The quality of life of patients following treatment for laryngeal cancer

One hundred and twenty-nine patients have been interviewed 9 to 15 months following treatment for laryngeal cancer to determine the post treatment quality of voice and life. The patients were subdivided into 3 groups, successfully irradiated TI and T2 patients, (89 patients successfully irradiated T3 and T4 patients (24 patients) and those treated by surgery (16 patients). Ninety-three percent of TI and T2 patients and 79% of T3 and T4 patients are working following treatment as compared to 44% of the surgery patients. Ninety-eight percent of the T1 and T2 and 87.5% of the T3 and T4 patients were able to use the telephone normally as compared to 12% of the surgery patients. Similarly major differences between the successfully irradiated patients and the surgically treated patients in terms of ability to live a normal social life have been noted. The patients also rated their voice in terms of volume, pitch, ability to communicate, quality, rate of speech, flow of speech and dry throat. In every parameter of rating of the voice, with the exception of dryness of the throat, the successfully irradiated patients in all stage groupings had better ratings than the surgery group. Since, in Toronto, survival in advanced glottic and supraglottic cancer is the same using radical radiation with surgery in reserve as survival with primary surgery, it is concluded in view of the superior quality of voice and life in the successfully irradiated patients that irradiation with surgery in reserve is the optimal treatment for these patients. We also conclude that the measurement of quality of life in patients with cancer of the larynx is of vital importance in determining optimal treatment and that further studies in this area are indicated.     

Validation of the QUAL-EC for assessing quality of life in patients with advanced cancer

Objective

Improving quality of life is the main goal of palliative cancer care. However, there is a lack of measures validated specifically for advanced cancer. The purpose of this study was to validate the Quality of Life at the End of Life (QUAL-E) measure in a sample of patients with advanced cancer.

Methods

Data were analysed for 464 patients with advanced cancer who were participating in a randomised controlled trial of early palliative care intervention versus routine care. Patients completed the 26-item QUAL-E, the Functional Assessment of Cancer Therapy (FACT-G) quality of life measure and measures of spiritual well-being, performance status, symptom burden, satisfaction with care and communication with health care providers. We conducted a confirmatory factor analysis on the QUAL-E to test for the hypothesised four-factor structure and examined construct validity by calculating correlations with relevant scales.

Results

A 17-item reduced version of the QUAL-E, the QUAL-E-Cancer (QUAL-EC) achieved an acceptable fit to a four-factor model. Both the full and reduced versions of the QUAL-E were internally reliable and showed good construct validity. Symptom Control was correlated with other measures of physical functioning; Relationship with Healthcare Provider was correlated with satisfaction with care and better physician and nurse communication; Preparation for End of Life was strongly associated with emotional well-being; and Life Completion was strongly associated with social and spiritual well-being.

Conclusions

Due to its good factor structure and sound psychometrics, we recommend the reduced QUAL-EC scale to assess quality of life in patients with advanced cancer.     

家居止痛治疗对中晚期癌症患者生活质量影响的观察

目的通过对宁养院患者服务前后疼痛治疗效果、生活质量、一般状况的调查对比,探讨家居止痛治疗对中晚期癌症患者的最佳服务形式、服务效果,以期进一步提高癌症患者的生活质量.方法以定期上门探访、电话随访为主要服务形式,止痛治疗、心理舒缓、护理指导等为主要服务内容,为癌症患者提供较为完善的家居治疗.治疗前后调查其疼痛评分、生活质量、一般状况并进行对比.结果通过这一形式的家居止痛治疗,患者疼痛缓解率达94.4%(475/503),其中明显缓解至完全缓解达56.1%(279/503),98.2%(494/503)的患者生活质量得到不同程度改善,88.2%(444/503)的患者一般状况得到不同程度改善.结论家居止痛治疗能使绝大多数中晚期癌痛患者达到较满意的止痛效果,提高生活质量,可作为失去根治性治疗机会患者的主要治疗方式之一.     

