Independent Predictors Of Quality Of Life Research Articles

The stability and correlates of quality-of-life scores over five years: Findings from a British cohort

This study explored a nationally representative longitudinal data set of 5273 adults, all born in 1958, examining the stability and change of quality-of-life (QoL) over five years. It also examined the associations between QoL and a set of socio-demographic, psychological and health variables in relation to QoL at both points in time. Results showed that self-report QoL scores were fairly stable over five years (r = 0.59), though there was a statistically significant increase in the total scores of QoL between age 50 to age 55 years. Correlational analysis showed parental social status indicators (measured at birth), childhood intelligence (measured at age 11 years), educational qualifications (measured at age 33 years), occupational levels, income and health, and the Big-Five personality factors (all measured at age 50 years) were all significantly associated with adult QoL. The strongest correlate of adult QoL was self-assessed health measured five years earlier, followed by the Big-Five personality factors, education and occupation, as well as parental social status. Gender was not significantly associated with QoL at either time points. Multiple linear regression analyses showed income, health and three of the Big-Five personality factors (Extraversion, Emotional Stability, Conscientiousness) were significant and independent predictors of QoL at age 55 years. After entering the initial QoL assessed five years earlier, health, traits Extraversion and Emotional Stability and initial QoL were significant predictors of the outcome variable. The implications and limitations of this study are discussed.

In heart failure, self-care behavior is an independent determinant of health-related quality of life, regardless of the severity of this patients

Abstract Background Poor self-care behaviour is associated with a higher risk of readmission and mortality in patients with heart failure (HF). The interplay between self-care and patient-reported outcomes such as health-related quality of life (QoL) has not been fully established. Purpose To describe the association between self-care and QoL in real-world cohort of HF patients. Methods We conducted an observational, prospective, cohort study of 1120 consecutive patients with chronic HF. We used the modified European Heart Failure Self-care Behaviour Scale 9-item version (EHFSCBS-9) to measure self-care. Scores were inverted and standardized (higher scores indicate better selfcare). To assess QoL, we used the Minnesota Living with Heart Failure Questionnaire (MLHFQ) (higher scores indicate worse QoL). Written informed consent, complete clinical and psychosocial information of patients were obtained at baseline. To determine the impact of global self-care and its dimensions (autonomy-based adherence, consulting behaviour and provider-based adherence), multivariate linear regressions models (backwards stepwise methods) to predict QoL were constructed. The multivariate parametric and non-parametric associations between EHFSCBS-9 scoresand the β estimated risk of impairment of QoL (defined as MLHFQ scores ≥ median values) were explored using General Additive Models (GAM). All models were adjusted by age, sex and prognostic factors such as LVEF, NYHA, NT-proBNP levels and recent hospitalization among other well-known determinants of HF severity. Results A total of 484 patients (43%) were women, mean age was 72±11 years, and mean LVEF was 45±17%. Mean MLHFQ scores were 45±24. Mean EHFSCBS-9 scores were 69±28. There was a significant inverse correlation between EHFScBS-9 and MLHFQ scores (r=−0.158; p-value<0.0001). As shown in Table 1, self-care behaviour and its 3 domains were independent predictors of QoL in 7 out of the 16 associations explored. These models confirmed a weak linear relationship between EHFSCBS-9 scores and MLHFQ scores particularly between global selfcare and consulting behaviour dimension with global, emotional and social dimensions of QoL. Interestingly, when QoL was dichotomized as impaired/preserved QoL, GAM showed a significant non-parametric “U-shape” relationship (p-value<0.05) between EHFScBS-9 scores and the risk of impairment in QoL (Figure 1). Conclusions We have shown that self-care behaviour is an independent predictor of health related QoL in HF regardless the level of disease severity. Global self-care and consulting behaviour were particularly and significantly associated with global QoL and emotional and social dimensions of QoL. Interestingly the relationship between self-care scores and the risk of impaired global QoL was non-linear showing a “U-shape” association pointing out that patients with extreme levels of self-care were more likely to experience impairments in QoL. Funding Acknowledgement Type of funding sources: None.

