Physical Well-being Scores Research Articles

Quality of life among breast cancer survivors treated with breast-conserving therapy in Hawaii.

154 Background: Aim of this study was to compare quality of life (QOL), treatment-related side effects, and needs of recent and long-term breast cancer survivors following breast-conserving therapy. Methods: Surveys were sent to 750 women with Tis, T1 – T4 breast tumors without lymph node involvement who received lumpectomy followed by radiotherapy at a large, tertiary care facility in Hawai‘i from January 2001 to December 2010. To assure adequate representation across years, 75 women were randomly selected from each year. Surveys included demographic items, City of Hope Quality of Life – Breast Cancer Instrument, and Breast Cancer Prevention Trial Symptom Scales. Completed surveys were received from 265 (35.3%) women, and findings were analyzed for long-term survivors (diagnosed from 2001-2003, n=76), mid-range survivors (diagnosed from 2004-2007, n=95), and recent survivors (diagnosed from 2008-2010, n=94). Results: Overall, respondents reported high QOL. Similarly to recent breast cancer survivors, long-term survivors reported slight to moderate side effects, including hot flashes, vaginal problems, musculoskeletal pain, and cognitive dysfunction. After controlling for age, ethnicity, and cancer stage, there was no significant differences in QOL physical, psychological, and social well-being subscale scores across time periods. Long-term survivors were more likely than shorter-term survivors to want information regarding nutrition (p<.01), physical activity (p=.018), and ways to restore strength, mobility, and cognition (p<.01). Conclusions: Breast cancer survivors treated with breast conserving therapy report relatively good QOL between 2 and 12 years post-treatment, although they continued to experience physiological issues (which could be exacerbated by age), and anxieties about their cancer. Healthcare professionals should continually assess for ongoing cancer-related side effects even years after completing treatment. Funding: This research was supported by ‘Imi Hale Native Hawaian Cancer Network (U54 CA153459).

Health-related Quality of Life, Fatigue, and Posttraumatic Growth of Cancer Patients Undergoing Radiation Therapy: A Longitudinal Study

The purpose of this study was to determine health-related quality of life (HRQoL), fatigue, and posttraumatic growth (PTG) among patients with breast or prostate cancer during and following radiation therapy (RT). A total of 91 patients completed measures at three time points as follows: one or two weeks before the start of RT, in the fifth/sixth week of treatment, and four to six weeks post-treatment. Consistent with the previous literature, the results of this study revealed that RT was associated with declines in global HRQoL, Physical Well-being, Social/Family Well-being, and Functional Well-being, as well as an increase in fatigue. By four to six weeks post-treatment, these factors improved significantly and returned to baseline levels with the exception of Social/Family Well-being. The PTG total score and almost all of its subscale scores did not change significantly during the period of the study. However, the subscale of Spiritual Change for PTG significantly increased during the RT, and sustained this improvement at four to six weeks post-treatment. A significant negative correlation was found between Physical Well-being and PTG total score, whereas a significant positive correlation was revealed between Social/Family Well-being and PTG total score. The results from this analysis suggest that a significant decrease in HRQoL is evident in the fifth/sixth week of RT treatment. However, recovery of HRQoL occurs as quickly as a few weeks after the end of treatment. Moreover, patients with high ratings of Social/Family Well-being experience more positive psychological changes (PTG) resulting from the cancer experience.

AB0212 A study to determine the relationship between fatigue, physical activity and sitting time in patients with inflammatory arthritis.

BackgroundFatigue is a common and debilitating symptom in inflammatory arthritis. Higher levels of physical activity are associated with better general health status and with better outcomes in inflammatory arthritis [1].ObjectivesOur...

