Cancer is a group of diseases that can
cause nearly any sign or symptom. Cancer (is also known as a malignant tumor)
cells. Cancer differs from normal cells in three major respects: Rapid
proliferation (growing) without control, it can invade the surrounding tissue,
Metastases; the spread of a cancer to other parts of the body.
There are several main types of cancer. Carcinoma
is a cancer that initiate in the skin or in tissues that line or lid internal
organs. Sarcoma is a cancer that start in bone, cartilage, muscle, fat, blood
vessels, or other connective or supportive tissue. Leukemia is a cancer that
begins in blood-forming tissue, such as the bone marrow, and causes large
numbers of abnormal blood cells to be generated and enter the blood. Lymphoma
and multiple myeloma are cancers that begin in the cells of the immune system.
Central nervous system cancers are cancers that begin in the tissues of the
brain and spinal cord. Also called malignancy.
The signs and symptoms will rely on where
the cancer is, how big it is, and how much it affects the organs or tissues. If
a cancer has expansion (metastasized), signs or symptoms may appear in several
parts of the body.
Statistics (Global & SA)
the result from the International Agency for Research on Cancer (IARC), in 2012
there were 14.1 million new cancer cases and 8.2 million cancer deaths worldwide.
By 2030, the global burden is expected to grow to 21.7 million new cancer cases
and 13 million cancer deaths simply according to the growth and aging of the
population. There were an estimated 13.3 thousand new cancer cases and 8.9
thousand dying every year around the Saudi Arabia in 2008. (from International
Agency for Research on Cancer IARC).
Quality of life
The concept of quality of life broadly cover
how an individual measures the ‘goodness’ of multiple sides of their life. QoL
must include all areas of life and experience and consider the impact of
illness and treatment. it can only be described and measured in individual
terms, and depends on present lifestyle, experience, hope for the future. Such
as person’s emotional reactions to life events, mood, sense of life fulfilment
and satisfaction, and satisfaction with job and personal relationships.
Health-related quality of life (HRQoL) is
a multi-dimensional concept that includes areas attached to physical, mental,
emotional, and social functioning. It goes beyond through measures of
population health, life hope, and causes of death, and focuses on the impact
health status has on quality of life. A related concept of HRQoL is well-being,
which estimate the positive aspects of a person’s life, such as positive
emotions and life satisfaction.
and public health officials have used HRQoL and well-being to measure the
effects of chronic illness, treatments, and short- and long-term disabilities. While
there are sundry existing measures of HRQoL and wellbeing, methodological
development in this area is still outstanding. Over the decade, Healthy People
2020 will evaluate the following measures for monitoring HRQoL and well-being
in the United States
Reported Outcomes Measurement Information System (PROMIS) Global Health
Measure – assesses global physical, mental, and social HRQoL through
questions on self-rated health, physical HRQoL, mental HRQoL, fatigue, pain,
emotional distress, social activities, and roles.
Measures – assess the positive evaluations of people’s daily
lives—when they feel very healthy and satisfied or content with life, the
quality of their relationships, their positive emotions, their resilience, and
the realization of their potential.
Quality of life for cancer patients in
A person’s quality of life is impacted
from the beginning of the oncology experience, during which he or she
encounters many unplanned, life-altering events. First, the person discovers
there’s something wrong and “it’s cancer.” After hearing these words, there’s a
great deal to learn and think about, not to mention the decisions to be made.
Some decisions are difficult, but need to be made soon depending on the stage
of the disease. then, the person, now better known as the patient, experiences
the consequences of those decisions, such as surgery, chemotherapy, radiation,
or palliative care. The patient is entangled in this storm of events.
prevalence and Incidence of leukemia
according to the result from national
cancer institute, Leukemia represents 3.7% of all new cancer cases in the U.S.
and the number of new cases of leukemia was 13.7 per 100,000 men and women per
year. it is the seventh leading cause of cancer death in the U.S. the number of
deaths was 6.8 per 100,000 men and women per year. These rates are age-adjusted
and based on 2010-2014 cases and deaths. Approximately 1.5 percent of men and
women will be diagnosed with leukemia at some point during their lifetime, based
on 2012-2014 data. Prevalence of This Cancer, in 2014, there were an estimated
387,728 people living with leukemia in the U.S.
In Saudi Arabia, according to the result
from global health Statistics, the annual mortality rate per 100,000 people
from leukemia has increased by 43.7% since 1990, an average of 1.9%
per year. 60.5 per 100,000 men died in 2013, the peak mortality rate for men
was higher than that of women, which was 38.2 per 100,000 women.
of life after medication for leukemia patient
of HRQoL in leukemia suggests that survivors typically make a good recovery,
although lasting impacts have been associated with more aggressive treatment. bone
marrow transplantation, which has dominated the CML HRQoL literature, is
associated with long-term reductions in physical and role functioning.
Reductions in sexual desire, enjoyment and ability are of concern following
treatment for AML; both total body irradiation and bone marrow transplantation
are suspected to contribute but research investigating specific links has so
far proved inconclusive. In children,
side-effects from treatments for leukemia may have a greater
short-term impact on HRQoL than those for other cancers, which presumably has
implications for heightened distress and reduced HRQoL in children’s families.
