Long-term Quality Of Life Outcomes Research Articles

Long-Term Quality of Life Outcome After Proton Beam Monotherapy for Localized Prostate Cancer

High-dose external radiation for localized prostate cancer results in favorable clinical outcomes and low toxicity rates. Here, we report long-term quality of life (QOL) outcome for men treated with conformal protons. QOL questionnaires were sent at specified intervals to 95 men who received proton radiation. Of these, 87 men reported 3- and/or 12-month outcomes, whereas 73 also reported long-term outcomes (minimum 2 years). Symptom scores were calculated at baseline, 3 months, 12 months, and long-term follow-up. Generalized estimating equation models were constructed to assess longitudinal outcomes while accounting for correlation among repeated measures in an individual patient. Men were stratified into functional groups from their baseline questionnaires (normal, intermediate, or poor function) for each symptom domain. Long-term QOL changes were assessed overall and within functional groups using the Wilcoxon signed-rank test. Statistically significant changes in all four symptom scores were observed in the longitudinal analysis. For the 73 men reporting long-term outcomes, there were significant change scores for incontinence (ID), bowel (BD) and sexual dysfunction (SD), but not obstructive/irritative voiding dysfunction (OID). When stratified by baseline functional category, only men with normal function had increased scores for ID and BD. For SD, there were significant changes in men with both normal and intermediate function, but not poor function. Patient reported outcomes are sensitive indicators of treatment-related morbidity. These results quantitate the long-term consequences of proton monotherapy for prostate cancer. Analysis by baseline functional category provides an individualized prediction of long-term QOL scores. High dose proton radiation was associated with small increases in bowel dysfunction and incontinence, with more pronounced changes in sexual dysfunction.

Postinjury Depression Is a Serious Complication in Adolescents After Major Trauma: Injury Severity and Injury-Event Factors Predict Depression and Long-Term Quality of Life Deficits

Little is known about the impact of postinjury depression after major trauma in adolescents. A prospective epidemiologic study was conducted to examine depression in injured adolescents. Specific objectives of this report are to identify risk factors for depression onset and the impact of depression on quality of life (QoL) outcomes. Four hundred one trauma patients were enrolled in this study (age, 12-19 years; injury severity score [ISS] ≥4). Depression diagnosis was based on the Children's Depression Inventory. QoL outcomes were measured using the Quality of Well-being Scale at 3-, 6-, 12-, 18-, and 24-month follow-up. Depression at discharge was diagnosed in 41% of 399 adolescent trauma survivors with complete Children's Depression Inventory data. Multivariate logistic regression identified ISS, >3 body regions injured, low socioeconomic status, family members injured at the scene, and suicidal ideology or attempted suicide before injury as strong and independent predictors of depression risk. ISS and three or more body regions injured predicted depression risk. Patients with severe injury (ISS ≥17) were twice more likely to have depressive symptoms than patients with moderate injury (ISS <17; odds ratio [OR] = 2.0; p < 0.01). Patients with three or more body regions injured were more likely to have depressive symptoms than patients with less than three body regions injured (OR = 2.1; p < 0.01). Adolescents from low socioeconomic status families were more likely to be depressed (OR = 2.2; p < 0.05). Adolescent patients who witnessed family injured at the trauma event were also more likely to be depressed (OR = 2.4; p < 0.01). Patients who experienced suicidal ideology or attempted suicide preinjury were more likely to be depressed than adolescent patients who did not (OR = 2.87; p < 0.05). Quality of well-being scores were significantly and markedly lesser for patients with depression across the 24-month follow-up (3-18 months follow-up, p < 0.0001; 24 months: with depression = 0.738 vs. without depression = 0.784, p < 0.0001). Patients with depression were also significantly more likely to develop acute stress disorder and long-term posttraumatic stress disorder (OR = 1.8, p < 0.001). Postinjury depression is a major and an important complication in seriously injured adolescents. Adolescent trauma survivors have high rates of predischarge depression. Depression severely impacts QoL outcomes and is associated with injury severity, injury event-related factors, social factors, acute stress disorder, and posttraumatic stress disorder. Early recognition and treatment of DEPR in seriously injured adolescents will improve acute trauma care and long-term QoL outcomes.

