Physical Well-being Scores Research Articles

Are Repeated Self-Reports of Psychological Variables Feasible for Patients Near the End of Life at a Palliative Care Unit?

Patient-reported outcome (PRO) measurement is crucial to assess the benefit of psychotherapeutic interventions. Is repeated assessment of psychometric self-report data possible, as inpatient palliative care patients suffer from physical and psychological symptoms? What is the self-perceived strain caused by the assessment? Objective The main objective of this study was to investigate the feasibility of a repeated comprehensive psychometric self-assessment of inpatient palliative care patients. Secondary objectives were the PROs of the psychometric assessment. We conducted a prospective cohort study. Patients admitted to our palliative care unit (PCU) were reviewed for eligibility within 72 hours. They were asked for weekly self-reports regarding hope (HHI-D), well-being (FACIT-Sp), anxiety and depression (STADI), and quality of life (QoL; EORTC-QLQ-C-30 single item). The strain caused by the assessment was assessed by a numeric rating scale (0-10) and free comments. Within 11 months, 219 patients were admitted to the PCU. In total, 92 patients were eligible. The most frequent exclusion criterion was "life expectancy <1 week." A total of 60 patients participated at the first point of measurement. The mean of self-perceived strain (Likert scale 0-10) due to the assessment was 1.44 (SD 1.99) at T1. Twenty-four patients participated twice. Here we found increased scores for physical well-being and QoL. Repeated assessment of psychological conditions is feasible for 27.4% of inpatients at a German PCU. The most limiting factor is life expectancy of only days at admission to the PCU. However, the self-perceived strain is low.

Parent-reported health-related quality of life of children with Down syndrome: a descriptive study.

To describe health-related quality of life of Australian children and adolescents with Down syndrome and compare it with norm-referenced data. A cross-sectional survey was conducted with parents of 75 children and adolescents (43 males, 32 females) with Down syndrome aged 5 to 18 years (mean age 13y 2mo, SD 4y 8mo). The proxy-report KIDSCREEN-27 questionnaire was administered and five dimensions of health-related quality of life were measured. Data were analysed descriptively and compared with normative data. Total group mean scores for psychological well-being, autonomy and parent relation, and school environment dimensions were within normal threshold values, whereas mean scores for physical well-being, and social support and peers dimensions, were poorer. For participants with Down syndrome aged 8 to 18 years, the difference with normative data for proxy-reported physical well-being, psychological well-being, and social support and peers dimensions favoured typically developing children. Adolescents (13-18y) with Down syndrome scored poorer on all dimensions than children (5-12y) with Down syndrome. Our findings assist a better understanding of the lived experiences of children and adolescents with Down syndrome, as perceived by their parents, and suggest aspects of health that could be influenced to optimize their quality of life. Proxy-reported psychological well-being and autonomy were within the normal range for children with Down syndrome. Physical well-being and social support scores were significantly lower than normative data. Proxy-reported scores for adolescents with Down syndrome were consistently poorer than for children with Down syndrome and the differences were clinically important.

Sensation of the autologous reconstructed breast improves quality of life: a pilot study

PurposeThe number of breast cancer survivors continues to grow. Due to refinements in operating techniques, autologous breast reconstruction has become part of standard care. Impaired sensation remains a debilitating side effect with a significant impact on the quality of life. Microsurgical nerve coaptation of a sensory nerve has the potential to improve sensation of the reconstructed breast. This study investigates the effect of improved sensation of the reconstructed breast on the quality of life in breast cancer survivors.MethodsA retrospective cohort study was performed in the Maastricht University Medical Center. Patients undergoing a DIEP flap breast reconstruction between January 2015 and January 2016 were included. The primary outcome was quality of life (BREAST-Q domain ‘physical well-being of the chest’). The Semmes–Weinstein monofilaments were used for objective sensation measurement of the reconstructed breast(s).ResultsEighteen patients with and 14 patients without nerve coaptation responded. Nipple reconstruction was the only characteristic that differed statistically significant between both groups (p = 0.04). The BREAST-Q score for the domain physical well-being of the chest was 77.89 ± 18.89 on average in patients with nerve coaptation and 66.21 ± 18.26 in patients without nerve coaptation (p = 0.09). Linear regression showed a statistically significant relation between objectively measured sensation and BREAST-Q score for the domain physical well-being of the chest with a regression coefficient of − 13.17 ± 3.61 (p < 0.01).ConclusionsImproved sensation in the autologous reconstructed breast, with the addition of microsurgical nerve coaptation, has a statistical significant positive impact on the quality of life in breast cancer survivors according to the BREAST-Q.

