Health‐related quality of life in men with localized prostate cancer

With the established effectiveness of diverse treatments for localized prostate cancer, the identification of the physical and psychological consequences of the disease and its various treatments has become critical. In the present review, we aim to familiarize the reader with the methodologies of health‐related quality of life (HRQOL) research and to review the recent literature on HRQOL outcomes in patients with localized prostate cancer. Studies have shown that prostate cancer and its treatment affect both disease‐specific HRQOL (i.e. urinary, sexual, and bowel function) as well as general HRQOL (i.e. energy/vitality and performance in physical and social roles). However, these effects appear to differ according to the type of treatment, stage of disease, age of the subjects, time after treatment, and, more importantly, race or ethnicity. By including HRQOL in clinical decision‐making, we can help our patients make more informed treatment choices for localized prostate cancer.     

Health‐related quality of life in peritoneal dialysis patients: A narrative review

Health‐related quality of life (HRQOL) is an important aspect of patients´ health that should be an integral part of the evaluation of patient‐centered outcomes, not least because HRQOL associates with patients´ morbidity and mortality. This applies also to chronic kidney disease patients, including those dependent on renal replacement therapies, the type of which may influence patients´ perception of HRQOL. Several studies have addressed HRQOL in chronic kidney disease patients undergoing renal replacement therapies, especially transplanted patients and hemodialysis patients, while publications concerning peritoneal dialysis (PD) patients are scarcer. This review describes some of the methods used to assess HRQOL, factors influencing HRQOL in PD patients, HRQOL in PD vs hemodialysis, and the relation between HRQOL and patient outcomes. We conclude that assessment of HRQOL–often neglected at present–should be included as a standard measure of patient‐centered outcomes and when monitoring the quality and effectiveness of renal care including PD treatment.     

Health‐related quality of life and patient burden in patients with split‐thickness skin graft donor site wounds

Split‐thickness skin grafting is a common procedure to treat different kinds of wounds. This systematic, multicentre, observational, cross‐sectional study of adult patients with split‐thickness skin graft (STSG) donor site wounds was conducted to evaluate quality of life (QoL) impairments caused by donor site wounds following split‐thickness skin grafting. Therefore, 112 patients from 12 wound centres in Germany were examined based on patient and physician questionnaires as well as a physical examination of the donor site wound. Most indications for skin grafting were postsurgical treatment (n = 51; 42.5%) and chronic wounds (n = 47; 39.2%). European QoL visual analoque scale (EQ VAS) averaged 64.7 ± 23.3, European QoL 5 dimensions (EQ‐5D) averaged 77.4 ± 30.0. Wound‐QoL (range: 0‐4) was rated 0.8 ± 0.8 post‐surgery and 0.4 ± 0.6 at the time of survey (on average 21 weeks between the time points). Compared to averaged Wound‐QoL scores of chronic wounds donor site‐related QoL impairments in split‐thickness skin‐graft patients were less pronounced. There were significant differences in patient burden immediately after surgery compared to the time of the survey, with medium effect sizes. This supports the hypothesis that faster healing of the donor site wound leads to more favourable patient‐reported outcomes.     

Health‐related physical fitness and quality of life in men with congenital hypogonadotropic hypogonadism

Congenital hypogonadotropic hypogonadism is a rare disorder characterised by impaired testosterone secretion since birth, and represents a valuable model for studying the effects of testosterone replacement therapy (TRT) in humans. This cross‐sectional study aimed to investigate all health‐related physical fitness (HRPF) components and quality of life in a series of eight men with hypogonadotropic hypogonadism under regular TRT. The study group was compared to a control group of 16 healthy subjects paired for age, body mass index and physical activity. Body composition, aerobic capacity, muscular strength and endurance, and joint flexibility were evaluated in two different 7‐day interval time points, based on the pharmacokinetics of testosterone in the hypogonadal group. Quality of life was assessed by the WHOQOL‐brief questionnaire. Both groups had similar performances in all HRPF components evaluated, independently of plasma testosterone levels (p > .05). Quality of life was also similar in the four domains analysed (p > .05). The results of this pilot study suggest that regular testosterone replacement was efficient in providing HRPF and quality of life in a series of congenitally hypogonadal men to levels like those observed in healthy men. In addition, acute fluctuations in plasma testosterone did not correlate with changes in muscle strength and endurance.     

