A follow-up study of the quality of life in cancer patients with different prognoses

The present study examines differences in quality of life between two points in time in a heterogeneous sample of cancer patients with different prognoses. The original sample comprised 253 patients, while the follow-up data obtained 3–4 years later included 75 patients, that is, 92% of the survivors. All the patients completed a questionnaire including the EORTC QLQ-C30. The research questions focus on overall changes in quality of life, and whether patients with a good prognosis would show less negative changes in quality of life than patients with a poor prognosis. The overall observed changes in quality of life were surprisingly small over a 3–4 year period. This study shows that prognoses do predict changes in social functioning and in some physical aspects of quality of life over a 3–4 year period after the assessment of prognoses by physicians. Prognoses did not, however, predict changes in psychological aspects of quality of life.     

How quality of life data contribute to our understanding of cancer patients' experiences? A study of patients with lung cancer

A prospective study was conducted to measure quality of life in newly diagnosed lung cancer patients attending a chest clinic in a large teaching and district general hospital in a geographically defined area (northern sector of Glasgow, Scotland). Quality of life was assessed at two points in time, pre-diagnosis (baseline) and 3 months after diagnosis (follow-up) using three standard measures; the Nottingham Health Profile (NHP); the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and its lung cancer supplement (QLQ-LC13). Out of 133 lung cancer patients diagnosed during the study period, 129 patients (97%) were interviewed pre-diagnosis. Of these, only 63% of the patients had an active treatment. Ninety-six patients were alive at follow-up, of whom 82 patients were re-interviewed. Thus, only 82 patients who had complete data were used in the analysis. Comparing patients' pre-diagnosis and follow-up scores on the NHP, only sleep difficulties improved slightly. Patients reported increased perceived health problems of all other characteristics studied (energy, p = 0.0004; physical mobility, p = 0.0008). Similar results were observed on the EORTC questionnaires indicating that patients' functioning and global quality of life had decreased. The only significant improvement after 3 months was seen in patients' cough (p = 0.006). There were marked increases in hair loss (p > 0.0001), constipation (p = 0.007), and sore mouth (p = 0.0004). The findings suggest that patient-centred variables should receive sufficient consideration in the treatment of lung cancer. The study results clearly indicate that information on quality of life contributes to our understanding of patients' experiences of their cancer treatment.     

胃癌根除术同步放化疗患者的生活质量及影响因素研究

目的 了解胃癌根除术经同步放化疗患者的生活质量及其相关影响因素.方法 选取某医院门诊随访的胃癌根除术后经同步放化疗后6~24个月的患者128例,使用中文版EORTC QLQ-C30量表评估其生活质量,采用多重线性回归分析其影响因素.结果 胃癌根除术者年龄为（50.36±9.73）岁,总体生活质量得分为（75.13±19.64）分.功能领域中以角色功能得分较高为（86.98±14.58）分,症状领域中以疲倦得分较高为（30.47±12.44）分,单一条目中以经济困难得分较高为（38.29±14.78）分.多重线性回归分析显示收入情况、病理分期和文化程度与胃癌患者生活质量有关联.结论 该组患者总体生活质量得分较高,与收入情况、病理分期和文化程度有关.     

A prospective comparison of quality of life measures for patients with esophageal cancer

Among the most widely used instruments to assess quality of life (QOL) in patients with cancer are the European Organization for Research and Treatment of Cancer core questionnaire (EORTC QLQ-C30) and the Functional Assessment of Chronic Illness Therapy, cancer instrument (FACT-G). This study compared these approaches in patients who had undergone esophagectomy for cancer. The EORTC core questionnaire and esophageal module and the FACT-G and esophageal scale were completed by 57 patients. Missing data, relationships between QOL scales and analyses of patients preferences were examined. There were 14/2736 (0.5%) missing items from EORTC questionnaires and 45/2565 (1.8%) from FACT instruments (p < 0.01). Relationships between corresponding generic EORTC and FACT scales were average to good (r 0.57) except for the social function scale (r = 0.01). EORTC symptom scores were moderately correlated with the FACT general scale, but poorly related to the FACT esophageal scale (r < 0.28). EORTC swallowing scores were moderately correlated with all FACT scales. The FACT-E and EORTC QLQ-C30 measure assess similar generic aspects of QOL (except social function). EORTC esophageal symptom scores relate poorly to FACT esophageal scales, except for swallowing. Choice of QOL measure after esophagectomy for cancer depends upon outcomes of interest. Future studies will determine which instruments are appropriate in each context.     

