Randomized comparison of four tools measuring overall quality of life in patients with advanced cancer

PURPOSE

We report on a clinical trial developed to compare four different instruments that provide overall quality-of-life (QOL) scores, ranging from a simple, one-item instrument to more detailed instruments. Two issues addressed were (1) Will QOL tools suffer from missing data when used in a community-based cooperative group setting?, and (2) Are there additional data generated by a more detailed multiitem instrument over that provided by a single-item global QOL question?

MATERIALS AND METHODS

A four-arm randomized trial was designed to compare four instruments that provide overall QOL scores in patients with advanced colorectal cancer. Patients and physicians completed the single-item Spitzer Uniscale (UNISCALE) at baseline and monthly. Patients were randomly assigned to complete, in addition, either the 22-item Functional Living Index-Cancer (FLIC), the five-item Spitzer QOL index (QLI), a picture-face scale (PICT), or nothing else.

RESULTS

A total of 128 patients were randomized. Greater than 90% complete QOL data were obtained. There was strong correlation, concordance, and criterion-related validity among all four patient-completed tools. The UNISCALE had a greater decrease over time than did the FLIC (P=.005), which suggests a greater sensitivity; the UNISCALE was similar to the QLI and the PICT in this regard. Physicians provided lower UNISCALE scores than patients. Results supported the hypothesis that QOL is prognostic for survival.

CONCLUSION

Patients can effectively complete QOL tools in a cooperative group setting with proper education of health care providers and patients. A simple single-item tool (UNISCALE) appears to be appropriate to obtain a measure of overall QOL.

Pilot study evaluating local anesthetics administered systemically for treatment of pain in patients with advanced cancer

Based on evidence that suggested that systemically administered local anesthetics might be useful in chronic pain, we initiated a pilot study to evaluate the activity and toxicity of mexiletene and flecainide in the treatment of cancer pain. Twenty-one courses of either mexiletine or flecainide were administered to patients with an Eastern Cooperative Oncology Group performance status of three or better, who were suffering from cancer pain inadequately controlled with opioid analgesics. Pain control was assessed by patient questionnaires to monitor benefit and toxicity. In 17 cases, there was no suggestion of benefit. Two cases had relatively clear-cut analgesic benefit, and two others had some suggestion of mild-to-moderate analgesic relief. Flecainide was relatively well tolerated, but mexiletine appeared to cause nausea and/or vomiting in five of eight patients. This pilot trial suggests that systemically administered local anesthetics can relieve pain in a minority of patients with cancer pain.