Health-related Quality Of Life Care Research Articles

The effects of oral nutritional supplements on functional outcomes and body composition in patients with solid cancer undergoing systemic chemotherapy: A pilot study.

10074 Background: Cancer cachexia is a complex syndrome characterized by significant weight loss and depletion of skeletal muscle mass. Despite its profound impact on the well-being of cancer patients, the effective management of cancer cachexia remains a challenging and underexplored aspect of oncology. This study aims to investigate the potential benefits of oral nutritional supplements (ONS) to cancer patients undergoing chemotherapy. Methods: This is single-arm, prospective pilot study. Patients with cancer cachexia undergoing chemotherapy were included. Patients received ONS twice a day for 8 weeks. The ONS contained 200 kcal, 22.5 gram of carbohydrates, 7.5 gram of fat, and 12.5 gram of protein per 200 mL. Primary endpoints were improvements of lean body mass and physical performance. The secondary endpoints were changes of health-care related quality-of-life (HRQoL), nutritional status, and gut microbiomes profiles. EORTC-QLQ-C30 questionnaire, body composition analysis, 4-meter-walk test, hand grip strength test, and fecal microbiome analysis were conducted at baseline and after 8 weeks. The bacterial 16S rRNA gene (V3 and V4 region) was amplified using PCR and sequenced on the Illumina MiSeq platform. The QIIME 2 pipelines were used to analyze the raw data. Results: From January 2023 to October 2023, total of 10 patients were included. There were no significant differences of the mean daily energy intake (p=0.62) and calf-circumferences (p=0.2) between baseline and after 8 weeks. However, participants exhibited a statistically significant improvement in hand-grip strength (p=0.002) and 4-meter walk test (p=0.021) after 8 weeks. In the body composition analysis using dual-energy X-ray absorptiometry, no differences were observed in body weight (p=0.43), fat mass (p=0.62), fat-free mass (p=0.27), and fat-free mass index (p=0.38). Also, no significant differences were detected in the results of HRQoL survey (p=0.85). In the microbiome analysis, no differences of microbiome composition at phylum and genus levels, α-diversity, and β-diversity were observed between baseline and after 8 weeks. Conclusions: While ONS have shown potential in enhancing physical functions of patients with cancer cachexia undergoing chemotherapy, this did not correlate with the anticipated microbiome changes or improvements in body composition. The absence of expected microbiome alterations, despite enriched protein and dietary fiber, underscores the complexity of cachexia and indicates that its management may extend beyond nutritional supplementation alone. Further research should explore the broader context of cachexia, including nutrition, metabolic processes, and the impact of chemotherapy.

Scaling-up an evidence-based intervention for family carers of people with dementia: Current and future costs and outcomes.

The STrAtegies for RelaTives (START) intervention is effective and cost-effective in supporting family carers of people with dementia. It is currently not available to all eligible carers in England. What would be the impacts on service costs and carer health-related quality of life if START was provided to all eligible carers in England, currently and in future? Effectiveness and cost-effectiveness data from a previously conducted randomised controlled trial were combined with current and future projections of numbers of people with newly diagnosed dementia to estimate overall and component costs and health-related quality of life outcomes between 2015 (base year for projections) and 2040. Scaling-up START requires investments increasing annually but would lead to significant savings in health and social care costs. Family carers of people with dementia would experience improvements in mental health and quality of life, with clinical effects lasting at least 6years. Scaling up the START intervention to eligible carers was estimated to cost £9.4 million in 2020, but these costs would lead to annual savings of £68 million, and total annual quality-adjusted life year (QALY) gains of 1247. Although the costs of START would increase to £19.8 million in 2040, savings would rise to £142.7 million and Quality adjusted life years gained to 1883. Scaling-up START for family carers of people with dementia in England would improve the lives of family carers and reduce public sector costs. Family carers play a vital part in dementia care; evidence-based interventions that help them to maintain this role, such as START, should be available across the country.

