|Quality of life measurement in cancer patients receiving palliative radiotherapy for symptomatic lung cancer: a literature review.|
|Jump to Full Text|
|PMID: 19370175 Owner: NLM Status: PubMed-not-MEDLINE|
|Approximately 27% of North American cancer deaths are attributable to cancer of the lung. Many lung cancers are found at an advanced stage, rendering the tumours inoperable and the patients palliative. Common symptoms associated with palliative lung cancer include cough, hemoptysis, and dyspnea, all of which can significantly debilitate and diminish quality of life (QOL). In studies of the effects of cancer therapies, the frequent evaluative endpoints are survival and local control; however, it is imperative that clinical trials with palliative patients also have a QOL focus when a cure is unattainable. We conducted a literature review to investigate the use of QOL instrument tools in trials studying QOL or symptom palliation of primary lung cancer or lung metastases through the use of radiotherapy. We identified forty-three studies: nineteen used a QOL tool, and twenty-four examined symptom palliation without the use of a QOL instrument. The European Organization for Research and Treatment of Cancer (eortc) QLQ-C30 survey was the most commonly used QOL questionnaire (in thirteen of twenty trials). Of those thirteen studies, eight also incorporated the lung-specific QOL survey eortc QLQ-LC13 (or the eortc QLQ-LC17). A second lung-specific survey, the Functional Assessment of Cancer Therapy-Lung (fact-L) was used in only two of the twenty trials. In total, only ten of forty-three trials (23%) used a lung-specific QOL tool, suggesting that QOL was of low priority as an endpoint and that measures created for lung cancer patients are underused. We encourage investigators in future trials to include specific QOL instruments such as the eortc QLQ-LC13 or the fact-L for studies in palliative thoracic radiotherapy because those instruments provide a measure of QOL specific to patients with lung cancer or lung metastases.|
|N Salvo; S Hadi; J Napolskikh; P Goh; E Sinclair; E Chow|
Related Documents :
|18711345 - Quality of life and social integration after allogeneic hematopoietic sct.
1933845 - Development of the inventory of functional status-cancer.
23358185 - Nqo1 c609t polymorphism correlated to colon cancer risk in farmers from western region ...
10427945 - A cross-sectional validation study of self-evaluation of communication experiences afte...
16700785 - The association between malignant melanoma and noncutaneous malignancies.
17621605 - A retrospective analysis of digital stereotaxis in breast screening.
|Type: Journal Article|
|Title: Current oncology (Toronto, Ont.) Volume: 16 ISSN: 1198-0052 ISO Abbreviation: Curr Oncol Publication Date: 2009 Mar|
|Created Date: 2009-04-16 Completed Date: 2011-06-17 Revised Date: 2013-05-23|
Medline Journal Info:
|Nlm Unique ID: 9502503 Medline TA: Curr Oncol Country: Canada|
|Languages: eng Pagination: 16-28 Citation Subset: -|
|Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON.|
|APA/MLA Format Download EndNote Download BibTex|
Journal ID (nlm-ta): Curr Oncol
Journal ID (publisher-id): CO
Publisher: Multimed Inc., 66 Martin St. Milton, ON, Canada L9T 2R2
2009 Multimed Inc.
open-access: This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Print publication date: Month: 3 Year: 2009
Volume: 16 Issue: 2
First Page: 16 Last Page: 28
Publisher Id: co16-2-16
PubMed Id: 19370175
|Quality of life measurement in cancer patients receiving palliative radiotherapy for symptomatic lung cancer: a literature review|
|J. Napolskikh, BSc|
|P. Goh, BSc|
|E. Sinclair, MRT(T)|
|E. Chow, MBBS|
* Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON.
|Correspondence: Correspondence to: Edward Chow, Department of Radiation Oncology, Odette Cancer Centre, Sunny-brook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5. E-mail:
Lung cancer is a rising epidemic and remains the leading cause of cancer death in both men and women in Canada1. In general, 500 Canadians are diagnosed with and 400 Canadians die of lung cancer every week1. Such high morbidity and mortality in patients with primary lung cancer emphasizes the need for palliative treatment intent.
