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Clinicians' Assessment Of Quality Of Life (QOL) In Outpatients With Advanced Cancer: How Accurate Is Our Prediction? A Hoosier Oncology Group Study

Heather Jones, MD

University of Pennsylvania Cancer
Last Modified: May 14, 2001

Presenter: Michael L. Titzer
Affiliation: Indiana University Cancer Center and the Walther Cancer Institute, Indianapolis, IN

Background:

Cancer and its related symptoms, such as depression and fatigue, can have substantial impact on a cancer patient's quality of life (QOL). Studies indicate that QOL can be and important prognostic factor. QOL has had increasing emphasis in oncology trials. This study evaluates the accuracy with which clinicians can predict the QOL presently experienced by their patients.

Materials and Methods:

• Prospective trial of 163 patients with advanced cancer and a life expectancy of 3 to 24 months.
• Clinicians were asked to rate impairment in QOL as mild, moderate, or severe.
• This estimate of QOL was compared with the patients' actual score on a standardized QOL assessment (FACT-G), with cutoffs used to define mild, moderate, and severe impairment.
• The clinicians also reported the patients' performance status and estimated the survival time as 3-6, 7-12, 13-18, or 19-24 months.
• The patients completed demographic data, a FACT-G QOL assessment form, and the FACT Spiritual Well-Being (SWB) scale, with a Meaning and Peace factor and a Faith factor.
• Clinician-predicted life expectancy, marital status, education level, and spirituality were compared with the patients' total FACT-G score.

Results:

• There was no relationship between average FACT-G scores and predicted life expectancy, marital status, or education level.
• In contrast, there was a strong association between SWB and FACT-G scores. The total SWB correlated significantly with the total FACT-G (r = .56), with the relationship primarily accounted for by the Meaning and Peace factor (r = .64), rather than the Faith factor (r = .28).
• Overall, physicians predicted the level of QOL correctly (mild, moderate, or severe impairment) in 54%, and nurses in 60% of cases.
• 61% of the clinicians predicted a better QOL than measured by FACT-G.

Authors' Conclusions

• These findings suggest that clinicians' ability to predict measured levels of QOL is limited.
• QOL does not appear to be significantly influenced by predicted life expectancy, marital status, or level of education.
• However, spiritual well-being, in particular maintaining a sense of inner meaning and peace, is strongly associated with QOL.

Clinical/Scientific Implications:

Several studies have demonstrated this discordance between patients and treating physician in QOL scores. This study again highlights this finding. The take home message here is that when it comes to QOL, the medical community should allow our patients to tell us how they are doing. Thus, we should measure QOL at baseline in all patients, and measure it often during treatment.