OP20 Carer Health-Related Quality of Life in Health Technology Assessments: Process Recommendations for Determining Relevance, Data Collection, and Inclusion in Health-Economic Models

OP20 Carer Health-Related Quality of Life in Health Technology Assessments: Process Recommendations for Determining Relevance, Data Collection, and Inclusion in Health-Economic Models

Modelling Spillover Effects on Informal Carers: The Carer QALY Trap.

The provision of informal (unpaid) care can impose significant 'spillover effects' on carers, and accounting for these effects is consistent with the efficiency and equity objectives of health technology assessment (HTA). Inclusion of these effects in health economic models, particularly carer health-related quality of life (QOL), can have a substantial impact on net quality-adjusted lifeyear (QALY) gains and the relative cost effectiveness of new technologies. Typically, consideration of spillover effects improves the value of a technology, but in some circumstances, consideration of spillover effects can lead to situations whereby life-extending treatments for patients may be considered cost ineffective due to their impact on carer QOL. In this piece we revisit the classic 'QALY trap' and introduce an analogous 'carer QALY trap' which may have practical implications for economic evaluations where the inclusion of carer QOL reduces incremental QALY gains. Such results may align with a strict QALY-maximisation rule, however we consider the extent to which this principle may be at odds with the preferences of carers themselves (and possibly society more broadly), potentially leading decision makers into the carer QALY trap as a result. We subsequently reflect on potential solutions, highlighting the important (albeit limited) role that deliberation has to play in HTA.

Health-Related Quality of Life and Healthcare Resource Use: Comparison of Patients with Bipolar I Disorder and Potentially Misdiagnosed Depression

AbstractBackgroundBipolar I disorder (BP-I) is associated with a high humanistic and economic burden. Evidence suggests that BP-I is often misdiagnosed as major depressive disorder (MDD), but the unmet needs associated with BP-I misdiagnosis are unknown. This study compares socioeconomic, healthcare-related quality of life (HRQoL), and healthcare resource utilization (HRU) burdens of participants diagnosed with BP-I vs participants who screened as probable for BP-I but were diagnosed only with MDD.MethodsUsing responses to the 2020 National Health and Wellness Survey, respondents were categorized into cohorts of potentially misdiagnosed BP-I (i.e., self-reported physician diagnosis of MDD but screened as probable BP-I [mBP-I]) or BP-I (i.e., self-reported physician diagnosis of BP-I, stratified by BP-I severity). Baseline characteristics were evaluated using bivariate analyses. HRQoL (Short Form-36v2 Health Survey [SF36v2] mental and physical component scores, EuroQol Five-Dimension Visual Analogue Scale [EQ-5D VAS]), HRU, were evaluated using multivariable analyses adjusting for key baseline differences.ResultsThere were 302 respondents in the mBP-I cohort and 818 in the BP-I cohort (mild=336, moderate=285, severe=197). Adults with mBP-I were similar in age and level of depression and anxiety to those with moderate and severe BP-I. With respect to HRQoL, the mBP-I cohort had significantly worse SF36v2 mental component scores and EQ-5D VAS scores vs the mild BP-I cohort (31.3 vs 40.3 [P<.001] and 60.6 vs 69.4 [P=.01], respectively) and statistically similar scores vs the moderate BP-I cohort. SF36v2 physical component scores were statistically similar to those of the mild BP-I cohort. Respondents with mBP-I reported similar rates of provider (5.5 vs 6.1 [P=.63]) and ER visits (.34 vs .40 [P=.59]) to patients with mild BP-I (but significantly fewer hospitalizations: .08 vs .19 [P=.03]).ConclusionsRespondents with mBP-I exhibited similar HRQoL scores to those with mild to moderate BP-I. As expected for patients without a formal BP-I diagnosis, HRU was lower for mBP-I patients than moderate or severe BP-I, but comparable with mild BP-I. These results suggest that patients with potentially misdiagnosed BP-I may experience considerable HRQoL and HRU burdens akin to those of patients with mild to moderate BP-I.FundingAbbVie

Design, Analysis, and 3D Printing of a Patient-Specific Polyetheretherketone Implant for the Reconstruction of Zygomatic Deformities.