Long-term QOL outcome after proton beam monotherapy for localized prostate cancer.

68 Background: High-dose conformal proton radiation for localized prostate cancer results in favorable clinical outcomes and low toxicity rates. Here, we report long-term quality of life (QOL) outcome for men treated with conformal protons. Methods: Serial QOL questionnaires were administered to men who received proton radiation. Long-term questionnaires (minimum 2 years) were completed by 72 patients. Men were stratified into functional groups from their baseline questionnaires (normal, intermediate or poor function) for each symptom domain. Symptom scores were calculated at baseline and long-term follow-up and expressed as mean values. QOL changes were assessed overall and within functional groups in a paired fashion using the Student's t-test. Results: The median age at treatment and follow-up were 66 years and 44 months, respectively. The median dose was 82 GyE (range 74-82 GyE). For all 72 patients, there were increased scores for incontinence (ID) (3.2 baseline vs. 9.9 long-term, p=&lt;0.001), obstructive/irritative voiding (OID; 20 vs. 24, p=0.028), bowel (BD; 4.4 vs. 8.0, p=0.001) and sexual dysfunction (SD; 25 vs. 48, p&lt;0.001). When stratified by functional category, more specific estimates were possible. For ID, only normal function was associated with a significant increased score (0 vs. 8.4 at baseline and long-term, p=&lt;0.001); for OID, only the group with normal baseline function showed a significant increased score (12 vs. 17, p=0.01); similarly for BD, only men with normal function had a significant increased score (0 vs. 5.4, p&lt;0.001). For SD, the score increased in men with normal (1.4 vs. 30, p&lt;0.001) and intermediate function (17 vs. 46, p&lt;0.001). Conclusions: Patient reported outcomes are sensitive indicators of treatment related sequelae and here quantitate, for the first time, the long-term consequences of proton monotherapy for prostate cancer. Analysis by baseline functional category is a useful means of predicting long-term QOL scores for an individual patient. High-dose proton radiation was associated with small increases in bowel dysfunction, obstructive/irritative voiding dysfunction and incontinence. With long term follow-up, sexual dysfunction increased more than any other symptom domain. No significant financial relationships to disclose.

Long-term quality of life outcome (SF-36) in traumatic acute subdural hematoma patients

Long-term quality of life outcome (SF-36) in traumatic acute subdural hematoma patients

Long-term QOL Outcome after Proton Radiation for Localized Prostate Cancer

High dose conformal proton radiation for localized prostate cancer results in favorable clinical outcomes and low toxicity rates. Here, we report long-term quality of life (QOL) outcome for men treated with conformal protons.

U-shaped sacral fractures: Surgical treatment and quality of life

Background U-shaped sacral fractures are rare and highly unstable pelvic ring fractures. They are not recognised in the standard classification systems of these fractures. The fracture pattern is associated with significant neurological injury and can lead to progressive deformity and chronic pain if not diagnosed and treated properly. In recent years a variety of surgical strategies have been shown to facilitate early mobilisation and reduce early mortality as compared to non-operative strategies. Poor evidence, however, has hampered the development of a standard treatment algorithm. As for the long-term morbidity, the influence of operative treatment may be difficult to assess due to associated injury. However, evidence exists that there is a significant effect on the long-term morbidity. Objective To assess the injury characteristics, choice of treatment and quality of life of U-shaped sacral fractures. Methods Eight polytraumatised patients with U-shaped sacral fractures were identified over a 7-year period and evaluated retrospectively. They were analysed for fracture classification, associated injury, and injury severity. Clinical and Radiological results were evaluated. Neurological outcome was retrospectively classified by Gibbons’ criteria. Long-term quality of life outcome was evaluated using the EuroQoL-6D questionnaire. Results The study population consists of five women and three men; with a median age of 29 years. All patients sustained severe associated injury. The Injury Severity Score ranged from 17 to 45 (median 23). The median time between trauma and definitive internal fixation was 4 days (range, 2–22 days). Definitive fixation included either percutaneous iliosacral screws ( n = 2), transsacral plate osteosynthesis ( n = 1) or triangular osteosynthesis with ( n = 4) or without transsacral plating ( n = 1). Early postoperative mobilisation and early partial weight-bearing were encouraged when possible. Follow-up ranged from 5 to 65 months (median, 36 months). Pain, mood disorders and mobility problems mainly influenced patients’ present general health status. Conclusion U-shaped sacral fractures present a rare and heterogeneous injury. Operative treatment depended mainly on fracture type, associated spinal fractures, and the surgeon's preference. Long-term quality of life is dominated by pain, mood disorders and moderate mobility problems.

