EORTC QLQ-C15-PAL quality of life score as a prognostic indicator of survival in patients with far advanced cancer

Purpose

Quality of life (QoL) and performance status predict survival in advanced cancer patients; these relationships have not been explored in the hospice palliative care setting. The aim of this study was to examine the survival predictability of patient-reported QoL using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C15-PAL questionnaire in far advanced cancer inpatients at the very end of life.

Methods

This is a retrospective cohort study. Patients reported QoL using the EORTC QLQ-C15-PAL. One hundred sixty-two inpatients in hospice palliative wards of six hospitals in South Korea were followed until death or the end of the study. Additional symptoms and performance status were assessed by the MD Anderson Symptom Inventory—Korean (MDASI-K), Palliative Performance Scale (PPS) and Eastern Cooperative Oncology Group (ECOG) performance status. Correlations between EORTC QLQ-C15-PAL, MDASI-K, PPS, and ECOG were assessed. Survival analyses were performed using Cox proportional hazard models.

Results

Patients’ median survival was less than 1 month. Physician-reported PPS significantly predicted survival (hazard ratio [HR] 0.493; p?<?0.001). From the EORTC QLQ-C15-PAL, patient-reported physical functioning predicted survival (HR?=?0.65; p?<?0.001). Other six domains of EORTC QLQ-C15-PAL were significantly related to survival after adjustment. Those domains were global health status, emotional functioning, fatigue, nausea/vomiting, appetite loss, and constipation.

Conclusions

EORTC QLQ-C15-PAL can be an independent prognostic factor in inpatients with far advanced cancer. Patient-reported physical functioning showed survival predictability as good as physician-reported performance status. It is notable that the QLQ instrument is useful even for patients in their final month of life. Cancer anorexia–cachexia syndrome-related symptoms may be independent prognostic symptoms. Prospective study is warranted.     

Do elderly patients with metastatic cancer have worse quality of life scores?

Purpose

The purpose of this study is to compare self-reported quality of life (QOL) scores in old and young patients with metastatic cancer using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C15-PAL questionnaire.

Materials and methods

Patients receiving palliative radiotherapy (RT) for bone metastases and brain metastases completed the QLQ-C15-PAL questionnaire prior to treatment. Using multiple linear regression analysis, a parametric test, the QLQ-C15-PAL scores were compared using 65 and 70?years as cutoff ages.

Results

A total of 340 patients were referred for palliative RT for bone metastases (n?=?190) or brain metastases (n?=?150). Physical functioning and appetite were worse in the older group using either 65 or 70?years as the cutoff age. Age-related differences in the QLQ-C15-PAL scores varied as a function of age cutoff used and location of metastatic site irradiated.

Conclusion

Based on the (EORTC) QLQ-C15-PAL, elderly advanced cancer patients have a different QOL profile. Similar observations have been reported with the (EORTC) QLQ-C30 questionnaire.     

The quality of life of Brazilian patients in palliative care: validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 PAL (EORTC QLQ-C15-PAL)

Purpose

The purpose of this study was to validate the Brazilian version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 PAL (EORTC QLQ-C15-PAL) to be used in patients with cancer in palliative care.

Methods

One hundred four outpatients with advanced cancer were recruited in Hospital das Clinicas—University of Sao Paulo, Brazil.

Results

The confirmatory factor analysis confirmed that Cronbach-α is ≥0.7 except for fatigue (α?=?0.58). Convergent validity was shown by the correlation observed between the EORTC QLQ-C15-PAL dimensions with the EORTC QLQ-C30, Brief Pain Inventory, and Beck Depression Inventory. The EORTC QLQ-C15-PAL detected significant differences in the performance status, supporting known-group validity.

Conclusions

Our data show that EORTC QLQ-C15-PAL is a brief, useful, and valid tool for assessing the quality of life of Brazilian patients in palliative care.     

