Global Health-related Quality Of Life Scores Research Articles

Determinants of health-related quality of life among patients with Ischemic heart disease

ABSTRACT Objective The aim of this study was to assess determinants of Health-Related Quality of Life (HRQOL) among Ischemic Heart Disease (IHD) patients. Materials It was a prospective study, carried out in ”cardiology A” department in Fattouma Bourguiba teaching hospital in Monastir, Tunisia. Data were obtained during hospitalisation (T0) through structured interviews. HRQOL was evaluated one month after discharge (T1) using the French version of MacNew questionnaire. Results The mean age of the population was 51.92 ±6.4 years. The global HRQOL score was 4.80 ±0.95. In multivariate analysis, Global HRQOL had a significant positive association with in-hospital stay (β=0.440, p=0.004), number of children in charge (β=0.312, p=0.046) and type 2 diabetes (β=0.396, p=0.008) and a significant negative association with smoking pack¬/years (p/y) (β=-0.424, p=0.008). Conclusion This study showed several factors that may affect HRQOL in IHD patients. Identifying these factors can provide early detection of patients who tend to have worse HRQOL post-IHD.

The Relationships between Physical and Emotional Symptoms and Health-Related Quality of Life of Patients after Percutaneous Coronary Intervention

Background: Percutaneous coronary intervention (PCI) for myocardial infarction patients has been shown to provide outstanding results, yet research has shown that patient quality of life varies. However, few studies have been done on the physical and emotional symptoms that impact health-related quality of life (HRQoL) of patients who have undergone PCI.Purpose: This study aimed to identify physical (fatigue, angina, dyspnea) and emotional (stress, anxiety, depression) symptoms related to HRQoL of myocardial infarction patients after PCI.Methods: This study used a cross-sectional approach. A total of 154 patients, who were recruited using a purposive sampling method, participated in this study. The Fatigue Assessment Scale (FAS), the Seattle Angina Questionnaire-7 (SAQ-7), the Dyspnea scale (modified MRC score), the Depression, Anxiety, Stress Scale 21 (DASS-21), and the MacNew Quality of Life Questionnaire were all used to collect the data. Linear regressions were used to analyze the data.Results: The mean of the global HRQoL score was 5.11(0.90). Results on physical symptoms showed that a total of 49.4% of participants reported fatigue; the mean angina score was 69.6(12.06), and the mean score of dyspnea level was 0.63(0.92). Emotional symptoms reported that stress was at an average level (83.1%), anxiety was at a moderate level (63%), and depression was at a standard level (72.7%). The multiple linear regression analyses revealed fatigue (β=-0.22), angina (β=0.30), and anxiety (β=-0.32) as the factors related to HRQoL.Conclusion: Despite having a PCI after an acute myocardial infarction, the patients’ HRQoL was above the middle score. It was discovered that anxiety, angina, and fatigue predicted HRQOL in patients with myocardial infarction after PCI.

Factors associated with quality of life among patients with a newly diagnosed oral cavity and oropharyngeal cancer

PurposeThe objectives of this report were 1) to examine the quality of life (QOL) of patients with a newly diagnosed oral cavity or oropharyngeal (OCOP) cancer; and 2) to examine factors contributing to QOL before cancer treatment. MethodsThe sample included 115 participants with a new diagnosis of OCOP cancer. Participants completed the demographic form, oral cancer disease and treatment form, Hospital Anxiety and Depression Scale (HADS), Brief Health Literacy Screen (BHLS), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Pearson correlations and linear regressions were used for data analysis. ResultsParticipants had a median global health related QOL score of 66.7 (interquartile range, IQR = 50.0, 83.4) with median scores for the subdomains being generally high (all >80 of possible 100). Anxiety and depression were significantly inversely correlated with all areas of EORTC QOL (r = - 0.48 to −0.78, all p < .001). Multivariable associations were strongest with the physical functioning domain (R = 0.56, p < .001), with younger age, higher income, Stage I/II cancer (compared to Stage III/IV) significant contributors to the multiple correlation (beta > ± 0.20, p < .05). ConclusionsHealth care providers should be attentive to OCOP cancer patients with older age, lower household income, advanced cancer stage, and presence of anxious and/or depressive symptoms for indicators of poor QOL. Clinicians should consider the benefit ofinitiating supportive interventions before cancer treatment among OCOP cancer patients with poor QOL.

