Perceived Quality-of-Life Importance Among Saudi Gynecologic Cancer Survivors: Latent Class Analysis

Using Latent Profile Analysis and Related Approaches in Adolescent Health Research

To evaluate the quality of life (QoL) of patients with Chagas disease (CD) and the association between QoL domains and several clinical, socioeconomic and lifestyle characteristics of this population. Cross-sectional observational study conducted from March 2014 to March 2017 including a total of 361 outpatients followed at Evandro Chagas National Institute of Infectious Disease, Brazil. QoL was assessed using the Portuguese shorter version of the original WHO Quality of Life questionnaire (WHOQOL-BREF). Information about clinical CD presentation, presence of comorbidities, functional class, previous benznidazole treatment, socioeconomic profile and lifestyle was also obtained. Environment and physical domains presented the worst QoL scores, while the social relationship domain presented the highest score. Multivariate regression analysis demonstrated that variables independently associated with QoL were functional class, sex, clinical presentation of CD, sleep duration, schooling, physical activity level, smoking, income per capita and residents by domicile. The low socioeconomic status and the physical limitations imposed by the disease presented an important impact on the QoL reduction among CD patients, especially on environment and physical domains. Strategies to improve QoL among CD patients should be tailored and consider many different variables to maximise improvements not only of patients' physical but also of their mental health.

S&T-09 THE FERTILITY QUALITY OF LIFE AND SEXUAL DYSFUNCTION IN MEN SEEKING FERTILITY TREATMENT

Pelvic floor disorders and sexual function in gynecologic cancer survivors: a cohort study

The main aim of the present study was to investigate the presence of Differential Item Functioning (DIF) using a latent class (LC) analysis approach. Particularly, we examined potential sources of DIF in relation to gender. Data came from 6,265 Saudi Arabia students, who completed a high-stakes standardized admission test for university entrance. The results from a Latent Class Analysis (LCA) revealed a three-class solution (i.e., high, average, and low scorers). Then, to better understand the nature of the emerging classes and the characteristics of the people who comprise them, we applied a new stepwise approach, using the Multiple Indicator Multiple Causes (MIMIC) model. The model identified both uniform and non-uniform DIF effects for several items across all scales of the test, although, for the majority of them, the DIF effect sizes were negligible. Findings from this study have important implications for both measurement quality and interpretation of the results. Particularly, results showed that gender is a potential source of DIF for latent class indicators; thus, it is important to include those direct effects in the latent class regression model, to obtain unbiased estimates not only for the measurement parameters but also of the structural parameters. Ignoring these effects might lead to misspecification of the latent classes in terms of both the size and the characteristics of each class, which in turn, could lead to misinterpretations of the obtained latent class results. Implications of the results for practice are discussed.

While survival outcomes for breast and cervical cancer have improved in Saudi Arabia, little is known about the long-term sexual and psychosocial well-being of survivors. This study aimed to assess sexual satisfaction, emotional health, and social relationship quality among Saudi women diagnosed with cervical and breast cancers and to identify sociodemographic predictors of quality of life (QoL) across these domains. A cross-sectional survey was administered to 129 women with a history of breast or cervical cancer during May-July 2021. The instrument combined validated tools measuring three core QoL domains: sexual function and satisfaction, psychological and emotional well-being, and social and relationship qualities. Multivariable ordinal logistic regression was used. A total of 129 women with cervical and breast cancers (51.2% cervical, 48.8% breast) participated. Most were aged 31-45 years (45.7%), married (83.0%), with 48.1% holding a bachelor's degree. Overall, 74.4% of participants reported high to moderate emotional well-being; 48.8% reported satisfactory sexual function, and only 41.1% perceived high quality in social relationships. Younger age (21-30 years), higher education, and having more children were significantly associated with lower emotional well-being (p < 0.05). Conversely, current treatment status and higher parity were associated with better sexual function. Social and relationship quality was significantly higher among younger and employed women. Perceived importance of domains varied, with emotional well-being rating the highest (82.9%). Sexual and social QoL are underserved yet critical components of survivorship care. Cultural, familial, and educational contexts play significant roles in shaping post-treatment experiences. Interventions tailored to age, family dynamics, and treatment stage are needed to improve the holistic well-being of survivors in Saudi Arabia.

