Prospective assessment of quality of life in long‐term ovarian cancer survivors

The objective of our study was to compare prospectively the QoL in long‐term ovarian cancer survivors with short‐term survivors and to explore discriminating variables between short‐term and long‐term survival. Thirty‐three patients were included, 22 died within 5 years post diagnosis and 11 survived beyond 10 years. QoL data were collected pre‐treatment (baseline), 1‐year post diagnoses and for long‐term survivors 10 years post‐treatment using the EORTC QLQ‐C30. At baseline, there was no difference in terms of FIGO stage, residual tumor and adjuvant chemotherapy. Significantly, more short‐term survivors (96%) had intra operative ascites as compared to long‐term survivors (55%) (p=0.01). Before treatment, short‐term survivors had clinically significantly lower QoL scores on the physical functioning (mean 75.45) and role functioning scale (mean 68.94) compared to long‐term survivors (mean 68.94 and 84.85, respectively). They also reported higher levels of symptoms. One year post‐diagnosis, QoL scores were comparable in most domains. Long‐term survivors had a significantly better global QoL but more insomnia. Emotional functioning and global QoL/health status improved significantly from baseline to 1‐year post‐diagnosis and remained relatively stable at the 10‐year follow‐up. The presence of intra operative ascites and a supporting social network were identified as significant variables that discriminated between short‐term and long‐term survival. Compared to a reference sample, long‐term survivors showed similar QoL scores but more dyspnoea. Although ovarian cancer patients do not belong to the most prevalent survivor populations, we found that long‐term survivors have QoL scores similar to females without a history of cancer.     

A comparison of the clinical determinants of health-related quality of life and subjective well-being in long-term breast cancer survivors

Research concerning long-term breast cancer survivors (BCS) has primarily analysed their health-related quality of life (HRQoL). However, other dimensions of life considered important by patients might be affected by cancer treatments as well. The aim of this paper is thus to compare the clinical determinants of HRQoL and of overall quality of life as described by measures of subjective well-being (SWB) in long-term BCS. SWB represents a person's own evaluation of their overall situation. A total of 321 French BCS diagnosed 5 to 15 years ago participated in a cross-sectional mailed survey. Outcome measures were the physical and mental health scores of the 36-item Short-Form survey and measures of SWB (happiness, life satisfaction and the positive and negative affect scales). Multivariate regression analyses suggest that HRQoL and SWB measures provide different pictures of the experience of breast cancer. Treatment type has no impact on HRQoL but is correlated with all our SWB measures while time since diagnosis positively affects physical health but not SWB. We conclude that it could be fruitful to analyse SWB, alongside the traditional study of HRQoL, in order to enhance our understanding of the various long-lasting consequences of breast cancer.     

Applying a conceptual model for examining health-related quality of life in long-term breast cancer survivors: CALGB study 79804

Objectives: The Survivor's Health and Reaction study used a quality‐of‐life model adapted for cancer survivors by Dow and colleagues to identify factors related to global health‐related quality of life (HRQL) and to document the prevalence of problems and health‐oriented behaviors in a follow‐up study of breast cancer patients who participated in CALGB 8541. Methods: A total of 245 survivors (78% of those invited) who were 9.4–16.5 years post‐diagnosis completed surveys that inquired about current HRQL, economic, spiritual, physical and psychosocial concerns, and health‐oriented behaviors (e.g. smoking, exercise, and supplement use). A regression model was developed to examine factors related to global HRQL across all domains. Results: The regression model revealed that decreased energy levels (odds ratio (OR)=1.05, 95% confidence interval (CI): 1.03, 1.07), having heart disease (OR=5.01, 95% CI: 1.39, 18.1), having two or more co‐morbidities (OR=2.39, 95% CI: 1.10, 5.19), and lower social support (OR=1.03, 95% CI: 1.02, 1.05) were associated with lower global HRQL. Factors related to psychological, spiritual, and economic domains were not predictive of global HRQL. Regarding lifestyle changes, some women reported engaging in health‐oriented behaviors since their cancer diagnosis, such as improving eating habits (54%), increasing exercise (32%), and reducing/quitting smoking (20%). The most prevalent problems reported by women at follow‐up were menopausal symptoms (64%), such as hot flashes and vaginal dryness, osteoporosis (25%), and lymphedema (23%). Conclusion: Suggestions are provided to target interventions, such as provider‐based strategies, in order to improve HRQL in long‐term breast cancer survivors. Copyright © 2008 John Wiley & Sons, Ltd.     

