Avanzando Caminos (Leading Pathways): design and procedures of the Hispanic/Latino Cancer Survivorship Study

Avanzando Caminos (Leading Pathways): The Hispanic/Latino Cancer Survivorship Cohort Study aims to examine the influence of sociocultural, medical, stress-related, psychosocial, lifestyle, behavioral, and biological factors on symptom burden, health-related quality of life, and clinical outcomes among Hispanics/Latinos who have been previously treated for cancer. Avanzando Caminos is a prospective, cohort-based study of 3000 Hispanics/Latinos who completed primary cancer treatment within the past 5 years that is representative of the general Hispanic/Latino population in the United States. Participants will complete self-report measures at baseline (time [T] 1), 6 months (T2), 1 year (T3), 2 years (T4), 3 years (T5), 4 years (T6), and 5 years (T7). Blood samples drawn for assessment of leukocyte gene expression, cardiometabolic markers, and genetic admixture will be collected at baseline (T1), 1 year (T3), 3 years (T5), and 5 years (T7). Medical and cancer characteristics and clinical outcomes will be extracted from the electronic medical record and/or state cancer registry at each time point. Data analysis will include general latent variable modeling and latent growth modeling. Avanzando Caminos will fill critical gaps in knowledge in order to guide future secondary and tertiary prevention efforts to mitigate cancer disparities and optimize health-related quality of life among Hispanic/Latino cancer survivors.

Quality of life assessment of breast cancer survivors in Northern Morocco: Rural-urban disparity

This article is a cross-sectional study of 216 women undergoing adjuvant hormone therapy for breast cancer in two oncology centers in northern Morocco. Quality of life (QoL) was assessed using the Functional Assessment of Cancer Therapy (FACT) questionnaire and its endocrine subscale (ES). The relationship between rural-urban status in our sample and QoL was assessed by linear regression analysis using sociodemographic and clinical variables as covariates. Our results show that physical and functional well-being are significantly (p < 0.001) higher in rural areas (24 and 29, respectively) than in urban areas (16 and 19, respectively), while social and emotional well-being are significantly (p < 0.001) higher in urban areas (22 and 21, respectively) than in rural areas (15 and 16, respectively). However, there was no significant difference (p = 0.097) between rural and urban breast cancer survivors regarding endocrine symptom burden. Regarding the effect of sociodemographic and clinical factors on overall HRQOL of breast cancer survivors, hormone type was shown to have a significant effect on overall HRQOL (FACT-ES) of rural and urban breast cancer survivors (𝛽 = +0.849 and 𝛽 = +0.678, respectively). A similar effect was observed for ES (𝛽 = +0.896 and 𝛽 = +0.180, respectively).In contrast, other factors (age, marital status, economic status, menopausal status, type of surgery) did not have a significant effect on HRQOL (FACT-ES) or ES.The study highlighted the need for increased psychosocial supportive care efforts for rural breast cancer survivors to improve their QoL.

The quality of life in neoadjuvant versus adjuvant therapy of esophageal cancer treatment trial (QUINTETT): Randomized parallel clinical superiority trial

Background

We compared the health‐related quality of life (HRQOL) in patients undergoing trimodality therapy for resectable stage I‐III esophageal cancer.

Methods

A total of 96 patients were randomized to standard neoadjuvant cisplatin and 5‐fluorouracil chemotherapy plus radiotherapy (neoadjuvant) followed by surgical resection or adjuvant cisplatin, 5‐fluorouracil, and epirubicin chemotherapy with concurrent extended volume radiotherapy (adjuvant) following surgical resection.

Results

There was no significant difference in the functional assessment of cancer therapy‐esophageal (FACT‐E) total scores between arms at 1 year (p = 0.759) with 36% versus 41% (neoadjuvant vs. adjuvant), respectively, showing an increase of ≥15 points compared to pre‐treatment (p = 0.638). The HRQOL was significantly inferior at 2 months in the neoadjuvant arm for FACT‐E, European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ‐OG25), and EuroQol 5‐D‐3 L in the dysphagia, reflux, pain, taste, and coughing domains (p < 0.05). Half of patients were able to complete the prescribed neoadjuvant arm chemotherapy without modification compared to only 14% in the adjuvant arm (p < 0.001). Chemotherapy related adverse events of grade ≥2 occurred significantly more frequently in the neoadjuvant arm (100% vs. 69%, p < 0.001). Surgery related adverse events of grade ≥2 were similar in both arms (72% vs. 86%, p = 0.107). There were no 30‐day mortalities and 2% vs. 10% 90‐day mortalities (p = 0.204). There were no significant differences in either overall survival (OS) (5‐year: 35% vs. 32%, p = 0.409) or disease‐free survival (DFS) (5‐year: 31% vs. 30%, p = 0.710).

Conclusion

Trimodality therapy is challenging for patients with resectable esophageal cancer regardless of whether it is given before or after surgery. Newer and less toxic protocols are needed.

Associations of meaning of illness with psychosocial, clinical, and immunological characteristics in patients with Leptomeningeal metastasis

Background

Leptomeningeal metastasis (LM) creates symptoms related to both the disease within the nervous system and treatment toxicities. Biologic processes, such as inflammation and behavioral processes, such as the meaning ascribed to illness (Meaning of Illness: MoI), can impact physical and psychosocial symptoms. The aim of this study was to understand the relationships among MoI, physical and psychosocial symptoms, and inflammation in patients with LM.

Methods

Thirty enrolled participants completed the MD Anderson Symptom Inventory-Brain Tumor with spine experimental symptoms added. Meaning of illness, quality of life (QoL), and depression were captured by validated instruments. Interleukin (IL)-6 and tumor necrosis factor (TNF)-α in serum and cerebrospinal fluid (CSF) were measured by ELISA. Correlations were performed to assess relationships among the variables.

Results

Participants were primarily white (73%), female (63%). Median age was 54 years (34–83). Breast (50%) and lung (20%) were most common diagnosis. Higher MoI scores were associated with better QoL (p < .01) and fewer depressive symptoms (p < .01). All CSF samples contained IL-6 and all but one sample had elevated IL-6. Higher levels of IL-6 in the CSF were associated with greater symptom burden (p < .01) and interference of symptoms in daily life (p = .02) but not MoI.

Conclusions

MoI was associated with QoL and depression. High levels of IL-6 in the CSF were associated with more severe symptoms. This study provides the groundwork for future research, including interventional studies to improve QoL in patients with LM.

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Ascribing positive meaning to illness is associated with higher reported QoL in patients with LM.

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High IL-6 in the CSF was associated with increased symptom burden but not depressive symptoms.

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Fostering meaning in patients with LM may help mood, reduce inflammation, and improve symptoms.

Efficacy and Safety of Auricular Acupuncture for the Treatment of Insomnia in Breast Cancer Survivors: A Randomized Controlled Trial

Among women, breast cancer is the most commonly diagnosed cancer worldwide. Sleep problems impair 40-70% of breast cancer survivors. This randomized controlled trial evaluates the effect of auricular acupuncture on sleep quality in breast cancer survivors suffering from insomnia. Fifty-two female breast cancer survivors with insomnia (mean age 55.73 ± 8.10 years) were randomized either to 10 treatments of auricular acupuncture within five weeks (n = 26), or to a single session of psychoeducation plus an insomnia advice booklet (n = 26). The primary outcome was sleep quality (measured by the Pittsburgh Sleep Quality Index) at week 5. Secondary outcomes were inflammation parameter (interleukin-6), stress, anxiety, depression, quality of life, and fatigue at week 5, and sleep quality, stress, anxiety, depression, quality of life, and fatigue 17 and 29 weeks after randomization. Intention-to-treat analysis showed a significantly stronger increase in sleep quality in the auricular acupuncture group compared to the psychoeducation group (p = 0.031; η²_p = 0.094) at week 5. Furthermore, auricular acupuncture improved stress (p = 0.030; η²_p = 0.094), anxiety (p = 0.001; η²_p = 0.192), and fatigue (p = 0.006; η²_p = 0.148) at week 5 compared to psychoeducation. No significant group difference was found concerning the other outcomes at week 5, or in any outcome at week 17 or week 29. No serious adverse events occurred during the study period. In conclusion, a semi-standardized group auricular acupuncture might be an effective and safe intervention in treating insomnia in breast cancer survivors in the short term, and may reduce stress, anxiety, and fatigue as well. Long-term effects remain questionable.

