Follow-up Health-related Quality Of Life Research Articles

Impact of preoperative LUTS on Health-Related Quality of Life following Radical Prostatectomy – A propensity score matched longitudinal study

To assess the impact of preoperative lower urinary tract symptoms (LUTS) on long-term health-related quality of life (HRQOL) up to 10 years after radical prostatectomy (RP) for prostate cancer (PC). Within our prospective institutional database of 6487 patients treated with RP for PC (2008- 2020), 2727 patients with preoperative LUTS (IPSS score of ≥8) were identified. A 1:1 propensity-score matched analysis of 3056 men (n=1528 LUTS, n=1528 no LUTS) was conducted. Primary endpoint was HRQOL (based on EORTC QLQ-C30 and PR25). Linear regression models tested the effect of preoperative LUTS on the net change in general HRQOL (p<0.05). Median follow-up was 48 months. Preoperative mean global health status (GHS) score (67.4 vs. 75.7) was significantly lower in the LUTS cohort (p<0.001). Post-RP the difference in general HRQOL between the LUTS cohort and the no-LUTS cohort became smaller (65.7 vs. 67.8), however remaining statistically significant (p=0.037). In long-term follow-up, general HRQOL was comparable between both subcohorts (p-range 0.716 - 0.876). Multivariable linear regression analysis revealed increased preoperative IPSS as an independent predictor for increased perioperative improvement of IPSS (p<0.001) CONCLUSIONS: For patients undergoing RP, preoperative LUTS were associated with a postoperative improvement of HRQOL outcomes. In long-term follow-up HRQOL was comparable to patients without preoperative LUTS. Hence RP is an efficient option to treat PC as well as LUTS in those patients.

The Impact of Unplanned Reoperation Following Adult Spinal Deformity Surgery: A Prospective Longitudinal Cohort Study with 5-Year Follow-up.

The long-term impact of reoperations following adult spinal deformity (ASD) surgery is still poorly understood. Our aim was to identify the relationship between unplanned reoperation and health-related quality of life (HRQoL) gain at 2 and 5 years of follow-up. We included patients enrolled in a prospective ASD database who underwent surgery ≥5 years prior to the start of the study and who had 2 years of follow-up data. Adverse events (AEs) leading to an unplanned reoperation, the time of reoperation occurrence, invasiveness (blood loss, surgical time, hospital stay), and AE resolution were assessed. HRQoL was measured with use of the Oswestry Disability Index, Scoliosis Research Society-22, and Short Form-36. Linear models controlling for baseline data and index surgery characteristics were utilized to assess the relationships between HRQoL gain at 2 and 5-year follow-up and the number and invasiveness of reoperations. The association between 5-year HRQoL gain and the time of occurrence of the unplanned reoperation and that between 5-year HRQoL gain and AE resolution were also investigated. Of 361 eligible patients, 316 (87.5%) with 2-year follow-up data met the inclusion criteria and 258 (71.5%) had 5-year follow-up data. At the 2-year follow-up, 96 patients (30.4%) had a total of 165 unplanned reoperations (1.72 per patient). At the 5-year follow-up, 73 patients (28.3%) had a total of 117 unplanned reoperations (1.60 per patient). The most common cause of reoperations was mechanical complications (64.9%), followed by surgical site infections (15.7%). At the 5-year follow-up, the AE that led to reoperation was resolved in 67 patients (91.8%). Reoperation invasiveness was not associated with 5-year HRQoL scores. The number of reoperations was associated with lesser HRQoL gain at 5 years for all HRQoL measures. The mean associated reduction in HRQoL gain per unplanned reoperation was 41% (range, 19% to 66%). Reoperations resulting in no resolution of the AE or resolution with sequelae had a greater impact on 5-year follow-up HRQoL scores than reoperations resulting in resolution of the AE. A postoperative, unplanned reoperation following ASD surgery was associated with lesser gain in HRQoL at 5 years of follow-up. The association did not diminish over time and was affected by the number, but not the magnitude, of reoperations. Resolution of the associated AE reduced the impact of the unplanned reoperation. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Investigating the effects of frailty on six-month outcomes in older trauma patients admitted to UK major trauma centres: a multi-centre follow up study