Morbidity from lung cancer or lung metastases often presents as troublesome thoracic symptoms such as hemoptysis, cough, chest pain, and dyspnea. Palliative radiotherapy has been effective in ameliorating these symptoms 2–4 and improves or preserves the quality of life (QOL) remaining in approximately one third of affected patients5.
In the past, clinical trials in patients with lung cancer have focused on traditional endpoints such as overall survival, disease-free survival, or local control 6. Given the relatively poor prognosis of patients with locally advanced lung cancer or lung metastases, the inclusion of QOL as a primary endpoint of treatment becomes increasingly important. Quality of life encompasses the minimization of risks and maximization of benefits of a treatment, including physical and psychosocial effects on the well-being of patients7. Studying QOL is particularly relevant in the field of palliative radiotherapy because of known treatment-related side effects and toxicities.
Few studies focus on QOL and symptom palliation as primary endpoints. The purpose of the present review was to accurately assess the recent use of QOL tools in trials that evaluated the efficacy of palliative radiotherapy in patients with lung cancer or lung metastases.
We conducted a literature review using the MEDLINE (Ovid) database for 1950 to February 2008. Key terms such as “lung cancer,” “lung neoplasms,” or “lung metastases” were combined with the terms “radiotherapy,” “radiation,” “external-beam irradiation,” or “palliative radiotherapy.” This search was then combined with “quality of life” or “QOL” and also “symptom palliation.” Relevant articles and abstracts were reviewed, and references from those sources were also manually searched for additional relevant publications.
To be included in the present literature review, articles had to meet these criteria:
- Population: patients with a histologic, cytologic, or radiologic diagnosis of primary lung cancer or lung metastases
- Intervention: external beam radiotherapy or endobronchial brachytherapy in at least one study arm, with palliative intent
- Types of studies: randomized trials, prospective or retrospective cohort studies
- Endpoints: QOL or symptom palliation as a primary or secondary endpoint or measured outcome
Articles were excluded if they met any of these criteria:
- Article type: individual case report or review article
- Language: publication in a language other than English
- Intervention: no evaluation, in at least one arm, of external beam irradiation to the thorax or endobronchial brachytherapy; or studies of interventions with curative intent
- Types of studies: focus on populations other than those with primary lung cancer or lung metastases
- Endpoints: use of the Karnofsky performance status (KPS) or other similar prognostic tools, correlation of QOL with cost–utility, or test of the reliability or validity of a QOL instrument
We extracted the following information from the studies:
- Primary and secondary outcomes
- Radiotherapy treatment details
- Type and number of QOL, symptom palliation, and additional tools, if any, used
- Number of patients in each study arm
- Median age and male: female ratio of the patients enrolled in the study
- Median survival in each study arm
We identified a total of forty-three trials that evaluated, in at least one study arm, the use of palliative radiotherapy to the thorax, and that assessed QOL or symptom palliation as a primary or secondary endpoint. Thirty studies (Table I) evaluated the treatment of patients with non-small-cell lung cancer (NSCLC). Four studies (Table II) involved patients who were treated with endobronchial brachytherapy alone or in addition to external-beam radiation. Brachytherapy differs from external-beam radiation in that it is a more localized form of radiation that limits toxicity in healthy tissue to the immediate vicinity of the radiated region5. Another nine trials (Table III) evaluated the use of palliative radiotherapy in patients with lung cancer of a histologic type other than NSCLC. The four identified studies that measured the difference in efficacy between endobronchial brachytherapy and external beam radiation 37–40 used both symptom palliation and QOL scores as a primary outcome.
In twenty of the identified studies, symptom palliation was used as a primary outcome 8,10,11,13, 14,17,19,20,21,23,26,28–33,44,45,47. Ten trials used QOL as a primary outcome 5,9,16,18,24,25,34,35,39,49, and six studies used both symptom palliation and QOL together as a primary endpoint 22,27,37,38,40,48. Seven of the studies used neither symptom palliation nor QOL as primary endpoints, but rather incorporated them as secondary outcomes 12,15,36,41–43,46. The four identified studies that measured the difference in efficacy between endobronchial brachytherapy and external beam radiation37–40 used both symptom palliation and QOL scores as primary outcomes.
