Comprehensive Quality Of Life Research Articles

Feasibility of a palliative care intervention for cancer patients in Phase I clinical trials.

Cancer patients with advanced disease who have exhausted most treatment options are often offered participation in Phase I clinical trials. To date, studies that assess the benefits of palliative care provided concurrently in Phase I clinical trial settings are lacking. The overall purpose of this study was to test the feasibility of a palliative care intervention administered concurrently to cancer patients receiving treatment in a Phase I clinical trial. Cancer patients enrolling in a Phase I clinical trial were invited to participate in this study. Patients completed baseline questionnaires prior to treatment initiation that assessed quality of life (QOL), symptom distress, psychological distress, and satisfaction with care. Patients then received the palliative care intervention (PCI), which consisted of comprehensive QOL assessment, care planning for the patient during an interdisciplinary team meeting, and two patient education sessions. Patients were surveyed again at 1 and 2 months following treatment initiation. A total of 14 patients were accrued to the pilot over a 3-month time period, representing 70% of eligible patients. Patient retention was high at 1 month (75%), and had declined at 2 months (50%). Patient outcome measure scores, including symptom distress, psychological distress, and satisfaction with care, were relatively stable over time, except for overall QOL, which declined over time. Concurrent palliative care is feasible for cancer patients treated in Phase I clinical trial settings. A large, multisite randomized controlled trial based on this pilot will be launched to test the efficacy of the intervention in this understudied cancer population.

A conceptual definition of quality of life with a left ventricular assist device: Results from a qualitative study

ObjectiveTo develop a conceptual definition of quality of life (QoL) with a left ventricular assist device (LVAD). BackgroundConceptual and operational definitions of QoL with an LVAD are lacking. MethodsA grounded theory method was used. Adult, outpatient LVAD recipients (n = 11) participated twice in individual or paired interviews. ResultsA conceptual definition of QoL while living with an LVAD was established as: “Being well enough to do and enjoy day-to-day activities that are important to me.” Participants described 5 important life domains consistent with QoL literature: physical, emotional, social, cognitive, and spiritual/meaning. However, participants identified unique concerns not addressed by generic or heart failure disease specific measures typically used in the LVAD population. ConclusionExisting generic and heart-failure specific QoL measures are not adequate for understanding QoL among LVAD patients. Cognition and spiritual/meaning domains were significant; these need inclusion for comprehensive QoL assessment in the LVAD population.

A pilot study exploring issues around decision making in older women with primary operable breast cancer.

e20588 Background: Decision making process related to cancer treatment is complex, influenced by tumour factors, patients and clinicians, and may affect outcomes eg quality of life (QOL). Studies are scarce in exploring this subject in the older population. This pilot study aimed to investigate this in older (≥70 years) women newly diagnosed with clinically T0-2N0-1M0 breast cancer. Methods: Patients as described were invited to participate. Actual treatment planning was made by the clinical team and was not part of the study. Semi-structured interviews were conducted within 6 weeks and at 6 months, alongside Comprehensive Geriatric Assessment (CGA) and QOL assessment using EORTC QLQ-C30. Interview recordings were transcribed (intelligent verbatim) and then analysed by (i) identifying themes; and (ii) comparing them with CGA and QOL measures. Results: Forty-one patients took part at the time of analysis. The following themes emerged in different patient combinations, at both time points. 1) Symptoms - The majority presented symptomatically (87%, 21/31). At 6 months, 45% (18/40) reported a negative feeling, but 81% (22/27) said they would choose the same treatment again. 2) Knowledge - Most patients (80%, 28/35) knew someone with a cancer diagnosis, but did not know much about breast cancer or treatment (87%, 18/24). 3) Reactions - At diagnosis, only 48% (10/23) felt ‘shocked’ or ‘surprised,’ while the remainder had ‘no reaction’ or ‘were prepared’. The majority (91%, 29/32) felt that they had received enough information about treatment options or that they did not have an option. 4) QOL - Most patients (88%, 15/17) thought they had made the right treatment choice. The majority (86%, 6/7) were not worried about the future and 91% (10/11) reported no change in QOL. No relationship was seen between these interview findings and the treatment modalities received. These findings were consistent with the results of CGA and QOL assessment. Conclusions: These preliminary findings suggest that these patients were generally happy with the decision made for their treatments and had a fairly good QOL and future outlook. The study has now entered into a second stage where more in-depth interviews are being conducted.

