Quality of life in patients with advanced non-small cell lung cancer

Quality of life (QOL) has been shown to improve with chemotherapy in patients with advanced non-small cell lung cancer (NSCLC), but the determinants of this improvement have not been thoroughly explored. Fifty consecutive NSCLC patients starting chemotherapy with measurable disease and with an Eastern Co-operative Oncology Group (ECOG) performance status of 相似文献   

Quality of life as a clinical trial endpoint: determining the appropriate interval for repeated assessments in patients with advanced lung cancer

One of the unresolved design issues for clinical trials with quality of life (QOL) as an endpoint is the frequency of measurement in patients with stage III and IV lung cancer. In a retrospective review of clinical trials, the QOL interval varied widely from 1 to 12 weeks during treatment. During follow-up, the interval was generally 2 to 3 months or not at all. The purpose of this methodological study was to determine an appropriate interval for QOL serial measurement based on prospectively collected data. The 20 patients for this study were part of a phase I/II study using combination chemotherapy in patients with advanced non-small cell lung cancer (NSCLC). They were typical of patients in lung cancer clinical trials, with a median age of 67 (interquartile range: 58, 72) years, the majority were male (13, 65%), and a baseline median Karnofsky performance status was 80 (interquartile range: 70%, 90%). The primary instrument, developed in 1985, was the Lung Cancer Symptom Scale (LCSS) patient form, a 9-item self-report and site-specific QOL measure. The method, outcome, and implication of these findings to research are presented for establishing a method for obtaining an appropriate serial measurement interval for QOL during therapy in clinical trials. Based on the findings of this study, an every 3-week QOL assessment for patients with advanced NSCLC provides data similar to more frequent evaluation (94% of data preserved compared to twice-weekly assessment, 95% confidence interval, 86–98%, p=0.05). Less frequent assessment (every 4 or every 6 weeks) retained less than 85% of the data, which is the recommended minimum adequacy rate. Retaining a high percentage of QOL information may lessen the effect of measurement bias due to patient attrition and may give more validity to QOL studies.     

Measuring quality of life in patients with pleural mesothelioma using a modified version of the Lung Cancer Symptom Scale (LCSS): psychometric properties of the LCSS-Meso

Health-related quality of life (QOL) assessment is a key component in patient assessment and the development of therapies for malignant pleural mesothelioma. However, no mesothelioma-specific instrument was available. The Lung Cancer Symptom Scale (LCSS), a site-specific instrument used to assess QOL in patients with lung cancer, was identified as an instrument that could be appropriate. A modified nine-item patient-reported and six-item observer-reported LCSS was incorporated into two clinical trials of pemetrexed in patients with pleural mesothelioma. Basic psychometric properties of feasibility, reliability, and validity were tested. Properties were stable or enhanced by deletion of the hemoptysis item. Feasibility was demonstrated with a high completion rate of 90% by 512 patients. Reliability was acceptable, with good internal consistency for the eight-item measure (alpha coefficient=0.86) and reasonably good for the five-item observer measure (alpha coefficient=0.66); there was also good stability for the patient measure using test–retest (r=0.87). Content validity was supported by a literature review and patient self-report of presenting symptoms (>90% of patients had three or more symptoms). Construct validity was well supported by finding better scores in the higher performance status groups and greater symptom improvement in patients with tumor response, good concordance with the LCSS conceptual model and good explanation of variance for summation items, and a high degree of convergence between the patient and observer forms (r=0.57). Criterion-related validity was supported by predicting survival time, time to progression, and tumor response rate; all three summary items and the total LCSS-Meso score were statistically significant predictors (p<0.005). The LCSS-Meso is a feasible, reliable, and valid instrument to assess health-related QOL in patients with pleural mesothelioma. One item, hemoptysis, was dropped from the original LCSS based on these findings.     

Evaluation of consultation-based rehabilitation for hospitalized cancer patients with functional impairment.

