Quality Of Life In Long-term Survivors Research Articles

Quality of Life in Long-Term Survivors of Surgical Necrotizing Enterocolitis

ObjectiveThis study evaluated the quality of life (QoL) in patients who have recovered from surgical necrotizing enterocolitis (NEC). MethodsThis is a cross-sectional study conducted in a tertiary centre and patients who have received surgery for NEC between 2000 and 2014 were invited to participate. The Pediatric Quality of Life Inventory Generic (PedsQL™) Core Scale Version 4.0 was used as the assessment tool. Values were reported as median (interquartile rage) and compared with age-matched controls. ResultsDuring the study period, 90 patients were eligible for the study and 29 patients have completed the survey. There was no gender difference and the median age was 10 years (9–13 years). Nine patients have suffered from short bowel syndrome (SBS) as a result of the surgery.For the QoL assessment, 17 participants have completed both parent proxy and child-rated survey; 11 completed the parent-rated survey and 1 completed child-rated survey only. The scores for parent-rated survey were - overall: 86.4 (70.7–92.7); physical: 95.3 (83.6–100) and psychosocial: 82.5 (66.3–90.4). The scores for child-rated survey were – overall: 82.1 (73.4–96.2); physical: 96.9 (90.6–99.2) and psychosocial: 81.7 (64.2–95.8).Regarding the impact of previous SBS on the QoL, there were no significant difference in the overall score for both parent proxy and child-rated survey (SBS-ve vs + ve) (parent-rated: 87.5 vs 85.3, p = 0.849; child-rated: 81.0 vs 88.0, p = 0.503). There were also no differences in physical and psychosocial assessments (parent-rated: [physical] 95.3 vs 95.3, p = 0.267; [psychosocial] 84.2 vs 80.0, p = 0.274; child-rated: [physical] 95.3 vs 96.9, p = 0.395; [psychosocial] 79.2 vs 87.5, p = 0.611). ConclusionThe QoL in long-term survivors of surgical NEC without major medical illnesses is comparable to normal population. However, they may have a lower psychosocial well-being that should be addressed. Previous history of SBS does not have a significant impact on the future QoL. Level of evidenceIII.

GCT-21. Long-term outcome and follow up of intracranial germ cell tumors: Reduced-dose radiotherapy and intensified chemotherapy improves clinical outcome and quality of life for long-term survivors

BACKGROUND: Intracranial germ cell tumors (iGCT) are heterogeneous tumors with several histopathology. Chemoradiotherapy is effective and required for treatment against them, but optimal treatment intensity should be selected from the viewpoint of both improvement of clinical outcome and avoidance of late complications. We introduced a protocol with reduced-dose radiotherapy and intensified chemotherapy for iGCT. OBJECTIVE: We retrospectively analysed the clinical outcome, especially for non-germinomatous germ cell tumors and long-term clinical outcome of late complications, enrollment and employment, as indicators of quality of life (QOL). MATERIALS AND METHODS: Thirty-eight children and young adults (28 men and 10 women) with iGCTs treated in our institution from 1997 to 2013 were enrolled in this study. They consisted of 26 germinomas including HCG-producing cases and 12 non-germinomatous GCTs (NGGCT). Local irradiation was selected for all patients, and the dose of irradiation was 23.4-54 Gy. The whole-brain irradiation was made in patients who had intracranial dissemination, but any prophylactic irradiation to the whole brain and spinal cord was not performed. For NGGCT, high-dose chemotherapy and peripheral blood stem cell transplantation (PBSCT) were introduced. Second-look surgeries were performed for cases with residual tumors after induction chemotherapies. RESULTS: In germinoma group and NGGCT group, 10-year progression-free survival was 86% and 84%, 10-year overall survival was 93% and 91%, respectively. About late complications, endocrinological replacement (39%), cerebrovascular disease such as cavernous hemangioma and arterial stenosis (18%), secondary neoplasm (2.6%) were observed. Regarding QOL, enrollment and return to school rate was 92% and employment and the return rate was 89%, which were influenced by hemipararesis associated with basal ganglia lesion, intractable epilepsy and whole-brain irradiation. CONCLUSION: Reduced-dose radiotherapy and intensified chemotherapy for iGCT, especially NGGCT, improved the clinical outcome and QOL of long-term survivors, suppressing late complications. Further comprehensive follow-up and analysis are needed.

Long-term Quality of Life in Survivors of Brain Metastases: A Roller Coaster of Perspective.

Longevity in cancer patients with brain metastases is increasingly being observed. This raises discussions about how best to maintain a good quality of life for these patients. Recent data suggest that post-treatment quality of life (QoL) can be maintained using new treatment options, but little data exist regarding the QoL in long-term survivors. This study of 19 patients surviving greater than two years from the initial treatment of brain metastases suggests that long-term QoL can be better than at the start of treatment and perhaps even better than normal, especially between three and five years post-treatment. This improved QoL seems mostly attributable to improved functional and social well-being and is possible as long as emotional and physical well-being are maintained within the normal range.

