Multiple Quality Of Life Domains Research Articles

Abstract PO2-12-01: Five-year quality of life (QOL) trajectories among young breast cancer (BC) survivors

Abstract Background: Young BC survivors are at risk for impaired QOL in part due to issues that are unique to their life stage. We sought to characterize trajectories of QOL in the 5 years following diagnosis among young BC survivors as well as evaluate patient and clinical characteristics associated with poorer or deteriorating QOL trajectories over time. Methods: Women diagnosed with stage I-III BC at age ≤40 enrolled in the Young Women’s BC Study, a prospective cohort in North America, who completed ≥2 study surveys through 5 years of post-diagnosis follow-up. QOL was evaluated with the Cancer Rehabilitation Evaluation System (CARES) physical, psychosocial, and sexual subscale scores. Demographic, treatment, and clinical characteristics were ascertained through surveys and chart review. Longitudinal trajectories for each CARES subscale were defined using group-based trajectory modeling; associations between patient/clinical characteristics and trajectory group membership were estimated for each subscale using multivariable multinomial logistic regression. Results: Among 900 women, median age at diagnosis was 36 (range: 17-40) 89% were white, 2% Black, and 4% Hispanic. At baseline, 73% were partnered, 61% parous and 49% perceived themselves as financially comfortable. Most had hormone-receptor positive (74%), HER2-negative (70%) BC, and most received chemotherapy (82%); 36% underwent mastectomy with radiation. Physical and psychosocial scores each clustered into 4 trajectories, with >75% of participants clustering in groups reflecting excellent or good QOL that was stable over time and few (6% for physical and 4% for psychosocial) clustering into groups that reflected poorer QOL at baseline that did not improve over time. Sexual health trajectories were more variable, clustering into 5 trajectories, with over half of participants clustered into groups reflecting good (35%) or excellent (20%) QOL that remained relatively stable over time, 22% clustered into a trajectory that was poor at baseline but moderately improved over follow-up, 13% in a group that reflected deteriorating from moderate-to-poor QOL and 11% in a group with poor QOL at baseline that did not improve over time. In multivariable regression analyses (Table), factors associated with clustering in a poorer trajectory (vs. clustering in an excellent trajectory), in multiple QOL domains included baseline financial discomfort (associated with poorer QOL across all 3 domains), mastectomy+radiation (vs. lumpectomy, associated with poorer QOL across all 3 domains); chemotherapy receipt (associated with poorer physical and sexual health trajectories); and baseline BMI >25 (vs. 18.5-24.9, associated with poorer physical and poorer/deteriorating sexual health trajectories). Conclusions: Young BC survivors follow distinct QOL trajectories in survivorship. While most will not experience substantial QOL impairment through the first 5 years following diagnosis, a substantial minority report persistently poor or deteriorating QOL. The association between more extensive local therapy and poorer physical/psychosocial/sexual health trajectories underscores the importance of communicating the potential for negative QOL outcomes when women are making surgical decisions. Additionally, the pervasive impact of financial wellbeing on multiple QOL domains supports the potential value of systematic screening for and addressing of financial distress to prevent or mitigate financial toxicity in survivorship Factors associated with clustering in poorer/deteriorating (vs. excellent) QOL trajectories *Reference trajectory=excellent QOL Citation Format: Tal Sella, Zheng Yue, Kathryn Ruddy, Shari Gelber, Rulla Tamimi, Jeffrey Peppercorn, Lidia Schapira, Virginia Borges, Steven Come, Eric Winer, Ann Partridge, Shoshana Rosenberg. Five-year quality of life (QOL) trajectories among young breast cancer (BC) survivors [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-12-01.

Abstract PO3-27-06: Investigating The Association Between Exercise and Quality of Life Among Breast Cancer Survivors in The Black Women’s Health Study

Abstract Background: Black breast cancer survivors (BCS) experience suboptimal quality of life (QoL) compared to White BCS. QoL is a multi-dimensional concept focused on different aspects of wellbeing. Exercise (a subset of physical activity) has been shown to improve QoL in cancer survivors. However, there is limited evidence on the benefits of exercise in relation to QoL among Black BCS and warrants further investigation. Purpose: To examine the association between exercise intensity (e.g., moderate activity) and multiple domains of QoL (e.g., physical wellbeing) among BCS in the Black Women’s Health Study (BWHS). Methods: The BWHS is the largest prospective cohort study following 59,000 Black women in the United States since 1995. Self-reported questionnaires are distributed every two years to obtain current health information, including lifestyle factors and disease occurrence. The 2019 survey data, completed by 3,608 Black BCS, were used to address the primary aim. Of the 3,608 Black BCS, 1,085 females were eligible to participate in this cross-sectional study. The primary predictors were moderate and vigorous exercise intensity. The outcomes (physical, mental, functional, social functioning, and financial wellbeing) were categorized as excellent, very good or good, and fair or poor health. The covariates were marital status, occupation, education, age, body mass index, time since diagnosis, breast cancer stage, and general health. Adjusted multinomial logistic regressions were performed to estimate the odds ratios and 95% confidence intervals for the associations with each predictor. Multiple imputation was used to address missing data. Results: At baseline, the majority of the BCS were 64 years or younger (99%), premenopausal (69%), employed (95%), and had more than a high school degree (86%). About 50% of the participants were married or living as married. There were significant and positive associations between exercise intensity and QoL (p< .05). Compared to BCS who reported little or no exercise (< 60 minutes/week), those who reported at least 60 minutes/week of vigorous exercise had greater odds of experiencing excellent QoL including financial wellbeing (OR=1.70, 95% CI: 1.08-2.67), functional wellbeing (OR=3.64, 95% CI: 1.56-8.49), social functioning (OR=4.56, 95% CI: 2.42-8.60), and physical wellbeing (OR=4.26, 95% CI: 2.12-8.52). Similarly, BCS who engaged in at least 150 minutes of moderate exercise/week had increased odds of reporting excellent social functioning (OR=2.59, 95% CI: 1.41-4.76) and functional wellbeing (OR=4.40, 95% CI: 1.89-10.24) than those who engaged in less than 150 minutes/week of moderate exercise. Conclusions: Black BCS who engage in certain durations (e.g., 150 minutes/week) and exercise intensities (e.g., moderate activity) tend to have better QoL. These findings may help to build upon the relevance of exercise in the context of supportive care for racial and ethnic minority cancer survivors and encourage healthcare professionals to assess the frequency, intensity, time, and type of exercise during routine or follow-up care. Future longitudinal studies are needed to examine the proposed associations among Black BCS and to compare the current study findings. Citation Format: Natasha Burse, Chris Wiesen, Todd Schwartz, Shawn Kneipp, Ashley Leak Bryant. Investigating The Association Between Exercise and Quality of Life Among Breast Cancer Survivors in The Black Women’s Health Study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-27-06.

Impact of Air Pollution and Allergic Status on Health-Related Quality of Life among University Students in Northern Thailand.

Global awareness of ambient air pollution has heightened due to its detrimental impact on health, particularly in regions with elevated PM2.5 levels. Chiang Mai has emerged as an area experiencing the highest PM2.5 levels in Thailand. to examine the prevalence of respiratory allergies and assess the impact of air pollution on the health-related quality of life (QoL) among university students in Chiang Mai. Chiang Mai University (CMU) and Maejo University (MJU) students were recruited. The Global Asthma Network (GAN) questionnaire screened for respiratory allergies (RAs). The disease-specific QoL questionnaire (Rcq-36) was administered twice during low-PM2.5 and high-PM2.5 seasons to evaluate air pollution's impact on health-related QoL. Those showing potential RAs underwent a skin prick test (SPT) to investigate allergic sensitization. Out of 406 participants, 131 (32%) reported respiratory allergies. Among those undergoing SPT, a high rate (82.54%) had positive results. Across both universities, students reported significantly lower QoL in multiple domains, particularly respiratory, eye, sleep, and emotional well-being, during the high-PM2.5 season. This aligned with their poorer self-reported health on a visual analog scale (VAS; p-value < 0.01). PM2.5 levels significantly impacted social functioning for CMU students (p-value = 0.001) and role limitations for MJU students (p-value < 0.001). Notably, participants without respiratory allergies (non-RAs) were more significantly affected by PM2.5 than RA participants in almost all parameters, despite experiencing fewer baseline symptoms. Respiratory allergies, particularly allergic rhinitis, are prevalent among university students in Chiang Mai. This study underscores the substantial negative impact of ambient air pollution on QoL for both allergic and non-allergic students.

