Curvilinear relationships between resource allocation and life domain‐specific interference

This study investigated the inherent complexities of the work‐life interface (WLI) by examining the relationship between resource allocation (i.e., time and energy dedicated to a particular domain) and perceived interference of individual life domains. Much of the research on the WLI is based on the assumption that a linear pattern best describes the relationship between resource allocation and the interference caused by various life domains; however, this study examined the possibility that curvilinear relationships may be a more appropriate representation. Results indicated that resource allocation is a meaningful predictor of interference, and for many life domains a curvilinear relationship accounts for more variance than a linear one; a breakdown of the sample also revealed this relationship varies by gender. Overall, findings suggest that the nature of the WLI is more individualized and complex than is currently conceptualized in the field.     

Prophylactic nipple‐sparing mastectomy in young previvors: Examining decision‐making,reconstructive outcomes,and patient satisfaction in BRCA+ patients under 30

Bilateral prophylactic mastectomies (BPM) in young previvors with high‐risk mutations are rising; however, little data on management, therapy timing, and outcomes exist. BRCA+ patients under 30 undergoing BPM from 2006 to 2018 were reviewed. Twenty‐two patients aged 23‐29 underwent mastectomy 4.2 years after genetic diagnosis. Twelve patients completed surveys, most often citing personal decisions (50%) for undergoing mastectomy and plastic surgeons’ recommendations (83.3%) for reconstruction. About 73% of patients completely understood risks/benefits of mastectomy and 63.6% of reconstruction. Patients reported high BREAST‐Q Satisfaction and Well‐Being scores. Continued educational resource development will optimize shared decision‐making in the reconstructive process.     

Accuracy of life tables in predicting overall survival in patients after radical prostatectomy

OBJECTIVE

To test the accuracy of life tables (LT), the standard tool for predicting life‐expectancy (LE), but the accuracy of which is unknown in patients with prostate cancer, where the 10‐year LE is a widely accepted threshold for the delivery of definitive therapy.

PATIENTS AND METHODS

We tested the accuracy of predictions of LE from LT in 9678 men treated with radical prostatectomy (RP) for prostate cancer. The predictions of LE from LT at 10 years after RP were compared to Kaplan Meier‐derived 10‐year survival values. Moreover, the accuracy of LT predictions was quantified in a Cox‐regression using Harrell’s concordance index. To control for the effect of prostate cancer mortality, analyses were repeated in a subset of 5955 patients with no evidence of disease recurrence. Additional stratification schemes were applied to control for age and comorbidity.

RESULTS

At RP, the median age was 64 years, the median Charlson Comorbidity Index (CCI) was 1 and the median LT‐derived LE was 16 years. The median actuarial survival was not reached (mean 12.4 years). In the whole group the LT‐predicted 10‐year survival was 96.8%, vs an observed of 75.3%. In men with no disease recurrence the LT‐predicted survival was 97.3%, vs 81.1% observed. After age and CCI stratification, LT overestimated the 10‐year survival the most in those aged 65–69 years and in patients with CCI scores of >2.

CONCLUSION

The overestimation of LE can lead to overtreatment of prostate cancer, especially in those men who die early from other causes.     

Impact of dysphagia on quality-of-life in nasopharyngeal carcinoma

BACKGROUND: Little is known about dysphagia or quality of life (QOL) in patients treated for nasopharyngeal carcinoma (NPC). The aim of this study was to determine the impact of dysphagia on QOL in patients treated for NPC as measured by two standard tools, the University of Washington Quality-of-Life Questionnaire(1) (UW-QOL) and the Swallow Quality-of-Life Questionnaire(3) (SWAL-QOL). METHODS: This is a cross-sectional survey of 59 consecutive disease-free survivors of NPC attending the head and neck cancer clinic at the National University Hospital, Singapore. The UW-QOL and SWAL-QOL underwent minor modification and were translated into Mandarin. A linear regression analysis was performed to identify significant predictors of health-related QOL. RESULTS: Fifty-one patients (86%) responded; of these, 43 had self-reported swallowing difficulties. On the UW-QOL, respondents indicated the three most important issues to be swallowing (59%), hearing (45%), and saliva/dry mouth (41%). Respondents with swallowing difficulty reported a lower UW-QOL composite score (p = .002) and a lower health-related QOL score (HR-QOL) than those without swallowing difficulty (p = .004). Self-reported swallowing difficulty predicted a lower HR-QOL score (p = .004). A longer time since treatment predicted a better score in HR-QOL (p = .024). A lower score in fatigue predicted a lower HR-QOL score (p = .001). CONCLUSIONS: Swallowing difficulties negatively impact QOL. It is recommended that future QOL studies aimed specifically at swallowing function in NPC use a swallowing specific questionnaire (eg, SWAL-QOL) in addition to a head and neck-specific measure. Further research is needed to look at the adaptation and usefulness of swallowing-specific QOL surveys for use with people treated for NPC.     