The reconstruction of craniomaxillofacial deformities, especially zygomatic bone repair, can be exigent due to the complex anatomical structure and the sensitivity of the crucial organs involved. The need to reconstruct the zygomatic bone in the most precise way is of crucial importance for enhancing the patient outcomes and health care-related quality of life (HRQL). Autogenous bone grafts, despite being the gold standard, do not match bone forms, have limited donor sites and bone volume, and can induce substantial surgical site morbidity, which may lead to adverse outcomes. The goal of this study is to provide an integrated approach that includes various processes, from patient scanning to implant manufacture, for the restoration of zygomatic bone abnormalities utilizing Polyetheretherketone (PEEK) material, while retaining adequate aesthetic and facial symmetry. This study takes an integrated approach, including computer-aided implant design using the mirror reconstruction technique, investigating the biomechanical behavior of the implant under loading conditions, and carrying out a fitting accuracy analysis of the PEEK implant fabricated using state-of-the-art additive manufacturing technology. The findings of the biomechanical analysis results reveal the largest stress of approximately 0.89 MPa, which is relatively low in contrast to the material's yield strength and tensile strength. A high degree of sturdiness in the implant design is provided by the maximum value of strain and deformation, which is also relatively low at roughly 2.2 × 10-4 and 14 µm. This emphasizes the implant's capability for load resistance and safety under heavy loading. The 3D-printed PEEK implant observed a maximum deviation of 0.4810 mm in the outside direction, suggesting that the aesthetic result or the fitting precision is adequate. The 3D-printed PEEK implant has the potential to supplant the zygoma bone in cases of severe zygomatic reconstructive deformities, while improving the fit, stability, and strength of the implant.

HTA10 Carer Health-Related Quality of Life in National Institute for Health and Care Excellence (NICE) Appraisals: An Update of the Pennington Review

HTA10 Carer Health-Related Quality of Life in National Institute for Health and Care Excellence (NICE) Appraisals: An Update of the Pennington Review

P10 Modelling Spillover Effects on Informal Carers: The 'Carer QALY Trap'

Caring for patients can impose significant ‘spillover effects’ on the health of informal carers. A review of National Institute for Health and Care Excellence technology appraisals found that carer health-related quality of life (HRQOL) is rarely included in appraisals, and when it is, modelling approaches have been inconsistent. Furthermore, when modelling carer HRQOL, situations can occur whereby a life extension for patients results in an overall reduction in net quality-adjusted life years (QALYs). In other words, for some life-extending treatments, a gain in patient QALYs may be outweighed by a loss in carer QALYs, which may be inconsistent with societal values. The objective of this study was to explore the circumstances through which this issue occurs and consider potential approaches for addressing it.

HTA244 Inclusion of Carer Health-Related Quality of Life (HRQOL) in National Institute for Health and Care Excellence (NICE) Appraisals Published Since 2019

Pennington (2020) reviewed methods for including carer HRQoL in NICE technology (TA) and highly specialised technology (HST) appraisals published up to 2019, and reported carer HRQoL estimates for adult populations from two publications. This research reviewed TAs and HSTs published since 2019 to report how many appraisals considered carer HRQoL in adult populations, and whether new sources of carer HRQoL estimates were used in these appraisals.

S164 Naloxegol Provides Clinically Meaningful Healthcare-Related Quality of Life (HR-QoL) Improvement (PAC-QOL) in Patients With Opioid-Induced Constipation (OIC): A Pooled Analysis of Two Global Phase 3 Studies of Naloxegol

S164 Naloxegol Provides Clinically Meaningful Healthcare-Related Quality of Life (HR-QoL) Improvement (PAC-QOL) in Patients With Opioid-Induced Constipation (OIC): A Pooled Analysis of Two Global Phase 3 Studies of Naloxegol

Breaking Through the Therapeutic Ceiling: What Will It Take?

