QLQ-C30 Quality Of Life Questionnaire Research Articles

Quality of Life Analysis in Patients with AA Using the QLQ-AA/PNH-54 at Initial Diagnosis of AA - a Registry Based Analysis

Objectives: Aplastic anemia (AA) and paroxysmal nocturnal hemoglobinuria (PNH) are ultra-rare, acquired bone marrow failure syndromes (BMFS) with need for long-term care and high morbidity despite recent therapeutic advances. There is a lack of disease-specific assessment tools of quality of life (QoL) in AA/PNH patients. So far, QoL has mostly been estimated according to surrogate parameters (e.g. blood counts, transfusion dependence or toxicity of treatment in AA patients) or has been assessed with tools specifically designed for cancer patients (e.g. EORTC Quality of Life Questionnaire QLQ-C30) or with tools focusing on fatigue (e.g. Functional Assessment of Chronic Illness Therapy, FACIT-Fatigue, PNH patients). Therefore, the QLQ-AA/PNH-54 has been developed to allow a patient tailored QoL assessment in patients with AA or PNH. Here, we present the first descriptive data of the QLQ-AA/PNH-54 of 74 AA patients at the timepoint of initial diagnosis collected between 2018 and 2020 (prior to the SARS-CoV-2 pandemic). Methods: The QLQ-AA/PNH-54 was designed, psychometrically validated, and is currently finally validated for PNH within the IPIG (international PNH interest group)-registry. Parallel to this process, the tool was implemented within the Aachen AA/BMF registry as an instrument for real-life QoL evaluation in AA patients. In total, 54 QoL items regarding physical functioning (21 items), psychological aspects (26 items) and health care related issues (7 items) are comprised. Patients rank the occurrence of each item within the last 14 days on a scale between 0 and 3 (0 = did not occur, 1 = low, 2 = moderate, 3 = severe). Results: 74 AA patients (37 female/ 37 male, mean/median/range age 38.42/ 35.47/ 11-73 years) were included. Patients were diagnosed with nsAA (n=11), sAA (n=23), vsAA (n=18), AA NOS (n=20) and AA/PNH-Overlap (n=2), respectively. Broken down into different functional scales, the most frequently and highest rated scales concerned psychosocial aspects (> 60 % of the patients scored 1-3; > 30% of the patients scored 3). Patients were especially burdened by worries and uncertainties with regards to their future, activity planning security and need for cautiousness in everyday life. Tiredness was the major symptom reported in relation to physical functioning. Patients often feared deterioration of their blood results as the most important health care-related issue. In comparison, low occurrence of pain, orthostatic dysregulation, susceptibility for infections, dyspnea, sleep disturbance and tendency to bleed was reported regarding physical functioning (scored 0 by over 40 to over 50 % of the patients). Similarly, low scores were reported for impairment of activities of daily life in terms of completion of household tasks and hobbies or loss of physical attraction. Conclusion: QoL of AA patients at initial diagnosis was mainly impaired by tiredness and a high psychological burden. Interestingly, complications frequently feared and highlighted by treating physicians had a minor impact on patients' QoL. These results emphasize the importance of further QoL analysis from patient view and recommend to especially focus on the psychological burden of AA patients in patient communication at initial diagnosis.

180. ENHANCED RECOVERY PROTOCOL VERSUS CONVENTIONAL CARE IN ESOPHAGECTOMY PATIENTS WITH ESOPHAGEAL CARCINOMA: ADVANTAGES ON THE PATIENT-REPORTED OUTCOMES