Admission to the Intensive Care Unit and Well-being in Patients With Advanced Chronic Illness

To describe the association of intensive care with trajectories of functional, emotional, social, and physical well-being in patients with 3 common advanced illnesses. Cross-sectional cohort study of 42 patients admitted to the intensive care unit selected from 210 patients with stage IV breast, prostate, or colon cancer or stage IIIb or IV lung cancer; New York Heart Association class III or IV congestive heart failure; and chronic obstructive pulmonary disease with hypercapnea (Pco2 > 46 mm Hg). Scores on subscales of the Functional Assessment of Chronic Illness Therapy-General survey were measured monthly for 6 months before and after admission to the intensive care unit and were analyzed by using the unit admission date as a point of discontinuous change to illustrate trajectories before and after the admission. Overall, trajectories of well-being declined sharply after admission to the intensive care unit. Declines in physical, functional, and emotional well-being were statistically significant. During the 6 months after admission, physical, functional, and emotional well-being scores trended back up to baseline while social well-being scores continued to decline. Well-being trajectories declined sharply after admission to the intensive care unit, with recovery in the subsequent 6 months, and may be characterized by common patterns. These results help to better describe intensive care as a marker for advancing illness in patients with advanced chronic illness.

Associations between active commuting and physical and mental wellbeing

ObjectiveTo examine whether a relationship exists between active commuting and physical and mental wellbeing. MethodIn 2009, cross-sectional postal questionnaire data were collected from a sample of working adults (aged 16 and over) in the Commuting and Health in Cambridge study. Travel behaviour and physical activity were ascertained using the Recent Physical Activity Questionnaire (RPAQ) and a seven-day travel-to-work recall instrument from which weekly time spent in active commuting (walking and cycling) was derived. Physical and mental wellbeing were assessed using the Medical Outcomes Study Short Form survey (SF-8). Associations were tested using multivariable linear regression. ResultsAn association was observed between physical wellbeing (PCS-8) score and time spent in active commuting after adjustment for other physical activity (adjusted regression coefficients 0.48, 0.79 and 1.21 for 30–149min/week, 150–224min/week and ≥225min/week respectively versus <30min/week, p=0.01 for trend; n=989). No such relationship was found for mental wellbeing (MCS-8) (p=0.52). ConclusionGreater time spent actively commuting is associated with higher levels of physical wellbeing. Longitudinal studies should examine the contribution of changing levels of active commuting and other forms of physical activity to overall health and wellbeing.

Mapping the FACT-G cancer-specific quality of life instrument to the EQ-5D and SF-6D

ObjectiveTo help facilitate economic evaluations of oncology treatments, we mapped responses on cancer-specific instrument to generic preference-based measures.MethodsCancer patients (n = 367) completed one cancer-specific instrument, the FACT-G, and two preference-based measures, the EQ-5D and SF-6D. Responses were randomly divided to form development (n = 184) and cross-validation (n = 183) samples. Relationships between the instruments were estimated using ordinary least squares (OLS), generalized linear models (GLM), and censored least absolute deviations (CLAD) regression approaches. The performance of each model was assessed in terms of how well the responses to the cancer-specific instrument predicted EQ-5D and SF-6D utilities using mean absolute error (MAE) and root mean squared error (RMSE).ResultsPhysical, functional, and emotional well-being domain scores of the FACT-G best explained the EQ-5D and SF-6D. In terms of accuracy of prediction as measured in RMSE, the CLAD model performed best for the EQ-5D (RMSE = 0.095) whereas the GLM model performed best for the SF-6D (RMSE = 0.061). The GLM predicted SF-6D scores matched the observed values more closely than the CLAD and OLS.ConclusionOur results demonstrate that the estimation of both EQ-5D and SF-6D utility indices using the FACT-G responses can be achieved. The CLAD model for the EQ-5D and the GLM model for the SF-6D are recommended. Thus, it is possible to estimate quality-adjusted life years for economic evaluation from studies where only cancer-specific instrument have been administered.

