Higher Physical Component Summary Scores Research Articles

Insufficiency of quality of life as the treatment endpoint for balloon pulmonary angioplasty in inoperable chronic thromboembolic pulmonary hypertension.

The ability of a quality of life (QoL) to guide balloon pulmonary angioplasty (BPA) among patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) has not been fully investigated. This study explored the relationship between QoL scores and hemodynamics in CTEPH patients after BPA and examined whether QoL could be applied as a treatment endpoint. This cohort study included patients with inoperable CTEPH who had undergone at least four sessions of BPA. The patients' demographic and clinical data as well as hemodynamic parameters and scores from the RAND 36-item short-form QoL questionnaire were recorded and compared before and after BPA. After BPA treatments, clinical characteristics, hemodynamic parameters, as well as QoL score improved significantly. A physical component summary (PCS) score of 35 or 46 can be used as the cutoff value for predicting better World Health Organization functional classification (WHO FC). Patients who had a higher PCS would have longer 6-min walk distance (6MWD), lower pulmonary vascular resistance (PVR), and better cardiac output (CO) both before and after BPA. However, 19 patients (55.9%) with a higher PCS score after BPA did not achieve the goal of mean pulmonary arterial pressure (mPAP) ≤30 mmHg. During the follow-up period, a significant reduction of PVR was observed, but the PCS score improved a little. QoL is a useful tool for assessing the exercise endurance of patients with inoperable CTEPH treated with BPA, but is insufficient to serve as a treatment endpoint for BPA.

Racial and Ethnic Disparities in Health-Related Quality of Life in Older Adults with Non-Hodgkin Lymphoma.

To investigate whether health-related quality of life (HRQOL) disparities exist among different racial and ethnic groups in older patients with Non-Hodgkin Lymphoma (NHL), pre- and post-diagnosis. Using the Surveillance, Epidemiology, and Ends Results-Medicare Health Outcomes Survey (SEER-MHOS) linked database, we included individuals 65 years and older with NHL and reported ethnicities of Whites, Asian, Black, and Hispanic, diagnosed from 1998-2019. HRQOL data within 24 months before and after diagnosis were measured by the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores from the SF-36® and VR-12 instruments. The total combined score (TCS) is reflected by both the PCS and MCS. Multivariate analyses (MVA) adjusted for sex, age, marital status, education, income, year of diagnosis, number of comorbidities, limitations in activities of daily living (ADLs), national region, treatment type (post-diagnosis cohort only), stage, and histology. We identified 2506 patients in the pre-diagnosis and 1903 patients in the post-diagnosis cohorts. In the pre-diagnosis cohort, univariate analysis (UVA) revealed that Whites had higher MCS scores than Asians (53.4 vs 50.2, p = 0.001), Blacks (53.4 vs 48.3, p<0.001), and Hispanics (53.4 vs 49.9, p<0.001). It was also revealed that Whites had higher PCS scores than Blacks (40.5 vs 37.4, p = 0.005), Whites had higher TCS scores than Blacks (93.4 vs 85.1, p<0.0001) and Hispanics (93.4 vs 87.3, p<0.0001), and Asians had higher TCS scores than Blacks (90.5 vs 85.1, p = 0.012). MVA revealed the following: Whites had higher MCS scores than Asians (52.3 vs 50.0, p = 0.038), Blacks (52.3 vs 49.1, p = 0.002), and Hispanics (52.3 vs 49.8, p = 0.005); Whites had higher TCS scores than Blacks (92.5 vs 87.9, p<0.006) and Hispanics (92.5 vs 88.6, p = 0.006); and Asians had higher TCS scores than Blacks (92.6 vs 87.9, p = 0.045). In the post-diagnosis cohort, UVA revealed that Whites had higher PCS scores than Hispanics (36.2 vs 34.1, p = 0.046); Whites had higher MCS scores than Asians (51.3 vs 48.8, p = 0.035), Blacks (51.3 vs 48.7, p = 0.033), and Hispanics (51.3 vs 46.7, p<0.0001); Whites had higher TCS scores than Blacks (87.0 vs 82.3, p = 0.021) and Hispanics (87.0 vs 78.5, p<0.0001); and Asians had higher TCS scores than Hispanics (86.5 vs 78.5, p = 0.001). MVA revealed that Whites had higher MCS scores than Hispanics (47.6 vs 44.0, p = 0.002); Whites had higher TCS scores than Hispanics (83.5 vs 76.5, p<0.0001), and Asians had higher TCS scores than Hispanics (83.7 vs 76.5, p = 0.006). HRQOL disparities exist among different racial and ethnic groups in older patients with NHL. Pre-diagnosis, Whites had better mental HRQOL compared to Asians, Blacks, and Hispanics. Whites also had better overall HRQOL as compared to Blacks and Hispanics, and Asians had better overall HRQOL than Blacks. Post-diagnosis, Whites had better mental and overall HRQOL than Hispanics, and Asians had overall better HRQOL than Hispanics.