Outcomes for patients starting a new treatment for inflammatory bowel disease are characterized by uncertainty of treatment response. Although it is natural to hope that new treatments will be characterized by better efficacy, remission is still far from a universal experience for patients living with inflammatory bowel disease. At times, an apparent "glass ceiling" appears to constrain progress toward a goal of maximal long-term health care-related quality of life for all. There are a number of areas that can and should be addressed if we are to make significant progress. These range from improved early diagnosis and initial management through better treatment stratification and response monitoring, to improvements in clinical trial design and selection of drugs in combination therapies. In this article, we discuss the steps required in all of these areas to make best use of new therapeutic options and shatter the glass ceiling.

P003. An Evidence Based Quality Improvement Project of the Impact of a Nurse Practitioner Led Heart Failure, Self-Care Focused, Patient Education on Healthcare Related Quality of Life

<h3>Background</h3> Heart failure (HF) is a progressive and debilitating disease with high morbidity and mortality rates. HF affects both physical and psychosocial health with over 75% of HF patients experiencing frailty and 10-40% of HF patients having difficulty preforming activities of daily living. These limitations heavily impact healthcare related quality of life (HRQOL). Patient education has been shown to improve HF outcomes, but it remains poorly utilized. <h3>Objective</h3> This evidence-based quality improvement project aims to show that a HF education packet with nurse practitioner (NP) led reinforcement can improve HRQOL. <h3>Methods</h3> This project uses a comparison prospective design that assesses pre and post intervention scores on the Kansas City Cardiomyopathy Questionnaire 12 (KCCQ-12). Participants had chronic heart failure and were selected from HF clinic referrals. A HF packet with educational materials focused on self-care education with reinforcement provided by NPs in the HF clinic was given to participants. Data on demographics, comorbidities, time since onset of HF, quantity of follow ups, and time between initial and post visit was collected. A KCCQ-12 was given at their initial visit and at a 3-6 month post initial visit. <h3>Results</h3> 12 participants were enrolled. KCCQ-12 domains and HRQOL metrics, including physical limitation (MD = 21.92, SD = 32.4, p = .039), quality of life (QOL) (MD = 20, SD = 26.8, p = .025), and overall summary score (MD = 14.67, SD = 18.2, p = .018). had a statistically significant improvement. Social limitations (MD = 8.08, SD = 31.1, p = NS) and symptom frequency (MD = 8.25, SD = 14.8, p = NS) had a trend towards improvement, but did not reach statistical significance. Within the reduced HF subgroup (N = 9) physical limitations (MD = 27.67, SD = 35.1, p = .038) and overall summary score (MD = 17.89, SD = 20.1, p = .028) significantly improved. Uniquely, symptom frequency (MD = 12.11, SD = 11.1, p = .011) significantly improved in the reduced HF subgroup. There was no statistically significant improvement in the preserved HF subgroup (N = 3) in any of the KCCQ-12 domains. There were no HF hospitalizations during the 3-6 month follow-up. <h3>Conclusion</h3> This project shows that a guideline driven patient education intervention that focuses on self-care via a HF packet with NP follow up to reinforce education improved overall HF HRQOL. Improvement in the KCCQ-12 overall summary score indicates improved HF outcomes such as reduced HF hospitalizations and mortality. Creating a standardized HF education packet that is readily available and can guide patients and clinicians in their HF education discussion may increase rate of HF patient education in clinics, although this study did not measure this specifically. Further studies, with larger participant base, are needed to confirm efficacy of this type of intervention in patients with HF with preserved ejection fraction. In addition, Studies with longer duration would be beneficial to assess impact on mortality.

PNS82 The Methods for Incorporating Carer HRQoL Should be More Clearly Defined By NICE

