Mean Global Quality Of Life Score Research Articles

Implications of the composite free flap harvest site on quality of life after head and neck surgery: a prospective series

Quality of life (QOL) has become a primary determinant of the treatment outcome. There is a poor evidence base regarding the QOL implications of free flap harvest from the various different osseous composite donor sites. This prospective study assessed the impact of free flap harvest on QOL and compared QOL morbidity between fibula, scapula, and iliac crest (deep circumflex iliac artery; DCIA) donor sites in head and neck reconstructive surgery. This was a single-site prospective cohort clinical research study. Fifty-nine patients were recruited between 2017 and 2021; 30 underwent fibula flap reconstructive surgery, 17 scapula flap, and 12 DCIA flap. The patients were assessed using the University of Washington Quality of Life Questionnaire version 4 (UW-QOL v4) preoperatively and again at >12 months postoperatively. The results showed no significant change in the mean global QOL score postoperatively when compared to the preoperative baseline in any of the donor site groups. However, the mean postoperative scores for the appearance domain were significantly lower than the preoperative scores in all of the donor site groups. In addition, fibula flap patients had significantly reduced physical activity and recreation QOL domain scores postoperatively when compared to the preoperative scores.

Severity of acne and quality of life of patients treated at Cameroonian hospitals (sub-Saharan Africa)

Background: The aim of this study was to assess the severity of acne and the impact on the quality of life (QoL) of patients undergoing anti-acne treatment. Methods: This was a cross-sectional study conducted from January to April 2017 at three hospitals in Yaoundé. Patients suffering from acne and under treatment were consecutively included. Clinical severity and QoL were assessed with the ECLA and CADI scales, respectively. Data was analyzed with SPSS 23.0. We employed the ANOVA test and linear regression to search for associations between variables. The significance level was at 5%. Results: We recruited 113 patients, predominantly female (83%), with a mean age of 26.0 ± 6.4 years. Mild-to-moderate forms were predominant (74%). The mean ECLA score was 10.1 ± 4.6, with a majority of the participants 74.3% (84/113) having mild-to-moderate acne, while 25.7% (29/113) had severe acne. The majority of the patients found the treatment expensive (69%). Therapeutic education had been conducted in 46.9% of the patients, and 60.2% of them reported a relapse during treatment. An impairment in QoL was found in 99% of the patients. The mean global QoL score was 6.3 ± 3.4. The impairment in QoL was positively correlated with clinical severity (r = 0.40; p = 0.003). Conclusion: The study revealed a predominance of mild-to-moderate forms of acne, an alteration in the QoL of almost all patients studied, and a positive correlation between the clinical severity of acne and the impairment in QoL. Key words: Acne; Clinical severity; Quality of life; Treatment; Cameroon; Sub-Saharan Africa

Adoption of patient-reported outcomes (PROs) in clinical practice for older patients receiving active anticancer treatment: Impact on health-related quality of life (QoL).

