Quality Of Life Expectancy Research Articles

P0745URINE TIMP-2 AND IGFBP-7- NEW BIOMARKERS OF KIDNEY INJURY IN MULTIPLE MYELOMA PATIENTS

Abstract Background and Aims Urine tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) seem to be novel kidney injury related biomarkers, especially in tubular cells damage. Free light chains (FLCs) are associated with renal failure in multiple myeloma (MM) and appear to have a prognostic value and indicate stages in MM. The aim of the study was to investigate the correlation between new biomarkers and acclaimed parameters of renal failure and markers of MM stages and prognosis. Method The study included 124 patients with MM in the mean age of 66 +/- 10 years, with median time from MM diagnosis of 30 (lower; upper quartile 14; 63) months. There were 7(6%) patients with smoldering MM, 80(65%) with ISS stage 1, 22 (18%)with stage 2 and 15 (12%) with stage 3 MM. Mean eGFR was 71 +/- 25 ml/min/1.73 m2 and 30 (24%) patients had eGFR <60 ml/min/1.73 m2. The examined parameters included creatinine, urine NGAL, urine and serum cystatin-C, urine and serum FLC kappa and lambda, serum monoclonal protein, IGFBP-7 and TIMP-2 in serum and urine, WBC count, IL-6, NT-proBNP, serum albumin and β2-microglobulin. IGFBP-7 and TIMP-2 in serum were measured in a subgroup of 73 patients, including 26 (36%) with eGFR <60 ml/min/1.73 m2. The association between between these parameters were determined by multivariate stepwise regression analysis. The p-value <0.05 was considered statistically significant. Results Except for urine cystatin C and urine TIMP-2, all the studied markers were higher among patients with eGFR <60 ml/min/1.73m2: urine NGAL: 23.3 (9.2; 68.4) vs. 7.8 (3.9; 16.8) ng/ml; p<0.001; urine IGFBP-7: ; serum IGFBP-7: 86.2 (29.3; 125.0) vs. 33.7 (13.2; 61.5) ng/ml; p=0.003; and serum TIMP-2: 628 (498; 663) vs. 431 (360; 614) ng/ml; p=0.011, respectively. Serum and urine IGFBP-7 and urine NGAL were also higher among patients with ISS grade 3 comparing to the rest of the group (p=0.008, p<0.001 and p=0.033, respectively). Patients with smoldering myeloma did not differ from those with symptomatic disease. No differences in studied markers were observed between patients with newly diagnosed MM in comparison to those who had been treated with one or more schemes. Only urinary IGFBP-7 differed between patients who were on treatment at the time of samples’ collection (median ng/ml) in comparison to untreated (median ng/ml; p=0.009). No differences in TIMP-2 and IGFBP-7 levels in patients divided according to MM state were observed (remission vs stable vs progressive disease). In whole studied group, urinary markers of tubular injury were interrelated: cystatin C correlated positively with NGAL monomer (R=0.22; p=0.016), IGFBP-7 (R=0.26; p=0.004) and TIMP-2 (R=0.22; p=0.016), NGAL correlated positively with IGFBP-7 (R=0.39; p<0.001) and TIMP-2 (R=0.25; p=0.005), and IGFBP-7 correlated positively with TIMP-2 (R=0.31; p<0.001). In multiple linear regression, the negative correlation between urinary IGFBP-7 and eGFR was independent of other studied urinary markers of tubular injury. However, after adjustment for confounders (age, smoldering versus symptomatic MM, ISS, LDH, remission versus stable or progressive disease, and the concentrations of involved urine light chains), only urinary NGAL was independently associated with eGFR. Conclusion Urine TIMP-2 and IGFBP-7 may be useful in investigating tubular renal damage in patients with chronic kidney injury among patients with MM. This can lead to noninvasive biomarker-targeted diagnostic interventions and contribute to early beginning of treatment that may improve life expectancy quality of life in MM.