The INTREST registry: protocol of a multicenter prospective cohort study of predictors of women's response to integrative breast cancer treatment

BACKGROUND

Cancer registries usually assess data of conventional treatments and/or patient survival. Beyond that, little is known about the influence of other predictors of treatment response related to the use of complementary therapies (CM) and lifestyle factors affecting patients' quality and quantity of life.

METHODS

INTREST is a prospective cohort study collecting register data at multiple German certified cancer centers, which provide individualized, integrative, in- and outpatient breast cancer care. Patient-reported outcomes and clinical cancer data of anticipated N = 715 women with pTNM stage I-III breast cancer are collected using standardized case report forms at the time of diagnosis, after completing neo-/adjuvant chemotherapy, after completing adjuvant therapy (with the exception of endocrine therapy) as well as 1, 2, 5, and 10 years after baseline. Endpoints for multivariable prediction models are quality of life, fatigue, treatment adherence, and progression-based outcomes/survival. Predictors include the study center, sociodemographic characteristics, histologic cancer and comorbidity data, performance status, stress perception, depression, anxiety, sleep quality, spirituality, social support, physical activity, diet behavior, type of conventional treatments, use of and belief in CM treatments, and participation in a clinical trial. Safety is recorded following the Common Terminology Criteria for Adverse Events.

DISCUSSION

This trial is currently recruiting participants. Future analyses will allow to identify predictors of short- and long-term response to integrative breast cancer treatment in women, which, in turn, may improve cancer care as well as quality and quantity of life with cancer.

TRIAL REGISTRATION

German Clinical Trial Register DRKS00014852 . Retrospectively registered at July 4th, 2018.

Patient-reported long-term quality of life after tisagenlecleucel in relapsed/refractory diffuse large B-cell lymphoma

The JULIET phase 2 trial evaluated a single infusion of tisagenlecleucel in adult patients with relapsed/refractory (r/r) diffuse large B-cell lymphoma (DLBCL). The objective of the current analysis was to evaluate patient-reported health-related quality of life (HRQoL) with a median follow-up of 19.3 months among patients infused with a single dose of tisagenlecleucel. Patients enrolled were ≥18 years of age with r/r DLBCL after ≥2 lines of therapy and had either undergone a failed autologous stem cell transplant or were ineligible for the procedure. Two validated HRQoL instruments, Functional Assessment of Cancer Therapy-Lymphoma (FACT-Lym) and Short Form-36 (SF-36) Health Survey, were used to measure HRQoL at baseline and months 3, 6, 12, and 18. At data cutoff (21 May 2018), 115 patients had received tisagenlecleucel infusion. Among the 99 patients evaluated, overall response rate was 54%, and 40% of patients achieved complete response (CR). Initially, 108 patients completed the HRQoL assessments at baseline, including 57 patients who eventually achieved CR or partial response (PR). Further, 30 and 21 patients in clinical response who completed assessments at baseline also completed assessments at months 12 and 18, respectively. Patients who achieved CR or PR sustained HRQoL improvement in all FACT scores at all time points. SF-36 instruments showed improvement above the minimal clinically important differences on 5 of 8 subscales. Long-term follow-up in the phase 2 JULIET study demonstrated that patients with r/r DLBCL who respond to tisagenlecleucel therapy had sustained, clinically meaningful improvements in HRQoL. This trial was registered at www.clinicaltrials.gov as #NCT02445248.

Quality of life outcomes from a randomized controlled trial of patient navigation in Latina breast cancer survivors

INTRODUCTION

Breast cancer survivorship is a life-long process involving challenges to health-care communities and individuals, especially Latinas. Patient Navigation has shown some success in meeting these challenges. The purpose of this study was to compare the effects of an enhanced Patient Navigation program (Intervention; PN+) vs Control (PN) over time on general cancer and breast cancer-specific quality of life (QoL) in Latina breast cancer survivors (BCS).

METHODS

We conducted a 2-year, two-arm randomized controlled trial of the "Staying Healthy" program among Latina BCS. The design compared PN+ vs PN over time. We recruited 60 patients into each study arm and randomized them by sequential numerical assignment. PN+ participants received culturally tailored educational materials and active, personalized Patient Navigation services, including phone calls, transportation, and care coordination. PN participants were navigated only upon request. Primary outcomes included general cancer (Functional Assessments of Cancer Therapy [FACTS]-G) and breast cancer-specific (FACT-B) QoL.

RESULTS

PN+ participants had significantly improved QoL measures compared to PN at 6-month follow-up on all subscales (P-values .007-.04) except physical well-being (PWB; P = .11). Intervention effect size coefficient (standard error) for FACT-G overall was 7.9 (3.1); P = .01. For FACT-B, it was 10.9 (3.9); P = .006. Again, all subscales showed significant effects [range 1.7-3.1 (0.8-1.2); P-values .006-.04], except for PWB [1.5 (1.0); P = .16] and social/family well-being (SWB) [2.1 (1.1); P = .06]. There were no differences between groups at baseline.

DISCUSSION

Multiple cultural, psychosocial, and socioeconomic variables contributing to these intervention effects will be addressed in future studies. As the national BCS population continues to increase, more Patient Navigation-focused partnerships among patients, health-care professionals, research groups, and community organizations are needed to improve BCS experiences. The Staying Healthy program has the potential to serve as a national survivorship care model for improving Latina BCS QoL.

Cognitive rehabilitation program to improve cognition of cancer patients treated with chemotherapy: A 3-arm randomized trial

Background

There is no treatment for cancer‐related cognitive impairment, an important adverse effect that negatively impacts quality of life (QOL). We conducted a 3‐arm randomized controlled trial to evaluate the impact of computer‐assisted cognitive rehabilitation (CR) on cognition, QOL, anxiety, and depression among cancer patients treated with chemotherapy.

Methods

Patients who reported cognitive complaints during or after completing chemotherapy were randomly assigned to 1 of 3 12‐week CR programs: computer‐assisted CR with a neuropsychologist (experimental group A), home cognitive self‐exercises (active control group B), or phone follow‐up (active control group C). Subjective cognition was assessed by the Functional Assessment of Cancer Therapy–Cognitive Function (FACT‐Cog), objective cognition was assessed by neuropsychological tests, QOL was assessed by the FACT‐General, and depression and anxiety were assessed by psychological tests. The primary endpoint was the proportion of patients with a 7‐point improvement in the FACT‐Cog perceived cognitive impairment (PCI) score.

Results

Among the 167 enrolled patients (median age, 51 years), group A had the highest proportion of patients with a 7‐point PCI improvement (75%), followed by groups B (59%) and C (57%), but the difference was not statistically significant (P = .13). Compared with groups B and C, the mean difference in PCI score was significantly higher in group A (P = .02), with better perceived cognitive abilities (P < .01) and a significant improvement in working memory (P = .03). Group A reported higher QOL related to cognition (FACT‐Cog QOL) (P = .01) and improvement in depression symptoms (P = .03).

Conclusions

These results suggest a benefit of a computer‐based CR program in the management of cancer‐related cognitive impairment and complaints.

In this 3‐arm randomized clinical trial of 167 patients, computer‐assisted cognitive rehabilitation improved cognitive complaints, with significant improvement in working memory, quality of life related to cognition, and depression symptoms. Computer‐assisted cognitive rehabilitation is a compelling approach toward the management of cancer‐related cognitive impairment and complaints.

