Development and validation of the simplified Chinese version of EORTC QLQ-H&N35 for patients with head and neck cancer

Goals

A simplified Chinese version of EORTC QLQ-H&N35 was developed using strict translation procedures according to EORTC translation guidelines. Psychometric properties were evaluated.

Patients and methods

Three instruments (QLQ-H&N35, QLICP-HN, and FACT-H&N) were used in a sample of 133 patients with head and neck cancer at the time of their admission to the hospital. Each patient was assessed for the second time 1–2 days after hospitalization so that the test–retest reliability could be calculated. A sub-sample of patients was sampled and measured for the third time at discharge in order to evaluate the responsiveness.

Results

Correlation analysis among domains and items of the three instruments showed good construct validity and criterion-related validity. Comparisons of QLQ-H&N35 between treatment groups and age groups supported clinical validity. The internal consistency reliability measured by Cronbach’s coefficient α was greater than 0.70 for all multi-item domains, and test–retest reliability coefficients for all domains were greater than 0.80, ranging from 0.88 to 0.95. Score changes between pre- and post-treatment were observed in 6 out of 18 domains, with effect size SRM ranging from 0.27 to 0.87.

Conclusions

The simplified Chinese version of QLQ-H&N35 demonstrates good validity, reliability, and responsiveness and can be used to measure QOL for Chinese patients with head and neck cancer.     

Changes in health related quality of life in women and men undergoing radiation treatment for head and neck cancer and the impact of smoking status in the radiation treatment period

PurposeThe aim of this study was to evaluate health-related quality of life (HRQOL) in women and men undergoing radiation treatment for head and neck cancer through the intervention period and examine if age, body mass index (BMI) and smoking status at baseline may modify changes in HRQOL.MethodsHRQOL was examined by the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the EORTC QLQ-H&N35, in the beginning and end of the treatment period in 65 patients at the University Hospital in Northern Norway. Changes in HRQOL were calculated and compared by paired sample T-tests. Linear multiple regression analyses were used to examine if baseline characteristics had any influence towards HRQOL changes.ResultsMost aspects of HRQOL declined substantially and significantly (p < 0.001) with a magnitude of more than one standard deviation during the radiation treatment period irrespective of sex and age. Smoking status at baseline had some, albeit minor, influence on changes in HRQOL. Patients who continued smoking during therapy had significantly higher decline in several aspects of HRQOL, compared to patients who stopped smoking.ConclusionsHRQOL declined with substantial magnitude in patients undergoing radiation treatment for head and neck cancer, but smoking cessation may modify the declining quality of life.     

二期喉重建术患者的生活质量调查及护理

目的　研究二期喉重建术患者的生活质量及护理。方法　采用欧洲肿瘤病研究生活质量核心问卷 (EORTCQLQ C3 0 )、头颈癌模型 (EORTCQLQ H&N3 7)、抑郁自评量表 (SDS)、焦虑自评量表 (SAS)、咽喉功能调查表对 12 6例二期喉重建术患者进行术前、术后问卷调查 ,并进行统计学处理。结果　二期喉重建术术后患者的焦虑、抑郁较术前明显改善 (P <0 .0 1) ;在角色功能、情感功能、社会功能和生活质量四方面得到提高 ,表现为交流、嗅觉、进食、打电话等各方面的改善。结论　二期喉重建术可以提高长期失喉者的生活质量 ,术前及术后护理对于辅助二期喉重建术达到预期的效果至关重要     

Cross-cultural application of the Korean version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care

ContextThe European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care (EORTC QLQ-C15-PAL) is a shortened version of the EORTC QLQ-C30, developed for use in advanced cancer patients.ObjectivesWe evaluated the psychometric properties of the Korean version of the EORTC QLQ-C15-PAL to determine if this tool can be used to evaluate Korean patients with cancer who receive palliative care.MethodsA multicenter, cross-sectional survey was performed in palliative care units and hospices in Korea from September to October 2009. A total of 102 patients with cancer completed the questionnaires that included the EORTC QLQ-C15-PAL.ResultsThe compliance rate was high, with the missing rate for each item ranging from 0% to 7.8% (mean 3.1%). A multitrait scaling analysis revealed good convergent and discriminant validity, with only three scaling errors. The Cronbach’s alpha coefficients ranged from 0.65 to 0.89. The questionnaire discriminated among patient subgroups with different clinical profiles (e.g., performance status and degree of oral intake), thereby demonstrating the clinical validity of this tool.ConclusionOur findings indicate that the Korean version of the EORTC QLQ-C15-PAL is a reliable and valid instrument with regard to its psychometric properties. This tool is suitable for measuring quality of life, particularly with regard to physical aspects, in Korean cancer patients who receive palliative care.     

Health-related quality of life in patients with metastatic,relapsed, or inoperable squamous cell carcinoma of the head and neck in India

Objective

The objective of this study was to evaluate changes in health related quality of life (HRQoL) in patients with metastatic head and neck (H&N) cancer randomized to receive metronomic (methotrexate and celecoxib) or cisplatin chemotherapy.

Methods

Patients older than 18 years, with a Karnofsky Performance score of ≥70, and diagnosed with metastatic, locally advanced inoperable or recurrent head and neck (H&N) cancer not amenable to surgery or radiation were randomized (1:1) to receive metronomic or cisplatin chemotherapy. All patients were recruited from the Tata Memorial Hospital, Mumbai, India. In addition to demographic and baseline clinical characteristics, patients were asked to rate their HRQoL using the EORTC QLQ-C30 and the EORTC QLQ-H&N35 questionnaires (Indian versions) at baseline and at the end of each chemo cycle (every 3 weeks) till the end of study or early termination.

Results

Of the 110 patients screened, 87 agreed to participate in the study. Mean age of the study population was 47.5 years (S.D. ±10.04) for the metronomic group and 47.2 years (S.D. ±9.89) for the cisplatin group. Overall quality of life was not significantly different between the two treatment groups from baseline to end of treatment. However, there was a statistically significant improvement in Pain QLQ-C30 score from baseline to week 3 (OR?=?3.14, p?=?0.036) and week 6 (OR?=?3.33, p?=?0.034) in the metronomic arm compared with the cisplatin arm.

Conclusion

In addition to improvements in survival, understanding the impact of treatment options on changes in HRQoL is important as it can aid physicians in making treatment and rehabilitation decisions for patients with advanced inoperable H&N cancer.

     

Assessment of peri-operative quality of life in patients undergoing surgery for gastrointestinal cancer

The purpose of this study was to assess the pre- and postoperative quality of life (QOL) of patients with gastrointestinal cancer and to investigate the relationship between QOL and various psychological and clinical factors. Eighty-five patients who underwent surgery for gastrointestinal cancer and 26 control patients undergoing surgery for digestive diseases other than cancer were interviewed. Two tests were administered to assess QOL and psychological status respectively: the Japanese-language version of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the Japanese-language version of the Hospital Anxiety and Depression Scale (HADS). Each test was administered before surgery, before discharge, and 6 months after discharge. Gastrointestinal tumors were localized to the stomach, colon, or rectum in 88% of cases and classified as advanced stage or early stage according to staging protocols. Changes in EORTC QLQ-C30 subscale scores over time were compared among advanced stage, early stage, and control patients. All groups showed significant changes in subscale scores of QOL; the scores of the advanced-stage group indicated worse QOL than the early-stage and control groups in a lot of areas. The physical function (PF2) QOL subscore was influenced by diagnosis, postoperative complications, medical equipment at discharge, and the length of admission and negatively correlated with depression and anxiety. These results suggest that QOL in gastrointestinal cancer patients is variable over time and is influenced by various clinical factors. Therefore, consideration of these clinical factors is paramount to the optimal care of gastrointestinal cancer patients.     

Pain experience following radical treatment for head and neck cancer.

During an investigation into the quality of life of people in the year following radical treatment for head and neck cancer, it became apparent that pain was a significant problem. Therefore, the current study was conducted to gain an understanding of the incidence and nature of pain in people who had received radical treatment for head and neck cancer and to explore their attitudes to pain and pain relief. A single cohort study was undertaken using a structured questionnaire designed for people with head and neck cancer (the EORTC QLQ-C30 and the EORTC QLQ H+N35). Fifty questionnaires were received from people who had received radical treatment between 6 and 12 months previously and who were disease-free. Twenty nine of the respondents also consented to a follow-up semi-structured interview. The interviews generated qualitative data about personal experiences of pain and pain management in head and neck cancer. Patient recollections from interviews identified that only nine out of 29 (31%) interviewees had pain at diagnosis. However, 74% (37) of respondents to the questionnaire reported some degree of pain at follow-up. Patients having both surgery and radiotherapy were significantly more likely to have troublesome pain than patients who received radiotherapy only (Fisher's exact test=0.039). The qualitative data identified a wide variety of pain sites, a number of which were not covered by the EORTC tool. A significant number of patients were rejecting regular pharmacological management and using a variety of other pain-relieving measures. We conclude that through an understanding of pain experience and attitudes to pain management, nurses can facilitate the care and support of patients in pain following treatment for head and neck cancer.     

Predictive factors for overall quality of life in patients with advanced cancer

Objective

This study examined which domains/symptoms from the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 15 Palliative (QLQ-C15-PAL), an abbreviated version of the health-related EORTC QLQ-C30 questionnaire designed for palliative cancer patients, were predictive of overall quality of life (QOL) in advanced cancer patients.

Methods

Patients with advanced cancer from six countries completed the QLQ-C15-PAL at consultation and at one follow-up point. Univariate and multivariate regression analyses were conducted to determine the predictive value of the EORTC QLQ-C15-PAL functional/symptom scores for global QOL (question 15).

Results

Three hundred forty-nine patients completed the EORTC QLQ-C15-PAL at baseline. In the total patient sample, worse emotional functioning, pain, and appetite loss were the most significant predictive factors for worse QOL. In the subgroup of patients with bone metastases (n?=?240), the domains mentioned above were also the most significant predictors, whereas in patients with brain metastases (n?=?109), worse physical and emotional functioning most significantly predicted worse QOL. One-month follow-up in 267 patients revealed that the significant predictors changed somewhat over time. For example, in the total patient sample, physical functioning, fatigue, and appetite loss were significant predictors at the follow-up point. A sub-analysis of predictive factors affecting QOL by primary cancer (lung, breast, and prostate) was also conducted for the total patient sample.

Conclusion

Deterioration of certain EORTC QLQ-C15-PAL functional/symptom scores significantly contributes to worse overall QOL. Special attention should be directed to managing factors most influential on overall QOL to ensure optimal management of advanced cancer patients.     

Validation and comparison of the health-related quality-of-life instruments EORTC QLQ-C30 and SF-36 in assessment of patients with chronic nonmalignant pain

The EORTC QLQ-C30 health-related quality of life (HRQoL) questionnaire was developed for use in clinical cancer trials. It has also been applied in studies of patients with chronic nonmalignant pain in spite of nondocumented validity. Validation of the EORTC QLQ-C30 in this patient population and comparison with the traditional first choice HRQoL instrument in chronic nonmalignant pain, the SF-36, are, therefore, required. Two hundred eighty-six patients admitted to the tertiary multidisciplinary pain center at St. Olavs University Hospital in Trondheim, Norway, completed both the EORTC QLQ-C30 and the SF-36 at admittance. Correlations between EORTC QLQ-C30 and SF-36 measures of the same concept were between 0.70 and 0.81 for all five domains covered by both instruments. Internal consistency was below 0.70 for the EORTC QLQ-C30 scales physical functioning (0.57), pain (0.68), role functioning (0.43), cognitive functioning (0.66), and nausea/vomiting (0.53), as well as the SF-36 scale role emotional functioning (0.66). Large floor or ceiling effects were seen for several EORTC QLQ-C30 scales. While SF-36 addresses no other symptoms than pain and fatigue, the EORTC QLQ-C30 also includes sleep, financial difficulties, nausea/vomiting, dyspnea, appetite loss, constipation, and diarrhea. Even though some EORTC QLQ-C30 scales have unsatisfactory internal consistency, EORTC QLQ-C30, similar to SF-36, has overall acceptable psychometric properties. The EORTC QLQ-C30 is a valid alternative to the SF-36 when a broader assessment of symptoms is desired.     

