Functional Assessment Of Cancer Therapy-General Scores Research Articles

Exploring Perception of Terminally Ill Cancer Patients about the Quality of Life in Hospice based and Home based Palliative Care: A Mixed Method Study.

The objectives of the study were to evaluate the perceptions and performance of terminally ill cancer patients regarding the quality of palliative care at different settings and to measure their quality of life (QOL) at the end of life. This comparative, parallel and mixed method study was conducted at the Community Oncology Centre, Ahmedabad, among 68 terminally ill cancer patients as per inclusion criteria; who were receiving hospice (HS)-based and home (HO)-based palliative care under 2 months permitted by the Indian Council of Medical Research. In this parallel and mixed method study, qualitative findings were supplemented by quantitative data with both components executed simultaneously. Interview data were recorded by taking extensive notes during interviews along with an audio recording. Interviews were transcribed verbatim and a thematic approach was adopted. QoL questionnaire ('FACIT© System') was used for the assessment of QOL in terms of four dimensions. Data were analysed using the appropriate statistical test on Microsoft Excel. The qualitative data (primary component) analysed under five themes - staff behaviour, comfort and peace, enough and consistent care, nutrition and moral support, in the present study favours a HS-based setting more than a HO-based setting. Among all four subscale scores, physical well-being and emotional well-being subscale scores were statistically significantly associated with the place of palliative care. Functional Assessment of Cancer Therapy-General (FACT-G) total score was high among patients getting HO-based palliative (mean = 67.64) care than HS-based palliative care (mean = 56.56) and the difference between total FACT-G scores was statistically significant (unpaired t-test = 2.20, P = 0.03). Overall, with the primary component favouring HS care and higher scores obtained in HO-based patients, the present study advocates the necessity for palliative services to expand their coverage regardless of whether they are provided at HS or HO, as it has improved the QOL of cancer patients significantly.

Understanding Cancer Survivorship among Firefighters: A Mixed-Method Study.

Firefighters are exposed to a unique set of carcinogens through their work environment that predispose them to several cancers, yet there is limited research related to cancer survivorship amongst this occupational group. A mixed-method approach was used to assess cancer survivorship amongst firefighters. Four focus groups and one in-depth interview were conducted with 29 active and retired firefighters who have been diagnosed with cancer to understand the experiences and challenges associated with cancer survivorship in the fire service and desired resources. Qualitative data were analyzed using Nvivo software. All participants completed the Functional Assessment of Cancer Therapy-General (FACT-G) survey to assess their quality of life. The primary themes that emerged from the focus groups included managing health and well-being changes, navigating support systems in place, and accessing new resources. FACT-G scores (mean ± standard deviation) of the firefighter cancer survivor sample demonstrate relatively lower levels of emotional well-being (19.26 ± 4.67) and higher quality of life in the physical well-being (23.67 ± 5.08), social well-being (23.38 ± 4.16), and functional well-being (22.6 ± 4.966) domains. Firefighters requested curated resources, such as support groups and department training resources, supporting the need for more cancer survivorship resources specific to firefighters.

Assessing the Prevalence of Financial Toxicity, its Predictors and Association with Health- Related Quality of Life Among Radiation Oncology Patients in India: A Cross-Sectional Patient Reported Outcome Study

Financial toxicity has been associated with several clinical outcomes such as early mortality and poor quality of life. The aim of this study was to evaluate the magnitude of financial toxicity among radiation oncology patients and its association with health-related quality of life (HRQOL) in Indian health care settings. This cross-sectional study was conducted among patients with cancer who had completed radiation therapy, either standalone or as part of a multimodal treatment. Financial toxicity and HRQOL were assessed using the Comprehensive Score for Financial Toxicity (COST) and Functional Assessment of Cancer Therapy: General (FACT-G) measures, respectively. Associations between financial toxicity and HRQOL were assessed using Pearson correlation. Univariate and multivariate regression analyses were conducted to identify the factors associated with financial toxicity. A total of 350 patients were included in this study. Of the 350 participants, 57.7% were male, 95.7% had no health insurance, and 61% were diagnosed with Head & Neck cancers. The average COST score was 15.38 ± 9.18 (range, 2-35), and the average FACT-G score was 69.63 ± 12.25 (range, 33-99). Based on the total COST score, 7.4% of participants reported grade 3 and 44.9% reported grade 2 financial toxicity. A significant positive correlation was observed between the COST and FACT-G scores, with a correlation coefficient of 0.58 (P < .001), indicating a large effect size. The COST score also significantly predicted the FACT-G score (β=0.77; 95% confidence interval [CI], 0.66-0.88; P < .001). The results of multivariate linear regression identified annual household income (β=3.9; 95% CI, 3.29-4.57; P < .001) and cancer type (β=3.74; 95% CI, 2.33-5.14; P < .001) as significant predictors of the COST score. More than 80% of the participants experienced financial toxicity in this study. The results highlight the need for interventions to alleviate the growing financial toxicity among cancer survivors in India.