A total of 11 tools were used to assess either QOL or palliation of lung cancer–related symptoms; the frequency of use of each tool is presented in Table IV. The most common QOL tool used was the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, a questionnaire that was created and validated to assess QOL in individuals with any form of cancer. It has been translated into 81 languages and consists of 30 questions that encompass 5 functional scales: physical, role, cognitive, emotional, and social functioning49. The EORTC QLQ-C30 also incorporates 3 symptom scales: fatigue, pain, and nausea and vomiting. The remaining items on the questionnaire cover other symptom-related events that are often described by cancer patients, including dyspnea, diarrhea, and loss of appetite, among others48.
The EORTC QLQ-C30 was used in fourteen of the forty-three studies identified in the search (32%), eight of which also used the lung cancer supplement, EORTC QLQ-LC13. The EORTC QLQ-LC13 is the latest version of a lung cancer specific questionnaire that consists of questions concerning lung cancer symptoms and the side effects of conventional treatments used for lung cancer49. One trial used an older version of the lung-specific module, the EORTC QLQ-LC17, in addition to the general questionnaire48
The Functional Assessment of Cancer Therapy (FACT) QOL tools constituted a second group used in the identified studies. Both the general questionnaire (FACT-G) and the lung-specific questionnaire (FACT-L) were used. Like the EORTC QLQ-C30, the FACT-G is a general questionnaire that was developed for patients with any type of cancer. The FACT-G covers 4 dimensions of QOL: physical, social, emotional, and functional well-being50. The FACT-L is similar to the EORTC QLQ-LC13 because it includes additional questions that relate specifically to QOL in patients with lung cancer. The FACT-L was used in two studies, and the FACT-G in one.
A third validated QOL tool was used in one trial: the Spitzer QOL Index. The Spitzer Index covers 5 dimensions of QOL: activity, daily living, health, support of family and friends, and outlook51. It is not a lung cancer–specific questionnaire, however; and thus it does not incorporate questions directly related to the lung-cancer-specific patient population.
Study-designed questionnaires were the most prevalent tool used in the forty-three identified studies. A study-specific method of determining QOL was used in three trials, and nineteen trials attempted to evaluate symptom palliation using a study-designed questionnaire. Table V shows a breakdown of the proportion of studies using a validated QOL or symptom palliation tool as compared with a study-designed tool. Study-designed instruments present a difficulty: drawing comparisons across studies is harder because the methods of measurement vary.
In five studies, a validated symptom palliation tool was used (the frequency of use can be seen in Table IV). The two general symptom tools used were the Hospital Anxiety and Depression Scale and the Rotterdam Symptom Checklist. The Rotterdam Symptom Checklist measures psychological and physical distress in cancer patients through the use of 38 items52. The Hospital Anxiety and Depression Scale is a tool used to measure anxiety and depression levels using 14 statements based on a patient’s experience over the preceding week53. One lung-specific symptom tool the Lung Cancer Symptom Scale was used. The Lung Cancer Symptom Scale is a tool designed to measure 6 lung-specific symptoms and their effects on symptomatic distress, functional burden, and global quality of life54,55.
Figure 1 outlines the overall picture of questionnaire use in the identified trials. Most of the trials (54%) measured symptom palliation alone; some measured both symptom palliation and QOL (14%). The remaining trials measured QOL only.
In forty studies (91%), the performance status of the subjects was measured in addition to QOL or symptom palliation. Performance status was measured primarily as a prognostic factor (twenty of forty trials, 50%) or as part of the exclusion criteria (fourteen of forty trials, 35%). Only six studies used a performance scale as part of the assessment. The 3 most predominant performance status tools used were the World Health Organization performance status, the Eastern Cooperative Oncology Group scale, and the Karnofsky performance status (KPS). Although performance scales are useful to determine the functional status of a patient, they are not adequate tools for measuring symptom palliation or QOL.
In patients with terminal cancer, QOL is a significant concept, and it is influencedby many factors, including symptoms, functional level, coping strategies, and support systems51. Common symptoms that influence a lung cancer patient’s QOL include anxiety, depression, pain, fatigue, dyspnea, and cough52. Because lung cancer is the leading cause of cancer death in men and the second-leading cause in women globally2, it is important that QOL is considered when caring for these patients.