Fragility influences the impact of self-care behavior on patient-reported outcomes further of psychosocial factors of self-perceived health status in patients with heart failure

Abstract Background Poor self-care behaviour is associated with a higher risk of readmission and mortality in patients with heart failure (HF). Psychosocial factors are key determinants of patient-reported outcomes (PROMs) such as health-realted quality of life (QoL). Little is known about the interplay between self-care and psychosocial factors on PROMs in HF. Purpose To describe the interaction of self-care and psycho-social factors on QoL in a real-world cohort of HF patients. Methods We conducted an observational, prospective, cohort study of 1120 consecutive patients with chronic. We used the modified European Heart Failure Self-care Behaviour Scale 9-item version (EHFSCBS-9) to measure self-care (inverted and standardised: higher scores indicate better self-care). To assess QoL, we used Minnesota Living with Heart Failure Questionnaire (MLHFQ) (higher scores indicate worse QoL). General linear models (GLM) were constructed to explore the interaction between psychosocial factors and poor self-care (defined as EHFSCBS-9 ≤lower tertile) on adjusted MLHFQ scores. To determine the impact of self-care, multivariate linear regressions models to predict QoL were constructed stratified according to selected psycho-social determinants. All models were adjusted by age, sex and psycho-social determinants of QoL including literacy, cognitive function (Pfeiffer test), dependency (Barthel and Lawton & Brody test), social support (Duke UNC and APGAR Familyfunction), depressive symptoms (15-item Geriatric Depression Scale) and fragility (Barber test scores ≥1). Results A total of 484 patients (43%) were women, mean age was 72±11 years, and mean LVEF was 45±17%. Mean MLHFQ scores were 45±24. Mean EHFSCBS-9 scores were 69±28. There was a significant inverse correlation between EHFScBS-9 and MLHFQ scores (r=−0.158; p-value <0.0001). Fragility was present in 883 patients (79%). In adjusted GLM, poor self-care (F=10.2; p-value=0.001) and fragility (F=17.9; p-value <0.001) were independent predictors of higher adjusted scores in the MLHFQ indicating worse QoL. As shown in Figure 1, the interaction between fragility and self-care was significant (F=6.8; p-value = 0.009). Linear regression models (Table 1) stratified according the absence (panel A) or the presence (panel B) of fragility showed that fragility modulated the association between self-care behaviour and QoL. Only in patients without fragility, self-care were independent predictors of QoL. On the other hand, in patients with fragility, self-care behaviour did not longer influence self-perceived health status in patients with HF. Conclusions We have shown that self-care behaviour is an independent predictor of PROMs in HF regardless the presence of important psycho-social determinants of QoL only when fragility status is taken into account. Fragility modulates the influence of self-care and QoL, including each one of its dimensions. Funding Acknowledgement Type of funding sources: None.

Quality of Life in Women over 65 Years of Age Diagnosed with Osteoporosis.

(1) Background: Today’s society is moving towards active aging, underlining the importance of understanding and improving quality of life (QoL). This QoL in women over the age of 65 years diagnosed with osteoporosis was compared with the QoL of the general population, and risk factors for osteoporosis related to QoL were identified. (2) Methods: This is an observational, descriptive, cross-sectional study with a personal interview. The study population was 704 women over 65 years of age diagnosed with osteoporosis as of 1 November 2018, based on medical records from four health centers of the eastern Valladolid urban health area. This was a random sample of 247 women stratified by health center. Information on osteoporosis risk factors, comorbidities, daily lifestyle habits, and QoL assessed with the EQ-5D was collected. QoL was modeled using sociodemographic variables, lifestyle, and clinical variables. (3) Results: Women with osteoporosis had a positive perception of their health (EQ-5D% VAS 64.9 ± 18.31). High EQ-5D QoL scores were obtained on the dimensions of mobility: 51.6% [95% CI (44.2%, 58.9%)]; self-care: 75.3% [95% CI (68.5%, 81.2%)]; activities of daily living: 71.4% [95% CI (64.4%, 77.6%)]; pain/discomfort: 25.8% [95% CI (19.8%, 32.6%)]; and anxiety/depression: 53.8% [95% CI (46.4%, 61.0%)]. (4) Conclusions: The QoL of the study group was no worse than the QoL of the general population, except for pain/discomfort and anxiety/depression. Age, highest educational level reached, inflammatory diseases, physical activity, and insomnia were independent predictors of QoL in women with osteoporosis.

