Poorer Quality Of Life Scores Research Articles

Clinical benefit and quality of life in patients with advanced biliary tract cancer receiving gemcitabine plus capecitabine (GemCap): Results from a multicenter phase II trial (SAKK 44/02)

15531 Background: In patients (pts) with advanced biliary tract cancer receiving palliative chemotherapy, no information is available on clinical benefit response (CBR) and quality of life (QL). Methods: Pts with pathologically confirmed, untreated, locally advanced, unresectable or metastatic biliary tract cancer with Karnofsky Performance Status (KPS) 60–80, and/or daily analgesic consumption ≥10 mg morphine equivalents, and/or pain intensity ≥20 (range 0–100) received gemcitabine 1 g/m2 IV on days 1 & 8 and capecitabine 650 mg/m2 orally twice daily on days 1–14 of a 3-week cycle for up to 8 cycles. CBR criteria were rated prior to randomization and on treatment: pts rated pain intensity (0–100) and analgesic consumption daily; physicians rated KPS and weight weekly. CBR was defined as improvement from baseline for ≥4 consecutive weeks either in pain and KPS, or stability in one but improvement in the other, or stability in pain and KPS but improvement in weight. Stable CBR (SCBR) was defined as stability in all 4 criteria. Pts rated QL indicators at baseline, weekly during cycles 1–3, and then twice per cycle. The primary endpoint was the proportion of pts with CBR or SCBR within the first 3 cycles. Associations between QL and CBR, objective response (OR), time to progression (TTP) and overall survival (OS) were described. Results: All 44 pts (median age: 65 years) enrolled from 6 Swiss centers between 2003 and 2006 completed baseline CBR and QL assessments. On treatment, 95% (771/812) of CBR and 92% (560/607) of QL assessments were completed. In the first 3 cycles, 16 pts (36%) had a CBR and 15 pts (34%) a SCBR. Baseline QL scores were moderate to good. Most QL indicators improved from cycle 3 onward. There was no QL difference between CBR and SCBR. Up to cycle 3, pts with no CBR (NCBR) reported worse scores than responders (CBR & SCBR) in several QL indicators. Pts with no OR, TTP<4 months, or OS ≤9 months had worse baseline scores in most QL indicators. Conclusions: GemCap is associated with high CBR and SCBR rates. The observation that poorer QL scores at baseline may be associated with a NCBR or unfavorable OR, TTP or OS outcomes needs further investigation. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Roche Roche Roche

Relationship between Depression and Quality of Life in Persons with Hiv Infection in Nigeria

Despite the fact that two-thirds of all the people with HIV live in sub-Saharan Africa, little is known about the emotional state and quality of life (QOL) of subjects with HIV in this region. The objective of this study was to evaluate the association between clinical depression and quality of life in a group of HIV sero-positive subjects in Nigeria. Subjects with HIV infection (n = 87) completed a questionnaire detailing sociodemographic and HIV related variables. The subjects were assessed for the diagnosis of depression using the Mini International Neuropsychiatric Interview (MINI) and their subjective health related quality of life (QOL) was assessed using the short version of the WHO quality of life scale (WHOQOL-BREF). There were 25 (28.7%) subjects with diagnosis of depression. Lower educational level correlated with poorer QOL in all the domains of WHOQOL-BREF except the "social relationship" domain. Also, poor social support correlated with poorer QOL scores on domains of "physical health" and "social relationship" and presence of medical problems was significantly associated with poorer scores on domains of "physical health" and "psychological health." Diagnosis of depression was significantly correlated with poorer QOL in all domains except the "social relationship" domain. Poorer health related QOL in Nigerian subjects with HIV was associated with depression, lower educational and socioeconomic levels, and poor social support. Early identification and referral of patients with depression needs to be incorporated into intervention programs designed for HIV infected individuals in this region.

