51
|
Fernandes L, Holm CE, Villadsen A, Sørensen MS, Zebis MK, Petersen MM. Clinically Important Reductions in Physical Function and Quality of Life in Adults with Tumor Prostheses in the Hip and Knee: A Cross-sectional Study. Clin Orthop Relat Res 2021; 479:2306-2319. [PMID: 33974591 PMCID: PMC8445557 DOI: 10.1097/corr.0000000000001797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/09/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with a bone sarcoma who undergo limb-sparing surgery and reconstruction with a tumor prosthesis in the lower extremity have been shown to have reduced self-reported physical function and quality of life (QoL). To provide patients facing these operations with better expectations of future physical function and to better evaluate and improve upon postoperative interventions, data from objectively measured physical function have been suggested. QUESTIONS/PURPOSES We sought to explore different aspects of physical function, using the International Classification of Functioning, Disability, and Health (ICF) as a framework, by asking: (1) What are the differences between patients 2 to 12 years after a bone resection and reconstruction surgery of the hip and knee following resection of a bone sarcoma or giant cell tumor of bone and age-matched controls without walking limitations in ICF body functions (ROM, muscle strength, pain), ICF activity and participation (walking, getting up from a chair, daily tasks), and QoL? (2) Within the patient group, do ICF body functions and ICF activity and participation outcome scores correlate with QoL? METHODS Between 2006 and 2016, we treated 72 patients for bone sarcoma or giant cell tumor of bone resulting in bone resection and reconstruction with a tumor prosthesis of the hip or knee. At the timepoint for inclusion, 47 patients were alive. Of those, 6% (3 of 47) had undergone amputation in the lower limb and were excluded. A further 32% (14 of 44) were excluded because of being younger than 18 years of age, pregnant, having long transportation, palliative care, or declining participation, leaving 68% (30 of 44) for analysis. Thus, 30 patients and 30 controls with a mean age of 51 ± 18 years and 52 ± 17 years, respectively, were included in this cross-sectional study. Included patients had been treated with either a proximal femoral (40% [12 of 30]), distal femoral (47% [14 of 30]), or proximal tibia (13% [4 of 30]) reconstruction. The patients were assessed 2 to 12 years (mean 7 ± 3 years) after the resection-reconstruction. The controls were matched on gender and age (± 4 years) and included if they considered their walking capacity to be normal and had no pain in the lower extremity. Included outcome measures were: passive ROM of hip flexion, extension, and abduction and knee flexion and extension; isometric muscle strength of knee flexion, knee extension and hip abduction using a hand-held dynamometer; pain intensity (numeric rating scale; NRS) and distribution (pain drawing); the 6-minute walk test (6MWT); the 30-second chair-stand test (CST); the Toronto Extremity Salvage Score (TESS), and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). The TESS and the EORTC QLQ-C30 were normalized to 0 to 100 points. Higher scoring represents better status for TESS and EORTC global health and physical functioning scales. Minimum clinically important difference for muscle strength is 20% to 25%, NRS 2 points, 6MWT 14 to 31 meters, CST 2 repetitions, TESS 12 to 15 points, and EORTC QLQ-C30 5 to 20 points. RESULTS Compared with controls, the patients had less knee extension and hip abduction strength in both the surgical and nonsurgical limbs and regardless of reconstruction site. Mean knee extension strength in patients versus controls were: surgical limb 0.9 ± 0.5 Nm/kg versus 2.1 ± 0.6 Nm/kg (mean difference -1.3 Nm/kg [95% CI -1.5 to -1.0]; p < 0.001) and nonsurgical limb 1.7 ± 0.6 Nm/kg versus 2.2 ± 0.6 Nm/kg (mean difference -0.5 Nm/kg [95% CI -0.8 to -0.2]; p = 0.003). Mean hip abduction strength in patients versus controls were: surgical limb 1.1 ± 0.4 Nm/kg versus 1.9 ± 0.5 Nm/kg (mean difference -0.7 Nm/kg [95% CI -1.0 to -0.5]; p < 0.001) and nonsurgical limb 1.5 ± 0.4 Nm/kg versus 1.9 ± 0.5 Nm/kg (-0.4 Nm/kg [95% CI -0.6 to -0.2]; p = 0.001). Mean hip flexion ROM in patients with proximal femoral reconstructions was 113° ± 18° compared with controls 130° ± 11° (mean difference -17°; p = 0.006). Mean knee flexion ROM in patients with distal femoral reconstructions was 113° ± 29° compared with patients in the control group 146° ± 9° (mean difference -34°; p = 0.002). Eighty-seven percent (26 of 30) of the patients reported pain, predominantly in the knee, anterior thigh, and gluteal area. The patients showed poorer walking and chair-stand capacity and had lower TESS scores than patients in the control group. Mean 6MWT was 499 ± 100 meters versus 607 ± 68 meters (mean difference -108 meters; p < 0.001), mean CST was 12 ± 5 repetitions versus 18 ± 5 repetitions (mean difference -7 repetitions; p < 0.001), and median (interquartile range) TESS score was 78 (21) points versus 100 (10) points (p < 0.001) in patients and controls, respectively. Higher pain scores correlated to lower physical functioning of the EORTC QLQ-C30 (Rho -0.40 to -0.54; all p values < 0.05). Less muscle strength in knee extension, knee flexion, and hip abduction correlated to lower physical functioning of the EORTC QLQ-C30 (Rho 0.40 to 0.51; all p values < 0.05). CONCLUSION This patient group demonstrated clinically important muscle weaknesses not only in resected muscles but also in the contralateral limb. Many patients reported pain, and they showed reductions in walking and chair-stand capacity comparable to elderly people. The results are relevant for information before surgery, and assessments of objective physical function are advisable in postoperative monitoring. Prospective studies evaluating the course of physical function and which include assessments of objectively measured physical function are warranted. Studies following this patient group with repetitive measures over about 5 years could provide information about the course of physical function, enable comparisons with population norms, and lead to better-designed, targeted, and timely postoperative interventions. LEVEL OF EVIDENCE Level III, therapeutic study.
Collapse
Affiliation(s)
- Linda Fernandes
- Department of Midwifery, Physiotherapy, Occupational Therapy, and Psychomotor Therapy, University College Copenhagen, Copenhagen, Denmark
| | - Christina Enciso Holm
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Allan Villadsen
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Michala Skovlund Sørensen
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mette Kreutzfeldt Zebis
- Department of Midwifery, Physiotherapy, Occupational Therapy, and Psychomotor Therapy, University College Copenhagen, Copenhagen, Denmark
| | - Michael Mørk Petersen
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| |
Collapse
|
52
|
Maldonado E, Thalla N, Nepaul S, Wisotzky E. Outcome Measures in Cancer Rehabilitation: Pain, Function, and Symptom Assessment. FRONTIERS IN PAIN RESEARCH 2021; 2:692237. [PMID: 35295495 PMCID: PMC8915687 DOI: 10.3389/fpain.2021.692237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/05/2021] [Indexed: 01/08/2023] Open
Abstract
Assessment of cancer rehabilitation outcome measures is integral for patient assessment, symptom screening, and advancing scientific research. In the broad field of cancer rehabilitation, outcome measures can cross-cut across many different branches of oncologic care including clinician-reported, patient-reported, and objective measures. Specific outcome measures that apply to cancer rehabilitation include those pertinent to pain, function, quality of life, fatigue, and cognition. These outcome measures, when used in cancer rehabilitation, can be utilized to evaluate the effectiveness of an intervention and to triage to the appropriate supportive care service. This review article summarizes some of the commonly used outcome measures that can be applied in the cancer rehabilitation setting to support scholarly work and patient care.
Collapse
Affiliation(s)
- Eduardo Maldonado
- MedStar National Rehabilitation Hospital, Washington, DC, United States
- Department of Rehabilitation Medicine, Georgetown University, Washington, DC, United States
| | - Nirguna Thalla
- MedStar National Rehabilitation Hospital, Washington, DC, United States
- Department of Rehabilitation Medicine, Georgetown University, Washington, DC, United States
| | - Sargoon Nepaul
- MedStar National Rehabilitation Hospital, Washington, DC, United States
- Department of Rehabilitation Medicine, Georgetown University, Washington, DC, United States
| | - Eric Wisotzky
- MedStar National Rehabilitation Hospital, Washington, DC, United States
- Department of Rehabilitation Medicine, Georgetown University, Washington, DC, United States
| |
Collapse
|
53
|
Christensen E, Foss OA, Quist-Paulsen P, Staur I, Pettersen F, Holien T, Juzenas P, Peng Q. Application of Photodynamic Therapy with 5-Aminolevulinic Acid to Extracorporeal Photopheresis in the Treatment of Patients with Chronic Graft-versus-Host Disease: A First-in-Human Study. Pharmaceutics 2021; 13:pharmaceutics13101558. [PMID: 34683851 PMCID: PMC8538664 DOI: 10.3390/pharmaceutics13101558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/17/2021] [Accepted: 09/19/2021] [Indexed: 11/30/2022] Open
Abstract
Extracorporeal photopheresis (ECP), an immunomodulatory therapy for the treatment of chronic graft-versus-host disease (cGvHD), exposes isolated white blood cells to photoactivatable 8-methoxypsoralen (8-MOP) and UVA light to induce the apoptosis of T-cells and, hence, to modulate immune responses. However, 8-MOP-ECP kills diseased and healthy cells with no selectivity and has limited efficacy in many cases. The use of 5-aminolevulinic acid (ALA) and light (ALA-based photodynamic therapy) may be an alternative, as ex vivo investigations show that ALA-ECP kills T-cells from cGvHD patients more selectively and efficiently than those treated with 8-MOP-ECP. The purpose of this phase I-(II) study was to evaluate the safety and tolerability of ALA-ECP in cGvHD patients. The study included 82 treatments in five patients. One patient was discharged due to the progression of the haematological disease. No significant persistent changes in vital signs or laboratory values were detected. In total, 62 adverse events were reported. Two events were severe, 17 were moderate, and 43 were mild symptoms. None of the adverse events evaluated by the internal safety review committee were considered to be likely related to the study medication. The results indicate that ALA-ECP is safe and is mainly tolerated well by cGvHD patients.
Collapse
Affiliation(s)
- Eidi Christensen
- Department of Dermatology, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway;
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, 0310 Oslo, Norway; (T.H.); (P.J.); (Q.P.)
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7030 Trondheim, Norway;
- Correspondence:
| | - Olav A. Foss
- Department of Orthopaedic Surgery, Clinic of Orthopaedy, Rheumatology and Dermatology, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway;
- Department of Neuroscience and Movement Science, Norwegian University of Science and Technology, 7030 Trondheim, Norway
| | - Petter Quist-Paulsen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7030 Trondheim, Norway;
- Department of Haematology, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
| | - Ingrid Staur
- Department of Dermatology, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway;
| | - Frode Pettersen
- Department of Nephrology, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway;
| | - Toril Holien
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, 0310 Oslo, Norway; (T.H.); (P.J.); (Q.P.)
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7030 Trondheim, Norway;
- Department of Haematology, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
| | - Petras Juzenas
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, 0310 Oslo, Norway; (T.H.); (P.J.); (Q.P.)
| | - Qian Peng
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, 0310 Oslo, Norway; (T.H.); (P.J.); (Q.P.)
- Department of Optical Science and Engineering, School of Information Science and Technology, Fudan University, Shanghai 200433, China
| |
Collapse
|
54
|
Wolters PL, Vranceanu AM, Thompson HL, Martin S, Merker VL, Baldwin A, Barnett C, Koetsier KS, Hingtgen CM, Funes CJ, Tonsgard JH, Schorry EK, Allen T, Smith T, Franklin B, Reeve S. Current Recommendations for Patient-Reported Outcome Measures Assessing Domains of Quality of Life in Neurofibromatosis Clinical Trials. Neurology 2021; 97:S50-S63. [PMID: 34230198 PMCID: PMC8594008 DOI: 10.1212/wnl.0000000000012421] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 05/13/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To review and recommend patient-reported outcome (PRO) measures assessing multidimensional domains of quality of life (QoL) to use as clinical endpoints in medical and psychosocial trials for children and adults with neurofibromatosis (NF) type 1, NF2, and schwannomatosis. METHODS The PRO working group of the Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration used systematic methods to review, rate, and recommend existing self-report and parent-report PRO measures of generic and disease-specific QoL for NF clinical trials. Recommendations were based on 4 main criteria: patient characteristics, item content, psychometric properties, and feasibility. RESULTS The highest-rated generic measures were (1) the Pediatric Quality of Life Inventory (PedsQL) Generic Core Scales for NF clinical trials for children or for children through adults, (2) the Functional Assessment of Cancer Therapy-General for adult medical trials, and (3) the World Health Organization Quality of Life-BREF for adult psychosocial trials. The highest-rated disease-specific measures were (1) the PedsQL NF1 Module for NF1 trials, (2) the NF2 Impact on Quality of Life Scale for NF2 trials, and (3) the Penn Acoustic Neuroma Quality of Life Scale for NF2 trials targeting vestibular schwannomas. To date, there are no disease-specific tools assessing multidimensional domains of QoL for schwannomatosis. CONCLUSIONS The REiNS Collaboration currently recommends these generic and disease-specific PRO measures to assess multidimensional domains of QoL for NF clinical trials. Additional research is needed to further evaluate the use of these measures in both medical and psychosocial trials.
Collapse
Affiliation(s)
- Pamela L Wolters
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.).
| | - Ana-Maria Vranceanu
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Heather L Thompson
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Staci Martin
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Vanessa L Merker
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Andrea Baldwin
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Carolina Barnett
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Kimberley S Koetsier
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Cynthia M Hingtgen
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Christopher J Funes
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - James H Tonsgard
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Elizabeth K Schorry
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Taryn Allen
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Taylor Smith
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Barbara Franklin
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Stephanie Reeve
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| |
Collapse
|
55
|
Janda M, Forder P, Gebski V, Sandjia S, Armfield N, Obemair A. Weight and weight control behaviors during long-term endometrial cancer survivorship: Results of the Laparoscopic Approach to Cancer of the Endometrium long-term follow-up study. Cancer Med 2021; 10:4896-4904. [PMID: 34145977 PMCID: PMC8290251 DOI: 10.1002/cam4.4032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Overweight or obesity is common in endometrial cancer (EC). This study aimed to examine sociodemographic, clinical, and psychosocial characteristics associated with being discontent with current weight and use of weight control methods among long-term EC survivors. METHODS Women diagnosed with early-stage EC who participated in the Laparoscopic Approach to Cancer of the Endometrium (LACE) trial (n = 516) were invited to complete a long-term follow-up survey at least 4.5 years after treatment. Chi-square test and multivariate logistic regression models adjusted for time since surgery were used to determine factors associated with being discontent with current weight. RESULTS On average 9 years after surgery, 190/259 (73%) of participants were currently discontent with their weight, and 146 (56%) had used one or more weight loss methods during the past 12 months. Women who were discontent with their weight were more likely to be younger than 70 years (p < 0.000), and used one or more weight loss methods ever or during the past 12 months (p < 0.000). Among the weight loss methods used, exercise (40.1%), meal reductions (52.7%), or fat/sugar reductions (48.5%) were much more commonly reported than fasting (2.6%) or designated weight loss programs (2.3%). CONCLUSIONS Our study provides evidence that the majority of long-term EC survivors in this clinical trial population are discontent with their weight and over half continue to use multiple methods to lose weight each year. These data indicate that health professionals and lifestyle educators need to assess weight issues, and develop a tailored plan to address the specific needs of long-term survivors to assist them become content with their weight after treatment for EC.
