Quality of life among chronic myeloid leukemia patients in the second-line treatment with nilotinib and influential factors

Quality of Life Research - This study aims to evaluate the quality of life (QoL) of chronic myeloid leukemia (CML) patients prescribed with nilotinib as a second-line therapy and explores the...     

干预管理对慢性阻塞性肺疾病患者生存质量的影响

目的 探讨干预管理对慢性阻塞性肺疾病（COPD）患者生存质量的影响.方法 门诊或病房收治的COPD患者90例,按照就诊顺序随机分为管理组和对照组,对照组给予常规治疗,管理组在常规治疗的基础上纳入管理,为每位患者建立个人健康档案,进行COPD防治知识讲座、戒烟宣传教育、呼吸功能锻炼、用药指导、心理疏导,时间为6个月,测定2组患者入选前后吸炯率、6分钟步行距离（6MWD/m）、圣乔治呼吸问题调查问卷（SGRQ）评分变化.结果 6个月后管理组吸烟率较对照组下降（x2=4.464,P＜0.05）,管理组戒烟率较对照组增高（x2=9.119,P＜0.05）.随访6个月后对照组6MWD/m为（318.7±70.6）m,与入选时相比差异无统计学意义（t=4.84,P=0.024）;管理组6 MWD/m为（372.0±76.3）m,较健康教育管理前增加（t=-7.14,P=0.00）.管理组6个月后呼吸症状、活动受限、疾病影响及SGRQ总评分（45.3±18.1）、（36.8±23.1）、（34.5±21.4）、（40.5±21.3）均较管理前（62.1±21.8）、（53.9±19.7）、（48.6±20.3）、（53.7±18.6）下降（t=6.15、5.18、4.70、5.07,均P＜0.05）;对照组6个月后呼吸症状、活动受限、疾病影响及SGRQ总评分与入选时比较,差异无统计学意义（t=-2.03、-1.24、-4.17、-2.95,均P＞0.05）.结论 对COPD患者干预管理可以降低患者吸烟率、增强患者运动耐力,提高患者生存质量.     

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.     

健康教育对慢性肾脏病患者生活质量影响的临床观察

目的：探讨健康教育对慢性肾脏病患者生活质量的作用。方法：选取119例患者，病人入院后由责任医师和护士对其和家属进行相关健康教育，每周评价一次，使病人能够正确地认识这种疾病，树立战胜疾病的信心。结果：通过健康教育，患者心理障碍减少，健康信念增强，生活满意度提高。结论：对慢性肾脏病患者实施健康教育可以提高患者的生活质量。     

四川省广元地区慢性粒细胞白血病患者治疗情况及生活质量分析

目的 探讨四川省广元地区慢性粒细胞白血病（CML）患者的治疗情况及生活质量,为该类患者的临床治疗及健康管理提供依据。方法 采用便利抽样的方法对2015—2018 年在广元市中心医院、广元市中医院和广元市肿瘤医院复诊的CML患者进行调查。采用临床资料调查表和白血病生活质量评估量表对患者进行问卷调查,采用单、多因素分析方法对患者生活质量的影响因素进行分析。结果 本研究共纳入CML患者185例,平均年龄（41.62 ± 15.47）岁,男性和女性分别为98（占52.97%）、87例（占47.03%）。185例患者中治疗药物为伊马替尼的94例（占50.81%）、干扰素-α联合阿糖胞苷57例（占30.81%）、羟基脲单药34例（占18.38%）。CML患者总体生活质量评分为（122.47 ± 14.43）分,得分率为（65.37 ± 6.25）%,在各维度评分中社会/家庭维度得分率最高,为（76.35 ± 5.17）%,功能模块维度得分率最低,为（55.87 ± 5.48）%。多元线性回归分析结果显示,年龄越小、无伴随疾病、有医疗保险、家庭人均月收入越高、血红蛋白数值高、红细胞计数高、治疗药物为伊马替尼的CML患者其生活质量较高（标准偏回归系数分别为0.358、0.765、0.546、0.456、0.469、0.462、0.486）。结论 四川广元地区CML患者生活质量不高,临床治疗以伊马替尼治疗、干扰素-α联合阿糖胞苷和羟基脲为主,可通过多种方式提高患者的生命质量。     

