Higher Mental Component Summary Research Articles

Effect of Patient-Reported Preprocedural Physical and Mental Health on 10-Year Mortality After Percutaneous or Surgical Coronary Revascularization.

Clinical and anatomical characteristics are often considered key factors in deciding between percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with complex coronary artery disease (CAD) such as left-main CAD or 3-vessel disease. However, little is known about the interaction between self-reported preprocedural physical/mental health and clinical outcomes after revascularization. This subgroup analysis of the SYNTAXES trial (SYNTAX Extended Survival), which is the extended follow-up of the randomized SYNTAX trial (Synergy Between PCI With Taxus and Cardiac Surgery) comparing PCI with CABG in patients with left-main CAD or 3-vessel disease, stratified patients by terciles of Physical (PCS) or Mental Component Summary (MCS) scores derived from the preprocedural 36-Item Short Form Health Survey, with higher PCS and MCS scores representing better physical and mental health, respectively. The primary end point was all-cause death at 10 years. A total of 1656 patients with preprocedural 36-Item Short Form Health Survey data were included in the present study. Both higher PCS and MCS were independently associated with lower 10-year mortality (10-point increase in PCS adjusted hazard ratio, 0.84 [95% CI, 0.73-0.97]; P=0.021; in MCS adjusted hazard ratio, 0.85 [95% CI, 0.76-0.95]; P=0.005). A significant survival benefit with CABG over PCI was observed in the highest PCS (>45.5) and MCS (>52.3) terciles with significant treatment-by-subgroup interactions (PCS Pinteraction=0.033, MCS Pinteraction=0.015). In patients with both high PCS (>45.5) and MCS (>52.3), 10-year mortality was significantly higher with PCI compared with CABG (30.5% versus 12.2%; hazard ratio, 2.87 [95% CI, 1.55-5.30]; P=0.001), whereas among those with low PCS (≤45.5) or low MCS (≤52.3), there were no significant differences in 10-year mortality between PCI and CABG, resulting in a significant treatment-by-subgroup interaction (Pinteraction=0.002). Among patients with left-main CAD or 3-vessel disease, patient-reported preprocedural physical and mental health status was strongly associated with long-term mortality and modified the relative treatment effects of PCI versus CABG. Patients with the best physical and mental health had better 10-year survival with CABG compared with PCI. Assessment of self-reported physical and mental health is important when selecting the optimal revascularization strategy. URL: https://www. gov; SYNTAXES Unique identifier: NCT03417050. URL: https://www. gov; SYNTAX Unique identifier: NCT00114972.

Patient-reported outcomes in the aging population of adults with congenital heart disease: results from APPROACH-IS.

The congenital heart disease (CHD) population now comprises an increasing number of older persons in their 6th decade of life and beyond. We cross-sectionally evaluated patient-reported outcomes (PROs) in persons with CHD aged 60 years or older, and contrasted these with PROs of younger patients aged 40-59 years and 18-39 years. Adjusted for demographic and medical characteristics, patients ≥60 years had a lower Physical Component Summary, higher Mental Component Summary, and lower anxiety (Hospital Anxiety and Depression Scale-Anxiety) scores than patients in the two younger categories. For satisfaction with life, older persons had a higher score than patients aged 40-59 years. Registration: ClinicalTrials.gov NCT02150603.

Health Related Quality of Life Among Chronic Kidney Disease Patients Undergoing Hemodialysis in Pakistan.

Background: Hemodialysis is a well-established replacement therapy for patient with end stage kidney disease havin a great impact on the patient’s quality of life. Therefore, the purpose of this study is to identify the health-related quality of life of patients undergoing maintenance hemodialysis. Methods: A cross sectional single centere survey was carried out from March 2018 to June 2018 at Department of Nephrology, Institute of Kidney diseases, Peshawar in Pakistan. A 36 item KDQOL validated Urdu version was used to identify the quality of life of patients. Results: A total of n=184 patients having chronic kidney disease undergoing hemodialysis participated,of whom 63.6% were males and 57.1% patients were Pashtun. A multiple linear regression showed that patients having kidney disease caused due to hypertension had 45% higher kidney disease component summary (KDCS) score while 16% higher physical component summary (PCS) score and 60% higher mental component summary (MCS) score and were statistically significant. Similarly; Peshawari patients had 22% lower PCS score as compared to other ethnic groups ; however, in MCS Peshawari patients had 16% higher score and were statistically significant. Conclusion: The patients have poor quality of life receiving hemodialysis therapy in all three domains like PCS, MCS and KDCS.