Quality of Life of Patients with Spinal Metastasis from Cancer of Unknown Primary Origin: A Longitudinal Study of Surgical Management Combined with Postoperative Radiation Therapy.

Patients with spinal metastasis from cancer of unknown primary origin have limited life expectancy and poor quality of life. Surgery and radiation therapy remain the main treatment options, but, to our knowledge, there are limited data concerning quality-of-life improvement after surgery and radiation therapy and even fewer data on whether surgical intervention would affect quality of life. Patients were enrolled between January 2009 and January 2014 at the Changzheng Hospital, Shanghai, People's Republic of China. The quality of life of 2 patient groups (one group that underwent surgery followed by postoperative radiation therapy and one group that underwent radiation therapy only) was assessed by the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire during a 6-month period. A subgroup analysis of quality of life was performed to compare different surgical strategies in the surgical group. A total of 287 patients, including 191 patients in the group that underwent surgery and 96 patients in the group that underwent radiation therapy only, were enrolled in the prospective study; 177 patients completed all 5 checkpoints and 110 patients had died by the final checkpoint. The surgery group had significantly higher adjusted quality-of-life scores than the radiation therapy group in each domain of the FACT-G questionnaire (all p < 0.05). Subgroup analysis showed that adjusted functional and physical well-being scores were higher in the circumferential surgical decompression group. Surgery followed by postoperative radiation therapy improved and maintained quality of life in patients with spinal metastasis from cancer of unknown primary origin in the 6-month assessment. In terms of surgical strategies, circumferential decompression seems better than laminectomy alone in quality-of-life improvement. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Review of 494 Consecutive Breast Augmentation Patients: System to Improve Patient Outcomes and Satisfaction.

Breast augmentation continues to be one of the most common surgical procedures performed by plastic surgeons. As implant options expand, controlling the numerous variables required for a successful result will prove increasingly challenging. The purpose of this study was to outline specific steps that can be taken during the patient consultation and during surgery to decrease complications and improve overall patient satisfaction and patient outcomes. A retrospective review of 494 consecutive patients who underwent primary augmentation mammaplasty performed by a single surgeon was undertaken. Surgical outcomes were recorded and compared with previously published results. Patient satisfaction was measured using the BREAST-Q Augmentation Module. Patients were followed for an average of 6 months (range, 0-45 months). Of the 494 patients, 1.3% developed capsular contracture. Other complications included 0.6% asymmetry, 0.4% malposition, 0.2% hematoma, and 0.2% rippling. The median BREAST Q score for the patient's overall satisfaction with outcome was 86%. The median BREAST Q score for patient's satisfaction with the plastic surgeon, medical team, and office staff was 100% in each case. The median score for psychological well-being, physical well-being, and sexual well-being was 100%, 90%, and 88%, respectively. The system outlined in this study showed very low rates of complications and high scores for patient satisfaction. Following a system like this will become increasingly important as breast augmentation continues to become more popular, implant options continue to expand, and social media continues to be used by patients to share surgical experiences.

A 6-month follow-up of disability, quality of life, and depressive and anxiety symptoms in pediatric migraine with magnesium prophylaxis.

Magnesium is frequently used for pediatric migraine prophylaxis. The aim of this study was to evaluate to which extent the disability levels, quality of life (QOL), and anxiety and depressive symptoms change after 6-month magnesium prophylaxis in pediatric migraine. This is a follow-up study of 34 children aged 7-17 years with migraine treated with oral magnesium. Disability due to migraine was assessed by the Pediatric Migraine Disability Assessment tool (PedMIDAS), QOL was assessed by the KIDSCREEN-27, and anxiety and depressive symptoms were assessed by the Revised Child Anxiety and Depression Scale (RCADS). PedMIDAS scores significantly decreased from baseline to end-point (F(df, dferror)=11.10 (1.63, 50.49), p<0.001), as well as anxiety (F(df, dferror)=8.95 (1.64, 50.67), p=0.001) and depressive symptoms (F(df, dferror)=8.91 (1.59, 49.29), p=0.001). Considering the KIDSCREEN-27, scores for physical and psychological well-being and social support domain significantly increased from baseline to end-point (p≤0.01). After 6 months of magnesium prophylaxis, disability due to migraine significantly decreased, whereas physical and psychosocial well-being improved. Children also reported fewer anxiety and depressive symptoms. More follow-up and randomized controlled clinical trials are needed to propose clinical recommendations for magnesium prophylaxis in pediatric migraine.