地域高齢者における活力度指標と摂食・嚥下関連要因との関連性

The purpose of the present study was to examine the relationship between comprehensive quality of life (QOL) and some factors regarding chewing and swallowing function among community-dwelling elderly individuals. The subjects were 675 independent elderly persons residing in the northern area of Miyazaki Prefecture, and we obtained the self-administered questionnaires from 545 elderly people. We used "active scale for the elderly (ASE)" and "dysphagia risk assessment for the community-dwelling elderly (DRACE)" to evaluate their comprehensive QOL and function of chewing and swallowing, respectively. Furthermore, we examined some factors such as age, gender, subjective satisfaction with diet and verbal communication. The score of ASE showed a significant decline with age (p<0.01) while the DRACE score increased significantly with age (p<0.01). Pearson's correlation coefficients revealed that the ASE score was significantly related to all of the factors regarding regulation of food intake. Partial correlation coefficients adjusted for age also revealed the same tendency. From the multiple regression analysis, subjective satisfaction with verbal communication, DRACE score, age and appetite were extracted as factors influencing ASE score (adjusted R(2)=0.43, p<0.01). Among independent elderly persons residing in the community, the comprehensive QOL was significantly related to factors such as subjective satisfaction with verbal communication, dysphagia risk, age, and appetite.

The correlates of unemployment and its association with quality of life in cervical cancer survivors

ObjectiveLittle is known regarding cervical cancer survivors' employment status, which represents social integration of cancer survivors as a pivotal domain of long-term quality of life. The goal of this study was to assess the correlates of unemployment and evaluate the impact on the comprehensive quality of life in cervical cancer survivors.MethodsWe enrolled 858 cervical cancer survivors from the gynecologic oncology departments of multi-centers in Korea. Factors associated with unemployment were identified using multivariate logistic regression analyses. We assessed different health-related quality of life domains with multivariate-adjusted least-square means between cervical cancer survivors who currently work and do not.ResultsAfter diagnosis and treatment, the percentage of unemployed survivors increased from 50.6% to 72.8%. Lower income (adjusted odds ratio [aOR], 1.97; 95% confidence interval [CI], 1.38 to 2.81), medical aid (aOR, 1.58; 95% CI, 1.05 to 2.38), two or more comorbidities (aOR, 1.80; 95% CI, 1.12 to 2.90), current alcohol drinkers (aOR, 2.33; 95% CI, 1.54 to 3.52), and employed at the time of diagnosis (aOR, 10.72; 95% CI, 7.10 to 16.16) were significantly associated with unemployment. Non-working groups showed significant differences with respect to physical functioning, role functioning, depression, and existential well-being.ConclusionThe proportion of unemployed cervical cancer survivors seems to increase, with low-income status and the presence of medical aid negatively being associated with employment, in addition to other comorbidities and previous working status. Effort should be made to secure the financial status of cervical cancer survivors.

The Importance of Quality of Life for Patients Living With Myelodysplastic Syndromes

Myelodysplastic syndromes (MDS) are a group of myeloid stem cell clonal disorders characterized by a wide variation in illness trajectory and potential treatment. The physical, functional, emotional, social, and spiritual well-being of individuals with MDS can be affected by both disease and treatment-related factors. As a result, the quality of life (QOL) in patients with MDS may vary throughout the course of the illness. To date, most research exploring QOL in patients with MDS has been conducted as part of clinical trials evaluating the effectiveness of a therapeutic intervention. Although data from those studies are useful, they do not fully address the issues critical to maintaining or maximizing QOL. Oncology nurses are in a key position to assist patients with MDS to maintain their QOL. Findings from comprehensive QOL assessments will guide nurses in providing relevant interventions and evaluating their outcomes. In this manner, oncology nurses can assist their patients to maximize QOL while living with this challenging illness.

