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Chintapalli R. Physical Health-Related Quality of Life and Postsurgical Outcomes in Brain Tumor Resection Patients. Asian J Neurosurg 2024; 19:412-418. [PMID: 39205899 PMCID: PMC11349402 DOI: 10.1055/s-0044-1787674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Background Patient-reported outcome measures (PROMs) have gained traction in assessing patients' health around surgery. Among these, the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29) is a widely accepted tool for evaluating overall health, yet its applicability in cranial neurosurgery remains uncertain. Objective This study aimed to evaluate the predictive value of preoperative PROMIS-29 scores for postoperative outcomes in patients undergoing brain tumor resection. Materials and Methods We identified adult patients undergoing brain tumor resection at a single neurosurgical center between January 2018 and December 2021. We analyzed physical health (PH) summary scores to determine optimal thresholds for predicting length of stay (LOS), discharge disposition (DD), and 30-day readmission. Bivariate analyses were conducted to examine the distribution of PH scores based on patient characteristics. Multivariate logistic regression models were employed to assess the association between preoperative PH scores and short-term postoperative outcomes. Results Among 157 patients (mean age 55.4 years, 58.0% female), 14.6% exhibited low PH summary scores. Additionally, 5.7% experienced prolonged LOS, 37.6% had nonroutine DDs, and 19.1% were readmitted within 30 days. Bivariate analyses indicated that patients with low PH summary scores, indicating poorer baseline PH, were more likely to have malignant tumors, nonelective admissions, and adverse outcomes. In multivariate analysis, low PH summary scores independently predicted increased odds of prolonged LOS (odds ratio [OR] = 6.09, p = 0.003), nonroutine DD (OR = 4.25, p = 0.020), and 30-day readmission (OR = 3.93, p = 0.020). Conclusion The PROMIS-29 PH summary score serves as a valuable predictor of short-term postoperative outcomes in brain tumor patients. Integrating this score into clinical practice can enhance the ability to anticipate meaningful postoperative results.
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Affiliation(s)
- Renuka Chintapalli
- School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Cambridge, United Kingdom
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Kumar R, Gothi D, Anand S, Khan S, Malhotra N. Survival among patients with lung cancer managed at a tertiary care center in North India. Monaldi Arch Chest Dis 2024. [PMID: 39077862 DOI: 10.4081/monaldi.2024.3045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/24/2024] [Indexed: 07/31/2024] Open
Abstract
Though there has been advancement in the management of lung cancer, it is not well utilized due to its limited availability and high cost. This is a prospective observational study done at a tertiary care center from January 2014 to December 2022, involving patients with primary lung cancer. After tumor-node-metastasis staging and molecular testing, the patients received chemotherapy, radiotherapy, surgery, targeted therapy, and immunotherapy in various combinations as per the prevailing National Comprehensive Cancer Network Guidelines. 92 patients were enrolled in the study, with the mean age being 58.94±10.33 and 72 (78.26%) being males. 69 (75%) patients were either current or former smokers. 78 (84.78%) patients had an Eastern Cooperative Oncology Group (ECOG) score of 0-2 while the remaining had an ECOG of 3-4. 80 (86.95%) patients had non-small cell lung cancer (NSCLC) [44 (47.83%) adenocarcinoma, 25 (27.17%) squamous cell carcinoma, and 11 (11.95%) NSCLC: not otherwise specified], while 12 (13.04%) patients had small cell lung cancer. One (1.08%) patient each presented in stage I and stage II, 31 (33.69%) patients presented in stage III, and 59 (64.13%) patients presented in stage IV. 44 patients with adenocarcinoma were subjected to mutational analysis, and an epidermal growth factor receptor mutation was found in 13 (29.5%) patients. None of the patients had ALK mutation, ROS-1 rearrangement, or BRAF mutation. PD-L1 expression was evaluated in 9 patients with NSCLC, and it was found in 6 (66.66%) patients. The overall mean survival was 12.7 months. The mean survival for patients with stages I, II, III, and IV was 70, 96, 8.1, and 12.7 months, respectively. Survival in stage IV was better than in stage III, as the eligible patients received targeted therapy and immunotherapy. Targeted therapy and immunotherapy have improved survival. Molecular analysis should be done whenever indicated, and eligible patients must be administered targeted therapy and immunotherapy.
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Affiliation(s)
- Rahul Kumar
- Department of Pulmonary, Critical Care and Sleep Medicine, ESI-PGIMSR, Basaidarapur, New Delhi.
| | - Dipti Gothi
- Department of Pulmonary, Critical Care and Sleep Medicine, ESI-PGIMSR, Basaidarapur, New Delhi.
| | - Shweta Anand
- Department of Chest and Respiratory Medicine, Delhi State Cancer Institute, Delhi.
| | - Shazia Khan
- Department of Pulmonary Medicine, American International Institute of Medical Sciences, Udaipur, Rajasthan.
| | - Nipun Malhotra
- Department of Pulmonary, Critical Care and Sleep Medicine, ESI-PGIMSR, Basaidarapur, New Delhi.
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Chakravarti S, Kuo CC, Kazemi F, Kang A, Lucas CH, Croog V, Kamson D, Schreck KC, Holdhoff M, Bettegowda C, Mukherjee D. Preoperative patient-reported physical health-related quality of life predicts short-term postoperative outcomes in brain tumor patients. J Neurooncol 2024; 167:477-485. [PMID: 38436894 DOI: 10.1007/s11060-024-04627-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/29/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are increasingly used to assess patients' perioperative health. The PROM Information System 29 (PROMIS-29) is a well-validated global health assessment instrument for patient physical health, though its utility in cranial neurosurgery is unclear. OBJECTIVE To investigate the utility of preoperative PROMIS-29 physical health (PH) summary scores in predicting postoperative outcomes in brain tumor patients. METHODS Adult brain tumor patients undergoing resection at a single institution (January 2018-December 2021) were identified and prospectively received PROMIS-29 surveys during pre-operative visits. PH summary scores were constructed and optimum prediction thresholds for length of stay (LOS), discharge disposition (DD), and 30-day readmission were approximated by finding the Youden index of the associated receiver operating characteristic curves. Bivariate analyses were used to study the distribution of low (z-score≤-1) versus high (z-score>-1) PH scores according to baseline characteristics. Logistic regression models quantified the association between preoperative PH summary scores and post-operative outcomes. RESULTS A total of 157 brain tumor patients were identified (mean age 55.4±15.4 years; 58.0% female; mean PH score 45.5+10.5). Outcomes included prolonged LOS (24.8%), non-routine discharge disposition (37.6%), and 30-day readmission (19.1%). On bivariate analysis, patients with low PH scores were significantly more likely to be diagnosed with a high-grade tumor (69.6% vs 38.85%, p=0.010) and less likely to have elective surgery (34.8% vs 70.9%, p=0.002). Low PH score was associated with prolonged LOS (26.1% vs 22%, p<0.001), nonroutine discharge (73.9% vs 31.3%, p<0.001) and 30-day readmission (43.5% vs 14.9%, p=0.003). In multivariate analysis, low PH scores predicted greater LOS (odds ratio [OR]=6.09, p=0.003), nonroutine discharge (OR=4.25, p=0.020), and 30-day readmission (OR=3.93, p=0.020). CONCLUSION The PROMIS-29 PH summary score predicts short-term postoperative outcomes in brain tumor patients and may be incorporated into prospective clinical workflows.
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Affiliation(s)
- Sachiv Chakravarti
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Cathleen C Kuo
- Jacobs School of Medicine And Biomedical Sciences, Buffalo, NY, United States
| | - Foad Kazemi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ashley Kang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Calixto-Hope Lucas
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Victoria Croog
- Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - David Kamson
- Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Karisa C Schreck
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Matthias Holdhoff
- Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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Dağdelen D, Zincir H. Effects of dependent care theory-based post-surgical home care intervention on self-care, symptoms, and caregiver burden in patients with primary brain tumor and their caregivers: a randomized controlled trial. Support Care Cancer 2024; 32:296. [PMID: 38635060 PMCID: PMC11026272 DOI: 10.1007/s00520-024-08488-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE This study aimed to examine the effect of dependent care theory-based post-surgical home care intervention on self-care, symptoms, and caregiver burden in primary brain tumor patients and their caregivers. METHODS A parallel-group randomized controlled trial was conducted with patients who underwent surgery for a primary brain tumor between March 2019 and January 2020 in a tertiary hospital and with caregivers who cared for them at home. Eligible patients and caregivers were determined by block randomization. Outcome measures included validated measures of self-care agency (Self-Care Agency Scale), symptoms and interference by symptoms (MD Anderson Symptom Inventory Brain Tumor-Turkish Form), and caregiver burden (Caregiver Burden Scale). Two-way analysis of variance was used in repeated measurements from general linear models compared to scale scores. RESULTS Self-care agency was significantly higher in the intervention group than in the control group in the first and sixth months after surgery (p < 0.05). The severity of the patients' emotional, focal neurologic, and cognitive symptoms and interference by symptoms were significantly lower in the intervention group than in the control group (p < 0.05). Caregiver burden was significantly lower in the intervention group in the first, third, and sixth months after surgery (p < 0.05). CONCLUSION Dependent care theory-based post-surgical home care intervention increased patients' self-care and reduced symptoms and their effects. It also reduced the caregiver burden. Dependent care theory can guide the nursing practices of nurses who provide institutional and/or home care services to patients with chronic diseases and their caregivers. TRIAL REGISTRATION NCT05328739 on April 14, 2022 (retrospectively registered).
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Affiliation(s)
- Derya Dağdelen
- Department of Public Health Nursing, Faculty of Health Sciences, Erciyes University, 38280, Kayseri, Turkey.
| | - Handan Zincir
- Department of Public Health Nursing, Faculty of Health Sciences, Erciyes University, 38280, Kayseri, Turkey
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Ariestine DA, Sari NK, Rinaldi I, Abdullah M. Quality of life in older survivors of non-Hodgkin's lymphoma who received chemotherapy and related factors. J Geriatr Oncol 2020; 12:326-331. [PMID: 33008767 DOI: 10.1016/j.jgo.2020.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/14/2020] [Accepted: 09/01/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Cancer and its treatment have a broad impact on patients' Quality of Life (QoL). Previous researches showed that many factors in Comprehensive Geriatric Assessment (CGA) affect QoL. CGA could predict toxicity, overall survival rate and can help adjust the choice and intensity of treatment in each patient. However, there has been no research explicitly exploring factors related to the QoL in older patients with Non-Hodgkin's Lymphoma (NHL). This research aims to explore the how factors in CGA relate to the QoL in older patients with NHL. MATERIALS AND METHOD The study design was cross-sectional in NHL patients aged ≥ 60 years, research was conducted in Integrated Geriatric Polyclinic and Hemato-Oncology Polyclinic of three public hospitals in Jakarta, during March-August 2019. RESULTS There were 62 subjects, with a median age of 66 years, 56.5% male. The result showed that most of the patients have a good QoL, based on each domain of SF-36 and EORTC QLQ-C30. In multivariate analysis, it was found that depression and frailty status were related to PCS SF-36 domain with PR 12.086 (95% CI 1.596-92.124) and PR 5.622 (95% CI 1.060-29.807), respectively. Multivariate analysis with SF-36's Mental Component Summary (MCS) showed a significant relationship with depression status with PR 24.400 (95% CI 2.961-140.539). While the results of multivariate analysis with the EORTC QLQ-C30 functional scale showed a significant relationship with the ECOG performance score with PR 171 (95% CI 8.470-3452.28). DISCUSSIONS After multivariate analysis, only frailty status, depression status and ECOG performance score have a statistically significant relationship.
