The recent cancer awareness campaign #nomakeupselfie popularized by social media led me on a search for psychological tests for cancer survivors, specifically assessing their quality of life (QOL) post diagnosis. According to statistics from the Canadian Cancer Society, cancer is the leading cause of death in Canada, responsible for almost 30% of all deaths. However, over the past 30 years the number of cancer survivors has steadily increased due to earlier screening and advances in treatment.

For long-term cancer survivors, physical effects post-diagnosis have lasting consequences on their quality of life, and better measures are needed as way to evaluate the adequacy of current treatment and suggest further areas of intervention.

Previous cancer-specific ‘quality of life’ measures, such as the Functional Adjustment to Cancer Therapy (FACT), only captured the short-term effects of individuals recently diagnosed with cancer and tended to focus on the period immediately following surgery and treatment. For example, they contained items related to side effects of treatment, such as vomiting.

A new multidimensional QOL measure was needed to encompass issues relevant to long-term cancer survivors (>5 years post-diagnosis), such as anxiety and fatigue, sexual problems, and appearance and body-image concerns.

In 2005, the Quality of Life in Adult Cancer Survivors (QLACS) was developed to address these long-term issues. It used an earlier-established conceptualization of QOL which consisted of two important components: their capacities (ability to perform everyday activities) and the level of satisfaction they received from these.

Interviews were conducted in the initial phases to determine which domains were most relevant to long-term cancer survivors, such as family relationships and feelings about themselves, thereby allowing a pool of appropriate questionnaire items to be generated. Critierion measures for each domain were also selected for assessing how adequate a given item reflected the domain it was intended to reflect. Scores for each domain were calculated by the sum of the individual item scores (1 = “Never” through 7 = “Always”). From this, the validity of individual domains was assessed by correlations between domain scores and the criterion ratings, and internal consistency among items from each domain was evaluated by Cronbach’s alpha.

Comparisons of domain scores using the QLACS across cancer type yielded results consistent with other studies; for example, scores were least favourable for bladder and neck cancer, whereas prostate cancer showed relatively fewer problems. The most frequently expressed concerns were related to sexual problems, family, and fatigue.

Several obstacles still remain before QOL measurements such as QLACS can overcome potential issues of generalizability. Psychometrically credible QOL instruments are assessed by rigorous standards of practicality, feasibility, and predictive validity. Despite shortcomings in these areas, the QLACS represents a critical step toward uncovering significant issues shared by cancer survivors, and symbolizes an important step toward more effective targeting of treatments and services in the future.