Health-related quality of life among disease-free stomach cancer survivors in Korea

Previous studies about the quality of life (QOL) in stomach cancer survivors focused on selected clinical parameters and did not consider the broader implications for overall health and QOL. We evaluated the impact of demographic and treatment-related factors on the QOL of stomach cancer survivors. We asked 391 stage I–III stomach cancer survivors who had been disease-free for at least 1 year after surgery to complete a demographic questionnaire, the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire, and its stomach module, QLQ-STO22. Survivors undergoing total gastrectomy reported greater eating restrictions than those undergoing subtotal gastrectomy. Receiving chemotherapy or radiotherapy did not significantly affect any QLQ-C30 or QLQ-STO22 scores. Role and emotional functioning improved with increasing age, and stomach-specific symptoms (pain, eating restrictions, and anxiety) lessened. Compared with female survivors, male survivors had better physical and role functioning. Smoking status was also a significant negative predictor of physical functioning and anxiety. Comorbidities and selected demographic characteristics had a greater effect than type of treatment on the QOL of post-operative stomach cancer patients. Notes: Drs Jae-Moon Bae and Sung Kim contributed equally to this work as first authors. An erratum to this article can be found at     

Measuring health related quality of life among women living with HIV

Although women had been under recognized in the literature on HIV/AIDS, increasing numbers of studies have focused on the lives and experiences of women living with HIV/AIDS. Areas of research in which the study of women and HIV continues to be noticeably lacking include health related quality of life (HRQOL). This paper describes HRQOL in an inner city sample of 287 HIV positive non-pregnant women, interviewed as part of a larger multi-site CDC funded study of the reproductive health of women. The average age of the respondents was 33 years and women had known their HIV status an average of 41 months. HRQOL was assessed using a 17-item modified version of the Medical Outcomes Study-HIV Health Survey and demonstrated acceptable internal consistency (0.64-0.89) and variability. Women in our study were similar to other HIV-positive female samples and reported lower levels of well-being and functioning than some HIV-positive male samples. Women's responses to individual items and areas of potential need for health care are discussed. Examination of HRQOL in women with HIV can aid in the comparison of how women and men are affected by HIV and can help health care professionals identify needed services and include possible interventions to promote quality of life. This revised version was published online in June 2006 with corrections to the Cover Date.     

心理社会干预对肺癌患者生活质量影响的Meta分析

目的 系统评价心理社会干预对肺癌患者生活质量的影响。方法 计算机检索多个中英文数据库,收集关于心理社会干预对肺癌患者生活质量影响的临床随机对照试验,采用RevMan5.3.0和Stata12.0软件进行数据分析。结果 共纳入11项临床随机对照研究。心理社会干预组在干预结束后即刻〔SMD = 0.33, 95%CI (0.16, 0.51), P = 0.0001 〕和3个月以内〔SMD = 0.30, 95%CI (0.01, 0.59), P = 0.04〕的总体生活质量评分优于对照组,而在3个月以后,2组无统计学差异（P＞0.05）。在功能方面,心理社会干预在提高患者的躯体功能〔MD = 0.30, 95%CI (0.16, 0.43), P＜0.0001〕上有显著作用;而在情绪、认知、角色和社会功能方面,2组无统计学差异（P＞0.05）。结论 采用心理社会干预,有利于肺癌患者在干预后短期内（≤3个月）生活质量的改善,尤其是在躯体功能方面,而心理社会干预在3个月以后的效果尚不能确定,有待临床开展大样本、设计严谨的临床随机对照研究进一步证实。     

Factors influencing quality of life in breast cancer survivors

Longitudinal data from 195 breast cancer survivors were used to identify factors affecting the level and rate of change in quality of life after completion of treatment. Women were interviewed up to four times at approximately yearly intervals using Kaplan and Bush's Quality of Well Being instrument (QWB). Random coefficient regression analysis was used to model QWB as a function of time since diagnosis and personal characteristics. QWB scores decreased over time and the rate of decline increased with age (p = 0.032). This was similar to declines in women with benign breast biopsies, but overall QWB levels were lower in women with breast cancer. Having a spouse tended to slow the rate of decline in breast cancer survivors (p = 0.004). The presence of comorbidity was associated with significantly lower QWB levels (p = 0.037) but did not affect the rate of change over time. Education, family history of breast cancer, cancer stage and treatment modalities were not significantly related to QWB levels or rates of change. Breast cancer survivors experience a reduction in quality of life that persists for years after treatment and is similar in magnitude to that associated with other health problems.     