Patient-Preferred Outcomes Measurement After Post-Mastectomy Radiation Therapy and Immediate Reconstruction

Women who undergo mastectomy with immediate breast reconstruction (RC) for breast cancer may receive postmastectomy radiation therapy (PMRT) to improve local control and survival. However, PMRT can negatively impact RC outcomes by increasing complications and worsening the cosmetic results. It is unclear how women prioritize these various outcomes. In the course of designing a larger trial of PMRT with a patient-centered approach, we conducted a survey study to assess patient-reported outcomes and prioritization of these outcomes by patients who had undergone immediate RC and PMRT. Sixty-two breast cancer patients who had undergone implant-based RC and completed PMRT 6-24 months prior at a single institution were approached for study participation. Twenty-nine (47%) completed interviews (by phone or in person) to evaluate opinions of the following validated quality-of-life (QOL) instruments: BREAST-Q, FACT-B, and LYMPH-ICF. These 3 instruments were selected by a group of patient advocates with the goal of capturing important outcomes while minimizing redundancy. After completing the instruments, study participants were asked to rank the relative importance of each domain of the instruments. Clinical data were abstracted from the electronic medical record, including patient age, initial tumor stage and adjuvant therapy. Linear regression modeling was performed to assess associations between patient-reported outcomes and clinical and treatment variables. The median age was 47 years (range, 26-66) and the median interval from PMRT to interview was 22 months (range, 8-27). Patients had T1-3, N0-3 disease and underwent unilateral (52%) or bilateral (48%) mastectomy. Twenty-seven (93%) received chemotherapy. The median total radiation dose was 5000 cGy (range, 4256-6400); 14 (48%) received a scar boost. The mean FACT-B total score was 112.2. Univariate predictors of higher FACT-B total scores included older age, lower N-stage and longer interval from end of PMRT to the interview. The physical well-being (PWB) subscale of the FACT-B was selected as the most important measure by 13/29 patients (45%) and was within the top 3 for 20 patients (69%). Multivariable analysis revealed that higher nodal stage (mean difference -8.1 points for N3 vs. N0; 95% CI: -15.8, -0.3) and younger age (-4.3 points for <40 vs. >40; 95% CI: -8.0, -0.7) were independently associated with a worse PWB score on the FACT-B instrument. These results indicate that among patients who agreed to participate in this study, physical well-being was valued as the most important QOL outcome after immediate implant-based reconstruction followed by PMRT. Future PMRT trials should carefully measure PWB and explore why younger patients and those with higher nodal stage may have a diminished QOL. Explicit elicitation by patients of outcomes most important to them would ensure patient-centeredness in trial design.

Improvements in Health-Related Quality of Life and Pain: A Cohort Study in Obese Patients After Laparoscopic Sleeve Gastrectomy.

The principal aim of the study was to investigate the effect of the sleeve gastrectomy (SG) in the quality of life (QoL) and pain in a population of morbidly obese patients. Seventy-two SG patients were assessed in this descriptive observational study, before the surgery and 6 months after that. We evaluated health-related QoL (Gastrointestinal Quality of Life Index [GIQLI]) and pain (spontaneous low back pain by Numerical Point Rate Scale [NPRS] and pressure pain thresholds [PPTs]). The results of the analysis of variance (ANOVA) revealed significant improvements in nearly all of the subscales of GIQLI questionnaire after 6 months: gastrointestinal symptoms (P = .01), physical well-being (P < .001), social well-being (P = .03), and total GIQLI score (P < .001), but not for the emotional condition (P = .20). Patients also had improvements in spontaneous low back pain (P = .002), but not in the PPTs in all the body areas explored, including the cervical area, low back, and hands (P > .05). Patients receiving SG improved their health-related QoL and low back pain 6 months after the intervention, but this improvement was not so important for pressure pain thresholds in different body areas.

Patient-Reported Outcomes Are Better after Oncoplastic Breast Conservation than after Mastectomy and Autologous Reconstruction.

The BREAST-Q questionnaire was distributed to 333 women following therapeutic mammaplasty or latissimus dorsi (LD) miniflap since 1991 [tumor diameter, 32.5 (5-100) mm). QScore software generated scores/100 for breast appearance, physical, emotional, and sexual wellbeing. Outcomes following therapeutic mammaplasty and LD miniflap were compared and qualitative data analyzed to identify common themes relating to satisfaction. One hundred fifty (45%) women responded [mammaplasty versus LD miniflap, 52% versus 42%; age, 52 (30-83) years; follow-up, 84 (4-281) months). Eighty-nine percent rated OBCS better than mastectomy, > 80% recommending it to others. Mean outcome scores for breast appearance, physical, and emotional wellbeing were high and persisted beyond 15 years. Therapeutic mammaplasty patients were significantly more satisfied than those undergoing LD miniflap with the shape (P < 0.05), the size (P < 0.005), and the natural feel of the treated breast (P = 0.01). They demonstrated similar scores for physical and emotional wellbeing and a lower score for sexual wellbeing than LD miniflap patients. More LD miniflap patients reported back/shoulder symptoms and were more likely to report upper back pain (P < 0.05), but very few (< 5%) were concerned about donor-site appearance. Overall satisfaction with surgical outcomes was high in both OBCS groups (82% "excellent/very good") but greatest after therapeutic mammaplasty (P < 0.005). Patients report long-lasting satisfaction after OBCS and outcomes that compare very favorably with those reported following mastectomy and immediate autologous reconstruction.

