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Quality of life aspects in cases of oral cancer
Dear Editor, Re:A. Langius Clinical Effectiveness in Nursing (1997) I, 2 i 2-219 Quality of life aspects in cases of oral cancer
This paper addresses aspects of quality of life in cases of oral cancer. I approached it, as I approach 99% of quality of life papers, with a considerable degree of ambivalence and scepticism. On the one hand, I find the argument that our assessment of patient outcomes should include psychosocial, subjective, or quality of life elements as well as objective, survival related data to be a compelling one. On the other hand, I find that the quality of such research is often very poor. When I recently reviewed a sequence of 14 such papers (Draper, 1997) I found many of them to be characterised by the use of badly designed scales with unreported psychometric properties, and inappropriate research designs. I therefore applaud this paper for using a combination of validated scales that is likely to give information about a range of functional and psycho-social issues, and for examining the inter-relationships between the data in a creative and useful way. Readers may also be interested to note that scientific review criteria to evaluate quality of life and health status instruments have recently been published (Lohr et at, 1996).
REFERENCES
Draper P 1997 Nursing perspectives on quality of life. Routledge, London Lohr K, Aaronson N, Alonso Jet al, 1996 Evaluating quality of life and health status instruments: developing scientific review criteria. Clinical Therapeutics 18(5): 979-992
Dr Peter Draper RN, PhD Lecturer in Nursing
The issue of quality of life (QOL) following treatment of patients with head and neck cancer has, quite rightly, received a good deal of recent attention as witnessed by the bibliography provided in
Clinical Effectiveness in Nursing (1998) I, 44-47 9 1998 Harcourt Brace & Co. Ltd
the above paper by Languis. It is no surprise that patients with these tumours do suffer in respect of QOL as a result of treatment. The main point of the work by Languis was to compare three standardized instruments used in the assessment of QOL issues in patients being treated for oral cancer. The instruments used were well recognized and the conclusion was that several instruments should be used in QOL studies on these patients. My criticisms of the paper are based on three points: 1. The timespan over which the patients were treated is not recorded and it is therefore impossible to know whether treatment protocols remain the same throughout. There was no mention made of TNM staging and surgery was merely defined as being minor, moderate or major with little discussion on what this really meant. No attempt was made to look at results in terms of individual tumour sites, e.g. comparison of results for tongue versus maxillary tumours. I would suggest that the QOL issues for tumours at these two disparate sites are quite different. Also, there was no attempt made to break down the results in relation to treatment mortality used. It would have been interesting to learn whether radiotherapy was associated with less QOL morbidity in the long term than with surgery. 2. Although starting off with a group of 71 patients only 15 were studied prospectively. Twenty-seven were assessed at 12 months following treatment, but I would be concerned that too much emphasis be put on the results for this latter group in that there was no pretreatment assessment available. 3. Whilst the conclusions drawn from the work are relevant and pertinent to future QOL studies, I found the way the author presented the results somewhat confusing; it could have been put over in a much more simplistic manner. Combined with the somewhat clumsy English it is not an easy paper to read and follow, particularly when the issues it covers are straightforward and uncontentious.
Nicholas D. Stafford
This paper addresses aspects of quality of life in cases of oral cancer. I approached it, as I approach 99% of quality of life papers, with a considerable degree of ambivalence and scepticism. On the one hand, I find the argument that our assessment of patient outcomes should include psychosocial, subjective, or quality of life elements as well as objective, survival related data to be a compelling one. On the other hand, I find that the quality of such research is often very poor. When I recently reviewed a sequence of 14 such papers (Draper, 1997) I found many of them to be characterised by the use of badly designed scales with unreported psychometric properties, and inappropriate research designs. I therefore applaud this paper for using a combination of validated scales that is likely to give information about a range of functional and psycho-social issues, and for examining the inter-relationships between the data in a creative and useful way. Readers may also be interested to note that scientific review criteria to evaluate quality of life and health status instruments have recently been published (Lohr et at, 1996).
REFERENCES
Draper P 1997 Nursing perspectives on quality of life. Routledge, London Lohr K, Aaronson N, Alonso Jet al, 1996 Evaluating quality of life and health status instruments: developing scientific review criteria. Clinical Therapeutics 18(5): 979-992
Dr Peter Draper RN, PhD Lecturer in Nursing
The issue of quality of life (QOL) following treatment of patients with head and neck cancer has, quite rightly, received a good deal of recent attention as witnessed by the bibliography provided in
Clinical Effectiveness in Nursing (1998) I, 44-47 9 1998 Harcourt Brace & Co. Ltd
the above paper by Languis. It is no surprise that patients with these tumours do suffer in respect of QOL as a result of treatment. The main point of the work by Languis was to compare three standardized instruments used in the assessment of QOL issues in patients being treated for oral cancer. The instruments used were well recognized and the conclusion was that several instruments should be used in QOL studies on these patients. My criticisms of the paper are based on three points: 1. The timespan over which the patients were treated is not recorded and it is therefore impossible to know whether treatment protocols remain the same throughout. There was no mention made of TNM staging and surgery was merely defined as being minor, moderate or major with little discussion on what this really meant. No attempt was made to look at results in terms of individual tumour sites, e.g. comparison of results for tongue versus maxillary tumours. I would suggest that the QOL issues for tumours at these two disparate sites are quite different. Also, there was no attempt made to break down the results in relation to treatment mortality used. It would have been interesting to learn whether radiotherapy was associated with less QOL morbidity in the long term than with surgery. 2. Although starting off with a group of 71 patients only 15 were studied prospectively. Twenty-seven were assessed at 12 months following treatment, but I would be concerned that too much emphasis be put on the results for this latter group in that there was no pretreatment assessment available. 3. Whilst the conclusions drawn from the work are relevant and pertinent to future QOL studies, I found the way the author presented the results somewhat confusing; it could have been put over in a much more simplistic manner. Combined with the somewhat clumsy English it is not an easy paper to read and follow, particularly when the issues it covers are straightforward and uncontentious.
Nicholas D. Stafford