Comparison of Two Instruments to Assess the Impact of Cachexia on Quality of Life in Women with Cervical Cancer

The assessment of quality of life (QOL) is an important part of cachexia management for cancer patients. Functional assessment of anorexia-cachexia therapy (FAACT), a specific QOL instrument for cachexia patients, has not been validated in Chinese population. The aim of this study was to validate the FAACT scale in Chinese cancer patients for its future use. Eligible cancer patients were included in our study. Patients' demographic and clinical characteristics were collected from the electronic medical records. Patients were asked to complete the Chinese version of FAACT scale and the MD Anderson symptom inventory (MDASI), and then the reliability and validity were analyzed. A total of 285 patients were enrolled in our study, data of 241 patients were evaluated. Coefficients of Cronbach's alpha, test-retest and split-half analyses were all greater than 0.8, which indicated an excellent reliability for FAACT scale. In item-subscale correlation analysis and factor analysis, good construct validity for FAACT scale was found. The correlation between FAACT and MDASI interference subscale showed reasonable criterion-related validity, and for further clinical validation, the FAACT scale showed excellent discriminative validity for distinguishing patients in different cachexia status and in different performance status. The Chinese version of FAACT scale has good reliability and validity and is suitable for measuring QOL of cachexia patients in Chinese population.

Many patients on maintenance hemodialysis (MHD) eventually suffer from cachexia. The Functional Assessment of Anorexia/Cachexia Therapy (FAACT) is a tool used to evaluate the quality of life of patients with cachexia related to various diseases, but its suitability for use in MHD patients has yet to be verified. This study aimed to explore the validation of the FAACT in MHD patients by conducting reliability and validity tests. Qualified MHD patients were selected to complete the FAACT and Kidney Disease Quality of Life Short Form 36 (KDQOL-36) questionnaires, and their demographic data and biochemical test results were collected from electronic medical records. Next, the Cronbach's alpha coefficient, paired sample t test and ICC were used to analyze the scale consistency. Additionally, the association between the KDQOL-36 and FAACT was analyzed using Bland-Altman plots and Pearson correlation analysis. Finally, the patients were divided into groups to evaluate discriminant validity. A total of 299 patients were included in this study. The Cronbach's alpha coefficients of the FAACT and its anorexia-cachexia subscale (ACS) were 0.904 and 0.842, respectively, and their ICC exceeded 0.90. The correlation coefficients between the FAACT and its items ranged from 0.146 to 0.631, and the correlation coefficients between the FAACT and KDQOL-36 dimensions ranged from 0.446 to 0.617. The Bland-Altman plots between the FAACT and KDQOL-36 showed that only 3.3% of the points were outside the 95% limits of agreement. The effects of cachexia status (present or absent) on FAACT and ACS scores had effect sizes of 0.54 (P< 0.001) and 0.60 (P< 0.001), respectively. The FAACT and ACS also significantly discriminated between patients with and without inflammation (P< 0.001). The FAACT and ACS have acceptable reliability and validity in MHD patients and are suitable for measuring the quality of life of MHD patients with cachexia.

Introduction: Lifelong Anti-Retroviral Therapy (ART) promotes good quality of life and health among HIV-positive men and women. However, simplified newer and effective ART has not increased retention in care, or long-term ART adherence, especially among women. There are many factors that impede long-term adherence in women. This includes among other things female gender, depression, greater than once-daily dosing, longer time since HIV diagnosis, and patient beliefs. This study measures the quality of life in women whose ART durations range from one to fifteen years, using the standardized WHO Quality of Life questionnaire. Material and Methods: One hundred and fourteen women were divided into three groups based on ART duration. Group 1 had 37 women on ART for less than five years, Group 2 had 48 women on ART from 5 to 10 years and Group 3 had 29 women on ART for more than ten years. They were administered the WHO Quality of Life (QOL) questionnaire, which assesses QOL in six domains. QOL was considered poor in scores between 4 - 9.9, medium in scores of 10 - 14.9 and good in scores of 15 - 20. Results: Scores in all 3 groups were more than 85% in five domains and around 74.5% in the psychological domain. Domain mean scores were Physical 18 (CI 17.63 - 18.37), Psychological 14.9 (CI 14.55 - 15.25), Independence 18.6 (CI 18.33 - 18.87), Social relationships 17.5 (CI 17.07 - 17.93), Environmental 17.6 (CI 17.25 - 17.95), Spiritual, Religious, Personal beliefs, 17.4 (CI 16.93 - 17.87). Scores for women on long-term ART (Group 3) are not different from the other 2 groups and the p-values were not statistically significant. Conclusion: Women on long-term ART fare extremely well compared to other groups with more than 93% showing good QOL and none showing poor Quality of Health in spite of being on ART for a longer period of time than the other two groups. Despite a multitude of impeding factors, women who continue ART faithfully and consistently enjoy a good quality of health and life. Adequate preparation and a supportive health system are essential for ensuring long-term adherence, but the attitude and commitment of women are also critical.

