Poor Quality Of Life Outcomes Research Articles

SA56 Disease Severity Is Associated With Poorer Quality of Life Outcomes and Higher Costs in Thyroid Eye Disease (TED): Evidence From Systematic Literature Reviews (SLRs)

SA56 Disease Severity Is Associated With Poorer Quality of Life Outcomes and Higher Costs in Thyroid Eye Disease (TED): Evidence From Systematic Literature Reviews (SLRs)

Quality of Life and Nutritional Outcomes of Stomach-Preserving Surgery for Early Gastric Cancer

The Sentinel Node Oriented Tailored Approach (SENORITA) randomized clinical trial evaluated quality of life (QoL) and nutritional outcomes between the laparoscopic sentinel node navigation surgery (LSNNS) and laparoscopic standard gastrectomy (LSG). However, there has been no report on the QoL and nutritional outcomes of patients who underwent stomach-preserving surgery among the LSNNS group. To compare long-term QoL and nutritional outcomes between patients who underwent stomach-preserving surgery and those who underwent standard gastrectomy and to identify factors associated with poor QoL outcomes in patients who underwent stomach-preserving surgery. This study is a secondary analysis of the SENORITA trial, a randomized clinical trial comparing LSNNS with LSG. Patients from 7 tertiary or general hospitals across the Republic of Korea were enrolled from March 2013 to December 2016, with follow-up through 5 years. Data were analyzed between August and September 2022. Among trial participants, patients who underwent actual laparoscopic standard gastrectomy in the LSG group and those who underwent stomach-preserving surgery in the LSNNS group were included. Patients who did not complete the baseline or any follow-up questionnaire were excluded. Stomach-preserving surgery vs standard gastrectomy. Overall European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 (EORTC QLQ-C30) and stomach module (STO22) scores, body mass index, hemoglobin, protein, and albumin levels. A total of 194 and 257 patients who underwent stomach-preserving surgery and standard gastrectomy, respectively, were included in this study (mean [SD] age, 55.6 [10.6] years; 249 [55.2%] male). The stomach-preserving group had better QoL scores at 3 months postoperatively in terms of physical function (87.2 vs 83.9), dyspnea (5.9 vs 11.2), appetite loss (13.1 vs 19.4), dysphagia (8.0 vs 12.7), eating restriction (10.9 vs 18.2), anxiety (29.0 vs 35.2), taste change (7.4 vs 13.0), and body image (19.5 vs 27.2). At 1 year postoperatively, the stomach-preserving group had significantly higher body mass index (23.9 vs 22.1, calculated as weight in kilograms divided by height in meters squared) and hemoglobin (14.3 vs 13.3 g/dL), albumin (4.3 vs 4.25 g/dL), and protein (7.3 vs 7.1 g/dL) levels compared to the standard group. Multivariable analyses showed that tumor location (greater curvature, lower third) was favorably associated with global health status (β, 10.5; 95% CI, 3.2 to 17.8), reflux (β, -8.4; 95% CI, -14.7 to -2.1), and eating restriction (β, -5.7; 95% CI, -10.3 to -1.0) at 3 months postoperatively in the stomach-preserving group. Segmental resection was associated with risk of diarrhea (β, 40.6; 95% CI, 3.1 to 78.1) and eating restriction (β, 15.1; 95% CI, 1.1 to 29.1) at 3 years postoperatively. Stomach-preserving surgery after sentinel node evaluation was associated with better long-term QoL and nutritional outcomes than standard gastrectomy. These findings may help facilitate decision-making regarding treatment for patients with early-stage gastric cancer. ClinicalTrials.gov Identifier: NCT01804998.