Quality of life in long-term and very long-term cancer survivors versus population controls in Germany

Background: With the increasing number and diversity of cancer survivors, studies of survivors’ physical, emotional, and social health are of growing importance. While there is a growing body of literature on the quality of life (QoL) of cancer patients during the early years past diagnosis, less is known regarding QoL in long-term survivors (LTS) (5 + years past diagnosis) and particularly in very long-term survivors (VLTS) (10 + years past diagnosis).The objective of our study is to: (1) compare QoL of long-term cancer survivors and population norms; and (2) assess whether any deficits in QoL of survivors observed 5–10 years past diagnosis persist beyond the 10th year past diagnosis.Methods: In total 6952 long-term cancer survivors (5–16 years past diagnosis of breast, colorectal, or prostate cancer) from Germany recruited in the context of the population-based CAESAR + study were compared with 1878 population-based controls without a history of cancer. QoL was assessed with the EORTC QLQ-C30. Differences in QoL between survivors and controls were assessed via multiple regression while controlling for age, gender, education, and case mix for survivors 5–9 years and 10 + years past diagnosis separately.Results: Overall QoL in long-term cancer survivors was comparable to population norms but specific deficits in social, role, emotional, cognitive, and physical functioning and symptoms such as insomnia, fatigue, dyspnea, constipation, diarrhea, and financial difficulties were more prevalent in LTSs. Detriments in QoL persisted during the observation period and affected particularly cancer survivors at younger ages (<50 years). Non-significant aggravations in QoL with longer time since diagnosis were observed in very young and very old cancer survivors.Conclusions: Detriments in health-related quality of life persist over more than a decade and affect predominantly younger patients. Improvements both in early and long-term follow-up care of cancer survivors seem warranted.

Quality of Life is Similar between Long-term Survivors of Indolent and Aggressive Non-Hodgkin Lymphoma

ABSTRACTDifferences in quality of life (QOL) of long-term survivors of aggressive or indolent subtypes of non-Hodgkin lymphoma (NHL) have not been frequently evaluated. We assessed these differences by analyzing results of a large QOL survey of long-term NHL survivors. We hypothesized that the incurable nature of indolent NHL would relate to worse QOL in long-term survivors while the potentially cured long-term survivors of aggressive lymphoma would have better QOL. We found that QOL was similar between the two groups. Results suggest that patients with indolent NHL are coping well with their disease, yet experience some overall feelings of life threat.

Adjuvant chemotherapy for early-stage cervical cancer.

The aim of this review is to address the current status of adjuvant chemotherapy alone in early-stage cervical cancer treatments in the literature. At present, the therapeutic effect of adjuvant chemotherapy alone after radical surgery (RS) has not yet been established, and radiation therapy (RT) or concurrent chemoradiotherapy (CCRT) is recommended as the standard adjuvant therapy after RS for early-stage cervical cancer in various guidelines. The main purpose of adjuvant therapy after RS, however, should be to reduce extrapelvic recurrence rather than local recurrence, although adjuvant RT or CCRT has survival benefits for patients with intermediate- or high-risk factors for recurrence. Moreover, several studies reported that adjuvant therapies including RT were associated with a higher incidence of complications, such as lymphedema, bowel obstruction and urinary disturbance, and a lower grade of long-term quality of life (QOL) or sexual functioning than adjuvant chemotherapy alone. The effect of adjuvant chemotherapy alone for early-stage cervical cancer with intermediate- or high-risk factors for recurrence were not fully investigated in prospective studies, but several retrospective studies suggest that the adjuvant effects of chemotherapy alone are at least similar to that of RT or CCRT in terms of recurrence rate, disease-free survival, or overall survival (OS) with lower incidence of complications. Whereas cisplatin based combination regimens were used in these studies, paclitaxel/cisplatin (TP) regimen, which is currently recognized as a standard chemotherapy regimen for patients with metastatic, recurrent or persistent cervical cancer by Gynecologic Oncology Group (GOG), had also survival benefit as an adjuvant therapy. Therefore, it may be worth considering a prospective randomized controlled trial (RCT) of adjuvant chemotherapy alone using TP regimen versus adjuvant RT as an alternative adjuvant therapy. Because early-stage cervical cancer is a curable condition, it is necessary that the therapeutic strategies should be improved with considering adverse events and QOL for long-term survivors.

