Rheumatic diseases often have a progressive course and place individuals at increased risk of mortality. Despite this, little research has investigated the relationship between death anxiety and fears about disease progression (FoP), and how these might relate to health-related quality of life (HRQoL) outcomes. This study investigated the relationship between death anxiety, FoP and HRQoL. A cross-sectional design with a longitudinal follow-up at 3 months. A total of 145 participants with at least one rheumatic condition were recruited through Prolific. They completed online questionnaires assessing FoP, death anxiety, HRQoL, pain and psychological distress. They also completed an additional measure of FoP 3 months later. A series of regression analyses were conducted to examine whether death anxiety predicted unique variance in FoP cross-sectionally, as well as three months later. We also investigated whether death anxiety and FoP were associated with HRQoL after controlling for pain, demographics and psychological distress. Death anxiety contributed unique variance to FoP, even when controlling for other variables of interest, and continued to predict FoP 3 months later. Surprisingly, neither death anxiety nor fear of progression were found to predict unique variance in psychological or physical HRQoL. These results indicate that death anxiety plays an important role in FoP. As such, death anxiety appears to be a particularly pertinent factor in the experience of FoP for people with rheumatic conditions that deserves further investigation. However, quality of life outcomes may be robust to the impact of death anxiety and FoP.

Functional and quality of life outcomes following surgical treatment for cauda equina syndrome: A retrospective tertiary centre study.

Randomized controlled trial of a remotely-delivered exercise training program in older adults with multiple sclerosis: Secondary effects on cognition, symptoms, and quality of life.

Children with chronic kidney disease (CKD) experience complex challenges affecting their physical, emotional and quality of life outcomes. Patient-reported outcome measures (PROMs) and experience measures (PREMs), collectively known as patient-reported measures (PRMs) are essential to capture these impacts, but their validation and suitability in pediatric CKD research remain underexplored. To identify and evaluate the psychometric properties of PRMs used in research in children with CKD. Medline, Embase, CINAHL and PSYCinfo searched from inception to March 2025. Studies that reported the results of at least one PRM completed by patients or proxies in children aged 0-18 years with CKD were included. Study and measure characteristics and psychometric properties of PRMs were extracted. One hundred seventy-five studies involving 21,423 children from 39 countries were eligible and included. 307 PRMs were identified, representing 121 unique tools across 23 outcome domains. Pediatric Quality of Life Inventory (PedsQL) was the most frequently used measure (50%). Approximately 40% were applied in the pediatric CKD population without evidence of external validation. Internal consistency was the most frequently reported psychometric property, assessed for 19 of all identified PRMs (6%). Disease-specific instruments (PRO-KID, TECAVNER) had good internal consistency (α ≥ 0.8). There is firm reliance on using generic PRMs in children with CKD; however, most lack robust external validation in this population. Co-development and comprehensive validation of disease-specific instruments that reflect outcomes valued by patients and families are required to enhance the relevance of outcome assessment in pediatric CKD care.

To evaluate the role of total neoadjuvant therapy (TNT) in locally advanced rectal cancer, focusing on its impact on compliance, tumor downstaging, and organ preservation when combined with watch-and-wait (W&W) protocols and to assess whether radiotherapy dose escalation may increase clinical complete response (cCR) rates. We retrospectively analyzed 135 patients with locally advanced rectal cancer treated with TNT and radiotherapy dose escalation (57.5 Gy to the tumor and nodes in 23fractions) between 2015 and 2024. Patients achieving cCR were considered for the W&W strategy. Outcomes included tumor response, local control, disease-free survival (DFS), and toxicity. Prognostic factors were explored through univariate and multivariate analyses. Atotal of 48.9% achieved cCR and were managed nonoperatively, while 51.1% underwent surgery. Local control at 3years was 83.5%, with local regrowth significantly higher in the W&W group (33.1%) than the rate of local recurrences in the surgical cohort (6.5%, p = 0.001). Poorer local control was associated with low rectal tumors, local regrowth, and the development of metachronous metastases. Disease-free survival at 3years was 69.2%, with better outcomes in patients who underwent surgery or were included in the W&W strategy based on multidisciplinary consensus. No acute or chronic radiotherapy-related toxicity greater than grade3 was observed. In multivariate analysis, local regrowth and nonconsensual W&W inclusion remained independent predictors of impaired DFS and metastasis-free survival. Total neoadjuvant therapy with radiotherapy dose escalation is effective and well tolerated. Tumor location, local regrowth, and the role of multidisciplinary decision-making are critical prognostic factors. Careful patient selection and structured follow-up are essential to optimize outcomes in the W&W strategy. Although functional and quality of life outcomes were not assessed, future prospective studies should incorporate these measures to further strengthen organ-preservation approaches.