Chlorella intake attenuates reduced salivary SIgA secretion in kendotraining camp participants

BackgroundThe green alga Chlorella contains high levels of proteins, vitamins, and minerals. We previously reported that a chlorella-derived multicomponent supplement increased the secretion rate of salivary secretory immunoglobulin A (SIgA) in humans. Here, we investigated whether intake of this chlorella-derived supplement attenuated the reduced salivary SIgA secretion rate during a kendo training camp.MethodsTen female kendo athletes participated in inter-university 6-day spring and 4-day summer camps. They were randomized into two groups; one took placebo tablets during the spring camp and chlorella tablets during the summer camp, while the other took chlorella tablets during the spring camp and placebo tablets during the summer camp. Subjects took these tablets starting 4 weeks before the camp until post-camp saliva sampling. Salivary SIgA concentrations were measured by ELISA.ResultsAll subjects participated in nearly all training programs, and body-mass changes and subjective physical well-being scores during the camps were comparable between the groups. However, salivary SIgA secretion rate changes were different between these groups. Salivary SIgA secretion rates decreased during the camp in the placebo group (before vs. second, middle, and final day of camp, and after the camp: 146 ± 89 vs. 87 ± 56, 70 ± 45, 94 ± 58, and 116 ± 71 μg/min), whereas no such decreases were observed in the chlorella group (121 ± 53 vs. 113 ± 68, 98 ± 69,115 ± 80, and 128 ± 59 μg/min).ConclusionOur results suggest that a use of a chlorella-derived dietary supplement attenuates reduced salivary SIgA secretion during a training camp for a competitive sport.

Use of the Functional Assessment of Cancer Therapy-Anemia (FACT-An) Instrument in Persons with MPN-Associated Myelofibrosis and Anemia

AbstractAbstract 4706 Background.Myeloproliferative neoplasm (MPN)-associated myelofibrosis is characterized by anemia in almost all affected persons. The Functional Assessment of Cancer Therapy (FACT) measurement system is a patient-reported outcome (PRO) developed to document symptoms to diverse aspects of cancer treatment. One FACT version, FACT-An, specifically addresses symptoms of anemia related to cancer- therapy. FACT-An has been validated in diverse cancer populations but not in MPN-associated myelofibrosis. Methods.Data were from a phase-2 randomized double-blind Bayesian “pick-the-winner” trial of pomalidomide and prednisone in subjects with MPN-associated myelofibrosis and anemia (including RBC-transfusion-dependence). Details of the study, including definitions of anemia, response, RBC-transfusion-dependence and –independence were published previously. Change in quality of life (QOL) from randomization to the last cycle of therapy was evaluated by using the FACT-An physical well-being (PWB), functional well-being (FWB), trial outcome index (TOI) and anemia (An) domains. Minimally clinically important differences (MID) were used to determine the smallest difference in scores which subjects perceived as beneficial in the FACT-An domains of interest. Subjects were classified as meeting MID for responsiveness if their change score from baseline was greater than one standard error of measurement (SEM), indicating improvement. Results.85 subjects were studied. All FACT-An domains showed strong reliability as measured by Cronbach's alpha. 31 were classified as anemia responders by clinical and laboratory criteria. Anemia responders showed greater improvement in PWB, FWB and TOI scores than non-responders (TOI presented below) across all FACT-An domains. Improvement began at the 2nd 28 d cycle of therapy and was sustained.Reliability and SEM for FACT-An subscale scores.FACT-An Domain ScoreCronbach AlphaSEMPWB0.772.31FWB0.872.31An0.924.16TOI0.955.10FACT-An TOI Score: Frequency and Percent Subjects Meeting MID by Responder Group and Cycle.Responders (N=29)Non-Responders (N=39)VisitFrequencyPercentFrequencyPercentC2D2918621949C3D5720691436C6D1411552615C9D225186238C12D309103525 Conclusion.We show anemia response defined by IWG-MRT criteria correlates with improved QOL measured by the FACT-An instrument in persons with MPN-associated myelofibrosis. Disclosures:Tencer:Celgene Corporation: Employment. Gale:Celgene Corporation: Employment. Khan:Celgene: Employment.