基于EQ - 5D效用积分体系的慢性病患者健康相关生命质量研究

目的 分析慢性病患者健康相关生命质量及其影响因素。方法 利用2018年江苏省第六次卫生服务调查数据,该调查采用多阶段分层整群随机抽样的方法,选择15岁及以上患慢性病的居民为研究对象（3 646人）,基于EQ - 5D健康效用值,利用秩和检验、Tobit回归研究慢性病患者健康相关生命质量的影响因素。结果 58.06%的慢性病患者在EQ - 5D各维度没有任何困难;城市、已婚或其他婚姻状况、文化程度提高、家庭人均年收入增加、BMI升高、参加健康体检、进行体育锻炼是健康的保护因素（OR＜1）,年龄增长是健康的危险因素（OR＞1）。结论 慢性病患者健康相关生命质量较低,提高慢性病患者收入水平、文化程度并改善其健康行为对于提高这类人群的生命质量具有重要意义。     

Treatment of chronic myeloid leukemia with interferon-alpha

The authors have treated 38 patients with chronic phase chronic myeloid leukemia in their single center in the last five years. Conventional chemotherapy provided about 40-50% hematological response, interferon-alpha seems to be more effective, complete hematological remission occurred in 65%. Interphase cytogenetics and fluorescein in situ hybridisation technique was used to measure the cytogenetic response. They observed complete cytogenetic remission in two cases (8%), major response in 11 (39%), minor response in 4 (15%) and minimal response in 4 cases (15%). Interferon-alpha is an effective, well-tolerated medicine in the treatment of chronic myeloid leukemia.     

Health related quality of life in patients with anogenital warts

Background

Pain is strongly related to poor quality of life. We performed a cross-sectional study in a universitary hospital to investigate quality of life in women suffering from chronic pelvic pain (CPP) due to endometriosis and others conditions.

Methods

Fifty-seven patients aged between 25 and 48 years-old submitted to laparoscopy because of CPP were evaluated for quality of life and depressive symptoms. Quality of life was accessed by a quality of life instrument [World Health Organization Quality of Life Assessment-Bref (WHOQOL-bref)]. Causes of pelvic pain were determined and severity of CPP was measured with a visual analogue scale. According to the intensity of pelvic pain score, patients were classified in two groups (group Low CPP < 25th percentile visual analogue scale and group High CPP > 25th percentile). Four dimensions on quality of life were measured (physical, psychological, social and environmental). We stratified the analysis of quality of life according CPP causes (presence or not of endometriosis in laparoscopy).

Results

Patients with higher pain scores presented lower quality of life status in psychological and environmental dimensions. We found a negative correlation between pain scores and psychological dimension of quality of life (r = -0.310, P = .02). Quality of life scores were similar between groups with and without endometriosis (physical 54.2 ± 12.8 and 51.1 ± 13.8, P = 0.504; psychological 56.2 ± 14.4 and 62.8 ± 12.4, P = 0.182; social 55.6 ± 18.2 and 62.1 ± 19.1, P = 0.325; environmental 59.2 ± 11.7 61.2 ± 10.8, P = 0.608; respectively)

Conclusions

Higher pain scores are correlated to lower quality of life; however the fact of having endometriosis in addition to CPP does not have an additional impact upon the quality of life.     

50例慢性粒细胞白血病慢性期患者随访8年预后评价

目的 随访慢性粒细胞白血病(CML)患者,了解患者长期生存状况.方法 通过多种形式的健康教育、病友联谊会、心理护理、预约复诊、电话回访等综合干预,对选择不同治疗方法的50例慢性粒细胞白血病慢性期患者进行随访,定期监测血象、骨髓象、融合基因(BCR/ABL)、Ph染色体.结果 随访8年(2004年1月1日～2011年12月31日),长期生存470 (94％),其中生存期8～9年25例(50％),10～15年17例(34％),18年2例(4％),21～24年3例(6％),死亡3例(6％),无失访.随访结束47例长期生存患者骨髓象缓解44例(93.61％),融合基因(BCR/ABL)未检出42例(89.36％)、Ph染色体阴性45例(95.74％).结论 对选择不同治疗方法的CML慢性期患者进行综合干预,提高患者复诊率、延长生存期有明显效果.     

