Health-related Quality Of Life Items Research Articles

Impact of oral care intervention on quality of life of patients with oral cancer undergoing radiotherapy in Sri Lanka: A quasi-experimental study.

Radiotherapy is used to treat oral cancer, yet it negatively affects patients' health-related quality of life (HRQOL). The aim was to evaluate the impact of an oral healthcare intervention on HRQOL of patients with oral cancer who receive radiotherapy with or without chemotherapy. An oral healthcare intervention was provided to 41 patients with oral cancer before radiotherapy (fluoride varnish application, scaling, permanent restorations, adjustment of sharp teeth, and extraction of teeth with questionable prognosis, oral hygiene instructions), during, and 3 months after radiotherapy (baking soda mouthwash, artificial saliva spray). EORTC QLQ-H&N35 was used to compare the HRQOL of the intervention and control groups, with the latter having received routine oral healthcare. The intervention group showed lesser values for HRQOL domains and items indicating fewer side effects during the last week of radiotherapy and 3 months after, compared to the control group. Most of the changes in HRQOL were significantly less in the intervention group compared to the control group (p < 0.01). The oral healthcare intervention effectively reduced the effect of radiotherapy and positively impacted on HRQOL of patients with oral cancer.

Health-related quality of life measures provide information on the contributors, components, and consequences of frailty in HIV: a systematic mapping review.

Frailty in HIV is extensively explored in epidemiological and clinical studies; it is infrequently assessed as an outcome in routine care. The focus on health-related quality of life (HRQL) measures in HIV presents a unique opportunity to understand frailty at a larger scale. The objective was to identify the extent to which generic and HIV-related HRQL measures capture information relevant to frailty. A systematic mapping review using directed and summative content analyseswas conducted. An online search in PubMed/Medline identified publications on frailty indices and generic and HIV-related HRQL measures. Directed content analysis involved identifying contributors, components, and consequences of frailty from thefrailty indices based on the International Classification of Functioning, Disability, and Health framework. Summative content analysis summarized the resultsnumerically. Electronic and hand search identified 447 review publications for frailty indices; nine reviews that included a total of 135 unique frailty indices. The search for generic and HIV-related HRQL measures identified 2008 records; five reviews that identified 35 HRQL measures (HIV-specific: 17; generic: 18). Of the 135 frailty indices, 88 cover more than one frailty dimension and 47 cover only physical frailty. Contributors to frailty, like sensory symptoms and nutrition, are extensively covered. Components of frailty such as physical capacity, cognitive ability, and mood are also extensively covered. Consequences of frailty namely self-rated health, falls, hospitalization, and health services utilization are incomprehensively covered. HRQL measures are informative for contributing factors, components of frailty, and a consequence of frailty. HRQL items and measures show a strong potential to operationalize multidimensional frailty and physical frailty. The study suggests that these measures, connected to evidence-based interventions, could be pivotal in directing resources toward vulnerable populations to mitigate the onset of frailty.

EMBARK post hoc analysis of sexual activity (SA) patient-reported outcome (PRO) measures.