Baseline quality of life and performance status as prognostic factors in patients with extensive-stage disease small cell lung cancer treated with pemetrexed plus carboplatin vs. etoposide plus carboplatin

BackgroundSmall cell lung cancer (SCLC) is associated with poor prognosis due to its early metastatic potential and lack of improved outcomes with newer cytotoxic agents. Identifying factors associated with clinical outcomes can help clinicians determine which patients are more likely to benefit from therapy. Functional Assessment of Cancer Therapy (FACT) subscales and Eastern Cooperative Oncology Group performance status (ECOG PS) were retrospectively analyzed as prognostic factors for overall survival (OS) and progression-free survival (PFS) in patients with extensive-stage disease (ED)-SCLC. MethodsUsing data from a Phase III trial of pemetrexed–carboplatin vs. etoposide–carboplatin, the effect of the prognostic factors on OS and PFS was analyzed via Cox models. The Kaplan–Meier method was used to estimate OS and PFS parameters for the prognostic subgroups (defined by baseline FACT scores and ECOG PS). ResultsPatients with higher baseline FACT-General (FACT-G) score (≥median) had significantly higher OS (hazard ratio [HR]=0.62, P<.0001) and PFS (HR=0.83, P=.032) compared with patients with lower FACT-G score (<median). Similar results were observed for higher baseline physical well-being (PWB) and functional well-being (FWB) scores. For OS, there was a significant interaction between PS and FACT-PWB score (P=.005). In patients with PS=2 and higher FACT-PWB scores at baseline, a 48% reduction in the risk of death (P=.025) and nearly 3-month longer median OS were estimated. ConclusionsHigher baseline FACT-G, FACT-PWB, and FACT-FWB scores were found to be favorable prognostic factors for survival in ED-SCLC. Higher FACT-PWB scores at baseline predicted better survival for patients with poorer PS.

695P - Quality of Life in Flags Trial a Randomized, Comparative, Open Label, Multicenter, Phase 3 of S-1 + Cisplatin (CS) Compared to 5-Fu + Cisplatin (CF) in Untreated advanced Gastric Cancer (AGC) Patients

ABSTRACT Background FLAGS' primary objective was overall survival. We report below the Patient-Reported Outcomes (PRO) (i.e., Quality-of-Life [QoL]) which was one of the secondary objectives. Methods All patients who completed at least one PRO assessment were eligible for analysis. The primary PRO endpoint was the Trial Outcome Index (TOI) of the Functional Assessment of Cancer Therapy – Gastric (FACT-Ga). Patients completed the FACT-Ga at the beginning of Cycles 1, 2, 3, 4, 6 and then every 3 cycles prior to treatment administration. All individual subscales in the FACT-Ga were also evaluated as secondary endpoints. The Chemotherapy Convenience and Satisfaction Questionnaire (CCSQ) was administered at the beginning of the first 4 cycles. Results Of the 508 patients dosed at cycle 1 in the CF arm, and the 521 in the CS arm, 456 and 498 respectively completed at least one question on the FACT-Ga and 445 and 486 respectively completed at least 37 items. Compliance to questionnaire fulfillment was more than 80% through Cycle 9. Although there were no overall difference in FACT-Ga scores between the treatment arms and minimal changes over time, an advantage for CS relative to CF was observed for Physical Well-Being (PWB) (51.7% versus 45.1%, p = 0.044). CS treated patients experienced significantly longer time to worsening in PWB scores, with a median time of 4.5 months (95% CI: 3.0 – 5.1) compared to 3.0 months (2.8 – 4.6) with CF (p = 0.014).Patients receiving CS reported higher best and worst score of PWB, Chemotherapy Convenience and Chemotherapy Concerns scores. Conclusions Even if there is little evidence to indicate any difference in FACT-Ga scores, some advantage to CS relative to CF was observed for PWB, one of the secondary PRO endpoints. This advantage was generally consistent across analysis method: time to worsening, best post-baseline score, and worst post-baseline score. CS treated patients did report significantly better Chemotherapy Convenience and Concerns scores, the difference was approximately one-half of a standard deviation generally considered to be a meaningful difference. Disclosure All authors have declared no conflicts of interest.