Subjective quality of life in patients with chronic fatigue syndrome

The aim of this study was to (1) assess Subjective Quality of Life (SQOL) of patients with Chronic Fatigue Syndrome (CFS) using a generic concept and to compare the findings with those in groups with mental disorders and healthy subjects, and (2) investigate whether and, if so, to what extent socio-demographic and clinical variables predict SQOL in CFS patients. Seventy-three patients diagnosed with CFS were randomly selected and interviewed from two specialised clinics. CFS was diagnosed using the Oxford Criteria. SQOL was assessed on the Manchester Short Assessment of Quality of Life (MANSA) and Health-Related Quality of Life (HRQOL) on the Medical Outcome Study Short-Form 36 (MOS) SF-36. A battery of mood and symptom questionnaires, including the Symptom Checklist Questionnaire (SCL-90-R), was administered to assess various aspects of symptomatology as potential predictor variables. Multiple regression analyses were conducted to identify predictors of SQOL. Overall, SQOL was low in CFS patients and less favourable than in groups with mental disorders and healthy subjects. Satisfaction was particularly low with life as a whole, leisure activities and financial situation. Whilst SQOL was only moderately correlated with HRQOL, the SCL-90-R score, especially SCL-90-R Depression scale score, was the best predictor of SQOL explaining 35% of the variance. HRQOL and generic SQOL appear distinct despite some overlap. The findings underline that SQOL is significantly disrupted in CFS patients. Depressive symptoms are statistically the strongest ‘predictor’ of SQOL, although the direction of the relationship is not established. These data suggest that treatment of depression associated with CFS, regardless of causation, could help to improve SQOL in CFS patients.     

Health-related quality of life and utility scores in short-term survivors of pediatric acute lymphoblastic leukemia

Purpose

Increase of survival in pediatric acute lymphoblastic leukemia (ALL) has made outcomes such as health-related quality of life (HRQL) and economic burden more important. To make informed decisions on the use of healthcare resources, costs as well as utilities need to be taken into account. Among the preference-based HRQL instruments, the Health Utilities Index (HUI) is the most employed in pediatric cancer. Information on utility scores during ALL treatment and in long-term survivors is available, but utility scores in short-term survivors are lacking. This study assesses utility scores, health state, and HRQL in short-term (6 months to 4 years) ALL survivors.

Methods

Cross-sectional single-center cohort study of short-term ALL survivors using HUI3 proxy assessments.

Results

Thirty-three survivors (median 1.5 years off treatment) reported 14 unique health states. The majority of survivors (61 %) enjoyed a perfect health, but 21 % had three affected attributes. Overall, HRQL was nonsignificantly lower compared to the norm, although the difference was large and may be clinically relevant. Cognition was significantly impaired (p = 0.03).

Conclusion

Although 61 % of short-term survivors of ALL report no impairment, the health status of the other patients lead to a clinically important impaired HRQL compared to norms. Prospective studies assessing utility scores associated with pediatric ALL should be performed, enabling valid and reliable cost-utility analyses for policy makers to make informed decisions.     

Health related quality of life in pregeriatric patients with chronic diseases at urban,public supported clinics

Background  

Understanding health-related quality of life (HRQOL) leads to more effective and focused healthcare. America's growing health disparities makes it is increasingly necessary to understand the HRQOL of pregeriatric individuals who are now 55–64 years old, i.e. before they are eligible for federally mandated health care at age 65. Our study measured the self-perceived HRQOL of pregeriatric, poor patients with multiple chronic diseases treated at 2 public clinics.     

