After a cancer diagnosis, the road ahead is not easy. Aside from the stress and anxiety of an uncertain future, treatment side effects—from nausea and brain fog to fatigue and neuropathy—can be difficult to live with. That’s partly why quality of life is such a critical part of cancer care.
“Quality of life is one of the most important factors in determining the course of treatment for a patient,” says Steven Chang, M.D., Chair of Otolaryngology – Head and Neck Surgery and Medical Director of the Center for Patient Reported Outcomes at Henry Ford Health. “Survival is obviously very important, but a close second is quality of life. It’s often a primary goal for patients.”
Research also shows that patient-reported quality of life is linked to survival. “If you monitor someone’s quality of life and act upon it in real time, you can improve survival,” says Dr. Chang. “Patient-reported quality of life can predict death three to six months out. It can also predict whether you need to go to the emergency department or be admitted to the hospital. We use quality of life as a vital sign.”
At Henry Ford Health, patients fill out a validated questionnaire before each appointment, answering questions about physical function, pain, fatigue and depression. “The questionnaires are important because unfortunately physician-reported quality of life cannot predict survival,” says Dr. Chang. “For example, I had a patient whose cancer unfortunately returned. At one of our visits, she seemed to be tolerating chemotherapy well. But in her quality-of-life questionnaire, she reported severe pain and fatigue. She had been putting on her best face and didn’t want me to know how much she was suffering.
“Knowing her patient-reported quality of life allowed us to do more testing and make decisions that gave her the support she needed. We realized we needed to hold chemotherapy and enroll her in hospice. And if you enroll someone in a timely fashion, research shows you actually extend their life.”
Here, Dr. Chang shares five additional factors—from treatments to functional medicine and mental health support—that can improve quality of life during cancer care.
1. Palliative care.
Palliative care provides patients with specialists who can help them manage pain and treatment side effects. “Our quality-of-life program identifies patients who would benefit from palliative care,” says Dr. Chang. This is especially important because research shows that, for those who need it, palliative care may help people live longer.
2. Targeted cancer treatments that minimize side effects.
A large part of cancer research centers around quality of life: scientists aim to find effective therapies that also come with reduced side effects. Precision medicine—which is revolutionizing cancer treatment—does just that.
Experts have learned that cancer treatment is not one-size-fits-all: Everyone responds differently to it because every tumor has a unique DNA fingerprint. Knowing the specific DNA of a tumor allows experts to develop personalized treatments that effectively attack tumors while leaving healthy cells intact. Chemotherapy, which isn’t a personalized treatment, damages both cancer cells and healthy cells, which is why it often comes with debilitating symptoms. Not only does precision medicine cause fewer side effects, but it’s also more effective and can increase survival.
3. Minimally invasive surgery.
Minimally invasive surgery allows surgeons to remove tumors using small incisions that are just a few centimeters long, instead requiring large incisions. This is thanks to sleek, modern surgical instruments and a miniscule camera that fits inside someone’s body, providing the surgeon with a magnified view of the surgical site. It involves less blood loss, tissue damage and stress on the body—and faster recovery.
Henry Ford Cancer
4. Integrative medicine.
From acupuncture and chiropractic care to nutritional education and individualized exercise programs, integrative medicine can help relieve side effects during and after cancer treatment. Acupuncture can improve neuropathy and exercise can boost mood, energy and endurance—and strengthen the immune system. For cancer survivors, a healthy diet and exercise may also help to reduce the risk of recurrence.
5. Health psychologists who specialize in cancer.
“No matter who you are, when you’re diagnosed with cancer, you’ll need support,” says Dr. Chang. “It’s abnormal to not be demoralized or depressed. Therapists will provide you with the tools you need to persevere.”
But it’s not only during cancer treatment that you may need help. Seeking help after cancer treatment is important, too.
“For head and neck cancer, one month after completing treatment is when people feel the worst, physically and emotionally,” says Dr. Chang. “There are a few reasons for this: There’s a cumulative dose of radiation that continues to work after treatment ends, leading to continued side effects. And there’s an emotional drop-off that occurs when someone isn’t being seen regularly. Patients have regular check-ins during treatment, but they don’t have support post-treatment. This is why we instituted a post-treatment clinic for head and neck cancer, where we see patients one month out. It helps them continue to manage the physical and emotional side effects and eases them into the next phase of their cancer journey: survivorship.”
Reviewed by Steven Chang, M.D., Chair of Otolaryngology – Head and Neck Surgery and Medical Director Center for Patient Reported Outcomes at Henry Ford Health. He sees patients at Henry Ford Cancer in Detroit.