Determinants of Quality of Life in Nigerian Children and Adolescents with Epilepsy: A Hospital-based Study

Purpose: Though studies abound on the quality of life (QoL) in chronic illnesses, there has been little focus on children and adolescents. This study investigated the determinants of QoL in children and adolescents with epilepsy in a Nigerian Tertiary Mental Health Institution. Methods: The study involved 67 adolescents between 11 and 18 years of age, diagnosed with epilepsy. Depression was assessed using the Centre for Epidemiology Study Depression Scale, and their QoL was assessed using the Comprehensive QoL Scale (ComQol-S). Data was analysed using Spearman’s Correlation Coefficients and linear regression (p<0.05). Results: The mean age of the participants was 14.5±4.0 years. Twenty-two (32.8%) of them were depressed. Participants scored significantly higher (p<0.00 ) in health, productivity, community participation and emotional domains and total QoL scores in the subjective axis than in the objective axis of QoL. When controlled for age and gender, the lower the educational attainments of the participants, the higher was their depression scores. Depression, seizure frequency at presentation at the clinic, seizure frequency at onset and age predicted poor QoL. Parents’ socio-economic status predicted seizure frequency. Conclusion: There is a high prevalence of depression in Nigerian adolescents with epilepsy. Epilepsy has a negative impact on their QoL. Therefore, it is necessary to pay more attention to the condition in order to reduce the frequency of seizures and improve their psycho-social well-being. DOI: 10.5463/dcid.v22i3.99

Abstract P62: Feasibility of Routine Quality of Life Assessment in Ambulatory Heart Failure Patients

Background: Assessment of quality of life (QOL) may be helpful in management of heart failure (HF) patients in ambulatory practice and is considered a performance measure. Little is known about the feasibility of routine assessment of QOL in clinical management of HF. The objectives of this study were to a) evaluate ability to serially measure QOL in clinical practice and b) determine patient characteristics that influence change in QOL scores. Methods: Patients presenting to the ambulatory HF clinic were routinely administered (prior to physician encounter) a 2-page questionnaire to assess QOL and concerns to be addressed during the visit. Visual analog scales (VAS) were used to assess a) overall QOL, b) dyspnea, and c) fatigue with scores ranging from 0 to 100 (higher scores representing better health status). Patients were asked if their QOL was affected more by their HF or another medical condition. Data was analyzed with ANOVA and Chi-square tests. Results: Of 1069 patients who completed baseline questionnaires, 557 (52%) had QOL assessed at subsequent visit (mean time between visits 225±142 days, 58% male, mean age 57 ± 15, LVEF 40±16%). Health status was impaired at baseline (VAS QOL 63±29, dyspnea 68±32, and fatigue 65±25). Of patients with paired data, 411 (74%) answered (at baseline) questions on the contribution of HF to their QOL (Table). HF affected QOL most in 48% of these patients, 23% felt HF and other medical conditions affected them equally, and 29% felt other medical conditions were more important. Patients affected more by HF had greater improvements in VAS scores despite trend of more hospitalizations. Patients with other medical problems had better QOL at baseline, but noted declines in VAS scores. Conclusions: QOL can be routinely monitored in HF clinics. Strategies to improve QOL should be developed to meet the individual patient's needs as other co-morbidities often affect QOL equally or more. Future studies should evaluate more comprehensive QOL tools. Patient characteristics that influence change in QOL scores

Addressing the religious and spiritual needs of dying patients by healthcare staff in Korea: patient perspectives in a multi‐religious Asian country

