Decrease In Quality Of Life Scores Research Articles

Influence of social determinants of health in the evolution of the quality of life of older adults in Europe: A comparative analysis between men and women

Population aging is a global phenomenon due to declining birth rates and increased life expectancy. This demographic shift poses a challenge to society, requiring adaptation of policies, economies, and healthcare systems to safeguard the well-being of older individuals. Health inequalities, influenced by social determinants such as education, economic status, and place of residence, impact this population group, with notable differences between men and women. Several studies have demonstrated that social determinants of health (SDH) affect the quality of life (QoL) of older individuals, especially women. In general, women report lower quality of life indicators, lower educational levels, and poorer health compared to men. This study aims to examine how social determinants of health can influence the quality of life of the population aged 50 or older in different European countries, from a sex perspective, through a longitudinal approach. The main SDHs associated with poorer QoL were female sex advanced age, economic hardship, educational level, and geographic location within Europe. Depression in women and men in Southern Europe was associated with a decrease in QoL scores.

Baseline total brain volume predicts changes in quality of life and overall survival after cranial radiotherapy in older patients with glioblastoma: Results from the prospective BRITER study

Abstract Background Short-course partial brain radiotherapy ± chemotherapy for older patients with GBM extends survival but there is no validated evidence for prediction of individual risk of acute radiotherapy-related side effects. Methods This prospective multicentre observational trial recruited patients with newly diagnosed GBM aged ≥65 planned for cranial radiotherapy. Baseline MRI scans were analyzed for markers of brain resilience including relative total brain volume (ratio of cerebrospinal fluid (CSF) volume to total intracranial volume (TIV)) and their relationship to change in quality of life (QoL). Results 126 patients enrolled: mean age 72 years (range 65-83). 77% had debulking surgery. 79% received radiotherapy with concurrent TMZ, and 21% received palliative radiotherapy alone. The median OS was 10.7 months. After accounting for age, sex, treatment, and baseline MoCA score, there was a relationship between baseline CSF:TIV and change in QoL score at 8 weeks post treatment. For each unit point of increase in CSF:TIV, there was a corresponding decrease in QoL score of 1.72 (95% CI −3.24 to −0.19 P = .027). 35 participants were too unwell to complete questionnaires or had died by the 8 week follow-up visit. In this subgroup, post hoc logistic regression showed baseline CSF:TIV was related to the risk of non-attendance (OR 1.35, 95% CI 1.01 to 1.80, P = .042). Cox regression models showed baseline CSF:TIV was associated with worsened OS (HR 1.41, 95% CI 1.19 to 1.66, P < .001). Conclusions This study provides evidence to support the use of an imaging biomarker to help assess the risk:benefit ratio for radiotherapy.

Quality of life of COVID-19 recovered patients: a 1-year follow-up study from Bangladesh

BackgroundThe COVID-19 pandemic posed a danger to global public health because of the unprecedented physical, mental, social, and environmental impact affecting quality of life (QoL). The study aimed to find the changes in QoL among COVID-19 recovered individuals and explore the determinants of change more than 1 year after recovery in low-resource settings.MethodsCOVID-19 patients from all eight divisions of Bangladesh who were confirmed positive by reverse transcription-polymerase chain reaction from June 2020 to November 2020 and who subsequently recovered were followed up twice, once immediately after recovery and again 1 year after the first follow-up. The follow-up study was conducted from November 2021 to January 2022 among 2438 individuals using the World Health Organization Quality of Life Brief Version (WHOQOL-BREF). After excluding 48 deaths, 95 were rejected to participate, 618 were inaccessible, and there were 45 cases of incomplete data. Descriptive statistics, paired-sample analyses, generalized estimating equation (GEE) analysis, and multivariable logistic regression analyses were performed to test the mean difference in participants’ QoL scores between the two interviews.ResultsMost participants (n = 1710, 70.1%) were male, and one-fourth (24.4%) were older than 46. The average physical domain score decreased significantly from baseline to follow-up, and the average scores in psychological, social, and environmental domains increased significantly at follow-up (P < 0.05). By the GEE equation approach, after adjusting for other factors, we found that older age groups (P < 0.001), being female (P < 0.001), having hospital admission during COVID-19 illness (P < 0.001), and having three or more chronic diseases (P < 0.001), were significantly associated with lower physical and psychological QoL scores. Higher age and female sex [adjusted odd ratio (aOR) = 1.3, 95% confidence interval (CI) 1.0–1.6] were associated with reduced social domain scores on multivariable logistic regression analysis. Urban or semi-urban people were 49% less likely (aOR = 0.5, 95% CI 0.4–0.7) and 32% less likely (aOR = 0.7, 95% CI 0.5–0.9) to have a reduced QoL score in the psychological domain and the social domain respectively, than rural people. Higher-income people were more likely to experience a decrease in QoL scores in physical, psychological, social, and environmental domains. Married people were 1.8 times more likely (aOR = 1.8, 95% CI 1.3–2.4) to have a decreased social QoL score. In the second interview, people admitted to hospitals during their COVID-19 infection showed a 1.3 times higher chance (aOR = 1.3, 95% CI 1.1–1.6) of a decreased environmental QoL score. Almost 13% of participants developed one or more chronic diseases between the first and second interviews. Moreover, 7.9% suffered from reinfection by COVID-19 during this 1-year time.ConclusionsThe present study found that the QoL of COVID-19 recovered people improved 1 year after recovery, particularly in psychological, social, and environmental domains. However, age, sex, the severity of COVID-19, smoking habits, and comorbidities were significantly negatively associated with QoL. Events of reinfection and the emergence of chronic disease were independent determinants of the decline in QoL scores in psychological, social, and physical domains, respectively. Strong policies to prevent and minimize smoking must be implemented in Bangladesh, and we must monitor and manage chronic diseases in people who have recovered from COVID-19.Graphical