Abstract Background The subjective metrics regarding quality of life are unclear in comparison of an enhanced recovery after surgery (ERAS) protocol with conventional care in esophagectomy patients with esophageal carcinoma, while the objective metrics are controversial. This study was to investigate the advantages of ERAS over conventional care on the Health-related Quality of Life (HRQoL) from patient-reported outcomes (PROs), and explore the key components of ERAS for benefit duration. Methods This was a single-center, retrospective study with prospective PROs data from esophagectomy patients with esophageal cancer between April 2019 and June 2021. The objective metrics included perioperative complications and postoperative length of stay (PLOS). PROs data were assessed using the European Organization for Research and Treatment of Cancer QLQ-C30 quality of life questionnaire and the QLQ-OES18 esophageal cancer module from pre-surgery to six months after surgery. Mixed-effects models were used to longitudinally compare the HRQoL scores between the two programs. Results 348 conventional care and 109 ERAS patients were analyzed. The ERAS group had less pneumonia, arrhythmia, and PLOS than the conventional group. The ERAS group outperformed the conventional group in six QLQ-C30 domains, especially physical functioning (p = 0.0115), role functioning (p = 0.0002), and fatigue (p = 0.0428). QLQ-OES18 revealed that the ERAS group had less dysphagia (p < 0.0001), trouble talking (p = 0.0006) and better eating (p < 0.0001) than the conventional group. The above advantages persisted three months after surgery. For cervical circular stapled anastomosis the initial items and duration of benefit were reduced in ERAS group than in conventional group. Conclusion The ERAS protocol has significant advantages over the conventional care in lowering postoperative symptom burden and improving HRQoL on PROs in esophagectomy patients with esophageal cancer, and the benefit persists up to three months after surgery. For the cervical anastomosis the optimal technique may be a key component of ERAS maintaining the items and duration of advantages on PROs.

Amelioration of acute radiation dermatitis in patients with breast cancer by a bioadhesive barrier-forming oral gel (Episil): A single-center, open, parallel, randomized controlled trial.

e12519 Background: Episil is a bioadhesive barrier-forming oral liquid gel that can relieve mucositis caused by radiotherapy (RT) and hence relieves pain effectively.The purpose of this trial is to compare the efficacy and safety of Episil in improving acute radiation dermatitis in breast cancer patients. Methods: Key eligibility criteria were as follows: Pathologically confirmed breast cancer; female ≥18 years of age; planning to receive postoperative radiation therapy; surgery with modified radical or breast-conserving surgery; fully healed surgical incision; intact skin in the irradiated area; KPS score ≥80; no severe endocrine or metabolic disease; voluntary participation and signed informed consent; ability to read and understand and good compliance. The primary endpoint was the grading of radiation dermatitis during treatment. Results: A total of 102 patients were included from January 2022 to December 2022. The patients were grouped in a 2:1 ratio by randomized number table method, 67 patients received Episil combined with conventional skin care and 35 patients served as the control group receiving conventional skin care only. Two patients in the Episil group dropped out halfway. According to the RTOG grading, the skin reaction rate and the degree were significantly better in the Episil group than control group (24.62%, 72.31%, 3.08, 0, 0 VS 0, 85.71%, 14.29%, 0, 0, 0) in the 0, 1, 2, 3 and 4 grades respectively (P<0.001). And the pruritus score was significantly lower in the Episil group than in the control group (P<0.05). The results of the EORTC QLQ-C30 Quality of Life Questionnaire showed that the overall health (P<0.05) and overall quality of life (P<0.05) were better in the Episil group than control group after radiotherapy. Relative to the control group, the Episil group produced significantly lower rates of stress, anxiety, and depression (P<0.05) and had less impact on family life and social activities (P<0.05). Most importantly, the Episil group produced fewer pain reactions after the end of radiotherapy. Conclusions: In breast cancer patients receiving radiotherapy, Episil may significantly reduce the grading of acute radiation dermatitis, reduce patient symptoms, and improve patient quality of life. Clinical trial information: ChiCTR2200059646 .

Functional decline and resilience in older adults over the age of 70 receiving radiotherapy for breast cancer: A pilot study

IntroductionRadiotherapy (RT) as an adjuvant, post-lumpectomy treatment has been shown to improve local control and survival in people with breast cancer. While adverse events because of cancer treatments are common, many older adults have demonstrated the ability to return to their baseline levels of physical functioning. There are limited reports on the functional decline and recovery of older patients undergoing RT. The primary objective of this study was to investigate physical function at various time points during RT in people with breast cancer over age 70 and their ability to recover post-decline. Materials and MethodsSeventy-nine patients with breast cancer aged 70+ undergoing adjuvant RT at Sunnybrook Health Science Centre, Toronto, Ontario, Canada were enrolled for a prospective observational study. Participants completed the EORTC QLQ-C30 quality of life questionnaire before their first RT, after their final RT, and at three- and six-months post-RT to assess changes in physical function. Descriptive statistics were utilized to evaluate EORTC QLQ-C30 scores. A higher score was indicative of poorer physical function. Physical decline was a 10+ point increase in EORTC QLQ-C30 score from baseline to the last RT, and resilience was a return to <10 points from the baseline score within six months post-RT. Resistance was a post-RT change from the baseline score by fewer than 10 points. ResultsNine patients (11%) experienced physical decline following their last RT, and two of them (22%) displayed resilience within six months. There were no demographic or symptom variables associated with functional decline from the baseline to post-RT, nor with resilience. Nausea, pain, and diarrhea post-RT were associated with functional decline at six months post-RT (P = 0.0185, P = 0.0449, P = 0.0007, respectively). Nausea and diarrhea at baseline were associated with resistance to decline (P = 0.0055, P = 0.019, respectively), and with decline at the six-month follow-up (P ≤0.0001, P = 0.0235, respectively). DiscussionThis study highlights the incidence of physical decline in patients over age 70 receiving RT for breast cancer and identifies risk factors for decline. Future research with a larger sample, longer follow-up period, and incorporating geriatric assessments pre-RT is warranted to better understand functional decline and resilience in this population.