e24014 Background: PROs are the gold standard to describe subjective symptoms. In order to improve clinical management of outpatients receiving active anti-cancer treatment at Medical Oncology, Mauriziano Hospital, Turin, Italy, in January 2018 we introduced in routine clinical practice an assessment of patient-reported symptoms and toxicities. We demonstrated that use of PROs in clinical practice was associated with a significant QoL improvement, compared to the traditional visit (Baratelli, Support Care Cancer 2019). In this secondary analysis, we show the results obtained in older pts ( > 70yrs). Methods: Eligible pts were receiving an active anti-cancer treatment, as outpatients. Pts treated in 2017 underwent “usual” visits (group A), while pts treated in 2018 before each visit received a paper questionnaire by a dedicated nurse, in order to provide information about symptoms and toxicities to be discussed during visit (group B). Primary objective was the comparison of QoL changes, measured by EORTC QLQ-C30. Results: Out of 211 pts, 88 were older than 70 yrs (47 group A, 41 group B). Median age was 76 (70-84 yrs). Most common tumors were colorectal (25.0%), lung (22.7%) and pancreatic (17.0%). 68.2% were receiving first-line treatment. Tumors and setting were similar between group A and B. Younger and older pts had comparable baseline QoL scores: mean global QoL score was 59.96 in younger pts vs. 57.39 in older pts. After 1 month, global QoL of older pts was significantly improved in group B compared to group A: mean change from baseline was -0.89 group A vs. +4.47 group B (p = 0.006, effect size 0.23). There were statistically significant differences in mean changes from baseline, in favor of group B, for role functioning (-5.67 group A and -0.81 group B, p = 0.034, effect size 0.20) and emotional functioning (-2.30 group A and +3.25 group B, p = 0.014, effect size 0.36). Mean changes from baseline for pain were significantly better for group B (-3.25) than group A (+6.03, p = 0.01, effect size 0.43). There were no significant differences between the 2 groups in terms of other functional scales or symptoms. There was no significant heterogeneity in the proportion of QoL responders between younger and older pts (p = 0.60). The proportion of older pts obtaining a clinically significant improvement in global QoL was numerically higher in group B (36.6%) compared to group A (19.1%, p = 0.09). Odds Ratio of obtaining an improvement in global QoL for group B vs group A was 1.73 (95%CI 0.75 – 3.99) in younger pts and 2.44 (95%CI 0.93 – 6.40) in older pts. Conclusions: This secondary analysis shows that the use of PROs in clinical practice, thanks to an active role of nurses and discussion of symptoms with physicians during the visit, is associated, also in older patients receiving active anticancer treatment, with a significant improvement in global QoL.

Assessing quality of life (QoL) of patients and their caregivers on phase I clinical trials.

e23130 Background: Patients on Phase I trials help advance science through their participation but there is a paucity of data regarding QoL of patients and their caregivers. Methods: Phase I trial patients from a single Asian centre were assessed at baseline and at 3 time intervals after treatment initiation with EORTC-core (QLQ-C30) and Comprehensive Score for Financial Toxicity (COST) questionnaires. Caregivers’ QoL were assessed with Zarit-Burden Interview (ZBI). Paired-sample t-tests were used to test for QoL differences at different time intervals. Results: 35 patients have been recruited with 70 individual visits so far. 60% of patients were female, 74% were Chinese. The most common cancer types were gastrointestinal (51.5%) and gynaecological (25.7%). Patients had a median of 3 lines of prior treatment (range: 0-9). QLQ-C30 scores range from 0 to 100, higher scores represent a high level of QoL/functioning. At baseline, the mean global QoL score was 51.9 (range: 16.7-100). The mean physical, role, cognitive, emotional and social functioning scores (FS) were 74.1 64.7, 86.6, 78.8 and 69.5 respectively. Patients were most bothered by fatigue and pain. 65.7% experienced grade 1 or 2 financial toxicities based on COST. There were significant improvements in physical (14.5 +/- 16.7, p < 0.001), cognitive (18.1 +/- 25.0, p = 0.002) and emotional (10.5 +/- 18.4, p = 0.012) FS at baseline and 1-month post treatment. Patients experienced a reduction in fatigue, but no change in pain or financial concerns. Only 28.6% of patients were referred to palliative care medicine. Of 19 caregivers surveyed with ZBI, 10 experienced little/no burden, 8 had mild-moderate levels of burden and 1 reported severe burden. Conclusions: This is the first Asian study reporting QoL of cancer patients and their caregivers in Phase I clinical trials. In this group of heavily pre-treated patients, Phase I options can result in QoL improvement. Two-thirds of caregivers had minimal burden. Identifying QoL issues of patients and their caregivers will improve supportive care rendered to them.

Hippocampal-Avoidance Whole-Brain Radiation Therapy: A New Standard for Patients With Brain Metastases?

