Quality of life aspects of bladder cancer: A review of the literature

Not much is generally known regarding the burden imposed by bladder cancer upon patient health-related quality of life (HRQL). The role of HRQL in affecting patient preferences and utility assessment and, ultimately, the selection of therapeutic regimen, or patient satisfaction with that selection, is considered increasingly important by the medical community. Therefore, the main focus of this evaluation was to review the international medical literature to better understand the impact of bladder cancer on patient HRQL. A search was performed using electronic and manual databases for published articles on HRQL and bladder cancer for the years 1966 onward. Thirty-five references dealing with HRQL were analyzed as part of this review. Of these, 29 were published after 1989. Most studies have identified urinary and sexual HRQL domains as being of greatest concern to patients. However, little is known about the short- and long-term impacts of specific therapeutic options for either superficial bladder cancer (SBC) or invasive bladder cancer (IBC). Increased awareness and use of the HRQL instruments such as the FACT-BL as well as the EORTC-QLQ-BLS24 and the EORTC-QLQ-BLM30 (when they are validated for SBC and IBC, respectively), should increase our understanding of the impact of this disease and its management options on patient HRQL.     

食管癌/贲门癌病变患者生命质量随访研究

摘要:目的　评价食管癌/贲门癌病变患者治疗前后生命质量变化情况。方法　以河南林州经早诊早治项目筛查并经病理学确诊的食管癌/贲门癌癌前病变及以上患者为研究对象,运用EQ-5D量表,分别于治疗前、治疗后1、6、12个月进行生命质量评估。结果　共纳入73例癌前病变患者,88例早期癌患者,58例中晚期癌患者。治疗前3组得分分别为（0.90±0.05）、（0.87±0.09）、（0.81±0.17）分,中晚期癌组得分最低（P＜0.01）。治疗后1个月,癌前病变组得分明显降低［（0.85±0.09）分,P＜0.01）］,后逐渐恢复,12个月时超过治疗前［（0.91±0.03）分,P＜0.05）］。早期癌组得分变化趋势与癌前病变组相似,但12个月时仍低于治疗前水平［分别为（0.85±0.15）分和（0.87±0.09）分,P＝0.226）］。治疗后中晚期癌组得分持续下降,6个月时达最低［（0.74±0.28）分,P＜0.05）］,12个月时恢复到治疗前水平［（0.80±0.13）分,P＝0.624）］。结论　食管/贲门癌前病变和早期癌组生命质量始终高于中晚期癌组,提示食管/贲门癌早期识别与治疗有利于提高患者生命质量。     

Changes in health related quality of life among patients treated for eating disorders

Objective: To prospectively investigate changes in the perception of health-related quality of life (HRQoL) among eating disorder patients after 2 years of treatment and follow-up and clinical predictors of change. Method: One hundred and thirty-one consecutive subjects were recruited from an eating disorder outpatient clinic. Subjects completed a generic HRQoL questionnaire, the Short Form-36 (SF-36), as well as the Eating Attitudes Test (EAT-40) to measure symptom severity and the Hospital Anxiety and Depression scale (HAD), at the first visit and after 24 months. Results: Perception of HRQoL, measured by the SF-36, showed significant improvement in all but the role emotional domain after 2 years. The greatest improvements were observed in the physical function and social function domains, followed by mental health and vitality. Despite significant improvement in the summary mental health scale, scores after 2 years of treatment and follow-up were still below normative population values of women aged 18–34. Severity of eating disorder symptoms and presence of anxiety or depression at baseline significantly affected improvement in various SF-36 domains. Conclusions: Despite improvements in perception of HRQoL, eating disorder patients were more dysfunctional in all domains of the SF-36 even after 2 years of treatment and follow-up compared with women in the general population, and the severity of eating disorder symptoms was correlated with degree of dysfunction.     

