Quality‐adjusted survival: A rigorous assessment of cure after cancer during childhood and adolescence

Survivors of cancer in childhood and adolescence, while increasing gratifyingly in number with ever more effective therapy, have a life expectancy that is compromised all-too-often in both duration and value as a result of adverse treatment-related sequelae. Accounting for this burden of morbidity and mortality is essential for a proper appreciation of cure. Adjusting estimates of survival by measures of its quality affords a means of accomodating this requirement. It can be accomplished by "weighting" the length of survival according to preference-based assessments of health-related quality of life (HRQL), which allow the calculation of quality-adjusted life years. Inclusion of measures of HRQL in clinical trials is imperative as we reach to the ultimate objective; the truly cured child restored to normal health.