What value is given to quality of life assessment by health professionals considering response to palliative chemotherapy for advanced cancer?
Article Abstract:
When clinical researchers are studying the effectiveness of cancer treatments, the results are usually assessed according to the toxicity of treatment, the response of the tumor, the performance status of the patient (which is a measure of the patient's physical activity), and the patient's survival. Since the patient's survival can only be known in retrospect, only the first three measures are of value in the ongoing process of determining treatment for a patient. In recent years it has become more common for clinicians to consider the patient's quality of life. Much controversy has arisen over how the quality of life might be evaluated objectively, but it is generally agreed that the arbitrary lengthening of survival should be balanced against some measure of the quality of the extra time achieved. Such considerations are most important for palliative treatment. Palliative treatment is administered to ease the symptoms of cancer among patients for whom cure or prolonged remission is not possible. To determine how health professionals view the assessment of quality of life, results from a questionnaire were tabulated. These questionnaires were answered by 392 general practitioners, 130 oncology nurses, and 20 oncologists. Quality of life appeared to be a more important assessment criterion among nurses than among physicians; doctors tended to view quality of life assessments on an equal par with the other measures of cancer treatment. The questionnaire included a hypothetical patient scenario, and the answers given indicated that the majority of respondents consider quality of life as an independent factor to be weighed in the process of deciding whether to continue or stop cancer treatment. A curious result uncovered by the study was that the oncologists were less inclined to continue chemotherapy than were either the general practitioners or the oncology nurses. The present study did not evaluate whether the responses to the hypothetical example reflected the actual practices of the physicians and nurses. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1991
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Correlation between bromodeoxyuridine-labeling indices and patient prognosis in cerebral astrocytic tumors of adults
Article Abstract:
Bromodeoxyuridine (BUdR) is a synthetic compound similar in molecular structure to thymidine, which is incorporated into the structure of DNA. Unlike thymidine, however, the uniqueness of BUdR allows its presence to be demonstrated in the completed DNA chain. In tissue sections, it is possible to specifically label the cells containing BUdR; since only cells that were actively synthesizing DNA will incorporate BUdR into their structure, the stained cells represent cells that are dividing. This method has been used to investigate the proliferation of tumor cells within brain tumors. Gliomas are brain tumors that range from the more benign astrocytoma to the malignant glioblastoma multiforme. The authors attempted to use the BUdR labelling technique to investigate the cell proliferation activity in 50 patients with gliomas. Two to three hours prior to the surgical removal of their tumor, each patient received an injection of BUdR. The brain tumor specimens labelled with BUdR were then processed for tissue examination. The authors identified the brain tumors as 10 differentiated astrocytomas, 12 anaplastic astrocytomas, and 28 glioblastomas. The ratio of labelled cells in a specimen to total cells, the so-called labelling index, ranged from 0 to 19 percent, and was correlated with survival. Of 13 patients with a labelling index of less than 3 percent, 9 have not suffered recurrence after a median of 3 years of follow-up. Conversely, among the 23 patients with a labelling index of more than 5 percent, the median recurrence-free period was 9 months, and no patient survived longer than 2 years. The authors suggest that the labelling of cells with BUdR may prove to be a useful prognostic indicator. The labelling of the cells with BUdR was also found to be strongly associated with the type of glioma, which is already well established as an important factor in prognosis. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1991
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Low-grade cerebral astrocytomas: survival and quality of life after radiation therapy
Article Abstract:
It is difficult to gain a clear picture of the management of low-grade astrocytomas from the medical literature. These brain tumors may occur in many different parts of the brain, yet the survival of patients with tumors in ominous locations is often statistically lumped with that of patients with tumors in more auspicious regions. Some studies do not provide details on the physical extent of radiotherapy, and most studies fail to make mention of the quality of life of the patient after treatment. In addition, major changes are taking place in the radiotherapy of brain tumors; larger doses of more energetic radiation are now being focused on the offending brain cells. In the early 1970s, doses rarely exceeded 4,000 cGy, while today doses from 5,000 to 6,000 cGy are standard (a Gy, or Gary, is 1 joule of energy absorbed per kilogram of tissue). To review the effects that modern treatment has had on both survival and quality of life, the cases of 77 patients with low-grade astrocytomas were reviewed. The patients selected for this study had tumors located above the brainstem; tumors in the brainstem, an area which controls breathing and heart rate, have always been particularly ominous. Overall survival among the patients was 71, 55, and 43 percent at 2, 5, and 10 years, respectively. Twenty-five of the 77 patients were children; unfortunately mental retardation was a side effect of treatment in half. However, a full 67 percent of the survivors experienced no neurological or intellectual impairment. The best chances for survival were seen among patients who were female, under 50 years of age, had seizures, and had only one brain lobe involved. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1990
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