The overall survival of patients with cervical cancer has improved due to detection at an early stage and availability of comprehensive treatments in China. As patients' lives prolonged, it is important to understand their health-related quality of life (QoL) during and after treatment. We used the EQ-5D questionnaire to assess QoL of 194 patients with cervical lesions at Sichuan University West China Second Hospital between May 2010 and January 2011. Patients were surveyed before primary treatment and at 1, 3, and 6 months after primary treatment. Results showed a consistent decline in EQ-5D scores in the spectrum of cervical lesions at each time point after treatment (all P < 0.05). For patients with precursor lesions, there was an increasing trend along the timeline of treatment (P < 0.01). For patients with early-stage cervical cancer, EQ-5D scores declined in the first month (P = 0.01) and gradually increased to higher levels at 6 months post-treatment than those before treatment (P < 0.01). EQ-5D scores followed a similar trend in patients with advanced cervical cancer (P = 0.04), though they did not statistically rebound after 6 months (0.84 ± 0.19 vs. 0.86 ± 0.11, P = 0.62). Regarding advanced cervical cancer, EQ-5D scores for women above 40 years of age appeared to recover more rapidly and reached higher levels than those for women below 40 years (P = 0.03). Caution and extra care are recommended in the early period of cervical cancer treatment given the slight deterioration in the QoL, and in particular, for younger cervical cancer patients. Our study implies that health care providers may need to improve the health-related QoL of cervical cancer patients.

Patients with cancer anorexia-cachexia syndrome (CACS) suffer a significant symptom burden, impaired quality of life (QoL), and shorter survival. Measurement of QoL impairments related to CACS is thereby important both in clinical practice and in research. We aimed to further validate the Functional Assessment of Anorexia-Cachexia Therapy (FAACT) scale in an advanced lung cancer population. We tested the performance of the FAACT and its anorexia-cachexia subscale (ACS) within a dataset of patients with advanced non-small cell lung cancer (aNSCLC), using standard statistical methods. We then compared the performance of commonly used QoL measures stratified by CACS status and by patient self-report of appetite and weight loss. The FAACT and its ACS demonstrate internal validity consistent with acceptable published ranges for other QoL scales (Cronbach alpha = 0.9 and 0.79, respectively). Correlation coefficients demonstrate moderate correlations in the expected directions between FAACT and ACS and scales that measure related constructs. Comparing patients with and without CACS, the ACS is more sensitive to change than other QoL instruments (mean score 33.1 vs. 37.2, p = 0.011, ES = 0.58). In patients with aNSCLC, the FAACT and its ACS performed well compared with other instruments, further supporting their validity and value in clinical research. FAACT and ACS scores covaried with symptoms and other QoL changes that are typical hallmarks of CACS, lending further support to their use as QoL endpoints in clinical trials among patients with CACS.

BackgroundCervical cancer is among the leading gynecological cancers affecting women worldwide. Maintenance and improvement of cervical cancer patients‘health related quality of life (HRQoL) is an important issue. The cervical cancer specific quality of life module of the European Organization for Research and Treatment of Cancer (EORTC QLQ-CX24) is the most commonly used tool, however, it is not validated in Ethiopia. Hence, the present study aimed to assess the psychometric properties of the tool among Ethiopian cervical cancer patients.MethodsHospital based cross-sectional study was done in Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia from January to February, 2018. The module was translated through forward-backward translation approach and pilot tested according to the EORTC Guidelines. One hundered and seventy one patients with confirmed cervical cancer were enrolled for the study. Amharic versions of EORTC QLQ-C30 and EORTC QLQ-CX24 were used to collect data along with socio-demographic and clinical characteristics. Descriptive statistics were used to assess socio-demographic and clinical characteristics of patients. The Psychometric properties of the EORTC QLQ-CX24 were evaluated in terms of acceptability, internal consistency, construct, concurrent and known group validity using SPSS version 22.ResultsOne hundred seventy one cervical cancer patients were enrolled in the study, with a mean age of 52.15 ± 10.4 years. The EORTC QLQ-CX24 was found to be acceptable with high compliance and low missing responses. The Cronbach’s alpha ranged from 0.70–0.84, indicating the reliability of the scales. Convergent and discriminant validity in multitrait scaling analysis was adequate. The EORTC QLQ-C30 subscales and EORTC QLQ-CX24 subscales had a weak to strong correlation, indicating concurrent validity. The scales and single-item measures were able to discriminate between subgroups of patients differing with regard to performance status, cancer stage and treatment status, indicating clinical validity.ConclusionAmharic version of the EORTC QLQ-CX24 questionnaire is a valid and reliable tool and could be used for clinical and epidemiological cancer researches to study the HRQoL of patients with cervical cancer in Ethiopia.