Collapse
Affiliation(s)
- Monika Janda
- Faculty of MedicineCentre for Health Services ResearchThe University of QueenslandBrisbaneQueenslandAustralia
| | - Peta Forder
- HMRI Public Health ProgramSchool of Medicine and Public HealthThe University of NewcastleNewcastleAustralia
| | - Val Gebski
- NHMRC Clinical Trials CentreThe University of SydneySydneyNew South WalesAustralia
| | - Saira Sandjia
- Faculty of MedicineCentre for Health Services ResearchThe University of QueenslandBrisbaneQueenslandAustralia
| | - Nigel Armfield
- Queensland Centre for Gynaecological CancerBrisbaneQueenslandAustralia
| | - Andreas Obemair
- Queensland Centre for Gynaecological CancerBrisbaneQueenslandAustralia
- Faculty of MedicineCentre for Clinical ResearchThe University of QueenslandBrisbaneQueenslandAustralia
| |
Collapse
|
56
|
Zimmermann K, Mostafaei H, Heidenreich A, Schmelz HU, Shariat SF, Mori K. Health-related quality of life in bladder cancer patients: general and cancer-specific instruments. Part 1. Curr Opin Urol 2021; 31:297-303. [PMID: 33965980 DOI: 10.1097/mou.0000000000000893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW Although survival outcomes are the primary outcomes to determine the effectiveness of treatment options, quality of life (QoL) is gaining in importance in addition to classic oncological outcomes. The present review aims to state and critically assess the challenges in health-related QoL (HRQoL) assessment especially in bladder cancer (BC) patients. RECENT FINDINGS General QoL-instruments do not address concerns specific to cancer patients or BC patients. Domains, such as sexual functioning, embarrassment, self-consciousness, psychological distress, and urinary incontinence, are not adequately covered by any of the available instruments. With these QoL-instruments becoming increasingly specialized, the general aspects of QoL and possible unanticipated adverse effects are no longer likely to be accurately assessed. Sex-specific requirements have not been properly addressed by these QoL-instruments. HRQoL is reported to be lower in the elderly population, which may be due to their associated comorbidities and limitations, rather than treatment-related issues. SUMMARY Due to their specifications, BC-specific instruments need to be used together with general QoL instruments to assess overall well being and disease- and treatment-specific QoL. Assessment of age-specific HRQoL is essential to understanding the QoL burden in each age group. QoL assessment calls for more detailed sex-specific questions to accurately address the HRQoL dimensions in men and women alike.
Collapse
Affiliation(s)
- Kristin Zimmermann
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Axel Heidenreich
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Hans U Schmelz
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, University of Jordan, Amman, Jordan
| | - Keiichiro Mori
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
57
|
Keaver L, McLaughlin C. Applying the thresholds for clinical importance for fourteen key domains of the EORTC QLQ-C30: a latent class analysis of cancer survivors. Support Care Cancer 2021; 29:7815-7823. [PMID: 34173040 PMCID: PMC8232988 DOI: 10.1007/s00520-021-06292-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/11/2021] [Indexed: 12/01/2022]
Abstract
A person’s quality of life is impacted from the beginning of their oncology experience. One of the most common tools to measure quality of life is the EORTC QLQ-C30. The absolute scores it produces can be difficult to interpret in the clinical setting, and thresholds to help identify those who require intervention have recently been introduced. The aim of this research was to identify heterogeneity of these thresholds for clinical importance using latent class analysis in cancer survivors (those undergoing and those who have completed treatment) attending a hospital in the northwest of Ireland. We identified 3 distinct classes of cancer survivors, using Mplus 6.11: high clinical impact (13.9%), compromised physical function (40.3%) and low clinical impact (45.9%). The compromised physical function group were slightly more likely to be older (OR = 1.042, p < .05, CI = 1.000–1.086), not employed (OR = 8.347, p < .01, CI = 2.092–33.305), have lower PG-SGA scores (OR = .826, p < .001, CI = .755–.904), and not have been diagnosed in the last 2 years (OR = .325, p < .05, CI = .114–.923) compared to the high clinical impact group. The low clinical impact group were more likely to be female (OR = 3.288, p < .05, CI = 1.281–1.073), not employed (OR = 10.129, p < .01, CI = 2.572–39.882), have a lower BMI (OR = .921, p < .05, CI = .853–.994), and lower PG-SGA scores (OR = .656, p < .001, CI = .573–.750) than the high clinical impact group. Functional and symptom issues impact on quality of life, and therefore, identifying those of clinical importance is crucial for developing supportive care strategies.
Collapse
Affiliation(s)
- Laura Keaver
- Department of Health and Nutritional Science, Institute of Technology Sligo, Ash Lane, Sligo, F91 YW50, Ireland.
| | - Christopher McLaughlin
- Department of Global Bus. & Enterprise, Ulster Business School, Magee Campus, Londonderry, BT48 7JL, Ireland
| |
Collapse
|
58
|
Thomis S, Helberg M, Kleiman J, De Vrieze T, Heroes AK, Fourneau I, Devoogdt N. The Interrater Reliability of the Scoring of the Lymphatic Architecture and Transport Through Near-InfraRed Fluorescence Lymphatic Imaging in Patients with Breast Cancer-Related Lymphedema. Lymphat Res Biol 2021; 20:133-143. [PMID: 34077678 DOI: 10.1089/lrb.2020.0105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Of the 1.38 million women who are diagnosed every year with breast cancer worldwide, 21% will develop arm lymphedema. Near-infrared fluorescence lymphatic imaging (NIRFLI) is an effective method for real-time evaluation of the lymphatic system. Reliability studies of the scoring of this NIRFLI are lacking. The aim of this study is to investigate if evaluation of the superficial lymphatic architecture and transport in patients with breast cancer-related lymphedema through NIRFLI can be performed in a reliable way. Methods and Results: The outcome parameters used to assess agreement were the presence of lymphatic transport from the injection sites, of dermal backflow patterns, of efferent lymphatic vessels, and of lymph nodes. The NIRFLI evaluations were scored before and after a break separately by two assessors. Twenty patients with lymphedema of the arm and/or hand were included. After the injection, there was weak to very strong agreement regarding the presence of transport from the injection sites (K = 0.459-1.000). The interpretation of the type of dermal backflow pattern varied from weak (WK = 0.452) to very strong agreement (WK = 1.000) between the two assessors. Agreement in the visualization of efferent lymphatic vessels was weak before and after the break (K = 0.490 and K = 0.571) and agreement regarding the presence of lymph nodes was very strong (K = 1.000). Conclusion: Overall, there was moderate to strong agreement between the assessors when evaluating the lymphatic architecture and transport through NIRFLI. The study has been registered at clinicaltrials.gov (NCT02609724).
Collapse
Affiliation(s)
- Sarah Thomis
- Department of Vascular Surgery, Centre for Lymphedema, UZ Leuven-University Hospitals Leuven, Leuven, Belgium.,Research Unit Vascular Surgery, Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Melissa Helberg
- Berekuyl Academy and European College of Decongestive Lymphatic Therapy, Harderwijk, The Netherlands
| | - Jantine Kleiman
- Berekuyl Academy and European College of Decongestive Lymphatic Therapy, Harderwijk, The Netherlands
| | - Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - An-Kathleen Heroes
- Department of Vascular Surgery, Centre for Lymphedema, UZ Leuven-University Hospitals Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, Centre for Lymphedema, UZ Leuven-University Hospitals Leuven, Leuven, Belgium.,Research Unit Vascular Surgery, Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Nele Devoogdt
- Department of Vascular Surgery, Centre for Lymphedema, UZ Leuven-University Hospitals Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| |
Collapse
|
59
|
Effect of lisocabtagene maraleucel on HRQoL and symptom severity in relapsed/refractory large B-cell lymphoma. Blood Adv 2021; 5:2245-2255. [PMID: 33904895 DOI: 10.1182/bloodadvances.2020003503] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/02/2021] [Indexed: 11/20/2022] Open
Abstract
CD19-directed chimeric antigen receptor (CAR) T-cell therapy has shown efficacy as a third-line or later treatment in patients with relapsed/refractory large B-cell lymphoma (LBCL). Using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire, we evaluated the impact of CAR T-cell treatment with lisocabtagene maraleucel (liso-cel) on health-related quality of life (HRQoL) and symptoms in patients with relapsed/refractory LBCL in the ongoing, open-label, nonrandomized TRANSCEND NHL 001 trial. Clinically meaningful improvement was observed in EORTC QLQ-C30 scores for global health status/QoL, based on a minimally important difference of 10 points at 2 to 18 months after liso-cel infusion. There were no clinically meaningful changes in physical functioning and pain, whereas clinically meaningful improvements were observed in fatigue at 2, 12, and 18 months. The proportion of patients with clinically meaningful improvement in global health status/QoL was generally higher for treatment responders than for nonresponders. A trend toward decreased mean EQ-5D-5L index scores was observed at 1 month after liso-cel infusion, followed by subsequent increases through 18 months. Mean EQ-5D-5L visual analog scale scores increased from 2 through 18 months. In summary, patients with relapsed/refractory LBCL treated with liso-cel had early, sustained, and clinically meaningful improvements in HRQoL and symptoms that correlated with antitumor activity. This study was registered at www.clinicaltrials.gov as #NCT02631044.
Collapse
|
60
|
McDowell L, Gough K, King M, Corry J, Rischin D. Patient-reported quality of life and symptom burden measures in human papillomavirus associated oropharyngeal cancer - A review of the literature and PRO methodology. Oral Oncol 2021; 118:105309. [PMID: 33933778 DOI: 10.1016/j.oraloncology.2021.105309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/13/2021] [Accepted: 04/12/2021] [Indexed: 12/21/2022]
Abstract
The emergence of human papillomavirus-associated oropharyngeal cancer (HPVOPC) has resulted in an explosion of clinical research offering reduced toxicity and improved health-related quality of life (HRQL) through treatment de-escalation. At the heart of this objective are patient-reported outcomes (PROs) which aim to quantify the patient experience, usually through the measurement of HRQL or symptom burden. A number of PRO measures (PROMs) are available to HNC researchers and selection of the optimal instrument relies on a detailed understanding of their content and psychometric properties matched to the clinical endpoint of interest. As PROMs become increasingly favoured as the primary or co-primary endpoints of interest in HNC clinical trials, particularly those focussed on HPVOPC, future treatment paradigms will be determined by these measures and it is imperative that they are applied with sophistication and rigor. This review draws attention to the limitations and challenges our specialty faces in PRO application, analysis and reporting. These shortfalls typically include a reliance on statistical rather than clinically relevant differences, multiple hypothesis testing, a lack of evidence-based minimal clinically important differences for the commonly used tools, as well as variations in PROM selection. The aim of this review is to provide: (1) an overview of PRO/PROM terminology and methodology in the HNC setting; (2) to provide a summary of HRQL and symptom burden reports in the HPVOPC literature; and (3) to draw attention to the unmet research need of refining PROM development, application and interpretation to guide our treatment decisions based on what matters to patients.
Collapse
Affiliation(s)
- Lachlan McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; The Sir Peter MacCallum Department of Medical Oncology, The University of Melbourne, Melbourne, Australia.
| | - Karla Gough
- Department of Cancer Experiences, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia; Department of Nursing, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Victoria, Australia
| | - Madeleine King
- The University of Sydney, Faculty of Science, School of Psychology, Sydney Quality of Life Office, Sydney, Australia
| | - June Corry
- GenesisCare Radiation Oncology, Division Radiation Oncology, St. Vincent's Hospital, Melbourne, Victoria Australia; Department of Medicine St Vincent's, The University of Melbourne, Victoria, Australia
| | - Danny Rischin
- The Sir Peter MacCallum Department of Medical Oncology, The University of Melbourne, Melbourne, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| |
Collapse
|
61
|
Reesink DJ, van de Garde EM, Somford DM, Meijer RP, Los M, Biesma DH, Horenblas S, van Melick HH, van der Nat PB. Development of the First Patient-centred Set of Outcomes for Muscle-invasive and Metastatic Bladder Cancer: A Multicentre Initiative. EUR UROL SUPPL 2021; 26:18-26. [PMID: 34337504 PMCID: PMC8317903 DOI: 10.1016/j.euros.2021.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To improve and compare outcomes in healthcare, it is necessary to standardise outcome measurements. There are no widely accepted standardised outcome measures reflecting quality of care for bladder cancer (BCa) patients. OBJECTIVE The aim of this study was to create a standardised set of outcomes for patients with muscle-invasive or metastatic BCa, using the value-based healthcare principles. DESIGN SETTING AND PARTICIPANTS A multidisciplinary working group of 25 healthcare professionals and patient representatives was assembled, to develop the set. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We used an online RAND-modified Delphi process to prioritise, discuss, and reach consensus regarding the outcomes, case-mix variables, and treatment factors. RESULTS AND LIMITATIONS Recognising the heterogeneity of patients with BCa, the working group defined the scope as patients with muscle-invasive and metastatic BCa. A total of 24 outcomes, including ten patient-reported outcomes, were included in the standard set of outcomes, covering survival, complication rates, recurrence of disease, readmissions after treatment, and quality of life (QoL). Fourteen case-mix variables were included. The EQ-5D and European Organisation for Research and Treatment of Cancer quality of life (EORTC-QLQ) questionnaires were recommended to measure QoL. CONCLUSIONS We developed the first standardised set of patient-centred outcomes for muscle-invasive and metastatic BCa. The sue of this set enables institutions to monitor, compare, and improve the quality of BCa care, on an international level. PATIENT SUMMARY Our group of healthcare professionals and patient representatives recommended a standardised set of patient-centred outcomes to be followed during the treatment of patients with muscle-invasive or metastatic bladder cancer, in order to monitor, compare, and improve the quality of care.