Associations of Health-Related Quality of Life and Sleep Disturbance With Cardiovascular Disease Risk in Postmenopausal Breast Cancer Survivors.

Breast cancer (BC) survivors are at an increased risk of long-term cardiovascular disease (CVD), often attributed to cancer treatment. However, cancer treatment may also negatively impact health-related quality of life (HRQoL), a risk factor of CVD in the general population. We examined whether sleep disturbance, and physical or mental HRQoL were associated with CVD risk in BC survivors. We conducted a longitudinal analysis in the Women's Health Initiative of postmenopausal women given a diagnosis of invasive BC during follow-up through 2010 with no history of CVD before BC. The primary outcome was incident CVD, defined as physician-adjudicated coronary heart disease or stroke, after BC. Physical and mental HRQoL, measured by the Short-Form 36 Physical and Mental Component Summary scores, and sleep disturbance, measured by the Women's Health Initiative Insomnia Rating Scale, were recorded post BC. Time-dependent Cox proportional hazards models were used starting at BC diagnosis until 2010 or censoring and adjusted for relevant confounders. In 2884 BC survivors, 157 developed CVD during a median follow-up of 9.5 years. After adjustment, higher Physical Component Summary scores were significantly associated with a lower risk of CVD (hazard ratio, 0.90 [95% confidence interval, 0.81-0.99]; per 5-point increment in Physical Component Summary). No associations with CVD were found for Mental Component Summary or Insomnia Rating Scale. In BC survivors, poor physical HRQoL is a significant predictor of CVD. Our findings highlight the importance for nurses to assess and promote physical HRQoL as part of a holistic approach to mitigating the risk of CVD in BC survivors.

Patient-Reported Outcomes in Long-Term Survivors of Autologous Hematopoietic Cell Transplantation for Multiple Myeloma: Secondary Analysis of Two Randomized Controlled Trials on Survivorship Care Plans

