Poorer Quality Of Life Scores Research Articles

Poor quality of life is associated with obesity and sedentary life style in atherosclerotic disease: a cross-sectional study / A má qualidade de vida está associada à obesidade e ao estilo de vida sedentário na doença aterosclerótica: um estudo transversal

The Health-related quality of life (HRQoL) is an important measure of the health status of a population. It can be related to nutritional status and risk factors of cardiovascular disease.This study aimed to assess the quality of life and the association with nutritional status and other modifiable risk factors in patients with atherosclerotic disease.This is a cross-sectional study carried out in two public health centers in Rio de Janeiro, Brazil. A total of 273 participants with a documented history of atherosclerotic disease in the last ten years from their entry to the study. Quality of life (SF-36 questionnaire); physical activity; food intake (food frequency questionnaire), blood pressure; anthropometric and biochemical measures were assessed. Poor quality of life scores were identified, women had lower scores (p0.05) for all SF-36 domains. Obesity was associated with a decreased score of SF-36 physical and mental health domains. Sedentary lifestyle was associated with poorer quality of life in almost all domains assessed. The adoption of healthy weight and appropriate physical activity was associated with better quality of life in patients with atherosclerotic disease.

Effects of Treatment Adherence on Quality of Life in Hypoparathyroid Patients.

This study aimed to evaluate the current situation of hypoparathyroid patients and to investigate the relationship between treatment adherence and quality of life. Prospective, multicentre study. Adult patients presenting with the diagnosis of hypoparathyroidism to 20 different endocrinology clinics were included. They were receiving conventional therapies for hypoparathyroidism, using calcium, active vitamin D, and magnesium. We collected data on demographic features, disease- and treatment-related information, and results of routine laboratory tests, treatment adherence, and presence of complications. Beck Depression Inventory, Beck Anxiety Inventory, and Short Form-36 quality of life assessments were administered. Among the 300 patients studied, 60.7% were adherent to their treatment, and 34.1% had complications. Anxiety and depression scores were significantly higher in non-adherent versus treatment-adherent patients (p<0.001 and p=0.001, respectively). Most of the domains of quality-of-life scores were also significantly lower in non-adherent patients. Both anxiety and depression scores showed significant, negative correlations with serum calcium and magnesium concentrations (r=-0.336, p<0.001 and r=-0.258, p<0.001, respectively). Nearly 40% of the patients were non-adherent to conventional treatment for hypoparathyroidism, and such patients had higher anxiety and depression scores and poorer quality of life scores. Conventional treatment might not be sufficient to meet the needs of patients with hypoparathyroidism. In addition to seeking new therapeutic options, factors influencing quality of life should also be investigated and strategies to improve treatment adherence should be developed.

Ten-Year Survivorship, Patient-Reported Outcome Measures, and Patient Acceptable Symptom State After Over-the-Top Hamstring Anterior Cruciate Ligament Reconstruction With a Lateral Extra-articular Reconstruction: Analysis of 267 Consecutive Cases

Background: Long-term patient-reported outcome measures (PROMs) and predictors of success or failure after anterior cruciate ligament (ACL) reconstruction are not fully understood, especially when combined with a lateral extra-articular reconstruction. Purpose: To assess the long-term PROMs, revision rate, and predictors of success or failure after ACL reconstructions using an over-the-top surgical technique with single-bundle hamstring tendon autografts and a lateral extra-articular reconstruction. Study Design: Case series; Level of evidence, 4. Methods: The study cohort consisted of 267 consecutive patients (mean age, 30.7 years) who underwent ACL reconstruction with an over-the-top surgical technique with single-bundle hamstring tendon autografts and a lateral extra-articular augmentation between November 2007 and May 2009. The number of subsequent ACL revisions and reoperations were recorded. Subjective clinical status was assessed with PROMs—specifically, the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm, Tegner, and visual analog scale for pain—at a minimum follow-up of 10 years. Results: Overall, 3% of patients underwent ACL revision, with a 10-year survival rate of 96.3%. High sport activity (hazard ratio, 6.9; P = .285) and concomitant meniscal lesion (hazard ratio, 2.6; P = .0487) were predictors of ACL revision or new meniscectomy. The mean ± SD Lysholm score was 94.1 ± 10.8, while that for the visual analog scale for pain was 0.2 ± 0.9 at rest and 2.1 ± 2.6 during activity. KOOS subscale scores were as follows: 95.7 ± 8.1 for Pain, 92.5 ± 10.5 for Symptoms, 98.4 ± 7.4 for Activities of Daily Living, 90.7 ± 17.2 for Sport, and 91.2 ± 17.1 for Quality of Life; respectively, 88%, 99%, 81%, 89%, and 91% of patients achieved the Patient Acceptable Symptom State. Female sex and chondropathy with Outerbridge grade ≥2 were predictors of worse KOOS subscales. Overall, 82% of patients returned to sport, and 57% were still participating at the 10-year evaluation. Conclusion: ACL reconstruction with an over-the-top surgical technique with single-bundle hamstring autografts and a lateral extra-articular reconstruction provided satisfactory results in terms of function, symptoms, sports, and quality of life in 80% to 90% of patients after 10 years. Long-term survivorship was 96%. Sport participation declined from 82% postoperatively to 57% at long-term follow-up. A concomitant medial meniscal lesion was a predictor of higher risk of ACL failure or new meniscal lesion, while advanced chondropathy and female sex were predictors of higher pain, lower function, and poor quality of life scores.