Validity and reliability of the EQ-5D for cancer patients in Korea

Purpose

The purpose of this study was to assess the validity and reliability of the Korean version of the EQ-5D health questionnaire for use in patients with cancer in Korea.

Methods

Patients with colorectal cancer were recruited from one ambulatory cancer center. Each participant consecutively self-administered the EQ-5D, the EORTC QLQ-C30, and the Short Form-36 (SF-36). Discriminatory ability was evaluated by comparing the SF-36 subscales with their corresponding EQ-5D dimensions. Convergent validity was assessed by examining the correlations between the EQ-5D index, EORTC QLQ-C30 subscales, and SF-36 scale and summary scores. Test-retest reliability was also evaluated.

Results

Subjects reporting problems in each EQ-5D dimension showed lower scores on all SF-36 subscales. As expected, the relationships were stronger between the EQ-5D functional dimensions and physical function on the EORTC QLQ-C30 and between the EQ-5D anxiety/depression dimension and emotional function on the EORTC QLQ-C30. The EQ-5D index and SF-36 scales were moderately or highly correlated. intraclass correlation coefficient of the EQ-5D index was 0.45.

Conclusions

The Korean version of the EQ-5D may be a valid tool for assessing the health-related quality of life of patients with cancer. However, further research is needed to determine the reliability of the Korean EQ-5D over different time intervals and disease conditions.     

Predictive factors for overall quality of life in patients with advanced cancer

Objective

This study examined which domains/symptoms from the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 15 Palliative (QLQ-C15-PAL), an abbreviated version of the health-related EORTC QLQ-C30 questionnaire designed for palliative cancer patients, were predictive of overall quality of life (QOL) in advanced cancer patients.

Methods

Patients with advanced cancer from six countries completed the QLQ-C15-PAL at consultation and at one follow-up point. Univariate and multivariate regression analyses were conducted to determine the predictive value of the EORTC QLQ-C15-PAL functional/symptom scores for global QOL (question 15).

Results

Three hundred forty-nine patients completed the EORTC QLQ-C15-PAL at baseline. In the total patient sample, worse emotional functioning, pain, and appetite loss were the most significant predictive factors for worse QOL. In the subgroup of patients with bone metastases (n?=?240), the domains mentioned above were also the most significant predictors, whereas in patients with brain metastases (n?=?109), worse physical and emotional functioning most significantly predicted worse QOL. One-month follow-up in 267 patients revealed that the significant predictors changed somewhat over time. For example, in the total patient sample, physical functioning, fatigue, and appetite loss were significant predictors at the follow-up point. A sub-analysis of predictive factors affecting QOL by primary cancer (lung, breast, and prostate) was also conducted for the total patient sample.

Conclusion

Deterioration of certain EORTC QLQ-C15-PAL functional/symptom scores significantly contributes to worse overall QOL. Special attention should be directed to managing factors most influential on overall QOL to ensure optimal management of advanced cancer patients.     

Association of social network and social support with health-related quality of life and fatigue in long-term survivors of Hodgkin lymphoma

Purpose

As the number of survivors of Hodgkin’s lymphoma (HL) increases, there has been a growing interest in long-term treatment-related side effects and their impact on the quality of life (QoL). The aim of this study was to assess the association of social network and social support with the QoL and fatigue among long-term HL survivors.

Methods

A total of 200 HL survivors were included. The generic Short Form-12 (SF-12) questionnaire, the QoL cancer survivor’s questionnaire (QOL-CS), and the Multidimensional Fatigue Inventory were used to assess QoL and fatigue. Social network and social support were evaluated with the Social Support Survey.

Results

Social network and all social support measures were favorably associated with two or more SF-12 scales, mainly with physical functioning and the mental health scales. Social network and social support dimensions were also associated with better QOL-CS scores. Affective support, informational support, positive interaction, and emotional support were associated with less fatigue.

Conclusions

Both social network and social support are associated with better QoL and lower levels of fatigue in HL survivors. This information may be useful to health professionals and community organizations in implementing effective interventions to improve these patients’ quality of life.     

Computerized monitoring of patient-reported speech and swallowing problems in head and neck cancer patients in clinical practice

Purpose

The purpose of this study is to evaluate computerized monitoring of speech and swallowing outcomes and its impact on quality of life (QoL) and emotional well-being in head and neck cancer patients in an outpatient clinic.

Methods

Sixty-seven patients, treated by single or multimodality treatment, completed the EORTC QLQ-C30 and QLQ-H&;N35 questionnaires and the Hospital Anxiety and Depression Scale in an outpatient clinic, using a touch screen computer system (OncoQuest), at baseline (at time of diagnosis) and first follow-up (1?month after end of treatment).

Results

Tumor sites included oral cavity (n?=?12), oropharynx (n?=?18), hypopharynx (n?=?8), and larynx (n?=?29). Tumor stage included carcinoma in situ (n?=?3), stage I (n?=?21), stage II (n?=?7), stage III (n?=?15), and IV (n?=?21). No speech or swallowing problems at baseline or follow-up were noted in 23?% (speech) and 41?% (swallowing) of patients. Twenty-one percent (speech) and 19?% (swallowing) had problems at baseline and returned to normal scores at follow-up, while 16?% (speech) and 19?% (swallowing) had normal scores at baseline and developed problems at follow-up. Forty percent (speech) and 21?% (swallowing) had persistent problems from baseline to follow-up. At baseline, speech problems were significantly related to tumor site and emotional distress. At baseline and follow-up, swallowing problems were significantly related to QoL and emotional distress. At follow-up, speech problems were significantly related to QoL, emotional distress, and swallowing problems.

Conclusions

Monitoring speech and swallowing problems through OncoQuest in an outpatient clinic is feasible. Many patients report speech and swallowing problems, negatively affecting their QoL and emotional well-being.     

Quality of life in patients with muscle invasive and non-muscle invasive bladder cancer

Purpose

Compared to the literature on other malignancies, data on quality of life (QoL) in bladder cancer are sparse. This study sought answers to the following questions: In what QoL domains do patients with bladder cancer differ from the general population? Do patients with radical cystectomy differ in QoL compared to those who received conservative treatment? Do patients with neobladder generally have better QoL compared to patients with other diversion methods?

Methods

At the beginning of inpatient rehabilitation, N?=?823 patients with bladder cancer were assessed. Data of a representative community sample (N?=?2037) were used for comparison. The questionnaire EORTC QLQ-C30 was used to measure QoL. Multivariate linear regression models were computed to investigate differences between groups.

Results

Patients with both non-muscle invasive and muscle invasive bladder cancer reported significantly more problems and worse functioning than the general population. Radiotherapy is associated with clinically relevant more pain, dyspnoea, constipation, appetite loss and decreased social functioning while chemotherapy is associated more with dyspnoea. Cystectomy patients reported more fatigue, appetite loss and decreased role functioning. Male patients ≥70 years with conduit experienced more sleep and emotional problems. These effects of urinary diversion were not observed in women and younger patients.

Conclusions

Patients with bladder cancer experience various QoL concerns at the beginning of inpatient rehabilitation. These problems can partly be explained by the type of treatment the patients receive. Type of urinary diversion is relevant for QoL in subgroups of patients.     

Further evaluation of the EORTC QLQ-C30 psychometric properties in a large Brazilian cancer patient cohort as a function of their educational status

Purpose

The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) is considered a valid instrument for use in Brazil. However, the previous Brazilian validation study included only 30 lung cancer patients and only measured test-retest reliability. The aim of this study was to evaluate the psychometric properties of the EORTC QLQ-C30 in a sample of cancer patients at different educational levels who completed the instrument administered by an interviewer.

Methods

Data from six prospective studies conducted by the same group of researchers were combined in this study (N?=?986).