Differences in depression, anxiety, and quality of life between women with and without breast pain prior to breast cancer surgery

Purpose of the researchLittle is known about the relationships between pain, anxiety, and depression in women prior to breast cancer surgery. The purpose of this study was to evaluate for differences in anxiety, depression, and quality of life (QOL) in women who did and did not report the occurrence of breast pain prior to breast cancer surgery. We hypothesized that women with pain would report higher levels of anxiety and depression as well as poorer QOL than women without pain. Methods and sampleA total of 390 women completed self-report measures of pain, anxiety depression, and QOL prior to surgery. Key resultsWomen with preoperative breast pain (28%) were significantly younger, had a lower functional status score, were more likely to be Non-white and to have gone through menopause. Over 37% of the sample reported clinically meaningful levels of depressive symptoms. Almost 70% of the sample reported clinically meaningful levels of anxiety. Patients with preoperative breast pain reported significantly higher depression scores and significantly lower physical well-being scores. No between group differences were found for patients' ratings of state and trait anxiety or total QOL scores. ConclusionsOur a priori hypotheses were only partially supported. Findings from this study suggest that, regardless of pain status, anxiety and depression are common problems in women prior to breast cancer surgery.

Quality of Life of Head and Neck Cancer Patients in Ghana

Objective: 1) Investigate quality of life (QOL) of patients undergoing radiation therapy for head and neck cancer at KATH hospital in Ghana. 2) Compare QOL of these patients with a healthy Ghanaian population. 3) Compare QOL for Ghanian patients with QOL of head and neck cancer patients in the United States. Method: Data collection is ongoing. We anticipate inclusion of 30 Ghanaian head and neck cancer patients, and 30 healthy Ghanaian controls. Participants complete the FACT-H+N QOL Question-naire. Data for patients in the United States are obtained from the FACIT database. Outcome measures include means, medians, standard deviations, and analysis of variance. Results: Preliminary results demonstrate lower QOL scores among Ghanaian patients undergoing treatment compared with healthy controls (94.5 vs 111). Patients undergoing treatment also have lower scores for physical well-being (22.5 vs 26.4), functional well-being (14 vs 18.5), and head and neck–specific symptoms (20.5 vs 36.4). Ghanaians undergoing treatment had higher scores for emotional well-being compared with healthy Ghanaians (22 vs 16.1). Initial comparison of the Ghanaian and American treatment groups revealed similar scores for physical well-being (22.5 vs 18.9) and functional impairment (14 vs 15.3). However, the Ghanaian patients had higher scores for emotional well-being (22 vs 16.8). Conclusion: QOL of Ghanaian head and neck cancer patients is significantly worse than healthy controls. Patients are most affected by physical and functional impairments. Emotional well-being is not worse for Ghanaians undergoing treatment. Ghanaian patients are similar to Americans in physical and functional well-being. However, Ghanaian patients demonstrate greater sense of emotional well-being.

