Assessment of Health Status and Outcomes in the Older Cancer Patient: QOL and Geriatric Assessment
Historically, most clinical trials in oncology have used tumor shrinkage, time to disease progression, treatment-related toxicities, and survival as their main study end points. However, over the past three decades, quality of life (QOL) has emerged as an important end point in the ﬁeld of oncology aswell as other ﬁelds ofmedicine. QOL considerations have been brought to the forefront of health care research as a result of the convergence of several important factors. These include (i) prolonged life expectancy, from the eradication of many infectious diseases and the successful treatment of other conditions (e.g., diabetes and kidney failure); (ii) the appearance of many new chronic diseases (e.g., arthritis, heart disease, cancer, andHIV infection); (iii) the increasing cost and toxicities of some treatments; and (iv) the concern about health outcomes beyondmortality. Coincident with these circumstances has been a rapidly growing science of outcomes assessment, which borrows extensively from concurrent methodological advances in the social sciences, enabling the quantiﬁcation and evaluation of the QOL outcomes of diseases and their treatments (1). In this chapter, wewill have an opportunity to examine the intersection of these events from the perspective of cancer in the elderly.