Results

Reliability was assessed using Cronbach’s alpha coefficient, all values of which were >0.7, with the exception of cognitive functioning, social functioning, and nausea and vomiting (α?=?0.57, α?=?0.69, and α?=?0.68, respectively). In multi-trait scaling analysis, convergent and divergent validity were considered adequate (validity indices were 91.6 and 97.4 %). In general, moderate to strong correlations were found between the subscales of the EORTC QLQ-C30 and its respective dimensions from the WHOQOL-bref, the hospital anxiety and depression scale, and the Edmonton Symptom Assessment System (ESAS) instruments. In addition, the EORTC QLQ-C30 was able to differentiate groups of patients with distinct performance statuses and types of treatment (known-group validation). Statistical analyses were also performed on educational status, yielding similar results.

Conclusions

Detailed psychometric property data using the EORTC QLQ-C30 in Brazil are added by this study. In addition, we demonstrated that this instrument is in general reliable and valid regardless of the patient educational level.     

Prevalence, predictors, and prognostic impact of fatigue among Brazilian outpatients with advanced cancers

Purposes

The purposes of this study are to evaluate the impact of cancer-related fatigue (CRF) on quality of life (QoL), and to identify its clinical predictors. In addition, the authors investigated the prognostic impact of CRF and its relationship with the inflammatory marker C-reactive protein.

Method

Data regarding patient characteristics, symptom scores, and QoL indices were collected at the initial evaluation. At the same time, blood samples were collected in order to evaluate some laboratorial markers. Patients were followed by telephone interviews every 15 days until death. CRF was defined as ≥66.67 points on EORTC QLQ-C30 fatigue subscale.

Results

The examined patients had a median age of 61 years (range, 21–86 years) and 50.7 % were male. Median Karnofsky performance score (KPS) was 75.5 (SD, 15.1). The prevalence of CRF was 25 % (55 out of 221). Overall, patients with CRF presented higher symptom burden and also worst QoL scores. The following variables were independently associated with CRF: nausea (OR 1.22, p?=?0.009), dyspnea (OR 1.33, p?=?0.002), KPS (OR 0.96, p?=?0.009), body mass index (OR 0.93, p?=?0.046), and C-reactive protein (OR 1.08, p?=?0.004). The median overall survival (OS) was lower in CRF patients (p?<?0.0001). Only KPS (HR?=?0.96, p?<?0.001) and C-reactive protein (HR?=?1.07, p?<?0.001) were independent prognostic factors for OS.

Conclusions

Advanced cancer patients (ACP) with CRF had a higher burden of symptoms and impaired QoL. Our findings support the hypothesis that chronic inflammatory state (CIS) could play a role in the pathogenesis of fatigue in ACP. Moreover, CIS seems to have greater prognostic impact than the associated fatigue.     

Determinants of quality of life in advanced cancer patients with bone metastases undergoing palliative radiation treatment

Purpose

Assessment of health-related quality of life (HRQOL) is critical to effective delivery of palliative care in patients with advanced cancer. The current study analyzes relationships between baseline social determinants of health and medical factors, and self-reported HRQOL in patients with bone metastases receiving palliative radiotherapy.

Methods and materials

Advanced cancer patients referred for radiotherapy treatment of bone metastases completed the EORTC QLQ-C30 questionnaire in multiple outpatient clinics internationally. Demographics and social determinants were collected as baseline information. Univariate and Bonferroni-adjusted multivariate linear regression analyses were used to detect significant correlations between baseline determinants and different HRQOL domains.

Results

Karnofsky Performance Status (KPS) was correlated with better physical (p?=?0.0002), role (p?<?0.0001), emotional (p?<?0.0001), and social (p?<?0.0001) functioning, and global health scores (p?=?0.0015) and predicted lower symptom scores for fatigue (p?<?0.0001), pain (p?<?0.0001), appetite loss (p?<?0.0001), and constipation (p?<?0.0001). Increased age was predictive of better social functioning (p?<?0.0001) and less insomnia (p?=?0.0036), higher education correlated with better global health status (p?=?0.0043), and patients who were employed or retired had improved physical functioning (p?=?0.0004 and p?=?0.0030, respectively) and less financial challenges compared to patients who were unemployed (p?=?0.0005).

