Quality of life and treatment value in the management of hematologic malignancies.
This report is an overview of quality-of-life (QOL) concerns among people living with hematologic malignancies, and attempts to place these concerns in the context of overall therapeutic benefit and treatment value. There are two general categories of potential benefit offered by any treatment: time and QOL. If time can be added by a treatment, either by cure or prolonging survival, the value of that time makes toxicity more tolerable to patients, providers, payers, and society. If QOL can be improved, this will also make toxicity more acceptable. However, in the absence of time extension, this trade-off must demonstrate that the QOL benefit clearly outweighs the toxicity. In other words, the acceptability of toxicity increases as the likelihood of benefit improves. The range of possible symptoms and functional problems associated with hematologic malignancies is diverse, characterized by site and degree of involvement. Uncertainty of prognosis and the need to tolerate ambiguity frame many of the emotional challenges that face patients who must make difficult treatment and follow-up decisions. As more QOL data become available from clinical trials in hematologic malignancies, treatment decisions, while still difficult, can be made with more information about risk, type of improvements, toxicities, and probability of overall clinical benefit.
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Evanston Northwestern Healthcare and Robert H. Lurie Cancer Center, Northwestern University, Chicago, IL, USA.
Webster
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D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D003657:Decision Making; D019337:Hematologic Neoplasms / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D011788:Quality of Life; D011879:Radiotherapy Dosage
D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents