Do internal standards of quality of life change in lung cancer patients?

BACKGROUND: Measurement of health-related quality of life (QOL) over time often yields results that may be difficult to understand. Patients may change their internal standards of QOL as a result of adaptation to deteriorating health, a phenomenon referred to as response shift. OBJECTIVES: To examine changes in internal standards of fatigue, global health/QOL, and physical function in patients with inoperable lung cancer at 3 months (n = 115) and 6 months (n = 89) after a baseline measurement close to diagnosis. Significant changes were expected to occur only in patients who reported improvement or deterioration in fatigue and global health/QOL. METHODS: Fatigue, global health/QOL, and physical function were assessed with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30, version 3.0). At follow-up, this questionnaire was administered conventionally and as a retrospective baseline assessment (thentest). Subjective transition questions were used to form mutually exclusive patient subgroups (i.e., deterioration, stable, or improvement). RESULTS: With respect to fatigue, significant changes occurred in patients reporting deterioration at 3 months follow-up and in patients reporting improvement after 6 months, but not in patients reporting improvement after 3 months or deterioration after 6 months. Significant changes in global health/QOL were found in patients reporting improvement at both 3 and 6 months follow-up and unexpectedly in stable patients after 3 months. No significant changes were found in patients reporting deteriorated global health/QOL at 3 and 6 months. Unexpectedly, changes occurred at both 3 and 6 months in patients reporting improved physical function. DISCUSSION: Given these mixed findings, it cannot be concluded that changes in internal standards occurred. These severely ill patients reported high levels of symptoms at baseline and may in part have adapted to their symptoms before study entry.     

Does dialysis adequacy impact on the quality of life of end-stage renal disease patients?

The relationship between quality of life and adequacy of dialysis is unclear, despite being an important clinical issue. Indeed, no studies have examined this relationship in a UK population. In this study, 24 adequately dialysed and 24 inadequately dialysed renal patients were compared on self-report measures of quality of life (Kidney Disease Quality of Life instrument and Hospital Anxiety and Depression scale). On two sub-scale measures of the KDQOL instrument, role – physical and pain and against the predicted direction, inadequately dialysed patients were found to have a better quality of life than adequately dialysed patients. The premise that better dialysis adequacy is associated with a greater quality of life was not supported. Moreover, evidence was found to suggest that the crucial issue in obtaining an optimal quality of life is the process of adaptation and acceptance of chronic illness.     

Do physical disabilities affect self-perceived quality of life in adolescents?

Purpose. We examined to what extent physical disabilities (PD) affect self-perceived quality of life (QOL) among adolescents.

Method. A survey was conducted on 157 adolescents (aged 15.6 ± 1.6 years) with PD, who were attending high schools in Taiwan; 855 students (15.3 ± 1.6 years) from the same geographic regions and without a disability were recruited as controls. The Student Version of the Comprehensive Quality of Life Scale (COMQOL-S) was used to assess their subjective and objective well-being.

Results. No significant differences in overall objective QOL score were found between the two groups but the PD group was poorer in health and material well-being. Adolescents with PD scored significantly higher in overall subjective QOL and all the seven domains examined. Stratified analysis showed that older students and female students with PD had lower life satisfaction in some domains. There were no significant differences in overall objective (62.1 ± 8.3 vs. 60.9 ± 6.4; p = 0.55) or subjective (72.3 ± 12.6 vs. 74.4 ± 13.6; p = 0.15) QOL between students in mainstream and special schools.

Conclusions. With national health care and educational coverage, the QOL of adolescents with PD in Taiwan do not seem to be affected by the disabilities, regardless of whether they are in mainstream or special schools. However, the negative effect of PD on QOL becomes a concern with increasing age; females with PD also appear to have a lower subjective QOL in health and emotion.     

Do elderly patients with metastatic cancer have worse quality of life scores?

Purpose

The purpose of this study is to compare self-reported quality of life (QOL) scores in old and young patients with metastatic cancer using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C15-PAL questionnaire.

Materials and methods

Patients receiving palliative radiotherapy (RT) for bone metastases and brain metastases completed the QLQ-C15-PAL questionnaire prior to treatment. Using multiple linear regression analysis, a parametric test, the QLQ-C15-PAL scores were compared using 65 and 70?years as cutoff ages.

Results

A total of 340 patients were referred for palliative RT for bone metastases (n?=?190) or brain metastases (n?=?150). Physical functioning and appetite were worse in the older group using either 65 or 70?years as the cutoff age. Age-related differences in the QLQ-C15-PAL scores varied as a function of age cutoff used and location of metastatic site irradiated.