The WHO quality of life assessment instrument (WHOQOL-Bref): The importance of its items for cross-cultural research

One of the fundamental issues in the area of assessment of quality of life is to determine what is important to the individuals' quality of life. This is even more crucial when the instrument is for use in diverse cultural settings. This paper reports on the importance ratings on WHOQOL-Bref items obtained as a part of WHOQOL pilot field trial on 4804 respondents from 15 centres from 14 developed and developing countries using 12 languages. All items were rated as moderately or more important, but this was expected because the items were selected by extensive qualitative research for their salience across the centres. Significant differences on mean importance ratings were found between centres, but rank orders of item for their importance showed highly significant correlations between centres. This was especially true for items in the top and the bottom thirds of the item list arranged by overall importance. Most items were rated as more important by women compared to men and by younger compared to older persons. The results are discussed for their relevance in cross-cultural research on quality of life assessment. This revised version was published online in June 2006 with corrections to the Cover Date.     

Measurement of the quality of life in cancer survivors

A QOL instrument was developed to measure the specific concerns of long term cancer survivors. The QOL-CS is based on previous versions of the QOL instrument developed by researchers at the City of Hope National Medical Centre (Grant, Padilla, and Ferrell). This instrument was revised over a one year pilot by Hassey-Dow and Ferrell. The revised instrument included 41 items representing the four domains of quality of life incorporating physical, psychological, social, and spiritual well being. The present study was conducted as a mail survey to the membership (n=1,200) of the National Coalition for Cancer Survivorship with 686 subjects responding to the survey. This survey included a Demographic tool, QOL-CS and the FACT-G tool developed by Cella. Psychometric analysis, performed on 686 respondents, included measures of reliability and validity. Two measures of reliability included test-retest and internal consistency. The overall QOL-CS tool test-retest reliability was 0.89 with subscales of Physicalr=0.88, Psychologicalr=0.88, Socialr=0.81, and Spiritual,r=0.90. The second measure of reliability was computation of internal consistency using Cronbach's coefficient as a measure of agreement between items and subscales. Analysis revealed an overallr=0.93. Subscale alphas average ranged fromr=0.71 for spiritual well being,r=0.77 for physical,r=0.81 for social, andr=0.89 for psychological.Several measures of validity were used to determine the extent to which the instrument measured the concept of QOL in cancer survivors. The first method of content validity was based on a panel of QOL researchers and nurses with expertise in oncology. The second measure used stepwise multiple regression to determine factors most predictive of overall QOL in cancer survivors. Seventeen variables were found to be statistically significant accounting for 91% of the variance in overall QOL. The fourth measure of validity used Pearson's correlations to estimate the relationships between the subscales of QOL-CS and the subscales of the established FACT-G tool. There was moderate to strong correlation between associated subscales including QOL-CS physical to FACT physical (r=0.74), QOL-CS Psych to FACT Emotional (r=0.65), QOL Social to FACT Social (r=0.44). The overall QOL-CS correlation with the FACT-G was 0.78. Additional measures of validity included correlations of indimeasures of validity included correlations of individual items of the QOL-CS tool, factor analysis, and construct validity discriminating known groups of cancer survivors. Findings demonstrated that the QOL-CS and its subscales adequately measured QOL in this growing population of cancer survivors.     

以腹膜延长阴道提高年轻宫颈癌患者术后生活质量的临床研究

目的:探讨年轻宫颈癌患者采用腹膜延长阴道的临床意义和术后放疗对性功能的影响;方法:选择2007年以来住院年龄<45岁资料完整、随访可靠的宫颈癌患者73例分为两组,研究组41例行宫颈癌根治术加一侧或双侧卵巢移位加以腹膜延长阴道术,术前、术后3、6、12个月测性激素;对照组32例行宫颈癌根治术,或加一侧或双侧卵巢移位。两组术后高危因素者均行辅助放疗。结果:研究组术后测量阴道长度较对照组长,差异有统计学意义(P<0.01);放疗后阴道较放疗前缩短,但仍较对照组长,差异有统计学意义(P<0.01);研究组术后性生活满意度优于对照组。研究组15例行放疗,放疗后测FSH、LH明显升高,与放疗前差异有统计学意义(P<0.01),提示放疗后卵巢衰竭明显;未行放疗者卵巢功能无明显变化。结论:年轻宫颈癌患者采用腹膜延长阴道明显提高术后性生活质量,但术后行放疗是影响性功能的不利因素。     

Testing the structural and cross-cultural validity of the KIDSCREEN-27 quality of life questionnaire

Objectives

The aim of this study is to assess the structural and cross-cultural validity of the KIDSCREEN-27 questionnaire.

