Introduction: or in tissues that line or lid

 Introduction:Cancer diseases Cancer is a group of diseases that cancause nearly any sign or symptom. Cancer (is also known as a malignant tumor)cells. Cancer differs from normal cells in three major respects: Rapidproliferation (growing) without control, it can invade the surrounding tissue,Metastases; the spread of a cancer to other parts of the body.

 There are several main types of cancer. Carcinomais a cancer that initiate in the skin or in tissues that line or lid internalorgans. Sarcoma is a cancer that start in bone, cartilage, muscle, fat, bloodvessels, or other connective or supportive tissue. Leukemia is a cancer thatbegins in blood-forming tissue, such as the bone marrow, and causes largenumbers of abnormal blood cells to be generated and enter the blood. Lymphomaand multiple myeloma are cancers that begin in the cells of the immune system.Central nervous system cancers are cancers that begin in the tissues of thebrain and spinal cord.

Also called malignancy. The signs and symptoms will rely on wherethe cancer is, how big it is, and how much it affects the organs or tissues. Ifa cancer has expansion (metastasized), signs or symptoms may appear in severalparts of the body.Statistics (Global & SA)Due tothe result from the International Agency for Research on Cancer (IARC), in 2012there were 14.1 million new cancer cases and 8.2 million cancer deaths worldwide.

By 2030, the global burden is expected to grow to 21.7 million new cancer casesand 13 million cancer deaths simply according to the growth and aging of thepopulation. There were an estimated 13.3 thousand new cancer cases and 8.9thousand dying every year around the Saudi Arabia in 2008. (from InternationalAgency for Research on Cancer IARC).  Quality of lifeThe concept of quality of life broadly coverhow an individual measures the ‘goodness’ of multiple sides of their life. QoLmust include all areas of life and experience and consider the impact ofillness and treatment.

it can only be described and measured in individualterms, and depends on present lifestyle, experience, hope for the future. Suchas person’s emotional reactions to life events, mood, sense of life fulfilmentand satisfaction, and satisfaction with job and personal relationships.Health-related quality of life (HRQoL) isa multi-dimensional concept that includes areas attached to physical, mental,emotional, and social functioning. It goes beyond through measures ofpopulation health, life hope, and causes of death, and focuses on the impacthealth status has on quality of life.

A related concept of HRQoL is well-being,which estimate the positive aspects of a person’s life, such as positiveemotions and life satisfaction.Cliniciansand public health officials have used HRQoL and well-being to measure theeffects of chronic illness, treatments, and short- and long-term disabilities. Whilethere are sundry existing measures of HRQoL and wellbeing, methodologicaldevelopment in this area is still outstanding.

Over the decade, Healthy People2020 will evaluate the following measures for monitoring HRQoL and well-beingin the United StatesPatientReported Outcomes Measurement Information System (PROMIS) Global HealthMeasure – assesses global physical, mental, and social HRQoL throughquestions on self-rated health, physical HRQoL, mental HRQoL, fatigue, pain,emotional distress, social activities, and roles. Well-BeingMeasures – assess the positive evaluations of people’s dailylives—when they feel very healthy and satisfied or content with life, thequality of their relationships, their positive emotions, their resilience, andthe realization of their potential. Quality of life for cancer patients ingeneral A person’s quality of life is impactedfrom the beginning of the oncology experience, during which he or sheencounters many unplanned, life-altering events.

First, the person discoversthere’s something wrong and “it’s cancer.” After hearing these words, there’s agreat deal to learn and think about, not to mention the decisions to be made.Some decisions are difficult, but need to be made soon depending on the stageof the disease. then, the person, now better known as the patient, experiencesthe consequences of those decisions, such as surgery, chemotherapy, radiation,or palliative care. The patient is entangled in this storm of events.

     prevalence and Incidence of leukemia  according to the result from nationalcancer institute, Leukemia represents 3.7% of all new cancer cases in the U.S.and the number of new cases of leukemia was 13.7 per 100,000 men and women peryear. it is the seventh leading cause of cancer death in the U.

S. the number ofdeaths was 6.8 per 100,000 men and women per year. These rates are age-adjustedand based on 2010-2014 cases and deaths.

Approximately 1.5 percent of men andwomen will be diagnosed with leukemia at some point during their lifetime, basedon 2012-2014 data. Prevalence of This Cancer, in 2014, there were an estimated387,728 people living with leukemia in the U.S. In Saudi Arabia, according to the resultfrom global health Statistics, the annual mortality rate per 100,000 peoplefrom leukemia has increased by 43.7% since 1990, an average of 1.

9%per year. 60.5 per 100,000 men died in 2013, the peak mortality rate for menwas higher than that of women, which was 38.2 per 100,000 women.  The qualityof life after medication for leukemia patient  A reviewof HRQoL in leukemia suggests that survivors typically make a good recovery,although lasting impacts have been associated with more aggressive treatment. bonemarrow transplantation, which has dominated the CML HRQoL literature, isassociated with long-term reductions in physical and role functioning.

Reductions in sexual desire, enjoyment and ability are of concern followingtreatment for AML; both total body irradiation and bone marrow transplantationare suspected to contribute but research investigating specific links has sofar proved inconclusive. In children,side-effects from treatments for leukemia may have a greatershort-term impact on HRQoL than those for other cancers, which presumably hasimplications for heightened distress and reduced HRQoL in children’s families.Although prognosis for children is relatively good, impacts on both physicaland psychosocial HRQoL may persist into adulthood. HRQoLassessment Four leukemia-specificHRQoL questionnaires are currently available – theFACT-Leu 6  from the FACITsuite, the Life Ingredient Profile (LIP),7 and two modulesfrom the EORTC QLQ suite – the  EORTC QLQ-CLL16 and theMRC/EORTC Leukemia-BMT Module (QLQ-LEU).

