Quality of life

In managing any disease problem a key objective is to improve the quality of a patient's survival as well as its duration. Part of the clinical decisionmaking process takes into account quality of life (QoL) in judging the most appropriate treatment.

Defining quality of life precisely is not easy; it has been described as a measure of the difference at a particular time point between the hopes and expectations of the individual and that individual's present experiences. QoL is multifaceted and can only be assessed by the individual since it takes into account many aspects of that individual's life and their current perception of what, for them, is good QoL in their specific circumstances.

A clear distinction exists between performance scores (e.g. Karnofsky or WHO) which record functional status and assess independence; these are assessed by the physician according to pre-set criteria. They have erroneously been considered to be surrogate markers of QoL.

Patient QoL as assessed by the treating physician has been shown to be unreliable in an oncological setting.

There is no single determinant of good QoL. A number of qualities which go to make up QoL are capable of assessment; these include ability to carry on normal physical activities, ability to work, to engage in normal social activities, a sense of general well-being and a perception of health.

Several validated instruments now exist to measure QoL; these mainly involve questionnaires completed by the patient. They are simple to complete and involve 'yes' or 'no' answers to specific questions, answers on a linear analogue scale or the use of 4- or 7- point Likert scales.

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