A longitudinal study of health related quality of life and utility measures in patients with advanced breast cancer

Health related quality of life (HRQOL) measures are now accepted as indicators of efficacy in the palliative treatment of cancer. Utility measures may also provide valuable information yet they have been applied less frequently. To assess the application of a time trade-off (TTO) utility measure and its concordance with the Spitzer uniscale and quality of life index (QLI) 38 women with advanced, symptomatic breast cancer were studied over a 12 month period. The correlation coefficient for QLI and TTO values was 0.54 and for uniscale and TTO 0.62. Using generalized estimating equations the regression of TTO scores on QLI and uniscale scores was significant at baseline. In longitudinal analyses results were significant only for QLI. Although all participants completed the HRQOL measures only 24 (63%) were prepared to trade time. The remaining 14 (32%) stated they felt too well to trade. Those prepared to trade time recorded significantly worse mean HRQOL scores throughout the study compared to those who felt too well to trade and had tumors which showed a poorer response to therapy. In this preliminary study utility and HRQOL scores were generally favorable throughout the 12 month study period and showed fair to moderate concordance. Further research in larger patient groups is required to better define the relationships between utility and HRQOL measures. This revised version was published online in June 2006 with corrections to the Cover Date.     

宫颈癌患者治疗后生活质量的影响因素分析

目的 评估宫颈癌患者术后或放化疗后的生活质量(QOL)及其影响因素,以采用针对性治疗措施提高宫颈癌患者治疗后的生活质量.方法 采用欧洲癌症研究与治疗组织生活质量核心调查表(EORTC QLQ-C30)对术后或放化疗后的100例宫颈癌患者进行生活质量调查.结果 年龄对宫颈癌患者整体生活质量、角色功能、认知功能、疲乏和恶心、呕吐均有影响(t值分别为-0.3083、-2.114、-2.090、-2.495、2.619,均P<0.05).家庭收入是影响整体生活质量、社会功能、经济困难的因素(t值分别为2.631、-3.082、-6.385,均P<0.05).疾病分期是影响患者认知功能、情绪功能的因素(t值分别为-2.634、-4.861,均P<0.05).肌层浸润深度、组织学转移、淋巴结转移均与宫颈癌患者的生活质量水平呈负相关.治疗方式是整体生活质量、疲乏、食欲减弱、经济困难的影响因素(t值分别为-5.171、3.471、2.023、2.738,均P<0.05).结论 重视宫颈癌的早诊早治,选择合理的治疗方式,为患者及其家人提供有针对性的治疗措施,可以提高宫颈癌患者治疗后的生活质量.     

Conceptual equivalence and health-related quality of life: an exploratory study in Japanese and Dutch cancer patients

Research into the equivalence of Western and Japanese conceptualizations of health-related quality of life (HR-QOL) is scarce. We used the Western (European Organization for Research and Treatment of Cancer, EORTC-QLQ-C30) and the Japanese (HRQoL-20) questionnaire in order to analyze the conceptual similarity of HR-QOL factors, and the associations between specific symptom items with overall HR-QOL in Japanese (n = 265) and Dutch (n = 174) patients with various types of cancer. Both populations completed both instruments. In both patient groups, the overall health scale of the EORTC-QLQ-C30 correlated highly (r = 0.59; p < 0.001) with the HRQOL-20 composite average score, indicating substantial conceptual comparability. Relationships between all EORTC-QLQ-C30 symptom items with HR-QOL were examined by ranking their correlations with the two overall measures of HR-QOL. Comparable patterns in the Japanese and Dutch samples were observed. The results suggest a considerable conceptual equivalence of HR-QOL in Japanese and Dutch cancer patients, and indicate a satisfactory structural and cross-cultural equivalence for the EORTC-QLQ-C30 with regard to items measuring functioning and specific symptoms. Longitudinal studies are needed to examine the impact of specific symptoms on general quality of life.     