Background: With advances in multiple myeloma therapy, approximately 1/3 rd of patients receiving frontline autologous hematopoietic cell transplantation (AHCT) are alive and progression-free at 8 years (Perrot et al. ASH. 2020). Although patient-reported outcomes (PROs) with induction therapy and early after AHCT are well-described, little is known regarding PROs in long-term disease-free survivors specifically in myeloma. The objective of our study was to assess health-related quality of life (HRQoL), distress, and healthcare care adherence (HCA) in myeloma survivors who are in a stable remission after AHCT.Methods: The data were obtained from two randomized controlled trials (RCTs), namely, SCP (Survivorship Care Plan) and INSPIRE (Internet and Social media Program for Long Term Hematopoietic Cell Transplant Survivors). Both RCTs enrolled patients who are in a stable remission 1-10 years after AHCT. Our primary objective was to evaluate patient-reported HRQoL, distress and HCA. The secondary objective was to examine association of PROs with available patient (age, sex, race, body mass index [BMI], and health behaviors) and transplant (time since AHCT) variables. BMI was categorized as obese (≥30), overweight (25-29.9), and normal/underweight (<25). HRQoL was assessed by SF-12 v 2 as physical component summary (PCS) and mental component summary (MCS) T scores, with higher scores indicating better functioning and a general population mean of 50 (Standard Deviation [SD] 10). Distress was assessed by Cancer and Treatment-Related Distress (CTXD) instrument, which reports mean scores from 0 to 3, with higher scores indicating greater distress. A CTXD score >1.10 was considered as clinically significant distress based on prior data. HCA was assessed by a standard questionnaire, with scores from 0-1, indicating the proportion of age/sex-specific recommendations adhered to.Results: A total of 345 patients were included, with the median age at AHCT of 61 years (range, 29-76). Median time from AHCT to study entry was 4 years (1.4-11.0). The mean (SD) PCS and MCS T-scores in the study population were 45.5 (±10.5) and 51.3 (± 10.1) respectively, compared to general population T-score of 50 (±10) for both (p-value for differences being <0.001 and 0.021 resp.; Figure 1). The mean CTXD distress score was 0.9 (± 0.6), with 32% of patients having a score of ≥1.1, indicating clinically significant distress. The two CTXD domains with highest burden of clinically significant distress were “Health Burden” and “Uncertainty” (Figure 2). The proportion of patients who met guideline for tobacco, alcohol, exercise, sunscreen, and diet were 94%, 92%, 33%, 23%, and 13% respectively. The proportion of patients who were obese, overweight, normal weight, and underweight was 31.2%, 40.5%, 27.7%, and 0.6% respectively.On multivariable analysis (MVA), factors significantly associated with decreased PCS score were obesity (Parameter Estimate [PE]: -5.0 [±1.6]; p=0.002) and meeting alcohol guidelines (PE: -4.2 [±2.0]; p=0.039), while meeting exercise guidelines was associated with a higher PCS score (PE: 3.4 [±1.3]; p=0.007). Obesity was significantly associated with a decreased MCS score (PE: -3.0 [±1.5]; p=0.05) and meeting sunscreen guidelines was associated with an increased MCS score (PE: 3.0 [±1.4]; p=0.029). Factors associated with lower distress were years since AHCT (PE: -0.04 [±0.02]; p=0.024) and meeting sunscreen guidelines (PE: -0.21 [+/-0.8]; p=0.005). Notably, increased time since AHCT was associated with lower distress in all domains except for identity and medical demands. Better overall HCA was associated with older age (PE: 0.005 [±0.0001]; p<0.001) and female sex (PE: 0.04 [±0.02]; p=0.01) on MVA.Conclusion: To our knowledge, this is the first study to characterize PROs in long-term myeloma survivors post-AHCT. Myeloma survivors have significantly worse physical HRQoL compared to general population but comparable mental HRQoL. Approximately 1/3rd are obese, with obesity being associated with worse physical and mental HRQoL. The inverse association between physical HRQoL and meeting alcohol guidelines could be secondary to abstinence from heavy drinking in those with poor physical functioning. Survivorship programs should address ongoing issues of health burden and uncertainty in myeloma survivors, encourage exercise and physical activity, and focus on groups at risk of poor HCA. [Display omitted] DisclosuresDevine: Johnsonand Johnson: Consultancy, Research Funding; Magenta Therapeutics: Current Employment, Research Funding; Orca Bio: Consultancy, Research Funding; Be the Match: Current Employment; Sanofi: Consultancy, Research Funding; Tmunity: Current Employment, Research Funding; Vor Bio: Research Funding; Kiadis: Consultancy, Research Funding. Shaw: mallinkrodt: Other: payments; Orca bio: Consultancy. Majhail: Incyte Corporation: Consultancy; Anthem, Inc: Consultancy.

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.

Protein Intake, Fatigue and Quality of Life in Stable Outpatient Kidney Transplant Recipients.

Fatigue is a frequent complaint in kidney transplant recipients (KTR), often accompanied by poor quality of life (QoL). The role of nutrition as determinant of fatigue in KTR is largely unexplored. The aims of this study are to examine the association of protein intake with fatigue and QoL in KTR and to identify other determinants of fatigue. This cross-sectional study is part of the TransplantLines Cohort and Biobank Study (NCT03272841). Protein intake was calculated from urinary urea nitrogen (UUN) in 24-h urine samples. Fatigue was assessed by the Checklist Individual Strength (CIS) questionnaire; moderate and severe fatigue were defined as a CIS score of 20–34 and ≥ 35, respectively. QoL was assessed with the RAND-36-Item Health Survey (RAND-36). Associations of protein intake with fatigue and QoL were analyzed using multinomial logistic and linear regression analyses. We included 730 stable outpatient KTR (median age 58 year [IQR 48–65], 57% male) with a mean protein intake of 82.2 ± 21.3 g/d. Moderate and severe fatigue were present in 254 (35%) and 245 (34%) of KTR. Higher protein intake was significantly associated with lower risk of moderate fatigue (OR 0.89 per 10 g/d; 95%CI 0.83–0.98, p = 0.01), severe fatigue (OR 0.85; 95%CI 0.78–0.92, p < 0.001) and was associated with higher physical component summary score of QoL (β 0.74 per 10 g/d; 95%CI 0.39–1.09, p < 0.001). Higher BMI, a history of dialysis, glomerulonephritis as primary kidney disease and a history of combined organ transplantation were also associated with severe fatigue. In conclusion, amongst the potential modifiable factors of fatigue, higher protein intake is independently associated with lower risk of moderate and severe fatigue and with better QoL in KTR. These findings underline the need to incorporate nutritional assessment in the diagnostic work-up of fatigue. Intervention studies are needed to assess the benefits and safety of higher protein intake in KTR.