Although prognosis for children is relatively good, impacts on both physical
and psychosocial HRQoL may persist into adulthood.
HRQoL questionnaires are currently available – the
FACT-Leu 6 from the FACIT
suite, the Life Ingredient Profile (LIP),7 and two modules
from the EORTC QLQ suite – the EORTC QLQ-CLL16 and the
MRC/EORTC Leukemia-BMT Module (QLQ-LEU).8
In its one related publication, 6 the FACT-Leu is
described as including 27 items that assess 17 physical symptoms (fevers,
bleeding, general pain, stomach pain, chills, night sweats, bruising, lymph
node swelling, weakness, tiredness, weight loss, appetite, shortness of breath,
functional ability, diarrhea, concentration, and mouth sores) and 10
emotional/social concerns (frustration with activity limitation, discouraged by
illness, future planning, uncertainty, worry about illness, emotional lability,
isolation, infertility concern, family worry, and worry about infections). The
version available from the FACIT website,
however, includes only 17 items additional to FACIT’s core measure, the FACT-G.
No published validation data for the FACT-Leu is yet available.
in Sweden, the LIP is a 4-part instrument administered at different times during
the patient’s disease.7 LIP 1 consists of 22 questions and is administered
at diagnosis to evaluate the patient’s physical and mental state as well as
leisure activities at baseline. LIP 2 is a 21-question follow-up component
aimed at tracking the physical and mental strain that the disease imposes. LIP
3 consists of 8 questions and is used in conjunction with LIP 2 to evaluate the
patient’s ability to enjoy activities despite the disease. Finally, LIP 4 is
used as a comparison to LIP 1 to show long-term changes to the patient’s HRQoL.
In a pilot study with 35 patients with leukemia, non-Hodgkin’s lymphoma and
myeloma, LIP 2 showed good internal consistency; test-retest reliability was
somewhat variable (Kappa = 0.42-1.00) across the 4 components; Pearson
correlations were above 0.7 between LIP2 scores and performance status (KPS)
and Vitagram scores; the LIP2 distinguished between advanced and total myeloma
groups and within the AML group over time.
EORTC-QLQ-CLL16 is a 16-item questionnaire designed to supplement the QLQ-C30
in assessing patients with CLL. It assesses fatigue (2 items), treatment side
effects (3 items), disease symptoms (5 symptoms) and infection (4 items), and
includes two single item scales on social activities and future health worries.
A full validation paper is expected to be published shortly.
systematic search of the literature from 1980 to 2007 was undertaken and
studies were identified and evaluated independently, according to a pre-defined
coding scheme, by three reviewers. Both HRQOL outcomes and traditional clinical
reported outcomes were systematically analyzed to evaluate their consistency
and their relevance for supporting clinical decision making. Nine RCTs were
identified, involving 3838 patients overall. There were four RCTs involving
acute myeloid leukemia patients (AML), three with chronic myeloid leukemia
(CML) and two with chronic lymphocytic leukemia (CLL). Six studies were published
after 2000 and provided robust methodological quality. Imatinib greatly
improved HRQOL compared to interferon based treatments in CML patients and
fludarabine plus cyclophosphamide does not seem to have a deleterious impact on
patient’s HRQOL when compared to fludarabine alone or chlorambucil in CLL
patients. This study revealed the paucity of HRQOL research in leukemia
patients. Nonetheless, HRQOL assessment is feasible in RCTs and has the great
potential of providing valuable outcomes to further support clinical decision
In other study that done to assess Quality of life and
long-term therapy in patients with chronic myeloid leukemia found
that. Due to the outstanding survival of patients treated with TKIs, the
prevalence of the disease is rapidly increasing across the world. However, with
this increased survival and increased prevalence more emphasis should be placed
on managing side effects to maximize the health-related quality of life of
patients with CML. First, health care providers should be aware of the impact
this disease and its treatments have on the health-related quality of life of
patients, across a broad set of symptoms and functions. Addressing the various
issues that arise is paramount in improving patients’ health related quality of
life and maintaining patients’ adherence and survival. The financial toxicity
associated with this disease cannot be overemphasized, and lowering the price
of drugs would alleviate some of the patient anxiety associated with the cost
While patients with CML are fortunate to have excellent
therapies available to control their disease, most do not lead normal lives due
to the diminished health-related quality of life that is associated with long
Cost of leukemia
From 2451 records identified, 27 studies were found to be eligible for
inclusion. Studies were heterogeneous with respect to methodology, perspective,
and data used. Annual direct costs per person ranged from US$4491 in Germany to
US$43,913 in the USA. The share of costs attributable to drug treatment varied
between 26.2 and 79 %. Indirect costs amounted to US$4208. Severity of
disease was a predictor for quality of life, whereas differences by age
and sex were mainly present in subdomains. Comparisons of treated and untreated
populations resulted in an increase of quality of life in favor of
treated populations in the long-term perspective. Differences between
treatments were small. Consequently, cost effectiveness in decision-analytic
models did not depend on whether quality of life or survival are used
to describe the benefits of treatment.
the quantity and the quality of health economic
and quality-of-life evidence have substantially increased, there is
still a need for studies that take a patient or societal perspective. Factors
that influence costs and the quality of life of patients seem to be
well-established, while longitudinal lifetime cost studies at the population
level are still scarce.