Abstract P4-07-10: Effect of acupuncture and exercise therapy on muscular strength, lymphedema and quality of life in breast cancer survivors: randomized clinical trial

Abstract Introduction: The continuous advance in the early detection and treatment of breast cancer has significantly reduced mortality and, consequently, increased the number of survivors with treatment side effects that act on the quality of life, such as lymphedema, loss of upper limb strength, shoulder dysfunction, decreased functional capacity, flexibility, and joint mobility. Exercise therapy is a recognized practice for the rehabilitation of these disorders; however, acupuncture needs to be better evaluated to compare its equivalence with classical therapy. Objective: To compare three distinct rehabilitation treatments (exercise therapy, acupuncture and Stiper®) in women undergoing breast cancer surgery, assessing strength, lymphedema and quality of life. Methods: Seventy-nine women with pain above 3 on the visual analogue pain scale (VAS) and with more than 90 days of surgery were included. They were divided into three groups that received weekly treatment for 10 weeks: group I (G1) treated with standard, pre-defined exercise therapy, based on stretching of the cervical muscles, shoulder girdle and shoulder ROM exercises with a duration of 30 minutes, group II (G2) treated with 30 minutes of acupuncture using predefined points and group III (G3) treated with the same acupuncture points as group II, however, using the Stiper® (silicon oxide micronized quartz pellet) in place of needles. Results: Sixty-seven patients completed the treatment, being 26 from G1, 23 from G2 and 18 from G3. There was an improvement in upper limb muscle strength over time in all groups, except for abduction and internal rotation movements. During treatment, there was no increase in the number of patients with lymphedema and there was no statistical difference between the groups. Regarding the EORTC QLQ-C30 quality of life questionnaire, nine of the fifteen factors analyzed showed significant differences between sessions. The factors that did not have significant differences between the three groups were Social Function, Nausea and Vomiting, Dyspnea, Loss of Appetite, Constipation and Diarrhea. Conclusion: The rehabilitation of physical dysfunctions in women who survived breast cancer through exercise therapy, acupuncture and Stiper® in upper limb muscle strength, lymphedema and quality of life, proved to be effective, without difference between groups, which leads to the conclusion that acupuncture didn’t show superiority of results when compared with exercise therapy, thus being an effective approach for the rehabilitation of these women. Citation Format: Patricia Santolia, Gil Facina, Cinira Haddad, Samantha K. Lopes de Almeida Rizzi, Afonso Nazário, Simone Elias. Effect of acupuncture and exercise therapy on muscular strength, lymphedema and quality of life in breast cancer survivors: randomized clinical trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-10.

Development of a diverse set of standard short forms based on the EORTC CAT Core item banks

PurposeThe European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group has developed item banks covering the 14 domains of the EORTC QLQ-C30 quality of life questionnaire. These allow for dynamic assessment and for forming population/study specific static short forms. To simplify selection of relevant short forms, we here present a portfolio of standard short forms with measurement properties optimized for different populations.MethodsFor each domain, a brief and a long version were constructed for each of three populations having mild, moderate, and severe symptoms, respectively. The most informative items were prioritised while also taking content into consideration. All short forms included at least one QLQ-C30 item. The measurement precision/power of the short forms was compared to the corresponding QLQ-C30 scales using simulations.ResultsIn total, 84 short forms were constructed. The brief versions included 3–5 items each, the long versions 5–9 items. Estimated sample size savings using the suggested short forms while maintaining the same power as with the QLQ-C30 ranged 3–50% across domains with median savings of 19% (brief versions) and 28% (long versions), respectively.ConclusionThe suggested short forms allow for simple selection of items particularly relevant for patients with mild, moderate, or severe symptoms, respectively. They facilitate the use of smaller samples without loss of power compared to the QLQ-C30 scales. The suggested short forms may be used as they are or adapted to the specific aims of individual studies/settings.

