No Influence of Surgical Volume on Patients’ Health-Related Quality of Life After Esophageal Cancer Resection

Background  Studies on factors that can counteract the negative impact of esophagectomy on patients’ health-related quality of life (HRQL) have been sparse. This study was undertaken to examine the question whether hospital or surgeon volume influences HRQL as evaluated 6 months after such surgery. Materials and Methods  A Swedish prospective, population-based cohort study of esophageal cancer patients treated surgically in 2001–2005 was conducted. All patients completed validated HRQL questionnaires, developed by EORTC, addressing general HRQL (QLQ-C30) and esophageal-specific symptoms (QLQ-OES18), 6 months postoperatively. Mean scores with 95% confidence intervals were calculated. Clinically relevant mean score differences (≥10) between groups were further analyzed in a linear regression model, adjusted for several potential confounders. Results  Some 355 patients were included (80% of eligible). No clinically relevant differences were found between low-volume (0–9 operations/year) and high-volume hospitals (>9 operations/year) or between low-volume (0–6 operations/year) and high-volume surgeons (>6 operations/year). Stratified analyses for tumor location did not reveal any differences between hospital or surgeon volume groups. Moreover, no material differences were found between the four individual high-volume hospitals. Conclusion  This study revealed no HRQL advantages of being treated at high-volume hospitals or by high-volume surgeons, as measured 6 months after esophageal cancer resection.     

Assessing the Quality of Life in Breast Cancer Women: A Cross Sectional Descriptive Study

Background: To assess the quality of life in Iraqi breast cancer women with regard to different Sociodemographic and medical variables. Methods: A cross sectional study was conducted on 150 women diagnosed with breast cancer and being treated in Iraq. The evaluation was done by using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire- Core- 30 (EORTC QLQ-C30) and QOL_BR23 Questionnaire. All data were conducted directly via hand writing by the patients at the Oncology Teaching Hospital/Medical City complex in Baghdad. When the questionnaire questions were completed by each participant, they were checked up to ensure their suitability for data insertion and then followed by the scoring manual of the EORTC questionnaire. All the data were analyzed by using SPSS. Results: Most of the patients undergoing this study were at the age of ≤ 50 (52.66%), and when they were diagnosed with breast cancer, they were younger than 50 (58.66%). The global health status was high in the case of working participants compared with those who are unemployed, i.e., (p=0.035). However, the emotional status appeared to be significant in the case with the working participants (P= 0.027). Also, the global status appeared to be high in the participants receiving radiation, while it showed insignificant values with the other data. The physical functioning, on the other hand, showed significant results in many places, as in the case with the patients present with no health problems, and high results in radiation, herceptin and hormonal therapy. As for the role functioning, it showed significant results in patients without health problems, patients who underwent radiation, and patients who were free of disease for less than five yeas. Conclusions: The results of this study will help identify gaps in all areas in which patients need additional support. Since the negative effects of the disease and related treatments influenced the patient’s quality of life, it has become necessary for health care providers to focus on designing social and psychological interventions to support cancer patients throughout their illness and treatment in a way that it leads to a better adaptation to their disease and improve their emotional status.     

Validation of the Korean version of the EORTC QLQ-C30

This study evaluated the Korean version of the EORTC QLQ-C30 (version 3.0) in terms of psychometric properties and its validation. One hundred and seventy patients completed three questionnaires EORTC QLQ-C30, the Beck depression inventory (BDI), and a brief pain inventory (BPI). Multitrait scaling analyses demonstrated that all scales met multidimensional conceptualization criteria, in terms of convergence and discrimination validity. Cronbach's alpha coefficients for eight multiple-item scales were greater than 0.70, with the exception of cognitive functioning. All interscale correlations were statistically significant in the expected direction (p < 0.01). Multivariate analyses showed that physical and emotional functioning were significant explanatory variables for the global quality-of-life (QOL) scale (regression coefficients: 0.36, p < 0.001; and 0.37, p < 0.001; respectively). All scales were significantly associated with pain severity and interference of the BPI, and with the cognitive-affective and somatic scales of the BDI. The emotional-functioning scale was substantially correlated with the cognitive-affective scale and somatic scale of the BDI. These results demonstrate that the Korean version of the EORTC QLQ-C30 is a valid instrument for evaluating Korean-speaking patients with cancer, and can be used to distinguish clearly between subgroups of patients of differing performance status.     

Spectrophotometric Skin Measurements Correlate with EORTC/RTOG-Common Toxicity Criteria

Purpose: It was investigated whether the elementary EORTC/RTOG-CTC score (Common Toxicity Criteria) for radiotherapy skin reactions correlates with spectrophotometric measurements of the skin color. Patients, Material, and Methods: In 41 patients irradiated for unilateral breast cancer the regular scoring by CTC was done during radiotherapy. In parallel, a total of 4,920 spectrophotometric measurements to determine the skin color were performed at baseline, at the beginning of radiotherapy, and at 20, 40 and 60 Gy. The nonirradiated contralateral breast was used for control measurements. Results: As expected, the skin color (especially red) depended on the radiation dose applied to the skin. The objective spectrophotometric measurements were found to correlate well with the subjective CTC scores. Conclusion: For classification of acute radiation toxicity there seems to be no need to replace the common CTC scoring by technical methods.*F.M. and S.B. contributed equally as first authors.     

