Symptom Control Quality of Life Survivorship

Cooperative group trials have also addressed complex questions regarding symptom control and quality of life in patients receiving therapy or palliative care. Quality of life scores have been used to determine if control of symptoms - pain, fatigue, nausea, anorexia and cachexia, chemotherapy-related anemia, depression, hot flashes - translates to an improvement in quality of life. For example, contrary to anecdotal reports and some small studies, results of a North Central Cancer Treatment Group Study suggested that megestrol acetate is superior to dronabinol for the treatment of cancer-associated anorexia and/or weight loss.47 Companion studies to treatment trials, such as those evaluating 5-azacitidine, have also prospectively analyzed the impact of therapy on quality of life.48

As recently reviewed, a growing body of literature, including seminal research from Cooperative Group trials,49'50, has examined the physical, mental, and emotional sequelae of cancer treatment on long-term survivors. Late physical effects include premature ovarian failure in women and its consequences, including sexual dysfunction, osteoporosis, hot flashes, and the risk of infertility. Other outcomes include growth retardation in pediatric patients, late cardiac effects, steroid-related diabetes mellitus, the effects on cognition following whole brain radiation, therapy-related second malignancies, economic consequences of survivorship51, and general physical and social functioning. Many of these effects would not have been detected without the cooperative group infrastructure to enable long term follow-up of patients treated with defined regimens in clinical trials.

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