Collapse
Affiliation(s)
- Daan J. Reesink
- Urology Department, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands
| | | | - Diederik M. Somford
- Urology Department, Canisius Wilhelmina Hospital [CWZ], Nijmegen, The Netherlands
| | - Richard P. Meijer
- Urology Department, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Maartje Los
- Oncology Department, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands
| | - Douwe H. Biesma
- Value Based Healthcare Department, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands
| | - Simon Horenblas
- Urology Department, The Netherlands Cancer Institute – Antoni van Leeuwenhoek [NCI-AVL] Hospital, Amsterdam, The Netherlands
| | | | - Paul B. van der Nat
- Value Based Healthcare Department, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud UMC, Nijmegen, The Netherlands
| | | |
Collapse
|
62
|
Moschopoulou E, Deane J, Duncan M, Ismail SA, Moriarty S, Sarker SJ, White P, Korszun A. Measuring quality of life in people living with and beyond cancer in the UK. Support Care Cancer 2021; 29:6031-6038. [PMID: 33783624 PMCID: PMC8410707 DOI: 10.1007/s00520-021-06105-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/24/2021] [Indexed: 11/30/2022]
Abstract
Purpose The aim of this study was to identify the most appropriate measure of quality of life (QoL) for patients living with and beyond cancer. Methods One hundred eighty-two people attending cancer clinics in Central London at various stages post-treatment, completed a series of QoL measures: FACT-G, EORTC QLQ-C30 , IOCv2 (positive and negative subscales) and WEMWBS, a wellbeing measure. These measures were chosen as the commonest measures used in previous research. Correlation tests were used to assess the association between scales. Participants were also asked about pertinence and ease of completion. Results There was a significant positive correlation between the four domain scores of the two health-related QoL measures (.32 ≤ r ≤ .72, P < .001), and a significant large negative correlation between these and the negative IOCv2 subscale scores (− .39 ≤ r ≤ − .63, P < .001). There was a significant moderate positive correlation between positive IOCv2 subscale and WEMWBS scores (r = .35, P < .001). However, neither the FACT-G nor the EORTC showed any significant correlation with the positive IOCv2 subscale. Participants rated all measures similarly with regards to pertinence and ease of use. Conclusion There was little to choose between FACT-G, EORTC, and the negative IOC scales, any of which may be used to measure QoL. However, the two IOCv2 subscales capture unique aspects of QoL compared to the other measures. The IOCv2 can be used to identify those cancer survivors who would benefit from interventions to improve their QoL and to target specific needs thereby providing more holistic and personalised care beyond cancer treatment.
Collapse
Affiliation(s)
- Elisavet Moschopoulou
- Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jennifer Deane
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, UK
| | - Morvwen Duncan
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Sharif A Ismail
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Sophie Moriarty
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Shah-Jalal Sarker
- Research Department of Medical Education, UCL Medical School, UCL, London, UK
| | - Peter White
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Ania Korszun
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
| | | |
Collapse
|
63
|
Hulbert-Williams NJ, Hulbert-Williams L, Flynn RJ, Pendrous R, MacDonald-Smith C, Mullard A, Swash B, Evans G, Price A. Evaluating process and effectiveness of a low-intensity CBT intervention for women with gynaecological cancer (the EPELIT Trial). AMRC OPEN RESEARCH 2021; 3:12. [PMID: 38708072 PMCID: PMC11064984 DOI: 10.12688/amrcopenres.12971.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 05/07/2024]
Abstract
Background Improving survival from gynaecological cancers is creating an increasing clinical challenge for long-term distress management. Psychologist-led interventions for cancer survivors can be beneficial, but are often costly. The rise of the Psychological Wellbeing Practitioner (PWP) workforce in the UK might offer a cheaper, but equally effective, intervention delivery method that is more sustainable and accessible. We aimed to test the effectiveness of a PWP co-facilitated intervention for reducing depression and anxiety, quality of life and unmet needs. Methods We planned this trial using a pragmatic, non-randomised controlled design, recruiting a comparator sample from a second clinical site. The intervention was delivered over six-weekly sessions; data were collected from participants at baseline, weekly during the intervention, and at one-week and three-month follow-up. Logistical challenges meant that we only recruited 8 participants to the intervention group, and 26 participants to the control group. Results We did not find significant, between-group differences for depression, quality of life or unmet needs, though some differences at follow-up were found for anxiety ( p<.001). Analysis of potential intervention mediator processes indicated the potential importance of self-management self-efficacy. Low uptake into the psychological intervention raises questions about (a) patient-driven needs for group-based support, and (b) the sustainability of this intervention programme. Conclusions This study failed to recruit to target; the under-powered analysis likely explains the lack of significant effects reported, though some trends in the data are of interest. Retention in the intervention group, and low attrition in the control group indicate acceptability of the intervention content and trial design; however a small baseline population rendered this trial infeasible in its current design. Further work is required to answer our research questions, but also, importantly, to address low uptake for psychological interventions in this group of cancer survivors. Trial registration ClinicalTrials.gov, NCT03553784 (registered 14 June 2018).
Collapse
Affiliation(s)
| | - Lee Hulbert-Williams
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chester, CH1 4BJ, UK
| | - Ryan James Flynn
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chester, CH1 4BJ, UK
| | - Rosina Pendrous
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chester, CH1 4BJ, UK
| | - Carey MacDonald-Smith
- North Wales Cancer Treatment Centre, Glan Clwyd Hospital, Bodelwyddan, Rhyl, LL18 5UJ, UK
| | | | - Brooke Swash
- School of Psychology, University of Chester, Chester, CH1 4BJ, UK
| | - Gemma Evans
- School of Psychology, University of Chester, Chester, CH1 4BJ, UK
| | - Annabel Price
- Department of Psychological Medicine, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK
| |
Collapse
|
64
|
Kask G, Repo JP, Tukiainen EJ, Blomqvist C, Barner-Rasmussen I. Soft Tissue Sarcoma of Lower Extremity: Functional Outcome and Quality of Life. Ann Surg Oncol 2021; 28:6892-6905. [PMID: 33740199 PMCID: PMC8460521 DOI: 10.1245/s10434-021-09774-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/24/2021] [Indexed: 02/06/2023]
Abstract
Background Few studies have focused on patient-related factors in analyzing long-term functional outcome and health-related quality of life (HRQoL) in patients with postoperative lower extremity soft tissue sarcoma (STS). Objective The purpose of this study was to investigate factors associated with postoperative functional outcome and HRQoL in patients with lower extremity STS. Methods This cross-sectional study was performed in a tertiary referral center using the Toronto Extremity Salvage Score (TESS), Quality-of-Life Questionnaire (QLQ)-C30 and 15 Dimension (15D) measures. Functional outcome and HRQoL data were collected prospectively. All patients were treated by a multidisciplinary team according to a written treatment protocol. Results A total of 141 patients who had undergone limb-salvage surgery were included. Depending on the outcome measure used, 19–51% of patients were completely asymptomatic and 13–14% of patients had an unimpaired HRQoL. The mean score for TESS, 15D mobility score, and QLQ-C30 Physical Functioning scale were 86, 0.83, and 75, respectively, while the mean score for 15D was 0.88, and 73 for QLQ-C30 QoL. Lower functional outcome was statistically significantly associated with higher age, higher body mass index (BMI), and the need for reconstructive surgery and radiotherapy, while lower HRQoL was statistically significantly associated with higher age, higher BMI, and reconstructive surgery. Conclusion Functional outcome and HRQoL were generally high in this cross-sectional study of patients with STS in the lower extremity. Both tumor- and treatment-related factors had an impact but patient-related factors such as age and BMI were the major determinants of both functional outcome and HRQoL. Supplementary Information The online version of this article (10.1245/s10434-021-09774-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Gilber Kask
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, HUS, Helsinki, Finland. .,Tampere University Hospital, Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere, Finland. .,Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Jussi P Repo
- Tampere University Hospital, Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere, Finland
| | - Erkki J Tukiainen
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, HUS, Helsinki, Finland
| | - Carl Blomqvist
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, HUS, Helsinki, Finland.,Department of Oncology, Örebro University Hospital, Örebro, Sweden
| | - Ian Barner-Rasmussen
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, HUS, Helsinki, Finland
| |
Collapse
|
65
|
Buneviciene I, Mekary RA, Smith TR, Onnela JP, Bunevicius A. Can mHealth interventions improve quality of life of cancer patients? A systematic review and meta-analysis. Crit Rev Oncol Hematol 2021; 157:103123. [PMID: 33190065 PMCID: PMC7574857 DOI: 10.1016/j.critrevonc.2020.103123] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 09/02/2020] [Accepted: 10/02/2020] [Indexed: 01/13/2023] Open
Abstract
mHealth can be used to deliver interventions to optimize Health-related quality of life (HRQoL) of cancer patients. In this systematic-review and meta-analysis, we explored the possible impact of health interventions delivered via mHealth tools on HRQoL of cancer patients. The systematic literature search was performed on July 20, 2019, to identify studies that evaluated the impact of mHealth intervention on HRQoL of cancer patients. We identified 25 studies (17 randomized controlled trials and 8 pre-post design studies; 957 patients) that evaluated mHealth interventions. The most commonly studied mHealth interventions included physical activity/ fitness interventions (9 studies), cognitive behavioral therapy (6 studies), mindfulness/ stress management (3 studies). In the majority of studies, mHealth interventions were associated with an improved HRQoL of cancer patients. The meta-analysis of the identified studies supported the positive effect of mHealth interventions for HRQoL of cancer patients. mHealth interventions are promising for improving HRQoL of cancer patients.
Collapse
Affiliation(s)
- Inesa Buneviciene
- Department of Public Communications, Vytautas Magnus University, Kaunas, Lithuania
| | - Rania A Mekary
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS University, Boston, MA, United States
| | - Timothy R Smith
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Avenue, Boston, MA 02115, United States
| | - Adomas Bunevicius
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Lithuanian University of Health Sciences, Lithuania; Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
| |
Collapse
|
66
|
Patil V, Joshi A, Noronha V, Bhattacharjee A, Dhumal S, Chandrakanth MV, Karpe A, Talreja V, Chandrasekharan A, Turkar S, Pande N, Ramaswamy A, Prabhash K. Quality of life and quality-adjusted time without toxicity in palliatively treated head-and-neck cancer patients. South Asian J Cancer 2020; 7:249-253. [PMID: 30430094 PMCID: PMC6190391 DOI: 10.4103/sajc.sajc_233_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background: Quality-adjusted time without toxicity (Q-TWiST) and quality of life (QOL) are indicators of benefit provided by different chemotherapy regimens. Methods: This was a prospective study, in which adult head-and-neck (H and N) cancer patients, treated with metronomic chemotherapy were enrolled. The Functional Assessment of Cancer Therapy-General H and N (FACT-G and H and N) version 4 pro formas were self-administered before the start of chemotherapy and then at 2, 4, and 6 months. FACT QOL and Q-TWiST analysis were then performed. Results: There was an improvement in the social well-being (P = 0.370), emotional well-being (P = 0.000), functional well-being (P = 0.000), H and N cancer subscale (P = 0.001), FACT H and N trial outcome index (P = 0.000), FACT G-total score (P = 0.000), and FACT H and N total score (P = 0.000) with palliative chemotherapy. The QTWiST value for a utility score of 0.25 for toxicity and relapse state was 145.93 days. Conclusion: Metronomic chemotherapy is associated with improvement in QOL and has a low duration of time spent in toxicity state.
Collapse
Affiliation(s)
- Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Atanu Bhattacharjee
- Department of Statistics and Epidemiology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Sachin Dhumal
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - M V Chandrakanth
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Ashay Karpe
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Vikas Talreja
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Arun Chandrasekharan
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Siddharth Turkar
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Nikhil Pande
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| |
Collapse
|
67
|
Hagiwara Y, Shiroiwa T, Taira N, Kawahara T, Konomura K, Noto S, Fukuda T, Shimozuma K. Mapping EORTC QLQ-C30 and FACT-G onto EQ-5D-5L index for patients with cancer. Health Qual Life Outcomes 2020; 18:354. [PMID: 33143687 PMCID: PMC7641825 DOI: 10.1186/s12955-020-01611-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/26/2020] [Indexed: 12/24/2022] Open
Abstract
Background To develop direct and indirect (response) mapping algorithms from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and the Functional Assessment of Cancer Therapy General (FACT-G) onto the EQ-5D-5L index. Methods We conducted the QOL-MAC study where EQ-5D-5L, EORTC QLQ-C30, and FACT-G were cross-sectionally evaluated in patients receiving drug treatment for solid tumors in Japan. We developed direct and indirect mapping algorithms using 7 regression methods. Direct mapping was based on the Japanese value set. We evaluated the predictive performances based on root mean squared error (RMSE), mean absolute error, and correlation between the observed and predicted EQ-5D-5L indexes. Results Based on data from 903 and 908 patients for EORTC QLQ-C30 and FACT-G, respectively, we recommend two-part beta regression for direct mapping and ordinal logistic regression for indirect mapping for both EORTC QLQ-C30 and FACT-G. Cross-validated RMSE were 0.101 in the two methods for EORTC QLQ-C30, whereas they were 0.121 in two-part beta regression and 0.120 in ordinal logistic regression for FACT-G. The mean EQ-5D-5L index and cumulative distribution function simulated from the recommended mapping algorithms generally matched with the observed ones except for very good health (both source measures) and poor health (only FACT-G). Conclusions The developed mapping algorithms can be used to generate the EQ-5D-5L index from EORTC QLQ-C30 or FACT-G in cost-effectiveness analyses, whose predictive performance would be similar to or better than those of previous algorithms.
Collapse
Affiliation(s)
- Yasuhiro Hagiwara
- Department of Biostatistics, Division of Health Sciences and Nursing, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Takeru Shiroiwa
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Wako, Japan
| | - Naruto Taira
- Breast and Endocrine Surgery Department, Okayama University Hospital, Okayama, Japan
| | - Takuya Kawahara
- Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Keiko Konomura
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Wako, Japan
| | - Shinichi Noto
- Center for Health Economics and QOL Research, Niigata University of Health and Welfare, Niigata, Japan
| | - Takashi Fukuda
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Wako, Japan
| | - Kojiro Shimozuma
- Department of Biomedical Sciences, College of Life Sciences, Ritsumeikan University, Kusatsu, Japan
| |
Collapse
|
68
|
Abstract
Radical and palliative treatments for non-small cell lung cancer (NSCLC) have faced a significant evolution during last decades, which in turn has modified their effects on the patient quality of life (QoL). QoL data collection is becoming methodologically rigorous, with published recommendations and societal statements. In lung cancer surgery, there is no standardization in collecting and analyzing this outcome yet. However, to face the evolution in lung cancer therapies, few initiatives like the European Organization for the Research and Treatment of Cancer (EORTC) lung cancer module update project or the Patient-Reported Outcomes Measurement Information System (PROMIS), have now the potential to help thoracic surgeons to collect QoL data with validated dynamic instruments to make this outcome comparable to the clinical ones. This review aims to give an overview of the available and most commonly used QoL questionnaires in lung cancer surgery in order to facilitate future research and practical implementation.