Adult survivors of childhood cancer have significant levels of impaired cardiorespiratory fitness, inflammatory markers and poor quality of life outcomes

Abstract Anthracycline chemotherapy is used in approximately two thirds of the 35,000 European children diagnosed with cancer each year. Unfortunately 1 in 10 will develop symptomatic heart failure at 40 years after therapy. Emerging evidence suggests that anthracyclines exert a significant cardiovascular insult that expands beyond an impaired ejection fraction. Impaired cardiac reserve has been demonstrated in patients treated as adults however the impact of cancer treatment in childhood during cardiac development, is less widely described, particularly the long-term effects, several decades post treatment. Purpose This study explores quality of life (QOL), cardiorespiratory fitness and imaging outcomes in adult childhood cancer survivors (CCS) treated with >100mg/m2 of anthracycline. Methods Adult CCS (>18 years) were recruited from our regional cardio-oncology surveillance programme. Anthracycline equivalence dose was calculated according to ESC 2022 guidance. Questionnaires were completed describing exercise habits and QOL (SF36). Outcomes in each domain were assessed against population age/gender matched normative values. A 6-minute walk test was performed and % predicted values adjusted for height/weight/age/gender (6MWT%). CCS with abnormal 6MWT% were referred for CPEX. Cardiac biomarker analysis (wrCRP, NTproBNP and TnT) and cardiac imaging were performed. Results Consent was gained from 86 CCS (55% male) mean age 28 (18-53 years). Mean dose was 270mg/m2 (108-705). 70% met NHS exercise targets. 49% were overweight or obese. 13% had an ejection fraction (EF) of <50% and 26% had an abnormal global longitudinal strain (GLS). 34 (40%) of patients had 6MWT% below the lower limit of normal (LLN). CCS scored below the LLN in every QOL domain, with marked abnormalities in general health (20% abnormal), mental health (16%) and physical functioning (13%). Symptoms were similar in sedentary and non-sedentary patients. Sedentary CCS had abnormal wrCRP (p = 0.002), 6MWT% (p = 0.002) and lower indexed stroke volumes on MRI (p = 0.015). Exercise duration (mins/week) correlated with improved 6MWT%, fractional shortening, septal E/e’ (all P<0.05). Vigorous exercise compared to sedentary habits were associated with better 6MWT%, wrCRP, reduced frailty and improved QOL as well as NTproBNP, GLS and EF. At 20 years post anthracycline, EF was impaired in 7/35 (20%), GLS impaired in 36% and 22% met criteria for frailty/prefrailty. Conclusion Childhood cancer survivors display significant impairment in cardiorespiratory fitness and score lower in all quality of life domains. Sedentary behaviour is associated with worse QOL, impaired cardiorespiratory fitness, inflammation and abnormal imaging. Interestingly, reported symptoms did not differ regardless of activity level. Whether sedentary behaviour is secondary to cardiotoxicity or exercise mitigates the effect of cardiotoxicity is still unclear and further research is anticipated in this field.

Adult Survivors of Childhood Cancer Have Significant Levels of Impaired Cardiorespiratory Fitness, Inflammatory Markers, and Poor Quality of Life Outcomes

Adult Survivors of Childhood Cancer Have Significant Levels of Impaired Cardiorespiratory Fitness, Inflammatory Markers, and Poor Quality of Life Outcomes

Assessment of health-related quality of life and its determinants among patients with diabetic foot ulcer in Ilorin, Nigeria

Background: The impact of foot ulceration on the psychosocial wellbeing of the Nigerian diabetic patients has not received enough attention. This study therefore attempted to evaluate the effect of diabetic foot ulcer on the quality of life of adults in a Nigerian diabetic population.
 Methodology: The impacts of diabetic foot ulcer (DFU) on the quality of life (QoL) of 104 adults living with diabetes were assessed using The Diabetes Foot Ulcer Scale and their determinants.
 Results: The mean QoL score was 42.25. Fifty-five (53.4%) had poor QoL status while 48 (46.6%) had good QoL. Determinants of poor QoL outcome include low socio-economic status (p = 0.017), lack of a tertiary education (p= 0.027), no diabetes-education (p = < 0.001), low socioeconomic status (p = 0.017), multiple ulcers (p = 0.022) and Wagner grade >3 ulcers (p = 0.004).
 Conclusion: Majority of patients with DFU in UITH, Nigeria have poor QoL and most of the predictors of poor QoL outcome are preventable and modifiable.

Adamantinomatous craniopharyngioma: evolution in the management.