Curb Your Enthusiasm: Definitions, Adaptation, and Expectations for Quality of Life in ICU Survivorship

Curb Your Enthusiasm: Definitions, Adaptation, and Expectations for Quality of Life in ICU Survivorship

When Anxiety Actually Hides an Overdose of Missing. The Therapeutic Approach of a Transgenerational Journey

Many people suffer from anxiety and panic attacks, statistics showing that 1 in 3 people have their lives affected because of these worrying and annoying symptoms. One of the most common anxiety disorders observed in general medical practice and in the general population is the generalized anxiety disorder. In about 85% of cases, generalized anxiety does not appear alone, but is accompanied by other psychological problems, of which the most common are: depression, other anxiety disorders, substance abuse, digestive problems, etc. The patient diagnosed with Generalized Anxiety Disorder (GAD) usually has suffered from severe anxiety and worries about several different areas of their life for at least six months. It occurs in 5-9% of the population, and the incidence is twice as high in women as in men. Generalized anxiety usually begins in adolescence or early adulthood. GAG is caused by several factors: 30%-50% of it can be genetic in nature, but it also can be caused by experiences during childhood, recent stressful life events, unrealistic expectations about others and oneself, conflicts in relationships, alcohol consumption, coping skills and other factors (Ciubara et al., 2018). Studies show that the anxiety levels in the general population have risen over the past 50 years - probably due to declining social cohesion affecting communities, unrealistic expectations for quality of life, excessive focus on negative news, and other factors, social and cultural aspects.

The Perception of Urban Residents on Creation and Management of Community Gardens

This study analyzed the factors affecting urban residents' expectations and participation in community gardens to present basic data of guidelines for community garden management. Urban citizens valued the necessity of community gardens overall, especially residents with outdoor gardens. The experience of private gardens was important in perceiving the need for community gardens, which are public spaces. The creation of community gardens had high expectations for social aspects such as improving quality of life, health promotion, and community revitalization. In particular, residents living in individual housing have high expectations for revitalization of the community, and community gardens can be a mediator for forming and maintaining local communities. Through this, the citizens' perception on the role and function of the garden as a community space could be examined. Expectations for quality of life, health promotion, and community revitalization are factors affecting the necessity of community garden. Participation was high in the creation and management of the community garden, and the necessity of community gardens, expectation for community revitalization, and expectation for environmental purification are factors that affect participation in the management of community gardens. The amount of donations that the residents are willing to pay for community garden management was KRW 75,222 /year on average. Overall, residents with higher need for community gardens and higher social expectation showed higher participation. Urban citizens have high expectations for community gardens, and they perceive the importance of social aspects more than personal aspects such as community revitalization and quality of life. As a strategy for increasing community involvement, it is necessary to set up the processes, determine participants' composition and roles, and establish a system to promote participation. Considering welfare aspects such as community revitalization and improvement of residents’ quality of life, motivation and administrative support for participation in the creation and management of community gardens will serve as important factors. Key words: community revitalization, donation, participation

The Determinants of M-Health Adoption in Developing Countries: An Empirical Investigation.

The potential benefit of mobile health (M-Health) in developing countries for improving the efficiency of health care service delivery, health care quality, and patient safety, as well as reducing cost, has been increasingly recognized and emphasized in the last few years. Limited research has investigated the facilitators and barriers for the adoption of M-Health in developing countries to secure successful implementation of the technology. To fill this knowledge gap, we propose an integrative model that explains the patient's adoption behavior of M-Health in developing countries grounded on the unified theory of acceptance and use of technology, dual-factor model, and health belief model. We empirically tested and evaluated the model based on data collected using a survey method from 280 patients living in a developing country. Partial least squares (PLS-SEM) technique was used for data analysis. The results showed that performance expectancy, effort expectancy, social influence, perceived health threat, M-Health app quality, and life quality expectancy have a direct positive effect on patients' intention to use M-Health. The results also showed that security and privacy risks have a direct negative effect on the patient's intention to use M-Health. However, resistance to change was found to have an indirect negative effect on patients' intention to use M-Health through the performance expectancy. The research contributes to the existing literature of health information systems and M-Health by better understanding how technological, social, and functional factors are associated with digital health applications and services use and success in the context of developing countries. With the widespread availability of mobile technologies and services and the growing demand for M-Health apps, this research can help guide the development of the next generation of M-Health apps with a focus on the needs of patients in developing countries. The research has several theoretical and practical implications for the health care industry, government, policy makers, and technology developers and designers.

Beyond Survival in Solid Organ Transplantation: A Summary of Expert Presentations from the Sandoz 6th Standalone Transplantation Meeting, 2018.

