Approximately 8.2 million people are now living with cancer. Cancer survivors are rightfully demanding, if not cure, more durable control of their disease with fewer side effects and better quality of life. Simply being alive five years after diagnosis is no longer considered good enough by survivors of most cancers.

Definitions of quality of life vary. For example, quality of life has been defined as the difference or gap between the hopes Read the rest of this entry »

Three stages of survival-acute, extended, and permanent-have been define and are widely recognized. “Acute” survival begins at diagnosis and continues through the end of treatment. In this stage of survival, patients generally experience depression and anxiety, energy reduction, decline in physical functioning, and distress related to disease symptoms; these effects typically relate to treatment and are independent of cancer site. Issues Read the rest of this entry »

Cancer survivors’ quality of life also is affected dramatically by the stresses cancer places on the family unit. Cancer treatment now involves less hospitalization, more home care, and more outpatient procedures than in years past; this reality places more responsibility on the family to provide care over long periods of time. In addition, recent decades have seen vast changes (e.g., greater mobility resulting in fragmentation and loss of the extended Read the rest of this entry »

Survivors of pediatric and adolescent cancers, and long-term survivors of adult cancers face special issues in addition to those described above. By the year 2000, one in 900 people between the ages of 16 and 44 years will be a survivor of a childhood cancer. Child and adolescent cancer survivors have an average life expectancy of 60 years compared with 15 years for the average adult cancer survivor. The long-term effects of cancer treatments and their Read the rest of this entry »

End of life care is a survivorship issue and a quality of care issue; 50 to 60 percent of patients diagnosed with cancer will eventually die from their disease. How cancer patients perceive their death dramatically affects their morbidity. A “bad death,” characterized by poor symptom control, physician abandonment, or inadequate closure, creates survivors’ fear of death. Speakers indicated that difficulty in addressing death with patients is an acknowledged Read the rest of this entry »

Although quality of life assessment-including some psychosocial aspects of quality of life-is now included in most clinical trials, this aspect of cancer care quality evaluation is relatively new. Quality of life data on patients not treated on trials, and data on most survivors who have completed treatment remain sparse.

Speakers noted that quality of life is a multidimensional concept that should be measured based on individual perceptions rather Read the rest of this entry »

Motivated both by continuing pressure to reduce health care costs and the desire to provide the most effective care, numerous health care organizations and health care practitioners are attempting to delineate when certain care is merited. These detailed descriptions of care are becoming equated with the provision and measurement of quality in cancer care. Defining quality care for the many cancers is made increasingly difficult by the Read the rest of this entry »

The quality of care issues that surfaced repeatedly in testimony that provided the impetus for three meetings to explore in detail quality of care and quality of life issues for cancer patients/survivors, their families, and those at risk for cancer. In all, 42 speakers representing the research, clinical, health industry, and advocacy communities provided testimony on issues in defining quality cancer care, the development and use of cancer care guidelines, and the importance of quality care to quality of life.

The meeting on the responsiveness of the health care delivery system to the needs of special populations, the Panel revisited quality issues as they relate to care provided under evolving health care payer arrangements, in public and private health programs, and in community-based cancer research settings such as the Community Clinical Oncology Programs (CCOPs). These included pharmacy-related problems, such as the use of non-formulary drugs, Read the rest of this entry »

The Panel met to review current statistics on cancer in the elderly; explore specific epidemiologic, genetic, and biologic issues of cancer and aging; and consider the preventive, screening, therapeutic, and supportive care needs of the older population with cancer and at risk for the disease. Our population is aging-by the year 2030, persons over age 65 will comprise 20 percent of the U.S. population, compared with 12.8 percent .The functional Read the rest of this entry »