Surgical intervention for thoracic outlet syndrome improves patient's quality of life

To assess long-term quality of life outcomes in patients following transaxillary first-rib resection and scalenectomy for thoracic outlet syndrome (TOS). This was a prospective observational study using the Short-Form 12 (SF-12) and Disability of Arm, Hand, and Shoulder (DASH) instruments between February 2005 and March 2008 in patients with TOS presenting to an academic medical center for preoperative surgical evaluation after failing physical therapy protocol. Surveys were conducted preoperatively and then again at 3, 6, 12, 18, and 24 months after surgery. Longitudinal data analysis was performed with population-averaged models using generalized estimating equations (GEE) method for average rate of recovery. Kaplan-Meier method was used to analyze time to return to work. A total of 70 out of 105 eligible patients (66.7%) completed the study protocol (44 neurogenic; 26 venous), returning 243 valid SF-12 surveys (162 neurogenic; 81 venous) and 188 valid DASH surveys (124 neurogenic; 64 venous). Half (50%) of the neurogenic patients and 77% of the venous patients returned to full-time work or activity within the study follow-up, with half of them doing so by 4 months and 75% of them by 5 months. There was no statistically significant difference in return to work between the neurogenic or venous patients. Neurogenic patients had baseline SF-12 Physical Component Scores (PCS) similar to chronic heart failure patients and were significantly worse than venous patients (33.8 vs 43.6, P < .001). In contrast, no difference existed in Mental Component Scores (MCS) (44.5 vs 43.5, P = .78). In follow-up, on average, PCS scores for neurogenic patients improved 0.24 points (P < .001) and MCS scores improved 0.15 points per month (P = .01); while PCS scores for venous patients improved 0.40 points (P = .004) and MCS scores improved 0.55 points per month (P < .001). Additionally, neurogenic patients had baseline DASH scores that were similar to patients with rotator cuff tears, and they were also significantly worse than venous patients (50.2 vs 25.0, P < .001). DASH scores, on average, also improved 0.85 points (P < .001) for neurogenic patients and 0.81 points (P < .001) for venous patients per month. The use of the SF-12 and DASH instruments in patients with TOS demonstrated significant improvement in patients postoperatively. Venous TOS patients typically improved both physical and mental scores in shorter periods of time than their neurogenic counterparts. Neurogenic and venous TOS patients returned to full-time work/activity within the same length of time postoperatively. However, neurogenic patients required more secondary interventions. We conclude that in appropriately selected patients with either neurogenic or venous TOS, surgical intervention can improve their quality of life over time.