Quality of Life, Shoulder Range of Motion, and Spinal Accessory Nerve Status in 5-Year Survivors of Head and Neck Cancer

To determine the association of neck dissection and radiation treatment for head and neck cancer (HNC) with subsequent shoulder range of motion (ROM) and quality of life (QOL) in 5-year survivors. A cross-sectional convenience sample. Otolaryngology clinics at tertiary care hospital and Veterans Affairs medical center. Five-year, disease-free survivors of HNC. Demographic and cancer treatment information was collected, including type of neck dissection (none, spinal accessory "nerve sparing," and "nerve sacrificing") and radiation. QOL questionnaires were administered, and shoulder ROM was measured. University of Washington Quality of Life (UWQOL), Functional Assessment of Cancer Therapy (FACT) Head and Neck, and Performance Status Scale for Head and Neck. Shoulder ROM measurements included abduction, adduction, flexion, extension, internal and external rotation. One hundred and five survivors completed QOL surveys; 85 survivors underwent additional shoulder ROM evaluations. The nerve sacrifice group exhibited significantly poorer scores for UWQOL measures of disfigurement, level of activity, recreation and/or entertainment, speech and shoulder disability, and willingness to eat in public, FACT functional well-being, and FACT Head and Neck (P< .05). Shoulder ROM for flexion and abduction was poorest in the nerve sacrifice group (P< .05). Radiation was associated with significantly worse UWQOL swallowing (P< .05), but no other differences were found for QOL or ROM measurements. Decreased QOL scores were associated with decreased shoulder flexion and abduction (P< .05). Survivors with decreased shoulder abduction had significantly (P< .05) worse scores in disfigurement, recreation and/or entertainment, employment, shoulder disability, and FACT emotional well-being. Sparing the spinal accessory nerve during neck dissection is associated with significantly less long-term shoulder disability in 5-year survivors of HNC. QOL measures demonstrated the highest level of function in the no dissection group, an intermediate level of functioning with nerve sparing, and poorest function when the nerve is sacrificed. Decreased shoulder flexion and abduction is associated with reduced QOL in long-term survivors of HNC.

Quality of Life in Long-Term Breast Cancer Survivors

There is considerable interest in the quality of life (QOL) of long-term breast cancer (BC) survivors. We studied changes in QOL from time of BC diagnosis to long-term survivorship and compared QOL in long-term survivors to that of age-matched women with no history of BC. In all, 535 women with localized BC (T1-3N0-1M0) were recruited from 1989 to 1996 and followed prospectively, completing QOL questionnaires at diagnosis and 1 year postdiagnosis. Between 2005 and 2007, those alive without distant recurrence were recontacted to participate in a long-term follow-up (LTFU) study. A control group was recruited from women presenting for screening mammograms, and both groups completed LTFU QOL questionnaires. Longitudinal change in BC survivors and differences between BC survivors and controls were assessed in eight broad categories with clinically significant differences set at 5% and 10% of the breadth of each QOL scale. A total of 285 patients with BC were included in the study, on average 12.5 years postdiagnosis. Longitudinally, clinically significant improvements were observed in overall QOL by 1 year postdiagnosis with further improvements by LTFU. Some clinically significant improvements over time were seen in all categories. A total of 167 controls were recruited. Deficits were observed in self-reported cognitive functioning (5.3% difference) and financial impact (6.3% difference) in BC survivors at LTFU compared with controls. Long-term BC survivors show improvement in many domains of QOL over time, and they appear to have similar QOL in most respects to age-matched noncancer controls, although small deficits in cognition and finances were identified.

788 Long-Term Quality of Life After Oesophagectomy for Cancer - Comparison of Cervical Versus Mediastinal Anastomoses

Introduction With improvements in neoadjuvant therapy and earlier diagnosis, long-term survival after oesophagectomy for adenocarcinoma is becoming more frequent. With longer survival the quality of life (QOL) of patients post resection has become a greater priority. There has been extensive debate focusing on the long term effects of different sites for anastomosis. We aimed to examine if post-oesophagectomy QOL is affected by the site of the surgical anastomosis. Methods QORTC C-30 and OG-25 QOL questionnaires were analysed from post-oesophagectomy patients surviving >3 years. Data were available both from a prospective database and questionnaires sent to post-oesophagectomy patients. Surgery was completed by two surgical teams and data were analysed in subsets dependant on the site of oesophago-gastric anastomosis—either thoracic or cervical. No patients underwent formal pyloroplasty. Data were analysed using the Student t test on SPSS statistical software. QORTC C-30 data were compared against the reference tables for oesophageal cancer pre-treatment and a cohort of pre-surgical patients awaiting oesophagectomy. Ethical approval was granted by the local MREC. Results A total of 60 patients responded (82%, anastomosis: thoracic n=29, cervical n=31) with a median time post-surgery of 6.1 years (range 3–12 years). Cervical and thoracic anastomosis subgroups were equivalent in terms of age at time of surgery, time post op and cancer stage. No significant QOL difference was noted between cervical or chest anastomosis groups for any functional or symptom score, especially focusing on dysphagia (OG25, p=0.24), odynophagia (OG 25, p=0.68) and swallowing problems (OG25, p=0.73). The patients9 overall general health (QL2) score was 72.0±19.43 (mean±SD) compared with 74.8±20.57 for a cohort of 53 NNUH pre-op oesophagectomy patients and 71.2±22.4 for the QORTC general population reference data. Functional indices and symptom scores are improved for our cohort compared to the QORTC oesophageal cancer reference baseline except symptom scores for diarrhoea and dyspnoea which worsen post-operatively. Conclusion There is no significant difference in QOL scores between oesophagectomy patients with cervical or thoracic anastomosis at >3 years post-surgery when analysed using the QORTC C-30 and OG25 questionnaires. QOL in long-term survivors after oesophagectomy compares favourably with QORTC reference data for both pre-treatment oesophageal cancer and baseline general population data in our cohort, possibly due to the absence of pylorplasty. Further prospective QOL data collection is required to elucidate any long-term differences between the two anastomosis sites. Competing interests None declared.