BackgroundPre-injury frailty is associated with adverse in-hospital outcomes in older trauma patients, but the association with longer term survival and recovery is unclear. We aimed to investigate post discharge survival and health-related quality of life (HRQoL) in older frail patients at six months after Major Trauma Centre (MTC) admission.MethodsThis was a multi-centre study of patients aged ≥ 65 years admitted to five MTCs. Data were collected via questionnaire at hospital discharge and six months later. The primary outcome was patient-reported HRQoL at follow up using Euroqol EQ5D-5 L visual analogue scale (VAS). Secondary outcomes included health status according to EQ5D dimensions and care requirements at follow up. Multivariable linear regression analysis was conducted to evaluate the association between predictor variables and EQ-5D-5 L VAS at follow up.ResultsFifty-four patients died in the follow up period, of which two-third (64%) had been categorised as frail pre-injury, compared to 21 (16%) of the 133 survivors. There was no difference in self-reported HRQoL between frail and not-frail patients at discharge (Mean EQ-VAS: Frail 55.8 vs. Not-frail 64.1, p = 0.137) however at follow-up HRQoL had improved for the not-frail group but deteriorated for frail patients (Mean EQ-VAS: Frail: 50.0 vs. Not-frail: 65.8, p = 0.009). There was a two-fold increase in poor quality of life at six months (VAS ≤ 50) for frail patients (Frail: 65% vs. Not-frail: 30% p < 0.009). Frailty (β-13.741 [95% CI -25.377, 2.105], p = 0.02), increased age (β -1.064 [95% CI [-1.705, -0.423] p = 0.00) and non-home discharge (β -12.017 [95% CI [118.403, 207.203], p = 0.04) were associated with worse HRQoL at follow up. Requirements for professional carers increased five-fold in frail patients at follow-up (Frail: 25% vs. Not-frail: 4%, p = 0.01).ConclusionsFrailty is associated with increased mortality post trauma discharge and frail older trauma survivors had worse HRQoL and increased care needs at six months post-discharge. Pre-injury frailty is a predictor of poor longer-term HRQoL after trauma and recognition should enable early specialist pathways and discharge planning.

Health-related quality of life in men with oligometastatic prostate cancer following metastases-directed stereotactic body radiotherapy: Real-world data from the E2-RADIatE OligoCare cohort

ObjectiveTo evaluate the impact of metastases-directed stereotactic body radiotherapy (SBRT) on health-related quality of life (HRQoL) in men with oligometastatic prostate cancer (PCa) using real-world data from the OligoCare cohort. Materials and methodsOligoCare is a pragmatic, observational cohort designed to assess the impact of metastases-directed SBRT on patients with oligometastatic disease (OMD). We report an interim analyses of the secondary endpoint HRQoL, assessed using the EORTC QLQ-C30, within six months of metastases-directed SBRT for oligometastatic disease in men with PCa among the first 1600 registered patients. HRQoL data collection was optional within the OligoCare cohort. To compare HRQoL between baseline and first follow-up assessment, a Wilcoxon signed-rank test was used. A multiple linear regression model was used to explore the HRQoL associations with predefined factors. ResultsOut of the 1600 registered patients, 658 were treated for oligometastatic PCa, of which 233 had baseline QoL data and 132 patients had both baseline and follow-up HRQoL data. At baseline, most patients had a WHO performance status of 0 or 1 (87 %), were de-novo oligometastatic (79 %), had one metastasis (90 %), and had a good overall global health status (mean 80.81, SD16.11, IQR 75–92). 51 % received hormonal therapy as concomitant systemic treatment. Patients with comorbidities as assessed by the Charlson Comorbidity index had a worse global health status at baseline (-4.88, 95 % CI:-9.35, −0.42). No clinically meaningful significant difference in global health status was observed at first assessment following SBRT (median 3.0 months) compared with baseline (mean difference 2.27, 95 % CI:-1.54, 6.08). Upon evaluating the proportions, meaningful clinically important differences (a 10-point or more difference) was observed in, 17 % and 11 % of the patients reporting deterioration and improvement of global health status, respectively. ConclusionMetastases-directed stereotactic body radiotherapy had no negative impact on global HRQoL within the first six months after treatment.

Longitudinal evaluation of health-related quality of life after removal of high-risk melanoma in a setting where adjuvant therapy is not available.