Effectiveness of the interactional and interdisciplinary school of fibromyalgia: a long-term randomized control study

ABSTRACT BACKGROUND AND OBJECTIVES: This study assessed long-term efficacy of an interdisciplinary group intervention of patients with fibromyalgia as compared with standard medical care. METHODS: A partially randomized controlled study with two groups and repeated measures. Variables were measured at baseline; immediately after the program; 4 months and 1 year later. Fibromyalgia patients were recruited by newspaper ads or physician references from two Quebec regions. Sixty women suffering from fibromyalgia were randomized to the experimental group (ISF) or the control group CG. The program, called Interactional School of Fibromyalgia (ISF), consists of nine sessions with eight participants and two clinicians. Five variables were measured: Fibromyalgia Impact Questionnaire (FIQ), Physical and Mental components summary of Short Form Health Survey 36 (SF-36), Clinical pain, and pressure pain threshold at tender points. RESULTS: Efficacy analyses from completers, as well as intent-to-treat analyses, showed a treatment effect on measures even one year after the end of the program. The experimental group experienced lower FIQ scores (p<0.01), less clinical pain (p<0.05), higher pressure-pain thresholds (p<0.01), and higher physical component summary scores on the SF-36 (p<0.05). CONCLUSION: This interdisciplinary group intervention of patients with fibromyalgia demonstrated better long-term outcomes compared with standard medical care.

Using Health-Related Quality of Life (SF-36v2®) to Predict Falls in Community-Dwelling Older Adults

Background: Falls are the leading cause of hospitalization and death among older adults; therefore, the ability to predict fall risk among older adults is critical. Several performance-based outcome measures exist to assess fall risk. Psychological factors are also associated with fall risk yet can be difficult to assess and are often overlooked. In this study, we investigated whether the Short Form 36 Item Health Survey (SF-36v2®), a measure of health-related quality of life (HRQOL), predicted future falls in a sample of community-dwelling older adults. A secondary purpose was to examine relationships between the SF-36v2® and balance performance. Methods: Forty-three community-dwelling older adults completed the SF-36v2® and 3 well-established measures of balance performance: Berg Balance Scale, Tinetti Mobility Assessment, and Timed Up and Go. Future falls were recorded for 12 months after testing. Results: The SF-36v2® physical component summary (PCS) scores predicted future fall status at 12 months. The PCS was correlated with all three measures of balance performance, in which higher PCS scores were associated with better balance. The mental component summary (MCS) scores were not significantly associated with balance performance. Conclusions: In this study, HRQOL as measured by the SF-36v2® predicted future falls and was associated with well-established balance performance measure scores. The instrument should be considered for inclusion in a comprehensive fall risk assessment.

2283-PUB: Association between Higher Health-Related Quality of Life Physical Component Score Measured by SF-8 and Lower All-Cause Mortality Risk among Japanese Patients with Type 2 Diabetes: A Prospective Cohort Study