Quality of life as a prognostic factor of overall survival in patients with advanced hepatocellular carcinoma: results from two French clinical trials

AIM: The aims of our study were to assess quality of life (QoL) as a prognostic factor of overall survival (OS) and to determine whether QoL data improved three prognostic classifications among French patients with advanced hepatocellular carcinoma (HCC). METHODS: We pooled two randomized clinical trials conducted by the Fédération Francophone de Cancérologie Digestive in a palliative setting. In each trial QoL was assessed at baseline using the Spitzer QoL Index (0-10). Three prognostic classifications were calculated: Okuda, Cancer of the Liver Italian Program (CLIP), and Barcelona Clinic Liver Cancer group (BCLC) scores. To explore whether the scores could be improved by including QoL, univariate Cox analyses of all potential baseline predictors were performed. A final multivariate Cox model was constructed including only significant multivariate baseline variables likely to result in improvement of each scoring system. In order to retain the best prognostic variable to add for each score, we compared Akaike information criterion, likelihood ratio, and Harrell's C-index. Cox analyses were stratified for each trial. RESULTS: Among 538 included patients, QoL at baseline was available for 489 patients (90%). Longer median OS was significantly associated with higher Spitzer scores at baseline, ranging from 2.17 months (Spitzer=3) to 8.93 months (Spitzer=10). Variables retained in the multivariate Cox model were: jaundice, hepatomegaly, hepatalgia, portal thrombosis, alphafetoprotein, bilirubin, albumin, small HCC, and Spitzer QoL Index (hazard ratio=0.84 95% CI [0.79-0.90]). According to Harrell's C-index, QoL was the best prognostic variable to add. CLIP plus the Spitzer QoL Index had the most discriminating value (C=0.71). CONCLUSIONS: Our results suggest that QoL is an independent prognostic factor for survival in HCC patients with mainly alcoholic cirrhosis. The prognostic value of CLIP score could be improved by adding Spitzer QOL Index scores.     

中国部分地区关节炎患者生活质量调查

目的　初步评价中国部分地区关节炎患者的生活质量。方法　采用分层随机抽样方法获得关节炎患者 1344例 ,生活质量调查采用关节炎患者生活质量量表 ,填答方式为自填法。结果调查的关节炎患者中 ,各年龄组不同性别患者的生活质量得分差异均无显著性 (P >0 .0 5 ) ;但其中 6 5岁以上女性、受教育年数较少者、月均收入较低者的生活质量得分均相对较差 ;丧偶或离婚者得分也较未婚和已婚者差 (t=9.310 ,P =0 .0 0 1) ;无业者、农民的得分较其他所有职业者低 (P <0 .0 5 ) ;在生理指标方面显示生理指标得分差者 ,生活质量得分也差 ,但对于压痛指数 2、3级者之间生活质量得分差异并无显著性 (平均差数为 4 .910 ,P =0 .76 5 ) ,对于关节肿胀指数 0、1级者之间 (平均差数为16 .30 8,P =0 .0 79)以及 2、3级者之间 (平均差数为 6 .6 4 3,P =0 .5 33)差异也无显著性。结论　关节炎患者整体生活质量的提高不仅有赖于医学水平的提高 ,还有赖于有关部门予以重视 ,并采取完善社会保障制度和农村医疗保障制度 ,提高农村教育水平 ,关注老年生活等有效措施。     

社区两类精神疾病患者生活质量的现况研究

目的 了解宁波市鄞州区精神疾病患者的生活质量及其主要影响因素,为制定公共卫生政策提供依据.方法 2047例研究对象选自宁波市鄞州区24家社区卫生服务中心在册登记的精神疾病患者,所有患者均由所在市级精神卫生诊断机构进行确诊.用生活质量量表对患者进行问卷调查,通过计算研究对象的生活质量评分比较不同性别的各维度生活质量评分,并将生活质量评分作为因变量,利用多因素回归模型分析可能影响精神疾病患者生活质量的因素.结果 2047例患者中,男性905例（44.2％）,女性1 142例（55.8％）.患者生活质量总分为（113.9±17.8）分,男性为（114.2±17.7）分,女性为（113.6±17.9）分,男性在社会维度的生活质量低于女性,差异有统计学意义（P＜0.01）.年龄较大、生活在农村、婚姻状况（未婚、丧偶或离婚）、从未工作过、未参与社会活动是影响精神疾病患者生活质量的危险因素（P＜0.01）;而目前病情稳定、接受药物治疗及无不良反应为保护因素（P＜0.01）.结论 社区精神疾病患者生活质量与多种因素有关.     

Quality of life and pain in Chinese lung cancer patients: Is optimism a moderator or mediator?