Parental cancer: Health‐related quality of life and current psychosocial support needs of cancer survivors and their children

The presence of cancer and additional parental responsibilities can increase strain for individual patients as well as for their children. The construct of health‐related quality of life (HRQL) is appropriate to measure a combination of physical, mental and social consequences as a result of disease. However, previous research has merely focused on symptom checklists. This study addresses the following questions: (i) does HRQL in children and their parents with cancer differ compared to the general population? (ii) Are there any variables that are associated with HRQL in children? (iii) What are current psychosocial support needs? A population‐based survey of 976 survivors (<6 years post diagnosis) with minor children between 6 and 18 years (n = 1,449) was conducted with two German cancer registries. HRQL was assessed using SF‐8 (survivors) and Kidscreen (children). The results were compared to normative populations, and predictors associated with HRQL in children were evaluated within a multilevel model. We found that the HRQL in children was better compared to the norm. Only children with support needs had worse HRQL. Older age, having a mother with cancer, having a parent not living together with a partner, and worse parental physical and mental health influenced HRQL in children. Illness characteristics were irrelevant. Even with a mean of 3.5 years after diagnosis, survivors had lower physical and mental health compared to the norm. Our findings reinforce the need for health professionals to pay attention to younger patients and their children. Even years after diagnosis, life might not have returned to normal.     

Health‐related quality of life in long‐term breast cancer survivors

BACKGROUND:

The Survivor's Health and Reaction (SHARE) study examined health‐related quality of life (HRQL) in breast cancer patients who had participated in Cancer and Leukemia Group B Trial 8541 from 1985 to 1991.

METHODS:

In total, 245 survivors (78% of eligible patients) who were 9.4 to 16.5 years postdiagnosis (mean, 12.5 years postdiagnosis) completed HRQL surveys relating to 5 domains. Analyses examined HRQL domains according to 3 different chemotherapy dose levels that were administered in the original treatment trial: low‐dose cyclophosphamide, doxorubicin, and fluorouracil (CAF) at 300 mg/m², 30 mg/m², and 300×2 mg/m², respectively, over 4 cycles; standard‐dose CAF at 400 mg/m², 40 mg/m², and 400×2 mg/m², respectively, over 6 cycles; and high‐dose CAF at 600 mg/m², 60 mg/m² and 600×2 mg/m², respectively, over 4 cycles.

RESULTS:

In univariate analyses, a statistically significant difference was observed on the Medical Outcomes Study 36‐item short form Physical Role Functioning subscale by treatment group, with lower mean scores in the standard treatment arm (mean, 65.05) compared with mean scores in the low‐dose arm (mean, 74.66) and the high‐dose arm (mean, 84.94; P.0001). However, multivariate analysis revealed that treatment arm no longer was statistically significant, whereas the following factors were associated with decreased physical role functioning: age ≥60 years (odds ratio [OR], 3.55; P = .006), increased comorbidity interference total score (OR, 1.64; P = .005), lower vitality (OR, 1.05; P = .0002), and increased menopausal symptoms (OR, 1.04 P = .02).

CONCLUSIONS:

At 9.4‐16.5 years after their original diagnosis, differences in physical role functioning among breast cancer survivors who had received 3 different dose levels of chemotherapy were explained by clinical and demographic variables, such as age, fatigue, menopausal symptoms, and comorbidities. Prospective studies are needed to further assess the role of these factors in explaining HRQL and physical role functioning among long‐term survivors. Cancer 2009. © 2009 American Cancer Society.     

疼痛对癌症患者抑郁和生活质量影响的研究

目的了解癌症患者疼痛和抑郁的发生率,疼痛对癌症患者生活质量的影响;探讨癌痛与肿瘤患者发生抑郁的相关性.方法以住院患者为主,采用癌症生活质量自评量表FACT-G、SDS抑郁自评量表、疼痛数字分级法(NRS)以及一般状况评定量表收集癌症患者相关资料.结果本研究入组患者236例,均为病理确诊的癌症患者,其中疼痛的发生率为64.4%,轻、中度痛占55.9%,重度痛占8.5%;抑郁的发生率为34.3%.不同程度的疼痛与身体状况、情感状况和功能状况的损害明显相关(P=0.001,0.047,0.008).疼痛与肿瘤患者的抑郁发生明显相关(P《0.001),癌症患者抑郁的发生率在无痛组、轻度痛组、中度痛组和重度痛组分别为14.3%,7.7%,60%,80%.结论癌症患者中约2/3发生疼痛,1/3发生抑郁.疼痛是影响癌症患者生活质量的主要因素;疼痛与抑郁的发生密切相关.     