Beyond Survival in Solid Organ Transplantation: A Summary of Expert Presentations from the Sandoz 6th Standalone Transplantation Meeting, 2018.

Quality of life versus length of life considerations in cancer patients: A systematic literature review.

ObjectivePatients with cancer face difficult decisions regarding treatment and the possibility of trading quality of life (QoL) for length of life (LoL). Little information is available regarding patients' preferences and attitudes toward their cancer treatment and the personal costs they are prepared to exchange to extend their life. The aim of this review is to determine the complex trade‐offs and underpinning factors that make patients with cancer choose quality over quantity of life.MethodsA systematic review of the literature was conducted using MeSH terms: cancer, longevity or LoL, QoL, decision making, trade‐off, and health utility. Articles retrieved were published between 1942 and October 2018.ResultsOut of 4393 articles, 30 were included in this review. Older age, which may be linked to declining physical status, was associated with a preference for QoL over LoL. Younger patients were more likely to undergo aggressive treatment to increase survival years. Preference for QoL and LoL was not influenced by gender, education, religion, having children, marital status, or type of cancer. Patients with better health valued LoL and inversely those with poorer physical status preferred QoL.ConclusionBaseline QoL and future expectations of life seem to be key determinants of preference for QoL versus LoL in cancer patients. In‐depth studies are required to understand these trade‐offs and the compromises patients are willing to make regarding QoL or LoL, especially in older patients with naturally limited life expectancy.

The History of Decompressive Craniectomy in Traumatic Brain Injury.

Decompressive craniectomy consists of removal of piece of bone of the skull in order to reduce intracranial pressure. It is an age-old procedure, taking ancient roots from the Egyptians and Romans, passing through the experience of Berengario da Carpi, until Theodore Kocher, who was the first to systematically describe this procedure in traumatic brain injury (TBI). In the last century, many neurosurgeons have reported their experience, using different techniques of decompressive craniectomy following head trauma, with conflicting results. It is thanks to the successes and failures reported by these authors that we are now able to better understand the pathophysiology of brain swelling in head trauma and the role of decompressive craniectomy in mitigating intracranial hypertension and its impact on clinical outcome. Following a historical description, we will describe the steps that led to the conception of the recent randomized clinical trials, which have taught us that decompressive craniectomy is still a last-tier measure, and decisions to recommend it should been made not only according to clinical indications but also after consideration of patients' preferences and quality of life expectations.

The Influence of Social, Economic, and Environmental Factors on Health Quality in ASEAN

There is a serious problem in term of health over the past 70 years in developing countries, one of them is the quality of life expectancy. Even it has continued to increase but still there is a gap between developed and developing countries. The gap in life expectancy is assumed to be rooted in the differences in socio-economic conditions of different social groups. Health matter, especially in the ASEAN region, is an important issue that must be addressed. Therefore, this research has an objective to explore the influence of social, economic and environmental factors on health quality in ASEAN. The variables in this research are the impacts of population, urbanization, food production, GDP, health spending, and CO2 emissions on health in 9 ASEAN countries in the period from 2001-2015. The analysis method is a panel of regression data. The findings of the research are that all the independent variables have a significant effect on Health quality in ASEAN.

Investigating the Effect of Self-Care Training on Life Expectancy and Quality of Life in Patients with Gastrointestinal Cancer under Radiotherapy

Objective:A huge amount of the efforts made by health teams is dedicated to caring for cancer patients. This study has aimed to investigate the effect of self-care training on life expectancy and quality of life (QOL) in patients with gastrointestinal cancer who were under radiotherapy.Methods:In this clinical trial, 50 patients were selected using the block randomization method. The intervention was performed at Ayatollah Khansari Hospital in Arak, Iran. The patients in the intervention group received three sessions of face-to-face training. The data collection tools included Schneider's Life Expectancy Questionnaire and EORTC QOLQ-C30. Data were analyzed by SPSS version 23.Results:In the control group, 16 were male (64%) and 9 female (36%), and in the intervention group, 14 were male (56%) and 11 were female (44%). Before the intervention, the two groups were homogenous regarding all variables. After the intervention, the mean of QOL was 67 ± 22.62 in the intervention group and 56 ± 18.55 in the control group (P < 0.05). In examining the different dimensions of QOL, improvement in all functional dimensions was observed in the intervention group. After the intervention, the mean score of life expectancy showed a significant difference (P < 0.05) between the intervention group (39.52 ± 5.26) and the control group (31.6 ± 7.13).Conclusions:It was found that self-care training improved the QOL and life expectancy of patients with gastrointestinal cancer who were under radiotherapy. Therefore, self-care training is recommended to improve the QOL and the life expectancy of cancer patients.

