Fatigue, Self-Care Behavior, and Quality of Life in Patients Undergoing Home-Based Chemotherapy with a Disposable Elastomeric Infusion Pump

ObjectivesLike morning stiffness, fatigue is a common, debilitating symptom of rheumatoid arthritis (RA). Delayed-release (DR) prednisone is designed for evening administration (approximately 22:00) and releases 4 h later to coincide...

Single- vs. Multiple-Item Instruments in the Assessment of Quality of Life in Patients with Advanced Cancer

Baseline Patient-Reported Quality-of-Life Is Not Related to Overall Survival in Patients Receiving Stereotactic Body Radiation Therapy for Thoracic Malignancies: A Preliminary Report

BackgroundIt is essential to evaluate the quality of life in patients with hematologic malignancies to reflect the therapeutic effect and prognosis, but lengthy assessments are often burdensome. The 7-Item Functional Assessment of Cancer Therapy-General (FACT-G7) is a brief, easy, and rapid index for evaluating quality of life. Nevertheless, there is no report about its application in Chinese patients with hematologic malignancies.ObjectiveThe purpose of this study was to validate the Chinese version of the FACT-G7 for patients with hematologic malignancies.MethodsThis study is a cross-sectional study. A total of 855 patients with hematologic malignancies completed the Functional Assessment of Cancer Therapy-General (FACT-G) and were scored the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) by nurses. Cronbach’s alpha, confirmatory factor analyses, Pearson’s correlation, and one-way analysis of variance were conducted to evaluate internal consistent reliability, structural validity and concurrent validity.ResultsThe FACT-G7 showed acceptable internal consistency, as indicated by a Cronbach’s alpha of 0.73. The confirmatory factor analyses test for single-factor model fit for the FACT-G7 scale was almost adequate. The satisfactory correlations between the FACT-G7 and the FACT-G and its subscales, and ECOG-PS groups differed in FACT-G7 scores demonstrating concurrent validity.ConclusionThis study suggested that the Chinese version of the FACT-G7 provides a useful and rapid measure for assessing quality of life in Chinese patients with hematologic malignancies, which providing a reference for further evaluation and care.

CN84 - Health-related quality of life in Greek haematological malignancies patients undergoing chemotherapy

Comprehensiveness of Quality of Life Instruments in Capturing Concerns Related to Chemotherapy-Induced Neutropenia

Although self-care has a therapeutic effect on heart failure (HF), patients experience a marked reduction in physical and executive function, resulting in poor quality of life (QoL). A literature review revealed limited evidence regarding the possible relationship between self-care and QoL in HF patients. Therefore, this scoping review aimed to identify scientific evidence that examines the extent of self-care, QoL, and relationship between self-care and QoL in patients with HF. Full-text research published from March 23, 2010, to March 23, 2020, written in English, that had content on both self-care and QoL among adult patients with HF was included. A literature search of electronic databases and web searches was conducted for published articles. Four databases were used: MEDLINE, Scopus, Web of Science, and the Cochrane Library. Studies collected from Google and Google Scholar web searches were also included. Of 1,537 papers identified by the search, 12 were included. The reviewed studies included 3,127 patients. Ten articles used a cross-sectional study design, whereas the remaining articles used a longitudinal and quasi-experimental design. This review found that the extent of self-care practices among patients with HF was inadequate, a significant proportion of patients enrolled in the reviewed studies had a moderate QoL, and higher self-care practices were associated with a better QoL. Self-care behavior and QoL were affected by social support, sex, age, educational level, place of residence, illness knowledge, presence of comorbidities, and functional classification of HF. Self-care behavior was positively correlated with QoL in patients with HF. Self-care and QoL in these patients have been reported to be affected by several factors. Further research with a rigorous study design is recommended to investigate the influence of self-care practices on QoL in patients with HF.