Health-related quality of life (HRQoL) was reportedly associated with mortality; however, these studies used questionnaires with relatively large number of items ranging from 20 to 30. We thus evaluated the prospective association between HRQoL measured by Short-Form (SF)-8, a short version of SF-36, in Japanese individuals with type 2 diabetes. Longitudinal data of 3,269 individuals with diabetes were obtained from a large Japanese diabetes registry. To assess the independent correlation between the 10-point increment of SF-8 physical component summary score (PCS) or mental component summary score (MCS) and all-cause mortality, the Cox proportional hazards model was used with adjustment for age, sex, body mass index, HbA1c, types of diabetes therapy, urinary albumin-creatinine ratio, history of diabetic retinopathy, symptomatic diabetic neuropathy, and past medical history (acute myocardial infarction, chronic stable angina, peripheral artery disease, leg ulceration, ischemic stroke, and hemorrhagic stroke). The mean age, body mass index, and HbA1c level were 64.9 years (SD 11.2), 24.6 kg/m2 (SD 3.9), and 7.5% (SD 1.2) [or 58.6 mmol/mol (SD 12.7)], respectively. We recorded 248 deaths during the median follow-up of 6.1 years (incidence ratio = 14.0/1,000 person-years). We observed significant association of PSC score and all-cause mortality, and multivariable-adjusted hazard ratio (HR) was 0.775 [95% confidence interval (CI), 0.668-0.899; p = 0.001] per 10-point increment of PCS score. We did not observe significant association between MCS score and all-cause mortality [HR = 0.864 (95% CI, 727-1.027; p = 0.097)]. In conclusion, higher PCS of SF-8, not MCS, was associated with lower risk of all-cause mortality in Japanese individuals with type 2 diabetes. SF-8 could be useful for predicting mortality in individuals with diabetes. Disclosure Y. Hayashino: Speaker's Bureau; Self; Astellas Pharma Inc., Kowa Pharmaceuticals, Kyowa Hakko Kirin Co., Ltd., MSD K.K., Ono Pharmaceutical Co., Ltd. S. Okamura: None. H. Ishii: None. Funding Manpei Suzuki Diabetes Foundation; Japan Society for the Promotion of Science (25460641)

Acupoint Embedding of Polyglactin 910 Sutures in Patients with Chronic Pain due to Cervical Spondylotic Radiculopathy: A Multicenter, Randomized, Controlled Clinical Trial

Objective We aimed to investigate the effectiveness of acupoint polyglactin 910 (PGLA) embedding in patients with cervical spondylotic radiculopathy (CSR). Methods A total of 102 CSR patients with neck and shoulder pain were recruited and assigned randomly into three groups: the sham acupoint embedding (SAE) group, the middle-layer acupoint PGLA embedding (MAPE) group, and the deep-layer acupoint PGLA embedding (DAPE) group. The primary outcomes were Visual Analog Scale (VAS) scores showing the analgesic effects of treatment. Secondary outcomes included clinical symptoms (evaluated by the Yasuhisa Tanaka 20 (YT-20) score and the neck disability index (NDI)) and patient health status (evaluated by the 36-item short-form survey (SF-36)) as reported in the trial. Results Compared with the SAE group, VAS scores were significantly reduced at 1, 2, 3, 4, and 10 weeks after the first treatment in both the DAPE and MAPE groups (P < 0.001). Moreover, there were statistically significant increases in the weekly YT-20 scores and significant reductions of the weekly NDI scores compared with baseline values in both the DAPE and MAPE groups (P < 0.001). Compared with baseline values, both the physical component summary (PCS) and the mental component summary scores of the SF-36 at 2, 3, 4, and 10 weeks were significantly higher in the DAPE and MAPE groups (P < 0.001). There were significant lower VAS scores (P < 0.01), higher PCS scores (P < 0.05) at 3 weeks, and lower NDI scores (P < 0.05) at 4 weeks in the DAPE group compared with the MAPE group. Conclusions Both DAPE and MAPE showed significant and long-lasting effects on alleviating pain and improving clinical symptoms as well as quality of life in CSR patients with neck and shoulder pain. A more intense effect was seen in the DAPE group compared with the MAPE group.

Treatment for Depression and Health-Related Quality of Life among Adults with Arthritis.

Depression treatment has been proven to relieve depressive symptoms and pain and may therefore improve the health-related quality of life (HRQoL) among adults with arthritis. The objective of the current study was to examine the HRQoL associated with depression treatment among adults with arthritis and depression. A retrospective longitudinal cohort study design using data from the Medical Expenditure Panel Survey(2009-2012) was adopted. The study sample consisted of adults (≥ 21years) with co-existing arthritis and depression (N=1692). Depression treatment was categorized into: antidepressants only, psychotherapy with or without antidepressants, and neither antidepressants nor psychotherapy. Multivariable Ordinary Least Square (OLS) regressions, which controlled for observed selection bias with inverse probability treatment weights (IPTW) were built to examine the association between depression treatment categories and the HRQoL scores. The OLS regression controlled for factors in the biological, psychological and social domains that may affect HRQoL. A majority of individuals reported taking antidepressants only (52%), 24.4% reported receiving psychotherapy with or without antidepressants and 23% did not receive either antidepressants or psychotherapy. In multivariable OLS regression with IPTWs, adults using only antidepressants had marginally higher physical component summary scores (beta=0.96, p value=0.096) compared to no depression treatment. There were no significant associations between depression categories and mental component summary scores. HRQoL was not affected by depression treatment in adults with coexisting arthritis and depression. Improvement in HRQoL may require a collaborative care approach and such intense care may not be replicated in real-world practice settings.