313 Background: In the phase 3 EMBARK trial (NCT02319837), enzalutamide (ENZ) + leuprolide (L) and ENZ monotherapy (mono) delayed metastasis-free survival (MFS) vs placebo (P) + L without impairing global health-related quality of life (HRQoL) in high-risk biochemically recurrent (BCR) nonmetastatic hormone-sensitive prostate cancer (nmHSPC) (PSA doubling time ≤9 months). A prespecified PRO analysis showed that SA (measured as a composite score using European Organization for Research and Treatment of Cancer QoL Questionnaire-Prostate 25 [QLQ-PR25]) was better preserved with ENZ mono vs P + L and no significant difference between ENZ + L vs P + L. A post hoc analysis at the HRQoL item level was conducted to understand the effect on SA in each comparison and enable shared decision-making between physicians and patients. Methods: Men with high-risk BCR nmHSPC were randomized (1:1:1) to ENZ + L (double blind), ENZ mono (open label), and P + L (double blind). HRQoL was assessed at baseline and every 12 weeks until metastasis/death. This post hoc analysis assessed effects on time to confirmed (two consecutive visits) deterioration (TTCD) using predefined thresholds of one category decline from baseline in sexual interest, activity, satisfaction, erectile function, and feeling like a man using QLQ-PR25 item 50; QLQ-PR25 item 51; FACT-P item GS7; FACT-P item BL5; and FACT-P item P5 measures, respectively (Table). Intent-to-treat principle was applied. Results: At baseline, 327–332 men per arm completed the PRO surveys; overall completion rates were ≥85%, except for GS7 (≤36% due to voluntary response). ENZ mono vs P + L : TTCD in items 50 (interest) and 51 (activity), GS7 (satisfaction), and BL5 (erectile function) was delayed with ENZ mono. ENZ + L vs P + L: no significant differences in TTCD were observed, except a shorter TTCD by a median 0.06 months in BL5 (erectile function) with ENZ + L (Table). Conclusions: This post hoc item-level analysis of the EMBARK trial confirmed that SA was better preserved with ENZ mono vs P + L in terms of interest, activity, satisfaction, and maintaining erection. Further, the SA PROs were similar between ENZ + L and P + L, implying there is no further SA burden when adding ENZ to androgen-deprivation therapy. Clinical trial information: NCT02319837 . [Table: see text]

Health-related quality of life in children under treatment for overweight, obesity or severe obesity: a cross-sectional study in the Netherlands

BackgroundIt is unknown whether weight class is associated with impairment of health-related quality of life (HRQOL) for children in the Netherlands. The aim of this study was to explore generic and weight-specific HRQOL in a clinical cohort of children with overweight, obesity or severe obesity aged 5–19 years in the Netherlands.Methods803 children from three clinical cohorts participated: mean age 11.5 (SD 2.9) years, 61.1% girls. The influence of weight class was explored in a subgroup of 425 children (25.2% with overweight, 32.5% obesity and 42.3% severe obesity), of whom the exact International Obesity Task Force (IOTF) BMI class was known. Generic HRQOL was measured by the PedsQL child report. Weight-specific HRQOL was measured by the IWQOL-Kids child or parent report. Average total, subscale and item scores were reported and the influence of the IOTF BMI class analyzed by multiple linear regression, corrected for age and sex.ResultsChildren with severe obesity had lower generic and weight-specific HRQOL scores than those with obesity or overweight. IOTF BMI class was negatively associated with item scores from all subscales, especially physical, social and emotional functioning. Children with overweight reported similar HRQOL total, subscale and item scores to children with obesity.ConclusionsIn the Netherlands, children treated for overweight, obesity or severe obesity experience problems on the majority of items within all subscales of generic and weight-specific HRQOL. Children with severe obesity especially report significantly more challenges due to their weight than children with obesity or overweight.

Health-related quality of life measures used with Indigenous children/youth in the Pacific Rim: a scoping review

ObjectiveTo identify and describe (1) which health-related quality of life (HRQoL) measures have been used with Indigenous children/youth (aged 8–17 years) within the Pacific Rim; and (2) studies that refer...

A study of modifiable factors associated with health-related quality of life in long-term cervical cancer survivors.

Health-related quality of life (HR-QoL) in cancer survivors is relevant for symptom relief and optimal care. The aim of this cross-sectional study of long-term cervical cancer survivors was two-fold: (a) To compare HR-QoL in long-term cervical cancer survivors with reference data; and (b) to identify modifiable factors significantly associated with low levels of generic cancer HR-QoL in long-term cervical cancer survivors using high HR-QoL as reference. Women treated for cervical cancer from 2000 through 2007 who were cancer-free and alive in 2013 received a mailed questionnaire including scales for anxiety, depression, and HR-QoL. To obtain a homogeneous sample only women with FIGO stages 1 and 2 were included. The questionnaire included the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire.C-30 (EORTC QLQ C-30) for generic HR-QoL. Groups with high and low HR-QoL were defined by the median score on the general HR-QoL item. Between-group differences were examined with descriptive statistics. Logistic regression analyses examined independent variables associated with low generic HR-QoL. Complete C-30 scores were delivered by 472 long-term cervical cancer survivors. Median age at survey was 53 (interquartile range 14.9) years, and median time since diagnosis was 11 (interquartile range 3.9) years. The proportion of survivors with stage 1 disease was 83% and stage 2 was 17%. Mean generic HR-QoL scores showed minor differences between long-term cervical cancer survivors and reference data. In the multivariable analysis, only modifiable variables remained significantly associated with low generic HR-QoL namely self-rated health, probable depression, fatigue, and pain. In bivariate analyses other modifiable variables also showed significant associations with low generic HR-QoL like probable anxiety disorder, obesity, smoking, sleep disturbances, and bowel symptoms. Clinicians should be aware that generic HR-QoL in long-term cervical cancer survivors eventually may be improved by identification and treatment of modifiable factors through the whole follow-up period.