The broader societal benefits offered by new technologies in terms of quality-adjusted life-years (QALYs) accrued by carers (e.g., a partner, parent, or family member) are accepted for inclusion in the Reference Case for National Institute for Health and Care Excellence (NICE) technology appraisals (TAs) and highly specialised technology (HST) guidance. The research presented here reviews all published TAs and HST assessments to identify those that considered the impact of an intervention on QALYs for carers and how these have incorporated carer health-related quality of life (HRQoL). We reviewed all TAs and HST assessments published between April 2013, when the current NICE methods guidance was issued, and July 2020. Manufacturers included carer HRQoL in their economic models in 5% (17/331) of NICE TAs and HST assessments. Most of these (9/17) concerned neurological conditions; 7/9 were for multiple sclerosis, 6 of which used utility decrements for carers of patients with Alzheimer’s disease. In 2/17 submissions, carer disutilities were derived using vignettes valued through the EuroQol five-dimension questionnaire (EQ-5D) visual analogue scale (VAS). One submission included the QALY loss to a family due to the premature death of a child. The remaining studies used disutilities from the literature. Of the 17 submissions, 9 included carer HRQoL in the base case only, and 2 in the base case and scenario analyses. NICE accepted inclusion of disutilities for carers in all of these. Six included carer HRQoL only in a scenario analysis. NICE rejected 4 of them. Carer HRQoL benefits/analyses are not routinely submitted for NICE decision-making. In the cases where NICE accepted it, various methodologies were applied besides EQ-5D to derive utility decrements. NICE should provide further guidance and evidence to support a consistent approach to including carer/family health outcomes in appraisals.

CORR Insights®: How Common Are Chronic Residual Limb Pain, Phantom Pain, and Back Pain More Than 20 Years After Lower Limb Amputation for Malignant Tumors?

Where Are We Now? Surgeons have changed how they manage patients with malignant tumors of the extremities over the last four decades, with the largest transition being the switch to limb salvage rather than amputation for the large majority of patients with bone sarcomas [8, 10, 12]. Indeed, modern day decision-making generally favors limb salvage in the absence of a specific contraindication [8]. Still, because some patients will undergo amputations, surgeons continue to try to improve how we perform these procedures. Areas of focus include amputation techniques as well as methods of preventing phantom limb pain and neuromas; generally, these studies focus on patient-reported outcomes and healthcare-related quality of life [3, 13]. Some of the more exciting discoveries have been on the topic of preventing nerve-related pain using targeted muscle reinnervation (TMR) [6], regenerative peripheral nerve interfaces (RPNI) [5], as well as other neuroma revision and prevention concepts. The current study by Döring et al. [2] is important because it focuses on the long-term outcomes and complications from the subset of patients who may not be good candidates for limb salvage. Where Do We Need To Go? Nerve-associated pain and associated sequelae can lead to poor functional outcomes and decreased mobility and prosthetic use. Research focused on minimizing these complications is an essential next step to improving function and quality of life for patients with sarcoma and limb loss. Although TMR was originally conceived of to allow autonomous zones for myoelectric prosthesis use in the upper extremity, the added benefit of decreased phantom limb pain and neuroma formation has made it an appealing technique for the lower extremity as well. A concern for TMR is that a specialized team is usually required to complete the procedure and it can increase OR time [5, 6]. RPNI has also shown excellent potential for prevention of these same nerve-related sequelae [5], and it is technically simpler and potentially easier for a wider range of surgeons. While TMR seems to have the best outcomes, it may not be a reality for widespread clinical use (due to the need for specialized teams to perform the procedure). In contrast, RPNI may be more practical because it can be performed by a non-hand surgery–trained surgeon. Well-designed studies looking at the two techniques prospectively are still needed. We also need to determine the impact each technique has on long-term pain and amputee function. Döring et al. [2] provide long-term functional and quality-of-life data for patients with amputation, which can serve as a baseline for future studies focused on amputation techniques. A large proportion of amputation-related studies focus on populations with the highest rates of amputation. This includes older patients with diabetes- or peripheral vascular disease–related complications [3, 13] as well as military and traumatic amputations [4, 11]. While these data are valuable, younger patients with sarcoma are quite different than those patient populations. Therefore, future research should focus on this younger patient group since those who survive their tumors would be expected to have both long life expectancy and high functional demands [9]. How Do We Get There? Due to the rarity of amputation for sarcoma in a younger population, a well-designed multicenter study comparing TMR and RPNI techniques would be a valuable collaborative effort. One study [1], which was the largest oncologic cohort to date (31 patients from a single institution treated with TMR for oncologic amputation), found that on short-term follow-up (1 year), the study group compared favorably to the control group, whose data were collected from a national amputee database. Building off of this study, researchers should compare TMR versus RPNI in a prospective study and include patient-reported as well as functional outcomes with a focus on prosthesis use [7]. Patient-reported outcomes and prosthesis use can be compared at 1, 3, and 5 years to definitively compare the techniques. Modern day prosthetic fitting and technology use should be integrated into this study, as well as a detailed cost analysis that examines the differences in resource requirements for the two techniques.