A novel nomogram to stratify quality of life among advanced cancer patients with spinal metastatic disease after examining demographics, dietary habits, therapeutic interventions, and mental health status

BackgroundIt would be very helpful to stratify patients and direct patient selection if risk factors for quality of life were identified in a particular population. Nonetheless, it is still challenging to forecast the health-related quality of life among individuals with spinal metastases. The goal of this study was to stratify patient’s populations for whom the assessment of quality of life should be encouraged by developing and validating a nomogram to predict the quality of life among advanced cancer patients with spine metastases.MethodsThis study prospectively analyzed 208 advanced cancer patients with spine metastases, and collected their general characteristics, food preferences, addictions, comorbidities, therapeutic strategies, and mental health status. The functional assessment of cancer therapy-general (FACT-G) and hospital anxiety and depression scale (HADS) were used to assess quality of life and mental health, respectively. The complete cohort of patients was randomly divided into two groups: a training set and a validation set. Patients from the training set were conducted to train and develop a nomogram, while patients in the validation set were performed to internally validate the nomogram. The nomogram contained significant variables discovered using the least absolute shrinkage and selection operator (LASSO) approach in conjunction with 10-fold cross-validation. The nomogram’s predictive ability was assessed utilizing discrimination, calibration, and clinical usefulness. Internal validation was also completed using the bootstrap method after applying 500 iterations of procedures. A web calculator was also developed to promote clinical practice.ResultsAdvance cancer patients with spinal metastases had an extremely low quality of life, as indicated by the average FACT-G score of just 60.32 ± 20.41. According to the LASSO and 10-fold cross-validation, Eastern Cooperative Oncology Group (ECOG) score, having an uncompleted life goal, preference for eating vegetables, chemotherapy, anxiety status, and depression status were selected as nomogram predictors. In the training set, the area under the receiver operating characteristic curve (AUROC) was 0.90 (95% CI: 0.84–0.96), while in the validation set, it was 0.85 (95% CI: 0.78–0.93). They were 0.50 (95% CI: 0.41–0.58) and 0.44 (95% CI: 0.33–0.56), respectively, for the discrimination slopes. The nomogram had favorable capacity to calibrate and was clinically useful, according to the calibration curve and decision curve analysis. When compared to patients in the low-risk group, patients in the high-risk group were above four times more likely to experience a poor quality of life (82.18% vs. 21.50%, P < 0.001). In comparison to patients in the low-risk group, patients in the high-risk group also exhibited significant higher levels of anxiety and depression. The webpage for the web calculator was https://starshiny.shinyapps.io/DynNomapp-lys/.ConclusionsThis study suggests a nomogram that can be applied as a practical clinical tool to forecast and categorize the quality of life among patients with spine metastases. Additionally, patients with poor quality of life experience more severe anxiety and depression. Effective interventions should be carried out as soon as possible, especially for patients in the high-risk group, to improve their quality of life and mental health condition.

Health-Related Quality of Life and Disease Impacts in Adults with Transfusion-Dependent β-Thalassemia: Preliminary Results from the Global Longitudinal Survey

Introduction: Transfusion-dependent β-thalassemia (TDT) is a chronic inherited blood disorder requiring frequent red blood cell transfusions and daily iron chelation therapy. Health-related quality of life (HRQoL) of individuals with TDT is impacted by a multitude of factors, including iron overload-related morbidity, substantial time required to manage TDT, and work and activity impairments. Nonetheless, the HRQoL impact of TDT is not well quantified. Here, we report the preliminary findings from a prospective longitudinal study evaluating the HRQoL and work productivity impacts among adult participants with TDT. Methods: A mixed-methods study was conducted to quantify the symptoms, HRQoL, and work and education impacts of adults with TDT. The study consisted of qualitative interviews and an online longitudinal survey administered at 3 timepoints (time 0, 3 months, 6 months) in the US, the UK, France, Germany, and Italy. The survey aimed to quantify the HRQoL impacts using multiple patient-reported outcomes measures (PROMs): the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT), composed of the Functional Assessment of Cancer Therapy-General (FACT-G) and a BMT subscale (BMTS); EuroQol 5-Dimension 5-Level (EQ-5D-5L); Transfusion-dependent Quality of Life (TranQoL); and Work Productivity and Activity Impairment (WPAI) questionnaire. Symptoms, comorbidities, treatment experiences, out-of-pocket costs, and time spent managing TDT were also collected and evaluated. Survey invitations were sent to patient communities via patient advocacy groups. Participants were required to meet the eligibility criteria and provide consent. Eligibility criteria included receiving ≥8 blood transfusions/year in each of the 2 years prior to enrollment. Descriptive analyses were conducted for participant characteristics and PROMs based on survey findings at time 0. Results: The survey was completed by 155 adult participants with TDT (aged ≥18 years) living in the US (n=83) and the UK, Germany, France, and Italy (n=72). Overall, 65.8% (n=102) were female, the mean age was 38.5 years (standard deviation [SD]: 10.8 years), and 32.9% (n=51) had full-time employment (32 hours/week). Participants reported a mean of 18.7 (SD: 8.2) transfusions in the previous 12 months. The mean FACT-G score was 70.1 (SD: 19.0) (0-108 scale; 108=best HRQoL), which is lower than the US general population mean of 80.1 (SD: 18.1). The largest HRQoL impact was observed on the emotional well-being domain of the FACT-G (-21.9% relative change) (mean: 14.7 [SD: 4.4] compared with the US general population (mean: 9.9 [SD: 4.8]) (0-24 scale; 24=best HRQoL). Participants reported a mean EQ-5D-5L visual analog scale score of 67.1 (SD: 20.4), with 73.2% reporting pain/discomfort, 60.8% anxiety/depression, 46.4% mobility impairment, and 24.8% self-care impairment. The mean TranQoL total score was 53.9 (SD: 18.5) (100-point scale; 100=best HRQoL). Forty percent of the participants felt that TDT limited their career opportunities "often” or "always.” Participants reported spending substantial time managing their condition in the last month, with 62.4% spending >6 hours at medical appointments and 36.1% needing >6 hours of care from family members/caregivers to manage their condition. Among those employed (n=84), 34.4% (SD: 30.9%) reported work impairment (presenteeism), 19.5% (SD: 25.5%) absenteeism, and 41.7% (SD: 32.4%) work productivity loss on the WPAI. Among all respondents (n=151), the mean activity impairment was 44.2% (SD: 31.0%). Results were consistent in a subset of 18-to-35-year-old participants. Conclusions: Adults with TDT currently receiving treatment experience significant HRQoL impacts and impaired work productivity and spend considerable time managing their disease, indicating significant humanistic burden and unmet needs in this patient population.