e20528 Background: The main objective of palliative cancer care is to improve quality of life (QOL). As multiple dimensions impact on the construct of QOL, multi-dimensional instruments are usually used in its measurement. These are time consuming and burdensome for repeated use. Recent authors have suggested that brief single-item global assessments can provide a reliable measure of QOL. We assessed the performance of the Edmonton Symptom Assessment System ‘feeling of well-being’ item (ESAS WB) using the Functional Assessment of Cancer Therapy - General (FACT-G) instrument as a gold standard. Methods: After obtaining IRB approval, we reviewed the data from 213 advanced cancer patients who had participated in six studies from March 2006 to June 2008 and determined the level of association between baseline ESAS WB and FACT-G total score and subscale domains (Physical (Pwb), Social/Family (Swb), Emotional (Ewb), and Functional (Fwb) Well-Being) and also the 9 ESAS symptom intensity scores using Spearman correlation coefficients. We also calculated the change between the baseline (T1) and second (T2) observations of ESAS WB and of FACT-G total score and determined their level of association using a Pearson correlation coefficient. In addition, we predicted the change in FACT-G as predicted by the change in ESAS WB score using regression analysis. Results: Mean age was 60 (SD 12) years and 48% were female. At T1, the Spearman correlation coefficient of ESAS WB and FACT-G was -0.48 (p<0.0001). Spearman correlation coefficients for ESAS WB and FACT-G subscale domains and ESAS symptom intensity scores were also highly significant (p<0.0001) for all physical and emotional symptoms (other than p=0.003 for nausea) except for FACT Swb (p=0.08). The Pearson correlation coefficient for difference between T1 and T2 in ESAS WB and FACT-G for 146 patients was -0.36 (p<0.0001). The regression analysis was highly significant (p<0.0001). The change in ESAS WB corresponding to FACT-G published minimally important difference (MID) was -0.24 for 3, -1.55 for 5, and -2.87 for 7, respectively. Conclusions: ESAS WB is a practical instrument for clinical use and best reflects the Pwb, Ewb and Fwb domains of FACT-G as compared to Swb. No significant financial relationships to disclose.

Introduction: Multimorbidity, the co-occurrence of various chronic conditions, is of major concern in patients with heart failure (HF) because it is associated with impaired quality of life (QOL) and adverse outcomes. Effective self-care is an essential adjunct to evidence-based medical treatment aimed at delaying progression of HF. Hypothesis: This study investigated the relationships between multimorbidity, QOL and level of self-care in HF patients. Methods: Study subjects completed questionnaires on HF-related quality of life (Minnesota Living with Heart Failure questionnaire), HF-related self-care behaviors (European Heart Failure Self-Care Behavior Scale), HF-related knowledge (Japanese heart failure knowledge scale) and depression symptoms. Comorbidities and other clinical and social characteristics were also assessed. Analyses of covariance and multivariate linear regression were used to assess associations between multimorbidity and QOL. Results: A total of 231 outpatients with HF were assessed; 119 with poor self-care (self-care score< 34) and 112 with adequate self-care (self-care score≥34); mean age 65.8 ± 13.9 and 69.8 ± 13.7 years, respectively. Of these patients, 57.6% had three or more additional chronic conditions; the most prevalent being hypertension (56.0%) and chronic kidney disease (46.6%). Patients with multimorbidity had worse QOL than patients without (P < 0.01). Subjects with poor self-care and multimorbidity had worse QOL than those without multimorbidity (P < 0.01); however, there was no association between multimorbidity and QOL in patients with adequate self-care. Multivariate analysis controlling for the effects of other variables showed that multimorbidity was an independent determinant of QOL overall and in poor self-care patients (sβ = 0.15, P = 0.04; sβ = 0.28, P < 0.01, respectively). However, in patients with adequate self-care, multimorbidity was not associated with QOL. Conclusions: Multimorbidity is an independent determinant of QOL in HF patients with poor self-care. To improve their QOL, both reinforcement of adequate self-care behavior regarding their HF and a multidimensional approach to enhancing self-management of their comorbidities are needed.