Congruence of knowledge, experiences, and preferences for disclosure of diagnosis and prognosis between terminally-ill cancer patients and their family caregivers in Taiwan

Background. Over the last 40 years, studies have shown cultural differences in attitudes toward truth telling at the end-of-life. Nevertheless, the argument that cancer patients from an Asian culture have different preferences about information disclosure that necessitate significantly modifying information disclosure practices has not been validated by direct investigation from patients' points of view. Methods. Six hundred seventeen dyads of patient-designated family caregivers across 21 hospitals throughout Taiwan were surveyed and interviewed by a semistructured interview guide. Percentage of agreement, kappa coefficients, McNemar tests, and paired t-tests were conducted to examine the extent of congruence of knowledge, experiences, and preferences for disclosure of diagnosis and prognosis between the dyads. Results. There were substantial discrepancies in the knowledge and experiences of being informed about the diagnosis and prognosis between Taiwanese terminally-ill cancer patients and their family caregivers (kappa values ranged from 0.08 to 0.44). Cancer patients strongly proclaimed their superior rights to be informed about their disease over their family and preferred their physicians to inform themselves before releasing any information to their family caregivers. Conclusion. The arguments that cancer patients from an Asian culture (i.e., Chinese/Taiwanese culture) have different preferences regarding being informed of their diagnosis and prognosis and that family members have legitimate superior power in decision making could not be supported by data from this group of terminally-ill cancer patients. Physicians need to respect patients' preferences rather than routinely taking the family's opinions into consideration first in the event of disagreement. Equipped with adequate information, terminally-ill cancer patients from Asia may have better opportunities to make end-of-life care decisions that are in accord with their wishes.     

宫颈癌放疗后生活及性生活质量分析

目的 调查宫颈癌放疗患者生活质量、性生活质量及其影响因素。方法 本研究纳入2013-2018年间北京协和医院放疗科诊治的87例疗前未绝经宫颈癌患者,采用宫颈癌生活质量评估量表及女性性功能指标量表进行评估。收集患者人口学及治疗资料,采用多元线性回归分析其影响因素。结果 生活质量总分平均值为114(100~126),其中生理状况19(16~21)、社会家庭状况21(18~24)、情感状况19(17~21),功能状况19(14~22),附加关注状况39(34~43);放疗结束时间是影响总分(P=0.034)、生理状况(P=0)、功能状况(P=0.008)的因素,社会家庭状况是影响社会家庭维度的因素(P=0.010)。性生活总分平均值为8.0(5.0~20.5分),其中性欲望1.8(1.2~3.0)、性唤醒1.5(0~2.7)、阴道润滑0.3(0~3.6)、性高潮0(0~3.6)、满意度3.2(2.0~4.0)、性交痛0(0~3.6)。97%受调查者总分<27分(84/87),存在性功能障碍。年龄是影响性唤醒(P=0.005)、阴道润滑(P=0.039)的因素,职业是影响性交痛(P=0.004)的因素。结论 未绝经宫颈癌患者的生活质量受多因素影响,应积极处理放疗相关并发症以提高患者生活及性生活质量。     

调强放疗的肿瘤患者营养状况与生活质量相关性分析

目的探讨食管肿瘤与头颈部肿瘤患者在调强放疗期间营养状况和生活质量的相关性。方法选取2018年11月至2019年5月肿瘤放疗患者进行研究,采用NRS 2002和PG-SGA对患者进行营养评估,运用EORTC QLQ-C30进行生活质量测评,并分析两者之间相关性。结果41例患者中食管肿瘤23例,头颈部肿瘤18例,放疗后体重丢失35例,占85.36%,其中丢失≥5%体重患者19例,占46.34%,体重丢失>10%患者2例,占4.88%,平均丢失体重3.6kg。41例患者中合并骨髓抑制31例、低蛋白血症15例,电解质紊乱24例。放疗后,41例患者在总健康水平及功能方面得分均低于放疗前（P<0.05）,症状方面如疼痛、疲倦、食欲丧失等得分均高于放疗前（P<0.05）。总健康水平、躯体功能、疼痛和食欲丧失等方面与营养状况存在明显相关性（P<0.05）;而社会功能、情绪功能、气促和便秘与营养状况无明显相关性（P>0.05）。结论肿瘤患者在放疗期间的营养状况和生活质量存在相关性,应重视肿瘤放疗患者的营养评估及干预,改善患者躯体功能、疼痛、食欲等方面的生活质量,从而提高放疗效果。     

