Response to Stewart and Nápoles-Springer: Quality-of-Life Assessment in Clinical Research

HIV-Related Neurological Syndromes Reduce Health-Related Quality of Life

Background:

Human immunodeficiency virus (HIV) infection frequently results in neurological complications but the impact of different neurological syndromes on patients' quality of life remains unknown.

Methods:

We investigated health-related quality of life (HRQoL) parameters among HIV/Acquired Immune Deficiency Syndrome (AIDS) patients with and without neurological disease, including 11 dimensions of HRQoL within the Medical Outcomes Short-form Health Survey-HIV.

Results:

Comparisons of sociodemographic and systemic clinical variables did not differ between HIV/AIDS patients with (n=94) and without (n=75) neurological disease. However, patients with neurological diseases exhibited significantly lower HRQoL scores compared to matched controls, which was most evident among HIV/AIDS patients with cognitive impairment and sensory neuropathy. Prospective analysis revealed diminishing HRQoL scores prior to neurological diagnosis followed by a progressive and sustained improvement in HRQoL scores after intervention over a 96-week period.

Conclusions:

These studies indicate that while HIV-related neurological diseases are associated with reduced HRQoL scores, enhanced neurological care has a positive impact on HIV/AIDS patients' overall well-being.

Health-related quality of life and associated outcomes among hemodialysis patients of different ethnicities in the United States: the Dialysis Outcomes and Practice Patterns Study (DOPPS)

BACKGROUND

In the United States, an association between mortality risk and ethnicity has been observed among hemodialysis patients. This study was developed to assess whether health-related quality of life (HRQOL) scores also vary among patients of different ethnic backgrounds. Associations between HRQOL and adverse dialysis outcomes (ie, death and hospitalization) also were assessed for all patients and by ethnicity.

METHODS

Data are from the Dialysis Outcomes and Practice Patterns Study for 6,151 hemodialysis patients treated in 148 US dialysis facilities who filled out the Kidney Disease Quality of Life Short Form. We determined scores for three components of HRQOL: Physical Component Summary (PCS), Mental Component Summary (MCS), and Kidney Disease Component Summary (KDCS). Patients were classified by ethnicity as Hispanic and five non-Hispanic categories: white, African American, Asian, Native American, and other. Multiple linear regression models were used to estimate differences in HRQOL scores among ethnic groups, using whites as the referent category. Cox regression models were used for associations between HRQOL and outcomes. Regression models were adjusted for sociodemographic variables, delivered dialysis dose (equilibrated Kt/V), body mass index, years on dialysis therapy, and several laboratory/comorbidity variables.

RESULTS

Compared with whites, African Americans showed higher HRQOL scores for all three components (MCS, PCS, and KDCS). Asians had higher adjusted PCS scores than whites, but did not differ for MCS or KDCS scores. Compared with whites, Hispanic patients had significantly higher PCS scores and lower MCS and KDCS scores. Native Americans showed significantly lower adjusted MCS scores than whites. The three major components of HRQOL were significantly associated with death and hospitalization for the entire pooled population, independent of ethnicity.

CONCLUSION

The data indicate important differences in HRQOL among patients of different ethnic groups in the United States. Furthermore, HRQOL scores predict death and hospitalization among these patients.

Quality of life after treatment for gynecologic malignancies: a pilot study in an outpatient clinic

OBJECTIVE

The objective of this study was to determine the health-related quality of life (QOL) of disease-free patients after therapy for gynecologic malignancies at follow-up in an outpatient clinic.

METHODS

Eighty-five patients (P) completed the general Functional Assessment of Cancer Therapy (FACT-G) QOL questionnaire at least 6 months after treatment for a gynecologic malignancy. Responses were compared to 42 unmatched healthy women (H) who were seen for standard gynecologic screening exams. Statistical evaluation was done using t tests, chi(2),and Wilcoxon rank-sum tests, Spearman rank correlations, and linear regression.

RESULTS

The demographic data for the groups were as follows: median age P, 59 years; H, 56 years; Caucasian P, 51%; H, 56%, African American P, 49%; H, 44%, cervix cancer (n = 51, 60%), uterine cancer (n = 24, 28%), ovarian cancer (n = 10, 12%). The median time since therapy was 39 months (range 6-149 months). There were no overall differences in FACT-G scores of patients and healthy women. Cancer survivors scored slightly higher on the emotional well-being subscale (mean 20.4 vs 19.2). Among cancer patients, all scores were lowest in patients with ovarian cancer. Longer treatment time was associated with a lower physical well-being. Older patients scored higher on emotional well-being, but lower on social/family well-being. Poor education and no help at home were associated with lower functional well-being and total FACT scores. Linear regression analysis revealed significantly lower total QOL scores in patients with the following characteristics: ovarian cancer diagnosis, treatment with radiation therapy or multi-modality therapy, less than high school education, and lack of help at home.

CONCLUSION

Overall the recovery from treatment for gynecological cancer is good. Patients with ovarian cancer, prolonged therapy, poor education, and little social support have the most significant impairments in health-related quality of life and need additional support resources.

Health outcomes methodology symposium: summary and recommendations

BACKGROUND

Interest in the philosophy and techniques of the assessment of health outcomes has burgeoned, prompting research funding agencies and others to examine traditional and emerging methods for outcome measurement.

OBJECTIVES

This report summarizes the presentations and discussions at and research recommendations stemming from an invitational symposium on health outcomes methodology convened in September 1999.

RESEARCH DESIGN

The summary is based on the preliminary drafts of all formal reports and discussions, transcripts of all presentations and plenary discussions, and notes from breakout groups.

RESULTS AND CONCLUSIONS

Existing health outcomes measures drawn from classic test theory and emerging approaches based on item response theory offer exciting opportunities for appreciably expanded applications in biomedical and health services research, clinical practice and decision making, and policy development. The major research agenda reflects the significance of this field of endeavor, its widening acceptance both at home and abroad, and its increasing applicability to many different patient and user communities. Of particular moment are the following: (1) refining and expanding of measurement techniques that rely on item response theory and making these approaches more understandable to potential users; (2) improving measurement tools to make them more culturally appropriate for diverse populations and more conceptually and psychometrically equivalent across such groups; (3) addressing longstanding issues in preference- and utility-based approaches, particularly in the elicitation of preference responses and scoring instruments; and (4) enhancing the ways in which data from outcomes measurement tools are calibrated against commonly understood clinical and lay metrics, are interpreted, and are made usable for different decision-makers.