We investigated how patients' spiritual and religious needs are addressed by healthcare staff in inpatient palliative care centers in Korea, a multi-religious country. We performed a cross-sectional, multicenter survey of terminal cancer patients in inpatient palliative care centers. Approximately half (50.5%) of the patients reported that their spiritual and religious needs were addressed by healthcare staff. Patients whose needs were addressed reported better quality of life (QoL), as measured using the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire for Palliative Care, than patients whose needs were not addressed (p<0.05), although these groups did not differ when measured using the Comprehensive QoL Scale. Patients with a religious affiliation [adjusted odds ratio (aOR), 2.38; 95% confidence interval (CI), 0.70-8.05], those who were admitted to a religious palliative care center (aOR, 2.61; 95% CI, 0.86-7.96), and those whose religious affiliation was the same as that of the palliative care center (aOR, 2.42; 95% CI, 0.96-6.07) tended to have their spiritual and religious needs addressed, although not statistically significant. Although patients whose spiritual and religious needs were addressed by healthcare staff showed significantly better QoL, such needs were not addressed in a significant proportion of patients, especially those who were not religious or were admitted to non-religious palliative care centers. Strategies should be developed to ensure that spiritual care is provided to all patients with terminal cancer, regardless of the religious background of the patient.

Quality of life in adults with spinal cord injury living in the community

The study design used is cross-sectional descriptive survey. The aim of this study is to describe the subjective and objective quality of life (QoL) of adults with chronic non-traumatic spinal cord injury (NT-SCI) and to compare the objective and subjective QoL of adults with chronic NT-SCI with adults who have a chronic traumatic spinal cord injury (T-SCI) and the general population. Living in the general community (non-residential care), Australia. The study included 443 adults with SCI (T-SCI, n=381) (NT-SCI, n=62), all SCI ≥6 months duration. Not applicable. Objective and subjective QoL domains--Comprehensive QoL Scale for Adults, version 5 (COMQoL-A5); acceptance subscale--the Spinal Cord Lesion Coping Strategies Questionnaire, version 1 Australia (SCL CSQ v1.0 Australia). Despite demographic differences, only the objective QoL domain material (higher in NT-SCI) and the subjective QoL domain health (lower in NT-SCI) were significantly different between the SCI subgroups. In contrast, five of the seven objective domains and four of the seven subjective domains were significantly lower in the SCI sample as a whole, compared with the general population. Post hoc analyses suggested that aetiology of the SCI was not responsible for QoL differences within the cohort with SCI. On the whole, aetiology makes little difference to QoL outcomes after SCI. The QoL of adults with chronic T-SCI and NT-SCI fall significantly below that of the general population in most domains.

Validation of the World Health Organization Quality of Life HIV Instrument in a Zambian Sample

Given the longevity achievable with the current treatment for people living with HIV, quality of life (QOL) has emerged as a significant health outcome measure. The purpose of this study was to test the QOL factor structure in a Zambian sample using the World Health Organization Quality of Life-HIV (WHOQOL-HIV) instrument. A cross-sectional 2 ×2 factorial design was conducted with 160 people living with HIV. Factor analysis yielded 3 new scales: Zambian WHOQOL-HIV, Zambian WHOHIV Medication Dependence, and Zambian WHOHIV spirituality religion personal beliefs (SRPB), and validated the Overall Quality of Life and General Health Perceptions Scale. The study tested the WHOQOL-HIV instrument, validated a scale that can be used for regular assessment, and yielded three comprehensive QOL assessment scales to monitor disease progression and response to care. The assessments will lead to the development of holistic nursing interventions based on perception of QOL.

Focus on the assessment of physical activity level of patients with cancer cachexia enrolled in a randomized phase III clinical trial.