To evaluate health-related quality of life (HRQoL) of people with a high-risk skin melanoma after completion of the primary surgical treatment over time, as well as, to identify factors associated with better HRQoL at the beginning and at the end of follow-up. The study included subjects with histopathologically confirmed high-risk skin melanoma in clinical stages IIC, IIIA, IIIB, and IIIC, in whom clinical and radiographic signs of the disease were not confirmed after primary surgical treatment. The HRQoL was evaluated using Short Form-36 (SF-36) after completion of primary surgical treatment (start of follow-up) and after 6 to 12months (end of follow-up). A total of 71 people completed SF-36 at both points in time. There were no significant differences between the initial and the follow-up total HRQoL score (t = 1.118; p = 0.267). At the start of follow-up, having fewer depressive symptoms, better functional status and lower vitamin D serum levels were associated with a better total HRQoL score. At the end of follow-up, having lower Breslow depth and being employed at the start of follow-up, having fewer depressive symptoms and lower C-reactive protein (CRP) serum levels at follow-up, and not developing metastases over follow-up were associated with a higher total HRQoL scores. The HRQoL of people with high-risk melanoma did not change in the year following the complete removal of the tumor. However, presence of depressive symptoms and metastases seem to have the strongest impact on poorer quality of life after surgery.

Cognition, Emotional States and Health-Related Quality of Life in Awake Craniotomy for Glioma: A Case Series

Awake craniotomy is an effective procedure for optimizing the onco-functional balance of resections in glioma. However, limited data exists on the cognition, emotional states, and health-related quality of life (HRQoL) of patients with glioma who undergo awake craniotomy. This study aims to describe (1) peri-operative cognitive function and emotional states in a multi-lingual Asian population, (2) associations between peri-operative cognitive function and follow-up HRQoL, and (3) associations between pre-operative emotional states and follow-up HRQoL. This is a case series of 14 adult glioma patients who underwent awake craniotomy in Singapore. Cognition was assessed with the Montreal Cognitive Assessment and the Repeatable Battery for the Assessment of Neuropsychological Status, emotional states with the Depression, Anxiety and Stress Scale-21 Items, and HRQoL using the EuroQol-5D-5L, the EORTC QLQ-C30, and the EORTC QLQ-BN20. Patients with better pre-operative cognitive scores on all domains reported better HRQoL. Better post-operative immediate memory and language scores were associated with better HRQoL. Moderate pre-operative depression scores and mild and moderate pre-operative stress scores were associated with poorer HRQoL compared to scores within the normal range. Mild pre-operative anxiety scores were associated with better HRQoL compared to scores within the normal range. This descriptive case series showed that patients with higher pre-operative cognitive scores reported better follow-up HRQoL, while patients who reported more pre-operative depressive and stress symptomatology reported worse follow-up HRQoL. Future analytical studies may help to draw conclusions about whether peri-operative cognition and emotional states predict HRQoL on follow up.

PD15-02 LONG-TERM HEALTH RELATED QUALITY OF LIFE IN PROSTATE CANCER PATIENTS REQUIRING RADIOTHERAPY AFTER RADICAL PROSTATECTOMY

PD15-02 LONG-TERM HEALTH RELATED QUALITY OF LIFE IN PROSTATE CANCER PATIENTS REQUIRING RADIOTHERAPY AFTER RADICAL PROSTATECTOMY

Comorbidities and predictors of health-related quality of life in Dravet syndrome: A 10-year, prospective follow-up study.

Dravet syndrome (DS) is a severe developmental and epileptic encephalopathy, leading to reduced health-related quality of life (HRQOL). Prospective outcome data on HRQOL are sparse, and this study investigated long-term predictors of HRQOL in DS. One hundred thirteen families of SCN1A-positive patients with DS, who were recruited as part of our 2010 study were contacted at 10-year follow-up, of which 68 (60%) responded. The mortality was 5.8%. Detailed clinical and demographic information was available for each patient. HRQOL was evaluated with two epilepsy-specific instruments, the Impact of Pediatric Epilepsy Scale (IPES) and the Epilepsy & Learning Disabilities Quality of Life Questionnaire (ELDQOL); a generic HRQOL instrument, the Pediatric Quality of Life Inventory (PedsQL); and a behavioral screening tool, the Strength and Difficulties Questionnaire (SDQ). Twenty-eight patients were 10-15 years of age (0-5 years at baseline) and 40 were ≥16 years of age (≥6 years at baseline). Patients 0- to 5-years-old at baseline showed a significant decline in mean scores on the PedsQL total score (p= .004), physical score (p< .001), cognitive score (p= .011), social score (p= .003), and eating score (p= .030) at follow-up. On multivariate regression, lower baseline and follow-up HRQOL for the whole cohort were associated with worse epilepsy severity and a high SDQ total score (R2 = 33% and 18%, respectively). In the younger patient group, younger age at first seizure and increased severity of epilepsy were associated with a lower baseline HRQOL (R2 = 35%). In the older age group, worse epilepsy severity (F= 6.40, p= .016, R2 = 14%) and the use of sodium-channel blockers were independently associated with a lower HRQOL at 10-year follow-up (F= 4.13, p= .05, R2 = 8%). This 10-year, prospective follow-up study highlights the significant HRQOL-associated cognitive, social, and physical decline particularly affecting younger patients with DS. Sodium channel blocker use appears to negatively impact long-term HRQOL, highlighting the importance of early diagnosis and disease-specific management in DS.

