Lower Physical Well-being Research Articles

Quality‐of‐life and surgical treatments for rectal cancer—a longitudinal analysis using the California Cancer Registry

Heterogeneous results for research investigating health-related quality of life (HRQL) in patients undergoing sphincter-ablating procedures for rectal cancer are likely due to single institution experiences and measurement of HRQL. To address this heterogeneity, we evaluated HRQL in patients with rectal cancer by type of surgery, location of tumor, and receipt of adjuvant therapy using an HRQL instrument that has not been used to address rectal cancer patients in a population-based sample over time. The Functional Assessment of Cancer Therapy-Colorectal instrument was administered at 9 and 19 months after diagnosis to a consecutive sample of 160 patients in Northern California identified by the California Cancer Registry. A broad multidimensional interpretation of HRQL was used to examine the impact of tumor location and treatment status, stage of disease, age, and gender. In general, men had lower social well-being scores, and younger patients had lower physical and emotional well-being scores and colorectal concerns scores. We found no differences in HRQL by either tumor location or type of surgery, at either 9 or 19 months after diagnosis. Lower physical well-being and greater adverse colorectal concerns were reported at 9 months among patients who received adjuvant therapy; however, only adverse colorectal concerns persisted over time. This study provides additional evidence that sphincter-ablating procedures do not necessarily reduce quality of life in patients with rectal cancer. Distinctive features of this study include a broad multidimensional interpretation of HRQL, the 19 months of longitudinal follow-up, and a prospective population-based study design.

Health-related quality of life and pain assessment in 36 patients with resected pancreas adenocarcinoma: Preliminary analysis

e20692 Background: In order to begin to understand the effects of disease on the patient (pt) and possibly of the pt on the disease, we have begun a systematic psychological inventory of all our pts who have has a pancreatectomy for pancreas adenocarcinoma and have began to correlate this with disease extent, and later with survival. Methods: Prior to post-op discharge home, pts were invited to fill out a brief pain inventory (BPI-SF), BPI interference, emotional (EWB) and physical well-being score (Fact-Hep), as well as social/family and functional well-being (FWB) Fact-Hep. The data was entered into a database, together with pertinent lab results, tumor markers, and tumor characteristics from the pre-op CT scan and post-op pathology report. Data was analyzed by descriptive statistics, frequencies and Pearson Correlation (2-tailed sig). Results: Descriptive means (and ranges) were - tumor size 3.43 cm mean (2.0 min-5.2 max), bilirubin 1.26 (0.2–4.7), albumin 2.69 (1.5–3.6), Hb 10.3 (7.5–13.2), platelets 254K (109K-672K), CEA 4.7 (0.8–24), and Ca 19–9 was 987 (1.0–8127). Pain at presentation pre-op of moderate severity was present in 11% of pts and severe pain was present in 5.6% of pts (16.6% total). Pathologically, LNs were involved by cancer in 50% of pts, vascular invasion in 30%, neural invasion in 35% and any margin positive in 14%. 22% had metastases noted at surgery. Statistically significant correlations were found for tumor size and pain severity (p<.035), platelets and FWB (p<.022), albumin and Hb (p=.000), CA 19–9 and bilirubin (p<.030 i.e. high CA 19–9 and high bilirubin). There was a negative correlation between CEA (but not CA 19–9) and both EWB (p<.039) and FWB (p<.035). Pain severity correlated with depressed mood (p<.010), lower physical well-being (p<.01) and interference with life activities (p<.01). Conclusions: CEA, but not CA 19–9 correlated with both emotional and functional well-being. Baseline pain was present in only 16.6% of this cohort. We plan to follow up to examine how these parameters correlate with pt coping throughout therapy and survival. No significant financial relationships to disclose.

Demographic and health-related factors associated with complementary and alternative medicine (CAM) use in multiple sclerosis

Complementary and alternative medicine (CAM) use is high among people with multiple sclerosis (MS), yet there are no reports on the association between CAM use and health-related quality of life (HRQL) in MS. To examine this relationship, a cross-sectional survey and SF-12 was used to collect demographic and HRQL data from 1667 survey respondents. Factors examined for their association with CAM use included, age, gender, race, self-reported disease severity, disease-modifying drug (DMT) use, MS duration, MS type, education level, physical and mental well-being. Multiple regression analysis revealed that female gender, high education level, longer MS duration, lower physical well-being and not using DMT were independent factors associated with both ‘ever’ and ‘current’ CAM use. The finding that a drop in physical component score (PCS) of the SF-12 is independently associated with an increased odds of ‘ever’ CAM use, ‘current’ CAM use, and ‘past’ CAM reflect an association of CAM use with PCS regardless of time of use. Although, temporality of this relationship cannot be established, as this was a cross-sectional study, a longitudinal study is warranted so that we can establish if HRQL is predictive for CAM use in MS.