Two-Year Longitudinal Study Reveals That Long COVID Symptoms Peak and Quality of Life Nadirs at 6-12 Months Postinfection.

Few longitudinal studies available characterize long COVID outcomes out to 24 months, especially in people with nonsevere acute coronavirus disease 2019 (COVID-19). This study sought to prospectively characterize incidence and duration of long COVID symptoms and their association with quality of life (QoL) from 1-24 months after mild-to-moderate COVID-19 using validated tools in a diverse cohort of unvaccinated people infected with SARS-CoV-2 in 2020. At 1-3, 6, 12, 18, and 24 months post-COVID-19, 70 participants had orthostatic vital signs measured, provided blood, and completed surveys characterizing symptoms, QoL, and return to pre-COVID-19 health and activities using validated tools (FLU-PRO+, Fatigue Severity Scale, Insomnia Severity Index, General Practitioner Assessment of Cognition, Patient Health Questionnaire Depression 8-Item, Generalized Anxiety Disorder 7-Item, 36-Item Short-Form Health Survey, EuroQol EQ-5D-5L). During the study period, 33% of participants experienced long COVID (had not returned to pre-COVID-19 health status and reported at least 1 symptom >90 days postinfection); 8% had not returned to their pre-COVID-19 health status 24 months postinfection. Long COVID symptoms peaked 6 months post-COVID-19, frequently causing activity limitations. Having long COVID was significantly associated with decreased QoL in multiple domains. Frequencies of orthostatic hypotension and tachycardia reflected levels reported in the general population. Within-person weight increased significantly between months 1 and 6. Long COVID was associated with pre-COVID-19 obesity and hyperlipidemia, but not with high-sensitivity C-reactive protein levels 1-3 months postinfection. Long COVID occurs in a significant proportion of unvaccinated people, even if the acute illness was not severe. Long COVID prevalence peaked 6-12 months post-COVID-19, and a small proportion of participants still reported not returning to their pre-COVID-19 health status 24 months post-COVID-19.

Assessing the Impact of Organ Failure and Metastases on Quality of Life in Breast Cancer Patients: A Prospective Study Based on Utilizing EORTC QLQ-C30 and EORTC QLQ-BR45 Questionnaires in Romania.

Breast cancer (BC) significantly impacts the quality of life (QoL) of affected individuals. This study, conducted at Colțea Clinical Hospital, Bucharest, aimed to assess the impact of organ failures and metastases on QoL in breast cancer patients using EORTC QLQ-C30 and EORTC QLQ-BR45 questionnaires and the survival rate to understand the clinical journey and the quality of life status in breast cancer patients. From January 2019 to October 2022, a prospective, observational study surveyed 874 patients, revealing 201 fatalities, 66 refusals, and 607 eligible participants. Results indicated statistically significant differences in various QoL aspects for patients experiencing heart failure, including physical functioning, pain, insomnia, global health status, and overall summary score. Kidney failure exhibited significance in physical functioning for QLQ-C30 and body image, sexual functioning, and endocrine sexual symptoms for QLQ-BR45. Respiratory failure demonstrated significant differences across multiple QoL domains. Patients with bone metastases reported lower physical functioning (p = 0.006) and increased pain (p = 0.002). This study has revealed an overall 5-year life expectancy of 68.8%, with survival rates of 93.8% for Stage I, 86.3% for Stage II, and 77.2% for Stage III breast cancer. Metastatic cancer patients have shown a 35.6% survival rate over 45 months, with a median survival duration of 36 months. A significant limitation of our study was the administration of the questionnaire only once, preventing us from quantifying the impact of specific treatment types on quality of life. This study emphasizes the necessity of using standardized QoL assessments in clinical practice from the initial presentation to ongoing follow-up.

Examining the Quality of Life and Discrimination Impact on Parents of Children With Autism Spectrum Disorder in Aseer Region, Saudi Arabia: A WHO-QOL Survey.

Background Autism spectrum disorder (ASD) is a neurodevelopmental disease marked by social and repetitive or restricted behaviors, as well as communication difficulty. Objectives This survey aimed to assess the quality of life (QoL) of parents with ASDs in the Aseer region of Saudi Arabia using the brief form of the World Health Organization (WHO-QOL) questionnaire. Furthermore, we sought to measure the severity of discrimination experienced by parents of children with ASDs and their impact on QoL. Methodology Using a Google form, a cross-sectional study was carried out online between March and April 2023. The patient records from four different regions of Saudi Arabia were used to recruit study participants. The survey was distributed through well-known social media channels (Instagram, Telegram, Facebook). Results A total of 99 parents were included in this study. The Southern region accounted for the bulk of participants (81.8%, n=81), nearly three-fourths of the children were boys (70.7%), mothers were more common among respondents (65.7%, n=65) than fathers, 66.7% of respondents reported being married, and 78.8% fall into the middle economic class category. The main source of information among the studied population was the Internet (39.4%, n=39), followed by relatives (23.0%, n=23), physicians (8.1%, n=9), and finally books (4%, n=4). The mean scores for the various domains are as follows: physical (58.48 ± 13.84), psychological (62.04 ± 18.08), social relations (61.20 ± 23.24), environment (24.12 ± 14.62), general QoL (72.93 ± 4.30), and general health (73.94 ± 4.63). Nearly half (46.5%) of parents have encountered stigma or discrimination toward their child or family. Individuals who reported experiencing discrimination exhibited significantly lower mean scores in multiple QoL domains than those who did not report discrimination for physical (54.11, ± 14.36vs, 62.26±12.28, p=0.003), psychological (55.80 ± 20.33 vs 67.45 ± 13.94, p=0.002), and social relations (55.43± 24.17 vs 66.20 ± 21.40, p=0.022). Multivariate analysis revealed that discrimination was the only significant predictor of QoL (p < 0.001). Conclusions The QoL of parents having a child with autism is low, moreover, the coincidence of discrimination and stigma significantly lowered QoL.

Quality of life (QOL) for patients with esophageal cancer receiving trimodality therapy with induction chemotherapy, chemoradiation, and surgery: Results from CALGB 80803 (Alliance).

283 Background: The randomized phase II CALGB 80803 trial evaluated use of PET imaging for early assessment of induction chemotherapy (iCT) responsiveness to tailor therapy for patients with esophageal and gastroesophageal junction adenocarcinomas (EC) undergoing trimodality therapy. The primary endpoint of improving pathologic complete response rates using PET-adapted therapy was met. A companion QOL study aimed to characterize patients’ experience through iCT, chemoradiation (CRT) and surgery (S). Methods: Between 11/2011 and 5/2015, 241 eligible patients were randomized to an iCT regimen: modified oxaliplatin, leucovorin, and 5-fluorouracil (FOLFOX) or carboplatin/paclitaxel (CP), followed by PET scan then CRT, either continuing on the same CT for PET-responders (PET-R) or crossing over to the alternative CT for PET-nonresponders (PET-NR). We prospectively collected QOL domains and symptoms at baseline (T1), after iCT (T2), after CRT (T3), and 3- (T4) and 6- months (T5) after S using the EORTC QLQ-C30, The Esophageal Cancer subscale (EORTC OES18), FACT Neurotoxicity Scale (FACT-NTX), and 6 questions from the PRO-CTCAE. QOL scores were compared between iCT groups and between PET-R and PET-NR at each time point using mixed models. The association of QOL scores at enrollment with overall survival (OS) was tested using Cox regression. Results: 189 patients enrolled on the QOL sub-study, 92 received induction FOLFOX and 97 induction CP. Of those, 110 were PET-R and 79 were PET-NR. 97.9% went on to CRT, and 83.6% underwent S. Global QOL and symptoms statistically significantly worsened from T1 to T2 in 14 of 25 domains, and remained significantly worsened from T1 at: T3 for 19 of 25 domains, T4 for 17 of 25 domains, and T5 for 6 of 25 domains. Changes from T1 significantly favored iFOLFOX (vs iCP) for ability to eat (at T3 and T4), GI symptoms (at T3 and T4), and talking (at T5). Changes from T1 significantly favored iCP (vs iFOLFOX) for neuropathy (at T2, T3, and T4) and coughing (at T5). Proportion of patients reporting worsened PRO-CTCAE scores did not differ between PET-R or PET-NR groups . Multiple QOL domains and symptoms were associated with OS including role functioning, global health status/QOL, appetite loss, pain, dysphagia, and ability to eat (all p&lt;0.002). Conclusions: QOL was impacted most by CRT but returned to baseline 6 months after surgery for most domains. Observed symptom differences did not consistently favor one iCT regimen. Early interventions such as nutritional support and prehabilitation should be studied to improve QOL and OS. Clinical trial information: NCT01333033 .