Collapse
Affiliation(s)
- Cecilia Pompili
- Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research at St. James's, University of Leeds, Leeds, UK.,Division of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Michael Koller
- Center for Clinical Studies Regensburg, University of Regensburg, Regensburg, Germany
| | - Galina Velikova
- Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research at St. James's, University of Leeds, Leeds, UK
| |
Collapse
|
69
|
Does it matter how we evaluate HRQOL? Longitudinal comparison of the EORTC QLQ-C30/QLQ-OG25 and FACT-E. J Cancer Surviv 2020; 15:641-650. [PMID: 33106994 DOI: 10.1007/s11764-020-00957-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/10/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE To determine whether EORTC QLQ-C30/QLQ-OG25 and FACT-E compared longitudinally provide similar reflections of health-related quality of life (HRQOL). METHODS Eighty-six esophageal cancer patients treated with curative intent, scheduled to complete both questionnaires at baseline and post-treatment time points until 36 months. A generalized estimating equation model utilizing a Gaussian family compared instruments longitudinally. The two-one-sided-test (TOST) method assessed equivalence between the instruments. RESULTS Trajectories for social domain and overall quality of life differed significantly between instruments. Also, FACT-G's functional well-being post-treatment returns to baseline 3-6 months earlier than the EORTC QLQ-C30's role functioning subscale, suggesting measurement of different components. Trajectories for physical and esophageal symptom subscales are similar and are deemed equivalent. Emotional domains are comparable and bear little resemblance to the physical domain trajectories indicating reflection of emotional experience rather than a physical proxy. EORTC QLQ-C30 subscales have a trajectory similar to its physical functioning scale except for the emotional and esophageal symptoms scales. Overall HRQOL in both instruments showed a consistent return to baseline/pre-treatment levels by 6 months post-treatment. CONCLUSIONS Overall HRQOL recovers earlier after curative-intent treatment than previously reported despite persistence of physical symptoms, with a consistent return to pre-treatment levels by 6 months after treatment. This supports the concept that HRQOL is not primarily defined by physical function. Based on this longitudinal comparison, FACT-E provides a more multidimensional assessment of HRQOL. IMPLICATIONS FOR CANCER SURVIVORS Curative intent treatment for esophageal cancer has adverse effects on HRQOL but despite intense treatment, overall HRQOL recovers within 6 months.
Collapse
|
70
|
Cotté FE, Voillot P, Bennett B, Falissard B, Tzourio C, Foulquié P, Gaudin AF, Lemasson H, Grumberg V, McDonald L, Faviez C, Schück S. Exploring the Health-Related Quality of Life of Patients Treated With Immune Checkpoint Inhibitors: Social Media Study. J Med Internet Res 2020; 22:e19694. [PMID: 32915159 PMCID: PMC7519426 DOI: 10.2196/19694] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/10/2020] [Accepted: 07/26/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) are increasingly used to treat several types of tumors. Impact of this emerging therapy on patients' health-related quality of life (HRQoL) is usually collected in clinical trials through standard questionnaires. However, this might not fully reflect HRQoL of patients under real-world conditions. In parallel, users' narratives from social media represent a potential new source of research concerning HRQoL. OBJECTIVE The aim of this study is to assess and compare coverage of ICI-treated patients' HRQoL domains and subdomains in standard questionnaires from clinical trials and in real-world setting from social media posts. METHODS A retrospective study was carried out by collecting social media posts in French language written by internet users mentioning their experiences with ICIs between January 2011 and August 2018. Automatic and manual extractions were implemented to create a corpus where domains and subdomains of HRQoL were classified. These annotations were compared with domains covered by 2 standard HRQoL questionnaires, the EORTC QLQ-C30 and the FACT-G. RESULTS We identified 150 users who described their own experience with ICI (89/150, 59.3%) or that of their relative (61/150, 40.7%), with 137 users (91.3%) reporting at least one HRQoL domain in their social media posts. A total of 8 domains and 42 subdomains of HRQoL were identified: Global health (1 subdomain; 115 patients), Symptoms (13; 76), Emotional state (10; 49), Role (7; 22), Physical activity (4; 13), Professional situation (3; 9), Cognitive state (2; 2), and Social state (2; 2). The QLQ-C30 showed a wider global coverage of social media HRQoL subdomains than the FACT-G, 45% (19/42) and 29% (12/42), respectively. For both QLQ-C30 and FACT-G questionnaires, coverage rates were particularly suboptimal for Symptoms (68/123, 55.3% and 72/123, 58.5%, respectively), Emotional state (7/49, 14% and 24/49, 49%, respectively), and Role (17/22, 77% and 15/22, 68%, respectively). CONCLUSIONS Many patients with cancer are using social media to share their experiences with immunotherapy. Collecting and analyzing their spontaneous narratives are helpful to capture and understand their HRQoL in real-world setting. New measures of HRQoL are needed to provide more in-depth evaluation of Symptoms, Emotional state, and Role among patients with cancer treated with immunotherapy.
Collapse
Affiliation(s)
| | | | | | - Bruno Falissard
- Paris-Sud University, Paris, France.,Paris-Descartes Universitiy, Paris, France.,AP-HP, Paris, France.,INSERM U1178, Paris, France
| | | | | | | | | | | | | | | | | |
Collapse
|
71
|
Seifart C, Koch M, Leppin N, Nagelschmidt K, Knorrenschild JR, Timmesfeld N, Rief W, von Blanckenburg P. Collaborative advance care planning in advanced cancer patients: col-ACP -study - study protocol of a randomised controlled trial. BMC Palliat Care 2020; 19:134. [PMID: 32838763 PMCID: PMC7445911 DOI: 10.1186/s12904-020-00629-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/06/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To assure patient-centred end-of-life care, palliative interventions need to account for patients' preferences. Advance care planning (ACP) is a structured approach that allows patients, relatives and physicians to discuss end-of-life decisions. Although ACP can improve several patient related outcomes, the implementation of ACP remains difficult. The col-ACP-study (collaborative advance care planning) will investigate a new ACP procedure (col-ACP-intervention (German: Hand-in-Hand Intervention)) in palliative cancer patients and their relatives that addresses individual values and targets barriers of communication before an ACP process. METHODS In a randomised controlled trial, 270 cancer patients without curative treatment options and their relatives will receive either 1) col-ACP 2) a supportive intervention (active control group) or 3) standard medical care (TAU). col-ACP comprises two steps: a) addressing various barriers of patients and relatives that discourage them from discussing end-of-life issues followed by b) a regular, structured ACP procedure. The col-ACP-intervention consists of 6 sessions. Primary endpoint is the patients' quality of life 16 weeks after randomisation. Secondary endpoints include measurements of distress; depression; communication barriers; caregivers' quality of life; existence of ACP or advance directives; the consistence of end of life care; and others. Patients will be followed up for 13 months. Multivariate analyses will be carried out. Qualitative evaluation of the intervention will be conducted. DISCUSSION Augmentation of a regular ACP program by a structured psycho-oncological intervention is an innovative approach to target barriers of communication about end-of-life issues. Study findings will help to understand the value of such a combined intervention in palliative care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03387436 (Date of registration: 01/02/2018, retrospectively registered.
Collapse
Affiliation(s)
- Carola Seifart
- Institutional Review Board, Clinical Ethics, Philipps-University Marburg, Marburg, Germany
| | - Martin Koch
- Institutional Review Board, Clinical Ethics, Philipps-University Marburg, Marburg, Germany
| | - Nico Leppin
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Katharina Nagelschmidt
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Jorge Riera Knorrenschild
- Department of Internal Medicine, Division Hematology and Oncology, University Clinic of Gießen and Marburg, Marburg, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University Bochum, Bochum, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Pia von Blanckenburg
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstraße 18, 35032, Marburg, Germany.
| |
Collapse
|
72
|
Suh Oh HJ, Flórez Menéndez Á, Sacristán Santos V, Fernández Ribeiro F, Vilanova-Trillo L, Constenla Figueiras M, Pereiro Ferreiros M. Cutaneous adverse events and quality of life in outpatients receiving anticancer agents: results from an observational, cross-sectional study. Drugs Context 2020; 9:dic-2020-6-6. [PMID: 32821263 PMCID: PMC7413591 DOI: 10.7573/dic.2020-6-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 11/24/2022] Open
Abstract
Background Despite growing interest in cutaneous adverse events (CAEs) and their management in patients with cancer, they are often underreported and there are no extensive data on their impact on quality of life (QoL). Healthcare professionals should consider this issue in order to minimize its negative impact on QoL and improve patient outcomes. This study evaluates the impact of CAEs on QoL in outpatients receiving anticancer drugs and aims to determine the differences in QoL between conventional chemotherapy versus targeted therapies. Methods A total of 114 cancer patients with CAEs were included in this observational, cross-sectional study. Patient-reported outcomes instruments (Functional Assessment of Cancer Therapy – General, Dermatology Life Quality Index, and Skindex-16) were used. Results Mean scores in QoL indices were 65.3±13.4, 8.4±5, and 30.8±16.9 in Functional Assessment of Cancer Therapy – General, Dermatology Life Quality Index, and Skindex-16, respectively. The CAEs that had the greatest impact on dermatologic-related QoL were hand–foot skin reaction, rash, palmo-plantar erythrodysesthesia, and papulopustular eruption. No significant differences in QoL indices according to the type of treatment (conventional chemotherapy versus targeted therapy) were observed. Conclusions CAEs, and particularly hand–foot toxicities, rashes, and papulopustular eruptions, can have an impact on QoL in outpatients receiving anticancer drugs as evaluated with three different patient-reported outcomes instruments. No differences in QoL related to CAEs were observed between conventional chemotherapy and targeted therapy.
Collapse
Affiliation(s)
- Hae-Jin Suh Oh
- Dermatology Department, Pontevedra University Hospital, Spain
| | | | | | | | | | | | - Manuel Pereiro Ferreiros
- Surgical Medical Specialties Department, Dermatology Section, Santiago de Compostela University, Spain
| |
Collapse
|
73
|
Gallardo-Rincón D, Toledo-Leyva A, Bahena-González A, Montes-Servín E, Muñoz-Montaño W, Coronel-Martínez J, Oñate-Ocaña LF. Validation of the Mexican-Spanish Version of the EORTC QLQ-OV28 Instrument for the Assessment of Quality of Life in Women with Ovarian Cancer. Arch Med Res 2020; 51:690-699. [PMID: 32768148 DOI: 10.1016/j.arcmed.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 07/03/2020] [Accepted: 07/21/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Health-related quality of life (HRQL) is an important outcome measure in Oncology. AIM OF THE STUDY To validate the Mexican-Spanish version of the QLQ-OV28 questionnaire to assess HRQL in women with ovarian cancer (OC). METHODS The QLQ-C30 and QLQ-OV28 instruments were applied to women with OC attending a cancer center in Mexico. The usual psychometric analyses were performed; the Spearman's method was used for correlation analysis, reliability analysis with the Cronbach's alpha, known-group comparisons with the Kruskal-Wallis test, responsiveness was tested employing repeated measures ANOVA, and the association of scale scores and overall survival (OS) were analyzed with the Kaplan-Meier method and Cox's model. RESULTS Two hundred fifty-two women with OC were included in this cohort. The instruments were well accepted and compliance rates were high; patients responded both instruments in <30 min. The QLQ-OV28 internal consistency tests demonstrated good convergent (Correlation coefficients [CC] 0.154‒0.694) and divergent validity (CC 0.003‒0.69). Cronbach's α coefficients of six of eight scales of the QLQ-OV28 instruments were >0.7 (range, 0.567‒0.857). Scales QLQ-OV28 instruments distinguished among clinically distinct groups of patients, particularly after basal serum albumin and basal Ca‒125 levels. The evaluation of responsiveness demonstrated that two scales of the QLQ-OV28 were sensitive to change over time during induction chemotherapy. Six scales of the QLQ-OV28 were associated with OS. CONCLUSIONS The Mexican-Spanish version of the QLQ-OV28 questionnaire is reliable and valid for the assessment of HRQL in patients with OC and can be broadly used in clinical trials.
Collapse
Affiliation(s)
- Dolores Gallardo-Rincón
- Programa de Cáncer de Ovario, Instituto Nacional de Cancerología, Ciudad de México, México; Departamento de Oncología Médica, Instituto Nacional de Cancerología, Ciudad de México, México; Grupo de Investigación en Cáncer de Ovario y Tumores Ginecológicos de México, A.C., Ciudad de México, México
| | - Alfredo Toledo-Leyva
- Programa de Cáncer de Ovario, Instituto Nacional de Cancerología, Ciudad de México, México
| | - Antonio Bahena-González
- Programa de Cáncer de Ovario, Instituto Nacional de Cancerología, Ciudad de México, México; Departamento de Oncología Médica, Instituto Nacional de Cancerología, Ciudad de México, México; Grupo de Investigación en Cáncer de Ovario y Tumores Ginecológicos de México, A.C., Ciudad de México, México
| | | | - Wendy Muñoz-Montaño
- Departamento de Oncología Médica, Instituto Nacional de Cancerología, Ciudad de México, México
| | - Jaime Coronel-Martínez
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología, Ciudad de México, México
| | - Luis F Oñate-Ocaña
- Grupo de Investigación en Cáncer de Ovario y Tumores Ginecológicos de México, A.C., Ciudad de México, México; Subdirección de Investigación Clínica, Instituto Nacional de Cancerología, Ciudad de México, México.
| |
Collapse
|
74
|
Meier-Girard D, Ribi K, Gerstenberg G, Ruhstaller T, Wolf U. Eurythmy therapy versus slow movement fitness in the treatment of fatigue in metastatic breast cancer patients: study protocol for a randomized controlled trial. Trials 2020; 21:612. [PMID: 32631427 PMCID: PMC7336433 DOI: 10.1186/s13063-020-04542-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cancer-related fatigue (CRF) is the most taxing symptom for many breast cancer patients during and after therapy. In patients with metastatic disease, the prevalence of CRF exceeds 75%. Currently, there is no gold standard for the treatment of CRF. Physical activity can reduce CRF and is recommended during and after cancer treatment, but may be too burdensome for patients with metastatic breast cancer. The aim of this study is to assess the effect on fatigue of eurythmy therapy (ERYT) compared to slow movement fitness (CoordiFit) in metastatic breast cancer patients. METHODS The ERYT/CoordiFit study is a randomized controlled, open-label, two-arm, multi-center Swiss clinical trial. A sample of 196 patients presenting with CRF will be recruited by oncologists from the departments of clinical oncology at each local study site. All participants will be randomly allocated to the intervention or control group in a 1:1 ratio. The control group is an active control intervention (CoordiFit) in order to control for potential non-intended effects such as therapist-patient interaction and participation in a program. Both ERYT and CoordiFit exercises are easy to learn, and the training sessions will follow the same frequency and duration schedule, i.e., 13 standardized therapy sessions of 45 min (once a week for 6 weeks and then once every second week) during the total intervention period of 20 weeks. The primary endpoint of the study is the change from baseline over the whole intervention period (i.e., including measurements at baseline, weeks 8, 14, and 20) in the Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F) subscale score. DISCUSSION This study is the first-known randomized clinical trial assessing eurythmy therapy in the treatment of fatigue in metastatic breast cancer patients. Given the distress that fatigue causes patients, it is important to validate treatment options. If eurythmy therapy proves beneficial in CRF as part of this randomized controlled clinical trial, the study may be very impactful with implications not only for metastatic breast cancer patients but also for other cancer patients, health care personnel, scientists, and funding and regulatory bodies. TRIAL REGISTRATION The ERYT/CoordiFit trial was registered at the US National Institutes of Health (ClinicalTrials.gov) on July 18, 2019, #NCT04024267 , and in the portal for human research in Switzerland on December 3, 2019, #SNCTP000003525 .