Conclusions

Baseline KPS had the greatest influence on EORTC QLQ-C30 domain scores. Age, education level, and employment status had significant impacts, although on fewer domains. Further studies that investigate baseline determinants are worthwhile to clarify relationships in order to care for patients more effectively at the end of life.     

Fatigue scores in patients with brain metastases receiving whole brain radiotherapy

Purpose

Whole brain radiotherapy (WBRT) is a treatment strategy used commonly to relieve burdensome symptoms and improve quality of life (QOL) in patients with multiple brain metastases. The purpose of this study is to determine changes in fatigue score following WBRT as it is a common symptom experienced in this population.

Methods

Fatigue and overall QOL scores were collected prospectively in patients for up to 3 months post-WBRT by several questionnaires at different times including the following: Edmonton Symptom Assessment System (ESAS), Brain Symptom and Impact Questionnaire (BASIQ), Spitzer Questionnaire, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), EORTC brain module (EORTC QLQ-BN20?+?2), EORTC QLQ-C15-PAL, and Functional Assessment of Cancer Therapy—General (FACT-G). Questionnaires were grouped for analysis by Wilcoxon Signed Rank test according to the scale of ranking into 0–10, 1–4, and 0–4.

Results

Thirty-six patients were interviewed with the ESAS or BASIQ. The median age was 65 years old, and median Karnofsky Performance Status (KPS) was 70. There was a significant increase in fatigue score from baseline to month 1 (p?=?0.02), and months 2 and 3 had no significant change. There was a significant correlation between fatigue and overall QOL score at baseline and month 1 (p?=?0.01, p?<?0.0001), respectively. Two hundred and twenty-eight patients were surveyed with Spitzer, C15-PAL, BN20?+?2, QLQ-C30, or FACT-G. Median age was 64 years old and median KPS was 80. Compared to baseline, fatigue score was significantly higher at month 1 (p?<?0.0001) and month 2 (p?=?0.001), with no significant change at month 3. Significant correlation was found between fatigue and overall QOL at baseline, months 1, 2 (p?<?0.0001), and 3 (p?=?0.0009). For all groups, there was no significant change in fatigue score between patients with or without dexamethasone (Dx), except for the fatigue changed score of the group with scale 0–4.

Conclusions

Fatigue was significantly increased from baseline to month 1 in all patients, and most patients experienced no difference in fatigue if they were receiving Dx. Increased fatigue was significantly related with decreased overall QOL.     

Monitoring changes in quality of life in patients with lung cancer by using specialised questionnaires: implications for clinical practice

Background

Quality of life (QoL) in lung cancer patients is overlooked due to the severity of the disease. Changes in factors comprising QoL need further exploration to determine therapy targets.

Methods and materials

QoL was assessed in 282 patients referred to a specialised centre in Greece for chemotherapy using three reliable scales: Functional Assessment of Cancer Therapy—Lung (FACT-L, Greek version 4), Short Form (SF-36) Health Survey and Hospital Anxiety and Depression Scale (HAD)S.

Results

Comparing QoL scores, it was observed that in comparison to the first chemotherapy, there was a statistically significant deterioration in patients’ physical well-being (p?<?0.0001) at the following chemotherapies. In contrast, there was a statistically significant improvement in patients’ emotional well-being (p?<?0.0001), mental health (p?<?0.0001) and social functioning (p?=?0.006) in the chemotherapies following the first. Observations deriving from survival analyses agree with literature findings: small cell lung cancer (SCLC) patients had significantly shorter survival than non-SLSC (NSCLC) patients, initial performance status was consistent with survival, radiotherapy improved survival, existence of metastases hindered survival, and the number of chemotherapies and QoL scores were positively correlated with survival.