Immunotargeted therapy in melanoma: patient, provider preferences, and willingness to pay at an academic cancer center.

New melanoma therapies have shifted the expectations of patients and providers. Evaluating the impact of treatment characteristics may enhance shared decision making. A survey, including a discrete choice experiment, was utilized to evaluate perceived trade-offs of different melanoma treatments and to estimate out-of-pocket (OOP) willingness-to-pay (WTP) thresholds (January 2016 to March 2016). Participants included patients with melanoma at Huntsman Cancer Institute and their cancer care providers. Stakeholder focus groups were conducted to identify treatment attributes. Descriptive and comparative statistics and multinomial logit model were used to evaluate responses. Response rates were 41.9% (N = 220) for patients and 37.7% (N = 20) for providers. Immunotherapy and targeted therapy attributes considered important by participants were overall survival, immunotherapy-related side effects, and skin toxicities. Patients and providers had significantly different views of quality-of-life expectations, anxiety toward melanoma, trust to make treatment decisions, sharing concerns about treatment, time to discuss treatment, understanding OOP costs, and willingness to undergo/recommend treatment (half of the patients would undergo treatment if it was effective for > 24 months). Among patients, the average monthly OOP WTP for combination immunotherapy with nivolumab + ipilimumab was $ 2357 and for BRAF/MEK inhibitor was $1648. Among providers, these estimates were $ 2484 and $1350, respectively. Discordance existed between patients' and providers' perceptions about quality of life expectations, degree of anxiety, sharing of opinions, and progression-free survival. Our study suggests that patients and providers exhibit a higher OOP WTP for combination immunotherapy treatment compared with BRAF/MEK inhibitors, influenced predominately by overall survival expectations.

Salvage Treatment Options after Failed Primary Treatment of Hypopharyngeal Cancer.

Recurrent hypopharyngeal cancer (rHPC) is a high-risk fatal disease associated with poor prognosis and high risk of complications in patients who are suitable to undergo salvage treatment. The treatment of such patients should be managed by a dedicated multidisciplinary team, most frequently a tertiary centre. and with the agreement of the patient. Close follow-up is crucial in achieving early detection and being able to treat the recurrence with curative intention. When persistent or recurrent disease is suspected, cross-sectional computed tomography imaging (CT) and positron emission tomography-CT scanning followed by panendoscopy with biopsies are the initial steps that need to be done in order to confirm diagnosis and accurate staging. The current treatment modality, which results in the best survival outcomes for rHCP is surgery. For most suitable patients, total pharyngolaryngectmy remains the best surgical modality, although open partial surgery OPS and transoral surgery are options for a small number of patients who have recurrences following treatment of an early stage disease. Free tissue transfer flaps or pedicled myocutaneous flaps will be necessary for most patients to reconstruct the excised pharynx. When making such a treatment plan it is most important to explain to each patient of the likely outcome both in terms of quantity and quality of life expectation. Many factors that are likely to increase the risk of treatment complications have been reported and are best anticipated and avoided. It is essential to perform a thorough preoperative assessment, follow a tried and trusted protocoled surgical plan and to have established enhanced recovery pathways for postoperative care that is available.

A systematic review of validated tools assessing functional and aesthetic outcomes following fibula free flap reconstruction of the mandible.

Segmental mandibulectomy impairs health-related quality of life (QoL), by altering speech, mastication, swallowing, and facial aesthetics. Fibula free flap (FFF) used for mandible reconstruction is known to improve outcomes; however, minimal information exists in the literature regarding patient-reported outcomes. We aim to assess how current studies evaluate patient perception following segmental mandibulectomy and FFF mandible reconstruction. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a search was conducted for publications involving FFF mandible reconstruction from 2005 to 2017 using PubMed, Cochrane, EMBASE, Web of Science, and PsychInfo. Of 2212 articles identified initially, only 7 studies were deemed suitable. Six studies used the University of Washington Quality of Life questionnaire, 3 Oral Health Impact Profile, and 1 used European Organization for Research and Treatment of Cancer Head and Neck (EORTC-H&N35). There is a paucity of information in published reports on QoL outcomes following mandible reconstruction with FFF. In the era of patient-centered health care, observations warrant attention from researchers for physician-assessed patient-reported measures to factor in QoL expectation during surgical decision-making about the choice of reconstruction.