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Affiliation(s)
- Dina Aprillia Ariestine
- Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia.; Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Nina Kemala Sari
- Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia.; National Cancer Center-Dharmais Cancer Hospital, Jakarta, Indonesia..
| | - Ikhwan Rinaldi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia
| | - Murdani Abdullah
- Division of Gastroenterology, Department of Internal Medicine/Human Cancer Research Cluster IMERI, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia
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Mohan A, Garg A, Gupta A, Sahu S, Choudhari C, Vashistha V, Ansari A, Pandey R, Bhalla AS, Madan K, Hadda V, Iyer H, Jain D, Kumar R, Mittal S, Tiwari P, Pandey RM, Guleria R. Clinical profile of lung cancer in North India: A 10-year analysis of 1862 patients from a tertiary care center. Lung India 2020; 37:190-197. [PMID: 32367839 PMCID: PMC7353932 DOI: 10.4103/lungindia.lungindia_333_19] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 12/24/2019] [Accepted: 01/17/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Over the past few years, the demographic profile of lung cancer has changed. However, most reports are limited by small numbers, short follow-up period, and show an inconsistent pattern. A comprehensive evaluation of changing trends over a long period has not been done. MATERIALS AND METHODS Consecutive lung cancer patients were studied over a 10-year period from January 2008 to March 2018 at the All India Institute of Medical Sciences, New Delhi, and relevant clinical information, and survival outcomes were analyzed. RESULTS A total of 1862 patients were evaluated, with mean (SD) age of 59 (11.1) years, and comprising 82.9% males. Majority were smokers (76.2%) with median smoking index of 500 (interquartile range [IQR]: 300-800). Adenocarcinoma (ADC) was the most common type (34%), followed by squamous cell carcinoma (SCC - 28.6%) and small cell lung cancer (SCLC) (16.1%). Over the 10-year period, ADC increased from 9.5% to 35.9%, SCC from 25.4% to 30.6%, and non-small cell lung cancer -not otherwise specified (NSCLC-NOS) decreased from 49.2% to 21.4%. The proportion of females with lung cancer increased although smoking rates remained similar. Majority of NSCLC (95%) continued to be diagnosed at an advanced stage (3 or 4). Epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) rearrangements were present in 25.3% and 11.5% ADC patients, respectively. The median overall survival was 8.8 months (IQR 3.7-19) for all patients and 12.57 (IQR 6.2-28.7) months among the 1013 patients who were initiated on specific treatment (chemotherapy, targeted therapy, radiotherapy, or surgery). Never-smokers were younger, more likely to be female and educated, had a higher prevalence of ADC and EGFR/ALK mutations, and had better survival. CONCLUSION Among this large cohort, our center seems to follow the global trend with increasing incidence of ADC. EGFR mutation positivity was similar to existing reports, while higher ALK positivity was detected. A characteristic phenotype of never-smokers with lung cancer was elucidated which demonstrated better survival.
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Affiliation(s)
- Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Avneet Garg
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Aditi Gupta
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Satyaranjan Sahu
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrashekhar Choudhari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vishal Vashistha
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Ashraf Ansari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rambha Pandey
- Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Hariharan Iyer
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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Salvetti MDG, Machado CSP, Donato SCT, Silva AMD. Prevalence of symptoms and quality of life of cancer patients. Rev Bras Enferm 2020; 73:e20180287. [PMID: 32162649 DOI: 10.1590/0034-7167-2018-0287] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 11/29/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to analyze the prevalence of symptoms and their relationship with the quality of life of cancer patients. METHODS this is a cross-sectional study with 107 patients evaluated using a sociodemographic instrument, the hospital anxiety and depression scale (HADS) and the quality of life scale (EORTC-QLQ-C30). Pearson's correlation test was used to evaluate the relationship between symptoms and quality of life. RESULTS prevalence of female patients (56.1%), 55 years as the mean age and 10 years of schooling. Fatigue (76.6%), insomnia (47.7%), pain (42.1%), loss of appetite (37.4%), anxiety (31.8%) and depression (21.5%) were identified. Anxiety and depression symptoms presented a negative correlation with quality of life and positive correlation with physical symptoms. CONCLUSIONS fatigue, insomnia, pain and loss of appetite were the most common and most intense symptoms. Anxiety and depression symptoms presented a negative correlation with quality of life and positive correlation with physical symptoms.
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Affiliation(s)
| | | | | | - Adriana Marques da Silva
- Universidade de São Paulo. São Paulo, São Paulo, Brazil.,Instituto do Câncer do Estado de São Paulo. São Paulo, São Paulo, Brazil
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Raj R, Brown B, Ahuja K, Frandsen M, Jose M. Enabling good outcomes in older adults on dialysis: a qualitative study. BMC Nephrol 2020; 21:28. [PMID: 31996167 PMCID: PMC6988330 DOI: 10.1186/s12882-020-1695-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 01/20/2020] [Indexed: 12/19/2022] Open
Abstract
Background Older patients on dialysis may not have optimal outcomes, particularly with regards to quality of life. Existing research is focused mainly on survival, with limited information about other outcomes. Such information can help in shared decision-making around dialysis initiation; it can also be used to improve outcomes in patients established on dialysis. We used qualitative research methods to explore patient perspectives regarding their experience and outcomes with dialysis. Methods Semi-structured interviews with participants aged ≥70, receiving dialysis at a regional Australian hospital, were recorded and transcribed. From participants’ responses, we identified descriptive themes using a phenomenological approach, with verification by two researchers. Factors affecting outcomes were derived reflexively from these themes. Results Seventeen interviews were analysed prior to saturation of themes. Participants (12 on haemodialysis, 5 on peritoneal dialysis) had spent an average of 4.3 years on dialysis. There were 11 males and 6 females, with mean age 76.2 years (range 70 to 83). Experiences of dialysis were described across four domains - the self, the body, effects on daily life and the influences of others; yielding themes of (i) responses to loss (of time, autonomy, previous life), (ii) responses to uncertainty (variable symptoms; unpredictable future; dependence on others), (iii) acceptance / adaptation (to life on dialysis; to ageing) and (iv) the role of relationships / support (family, friends and clinicians). Conclusions Older patients experience the effects of dialysis across multiple domains in their lives. They endure feelings of loss and persistent uncertainty, but may also adapt successfully to their new circumstances, aided by the support they receive from family, health professionals and institutions. From these insights, we have suggested practical measures to improve outcomes in older patients.
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Affiliation(s)
- Rajesh Raj
- School of Medicine, University of Tasmania, Hobart, Australia. .,Launceston General Hospital, Launceston, Tasmania, 7250, Australia.
| | - Bridget Brown
- Launceston General Hospital, Launceston, Tasmania, 7250, Australia
| | - Kiran Ahuja
- School of Health Sciences, University of Tasmania, Hobart, Australia
| | - Mai Frandsen
- Faculty of Health, University of Tasmania, Hobart, Australia
| | - Matthew Jose
- School of Medicine, University of Tasmania, Hobart, Australia
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Stene GB, Balstad TR, Leer ASM, Bye A, Kaasa S, Fallon M, Laird B, Maddocks M, Solheim TS. Deterioration in Muscle Mass and Physical Function Differs According to Weight Loss History in Cancer Cachexia. Cancers (Basel) 2019; 11:cancers11121925. [PMID: 31816924 PMCID: PMC6966581 DOI: 10.3390/cancers11121925] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Muscle mass and physical function (PF) are common co-primary endpoints in cancer cachexia trials, but there is a lack of data on how these outcomes interact over time. The aim of this secondary analysis of data from a trial investigating multimodal intervention for cancer cachexia (ClinicalTrials.gov: NCT01419145) is to explore whether changes in muscle mass and PF are associated with weight loss and cachexia status at baseline. Methods: Secondary analysis was conducted using data from a phase II randomized controlled trial including 46 patients with stage III–IV non-small cell lung cancer (n = 26) or inoperable pancreatic cancer (n = 20) due to commence chemotherapy. Cachexia status at baseline was classified according to international consensus. Muscle mass (assessed using computed tomography (CT)) and PF outcomes, i.e., Karnofsky performance status (KPS), self-reported PF (self-PF), handgrip strength (HGS), 6-minute walk test (6MWT), and physical activity (PA), were measured at baseline and after six weeks. Results: When compared according to cachexia status at baseline, patients with no/pre-cachexia had a mean loss of muscle mass (−5.3 cm2, p = 0.020) but no statistically significant change in PF outcomes. Patients with cachexia also lost muscle mass but to a lesser extent (−2.8 cm2, p = 0.146), but demonstrated a statistically significant decline in PF; KPS (−3.8 points, p = 0.030), self-PF (−8.8 points, p = 0.027), and HGS (−2.7 kg, p = 0.026). Conclusions: Weight loss history and cachexia status at baseline are of importance if one aims to detect changes in PF outcomes in cancer cachexia trials. To improve the use of co-primary endpoints that include PF in future trials, outcomes that have the potential to detect change relative to weight loss should be investigated further.
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Affiliation(s)
- Guro Birgitte Stene
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU—Norwegian University of Science and Technology, 7491 Trondheim, Norway;
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU—Norwegian University of Science and Technology, 7491 Trondheim, Norway; (T.R.B.); (S.K.); (B.L.); (T.S.S.)
- Cancer Clinic, Trondheim University Hospital, 7491 Trondheim, Norway
- Correspondence: ; Tel.: +47-48226799
| | - Trude Rakel Balstad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU—Norwegian University of Science and Technology, 7491 Trondheim, Norway; (T.R.B.); (S.K.); (B.L.); (T.S.S.)
- Cancer Clinic, Trondheim University Hospital, 7491 Trondheim, Norway
| | - Anne Silja M. Leer
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU—Norwegian University of Science and Technology, 7491 Trondheim, Norway;
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU—Norwegian University of Science and Technology, 7491 Trondheim, Norway; (T.R.B.); (S.K.); (B.L.); (T.S.S.)
| | - Asta Bye
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet—Oslo Metropolitan University, 0167 Oslo, Norway;
- Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, 0167 Oslo, Norway
| | - Stein Kaasa
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU—Norwegian University of Science and Technology, 7491 Trondheim, Norway; (T.R.B.); (S.K.); (B.L.); (T.S.S.)
- Cancer Clinic, Trondheim University Hospital, 7491 Trondheim, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, 0167 Oslo, Norway
| | - Marie Fallon
- Edinburgh Cancer Research Centre, University of Edinburgh, Crewe Road, Edinburgh EH4 2XR, UK;
| | - Barry Laird
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU—Norwegian University of Science and Technology, 7491 Trondheim, Norway; (T.R.B.); (S.K.); (B.L.); (T.S.S.)