Abstract Quality of life (QoL) is a critical outcome measure for cochlear implant (CI) users, yet the association between sociodemographic disparities, respondent type, and QoL remains under-explored in the Saudi Arabian context. This study aimed to examine the relationship between sociodemographic and clinical factors specifically respondent type (self-report vs. proxy-report), socioeconomic status, and device usage and CI-related quality of life domains. A cross-sectional observational study was conducted involving 156 participants (CI users and parents/guardians) recruited via digital rehabilitation networks in Saudi Arabia. Data were collected using a structured electronic questionnaire incorporating the modified Cochlear Implant Quality of Life-35 Profile (CIQOL-35). Multiple linear regression models (OLS) were estimated to evaluate factors associated with six QoL domains: communication, emotional, entertainment, environment, listening effort, and social functioning. The regression analysis indicated that family economic status was significantly associated with better outcomes in the communication, environment, and social domains ( p < .05). Conversely, parents with higher education levels reported significantly lower scores in the communication and environment domains ( β = − 0.37 and − 0.38, respectively, p < .05) compared to those with primary education, potentially reflecting an expectation bias. Notably, respondent type (adult self-report vs. proxy-report) did not demonstrate a statistically significant association with emotional well-being or other domains in this model. Clinical factors such as lack of post-implant habilitation were associated with significantly lower scores across multiple domains. Sociodemographic factors are significantly associated with perceived quality of life among CI users in Saudi Arabia. While families with higher economic resources report better social and environmental outcomes, highly educated parents perceive lower benefits, potentially reflecting differences between clinical outcomes and parental expectations. These findings suggest that rehabilitation programs must integrate psychosocial support that addresses family expectations and socioeconomic barriers to optimize QoL outcomes. Interpretations should be contextualized within the study’s limitations, notably a proxy-dominant sample and the use of a modified instrument not originally validated for pediatric proxy reports.

BACKGROUND Patients with hepatocellular carcinoma (HCC) often experience considerable psychological distress that affects their quality of life (QoL). AIM To investigate the effects of drug-eluting microsphere - transcatheter arterial chemoembolization (DEM-TACE) combined with lenvatinib on anxiety, depression, and QoL. METHODS This prospective study enrolled 126 patients with primary HCC treated with DEM-TACE combined with lenvatinib from October 2022 to October 2025. Anxiety and depression assessment with the Hospital Anxiety and Depression Scale (HADS) and QoL evaluation with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and HCC-specific module were conducted at baseline and at 3-, 6-, and 12-month. Clinical outcomes, including overall survival, progression-free survival, and adverse events (AEs), were recorded. RESULTS Overall, 58.7% and 61.1% of patients exhibited anxiety and depression at baseline, respectively. After treatment, both psychological status and QoL significantly improved. At 12 months, the prevalence rates of anxiety and depression decreased to 31.0% and 28.6%, respectively (both P < 0.001). The EORTC QLQ-C30 global health status score increased from 52.3 ± 15.7 to 71.2 ± 14.3 (P < 0.001). Physical, role, and emotional functioning scores also significantly improved (all P < 0.001). Treatment-related AEs were generally manageable. Multivariate analysis showed that baseline HADS score, Barcelona Clinic Liver Cancer stage, and tumor response were independent predictors of QoL outcomes (P < 0.05). CONCLUSION DEM-TACE combined with lenvatinib shows an acceptable safety profile and favorable efficacy in improving anxiety, depression, and QoL in patients with HCC. Early psychological assessment and intervention may optimize outcomes.

