Quality of Life Research

, Volume 9, Issue 9, pp 1041–1052 | Cite as

Perception of quality of life by patients, partners and treating physicians

  • Kerry A. Wilson
  • Anthony J. Dowling
  • Mohamed Abdolell
  • Ian F. Tannock


The objective of the study was to determine possible differences in perception of quality of life (QoL) between patients with metastatic breast or prostate cancer, their partners, and the treating physician. Patients with metastatic breast cancer (n = 71), and metastatic prostate cancer (n = 29), a partner, and the physician each completed the same QoL questionnaire indicating how they perceived the patient's QoL. The European organization for research and treatment of cancer (EORTC) QLQ-C30 questionnaire was used to assess patients with breast cancer and the modified prostate cancer specific quality of life instrument (PROSQOLI) for patients with prostate cancer. There was reasonable agreement in mean scores between patients, and physicians or partners, for many domains of QoL; however, there was substantial discordance between scores when considering individual patients. For patients with metastatic breast cancer, physicians systematically underestimated overall QoL (p = 0.0002), social functioning (p = 0.001), and role functioning (p = 0.008), while partners showed better agreement. With prostate cancer physicians tended to underestimate pain, while mean scores for spouses were more concordant. There is substantial variability between ratings of QoL by physicians or partners, as compared to patient ratings. Medical decisions should be based on information about QoL provided by patients using validated methods.