PS-C18-1: SLEEP SCORE AMONG HEALTH-RELATED QUALITY OF LIFE SUBSCALES PREDICTS TECHNIQUE SURVIVAL IN PATIENTS WITH PERITONEAL DIALYSIS

Purpose: There is sufficient evidence that peritoneal dialysis (PD) is superior to hemodialysis in terms of health-related quality of life (HRQOL), and higher HRQOL scores are associated with better clinical outcomes in patients with PD, however, the specific HRQOL subscales that predict prognosis remain uncertain. Design and method: In addition to various PD-related parameters and exercise capacity, HRQOL of outpatients with PD were assessed using Kidney Disease Quality of Life-Short Form Japanese version 1.3 from March 2017 to March 2018, and the association of HRQOL items with technique survival was prospectively analyzed until June 2021. Result: Among the 50 recruited PD outpatients, age and PD vintage were 63.8 ± 9.6 and 3.8 ± 2.8 years, respectively, and 21 patients discontinued PD and transferred to hemodialysis during the study period. In a univariate Cox proportional hazards model, higher scores (per 10) for symptoms, sleep, and vitality among HRQOL subscales were significantly associated with lower technique failure rate (Hazard Ratio(HR) 0.66, P = 0.002; HR 0.70, P = 0.006; and HR 0.80, P = 0.04, respectively). In multivariate analysis adjusted for Charlson comorbidity index, incremental shuttle walk test distance, and baseline PD vintage, only higher sleep score was significantly associated with lower technique failure rate (HR 0.68 per 10, P = 0.003). Among PD-related parameters, serum potassium level was significantly inversely correlated with sleep score (r = -0.34, P = 0.01). Discussion and Conclusion: Our results suggest that sleep score among HRQOL subscales is particularly useful as a predictor of technique survival in patients with PD. Improvement in sleep quality may improve technique survival in prevalent PD patients.

NQPC-10 IMPACT OF HEALTH-RELATED QOL (HRQOL) IN THE FIRST SIX MONTHS AFTER SURGERY ON LONG-TERM POSTOPERATIVE GENERAL HEALTH STATUS IN GLIOMA PATIENTS

Abstract Purpose Though prolonging survival is often the focus of brain tumor therapy, evaluation of health-related quality of life (HRQoL) is important in postoperative follow-up since treatment-induced side effects or tumor-induced functional impairment could affect HRQoL.In glioma treatment, we investigated the relationship between patient-reported HRQoL assessment from 1 month preoperatively to 6 months postoperatively and overall health status at 1 year and 1.5years postoperatively. Methods Thirty-one glioma patients who underwent surgical treatment at our hospital and the National Cancer Center Hospital from May 2011 to August 2022 were included in this study. HRQoL and KPS were evaluated at 1 month before surgery, 6 months, 1 year and 1.5 years after surgery, respectively. The median age was 47 years, 15 (48%) were men and 16 (52%) were women. Pathological results were GBM in 19 (61%), AA in 4 (13%), AO in 2 (6%), and others in 6 (19%). The EORTC QLQ-C30/BN20 was used as a measure of HRQoL, and eligible patients answered each of the 50 questions on a 4-point scale, with scores calculated for 26 QoL status items. Bivariate analysis (Wilcoxon test) was performed on the 26 HRQoL items and KPS. Results/Consideration High KPS(≥70)was seen in patients who perceived themselves at 6 months postoperatively, to be “good” in the following 10 items “Physical functioning,” “Role functioning,” “Cognitive functioning,” “Global health status,” “Fatigue,” “Constipation,” “Motor dysfunction,” Communication deficit,” “Itchy skin” and “Weakness of legs. “In addition, patients who perceived their HRQoL conditions of” Sleep disturbance,”“ Future Uncertain,”and “ Bladder control”to be “good” after 6 months had a KPS of 70 or higher at 1.5 years. Conclusions The results suggest that long-term systemic status can also be monitored by assessing HRQoL in the first six months after surgery. Patient evaluation including sequential HRQoL is important in the treatment of glioma.