Conclusions

Although patients’ physical functioning deteriorated after chemotherapy, their psychological state, mental health and social functioning improved in comparison with their first chemotherapy. This may be due to the fear of the unknown and the stress patients experience before their treatment. Regarding survival analysis results, it could be stated that the better QoL scores, the longer the survival. The findings underline the importance of psychological support after diagnosis and during the initiation of treatment. This may result in a better QoL, hence leading to prolongation of survival.     

How does pain experience relate to the need for pain relief? A secondary exploratory analysis in a large sample of cancer patients

Purpose

To explore (1) the information obtained from related but conceptually different approaches to pain assessment and (2) the extent to which the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) can be used as a screening tool to predict patient-reported need for pain relief.

Methods

Cancer patients randomly sampled from 56 hospital departments were included. Questionnaire items assessed patients’ (a) pain experience using the EORTC QLQ-C30 pain scale and its two pain items separately (pain intensity and pain interference) and (b) pain burden and (c) need for pain relief using the Three-Levels-of-Needs Questionnaire (3LNQ).

Results

Of the 2364 patients contacted by mail, 1447 (61 %) completed the questionnaires. Among these, 51 % reported at least “a little” pain on the pain intensity item. The number of patients reporting pain to be a burden was similar, and pain experience and pain burden were highly correlated (correlation coefficients ranged from 0.85 to 0.91). Pain experience and pain burden were moderately correlated with the need for pain relief. A receiver-operating characteristic (ROC) curve analysis showed that the EORTC QLQ-C30 discriminated between patients with and without a need for pain relief to an acceptable degree (area under the curve (AUC) 0.73–0.77). The cut-point a little gave a sensitivity of 84 % and specificity of 59 % for the item “Have you had pain?” and a sensitivity of 72 % and a specificity of 72 % for the pain scale.

Conclusions

The majority of patients who experienced pain felt it to be a problem. Pain experience and pain burden were substantially related to need for pain relief, and the latter could be predicted from the EORTC QLQ-C30.

     

Comparison of the EORTC QLQ-BN20 and the FACT-Br quality of life questionnaires for patients with primary brain cancers: a literature review

Purpose

This review compares and contrasts the development, validity, and characteristics of two quality of life (QOL) assessment tools used in patients with primary brain cancers: the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Brain Cancer Module (EORTC QLQ-BN20) and the Functional Assessment of Cancer Therapy-Brain (FACT-Br).

Methods

A literature search was conducted using the Cochrane Central Register of Controlled Trials (June 2013), Ovid EMBASE (1947 to 2013, week 27), and Ovid MEDLINE (1946 to July 2013, week 1) to identify studies that discussed the development, characteristics, validity, and reliability of the EORTC QLQ-BN20 or the FACT-Br.

Results

The EORTC QLQ-BN20 consists of 20 items that assess future uncertainty, visual disorder, motor dysfunction, and communication deficit. Items are presented as questions on a scale ranging from 1?=?“not at all” to 4?=?“very much.” Reliability and validity testing of the QLQ-BN20 revealed a Cronbach’s alpha coefficient that ranged from 0.71 to 0.90. The FACT-Br consists of 23 items that assess general well-being and brain cancer-specific concerns that include concentration, memory, seizures, eyesight, hearing, speech, personality, expression of thoughts, weakness, coordination, and headaches. These items are presented as statements on a scale ranging from 0?=?“not applicable” to 4?=?“extremely relevant.” The FACT-Br underwent validity as well as test-retest reliability testing with 101 and 46 patients, respectively. Validity testing found low to moderate correlation with the FACT-G questionnaire, while reliability testing for the brain subscale revealed an acceptable correlation coefficient (r?=?0.66; p?<?0.001).

Conclusions

The QLQ-BN20 and the FACT-Br are both valid and reliable tools that have been used extensively in the primary brain cancer population. Choice between the two tools should consider each instrument’s individual strengths and weaknesses.     