Change in health‐related quality of life of newly diagnosed cancer patients,cancer survivors,and controls*

BACKGROUND:

Data from the 1998 Health Outcomes Survey (HOS) of patients who were enrolled in Medicare managed care and follow‐up data from the 2000 HOS resurvey were analyzed to examine changes in health‐related quality of life (HRQOL) of newly diagnosed cancer patients, cancer survivors, and patients without cancer.

METHODS:

In 1998, the HOS was mailed to a random sample of 279,135 beneficiaries, and 167,096 respondents (60%) returned completed surveys. Those who were diagnosed with cancer (22,747) were frequency age‐matched to an equal number of patients with no cancer. In 2000, the HOS was mailed to the same cohort of beneficiaries. Complete data at both baseline and follow‐up were available on 16,850 individuals for inclusion in the current study.

RESULTS:

After 2 years, respondents who had been diagnosed with cancer at baseline continued to have lower scores on all but 3 scales of the 36‐item short‐form HRQOL measure. However, there was no evidence that they were declining any faster than or catching up with noncancer patients. Those who had been newly diagnosed with cancer since the baseline survey had lower mean scale scores than the no‐cancer group on all scales and lower mean scores than the cancer survivors on all subscales except Bodily Pain, Vitality, and Mental Health.

CONCLUSIONS:

This study demonstrated that, after 2 years, cancer survivors continued to have poorer HRQOL than the no‐cancer group. Newly diagnosed cancer patients had poorer quality of life than both the longer term cancer survivors and the no‐cancer group. Cancer 2009. Published 2009 by the American Cancer Society*.     

癌痛及其对癌症患者生活质量影响的调查

目的　探讨癌痛及其对癌症患者生活质量的影响。方法　应用简明健康状况调查表(SF 36简表 )及简明疼痛调查表 (briefpaininventoryBPI)对 2 0 0例住院患者的癌痛情况、癌痛对其生活质量的影响及癌痛的处理进行系统的调查。结果　 (1)疼痛的发生率为 6 9 0 % ,其中轻度疼痛占2 1.5 % ,中度疼痛占 19.0 % ,重度疼痛占 2 8.5 %。 (2 )中、重度疼痛患者中消化道肿瘤比例较高。 (3)疼痛与疾病分期无关 (P >0 .0 5 )。 (4)疼痛的发生与骨转移的存在密切相关 (P <0 .0 1)。 (5 )无论是轻度、中度还是重度疼痛 ,均严重影响患者的日常生活、情绪、行走能力、工作、睡眠 ,且随着疼痛程度的加重 ,影响也逐渐加深。但在对生活乐趣和社交两方面的影响上 ,中度疼痛和重度疼痛差异无显著性 (P >0 .0 5 )。 (6 )中度疼痛对患者精神状态的影响要早于重度疼痛 ,因此在癌症患者的疼痛达到中度时 ,就应在止痛治疗的同时密切配合对其心理上的治疗 ,以期达到更好的疼痛缓解。 (7)在疼痛处理上 ,未经适当处理的占 41.3% ;在重度疼痛中 ,强阿片类药物应用仅达 5 2 .1% ,与WHO要求的阶梯止痛治疗原则差距较大。结论　疼痛是影响生活质量的一个重要因素 ,而癌痛的治疗尚存在较大差距。要达到WHO提出的到 2 0 0 0年使全世界癌症患者     

Possible socioeconomic and ethnic disparities in quality of life in a cohort of breast cancer survivors

Background This paper describes the ethnic and socioeconomic correlates of functioning in a cohort of long-term nonrecurring breast cancer survivors. Methods Participants (n = 804) in this study were women from the Health, Eating, Activity, and Lifestyle (HEAL) Study, a population-based, multicenter, multiethnic, prospective study of women newly diagnosed with in situ or Stages I to IIIA breast cancer. Measurements occurred at three timepoints following diagnosis. Outcomes included standardized measures of functioning (MOS SF-36). Results Overall, these long-term survivors reported values on two physical function subscales of the SF-36 slightly lower than population norms. Black women reported statistically significantly lower physical functioning (PF) scores (P = 0.01), compared with White and Hispanic women, but higher mental health (MH) scores (P < 0.01) compared with White and Hispanic women. In the final adjusted model, race was significantly related to PF, with Black participants and participants in the “Other” ethnic category reporting poorer functioning compared to the White referent group (P < 0.01, 0.05). Not working outside the home, being retired or disabled and being unemployed (on leave, looking for work) were associated with poorer PF compared to currently working (both P < 0.01). Conclusion These data indicate that race/ethnicity influences psychosocial functioning in breast cancer survivors and can be used to identify need for targeted interventions to improve functioning.