Employing cognitive interviewing to evaluate, improve and validate items for measuring the health-related quality of life of women diagnosed with ovarian cancer.

BackgroundUse of patient-reported outcome measures in clinical settings facilitate the delivery of better health care to improve patient health outcomes. Previously collected qualitative data indicated themes that could inform items for a health-related quality of life measure. This study investigated the content validity of items for inclusion in a new health-related quality of life measure suitable for patients with ovarian cancer.MethodsCognitive interviewing techniques were used with fourteen women diagnosed with ovarian cancer and at different times since diagnosis, to evaluate items derived from the previously collected qualitative dataset. A set of draft items was administered via telephone, Zoom and WhatsApp app together with questions on item meaning and wording. Interviews were transcribed and thematically analysed.ResultsFour broad themes emerged in relation to the questionnaire construction and comprehension of items: intent and clarity, wording, relevance and context, and overall questionnaire construct. All draft items were adjusted based on the interview findings. A final set of 38 health-related quality of life items comprised 7 items describing physical health and functioning, 21 describing emotional wellbeing and 10 items describing social wellbeing; each rated on a five-point frequency response scale. ConclusionThe items reflected a range of personal experiences associated with the patient clinical journey, creating a health-related quality of life tool specific to women diagnosed with ovarian cancer. The cognitive interviewing process established content validity for the tool, thereby, preparing it for field testing and evaluation of its psychometric properties. This study highlighted the fundamental role of cognitive interviewing during health-related quality of life questionnaire development to ensure that item content is grounded in patient feelings, functioning and meaning.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12905-022-01966-w.

Translation, linguistic validation and reliability of FACT-H&N questionnaire in Oral Cancer patients in Sudan

BackgroundThis study aimed to translate and validate an Arabic version of the Functional Assessment of Cancer Therapy Head and Neck Scale (FACT-H&N, v-4) for use among Sudanese oral cancer patients.MethodsThe instrument underwent translation and validation following the standard FACT translation methodology. The translated instrument was pre-tested for face validity and content validity using semi-structured, in-depth interviews with ten oral cancer patients to assess acceptability. The questionnaire was pilot tested with 60 patients; reliability was tested for internal consistency with Cronbach’s alpha while construct validity was tested using ‘known-group validity’.ResultsThe pre-test study revealed no major issues, apart from a reluctance to answer questions on sexual satisfaction. The FACT-H&N demonstrated good internal consistency, it considered five particular constructs: PWB, SWB, EWB, FWB and FACT-H&N, their Cronbach’s α values were positive and close to 1 with values of 0.85, 0.788, 0.86, 0.895 and 0.703 respectively, indicating that the questionnaire was valid and the responses consistent. Sixty patients were asked the global health-related quality of life item, 36.3% rated their QOL as very good or good (36.3%), while 41.7% rated it as average, and 21.7% as poor or very poor. Then FACT subscale mean scores were tabulated against three categories; patients with very poor/poor recorded significantly lower scores indicating construct validity. Some psychometric properties were consistent with other FACT-H&N translations such as the Chinese, French, Pakistani and Malaysian.ConclusionsThis study validates the Arabic version of the FACT-H&N. It is a reliable tool and, will assist further QoL research in other Arabic-speaking countries.