Impact of erythropoietin treatment on the quality of life of oncologic patients

Anaemia has a high incidence in cancer patients, especially when it is a consequence of myelosuppressive treatments. The incidence and prevalence of this condition is influenced by the type and extension of the tumour, type and intensity of the myelosuppressive treatment that patients receive, and previous surgery or intercurrent infections. Clinical manifestations of anaemia, overlapped by tumour symptomatology, depend on haemoglobin (Hb) levels; these manifestations cause impairment of the functional capacity, as well as a negative impact on the quality of life (QOL) of cancer patients as a consequence. Erythropoietin treatment for anaemia has been established as optimal for correcting Hb levels. Its impact on patients’ QOL has been evaluated in numerous randomised prospective studies by the use of diverse types of erythropoietin and administration moes. The three types of erythropoietin, alpha, beta and darbepoetin alpha, have shown a clear efficacy in all haematological parameters. This positive effect is related with significant improvements in the QOL of patients, especially those patients undergoing myelosuppressive treatments, and with regard to specific scales of fatigue and anaemia.     

Pretreatment factors significantly influence quality of life in cancer patients: a Radiation Therapy Oncology Group (RTOG) analysis

PURPOSE: The purpose of this analysis was to assess the impact of pretreatment factors on quality of life (QOL) in cancer patients. METHODS AND MATERIALS: Pretreatment QOL (via Functional Assessment of Cancer Therapy [FACT], version 2) was obtained in 1,428 patients in several prospective Radiation Therapy Oncology Group (RTOG) trials including nonmetastatic head-and-neck (n = 1139), esophageal (n = 174), lung (n = 51), rectal (n = 47), and prostate (n = 17) cancer patients. Clinically meaningful differences between groups were defined as a difference of 1 standard error of measurement (SEM). RESULTS: The mean FACT score for all patients was 86 (20.7-112) with SEM of 5.3. Statistically significant differences in QOL were observed based on age, race, Karnofsky Performance Status, marital status, education level, income level, and employment status, but not by gender or primary site. Using the SEM, there were clinically meaningful differences between patients /=65 years. Hispanics had worse QOL than whites. FACT increased linearly with higher Karnofsky Performance Status and income levels. Married patients (or live-in relationships) had a better QOL than single, divorced, or widowed patients. College graduates had better QOL than those with less education. CONCLUSION: Most pretreatment factors meaningfully influenced baseline QOL. The potentially devastating impact of a cancer diagnosis, particularly in young and minority patients, must be addressed.     

Quality of life in cancer patients with pain in Beijing

Objective:To investigate the quality of life(QOL) of cancer pain patients in Beijing,and explore the effect of cancer pain control on patients’ QOL.Methods:Self-developed demographic questionnaire,numeric rating scale and SF-36 questionnaire were used together among 643 cancer pain patients in 28 Grade 2nd to 3rd general hospitals and 2 Grade 3rd cancer hospitals.Results:The SF-36 eight dimensions scores ranged from 31.75 to 57.22 in these cancer pain patients.The t test and Wilcoxon rank sum test were used to compare the QOL between pain controlled(PC) group and pain uncontrolled(PUC) group,and the results showed that patients in PC group had the higher QOL scores in 6 areas of SF-36(P<0.05).Binary logistic regression results found that pain management satisfaction scores(P<0.001),family average personal monthly income(P=0.029),current receiving chemotherapy(P=0.009) and cancer stage(P<0.001) were the predictors to cancer pain controlled results.Conclusion: Cancer patients with pain in Beijing had poor QOL. Pain control will improve the QOL of cancer pain patients.     

Evaluation on quality of life for gynecologic cancer patients

Objective: To compare the quality of life (QOL) for gynecologic cancer patients with different cancer sites and to assess the impact of patients‘ characteristics,disease parameters, and treatments on the subscale and overall QOL. Methods: A prospective study was conducted including 146 gynecologic cancer patients.QOL data were collected using the general Functional Assessment of Cancer Therapy (FACT- G) QOL questionnaire. Results: Advanced stage patients showed significantly poor physical well-being, emotional well-being, and functional well-being, as compared with early stage patients. QOL was reported higher in older patients (P=0.03), patients above high school education(P=0.004), and patients with help at home (P=0.009).Conclusion: Patients with later stage, multi- modality therapy, poor education, and little social support have the most significant impairments and need moresupport.     