Work Locus of Control as a Moderating Influence on the Quality of Work Life for Radiation Therapists

Radiation Therapists practising in British Columbia, Canada, were surveyed to determine the extent of work-related stressors and resultant job strains. Also measured was the personality variable of Work Locus of Control (WLOC) for respondents. WLOC is the degree to which individuals feel they have influence over work-related rewards or punishments. Those with an internal locus feel believe that they have control, while those that have an external locus believe that rewards are more governed by external factors such as luck or the actions of others. The results compared the perception of stress and prevalence of job strains for those with a more external locus compared to those with a more internal WLOC. It was found that those with a more external locus were more likely to experience both interpersonal conflict at work and organizational constraints. They also exhibited lower affective well-being, experienced more low pleasure emotions and had lower physical well-being. Respondents with a more external locus scored lower on job satisfaction ratings. The results support existing literature identifying that perceptions of job stress and resultant job strains are a function of personality as well as environment.

PHYSICAL ACTIVITY AND QUALITY OF LIFE IN BREAST CANCER SURVIVORS

Given the relatively high rates of breast cancer survival, identifying factors that are associated with positive quality of life (QOL) is an important question. To address this issue, preliminary baseline data on the relation between physical activity (PA) and QOL were examined in 781 breast cancer survivors participating in LACE (Life After Cancer Epidemiology study), an observational, cohort study of the behavioral correlates of breast cancer recurrence and survival. The LACE cohort consists of women with early stage breast cancer, 12 to 36 months after diagnosis, who were identified through the Northern California Cancer Registry, and who responded to a mailed survey. QOL was assessed with the Functional Assessment of Cancer Therapy (FACT-B), a reliable and valid self-administered questionnaire that measures physical, emotional and functional well-being. A low domain-specific QOL was defined as 75% or less of the total possible score. Physical activity (PA) was assessed by asking about frequency and duration of participation in various activities during the preceding 12 months. Responses were summarized as MET-mins/wk of recreational PA, and MET-mins/wk of household PA. Multiple logistic regression was used to model the likelihood of a low domain-specific QOL score as a function of quartiles of domain-specific PA, body mass index, age at diagnosis, and time since diagnosis. Recreational PA was inversely associated with physical (Odds Ratio [OR] for Q4 vs. Q1 = 0.32, 95% confidence Intervals [CI] = 0.16–0.64, p for trend = .02) and functional well-being (OR = 0.49, 95% CI = 0.0.31–0.78, p for trend = .009). Similar reductions in risk of low physical and functional well-being were also associated with household PA. Neither domain of PA was associated with emotional well-being. Although cross-sectional relations limit temporal inference, these findings suggest that physical activity may contribute to improved quality of life in breast cancer survivors. Supported by the National Cancer Institute, R01-CA80027-02

The influence of sociodemographic characteristics on well-being and symptoms in a Swedish community: Results from a postal questionnaire survey

Study objective - To assess the influence of sociodemographic characteristics on self-reported well-being and symptoms. Design - A postal questionnaire was sent to a representative population sample drawn from the population census. Setting - The municipality of Håbo, Sweden. Participants - Out of 1312 subjects in the population sample, 827 (63%) participated in the study, i.e. answered the questionnaire. Results - Sociodemographic characteristics significantly influenced most well-being variables and symptoms. The prevalence of symptoms in the categories depression and tension, as well as headache, decreased while most other symptoms increased with age. Women had more symptoms than men. Married subjects, compared to others, had higher social and mental but lower physical well-being. Subjects from households with up to three persons, and subjects with comprehensive school only, had lower physical well-being than other subjects. Working subjects generally had a higher well-being than non-working subjects. Conclusion - Sociodemographic characteristics had a significant influence on most well-being variables and symptoms.