Effects of self‐directed stress management training and home‐based exercise on quality of life in cancer patients receiving chemotherapy: a randomized controlled trial

Research has shown that self-directed stress management training improves mental well-being in patients undergoing chemotherapy. The present study extends this work by evaluating separate and combined effects of stress management training and home-based exercise. Following assessment of mental and physical well-being, depression, anxiety, exercise, and stress reduction activity before chemotherapy started, patients were randomized to stress management training (SM), exercise (EX), combined stress management and exercise (SMEX), or usual care only (UCO). Outcomes were reassessed 6 and 12 weeks after chemotherapy started. Significance testing of group-by-time interactions in 286 patients who completed all assessments was used to evaluate intervention efficacy. Interaction effects for mental and physical well-being scores were not significant. Depression scores yielded a linear interaction comparing UCO and SMEX (p = 0.019), with decreases in SMEX but not UCO. Anxiety scores yielded a quadratic interaction comparing UCO and SMEX (p = 0.049), with trends for changes in SMEX but not UCO. Additional analyses yielded quadratic interactions for exercise activity comparing UCO and SMEX (p = 0.022), with positive changes in SMEX but not UCO, and for stress management activity comparing UCO and SM (p < 0.001) and UCO and SMEX (p = 0.013), with positive changes in SM and SMEX but not UCO. Only the combined intervention yielded effects on quality of life outcomes, and these were limited to anxiety and depression. These findings are consistent with evidence that only the combined intervention yielded increases in both exercise and stress management activity. Future research should investigate ways to augment this intervention to enhance its benefits.

Ginseng and Ganoderma lucidum Use after Breast Cancer Diagnosis and Quality of Life: A Report from the Shanghai Breast Cancer Survival Study

ObjectiveTo evaluate associations between quality of life (QOL) and use of ginseng and Ganoderma lucidum (G. lucidum) among breast cancer survivors.MethodsIncluded in this study were 4,149 women with breast cancer who participated in the Shanghai Breast Cancer Survival Study. Ginseng use was assessed at 6-, 18-, and 36-month post-diagnosis surveys; G. lucidum use was assessed at the 6- and 36-month surveys. QOL was evaluated at the 6- and 36-month surveys. Multiple linear regression models were used to examine associations between ginseng and G.lucidum use and QOL assessed at the 36-month survey, with adjustment for potential confounders and baseline QOL.ResultsAt 6 months post-diagnosis, 14.2% of participants reported regular use of ginseng and 58.8% reported use of G. lucidum. We found no significant associations between ginseng use at 6, 18, and 36 months post-diagnosis and participants’ total QOL score or individual scores for psychological, physical, or social well-being. Post-diagnosis G. lucidum use was positively associated with social well-being (adjusted mean difference: 1.26; 95% CI: 0.66, 1.86), but was inversely associated with physical well-being (adjusted mean difference: −1.16; 95% CI: −1.86, −0.47) with a dose-response pattern observed for cumulative number of times of use (P for trend <0.001 for both).ConclusionWe found no evidence that post-diagnosis ginseng use improved the QOL of breast cancer survivors. Post-diagnosis G. lucidum use was associated with better social well-being scores, but poorer physical well-being scores.

Improved health status with insulin degludec compared with insulin glargine in people with Type 1 diabetes

AimsThe efficacy and safety of insulin degludec (degludec), a new-generation ultra-long-acting basal insulin, was compared with insulin glargine (glargine) in people with Type 1 diabetes mellitus in a 16-week, open-label, randomized trial. Health status, an important aspect of effective diabetes management, was also assessed.MethodsDegludec (n = 59) or glargine (n = 59) were injected once daily, with insulin aspart at mealtimes. Health status assessment utilized the validated Short Form 36 Health Survey, version 2, which has two summary component scores for mental and physical well-being, each comprising four domains.ResultsAt study end, HbA1c reductions were comparable between groups, but confirmed nocturnal hypoglycaemia was significantly less frequent with degludec [relative rate 0.42 (95% CI 0.25–0.69)], and overall hypoglycaemia numerically less frequent [relative rate 0.72 (95% CI 0.52–1.00)]. After 16 weeks, a significant improvement in Short Form 36 Health Survey mental component score of +3.01 (95% CI 0.32–5.70) was obtained for degludec against glargine, attributable to significant differences in the social functioning [+8.04 (95% CI 1.89–14.18)] and mental health domains [+2.46 (95% CI 0.10–4.82)]. For mental component score, Cohen’s effect size was 0.42, indicating a small-to-medium clinically meaningful difference. The physical component score [+0.66 (95% CI –2.30 to 3.62)] and remaining domains were not significantly different between degludec and glargine.ConclusionsIn the context of comparable overall glycaemic control with glargine, degludec improved mental well-being as measured using the mental component score of the Short Form 36 Health Survey. The improvements in overall mental component score and the underlying social functioning and mental health domains with degludec compared with glargine may relate to the observed reduction in hypoglycaemic events.