Validation of the English version of the arrhythmia-specific questionnaire in tachycardia and arrhythmia (ASTA): a Rasch evaluation study

BackgroundPatient-reported outcome measures are important in person-centered care, providing valuable information about patients’ experiences. Disease-specific questionnaires add important information about a certain disease in comparison to generic questionnaires. Questionnaires need to be validated in the targeted population to achieve reliable data. The purpose with the study was to use Rasch measurement theory to evaluate the English version of the ASTA questionnaire.MethodsThe Rasch model theory was used to evaluate global and item fit, targeting, response category functioning, local independency, unidimensionality, differential item functioning (DIF) for gender and age, and reliability.ResultsThe study included 202 patients undergoing DC conversion or catheter ablation at the Centre for Heart Rhythm Disorders at the University of Adelaide, Australia. The mean age was 67 years and 30% were women. Most patients had atrial fibrillation (n = 179), others had atrial flutter or had a combination. One of nine items demonstrated unsatisfactory model fit in the ASTA Symptom scale and two of 13 in the ASTA Health-Related Quality of Life (HRQoL) scale. Unidimensionality was supported for both scales. The targeting was acceptable except for the lower end of the scales. Both scales showed reversed thresholds for the response categories “quite a lot” and “a lot” (eight of ASTA symptoms and 12 of ASTA HRQoL items). Some problems with local dependency were detected in both scales. The reliability (person separation index) was satisfactory: 0.75 for the ASTA symptom scale and 0.77 for the ASTA HRQoL scale. No DIF for gender and age were detected.ConclusionsThe English version of the ASTA questionnaire demonstrated satisfactory measurement properties according to the Rasch model. However, it needs to be evaluated in patients with other arrhythmias. The response categories should be considered as well as DIF in further validation. The ASTA questionnaire can be used for assessments of symptoms and HRQoL between groups of different ages and genders in patients with arrhythmia.

Impact of lurasidone on health-related quality of life in adults with bipolar depression: a post-hoc analysis

Objective The objective of this post-hoc analysis was to assess the impact of lurasidone monotherapy on health-related quality of life (HRQoL) in adults with bipolar depression. Methods Data were analyzed from a 6-week randomized, double-blind (DB), placebo-controlled trial of lurasidone monotherapy (NCT00868699) and a 6-month open label extension (OLE; NCT00868959). Patients who received lurasidone monotherapy or placebo during the DB trial were eligible to continue or switch to lurasidone monotherapy during the OLE. The 16-item Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF) was collected at DB baseline, DB week 6/OLE baseline, OLE month 3, and OLE month 6. Effect size (ES) and mean changes from baseline were reported for Q-LES-Q-SF total and item scores during the DB trial and OLE, respectively. Results Of 485 patients in the DB trial (lurasidone monotherapy: n = 323; placebo: n = 162), 316 patients continued or switched to lurasidone monotherapy during the OLE. Significant improvements in Q-LES-Q-SF scores in lurasidone vs. placebo were reported for 13 of 16 items (all p < 0.05) at DB week 6. The greatest improvements were overall life satisfaction (ES =0.57), social relationships (0.55), medication satisfaction (0.48), family relationships (0.46), and ability to function in daily life (0.45, all p < 0.001). Improvements in Q-LES-Q-SF total and item scores were sustained at OLE month 6. Conclusions Treatment with lurasidone provided a significant improvement across HRQoL items including overall life satisfaction, social and family relationships, medication satisfaction, and ability to function in daily life. Improvements were sustained during the 6-month OLE.

Health-related quality of life of breast and colorectal cancer patients undergoing active chemotherapy treatment: Patient-reported outcomes.