Prospective Evaluation of Stereotactic Body Radiation Therapy (SBRT) for Patients with Metastatic Epidural Spinal Cord Compression

<h3>Purpose/Objective(s)</h3> Metastatic epidural spinal cord compression (MESCC) can be very painful and disabling. We hypothesized that an initial fraction of SBRT would provide rapid decompression and allow for potential dose escalation via a follow up treatment. Our primary objective was to assess the feasibility of a staged SBRT approach to provide short-interval treatment response. Secondary endpoints included pain control and quality of life (QoL). <h3>Materials/Methods</h3> This single institution, prospective study enrolled non-surgical candidates with MESCC from 07/2015 to 02/2018. Those with spine instability (SINS>12), bony retropulsion, or radiosensitive histologies were excluded. After baseline imaging (MRIpre), patients received SBRT (10-16 Gy) and a short interval MRI within 2-3 weeks (MRI1). Subsequently, patients could receive an additional treatment at the discretion of the treating physician. A second MRI was completed 8-10 weeks post-tx (MRI2). QoL questionnaires and pain scores were obtained at all time points. The primary endpoint was the smallest cord-disease distance (CDD) in the axial plane and the thecal sac patency (TSP), defined as the thecal sac area at the level of maximal compression divided by the average thecal sac area one level above and below. Secondary endpoints included pain scores and QoL using the Functional Assessment of Cancer Therapy – General (FACT-G). Statistical comparisons utilized the Wilcoxson signed-rank test. <h3>Results</h3> 22 patients were enrolled in the study and received SBRT. The most common primary diagnoses were lung (36%) and prostate (32%) cancer. The most common initial SBRT doses were 16 Gy (41%) and 14 Gy (36%). 12 patients completed all 3 scans and 3 other patients completed 2 scans (MRIpre and either MRI1 or MRI2). No patient received a second,adaptive fraction of radiation (due to lost to follow up, systemic progression, or no local progression). TSP significantly increased on MRI1 (median change 9%, IQR 1%-28%, p = 0.034) and on MRI2 (median change 24%, IQR 12-32%, p = 0.002). CDD did not increase significantly on MR1 (median change 0.0 mm, IQR 0-0.3 mm, p = 0.125) but did on MRI2 (median change 1.5 mm, IQR 0-1.8 mm, p = 0.001). On radiology report, 23% had disease improvement on MRI1, all of whom received 16 Gy. 64% had disease improvement on MRI2. No patients progressed neurologically. There was a numerical decrease in best and worst pain score over time (p=0.093). FACT-G scores did not change significantly over time. There were no grade 3 or greater toxicities related to RT. <h3>Conclusion</h3> Single-fraction SBRT can provide rapid decompression of epidural disease safely and quickly. Radiosurgical decompression can be a feasible alternative to surgery in patients with MESCC, especially as a large segment of such patients are non-surgical candidates. A follow up study comparing SBRT to 3D CRT is being planned.

Reallocating Time Between Sleep, Sedentary Time, And Physical Activity On Quality Of Life In Cancer Survivors

PURPOSE: Increasing time in moderate-vigorous physical activity (MVPA) and reducing time in sedentary behaviors (SB) can improve quality of life (QOL) in cancer survivors (CS). However, these behaviors only account for a small portion of the day, neglecting other important health behaviors like sleep and light PA. When examining the effects of these behaviors on QOL, it is important to account for their interdependent nature within the confines of the 24-hour day (i.e., you must decrease time in one activity to increase time in another). This study examined the effect of reallocating time between sleep, SB, light PA and MVPA on QOL in a mixed sample of CS. METHODS: A cross-sectional evaluation of adult CS within five-years of completing active cancer treatment(s). Participants concurrently wore the activPAL™ accelerometer to measure SB, light PA and MVPA, and the Actiwatch-2 to measure sleep duration for 7-days, 24-hours per day. QOL was measured using the Functional Assessment of Cancer Therapy-General (FACT-G). FACT-G scores range from 0-108, a difference of 4 points is considered clinically meaningful, and higher scores indicate better QOL. Isotemporal substitution methods in linear regression models were used to examine the effect of 30-minute time reallocations on total QOL. RESULTS: Participants (N=73) were M=53±13 years old, mostly female (75.7%), and diagnosed with colorectal (33.8%) breast (29.7%), leukemia/lymphoma (9.5%), or other (27.0%) cancer. Average QOL score was 87.0±15.3 (range = 41-107). No time reallocations were statistically significant, however, clinically meaningful associations (i.e., lower QOL) were observed for reallocating 30 minutes from MVPA to sleep (-4.42), SB (-4.32), or light PA (-5.06). CONCLUSION: Findings suggest that moving time away from MVPA may negatively impact QOL but did not reach statistical significance. These findings are congruent with previous literature which has established the important role of MVPA for QOL in CS. Future studies should evaluate reallocating time among a sample of survivors presenting with poor versus good QOL to guide intervention development.

Effect of Intensive Psychological Care on Patients with Benign Breast Lumps after Mammotome-Assisted Tumor Resection.

