Physical Well-being Scores Research Articles

Real-world health-related quality of life and caregiver need in patients with metastatic hormone-sensitive and metastatic castration-resistant prostate cancer.

54 Background: Prostate cancer (PC) is one of the most common cancers in men. When making treatment decisions, patient health-related quality of life (HRQoL) and caregiver need are important considerations, and as such it is imperative to understand the impact that PC has on HRQoL. We aimed to assess the impact of metastatic hormone-sensitive PC (mHSPC) and castration-resistant PC (mCRPC) on HRQoL and associated caregiver need. Methods: Real-world data were drawn from the PC Disease Specific Programme, a point-in-time survey conducted in the United States of America and Europe (France, Germany, Italy, Spain and the United Kingdom) between Jan-Aug 2020. Physicians completed patient record forms for their next 8 consecutively consulting adult metastatic PC patients (4 mHSPC/4 mCRPC). Eligible patients were invited to complete a voluntary patient self-reported form on caregiver need and HRQoL including EuroQol 5-dimension 5-level (EQ-5D-5L), EuroQol Visual Analogue Scale (EQ-VAS), Functional Assessment of Cancer Therapy – General/Prostate (FACT-G/P) and Brief Pain Inventory (BPI) questionnaires. Higher scores indicate better HRQoL and more pain. Data were analysed descriptively. Results: 376 mHSPC and 331 mCRPC patients completed patient self-reported forms. Demographics and clinical characteristics for mHSPC/mCRPC patients were: mean age 71.1/71.5 years, 77%/69% of patients had an ECOG performance status of 0-1, 82%/83% of patients were retired and 42%/44% of patients had a caregiver. At data collection, mean HRQoL scores for mHSPC/mCRPC patients were: 66.4/63.4 (EQ-VAS), 0.76/0.72 (EQ-5D-5L), 66.2/62.9 (FACT-G) and 94.6/90.2 (FACT-P). Patients with mHSPC had FACT-P social, emotional, functional and physical well-being subscale scores of 18.2, 14.7, 13.6 and 19.7, respectively. These scores were 17.7, 14.0, 12.7 and 18.5 in mCRPC patients, respectively. Mean “worst pain” scores were mild (3.6/3.9 on BPI for mHSPC/mCRPC patients). In terms of both non-professional and professional caregivers, mHSPC/mCRPC patients reported a mean of 31.6/28.9 care hours/week. Most caregivers were partners/spouses (in 89% of mHSPC and 82% of mCRPC patients) providing a mean of 29.0 and 27.7 care hours/week, respectively. Conclusions: We showed that HRQoL and well-being are impacted in both mHSPC and mCRPC patients, and that there is a considerable time burden on caregivers. Patients with mCRPC reported the lowest HRQoL scores and highest pain scores, suggesting that patients who are sicker may have greater disease burden. Our findings suggest an unmet need for HRQoL in patients with mHSPC and mCRPC, and also a need for greater caregiver support in these patients.

Abstract P3-18-06: Satisfaction and physical wellbeing after breast conserving therapy: Clinical predictors and reference values using the BREAST-Q