Objective To clarify if optimism exerts a primarily moderating or mediating influence on the pain–QoL association in Chinese lung cancer patients. Methods About 334 Chinese lung cancer patients were interviewed at baseline during the first outpatient visit (Baseline), at 4 months after Baseline (FU1), and at 8 months after Baseline (FU2). Respondents completed the Chinese version of the FACT-G version-3 scale (FACT-G (Ch)). Optimism and pain were assessed using two 11-point self-rated items. Linear mixed effects (LME) models tested the moderating and mediating effects of optimism on QoL. Results Optimism, pain, and QoL were most strongly correlated at FU1. LME models failed to show any moderating effect by optimism on the pain–QoL association (standardized β = −0.049, 95% CI −0.097 to 0.001). After adjustment for age, cancer stage, and disease recurrence, a modest mediating effect was observed for optimism on the pain–QoL association over the duration of the study (standardized β = 0.047; Sobel test z = −4.317, p<0.001). Conclusions Optimism qualifies as a mediator between pain and QoL suggesting that pessimistic lung cancer patients are likely to experience greater QoL decrements in response to pain in the early post-diagnostic period. Effective pain control may be enhanced by inclusion of interventions that facilitate optimistic perspectives in patients. This study lends further support to the view that lung cancer patients’ psychological needs are important in both pain control and QoL.     

缺血后处理对急性ST段抬高型心肌梗死患者术后生存质量的随访研究

目的 探讨缺血后处理对急性ST段抬高型心肌梗死患者术后6个月生存质量的变化及影响.方法 选择接受缺血后处理的急性ST段抬高型心肌梗死患者129例,分别于术前、术后6个月采用健康调查简表(SF-36)和特异性西雅图心绞痛量表(SAQ),对患者生存质量予以评价,分析患者术后生存质量的变化及影响因素.结果 经缺血后处理的急性ST段抬高型心肌梗死患者,术后6个月SF-36和SAQ各项评分较术前均有不同程度升高[SF-36:躯体健康总评分(76.4±17.3)分比(56.3±16.8)分、生理功能(75.3±18.1)分比(52.4±19.2)分、生理职能(75.6±16.5)分比(48.5±20.3)分、躯体疼痛(77.2±15.4)分比(58.7±16.6)分、总体健康状态(73.6±17.8)分比(50.6±14.7)分、精神健康总评分(77.5±15.3)分比(55.3±17.3)分、生命力(69.3±18.1)分比(43.2±17.4)分、社会功能(70.3±17.5)分比(41.3±14.2)分、情感职能(80.2±17.4)分比(63.5±14.3)分、精神健康(77.6±18.4)分比(55.6±20.1)分、健康变化(76.3±17.4)分比(53.4±16.6)分;SAQ:躯体活动受限(78.46±12.21)分比(35.34±15.33)分、心绞痛稳定状态(74.23±8.53)分比(30.12±5.38)分、心绞痛发作情况(72.34±10.33)分比(27.33±9.12)分、治疗满意度(76.42±12.13)分比(30.56±15.57)分、疾病认知程度(74.22±9.35)分比(37.25±20.32)分],差异有统计学意义(P＜0.05).采用多元线性回归方程进行评价,结果表明患者年龄越大、血管病变越重、术前躯体健康总评分越低,则术后躯体健康总评分越低,其生存质量越差.结论 缺血后处理的急性ST段抬高型心肌梗死患者术后6个月生存质量较术前明显改善;高龄、血管病变严重及术前低躯体健康总评分是影响患者术后躯体生存质量的危险因素.     

宫颈浸润癌患者术后性生活质量调查分析

目的:调查宫颈浸润癌术后患者性生活质量的变化及影响因素。方法:对2003年1月～2010年1月深圳市人民医院87例经手术治疗的宫颈浸润癌患者进行问卷调查,生存质量量表应用欧洲癌症研究和治疗机构的生存质量量表C30(EORTC QLQ-C30),结果应用t检验,方差分析及逐步回归分析。结果:宫颈癌患者治疗后性生活质量明显下降,影响患者性生活质量的因素包括:年龄、治疗方式、家庭经济、从业状况、文化程度(P<0.05)。结论:宫颈癌患者性生活质量受多因素影响,正确的健康教育有助于患者术后性生活的恢复。     