Validación de la versión española del Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer (FACT-B+4)

To evaluate the acceptability, reliability, validity, and sensitivity to change of the Spanish version of the FACT-B+4 questionnaire, designed to assess the health related quality of life (HRQL) in breast cancer.Prospective study with 2 samples: patients with incident breast cancer (n=104) evaluated before and after surgery; and patients with chronic lymphedema of the upper extremity (n=30), evaluated twice in 7days. HRQL was assessed using the generic instrument SF-36 and the specific one FACT-B+4.Reliability coefficients were ≥ 0.7 for most scores. The Physical wellbeing, Breast Cancer, Arm and TOI scores discriminated between patients with and without chemotherapy (p<0.05), while the Arm scale discriminated between patients with and without axillary surgery (p<0.001). In the worsening sub-sample, the FACT-B+4 detected changes in Physical, Emotional and Functional Wellbeing, and TOI scores.The metric characteristics of the Spanish version of the FACT-B+4 are similar to the original questionnaire and support its equivalence, documenting its suitability for use in our country or in international studies.

Associations among baseline variables, treatment-related factors and health-related quality of life 2 years after breast cancer surgery

Provision of social support and rehabilitation for patients with physical, mental, and functional problems after cancer treatment is important for long-term health-related quality of life (HRQOL). Effective use of human and financial healthcare resources requires identification of patients requiring rehabilitation. The objectives of the current study were to clarify the patterns of physical and psychosocial recovery over time, to evaluate the associations among baseline variables, treatment-related factors and HRQOL at 6 months, 1, and 2 years after breast cancer surgery, and to identify the significant factors predicting HRQOL at each point. A multicenter longitudinal study was performed to evaluate physical conditions, anxiety, depression, and HRQOL at 1 month (baseline), 6 months, 1, and 2 years after surgery in 196 patients (mean age: 53.3 years old) with early breast cancer and no postoperative recurrence. Physical conditions were evaluated using a patient-reported symptom checklist. HRQOL was rated using the functional assessment of cancer treatment scale-general (FACT-G) and the breast cancer subscale (FACT-B). Anxiety and depression were rated using the hospital anxiety and depression scale (HADS). More than 50% of patients had local problems of "tightness", "arm weakness." and "arm lymphedema", and systemic problems of "reduced energy, fatigue, and general weakness" postoperatively. The HRQOL score significantly improved 1 year after surgery, and scores for physical, emotional and functional well-being also increased with time, whereas the score for social well-being was the highest at baseline and decreased with time. Depression and anxiety significantly improved with time. Concomitant disease, marital status, and the presence of a partner, anxiety and depression at baseline, pathological lymph node involvement, and adjuvant intravenous chemotherapy were significant factors predicting FACT-G scores at 6 months, 1, and 2 years after surgery. Depression at baseline was a strong predictor of HRQOL up to 2 years after surgery. These results suggest that physical rehabilitation is required for tightness and lymphedema to improve long-term postoperative physical function. A further study of psychosocial interventions is required to improve depression and social well-being after breast cancer surgery.

Does Intrathecal Morphine Sulfate Provide Preemptive Analgesia for Patients Undergoing Stapled Hemorrhoidopexy?