Abstract Background: BREAST-Q is a widely accepted patient reported outcome measure (PROM) for breast surgery patients. BREAST-Q has been challenging to implement for clinical practice, due to insufficient understanding of clinical factors influencing BREAST-Q scores and lack of reference values for score interpretation. As a result, the clinical applicability of the BREAST-Q is limited, and benefits of routine PROM implementation on care quality have not been realized for breast surgery patients. This study finds predictors impacting long-term scores for the BREAST-Q Breast Conserving Therapy (BCT) module and determines reference values to guide score interpretation in clinical practice. Methods: A retrospective review of BCT patients at Memorial Sloan Kettering Cancer Center was conducted. All patients completed at least one BREAST-Q in 2018-2020. Patient characteristics were collected, including age, BMI, race, smoking status, chemotherapy, radiation therapy (RT), and axillary surgery (sentinel lymph node biopsy, axillary lymph node dissection). BREAST-Q was collected routinely during clinical visits as part of standard of care. Linear regression measured the impact of patient characteristics on 1 year and 2 year BREAST-Q scores. Median scores at baseline and 2 weeks, 6 months, 1 year, and 2 years after surgery were determined for RT and No RT patients. Pearson’s Chi-square and Student t-tests were used for categorical and continuous variables, respectively. Based on prior literature, a minimal clinically important difference of 4 points was used (scale 0-100). Results: 1866 BCT patients were included. Average age was 58.9(11.4) with BMI of 27.9(6.4). Patients were primarily white (76.8%) and non-smokers (89.7%); 36.8% had chemotherapy, 74.7% had axillary surgery, and 73.3% had RT. Regression analysis showed age and race as significant predictors of Satisfaction with Breast and Physical Wellbeing scores (Table 1). RT was a clinically significant predictor for Physical Wellbeing, reducing scores by 4.5 points at 1 year and 4.6 points at 2 years. Reference values were then created for RT and No RT patients. (Table 2). Conclusions: This study found factors impacting satisfaction and physical wellbeing after BCT using BREAST-Q scores of a longitudinal cohort of women and presented references values for score interpretation. Separate reference values were created based on RT as it is a significant predictor of BREAST-Q scores and omission of RT is increasingly offered to older women with low-risk breast cancer, given no survival benefit. These reference values can be incorporated into a user-friendly application or integrated into electronic medical records to help patients and physicians interpret BREAST-Q scores in a clinically meaningful way. Future research should assess the impact of early interventions targeting BCT patients below the 25th percentile (e.g. referrals to plastic surgeons or physical therapy) on BREAST-Q scores. Table 1.Multivariate analysis of BREAST-Q score predictors at 1 year and 2 years after surgerySatisfaction with BreastPhysical Wellbeing1 year2 year1 year2 yearScore changeSEp-valueScore changeSEp-valueScore changeSEp-valueScore changeSEp-valueAge0.1533.907p=0.0020.1280.068p=0.0610.2800.041p < 0.0010.2930.054p < 0.001BMI0.0190.0483p=0.821-0.2200.119p=0.065-0.0120.073p=0.867-0.1380.093p=0.141RaceWhiteReference--Reference--Reference--Reference--Black-7.3462.018p < 0.001-11.4652.876p < 0.001-7.4821.748p < 0.001-6.6512.259p=0.003Asian-1.4631.936p=0.450-1.5842.842p=0.578-2.2221.677p=0.185-0.3472.248p=0.878Other-3.7162.998p=0.2150.7904.451p=0.859-7.4672.575p=0.004-4.1963.495p=0.230Unknown1.4962.804p=0.5946.2213.914p=0.1120.2342.410p=0.923-1.9253.074p=0.531Smoking StatusNeverReference--Reference--Reference--Reference--Previous-1.2161.174p=0.300-1.4221.603p=0.375-1.5821.013p=0.119-1.0301.259p=0.414Current-1.7752.584p=0.492-3.3293.946p=0.399-3.8962.238p=0.082-8.0853.099p=0.009Unknown6.7652.384p=0.0059.4784.054p=0.1120.7612.064p=0.7136.1623.183p=0.531ChemotherapyNoReference--Reference--Reference--Reference--Yes-0.7401.148p=0.5190.3961.603p=0.805-3.3750.993p < 0.001-1.8101.262p=0.152Radiation TherapyNoReference--Reference--Reference--Reference--Yes-0.8961.293p=0.488-2.8961.830p=0.114-4.4951.118p < 0.001-4.6431.435p=0.001Axillary SurgeryNoReference--Reference--Reference--Reference--Yes-0.3581.319p=0.786-1.8711.948p=0.337-3.9091.140p < 0.001-3.6461.526p=0.017 Table 2.BREAST-Q reference values at 2 weeks, 6 months, 1 year, and 2 years after surgeryBaseline2 Weeks6 Months1 Year2 YearsRTSatisfaction with Breastsn=445-n=485n=1223n=65325th percentile53-63615950th percentile64-78757275th percentile82-100100100Physical Wellbeingn=483n=843n=486n=1228n=65125th percentile726060606650th percentile857176717675th percentile10082898989Psychosocial Wellbeingn=445-n=487n=1221n=65125th percentile62-66646650th percentile71-83838375th percentile87-100100100Sexual Wellbeingn=417-n=430n=1108n=58025th percentile46-48484850th percentile62-66666675th percentile70-798484No RTSatisfaction with Breastsn=172-n=186n=439n=22925th percentile48-67.5636350th percentile64-88827875th percentile82-100100100Physical Wellbeingn=184n=323n=188n=442n=23025th percentile726066717650th percentile897176828975th percentile1008289100100Psychosocial Wellbeingn=174-n=187n=437n=23025th percentile64-71666950th percentile74-87878775th percentile93-100100100Sexual Wellbeingn=161-n=158n=387n=19925th percentile43-535354.550th percentile62-66666675th percentile74-919191 Citation Format: Jacqueline J Chu, Jonas A Nelson, Paula Garcia, Babak J Mehrara, Andrea L Pusic, Monica Morrow, Mary L Gemignani, Audree B Tadros. Satisfaction and physical wellbeing after breast conserving therapy: Clinical predictors and reference values using the BREAST-Q [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-18-06.

Electronic self-reporting of adverse events for patients undergoing cancer treatment: the eRAPID research programme including two RCTs

Electronic self-reporting of adverse events for patients undergoing cancer treatment: the eRAPID research programme including two RCTs

Measuring health-related quality of life in young children with physical illness: psychometric properties of the parent-reported KIDSCREEN-27.

This study examined whether the KIDSCREEN-27 was reliable and valid in young children 2-7years with chronic physical illnesses which included estimating inter-domain correlations and internal consistency; measurement invariance testing; and, discriminant and convergent validity assessments. Data come from the Multimorbidity in Children and Youth across the Life-course; a longitudinal study of individuals aged 2-16years with physical illness. The parent-reported KIDSCREEN-27 was administered. Children (2-7years; n = 106) were compared to adolescents (8-16years; n = 157). Reliability was estimated using Cronbach α for internal consistency. Multiple group confirmatory factor analysis tested for measurement invariance. Cohen's d and Pearson coefficient were used to assess discriminant validity by sex and age. Convergent validity was tested using Pearson coefficients with the WHODAS 2.0 (child functioning/impairment). Multiple regression examined associations between multimorbidity (co-occurring physical and mental illness) and HRQL. Internal consistency reliabilities were α = 0.74-0.88 (children) and α = 0.77-0.88 (adolescents). Inter-domain correlations were relatively low (children: r = 0.18-0.59; adolescents: r = 0.30-0.62) indicating that each KIDSCREEN-27 domain was measuring a unique aspect of health-related quality of life. Measurement invariance was demonstrated (scalar level). Parameter estimates of the invariant models were similar for children and adolescents. Small, non-significant correlations were found for sex and age for children and adolescents. Medium, significant correlations were found for both groups between the KIDSCREEN-27 and WHODAS 2.0. Children and adolescents with multimorbidity had significantly lower physical well-being, psychological well-being, and school environment scores compare to those without multimorbidity. Regression coefficients were similar between groups. Findings provide evidence of adequate psychometrics for the KIDSCREEN-27 in young children with chronic physical illness.