Impaired Sleep Influences Health Care Related Quality of Life in Patients With Well Differentiated Thyroid Carcinoma

Background: Most patients with well differentiated thyroid carcinoma (WDTC) have a favorable prognosis but often report lower health care related quality of life (HRQoL). Sleep quality is one contributor to HRQoL that has also been reported to be impaired in WDTC patients. We evaluated patient reported outcome measures (PROM) of HRQoL and sleep quality in patients with WDTC, and compared them to patients with thyroid nodules.Methods: This is a single institution cohort study utilizing data on consented adult patients with WDTC or thyroid nodules from an integrated cancer research database. We included participants with WDTC and thyroid nodules who completed the SF-36v2 HRQoL survey and the Pittsburgh Sleep Quality Index (PSQI). HRQoL was reported as a composite mental (MCS) and physical (PCS) component score that was compared with population-based norms and reported as the frequency of patients scoring below or well below the age-controlled reference population. Sleep quality was reported as PSQI raw score. Poor sleep quality was defined as a PSQI score >5. Cancer stage was calculated as American Joint Commission on Cancer (AJCC) 7th and 8th edition for each subject in the registry.Results: We evaluated 727 patients and 424 (58%) had WDTC: 219 (72%) with papillary thyroid carcinoma (PTC), 28 (9%) with follicular variant of PTC, 53 (18%) with follicular thyroid carcinoma and 3 (1%) with Hurthle cell carcinoma. Of these, 208 (68.7%) were treated with radioactive iodine ablation with a mean cumulative dose of 197.7 (range 29-700) mCi. Mean age for WDTC was 42.7 years (standard deviation SD 15.4), and 53.4 years (SD 14.3) for nodules (p < 0.001). Eighty one percent of WDTC and 368 (87%) of nodules were female (p = 0.022). PSQI indicated worse sleep quality for WDTC patients with a mean of 6.85 (SD 3.97) and 174 (57.4%) reporting poor sleep quality with a PSQI > 5, compared with a mean score of 6.8 (SD 4.05) and 170 (40.1%) with PSQI > 5 for nodules (p < 0.001). WDTC diagnosis was associated with poor sleep quality with an odds ratio of 2.02 (95% confidence interval 1.48 - 2.75), p < 0.001. Poor quality sleep was also associated with WDTC stage using AJCC8 (0.017) but not AJCC7 (p = 0.067). Overall PCS, MCS, and HRQoL category were not significantly different between WDTC and nodule groups. When stratified by stage, MCS was inversely associated with cancer stage using AJCC7 (p = 0.035) but not AJCC8 (p = 0.96); PCS was associated with cancer stage using both AJCC7 (p = 0.003) and AJCC8 (p < 0.001).Conclusions: Patients with WDTC report worse sleep quality than those with thyroid nodules and it is correlated with AJCC8 stage. HRQoL is similar between all WDTC patients and those with thyroid nodules in this cohort, though WDTC patients with higher stage reported worse physical function. The AJCC 8th was more sensitive to differences in sleep quality and physical function by stage than AJCC 7th.

Treatment Burden for Pediatric Eosinophilic Esophagitis: A Cross-Sectional Survey of Carers.