The institution of a Multi‐disciplinary Italian Breast Unit: Reflections of the first psychosocial research study results on distress and quality of life

Breast cancer affects patients both emotionally and physically. It is time to consider distress as the sixth vital sign in breast cancer patients in Europe. Between 2012 and 2015, our EUSOMA‐certified multi‐disciplinary group conducted a study on emotional distress and quality‐of‐life in breast cancer patients at diagnosis, and observed their trend over the first 8 months of treatment. One hundred and forty‐nine patients concluded the program. The psycho‐oncologist and the breast nurses gave out SF36, Hospital Anxiety and Depression Scale and Distress Thermometer. Our Italian data go along with the reported literature on distress and quality‐of‐life. Despite modern advances, experiencing breast cancer impacts on overall quality‐of‐life.     

Long‐Term Renal Allograft Survival in the United States: A Critical Reappraisal

Renal allograft survival has increased tremendously over past decades; this has been mostly attributed to improvements in first‐year survival. This report describes the evolution of renal allograft survival in the United States where a total of 252 910 patients received a single‐organ kidney transplant between 1989 and 2009. Half‐lives were obtained from the Kaplan–Meier and Cox models. Graft half‐life for deceased‐donor transplants was 6.6 years in 1989, increased to 8 years in 1995, then after the year 2000 further increased to 8.8 years by 2005. More significant improvements were made in higher risk transplants like ECD recipients where the half‐lives increased from 3 years in 1989 to 6.4 years in 2005. In low‐risk populations like living‐donor‐recipients half‐life did not change with 11.4 years in 1989 and 11.9 years in 2005. First‐year attrition rates show dramatic improvements across all subgroups; however, attrition rates beyond the first year show only small improvements and are somewhat more evident in black recipients. The significant progress that has occurred over the last two decades in renal transplantation is mostly driven by improvements in short‐term graft survival but long‐term attrition is slowly improving and could lead to bigger advances in the future.     

Longitudinal health-related quality of life after mandibular resection for oral cancer: a comparison between rim and segment

BACKGROUND: Mandibular resection for oral cancer is often necessary to achieve an adequate margin of tumor clearance. Segmental mandibulectomy has been associated with a poor health-related quality of life (HRQOL), particularly before composite free tissue transfer to reconstruct the defect. Little is published in the literature contrasting the subjective deficit of segmental compared with rim resection. The aim of this study was to use a validated head and neck HRQOL questionnaire to compare rim and segmental mandibular resection in patients having primary surgery for oral cancer. METHOD: There were 224 consecutive patients between 1995 and 1999 who were treated by primary surgery for oral squamous cell carcinoma. One hundred twenty-tree had no mandibular resection, 44 had a rim resection, and 57 had a segmental resection. The University of Washington Quality of life questionnaire (UW-QOL) was administered before treatment, at 6 months, 12 months and after 18 months. RESULTS: Preoperatively, patients undergoing segmental resection reported significantly more pain, chewing problems, and a lower composite UW-QOL score. Postoperatively, the segment group tended to score worse at all time points, particularly in appearance, swallowing, recreation, and chewing; however, the difference between rim and segment was only seen in smaller resections without adjuvant radiotherapy. Little difference was seen between rim or segment for tumors < 4 cm with radiotherapy and between rim and segments for tumors > 4 cm. CONCLUSION: After segmental mandibulectomy and reconstruction using composite free tissue transfer, the UW-QOL scores were relatively good. The only 2 difference between rim and segments was noted in the small resections without radiotherapy, and some of this was reflected in differences at baseline.     

Results of Gal‐Knockout Porcine Thymokidney Xenografts

Clinical transplantation for the treatment of end‐stage organ disease is limited by a shortage of donor organs. Successful xenotransplantation could immediately overcome this limitation. The development of homozygous α1,3‐galactosyltransferase knockout (GalT‐KO) pigs removed hyperacute rejection as the major immunologic hurdle to xenotransplantation. Nevertheless, GalT‐KO organs stimulate robust immunologic responses that are not prevented by immunosuppressive drugs. Murine studies show that recipient thymopoiesis in thymic xenografts induces xenotolerance. We transplanted life‐supporting composite thymokidneys (composite thymus and kidneys) prepared in GalT‐KO miniature swine to baboons in an attempt to induce tolerance in a preclinical xenotransplant model. Here, we report the results of seven xenogenic thymokidney transplants using a steroid‐free immunosuppressive regimen that eliminated whole‐body irradiation in all but one recipient. The regimen resulted in average recipient survival of over 50 days. This was associated with donor‐specific unresponsiveness in vitro and early baboon thymopoiesis in the porcine thymus tissue of these grafts, suggesting the development of T‐cell tolerance. The kidney grafts had no signs of cellular infiltration or deposition of IgG, and no grafts were lost due to rejection. These results show that xenogeneic thymus transplantation can support early primate thymopoiesis, which in turn may induce T‐cell tolerance to solid organ xenografts.     