Associations between health-related quality of life, cardiorespiratory fitness, muscle strength, physical activity and waist circumference in 10-year-old children: the ASK study

To examine the associations between cardiorespiratory fitness, muscle strength, physical activity and waist circumference with self-reported health-related quality of life (HRQoL) in children. We conducted a cross-sectional analysis that included 1129 school children aged 10years from 57 schools in Sogn and Fjordane County, Norway. The HRQoL outcome was assessed by the self-reported KIDSCREEN-27 questionnaire, which covers five life domains. Independent variables were cardiorespiratory fitness assessed by the Andersen intermittent field running test, handgrip strength measured by a hand dynamometer, explosive strength in the lower body using a standing broad jump test, physical activity (counts per minute) using an accelerometer and abdominal adiposity measured by waist circumference. Statistical analyses were performed using linear mixed-effect models including school site as a random effect. Age and sex were entered as covariates. Only cardiorespiratory fitness was positively associated with higher scores on all five KIDSCREEN-27 domains (P<0.047 for all). Explosive strength in the lower body was positively associated with higher autonomy and parents scores (P=0.018), while physical activity was positively associated with higher physical well-being scores (P=0.008). Improving cardiorespiratory fitness might be especially useful for improving HRQoL in children.

Health-related quality of life from a phase 3 randomized trial of fulvestrant 500 mg vs anastrozole for hormone receptor-positive advanced breast cancer (FALCON).

1048 Background: The Phase 3 randomized FALCON trial (NCT01602380) demonstrated improved progression-free survival with fulvestrant 500 mg (F) vs anastrozole 1 mg (A) in postmenopausal women with hormone receptor-positive (HR+) locally advanced or metastatic breast cancer (BC) without prior endocrine therapy (hazard ratio [HR] 0.797, 95% confidence interval [CI] 0.637-0.999; p = 0.0486; Robertson et al. Lancet 2016). Overall health-related quality of life (HRQoL) was maintained and similar for F and A. There was no evidence of a detriment with F vs A in time to deterioration for both Trial Outcome Index (TOI; HR 0.90, 95% CI 0.70-1.15; p = 0.4008) and Functional Assessment of Cancer Therapy for Breast Cancer (FACT-B) total score (HR 0.84, 95% CI 0.66-1.07; p = 0.1594). We present additional analyses of patient (pt)-reported HRQoL outcomes from FALCON. Methods: Women with HR+ BC were randomized 1:1 to F (Days 0, 14, 28, then every 28 days) or A (daily) until disease progression or discontinuation. HRQoL was assessed by FACT-B questionnaire (TOI [summary of physical and functional well-being and breast cancer subscale scores] and FACT-B total score) at randomization and every 12 weeks during treatment. HRQoL data post-treatment (with or without progression) were also collected. Results: 462 pts were randomized (F, n = 230; A, n = 232). Compliance to FACT-B during treatment ranged from 84.6-100.0%. Mean change from baseline in TOI (scale range 0-92) and FACT-B total score (scale range 0-144) remained broadly stable (approximately ±3 points to Week 132) and similar between arms during treatment. HRQoL was also maintained in FACT-B subscales. Approximately one third of pts had improved TOI (≥ +6 points) and FACT-B (≥ +8 points) total scores from baseline up to Week 144 of treatment with F (ranges 26.4-45.0%, and 20.0-35.8%, respectively) and A (ranges 18.6-32.9%, and 22.7-37.9%, respectively). Conclusions: Compliance to the FACT-B questionnaire on treatment with F and A for HR+ BC in the FALCON trial was good; mean change from baseline in TOI and FACT-B total score was maintained, and similar proportions of pts had improved TOI and FACT-B total score in both arms. Clinical trial information: NCT01602380.

Breast Cancer and Reconstruction: Normative Data for Interpreting the BREAST-Q.