We sought to explore the Health-Related Quality of Life (HRQoL) of Breast Cancer (BC) and Colorectal Cancer (CRC) patients receiving active chemotherapy. A cross-sectional study was conducted among a convenient sample of BC and CRC patients between May 2018 and June 2019. HRQoL was measured with the Functional Assessment of Cancer Therapy-Breast (FACT-B; 36 items, score range 0-144)) and the Functional Assessment of Cancer Therapy-Colon (FACT-C; 34 items, score range 0-136) scales. Both scales measured Physical Well-Being (PWB), Social Well-Being (SWB), emotional well-being, Functional Well-Being (FWB), and an additional disease-specific HRQoL items. A total of 209 BC and 159 CRC patients were included, with a mean age 49.73±10.41 and 55.38±11.35years, respectively. 110 (52.6%) of BC and 86 (54.1%) CRC patients were dependent on caregivers, and 115 (55%) of BC and 92 (57.9%) CRC patients slept > 7h/night. Reported HRQoL mean scores of BC (FACT-B) and CRC (FACT-C) were 85.53±14.81 and 87.69±20.21, respectively. For BC, the PWB score of patients aged >49years (postmenopausal) was statistically significantly (p=0.013) worse than those aged ≤49years (premenopausal). Patients dependent on caregivers had statistically significant better PWB and worse EWB (p=0.041; p=0.027, respectively). CRC patients' dependent on caregivers had better statistically significant differences scoring in FACT-C (p=<0.001), PWB (p=0.001), EWB (p=<0.001), and FWB (p=0.001). In this study, BC and CRC patients who received active chemotherapy were more likely to have poor HRQoL. BC and CRC HRQoL should be addressed early and continuously, to limit their effects on treatment plan.

Therapeutic roles of hematopoietic growth factors

Background Eltrombopag (EPAG) was recently approved for aplastic anemia (AA). The recommended regimen is triple agents, EPAG, anti-thymocyte globulin, and cyclosporin A (CsA). Anti-thymocyte globulin is not available in many centers and has serious adverse effects. Aim This study assessed, for the first time, two-agent therapies comprising EPAG+CsA in patients with AA. Patients and methods Group A included 33 patients with AA who were treated with EPAG+CsA and prospectively recruited. Their health-related quality of life (HRQoL) was assessed. All parameters were evaluated at enrollment and after 2−3 months. Bone marrow aspirate was done after 6 months. Another 33 patients who received CsA only (group B) were retrospectively recruited for comparison. Results Both groups were matched regarding demographic and baseline hematologic profile. Significant increment and reduction, after treatment, of absolute neutrophil count and platelets, and transfusion requirements, were respectively seen in group A compared with group B, whereas mean platelet volume was significantly increased in group A only (0.025). The overall response rate and complete remission rate were 72.7 vs. 45.5% and 15.1 vs. 3% in groups A and B, respectively. Significant improvement of the total RAND scoring was found in HRQoL items of group A; however, the social functioning score did not improve significantly. Therapeutic response to EPAG+CsA was an independent effector of HRQoL. After 6 months, one patient had acute leukemia and another one developed fibrosis. Conclusions A ramp-up, short-duration, therapy with EPAG+CsA in AA is as effective as fixed-dose triple agents, with lower risk of disease progression or fibrosis.

Quality of Life of Pregnant Women with Systemic Lupus Erythematosus.

To assess the quality of life (QoL) of pregnant women with systemic lupus erythematosus (SLE) treated at a high-risk prenatal outpatient clinic during the third trimester of gestation. An observational descriptive study was performed in a high-risk prenatal outpatient clinic. Women in the third trimester of pregnancy and undergoing antenatal care between July 2017 and July 2019 answered the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, consisting of 26 questions divided into 4 domains (physical, psychological, social and environmental). We interviewed 50 pregnant women with a mean gestational age of 30 weeks (standard deviation [SD]: 10 weeks) who were diagnosed with SLE. The average age of the participants was 30 years (SD: 14.85), and the average time since the diagnosis of SLE was of 9.06 years (SD: 6.8 years). Most participants had a partner, did not plan their pregnancy (76%), and did not use contraception prior to pregnancy (80%). The score of each domain ranges from 0 (the worst score) to 100 (the best score). The means ± SDs of the scores of the participants on each domain were: physical - 52.21 ± 18.44); psychological - 64.17 ± 18.56); social - 66.33 ± 27.09); and environmental - 64.56 (18.53). The means ± SDs of the general QoL, and health-related QoL items were of 70.50 ± 24.06 and 70.00 ± 30.72 respectively. The physical domain presented the lowest scores compared with the other three domains. Pregnant women with SLE had high overall QoL scores, and their health-related QoL scores were also relatively high.

Open Radical Cystectomy versus Robot-Assisted Radical Cystectomy with Intracorporeal Urinary Diversion: Early Outcomes of a Single-Center Randomized Controlled Trial.

