Quality of life during and after therapy

With a three-fold increase in life expectancy between 1770 and 1970 in western countries, but no significant improvement since then, quality of life (QoL) has progressively become more and more important for healthcare evaluation. Using the classical evidence-based methods, QoL remains, however, quite difficult to assess and to analyse. Colorectal cancer is a frequent and severe disease. Major therapeutic advances have, however, been made during the past two decades. Currently 75% of patients with a non metastatic disease may expect, after surgical removal of their primary tumor; a long lasting remission. This is also the case in 40% of patients with metastatic disease suitable for surgery. Finally, in non-surgical, advanced disease stage cases, median overall survival moved from 6 to 30 months. As treatment duration and percentage of remissions increased, QoL has been more and more studied in these patients. Follow-up of patients receiving adjuvant chemotherapy following complete surgical removal showed treatment-induced side effects impairing long term QoL. This has led to stopping rules. International consortiums have been developed in order to perform extremely large clinical trials so as to decrease the duration of adjuvant treatments, and thus limit the occurrence of the long lasting side effects impairing QoL. In patients with a more advanced disease, de-escalation of treatment intensity has been successfully evaluated, leading to the use of maintenance therapy, in order to preserve both patients' survival and QoL. These approaches have simplified treatment schedules, decreased the incidence of clinically relevant side effects and significantly improved patients QoL. They are currently part of our practice routine. If QoL seems today important in clinical trials and medico-economic assessment of new anti-cancer agents, it may be tomorrow integrated in daily practice through dedicated software in day hospital units in order to better choose each patients' tailored treatment.