Postdischarge pain, fatigue severity and quality of life in COVID-19 survivors

Objectives: Fatigue and pain symptoms were common complaints among post-COVID-19 patients, and these lead to impaired quality of life (QoL). We aimed to evaluate severity of pain and fatigue 3 months after disease onset in discharged COVID-19 patients. Methods: Patients were contacted by phone at their third month following disease onset. Demographic data of the patients such as weight, height, body mass index (BMI), gender, smoking history, comorbidities, length of hospitalization, duration of stay in the intensive care unit, were recorded. The patients' pain and fatigue severities were evaluated by visual analog scale (VAS). QoL was questioned with the EuroQol Group Association five-domain, three-level questionnaire (EQ-5D-3L). Results: A total of 392 participants enrolled into the study. At admission, 94.6% of the participants had fatigue and 73.7% of them had pain. A high proportion of them still reported fatigue (55.1%) and pain (41.3%) at third month. The mean value of pain-VAS score was 5.37 ± 3.85, and it was 7.58 ± 2.82 for fatigue-VAS at admission. VAS scores of pain and fatigue at third month were 1.44 ± 2.11 and 2.04 ± 2.40 respectively. While 66.6% of the patients reported moderate-severe pain at disease onset, the rate was 18.1% at the third month. And also almost half had severe pain at admission (48%), it was 2.8% at third month. At disease onset 89.6% of the patients reported moderate-severe fatigue (severe: 48%). Aproximately one third of them had moderate-severe fatigue (27.9%) at third month (severe: 5.1%). The mean value of EQ-VAS score was 26.76 ± 20.26 at admission, and it was 78.84 ±16.15 at third month. Statistically significant differences were recorded between the disease onset and third month in terms of pain-VAS fatigue-VAS, and EQ-VAS scores (p &amp;lt; 0.001). Female gender, ICU admission, long duration of hospitalization, older age, higher BMI scores, multiple comorbidities, fatigue and pain severity were related to the decrease in QoL scores. Conclusions: Hospitalized COVID-19 survivors need ongoing support for pain, fatigue complaints and impaired QoL after discharge. The factors that cause poor QoL should be taken into account during post-COVID-19 follow up.

Demoralization profiles and their association with depression and quality of life in Chinese patients with cancer: a latent class analysis.

The study aimed to identify latent classes of demoralization and examine their associations with depression and quality of life (QOL) among patients with cancer. Cross-sectional data from 874 patients with cancer from three tertiary hospitals in Fujian province were collected using a convenience sampling method. Demoralization, depression, and QOL were assessed using the Chinese version of the Demoralization Scale-II, Patient Health Questionnaire-9, and McGill Quality of Life Questionnaire. Latent class analysis was performed on demoralization profiles. Binary logistic regression and multiple stepwise linear regression were used to examine the identified classes' associations with depression and QOL. Three latent classes of demoralization were identified: the "low demoralization and emotional disturbance" class (Class 1; 49.6%); "moderate demoralization and meaninglessness" class (Class 2; 29.1%); and "high demoralization and existential despair" class (Class 3; 21.3%). The severity of depression increased and the levels of QOL decreased with the three classes of demoralization. Patients with cancer being depressed in Classes 1 and 2 were 0.128 and 0.018 times that of Class 3, respectively, whereas the magnitudes of decrease in QOL scores for Classes 2 and 3 were 0.378 and 0.629, respectively. This study revealed three heterogeneous classes of demoralization in Chinese patients with cancer and indicated that increased classes were associated with more severe depression and decreased QOL. Targeted, step-by-step psychological interventions should be developed and implemented according to the characteristics of each class of demoralization to effectively promote psychological well-being among patients with cancer.

