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Table of Contents
Year : 2019  |  Volume : 2  |  Issue : 2  |  Page : 213-214

Health-related quality of life: Is it a missing feature in the Indian cancer setting?

Department of Palliative Medicine and Supportive Care, MAHE, Kasturba Medical College, Manipal, Karnataka, India

Date of Web Publication20-Dec-2019

Correspondence Address:
Naveen Salins
Department of Palliative Medicine and Supportive Care, MAHE, Kasturba Medical College, Manipal - 576 104, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/CRST.CRST_91_19

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How to cite this article:
Salins N. Health-related quality of life: Is it a missing feature in the Indian cancer setting?. Cancer Res Stat Treat 2019;2:213-4

How to cite this URL:
Salins N. Health-related quality of life: Is it a missing feature in the Indian cancer setting?. Cancer Res Stat Treat [serial online] 2019 [cited 2022 Jul 1];2:213-4. Available from: https://www.crstonline.com/text.asp?2019/2/2/213/273705

Health-related quality of life (HRQOL) in an advanced cancer setting is a person-centered comprehensive care of an individual. It has four determinants. First, the person with advanced cancer has access to complete health-related information, where the patient understands the diagnosis and prognosis and knows what is to be expected and can be prepared. Second, the person has access to pain and symptom management and receives emotional, social, and spiritual support. Third, the person's autonomy is preserved wherein the wishes of the person regarding nature, timing, and place of care are respected. Fourth, the person is able to receive person-centered comprehensive care across various settings, including care in the hospital, at home, or hospice and has access to good, peaceful, and dignified end-of-life care.[1],[2]

Every year, approximately 1.15 million new cancer cases are diagnosed in India, and at least 70%–80% present with Stage III and Stage IV disease at diagnosis.[3] Cancer-related death in India is around 785,000/year.[3] Around two-thirds of patients with cancer are incurable at the time of presentation and receive upfront palliative cancer treatment. However, according to the 2015 quality of death report ranking, in India, the capacity to deliver palliative care is scored as 0.6/100, i.e., only 0.4% of the population in India have access to palliative care.[4] Palliative care interventions are known to improve the HRQOL.[5] In India, there is a significant gap between the need for palliative care and palliative care provision, which negatively impacts the HRQOL in the Indian patients with advanced cancer.

The review of Indian HRQOL studies in the cancer settings has shown that in a mixed group of cancer patients in South India, 80% of the cancer patients reported average to below-average HRQOL.[6] In another South Indian study involving patients with advanced cancer, pain and breathlessness had a greater impact on HRQOL. Moreover, social, emotional, and role functioning domains of the HRQOL scores were lower in comparison to other HRQOL scores.[7] In Indian patients with aerodigestive tract cancers, lower scores in HRQOL were observed across all domains, and mood and anxiety had a significant impact on HRQOL. Moreover, clinical site and stage of the cancer also had an impact on HRQOL scores.[8] Among the rural Indian breast cancer patients, poor HRQOL scores were associated with lack of education, loss of income, and lack of spousal or family support.[9] These findings were corroborated in another study, where lack of family support, lack of insurance coverage, and financial difficulties were associated with high rates of depression that had an impact on HRQOL.[10] Patients treated with novel agents for multiple myeloma at a tertiary cancer center in rural India, had higher financial strain and lower scores in physical functioning as compared to the reference values. Patients reported that the most common symptom experienced was pain in 60% and the most common toxicity was peripheral neuropathy in 60% patients.[10]

The study by Asthana et al.,[11] published in this issue, explores the HRQOL in 100 patients accessing outpatient palliative care in a tertiary cancer hospital in an Indian metropolitan city. The study results demonstrated the complex interplay of physical symptoms, emotional issues, social factors, and spiritual concerns impairing the HRQOL. Although in the discussion section, the author has compared the study results with the Middle Eastern, African, and Western studies, the Indian studies on HRQOL[6],[7],[8],[9],[10] in advanced cancer have demonstrated similar findings.

The search of literature performed using the SCOPUS database showed very few studies on HRQOL in the Indian cancer setting, and majority of them explored the HRQOL needs in advanced cancer. Interventions to improve HRQOL or HRQOL as an outcome of an intervention in the Indian cancer setting were seldom seen. Therefore, the study by Asthana et al.[11] also falls into the category of exploratory research on HRQOL in cancer. Although there is limited number of studies exploring HRQOL in cancer, the presence of poor quality of life in advanced cancer setting is already established. Therefore, it is now time to develop interventions that improve HRQOL and test its effectiveness.