Chronic Pain and Quality of Life in Maintenance Hemodialysis Patients in China: A Multicenter, Cross-Sectional Study.

PurposePatients undergoing maintenance hemodialysis (MHD) frequently experience chronic pain, which can severely affect their quality of life (QOL). The objective of this study was to evaluate the prevalence of chronic pain in MHD patients and examine the factors associated with QOL.Patients and MethodsA cross-sectional questionnaire-based survey was conducted between October 2020 and April 2021, 1204 MHD patients from nine hemodialysis units were screened for chronic pain in Chengdu, China, and 296 MHD patients with chronic pain were enrolled in this study. We analyzed data on clinicodemographic characteristics, pain interference and severity (Brief Pain Inventory), QOL (Medical Outcomes Study 36-item Short Form Health Survey - mental component summary [MCS] and physical component summary [PCS]), pain self-efficacy (Pain Self-Efficacy Questionnaire), and social support (Social Support Rating Scale).ResultsThe prevalence of chronic pain in MHD patients was 26.74% in this study. The most common areas of pain were lower back (63.5%), lower limbs (55.0%), and head (33.5%), 36.5% did not implement any measures to relieve it. Of the patients who did receive pain treatment or medication, 56.9% reported that the measures they took had less than half of the pain relief. MHD patients with chronic pain had poor QOL based on scores on the MCS (53 ± 16.76) and PCS (40.56 ± 13.81). Stepwise multiple regression identified age, financial strain, pain interference, social support, and pain self-efficacy as independent predictors of QOL. Pain self-efficacy was significantly associated with social support (r = 0.5, p < 0.01), MCS (r = 0.69, p < 0.01), and PCS (r = 0.8, p < 0.01). The mediating effects of pain self-efficacy were 70.31% on the relationship between social support and MCS, and 75.62% on the relationship between social support and PCS.ConclusionChronic pain is prevalent and undermanaged in Chinese MHD patients, resulting in worse QOL. Healthcare providers should focus on pain management and the impact of psychosocial factors on patient QOL. Further research should deepen our understanding of how pain self-efficacy mediates the relationship between social support and QOL.

Predictors of quality of life in people living with type-1 and type-2 diabetes: An Indian perspective study and systematic review

Background: This study evaluated predictors of good quality of life (QOL) in people with type-1 diabetes (T1DM) and type-2 diabetes (T2DM) using validated general health questionnaire [World Health Organization’s (WHO)-QOL-Brief (BREF) questionnaire] and diabetes specific questionnaire [Multidimensional Diabetes Questionnaire (MDQ)]. Methods: Consecutive people &gt; 18 years age, having T1DM or T2DM of &gt; 6 months duration, without any severe co-morbid states or hospital admission in last 3 months, attending endocrinology-clinics of 3 different centres in Delhi, between August 2014 to September 2019, underwent QOL assessment. PubMed and Medline search for articles published to till November 2019 on QOL in diabetes was done for systematic review. Result: Data from 2067 patients was analysed. WHO-QOL-BREF aggregate score was significantly better in T2DM compared to T1DM (3.39±0.46 vs 3.11±0.63; P &lt; 0.001). T1DM did significantly better than T2DM patients only with regards to physical health. T1DM patients’ QOL scores were worse for psychological, social relationship and environmental domains. Analysis based on quartiles of WHO-QOL-BREF aggregate score revealed people in Quartile-4 were significantly older, had lowest hypoglycaemia, nephropathy, retinopathy, neuropathy, CAD and peripheral artery disease. Patients with lowest QOL (Quartile-1) had highest blood glucose and HbA1c. Step-wise linear regression revealed age, sex, diabetes type, duration, HbA1c, hypoglycemia, nephropathy, neuropathy and coronary artery disease to be independent predictors of QOL. Every percent increase in HbA1c was associated with 2.1% reduction in aggregate QOL score. Hypoglycemia, presence of nephropathy and neuropathy were associated with 9.1%, 11.4% and 7.8% reduction in QOL aggregate score. Conclusion: Younger age, female sex, T1DM, disease duration, glycaemic control, hypoglycaemia end organ damage are important predictors of poor QOL in Indians. Insulin use and number of medications have no impact on QOL.

