s. Outcome research 249 Questionnaire 63,152 Would pick up refer-

Evaluating patient-based outcome measures for use in clinical trials.

PURPOSEThis is the first published report on the validation of the Functional Assessment of Cancer Therapy-Breast (FACT-B), a 44-item self-report instrument designed to measure multidimensional quality of life (QL) in patients with breast cancer. The FACT-B consists of the FACT-General (FACT-G) plus the Breast Cancer Subscale (BCS), which complements the general scale with items specific to QL in breast cancer. The FACT-B was developed with an emphasis on patients' values and brevity and is available in nine languages.METHODS AND RESULTSTwo validation samples were used for this report. The first (n = 47) was tested twice over a 2-month period to assess sensitivity to change. Significant sensitivity to change in performance status rating (PSR) was demonstrated for the FACT-B total score, the Physical Well-Being (PWB) subscale, the Functional Well-Being (FWB) subscale, and the BCS. Sensitivity to change in QL as measured by the Functional Living Index-Cancer (FLIC) was documented in the FACT-B total score, ...

Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument.

The role of health care providers and significant others in evaluating the quality of life of patients with chronic disease: A review

People exaggerate the degree to which their future tastes will resemble their current tastes. We present evidence from a variety of domains which demonstrates the prevalence of such projection bias, develop a formal model of it, and use this model to demonstrate its importance in economic environments. We show that, when people exhibit habit formation, projection bias leads people to consume too much early in life, and to decide, as time passes, to consume more— and save less— than originally planned. Projection bias can also lead to misguided purchases of durable goods. We discuss a number of additional applications and implications.

/pdf/projection-bias-in-predicting-future-utility-22g5ul6ukd.pdf

Projection Bias in Predicting Future Utility

OBJECTIVE--To compare responses of patients with cancer with those of a matched control group, cancer specialists, general practitioners, and cancer nurses in assessing personal cost-benefit of chemotherapy DESIGN--Prospective study of consecutively recruited patients with cancer and other groups by questionnaire; half of the patients received the questionnaire again three months after starting treatment SETTING--A medical oncology ward of a London teaching hospital SUBJECTS--106 Patients with newly diagnosed solid tumours referred to the unit for consideration of treatment with cytotoxic chemotherapy, 100 of whom were able to complete the questionnaire 100 Matched controls, 315 cancer doctors (238 radiotherapists and 77 medical oncologists), 1500 randomly chosen general practitioners, and 1000 randomly chosen cancer nurses MAIN OUTCOME MEASURES--Percentage chance of cure, prolonging life, or palliation of symptoms required to make treatment worth while with two hypothetical chemotherapy treatments, with severe and mild side effects respectively RESULTS--Respondents to the questionnaire comprised 100 patients, 100 controls, 60 (78%) medical oncologists, 88 (37%) radiotherapists, 790 (53%) general practitioners, and 303 (30%) cancer nurses Most patients were willing to accept intensive chemotherapy for a very small chance of benefit The median benefit required to make the hypothetical intensive treatments worth while for patients compared with controls were: for chance of a cure (range 1 to 100%) 1% v 50%, for prolonging life (range three months to five years) 12 months v 24-60 months, and for relief of symptoms (range 1 to 100%) 10% v 75% respectively There were no significant differences in the responses of the 50 patients completing the questionnaire on a second occasion Doctors and nurses were less likely to accept radical treatment for minimal benefit compared with the patients (median scores 10-50%, 12-24 months, and 50-75%, for chance of cure, prolonging life, and relief of symptoms respectively) Significantly more patients than controls accepted treatments giving the minimal benefit for each category (cure 531 v 190%, 670 v 350%; prolonging life 421 v 100%, 530 v 250%; relief of symptoms 426 v 100%, 587 v 190% for intensive and mild treatments respectively, p less than 0001) as was the case for comparison of patients with other groups CONCLUSION--Patients with cancer are much more likely to opt for radical treatment with minimal chance of benefit than people who do not have cancer, including medical and nursing professionals This could be taken into account when discussing treatment options with patients and their relatives

https://www.bmj.com/content/bmj/300/6737/1458.full.pdf

Attitudes to chemotherapy: comparing views of patients with cancer with those of doctors, nurses, and general public.

The extent to which a doctor or health professional can make a valid assessment of a patient's quality of life, anxiety and depression was investigated in a series of cancer patients. Doctors and patients filled out the same forms, viz. the Karnofsky, Spitzer, Linear Analogue Self Assessment Scales and a series of simple scales designed for this study, at the same time. Correlations between the two sets of scores were poor, suggesting that the doctors could not accurately determine what the patients felt. A further study examining the reproducibility of these scales demonstrated considerable variability in results between different doctors. It is concluded that if a reliable and consistent method of measuring quality of life in cancer patients is required, it must come from the patients themselves and not from their doctors and nurses.

D Lynch

Papers

Who should measure quality of life, the doctor or the patient?

Evaluation of a support group for cancer patients and their families and friends.

A Randomized Double-Blind Placebo Controlled Trial of Medroxyprogesterone Acetate (Mpa) in Cancer Cachexia