Quality of Life (QOL) is a term heard frequently these days, particularly when issues of health, aging and economics are being discussed. Individuals have their own definition or interpretation of just what a good quality of life means to them. For some, QOL means having a job, a family and friends. To others, their measure of quality centers on the ability to afford travel, luxury cars, a "dream house" and a profitable stock portfolio. Still others would consider good health and grandchildren as essential to their idea of a good quality of life. We all have our dreams and needs that help to define quality in our lives.

The world Health Organization (WHO) defines QOL as: "(an) individual's perception of their position in life in the context of the culture and value system in which they live and in relation to their goals, expectations, standards and concerns. It is a broad-ranging concept affected in a complex way by the person's physical health, psychological state, level of independence, social relationships, and their relationship to salient features of their environment."

But what about quality when a diagnosis of cancer enters one's life? Any change in health status can disrupt what we might have considered a normal, stable lifestyle. And when that change is caused by a diagnosis of cancer, quality is certainly threatened or diminished, often replaced by fear and uncertainty.

Quality of life has several dimensions. People with cancer, their families and their loved ones have every right to expect those dimensions of quality to continue in spite of their diagnosis and all that it can bring. Healthcare professionals generally agree that quality of life has four dimensions or domains: physical, psychological, social and spiritual.

The physical dimension of quality of life includes comfort and mobility, among the many things that we take for granted in good health. The onset of disease and treatment related symptoms such as pain, weakness, fatigue, loss of appetite and changes in bowel or bladder function can drastically alter one's physical well-being. These symptoms may never occur in some people with cancer. However, those who do develop physical problems and symptoms will need care and support to restore an acceptable quality of life.

When describing the psychological dimensions of quality of life, most healthcare professionals include such human needs as enjoyment and leisure activity, happiness, a sense of purpose and control over one's life. Any or all of these elements can be challenged when a diagnosis of cancer leads to uncertainty, anxiety, fear for the future or depression. Family and caregivers must be alert to any signs that psychological intervention is needed to address these concerns.

Social well-being refers to the fact that we are all part of a broad and complex social environment where decreased quality of life is any single individual can have a "ripple" effect on many others. The social dimension of QOL includes roles and relationships, financial concerns, burden on the family, affection and sexuality. It is not difficult to see how easily these elements of everyday life can be severely disrupted when cancer is diagnosed. Early intervention with understanding and social support can help to ease the social burdens that may accompany the diagnosis of cancer.

Spiritual well-being is considered by some to be the most significant dimension of quality of life, and may also be the least well understood. Until recently, the concept of spirituality was considered to be faith-based or religious in nature. Although religion may well be a part of the spiritual dimension of quality of life, there are many other aspects of this dimension to be considered. Spiritual well-being encompasses uncertainty, religiosity, the meaning of illness and suffering, the purpose of life, transcendence (lying beyond the limits of ordinary experience) and hopefulness. It is not difficult to see how a diagnosis of cancer can lead to self-doubt and conflict with one's beliefs. In contrast, some will find meaning and solace through reliance on their strong spiritual foundation.

When facing the diagnosis of cancer, patients and their families may find problems arising from expected vs. experienced levels of well-being. Disturbances in quality of life can be the result. Attention to QOL becomes an important factor in treatment decision-making, supportive care and in evaluation of outcomes. Indeed, attention to quality of life must be an essential element throughout the entire spectrum of life with a cancer diagnosis, regardless of whether the outcome is end of-life or long term survivorship.

For more information and answers to specific questions contact the Rhode Island Cancer Council at info@ricancercouncil.org or call us at (401) 728-4800 or toll free 866-879-4100.

IT IS EASIER TO PREVENT CANCER THAN TO TREAT IT.

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