The importance of mental health in improving quality of life in transition-aged patients with epilepsy

ObjectiveAdolescents with epilepsy are known to have a lower quality of life (QoL) than the typically developing adolescent population. In order to address this, treating physicians have primarily focused on obtaining seizure control. However, growing evidence suggests a strong relation between QoL and mental health in adults with epilepsy and other chronic conditions. Given the high rate of mental health issues in transition-aged adolescents with epilepsy, this study aimed to examine the relation between QoL and mental health. MethodsBaseline data from 107 transition-aged adolescents (M = 16.08 years; 52 males, 55 females) enrolled in an epilepsy transition clinic were analyzed for this study. ResultsAnalysis found that over 56% of participants showed some signs of mental illness, and that these participants had significantly lower QoL scores than those without mental health issues. Furthermore, regression analysis found that both depression and anxiety remained significant, independent predictors of QoL, even when significant epilepsy and demographic variables were accounted for (t(99) = −1.28, p < .001 and t(99) = −1.10, p = .002, respectively). SignificanceResults suggest that in order to ensure best outcomes for these adolescents, it may be important for clinicians to take a holistic approach to treatment, managing and treating both seizures and mental health concerns.

Neuropathic pain as independent predictor of worse quality of life in patients with diabetic neuropathy

Background/Aim. The prevalence of diabetes mellitus in general population is constantly increasing. On the other hand, the number of diabetic patients with neuropathic pain is large. The aim of the study was to examine influence of neuropathic pain on quality of life (QoL) in patients with diabetic sensorimotor polyneuropathy (DSPN) who did not have any other diabetic complication or any other significant comorbidity. Methods. A total of 32 patients with DSPN and definitive neuropathic pain were compared with 32 patients with DSPN without neuropathic pain. The respondents were matched according to age, gender, and duration of illness. The following scales were used: the Pain Detect Questionnaire, Leeds Assessment of Neuropathic Symptoms and Signs, Douleur Neuropathique EN 4 Questions, Hamilton depression and anxiety rating scales, Neuropathy Impairment Score of the Lower Limb (NIS-LL), and the Short Form 36 Health Survey Questionnaire (SF-36). Results. Patients with neuropathic pain had significantly more severe DSPN measured with NIS-LL (p &lt; 0.01). They were more likely to be engaged in physical work (p &lt; 0.05), and had more symptoms of depression (p &lt; 0.05) than patients without neuropathic pain. Patients with neuropathic pain had significantly lower QoL in both physical and mental domains (p &lt; 0.01). Independent predictors of worse QoL in DSPN were presence of depression (beta=-0.58, p &lt; 0.01) and presence of neuropathic pain (beta = -0.23, p &lt; 0.05) - R2adjusted = 0.48. Conclusion. Independent predictors of QoL in patients with DSPN were presence of depression and neuropathic pain, which signifies importance of their early recognition and early treatment.

Does sex predict quality of life after acute coronary syndromes: an Australian, state-wide, multicentre prospective cohort study

ObjectiveWomen have reported higher mortality and major adverse cardiovascular events (MACE) following acute coronary syndromes (ACSs) compared with men. With this in mind, we aimed to identify predictors of poor...