Factors associated with poor quality of life in survivors of childhood acute lymphoblastic leukemia and lymphoma

Previous studies of health-related quality of life (QoL) in childhood cancer survivors have hardly focused on factors associated with poor QoL. (1) to assess QoL in long-term survivors (LTSs) of childhood acute lymphoblastic leukemia (ALL) and lymphomas compared to age-matched controls from the general population (NORMs). (2) To investigate factors associated with poor QoL in LTSs. This population-based cross-sectional study enrolled 285 LTSs of ALL and lymphomas diagnosed between 1970 and 2002 at age <18 years. The LTSs completed an extensive mailed questionnaire including the Short Form 36 (SF-36) as QoL-measure. NORMs consisted of five age-matched controls for each LTS (N = 1,425). Poor QoL was defined as SF-36 physical or mental component summary score <40. The median age of LTSs' at survey was 30 years (range: 18-54), median follow-up time 21 years (range: 7-39). Compared to NORMs, LTSs scored significantly lower on 7 of 8 SF-36 subscales. Among LTSs 32% reported poor QoL versus 19% among NORMs (P < 0.001). Among LTSs, psychosocial, lifestyle- and health-related variables, but not type of malignancy, treatment factors or socio-demographic factors were clinically significantly associated with poor QoL in bivariate regression analyses. In multivariate analysis, levels of fatigue, anxiety and depression, as well as obesity and insomnia remained significantly associated with poor QoL. Significantly more LTSs than age-matched NORMs experienced poor QoL. Clinically significant associations with fatigue, anxiety, depression, obesity and insomnia were observed, which may be amenable for interventions, and thereby improvement of QoL in LTSs.

Quality of Life Following Completion of Treatment for Adult Acute Lymphoblastic Leukemia with a Pediatric-Based Protocol.

Abstract 2567 Background:The use of pediatric-based protocols in the management of adult acute lymphoblastic leukemia (ALL) appears to result in improved survival, particularly in young adults. However, significant treatment-related toxicities have been identified with these regimens, including osteonecrosis and peripheral neuropathy. These are potentially disabling and can adversely affect quality of life (QoL); however, the long-term impact of such treatment regimens on health-related QoL in this adult population has not previously been reported. We therefore aimed to assess various dimensions of QoL in long-term survivors of adult ALL following treatment with a modified Dana Farber Cancer Institute 91-01 pediatric protocol, which is used as standard frontline therapy in our institution. Methods:QoL was self-reported using 5 psychometrically validated instruments: the EORTC QLQ-C30, the Functional Assessment of Cancer Therapy fatigue subscale (FACT-F), the Brief Pain Inventory, the Subjective Peripheral Neuropathy Screen (SPSS), and the 9-item Patient-Health Questionnaire (PHQ-9). Standard analyses of each instrument were conducted. Where available, results were compared to published population normative data. Results:29 patients (median age 41 years, range 21–64, 90% male), in continuous complete remission at a median of 28 months following completion of the two-year treatment protocol, were enrolled between March 2010 - April 2012. In comparison to reference data from a general population, the mean global health score on the EORTC QLQ-C30 was similar (p=0.68), but leukemia survivors had lower cognitive (p<0.001) and social (p<0.001) function scores, as well as more marked financial difficulty (p<0.001). The most prevalent and severe of the symptom items assessed by the EORTC QLQ-C30 were fatigue and pain, both of which showed significant inverse correlation with global health status and all functional scales (physical, role, emotional, cognitive, and social). Some degree of fatigue was reported by 83% of patients. Evaluation by FACT-F revealed worse fatigue scores for leukemia survivors compared with the general population (p=0.03). Mean pain intensity was higher in those more than 24 months from completion of treatment, vs. < 24 months (p=0.04). In the 9 patients (31%) experiencing moderate-severe pain, the most common sites were joints and neck/back. Of the 10 patients reporting regular use of analgesics, 4 were using opioids. The SPSS identified 12 patients (43%) with moderate or severe symptoms associated with peripheral neuropathy (burning, paraesthesias and/or numbness), mostly affecting the lower extremities. Neuropathy was more severe in patients over age 40 (p<0.01). The PHQ-9 identified 4 patients (14%) with significant depressive symptoms. Conclusions:Long-term adult ALL survivors who were treated with a pediatric-based regimen generally do well in terms of global QoL. However, fatigue, joint-related pain and neuropathy symptoms are common and can negatively affect QoL. Impairments in the domains of cognitive function and social function, as well as the prominence of financial hardship in this population, are findings that warrant further exploration. Disclosures:No relevant conflicts of interest to declare.