9164 Background: Physical activity is an important component of the physical and social domains of quality of life (QL); therefore any restoration of physical activity level (PAL) towards a normal level may translate into an improvement in QL of cachectic cancer patients. Purpose: We carried out a phase III randomized study to establish which was the most effective and safest treatment to improve the primary endpoints of cancer cachexia and among them we have selected as the most relevant PAL. Patient total daily PAL and associated energy expenditure was assessed with an electronic device (SenseWear PRO2 Armband), shown in some validation studies to be able to assess appropriately the total energy expenditure (TEE) and its specific components, resting energy expenditure (REE) and active energy expenditure (AEE). AEE was recorded at an intensity ≥ 3.0 metabolic equivalents corresponding to a moderate physical activity. The armband is able to identify the specific type of patient physical activity in such a way to attribute to it a “functional quality.” Methods: Seventy out of 332 patients with cancer cachexia enrolled in the study were assessed for total daily PAL before and after treatment. The study design planned to randomly assign eligible patients to 1 of 5 arms of treatment: 1) medroxyprogesterone 500 mg/d or megestrol acetate 320 mg/d; 2) oral supplementation with 2 g EPA; 3) L-carnitine 4 g/d; 4) thalidomide 200 mg/d; 5) a combination of the above. Treatment duration: 4 months. Results: Total daily PAL showed that TEE and AEE increased significantly in arm 5 (TEE from 1291 kcal/die to 1649 kcal/die, p=0.04 and AEE from 93.8 kcal/die to 155 kcal/die, p=0.032) with a concomitant significant decrease of REE (from 1227 ± 439 to 1067 ± 181 kcal/die, p=0.044). The primary endpoints LBM (by DEXA) and fatigue improved significantly in arm 5. Toxicity was substantially negligible, comparable between treatment arms. Conclusions: The present study showed that the combination regimen was the only effective treatment in improving patient total daily PAL. Our trial shows that PAL monitoring provides a new dimension in the assessment of the comprehensive quality of life of cachectic cancer patients. No significant financial relationships to disclose.

Don't Wanna Go Through That Madness No More: Quality of Life Satisfaction as Predictor of Sustained Remission from Illicit Drug Misuse

Individuals who have developed a clinical dependence on drugs and/or alcohol often report that they sought help because they were “sick and tired of being sick and tired.” Quality of life (QOL) remains the missing measurement in the addictions arena. The few studies conducted to date show that QOL is typically poor during active addiction and improves as a function of remission. An intriguing question bears on the role of QOL in subsequent remission status. Reasoning that higher life satisfaction may “increase the price” of future use and thus enhance the likelihood of sustained remission, this exploratory study tests the hypotheses that QOL satisfaction prospectively predicts sustained remission, and that motivational constructs mediate the association. Inner city residents (N = 289, 53.6% male, mean age 43) remitting from chronic and severe histories of dependence to crack and/or heroin were interviewed three times at yearly interval beginning in April 2003. Logistic regression findings generally support our hypotheses: Controlling for other relevant variables, baseline life satisfaction predicted remission status 1 and 2 years later and the association was partially mediated by motivation (commitment to abstinence) although the indirect effect did not reach statistical significance. Findings underline the importance of examining the role of QOL satisfaction in remission processes. Limitations of this exploratory study are discussed, including the use of a single-item global life satisfaction rating; suggestions for future studies are discussed including the need to embrace QOL as a bona fide clinical outcome and to use comprehensive standardized QOL measures that speak to individual dimensions of functioning. Implications are noted, especially the need for the addiction field to continue moving away from the pathology-focused model of care toward a broader model that embraces multiple dimensions of positive health as a key outcome.

Occupations of Healthy Asian Retirees

Aim: To find associations between types of activity participated in by healthy Asian retirees and 7 quality of life (QOL) domains. Methods: Fiftyfour retireeswere recruited. An inventory of 16 types of activity was used. Satisfaction levels on QOL domains were measured using modified Comprehensive QOL Scale Adult questionnaire. Multivariate linear regression analysis was performed. Results: Socialactivities had positive impact on material well-being, health, productivity, and safety satisfaction. Participation in fine art and travel activities also reportedhigher satisfaction in QOL domains. Conclusion: Social engagement is crucial inenhancing QOL. Artistic and travel activities help retirees build closer relationships with others.