Abstract B9: Long-Term Outcomes of Affected Women who Received Uninformative BRCA1/2 Results

Abstract B9 Little is known about long-term behavioral and psychological outcomes following receipt of an uninformative BRCA1/2 genetic test result. The purpose of this study was to examine the behavioral, medical, and psychosocial outcomes. Specifically, we evaluated long-term bilateral prophylactic salpingo-oophorectomy (BPO) rates, current quality of life (QOL) outcomes, and predictors of distress for women affected with breast cancer who received an uninformative result. Method Participants were women with a 10% or greater likelihood of carrying a BRCA mutation who had received genetic counseling and genetic test results 4-8 years prior. All women in the present sample (N = 230) received uninformative BRCA1/2 test results and were affected with breast cancer. Women completed assessments measuring demographics, global distress (BSI), cancer-specific distress (IES), risk perceptions, surgery and surveillance behaviors, and quality of life (MOS SF-12, FACT) before and 4-8 years (M=5.8 yrs) after genetic testing. Analyses/Results In terms of surveillance for breast cancer, most women had a mammogram (84%) and a clinical breast exam (94%) within the past year. When evaluating BPO surgery outcomes, we eliminated women who had been diagnosed with ovarian cancer (n = 13). Of the women with uninformative results and no prior history of ovarian cancer, 12% (n=26) reported BPO prior to receipt of test results, 10.1% (n=22) reported BPO after receipt of test results, and 77.9% (n=169) reported never having BPO. BPO was obtained an average of 2.75 years after receipt of test results (range 0.1 to 5.0 yrs). The BPO groups (never, prior to testing, after testing) did not differ on long-term QOL outcomes (p&amp;lt;.41); however, the groups significantly differed on global distress (F=4.96, p&amp;lt;.01), with women who had BPO after testing reporting more distress than women who had BPO before testing. Regardless of BPO status, greater long term cancer-specific distress among uninformatives was predicted by greater levels of baseline cancer-specific distress prior to receipt of test result (β=.30, p&amp;lt;.001), higher current perceived risk of cancer (β= .23, p&amp;lt;.01), and ovarian cancer family history, specifically a greater number of relatives affected by ovarian cancer (β= .22, p&amp;lt;.01). A trend was found where BPO timing and status (never, prior to testing, after testing) was associated with current cancer-specific distress (β= -.15, p=.07). Specifically, having BPO after receipt of uninformative results was marginally related to higher current levels of cancer-specific distress. Conclusions Previous studies have found that the uninformative group is diverse in their psychosocial outcomes and this study is among the first to report long-term behavioral and psychosocial outcomes among women who receive uninformative BRCA1/2 genetic test results. Women who opt for BPO after notification of an uninformative result appear to have higher current global distress than women who never had BPO or those who had the surgery prior to receipt of test results, with a similar trend for current cancer-specific distress. Our findings suggest that women who receive uninformative test results, mainly those with a strong family history of ovarian cancer, high cancer-specific distress prior to genetic testing, and those who opt for BPO following result notification, may benefit from routine long-term follow up from genetic counselors. Citation Information: Cancer Prev Res 2008;1(7 Suppl):B9.

Psychosocial factors in living organ donation: clinical and ethical challenges

Living donor surgery has come to the forefront of public attention because increasing numbers of potential donors respond to the organ shortage. Because of several factors including decreased morbidity from donor surgery, online resources appealing for organs, and increased publicity about donation, new populations of unrelated donors are seeking evaluation for donor surgery. However, concern about potential coercion of vulnerable individuals, the potential for adverse psychosocial outcomes, and recent reports of donor deaths have reinvigorated discussion within the medical community about how best to assess donors. Research on the long-term quality of life outcomes for donors suggests that most donors are satisfied with their decision to donate. Small single-center studies on psychosocial outcomes have reported psychiatric sequelae after donor surgery. Little is known about the psychosocial outcomes for donors who are psychosocially excluded from donating. A multidisciplinary team approach, including social work and psychiatry evaluations, allows for the comprehensive assessment of important areas including motivation and expectations about surgery, current and past psychiatric conditions, history of substance or alcohol abuse, family support, understanding of the risks and alternatives of donor surgery for the donor and recipient, and motivation for donation including any evidence of coercion.