Quality of life assessment in patients with inguinal hernia

BACKGROUND: The natural history of untreated inguinal hernia (IH) is poorly understood. Whether a delay in operative repair of IH leads to excessive physical suffering or significant psychosocial impairment is not known. This study attempts to quantify the morbidity of patients with IH by assessing their quality of life (QOL) while on a waiting list for IH surgery. METHODS: QOL was measured in adult patients with IH who were on the waiting list using a standardized SF-36 questionnaire. Scores were compared with a sample of age-, sex- and comorbidity-matched controls. RESULTS: A total of 143 patients were identified, of which 106 were included in the study. Patients with IH had significantly impaired QOL compared with comorbidity- and demographic-matched controls across all of the domains measured. Subgroup analysis showed an inverse relationship between the size of the IH and the QOL and patients employed in manual work tended to have lower QOL compared with those with sedentary vocations. CONCLUSIONS: In conclusion, we showed that the SF-36 score is a good measure of QOL in this patient group. Those patients on the elective waiting list for repair of IH have a significantly impaired QOL compared with age-, sex- and comorbidity-matched controls.     

Radical prostatectomy versus high-dose rate brachytherapy for prostate cancer: effects on health-related quality of life

OBJECTIVE: To examine the effects of different treatments on the health-related quality of life (HRQoL) of men with localized prostate cancer. PATIENTS AND METHODS: Between October 1997 and August 2002, 182 men diagnosed with prostate cancer (T1c to T3bN0M0) had radical prostatectomy (RP, 89) or (192)iridium high-dose rate brachytherapy (HDR-BT, 93) with external beam radiotherapy, and were followed for > or = 6 months. A postal survey was sent in which HRQoL was assessed using the 36-item Short-Form Health Survey (SF-36) QoL questionnaire, and disease-specific QoL using the University of California Los Angeles Prostate Cancer Index (UCLA-PCI). RESULTS: Questionnaire responses were obtained from 151 of 182 patients; there was no significant difference in SF-36 scale scores between men treated with RP or HDR-BT. In the UCLA-PCI, the HDR-BT group had better urinary function (P < 0.001) and sexual function scores (P= 0.043). Men treated with RP had better bowel bother scores (P = 0.027). In patients with > or = 2 years of follow-up, urinary function (P < 0.001) and sexual bother (P = 0.029) were better for men treated with HDR-BT than for men treated with RP. Men treated with HDR-BT had significantly better urinary function (P = 0.009) and sexual bother (P = 0.013) even than 30 men treated with unilateral nerve-sparing RP. CONCLUSIONS: In terms of HRQoL, RP and HDR-BT did not differ, but HDR-BT resulted in better urinary and sexual function than RP. When planning treatment, QoL concerns, including mental health issues associated with prostate cancer, need to be addressed with the patients, as do the potential side-effects.     

Prospective assessment of health‐related quality of life in men with late‐onset hypogonadism who received testosterone replacement therapy

The objective of this study was to characterise the status of health‐related quality of life (HRQOL) in Japanese men with late‐onset hypogonadism (LOH) treated with testosterone replacement therapy (TRT). HRQOL in 69 consecutive Japanese men with LOH undergoing TRT for at least 6 months was prospectively evaluated before and 6 months after the initiation of TRT using the Medical Outcomes Study 8‐Item Short‐Form Health Survey (SF‐8). All eight‐scale scores except for bodily pain (BP) in the 69 patients at 6 months after the introduction of TRT significantly improved compared with those before TRT; however, all scale scores except for BP in the 69 patients were significantly inferior to those in age‐matched Japanese controls irrespective of the timing of SF‐8. Multivariate analyses of several parameters revealed that both age and Aging Male Symptom (AMS) score had an independent impact on mental health (MH), despite the lack of an independent association between any score and the remaining factors examined. TRT appeared to significantly improve the status of HRQOL in men with LOH; however, even after the introduction of TRT, HRQOL associated with MH remained significantly impaired in elderly men and/or those with a high AMS score.