Quality of Life

Patient’s evaluation of quality of life  Provides understanding of impact of illness from patient’s viewpoint –Different from health status or physical functioning –Quality of life can be good even with physical disability –More than health problems, loss of abilities, or functional deficits  Incorporation of patient’s values sets QOL assessment apart from measures of health status

Patient’s evaluation of quality of life  Important tool for understanding individual differences in response to illness –Individual responses in adapting to cancer and treatment –Re-evaluation of life in context of life-threatening disease  Ultimate purpose for QOL assessment  Enhanced well-being –Particularly in palliative care and at end of life (interventions aimed at providing comfort and emotional support) –Maximize QOL

Ferrans Model of QOL (1985 & 1990) Scope of the Concept Social and Economic Domain Psychological/ Spiritual Domain Quality of Life Health and Functioning Domain Family Domain

Ferrans & Powers Quality of Life Index Part 1: SATISFACTION with various aspects of life Part 2: IMPORTANCE of those same aspects of life Scores reflect satisfaction with the aspects of life that are valued by the individual. Five Scores –Overall QOL –Health and functioning –Psychological/spiritual –Social and economic –Family

Ferrans & Powers Quality of Life Index  Published first in 1985 (200+ published studies)  International research (30+ countries) –Americas : USA, Canada, Mexico, Brazil, Chile –Europe: Denmark, France, Great Britain, Hungarian, Italy, Lithuania, Norway, Poland, Portugal, Romania, Russia, Spain, Sweden –Middle East: Israel, Jordan, Turkey –Africa: South Africa –Asia: India, China, Korea, Japan, Thailand, Taiwan –Australia and New Zealand  U.S. cross-cultural research –African Americans –Mexican Americans –Korean Americans

21 Languages  Arabic  Chinese  Danish  English  French  Hebrew  Hungarian  Italian  Japanese  Korean  Lithuanian  Norwegian  Polish  Portuguese  Romanian  Russian  Spanish  Swedish  Tamil  Thai  Turkish

Ferrans & Powers Quality of Life Index -- Prognostic value in 251 breast cancer patients (p =.0006)

Quality of Life of African American Cancer Survivors

Quality of Life of African American Cancer Survivors NIH R01 CA89418 (CALGB )  Survivors: 500 African American cancer survivors –Breast, prostate, colon –Currently free of cancer  Controls: 500 African American non-cancer controls –Selected via random digit dialing from the areas in which the cancer survivors reside. –Matched (as a group) to the survivor group on age, gender, health insurance status, and education level

16 Participating CALGB Institutions  Heme/Onc Associates of Central NY  Northern Indiana  Ohio State University  University of Chicago  University of Illinois at Chicago  Wake Forest  Walter Reed  Washington University – St. Louis  Hartford Hospital  Jersey Shore Medical Center  Navy Medical Center – San Diego  Queens Hospital Medical Center  Roswell Park Cancer Center  Sibley Memorial Hospital  Wayne Memorial Hospital - SCCC  Jesse Brown VA Medical Center

Distribution of Participating Institutions

Explaining the Variance in Quality of Life 26% 22% 19% 9% 8% 5% 3% 2%.4%.2% Model explained 66% of variance in QOL