The effect of group psychotherapy on quality of life of cancer patients undergoing chemotherapy or endocrine therapy during Covid-19 pandemic: One center experience.

e24133 Background: The announcement of the pandemic by WHO had a great impact on global mental health. Mental disorders like stress, anxiety, depressive symptoms, insomnia, denial, anger, and fear affected the population worldwide. Cognitive-behavioral techniques are effective in improving the control of symptoms, the affective state and coping with the disease. Methods: Female patients were offered to take part in the study by their oncologists. Inclusion criteria included female patients who were diagnosed with cancer during the last 5 years. Intervention included - Online group psychotherapy which was conducted for 3 consecutive months, three times per week, using the interactive ZOOM platform. The Research and Treatment of Cancer (EORTC) quality of life questionnaire QLQ-C30 was used to assess QoL of participants. We asked patients to fill the ERTC questionnaire twice, before the first and after the last psychotherapy sessions. Results: Total of 25 patients aged 18-55 were included in the study, 72% were receiving hormonal therapy, and 28% were receiving chemotherapy. Majority of patients (18) were diagnosed with breast, 4 with cervical and 1 with uterine and 2 with ovarian cancer in last 5 years. All patients were white Caucasian females. Analysis of Variance (ANOVA) showed no difference between groups on pre-RS score; But the study showed significant improvement in post RS (EORTC QLQ-C30) in patients with hormone therapy (Goodness of Fit-R square-0.4471, P-value-0.0024, 95% Confidence Intervals-0.4200 to 1.626), compare to patients with chemotherapy (Goodness of Fit-R square-0.003372, P-value- 0.9016, 95% Confidence Intervals--1.743 to 1.929).All measures were presented as mean with standard deviation and the level of significance was defined as DELTA(D) = 0.05. Conclusions: According to our research, group psychotherapy had a positive effect on quality of life of cancer patients undergoing hormonal therapy and showed no significant impact on patients treated with chemotherapy. More research and a larger sample size is needed for a better interpretation of results.

Content Validity of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire QLQ-C30 for Use in Cancer

Content Validity of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire QLQ-C30 for Use in Cancer

Quality of Life of Patients with Head and Neck Cancer Receiving Cetuximab, Fluorouracil, Cisplatin Comparing to Cetuximab, Fluorouracil, Cisplatin, and Docetaxel within the CEFCID Trial

Introduction: CeFCiD was a multicenter phase II study comparing the efficacy of cetuximab (C), 5-flourouracil, and cisplatin with the same regimen adding docetaxel (D) in recurrent/metastatic head and neck cancer. The primary analysis trial did not demonstrate survival benefit from therapy intensification in first-line recurrent and/or metastatic squamous cell carcinoma of the head and neck (SCCHN). The current analysis of the trial assessed the impact of treatment on quality of life (QoL). Methods: The European Organization for Research and Treatment of Cancer Quality of life Questionnaire QLQ-C30 and the tumor-specific module for head and neck cancer (QLQ-H&N35) were used to assess QoL at baseline (visit 1), after 2 (visit 3), 4 (visit 5), and 6 (visit 7) cycles of chemotherapy. Results: Of 180 patients included in this study, 86 patients (47.8%) completed the questionnaires at baseline. Considering selected scores over treatment time, there was no difference in global QoL, dyspnea, swallowing, and speech between the treatment arms in the course. For fatigue, a significant increase from baseline to visit 3 (p = 0.02), visit 5 (p = 0.002), and to visit 7 (p = 0.003) was observed for patients receiving D, cisplatin or carboplatin (P), 5-fluorouracil (F), and C. At the end of chemotherapy, the manifestation of fatigue was similar compared in the 2 treatment arms. Discussion/Conclusion: Therapy intensification not adversely affects selected scores of QoL of patients with recurrent and/or metastatic SCCHN. Nevertheless, fatigue seems to be pronounced in patients treated with D.