Integration of Patient Reported Outcomes in Drug Development in Genitourinary Cancers

PURPOSE OF REVIEW

Patient reported outcomes (PROs) are increasingly utilized in cancer drug development, and are of particular importance in genitourinary cancers due to symptom burden, multiple treatment options with similar efficacy, and often prolonged duration of disease. Here we review current data and perspectives related to use of PROs in drug development for genitourinary cancers, including insights on the regulatory process for drug approval.

RECENT FINDINGS

The FDA is committed to incorporating PRO data into the regulatory process for development and approval of new cancer drugs, but challenges exist due to lack of standardization of PRO instrument choice and analytic approach, missing data, and difficulty isolating treatment effect from disease-related effects. We review guidance for standardization of PRO methodology that is nonetheless tailored to disease state and anticipated effects of treatment. PRO and efficacy data should be simultaneously analyzed and reported for best clinical practice. Multiple disease-specific PRO instruments exist for genitourinary cancers. While clinicians, researchers, and regulatory bodies alike recognize the importance of PROs in cancer drug development, challenges remain regarding implementation of best practices.

Dyadic Coping Across the Lifespan: A Comparison Between Younger and Middle-Aged Couples With Breast Cancer

The association between dyadic coping and adjustment to cancer has been well-established. However, a significant gap in the literature is the understanding of how the life stage of couples may influence their dyadic coping and the accompanying quality of life. Although younger couples have been identified at higher risk for poor coping because of less collaborative behaviors and higher vulnerability to stress, only a limited number of studies have addressed younger women's coping with breast cancer in the context of close relationships. The present study addressed the differential impact of the illness on the quality of life and dyadic coping behaviors of younger and middle-aged dyads and the influence of relational mutuality on couples' coping in the two groups. A sample of 86 couples participated in a cross-sectional study; 35 younger couples were compared to 51 middle-aged dyads. Patients and partners completed measures of quality of life, dyadic coping, and mutuality. Independent-samples t-tests were used to examine differences in the two groups, while the Actor-Partner Interdependence Model (APIM) identified actor and partner effects of relational mutuality on dyadic coping. Younger women and their partners reported statistically significant worse quality of life and dyadic coping scores than the middle-age group. For younger couples, positive and negative coping styles were the result of both actor and partner effects of mutuality. The study highlighted the more negative impact of breast cancer on the quality of life of younger patients and partners. It also revealed a stronger influence of each partner's relational mutuality compared to the middle-age group in predicting both adaptive and maladaptive coping behavior. Future studies should continue to examine the developmental trajectory of dyadic coping across the lifespan in order to develop psychosocial interventions to promote younger dyads' coping efforts.

Effect of the soft-tissue techniques in the quality of life in patients with Crohn's disease: A randomized controlled trial

BACKGROUND

Crohn's disease (CD) is a highly prevalent inflammatory bowel disease (IBD), characterized by recurring flares altered by periods of inactive disease and remission, affecting physical and psychological aspects and quality of life (QoL). The aim of this study was to determine the therapeutic benefits of soft non-manipulative osteopathic techniques in patients with CD.

METHODS

A single-blind randomized controlled trial was performed. 30 individuals with CD were divided into 2 groups: 16 in the experimental group (EG) and 14 in the control group (CG). The intervention period lasted 30 days (1 session every 10 days). Pain, global quality of life (GQoL) and QoL specific for CD (QoLCD) were assessed before and after the intervention. Anxiety and depression levels were measured at the beginning of the study.

RESULTS

We observed a significant effect of the treatment in both the physical and task subscales of the GQoL (P = .01 and P = .04, respectively) and also in the QoLCD (P ≤.0001) but not in pain score (P = .28). When the intensity of pain was taken into consideration in the analysis of the EG, there was a significantly greater increment in the QoLCD after treatment in people without pain than in those with pain (P = .02) The improvements in GQoL were independent from the disease status (P = .16).

CONCLUSIONS

Soft, non-manipulative osteopathic treatment is effective in improving overall and physical-related QoL in CD patients, regardless of the phase of the disease. Pain is an important factor that inversely correlates with the improvements in QoL.

Validation of the Spanish version of the Cancer Symptom Scale in Hispanic cancer patients

AIM

To assess the validity of the translated Spanish Cancer Symptom Scale.

BACKGROUND

Instruments to facilitate comprehensive and objective assessments of the cancer symptom experience in underrepresented populations are essential.

METHODS

The Cancer Symptom Scale was translated into Spanish, and a back translation was conducted. During June 2016, a sample of 121 Hispanic Puerto Rican patients with any cancer diagnosis, all undergoing cancer treatments, completed four paper surveys. A subgroup of 15 patients agreed to complete the Spanish Cancer Symptom Scale a second time after a short delay of 1 to 2 hours. Construct validity and reliability (internal consistency via Cronbach alpha and test-retest reliability) was evaluated.

RESULTS

All the Intensity Items of the Spanish Cancer Symptom Scale correlated significantly with the matched items on the MD Anderson Symptom Inventory. In a subgroup of 77 participants, each Cancer Symptom Scale subscale total of scores correlated significantly with the total scores from the Functional Assessment of Cancer Therapy-General. Discriminant validity was demonstrated between those receiving chemotherapy and those from post treatment. The Spanish Cancer Symptom Scale internal consistency reliability was 0.98.

CONCLUSION

The Spanish Cancer Symptom Scale has excellent evidence of validity and reliability for assessing cancer-therapy-related symptoms.

Assessing whether EORTC QLQ-30 and FACT-G measure the same constructs of quality of life in patients with total laryngectomy

BACKGROUND

The European Organization for Research and Treatment of Cancer QOL Core Questionnaire 30 (EORTC QLQ-30) and the Assessment of Cancer Therapy-General (FACT-G) are the two most widely used measures of cancer-specific health-related quality of life (HRQOL). This study aims to assess whether the two instruments measure the same constructs of HRQOL in patients with total laryngectomy.

METHODS

The EORTC QLQ-30 and the FACT-G was completed by 132 patients with total laryngectomy. Convergent, discriminant, and construct validity of the EORTC QLQ-C30 and the FACT-G were assessed by Spearman's correlation and explanatory factor analysis.

RESULTS

The results of factor analysis showed that the EORTC QLQ-C30 and the FACT-G measure different aspects of HRQOL. Moreover, both instruments showed excellent convergent and discriminant validity, except for nausea and vomiting symptom subscale in the EORTC QLQ-C30 questionnaire. The internal consistency was close or greater than 0.7 for all domains of both instruments except for functional wellbeing in FACT-G.

CONCLUSIONS

This study revealed that neither of the two instruments can be replaced by the other in the assessment of HRQOL in Iranian patients with total laryngectomy. Accordingly, clinicians should exactly define their research questions related to patient-reported outcomes before choosing which instrument to use.

The modified Memorial Symptom Assessment Scale Short Form: a modified response format and rational scoring rules

PURPOSE

The Memorial Symptom Assessment Scale Short Form (MSAS-SF) is a widely used symptom assessment instrument. Patients who self-complete the MSAS-SF have difficulty following the two-part response format, resulting in incorrectly completed responses. We describe modifications to the response format to improve useability, and rational scoring rules for incorrectly completed items.

METHODS

The modified MSAS-SF was completed by 311 women in our Peer and Nurse support Trial to Assist women in Gynaecological Oncology; the PeNTAGOn study. Descriptive statistics were used to summarise completion of the modified MSAS-SF, and provide symptom statistics before and after applying the rational scoring rules. Spearman's correlations with the Functional Assessment for Cancer Therapy-General (FACT-G) and Hospital Anxiety and Depression Scale (HADS) were assessed.

RESULTS

Correct completion of the modified MSAS-SF items ranged from 91.5 to 98.7%. The rational scoring rules increased the percentage of useable responses on average 4% across all symptoms. MSAS-SF item statistics were similar with and without the scoring rules. The pattern of correlations with FACT-G and HADS was compatible with prior research.