Reliability and Validity of the Korean Version of Kidney Disease Quality of Life Instrument (KDQOL-SFTM)

Although the Kidney Disease Quality of Life instrument (KDQOL-SF), which was designed to measure the comprehensive quality of life in patients with end stage renal disease, has been tested and widely administered in many other counties, it has not yet been translated, validated and reported for Korea. The primary purpose of this study was to validate a Korean version of KDQOL-SF and to evaluate its psychometric properties. The study subjects were 164 patients with hemodialysis or continuous ambulatory peritoneal dialysis in university dialysis centers in Korea. In order to investigate the reliability, test-retest reliability and internal consistency reliability were assessed. Both test-retest reliability and internal consistency reliability were found to be high. In order to investigate the construct validation, all the items of the SF-36 scales, an established generic QOL measures, were compared with an overall health rating scale in kidney disease-targeted scale. They found to be highly correlated with each other. Moreover, overall health rating scale was significantly correlated with symptoms/problems, effects of kidney disease, burden of kidney disease, cognitive function (p < 0.001), and quality of social interaction (p < 0.05). These results suggest that the Korean version of KDQOL-SF satisfies its reliability and validity in Korean patients with hemodialysis or continuous ambulatory peritoneal dialysis. This questionnaire provides important and clinically valuable information for understanding the health related quality of life in the Korean patients with dialysis.

The EORTC QLQ-HDC29: A supplementary module assessing the quality of life during and after high-dose chemotherapy and stem cell transplantation

High-dose chemotherapy followed by haematopoietic stem cell transplantation can be associated with high physical and emotional distress levels and reduced quality of life. Systematic prospective measurement of impact of therapy on patient quality of life can aid treatment choices and provide better patient information. We describe the development of a high-dose chemotherapy questionnaire module to supplement the European Organisation for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-C30). Phases 1–3 of module development were conducted in United Kingdom, Germany, Austria and Norway, according to EORTC QOL Group guidelines. Forty-eight quality of life (QOL) issues were generated from the literature searches and interviews with health care professionals ( n = 24) and patients ( n = 92). This produced a 50 item provisional module. Further testing in 169 patients resulted in the QLQ-HDC29 module, containing 29 items, conceptualised into six multi-item scales and eight single items. The EORTC QLQ-C30, supplemented by QLQ-HDC29 will provide a comprehensive QOL measure for the international clinical trials of high-dose chemotherapy.

Efficient palliation in patients with small-cell lung cancer by a combination of paclitaxel, etoposide and carboplatin: Quality of life and 6-years’-follow-up results from a randomised phase III trial

Based on the promising activity of paclitaxel in small-cell lung cancer (SCLC) we conducted a randomized phase III trial to evaluate whether a combination of paclitaxel, carboplatin and etoposide phosphate (TEC) improves survival and time to progression as well as tolerability and quality of life (QoL) compared to a regimen of carboplatin, etoposide phosphate and vincristine (CEV) in SCLC patients. Six hundred and fourteen patients with stages I-IV SCLC were randomly assigned between January 1998 and December 1999 to both treatment arms. All patients were evaluated for response rate, survival, side effects and quality of life with overall survival (OS) serving as primary endpoint. A final analysis was done after a six-year follow-up. Survival curves were estimated using Kaplan-Meier curves and tested with the log-rank test. Quality of life data were assessed in using the EORTC QLQ-C30 questionnaire and evaluated by calculating and comparing the mean scores as well as applying longitudinal techniques. Six hundred and eight patients were evaluable for efficacy and toxicity. The long-term follow-up confirms the significant survival benefit for the paclitaxel, etoposide, carboplatin (TEC) regimen with a median OS of 12.5 months compared to 11.7 months for the CEV arm (HR, 1.21; 95% CI, 1.02-1.43; P=.030). The 5-year survival rates were 14% for the experimental versus 6 % for the CEV arm. Significant survival prolongation was also observed in the subgroup of patients with stage IV disease (HR, 1.27; 95% CI, 1.00-1.60; P=.047). The previously reported clinical benefit in form of an overall reduction of grade 3/4 toxicity was backed by the results of the comprehensive QoL analysis we report hereby. TEC significantly improves the relevant QoL parameters like global overall QoL or physical functioning. When administered in combination with etoposide and carboplatin, paclitaxel is able to offer in SCLC patients with extensive disease a survival benefit without additional toxicities, but with gains in patient-reported quality of life. In terms of efficient palliative care, TEC might be seen as an alternative to standard cisplatin plus etoposide in patients requesting a powerful palliative regimen not compromising any survival benefit.