Trauma in Adolescents Causes Long-Term Marked Deficits in Quality of Life: Adolescent Children do not Recover Preinjury Quality of Life or Function up to Two Years Postinjury Compared to National Norms

Injury is a leading cause of death and preventable morbidity in adolescents. Little is known about long-term quality of life (QoL) outcomes in injured adolescents. The objectives of the present report are to describe long-term QoL outcomes and compare posttrauma QoL to national norms for QoL in uninjured adolescents from the National Health Interview Survey (NHIS). In all, 401 trauma patients aged 12 to 19 years were enrolled in the study. Enrollment criteria excluded spinal cord injury. QoL after trauma was measured using the Quality of Well-being (QWB) scale, a sensitive and well-validated functional index (range: 0 = death to 1.000 = optimum functioning). Patient outcomes were assessed at discharge, and 3, 6, 12, 18, and 24 months after discharge. NHIS data were based on 3 survey years and represent a population-based U.S. national random sample of uninjured adolescents. Major trauma in adolescents was associated with significant and marked deficits in QoL throughout the 24-month follow-up period, compared with NHIS norms for this age group. Compared with NHIS norms for QoL in uninjured adolescents aged 12 to 19 years (N = 81,216,835; QWB mean = 0.876), injured adolescents after major trauma had striking and significant QoL deficits beginning at 3-month follow-up (QWB mean = 0.694, p < 0.0001), that continued throughout the long-term follow-up 24 months after discharge (6-month follow-up QWB mean = 0.726, p < 0.0001; 12-month follow-up QWB mean = 0.747, p < 0.0001; 18-month follow-up QWB mean = 0.758, p < 0.0001; 24-month follow-up QWB mean = 0.766, p < 0.0001). QoL deficits were also strongly associated with age (>or=15 years) and female sex. Other significant risk factors for poor QoL outcomes were perceived threat to life, pedestrian struck mechanism, and Injury Severity Scores >16. Major trauma in adolescents is associated with significant and marked deficits in long-term QoL outcomes, compared with U.S. norms for healthy adolescents. Early identification and treatment of risk factors for poor long-term QoL outcomes must become an integral component of trauma care in mature trauma care systems.

Quality of Life 17 to 20 Years After Uvulopalatopharyngoplasty

To study the long-term quality of life outcomes of a group of unselected patients for the long-term effects of uvulopalatopharyngoplasty (UPPP). Retrospective chart review and telephone survey. Forty-nine patients who underwent UPPP between July 1980 and July 1983 and who had their medical records were reviewed and were asked to grade on a visual analogue scale (VAS) the clinical benefits and complications of UPPP after the surgery. Forty-three (87.8%) males and six (12.2%) female patients were studied. Improvement in snoring, excessive daytime somnolence, and nocturnal arousals were seen after UPPP with decreased effectiveness after time. The most common complication of UPPP was velopharyngeal insufficiency (VPI) (28.5%); however, dry throat and swallowing difficulty tended to be more severe in those patients who had them. No correlation between the snoring and VPI VAS grades was observed. Forty-three patients had a preoperative sleep study and 22 patients a postoperative sleep study. There was lack of correlation between the significant subjective clinical improvement and their postoperative polysomnography. When undertaking UPPP, both subjective and objective benefits should be weighed against the risk of long-term ill effects. Patients should also be warned that the long-term side effects such as VPI, dry throat, and abnormal swallowing sensation might be more common than previously expected.

Male pseudohermaphroditism: long-term quality of life outcome in five 46,XY individuals reared female.

We assessed the adult quality of life of five medical chart-selected genetic males (ages 29-34 years) assigned and reared as females due to ambiguity of the external genitalia. All five were treated following the traditional method proposed by John Money and colleagues in 1955, commonly referred to as the "optimal gender policy". The adult follow-up assessment included physical and endocrinological evaluation, completion of self-report questionnaires, and a semi-structured interview assessing gender identity, sexual experience and orientation. Quality of life domains assessed by questionnaire included health-related issues, satisfaction with health-care management, emotional distress, and relationship satisfaction. Vaginoplasty in four out of five patients was initially unsuccessful. Four patients had periodic lapses in adherence to hormone replacement therapy. Gender role behavior across development was masculine relative to norms for women. All participants reported a female gender identity without a history of gender dysphoria. The majority of participants (four of five) reported being sexually active and in long-term relationships (three heterosexual, one homosexual). Current emotional adaptation and health-related quality of life are within the normal range for four participants. Sex assignment of 46,XY individuals with ambiguous genitalia as females is compatible with a positive quality of life.