To implement a nurse-led sexual rehabilitation programme for gynaecological cancer (GC) survivors and to evaluate its effects on their sexual functioning, sexual distress and marital satisfaction. An assessor-blinded, randomized controlled trial. The development of the nurse-led sexual rehabilitation intervention was guided by the concept of sexual health, as stated in the Neotheoretical Framework of Sexuality; the explicit permission giving, limited information, specific suggestions and intensive therapy model; and evidence-based nursing interventions for sexuality. Four intervention sessions will be delivered along the treatment trajectory. Women newly diagnosed (within 3months) with GC will be recruited from the gynaecological units of three hospitals in Hong Kong. The participants (N=172) will be randomly assigned to the intervention group to receive the nurse-led sexual rehabilitation programme, or to an attention control group to receive attention on four occasions during the same period when the intervention group receives the intervention. Sexual functioning, sexual distress and marital quality will be measured at baseline, 1month after the completion of cancer treatment, after completion of the sexual rehabilitation programme and 12months after cancer treatment. Semi-structured interviews will be conducted with the participants in the intervention group to explore their experiences with and feelings towards the programme. The study was funded in March 2019 and ethics approval was obtained in January 2019. Positive outcomes of the nurse-led sexual rehabilitation programme will contribute to scientific and practical knowledge about nursing interventions to help GC survivors and their partners to resume a satisfying intimate relationship and adapt to changes in sexuality after treatment. This study will contribute to the evidence for and advance research on the effectiveness of nurse-led sexuality rehabilitation interventions to support women and their partners to rebuild sexuality and intimacy after treatment for GC.

The Influence of Chemotherapy-Induced Peripheral Neuropathy on Quality of Life of Gynecologic Cancer Survivors.

Purpose: Our objectives were to (a) identify oral and pharyngeal physiologic swallowing impairment severity classes based on latent class analyses (LCAs) of the Modified Barium Swallow Impairment Profile (MBSImP) swallow task scores and (b) quantify the probability of severity class membership given composite MBSImP oral total (OT) and pharyngeal total (PT) scores.Method: MBSImP scores were collected from a patient database of 319 consecutive modified barium swallow studies. Because of missing swallow task scores, LCA was performed using 25 multiply imputed data sets.Results: LCA revealed a three-class structure for both oral and pharyngeal models. We identified OT and PT score intervals to assign subjects to oral and pharyngeal impairment latent severity classes, respectively, with high probability (probability of class membership ≥ 0.9 given OT or PT scores within specified ranges) and high confidence (95% credible interval [CI] widths ≤ 0.24 for all total scores within specified ranges). OT scores ranging from 0 to 10 and from 14 to 18 yielded assignments in Oral Latent Classes 1 and 2, respectively, while OT = 22 was assigned to Oral Latent Class 3. PT scores ranging from 0 to 13 and from 18 to 24 yielded assignments in Pharyngeal Latent Classes 1 and 2, respectively, while PT = 26 was assigned to Pharyngeal Latent Class 3.Conclusions: LCA of MBSImP task-level data revealed significant underlying oral and pharyngeal ordinal class structures representing increasingly severe gradations of physiologic swallow impairment. Clinically meaningful OT and PT score ranges were derived facilitating latent class assignment.Supplemental Material S1. Summary of the mathematical details of the latent class model and the procedures for construction of all model-derived conditional probabilities.Beall, J., Hill, E. G., Armeson, K., (Focht) Garand, K. L., (Humphries) Davidson, K., & Martin-Harris, B. (2020). Classification of physiologic swallowing impairment severity: A latent class analysis of modified barium swallow impairment profile scores. American Journal of Speech-Language Pathology, 29(2S), 1001–1011. https://doi.org/10.1044/2020_AJSLP-19-00080Publisher Note: This article is part of the Special Issue: Select Papers From the 2018 Charleston Swallowing Conference at Northwestern University.

e24034 Background: Active Living After Cancer (ALAC) is a 12-week evidence-based program funded by the Cancer Prevention and Research Institute of Texas (CPRIT) to provide physical activity and survivorship education to cancer survivors. Given the limited data evaluating the effects of physical activity educational programs in gynecologic cancer survivors, we aim to assess the effects of the ALAC intervention in this patient population. Methods: A retrospective analysis was performed on gynecologic cancer survivors who participated in ALAC from 2017 to 2021. The 12-week ALAC program included weekly meetings (in-person or virtual) led by a facilitator providing physical activity behavioral skills training, leading 10 minutes of exercise, and discussing topics related to cancer survivorship. Surveys and functional testing assessments were collected pre- and post-program which included: The Godin-Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ) and 30-second sit-to-stand. A patient-reported outcomes survey was used to assess patient perceived benefits and program satisfaction. Results: Thirty-two patients participated in ALAC and 22 completed pre- and post-program assessments. The mean age of participants was 60.2 years (range 50.7-69.7 years) and mean number of classes attended was 8 (range 0-12 classes). Prior cancer diagnoses included 14 cervical, 11 uterine, and 7 ovarian cancers. A significant improvement was seen pre- and post-ALAC in moderate-intensity physical activity minutes (n = 17, 97 vs 252 minutes, p = 0.007) by GSLTPAQ and 30-second sit-to-stand test (n = 16, 12.3 vs 15.8 repetitions, p = 0.003) in our cohort. The post-ALAC patient reported outcome survey (n = 22) revealed improvement in emotional well-being (90%), physical well-being (91%), physical activity level (100%), comfort speaking openly in a group (85%), and willingness to discuss their cancer journey (66%). Overall, 95.3% of participants were satisfied with the ALAC program and 100% of participants would recommend the ALAC program to other cancer survivors. Conclusions: Educational physical activity-based programs like ALAC improve physical functioning and moderate-intensity physical activity in gynecologic cancer survivors. Further studies on the long-term health benefits of structured educational programs which promote active lifestyles in gynecologic cancer survivors are needed in larger patient cohorts.

