The Use of Herbal Therapy to Improve the Quality of Life among Cancer Patients in the Southern Region of Peninsular Malaysia

Objective: To investigate the impact of herbal therapy on the quality of life (QoL) among cancer patients and to evaluate the relationship of QoL with age, gender, cancer stage, cancer type, and history of conventional treatment.Methodology: A prospective study was targeted on cancer patients receiving herbal therapy from a Traditional and Complementary Medicine (T&CM) clinic in a public hospital from 1st January 2016 to 31st August 2018. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTCQLQ-C30) was distributed to the patients prior to herbal therapy (baseline) and after the sixth and twelfth week of herbal therapy. Socio-demographic and clinical data were collected and analyzed using SPSS version 16. Results: The majority of the patients were females (60.0%) and were from the Chinese ethnic group (77.4%) with a mean age of 58.72 ± 12.17 years. Approximately 42.4% of patients were in advanced cancer stages at the time of study and 60.7% of patients had undergone radiotherapy before receiving herbal therapy. The most commonly prescribed herbs were Bai Hua She She Cao (90.6%) and Zhen Ren Huo Ming Yin (57.6%). Significant differences in mean score were observed in global health status, overall functional scales, and symptom scales after the sixth and twelfth week of receiving herbal therapy. QoL in terms of global health status and overall functional scales improved with higher scores while symptom scales recorded a lower score after twelve weeks of receiving herbal therapy in the T&CM clinic. Herbal therapy has a significant effect (p < 0.05) on the improvement of QoL of cancer patients. However, gender, cancer stage, cancer type, age, history of radiotherapy, and history of chemotherapy has no effect (p > 0.05). Conclusion: Herbal therapy did improve the QoL of cancer patients in the southern region of Peninsular Malaysia.     

Assessment of Quality of Life in Patients with Colorectal Cancer in Kazakhstan

Background: The problem of quality of life (QOL) of patients with colorectal cancer (CRC) is particularly relevant due to the dynamics of CRC incidence growth. This study aims to assess QOL of patients with CRC in the Republic of Kazakhstan in order to give an idea about the impact of burden on QOL of patients. Methods: A total of 319 patients diagnosed with CRC participated in this one-stage cross-sectional study. The survey was conducted between November 2021 and June 2022 at cancer centers in Kazakhstan.  Data were collected using the valid and reliable European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30, version 3.0). Results: The average age of respondents was 59, 23 (SD=10,604) years. The main age group 50-69 years old accounted for 62.1% of the total sample. Among all ill respondents, 153 (48%) were male and 166 (52%) were female. The mean global health status was 59.24 ± 22.62. Two of the five functional scales were below the ≥66.7% threshold, namely, emotional functioning 61.65 (28.04) and social functioning 61.96 (31.84); while scores for the other three were: physical functioning 69.38 (22.06), role functioning 69.69 (26.45), and cognitive functioning 74.60 (25.07). Conclusions: This study gives an indication of good life functioning among our participants on the functional and symptom scales. However, they reported inadequate global health status.     

Quality of Life by Stage of Cervical Cancer among Malaysian Patients

Stage of cervical cancer may adversely affect the quality of life (QOL) among patients. The objective of this study was to predict the QOL among cervical cancer patients by the stage of their cancer. A cross-sectional study from September 2012 until January 2013 was conducted among cervical cancer patients who completed treatment. All patients completed a interviewer-guided questionnaire comprising four sections: (A) sociodemographic data, (B) medical history, (C) QOL measured by general health status questionnaire (QLQ-30) and (D) cervical cancer specific module CX-24 (EORTC) was used to measured patient’s functional, symptom scale and their global health status. Results showed that global health status, emotional functioning and pain score were higher in stage III cervical cancer patients while role functioning was higher in stage I cervical cancer patients. Patients with stage IV cancer have a lower mean score in global health status (adjusted b-22.0, 95 CI% -35.6, -8.49) and emotional functioning (adjusted b -22.5, 95CI% -38.1, -6.69) while stage III had lower meanscore in role functioning (adjusted b -14.3, 95CI% -25.4, -3.21) but higher mean score in pain (adjusted b 22.1, 95 CI% 8.56, 35.7). In conclusion, stage III and IV cervical cancers mainly affect the QOL of cervical cancer patients. Focus should be given to these subgroups to help in improving the QOL.     