Wake-Up Call to Address Sleep Health in Non-Muscle Invasive Bladder Cancer: Underappreciated Contributor to Poor Quality of Life.

Few studies have specifically examined sleep health in patients with non-muscle invasive bladder cancer (NMIBC). Further study is warranted to inform future strategies in patients with NMIBC. We aim to describe sleep health in a cohort of patients with NMIBC, and its relationship with quality of life (QOL). We conducted an observational cross-sectional study in patients undergoing surveillance for NMIBC. The validated Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep health (scores from 0-21) in the overall study population as well as stratified. We assessed QOL among participants with and without poor sleep quality using the SF-12 and QLQ-NMIBC-24. In a cohort of 94 NMIBC patients, median age was 67 years (IQR: 58, 72) and median time since initial diagnosis was 27 months (IQR: 9, 41). The mean PSQI score was 6.3 (SD: 3.8) and 64% percent of participants met or exceeded the PSQI cut-off score of 5, with a score of 5 or more indicating overall poor sleep quality. In those with poor sleep quality, there were statistically significant detriments in multiple QOL domains. In patients undergoing surveillance for NMIBC, there is a substantial burden of sleep disturbances and resulting decrements in QOL. These data support the need for future interventions to support sleep quality and highlight the importance of addressing sleep health as part of NMIBC survivorship care to improve QOL in patients with NMIBC.

Neighborhood environment and quality of life among community-living older adults in Nigeria: The moderating effect of physical activity

Understanding how neighborhood environments are related to older adults’ quality of life (QoL) and physical activity (PA) is important for public health actions on healthy ageing in sub-Saharan Africa. We examined associations of perceived neighborhood environment attributes with QoL among older adults in Nigeria and investigated the moderating effects of PA on these associations. We conducted a cross-sectional study of 353 older adults (mean age = 68.9 ± 9.1 years) selected from 5 high- and low-income communities in Maiduguri, Nigeria. QoL, attributes of the neighborhood environments and PA were self-reported using validated questionnaires. Multi-level models were used to examine the direct associations between neighborhood environment attributes and each of the four domains of QoL (physical health, psychological health, social relationships, and environmental health), as well as the moderating effects of leisure-time and total PA. Seven of nine neighborhood environment features were positively associated with multiple domains of QoL. Residential density, land-use diversity, land-use mix-access, walking infrastructure, traffic safety and ‘overall walkability’ were positively related to both or either physical health and environmental health QoL among those who are physically active. In contrast, walking infrastructure, traffic safety, and ‘overall walkability’ were negatively related to psychological health QoL among those not physically active. Our findings suggest being physically active moderates the association of neighborhood environments with QoL among Nigerian older adults. We suggest that designing age-friendly communities and simultaneously promoting PA may be needed to improve QoL and help prepare the Nigerian society for the predicted increase in the older adult population.

Patient-reported Quality of Life After Breast-conserving Surgery With Radiotherapy Versus Mastectomy and Reconstruction.

To compare long-term quality of life (QOL) outcomes in breast cancer survivors who received breast-conserving surgery with radiotherapy (BCS+RT) with those who received a mastectomy and reconstructive surgery (Mast+Recon) without radiotherapy and identify other important factors. The long-term differences in patient-reported QOL outcomes following BCS+RT and Mast+Recon are not well understood. We identified patients from the Texas Cancer Registry with stage 0-II breast cancer diagnosed in 2009-2014 after BCS+RT or Mast+Recon without radiotherapy. Sampling was stratified by age and race and ethnicity. A paper survey was sent to 4800 patients which included validated BREAST-Q and PROMIS modules. Multivariable linear regression models were implemented for each outcome. Minimal clinically important difference for BREAST-Q and PROMIS modules, respectively, was 4 points and 2 points. Of 1215 respondents (25.3% response rate), 631 received BCS+RT and 584 received Mast+Recon. The median interval from diagnosis to survey completion was 9 years. In adjusted analysis, Mast+Recon was associated with worse BREAST-Q psychosocial well-being (effect size: -3.80, P =0.04) and sexual well-being (effect size: -5.41, P =0.02), but better PROMIS physical function (effect size: 0.54, P =0.03) and similar BREAST-Q satisfaction with breasts, physical well-being, and PROMIS upper extremity function ( P >0.05) compared with BCS+RT. Only the difference in sexual well-being reached clinical significance. Older (≥65) patients receiving BCS+RT and younger (<50) patients receiving autologous Mast+Recon typically reported higher QOL scores. Receipt of chemotherapy was associated with detriments to multiple QOL domains. Patients who underwent Mast+Recon reported worse long-term sexual well-being compared with BCS+RT. Older patients derived a greater benefit from BCS+RT, while younger patients derived a greater benefit from Mast+Recon. These data inform preference-sensitive decision-making for women with early-stage breast cancer.

Validation and the associated factors of the Malay version of systemic lupus erythematosus-specific health-related quality of life questionnaires (SLEQoL and LupusQoL).

To assess the reliability and validity of two disease-specific questionnaires that assess the quality of life (QoL) among patients with Systemic Lupus Erythematosus (SLE); SLEQoL and LupusQoL in Malay language. This study also identified the factors affecting each domain of the questionnaires. This cross-sectional study was conducted from June 2021 until April 2022, and SLE patients were recruited to complete the SLEQoL, LupusQoL and Short Form Health Survey (SF-36) in Malay language. Disease activity were recorded using the modified SLE Disease Activity Index (M- SLEDAI) and British Isles Lupus Assessment Group 2004 (BILAG-2004) index. Presence of organ damage was determined using the SLICC Damage index. Cronbach's alpha was calculated to determine internal consistency while exploratory factor analysis was done to determine the construct validity. Concurrent validity was evaluated using correlation with SF-36. Multiple linear regression analysis was deployed to determine the factors affecting each domain of SLEQoL and LupusQoL. A total of 125 subjects were recruited. The Cronbach's α value for the Malay-SLEQoL (M-SLEQoL) and Malay-LupusQOL (M-LupusQoL) was 0.890 and 0.944 respectively. Exploratory factor analysis found formation of similar number of components with the original version of questionnaires and all items have good factor loading of >0.4. Both instruments also had good concurrent validity with SF-36. M-SLEQoL had good correlations with BILAG-2004 and M-SLEDAI scores. Musculoskeletal (MSK) involvement was independently associated with lower M-SLEQoL in physical function, activity and symptom domains. Meanwhile, MSK and NPSLE were associated with fatigue in M-LupusQoL. Both M-SLEQoL and M-LupusQoL are reliable and valid as disease -specific QoL instruments for Malaysian patients. The M-Lupus QoL has better discriminative validity compared to the M-SLEQoL. SLE patients with MSK involvement are at risk of poor QoL in multiple domains including physical function, activity, symptoms and fatigue.

Spinal cord epidural stimulation for motor and autonomic function recovery after chronic spinal cord injury: A case series and technical note.

Traumatic spinal cord injury (tSCI) is a debilitating condition, leading to chronic morbidity and mortality. In recent peer-reviewed studies, spinal cord epidural stimulation (scES) enabled voluntary movement and return of over-ground walking in a small number of patients with motor complete SCI. Using the most extensive case series (n = 25) for chronic SCI, the present report describes our motor and cardiovascular and functional outcomes, surgical and training complication rates, quality of life (QOL) improvements, and patient satisfaction results after scES. This prospective study occurred at the University of Louisville from 2009 to 2020. scES interventions began 2-3 weeks after surgical implantation of the scES device. Perioperative complications were recorded as well as long-term complications during training and device related events. QOL outcomes and patient satisfaction were evaluated using the impairment domains model and a global patient satisfaction scale, respectively. Twenty-five patients (80% male, mean age of 30.9 ± 9.4 years) with chronic motor complete tSCI underwent scES using an epidural paddle electrode and internal pulse generator. The interval from SCI to scES implantation was 5.9 ± 3.4 years. Two participants (8%) developed infections, and three additional patients required washouts (12%). All participants achieved voluntary movement after implantation. A total of 17 research participants (85%) reported that the procedure either met (n = 9) or exceeded (n = 8) their expectations, and 100% would undergo the operation again. scES in this series was safe and achieved numerous benefits on motor and cardiovascular regulation and improved patient-reported QOL in multiple domains, with a high degree of patient satisfaction. The multiple previously unreported benefits beyond improvements in motor function render scES a promising option for improving QOL after motor complete SCI. Further studies may quantify these other benefits and clarify scES's role in SCI patients.