The assessment of health-related quality of life and related factors in Chinese elderly patients undergoing chemotherapy for advanced cancer: A cross-sectional study

Purpose of the research(i) To assess the health-related quality of life (HRQOL) and analyse the potential contributing factors of HRQOL in elderly cancer patients in China; and (ii) to evaluate the possible correlation between the Medical Outcomes 36-Item Short Form Health Survey (SF-36) and the European Organization for Research and Treatment of Cancer, quality of life questionnaire (EORTC QLQ-C30).Methods and sampleA total of 109 elderly patients undergoing chemotherapy with advanced cancer completed a survey assessing HRQOL, anxiety and depression. HRQOL was measured by SF-36 and EORTC QLQ-C30. Anxiety and depression, was measured by the Hospital Anxiety and Depression Scale (HADS).Key resultsScales pertaining to role functioning, including SF-36 role physical (25.92 ± 37.10) and role emotional (36.12 ± 43.50), EORTC QLQ-C30 role functioning (46.94 ± 36.86), were the worst domains of SF-36 and EORTC QLQ-C30 respectively. Financial impact (55.77 ± 36.55) and fatigue (46.18 ± 26.48) were the top two highest scores among all nine symptom-related scales of EORTC QLQ C-30. The correlation matrix of SF-36 versus EORTC QLQ-C30 showed that, in general, there was good correlation between scales pertaining to the same health domain, and low correlation was observed between scales pertaining to different domains.ConclusionsThe findings of this study highlight role functioning, financial impact, fatigue, anxiety, and depression as areas where elderly cancer patients could most benefit from intervention. These findings also call attention to HRQOL and its related factors in elderly cancer patients. Interventions to be developed for improving HRQOL in cancer patients are highly recommended.     

低位/超低位直肠癌患者前切除保肛手术后生存质量调查

目的了解低位/超低位直肠癌患者前切除保肛手术后的生存质量。方法使用欧洲癌症协会组织生存质量核心量表及结直肠癌专用问卷,对58例行前切除保肛术的低位/超低位直肠癌患者在出院后首次门诊随访时(术后第4周)、术后第3个月(化疗中期)、术后第6个月(化疗结束)进行调查。结果患者术后总的生存质量、生理功能、角色功能、情感功能、认知功能、社会功能、性功能、性满意度及对预后的期望及疼痛、泌尿道症状及男性性功能在术后第4周、第3个月、第6个月随时间延长逐渐好转;而疲乏、恶心呕吐、食欲下降、便秘症状、排便问题与体质量下降问题在术后3个月内变化不明显,术后第6个月则明显减轻。结论本组低位直肠癌前切除保肛术患者总的生存质量在术后6个月内是动态变化的,从术后4周、术后3个月至术后半年呈现明显改善趋势。临床护理和健康教育指导需根据前切除保肛术患者的情况有针对性地进行。     

