Quality Of Life In Advanced Cancer Patients Research Articles

Self-perceived burden predicts lower quality of life in advanced cancer patients: the mediating role of existential distress and anxiety

BackgroundSelf-perceived burden (SPB) is an important predictor of quality of life (QoL) in patients with advanced cancer. However, the mechanism how SPB affects patients’ QoL remains unclear. This study aimed to examine the potential mediating roles of existential distress (ED) and anxiety in the relationship between SPB and QoL.MethodsA multicenter cross-sectional study was conducted. 352 advanced cancer patients were recruited from three hospitals in southeast of China. The Self-perceived Burden Scale, the Existential Distress Scale, the Hospital Anxiety and Depression Scale, and the Quality-of-Life Concerns in the End of Life Questionnaire were adopted to collect data. Hayes’s bootstrapping method was used to analyze the data.ResultsSPB was negatively associated with QoL (P < 0.01). ED and anxiety partially mediated the relationship between SPB and QoL (P < 0.01). Moreover, ED had direct effects on anxiety, and sequentially QoL (P < 0.01). The serial multiple mediation model of SPB accounted for 73.25% of the variance in QoL in advanced cancer patients.ConclusionsED and anxiety are important mediating factors between SPB and QoL in advanced cancer patients. To improve patients’ QoL, comprehensive interventions for reducing anxiety and ED are highly recommended in clinical practices.

Psychotherapy for advanced cancer patients: A meta-analysis of the quality of life and survival assessments.

A meta-analysis has explored the effect of psychotherapy on the quality of life (QOL) but has not explored the effect on advanced cancer patients' survival, which is highly debated. Therefore, we consider the survival days and QOL as the primary outcomes in our analysis. Eligible studies were collected from four databases (PubMed, Embase, Cochrane Library, and Web of Science) until February 20, 2021. The pooled effect sizes were presented as weighted mean difference (WMD) or relative risk (RR) with 95% confidence intervals (CIs). Publication bias was evaluated by Egger's test, and I2 statistics was used to assess the heterogeneity. Thirty-three studies were finally included, containing 2,159 patients in the psychotherapy group and 2,170 patients in the control group. McGill Quality of Life Questionnaire (MQOL) and European Organization for Research and Treatment of Cancer Quality of Life-C15-Palliative (EORTC-QLQ-C15-Pal) supported that QOL of the psychotherapy group was significantly higher than that of the control group, and WMD value was 0.42 (95% CI: 0.12-0.71) and 17.26 (95% CI: 11.08-23.44), respectively. No significant difference was observed between the two groups regarding to the survival time (WMD: 17.85, 95% CI: -8.79, 44.49, P = 0.189). Moreover, the levels of anxiety, depression, confusion, pain, and suffering were lowered in psychotherapy group (all P < 0.05). Psychotherapy could improve the QOL of advanced cancer patients but not affect the survival time.

Content validation of the EORTC QLQ-C15-PAL with advanced cancer patients and health care professionals from palliative care services in Chile

BackgroundThe assessment of patients’ quality of life (QOL) is essential when evaluating the outcome of palliative care; however, no instruments have been validated for measuring symptoms and QOL in patients receiving palliative care in Chile. We aimed to investigate the content validity of the EORTC Quality of Life Questionnaire Core 15 Palliative Care (QLQ-C15-PAL), replicating the methods used previously to shorten the EORTC Quality of Life Questionnaire Core 30 (QLQ-C30) for use among patients in palliative care.MethodsThis cross-sectional study was conducted from October to November 2017 in four palliative care services. Patients with advanced cancer and health care professionals (HCPs) were invited to individual interviews to determine the relevance, appropriateness and relative importance of the 30 items of the QLQ-C30 for evaluating the outcome of palliative care, and whether relevant additional issues should be included.ResultsA total of 48 patients and 35 HCPs participated. The most important dimensions selected were pain, physical functioning, sleeping difficulties, emotional functioning, nausea/vomiting, fatigue, social functioning, lack of appetite, role functioning and constipation. Qualitative data identified important additional issues not covered by the questionnaire such as satisfaction with care, emotions and psychological support, as well as linguistic issues in the dyspnea and constipation items.ConclusionsThe EORTC QLQ-C15-PAL showed good content validity in the assessment of symptoms and QOL of advanced cancer patients; therefore, we recommend the use of this questionnaire in palliative care in Chile. Dyspnea and constipation items were revised by the EORTC group. More research is needed to add a social dimension for a comprehensive assessment of patients’ QOL.