Objective To investigate influencing factors of life quality of adult patients with acute leukemia (AL), and to provide a basis for the intervention of their life quality. Methods During September to December 2016, a total of 142 cases of AL adult patients admitted in Department of Hematology, West China Hospital were recruited as study subject by convenient sampling. General Data Questionnaire of AL Adult Patients which was self-designed by researchers and Functional Assessment of Cancer Therapy-Leukemia (FACT-Leu) which was used to investigate life quality of leukemia patients were conducted among patients to understand life quality of AL adult patients and related factors. Independent sample t test and one-way ANOVA were used to compare the scores of FACT-Leu dimensions of AL adult patients with different general data. Multiple stepwise regression analysis was used to analyze the factors influencing the quality of life of AL adult patients. Informed consent was obtained from all subjects. Results ① A total of 142 sets of questionnaires were hand out and 137 sets of valid questionnaires were collected. The feedback rate of valid questionnaires was 96.47%. The median age of the 137 AL adult patients was 39 years old (15-72 years old), average age was (38.4±13.8) years old. And 56(40.9%) patients were male, 81(59.1%) patients were female. The average score of FACT-Leu of 137 AL adult patients was (107.7±28.8) scores. ② According to the survey results of General Data Questionnaire of AL Adult Patients and FACT-Leu among 137 AL adult patients, female patients′ scores of emotional well-being (EWB) dimension, Functional Assessment of Cancer Therapy-General (FACT-G) and FACT-Leu were (15.3±5.7) , (62.1±19.0) , (103.5±28.7) scores and lower than those of male patients, which were (17.3±5.0) , (69.4±18.9) , (113.8±28.2) scores, and the difference were statistically significant (t=2.145, 2.206, 2.072; P=0.034, 0.029, 0.040). Scores of physical well-being (PWB), leukemia specific dimensions, FACT-G and FACT-Leu of patients continuing to work after onset of AL were (19.8±5.3) , (47.1±10.8), (72.6±18.4), (119.6±26.5) scores, and higher than those of patients who didn′t continue to work after onset, which were (16.9±6.6), (41.6±11.9), (63.2±19.1), (104.8±28.7) scores, and the difference were statistically significant (t=2.451, 2.168, 2.301, 2.439; P=0.018, 0.032, 0.023, 0.016). Score of EWB dimension (n=74) of acute myeloid leukemia (AML) patients was (17.2±4.8) scores, and higher than that of acute lymphoblastic leukemia (ALL) patients (n=63), which was (14.8±5.9) scores, and the difference was statistically significant (t=2.587, P=0.011). Self-care ability score and PWB dimension, EWB dimension, functional well-being (FWB) dimension, leukemia specific dimension, FACT-G and FACT-Leu scores were positively correlated (r=0.539, 0.500, 0.405, 0.557, 0.495, 0.561; P=0.000, 0.000, 0.000, 0.000, 0.000, 0.000). ③ Results of multiple stepwise regression analysis of related factors affecting AL adult patients′ life quality showed that self-care ability score was the main influencing factor of scores of PWB dimension, EWB dimension, FWB dimension, leukemia specific dimension, FACT-G, FACT-Leu (t=7.567, 6.774, 5.108, 7.850, 6.769, 8.003; P=0.000, 0.000, 0.000, 0.000, 0.000, 0.000). Gender was the main influencing factor of scores of PWB dimension, EWB dimension, FWB dimension, leukemia specific dimension, FACT-G, FACT-Leu (t=-2.501, -2.896, -2.311, -2.096, -3.060, -3.007; P=0.014, 0.004, 0.022, 0.038, 0.003, 0.003). Occupational status after onset was the main influencing factor associated with AL patients′ scores of social/family well-being (SWB) dimension (t=2.070, P=0.040). And the male patients, patients continuing to work after onset and with higher self-care ability score reported better quality of life. Conclusions In order to improve the life quality of AL adult patients, nurses of Hematology Department and patients′ family should pay attention to the AL adult female patients and patients with low self-care ability score, and enhance the self-care ability assessment and exercise education, and encourage the patients to participate in light-physical work during stable stage. Key words: Leukemia; Leukemia, myeloid, acute; Precursor cell lymphoblastic leukemia-lymphoma; Quality of Life; Oncologic nursing; Questionnaires