Objective The aim of the study was to evaluate the effect of intensive psychological care on patients with benign breast lumps after Mammotome-assisted tumor resection. Methods A total of 160 patients with benign breast lumps diagnosed and treated in our hospital between May 2019 and January 2021 were recruited and divided into a study group (n = 80) and a control group (n = 80) via the random number table method. All patients received Mammotome-assisted tumor resection. Patients in the control group received conventional nursing, and those in the study group received intensive psychological care. The outcome measure included quality of life of patients, psychological states, treatment compliance, and nursing satisfaction. Results The differences in the Functional Assessment of Cancer Therapy-General (FACT-G) scores, self-rating anxiety scale (SAS) scores, Hamilton Depression Rating Scale (HAMD) scores, and Morisky scores between the two groups were not significant before the intervention (p > 0.05). The FACT-G scores improved in both groups after the intervention, with higher results in the study group than those in the control group (p < 0.05). Patients in the study group showed a significantly greater reduction in the SAS and HAMD scores than those in the control group (p < 0.05). Intensive psychological care used in the study group resulted in significantly higher compliance scores in the body mass control, medication compliance, exercise compliance, and dietary compliance versus conventional care for the control group (p < 0.05). Conclusion Intensive psychological care provides satisfactory outcomes in patients with benign breast lumps after Mammotome-assisted tumor resection. It effectively improves the quality of life of patients, relieves their negative emotions, and strengthens treatment compliance and patient satisfaction, which shows good potential for clinical promotion.

Inclusion of information technology-based assessments of health-related quality of life in routine oncology practice in Uruguay

BackgroundPrevious research has shown that the inclusion of patient-reported outcomes measures in the patient’s visit to the oncologists might improve the quality of global health care. The aim of the study was to assess the feasibility, acceptance, and utility perceived by patients and oncologists of health-related quality of life (HRQL) assessments obtained prior to clinical visits, and to evaluate if this has an impact on patient’s well-being in a sample of Spanish-speaking patients from Uruguay.MethodsPatients assisted regularly in the Oncology Clinic were randomized into two groups: an intervention group that completed a set of questionnaires (European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire-C30 (EORTC QLQ-C30) and Hospital Anxiety and Depression Scale using a touch screen device and a control group that did not respond to these questionnaires. At 2 months, the responses of all the participants to the Functional Assessment of Cancer Therapy-General (FACT-G) were collected over a telephone to determine whether there were differences in the HRQL between the intervention and control groups. The graphed scores of the intervention group were included in the clinical history of the patient during consultation. Patients and physicians completed the questionnaires on the usefulness of these measurements.ResultsIn total, 58 patients participated in this study: 36 in the intervention group and 22 in the control group; 65% of the participants were female, and median age was 59 years (18–79). Regarding patients, 97% found the questionnaires easy to complete and thought that they included important questions. As for oncologists, 68.8% used the information and 87.5% found it useful for the consultation. There were no significant differences in the FACT-G scores between the intervention and control groups.ConclusionsThe routine HRQL assessments using an electronic device prior to the consultations were positively valued by almost all patients and physicians. This could significantly contribute to a better understanding of the patient's overall problems during consultation. These results confirm the benefits of integrating the patient’s self-reported quality of life outcomes into consultations.

Temporal evolution in quality of life following melphalan percutaneous hepatic perfusion for patients with metastatic uveal melanoma.

e21520 Background: Recent studies have demonstrated a clear survival benefit of melphalan percutaneous hepatic perfusion (M-PHP) for liver metastases from ocular melanoma (mUM). Importantly, the survival benefit relating to each treatment cycle must be carefully balanced with changes in patient Quality of Life. We contribute our single centre findings on the temporal change in the quality of life after M-PHP therapy. Methods: We performed a retrospective analysis of the change in quality of life (QoL) using the Functional Assessment of Cancer Therapy - General (FACT-G) with mUM patients receiving M‐PHP at our institutions (n = 13). The FACT-G score which comprises physical (PWB), social (SWB), emotional (EWB) and functional (FWB) wellbeing were measured pre-procedure and at day 1, day of discharge, 7, 14 and 28 days after M-PHP therapy. Paired t-test was used to assess for any significant change in each QoL domain. Results: The baseline FACT-G score was 93.4 out of 108 +/- 14.7 (mean +/- std). Quality of life scoring significantly decreased immediately after the procedure (day 1; 84.8 +/- 13.1, p = 0.01) and gradually improved over time, with no significant difference in total score by the day of discharge; 88.7 +/- 13.7, c.f baseline p = 0.22). By day 28, there was a trend for overall improved QoL (96.6 +/-9.3, p = 0.25). Sub-score analysis revealed that by day 28 there was a statistically significant improvement in EWB (p = 0.02), a trend towards improved scores in PWB and SWB domains. FWB was slightly below baseline by day 28 (23.8 vs 23.2). Conclusions: Quality of life following M-PHP decreases immediately after therapy and is not significantly different from baseline by the day of discharge. By day 28 there is a trend towards improved overall quality of life. This study could provide the basis for determining the optimal time between treatment cycles.

Health-related quality of life in patients with resectable undifferentiated pleomorphic sarcoma treated with neoadjuvant checkpoint blockade in a single institution randomized phase II clinical trial.

