Early Quality Of Life Outcomes Research Articles

Normofractionated and moderately hypofractionated proton therapy: comparison of acute toxicity and early quality of life outcomes

AimData on the safety of moderately hypofractionated proton beam therapy (PBT) are limited. The aim of this study is to compare the acute toxicity and early quality of life (QoL) outcomes of normofractionated (nPBT) and hypofractionated PBT (hPBT).Material and methodsWe prospectively compared acute toxicity and QoL between patients treated with nPBT (dose per fraction 1.8–2.3 Gy, n = 90) and hPBT (dose per fraction 2.5–3.1 Gy, n = 49) in following locations: head and neck (H&N, n = 85), abdomen and pelvis (A&P, n = 43), and other soft tissue (ST, n = 11). The toxicities were grouped into categories—mucosal, skin, and other sites—and evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE) version 4.03 at baseline, treatment completion, and 3 months after PBT completion. QoL was evaluated with the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 scale for all locations and additionally with EORTC QLQ-HN35 for H&N patients.ResultsOverall, the highest toxicity grades of G0, G1, G2, and G3 were observed in 7 (5%), 40 (28.8%), 78 (56.1%), and 15 (10.8%) patients, respectively. According to organ and site, no statistically significant differences were detected in the majority of toxicity comparisons (66.7%). For A&P, hPBT showed a more favorable toxicity profile as compared to nPBT with a higher frequency of G0 and G1 and a lower frequency of G2 and G3 events (p = 0.04), more patients with improvement (95.7% vs 70%, p = 0.023), and full resolution of toxicities (87% vs 50%, p = 0.008). Skin toxicity was unanimously milder for hPBT compared to nPBT in A&P and ST locations (p = 0.018 and p = 0.025, respectively). No significant differences in QoL were observed in 97% of comparisons for QLQ-C30 scale except for loss of appetite in H&N patients (+33.3 for nPBT and 0 for hPBT, p = 0.02) and role functioning for A&P patients (0 for nPBT vs +16.7 hPBT, p = 0.003). For QLQ-HN35, 97.9% of comparisons did not reveal significant differences, with pain as the only scale varying between the groups (−8.33 vs −25, p = 0.016).ConclusionHypofractionated proton therapy offers non-inferior early safety and QoL as compared to normofractionated irradiation and warrants further clinical investigation.

Early quality of life outcomes after surgery in head and neck cancer survivors with EORTC QLQ-C30 and EORTC QLQ-HN35 in an Asian tertiary centre.

The objective of the study was to evaluate the quality of life (QOL) of head and neck cancer survivors after surgical treatment and to identify patients' main concerns. The study also aims to establish pre-treatment reference values particularly for the Asian patient. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and Head and Neck module (EORTC QLQ-HN35) were used for objective evaluation. Patients planned for elective surgery for head and neck cancers were enrolled in the study. The questionnaires were completed at pre-treatment and at 6 months after surgery. Results were compared with previously published reference values. One hundred forty patients completed both questionnaires. Locally advanced tumour and extent of surgery (tracheostomy (p<0.01), surgical flap (p<0.01)) were associated with lower global health scores. Adjuvant treatment was also a contributory factor (p<0.01). Dysphagia and social eating was a primary concern within our population. Surgical treatment of head and neck cancers is safe, but there is poor QOL in the early post-treatment period especially with eating. Previously published data suggested improvement after a year.

Early Quality of Life Outcomes After Robotic-Assisted Minimally Invasive and Open Esophagectomy

Minimally invasive esophagectomy may improve some perioperative outcomes over open approaches; effects on quality of life are less clear. A prospective trial of robotic-assisted minimally invasive esophagectomy (RAMIE) and open esophagectomy was initiated, measuring quality of life via the Functional Assessment of Cancer Therapy-Esophageal and Brief Pain Inventory. Mixed generalized linear models assessed associations betweenquality of life scores over time and by surgerytype. In total, 106 patients underwent open esophagectomy; 64 underwent minimally invasive esophagectomy (98% RAMIE). The groups did not differ in age, sex, comorbidities, histologic subtype, stage, or induction treatment (P= .42 to P > .95). Total Functional Assessment of Cancer Therapy-Esophageal scores were lower at 1 month (P < .001), returned to near baseline by 4 months, and did not differ between groups (P= .83). Brief PainInventory average pain severity (P= .007) and interference (P= .004) were lower for RAMIE. RAMIE had lower estimated blood loss (250 vs 350 cm3; P < .001), shorter length of stay (9 vs 11 days; P < .001), fewer intensive care unit admissions (8% vs 20%; P= .033), more lymph nodes harvested (25 vs 22; P= .05), and longer surgical time (6.4 vs 5.4 hours; P < .001). Major complications (39% for RAMIE vs 52% for open esophagectomy; P > .95), anastomotic leak (3% vs 9%; P= .41), and 90-day mortality (2% vs 4%; P= .85) did not differ between groups. Pulmonary (14% vs 34%; P= .014) and infectious (17% vs 36%; P= .029) complications were lower for RAMIE. RAMIE is associated with lower immediate postoperative pain severity and interference and decreased pulmonary and infectious complications. Ongoing data accrual will assess mid-term and long-term outcomes in this cohort.