Efficacy and Feasibility of Presurgical Exercise in Bladder Cancer Patients Scheduled for Open Radical Cystectomy.

This study aimed to examine the feasibility and potential efficacy of presurgical exercise in patients with bladder cancer scheduled for open radical cystectomy with follow-up postsurgery. Prospective single-group design with assessments at baseline, presurgery, and 3 months postsurgery was used in this study. Multimodal supervised resistance and aerobic exercise was undertaken 2-3 d·wk -1 at moderate intensity for a median of 3.5 wk (interquartile range [IQR] = 1.3-5.6). Feasibility was assessed by recruitment and completion rates, patient safety, program tolerance, adherence, and compliance. Lean and fat mass were assessed by dual-energy x-ray absorptiometry, physical function by a battery of tests (chest press and leg press strength, 6-min walk test [6MWT], timed up-and-go, repeated chair rise), and quality of life (QoL), psychological distress, and body image by questionnaire. Hospital length of stay (LOS) and complications were assessed by medical records. Thirty-seven patients were referred with 20 recruited (67.3 ± 12.2 yr) and a presurgery intervention completion rate of 80% (16 of 20). The individual median program adherence was 100.0% (IQR = 89.4-100.0) with compliance of 100.0% (IQR = 90.5-100.0) for resistance exercise and 81.8% (IQR = 55.0-99.5) for aerobic exercise. There were no exercise-related adverse events. Body composition did not change presurgery; however, there were improvements ( P < 0.05) in leg press strength (16%), 6MWT distance (8%), timed up-and-go (12%), chair rise (10%), and multiple QoL domains including mental health. Median LOS was 8.0 d (IQR = 7.0, 15.0). Postsurgery, there were declines in components of QoL and apparent body image dissatisfaction. A preradical cystectomy exercise program is feasible, safe, and well tolerated with improvements in physical function and QoL. Supervised multimodal exercise in bladder cancer patients before cystectomy can enhance physical and mental health potentially buffering the effects of surgery.

Modifiable risk factors for neurocognitive and psychosocial problems after Hodgkin lymphoma

AbstractLong-term survivors of childhood Hodgkin lymphoma (HL) experience a high burden of chronic health morbidities. Correlates of neurocognitive and psychosocial morbidity have not been well established. A total of 1760 survivors of HL (mean ± SD age, 37.5 ± 6.0 years; time since diagnosis, 23.6 ± 4.7 years; 52.1% female) and 3180 siblings (mean age, 33.2 ± 8.5 years; 54.5% female) completed cross-sectional surveys assessing neurocognitive function, emotional distress, quality of life, social attainment, smoking, and physical activity. Treatment exposures were abstracted from medical records. Chronic health conditions were graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events version 4.3 (1 = mild, 2 = moderate, 3 = severe/disabling, and 4 = life-threatening). Multivariable analyses, adjusted for age, sex, and race, estimated relative risk (RR) of impairment in survivors vs siblings and, among survivors, risk of impairment associated with demographic, clinical, treatment, and grade 2 or higher chronic health conditions. Compared with siblings, survivors had significantly higher risk (all, P < .05) of neurocognitive impairment (eg, memory, 8.1% vs 5.7%), anxiety (7.0% vs 5.4%), depression (9.1% vs 7%), unemployment (9.6% vs 4.4%), and impaired physical/mental quality of life (eg, physical function, 11.2% vs 3.0%). Smoking was associated with a higher risk of impairment in task efficiency (RR, 1.56; 95% confidence interval [CI], 1.02-2.39), emotional regulation (RR, 1.84; 95% CI, 1.35-2.49), anxiety (RR, 2.43; 95% CI, 1.51-3.93), and depression (RR, 2.73; 95% CI, 1.85-4.04). Meeting the exercise guidelines of the Centers for Disease Control and Prevention was associated with a lower risk of impairment in task efficiency (RR, 0.70; 95% CI, 0.52-0.95), organization (RR, 0.60; 95% CI, 0.45-0.80), depression (RR, 0.66; 95% CI, 0.48-0.92), and multiple quality of life domains. Cardiovascular and neurologic conditions were associated with impairment in nearly all domains. Survivors of HL are at elevated risk for neurocognitive and psychosocial impairment, and risk is associated with modifiable factors that provide targets for interventions to improve long-term functional outcomes.

The role of alexithymia and autistic traits in predicting quality of life in an online sample

BackgroundAutistic people tend to report poorer Quality of Life (QOL) than comparison groups, though some studies do report more optimistic findings. Higher autistic traits are also related to poorer QOL. However, the role of alexithymia in this relationship has not been explored. MethodA total of 163 participants (N = 53 autistic and N = 111 comparison) consented to take part; however, 30 participants were excluded due to missing data (who did not differ from those who were retained on age, gender, education, employment, or living status), leaving a final sample of 133 (N = 42 Autistic and 91 Comparison participants). Demographic information (including age, gender) was collected, alongside self-report measures of autistic traits, mental health, alexithymia, and QOL. We estimated regression models based on pre-registered analysis, and we conducted exploratory network analyses. ResultsAlexithymic traits did not predict QOL when controlling for covariates. Depression significantly predicted Physical, Psychological, and Social QOL. When examining the impact of just alexithymic traits and autistic traits, both were significantly associated with Physical and Psychological QOL. For participants with a low depression score, the correlation between alexithymia and QOL was strong; suggesting that depression occludes the association between alexithymia and QOL. Network analyses suggested that depression and anxiety exert direct effects on Physical and Psychological QOL, whereas alexithymia scores may influence Physical QOL via autistic traits. ConclusionIn sum, depression is a pervasive negative predictor of multiple QOL domains. The role of alexithymia in predicting QOL dimensionally and categorically was not ruled out, given our exploratory analyses, we suggest that interventions which target alexithymia may positively impact QOL for those who score low on depressive symptoms.