Collapse
Affiliation(s)
- Delphine Meier-Girard
- Institute of Complementary and Integrative Medicine, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Karin Ribi
- International Breast Cancer Study Group, Coordinating Center, Bern, Switzerland
| | - Gisa Gerstenberg
- Institute of Complementary and Integrative Medicine, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | | | - Ursula Wolf
- Institute of Complementary and Integrative Medicine, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| |
Collapse
|
75
|
Dulko D. Quality of Life as an Important Clinical Research Treatment Trial Outcome to Guide Evidence-Based Practice. Worldviews Evid Based Nurs 2020; 17:334-336. [PMID: 32573928 DOI: 10.1111/wvn.12441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Dorothy Dulko
- Graduate Program, College of Nursing, Walden University, Minneapolis, Minnesota, USA
| |
Collapse
|
76
|
Lo Dico R, Gornet JM, Guglielmo N, Zaanan A, Taieb J, Pocard M. Bidirectional chemotherapy combining intraperitoneal docetaxel with intravenous 5-fluorouracil and oxaliplatin for patients with unresectable peritoneal metastasis from gastric cancer: the first study in Western countries. Pleura Peritoneum 2020; 5:20190035. [PMID: 32566725 PMCID: PMC7292234 DOI: 10.1515/pp-2019-0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/03/2020] [Indexed: 12/18/2022] Open
Abstract
Background A new treatment using bidirectional intraperitoneal (IP) and intravenous (IV) chemotherapy developed by Asiatic surgeons improves outcomes in patients with synchronous peritoneal metastasis (PM) from gastric cancer (GC). Methods We enrolled six consecutive patients with unresectable PM from GC who underwent bidirectional chemotherapy using IP docetaxel and IV FOLFOX or LV5FU2. In one course, IP docetaxel 30 mg/m2 was administrated on days 1, 8 and 15, and IV FOLFOX or LV5FU2 was administered on days 1 and 15, followed by 7 days of rest. Before and after a complete bidirectional cycle of three courses, the peritoneal cancer index (PCI) was evaluated by laparoscopy. The primary endpoint was to evaluate the feasibility and safety of bidirectional chemotherapy. Secondary endpoints were overall survival (OS), and the success of the therapeutic strategy was reflected by a decrease of 25% of the initial PCI. Results All patients completed one bidirectional cycle. The regimen was well tolerated. The median OS was 13 months [range 5–18], and the 1-year OS rate was 67%. After the first bidirectional cycle, the PCI decrease ≥25% of the initial value in four patients. A major histological response was observed in four patients. Conclusions This is the first Western study and confirms the feasibility and safety of bidirectional treatment using IP and IV chemotherapy for patients with unresectable PM from GC, resulting in a 13-month median OS with limited morbidity. The decrease in PCI after one bidirectional cycle is promising.
Collapse
Affiliation(s)
- Rea Lo Dico
- University of Paris, UMR 1275 CAP Paris-Tech, Department of Digestive Surgery, Lariboisière Hospital, AP-HP, F-75010Paris, France
| | - Jean Marc Gornet
- Department of Hepatology, Gastroenterology and Digestive Oncology, Saint-Louis Hospital, AP-HP, Paris, France
| | - Nicola Guglielmo
- Department of Digestive Surgery, Lariboisiere Hospital, AP-HP, Paris, France
| | - Aziz Zaanan
- Department of Hepatology, Gastroenterology and Digestive Oncology, Georges Pompiodou European Hospital, AP-HP, Paris, University of Paris, France
| | - Julien Taieb
- Department of Hepatology, Gastroenterology and Digestive Oncology, Georges Pompiodou European Hospital, AP-HP, Paris, University of Paris, France
| | - Marc Pocard
- University of Paris, UMR 1275 CAP Paris-Tech, Department of Digestive Surgery, Lariboisière Hospital, AP-HP, F-75010Paris, France
| |
Collapse
|
77
|
Ooi SL, Pak SC, Micalos PS, Schupfer E, Zielinski R, Jeffries T, Harris G, Golombick T, McKinnon D. Rice bran arabinoxylan compound and quality of life of cancer patients (RBAC-QoL): Study protocol for a randomized pilot feasibility trial. Contemp Clin Trials Commun 2020; 19:100580. [PMID: 32548333 PMCID: PMC7284132 DOI: 10.1016/j.conctc.2020.100580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/14/2020] [Accepted: 05/24/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction Rice bran arabinoxylan compound (RBAC) is a nutraceutical for enhancing a depleted immune system during and after cancer treatment. This pilot feasibility trial aims to evaluate the effects of RBAC on cancer patients' quality of life during active treatment, compared to placebo, using a validated questionnaire. Other outcome measures include changes in inflammatory and nutritional status, cytokine profile, and gut microbiota. Methods/Design The study will recruit 50 participants from a regional cancer center in Australia. Patients aged 18–70, diagnosed with solid organ cancers stage II and above, and currently undergoing active systemic therapies, are eligible. Random allocation of participants into two groups is stratified based on metastatic status and treatment type. The dosage is either 3 g/day of RBAC or placebo in identical packaging. The participants, study coordinator, and treating oncologists are blinded to the interventions. Data collections are at baseline and at four follow-up sessions, which are six weeks apart (24 weeks). Statistical analysis will involve a protected p-value with multiple dependent values and analyzed by ANOVA with repeated measures on the occasion of testing and with both a full Bonferroni or Sidak corrections applied to protect against Type I errors. Any observed significance warrants further analysis with pairwise comparisons. Analysis of covariance will also be performed to assess any influence of the demographic data, cancer diagnosis, as well as changes in physical activity, dietary habits, and complementary medicine usage. Comparisons of gut microbiota will be based on the analysis of the fecal microbiome using 16S ribosomal ribonucleic acid amplicon sequencing. The proposed research timeline is from October 2018 to May 2022. Trial registration ANZCTR. Reg No: ACTRN12619000562178p.
Collapse
Affiliation(s)
- Soo Liang Ooi
- School of Biomedical Sciences, Charles Sturt University, Bathurst, NSW, 2795, Australia
- Graham Centre for Agricultural Innovation, Charles Sturt University, Wagga Wagga, NSW, 2650, Australia
| | - Sok Cheon Pak
- School of Biomedical Sciences, Charles Sturt University, Bathurst, NSW, 2795, Australia
- Graham Centre for Agricultural Innovation, Charles Sturt University, Wagga Wagga, NSW, 2650, Australia
- Corresponding author. School of Biomedical Sciences, Charles Sturt University, Panorama Avenue, Bathurst, NSW, 2795, Australia.
| | - Peter S. Micalos
- School of Biomedical Sciences, Charles Sturt University, Bathurst, NSW, 2795, Australia
| | - Emily Schupfer
- School of Biomedical Sciences, Charles Sturt University, Bathurst, NSW, 2795, Australia
| | - Rob Zielinski
- Central West Cancer Centre, Orange Health Service, Orange, NSW, 2800, Australia
- School of Medicine, Western Sydney University, Penrith, NSW, 2751, Australia
| | - Thomas Jeffries
- School of Science, Western Sydney University, Penrith, NSW, 2751, Australia
| | - Garth Harris
- BioMedica Nutraceuticals Pty Ltd, Alexandria, NSW, 2015, Australia
| | | | - David McKinnon
- Edith Cowan Institute for Education Research, Edith Cowan University, Joondalup, WA, 6027, Australia
| |
Collapse
|
78
|
de Mol M, Visser S, Aerts J, Lodder P, van Walree N, Belderbos H, den Oudsten B. The association of depressive symptoms, personality traits, and sociodemographic factors with health-related quality of life and quality of life in patients with advanced-stage lung cancer: an observational multi-center cohort study. BMC Cancer 2020; 20:431. [PMID: 32423432 PMCID: PMC7236491 DOI: 10.1186/s12885-020-06823-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 04/02/2020] [Indexed: 01/11/2023] Open
Abstract
Background Identification of patient-related factors associated with Health-Related Quality of Life (HRQoL) and Quality of Life (QoL) at the start of treatment may identify patients who are prone to a decrease in HRQoL and/or QoL resulting from chemotherapy. Identification of these factors may offer opportunities to enhance patient care during treatment by adapting communication strategies and directing medical and psychological interventions. The aim was to examine the association of sociodemographic factors, personality traits, and depressive symptoms with HRQoL and QoL in patients with advanced-stage lung cancer at the start of chemotherapy. Methods Patients (n = 151) completed the State-Trait Anxiety Inventory (trait anxiety subscale), the Neuroticism-Extraversion-Openness-Five Factor Inventory (NEO-FFI), the Center for Epidemiologic Studies Depression (CES-D), the World Health Organization Quality of Life-BREF (WHOQOL-BREF), and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Simple linear regression analyses were performed to select HRQoL and QoL associated factors (a P ≤ 0.10 was used to prevent non-identification of important factors) followed by multiple linear regression analyses (P ≤ 0.05). Results In the multiple regression analyses, CES-D score (β = − 0.63 to − 0.53; P-values < 0.001) was most often associated with the WHOQOL-BREF domains and general facet, whereas CES-D score (β = − 0.67 to − 0.40; P-values < 0.001) and Eastern Cooperative Oncology Group (ECOG) performance status (β = − 0.30 to − 0.30; P-values < 0.001) were most often associated with the scales of the EORTC QLQ-C30. Personality traits were not related with HRQoL or QoL except for trait anxiety (Role functioning: β = 0.30; P = 0.02, Environment: β = − 0.39; P = 0.007) and conscientiousness (Physical health: β = 0.20; P-value < 0.04). Conclusions Higher scores on depressive symptoms and ECOG performance status were related to lower HRQoL and QoL in patients with advanced-stage non-small cell lung cancer. Supportive care interventions aimed at improvement of depressive symptoms and performance score may facilitate an increase of HRQoL and/or QoL during treatment.
Collapse
Affiliation(s)
- Mark de Mol
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands.,Department of Pulmonary Diseases, Erasmus MC Cancer Institute, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Sabine Visser
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands.,Department of Pulmonary Diseases, Erasmus MC Cancer Institute, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Joachim Aerts
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands.,Department of Pulmonary Diseases, Erasmus MC Cancer Institute, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Paul Lodder
- Department of Methodology and Statistics, Tilburg University, P.O. Box 90151, 5000, LE, Tilburg, The Netherlands.,Department of Medical and Clinical Psychology, Centre of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, P.O. Box 90151, 5000, LE, Tilburg, The Netherlands
| | - Nico van Walree
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands
| | - Huub Belderbos
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands
| | - Brenda den Oudsten
- Department of Medical and Clinical Psychology, Centre of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, P.O. Box 90151, 5000, LE, Tilburg, The Netherlands.
| |
Collapse
|
79
|
Álvaro Sanz E, Abilés J, Garrido Siles M, Pérez Ruíz E, Alcaide García J, Rueda Domínguez A. Impact of weight loss on cancer patients' quality of life at the beginning of the chemotherapy. Support Care Cancer 2020; 29:627-634. [PMID: 32424642 DOI: 10.1007/s00520-020-05496-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/23/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE Among the prognostic factors relevant to the condition of oncological patients, nutritional status (NS) has the greatest single impact on quality of life (QL). The goals of our study were to evaluate the influence of NS, weight loss (WL), and the presence of cachexia, prior to the initiation of chemotherapy, on the patient's QL. METHODS Adult patients (aged ≥ 18 years) diagnosed with solid tumours for whom chemotherapy was started between April 2016 and June 2017 were eligible for inclusion in the study. They were asked to complete a QL questionnaire (Functional Assessment of Cancer Treatment (FACT-G)) at the beginning. The presence or absence of cachexia was evaluated at the outset, following the definition proposed by Fearon and nutritional assessment by the Patient-Generated Subjective Global Assessment (PG-SGA) scale. RESULTS A total of 177 patients completed the FACT-G, the 60% receiving curative therapy. At the start of the treatment, 58.2% of patients had experienced WL, with an average of 4.4 ± 7.4%, and 19% were at risk of malnutrition. Patient who presented cachexia at diagnosis, were treated with palliative intention, had a Nutriscore ≥ 5 points or presented malnutrition in accordance with PG-SGA had a poorer QL (p < 0.05). Greater WL was associated with a worsened QL (p = 0.001). Breast cancer patients presented an inverse correlation between the %WL and the initial score in the FACT-G (r = - 0.304, p = 0.023), whereas no such correlation was observed for the other types of tumour (r = - 0.012, p = 0.892). CONCLUSIONS These results underline the relation of NS before starting chemotherapy and QL. Greater WL was associated with a worsened QL, especially in women with breast cancer.
Collapse
Affiliation(s)
- Elena Álvaro Sanz
- Área de Farmacia y Nutrición, Hospital Costa del Sol, Agencia Sanitaria Costa del Sol, A7, km. 187, 29603, Marbella, Málaga, Spain
| | - Jimena Abilés
- Área de Farmacia y Nutrición, Hospital Costa del Sol, Agencia Sanitaria Costa del Sol, A7, km. 187, 29603, Marbella, Málaga, Spain
| | - Margarita Garrido Siles
- Área de Farmacia y Nutrición, Hospital Costa del Sol, Agencia Sanitaria Costa del Sol, A7, km. 187, 29603, Marbella, Málaga, Spain.
| | - Elísabeth Pérez Ruíz
- Oncology service, Hospital Costa del Sol, A7, km 187, 29603, Marbella, Málaga, Spain
| | - Julia Alcaide García
- Oncology service, Hospital Costa del Sol, A7, km 187, 29603, Marbella, Málaga, Spain
| | - Antonio Rueda Domínguez
- UGCI Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, P° Limonar, 2, Bq3, 5°A, Málaga, Spain
| |
Collapse
|
80
|
Giulietti MV, Vespa A, Ottaviani M, Berardi R, Balercia G, Arnaldi G, Gattafoni P, Fabbietti P, Rosa MD, Spatuzzi R. Personality (at Intrapsychic and Interpersonal Level) Associated With Quality of Life in Patients With Cancer (Lung and Colon). Cancer Control 2020; 26:1073274819880560. [PMID: 31775525 PMCID: PMC6883362 DOI: 10.1177/1073274819880560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The objective of this study was to determine the association of quality of life
(QoL) and intrapsychic and interpersonal behaviors (Structural Analysis of
Social Behavior [SASB]) of patients with cancer (lung: n = 88; age 62.8 ± 10.1;
colon: n = 56; age 60.1 ± 11.4). Personality described by SASB clusters (Cls):
SASB-Questionnaire; QoL tests: FACT_G and QLQ-C30. Patients with lung cancer (n
= 88; age 62.8 ± 10.1) and colon cancer (n = 56; age 60.1 ± 11.4; all stages of
severity). Multiple regression analyses. Multiple linear regression: dependent
variable: FACT_G; covariates: physical functioning, cognitive functioning,
SASB-Cl3-50°, SASB-Cl6-50°. Analysis of variance and t test
confirm validity of the model (P < .001). SASB-Cl3 with
FACT_G (P = .034); SASB-Cl6 with FACT_G (P =
.002); age with FACT_G (P = .018); physical functioning with
FACT_G (P < .001); cognitive functioning with FACT_G
(P < .001). Personality traits such as self-critical and
oppressive behaviors, low capacity for self-esteem, physical and cognitive
functioning, and age (a higher age determines a better QoL) strongly determine
QoL in patients with lung and colon cancer. This may suggest areas of
therapeutic intervention.
