EORTC QLQ-C30 Questionnaire Research Articles

Sleep quality and risk of obstructive sleep apnea among breast cancer survivors with and without lymphedema.

Breast cancer survivors (BCSs) tend to have sleep disturbances such as obstructive sleep apnea (OSA). However, limited evidence exists on the role of breast cancer-related lymphedema (BCRL) in sleep disturbances and OSA. Therefore, this study aimed to investigate the quality of sleep (QoS) and OSA risk among women with and without BCRL. The quality of life (QoL) was evaluated using the SF-12 and EORTC-QLQ C-30 questionnaires, while their sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The STOP-bang questionnaire (SBQ) was utilized to quantify OSA risk. Sleepiness was assessed using the Epworth Sleepiness Scale (ESS). Also, neck and waist circumference and the excessive volume in the affected limb were measured using a tape measure. The statistical analyses were performed using the SPSS 21.0 software. Seventy-one women with BCRL and 84 BCS without lymphedema were included. The comparison of PSQI, SBQ, ESS, SF-12, and EORTC QLQ-C30 questionnaires exhibited no significant difference between these two groups. The overnight snoring and average neck circumference were significantly higher in the BCRL group than in the control. The BCRL stage significantly correlated with neck circumference and SBQ total score. Additionally, the mean volume difference indicated a significant correlation with the ESS total score and both physical and mental summary components of the SF-12 questionnaire. The prevalence of sleep disturbances among BCSs with and without BCRL is high. Women with advanced stages of BCRL might be at high risk for OSA. Therefore clinical evaluation of BMI, neck circumference, and, snoring overnight should be emphasized among this population.

A comparative study between early and conventional intestinal stoma closure in a tertiary care institute

Background: Little is known about ideal time for stoma closure. Therefore, the aim of this study is to compare early versus conventional stoma closure following bowel surgery in terms of quality of life (QoL), length of hospital stay (LoH), and postoperative complications. Methods: This randomized controlled trial was conducted at a medical college affiliated teaching hospital from May 2023 to June 2024. The 116 patients undergoing bowel surgery with temporary stoma creation were randomized into early closure (3 weeks post-surgery) and conventional closure (8-12 weeks post-surgery) groups. Primary outcome was anastomotic leak rate. Secondary outcomes included other postoperative complications, LoH, and QoL assessed using the EORTC QLQ-C30 questionnaire. Results: There was no significant difference in anastomotic leak rates between early (6.9%) and conventional (12.1%) closure groups. Overall complication rates were similar (56.9% early vs 50% conventional). LoH did not differ significantly between groups. QoL scores were significantly higher in the early closure group, with 100% of patients achieving considerable improvement (EORTC score 26-36) compared to 79.3% in the conventional group (p<0.05). Conclusions: Early stoma closure is safe and feasible in appropriately selected patients, with no increased risk of anastomotic leak or other complications. It significantly improves QoL compared to conventional closure timing, without prolonging hospital stay. These findings suggest that early stoma closure may be a beneficial option for suitable patients following bowel surgery.

A 3-Arm case-matched analysis of anti-reflux reconstruction methods after laparoscopic proximal gastrectomy — Single tract jejunal interposition vs double tract reconstruction vs tube-like stomach reconstruction

BackgroundOwing to reportedly superior prognosis, proximal gastrectomy (PG) is expected to be an alternative to total gastrectomy for upper gastric cancer. However, limited data are available regarding the optimal anti-reflux reconstruction method after PG. This study aimed to evaluate the effect of laparoscopic PG with single-tract jejunal interposition (LPG-STJI), double-tract reconstruction (LPG-DTR), and tube-like stomach reconstruction (LPG-TLR) on surgical outcomes in patients with upper-third gastric cancer. MethodsUsing propensity score-matching (PSM) to adjust for baseline characteristics, a well-balanced cohort was established by matching each patient who underwent LPG-STJI as the study group with one who underwent LPG-DTR or LPG-TLR as the control group at a 1:1 ratio. This study was registered at ClinicalTrials.gov (No. NCT06347757). ResultsPSM yielded 62 matched pairs, with comparable demographic and tumor characteristics. The incidence of reflux esophagitis at one year postoperatively was significantly lower in the LPG-STJI and LPG-DTR groups than in the LPG-TLR group (11.3 % vs 9.7 % vs 24.2 %, P = 0.046), and fewer patients required proton-pump inhibitor administration (62.9 % vs 56.5 % vs 79.0 %, P = 0.024). In terms of nutritional status, the LPG-STJI group showed minimal changes in postoperative body weight and nutrition-related biochemical indices, approaching preoperative levels by the 12-month mark. In addition, the LPG-STJI group demonstrated a more favorable quality of life than the LPG-DTR and LPG-TLR groups, as assessed using the EORTC QLQ-C30 and QLQ-STO22 questionnaires. ConclusionLPG-STJI may be the preferred option for anti-reflux reconstruction, since it appears to reduce the occurrence of endoscopic reflux esophagitis and improve quality of life without raising surgical complications or compromising nutritional status. Further well-designed prospective studies are warranted to re-evaluate these findings.