361P Tucatinib plus trastuzumab in patients (Pts) with HER2-positive metastatic colorectal cancer (mCRC): Patient-reported outcomes (PROs) from ph II study MOUNTAINEER

HER2 amplification/overexpression (HER2-positive [HER2+]) is reported in ∼3-5% of all pts with mCRC. Treatment strategies for mCRC focus on prolonging survival, delaying tumor progression, and maintaining health-related quality of life (HRQoL). Tucatinib (TUC) is a highly selective, HER2-directed, tyrosine kinase inhibitor. Results from the MOUNTAINEER (NCT03043313) study demonstrated that dual HER2 inhibition with TUC and trastuzumab (T) in pts with HER2+ RAS WT mCRC is well tolerated with durable clinical benefit. Here we report the impact of TUC + T on HRQoL in pts from MOUNTAINEER. MOUNTAINEER is a global, multi-center, open-label, phase 2 trial that enrolled pts with HER2+ RAS WT mCRC previously treated with fluoropyrimidine, oxaliplatin, irinotecan, and anti-VEGF mAb. Overall, 117 pts were enrolled or randomized to receive TUC + T (cohorts A [n=45] and B [n=41]) or TUC monotherapy (cohort C [n=31]). HRQoL was assessed with EQ-5D-5L and EORTC QLQ-C30 for cohorts B and C. Cohort A was not assessed for HRQoL. Questionnaires were administered at predose on Cycle 1 Day 1 (C1 D1), C1 D8, C1 D15, then every D1 of C2-4 and every 3 following cycles until end of treatment. HRQoL data for cohorts B and C were analyzed using descriptive statistics. Thirty-seven pts in cohort B and 28 pts in cohort C had ≥1 dose of study treatment and completed baseline and at least 1 follow-up HRQoL assessment. For both cohorts, the mean changes from baseline during the treatment period for EORTC QLQ-C30 generally remained stable across all scales, including global health status/QoL and functional domains. Descriptive analyses showed some fluctuations in observed individual domain scores; however, global health status/QoL remained stable over time. EQ-5D-5L VAS scores also remained similar over time. HRQoL was maintained for pts treated with TUC + T or TUC monotherapy throughout the treatment period. These results, together with the primary efficacy and safety data from MOUNTAINEER, further support the overall tolerability profile of TUC + T and suggest this regimen may be an important treatment option for pts with HER2+ mCRC.

Recurrent Clostridioides difficile infection worsens anxiety-related patient-reported quality of life

BackgroundClostridioides difficile infection (CDI) is associated with high recurrence rates impacting health-related quality of life (HrQOL). However, patient-reported data are lacking particularly in the outpatient setting. We assessed changes in HrQOL over time in patients treated with bezlotoxumab at US infusion centers and determined clinical factors associated with HrQOL changes.MethodsThe HrQOL survey was conducted in adult patients with CDI, who received bezlotoxumab in 25 US outpatient infusion centers. The survey was adapted from the Cdiff32 instrument to assess anxiety-related changes to HrQOL and completed on the day of infusion (baseline) and at 90 days post bezlotoxumab (follow-up). Demographics, disease history, CDI risk factors, and recurrence of CDI (rCDI) at 90-day follow-up were collected. Changes in HrQOL scores were calculated and outcomes assessed using a multivariable linear regression model with P < 0.05 defined as statistically significant.ResultsA total of 144 patients (mean age: 68 ± 15 years, 63% female, median Charlson index: 4, 15.9% rCDI) were included. The overall mean baseline and follow-up HrQOL scores were 26.4 ± 11.5 and 56.4 ± 25.0, respectively. At follow-up, this score was significantly higher for patients who had primary CDI (34.5 ± 21.7) compared to those with multiple rCDI (24.7 ± 21.0; P = 0.039). The mean HrQOL change at follow-up was significantly higher for patients without rCDI (34.1 ± 28.8 increase) compared to patients with rCDI (6.7 ± 19.5 increase; P < 0.001), indicating improvement in anxiety.ConclusionsUsing the Cdiff32 instrument, we demonstrated that HrQOL worsened significantly in patients with further rCDI. These findings support the use of Cdiff32 in assessing CDI-related humanistic outcomes.

