Work-related stress, quality of life, and positivity among bank employees

Quality of Life of Informal Caregivers of Hematopoietic Cell Transplant Recipients

BACKGROUND AND AIMS In autosomal dominant polycystic kidney disease (ADPKD), the enlarged kidneys can cause clinical problems, for instance pain or gastro-intestinal complaints, recurrent infections, or cause a lack of space for a kidney transplant. In selected ADPKD patients, a nephrectomy is required in the work-up for a kidney transplantation. Currently, it is unknown how this procedure affects quality of life (QoL), nor how leaving both kidneys in situ influences wellbeing. The aim of this study was to investigate the impact of pretransplantation nephrectomy on quality of life in APDKD patients. METHOD In this retrospective cohort study all ADPKD patients, ≥18 years, who received a kidney transplantation in 2 ADPKD expertise centers in the Netherlands (UMC Groningen and UMC Leiden) between January 2000 and January 2016, were asked to participate. Of these two centers, one has a restrictive approach, wherein a unilateral procedure is only performed when strict indications are met, and one a proactive approach, wherein a bilateral procedure is performed routinely in the work-up for transplantation. Data were collected on patients characteristics, date of nephrectomy, date of kidney transplantation and QoL. QoL was assessed using validated questionnaires (the SF-36, PHQ-9 and ADPKD-Impact Score) on three different time points (12 months before transplantation, 12 months after transplantation and date of filling out the questionnaire). Patients were followed for at least 24 months after transplantation. RESULTS 321 ADPKD (61 ± 9 years, 57.9% male) patients were included. The minority of patients (n = 99, 30.8%) underwent native nephrectomy in preparation for transplantation, of which 43 patients (13.4%) underwent bilateral nephrectomy. Lack of space was the most common indication for nephrectomy (68.7%), followed by recurrent cyst infection (18.2%) and refractory pain complaints (9.1%). Age, sex and comorbidities did not differ before transplantation between patients who would later undergo a pretransplantation nephrectomy when compared to those who would not undergo this procedure, except for QoL. The SF-36 physical component score (PCS) and mental component score (MCS) were lower in the nephrectomy group vs. no nephrectomy group (33.8 versus 38.4, P = 0.003; 48.7 versus 51.7, P = 0.04, respectively). In addition, the PHQ-9 and ADPKD-IS were significantly lower in patients who would later undergo a pre-transplantation nephrectomy compared to patients who would not undergo this procedure (P = 0.01, P = 0.01, respectively). After transplantation the PCS and MCS improved significantly in both groups, with this improvement in PCS and MCS being significantly more in patients who had a pretransplant nephrectomy compared with those who did not have a nephrectomy (change in PCS 17.3, P < 0.001 versus 13.4, P < 0.001; change in MCS 9.7, P < 0.001 versus 4.5, P < 0.001). Similar findings were noted for the PHQ-9 and APDKD-IS. At the end of follow-up, 7.9 ± 4.6 years after transplantation, PCS and MCS were still better in both groups (PCS 45.9, P < 0.001 versus 49.7, P < 0.001; MCS 57.4, P < 0.001 versus 55.1, P < 0.001, respectively). No differences in the PCS, MCS, PHQ-9 and ADPKD impact scores were observed between both expertise centers as well as in patients who underwent unilateral versus bilateral nephrectomy. CONCLUSION This study shows that ADPKD patients who underwent a pretransplantation nephrectomy experienced more complaints compared with patients without nephrectomy. After nephrectomy and transplantation, QoL significantly improved in these patients, resulting in a similar QoL level in all transplanted ADPKD patients on short as well as long-term follow-up. Bilateral nephrectomy had no additional benefit on QoL compared with unilateral nephrectomy. Together, this indicates that a restrictive approach, wherein a unilateral procedure is performed only when strict indications are met, may improve QoL in these patients and is therefore justified.