Quality of life following treatment for early prostate cancer: does low dose rate (LDR) brachytherapy offer a better outcome? A review.

Due to a lack of evidence from randomised studies, there is little agreement on the best form of treatment among men who require curative treatment for prostate cancer. The relative impact of the various treatments on symptoms and health-related quality of life is also controversial. We review the literature on quality of life changes following low dose rate brachytherapy (BXT) and compare BXT to other treatments for early prostate cancer. Systematic literature review 1988-2003 (Medline). Brachytherapy; Radical prostatectomy; External beam radiotherapy; Quality of life; Symptoms. Review of the current literature suggests that radical prostatectomy, external beam radiotherapy and BXT either alone or in combination with supplementary external beam radiotherapy offer good long-term health-related quality of life. However differences exist in the toxicity of treatment in terms of erectile function, voiding difficulty, incontinence and bowel function. These differences seem to persist for at least 3-5 years post-treatment though longer-term quality of life outcomes from modern techniques are unknown. BXT offers a high probability of maintaining continence, potency and normal rectal function though both storage and voiding urinary symptoms have been reported. Addition of androgen deprivation and EBRT to BXT may increase urinary, bowel and sexual toxicity of treatment. Quality of life outcome following brachytherapy compares favourably with other radical treatment options for the management of early prostate cancer.

Prospective assessment of patient-reported long-term urinary morbidity and associated quality of life changes after 125I prostate brachytherapy

Purpose: Prostate brachytherapy has been reported to have less morbidity for patients than radical prostatectomy or external beam irradiation. However, to date there have been no long-term data to support these claims. With radiation doses in excess of 140 Gy required to control the tumor, disabling chronic urinary symptoms and associated quality of life (QOL) changes might be expected to occur. This study prospectively assessed the long-term effects of 125I prostate brachytherapy on urinary morbidity.Methods and Materials: A total of 248 patients with a median age of 67 years (range, 43–83 years) who presented with T1–T2 prostate cancer were treated with 125I seed implantation and followed up for a minimum of 18 months after treatment (range, 18 to 108 months; median, 31 months). There were 177 T1b–T2a cases and 41 patients with prostate-specific antigen >10 ng/ml; 20.2% were treated with hormonal therapy. All patients prospectively reported their urinary symptoms and QOL assessment on American Urological Association symptom score records before treatment and at each follow-up visit. Urinary symptoms at last follow-up were compared with pretreatment scores. Radiation doses to the prostate (dose delivered to 90% of the gland; D90) and urethra (D30) were determined by CT-based dosimetry.Results: The median prostate D90 was 165 Gy (range, 16.5–260 Gy), and the median urethra D30 was 192 Gy (range, 23.5–306 Gy). Mean individual scores and QOL ranged from 0.31 to 1.65 before implantation and 0.39 to 1.73 afterward. There were no significant differences between pretreatment and last mean scores for any of the categories except for a small but significant increase in urgency (p=0.01) and weak stream (p=0.03). The cohort of patients who initially presented with marked urinary symptoms (initial score ≥3) had improvement in individual scores by 31.4% to 58.2%, total score by 31.1% (p=0.0005), and QOL by 40.6% (p<0.0001).Conclusions: This study suggests that prostate brachytherapy is associated with minimal long-term urinary morbidity. The subgroup of patients who present with marked urinary symptoms before implantation has improvement in symptoms and QOL after implantation. These data substantiate the favorable long-term QOL outcomes associated with modern brachytherapy techniques.

Age at diagnosis and quality of life in breast cancer survivors.