To investigate treatment burden and impact on health-related quality of life (HRQoL) for children with eosinophilic esophagitis (EoE) and their carers. An Australian cross-sectional online survey of carers of children aged 18 years and under with EoE between September 2018 to February 2019. Of 181 complete responses, more than half of carers experienced reduced HRQoL since their child's diagnosis. Reported mean out-of-pocket expenditure for healthcare utilization (practitioner visits and treatment) was AUD$3064.3 annually. Backwards stepwise linear regression models showed that reduced ability to manage on income and missing more than one workday in the previous 30 days were significant predictors of lower carer HRQoL. Ability to manage on the current income described as "difficult some of the time," "difficult all of the time," and "impossible" were associated with lower child HRQoL. When compared with EoE diagnosis between 13 and 23 months of age, diagnosis between 2 and 4 years was a significant predictor of lowered child HRQoL. Pediatric EoE in Australia leads to high treatment burden for carers. Changes in carer employment and income manageability can negatively impact carer psychosocial wellbeing. Carers of children with EoE need to be informed about available financial and social support to reduce treatment-related burden and improve the quality of life of both the carer and child.

Inclusion of Carer Health-Related Quality of Life in National Institute for Health and Care Excellence Appraisals.

Health interventions for patients can have effects on their carers too. For consistency, decision makers may wish to specify whether carer outcomes should be included. One example is the National Institute for Health and Care Excellence (NICE), whose reference case specifies that economic evaluations should include direct health effects for patients and carers where relevant. We aimed to review the methods used in including carer health-related quality of life (HRQL) in NICE appraisals. We reviewed all published technology appraisals (TAs) and highly specialized technologies (HSTs) to identify those that included carer HRQL and discussed the methods and data sources. Twelve of 414 TAs (3%) and 4 of 8 HSTs (50%) included carer HRQL in cost-utility analyses. Eight were for multiple sclerosis, the remainder were each in a unique disease area. Twelve of the 16 appraisals modeled carer HRQL as a function of the patient's health state, 3 modeled carer HRQL as a function of the patient's treatment, and 1 included family quality-adjusted life year (QALY) loss. They used 5 source studies: 2 compared carer EQ-5D scores with controls, 2 measured carer utility only (1 health utilities index and 1 EQ-5D), and 1 estimated family QALY loss from a child's death. Two used disutility estimates not from the literature. Including carer HRQL increased the incremental QALYs and decreased incremental cost-effectiveness ratios in all cases. The inclusion of carer HRQL in NICE appraisals is relatively uncommon and has been limited by data availability.

Quality of life among caregivers of people with end-stage kidney disease managed with dialysis or comprehensive conservative care

BackgroundTo measure health-related and care-related quality of life among informal caregivers of older people with end-stage kidney disease (ESKD), and to determine the association between caregiver quality of life and care recipient’s treatment type.MethodsA prospective cross-sectional study was conducted. Three renal units in the UK and Australia were included. Informal caregivers of people aged ≥75 years with ESKD managed with dialysis or comprehensive conservative non-dialytic care (estimated glomerular filtration (eGFR) ≤10 mL/min/1.73m2) participated. Health-related quality of life (HRQoL) was assessed using Short-Form six dimensions (SF-6D, 0–1 scale) and care-related quality of life was assessed using the Carer Experience Scale (CES, 0–100 scale). Linear regression assessed associations between care-recipient treatment type, caregiver characteristics and the SF-6D utility index and CES scores.ResultsOf 63 caregivers, 49 (78%) were from Australia, 26 (41%) cared for an older person managed with dialysis, and 37 (59%) cared for an older person managed with comprehensive conservative care. Overall, 73% were females, and the median age of the entire cohort was 76 years [IQR 68–81]. When adjusted for caregiver sociodemographic characteristics, caregivers reported significantly worse carer experience (CES score 15.73, 95% CI 5.78 to 25.68) for those managing an older person on dialysis compared with conservative care. However, no significant difference observed for carer HRQoL (SF-6D utility index − 0.08, 95% CI − 0.18 to 0.01) for those managing an older person on dialysis compared with conservative care.ConclusionsOur data suggest informal caregivers of older people on dialysis have significantly worse care-related quality of life (and therefore greater need for support) than those managed with comprehensive conservative care. It is important to consider the impact on caregivers’ quality of life when considering treatment choices for their care recipients.

Preoperative Mental Health Component Scoring Is Related to Patient Reported Outcomes Following Lumbar Fusion.

