepancies between probable outcomes and patient expectations
Monitoring changes or responses to treatment	Quality of life information can help determine whether treatment is leading to improvements that are relevant to patients.

Table 1.

Uses for quality of life information/measures in medical practice.

Source: [4].

4. Definition of quality of life

If we talk about root of the QOL concept goes way back to the 1947 World Health Organization (WHO) definition of health as a “state of complete physical, mental and social well-being, and not merely the absence of disease and infirmity [5].

It is not easy to define QOL in single sentence QOL is such a broad domain with lot of subjective perceptions. Many researchers have tried to give one definition of QOL and tried to make it more objective & measurable but neither of definition could explain QOL completely. Nevertheless QOL has been defined by various researchers/organizations differently. Some of the definitions may be accessed by referring the available literature [6].

5. Various dimensions of quality of life

Broadly dimensions of QOL may be explained as Physical, Mental, Social and Functional Health. These dimensions of QOL have certain components so that every dimension may be attained more objectively. Table 2 mentions each dimension of QOL along with their respective components. Every cancer patient should be subjected to attain all these dimensions in all possible manners [6].

Dimensions of QOL	Components
Physical health	Somatic sensations, disease symptoms, treatment side effects/Adverse effetcs
Mental health	May vary from a positive sense of well-being to non-pathological forms of psychological distress to diagnosable psychiatric disorder/disease.
Social health	Quantitative and qualitative aspects of social contacts and interactions with each other & their assessment
Functional health	Physical functioning like self-care, mobility, and physical activity level and social role functioning in relation to family and in relation to working.

Table 2.

Dimension of QOL and their respective components.

Source: [6].

6. Quality of life among cancer patients

Cancer patients tend to experience a variety of signs & symptoms. Inadequate & Improper medical management of these symptoms does hamper the performance of the day today functioning of a cancer patient including disturbed quality of life. Effective management of these symptoms will surely help in relieving the suffering from dreaded cancer and improve the quality of life (QOL) either.

These Symptoms led to major impact on QOL among the patients with breast cancers as well. This high symptom load has always been associated with the more levels of emotional suffering, poor physical & societal functioning and deteriorated QOL. Hence, effective clinical management of these symptoms can improve the QOL in cancer patients [7].

A study from India showed that cancer patients were in the below average category of QOL and the QOL of the cancer patients was influenced by reported symptoms. Very low-level QOL was observed in general, physical, psychological well-being of cancer patients. They were also suffered with below average economic well-being, pain, sleep problems and fatigue.The psychological health was affected by feeling very much depressed and they were not feeling comfortable in attending the social functions [7].

7. Parameters of quality of life

Various literatures have also explained various parameters of QOL. All treating doctors must ensure that patient to attain as many parameters as possible. Following parameters may be considered to ensure and measure quality of life among cancer patients (Table 3) [7].

1. Psychological well-being

2. General well-being

3. Physical well-being

4. Familial relationship

5. Sexual and personal ability

6. Cognitive well-being

7. Optimism and belief

8. Economic well-being

9. Informational support

10. Patient–physician relationship

11. Body image

Table 3.

Parameters for ensure and measure quality of life among cancer patients.

8. Scales for QOL

Health-related quality of life is a subjective state of cancer patients and therefore must be reported or rated by individuals (patients) themselves. This QOL rating is usually done using a questionnaire. Individuals are asked to answer one or more questions in a variety of areas that include physical, emotional, and social health [8].

Physical Health: Physical functioning, satisfaction with physical ability, mobility, pain effects, pain severity, role limitations due to physical health.

Mental Health: Psychological distress (anxiety and depression), psychological well-being (positive affect and feelings of belonging), cognitive functioning, role limitations due to emotional problems.

General Health: Energy/fatigue, sleep problems, psychophysiologic symptoms, social functioning, role functioning (e.g., unable to work), current health perceptions, and health distress.