Impacto da intervenção com música na qualidade de vida de pacientes submetidos ao tratamento quimioterápico

The diagnosis and treatment of cancer can affect the patient's quality of life, and music can prove to be an effective therapeutic tool. This study aims to observe the effects of music on the quality of life of patients undergoing chemotherapy. Eighteen patients diagnosed with breast cancer, virgins of previous chemotherapy treatment, separated into two groups were included in the study, where A was submi�ed to the intervention with music and group B was observational. An EORTC QLQ-C30 quality of life questionnaire and the performance scale were applied. There was a reduction in physical performance in the control group, while in the treated group, the physical factor remained the same as at the beginning of treat-ment. Study results suggested that the sample number be larger and that patients' physical functioning during treatment is evaluated to have even more noticeable results on the bene-fits of music.

Symptom Burden and Unmet Needs in Malignant Pleural Mesothelioma: Exploratory Analyses From the RESPECT-Meso Study.

Malignant Pleural Mesothelioma (MPM) has a poor prognosis and high symptom burden. RESPECT-Meso was a multicenter randomized study examining the role of early specialist palliative care (SPC) on quality of life (QoL) with MPM. This is a post-hoc exploratory analysis of the symptom burden and unmet needs identified from RESPECT-Meso participants. Exploratory analysis from 174 participants using the General Health Status (GHS) measure (from the EORTC QLQ-C30 QoL questionnaire) and 87 participants using validated assessment questionnaires in those randomized to SPC. Eligibility for the study included confirmed MPM with diagnosis <6 weeks prior, performance score (PS) 0 or 1, no significant physical or psychological comorbidity. Cox proportional hazards models were derived to examine for relationships with survival. Free text was assessed using content analysis, looking for common themes and words. Participants were predominantly male (79.9%), mean age 72.8 years, PS was 0 in 38%, 78% of MPM was epithelioid. At least 3 symptoms were reported in 69.8% of participants, including fatigue (81%), dyspnea (73.3%), pain (61.2%), weight loss (59.3%). Anxiety was reported by 54.7% of participants, 52.3% low mood and 48.8% anhedonia symptoms. After multivariable adjustment, only pain remained statistically significant with a hazard ratio (HR) 2.9 (95% CI 1.3-6.7; p = 0.01). For each 1 unit increase in GHS score, the HR for death was 0.987 (0.978-0.996; p = 0.006), indicating a worse reported QoL is related to shorter survival. Unmet needs were common: 25.9% wanted more information about their condition, 24.7% about their care and 21.2% about their treatment. 79.1% were concerned about the effect of their illness on family. There is a high symptom burden in mesothelioma despite good baseline performance status. A worse QoL is associated with a worse survival. Unmet needs are common, perhaps highlighting a need for improved communication and information sharing.

Pulsed radiation therapy for the treatment of newly diagnosed glioblastoma.

Pulsed radiation therapy (PRT) has shown effective tumor control and superior normal-tissue sparing ability compared with standard radiotherapy (SRT) in preclinical models and retrospective clinical series. This is the first prospective trial to investigate PRT in the treatment of patients with newly diagnosed glioblastoma (GBM). This is a single-arm, prospective study. Patients with newly diagnosed GBM underwent surgery, followed by 60 Gy of PRT with concurrent temozolomide (TMZ). Each day, a 2-Gy fraction was divided into ten 0.2-Gy pulses, separated by 3-minute intervals. Patients received maintenance TMZ. Neurocognitive function (NCF) and quality of life (QoL) were monitored for 2 years using the Hopkins Verbal Learning Test‒Revised and the European Organisation for Research and Treatment of Cancer QLQ-C30 QoL questionnaire. Change in NCF was evaluated based on a minimal clinically important difference (MCID) threshold of 0.5 standard deviation. Twenty patients were enrolled with a median follow-up of 21 months. Median age was 60 years. Forty percent underwent subtotal resection, and 60% underwent gross total resection. One patient had an isocitrate dehydrogenase (IDH)-mutated tumor. Median progression-free survival (PFS) and overall survival (OS) were 10.7 and 20.9 months, respectively. In a post-hoc comparison, median OS for the prospective cohort was longer, compared with a matched cohort receiving SRT (20.9 vs 14 mo, P = 0.042). There was no decline in QoL, and changes in NCF scores did not meet the threshold of an MCID. Treatment of newly diagnosed GBM with PRT is feasible and produces promising effectiveness while maintaining neurocognitive function and QoL. Validation of our results in a larger prospective trial warrants consideration.

Physical Activity and Long-term Quality of Life among Colorectal Cancer Survivors-A Population-based Prospective Study.