CONCLUSION

The modified MSAS-SF was useable for self-completion and responses demonstrated validity. The rational scoring rules can minimise loss of data from incorrectly completed responses. Further investigation is recommended.

Feasibility of Mind-Body Movement Programs for Cancer Survivors

PURPOSE/OBJECTIVES

To evaluate mind-body movement exercise (MBME) classes (yoga, tai chi, and Qigong) for cancer survivors. 
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DESIGN

A single-group, repeated-measures design.
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SETTING

The Ohio State University Wexner Medical Center-Arthur G. James Cancer Hospital in Columbus.
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SAMPLE

33 adult cancer survivors, with any cancer diagnosis, participating in MBME classes.
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METHODS

The researchers sought to examine feasibility of multiple data collection time points and data collection measures; acceptability; and changes to physical, emotional, and biometric measures over time, as a result of participation in MBME classes.
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MAIN RESEARCH VARIABLES

Quality of life, sleep, depressive symptomatology, fatigue, stress, upper body strength, gait and balance, body mass index, heart rate, and blood pressure.
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FINDINGS

The current study was feasible because survivors were willing to participate and completed most of the questionnaires. Participants found these classes to be beneficial not only for exercise, but also for social support and social connectedness. Poor sleep quality was consistently reported by participants. MBME classes should be recommended to survivors and are beneficial for oncology practices to offer.
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CONCLUSIONS

Conducting MBME research with cancer survivors is feasible, and participants find the MBME acceptable and a way of addressing health and managing cancer-related symptoms.
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IMPLICATIONS FOR NURSING

Nurses should help patients and caregivers identify locations and times when MBME class participation is possible, assess MBME class participation during each clinic visit to promote continued involvement and to understand if positive effects are occurring, and continue to provide support for MBME classes throughout the survivorship experience.

Translation and validation of the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) version 4 quality of life instrument into Arabic language

Background

Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) has been translated from English into several languages. Currently, there is no validated translation of FACT-BMT in Arabic. Here, we are reporting the first Arabic translation and validation of the FACT-BMT.

Methods

The study was approved by the Institutional Research Advisory Council. The Arabic translation followed the standard Functional Assessment of Chronic Illness Therapy (FACIT.org) translation methodology (with permission). Arabic FACT-BMT (50- items) was statistically validated. Cronbach’s alpha for internal consistency, Spearman’s rank correlation coefficients method for Inter-scale correlations and Principal Component Analysis for factorial construct validity was used.

Results

One hundred and eight consecutive relapsed /refractory lymphoma patients who underwent high dose chemotherapy and autologous stem cell transplant were enrolled. There were 68 males (63%) and 40 females (37%) with a median age of 29 years (range 14–62). After Arabic questionnaire pre-testing (Cronbach’s alpha 0.744), the study included 108 patients. Cronbach’s alpha for the entire FACT-BMT indicated an excellent internal consistency (0.90); range (0.67 to 0.91). Cronbach’s alpha for sub-groups of social (0.78), emotional (0.67) and functional wellbeing was (0.88). Cronbach’s alpha for bone marrow transplant (0.81), FACT-General (0.89), and FACT- Trial Outcome Index (TOI); (0.91) also revealed excellent internal consistency. Patients had high scores in all domains of quality of life, indicating that most patients were leading a normal life. This translation of FACT-BMT in Arabic was reviewed and approved for submission by the FACIT.org.

Conclusions

Our data reports the first translated, validated and approved Arabic version of FACT-BMT. This will help large numbers of Arabic speaking patients undergoing stem cell/bone marrow transplantation, across the globe.

Electronic supplementary material

The online version of this article (10.1186/s12955-018-0861-7) contains supplementary material, which is available to authorized users.

A Guide of the Questionnaires Used in the Measurement of Health-Related Quality of Life in Head and Neck Oncology

Aims and background

There is a plethora of instruments which measure health-related quality of life (HRQOL), although only a fraction of these have been used in surgical studies and palliative care. Clinicians involved in the management of head and neck pathology face the difficult task of selecting the instrument most suited to the aspect of the patients’ perspective that they want to measure. The aim of this article is to guide head and neck trainees in deciding on the use of the appropriate instrument for evaluation of the patient's perspective.

Methods and study design

The two authors independently searched and scrutinized the literature. The ISI search engine with cross-reference using PubMed and Ovid was searched with the terms “quality of life”, “questionnaire” and specific specialty terms. Studies written in the English language were selected and the abstracts searched for evidence of patient self-completed questionnaires and HRQOL outcome.

Results

There are five broad category headings into which quality of life studies in head and neck oncology can be divided. These include: patient performance questionnaires, generic quality of life questionnaires, generic cancer questionnaires, head and neck cancer questionnaires, and head and neck functional questionnaires.

Conclusions

Patient perspective can be assessed using a number of instruments, including open interview, semi-structured interview, and the simple questionnaire. The choice of instrument depends somewhat on personal preference, the outcomes being measured, and available resources.

A cluster-randomised, controlled proof-of-concept study to explore the feasibility and effect of a patient-directed intervention on quality of life in patients with advanced soft tissue sarcoma

INTRODUCTION

Even with evolving and expanding therapeutical options for the treatment of advanced sarcomas over recent years, the balance between efficacy and toxicity still remains a major concern. Moreover, the symptom burden in patients with sarcoma remains high compared with other malignant diseases. It is, therefore, crucial to assess treatment effectiveness not only in terms of disease-related outcomes (eg, overall survival) but also from an individual and patient-centred perspective using the assessment of patient-reported outcomes (PROs). By focusing on PROs as a primary study endpoint, we aim to address key issues for patients with advanced soft tissue sarcoma (STS) undergoing palliative treatment.

METHODS AND ANALYSIS

The protocol of the YonLife study describes a multicentre, cluster-randomised, controlled, open-label proof-of-concept study conducted in patients with advanced or metastatic STS treated with trabectedin in seven German hospitals. The primary objective of the study is to exploratively compare overall quality of life between the patients receiving a multidimensional intervention based on individual PROs and those receiving usual supportive treatment. This complex intervention consists of the (1) electronic assessment of PRO, (2) creation of a case vignette based on PRO and clinical data and (3) treatment suggestions based on the discussion of these vignettes in a regularly meeting expert panel. Additionally, the YonLife trial assesses the applicability of a tablet-based assessment of PROs. Patients' and physicians' acceptance and challenges concerning the implementation process will be evaluated.

ETHICS AND DISSEMINATION

The YonLife trial has been approved by the Ethics Committee of the University Hospital Dresden as well as by the relevant institutions of each participating centre before patient enrolment. The findings will be reported via relevant peer-reviewed journals as well as through presentation at international conferences.

TRIAL REGISTRATION NUMBER

NCT02204111, pre-results.

Urban-Rural Variations in Quality-of-Life in Breast Cancer Survivors Prescribed Endocrine Therapy

The number of breast cancer survivors has increased as a result of rising incidence and increased survival. Research has revealed significant urban-rural variation in clinical aspects of breast cancer but evidence in the area of survivorship is limited. We aimed to investigate whether quality of life (QoL) and treatment-related symptoms vary between urban and rural breast cancer survivors prescribed endocrine therapy. Women with a diagnosis of stages I-III breast cancer prescribed endocrine therapy were identified from the National Cancer Registry Ireland and invited to complete a postal survey (N = 1606; response rate = 66%). A composite measure of urban-rural classification was created using settlement size, population density and proximity to treatment hospital. QoL was measured using the Functional Assessment of Cancer Therapy (FACT-G) and an endocrine subscale. The association between urban-rural residence/status and QoL and endocrine symptoms was assessed using linear regression with adjustment for socio-demographic and clinical covariates. In multivariable analysis, rural survivors had a statistically significant higher overall QoL (β = 3.81, standard error (SE) 1.30, p < 0.01), emotional QoL (β = 0.70, SE 0.21, p < 0.01) and experienced a lower symptom burden (β = 1.76, SE 0.65, p < 0.01) than urban survivors. QoL in breast cancer survivors is not simply about proximity and access to healthcare services but may include individual and community level psychosocial factors.