Prevalence, risk factors and quality of life of Lower Urinary Tract Symptoms (LUTS) among men attending Primary Care slum clinics in Bangalore: A cross-sectional study.

Background:Men, more than 50 years of age, have a higher incidence of lower urinary tract symptoms (LUTS), and this increases with the advancing age. The prevalence of LUTS varies in different geographical areas across the world, and studies have reported that LUTS in men may significantly affect the quality of life (QoL) and influence their health-seeking behavior. Early detection of LUTS is essential as it is related to several complications. This study aimed to estimate the prevalence of LUTS and factors associated with LUTS and health-seeking behavior.Methods:We interviewed 201 men (>50 years) attending two urban primary care clinics in Bangalore using the IPSS questionnaire and calculated the prevalence of LUTS. Factors associated with LUTS and health seeking-behavior were tested using the Chi-square test. A P-value less than 0.05 was considered as significant.Results:The prevalence of LUTS was 85%. LUTS was significantly associated with those having diabetes and those consuming more than two cups of tea per day. The most common symptom was nocturia (85.4%) and a weak stream (35.0%). Moderate and severe LUTS were significantly associated with poor QoL score (P < 0.0001). Only 9.3% of the men sought medical help in spite of their symptoms, and the most common reason for seeking health care was the disturbance they had due to the urinary symptoms (81.3%).Conclusions:Family physicians should be aware that a significant proportion of the men in the age group of 50 years suffer from LUTS, and eliciting the same is essential during the process of consultation.

Assessment of Quality of Life and Functional Outcomes of Operated Cases of Hirschsprung Disease in a Developing Country.

PurposeChildren treated for Hirschsprung disease (HD) are adversely affected by fecal incontinence and soiling. This can be detrimental to their physical, psychosocial quality of life (QoL) and impacts the normal functioning of their family. QoL studies in HD are predominantly from developed countries. We measured general quality of life, impact on family and functional bowel status using validated questionnaires in HD children in a developing country.MethodsPatients with HD, treated in a tertiary paediatric institution in India between 2010 and 2017, were identified. Patients and/or their proxy completed the Pediatric Quality of Life and Family Impact Module questionnaires. Functional outcomes were assessed using Rintala's score.ResultsA 86 children and their parents participated in the study. Majority had rectosigmoid disease (67.4%) and underwent Soave's endoanal pull through (74.4%). A 21% of patients had low Rintala score indicating poor functional bowel outcomes. Only 11% of children had poor QoL scores. Family functioning outcomes were also severely affected in the same subgroup of patients. There was statistically significant correlation between Rintala score and QoL scores (p-value<0.001). Disease severity, type of surgery, and duration of follow-up did not have a statistically significant impact on the QoL.ConclusionQoL in children with HD was comparable to the general population. Bowel dysfunction affects a notable number of children and was the most significant determinant of poor QoL.

A descriptive study on prevalence of arm/shoulder problems and its impact on quality of life in breast cancer survivors.

