Recent evidence suggests that detailed assessment can by itself have a salutary treatment effect. This study will determine whether specialized assessment can be a useful strategy to improve quality of life (QL) in cancer patients. The Functional Assessment of Cancer Therapy (FACT) has been developed by the investigators to assess disease-specific problems as well as general QL, and mobilize the patient and staff to action. The study will assess whether using the FACT scale can provide a mechanism for improving QL. Two treatment groups will be compared: one which includes a structured dialogue about specific QL concerns during a four month period of chemotherapy, and another which employs paper-and-pencil self-report of the same concerns. A third, no treatment control group will also be included. The primary question is whether one or both of two manipulated uses of these newly-developed scales will improve QL. It is expected to be related to enhancing awareness of oral communication about important problems and QL concerns which then stimulate treatment decisions, the hypotheses are: 1. All patients completing the FACT will show improved QL, increased satisfaction with treatment, and more objective changes in treatment than those in the control group who receive standard medical care. 2. Patients participating in a structured dialogue as part of the assessment, will have improved QL compared to those completing the assessment without the structured dialogue. If the magnitude of the difference between these two groups is not dramatic, a follow-up study in Years 4-5 will examine the cost effectiveness of the two treatments to determine if the extra effort of a face to face interview is necessary to improve QL. In addition, an attention placebo control group will be added if the therapeutic component of the intervention requires further specification.
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