Distal end of Double-J ureteral stent position on ureteral stent-related symptoms: A systematic review and meta-analysis.

BackgroundMost patients suffer from ureteral stent-related symptoms (USRS) caused by indwelling ureteral stents. Nevertheless, various medications to alleviate discomfort as well as novel stents are continually being developed, and in recent years, some researchers have believed that proper intravesical stent placement can relieve USRS.ObjectiveTo determine appropriate intravesical ureteral stent position may alleviate USRS.MethodsUp to May 1, 2022, the PubMed, Embase, Scopus and Web of Science databases were thoroughly searched, and two independent reviewers included relevant studies that met the PICO (Patient, Intervention, Comparison, Outcome) criteria. Studies methodological quality were assessed by ROB2 and ROBINS-I. Ureteral stent symptom questionnaire (USSQ), international prostate symptom score (IPSS) and quality of life (QoL) was used to quantify the USRS. According to intravesical ureteral stent position, Group A was defined as the contralateral group, that is distal end of ureteral stent crossed the bladder midline, whereas Group B was classified as ipsilateral group, meaning stent end did not cross the midline.ResultsSix studies incorporating a total of 590 patients were eligible. In terms of USSQ score, the meta-analysis showed that contralateral group was associated with a significant increase in USSQ total (MD, 17.55; 95% CI, 12.04 to 23.07; P < 0.001), urinary symptoms (MD, 2.74; 95% CI, 0.48 to 5.01; P = 0.02), general health (MD, 4.04; 95% CI, 2.66 to 5.42; P < 0.001), work performance (MD, 1.36; 95% CI, 0.75 to 1.98; P < 0.001) and additional problems (MD, 0.89; 95% CI, 0.47 to 1.32; P < 0.001) scores while not associated with a significant increase in body pain (MD, 3.13; 95% CI, −0.19 to 6.44; P = 0.06) and sexual matters (MD, 1.01; 95% CI, −0.03 to 2.06; P = 0.06). As for IPSS, although no significant differences in IPSS total (MD, 2.65; 95% CI, −0.24 to 5.54; P = 0.07) or voiding symptoms (MD, −0.84; 95% CI, −3.16 to 1.48; P = 0.48) scores were found, ipsilateral group was associated with a significant decrease in storage symptoms (MD, 1.92; 95% CI, 0.91 to 2.93; P = 0.0002). Furthermore, ipsilateral group was linked to a significant decrease in QoL score (MD, 1.00; 95% CI, 0.18 to 1.82; P = 0.02).ConclusionThis meta-analysis proven that correct intravesical stent position was critical, and patients with stents crossing the midline experienced more severe USRS than those who did not. Further high-quality randomized controlled trials are needed to corroborate our findings.

Quality of life as an indicator of the effects of concomitant hypertensive disease on the state of health of patients with non-alcoholic fatty liver disease

Objective — to determine the effects of concomitant hypertension on the quality of life (QOL) of patients with non‑alcoholic fatty liver disease (NAFLD) using the Medical Outcomes Study Short Form (SF‑36) and The Chronic Liver Disease Questionnaire (CLDQ).&#x0D; Materials and methods. Examinations involved 115 patients with NAFLD at the stage of non‑alcoholic steatohepatitis. The patients were divided into two groups: the main group included 63 patients with NAFLD and hypertension (32 men and 31 women, the mean age 48.4 years) and comparison group consisted of 52 patients with NAFLD (25 men and 27 women, the mean age 48.3 years). The control group consisted of 20 practically healthy people (12 women and 8 men, the mean age 47.1 years). The NAFLD duration did not significantly differ between the groups of comorbid course (6.6 years (95 % confidence interval (CI) — 5.8; 7.3)) and isolated NAFLD (7.8 years (95 % CI 6.7; 8.8)) (p = 0.086). Hypertension duration was 8.4 years (95 % CI 7.3; 9.5). Assessments included body mass index calculation (BMI) and measurements of systolic (SBP) and diastolic (DBP) arterial pressure. The Medical Outcomes Study Short Form (SF‑36) and Chronic Liver Disease Questionnaire (CLDQ) were used to assess the QOL of NAFLD patients.&#x0D; Results. In comparison with the control group and regardless of the presence of concomitant pathology, the significant decrease in QOL scores of almost all SF‑36 scales was established in NAFLD patients. In NAFLD patients with hypertension, decrease in the QOL indicators was observed for all components of health, except for the results on the scale of physical functioning («PF»). Indicators of the total physical («PCS») and mental («MCS») health components were also significantly lower in the group with NAFLD and hypertension and amounted to 25.00 % (95 % CI 21.20; 29.60) and 44.00 % (95 % CI 42.23; 50.47) out of the maximum possible 100 %. There was a significant decrease in indicators for all domains of the CLDQ questionnaire in patients with NAFLD and hypertension compared to the isolated NAFLD and the control group. Significant inverse correlations were determined between the QOL indicators according to both questionnaires and the diseases duration, SBP, DBP levels and BMI.&#x0D; Conclusions. NAFLD is associated with significant deviant changes in patients’ quality of life indicators according to the SF‑36 and CLDQ questionnaires. The presence of concomitant hypertension, the duration of fatty changes in the liver, the experience of hypertension, the levels of SBP, DBP and BMI significantly worsen the QOL of patients with NAFLD. The quantitative variability of QOL components in patients with NAFLD and hypertension can negatively affect the course of the disease and reduce the effectiveness of therapeutic and rehabilitation measures.&#x0D;

