Quality of life assessments in advanced breast cancer: should there be more consistency?

Quality of life (QOL) measures have assumed increasing importance in assessing the impact of therapeutic drugs and interventions on patients and in making judgements about their cost-effectiveness. Important treatment decisions and crucial funding strategies involve QOL data and, for patients with a disease such as advanced breast cancer that impinges on their life expectancy, QOL can become a hugely important consideration. Yet, despite this, there is a lack of consensus on what defines an appropriate QOL measure, and inconsistency in the instruments that are chosen to measure it. The National Institute for Health and Clinical Excellence (NICE) is seen as a model for appraising the value of new treatments and NICE approval is required for treatments to be funded in the UK. In order to compare different disease conditions they use a generic measure, preferring the EQ-5D. We have performed a literature search of clinical trials in advanced breast cancer to establish which QOL measures have been used. Our findings show marked heterogeneity in terms of which QOL tools are used. It is suggested that there should be more consensus on which QOL instruments are used, not only between researchers, but between them and the bodies that approve funding.