Considerable differences in the evaluation of global quality of life in primary breast cancer patients – Results in the control group of a randomized controlled trial

Introduction:

Many breast cancer patients are affected by reduced quality of life (QoL). Problems often remain unrecognized. We investigated identification of diseased QoL by coordinating practitioners (CP).

Method:

Effectiveness of a QoL-pathway with QoL-diagnosis and therapy was investigated in an RCT with 199 primary breast cancer patients (intervention group (IG) n=99, control group (CG) n=100). All patients answered a QoL-questionnaire (EORTC QLQ-C30+BR23) during follow-up (0;3;6;9;12 months). CPs judged patients'global QoL as well. Diseased QoL was diagnosed below 50points (scale 0–100, very bad-very good). In IG results were presented to CP in expert reports, including recommendations for QoL-therapy. Therefore, statistical analyses were restricted to CG. Rates of diseased global QoL (<50points) of patients and CPs were compared by Chi square tests.

Results:

Discrepancy between rates of diseased QoL judged by CPs vs.patients was largest directly after surgery when 31 of 98 patients reported diseased QoL, but only 2 of 98 clinicians (χ²=30.644, p<0,001). 4 of these 31 patients had very bad global QoL (0points), but 3 were diagnosed QoL≥50points by clinicians. After clinical discharge, rates of diseased QoL diagnosed by CPs significantly increased (0months: 2/98 vs. 3 months: 11/80; p<0.001, McNemar's test), but remained below those of patients (significant at 3 (patient: 26/82 vs.CP: 11/80; χ²=7.410, p=0.006) and 6 months (25/84 vs. 11/83; χ²=6.729, p=0.009)).

Discussion:

Diseased QoL often was not identified by CPs. Discrepancy in QoL-judgments was largest directly after surgery, when clinicians almost always diagnosed good QoL whereas patients reported diseased or even zero QoL, indicating that patients often did not communicate their complaints to CPs.

Conclusion:

QoL-pathway with regular diagnosis and targeted therapy of diseased QoL supports patients and physicians in identification of QoL-deficits and creates background for better physician-patient communication.