上海市社区肿瘤患者症状对生活质量影响的相关性分析

目的:了解上海市社区肿瘤患者中普遍存在的症状及其影响程度,分析这些症状与生活质量之间的相互关系,为有针对性的干预工作提供具体指导。方法:从上海市肿瘤登记系统的彭浦社区肿瘤患者中,采用随机抽样的方法,纳入200例现患病人,填写症状自评量表和FACT-G自评量表,采用相关性分析和回归分析方法进行统计分析。结果:症状因素与FACT-G量表社交家庭维度无明显相关性,与社区肿瘤患者FACT-G自评量表评分相关的主要症状因素为纳差、失眠、疲劳、疼痛和便秘。多元线性回归模型可以解释FACT-G自评量表评分13.2%的变化,可解释身体状况维度评分41.8%的变化,可解释情绪维度评分27.0%的变化,可解释功能状态维度评分4.2%的变化。结论:上海市社区肿瘤患者生活质量与纳差、疼痛、失眠等症状有关,可命名为"生活质量相关症候群"。重视对相关症候群的干预可能提高干预效果,改善患者的生活质量。     

Palliative partial pancreaticoduodenectomy impairs quality of life compared to bypass surgery in patients with advanced adenocarcinoma of the pancreatic head

Background

Some surgical centres consider palliative resection (PR) to be superior to double loop bypass (DLB) as treatment for advanced carcinoma of the pancreatic head. We performed a retrospective study with prospectively collected data at a single centre to compare PR and DLB in regard to quality of life (QoL).

Methods

From January 1996 to September 2008, 196 patients were given palliative surgery for advanced pancreatic cancer at the University Hospital of Kiel. Forty-two patients underwent PR and 154 underwent DLB. These groups were compared with regard to survival, post-operative morbidity, and QoL. The EORTC QLQ-C30 was used to assess QoL before surgery, at discharge, three months after surgery, and six months after surgery.

Results

The median survival time after PR was 7.5 months (95% CI: 4.95-10.05) and after DLB was 6 months (95% CI: 4.98-7.02; log rank test: p = 0.066). There were no significant differences in mortality and morbidity rates (7.1% and 45.2% for PR; 3.9% and 38.3% for DLB, respectively). Assessment of QoL indicated that patients who underwent PR had more impairment of some functional metrics and increased symptoms compared to those who underwent DLB.

Conclusion

There was no significant difference in survival or morbidity after PR and DLB, but patients who underwent DLB had better QoL than patients who underwent PR. Therefore, clinicians may want to reconsider the use of PR for patients with advanced pancreatic cancer.     

Influence of neoadjuvant radiochemotherapy combined with hyperthermia on the quality of life in rectum cancer patients

Purpose: The present study compares quality of life (QoL) after neoadjuvant radiochemotherapy with or without hyperthermia in patients with advanced rectal cancer.

Methods: Between April 1994 and May 1999, 137 patients were treated by neoadjuvant radiochemotherapy with (69 patients (50.4%)) or without (68 patients (49.6%)) hyperthermia. Forty-six patients (33.6%) filled-out a ‘Gastrointestinal Quality of Life Index’ (GIQLI) questionnaire at four time points (before and after neoadjuvant therapy, early after surgery and after long-term follow-up) and were included in the present study.

Results: There were no statistically significant differences in the global GIQLI index between patients treated with neoadjuvant radiochemotherapy with and without hyperthermia at any time point. The longitudinal analysis of GIQLI values in both treatment groups showed specific profiles that were identical in both treatment groups. Occurrence of severe toxicity during the neoadjuvant therapy in both arms lead to a significant temporary reduction of QoL scores at TP2 without any detrimental long-term effects. Patients with sphincter preservation and patients with sphincter resection reported similar QoL scores during long-term follow-up.

Conclusion: Neoadjuvant radiochemotherapy with and without hyperthermia has similar effects on the QoL of patients with locally advanced rectal cancer. The addition of hyperthermia during the neoadjuvant therapy with the potentially associated inconveniences has no negative effects on QoL.     

肺癌患者生活质量的影响因素

临床研究显示,多种因素都可影响肺癌患者的生活质量(QOL),生理因素有呼吸困难、癌因性疲乏等,抑郁、焦虑等心理因素起主要作用,社会和家庭支持对提高肺癌患者的QOL也很关键.     