The CARES: a generic measure of health-related quality of life for patients with cancer

In spite of the prevalence of neoplastic disorders as a cause of chronic illness, very few of the currently available generic measures of health-related quality of life or health status have been utilized with cancer patients. In this paper we reviewed our studies with the Cancer Rehabilitation Evaluation System (CARES), a cancer-specific measure of rehabilitation needs and quality of life. We present data to demonstrate that the CARES is a generic measure of health-related quality of life, suitable for use in the many different diseases called cancer. The data that form the basis for this paper were collected during a decade of research on the CARES. This paper represents the first discussion of the performance of the CARES across separate cancer sites and phases of the disease. In addition, we demonstrated that the CARES is responsive to changes in health-related quality of life over time. Finally, we will discuss the application of the CARES in clinical and research settings.This research was supported by Grant No. CA 43461 from the National Institutes of Health/National Cancer Institute, USA.     

Self-reported health-related quality of life predicts survival for patients with advanced gastric cancer treated with first-line chemotherapy

Purpose To determine whether patients’ self-reported quality-of-life (QOL) parameters could predict survival for patients with advanced gastric cancer (AGC) treated with first-line chemotherapy, we performed this analysis based on the data obtained from 254 patients enrolled in three consecutive prospective randomized trials at a single institution. Methods Consenting patients with AGC received first-line chemotherapy as specified in the protocols. QOL was assessed at baseline using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaires. Baseline univariate and multivariate analyses were performed on the QOL data and the recognized clinical predictors for survival. Results Of 254 patients, 164 completed the QOL questionnaire at baseline. All patients received fluorouracil-containing first-line chemotherapy for AGC. With 88% observed deaths and a reported median survival of 9.5 months [95% confidence interval (CI) 8.8–10.2 months], there were no significant differences in survival between patients with or without QOL data. The final Cox multivariate model revealed four prognostic factors: age [hazard ratio (HR) 2.08, 95% CI 1.32–3.33, P = 0.002], bone metastasis (HR 2.70, 95% CI 1.30–5.56, P = 0.008), hemoglobin (HR 0.58, 95% CI 0.37–0.92, P = 0.020), and social functioning (HR 0.40, 95% CI 0.23–0.64, P = 0.001). When adjusting for clinical parameters, social functioning was an independently significant prognostic factor for longer survival. Conclusion Baseline social functioning, along with age, presence of bone metastasis, and baseline hemoglobin level, independently predicts survival of AGC patients treated with first-line chemotherapy. QOL assessment should be routinely included to provide useful prognostic information concerning AGC patients.     

Quality of life in cancer patients in South Asia: psychometric properties of the Sinhala version of the EORTC QLQ-C30 in cancer patients with heterogeneous diagnoses

BACKGROUND: The European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) was evaluated for its psychometric properties in a sample of cancer patients from the culturally distinct South Asian subcontinent, which accounts for a significant proportion of the global cancer burden. METHODS: Psychometric testing assessed the hypothesised scale structure, internal consistency, content and construct validity, and acceptability of the Sinhala version of the QLQ-C30 independently in two heterogeneous groups of cancer patients at pretreatment (N = 489) and during treatment (N = 343). RESULTS: Qualitative feedback from an expert panel assessing content validity recommended measuring family support during illness as an additional, culturally-relevant dimension of health-related quality of life (HRQL). Compliance was high (100%), with little missing data (0.11%). Multitrait scaling results supported the scale structure of the QLQ-C30, with the exception of the cognitive functioning scale, which was also the only scale that did not meet the 0.70 internal consistency criteria in either sample. Interscale correlations were of a moderate size, with conceptually related scales showing higher correlations. All scales were able to discriminate clearly between pre- and current treatment patients (P < 0.01), although results were less consistent when comparing groups formed on the basis of age and disease stage. CONCLUSIONS: Overall psychometric results confirmed the QLQ-C30 as a reliable and valid questionnaire for assessing HRQL of cancer patients in Sri Lanka.     

Quality of life of lung cancer patients: Validation of the Taiwan Chinese version of the EORTC QLQ-C30 and QLQ-LC13