Separating Fact from Fiction in the Diagnosis and Management of Food Allergy

Food allergy is one of the most common chronic conditions of childhood, impacting up to 10% of children.1Soller L. Ben-Shoshan M. Harrington D.W. Fragapane J. Joseph L. St Pierre Y. et al.Overall prevalence of self-reported food allergy in Canada.J Allergy Clin Immunol. 2012; 130: 986-988Abstract Full Text Full Text PDF PubMed Scopus (134) Google Scholar, 2Clarke A.E. Elliott S. Pierre Y.S. Soller L. La Vieille S. Ben-Shoshan M. Temporal trends in prevalence of food allergy in Canada.J Allergy Clin Immunol Pract. 2020; 8: 1428-1430Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar, 3Gupta R.S. Warren C.M. Smith B.M. Jiang J. Blumenstock J.A. Davis M.M. et al.Prevalence and severity of food allergies among US adults.JAMA Netw Open. 2019; 2: e185630Crossref PubMed Scopus (303) Google Scholar However, despite the apparent increasing prevalence of this condition, there remain gaps in understanding of the diagnosis and management. There is a common perception held by many regarding a fear of food allergens provoking life-threatening reactions, potentially even fatal food-induced anaphylaxis. Although severe reactions do occur and deaths from food allergy have been reported, fatal food allergy is a very rare event (defined as <1 case per 100 000).4Turner P.J. Jerschow E. Umasunthar T. Lin R. Campbell D.E. Boyle R.J. Fatal anaphylaxis: mortality rate and risk factors.J Allergy Clin Immunol Pract. 2017; 5: 1169-1178Abstract Full Text Full Text PDF PubMed Scopus (211) Google Scholar,5Baseggio Conrado A. Ierodiakonou D. Gowland M.H. Boyle R.J. Turner P.J. Food anaphylaxis in the United Kingdom: analysis of national data, 1998-2018.BMJ. 2021; 372: n251Crossref PubMed Scopus (33) Google Scholar Paradoxically, fear regarding a severe food allergy can cause more morbidity than the food allergy itself.6Nowak-Wegrzyn A. Hass S.L. Donelson S.M. Robison D. Cameron A. Etschmaier M. et al.The Peanut Allergy Burden Study: impact on the quality of life of patients and caregivers.World Allergy Organ J. 2021; 14: 100512Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar, 7DunnGalvin A. Gallop K. Acaster S. Timmermans F. Regent L. Schnadt S. et al.APPEAL-2: A pan-European qualitative study to explore the burden of peanut-allergic children, teenagers and their caregivers.Clin Exp Allergy. 2020; 50: 1238-1248Crossref PubMed Scopus (16) Google Scholar, 8Couratier P. Montagne R. Acaster S. Gallop K. Patel R. Vereda A. et al.Allergy to Peanuts imPacting Emotions And Life (APPEAL): the impact of peanut allergy on children, adolescents, adults and caregivers in France.Allergy Asthma Clin Immunol. 2020; 16: 86Crossref PubMed Scopus (6) Google Scholar There are also misconceptions in the presentation and diagnosis of food allergy; as urticaria is not pathognomonic of food allergy and diagnostic testing, although sensitive, is not specific. Finally, it is under-recognized that antihistamines have no place in the first-line management of anaphylaxis, nor do oral corticosteroids have a role in prevention of a biphasic reaction. The goal of this commentary is to review important themes that have emerged in our understanding of food allergy management. Anaphylaxis has been defined as a “serious allergic reaction that is rapid in onset and may cause death.”9Boyce J.A. Assa'ad A. Burks A.W. Jones S.M. Sampson H.A. Wood R.A. et al.Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel.J Allergy Clin Immunol. 2010; 126: S1-S58Abstract Full Text Full Text PDF PubMed Scopus (1119) Google Scholar However, although it is essential that anaphylaxis be recognized and managed, the risk of fatality from anaphylaxis is very low. Moreover, it has been shown that fatal food anaphylaxis is “rare, and adds little to overall mortality risk, even in young people known to have a food allergy.”4Turner P.J. Jerschow E. Umasunthar T. Lin R. Campbell D.E. Boyle R.J. Fatal anaphylaxis: mortality rate and risk factors.J Allergy Clin Immunol Pract. 2017; 5: 1169-1178Abstract Full Text Full Text PDF PubMed Scopus (211) Google Scholar The risk of fatal anaphylaxis is about 1 in 10 million (about equivalent to being struck by lightning, and 100-fold lower than death owing to fire or murder).4Turner P.J. Jerschow E. Umasunthar T. Lin R. Campbell D.E. Boyle R.J. Fatal anaphylaxis: mortality rate and risk factors.J Allergy Clin Immunol Pract. 2017; 5: 1169-1178Abstract Full Text Full Text PDF PubMed Scopus (211) Google Scholar,10Jerschow E. Lin R.Y. Scaperotti M.M. McGinn A.P. Fatal anaphylaxis in the United States, 1999-2010: temporal patterns and demographic associations.J Allergy Clin Immunol. 2014; 134: 1318-1328.e7Abstract Full Text Full Text PDF PubMed Scopus (244) Google Scholar In a systematic review and meta-analysis regarding the incidence of fatal food anaphylaxis in people with food allergy in Europe, the incidence of (food-related) fatal anaphylaxis was 1.81 per million person-years (95% CI, 0.94-3.45), which is lower than the incidence of accidental death among the general European population.11Umasunthar T. Leonardi-Bee J. Hodes M. Turner P.J. Gore C. Habibi P. et al.Incidence of fatal food anaphylaxis in people with food allergy: a systematic review and meta-analysis.Clin Exp Allergy. 2013; 43: 1333-1341Crossref PubMed Scopus (160) Google Scholar Even among infants, the risk of anaphylaxis, and fatal anaphylaxis, are both extremely low. Infant anaphylaxis tends to be milder than in older children, and fatality on first ingestion of an allergen in infancy has never been described.12Abrams E.M. Primeau M.-N. Kim H. Gerdts J. Chan E.S. Increasing awareness of the low risk of severe reaction at infant peanut introduction: implications during COVID-19 and beyond.J Allergy Clin Immunol Pract. 2020; 8: 3259-3260Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar A focus on mortality risk often cloaks the importance that there can be considerable morbidity related to food allergy, which is largely psychological and related to its impact on quality of life (QoL).13Shaker M.S. Schwartz J. Ferguson M. An update on the impact of food allergy on anxiety and quality of life.Curr Opin Pediatr. 2017; 29: 497-502Crossref PubMed Scopus (48) Google Scholar Studies of children with food allergy note a significant impact on multiple domains of QoL, including overall QoL, health-related QoL, QoL in school, and emotional QoL (including separation anxiety and bullying).14King R.M. Knibb R.C. Hourihane J.O. Impact of peanut allergy on quality of life, stress and anxiety in the family.Allergy. 2009; 64: 461-468Crossref PubMed Scopus (242) Google Scholar,15Fong A.T. Katelaris C.H. Wainstein B. Bullying and quality of life in children and adolescents with food allergy.J Paediatr Child Health. 2017; 53: 630-635Crossref PubMed Scopus (27) Google Scholar In recent studies, more than 30% of children and adolescents reported being bullied because of their food allergy (although these studies tend to over-rely on clustered samples and self-report).15Fong A.T. Katelaris C.H. Wainstein B. Bullying and quality of life in children and adolescents with food allergy.J Paediatr Child Health. 2017; 53: 630-635Crossref PubMed Scopus (27) Google Scholar, 16Fong A.T. Katelaris C.H. Wainstein B.K. Bullying in Australian children and adolescents with food allergies.Pediatr Allergy Immunol. 2018; 29: 740-746Crossref PubMed Scopus (23) Google Scholar, 17Brown D. Negris O. Gupta R. Herbert L. Lombard L. Bozen A. et al.Food allergy-related bullying and associated peer dynamics among Black and White children in the FORWARD study.Ann Allergy, Asthma Immunol. 2021; 126: 255-263.e1Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar, 18Lieberman J.A. Gupta R.S. Knibb R.C. Haselkorn T. Tilles S. Mack D.P. et al.The global burden of illness of peanut allergy: a comprehensive literature review.Allergy. 2021; 76: 1367-1384Crossref PubMed Scopus (11) Google Scholar Food allergy impacts many aspects of daily life. In a questionnaire of 87 caregivers of children with food allergy, more than 60% reported that food allergy significantly affected meal preparation, 49% reported that it affected family social activities, 41% reported it had a significant impact on stress levels, and 34% reported that it impacted school attendance (with 10% choosing home schooling because of a food allergy).19Bollinger M.E. Dahlquist L.M. Mudd K. Sonntag C. Dillinger L. McKenna K. The impact of food allergy on the daily activities of children and their families.Ann Allergy Asthma Immunol. 2006; 96: 415-421Abstract Full Text PDF PubMed Scopus (272) Google Scholar The impact of peanut allergy on QoL has been noted to be significantly worse than the impact of other chronic childhood diseases such as rheumatologic disease and type 1 diabetes mellitus.20Primeau M.N. Kagan R. Joseph L. Lim H. Dufresne C. Duffy C. et al.The psychological burden of peanut allergy as perceived by adults with peanut allergy and the parents of peanut-allergic children.Clin Exp Allergy. 2000; 30: 1135-1143Crossref PubMed Scopus (328) Google Scholar,21Avery N.J. King R.M. Knight S. Hourihane J.O. Assessment of quality of life in children with peanut allergy.Pediatr Allergy Immunol. 2003; 14: 378-382Crossref PubMed Scopus (355) Google Scholar The burden of food allergy on QoL in food-allergic children and their families is partially, if not largely, related to the concern that accidental exposure could result in fatal anaphylaxis.14King R.M. Knibb R.C. Hourihane J.O. Impact of peanut allergy on quality of life, stress and anxiety in the family.Allergy. 2009; 64: 461-468Crossref PubMed Scopus (242) Google Scholar,22Abrams E.M. Chan E.S. Sicherer S. Peanut allergy: new advances and ongoing controversies.Pediatrics. 