综合护理干预对妇科恶性肿瘤术后化疗患者生活质量的影响

目的探讨综合护理干预对妇科恶性肿瘤术后化疗患者生活质量的影响。方法选取2011年10月至2013年10月间收治的妇科恶性肿瘤术后行化疗患者140例,随机分为观察组和对照组,每组70例。对照组患者采取常规护理,观察组患者在常规护理的同时给予综合护理干预,比较两组患者的满意度评价、总不良反应发生情况、生理指标情况以及生活质量评定量表(QLQC30)评分。结果实施综合护理干预后,观察组患者的满意度为84.3%,明显高于对照组的61.4%,差异有统计学意义(P<0.05)。观察组患者恶心呕吐、便秘、腹泻、乏力、脱发等5种不良反应严重程度低于对照组,差异有统计学意义(P<0.05)。观察组患者的生理指标情况显著优于对照组,差异有统计学意义(P<0.05)。观察组患者QLQ-C30评分除躯体功能与经济困难两项指标差异不明显外,其余指标均显著高于对照组,差异有统计学意义(P<0.05)。结论对妇科恶性肿瘤术后化疗患者进行综合护理干预后,患者功能和生活质量有所改善,值得临床广泛推广使用。     

胃癌患者术后近期生活质量现状及相关因素分析

目的 探讨胃癌患者行根治性切除术后近期生活质量及相关因素分析.方法 选取2018年11月至2019年6月间中国医学科学院肿瘤医院收治的129例行胃癌根治手术治疗的患者,术前采用主观整体营养状况评估量表(PG-SGA)评估患者营养状态,围手术期实行标准术前、术后及出院护理流程,于术后3个月随访患者体质量及生活质量,并分析...     

榄香烯对复发性卵巢癌腹腔积液患者疗效及生命质量的影响

目的：探讨榄香烯对复发性卵巢癌伴腹腔积液患者的治疗效果及其对化疗后生命质量的影响。方法选择2013年8月—2015年7月青岛市黄岛区中医医院收治的上皮性卵巢癌术后复发伴腹腔积液患者64例,采用随机数字表法将其分为对照组（n ＝32）和观察组（n ＝32）,观察组应用榄香烯联合顺铂腹腔灌注化疗,对照组应用顺铂腹腔灌注化疗。比较两组间治疗效果及患者生命质量的差异。结果对照组完全缓解（CR）10例,部分缓解（PR）13例,病情稳定（SD）6例,疾病进展（PD）3例,总有效率（ORR）为71．88％;观察组 CR 19例,PR 9例,SD 3例,PD 1例,ORR 为87．50％,两组疗效差异有统计学意义（Z ＝－2．312,P ＝0．021）。观察组与对照组化疗后躯体功能（61．66±9．27∶51．66±15．73;t ＝－3．102,P ＝0．003）、角色功能（59．89±13．29∶45．83±19．40;t ＝－3．383,P ＝0．001）、情绪功能（49．73±11．29∶30．72±13．45;t ＝－6．120,P ＝0．000）、认知功能（62．50±13．39∶50．00±19．40;t ＝－3．000,P ＝0．004）、总健康状况（54．69±10．99∶42．97±14．98;t ＝－3．568,P ＝0．001）、疲倦症状（38．53±13．23∶47．57±19．39;t ＝2．175,P ＝0．033）、恶心呕吐症状（19．27±4．77∶36．45±12．29;t ＝5．483,P ＝0．000）及失眠症状（23．95±10．77∶38．54±11．46;t ＝2．216,P ＝0．030）的评分差异具有统计学意义。观察组与对照组化疗后社会功能（37．50±17．96∶36．97±16．79;t ＝－0．120,P ＝0．905）、疼痛症状（23．43±9．58∶22．92±9．19;t ＝－0．118,P ＝0．906）、呼吸困难症状（19．79±6．49∶16．67±5．74;t ＝－0．606,P ＝0．547）、食欲减退症状（63．54±25．90∶66．67±18．93;t ＝0．551,P ＝0．584）、便秘症状（27．08±10．59∶23．96±9．14;t ＝－0．545,P ＝0．588）、腹泻症状（63．54±25．90∶66．67±18．93;t ＝0．551,P ＝0．584）及经济困难（60．41±21．03∶65．62±29．91;t ＝0．683,P ＝0．497）的评分差异无统计学意义。结论榄香烯联合顺铂腹腔灌注化疗对于复发性卵巢癌伴腹腔积液患者有更好的疗效,并且有可能进一步改善患者的生命质量,值得深入研究和推广应用。