Explainable Analytics to Predict the Quality of Life in Patients with Prostate Cancer from Longitudinal Data

ABSTRACT Prostate cancer (PCa) is a complicated cancer with high level of unexplained variability that might affect the patient’s health-related quality of life (HRQoL). Using 2670 patients’ information with 433 measures per patient, our objective is to identify the minimal set of important variables which can predict 1-year follow-up HRQoL for PCa patients while adding interpretability to the proposed model. We address three problems of dimension reduction, prediction, and interpretability by first developing deep neural networks on top of a clustering algorithm to extract minimal set of important variables of baseline visit. Second, we build a model to predict a 1-year follow-up of HRQoL for PCa patients using the extracted important baseline variables. Third, we utilize Bayesian networks method to provide insights into the proposed model results to discover the relationship between patients’ baseline variables and their 1-year follow-up satisfaction. The results support the use of the proposed machine-learning technique as an essential tool in identifying potential baseline variables for predicting 1-year HRQoL. Furthermore, our approach to interpret the findings will help to establish guidelines for a better shared decision-making platform for PCa patients.

803 QUALITY OF LIFE IN OLDER TRAUMA PATIENTS AFTER INJURY: FINDINGS FROM THE FRAILTY IN MAJOR TRAUMA STUDY (FRAIL-T)

Abstract Introduction Major trauma is a substantial health burden for older patients with a significant proportion having ongoing functional and psychological difficulties long after their injury. Frailty impacts adversely on outcome after trauma but the longer term effects are unknown. This study aimed to determine differences in health related quality of life (HRQoL) and change in dependence for frail and non-frail patients aged 65 or over discharged from Major Trauma Centres (MTCs) following injury. Methods This prospective multi-centre study recruited from five UK MTCs between June 2019 and March 2020. Eligible patients were aged 65 or over requiring ‘trauma team activation’ and admitted to hospital. Follow-up data was collected via questionnaire at two time points: on day of hospital discharge and at 6 months. Primary outcome at follow-up was patient reported health-related quality of life (HRQoL) using the EQ-5D-5L measure. Results Data were analysed from 181 patients. 54 died in the follow-up period and HRQoL data was available for 127 patients. Of these 16% were identified as frail during the trauma hospital admission using the Clinical Frailty Scale. On average, frail patients were older (82 years) compared to non-frail (77 years). HRQoL was rated similarly at discharge in both groups (Non-Frail: 60, Frail: 65, p = 0.137), but at follow-up non-frail patients reported improvement whilst those who were frail had deteriorated from the discharge base-line (Non-Frail: 70, Frail: 50, p = 0.01). At 6 months post injury, half of the frail cohort (49%) were more dependent on care than pre-trauma compared to less than a third of non-frail patients (29%). Conclusion Patients who were frail in-hospital had worse HQRoL than non-frail patients 6 months after discharge from hospital, with increased dependence. Understanding the impact of injury on quality of life is important in planning for, and supporting, the ongoing care of frail older trauma patients.

Longitudinal association between physical activity and health-related quality of life among community-dwelling older adults: a longitudinal study of Urban Health Centres Europe (UHCE)

BackgroundPhysical activity (PA) may play a key role in healthy aging and thus in promoting health-related quality of life (HRQoL). However, longitudinal studies on the association between PA and HRQoL are still scarce and have shown inconsistent results. In this study, we aimed to examine the longitudinal association between frequency of moderate PA and physical and mental HRQoL. Secondly, to assess the association between a 12-month change in frequency of moderate PA and HRQoL.MethodsA 12-month longitudinal study was conducted in Spain, Greece, Croatia, the Netherlands, and the United Kingdom with 1614 participants (61.0% female; mean age = 79.8; SD = 5.2) included in the analyses. Two categories of the self-reported frequency of moderate PA including 1) ‘regular frequency’ and 2) ‘low frequency’ were classified, and four categories of the change in frequency of moderate PA between baseline and follow-up including 1) ‘continued regular frequency’, 2) ‘decreased frequency’, 3) ‘continued low frequency’ and 4) ‘increased frequency’ were identified. Physical and mental HRQoL were assessed by the 12-Item Short-Form Health Survey (SF-12).ResultsThe frequency of moderate PA at baseline was positively associated with HRQoL at follow-up. Participants with a continued regular frequency had the highest HRQoL at baseline and follow-up. Participants who increased the frequency of moderate PA from low to regular had better physical and mental HRQoL at follow-up than themselves at baseline. After controlling for baseline HRQoL and covariates, compared with participants who continued a regular frequency, participants who decreased their frequency had significantly lower physical (B = -4.42; P < .001) and mental (B = -3.95; P < .001) HRQoL at follow-up; participants who continued a low frequency also had significantly lower physical (B = -5.45; P < .001) and mental (B = -4.10; P < .001) HRQoL at follow-up. The follow-up HRQoL of participants who increased their frequency was similar to those who continued a regular frequency.ConclusionsMaintaining or increasing to a regular frequency of PA are associated with maintaining or improving physical and mental HRQoL. Our findings support the development of health promotion and long-term care strategies to encourage older adults to maintain a regular frequency of PA to promote their HRQoL.