Collapse
Affiliation(s)
- Maria Velia Giulietti
- Department of Neurology, INRCA-IRCCS National Institute of Health and Science on Aging, Ancona, Italy
| | - Anna Vespa
- Scientific and Technological Area, Department of Neurology, INRCA-IRCCS National Institute of Health and Science on Aging, Ancona, Italy
| | - Marica Ottaviani
- Department of Neurology, INRCA-IRCCS National Institute of Health and Science on Aging, Ancona, Italy
| | - Rossana Berardi
- Department of Oncology, Ospedali Riuniti, Polytechnic University of Marche, Ancona, Italy
| | - Giancarlo Balercia
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Giorgio Arnaldi
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Pisana Gattafoni
- Clinic of Internal Medicine and Geriatrics, INRCA-IRCCS National Institute of Health and Science on Aging, Ancona, Italy
| | - Paolo Fabbietti
- Laboratory of Biostatistics, INRCA-IRCCS National Institute of Science and Health on Aging, Ancona, Italy
| | - Mirko Di Rosa
- Laboratory of Biostatistics, INRCA-IRCCS National Institute of Science and Health on Aging, Ancona, Italy
| | | |
Collapse
|
81
|
Chen Q, Terhorst L, Geller DA, Marsh W, Antoni M, Dew MA, Biala M, Weinstein J, Tsung A, Steel J. Trajectories and predictors of stress and depressive symptoms in spousal and intimate partner cancer caregivers. J Psychosoc Oncol 2020; 38:527-542. [PMID: 32367788 DOI: 10.1080/07347332.2020.1752879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE The objective of the study is to investigate trajectories of stress and depressive symptoms of spousal and intimate partner caregivers in the context of cancer. We also examined the patient-related predictors of caregiver stress and depression. DESIGN This is a longitudinal cohort study. PARTICIPANTS Patients diagnosed with cancers affecting the hepatobiliary and pancreatic system and their spousal or intimate partner caregivers were recruited at a large tertiary cancer center. METHODS The patients and caregivers were assessed for their level of stress, depressive symptoms, relationship quality, and quality of life at the time of the patients' diagnosis, every 2 months for 12 months and then at 18 months. FINDINGS One hundred and seventy-nine caregivers were included in the trajectory analyses. Amongst the 179 caregivers, 120 patient and caregiver dyads had complete data at baseline to 6-months. The majority of the spousal caregivers were female (84%) and the mean age was 57 years. 25% of caregivers reported high levels of chronic depressive symptoms. However, significant reductions were observed at 6 months. High and moderate levels of caregiver stress were also reported in 21% and 36% of caregivers, respectively. The caregivers who reported moderate levels of stress had a decrease in stress over time while those in the high stress group reported stable levels of stress over time. Caregivers' stress is predicted by the cancer patients' depressive symptoms but not patients' quality of life. CONCLUSIONS Caregivers who reported high levels of stress and depressive symptoms at patients' cancer diagnosis remain high even after the initial adjustment. A bidirectional relationship between the caregivers' stress and the patients' depressive symptoms was observed. IMPLICATIONS The development of dyadic interventions focusing on the patients' and caregivers' distress is warranted to decrease psychological morbidities of the dyad.
Collapse
Affiliation(s)
- Qi Chen
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - David A Geller
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Wallis Marsh
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michael Antoni
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology, and Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michelle Biala
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Josh Weinstein
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Allan Tsung
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jennifer Steel
- Departments of Surgery, Psychiatry, and Psychology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
82
|
Firkins J, Hansen L, Driessnack M, Dieckmann N. Quality of life in "chronic" cancer survivors: a meta-analysis. J Cancer Surviv 2020; 14:504-517. [PMID: 32162194 DOI: 10.1007/s11764-020-00869-9] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/18/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Cancer survivors are now living longer giving rise to a new concept-chronic cancer as survivors continue to face long-term consequences of cancer and its treatment. For these survivors, QOL becomes a vital consideration in understanding their survivorship and the long-term impact of cancer and its treatment. The primary aim of this review is to describe QOL in cancer survivors two or more years from diagnosis. METHODS A meta-analysis was completed of relevant studies assessing QOL in long-term cancer survivorship using PubMed, CINHAL, and PsycINFO. A total of 64 articles met inclusion criteria and included in the analysis. Standardized effect sizes and errors were calculated using previously published standard QOL pass rates to compare QOL across measurement tools and calculate cumulative effect sizes (CES). Fixed-effect or random-effects models were used based on the presence of significant heterogeneity of ≤ 0.10. RESULTS Physical health (CES = - 0.894; CI, - 1.472, - 0.316), role-physical health (CES = - 2.039; CI, - 2.643, - 1.435), and mental health (CES = - 0.870; CI, - 1.447, - 0.292) had large, negative cumulative effect sizes signifying worse QOL compared with acceptable QOL rates. Tested moderators, cancer type, average age, country of origin, time since diagnosis, or decade of diagnosis, were not significant to explain heterogeneity between included studies. CONCLUSION QOL is significantly impacted 2 to 26 years after cancer diagnosis. More research is needed to determine possible moderators of QOL in long-term cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS QOL continues to be significantly impacted in long-term cancer survivorship. More research is needed to understand the impact of these findings on care needs for survivors with chronic cancer.
Collapse
Affiliation(s)
- Jenny Firkins
- Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA.
| | - Lissi Hansen
- Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA
| | - Martha Driessnack
- Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA
| | - Nathan Dieckmann
- Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA.,Division of Clinical Psychology, Oregon Health & Science University, 3314 SW US Veterans Hospital Road, Portland, OR, 97239, USA
| |
Collapse
|
83
|
A Prospective Evaluation of the Reliability and Utility of Quality of Life Measures in Patients With Hepatocellular Carcinoma. Am J Clin Oncol 2020; 42:555-563. [PMID: 31135382 DOI: 10.1097/coc.0000000000000555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Little is known about how quality of life (QOL) can assist clinical decision-making for patients with hepatocellular carcinoma (HCC). This study aimed to investigate the reliability and validity of QOL as well as its prognostic value and utility. MATERIALS AND METHODS A prospective cohort of 300 HCC patients at various stages was recruited from 2015 to 2017 in Korea. The subjects answered the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core-30 (QLQ-C30) and QLQ-HCC18 and the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) questionnaire. Prognostic nomograms including the QOL scales were developed. The prediction performance of the Barcelona Clinic Liver Cancer (BCLC) and the American Joint Committee on Cancer (AJCC) staging systems when they were incorporated with QOL was investigated. RESULTS The EORTC QLQ-C30 and QLQ-HCC18 subscales showed higher reliability than FACT-Hep subscales. With regard to the validity, both questionnaires discriminated the patients by stages, treatment modalities, and performance status effectively. Multivariable analysis revealed that EORTC role functioning and EORTC appetite loss subscales were statistically associated with overall survival and disease progression. The developed nomograms accurately estimated the 1-year overall survival and disease progression-free rates. Incorporating the EORTC role functioning subscale or Hepatobiliary Cancer Subscale of FACT-Hep with the BCLC and AJCC systems improved the prognostic classification. Incorporating QOL into the AJCC system showed better predictive accuracy than incorporating performance status into it did. CONCLUSIONS The findings suggest that QOL data can serve as a reliable predictive factor and assist prognostic calculation for HCC patients.
Collapse
|
84
|
Kalyani CV, Sharma SK, Kusum K, Lijumol KJ. HealthCare-Related Quality of Life and Lived Existential Experiences among Young Adults Diagnosed with Cancer: A Mixed-Method Study. Indian J Palliat Care 2020; 26:19-23. [PMID: 32132778 PMCID: PMC7017692 DOI: 10.4103/ijpc.ijpc_207_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 08/30/2019] [Accepted: 11/02/2019] [Indexed: 12/24/2022] Open
Abstract
Background: As cancer is a noncommunicable disease and it is a major global burden in terms of finances. It is also affecting quality of life of a person completely. Aim: The aim of the present study was to identify the effect of cancer on quality of life of an individual as a whole. Methods: The present study was triangulation study, and we examined 30 young adult cancer patients of age group 20–44 years who were admitted in different oncological units of our hospital in 2018. We included all their case datasheets for identifying clinical variables. Data collection tools used were the European organization for research and treatment for cancer quality of life questionnaire (version 3-Hindi). Qualitative data were collected using open-ended questionnaire regarding young adult cancer patient's experiences, feelings, and difficulties faced during cancer diagnosis and treatment. Results: Results concluded that young adult cancer patient's global health status score were average. Their physical function as well as social function score depicted that both were affected significantly, whereas cognitive functions were not affected anymore. Most commonly symptoms faced by young adult's cancer patients were pain, insomnia, fatigue, nausea, vomiting, and appetite loss. Financial burden was major burden faced by patient as well as caregiver during the diagnosis and treatment of cancer. From qualitative data of the study, it was concluded that when patient were first told about cancer diagnosis first, they feel sad. Their primary relatives were first informed about their diagnosis. Most of patient's cancer were diagnosed in first stage. Cancer had affected patient's personal as well as social life completely. Nobody helps them during the diagnosis and treatment of their disease. Majority of cancer treatment options were chemotherapy, radiation therapy, and surgery and majority of them were getting chemotherapy from AIIMS, Rishikesh. The most common difficulty the patient's faced during the diagnosis of cancer was financial. Patient's opinion for cancer and its treatment were that everybody who had any symptoms of cancer they should immediately come to hospital for treatment. When we asked them about effect of cancer as a whole their responses were disturbed family role, disturbed attachment with family and friends, disturbed social role, financial burden as well as disturbed education, respectively. Conclusion: From this study, we concluded that quality of life of young adult cancer patients were affected badly in terms of physical, social, symptomatically, and financially. It may also help to plan ahead by patients as well as health professionals to improve the patient's quality of life.
Collapse
Affiliation(s)
- C Vasantha Kalyani
- Department of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Suresh K Sharma
- Department of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - K Kusum
- Department of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - K J Lijumol
- Department of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| |
Collapse
|
85
|
Maharaj AD, Samoborec S, Evans SM, Zalcberg J, Neale RE, Goldstein D, Merrett N, White K, Croagh D, Pilgrim CHC, Evans P, Knowles B, Leong T, Philip J, Smith M, Ioannou L. Patient-reported outcome measures (PROMs) in pancreatic cancer: a systematic review. HPB (Oxford) 2020; 22:187-203. [PMID: 31635959 DOI: 10.1016/j.hpb.2019.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 09/02/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this systematic review is to examine patient-reported outcome measures (PROMs), their attributes and application in patients with pancreatic cancer (PC). METHOD A systematic literature search was undertaken of articles published to June 2018 to identify PROMs applied in primary studies in PC. Characteristics of the included studies and PROMs were described with identified scales grouped into five domains. The psychometric properties of the identified PROMs were further assessed for reliability and validity among patients with PC. RESULTS From 1688 studies screened, 170 were included. Almost half (48%) were conducted in patients with unresectable PC; the majority of these (68%) were evaluated in randomized controlled trials. Median questionnaire completion rates fell below 10% of the original cohort within 12 months in patients with unresectable PC compared to 75% in patients with resectable PC. Seventy PROMs were identified, 32 measuring unidimensional parameters (e.g. pain) and 35 measuring multidimensional (e.g. quality of life) constructs. Only five (7%) PROMs were disease-specific and 13 (19%) were validated in patients with PC. Fifty scales were grouped into 19 physical, 9 psychological, 6 psychiatric, 9 social and 7 other domains. CONCLUSION Three multidimensional PROMs, the: (i) FACT-HEP in unresectable PC; (ii) QLQ-PAN26 (in conjunction with its core QLQ-C30 PROM) in resectable PC; and (iii) MDASI-GI are recommended as instruments to capture quality of life in patients with PC. Summarised scales and psychometric evaluation provide a framework to choose PROMs for scales not captured by the recommended PROMs.
Collapse
Affiliation(s)
| | | | - Sue M Evans
- Monash University, Melbourne, VIC, Australia
| | | | - Rachel E Neale
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | | | - Neil Merrett
- Western Sydney University, Penrith, NSW, Australia
| | - Kate White
- University of Sydney, Camperdown, NSW, Australia
| | - Daniel Croagh
- Monash University, Melbourne, VIC, Australia; Monash Health, Clayton, VIC, Australia; Epworth HealthCare, Richmond, VIC, Australia
| | - Charles H C Pilgrim
- Monash University, Melbourne, VIC, Australia; Peninsula Private Hospital, Melbourne, VIC, Australia; Alfred Health, Melbourne, VIC, Australia; Cabrini Health, Malvern, VIC, Australia; Peninsula Health, Frankston, VIC, Australia
| | - Peter Evans
- Monash University, Melbourne, VIC, Australia; Cabrini Health, Malvern, VIC, Australia
| | - Brett Knowles
- Royal Melbourne Hospital, Parkville, VIC, Australia; St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Trevor Leong
- Monash University, Melbourne, VIC, Australia; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; University of Melbourne, Parkville, VIC, Australia
| | - Jennifer Philip
- Royal Melbourne Hospital, Parkville, VIC, Australia; St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; University of Melbourne, Parkville, VIC, Australia; Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - Marty Smith
- Alfred Health, Melbourne, VIC, Australia; Cabrini Health, Malvern, VIC, Australia
| | | |
Collapse
|
86
|
Park R, Shaw JW, Korn A, McAuliffe J. The value of immunotherapy for survivors of stage IV non-small cell lung cancer: patient perspectives on quality of life. J Cancer Surviv 2020; 14:363-376. [PMID: 31950409 PMCID: PMC7256093 DOI: 10.1007/s11764-020-00853-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/03/2020] [Indexed: 12/26/2022]
Abstract
Purpose The aim of this study was to examine what personally mattered to 24 patients who received immuno-oncology (IO) therapy for stage IV non-small cell lung cancer (NSCLC), as well as their families and friends, to understand how they evaluated their cancer treatments and the determinants of the quality of life (QoL) of long-term survivors. Methods Ethnographic research was conducted with 24 patients who had responded to IO (pembrolizumab, nivolumab, atezolizumab, or durvalumab) for stage IV NSCLC, and their families and friends, evenly split among field sites in Denmark, the USA, and the UK. Data were collected using in-depth qualitative interviews, written exercises, and participant observation. Data analysis methods included interpretative phenomenological analysis, coding, and the development of grounded theory. Researchers spent 2 days with participants in their homes and accompanied them on health-related outings. Results Our findings reveal that long-term survivors on IO experienced their journey in two phases: one in which their cancer had taken over their lives mentally, physically, and spiritually, and another in which their cancer consumed only a part of their everyday lives. Patients who survived longer than their initial prognosis existed in a limbo state in which they were able to achieve some semblance of normalcy in spite of being identified as having a terminal condition. This limbo state impacted their life priorities, decision-making, experience of patient support, and health information-seeking behaviors, all of which shaped their definitions and experience of QoL. Conclusions The results of this study, which identify the specific challenges of living in limbo, where patients are able to reclaim a portion of their pre-cancer lives while continuing to wrestle with a terminal prognosis, may inform how cancer research can more effectively define and measure the QoL impacts of IO treatments. Also, they may identify approaches that the cancer community can use to support the needs of patients living in a limbo state. These experiences may not be adequately understood by the cancer community or captured by existing QoL measures, which were designed prior to the emergence of IO and without sufficient incorporation of contextual, patient-driven experience. Implications for Cancer Survivors Increased awareness of the specific experiences that come with long-term survival on IO may direct how resources should be spent for cancer support for patients and their families. Expanding how QoL is evaluated based on patients’ lived experiences of IO can reflect a more accurate depiction of the treatment’s benefits and harms.