Paclitaxel-Based High-Dose Chemotherapy with Autologous Stem Cell Rescue for Relapsed Germ Cell Tumor: Clinical Outcome and Quality of Life in Long-Term Survivors

BackgroundHigh-dose chemotherapy (HDCT) is a viable and potentially curative approach for patients with relapsed or refractory germ cell tumors (GCTs). However, no comparative data exist to define the optimal chemotherapeutic strategy, and little is known about the quality of life (QOL) of long-term survivors. Herein we attempt to characterize the QOL in long-term survivors who received high-dose paclitaxel, etoposide, carboplatin, and ifosfamide (TECTIC). Patients and MethodsDetails of the TECTIC regimen and clinical outcomes for the initial 33 patients have been reported. In the present study, we report the clinical data for 15 additional patients. Using the European Organization for the Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) and the Functional Assessment of Cancer Therapy–Taxane (FACT-T) questionnaires, we surveyed all patients who survived at least 4 years after HDCT. ResultsForty-eight patients were enrolled and 46 patients received protocol therapy. For all 48 patients, the median progression-free survival (PFS) and overall survival (OS) were 11.8 months (range, 5.8-not reached) and 21.7 months (range, 12.7-not reached), respectively. Seventeen patients were progression free at a median of 123.2 months (51.6-170.2 months), and 6 patients remain alive after progression with a median OS of 68.8 months (47.6-147.1 months). Of the 23 surviving patients, 18 were accessible and consented to telephone interviews. Compared with historical cohorts, survivors had a higher global health scale score (87.04 vs. 75.62; P = .02) but a lower physical functioning score (68.89 vs. 92.66; P = .0001) by the QLQ-C30 scale. ConclusionsHDCT with the TECTIC regimen produces durable remissions in patients with relapsed or refractory GCTs with acceptable QOL in long-term survivors.

PTU-187 Long-term quality of life after oesophagectomy for cancer: comparison of cervical vs mediastinal anastomoses

IntroductionWith improvements in neoadjuvant therapy and earlier diagnosis, long-term survival after oesophagectomy for adenocarcinoma is becoming more frequent. With longer survival the quality of life (QOL) of patients post resection...

Long-term quality of life in pouch patients compared with stoma patients following rectal cancer surgery

Low and ultralow anterior resection for rectal cancer with colorectal or coloanal anastomosis does not compromise oncological results compared with abdominoperineal excision. Although avoidance of a permanent colostomy is regarded as beneficial for a patient's quality of life (QoL), patients undergoing sphincter-sparing surgery may develop a number of functional problems. A colonic pouch significantly improves functional outcome after rectal resection and low anastomosis and may positively influence QoL. The aim of this study was to compare QoL in long-term survivors who underwent ultralow anterior resection with total mesorectal excision and colonic J-pouch anastomosis (CPA) with patients treated with abdominoperineal excision (APE) and end colostomy for rectal cancer. The medical records from our institution's prospectively maintained rectal cancer database of 151 patients who underwent surgery for ultralow rectal cancer from 2001 to 2007 were analysed. QoL in 59 eligible patients was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 core and Colorectal Cancer 29. Results were compared for patients with CPA and APE. The median follow-up in the 59 patients was 74 (37-119) months. QoL was good in all patients, but it was better in CPA than in APE patients. Global health status (P = 0.009), physical functioning (P = 0.0002), role functioning (P = 0.03), cognitive functioning (P = 0.046), social functioning (P = 0.002), body image (P = 0.053), embarrassment (P = 0.002) and urinary frequency (P = 0.003) were significantly improved for patients with CPA. QoL after rectal resection and CPA was better than after APE in several respects. However, QoL should not be regarded as an isolated concept but rather as one of several possible clinical outcomes of interest.

Quality of Life of Long Term Survivors with Follicular Lymphoma After High-Dose Chemotherapy with Autologous Stem Cell Transplantation and Conventional Chemotherapy.