Quality of life and Its Determinants among Cervical Cancer Patients in South India

Introduction: Cervical Cancer is the leading cause of morbidity and mortality in India. It affects the patient’s, physical and psychological state which results in lower quality of life (QoL). Women with cervical cancer may require counselling and time to enable them to deal with the disease and its treatment. The present study aimed to determine the quality of life and its determinants among cervical cancer patients. Methods: A cross-sectional study was undertaken from April 2017 to September 2017 in a regional cancer centre in South India. Cervical cancer patients (N= 210) with histological confirmation were interviewed at the hospital. European Organization of Research and Treatment of Cancer (EORTC) questionnaire core module, QLQ-C30 Version 3.0, and recommended scoring algorithm were used to measure and analyse QoL. The Association of socio-economic determinants on quality of life was evaluated using multiple logistic regression. Results: Among 210 cervical cancer patients enrolled, the majority 106 (50.5%) of women were between the age group 46 to 59 years and most, i.e.  167(63.0%) were not literate. The median score in the global health status was 50.0[IQR 33.3 – 66.7], 66.7[IQR 60.0 – 80.0] in physical functioning, and 83.3[IQR 66.7 – 83.3] in pain symptoms respectively which were poor compared to reference score of EORTC for all normal females and those with any cancer. The factors which were significantly associated with the GHS QoL score were the advanced stage of disease (OR:2.1, 95%CI: 1.1 – 3.9) and the age of the patients ≥60 years compared with ≤ 45 years (OR:18.4, 95%CI: 6.8 – 50.1). Conclusion: Cervical cancer patients had poor global health status compared to the reference score for all females with any cancer and the normal females. Advanced stage of cancer and older age have a significant association with QoL.     

Quality of Life after Accelerated Partial Breast Irradiation in Early Breast Cancer: Matched Pair Analysis with Protracted Whole Breast Radiotherapy

AimsTo compare the quality of life of women with early breast cancer treated with either accelerated partial breast irradiation (APBI) or whole breast radiotherapy (WBRT).Materials and methodsAfter matching for the American Brachytherapy Society criteria, the general European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the breast cancer-specific BR23 modules were given to 48 women (23 APBI and 25 WBRT) who attended the radiotherapy clinic between May 2006 and December 2006 at Tata Memorial Hospital.ResultsThe median follow-up of patients in both groups was 3 years. The reliability and validity of the English and translated versions of the questionnaires were tested by Cronbach alpha (0.67–0.96) and Pearson's correlation for scale–scale correlation statistic (0.013–0.505). The scores for social functioning and financial difficulties in QLQ-C30 showed a trend towards a better outcome in the APBI group (P = 0.025 and 0.019, respectively) and body image in BR23 was significantly better in the APBI group as compared with the WBRT group (P = 0.005). When the analysis was restricted to women receiving chemotherapy in order to eliminate the confounding effect of the heterogeneous use of chemotherapy in the WBRT group, the difference in social functioning was not significant. However, financial difficulties and body image showed a trend towards a worse outcome in the WBRT group.ConclusionFavourable long-term results of APBI in terms of superior body image perception and lesser financial difficulties compared with WBRT need to be confirmed in larger prospective studies investigating the effect of APBI on quality of life and health economics in different ethnic groups and health care set-ups.     

Quality of Life in Breast Cancer Patients - A Quantile Regression Analysis

Background: Quality of life study has an important role in health care especially in chronic diseases, inclinical judgment and in medical resources supplying. Statistical tools like linear regression are widely used toassess the predictors of quality of life. But when the response is not normal the results are misleading. The aimof this study is to determine the predictors of quality of life in breast cancer patients, using quantile regressionmodel and compare to linear regression. Methods: A cross-sectional study conducted on 119 breast cancer patientsthat admitted and treated in chemotherapy ward of Namazi hospital in Shiraz. We used QLQ-C30 questionnaireto assessment quality of life in these patients. A quantile regression was employed to assess the assocciatedfactors and the results were compared to linear regression. All analysis carried out using SAS. Results: Themean score for the global health status for breast cancer patients was 64.92±11.42. Linear regression showedthat only grade of tumor, occupational status, menopausal status, financial difficulties and dyspnea werestatistically significant. In spite of linear regression, financial difficulties was not significant in quantile regressionanalysis for and dyspnea was only significant for first quartile. Also emotion functioning and duration of diseasewere statistically predicted QOL's score in third quartile. Conclusion: The results have demonstrated that usingquantile regression leads to better interpretation and richer inference about predictors of breast cancer patient'squality of life.     