B.05 The importance of mental health in improving quality of life in transition-aged patients with epilepsy

Background: Growing evidence has that a suggested that mental health strongly influences quality of life (QoL) in adolescents with epilepsy. In addition, research has suggested that these mental health issues are associated with increased seizure burden and worsened health outcomes. Despite this, and the elevated rate of mental health issues in this population, seizure control tends to be the dominant or sole concern for treating physicians. Methods: In order to look at potential predictors of QoL in adolescents we looked at seizure related data, demographic variables, and comorbid conditions in 70 adolescents with epilepsy aged 14 to 18 (M= 16.3l; 37 males, 33 females) enrolled into an epilepsy transition clinic. Results: Regression analysis found that mental health remained a significant and independent predictor of QoL even when other significant seizure related variables were accounted for (t(58)= -3.44, p= .001). Furthermore, when looking at the individual subscales of patient QoL (e.g., memory, social support, stigma), mental health was consistently found to be the strongest correlate. Conclusions: These results demonstrate that in order to ensure the best outcomes for transition-aged adolescents with epilepsy, it is important to not only manage and treat seizures, but also to assess and treat mental health issues.

Predictors of Quality of Life among Peritoneal Dialysis Patients with End-Stage Renal Disease in Kuwait.

Quality of life (QOL) is an important indicator of quality of healthcare. Measuring QOL and its correlates for peritoneal dialysis (PD) patients is important for public health policy, intervention, and clinical decision-making. Data from 62 patients treated at 6 dialysis centers were collected using short form (SF)-36. Multiple linear regression was used to assess the relationship between QOL and several covariates. Results indicated most patients were ≥ 60 years old (51.6%), retired (40.3%), diagnosed with end-stage renal disease (ESRD) > 1 year (82.3%), with diabetes as primary cause of ESRD (38.7%), and performing daily dialysis (77.4%). After adjustment of covariates, males (β = 19.03, p = 0.0001) scored on average 19.03 higher on QOL than females. Patients 41 - 60 years (β = 11.4, p = 0.018) scored on average 11.4 higher than those ≥ 60 years. Kuwaitis (β = -9.61, p = 0.057) scored on average 9.61 lower than non-Kuwaitis. Patients living with family/others (β = 13.02, p = 0.076) scored on average 13.02 higher than those living alone. Patients satisfied with their dialysis (β = 28.37, p = 0.001) scored on average 28.37 higher than non-satisfied patients. Performing dialysis at home (β = -15.52, p = 0.006) resulted in an average decrease of 15.52 in QOL compared with those in dialysis centers. Finally, patients with diabetes as the primary cause of ESRD (β = -9.8, p = 0.047) saw an average 9.8 decrease in QOL compared with patients with other ESRD causes. Gender, age, nationality, living status, satisfaction and place of dialysis, and causes of ESRD are independent predictors of QOL. Healthcare providers should pay more attention to females, those living alone, and those older than 60 years. Patients performing PD at home should have assistance from a nurse or health practitioner.

Abstract P160: Relationship of Physical Function and Quality of Life in Elderly Patients With Acute Decompensated Heart Failure: The Rehabilitation Therapy in Older Acute Heart Failure Patients (The REHAB-HF Trial)

Introduction: Older patients with acute decompensated heart failure (ADHF) have impaired physical function (PF) and reduced quality of life (QOL). However, the relationship between impairments in PF and QOL are unknown but relevant to clinical practice and design of targeted intervention trials in this high-risk population. Methods: We assessed 202 consecutive patients hospitalized with ADHF in the multicenter Rehabilitation Therapy in Older Acute HF Patients (REHAB-HF) Trial. Standard measures of PF included the Short Physical Performance Battery (SPPB), a validated PF outcome measure in frail elderly, and 6-minute Walking Distance (6MWD). QOL was assessed by Kansas City Cardiomyopathy Questionnaire (KCCQ). Pearson’s correlation statistics examined associations between PF and QOL. Stepwise regressions were performed to identify independent predictors of QOL including PF measures, demographics, and disease severity indicators (NYHA class, previous hospitalizations, duration of current hospitalization, and number of HF signs and symptoms). Results: Participants were 72±7.5 years, BMI 33.2±8.8 kg/m 2 , 54% women, 52% non-white, 52% with reduced ejection fraction, and 44% with previous hospitalizations within 6 months. Participants had marked deficits in PF (SPPB 6.0±2.5 units, 6MWD 185±99 meters) and low QOL (KCCQ Physical Limitation Score (PLS) 47.3±23.8). There were modest but highly significant correlations of QOL measures with SPPB, 6MWD, and number of HF symptoms and signs (Table). Using stepwise regressions, 6MWD and BMI were modest, significant independent predictors of QOL (partial r=0.18, p=0.012 and partial r=-0.27, p=0.0003, respectively), while SPPB, demographics, and HF severity indicators were not. Conclusion: In older, hospitalized ADHF patients, PF and QOL are both severely impaired, but are only modestly related. PF and QOL assess unique domains of impairment and provide complementary information for characterizing clinically meaningful patient-oriented outcomes in ADHF.