Skin diseases such as psoriasis and scabies can severely impact sleep quality and quality of life (QoL), especially under extreme stress conditions such as war. During the 2024 conflict in Gaza, displacement, limited access to healthcare, and widespread trauma created a unique context in which to study these interactions. This cross-sectional study included 498 participants from three healthcare centers across Gaza. Data on dermatological diagnoses, sleep quality (PSQI), quality of life (DLQI/CDLQI), pain levels, and displacement history were collected. Statistical analyses were performed to explore correlations and significant predictors of sleep and QoL outcomes. Poor sleep and reduced QoL were significantly associated with psoriasis, scabies, frequent displacement, high pain levels, and unemployment. Adults with psoriasis had the highest DLQI scores (mean = 15.82), whereas children with psoriasis and scabies had scores of 9.25 and 8.22, respectively, on the CDLQI. Sleep was worst among those with scabies (mean PSQI = 15.88). Displacement frequency was a key predictor; those displaced 10 or more times had notably higher impairment scores. Employment status, residency status (especially in Gaza City), and pain level were also significant. No substantial differences were found by sex, marital status, or education. Warm intensified the burden of skin diseases on both sleep quality and QoL. Displacement, pain, and socioeconomic hardship are key drivers of poor outcomes. Children and unemployed individuals are particularly vulnerable. These findings call for trauma-informed, integrated care approaches that combine dermatological treatment, mental health support, and social services, particularly for displaced and high-risk groups.

Frailty is increasingly recognized as a multidimensional clinical condition associated with impaired quality of life (QoL). However, the prevalence and clinical implications in patients with Behçet's disease (BD) remain unclear. This study aimed to evaluate the frailty status and its association with QoL in Japanese patients with BD. We surveyed 50 patients with BD aged ≥ 40years. Frailty was assessed using the Japanese version of the Cardiovascular Health Study criteria. QoL was evaluated using the 36-Item Short Form Survey (SF-36) and the Behçet's Disease Quality of Life scale. Associations between the frailty status and QoL were examined using multivariable linear regression models. The mean age of participants was 65.5years. The prevalences of frailty, pre-frailty, and robustness were 12.0%, 69.0%, and 18.0%, respectively. In the multivariable analyses, frailty was associated with poorer disease-specific QoL, although the association did not reach statistical significance, whereas pre-frailty was not significantly associated with QoL outcomes. Frail patients had significantly lower SF-36 scores across most subscales than pre-frail patients. Slower walking speed was consistently associated with lower physical QoL, whereas weight loss was associated with the mental aspects of QoL. Frailty and pre-frailty are highly prevalent among patients with BD. Frailty is associated with an impaired QoL, particularly in the physical domains. Routine assessment of walking speed and nutritional status may facilitate the early identification of vulnerable patients and inform targeted management strategies to maintain QoL in patients with BD. Key Points • Frailty was observed in 12.0% of Japanese patients with Behçet's disease and 69.0% were classified as pre-frail. • Frailty is associated with impaired quality of life (QoL), particularly reduced physical domains. • Slower walking speed was consistently associated with poorer physical QoL, while weight loss was associated with the mental aspects of QoL. • Early assessment of frailty components may help identify patients at risk of QoL deterioration.

