Quality of life: philosophical question or clinical reality?

Conclusions: Today we are in a better position to treat patients with palliative chemotherapy with minimisation of side effects than ever before. The use of effective modern single agents for palliative chemotherapy, which cause less side effects, together with symptom control with drugs such as ondansetron or granisetron, which reduce nausea and vomiting, allows doctors to offer patients a chance of benefit with minimal cost and maintain a hopeful outlook. Quality of life studies comparing modern single agent therapy with combination chemotherapy in advanced cancers are now needed. Research into quality of life cannot compete for the spotlight with treatment designed to improve survival, and indeed it would be inappropriate for it to do so. However, the current reality is that most advanced cancers are treated with palliative intent and quality of life issues are of primary concern. The quality of symptom control, the use of the least toxic effective chemotherapy, possibly going back to single agents in many cases, may significantly reduce the physical effects of cancer and its treatment. In addition doctors can contribute substantially to emotional support by understanding the patient's need for information thereby giving them back a sense of control while not removing all hope.