Quality of Life

With a steadily growing number of patients in the United States experiencing multiple chronic illnesses, palliative care should be integrated into the management of chronic conditions promoting a comprehensive approach to effective symptom management – boosting physical function and improved quality of life. This evolutionary change was prompted by the Patient Protection and Affordable Care Act in 2010, which expanded the discussion on patient access and requirements in the palliative care setting.
Support and Encourage Cancer Survivors in Staying Active With This Essential Resource!  
"Assessment of Neutropenia-Related Quality of Life in a Clinical Setting," available as a journal article and podcast, explores assessment strategies and recommendations for a questionnaire assessing patients’ neutropenia-related quality of life (QOL). The authors discuss how implementing a QOL screening questionnaire for neutropenia could help nurses identify at-risk patients and guide interventions that could have a positive influence on their treatment.
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 (e.g., 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 QOL (Nirenberg, 2006).
Older patients with cancer remain relatively underrepresented in clinical trials in general, let alone in trials examining exercise and its effects. However, a review of the literature did support that older patients who have higher levels of physical activity during their cancer treatment reported lower levels of fatigue, higher levels of functioning, and higher quality-of-life (QOL) evaluations both during and after their treatment.
The first real research linking exercise to improved quality of life (QOL) and management of fatigue was done by Winningham, MacVicar, and Burke (1986) with a population of patients with breast cancer during a time in medical thinking when the typical recommendation for patients with cancer was increased rest. During the 1980s, more than 40 studies demonstrated that physical activity in patients with cancer improves their functioning and QOL (Young-McCaughan et al., 2003). Winningham and colleagues published guidelines for exercise use in the cancer population.
This 18-minute slideshow provides an overview of management principles for chemotherapy-induced nausea and vomiting (CINV) in two parts (1 and 2). The discussion focuses on highly, moderately, and low emetogenic chemotherapy regimens and management strategies for them. A key point is prevention of CINV as the goal of care, with an emphasis on a proactive rather than reactive approach.  
Sleep-wake disturbances are frequently looked at as “symptom clusters”—groups of interrelated symptoms that can occur simultaneously and interact with each other to cause additional symptoms or worsen existing ones. Symptoms from cancer and its treatment have been studied as clusters only since around 2001 (Beck, Dudley, & Barsevick, 2005).
Specific, well-designed goals of an exercise program should drive the interventions, because specific interventions will likely produce specific outcomes. The most common types of exercise are aerobic, strength training, and flexibility regimens. However, given the heterogeneity of cancer types, a one-size-fits-all approach to exercise and cancer is unlikely to be effective. For example, for patients in whom cardiac output may have been compromised, a carefully planned exercise program with the goal of improving cardio-respiratory fitness may be in order.
Specific Effects of Aerobic Exercise Studies of aerobic exercise regimens ranging from supervised treadmill tests to stationary bike programs three times a week for 10–12 weeks showed that participants experienced (Visovsky & Dvorak, 2005)
Although more than one definition can be found, quality of life (QOL) is often defined as a state of well-being in which an individual can perform daily activities, combined with satisfaction with the levels of functioning and control of the disease and/or its symptoms (Hacker, 2009). Key to this definition is patients’ perception of their own QOL versus healthcare providers’ impression of it.
Side effects from cancer treatment can greatly affect the quality of life for many patients. Among the many troubling side effects, patients often describe loss of functional capacity and fatigue as some of the most debilitating (Hanna, Avila, Meteer, Nicholas, & Kaminsky, 2008). Research has found, however, that exercise has proven to be an effective management tool. What Is Important About Exercise and Its Relationship to Cancer?