Health Status Of Long-term Survivors Research Articles

QOL-22. IDENTIFYING HEALTH STATUS PROFILES AMONG LONG-TERM CNS TUMOR SURVIVORS: A LATENT PROFILE ANALYSIS

Abstract CNS tumors are associated with a high mortality rate, quick onset, limited therapeutic options, and a devastating symptom burden that has a negative impact on general health status and results in functional limitations. While research is focused on development of new therapies, little is known about the health status of long-term survivors. We aimed to identify subgroups of CNS tumor survivors ( > 5 years from diagnosis) with distinct health profiles using latent profile analysis ordinal logit estimation in Mplus V8.8. General health status was measured using the EQ-5D-3L (dimensions: mobility, self-care, usual activities, pain/discomfort, anxiety/depression). Associations with demographic/clinical characteristics were identified with Pearson’s correlations and chi-square tests. Sample median age was 48 years (range: 21-85), 54% were male, 82% Caucasian, 56% employed, and 53% had a KPS ≥ 90. Most had a high-grade glioma (60%), at least one recurrence (70%), and 17% were on active treatment. Two subgroups were identified: good health status (GHS) (n=183) and poor health status (PHS) (n=115). Most patients in the GHS ( > 86%) reported no issues with mobility or usual activities and 100% had no self-care issues. However, 38% did report some problems with anxiety and depression and 21% had pain. PHS class was characterized by > 94% having at least moderate issues with mobility and usual activities and over 50% having pain, self-care issues, and anxiety and depression. Older age (r=0.21), spine tumors (OR=3.3), active treatment at assessment (OR=2.9), tumor recurrence (OR=4.2), unemployment (OR=3.5), and poor KPS scores (OR=18.1) were associated with belonging in the PHS. While maintaining physical health and function may contribute to better health status in long-term survivors, patients dealing with tumor recurrence, ongoing treatments, and spine tumors may face significant challenges. These functional profiles can be used to develop survivorship care plans and supportive care interventions.

Neurological outcome and general health status of long-term survivors after out-of-hospital cardiac arrest

Zusammenfassung Fragestellung Für Deutschland liegen nur wenige Daten zum Gesundheitszustand und Langzeitüberleben nach außerklinischer Reanimation vor. Die vorliegende Studie untersucht den allgemeinen Gesundheitszustand und das neurologische Langzeitergebnis 2,5 bis 5 Jahre nach dem Reanimationsereignis sowie den Zusammenhang zwischen Behandlungsergebnis und präklinischen Patienten- und Behandlungsfaktoren. Methodik Alle über einen Zeitraum von 30 Monaten (2011–2013) durch den Rettungsdienst der Stadt Bonn durchgeführten Reanimationen wurden auf Grundlage der Notarzteinsatzprotokolle und des Deutschen Reanimationsregisters retrospektiv analysiert. Der allgemeine Gesundheitszustand wurde in Anlehnung an den SF-12 erfasst und das neurologische Langzeitergebnis kategorisiert (Cerebral Performance Category [CPC]). Die vorliegenden Daten wurden einer uni- und multivariaten logistischen Regressionsanalyse unterzogen. Ergebnis Von insgesamt 458 Patienten überlebten 17,9 % bis zur Krankenhausentlassung, 13,8 % mehr als 2,5 Jahre und 7,7 % bis zum Stichtag der Befragung. Von den noch lebenden Patienten hatten 85,3 % ein gutes neurologisches Ergebnis (CPC ≤ 2), welches durch ein geringeres Alter, einen beobachteten Kollaps, die Durchführung einer Defibrillation und das Ausbleiben einer Vasopressorgabe begünstigt wurde (multivariate Analyse). 74,2 % der Überlebenden beschrieben ihren Gesundheitszustand als gut. Interpretation Insgesamt überleben langfristig nur wenige Patienten einen außerklinischen Herz-Kreislauf-Stillstand. Die überlebenden Patienten beurteilen ihren Gesundheitszustand als gut und zeigen ein gutes neurologisches Ergebnis. Dabei hängt dieses Behandlungsergebnis von denselben Parametern wie der primäre Reanimationserfolg (Überleben bis Krankenhausaufnahme) ab. Die Etablierung klinischer Instrumente zur frühen Prognoseerstellung ist wünschenswert. Hierzu sind weitere Langzeituntersuchungen größerer Patientenkollektive mit Zugriff auf Routinedaten notwendig.