Influence of malnutrition stage according to GLIM 2019 criteria and SGA on the quality of life of patients with advanced cancer.

Introduction: the nutritional status of cancer patients should be screened regularly due to their high risk of malnutrition, which impairs patient quality of life (QoL). Therefore, an assessment of nutritional status is strongly necessary. Recently, the Global Leadership Initiative on Malnutrition (GLIM) criteria for assessing the severity of malnutrition were published (2019). Objectives: the primary aim of this study was the assessment of nutritional status and QoL in advanced cancer patients. A secondary aim was to investigate the impact of malnutrition severity on QoL in these patients. Methods: this study included 33 advanced cancer patients (head/neck, esophageal, gastric) from the Nutritional Counselling Centre Copernicus in Gdansk, and the Department of Surgical Oncology, Medical University of Gdansk, Poland. The assessment of nutritional status was conducted with the 2019 GLIM criteria and the Subjective Global Assessment (SGA) method. QoL was assessed using the World Health Organization Quality of Life-BREF questionnaire (WHOQOL-BREF). Results: according to the SGA method, most of the patients were malnourished (42.42 %) or severely malnourished (42.42 %). Based on the GLIM criteria, 69.7 % of patients (n = 23) were severely malnourished. Among all participants, the highest impairments of QoL were observed in the environmental and psychological domains of the self-assessed satisfaction with own health questionnaire. Severe malnutrition significantly impairs QoL in the psychological (GLIM stage 2, p = 0.0033; SGA C, p = 0.0310) and somatic domains (GLIM stage 2, p = 0.0423). Conclusions: most patients with advanced cancer are malnourished or severely malnourished. Overall, the QoL of these patients is impaired. The severity of malnutrition has an impact on the QoL of cancer patients, which is observed as an impairment of mainly psychological and somatic aspects. This is the first study assessing the impact of malnutrition severity, as based on the new 2019 GLIM criteria, on the QoL of advanced cancer patients.

Is quality of life improved by neurolytic coeliac plexus block in pancreatic cancer pain management?

Pancreatic cancer (PC) is a disease of insidious onset and late clinical presentation with an annual incidence of 100 per million population. Itis the sixth most common cause of mortality from cancer and records a median survival of about 3–6 months without treatment. Quality of life (QOL) is the major consideration in the management of advanced cancer. PC adversely affects QOL of sufferers and mostly presents with abdominal pain from intra- and extra-pancreatic origins. Opioids are the “Gold-standard” treatment in severe cancer pain management. However, its use may be challenged by debilitating side effects such as drowsiness, respiratory depression, constipation, nausea/vomiting, or opioid toxicity which further worsens QOL of patients burdened with cancer. Neurolytic coeliac plexus block (NCPB) is indicated in PC pain that is resistant or refractive to conventional analgesic methods. Such potent analgesic technique could ease the suffering of cancer patients and provides an improved QOL. Reports indicate that NCPB provides effective analgesia in advanced PC but might be associated with minor and transient side effects such as hypotension, diarrhea, and retroperitoneal hemorrhage. Reports from studies analyzed in this review show that NCPB provides superior analgesia in PC pain management than opioid-based therapies. However, there is no satisfactory evidence that NCPB improved QOL in these patients. This shows that QOL of advanced cancer patients is not synonymous with pain relief. Improvement in QOL will be difficult without management of the “total pain” felt by the patients.