Health-related quality of life determinants in survivors of a mass methanol poisoning outbreak: six-year prospective cohort study

Purpose: The effect of acute methanol poisoning on the follow-up quality of life of survivors in mass poisoning outbreaks is not known. The objective of this is to study the impact of visual and central nervous system (CNS) sequelae of methanol poisoning on long-term health-related quality of life (QoL) of survivors, its clinical determinants, and dynamics.Materials and methods: A total of 54 patients with confirmed methanol poisoning (mean age 46.7 ± 13.4 years, 9 females) were examined consequently three times within six-year prospective cohort study and compared to 23 controls with the history of chronic alcohol abuse. The following tests were performed: SF-36 QoL questionnaire, visual evoked potentials (VEP) of optic nerve, ocular examination with retinal nerve fiber layer (RNFL) thickness measurement, brain magnetic resonance imaging (MRI), and biochemical and toxicological tests.Results: Acute methanol poisoning led to significant decrease in physical component summary (PCS) compared to PCS of age-adjusted controls (mean score with SD 46.8 ± 11.0 versus 52.3 ± 9.4 points; p = .003). In 17/40 (42.5%) patients with three rounds of examination, signs of severe disability (≤30 points in at least one score) were present six years after discharge, with negative dynamics of PCS score during the observation period. The patients with abnormal RNFL thickness had lower PCS (mean difference 10.5 points; 95%CI 3.5–17.5, p = .004) and mental component summary score (9.5 points; 95%CI 1.9–17.1, p = .015) compared to the patients with normal RNFL. Signs of physical and mental adaptation to long-term visual sequelae were registered with gradual reduction of difference in most of physical and mental components scores compared to the patients with normal RNFL during six years of observation. Signs of hemorrhagic brain lesions were associated with permanent decrease of PCS score (mean difference 7.4 points; 95%CI 0.6–14.0; p = .033), bodily pain (8.7 points; 95%CI 1.6–17.6; p = .018), and social functioning (8.2 points; 95%CI 3.0–17.4; p = .005) six years after discharge. No effect of type of antidote (fomepizole versus ethanol) and extracorporeal enhanced elimination modality (intermittent hemodialysis versus continuous renal replacement therapy) applied in hospital on long-term QoL was found (all p > .05).Conclusion: Acute methanol poisoning was associated with a significant decrease of health-related quality of life of survivors persisting for at least six years after discharge. The more pronounced decrease in QoL scores was observed in the patients with hemorrhagic brain lesions and visual sequelae of poisoning with abnormal RNFL thickness.

Eosinophilic Esophagitis Is Rarely Continually Symptomatic 10Years After an Initial Treatment Course in Adults.

Despite its initial description over 25years ago, there is little known about the course of eosinophilic esophagitis (EoE) after an initial course of medical or dietary treatment. We aim to assess the long-term symptomology and quality of life (QoL) metrics in patients 10years after initial treatment for eosinophilic esophagitis. Inclusion criteria: single center study of EoE patients diagnosed over 10years ago with completion of an 18-question structured telephone interview. A cohort of patient's prospectively underwent an esophageal barium exam, esophageal sponge cytology, and evaluation by a esophagologist at greater than 10years' time since original diagnosis. A total of 54 patients were included in the study. The average age at follow-up was 55.0, with the majority male (64.8%). At the original diagnosis, 62.9% and 37.0% were initially treated with topical steroids and a proton pump inhibitor (PPI), respectively,compared to 59.3% and 7.4% after 10years, and 7.4% of patients reported a history of dilatations. Only 11.8% noted avoidance of trigger foods, with 62.7% noting an unlimited diet without caution. QoL decrease secondary to EoE was noted to be trivial to minimal in 56.9% of patients, mild in 19.6%, moderate in 15.7% and severe in 7.8%. In the prospective follow-up cohort, the results of telephone survey results matched the direct physician-obtained interview in 88% of cases. Tenyears after diagnosis, treated EoE is rarely continually symptomatic, requires mainly PPI-based therapies and is associated with a minimal decrease in QoL scores.