日本人高齢者のQOL評価―研究の流れと健康関連QOLおよび主観的QOL

The aims of this review are to (1) outline the course of quality of life (QOL) studies in Japan, (2) clarify the concept and scale of health-related QOL and subjective QOL, (3) clarify the problems in the Japanese version of subjective QOL scales and the characteristics of subjective QOL in Japanese elderly, and (4) propose a direction of QOL assessment for the aging society in Japan. Since the 1970s in Japan, QOL has been studied in several fields, such as medical science, social psychology and gerontology, but a unified concept or definition of QOL has not been established. Health-related QOL, developed in the field of medical science, evaluates the individual condition from multiple dimensions including physical, psychological, social, functional and spiritual aspects. Since the aging society in Japan is largely composed of healthy elderly, comprehensive health-related QOL scales, which can provide continuous assessment from the disabled to healthy elderly, have a high degree of availability. Subjective QOL scales measure individual subjective evaluations of all aspects of daily life. Subjective QOL has mainly been assessed from the viewpoint of life satisfaction or morale. However, it has been reported that the existing scales have certain problems, and that subjective QOL is influenced by culture and individual values. In the aging society of Japan, it will be important to evaluate QOL in the elderly from the aspects of both health-related and subjective QOL to clarify the criteria for “successful aging”. In addition, ikigai (“something to live for”), which is unique to Japan, will be an effective measure for evaluation of QOL.

Quality of life in long-term cervical cancer survivors

Objectives To describe the quality of life (QOL) and long-term psychosocial sequelae of women of childbearing age diagnosed with cervical cancer 5–10 years earlier. Methods Utilizing a cross-sectional descriptive design, 51 cervical cancer survivors and 50 age-matched controls completed a comprehensive QOL interview. Results Participants were predominantly married, non-Hispanic White, with a mean age at diagnosis of 37 years and a mean age at interview of 45 years. This disease-free sample enjoys a good QOL, with physical, social, and emotional functioning comparable to or better than comparative norms. However, certain psychological survivorship sequelae and reproductive concerns persist. Participants reporting good QOL were less likely to report ongoing coping efforts related to having had this illness and were more likely to report greater social support, greater sexual pleasure, and less cervical cancer-specific distress. In a multiple-regression model, cancer-specific distress, spiritual well-being, maladaptive coping, and reproductive concerns accounted for 72% of the variance in QOL scores. Fifty-nine percent of respondents expressed that they would likely participate in a counseling program today to discuss psychosocial issues raised by having had cervical cancer, and 69% stated that they would have attended a support group program during the initial treatment if it had been offered. Conclusions This information provides insight into the complex survivorship relationships between QOL and sequelae of cervical cancer for women diagnosed during childbearing years. Therefore, it is important for health care professionals to recognize that aspects of cancer survivorship continue to require attention and possible follow-up care.

Finding a useful conceptual basis for enhancing the quality of life of nursing home residents.

In this article it is depicted that before nursing home staff can effectively contribute to optimising the quality of life (QOL) of nursing home residents, it has to be clear what exactly QOL is and how it can be enhanced. The aim is to identify a QOL framework that provides tools for optimising QOL and can form the basis for the development of guidelines for QOL enhancement. For that purpose, a framework should meet three basic criteria: (1) it should be based on assumptions about comprehensive QOL of human beings in general; (2) it should clearly describe the contribution of each dimension to QOL and identify relationships between the dimensions; (3) it should take individual preferences into account. After the criteria are defined, frameworks identified from a literature search are discussed and evaluated according to these criteria. The most suitable framework appears to be the QOL framework of the theory of Social Production Functions. The implications of this framework in understanding the QOL of nursing home residents are described and recommendations for further research are discussed.