Malone antegrade continence enema (MACE) for fecal incontinence in imperforate anus improves quality of life

The MACE procedure has been used in patients with imperforate anus (IA) to improve fecal continence. Our aim was to assess the impact of the MACE on the quality of life (QOL) in children with IA and fecal incontinence. A retrospective review was performed of children with IA that underwent the MACE procedure between 1997 and 2004. Patients and their parents were contacted by telephone survey regarding continence and its psychosocial effects before and after MACE. The same survey was given to the patients' teachers. Responses to 15 questions were compiled and a QOL score calculated and significance evaluated by t-test (P < or = 0.05). IRB approval was obtained. Thirty-two patients were identified with a mean age at operation of 9 years (4-19 years) and mean follow-up of 3.8 years (7 months to 8 years). Four patients had a low malformation, 8 were intermediate, 15 were high, and 5 had a cloacal anomaly. Twenty patients had documented sacral/spinal anomalies, including five with tethered cord. Post-MACE complications included stenosis in 16 (50%), with 11 requiring an operative revision at a mean of 21.7 months (2 months to 6 years), takedown in one at 4 years and volvulus in one at 18 months. Prior to the MACE, 18/25 (72%) had poor QOL scores. Post-MACE QOL results were similar between patients, parents and teachers. Patients' mean QOL score improved from 59.9 to 26.3% (P < 0.001), with parents from 59.7 to 26.4% (P < 0.001). QOL score improved >50% in nine families, 25-50% in ten and <25% in six. All patients and parents interviewed reported an improvement in their QOL following the MACE. This procedure should be offered to children with IA with the expectation of significant improvement in QOL.

Characterisation of phenotypes based on severity of emphysema in chronic obstructive pulmonary disease

Background:Airflow limitation in chronic obstructive pulmonary disease (COPD) is caused by a mixture of small airway disease and emphysema, the relative contributions of which may vary among patients. Phenotypes of...

Quality of life and psychological morbidity in women with polycystic ovary syndrome: body mass index, age and the provision of patient information are significant modifiers

Polycystic ovary syndrome (PCOS) has clinical features and implications for long-term health that may lead to decreased quality of life (QoL) and psychological morbidity. We studied QoL in women with PCOS, compared the findings with population norms and assessed whether they correlated with reported quality of patient information received. Cross-sectional study. Women with PCOS by National Institutes of Health (NIH) criteria, diagnosis confirmed by one endocrinologist. Four questionnaires were mailed: the Short Form-36 (SF-36), the Quality-of-Life Questionnaire for Women with Polycystic Ovary Syndrome (PCOSQ), the General Health Questionnaire-28 (GHQ-28) and an assessment of information quality and sources, the Patient Information Questionnaire (PIQ). Questionnaires were sent to 443 women with PCOS from one endocrinologist's database; 203 women aged 15-65 years agreed to participate. To compare with Australian population norms, data from those women aged 18-44 years (n = 173) were used. Of these, 64% were obese, 18% overweight and 18% of normal weight. The demographics, socioeconomic status and untreated biochemistry of the responders and the total patient group were not significantly different. SF-36 scores were significantly lower than the age- and sex-matched Australian population (P < 0.01), including the overweight subset (P < 0.01). Health-related QoL by PCOSQ was similar to other published studies. GHQ-28 identified psychological morbidity in 62.4%, compared with 26.4% in a matched Australian population (P < 0.0001). Body mass index (BMI) was negatively correlated with QoL (P < 0.01). There was a positive association between the psychological domain of QoL and the subjective assessment of the quality of health-related information in general (P < 0.001), for hirsutism (P < 0.01) and for menstrual irregularity (P < 0.05). We have shown impaired QoL and increased prevalence of psychological morbidity in PCOS compared with population norms. The perception of inadequate information about the condition correlated with poorer QoL scores. Improved information delivery may lead to an improvement in QoL and needs to be tested with an intervention study.