Imatinib therapy in chronic myeloid leukemia

Chronic myeloid leukemia is a malignant clonal alteration of the pluripotent hemopoietic stem cell. The genetic hallmarks of the disease are the t(9,22) (Philadelphia chromosome), registered by conventional cytogenetics in more than 90% of all chronic myeloid leukemia cases and the active tyrosine kinase protein encoded by bcr-abl fusion gene. The constitutively active tyrosine kinase is currently accepted to be the cause of chronic myeloid leukemia. The introduction of imatinib has considerably changed the treatment of chronic myeloid leukemia. Prior studies demonstrated high rates of cytogenetic responses in all phases of the disease. METHODS: The authors evaluated the cytogenetic and molecular responses of 21 chronic phase chronic myeloid leukemia patients who were consecutively admitted to their center. 13 of them were primarily treated with imatinib, and the other 7 were heavily pretreated with interferon alfa, cytarabine, all-trans-retinoic acid. Hydroxiurea pretreatment was routinely introduced in all patients until complete hematologic remission. Peripheral blood sample in every 3 months were collected for quantitative real-time polimerase chain reaction, and bone marrow aspirate in every 6 months for conventional cytogenetics. Results: Hematologic remission could have been achieved with hydroxiurea pretreatment in each patient. Complete cytogenetic remission at the 6th month and major molecular response at the 12th month were observed in each patient. CONCLUSIONS: Imatinib treatment caused complete cytogenetic response and major molecular response in each chronic phase chronic myeloid leukaemia patient in our group. Hydroxiurea might have some effect on the rapid and deep cytogenetic and molecular responses, observed in the primary imatinib-treated group.     

Treatment and quality of life in patients with chronic obstructive pulmonary disease

Treatments administered to patients with chronic obstructive pulmonary disease (COPD), especially when used in multiple combinations, are not free of interactions and side effects that can potentially impair health-related quality of life (HRQL). We studied HRQL and its relationship with treatment in a group of 441 patients with stage II or III COPD (age: 66.6 (SD: 8.3) years; FEV1: 32.4% (SD: 8.1%)) using the St George's Respiratory Questionnaire (SGRQ) and the 12-item short form (SF-12) Health Survey. The most prescribed drugs were ipratropium bromide (87.5%), inhaled corticosteroids (69.4%) and short-acting -2 agonists (64.9%). Patients with stage III of the disease were receiving more drugs, particularly short-acting -2 agonists (p = 0.002) and inhaled corticosteroids (p = 0.031). The use of theophyllines was associated with a worse total SGRQ score ( = 4.49; p < 0.001), although this negative association decreased with advanced age. A trend towards worse SGRQ scores was observed with the use of high doses of long-acting -2 agonists ( = 3.22; p = 0.072). Patients receiving three drugs or more presented worse total SGRQ scores than patients receiving fewer drugs ( = 6.1, p < 0.001; and = 7.64, p < 0.001, respectively). These findings suggest that the use of multiple drugs in the treatment of patients with COPD is associated with worse total SGRQ scores. The effect of drugs, their dosages and associations with other drugs on HRQL merit further research.     

General life satisfaction and domain-specific quality of life in chronic schizophrenic patients

Subjective quality of life (QOL) has often been assessed through questionnaires or structured interviews focusing on the person's satisfaction with various life domains. In particular, most QOL instruments for psychiatric patients are based on this concept. We report on a study casting some doubts on the rationale of this approach. We investigated the QOL of 48 chronic schizophrenic outpatients with a long-term disease history (at least 20 years) using a German version of the Lancashire QOL Profile. The interrelations between general life satisfaction, satisfaction with specific life domains, psychological well-being and psychopathology were studied using correlation analysis and multiple linear regression. Of the life domains assessed, only two, namely social relations and health, contributed significantly to the patients' general life satisfaction, while the others (including work, leisure, family relations and housing) did not. The subscales on psychological well-being (self-esteem, affective state) as well as psychopathology were found to be more closely associated with general life satisfaction than almost all life domains considered. The findings are discussed with regard to the specific situation of the group of patients investigated. They give indications that the life domain approach to measuring QOL has its limitations, in particular when applied to patients having adapted to a very restricted everyday life.     

Which health-related quality of life score? A comparison of alternative utility measures in patients with Type 2 diabetes in the ADVANCE trial

Background  

Diabetes has a high burden of illness both in life years lost and in disability through related co-morbidities. Accurate assessment of the non-mortality burden requires appropriate health-related quality of life and summary utility measures of which there are several contenders. The study aimed to measure the impact of diabetes on various health-related quality of life domains, and compare several summary utility measures.