Surgery for breast cancer and adjuvant radiotherapy are frequently associated with impairment of arm/shoulder function and development of lymphedema. However, most of the studies in Indian breast cancer survivors (BCSs) have focused on the development of lymphedema even though restriction of shoulder movement and pain are even more prevalent and adversely affect the quality of life (QOL). Hence, this study was conducted with the objectives to (1) study the prevalence of arm/shoulder problems (ASPs) including restricted shoulder mobility (ROM), lymphedema and arm/shoulder pain (2) assessment of the QOL in BCSs (3) to study the impact of ASPs on QOL. This descriptive study was conducted on BCSs at an academic center in Delhi These patients underwent a mastectomy and axillary lymph node dissection with adjuvant therapies and were within 6 months to 5 years of follow-up. Assessment of ASPs was done using Kwan's arm problem scale (KAPS), and survivors with scores of more than 21.5 were considered to have significant ASPs. Assessment of shoulder movements was done by using a goniometer, lymphedema by measuring arm circumference at multiple points and arm/shoulder pain by using a numerical pain rating scale (NPRS). QOL was assessed using short form (SF-36) questionnaire. A total of 212 BCSs were studied with a mean duration of follow-up of 2.7 years (range = 6 months - 60 months). The prevalence of ASPs was 49% on KAPS. Prevalence of ROM, lymphedema, and arm/shoulder pain was found to be 51%, 27%, and 12% respectively. Patients with ASPs had poorer QOL scores on SF-36, significantly affecting both physical and mental component summary score. Among ASPs, worst scores were reported for limb swelling. There is a high prevalence of ASPs in BCSs. Survivorship care plans should appropriately address these issues.

The prevalence of malnutrition and impact on patient outcomes among older adults presenting at an Irish emergency department: a secondary analysis of the OPTI-MEND trial

BackgroundMalnutrition is common among older adults and is associated with adverse outcomes but remains undiagnosed on healthcare admissions. Older adults use emergency departments (EDs) more than any other age group. This study aimed to determine the prevalence and factors associated with malnutrition on admission and with adverse outcomes post-admission among older adults attending an Irish ED.MethodsSecondary analysis of data collected from a randomised controlled trial exploring the impact of a dedicated team of health and social care professionals on the care of older adults in the ED. Nutritional status was determined using the Mini Nutritional Assessment- short form. Patient parameters and outcomes included health related quality of life, functional ability, risk of adverse health outcomes, frailty, hospital admissions, falls history and clinical outcomes at index visit, 30-day and 6-month follow up. Aggregate anonymised participant data linked from index visit to 30-days and 6-month follow-up were used for statistical analysis.ResultsAmong 353 older adults (mean age 79.6 years (SD = 7.0); 59.2% (n = 209) female) the prevalence of malnutrition was 7.6% (n = 27) and ‘risk of malnutrition’ was 28% (n = 99). At baseline, those who were malnourished had poorer quality of life scores, functional ability, were more frail, more likely to have been hospitalised or had a fall recently, had longer waiting times and were more likely to be discharged home from the ED than those who had normal nutrition status. At 30-days, those who were malnourished were more likely to have reported another hospital admission, a nursing home admission, reduced quality of life and functional decline than older adults who had normal nutrition status at the baseline ED visit. Differences between the MNA SF and 6-month outcomes were similar but not statistically significant.ConclusionOver one-third of older adults admitted to an Irish ED are either malnourished or at risk of malnourishment. Malnutrition was associated with a longer stay in the ED, functional decline, poorer quality of life, increased risk of hospital admissions and a greater likelihood of admission to a nursing home at 30 days.Trial registrationProtocol registered in ClinicalTrials.gov, ID: NCT03739515, first posted November 13, 2018.

Neurocognitive and Quality-of-life Outcomes Following Intensive Care Admission: A Prospective 6-month Follow-up Study.

