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By
Michael J. Barry, Chief Massachusetts General Hospital, Boston, MA,
Janet E. Dancey, Senior Clinical Investigator National Cancer Institute, Rockville, MD
Surgery, radiation, and chemotherapy are used to cure, to prolong life, and to palliate symptoms of cancer patients. These treatments can have complicated effects on the patients who receive them. Their therapeutic effects on the cancers are intended to preserve or improve health status over time. However, these therapies can cause short-term and long-term adverse effects that result in deterioration in health status.– Prescribing these treatments requires a careful assessment of the risks and benefits of the proposed therapy by both the treating physician and patient. In situations where the benefits are curing the disease and the risks are minimal, treatment decisions are straightforward. Conversely, in situations where benefits are marginal, such as modest improvements in survival or palliation of symptoms, and the risks include treatment-related morbidity, treatment decisions are more difficult. If the fundamental question to be addressed by health care professionals and patients before prescribing treatment is “Does the toxicity and/or the inconvenience of the proposed treatment justify the expected gain?” then providing data on the impact of therapy on patient health from carefully conducted clinical studies, using robust instruments designed to assess impact of treatment-related morbidities specifically, could provide useful information. The purpose of this chapter is to review the treatment-specific instruments that have been developed and discuss their potential role in assessing the impact of therapy on cancer patients.
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