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XR, UK
- St Columba’s Hospice, Boswall Road, Edinburgh EH4 2XR, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London SE5 9PJ, UK;
| | - Tora S. Solheim
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU—Norwegian University of Science and Technology, 7491 Trondheim, Norway; (T.R.B.); (S.K.); (B.L.); (T.S.S.)
- Cancer Clinic, Trondheim University Hospital, 7491 Trondheim, Norway
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Dolgin NH, Movahedi B, Anderson FA, Brüggenwirth IMA, Martins PN, Bozorgzadeh A. Impact of recipient functional status on 1-year liver transplant outcomes. World J Transplant 2019; 9:145-157. [PMID: 31850158 PMCID: PMC6914386 DOI: 10.5500/wjt.v9.i7.145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 10/16/2019] [Accepted: 11/07/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The Karnofsky Performance Status (KPS) scale has been widely validated for clinical practice for over 60 years.
AIM To examine the extent to which poor pre-transplant functional status, assessed using the KPS scale, is associated with increased risk of mortality and/or graft failure at 1-year post-transplantation.
METHODS This study included 38278 United States adults who underwent first, non-urgent, liver-only transplantation from 2005 to 2014 (Scientific Registry of Transplant Recipients). Functional impairment/disability was categorized as severe, moderate, or none/normal. Analyses were conducted using multivariable-adjusted Cox survival regression models.
RESULTS The median age was 56 years, 31% were women, median pre-transplant Model for End-Stage for Liver Disease score was 18. Functional impairment was present in 70%; one-quarter of the sample was severely disabled. After controlling for key recipient and donor factors, moderately and severely disabled patients had a 1-year mortality rate of 1.32 [confidence interval (CI): 1.21-1.44] and 1.73 (95%CI: 1.56-1.91) compared to patients with no impairment, respectively. Subjects with moderate and severe disability also had a multivariable-adjusted 1-year graft failure rate of 1.13 (CI: 1.02-1.24) and 1.16 (CI: 1.02-1.31), respectively.
CONCLUSION Pre-transplant functional status is a useful prognostic indicator for 1-year post-transplant patient and graft survival.
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Affiliation(s)
- Natasha H Dolgin
- Department of Surgery, Division of Organ Transplantation, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA 01605, United States
- Department of Quantitative Health Sciences, Clinical and Population Health Research Program, University of Massachusetts Medical School, Worcester, MA 01605, United States
- Department of Surgery, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA 01655, United States
| | - Babak Movahedi
- Department of Surgery, Division of Organ Transplantation, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA 01605, United States
| | - Frederick A Anderson
- Department of Surgery, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA 01655, United States
| | - Isabel MA Brüggenwirth
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen 9713GZ, Netherlands
| | - Paulo N Martins
- Department of Surgery, Division of Organ Transplantation, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA 01605, United States
| | - Adel Bozorgzadeh
- Department of Surgery, Division of Organ Transplantation, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA 01605, United States
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Clinical regularities in acupuncture-moxibustion treatment of cancer pain in recent 30 years. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2019. [DOI: 10.1007/s11726-019-1097-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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12
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Chaitoff A, Sarmey N, Thompson NR, Fan Y, Ahluwalia M, Katzan IL. Quality of life outcomes in patients presenting for evaluation of CNS tumors. Neurol Clin Pract 2019; 9:32-40. [PMID: 30859005 DOI: 10.1212/cpj.0000000000000571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/19/2018] [Indexed: 12/25/2022]
Abstract
Background We describe patient-reported outcomes (PROs) in adults with CNS tumors and evaluate their correlation with physician-reported functional status. Methods We completed a retrospective cohort study of patients managed at a high-volume CNS tumor institute between September 2013 and September 2014. PROs were measured using 6 domains from the PROs Measurement Information System (PROMIS): anxiety, physical function, pain interference, sleep disturbance, fatigue, and satisfaction with social roles. Physician-reported outcomes were measured using the Eastern Cooperative Oncology Group Scale of Performance Status (ECOG). We compared differences in PROMIS scores across tumor types using analysis of variance and measured the correlation between PROMIS scores and ECOG scores using spearman correlations. Finally, we compared the range of PROMIS physical function scores within each ECOG level. Results In a cohort of 2,828 patients, 1,284 (45.4%) completed all 6 PROMIS domains. There were significant differences in PROMIS scores across tumor types for all domains except anxiety. The strength of the correlation between PROMIS and ECOG scores was weak to moderate for all PROMIS domains (all p < 0.001). The correlation was the strongest between the physical function domain and ECOG score (ρ = -0.54), although there was a broad distribution of physical function scores within ECOG level, with scores spanning nearly 5 SDs within most ECOG levels. Conclusions Symptom burden was associated with tumor type. There were only weak to moderate correlations between PROMIS and ECOG scores, underscoring the importance of integrating PROs into clinical practice for patients with CNS tumors.
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Affiliation(s)
- Alexander Chaitoff
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (A.C., M.A., I.L.K.); Department of Neurosurgery (N.S.), Cleveland Clinic; Neurological Institute Center for Outcomes Research & Evaluation (N.R.T., Y.F., I.L.K.), Cleveland Clinic; Department of Quantitative Health Sciences (N.R.T., Y.F.), Cleveland Clinic; and Neurological Institute Brain Tumor and Neuro-Oncology Center (M.A.), Cleveland Clinic, OH
| | - Nehaw Sarmey
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (A.C., M.A., I.L.K.); Department of Neurosurgery (N.S.), Cleveland Clinic; Neurological Institute Center for Outcomes Research & Evaluation (N.R.T., Y.F., I.L.K.), Cleveland Clinic; Department of Quantitative Health Sciences (N.R.T., Y.F.), Cleveland Clinic; and Neurological Institute Brain Tumor and Neuro-Oncology Center (M.A.), Cleveland Clinic, OH
| | - Nicolas R Thompson
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (A.C., M.A., I.L.K.); Department of Neurosurgery (N.S.), Cleveland Clinic; Neurological Institute Center for Outcomes Research & Evaluation (N.R.T., Y.F., I.L.K.), Cleveland Clinic; Department of Quantitative Health Sciences (N.R.T., Y.F.), Cleveland Clinic; and Neurological Institute Brain Tumor and Neuro-Oncology Center (M.A.), Cleveland Clinic, OH
| | - Youran Fan
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (A.C., M.A., I.L.K.); Department of Neurosurgery (N.S.), Cleveland Clinic; Neurological Institute Center for Outcomes Research & Evaluation (N.R.T., Y.F., I.L.K.), Cleveland Clinic; Department of Quantitative Health Sciences (N.R.T., Y.F.), Cleveland Clinic; and Neurological Institute Brain Tumor and Neuro-Oncology Center (M.A.), Cleveland Clinic, OH
| | - Manmeet Ahluwalia
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (A.C., M.A., I.L.K.); Department of Neurosurgery (N.S.), Cleveland Clinic; Neurological Institute Center for Outcomes Research & Evaluation (N.R.T., Y.F., I.L.K.), Cleveland Clinic; Department of Quantitative Health Sciences (N.R.T., Y.F.), Cleveland Clinic; and Neurological Institute Brain Tumor and Neuro-Oncology Center (M.A.), Cleveland Clinic, OH
| | - Irene L Katzan
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (A.C., M.A., I.L.K.); Department of Neurosurgery (N.S.), Cleveland Clinic; Neurological Institute Center for Outcomes Research & Evaluation (N.R.T., Y.F., I.L.K.), Cleveland Clinic; Department of Quantitative Health Sciences (N.R.T., Y.F.), Cleveland Clinic; and Neurological Institute Brain Tumor and Neuro-Oncology Center (M.A.), Cleveland Clinic, OH
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Andrews C, Smith S, Kennel M, Schilling S, Kalpakjian C. The Association of Performance Status and Disease Severity in Patients With Chronic Graft-vs-Host Disease. Arch Phys Med Rehabil 2018; 100:606-612. [PMID: 30205083 DOI: 10.1016/j.apmr.2018.04.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 03/29/2018] [Accepted: 04/07/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Determine the relationship between functional status and degree of specific organ involvement, physical performance, and subjective well-being chronic graft-vs-host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation. DESIGN Observational cohort. SETTING Outpatient clinic. PARTICIPANTS Adult patients (N=121) with cGVHD with 634 assessments. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Karnofsky Performance Status (KPS). Skin, fascia/joints, lungs, upper and lower extremity range of motion, liver, eye, mucosal, and gastrointestinal involvement were measured using the National Institutes of Health GVHD scale. Physical performance was assessed with the 2-minute walk test (2MWT) and hand grip strength. Subjective measures were the Patient Health Questionnaire 9 (PHQ-9) and Lee Symptom Burden (LSB) scale. RESULTS Myofascial (P<.001) and lung (P=.001) involvement, 2MWT (P<.001), LSB (P<.001), and PHQ-9 (P=.03) had the largest associations with KPS with liver (P=.05) and hand grip strength (P<.001) more modest associations with KPS. CONCLUSIONS Patients with cGVHD experience multifactorial impairment in function associated with potentially modifiable symptoms physiatrists have the expertise to address to enhance function. More research is needed to determine rehabilitation interventions to mitigate the impact of cGVHD on function.
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Affiliation(s)
- Cody Andrews
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI.
| | - Sean Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI
| | - Maggi Kennel
- Department of Internal Medicine-Hematology and Oncology, University of Michigan Medical School, Ann Arbor, MI
| | - Steve Schilling
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI
| | - Claire Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI
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Estimating the survival of elderly patients diagnosed with dementia in Taiwan: A longitudinal study. PLoS One 2018; 13:e0178997. [PMID: 30044781 PMCID: PMC6059383 DOI: 10.1371/journal.pone.0178997] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 07/09/2018] [Indexed: 12/19/2022] Open
Abstract
Background Dementia is characterized by prolonged progressive disability. Therefore, predicting mortality is difficult. An accurate prediction tool may be useful to ensure that end-of-life patients with dementia receive timely palliative care. Purpose This study aims to establish a survival prediction model for elderly patients with dementia in Taiwan. Methods Data from the 2001 to 2010 National Health Insurance Research Database in Taiwan were used to identify 37,289 patients with dementia aged ≥65 years for inclusion in this retrospective longitudinal study. Moreover, this study examined the mortality indicators for dementia among demographic characteristics, chronic physical comorbidities, and medical procedures. A Cox proportional hazards model with time-dependent covariates was used to estimate mortality risk, and risk score functions were formulated using a point system to establish a survival prediction model. The prediction model was then tested using the area under the receiver operating characteristic curve. Results Thirteen mortality risk factors were identified: age, sex, stroke, chronic renal failure, liver cirrhosis, cancer, pressure injury, and retrospectively retrieved factors occurring in the 6 months before death, including nasogastric tube placement, supplemental oxygen supply, ≥2 hospitalization, receiving ≥1 emergency services, ≥2 occurrences of cardiopulmonary resuscitation, and receiving ≥2 endotracheal intubations. The area under the receiver operating characteristic curves for this prediction model for mortality at 6 and 12 months were 0.726 and 0.733, respectively. Conclusions The survival prediction model demonstrated moderate accuracy for predicting mortality at 6 and 12 months before death in elderly patients with dementia. This tool may be valuable for helping health care providers and family caregivers to make end-of-life care decisions.