BackgroundPost-intensive care survivors have decreased quality-of-life scores and prolonged cognitive dysfunction due to baseline factors and events related to intensive care unit admission, which remain largely unrecognized.Materials and methodsA prospective observational cohort study to assess the quality of life and occurrence of cognitive dysfunction, 3 and 6 months following discharge from the intensive care unit, was carried out. We enrolled 136 adults presenting to the intensive care unit with no prior cognitive dysfunction or depression and followed up and assessed them with repeatable battery for the assessment of neuropsychological status (RBANS) and quality of life with short Form-36 (SF-36) health survey.ResultsThe incidence and prevalence of cognitive dysfunction was 100% at 3 and 6 months, respectively, as assessed by RBANS with a global cognition scores at 3 and 6 months of 71 (IQR 68.5–73) and 74 (IQR 72–86), respectively. Higher Charlson's comorbidity score, increased severity of illness, longer duration of mechanical ventilation, pain, delirium, coma, and hospital stay were associated with statistically significant lower scores at 3 months. The median SF-36 mental component score (MCS) and physical component score (PCS) at 3 months were 38.4 and 32.5 and at 6 months were 38.2 and 32.6, respectively. Poor score was associated significantly with advancing age, poor functional parameters at baseline as evidenced by clinical frailty, poor baseline Katz ADL scores, increased severity of illness, longer duration of mechanical ventilation, occurrence and duration of delirium, coma, pain, and usage of sedatives with or without analgesics.Conclusion and clinical significancePatients discharged from the intensive care unit are at high risk for persistent cognitive impairment and poor quality of life score. Poor baseline patient characteristics and events occurring in ICU are associated with worse cognition and quality of life scores. There is an urgent need to prevent, diagnose, and manage these patients by optimizing intensive care practices.How to cite this articleBalasubramanian V, Suri JC, Ish P, Gupta N, Behera D, Gupta P, et al. Neurocognitive and Quality-of-life Outcomes Following Intensive Care Admission: A Prospective 6-month Follow-up Study. Indian J Crit Care Med 2020;24(10):932–937.

Rural Patients With Heart Failure And Multiple Chronic Conditions: A Cross-Sectional, Descriptive Study

Introduction Living in a rural area increases the risk of adverse heart failure (HF)-related outcomes including decreased quality of life (QOL). Multiple chronic conditions (MCC) are also known to affect QOL. HF is frequently accompanied by MCC including hypertension (HTN), diabetes (DM), pulmonary disease, and/or renal dysfunction. However, little is known about the occurrence of these HF+MCC clusters and their impact on QOL in rural patients. Therefore, we aimed to identify and describe HF+MCC clusters and examine characteristics including demographics, ejection fraction (EF), and QOL across clusters in a sample of rural adults with HF. Methods We used data previously collected by the RICH Heart Program at the University of Kentucky. Subjects in the database with rural-urban commuting area codes of 7-10 were considered rural. We extracted demographics, EF, MCC (coronary heart disease (CHD), HTN, peripheral vascular disease, stroke, pulmonary disease, DM, peptic ulcer disease (PUD), dementia, renal disease, connective tissue disease, liver disease, dementia, AIDS, and cancer), and responses to the Minnesota Living with Heart Failure Questionnaire (MLHFQ) for analysis. Latent class analysis, one-way ANOVA, and Chi-square tests were applied as appropriate. Results Subjects (n=839) were mostly male (513/839, 61.1%), non-Hispanic (601/839, 71.9%), White/Caucasians (715/839, 85.2%) with a mean age of 64.8 ± 12.8 and EF of 38.2 ±15. HTN was the most reported MCC followed by CHD. Mean MLHFQ for all subjects was 44.6 ± 26.9. A three-class (HF+MCC cluster) solution was the best fitting latent model. Discriminatory MCC were DM and PUD. HF+MCC Cluster 1 (n=367, 43.7%) was defined by DM and the largest proportion of members with HTN. HF+MCC Cluster 2 (n=70, 8.3%) had the greatest proportion of comorbidities overall, the highest proportion of PUD, and zero members with DM. HF+MCC Cluster 3 (n=402, 47.9%) had the least proportion of comorbidities and was differentiated by no class members with PUD. We compared the MLHFQ total QOL score (lower scores reflect better QOL) across clusters. Mean scores (Cluster 1 - 51.4 ± 26.4, Cluster 2- 48.8 ± 26.5, Cluster 3- 37.7 ± 25.7) were significantly different (F(2,834)=27.25, p= Conclusions Most subjects in this sample reported MLHFQ scores that indicate poor QOL (scores >45). Cluster 3 members reported better QOL (lower scores) which is likely related to the low HF+MCC burden in this class. Interestingly, Cluster 1 members reported the lowest QOL (highest MLHFQ scores) despite Cluster 2 including a greater HF+MCC burden. Cluster 1 included the highest proportion of members with DM which may have driven this finding. QOL interventions in rural patients with HF should be designed to account for the number of MCC and the influence of HF+MCC clusters.