Collapse
Affiliation(s)
- Rebekah Park
- ReD Associates, 26 Broadway Ste. 2505, New York, NY, 10004, USA.
| | - James W Shaw
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ, USA
| | - Alix Korn
- ReD Associates, 26 Broadway Ste. 2505, New York, NY, 10004, USA
| | - Jacob McAuliffe
- ReD Associates, 26 Broadway Ste. 2505, New York, NY, 10004, USA
| |
Collapse
|
87
|
Corbett TK, Groarke A, Devane D, Carr E, Walsh JC, McGuire BE. The effectiveness of psychological interventions for fatigue in cancer survivors: systematic review of randomised controlled trials. Syst Rev 2019; 8:324. [PMID: 31836007 PMCID: PMC6911282 DOI: 10.1186/s13643-019-1230-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 11/12/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fatigue is a common symptom in cancer patients that can persist beyond the curative treatment phase. This systematic review evaluated the effectiveness of psychological interventions for cancer-related fatigue in post-treatment cancer survivors. METHODS We searched relevant online databases and sources of grey literature. Randomised controlled trials (RCTs) evaluating psychological interventions in adult cancer patients after the completion of treatment, with fatigue as an outcome measure, were included. Two review authors extracted data independently from the selected studies and assessed the methodological quality using the Cochrane Collaboration Risk of Bias Tool. RESULTS Thirty-three psychological interventions were identified. The sample size of the included studies varied between 28 and 409, with 4525 participants overall. Twenty-three of the included studies reported a significant effect of the interventions on reducing fatigue in cancer survivors. Most interventions focused on psychoeducation, mindfulness, cognitive or behaviour therapy-oriented strategies. However, studies differed widely in terms of measurement tools used to assess fatigue, mode, duration and frequency of the intervention delivery. CONCLUSIONS This review showed some tentative support for psychological interventions for fatigue after cancer treatment. However, as the RCTs were heterogeneous in nature and the number of high-quality studies was limited, definitive conclusions are not yet possible. With the growing need for stage-specific research in cancer, this review sought to inform current practice and to summarise the existing evidence base of randomised controlled trials in the area. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42014015219.
Collapse
Affiliation(s)
- T K Corbett
- NIHR ARC Wessex, School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
| | - A Groarke
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - D Devane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - E Carr
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - J C Walsh
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - B E McGuire
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
88
|
Malhotra C, Harding R, Teo I, Ozdemir S, Koh GCH, Neo P, Lee LH, Kanesvaran R, Finkelstein E. Financial difficulties are associated with greater total pain and suffering among patients with advanced cancer: results from the COMPASS study. Support Care Cancer 2019; 28:3781-3789. [PMID: 31832824 DOI: 10.1007/s00520-019-05208-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/24/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND The Universal Health Coverage goals call for access to affordable palliative care to reduce inequities in "total pain" and suffering. To achieve this, a patient-centred understanding of these inequities is required. AIM To assess association of total pain and suffering (i.e. physical, psychological, social, and spiritual health outcomes) and perceived health care quality with financial difficulties among stage IV solid malignancy patients. DESIGN Using baseline data from the COMPASS cohort study, we assessed total pain and suffering including physical (physical and functional well-being, pain, symptom burden), psychological (anxiety, depression, emotional well-being), social (social well-being), and spiritual (spiritual well-being, hope) outcomes and perceived health care quality (physician communication, nursing care, and coordination/responsiveness). Financial difficulties were scored by assessing patient perception of the extent to which their resources were meeting expenses for their treatments, daily living, and other obligations. We used multivariable linear/logistic regression to test association between financial difficulties and each patient-reported outcome. SETTING/PARTICIPANTS Six hundred stage IV solid malignancy patients in Singapore. RESULTS Thirty-five percent reported difficulty in meeting expenses. A higher financial difficulties score was associated with worse physical, psychological, social, spiritual outcomes, and lower perceived quality of health care coordination and responsiveness (i.e. greater total pain and suffering) (all p < 0.05). These associations persisted after adjustment for socio-economic indicators. CONCLUSION Results identify advanced cancer patients with financial difficulties to be a vulnerable group with greater reported total pain and suffering. A holistic patient-centred approach to care at end-of-life may help meet goals for Universal Health Coverage.
Collapse
Affiliation(s)
- Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore. .,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Irene Teo
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,National Cancer Centre Singapore, Singapore, Singapore
| | - Semra Ozdemir
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Gerald C H Koh
- Saw Swee Hock School of Public Health, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Patricia Neo
- National Cancer Centre Singapore, Singapore, Singapore
| | - Lai Heng Lee
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | | | - Eric Finkelstein
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | | |
Collapse
|
89
|
Girgis A, Durcinoska I, Koh ES, Ng W, Arnold A, Delaney GP. Development of Health Pathways to Standardize Cancer Care Pathways Informed by Patient-Reported Outcomes and Clinical Practice Guidelines. JCO Clin Cancer Inform 2019; 2:1-13. [PMID: 30652587 DOI: 10.1200/cci.18.00024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE High-quality symptom management and supportive care are essential components of comprehensive cancer care. We aimed to describe the development of an evidence-based automated decisional algorithm for patients with cancer that had specific, actionable, clinical, evidence-based recommendations to improve patient care, communication, and management. METHODS We reviewed existing literature and clinical practice guidelines to identify priority domains of patient care and potential clinical recommendations. Two multidisciplinary clinical advisory groups used a two-stage consensus decision-making approach to determine domains of care and patient-reported outcome (PRO) measures and subsequently developed automated algorithms with clear clinical recommendations amendable to intervention in clinical settings. RESULTS Algorithms were developed to inform management of patient symptoms, distress, and unmet needs. Three PRO measures were chosen: Distress Thermometer and problem checklist, Edmonton Symptom Assessment Scale, and the Supportive Care Needs Survey-Screening Tool 9. PRO items were mapped to five domains of patient well-being: physical, emotional, practical, social and family, and maintenance of well-being. A total of 15 actionable clinical recommendations tailored to specific issues of concern were established. CONCLUSION Using automated algorithms and clinical recommendations provides a platform for streamlining and systematizing the use of PROs to inform risk-stratified guideline-informed care. The series of algorithms, which set out systematized care pathways for the clinical care of patients with cancer, can be used to potentially inform patient-centered care.
Collapse
Affiliation(s)
- Afaf Girgis
- Afaf Girgis, Ivana Durcinoska, and Geoff P. Delaney, The University of New South Wales, Sydney; Eng-Siew Koh, Weng Ng, and Geoff P. Delaney, Liverpool Hospital, Liverpool; and Anthony Arnold, Wollongong Hospital, Wollongong, NSW, Australia
| | - Ivana Durcinoska
- Afaf Girgis, Ivana Durcinoska, and Geoff P. Delaney, The University of New South Wales, Sydney; Eng-Siew Koh, Weng Ng, and Geoff P. Delaney, Liverpool Hospital, Liverpool; and Anthony Arnold, Wollongong Hospital, Wollongong, NSW, Australia
| | - Eng-Siew Koh
- Afaf Girgis, Ivana Durcinoska, and Geoff P. Delaney, The University of New South Wales, Sydney; Eng-Siew Koh, Weng Ng, and Geoff P. Delaney, Liverpool Hospital, Liverpool; and Anthony Arnold, Wollongong Hospital, Wollongong, NSW, Australia
| | - Weng Ng
- Afaf Girgis, Ivana Durcinoska, and Geoff P. Delaney, The University of New South Wales, Sydney; Eng-Siew Koh, Weng Ng, and Geoff P. Delaney, Liverpool Hospital, Liverpool; and Anthony Arnold, Wollongong Hospital, Wollongong, NSW, Australia
| | - Anthony Arnold
- Afaf Girgis, Ivana Durcinoska, and Geoff P. Delaney, The University of New South Wales, Sydney; Eng-Siew Koh, Weng Ng, and Geoff P. Delaney, Liverpool Hospital, Liverpool; and Anthony Arnold, Wollongong Hospital, Wollongong, NSW, Australia
| | - Geoff P Delaney
- Afaf Girgis, Ivana Durcinoska, and Geoff P. Delaney, The University of New South Wales, Sydney; Eng-Siew Koh, Weng Ng, and Geoff P. Delaney, Liverpool Hospital, Liverpool; and Anthony Arnold, Wollongong Hospital, Wollongong, NSW, Australia
| | | |
Collapse
|
90
|
Health-related quality of life in Croatian general population and multiple myeloma patients assessed by the EORTC QLQ-C30 and EORTC QLQ-MY20 questionnaires. Radiol Oncol 2019; 53:337-347. [PMID: 31553711 PMCID: PMC6765165 DOI: 10.2478/raon-2019-0047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 08/09/2019] [Indexed: 12/13/2022] Open
Abstract
Background The impact of disease and treatment on the patient's overall well-being and functioning is a topic of growing interest in clinical research and practice. The aim of this study is to obtain reference data on quality of life of Croatian general population. Further, we aim to assess the impact of the disease and its primary systemic treatment on their health related quality of life (HrQoL) in multiple myeloma (MM) patients. Patients and methods Participants for the first part of the study were randomly selected from adult Croatian population. In the clinical part of the study MM patients were included as prospectively diagnosed within two years in two major Croatian haematological centres. The EORTC QLQ-C30 in both trials and QLQ-MY20 in MM patients only were applied for HrQoL assessment. Results Gender, age and place of residence have great impact on quality of life scores in Croatian population. The MM patients at the time of diagnosis have lower QLQ-C30 scores for global quality of life, functional and symptom scale scores, as well as single items. The type of disease followed by the choice of therapy options are important HrQoL determinants. Conclusions The norm values available now for Croatian population will help to interpret HrQoL for clinicians and aid in planning cancer care interventions. This study identified treatment effect consistent with those from other observational studies and provided new data on HrQoL across two different treatment choices for MM patients.
Collapse
|
91
|
Lee JR, Oh PJ. [A Structural Model for Chemotherapy Related Cognitive Impairment and Quality of Life in Breast Cancer Patients]. J Korean Acad Nurs 2019; 49:375-385. [PMID: 31477668 DOI: 10.4040/jkan.2019.49.4.375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/07/2019] [Accepted: 02/07/2019] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to develop and test a structural model for chemotherapy-related cognitive impairment of breast cancer patients based on a literature review and Hess and Insel's chemotherapy-related cognitive change model. METHODS The Participants consisted of 250 patients who were ≥19 years of age. The assessment tools included the Menopause Rating Scale, Symptom Experience Scale, Hospital Anxiety and Depression Scale, Everyday Cognition, and Functional Assessment of Cancer Therapy-Breast Cancer. Data were analyzed using the SPSS 21.0 and AMOS 21.0 programs. RESULTS The modified model was a good fit for the data. The model fit indices were χ²=423.18 (p<.001), χ²/df=3.38, CFI=.91, NFI=.91, TLI=.89, SRMR=.05, RMSEA=.09, and AIC=515.18. Chemotherapy-related cognitive impairment was directly influenced by menopausal symptoms (β=.38, p=.002), depression and anxiety (β=.25, p=.002), and symptom experiences (β=.19, p=.012). These predictors explained 47.7% of the variance in chemotherapy-related cognitive impairment. Depression and anxiety mediated the relations among menopausal symptoms, symptom experiences, and with chemotherapy related cognitive impairment. Depression and anxiety (β=-.51, p=.001), symptom experiences (β=-.27, p=.001), menopausal symptoms (β=-.22, p=.008), and chemotherapy-related cognitive impairment (β=-.15, p=.024) had direct effects on the quality of life and these variables explained 91.3%. CONCLUSION These results suggest that chemotherapy-related toxicity is highly associated with cognitive decline and quality of life in women with breast cancer. Depression and anxiety increased vulnerability to cognitive impairment after chemotherapy. Nursing intervention is needed to relieve chemotherapy-related toxicity and psychological factor as well as cognitive decline for quality of life in patients undergoing chemotherapy.
Collapse
Affiliation(s)
- Jung Ran Lee
- Department of Nursing, Korea Cancer Center Hospital, Seoul, Korea
| | - Pok Ja Oh
- Department of Nursing, Sahmyook University, Seoul, Korea.
| |
Collapse
|
92
|
Roydhouse JK, Gutman R, Bhatnagar V, Kluetz PG, Sridhara R, Mishra-Kalyani PS. Analyzing patient-reported outcome data when completion differs between arms in open-label trials: an application of principal stratification. Pharmacoepidemiol Drug Saf 2019; 28:1386-1394. [PMID: 31410963 DOI: 10.1002/pds.4875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 06/10/2019] [Accepted: 07/13/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE Cancer trials are often open-label and include patient-reported outcomes (PROs). Previous work has demonstrated that patients may complete PRO assessments less frequently in the control arm compared with the experimental arm in open-label trials. Such differential completion may affect PRO results. This paper sought to explore principal stratification methodology to address potential bias caused by the posttreatment intermediate variable of questionnaire completion. METHODS We evaluated six randomized trials (five open-label and one double-blind) of anticancer therapies with varying levels of PRO completion submitted to the Food and Drug Administration (FDA). We applied complete case analysis (CCA), multiple imputation (MI), and principal stratification to evaluate PRO results for quality of life (QOL) and the domains of physical, role, and emotional function (PF, RF, and EF). Assignment to potential principal strata was by the expectation maximization algorithm using patient baseline characteristics. RESULTS Completion rates in the experimental arm ranged from 66% to 94% and 51% to 95% in the control arm. Four trials had negligible completion differences between arms (1%-2%), and two had large differences favoring the experimental arm (15%-17%). For trials with negligible completion differences, principal stratification results were similar to CCA and MI results for all domains. Notable differences in point estimates may be observed in trials with large differences in completion rates. However, in the examined trials, the confidence intervals for the principal stratification estimates overlapped with the ones obtained using CCA. CONCLUSIONS The principal stratification estimand may be a useful additional analysis, especially if PRO completion differs between arms.