Hospitalized patients with heart failure: the impact of anxiety, fatigue, and therapy adherence on quality of life.

IntroductionHeart failure (HF) is a major global health problem associated with increased morbidity and mortality and reduced quality of life (QoL). The aim of the study was to assess the impact of anxiety, fatigue and adherence to therapeutic guidelines on HF patients’ QoL.Material and methodsA hundred and twenty hospitalized HF patients were enrolled in the study. Data collection was performed by completion of the Minnesota Living With Heart Failure Questionnaire (MLHFQ), the Greek version of the Modified Fatigue Impact Scale (MFIS-Greek), the Zung Self-Rating Anxiety Scale (SAS) and a questionnaire that measured adherence to therapeutic guidelines.ResultsData analysis showed moderate levels of anxiety and high levels of adherence to therapeutic guidelines as well as moderate to large effects of HF on patients’ fatigue and QoL. A statistically significant positive linear association was observed between anxiety and QoL (rho > 0.6) as well as fatigue and QoL (rho > 0.3). An increase in the anxiety or fatigue score indicated an increase also in the QoL score, meaning that the more anxiety and fatigue a patient felt the worse the QoL also was. Moreover, a statistically significant negative linear association was observed between adherence to therapeutic guidelines and QoL (rho < –0.2). An increase in adherence score indicated a decrease in QoL score, meaning that the more adherent a patient was the better was the QoL.ConclusionsThe present findings suggest that QoL may be improved when adherence to therapy is increased and fatigue and anxiety are alleviated.

The quality of life and satisfaction rate of patients with upper limb hyperhidrosis before and after bilateral endoscopic thoracic sympathectomy.

Background:Hyperhidrosis is a functional disorder identified by excessive sweating. Its incidence is approximately 1% in any population. Bilateral endoscopic thoracic sympathectomy (BETS) intervention is the definitive treatment of choice for palmar and axillary hyperhidrosis.Aims and Objectives:The purpose of this study is to evaluate and compare the quality of life (QOL) and satisfaction rate of patients with upper limb hyperhidrosis before and after BETS surgery and the influence of compensatory hyperhidrosis (CH) on patients’ QOL after surgery.Settings and Design:This study is a cross-sectional study designed to generate longitudinal data.Subjects and Methods:This study is a cross-sectional study designed to generate longitudinal data pre- and postbilateral BETS prospectively. This study was conducted in the surgery department of University Hospital in Riyadh, Saudi Arabia. Hundred patients with upper limb hyperhidrosis who underwent BETS from 2014 to 2017 were included. A modified and validated QOL questionnaire for hyperhidrosis was completed by the patients themselves in order to compare the QOL for patients both before and after BETS. Patients’ satisfaction and the occurrence of CH were obtained postoperatively.Statistical Analysis Used:Data were analyzed using the SPSS® statistical package for social studies, version 22.0 (SPSS 22; IBM Corp., New York, NY, USA) for Windows®.Results:A total of 100 patients completed the questionnaire; 94% of patients had a positive QOL outcome after the surgery. The mean decrease in QOL scores was −42.0 points toward better QOL. The site of sweating had a significant effect on the patients’ QOL before and after the surgery (P value < 0.001). Moreover, 76% of patients reported a high satisfaction rate.Conclusion:Primary hyperhidrosis can negatively impair patients’ QOL in different domains. BETS showed to be an effective option for improving the QOL of patients and it provided both short- and long-term effectiveness in treating upper limb hyperhidrosis. CH did not interfere with the rate of patient satisfaction or their QOL postoperatively.

Effects of depression and anxiety on asthma-related quality of life.

Asthma is the most prevalent chronic disease in adults. It affects their quality of life. Studies confirm that depression and anxiety occurs in asthma patients. The study involved 96 patients with asthma divided into two groups: patients with controlled (n = 33) and uncontrolled asthma (n = 63). The analysis of asthma control was performed on the basis of the ACT (Asthma Control Test) results. The study used SF-36 (Short Form 36) questionnaire and HADS (Hospital and Depression Scale) Scale. An analysis of the correlations between QoL (Quality of Life) and the level of depression revealed a decrease in QoL scores in MCS (Mental Component Score) domain in the group with controlled asthma (71.8 - patients without depression, 53.4 - patients with probable depression, and 51.4 - patients with depression; p = 0.032). A similar analysis of the correlations between QoL and the level of anxiety in this group of patients proved no correlations in PCS (Physical Component Score) and MCS domains. In the group of patients with uncontrolled asthma, anxiety and depression correlated negatively with the QoL in PCS and MCS domains. Anxiety and depression are found in asthma patients, with higher severity observed in patients with uncontrolled asthma. Female gender, the level of asthma control, asthma severity, smoking, as well as diagnoses of anxiety and depression are predictors of a significantly lower QoL in asthma. Anxiety and depression are found in asthma patients, with higher severity observed in patients with uncontrolled asthma. Female gender, the level of asthma control, asthma severity, smoking, as well as diagnoses of anxiety and depression are predictors of a significantly lower quality of life in asthma.