Retrospective cohort review. The objective of this study was to identify depression using the Mental Component Score (MCS-12) of the Short Form-12 (SF-12) survey and to correlate with patient outcomes. The impact of preexisting depressive symptoms on health-care related quality of life (HRQOL) outcomes following lumbar spine fusion is not well understood. Patients undergoing lumbar fusion between one to three levels at a single center, academic hospital were retrospectively identified. Patients under the age of 18 years and those undergoing surgery for infection, trauma, tumor, or revision, and less than 1-year follow-up were excluded. Patients with depressive symptoms were identified using an existing clinical diagnosis or a score of MCS-12 less than or equal to 45.6 on the preoperative SF-12 survey. Absolute HRQOL scores, the recovery ratio (RR) and the percent of patients achieving minimum clinically important difference (MCID) between groups were compared, and a multiple linear regression analysis was performed. A total of 391 patients were included in the total cohort, with 123 (31.5%) patients reporting symptoms of depression based on MCS-12 and 268 (68.5%) without these symptoms. The low MCS-12 group was found to have significantly worse preoperative Oswestry disability index (ODI), visual analogue scale back pain (VAS Back) and visual analogue scale leg pain (VAS Leg) scores, and postoperative SF-12 physical component score (PCS-12), ODI, VAS Back, and VAS Leg pain scores (P < 0.05) than the non-depressed group. Finally, multiple linear regression analysis revealed preoperative depression to be a significant predictor of worse outcomes after lumbar fusion. Patients with depressive symptoms, identified with an MCS-12 cutoff below 45.6, were found to have significantly greater disability in a variety of HRQOL domains at baseline and postoperative measurement, and demonstrated less improvement in all outcome domains included in the analysis compared with patients without depression. However, while the improvement was less, even the low MCS-12 cohort demonstrated statistically significant improvement in all HRQOL outcome measures after surgery. 3.

HealthCare-Related Quality of Life and Lived Existential Experiences among Young Adults Diagnosed with Cancer: A Mixed-Method Study.

Background:As cancer is a noncommunicable disease and it is a major global burden in terms of finances. It is also affecting quality of life of a person completely.Aim:The aim of the present study was to identify the effect of cancer on quality of life of an individual as a whole.Methods:The present study was triangulation study, and we examined 30 young adult cancer patients of age group 20–44 years who were admitted in different oncological units of our hospital in 2018. We included all their case datasheets for identifying clinical variables. Data collection tools used were the European organization for research and treatment for cancer quality of life questionnaire (version 3-Hindi). Qualitative data were collected using open-ended questionnaire regarding young adult cancer patient's experiences, feelings, and difficulties faced during cancer diagnosis and treatment.Results:Results concluded that young adult cancer patient's global health status score were average. Their physical function as well as social function score depicted that both were affected significantly, whereas cognitive functions were not affected anymore. Most commonly symptoms faced by young adult's cancer patients were pain, insomnia, fatigue, nausea, vomiting, and appetite loss. Financial burden was major burden faced by patient as well as caregiver during the diagnosis and treatment of cancer. From qualitative data of the study, it was concluded that when patient were first told about cancer diagnosis first, they feel sad. Their primary relatives were first informed about their diagnosis. Most of patient's cancer were diagnosed in first stage. Cancer had affected patient's personal as well as social life completely. Nobody helps them during the diagnosis and treatment of their disease. Majority of cancer treatment options were chemotherapy, radiation therapy, and surgery and majority of them were getting chemotherapy from AIIMS, Rishikesh. The most common difficulty the patient's faced during the diagnosis of cancer was financial. Patient's opinion for cancer and its treatment were that everybody who had any symptoms of cancer they should immediately come to hospital for treatment. When we asked them about effect of cancer as a whole their responses were disturbed family role, disturbed attachment with family and friends, disturbed social role, financial burden as well as disturbed education, respectively.Conclusion:From this study, we concluded that quality of life of young adult cancer patients were affected badly in terms of physical, social, symptomatically, and financially. It may also help to plan ahead by patients as well as health professionals to improve the patient's quality of life.