Impact of a Physical Exercise and Health Education Program on Metabolic Syndrome and Quality of Life in Postmenopausal Breast Cancer Women Undergoing Adjuvant Treatment with Aromatase Inhibitors.

Background and Objectives: Adjuvant treatment with aromatase inhibitors (AIs) in breast cancer (BC) survivors can cause adverse effects such as metabolic syndrome (MS) (insulin resistance, central obesity, atherogenic dyslipidemia, and hypertension) associated with morbidity and premature mortality. We evaluate the effect of a multimodal program based on physical exercise and health education on MS and health-related quality of life (QoL) in postmenopausal women with BC under AIs. Methods: A total of 56 postmenopausal women, diagnosed with BC, aged 60 years or older (mean age 67.2 years) and on hormonal treatment with AIs, were included in the multimodal physical exercise and health education program, and evaluated before and after their participation. The assessment of the five criteria of the MS included the following: waist circumference, high blood pressure, fasting glucose, triglycerides, and high-density lipoprotein cholesterol. Two main instruments were used to evaluate the impact of the intervention on QoL: the EORTC QLQ C30 (questionnaire for cancers in general) and the EORTC QLQ BR23 (specifically for breast cancer patients). The EuroQol 5D (EQ-5D) was also used to compare these results. Results: The percentage of women meeting the MS criteria was 37.7% at baseline and fell to 15.1% at 3 months after the intervention (p = 0.02). The intervention significantly reduced hypertension (p < 0.001), central obesity (p < 0.001), and the concentration of triglycerides (p = 0.016). No significant changes were observed in fasting glucose and HDL concentration. A statistically significant improvement was found in QoL (on both the QLQ30 and BR23 scales). A multivariate regression model analysis identified marital status (being married) (95% CI: 1.728-131.615, p = 0.014), and percentage of attendance at health education sessions (95% CI: 1.010-1.211, p = 0.029) as positive predictive variables of improvement in MS. Conclusions: The implementation of multimodal, community-based programs of physical exercise and health education improve the prevalence of MS and specific criteria of MS and QoL in postmenopausal women with breast cancer receiving AI treatment.

The Effect of Vitamin D Supplementation on Quality of Life in Stage II-III Colorectal Cancer Patients Undergoing Adjuvant Chemotherapy: A Single-Blind, Randomized Controlled Trial.

Colorectal cancer is the third most common cancer with the second highest mortality worldwide in 2020. Adjuvant chemotherapy is given for stage II-III colorectal cancer. However, there are side effects that decrease the patient's quality of life. Several studies have found that vitamin D could reduce the side effects of chemotherapy, but studies at Hasan Sadikin Hospital have not been done. A study regarding the effect of vitamin D supplementation on the quality of life of stage II-III colorectal cancer patients undergoing adjuvant chemotherapy from May 2022 to April 2023 at Hasan Sadikin Hospital was conducted. A single-blinded, randomized controlled trial (RCT) with consecutive sampling was done at the digestive surgery outpatients. Data was taken from the medical record, history taking, and personal interviews. Quality of life was measured at the first, third, and sixth months after chemotherapy using the validated Indonesian version of the EORTC QLQ-C30 questionnaire. A total of 34 patients received vitamin D and 34 others received placebo. Serum vitamin D levels significantly increased (p < 0.001) in the intervention arm, from a median of 21.34 (5.26-29.95) to 27.92 (13.58-40.49). Meanwhile, it decreased in the placebo arm, from a median of 22.78 (8.3-29.93) to 21.37 (7.45-31.26). The patient's quality of life improved significantly after receiving vitamin D, compared with the placebo group on the third (median of 75.0 vs 45.83) and sixth (median of 83.33 vs 33.33) months after chemotherapy. Vitamin D consumption (10,000 IU/day) could improve the quality of life of colorectal cancer patients undergoing adjuvant chemotherapy.