Linking Wise Organizations to Wise Leadership, Job Satisfaction, and Well-Being

Objective:Research shows that wisdom benefits individuals, but is this also true for organizations? To answer this question, we first delineated the characteristics of wise and not-so-wise organizations in the areas of goals, approach, range, characteristics of leaders and employees, and perception of aging, using a framework derived from comparing wisdom with intellectual knowledge. Guided by this framework, we then tested whether wise organizations have a positive effect on employees’ physical and subjective well-being mediated by wise leadership and job satisfaction.Method:We created a wise organization index for nine organizations from the 2007–2008 Age and Generations Study based on 74 to 390 average employees’ ratings of perceived work opportunities for training and development, flexibility at work, absence of time pressure at work, work-life balance, satisfaction with work benefits, job security, and job opportunities. A mediated path model was analyzed to test the hypothesis. The sample contained 821 employees (age range 19–74 years; M = 41.98, SD = 12.26) with valid values on wise (fair and supportive) leadership at the first wave of data collection and employee job satisfaction (career as calling, satisfaction with career progress, engagement at work, and organizational commitment) and physical and subjective well-being at the second wave of data collection at least 6 months later.Findings:Results confirmed that the positive associations between the organizations’ overall wisdom index and employees’ physical and subjective well-being scores at Wave 2 was mediated by employees’ perception of wise leadership at Wave 1 and employee job satisfaction at Wave 2.Originality/value:This study fills a gap in the organizational wisdom literature by 1) systematically contrasting the characteristics of wise organizations with not-so-wise organizations, 2) creating a novel wise organization index, and 3) testing the effects of wise organizations and wise leadership on employees’ job satisfaction and physical and subjective well-being.Practical and societal implications:The results suggest that wise organizations encourage wise leadership, and wise leadership, in turn, fosters job satisfaction, which benefits employees’ physical and subjective well-being. Hence, wise organizations ultimately enhance workers’ well-being, which likely contributes to the success and reputation of the organization through higher employee productivity and better customer service.

Quality of Life in Patients

Quality of Life in Patients <=70 Years of Age with Chronic Lymphocytic Leukemia Treated Frontline with Ibrutinib-Rituximab Versus Fludarabine Cyclophosphamide Rituximab: Analysis from ECOG-ACRIN E1912

Changes in Quality-of-Life Parameters in Patients Receiving Therapeutic Interventions for Cancer-Associated Anemia: A Systematic Review

Introduction: Cancer-associated anemia (CAA) is multifactorial in etiology and can occur due to the malignancy itself or as a side effect of the treatment. The prevalence of CAA can exceed 90%. Several studies have reported positive correlations between increased hemoglobin (Hb) and improved health-related quality of life (HR-QoL) measures including fatigue scores and scores for physical, mental and social well-being. However, Hb increases and extent of improvement in HR-QoL measures varied by therapeutic interventions (Oral/intravenous iron, erythropoietin stimulating agents (ESAs), transfusions, and/or others), as did HR-QoL tools used in these studies. We conducted a systematic review to identify final target Hb levels as well as changes in Hb from baseline that resulted in significant improvement in HR-QoL parameters following interventions for CAA. We also sought to identify HR-QoL tools that effectively and comprehensively captured symptomatic improvement following Hb increases in patients with CAA.Methods: Randomized Controlled Trials (RCTs) and prospective studies which evaluated HR-QoL changes following drug interventions for CAA were identified through searches of the CINAHL Plus, Embase, PubMed, and Web of Science for articles in English from 1997-2021. Inclusion criteria were: RCT or prospective study; patients with CAA; a HR-QoL was used. Two reviewers independently screened abstracts. A third reviewer resolved disagreements. Bias assessment was performed using Joanna Briggs checklist.Results: Of the 8243 studies identified of which 1718 were duplicates and 6525 records were screened at the title and abstract level. Of the 59 full text articles reviewed, 38 articles met our eligibility criteria (Figure 1). A total of 19 RCTs and 19 prospective studies were identified. On average, studies were conducted over 14.2 ± 5.5 weeks, with a mean of 546 ± 693 study participants in each study. 23 studies provided information on the number of enrolled participants completing study. Mean study completion rates among participants was 70 ± 1 (%). A summary of HR-QoL measures utilized in the various studies is presented in Table 1.Hb changes and HR-QoL score changes were reported consistently in 30 studies and are presented in Table 2. Therapeutic interventions for CAA included ESAs (n=19; 65.5%), Oral/IV iron (n=1; 3.4%); transfusions (n=2; 6.9%), other agents used in specific conditions (luspatercept (MDS)) n=1; 3.3%, or combinations of these (n=7; 24.1%). Overall, 78% of studies that reported an Hb increase following drug interventions for CAA also reported an improvement in HR-QoL measures. Mean Hb increases was 1.9 g/dL. Median change in the most frequently used HR-QoL (FACT-An, FACT-F) was +3 points (Range: 0-4).Studies utilizing transfusions as the intervention for CAA reported the lowest final Hb (8.8 gm/dL) as well as the lowest change in Hb (Δ Hb= 1gm/dL) levels from study onset to completion. These studies also reported the least improvements in HR-QoL scores. HR-QoL tools used in transfusion-based studies were variable. With regard to other outcomes measured in the various studies, raising Hb levels by various interventions did not significantly impact bleeding scores, infections, hospitalizations, or mortality.Conclusions: Our data suggest the need to identify optimum Hb thresholds (final target Hb levels as well as changes in Hb levels from baseline) that result in meaningful improvements in HR-QoL parameters following the use of any therapeutic intervention for CAA. Specifically, studies utilizing transfusions alone as intervention for CAA may not reach the optimum threshold (>11gm/dL or a Δ Hb of greater than 2 gm/dL) to result in meaningful improvements in HR-QoL measures as has been shown in studies utilizing ESAs or iron or a combination of these agents. Further, it is imperative for studies in transfusion medicine to identify appropriate HR-QoL tool/s that comprehensively capture all aspects of well-being related to CAA. As such, studies may need to utilize more than one HR-QoL tool that gathers information on physical, social and emotional well-being before and after transfusions, while balancing the risk of questionnaire fatigue. A meta-analysis of our systematic review is ongoing and will provide additional information on data gathered thus far. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Patient-reported Outcomes following Implant Removal for Breast Implant Illness