BackgroundSport participation has many physical and psychosocial benefits, but there is also an inherent risk of injury, subsequent osteoarthritis and psychological challenges that can negatively impact quality of life (QOL). Considering the multifaceted impacts of sport participation on QOL across the lifespan, there is a need to consolidate and present the evidence on QOL in former sport participants.ObjectiveTo evaluate QOL and life satisfaction in former sport participants, and determine what factors are associated with QOL and life satisfaction in this population.MethodsEight electronic databases were systematically searched in July 2018 to retrieve all articles that evaluated QOL or life satisfaction in former sport participants. Two authors independently screened titles/abstracts and full texts, extracted data, and appraised methodological quality using a modified Downs and Black Checklist. Random-effects meta-analysis estimated pooled mean and 95% confidence intervals (Cis) for Mental Component Scores (MCS) and Physical Component Scores (PCS) derived from the SF-12, SF-36, VR-12 and VR-36 measures. MCS and PCS were pooled for all former sport participants, as well as professional- and collegiate-athlete subgroups. Data that were inappropriate for meta-analysis (i.e. EQ-5D, PROMIS and life-satisfaction outcomes) were collated and reported descriptively.ResultsSeventeen articles evaluated QOL or life satisfaction in a total of 6692 former athletes [eight studies (n = 4255) former professional athletes; six studies (n = 1946) former collegiate athletes; two studies (n = 491) included both] with a mean age ranging from 21 to 66 years. Most studies were cross-sectional (15 of 17 articles) and 12 studies had a moderate risk of bias (n = 1 high-risk, n = 4 low-risk). Unpublished data were provided for five studies. Meta-analysis of seven studies resulted in a pooled PCS mean (95% CI) of 50.0 (46.6–53.3) [former professional athletes from two studies: 46.7 (42.1–51.2), former collegiate athletes from five studies: 51.2 (48.4–53.9)] and a pooled MCS of 51.4 (50.5–52.2) [former professional athletes: 52.7 (51.3–54.2), former collegiate athletes: 50.9 (50.0–51.8)]. Factors associated with worse QOL or life satisfaction in former athletes included involuntary retirement from sport (three studies), collision/high-contact sport compared with low/no-contact sport (three studies), three or more concussions compared with no/fewer concussions (two studies), increased body mass index (BMI) (worse PCS, three studies), and osteoarthritis or musculoskeletal issues (worse PCS and MCS, three studies; worse PCS but not MCS, two studies).ConclusionsFormer athletes had similar PCS and better MCS, compared to general-population norms. Former athletes with impaired PCS reported better MCS than population norms, highlighting the need to use an instrument that differentiates between physical and mental components of QOL in former sport participants. Factors associated with worse QOL that may explain between-study variation include involuntary retirement, collision/high contact sports, concussion, BMI and osteoarthritis.PROSPEROCRD42018104319.

The aim was to compare postoperative quality of life (QOL) between patients undergoing pelvic exenteration (PE) and pelvic exenteration with sacrectomy (PES), and to investigate the influence of high (L5-S2) vs low (≤S3) sacrectomy on QOL and functional outcomes. Patients undergoing en bloc sacrectomy as part of a PE and PE alone from 2008 to 2015 were identified from a prospectively maintained database. QOL and functional outcomes were assessed using the 36-Item Short Form Survey, the European Organization for Research and Treatment of Cancer Colorectal Cancer questionnaire and Quality of Life questionnaire, the Revised Musculoskeletal Tumour Scale, the Lower Extremity Functional Scale, the Sexual Health Inventory for Men and the Female Sexual Function Index. Of the 344 patients identified, data were available for 116 patients who underwent PE alone and 140 patients who underwent PES. PES patients had significantly poorer physical component scores (P<0.001) but not mental component scores (P=0.17). Of the 140 PES patients, 55 were eligible and were invited to participate in a second functional survey, with 30 patients returning the study questionnaire. High sacrectomy patients, compared with low sacrectomy, had significantly worse lower limb motor function (P=0.03) and poorer physical (P=0.001) and mental health component scores (P=0.02). No differences were found in sexual, bladder and bowel function between high and low sacrectomy patients. Patients undergoing PES had worse physical component scores compared with PE alone, whereas high sacrectomy patients had significantly worse lower limb motor function and physical and mental component scores but comparable bowel, bladder and sexual functional outcomes compared with low sacrectomy patients.