OBJECTIVE: To evaluate prospectively the effect of consultation-based interdisciplinary rehabilitation in hospitalized cancer patients. PATIENTS AND METHODS: Three hundred forty-one hospitalized patients with cancer were referred to the Cancer Adaptation Team (interdisciplinary rehabilitation services) over an 8-month period. Functional status at enrollment and dismissal was evaluated with a Barthel Mobility Index and Karnofsky Performance Status scale. Quality-of-life parameters were evaluated with specifically designed questionnaires. RESULTS: Two hundred ninety patients met the inclusion criteria. One hundred eighty-nine survived and completed the study. Significant functional improvement was observed between enrollment and dismissal on both functional indexes (P< or =.001). Quality-of-life questionnaires, while limited by low completion rate, showed significant improvement on multiple parameters. CONCLUSION: Significant functional gains were observed in hospitalized cancer patients who received interdisciplinary rehabilitation services on a consultation basis.     

Efficacy of an in-home nursing intervention following short-stay breast cancer surgery

This randomized controlled trial (n = 240) was designed to test the efficacy of a sub-acute home nursing intervention following short-stay surgery for breast cancer. Intervention participants received the in-home nursing protocol, whereas non-intervention participants received agency nursing care or no nursing care. Data, collected via questionnaire, telephone interview, and chart audit, included surgical recovery/self-care knowledge, functional status, anxiety, quality of life (QOL), and health service utilization. There were no significant group differences on postoperative functional status, anxiety, QOL, further surgeries, or complications. Intervention participants were more likely to receive instruction on surgical self-care (p 相似文献   

Association of optimism-pessimism with quality of life in patients with head and neck and thyroid cancers

OBJECTIVE: To examine the relationship between optimism-pessimism and quality of life (QOL) in survivors of head and neck and thyroid cancers. PATIENTS AND METHODS: Between 1963 and 2000, 190 patients completed both the Minnesota Multiphasic Personality Inventory (MMPI), used to assess explanatory style (optimism-pessimism), and either the 12-Item or 36-Item Short-Form Health Survey (SF-12 or SF-36), used to assess QOL. The MMPIs were completed an average of 13.4 years before the QOL assessment. The QOL measures were completed an average of 12.5 years after cancer diagnosis. Patients were divided into quartiles based on their MMPI Optimism-Pessimism scale score. Analysis was performed for all patients, those with head and neck cancer, and those with thyroid cancer. Adjustments were made for age, sex, and disease stage. RESULTS: For all 190 patients, optimism was associated with a higher QOL on both the mental and the physical component scales and 6 of 8 subscales of the SF-12 and SF-36. For patients with head and neck cancer, optimism was associated with higher QOL on 3 subscales but neither component scale. For patients with thyroid cancer, optimism was associated with higher QOL on both component scales and 6 subscales. After adjusting for age, sex, and disease stage, optimism was not associated with QOL in the head and neck cancer group. CONCLUSIONS: Optimism was associated with a higher QOL in survivors of thyroid cancer compared with survivors of head and neck cancer. After adjusting for age, sex, and disease stage, optimism was not associated with QOL for survivors of head and neck cancer. Optimism was more associated with the mental rather than physical QOL subscales.     

羟考酮控释片（奥施康定）缓解癌痛及改善肺癌患者生活质量的观察

目的：评价羟考酮控释片在治疗慢性癌痛中的疗效及安全性。同时观察伴随疼痛的肺癌患者在接受奥施康定镇痛治疗后其生活质量的改善情况。方法：疼痛的评价采用0-10数字疼痛强度评分法，并记录剂量滴定达稳态时间和维持剂量。采用生活质量量表EORT CQLQ-C30（V3．0）中文版对其中28名肺癌患者治疗前后的生活质量进行了评估。结果：入组的48例患者中，有46例可评价疗效及安全性。其中42例（87．5％）患者达到了满意的疼痛缓解，平均滴定达稳态时间为2．1天。用药期间，25名（52．1％）患者曾经发生至少1种不良反应。在疼痛缓解的同时，大多数肺癌患者的生活质量得到了改善。结论：奥施康定用于治疗中重度癌性疼痛是安全有效的；它能改善肺癌疼痛病人的生活质量。     

老年大肠癌术后生存质量现状评估

目的评估老年大肠癌术后生存质量的现状，提高患者的生存质量。方法根据Chewwon Wu评分表，通过特定设计的调查问卷进行评估。结果大肠癌术后患者的生理、社会和心理上的健康状况受到影响。结论应将QOL评估应用到临床治疗、护理实践中，提高患者生存质量。     