IntroductionEstimation of health-related quality of life of cervical cancer patients in India is important in assessing the well-being of patients, monitor treatment outcomes, and conduct health technology assessments. However, health-related...

Health Related Quality of Life (HRQoL) is an important health outcome in the holistic management of patients especially those suffering from life limiting conditions such as cervical cancer. In Kenya, Cervical cancer is the most frequent cancer among women. However, little is known and documented on HRQoL of cervical cancer patients. This study assessed HRQoL of cervical cancer patients in western Kenya. A cross-sectional study involving 334 cervical cancer patients was conducted in Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kisumu from September 2014 to February 2015. FACT-Cx (The Functional Assessment of Chronic Illness Therapy –for measuring Quality of Life in cervical cancer patients) Version 4 and a structured questionnaire were used to collect data. Quantitative data was analyzed using Statistical Package for Social Scientists (SPSS) Version 20 and Statistical Application Software (SAS) version 9.2 at a statistical significance of P ≤ 0.05, descriptive and inferential statistics were performed. The mean HRQoL was 35.35 (SD=13.21). More than half of the respondents experienced poor functional and physical wellbeing, 221 (66%) and 201 (60%) respectively and no patient experienced good functional and physical wellbeing. While 189 (57%) experienced fair overall quality of life. Multiple cumulative logistic regression analysis between cancer stage and treatment had statistically significant association with overall quality of life (X2 = 105.34 and 70.72; with df=3 and 6; p-values = 0.0001 and 0.0001, respectively); also between age, marital status, level of education and religion showed positive influence on overall quality of life except for religion (X2 = 21, 11, 113 and 4 with df=3 for all and p-values = 0.0001, 0.0121, 0.0001, 0.2563 respectively). Cervical cancer patients do fairly better with emotional and social wellbeing, while they experience poor functional and physical wellbeing due to large proportion of patients presenting at stage IV and III of the disease. There is a need to include HRQoL assessment in routine management of cervical cancer patients to enhance their quality of life.

259 Background: Cancer anorexia-cachexia syndrome (CACS) is common in advanced cancer patients and associated with weight loss, fatigue, impaired quality of life (QoL), and poor prognosis. The goal of this project was to identify the most responsive items and evaluate their validity from two QoL measures in the ROMANA 2 (NCT01387282) Phase III global study evaluating anamorelin HCl in the treatment of non-small cell lung cancer (NSCLC) cachexia: the Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F) and the Functional Assessment of Anorexia/ Cachexia Therapy (FAACT). Methods: In the ROMANA 2 trial, 477 patients with unresectable Stage III or IV NSCLC and cachexia were to be enrolled and randomized (2:1) to receive anamorelin HCl or placebo once daily for 12 weeks. All 383 patients who reached the Week 12 visit at the time of this blinded data analysis were included. Co-primary endpoints were change from baseline in lean body mass and handgrip strength. QoL was a key secondary outcome with FACIT-F and FAACT questionnaires administered at baseline and at weeks 3, 6, 9, and 12. Results: Two 4-item scales (referred to as the Simplified Evaluation of Fatigue [SEF] &amp; Simplified Evaluation of Appetite [SEA]) from the FACIT-F and FAACT, respectively, demonstrated good internal consistency reliability with Cronbach’s alphas &gt;0.70. In analysis of known group validity, scores significantly differed between groups defined by performance status and appetite (with effect sizes ≥0.34). Convergent validity analysis showed significant correlations with general QoL/functioning scales (correlation coefficients 0.41–0.77), further demonstrating validity. In terms of responsiveness, changes from baseline to week 12 in SEF and SEA scores were associated with changes in general QoL/ functioning, appetite, weight, and lean body mass (correlations &gt;0.20). The estimated important difference for each scale was ~1-2 points. Conclusions: These brief scales are valid and responsive measures that provide psychometric properties necessary to promote future research in NSCLC patients with CACS. Additional work should examine clinical utility of these scales and their impact on treatment decision-making.