Few studies have addressed health-related quality of life (QoL) in patients who chose conservative management over dialysis. This systematic review aims to better define the role of conservative management in improving health-related QoL in patients with end-stage renal disease (ESRD). Medline, Cochrane and EMBASE were searched for prospective or retrospective studies published until June 30, 2016, that examined QoL of ESRD patients. The primary outcome was health-related QoL. Four studies were included (405 patients received dialysis and 332 received conservative management). Two studies that used the Short Form-36 Survey (SF-36) showed that the dialysis group had higher physical component scores, but the conservative management group had similar, or better, mental component scores at the end of intervention. Another study using the SF-36 showed that the physical and mental component scores of the dialysis group did not significantly change after intervention. In the conservative management group, the physical component scores did not change, but the mental component scores increased significantly over time (0.12 ± 0.32, p < 0.05). One study, which used the Kidney Disease Quality of Life-Short Form (KD QoL-SF), found no change after intervention in either physical or mental component scores in the dialysis group; however, the physical component score declined (p = 0.047) and the mental component score increased (p = 0.033) in the conservative management group. Although there are only a limited number of published articles, ESRD patients who receive conservative management may have improved mental health-related QoL when compared with those who receive dialysis.

Health-related quality of life (QoL), physical component score (PCS) and mental component score (MCS), was assessed for bile duct injury sustained at cholecystectomy. QoL was studied using Short Form-36 in 119 patients at least 24 months after repair (hepatico-jejunostomy), 50 patients who underwent uneventful cholecystectomy at least 24 months ago were controls. Effect of age, sex, type (laparoscopic, open, laparoscopic converted-to-open) of cholecystectomy, pre-repair interventions, (endoscopic and surgical) number of pre-repair interventions, Bismuth type of biliary stricture, post-repair complications, need for intervention in the follow up, total number of operations required, total duration of hospitalization on QoL was studied. Age > 50 years (n = 25) (PCS, MCS 44, 51 vs. 66, 70 in < 30 vs. 61, 62 in 30-50; p < 0.001, 0.018), need for pre-repair intervention (n = 102) (MCS 61 vs. 75; p = 0.01), post-repair Clavien-Dindo III, IV complications (n = 8) (PCS, MCS 46, 50 vs. 64, 68; p = 0.03, 0.04), need for post-repair surgical intervention (n = 28) (PCS, MCS 49, 54 vs. 60, 63; p = 0.004, 0.01) and need for reHJ in follow up (n = 16) (PCS 44 vs. 59; p = 0.12) adversely affected QoL. Patients (n = 15) who did not require pre-repair intervention, did not have post-repair complication and did not require intervention in follow up had better QoL (PCS 63 vs. 51, MCS 82 vs. 56, p < 0.03) than those (n = 32) who required pre-repair intervention, had post-repair complication, and required intervention in follow up. QoL is compromised, even after repair of BDI at biliary center; older patients, those who required pre-repair (HJ) interventions, had post-repair (HJ) complications, required post-repair (HJ) surgical intervention and required reHJ in follow up had poorer QoL.