Health-related quality of life of children and adolescents with chronic illness – a two year prospective study

The aim of this study was to compare the self-reported health-related quality of life (HRQL) of children and adolescents with diabetes, asthma or cystic fibrosis (CF) with the HRQL of a large community sample, to assess the extent to which the HRQL of the children and adolescents with chronic illness changes over time, and to examine the consistency of changes in different HRQL domains. One hundred and twenty three young people aged 10-16 years with asthma, diabetes, or CF were recruited from specialist paediatric clinics. Children rated their HRQL using the Child Health Questionnaire (CHQ) and three disease-specific measures at baseline, 6, 12, 18 and 24 months post-baseline. In several areas, the HRQL of children with chronic illness was significantly worse than that of children in the community sample. Over the 2 years of the study, although children with asthma and diabetes did not report significant changes in CHQ scores rating their physical health, they reported significant improvements in scores rating the extent to which health problems interfered with physical and family activities. CHQ scores describing their physical health reported by children with CF declined significantly but there was no significant change in scores rating interference with physical and family activities.     

甲状腺功能亢进症患者生活质量及其影响因素分析

目的:探讨甲状腺功能亢进症（甲亢）患者生活质量及其影响因素。方法:选取2017年6月至2019年6月海南医学院第一附属医院收治的初次诊断为甲亢的患者作为研究对象,采用世界卫生组织生存质量简表（WHOQOL-BREF）中文版评估患者的生活质量;采用汉密尔顿焦虑量表（HAMA）和汉密尔顿抑郁量表（HAMD）评估患者的心理状...     

Quality of life in breast cancer patients: Validation of a FACT-B Malayalam version

Background: Recent advances in diagnosis and treatment of cancer have led to an increase in cancer survival, and hence, there is a greater emphasis on quality beside quantity of survival. Developing countries too have begun to recognize the need for monitoring quality of life (QOL). However, in most of the developing countries, a validated and reliable tool for the purpose is yet to be realized. Material and method: The functional assessment of chronic illness therapy (FACIT) system is a collection of QOL questionnaires targeted to measure QOL in chronic illness. The functional assessment of cancer therapy for breast cancer (FACT-B) was translated into the local language (Malayalam) and tested for validity and reliability. Results: The tool thus developed showed substantial sensitivity, as does the source tool. The Cronbach's for the total FACT-B was 0.87, which is similar to the of 0.9 observed in the FACT-B English version. The mean FACT-B score was 94.3 compared to 112.8 for the source tool. Conclusion: The Malayalam translation of the FACT-B questionnaire was developed, tested and validated, and was found satisfactory in comparison to the source tool.     

Alcohol drinking and colorectal cancer: A population-based prospective cohort study in China

Study objective: To asses the association between alcohol consumption and the risk of colorectal cancer (CRC) in the Chinese population. Design: A population-based prospective cohort study was initiated from the colorectal cancer screening population in Jiashan County in 1989–1990. The drinking habits of individuals were investigated with demographic information. Setting: A cohort study was followed-up from 1st May 1990 to 1st January 2001 and censored at the date of diagnosis of CRC, at death from any causes, or at 1st January 2001, whichever came first, and the person-time was computed. Participants: Two hundred and forty two CRC patients were diagnosed during the study period and 64,100 individuals finished the follow-up. Results: The distribution of sex, smoking status, occupation, education level and marital status were all significantly different among different drinking habits at baseline. When the above factors were adjusted, no significant association was observed between alcohol consumption and the risk of CRC. Exclusion of individuals diagnosed cancer less than 1 year after the examination date did not alter the strength of an alcohol–CRC relationship. Further analysis in sex strata also did not show a significant relationship. Conclusions: Alcohol drinking may not be associated with a higher risk of CRC in the Chinese population.This revised was published online in April 2005. In the previous version the article category was missing.     

