Measuring Quality of Life

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Many instruments are available for measuring quality of life in clinical trials. These can be divided into general and disease-specific instruments. Commonly used general instruments include the SF-36 (10), the Sickness Impact Profile (11), and the SCL-90-R (12). Each of these instruments includes general questions relating to a patient's health and functioning, and they can be applied in a wide range of disease settings. A list of cancer-specific instruments is provided in Table 1.

The goal of each instrument is to measure overall quality of life and various quality-of-life domains, such as physical functioning, social functioning, and mental health. Other domains include disease symptoms, pain, general health perceptions, vitality, and role functioning. Quality-of-life instruments usually include several individual questions, or items pertaining to a particular domain, and the domain score (also called scale score) is obtained by summarizing the responses from the associated items (e.g., average of the item responses). Each

Table 1 Cancer-Specific Quality-of-Life Measurement Instruments

Instrument and reference

Number of Items

Domains assessed

Breast Cancer Chemotherapy Ques- 30 tionnaire (BCQ) (43)

Cancer Rehabilitation Evaluation 93-132 System (CARES) (44)

European Organization for Research 42 and Treatment of Cancer scale (EORTC: QLQ-C30) (45)

Functional Assessment of Cancer 36-40 Therapy (FACT) (46)

Functional Living Index—Cancer 22

International Breast Cancer Study 10

Group Quality of Life Questionnaire (IBCSG-QL) (48) Linear Analogue Self-Assessment 25

Attractiveness, fatigue, physical symptoms, inconvenience, emotional, hope, social support Physical, psychosocial, medical interaction, marital, sexual, symptom- and treatment-specific items Five functional scales (physical, role, cognitive, emotional, social), three symptom scales (fatigue, pain, nausea), disease-specific items, global quality of life Physical, social/family, relationship with doctor, emotional, functional, well-being, disease-specific items Psychological, social, disease symptoms, global well-being, treatment and disease issues, physical functioning Physical well-being, mood, fatigue, appetite, coping, social support, symptoms, overall health Physical, psychological, social

Physical activity, daily living, health perceptions, psychological, social support, outlook on life instrument has its own rules regarding the computation of the domain scores, and these rules are established after careful testing. Each item is generally measured on a Likert scale or a linear analogue self-assessment (LASA) scale. The Likert scale is an ordered categorical scale consisting of a limited choice of clearly defined responses. The most frequently used scales have either four or five categories. In contrast, the LASA scale is an unmarked line, usually 10 cm long, with text at either end describing the extremes of the scale. Each patient is asked to place a mark on the line in a position that best reflects his or her response relative to the two labeled extreme points.

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