Cervical cancer is the second common female malignant tumor globally which seriously threatens female’s health. In 2020, cervical cancer accounted for 18.3% of new cases in India, according to GLOBOCAN. The situation is more alarming in rural areas where women are illiterate, ignorant, poverty, socio-economic status lack the knowledge for detection and early diagnosis. The fatigue is a common and distressing symptom in cancers and also contributes to depletion in health-related quality of life of an Individual. The aim of this study was to assess the Impact of Cervical Cancer on fatigue level and Quality of Life in women with cervical cancer in a tertiary care hospital. Methodology: The study involved 30 cervix cancer patients aged above 18 years receiving anticancer treatment. They were assessed for fatigue severity and quality of life using the Brief Fatigue Inventory and FACT-Cx scale. Results: The study included 23 patients with mean age of 63.30(±11.65) years. 52% experienced severe fatigue, while 48% experienced moderate fatigue. The lowest scores were in emotional and functional well-being, while the highest were in social/family and physical well-being. The FACT-CX score was 99.3±13, there is a significant negative correlation between fatigue and quality of life in cervical cancer patients. Conclusion: The study concludes moderate to severe levels of fatigue was experienced, which also impacts the quality of life. Fatigue has negative correlation with quality of life in patients with cervical cancer. Keywords: Cervix cancer, Fatigue, Quality of Life, Gynaecological cancer.

Previous study showed that health-related quality of life (HRQoL) was adversely affected during treatment of cervical cancer, with a worsening global score. Therefore, this study aimed to determine the HRQoL of cervical cancer patients at Kenyatta National Hospital. A cross-sectional study design was employed among cervical cancer patients. All eligible consecutive samples of 103 cervical cancer patients were included in the study. Following consent, patients were interviewed using The European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire 30 (EORTC QLQ-30) and Cervical Cancer Module CX24 (EORTC QLQ-CX24). The data were entered and analyzed using the SPSS version 20.0 software. Univariate and multivariate binary logistic regression analysis was employed to investigate the predictors of HRQoL. A p-value of ≤ 0.05 was considered statistically significant. The majority (69%) of the patients had a poor overall quality of life while 31% of study participants had a good quality of life. Patients with early-stage disease were 7.3 times (AOR = 7.3, 95% CI = 2.4-21.7, p = 0.000) more likely to have a good HRQoL than patients with advanced-stage disease. Patients with no comorbidities were 3.1 times (COR = 3.1, 95% CI = 1.1-9.1, p = 0.037) more likely to have a good HRQoL than patients with comorbidities. The overall HRQoL among cervical cancer patients was poor in the setting. Advanced stage of disease and presence of comorbidities were the significant predictors of poor quality of life.

BackgroundData on health-related quality of life (HRQoL) is paramount for shared and evidence based decision-making. Since an overview of cervical cancer HRQoL tools and their validity appears to be lacking, we performed a systematic review on usage of disease specific HRQoL instruments in cervical cancer patients and their psychometric properties to identify the most suitable cervical cancer specific HRQoL tool.MethodsWe searched Pubmed, EMBASE and PsycINFO from inception up to 18 October 2016 for studies on quality of life in cervical cancer patients. Data extraction and HRQoL identification was performed by two independent reviewers. Validation studies of the identified cervical cancer specific HRQoL tools were retrieved and assessed on psychometric properties using the COSMIN checklist. All used cervical cancer specific HRQoL instruments were scored and ranked according to their psychometric properties.ResultsWe included 156 studies (20,690 patients) and identified 31 HRQoL tools. The EORTC QLQ-CX24 (35 studies; 5,556 patients) and FACT-Cx (22 studies; 4,224 patients) were the only cervical cancer specific tools.The EORTC QLQ-CX24 had 4 out of 9 positive rated psychometric properties; internal consistency, content and construct validity, and agreement. Criterion validity, reliability, and interpretability scored doubtful. Responsiveness and floor- and ceiling effects were not reported. The FACT-Cx had 2 out of 9 positive rated psychometric properties; internal consistency and agreement. Content validity, reliability, and interpretability scored doubtful while criterion and construct validity scored negative. Responsiveness and floor- and ceiling effects were not reported.ConclusionThe validity of the often used EORTC QLQ-CX24 questionnaire for cervical cancer patients remains uncertain as 5 out of 9 psychometric properties were doubtful or not reported in current literature. Cervical cancer specific HRQoL tools should therefore always be used in conjunction with validated generic cancer HRQoL tools until proper validity has been proven, or a more valid tool has been developed.