8In its one related publication, 6 the FACT-Leu isdescribed as including 27 items that assess 17 physical symptoms (fevers,bleeding, general pain, stomach pain, chills, night sweats, bruising, lymphnode swelling, weakness, tiredness, weight loss, appetite, shortness of breath,functional ability, diarrhea, concentration, and mouth sores) and 10emotional/social concerns (frustration with activity limitation, discouraged byillness, future planning, uncertainty, worry about illness, emotional lability,isolation, infertility concern, family worry, and worry about infections). Theversion available from the FACIT website,however, includes only 17 items additional to FACIT’s core measure, the FACT-G.No published validation data for the FACT-Leu is yet available.Developedin Sweden, the LIP is a 4-part instrument administered at different times duringthe patient’s disease.7 LIP 1 consists of 22 questions and is administeredat diagnosis to evaluate the patient’s physical and mental state as well asleisure activities at baseline. LIP 2 is a 21-question follow-up componentaimed at tracking the physical and mental strain that the disease imposes. LIP3 consists of 8 questions and is used in conjunction with LIP 2 to evaluate thepatient’s ability to enjoy activities despite the disease. Finally, LIP 4 isused as a comparison to LIP 1 to show long-term changes to the patient’s HRQoL.

In a pilot study with 35 patients with leukemia, non-Hodgkin’s lymphoma andmyeloma, LIP 2 showed good internal consistency; test-retest reliability wassomewhat variable (Kappa = 0.42-1.00) across the 4 components; Pearsoncorrelations were above 0.7 between LIP2 scores and performance status (KPS)and Vitagram scores; the LIP2 distinguished between advanced and total myelomagroups and within the AML group over time.TheEORTC-QLQ-CLL16 is a 16-item questionnaire designed to supplement the QLQ-C30in assessing patients with CLL. It assesses fatigue (2 items), treatment sideeffects (3 items), disease symptoms (5 symptoms) and infection (4 items), andincludes two single item scales on social activities and future health worries.

A full validation paper is expected to be published shortly.Asystematic search of the literature from 1980 to 2007 was undertaken andstudies were identified and evaluated independently, according to a pre-definedcoding scheme, by three reviewers. Both HRQOL outcomes and traditional clinicalreported outcomes were systematically analyzed to evaluate their consistencyand their relevance for supporting clinical decision making. Nine RCTs wereidentified, involving 3838 patients overall. There were four RCTs involvingacute myeloid leukemia patients (AML), three with chronic myeloid leukemia(CML) and two with chronic lymphocytic leukemia (CLL). Six studies were publishedafter 2000 and provided robust methodological quality. Imatinib greatlyimproved HRQOL compared to interferon based treatments in CML patients andfludarabine plus cyclophosphamide does not seem to have a deleterious impact onpatient’s HRQOL when compared to fludarabine alone or chlorambucil in CLLpatients.

This study revealed the paucity of HRQOL research in leukemiapatients. Nonetheless, HRQOL assessment is feasible in RCTs and has the greatpotential of providing valuable outcomes to further support clinical decisionmaking. In other study that done to assess Quality of life andlong-term therapy in patients with chronic myeloid leukemia foundthat.

 Due to the outstanding survival of patients treated with TKIs, theprevalence of the disease is rapidly increasing across the world. However, withthis increased survival and increased prevalence more emphasis should be placedon managing side effects to maximize the health-related quality of life ofpatients with CML. First, health care providers should be aware of the impactthis disease and its treatments have on the health-related quality of life ofpatients, across a broad set of symptoms and functions. Addressing the variousissues that arise is paramount in improving patients’ health related quality oflife and maintaining patients’ adherence and survival. The financial toxicityassociated with this disease cannot be overemphasized, and lowering the priceof drugs would alleviate some of the patient anxiety associated with the costof treatment.While patients with CML are fortunate to have excellenttherapies available to control their disease, most do not lead normal lives dueto the diminished health-related quality of life that is associated with longterm treatment.

 Cost of leukemia From 2451 records identified, 27 studies were found to be eligible forinclusion. Studies were heterogeneous with respect to methodology, perspective,and data used. Annual direct costs per person ranged from US$4491 in Germany toUS$43,913 in the USA. The share of costs attributable to drug treatment variedbetween 26.2 and 79 %.

Indirect costs amounted to US$4208. Severity ofdisease was a predictor for quality of life, whereas differences by ageand sex were mainly present in subdomains. Comparisons of treated and untreatedpopulations resulted in an increase of quality of life in favor oftreated populations in the long-term perspective. Differences betweentreatments were small. Consequently, cost effectiveness in decision-analyticmodels did not depend on whether quality of life or survival are usedto describe the benefits of treatment.

Althoughthe quantity and the quality of health economicand quality-of-life evidence have substantially increased, there isstill a need for studies that take a patient or societal perspective. Factorsthat influence costs and the quality of life of patients seem to bewell-established, while longitudinal lifetime cost studies at the populationlevel are still scarce.                    References 1.



6.aspx#O3-6-26. 7.    http://global-disease-burden.healthgrove.


aspx?page=Leukaemia 9.    https://www.ncbi.nlm.nih.



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