We first published our studies on the quality of life of cancer patients in 1991* and to help understand the concept at the time I created the construct shown in the figure. 

Each one of the elements in the construct can have a significant impact on the overall well being of patients and it is so important for the care team to attend to all of the components if we are to truly help restore health. Following this line of thought, we subsequently worked on items such as loss of appetite, fatigue, depression, pain, nausea, as well as cost of and satisfaction with care as targets for research and improvement. We later shared our findings and recommendations in additional publications over the years (listed below). 

At Pacific Shores Medical Group, we start the process of assessing the quality of life of patients in part by asking questions in the review of systems form so that we get a good idea about functional status, symptoms, mood, appetite, pain, and multiple other variables. Based on this initial information, the doctor and nursing team can expand the level of communication to learn more as to what is really happening with the patient. This understanding then guides the interventions that are pursued to help each patient individually, based on their unique problems. Ultimately, it comes down to caring and paying attention to detail, and doing all we can possibly do to help patients regain a sense of well being and control, regain hope, and find a path forward with confidence and trust in the care team.