Quality of Life Issues Related to Neutropenia

Quality of life (QOL) is a broad term that reflects a patient’s overall sense of well-being and satisfaction with living (Ropka & Padilla, 2007).  Studies demonstrate that the incidence, severity, and duration of other side effects associated with cancer treatment (such as vomiting, anorexia, fatigue) are higher when they occur in the presence of neutropenia , and that neutropenia occurring alone has a negative effect on patients’ willingness to continue treatment, and their general quality of life (Nirenberg, 2006b). Although QOL considerations are of importance in the treatment phase of patient care, they become even more critical in the palliative care setting.

At the onset, the presence of neutropenia in a patient’s life has a diminishing effect on its quality, as patients must increase their vigilance to assure meticulous skin care, avoid others with respiratory diseases, or monitor their diet for restrictions.  Those who experience febrile neutropenia are typically hospitalized, leading to isolation or loss of family and work roles.   QOL measurement tools are often used in the research setting, but inconsistently utilized in clinical practice. Research has demonstrated that an assessment of QOL at baseline may be an independent predictor of survival in some cancer scenarios, and that poor QOL during chemotherapy treatment may affect the patient’s willingness to continue treatment (Ropka & Padilla, 2007).

Literally hundreds of QOL questionnaires exist. Some examples include the commonly used European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire-C30 (EORTC QLQ-C30), which detects numerous conditions including depression, anxiety, and functional limitations, and can be used for a variety of cancer conditions. Other QOL questionnaires are more disease or condition specific; an example is the Functional Assessment of Cancer Treatment (FACT).  The FACT-G, a 33-question scale, was developed specifically for the cancer patient population. The neutropenia- specific sub-questionnaire FACT-N (Calhoun et al., 2002) adds additional questions specific to the neutropenia experience.

The use of a culturally appropriate, easy-to-use, sensitive, specific, reliable and validated QOL questionnaire that measures those issues most likely to be experienced by patients with neutropenia should be a part of daily clinical practice. Its routine use will facilitate dialogue, uncover social or psychological issues not always identified during rushed clinic visits, and can help identify and prioritize issues requiring intervention.

For additional information, consider reading Marr, J.A. (2006). Care of patients with neutropenia. CJON 10(2), 164-166.

References:

Calhoun, E.A., Chang, C.H., Welshman, E., & Cella, D. (2002). A neutropenia-specific quality of life instrument: Rationale for the development of the FACT-N (Abstract 1498). Poster presented at the annual meeting of the American Society of Clinical Oncology, Orlando, Fl.

Nirenberg, A., Bush, A.P., Davis, A., Friese, C.R., Gillespie, T.W., & Rice, R.D. (2006b). Neutropenia: State of the knowledge part II. Oncology Nursing Forum33(6), 1202-1208.

Ropka, M.E. & Padilla, G. (2007). Assessment of neutropenia-related quality of life in a clinical setting. Oncology Nursing Forum 24(2), 403-408.