The purpose of the study was to determine the relationship between life-stage variables (ie, age at diagnosis and years of survival) and quality-of-life (QOL) outcomes in long-term survivors of breast cancer. In this cross-sectional study, 105 long-term survivors of breast cancer participated in a mailed survey assessing QOL. Participants were selected from a cancer center tumor registry using a stratified random-sampling procedure that was based on age at diagnosis. The Quality of Life-Cancer Survivors scale was used to assess QOL outcomes in the physical, psychological, social, and spiritual domains. Long-term survivors of breast cancer who had received diagnoses at an older age (> 65 years) showed significantly (P <.05) worse QOL outcomes in the physical domain, while those who had received diagnoses at a younger age (27-44 years) showed worse QOL outcomes in the social domain than other age groups. A nonlinear relationship was observed, with long-term survivors who had received diagnoses in middle age (45-65 years) showing better QOL outcomes in the physical domain and in overall QOL. Age at diagnosis and years of survival were significant predictors of QOL outcomes. These findings indicate that the life stage at diagnosis can help to predict long-term QOL outcomes in breast cancer survivors. Educational strategies to help oncology professionals develop a better understanding of the impact of age at diagnosis may be important in developing tailored interventions that respond to the specific needs of breast cancer survivors at each life stage.

Quality of life of survivors of pediatric intensive care.

Measuring outcome in pediatric intensive care is necessary to equate the high cost of treatment with benefits to the patient. Although mortality rates and morbidity are relatively insensitive measures of the benefits of treatment, quality of life measurement gives insight into the long-term outcomes. The aim of this study was to investigate the long-term quality of life outcome of children admitted to a pediatric intensive care unit. Prospective survey. A 13-bed pediatric intensive care unit in a university-affiliated, tertiary referral children's hospital. Patients were 432 children discharged from the pediatric intensive care unit between May 1992 and April 1994. Quality of life was measured by using the Royal Alexandra Hospital for Children Measure of Function. The scale has two components, the first part completed by the clinician after parent interview and the second part completed separately by the parent. Parents of 432 children were contacted between 3 and 24 months after discharge. Twenty-seven children (6.3%) had died after discharge from the pediatric intensive care unit; 59.3% (256) had scores indicating a normal quality of life, and 32.4% (140) had a fair quality of life with ongoing health, social, or cognitive problems requiring some intervention. Two percent of survivors (nine children) had scores indicating a poor quality of life as they had continued to experience significant or disabling health problems requiring hospitalization or the equivalent. Predictors of poor quality of life included presence of comorbidities, increased length of stay, and a diagnostic category of malignancy. Diagnostic categories of respiratory, trauma, and cardiac dysfunction were associated with a better outcome. Our results indicate that the long-term outcome in terms of quality of life after admission to a pediatric intensive care unit is good or normal for the majority of surviving children. Those children with a poor outcome are likely to have significant comorbidities or a diagnosis of malignancy.

Improvement in quality of life outcomes 2 weeks after left ventricular assist device implantation

Background The successful use of left ventricular assist devices (LVADs) as a bridge to heart transplantation has prompted our examination of quality of life (QOL) outcomes. The purposes of this study are to describe QOL in patients 1 to 2 weeks after LVAD implantation and to compare QOL in a smaller cohort of patients from before to 1 to 2 weeks after surgery. Methods Data were collected from a convenience sample of 81 patients who completed booklets of questionnaires that measure domains of QOL 1 to 2 weeks after LVAD insertion and from 30 of 81 patients who completed booklets at both the pre-implantation and post-implantation periods. Patients completed booklets of 6 to 8 self-reporting instruments, with acceptable reliability and validity. Data were analyzed using descriptive and comparative statistics (chi-square, Mann-Whitney U and Wilcoxon signed ranks tests) with p = 0.01 considered statistically significant. Results One to 2 weeks after LVAD implantation, patients were quite satisfied with their lives, experienced moderately low amounts of stress, coped well, and perceived themselves as having good health and QOL, low symptom distress, and moderately low functional disability. Patients reported significantly better QOL, more satisfaction with health and functioning, and were significantly less distressed by symptoms from immediately pre-operatively to post-operatively. However, patients reported significantly more self-care disability and more dissatisfaction with socioeconomic areas of life from before to immediately after surgery. Psychological distress was low and did not change with time. Conclusion Given that QOL improved from before to after LVAD implantation, our findings provide a springboard for investigation of the impact of LVADs on long-term QOL outcomes.