Patient-reported outcome after radical cystectomy: translation and psychometric validation of the Swedish version of the Functional Assessment of Cancer Therapy Scale Vanderbilt Cystectomy Index

OBJECTIVE

The aim of this study was to translate and validate the Swedish version of the Functional Assessment of Cancer Therapy Scale - Vanderbilt Cystectomy Index (FACT-VCI).

MATERIALS AND METHODS

For adaptation into Swedish, a multiprofessional team was used for translation including cultural adjustment, followed by back-translation. Test and retest in 10 individuals was followed by assessing metric properties in 75 consecutive patients with bladder cancer treated with radical cystectomy. Reliability and internal consistency were measured by Cronbach's alpha. Face validity was tested with two laypersons and construct validity was tested by correlation to the dimensions in the Functional Assessment of Cancer Therapy Scale - General (FACT-G).

RESULTS

The translated Swedish instrument showed validity and reliability similar to the original, and the results were comparable to published studies using FACT-VCI. The correlation between the VCI sum score and FACT-G dimensions was significant in all dimensions and the item-total correlation was over 0.3; therefore, the construct validity was acceptable. In addition, it was possible to detect differences in separate items in the translated version of FACT-VCI between age groups, type of diversion and those treated with chemotherapy, even though the samples were small.

CONCLUSIONS

The Swedish version of FACT-VCI is a valid and reliable instrument for use in the follow-up of patients with bladder cancer treated with urinary diversion. To measure changes after surgery, preoperative assessment with the related FACT-G instrument is advisable.

Psychometric characteristics of the Functional Assessment of Cancer Therapy-General when applied to Brazilian cancer patients: a cross-cultural adaptation and validation

BACKGROUND

The psychometric properties of an instrument should be evaluated routinely when using different samples. This study evaluated the psychometric properties of the Functional Assessment of Cancer Therapy-General (FACT-G) when applied to a sample of Brazilian cancer patients.

METHODS

The face, content, and construct (factorial, convergent, and discriminant) validities of the FACT-G were estimated. Confirmatory factor analysis (CFA) was conducted the ratio chi-square by degrees of freedom (χ (2)/df), the comparative fit index (CFI), the Tucker-Lewis index (TLI), and the root mean square error of approximation (RMSEA) as indices. The invariance of the best model was assessed with multi-group analysis using the difference of chi-squares method (Δχ(2)). Convergent validity was assessed using Average Variance Extracted (AVE) and discriminant validity was determined via correlational analysis. Internal consistency was assessed using the Cronbach's alpha (α) coefficient, and the Composite Reliability (CR) was estimated.

RESULTS

A total of 975 cancer patients participated in the study, with a mean age of 53.3 (SD = 13.0) years. Of these participants, 61.5 % were women. In CFA, five correlations between errors were included to fit the FACT-G to the sample (χ (2)/df = 8.611, CFI = .913, TLI = .902, RMSEA = .088). The model did not indicate invariant independent samples (Δχ(2): μ: p < .001, i: p < .958, Cov: p < .001, Res: p < .001). While there was adequate convergent validity for the physical well-being (AVE = .54) and social and family Well-being factors (AVE = .55), there was low convergent validity for the other factors. Reliability was adequate (CR = .76-.89 and α = .71-.82). Functional well-being, emotional well-being, and physical well-being were the factors that demonstrated a strong contribution to patients' health-related quality of life (β = -.99, .88, and .64, respectively).

CONCLUSION

The FACT-G was found to be a valid and reliable assessment of health-related quality of life in a Brazilian sample of patients with cancer.

The Complementary Nature of Patient-Reported Outcomes and Adverse Event Reporting in Cooperative Group Oncology Clinical Trials: A Pooled Analysis (NCCTG N0591)

CONTEXT

Clinical trials use clinician-graded adverse events (AEs) and patient-reported outcomes (PROs) to describe symptoms.

OBJECTIVES

The aim of the study was to examine the agreement between PROs and AEs in the clinical trial setting.

METHODS

Patient-level data were pooled from seven North Central Cancer Treatment Group, two Southwest Oncology Group, and three Radiation Therapy Oncology Group lung studies that included both PROs and AE data. Ten-point changes (on a 0-100 scale) in PRO scores were considered clinically significant differences (CSDs). PRO score changes were compared to AE grade (Gr) categories (2+ yes vs. no and 3+ yes vs. no) using Wilcoxon rank-sum or two-sample t-tests between Gr categories. Incidence rates and concordance of CSD in PRO scores and AE Gr categories were compiled. Spearman correlations were computed between PRO scores and AE severity.

RESULTS

PROs completed by patients (n = 1013) were the Uniscale, Lung Cancer Symptom Scale (LCSS), Functional Assessment of Cancer Therapy-Lung (FACT-L), Symptom Distress Scale, and/or Functional Living Index-Cancer. Significantly worse PRO score changes were found for the FACT-L in patients with Gr 2+ AEs. Worse scores were seen for the Uniscale for patients with Gr 2+ AEs (P = 0.07) and LCSS for patients with Gr 3+ AEs (P = 0.09). Agreement between incidence of any Gr 2+ (Gr 3+) AE and a CSD in PROs ranged from 27% to 67% (36%-61%). Correlations between PRO scores and AE severity were low: -0.06 Uniscale, -0.03 LCSS, 0.10 FACT-L, -0.11 Symptom Distress Scale, and -0.51 Functional Living Index-Cancer.

CONCLUSION

These results support previous work and an a priori hypothesis that AEs and PROs measure differing aspects of the disease experience and are complementary.

Assessing the Functional Status of Older Cancer Patients in an Ambulatory Care Visit

Functional status assessment is a useful and essential component of the complete history and physical exam of the older patient diagnosed with cancer. Functional status is the ability to conduct activities that are necessary for independence and more executive activities, such as money management, cooking, and transportation. Assessment of functional status creates a portal into interpreting the health of in older persons. Understanding limitations and physical abilities can help in developing cancer treatment strategies, patient/family teaching needs, and in-home services that enhance patient/family care. This article will review the benefits of functional assessment, instruments that can be used during an ambulatory care visit, and interventions that can address potential limitations.

Health Literacy and Health-Related Quality of Life Among a Population-Based Sample of Cancer Patients

Health-related quality of life is an important outcome in cancer care. A few studies indicate that health literacy influences cancer patients' health-related quality of life, but additional investigation is needed. The authors examined the relation between health literacy and health-related quality of life among cancer patients. A cross-sectional survey was conducted with cancer patients in Wisconsin during 2006-2007. Data on sociodemographics, clinical characteristics, health-related quality of life, and health literacy were obtained from the state's cancer registry and a mailed questionnaire. Regression analyses were used to characterize the association between health-related quality of life and health literacy. The study sample included 1,841 adults, newly diagnosed with lung, breast, colorectal, or prostate cancer in 2004 (response rate = 68%). Health-related quality of life was measured with the Functional Assessment of Cancer Therapy-General. Adjusting for confounders, higher health literacy was associated with greater health-related quality of life (p < .0001). Controlling for covariates, we found significant differences between those in the highest and lowest health literacy categories (p < .0001) and in the physical (p < .0001), functional (p < .0001), emotional (p < .0001), and social (p = .0007) well-being subscales. These associations exceeded the minimally important difference threshold for overall health-related quality of life and functional well-being. Health literacy is positively and independently associated with health-related quality of life among cancer patients. These findings support adoption of health literacy best practices by cancer care systems.

Health-related quality of life and associated factors in Chinese women with cervical cancer: a 9-month follow-up

BACKGROUND

There is a lack of health-related quality of life (HRQOL) studies in Chinese women with cervical cancer.