2020; 145: e20192102Crossref PubMed Google Scholar In a survey of 305 caregivers of children with food allergy, accurate reaction perception was significantly associated with overall improved QoL score (P = .04).23Howe L. Franxman T. Teich E. Greenhawt M. What affects quality of life among caregivers of food-allergic children?.Ann Allergy Asthma Immunol. 2014; 113: 69-74.e2Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar In a study of 876 families of children with food allergy that assessed parental empowerment and QoL, parental concern in the QoL assessment was greatest for items involving fear of allergen exposure outside of their control (the home).24Warren C.M. Gupta R.S. Sohn M.-W. Oh E.H. Lal N. Garfield C.F. et al.Differences in empowerment and quality of life among parents of children with food allergy.Ann Allergy Asthma Immunol. 2015; 114: 117-125Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar As a result, it is possible that accurate risk perception regarding anaphylaxis may improve QoL. Thus, although much work has focused on the early recognition and management of anaphylaxis to prevent morbidity and even the rare occurrence of mortality, the absolute risk of anaphylaxis fatality is exceptionally low. Living with food allergy remains a challenge for many families, and potentially the greatest source of morbidity facing children with food allergy and their families relates to fear and uncertainty. Cutaneous symptoms (including urticaria, angioedema, and erythema) are the most common presenting symptoms of food allergy and are present in up to 80% of acute food-allergic reactions in children.9Boyce J.A. Assa'ad A. Burks A.W. Jones S.M. Sampson H.A. Wood R.A. et al.Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel.J Allergy Clin Immunol. 2010; 126: S1-S58Abstract Full Text Full Text PDF PubMed Scopus (1119) Google Scholar,25Abrams E.M. Sicherer S.H. Diagnosis and management of food allergy.CMAJ. 2016; 188: 1087-1093Crossref PubMed Scopus (32) Google Scholar However, there is a broad differential for urticaria, particularly in children. Thus, although urticaria is commonly equated with a food allergy, food allergy accounts for less than 10% of the causes of all acute urticaria and is not a cause of chronic urticaria.26Sicherer S.H. Sampson H.A. Food allergy.J Allergy Clin Immunol. 2010; 125: S116-S125Abstract Full Text Full Text PDF PubMed Scopus (845) Google Scholar,27Kulthanan K. Chiawsirikajorn Y. Jiamton S. Acute urticaria: etiologies, clinical course and quality of life.Asian Pacific J allergy Immunol. 2008; 26: 1-9PubMed Google Scholar In children, the most common cause of acute urticaria is not food allergy, but viral infection. An observational study of 44 children seen in the emergency department (ED) with acute urticaria found that 90.9% had symptoms of respiratory tract infection and in 45.4% a probable infectious etiology could be identified.28Bilbao A. García J.M. Pocheville I. Gutiérrez C. Corral J.M. Samper A. et al.[Round Table: Urticaria in relation to infections].Allergol Immunopathol (Madr). 1999; 27: 73-85PubMed Google Scholar A study of 54 children with various forms of urticaria documented infection as the most frequent cause of acute urticaria (48.6%), followed by drug allergy (5.4%) and food allergy (2.7%).29Sackesen C. Sekerel B.E. Orhan F. Kocabas C.N. Tuncer A. Adalioglu G. The etiology of different forms of urticaria in childhood.Pediatr Dermatol. 2004; 21: 102-108Crossref PubMed Scopus (145) Google Scholar A review of urticaria and infection documented infections to cause up to 57% of all acute urticaria, with upper respiratory and gastrointestinal infections being the most common etiologies.30Wedi B. Raap U. Wieczorek D. Kapp A. Urticaria and infections.Allergy Asthma Clin Immunol. 2009; 5: 10Crossref PubMed Google Scholar Other common symptoms that are often incorrectly attributed to food allergy include headaches, chronic behavioral symptoms, or chronic nonspecific abdominal pain.25Abrams E.M. Sicherer S.H. Diagnosis and management of food allergy.CMAJ. 2016; 188: 1087-1093Crossref PubMed Scopus (32) Google Scholar There are several elements of the medical history that help to differentiate whether urticaria is attributable to food allergy (Figure 1).31Sampson H.A. 9. Food allergy.J Allergy Clin Immunol. 2003; 111: S540-S547Abstract Full Text Full Text PDF PubMed Scopus (231) Google Scholar These include the age of the child, the time of onset of the reaction, the food ingested, whether it had been ingested (and tolerated) before, and associated signs and symptoms.25Abrams E.M. Sicherer S.H. Diagnosis and management of food allergy.CMAJ. 2016; 188: 1087-1093Crossref PubMed Scopus (32) Google Scholar,31Sampson H.A. 9. Food allergy.J Allergy Clin Immunol. 2003; 111: S540-S547Abstract Full Text Full Text PDF PubMed Scopus (231) Google Scholar Foremost, allergic urticaria by definition involves histamine release and typically pruritus; therefore, urticaria in an allergic reaction will usually be itchy or bothersome to the patient (and not just bothersome to the caregiver). Thus, nonbothersome urticarial rashes are less likely to represent an allergic reaction. The timing of onset is another clue to the nature of the finding. Food proteins are digested within several hours; therefore, urticaria associated with a food ingestion will occur within minutes to 2 hours of ingestion, but typically last no more than a few hours (and less with treatment). Thus, urticaria occurring more than 4-6 hours after ingestion and/or urticaria that lasts more than 6-12 hours or that waxes and wanes over the next several days without any reingestion are also unlikely to represent a classical food allergy (although delayed mammalian meat anaphylaxis owing to galactose-α-1,3-galactose allergy is a notable exception). An understanding of the child's state of health is also a clue. Given a very common association of an urticarial exanthem in the setting of a viral illness, assessing if the child has recent sick contacts or has had any upper respiratory illness in the days immediately before or after the event can provide key diagnostic insight. Distribution of the rash is also key. Allergic urticaria is usually not a localized phenomenon (eg, isolated lower extremity and often non bothersome urticarial rash associated with upper respiratory infection symptoms as may be seen in early Henoch-Schoenlein purpura). Acute onset of urticaria in a young child can certainly occur on both first (or subsequent) ingestion of a common allergen (because there could be pre-existing sensitization from environmental exposure), and this phenomenon can occur with or without associated respiratory or gastrointestinal symptoms. This factor notwithstanding, allergic urticaria is unlikely after eating a food that has been tolerated multiple times before, and urticaria arising in this context should immediately raise suspicion that the rash may not be food allergy related (although shellfish allergy and delayed mammalian meat allergy may be notable exceptions). Finally, there are a few common allergens (cow's milk, eggs, soy, peanut, tree nuts, fish, and grains) that account for the vast majority of food allergic reactions in children. In summary, the pediatrician should keep in mind several key points in the history that can help to clarify the diagnosis. A history of recent illness proximal to the onset of urticaria may suggest an infectious etiology. Urticaria that is objectively pruritic or bothersome to the child, or that starts after ingestion of a suspect food should raise concern. Last, regular tolerance to a potential culprit may provide some tentative reassurance; however, realizing that new allergies may develop over time, caution is warranted when reintroducing a potential but unlikely culprit food. An often-misunderstood point regarding allergy testing is how to interpret results. Testing denotes allergic sensitization, for example, the presence of allergen-specific immunoglobulin E (IgE) against whatever the clinician has chosen to test. The body makes IgE for many reasons, one of which is an allergic response, but the presence of a food-specific IgE is not itself indicative of an allergy. Allergy implies that there is a symptomatic response to the allergen (eg, urticaria and/or wheezing after ingestion), occurring in the setting of a sensitized individual. So, more succinctly, isolated positive allergy tests in someone without the context of a symptomatic ingestion do not necessarily translate into a clinical allergy. First-line allergy diagnostic tests are either skin prick tests, serologic food-specific IgE tests (sIgE), or both. Although both skin prick testing and food-specific IgE testing are highly sensitive (>90% for skin prick tests, 70%-90% for sIgE), the specificity and positive predictive values of testing are often very low.9Boyce J.A. Assa'ad A. Burks A.W. Jones S.M. Sampson H.A. Wood R.A. et al.Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel.J Allergy Clin Immunol. 2010; 126: S1-S58Abstract Full Text Full Text PDF PubMed Scopus (1119) Google Scholar,39Cox L. Williams B. Sicherer S. Oppenheimer J. Sher L. Hamilton R. et al.Pearls and pitfalls of allergy diagnostic testing: report from the American College of Allergy, Asthma and Immunology/American Academy of Allergy, Asthma and Immunology Specific IgE test task force.Ann Allergy Asthma Immunol. 