Health‐related quality of life may improve after transplantation in pancreas–kidney recipients

Pancreas–kidney transplantation (PKT) may significantly improve quality of life (HRQOL) in patients with type 1 diabetes. We have assessed the changes felt by PKT patients, using the Gastrointestinal Quality of Life Index (GIQLI) and EuroQol‐5D questionnaires. Patients were asked to compare how their HRQOL had changed from pre‐transplantation to the last visit. The 60 men and 66 women enrolled had a mean follow‐up of five yr; 84.1% with both grafts, 15.9% with one graft functioning. In all domains of EuroQol‐5D scores improved after PKT, as well as the visual analogue scale health state (from 38% to 84%, p < 0.001; effect size 3.34). In GIQLI, physical function was felt better after PKT than before (14.83 ± 3.86 vs. 7.86 ± 4.43, p < 0.001; effect size 1.68); the same was observed for psychological status, social function, and GI complaints. Concerning the burden of medical treatment, the score significantly improved (from 1.31 to 3.63, p < 0.001, effect size 2.02). The rate of unemployed patients decreased after PKT (from 50.8% to 36.5%, p < 0.001). Multivariate analysis showed that having only one functioning graft was associated with worse HRQOL scores (B = ?5.157, p = 0.015). In conclusion, for all assessed domains, patients reported a significant improvement in HRQOL after PKT. Maintenance of the two grafts functioning predicted higher improvement of HRQOL scores.     

Health‐related quality of life of patients on chronic dialysis: The need for a focused effort

Health‐related quality of life (HRQOL) in patients on chronic hemodialysis has not improved significantly in the last 20 years. This is largely due to their substantial symptom burden which is rarely assessed and treated in routine clinical practice. It also is a consequence of the lack of an appropriate armamentarium for the treatments of such symptoms. Adequate studies on the causes and pathogenesis of the symptoms of hemodialysis patients are needed followed by high quality studies on possible therapeutic pharmacological and nonpharmacological interventions.     

Health‐related quality of life after salvage high‐intensity focused ultrasound (HIFU) treatment for locally radiorecurrent prostate cancer

Objective: To evaluate health‐related quality of life (HRQOL) after salvage high‐intensity focused ultrasound (HIFU) for locally radiorecurrent prostate cancer (PCa). Methods: Since June 2006 we have treated 61 patients consecutively by salvage HIFU. All patients were offered the University of California, Los Angeles Prostate Cancer Index (UCLA‐PCI) questionnaire at baseline and at follow‐up. Scores ranged from 0 (worst) to 100 (best). Clinically significant changes were defined as a minimum difference of 10 points between the baseline score and the score at follow‐up. Results: Fifty‐seven patients (93%) had evaluable data at baseline, compared with 46 (75%) after treatment. The mean time lapse between HIFU treatment and questionnaire response was 17.5 months (range 6–29 months). The mean score for urinary function decreased from 79.7 ± 12.1 prior to HIFU to 67.4 ± 17.8 after HIFU (P < 0.001). The mean score for sexual function decreased from 32.1 ± 24.1 prior to HIFU to 17.2 ± 17.0 after HIFU (P < 0.001). There were no significant effects on bowel function. There was a significant reduction in the mean score for Physical HRQOL, but the mean score for Mental HRQOL was did not change significantly. Conclusion: Treatment of localized radiorecurrent PCa by salvage HIFU is associated with clinically significant reductions in urinary and sexual function domains after a mean follow‐up of 17.5 months.     

Health‐related quality of life's dependence on socio‐economic status and demographic characteristics among men with benign prostatic hyperplasia

This study investigated the effect of socio‐economic status (SES) on health‐related quality of life (HRQoL) among persons with benign prostatic hyperplasia (BPH). The data were collected by way of surveying persons with BPH aged from 35 to 85 (937) and selected via random sample. The diagnosis was confirmed with the use of I‐PSS questionnaires (8–19 points), OABq‐AT (≥8 points) and daily urinations. A study on HRQoL was conducted using the SF‐36 questionnaire. SES was evaluated using the patients’ ambulance cards (F112U) and tax inspection documents with their written permission. Verification of the viability of the differences in the HRQoL level of patients with different SES was conducted in each age cohort using ANOVA. The goal of the multifactor regressive analysis using least weighted squares was identified as featuring the strongest relationships between SES and HRQoL. In comparing the average regression squares with average error squares, selection of the entry variables was conducted. Among persons with a BPH, the strongest relationship was discovered between profession, level of education, place of residence and HRQoL. A weaker relationship was identified between income and HRQoL, and there was no relationship between marital status and HRQoL. HRQoL among persons with a different level of SES figures aged 65+ proved homogeneous. We can expect HRQoL improvement among persons with BPH while increasing informedness on the possibilities for treating and improving help for workers of industrial and rural production residing in rural areas.