Introduction: A regulatory FDA IDE prospective multi-center clinical trial (G170261-NCT03525808) was performed to evaluate rigorous protocolized management of walled off necrosis (WON) ≥ 6 cm in size with > 30% necrotic material using endoscopic ultrasound (EUS) guided lumen apposing metal stent (LAMS) placement with/without endoscopic necrosectomy. Few studies have examined changes in health related quality of life (HRQOL) before and after endoscopic management for WON. The SF-12 is a validated measure of HRQOL containing 12 items which yield a Mental Components Score (MCS) and a Physical Components Score (PCS). Higher scores correspond to a greater perceived quality of life. Methods: The pre-specified target sample of 40 consecutive eligible patients was enrolled by multiple centers from September 2018 to March 2020. Patients with radiographic WON resolution (as demonstrated by size ≤ 3 cm on CT or MRI) and/or 60 days LAMS indwell time had stent removal followed by an end of study visit 6 months later. SF-12 quality of life questionnaires were completed by patients at baseline, stent removal and at the end of study visit. Results: Mean SF-12 Physical Components Score (PCS) was 27.5±21.1 at baseline, 54.4±19.5 at the time of LAMS removal, and 77.9±22.3 at end of study. Mean SF-12 Mental Components Score (MCS) was 44.9±20.1 at baseline, 64.7±16.5 at the time of LAMS removal, and 79.0±17.2 at end of study. The mean improvement in PCS score from baseline to LAMS removal was 26.0±24.8 (p< 0.0001), with the mean improvement in score from baseline to end of the study being 49.1±29.6 (p< 0.0001). The mean improvement in MCS was 19.6±20.1 from baseline to LAMS removal (p< 0.0001) and 32.0±22.3 from baseline to the end of study (p< 0.0001). The mean improvement from the time of stent removal to the end of study was 25.2±18.0 (PCS, p< 0.0001) and 15.5±18.5 (MCS, p=0.0002) (Figure). Conclusion: These data suggest that patients undergoing protocolized endoscopic necrosectomy for walled-off pancreatic necrosis experience significant improvement in both physical and mental HRQOL. Improvement in the physical score domain appeared to be greater than for the mental score domain. HRQOL indicators continued to improve over a mean follow-up of 180 days.Figure 1.: SF-12 Physical and Mental Components Score.

Background: In COPD, respiratory symptoms, exacerbations and lung function affect quality of life (QOL), but how comorbidities impact QOL is undefined Methods: We analyzed COPDGene subjects with COPD. Based upon patient-report of physician-diagnosed comorbidities, we calculated two composite comorbidity measures: the modified Charlson index, and the Fan modification of the Functional Comorbidity index (mFCI) (a self-reported comorbidity score comprising arthritis, osteoporosis, stroke, angina, diabetes, congestive heart failure, heart attack, stomach ulcers, cancer, kidney disease and pneumonia). We evaluated the independent effect of these indices on QOL using multivariate models adjusted for demographics and pulmonary function. Gastroesophageal reflux disease (GERD), not part of those indices, was included individually. Data are presented as mean [SD] unless noted. Results: From the full COPDGene cohort of 10,276 individuals, we analyzed 4,475 subjects (1,974 female, 2,501 male) with COPD, with age 65.1 [8.6] years, Charlson index 1.56 [1.0], and mFCI 1.5 [1.34]. SGRQ total score was 36.9 [22.9], with the following subscores: activity 51.7 [29.3], impact 26.7 [21.9], symptom 42.5 [25.8]. In the SF-36, the mental component score (MCS) was 48.7 [12.6]; the physical component score (PCS) was 40.5 [11.0]. Adjusted multivariate models demonstrated a significant relationship between comorbidities (by mFCI but not by Charlson index) and increase in SGRQ {total score (2.53, p<0.0001)}, and its components {activity (2.59, p<0.0001), impact (2.41, p<0.0001), and symptom (2.80, p<0.0001)}. mFCI also correlated with decrease in SF-36 PCS (-1.18, p<0.0001) and SF-36 MCS (-1.25, p<0.0001). The highest contribution of a single comorbidity to QOL was made by GERD, which was significantly associated with total SGRQ (4.37, p<0.0001); its components {activity (4.58, p<0.0001), impact (3.80, p<0.0001), and symptom (5.85, p<0.0001)}; and with SF-36 PCS (-2.11, p<0.0001), but not SF-36 MCS (-0.94, p=0.11). Although women reported some comorbidities more frequently than men {GERD (34% vs. 26%, p<0.001), osteoporosis (23% vs. 5%, p<0.001), osteoarthritis (26% vs. 17%, p<0.0001)}, no interaction between gender and comorbidities was found. The contribution of comorbidity, measured by mFCI, to explained variance of SGRQ total score was 6.7%, and for the activity scale was 7.0%. Comorbidities explained 7.3% of the variance of the SF-36 PCS score, but only 1.2% of SF-36 MCS. Conclusions: Among COPDGene participants with COPD, comorbidities are frequent and significantly affect QOL. The separate contribution of comorbidities to QOL was greater for SGRQ total and activity scores and for SF-36 PCS. GERD was the individual comorbidity with the greatest influence on QOL.