Assessment of quality of life in parents of epileptic children and its associated factors

Background: Aim of the study was to assess quality of life (QOL) of parents of epileptic child and its association with various factors like demographic, clinical, therapeutic and behavioral factors.Methods: Consenting parents of 160 epileptic children were enrolled after finishing child’s visit to the pediatrician. Parents were enquired on baseline demographic variables like age, gender, socio-economic status, parental education; clinical details like type of epilepsy, duration of seizure, seizure frequency and co-morbidity and therapeutic factors like treatment of epilepsy and adverse drug reactions. QOL was evaluated using QOLCE questionnaire and Childhood Illness-related Parenting Stress Inventory and analysed.Results: Out of 160 parents, 85% belong to 30-40 years of age and 62.5% were male. Deteriorated quality of life was reported by parents as mean score 63.46±7.69. QOL was significantly poor (p&lt;0.05) in parents of younger child (&lt;6 yrs), education status (upto primary school only), employment status of parent (unemployed) and lower socioeconomic status. Assessment of disease related parameters revealed that type of seizure, seizure frequency, duration and co-morbidity were factors significantly affecting quality of life of parents with lower QOL scores(p&lt;0.05). QOL of parents of child with epilepsy undergoing polytherapy with multiple AEDs treatment, particle seizure control and having adverse drug reaction were associated with poor scores of health and well being (p&lt;0.05). It was found that parents of epileptic child had deteriorated QOL score with respect to behaviour patterns irrespective to conditions of epilepsy due to constant stress and anxiety and poor state of mind.Conclusions: QOL of parents was compromised in Indian children with epilepsy. Demographic factors like age of child, parental education, socio-economic status and clinical factors like type of seizure, frequency &amp; duration of seizure and co-morbid conditions significantly affect the QOL of parents. Significantly poor QOL scores was also due to therapeutic factors like treatment with polytherapy and adverse drug reactions with poor behavioral patterns which was observed in parents that should be taken care and should not be overlooked.

Evaluation of the Japanese Version of the Cancer Survivors' Unmet Needs Scale

Objective:This study aimed to evaluate the psychometric properties of the Japanese version of the Cancer Survivors' Unmet Needs (CaSUN-J) scale among cancer survivors in Japan.Methods:The CaSUN-J was developed using standardized translation methodology. Content validity was evaluated by a group of experts, and a pilot test was conducted with a convenience sample of 10 cancer patients. A total of 183 Japanese cancer survivors completed the CaSUN-J. The internal consistency of the scale was examined with Cronbach's α. Construct validity was analyzed using correlations with the physical effects, quality of life (QoL), and age. To assess the factorial validity of the CaSUN-J, confirmatory factor analysis (CFA) was performed.Results:The CaSUN-J indicated good readability and high content validity for use as an assessment tool among Japanese cancer survivors. All Cronbach's α coefficients were above the minimum acceptable criterion of ≥0.70. For construct validity, higher physical effect scores, as well as poorer QoL scores and younger patients, were significantly positively associated with higher levels of needs. CFA indicated that the five-factor structure of the CaSUN-J was a good fit to the data.Conclusions:The CaSUN-J can serve as a valid and reliable tool to evaluate unmet needs among Japanese cancer survivors.

Predictors of Health-Related Quality of Life After Revision Total Hip Arthroplasty for Aseptic Loosening.

Few studies have investigated the relationships between preoperative or intraoperative patient factors and postoperative quality of life (QOL) after revision total hip arthroplasty (THA). The aim of our study was to identify the predictors of QOL after revision THA for aseptic loosening. Fifty-one patients who underwent revision THA for aseptic loosening were included in the present study. Preoperative hip function was evaluated using the Japanese Orthopaedic Association (JOA) score. The patients' QOL after surgery was evaluated with EuroQol 5D (EQ-5D) assessment at the end of the 2-year follow-up. The patients were then divided into two groups: good QOL (score ≥ 0.6) and poor QOL (score < 0.6). Predictive factors (i.e., age, BMI, preoperative JOA score, and the degree of acetabular bone defect according to the Paprosky classification) were compared between both QOL groups. Furthermore, multiple linear regression was performed to assess independent factors affecting the QOL. Significant differences between the good and poor QOL groups were identified for BMI, walking ability, and severity of acetabular bone defect (BMI: 21.5 ± 2.9 vs. 24.1 ± 4.3, P = 0.0331; walking ability: 11.5 ± 5.0 vs. 5.5 ± 4.9, P = 0.0058; acetabular bone defect: 44.4% vs. 81.0%, P = 0.0103). The walking ability independently affected the EQ-5D utility score. The present study indicates that a higher BMI, lower walking ability, and more severe acetabular bone defect are predictors of lower QOL after revision THA for aseptic loosening. In particular, the walking ability was the only independent factor. Thus, surgeons should pay attention to the postoperative management of patients with these risk factors.