In spite of the continuous progresses in pediatric neurosurgery, adamantinomatous craniopharyngioma (AC) remains a challenging tumor due to its proximity to optic pathways, pituitary gland, hypothalamus, and Willis' circle, which can result in significant endocrine, cognitive, and neurological morbidity after treatment with subsequent impact on the patient's quality of life (QoL). The relevance that QoL has today explains the changes in the management of AC observed over the time. The goal of the present article is to provide a historical background, to show the milestones in the changes of the AC treatment, and to analyze the current main options to manage such a challenging tumor. The pertinent literature has been reviewed. Moreover, a comparison between the past and recent personal series is reported. Three main eras have been identified. The first (named Cushing era) was characterized by the need to realize a harmless surgery and to define the best way to approach AC; the second (microscope era) was characterized by a tremendous technical and technological development, with remarkable results in term of safe tumor resection and control but relatively poor QoL outcomes; and the third one (current period) is characterized by an increasing integration between surgery and adjuvant treatments, with relatively minor tumor control but significant improvement of QoL (comparable overall survival). The authors' experience reflects these changes. Two groups of children were compared: 52 cases (mean follow-up: 17.5 years) belong to the historical series (group 1, 1985-2003, aggressive surgical management) and 41 (mean follow-up: 8.5 years) to the current one (Group 2, 2004-2021, integrated management). No significant differences between the two groups were detected about recurrence rate, surgical mortality, and overall survival. However, Group 2 showed significant lower rates of postoperative panhypopituitarism, obesity, and visual deterioration. Radical surgery allows for a good AC control with a low rate of recurrence but high risk of permanent morbidity. Despite the greater number of recurrences and surgeries, the more conservative policy, based on a combination of treatments, seems to provide the same tumor control with a better QoL. The advances in trans-nasal and trans-ventricular endoscopy, in proton therapy and in the management of the AC cyst are the main factors that allowed such an improvement.

Patient-reported outcomes of taste alterations and quality of life in patients with nasopharyngeal carcinoma.

To investigate patient-reported outcomes of taste alterations and quality of life (QoL) in patients with nasopharyngeal carcinoma (NPC). In this single-center retrospective study medical records of 191 patients with NPC undergoing chemoradiotherapy (CRT) in the Department of Radiotherapy, Jiangsu Cancer Hospital, the Affiliated Cancer Hospital of Nanjing Medical University from January 2021 to December 2021 were reviewed. A total of 120 patients met eligibility criteria and were included. The taste alterations and QoL at multiple time points during radiotherapy (RT) were compared. There were significant differences in the intensity of taste, discomfort, phantogeusia and parageusia or overall taste alterations at multiple time points during CRT (p-Value<0.001). These four parameters were significantly higher two or four weeks after CRT, or at the end of CRT compared to before CRT (p-Value <0.001). The intensity of taste, discomfort, phantogeusia and parageusia or overall taste alterations were all significantly higher four weeks after CRT compared to two weeks after CRT (p-Value <0.001), and at the end of CRT compared to four weeks after CRT (p-Value <0.001). The chemotherapy-induced taste alteration scale (CiTAS) scores were highest at the end of CRT (p-Value <0.001). There were significant differences in QoL at multiple time points during CRT (p-Value <0.001), and each parameter differed significantly at various time points (p <0.05). The QoL of all areas at the end of CRT were significantly higher than those before CRT, or two or four weeks after CRT (p-Value <0.001). In patients with NPC undergoing CRT, taste alterations increasingly worsen as treatment progresses, with poor QoL outcomes.

The relationship between frailty and HRQoL in elderly cardiovascular patients in Phase II Cardiac Rehabilitation

Abstract Funding Acknowledgements Type of funding sources: None. Background With an aging cardiovascular disease population, frailty is become an important prognostic factor in patients, which is associated with poor quality of life outcomes, such as fatigue, and decreased physical activity. However, the relationship between frailty and health-related quality of life (HRQOL) in elderly patients undergoing cardiac rehabilitation (CR) remains unclear. Methods In this study, 217 patients (mean age: 74.6 ± 5.8 years; male: 67%) were recruited who participated in early phase II CR at a university hospital between November 2015 and December 2016. As part of the CR processed, patients were asked to complete the Kihon Checklist (KCL) and 36-Item Short Form Survey (SF-36). We divided patients into three groups according to their KCL results: the frailty group (n = 81; 37%), the pre-frailty group (n = 71; 32%), and the non-frailty group (n = 65; 29%). The three groups were compared based on their basic characteristics and SF-36 scores. Results Among the three groups, sex, body mass index, 6-minute walking distance (6MWD), hemoglobin level, and low-density lipoprotein cholesterol level varied significantly (p&amp;lt;0.05). The frailty group scored significantly lower than the other two groups on all items of the SF-36, the Physical Component Summary (PCS), and the Mental Health Component Summary (MCS) (p&amp;lt; 0.05). In all groups, the PCS scores were below the standardized mean scores. Interestingly, MCS score in the frailty group was below the standardized mean scores. Additionally, the significant correlations were found between the PCS and 6MWD in the non-frailty group (p=0.006, r=0.38) and pre-frailty group (p=0.002, r=0.52), but no correlation was found in the frailty group (p=0.14, r=0.22). On the other hand, there was no significant correlation between MCS score and 6MWD in all groups. Conclusions HRQOL as well as physical and mental domains declined in frail elderly patients undergoing CR, which suggests that an intervention program considering social life and daily roles is necessary.