A survey of female sexual dysfunction in gynaecological cancer survivors: A case–control study

As obesity prevalence among gynecologic cancer (GC) survivors is expected to increase, the role of obesity in sexual health needs to be understood. This systematic review examined the impact of obesity on patient-reported sexual health outcomes (SHOs) in this population. PubMed, Embase, Web of Science, CINAHL, and PsycINFO were searched for original studies published between 2015 and 2020 following the Preferred Reporting Items for Systematic Review and Meta-Analyses guideline. We performed a narrative synthesis of findings via cancer type, cancer treatment, sexual health measures, and countries. Eleven observational studies were included. Most were conducted in European countries (n = 7), reported on endometrial cancer survivors (n = 7), and defined obesity as body mass index ≥30 kg/m2 (n = 10). Studies about cervical cancer survivors reported negative effects of obesity on sexual activity and body image while studies about endometrial cancer survivors reported positive effects of obesity on vaginal/sexual symptoms. Findings suggested interaction effects of radiotherapy and obesity on SHOs. Sexual functioning measured by the Female Sexual Function Index was less likely to be associated with obesity than other SHOs. A positive effect of obesity on SHOs was only found in studies conducted in European countries. Current evidence on the association between obesity and sexual health in GC survivors lacks in both quantity and quality. To better understand the effect of obesity on SHOs in the population, more studies are needed with critical evaluations of obesity and sexual health measures, careful considerations of cancer type and treatment, and a focus on the cultural context of obesity.

Sexual morbidity associated with poorer psychological adjustment among gynecological cancer survivors.

The basic idea underlying latent class (LC) analysis is a very simple one: some of the parameters of a postulated statistical model differ across unobserved subgroups. These subgroups form the categories of a categorical latent variable (see entry latent variable). This basic idea has several seemingly unrelated applications, the most important of which are clustering, scaling, density estimation, and random-effects modeling. Outside social sciences, LC models are often referred to as finite mixture models. LC analysis was introduced in 1950 by Lazarsfeld, who used the technique as a tool for building typologies (or clustering) based on dichotomous observed variables. More than 20 years later, Goodman (1974) made the model applicable in practice by developing an algorithm for obtaining maximum likelihood estimates of the model parameters. He also proposed extensions for polytomous manifest variables and multiple latent variables, and did important work on the issue of model identification. During the same period, Haberman (1979) showed the connection between LC models and log-linear models for frequency tables with missing (unknown) cell counts. Many important extensions of the classical LC model have been proposed since then, such as models containing (continuous) covariates, local dependencies, ordinal variables, several latent variables, and repeated measures. A general framework for categorical data analysis with discrete latent variables was proposed by Hagenaars (1990) and extended by Vermunt (1997). While in the social sciences LC and finite mixture models are conceived primarily as tools for categorical data analysis, they can be useful in several other areas as well. One of these is density estimation, in which one makes use of the fact that a complicated density can be approximated as a finite mixture of simpler densities. LC analysis can also be used as a probabilistic cluster analysis tool for continuous observed variables, an approach that offers many advantages over traditional cluster techniques such as K-means clustering (see latent profile model). Another application area is dealing with unobserved heterogeneity, for example, in regression analysis with dependent observations (see non-parametric random-effects model).

BackgroundsThe aim of this study was to investigate the sexual function status of young breast cancer patients during endocrine therapy, identify potential categories of sexual function status, and analyze the factors affecting the potential categories of sexual function status during endocrine therapy.MethodsA cross-sectional survey was conducted on 189 young breast cancer patients who underwent postoperative adjuvant endocrine therapy in Shanghai Ruijin Hospital. The latent class analysis was used to identify potential categories of patient sexual function characteristics with respect to the FSFI sex health measures. Logistic regression analysis was used to analyze the influencing factors for the high risk latent class groups. A nomogram prognostic model were then established to identify high risk patients for female sexual dysfunction (FSD), and C-index was used to determine the prognostic accuracy.ResultsPatients were divided into a “high dysfunction-low satisfaction” group and a “low dysfunction-high satisfaction” group depending on the latent class analysis, accounting for 69.3% and 30.7%, respectively. Patients who received aromatase inhibitors (AI) combined with ovarian function suppression (OFS) treatment (p = 0.027), had poor body-image after surgery (p = 0.007), beared heavy medical economy burden(p < 0.001), and had a delayed recovery of sexual function after surgery (p = 0.001) were more likely to be classified into the “high dysfunction-low satisfaction” group, and then conducted into the nomogram. The C-index value of the nomogram for predicting FSD was 0.782.ConclusionThe study revealed the heterogeneity of sexual function status among young breast cancer patients during endocrine therapy, which may help identify high-risk patients and provide early intervention.