Limb Kinetic Apraxia Is an Independent Predictor for Quality of Life in Parkinson's Disease.

Impaired dexterity is a common symptom in Parkinson's disease (PD) and has been related to limb kinetic apraxia (LKA). LKA negatively influenced activities of daily living (ADL) in PD. However, the impact on quality of life (QoL) remains to be clarified, which was the aim of the current study. Eighty nondemented patients with PD and 60 age-matched, sex-matched healthy individuals participated in this study. The 39-item Parkinson's Disease Questionnaire was used to measure QoL. Dexterity was assessed by the coin rotation (CR) task and the ADL-related Dexterity Questionnaire 24. Nonmotor symptoms were monitored with part I of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale, and motor symptoms were measured with parts II and III of the modified Movement Disorder Society-Unified Parkinson's Disease Rating Scale. Regression analysis revealed that dexterity scores controlled for parkinsonian motor symptoms were a strong and independent predictor of QoL in patients with PD. The study demonstrated that the strong association of impaired dexterity and QoL is independent of bradykinesia, thereby underscoring the clinical relevance of LKA in PD.

Longitudinal Impact of Depression on Quality of Life in Stroke Patients.

Objective Stroke is associated with significant long-term morbidity and poor quality of life (QOL). Depression is one of the most common complications after stroke and has been associated with QOL cross-sectionally. We investigated the longitudinal impact of depression in the acute phase of stroke on QOL 1 year after stroke. Methods In total, 423 patients were evaluated 2 weeks after stroke, and 288 (68%) were followed 1 year later. QOL was assessed using the World Health Organization Quality of Life-Abbreviated form (WHOQOL-BREF) at baseline and follow-up. Depression was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders-IV criteria; demographic and clinical characteristics data, including stroke severity, were obtained at baseline. The longitudinal associations of post-stroke depression (PSD) at baseline with QOL across two evaluation points were assessed using a repeated-measures analysis of variance. Results The WHOQOL-BREF scores were significantly and persistently lower 1 year after stroke in patients with PSD at baseline compared with those without PSD at baseline independent of demographic and clinical characteristics, including stroke severity. Conclusion PSD in the acute phase of stroke is an independent predictor of QOL in both the acute and chronic phases of stroke. Our findings underscore the importance of evaluating depression in the acute phase of stroke.

Predictors of quality of life after moderate to severe traumatic brain injury.

Objective To verify correlations between age, injury severity, length of stay (LOS), cognition, functional capacity and quality of life (QOL) six months after hospital discharge (HD) of victims of traumatic brain injury (TBI). Method 50 patients consecutively treated in a Brazilian emergency hospital were assessed at admission, HD and six months after HD. The assessment protocol consisted in Abbreviated Injury Scale, Injury Severity Score, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Mini Mental Test, Barthel Index and World Health Organization QOL - Brief. Results Strong negative correlation was observed between LOS and GCS and LOS and RTS. An almost maximal correlation was found between RTS and GCS and functional capacity and GCS at HD. Age and LOS were considered independent predictors of QOL. Conclusion Age and LOS are independent predictors of QOL after moderate to severe TBI.