The use of whole-brain radiation therapy (WBRT) for brain metastases was first described in the 1950s. Since that time, WBRT has long been considered the treatment of choice, given its wide availability, ease of delivery, and effectiveness in providing palliation for many patients. Numerous phase III trials have also validated its benefit in improving neurologic signs and symptoms for many patients, with median survival times ranging from 3 to 6 months. Because of the poor outcomes for most patients with brain metastases, some physicians developed a nihilistic view of brain metastases and considered the routine use of WBRT as an obvious approach, given the limited treatment options. As a result, the potential toxicities resulting from WBRT were largely dismissed. However, with the many advances in neurosurgery, imaging, medical oncology, and radiation oncology, the outcomes for some patients have greatly improved, particularly for those with favorable prognostic factors. With this improvement in outcomes and the higher expectations of patients and physicians, the routine use of WBRT has been highly scrutinized, considering its potential impact on neurocognitive function (NCF) and quality of life (QOL). As a result, the optimal management of brain metastases remains one of the most controversial areas of oncology, even among experts. Given the improved outcomes for some patients with brain metastases, the impact of WBRT on NCF has recently been an active area of investigation. A comprehensive phase III trial (PCI-P-120-9801) of WBRT versus WBRT plus motexafin gadolinium, a radiation sensitizer, was performed and included a battery of neurocognitive tests. This study of 401 patients demonstrated that the vast majority of patients with brain metastases (90.5%) had some decline in NCF before initiation of treatment. Neurocognitive test scores and global neurocognitive impairment at baseline were correlated with brain tumor volume and also predicted for survival. Further analysis suggested the adverse impact of tumor progression on NCF was greater than the treatment-related effects of WBRT. In addition, recent neurocognitive data from RTOG (Radiation Therapy Oncology Group) 0214, a phase III randomized trial of observation versus prophylactic cranial irradiation (PCI) for patients with non–small-cell lung cancer, have also suggested a negative impact of PCI. In addition to the neurocognitive effects, the impact of WBRT on QOL and functional independence has also been investigated. Although phase III trials of stereotactic radiosurgery (SRS) and WBRT for patients with a limited number of brain metastases ( four) have shown a significant improvement in local and distant brain control with the addition of WBRT to SRS, the decline in Hopkins Verbal Learning Test–Revised (HVLT-R) scores at 4 months and lack of improvement in the duration of functional independence have further decreased the advocacy for WBRT. In addition, the healthrelated QOL (HRQOL) data from the phase III European Organisation for Research and Treatment of Cancer trial of SRS or surgery with or without WBRT have also introduced additional concerns. In this trial, the WBRT arm had a statistically significant detriment in mean global QOL scores at 9 months and also had lower cognitive function at 8 weeks and 1 year; however, this trial did not formally assess patients with a battery of neurocognitive tests and had only a 45% compliance rate at 1 year. On the basis of the results of these studies and the concerns regarding the effects of WBRT on NCF, strategies to mitigate the late effects of WBRT have been actively explored. Omission of WBRT through the use of SRS is emerging as an attractive treatment approach compared with WBRT, given its inherent advantages, including its multidisciplinary approach, single-session outpatient delivery, minimal recovery time, patient convenience, and more rapid initiation of systemic treatments. Technologic advances in treatment delivery and treatment planning have also facilitated the use of SRS alone as the primary treatment for patients with five lesions. Recently, a prospective observational study of SRS alone in 1,194 patients with one to 10 brain metastases suggested no difference in survival or treatment-related adverse events for patients with two to four and five to 10 lesions. To confirm this and other studies, the North American Gamma Knife Consortium will be performing a prospective randomized trial evaluating NCF of SRS versus WBRT for patients with five metastases (ClinicalTrials .gov NCT01731704). Another approach to minimize the neurocognitive effects of WBRT uses memantine, an N-methyl-D-aspartate receptor antagonist, as a potential neuroprotector, which has been used for patients with mild to moderate dementia in Alzheimer’s disease. RTOG 0614 was a double-blind, placebo-controlled phase III trial of WBRT plus memantine versus WBRT plus placebo. This trial randomly assigned 554 patients to WBRT with or without memantine 10 mg initially then JOURNAL OF CLINICAL ONCOLOGY E D I T O R I A L VOLUME 32 NUMBER 34 DECEMBER 1 2014

Prevalence, severity and correlates of fatigue in newly diagnosed patients with myelodysplastic syndromes.