Low serum adiponectin level is associated with better physical health-related quality of life in chronic kidney disease

Hyperadiponectemia is paradoxically associated with renal disease progression and mortality in chronic kidney disease (CKD). Its association with health-related quality of life (HR-QOL) is unknown. This study aimed to verify the association between adiponectin and HR-QOL in Korean pre-dialysis CKD cohort. This cross-sectional study analyzed 1551 pre-dialysis CKD patients from KNOW-CKD (KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease). Participants were categorized into three tertiles (T1–T3) according to adiponectin levels. HR-QOL was assessed using SF-36. High physical component summary (PCS) and mental component summary (MCS) were defined as highest quartile of each score. Multivariate logistic regression was used to analyze odds ratio (OR) and 95% confidence interval (CI) for high PCS and MCS. Prevalence of high PCS were 33.3%, 27.5%, and 17.0% and that of high MCS were 31.7%, 24.8%, and 21.3% for T1, T2, and T3 (both p for trend < 0.001). The adjusted OR [95% CI] of T1 and T2 in reference to T3 were 1.56 [1.09–2.23] and 1.19 [0.85–1.68] for high PCS and 1.19 [0.85–1.68] and 0.94 [0.68–1.29] for high MCS. Serum adiponectin level was inversely associated with physical HR-QOL in Korean pre-dialysis CKD patients. This relationship was independent of various cardiovascular risk factors.

T3 Are Burns a Chronic Condition: Examining Physical and Mental Functioning up to 20 Years After Injury

Abstract Introduction Burn survivors often face many long-term physical and psychological symptoms associated with their injury. To date, however, few studies have examined the impact of burn injuries on quality of life beyond 2 years post-injury. The purpose of this study is to examine the physical and mental well-being of burn survivors up to 20 years after injury. Methods Data from the Burn Model System National Database (1997–2020) were analyzed. Patient-reported outcome measures were collected at discharge with a recall of preinjury status, and then at 5, 10, 15, and 20 years after injury. Outcomes examined were the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Short Form-12. Trajectories were developed using linear mixed methods model with repeated measures of PCS and MCS scores over time and controlling for demographic and clinical variables. The model fitted score trajectory was generated with 95% confidence intervals to demonstrate score changes over time and associations with covariates. Results The study population included 420 adult burn survivors with a mean age of 42.4 years. The population was mainly male (66%) and white (76.4%) with a mean burn size of 21.5% and length of hospital stay of 31.3 days. Higher PCS scores were associated with follow-up time points closer to injury, shorter hospital stay, and younger age. Similarly, higher MCS scores were associated with earlier follow-up time points, shorter hospital stay, female gender, and non-perineal burns. MCS trajectories are demonstrated in the Figure. Conclusions Burn survivors’ physical and mental health worsened over time. Such a trend is different from previous reported results for mental health in the general population. Demographic and clinical predictors of recovery over time are identified.

Quality of Life in patients with nonalcoholic fatty liver disease: Structure and related factors focusing on illness uncertainty.

Patients with nonalcoholic fatty liver disease (NAFLD) have a low quality of life (QOL) and illness uncertainty. This study examined the structure of QOL and associated factors, including illness uncertainty, among individuals with NAFLD. A cross-sectional survey was conducted using a self-administered questionnaire for outpatients with NAFLD. QOL was measured using the Short Form-8. Dietary habits, physical activity level, illness uncertainty, health locus of control, and knowledge of NAFLD were assessed. Path analysis was used to study the associated factors of QOL and their structure, including uncertainty of disease. Path analysis of 168 NAFLD patients indicated that a high Physical Component Summary score on the Short Form-8-representing physical QOL-was predicted by a body mass index <25 kg/m2 and high educational level. A high Mental Component Summary score-representing mental QOL-was predicted by being male, good dietary habits, low illness uncertainty, and presence of consultants. The model showed satisfactory goodness-of-fit without being rejected by the chi-square test (goodness-of-fit index = .947, adjusted goodness-of-fit index = .917, comparative fit index = .967, root mean square error of approximation = 0.023). Nurses need to work closely with NAFLD patients as consultants, providing adequate information about the causes, treatments, and dietary habits, and focusing on the individual's perception of health. This could reduce illness uncertainty and contribute to the improvement of QOL.

Evaluation of quality of life and its influencing factors after transplantation of leukemia patients based on SF-36 score: a cohort study.

