One of the most interesting findings in quality of life studies of lung cancer patients is that initial quality of life was found to be the strongest prognostic factor for survival. This was confirmed by studies carried out by Ruckdeschel and Piantadosi and by Ganz et al. Using the Functional Living Index-Cancer (FLI-C), it was found that FLI-C score was an independent predictor of survival even after correcting for initial performance status, weight loss, stage of disease, number of metastatic sites, and type of treatment. Diastolic
These findings have shown that nonmedical factors such as quality of life assessment play an important role in predicting survival and that they should be evaluated. For example, Buccheri et al, in a study of 128 lung cancer patients using the Therapy Impact Questionnaire, found that in addition to the stage of disease, some aspects of quality of life such as difficulty at work and doing household jobs are prognostic factors of improved survival.
The contribution of communication problems between patients and their physicians to the quality of life in lung cancer patients has been investigated by several researchers. Early studies on the subject showed that psychological adjustment in lung cancer patients might be improved if patients were given opportunities to ask questions about their disease and participate in decisions about treatment. Ber-glund and Sjoden noticed that communication problems with medical staff were strongly associated with anxiety and with anticipatory nausea and vomiting. Of 94 lung cancer patients, 74% wanted to be told about their diagnosis. However, in those who did not want to know about the disease, their quality of life was found to have deteriorated as measured by psychological, social, and financial factors.
However, these indicate firstly the importance of the communication issues, and secondly that studying quality of life requires a straightforward communication with patients themselves. Relying on other sources of information such as relatives or physicians may not reflect the exact nature of the patients’ feelings and concerns. Interviewing 40 lung cancer patients and their relatives showed that relatives rated symptoms higher and mood lower than patients. Significant differences were found between 71 lung cancer patients and their relatives or physicians. Physicians were more optimistic, relatives were more pessimistic. Physicians were most reliable at rating treatment tolerance by patients. Two British randomized clinical trials revealed high levels of agreement between clinicians and patients in reporting symptoms, but increasing disagreement with increasing severity of symptoms. They found that physicians underestimated the level of severity of the patient’s symptoms.