The primary objective of this study was to investigate factors associated with fatigue severity in newly diagnosed patients with higher-risk myelodysplastic syndromes (MDS). The secondary objectives were to assess symptom prevalence and to examine the relationships between fatigue, quality of life (QoL) and overall symptom burden in these patients. The analyses were conducted in 280 higher-risk MDS patients. Pre-treatment patient-reported fatigue was evaluated with the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue scale and QoL was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Female gender (P=0·018), poor performance status (i.e., ECOG of 2-4) (P<0·001) and lower levels of haemoglobin (Hb) (P=0·026) were independently associated with higher fatigue severity. The three most prevalent symptoms were as follows: fatigue (92%), dyspnoea (63%) and pain (55%). Patients with higher levels of fatigue also had greater overall symptom burdens. The mean global QoL scores of patients with the highest versus those with the lowest levels of fatigue were 29·2 [standard deviation (SD), 18·3] and 69·0 (SD, 18·8), respectively and this difference was four times the magnitude of a clinically meaningful difference. Patient-reported fatigue severity revealed the effects of disease burden on overall QoL more accurately than did degree of anaemia. Special attention should be given to the female patients in the management of fatigue.

Standard chemotherapy with or without bevacizumab in advanced ovarian cancer: quality-of-life outcomes from the International Collaboration on Ovarian Neoplasms (ICON7) phase 3 randomised trial

SummaryBackgroundIn the Gynecologic Cancer Intergroup International Collaboration on Ovarian Neoplasms 7 (ICON7) trial, bevacizumab improved progression-free survival in patients with ovarian cancer when used in combination with first-line chemotherapy and as a single-drug continuation treatment for 18 cycles. In a preliminary analysis of a high-risk subset of patients, there was also an improvement in overall survival. This study aims to describe the health-related quality-of-life (QoL) outcomes from ICON7.MethodsICON7 is a randomised, multicentre, open-label phase 3 trial. Between Dec 18, 2006, and Feb 16, 2009, after a surgical procedure aiming to debulk the disease, women with International Federation of Gynecology and Obstetrics (FIGO) high-risk stage I–IV epithelial ovarian cancer were randomly allocated (1:1) by computer program and block randomisation to receive either six cycles of standard chemotherapy (total 18 weeks) with carboplatin (area under the curve 5 or 6) and paclitaxel (175 mg/m2) alone or with bevacizumab (7·5 mg/kg) given intravenously with chemotherapy and continued as a single drug thereafter (total 54 weeks). The primary QoL endpoint was global QoL from the European Organisation for Research and Treatment of Cancer quality-of-life questionnaire–core 30 at week 54, analysed by ANOVA and adjusted for baseline score. Analyses were by intention to treat. The ICON7 trial has completed recruitment and remains in follow-up. This study is registered, number ISRCTN91273375.Findings764 women were randomly assigned to the standard chemotherapy group and 764 to the bevacizumab group. At baseline, 684 (90%) of women in the standard chemotherapy group and 691 (90%) of those in the bevacizumab group had completed QoL questionnaires. At week 54, 502 (66%) women in the bevacizumab group and 388 (51%) women in the standard chemotherapy group provided QoL data. Overall, the mean global QoL score improved during chemotherapy by 7·2 points (SD 24·4) when analysed for all women with data at baseline and week 18. The mean global QoL score at 54 weeks was higher in the standard chemotherapy group than in the bevacizumab group (76·1 [SD 18·2] vs 69·7 [19·1] points; difference 6·4 points, 95% CI 3·7–9·0, p<0·0001).InterpretationBevacizumab continuation treatment seems to be associated with a small but clinically significant decrement in QoL compared with standard treatment for women with ovarian cancer. The trade-off between the prolongation of progression-free survival and the quality of that period of time needs to be considered in clinical practice when making treatment decisions.FundingRoche and the National Institute for Health Research through the UK National Cancer Research Network.