Effect of transurethral resection on urinary quality of life after permanent prostate brachytherapy

Purpose To determine the effect of transurethral resection on urinary function after permanent prostate brachytherapy using a validated, patient-administered, quality-of-life (QOL) instrument. Methods and materials Twenty-seven consecutive brachytherapy patients with clinical T1b-T2b (1997 American Joint Commission on Cancer) prostate cancer and a history of either preimplant or postimplant transurethral resection of the prostate (TURP) were evaluated. Of the 27 patients, 1 continued to be catheter dependent and was excluded from analysis. Of the remaining 26 patients, each was mailed the urinary function component of the Expanded Prostate Cancer Index (EPIC) and the International Prostate Symptom Score (IPSS). Twenty-six surveys (100%) were returned. The mean and median follow-up was 44.8 and 39.8 months, respectively. The clinical, treatment, and dosimetric parameters evaluated included age, pretreatment prostate-specific antigen level, Gleason score, stage, risk group, prostate volume, presence of diabetes and hypertension, tobacco consumption, number of TURPs, number of grams resected, ultrasound planning volume, hormonal status, supplemental external beam radiotherapy, isotope, follow-up (in months), minimal dose received by 90% of the prostate gland, percentage of prostate volume receiving 100%, 150%, and 200% of the prescribed minimal peripheral dose, and the average and maximal urethral dose. Because baseline IPSSs, but not EPIC scores, were available, a cross-sectional survey was performed in which 51 newly diagnosed prostate cancer patients yet to receive any therapeutic intervention and 195 non-TURP brachytherapy patients served as controls. Results For all evaluated parameters, superior urinary scores were noted in the preimplant TURP group, with intermediate scores in the postimplant TURP patients and poor urinary QOL scores in the pre- and postimplant TURP patients. With time, the EPIC scores improved in the pre- and postimplant TURP cohorts. In multivariate linear regression analysis of the EPIC urinary summary score, the number of TURPs and supplemental external beam radiotherapy were the strongest predictors for diminished QOL. Conclusion TURP results in diminished urinary QOL after brachytherapy. However, patients who underwent preimplant TURP had urinary QOL approaching that of non-TURP brachytherapy patients. Significant urinary dysfunction was noted in approximately one-half of patients who underwent postimplant TURP (especially pre- and postimplant TURP). Because most patients with brachytherapy-related urinary obstruction will eventually spontaneously void, TURP should be approached with extreme caution and only after substantial time has transpired.

Relation between severe illness and non-completion of quality-of-life questionnaires by patients with rectal cancer.

Quality of life (QoL) is an important outcome measure in clinical studies, but interpretation is hindered by incompleteness of data. We addressed this issue in a population-based cohort study of 146 patients with newly diagnosed rectal cancer. QoL was assessed by means of European Organization for the Research and Treatment of Cancer questionnaires at discharge from hospital after primary treatment and then every 3 months for 2 years. In parallel, objective clinical data were documented. Analyses were conducted in three steps: participants versus non-participants with QoL-assessment; poor compliers who filled in only one or two questionnaires (n=20) versus good compliers who filled in all or nearly all questionnaires (n=18); and the proportion of missing forms and critical (very poor) QoL scores in risk patients versus non-risk patients over the course of 2 years. Non-participants and poor compliers were older, were more likely to receive palliative (rather than curative) treatment, and had worse scores for physical status. Tumour progression and therapeutic interventions were more frequent in poor compliers than in good-compliers. Patients with risk factors (age 475 years, poor physical status, palliative treatment) were more likely to have missing questionnaires and critical QoL scores in respect of physical functioning and global quality of life over the course of 2 years. Missing values for QoL have clinical as well as methodological implications, because QoL scores can enhance a clinician's insight. Unwillingness to fill in a questionnaire is an indicator of serious illness. Studies that report sample statistics without specifying compliance rates and the characteristics of non-compliers will give a misleadingly positive picture.

Relation between severe illness and non-completion of quality-of-life questionnaires by patients with rectal cancer