Effect of a Pedometer-based Exercise Program on Cancer Related Fatigue and Quality of Life amongst Patients with Breast Cancer Receiving Chemotherapy

Background: Breast cancer is the most common cancer amongst Indian women. Cancer treatments leads to various side effects out of which Cancer-Related fatigue (CRF) is one of the most under-addressed side-effects. It is experienced the most in patients receiving chemotherapy. Exercise has been proven to be a beneficial intervention to manage CRF but the benefits of pedometer-based exercise programs is under-studied in patients with breast cancer. Hence, we set out to investigate the effects of a pedometer-based exercise program for patients with breast receiving chemotherapy. Methods: The current study was a non-randomized controlled trial with 22 patients each in exercise and control group. The exercise group received a pedometer-based walking program, whereas the control group received standard physical activity advice. Fatigue, quality of life, functional capacity and body composition were assessed at baseline, 3rd week and 7th week. Results: At the end of 7 weeks intervention, functional capacity, quality of life and skeletal mass were found to have improved with statistical significance, while the fatigue and changes in total fat did improve but were not statistically significant. Conclusion: A 7-week pedometer-based exercise program improved functional capacity, quality of life and percentage of skeletal mass and also shows to have prevented deterioration in fatigue levels in patients with breast cancer receiving chemotherapy.     

Validation of the Turkish Versions of EORTC QLQ-C30 and BR23 Modules in Breast Cancer Patients

Purpose: To test the validity and reliability of The European Organization for Research and Treatment ofCancer (EORTC) core (QLQ-C30) and breast cancer module (QLQ-BR23) for Turkish breast cancer patients.Patients and Methods: A total of 127 patients treated with radiotherapy (RT) enrolled to this prospective study.EORTC QLQ-C30 and QLQ-BR23 modules applied to patients before initiation of RT and at follow-up period.Statistical analyses were performed by SPSS 13.0. Results: Questionnaires’ were found reliable and valid forTurkish breast cancer patients. Six of the 8 multi-item scales of QLQ-C30 had a high reliability (Cronbach’s α>0.7); where physical functioning and pain scores were less reliable (Cronbach’s α of 0.66 and 0.68 respectively).In the QLQ-BR23, 3 of 5 multi-item scales were reliable; less reliable were breast and arm symptoms scale(Cronbach’s α of 0.65 and 0.61 respectively). In our analysis the most determinative subscales of QLQ-C30on global health was emotional functioning followed by fatigue, role functioning and appetite loss (respectivelyp=0.002, p=0.01; p=0.03 and p=0.08). Among QLQ-BR23 scales systemic therapy side effects, future perspectiveand upset by hair loss subscales had high impact on global health status (respectively p=0.006; p=0.01 and p=0.03).Conclusions: The Turkish version of EORTC QLQ-C30 and QLQ-BR23 modules are reliable and valid tools toassess quality of life of Turkish breast cancer patients.     

The Azeri Version of European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30): Translation and Validation