Dynamics in Quality of Life of Breast Cancer Patients Following Breast-Conserving Surgery Versus Mastectomy: Protocol for Systematic Review and Meta-Analysis.

Background: Quality of life (QoL) may change in female patients with breast cancer over time due to its dynamic construct. Recent studies have provided statistics on the diverse predictors of QoL in breast cancer patients. Still, the literature findings on the prognostication of QoL are scarce. Objectives: With this meta-analysis, we aim to describe the dynamics of overall QoL and its dimensions: mental status, physical functioning, and social interactions. Methods: To reach this aim, we will systematically evaluate the peer-reviewed literature on QoL of women who have undergone either mastectomy or breast-conserving surgery. The proposed study will focus on, but not be limited to, the analysis of BIRS, FACT-B, and EORTC QLQ-C30 questionnaires, which are most commonly used in the assessment of the quality of life of cancer patients. Then, we will extract the following outcome measures: The participants' age, time since surgery, type of tumor removal procedure (mastectomy or breast-conserving surgery), breast reconstruction technique, mean value, and standard deviation in a QoL score. A random-effects model will then compute the pooled QoL and construct the trend lines for scores received from each diagnostic tool. The findings will be adjusted according to the reconstruction techniques and tumor removal surgery. Finally, we will model the QoL dynamics with a set of predictors identified in the extracted studies. Conclusions: The study findings may serve as a tool for stratifying female patients with breast cancer by the risk of significant reduction in QoL.

A06 - OGC LAsting Symptoms after Oesophageal Resectional Surgery (LASORS): Multicentre validation cohort study

Abstract Background Patients are living longer with the long-term morbidity of oncological and surgical therapies as oesophageal cancer outcomes improve. Existing symptomatology and quality of life tools are cumbersome and moreover not designed for the post-treatment survivorship setting. The LASER study identified six key symptoms thought to predict poor health-related quality of life. The current study aimed to validate this six-symptom LAsting Symptoms after Oesophageal Resection (LASOR) clinical tool, and assess its clinical utility. Method Between 2015 and 2019, patients from UK centres who underwent curative-intent oesophageal cancer treatment, and were disease-free at least one year postoperatively, were asked to complete LASOR, EORTC QLQ-C30 and QLQ-OG25 questionnaires. LASOR symptoms (low mood, reduced energy, thoracotomy pain, heartburn, diarrhoea, and bloating after eating) were correlated with EORTC HRQOL scores. Multivariable regression analysis identified symptoms associated with poor HRQoL. Receiver operating characteristic curve analysis was used to validate the LASOR tool. Results 263 patients, spanning a combination of surgical approaches (two-stage, three-stage, left thoracoabdominal, transhiatal), techniques (open, minimally invasive, hybrid), and disease stage, completed the questionnaires. Four of the six LASOR symptoms were associated with poor HRQoL: reduced energy (OR 2.13; 95% CI 1.20-2.87), low mood (OR 1.86; 95% CI 1.4503.12), diarrhoea (OR 1.48; 95% CI 1.06-2.05), and bloating after eating (OR 1.35; 95% CI 1.03-1.77). The LASOR tool produced an area under the curve of 0.85. Conclusion The six-symptom LASOR tool generated a reliable model for identification of patients with a poor HRQOL, with an overall diagnostic accuracy of over 80%. This is the first clinical symptom and quality of life tool to be validated in esophageal cancer patients post-curative treatment. The LASOR tool is straightforward to administer and acceptable to patients. Clinical utility lies both in identifying patients at risk of poor HRQoL and in planning survivorship services.

Health-related quality of life and associated factors in breast cancer patients in Abidjan (Ivory Coast)