PURPOSE: Current evidence has not linked breast implants to autoimmune or other systemic diseases; however, women continue to pursue explantation due to a heterogenous constellation of symptoms referred to as “breast implant illness” (BII). Although BII has no clear medical definition, pathophysiological explanation or diagnostic testing, a subset of patients report symptomatic improvement after explantation. Although several studies have attempted to clarify and better define this phenomenon, none have considered patient satisfaction and quality of life following implant removal. This study aims to assess patient reported satisfaction with the removal of implants through the use of the BREAST-Q. METHODS: Patients who underwent breast implant removal due to concerns for BII were asked to complete the augmentation BREAST-Q. Additionally, a survey was administered that queried 35 different BII-related symptoms and their response to implant removal. Questions specifically referencing the implants were removed because they were not applicable to this cohort. Consistent with scoring guidelines, missing data were replaced with the mean of remaining scores as long as 50% of questions were still completed. Outcomes in this cohort were compared with normative data for all modules this information was available for. Furthermore, satisfaction for patients who underwent explantation alone was compared with those who pursued explantation with cosmetic reconstruction. RESULTS: Of the 29 patients who underwent implant removal for BII, 16 patients (55.2%) completed the BREAST-Q and symptom survey. Mean age was 49.1 ± 10.8, and mean BMI was 25.1 ± 8. Interestingly, all patients were Whites. En bloc capsulectomy was requested by patients and performed in 100% of cases. The average time between augmentation and implant removal was 11.3 ± 6.2 months. Only 11 patients (68.8%) underwent implant removal and the other five underwent a cosmetic procedure (either autologous reconstruction or mastopexy) in addition to implant removal. Subjects report on average a total of 13.1 symptoms with brain fog, fatigue, chest discomfort, and anxiety being the most common. On average, symptoms of 14.9% of patients did not improve, those of 48.1% partially improved, and those of 37.0% were completely resolved. Compared with normative data, BII patients with implant removal alone had scores comparable to those of normative BREAST-Q data in the psychosocial well-being (P = 0.928), sexual well-being (P = 0.819), and satisfaction with breast modules (P = 0.529). They had lower scores for physical well-being (17 versus 86, P < 0.001). Upon subgroup analysis, implant removal with cosmetic procedures had a higher score in the satisfaction with breast module when compared with implant removal alone (76 versus 48, P = 0.022), though no other differences were seen. CONCLUSIONS: Concurrent with previous literature, patients with BII report some degree of symptomatic improvement after removal of implants. Patient-reported outcomes are similar to normative data in recently augmented patients. However, despite reported improvement of symptoms, physical well-being remains lower for patients with breast implant illness even after implant removal. Implant removal may be combined with cosmetic procedures to improve satisfaction with breasts. These results may aid in preoperative patient counseling.

Patient-reported outcomes predict overall survival in older patients with acute myeloid leukemia