The BREAST-Q is a patient-reported outcome instrument used to evaluate outcomes in patients undergoing breast cancer surgery and reconstruction. Normative values for the BREAST-Q breast cancer modules have not been established, limiting data interpretation. Participants were recruited by means of the Army of Women, an online community of women (with and without breast cancer), to complete Mastectomy, Breast Conserving Therapy, and Reconstruction preoperative BREAST-Q scales. Inclusion criteria were women aged 18 years or older without a history of breast surgery or breast cancer. Analysis included descriptive statistics, a linear multivariate regression, and a comparison of the generated normative data to previously published BREAST-Q findings. The BREAST-Q was completed by 1201 women. The mean patient age was 54 ± 13 years, mean body mass index 26 ± 6 kg/m, and 38 percent (n = 455) had a bra cup size of D or greater. Mean ± SD scores for BREAST-Q scales were as follows: Satisfaction with Breasts (58 ± 18), Psychosocial Well-being (71 ± 18), Sexual Well-being (56 ± 18), Physical Well-being-Chest (93 ± 11), and Physical Well-being Abdomen (78 ± 20). Women with a body mass index of 30 kg/m or greater, cup size of D or greater, age younger than 40 years, and annual income less than $40,000 reported lower scores. Comparing normative scores to published data in breast cancer patients, Satisfaction with Breasts scores were higher after autologous reconstruction and lower after mastectomy; Sexual Well-being scores were lower after mastectomy and breast conserving therapy; and Physical Well-being Chest scores were lower after mastectomy, breast conserving therapy, and reconstruction. These are the first published normative scores for the BREAST-Q breast cancer modules and provide a clinical reference point for the interpretation of data.

Physical and psychosocial aspects of adolescent and young adults after allogeneic hematopoietic stem-cell transplantation: results from a prospective multicenter trial.

Allogeneic hematopoietic stem-cell transplantation (alloHSCT) is physically and psychosocially demanding. Among transplant recipients, adolescent and young adults (AYA) represent a special group, as disease occurs early in life, resulting in the prospect of long survival time and high burden of alloHSCT sequelae. However, data focusing on AYA undergoing alloHSCT are rare. Data resulting from a prospective multicenter trial initially focusing on graft-versus-host disease (GvHD) after alloHSCT were reused to analyse the differences between AYA and elderly patients. In total, data of 205 alloHSCT recipients were evaluated. Patients completed the FACT-BMT, HAP, SF-36, 24-AM, LOT-R, BSSS, HADS, and GvHD questionnaires. Median age of AYA and non-AYA patients was 29 and 52years. Using 24-AM-Test, evaluating personality traits, non-AYA reported to be more conscientious (p=0.033). However, AYA described higher quality of life regarding physical role functioning (p=0.001), physical functioning (p=0.002), bodily pain (p=0.023), and emotional role function (p=0.027) in the SF-36. General health perception, vitality, social role functioning, and mental health were comparable among both groups. On HAP scale, AYA reported higher maximum (p=0.003) and adjusted activity scores (p=0.002), but showed similar restrictions regarding activity, self-supply, and self-determination. AYA represent a particular group characterized by higher physical well-being and activity scores, and significantly vary from non-AYA patients in psychosocial aspects. Studies covering distinctive features of AYA undergoing alloHSCT are warranted to improve awareness of the special needs of this group.

Psychometric Validation of the Heart Failure Caregiver Questionnaire (HF-CQ®)

The Heart Failure Caregiver Questionnaire (HF-CQ®) was developed to assess subjective outcomes of heart failure caregivers. The HF-CQ® comprises 21 questions on three domains, namely physical, emotional/psychological and lifestyle. The objective of this study was to evaluate the psychometric properties of the HF-CQ®. Patients (n=150) with heart failure and their primary caregivers (n=150) were recruited from 11 sites in USA. Caregivers completed the HF-CQ® and additional questionnaires, namely Caregiver Reaction Assessment, Work Productivity and Activity Impairment questionnaire, EuroQol-5 domain, and the Hospital Anxiety and Depression Scale. Patient-completed Global Impression of Severity, construct validity, concurrent validity, reliability and responsiveness of the HF-CQ® were also assessed. In the physical and lifestyle domains, all items showed acceptable validity. No high correlations between HF-CQ® scores and other caregiver-completed instruments, including the Hospital Anxiety and Depression Scale, Work Productivity and Activity Impairment questionnaire, EuroQol-5 domain or Caregiver Reaction Assessment, were reported. The intra-class correlation coefficient exceeded the threshold for reliability (>0.7) across the physical well-being (0.785), emotional/psychological (0.797), lifestyle (0.787) and total scores (0.850), indicating acceptable reliability. Internal consistency results using Cronbach's alpha showed the total aggregate score of 0.942 to be reliable. In the responsiveness analyses, each of the three scales and the total score showed responsiveness to changes defined by the Caregiver Global Impression of Severity. The overall caregiver burden score increased with increased severity of illness in the cared-for patients. The study provides initial evidence for the acceptable validity of the HF-CQ® as an instrument to measure heart failure caregiver burden.