Objective: Quality of life in cancer patients has become an important outcome measure. This study aimed to translate and validate the European Cancer Research and Treatment Core Quality of Life Questionnaire (EORTC QLQ-C30) in Azerbaijan. Methods: Forward-backward procedure was applied to translate the EORTC QLQ-C30 from English into Azeri. Then a cross sectional study was conducted to validate the questionnaire in Azerbaijan. A sample of patients with confirmed diagnosis of oral cancer completed the Azeri version of the questionnaire from January 2017 to December 2018. Construct validity was assessed by performing know groups comparison and item-scale correlation matrix. Reliability was examined by estimating the Cronbach’s alpha coefficient for internal consistency. Results: In all 141 patients with oral cancer participated in the study. Known groups comparison indicated that the Azeri version of EORTC QLQ-C30 well differentiated between patients who differed in the disease stage. Those with higher stage reported lower functioning and higher symptoms. In addition item-scale correlation matrix showed a good correlation between items and its own hypothesized subscales as expected (Pearson correlation coefficient ranging from 0.735-0.978). The Cronbach’s alpha coefficient ranged form 0.68 to 0.94 indicating acceptable results for the internal consistency of the questionnaire. Conclusion: This preliminary validation study proved that the Azeri version of EORTC QLQ-C30 is a valid measure of quality of life in cancer patients. However, studies with other cancer patients and stronger psychometric evaluations are recommended.     

The Impact of Chemotherapy on the Quality of Life of Breast Cancer Patients

One hundred and thirty-seven breast cancer patients, 102 receiving adjuvant chemotherapy and 35 receiving palliative chemotherapy for metastatic disease underwent a 37-item quality-of-life questionnaire to evaluate the impact of disease and treatment on physical, psychological and social well being. Patient groups were designated as follows — Adj CT: patients undergoing the questionnaire during their adjuvant chemotherapy program; Post Adj CT: patients evaluated 3 to 8 months after termination of adjuvant chemotherapy; Mts CT: patients assessed during palliative chemotherapy for metastatic disease, and Post Mts CT: patients 3 to 8 months after termination of palliative chemotherapy. Physical and social activities were reported as unaltered or normal by 64 to 70% and 52 to 67% of patients, respectively. Psychological status was judged normal by 39 to 45% of patients. No significant differences were observed between the patient groups. In 83 to 90% of cases the patient normally took care of herself. In 62 to 87% of cases time dedicated to recreational activities was reported as unaltered. The majority of patients (84%) judged that their relationship with partner and/or family were good. Severe anxiety was reported in 19 to 28% of patients and severe depression was infrequent (3.9%). Information regarding disease and treatment given by health professionals was considered satisfactory by 80 to 100% of patients. This pilot experience indicates that the majority of breast cancer patients respond normally to the stresses of both adjuvant and palliative chemotherapy; quality of life does not appear to improve 3-8 months after termination of chemotherapy; family support is good in the majority of cases and that a subset of patients with severe anxiety who could benefit from pharmacological and/or psychological intervention can be identified.     

Assessing the Quality of Life in Breast Cancer Women: A Cross Sectional Descriptive Study

Background: To assess the quality of life in Iraqi breast cancer women with regard to different Sociodemographic and medical variables. Methods: A cross sectional study was conducted on 150 women diagnosed with breast cancer and being treated in Iraq. The evaluation was done by using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire- Core- 30 (EORTC QLQ-C30) and QOL_BR23 Questionnaire. All data were conducted directly via hand writing by the patients at the Oncology Teaching Hospital/Medical City complex in Baghdad. When the questionnaire questions were completed by each participant, they were checked up to ensure their suitability for data insertion and then followed by the scoring manual of the EORTC questionnaire. All the data were analyzed by using SPSS. Results: Most of the patients undergoing this study were at the age of ≤ 50 (52.66%), and when they were diagnosed with breast cancer, they were younger than 50 (58.66%). The global health status was high in the case of working participants compared with those who are unemployed, i.e., (p=0.035). However, the emotional status appeared to be significant in the case with the working participants (P= 0.027). Also, the global status appeared to be high in the participants receiving radiation, while it showed insignificant values with the other data. The physical functioning, on the other hand, showed significant results in many places, as in the case with the patients present with no health problems, and high results in radiation, herceptin and hormonal therapy. As for the role functioning, it showed significant results in patients without health problems, patients who underwent radiation, and patients who were free of disease for less than five yeas. Conclusions: The results of this study will help identify gaps in all areas in which patients need additional support. Since the negative effects of the disease and related treatments influenced the patient’s quality of life, it has become necessary for health care providers to focus on designing social and psychological interventions to support cancer patients throughout their illness and treatment in a way that it leads to a better adaptation to their disease and improve their emotional status.     