Radical cystectomy (RC) with urinary diversion (UD) is still considered a complex surgery associated with significant morbidity. Open RC (ORC) remains the reference option of treatment, even if adoption of robot-assisted RC (RARC) is rapidly increasing. To date, all the available randomized controlled trials were characterized by an extracorporeal approach in performing UD, undermining potential benefits of a totally minimally invasive procedure. In this study, we aimed to report perioperative and 6-month outcomes from the first RCT comparing ORC and RARC with totally intracorporeal UD. Patients were eligible for randomization if they had a diagnostic transurethral resection of bladder tumor with cT2-4, cN0, cM0 or recurrent high-grade nonmuscle-invasive bladder cancer and no anesthesiological contraindications to robotic surgery. Patients were enrolled with a covariate adaptive randomization process based on the following variables: body mass index, American Society of Anesthesiologists® score, baseline hemoglobin, planned UD, neoadjuvant chemotherapy and cT stage. The primary end point was to demonstrate the superiority of RARC with intracorporeal UD in terms of a 50% transfusion rate reduction. Overall, 116 consecutive patients (58 RARC, 58 ORC) were enrolled. Among primary endpoint, overall perioperative transfusion rates were significantly lower in the RARC cohort (RARC: 22% vs ORC: 41%; p=0.046). This prospective randomized trial observed 22% and 41% overall perioperative transfusion rates in patients treated by RARC and ORC, respectively, confirming a significant benefit in favor of RARC with intracorporeal UD. However, perioperative complications, hospital stay and 6-month health-related quality of life were largely comparable between groups. Oncologic and functional outcomes will be assessed at longer followup to observe potential differences between arms.

Long-term Prognosis of Vertigo Attacks and Health-related Quality of Life Limitations in Patients With Vestibular Paroxysmia.

To explore the long-term course of outcomes in vestibular paroxysmia (VP). Cross-sectional observational study with a retrospective collection of baseline data. Tertiary referral center. Adult patients who visited the Apeldoorn Dizziness Center between 2010 and 2020 and were diagnosed with definite or probable VP according to the Bárány Society criteria were contacted by telephone to complete a study-specific questionnaire. Baseline data were retrospectively collected from patients electronic medical records to allow comparison between baseline and follow-up data. Vertigo attack frequency, use of carbamazepine and health-related quality of life (HRQoL) limitations were the primary outcomes. Secondary outcomes were the number of attack-free years and perceived effect of medication for VP. Seventy three patients were included, 61 (84%) of whom agreed to participate in the follow-up study. Mean age was 55.0 (SD 13.1) years, 49.2% were females. Mean follow-up was 3.4 years (range 0.4-11.3). At follow-up, 44 responders (72%) still experienced vertigo attacks. Average attack frequency in the past 6 months was 307 (SD 451) at baseline and 153 (SD 279) at follow-up (p = 0.050). At follow-up, 19.7% (n = 12) of the responders reported to use or have used carbamazepine, 58% of patients who (had) used this medication reported a positive perceived effect. Overall, 71% (n = 31) of the responders reported to have limitations in one or more HRQoL items due to their VP. Our study shows a rather unfavorable prognosis in patients with VP in terms of vertigo attacks and HRQoL limitations. After the initial diagnosis follow-up is warranted to monitor clinical outcomes in these patients.

Age-Related Hearing Loss With Tinnitus and Physical Frailty Influence the Overall and Domain-Specific Quality of Life of Chinese Community-Dwelling Older Adults.