Long-term quality of life in patients with vestibular schwannoma managed with microsurgery.

Little is known about the long term (greater than 10 years) quality of life in patients with vestibular schwannoma. This study aimed to evaluate long-term outcomes in patients with vestibular schwannoma. A retrospective cohort study was performed across 2 academic institutions, with patients followed at least 10 years after vestibular schwannoma surgery (2000 to 2007). Telephone interviews were used to assess quality of life using the Glasgow Benefit Inventory and short form 12 item (version 2) health survey. A total of 99 out of 110 patients were included. Increasing age and symptom burden were associated with poorer quality of life (p = 0.01 and 0.02, respectively). The presence of imbalance, headache and facial nerve dysfunction were all associated with poorer quality of life scores (p = 0.01, 0.04 and 0.02, respectively). Identifying and managing post-operative symptoms may improve quality of life in vestibular schwannoma patients and can guide clinical decision making.

Effect of joint range of motion on health-related quality of life in children with hemophilia

BackgroundAssessment of quality of life (QOL) in patients with hemophilia is important for the disease outcome. In patients with hemophilia, repeated occurrences of hemarthrosis lead to limitations in range of motion (ROM) of major joints.ObjectiveThe aim of this work is to assess joint ROM and detect the presence of limitation of joint ROM in patients with hemophilia and their effect on the QOL in these patients.Patients and methodsThe study included 25 children with hemophilia recruited from Pediatric Hematology Unit, Fayoum University Hospital, during the period from June 2016 to December 2016. Their ages ranged between 4 and 16 years. Large joint examination and measurement of joint ROM were done at rheumatology clinic using goniometry by rheumatologist. QOL was assessed by using the hemophilia QOL questionnaire.ResultsThe most impaired dimensions of QOL were family, treatment, and physical domains. Total health-related quality of life (HRQOL) score, physical health, view of self, and sport and school scores were found worse with increasing age. Patients who had target joints had poor QOL score. Limitation of movement (LOM) of the knee and ankle joints mainly impaired the physical and social aspects and the overall HRQOL, and LOM of shoulder joint impaired the treatment domain.ConclusionAge of the patient was found a factor affecting the total HRQOL score, in addition to physical, view of self, and sport and school dimensions. LOM of the knee and ankle joints mainly impaired physical and social aspects and the overall HRQOL.

1599P - The relation between the symptom burden of hospitalized patients with incurable cancer and the quality-of-life of their family caregivers

BackgroundFamily caregivers (FCs) play important roles in the care provided to patients with incurable cancer. These patients experience a wide range of distressing symptoms. This symptom burden may add to the burden of FCs and consequently may have a negative impact on their quality of life (QoL). This study was conducted to determine the relationship between the symptom burden in a cohort of patients with incurable cancer and the QoL of their FCs. MethodsThe study included 94 dyads of hospitalized incurable cancer patients and one of their FCs. The symptom burden among patients was assessed using the revised Edmonton Symptom Assessment System (ESAS-r) and the QoL of their FCs was measured using the Medical Outcomes Study 36-Item Short-Form (MOS SF-36) questionnaire. ResultsNausea was the most common symptom to associate with poorer QoL scores. There was a significant negative correlation between nausea and the following MOS SF-36 scales: physical functioning (r=-0.219, p=0.034), role limitations due to physical health (r =-0.0228, p=0.027), pain (r=-0.404, p<0.001), general health (r =-0.222, p=0.031) and health change (r=-0.317, p=0.002). Other symptoms that correlated significantly with at least one of the MOS SF-36 scales were weakness, drowsiness, lack of appetite, shortness of breath, depression and wellbeing. The total ESAS-r score correlated significantly with poorer scores on the pain (r=-0.248, p=0.016) and health change (r=-0.311, p=0.002) scales of MOS SF-36. In addition; older FCs age, hours of care per day, total period of care, FCs employment and inadequate income correlated significantly with poorer scores of at least one of the MOS SF-36 scales. ConclusionsThe high symptom burden experienced by patients with incurable cancer may have a negative impact on the QoL of their FCs, especially the physical aspect. Legal entity responsible for the studyClinical Oncology Department, Menofia University. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Quality of Life and Associated Factors among Primary Care Asian Patients with Type 2 Diabetes Mellitus.

