Quality of Life
Patient’s evaluation of quality of life
 Provides understanding of impact of illness
from patient’s viewpoint
– Different from health status or physical functioning
– Quality of life can be good even with physical disability
– More than health problems, loss of abilities, or
functional deficits
 Incorporation of patient’s values sets QOL
assessment apart from measures of health
status
Patient’s evaluation of quality of life
 Important tool for understanding individual
differences in response to illness
– Individual responses in adapting to cancer and
treatment
– Re-evaluation of life in context of life-threatening
disease
 Ultimate purpose for QOL assessment 
Enhanced well-being
– Particularly in palliative care and at end of life
(interventions aimed at providing comfort and
emotional support)
– Maximize QOL
Ferrans Model of QOL (1985 & 1990)
Scope of the Concept
Health and
Functioning Domain
Quality of
Life
Social and
Economic Domain
Psychological/
Spiritual Domain
Family
Domain
Ferrans & Powers Quality
of Life Index
Part 1: SATISFACTION with various aspects of life
Part 2: IMPORTANCE of those same aspects of life
• Scores reflect satisfaction with the aspects of life
that are valued by the individual.
• Five Scores
–
–
–
–
–
Overall QOL
Health and functioning
Psychological/spiritual
Social and economic
Family
Ferrans & Powers Quality
of Life Index
 Published first in 1985 (200+ published studies)
 International research (30+ countries)
– Americas: USA, Canada, Mexico, Brazil, Chile
– Europe: Denmark, France, Great Britain, Hungarian,
Italy, Lithuania, Norway, Poland, Portugal, Romania,
Russia, Spain, Sweden
– Middle East: Israel, Jordan, Turkey
– Africa: South Africa
– Asia: India, China, Korea, Japan, Thailand, Taiwan
– Australia and New Zealand
 U.S. cross-cultural research
– African Americans
– Mexican Americans
– Korean Americans
21 Languages
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Arabic
Chinese
Danish
English
French
Hebrew
Hungarian
Italian
Japanese
Korean
Lithuanian
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Norwegian
Polish
Portuguese
Romanian
Russian
Spanish
Swedish
Tamil
Thai
Turkish
Ferrans & Powers Quality of Life Index -Prognostic value in 251 breast cancer patients (p = .0006)
Survival Functions
1.2
1.0
.8
.6
Cum Survival
NTILES of HEALTHFU
.4
2
2-censored
.2
1
0.0
1-censored
-10
0
10
20
30
40
50
60
Overall survival from the date first seen at MRMC
Quality of Life of African American
Cancer Survivors
Quality of Life of African American Cancer Survivors
NIH R01 CA89418 (CALGB 119901)
 Survivors: 500 African American cancer survivors
– Breast, prostate, colon
– Currently free of cancer
 Controls: 500 African American non-cancer controls
– Selected via random digit dialing from the areas in
which the cancer survivors reside.
– Matched (as a group) to the survivor group on age,
gender, health insurance status, and education level
16 Participating CALGB Institutions
 Heme/Onc Associates
of Central NY
 Northern Indiana
 Ohio State University
 University of Chicago
 University of Illinois at
Chicago
 Wake Forest
 Walter Reed
 Washington University –
St. Louis
 Hartford Hospital
 Jersey Shore Medical
Center
 Navy Medical Center –
San Diego
 Queens Hospital
Medical Center
 Roswell Park Cancer
Center
 Sibley Memorial
Hospital
 Wayne Memorial
Hospital - SCCC
 Jesse Brown VA
Medical Center
Distribution of Participating Institutions
Explaining the Variance in Quality of Life
3%
2%
.4% .2%
Urban Life Stress
5%
5%
Depression
26%
Social Support
Physical Function
8%
Comorbidities
9%
Work Problems
Trust in MD
19%
22%
Spirituality
Age
Cancer Survivor
Model explained 66% of variance in QOL
Interaction