Health-related Quality of Life of Children with Gastro-oesophageal Reflux Disease after Nissen Fundoplication and Gastrostomy Tube Insertion

Introduction: Severe gastro-oesophageal reflux disease (GERD) is associated with a poor health-related quality of life (HRQoL). Nissen fundoplication is the most common surgical procedure for patients with GERD. A feeding gastrostomy tube may be inserted at the same time in selected patients where there are unsafe swallowing and/or feeding difficulties. The goals of surgery are to eliminate symptoms, prevent reflux complications and ultimately improve the quality of life. The main objective of this study was to assess the HRQoL of children with GERD after Nissen fundoplication and gastrostomy tube insertion. Materials and Methods: This was an observational retrospective cohort study at two private, not-for-profit tertiary hospitals in Nairobi. The study population included children under 18 years of age with GERD who had Nissen fundoplication with or without gastrostomy tube insertion from January 2010 to December 2020. The quality of life was assessed from the caretakers using the Paediatric Quality of Life Inventory applied through a telephone call. Data analysis was done using SPSS version 26. The HRQoL was summarised using mean and standard deviation (SD) with a 95% confidence interval (CI) around the scores. Independent samples t-test was conducted to compare the means of HRQoL for gender, complications and comorbidities. Spearman’s correlation was done for HRQoL and age. Results: Eighty-two children were included in the study. Eighty-four per cent had comorbidities, with almost three-quarters of them having neurological impairment. Majority (91%) had open Nissen fundoplication, while 9% had laparoscopic Nissen fundoplication. One-third of these children reported complications post-procedure. Nissen fundoplication failure rate was 10%. Two-thirds had a concurrent gastrostomy tube insertion. The global mean HRQoL score was 75.8 (SD: 23.5, 95% CI: 70.4–81.2). Gastrostomy tube insertion had no impact on the quality of life. Children with neurological impairment had significantly lower quality of life than those without neurological impairment. Conclusion: The global score of the HRQoL following Nissen fundoplication in this cohort of children was 75.8. Further studies to reduce the proportion of children who experience complications postoperatively in this setting are required.

Health‐related quality of life of patients with sickle cell disease aged 8–17 years at Kamuzu Central Hospital, Malawi

Sickle cell disease (SCD) is characterized by both acute and chronic complications that affect the daily lives of patients and lower their quality of life. To describe the health-related quality of life (HRQoL) and the associated factors in children aged 8-17 years with SCD attending the pediatric hematology clinic at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi. A mixed-methods cross-sectional study was conducted at KCH. Patient data were collected with the aid of a standardized case report form. HRQoL was assessed using PedsQL™ Sickle Cell Disease Module by the child's report. Associations between HRQoL scores and independent variables were evaluated by a linear regression model. In-depth interviews were then carried out and the qualitative data were analyzed using content thematic analysis. A hundred and sixty-three children with SCD were enrolled and 52.1% were females. Their median age was 11.2±2.7 years. The mean global HRQoL score of the children was 62 ±17.3. The highest scores were in the treatment domain (72.5±15.1) while the lowest scores were in the emotions domain (55.2±28.7). The mean pain score was 58.8±16.3. The factors associated with low HRQoL scores were pain (β-coefficient -6.97 CI (-3.07,-15.58); p value .034) and low hemoglobin levels (β-coefficient 2.29 CI (.65-3.91); p value .006). The HRQoL of this population is low. Pain and low hemoglobin were significantly associated with low HRQoL scores. Adequate treatment to control pain and increase the steady-state hemoglobin may improve the HRQoL of children with SCD. Interventions to address low emotional scores are recommended.

Factors associated with baseline quality of life in patients with oral cavity and oropharyngeal cancer.

e18079 Background: Baseline quality of life (QOL) predicts for survival in head and neck cancer patients. The purpose of this study was to identify factors contributing to baseline QOL in patients with newly diagnosed oral cavity or oropharyngeal cancer (OCOPC) in order to identify potential targets for intervention. Methods: 115 patients with OCOPC completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, Hospital Anxiety and Depression Scale, and Brief Health Literacy Screen (BHLS). Pearson correlation and ANOVA statistics were used to analyze the data. Results: The median global health-related QOL score was 66.7 (IQR: 50, 83.4); 35.7% of participants reported anxiety and 18.3% reported depressive symptoms (HADS ≥8); 30.8% of patients had BHLS values of ≤ 9. Factors associated with significant decrease in global health-related QOL score: household income of &lt; $20,000/year (p = .010); low health literacy (p = .021); having symptoms of anxiety (p &lt; .001); having depressive symptoms (p &lt; .001); and non-HPV associated cancer (p &lt; .001). Increased tumor stage, older age, single/widowed marital status, and unemployment were associated with the lower scores on the physical QOL subscale (p &lt; .05). Increased tumor stage was associated with lower scores on role and social QOL subscales (p &lt; .05), and younger age was associated with lower scores on emotional QOL subscale (p &lt; .05). Conclusions: Baseline QOL is associated with socioeconomic and disease-related determinants. Clinical trial information: NCT02412241.