OBJECTIVE

The objectives of this study were to investigate the HRQOL trajectory in women with cervical cancer in Mainland China in the 9 months following diagnosis and to identify factors that influence HRQOL.

METHODS

Initially, 187 patients with cervical cancer were included in the study, but at each follow-up, the number declined to 128, 112, and 106, respectively. The Functional Assessment of Cancer Therapy-Cervix (FACT-Cx) was used to collect data sequentially at the time of diagnosis (T1) and at 3 (T2), 6 (T3), and 9 months after diagnosis (T4). Medical characteristics, sense of coherence, and social support were included as factors likely to contribute to HRQOL.

RESULTS

Functional Assessment of Cancer Therapy-Cervix ranged in mean from 120.30 at T1 to 126.22 at T4 (P = .001), whereas social/family well-being ranged from 23.56 at T1 to 20.23 at T4 (P = .025). In the stepwise regression with FACT-Cx as the independent variable, sense of coherence entered the equation with the highest standardized coefficients (0.554) at T1 and stage II at T2 and T3 (-0.53 and -0.26, respectively). Satisfaction with family relationships had the second highest standardized coefficient (-0.21) at T3.

CONCLUSIONS

Overall HRQOL improved, although social/family well-being deteriorated. Sense of coherence contributed to HRQOL initially, whereas disease stage and family support did so later on.

IMPLICATIONS FOR PRACTICE

The study highlights the importance of identifying those with a low sense of coherence at the time of diagnosis. Family members should be included in caring process as a vital source of social support.

Quality of life in urban and rural settings: a study of head and neck cancer survivors

OBJECTIVE

Urban-rural variation in cancer incidence, treatment, and clinical outcomes has been well researched. With the growing numbers and longer lifespan of cancer survivors, quality of life (QOL) is now a critical issue. The present study investigates the QOL of head and neck cancer (HNC) survivors in Ireland, paying special attention to urban and rural variation.

METHODS

From the population-based National Cancer Registry Ireland, we identified 991 survivors of HNC (ICD10 C00-C14, C32), who were at least eight months post-diagnosis, and invited them to complete a postal survey. We used self-reported data and information from the Registry to create a composite variable classifying respondents' current area of residence as "urban" or "rural." Respondents self-reported QOL using the Functional Assessment for Cancer Therapy with Head and Neck module (FACT-HN). We used bootstrap linear regression to control for confounding variables, while estimating the association of urban and rural residence to FACT-HN domain scores.

RESULTS

We obtained survey and Registry data from 583 HNC survivors. Controlling for demographic and clinical variables, rural survivors reported higher physical (coefficient 1.27, bias-corrected and accelerated 95% confidence interval 0.54, 2.43), emotional (coef. 0.99, 95% CI 0.21, 2.02), and HNC-specific (coef. 1.55, 95% CI 0.32, 3.54) QOL than their urban counterparts. Social and functional QOL did not differ significantly.

CONCLUSIONS

These findings add to growing evidence of important differences in life experiences of cancers survivors in urban and rural settings. Results such as these will allow health professionals, policy makers and service providers to better serve these populations.

A randomized trial of a Facebook-based physical activity intervention for young adult cancer survivors

PURPOSE

Over half of young adult cancer survivors do not meet physical activity (PA) guidelines. PA interventions can enhance health and quality of life among young adult cancer survivors. However, few exercise interventions have been designed and tested in this population. This study evaluated the feasibility and preliminary efficacy of a 12-week, Facebook-based intervention (FITNET) aimed at increasing moderate-to-vigorous intensity PA compared with a Facebook-based self-help comparison (SC) condition.

METHODS

Young adult cancer survivors (n = 86) were randomly assigned to the FITNET or SC group. All participants were asked to complete self-administered online questionnaires at baseline and after 12 weeks.

RESULTS

Seventy-seven percent of participants completed postintervention assessments, and most participants reported using intervention components as intended. Participants in both groups would recommend the program to other young adult cancer survivors (FITNET, 46.9 vs. SC, 61.8 %; p = 0.225). Over 12 weeks, both groups increased self-reported weekly minutes of moderate-to-vigorous PA (FITNET, 67 min/week (p = 0.009) vs. SC, 46 min/week (p = 0.045)), with no significant difference between groups. Increases in light PA were 135 min/week greater in the FITNET group relative to the SC group (p = 0.032), and the FITNET group reported significant weight loss over time (-2.1 kg, p = 0.004; p = 0.083 between groups).

CONCLUSION

Facebook-based intervention approaches demonstrated potential for increasing PA in young adult cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Social networking sites may be a feasible way for young adult cancer survivors to receive health information and support to promote PA and healthy behaviors.

Does gender influence outcomes from a multidisciplinary intervention for quality of life designed for patients with advanced cancer?

PURPOSE

Cancer treatment can profoundly impact the patient's quality of life (QOL). It has been well documented that there are gender differences in the symptoms associated with cancer treatment. This study explores the impact of gender on QOL for patients with newly diagnosed advanced cancer.

METHODS

A randomized, controlled clinical trial in patients receiving radiotherapy for advanced cancer demonstrated maintenance of QOL with a six session multidisciplinary structured intervention compared to controls. This current study reports the gender differences in that trial. Outcome measures included the functional assessment of cancer therapy-general (FACT-G), linear analog self-assessment (LASA), and profile of mood states (POMS) at baseline and weeks 4, 27, and 52. Kruskal-Wallis was used to compare QOL scores.

RESULTS

One hundred thirty-one patients (45 women and 86 men, mean age 58.7) participated in the clinical trial. At week 4 postintervention, women in the intervention group had statistically significant improvement in their FACT-G score, FACT-G physical well-being subscale, LASA fatigue, POMS total score, POMS fatigue-inertia subscale, and POMS confusion-bewilderment subscale (p < 0.05). Men receiving the intervention had a smaller decrease in FACT-G score compared to controls (p = 0.048) and also worsened on the LASA financial (p = 0.02). At week 27, the only gender difference was that intervention group men had more POMS anger-hostility (p = 0.009). By week 52, there were no statistically significant gender differences in any of the QOL measures.

CONCLUSIONS

Gender-based differences appear to play a role in the early, but not late, response to a multidisciplinary intervention to improve QOL for patients with advanced cancer, suggesting that early interventions can be tailored for each gender.

Quality-of-life assessment after palliative interventions to manage malignant ureteral obstruction

PURPOSE

Malignancies may cause urinary tract obstruction, which is often relieved with placement of a percutaneous nephrostomy tube, an internal double J nephro-ureteric stent (double J), or an internal external nephroureteral stent (NUS). We evaluated the affect of these palliative interventions on quality of life (QoL) using previously validated surveys.

METHODS

Forty-six patients with malignancy related ureteral obstruction received nephrostomy tubes (n = 16), double J stents (n = 15), or NUS (n = 15) as determined by a multidisciplinary team. QoL surveys were administered at 7, 30, and 90 days after the palliative procedure to evaluate symptoms and physical, social, functional, and emotional well-being. Number of related procedures, fluoroscopy time, and complications were documented. Kruskal-Wallis and Friedman's test were used to compare patients at 7, 30, and 90 days. Spearman's rank correlation coefficient was used to assess correlations between clinical outcomes/symptoms and QoL.

RESULTS

Responses to QoL surveys were not significantly different for patients receiving nephrostomies, double J stents, or NUS at 7, 30, or 90 days. At 30 and 90 days there were significantly higher reported urinary symptoms and pain in those receiving double J stents compared with nephrostomies (P = 0.0035 and P = 0.0189, respectively). Significantly greater fluoroscopy time was needed for double J stent-related procedures (P = 0.0054). Nephrostomy tubes were associated with more frequent minor complications requiring additional changes.

CONCLUSION

QoL was not significantly different. However, a greater incidence of pain in those receiving double J stents and more frequent tube changes in those with nephrostomy tubes should be considered when choosing palliative approaches.