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15
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The Prevalence and Associated Distress of Physical and Psychological Symptoms in Patients With Advanced Heart Failure Attending a South African Medical Center. J Cardiovasc Nurs 2018; 31:313-22. [PMID: 25829136 DOI: 10.1097/jcn.0000000000000256] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite the high prevalence of heart failure in low- and middle-income countries, evidence concerning patient-reported burden of disease in advanced heart failure is lacking. OBJECTIVE The aim of this study is to measure patient-reported symptom prevalence and correlates of symptom burden in patients with advanced heart failure. METHODS Adult patients diagnosed with New York heart Association (NYHA) stage III or IV heart failure were recruited from the emergency unit, emergency ward, cardiology ward, general medicine wards, and outpatient cardiology clinic of a public hospital in South Africa. Patients were interviewed by researchers using the Memorial Symptom Assessment Scale-Short Form, a well-validated multidimensional instrument that assesses presence and distress of 32 symptoms. RESULTS A total of 230 patients (response, 99.1%), 90% NYHA III and 10% NYHA IV (12% newly diagnosed), with a mean age of 58 years, were included. Forty-five percent were women, 14% had completed high school, and 26% reported having no income. Mean Karnofsky Performance Status Score was 50%. Patients reported a mean of 19 symptoms. Physical symptoms with a high prevalence were shortness of breath (95.2%), feeling drowsy/tired (93.0%), and pain (91.3%). Psychological symptoms with a high prevalence were worrying (94.3%), feeling irritable (93.5%), and feeling sad (93.0%). Multivariate linear regression analyses, with total number of symptoms as dependent variable, showed no association between number of symptoms and gender, education, number of healthcare contacts in the last 3 months, years since diagnosis, or comorbidities. Increased number of symptoms was significantly associated with higher age (b = 0.054, P = .042), no income (b = -2.457, P = .013), and fewer hospitalizations in the last 12 months (b = -1.032, P = .017). CONCLUSIONS Patients with advanced heart failure attending a medical center in South Africa experience high prevalence of symptoms and report high levels of burden associated with these symptoms. Improved compliance with national and global treatment recommendations could contribute to reduced symptom burden. Healthcare professionals should consider incorporating palliative care into the care for these patients.
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Guerrero-Suarez PD, Magdaleno-Estrella E, Guerrero-López P, Vargas-Figueroa AI, Martínez-Anda JJ. Intradural spinal tumors: 10 - years surgical experience in a single institution. Clin Neurol Neurosurg 2018; 169:98-102. [PMID: 29649676 DOI: 10.1016/j.clineuro.2018.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/09/2018] [Accepted: 03/09/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The aim of the study is to present the therapeutic results of intradural tumor management over a 10 years period in a single institution. PATIENTS AND METHODS The study consists in a prospective case series of patients treated at the neurosurgery service of the Social Security Institute of Mexico State and Provinces (ISSSEMYM), between January 2006 and December 2016. All patients were provided with information about the procedure and signed informed consent and institutional board approved files review for this study. RESULTS Thirty-five patients with intradural tumor were treated between 2006-2016. Most frequent lesions were extramedullary (30 patients, 85.7%). Most frequent tumor was Schwannoma, with thoracic/thoraco-lumbar location, being the most frequent location. All patients underwent surgical treatment, with total gross resection accomplished in 19 patients (54.3%). Surgical complication rate was 11.4%. Spine instrumentation was necessary in 26 patients (74.3%) because of bone destruction by the tumor, or bone removal for approach. All patients with intramedullary lesions and 5 patients (16.7%) with extramedullary lesions received post-operative radiotherapy. During the follow-up, 8.5% of patients had recurrence/progression of residual disease. CONCLUSIONS Microsurgery is the treatment of choice for intradural spinal tumors, and gross total resection with low morbidity must be the surgical goal. When this is not possible, partial resection and adjuvant therapy with radiosurgery are a valid option. Patients most be long followed-up because of recurrence risk or disease progression.
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Affiliation(s)
- Pablo David Guerrero-Suarez
- Neurosurgery Department of Toluca Medical Center of Social Security Institute of the State of Mexico and Provinces, Toluca, State of Mexico, Mexico
| | - Ernesto Magdaleno-Estrella
- Neurosurgery Department of Toluca Medical Center of Social Security Institute of the State of Mexico and Provinces, Toluca, State of Mexico, Mexico
| | - Paola Guerrero-López
- Neurosurgery Department of Toluca Medical Center of Social Security Institute of the State of Mexico and Provinces, Toluca, State of Mexico, Mexico
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Li D, Madoff DC. Incorporating Quality of Life Metrics in Interventional Oncology Practice. Semin Intervent Radiol 2017; 34:313-321. [PMID: 29249854 DOI: 10.1055/s-0037-1608826] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Interventional radiologists care for a large number of cancer patients with the breadth of palliative intent minimally invasive procedures that we provide. Understanding our meaningful impact on patients' quality of life is essential toward validating our role in the palliation of cancer patients. As such, it is critically important for interventional radiologists to understand common instruments used for the reporting of patient's quality of life measures. Common instruments used to measure pain and quality of life for cancer patients include the numerical rating scale, visual analog scale, brief pain inventory, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and the Functional Assessment of Cancer Therapy. An ideal quality of life instrument should be a patient reported outcome measure across multiple domains (e.g., physical health, psychological, social), and be both validated and reliable.
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Affiliation(s)
- David Li
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - David C Madoff
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
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Tanti MJ, Marson AG, Jenkinson MD. Epilepsy and adverse quality of life in surgically resected meningioma. Acta Neurol Scand 2017; 136:246-253. [PMID: 27861722 DOI: 10.1111/ane.12711] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Meningiomas are common intracranial tumors, and despite surgery or therapy with anti-epileptic drugs (AEDs), many patients suffer from seizures. Epilepsy has a significant impact on quality of life (QoL) in non-tumor populations, but the impact of epilepsy on QoL in patients with meningioma is unknown. Our aim was to evaluate the impact of epilepsy on QoL in patients that have undergone resection of a benign meningioma. MATERIALS AND METHODS We recruited meningioma patients without epilepsy (n=109), meningioma patients with epilepsy (n=56), and epilepsy patients without meningioma (n=64). QoL was measured with the Short Form 36 version 2 (SF-36), the Functional Assessment of Cancer Therapy (FACT-BR), and the Liverpool Adverse Events Profile (LAEP). Regression analyses identified significant determinants of QoL. RESULTS Patients with meningioma and epilepsy had poorer QoL scores than meningioma patients without epilepsy in all measures. In FACT-BR, this difference was significant. Multiple regression analyses demonstrated that current AED use had a greater impact on QoL scores than recent seizures. Other variables associated with impaired QoL included depression, unemployment, and meningioma attributed symptoms. CONCLUSIONS Epilepsy has a negative impact on quality of life in patients with benign meningioma. AED use is correlated with impaired QoL and raised LAEP scores, suggesting that AEDs and adverse effects may have led to impaired QoL in our meningioma patients with epilepsy. The severity of epilepsy in our meningioma population was comparatively mild; therefore, a more conservative approach to AED therapy may be indicated in an attempt to minimize adverse effects.
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Affiliation(s)
- M. J. Tanti
- The Walton Centre NHS Foundation Trust; Fazakerley Liverpool UK
- School of Medicine; University of Liverpool; Liverpool UK
- Institute of Translational Medicine; University of Liverpool; Liverpool UK
| | - A. G. Marson
- The Walton Centre NHS Foundation Trust; Fazakerley Liverpool UK
- Institute of Translational Medicine; University of Liverpool; Liverpool UK
| | - M. D. Jenkinson
- The Walton Centre NHS Foundation Trust; Fazakerley Liverpool UK
- Institute of Infection and Global Health; University of Liverpool; Liverpool UK
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Feli A, Jazayeri S, Bitaraf MA, Solaymani Dodaran M, Parastouei K, Hosseinzadeh-Attar MJ. Combination Therapy with Low Copper Diet, Penicillamine and Gamma Knife Radiosurgery Reduces VEGF and IL-8 In Patients with Recurrent Glioblastoma. Asian Pac J Cancer Prev 2017; 18:1999-2003. [PMID: 28749642 PMCID: PMC5648411 DOI: 10.22034/apjcp.2017.18.7.1999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose: Vascular Endothelial Growth Factor (VEGF) and interleukin-8 (IL-8) appear important in tumor growth. In this study, we have investigated the effect of copper reduction along with gamma knife radiosurgery on IL-8 and VEGF in patients with recurrent glioblastoma multiforme (GBM). Materials and Methods: In a 3-month randomized clinical trial, patients with recurrent GBM were allocated randomly between intervention and placebo groups. Radiosurgery was performed for both groups (Reference dose: 16-18 Gray, in one fraction). The intervention group received low copper diet and penicillamine while the patients in the placebo group continued with their usual diet. VEGF and IL-8 were measured at baseline and the end of intervention. Results: VEGF in intervention group significantly reduced compared to placebo group (Mean ± SD, 4.5±1.91 vs. 7.8±3.21; P<0.001). IL-8 in intervention group decreased compared to placebo group but not significant (2.7±1.91 vs. 3.2±3.20; P=0.49). We also detected a significant positive correlation between serum copper and VEGF (r=0.57; P<0.05) and a negative correlation between KPS and serum copper. Discussion: Our results could reflect that low copper diet and penicillamine may decrease serum VEGF in patients who underwent gamma knife radiosurgery for recurrent glioblastoma multiforme.
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Affiliation(s)
- Alireza Feli
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
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Alhelih E, Ghazi Baker O, Aboshaiqah AE. Retracted: Symptom trajectories and occurrence in older Saudi children with cancer during a course of chemotherapy. Eur J Cancer Care (Engl) 2017; 26:e12555. [PMID: 27434998 DOI: 10.1111/ecc.12555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2016] [Indexed: 11/30/2022]
Abstract
This research aimed to describe changes in symptom occurrence and severity of the 31 symptoms during the chemotherapy cycle at three time points. This descriptive, longitudinal study investigated Saudi children who underwent a cycle of chemotherapy (n = 132) in four tertiary hospitals. The Arabic version of the Memorial Symptom Assessment Scale, Karnofsky Performance Status and a demographic questionnaire were used. More than 30% of children reported 10 or more symptoms during the cycle. Symptom occurrence trajectories were analysed using multilevel logistic regression. Six symptoms (i.e. fatigue, sadness, irritability, worrying, weight loss, sweating) showed a decreasing linear trend. Significant quadratic patterns of change were found for feeling drowsy, nausea and vomiting. No significant differences, over time were found in any of the symptom severity scores by using multilevel negative binomial regression. This study is the first to examine the trajectory of multiple symptoms that children experience during a cycle of chemotherapy in Saudi Arabia. Children in this study reported a high number of symptoms across the entire cycle of chemotherapy. Intervention studies are needed to improve care for these symptoms.