Relationship between "Blue Space" Proximity and Children's Weight Status, Health Behaviors, and Health-Related Quality of Life among a Sample of Regional Victorian Primary School Children.

Background: Access to green space (e.g., parks and gardens) has been associated with child health and wellbeing, whereas blue space (e.g., coasts, lakes, and rivers) is understudied. Our aim was to determine whether proximity to the coast was associated with primary school children's weight status, modifiable health-related behaviors, and health-related quality of life (HRQoL). Methods: Exploratory cross-sectional analysis of baseline data from the Whole of Systems Trial of Prevention Strategies for Childhood Obesity (WHOSTOPS) study, to estimate gender-specific differences in weight and behaviors across four bands of distance from the coast (<5 km, 5 to <25 km, 25 to <50 km, ≥50 km). Linear and logistic models, with robust standard errors, adjusted for school year level, area-level socioeconomic position and rurality, and allowing for distance by gender interaction were fitted on data from 1216 children (aged 8.5-13 years). Main outcomes were weight status (categorical), physical activity (PA) (categorical), and global HRQoL score (continuous). Results: Compared with girls living in towns ≥50 km from the coast, those living within 5 km had lower odds for overweight/obesity [odds ratio (OR) = 0.50; 95% confidence interval (CI): 0.37-0.67] and higher mean moderate-to-vigorous PA minutes (accelerometry) (β = 8.7; 95% CI: 2.0-15.5) and global HRQoL (β = 3.2; 95% CI: 1.4-5.0). Compared with boys living ≥50 km from the coast, those living within 5 km had higher odds of meeting self-reported PA guidelines (≥60 minutes/day) for ≥5 days (OR = 2.33; 95% CI: 1.75-3.10), and higher mean global HRQoL scores (β = 5.6; 95% CI: 1.9-9.3). Conclusions: Living close to the coast was associated with some favorable health outcomes and behaviors, which differed between girls and boys.

Association between skeletal muscle mass and quality of life in adults with cancer: a systematic review and meta-analysis.

Low skeletal muscle mass is known to be associated with poor morbidity and mortality outcomes in cancer, but evidence of its impact on health‐related quality of life (HRQOL) is less established. This systematic review and meta‐analysis was performed to investigate the relationship between skeletal muscle mass and HRQOL in adults with cancer. Five databases (Ovid MEDLINE, Embase via Ovid, CINAHL plus, Scopus, and PsycInfo) were systematically searched from 1 January 2007 until 2 September 2020. Studies reporting on the association between measures of skeletal muscle (mass and/or radiodensity) derived from analysis of computed tomography imaging, and a validated measure of HRQOL in adults with cancer, were considered for inclusion. Studies classifying skeletal muscle mass as a categorical variable (low or normal) were combined in a meta‐analysis to investigate cross‐sectional association with HRQOL. Studies reporting skeletal muscle as a continuous variable were qualitatively synthesized. A total of 14 studies involving 2776 participants were eligible for inclusion. Skeletal muscle mass classified as low or normal was used to dichotomize participants in 10 studies (n = 1375). Five different cut points were used for classification across the 10 studies, with low muscle mass attributed to 58% of participants. Low muscle mass was associated with poorer global HRQOL scores [n = 985 from seven studies, standardized mean difference −0.27, 95% confidence interval (CI) −0.40 to −0.14, P < 0.0001], and poorer physical functioning domain HRQOL scores (n = 507 from five studies, standardized mean difference −0.40, 95% CI −0.74 to −0.05, P = 0.02), but not social, role, emotional, or cognitive functioning domain scores (all P > 0.05). Five studies examined the cross‐sectional relationship between HRQOL and skeletal muscle mass as a continuous variable and found little evidence of an association unless non‐linear analysis was used. Two studies investigated the relationship between longitudinal changes in both skeletal muscle and HRQOL, reporting that an association exists across several HRQOL domains. Low muscle mass may be associated with lower global and physical functioning HRQOL scores in adults with cancer. The interpretation of this relationship is limited by the varied classification of low muscle mass between studies. There is a need for prospective, longitudinal studies examining the interplay between skeletal muscle mass and HRQOL over time, and data should be made accessible to enable reanalysis according to different cut points. Further research is needed to elucidate the causal pathways between these outcomes.

Time from Diagnosis and Correlates of Health-Related Quality of Life among Young Adult Colorectal Cancer Survivors.