Quality of life assessment and research in the EORTC (European Organisation for Research and Treatment of Cancer)

Abstract: Quality of Life (QOL) assessment and research within the European Organisation for Research and Treatment of Cancer (EORTC) has become increasingly important over the past 25 years, starting already in 1979 with the founding of the EORTC Quality of Life Group (EORTC QLG), and QOL has become part of many cancer clinical trial protocols in different ways. This paper briefly presents an overview of QOL within the EORTC, the development of the QLQ-C30 instrument, the construction of specific modules, issues of cross-cultural validation and translation, and the various other activities of the QLG and the Data Centre Quality of Life Unit (QLU). The article also includes key findings from selected QOL studies published by the EORTC, highlighting this large international clinical trial organisation’s contribution to this field of oncology. Qualité de vie     

Quality of Life in Patients with Gynecological Cancers: A Web-Based Study

Introduction: Gynecological cancers are common in adult women. One of the most important goals in the management of these patients is to improve quality of life, along with survival as a traditional outcome. The aim of this study was to evaluate quality of life in gynecological cancers in Iran. Methods: This cross-sectional study was performed on a sample of patients with gynecological cancers including uterine, ovarian, cervical, and vulvovaginal attending a teaching hospital affiliated to Tehran University of Medical Sciences between 2014 and 2019. The data was collected by a web-based platform with validated self-administered questionnaires including demographic information, the EORTC QLQ-C30 and the Hospital Anxiety and Depression (HADS). The data were analyzed using appropriate tests. Results: In all 251 patients were studied. The mean age of patients was 52.8±12.4 years and 43% had uterine, 30% had ovarian, 25% had cervical, and 2% had vulvovaginal cancer. The mean global quality of life score as measured by the EORTC QLQ-C30 was 59.8 ± 24.9. Women with ovarian cancer had the highest and women with cervical cancer had the lowest global quality of life score. There were significant differences in emotional, cognitive and global quality of life by cancer diagnosis (p <0.05). Although not significant, overall physical, role, cognitive and social functioning was found to be better in women who had been treated with surgery. The mean anxiety and depression score were 8.7± 5.0 and 7.1 ± 5.2, respectively. Conclusion: The results demonstrated that patients with gynecological cancers had a low quality of life, and experience higher anxiety and depression.     

Factors Predictive of Quality of Life among Breast Cancer Patients

Background: Due to progress in medical care, the number of survivors from cancer has increased significantlyduring recent years and this raises the question of the quality of life (QoL), especially of the many women treatedfor a breast cancer. This paper focuses on correlations of QoL with anxiety and depression on the one hand and withsocio demographic, anatomo-clinical and therapeutic parameters on the other. Methods: In this cross-sectional study,seventy patients were enrolled and filled in two auto-questionnaires, both in validated Arabic versions: The SF-36 forassessment of QoL and the Hospital Anxiety and Depression Scale (HAD-S) for evaluation of anxiety and depression.The statistical approaches used to determine predictive factors were bivariate correlations to determine relationshipsbetween quantitative variables, and T-tests and one-way Anova to analyze links between qualitative and quantitativevariables. Results: The QoL of patients was altered with an SF-36 mean total score of 54.0 ± 22.7, and the alterationaffects the different aspects. The mean scores for anxiety and depression in patients were 6.91 ± 4.72 and 6.24 ± 3.88,respectively. The results of this study suggested an association between the QoL and chemotherapy (p= 0.014) and itsadverse effects (p=0.01), as well as anxiety (p= 0.0001) and depressive symptoms (p= 0.0001). Socio-demographicfactors, the stage of the cancer, and surgery, radiotherapy or hormone therapy did not appear to have significanteffects. Conclusion: The management of breast cancer patients needs a collaborative approach between oncologists,gynecologists, psychologist and psychiatrists.     