脑瘤患者生活质量测定量表EORTCQLQ-C30、QLQ-BN20的中文版评价

目的考评中文版EORTC QLQ-C30、QLQ-BN20量表组合的信度、效度、相关系数,并评价用这种量表组合评估中国原发及继发脑瘤患者生活质量的可行性。方法2013年9月-2014年3月,采用通过翻译、回译及文化调适制定的中文版EORTC QLQ-C30[1]和QLQ-BN20[2]量表组合,对我院165例原发或继发脑瘤患者进行生活质量测定来对量表组合进行评价。结果EORTC QLQ-BN20的4个多条目维度中,两个维度的Cronbach′sα系数>0.8(分别为0.822和0.811),另外两个维度的α系数也都>0.7(分别为0.796和0.762),且4个多条目维度的条目与其自身维度相关系数均>0.4,基本所有条目与自身维度的相关系数均大于与其它维度的相关系数。采用Pearson相关系数检验EORTC QLQ-C30、EORTC QLQ-BN20两量表各维度间的相关性,结果显示,除个别维度中度相关,其余均为弱相关。结论EORTC QLQ-C30、QLQ-BN20的中文版量表组合具有较好的相关性、信度、聚合效度及区分效度。EORTC QLQ-BN20是对EORTC QLQ-C30的较好补充,使其更适用于原发或继发脑瘤患者。该量表组合可用于中国脑瘤患者的生活质量测定。     

No differences between Calendula cream and aqueous cream in the prevention of acute radiation skin reactions – Results from a randomised blinded trial

PurposeThe purpose of this blinded, randomized clinical trial was to compare two topical agents (Calendula Weleda^® cream vs. Essex^® cream) in reducing the risk of severe acute radiation skin reactions (ARSR) in relation to adjuvant radiotherapy (RT) for breast cancer.MethodThe primary endpoint was the difference in proportion of patients with ARSR, assessed with the Radiation Therapy Oncology Group/The Organization for Research and Treatment of Cancer Acute Radiation Morbidity Scoring Criteria (RTOG/EORTC scale) at follow-up. The secondary endpoints included patient reported outcome measures; Quality of Life Questionnaire (QLQ-C30), Sleep disturbances (MOS-sleep questionnaire) and symptoms from the irradiated area (visual analogue scale). Patients' experiences and adherence to the topical agents were also evaluated.ResultsA total of 420 patients were randomised and 411 were analysed. With the exception of previous chemotherapy, the treatment groups were well balanced, both regarding treatment- and patient-related factors. The incidence of severe ARSR (RTOG/EORTC grade ≤2) at the follow-up visit was 23% (n = 45) in the Calendula group and 19% (n = 38) in the Essex group. We found no difference in severe ARSR between the groups at any point of assessment. The patients reported low levels of skin related symptoms and no statistically significant differences between the groups were found.ConclusionsNo differences in ARSR between patients randomised to Calendula or Essex cream was found. ARSR seem to be a relatively limited problem, probably more influenced by treatment related factors than by choice of skin care products in this patient group.     

Development of an EORTC Item Bank for Computer-Adaptive Testing of Nausea and Vomiting

ObjectivesNausea and vomiting (NV) remain common cancer symptoms and frequent side effects of anticancer therapies despite available antiemetics. They can lead to treatment disruption and discontinuation. NV is an important patient reported outcome in oncology. This study aimed to build an item bank for computer-adaptive testing (CAT) based on NV questions in the European Organisation for Research for Treatment of Cancer, Quality of Life for Cancer Patients (EORTC QLQ-C30) questionnaire and complete the first three phases of development as described in the EORTC Quality of Life Group guidelines.Data SourcesThe development followed a standard procedure. The three phases include conceptualization and literature search (phase 1); item classification, selection, formulation and rating, and expert evaluations (phase 2); and patient pretesting (phase 3). The literature search resulted in a preliminary list of 115 items. Following classification, formulation, and rating, 21 candidate items adhered to the QLQ-C30 format. Evaluation by experts (n = 11) from five countries and patients (n = 31) pretesting in Denmark, Poland, and the UK lead to a final list of 20 items.ConclusionThe selection, development, and refining of NV items have been described. The nature of this testing ensures an initial CAT item bank that after field testing (phase 4) and psychometric analysis is expected to provide a precise and efficient NV measurement while still being comparable to the original QLQ-C30 scale.Implications for Nursing PracticeAccess to reliable tools that facilitate NV comprehensive assessment is an important issue for nurses caring for patients with cancer. This CAT item bank is meant to support clinical decisions when all phases of testing are completed.     