Objective: To investigate the impact of the severity of age-related hearing loss (ARHL) and tinnitus, presence of ARHL and/or tinnitus, and physical frailty on the health-related quality of life (HRQoL) and domain-specific HRQoL in Chinese community-dwelling older adults.Design: This was a cross-sectional study of a community-based cohort.Participants: We evaluated Chinese older adults (n = 429, 183 men and 246 women) aged ≥ 58years.Measurements: The severity of HL and tinnitus were measured using pure-tone audiometry and the Tinnitus Handicap Inventory (THI), respectively. Physical frailty was measured using the five-item Fried scale. HRQoL was assessed using the Assessment of Quality of Life-8-Dimension (AQoL-8D) multi-attribute utility instrument (35 HRQoL items and eight domain-specific HRQoL subcategories). Low HRQoL (HRQoL score or subscores in the highest quintile) was used as a dependent variable in logistic regression analyses adjusted for demographic (Model 1) and health-related (Model 2) and psychosocial (Model 3) confounders.Results: Age-related hearing loss severity was an independent determinant of senses in the physical dimension of HRQoL after adjusting for all covariates. Tinnitus severity was significantly associated with HRQoL and with independent living, senses, and pain in the physical dimension after adjusting for demographic and health-related covariates and was still associated with independent living and senses after adjusting for all covariates. The presence of ARHL and/or tinnitus was significantly associated with independent living and senses in the physical dimension after adjusting for all the covariates. Physical frailty was an independent determinant of HRQoL, independent living, and pain in the physical dimension and with mental health, happiness, and coping in the psychosocial dimension after adjusting for demographic and health-related covariates. The association with HRQoL, independent living, and pain in the physical dimension, and with happiness and coping in the psychosocial dimension remained significant after adjusting for the covariates. Depressive symptoms, social dysfunction, and a number of comorbidities were critical determinants of psychosocial HRQoL.Conclusion: Physical frailty has a stronger and more profound effect on HRQoL, particularly on independent living and pain in the physical dimension and on happiness and coping in the psychosocial dimension. Domain-specific HRQoL should be considered in the management of patients with ARHL with tinnitus and physical frailty.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT2017K020.

Stoma location and ostomy-related quality of life among cancer survivors with ostomies: A pooled analysis

IntroductionWe sought to explore how stoma location may affect self-care events and health-related quality of life (HRQOL) in cancer survivors with ostomies. MethodsA pooled dataset was obtained from three multi-site studies that used the City of Hope Quality of Life-Ostomy questionnaire. Predicted means for HRQOL and individual items were generated adjusting for sex, ostomy type, and body mass index. ResultsAmong 607 cancer survivors, abdominal quadrant groups were: 138 (23%) upper left, 298 (49%) lower left, 51 (8%) upper right, and 120 (20%) lower right. Survivors with lower right side ostomies more frequently reported weight gain after ostomy surgery (p < 0.001). Stoma on the right side of the abdomen was associated with lower scores for issues with the skin surrounding the ostomy (p = 0.03) and satisfaction with appearance (p = 0.008). DiscussionStoma location is associated with HRQOL and difficulties adjusting to the ostomy.

Impact of intellectual and developmental disability on quality-of-life priorities in adults with epilepsy

ObjectiveAdults living with intellectual and developmental disability (IDD) and epilepsy (IDD-E) face challenges in addition to those faced by the general population of adults with epilepsy, which may be associated with distinct priorities for improving health-related quality of life (HR-QOL). This study sought to (1) conduct a survey of HR-QOL priorities identified by adults with IDD-E and caregivers, and (2) perform an exploratory cross-sectional comparison to adults with epilepsy who do not have IDD. MethodsThis cross-sectional study recruited 65 adults with IDD-E and 134 adults with epilepsy without IDD and caregivers. Using a three-step development process, 256 items from existing quality-of-life scales recommended by the American Academy of Neurology (AAN) were rated by patients/caregivers for their importance as HR-QOL priorities. HR-QOL items identified as critical to the majority of the sample of adults with IDD-E were reported. Health-related quality of life priorities were compared between adults with IDD-E and adults with epilepsy without IDD. ResultsHealth-related quality of life was significantly lower in adults with IDD-E. Health-related quality of life domains identified as critical priorities by adults with IDD-E included seizure burden, anti-seizure medication side effects, seizure unpredictability, and family impact. Priorities for improving HR-QOL differed between adults with and without IDD-E, with concerns about family impact, difficulty finding appropriate living conditions, inadequate assistance, and difficulty transitioning from pediatric-to-adult care valued significantly more among those with IDD-E. SignificanceIntellectual and developmental disability is an important determinant of HR-QOL among adults with epilepsy. We report HR-QOL priorities identified by adults with IDD-E and their caregivers. These results may help epilepsy clinicians and researchers develop tailored strategies to address priorities of the patient with IDD-E/caregiver community.