Schraub S, Mercier M, Turkeltaub E, Fournier J
Bull Cancer. 1987;74(3):297-305.
Increases in survival rates obtained in the years with cancer patients are offset by the aggressivity of the treatments and especially by those based on antitumor drugs. So far, oncologists have addressed themselves to the notions of survival (with or without evolution of the disease), and of indicators of tumor regression and toxicity. The global notion of quality of life may be an additional parameter for weighing the impact of anticancer therapies. The assessment of the quality of life of a patient is complicated by the issue of objective versus subjective judgements. The patient's self-appreciation of his status is of primary importance, but quality of life is only a relative assessment of the patient linked to the different stages of therapy. The quest for a suitable analytical tool endowed with sufficient sensitivity and reproducibility has not yet ended. Some authors regard to psychological contact as the only satisfactory means in terms of fruitfulness, although it raises questions of quantitative estimations. Others, especially anglo-saxon authors, have compiled questionnaires to be filled out by the patients and rated them using general or itemized scores. Similar to this type of questionnaires is the technique of the linear analogs which consists in asking the patient to express an appraisal of his state by indicated a position between two extreme situations on a linear scale graded in centimeters. Some authors have prepared general questionnaires suitable to all types of cancer. Others, instead, have perfected tools specific to certain types of tumors. Finally, methods of global assessment have also been proposed, notably by Bernheim. Thus, questions arise such as the evaluation (doctor's versus patient's judgement), and that of finding a tool for assessing the physical autonomy and the well-being (in the wide sense) of the patient. In addition, such a tool should be applicable to a large number of cancer patients in order to achieve an objective evaluation of the proposed treatments. Here we report preliminary results of a study aimed at answering these different questions. Our study intended to compare: the assessment of the general condition versus the toxicity of the therapy as evaluated by the patient and the doctor; the appreciation of quality of life as determined by questionnaires and linear analogues filled out by the patients and psychological interviews. Finally, a compliance study could be made on the assessment of the quality of life in a randomized chemotherapeutic trial concerning patients with metastatic breast cancers.
癌症患者生存率的提高被治疗的侵袭性抵消了，尤其是那些基于抗肿瘤药物的治疗。到目前为止，肿瘤学家关注的是生存概念（疾病有无进展）、肿瘤消退指标和毒性指标。生活质量的整体概念可能是衡量抗癌治疗影响的一个额外参数。患者生活质量的评估因客观与主观判断的问题而变得复杂。患者对自身状况的自我评估至关重要，但生活质量只是与治疗不同阶段相关的患者的相对评估。寻找一种具有足够敏感性和可重复性的合适分析工具的探索尚未结束。一些作者认为心理接触是唯一富有成效的令人满意的方法，尽管它引发了定量估计的问题。其他作者，尤其是盎格鲁 - 撒克逊作者，编制了供患者填写的问卷，并使用总体或分项评分进行评级。与这类问卷类似的是线性模拟技术，即要求患者通过在以厘米分级的线性量表上指出两个极端情况之间的位置来表达对自己状态的评价。一些作者编制了适用于所有类型癌症的通用问卷。另一些作者则完善了特定于某些类型肿瘤的工具。最后，也有人提出了整体评估方法，尤其是伯恩海姆提出的。因此，出现了一些问题，如评估（医生与患者的判断），以及找到一种评估患者身体自主性和幸福感（广义上）的工具。此外，这样一种工具应该适用于大量癌症患者，以便对所提议的治疗进行客观评估。在此，我们报告一项旨在回答这些不同问题的研究的初步结果。我们的研究旨在比较：患者和医生评估的一般状况与治疗毒性；通过患者填写的问卷、线性模拟以及心理访谈确定的生活质量评价。最后，可以在一项关于转移性乳腺癌患者的随机化疗试验中对生活质量评估进行依从性研究。