Zeitlicher Verlauf der Lebensqualität nach Prostatakarzinom

Each year more than 60,000 German men are diagnosed with prostate cancer. The incidence nearly doubled in the last 10 years due to intensified use of PSA testing for early detection. To date, either radical prostatectomy or radiotherapy is recommended for treatment of localized prostate cancer. Both strategies have similar survival chances (83-94%), but show different side effects. In view of the good prognosis implications for health-related quality of life (QoL) may play an important role in the therapy decision-making process and should be discussed with patients. Prostate cancer patients were asked twice about oncological health care and QoL (EORTC QLQ-C30, Version 2) as part of the OVIS study conducted in Schleswig-Holstein. The first questioning took place 16 months after the initial diagnosis and the second one at month 42. QoL was compared with German reference data. Logistic regression identified predictors for (a) low QoL at baseline (as indicated by global health status/QoL below the group median) and (b) clinically relevant detriments, defined as a difference of ≥10 points, in the chronological sequence. Prostate cancer patients (n=1,345; median age at diagnosis 66 years) report a mean global QoL score that is higher than that of a healthy German reference sample (difference 6.3). In the temporal course, 56% of patients did not experience a clinically relevant change in QoL (<10 points difference). However, 20% reported a clinically relevant decrease and 24% a clinically relevant increase (≥ 10 points difference) regarding global health status/QoL. Higher age, lower social class, chemotherapy, undesired side effects and long-term complications as well as rehabilitative care predict low QoL at baseline, while progression of the disease and living in an urban surrounding as well as young age at diagnosis predict a decrease of QoL in the chronological sequence. Self-reported QoL of prostate cancer patients depends on various personal and medical factors. Physicians should be aware of these factors and include them in the discussion about the appropriate therapy method with their patients. In general, therapists and family members have problems describing the QoL of their patients and relatives. Assessing the QoL and QoL-influencing factors with a short questionnaire seems to be feasible and may be helpful in the therapy decision-making process.

Whole saliva physico-biochemical changes and quality of life in head and neck cancer patients following conventional radiation therapy: A prospective longitudinal study

We investigated the physico-biochemical changes in saliva and its relation to quality of life (QOL) in head and neck cancer patients following conventional radiation therapy (RT). 53 consecutive head and neck cancer patients underwent conventional RT using telecobalt photons. We analyzed objective sialometry and sialochemical parameters of salivary gland function and a physician reported Oral Assessment Protocol to assess the patients' QOL during (baseline, 3 and 6 weeks) and post RT (3 and 6 months). Statistical analysis was done using SPSS software (version 15.0; SPSS, Inc., Chicago, IL, USA). Stimulated salivary flow rates had shown a consistent decline during and in post-RT analysis (P < 0.001). A significant correlation was seen between mean salivary flow rates at 6 months post-RT and mean salivary electrolytes and amylase levels during the same period (P < 0.001). Mean global QOL scores had significantly worsened during RT and were still significantly poorer at 6 months than initial pre-RT levels (P < 0.001). Further, significant correlation was established between salivary pH values with global QOL scores at 6 months (P = 0.05). Radiation-induced hyposalivation invariably persists and correlates with poor global QOL scores seen during and following conventional RT. Post RT, there is a trend for biochemical reversal toward pre-irradiation levels suggesting a subsiding inflammation or a probable functional recovery.

The prognostic role of quality-of-life assessment in lung cancer.