Development and psychometric validation of a patient-reported outcome measure of recurrent urinary tract infection impact: the Recurrent UTI Impact Questionnaire

PurposeRecurrent urinary tract infection (rUTI) is a highly prevalent condition associated with significant poor quality of life outcomes. A patient-reported outcome measure (PROM) of rUTI-associated psychosocial impact is urgently required to supplement clinical evaluation and validate the challenges experienced by patients. This study therefore developed and validated the Recurrent UTI Impact Questionnaire (RUTIIQ).MethodsA rigorous four-stage methodology was followed: (I) concept elicitation through a qualitative survey of the experiences of people with rUTI (N = 1983); (II) Delphi expert screening of the RUTIIQ with expert rUTI clinicians (N = 15); (III) one-to-one cognitive interviews with people experiencing rUTI (N = 28) to evaluate the comprehensiveness and comprehensibility of the RUTIIQ, and (IV) full pilot testing of the RUTIIQ with people experiencing rUTI (N = 240) to perform final item reduction and psychometric analysis.ResultsExploratory factor analysis demonstrated a five-factor structure comprising: ‘patient satisfaction’, ‘work and activity interference’, ‘social wellbeing’, ‘personal wellbeing’, and ‘sexual wellbeing’, collectively accounting for 73.8% of the total variance in pilot scores. Results from expert clinicians and patients indicated strong item content validity (I-CVI > .75). The internal consistency and test–retest reliability of the RUTIIQ subscales were excellent (Cronbach’s α = .81–.96, ICC = .66–.91), and construct validity was strong (Spearman’s ρ > .69).ConclusionThe RUTIIQ is a 30-item questionnaire with excellent psychometric properties, assessing the patient-reported psychosocial impact of living with rUTI symptoms and pain. This new instrument delivers the unique opportunity to enhance patient-centred care through standardised observation and monitoring of rUTI patient outcomes.Trial registrationThis study was pre-registered with ClinicalTrials.gov (identifier: NCT05086900).

Predictors of health state utility values using SF-6D for Chinese adult patients with β-thalassemia major.

Patients with β-thalassemia major (β-TM), predominantly adult patients, are associated with physical, mental, and social problems, that result in decreased quality of life (QoL). However, there is a paucity of data on QoL and health status utility (HSU) among adult patients with β-TM in mainland China. Our study aimed to evaluate the QoL by short form 36 questionnaire (SF-36) of adult patients with β-TM in mainland China and to estimate their HSU by SF-6D. In addition, we aimed to identify predictors of HSU. In this cross-sectional descriptive study, a total of 75 adult patients with β-TM were included by the snowball sampling method that applied involving seven provinces with a relatively high prevalence of thalassemia across mainland China between September 1, 2021 and January 31, 2022. The collected information included social-demographic characteristics, health conditions, treatment, social support (social support rating scale), caregiver burden (Zarit burden interview), and QoL (SF-36). HSU scores were calculated for each adult patient from their SF-36 responses using the SF-6D algorithm with Hong Kong's tariff. The frequency of participants' responses to the SF-6D for each item of the options was described. Mean HSU scores between different subgroups were calculated. Ordinary least squares (OLS) regression modeling was performed to identify factors associated with HSU. A total of 75 adult patients with β-TM were included in this study. The mean SF-36 score was 50.2 ± 10.70, of which physical and mental scores were 47.57 ± 11.28 and 52.85 ± 14.21, respectively. In addition, the mean SF-6D utility score was estimated to be 0.598 ± 0.112, ranging from 0.391 to 0.962. Univariate analyses showed that interruption of iron chelation treatment significantly affected HSU values (P = 0.038); diagnosis with comorbidity very slightly affected HSU values (P = 0.0996). In the multivariate analysis, diagnosis with comorbidity (P = 0.042) was significantly negatively associated with HSU values; the minimum pre-transfusion hemoglobin concentration (P = 0.047) and social support (P = 0.068) were positively associated with HSU values. This study presents poor QoL and HSU outcomes in Chinese adult patients with β-TM. The study also highlights the importance of social support and treatment compliance, which can increase hemoglobin content and reduce comorbidities, further to ensure the QoL of patients. These findings can be used for future clinical and economic studies.