The purpose of this study was to test the validity and reliability of the Taiwan Chinese translation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30, version 3) and Quality of Life Questionnaire Lung Cancer-13 (QLQ-LC13) questionnaires. Consecutively 51 patients with lung cancer undergoing active chemotherapy and 48 such patients undergoing regular follow-up completed the questionnaires. The intraclass correlation between test and retest ranged from 0.46 to 0.85 for the QLQ-C30 and was 0.76 for dyspnea for the QLQ-LC13. The kappa coefficients between test and retest ranged from 0.51 to 0.73 for single items of the QLQ-C30 and 0.49-0.68 for five of the nine items in the QLQ-LC13. The Cronbach's alpha coefficients were > or = 0.70 for all scales of the two questionnaires apart from that of cognitive functioning. The correlation coefficients between indices measuring similar dimensions of the EORTC QLQ-C30 and the SF-36 questionnaires ranged from 0.43 to 0.73, and that between the dyspnea scales of the two EORTC questionnaires was 0.70. Patients in the follow-up group revealed higher scores of global status/quality of life, and lower scores of nausea/vomiting, as also physical functioning. The questionnaires could also detect expected adverse effects of radiotherapy, cisplatin, and paclitaxel.     

上海市部分社区癌症患者生活质量影响因素的研究

目的探讨社区癌症患者生活质量的主要影响因素。方法应用癌症患者功能量表（FACT—G）及癌症患者疾病和社会信息的一般状况登记表对上海市社区癌症患者进行抽样问卷调查。调查方法包括自评和访谈,统计学方法采用单因素方差分析和线性模型等分析。结果共收回有效问卷7580份,对上海市社区癌症患者的生活质量（QOL）各维度均有显著影响的因素有家庭收入、本人受教育程度、职业状况、知情状况、体育活动状况、医疗费来源和疼痛状况（P〈0．01）。而患者年龄、婚姻状况、肿瘤类型、肿瘤分期等因素对上述癌症患者QOL部分维度评分有非常显著影响。KPS评分与FACT—G各维度评分具有显著相关性（P〈0．000）。结论年龄大、肿瘤分期晚、伴有疼痛、受教育水平低、收入低、离异或丧偶、不参加体育锻炼以及医疗费用来源为合作医疗者,QOL相应较差。[编者按]     

多学科联合干预治疗模式对晚期癌症患者生活质量的研究

目的探讨多学科联合干预治疗模式对晚期肿瘤患者生活质量的影响。方法选取466例中晚期癌症患者,随机分为治疗组和对照组,每组233例。2组患者均使用手术+化疗和(或)放疗等治疗方法、中医相结合的综合干预模式进行常规治疗,治疗组再加心理学治疗方法。采用癌症患者生活质量测评量表(EORTC QLQ-C30)、疼痛强度数字等级量表(NRS)和活动能力量表(KPS)进行综合评估。结果 2组患者治疗前后躯体功能、角色功能、认知功能、情绪功能都得到提高,临床症状均改善(P0.05),治疗组较对照组改善明显(P0.05),但社会功能和经济困难情况均改善不明显(P0.05);两组患者治疗前后活动能力和疼痛程度均改善(P0.05),治疗组活动能力和疼痛程度较对照组改善明显(P0.05)。结论多学科联合干预治疗模式与心理学治疗方法能改善晚期肿瘤患者的生活质量、活动能力,提高综合疗效。     

Health-related quality of life (HRQoL) in patients with cancer and other concurrent illnesses

This study analyzed the impact of eight common chronic medical conditions on cancer patients' health-related quality of life (HRQoL) as measured by the functional living index-cancer (FLIC). The FLIC was administered to a population of 405 people in 14 communities in the North Central US within 4-8 weeks of diagnosis with breast or colorectal cancer. At that time, patients also self-reported any other health conditions for which they had been receiving medical treatment. The impact of the selected chronic conditions on the FLIC scores was analyzed using Student's t-tests and linear multiple regression. In the bivariate analysis, patients with heart/circulation problems had lower FLIC total scores (p < 0.05), physical well-being subscale scores (p < 0.05), and nausea subscale scores (p < 0.01). Patients with diabetes had lower nausea subscale scores (p < 0.05). The social well-being subscale score was higher with the report of arthritis/joint problems (p = 0.001). In multivariate analysis adjusted for age, arthritis/joint problems were predictive of the social well-being (p < 0.01) and hardship due to cancer (p < 0.05) subscale scores; heart/circulation problems (p < 0.001) and diabetes were predictive of the nausea subscale scores. ECOG performance status was significant predictor for the FLIC total and all of the subscale scores. HRQoL as measured with the FLIC scores in patients with cancer is impacted by the presence of other concurrent health conditions; this finding has implications for HRQoL theory and application.     