IntroductionPatient-reported outcomes (PROs) predict overall survival (OS) in many cancer types, but there is little evidence of their prognostic value in older patients with acute myeloid leukemia (AML). We examined whether the Functional Assessment of Cancer Therapy – Leukemia (FACT-Leu) predicted OS beyond established prognostic factors among these patients. Materials and MethodsData were from AML2002 (n = 309), a randomized phase 2/3 study comparing decitabine plus talacotuzumab versus decitabine alone in older AML patients ineligible for intensive chemotherapy. We used ridge-penalized Cox proportional hazards models to estimate the association between baseline FACT-Leu scales and OS. We then conducted a bootstrap analysis to determine how often FACT-Leu scales appeared in forward- and backward- selected “final models” predicting OS relative to prognosticators from the AML Composite Model (AML-CM; e.g., chronic comorbidities, previous cancer, cytogenetic/molecular risk). ResultsIn ridge-penalized models, the FACT-Leu Physical Well-Being (PWB), Trial Outcomes Index (TOI), and Total scales predicted OS. Adjusting for AML-CM factors, an important increase (3 points) in PWB score was associated with a 14% reduction in the hazard of death. In the bootstrap analysis, the PWB scale appeared in 93% of backward- and 98% of forward selected models, while the TOI [57% (backward), 79% (forward)] and FACT-Leu Total [51% (backward), 78% (forward)] appeared less often in final models. Discussion and ConclusionsThese results indicate PROs' value for predicting outcomes among older AML patients and underscore the need to more systematically collect PRO data in routine care with these patients.ClinicalTrials.gov Registration: NCT02472145

Healthy-related quality of life in patients with cervical cancer in Southwest China: a cross-sectional study

BackgroundCervical cancer is the second most common female malignant tumor in the world. According to a study in 2018, the incidence of cervical cancer in Yunnan Province of China was 11.42 per 100,000, the mortality rate was 3.77 per 100,000, and higher than the national average. Health-related quality of life (HRQoL) can be used not only in the selection and effect evaluation of clinical treatment plans of cervical cancer, but also in the evaluation of prognosis and long-term survival status. In this study, 288 cervical cancer patients admitted to the Yunnan Cancer Hospital in Southwest China from 2018 to 2020 were used as the survey objects to understand the HRQoL of cervical cancer patients and explore the related factors that affect HRQoL.MethodsThe Chinese version of the functional assessment of cancer therapy-cervix (functional assessment of cancer therapy-cervix v4.0, FACT-Cx V4) was used to investigate 288 patients with cervical cancer in Yunnan Province. Statistical analysis was performed using t-test, analysis of variance, multiple linear regression and other methods.ResultsThe total FACT-Cx score of cervical cancer patients was (130.16 ± 14.20), the physical well-being (PWB) score was (22.02 ± 4.47), the social/family well-being (SWB) score was (25.66 ± 3.59), the emotional well-being (EWB) score was (19.75 ± 3.54), the functional well-being (FWB) score was (16.91 ± 5.01) and the additional focus area (cervical cancer subscale, CxS) score was (45.78 ± 4.61). From the multi-factor analysis results, the scores of PWB, FWB, Cxs and the total FACT-Cx were related to the choice of different treatment methods, the PWB scores of patients with concurrent chemoradiotherapy was low(β = − 1.67, P = 0.003), the FWB scores of patients with concurrent chemoradiotherapy was low(β = − 2.02, P = 0.001), the CxS scores of patients with concurrent chemoradiotherapy was low(β = − 1.61, P = 0.006), the total score of FACT-Cx of patients with concurrent chemoradiotherapy was low(β = − 5.91, P = 0.001). SWB score was affected by marital status, married patients had high PWB scores(β = 5.44, P = 0.006). The patients with heavy disease expenditures as aproportion of family disposable income(β = − 3.82, P = 0.002) and aged 60 and above(β = − 3.29, P = 0.003) had lower FWB scores. The total score FACT-Cx of patients participating in cervical cancer screening was higher(β = 7.61, P = 0.001).ConclusionThe choice of treatment method is the common influencing factor of PWB, FWB, Cxs and the total FACT-Cx. Disease expenditures as a proportion of family disposable income, the treatment method, the marital status and whether to participate in cervical cancer screening affect the patient’s evaluation of their own HRQoL. Medical staff should pay special attention to the choice of different treatment methods, popularize vaccination knowledge and cervical cancer screening, give more humanistic care and health education to cervical cancer patients who have low education level, poor economic conditions, divorced or separated, and encourage patients to participate in active treatment to improve the health-related quality of life.

Intra-operative Radiation Therapy versus Whole Breast External Beam Radiotherapy: A Comparison of Patient-Reported Outcomes.

IntroductionThis project sought to compare patient-reported outcomes between patients who received intra-operative radiation therapy (IORT) and those who qualified for IORT but received whole-breast external beam radiation therapy (EBRT) following breast-conserving surgery (BCS).MethodsThree scales from the BREAST-Q Breast Cancer BCT Module Version 2.0 questionnaire were used to collect patient-reported outcomes regarding post-operative physical well-being of the chest, post-operative satisfaction with breast cosmesis, and post-operative adverse effects of radiation.ResultsPatients who received EBRT travelled farther on average than patients who received IORT to complete treatment. Respondents who received IORT reported better physical well-being of the chest than those who received EBRT. Regression revealed that the respondent’s age was the determining factor in the difference between IORT and EBRT post-operative physical well-being scores, where younger patients report poorer well-being. There was no difference in patient-reported outcomes regarding post-operative satisfaction with breast cosmesis or adverse effects of radiation.ConclusionsPatients who received IORT reported better physical well-being of the chest than patients who received EBRT. There appeared to be a relationship between age and physical well-being of chest. This study suggested that there was no difference in patient-reported outcomes concerning post-operative satisfaction with breast cosmesis or post-operative adverse effects of radiation between patients who received IORT and those who received EBRT.

Health-related quality of life in children with hereditary angioedema compared with patients with histaminergic angioedema.