The aim of this study is to clarify the short-term quality of life (QoL) of acute leukemia (AL) patients early after stem cell transplantation (SCT) and related predictors of QoL recovery. We investigated adult AL patients who underwent SCT at the Institute of Hematology and Blood Diseases Hospital after transplantation. Physical/functional and emotional/mental recovery were evaluated using the Short Form 36 (SF-36) questionnaire to identify its trajectory as well as related predictors for the physical component summary (PCS) and mental component summary (MCS). The score was also used to establish a QoL prediction model. A total of 326 AL patients responded to our QoL survey. The results revealed the profile of patient follow-up from 2013 to 2015. Along follow-up after transplantation, there was a significant increase in PCS (p = 0.139) and MCS (p = 0.122). On multivariate regression analysis, apart from follow-up, marriage, financial situation, employment situation, and history of chronic graft-versus-host disease (cGVHD) had clinical significance for both PCS and MCS. A prediction model for patient risk hierarchy estimation was further established. The logistic results revealed that the significant characteristics of patients with high PCS and high MCS were unmarried, without financial burden, reliable on drugs, and with history of acute graft-versus-host disease (aGVHD). This well-established study enabled evaluation of the QoL of AL patients post-HSCT in China. The established prediction model could provide more indications and insights into improvement in quality of life for better medical interventions.

Are Patient-Reported Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion Influenced by Preoperative Mental Health?

Study design:This was a retrospective review of prospectively collected data.Objectives:Few studies have described the relationship between mental health and patient-reported outcome measures (PROMs) after minimally invasive spine surgery. Prior studies on open surgery included small cohorts with short follow-ups.Methods:Patients undergoing primary minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for degenerative pathology were retrospectively reviewed and stratified by Short Form (SF-36) Mental Component Summary (MCS): low MCS (<50, n = 436) versus high MCS (≥50, n = 363). PROMs assessed were back pain, leg pain, North American Spine Society Neurogenic Symptoms, Oswestry Disability Index, SF-36 Physical Component Summary, and MCS. Satisfaction, expectation fulfilment, and return to work (RTW) rates also were recorded at 1 month, 3 months, 6 months, and 2 years.Results:Preoperative MCS was 39.4 ± 8.6 and 58.5 ± 5.4 in the low and high MCS groups, respectively (P < .001). The low MCS group had significantly poorer preoperative PROMs and longer lengths of stay. Despite this, both groups achieved comparable PROMs from 3 months onward. The mean MCS was no longer significantly different by 3 months (P = .353). The low MCS group had poorer satisfaction (P = .022) and expectation fulfilment (P = .020) at final follow-up. RTW rates were initially lower in the low MCS group up to 3 months (P = .034), but the rates converged from 6 months onward.Conclusions:Despite poorer PROMs preoperatively, patients with poor baseline mental health still achieved comparable results from 3 months up to 2 years after MIS-TLIF. Preoperative optimization of mental health should still be pursued to improve satisfaction and prevent delayed RTW after surgery.

Patients With Poor Baseline Mental Health May Experience Significant Improvements in Pain and Disability After Minimally Invasive Transforaminal Lumbar Interbody Fusion: A 5-Year Follow-up Study.

A retrospective study using prospectively collected registry data. Examine the influence of preoperative mental health on outcomes after Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF). Prior studies investigating the relationship between mental health and outcomes after lumbar spine surgery included small cohorts with short follow-up and heterogenous fusion techniques. The effect of MIS-TLIF on mental health also remains unclear. Prospectively collected registry data of 226 patients who underwent single-level MIS-TLIF at a single institution were reviewed. Patients had completed 5-year follow-up data and were assigned into propensity score-matched groups: poor baseline mental health, that is, low Mental Component Summary (MCS) (<50, n=113) and normal baseline mental health, that is, high MCS (≥50, n=113). Outcomes assessed were visual analog scale for back pain (BP), leg pain (LP), Oswestry Disability Index (ODI), Short-Form 36, North American Spine Society-Neurogenic Symptoms (NS), return to work, return to function, satisfaction, and expectation fulfillment. Length of operation and length of stay were recorded. Preoperative MCS was 40.6±8.2 and 58.5±5.4 in the low and high MCS groups, respectively, after propensity score matching (P<0.001). At 5 years, the high MCS group had significantly lower LP (P=0.020) and NS (P=0.009). Despite a significantly poorer baseline (44.3 vs. 38.7, P=0.007) and 6-month ODI (20.3 vs. 15.7, P=0.018) in the low MCS group, both groups achieved a comparable ODI at 5 years (P=0.084). There was no significant difference in proportion that achieved minimal clinically important difference for ODI, PCS, BP, and LP (P>0.05). Both groups reported similar proportions that return to work. However, the low MCS group had a smaller proportion of patients that return to function at 5 years (P=0.025). Although patients with poorer baseline mental health had greater pain and worse NS preoperatively and up to 5 years postoperatively, a similar proportion experienced a clinically significant improvement in all outcomes. Level III-nonrandomized cohort study.