Living with stroke in Bangladesh: Factors influencing quality of life (QoL)

ABSTRACTThis study examined factors that may predict the quality of life (QoL) of stroke survivors in Bangladesh. The objectives were: to examine the relationship between QoL and health-related variables (i.e. disability status, cognitive status, mobility status, self-care, getting along with people, life activities, social participation, and psychological state); and also to examine the influence of demographically related variables (i.e. gender, age, level of education, marital status, and living arrangements) on QoL. Data were collected from 110 stroke survivors in Bangladesh. Data collection tools included a semi-structured questionnaire along with WHOQOL-BREF, WHODAS 2.0, and DASS21. A regression analysis was undertaken to determine the significant independent predictors of QoL. Post stroke psychological distress was found to be the key predictor of QoL. Therefore, psychological interventions need to be incorporated in rehabilitation to enhance better QoL post stroke. Other health and demographically related predictor variables had no influence on overall QoL post stroke.

Physical and Psychological Predictors of Quality of Life in Chinese Colorectal Cancer Patients During Chemotherapy.

Maintaining quality of life (QOL) during chemotherapy is a critical aspect of cancer treatment. Instruments have been developed to assess symptom distress, self-efficacy, anxiety, depression, and other factors impacting QOL during cancer treatment, but Chinese versions have become available only recently. The aim of this study was to identify factors predictive of QOL during chemotherapy in Chinese colorectal cancer (CRC) patients. Patients completed Chinese versions of the Hospital Anxiety and Depression Scale, MD Anderson Symptom Inventory (a measure of symptom distress), Stanford Inventory of Cancer Patient Adjustment (a measure of self-efficacy), and Functional Assessment of Cancer Treatment-General (a measure of QOL) before and after 3 and 6 months of chemotherapy. Of 152 consecutive CRC patients (men/women, 98/54; mean age, 53.3 ± 11.3 years, 25-75 years; stage II/III, 59/93), 121 completed all questionnaires (79.6%). Self-efficacy dimensions "communication," "activity management," "personal management," and "affective management" improved progressively over 6 months (all P < .05). Fatigue, nausea, lack of appetite, disturbed sleep, and vomiting peaked at 3 months and declined thereafter (P < .05). Patients who are younger than 60 years, are male, and with stage II CRC exhibited higher 3- and 6-month QOL scores (all P < .05). Multiple regression identified self-efficacy, anxiety, and symptom distress as independent predictors of QOL at 6 months. Enhanced self-efficacy, reduced symptom distress, and lower general anxiety would improve QOL during chemotherapy for CRC patients.These instruments can help identify CRC patients at risk of low QOL for additional psychotherapy or specific treatment modifications.

Exercise behavior and patient-reported outcomes in women with early breast cancer receiving locoregional radiation therapy

PurposeRadiation therapy is associated with acute treatment-related complications that can lead to decreased quality of life (QOL). Exercise has been shown in other cancer treatment settings to improve negative outcomes. We conducted a prospective pilot study to explore the association between exercise, patient-reported outcomes, and acute radiation therapy toxicities. Methods and materialsWomen receiving curative breast radiation therapy were enrolled. Each patient completed an exercise behavior/QOL survey before or during the first week of treatment and again during the last week of treatment. Exercise behavior was quantified with the Godin Leisure Time Exercise Questionnaire (metabolic equivalent [MET] hours per week). Measurements to evaluate upper extremity lymphedema and shoulder range of motion were completed. Skin toxicity was assessed weekly. Patient-reported outcomes were measured using standardized questionnaires. ResultsForty-five patients were enrolled. Mean patient age was 54 (range, 28-73) years. Mean METs in the exercise cohort (≥9 METs/wk) was 21 per week (range, 11-38, n = 14); 3 per week (range, 0-8, n = 25) in the nonexercise cohort (<9 METs/wk). Women in the exercise cohort showed improvements in treatment-induced quality of life and fatigue (not significant) despite more extensive surgical, medical, and radiation treatment. No differences in treatment-related toxicities, pain, or sleep scores were noted. Lymphedema was mild (<3 cm) in the entire patient cohort. ConclusionsThe vast majority of current exercise oncology literature implicates physical activity as an independent predictor of QOL in cancer patients. Our study noted similar trends, but they were not statistically significant. This may be due to our finding that patient-reported outcomes with radiation therapy are relatively high compared with other treatment modalities and remain stable throughout treatment. Thus, it may be that radiation therapy has a limited impact on QOL in breast cancer patients. Exercise may be best used as a targeted therapy in patients at high risk for poor QOL or radiation-related toxicities at baseline.