Background: Hereditary angioedema (HAE) is a potentially life-threatening disease that remarkably impacts patients' health-related quality of life (HRQoL). This study evaluated the HRQoL in children with HAE and compared it with healthy controls and patients with histaminergic angioedema (HA). Methods: Fifty-nine children with HAE (median [interquartile range {IQR}], ages, 8.9 years [5.4-12.6 years]), 60 children with HA (median [IQR] ages, 10.3 years [8-15.4 years]), and 72 healthy controls (median [IQR] ages, 10.3 years [6.6-13.9 years]) were recruited. All the children and their families completed the age-adapted KINDL generic instrument for assessing health-related quality of life in children and adolescents. Results: The total HRQoL score and other subscales scores of both the patients with HAE and patients with HA, and the parent-proxy reports were significantly lower than those of the healthy children (p < 0.05). In the patients with HAE, the age at symptom onset was positively correlated with physical well-being (r = 0.335; p = 0.043) and negatively correlated with self-esteem (r = -0.324; p = 0.049). In addition, the physical well-being scores were affected by the site of attacks, which was significantly lower in the patients with abdominal pain attacks (p = 0.045). The family scores and total scores were statistically significantly higher in the HA group than the HAE group (p < 0.001 and p = 0.009, respectively). A significant correlation was found between self-report and parent-proxy HRQoLs in total and all subscales scores in the patients with HAE. For HA, there were no significant correlations for family scores. Conclusion: HAE caused significant impairment of the HRQoL of children and their families, and affected their lifestyle and quality of life. In pediatric patients with HAE, the HRQoL is mainly related to age at symptom onset and the site of attacks. Although patients with HAE are affected more negatively than the patients with HA, HA affected the quality of life as well.

Physical and functional well-being and symptoms of ovarian cancer in women undergoing first-line of chemotherapy: a one-year follow-up.

Clinicopathological features and chemotherapy can influence the quality of life (QOL), women with ovarian cancer. This study aimed to evaluate the physical and functional well-being, and ovarian cancer-specific effects scores reported from QOL questionnaire among women with ovarian cancer at the time of in their initial diagnosis and access the scores trajectory of women receiving neoadjuvant and adjuvant chemotherapy. This prospective study used cross-sectional analysis at baseline and longitudinal analysis from baseline to 12-month post-chemotherapy. QOL was evaluated at the baseline, at sixth cycle and 12-month post-chemotherapy using FACT-O questionnaire. Clinicopathological features and chemotherapy regime were evaluated and tested for associations with QOL measures. Of the 38 women enrolled in this study, 27 (80.1%) completed the questionnaire for 12months. The multivariate linear regression results suggest, at the baseline, women with advance stage and presence of post-surgery residual disease showed lower scores in physical and functional well-being, ovarian cancer-specific effects, and FACT-O TOI domains (p < 0.05). Longitudinal analysis spanning over 12months showed an improvement in mean physical well-being, functional well-being, and ovarian cancer-specific effects scores, independent of chemotherapy received (p < 0.05). At the baseline, the clinicopathological features such as stage, presence of post-surgery residual disease, and type of chemotherapy correlated with on QOL scores. At one-year follow-up, women who underwent chemotherapy showed improvement in QOL regardless of the type of chemotherapy they received. Future prospective study with a larger group is recommended.

Factors Affecting Patient Satisfaction in Breast Reduction Surgeries: A Retrospective Clinical Study.

Breast reduction surgeries increase the individual's comfort of life by eliminating the problems caused by breast hypertrophy. We aimed to evaluate the effects of patients' demographic and operational data on satisfaction by using Breast-Q Questionnaire. Breast-Q Questionnaire breast reduction module was applied to patients who had undergone breast reduction surgery by a single surgeon between 2016 and 2020 and who agreed to participate in the study. Demographic and operational data and Questionnaire results were analyzed with the help of SPSS Statistics V21.0 program by considering p < 0.05 as significant. Of the 94 patients who had undergone surgery, 52 who agreed to fill in the questionnaire were included in the study. Mean age was 39 and mean body mass index was (BMI) 28.6 kg/m2. Forty eight (92.3%) patients had undergone surgery for noncosmetic reasons. Significant differences were found between the physical well-being scores of the participants whose BMI was <25 and those whose BMI was >30. It was found that physical well-being (p= 0.001) and the amount of tissue removed increased with the increase in BMI (p = 0.018). No association was found between the tissue removed, the change in bra sizes and satisfaction. Satisfaction with outcome of surgery was found as 84.51% ± 24.28. Linear association was found between pre-information given and Breast-Q scores (p < 0.001). In our study, it was found that the tissue removed, breast size and the change in bra size had no effect on patient satisfaction. Being informed was found to be directly related to satisfaction. Providing sufficient information, understanding the expectations and obtaining the desired cosmetic results is important. Although physical complaints are at the forefront in the decision of surgery, aesthetic appearance is more effective in being satisfied with the surgery. A breast the weight of which is reduced through breast reduction and which looks aesthetically beautiful can only please the patient. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Quality of life outcomes in sarcoma patients receiving care at a tertiary center.