Simple SummaryYoung adult survivors of colorectal cancer often undergo intensive and multimodal cancer therapy and may experience impairments in health-related quality of life. However, knowledge regarding the impacts of colorectal cancer on the quality of life of young adults is limited. This study aimed to characterize overall health-related quality of life among young adult colorectal cancer survivors within 36 months of their diagnosis or relapse, to compare those who are shorter versus longer time from initial diagnosis or relapse, and to examine correlates across the distinct domains of quality of life. Such information can inform the development of life stage-appropriate counseling and interventions to maintain and improve health-related quality of life following a colorectal cancer diagnosis for this at-risk patient population.The incidence of colorectal cancer (CRC) is rising among young adults. Health-related quality of life (HRQoL) in survivorship is not well-described in this population. We assessed HRQoL among young adult CRC survivors diagnosed from age 18–39 (AYAs) to examine differences by time from diagnosis, and to identify key correlates. A cross-sectional online survey was administered in collaboration with a national patient advocacy organization. The Functional Assessment of Cancer Therapy (FACT-C) was used to measure HRQoL, which assesses HRQoL globally and across 4 domains: emotional, physical, social, and functional. T-tests were conducted to compare HRQoL between survivors who were 6–18 months versus 19–36 months from diagnosis or relapse and multiple linear regression was conducted to identify correlates. The sample (n = 196) had a mean age of 32.2(SD ± 4.5); 116 (59.9%) were male; and the self-reported tumor location was colon (39.3%) or rectal (60.7%). The majority (56.4%) were diagnosed with stage 2 disease; 96.9% were non-metastatic. The mean global HRQoL score was 67.7 out of a possible score of 136. Across domains, mean scores were low. Emotional and physical well-being were significantly higher among survivors who were 19–36 months from diagnosis/relapse compared to those 6–18 months from diagnosis/relapse. Longer time from diagnosis and older current age were associated with higher HRQoL, while more intensive treatment and higher clinical disease stage were negatively associated, particularly in the emotional and physical domains. Overall, HRQoL was low in this population, and further research is needed to inform age-appropriate interventions to improve HRQoL for AYA CRC survivors.

Health related quality of life of Icelandic patients six months after coronary heart disease incidence

Abstract Funding Acknowledgements Regional Development Institute, Landspitali, Akureyri Hospital; University of Akureyri, Icelandic Nursing Association, KEA, Akureyri Heart Association OnBehalf KRANS-Study research group Background Patients with coronary heart disease (CHD) are likely to have impaired health-related quality of life (HRQoL) due to functional and emotional effects of the disease. Research suggests that HRQoL is an indicator of CHD patient’s health and it has been associated with self-care and risk factor management. Purpose The aim of this study was to assess HRQoL of Icelandic patients with CHD, six months after coronary heart disease incidence and to identify associated factors. Methods Cross-sectional study design was used. Participants were admitted to two main hospitals in Iceland. Data was collected with questionnaires and from patient records in the years 2018 to 2019. HRQoL was assessed with The HeartQoL questionnaire, which comprises 14-items with 10-item physical and 4-item emotional subscales which are scored from 0 (poor) to 3 (better) HRQoL and a global score. Data was analyzed with descriptive and inferential statistics. Results Data from 366 patients with CHD will be presented. Preliminary data analysis shows that patients, (mean age 64 years (SD 8.8), 81% male), had mean global HRQoL score of 2.3 (SD = 0.6). The physical score measured 2.2 (SD = 0.7) and the emotional score 2.4 (SD = 0.7). The mean global HRQoL score were lower in women (t(364) =3.7, p &amp;lt; 0.001) and so were the physical score (t(364) =3.8, p &amp;lt; 0.001). However, the emotional score did not differ between the genders (t(363) =1.9, p = 0.061). Low income patients had lower HRQoL (p &amp;lt; 0.001). While physical HRQoL decreased with age (β= -0.12, p = 0.006), emotional HRQoL increased (β=0.14, p = 0.001). Better HRQoL was associated with more physical activity on global (β=0.28, p &amp;lt; 0.001), emotional (β=0.16, p = 0.001) and physical (β=0.36, p &amp;lt; 0.001) scales. Association between HRQoL and other risk factor profiles will be presented. Conclusion Our findings suggest that among patients with CHD physical activity is associated with better HRQoL. This emphasizes the importance of cardiac rehabilitation and physical activity after discharge from hospital. Special attention should be given to follow up of women and low-income groups.

Recovery of health-related quality of life in patients undergoing robot-assisted radical cystectomy with intracorporeal diversion.

