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. 2013 Sep;9(3):179-90.
doi: 10.1177/1742395312466903. Epub 2012 Dec 13.

'Just give me the best quality of life questionnaire': the Karnofsky scale and the history of quality of life measurements in cancer trials

Carsten Timmermann  1
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Free PMC article

'Just give me the best quality of life questionnaire': the Karnofsky scale and the history of quality of life measurements in cancer trials

Carsten Timmermann. Chronic Illn. 2013 Sep.
Free PMC article

Abstract

Objectives: To use the history of the Karnofsky Performance Scale as a case study illustrating the emergence of interest in the measurement and standardisation of quality of life; to understand the origins of current-day practices.

Methods: Articles referring to the Karnofsky scale and quality of life measurements published from the 1940s to the 1990s were identified by searching databases and screening journals, and analysed using close-reading techniques. Secondary literature was consulted to understand the context in which articles were written.

Results: The Karnofsky scale was devised for a different purpose than measuring quality of life: as a standardisation device that helped quantify effects of chemotherapeutic agents less easily measurable than survival time. Interest in measuring quality of life only emerged around 1970.

Discussion: When quality of life measurements were increasingly widely discussed in the medical press from the late 1970s onwards, a consensus emerged that the Karnofsky scale was not a very good tool. More sophisticated approaches were developed, but Karnofsky continued to be used. I argue that the scale provided a quick and simple, approximate assessment of the 'soft' effects of treatment by physicians, overlapping but not identical with quality of life.

Keywords: History of medicine; cancer; chemotherapy; clinical scales; quality of life.

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References

    1. Karnofsky DA, Burchenal JH. The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod CM. (eds). Evaluation of chemotherapeutic agents, New York: Columbia University Press, 1949, pp. 191–205
    1. Zubrod CG, Schneiderman M, Frei III E, et al. Appraisal of methods for the study of chemotherapy of cancer in man: comparative therapeutic trial of nitrogen mustard and triethylene thiophosphoramide. J Chronic Dis 1960; 11(1): 7–33
    1. World Health Organization WHO handbook for reporting results of cancer treatment, Geneva: World Health Organization, 1979
    1. Bardelli D, Saracci R. Measuring the quality of life in cancer clinical trials: a sample survey of published trials. UICC Technical Reports 1978; 36: 75–94
    1. Miller AB, Hoogstraten B, Staquet M, et al. Reporting results of cancer treatment. Cancer 1981; 47(1): 207–214 - PubMed

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