Review Article: Operative versus nonoperative treatment for displaced intraarticular calcaneal fracture: a meta-analysis of randomised controlled trials.

We reviewed 8 randomised controlled trials that compared operative and non-operative treatment for displaced intra-articular calcaneal fractures. Patients with operative treatment were more likely to resume pre-injury work (relative risk [RR]=0.60, p=0.04), had fewer problems when wearing shoes (RR=0.42, p=0.0004), and had a higher physical component summary score of SF-36 (difference in means=6.75, p<0.0001) but a higher complication rate (RR=1.74, p=0.0005).

Depression treatment and health-related quality of life among adults with diabetes and depression.

Previous findings regarding depression treatment and its consequences on health-related quality of life (HRQoL) of adults with diabetes were inconsistent and targeted certain groups of population. Therefore, there is a critical need to conduct a population-based study that focuses on a general population with diabetes and depression. The primary aim of this study was to examine the physical and mental HRQoL associated with depression treatment during the follow-up year. We adopted a longitudinal design using multiple panels (2005-2011) of the Medical Expenditure Panel Survey to create a baseline year and follow-up year. We included adults with diabetes and depression. We categorized the baseline depression treatment into: (1) antidepressant use only; (2) psychotherapy with or without antidepressants; and (3) no treatment. HRQOL was measured using SF-12 version 2 physical component summary (PCS) and SF-12 mental component summary (MCS) scores during both baseline year and follow-up year. Ordinary least squares (OLS) were used to estimate the association between depression treatment and the HRQoL measures. The OLS regression controlled for predisposing, enabling, need, external environment factors, personal health practices, and baseline HRQoL measures. After controlling for all the independent variables and the baseline PCS, individuals who received psychotherapy with or without antidepressants had higher PCS scores as compared to those without any treatment for depression (beta=1.28, p<0.001). Individuals who reported using only antidepressants had lower PCS scores (beta=-0.54, p<0.001) as compared to those without depression treatment. On the contrary, individuals who reported receiving psychotherapy with or without antidepressants had lower MCS scores as compared to those without depression treatment (beta=-1.43, p<0.001). Those using only antidepressants had higher MCS scores as compared to those without depression treatment (beta=0.56, p<0.001). The associations between depression treatment and the HRQoL varied by the type of depression treatment and the component of the HRQoL measures.

PDB86 - Depression Treatment and Health-Related quality of Life among adults with Diabetes and depression

Previous findings regarding depression treatment and its consequences on health-related quality of life (HRQoL) of adults with diabetes were inconsistent and targeted certain groups of population. Therefore, there is a critical need to conduct a population-based study that focuses on a general population with diabetes and depression. The primary aim of this study was to examine the physical and mental HRQoL associated with depression treatment during the follow-up year. We adopted a longitudinal design using multiple panels (2005–2011) of the Medical Expenditure Panel Survey to create a baseline year and follow-up year. We included adults with diabetes and depression. We categorized the baseline depression treatment into: (1) antidepressant use only; (2) psychotherapy with or without antidepressants; and (3) no treatment. HRQOL was measured using SF-12 version 2 physical component summary (PCS) and SF-12 mental component summary (MCS) scores during both baseline year and follow-up year. Ordinary least squares (OLS) were used to estimate the association between depression treatment and the HRQoL measures. The OLS regression controlled for predisposing, enabling, need, external environment factors, personal health practices, and baseline HRQoL measures. After controlling for all the independent variables and the baseline PCS, individuals who received psychotherapy with or without antidepressants had higher PCS scores as compared to those without any treatment for depression (beta = 1.28, p < 0.001). Individuals who reported using only antidepressants had lower PCS scores (beta = −0.54, p < 0.001) as compared to those without depression treatment. On the contrary, individuals who reported receiving psychotherapy with or without antidepressants had lower MCS scores as compared to those without depression treatment (beta = −1.43, p < 0.001). Those using only antidepressants had higher MCS scores as compared to those without depression treatment (beta = 0.56, p < 0.001). The associations between depression treatment and the HRQoL varied by the type of depression treatment and the component of the HRQoL measures.