Methods

The 27-item version of the KIDSCREEN instrument was derived from a longer 52-item version and was administered to young people aged 8–18 years in 13 European countries in a cross-sectional survey. Structural and cross-cultural validity were tested using multitrait multi-item analysis, exploratory and confirmatory factor analysis, and Rasch analyses. Zumbo’s logistic regression method was applied to assess differential item functioning (DIF) across countries. Reliability was assessed using Cronbach’s alpha.

Results

Responses were obtained from n = 22,827 respondents (response rate 68.9%). For the combined sample from all countries, exploratory factor analysis with procrustean rotations revealed a five-factor structure which explained 56.9% of the variance. Confirmatory factor analysis indicated an acceptable model fit (RMSEA = 0.068, CFI = 0.960). The unidimensionality of all dimensions was confirmed (INFIT: 0.81–1.15). Differential item functioning (DIF) results across the 13 countries showed that 5 items presented uniform DIF whereas 10 displayed non-uniform DIF. Reliability was acceptable (Cronbach’s α = 0.78–0.84 for individual dimensions).

Conclusions

There was substantial evidence for the cross-cultural equivalence of the KIDSCREEN-27 across the countries studied and the factor structure was highly replicable in individual countries. Further research is needed to correct scores based on DIF results. The KIDSCREEN-27 is a new short and promising tool for use in clinical and epidemiological studies.     

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.     

Influence of exercise activity on quality of life in long-term breast cancer survivors

Background: Behavioral and lifestyle factors may influence quality of life (QOL) outcomes in breast cancer survivors. Methods: Information on QOL (Short Form-36, SF-36), lifestyle and survivorship was collected during telephone interviews with 374 breast cancer patients, diagnosed between 1983 and 1988 at ages 40 years or younger and interviewed, on average 13.2 years following diagnosis. These women previously participated in a case-control study soon after their diagnoses, providing information on breast cancer risk factors including exercise activity. We examined the impact of changes in exercise activity (comparing pre- to post-diagnosis levels) on the SF-36 mental and physical health summary scales using regression analyses. Results: A positive change in exercise activity was associated with a higher score on the SF-36 physical health summary scale at follow-up (p= 0.005). Change in exercise activity was not associated with the SF-36 mental health summary scale score. Patients who increased their activity levels did not differ from those who did not in terms of medical or demographic characteristics. Conclusion: This study provides one of the longest follow-up periods of breast cancer survivors to date among studies that focus on QOL and is unique in its focus on women diagnosed at a young age. Our results confirm high levels of functioning and well-being among long-term survivors and indicate that women whose exercise activity increased following diagnosis score higher on the SF-36 physical health summary scale. These findings suggest a potential role for exercise activity in maintaining well-being after a cancer diagnosis.     

基于QLICP-CE（V2.0）量表的宫颈癌患者生命质量及其与临床客观指标的典型相关分析

目的 分析宫颈癌患者生命质量与临床客观指标之间的关系。方法 采用癌症患者生命质量测定量表体系之宫颈癌量表（QLICP-CEV2.0）对186名宫颈癌患者进行调查,采用典型相关分析来研究生命质量得分与其临床客观指标之间的关系。结果 乳腺癌患者生命质量标准得分分别为:总量表（59.97±14.27）,躯体功能领域（55.01±14.85）,心理功能领域（55.55±16.61）,社会功能领域（60.32±14.63）,共性症状与副作用领域（64.76±21.03）,特异模块领域（63.87±24.48）。典型相关分析显示有5对典型变量,其典型相关系数分别为r1=0.419、r2=0.401、r3=0.332、r4=0.292、r5=0.206,前四对P<0.05,前两对典型变量可解释60.742%的信息量。结论 铁、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶/丙氨酸氨基转移酶、乳酸脱氢酶、中性粒细胞百分率、淋巴细胞百分率、单核细胞百分率、白/球蛋白与患者的生命质量具有较高的相关性,临床医生治疗时应予以重视,并综合多方面因素提高宫颈癌患者的生命质量。     

宫颈浸润癌患者术后性生活质量调查分析

目的:调查宫颈浸润癌术后患者性生活质量的变化及影响因素。方法:对2003年1月～2010年1月深圳市人民医院87例经手术治疗的宫颈浸润癌患者进行问卷调查,生存质量量表应用欧洲癌症研究和治疗机构的生存质量量表C30(EORTC QLQ-C30),结果应用t检验,方差分析及逐步回归分析。结果:宫颈癌患者治疗后性生活质量明显下降,影响患者性生活质量的因素包括:年龄、治疗方式、家庭经济、从业状况、文化程度(P<0.05)。结论:宫颈癌患者性生活质量受多因素影响,正确的健康教育有助于患者术后性生活的恢复。     

