FORT LAUDERDALE, Fla--Although many quality of life measures for
cancer have been validated, eg, the FLIC (Functional Living Index-Cancer)
and the FACT (Functional Assessment of Cancer Therapy), use of
a single instrument facilitates analysis of data obtained at different
sites, David F. Cella, PhD, said at the first annual conference
of the National Comprehensive Cancer Network (NCCN).
However, it is now possible to convert the total or aggregate
score from a specific assessment tool to a "Q" score
that provides "a reasonable estimate of a person's quality
of life," he said, adding that Q score can also potentially
be used as a modifier of survival time.
Dr. Cella and his colleagues at Rush Medical College, Chicago,
where is he associate professor of psychology and internal medicine,
have shown that the total scores obtained with FLIC or FACT (developed
by Dr. Cella) are equivalent.
"This means that you can take the total score from either
instrument and convert it to a standardized Q score," he
said, "and then use that standardized score as the basis
for discussion and comparison across trials, across physicians,
or between physician and patient." The Rush researchers have
devised a table that converts a raw FACT score to a FLIC score
and a Q score.
About a dozen subscales are available for use with the FACT-G,
a 34-item general quality of life measure, targeted to specific
treatments, disease symptoms, issues (such as treatment satisfaction),
and even protocols, Dr. Cella said.
The ovarian cancer subscale, for example, asks about problems
specific to ovarian cancer such as abdominal swelling, cramps,
mobility, weight loss, and bowel control. An ovarian cancer therapy
might not be deemed effective measured by the FACT-G, he said,
but could be shown to have a pronounced impact on symptom relief,
measured by the subscale.
"The better you're able to chart quality of life benefits,
the more ammunition you're going to have to justify a treatment,"
Dr. Cella said, especially in the era of managed care. He said
that physicians should not assume that the impact of treatments
on quality of life will be negative if the treatment has no measurable
effect on response rate and survival.