Health-related quality of life and disability in young patients with spina bifida

OBJECTIVES: To assess the health-related quality of life (QOL) and disability in young patients with spina bifida and to correlate them with the clinical examination findings. DESIGN: Prospective multidimensional study by means of (1) clinical assessment, (2) self-administered questionnaire for general health, and (3) standardized disability measurements. Relationships between disability measurement, patient-oriented examination, and conventional clinical assessment were evaluated. SETTING: Pediatric department at a university hospital in Italy. PATIENTS: Twelve consecutive young patients with spina bifida (mean age, 15.2 y; range, 14-18 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Medical Outcomes Study 36-Item Short-Form Health Survey, the FIM trade mark instrument, and the Barthel Index. RESULTS: As expected, disability was inversely related (r=.72, P<.02) to the physical aspect of QOL. Unexpectedly, for the mental aspects of QOL, less disability was associated (r=-.70, P<.05) with higher psychologic distress and severe role disability because of emotional problems. The findings at clinical examination, especially proximal deficit of inferior limbs (r=-.70, P<.05), were usually related to higher disability and lower physical aspects of QOL. CONCLUSION: There was no linear inverse correlation between disability and QOL in patients with spina bifida. Patients with mild disability needed as much psychologic support as patients with severe whole disability.     

Relationship Between Quality of Life and Dysarthria in Patients With Multiple Sclerosis

Objective

To evaluate dysarthria and dysarthria-related quality of life (QOL) and analyze its relations with duration of disease, severity, and general QOL in patients with multiple sclerosis (MS).

Design

Cross-sectional observational study.

Setting

Rehabilitation center.

Participants

Consecutive patients with MS (N=163) were recruited (mean age, 52±10.4y; mean MS duration, 19±10.4y).

Interventions

Not applicable.

Main Outcome Measures

Presence of dysarthria; dysarthria characteristics; MS severity and duration; and dysarthria-related and generic QOL were evaluated by means of the therapy outcome measure scale; Robertson profile; Expanded Disability Status Scale (EDSS), years of disease; QOL of the dysarthric speaker questionnaire; and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), respectively.

Results

The mean EDSS score was 6.5±1.3. Dysarthria affected 57 (35%) of the 163 patients. Dysarthria severity was mild in most of the 57 patients with dysarthria. Median Robertson profile scores were slightly but significantly higher in the nondysarthric group compared with the dysarthric group (P=.001). The QOL for the dysarthric speaker questionnaire was significantly more compromised in patients with dysarthria (P=.001). No difference on the SF-36 scores between patients with and without dysarthria was found, with the exception of the physical activity and physical pain subscales. The QOL for the dysarthric speaker questionnaire showed no correlation with MS duration and a weak correlation with EDSS score (r=.25). Correlations between the SF-36 and QOL for the dysarthric speaker scores were few and weak, with the exception of the role limitations because of emotions (r=−.428) and mental health subscales (r=−.383).

Conclusions

Dysarthria-related QOL is compromised in patients with MS and dysarthria and might be used as a supplementary measure in clinical practice and research for patients who have MS.     

同步放化疗肺癌患者生活质量及其影响因素分析

目的 评价同步放化疗后肺癌患者的生活质量及其影响因素.方法 采用癌症患者生存质量测定量表3.0版对43例肺癌患者同步放化疗结束时的生活质量及其影响因素进行调查.结果 肺癌患者同步放化疗结束时,其总体健康状况/生活质量及各功能领域得分均较低;总体健康状况/生活质量及各功能领域得分之间存在不同程度的正相关关系;多元线性回归分析显示,患者的年龄、吸烟史、治疗期间疲乏及贫血程度等与患者的生活质量有关(P<0.05).结论 肺癌患者同步放化疗结束时的生活质量较低;减轻患者的疲乏、纠正贫血和积极戒烟将有助于改善患者的生活质量.     

