Annals of Oncology Advance Access originally published online on May 12, 2005
Annals of Oncology 2005 16(6):991; doi:10.1093/annonc/mdi172
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© 2005 European Society for Medical Oncology
Letter to the Editor |
Quality of cancer care
The review article by Vardy and Tannock [1
] focuses on the important issues regarding quality of cancer care. The authors stress that ‘quality of cancer care is difficult to define and evaluate’. In our opinion, Drs Vardy and Tannock aim to demonstrate the major elements of high quality cancer care. Most important among them are evidence-based standards of cancer care and delivery of treatment in the right way to a patient. We completely agree with the authors’ definition of high quality cancer care, but we consider that it is important not only to declare it but to show a way to measure it. We consider that quality of cancer care could be measured based on two key indicators: survival and quality of life (QoL). There are common ways to evaluate survival. As for QoL items there is no consensus on how to measure QoL response in cancer care. We proposed an approach to the QoL response paradigm in oncology in 2004 [2]. According to this paradigm QoL response is measured based on the difference between integral QoL indices at baseline and at the end of treatment. The following QoL response grades are defined: complete QoL response; partial QoL response; QoL stabilisation; and QoL worsening. An integral QoL index might be obtained using generic and cancer-specific QoL instruments [3]. It combines the benefits of profile questionnaires that are used in cancer clinical trials and clinical practice [4] and global ratings that can be easily interpreted in terms of improvement or worsening. We have tested the above approach in the following groups of new cancer patients: breast cancer, Hodgkin's disease and non-Hodgkin's lymphoma, and showed its applicability in determining QoL response.
Thus, measurement of survival and QoL response make it possible to provide a comprehensive evaluation of quality of cancer care. The first element of high-quality cancer care according to Vardy and Tannock, use of evidence-based medicine, is to be measured in terms of survival. The second one, delivery of treatment in the right way, correlates with both survival and QoL response. Finally, the last one, but perhaps the most important, treatment of the patient, not just the disease, is measured by QoL response.
In conclusion, treatment of a patient with cancer resting on the elements proposed by Drs Vardy and Tannock, from one side, and evaluation of quality of care in terms of survival and QoL response, from another, is a real way to high-quality cancer care.
New Jersey Center for Quality of Life and Health Outcome Research, 5 Toboggan Ridge Road, Saddle River, NJ 07458, USA
Email: njc4qol{at}aol.com)
References
1. Vardy J, Tannock IF. Quality of cancer care. Ann Oncol 2004; 15: 1001–1006.
2. Novik A. Quality of Life- new criterion of the treatment efficacy in clinical medicine. Bull Multinatl Center Quality Life Res, 2004; 3: 4.
3. Novik A, Ionova T, Kishtovich A. Heterogeneity of new lymphoma patients in terms of quality of life parameters. Blood 2003; 22: 302.
4. Osoba D. Lessons learned from measuring health-related quality of life in oncology. J Clin Oncol 1994; 12: 608–616.[Abstract]
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