Abstract Introduction Virtual wards (VWs) and Hospital-at-Home (HaH) services are increasingly used in the UK to support acute care delivery. While clinical outcomes are often comparable to conventional inpatient care, the success of these models also depends on patient and carer experiences, including quality of life (QoL), satisfaction, and caregiver burden. Evidence synthesising these patient-centred outcomes within the UK context is needed to inform service implementation. Aim To systematically synthesise evidence from UK-based randomised controlled trials (RCTs) evaluating patient and carer satisfaction, QoL, and caregiver burden in VWs/HaH compared with traditional inpatient care. Methods Following PRISMA guidelines, PubMed and CINAHL databases were searched for UK-based randomised controlled trials (RCTs) (inception-October 2024) reporting QoL measures, patient/carer satisfaction, or caregiver burden, comparing VWs/HaH to traditional inpatient care for patients with acute illness. Validated tools (e.g. EQ-5D and custom surveys) were prioritised in data extraction. Risk of bias was assessed using the Cochrane RoB2 tool. Meta-analysis employed a random-effects model; heterogeneity was assessed using the I2 statistic. Results Fourteen RCTs (n = 3416 participants) met the inclusion criteria. Patient satisfaction was consistently high across studies. For example, one RCT reported very good/excellent satisfaction ratings of 91.7% for HaH compared with 88.1% for inpatient care.[1] Meta-analysis of satisfaction outcomes (five studies) showed no significant difference between groups (OR 0.67; 95% CI 0.29–1.54) with substantial heterogeneity (I2 = 78%). Carer outcomes varied; some studies found high satisfaction and no additional workload, while moderate-to-severe caregiver burden in 25% of carers was reported in one RCT.[2] QoL outcomes measured by various tools like the Euro Quality of Life EQ-5D-5L showed no clinically meaningful differences between groups. Some studies indicated better outcomes for home-treated patients in specific domains, including significantly lower depression scores (p < 0.001) and slightly higher social activity, and lower rate of select medical complications, although overall QoL remained comparable. Conclusion UK virtual health care services offer patient experiences that are comparable to traditional hospital care, with consistently high satisfaction and similar QoL outcomes. Carer experiences are more variable, highlighting a need for improved caregiver support within VW/HaH models. A key limitation of this review is the heterogeneity in the QoL and satisfaction measures used across included RCTs, which restricted the scope of quantitative synthesis. Future UK research should adopt standardised, validated outcome sets to strengthen comparability and inform evidence-based implementation.

The impact of workplace sexual harassment on health and quality of life outcomes among flight attendants: a two-wave longitudinal study.

Sex-related differences in non-obstructive coronary artery disease endotypes and in quality of life outcomes. Findings from the TRI-NOCA registry.

Obesity impacts physical, physiological and psychological domains of life. The long-term effects of metabolic bariatric surgery (MBS) on patient-centred outcomes such as mental health and quality of life (QOL) may enhance the management of obesity and the application of MBS. A prospective, blinded, double arm, parallel, randomised trial was carried out at a single bariatric centre in Waitemata, New Zealand. Adults with type 2 diabetes mellitus and obesity were randomised 1:1 to undergo laparoscopic sleeve gastrectomy (SG) or silastic ring Roux-en-Y gastric bypass (SR-RYGB). After unblinding at 5 years, patients were followed up at 10 years. This analysis focuses on secondary outcomes: Hospital Anxiety and Depression Scale (HADS) scores and RAND-36 QOL scores. Of 114 patients randomised, 80 patients (70.2%) completed 10-year follow up (39 SG; 41 SR-RYGB). SR-RYGB was associated with greater weight loss (33.3kg vs. 25.8kg, p = 0.031) and trended towards higher diabetes remission (31.7% vs. 23.1%, adjusted OR 2.07, 95% CI 0.70, 6,10, p = 0.186). Mean HADS anxiety score for SG decreased by 1.59 units over 10-years (p = 0.027). Improvements in RAND-36 scores were significantly greater after 10 years for SR-RYGB than SG for physical function (19 vs. 12 points, p = 0.026) and general health (17 vs. 10 points, p = 0.036). Role limitation due to emotional problems worsened significantly by 16 points for the SG group (p = 0.032). SR-RYGB demonstrated superior long-term improvements in physical function and general health QOL domains of RAND-36 compared to SG. Anxiety symptoms may be reduced long-term following SG.