Comprehensive assessment of xerostomia in patients receiving radiation for head and neck cancer

Purpose: Xerostomia is a well known complication of radiation for head and neck cancer. It causes significant impairment of Quality Of Life (QOL).Comprehensive assessment is possible with the help of scintigraphy, Dose-volume histogram (DVH) parameters as well as QOL questionnaire. Methods: Thirty patients of head and neck cancer undergoing radiation were assessed for xerostomia. Scintigraphic assessment of parotid gland function was done before and at six weeks after radiation. QOL questionnaire was administered before, during, and at six weeks after radiation as well as at two years of follow up. Dose received by parotids were correlated with scintigraphic and QOL outcomes. Results: Mean parotid gland volume and dose received were 24.9 cc and 45.3 Gy respectively. Mean Salivary Excretion Factor (SEF) decreased from 54.1 to 12 at six weeks after radiation. QOL scores worsened from first week (mean value: 2.37) of radiotherapy (RT) to fourth week (mean value: 15.50, p < 0.0000) , remained same till completion of RT (mean value: 17.57, p = 0.1063) and at six weeks after radiation (mean value:16.10, p = 0.2519 ). There was a significant decrease in QOL scores between post RT six weeks versus two years follow up (p < 0.0000). Mean parotid dose and QOL scores correlated at six weeks (p < 0.0000), whereas no correlation was found between SEF and QOL. Conclusion: Comprehensive assessment of parotid gland function with Scintigraphy, QOL questionnaire and its correlation with dose volume parameters is helpful in quantifying xerostomia. Even though radiation induced xerostomia persisted for a long time after radiation, it did not translate to decreased QOL.

Changes in life-space mobility and quality of life among community-dwelling older people: a 2-year follow-up study.

Life-space mobility refers to the spatial area in which a person moves in daily life, taking into account distance, frequency and assistance needed. The aim was to examine how changes in life-space mobility are associated with changes in quality of life (QOL) over a 2-year period. Community-dwelling people aged 75-90 years (n = 848) were interviewed face-to-face in their homes and followed up annually for 2 years. QOL was assessed with the short version of the World Health Organization QOL assessment (range 0-130, higher scores indicate better QOL). Life-space mobility was assessed with the Life-Space Assessment (range 0-120, higher scores indicate better life-space mobility). Lower extremity performance was objectively measured with the Short Physical Performance Battery (SPPB). Cognitive impairment was assessed using the Mini-Mental State Examination. Chronic conditions and years of education were self-reported. Data were analyzed with generalized estimation equation models. The mean life-space score at baseline was 63.9 ± SD 20.6 and mean QOL score 100.3 ± 11.8. Over the follow-up, the QOL score decreased to 95.0 ± 13.8 across the total study sample. The decrease in QOL score was somewhat higher among those whose life-space mobility score declined > 10 points during the follow-up compared to those whose life-space remained stable or improved, even after adjustment for age, gender, number of chronic conditions, cognitive impairment, SPPB and education. Decline in life-space mobility is associated with decline in QOL. The results highlight the importance of ensuring continuous possibilities for out-of-home mobility in maintaining QOL among older people.

Perception of social exclusion, neuropathy, and quality of life among Hansen's disease patients.

Leprosy subjects are strongly affected not only by physical issues such as peripheral neuropathy but also by massive social exclusion that may be related to quality of life (QoL) impairment. However, there are as yet no studies evaluating the impact of perceived stigma in conjunction with neuropathy on QoL and the respective role of each one on QoL. The present study aims to investigate the variations in clinical and socio-demographic profile of Hansen's disease patients with/without perception of social exclusion (PSE) and neuropathy as the impact of both conditions on their QoL. A sample of 160 consecutive leprosy outpatients seeking treatment in two reference centers for leprosy in Brazil was recruited. Patients were assessed using a socio-demographic questionnaire, M.I.N.I. PLUS and SF-36. Data from medical records were also collected. Participants were divided into four groups: control group, perceived stigma, neuropathy, and stigma neuropathy. Of the 160 patients who consented to participate, 78.75% completed the survey. All four groups were similar in terms of demographic parameters, except for occupational status, which was compensated statistically. The group with neuropathy and PSE reported the worst QoL in half of the evaluated domains. The cross-sectional design does not allow cause and effect to be established between variables, and the relatively small sample size may limit the ability to demonstrate a relative decrease in QoL scores from the isolated variables analyzed. The results of this survey show that the presence of both neuropathy and PSE significantly increases impairment in QoL, especially in some specific domains.