Evidence suggests that physical activity (PA) is positively associated with (health-related) quality of life (QOL) in colorectal cancer survivors. However, little is known regarding long-term effects of PA on QOL and if prediagnosis PA is associated with QOL in the years after diagnosis. Our study aimed to investigate the association of prediagnosis and postdiagnosis PA with long-term QOL in colorectal cancer survivors.This study is based on a population-based cohort from Germany of 1,781 newly diagnosed colorectal cancer survivors over a 5-year period. PA was assessed at diagnosis and at 5-year follow-up (5YFU). Quality of life was assessed by the European Organisation for Research and Treatment of Cancer C Quality of Life Questionnaire QLQ-C30 at 5YFU. Multivariable linear regression was used to explore associations between prediagnosis and postdiagnosis PA and QOL at 5YFU.No evidence of a positive association between higher levels of prediagnosis PA and better long-term QOL was found. Higher levels of prediagnosis work-related PA and vigorous PA were even associated with decreased QOL in domains such as cognitive [Beta(β) = -2.52, 95% confidence interval (CI) = -3.77, -1.27; β = -1.92, CI = -3.17, -0.67) and emotional functioning (β = -2.52, CI = -3.84, -1.19; β = -2.12, CI = -3.44, -0.80). In cross-sectional analyses, higher postdiagnosis PA was strongly associated with higher QOL. Survivors physically active at both prediagnosis and postdiagnosis as well as survivors who increased their PA between prediagnosis and postdiagnosis reported significantly higher long-term QOL compared with survivors who remained inactive at prediagnosis and postdiagnosis. In this study, higher prediagnosis PA does not appear to be associated with higher QOL among long-term colorectal cancer survivors but our results support the importance of ongoing PA throughout survivorship.

International validation of the EORTC CAT Core: a new adaptive instrument for measuring core quality of life domains in cancer.

The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group (QLG) has developed computerised adaptive tests (CATs) for the 14 functional and symptom domains of the EORTC QLQ-C30 quality of life questionnaire. This is expected to optimise measurement precision, relevance to patients and flexibility. Here, we present the first international validation of the EORTC CAT Core. A heterogeneous sample of 699 cancer patients scheduled for chemotherapy and/or radiotherapy was recruited across seven European countries. The EORTC CAT Core and all QLQ-C30 items were administered to participants before and after initiating treatment. Correlations between CAT and QLQ-C30 scores and floor/ceiling effects were calculated. Using several grouping variables, relative validity (cross-sectional known groups difference), responsiveness (changes over time) and relative sample size requirements of the CAT compared to the QLQ-C30 were estimated. Correlations of the CAT and QLQ-C30 ranged from 0.81 to 0.93 across domains. The mean relative reduction in floor and ceiling effects using the CAT was 42% (range 3-99%). Analyses of known groups validity and responsiveness indicated that, across domains, mean sample size requirements for the CAT were 72% and 70%, respectively, of those using the QLQ-C30. The EORTC CAT Core measures the same domains as the QLQ-C30 with reduced floor/ceiling effects. The CAT generally facilitated the use of smaller samples (about 30% smaller on average) without loss of power compared to the QLQ-C30. Based on this study, the EORTC QLG will release the EORTC CAT Core for general use.

The effects of add-on self-care education on quality of life and fatigue in gastrointestinal cancer patients undergoing chemotherapy

BackgroundGastrointestinal cancer is one of the most common malignancies and imposes heavy burdens on both individual health and social economy. We sought to survey the effect of a self-care education program on quality of life and fatigue in gastrointestinal cancer patients who received chemotherapy.MethodsNinety-one eligible gastrointestinal cancer patients were enrolled in this study and 86 valid samples were analyzed. Data were acquired with a demographics questionnaire, endpoint multidimensional questionnaire and the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire QLQ-C30. The collected data were analyzed using SPSS software.ResultsThe self-care education intervention significantly improved the quality of life with respect to emotional function (p = 0.018), role function (p = 0.041), cognitive function (p = 0.038) and alleviated side effects such as nausea/vomiting (p = 0.028) and fatigue (p = 0.029). Further analysis demonstrated that the self-care education benefited total fatigue, affective fatigue and cognitive fatigue in gastrointestinal cancer patients regardless of baseline depression.ConclusionOur results suggested the beneficial effects of the self-care education in both quality of life and anti-fatigue in gastrointestinal cancer patients under chemotherapy. The self-care education could be considered as a complementary approach during combination chemotherapy in gastrointestinal cancer patients.