Moxibustion Plus Medication Can Relieve Refractory Nausea and Vomiting and Improve Quality of Life of Advanced Cancer Patients Undergoing Chemical Therapy

To explore the efficacy of moxibustion combined with medication in the treatment of refractory nausea and vomiting and quality of life (QOL) in advanced cancer patients. A total of 266 advanced cancer patients with nausea and vomiting were randomly assigned to Metoclopramide group (M group, n＝70), Metoclopramide plus Haloperidol group (MH group, n＝65), moxibustion ＋ M group (n＝63), and moxibustion ＋ MH group (n＝68). Moxibustion was applied to bilateral Zusanli (ST 36), and Guanyuan (CV 4), Qihai (CV 6) for 20 min every time, twice a day for 2 weeks. The Rhodes' Index of nausea, Vomiting and Retching (INVR) was used for assessing the state of these symptoms in duration, frequency and severity (40 points), the 24-item Hamilton Depression Rating Scale (HAMD, 0－76 points) was employed to measure the patients' depression severity, and the Functional Assessment of Cancer Therapy-General (FACT-G, including physical, social/family, emotional, and functional dimensions, 27 items, 108 points) was adopted to measure the cancer patients' QOL. Following the treatment, the INVR and HAMD scores were significantly decreased in the M, MH, moxibusion＋M and moxibustion＋MH groups in comparison with their own pretreatment (P<0.05) and were significantly lower in the moxibustion＋MH group than in the M, MH and moxibustion＋M groups (P<0.05). The FACT-G scoring outcomes showed that the scores of physical well-being, emotional well-being, and total score of QOL were significantly higher in the MH, moxibustion＋M and moxibustion＋MH groups than in the M group, and were significantly higher in the moxibustion＋MH group than in the MH and moxibustion＋M groups (P<0.05). No significant differences were found between the MH and moxibustion＋M groups in the INVR and HAMD scores, and in the scores of physical well-being, emotional well-being and total score of QOL (P>0.05)．. Moxibustion plus Metoclopramide and Haloperidol can relieve refractory nausea and vomiting, and better depression and QOL in advanced cancer patients, being worthy of popularization in clinical practice.

Psychosocial Interventions for Patients With Advanced Cancer and Their Families.

Few randomized controlled trials of family-based psychosocial interventions involving patients and at least one other family member have been conducted in the context of advanced cancer. Moreover, existing interventions have largely been stand-alone programs that have not been well integrated into routine palliative and clinical care. Programs that address this gap may not only improve patient and caregiver quality of life (QOL) but also the quality of palliative and supportive care services. The aim of this narrative review is to describe published interventions that have attempted to improve the QOL of advanced cancer patients and their family caregivers (eg, spouses, partners, and other family members) and to describe some of the challenges that make it difficult to implement such programs in clinical settings. Toward that end, the added value that family-based psychosocial interventions can bring to advanced cancer care is first described. Next, the literature on family-based interventions in advanced cancer is reviewed, and different theoretical approaches and outcomes are highlighted. This is followed by a description of some of the health system barriers to supportive family care in advanced cancer care. The article concludes with a synthesis of research findings and proposes directions for future research.

The promise of clinical interventions for hepatocellular carcinoma from the west to mainland China.