心理干预对鼻咽癌患者情绪障碍和生活质量的影响

目的探讨心理干预对鼻咽癌患者情绪障碍和生活质量的影响。方法收集确诊为鼻咽癌半年以内,未转移或复发,未合并其他慢性疾病的患者48例。采用SCL-90、SAS、SDS和EORTC QLQ—C30对其进行精神心理状态和生活质量的追踪评估,并根据初期的评估后果进行有针时性的心理干预,并对干预结果进行分析。结果鼻咽癌确诊初期患者的心理健康状况较差,焦虑、抑郁情况明显,生活质量明显下降;初期各评定结果分别为SCL-90（197．75±1．82）分、SAS（44．90±7．98）分、SDS（44．49±7．52）分和EORTCQLQ-C30（60．08±4．48）分。干预半年后,患者无论在心理状态和生活质量上均较半年前有显著改善,各量表评分分别为SCL-90（157．26±13．66）分、SAS（41．94±4．86）分、SDS（40．53±4．61）分和EORTCQLQ—C30（67．96±6．68）分;前后分值比较差异均有统计学意义（p〈0．01或p〈0．05）。结论对确诊为鼻咽癌的初期患者实施有效的心理干预,可以减轻患者的负性心理状态,提高生活质量。     

基于多媒体网络平台的延续性护理结合社会支持对乳腺癌术后化疗患者生存质量的影响

目的探讨基于多媒体网络平台的延续性护理结合社会支持对乳腺癌术后化疗患者生存质量的影响。方法选取我科2017年9月至2018年9月收治的60例乳腺癌术后化疗患者作为研究对象,按随机数字表法分为对照组和观察组,各30例。对照组采用常规方式的健康教育及随访;观察组通过多媒体网络平台进行延续性护理,同时实施社会支持干预。比较两组患者的生存质量和自我管理效能。结果随访6个月,观察组的EORTC QLQ-BR23、EORTC QLQ-C30及SUPPH评分均明显高于对照组,差异具有统计学意义(P<0.05)。结论给予乳腺癌术后化疗患者基于多媒体网络平台的延续性护理结合社会支持,能够提高患者化疗后的生存质量和自我管理效能,值得临床推广应用。     

EORTC QLQ-C15-PAL quality of life score as a prognostic indicator of survival in patients with far advanced cancer

Purpose

Quality of life (QoL) and performance status predict survival in advanced cancer patients; these relationships have not been explored in the hospice palliative care setting. The aim of this study was to examine the survival predictability of patient-reported QoL using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C15-PAL questionnaire in far advanced cancer inpatients at the very end of life.

Methods

This is a retrospective cohort study. Patients reported QoL using the EORTC QLQ-C15-PAL. One hundred sixty-two inpatients in hospice palliative wards of six hospitals in South Korea were followed until death or the end of the study. Additional symptoms and performance status were assessed by the MD Anderson Symptom Inventory—Korean (MDASI-K), Palliative Performance Scale (PPS) and Eastern Cooperative Oncology Group (ECOG) performance status. Correlations between EORTC QLQ-C15-PAL, MDASI-K, PPS, and ECOG were assessed. Survival analyses were performed using Cox proportional hazard models.

Results

Patients’ median survival was less than 1 month. Physician-reported PPS significantly predicted survival (hazard ratio [HR] 0.493; p?<?0.001). From the EORTC QLQ-C15-PAL, patient-reported physical functioning predicted survival (HR?=?0.65; p?<?0.001). Other six domains of EORTC QLQ-C15-PAL were significantly related to survival after adjustment. Those domains were global health status, emotional functioning, fatigue, nausea/vomiting, appetite loss, and constipation.