Cancer Proxy Quality of life 


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  1. 1.
    Chlebowski RT, Lillington LM. A decade of breast cancer clinical investigation: Results as reported in the Program/ Proceedings of the American Society of Clinical Oncology. J Clin Oncol 1994; 12: 1789–1795.PubMedGoogle Scholar
  2. 2.
    Tannock IF, Osoba D, Stockler MR, et al. Chemotherapy with mitoxantrone plus prednisone or prednisone alone for symptomatic hormone-resistant prostate cancer: A Canadian randomized trial with palliative end points. J Clin Oncol 1996; 14: 1756–1764.PubMedGoogle Scholar
  3. 3.
    Kantoff PW, Conaway M, Winer E, Picus J, Volgelzang NJ. Hydrocortisone with or without mitoxantrone in men with hormone-refractory prostate cancer: Results of the Cancer and Leukemia Group B 9182 study. J Clin Oncol 1999; 17: 2506.PubMedGoogle Scholar
  4. 4.
    Anonymous. Outcomes of cancer treatment for technology assessment and cancer treatment guidelines. American Society of Clinical Oncology. J Clin Oncol 1996; 14: 671–679.Google Scholar
  5. 5.
    Priestman TJ, Baum M. Evaluation of quality of life in patients receiving treatment for advanced breast cancer. Lancet 1976; 1: 899–900.PubMedCrossRefGoogle Scholar
  6. 6.
    Coates A, Gebski V, Bishop JF, et al. Improving the quality of life during chemotherapy for advanced breast cancer. A comparison of intermittent and continuous treatment strategies. N Engl J Med 1987; 317: 1490–1495.PubMedCrossRefGoogle Scholar
  7. 7.
    Richards MA, Hopwood P, Ramirez AJ, et al. Doxorubicin in advanced breast cancer: Influence of schedule on response, survival and quality of life. Eur J Cancer 1992; 28A: 1023–1028.PubMedCrossRefGoogle Scholar
  8. 8.
    Bishop JF, Dewar J, Toner GC, et al. Paclitaxel as first-line treatment for metastatic breast cancer. The Taxol Investigational Trials Group, Australia and New Zealand. Oncology 1997; 11: 19–23.PubMedGoogle Scholar
  9. 9.
    Spitzer WO, Dobson AJ, Hall J, et al. Measuring the quality of life of cancer patients: A concise QL-index for use by physicians. J Chronic Dis 1981; 34: 585–597.PubMedCrossRefGoogle Scholar
  10. 10.
    Schipper H, Clinch J, McMurray A, Levitt M. Measuring quality of life of cancer patients: The Functional Living Index-Cancer: Development and validation. J Clin Oncol 1984; 2: 472–483.PubMedGoogle Scholar
  11. 11.
    Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85: 365–376.PubMedGoogle Scholar
  12. 12.
    Osoba D, Zee B, Pater J, Warr D, Kaizer L, Latreille J. Psychometric properties and responsiveness of the EORTC quality of life questionnaire (QLQ-C30) in patients with breast, ovarian and lung cancer. Qual Life Res 1994; 3: 353–364.PubMedCrossRefGoogle Scholar
  13. 13.
    Sneeuw KC, Aaronson NK, Osoba D, et al. The use of significant others as proxy raters of the quality of life of patients with brain cancer. Med Care 1997; 35: 490–506.PubMedCrossRefGoogle Scholar
  14. 14.
    Sprangers MA, Aaronson NK. The role of health care providers and significant others in evaluating the quality of life of patients with chronic disease: A review. J Clin Epidemiol 1992; 45: 743–760.PubMedCrossRefGoogle Scholar
  15. 15.
    Rothman ML, Hedrick SC, Bulcroft KA, Hickam DH, Rubenstein LZ. The validity of proxy-generated scores as measures of patient health status. Med Care 1991; 29: 115–124.PubMedGoogle Scholar
  16. 16.
    Hays RD, Vickrey BG, Hermann BP, et al. Agreement between self reports and proxy reports of quality of life in epilepsy patients. Qual Life Res 1995; 4: 159–168.PubMedCrossRefGoogle Scholar
  17. 17.
    Dorman PJ, Waddell F, Slattery J, Dennis M, Sandercock P. Are proxy assessments of health status after stroke with the EuroQol questionnaire feasible, accurate, and unbiased? Stroke 1997; 28: 1883–1887.PubMedGoogle Scholar
  18. 18.
    Rogers J, Ridley S, Chrispin P, Scotton H, Lloyd D. Reliability of the next of kins' estimates of critically ill patients' quality of life. Anaesthesia 1997; 52: 1137–1143.PubMedCrossRefGoogle Scholar
  19. 19.
    Blazeby JM, Williams MH, Alderson D, Farndon JR. Observer variation in assessment of quality of life in patients with oesophageal cancer. Br J Surg 1995; 82: 1200–1203.PubMedGoogle Scholar
  20. 20.
    Sneeuw KC, Aaronson NK, Sprangers MA, Detmar SB, Wever LD, Schornagel JH. Value of caregiver ratings in evaluating the quality of life of patients with cancer. J Clin Oncol 1997; 15: 1206–1217.PubMedGoogle Scholar
  21. 21.
    Sneeuw KC, A aronson NK, Sprangers MA, Detmar SB, Wever LD, Schornagel JH. Evaluating the quality of life of cancer patients: Assessments by patients, significant others, physicians and nurses. Br J Cancer 1999; 81: 87–94.PubMedCrossRefGoogle Scholar
  22. 22.
    Stockler MR, Osoba D, Goodwin P, Corey P, Tannock IF. Responsiveness to change in health-related quality of life in a randomized clinical trial: A comparison of the Prostate Cancer Specific Quality of Life Instrument (PROSQOLI) with analogous scales from the EORTC QLQ-C30 and a trial specific module. European Organization for Research and Treatment of Cancer. J Clin Epidemiol 1998; 51: 137–145.PubMedCrossRefGoogle Scholar
  23. 23.
    Stockler MR, Osoba D, Corey P, Goodwin PJ, Tannock IF. Convergent, discriminative and predictive validity of the Prostate Cancer Specific Quality Of Life Instrument (PROSQOLI): Assessment and comparison with analogous scales from the EORTC QLQ-C30 and a trial specific module. J Clin Epidemiol 1999; 52: 653–666.PubMedCrossRefGoogle Scholar
  24. 24.
    Bartko JJ. The intraclass correlation coefficient as a measure of reliability. Psychol Rep 1996; 19: 3–11.Google Scholar
  25. 25.
    Dixon JS, Bird HA. Reproducibility along a 10 cm vertical visual analogue scale. Ann Rheum Dis 1981; 40: 87–89.PubMedCrossRefGoogle Scholar
  26. 26.
    King MT. The interpretation of scores from the EORTC quality of life questionnaire QLQ-C30. Qual Life Res 1996; 5: 555–567.PubMedCrossRefGoogle Scholar
  27. 27.
    Osoba D, Rodrigues G, Myles J, Zee B, Pater J. Inter-preting the significance of changes in health-related quality-of-life scores. J Clin Oncol 1998; 16: 139–144.PubMedGoogle Scholar
  28. 28.
    Presant CA. Quality of life in cancer patients. Who mea-sures what? Am J Clin Oncol 1984; 7: 571–573.PubMedGoogle Scholar
  29. 29.
    Grossman SA, Sheidler VR, Swedeen K, Mucenski J, Piantadosi S. Correlation of patient and caregiver ratings of cancer pain. J Pain Symptom Manage 1991; 6: 53–57.PubMedCrossRefGoogle Scholar
  30. 30.
    Stephens RJ, Hopwood P, Girling DJ, Machin D. Randomized trials with quality of life endpoints: Are doctors' ratings of patients' physical symptoms interchangeable with patients' self-ratings? Qual Life Res 1997; 6: 225–236.PubMedCrossRefGoogle Scholar
  31. 31.
    Sprangers MA. Response-shift bias: A challenge to the assessment of patients' quality of life in cancer clinical trials. Can Treat Rev 1996; 22: 55–62.CrossRefGoogle Scholar
  32. 32.
    Epstein AM, Hall JA, Tognetti J, Son LH, Conant L, Jr. Using proxies to evaluate quality of life. Can they provide valid information about patients' health status and satis-faction with medical care? Med Care 1989; 27: S91–S98.PubMedGoogle Scholar
  33. 33.
    O'Brien J, Francis A. The use of next-of-kin to estimate pain in cancer patients. Pain 1988; 35: 171–178.PubMedCrossRefGoogle Scholar
  34. 34.
    da Silva FC, Reis E, Costa T, Denis L. Quality of life in patients with prostatic cancer. A feasibility study. The Members of Quality of Life Committee of the EORTC Genitourinary Group. Cancer 1993; 71: 1138–1142.PubMedCrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • Kerry A. Wilson
    • 1
  • Anthony J. Dowling
    • 1
  • Mohamed Abdolell
    • 2
  • Ian F. Tannock
    • 1
  1. 1.Department of Medical Oncology and Haematology, Princess Margaret HospitalUniversity of TorontoTorontoCanada
  2. 2.Department of Biostatistics, Princess Margaret HospitalUniversity of TorontoTorontoCanada

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