A nurse- and peer-led support program to assist women in gynaecological oncology receiving curative radiotherapy, the PeNTAGOn study (peer and nurse support trial to assist women in gynaecological oncology): study protocol for a randomised controlled trial

Background

Women who undergo radiotherapy for gynaecological cancer (GC) can experience distressing side effects which impact on psychosocial functioning and intimate relationships. Cancer-related distress may be ameliorated by comprehensive preparation for treatment and addressing women’s informational, physical, psychological and psychosexual needs. This paper describes the protocol for a multisite randomised controlled trial (RCT) testing a novel intervention package which combines tailored specialist nursing consultations and telephone peer support with the primary aim to reduce psychological distress. Secondary aims assess patient quality of life, symptom distress, unmet supportive care needs, preparation for treatment, psychosexual functioning and vaginal stenosis.

Methods/design

This multifaceted intervention comprises four nurse-led consultations coupled with four phone calls from a peer support volunteer (GC survivor). The evidence-based intervention will be delivered at critical points in the illness trajectory: pre-treatment, mid-treatment, treatment completion and post-treatment. Nurses and peers undergo 2-day intensive training workshops, are guided by comprehensive study intervention manuals and receive ongoing supervision and support. Eligible patients will have a diagnosis of GC, be scheduled to receive curative radiotherapy, be aged 18 years or over and speak English. Three-hundred and six participants will be randomized to receive usual care or usual care with the intervention package. Study outcome measures will be collected at baseline, day 1 of radiotherapy and 1, 6 and 12 months post radiotherapy. Clinical assessments of vaginal toxicity will occur at baseline, and 3, 6, and 12 months post radiotherapy.

Discussion

This timely research has the potential to substantially reduce the physical, psychosexual and supportive care needs of women with GC. Using a telephone peer support model, the intervention package ensures equitable access to support services for geographically isolated patients. The novel intervention engages peer volunteers who liaise with nurses to encourage adherence to professionally-delivered information and provide emotional support. It has been designed to be potentially transferable to a range of treatment settings and diseases. Based on pilot data, the proposed intervention was found to be useful and acceptable to patients and clinicians. If effective and feasible in the multisite RCT, the program could be widely disseminated.

Trial registration

Australian New Zealand Clinical Trial Registry ACTRN12611000744954

Psychometric properties of the Chinese version of the Functional Assessment of Cancer Therapy-Cervix (FACT-Cx) measuring health-related quality of life

Background

The Functional Assessment of Cancer Therapy (FACT) is one of the most commonly used self-report instruments for evaluation of health-related quality of life in oncology patients. However, cultural considerations necessitate testing of the subscales in different populations. We sought to qualitatively and quantitatively investigate the applicability and psychometric properties of the Chinese version of the FACT-Cervix (FACT-Cx) in Chinese women with cervical cancer.

Methods

Ten personal interviews were conducted in order to explore patients’ opinions about the scale and its items in depth. In addition the questionnaire was administered to 400 women with cervical cancer to test its psychometric properties. Reliability was assessed using Cronbach’s alpha coefficient and item-subscale correlation while validity was evaluated using factor analysis and known-group validity.

Results

Some items related to sex and the ability to give birth were questioned in the personal interviews, mostly regarding their significance and acceptance in the Chinese cultural context. The Cronbach’s alphas of FACT-Cx and the subscales were greater than 0.7, except for the cervical-cancer-specific subscale which was 0.57. Factor analysis demonstrated that the FACT-G construct generally paralleled the original. There were significant differences in the FACT-Cx and some subscales between those receiving and not receiving treatment and among the patients with different performance status.

Conclusions

In general, psychometric properties of the Chinese version supported its use with cervical cancer patients in Mainland China. Further work is needed to improve the psychometric adequacy of the cervical-cancer-specific subscale and adjust it to cultural considerations.

Improvements in measuring the health-related quality of life of cancer patients

There have been considerable improvements in the collection of health-related quality of life (HRQOL) data in oncology over the past 20 years. The facility with which HRQOL information can now be collected from patients has also been associated with an improved understanding of the meaning of HRQOL and the association between HRQOL and patients' treatment and care plans. Therefore the role that HRQOL data can play in routine clinical practice is increasingly being recognized. The appearance of computer-adaptive tests will herald a new era in HRQOL where questionnaires will be individually tailored to each patient utilizing details unique to that person and linked to clinical management systems to allow a comprehensive assessment of HRQOL status.

Stereotactic body radiation therapy in spinal metastases

PURPOSE

Based on reports of safety and efficacy, stereotactic body radiotherapy (SBRT) for treatment of malignant spinal tumors was initiated at our institution. We report prospective results of this population at Mayo Clinic.

MATERIALS AND METHODS

Between April 2008 and December 2010, 85 lesions in 66 patients were treated with SBRT for spinal metastases. Twenty-two lesions (25.8%) were treated for recurrence after prior radiotherapy (RT). The mean age of patients was 56.8 ± 13.4 years. Patients were treated to a median dose of 24 Gy (range, 10-40 Gy) in a median of three fractions (range, 1-5). Radiation was delivered with intensity-modulated radiotherapy (IMRT) and prescribed to cover 80% of the planning target volume (PTV) with organs at risk such as the spinal cord taking priority over PTV coverage.

RESULTS

Tumor sites included 48, 22, 12, and 3 in the thoracic, lumbar, cervical, and sacral spine, respectively. The mean actuarial survival at 12 months was 52.2%. A total of 7 patients had both local and marginal failure, 1 patient experienced marginal but not local failure, and 1 patient had local failure only. Actuarial local control at 1 year was 83.3% and 91.2% in patients with and without prior RT. The median dose delivered to patients who experienced local/marginal failure was 24 Gy (range, 18-30 Gy) in a median of three fractions (range, 1-5). No cases of Grade 4 toxicity were reported. In 1 of 2 patients experiencing Grade 3 toxicity, SBRT was given after previous radiation.

CONCLUSION

The results indicate SBRT to be an effective measure to achieve local control in spinal metastases. Toxicity of treatment was rare, including those previously irradiated. Our results appear comparable to previous reports analyzing spine SBRT. Further research is needed to determine optimum dose and fractionation to further improve local control and prevent toxicity.

Few changes observed in polysomnographic-assessed sleep before and after completion of chemotherapy

OBJECTIVE

Sleep disturbance is prevalent among patients undergoing chemotherapy and is strongly associated with cancer-related fatigue (CRF). However, little objective evidence has been gathered on the patterns of sleep before and following chemotherapy.

METHODS

Twenty-six patients scheduled to receive chemotherapy were recruited. Sleep parameters were assessed by in-lab polysomnography (PSG) for two consecutive nights prior to first chemotherapy, approximately 3weeks following the patients' last chemotherapy, and 3months following the last treatment. Fatigue was measured on the first night of each of the two-night PSG assessments. We focus on Slow-Wave Sleep (SWS) as we hypothesized that a decrease of this restorative phase of sleep might be implicated in CRF.

RESULTS

Repeated-measures analyses examining changes from baseline to the later time points in the proportion of time asleep spent in each of the four sleep architecture stages (Stage 1, Stage 2, SWS, and REM sleep) were non-significant, all Ps>0.41. Canonical correlation analysis showed that the proportion of time spent in SWS was not significantly correlated with any of the three CRF measures at any of the three assessment points, P=0.28.

CONCLUSIONS

Sleep architecture is not affected by cancer treatment. No evidence of an association between CRF and SWS, or alterations in SWS, was found.

Development and validation of a quality of life instrument for patients with drug dependence: comparisons with SF-36 and WHOQOL-100

AIM

Our goal was to develop a self-administered quality of life scale for patients with drug addiction/dependence (QOL-DA) and compare it with the SF-36 and the WHOQOL-100.

METHODS

Employing theory and methodology of rating scale construction, a self-administered quality of life instrument for individuals with drug dependence QOL-DA was developed and evaluated utilizing responses from 212 drug-dependent subjects at the Kunming Municipal Mandatory Detoxification and Rehabilitation Center in China. Quality of life was measured using the SF-36, WHOQOL-100 and QOL-DA three times during the detoxification.