Relationship Between Nutritional Parameters and Quality of Life in Patients With End-Stage Kidney Disease on In-Centre Haemodialysis in Al-Ahsa, Saudi Arabia.

Nutrition threatens the quality of life (QOL) in end-stage kidney disease (ESKD) patients on haemodialysis (HD). The aim of the study is to assess which nutritional parameters associate with the health-related QOL category score usingArabic translated, adapted, and validated version of the Kidney Disease Quality of Life Short-Form 36 (KDQOL-36). We carriedout a cross-sectional study with a total of 60 ESKD patients in one haemodialysis centre in Al-Ahsa, Saudi Arabia. The health-related QOL of the five components of the KDQOL-36 are as follows: physical component score (PCS), mental component score (MCS), the burden of kidney disease (BKD), symptoms and problems of kidney disease (SPKD), and effects kidney disease (EKD) which were grouped into three categories (good, average and poor) based on the score. Of the 60 HD patients, 43 (71.7%) were between 19 and 59 years old and 41 patients (68.3%) were males. This study revealed that high haemoglobin impact PCS, MCS, SPKD, and EKD in favour of poor health-related QOL, but normal haemoglobin impacts BKD in favour of good QOL. In addition, patients who had a normal serum albumin level had good scores for MCS, BKD, SPKD, and EKD. Also, there was a significant association between Kt/V value with EKD (p=0.001). According to the findings of this study, patients with HD have poor health-related QOL outcomes than those with good nutritional status. This finding demonstrates the critical need for further articles to study this particular group of population.

Quality of Life Outcomes Over Time in Patients With Unruptured Intracranial Aneurysms With and Without Preventive Occlusion: A Prospective Cohort Study.

In counseling patients with an unruptured intracranial aneurysm (UIA), quality of life (QoL) outcomes are important for informed decision making. We evaluated QoL outcomes in patients with and without preventive aneurysm occlusion at multiple time points during the first year after UIA diagnosis and studied predictors of QoL outcomes. We performed a prospective cohort study in patients aged ≥18 years with a newly diagnosed UIA in 2 tertiary referral centers in the Netherlands between 2017 and 2019. Patients were sent QoL questionnaires at 7 (aneurysm occlusion) or 5 (no occlusion) moments during the first year after diagnosis. We collected baseline data on patient and aneurysm characteristics, passive coping style (Utrecht Coping List), occlusion modality, and neurologic complications. We assessed health-related QoL (HRQoL) with the EuroQol 5 dimensions (EQ-5D), emotional functioning with the Hospital Anxiety and Depression Scale (HADS), and restrictions in daily activities with the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P). We used a linear mixed-effects model to assess the course of QoL over time and to explore predictors of QoL outcomes. Of 153 eligible patients, 99 (65%) participated, of whom 30/99 (30%) underwent preventive occlusion. Patients undergoing occlusion reported higher baseline levels of passive coping, anxiety and depression, and restrictions than patients without occlusion. During recovery after occlusion, patients reported more restrictions compared with baseline (adjusted USER-P decrease 1 month post occlusion: -12.8 [95% CI -23.8 to -1.9]). HRQoL and emotional functioning gradually improved after occlusion (EQ-5D increase at 1 year: 8.6 [95% CI 0.1-17.0] and HADS decrease at 1 year: -5.4 [95% CI -9.4 to -1.5]). In patients without occlusion, the largest HRQoL improvement occurred directly after visiting the outpatient aneurysm clinic (EQ-5D increase: 9.2 [95% CI 5.5-12.8]). At 1 year, QoL outcomes were comparable in patients with and without occlusion. Factors associated with worse QoL outcomes were a passive coping style in all patients, complications in patients with occlusion, and higher rupture risks in patients without occlusion. After UIA diagnosis, QoL improves gradually after preventive occlusion and directly after counseling at the outpatient clinic in patients without occlusion, resulting in comparable 1-year QoL outcomes. A passive coping style is an important predictor of poor QoL outcomes in all patients with UIA.