Quality of life (QoL) is an important outcome measure in clinical studies, but interpretation is hindered by incompleteness of data. We addressed this issue in a population-based cohort study of 146 patients with newly diagnosed rectal cancer. QoL was assessed by means of European Organization for the Research and Treatment of Cancer questionnaires at discharge from hospital after primary treatment and then every 3 months for 2 years. In parallel, objective clinical data were documented. Analyses were conducted in three steps: participants versus non-participants with QoL-assessment; poor compliers who filled in only one or two questionnaires (n=20) versus good compliers who filled in all or nearly all questionnaires (n=18); and the proportion of missing forms and critical (very poor) QoL scores in risk patients versus non-risk patients over the course of 2 years. Non-participants and poor compliers were older, were more likely to receive palliative (rather than curative) treatment, and had worse scores for physical status. Tumour progression and therapeutic interventions were more frequent in poor compliers than in good-compliers. Patients with risk factors (age 475 years, poor physical status, palliative treatment) were more likely to have missing questionnaires and critical QoL scores in respect of physical functioning and global quality of life over the course of 2 years. Missing values for QoL have clinical as well as methodological implications, because QoL scores can enhance a clinician's insight. Unwillingness to fill in a questionnaire is an indicator of serious illness. Studies that report sample statistics without specifying compliance rates and the characteristics of non-compliers will give a misleadingly positive picture.

Paternal Commitment and Father’s Quality of Life

This study explored the effects of paternal commitment on the quality of life of fathers. Data were gathered from 56 fathers who had at least one child under the age of 10 years. Respondents completed self-report measures that assessed their level of involvement with the children, proportion of contribution to the family income, perception of social supports, as well as objective and subjective quality of life. Higher levels of involvement with the children together with a greater contribution to family finances were related to fathers scoring lower on both the objective and subjective domains of the quality of life measure. It appears that the poorer quality of life scores might be attributed to fathers experiencing role-overload. A second finding was that a greater contribution to family finances predicted higher subjective quality of life scores. This positive relationship suggests that the breadwinner-role still features in the paternal script. Finally, a negative association was found between the level of involvement with the children and perceived social supports. That is, fathers who remained at home appeared to suffer from greater social isolation. In conclusion, while the image of the involved father might be popular, the reality of being a co-parent includes substantial costs in terms of psychological wellbeing and social support. Greater research and policy attention is required to develop support structures for stay at home fathers and to enable men to achieve a more effective balance between work and family commitments.

Propranolol for small abdominal aortic aneurysms: Results of a randomized trial

Purpose: Animal and human studies have suggested that beta-blockade may decrease the growth rate of aneurysms. We investigated whether propranolol decreases the growth rate of small abdominal aortic aneurysms (AAAs). Methods: We randomly assigned patients with an asymptomatic AAA between 3.0 and 5.0 cm to receive either a placebo (n = 272) or propranolol (n = 276) in a double-blind fashion. Patients were observed for a mean of 2.5 years. The primary end point was the mean annual growth rate as determined by means of ultrasound scanning performed every 6 months. Secondary outcomes were death, surgery, withdrawal from study medication, and quality of life measured by means of the Short-form Health Survey (SF-36). The main analyses were performed by means of intention to treat. Results: The two groups were similar at baseline: 84% were men with a mean age of 69 years and a mean AAA size of 3.8 cm. Fewer patients in the placebo group stopped their study medication (26.8% vs 42.4%; P =.0002). The annual growth rate was similar in the two groups (placebo, 0.26 cm/y vs propranolol 0.22 cm/y; P =.11). There was a trend toward more elective surgery in the placebo group (26.5% vs 20.3%; P =.11), but there was no difference in death rate (placebo, 9% vs propranolol, 12%; P =.36). Patients in the propranolol group had significantly poorer quality of life scores in the physical functioning, physical role, and vitality dimensions of the SF-36. Conclusion: Patients with AAAs do not tolerate propranolol well, and the drug did not significantly affect the growth rate of small AAAs. (J Vasc Surg 2002;35:72-9.)

Effect of substance misuse in early psychosis

Studies examining the temporal relationship between substance use and the onset of psychotic symptoms in schizophrenia are inconclusive. Three groups of out-patients with schizophrenia were compared on onset of illness, symptoms and quality of life. Fifty-one subjects had no past or present history of substance misuse, 29 subjects had a history of past substance misuse occurring around the onset of their illness, and 33 subjects were currently misusing substances. Current substance misusers had poorer quality of life scores and less negative symptoms than the non-users. Those who had a past history of substance misuse had a significantly earlier age of onset than those with no substance use. Attention should be paid to substance misuse present at the first episode. Treatment for schizophrenia should begin even though a diagnosis of drug-induced psychosis cannot be ruled out.