Randomized Controlled Trial of Expressive Writing for Patients With Renal Cell Carcinoma

This randomized controlled trial examined the quality-of-life benefits of an expressive writing (EW) intervention for patients with renal cell carcinoma (RCC) and identified a potential underlying mechanism of intervention efficacy. Patients (N = 277) with stage I to IV RCC were randomly assigned to write about their deepest thoughts and feelings regarding their cancer (EW) or about neutral topics (neutral writing [NW]) on four separate occasions. Patients completed the Center for Epidemiologic Studies Depression Scale (CES-D), MD Anderson Symptom Inventory (MDASI), Brief Fatigue Inventory (BFI), Pittsburgh Sleep Quality Index (PSQI), Medical Outcomes Study Short Form-36 (SF-36), and Impact of Event Scale (IES) at baseline and 1, 4, and 10 months after the intervention. The mean age of participants (28% stage IV; 41% female) was 58 years. Multilevel modeling analyses, using a Bonferroni-corrected α = .021 for six outcomes adjusted for the correlation among outcomes, revealed that, relative to the NW group, patients in the EW group reported significantly lower MDASI scores (P = .003) and higher physical component summary scores on the SF-36 (P = .019) at 10 months after the intervention. Mediation analyses revealed that significant group differences for MDASI scores at 10 months were mediated by lower IES scores at 1 month after the intervention in the EW group (P = .042). No significant group differences were observed in the BFI, CES-D, PSQI, and mental component summary of the SF-36. EW may reduce cancer-related symptoms and improve physical functioning in patients with RCC. Evidence suggests that this effect may occur through short-term improvements in cognitive processing.

Dose–response relationships between physical activity, social participation, and health-related quality of life in colorectal cancer survivors

The purpose of this study was to examine the relationships between physical activity (PA), social participation, and health-related quality of life (HQOL) in older, long-term colorectal cancer survivors. Male and female colorectal cancer survivors (n = 1,768), aged ≥65 and ≥5years post-diagnosis, completed surveys on their current PA, social participation, HQOL, health history, and relevant covariates. Analysis of covariance was used to evaluate the cross-sectional relationship between PA and social participation with the SF-36 subscales, as well as the physical component summary score (PCS) and mental health component summary score (MCS). The final analytic sample (n = 832) was 81.5 ± 5.8 years and 8.2 ± 1.7years post-diagnosis (mean ± SD). Meeting the current recommendation of 150min/week of PA was associated with higher PCS (p < 0.001) but not MCS (p = 0.30). Engaging in any social participation, vs. none, was associated with MCS (p = 0.003), but not PCS (p = 0.13). There was a dose-response relationship between moderate-vigorous-intensity PA and PCS (p trend<0.001). Light-intensity PA was not associated with either summary score after adjustment for moderate-vigorous PA (p > 0.05), but in survivors performing no higher-intensity PA, it was associated with both (p < 0.01, p = 0.02, respectively). Participants reporting greater amounts of both planned exercise and non-exercise PA had significantly higher PCS (p trend<0.01, p trend < 0.01, respectively). Individuals participating in greater weekly hours of social participation had higher PCS and MCS (p trend<0.05) than those participating in less. Among older, long-term colorectal cancer survivors, PA is related to their physical health, while social participation is predominantly related to their mental health. Older colorectal cancer survivors who participate socially and are engaged in PA, even non-exercise and light-intensity activities, have higher levels of physical and mental health.

