Michael M, Tannock I F
Department of Medicine, Princess Margaret Hospital and University of Toronto, Ont.
CMAJ. 1998 Jun 30;158(13):1727-34.
Quality of life is a subjective multidimentional concept that can be assessed by means of validated questionnaires completed by patients. The psychological effects of a diagnosis of cancer and the physical effects of the disease and its treating have a major impact on a patient's health-related quality of life. Much cancer treatment, especially chemotherapy for metastatic disease, is given for palliation. Palliation implies improvement in either the duration or quality of life remaining. However, treatment patients with common metastatic tumours to prolong life is generally unsuccessful, so improving quality of life is a more realistic goal. Most trials involve evaluating shrinkage of a tumour (i.e., tumour response), which does not imply a benefit to the patient. Few trials have assessed quality of life directly, although several validated instruments, described here, are available to quantify quality of life in cancer patients. These instruments represent a wide scope, from evaluating general health to assessing the quality of life of patients with specific types and stages of cancer. They respond to changes in clinical state and are strongly predictive of survival. Measures of quality of life should be incorporated in all clinical trials where treatment is palliative, and a simple, relevant measure of quality of life should be used as a (or the) primary outcome measure. Other measures of quality of life are important to ensure that gains in one area do not occur at the expense of others. A few large trials incorporating these principles have shown that chemotherapy can provide palliation for patients with advanced cancer.
生活质量是一个主观的多维度概念，可以通过患者填写的经过验证的问卷来评估。癌症诊断带来的心理影响以及疾病及其治疗带来的身体影响，对患者与健康相关的生活质量有重大影响。许多癌症治疗，尤其是针对转移性疾病的化疗，是用于姑息治疗的。姑息治疗意味着剩余生命的持续时间或质量得到改善。然而，治疗常见转移性肿瘤患者以延长生命通常并不成功，因此改善生活质量是一个更现实的目标。大多数试验都涉及评估肿瘤的缩小情况（即肿瘤反应），这并不意味着对患者有益。虽然有几种经过验证的工具（本文将予以介绍）可用于量化癌症患者的生活质量，但很少有试验直接评估生活质量。这些工具涵盖范围广泛，从评估总体健康状况到评估特定类型和阶段癌症患者的生活质量。它们能反映临床状态的变化，并且对生存具有很强的预测性。在所有姑息治疗的临床试验中都应纳入生活质量测量指标，并且应使用一个简单、相关的生活质量测量指标作为主要结局指标。其他生活质量测量指标也很重要，以确保在一个领域取得的改善不会以牺牲其他领域为代价。一些纳入这些原则的大型试验表明，化疗可以为晚期癌症患者提供姑息治疗。