Impact of response shift on time to deterioration in quality of life scores in breast cancer patients.

BackgroundThis prospective multicenter study aimed to study the impact of the recalibration component of response-shift (RS) on time to deterioration (TTD) in health related quality of life (QoL) scores in breast cancer (BC) patients and the influence of baseline QoL expectations on TTD.MethodsThe EORTC-QLQ-C30 and BR-23 questionnaires were used to assess the QoL in a prospective multicenter study at inclusion (T0), at the end of the first hospitalization (T1) and, three (T2) and 6 months after the first hospitalization (T3). Recalibration was investigated by the then-test method. QoL expectancy was assessed at diagnosis. Deterioration was defined as a 5-point decrease in QoL scores, considered a minimal clinically important difference (MCID). TTD was estimated using the Kaplan-Meier method. Cox regression analyses were used to identify factors influencing TTD.ResultsFrom February 2006 to February 2008, 381 women were included. Recalibration of breast cancer patients' internal standards in the assessment of their QoL had an impact on TTD. Median TTD were significantly shorter when recalibration was not taken into account than when recalibration was taken into account for global health, role-functioning, social-functioning, body-image and side effects of systemic therapy. Cox multivariate analyses showed that for body image, when recalibration was taken into account, radiotherapy was associated with a shorter TTD (HR: 0.60[0.38–0.94], whereas, no significant impact of surgery type on TTD was observed. For global health, cognitive and social functioning dimensions, patients expecting a deterioration in their QoL at baseline had a significantly shorter TTD.ConclusionsOur results showed that RS and baseline QoL expectations were associated with time to deterioration in breast cancer patients.

Randomized Double-Blind Placebo-Controlled Crossover Study of Efficacy of Pollen Blocker Cream for Perennial Allergic Rhinitis

This study evaluates the efficacy and safety of a pollen blocker cream in treatment of perennial allergic rhinitis (PAR) in a Chinese population. A randomized double-blind placebo-controlled, crossover trial was conducted in the Outpatient Department of the Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China. Patients diagnosed with PAR were randomly assigned to receive pollen blocker cream or placebo, which was applied and evenly distributed to the lower internal nose region three times daily for a total of 30 days. The primary outcome measures for efficacy were nasal symptom scores (NSSs) and quality of life scores (QoLSs). Medication scores and adverse events were also monitored. After application of pollen blocker, the mean NSS fell from 23.1 to 12.4 points, and the QoLSs fell from 83.9 to 53.2 points (p < 0.001). The decrease in NSSs of pollen blocker (10.7) was highly significant compared with the placebo (3.6; p < 0.001). The decrease in QoLSs of pollen blocker was 30.7 compared with 7.1 in the placebo group, and the difference was also significant (p < 0.05). Interestingly, the mean NSS of the placebo group also decreased from 23.7 to 20.1 (p < 0.05). Additionally, the efficacy of pollen blocker was superior to the placebo both in adults and in children. However, there was no significant difference for individual symptoms of rhinorrhea, nasal itching, sneezing, and nasal congestion between the pollen blocker group and placebo group (p > 0.05). Only one mild epistaxis was reported. The pollen blocker was significantly more effective than the placebo in relieving allergy symptoms and improving life quality of PAR in 30 Chinese people.

9:20 AM Abstract No. 69 - Quality of life in patients with hepatic malignancies treated with Holmium-166 radioembolization

Purpose Quality of life (QoL) is an important outcome measure for palliative treatment options like radioembolization (RE) of liver tumors. Several studies have shown a trend towards a decrease in overall QoL after 90Y RE (1-6). The purpose of this study was to evaluate the QoL after RE with 166Ho microspheres; a new imageable particle for RE. Materials and Methods QoL was evaluated in patients with unresectable, chemorefractory liver metastases who were enrolled in a phase 1 dose-escalation clinical trial (7). Patients were enrolled between November 30, 2009 and September 19, 2011. Patients were treated with 166Ho RE in cohorts of three patients with escalating whole-liver absorbed doses of 20, 40, 60 and 80 Gy. QoL was assessed using the global health status and QoL score of the validated European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-LMC21 questionnaires at baseline and at 6 and 12 weeks after treatment. Results 15 patients underwent 166Ho RE. QoL could be assessed in 14 patients, because one patient developed brain metastases and did not comply with follow-up. Compared with baseline values, the mean QoL score at 6 weeks after treatment had decreased by 13 points for the whole group (from 75.6 to 62.5, p=0.053) and by 14 points at 12 weeks to a mean score of 61.9 (p=0.048). There was a difference in decrease in QoL scores between patients with progressive disease and patients with response to treatment, favouring responders, respectively -18.8 versus -5.6 points at 6 weeks (p=0.31). Decrease in QoL scores was most prominent in high dose cohorts: -8 (20 Gy), 3 (40 Gy), -13 (60 Gy), -39 (80 Gy) at 6 weeks. Conclusion Overall QoL decreased in patients with liver metastases after treatment with 166Ho RE. Patients with progressive disease and patients treated with high liver absorbed doses show the greatest decrease in QoL.