11544 Background: In SARC028, patients with undifferentiated pleomorphic sarcoma (UPS) had a 40% overall response rate to pembrolizumab. Based on this, we conducted a randomized, phase II, non-comparative trial of combination nivolumab (nivo/RT) and ipilimumab (ipi/nivo/RT) and demonstrated an 89% major pathologic response. Here, we report the health-related quality of life (HRQoL) metrics. Methods: In this study (NCT03307616), patients with resectable UPS were randomized (1:1) to receive one dose of nivo (3mg/kg) or one dose of combination nivo (3 mg/kg) and ipi (1 mg/kg), followed by combination of nivo (3 doses, 3mg/kg every 2 weeks) plus 50 Gy in 25 fractions (both arms). HRQoL was assessed using the MD Anderson Symptom Inventory (MDASI), European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLC) Core 30, and the Functional Assessment of Cancer Therapy – General (FACT-G) questionnaires. Questionnaire completion rates were calculated using the number of patients with at least one baseline and post-baseline assessment. Analyses included mean change from baseline scores to week 11 (preoperative) and week 54 (postoperative). Results: Ten patients were randomized from October 2017 to February 2020. HRQoL were collected at baseline (n = 10) and at week 11 for five (83%) nivo/RT and three (60%) ipi/nivo/RT patients. Three (60%) nivo/RT and three (100%) ipi/nivo/RT patients had week 54 assessments. MDASI scores indicative of symptom severity and interference of daily life both decreased for patients undergoing ipi/nivo/RT (0.8→0.67 and 0.9→0.46, respectively) while both increased in the nivo/RT group (1.6→2.22 and 1.9→3.33, respectively). Both arms had similar increases at 54 weeks. Patients undergoing ipi/nivo/RT experienced a greater decline in EORTC-QLC global health status at 54 weeks than those undergoing single agent therapy (-22.92 vs -8.33). The mean change in total FACT-G score did not differ between the two arms at 11 weeks (-4.0 vs -4.5), however, there was a significant decline for patients undergoing ipi/nivo/RT at 54 weeks (-20.3 vs -5.7). Conclusions: For patients with resectable UPS, combination immune checkpoint blockade with ipi/nivo/RT is associated with an improvement in short term HRQoL compared to single-agent nivo/RT. This finding warrants further study with more patients, controlling for baseline symptom scores. Combination therapy was associated with a slower recovery to baseline function, with ongoing decline in HRQoL at 54 weeks post treatment. Our study demonstrates the feasibility of collecting HRQoL metrics, which can be key factors in guiding patient management decisions. Clinical trial information: NCT03307616.

A Case Report on Opioid-Induced Constipation in a Patient with Cancer Treated by &lt;italic&gt;Jowiseunggi-tang&lt;/italic&gt;

Objective: &lt;i&gt;Jowiseunggi-tang&lt;/i&gt; (JWSGT) is a traditional herbal medicine commonly used for purgative activity in constipation. This study evaluates JWSGT for the treatment of opioid-induced constipation (OIC), the most common and debilitating gastrointestinal effect of opioid use.Methods: A 64-year-old man with floor of mouth cancer was hospitalized for OIC, and JWSGT was administered orally twice a day for 10 days, along with acupuncture, moxibustion, and cupping. The primary outcome measures were defecation type according to the Bristol Stool Form Scale (BSFS) and the frequency of bowel movements. The Brief Fatigue Inventory (BFI) and the Functional Assessment of Cancer Therapy-General (FACT-G) were used as secondary measures.Results: After three days of JWSGT administration, spontaneous bowel movements were observed two to three times per week with improved BSFS from type 2 to 4. A reduction in BFI score (8.7 to 2.0) and an increase in FACT-G score (44.3 to 59.0) suggested an improvement in fatigue level and quality of life.Conclusion: This is the first report to assess the efficacy of JWSGT for the management of OIC in patients with cancer, and JWSGT may be an effective option to improve symptoms and quality of life in this group.

Abstract PD5-10: Consequent job loss, return to work and multidimensional well-being after breast cancer treatment in working-age black and white women

Abstract Background: Few studies have assessed relationships between job loss due to breast cancer and well-being. These relationships may vary by race, work type, and functional difficulties.Methods: In the Carolina Breast Cancer Study, 1,646 women with primary breast cancer who worked prior to diagnosis were longitudinally evaluated for post-diagnosis job loss and well-being using the Functional Assessment of Cancer Therapy General (FACT-G) measure. Women were classified as having ‘sustained work’ (working at baseline and 25 months); ‘returned to work’ (not working at baseline, working at 25 months); ‘consequent job loss’ (working at baseline, not working at 25 months); or ‘persistent non-employment’ (not working at either timepoint). Analysis of covariance was used to evaluate associations between work status and well-being (physical, functional, social, emotional).Results: Women who had sustained work or returned to work had higher FACT-G scores than women with consequent job loss and persistent non-employment in all well-being domains (p&amp;lt;.05). Consequent job loss and persistent non-employment were associated with higher frequency of service/laborer job types, lower education and income, later stage at diagnosis, longer treatment duration, non-private insurance, and greater disability. Consequent job loss was more common among Black than White women (adjusted odds ratio [aOR]=3.44; 95% confidence interval [CI] 2.37-4.99). Black versus White women with job loss reported lower well-being in all domains (p&amp;lt;.05) and greater disability (mean score 42.8 vs. 29.3) and work-related difficulties (aORs=10.3, 95% CI 5.9-18.2 vs. 5.7, 95% CI 2.9-11.2).Conclusions: Work status is an indicator of multidimensional well-being after breast cancer. Citation Format: Marc A Emerson, Bryce B Reeve, Melissa B. Gilkey, Shekinah N Elmore, Cathy J Bradley, Melissa A Troester. Consequent job loss, return to work and multidimensional well-being after breast cancer treatment in working-age black and white women [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD5-10.

Effect of Narrative Nursing Intervention Based on Targeted Nursing Intervention on Anxiety and Nursing Satisfaction of Patients with Malignant Tumors Undergoing Chemotherapy.