Quality of life (QOL) is an important metric of high-quality dialysis care. QOL is commonly measured by the Short Form 36 Questionnaire (SF-36), which provides two summary scores: a mental component score (MCS) and a physical component score (PCS). Poor QOL is associated with mortality in dialysis patients. Small studies show that changes in QOL also predicts mortality. We investigated whether changes in QOL over time are associated with mortality in a large cohort of maintenance hemodialysis patients. This retrospective study was conducted in 1017 outpatient dialysis facilities. Over 10,000 hemodialysis patients completed two SF-36 surveys. We compared 1-year morality rates in those whose MCS or PCS increased or decreased ±5 vs. those whose did not. For those who completed two surveys, mean score for PCS was unchanged, whereas MCS increased slightly (48.6 vs. 48.9, p=0.05). Individual patients, however, showed marked variation. On the second survey, more than half of patients demonstrated a±5 point change in the PCS and/or MCS. After multivariate adjustment, a≥5 decrease in MCS was associated with an increase in mortality (HR=1.33, 95% CI 1.18, 1.50). Clinicians should be aware that many patients experience a significant change in both the MCS and PCS on dialysis. A MCS decrease of ≥5 was associated with increased mortality. More study is needed to determine whether this is a causal relationship. Physicians should evaluate root causes and seek to mitigate declines in QOL whenever possible.

This study was conducted to evaluate the physical and mental status change during and after a course of radiation treatment in patients with cancer. Twenty-four patients with various malignant diseases were enrolled, including 9 men and 15 women, whose median age was 64.5, to receive radiation therapy. All patients also received psychosocial support from nurses, social workers, and/or organized support groups. The Rand 36-item survey 1.0 (SF-36) was completed at the beginning, the second week, the completion of treatment, and 1 and 3 months after treatment for the evaluation of physical component scores and mental component scores. Karnofsky performance scale and toxicity scores were determined by the treating nurses and physicians. The physical component scores of evaluated patients before treatment were approximately 20% lower than those of the general U.S. population, whereas mental component scores were similar to those of the general U.S. population. After treatment started, Karnofsky performance scale decreased concurrently with an increased rate of toxicity. Both physical and mental component scores were relatively stable throughout the course of evaluation. Mental component scores were the only predictor of toxicity during the treatment. Karnofsky performance scale dropped to their lowest point at the completion of treatment and then improved at 1-month follow-up. The patients who had higher mental component scores before treatment appeared to have higher, and improving, physical component scores throughout the course of evaluation. Along with complementary social support, the implementation of psychosocial support early and throughout the course of treatment may result in physical benefits and improving overall quality of life. Care should also be taken to make psychosocial support available to patients after the completion of treatment.

6603 Background: Although chronic lymphocytic leukemia (CLL) accounts for 25–30% of leukemia cases in the USA, little is known about its quality of life (QOL) and psychosocial burden. The purpose of this study was to compare QOL, anxiety and depression in watch and wait versus actively treated CLL. Methods: Using a cross-sectional design, 105 patients were recruited from a CLL research database. 57 were classified as watch and wait and 48 as receiving or having received chemotherapy for CLL. The patients completed a battery of QOL measures including the SF-36, FACT-Lym, Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI) and the Patient Health Questionnaire. Results: No differences were found between the treatment groups on the main QOL outcome measures - Mental Component Score, Physical Component Score, FACT-G, FACT-lymphoma (15 item), BDI-II and BAI. There was a clear age effect: younger patients (&lt;60 years old) have worse Mental Component (p=0.0001), FACT-G (p=0.060), depression (p=0.014), Role Emotional (p=0.042), Mental Health (p=0.001), FACT-Emotional (p=0.0001) and FACT-Social (p=0.002) scores. Younger watch and wait patients seem to be particularly vulnerable to anxiety (p=0.052). Social and emotional QOL are statistically similar in both newly diagnosed and patients diagnosed six or more years ago, although patients do carry a greater physical QOL burden with time (p=0.05). Conclusions: Overall QOL, depression and anxiety are remarkably similar in watch and wait versus actively treated CLL, despite the latter group having, by definition, later stage disease. Younger patients (&lt;60 years old) seem particularly vulnerable to having a reduced emotional and social QOL and having more depression. Younger watch and wait patients stood out as suffering from more anxiety. Patients diagnosed for more than 6 years carry a greater physical QOL burden, but social and emotional QOL are similar to newly diagnosed patients. Implications of these findings are considered. [Table: see text] No significant financial relationships to disclose.