Diagnostic criteria of cancer cachexia: relation to quality of life, exercise capacity and survival in unselected palliative care patients

Purpose

Cachexia is associated with adverse outcomes. There is limited information on the impact of different diagnostic criteria of cachexia on patient centered outcomes.

Methods

We compared the prevalence of reduced quality of life (QoL), physical function and survival in palliative care cancer patients classified by different cachexia criteria. Four hundred and five patients with advanced cancer were included. Cachexia criteria were BMI, weight loss, fatigue, Karnofsky performance score, low handgrip strength, lean tissue depletion (DXA or arm muscle circumference) and abnormal biochemistry (inflammation, anemia or low serum albumin). QoL was assessed with a cancer specific questionnaire (EORTC QLQ-C30) and classified by cluster analysis. Dietary intake was obtained from a 4-day food record. Physical function was measured on a treadmill.

Results

Weight loss >2 %, BMI <20, fatigue and CRP >10 mg/L were associated with adverse QoL, function and symptoms (odds ratios: 2.1, 2.9, 4.0 and 3.1 respectively, P?<?0.05 for all). Fatigue, low grip strength and markers of systemic inflammation were associated with short walking distance (P?<?0.05). Weight loss?>?2 %, fatigue, CRP?>?10 mg/L and S-albumin?<?32 g/L were associated with shorter survival (hazard ratios: 1.4, 1.6, 2.2 and 2.0 respectively, P?<?0.05 for all). The prevalence of cachexia diagnosis varied from 12 to 85 % using different definitions.

Conclusions

Weight loss, fatigue and markers of systemic inflammation were most strongly and consistently associated with adverse QoL, reduced functional abilities, more symptoms and shorter survival. The prevalence of cachexia using different definitions varied widely; indicating a need to further explore and validate diagnostic criteria for cancer cachexia.     

Validation of the Chinese version of EORTC QLQ-BM22 in patients with bone metastases

Purpose

Our aim is to test the validity, reliability, and acceptability of the Chinese version of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Bone Metastases 22 (EORTC QLQ-BM22) module to assess health-related quality of life (HRQOL) in patients with bone metastases in China.

Methods

Patients with histological confirmation of malignancy and bone metastases from Tianjin Cancer Institution and Hospital from June 2013 to April 2014 were enrolled in this study. All patients self-administered the EORTC QLQ-BM22 and the EORTC QLQ-C30. The Karnofsky Performance Scale (KPS) was performed to evaluate scores. The reliability and validity tests of the questionnaires were based on Cronbach’s α coefficients, Pearson correlation test, and Wilcoxon rank sum nonparametric test.

Results

Internal consistency reliabilities of all the four scales were acceptable. Scales measuring similar HRQOL aspects were found to correlate with one another between EORTC QLQ-BM22 and EORTC QLQ-C30, but differences still existed. Significant differences were demonstrated in the scores of all four subscales of the QLQ-BM22 between the two KPS subgroups (KPS?≤?80; KPS?>?80). Meanwhile, the compliance for item completion of the QLQ-BM22 was satisfactory.

Conclusions

The Chinese version of EORTC QLQ-BM22 is a reliable and valid instrument, which is appropriate for measuring the HRQOL of patients with bone metastases in China.

     

A descriptive analysis of the relationship between quality of life and distress in individuals with head and neck cancer

Purpose

Both short- and long-term outcomes for individuals with head and neck cancer (HNCa) may be influenced by multiple factors. Identification of distress in those with HNCa may provide a critical dimension that influences quality of life (QoL). Consequently, this investigation assessed distress and QoL in those with HNCa.

Methods

This study utilized a cross-sectional, self-report survey design. Participants included 49 adults diagnosed with HNCa. Upon assessment, post-diagnosis time ranged between 3–12?months. All participants completed a validated distress screening measure, the Brief Symptom Inventory 18 (BSI-18), and the EORTC general QoL assessment tool (EORTC-QLQ-C30) and HNCa module (EORTC-QLQ-H&;N35).

