Quality of life in the chemotherapy treatment of Spanish cancer patients: a comparison of general population norms

Differences in Quality of Life and Emotional Well-being in Breast, Colon, and Lung Cancer Patients During Outpatient Adjuvant Chemotherapy: A Longitudinal Study

BACKGROUND

Adjuvant chemotherapy used at each cancer site may affect quality of life (QoL) and emotional well-being (affect) of cancer patients differently; however, these differences between groups have not been studied.

OBJECTIVES

The aim of this study was to assess differences in QoL and affect by cancer site at the start of outpatient adjuvant chemotherapy, whether QoL and affect change during this treatment, and whether adverse effects influence these variables.

METHODS

A multicenter longitudinal descriptive study was conducted with 247 participants with breast, colon, or lung cancer at the beginning (T1) and end of treatment (T2). We used the SF-12 Health Survey, Positive and Negative Affect Scale, and an "ad hoc" adverse effects questionnaire.

RESULTS

At the start of chemotherapy, the lung group had poorer Physical Component Summary and poorer positive and negative affect ( P < .05) scores. In the end-of-treatment comparisons, breast and colon cancer patients' status had worsened, whereas lung cancer patients had tended to stabilize, although they remained the most vulnerable. Adverse effect severity was significant for Physical Component Summary ( r = -0.13, P = .035), with decreases in positive affect ( r = -0.17, β = -.16) and increases in negative affect ( r = 0.15, β = .14).

CONCLUSIONS

Changes in QoL and emotional state differ between groups, implying a need for varying levels of follow-up and emotional support. Patients with lung cancer seem particularly vulnerable.

IMPLICATIONS FOR PRACTICE

Cancer nurses could strengthen the assessment of patients undergoing chemotherapy using more sensitive instruments such as the Positive and Negative Affect Scale and considering differences by cancer site, to provide care tailored to individual patient needs and preferences.

Chilean population norms derived from the health-related quality of Life SF-6D

OBJECTIVES

The Health-Related Quality of Life Short Form 6D (HRQoL SF-6D) provides utility values for health status. Utilities generated have a number of potentially valuable applications in economic evaluations and not only to ensure comparability between studies. Reference values can be useful to estimate the effect on patients' HRQoL as a result of interventions in the absence of control groups. Thus, the purpose of this study was to provide normative values in the SF-6D in relation to the Chilean population.

METHODS

A cross-sectional study was conducted evaluating 5293 people. SF-6D utilities were derived from the SF-12 questions.

RESULTS

Mean SF-6D utility index for the whole sample was 0.74. It was better for men (0.78) than for women (0.71). The ceiling effect was much higher for men (11.16%) than for women (5.31%). Women were more likely to show problems in any dimension than were men.

CONCLUSIONS

Chilean population norms for the SF-6D help in the decision-making process around health policies. Men reported higher health status than women in all subcategories analyzed. Likewise, men also reported higher scores than women in overall SF-6D dimensions.

Pain, Sleep Disturbance, and Quality of Life Among Palestinian Patients Diagnosed with Cancer

The objective of this descriptive study is to explore the relationships between pain, sleep disturbance, and quality of life among Palestinian patients diagnosed with cancer in the West Bank. A cross-sectional, descriptive-correlational design was used to collect data from 184 patients with cancer. The quality of life questionnaire, visual analogue pain scale, and physical health status were used in data collection. The results showed that the mean score for pain was 5, the best functioning was for cognitive scale (M = 75, SD = 29), the worst symptoms experienced by patients was appetite loss (M = 47, SD = 35), a moderate global health status (M = 53, SD = 27), and the mean for sleep disturbance was 43 (SD = 35). Pain and sleep disturbance showed high negative correlations with functional scales of quality of life and positive with symptom scales. The findings showed that the co-occurrence of pain and sleep disturbance was negatively correlated with quality of life (QoL) and positively with symptom scales. The regression analysis revealed that pain and sleep disturbance accounted for a significant proportion of variance in the QoL (p < 0.001), and the highest proportion was in predicting global health status (41.9 %). The findings of this study give evidence about the importance of assessing pain and sleep quality among Palestinian patients with cancer.

[Changes in symptom patterns and health-related quality of life of cancer patients before and after chemotherapy]

OBJECTIVE

Symptom patterns are an important diagnostic concept in terms of Traditional Chinese Medicine. Although symptom patterns and health related quality of life (HRQOL) are common diagnostic measures for cancer patients, the association between them has not been studied. This study aimed to describe the changes in the pattern of symptoms of Yang-deficiency, Yin-deficiency, blood stasis, and HRQOL before and after chemotherapy, and to examine the association between the patterns and the cancer patients' HRQOL.

METHODS

A panel study was undertaken with 123 cancer patients who were about to begin their first course of chemotherapy at four teaching hospitals in Taiwan. A structured questionnaire was used before and after chemotherapy. HRQOL was assessed using the Medical Outcomes Survey Short-Form 36. The Traditional Chinese Medical Constitutional Scale was used to measure Yang-deficiency, Yin-deficiency, and blood stasis patterns, with higher scores indicating a larger deficiency.

RESULTS

The patients had significantly worse scores for Yang-deficient pattern, Yin-deficiency pattern, blood stasis pattern, and the physical components of HRQOL after chemotherapy compared with before chemotherapy. The HRQOL scores correlated significantly with Yang-deficiency, Yin-deficiency, and the blood stasis pattern scores. A generalized estimating equation model showed that the HRQOL scores were significantly worse after chemotherapy compared with before chemotherapy for the physical component, but not for the mental component. Blood stasis pattern was significantly associated with a decreased HRQOL in both the physical and mental components. A hemoglobin level < 12 g/dL was associated with a worse physical component of HRQOL.

