It is an important topic, but one that does not get much discussion: the quality of life for terminally ill cancer patients.

Often, the news is about new breakthroughs in treatment or prevention, but the fact remains that 560,000 people will die of cancer this year. And it is the obligation of organizations concerned about the care of cancer patients, such as the American Cancer Society, to stress that attending to a patient's quality of life is no less important than monitoring the course of their disease.

But what concerns most affect a patient's quality of life? Unfortunately, relatively little research has gone into this area. To counter this deficit, researchers at the University of Texas MD Anderson Cancer Center and the University of Texas School of Public Health devised a questionnaire for patients with less than six months to live. They began by asking 74 patients to identify their main concerns. These issues were then ranked according to importance by a second group of 120 patients. Results from the questionnaire will be used to evaluate how well current practices meet the needs of terminally ill cancer patients. A description of the study and its findings were recently published in the American Cancer Society's journal, Cancer Practice.

FINDINGS FROM THE STUDY

In the existential concerns category, respondents said that having a sense of hope, knowing that life has meaning and purpose, and knowing that life has been productive were very important.

Finding strength in their spiritual beliefs and finding comfort in their faith were highly rated in the spiritual concern category. Several patients stressed that spirituality was one of the main keys to coping well with advanced cancer.

An important category was family concerns. Most patients felt it was very important to be appreciated by their family, to say goodbye to the people closest to them, and to be able to express their feelings to their family. When patients and their families failed to address these concerns, the researchers found a significant negative effect on the patients' quality of life.

Physical symptoms were also a concern. Patients with advanced cancer want to know what symptoms they might experience, they want to know their prognosis, and want to be able to talk to their doctor truthfully.

Feeling restless was the most highly rated emotional concern. Patients who are coping with advanced cancer reported that their emotions and thoughts often vary from minute to minute and from day to day.

HOW THIS RESEARCH CAN BE APPLIED

The researchers did draw some clinical conclusions from their study. Among them:

• patients' spiritual, existential, familial, and emotional needs should be considered along with their physical needs.
• healthcare professionals can help patients discuss their concerns openly, which in turn, allows the healthcare professional to provide assistance in those areas.
• specific interventions can be developed based on a patient's response to this questionnaire which can help improve the patient's quality of life.
• the introspective process of filling out a questionnaire can highlight issues for the patient that need to be resolved.
• the wide range of responses to the questionnaire points out that a team approach may best meet the needs of terminally ill cancer patients. Social workers, psychiatrists, chaplains, psychologists, doctors, and nurses are key to the patient's quality of life.

Source: Greisinger AJ, Lorimor RJ, Aday LA, et al. Terminally Ill Cancer Patients: Their Most Important Concerns. Cancer Practice, 1997: 5;3.



Joann Schellenbach
National Director Media Relations
American Cancer Society
212-382-2169
jschelle@cancer.org