Origins of QOL

Question 1

Karnofsky

Answer 1

• performance status scale was developed in the late 1940s
• clinicians measured immediate “objective” and “subjective” improvement
• introduced measures of “performance status”

Question 2

Karnofsky Scale Numbers

Answer 2

• Able to work (80-100)

- Highly dependent people (20-30)

Question 3

The Discovery of “QOL”

Answer 3

• new concept in 1970s

- major social shifts in the 1960s (environmental movement)

Question 4

Bardelli & Saracci 1978

Answer 4

“Assessment of quality of life and, more generally, cost benefit evaluations in the health area have become a subject of increasing interest in recent years”

• RCTs had become more common in the 1970s and included “hard” parameters
• identified direct or indirect indicators

Question 5

British Journal of Cancer 1988

Answer 5

The need to measure quality of life during clinical trials of cancer therapy, according to the authors of a paper published in the British Journal of Cancer in 1988, was now ‘widely recognized’ as treatment was often toxic and frequently given with palliative rather than curative intentions

Question 6

Palliative Care

Answer 6

• increase in survival rates
• QOL became more important than just surviving
• more than just relieving symptoms

Question 7

Measuring QOL

Answer 7

assessment instruments took the form of questionnaires, sometimes developed with input from psychologists and completed mostly by doctors, nurses, or social workers

Question 8

Self-Reported Diary Card

Answer 8

• incorporated the patient’s perspective was a diary card that had to be filled in by the subjects of clinical trials themselves and that by the early 1980s was used in several cancer treatment studies organized by the Medical Research Council (MRC)
• ambiguous and context-dependent
• need to balance practicality and accuracy