There are many landmark Western studies that have established the effectiveness of interventions to improve HRQOL.[5],[12],[13],[14] However, these interventions or outcomes of these interventions are not readily transferrable to the Indian setting.[15] The complex interventions to improve HRQOL in the Indian cancer patients have to be developed de novo or harmonized from the existing interventions proven to be effective. It involves conducting qualitative studies to know the views of the stakeholders, i.e., patients, families, and providers about the nature of the interventions and their outcomes. The qualitative data are used to either develop a new intervention or harmonize an existing intervention. Subsequently, the complex intervention developed to improve HRQOL is tested for its effectiveness in the Indian cancer setting. Therefore, the further research in India on HRQOL in cancer should be focused on developing interventions for improving HRQOL and determining the benefits of these interventions.

  References Top

Smith R. A good death. An important aim for health services and for us all. BMJ 2000;320:129-30.  Back to cited text no. 1
Steinhauser KE, Clipp EC, McNeilly M, Christakis NA, McIntyre LM, Tulsky JA. In search of a good death: Observations of patients, families, and providers. Ann Intern Med 2000;132:825-32.  Back to cited text no. 2
Chandramohan K, Thomas B. Cancer trends and burden in India. Lancet Oncol 2018;19:e663.  Back to cited text no. 3
Unit EI. The 2015 Quality of Death Index: Ranking Palliative Care Across the World. London: The Economist Intelligence Unit; 2015:15.  Back to cited text no. 4
Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010;363:733-42.  Back to cited text no. 5
Kannan G, Rani V, Ananthanarayanan RM, Palani T, Nigam N, Janardhan V, et al. Assessment of quality of life of cancer patients in a tertiary care hospital of South India. J Cancer Res Ther 2011;7:275-9.  Back to cited text no. 6
Sowmya SKR, Thomas D, Zachariah S, Daniel Sunad A. Assessment of adverse events and quality of life of cancer patients in a secondary level care, rural hospital in South India. Value Health Reg Issues 2013;2:103-6.  Back to cited text no. 7
Gupta B, Kumar N, Johnson NW. Predictors affecting quality of life in patients with upper aerodigestive tract cancers: A case-control study from India. Oral Surg Oral Med Oral Pathol Oral Radiol 2017;123:550-8.  Back to cited text no. 8
Gangane N, Khairkar P, Hurtig AK, San Sebastián M. Quality of life determinants in breast cancer patients in central rural india. Asian Pac J Cancer Prev 2017;18:3325-32.  Back to cited text no. 9
Sudarisan SS, Abraham B, George C. Prevalence, correlates of depression, and its impact on quality of life of cancer patients attending a palliative care setting in South India. Psychooncology 2019;28:1308-13.  Back to cited text no. 10
Asthana S, Bhatia S, Dhoundiyal R, Labani SP, Garg R, Bhatnagar S. Quality of life and needs of the Indian advanced cancer patients receiving palliative care. Cancer Res Stat Treat 2019;2:138-44.  Back to cited text no. 11
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Bakitas MA, Tosteson TD, Li Z, Lyons KD, Hull JG, Li Z, et al. Early Versus delayed initiation of concurrent palliative oncology care: Patient outcomes in the ENABLE III randomized controlled trial. J Clin Oncol 2015;33:1438-45.  Back to cited text no. 12
El-Jawahri A, Abel GA, Traeger L, Waldman L, Markovitz N, VanDusen H, et al. Quality of life and mood of older patients with acute myeloid leukemia (AML) receiving intensive and non-intensive chemotherapy. Leukemia 2019;33:2393-402.  Back to cited text no. 13
El-Jawahri A, Greer JA, Pirl WF, Park ER, Jackson VA, Back AL, et al. Effects of early integrated palliative care on caregivers of patients with lung and gastrointestinal cancer: A randomized clinical trial. Oncologist 2017;22:1528-34.  Back to cited text no. 14
Deodhar JK, Noronha V, Muckaden MA, Atreya S, Joshi A, Tandon SP, et al. A study to assess the feasibility of introducing early palliative care in ambulatory patients with advanced lung cancer. Indian J Palliat Care 2017;23:261-7.  Back to cited text no. 15
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