Objective To explore the effect of narrative nursing intervention based on targeted nursing intervention on anxiety and nursing satisfaction of patients with malignant tumors undergoing chemotherapy. Methods 120 malignant tumor patients treated with chemotherapy in our hospital from January 2019 to January 2020 were selected as the research objects and randomly divided into group A and group B, with 60 cases in each group. The targeted nursing intervention was performed to group B, and the targeted nursing intervention centering on narrative nursing was performed to group A, so as to compare their distress thermometer (DT) scale scores, depression and anxiety scale scores, Medical Coping Modes Questionnaire (MCMQ) scores, Functional Assessment of Cancer Therapy-General (FACT-G) scores for quality of life, and nursing satisfaction. Results After nursing intervention, group A obtained 5.00 ± 1.20 points in the DT score, which were significantly lower than group B (P < 0.05); and group A achieved significantly lower depression and anxiety scale scores (P < 0.001), better MCMQ scores (P < 0.05), and higher FACT-G scores (P < 0.05) and nursing satisfaction (P < 0.05) than group B. Conclusion The targeted nursing intervention based primarily on narrative nursing can greatly reduce negative emotions, alleviate anxiety, and improve confidence in treatment and quality of life for malignant tumor patients undergoing chemotherapy, with higher nursing satisfaction, which should be promoted and applied in the practice.

Utility Estimation of Rituximab Versus Bendamustine-Rituximab Induction in Indolent Non-Hodgkin Lymphomas Using Patient-Reported Quality of Life Survey Data

BackgroundRituximab induction (RI) and bendamustine-rituximab (BR) induction are both options for the frontline management of indolent non-Hodgkin lymphomas (NHLs). Although BR induces longer progression-free survival than RI, BR confers more toxicity and a longer duration of initial induction than RI. The effects of RI versus BR on health-related quality of life (HRQoL) after induction treatment, and the implications on patient utility and quality-adjusted life-years (QALYs), have not been previously studied. We conducted a cost-utility analysis of RI versus BR utilizing patient-reported HRQoL survey data.MethodsPatient-reported utility data were collected from the Hoogland Lymphoma Biobank, which enrolls patients with lymphoma at the University of Chicago and prospectively administers serial patient-level HRQoL surveys utilizing the Functional Assessment of Cancer Therapy-General (FACT-G) and FACT-Lymphoma (FACT-LYM) instruments. Patients with indolent NHLs (follicular lymphoma, marginal zone lymphoma, and lymphoplasmacytic lymphoma) who were treated with frontline RI (4 doses of weekly rituximab) or BR (6 months of monthly BR) and who had completed HRQoL surveys at both of the following timepoints were included: within 6 months of treatment completion (timepoint 1) and 6-12 months after treatment completion (timepoint 2). Individual FACT-G scores were converted into EQ-5D utility index scores using a United States-based validated mapping algorithm (Teckle et al., Health Qual Life Outcomes, 2013). Cost-utility analysis was performed by trial-based methodology in which patient-level QALYs are estimated using area-under-the-curve (AUC) between timepoints 1 and 2. Incremental cost utility ratio (ICUR) was calculated utilizing cost and life years gained inputs of RI and BR from previous cost-effectiveness literature. All HRQoL scores for RI versus BR at both timepoints were compared with unpaired two-tailed t-tests.ResultsThere were 19 patients treated with RI and 13 patients treated with BR (Table 1). At timepoint 1, the BR cohort had significantly worse physical and emotional wellbeing on the FACT-G compared to the RI cohort, with emotional wellbeing significantly worse in the BR cohort at timepoint 2 (Table 2). EQ-5D utility index was stable at both timepoints for the RI cohort, and was initially lower in the BR cohort at timepoint 1 compared to RI but improved by timepoint 2 (Table 2). During the initial 12-month observation period after treatment completion, quality of life was higher for RI compared to BR (+0.02); however, when accounting for life years gained, the BR cohort had more QALYs (+1.53) (Table 3). Compared with RI, BR had an ICUR of $37,442.ConclusionsAlthough HRQoL was inferior in the BR cohort in the first year after treatment completion, particularly in the emotional wellbeing domain on FACT-G, BR induction conferred higher QALYs owing to more life years gained as compared to RI induction. Given a cost-effectiveness threshold of $100,000 in the United States (Vanness et al., Ann Intern Med, 2021), BR induction is likely to be cost effective when considering patient-reported HRQoL over the first year after treatment completion. The present analysis is limited by the small number of patients from which utility values at each timepoint were derived; however, calculation of QALYs using a database of prospectively-collected HRQoL data is feasible. Further incorporation of patient-reported outcomes into cost-utility analysis is warranted, particularly with larger datasets. [Display omitted] DisclosuresSmith: Alexion, AstraZeneca Rare Disease: Other: Study investigator; Celgene, Genetech, AbbVie: Consultancy.

Quality of Life Outcomes Following Stereotactic Body Radiotherapy in Patients with Oligo-Metastatic Disease: A Systematic Review and Meta-Analysis