Investigating the Effect of Mindfulness-Based Training on Psychological Status and Quality of Life in Patients with Breast Cancer

Cancer poses substantial challenges to both physical and mental health of patients. On the other hand, breast cancer is one of the most common cancers among Iranian women. Therefore, the present study was conducted to investigate the effect of mindfulness-based training on psychological status and quality of life (QoL) of patients with breast cancer living in Ilam, Iran. This quasi-experimental study was performed on 66 patients diagnosed with breast cancer. The patients assigned into two groups of experimental and control. Experimental group received mindfulness-based group training through eight 90-min sessions. Sessions were conducted twice a week and were completed within 1 month. The research tools included a QoL questionnaire (WHOQOL-BREF), Schneider’s life expectancy questionnaire, and the depression anxiety stress scale (DASS-21). The questionnaires were completed before and during the interviews with the patients 2 months after intervention. Data were analyzed using SPSS (version 16) and running descriptive and analytical statistics. Before the intervention, there was no significant difference between he experimental and control groups considering QoL, life expectancy, depression, anxiety, and stress (p>0.05). However, after the intervention, the patients in the experimental group reported higher QoL and life expectancy and less severe depression, anxiety, and stress (p < 0.05). Considering the positive effect of mindfulness-based training on the psychological status and QoL of patients with breast cancer, we recommend health nurses conduct mindfulness-based training for patients receiving clinical care services.

Refractory Intracranial Hypertension: The Role of Decompressive Craniectomy.

Raised intracranial pressure (ICP) is associated with worse outcomes after acute brain injury, and clinical guidelines advocate early treatment of intracranial hypertension. ICP-lowering therapies are usually administered in a stepwise manner, starting with safer first-line interventions, while reserving higher-risk options for patients with intractable intracranial hypertension. Decompressive craniectomy is a surgical procedure in which part of the skull is removed and the underlying dura opened to reduce brain swelling-related raised ICP; it can be performed as a primary or secondary procedure. After traumatic brain injury, secondary decompressive craniectomy is most commonly undertaken as a last-tier intervention in a patient with severe intracranial hypertension refractory to tiered escalation of ICP-lowering therapies. Although decompressive craniectomy has been used in a number of conditions, it has only been evaluated in randomized controlled trials after traumatic brain injury and acute ischemic stroke. After traumatic brain injury, decompressive craniectomy is associated with lower mortality compared to medical management but with higher rates of vegetative state or severe disability. In patients with stroke-related malignant hemispheric infarction, hemicraniectomy significantly decreases mortality and improves functional outcome in adults <60 years of age. Surgery also reduces mortality in those >60 years, but results in a higher proportion of severely disabled survivors compared to medical therapy in this age group. Decisions to recommend decompressive craniectomy must always be made not only in the context of its clinical indications but also after consideration of an individual patient's preferences and quality of life expectations. This narrative review discusses the management of intractable intracranial hypertension in adults, focusing on the role of decompressive craniectomy in patients with traumatic brain injury and acute ischemic stroke.

Editorial: Stopping Pancreatic Cyst Surveillance?

The management of patients with pancreatic cysts, especially presumed branch duct intraductal papillary mucinous neoplasms (BD-IPMNs), remains a challenge. BD-IPMNs carry a very low risk of malignancy and occur in predominantly older individuals who often die from causes not related to their pancreatic disease. The specific decision to stop surveillance of presumed low risk BD-IPMNs (those without either worrisome features (WF) or high risk stigmata (HRS)) is controversial, and needs to balance the real risk of malignancy or developing malignancy and IPMN-related mortality, with the patient's life expectancy, quality of life expectations, and mortality from non-pancreatic-related causes. With improved life expectancy, improved survival from non-pancreatic malignancies, rising health costs, and growing detection of ever smaller presumed BD-IPMNs, this issue is becoming ever more critical.