Conclusion

Based on the (EORTC) QLQ-C15-PAL, elderly advanced cancer patients have a different QOL profile. Similar observations have been reported with the (EORTC) QLQ-C30 questionnaire.     

Chemotherapy-induced nausea and vomiting in clinical practice: impact on patients’ quality of life

Background

Chemotherapy-induced nausea and vomiting (CINV) in cancer patients are common symptoms most feared by patients. The aim of this study was to analyze the impact of CINV associated to moderate/highly emetogenous chemotherapy regimens on patients’ quality of life (QoL).

Patients and methods

Open, multicenter, prospective observational study was performed. Each patient filled out a patient diary for each cycle from the day before chemotherapy and for the next 5?days that included the number of emetic episodes, the intensity of nausea, and QoL evaluation (functional living index-emesis questionnaire).

Results

Data from 202 consecutive patients from nine university hospitals were collected, but only data from 160 were analyzed (79.2?%). Most of the participants (70?%) were women with a mean age of 50?years (SD 1.2?years). The most frequent cancer site was breast (44?%) followed by lung (16?%) and 76.3?% were receiving highly emetogenous chemotherapy. Despite the use of antiemetic prophylaxis, patients experienced significant nausea and vomiting during 31?% (3.2?% during acute, 15.0?% during delayed phase, and 13.2?% during both phases) and 45.1?% (5.1?% only during the acute phase, 23.5?% only during the delayed phase and 16.5?% during both phases) of the cycles, respectively, having 44.5?% (nausea) and 39.3?% (emesis) of the cycles an impact on patients’ QoL.

Conclusions

The results of the study confirm the detrimental effect of CINV on patients’ QoL despite the use of antiemetic prophylaxis (5HT₃ receptor antagonist, steroids, and dopamine receptor antagonists). It is mandatory to intensify the detection of CINV in order to improve the management of these important, albeit frequent, side effects of cancer treatments.     

Do patients’ information needs decrease over the course of radiotherapy?

Purpose

We aimed to investigate if cancer patients’ information needs decrease during radiotherapy and if so, which patient, consultation and radiation oncologist characteristics are associated with a decrease in information needs over time.

Methods

In this longitudinal study, patients (n?=?104) completed a baseline questionnaire a week before the initial radiotherapy consultation, immediately following this initial consultation, and 1?week prior to the first follow-up visit, which took place on average 3–5?weeks after the initial visit. Besides information needs, measured by the Information Preference for Radiotherapy Patients scale, the questionnaire assessed patient, consultation and radiation oncologist characteristics.

Results

Information needs decreased over time, but remained at a high level. Being religious, being male, having low health literacy and higher perceived involvement during the consultation were all statistically significantly associated to a decrease in information needs on specific domains (e.g. procedures or side effects).

Conclusions

Cancer patients’ information needs decline between the initial consultation and the first follow-up visit, but remain high. It is therefore advised to investigate the patients’ information needs at every radiotherapy visit and not rely on giving information just once. Furthermore, radiation oncologists should check if the information given at first consultation is understood and remembered. By those means, tailored information giving becomes possible.     

Impact of branchoplasty plus pulmonary lobectomy on quality of life in lung cancer patients

Background：Withregardtoimprovementofmortalityasso－ciatedwithoperation，５－yearsurvivalrate，andqualityoflife，branchoplastypluspulmonarylobectomyisworthapplyinginclin－ic．Objective：Toinvestigatetheimpactofbranchoplastypluspulmonarylobectomyonqualityoflifeinlungcancerpatients．Unit：DepartmentofChestSurgeryofFifthPeople＇sHospitalofDalian．Subjects：４４casesofprimarylungcancerpatientswerere－cruitedfrom１９９０to２０００．Allpatientsunderwentbranchoplastypluspulmonarylobectomy．Patien…     

Long-term impact of stroke on patients’ health-related quality of life

Purpose: This international study aims to examine the size and determinants of the impact of stroke on five-year survivors’ health-related quality of life (HRQoL) in four different European countries.

Method: Patients were recruited consecutively in four European rehabilitation centers. Five years after stroke, the EuroQol-visual analog scale (EQ-VAS) was administered in 226 first-ever stroke patients. Impact of stroke was determined by calculating EQ-VAS z-norm scores (= deviation – expressed in SD – of patients’ EQ-VAS level relative to their age-and gender-matched national population norms). Determinants of EQ-VAS z-norm scores were identified using multivariate linear regression analysis.