Understanding the Vulnerability, Resilience and Quality of Life of older adults during natural disasters

Globally, disasters constantly challenge the capacity of humans to adapt to its consequences and endure the impact. It comprises a range of impacts including loss of life and properties, risk of mental health issues like post-traumatic stress disorder, depression, grief, anxiety etc. The disaster risk relies upon the individual’s exposure to disaster vulnerability and resilience. It also includes the needs of a vulnerable population including older adults and the presence of secondary stressors within the affected community. Therefore, older adults are found to be a highly vulnerable age group during every disaster. Especially in developing countries, older adults face numerous issues and challenges due to inadequate disaster infrastructure and response, which are often associated with poor quality of life outcomes. The present study tries to conceptualize the significance of disaster vulnerability, resilience as a decisive factor for the quality of life (QoL) of older adults in the natural disaster. Further, the current study highlights the functional relationship between disaster phases, vulnerability, resilience, psychosocial factors and preparedness measures to ensure a better quality of life for older adults.

Oncology outpatients with worse depression and sleep disturbance profiles are at increased risk for a higher symptom burden and poorer quality of life outcomes

Objective/Background - Depression and sleep disturbance are significant problems during chemotherapy. Study purposes were to identify subgroups of patients with distinct joint depression AND sleep disturbance profiles and evaluate for differences in demographic and clinical characteristics, severity of symptoms, and quality of life (QOL) outcomes among these subgroups. Patients/methodsOncology outpatients (n = 1331) completed measures of depression and sleep disturbance six times over two chemotherapy cycles. Latent profile analysis, that modeled the two symptoms together, was done to identify the distinct joint depression and sleep disturbance profiles. ResultsFive distinct profiles were identified (i.e., no depression or sleep disturbance (None, 21.4%); no depression and moderate sleep disturbance (32.3%); subsyndromal depression and very high sleep disturbance (20.4%); moderate depression and moderate sleep disturbance (17.7%); and high depression and very high sleep disturbance (8.2%)). Compared to the None class, the other four classes were more likely to be female; less likely to be employed; had a higher comorbidity burden; and had a lower functional status. Patients in the two very high sleep disturbance classes had problems with both sleep initiation and maintenance. These patients reported higher levels of depressive symptoms, trait and state anxiety, and fatigue as well as lower levels of energy, cognitive function, and poorer QOL. ConclusionsOver 45% of the patients had subsyndromal to high levels of depression AND moderate or very high levels of sleep disturbance. Characteristics associated with the higher risk profiles can be used to screen patients at increased risk for both symptoms.

Comparative cohort study of Duhamel and endorectal pull-through for Hirschsprung's disease.

