Aspects of quality-of-life in patients with lung-cancer - a 3 observer evaluation study

Only 5 to 10 % of patients with lung cancer can expected to be cured by radical treatments. In the remaining subjects the potential survival benefit of the treatment must be weighed, taking into consideration the possible deterioration of their quality of life (QL). A problem arising from this evaluation is the subjective variability of measurements. We distributed 279 QL instruments to 71 patients, their relatives, and the doctors responsible for their management. Each instrument bore 3 simple questions concerning patients' treatment tolerance, physical well-being, and psychological condition. We collected in all 267, 252, and 147 questionnaires completed by patients, doctors, and relatives, respectively. Correlations between replies were all statistically significant. Patients and relatives manifested the highest degree of interobserver agreement, while doctors and relatives the lowest. Differences in the QL assessment from different observers were also highly significant. Relatives were generally the most pessimistic raters. In comparison with patients, doctors judged more favourably treatment tolerance, but estimated quite similarly physical well-being and the emotional status. Doctors were the most reliable raters of chemotherapy tolerance, on the basis of the highest degree of correlation between their replies and the standard grading of toxicity. The results of this study may help physicians dealing with incurable patients with lung cancer to give the most appropriate weight to potentially differing perceptions of QL.