[Assessment of the quality of life]

Increases in survival rates obtained in the years with cancer patients are offset by the aggressivity of the treatments and especially by those based on antitumor drugs. So far, oncologists have addressed themselves to the notions of survival (with or without evolution of the disease), and of indicators of tumor regression and toxicity. The global notion of quality of life may be an additional parameter for weighing the impact of anticancer therapies. The assessment of the quality of life of a patient is complicated by the issue of objective versus subjective judgements. The patient's self-appreciation of his status is of primary importance, but quality of life is only a relative assessment of the patient linked to the different stages of therapy. The quest for a suitable analytical tool endowed with sufficient sensitivity and reproducibility has not yet ended. Some authors regard to psychological contact as the only satisfactory means in terms of fruitfulness, although it raises questions of quantitative estimations. Others, especially anglo-saxon authors, have compiled questionnaires to be filled out by the patients and rated them using general or itemized scores. Similar to this type of questionnaires is the technique of the linear analogs which consists in asking the patient to express an appraisal of his state by indicated a position between two extreme situations on a linear scale graded in centimeters. Some authors have prepared general questionnaires suitable to all types of cancer. Others, instead, have perfected tools specific to certain types of tumors. Finally, methods of global assessment have also been proposed, notably by Bernheim. Thus, questions arise such as the evaluation (doctor's versus patient's judgement), and that of finding a tool for assessing the physical autonomy and the well-being (in the wide sense) of the patient. In addition, such a tool should be applicable to a large number of cancer patients in order to achieve an objective evaluation of the proposed treatments. Here we report preliminary results of a study aimed at answering these different questions. Our study intended to compare: the assessment of the general condition versus the toxicity of the therapy as evaluated by the patient and the doctor; the appreciation of quality of life as determined by questionnaires and linear analogues filled out by the patients and psychological interviews. Finally, a compliance study could be made on the assessment of the quality of life in a randomized chemotherapeutic trial concerning patients with metastatic breast cancers.