Quality of life in cancer trials.

Quality of life in cancer trialsLove, beauty, and happiness have eluded measurement.The quality of life may be equally elusive, but attempts to measure it are certainly in fashion.Indeed, in the manage- ment of patients with cancer the quality of the person's life before, during, and after treatment is now recognised as an important factor in the costs and benefits equation.When the benefits are likely to be high, with a probability of "cure," high costs in terms of temporary or even permanent morbidity are willingly accepted.Patients under- stand that the quality of their life may be changed by the treatment but will do their best to cope with the changes because they accept that they are a necessary part of a "curative" procedure.But many treatments for cancer are only palliative from the outset.The condition may be advanced or not amenable to treatment.With palliative treatments the quality of the patient's life weighs more heavily in the costs side of the equation because the benefits are smaller.The length of survival is frequently taken as a measure of success in palliative treatment, but it is an unsatisfactory index.Survival for a few extra months is of no great benefit if there is no capacity to enjoy the time or if the patient suffers pain, loss of purpose, dependence, and despair.But palliative treatments are much needed to relieve distressing symptoms and to comply with patients' and relatives' wishes "for something to be done."Such treatments may control symptoms for many years and achieve considerable success in prolonging reasonable and valued lives.Another factor that comes into the equation is the need to evaluate new treatments and new agents, for it is from trials of new drugs and new combinations of drugs that progress has been made in cancer chemotherapy and curative treatments developed.Any evaluation of palliative treatments, especially when used in clinical trials, should always include an assessment of the side effects and of the general effects on the patient's life.If two treatments prove equally effective the one causing the less upset to the patient's life would normally be preferred.Ideally, the assessment of these effects on quality of life should be based on objective or at least quantitative measures.