Determinants of health-related quality of life in systemic lupus erythematosus: amonocentric, retrospective long-term observational study in Germany

Improvement of health-related quality of life (HRQoL) is aprioritized treatment target in systemic lupus erythematosus (SLE). Aretrospective chart review of patients with repeated HRQoL measurements from the outpatient department was conducted in order to better understand which factors drive HRQoL in established SLE. Of particular interest was the association between HRQoL and disease activity. The medical outcomes study short form36 (SF-36), systemic lupus activity measure (SLAM) and routine clinical data of 169 patients (83% female, mean age 40.3 ± 13years, disease duration 9.4 ± 7years) over an average of 7.1 ± 4.2years were available for analysis by linear mixed modelling. Factors associated with the physical component summary (PCS) and mental component summary (MCS) of the SF-36 were assessed. The proportion of HRQoL which could be explained by the variables was estimated by marginal R2 (mR2) and conditional R2 (cR2). At baseline, SLE patients showed a reduced HRQoL in all subscales of the SF-36 including PCS and MCS with the exception of vitality. A higher PCS over time was significantly associated with concurrent parameters, such as intake of antimalarial drugs, no glucocorticoid use, less fatigue, lower disease activity as well as to the baseline parameters of younger age and higher PCS (mR2 54.7%, cR2 59.9%). A higher MCS was associated with concurrent use of glucocorticoids and a higher baseline MCS (mR2 21.7%, cR2 25.1%). The use of antimalarial drugs and no glucocorticoid intake as well as low current disease activity are modifiable factors associated with a better physical HRQoL. The mental component of HRQoL was poorly represented by conventional parameters and not associated with parameters of disease activity in the present study cohort.

Health-related Quality of Life, Cognitive Performance, and Incident Dementia in a Community-based Elderly Cohort.

We hypothesized that higher quality of life would be associated with better cognitive function and a reduced risk of incident all cause dementia and Alzheimer disease (AD) in older adults. Participants included 1183 older adults with an average age of 78.2 (SD=5.3) from Einstein Aging Study. The 36-Item Short-Form Health Survey was used to measure health-related quality of life (HRQoL). We investigated baseline associations between the cognitive domains of memory, executive function, and general fluid ability with 8 subscales of the 36-Item Short-Form Health Survey (physical functioning, role limitations due to physical problems, bodily pain, general health perceptions, social functioning, role limitations due to emotional problems, vitality, and general mental health) and the 2 component summary scores of physical component summary (PCS) and mental component summary (MCS). Next, we used Cox proportional hazard models to assess the predictive validity of HRQoL subscales for the onset of incident dementia and incident AD. At baseline, higher scores (better HRQoL) on MCS and its 4 subscales (social functioning, role limitations due to emotional problems, vitality, and general mental health) were associated with higher performance on both memory and executive function domains. Higher scores in role limitation due to physical problems, role limitation due to emotional problems, and general mental health subscales were associated with reduced risk of incident dementia. Higher MCS, but not PCS, predicted a reduced incident of all-cause dementia and AD. These findings suggest that diminution of HRQoL precedes the onset of diagnosable dementia and may be useful in the prediction of dementia onset.

Poor Baseline Mental Health Does Not Influence Improvement in Patient-reported Outcomes, Satisfaction, and Return to Work Two Years After Single-level Anterior Cervical Discectomy and Fusion.

Retrospective study using prospectively collected registry data. The authors examine the influence of preoperative mental health on outcomes after anterior cervical discectomy and fusion (ACDF) and determine the impact of ACDF on postoperative mental health. While studies have reported a negative correlation between preoperative mental health and outcomes following lumbar spine surgery, the influence on outcomes following cervical spine surgery remains relatively understudied. Prospectively collected registry data of 104 patients who underwent single-level ACDF for cervical spondylotic myelopathy were reviewed. Patients were dichotomized into top and bottom halves based on preoperative SF-36 MCS (Mental Component Summary) using a cutoff of 48. Outcomes assessed were visual analogue scale for neck pain, arm pain, AAOS Neck Pain and Disability, Neurogenic Symptoms, Neck Disability Index, Short-Form 36, Japanese Orthopaedic Association myelopathy score, return to work, return to function, satisfaction and expectation fulfilment up to 2 years postoperatively. The preoperative MCS was 37.5 ± 8.1 and 57.4 ± 6.3 in the Low and High MCS groups respectively (P < 0.001). The Low MCS group had poorer preoperative scores (P < 0.05). There was no significant difference in length of stay or comorbidities (P > 0.05). The High MCS group had less neck pain (P = 0.002) and showed a trend towards lower Neck Disability Index (P = 0.062) at 2 years. The Low MCS group demonstrated greater improvement in Japanese Orthopaedic Association (P = 0.007) and similar improvement in other scores (P > 0.05). There was no significant difference in proportion that achieved minimal clinically important difference for each score (P > 0.05). Both groups had similar rates of return to work, return to function, expectation fulfilment, and satisfaction (P > 0.05). Lower preoperative MCS was predictive of greater improvement in MCS (r = -0.477, P < 0.001). Despite relatively greater pain and disability at 2 years, patients with poor baseline mental health experienced similar improvement in clinical outcomes, return to work, and satisfaction rates. 3.