<h3>Purpose/Objective(s)</h3> The management of oligo-metastatic disease (OMD) is evolving, with increasing data supporting the use of stereotactic body radiotherapy. The aim of this systematic review and meta-analysis is to analyses health related quality of life (HRQOL) outcomes and the side-effects of SBRT in patients with OMD. <h3>Materials/Methods</h3> We searched MEDLINE, Epub Ahead of Print, EMBASE, Cochrane CT, Cochrane SR, Emcare, and PsycInfo databases (from inception to March 2020). Randomized clinical trials (RCTs) or observational studies were included if HRQOL outcomes were reported from patients with defined OMD (£5 metastases) who received SBRT as metastasis-directed therapy, and who completed validated HRQOL questionnaires at baseline and 12-months. Meta-analysis using weighted mean difference was performed to estimate a difference between baseline and 12-month scores. Secondary outcome, calculated by the pooled incidence rate approach using the inverse variance method, was the estimated event rate of clinically significant Common Terminology Criteria for Adverse Events (CTCAE) grade 2-4 and grade 5 toxicity, expressed per person-time of follow-up. Authors of studies included were contacted to obtain additional information. Methods adhered to PRISMA guidelines. <h3>Results</h3> Four of 7,545 studies screened were eligible for inclusion. Two studies were phase II RCTs and two were prospective single arm studies. Among 277 patients who received SBRT, median follow-up was 31 months (range 24–41 months). Two studies included only prostate cancer patients and two studies included mixed histologies. Two studies measured European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and two measured Functional Assessment of Cancer Therapy – General (FACT-G) scores. Using a fixed effects model, the mean change in 12-month EORTC QLQ-C30 global health QOL score from baseline demonstrated a statistically significant decline (pooled weighted mean difference -5.2, 95% CI -9.3 to -1.2, both prostate cancer studies, 57 patients total). Meta-analysis of total FACT-G scores in the other two studies was not possible as mean difference results for one study were unavailable. For the available multi-histology study, no statistically significant difference was seen in baseline to 12-month mean FACT-G total scores in the SBRT arm. We estimated an event rate of 0.06 (95% CI: 0.024, 0.15) CTCAE grade 2-4 toxicities per person-year and 0.008 (95% CI: 0.002, 0.031) grade 5 toxicities per person-year. <h3>Conclusion</h3> Although a statistically significant decline in the EORTC QLQ C30 global health/QOL measure was seen, it was small and unlikely to be of clinical importance. Rates of SBRT-related clinical toxicities are low. There is limited QOL data published for patients with OMD, with varying HRQOL tools used.

MP19-03 COMPARISON OF FACT-G SCORES WITH CANCER AND GENERAL POPULATION NORMS IN CANADIAN PATIENTS UNDERGOING RADICAL CYSTECTOMY

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making II (MP19)1 Sep 2021MP19-03 COMPARISON OF FACT-G SCORES WITH CANCER AND GENERAL POPULATION NORMS IN CANADIAN PATIENTS UNDERGOING RADICAL CYSTECTOMY Julie Trudel, Ryan McLarty, and Conrad Maciejewski Julie TrudelJulie Trudel More articles by this author , Ryan McLartyRyan McLarty More articles by this author , and Conrad MaciejewskiConrad Maciejewski More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002004.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Functional Assessment of Cancer Therapy-General (FACT-G) is often used as a generic measure in Health-Related Quality of Life (HRQOL) assessment among cancer patients. Its reference values relating to the general population and patients with different diseases are useful for the interpretation of HRQOL scores and allow a better understanding of the patients needs and HRQOL. No study to date has yet compared FACT-G normative data scores to those of Canadian patients undergoing radical cystectomy (RC) for bladder cancer. The objective of this study was to compare our patients pre-cystectomy FACT-G scores with US cancer and general population norms. METHODS: Patients were recruited from the Diana Wood Cancer Survivorship Clinic at The Ottawa Hospital between January 2019 and August 2020. HRQOL was evaluated by the FACT-G and raw scores were obtained for each FACT-G subscale, higher scores indicating better HRQOL. Effect sizes (ES-Hedge's g statistics), confidence intervals and minimal clinical significant differences (MCIDs) were used to compare pre FACT-G subscale scores with normative data. As suggested by current literature, a change of at least 5% to 10% within the instrument range was used as an estimate calculation of the MCID. RESULTS: 55 patients completed the FACT-G questionnaire before RC. The mean age was 67 years (SD: 10 years), 71% were male, 80% were in a married/common law partnership and 84% lived with someone. Overall, ES between pre-surgery FACT-G subscale scores and US cancer norms were small (ES≤0.2) and the MCIDs were less than 5% of change in the FACT-G measurement scale except for the dimension “Physical Well-Being” (ES=0.3, reported MCID value of 1.77, 6% of change). ES calculated between FACT-G scores and those from the US general population showed small effect sizes (ES≤0.2) for all FACT-G subscales except for the dimensions “Emotional Well-Being” (Medium ES=-0.56, reported MCID value of 2.7, 11% of change) and “Social Well-Being” (Medium ES=0.37, reported MCID value of 2.5, 9% of change). CONCLUSIONS: In our survivorship clinic, patients undergoing RC reported broadly similar FACT-G scores to US cancer population norms, with a notable exception of increased perceived “Physical Well-Being”. When comparing our data to US population norms, we once again showed similar scores on FACT-G subscales with the exception of decreased “Emotional Well-Being” and higher “Social Well-Being”. These results emphasize unique aspects of the bladder cancer survivorship experience, and highlight the value of patient reported assessment of HRQOL in RC patients. Source of Funding: The Diana Wood Bladder Cancer Survivorship Program © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e328-e328 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Julie Trudel More articles by this author Ryan McLarty More articles by this author Conrad Maciejewski More articles by this author Expand All Advertisement Loading ...

Study on the correlation between postoperative mental flexibility, negative emotions, and quality of life in patients with thyroid cancer.