To report the health-related quality of life (HRQoL) after robot-assisted radical cystectomy and intracorporeal urinary diversion (iRARC), and to identify factors impacting on return to baseline. Consecutive patients undergoing iRARC between January 2016 and December 2017 completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 30-item core (EORTC-QLQ-C30) and EORTC-QLQ-Muscle-Invasive Bladder Cancer Module (EORTC-QLQ-BLM30) questionnaires before surgery and had a minimum of 12 months follow-up postoperatively. A total of 76 patients met the inclusion criteria at 12 months. Neobladder (NB) cases (n = 24) were younger (57.0 vs 71.0 years, P < 0.001) and fitter than ileal conduit (IC) cases (n = 52), and had higher physical (100.0 vs 93.3, P = 0.039) and sexual functioning (66.7 vs 50.0, P = 0.013) scores at baseline. Longitudinal analysis of the EORTC-QLQ-C30 showed that physical (NB: 93.3 vs 100.0, P = 0.020; IC: 80.0 vs 93.3, P < 0.001) and role functioning scores (NB: 83.3 vs 100.0, P = 0.010; IC: 83.3 vs 100.0, P = 0.017) decreased and fatigue score (NB: 22.2 vs 11.1, P = 0.026; IC: 33.3 vs 22.2, P = 0.008) increased at 3 months in both diversion groups. Scores returned to baseline at 6 months except physical functioning score in IC patients that remained below baseline until 12 months (86.7 vs 93.3, P = 0.012). The global HRQoL score did not show significant change postoperatively in both groups. A major 90-day Clavien-Dindo complication was a significant predictor (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.02-0.62; P = 0.012) of deteriorated global HRQoL score at 3 months, while occurrence of a late complication (OR 0.14, 95% CI 0.03-0.65; P = 0.013) was a predictor of deteriorated global HRQoL score at 12 months. Longitudinal analysis of the EORTC-QLQ-BLM30 showed that urinary problems (NB: 14.3 vs 38.3, P < 0.001; IC: 5.6 vs 19.1, P < 0.001) and future perspective (NB: 33.3 vs 44.4, P = 0.004; IC: 22.2 vs 44.4, P < 0.001) scores were better than baseline at 3 months. Sexual function deteriorated significantly at 3 months (NB: 8.3 vs 66.7, P < 0.001; IC: 4.2 vs 50.0, P < 0.001) and then showed improvement at 12 months but was still below baseline (NB: 33.3 vs 66.7, P = 0.001; IC: 25.0 vs 50.0, P < 0.001). Involvement in penile rehabilitation was shown to be a significant predictor (β 18.62, 95% CI 6.06-30.45; P = 0.005) of higher sexual function score at 12 months. While most functional domains and symptoms scales recover to or exceed baseline within 6 months of iRARC, physical function remains below baseline in IC patients up to 12 months. Global HRQoL is preserved for both types of urinary diversion; however, postoperative complications seem to be the main driving factor for global HRQoL. Sexual function is adversely affected after iRARC suggesting that structured rehabilitation of sexual function should be an integral part of the RC pathway.

In spite of successful curative surgery for buccal mucosa carcinoma the health-related quality-of-life continues to remain poor.

In early stage buccal mucosa carcinoma, in spite of successful curative surgery, the health-related quality-of-life (HRQoL) may not improve. We aimed to study HRQoL in these patients who had undergone successful curative surgery and determined factors that influence the HRQoL. Subjects, aged 18-70years, who had undergone successful curative surgery for stage I and II buccal mucosa cancer, were assessed for HRQoL using the University of Washington Quality of Life Questionnaire and factors affecting HRQoL were determined. Their scores were compared with normative reference scores. 54 patients (stages I 54%, II 46%) aged 44 ± 11years (87% males) were studied. They had undergone curative surgery a median of 8.5 (IQR 4-13.5) months ago. Their mean global HRQoL score was 77 ± 30, with significantly poorer scores compared to reference in domains of appearance, activity, swallowing, chewing, speech, shoulder, saliva, mood and anxiety. Anxiety, activity, and chewing were considered the most important domains by the patients. Among the factors influencing HRQoL, duration since surgery was the most important factor, and patients with recent surgery had worse performance in chewing, saliva and mood. Patients with stage II had worse performance in shoulder and anxiety compared to stage I. Post-operative radiotherapy worsened swallowing and shoulder function. In spite of successful curative surgery for buccal mucosa carcinoma, the HRQoL continues to remain sub-optimal with poor scores in most of the domains. These domains must be focused on with appropriate measures in order to improve overall HRQoL in patients after successful curative surgery.

Health-related quality of life and time from diagnosis among young adult colorectal cancer survivors.