2008; 101: 580-592Abstract Full Text Full Text PDF PubMed Scopus (148) Google Scholar,40Kattan J.D. Sicherer S.H. Optimizing the diagnosis of food allergy.Immunol Allergy Clin North Am. 2015; 35: 61-76Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar The rate of false-positive tests is up to 40%.25Abrams E.M. Sicherer S.H. Diagnosis and management of food allergy.CMAJ. 2016; 188: 1087-1093Crossref PubMed Scopus (32) Google Scholar The tests themselves are very good at detecting sIgE if it is present, but as stated, its presence is not pathognomonic for clinical allergy, and it is difficult to understand the significance of what isolated sIgE means without the context of a suspected reaction to the food in question. Testing is an easily available, generally well-tolerated procedure and is highly used. However, most children with positive allergy testing may in fact be clinically tolerant to the food in question. A retrospective chart review of 125 children, of whom 96% had eczema, noted that 80%-100% of foods that were avoided owing to positive allergy testing could be reintroduced into the diet after an oral food challenge.41Fleischer D.M. Bock S.A. Spears G.C. Wilson C.G. Miyazawa N.K. Gleason M.C. et al.Oral food challenges in children with a diagnosis of food allergy.J Pediatr. 2011; 158: 578-583.e1Abstract Full Text Full Text PDF PubMed Scopus (149) Google Scholar Among siblings of food allergic children in a Chicago Family Cohort study, 53% had positive allergy testing in the absence of a clinical history of reactivity to that food.42Gupta R.S. Walkner M.M. Greenhawt M. Lau C.H. Caruso D. Wang X. et al.Food allergy sensitization and presentation in siblings of food allergic children.J Allergy Clin Immunol Pract. 2016; 4: 956-962Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar Data from the Danish Allergy Research Centre prospective population-based cohort noted that, among children with food allergy (of whom 90% had eczema), 80% were sensitized to other foods which they clinically tolerated, leading the authors to conclude that sensitization in the absence of food allergy in childhood is a “normal phenomenon.”43Eller E. Kjaer H.F. Host A. Andersen K.E. Bindslev-Jensen C. Food allergy and food sensitization in early childhood: results from the DARC cohort.Allergy. 2009; 64: 1023-1029Crossref PubMed Scopus (105) Google Scholar Food allergy testing is only diagnostic within the context of a history of a reaction, and when testing is performed, it should be as narrow as possible. Pre-emptive testing, broad “panel testing” (eg, to a panel of “common” foods), or any food allergy diagnostic testing in the absence of a convincing clinical history has high potential to overdiagnose food allergy and result in unnecessary food avoidances. Because these tests have poor specificity, they are not intended to be used as screening tools to determine to what food someone “could” be allergic. In addition, because early food introduction has a role in food allergy prevention (in particular for egg and peanut),44Fleischer D.M. Chan E.S. Venter C. Spergel J.M. Abrams E.M. Stukus D. et al.A consensus approach to the primary prevention of food allergy through nutrition: guidance from the American Academy of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; and the Canadian Society for Allergy and Clinica.J Allergy Clin Immunol Pract. 2021; 9: 22-43.e4Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar there is a risk that screening may inadvertently increase the risk of true food allergy by delaying introduction.45Abrams E.M. Brough H.A. Keet C. Shaker M.S. Venter C. Greenhawt M. Pros and cons of pre-emptive screening programmes before peanut introduction in infancy.Lancet Child Adolesc Health. 2020; 4: 526-535Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar Another food allergy diagnostic myth is that food-specific IgG testing has a role in identifying food sensitivities or should be used to direct food avoidances. This trendy fad is offered by many wellness companies or even directly marketed to consumers without having to see a physician. IgG testing for food allergy has been consistently criticized by national allergy associations such as the Canadian Society of Allergy and Clinical Immunology (CSACI) and the American Academy of Allergy Asthma and Immunology (AAAAI) as invalid for the assessment of this condition.46Carr S. Chan E. Lavine E. Moote W. CSACI position statement on the testing of food-specific IgG.Allergy Asthma Clin Immunol. 2012; 8: 12Crossref PubMed Scopus (35) Google Scholar,47Hammond C. Lieberman J.A. Unproven diagnostic tests for food allergy.Immunol Allergy Clin North Am. 2018; 38: 153-163Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar The CSACI, in a position statement about IgG testing, noted it “strongly discourages the practice of food-specific IgG testing for the purposes of identifying or predicting adverse reactions to food.”46Carr S. Chan E. Lavine E. Moote W. CSACI position statement on the testing of food-specific IgG.Allergy Asthma Clin Immunol. 2012; 8: 12Crossref PubMed Scopus (35) Google Scholar There is no evidence that IgG testing marks food sensitivity; in fact, the presence of IgG is both expected and is a potential indicator of ongoing tolerance.46Carr S. Chan E. Lavine E. Moote W. CSACI position statement on the testing of food-specific IgG.Allergy Asthma Clin Immunol. 2012; 8: 12Crossref PubMed Scopus (35) Google Scholar Concerns have been raised that the use of this test results in unnecessary dietary restrictions that can worsen QoL and carries a significant financial cost to the family.46Carr S. Chan E. Lavine E. Moote W. CSACI position statement on the testing of food-specific IgG.Allergy Asthma Clin Immunol. 2012; 8: 12Crossref PubMed Scopus (35) Google Scholar A similar sentiment was expressed by the European Academy of Allergy and Clinical Immunology, and endorsed by the AAAAI, in a report that stated that IgG testing is “irrelevant” for the work up of food allergy or intolerance and “should not be performed in case of food-related complaints.”48Stapel S.O. Asero R. Ballmer-Weber B.K. Knol E.F. Strobel S. Vieths S. et al.Testing for IgG4 against foods is not recommended as a diagnostic tool: EAACI task force report.Allergy. 2008; 63: 793-796Crossref PubMed Scopus (225) Google Scholar In conclusion, although first-line food allergy diagnostic testing is highly sensitive, it lacks specificity and should generally only be pursued in the context of a convincing clinical history of a reaction. IgG testing should never be considered in the work up of food allergy. In real-world settings, antihistamines may often be used in the place of epinephrine in the treatment of anaphylaxis, and it is under-recognized that antihistamines have no role in the acute management of a life-threatening reaction and in fact are second- or third-line therapy in anaphylaxis guidelines.49Simons F.E.R. Ardusso L.R.F. Bilo M.B. Dimov V. Ebisawa M. El-Gamal Y.M. et al.2012 Update: World Allergy Organization Guidelines for the assessment and management of anaphylaxis.Curr Opin Allergy Clin Immunol. 2012; 12: 389-399Crossref PubMed Scopus (208) Google Scholar Antihistamines are unlikely to relieve upper or lower airway obstruction, shock or hypotension and their onset of action ranges from 1 to 3 hours.50Simons F.E.R. Anaphylaxis.J Allergy Clin Immunol. 2010; 125: S161-S181Abstract Full Text Full Text PDF PubMed Scopus (331) Google Scholar Their only usefulness is in the treatment of cutaneous symptoms, such as urticaria.50Simons F.E.R. Anaphylaxis.J Allergy Clin Immunol. 2010; 125: S161-S181Abstract Full Text Full Text PDF PubMed Scopus (331) Google Scholar In addition, there are serious safety concerns with the use of first-generation sedating antihistamines (such as diphenhydramine and hydroxyzine), which can be associated with somnolence, sedation, or a paradoxical stimulatory response in children (Table).32Church M.K. Maurer M. Simons F.E.R. Bindslev-Jensen C. van Cauwenberge P. Bousquet J. et al.Risk of first-generation H(1)-antihistamines: a GA(2)LEN position paper.Allergy Eur J Allergy Clin Immunol. 2010; 65: 459-466Crossref Scopus (286) Google Scholar Dizziness and orthostatic hypotension owing to α-adrenergic effects and peripheral vasodilation have been theorized to potentially mask symptoms of allergic reactions that are progressing toward anaphylaxis, which can also be associated with central nervous system effects.50Simons F.E.R. Anaphylaxis.J Allergy Clin Immunol. 2010; 125: S161-S181Abstract Full Text Full Text PDF PubMed Scopus (331) Google Scholar A survey in Canada noted that first-generation antihistamines (diphenhydramine) are the most recommended antihistamines in children.53Prendergast C. Plint A.C. Tang K. Crawford T. Neto G. Alqurashi W. Management of pediatric allergic reaction: practice patterns of Canadian pediatric emergency physicians.CJEM. 2020; 22: 802-810Crossref PubMed Scopus (1) Google Scholar However, a statement by the CSACI notes that newer generation antihistamines are safer and have superior efficacy.51Fein M.N. Fischer D.A. O'Keefe A.W. Sussman G.L. CSACI position statement: newer generation H(1)-antihistamines are safer than first-generation H(1)-antihistamines and should be the first-line antihistamines for the treatment of allergic rhinitis and urticaria.Allergy Asthma Clin Immunol. 2019; 15: 61Crossref PubMed Scopus (31) Google Scholar In fact, the CSACI recommends that first-generation antihistamines such as diphenhydramine should be considered for availability only on a behind the counter basis, although the AAAAI and the American College of Allergy Asthma and Immunology have not issued similar statements.TablePotential serious adverse event of first-generation sedating antihistamines32Church M.K. Maurer M. Simons F.E.R. Bindslev-Jensen C. van Cauwenberge P. Bousquet J. et al.Risk of first-generation H(1)-antihistamines: a GA(2)LEN position paper.Allergy Eur J Allergy Clin Immunol. 2010; 65: 459-466Crossref Scopus (286) Google Scholar,51Fein M.N. Fischer D.A. O'Keefe A.W. Sussman G.L. CSACI position statement: newer generation H(1)-antihistamines are safer than first-generation H(1)-antihistamines and should be the first-line antihistamines for the treatment of allergic rhinitis and urticaria.Allergy Asthma Clin Immunol. 2019; 15: 61Crossr