Results: Five years post-stroke, patients’ mean EQ-VAS was 63.74 (SD?=?19.33). Mean EQ-VAS z-norm score was ?0.57 [95%CI: (?0.70)–(?0.42)]. Forty percent of the patients had an EQ-VAS z-norm score SD; 52% had an EQ-VAS z-norm score between ?0.75 and?+0.75 SD, only 8% scored >+0.75 SD. Higher patients’ levels of depression, anxiety and disability were associated with increasingly negative EQ-VAS z-norm scores (adjusted R^2?=^?0.392).

Conclusions: Five years after stroke, mean HRQoL of stroke survivors showed large variability and was more than ½ SD below population norm. Forty percent had a HRQoL level below, 52% on, and 8% above population norm. The variability could only partially be explained by the variables considered in this study. Longitudinal studies are needed to increase our understanding of the size and determinants of the impact of stroke on the HRQoL of long-term stroke survivors.

• Implications for rehabilitation

• The current European concept of stroke rehabilitation is focused on the acute and sub-acute rehabilitation phase, i.e., in the first months after stroke. The results of this study show that at five years after stroke, the mean level of HRQoL of stroke survivors remains below the healthy population level. This finding shows the need for continuation of rehabilitation in the chronic phase.

• At five years after stroke, higher patients’ levels of depression, anxiety and disability were associated with lower scores for HRQoL. This finding implicates that chronic rehabilitation programs should be multi-faceted in order to increase long-term survivors’ psychosocial outcomes.

     

Long-term outcome in ICU patients: what about quality of life?

Objective Analysis of mortality and quality of life (QOL) after intensive care unit (ICU) discharge.Design Prospective, observational study.Setting Mixed, 31-bed, medico-surgical ICU.Patients Consecutive adult ICU admissions between June 25 and September 10, 2000, except admissions for uncomplicated elective postoperative surveillance.Interventions None.Measurements and results Age, past history, admission APACHE II, SOFA score (admission, maximum, discharge), ICU and hospital mortality were recorded. A telephone interview employing the EuroQol 5D system was conducted 18 months after discharge. Of 202 patients, 34 (16.8%) died in the ICU and 23 (11.4%) died in the hospital after ICU discharge. Of the 145 patients discharged alive from hospital, 22 could not be contacted and 27 (13.4%) had died after hospital discharge. Of the 96 patients (47.5%) who completed the questionnaire, 38% had a worse QOL than prior to ICU admission, but only 8.3% were severely incapacitated. Twenty-three patients (24%) had reduced mobility, 15 (15.6%) had limited autonomy, 24 (25%) had alteration in usual daily activities, 29 (30.2%) expressed more anxiety/depression, and 42 (44%) had more discomfort or pain. Twenty-eight (62.2% of those who worked previously) patients had returned to work 18 months after ICU discharge.Conclusions Comparing QOL after discharge with that before admission, patients more frequently report worse QOL for the domains of pain/discomfort and anxiety/depression than for physical domains. Factors commonly associated with a change in QOL were previous problems in the affected domains, prolonged hospital length of stay (LOS), greater disease severity at admission and degree of organ dysfunction during ICU stay.     

Impact of cancer patients’ quality of life on that of spouse caregivers

Goals of work This study aimed to examine the correlation between quality of life (QOL) in cancer patients and that of their spouse caregivers and to identify factors that influence this correlation.Patients and methods This cross-sectional study collected data from 121 cancer patient/spouse caregiver dyads. The Functional Assessment of Cancer Therapy Scale-General (FACT-G) was used to measure patients QOL, and the Caregiver Quality of Life Index (CQLI) was used to measure spouse caregivers QOL. Correlation coefficients between patients and caregivers QOL were computed for four dimensions of QOL, as well as a total score for QOL. Correlations between patients and caregivers total QOL scores were furthered analyzed by three groups of factors: disease-/treatment-related, caregiving-related, and relationship-related variables.Main results Only the social/family and functional dimensions of patient QOL and total score for patient QOL were associated with each dimension of their caregivers QOL and with the total score (r=0.27–0.44). Physical and emotional dimensions of patients QOL did not significantly influence spouse caregivers QOL for any dimension nor for the total score. Factors influencing the association between patients and caregivers overall QOL included cancer diagnosis, length of hospitalization, caregiving intensity and duration, marital satisfaction, and caregiving self-esteem.Conclusions Social and functional aspects of patients QOL play a significant role in determining the QOL of their spouse caregivers. The strength of association between patients and spouse caregivers overall QOL can be moderated by some factors.