34 Background: Incidence of colorectal cancer (CRC) in patients under 50 years of age is rising. Quality of life in survivorship is not well-described in this population. We compared health-related quality of life (HRQoL) in CRC survivors ≤ 50 years old who were 6-18 months or 19-36 months from initial diagnosis or relapse. Methods: A cross-sectional online survey was administered in collaboration with a national organization for young CRC survivors. The Functional Assessment of Cancer Therapy (FACT-C) was used to measure HRQoL, which assesses HRQoL globally, including a CRC specific scale, and emotional, physical, social, and functional well-being domains. T-tests were conducted to compare HRQoL between survivors who were 6-18 months versus 19-36 months from diagnosis/relapse. Results: This sample (n=308) had a mean age of 33.76 SD±6.68; 201 (65.3%) were male; tumor location was colon or rectal in 41.7% and 58.3%, respectively. The majority (55.23%) were diagnosed with stage 2 disease; 98.0% were non-metastatic. 42.2% experienced relapse; 25% had an ostomy. Most survivors were 6-18 months (N=189; 61.4%) from diagnosis/relapse, and key demographics and disease characteristics did not significantly differ between those who were shorter versus longer time from diagnosis/relapse. The mean global HRQoL score was 67.3 out of a possible score of 136. Across domains, scores were low, with social well-being the highest (15.15/28) and emotional well-being the lowest (11.44/24). Social well-being was significantly higher among survivors who were 6-18 months from diagnosis/relapse compared to those 19-36 months (15.98 for 6-18 months vs. 13.83 for 19-36; p&lt;0.01), as was functional well-being (13.20 for 6-18 months vs. 11.12 for 19-36; p&lt;0.01). Emotional well-being and physical well-being did not significantly differ between groups. Conclusions: Overall HRQoL scores were low among younger CRC survivors, and social and functional well-being were significantly worse for those longer from diagnosis. Appropriate counseling and other targeted interventions are necessary to maintain HRQoL over time in this at-risk population. [Table: see text]

Long-term health-related quality of life following colorectal cancer surgery: patient-reported outcomes in a remote follow-up population.

Remote follow-up (RFU) after colorectal cancer (CRC) surgery allows delivery of surveillance tests without the need for regular outpatient clinical appointments. However, little is known about health-related quality of life (HRQoL) in RFU patients. The main aim of this study was to quantify HRQoL in our RFU population to identify particular patient groups that may benefit from a more personalised approach to follow-up, including access to a survivorship clinic. EQ-5D, QLQ-C30 and QLQ-C29 questionnaires were distributed to CRC patients enrolled in a RFU programme. The primary outcome of HRQoL scores was analysed by year of RFU, demographics, operation type, stoma and adherence to RFU protocols. A total of 428 respondents were included, with a mean age of 71years (SD 10.1years) and a median RFU time of 2.6years [interquartile range (IQR) 1.6-4.8years]. 'Perfect health' was reported by 26.6% of patients. The median EQ-5D index score was 0.785 (IQR 0.671-1) and the median QLQ-C30 Global HRQoL score was 75 (IQR 58.3-83.3). Women had a significantly lower EQ-5D median score of 0.767 (IQR 0.666-0.879, P=0.0088). Lower QLQ-C30 HRQoL scores were seen in stoma patients (median 66.6, IQR 58.3-83.3, P=0.0029). Erectile dysfunction (P=0.0006) and poor body image (P=0.001) were also reported more frequently in stoma patients. Patients undergoing right-sided resection reported a lower median EQ-5D score of 0.765 (IQR 0.666-0.879, P=0.028) and higher pain severity (P=0.0367) compared with left-sided resections. There were 128 (29.4%) patients who breached RFU protocol and were seen in ad hoc colorectal clinics. However, there was no statistical difference in HRQoL between patients who adhered to or breached RFU protocols. Overall HRQoL in patients in RFU is good, with no difference in those strictly followed up remotely. However, women, patients with right-sided resection and patients with a stoma may require additional clinical reviews.

