Quality of Life

Patient’s evaluation of quality of life

Provides understanding of impact of illness from patient’s viewpoint– Different from health status or physical functioning– Quality of life can be good even with physical disability– More than health problems, loss of abilities, or

functional deficits

Incorporation of patient’s values sets QOL assessment apart from measures of health status

Patient’s evaluation of quality of life

Important tool for understanding individual differences in response to illness– Individual responses in adapting to cancer and

treatment– Re-evaluation of life in context of life-threatening

disease

Ultimate purpose for QOL assessment Enhanced well-being – Particularly in palliative care and at end of life

(interventions aimed at providing comfort and emotional support)

– Maximize QOL

Ferrans Model of QOL (1985 & 1990) Scope of the Concept

Social and Economic Domain

Psychological/Spiritual Domain

Quality of Life

Health andFunctioning Domain

Family Domain

Ferrans & Powers Quality of Life Index

Part 1: SATISFACTION with various aspects of life

Part 2: IMPORTANCE of those same aspects of life

• Scores reflect satisfaction with the aspects of life that are valued by the individual.

• Five Scores– Overall QOL

– Health and functioning

– Psychological/spiritual

– Social and economic

– Family

Ferrans & Powers Quality of Life Index

Published first in 1985 (200+ published studies) International research (30+ countries)

– Americas: USA, Canada, Mexico, Brazil, Chile

– Europe: Denmark, France, Great Britain, Hungarian, Italy, Lithuania, Norway, Poland, Portugal, Romania, Russia, Spain, Sweden

– Middle East: Israel, Jordan, Turkey

– Africa: South Africa

– Asia: India, China, Korea, Japan, Thailand, Taiwan

– Australia and New Zealand U.S. cross-cultural research

– African Americans– Mexican Americans– Korean Americans

21 Languages

Arabic Chinese Danish English French Hebrew Hungarian Italian Japanese Korean Lithuanian

Norwegian Polish Portuguese Romanian Russian Spanish Swedish Tamil Thai Turkish

Ferrans & Powers Quality of Life Index --Prognostic value in 251 breast cancer patients (p = .0006)

Survival Functions

Overall survival from the date first seen at MRMC

6050403020100-10

Cum

Sur

viva

l

1.2

1.0

.8

.6

.4

.2

0.0

NTILES of HEALTHFU

2

2-censored

1

1-censored

Quality of Life of African American Cancer Survivors

Quality of Life of African American Cancer SurvivorsNIH R01 CA89418 (CALGB 119901)

Survivors: 500 African American cancer survivors – Breast, prostate, colon– Currently free of cancer

Controls: 500 African American non-cancer controls– Selected via random digit dialing from the areas in

which the cancer survivors reside.

– Matched (as a group) to the survivor group on age, gender, health insurance status, and education level

16 Participating CALGB Institutions

Heme/Onc Associates of Central NY

Northern Indiana Ohio State University University of Chicago University of Illinois at

Chicago Wake Forest Walter Reed Washington University –

St. Louis Hartford Hospital

Jersey Shore Medical Center 

Navy Medical Center – San Diego

Queens Hospital Medical Center

Roswell Park Cancer Center

Sibley Memorial Hospital Wayne Memorial

Hospital - SCCC Jesse Brown VA Medical

Center

Distribution of Participating Institutions

Explaining the Variance in Quality of Life

Urban Life Stress

Depression

Social Support

Physical Function

Comorbidities

Work Problems

Trust in MD

Spirituality

Age

Cancer Survivor

Interaction

26%

22%19%

9%

8%

5%5%

3%2% .4% .2%

Model explained 66% of variance in QOL