Meaningful palliation refers to symptom relief and prolongation of good-quality survival in lung cancer patients26. When treating a patient with palliative intent, it is necessary to use tools that measure the intent of the treatment. For 86% of doctors from the United Kingdom, the United States, and Canada, the treatment of choice for patients with inoperable report of a lung cancer is palliative radiotherapy33. It is therefore important that, when considering the side effects of palliative radiotherapy as compared with the side effects of the lung cancer itself, trials investigating the use of palliative radiotherapy use a QOL measure to determine the benefit of the treatment.
A total of twenty identified trials considering palliative radiotherapy for lung cancer included an evaluation of QOL. Of these trials, eleven used a tool that was specific to patients with lung cancer; the remaining nine used general QOL questionnaires for cancer patients or a study-designed questionnaire. In thirty-one identified studies, the level of symptom palliation, one aspect that contributes to a QOL measure, was assessed. This finding suggests that more trials should use a validated lung-specific tool when evaluating the outcome of palliative thoracic radiotherapy. Use of a validated, lung-specific tool will allow for comparisons between trials and will also increase the internal validity of individual studies. Two recommended lung-specific validated tools that would be beneficial for the measurement of QOL in trials evaluating palliative thoracic radiotherapy are the FACT-L and the EORTC QLQ-LC13.
This project was generously supported by the Michael and Karyn Goldstein Cancer Research Fund. We thank Ms. Stacy Lue for secretarial service.
|1.||Canadian Cancer Society and the National Cancer Institute of Canada. Canadian Cancer Statistics. 2007Toronto: Canadian Cancer Society; 2007|
|2.||Okawara G,Mackay JA,Evans WK,Ung YC. on behalf of the Lung Cancer Disease Site Group of Cancer Care Ontario’s Program in Evidence-Based Care. Management of unresected stage III non-small cell lung cancer: a systematic reviewJ Thorac Oncol 2006;1:377–93. [pmid: 17409887]|
|3.||Brundage MD,Bezjak A,Dixon P,et al. The role of palliative thoracic radiotherapy in non-small cell lung cancerCan J Oncol 1996;6(suppl 1):25–73. [pmid: 8853535]|
|4.||Sirzén F,Kjellén E,Sörenson S,Cavallin–Ståhl E. A systematic overview of radiation therapy effects in non-small cell lung cancerActa Oncol 2003;42:493–515. [pmid: 14596509]|
|5.||Langendijk JA,Aaronson NK,ten Velde GP,de Jong JM,Muller MJ,Wouters EF. Pretreatment quality of life of inoperable non-small cell lung cancer patients referred for primary radiotherapyActa Oncol 2000;39:949–58. [pmid: 11207002]|
|6.||Movsas B,Scott C. Quality-of-life trials in lung cancer: past achievements and future challengesHematol Oncol Clin North Am 2004;18:161–86. [pmid: 15005287]|
|7.||Yancik R,Edwards BK,Yates JW. Assessing the quality of life of cancer patients: practical issues in study implementationJ Psychosoc Oncol 1989;7:59–74.|
|8.||Simpson JR,Francis ME,Perez–Tamayo R,Marks RD,Rao DV. Palliative radiotherapy for inoperable carcinoma of the lung: final report of a rtog multi-institutional trialInt J Radiat Oncol Biol Phys 1985;11:751–8. [pmid: 2579938]|
|9.||Kaasa S,Mastekaasa A,Naess S. Quality of life of lung cancer patients in a randomized clinical trial evaluated by a psychosocial well-being questionnaireActa Oncol 1988;27:335–42. [pmid: 2849460]|