Pain, Sleep, and Health-Related Quality of Life after Multidisciplinary Intervention for Chronic Pain.

Multidisciplinary pain-management programs have the potential to decrease pain intensity, improve health-related quality of life (HRQOL), and increase sleep quality. In this longitudinal prospective cohort study, the aim was to investigate the long-term effects of multidisciplinary pain rehabilitation interventions in Iceland. More precisely, we (a) explored and described how individuals with chronic pain evaluated their pain severity, sleep, and HRQOL at pre-treatment and at one-year follow-up and (b) examined what predicted the participants’ one-year follow-up HRQOL. Seventy-nine patients aged 20–68 years, most of whom were women (85%), responded. The participants scored their pain lower at one-year follow-up (p < 0.001). According to their response, most of them had disrupted sleep, mainly because of pain. One year after the treatment, more participants slept through the night (p = 0.004), and their HRQOL increased. Higher pre-treatment mental component summary (MCS) scores and having pursued higher education predicted higher MCS scores at one-year follow-up, and higher pre-treatment physical component summary (PCS) scores predicted higher PCS scores at one-year follow-up. Sleep problems, being a woman, and having children younger than 18 years of age predicted lower MCS scores at one-year follow-up. These findings are suggestive that patients should be examined with respect to their mental status, and it could be beneficial if they received some professional support after completing the intervention.

P104. Identifying C2 slope and T1 slope thresholds for optimal functional and clinical outcomes in cervical deformity correction

<h3>BACKGROUND CONTEXT</h3> Surgical correction of cervical deformity (CD) has been associated with superior alignment and functional outcomes. It has not yet been determined whether baseline and postoperative T1 slope and C2 slope correlate with health-related quality of life (HRQL) metrics and radiographic complication. <h3>PURPOSE</h3> To determine the impact of T1S and C2S deformity severity on HRQL metrics and DJK development in operative cervical deformity patients. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> A total of 119 CD patients. <h3>OUTCOME MEASURES</h3> Radiographic parameters; HRQLs. <h3>METHODS</h3> Included: Operative CD patients with UIV above C7 and with pre-(BL) and up to 2-year (2Y) postop radiographic/HRQL data. Cervical deformity was defined as meeting at least one of the following radiographic parameters: C2-C7 lordosis < -15°, TS-CL >35°, segmental cervical kyphosis >15° across any 3 vertebra between C2-T1, C2-C7 SVA >4cm, McGregor's slope >20°, or CBVA > 25°. Spearman's rank-order correlation and linear regression analysis assessed the impact of baseline T1 slope (T1S) and C2 slope (C2S) on baseline HRQL metrics (NDI, mJOA, EQ5D, NRS Neck, NRS Back), and the impact of postoperative T1S and C2S on follow-up HRQLs. Logistic regression and conditional inference tree (CIT) machine learning were used to determine baseline radiographic thresholds for improving in ≥2 HRQL metrics from BL to 2Y, and 2Y radiographic thresholds for developing DJK or DJF by 2Y postop. <h3>RESULTS</h3> A total of 119 CD patients met inclusion criteria (61.2±10.5years, 63%F, BMI 29.0±7.5kg/m2, CCI: 1.00±1.31) and underwent surgery (levels fused 7.5±3.7, EBL 990mL, op time 547min). By approach, 19.3% anterior-only, 44.5% posterior-only, and 36.1% combined. Mean BL radiographic parameters: PT 19.6°, PI-LL 1.4°, SVA 1.9mm, T2-T12 kyphosis -46.8°, C2-C7 lordosis -9.0°, T1S 29.0°, TS-CL 38.2°, C2S 37.7°, cSVA 44.0mm, and C2-T3 -18.0°. Mean BL HRQLs were as follows: NRS back 5.0, NRS neck 6.7, NDI 47.9, mJOA 13.5, and EQ5D 0.74. Spearman correlation and linear regression identified no association between baseline T1S or C2S and HRQL metrics, or between 2Y postop T1S and HRQLs (all p>0.05). Correlation and linear regression found significant associations of higher C2S with higher NDI (p=0.042), lower mJOA (p=0.011), and lower EQ5D (p=0.009), all indicating higher degree of disability at 2Y postop. Logistic regression with CIT identified thresholds for improving in 2 or more HRQL metrics by 2Y postop: baseline T1S < 32.8° (OR: 2.47) and C2S <46.7° (OR: 2.40); both p<0.05. Regression and CIT also identified postoperative radiographic thresholds for developing DJK or DJF by 2Y: T1S >45.3° (OR: 16.0) and C2S >32.5° (OR: 6.07); both p<0.05. <h3>CONCLUSIONS</h3> Baseline deformity severity in terms of T1 slope and C2 slope can be predictive of postoperative functional outcomes in cervical deformity patients, while postoperative deformity in T1S and C2S can be predictive of DJK and DJF occurrence. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