In recent years, the global incidence of thyroid cancer has increased year by year. The purpose of this study is to investigate the post-surgical psychological flexibility and negative feelings of patients with thyroid cancer and their association with quality of life. A total of 82 patients with thyroid cancer were selected. The study utilized the Acceptance and Action Questionnaire 2nd edition (AAQ-II), the Cognitive Fusion Questionnaire (CFQ), and the Meaning in Life Questionnaire-the Presence of Meaning (MLQ-P). By quantifying psychological flexibility, we assessed the patient's experiential avoidance, cognitive fusion, and sense of life meaning. The Self-rating Depression Scale (SDS) and the Self-rating Anxiety Scale (SAS) were employed to evaluate depression and anxiety, respectively. Quality of life was evaluated with the Functional Assessment of Cancer Therapy-General (FACT-G). The mean AAQ-II, CFQ, MLQ-P, SAS, and SDS scores were 20.1±9.2, 27.5±10.7, 23.0±5.7, 47.7±13.3, and 43.3±12.8, respectively. In total, 24.4% and 45.1% of patients had depression and anxiety to some extent, respectively. The AAQ-II and CFQ scores were positively correlated with the SDS and SAS scores, and negatively correlated with the FACT-G score. The MLQ-P score was inversely correlated with the SDS and SAS scores, and was positively correlated with the FACT-G score. Logistic regression analysis indicated that the AAQ-II, CFQ, and MLQ-P were independent risk factors for quality of life. Depression and anxiety are ubiquitous in patients with thyroid cancer following surgery. The psychological flexibility of patients is significantly negatively correlated with depression and anxiety and can dramatically influence quality of life.

Effect of palliative care services on quality of life over time among gynecologic oncology patients

<h3>Objectives:</h3> Palliative Care (PC) has been shown to be a beneficial adjunct to cancer therapy. This study aimed to compare the impact on the quality of life in attending a PC appointment among gynecologic oncology patients utilizing the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire over time. <h3>Methods:</h3> A longitudinal analysis was conducted utilizing data obtained from a previous randomized control trial that evaluated the effect of an interventional video on improving PC knowledge and attendance at outpatient PC appointments in gynecologic oncology patients receiving active treatment at a single academic tertiary care center. Women were divided into two groups: those that attended PC appointments (PC group) and those that did not (no PC group). All participants completed the FACT-G questionnaire at initial enrollment and were asked to repeat the same questionnaire at 3 and 6 months electronically. Data with complete questionnaires at the 3 and 6 month time point were utilized in analysis separately. Measurement data included demographics, FACT-G, and FACT-G sub-score results. Data analyses were performed using descriptive statistics, ANOVA, and Mann Whitney rank sums tests with a significance level of α = 0.05 <h3>Results:</h3> The initial cohort included 111 patients completing the FACT-G questionnaire: 68 (61.2%) of those completed the 3-month FACT-G questionnaire (20 PC, 48 no PC), while 30 (27%) completed the 6-month questionnaire (8 PC, 22 no PC). Baseline demographics were not significantly different between the entire cohort and respondents. The majority of patients were Caucasian, never smoked, were married, had stage III disease, had ovarian cancer, were platinum-sensitive, and were treated with primary cytoreduction. There was no statistical change in longitudinal FACT-G score at 3 months [(n=68) = 0.76, p=0.39], and 6 months [(n=30) = 0.43, p=0.66] (Table 1). Secondary analysis compared PC vs no PC group FACT-G sub-scores at baseline, 3 month and 6 months: physical well-being (GP) [(n=111, p=0.02) (n=68, p=0.11) (n=30, p=0.60)], social/family well-being (GS) [(n=111, p=0.20) (n=68, p=0.40) (n=30, p=0.38, emotional well-being (GE) [(n=111, p=0.10) (n=68, p=0.07) (n=30, p=0.85)], and functional well-being (GF) [(n=111, p=0.003) (n=68, p=0.001) (n=30, p=0.73)]. There was a statistically significant difference in GF (p=0.003) and GP (0.02) sub-scores at the initial survey, with no PC group having higher scores. By the 6-month survey, the statistical significance between groups was lost in the GF (p=0.73) and GP (p=0.60) sub-scores; noting the minimal change in the no PC scores (GF 21.5 to 20.4, GP 23 to 23.5) but with improvement in the PC scores (GF 16 to 19.8, GP 18 to 20). This suggests a potential positive impact of PC on these sub-score outcomes and quality of life. <h3>Conclusions:</h3> Attending a PC appointment did not significantly improve the quality of life as assessed by FACT-G at 3 or 6-month intervals for this small cohort. However, the differences at the initial survey in the GP and GF sub-scores were no longer significant by 6 months, suggesting a positive impact of PC on these aspects. Further research should focus on investigating the effect of PC over time in a larger population as well as explore other metrics that may better identify the effect of PC on quality of life.

Kanser Tedavisinin İşlevsel Değerlendirmesi Ölçeği FACT-G Türkçe Versiyonunun Geçerlik ve Güvenilirliği

Objective: Many of the cancer-specific quality of life (QOL) questionnaires improved over the last 20 years, can be contemplated as reference measures. The Functional Assessment of Chronic Illness Therapy (FACIT) system is an based and generic health-related quality of life measures. The aim of this study was conducted to test the reliability and construct validity of the Functional Assessment of Cancer Therapy General (FACT-G) for Turkish cancer patients. Material and Methods: This research is a methodological study. The data were obtained by using the sociodemographic and the FACT-G questionnaire. The sample comprised 148 cancer pa¬tients. Data were analysed by using the SPSS package program, descriptive statistics and to assess the reliability of the scales, cronbach alpha coefficient, item total score analysis, and, item total correlation coefficient (Pearson's correlation). For the construct validity of the instrument; exploratory factor analysis and confirmatory factor analysis were used. Results: The mean total score of FACT-G was 60.71±14.42, and for the physical, social/ family, emotional and functional well-being subscales 15.83±5.48, 13.91±4.90, 13.45±5.03 and 17.51± 5.04, respectively. The alpha coefficient was 0.88 for the global scale of the FACT-G questionnaire and ranged from 0.70 to 0.79 across subscales. A statistically significant positive correlation was found between FACT-G and test-retest scores of the four sub-dimensions (p=0.001). Conclusion: In this study, as a result of evaluating the psychometric properties of the FACT-G scale, the scale is a valid and reliable tool for use in Turkish patients with cancer.