Hepatocellular carcinoma (HCC) presents a major health problem with its steadily increasing incidence in Western countries, and persistent high fatality rates worldwide. The well-recognized complexity and toxicity of its treatment as well as inadequate care and limited resources in mainland China exacerbate the difficulty of maintaining quality of remaining life of patients living with this illness. The goal of this comprehensive literature review was to identify promising clinical interventions for improving quality of life (QOL) of people with advanced HCC in mainland China. A comprehensive literature review was performed in China Academic Journals (CAJ), Cochrane, and PubMed databases. The review was confined to studies of randomized controlled trials (RCT) for adults, in Chinese and English, from 1980 to 2012. A total of 676 studies in Chinese and 391 studies in English were identified. Eighteen RCTs were selected for the final review, among which three were conducted in mainland China. Nurse-led home-based comprehensive interventions using a collaborative care approach addressing multiple dimensions of QOL show promise for enhancing clinical outcomes for people with advanced HCC in mainland China. Education and psychosocial support combined with symptom management early in the illness trajectory and ongoing close attention to physical symptoms, emotional distress, as well as spiritual well-being are crucial for maintaining QOL of people with advanced HCC. Telephone monitoring appears to be a feasible way in rural as well as urban areas. Families are advised to be part of overall interventions. It is warranted that promising interventions aiming at improving QOL for advanced cancer patients reported in Western literature be further tested in mainland China.

A survey on the quality of life and symptoms of community patients with advanced cancer

Objective To investigate the quality of life(QOL) and symptoms of community patients with advanced cancer,and analyze their correlation.Methods 94 advanced cancer patients in 3 communities of Yangpu district in Shanghai were surveyed by self-designed questionnaire,FACT-G and MDASI.The correlation between QOL and symptoms was analyzed.Results QOL of advanced cancer patients was poor,and the main influencing factors were gender,age,stage of cancer,KPS score,marital statusand economic burden.There was significant negative correlation between symptoms and QOL.Fatigue,amnesia,uneasy sleep,insensible feeling,distress and dry mouth were the symptoms patients suffered mostly.Conclusions For patients with advanced cancer,evaluation of the influencing factors of QOL and better control of symptoms could improve their QOL. Key words: Advanced cancer; Quality of life; Palliative care; Community care; Symptom

Prospective cohort study of quality of care (QC) and quality of life (QL) of palliative cancer patients in three different situations: In-patient hospitalization (IN), palliative care unit (PA) and home care (HO). Final analysis

20670 Background: The aim of the study was to assess QC and QL in advanced cancer patients receiving palliative care during (i) in-patient hospitalization in a comprehensive cancer center, (ii) in-patient hospitalization in a palliative care unit, (iii) home-care. Methods: After giving informed consent, the patient chose one of the three possibilities. QC was assessed by the STASS questionnaire, QL by the EORTC QLQ-C30, mood disturbance by Spielberger questionnaire and pain by VAS. The impact on family members was assessed by semi- structured interviews. Evaluations were conducted at days 0, 15, 30 and then monthly until death (max four months). Results: 51 men and 49 women were included (median-age: 61 years). The choices expressed by the patients were IN 14%, PA 20% and HO 66%. The type of care actually provided was IN 26%, PA 19%, HO 55%. At the end of the study (85% patients died before 4 months), the distribution was IN 50%, PA 24% and HO 26%. Symptom evaluation was consistent between patients and care-givers. QC, QL and pain assessment were similar between the three cohorts. IN nurses were more anxious and considered that patients had a better estimation of their prognosis. The level of anxiety among patients and families was lower in HO. Re hospitalization was correlated with Karnofsky index alteration but not with pain, patient or family anxiety. Conclusions: The majority of patients choose home hospitalization, but families frequently find it difficult to cope. Even if the family agrees with the patient’s choice, re-hospitalization is frequently required at the end of life. Physical and psychological symptoms are frequent but under control and do not differ between the three cohorts. Home palliative care demands special attention and specific support for family members. No significant financial relationships to disclose.

Influence of social support to QOL of advanced cancer patients in domestic hospice

目的 探讨晚期癌症家居宁养患者所得到的社会支持和生活质量的相关性,以寻找提高其生活质量的护理对策.方法将宁养院100例晚期癌症患者随机分为2组,对患者所获得的社会支持、生活质量进行问卷调查.结果实验组患者的生活质量明显高于对照组(P＜0.01),患者的生活质量与其得到的社会支持呈正相关.结论在家居宁养服务中,通过医护人员的努力,能帮助患者及家人得到更多的社会支持,可以有效地提高患者的生活质量。