Abstract 048: Decision Regret in Patients With Durable Ventricular Assist Devices

Background: Patients presented with the option of undergoing ventricular assist device (VAD) therapy are by definition very sick, and often in crisis. They are typically told that they have a high likelihood of dying in the next year without VAD. Though most patients have improved functional status and quality of life (QoL), repeated hospitalizations and potentially catastrophic complications in the post implant period can be burdensome. Objective: To assess for decisional regret or ambivalence about VAD implant. Methods: During a 3 year pilot program of outpatient palliative care embedded in a cardiology/CT surgery clinic, all post VAD implant patients were referred to palliative care as part of routine care. As part of their assessment, they were administered a survey consisting of a 5 question decision regret scale that has been validated for a wide range of treatment decision making, and has correlated well with decision satisfaction and decisional conflict. The results were entered into a QI database. On a scale of 0 (no regret) to 100 (regret), scores &gt;25 were considered to reflect significant ambivalence about their decision to have VAD implant. Scores between 10-25 were defined as mild ambivalence. Patients were also administered the PHQ-9 depression inventory. Results: 129 unique patients were seen as outpatients over a period of 49 months. 102 (79%) completed decision regret surveys. Of these, the majority (64/102, 63%) scored 0, 7/102 (7%) scored &gt; 25, and another 29/102 (28%) scored between 10 and 25. The average age of the patients scoring &gt; 25 on the scale was 46, compared with the average age of 55 of the whole cohort. Of those that expressed some degree of ambivalence (n=36) about their decision, 11/35 (31%) met criteria for at least moderate depression on the PHQ-9, compared with 18% for the whole cohort. Though 26% of the total cohort had VADs as BTT, 20/36 (44%) ambivalent patients and 3/7 (57%) very ambivalent patients were living with their VAD as BTT. The percent of patients expressing ambivalence &lt; or &gt; 6 months post implant was equivalent (33%). Conclusions: In this preliminary study, as expected, a majority of patients do not regret their decision. However a significant minority expressed some ambivalence about this decision, and a small number expressed significant ambivalence. Ambivalence was more common in those who are younger, those with VAD as BTT, and in patients with depression. Ambivalence is likely a marker for patients whose expectations for quality of life with VAD are not being met. It is important to recognize pre-implant that patients have different decision-making needs, and that managing their expectations may be a key component of helping them to adjust post VAD. It is also important to identify those patients who would benefit from more post implant support to optimize their quality of life.

Patients' Adoption of WSN-Based Smart Home Healthcare Systems: An Integrated Model of Facilitators and Barriers

Background: Patient-centered care emphasizes care coordination and communication through active involvement of patients, their families, physicians, and other professionals to improve decision making. Smart telecommunication technology and the Internet of Things, such as wireless-sensor-network-based smart home healthcare systems (WSN-SHHS) facilitate communication and collaboration among these different roles. Research problem: Despite the great potential of such systems to improve the quality and experience, and lower the cost of health care, the technology has not been widely adopted partly due to an inadequate understanding of user expectations, needs, and preferences. This study addresses facilitators and barriers with regard to WSN-SHHS adoption by identifying important sociotechnical, cognitive, affective, and contextual factors. Research questions: What are the main facilitators and barriers of patients' adoption of WSN-SHHS? How can we contextualize a generic technology adoption model for WSN-SHHS that takes into account unique characteristics of the domain? Literature review: We surveyed the literature in WSN-SHHS research and application, technology adoption theories, and the pleasure-arousal-dominance emotional state model. We discovered that WSN-SHHS research has focused on technology development but has given little attention to the issue of patients' adoption. Methodology: We used a mixed method design that combined an interview and survey over two studies. Participants were recruited from home healthcare agencies in the eastern US. In semistructured interviews, we collected data from 15 home healthcare patients and medical professionals, and analyzed the data using Kvale's approach. In our online- and paper-based surveys, we analyzed the data from 140 respondents using partial least square. Results and conclusions: We identified several new constructs in relation to WSN-SHHS adoption, including human detachment concerns, privacy concerns, life-quality expectancy and cost concerns. In addition, we confirmed the constructs from the general adoption model. Based on the findings of the qualitative study, the researchers created a research model. The quantitative study provided empirical support for the model, which has substantial predictive power accounting for more than half of the variance in WSN-SHHS adoption. In particular, our findings reveal that human detachment concerns rather than performance expectancy is the strongest predictor of patients' adoption of WSN-SHHS.