AbstractAbstract 3808 Introduction:High-dose chemotherapy (HDCT) followed by peripheral blood stem cell transplantation (PBSCT) is frequently applied in eligible patients with relapsed or refractory follicular lymphoma (FL). The toxicity of HDCT, however, might manifest itself in the respective patients' reduced quality of life (QoL). In this study we investigated the QoL of long term survivors after HDCT in comparison with patients after conventional chemotherapy and the healthy German population. Patients and Methods:QoL was evaluated with the standardized questionnaires EORTC QLQ-C30 and EQ-5D. A total of 124 patients with FL were included in the study. 63 patients (29 female) with a median age of 60.4 (range 41–80) received HDCT with PBSCT between 1992 and 2002. This group was compared with 61 patients (38 female) with a median age of 62.9, range 31–81) who were treated with Rituxmab and CHOP chemotherapy and supplementary radiation in our institution. 55 patients of 63 (88%) of the HDCT group and 25 of 61 (41%) patients of the conventional group were in continuous complete remission (CR). Median follow-up for the HDCT group is 9 years and for the conventional chemotherapy group it is 4.4 years. In addition, QoL of the patients was compared to QoL of healthy people on the basis of two studies about the general health status of the German population (R. Schwarz and A. Hinz: “Reference data for the quality of life questionnaire EORTC QLQ-C30 in the general German population,” European Journal of Cancer 37 [2001]: 1345–1351; H. H. König et al.: “Health Status of the German Population: Results of a Representative Survey Using the EuroQoL Questionnaire,” Gesundheitswesen 67 [2005]: 173–182). Results:In the HDCT group, the results of the questionnaires show a reduced QoL compared to the healthy population. Regarding the three main categories of the EORTC QLQ-C30, the mean sum score for global health state (ghs) is 71.38, for functional state (fs) 78.38 and for symptomatic state (ss) 18.60 (the ideal score being 100.00 for the first two items and 0.00 for the latter). The mean value for EQ-5D is 0.911 (ideal value: 1.000) and that for VAS is 75.52 (ideal value: 100.00). The one sample t-test evaluation shows that the decrease in QoL is significant with p<0.05 in four of five of the subcategories of the functional state; six of the nine subcategories of the symptomatic state, namely fatigue, dyspnoea, insomnia, constipation, diarrhoea and financial difficulties. Patients who received conventional chemotherapy (ghs: 67.04; fs: 70.49; ss: 25.01) also showed a reduced QoL compared to the healthy population in all of the three main categories of the EORTC-QLQ-C30, in particular in the category of functional and symptomatic state. These differences were statistically significant in all subcategories of the functional state namely physical,-role,-emotional,-cognitive,- and social functioning (p=0.001). The differences of the symptomatic state were statistically significant in seven of nine subcategories, namely fatigue, pain, dyspnoea, insomnia, constipation, diarrhea and financial difficulties. When QoL of the HDCT group and the conventional therapy group were compared, there were significant differences in favor of the HDCT group only in the functional subcategory social functioning (p=0.04) and the symptomatic subcategory pain (p=0.01), with no significant differences in all other categories. In the EQ-5D questionnaire, we found a reduced QoL in patients after conventional chemotherapy compared to HDCT patients (p=0.05) and healthy people (p=0.02). Conclusions:In this long term follow up study, we found a reduced QoL in FL patients after conventional chemotherapy as well as after HDCT compared to the healthy population. There was a tendency of a better QoL in patients of the HDCT group compared to patients of the conventional chemotherapy group, maybe due to a higher proportion of patients in CR or a longer follow up period in the HDCT group. We conclude that the negative impact of both HDCT and conventional therapy on QoL of patients with follicular lymphoma should not be underestimated and should lead to the development of less toxic therapy strategies. Disclosures:No relevant conflicts of interest to declare.

Quality of life of long-term survivors with Hodgkin lymphoma after high-dose chemotherapy, autologous stem cell transplantation, and conventional chemotherapy

In this study, we investigated the quality of life (QoL) of long-term survivors with Hodgkin lymphoma who received high-dose chemotherapy (HDCT) followed by peripheral blood stem cell transplantation (PBSCT). QoL of this group was compared with QoL of patients who were treated with conventional chemotherapy and with QoL of the healthy German population. Two standardized questionnaires, the EORTC QLQ-C30 and the EQ-5D, including the visual analogue scale (VAS) were applied. A total of 98 patients were included in the study, all of them treated in our institution. Thirty-seven patients who received HDCT with PBSCT between 1986 and 2007 were compared with 61 patients treated with conventional chemotherapy and supplementary radiation between 1998 and 2009. The median follow-up for the HDCT group was 11 years. Statistical analysis with the one-sample t-test shows a reduced QoL of both groups of patients compared to the healthy population. Compared to the group of patients who received conventional chemotherapy, there is a tendency towards reduced QoL in patients with HDCT in all of the three main categories of the EORTC-QLQ-C30. However, these differences were not statistically significant, with the exception of the subcategory of dyspnoea, which was worse in the group that was treated with BCNU containing high-dose protocols. We conclude that the negative impact of both HDCT and conventional therapy on the QoL of long-term survivors with Hodgkin lymphoma should not be underestimated and should lead to the development of less toxic therapy strategies.