Cross-cultural application of the Korean version of the European Organization for Research and Treatment of Cancer (EORTC) Breast-Cancer-Specific Quality of Life Questionnaire (EORTC QLQ-BR23)

The aim of this study was to evaluate the psychometric properties of the Korean version of the European Organization for Research and Treatment of Cancer Breast-Cancer-Specific Quality of Life Questionnaire (EORTC QLQ-BR23). A total of 153 patients with breast cancer and 153 normal subjects completed three questionnaires of the Korean version of the EORTC QLQ-BR23. Multitrait scaling analyses demonstrated that all scales met multidimensional conceptualization criteria in terms of convergence and discrimination validity. Cronbachs alpha coefficients for five multiple-item scales were greater than 0.70 (range, 0.72–0.91). In known-group comparisons, there were marked group differences between patients differing in disease stage. In breast cancer patients, performance on the questionnaires was in the expected direction for almost all functioning and symptom scores. In addition, comparison between the patient and control groups showed that almost all variables discriminated between patients and normal individuals. In conclusion, the Korean version of the EORTC QLQ-BR23 was found to be a reliable and valid measure of quality of life in breast cancer patients, indicating that it should be used in clinical and epidemiological cancer research.     

肿瘤危险因素评分对非肌层浸润性膀胱肿瘤预后判断的价值（附248例报告）

目的：评价膀胱肿瘤复发及进展评分对非肌层浸润性膀胱肿瘤预后判断的价值。方法：收集自2006年7月～2010年3月于我院接受腔内治疗的248例T0和T1期膀胱肿瘤患者临床资料,记录肿瘤数量、肿瘤大小、肿瘤临床分期、病理级别、既往有无肿瘤复发及有无伴随原位癌等相关资料,以EORTC（The European Organization for Research and Treatment of Cancer）肿瘤风险评分表对患者评分,随访术后患者肿瘤复发及进展情况。结果：本组肿瘤复发危险评分为O～15分,平均（4．37±2．93）分;肿瘤进展危险得分为0～23分。平均（5．21±3．95）分。随访3～60个月,平均（25．8±18．5）个月,共有123例（49．6％）肿瘤复发,平均（11．4±6．5）个月。87例（70．7％）于1年内肿瘤复发,36例（29．3％）复发超过1年。24例（19．5％）肿瘤进展[平均（9．8±6．2）个月]。复发评分0～2分者肿瘤复发不足20％,进展评分0～2分者肿瘤无进展。3分者肿瘤进展率为6．1％。肿瘤数量是肿瘤复发与进展的首要危险因素,相对危险度分别为2．229和5．246。结论：肿瘤复发及进展评分可简便准确地判断非肌层浸润性膀胱肿瘤患者预后,但仍有修改与完善的必要。     

Development and psychometric validation of a shorter version of the Breast Cancer Treatment Outcome Scale (BCTOS-12)

ObjectivesAesthetic and functional outcomes after oncoplastic breast-conserving surgery (BCS) are directly related to the patients' quality of life (QoL). The Breast Cancer Treatment Outcome Scale (BCTOS) is a validated but burdensome questionnaire for the assessment of these outcomes. The aim of the study was to strengthen and focus the BCTOS instrument by reducing the number of items and subscales without loss of information and validity.MethodsThis study used a dataset of 871 patients with stage 0 – III breast cancer, from a prospective cohort study, who underwent BCS. We investigated correlations and other criteria of homogeneity of the BCTOS items to identify redundancies. An exploratory factor analysis was used to remodel the item-factor structure. Correlation and linear regression analysis with validated QoL subscales assessed the convergent and discriminant validity of the modified BCTOS structure.ResultsThe factor analysis revealed two distinct subscales for aesthetic and functional outcomes. It was possible to reduce the 22 items of the original BCTOS to 12 items, thus the “BCTOS-12”. The two new scales had very good internal consistency: Cronbach's α = 0.86 for the new Aesthetic Status subscale and α = 0.81 for the new Functional Status subscale. Bootstrapping confirmed the item-factor structure for all 10,000 samples, remarkably.ConclusionThe modified BCTOS questionnaire with only 12 items (BCTOS-12) is shorter, easier to interpret, and shows good validity.     

Surgical treatment for non-parasitic liver cysts improves quality of life

Background&purposeLiver cysts occur frequently. Most are harmless, however some carry a significant patient burden. Optimizing treatment strategy is complicated as needs differ between patients. The current study assesses the effect of surgery on quality of life (QoL) of patients with non-parasitic liver cysts.MethodsA retrospective cohort study of all patients who underwent surgery for non-parasitic liver cysts in three major Dutch medical centers from 1993 to 2017. Patient characteristics and surgery related variables were collected from the electronic patient file. QoL was measured before and after surgery using the EORTC QLQ-C30. Summary scores (SumSc) were calculated and compared to reference values of the general population. Multivariate analysis using logistic regression was performed for identifying outcome related factors. Increase of ≥ 10% in SumSc was defined as clinically relevant.Main findingsEighty-eight of 132 eligible patients (67%) completed two QoL assessments. Respondents demonstrated significant improvement in the global health status, on all 5 functional scales (all p ≤ 0.005), on all 9 symptom scales after surgery (all p < 0.05), and on SumSc (p < 0.001) to levels similar or better than the general population. Patients with complications demonstrated a significant QoL gain (p < 0.05), and reported a similar postoperative status compared to patients without complications (p = 0.74). QoL gain for patients who underwent open and laparoscopic cyst fenestration were similar (p = 0.08). Multivariate analysis of SumSc found mechanical complaints as significant factor for ≥ 10% SumSc increase (OR 0.11, 95% CI (0.02–0.55).ConclusionsSurgery is a safe and effective strategy to significantly improve QoL in patients with symptomatic liver cysts.