Bipolar disorder (BD) affects approximately 40 million people worldwide and is a chronic, potentially disabling mood disorder. Although effective treatments exist, access to evidence-informed psychosocial care remains limited, particularly for culturally and linguistically diverse populations, contributing to persistent global treatment gaps. Digital mental health interventions (DMHIs), such as smartphone apps, offer a promising means to improve access to self-management support and quality of life (QoL), an outcome prioritized by people with BD and in clinical guidelines. However, most apps for BD lack quality and are not culturally adapted or co-designed with people with BD, limiting relevance and engagement. PolarUs (mobile app) is an evidence-informed DMHI developed using co-design with people with BD. The app is structured on the core 14 domains from the Quality of Life in BD scale, the only BD-tailored scale, combined with psychoeducation on self-management strategies and QoL. A recent pilot study demonstrated promising QoL, clinical, and feasibility outcomes. This study aims to culturally and linguistically adapt the PolarUs app into French, Chinese, and Spanish for the North American context using qualitative and co-design methods. Guided by community-based participatory research principles, whereby end users are engaged throughout the research process, and the Ecological Validity Framework of Bernal et al, we will engage advisory groups of people with lived experience from each linguistic community throughout the cultural adaptation process. Semimonthly virtual meetings will support systematic cultural adaptation of the self-management strategies, affirmations, and resources while maintaining fidelity to core evidence-based components. This will include cultural tailoring of app content and the identification of culturally appropriate resources. Advisory groups will also contribute to the cointerpretation of findings and the co-design of culturally appropriate recruitment and implementation strategies of PolarUs for a future clinical trial. Meetings will be recorded and coanalyzed as research data with advisory groups using qualitative reflexive thematic analysis to capture advisory group perspectives and experiences. This study was funded in October 2024. As of January 31, 2026, we enrolled 7 participants, and the results are expected to be published in the fall of 2026. The findings will support the development of a culturally appropriate DMHI for BD for additional linguistic communities, advance cultural adaptation methodologies, and inform preparation for a future clinical trial. This study will produce the first culturally adapted, BD-specific DMHI developed through co-design using a community-based participatory research approach with multilingual end users from traditionally underserved communities, advancing equitable access, engagement, and scalability of DMHIs for BD and digital health care more broadly.

Introduction: Advanced gynecologic cancers are associated with significant symptom burden and impaired quality of life (QoL). While early palliative care integration has demonstrated benefits in other oncology populations, its effectiveness specifically in women with advanced gynecologic malignancies remains uncertain. This systematic review aimed to evaluate the effectiveness of early palliative care integration on QoL and symptom management in women with advanced gynecologic cancer. Methods: A systematic review was conducted following PRISMA guidelines. We included randomized controlled trials, etc examining early palliative care (initiated within 8 weeks of advanced cancer diagnosis or concurrently with active treatment) in adult women with stage III/IV or recurrent gynecologic cancers. Studies were required to report QoL, symptom management, or healthcare utilization outcomes. Data were extracted on study characteristics, interventions, and outcomes. Results: Thirty-five studies met inclusion criteria, encompassing diverse designs and populations (sample sizes 23–8,297). Ovarian cancer was most commonly studied. QoL findings were mixed: while several smaller studies reported significant improvements across FACT-G domains (p<0.05) [6,19,32], the largest RCTs in recurrent ovarian cancer failed to demonstrate significant overall QoL improvements [1,2]. A meta-analysis of four RCTs found non-significant pooled QoL effects (SMD=0.26; 95% CI -0.29–0.80) [4]. Symptom management showed more consistent benefits, particularly for acute symptom relief [8] and psychological symptoms [6]. Healthcare utilization outcomes demonstrated the most robust improvements, including reduced aggressive end-of-life care [9], increased hospice enrollment [10,11], and cost-effectiveness [17]. However, persistent underutilization (referral rates <50%) [13,14] and racial disparities [13,15] were identified. Conclusion: Early palliative care integration in advanced gynecologic cancer consistently improves healthcare utilization outcomes and shows benefits for psychological symptoms, but QoL improvements remain inconsistent across well-controlled trials. System-level interventions and standardized referral protocols may optimize real-world effectiveness. Further research should address implementation barriers and disparities.