RESULTS

Test-retest reliability in the domains of physical function, psychological function, social function and toxicity were 0.82, 0.64, 0.78, and 0.76, respectively. Cronbach's coefficient α for the 4 domains was 0.87, 0.89, 0.93 and 0.86, respectively. Correlations and factor analysis showed good construct validity. Criterion-related and convergent validity was confirmed by using the SF-36 and the WHOQOL-100 simultaneously. The instrument does show the change in QOL after two weeks of detoxification with higher standardized response mean higher than that of SF-36 and WHOQOL-100.

CONCLUSION

The instrument developed has good validity, reliability and better responsiveness than instruments currently used, and can be employed effectively to measure the quality of life of individuals with drug dependence.

Polarity Therapy for cancer-related fatigue in patients with breast cancer receiving radiation therapy: a randomized controlled pilot study

BACKGROUND

Cancer-related fatigue (CRF) is the most frequently reported side effect of cancer and its treatment. In previous research, Polarity Therapy (PT), an energy therapy, was shown to reduce CRF in patients receiving radiation. This study reports on a small randomized clinical trial designed to collect preliminary data on the efficacy of PT compared with an active control (massage) and passive control (standard care) for CRF among cancer patients receiving radiation therapy.

METHODS

Forty-five women undergoing radiation therapy for breast cancer were randomized to 1 of 3 weekly treatment conditions. Patients received standard clinical care, 3 modified massages, or 3 PT treatments. CRF and health-related quality of life (HRQL) were assessed during baseline and the 3 intervention weeks.

RESULTS

TResults show CRF ratings were reduced after PT. The effect sizes for PT versus modified massage and versus standard care were small when using the primary measure of CRF (Brief Fatigue Inventory) and large when using the secondary measure of CRF (Daily CRF Diaries).The effect size was medium when assessing the benefit of PT on maintaining HRQL compared with standard care with very little difference between the PT and modified massage conditions. Patients' feedback showed that both the modified massage and PT treatments were deemed useful by radiation patients.

CONCLUSION

The present pilot randomized clinical trial supports previous experimental research showing that PT, a noninvasive and gentle energy therapy, may be effective in controlling CRF. Further confirmatory studies as well as investigations of the possible mechanisms of PT are warranted.

What determines the health-related quality of life among regional and rural breast cancer survivors?

OBJECTIVE

To assess the health-related quality of life (HRQoL) of regional and rural breast cancer survivors at 12 months post-diagnosis and to identify correlates of HRQoL.

METHODS

In 2006/07, 323 (202 regional and 121 rural) Queensland women diagnosed with unilateral breast cancer participated in a population-based, cross-sectional study. HRQoL was measured using the Functional Assessment of Cancer Therapy, Breast plus arm morbidity (FACT-B+4) self-administered questionnaire.

RESULTS

In age-adjusted analyses, mean HRQoL scores of regional breast cancer survivors were comparable to their rural counterparts 12 months post-diagnosis (122.9, 95% CI: 119.8, 126.0 vs. 123.7, 95% CI: 119.7, 127.8; p>0.05). Irrespective of residence, younger (<50 years) women reported lower HRQoL than older (50+ years) women (113.5, 95% CI: 109.3, 117.8 vs. 128.2, 95%CI: 125.1, 131.2; p<0.05). Those women who received chemotherapy, reported two complications post-surgery, had poorer upper-body function than most, reported more stress, reduced coping, who were socially isolated, had no confidante for social-emotional support, had unmet health care needs, and low health self-efficacy reported lower HRQoL scores.

CONCLUSIONS AND IMPLICATIONS

The results underscore the importance of supporting and promoting regional and rural breast cancer programs that are designed to improve physical functioning, reduce stress and provide psychosocial support following diagnosis. Further, the information can be used by general practitioners and other allied health professionals for identifying women at risk of poorer HRQoL.

Acupressure bands are effective in reducing radiation therapy-related nausea

Previous studies have shown that acupressure bands can reduce chemotherapy-related nausea. Patients' expectations of efficacy account for part of this outcome. We conducted a three-arm randomized clinical trial to investigate the effectiveness of acupressure bands in controlling radiation therapy-induced nausea and to test whether an informational manipulation designed to increase expectation of efficacy would enhance the effectiveness of the acupressure bands. Patients who experienced nausea at prior treatments were randomized to either standard care (Arm 1, n=29) or standard care plus acupressure bands with either neutral (Arm 2, n=30) or positive (Arm 3, n=29) information regarding the efficacy of the bands. Patients reported nausea for two days prior to randomization (baseline) and for five days following using a seven-point semantic rating scale (1=not nauseated to 7=extremely nauseated). Patients in Arms 2 and 3 combined reported greater reduction in average nausea than patients in Arm 1 (P=0.01; mean(bands)=0.70, mean(no bands)=0.10). This equates to a 23.8% decrease in nausea in the band groups compared to a 4.8% decrease in the control group, a 19% difference. The informational manipulation failed to alter efficacy expectations and there was no statistically significant difference in nausea between patients in Arms 2 and 3. Acupressure bands are an effective, low-cost, nonintrusive, well-accepted, and safe adjunct to standard antiemetic medication. An attempt to boost the efficacy of the acupressure bands by providing positive information was not successful.

Reliability across studies from the functional assessment of cancer therapy-general (FACT-G) and its subscales: a reliability generalization

PURPOSE

The aim of this study was to conduct a reliability generalization of the Functional Assessment of Cancer Therapy-General (FACT-G) and its subscales to examine variation in score reliability across all published studies.

METHODS

We reviewed 344 publications based on predetermined criteria. About 78 published studies reported Cronbach's Alpha reliability coefficients from their study in which data were collected. Sample size based weights were applied, and studies were coded on several scale and demographic characteristics. Using independent samples t tests, we examined associations between study characteristics and internal consistency variability.

RESULTS

Average FACT-G score reliability was .88 (subscales ranged between .71-.83). Three variables produced small, statistically significant (P < or = .05) eta squared effects (ranging between .06-.21) due to different sources of variation in the FACT-G and subscales: ethnicity, cancer type, and study type-all of which appeared to be related to disproportionate representation of studies with the majority including Caucasian samples, mixed cancer samples, and validation type studies.

CONCLUSIONS

The FACT-G and its subscales demonstrated acceptable reliability evidence across observed studies, without substantial variability due to scale or demographic characteristics.

Quality of Life of Chinese Patients With Ovarian Malignancies During Chemotherapy Under Condition of No Recurrence

The purpose of this study was to describe the quality of life of patients with ovarian malignancies during chemotherapy under condition of no recurrence and to explore changes in quality of life during chemotherapy and factors associated with quality of life. It was a cohort study during treatment. Quality of life of 75 patients with ovarian malignancies at baseline, reduced to 63 and 61 patients at later points, was assessed by the Functional Assessment of Cancer Therapy-Ovarian scale in the gynecologic wards of the Obstetrics and Gynecology Hospital affiliated to Fu Dan University within 1 to 2 days after the second, fourth, and sixth cycles of chemotherapy. During chemotherapy, under condition of no recurrence, the overall quality of life was at the middle or upper level and improved significantly over time (P = .044). There were significant improvements in physical well-being and additional concerns, whereas there was significant deterioration in social well-being. Emotional and functional well-being showed a trend toward improvement (not statistically significant). The relationship with doctors showed a significant difference between the first time point and each of the other two. Economic condition and intrafamily support were key factors for predicting the quality of life of these patients in all assessments. These findings give insights into the quality of life of women with ovarian cancer during chemotherapy and imply that nurses and other medical professionals should provide continuing support to them in accordance with their needs. Furthermore, nurses should help prevent them from social isolation as a consequence of their illness and treatment and acknowledge family members as a major support resource.