The impact of progressive chronic kidney disease on health-related quality-of-life: a 12-year community cohort study.

Quality-of-life is poor in end-stage kidney disease; however, the relationships between earlier stages of chronic kidney disease (CKD) and are poorly understood. This study explored longitudinal quality-of-life changes in a community-based CKD cohort and assessed associations between CKD and quality-of-life over time, and between baseline quality-of-life and CKD outcomes. We used the Australian diabetes, obesity and lifestyle study-a nationally representative, prospective cohort with data collected at baseline, year 5 and year 12-to examine the relationships between CKD stage, quality-of-life and outcomes. Linear mixed regression, cox proportional hazards, Kaplan-Meier and competing risks analyses were used. Of 1112 participants with CKD and baseline quality-of-life data, the physical component summary (PCS) score was significantly lower than for the general population (p = 0.01 age and sex adjusted), while the mental component summary (MCS) score was no different (p = 0.9 age and sex adjusted). In our unadjusted mixed effects model, more advanced kidney disease was associated with lower PCS and higher MCS at baseline (p < 0.001 and p < 0.01, respectively); however, this effect was no longer significant after adjustment for demographic and clinical variables. The rate of decline in PCS over the period of follow-up was greatest for those with more advanced kidney disease (p < 0.001 in unadjusted model, p = 0.007 in adjusted model). There was no association between change in MCS over the period of follow-up and severity of kidney disease in either the unadjusted or adjusted model (p = 0.7 and p = 0.1, respectively). Lower PCS, but not MCS, was associated with increased cardiovascular and increased all-cause mortality even after adjustment for key demographic and clinical variables (p < 0.001). Physical, but not mental, quality-of-life is significantly impaired in CKD, and continues to decline with disease progression.

MP36-15 SELF-REPORTED QUALITY OF LIFE FOR PREDICTING MORTALITY IN RENAL CELL CARCINOMA

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging II1 Apr 2018MP36-15 SELF-REPORTED QUALITY OF LIFE FOR PREDICTING MORTALITY IN RENAL CELL CARCINOMA Ridwan Alam, Hiten D. Patel, Michael A. Gorin, Michael H. Johnson, Mohamad E. Allaf, and Phillip M. Pierorazio Ridwan AlamRidwan Alam More articles by this author , Hiten D. PatelHiten D. Patel More articles by this author , Michael A. GorinMichael A. Gorin More articles by this author , Michael H. JohnsonMichael H. Johnson More articles by this author , Mohamad E. AllafMohamad E. Allaf More articles by this author , and Phillip M. PierorazioPhillip M. Pierorazio More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1149AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Quality of life (QOL) in cancer patients has gained increasing attention and may provide prognostic value above and beyond traditional demographic and disease parameters. We evaluate the utility of self-reported QOL to predict mortality in patients with renal cell carcinoma (RCC). METHODS The Medicare Health Outcomes Survey was linked to the SEER database to identify patients who completed a QOL questionnaire after the diagnosis of RCC from 1998-2014. Mental component summary (MCS) and physical component summary (PCS) scores were classified as high (≥50) or low (<50) based on a population mean score of 50 points. Patients were classified into four groups: 1) high MCS, high PCS; 2) high MCS, low PCS; 3) low MCS, high PCS; and 4) low MCS, low PCS. Multivariable Cox proportional hazards regression evaluated associations between QOL and all-cause mortality (ACM). The Harrell's concordance statistic (C-index) estimated the model's predictive accuracy. Fine and Gray competing risks models adjusting for disease extent, demographics, and comorbidities evaluated the incidence of RCC-specific and non-RCC-specific mortality. RESULTS A total of 1494 patients with a median age of 73.4 years (IQR 68.8-79.3) at survey completion were included. Median follow-up was 5.6 years (IQR 4.0-8.3). There were 747 deaths, of which 139 were due to RCC. Cox regression showed that each additional MCS and PCS point reduced the hazard of ACM by 1.3% (95% CI 0.981-0.993, P<0.001) and 2.2% (95% CI 0.972-0.985, P<0.001), respectively. The C-index was 72.1%. In the competing risks model, the subdistribution hazard ratio (SHR) of RCC mortality in Groups 2, 3, and 4 were 2.71 (95% CI 1.18-6.22, P=0.02), 4.55 (95% CI 1.57-13.18, P=0.005), and 3.11 (95% CI 1.35-7.16, P=0.008), respectively, compared to Group 1 [Figure A]. The SHR for non-RCC mortality in Groups 2, 3, and 4 were 1.50 (95% CI 1.16-1.94, P=0.002), 1.03 (95% CI 0.59-1.78, P=0.9), and 1.83 (95% CI 1.41-2.38, P<0.001), respectively, relative to Group 1 [Figure B]. CONCLUSIONS Self-reported QOL metrics can be used to predict ACM in RCC patients with good accuracy. Lower PCS and MCS scores led to higher rates of ACM, even after accounting for differences in disease, demographics, and comorbidity. Furthermore, non-RCC mortality was associated more with low physical health rather than low mental health. © 2018FiguresReferencesRelatedDetailsCited bySotimehin A, Patel H, Alam R, Gorin M, Johnson M, Chang P, Wagner A, McKiernan J, Allaf M and Pierorazio P (2019) Selecting Patients with Small Renal Masses for Active Surveillance: A Domain Based Score from a Prospective Cohort StudyJournal of Urology, VOL. 201, NO. 5, (886-892), Online publication date: 1-May-2019. Volume 199Issue 4SApril 2018Page: e463-e464 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Ridwan Alam More articles by this author Hiten D. Patel More articles by this author Michael A. Gorin More articles by this author Michael H. Johnson More articles by this author Mohamad E. Allaf More articles by this author Phillip M. Pierorazio More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Patients With Poor Baseline Mental Health Undergoing Unicompartmental Knee Arthroplasty Have Poorer Outcomes