Conclusions

EORTC QLQ-C15-PAL can be an independent prognostic factor in inpatients with far advanced cancer. Patient-reported physical functioning showed survival predictability as good as physician-reported performance status. It is notable that the QLQ instrument is useful even for patients in their final month of life. Cancer anorexia–cachexia syndrome-related symptoms may be independent prognostic symptoms. Prospective study is warranted.     

Quality of life in terminal care—with special reference to age, gender and marital status

Objectives This study was conducted to explore symptoms, other quality of life (QoL) aspects and impact of age, gender, marital status, cancer diagnosis and time of survival in patients with advanced cancer admitted to palliative care.Patients and methods A cross-sectional study of 278 cancer patients completing the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 at referral to palliative care.Main results Gynaecological and gastro-intestinal tract cancers were the most common. Mean age was 67 years; 62% were female. Median survival was 43 days and 39% lived less than 30 days. Patients reported impaired general QoL and high occurrence of symptoms (44 and 100% for diarrhoea and fatigue, respectively). Fatigue, appetite loss and dyspnoea were reported as most severe (mean values of 80, 59 and 51, respectively, 0–100 scales). Married/cohabiting patients and younger patients reported lower functional abilities and more symptoms. No impact of diagnoses on QoL parameters was found. Patients closest to death did not differ significantly from those with longer time to live in social functioning.Conclusion Young and married patients may be at higher risk for perceived low quality of life at the end of life. EORTC QLQ-C30 could be used as a clinical tool for screening of symptoms and reduced functioning in palliative care, but may not be appropriate for use in the most severely ill patients. Limitations of the instrument and the need for robust measurements of patient mix are discussed. Proxy ratings of physical symptoms and nurse responsibility to include QoL assessment in daily practice would increase attrition and decrease selection bias.     

Health-related quality of life during the last three months of life in patients with advanced cancer

Goals of work  The aim of the study was to explore the development of functioning impairments and symptom occurrence during the last months of life of advanced cancer patients. Materials and methods  Self-reported data from 116 patients who all completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire—Core 30 (EORTC QLQ-C30) at 3, 2 and 1 month before death were analysed. Main results  All functioning aspects deteriorated. For physical, cognitive and social function, the most marked changes occurred between 2 and 1 month before death. The proportion reporting serious difficulties with self-care activities increased from 14% to 43%. The most seriously affected activity could not be distinguished from the EORTC QLQ-C30 scores. Levels of fatigue, dyspnoea and appetite loss increased significantly. More than 50% of the patients had severe pain at all assessments, and only a minor number (8%) reported any improvement. Conclusions  The findings have implications for the planning of care and indicate that further research is required to improve assessment, treatment and follow-up procedures. Adequate pain treatment seems still to be a challenge. Anorexia, fatigue as well as dyspnoea are all symptoms that need further focus.     

延伸护理服务对大肠癌术后造口患者生活质量的影响

目的 探究延伸护理服务对大肠癌术后造口患者生活质量的影响.方法 选取2013年5月~2016年10月该院普外科收治的大肠癌术后造口患者150例,随机分为观察组和对照组各75例.在两组患者住院期间均采用常规护理,出院后3个月、6个月、1年对对照组患者进行电话随访调查,而对观察组患者进行家庭随访、电话随访和联谊活动等延伸护理服务.采用生活质量量表(core quality of life questionnaire,QLQ-C30)对患者进行评估.结果 观察组患者在延伸护理干预3个月、6个月和1年后的躯体功能、角色功能、情绪功能、认知功能、社会功能和总体健康状况均明显高于对照组,差异均有统计学意义(均P<0.05).结论 对大肠癌术后造口患者实施延伸护理服务提高了患者对知识的掌握和社会交流能力,有效地提高了患者的生活质量.