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Affiliation(s)
- E Alhelih
- Department of Medical Surgical Nursing, College of Nursing, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - O Ghazi Baker
- Department of Nursing Administration and Education, College of Nursing, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - A E Aboshaiqah
- Department of Nursing Administration and Education, College of Nursing, King Saud University, Riyadh, Kingdom of Saudi Arabia
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21
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Validity and Reliability of Turkish Version of the Functional Assessment of Cancer Therapy–Brain Questionnaire. Cancer Nurs 2017; 40:224-229. [DOI: 10.1097/ncc.0000000000000390] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Raj R, Ahuja KD, Frandsen M, Jose M. Symptoms and their recognition in adult haemodialysis patients: Interactions with quality of life. Nephrology (Carlton) 2017; 22:228-233. [PMID: 26891151 DOI: 10.1111/nep.12754] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/14/2016] [Accepted: 02/15/2016] [Indexed: 11/28/2022]
Abstract
AIM We investigated the symptom burden in adults on haemodialysis, the recognition of symptoms by nurses and nephrologists, and the relationship between symptoms and quality of life. METHODS In this cross-sectional observational study, symptoms and quality of life in haemodialysis patients were determined using validated surveys. Nurses and nephrologists independently estimated their patients' symptoms, and these estimates were compared with patient responses (sensitivity; kappa values for interrater agreement). Associations between symptoms and quality of life were assessed using multi-level regression. RESULTS Forty-three patients, 18 nurses and 3 nephrologists participated. The commonest symptoms (95%CI) reported by patients were weakness, 69% (53 to 82); poor mobility, 44% (29 to 60); and drowsiness, 44% (29 to 60). Sensitivity less than 50% was seen towards 11 of 17 symptoms in nurse ratings compared with 15 of 17 in nephrologist ratings. Agreement with patient symptom ratings was mostly 'fair' (0.21-0.4), with nurses' scores showing greater agreement than nephrologists'. Physical, mental and kidney disease component summary scores of quality of life were negatively associated with total symptom score and the number of 'major' symptoms (r2 values 0.3-0.36); while with multivariate regression, 50% to 60% of the variance in these scores was accounted for by parsimonious models containing symptoms such as pain and poor mobility. CONCLUSION Symptom burden worsened quality of life scores in haemodialysis patients. Clinician recognition of symptom burden was inaccurate, although nurses were more accurate than nephrologists. Using patient-completed surveys or including dialysis nurse feedback in routine outpatient settings may help improve symptom recognition by nephrologists.
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Affiliation(s)
- Rajesh Raj
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Kiran Dk Ahuja
- School of Health Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - Mai Frandsen
- School of Health Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - Matthew Jose
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Factors influencing the quality of life of patients with advanced cancer. Appl Nurs Res 2017; 33:108-112. [DOI: 10.1016/j.apnr.2016.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 08/21/2016] [Accepted: 10/03/2016] [Indexed: 01/17/2023]
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Mol L, Ottevanger PB, Koopman M, Punt CJA. The prognostic value of WHO performance status in relation to quality of life in advanced colorectal cancer patients. Eur J Cancer 2016; 66:138-43. [PMID: 27573427 DOI: 10.1016/j.ejca.2016.07.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 07/05/2016] [Accepted: 07/07/2016] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Performance status (PS) is an established prognostic factor in patients with advanced cancer and is usually scored by the treating physician. The EORTC QLQ-C30 questionnaire as reported by cancer patients is a validated tool to assess quality of life (QoL). Subjectivity plays a role in both assessments, and data on a direct comparison are scarce. METHODS We compared the prognostic value for overall survival (OS) of the WHO PS to the baseline physical function scale of the EORTC QLQ-C30 (QLQ-C30 PF) in a prospective randomised phase 3 trial in advanced colorectal cancer (ACC), the CAIRO study. Patients were divided into two groups based on the baseline QLQ-C30 PF. QLQ-C30 PF was considered 'good' if the score was more than 66.7% and 'poor' if 66.7% or less. Results were validated in a subsequent phase 3 study in ACC, the CAIRO2 study. RESULTS The median OS for patients with a 'good' QLQ-C30 PF and a 'poor' PF in patients with WHO PS 0 was 20.3 months (n = 300) and 10.4 months (n = 44), in patients with WHO PS 1 16.8 months (n = 125) and 10.1 months (n = 63), and in patients with WHO PS 2 16.2 months (n = 11) and 9.9 months (n = 12), respectively. In a Cox regression model which included other prognostic factors, 'good' versus 'poor' QLQ-C30 PF was significantly prognostic for OS (0.57 95% confidence interval: 0.46-0.72), but not WHO PS. These results were confirmed in the CAIRO2 study. CONCLUSIONS We demonstrate in ACC patients that PF, as assessed by patients using the EORTC QLQ-C30, is superior in terms of prognostic value to WHO PS as scored by physicians. Our data support to include the results of baseline EORTC QLQ-C30 PF instead of WHO PS as a stratification parameter in oncology trials.
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Affiliation(s)
- L Mol
- Clinical Trial Department, Netherlands Comprehensive Cancer Organisation (IKNL), The Netherlands
| | - P B Ottevanger
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M Koopman
- Department of Medical Oncology, University Medical Centre, Utrecht, The Netherlands
| | - C J A Punt
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, The Netherlands.
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Berdine HJ, Mihalyo MG. Demographics, Pharmacoeconomics, Assessment, and Treatment of Pain in the Elderly. J Pharm Pract 2016. [DOI: 10.1177/0897190004263218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The burden of pain in the elderly population of our society is observed by the greater numbers of the aged who suffer from pain as compared to their younger counterparts. The elderly present difficult challenges for pain clinicians in terms of the ability to assess for pain, amid other medical and pain problems, due to cognitive, sensory, and functional impairment. Treatment with pharmaceuticals may be altered by the impact of aging. Finally, the elderly suffer financial restraints that often prevent optimal treatment of pain even if pain is identified. Principles of pain management in the elderly are reviewed in the context of special attention to assessment tools for the elderly, the evaluation of comorbid factors in the presentation of pain, and pharmacokinetic/pharmacodynamic concerns in the aging. Pharmacologic and nonpharmacologic treatment strategies are described relative to the elder.
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Affiliation(s)
- Hildegarde J. Berdine
- Duquesne University in the Mylan School of Pharmacy, Pittsburgh, Pennsylvania, Palliative Care Consulting Group in Dublin, Ohio,
| | - Mary Grace Mihalyo
- Duquesne University in the Mylan School of Pharmacy, Pittsburgh, Pennsylvania, Palliative Care Consulting Group in Dublin, Ohio
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Denvir MA, Cudmore S, Highet G, Robertson S, Donald L, Stephen J, Haga K, Hogg K, Weir CJ, Murray SA, Boyd K. Phase 2 Randomised Controlled Trial and Feasibility Study of Future Care Planning in Patients with Advanced Heart Disease. Sci Rep 2016; 6:24619. [PMID: 27090299 PMCID: PMC4836296 DOI: 10.1038/srep24619] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/24/2016] [Indexed: 12/24/2022] Open
Abstract
Future Care Planning (FCP) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost. We assessed the feasibility, acceptability and tested a design of a randomised trial evaluating the impact of FCP in patients and carers. 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of >20% were randomly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks. Quality of life, symptoms and anxiety/distress were assessed by questionnaire. Hospitalisation and mortality events were documented for 6 months post-discharge. FCP increased implementation and documentation of key decisions linked to end-of-life care. FCP did not increase anxiety/distress (Kessler score -E 16.7 (7.0) vs D 16.8 (7.3), p = 0.94). Quality of life was unchanged (EQ5D: E 0.54(0.29) vs D 0.56(0.24), p = 0.86) while unadjusted hospitalised nights was lower (E 8.6 (15.3) vs D 11.8 (17.1), p = 0.01). Qualitative interviews indicated that FCP was highly valued by patients, carers and family physicians. FCP is feasible in a randomised clinical trial in patients with acute high risk cardiac conditions. A Phase 3 trial is needed urgently.
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Affiliation(s)
- Martin A. Denvir
- Cardiology, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Sarah Cudmore
- Cardiology, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Gill Highet
- Primary Palliative Care Research Group, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Shirley Robertson
- Cardiology, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Lisa Donald
- Cardiology, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Jacqueline Stephen
- Edinburgh Clinical Trials Unit, University of Edinburgh, Outpatients Building, Floor Two, Room D36, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK
| | - Kristin Haga
- Cardiology, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Karen Hogg
- Cardiology Department, Glasgow Royal Infirmary, Castle Street, Glasgow, G4 0SF, UK
| | - Christopher J. Weir
- Edinburgh Health Services Research Unit, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Scott A. Murray
- Primary Palliative Care Research Group, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Kirsty Boyd
- Primary Palliative Care Research Group, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
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Symptom assessment in pediatric oncology: how should concordance between children's and parents' reports be evaluated? Cancer Nurs 2015; 37:252-62. [PMID: 24936750 DOI: 10.1097/ncc.0000000000000111] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clinical evaluations in pediatric oncology are often triadic, involving children or adolescents, parents, and clinicians. However, few studies have evaluated the concordance between children's and parents' reports of symptom occurrence. OBJECTIVES The purposes of this study were to evaluate the concordance between children's and parents' symptom reports during the week of chemotherapy administration using 5 statistical approaches and determine which factors are associated with higher levels of dyadic concordance. METHODS Independent assessments of symptom occurrence were obtained from children and adolescents with cancer (n = 107) and their parents using the Memorial Symptom Assessment Scale 10-18. Concordance was assessed using (1) percentage of overall agreement, (2) Cohen κ coefficients, (3) McNemar tests, (4) positive percentage agreement, and (5) negative percentage agreement. RESULTS For each dyad, an average of 20 of the 31 symptom reports were concordant. Using children's reports as the "gold standard," parents rarely underestimated the children's symptoms. However, compared with children's reports, parents overestimated 7 symptoms. Advantages and disadvantages of each of the statistical approaches used to evaluate concordance are described in this article. CONCLUSIONS A variety of statistical approaches are needed to obtain a thorough evaluation of the concordance between symptom reports. Discordance was most common for symptoms that children refuted, particularly psychosocial symptoms. IMPLICATIONS FOR PRACTICE Clinicians need to interview children and adolescents along with their parents about the occurrence of symptoms and evaluate discrepant reports. Effective approaches are needed to improve communication between children and parents to improve symptom assessment and management.