Subjective and objective assessment of quality of life after chest wall resection

To date, quality of life (QoL) after extensive chest wall resection is not known. This study analyses QoL in long-term survivors after extensive resection. Retrospective analysis of 51 patients operated for non-small-cell lung cancer (NSCLC)/mediastinal tumour invading the chest wall, primary/secondary chest wall tumours. QoL and functional status of long-term survivors (>36 months) were studied using Borg scale, Mahler dyspnoea index, Functional Autonomy Measuring System (SMAF) and 36-item Short Form Health Survey (SF-36) questionnaire. Out of the 51 patients, pulmonary function tests were available before and after resection in 24 patients and were subjected to analysis. Five-year survival was 50%, 26 patients survived>36 months. At follow-up, 22/28 deaths were cancer related. Compared to baseline, the reduction of flow expiratory volume in 1s (FEV1) and forced vital capacity (FVC) were 18% and 15%, respectively (p<0.001). The QoL study included 23 long-term survivors. A moderate/severe dyspnoea was present in 5/23 patients (21%). The SF-36 questionnaire revealed that, compared to controls, patients with chest wall resection experienced impaired QoL in physical functioning, in role physical, in body pain, in social functioning and in mental health. Objective measurements of pulmonary function correlated poorly with QoL, whereas subjective assessment of dyspnoea was significantly associated with QoL. This study shows that long-term survivors after extensive chest wall resection experienced moderate impairments in several QoL subscales. As previously reported in patients after pulmonary resection, subjective assessment such as dyspnoea correlated well with patient-perceived QoL.

Quality of Life of Long-Term Survivors after a Distal Subtotal Gastrectomy

The aim of this study was to investigate the impact of a distal subtotal gastrectomy on the quality of life (QoL). The QoL data of 126 patients were obtained on their 5th annual follow-up visit after a curative distal subtotal gastrectomy for gastric cancer (Group A). The QoL data of 130 age- and gender-adjusted healthy population were obtained from the individuals who visited the health screening center for a medical check-up (Group B). There were 42 women and 84 men in the study group and their mean age was 56.0±11.1 years. QoL was assessed using the Korean versions of the European Organization for Research and Treatment of Cancer (EORTC) QoL Questionnaire Core 30 (QLQ-C30) and QLQ-STO22. The EORTC QLQ-C30 global health status and QoL scores of Group A and Group B were 63.9±22.7 and 61.3±22.1, respectively (p=0.361). Group A revealed a better score for emotional functioning (84.1±16.1 and 75.2±21.4, respectively; p<0.001), cognitive functioning (82.0±16.4 and 75.0±21.4, respectively; p=0.004) and fatigue (27.7±20.8 and 33.8±23.2, respectively; p=0.028). However, Group A revealed a worse score for nausea and vomiting (14.8±20.0 and 10.2±16.0, respectively; p=0.042), financial difficulties (14.8±22.9 and 7.1±16.1, respectively; p=0.002), reflux (16.7±17.7 and 10.1±17.0, respectively; p=0.003), eating restrictions (13.6±15.2 and 6.6±10.2, respectively; p<0.001) and body image (23.3±25.4 and 16.2±24.6, respectively; p=0.023). The QoL of long-term survivors after a distal subtotal gastrectomy is still influenced by the surgery itself even though they are considered to be free of disease.

Quality of Life of Long Term Survivors with Hodgkin's Lymphoma After High-Dose Chemotherapy with Autologous Stem Cell Transplantation and Conventional Chemotherapy.