9096 Background: There is accumulating evidence that various quality of life (QoL) domains provide information on patient longevity independent of known prognostic factors. We investigated whether QoL functional domains and symptom items could identify lung cancer patients at high or low risk of treatment failure. Methods: 1,194 lung cancer patients treated at two single-system cancer centers between Jan 2001 and Dec 2008. QoL was evaluated prior to initiation of treatment using EORTC-QLQ-C30 which incorporates a global, 5 functional and 9 symptom scales. Univariate and multivariate Cox regression analyses evaluated survival. Results: Mean age at presentation was 58.3 years. There were 605 analytic (newly diagnosed) and 589 non-analytic patients (recurrent disease); 601 males and 593 females. Stage of disease at diagnosis was I, 100; II, 63; III, 348; IV, 656; and 27 indeterminate. Median overall survival was 8.8 months (95% CI: 8.0-9.5). Mean global QoL score was 53.8 and 53.1 for locoregional and metastatic disease (p=0.63) and 56.1 and 50.9 for analytic and non-analytic disease (p=0.001). On univariate analysis, QoL scales predictive of survival were physical (p<0.001), role (p<0.001), emotional (p=0.04), cognitive (p=0.003), social (p<0.001), fatigue (p<0.001), nausea/vomiting (p=0.001), pain (p<0.001), dyspnea (p<0.001), loss of appetite (p<0.001), constipation (p=0.001) and diarrhea (p=0.02). Upon multivariate analyses, only physical function (p<0.001), pain (p=0.05) and insomnia (p=0.03) were predictive of survival independent of other QoL scales, age, gender, stage, and treatment history. Higher stage of disease, prior treatment history and male gender predicted worse survival (p <0.001 for all). Physical function, nausea/vomiting, insomnia, and diarrhea (p<0.05 for all) in analytic patients while only physical function (p<0.001) in nonanalytic patients were independently predictive of survival. Conclusions: In newly diagnosed patients, a cluster of symptoms—insomnia, nausea/vomiting and diarrhea—identified patients at high risk for treatment failure. While this symptom cluster was uninformative in patients with recurrent disease, low physical function identified patients at high risk of treatment failure. No significant financial relationships to disclose.

Quality-of-life outcomes of patients with breast cancer in an integrative cancer treatment setting.

1107 Background: There is evidence in the literature to suggest that patients undergoing cancer therapy experience an initial deterioration in their quality of life (QoL). We longitudinally investigated the impact of an integrative care model characterized by conventional cancer treatment in combination with a comprehensive, complementary program on QoL outcomes of patients with breast cancer. Methods: We examined a random sample of 689 breast cancer patients treated at two single-system cancer centers from January 2001 to December 2008 who were available for a minimum follow-up of 3 months. QoL was evaluated using the validated survey instrument European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) at baseline and after 3 months of treatment. The QLQ-C30 provides a global score as well as five functional and nine symptom scores. Higher scores in the global and functional scales and lower scores in the symptom scales indicate better QoL. The mean QoL scores were compared using paired sample t-test. Results: QoL scores for all patients together were well maintained from baseline to 3 months for both global scores (63.6 vs. 61.7, p=0.11) and across scales, excluding emotional functioning (66.6 vs. 71.3, p<0.001) and insomnia (36.7 vs. 32, p=0.003), both of which actually improved at 3 months. There were 257 analytic and 432 non-analytic patients whose mean global QoL scores were 67 and 61.5 at baseline (p=0.005) and 65 and 59.7 at 3 months (p=0.006). There was no significant difference in mean global scores at baseline as compared with 3 months for either analytic or non-analytic patients. Patient's stage of disease at diagnosis was I, 133; II, 282; III, 145; and IV, 85. Mean global QoL scores for locoregional (stages I-III) and metastatic (stage IV) disease patients were 63.4 and 65.2 at baseline (p=0.53) and 61.9 and 59.8 at 3 months (p=0.45); there was no significant difference in mean global scores at baseline as compared with 3 months for either loco-regional or metastatic disease patients. Conclusions: This study suggests that the QoL outcomes of patients with breast cancer are maintained and may even be improved while undergoing therapy in an integrative cancer treatment setting. No significant financial relationships to disclose.