BackgroundThere are limited data available to compare outcomes between surgical approaches for Hirschsprung’s disease. Duhamel and endorectal pull-through (ERPT) are two of the most common procedures performed worldwide.MethodsObjective outcomes were compared between contemporary cohorts (aged 4–32 years) after Duhamel or ERPT using case–control methodology. Data were collected using prospectively administered standardized questionnaires on bowel and bladder function and quality of life (Pediatric Quality of Life Inventory, Short form 36 and Gastrointestinal Quality of Life Index). Patients were compared in two age groups (18 years and younger and older than 18 years) and reference made to normative control data. Multivariable analysis explored factors associated with poor outcomes.ResultsCohorts were well matched by demographics, disease characteristics and incidence of postoperative complications (120 patients who underwent Duhamel versus 57 patients who had ERPT). Bowel function scores were similar between groups. Patients who underwent Duhamel demonstrated worse constipation and inferior faecal awareness scores (P < 0.01 for both age groups). Recurrent postoperative enterocolitis was significantly more common after ERPT (34 versus 6 per cent; odds ratio 15.56 (95 per cent c.i. 6.19 to 39.24; P < 0.0001)). On multivariable analysis, poor bowel outcome was the only factor significantly associated with poor urinary outcome (adjusted odds ratio 6.66 (95 per cent c.i. 1.74 to 25.50; P = 0.006)) and was significantly associated with markedly reduced quality of life (QoL) in all instruments used (P < 0.001 for all). There were no associations between QoL measures and pull-through technique.ConclusionOutcomes from Duhamel and ERPT are good in the majority of cases, with comparable bowel function scores. Constipation and impaired faecal awareness were more prevalent after Duhamel, with differences sustained in adulthood. Recurrent enterocolitis was significantly more prevalent after ERPT. Clustering of poor QoL and poor functional outcomes were observed in both cohorts, with seemingly little effect by choice of surgical procedure in terms of QoL.

Treatment and Survivorship Interventions to Prevent Poor Body Image Outcomes in Breast Cancer Survivors.

Body image concerns often arise during and after treatment and are a major concern in up to 67% of breast cancer survivors. Negative changes in body image are a predictor of worse satisfaction with appearance and poor quality of life outcomes. Opportunities to mitigate the negative impact of cancer treatment on a patient’s body image present during preoperative education or in the neoadjuvant setting, or during surgical management, adjuvant therapy delivery, and survivorship. The surgical management of breast cancer has evolved from breast amputations to procedures that provide improved cosmesis without compromising the oncologic outcome. The advent of the sentinel lymph node biopsy and lymphatic reconstruction techniques has led to decreased axillary morbidity. Modified radiation techniques and systemic therapies tailored to subtype limit unnecessary exposure to skin and systemic toxicities. Finally, incorporating prehabilitation and survivorship support optimizes the physical and psychosocial well-being of these patients. Setting expectations, treatment de-escalation when appropriate, morbidity risk reduction and improved screening and management of psychological sequelae during survivorship can decrease breast cancer treatment’s negative impact on body image. The following review synthesizes interventions during preoperative planning, local and systemic treatment, and survivorship to prevent poor body image outcomes without compromising oncologic success.

Surgical factors associated with patient-reported quality of life outcomes after free flap reconstruction of the oral cavity

ObjectivesTo determine which surgical factors are associated with quality-of-life (QOL) outcomes in oral cavity cancer survivors after free flap reconstruction of the oral cavity. Patients and MethodsA cross-sectional study was conducted from a multidisciplinary head and neck cancer (HNC) survivorship clinic. Oral cavity cancer survivors with at least 6-months of postoperative follow-up from ablation and free flap reconstruction were included. Primary outcome measures were validated patient-reported outcome measures (PROMs) including the Eating Assessment Tool-10 (EAT-10) measure of swallowing-specific QOL, University of Washington Quality of Life (UW-QOL) physical and social-emotional subscale scores and feeding tube dependence. ResultsExtent of tongue resection was associated with EAT-10 and the UW-QOL Physical subscale scores. Patients with oral tongue defects reported worse scores than with composite defects in the EAT-10 and UW-QOL physical domain (p = 0.0004, 0.0025, respectively). This association no longer applies when controlling for differences in extent of tongue resection. Patients with anterior composite resections reported worse EAT-10 scores than lateral resections (p = 0.024). This association no longer applies when controlling for extent of tongue resection (p = 0.46). Gastric tube dependence demonstrates similar trends to PROMs. ConclusionExtent of tongue resection was strongly associated with poor QOL outcomes after free tissue reconstruction of the oral cavity and mediates the associations between other defect characteristics and QOL. These findings demonstrate the need for emphasis on expected oral tongue defects when counseling patients and highlight the need to address QOL in a multidisciplinary fashion post-operatively.

Distinct profiles of multiple co-occurring symptoms in patients with gastrointestinal cancers receiving chemotherapy.