Measuring quality of life of persons with spinal cord injury: Substantive and structural validation

The purpose of this study was to evaluate the substantive and structural validity of an existing measure of quality of life (QOL), the spinal cord injury (SCI) version of the Ferrans and Powers quality of life index (QLI). To evaluate substantive validity, 11 individuals with a SCI participated in ‘think aloud’ interviews to determine meaningfulness of the QLI items and to identify areas requiring modification. Free sort and ranking exercises of the items were used to evaluate the structural validity of the domains and scoring rubric. Content analysis of the interview comments resulted in the addition of two items and wording revision to three items. The free sort exercise revealed that the domains as perceived by the participants differed somewhat from those of the test developer. The contribution of the satisfaction and importance sections proposed by the scoring model was not completely supported by the data from the ranking exercise. It is concluded that the modified version of the QLI reflects the perspectives of persons with SCI spinal cord injury as represented by the participants of this study. The structural validity evaluation has implications for the use of domain subscores and weighted vs. section scores. Further evaluation of the modified version is necessary before widespread use with this patient population. This revised version was published online in June 2006 with corrections to the Cover Date.     

Personal accounts of exercise and quality of life from the perspective of breast cancer survivors

Objectives The purpose of the study was to examine breast cancer survivors’ perceptions of exercise and their quality of life (QoL). Methods About 289 breast cancer survivors completed a survey addressing exercise attitudes, behaviour and perceived QoL. In addition, the breast cancer survivors completed two open-ended questions designed to explore perceptions of exercise and QoL throughout their cancer experience. Inductive and deductive content analyses were used to analyse responses. Results About 19 first-order themes were identified, which were clustered into five second-order themes that included; Exercise behaviour, Lifestyle, Limitations and barriers, Growth and priorities, and Personal beliefs and values. The findings identified a framework of multifaceted views held by breast cancer survivors in relation to their QoL and outlook on their disease. Conclusions Given that cancer survivors are faced with a number of treatment related morbidities 2 years post-diagnosis, there is a need for health professionals to carefully address a cancer survivor’s exercise needs in an attempt to help improve their future QoL.     

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.     

老年胃癌患者术后近期生存质量的研究

[目的]评估胃癌患者术后生存质量并探讨年龄对生存质量的影响。[方法]将135例胃癌患者随机分为老年组(≥ 60岁)和非老年组(<60岁),于确诊并行胃癌根治术后7 d用生存质量问卷(EORTC QLQ-C30)比较其差异。[结果]老年组术后住院时间长于非老年组(P<0.05);术后肺部感染和伤口感染的发生率高于非老年组(P<0.05)。QLQ-C30评分,功能子量表的躯体功能得分老年组低于非老年组(P<0.05);角色功能、情绪功能得分老年组高于非老年组(P<0.05)。症状子量表中的疼痛症状得分老年组低于非老年组(P<0.05)。其他测量项目的睡眠困难得分老年组高于非老年组(P<0.05)。总体健康子量表得分老年组高于非老年组(P<0.05)。[结论]老年胃癌患者术后生存质量总体上较非老年患者更高,但在躯体功能、睡眠等方面生存质量较低,应在围手术期采取针对性的措施。     

乳腺癌患者心理应对调节与生活质量相关分析

目的了解乳腺癌患者心理调节、应对方式与生活质量之间的相关性。方法采用病例对照研究方法,于2008年8月-2010年8月选择广东省广州市3家三级甲等医院确诊的女性乳腺癌患者进行调查,采用Pearson相关分析方法分析患者心理调节、应对方式及生活质量三者间相关性。结果病例组生活质量的"躯体良好和能力"与应对的"发泄"、"幻想"均呈负相关(P<0.05),生活质量的"心理良好"与应对的"幻想"、"回避与压抑"均呈负相关(P<0.05);对照组生活质量的"社会良好"与应对的"发泄"、 "幻想"、"屈服"均呈负相关(P<0.05),生活质量的"社会良好"与应对的"回避与压抑"呈正相关(r=0.259,P<0.05),生活质量的"心理良好"与应对的"屈服"呈正相关(r=0.268,P<0.05)。结论不同病程的乳腺癌患者采取不同的应对方式,长期存活者更倾向于积极乐观的应对调节。