Abstract P332: Younger Patients Report Impaired Mental Functioning in Health-Related Quality of Life After Valve Surgery

Background: Heart valve surgery is indicated for a number of presenting conditions and is performed even in young patients. It is known that younger age can be protective for surgical outcomes, such as mortality, but less is know about how age impacts quality of life in patients undergoing valve surgery. Objective: To determine if age was associated with health related quality of life (HRQL) after valve surgery. Methods: Patients who underwent valve surgery (stand alone or concomitant) since late 2005 were included in these analyses (N=288). The age range for this sample was 21-87. Patients were divided into tertiles based on age: younger (age &lt; 60 years; n=95), older (age ≥ 60 and &lt; 72; n=93) and oldest (age ≥ 72; n=100). HRQL was measured using the Medical Outcomes Trust Short Form 12 (SF-12) prior to surgery, and at 6 and 12 months post-surgery. The SF-12 mental component summary (MCS) and physical component summary (PCS) scores were calculated to assess differences in HRQL over time based on age groups. Results: There was a significant main effect of time for MCS (F=5.6, p&lt;0.006) and PCS (F=39.6, p&lt;0.001) with significant increases in HRQL from baseline through 12 months. No significant interaction of time by age group was found for MCS or PCS. All three groups increased similarly for both MCS and PCS. There was a significant main effect of group for both MCS (F=4.1, p&lt;0.02) and PCS (F=22.3, p&lt;0.001). The younger group had significantly lower MCS scores as compared to the older group (p&lt;0.02), regardless of time point. However, the younger group had significantly higher PCS scores as compared to the older (p&lt;0.04) and oldest groups (p&lt;0.001). The older group also had significantly higher PCS scores than the oldest group (p&lt;0.001). Conclusion: Improvement in HRQL was shown across all age groups in both MCS and PCS. Despite the fact that the younger patients had the highest physical HRQL, this group had the lowest mental HRQL regardless of time point. These results suggest that valve disease in the younger patients had a detrimental effect on their mental HRQL prior to and after surgery. Further study is needed to investigate the impact of valve disease and surgery on quality of life in younger patients, particularly on how to improve the psychological experience.

Use of point-of-service health status assessments by community pharmacists to identify and resolve drug-related problems in patients with musculoskeletal disorders.

To determine whether community pharmacists can use point-of-service health status assessments to identify and resolve drug-related problems (DRPs) in ambulatory patients with selected musculoskeletal (MSK) disorders. Twelve-month, prospective, multicenter demonstration project. Twelve independent community pharmacies in eastern Iowa. Ambulatory patients with self-reported diagnosis of osteoarthritis, rheumatoid arthritis, or low back pain. During quarterly pharmacy visits for 1 year, patients used touch-screen computers to report their health status. Patients answered questions on the Short Form-36 (SF-36) general health survey, as well as questions assessing limitations associated with their MSK condition. Pharmacists used this data in interviewing patients to assess for DRPs. The study enrolled 461 patients, of whom 388 returned for the 12-month visit. During this 1-year period, community pharmacists identified 926 cumulative DRPs. Patients with no DRPs had significantly higher physical component summary scores on the SF-36 (p<0.05) than patients with more than one DRP at baseline (36.2 vs 31.6), 6 months (39.2 vs 33.3), and 12 months (40.1 vs 35.4). At 12 months, actions performed by pharmacists led to resolution or improvement of 70.7% of DRPs. Drug-related problems are numerous in community-dwelling patients with MSK disorders and correspond to decreased physical health status. Community pharmacists can use patient-reported measures of health status to identify DRPs and initiate processes to resolve them.

Hemodialysis patient-assessed functional health status predicts continued survival, hospitalization, and dialysis-attendance compliance

We asked patients to assess their functional health status by completing the SF-36. Over 2 years, we studied 1,000 patients (average age, 58 years; 50% male; 25% white; 36% diabetic) in three outpatient, staff-assisted hemodialysis units. We used both the eight-scale scores and two-component summary scores to study the relationship between baseline functional health status and clinical outcomes. The physical component summary (PCS) score was as significant a predictor of mortality as was the normalized protein catabolic rate or the delivered Kt/V. Patients with a PCS score below the median for our patients (<34) were twice as likely to die and 1.5 times more likely to be hospitalized as patients with PCS scores at or above the median score. Either a low PCS score or a low mental component summary (MCS) score correlated with the number of days of hospitalization. While the average dialysis patient has a relatively normal (47 v 50) MCS score and a low (37 v 50) PCS score compared with the normal population, patients who skipped more than two treatments per month tended to have a relatively higher PCS score (judged themselves physically healthier) and a relatively lower MCS score (judged themselves less mentally healthy) than patients who did not skip two or more treatments per month. The prevalence of depression as defined by an MCS score of ≤42 was approximately 25%. The SF-36 provided a good screening tool for patients at high risk for death, hospitalization, poor attendance, and depression.