Randomized trial of quality-of-life measurement in oncology practice: Do oncologists need to know?

Abstract

9586 Background: Previous randomised trial suggested that regular measurement of quality of life (QOL) during chemotherapy may have a positive impact on patient wellbeing, even when the data was not provided to physicians (Velikova et al. J Clin Oncol 2004, 22:714). The trial design allowed for possible contamination effect on physicians behaviour, as patients were randomized, but physicians saw both patients with and without QOL information. This subsequent randomized study was designed to replicate previous trial without contamination effect, evaluating the impact of questionnaire completion only, without feedback and training of oncologists. Methods: Cancer patients on chemotherapy were randomized to: intervention-completion of EORTC QLQ-C30 and Hospital Anxiety and Depression Scale on touch-screen computers before 3 consecutive clinic visits, without providing scores to oncologists; and Control group-standard care. Outcome measures were doctor-patient communication (measured by content analysis of recorded consultations) and patient wellbeing (measured by FACT-G questionnaire). Results: 502 patients from 3 hospitals were approached, 145 (29%) declined, 356 were randomized, 236 completed the study. No significant impact on doctor-patient communication was found, apart from an increased discussion of appetite in the intervention group (51% of encounters vs 40% in control group, p=0.015). Patients completing the questionnaires showed a small, but statistically significant deterioration in their wellbeing in comparison with the control group (mean change FACT-G score -3.3 in intervention group vs 0.99 in control, p=0.047) in a regression analysis controlling for baseline FACT-G, age, gender, diagnosis, performance status, response to treatment. Conclusions: This trial did not confirm previous findings of positive effect on patient care from regular QOL measurement during chemotherapy and suggested a small negative effect, when the information is not provided to oncologists. It appears that the QOL intervention could only work if both patients and physicians participate in eliciting relevant issues. Training physicians how to engage and use QOL information in clinical practice should be the focus of future work. No significant financial relationships to disclose.