Abstract B25: Understanding Racial Differences in Health-Related Quality of Life in a Diverse, Population-Based Cohort of Breast Cancer Survivors in North Carolina

Abstract Objective: There are over 3 million women in the United States living with breast cancer or who have a history of breast cancer. As the number of women undergoing treatments and surviving breast cancer grows, characterizing changes in health-related quality of life (HRQOL) is critical to ensuring patient-centered breast cancer care. Breast cancer risk and burden varies systemically between Black and White women. Black women are more likely to be diagnosed at younger ages and with more aggressive breast cancer tumors. Although racial disparities in HRQOL are well documented, less is known about differences in HRQOL at distinct phases of breast cancer care. Our objective was to assess racial disparities in HRQOL between active treatment and survivorship phases of the breast cancer care continuum. Methods: The study used data from the third phase of the Carolina Breast Cancer Study (CBCS-III). CBCS-III enrolled 3,000 women in North Carolina aged 20-74 years diagnosed with invasive, pathologically confirmed breast cancer between 2008 and 2013. HRQOL assessments occurred 5- and 25-months after diagnosis, respectively, representing distinct phases of care. The Functional Assessment of Cancer Therapy for Breast Cancer and the Functional Assessment of Chronic Illness Therapy for Spiritual Well-Being measured HRQOL. We implemented three approaches (Institute of Medicine, Residual Direct Effect and interactive effects of race and socioeconomic factors) to assessing racial disparities to better understand if racial disparities in HRQOL changes existed and to identify potential mediators of disparities in HRQOL. Analysis of covariance models assessed racial differences in changes in HRQOL between active treatment and survivorship. Adjusted models included demographic, socioeconomic, tumor and treatment characteristics. Results: The cohort included 2,142 Non-Hispanic White (52%) and Black (48%) women with breast cancer who completed both HRQOL assessments. During active treatment, White women reported significantly better physical and functional HRQOL than Black women, but spiritual HRQOL was 2 points higher for Black women. At 25-months post-diagnosis, White women reported HRQOL scores well above U.S norms across physical, social, emotional and functional well-being domains. Black women, however, continued to report physical well-being scores 1.2 points below the U.S norm and 2.3 points below their White breast cancer counterparts. Once demographic, socioeconomic, tumor and treatment characteristics were adjusted for, racial differences narrowed and were not considered clinically meaningful. Conclusions: Racial differences in physical and functional HRQOL may be mediated by socioeconomic factors. Psychosocial and spiritual HRQOL seem well supported, mitigating negative effects of breast cancer care, especially among Black women. These results inform opportunities for improving the quality and equity of supportive services for women with breast cancer. Citation Format: Laura C. Pinheiro, Cleo A. Samuel, Katherine E. Reeder-Hayes, Stephanie B. Wheeler, Andrew F. Olshan, Bryce B. Reeve. Understanding Racial Differences in Health-Related Quality of Life in a Diverse, Population-Based Cohort of Breast Cancer Survivors in North Carolina. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B25.

The evaluation of health-related quality of life for prostate cancer patients receiving androgen deprivation therapy

Objective To evaluate the health-related quality of life (HRQOL) for prostate cancer patients receiving androgen deprivation therapy (ADT). Methods We studied 200 patients with prostate cancer who were treated with primary ADT in Peking University People's Hospital from June 2014 to June 2015. The patients'average age was 73.9 years. The mean PSA level was 21.57 ng/ml when they were diagnosed with prostate cancer. Of these 200 patients, 79%(158/200) were localized and seclected ADT therapy due to age, body condition, basic diseases or individual will.21% (42/200) were locally advanced or metastasic, which accord with the indication of ADT therapy.The scales, including the MOS item short from health survey (SF-36), Functional Assessment of Cancer Therapy -General module (FACT-G), Functional Assessment of Cancer Therapy -Prostate instrument (FACT-P), Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) were used to evaluate their HRQOL. Results According to results of SF-36, the physical health component score and mental health component score was 67.41±16.39 and 64.81±17.51, respectively. They indicated that the overall quality of life of these patients was at an acceptable level. And the average score of domains exceeded 60 except general health domain, which the score was only 40.03±21.89. When it comes to FACT-P, the sum score, emotional well-being score and prostate cancer component score were 8.15±3.72, 12.30±4.04 and 77.41±9.95, respectively, which were less than half of their respective top score. However the physical well-being score was 20.41±4.29, which was a relatively satisfactory value. In addition, 61% (121/200) patient selected not at all in item I am able to have and keep an erection . The score of SDS and SAS was 46.76±8.29 and 43.25±9.69, respectively. And there were 23.0% (46/200) and 21.5% (43/200) patiens exhibited depression and anxiety, respectively. Conclusion In the present study, the prostate cancer patients receiving ADT showed acceptable HRQOL, but some patients sufferd from depression, anxiety and erectile dysfunction. Key words: Prostate cancer; Androgen deprivation therapy (ADT); Health-related quality of life (HRQOL)