Determinants of Quality of Life Among Gynaecological Cancer Patients on Follow Up at a Referral Hospital in Kenya

Various factors influence the quality of life (QOL) in cancer patients. This study sought to determine the predictors and factors associated with quality of life among gynaecological cancer patients on follow up at Kenyatta National Hospital, Kenya. A cross-sectional descriptive study was carried out between April and June 2014, involving both outpatient and inpatient gynaecological cancer patients receiving care at the palliative care unit. A structured questionnaire adopting the Missoula Vitas Quality of Life Index was used to collect information on socio-demographics, clinical characteristics and their perceptions about quality of life. The association between socio-demographic and clinical factors with QOL was analyzed using one way ANOVA and linear regression analysis to identify the predictors of QOL. A total of 108 study patients were interviewed. Their mean age was 48 years with a range of 18 to 72 years. Age, level of education, marital status, occupation and monthly income were the socio-demographic factors significantly associated with QOL scores, (p<0.05). The patients’ type of cancer, type of cancer treatment, duration of illness and palliative care services were the clinical characteristics significantly associated with QOL scores, (p<0.05). Age, level of education, occupation, average monthly income, type of cancer treatment, duration of illness and type of cancer were the independent predictors of QOL. Vulnerable patients were those who were less educated, peasant farmers or casual workers, had a long duration of illness and underwent combined therapy. Age, education, occupation, income, type of cancer, type of cancer treatment and duration of illness were the determinants of quality of life among gynaecological cancer patients in the study. Sufficient attention should be given to the more vulnerable gynaecological cancer patients in identifying and addressing their specific needs by the palliative care team.

Neuroticism personality trait is associated with Quality of Life in patients with Chronic Heart Failure.

To evaluate Quality of life (QoL) in chronic heart failure (CHF) in relation to Neuroticism personality trait and CHF severity. Thirty six consecutive, outpatients with Chronic Heart Failure (6 females and 30 males, mean age: 54 ± 12 years), with a left ventricular ejection fraction ≤ 45% at optimal medical treatment at the time of inclusion, were asked to answer the Kansas City Cardiomyopathy Questionnaire (KCCQ) for Quality of Life assessment and the NEO Five-Factor Personality Inventory for personality assessment. All patients underwent a symptom limited cardiopulmonary exercise testing on a cycle-ergometer, in order to access CHF severity. A multivariate linear regression analysis using simultaneous entry of predictors was performed to examine which of the CHF variables and of the personality variables were correlated independently to QoL scores in the two summary scales of the KCCQ, namely the Overall Summary Scale and the Clinical Summary Scale. The Neuroticism personality trait score had a significant inverse correlation with the Clinical Summary Score and Overall Summary Score of the KCCQ (r = -0.621, P < 0.05 and r = -0.543, P < 0.001, respectively). KCCQ summary scales did not show significant correlations with the personality traits of Extraversion, Openness, Conscientiousness and Agreeableness. Multivariate linear regression analysis using simultaneous entry of predictors was also conducted to determine the best linear combination of statistically significant univariate predictors such as Neuroticism, VE/VCO2 slope and VO2 peak, for predicting KCCQ Clinical Summary Score. The results show Neuroticism (β = -0.37, P < 0.05), VE/VCO2 slope (β = -0.31, P < 0.05) and VO2 peak (β = 0.37, P < 0.05) to be independent predictors of QoL. In multivariate regression analysis Neuroticism (b = -0.37, P < 0.05), the slope of ventilatory equivalent for carbon dioxide output during exercise, (VE/VCO2 slope) (b = -0.31, P < 0.05) and peak oxygen uptake (VO2 peak), (b = 0.37, P < 0.05) were independent predictors of QoL (adjusted R2 = 0.64; F = 18.89, P < 0.001). Neuroticism is independently associated with QoL in CHF. QoL in CHF is not only determined by disease severity but also by the Neuroticism personality trait.