We aimed to assess quality of life (QOL) among Saudi hemodialysis (HD) patients and the impact on the QOL of a certain demographic and clinical factors. The QOL was assessed using an Arabic version of Kidney Disease Quality of Life Instrument Short Form (KDQOL-SF). Mean scores were compared for individual domain scores and for the three composite summary scores, namely the mental component score (MCS), the physical component score (PCS) and kidney-disease component score (KDCS). The study included one hundred chronic HD patients from King Abdulaziz Medical City, Riyadh. The overall mean score was 60.4. Domains with very low scores were "cognitive function", "role-emotional", "role-physical" and "work status". Domains with high scores were "patient satisfaction", "dialysis staff encouragement" and "quality of social interaction". The mean scores for "KDCS", "MCS" and "PCS" were 59.7, 54.2 and 52.7 respectively. KDC scores were higher among males and the married group. PCS scores were higher among males, patients aged < 40 years, and the higher income group. MCS scores were higher among males and the higher income groups. There was a positive correlation between "KDCS" and "MCS"(r=0.62, P=0.0001); and between "KDCS" and "PCS" (r=0.65, P=0.0001). The current study provides a detailed description of the QOL scores of a group of Saudi HD patients and the impact of certain factors on their QOL. Low scores were seen in the "work status", "cognitive function", "role-physical" and "role-emotional" while high scores were seen in "patient satisfaction", "dialysis staff encouragement" and "quality of social interaction" domains.

Background COVID-19 survivors overcome long-lasting symptoms that affect their quality of life (QoL). We assessed the impact on QoL and the factors associated with the persistence and reversibility of poor QoL 6 months after acute COVID 19. Methods We enrolled symptomatic patients who tested positive for SARS-COV-2 with an antigenic or RT-PCR test between August 2021 and October 2022. We classified subjects according to disease severity: B1 (mild: outpatient), B2 (moderate: outpatient with pneumonia), B3 (severe: inpatient with oxygen supply) and B4 (critical: inpatient admitted to intensive care unit). Measurements were taken at baseline (BL), month 1 (M1), 3 (M3), and 6 (M6) after acute infection. We evaluated QoL with the RAND-36 questionnaire which provides a score for the Physical Component Score (PCS) and the Mental Component Score (MCS). The PCS comprises scales for physical functioning, role limitations due to physical health, pain and general health. MCS includes scales of role limitations due to mental health, energy/fatigue, emotional wellbeing, and social functioning. PCS and MCS scores were standardized on a 0-100 scale and poor QoL was considered &amp;lt; 40 in each scale. Results We enrolled 147 participants: 46 in B1 (31%), 39 in B2 (27%), 22 in B3 (15%), and 40 in B4 (27%). We lost to follow-up 33 participants (22.5%) from BL to M6. Significant improvements in PCS were observed between BL and M6 within B3 [35.77 (95%CI 29.7-41.8) vs 51.63 (95%CI 47.1-56.2), p=0.0002] and B4 [28.8 (95%CI 24.5-33.2) vs 43.3 (95%CI 39.4-47.2), p&amp;lt; 0.0001]. In the MCS, significant improvement occurred within B3 between BL and M6 [44.0 (95%CI 36.9-51.0) vs 54.4 (95%CI 49.89-58.86) p=0.0229]. Low MCS and PCS at M6 after COVID-19 was associated with both pulmonary and cardiac clinical abnormalities at M1, M3 and M6. Additionally, only low PCS at M6 was associated with diabetes, age older than 60 years and cardiac clinical abnormalities at BL. Patients who reversed their poor QoL at M6 to a normal value were 122 (83%) for MCS and 93 (63.27%) for PCS. Factors associated with increased reversibility in both scales were severity group B3 and male sex. Conclusion Our findings, the first cohort study on post COVID-19 from Peru, underscore the need for ongoing physical and mental patient monitoring beyond the acute phase of COVID-19. Disclosures All Authors: No reported disclosures

