Quality and quantity of life
Read McNeil BJ, Weichselbaum R, Pauker SG (1981) Speech and survival: tradeoffs between quality and quantity of life in laryngeal cancer, N Engl J Med. Oct 22;305(17) : 982-7 [Direct Link]
Hamilton, D, Bins, J, McMeekin, P, Pedersen, A, Steen, N, De Soyza, A, Thomson, R, Paleri, V & Wilson, J 2015. ‘Quality compared to quantity of life in laryngeal cancer: A time trade-off study’, Head and Neck, Vol. 38, No. 1, pp. 631–637.
McNeil et al., paper marked a shift in the way T3 laryngeal cancers were treated. Less radical surgery was performed and more chemo/radiotherapy was used. Do you think McNeil’s findings justified this change at the time? WHY?
Compare this work with the more recent work by Hamilton et al., (2015) what are the key areas influencing patient decisions outcome or modality of treatment.
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Quantity and Quality of Life
Cancer patients have to make tough decisions concerning their therapy and the probability of choosing the length of life over quality of life (Shrestha et al- 2019). Patient understanding of the benefits and potential harms of the treatment choices is vital to make these difficult decisions. McNeil et al., (1981) findings on the preference of chemotherapy over radical surgery in laryngeal cancer are justified because the physicians should make treatment options based on the patient’s attitude towards the quality of life and length of life.
McNeil et al., (1981) findings justified the use of less radical surgery and more radiation in the treatment of laryngeal cancer. Some patients do not mind experiencing harm related to treatment to add the length of life. while others cherish the quality of life more and are unwilling to endanger themselves. Therapy should therefore recognize the patient’s decision on the method to be used (Katz, Belkora and Elwyn, 2014); thus justifies McNeill et al., (1981) findings that the physician should make treatment based on patient’s perception towards quality and quantity of survival.
McNeil et al., (1981) found out that more people would choose chemotherapy instead of radical surgery to treat laryngeal cancer. Despite radiation therapy having a lower survival rate than laryngectomy, most people would go for it due to conservation of speech, unlike surgery that would lead to loss of speech (Hoffmann, 2021). These findings relate to Hamilton et al., (2015) findings in a time trade-off study. In the time trade-off study, the researchers described life after radiation and surgery. and results showed that 62 per cent preferred radiation and 38 per cent chose surgery. The treatment outcome had a significant control on the health state utility than the modality of treatment.