Identify subgroups of gastrointestinal (GI) cancer patients with distinct multiple co-occurring symptom profiles and evaluate for differences among these subgroups in demographic and clinical characteristics and quality of life (QOL) outcomes. Patients with GI cancers (n = 399) completed the Memorial Symptom Assessment Scale (MSAS) that was used to assess for multiple co-occurring symptoms. Latent class analysis (LCA) was used to identify subgroups of patients with distinct symptom profiles using symptom occurrence ratings. Differences in demographic and clinical characteristics and QOL outcomes among the subgroups were evaluated using parametric and nonparametric tests. All Low (36.6%), Moderate (49.4%), and All High (14.0%) classes were identified. Compared to the All Low class, patients in the other two classes were significantly younger and were more likely to report depression and back pain. Compared to the other two classes, patients in the All High class had fewer years of education and a higher number of comorbidities. Significant differences were found among the three classes for comorbidity burden and total number of MSAS symptoms (i.e., All Low < Moderate < All High), as well as for performance status (i.e., All Low > Moderate > All High). A higher symptom burden was associated with poorer QOL outcomes. The first study to identify subgroups of patients with GI cancers based on distinct symptom profiles. LCA allowed for the identification of risk factors associated with a higher symptom burden. Clinicians can use this information to identify high-risk patients and develop personalized symptom management interventions.

Beyond morbidity and mortality: The practicality of measuring patient-reported outcomes in trauma

Background: The 2016 Zero Preventable Deaths report highlighted the need for comprehensive injury data to include long term outcomes such as societal and workforce re-entry. Currently, postinjury quality of life is poorly understood. We hypothesized that routine measurement of patient-reported outcomes is feasible as a part of post-discharge follow-up, and that trauma patients would report that their injury had a detrimental impact on health-related quality of life (HRQoL) after discharge.Methods: After instruction, patients self-administered the PROMIS-29 instrument in our outpatient office (11/2019-4/2020). We surveyed 7 domains: Participation in Social Roles/Activities, Anxiety, Depression, Fatigue, Pain Interference, Physical Function, and Sleep Disturbance. Results are reported as means (SD) and compared to the U.S population by t-score (mean score=50). Higher scores in negatively-worded domains (e.g. “Depression”) are worse; vice versa for positively-worded domains (e.g. “Physical Function”). Repeated scores among patients returning for a second visit were analyzed using paired t-tests.Results: 103 patients completed the PROMIS-29. Mean (SD) age was 42.3 (17.3) years, 75% were male, and 42% suffered a penetrating injury. Median length of stay was 3 days and median time from injury to clinic visit was 18 days. Mean scores were worse than population means in every domain. Pain Interference (mean 63.5, 95%CI [61.8-65.3]) and Physical Function (38.0 [36.2-39.8]) were particularly affected. Among patients returning for a second visit (n=10; median time between clinic visits: 17.5 days), there were no significant differences in domain scores over time.Conclusion: Trauma patients are at high risk for poor quality of life outcomes in the short term following injury. Our results highlight the need for early recognition and multidisciplinary treatment following injury.

Oral and oropharyngeal cancer surgery with free-flap reconstruction in the elderly: Factors associated with long-term quality of life, patient needs and concerns. A GETTEC cross-sectional study

ObjectivesTo assess the factors associated with long-term quality of life (QoL) and patient concerns in elderly oral or oropharyngeal cancer (OOPC) patients after oncologic surgery and free-flap reconstruction. MethodsPatients aged over 70 years who were still alive and disease-free at least 1 year after surgery were enrolled in this cross-sectional multicentric study. Patients completed the EORTC QLQ-C30, -H&N35 and -ELD14 QoL questionnaires, and the Hospital Anxiety and Depression Scale (HADS). Patient needs were evaluated using the Patient Concerns Inventory (PCI). Factors associated with these clinical outcomes were determined in univariate and multivariate analysis. ResultsSixty-four patients were included in this study. Long-term QoL, functioning scales and patient autonomy were well-preserved. Main persistent symptoms were fatigue, constipation and oral function-related disorders. Salivary and mastication/swallowing problems were the main patient concerns. The mean number of patient concerns increased with the deterioration of their QoL. Psychological distress (HADS score ≥ 15) and patient frailty (G8 score < 15) were significantly associated with poor QoL outcomes. ConclusionsWe found a negative correlation between the number of patient concerns and QoL. Dental rehabilitation and psychological and nutritional supportive measures are of critical importance in the multidisciplinary management of elderly OOPC patients.