Surgical excision of hemorrhoids is characterized by a prolonged and painful postoperative course. This double-blind, randomized, prospective, controlled trial was conducted to determine if morphine sulfate provides additional pain relief after stapled hemorrhoidopexy when added to a standard lidocaine spinal anesthetic. It was hypothesized that the addition of morphine sulfate to a spinal anesthetic would decrease postoperative pain. Thirty-four patients were randomized prospectively to receive a spinal block with either lidocaine or lidocaine plus morphine sulfate. Patients were followed postoperatively for 42 days to record Numeric Pain Scale (NPS) values and to record analgesic use. Patients also filled out a Short Form 36 (SF-36) Health Survey Questionnaire preoperatively and at days 3, 14, and 28 after their operation to assess physical and mental well-being. Longitudinal mixed models were used to determine whether there was a difference in maximum pain, average pain, narcotic analgesic use, and physical or mental well-being over time. No group differences were found in maximum or average NPS, analgesic use, mental well-being, or time to complete pain relief. There was a four-point difference in mean scores for physical well-being, favoring the lidocaine plus morphine group. This study provides evidence that intrathecal morphine sulfate does not significantly alter postoperative pain, narcotic use, or well-being when used as preemptive analgesia for patients undergoing stapled hemorrhoidopexy.

Validation of pediatric Functional Assessment of Cancer Therapy: patient version 2 of “brain tumor survivor” for grade school patients aged 7–12 years

We evaluated the reliability and validity of the Pediatric Functional Assessment of Cancer Therapy-Childhood Brain Tumor Survivor version 2.0 (pedsFACT-BrS; patient version for grade school children aged 7-12 years). After translating and cross-culturally adapting it into Korean, the psychometric properties of the pedsFACT-BrS were evaluated in 148 childhood brain tumor survivors (mean age, 9.67 years). Pre-testing was performed in 25 patients. The pedsFACT-BrS showed good symptom coverage and overall user comprehension. Internal consistency was acceptable, with Cronbach's α coefficients ranging from 0.70 to 0.92. The pedsFACT-BrS also demonstrated good convergent and divergent validities when correlated with the Revised Children's Manifest Anxiety Scale and Kovacs' Children's Depression Scale. The pedsFACT-BrS showed good known-group validity and effectively differentiated between clinically distinct patient groups (patient vs. control groups, and among patients having different Karnofsky scores), but offered only partial discrimination of physical well-being (PWB) scores when patients were grouped by treatment type. Our results indicate that this instrument is reliable and valid and can be used to evaluate the quality of life of Korean childhood brain tumor survivors.

Exploring the relationship between physical well‐being and healthy lifestyle changes among European‐ and Latina‐American breast and cervical cancer survivors

Cancer and its treatments have a lingering and often negative impact on survivors' physical well-being. The physical sequelae impinge on daily functioning and overall HRQOL, and perhaps influence lifestyle changes post-cancer. This study aims to examine: (1) physical well-being items that are associated with low overall health-related quality of life; and (2) the relationship between physical well-being outcomes and healthy lifestyle changes by cancer type. This study employed a cross-sectional design with mixed sampling methods. In total 922 European- (n=452) and Latina-American (n=470) breast (BCS) or cervical cancer survivors (CCS) were recruited from the California Cancer Surveillance Program and Los Angeles area hospital registries. Item responses from survivors in the lowest quartile of total quality of life scores and percentages reflecting low physical well-being levels were calculated. A statistical approach to individual items provides unique and valuable measurement and clinical information above and beyond physical well-being total scores. Physical well-being item responses varied according to ethnicity, income, and education. BCS and CCS showed different patterns in the relationship between physical well-being items and lifestyle changes. Specifically, exercise was significantly related to physical well-being items for BCS, while diet changes were significantly associated with physical well-being for CCS. Results reveal unique correlates of physical well-being items by cancer type, ethnicity, and lifestyle changes. Clinically, this study highlights the need for greater consideration of individual and medical characteristics in developing culturally sensitive and patient responsive interventions to promote healthy lifestyles and improve survivorship outcomes.