ObjectiveThe main objective of this study was to assess health-related quality of life, and to investigate associated factors in breast cancer patients living in Ivory Coast. MethodsWe conducted a cross-sectional, descriptive and analytical study that took place from August 1, 2022 to October 31, 2022 in the Medical Oncology Department of the Treichville University Hospital. Seventy-six breast cancer patients participated in the study. Quality of life was assessed using the EORTC QLQ-C30 and QLQ-BR23 EORTC questionnaires. ResultsThe mean score for overall quality of life was 69.3 ± 21.9. Among the functional scales, emotional functioning, social functioning, sexual functioning, and sexual pleasure were the most affected, with 21.1 respectively; 23.7; 78.9, and 86.8 % of patients who had a bad score. Nausea/vomiting, loss of appetite, and hair loss are the symptoms that most affected the QoL of our patients with respectively 19.7; 21.1, and 52, % of patients who had a bad score. Financial difficulties also negatively affected the QoL of our patients (55.3 % had a poor score). The factors significantly associated with QoL deterioration were the metastatic stage, the presence of anemia, and the triple-negative immunohistochemical subtype. ConclusionThe overall quality of life of our patients was good. The psychosocial factors that were most affected in our patients were emotional functioning, social functioning, sexual functioning, and financial difficulties. The physical factors that most negatively affected the QoL of our patients were nausea/vomiting, loss of appetite and hair loss, presence of anemia, metastatic stage, and triple negative immunohistochemical type.

Quality of Life and Symptoms of Hospitalized Hematological Cancer Patients.

Patients with hematological malignancies undergo intensive treatment and prolonged hospitalization, thus having a variety of physical and psychosocial symptoms and worse quality of life (QOL). This study aimed to assess the QOL and investigate the symptoms of hospitalized hematological cancer patients. A cross-sectional study was conducted in the hematology clinics and day units of two general hospitals of Heraklion, Crete. Adult patients with hematological malignancy and an adequate understanding of the Greek language participated. A demographic questionnaire, the European Organization for Research and Treatment for Cancer quality assessment questionnaire (EORTC QLQ-C30), and the MD Anderson Symptom Inventory (MDASI) were used. The sample consisted of 120 patients-42.5% were women, with a mean age of 65.6 years. The mean time from diagnosis was 33 months. The global health status of QoL had an average value of 47.1. The highest levels of QOL were found in the subscale of cognitive function (72.8) and the lowest in the role function (46.1). For the EORTC QLQ-C30 symptoms scale, the lowest score was found in nausea-vomiting (11.0) and the highest in fatigue (59.1). In the MDASI, in part I (core symptoms), higher levels but also medium intensities were reported at fatigue (78.3%, mean 3.5), drowsiness (65.0, mean 3.3), and distress (65.8%, mean 2.8). In part II, enjoyment of life (85.8%, mean 5.1) had the highest, and relation with other people (67.5%, mean 3.7) had the lowest scores. The increase in the severity of the core symptoms (part I) was related to females (rho = 0.193, p <0.05) and comorbidities (rho = 0.220, p < 0.05). It was also associated with a significant decrease in all functional domains and increased fatigue (rho = 0.571, p < 0.05) in the EORTC QLQ-C30 questionnaire. The increased global health status was related to males (rho = -0.185, p < 0.05) and physical functioning with younger age (rho = -0.331, p < 0.05), higher education (rho = 0.239, p < 0.05), fewer months from diagnosis (rho = -0.199, p < 0.05), and low comorbidity (rho = -0.209, p < 0.05). Finally, multiple linear regression analysis revealed that the total average symptom score of the MDASI was the most significant factor influencing the global health status of the EORTC QLQ-C30 (β = -4.91, p < 0.001). The increased global health status of the EORTC QLQ C30 was not significantly related (p > 0.05) to the social characteristics of the patients, such as education or employment, which requires further validation. The QoL of hematological cancer patients significantly decreases during treatments due to a considerable number of symptoms that must be taken into consideration for high-quality, individualized care.

Change in Quality of Life in Patients with Advanced Rectal Cancer Between 2010 and 2022.

Advanced rectal cancer is one of the most common cancers worldwide and has a significant impact on public health. Because favorable and long-term survival has been achieved with multimodal therapy, patient quality of life is very important. The intention of this study was to assess patients' quality of life using various functioning and symptom scores from the years 2010 to 2022 and to examine changes over time. Data on health-related quality of life were collected from rectal cancer patients treated at the University Hospital Erlangen in Germany over a period of 13 years. The EORTC QLQ-C30 questionnaire and the rectal cancer-specific module QLQ-CR38 were completed in this study by a total of 516 patients. The questionnaires were collected before, during and at annual follow-up visits after treatment. Statistical significance was defined as p-values < 0.05 as well as a difference of 10 or more percentage points. The deterioration in scores is most pronounced immediately after radiochemotherapy, especially for pain (+19.8 pp), fatigue (+16.1 pp) and diarrhoea (+24.8 pp). One year after the end of therapy, most of the values are again comparable to or better than those of the German general population and only role functioning (-19.8 pp), social functioning (-24.6 pp), diarrhoea (-21.6 pp) and financial difficulties (-16.3 pp) are considerably worse. Some baselines deteriorate clearly over time from 2010 to 2022; these are role functioning (-23.9 pp), social functioning (-17.3 pp), body image (-15.2 pp), fatigue (+13.8 pp) and nausea and vomiting (+10.5 pp). An improvement in therapy in terms of a reduction in side effects and, thus, an improvement in quality of life over time could not be proven. The deterioration in individual scores over time does not appear to be a problem specific to rectal cancer patients, but rather, is associated with social developments or systemic healthcare factors in German society that are not directly related to oncological diseases.