Diabetes complications, medication adherence, and psychosocial well-being have been associated with quality of life (QOL) among several Western and Asian populations with diabetes, however, there is little evidence substantiating these relationships among Malaysia’s unique and diverse population. Therefore, a cross-sectional study was conducted in a Malaysian public primary care clinic among 150 patients diagnosed with type 2 diabetes mellitus (T2DM). Structured and validated questionnaires were used to investigate the associations between demographic, clinical, and psychological factors with QOL of the study participants. Approximately three-quarters of patients had a good-excellent QOL. Diabetes-related variables that were significantly associated with poor QOL scores included insulin containing treatment regimens, poor glycemic control, inactive lifestyle, retinopathy, neuropathy, abnormal psychosocial well-being, higher diabetes complication severity, and nonadherence (p < 0.05). The main predictors of a good-excellent QOL were HbA1c ≤ 6.5% (aOR = 20.78, 95% CI = 2.5175.9, p = 0.005), normal anxiety levels (aOR = 5.73, 95% CI = 1.8–18.5, p = 0.004), medication adherence (aOR = 3.35, 95% CI = 1.3–8.7, p = 0.012), and an aDCSI score of one and two as compared to those greater than or equal to four (aOR = 7.78, 95% CI = 1.5–39.2, p = 0.013 and aOR = 8.23, 95% CI = 2.1–32.8, p = 0.003), respectively. Medication adherence has also been found to be an effect modifier of relationships between HbA1c, depression, anxiety, disease severity, and QOL. These predictors of QOL are important factors to consider when managing patients with T2DM.

OVQUEST – Life after the diagnosis and treatment of ovarian cancer - An international survey of symptoms and concerns in ovarian cancer survivors

ObjectivesOur aim was to investigate the prevalence and potential risk factors for persistent and troublesome physical and psychological symptoms following treatment for ovarian cancer (OC). MethodsOvQuest is an international, internet-based, cross-sectional questionnaire which explored symptom burden and quality of life (QOL) after treatment for OC. Eligible women were aged 18 and over, diagnosed with OC at least 6 months previously and had received chemotherapy. Self-report data were collected including demographics, diagnosis and treatment, and standardised instruments for treatment-related toxicities, QOL, physical activity (PA) and supportive care needs. ResultsThe survey included 1360 patients, of whom 421 (31%) had been treated for recurrent OC. 78% reported symptoms of peripheral neuropathy, 60% significant fatigue, 48% mood disturbance and 59% moderate-severe insomnia. Rates of fatigue, mood disorders, neuropathy and insomnia did not differ between women with or without recurrence. The majority of respondents were overweight or obese (high BMI, 59%) and 35% reported low PA. Low PA and high BMI were associated with poorer QOL scores and higher symptom burden across a range of domains. ConclusionWomen living after a diagnosis of OC report a substantial and ongoing symptom burden which impacts significantly on their quality of life across multiple domains. The reported associations between obesity, physical inactivity and poor QOL warrant prospective evaluation of lifestyle interventions to improve QOL.

Long-term mortality and quality of life after trauma: an ancillary study from the prospective multicenter trial FROG-ICU

The long-term outcomes of intensive care unit (ICU) patients are known to be worse than those of the general population, but they are poorly known in severe trauma patients. We conducted an ancillary examination of the FROG-ICU study to identify risk factors and biomarkers associated with the poorer long-term outcomes and mortality in trauma ICU patients. Mortality, quality of life (QoL) and stress level scores were obtained 1year after discharge from ICU. Blood samples were collected at ICU admission and discharge for measurement of inflammatory and cardiovascular biomarkers. ICU trauma patients had a significantly lower 1-year mortality than non-trauma patients (7% vs. 23%, p < 0.001), but had worse stress levels scores (19 vs. 13, p = 0.041). No difference was found regarding physical and mental QoL scores (33 vs. 31, p = 0.19 and 30 vs. 28, p = 0.42). Patients with better QoL scores had lower tracheotomy rates (11% vs. 30%, p = 0.01). Worse stress level scores are associated with poor QoL scores and vice versa. Some study biomarkers were significantly higher in those ICU trauma patients who had worse QoL scores at 1year after discharge. Our study suggests that quality of life 1year after an ICU stay is poor and is similar in both trauma and non-trauma patients, but ICU trauma patients are at greater risk of developing post-traumatic stress disorder-related symptoms. Tracheotomy and high levels of inflammatory biomarkers could be associated with impaired quality of life.