Health status and health resource use among long-term survivors of breast, colorectal and prostate cancer

IntroductionThe growing number of long-term cancer survivors poses a new challenge to health care systems. In Spain, follow-up is usually carried out in oncology services, but knowledge of cancer survivors’ health care needs in this context is limited. The purpose of this study was to ascertain the health status of long-term survivors of breast, prostate, and colorectal cancer and to characterize their use of health care services. MethodsRetrospective multicenter cohort study. We collected data from patients’ clinical histories and through telephone interviews, using a specially designed questionnaire that included the SF-36v2 Quality of Life and Nottingham Health Profile scales. ResultsThe questionnaire was completed by 51.2% (n= 583) of the potential sample. No significant differences were observed between 5-year and 10-year survivors. Overall, more than 80% of respondents were undergoing drug treatment for morbidity related to advanced age. Quality of life was good in most patients, and cancer-related morbidity was low and of little complexity. For the most part, participants reported using primary care services for care of chronic diseases and opportunistic treatment of sequelae related to the cancer treatment. Oncological follow-up was centralized at the hospital. ConclusionsSurvivors of breast, prostate and colorectal cancer with tumoral detection at an early stage and without recurrences or second neoplasms experienced little morbidity and enjoyed good quality of life. This study proposes exploration of a follow-up model in the Spanish health system in which primary care plays a more important role than is customary in cancer survivors in Spain.

Health Status in Long-Term Survivors of Pediatric Craniopharyngiomas

Craniopharyngiomas are the third most common pediatric brain tumor and most common pediatric suprasellar tumor. Contemporary treatment of craniopharyngiomas uses limited surgery and radiation in an effort to minimize morbidity, but the long-term health status of patients treated in this fashion has not been well described. The purpose of this study was to analyze the health status of long-term survivors of pediatric craniopharyngioma treated primarily with radiation and conservative surgical resection. Medical records of all long-term survivors of craniopharyngioma treated at St. Jude Children's Research Hospital and then transferred to the long-term follow-up clinic were reviewed. The initial cohort comprised 55 patients. Of these, 51 (93%) were alive at the time of this analysis. The median age at diagnosis was 7.1 years (range, 1.2-17.6 years), and 29 (57%) were male. At the time of analysis, the median survival was 7.6 years (range, 5.0-21.3 years). Diagnosis and treatment included surgical biopsy, resection (n = 50), and radiation therapy (n=48). Only 1 patient received chemotherapy. Polyendocrinopathy was the most common morbidity, with hypothyroidism (96%), adrenocorticotropic hormone deficiency (84%), and diabetes insipidus (53%) occurring most frequently. Half of the patients were hypogonadal, and 33 (65%) were overweight or obese. The most common neurologic problems included shunt dependence (37%), seizures (28%), and headaches (39%). Psychological and educational deficits were also identified in a significant number of these individuals. Despite efforts to reduce morbidity in these patients, many survivors remain burdened with significant medical complications. In a small percentage of patients, complications may result in death even during extended remission of craniopharyngioma. Because of the broad spectrum or morbidities experienced, survivors of craniopharyngioma continue to benefit from multidisciplinary care.

Perioperative morbidity and quality of life in long-term survivors following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Background Improved prognosis can be achieved in selected patients with peritoneal carcinomatosis (PC) by major surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Method Sixty seven patients with PC were operated with the aim of complete macroscopical cytoreduction followed by HIPEC (using cisplatin, mitomycin or mitoxantrone). Quality of life was assessed with the EORTC QLQ-C30 questionnaire. Results The patients had a variety of primary tumours, including appendix carcinomas (22/67). Mean operating time was 7 hours and complete cytoreduction was achieved in 58% of the patients. Overall morbidity was 34%. Post-operative mortality was 4.5%. The mean score for global health status of long-term survivors (20 questionnaires/25 patients) was 62.6 (73.3 for the control population, p=0.07). Functional status, particularly the role (56.4) and the social functioning (53.9) were impaired. Conclusion Cytoreductive surgery combined with HIPEC is associated with an increased morbidity and mortality. Complications are predominantly related to major surgery. Following this aggressive treatment, survivors may achieve a satisfactory quality of life.

Acute leukemia in children.

Childhood leukemia comprises approximately one third of cancer cases in children younger than 15 years of age. The incidence of childhood acute lymphoblastic leukemia is increasing. Outcomes have improved for childhood acute lymphoblastic leukemia over past decades and we may be at the dawn of improvement for childhood acute nonlymphoblastic leukemia. Technology has advanced to where submicroscopic bone marrow involvement may be detected in some patients with acute lymphoblastic leukemia in remission or with isolated extramedullary relapse by conventional criteria. Outcome may be predicted by in vitro chemosensitivity assays like the methyl thiazol tetrachium assay. Estimation of end-induction residual leukemic burden by polymerase chain reaction-based clonotypic assays has prognostic significance and provides a strategy for quantitative assessment of new therapeutic interventions. The relation of outcome to the intracellular accumulation of 6-thioguanine nucleotides provides an additional therapeutic avenue. Improved cure rates require increased attention to the health status of long-term survivors.

Health status of survivors of out-of-hospital cardiac arrest six months later.

The health status of long-term survivors of out-of-hospital cardiac arrest was studied six months after the event. Although Sickness Impact Profile scores for arrest survivors were higher (worse) than scores of enrollees in a prepaid closed panel health plan, in most cases problems of survivors were not incapacitating. Approximately three-fifths of survivors reported same or better memory function and stair climbing ability compared to that at time of arrest. Three-fifths of those who had been working continued to do so.