|10.||Teo P,Tai TH,Choy D,Tsui KH. A randomized study on palliative radiation therapy for inoperable non small cell carcinoma of the lungInt J Radiat Oncol Biol Phys 1988;14:867–71. [pmid: 2452146]|
|11.||Lung Cancer Working Party, Medical Research Council. Inoperable non-small-cell lung cancer (nsclc): a Medical Research Council randomised trial of palliative radiotherapy with two fractions or ten fractions. Report to the Medical Research Council by its Lung Cancer Working PartyBr J Cancer 1991;63:265–70. [pmid: 1705140]|
|12.||Regan J,Yarnold J,Jones PW,Cooke NT. Palliation and life quality in lung cancer; how good are clinicians at judging treatment outcome?Br J Cancer 1991;64:396–400. [pmid: 1892773]|
|13.||Medical Research Council Lung Cancer Working Party. A Medical Research Council (mrc) randomised trial of palliative radiotherapy with two fractions or a single fraction in patients with inoperable non-small-cell lung cancer (nsclc) and poor performance statusBr J Cancer 1992;65:934–41. [pmid: 1377484]|
|14.||Omand M,Meredith C. A study of acute side-effects related to palliative radiotherapy treatment of lung cancerEur J Cancer Care (Engl) 1994;3:149–52. [pmid: 7535638]|
|15.||Abratt RP,Shepherd LJ,Salton DG. Palliative radiation for stage 3 non-small cell lung cancer a prospective study of two moderately high dose regimensLung Cancer 1995;13:137–43. [pmid: 8581393]|
|16.||Macbeth FR,Bolger JJ,Hopwood P,et al. Randomized trial of palliative two-fraction versus more intensive 13-fraction radiotherapy for patients with inoperable non-small cell lung cancer and good performance statusClin Oncol (R Coll Radiol) 1996;8:167–75. [pmid: 8814371]|
|17.||Ball D,Smith J,Bishop J,et al. A phase iii study of radiotherapy with and without continuous-infusion fluorouracil as palliation for non-small-cell lung cancerBr J Cancer 1997;75:690–7. [pmid: 9043026]|
|18.||Gava A,Bertossi L,Zorat PL,et al. Radiotherapy in the elderly with lung carcinoma: the experience of the Italian “Geriatric Radiation Oncology GroupRays 1997;22:61–5. [pmid: 9250017]|
|19.||Lutz ST,Huang DT,Ferguson CL,Kavanagh BD,Tercilla OF,Lu J. A retrospective quality of life analysis using the Lung Cancer Symptom Scale in patients treated with palliative radiotherapy for advanced nonsmall cell lung cancerInt J Radiat Oncol Biol Phys 1997;37:117–22. [pmid: 9054885]|
|20.||Vyas RK,Suryanarayana U,Dixit S,et al. Inoperable non-small cell lung cancer: palliative radiotherapy with two weekly fractionsIndian J Chest Dis Allied Sci 1998;40:171–4. [pmid: 9919836]|
|21.||Donato V,Zurlo A,Bonfili P,et al. Hypofractionated radiation therapy for inoperable advanced stage non-small cell lung cancerTumori 1999;85:174–6. [pmid: 10426127]|
|22.||Langendijk JA,ten Velde GP,Aaronson NK,de Jong JM,Muller MJ,Wouters EF. Quality of life after palliative radiotherapy in non-small cell lung cancer: a prospective studyInt J Radiat Oncol Biol Phys 2000;47:149–55. [pmid: 10758317]|
|23.||Nestle U,Nieder C,Walter K,et al. A palliative accelerated irradiation regimen for advanced non-small-cell lung cancer vs. conventionally fractionated 60 Gy: results of a randomized equivalence studyInt J Radiat Oncol Biol Phys 2000;48:95–103. [pmid: 10924977]|
|24.||Schaafsma J,Coy P. Response of global quality of life to high-dose palliative radiotherapy for non-small-cell lung cancerInt J Radiat Oncol Biol Phys 2000;47:691–701. [pmid: 10837953]|
|25.||Auchter RM,Scholtens D,Adak S,Wagner H,Cella DF,Mehta MP. on behalf of the Eastern Cooperative Oncology Group. Quality of life assessment in advanced non-small-cell lung cancer patients undergoing an accelerated radiotherapy regimen: report of ECOG study 4593Int J Radiat Oncol Biol Phys 2001;50:1199–206. [pmid: 11483329]|