Health-Related Quality of Life Outcomes in Head and Neck Cancer: Results From a Prospective, Real-World Data Study With Brazilian Patients Treated With Intensity Modulated Radiation Therapy, Conformal and Conventional Radiation Techniques

To compare global health-related quality of life (HRQoL) and overall survival (OS) in patients with head and neck cancer treated with intensity modulated radiation therapy (IMRT), conformal radiation therapy (3DCRT) or conventional radiation therapy (2DRT). In this real-world, multi-institutional and prospective study, HRQoL outcomes were assessed using the European Organisation for Research and Treatment of Cancer Quality-of-life Questionnaire Core 30 (EORTC QLQ-C30) and European Organisation for Research and Treatment of Cancer Quality-of-life Questionnaire Head and Neck 43 (H&N43) questionnaires. Item response theory was used to generate a global HRQoL score, based on the 71 questions from both forms. The effect of treatment modality on HRQoL was studied using multivariate regression analyses. Survival was estimated using the Kaplan-Meyer method, and groups were compared by the log-rank test. Five hundred and seventy patients from 13 institutions were included. Median follow-up was 12.2 months. Concerning the radiation technique, 29.5% of the patients were treated with 2DRT, 43.7% received 3DCRT, and 26.8% were treated with IMRT. A higher proportion of patients receiving 2DRT had a treatment interruption of more than 5 days (69% vs 50.2% for 3DCRT and 42.5% for IMRT). IMRT had a statistically significant positive effect on HRQoL compared with 3DCRT (β= 2.627, standard error = 0.804, P = .001) and 2DRT had a statistically significant negative effect compared with 3DCRT (β= -5.075, standard error = 0.926, P < .001). Patients receiving 2DRT presented a worse OS (P = .01). There were no differences in OS when IMRT was compared with 3DCRT. IMRT provided better HRQoL than 3DCRT, which provided better HRQoL than 2DRT. Patients receiving 2DRT presented a worse OS, which might be related to more frequent treatment interruptions.

Health-related quality of life scores of typically developing children and adolescents around the world: a meta-analysis with meta-regression.

In the context of identifying consequences and evaluating interventions for rare diseases, health-related quality of life (HRQL) measures are often used. Conclusions about HRQL are difficult to make as the participants are likely drawn from different countries. A global estimate of HRQL with estimates of variation would permit pooling of data from diverse sources. The aim was to estimate a global HRQL score of typically developing children and adolescents on the Pediatric Quality of Life Inventory (PedsQL™) and to identify sources of variation across studies. A systematic search was conducted in December 2018 on four databases: MEDLINE, EMBASE, CINAHL and PsycINFO. Inclusion criteria were all population health studies or validation studies using the self-report version of the PedsQL™ for typically developing children aged 5 to 18years. Quality appraisal was conducted using the Appraisal Tool for Cross-Sectional Studies. Meta-analysis and meta-regression were conducted. A total of 66 studies with a sample size of 67,805 participants were included in this analysis. The average QOL score across all studies was 80.9 (CI 78.6-83.2). Univariate analyses showed that region, minimum age of sample and income of country, was associated with the total HRQL score. Subgroup analysis showed that there was an effect of age and region on HRQL scores. Results of this review provide ranges of pediatric HRQL across personal factors and regions that can be used for normative comparisons of HRQL. Interpretation of scores on generic measures should always take into consideration the contextual influences in the child's life. PROSPERO, CRD42019128313 https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42019128313 .

Quality of life, cognitive, physical and emotional function at diagnosis predicts head and neck cancer survival: analysis of cases from the Head and Neck 5000 study

PurposeThe aim of this paper is to determine whether health-related quality of life (HRQOL) at diagnosis of head and neck cancer (HNC) is associated with overall survival following treatment with curative intent after adjusting for other factors.MethodsData were collected from 5511 participants of the Head and Neck 5000 study (HN5000). HRQOL was measured using the EORTC QLQ-C30. Questionnaire and covariate data were available from 2171 participants diagnosed as follows: oral cavity (655), oropharynx HPV+ (723) and HPV− (277), and larynx (516). On average, participants were followed up 3.2 years (SD 1.2) after diagnosis. Data were adjusted for age, gender, co-morbidity, intended treatment, education level, income from benefits, smoking status and alcohol consumption.ResultsThere was a clinically meaningful difference between Global HRQOL scores at diagnosis and survival in an unadjusted and adjusted model: [HR = 0.86, CI 0.82–0.89, p < 0.001 (unadjusted) and HR = 0.90, CI 0.86–0.94, p < 0.001 (adjusted)]. In analyses stratified by tumour site and HPV status, this association was similarly noted before adjustment and persisted after. There were some tumour sub-site variations: improved survival for people with laryngeal cancer reporting higher levels of physical role or social functioning and people with oral cancer reporting higher levels of role or social functioning.ConclusionAs survival is the main priority for most people diagnosed with cancer, pre-treatment HRQOL is an additional factor to be included in risk stratification and case-mix adjustments. There is merit in incorporating HRQOL into routine clinical care as this is a useful facet in patient-clinician decision making, prognostication and recovery.