Abstract 2495Poster Board II-472 Introduction:High-dose chemotherapy (HDCT) followed by peripheral blood stem cell transplantation (PBSCT) is frequently applied in eligible patients with relapsed or refractory Hodgkin's disease. The toxicity of HDCT, however, might manifest itself in the respective patients' reduced quality of life (QoL). In this study we investigated the QoL of long term survivors after HDCT in comparison with patients after conventional chemotherapy and the healthy German population. Patients and Methods:QoL was evaluated with two standardized questionnaires: EORTC QLQ-C30 and EQ-5D. The cancer-specific EORTC-QLQ-C30 consists of thirty questions concerning three main categories: global health state, functional and symptomatic state. The single questions belonging to functional and symptomatic state can furthermore be grouped into different subcategories. The EQ-5D visualizes five dimensions of health: mobility, self-care, daily activities, pain, and anxiety. In addition to that, the visual analogue scale (VAS) is included to outline the patients' overall health state. A total of 98 patients were included in the study. 37 patients (13 female, 24 male) with a median age of 46 (range 23-72) received HDCT with PBSCT between 1986 and 2007. This group was compared with 61 patients (36 female, 25 male; median age 41, range 21-72) treated with conventional chemotherapy and supplementary radiation in our institution. In the conventional chemotherapy group BEACOPP was used in most cases (n=31), followed by ABVD (n=20), a combination of both (n=8) and ABV (n=2). All patients were in continuous clinical remission. Median follow-up for the HDCT group is 11 and for the conventional chemotherapy group 3.5 years. In addition, Qol of the patients was compared to QoL of healthy people on the basis of two studies about the general health status of the German population (R. Schwarz and A. Hinz: “Reference data for the quality of life questionnaire EORTC QLQ-C30 in the general German population,” European Journal of Cancer 37 [2001]: 1345-1351; H. H. König et al.: “Health Status of the German Population: Results of a Representative Survey Using the EuroQoL Questionnaire,” Gesundheitswesen 67 [2005]: 173-182). Results:In the HDCT group, the results of the questionnaires show a reduced QoL compared to the healthy population. Regarding the three main categories of the EORTC QLQ-C30, the mean sum score for global health state (ghs) is 68.69, for functional state (fs) 72.49 and for symptomatic state (ss) 21.55 (the ideal score being 100.00 for the first two items and 0.00 for the latter). The mean value for EQ-5D is 0.880 (ideal value: 1.000) and that for VAS is 71.60 (ideal value: 100.00). The one sample t-test evaluation shows that the decrease in QoL is significant with p<0.05 in all of the subcategories of the functional state; four of the nine subcategories of the symptomatic state, namely fatigue, dyspnoea, diarrhoea and financial difficulties. Compared to the group of patients who received conventional chemotherapy (ghs: 73.92; fs: 77.36; ss: 16.27), there is a tendency towards reduced QoL in patients with HDCT in all of the three main categories of the EORTC-QLQ-C30, in particular in the category of symptomatic state. However, these differences were not statistically significant, with the exception of the subcategory of dyspnoea (p<0.001). In the EQ-5D questionnaire, there was a trend for reduced QoL of patients after HDCT compared to conventional chemotherapy patients and healthy people, however these effects were not significant (p = 0.06 and p = 0.089). Conclusions:In this long term follow up study, QoL is reduced in patients after HDCT as well as in patients after conventional treatment compared to the healthy population. There was a trend that QoL might be worse in the HDCT group compared to the conventional therapy group; however this effect was not statistically significant. We conclude that the negative impact of both HDCT and conventional therapy on the QoL of long term survivors with Hodgkin's lymphoma should not be underestimated and should lead to the development of less toxic therapy strategies. Disclosures:No relevant conflicts of interest to declare.

Evaluating Quality of Life and Pulmonary Function of Long-term Survivors of Non-Small Cell Lung Cancer Treated With Radical or Postoperative Radiotherapy

Our aim in the present study was to describe the quality of life (QOL), evaluate pulmonary function, and compare demographic and clinical characteristics with QOL in long-term survivors of non-small cell lung cancer treated with radical or postoperative radiotherapy. Twenty-eight patients were recruited in the study. QOL was evaluated using The European Organization for Research and Treatment of Cancer, Quality of Life Core Questionnaire (EORTC QLQ-C30, v.3). Statistical analysis was performed by SPSS 14. Patients' files were reviewed in October 2006. Median duration of follow-up was 46 months (range: 25-125 months). Seven of 9 scales were found to meet the minimal reliability limit (Cronbach's alpha >0.70). The lowest and highest reliability coefficients were 0.56 and 0.93 for social and role functioning, respectively. All interscale correlations were statistically significant (P < 0.01). The strongest positive correlation was found between physical functioning and, role and cognitive functioning (r = 0.59, r = 0.37 or P = 0.01, P = 0.05, respectively). The highest correlation of EORTC QLQ-C30 and the Karnofsky performance scale (KPS) during the questionnaire was found to be with physical functioning and constipation (r = 0.41, r = 0.44 or P = 0.02, P = 0.01, respectively). When the effect of various demographic and clinical parameters on QOL was evaluated; initial KPS, age, educational level, health insurance status, stage, chemotherapy, comorbid disease, and passive smoking were determined as significant factors influencing QOL. Physical, role, cognitive, and emotional functions were found to be significantly lower in the presence of dyspnea (r = 0.42, r = 0.58, r = 0.50, r = 0.63 or P = 0.02, P < 0.01, P < 0.01, P < 0.05, respectively). Regarding the symptom scales, dyspnea was found to be correlated with increasing of fatigue, pain, insomnia, and appetite loss (r = 0.52, r = 0.40, r = 0.64, r = 0.38 or P < 0.01, P = 0.03, P < 0.05, P = 0.04, respectively). The parameters of pulmonary function tests (FEV1, FVC, and FEV1/FVC) did not show any significant relation with any scale of QOL. Overall, we found that QOL of our patients who survived at least 2 years after radiotherapy, was good. The Turkish version of the EORTC QLQ-C30, v.3 is a valid and reliable instrument for Turkish lung cancer patients and can be used in clinical studies. We believe further studies are needed to have a better understanding of patients' pretreatment and posttreatment QOLs.