|26.||Cetingoz R,Kentli S,Uruk O,Demirtas E,Sen M,Kinay M. The role of palliative radiotherapy in locally advanced non-small cell lung cancerNeoplasma 2001;48:506–10. [pmid: 11949846]|
|27.||Langendijk H,de Jong J,Tjwa M,et al. External irradiation versus external irradiation plus endobronchial brachytherapy in inoperable non-small cell lung cancer: a prospective randomized studyRadiother Oncol 2001;58:257–68. [pmid: 11230886]|
|28.||Bezjak A,Dixon P,Brundage M,et al. on behalf of the Clinical Trials Group of the National Cancer Institute of Canada. Randomized phase iii trial of single versus fractionated thoracic radiation in the palliation of patients with lung cancer (ncic ctg sc.15)Int J Radiat Oncol Biol Phys 2002;54:719–28. [pmid: 12377323]|
|29.||Falk SJ,Girling DJ,White RJ,et al. on behalf of the Medical Research Council Lung Cancer Working Party. Immediate versus delayed palliative thoracic radiotherapy in patients with unresectable locally advanced non-small cell lung cancer and minimal thoracic symptoms: randomised controlled trialBMJ 2002;325:465. [pmid: 12202326]|
|30.||Nihei K,Ishikura S,Kawashima M,Ogino T,Ito Y,Ikeda H. Short-course palliative radiotherapy for airway stenosis in non-small cell lung cancerInt J Clin Oncol 2002;7:284–8. [pmid: 12402061]|
|31.||Borthwick D,Knowles G,McNamara S,Dea RO,Stroner P. Assessing fatigue and self-care strategies in patients receiving radiotherapy for non-small cell lung cancerEur J Oncol Nurs 2003;7:231–41. [pmid: 14637126]|
|32.||Kramer GW,Wanders SL,Noordijk EM,et al. Results of the Dutch National study of the palliative effect of irradiation using two different treatment schemes for non-small-cell lung cancerJ Clin Oncol 2005;23:2962–70. [pmid: 15860852]|
|33.||Senkus–Konefka E,Dziadziuszko R,Bednaruk–Mlyńnski E,et al. A prospective, randomised study to compare two palliative radiotherapy schedules for non-small-cell lung cancer (nsclc)Br J Cancer 2005;92:1038–45. [pmid: 15770205]|
|34.||Sundstrøm S,Bremnes R,Brunsvig P,et al. on behalf of the Norwegian Lung Cancer Study Group. Immediate or delayed radiotherapy in advanced non-small cell lung cancer (nsclc)? Data from a prospective randomised studyRadiother Oncol 2005;75:141–8. [pmid: 16094739]|
|35.||Sundstrøm S,Bremnes RM,Brunsvig P,Aasebø U,Kaasa S. on behalf of the Norwegian Lung Cancer Study Group. Palliative thoracic radiotherapy in locally advanced non-small cell lung cancer: can quality-of-life assessments help in selection of patients for short- or long-course radiotherapyJ Thorac Oncol 2006;1:816–24. [pmid: 17409965]|
|36.||Temel JS,Jackson VA,Billings JA,et al. Phase ii study: integrated palliative care in newly diagnosed advanced non-small-cell lung cancer patientsJ Clin Oncol 2007;27:2377–82. [pmid: 17557950]|
|37.||Stout R,Barber P,Burt P,et al. Clinical and quality of life outcomes in the first United Kingdom randomized trial of endobronchial brachytherapy (intraluminal radiotherapy) vs. external beam radiotherapy in the palliative treatment of inoperable non-small cell lung cancerRadiother Oncol 2000;56:323–7. [pmid: 10974381]|
|38.||Langendijk H,de Jong J,Tjwa M,et al. External irradiation versus external irradiation plus endobronchial brachytherapy in inoperable non-small cell lung cancer: a prospective randomized studyRadiother Oncol 2001;58:257–68. [pmid: 11230886]|
|39.||Mallick I,Sharma SC,Behera D,Ghoshal S,Oinam AS. Optimization of dose and fractionation of endobronchial brachytherapy with or without external radiation in the palliative management of non-small cell lung cancer: a prospective randomized studyJ Can Res Ther 2006;2:119–25.|