Health Related Quality of Life and the Quality of Sleep in School Aged Children with Functional Constipation

ABSTRACTThe aim of the present study was to investigate the sleep quality and health related quality of life in children with functional constipation. Fifty patients (7–13 years) attended to our general pediatric outpatient clinic and diagnosed with functional constipation and 50 healthy controls were enrolled in this case-control study. Health-related quality of life was assessed by using Kid-KINDL inventory and sleep quality was assessed by using PSQI. Children with functional constipation had lower scores of quality of life compared to healthy controls. Although the total score was not statistically significant the physical well-being scores of constipated children was significantly lower than control group. The Pittsburgh Sleep Quality Index score for children with functional constipation was significantly higher than controls (2.5 ± 2.4 and 0.5 ± 0.6, respectively; p < 0.05). School-aged children with functional constipation had lower quality of life and quality of sleep compared to their healthy peers. Physical well-being was especially impaired in constipated children affecting daily activities negatively. Assessment of quality of sleep as well as quality of life should be a part of management of functional constipation in childhood.

Impact of Self-Reported Pre-Transplant Quality of Life (QOL) on Long-Term Survival after Allogeneic or Autologous Hematopoietic Cell Transplantation (HCT)

The role of pre-HCT self-reported QOL on long-term survival in autologous and allogeneic HCT recipients is not well understood. Although pre-HCT comorbidity is now a well-established indicator of post-HCT short-term outcome, patient-reported pre-HCT QOL may provide additional information for predicting long-term survival after HCT.This study examined the relationship between pre-HCT QOL scores and overall survival (OS), non-relapse mortality (NRM), and disease-related mortality (DRM) in patients who received their first allogeneic or autologous HCT at City of Hope between 2001 and 2005. Four domains of QOL (physical, psychological, social, and spiritual well-being; scale of 0 [worst] to 10 [best]) were assessed prior to HCT using the City of Hope-QOL instrument. Cox regression analysis was used to identify QOL domains associated with long-term survival, adjusted for demographic, clinical, and transplant-related variables. HCT-Comorbidity-Age Index (HCT-CAI) (Sorror et al. 2014) was also assessed in allogeneic HCT recipients. Vital status was determined using medical records and linkage with the National Death Index. OS probabilities were estimated using the Kaplan-Meier estimator. Analyses were conducted by stem cell source.The cohort comprised 103 allogeneic HCT recipients (median age at HCT, 42 years; 51% males; median follow-up since HCT, 7.6 years; 55 deaths) and 141 autologous HCT recipients (median age at HCT, 50 years; 56% males; median follow-up, 7.1 years; 59 deaths). The diagnoses included acute leukemia (n=45), chronic leukemia (n=20), lymphoma (n=14) and other hematologic conditions (n=24) in allogeneic HCT recipients and acute leukemia (n=24), lymphoma (n=76), myeloma (n=35), and other hematologic conditions (n=6) in autologous HCT recipients. All autologous and 81.5% of allogeneic HCT patients received myeloablative conditioning agents. OS: In allogeneic HCT recipients, OS adjusted for significant covariables increased with higher pre-HCT physical well-being score (Hazard Ratio [HR]=0.76 per point increase, p=0.003). Of note, HCT-CAI was not associated with OS in the multivariate model (HR=1.1, p=0.39). The hazard of death for physical well-being scores below the 75th percentile was 3.7 times that above this percentile (p=0.002). Survival rates at 5 and 10 years after HCT for physical well-being scores below the 75th percentile were 51% and 38%, respectively, compared to 72% (p=0.062) and 68% (p=0.018), respectively, above the 75th percentile. OS was also independently worse in males, unrelated donor HCT recipients, patients with acute leukemia vs. other diagnoses, absence of chronic GvHD, and pre-HCT income of $20K to $100K vs. <$20K or >$100K. In autologous HCT recipients, adjusted OS varied non-linearly with pre-HCT physical well-being score (p=0.03), with OS being significantly lower in the lowest (worst) quartile of pre-HCT physical well-being score (HR=2.4, p=0.004) compared to those with better scores. Survival rates at 5 and 10 years after HCT in the lowest quartile were 53% and 47%, respectively, compared to 70% (p=0.048) and 62% (p=0.065) for those with scores above the lowest quartile. Older age at HCT, other diagnoses vs. lymphoma, high risk of relapse at pre-HCT, cyclophosphamide as conditioning agent vs. no cyclophosphamide were also independently associated with worse OS. Other QOL domains were not significant for either HCT types. NRM: In allogeneic HCT recipients, NRM was not associated with HCT-CAI (HR=1.18, p=0.11) adjusted for chronic GvHD and stem cell donor relatedness. However, adjusted OS increased for higher pre-HCT physical well-being score (HR=0.8, p=0.06). NRM was higher for those with physical well-being score below the 75th percentile (HR=7.3, p=0.007) compared to those with scores above the 75thth percentile. In autologous HCT recipients, no QOL domains were significant. DRM: None of the QOL domains for either HCT types, or HCT-CAI in allogeneic HCT recipients were significant after accounting for salient clinical and demographic factors.This study shows that patient-reported pre-HCT physical well-being scores provide information not captured by medical factors that can aid in predicting long-term OS and NRM in allogeneic and OS in autologous HCT patients. Effort to incorporate such evaluation as part of the routine assessment preceding HCT may be useful in developing patient selection and intervention strategies. DisclosuresForman:Mustang Therpapeutics: Other: Construct licensed by City of Hope.

