Pathways for Improving Quality of Life

As early detection of cancers and improved treatments continue to improve outcomes for patients with cancer, care providers have been able to increase their focus on the quality of life for patients with cancer who are undergoing treatment and for cancer survivors. The articles in this issue aim to improve our understanding of how health-related quality of life should be assessed and its impact on patient outcomes.

Understanding the patient burden due to illness requires an understanding of all factors affecting the patient, from the start of treatment through survival. Understanding the needs of cancer survivors, and understanding how these needs may change throughout the cancer journey, is essential for properly designing care and support plans for inclusion on pathways.

In this issue, Nancy Ehmke, RN, MN, AOCN, et al, report the early results of a prospective study to identify the preferences and the educational, physical, psychosocial, financial, and spiritual needs of breast and prostate cancer survivors during survivorship (page 30). The findings of the study can be used in the development of educational and supportive programs for cancer survivors to be included in clinical pathways for these cancers.

Clinical pathways also are designed to take into account quality of life considerations through the evaluation of toxicities associated with different treatments. However, the factors used to compare different treatments in terms of their impact on quality of life are a source of debate. Health-related quality of life is frequently assessed through the calculation of health state utilities. These allow researchers to quantify the impact of adverse events associated with different treatments.

Stacie Hudgens, MA, and colleagues report an indirect approach to deriving health state utilities for patients with metastatic breast cancer, using a published regression algorithm to map toxicity data from a clinical trial of eribulin and capecitabine (page 39). The results of their estimation strategy were then compared with utility estimates from a previously reported vignette study of patients with metastatic breast cancer in order to examine potential differences between the results. The novel method may provide an improved way for researchers to assess the comparative toxicities of different treatments for diseases, including metastatic breast cancer, for which adverse events can have a severe impact on quality of life.

The articles in this issue demonstrate the importance of incorporating quality of life considerations into clinical pathways in order to ensure the best outcomes for patients.