Individual quality of life of people with severe mental disorders

People with mental disorders have been found to suffer from impaired quality of life (QoL). Therefore, the assessment of QoL has become important in psychiatric research. This explorative study was carried out in acute psychiatric wards. Thirty-five patients diagnosed with schizophrenia and related psychosis were interviewed. QoL was rated by the Schedule for Evaluation of Individual Quality of Life which is a respondent-generated QoL measure using semi-structured interview technique. Patients named five areas of life important to them and then rated their current status and placed relative weight on each QoL area. The data were analysed with qualitative content analysis and descriptive statistics. The most frequently named areas for QoL were health, family, leisure activities, work/study and social relationships, which represented 72% of all QoL areas named. Patients' average satisfaction with these QoL areas ranged 49.0-69.1 (scale 0-100). The mean global QoL score was 61.5 (standard deviation 17.4; range 24.6-89.6; scale 0-100). Awareness of patients' perceptions of their QoL areas can enhance our understanding of an individual patient's QoL and reveal unsatisfactory areas where QoL could be improved with individually tailored needs-based interventions.

Quality of life of people with spinal cord injury in Northern India

This is a prospective longitudinal descriptive study to prospectively evaluate quality of life (QoL) in the spinal cord injury (SCI) population in Northern India and identify any association between clinical variables and QoL; and, finally, to see the impact of remedial measures taken to improve QoL over time. Fifty persons with SCI were surveyed for medical problems, neurological status and social adjustments in Northern India. QoL was determined on the Global QoL scale (Visual Analogue Scale) and follow-up assessment was performed 6 months later to examine the impact of remedial measures over time. Thirty-six (72%) men and 14 (28%) women participated. Mean age and duration of injury were 37.7 and 3.7 years, respectively. Bladder problems (44%), bedsores (36%), gastrointestinal problems (56%), neuropathic pain (42%) and spasticity (60%) were the most common medical problems. Age, education, marital status and duration of injury were not associated with significant difference on QoL scores. Female sex, employment, mobility, autonomy, cordial partner relations and good social adjustment were associated with higher scores of QoL. Mean Global QoL scores were 54.3 and 63.7 at the initial survey and at the 6-month follow-up survey, respectively. In a community-based sample of SCI in Northern India, a good-to-fair QoL was found. It is reasonable to believe that understanding and taking appropriate remedial measures through more comprehensive rehabilitation programmes will play a vital role in enhancement of QoL in persons with SCI.

Impaired quality of life in patients commencing radiotherapy for cancer.

This study tested a three-item questionnaire to measure global quality of life (QOL) and pain in patients commencing radiotherapy, based on items from the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 instrument. In a pretest, the EORTC QLQ-C30 and the three-item short questionnaire were administered to 100 patients, yielding similar global QOL and pain scores. After the pretest, the three-item questionnaire was administered to 1,837 patients prior to first radiotherapy treatment. 254 (13.8%) patients with impaired QOL were identified. These patients had a mean global QOL score of 32.6 compared to 72.4 (p < 0.001) found in patients with satisfactory QOL. Patients with impaired QOL were also more likely < 60 years and treated for lung, gastrointestinal or head and neck cancer or advanced, metastatic cancer. This brief questionnaire addresses important aspects of QOL, is feasible to use in a clinical setting and therefore represents a potentially useful tool for detecting those patients who may benefit from further evaluation and/or psychosocial support.

Outcomes and quality of life in conductive hearing loss

Objective: The goal was to measure quality of life (QOL) and hearing-specific functional status before and after treatment of conductive hearing loss (CHL). Study Design and Setting: A prospective, longitudinal, outcomes-based study was performed at an academic medical center. Results: Mean baseline QOL scores in CHL patients were comparable with those of the general population. Audiometric studies indicated significant improvements in hearing threshold in all treated patients. There was no significant improvement in mean global QOL scores after treatment of CHL, although there was little room for improvement over baseline. The hearing-specific instrument did demonstrate significant improvements in emotional and social/situational hearing status after treatment. Patients treated with hearing aids had poorer baseline QOL and hearing status than patients treated with surgery and tended to show declines in QOL and only partial improvement in hearing-specific functional status after treatment. Conclusions: Treatment of CHL resulted in improvements in hearing-specific functional status, although changes were difficult to detect with a global QOL instrument. (Otolaryngol Head Neck Surg 2000;123:527-3.)