QUALITY OF LIFE in a Patient with Cancer

Developments in cancer science and treatment innovations in recent years have been breathtaking. New chemotherapy drugs, targeted smart drugs developed over the past twenty years, immunotherapy and advances in radiotherapy technology enable two out of every 3 patients with cancer to recover from their disease. Of course, these treatments have side effects, and some of our patients lose their lives because treatment is insufficient.

Our view of cancer treatment strategy has also changed in recent years alongside scientific innovation. The classical goals of achieving a cure and providing supportive treatments have broadened into a modern perspective encompassing prevention, early diagnosis, cure, prolonging survival and improving quality of life. So, what is quality of life? What should patients and relatives understand by it, and what should they request from healthcare professionals? Let us examine this together.

One of the first physicians to define quality of life in medicine was Alexis Carrel. In the first half of the 20th century, Nobel laureate Dr. Carel (1873-1944), considered the father of vascular surgery and therefore organ transplantation, left a major mark on medicine with his statement: “Quality of life is more important than life itself.”

How Is Quality of Life Defined in Patients with Cancer?

Quality of life is an individual concept. Although difficult definitions describe how individuals perceive their situation within their own culture and values, the definition for patients with cancer should actually be simpler and more understandable.

For patients with cancer, quality of life is defined as the patient’s perception of physical, psychological and social well-being. Methods developed over the years have attempted to standardize this seemingly difficult-to-measure concept.

Can patients’ quality of life be scored and measured?

Physical well-being is more easily measured by physicians. Known as Karnofski and ECOG performance assessments, these measures are extremely important in clinical trials, and we oncologists also assess and record them in patients’ files at every visit in daily practice.

Quality of life can be measured through complex international QLQ C30 and FACD-G scales or through simple methods called visual analog scales, which can be taught to patients. If patients learn this measurement method, called the VAS scale, it can guide physicians about the disease and treatment process during follow-up. As shown below, patients are asked to rate their quality of life over the last 1 week, with 0 being the worst and 10 the best. They are asked to consider physical, psychological and social well-being holistically.

What affects quality of life in a patient with cancer?

Quality of life may already be impaired before cancer is diagnosed: cancer-related symptoms adversely affect daily life, prompting a medical consultation and cancer diagnosis. Diagnosis and treatment then begin. Even without serious disease-related complaints, almost every patient or relative has already begun worrying about death and suffering

Cancer itself affects quality of life, and the treatment process also has effects that impair it

In recent years, the FDA (American drug agency) and ASCO (American Society of Clinical Oncology) have required quality-of-life measurements in studies developing cancer drugs and treatment strategies. A drug’s contribution to survival alone is no longer considered scientifically sufficient; it must also be shown to improve quality of life while prolonging life.

For these reasons, when planning treatment, we physicians consider its contribution to quality of life as well as its effectiveness.

Let us look together at cancer- and treatment-related factors affecting quality of life

1. Physical problems: Pain comes first. Other problems include poor appetite, weight loss, bodily edema, fatigue, nausea and vomiting, constipation, problems from loss of limb or organ function—such as a hole in the throat and speech difficulties after laryngeal cancer surgery—and sexual dysfunction. Sexual problems may be physical or psychological, but they are often neglected by healthcare professionals and can impair patients’ and families’ quality of life.
2. Psychological problems: These arise from the moment of cancer diagnosis and vary in form and severity between individuals. They include anxiety, mild depressive disorder, inability to accept the diagnosis, excessive resignation (“I will die anyway”), and severe depressive disorder . Physical problems caused by cancer itself or treatment can also cause psychological difficulties, such as hair loss or living with an opening in the throat...
3. Social problems: People may face inadequate access to social interaction and entertainment that bring enjoyment to life. Sharing the burden of illness and its consequences with family and friends may itself become a social problem. Physical and psychological difficulties inevitably affect occupational, economic, social and family life.
   
   Social disruption from physical and psychological limitations can further worsen mental health, while occupational problems can affect other quality-of-life indicators. This vicious circle must be broken somewhere. Reviewing factors affecting quality of life in cancer shows that they are all interconnected. This reminds us of the importance of a holistic approach requiring a good team for the patient with cancer.

Can quality of life be more important than life itself?

Cancer is among the leading causes of death in many countries. Although substantially treatable and preventable, it is a serious disease that is difficult to treat. Its impact on quality of life is correspondingly high. Cancer is one of the disease groups most extensively studied for its quality-of-life effects. Discomfort caused by the illness and treatment side effects adversely affects quality of life and makes treatment adherence difficult.

During illness, a person may struggle with such problems and experience such impaired quality of life that living becomes unbearable. At this point, we can clearly say that in a serious disease such as cancer—even though concern about survival is always present— quality of life can become more important than life itself .

To improve quality of life after a cancer diagnosis, alongside treatment directed at the cancer itself, the development of palliative care and home-care services, together with education and awareness for patients and relatives, is extremely important.

Palliative care is fundamentally an approach that helps people feel better, distinct from treatment directed at the disease. Its purpose is to make life livable and preserve quality of life under existing circumstances, addressing all problems affecting it. In countries with developed palliative care services, specialists shoulder this responsibility and also consider relatives’ needs.

A plan to improve a cancer patient’s quality of life should be based on this principle

"Not adding years to life, but adding life to years". This has, in fact, become a palliative care slogan.

To achieve quality of life, which can become more important than life itself for a patient with cancer, the problems impairing it must first be thoroughly identified. The healthcare team’s questioning and investigative approach is important, as is the ability of patients and relatives to express their situation adequately.

In our country, increasing importance is being placed on quality of life in cancer and other serious diseases. We wish you a life as healthy and fulfilling as possible.