The cancer anorexia-cachexia syndrome (CACS) is highly prevalent in lung cancer (LC) patients (57-61%), and represents the direct cause of death in 20% of cases. Accurately quantifying CACS has been a challenging issue; consequently, this study presents the clinical validation of the Spanish version of the Functional Assessment of Anorexia-Cachexia Therapy (FAACT) scale in LC patients from Latin America. The Spanish version of the FAACT and the Mexican-Spanish version of the EORTC-QLQ-C30 instruments were applied to a cohort of patients with LC at the National Cancer Institute of Mexico. Reliability and validity tests were performed to assess the psychometric properties of the scales, and clinical validation was assessed considering the association of scales with subjective and objective clinical data. Two hundred patients were included. Questionnaire compliance rates were high (100%) and the instrument was well accepted in all cases; internal consistency tests demonstrated good convergent and divergent validity of the scale structure. Cronbach's α coefficient for three out of five basic multi-item scales was > 0.7 (0.55-0.86). FAACT scales presented significant associations with clinical parameters, including biochemical and nutritional variables (i.e., energy intake, p = 0.002), as well as strongly correlated with the appetite loss subscale of the QLQ-C30 questionnaire (r = - 0.624). Physical well-being (p < 0.0009), functional well-being (p = 0.004), anorexia/cachexia scale (p = 0.029), and FAACT total scores (p = 0.0009) were strongly associated to overall survival. The Spanish version of the FAACT questionnaire is reliable and valid for the assessment of health-related quality of life and CACS in LC patients and can be used in clinical trials.

The purpose of this study was to investigate the factors that influenced health related quality of life in women with disabilities. The other purpose was to examine the correlations of activities of these women's daily life, self esteem, and health promoting behavior with health related quality of life. The subjects consisted of 120 adult disabled women. Data was collected from February to June 2004 using structured questionnaires. Spearman's correlation, and multiple regression were used to test the quality of life with K-ADL, self esteem, and health promoting behaviors by using SPSS 12.0 for windows. The health related quality of life of women with disabilities was related to educational level, marital status, residential type, cause of acquired disability and disability of spouse. In addition, it was related to self esteem (r=.385, p=0.00), health promoting behaviors (r=.428, p=0.00), K-ADL (r=-.419, p=0.00) and K-IADL (r=-.439, p=0.00). Activities of daily life, self esteem and health promoting behaviors were significant predictors 37.3% (r=0.212, p=0.000) to explain quality of life in disabled women. The more self esteem, health promoting behaviors, K-ADL and K-IADL are positive, the more the health related quality of life is good. Further studies need to be done to investigate additional effects of health related quality of life and to investigate nursing approaches to improve their health related quality of life with significant predictors.

Postmenopausal osteoporosis has become a global trend, which seriously affects women's quality of life. However, the differences remain unclear in health-related quality of life (HRQoL) among postmenopausal women with normal bone mineral density, osteoporosis, and osteoporotic fractures. The aim of this study was to assess health-related quality of life in women with three different bone states. Databases of PubMed, Embase, Cochrane, and Web of Science were based on the search terms, and the search time was set from the inception of each database to January 2022. A study was included if the researchers used a validated quality of life questionnaire to investigate the quality of life of postmenopausal women with osteoporosis or osteoporotic fractures. The random-effect model was used for meta-analysis, and the mean difference with a 95% confidence interval (95%CI) was calculated. Thirteen studies that met the inclusion criteria were systematically reviewed, involving 2897 postmenopausal women, and 12 of them were included in the meta-analysis. Postmenopausal women with osteoporosis had worse overall HRQoL and different HRQoL dimensions compared with postmenopausal women with normal bone density. Compared with postmenopausal women with osteoporosis, postmenopausal women with osteoporotic fractures had worse overall HRQoL and individual dimensions of HRQoL, especially physical component summary (SMD = -0.61, 95% CI, -0.98 to-0.24). Bone mineral density was positively associated with HRQoL, while fragility fracture severity was negatively associated with HRQoL. Postmenopausal osteoporosis and fragility fractures reduce HRQoL to varying degrees in women. More research should be done to reduce the incidence of the disease.