Early Changes in Health-Related Quality of Life as a Biomarker of Survival in African Patients with HIV-Associated Kaposi Sarcoma.

Sub-Saharan Africa bears the largest public health burden of Kaposi sarcoma (KS), a leading cause of cancer mortality. Quality of life (QOL) assessments in cancer patients can provide information on prognosis beyond traditional biomarkers or biological measures. The prognostic value of QOL measures in patients with HIV-KS was evaluated. Prognostic associations of baseline QOL scores (by quartiles or thresholds for clinical importance) and changes in QOL scores (using minimum important difference) over the first 3 months of therapy were evaluated in 112 participants with HIV-KS randomised to receive ART, with or without chemotherapy. Cox's regression analysis assessed the prognostic contribution of QOL scores from the EORTC QLQ-C30 questionnaire. Survival curves were generated using the Kaplan-Meier method. Baseline QOL scores did not predict overall survival. The change in the 3-month QOL scores for the global health scale, fatigue, and pain domains was prognostic; the hazard ratios were 3.88 (95% CI 1.32-11.38, p = 0.01), 3.72 (95% CI 1.61-8.62, p = 0.00) and 5.96 (95% CI 2.46-14.43, p = 0.00), respectively. QOL assessments can provide useful prognostic information in patients with HIV-KS. Patients lacking meaningful improvement early into treatment represent a population at high risk of death.

Longitudinal assessment of health-related quality of life in Japanese patients with advanced urothelial carcinoma receiving immune check point inhibitors

Real-world data on health-related quality of life (HRQoL) in advanced urothelial carcinoma (aUC) receiving immune checkpoint inhibitors (ICIs) are limited. This study included 42 patients with aUC who received second-line or later pembrolizumab (n = 19), maintenance avelumab followed by first-line chemotherapy (n = 13), or adjuvant nivolumab after radical surgery (n = 10). Time-course changes in the domains and scales related to HRQoL were evaluated using the EORTC QLQ-C30, FACT-G, and SF-8 questionnaires during ICI therapy. Anchor-based approaches for minimally important differences were determined as ‘improved’, ‘stable’, and ‘deteriorated’. We found significant improvements after the start of pembrolizumab treatment on many scales. Almost none of the scales changed significantly in the avelumab and nivolumab groups. Approximately 80% of the pembrolizumab group had deteriorated social/family well-being in FACT-G. Approximately 60% of the patients in the avelumab group had deteriorated general health and vitality in SF-8. In the nivolumab group, none of the scales deteriorated in > 50% of the patients. Deterioration of physical function in the SF-8 was associated with occurrence of treatment-related adverse events ≥ grade 2 during ICI therapy (P = 0.013). Our findings demonstrated that majority of patients with aUC who received ICI therapy had a stable HRQoL, which was consistent with evidence from clinical trials.

Randomized Prospective Trial Comparing 2 Schedules of Hypofractionated Adjuvant Radiotherapy 3 Weeks Against One Week Fractionation Regimen in Females with Breast Cancer