Outcome of Frail Do-Not-Intubate Subjects With End-Stage Chronic Respiratory Failure and Their Opinion of Noninvasive Ventilation to Reverse Hypercapnic Coma.

The use of noninvasive ventilation (NIV) in the emergency setting to reverse hypercapnic coma in frail patients with end-stage chronic respiratory failure and do-not-intubate orders remains a questionable issue given the poor outcome of this vulnerable population. We aimed to answer this issue by assessing not only subjects' outcome with NIV but also subjects' point of view regarding NIV for this indication. A prospective observational case-control study was conducted in 3 French tertiary care hospitals during a 2-y period. Forty-three individuals who were comatose (with pH < 7.25 and PaCO2 > 100 mm Hg at admission) were compared with 43 subjects who were not comatose and who were treated with NIV for acute hypercapnic respiratory failure. NIV was applied by using the same protocol in both groups. They all had a do-not-intubate order and were considered vulnerable individuals with end-stage chronic respiratory failure according to well-validated scores. NIV yielded similar outcomes in the 2 groups regarding in-hospital mortality (n = 12 [28%] vs n = 12 [28%] in the noncomatose controls, P > .99) and 6-month survival (n = 28 [65%] vs n = 22 [51%] in the noncomatose controls, P = .31). Despite poor quality of life scores (21.5 ± 10 vs 31 ± 6 in the awakened controls, P = .056) as assessed by using the VQ11 questionnaire 6 months to 1 y after hospital discharge, a large majority of the survivors (n = 23 [85%]) would be willing to receive NIV again if a new episode of acute hypercapnic respiratory failure occurs. In the frailest subjects with supposed end-stage chronic respiratory failure that justifies treatment limitation decisions, it is worth trying NIV when acute hypercapnic respiratory failure occurs, even in the case of extreme respiratory acidosis with hypercapnic coma at admission.

Prostate cancer-related quality of life and risk for anxiety and depression.

41 Background: Due to side effects of invasive treatments, prostate cancer (PC) patients face long-term quality of life (QoL) concerns and enduring psychosocial distress. We explored how QoL is linked to distress among a national sample of men with PC. Methods: 214 men with PC enrolled in the Cancer Support Community’s Cancer Experience Registry. Participants provided demographic/clinical background and completed the Prostate Cancer-Related QoL Scales, covering 6 QoL domains ( urinary control, sexual intimacy, sexual confidence, masculine self-esteem, cancer control, and treatment regret). Psychosocial distress was captured by CancerSupportSource, a 25-item tool with 2-item depression and anxiety screening subscales. Scores ≥3 indicate risk for clinically significant depression or anxiety respectively, and signal need for referral and further assessment. We examined bivariate correlations between demographic/clinical background, QoL, and prevalence of ‘risk for clinically significant anxiety and depression’, and used logistic regression to calculate odds of anxiety and depression risk by QoL, adjusting for demographic/clinical variables. Results: Participants were 93% White; mean ( SD) age=64 (12) years; mean ( SD) years since diagnosis=4.3 (4.9); 25% had metastatic disease. 54% underwent radiation; 55% surgery. 40% were at risk for clinically significant anxiety; 35% depression. Poorer QoL scores for sexual intimacy, sexual confidence, masculine self-esteem, cancer control, and treatment regret were bivariately associated with anxiety ( p&lt;.05) and depression ( p&lt;.001) risk. In logistic regression, poorer perceived cancer control predicted anxiety risk (R2=.44; OR=0.97; p&lt;.01). Lower masculine self-esteem predicted depression risk (R2=.68; OR=0.88; p&lt;.05). Conclusions: Questioning treatment efficacy and worrying about disease progression (i.e., lower perceived cancer control) predicts greater likelihood of anxiety risk. Lower masculine self-esteem predicts odds of depression risk. These findings elucidate the ways that PC patients’ perceptions of advancing disease and diminishing masculinity are linked to distress, thus identifying areas for psycho-educational and supportive interventions.