BackgroundThe relationship between mental health and outcomes of unicompartmental knee arthroplasty (UKA) remains unclear. Poor preoperative mental health may be caused by pain and functional limitations associated with knee arthritis. We aimed at (1) investigating the effect of preoperative mental health on early outcomes and (2) assessing whether mental health improves after UKA. MethodsProspectively collected registry data of 1473 medial UKAs performed at a single institution in 2007-2014 were reviewed. Linear regression was used to determine improvement in mental health up to 2 years according to preoperative Short-Form 36 Mental Component Summary (MCS). Patients were stratified into low MCS (<50, n = 579) and high MCS (≥50, n = 894). The Knee Society Knee Score (KSKS), Function Score (KSFS), Oxford Knee Score (OKS), Short-Form 36, satisfaction, and expectation fulfilment were compared at 6 months and 2 years. ResultsThe mean preoperative MCS was 41.2 in low MCS group and 58.6 in high MCS group (P < .001). The high MCS group had higher KSKS, KSFS, OKS, and Physical Component Summary, and a greater proportion of patients were satisfied and had expectations fulfilled at 6 months and 2 years (P < .05). However, the low MCS group demonstrated greater improvement in KSKS, KSFS, and OKS (P < .05). Lower preoperative MCS score was predictive of greater improvement in MCS (coefficient = −0.662, R = −0.602, P < .001). ConclusionPatients with poor mental health benefit from greater improvements in their mental health and knee function after UKA, but also have a greater dissatisfaction.

Self-reported quality of life as a predictor of survival in renal cell carcinoma.

595 Background: Quality of life (QOL) in cancer patients has gained increasing attention and may provide prognostic value above and beyond traditional demographic and disease parameters. We evaluate the utility of self-reported QOL to predict mortality in patients with renal cell carcinoma (RCC). Methods: The Medicare Health Outcomes Survey was linked to SEER data to identify patients who completed a QOL questionnaire after the diagnosis of RCC from 1998-2014. Mental component summary (MCS) and physical component summary (PCS) scores were classified as high (≥50) or low ( &lt; 50) based on a population mean score of 50 points. Patients were classified into four groups: 1) high MCS, high PCS; 2) high MCS, low PCS; 3) low MCS, high PCS; and 4) low MCS, low PCS. Multivariable Cox proportional hazards regression evaluated associations between QOL and all-cause mortality (ACM). The Harrell’s concordance statistic (C-index) estimated predictive accuracy. Fine and Gray competing risks models adjusted for stage, demographics, and comorbidities evaluated RCC-specific and non-RCC-specific mortality. Results: A total of 1494 patients with a median age of 73.4 years (IQR 68.8-79.3) at survey completion were included. Median follow-up was 5.6 years (IQR 4.0-8.3). There were 747 deaths, of which 139 were due to RCC. Models showed that each additional MCS and PCS point reduced the hazard of ACM by 1.3% (95% CI 0.981-0.993, P&lt; 0.001) and 2.2% (95% CI 0.972-0.985, P&lt; 0.001), respectively. The C-index was 72.1%. In the competing risks model, the subdistribution hazard ratio (SHR) of RCC mortality in Groups 2, 3, and 4 were 2.71 (95% CI 1.18-6.22, P= 0.02), 4.55 (95% CI 1.57-13.18, P= 0.005), and 3.11 (95% CI 1.35-7.16, P= 0.008), respectively, compared to Group 1. The SHR for non-RCC mortality were 1.50 (95% CI 1.16-1.94, P= 0.002), 1.03 (95% CI 0.59-1.78, P= 0.9), and 1.83 (95% CI 1.41-2.38, P&lt; 0.001), respectively, relative to Group 1. Conclusions: Self-reported QOL metrics can be used to predict ACM in RCC patients with good accuracy; lower PCS and MCS scores led to higher rates of ACM, even after accounting for differences in disease, demographics, and comorbidity. Furthermore, non-RCC mortality was associated more with low physical health rather than low mental health.

