The concept of ‘quality of life’

The impact that the disease and the treatments have on the quality of life is of interest as .much to care-givers as to patients and their relatives (de Haes and van Knippenberg 1985; Wellisch 1984). Advances in treatment have had the result-cancer often now being a chronic disease-that it is more a question of knowing how to survive rather than how to prepare for a fatal outcome. The policy of care must go beyond the traditional biomedical procedures and be concerned with total well-being (Fallowfield 1990). The treatments are aggressive in their impact on the physical, social, and emotional life of patients (Greer 1984). Surgery is at times very mutilating (breast, ENT area, urogenital system and rectum); radiotherapy has significant secondary effects (skin problems, postactinic lesions, asthenia, anxiety and depression) (Priestman et al. 1981); chemotherapy, often considered to be the most disturbing, is administered over long periods and induces considerable toxicity (nausea, vomiting, digestive problems, hair loss, and anxiety) (Linssen et al. 1982; Priestman and Baum 1976; Hochberg and Linggood 1979). It is necessary to assess whether the chances of improvement and survival have any benefit in comparison with all the inconveniences. For most writers, the concept of quality of life is more important than quantity and duration. It integrates physical comfort, psychological well-being, and level of performance. It should be linked with an assessment of the wider social context and function. Moreover, the economic aspect should not be neglected, since some patients often devote large sums to the search for adjuvant treatments and special diets to alleviate their distress.