Results

Approximately 22% of participants demonstrated clinically significant distress. Additionally, distress was significantly related to QoL status and specific symptoms.

Conclusions

Screening for distress in those with HNCa may permit early identification of problems that influence QoL outcomes. The ability to identify distress early may also facilitate timely intervention to reduce distress and optimize QoL.     

Changes in nutritional status, body composition, quality of life, and physical activity levels of cancer patients undergoing autologous peripheral blood stem cell transplantation

Purpose

This pilot exploratory study aimed to describe the changes in nutritional status, body composition, quality of life (QoL), and physical activity levels (PAL) of cancer patients undergoing high-dose conditioning and autologous peripheral blood stem cell transplantation (PBSCT) at pre-admission, hospital discharge, and at 100 days post-transplantation, and to examine if changes in these parameters are interrelated.

Methods

Twenty-four patients (56.2?±?12.9 years; 7 females, 17 males) were recruited from an Australian transplant center. Assessment was prospectively conducted at pre-admission, hospital discharge, and 100 days post-transplantation using the scored patient-generated subjective global assessment, air displacement plethysmography, EORTC QLQ-C30 (version 3), and the international physical activity questionnaire.

Results

At discharge, nutritional status deteriorated (patient-generated subjective global assessment (PG-SGA) median, +8.0; interquartile range, 6.0–13.0; p?<?0.001) and the number of malnourished patients increased (n?=?8/23; p?=?0.023). Patients experienced significant loss of lean body mass (LBM; ?2.2 kg, CI 95 % ?3.0, ?1.4; p?<?0.001), and decrease in QoL (?10.6, CI 95 % ?24.1, 2.9; p?=?0.117); the proportion of patients with high PAL decreased (p?=?0.012). By 100 days post-transplantation, all patients were well-nourished; however, LBM remained lower ?1.0 kg (CI 95 % ?1.9, ?0.1; p?=?0.028). Change in nutritional status (PG-SGA score) was associated with weight (r?=??0.46; p?=?0.039) and fat mass (r?=??0.57; p?=?0.013). Change in QoL was associated with nutritional reservoir (i.e., fat; r?=?0.54; p?=?0.024); QoL was consistently higher for patients with high PAL.

Conclusions

High-dose conditioning and autologous PBSCT is associated with deterioration in nutritional status, QoL and PAL, with LBM remaining below baseline levels at 100 days post-transplantation. A nutrition and exercise intervention program post-hospital discharge may be beneficial for these patients.     

A randomized controlled trial of a support group intervention on the quality of life and fatigue in women after primary treatment for early breast cancer

Background

When diagnosed with breast cancer, most women’s lives change as well as their perspectives on and appreciation of life. The aim of the present study was to evaluate whether psychosocial support intervention could influence health-related quality of life (HRQOL) and fatigue during the first year after diagnosis.

Material and methods

Of 382 patients with newly diagnosed breast cancer, 191 patients were randomized to an intervention group and 191 patients were randomized to a routine control group. The intervention group received support intervention that lasted 1?week on a residential basis, followed by 4?days of follow-up 2?months later. The support intervention included informative educational parts, relaxation training, mental visualization, and nonverbal communication. HRQOL was measured using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-BR23 questionnaires and fatigue with the Norwegian version of the fatigue scale at baseline and at 2, 6, and 12?months after intervention.

Result

There was a time-dependent improvement in both functional and symptom scales between baseline and 12?months as measured by the EORTC QLQ-C30 and BR23 questionnaires and there was a decrease in fatigue between baseline and after 2?months with further improvement up to 12?months in both groups, but there were no differences between the intervention and control groups at any point in time.

Conclusion

HRQOL improves and symptoms of fatigue decrease over time, but we could not see any additional effect from the rehabilitation program in this setting.