e23557 Background: Sarcomas are a diverse group of neoplasms that vary greatly in clinical presentation and responsiveness to treatment. Given the differences in the sites of involvement, rarity, and treatment modality, a multidisciplinary approach is required. Previous literature suggests patients with sarcoma suffer from poorer quality of life (QoL) especially physical and functional well-being. This study aims to understand if there is an association between treatment at a tertiary sarcoma center and a difference in QoL. Methods: De-identified data was obtained from the Sarcoma Tissue Repository at University of Iowa. Mixed effects regression models were utilized to evaluate the association between disease and treatment characteristics and QoL. QoL was assessed using the self-report FACT-G questionnaire at 12-, 24-, and 36-months post-diagnosis; overall scores and the 4 well-being subscales (Physical, Emotional, Social, Functional) were calculated. Results: 443 patients were identified. Soft tissue sarcomas were more prevalent (87.6%) than bone (12.4%). 53% of patients received chemotherapy and 38.6% got radiation therapy. Sarcomas were most frequently located in the lower extremities(ext.) (33.1%), followed by abdomen (20.9%), pelvic (13.6%), upper ext. (13.1%), thorax (11.3%), head &amp; neck (7.8%). For ext. sarcoma; lower ext: 144 (71.3%), Upper ext: 58 (28.7%). Patients with extremity sarcoma; 133 had limb sparing and 48 had amputations. FACT-G Scores did not appreciably vary between 12, 24-, and 36-month for any QoL responses. Overall well-being had a mean score reported of 87.7 (sd = 15.7). Social well-being sores averaged 23.5 (5.0). Emotional well-being (EWB) 19.2 (4.1) and functional well-being (FWB) 21.3 (6.1), and physical well-being (PWB) 23.7 (4.6). There was no association between overall, PWB, EWB, or FWB with the histological subtype, radiation treatment, type of limb surgery, or any location in the same patients over time. Chemotherapy treatments were associated with lower well-being in multiple domains; PWB scores being 2.01 points lower, (p &lt; 0.01), EWB scores being 1.27 points lower (p = 0.01) and FWB scores being 1.72 (p = 0.03), and 4.44 points lower overall (p = 0.03), on average, after adjusting for overall changes across time. Patients with ext. sarcoma only overall FACT-G scores differed 6.72 points higher for upper ext. than lower ext (p = 0.04). Conclusions: Overall QoL areas were similar to normative FACT-G scores both overall and specific areas. Having received chemotherapy was associated with lower well-being scores physically, emotionally, functionally, and overall. There were no clinically relevant differences reported in QoL scores between 12-,24-, and 36-months in the same patients. Further work is needed to describe QoL differences among patients with sarcoma at tertiary centers and examine what protective factors may influence patient well-being.

Comprehensive TCM treatments combined with chemotherapy for advanced non-small cell lung cancer: A randomized, controlled trial.

Objective:We conducted this study to evaluate the efficacy and safety of traditional Chinese medicine (TCM) in advanced non-small cell lung cancer (NSCLC) patients who underwent chemotherapy.Design:This was a prospective, open-label, randomized controlled trial. NSCLC patients at stage IIIA, IIIB, or IV were randomly assigned to either TCM plus chemotherapy or chemotherapy alone. The comprehensive TCM treatment consisted of Kang Ai injection, herbal decoction, and Zhenqifuzheng capsules. The primary endpoint was quality of life (QOL) measured by the Functional Assessment of Cancer Therapy-Lung version 4.0. The secondary endpoints were chemotherapy completion rate, tumor response, and adverse events. All assessments were done at baseline, the third week, and the sixth week.Results:Thirty-nine participants were randomly assigned to the treatment group and 36 to the control group. The QOL scores were significantly improved in the treatment group compared with those of the control group in social well-being (cycle 1, P = .048; cycle 2, P = .015), emotional well-being (cycle 1, P = .047; cycle 2, P = 4.29E-05), and functional well-being (cycle 1, P = .030; cycle 2, P = .003), while the QOL scores in the above 3 domains declined in the control group (P < .05). Both groups had a decline in the physical well-being score (cycle 1, P = .042; cycle 2, P = .017) and lung cancer symptom score (cycle 1, P = .001; cycle 2, P = .001) after 2 courses of intervention. The deterioration in physical well-being and lung cancer symptoms was noticeably smaller in the treatment group (P < .05). There were significant differences between the 2 groups in social well-being, emotional well-being, functional well-being, lung cancer symptom domain, and the total score (P < .05). Patients in the treatment group had a significantly lower incidence of platelet reduction than the control group (P = .028) after 2 cycles of treatment. No significant difference in nonhematological adverse events (AEs) was observed.Conclusion:This study illustrated that comprehensive TCM treatment could promote the QOL of NSCLC patients, alleviate symptoms, and reduce the AEs caused by chemotherapy, verifying the synergistic and attenuating effects of TCM in NSCLC patients undergoing chemotherapy.Trial registration:Chinese Clinical Trial Registry (www.chictr.org.cn): ChiCTR-TRC-13003637

Patient‐reported outcomes following neoadjuvant endocrine therapy, external beam radiation, and adjuvant continuous/intermittent endocrine therapy for locally advanced prostate cancer: A randomized phase III trial