乳腺癌患者化疗后抗抑郁治疗对患者生活质量及其免疫功能的影响

目的观察乳腺癌患者化疗后抗抑郁治疗对患者生活质量及其免疫功能的影响。方法选择80例乳腺癌化疗后伴抑郁的患者作为研究对象,随机分为试验组和对照组,每组40例。对照组术后不给予抗抑郁药物治疗,试验组给予帕罗西汀。比较2组患者汉密尔顿抑郁量表(HAMD)评分情况,比较2组患者生活质量评分情况,检测2组患者免疫功能。结果2组患者HAMD评分治疗前比较,无明显差异(P>0.05)。试验组治疗后HAMD评分较治疗前降低,差异有统计学意义(P<0.05)。治疗后,试验组HAMD评分较对照组降低,差异有统计学意义(P<0.05)。生活质量调查表结果表明,试验组治疗后躯体功能、角色功能、情绪功能评分、疲乏、疼痛、失眠、食欲减退方面评分大于对照组,差异有统计学差异(P<0.05);试验组整体生活质量评分(63.22±1.78)高于对照组(43.22±1.73),差异有统计学意义(P<0.05)。治疗后,试验组患者CD_3^+T细胞、CD_4^+T细胞、IgG、IgA、IgM均明显高于对照组,差异有统计学意义(P<0.05);治疗后,2组患者CD_8^+T细胞水平差异无统计学意义(P>0.05)。结论乳腺癌化疗后伴抑郁的患者采取帕罗西汀抗抑郁治疗的疗效显著,同时还可改善患者生活质量和免疫功能,值得临床推广。     

甲孕酮合并化疗改善晚期肺癌患者的生活质量

目的 :观察患者服用甲孕酮后改善化疗所致的厌食、体重下降、ECOG下降、骨髓抑制及胃肠道反应的作用 ,同时观察甲孕酮对晚期癌症的止痛作用及促进蛋白同化作用。方法 :130例接受化疗的晚期肺癌患者 ,采用单盲随机分成单用化疗组及化疗 甲孕酮组。结果 :在化疗 甲孕酮组治疗的160个周期中有43 1 %食量增加 ;45%体重增长 ;平均每周期体重增加0 74±1 56kg;血浆白蛋白升高1 2±2 9g/L ;88 1 %疼痛减轻及28 1 ?OG改善。化疗的毒副作用按WHO抗癌药物急性毒性分级标准 ,出现Ⅱ度以上的白细胞下降33 8%、血红蛋白下降15 6 %及胃肠道反应18 1 % ,平均恢复时间分别为6 4±4 6天、5 3±4 1天及1 89±1 2天。以上各项指标与单用化疗组相比均有显著性差异。结论 :甲孕酮如能正确合理地用于晚期癌症的治疗 ,可以全面改善化疗期癌症患者的生活质量     

Quality of Life among Breast Cancer Patients Undergoing Treatment in National Cancer Centers in Nepal

Purpose: To study the quality of life and to identify associated factors among breast cancer patients undergoingtreatment in national cancer centers in Nepal. Materials and Methods: One hundred breast cancer patients wereselected and interviewed using a structured questionnaire. European Organization of Research and Treatmentof Cancer EORTC-QLQ-C30 and EORTC-QLQ-BR23 were used to assess quality of life and modified MedicalOutcome Study -Social Support survey(mMOS-SS) was used to assess social support. Only multi-item scales ofEORTC C30 and BR23 were analyzed for relationships. Independent sample T-tests and ANOVA were appliedto analyze differences in mean scores. Results: The score of global health status/quality of life (GHS/GQoL) wasmarginally above average (mean=52.8). The worst performed scales in C-30 were emotional and social functionwhile best performed scales were physical and role function. In BR-23, most of the patients fell into the problematicgroup regarding sexual function and enjoyment. Almost 90% had financial difficulties. Symptom scales did notdemonstrate many problems. Older individuals, patients with stage I breast cancer and thosewith good socialsupport were found to have good GHS/GQoL. Of all the influencing factors, social support was established tohave strong statistical associations with most of the functional scales: GHS/GQoL (0.003), emotional function(<0.001), cognitive function (0.020), social function (<0.001) and body image function (0.011). Body image wassignificantly associated with most of the influencing factors: monthly family income (0.003), type of treatment(<0.001), type of surgery (<0.001), stage of cancer (0.017) and social support (0.011). Conclusions: Strategies toimprove social support of the patients undergoing treatment should be given priority and financial difficultiesfaced by breast cancer patients should be well addressed from a policy making level by initiating health financingsystem.