331P - Impact of Response Shift On Time to Quality of Life Scores Deterioration in Breast Cancer Patients: Is it Time to Move For QOL Recist Criterion?

ABSTRACT Background Time to quality of life (QoL) score deterioration (TD) is a method of longitudinal QoL data analysis that has been proposed for breast cancer (BC) patients (Hamidou et al Oncologist 2011). As for RECIST criteria, the optimal definitions dealing with reference should be explored. This study aims to study the impact of changes in internal standards (CIS) of response-shift (RS) and the influence of baseline QoL expectancies on TD. Methods A prospective multicenter study including all women hospitalized for a primary BC was conducted. The EORTC-QLQ-C30 and BR-23 questionnaires were used to assess the QoL at baseline, at the end of 1st hospitalization, and 3 and 6 months after. CIS was investigated by the then-test method. QoL expectancy was assessed at baseline using Likert scale. Deterioration was defined as a decrease in QoL scores reaching at least the mean difference identified as minimal clinically important difference (MCID) using Jaeschke's transition question. Sensitivity analyses were done using the then-test score as reference score, and considering 5 and 10 points as MCID. TD was estimated using Kaplan-Meier method. Cox regression analyses were used to identify factors influencing TD. Results From February 2006 to February 2008, 381 women were included. For role functioning dimension, the median TD increased from 3.2 months [95% CI: 3.1-3.36] to 4.76 months [3.3-6.2] when adjusting on CIS. For body image when adjusting on CIS, sentinel lymph node biopsy became significantly associated with longer TD (HR: 0.64[0.43-0.94]) as compared to axillary lymph node dissection, radiotherapy to a shorter TD (HR: 0.63[0.42-0.95] and the type of surgery had no effect on TD. For global health, cognitive and social functioning dimensions, patients expecting deterioration in their QoL had a significantly shorter TD. For fatigue and breast symptom scales, patients expecting no change had a significantly shorter TD, as compared to patients expecting an improvement. Sensitivity analyses using a MDCS of 5 or 10 confirmed these results. Conclusions Our results suggest that it would be more accurate to take into account CIS component of RS as well as QoL expectancies to estimate TD of QoL scores in patient with BC. Disclosure All authors have declared no conflicts of interest.

Impact of response shift on time to quality-of-life scores deterioration in patients with breast cancer.

1584 Background: Time to quality of life (QoL) score deterioration (TD) is a method of longitudinal QoL data analysis that has been proposed for breast cancer (BC) patients (Hamidou et al Oncologist 2011). As for RECIST criteria, the optimal definitions dealing with reference should be explored. This study aims to study the impact of changes in internal standards (CIS) of response-shift (RS) and the influence of baseline QoL expectancies on TD. Methods: A prospective multicenter study including all women hospitalized for a primary BC was conducted. The EORTC-QLQ-C30 and BR-23 questionnaires were used to assess the QoL at baseline, at the end of 1st hospitalization, and 3 and 6 months after. CIS was investigated by the then-test method. QoL expectancy was assessed at baseline using Likert scale. Deterioration was defined as a decrease in QoL scores reaching at least the mean difference identified as minimal clinically important difference (MCID) using Jaeschke’s transition question. Sensitivity analyses were done using the then-test score as reference score, and considering 5 and 10 points as MCID. TD was estimated using Kaplan-Meier method. Cox regression analyses were used to identify factors influencing TD. Results: From February 2006 to February 2008, 381 women were included. For role functioning dimension, the median TD increased from 3.2 months [95% CI: 3.1-3.36] to 4.76 months [3.3-6.2] when adjusting on CIS. For body image when adjusting on CIS, sentinel lymph node biopsy became significantly associated with longer TD (HR: 0.64[0.43-0.94]) as compared to axillary lymph node dissection, radiotherapy to a shorter TD (HR: 0.63[0.42-0.95] and the type of surgery had no effect on TD. For global health, cognitive and social functioning dimensions, patients expecting deterioration in their QoL had a significantly shorter TD. For fatigue and breast symptom scales, patients expecting no change had a significantly shorter TD, as compared to patients expecting an improvement. Sensitivity analyses using a MDCS of 5 or 10 confirmed these results. Conclusions: Our results suggest that it would be more accurate to take into account CIS component of RS as well as QoL expectancies to estimate TD of QoL scores in patient with BC.