ObjectiveTo evaluate the effects of Physical Therapies (PTs) on improvement in psychosomatic symptoms and quality of life (QOL) in breast cancer patients.Data SourcesSeven databases (MEDLINE, EMBASE, Cochrane CENTRAL, China National Knowledge Infrastructure, Wangfang, VIP, and China Biology Medicine disc databases) were systematically searched from the database inception through May 18, 2021.Study SelectionRandomized controlled trials (RCTs) which compared acupuncture or exercise with a sham control or usual care for the treatment of aromatase inhibitors (AIs)-related psychosomatic symptoms and QOL.Data Extraction and SynthesisData were screened and extracted independently using predesigned forms. The quality of RCTs was assessed with the Cochrane Handbook for Systematic Reviews of Interventions. The effect size was calculated via random-effects modeling. The quality of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation approach.Main Outcomes and MeasuresThe score of pain was measured with BPI scale and Western Ontario and the McMaster Universities Index (WOMAC) scale. Emotional state was measured with Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS-A), and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue). The QOL score was measured by self-reported measurements, including the Functional Assessment of Cancer Therapy-General (FACT-G) scale and 36-Item Short Form Survey (SF-36) scale.ResultsEleven RCTs (with 830 patients) were included in the systematic review, and data from 10 RCTs (with 798 patients) were used in the meta-analysis. Results showed acupuncture significantly reduced worst pain scores (P < 0.00001, I 2 = 83.5%) [SMD = −0.81, 95% CI (−1.51, −0.11)], but the effect of exercise therapies was not significant in overall change in worst pain scores (P =0.006, I 2 = 72.3%) [SMD = −0.30, 95% CI (−0.76, 0.16)]. Both acupuncture and exercise resulted in little to no difference in overall change in HADS-A subscale (P = 0.026<0.05, I 2 = 79.8%) [WMD = −0.21, 95% CI (−3.44, 3.03)], PSQI subscale (P = 0.488, I 2 = 0%) [WMD = 0.98, 95% CI (−0.57, 2.53)], and FACIT-Fatigue subscale (P = 0.022<0.05, I 2 = 81.0%) [WMD = 1.6, 95% CI (−5.75, 8.94)]. Exercise (compared with usual care) was associated with improving overall change in health-related QOL (subscales of SF-36 tool) (P = 0, I 2 = 72.1%) [WMD = 7.97, 95% CI (5.68, 10.25)] and cancer-specific QOL (subscales of FACT-G tool) (P = 0.304, I 2 = 16%) [WMD = 1.16, 95% CI (0.34, 1.97)].Conclusions and RelevanceThis systematic review and meta-analysis suggested that based on moderate-level evidence, acupuncture was associated with significant reductions in pain intensity, and exercise might improve QOL in breast cancer patients treated with AIs. However, in psychosomatic symptoms such as anxiety, sleep disturbance, and fatigue, acupuncture and exercise training did not result in significant improvements.

BackgroundSelf-care of diabetes is an essential part for controlling the disease and improvement of quality of life in type 2 diabetes mellitus (T2DM) patients. This study aimed to analyze the associated factors of quality of life in patients with T2DM in order to design effective interventions.MethodsThis cross-sectional study was conducted on 120 T2DM patients referred to health centers of Chaldoran, West Azerbaijan Province, Iran. The quality of life's questionnaires from World Health Organization and the self-care behaviors' questionnaires were used for data collection.ResultsThe mean age of patients was 46.30% and 53.30% of them were male. Among demographic variables, gender (P=0.002), age groups (P=0.007), and household monthly income (P=0.009) were significantly associated with total quality of life. Also, self-care nutrition (odds ratio [OR], 1.47; P=0.001), self-management of blood glucose control (OR, 1.29; P=0.002), and self-medication behavior (OR, 1.18; P=0.030) were identified as factors significantly associated with quality of life.ConclusionSelf-care behaviors were significantly associated with quality of life; among them, the greatest influence was observed in self-care nutrition behavior. According to the findings of this study, appropriate interventions on self-care behaviors about nutrition can improve the quality of life for T2DM patients.