Early Quality of Life Outcomes and Patient Satisfaction Metrics for MRI-Assisted Prostate Brachytherapy Patients

Early Quality of Life Outcomes and Patient Satisfaction Metrics for MRI-Assisted Prostate Brachytherapy Patients

Early Quality of Life Outcomes for MRI-Assisted Prostate Brachytherapy Patients

Early Quality of Life Outcomes for MRI-Assisted Prostate Brachytherapy Patients

Impact of Dehydrated Human Amniotic Membrane Allograft (AmnioFix®) on Continence and Potency Following Robot-Assisted Radical Prostatectomy

Abstract Introduction and Objectives: Allografts of dehydrated human amniotic membrane (dHAM) have cytokines and growth factors that have been shown to reduce the inflammatory response during tissue healing and promote nerve regeneration. This is the first reported study evaluating the early quality of life outcomes after placement of dHAM on the neurovascular bundle (NVB) during nerve-sparing robot-assisted radical prostatectomy (RARP). We demonstrate our technique in this video. Methods: From March 2013 to July 2014, 58 preoperatively potent (Sexual Health Inventory for Men score >19) and continent patients underwent full nerve-sparing RARP, followed by intraoperative dHAM placement at our institution. In each patient, the dHAM was wrapped around the NVB following the RARP procedure. We performed propensity matching using our prospective database in matched nongrafted patients from the same time period. Pre-, peri-, and postoperative outcomes were analyzed between patient groups, including the time to r...

Early quality of life outcomes in patients with prostate cancer managed by high‐dose‐rate brachytherapy as monotherapy

To evaluate the early quality of life outcomes in prostate cancer patients managed by high-dose-rate brachytherapy as monotherapy. A total of 51 patients with cT1c-T3aN0M0 prostate cancer treated between July 2007 and January 2010 were included in this study. The average age was 69 years, and the average initial serum prostate-specific antigen was 10.98 ng/mL. A total of 25, 18 and eight patients were considered to be low, intermediate and high risk, respectively. All patients received one implant of Ir-192 and seven fractions of 6.5 Gy within 3.5 days for a total prescribed dose of 45.5 Gy. For high-risk prostate cancer, neoadjuvant androgen deprivation therapy was carried out for at least 6 months, and continued after high-dose-rate brachytherapy. Quality of life outcomes were measured by using the International Prostate Symptom Score, the Functional Assessment of Cancer Therapy-Prostate and the International Index of Erectile Function Questionnaire. The oncological outcome was assessed by serum prostate-specific antigen and diagnostic imaging. Adverse events were also recorded. The Functional Assessment of Cancer Therapy-Prostate scores decreased for a few months after high-dose-rate brachytherapy, and recovered to pretreatment condition thereafter. The International Prostate Symptom Score significantly increased 2 weeks after treatment for each of its items and their sum, and it returned to baseline after 12 weeks. Sexual function decreased at 2 and 4 weeks, and recovered after 12 weeks. Severe complications were rare. Within a median follow up of 17.2 months, two patients showed a prostate-specific antigen recurrence. High-dose-rate brachytherapy for prostate cancer is a feasible treatment modality with acceptable toxicity and only a limited impact on the quality of life.

PTU-170 A comparison of the early quality of life outcomes between open and laparoscopic oesophagogastric resectional surgery

IntroductionThere is a paucity of data directly comparing health related quality of life (HRQL) between laparoscopic and open oesophagogastric resections. This study aims to evaluate differences between these groups in...

Comparison of early quality of life outcomes in autologous and allogeneic transplant patients

The Functional Assessment of Cancer Therapy-Bone Marrow Transplant measures quality of life (QOL) in SCT patients. Prior reports found mixed results regarding QOL differences among autologous and allogeneic SCT patients. In addition, there is a paucity of literature examining differences in QOL patterns over time between autologous and allogeneic patients. The present study examines differences in QOL between patients free of clinical depression undergoing autologous (n = 41) and allogeneic (n = 64) SCT during early stages of treatment. Despite clinical differences, autologous and allogeneic patients demonstrated similar changes in QOL. The exception was the Functional subscale which indicated worse QOL for allogeneic patients at discharge (F test = 4.61, df = 1, P < 0.05); allogeneic patients (Mean = 13.06, s.d. = 5.36) indicated they were less able to function at work and were less accepting of their illness than autologous patients (Mean = 16.02, s.d. = 6.73). There was a significant main effect for time on nearly all QOL subscales (P < 0.05) demonstrating decline during treatment and return to baseline by discharge; only the Social Well-Being scale did not significantly change over time. These results help to understand patients' response to SCT in the earliest stages and ultimately help identify patients at risk who could benefit from therapeutic interventions.

Absence of adverse early quality of life outcomes of radiation therapy in breast conservation therapy for early breast cancer

The New South Wales Breast Radiation Oncology Group has completed a prospective multicentre study of the impact of radiation therapy (RT) on acute toxicity and quality of life (QoL) in women with early breast cancer treated with breast conservation therapy. The patient group received adjuvant breast tangential RT after wide local excision of breast cancer. Acute toxicity and cosmesis was assessed quantitatively and qualitatively. European Organization of Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-30) and Perceived Adjustment to Chronic Illness Scale (PACIS) were the QoL instruments used. Of 175 women, 34.3% described lethargy leading to a significant disruption to normal activity during RT. At week 6, this had reduced to 7.5% reporting significant lethargy. No negative effects on QoL were noted over the time period of RT; EORTC demonstrated no difference (P = 0.79). PACIS recorded a significant improvement in functioning (P < 0.001) from baseline to week 6. Univariate analysis on potential predictive patient, tumour and treatment factors demonstrated an association of baseline pre-RT breast discomfort with worse lethargy (P = 0.03), EORTC (P < 0.01) and PACIS (P < 0.01) measures. This study confirms the minimal impact of RT on patient functioning at 6 weeks post-treatment.