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Faller H, Brähler E, Härter M, Keller M, Schulz H, Wegscheider K, Weis J, Boehncke A, Richard M, Sehner S, Koch U, Mehnert A. Performance status and depressive symptoms as predictors of quality of life in cancer patients. A structural equation modeling analysis. Psychooncology 2015; 24:1456-62. [PMID: 25851732 DOI: 10.1002/pon.3811] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 02/09/2015] [Accepted: 02/28/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study aimed to examine whether depressive symptoms and performance status are independent predictors of both the physical and psychological domains of health-related quality of life (HRQoL) in cancer patients. METHODS A sample of 4020 cancer patients (mean age 58 years, 51% women) was evaluated. Depressive symptoms were measured with the patient health questionnaire and HRQoL with the European Organisation for Research and Treatment of Cancer quality of life questionnaire core 30. The impact of the illness on everyday activities was assessed with physician ratings of both the Karnofsky performance status and the Eastern Cooperative Oncology Group performance status. The simultaneous effects of depression and performance status on quality of life outcomes were estimated using structural equation modeling. RESULTS Both depressive symptoms and performance status independently predicted the physical and psychological domains of HRQoL. However, the impact of depressive symptoms on the physical HRQoL was stronger than the impact of performance status on the psychological HRQoL. CONCLUSION Our results suggest that comorbid depressive symptoms are independently associated with both physical and psychological HRQoL in cancer patients after controlling for the physician-rated performance status. Thus, comorbid depression should be taken into account when evaluating reduced HRQoL in cancer patients. To support a causal impact of depression on HRQoL, intervention studies are needed to show that improving depression enhances cancer patients' HRQoL.
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Affiliation(s)
- Hermann Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, and Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Elmar Brähler
- Department of Medical Psychology and Medical Sociology, Section of Psychosocial Oncology, University Medical Center Leipzig, Leipzig, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Martin Härter
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Keller
- Division of Psychooncology, Department for Psychosomatic and General Clinical Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Holger Schulz
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Weis
- Department of Psychooncology, Tumor Biology Center, University of Freiburg, Freiburg, Germany
| | - Anna Boehncke
- Department of Psychooncology, Tumor Biology Center, University of Freiburg, Freiburg, Germany
| | - Matthias Richard
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, and Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Susanne Sehner
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Koch
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Mehnert
- Department of Medical Psychology and Medical Sociology, Section of Psychosocial Oncology, University Medical Center Leipzig, Leipzig, Germany.,Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Ferreira MLL, Souza AID, Ferreira LOC, Moura JFDP, Junior JIC. Qualidade de vida relacionada à saúde de idosos em tratamento quimioterápico. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2015. [DOI: 10.1590/1809-9823.2015.14008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJETIVO: Avaliar os efeitos da quimioterapia antineoplásica na qualidade de vida relacionada à saúde QVRS de idosos. MÉTODO: Foi analisada uma série de casos de idosos submetidos a quimioterapia antineoplásica, selecionados por amostra não probabilística do tipo tempo-local no período de agosto a dezembro de 2012. Foram incluídos idosos em tratamento quimioterápico e excluídos aqueles com indicação de radioterapia concomitante à quimioterapia. Para avaliação da QVRS, foi utilizado o European Organization for Research and Treatment of Cancer Quality of Life Questionnaire "core" 30 item EORTC-QLQ-C30, aplicado antes e cerca de dois meses após o início da quimioterapia. A qualidade de vida foi avaliada por meio da comparação das médias dos escores antes e depois da quimioterapia, por meio do teste t Student. RESULTADOS: Dos 31 pacientes observados, 58,1% eram do sexo feminino. As neoplasias mais frequentes foram: mama 32,3%, pulmão 22,6% e próstata 16,1%, sendo que 51,6% tinham o estadiamento clínico TNM IV. Para os 28 pacientes avaliados na segunda entrevista, o domínio "desempenho físico" teve variação da média "antes" e "depois" estatisticamente significante p=0,008, enquanto o domínio "estado de saúde geral/QV" teve média na primeira entrevista de 69,3 pontos e, após dois meses, 64,3 pontos sem diferença estatística p=0,413. Quando se analisou a QVRS por tipo de tumor, houve piora significativa nas médias dos escores no domínio "estado de saúde geral/QV" para os pacientes com neoplasia da próstata p=0,042. CONCLUSÃO: A quimioterapia piorou o desempenho físico sem modificar o estado geral de saúde de idosos, exceto para os pacientes com neoplasia da próstata.
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Meng DU, Chai YL, He YF, Hu H, Liu R, Liu Z. Cervical carcinoma following myelodysplastic syndrome: A case report. Oncol Lett 2014; 8:82-84. [PMID: 24959223 PMCID: PMC4063629 DOI: 10.3892/ol.2014.2061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 03/11/2014] [Indexed: 11/26/2022] Open
Abstract
Solid tumors following myelodysplastic syndrome (MDS) are rare and have no uniform treatment guidelines. The current study presents a rare case of a 47-year-old female diagnosed with cervical cancer (International Federation of Gynecology and Obstetrics stage IIIB) with an eight-year history of MDS. A multidisciplinary treatment discussion was organized and a rigorous treatment plan was developed. With injection of granulocyte colony-stimulating factor and interleukin-11 factor, transfusion of red blood cell suspension and close monitoring of the blood count, the patient was administered radiotherapy, specifically intensity modulated radiation therapy. However, a degree IV bone marrow suppression repeatedly assaulted, leading to interruption of the radiotherapy treatment. Eventually, the total dose received by point A (2 cm above the cervical os marker and 2 cm perpendicular to the uterine axis along the plane of the uterus) was 51 Gy. One month later, a gynecological examination and magnetic resonance imaging of the pelvis revealed that the treatment resulted in a complete remission. In conclusion, radiation therapy can still be implemented to obtain satisfactory local control when the hematopoietic function of the bone marrow is weakened due to long-term MDS.
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Affiliation(s)
- DU Meng
- Department of Radiotherapy Oncology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, Shaanxi 710061, P.R. China
| | - Yan-Lan Chai
- Department of Radiotherapy Oncology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, Shaanxi 710061, P.R. China
| | - Yin-Fang He
- Department of Gynaecology, Shangluo Central Hospital, Shangluo, Shaanxi 726000, P.R. China
| | - Honglian Hu
- Department of Blood Pathology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, Shaanxi 710061, P.R. China
| | - Rui Liu
- Department of Radiotherapy Oncology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, Shaanxi 710061, P.R. China
| | - Zi Liu
- Department of Radiotherapy Oncology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, Shaanxi 710061, P.R. China
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Diaz RJ, Maggacis N, Zhang S, Cusimano MD. Determinants of quality of life in patients with skull base chordoma. J Neurosurg 2014; 120:528-37. [DOI: 10.3171/2013.9.jns13671] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Object
Skull base chordomas can be managed by surgical intervention and adjuvant radiotherapy. As survival for this disease increases, identification of determinants of quality of life becomes an important focus for guiding comprehensive patient care. In this study the authors sought to measure functional outcome and quality of life in patients with skull base chordomas and to identify determinants of quality of life in these patients.
Methods
The authors carried out an internet-based cross-sectional survey, collecting detailed data for 83 individual patients. Demographic and clinical variables were evaluated. Functional outcomes were determined by Karnofsky Performance Scale (KPS) and Glasgow Outcome Scale Extended (GOSE), quality of life was measured using the 36-Item Short Form Health Survey (SF-36), and depression was assessed using Patient Health Questions–9 (PHQ-9) instrument. Caregiver burden was assessed using the Zarit Burden Interview (ZBI). Univariate and multivariate analysis was performed to identify determinants of the physical and mental components of the SF-36.
Results
Patients with skull base chordomas who have undergone surgery and/or radiation treatment had a median KPS score of 90 (range 10–100, IQR 10) and a median GOSE score of 8 (range 2–8, IQR 3). The mean SF-36 Physical Component Summary score (± SD) was 43.6 ± 11.8, the mean Mental Component Summary score was 44.2 ±12.6, and both were significantly lower than norms for the general US population (p < 0.001). The median PHQ-9 score was 5 (range 0–27, IQR 8). A PHQ-9 score of 10 or greater, indicating moderate to severe depression, was observed in 29% of patients. The median ZBI score was 12 (range 0–27, IQR 11), indicating a low burden. Neurological deficit, use of pain medication, and requirement for corticosteroids were found to be associated with worse SF-36 Physical Component Summary score, while higher levels of depression (higher PHQ-9 score) correlated with worse SF-36 Mental Component Summary score.
Conclusions
Patients with skull base chordomas have a lower quality of life than the general US population. The most significant determinants of quality of life in the posttreatment phase in this patient population were neurological deficits (sensory deficit and bowel/bladder dysfunction), pain medication use, corticosteroid use, and levels of depression as scored by PHQ-9.
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Affiliation(s)
- Roberto Jose Diaz
- 1Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto; and
- 2Arthur & Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicole Maggacis
- 1Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto; and
| | - Shudong Zhang
- 1Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto; and
| | - Michael D. Cusimano
- 1Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto; and
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Patients over 65 years are assigned lower ECOG PS scores than younger patients, although objectively measured physical activity is no different. J Geriatr Oncol 2013; 5:49-56. [PMID: 24484718 DOI: 10.1016/j.jgo.2013.07.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 03/05/2013] [Accepted: 07/30/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The Eastern Cooperative Group Performance Status (ECOG PS) is a widely used standard functional classification in oncology practice, the verbal descriptors of which refer to physical activity (PA). Little is known about the cut-off points of this scale and measured PA levels. This research investigated the relationship between PS assigned, objectively measured PA, and patient age. MATERIALS AND METHODS One hundred ambulatory patients with treatment-naive cancer wore an accelerometer (RT3) for a mean (SD) of 5.6 (1.1) days before initial oncology evaluation and ECOG PS assignment. RESULTS Seventy five participants (75%) were <65 years and 25 were ≥65 years. Eighty nine (89%) were assigned an ECOG PS of 0 or 1 and 11% a PS of 2 or 3. A weak but significant inverse association was found between objectively measured PA and PS (rho = -0.26, p = 0.01). Seventy one participants (80%) with a PS of 0 or 1 spent more than 50% of waking hours resting. Participants assigned a PS of 2-3 spent significantly more time resting than those assigned a PS of 0 (p = 0.01). Age ≥65 years was significantly related to PS assigned (p = 0.04), although the older cohort were no less sedentary than younger patients. CONCLUSION PA levels were low, but PS scoring reflected relative PA levels and differentiated between patients of PS 0 and 2-3. Chronological age was not predictive of activity levels, but older patients were assigned lower PS scores. Incorporation of objective PA measures may merit further investigation especially in the geriatric oncology setting.