|40.||Mallick I,Sharma SC,Behera D. Endobronchial brachytherapy for symptom palliation in non-small cell lung cancer analysis of symptom response, endoscopic improvement and quality of lifeLung Cancer 2007;55:313–18. [pmid: 17157949]|
|41.||Berry RJ,Laing AH,Newman CR,Peto J. The role of radiotherapy in treatment of inoperable lung cancerInt J Radiat Oncol Biol Phys 1977;2:433–9. [pmid: 69621]|
|42.||Collins TM,Ash DV,Close HJ,Thorogood J. An evaluation of the palliative role of radiotherapy in inoperable carcinoma of the bronchusClin Radiol 1988;39:284–6. [pmid: 2456177]|
|43.||Lung Cancer Working Party, Medical Research Council. Survival, adverse reactions and quality of life during combination chemotherapy compared with selective palliative treatment for small-cell lung cancer. Report to the Medical Research Council by its Lung Cancer Working PartyRespir Med 1989;83:51–8. [pmid: 2479963]|
|44.||Devereux S,Hatton MQ,Macbeth FR. Immediate side effects of large fraction radiotherapyClin Oncol (R Coll Radiol) 1997;9:96–9. [pmid: 9135894]|
|45.||Rees GJ,Devrell CE,Barley VL,Newman HF. Palliative radiotherapy for lung cancer: two versus five fractionsClin Oncol (R Coll Radiol) 1997;9:90–5. [pmid: 9135893]|
|46.||Ampil FL,Chin HW. Palliative radiotherapy for synchronous bilateral lung cancersAm J Clin Oncol 2001;24:385–7. [pmid: 11474269]|
|47.||Erridge SC,Gaze MN,Price A,et al. Symptom control and quality of life in people with lung cancer: a randomised trial of two palliative radiotherapy fractionation schedulesClin Oncol (R Coll Radiol) 2005;17:61–7. [pmid: 15714933]|
|48.||Turner NJ,Muers MF,Haward RA,Mulley GP. Do elderly people with lung cancer benefit from palliative radiotherapy?Lung Cancer 2005;49:193–202. [pmid: 16022913]|
|49.||Hicsönmez A,Köse K,Andrieu MN,Güney Y,Kurtman C. The European Organization for Research and Treatment of Cancer core quality of life questionnaire (qlq-C30 version 3.0 Turkish) in cancer patients receiving palliative radiotherapyEur J Cancer Care (Engl) 2007;16:251–7. [pmid: 17508945]|
|50.||Di Lorenzo G,Autorino R,Ciardiello F,et al. External beam radiotherapy in bone metastatic prostate cancer: impact on patients’ pain relief and quality of lifeOncol Rep 2003;10:399–404. [pmid: 12579279]|
|51.||Spitzer WO,Dobson AJ,Hall J,et al. Measuring the quality of life of cancer patients: a concise ql-index for use by physiciansJ Chronic Dis 1981;34:585–97. [pmid: 7309824]|
|52.||Vinholes JJ,Purohit OP,Abbey ME,Eastell R,Coleman RE. Relationships between biochemical and symptomatic response in a double-blind randomised trial of pamidronate for metastatic bone diseaseAnn Oncol 1997;8:1243–50. [pmid: 9496390]|
|53.||Henoch I,Bergman B,Gustafsson M,Gaston–Johansson F,Danielson E. The impact of symptoms, coping capacity, and social support on quality of life experience over time in patients with lung cancerJ Pain Symptom Manage 2007;34:370–9. [pmid: 17616335]|
|54.||Bergman B,Aaronson NK. Quality-of-life and cost-effectiveness assessment in lung cancerCurr Opin Oncol 1995;7:138–43. [pmid: 7756378]|
|55.||Quality of Life Research Associates. Lung Cancer Symptom Scale. Charlottesville, VA: Quality of Life Research Associates; 2004|
Keywords: Lung cancer, quality of life, QOL instrument, review, FACT-L, EORTC QLQ-LC13, EORTC QLQ-C30.
Previous Document: Metronomic chemotherapy: changing the paradigm that more is better.
Next Document: Community-based organizations are critical partners in providing complete cancer care.