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04.03.2020:  MEASURING QUALITY OF LIFE

Quality of life (QOL) consists of a number of domains such as physical, functioning, psychological and social. These domains start early on from diagnosis, primary therapy and continue during the post-treatment and follow-up period.
Objective tumor response, disease free survival and overall survival, traditionally have been used to evaluate cancer treatment outcome. However, over the past decades, the value of the patient’s well-being was recognized as a very important issue in cancer outcome. This included not only the physical and functional status of the cancer patients but also the psychological and social as well. All these consisted the Quality of Life.


Measurement of Quality of life
Many efforts have been undertaken to measure the Quality of life. Several instruments have been developed and currently are being used in clinical trials(1). All these instruments assess the Quality of life of cancer patients in order to compare the effect of the disease and its treatment to those of people with other chronic illnesses or even healthy individuals. Also to evaluate this disease and its treatment effects in time intervals and to intervene accordingly.  


List of QoL instruments
Here are some of the used instruments
- Beck Depression Inventory (BDI)
- The Breast Cancer Chemotherapy Questionnaire (BCQ)
- Breast Cancer Prevention Trial Symptom Checklist (BCPT)
- Cancer Needs Questionnaire – Short Form (CNQ-SF)
- Cancer Rehabilitation Evaluation System – Short Form (CARES-SF)
- Center for Epidemiologic Studies Depression Scale-10 (CES-D)
- Edmonton Symptom Assessment System (ESAS)
- European Organization for Research and Treatment of Cancer QOL Cancer Specific Version (EORTC QLQ-C30)
- European Organization for Research and Treatment of Cancer QOL Breast Cancer Specific Version (EORTC QLQ-BR23)
- Functional Assessment of Cancer Therapy – Breast Symptom Index (FACT-B – FBSI)
- Functional Assessment of Cancer Therapy – Endocrine  Symptom Subscale (FACT-ES)
- Functional Living Index - Cancer (FLIC)
- Geriatric Depression Scale – Short Form (GDS-SF)
- Hospital Anxiety and Depression Scale (HADS)
- Life Satisfaction Questionnaire (LSQ)
- Medical Outcome Study’s 36-Item Short Form Health Survey (SF-36)
- Rotterdam Symptoms Checklist (RSCL) – Modified
- Satisfaction with Life Domains Scale for Breast Cancer (SLDS-BC)
- Spitzer Quality of Life Index (QL-Index)
- World Health Organization Quality of Life – Brief Version (WHOQOL-BREF)
- Zung Self-Rating Depression Scale (SDS)
Barriers in QoL measurements
Although, measuring quality of life is a very important step in the desirable communication between doctor and patients, it must be accepted that several barriers exist.
The QoL assessment is a common component of clinical trials but it is questionable this is implicated in daily clinical practice where time is very much limited.
There are patients unwilling to talk openly about their disease and treatment and in particular, psychological problems.
Most of the answers given by the cancer patients are retrospective and do not represent real – time problems 
Language and reading barriers.
Physicians and cancer patients have often different priorities about treatment outcome and QoL.
Compliance in the elderly population is limited.
Staff and financial limitation.
Compliance of cancer patients with poor or deteriorating health is limited.
Fewer than 50% of doctors implement QoL assessments in their practice.
In a common practice, physicians usually ask questions regarding basic side effects of the treatment and look at the lab tests for the evaluation of cancer status (X-Rays, PSA, etc). Several manifestations that took place between the clinic visits are missed or overlooked.
The time interval between the clinic visits is often long and in between communication difficult. Therefore, intervention results are many times not evaluated.

IMPROVING QUALITY OF LIFE
Quality of life assessment in cancer patients means information and analysis of disease and treatment effect on these individuals.
The overall benefit for the patients is the preventive intervention by the treating physician.
The benefit of QoL assessment in clinical trials has been proven and is a well-accepted end-point in cancer treatment.
The implication of QoL analysis during standard clinical practice is questionable due to the previous mentioned barriers. In addition, the traditional collection of printed self-reported responses, which enter databases manually, introduce many errors, besides the cost and personnel.
Certainly, there is room for improvement with recent technology. Computerized QoL assessment may provide more accurate, on time data which can be stored immediately. 
It takes less time to complete the questionnaire, anytime, anywhere without cost, with better quality of data, with fewer errors.
What is important for the QoL assessment is to easily implemented into the routine clinical practice. The busy physician having his patient in front of him or her with all responses of the questionnaire already in the screen is able to effectively intervene to improve QoL. 
Psycological distress, sexual dysfunction, Employability, Fertility issues, maternity problems will be paid attention in breast cancer patients which otherwised will be overlooked(2). 
Similarly, in prostate cancer patients, mental problems, sexual dysfunction, psychological distress, hormonal symptoms, skeletal related events, urinary, problems will be paid more attention and better solution(3).
Just to proceed a step further, collecting all these information, a big data can be formed and through machine learning, effective algorithm intervention can be implicated through Artificial Intelligence.
So, improvement in QoL assessment and effective intervention to cancer patients can be achieved with the new technology in combination with a better patients reported outcome. 


LITERATURE
1. Perry S, Kowalski T.L., Chang C.H. Quality of life assessment in women with breast cancer: benefits, acceptability and utilization. Health Quality of Life Outcomes 5:24, 2007.
2. Gordon N.H., Siminoff L.A. Measuring quality of life of long-term breast cancer survivors: The long term Quality of life – Breast cancer (LTQOL – BC) Scale. J Pshychosoc. Oncol. 28(6) 589 – 609, 2010.
3. Eton D.T., Lepare S.J. Prostate cancer and Health – Related Quality of life. A review of the Literature. Pshychooncology 11(4) 307 – 326, 2002.