How important is current physical fitness for future quality of life? Results from an 8-year longitudinal study on older adults.

A vast amount of research has focused on the effects of physical fitness (PF) on mortality, with little research evaluating the effects of PF on future expected health related quality of life (HRQoL). To evaluate how current PF influences future HRQoL measured in a prospective 8-year study in older adults. A total of 617 (157 males) older adults (>65y) participated in the study. PF was assessed with the EXERNET battery in 2008-2009 (baseline) and 2016-2017 (follow-up). HRQoL was assessed using the EQ-5D-3L questionnaire in both evaluations. PF tertiles were developed from baseline PF variables: FIT (highest PF values), REGULAR and UNFIT (lowest PF values) taking into account age and sex. Follow-up HRQoL values were compared to sex and age-specific expected values. Logistic regressions were performed to test differences between PF tertiles regarding future expected quality of life. Linear regressions were developed to test whether baseline PF could predict future HRQoL scores. The FIT group showed higher probabilities of an improved HRQoL when compared to the UNFIT group. All PF variables seemed to be important at some point of the study except upper extremities flexibility. Aerobic endurance was the variable that showed to be significant for most of the HRQoL predictions. PF influences future HRQoL in older adults who accordingly should try to remain fit to maintain an increased age-adjusted HRQoL.

Health related quality of life in individuals at high risk of chronic liver disease: Impact of a community diagnostic pathway

ObjectivesThere is a lack of understanding of health related quality of life (HRQoL) in chronic liver disease (CLD). With the rising prevalence of alcohol and obesity driven CLD, and the increasing ability to screen for fibrosis, it is important to understand the impact of the diagnostic process for patients. Study designProspective cohort study. MethodsA cohort study conducted utilising the Nottingham Adult Liver Disease Stratification Pathway, UK. All patients referred as high risk for CLD (due to metabolic, alcohol or abnormal liver enzymes) completed the EQ-5D before diagnosis and at three and 12 months after. HRQoL was investigated by domain, CLD severity (transient elastography) and temporally. Results493 patients participated with 300 (60.9%) completing at least one follow-up HRQoL assessment.Pre-diagnosis the median (IQR) utility index was 0.75 (0.61–0.85) and visual analogue scale was 75/100 (60–90). The median utility index was significantly lower amongst those with advanced liver disease compared to those without at all time points (baseline 0.68 vs 0.77, three-months 0.65 vs 0.79, 12-months 0.69 vs 0.84, all p ​< ​0.05). The majority of decrements in HRQoL score were in the pain domain. ConclusionsThere was no reduction, over three or 12 months, in HRQoL identified amongst high-risk individuals progressing through the diagnostic pathway. Overall the HRQoL of participants at high risk for the development of significant CLD was lower than the UK and regional (East Midlands) norms. Furthermore, we found reduced HRQoL in those going on to receive a diagnosis of advanced liver disease compared to those without.

Measuring change in health-related quality of life: the impact of different analytical methods on the interpretation of treatment effects in glioma patients.