Coping Strategies, Pain, and Quality of Life in Patients with Breast Cancer.

Introduction: Each year, around 16,500 women in Poland are diagnosed with breast cancer, the second most common cause of death in women. In Poland, nearly 70,000 women live with breast cancer diagnosed within the last 5 years. Quality of life (QoL) research is particularly important in cancer patients, as it provides knowledge on their psychological and physical health, as well as the environment in which the patients function, all of which is essential to implementing multidisciplinary care involving the best use of the appropriate methods. Carrying the burden of cancer is a major challenge for patients. The strategy that patients use to cope with breast cancer significantly affects their quality of life. The purpose of the study is to assess the impact of coping strategies on the QoL in breast cancer patients. Material and Methods: The prospective study included a group of 202 women who had undergone surgical treatment for breast cancer at the Lower Silesian Cancer Center and who reported for follow-up appointments at the Oncology Clinic and the Surgical Oncology Clinic. For the study, we used the: EORTC QLQ-C30 cancer questionnaire, EORTC QLQ-BR23 module, Mental Adjustment to Cancer (Mini-MAC) scale, visual analog scale (VAS) for pain intensity, as well as the patients’ medical records, hospital records, and our own survey form. Results: The mean patient age was 53 years. Most patients had been diagnosed with cancer between one and two years before. In the women studied, there was a negative association between QoL and the choice of a destructive strategy for coping with cancer, and a positive one between QoL and a constructive coping strategy. Severe pain caused by the disease and its treatment significantly decreased the patients’ QoL in multiple domains. Conclusions: Patients choosing constructive strategies obtained higher QoL scores, while greater reliance on destructive coping strategies was associated with significantly worse QoL. In all functioning domains, higher levels of pain were associated with poorer QoL and more severe symptoms associated with the disease and its treatment.

Association of Local Therapy With Quality-of-Life Outcomes in Young Women With Breast Cancer

Increasing rates of bilateral mastectomy have been most pronounced in young women with breast cancer, but the association of surgery with long-term quality of life (QOL) remains largely unknown. To examine the association of surgery with longer-term satisfaction and QOL in young breast cancer survivors. This multicenter cross-sectional study of a prospective cohort was conducted from October 2016 to November 2017, at academic and community hospitals in North America. Women 40 years or younger enrolled in the Young Women's Breast Cancer Study were assessed. Data analysis was performed from during a 1- to 2-year period after conclusion of the study. Primary breast surgery, reconstruction, and radiotherapy. Mean BREAST-Q breast satisfaction and physical, psychosocial, and sexual well-being scores were compared by type of surgery; higher BREAST-Q scores (range, 0-100) indicate better QOL. Linear regression was used to identify demographic and clinical factors associated with BREAST-Q scores for each domain. A total of 560 women with stage 0 to III breast cancer (median age at diagnosis, 36 years; range, 17-40 years; 484 [86%] with stage 0-II disease) completed the BREAST-Q a median of 5.8 years (range, 1.9-10.4 years) from diagnosis. A total of 290 patients (52%) of patients underwent bilateral mastectomy, 110 patients (20%) underwent unilateral mastectomy, and 160 patients (28%) received breast-conserving therapy. Among mastectomy patients, 357 (89%) had reconstruction and 181 (45%) received radiotherapy. In multivariate analyses, implant-based reconstruction (vs autologous) was associated with decreased breast satisfaction (β = -7.4; 95% CI, -12.8 to -2.1; P = .007) and complex reconstruction (vs autologous) with worse physical well-being (β = -14.0; 95% CI, -22.2 to -5.7; P < .001). These results suggest that local therapy in young breast cancer survivors is persistently associated with poorer scores in multiple QOL domains, particularly among those treated with mastectomy and radiotherapy, irrespective of breast reconstruction. Socioeconomic stressors also appear to play a role.

Mood and quality of life in patients treated with brain-responsive neurostimulation: The value of earlier intervention

ObjectiveTo establish whether earlier treatment using direct brain-responsive neurostimulation for medically intractable focal-onset seizures is associated with better mood and Quality of Life (QoL) compared to later treatment intervention. MethodsData were retrospectively analyzed from prospective clinical trials of a direct brain-responsive neurostimulator (RNS® System) for treatment of adults with medically intractable focal-onset epilepsy. Participants completed the Quality of Life in Epilepsy Inventory (QOLIE-31) yearly through 9 years of follow-up and the Beck Depression Inventory-II (BDI-II) through 2 years of follow-up. Changes in each assessment after treatment with responsive neurostimulation were calculated for patients who began treatment within 10 years of seizure onset (early) and those who began treatment 20 years or more after seizure onset (late). ResultsThe median duration of epilepsy was 18.3 years at enrollment. At 9 years, both the early (N = 51) and late (N = 109) treatment groups experienced similar and significant reductions in the frequency of disabling seizures (73.4% and 77.8%, respectively). The early treatment patients had significant improvements in QoL and mood. However, the late treatment patients not only failed to show these improvements but also declined in the emotional QoL subscale. ConclusionsPatients treated with brain-responsive neurostimulation earlier in the course of their epilepsy show significant improvements in multiple domains of QoL and mood that are not observed in patients treated later in the course of their epilepsy despite similar efficacy in seizure reduction. Even with similar and substantial reductions in seizure frequency, the comorbidities of uncontrolled epilepsy may be less responsive to treatment when too many years have passed. The results of this study suggest that, as with resective and ablative surgery, treatment with brain-responsive neurostimulation should be delivered as early as possible in the course of medically resistant epilepsy to maximize the opportunity for improvements in mood and QoL.

52528 Implementation of Web-Based Patient-Reported Outcome Measures (PROMs) in the Clinical Care of Systemic Lupus Erythematosus (SLE): A Multi-Center Prospective Cohort Study

ABSTRACT IMPACT: The integration of patient-reported outcome measures into clinical care is feasible and can facilitate patient-centered care for individuals with systemic lupus erythematosus. OBJECTIVES/GOALS: Patient-reported outcome measures (PROMs) are powerful tools which can facilitate patient-centered care by highlighting individuals’ experience of illness. The aim of this study was to assess the feasibility and impact of implementing web-based PROMs in the routine clinical care of outpatients with systemic lupus erythematosus (SLE). METHODS/STUDY POPULATION: Outpatients with SLE were enrolled in this longitudinal cohort study at two academic medical centers. Participants completed PROMIS computerized adaptive tests assessing multiple quality of life domains at enrollment and prior to two consecutive routinely scheduled rheumatology visits using the ArthritisPower research registry mobile or web-based application. Score reports were shared with patients and providers before the visits. Patients and rheumatologists completed post-visit surveys evaluating the utility of PROMs in the clinical encounters. Proportions with confidence intervals were calculated to evaluate survey completion rates and responses. RESULTS/ANTICIPATED RESULTS: A total of 105 SLE patients and 16 rheumatologists participated in the study. Subjects completed PROMs in 159 of 184 eligible encounters (86%, 95% CI 81 - 91), including 90% of visit 1’s (95% CI 82 - 95) and 82% of visit 2’s (95% CI 72 - 90. Patients and rheumatologists found that PROMs were useful (91% and 83% of encounters respectively) and improved communication (86% and 72%). Rheumatologists reported that PROMs impacted patient management in 51% of visits, primarily by guiding conversations (84%), but also by influencing medication changes (15%) and prompting referrals (10%). There was no statistically significant difference in visit length before (mean=19.5 min) and after (mean=20.4 min) implementation of PROMs (p=0.52). DISCUSSION/SIGNIFICANCE OF FINDINGS: The remote capture and integration of web-based PROMs into clinical care was feasible in a diverse cohort of SLE outpatients. PROMs were useful to SLE patients and rheumatologists and promoted patient-centered care by facilitating communication.