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Brown MA, Sampson EL, Jones L, Barron AM. Prognostic indicators of 6-month mortality in elderly people with advanced dementia: a systematic review. Palliat Med 2013; 27:389-400. [PMID: 23175514 PMCID: PMC3652641 DOI: 10.1177/0269216312465649] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND For end-of-life dementia patients, palliative care offers a better quality of life than continued aggressive or burdensome medical interventions. To provide the best care options to dementia sufferers, validated, reliable, sensitive, and accurate prognostic tools to identify end-of-life dementia stages are necessary. AIM To identify accurate prognosticators of mortality in elderly advanced dementia patients consistently reported in the literature. DESIGN Systematic literature review. DATA SOURCES PubMed, Embase, and PsycINFO databases were searched up to September 2012. Reference lists of included studies were also searched. Inclusion criteria were studies measuring factors specifically related to 6-month outcome in patients diagnosed with dementia in any residential or health-care setting. RESULTS Seven studies met the inclusion criteria, five of which were set in the United States and two in Israel. Methodology and prognostic outcomes varied greatly between the studies. All but one study found that Functional Assessment Staging phase 7c, currently widely used to assess hospice admission eligibility in the United States, was not a reliable predictor of 6-month mortality. The most common prognostic variables identified related to nutrition/nourishment, or eating habits, followed by increased risk on dementia severity scales and comorbidities. CONCLUSIONS Although the majority of studies agreed that the Functional Assessment Staging 7c criterion was not a reliable predictor of 6-month mortality, we found a lack of prognosticator concordance across the literature. Further studies are essential to identify reliable, sensitive, and specific prognosticators, which can be applied to the clinical setting and allow increased availability of palliative care to dementia patients.
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Affiliation(s)
- Meghan A Brown
- Department of Neuroscience, College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, USA
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Singer S, Langendijk J, Yarom N. Assessing and improving quality of life in patients with head and neck cancer. Am Soc Clin Oncol Educ Book 2013:0011300e230. [PMID: 23714510 DOI: 10.14694/edbook_am.2013.33.e230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Health-related quality of life (QoL) indicates the patients' perception of their health. It depends not only on disease- and treatment-related factors but also on complex inter-relationships of expectations, values and norms, psychologic distress, and comparison with other patients. This article introduces methods and challenges of QoL assessment in patients with head and neck cancer, as well as ways to overcome measurement problems and ways to improve their QoL.
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Affiliation(s)
- Susanne Singer
- From the Division of Epidemiology and Health Services Research, Institute of Biostatistics, Epidemiology, and Informatics, University Medical Centre, Mainz, Germany; Department of Radiation Oncology, University Medical Centre Groningen, University of Groningen, The Netherlands; Department of Oral & Maxillofacial Surgery, Sheba Medical Centre, Tel-Hashomer, and Department of Oral Pathology and Oral Medicine, School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Şenkal HA, Hayran M, Karakaya E, Yueh B, Weymuller EA, Hoşal AŞ. The validity and reliability of the Turkish version of the University of Washington Quality of Life Questionnaire for patients with head and neck cancer. Am J Otolaryngol 2012; 33:417-26. [PMID: 22137146 DOI: 10.1016/j.amjoto.2011.10.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 10/05/2011] [Accepted: 10/12/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE The University of Washington Quality of Life Questionnaire (UW-QOL) is an English-language survey used to assess the quality of life of patients with head and neck cancer. The present study aimed to translate this widely used questionnaire into Turkish according to international guidelines and to statistically determine its validity and reliability by administering it to native Turkish-speaking patients. MATERIALS AND METHODS This prospective study was performed at Hacettepe University, Faculty of Medicine, Turkey. The study included patients newly diagnosed as having head and neck cancer. Translation and cultural adaptation of the questionnaire were performed first. Then, the translated version was tested on a consecutive series of patients seen in the department of otorhinolaryngology head and neck surgery and the department of radiation oncology between September 2006 and February 2008. The patients were asked to complete 3 sets of questionnaires. The first set was completed 1 day before the beginning of treatment, the second 3 months after the completion of treatment, and the third 10 days after the second questionnaire was completed. The first and second sets included the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire-Turkish version and UW-QOL-Turkish version. The third set included the Turkish UW-QOL only. Performance status was assessed and rated by a physician using the Karnofsky and ZEW (Zubrod/The Eastern Cooperative Oncology Group (ECOG)/World Health Organization) performance scales, synchronous with the first and second sets of questionnaires. RESULTS The original English version of UW-QOL was carefully translated into Turkish, and a final Turkish version of UW-QOL was developed in an iterative fashion. To determine its validity and reliability, 67 patients were included in the study. Internal consistency (Cronbach α = .757) was adequate, and test-retest reliability (interclass correlation coefficient, 0.941) was excellent. The composite scores of the translated UW-QOL were compared statistically with the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire scores, Karnofsky and ZEW performance scales, T stage of the disease, and UW-QOL global questions scores to support the scale's construct validity, and statistically significant associations were observed. CONCLUSIONS The Turkish UW-QOL appears to be a valid and reliable tool for use with Turkish patients with head and neck cancer; it can also be used in clinical investigations and routine clinical practice in Turkey.
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Salvo N, Zeng L, Zhang L, Leung M, Khan L, Presutti R, Nguyen J, Holden L, Culleton S, Chow E. Frequency of Reporting and Predictive Factors for Anxiety and Depression in Patients with Advanced Cancer. Clin Oncol (R Coll Radiol) 2012; 24:139-48. [PMID: 21652191 DOI: 10.1016/j.clon.2011.05.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 03/21/2011] [Accepted: 03/22/2011] [Indexed: 11/15/2022]
Affiliation(s)
- N Salvo
- Rapid Response Radiotherapy Program, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
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Symptom cluster analyses based on symptom occurrence and severity ratings among pediatric oncology patients during myelosuppressive chemotherapy. Cancer Nurs 2012; 35:19-28. [PMID: 21921793 DOI: 10.1097/ncc.0b013e31822909fd] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Symptom cluster research is an emerging field in symptom management. The ability to identify symptom clusters that are specific to pediatric oncology patients may lead to improved understanding of symptoms' underlying mechanisms among patients of all ages. OBJECTIVE The purpose of this study, in a sample of children and adolescents with cancer who underwent a cycle of myelosuppressive chemotherapy, was to compare the number and types of symptom clusters identified using patients' ratings of symptom occurrence and symptom severity. METHODS Children and adolescents with cancer (10-18 years of age; N = 131) completed the Memorial Symptom Assessment Scale 10-18 on the day they started a cycle of myelosuppressive chemotherapy, using a 1-week recall of experiences. Symptom data based on occurrence and severity ratings were examined using exploratory factor analysis. The defined measurement model suggested by the best exploratory factor analysis model was then examined with a latent variable analysis. RESULTS Three clusters were identified when symptom occurrence ratings were evaluated, which were classified as a chemotherapy sequela cluster, mood disturbance cluster, and a neuropsychological discomfort cluster. Analysis of symptom severity ratings yielded similar cluster configurations. CONCLUSIONS Cluster configurations remained relatively stable between symptom occurrence and severity ratings. The evaluation of patients at a common point in the chemotherapy cycle may have contributed to these findings. IMPLICATIONS FOR PRACTICE Additional uniformity in symptom clusters investigations is needed to allow appropriate comparisons among studies. The dissemination of symptom cluster research methodology through publication and presentation may promote uniformity in this field.
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Wilson JTL. Lessons from traumatic head injury for assessing functional status after brain tumour. J Neurooncol 2012; 108:239-46. [DOI: 10.1007/s11060-012-0812-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 01/27/2012] [Indexed: 11/25/2022]
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Activity Limitations and Participation Restrictions in Patients with Chronic Fatigue Syndrom—Construction of a Disease Specific Questionnaire. ACTA ACUST UNITED AC 2011. [DOI: 10.1300/j092v10n03_02] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Liepe K, Kotzerke J. Internal radiotherapy of painful bone metastases. Methods 2011; 55:258-70. [DOI: 10.1016/j.ymeth.2011.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 06/16/2011] [Accepted: 07/07/2011] [Indexed: 02/03/2023] Open
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Baggott CR, Dodd M, Kennedy C, Marina N, Matthay KK, Cooper B, Miaskowski C. An evaluation of the factors that affect the health-related quality of life of children following myelosuppressive chemotherapy. Support Care Cancer 2011; 19:353-61. [PMID: 20157746 PMCID: PMC2909452 DOI: 10.1007/s00520-010-0824-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 01/18/2010] [Indexed: 11/19/2022]
Abstract
PURPOSE The purposes of this study, in children who were assessed 1 week after the administration of myelosuppressive chemotherapy were: to compare the total and subscale scores on a generic measure of health-related quality of life (HRQOL) to normative data from healthy children and describe the relationships between demographic, clinical, and symptom characteristics of children with cancer and generic and disease-specific dimensions of HRQOL. METHODS Patients (n = 61) were predominantly male (52.5%), minority (63.9%), and 14.7 years of age. Children completed the Memorial Symptom Assessment Scale for 10- to 18-year olds, the PedsQL™ Generic and Cancer Modules, and the Karnofsky Performance Status (KPS) scale 1 week after the start of a chemotherapy cycle. RESULTS The mean number of symptoms per patient was 10.6. Compared with the normative sample, children with cancer reported significantly lower scores for the total scale and all of the subscales except emotional and social functioning. No significant differences were found between any demographic characteristics and total or subscale scores on the generic or disease-specific measures of HRQOL. Lower KPS scores were associated with poorer generic and disease-specific HRQOL scores. In addition, a higher number of symptoms was associated with poorer generic and disease-specific HRQOL scores. Finally, higher symptom distress scores were associated with poorer generic and disease-specific HRQOL scores. CONCLUSION Among the demographic, clinical, and symptom characteristics studied, poorer functional status and higher symptom burden were associated with significant decreases in HRQOL in children who received myelosuppressive chemotherapy.
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Affiliation(s)
- Christina R Baggott
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA 94143, USA.
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De Marco MA, Cítero VA, Nogueira-Martins MCF, Yazigi L, Wissow LS, Nogueira-Martins LA, Andreoli SB. Medical residency: factors relating to "difficulty in helping" in the resident physician-patient relationship. SAO PAULO MED J 2011; 129:5-10. [PMID: 21437502 PMCID: PMC10865906 DOI: 10.1590/s1516-31802011000100002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 01/08/2010] [Accepted: 09/29/2010] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Previous studies have attempted to understand what leads physicians to label patients as 'difficult'. Understanding this process is particularly important for resident physicians, who are developing attitudes that may have long-term impact on their interactions with patients. The aim of this study was to distinguish between patients' self-rated emotional state (anxiety and depression) and residents' perceptions of that state as a predictor of patients being considered difficult. DESIGN AND SETTING Cross-sectional survey conducted in the hospital of Universidade Federal de São Paulo (Unifesp). METHODS The residents completed a sociodemographic questionnaire and rated their patients using the Hospital Anxiety and Depression Scale (HADS) and Difficulty in Helping the Patient Questionnaire (DTH). The patients completed HADS independently and were rated using the Karnofsky Performance Status scale. RESULTS On average, the residents rated the patients as presenting little difficulty. The residents' ratings of difficulty presented an association with their ratings for patient depression (r = 0.35, P = 0.03) and anxiety (r = 0.46, P = 0.02), but not with patients' self-ratings for depression and anxiety. Residents from distant cities were more likely to rate patients as difficult to help than were residents from the city of the hospital (mean score of 1.93 versus 1.07; P = 0.04). CONCLUSIONS Understanding what leads residents to label patients as having depression and anxiety problems may be a productive approach towards reducing perceived difficulty. Residents from distant cities may be more likely to find their patients difficult.