Risk factors predictive of chronic postsurgical neuropathic pain: the value of the iliac crest bone harvest model

Nerve lesions and secondary hyperalgesia may both be present after surgery, and their relative contributions to chronic postsurgical neuropathic pain (CPSNP) remain unclear. This prospective study explored the roles of these factors in the development of CPSNP after iliac crest bone harvest. CPSNP was defined as pain in the area of hypoesthesia, with a positive Douleur neuropathique 4 questionnaire (DN4) score 3 months after iliac crest bone harvest. The location, intensity, and neuropathic characteristics of pain were evaluated in 82 patients who were followed for 6 months. Neuropathic characteristics were assessed by clinical examination and DN4 questionnaire. The area of secondary hyperalgesia was evaluated 48 h and 1 month after surgery. The area of mechanical hypoesthesia, detection, and mechanical pain threshold were evaluated at 48 h and at 1 and 3 months. Nineteen patients (23%) had CPSNP at 3 months. The patients who developed CPSNP had a larger area of secondary hyperalgesia at 48 h (88 cm(2) vs 33 cm(2); P=.001), higher pain intensity (numerical rating scale 6.7 vs 4.7; P=.02), and higher neuropathic characteristics score on the DN4 questionnaire (4.3 vs 2.3; P=.001). However, neither the area nor the severity of hypoesthesia differed significantly between patients with and without CPSNP. Two independent, additive predictors of CPSNP were identified: area of secondary hyperalgesia (odds ratio 1.02; P=.004) and DN4 score (odds ratio 1.94; P=.001). These findings suggest that both nerve lesions and central sensitization are involved in CPSNP development and could be seen as early warning signs.     

Psychometric properties of the Dutch Chronic Fatigue Syndrome--Activities and Participation Questionnaire (CFS-APQ)

BACKGROUND AND PURPOSE: The Chronic Fatigue Syndrome-Activities and Participation Questionnaire (CFS-APQ) is a recently developed disease-specific assessment tool for monitoring activity limitations and participation restrictions in patients with chronic fatigue syndrome (CFS). In this study, the convergent validity, content validity, and test-retest reliability of data obtained with the Dutch-language version of the questionnaire were examined. SUBJECTS AND METHODS: One hundred eleven consecutive patients with CFS were enrolled, of whom 47 fulfilled all inclusion criteria. The subjects were first asked to rate their pain, fatigue, and ability to concentrate using 3 visual analog scales, to list at least 5 activities that had become difficult to perform due to their complaints, and to complete the CFS-APQ. Furthermore, subjects were asked to complete a modified version of the CFS-APQ at home and return it to the investigators. The content of the questionnaire was reviewed using the World Health Organization's International Classification of Impairments, Disability and Health (ICIDH) beta II draft. Spearman rank correlation coefficients (R) were used for the convergent validity analysis, and intraclass correlation coefficients were computed for the assessment of the test-retest data. RESULTS: Overall scores on the CFS-APQ correlated with the scores from the visual analog scales for pain (R=.51, P<.001) and fatigue (R=.50, P<.001). The majority of the responses (157 out of 183 answers [85.8%]) to the request to "list difficult activities" matched the content of the CFS-APQ. Using the ICIDH beta II draft, 21 out of 26 questions were found to address activities, and the remaining 5 questions measured the participation level. The Cronbach alpha coefficient was.94, and intraclass correlation coefficients for test-retest reliability of the overall scores were >or= .95 (P<.001). DISCUSSION AND CONCLUSION: The results substantiate the convergent validity, content validity, and reliability of the CFS-APQ scores for patients with CFS.     

A multicenter study of burnout, depression, and quality of life in minority and nonminority US medical students

OBJECTIVE: To determine the well-being of minority medical students in a multicenter sample of US medical students. PARTICIPANTS AND METHODS: All 1098 medical students at 3 medical schools in Minnesota were surveyed in April 2004. Validated instruments were used to assess burnout, depression, and quality of life (QOL). Students were also asked about the prevalence of significant personal life events in the previous 12 months and strategies used to cope with stress. RESULTS: Although symptoms of depression and overall burnout were similar among minority and nonminority students, minority students were more likely to have a low sense of personal accomplishment (P=.02) and lower QOL In a number of domains (all P< or =.05). These differences persisted on multivariate analysis that controlled for demographic characteristics and recent life events. Minority students were also more likely to have a child (P=.01), originate from outside Minnesota (P<.001), and experience a major personal Illness in the last 12 months (P=.03). CONCLUSION: As a group, the minority medical students in this survey had a lower sense of personal accomplishment and QOL than nonminority students. Additional studies are needed to provide insight regarding the causes of these inequities and the unique challenges faced by minority medical students. Efforts to improve minority students' well-being, QOL, and learning experience may help prevent attrition among minority medical students and promote diversification in the physician workforce.     