Collapse
Affiliation(s)
- Jessica K Roydhouse
- Oak Ridge Institute for Science and Education Fellow, Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Roee Gutman
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Vishal Bhatnagar
- Division of Hematology Products, Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Paul G Kluetz
- Oncology Center of Excellence, US Food and Drug Administration, Silver Spring, MD, USA
| | - Rajeshwari Sridhara
- Office of Biostatistics, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Pallavi S Mishra-Kalyani
- Office of Biostatistics, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| |
Collapse
|
93
|
Influence of Tai Chi on Self-Efficacy, Quality of Life, and Fatigue Among Patients With Cancer Receiving Chemotherapy: A Pilot Study Brief. J Holist Nurs 2019; 37:354-363. [DOI: 10.1177/0898010119867557] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: While exercise is an effective intervention used to minimize side effects associated with chemotherapy, tai chi (TC) exercise for persons actively receiving chemotherapy remains understudied. The purposes of this study were to (a) evaluate the effects of TC on self-efficacy, quality of life (QOL), and cancer-related fatigue (CRF) and (b) understand the experience and perceived benefits of patients taking chemotherapy involved in a TC program. Design: An explanatory sequential mixed methods study with a dominant qualitative strand was used to explore the differences between an intervention group participating in TC ( n = 3) and a nonexercising, wait-listed comparison group ( n = 3). Method: Following 8-weeks of TC classes, a focus group was conducted with the intervention group. Pretest/posttest scores for CRF, self-efficacy, and QOL were analyzed using t tests to compare the means between and within groups. Thematic analysis was used to interpret transcripts. Quantitative and qualitative results were compared to determine congruence between findings. Findings: Qualitative findings revealed increased mind/body strength. Quantitative scores trended toward improved CRF, self-efficacy, and QOL. Findings from the two strands supported one another. Conclusions: Tai chi is an effective and feasible exercise for individuals with cancer receiving chemotherapy. This mind–body exercise appears to provide benefits beyond improved physical functioning.
Collapse
|
94
|
Understanding survivors' needs and outcomes: the role of routinely collected data. Curr Opin Support Palliat Care 2019; 12:254-260. [PMID: 29916842 DOI: 10.1097/spc.0000000000000352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW The number of cancer survivors is growing due to population ageing, earlier detection and more effective therapies. Routinely collected data (RCD), generally cancer registry data, has been used to investigate survivors' needs and outcomes. We reviewed uses of RCD since 2017, identifying novel findings and research directions. RECENT FINDINGS Survival is improving internationally but continues to vary between subgroups. Longitudinal survivor surveys suggest malignancy-specific temporal patterns in unmet needs and health-related quality-of-life (HRQoL). Unmet needs are a risk factor for future depression and depression predicts poorer HRQoL in all domains. Emerging evidence suggests links between posttraumatic stress and poor HRQoL and posttraumatic growth and improved HRQoL. Evidence for a link between cancer-related financial hardship and poor HRQoL is accumulating. Surveys and linkage studies continue to show poorer work outcomes in survivors. Among survivors of childhood and young adult cancers, large linkage studies demonstrate significant risk of late effects, including hospitalization, pregnancy and labour complications, and cardiac death. SUMMARY RCD plays a significant role in understanding survivors' needs and outcomes. New approaches which overlay different types of data - including detailed clinical and treatment data, biomarker data and nonhealth administrative data - have the potential to generate considerable new knowledge.
Collapse
|
95
|
O'Connell L, Coleman M, Kharyntiuk N, Walsh TN. Quality of life in patients with upper GI malignancies managed by a strategy of chemoradiotherapy alone versus surgery. Surg Oncol 2019; 30:33-39. [PMID: 31500782 DOI: 10.1016/j.suronc.2019.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/09/2019] [Accepted: 05/25/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Neoadjuvant chemoradiotherapy (nCRT) induces a pathological complete response (pCR) in 25-85% of oesophago-gastric cancer. As surgery entails morbidity and mortality risks and quality of life (QL) impairment, its avoidance in patients without residual disease is desirable. This study aimed to compare quality of life of patients with a cCR who chose surveillance with those who chose surgery. METHODS Four groups of patients were studied. Group 1(n = 31) were controls; Group 2 (n = 26) had chemoradiotherapy only; Group 3 (n = 31) had oesophagectomy after nCRT; Group 4 (n = 26) had gastrectomy alone. A 33-point novel questionnaire was administered at two 3 month time points. Participants were also interviewed with a validated questionnaire. RESULTS Mean(±sd) quality of life scores in cCR patients offered surveillance (28.9 ± 4.5) were superior to patients undergoing oesophagectomy (32.3 ± 58. p=0.042) or gastrectomy (33.19 ± 5.9, p=0.004). This result was replicated in the validated questionnaire (p=0.017). There was a trend towards increased reflux-related respiratory symptoms in the oesophagectomy group (7.3 ± 2.2 vs 6.5 ± 1.9; p=0.396) and towards early dumping (8.2 ± 1.4 vs 7.1 ± 1.; p=0.239) and vagotomy-related symptoms (1.82 ± 0.9 vs 1.4 ± 0.6; p=0.438) in the gastrectomy group. CONCLUSIONS Avoidance of surgery in cCR patients is rewarded with a superior quality of life to those undergoing surgery.
Collapse
Affiliation(s)
- Lauren O'Connell
- Royal College of Surgeons in Ireland, Department of Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland.
| | - Mary Coleman
- Royal College of Surgeons in Ireland, Department of Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - N Kharyntiuk
- Royal College of Surgeons in Ireland, Department of Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - Thomas N Walsh
- Royal College of Surgeons in Ireland, Department of Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland; Royal College of Surgeons in Ireland, Department of Surgery, Beaumont Hospital, Dublin 9, Ireland
| |
Collapse
|
96
|
Abstract
Continuous improvements in the diagnosis and treatment of cancer lead to improved cure rates and longer survival. However, in many patients, the disease becomes chronic. In this context, the patients' quality of life (QOL) becomes a crucial issue. After an introduction about QOL, results from different areas of cancer treatment are presented considering their impact on QOL. Finally, implications are discussed for researchers, clinicians, and patients.
Collapse
|
97
|
Shi J, Sun J, Liu C, Chai Z, Wang N, Zhang H, Cheng S. All-trans-retinoic acid (ATRA) plus oxaliplatin plus 5-fluorouracil/leucovorin (FOLFOX) versus FOLFOX alone as palliative chemotherapy in patients with advanced hepatocellular carcinoma and extrahepatic metastasis: study protocol for a randomized controlled trial. Trials 2019; 20:245. [PMID: 31036040 PMCID: PMC6489221 DOI: 10.1186/s13063-019-3349-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/03/2019] [Indexed: 12/20/2022] Open
Abstract
Background Among patients with hepatocellular carcinoma (HCC), 85% of patients have an advanced disease stage at diagnosis and curative therapies cannot be performed. Prognosis has been quite poor as until recently there was no proven effective chemotherapy. Our group found that all-trans-retinoic acid (ATRA) could improve the efficacy of platinum in HCC in vivo and in vitro, thus we wish to validate the efficiency of ATRA in clinical practice. Methods This is a double-blinded, 1:1 randomized, controlled, multicenter clinical trial. Three hundred and sixty-eight patients with HCC and extrahepatic metastases will receive palliative chemotherapy at the Eastern Hepatobiliary Surgery Hospital, First Hospital of Jilin University and Fujian Provincial Cancer Hospital. Subjects will be randomly assigned to one of the two arms, either ATRA + oxaliplatin + 5-fluorouracil/leucovorin (FOLFOX4) or FOLFOX4 alone. ATRA 20 mg will be given orally three times/day for 3 days prior to the initiation of FOLFOX4. ATRA will be discontinued at the end of FOLFOX4. Discussion Overall survival rate is the primary endpoint. Secondary endpoints are time to progression according to the modified response evaluation criteria in solid tumors (mRECIST) criteria, acute and chronic adverse events, and quality of life. Trial registration Chinese Clinical Trial Registry, ChiCTR-IIR-17012916. Registered on 9 October 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3349-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jie Shi
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Rd No.225, Shanghai, 200438, China
| | - Juxian Sun
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Rd No.225, Shanghai, 200438, China
| | - Chang Liu
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Rd No.225, Shanghai, 200438, China
| | - Zongtao Chai
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Rd No.225, Shanghai, 200438, China
| | - Nanya Wang
- Department of Cancer Center, First Hospital of Jilin University, Xinmin Rd No71, Changchun, 130021, Jilin Province, China
| | - Hui Zhang
- Department of Surgery of Hepato-Biliary & Pancreatic Tumor, Fujian Provincial Cancer Hospital, Fuma Rd No.420, Fuzhou, 350011, Fujian Province, China
| | - Shuqun Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Rd No.225, Shanghai, 200438, China.
| |
Collapse
|
98
|
Chernyshov PV, Lallas A, Tomas-Aragones L, Arenbergerova M, Samimi M, Manolache L, Svensson A, Marron SE, Sampogna F, Spillekom-vanKoulil S, Bewley A, Forsea AM, Jemec GB, Szepietowski JC, Augustin M, Finlay AY. Quality of life measurement in skin cancer patients: literature review and position paper of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient Oriented Outcomes, Melanoma and Non-Melanoma Skin Cancer. J Eur Acad Dermatol Venereol 2019; 33:816-827. [PMID: 30963614 DOI: 10.1111/jdv.15487] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/18/2019] [Indexed: 12/13/2022]
Abstract
The European Academy of Dermatology and Venereology (EADV) Task Forces (TFs) on Quality of Life (QoL) and Patient Oriented Outcomes, Melanoma and Non-Melanoma Skin Cancer (NMSC) present a review of the literature and position statement on health-related (HR) QoL assessment in skin cancer patients. A literature search was carried out to identify publications since 1980 that included information about the impact of SC on QoL. Generic, dermatology-specific, cancer-specific, SC-specific, facial SC-specific, NMSC-specific, basal cell carcinoma-specific and melanoma-specific QoL questionnaires have been used to assess HRQoL in SC patients. HRQoL was assessed in the context of creation and validation of the HRQoL instruments, clinical trials, comparison of QoL in SC and other cancers, other diseases or controls, HRQoL assessment after treatment, comorbidities, behaviour modification, predictors of QoL and survival, supportive care needs, coping strategies and fear of cancer recurrence. The most widely used instruments for HRQoL assessment in SC patients are the European Organisation for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-C30), the Functional Assessment of Cancer Therapy-Melanoma (FACT-M), Skin Cancer Index (SCI), Short Form 36 Item Health Survey (SF-36) and the Dermatology Life Quality Index (DLQI). The TFs recommend the use of the cancer-specific EORTC QLQ-C30, especially in late stages of disease, and the melanoma-specific FACT-M and SC-specific SCI questionnaires. These instruments have been well validated and used in several studies. Other HRQoL instruments, also with good basic validation, are not currently recommended because the experience of their use is too limited. Dermatology-specific HRQoL instruments can be used to assess the impact of skin-related problems in SC. The TFs encourage further studies to validate HRQoL instruments for use in different stages of SC, in order to allow more detailed practical recommendations on HRQoL assessment in SC.
Collapse
Affiliation(s)
- P V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine
| | - A Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - L Tomas-Aragones
- Department of Psychology, University of Zaragoza, Zaragoza, Spain
| | - M Arenbergerova
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - M Samimi
- Dermatology Department, University of Tours, Tours, France
| | - L Manolache
- Dermatology, Dali Medical, Bucharest, Romania
| | - A Svensson
- Department of Dermatology and Venereology, Skane University Hospital, Malmö, Sweden
| | - S E Marron
- Department of Dermatology, Royo Villanova Hospital, Aragon Psychodermatology Research Group (GAI+PD), Zaragoza, Spain
| | - F Sampogna
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS FLMM, Rome, Italy
| | - S Spillekom-vanKoulil
- Radboud Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Bewley
- Whipps Cross University Hospital, London, UK.,The Royal London Hospital, London, UK
| | - A M Forsea
- Department of Oncologic Dermatology and Allergology, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - G B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, Wrocław, Poland
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Y Finlay
- Department of Dermatology and Wound Healing, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| |
Collapse
|
99
|
Besson A, Deftereos I, Chan S, Faragher IG, Kinsella R, Yeung JM. Understanding patient-reported outcome measures in colorectal cancer. Future Oncol 2019; 15:1135-1146. [PMID: 30880455 DOI: 10.2217/fon-2018-0723] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Quality of life has become increasingly regarded as a key outcome measurement for cancer patients. Patient-reported outcome measures (PROMs) represent the tools used to ascertain self-reported quality of life. This review provides a summary of the literature regarding the use of PROMs in colorectal cancer and evaluates the advantages and limitations of generic and disease specific questionnaires that can be utilized in clinical practice. Factors that influence PROMs are outlined, including cancer characteristics, patient factors and treatment methods. Finally, future directions for the use of PROMs in colorectal cancer to inform healthcare delivery at an individual- and systems-based level are discussed.
Collapse
Affiliation(s)
- Alex Besson
- Department of Surgery, Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Irene Deftereos
- Department of Surgery, Western Health, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Nutrition, Western Health, Footscray, Victoria, Australia
| | - Steven Chan
- Department of Surgery, Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ian G Faragher
- Department of Colorectal Surgery, Western Health, Footscray, Victoria, Australia
| | - Rita Kinsella
- Department of Surgery, Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Justin Mc Yeung
- Department of Surgery, Western Health, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Colorectal Surgery, Western Health, Footscray, Victoria, Australia
| |
Collapse
|
100
|
Health-related quality of life in Slovenian patients with colorectal cancer: a single tertiary care center study. Radiol Oncol 2019; 53:231-237. [PMID: 30893057 PMCID: PMC6572500 DOI: 10.2478/raon-2019-0015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/02/2019] [Indexed: 12/18/2022] Open
Abstract
Background The aim of this study was to evaluate the influence of the surgical treatment on Slovenian colorectal cancer patients’ health-related quality of life and to compare the results to the health-related quality of life of the general Slovenian population. Patients and methods A total of 413 patients with colorectal cancer operated on at the Abdominal Surgery Department at the Ljubljana University Medical Center between January 1st, 2016 and December 31st, 2017 were sent two standardized and validated questionnaires: the EORTC QLQ-C30 version 3 and EORTC QLQ-CR29. The questionnaires were returned by 197 patients. Results Compared to the general population, poorer physical (p < 0.001), role (p = 0.002), cognitive (p = 0.021), and social functioning (p < 0.001) with higher frequency of constipation (p < 0.001), diarrhea (p < 0.001), and financial difficulties (p < 0.001) were reported by the colorectal patients. Female patients reported lower cognitive (p = 0.034) and emotional (p = 0.008) functioning, as well as higher frequency of bloating (p = 0.049) and hair loss (p = 0.01). Compared to the younger group of patients, lower physical functioning (p < 0.001) and higher urinary frequency (p = 0.007), urinary incontinence (p = 0.007), buttock pain (p = 0.007), and anxiety regarding body weight (p = 0.031) were detected among the older group of colorectal patients. Conclusions The global health status of colorectal patients in Slovenia is comparable to that of the general Slovenian population, but there is a significantly lower level in some of the quality-of-life scales.
Collapse
|