Randomised trial of paclitaxel versus doxorubicin as first-line chemotherapy for advanced breast cancer: quality of life evaluation using the EORTC QLQ-C30 and the Rotterdam Symptom Checklist

The aim of the study was to compare the quality of life (QL) of patients treated with single-agent paclitaxel versus doxorubicin as first-line chemotherapy for advanced breast cancer. 331 patients with advanced breast cancer were randomised, with 294 eligible for analysis. Patients completed both the EORTC QLQ-C30 questionnaire and the Rotterdam Symptom Checklist (RSCL) with six additional items, at baseline and after the third, fifth and seventh cycles of chemotherapy. A significant difference in progression-free survival in favour of doxorubicin caused a bias in the data with differences in expected completion rates of questionnaires beyond cycle three. Therefore, statistical comparisons were performed only for the first three cycles. Baseline compliance was 64% and 61% for the QLQ-C30 and RSCL questionnaires, respectively. Doxorubicin was associated with significantly more nausea/vomiting ( P=0.001), loss of appetite ( P=0.010) and a greater burden of disease and treatment ( P=0.044), but with less bone pain ( P=0.042) and rash ( P=0.045) than paclitaxel. Both treatments were associated with improved emotional function and reduction in psychological distress at cycle 3. Longitudinal data suggested that doxorubicin was associated with less pain, specifically bone pain. Doxorubicin was more active but may have had more side-effects during the first three cycles. Long-term QL outcomes could not be assessed.

QUALITY OF LIFE AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER IN PATIENTS WITH AN ILEAL CONDUIT, OR CUTANEOUS OR URETHRAL KOCK POUCH

Purpose Radical cystectomy for bladder cancer is associated with many changes in bodily function with sexual and urinary dysfunction most prevalent. However, little research has been done on how efforts to improve erectile function relate to quality of life. Also, the psychological benefits associated with continent urinary diversion have not been fully explored. We compared long-term quality of life outcomes among 3 urinary diversion groups, and between patients who had and had not received an inflatable penile prosthesis. Materials and Methods The 224 participating patients completed 4 self-reporting questionnaires, including the profile of mood states, and adapted versions of the sexual history form, body image dissatisfaction scale and quality of life questionnaire. We compared self-reports of emotional distress, global quality of life, sexuality, body image dissatisfaction, urinary diversion problems, and problems with social, physical and functional activities in patients with advanced bladder cancer who underwent urinary diversion, including an ileal conduit in 25, cutaneous Kock pouch in 93 and urethral Kock pouch in 103. Patients who had or had not received an inflatable penile prosthesis after cystectomy were also compared in regard to quality of life variables. Results Regardless of type of urinary diversion the majority of patients reported good overall quality of life, little emotional distress and few problems with social, physical or functional activities. Problems with urinary diversion and sexual functioning were identified as most common. After controlling for age analysis of variance showed no significant differences among urinary diversion subgroups in any quality of life area. However, t tests controlling for age indicated that penile prosthesis placement was significantly associated with better sexual function and satisfaction. Conclusions Quality of life appears good in these long-term survivors of advanced bladder cancer. The type of urinary diversion does not appear to be associated with differential quality of life. Findings suggest that physicians may wish to discuss urinary diversion problems and sexual dysfunction as long-term correlates of radical cystectomy for bladder cancer. Furthermore, they may also wish to discuss the option of erectile aids in men with erectile dysfunction after cystectomy.