The Health-Related Quality of Life of Chinese Patients on Hemodialysis and Peritoneal Dialysis.

Our aim was to compare health-related quality of life (HRQOL) between end-stage renal disease (ESRD) patients and the Hong Kong general population to identify how the mode of dialysis and other factors were associated with HRQOL. We conducted a cross-sectional study involving 253 hemodialysis (HD) patients and 103 peritoneal dialysis (PD) patients recruited in 2014-2015. Their HRQOL was evaluated using Kidney Disease and Quality of Life-36 (KDQOL-36) sub-scale scores and the Short Form-6 Dimensions (SF-6D) health preference score. One-way analysis of variance was used to analyze the difference in mean KDQOL-36 and SF-6D scores among PD patients, HD patients, and an exact age- and sex-matched general population. Multiple linear regressions were conducted to evaluate factors associated with the KDQOL-36 and SF-6D scores. The physical HRQOL of ESRD patients on dialysis was worse than that of the age- and sex-matched general population (38.4 vs. 49.6), but mental HRQOL was similar (50.7 vs. 52.0). After adjusting for all baseline characteristics, male subjects was associated with higher physical component summary (PCS), SF-6D, and symptom scores. A higher level of education (secondary or tertiary) was associated with higher mental component summary (MCS), SF-6D, symptom, and effects scores. Patients who were female, younger, married, and less educated and had a history of cardiovascular disease (CVD) and did not achieve target hemoglobin and albumin levels were associated with poorer HRQOL outcomes. HD was associated with a greater negative impact of ESRD on daily lives than was PD, which may be a consideration when deciding on the dialysis modality for first-line renal replacement therapy. To improve HRQOL among patients on maintenance dialysis, more attention should be paid to those with demographic risk factors, preventing CVD, and meeting clinical dialysis outcome targets such as hemoglobin and albumin levels.

Predictors of decision ambivalence and the differences between actual living liver donors and potential living liver donors.

BackgroundThe decision to become a living liver donor is a stressful event. Ambivalence in decision making may result in psychological distress. Thus, the purpose of this study was to provide a description of the ambivalence of potential living liver donors, to examine the predictors of ambivalence, and to compare the ambivalence of potential living liver donors with that of actual living liver donors.MethodsThis descriptive and correlational study was conducted in a medical center from August 2013 to December 2015. Self-reported questionnaires were used to collect data. A total of 263 potential living liver donors who were assessed for donation to their parents were included in this study.ResultsThe mean age of the total sample was 30.7 years (SD = 6.39, range = 20–47), and males comprised 53.6% of the sample. The majority of the potential donors had a college education (70.8%) and were single (63.5%). Of the total sample, the mean score for ambivalence was 4.27 (SD = 1.87, range = 0–7). Multivariate analysis revealed that the Mental Component Summary (MCS) of quality of life (β = -0.24, p < 0.01), family support (β = -0.17, p = 0.007), and intimacy (β = -0.13, p = 0.04) were significant protective predictors of ambivalence. Actual living liver donors had significantly lower ambivalence (3.82 versus 4.60), higher intimacy with recipients (3.55 versus 3.34), higher MCS (45.26 versus 42.80), and higher family support (34.39 versus 29.79) than did the remaining potential living liver donors.ConclusionAmbivalence is common in potential living liver donors. The MCS of quality of life, family support, and intimacy were protective predictors in terms of ambivalence. Future research should explore other factors and design interventions targeted toward reducing ambivalence, promoting family support, and enhancing the mental dimensions of quality of life in potential living liver donors.