CONCLUSION

The Yang-deficiency, Yin-deficiency, and blood stasis patterns were all associated with lower HRQOL in cancer patients after chemotherapy.

First anxiety, afterwards depression: psychological distress in cancer patients at diagnosis and after medical treatment

OBJECTIVE

The purpose of this study was to assess psychosocial changes at two particular moments: at cancer diagnosis and 2-4 weeks after having finished treatment.

MATERIAL AND METHODS

A total of 67 cancer outpatients were assessed in this study. The inclusion/exclusion criteria were as follows: ambulatory cancer patients aged 18 years or older and receiving medical treatment. Patients with a performance status <50 or with cognitive impairment (≥3 errors in the Pfeiffer Questionnaire) were excluded. The inclusion period ranged from 1 April 2005 to 30 April 2007. The scales used were the 14-item Hospital Anxiety and Depression Scale (HADS), which has two subscales for anxiety (seven items) and for depression (seven items), the Quality of Life Short Form 36 Questionnaire, the Mental Adjustment Scale and the Medical Outcomes Study Questionnaire for measuring social support. All data were compared with sociodemographic and medical characteristics.

RESULTS

Patients had higher levels of pre-treatment versus post-treatment anxiety (HADS-Anxiety mean, 7.41 versus 6.69), whereas depression scores were higher post-treatment versus pre-treatment (HADS-Depression mean, 3.14 versus 3.89). After medical treatment, patients were more fatigued, with lower performance status (Karnofsky Index), less social support and less quality of life, but no differences in coping styles were found. Women had higher levels of anxiety than men. Patients with psychiatric antecedents had higher levels of distress, but these differences were only observed after diagnosis and not after the treatment. In general, head and neck cancer patients had higher levels of distress, worse coping and worse social functioning.

CONCLUSIONS

Cancer patients require special consideration before and after treatment. Anxiety is the symptom that characterizes diagnosis, whereas depression is more common after medical treatment. The head and neck cancer patients were the group with the highest complexity.

Gender differences in health-related quality of life, physical function and psychological status among patients in the early phase following allogeneic haematopoietic stem cell transplantation

OBJECTIVE

The aim of this study was to examine gender differences in quality of life (QOL), physical function and psychological status before and in the early phase after allogeneic haematopoietic stem cell transplantation (allo-HSCT).

METHODS

One hundred patients (66 men, 34 women) who underwent allo-HSCT between July 2007 and June 2011 at Hyogo College of Medicine Hospital were included in this study. Patients were evaluated for health-related QOL using the Medical Outcome Study 36-item Short Form Health Survey; exercise capacity was measured with the 6-min walk test, hand grip strength and knee extensor strength. Fatigue and psychological status were measured by the Piper Fatigue Scale and Hospital Anxiety and Depression Scale, respectively.

RESULTS

Women had significantly lower scores for physical function and general health on health-related QOL tests compared with men (p < 0.01). No difference between genders was found in decline of physical function. In women, exercise capacity was strongly associated with QOL (p < 0.01). In men, depression and anxiety were closely related to QOL (p < 0.01).

CONCLUSIONS

Gender-appropriate rehabilitation in allo-HSCT patients is important. Women may need more endurance exercises and training for activities of daily life. Men may need rehabilitation including a psychological approach.

Health-related quality of life in Japanese patients with metastatic renal cell carcinoma treated with sunitinib

BACKGROUND

To analyze the impact of sunitinib treatment on health-related quality of life (HRQOL) in Japanese patients with metastatic renal cell carcinoma (mRCC).

METHODS

This study prospectively included 90 consecutive patients with mRCC treated with sunitinib for at least 3 months. HRQOL in these patients was assessed using the Medical Outcomes Study 36-Item Short Form (SF-36) consisting of 8 multi-item scales measuring health status.

RESULTS

There were no significant differences in any of the 8 scores in these 90 patients between surveys conducted before and 3 months after sunitinib treatment. Three months after treatment, all 8 scores in patients who had some degree of tumor shrinkage were more favorable than those in the remaining patients, and there were significant differences in 2 of the 8 scale scores (role limitations because of emotional problems, mental health) between these two groups. However, there were no significant differences in any scale scores except one (social function) between patients with and without severe adverse events (AEs). Furthermore, a significant time-dependent improvement was observed in one score (body pain), while there were no significant differences in the remaining 7 scores 3, 6 and 12 months after sunitinib treatment in 29 patients who could be followed for at least 12 months.

CONCLUSIONS

Although this was a non-randomized study including a comparatively small number of patients, these findings suggest that efficacy rather than AE is likely to be associated with HRQOL in Japanese mRCC patients treated with sunitinib.

Posttraumatic stress disorder symptoms in cancer: psychometric analysis of the Spanish Posttraumatic Stress Disorder Checklist-Civilian version

OBJECTIVE

The PTSD Checklist-Civilian version (PCL-C) was used as a screening tool to assess the presence of PTSD symptoms. The aim of this study was to explore the factorial structure of the Spanish version of the PCL-C and calculate the correlation of PTSD symptoms with distress and health-related quality of life.

METHOD

The sample included 494 cancer outpatients. In order to validate the PCL-C, a principal component analysis was applied. The association between variable was measured by Pearson correlation.

RESULTS

Findings evidenced three symptoms clusters on the PCL-C version, defined as Hyperarousal/Re-experiencing, Numbing and Avoidance. About 10% of the total sample met clinical PTSD symptoms. In addition, PTSD symptoms were related negatively to health-related quality of life and positively related with distress.

CONCLUSION

The conceptualization of PTSD symptoms for cancer patients is supported by the specific symptom clusters identified on PCL-C.