The effects of a new foot-toe orthosis in treating painful hallux valgus

OBJECTIVE: To assess the effects of a new foot-toe orthosis on painful hallux valgus. DESIGN: Uncontrolled intervention study. SETTING: An outpatient clinic in a tertiary medical center with an orthotic laboratory in Taiwan. PARTICIPANTS: Seventeen patients with painful hallux valgus. INTERVENTION: Application of a new total contact insole with fixed toe separator. MAIN OUTCOME MEASURES: The hallux valgus angle, an 11-point numeric rating scale (NRS-11) for pain assessment, and walking ability scale. RESULTS: The average hallux valgus angle reduction +/- standard deviation was 6.5 degrees +/-3.8 degrees after insole application (P<.001). An improvement on the NRS-11 pain scale from 4.06+/-2.8 to 0.88+/-1.17 (P<.001) was noted after immediate insole application and was.42+/-.67 (P=.002) 3 months later for the 12 patients who completed the study. The walking ability scale improved at least 1 grade or more after the insole was worn for 3 months (P=.002). All patients tolerated the insole well without any clinical evidence of skin ulcers or blisters. CONCLUSION: Our new total contact insole with fixed toe separator reduced pain, and improved walking ability and the hallux valgus angle. It is an effective alternative treatment for patients with painful hallux valgus.     

Inpatient rehabilitation outcome after hip fracture surgery in elderly patients: a prospective cohort study of 946 patients

OBJECTIVE: To identify the factors associated with inpatient rehabilitation outcome after surgical repair of hip fracture in elderly patients. DESIGN: A noninterventional prospective cohort study. SETTING: Geriatric inpatient rehabilitation center in a tertiary university medical center in southern Israel. PARTICIPANTS: Patients (N=946) aged 65 years of age or older who were hospitalized for rehabilitation after surgery for hip fracture. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional studies by the FIM instrument and a broad spectrum of clinical, demographic, and social variables. Stepwise multiple regression was used to assess the relative contribution of the variables to the variance of the percentage change in the FIM score during the course of rehabilitation in relation to the severity of the functional impairment at its inception. RESULTS: Eight variables were significantly and independently associated with rehabilitation outcome. Prefracture FIM scale (standardized regression coefficient in multiple regression [beta]=.261, P<.001), serum albumin at discharge (beta=.222, P<.001), Folstein Mini-Mental State Examination (beta=.174, P<.001), visual impairment (beta=-.089, P=.002), dyspnea at mild exertion (New York Heart Association class III) (beta=-.080, P=.005), age (beta=-.080, P=.007), poststroke motor impairment (beta=-.072, P=.011), and decreased serum folic acid (beta=-.055, P=.047). The total percentage of the explained variance of the primary rehabilitation outcome measure accounted for by these 8 variables (adjusted R(2)) was 31.9%. CONCLUSIONS: The outcome of rehabilitation of elderly patients after surgical repair of hip fracture is associated with 4 clinical and nutritional correctable parameters. The other 4 variables that are associated with the process cannot be corrected but may help predict outcomes and adjust expectations.     

接纳与承诺疗法用于干预终末期癌痛患者的效果

目的 探讨接纳与承诺疗法(ACT)用于干预终末期癌痛患者的效果.方法 选取2018年1月至2019年1月在江苏省肿瘤医院进行终末期癌痛护理的100例患者,随机分为对照组与研究组,每组50例.两组患者入院后均行常规镇痛治疗与常规终末期癌痛护理,研究组另给予以接纳与承诺疗法为核心的心理灵活性护理.通过对比两组患者的生活质量...