Abstract 3466: Mental health-related quality of life assessment at diagnosis as a predictor for prognosis of colorectal cancer patients

Abstract Purpose: Health-related quality of life (HR-QoL) is emerging as an important metric for assessing and predicting outcomes in colorectal cancer (CRC) patients. While most studies focus on QoL in treatment response, few studies have investigated the impact of baseline mental health QoL variables on prognosis of CRC patients. The objective of our study was to explore mental health and vitality QoL measurements and association with prognosis in CRC patients. Patients and Methods: QoL was assessed in a hospital-based cohort of 2,900 non-Hispanic white CRC patients that completed the SF-12 questionnaire within 1-year of diagnosis. Mental Component Summary (MCS) scores were dichotomized by the normalized scoring-based mean of 50. Hazard ratios were generated using univariate cox regression analysis and survival estimates generated using the Kaplan-Meier method. Sub-domain variables under mental health (“downhearted and blue” and “calm and peaceful”) and vitality (“energy”), were scored and dichotomized before stratifying by patient demographics and statistically evaluated. Results: We observed that CRC patients with poor mental QoL (MCS&amp;lt;50) had a 1.48-fold increased risk (95%CI:1.31-1.66; P = 5.17×10−14) of a poorer prognosis compared to those with a high MCS score (≥50). This corresponded to a 61.9 month reduction in median survival time in this group (log-rank P = 5.88×10−11). Patients that reported feeling downhearted and blue compared to those that did not, had a 65.7 month reduction in median survival time (log-rank P = 1.13×10−5). Similarly, there was an increased survival time for patients that felt peaceful and calm (MST:113.1 months) compared to those that reported not feeling peaceful and calm (MST:59.4 months; log-rank P = 1.36×10−5). The most striking finding was for the energy variable. Patients that reported having energy compared to those that did not, were found to have significantly better survival with MSTs of &amp;gt;175 months and 42.3 months, respectively (log-rank P = 2.91×10−27). Several patient characteristics (alcohol use, tobacco use, gender and marital status) were significantly associated with these sub-domain measurements. We found those that reported combined poor mental health and vitality had a dramatic reduction in survival by 102.7 months (log-rank P = 8.39×10−18). Conclusion: We conclude that baseline mental QoL assessment may identify CRC patients at increased risk of a poor prognosis and merits further investigation of these variables as independent CRC prognostic factors. Interestingly, a potential coping mechanism may underlie the protective effect observed among current users of alcohol, while smoking may serve as a risk factor for poor prognosis in those that reported poor mental QoL. Further studies are warranted to explore the relationship between these MCS sub-domain variables and survival in CRC patients. Citation Format: Monica E. Reyes, Yeling Zhou, Yuanqing Ye, Xifeng Wu, Michelle Hildebrandt. Mental health-related quality of life assessment at diagnosis as a predictor for prognosis of colorectal cancer patients. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3466.

Potential benefits of diagnosis and treatment on health outcomes among elderly people with symptoms of overactive bladder.

SummaryObjectivesThis study examined potential benefits of diagnosing and treating elderly adults with overactive bladder (OAB) symptoms.MethodsData were analysed from the OAB Re‐Contact Study (N = 2750), a cross‐sectional, self‐reported Internet survey. Elderly respondents (65+ years old) with OAB were identified according to current medication use to control OAB symptoms or by scores > 14 (men) or > 16 (women) on the OAB Awareness Tool. Treated were those currently using prescription medication and never treated were those who never used prescription medication for OAB. Outcome measures included health‐related quality of life, activity impairment, OAB‐related severity and symptoms, and healthcare resource use (e.g. hospitalisations). Generalised linear models predicted health outcomes as a function of diagnosis or treatment, adjusting for covariates.ResultsDiagnosed vs. not diagnosed elderly respondents had higher mental component summary (MCS) scores and SF‐6D health utilities, and less activity impairment. Treated vs. never treated elderly respondents had higher MCS and SF‐6D health utilities, less activity impairment, fewer OAB symptoms, lower OAB Awareness Tool scores, and lower odds of having bladder problems or incontinence. There were no significant differences in healthcare resource use. Further analysis by age group (middle‐aged vs. elderly respondents) revealed significantly greater diagnosis‐ and treatment‐related benefits on MCS (2.93 and 4.49 points more, respectively) and activity impairment (1.24 and 1.37 times as much, respectively) among elderly respondents.ConclusionsDiagnosis and treatment were each associated with a lower health burden for elderly adults with OAB symptoms. These findings highlighted the importance of diagnosis and treatment in alleviating OAB symptoms and their impact on health outcomes.