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Affiliation(s)
- Mario Alfredo De Marco
- PhD. Associate professor in the Department of Psychiatry, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
| | - Vanessa Albuquerque Cítero
- PhD. Affiliated professor in the Department of Psychiatry, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
| | | | - Latife Yazigi
- PhD. Titular professor of the Department of Psychiatry, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
| | - Lawrence Sagin Wissow
- PhD. Professor in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America.
| | - Luiz Antonio Nogueira-Martins
- PhD. Associate professor in the Department of Psychiatry, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
| | - Sergio Baxter Andreoli
- PhD. Affiliated professor in the Department of Psychiatry, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
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Rossi S, Ravetta V, Rosa L, Ghittoni G, Viera FT, Garbagnati F, Silini EM, Dionigi P, Calliada F, Quaretti P, Tinelli C. Repeated radiofrequency ablation for management of patients with cirrhosis with small hepatocellular carcinomas: a long-term cohort study. Hepatology 2011; 53:136-47. [PMID: 20967759 DOI: 10.1002/hep.23965] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 08/31/2010] [Indexed: 12/17/2022]
Abstract
UNLABELLED In most patients with cirrhosis, successful percutaneous ablation or surgical resection of hepatocellular carcinoma (HCC) is followed by recurrence. Radiofrequency ablation (RFA) has proven effective for treating HCC nodules, but its repeatability in managing recurrences and the impact of this approach on survival has not been evaluated. To this end, we retrospectively analyzed a prospective series of 706 patients with cirrhosis (Child-Pugh class ≤ B7) who underwent RFA for 859 HCC ≤ 35 mm in diameter (1-2 per patient). The results of RFA were classified as complete responses (CRs) or treatment failures. CRs were obtained in 849 nodules (98.8%) and 696 patients (98.5%). During follow-up (median, 29 months), 465 (66.8%) of the 696 patients with CRs experienced a first recurrence at an incidence rate of 41 per 100 person-years (local recurrence 6.2; nonlocal 35). Cumulative incidences of first recurrence at 3 and 5 years were 70.8% and 81.7%, respectively. RFA was repeated in 323 (69.4%) of the 465 patients with first recurrence, restoring disease-free status in 318 (98.4%) cases. Subsequently, RFA was repeated in 147 (65.9%) of the 223 patients who developed a second recurrence after CR of the first, restoring disease-free status in 145 (98.6%) cases. Overall, there were 877 episodes of recurrence (1-8 per patient); 577 (65.8%) of these underwent RFA that achieved CRs in 557 (96.5%) cases. No procedure-related deaths occurred in 1,921 RFA sessions. Estimated 3- and 5-year overall and disease-free (after repeated RFAs) survival rates were 67.0% and 40.1% and 68.0 and 38.0%, respectively. CONCLUSION RFA is safe and effective for managing HCC in patients with cirrhosis, and its high repeatability makes it particularly valuable for controlling intrahepatic recurrences.
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Affiliation(s)
- Sandro Rossi
- VI Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
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Nazar G, Garmendia ML, Royer M, McDowell JA, Weymuller EA, Yueh B. Spanish validation of the University of Washington Quality of Life questionnaire for head and neck cancer patients. Otolaryngol Head Neck Surg 2010; 143:801-7, 807.e1-2. [PMID: 21109081 DOI: 10.1016/j.otohns.2010.08.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 07/11/2010] [Accepted: 08/10/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The University of Washington Quality of Life (UW-QOL) questionnaire is one of the most widely used instruments to evaluate the quality of life of head and neck cancer patients. The aim of this study was to perform a Spanish translation and validation of the UW-QOL questionnaire. STUDY DESIGN A cross-sectional study. SETTING Three tertiary-care hospitals and a laryngectomee rehabilitation center. SUBJECTS AND METHODS The translation and cultural adaptation of the questionnaire were performed following accepted international guidelines. The psychometric validation was performed on a consecutive series of patients treated for squamous cell carcinoma of the upper aerodigestive tract with no signs of relapse, recruited from May 2007 to December 2008. Eligible subjects were invited to complete the Spanish version of the UW-QOL questionnaire during routine clinical consultation, and complete it again within 15 days. Subjects also completed a validated Spanish version of the Goldberg Mental Health Survey and were evaluated by the use of the Karnofsky Index. RESULTS A Spanish version of the questionnaire was developed in iterative fashion. In the psychometric validation process, a total of 76 patients were analyzed. Reliability was excellent, including both internal consistency (Cronbach's alpha of 0.84) and test-retest reliability (intraclass correlation coefficient between 0.91 and 0.97 with a confidence interval of 95%). Construct validity was supported by statistically significant relationships between the Karnofsky Index, the Goldberg Mental Health Survey, and the translated UW-QOL questionnaire. CONCLUSION The Spanish version of the UW-QOL questionnaire appears to be culturally appropriate and psychometrically valid.
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Affiliation(s)
- Gonzalo Nazar
- Department of Otolaryngology, Clínica Las Condes, Santiago, Chile.
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Baggott C, Dodd M, Kennedy C, Marina N, Matthay KK, Cooper BA, Miaskowski C. Changes in children's reports of symptom occurrence and severity during a course of myelosuppressive chemotherapy. J Pediatr Oncol Nurs 2010; 27:307-15. [PMID: 20739586 DOI: 10.1177/1043454210377619] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purposes of this study in children who underwent a cycle of myelosuppressive chemotherapy were to describe changes in symptom occurrence and severity during the chemotherapy cycle. Patients (N = 66) 10 to 18 years of age completed the Memorial Symptom Assessment Scale for 10- to 18-year-olds (MSAS 10-18) at the start of a chemotherapy cycle (T1) and weekly for the next 2 weeks (T2 and T3). More than 30% of children reported 10 or more symptoms at all 3 time points. Symptom occurrence trajectories were tested with multilevel logistic regression. In all, 6 symptoms (ie, fatigue, sadness, irritability, worrying, weight loss, sweating) showed a decreasing linear trend. Significant quadratic patterns of change were found for feeling drowsy, nausea, and vomiting. Changes in symptom severity over time were evaluated with multilevel negative binomial regression. No significant differences over time were found in any of the symptom severity scores on the MSAS. Children experienced a high number of symptoms at the initiation of a chemotherapy cycle that persisted over the subsequent 2 weeks.
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Affiliation(s)
- Christina Baggott
- University of California San Francisco, San Francisco, CA 94143, USA.
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Wang KY, Chang NW, Wu TH, Hsu CC, Lee YH, Lee SC. Post-discharge health care needs of patients after lung cancer resection. J Clin Nurs 2010; 19:2471-80. [DOI: 10.1111/j.1365-2702.2010.03298.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Burgos L, Barrena S, Andrés AM, Martínez L, Hernández F, Olivares P, Lassaletta L, Tovar JA. Colonic interposition for esophageal replacement in children remains a good choice: 33-year median follow-up of 65 patients. J Pediatr Surg 2010; 45:341-5. [PMID: 20152348 DOI: 10.1016/j.jpedsurg.2009.10.065] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 10/27/2009] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Gastric pull-up has become the predominant technique for esophageal replacement because of allegedly deficient results of colon grafts. This retrospective study examines the long-term results in a large series of colonic interpositions. PATIENTS AND METHOD One hundred six children (median, 2.9 years; range, 0.32-15 years) had their esophagus replaced between 1965 and 2008, of which 96 had colon grafts. Those survivors who were 18 years and older were contacted and, if willing, interviewed, examined, and had their functional ability rated using the Karnofsky index. RESULTS Ninety-six children had undergone a colon graft, and of these, 9 (9.3%) died. There were 65 long-term survivors whose indications for surgery included caustic injury (n = 32), failed tracheoesophageal fistula repair (n = 16), pure esophageal atresia (n = 14), and others (n = 3). The graft was either retrosternal (n = 49) or mediastinal (n = 16 patients). Twelve patients were unavailable for long-term assessment. After a median follow-up of 33.3 (11-41) years, 23 (43%) of 53 individuals experienced mild symptoms of reflux; scoliosis, 12 (22%) of 53, and/or other complications, 15 (27%) of 53 required further surgery. Thirty-two patients (60%) with Karnofsky indexes of 80% or higher felt healthy, 19 (36%) had mild life-style limitations (index, 40%-80%), and 2 had indexes less than 40%. Most patients live normal lives. CONCLUSIONS Colon conduits restored gastrointestinal continuity with limited mortality and considerable morbidity but good functional outcome and health perception in the long-term. Our study suggests that colon grafts are no worse than gastric pull-ups in the long-term.
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Affiliation(s)
- Laura Burgos
- Department of Pediatric Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain
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Albers G, Echteld MA, de Vet HCW, Onwuteaka-Philipsen BD, van der Linden MHM, Deliens L. Evaluation of quality-of-life measures for use in palliative care: a systematic review. Palliat Med 2010; 24:17-37. [PMID: 19843620 DOI: 10.1177/0269216309346593] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE In this literature review we evaluated the feasibility and clinimetric quality of quality-of-life (QoL) measurement instruments suitable for use in palliative care. METHODS We conducted a systematic literature review to identify instruments measuring (at least one domain of) QoL. We selected articles that present data on patients receiving palliative care and at least one measurement property. A checklist was used to describe the characteristics of the instruments, and a widely accepted rating list was used to evaluate the clinimetric aspects. RESULTS 29 instruments were identified and evaluated, most of which were targeted at palliative patients in general. None of the instruments demonstrated satisfactory results for all measurement properties. Fourteen instruments received positive ratings for construct validity. Thirteen instruments were tested for reliability, but only two were tested adequately and had positive results (ICC>0.70). Responsiveness was not tested adequately for any of the instruments. Very few of the studies provided information on the interpretation of the scores. Overall, the MQOL, followed by the QUAL-E and the QODD, received the best ratings for their measurement properties. CONCLUSIONS Many measurement instruments were identified, but most had not yet been adequately evaluated. The evaluation of existing instruments with good content validity should have priority over the development of new instruments.
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Affiliation(s)
- Gwenda Albers
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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Abstract
AbstractPalliative care aims at improving the patient’s quality of life. The assessment of this quality of life (QoL) is crucial for the evaluation of palliative care outcome. Many patients require hospital admissions for symptom control during their cancer journey and most of them die in hospitals, although they would like to stay at home until the end of their lives. In 1986, the European Organization for Research and Treatment (EORTC) initiated a research programme to develop an integrated, modular approach for evaluating the quality of life of patients participating in international clinical trials. This questionnaire measures cancer patients’ physical, psychological and social functions and was used in a wide range of clinical cancer trials with large numbers of research groups and also in various other non-trial studies. The aim of this study was to evaluate the psychometric properties, especially the reliability, validity and applicability of the EORTC QLQ-C30 in a German sample of terminally ill cancer patients receiving palliative care in different settings. The questionnaire was well accepted in the present patient population. Scale reliability was good (pre-treatment 0.80) especially for the functional scale. The results support the reliability and validity of the QLQ-C30 (version 3.0) as a measure of the health-related quality of life in German cancer patients receiving palliative care treatment.
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