BackgroundDifferent analytical methods may lead to different conclusions about the impact of treatment on health-related quality of life (HRQoL). This study aimed to examine 3 different methods to evaluate change in HRQoL and to study whether these methods result in different conclusions.MethodsHRQoL data from 15 randomized clinical trials were combined (CODAGLIO project). Change in HRQoL scores, measured with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and BN20 questionnaires, was analyzed in 3 ways: (1) at the group level, comparing mean changes in scale/item scores between treatment arms, (2) at the patient level per scale/item, calculating the percentage of patients that deteriorated, improved, or remained stable per scale/item, and (3) at the individual patient level, combining all scales/items.ResultsBaseline and first follow-up HRQoL data were available for 3727 patients. At the group scale/item level, only the item “hair loss” showed a significant and clinically relevant change (ie, ≥10 points) over time, whereas change scores on the other scales/items were statistically significant only (all P < .001; range in change score, 0.1-6.2). Although a large proportion of patients had stable HRQoL over time (range, 27%-84%) on the patient level per scale/item, many patients deteriorated (range, 6%-43%) or improved (range, 8%-32%) on a specific scale/item. At the individual patient level, the majority of patients (86%) showed both deterioration and improvement, whereas only 1% remained stable on all scales.ConclusionsDifferent analytical methods of changes in HRQoL result in distinct conclusions of treatment effects, all of which may be relevant for informing clinical decision making.

Social Disadvantage, Access to Care, and Disparities in Physical Functioning Among Children Hospitalized with Respiratory Illness.

Understanding disparities in child health-related quality of life (HRQoL) may reveal opportunities for targeted improvement. This study examined associations between social disadvantage, access to care, and child physical functioning before and after hospitalization for acute respiratory illness. From July 1, 2014, to June 30, 2016, children ages 8-16 years and/or caregivers of children 2 weeks to 16 years admitted to five tertiary care children's hospitals for three common respiratory illnesses completed a survey on admission and within 2 to 8 weeks after discharge. Survey items assessed social disadvantage (minority race/ ethnicity, limited English proficiency, low education, and low income), difficulty/delays accessing care, and baseline and follow-up HRQoL physical functioning using the Pediatric Quality of Life Inventory (PedsQL, range 0-100). We examined associations between these three variables at baseline and follow-up using multivariable, mixed-effects linear regression models with multiple imputation sensitivity analyses for missing data. A total of 1,325 patients and/or their caregivers completed both PedsQL assessments. Adjusted mean baseline PedsQL scores were significantly lower for patients with social disadvantage markers, compared with those of patients with none (78.7 for >3 markers versus 85.5 for no markers, difference -6.1 points (95% CI: -8.7, -3.5). The number of social disadvantage markers was not associated with mean follow-up PedsQL scores. Difficulty/delays accessing care were associated with lower PedsQL scores at both time points, but it was not a significant effect modifier between social disadvantage and PedsQL scores. Having social disadvantage markers or difficulty/delays accessing care was associated with lower baseline physical functioning; however, differences were reduced after hospital discharge.

Frailty and health-related quality of life in older women with breast cancer.

In older women, breast cancer and its treatment can have profound impact on their physical, mental, and social health, especially in frail patients. This study evaluated the association between frailty and long-term health-related quality of life (HRQOL) in older women undergoing breast cancer treatment. Using the Carolina Senior Registry (CSR), participants with breast cancer were contacted to complete a follow-up HRQOL questionnaire (median 4years). Baseline Geriatric Assessment (GA) variables were used to calculate the Carolina Frailty Index (CFI) and categorize participants as robust, pre-frail, or frail. Outcomes included HRQOL domains of physical function, social roles, fatigue, depression, anxiety, pain, and sleep disturbance assessed using PROMIS® instruments. Regression modeling compared outcomes between frailty groups using adjusted mean differences (AMD). Of 190 eligible patients, 63 completed follow-up HRQOL survey. Mean age was 70years (range 65-86) and 91% were white. Based on the CFI, 49 (78%) patients were robust, 11 (18%) pre-frail, and 3 (5%) frail. After controlling for age and cancer stage, patients identified as pre-frail/frail reported worse physical function (AMD - 9.2, p < 0.001) and social roles (AMD - 7.2, p =0.002) and more fatigue (AMD 7.6, p =0.008), depression (AMD 5.6, p =0.004), and sleep disturbance (AMD 6.9, p = 0.008) compared to robust patients at follow-up. Frailty in older women with breast cancer was associated with worse long-term HRQOL outcomes. Further research is needed to develop interventions for frail patients at-risk for reduced HRQOL.