Use of tranquilizers and sleeping pills among cancer patients is associated with a poorer quality of life

To evaluate the association between sleeping pill/tranquilizer (SP/T) use and quality of life (QOL) among cancer patients. Patients and methods: Oncology patients (n=909) in three Israeli hospitals were interviewed in clinics, day centers and in-patient departments regarding SP/T use in the previous week. Crude and adjusted QOL scores, measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30), were compared in users vs. non-users. Results: Sleeping pill/tranquilizer use was self-reported by 234 (25.7%) participants, but rarely documented in medical charts. Factors associated with SP/T use were female gender (adjusted Odds ratio, OR: 1.79; 95% Confidence interval, CI: 1.22–2.62, age (OR: 4.6; 95% CI: 1.66–12.53 for age 70+), place of birth (OR: 1.97; 95% CI: 1.19–3.26 for Eastern Europe compared with Israel), concomitant use of painkillers (OR: 2.88; 95% CI: 1.97–4.20) and presence of cardiovascular disease (OR: 2.41; 95% CI: 1.48–3.91). Controlling these factors as well as disease status, users had a poorer QOL on all functional scales (P<0.001) as well as global QOL. Furthermore, users reported increased severity of symptoms, especially fatigue, insomnia, pain, dyspnea and constipation (P<0.01), compared to non-users. Conclusions: Use of SP/T, reported by one fourth of cancer patients, was associated with substantially poorer QOL and increased severity of symptoms. Causal inference is not possible given the cross-sectional design. Periodic inquiry regarding use of these medications in the Oncology Clinic is recommended since it may identify patients with poor QOL and unmet needs.     

The health-related quality of life and survival of small-cell lung cancer patients: Results of a companion study to CALGB 9033

The purposes of this study were 2-fold: to evaluate the impact of the schedule dependency of etoposide (3-day IV short course vs. a 21-day oral prolonged course) with cisplatin on the quality of life of small-cell lung cancer (SCLC) patients; and to examine the effect of baseline quality of life variables on long-term survival, after adjustment for known demographic and clinical prognostic factors. Participants were 70 patients enrolled in the cancer and leukemia group B (CALGB) protocol 9033. Quality of life was assessed at baseline, 6 and 12 weeks by: the EORTC QLQ-30, the Centers for epidemiology studies – Depression short form, the medical outcomes study (MOS) social support questionnaire, and a scale of sleep quality. Contrary to expectations, study results suggested no significant differences in the patients' life quality and treatment response based on whether they received etoposide in a 3-day IV vs. a 21-day oral regimen. The use of the baseline variables in predicting overall survival indicated that patients who were non-white and with liver involvement had decreased survival. Brain involvement, being male, and higher depressive symptoms were also found to be borderline significant in predicting decreased survival in this patient population.     

Measuring and analysing quality of life in cancer clinical trials: a review

After brief consideration of the definition of the term 'quality of life', methods previously adopted and problems encountered in assessing and evaluating quality of life in clinical studies of cancer are reviewed. Desirable properties of any such assessment methods and approaches to the analysis of quality of life data are discussed. Illustrations are provided by reference to the methods of assessment of quality of life incorporated in two recently-initiated studies of cancer treatment.     

姑息关怀服务模式对癌症晚期患者生命质量的影响研究

目的 评估姑息关怀服务对癌症晚期患者生命质量的影响并提出管理建议。方法 采用问卷调查的方式对H医院接受姑息关怀治疗和常规抗癌治疗的248名癌症晚期住院患者的生命质量进行调查。选取中国癌症患者生命质量量表对癌症晚期患者的生命质量进行评估,然后通过统计分析探讨不同治疗方式下患者生命质量的差异。结果 癌症晚期患者生命质量普遍较差(36.38±4.82),其中躯体症状得分最低,依次是精神心理和社会关系。接受姑息关怀后患者生命质量及各指标得分均有显著提高。治疗前生命质量更差、疼痛程度更高的姑息关怀组患者,其治疗后的生命质量评分与常规抗癌组患者相比无显著差异,疼痛程度更是低于常规抗癌组。两组治疗方式下患者生命质量治疗前后的差值对比(6.82±2.71 vs 2.53±2.95),姑息关怀组的改善效果更明显(t=11.908,P<0.05)。结论 姑息关怀治疗相对于常规抗癌治疗,对癌症晚期患者生命质量的改善效果更为显著,应加强对以价值为核心的姑息关怀服务模式的宣传和推广。