675PD - POLO: Health-related quality of life (HRQoL) of olaparib maintenance treatment versus placebo in patients with a germline BRCA mutation and metastatic pancreatic cancer (mPC)

675PD - POLO: Health-related quality of life (HRQoL) of olaparib maintenance treatment versus placebo in patients with a germline BRCA mutation and metastatic pancreatic cancer (mPC)

Effects of neratinib on health-related quality of life in women with HER2-positive early-stage breast cancer: longitudinal analyses from the randomized phase III ExteNET trial

BackgroundWe report longitudinal health-related quality-of-life (HRQoL) data from the international, randomized, double-blind, placebo-controlled phase III ExteNET study, which demonstrated an invasive disease-free survival benefit of extended adjuvant therapy with neratinib over placebo in human epidermal growth factor receptor-2-positive early-stage breast cancer. Patients and methodsWomen (N = 2840) with early-stage HER2-positive breast cancer who had completed trastuzumab-based adjuvant therapy were randomly assigned to neratinib 240 mg/day or placebo for 12 months. HRQoL was an exploratory end point. Patients completed the Functional Assessment of Cancer Therapy–Breast (FACT-B) and EuroQol 5-Dimensions (EQ-5D) questionnaires at baseline and months 1, 3, 6, 9, and 12. Changes from baseline were compared using analysis of covariance with no imputation for missing values. Sensitivity analyses used alternative methods. Changes in HRQoL scores were regarded as clinically meaningful if they exceeded previously reported important differences (IDs). ResultsOf the 2840 patients (intention-to-treat population), 2407 patients were evaluable for FACT-B (neratinib, N = 1171; placebo, N = 1236) and 2427 patients for EQ-5D (neratinib, N = 1186; placebo, N = 1241). Questionnaire completion rates exceeded 85%. Neratinib was associated with a decrease in global HRQoL scores at month 1 compared with placebo (adjusted mean differences: FACT-B total, –2.9 points; EQ-5D index, −0.02), after which between-group differences diminished at later time-points. Except for the FACT-B physical well-being (PWB) subscale at month 1; all between-group differences were less than reported IDs. The FACT-B breast cancer-specific subscale showed small improvements with neratinib at months 3–9, but all were less than IDs. Sensitivity analyses exploring missing data did not change the results. ConclusionsExtended adjuvant neratinib was associated with a transient, reversible decrease in HRQoL during the first month of treatment, possibly linked to treatment-related diarrhea. With the exception of the PWB subscale at month 1, all neratinib-related HRQoL changes did not reach clinically meaningful thresholds. ClinicalTrials.gov: NCT00878709.

Life after surgical resection of a meningioma: a prospective cross-sectional study evaluating health-related quality of life

Few studies have evaluated the health-related quality of life (HRQoL) of patients with meningiomas. Here, we report the largest prospective, longitudinal cross-sectional cohort study of HRQoL in meningiomas to date, in order to identify possible actionable determinants of global HRQoL. Adults who had undergone resection of a grade I intracranial meningioma and were in routine follow-up at a single large tertiary center underwent HRQoL assessment using the QLQ-C30 questionnaire administered opportunistically at follow-up visits. Averaged transformed QLQ-C30 scores at 12-month intervals were compared with scores from a normative reference population, with reference to known minimal clinically meaningful difference (CMD) in scores. To evaluate for possible determinants of changes in global HRQoL, global HRQoL scores were correlated (Spearman's Rho) with subdomain and symptom scores and with interval time from surgical resection. A total of 291 postoperative patients with histologically confirmed and surgically treated grade I meningiomas consented to participation and a total of 455 questionnaires were included for analysis. Patients with meningiomas reported reduced global HRQoL at nearly every 12-month interval with clinically and statistically significant impairments at 12, 48, 108, and 120 months postoperative compared with the normative population (P < 0.05). Meningioma patients at the 12-month interval also reported a reduction of each subdomain of HRQoL assessment (P < 0.05); however, a CMD was only seen in cognitive functioning. Physical, emotional, cognitive, and social subdomains, as well as fatigue and sleep/insomnia, were significantly associated with global HRQoL at the first 12-month interval. Overall, there was no significant correlation between time from surgery and global HRQoL or the subdomain functional or symptom sections of the QLQ-C30. Meningioma patients report considerable limitations in HRQoL for more than 120 months after surgery, particularly in cognitive, emotional, and social function, as well as suffering significant fatigue and sleep impairment compared with a normative reference population. The majority of these reported functional impairments and symptoms are strongly associated with global HRQoL and thus can be considered determinants of global HRQoL that if treated, have the potential to improve HRQoL for our meningioma patients. This hypothesis requires future study of targeted interventions to determine their efficacy.