Abstract Purpose Acceleration of radiotherapy in 5 fractions for breast cancer can reduce the burden of treatment especially in Low middle income countries. We report on acute toxicity after whole breast irradiation /chest wall irradiation ± nodal irradiation, QOL score &amp; Local recurrence incidence with ultra- hypofractionation schedule compared to modest hypofractionation protocol. Material and Methods Acute toxicity and health-related quality of life (HRQoL) of 101 patients, randomized between a 15- or 5-fractions schedule, were collected, using the RTOG acute toxicity scoring system, EORTC QLQ-C30 and BR23 questionnaire. The prescribed dose to the breast was either 15∗2.67 Gy (40.05 Gy) or 5∗5.2 Gy (26 Gy),60.1% of patients received tumor boost divided in both arms, with prescribed dose 5∗200cGy with 3D conformal radiotherapy technique. Inclusion criteria were: T1–T3 invasive breast cancer with or without axillary involvement (N0-N1&amp;N2) after breast conserving or modified radical surgery. Results A total of 101 patients included in the study. Median age was 53±10.29 years, most of the cases enrolled were stage II with 38 patients in arm 1 (26 Gy) and 26 in arm 2(40Gy),only 19 cases had stage III breast cancer with 14 cases included in arm 2,while nodal negative status reported in 49 cases. A significant difference was observed for acute skin toxicity after radiotherapy in favor of better tolerability for arm 1 (P value &amp;lt;0.0001),also patients in ultra hypofractionation arm reported significant lower score for symptom scale including breast pain (P value &amp;gt;0.0001),swollen breast (P value &amp;lt;0.0001),difficulty to move arm (P value=0.0001),swollen hand (P value &amp;lt;0.0001)and QOL deterioration was less also in ultra fractionation arm (P value &amp;lt;0.0001) and none of the cases in both arms had local recurrence till time of data collection (12-20 months follow up duration). Conclusion In this single institute study, acute toxicity of accelerated breast radiotherapy in 5 fractions over 5 days seems to compare favorably to hypofractionated breast radiotherapy in 15 fractions. Less radiation dermatitis, breast edema, breast pain, difficulty to move arm and swollen hand. Quality of life is also less disturbed and patients have a better future perspective, however longer time for follow up &amp;larger enrolled numbers needed to confirm non inferiority of this approach.

Assessment of Quality of Life in Advanced-Stage Lung Cancer Patients Using EORTC QLQ-C30 Questionnaire

Introduction: Quality of life (QoL) is a multidomain concept that assesses a person through health status, functional status, and symptoms. The patient's QoL is greatly reduced due to the course of disease, severity of symptoms, and side effects of chemotherapy treatment. This study aimed to assess the QoL in advanced lung cancer patients using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30). Methods: This descriptive and observational study was conducted at the Pulmonary Polyclinic, Prof. Dr. Chairuddin Panusunan Lubis Universitas Sumatera Utara (USU) Hospital from February to July 2024, with a cross-sectional design using patient medical records and EORTC QLQ-C30 questionnaire. The EORTC QLQ-C30 questionnaire was analyzed with a score formula and categorized as good, moderate, and bad. The sample was 100 lung cancer patients using a purposive sampling technique according to the criteria. Results: The results showed that almost all QoL was in the moderate category (80%). The general health status was mostly in the moderate category (61.66%), the functional status was mostly in the good category (75.35%), and the symptoms were in the moderate category (35.65%). In the functional scale, the role domain had the lowest mean, 69.99 ± 29.43. In the symptoms scale, the pain domain had the highest mean, 52.66 ± 29.43. Conclusion: The overall QoL of lung cancer patients was in the moderate category, lower than the healthy population. It needs to be improved, especially in the role domain, by providing supportive-expressive group therapy.

454. QUALITY OF LIFE AFTER ESOPHAGECTOMY WITH INTRATHORACIC VS CERVICAL ANASTOMOSIS: A NATIONWIDE COHORT STUDY

Abstract Background Transthoracic esophagectomy with either intrathoracic or cervical anastomosis is considered standard of care in patients with mid to distal esophageal or gastroesophageal junction (GEJ) cancer. Patients after esophagectomy will experience a deterioration in health-related quality of life (HR-QoL) after esophageal cancer surgery. Whilst some reports describe long-lasting deterioration, other reports show recovery of HR-QoL comparable with the general population after 2 years. The aim of this study was to investigate the difference in HR-QoL in patients after a transthoracic esophagectomy with either intrathoracic- or cervical anastomosis in a nationwide database. Methods A nationwide cohort study was performed combining data from two registries: Netherlands Cancer Registry (NCR) and Prospective Observational Cohort Study of Esophageal-Gastric Cancer Patients (POCOP). All patients after esophagectomy for mid/distal esophageal or GEJ cancer between 2015 and 2022 were included. HR-QoL was measured at baseline, 3, 6, 9, 12, 18, and 24 months postoperatively using EORTC QLQ-C30 and OG-25 questionnaires. Linear mixed models were used to assess the mean score difference between patients with intrathoracic and cervical anastomosis. A difference of 10 points or more was considered clinically relevant. Adjustments were made for potential confounders (age, gender, ASA classification). Results Of the 4269 registered patients in the NCR, in 1274 patients at least one questionnaire was available. Of these patients 346 underwent an esophagectomy with cervical - and 928 with intrathoracic anastomosis. Patients after esophagectomy with cervical anastomosis reported statistically significant more problems in the following categories: dysphagia, couching, trouble eating with others and swallowing saliva during the first 3 months, choked when swallowing and trouble talking during the first 12 months postoperatively. In all other categories no significant difference was found. Only trouble talking at the 3-month time point was considered as a clinically relevant difference. Conclusion Although the intrathoracic anastomosis is associated with significantly better HR-QoL in several categories, only trouble talking at 3 months postoperatively was considered clinically relevant. Overall HR-QoL was comparable for esophageal cancer patients after an esophagectomy with either a cervical or intrathoracic anastomosis.