The purpose of this longitudinal study was to investigate quality of life (QOL) before, during, and after the course of radiotherapy (RT) and to identify risk factors for diminished QOL in women with breast cancer. Patients (N = 188) completed the short-form 12 (SF-12), the Karnofsky Performance Status Scale, Memorial Symptom Assessment Scale, and the Self-Administrated Comorbidity Questionnaire 1 week prior to the start of RT. To assess changes in QOL, patients also completed the SF-12 1, 2, 3, and 6 months after the baseline. A random-intercept and slope model (mixed model) for each patient was used to estimate linear trends for the mental component score and physical component score of QOL (five time points for each patient). Descriptive statistics were used to analyze demographic and clinical characteristics. The physical component score (PCS) did not change significantly (p = 0.078) during the course of RT in women with breast cancer. An increase in the number of symptoms and a higher comorbidity profile was negatively related to the PCS. The mental component score (MCS) did not change from the start of RT until the 2-month assessment, but increased significantly after 2 months (p = 0.044). An increase in the number of symptoms was negatively related to the MCS. The MCS and PCS of QOL remained stable at a diminished level except for the MCS which improved between 2 and 6 months after the start of RT. The total number of symptoms was the only variable that was negatively associated with both component scores (MCS and PCS) during the 6 months.

Inflammatory bowel disease (IBD) is a chronic debilitating condition involving the gastrointestinal (GI) tract that has a negative impact on quality of life (QoL). Depressive symptoms (DS) are common in affected patients and contribute to decreased QoL. Telemedicine is the use of information technology to remotely deliver health care; it is poised to gain widespread use in the care of IBD patients. However, its effect on DS and QoL is unknown in IBD. We investigated the impact of telemedicine on DS and QoL over time. This was a one-year, multicenter, randomized, controlled trial evaluating disease activity and QoL in IBD patients using text message-based telemedicine. Participants were randomized to three groups: standard of care and telemedicine weekly or every other week (EOW). Using mobile phones, telemedicine participants relayed information on their clinical symptoms and treatment plans were similarly conveyed to them. DS and QoL were measured using the Mental Health Inventory (MHI-5) and Short Form (SF-12) respectively. The SF-12 score has a physical component score (PCS) and a mental component score (MCS). Change in MHI-5 and SF-12 scores from baseline to 12 months was assessed, and comparison was made between the intervention and control groups. Of the 217 study participants, 59% were woman and 69% had Crohn’s disease. The number of participants in the control, telemedicine weekly and EOW groups were 72, 71, and 74 respectively. The baseline PCS, MCS, and MHI-5 scores were 46.9, 48.6, and 74.9 for all participants. Increase in mean PCS (p=0.0003) and MCS (p=0.04) was significant in the standard of care group over the study period. After controlling for confounding variables, there was no significant difference in the mean change in PCS (p=0.06), MCS (p=0.89), and MHI-5 (p=0.70) scores among the standard of care, weekly and EOW telemedicine groups. Text message-based telemedicine does not lead to improvement of DS or QoL when compared to standard of care in IBD patients. Although telemedicine has been shown to reduce healthcare utilization and improve access to care, caution should be exercised in overstating its benefits with regards to outcomes such as DS and QoL. Future studies should explore the impact of telemedicine on DS and QoL in other settings such as community practices.