Introduction and Objectives: New diagnosis of prostate cancer (PCa) may lead to anxiety, mental distress, fear and depression in up to 30% of men, which can contribute to poor quality of life (QOL). Recent research on Yoga in cancer patients has shown significant improvement in health related QOL, emotional health and fatigue. Given the lack of randomized clinical data regarding the effects of Yoga in PCa, we performed this study to evaluate the potential impact of Yoga on disease-specific QOL in men undergoing radical prostatectomy (RP) for PCa. Material and Method: We randomly assigned newly diagnosed men with localized prostate cancer to Yoga (n = 15) or standard of care (n= 15) prior to their RP. Yoga was given to the intervention group twice a week for 6 weeks for 60 minutes before the surgery and then re-initiated 3 to 6 weeks after the surgery for another six weeks. Self-report measures of QOL [ Expanded Prostate Index Composite (EPIC), Functional Assessment of Cancer Therapy-Prostate (FACT-P), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Functional Assessment of Cancer Therapy-General (FACT-G) and Five Facets of Mindfulness Questionnaire (FFMQ) primary outcomes], blood specimen (cytokine and immune markers; secondary outcome) were collected at baseline, prior to the surgery and 6 weeks after surgery. Results: Improvements in EPIC sexual domain (mean difference: 8.5 points), FACT-P (mean difference: 5.3 points), FACIT-F (mean difference: 5.4 points), and FACT-G (mean difference: 7.2 points) were seen at 6 weeks in the Yoga arm compared with controls. Greatest benefit of Yoga was seen in the subdomains of EPIC sexual function (mean difference: 8.9 points), EPIC sexual bother (mean difference: 7.6 points), FACT emotional wellbeing (mean difference: 5.4 points), FACT functional wellbeing (mean difference 8.3 points) and FACT social wellbeing (mean difference 14.1 points). We identified statistically significant reduction in the inflammatory cytokines- granulocyte colony-stimulating factor (G-CSF; 0.55 [0.05 - 1.05]; p-value = 0.03), Monocyte chemoattractant protein (MCP-1; 0.22 [0.01 - 0.43]; p-value = 0.04), FMS-like tyrosine kinase-3 ligand (FLT-3 L; 0.91 [-0.01 - 1.82]; p-value = 0.053) in the Yoga group during the same time period. Conclusions: A structured Yoga intervention in the preoperative setting improved QOL, especially in the domains of sexual function, social, emotional and functional well-being as well as fatigue. Yoga positively modulates chronic low-grade inflammation which may impact tumor microenvironment. Yoga is feasible and safe and has promising benefits to physical, mental and emotional well-being. Health care providers can utilize the preoperative period as a window of opportunity for an intervention and a teaching moment for the patient to enhance their overall health. Further integrated large-scale research into molecular impact of yoga on markers of inflammation and immune function are essential. Source of Funding: This project was supported by the ThriveWell Cancer Foundation grant to Dharam Kaushik. The content is solely the responsibility of the authors and does not necessarily represent the official views of the ThriveWell Cancer Foundation. Citation Format: Dharam Kaushik, Pankil Shah, Kumar A. Pratap, Ian M. Thompson, Robert S. Svatek, Javier Hernandez, Ian Thompson, Ahmed Mansour, Richapriya Jha, Yang Xiaoyu, Deepak K. Pruthi, Hanzhang Wang, J. Ricardo Rivero, Nydia Darby, Ronald Rodriguez, Michael A. Liss. A randomized controlled trial of yoga in men with prostate cancer undergoing radical prostatectomy [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr LB-292.

e15693 Background: Carcinoid syndrome (CS) results from the secretion of bioactive amines by functional neuroendocrine tumors. The only FDA-approved agents to treat carcinoid syndrome symptoms (CSS) are SSAs. This study assessed the association of duration of SSA use and quality of life (QoL) among patients with CSS usingthe validated Functional Assessment of Cancer Therapy-General (FACT-G) instrument. Methods: Patients with CSS in the US were recruited by NCAN for a two-part online, anonymous survey (~6 months apart). The first survey was fielded between July-October 2016 and results are reported here. Eligible patients were ≥18 years old with CSS and received either SSA or non-SSA treatment for CSS control. The survey consisted of demographic, clinical and QoL questions, including FACT-G. Descriptive and multivariable regression analyses, adjusting for demographic and clinical characteristics, were performed to assess predictors of FACT-G QoL scores. Duration of SSA use was categorized into quartiles ( &lt; 2.7, 2.7-4.42, 4.43-8.0, and &gt; 8.0 years). Results: Among 117 patients who completed the first survey, 76.9% were female and 87.2% Caucasian with a mean age of 58.0 years. A predominant number of patients (98.3%) received SSAs in the past month. The mean ± SD FACT-G total score was 67.6 ± 20.0 (possible range: 0-108), lower than that of the general US population (80.1 ± 18.1). The mean ± SD duration of SSA use was 6.1 ± 4.7 years. Descriptive analysis suggested that patients receiving SSA treatment for &gt; 8 years had higher (better) FACT-G subscale and total scores than reference group &lt; 2.7 years. Multivariable models showed that FACT-G total score was 11.3 points ( P= 0.033) higher for patients treated with SSA &gt; 8 years compared to those treated for &lt; 2.7 years. Similar patterns were observed for two FACT-G subscales - Physical Well Being and Functional Well Being. Conclusions: The duration of SSA use was positively associated with QoL benefit among CS patients. This may be explained by long-term effectiveness of SSAs or selection bias favoring patients with more indolent disease. Future studies will be needed to distinguish between these possibilities.

Prospective Evaluation of Patient-Reported Outcome up to 10 Years after Allogeneic Stem Cell Transplantation Using FACT-G/BMT and EORTC-QLQ30 Questionnaires