Some of the scales are also available to measure the QOL among cancer patients as mentioned below [8]:

1. Functional Assessment of Cancer Therapy (FACT) scale for breast cancer (FACT-B)

2. Memorial Symptom Assessment Scale (MSAS)

3. European Quality of Life-5D (EQ-5D)

4. Kornblith Fear of Recurrence Scale

5. Decision-Making and Risk-Benefit Evaluation

9. Models of quality of life

Various models have also been suggested for assessment of QOL among patients including cancer patients. Following are the various models of QOL:

1. Dijkers’s model of quality of life and its evaluation (Figure 1)

2. Wilson and Cleary model of quality of life (Figure 2)

3. PROMIS conceptual model (Table 4)

4. Function-Neutral Health-Related Quality of Life Measure (Table 5)

Figure 1.

Source: [9].

Figure 2.

Source: [10].

	Physical Health	Mental Health	Social Health
PROMIS Profile domains	Physical health; Pain intensity; Pain interference; Fatigue; Sleep disturbance	Depression; Anxiety	Ability to participate in social role and responsibilities
PROMIS Additional domains	Pain behavior; Pain quality; Sleep related impairment; Sexual functions; Gastro intestinal symptoms; Dyspnea	Anger; Cognitive functions; Alcohol use, consequences, expectancies; Psychosocial illness impact; Self-efficacy; Smoking	Satisfaction with social roles & activities; Social support; Social isolation; Companionship

Table 4.

PROMIS conceptual model.

Source: [11].

Health Related Quality of Life				Ancillary
Physical health	Mental health	Social health	Life satisfaction/Belief	Environment
Energy/fatigue; Stamina; Pain; Sick /well; Rest	Distress; Affect/mood; Memory; Decision making; Emotional regulation	Civic engagement; Social engagement; Relationship; Intimacy; Oppression/discrimination	Livings ones values; Meaning of life; Life satisfaction; Recreation; Meaningful activities	Safety & security; Access to service & transportation; Public policies; Societal attitudes; Air /water/climate

Table 5.

Function-neutral health-related quality of life measure.

Source: Krahn et al. [12]

10. Impact of screening of Cancer disease & QOL of cancer patients

Screening will ensure early diagnosis among cancer patients. Early diagnosis and treatment gives sense of confidence among cancer patients that they may either be cured or if not, may have good survival probability. This all psychological effects of screening will surely add in to QOL of cancer patients [1].

11. Impact of QOL on life expectancy of various cancers

Different cancers have all range of life expectancies, some of them are having very good life expectancy and some are having very less. This life expectancy is always influenced by the quality of life a cancer patient live after getting diagnosed and when on treatment. Cancer treating medical professional must never forget role of QOL in survival of cancer patients. Maintenance of good QOL should be integral part of prevention and control on all cancers. Good quality of life among cancer patients will also have an impact on DALYs (Disability adjusted life years) and this reduction of morbidity will provide opportunity to cancer patients for their social and vocational rehabilitation. This will also ensure to live most productive life among cancer patients [7].

12. QOL improvement among cancer patients

Cancer patients tend to experience array of signs & symptoms which can affect their QOL. The Medical & clinical management of cancer pain is one of most critical & priority issue in the care & effective treatment of patients with cancer. All health & medical professionals must make sure that all cancer patients must receive education and care adequately & well on time. There is always a felt need to develop measures & policies for effective management of sign & symptoms in a bid to improve the QOL among cancer patients. Predominant issues for cancer patient’s management are the adequate & effective management of symptoms and embark on policies & strategies that will empower the cancer patients to have a better sense of control & wisdom over their illness and treatment [7].

13. Conclusion

1. Cancer is one rapidly rising non communicable disease worldwide. Cancer is not only affecting patients physically but also affecting psychological, mental & social health of patients. Cumulatively, it will impact upon the quality of life of patients.

2. There are various dimensions and models of QOL which may be followed to ensure & measure QOL among patients.

3. QOL is not easy to measure, despite this many researchers have coined the definition of QOL and certain scales are also available to measure the QOL more objectively.

4. Cancer treating medical professionals must also consider this aspect of QOL along with curative treatment of cancer patients.