Quality of Life Assessment in Oncology Practice

Numerous reports have identified the need to improve the management of symptoms and quality-of-life problems in cancer patients, whether these problems are related to treatment or the course of disease. The systematic use of patient-reported outcomes (PRO) information to guide care is accepted by clinicians in theory but does not occur in routine oncology practice in the US.

Although much methodological instrument development has occurred, and feasibility studies collecting data in conjunction with the patient visit have shown improved patient-clinician communication, many challenges to widespread adoption still exist. These challenges include general clinician belief that instruments are not adapted for efficient use at the individual (rather than clinical trial) level.

The use of HRQOL in routine practice requires acceptance by clinicians, patients, and administrators; timely communication among all who provide care; efficient data collection, analysis, and reporting; and resources for responding to identified patient problems. For patients, it will require addressing the acceptability of PRO assessment in light of response burden and possible concerns about confidentiality. Importantly, patients will expect that data they provide will help to improve their care.

The way forward, however, does not lie simply in adding PRO measurements to other clinician tasks, such as the occasional time-limited patient visit. Rather, effective implementation will require new information infrastructures and technologies to embed the timely, routine use of PRO information in the care process. The NCI is funding two Small Business Innovation Research (SBIR) contracts (Dynamic Clinical Systems, Inc. and Caracal, Inc.) to develop integrated, ongoing PRO measurement systems that can provide timely, efficient, individualized information for monitoring patient progress and improving decision-making in routine oncology patient care.