The use of chemotherapeutic agents for treatment of cancer has expanded widely with multiple potent agents being administered at higher but more tolerable doses. The majority of these patients receive several cycles of chemotherapy over a period of months, resulting in a toxic physiologic environment that causes adverse effects. These adverse effects can lead to a significant impact on the patients’ quality of life. Despite the amount of information regarding quality of life (QoL) instruments available in the literature, no systematic review has been conducted that examined QoL instrument that consists of all four subscales of physical, psychological, social and spiritual psychometric properties using a systematic approach.
The objective of this review was to critically analyse the literature and present the best available evidence related to QoL instruments, which can be used to assess adult patients with cancer on chemotherapy for use in clinical practice.
This review included randomised control trials (RCTs) and observational studies without control group related to QoL instruments used for cancer chemotherapy. The types of participants for this review included all adults with cancer over the age of 18 years old whom have undergone chemotherapy.
A three-step search strategy was utilised to search for primary research articles published in English language from January 1998 to December 2009. An initial search of MEDLINE and CINAHL was undertaken followed by analysis of the text words contained in the title and abstract, and the text terms used to describe the article. A second search strategy using all the identified keywords and the index terms was used for the 20 databases. The relevant list of all identified articles were searched for additional articles.
A total of 3,149 references were retrieved during the initial search. Only 13 articles that had performed validation of the QoL instruments and contained the four subscales of physical, psychological, social and spiritual were included in this review. Four QoL instruments were identified. These include the City of Hope QOL - Ovarian Cancer Tool (QOL-OVCA), QOL-Breast cancer version (QOL-BC), New QOL tool India, and Quality of Life Index-Cancer version (QLI-CV).
The four QoL instruments included in this systematic review were validated comprehensively, which were feasible in clinical practice to assess patients with cancers undergoing chemotherapy. Although among the four QoL instruments, two are for specific types of cancer.
Implications for practice
The clinician needs to consider their specific population before selection of a suitable instrument, as not all of the identified instruments in this review are suitable for all types of cancer. The QOL-BC is breast cancer specific and QOL-OVCA is ovarian cancer specific. The QLI-CV instrument was used on patients with all types of cancer. However, male gender was absent or underrepresented with a high proportion of women with breast cancer recruited.
Implications for research
Future research examining the validity of the shortened versions of QOL-BC, QOL-OVCA, and QLI-CV instruments and other QoL instruments comprising the four subscales are required. The new Indian QOL tool may be useful in the clinical setting but needs further psychometric testing in different settings or languages.