OA14.06 The Role of a Multi-Disciplinary Team Approach to Early Rehabilitation and Symptom Management in Thoracic Oncology

In the United Kingdom thoracic cancer is mainly diagnosed in an older population, who generally have significant co-morbidities, and advanced stage disease. Due to this, they experiences high levels of disease burden, both physical and psychological, impacting on individuals’ functional independence and quality of life (QoL). The national governing bodies, such as NICE and LCA, recommend that all patients should have access to an Holistic Needs Assessment (HNA) and rehabilitation services. At Guy’s And St Thomas' NHS Foundation Trust (GSTFT) we have developed a multi-disciplinary team (MDT), consisting of Dietetics, Occupational Therapy (OT) and Physiotherapy (PT), who are present within the outpatient thoracic oncology clinics and aim to address the rehabilitation and supportive care needs of all patients. All new thoracic oncology patients attending outpatient consultant lead clinics at GSTFT were offered an HNA, in order to identify their individual concerns/needs. The assessments are completed by the MDT and individual intervention plans created. Over a three-month period, January to March 2015, data was collected on patient's diagnosis, treatment offered, treatment intent, symptom concerns, QoL indicators, onward MDT referrals and mortality. 82 patients completed the assessments, of these 85% reported unmet needs/concerns. The main tumor types seen were Adenocarcinoma, Squamous cell carcinoma, mesothelioma and small cell lung cancer. Of those reporting symptoms the most common were; breathlessness (55%), fatigue (52%), reduced appetite (43%), weight loss (41%), pain (37%), emotions/mood (33%). sleep concerns (33%), and reduced mobility (32%). 69 patients had onward referrals to supportive care services. The most common referrals were; OT (65%), PT (60%), Dietitian (43%), and patient information (38%). 66% of patients were provided with on the spot MDT intervention. Providing thoracic oncology patients access to an MDT service on their initial oncology visit, has enabled early identification of the key symptoms this patient group experience, as well as the need for allied health services. This has supported the role of early rehabilitation as being integral to improving patient's level of symptom burden and QoL. Moving forward it would be beneficial to do a comparative study of the symptoms and intervention needs of this patient group over a longitudinal analysis, with the aim of showing the impact of early rehabilitation on patient's QoL, survivorship, and life expectancy.

Abstract P5-15-15: Survival duration and quality of life expectations in patients with metastatic breast cancer: The role of treating oncologists in influencing patients' expectations of therapy – A questionnaire-based study

Abstract Introduction Breast cancer is the most common female cancer in the United States. Median survival for patients with metastatic disease is 18 to 24 months with some patients enjoying long term survival1,2. Multiple studies have documented that cancer patients tend to overestimate survival duration and that their understanding of their prognosis is insufficient. This is due in part to vague doctor- patient communication, Lack of information concerning the effect of alternative therapies on overall outcomes and Lack of patient understanding of the likely outcomes of their disease3,4. Objectives: To investigate the expectations of patients with metastatic breast cancer in regards to survival duration and quality of life from different treatments, and identify oncologists’ role in influencing these expectations. Methods: Electronic charts were used to select women diagnosed with metastatic breast cancer between the age of 35 and 80 treated at the cancer center at the University of Toledo medical center. A detailed questionnaire evaluated the level of comfort between patients and oncologist/s regarding survival duration and quality of life. The questionnaire also evaluated patients’ expectations from treatments they received, are receiving. Results: 40 patients were identified. 26 out of which completed the survey. The majority of patients ( 65-77 % ) expected different treatments for their metastatic disease to prolong their survival for more than 5 years. 57 to 66% of our patients stated that their expectations regarding QOL outcomes from different treatments changed after discussion with their oncologist. 7% of our patients stated that their oncologist does not spend enough time explaining what to expect from the treatment in regards to quality of life outcomes. Conclusion: Our study highlights the importance of communication between oncologists and metastatic breast cancer patients and the influential role they play in patients’ expectations regarding survival and quality of life. It is also important to recognize patients’ concerns and spend enough time explaining expected outcomes from different treatments. Although this could be challenging in busy practices, short interval follow up visits and re-addressing those concerns along with involving the palliative care team early could be a potential steps for improvement.