总胆固醇与男性肺癌发病关系的前瞻性队列研究

目的 探讨基线TC与中国男性肺癌发病风险的关联及其强度。方法 自2006年5月,以开滦集团全体在职及离退休男性职工为调查对象,建立开滦集团男性动态队列并随访。基线调查时收集研究对象的社会人口学、个人疾病史、身体测量指标和TC等基线信息,并利用随访收集肺癌发病结局信息。参考《中国成人血脂异常防治指南》与研究人群TC分布特征,TC按照五分位数进行分组：<160、160～、180～、200～、≥240 mg/dl,以TC 160～mg/dl组为参比组,利用Cox比例风险模型分析基线TC与男性肺癌发病风险的关联性、限制性立方样条曲线分析其非线性关系。结果 截至2014年12月31日,109 884名男性进入队列,共计随访763 819.25人年,随访时间M=7.88年,收集肺癌新发病例808例。调整年龄、文化程度、收入、吸烟、饮酒、粉尘暴露史、FPG、BMI后,以160～mg/dl组为对照,TC偏低（<160 mg/dl）和TC升高（≥240 mg/dl）组男性肺癌发生风险分别升高34%（HR=1.34,95% CI：1.04～1.72）和45%（HR=1.45,95% CI：1.09～1.92）。剔除随访2年内肺癌新发病例及有高血脂病史者后,结果无显著变化。结论 TC与男性肺癌发生相关,TC过高或过低男性的肺癌发病风险均升高,保持适当的TC水平可能是预防和控制肺癌的有效措施之一。     

放疗对食管癌患者生活质量的影响

目的评价食管癌放疗患者的短期生活质量。方法在放疗前及放疗后3个月的特定时间,对放疗患者进行EORTC QLQ-C30问卷调查,并计算出放疗后存活3个月以上患者的平均得分（n=38）。结果适形调强放疗组情绪功能、经济困难领域比常规放疗组好,食欲丧失领域较常规放疗组差,差异有统计学意义。与放疗前相比,放疗后生活质量下降但在放疗后3个月内恢复。放疗结束后1天功能及总体生活质量显著性下降,放疗结束后3个月大部分症状及单项项目显著改善。结论放疗对患者生活质量的负性影响是暂时的,QLQ-C30为测量食管癌治疗后生活质量的变化提供了选择。     

Quality of life as conveyed by pediatric patients with cancer

Quality-of-life instruments have provided important advances in measuring the quality of life of pediatric patients receiving treatment for cancer. However, the bases of these instruments have not included first-hand reports from the patients; thus, these instruments may be conceptually incomplete. We directly solicited from pediatric patients their perspectives regarding their quality of life during treatment for cancer. We conducted two pilot studies: 23 patients (aged 8-15 years) participated in the first, a cross-sectional study; and 13 patients (aged 10-18 years) participated in the second, a 2-year longitudinal study. Data were analyzed by using a semantic-content method, and the following six domains were recognized in data from both of the studies: symptoms, usual activities, social/family interactions, health status, mood, and the meaning of being ill. These domains were compared with those of seven established pediatric oncology quality-of-life instruments, none of which included all six of these domains; the domain most frequently missing was the meaning of being ill domain. Here we present a new definition of the quality of life of pediatric oncology patients that is based on six domains; this definition may ensure the completeness and sensitivity of these important instruments.     

基于QLICP-CE（V2.0）量表的宫颈癌患者生命质量及其与临床客观指标的典型相关分析

目的 分析宫颈癌患者生命质量与临床客观指标之间的关系。方法 采用癌症患者生命质量测定量表体系之宫颈癌量表（QLICP-CEV2.0）对186名宫颈癌患者进行调查,采用典型相关分析来研究生命质量得分与其临床客观指标之间的关系。结果 乳腺癌患者生命质量标准得分分别为:总量表（59.97±14.27）,躯体功能领域（55.01±14.85）,心理功能领域（55.55±16.61）,社会功能领域（60.32±14.63）,共性症状与副作用领域（64.76±21.03）,特异模块领域（63.87±24.48）。典型相关分析显示有5对典型变量,其典型相关系数分别为r1=0.419、r2=0.401、r3=0.332、r4=0.292、r5=0.206,前四对P<0.05,前两对典型变量可解释60.742%的信息量。结论 铁、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶/丙氨酸氨基转移酶、乳酸脱氢酶、中性粒细胞百分率、淋巴细胞百分率、单核细胞百分率、白/球蛋白与患者的生命质量具有较高的相关性,临床医生治疗时应予以重视,并综合多方面因素提高宫颈癌患者的生命质量。