Self-perceived cognitive impairment in the first year after breast cancer and the identification of at-risk patients

PurposeThis study investigated self-reported clinically relevant cognitive impairment of breast cancer patients in routine clinical care and assessed factors associated with new-onset clinically relevant cognitive impairment. MethodsCognitive functioning was assessed before start of any treatment (T0) and at 6 (T6) and 12 (T12) months after diagnosis. Cognitive functioning (CF) was measured on a scale of 0–100 with the EORTC QLQ-C30 questionnaire, and the EORTC pre-defined threshold for clinical importance. Multivariable logistic regression analyses was used to identify factors associated with new-onset clinically relevant cognitive impairment at T6 ((CF > 75 at T0 and CF < 75 at T6 and T12) or (CF > 75 at T0 and T6 and <75 at T12)). ResultsPre-treatment, 21% of patients reported clinically relevant cognitive impairment. At T12, percentage was 32%; 20% of patients reported new-onset clinically relevant cognitive impairment at T6 and/or T12. New-onset clinically relevant cognitive impairment was associated with chemo(immuno)therapy and impairment in role and emotional functioning. Younger patients and patients receiving chemo(immuno)therapy were more likely to report new-onset clinically relevant cognitive impairment post treatment. ConclusionOne in five breast cancer patients reported clinically relevant cognitive problems before start of treatment. This percentage further increased within the first year, particularly among patients treated with chemo(immuno)therapy. One in five patients reported new-onset clinically relevant cognitive impairment. Ultimately, these patients may benefit from systematic monitoring and potential referral to interventions.

Nationwide cost-effectiveness and quality of life analysis of minimally invasive distal pancreatectomy

BackgroundThis study analyzed the Quality of Life (QoL) and cost-effectiveness of laparoscopic (LDP) versus robotic distal pancreatectomy (RDP).MethodsConsecutive patients submitted to LDP or RDP from 2010 to 2020 in four high-volume Italian centers were included, with a minimum of 12 months of postoperative follow-up were included. QoL was evaluated using the EORTC QLQ-C30 and EQ-5D questionnaires, self-reported by patients. After a propensity score matching, which included BMI, gender, operation time, multiorgan and vascular resections, splenic preservation, and pancreatic stump management, the mean differential cost and Quality-Adjusted Life Years (QALY) were calculated and plotted on a cost-utility plane.ResultsThe study population consisted of 564 patients. Among these, 271 (49%) patients were submitted to LDP, while 293 (51%) patients to RDP. After propensity score matching, the study population was composed of 159 patients in each group, with a median follow-up of 59 months. As regards the QoL analysis, global health and emotional functioning domains showed better results in the RDP group (p = 0.037 and p = 0.026, respectively), whereas the other did not differ. As expected, the median crude costs analysis confirmed that RDP was more expensive than LDP (16,041 Euros vs. 10,335 Euros, p < 0.001). However, the robotic approach had a higher probability of being more cost-effective than the laparoscopic procedure when a willingness to pay more than 5697 Euros/QALY was accepted.ConclusionRDP was associated with better QoL as explored by specific domains. Crude costs were higher for RDP, and the cost-effectiveness threshold was set at 5697 euros/QALY.

Partial pancreatoduodenectomy versus total pancreatectomy in patients with preoperative diabetes mellitus: Comparison of surgical outcomes and quality of life.