527P An observational study of quality of life in Thai colorectal cancer patients who received chemotherapy

Background Chemotherapy is known to prolong life of colorectal cancer (CRC) patients. However, it comes with unavoidable toxicities, which should be balanced with its efficacy. Quality of life (QOL) has become an important outcome measurement for all cancer patients. There is a limited data of QOL in Thai CRC patients who receive chemotherapy. Thus, we aimed to describe the QOL of these patients. Methods CRC patients who received chemotherapy at Ramathibodi Hospital between December 2011 and August 2013 were enrolled. All consented patients were interviewed by trained registered nurses, and completed demographic questionnaire, validated Thai version of the Functional Assessment of Cancer Therapy-General (FACT-G), Functional Assessment of Cancer Therapy –Colorectal (FACT-C), and FACT-C Trial Outcome Index (TOI). All questionnaires were obtained at baseline prior to chemotherapy, 2, 4, and 6 months after starting chemotherapy Results 147 CRC patients were included in this study with male to female ratio of 3:2. Most patients (99%) had ECOG performance status of 0-2. 77 patients (52%) were treated with adjuvant chemotherapy while 70 patients (48%) received chemotherapy with palliative aim. Targeted therapy in combination with chemotherapy was administered in only 18 patients (12%). Two third of the patients received radiotherapy. FACT-C, and FACT-C TOI scores demonstrated significant improvement in QOL at 6 months after chemotherapy when compared with baseline. Among the five scales of QOL at 6 months, physical well-being function score of CRC patients significantly increased while social well-being scales significantly decreased. Overall, patients had improvement in scores of the Colorectal Cancer Subscale, except for diarrhea..Tabled 1Table: 527PScore at 6 monthsCoefficient95% CIp-valueFACT-G1.88-0.29, 4.050.089FACT-C3.431.61, 5.26<0.001FACT-C TOI3.310.75, 5.870.011Physical well-being1.320.45, 2.190.003Social well-being-0.78-1.52, -0.030.041 Open table in a new tab Conclusions There was an improvement in QOL of Thai CRC patients who received chemotherapy. Chemotherapy relieved cancer related symptoms in CRC patients, except for diarrhea, which could be chemotherapy related toxicity. Legal entity responsible for the study Phichai Chansriwong Funding Ramathibodi Hospital, Mahidol University Disclosure All authors have declared no conflicts of interest.

Adapting to Aging: Older People Talk About Their Use of Selection, Optimization, and Compensation to Maximize Well-being in the Context of Physical Decline.

Objectives:Selection, Optimization, and Compensation (SOC) may contribute to successful aging by helping older people maximize well-being in the context of physical decline. To explore this hypothesis, and to investigate the potential for narrative analysis to improve understanding of SOC, we analyze interviews conducted with 15 members of the 6-Day Sample, a cohort of Scots born in 1936.Method:Interviewees were chosen based on their physical function and well-being scores. Interviews were analyzed to investigate “SOC talk,” that is, older people’s talk about SOC behaviors in everyday life. Types and amounts of SOC talk were quantified, and talk was narratively analyzed. We hypothesized that older people who engaged in more SOC talk would have higher well-being.Results:Older people who engaged in high levels of SOC talk had high well-being despite low physical function. Those who engaged in little SOC talk had low well-being despite higher physical function.Discussion:The concept of successful aging is valuable in part because of its narrative quality: One must strive to keep one’s life story developing despite physical decline and other losses. We provide evidence, from the perspectives of older people themselves, of the ways in which SOC may play a role in that process.