BackgroundWe evaluated patient‐reported outcomes (PRO) during neoadjuvant androgen deprivation therapy (ADT) plus external beam radiation therapy (EBRT) followed by either adjuvant continuous ADT (CADT) or intermittent ADT (IADT) for patients with locally advanced prostate cancer (Pca).MethodsA multicenter, randomized phase III trial enrolled 303 patients with locally advanced Pca. The patients were treated with 6 months (M) of ADT followed by 72 Gy of EBRT, and were randomly assigned to CADT or IADT after 14 M. The PROs were evaluated at sic points: baseline, 6 M, 8 M, 14 M, 20 M, and 38 M using FACT‐P questionnaires and EPIC urinary, bowel, and sexual bother subscales.ResultsThe FACT‐P total scores were significantly better (p < 0.05) in IADT versus CADT at 20 M (121.6 vs.115.4) and at 38 M (119.9 vs. 115.2). The physical well‐being scores (PWB) were significantly better (p < 0.05) in IADT versus CADT at 38 M (25.4 vs. 24.0). The functional scores were significantly better in IADT than those in CADT at 14 M (20.2 vs18.7, p < 0.05) and at 20 M (21.0 vs.18.9, p < 0.05).ConclusionThe PRO was significantly favorable in IADT on FACT‐P total score at 20 M and 38 M, PWB and functional scores at 38 M.

Exploring health-related quality of life among non-Hodgkin's lymphoma survivors after completion of primary treatment: a cross-sectional study in Thailand.

To investigate health-related quality of life (HR-QoL) and its influencing factors among non-Hodgkin's lymphoma (NHL) survivors after completion of primary treatment. A cross-sectional study with 312 NHL survivors after completing primary treatment using self-reported data collected through face-to-face interviews or postal survey between May 2019 and December 2019. Sociodemographic factors, clinical characteristics, physical symptom distress, anxiety, depression, unmet supportive care needs, and adaptation (post-traumatic growth and post-traumatic stress disorder) were assessed. Data analysis included ANOVA tests to investigate HR-QoL among NHL survivors at different time points and GEE to assess predictors of HR-QoL. The mean score of HR-QoL was 136.05 (SD 19.12). HR-QoL scores reported by NHL survivors in phase I (6months or less post-treatment) were significantly lower than those in phase II (> 6months-4years), phase III (> 4-9years), and phase IV (over 9years post-treatment). Regarding HR-QoL domains, NHL survivors in phase I had significantly lower physical well-being and functional well-being scores than those in phases II, III, and IV; and significantly lower lymphoma domain score than those in phase III. GEE analysis showed that physical symptom distress, anxiety, depression, unmet supportive care needs, poor adaptation, and receiving chemotherapy disrupted HR-QoL (all P < .001). Healthcare providers should re-prioritize intervention guidelines and survivorship care planning to promote HR-QoL among NHL survivors, particularly in phase I, through reducing physical and psychological symptom distress, addressing unmet needs, and enhancing adaptation outcomes.

Treating Anisomastia and Tuberous Breast with Fat Grafting: Technique and Evaluation of Outcomes Using BREAST-Q Surveys.

In the surgical correction of tuberous breast deformity, implants and regional flaps play a prominent role. Lately, fat grafting has been used as an alternative, but there is evidence that patient satisfaction is higher after correction with implants compared with lipofilling. We report a tuberous breasts correction series of ten cases, enrolled between 2015 and 2018. Percutaneous fasciotomies and fat grafting were performed by the Body-Jet technique. Analysis of outcomes was undertaken with BREAST-Q surveys. The breast satisfaction scores increased from 0 to 75 (p < 0.01), the psychological well-being scores from 20 to 70 (p < 0.01) and the sexual well-being scores from 18.5 to 58 (p = 0.02), while the physical well-being scores remained stable (from 68 to 63, p = 0.2). The median outcome satisfaction score was 86. Scores of patient-reported outcomes after lipofilling can reach and even exceed those of patients corrected with implants, at the cost of more interventions. Fat grafting is beginning to establish itself as a true alternative in the treatment of tuberous breast deformity in patients with the appropriate fat deposits. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

Effects of a personal trainer-led exercise intervention on physical activity, physical function, and quality of life of breast cancer survivors.

Exercise is important to address physical and emotional effects of breast cancer treatment. This study examines effects of a personal trainer led exercise intervention on physical activity levels, physical function and quality of life (QoL) in breast cancer survivors. Women post active breast cancer treatment were recruited from 2015 to 2017, randomized to immediate exercise or wait-list control, and received three personal training sessions for up to 30weeks. Physical activity and function were assessed by pedometer, and tests of endurance, strength, and flexibility. Self-reported physical activity, physical activity self-efficacy, and QoL were also assessed. 60 women were randomized to immediate intervention (n = 31) or wait-list control (n = 29). Subjects were aged (mean ± SD) 56 ± 10years. On the endurance test, the exercise group significantly improved (increase of 18 ± 20 steps vs control 9 ± 12 steps) (p = 0.036). On the strength test, the exercise group significantly improved (increase of 4 ± 3 curls vs control 1 ± 3 curls) (p = 0.002). After intervention, change (mean ∆ ± SD) in the FACT-ES physical well-being subscale score was 1 ± 2 in the exercise group and - 1 ± 2 in the control group (p = 0.023). Improvement in Self-efficacy and Physical Activity (SEPA) score was significant with a change (mean ∆ ± SD) of 2 ± 5 for exercise vs 0 ± 5 for control (p = 0.047). The number of steps/day, back scratch test, weight, and self-reported physical activity did not significantly improve with intervention. The intervention yielded significant improvements in endurance and strength but not physical activity or quality of life. Future efforts to explore feasible ways to support patient's physical activity efforts need to be undertaken.