Introduction Lumbar microdiscectomy improves radiculopathy and quality of life (QOL), but the impact of surgical timing on outcomes remains unclear. This study aims to assess whether early surgery is superior in improving QOL compared to late surgery. Methods A retrospective review of a prospectively maintained database identified eligible patients. Waiting times were recorded and post-operative outcomes were recorded by telephone interviews using the core outcome measures index (COMI) questionnaire post-operatively, evaluating pain, physical function and QOL. Patients were grouped to early (<12 months) or late (>12 months) surgery cohorts. Results Thirty-eight 38 patients were included (20 early, 18 late). Timing of post-operative questionnaire assessment ranged from 10 to 34 months. Postoperative sciatica severity was significantly worse in the late group (3.9 versus 1.8). “Rest of life” satisfaction also differed significantly, with higher satisfaction among early surgery patients. Length of stay approached significance, with a median of 3 days (early) versus 2 days (late). Conclusion Patients undergoing surgery within 12 months demonstrate superior patient-reported outcomes. Delays may reduce perceived effectiveness despite technically successful surgery. Timely intervention is essential to optimise QOL outcomes.

Supportive Care Interventions in Hematopoietic Stem Cell Transplantation: Systematic Review and Meta-Analysis.

Clinical, psychological and quality of life outcomes up to 12-months following thrombosis with thrombocytopenia syndrome after ChAdOx1-S (AZD1222) vaccination in Australia.

ABSTRACTObjectiveThe 7‐item Functional Assessment of Cancer Therapy‐General (FACT‐G7) is a validated, brief measure of health‐related quality of life (QoL) used in oncology settings. While many conceptualize QoL as a static trial endpoint, growing evidence underscores its dynamic nature over time to inform point‐of‐care interventions. Grounded in the Wilson and Cleary model, this study aims to (1) identify distinct trajectories of QoL over a 12‐month period using FACT‐G7, and (2) incorporate clinical, mental health, sociodemographic, and healthcare system related factors to uncover risk and protective factors that shape patients' QoL trajectories.MethodsUsing FACT‐G7 scores over a 12‐month period from a sample of 4104 cancer patients (aged 19–92, M = 60.50, SD = 12.95) receiving cancer treatment, growth mixture modeling was fitted to identify subgroups of QoL trajectories. Multinomial logistic regression was conducted to examine the predictors of class membership.ResultsResults revealed a three‐class model provided optimal fit: high QoL (40.1%), average QoL (40.3%), and low QoL (19.6%). Psychosocial factors ‐ particularly loneliness (OR = 1.70, 95% CI:1.35–2.13) and financial difficulties (OR = 1.47, 95% CI:1.27–1.71) ‐ strongly predicted membership in the low QoL trajectory. Clinical factors, including comorbidities (Charlson Comorbidity Index; CCI) and symptom burden severity (PRO‐CTCAE), were associated with poorer QoL trajectories, with insomnia and nausea demonstrating the strongest negative effects. Conversely, higher satisfaction with cancer care and cancer‐related self‐efficacy were protective factors associated with higher QoL trajectories.ConclusionsThe findings identify modifiable risk and protective factors that can inform targeted early interventions to improve long‐term QoL outcomes across the cancer care continuum.

The perioral region is frequently targeted surgically, with its vulnerability to nonmelanoma skin cancers, congenital deformities, and its role in facial attractiveness. This highlights the need for comprehensive evaluation tools for the region. Functional outcome evaluation can ensure the preservation of vital abilities necessary for daily independence. We reviewed and validated postsurgical assessment tools used in oncologic, reconstructive, and cosmetic procedures involving the perioral region, focusing on perioral functional outcomes covered. A systematic review across PubMed, Web of Science, Embase, and Scopus identified validated surgical assessment tools for perioral surgery and the perioral functional outcomes they cover. Fifty-five validated tools for cosmetic, 17 for oncologic, and 29 for reconstructive surgeries were identified. All surgery types showed a relatively narrow scope in assessing perioral functional outcomes, including speech, eating, and facial expressions. In total, 10/17 oncologic, 12/29 reconstructive, and 2/55 cosmetic tools assessed functional outcomes. A large proportion of cosmetic tools exclusively focused on aesthetic factors, while tools for other surgery types more frequently covered functional, aesthetic, and quality of life outcomes. Functional outcome assessment seems less emphasized across all perioral surgery types, particularly within cosmetic procedures. Refining tools for comprehensive functional evaluation can enhance patient care.