The relationship between truth telling and culture has been the subject of increasing attention in the literature. The issue of whether, how and how much to tell cancer patients concerning diagnosis is still approached differently depending on country and culture. The majority of physicians tell the truth more often today than in the past, in both developed and developing countries, but most of them prefer to disclose the truth to the next of kin. Nurses in Anglo-Saxon countries are considered to be the most suitable health-care professionals for the patients to share their thoughts and feelings with. Nevertheless, in most other cultures the final decision on information disclosure lies with the treating physician. Regardless of cultural origin, the diagnosis of cancer affects both family structure and family dynamics. In most cases patients’ families, in an effort to protect them from despair and a feeling of hopelessness, exclude the patient from the process of information exchange. The health-care team–patient relationship is a triangle consisting of the health-care professional, the patient and the family. Each part supports the other two and is affected by the cultural background of each of the others as well as the changes that occur within the triangle.

In 1986, the European Organization for Research and Treatment (EORTC) initiated a research program to develop an integrated, modular approach for evaluating the quality of life of patients participating in international clinical trials. The questionnaire was designed to measure cancer patients' physical, psychological and social functions. The questionnaire is composed of 5 multiitem scales (physical, role, social, emotional and cognitive functioning) and 9 single items (pain, fatigue, financial impact, appetite loss, nausea/vomiting, diarrhea, constipation, sleep disturbance and quality of life). It was administered to the patients before the initiation of palliative treatment and then once again during the treatment. The validation of the questionnaire took place at Areteion Hospital, while the translation was conducted by the EORTC bureau. The final validation sample consisted of 120 cancer patients. The clinical variable assessed was the performance status. The aim of our study was to assess the applicability of this quality of life measurement on a Hellenic sample of cancer patients receiving palliative care. The results showed that the questionnaire was well accepted in the present patient population. In addition, the questionnaire was found to be useful in detecting the effectiveness of palliative treatment over time. The scale reliability was very good (pretreatment from 0.57–0.79, ontreatment from 0.56–0.75), especially for the functioning scale. In addition, very good validity was found in all the approaches used. Moreover, the factor analysis results in a 6-factor solution that satisfies the criteria of reproducibility, interpretability and confirmatory setting. Performance status showed an improvement (p < 0.0025) during the studied period. These results support that the QLQ-C30 (version 3.0) has proven to be a reliable and valid measure of the quality of life in Greek cancer patients receiving palliative care treatment.

Cancer patients have been reported to complain about poor quality of sleep. This study evaluated the quality of sleep in this group, utilizing demographic data and clinical features of the cancers as assessment criteria. A secondary aim was to evaluate the correlation between the self-rated questionnaire for the quality of sleep with other instruments used in measuring pain and quality of life. A total of 102 patients with stage IV cancer completed the study and were subsequently followed for up to 10 months. Self-rated questionnaires were administered for the evaluation of quality of sleep (PSQI), quality of life Medical Outcomes Study 12-item short-form (SF-12) questionnaire, the Mental Component Summary (MSC) and the Physical Component Summary (PCS), and pain (VAS Pain). The mediation analysis model was also used to evaluate how quality of life can influence the quality of sleep through its relation to pain, the performance status of patients and analgesics (Opioids). The mean age of the study participants was 62.8 (range: 26.0–87.0) years old. The majority (70.6%) of the patients presented with ECOG score between 2 and 3 and with metastasis (58.8%). Mean Global Sleep Quality score was 12.0±4.6. The use of the PSQI questionnaire in cancer patients demonstrated that these subjects were prone to sleep poor quality. However, the various demographic variables and clinical features of the cancers did not affect quality of sleep. Global Sleep Quality scores from the PSQI correlated with the scores obtained from the SF-12 questionnaire and with the VAS Pain results, indicating a relationship between quality of sleep, quality of life and pain. However, only the SF-12 questionnaire had predictive value on quality of sleep. Mediation analysis showed that quality of life influences quality of sleep both directly and indirectly by its effect on pain. In addition, some of the effect of quality of life on sleep quality was mediated by the use of opioids. Quality of sleep in patients suffering from stage IV cancer was significantly decreased. Demographic data and clinical variables of cancers did not affect the PSQI Global Sleep Quality score. The use of the mediation model also provides evidence that quality of sleep, quality of life, pain, and opioids are strictly correlated each other.