There is growing consensus that patient-based criteria for assessment of the quality of life should supplement the judgements of physicians. There is, however, no widely accepted instrument that fulfills all stipulations. We therefore propose a questionnaire that can be supplemented according to specific problems in various clinical trials as well as under clinical routine conditions. Its modules have been tested for reliability, responsiveness to change, content, concurrent validity, predictive validity, feasibility, and compliance in a prospective study using 488 single assessments with a total of 31,073 evaluable answers and a total of 2,961 curves. The questionnaire is proposed as a compromise between desired information and the patients’ compliance.

The paper gives an overview of the development of psychosocial factors concerning cancer patients and their relatives. Special attention is paid to the problem of informing them of the diagnosis and to helping patient and family to maintain hope in the face of the often upsetting changes in the life situation as a consequence of the disease. Empirical data are given on the long-term reaction of patients after survival.

Patients with a more favorable prognosis, and a higher social and educational status, are more likely to get structured educational group intervention in an acute cancer care setting. For this subset of patients this intervention proves effective. Its importance for the standard care of cancer should be further investigated.

Of 235 patients who, between 1982 and 1988, had undergone an oesophagectomy for cancer of the oesophagus, 80 (64 men, 16 women; mean age 54.6 [39-67] years) were re-assessed for the quality of their life since surgery. Three standardized questionnaires were used ("general physical complaints" [PC], "satisfaction with life" [SL], "psychosocial stress" [PS]), plus data from a representative random group of the normal population (n = 1761; PC), a group of 48 healthy persons (SL) and a group of 788 cancer patients (PS) with different types of malignancy. The point score for PC was, as expected, significantly higher for the patients than the random controls (23.5 vs. 14.3; P less than 0.001), but was lower than that of cardiac (30.2) and psychiatric patients (30.0; P less than 0.001). As for quality of life, the postesophagectomy patients scored 68.17, compared with 56.75 (P less than 0.001) for the healthy controls. The main psychosocial stress was less in the areas of anxiety and depression than in a loss of social activity and impairment of physical capacity.

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