To reduce perioperative risks among patients with a preoperative diabetes mellitus (DM) a total pancreatectomy (TP) might be a alternative to pancreatoduodenectomy (PD). This study aimed to compare the postoperative quality of life (QoL) of patients with preoperative DM undergoing PD or TP. A single-centre retrospective study was conducted, all consecutive patients with preoperative DM undergoing PD or TP between 2011 and 2023 were identified in a prospective database. The primary endpoint was QoL, prospectively assessed using EORTC QLQ-C30 questionnaires at 3, 6, and 12months after surgery and then annually until death. Secondary endpoints were morbidity and mortality. Seventy-one patients were included, 17 after TP and 54 after PD. Insulin-dependent DM occurred in 21 (39%) of the PD patients. QoL was worse after TP, especially in terms of physical functioning (-31.7 points; 95% CI: -50.0 to -13.3; P < 0.001), role functioning (-41.3 points; 95% CI: -61.3 to -21.3; P < 0.001), emotional functioning (-27.5 points; 95% CI: -50.4 to -4.6; P = 0.019), fatigue symptoms (20 points; 95% CI: 2.7 to 37.4; P = 0.024) and pain symptoms (30.2 points; 95% CI: 4.1 to 56.3; P = 0.024). The rates of postoperative major complications (29% vs. 35%; P = 0.853) and mortality (11% vs. 7%; P = 0.857) were similar between TP and PD. Postoperative morbidity and mortality were comparable between PD and TP, however QoL is significantly lower after TP. Importantly, patients with preoperative DM have a 60% chance of remaining noninsulin-dependent after PD.

THE EFECTIVENESS OF PROVIDING OREM SELF CARE BASED HEALTH EDUCATION ON IMPROVING THE QUALITY OF LIFE OF BREAST CANCER PATIENTS

Introduction: Breast cancer can cause many problems, both psychosocial and physical problems, which can reduce the patient's quality of life. Therefore, an intervention is needed that can improve their quality of life. This study aims to analyze the benefits of the intervention of implementing a self-care orem-based education system to improve the quality of life of breast cancer chemotherapy patients at Graha Amerta Surabaya. Method: This study used a pre-experimental design with a one-group pre-posttest design method on 60 breast cancer patients treated with chemotherapy who were taken using a consecutive sampling technique. The quality of life instrument was measured using the EORTC QLQ-C30 questionnaire. Data were analyzed using the Wilcoxon signed rank statistical test. Results: The results of the study showed that after being given the intervention to implement an educational system based on self-care orem, the results showed that the majority of 39 (65.0%) respondents had a quality of life in the good category and 21 (35.0%) respondents had a quality of life in the sufficient category. The results of the Wilcoxon statistical test analysis on the quality of life of breast cancer patients produced a significance value of 0.000. Conclusion: There is a significant effect of implementing an OREM self-care system education on improving the quality of life of breast cancer chemotherapy patients at Graha Amerta Surabaya. It is hoped that nurses can implement interventions to implement educational systems based on self-care orem for breast cancer patients in hospitals so that patient independence can increase so that the patient's quality of life can be optimal.

Analyzing quality of life after low anterior resection for rectal cancer.

Rectal cancer is one of the most common cancers worldwide that imposes high costs on patients and the healthcare system while also having a significant impact on the patient's quality of life (QoL). We aimed to assess the QoL of rectal cancer patients undergoing lower anterior resection (LAR) and evaluate potential confounding factors. In this cross-sectional study, we included patients undergoing neo-adjuvant chemotherapy followed by LAR, diverting ileostomy, and adjuvant chemotherapy. Six months after stoma reversal, QoL was assessed using a cancer-specific core questionnaire EORTC QLQ-C30 and also a colorectal cancer module EORTC QLQ-CR29. Linear and quantile regression models were used to examine associations of QoL and patients' demographical and clinical features. The study population comprised 210 patients with an average age of 61.9 ± 11.0 (range: 37-85) and 112 (53.3%) male patients. The higher tumor stage increases the QoL of patients by reducing diarrhea, loss of appetite, defecation problems, and stool frequency. Based on the linear regression analysis, a farther distance of the anastomosis from the anal verge (AV) was correlated with lower symptom scores and higher QoL. Also, at the 75th percentile cut-off of the QLQ-CR29 scores, a higher N stage of the tumor was correlated with higher QoL based on functional subscale (coefficient = 3.032, P = 0.016). QoL of patients after LAR for rectal cancer is significantly associated with the distance of the anastomosis site from the AV.