Acute Stage Longitudinal Change of Quality of Life from Pre- to 3 Months after Surgical Treatment in Head and Neck Cancer Patients.

Purpose:Head and neck cancer (HNC) patients experience various posttreatment side effects that decrease quality of life (QOL). Some previous study reported that QOL of HHC patients were returned baseline (before treatment) after a year post treatment. However, acute stage longitudinal changes of QOL in HNC patients remains unclear. This point might be important for early reintegration of HNC patients. This study aimed to investigate the acute stage longitudinal change of the relationship between QOL and oral function in HNC patients had surgery. Methods:45 HNC patients (23 men) scheduled for surgical treatment were enrolled in this study. Primary tumor sites were 22 tongue, 5 maxilla, 4 mandible, 3 pharynx and others. Weight, body mass index (BMI), whole body soft lean mass (SLM), and skeletal muscle mass (SMM) were evaluated as muscle mass-related measurements. Lip closure force (LC) and tongue pressure (TP) were evaluated as oral function measurements. Feeding function was evaluated using the Functional Oral Intake Scale (FOIS). QOL was assessed using the European Organization for Research and Treatment of Cancer QOL Questionnaire QLQ-C30 and H&N 35. Measures were evaluated at pre-surgical treatment (PT), and 1 month (1M) and 3 months (3M) after surgery. The change of QOL parameters and relationships between measurements were assessed.Results:For QOL assessments, role functioning, fatigue, speech problems, trouble with social eating, trouble with social contact, and opening mouth significantly decreased from PT to 1M, but significantly increased from 1M to 3M. Weight, BMI, SLM, SMM, LC, TP, and FOIS demonstrated significant relationships with QOL from PT to 1M. Meanwhile, from 1M to 3M, weight, BMI, SLM, SMM, LC, and FOIS showed significant relationships with QOL assessments.Conclusions:Both oral function and muscle mass-related measurements significantly affected QOL in HNC patients.

Staging of nutrition disorders in non-small-cell lung cancer patients: utility of skeletal muscle mass assessment.

BackgroundAn international consensus proposed in 2011 a definition and classification system for cachexia (CAX), mainly based on weight loss, sarcopenia [skeletal muscle mass (SMM) loss], inflammation, and anorexia. The aim of this study was to stage CAX in non‐small‐cell lung cancer (NSCLC) patients by using a classification based on the Fearon criteria and supported by quantifiable parameters.MethodsThis was a cross‐sectional and non‐interventional multicentre study. SMM was assessed by analysing L3 computed tomography‐scan images. Patients completed the anorexia/CAX subscale of the Functional Assessment of Anorexia/Cachexia Therapy, EORTC QLQ‐C30 quality of life (QoL) and International Physical Activity Questionnaire (IPAQ).ResultsPatients were recruited in 56 sites. The analysis population comprised 531 patients, and SMM was assessed in 312 patients. Male patients were 66.5%, with a mean (SD) age of 65.2 (10.0) years, 79.9% were PS 0–1, and the tumour stage was mainly IIIB‐IV (87.3%). Overall, 38.7% of patients had CAX, 33.8% pre‐CAX, and 0.9% refractory CAX. Molecular tumour profiles were significantly associated with the presence of CAX: 23.9% in EGFR, ALK, ROS1, BRAF, or HER2+ patients, 41.4% in K‐RAS+, and 43.2% in patients with no molecular abnormality (P = 0.003). The more advanced the CAX stage, the poorer the scores of functional items of the QoL (P < 0.001) and International Physical Activity Questionnaire (P < 0.001). Sarcopenia was present in 66.7% of CAX and 68.5% of pre‐CAX patients. Overall, 43.8% of pre‐CAX patients had only sarcopenia with limited weight loss (≤2%) and no anorexia.ConclusionsThis is the first study to show the distribution of CAX in a population of NSCLC patients and an association between molecular abnormality in NSCLC and CAX. The original Fearon classification for CAX stages was supported by the associated functional QoL scores and physical activity levels, resulting in a clinically relevant system for detection of early stages of CAX.

PROMs following breast-conserving therapy for breast cancer: results from a prospective longitudinal monocentric study

Treatment of breast cancer includes many options and shared decision making is becoming standard practice. Within the context of treatment individualization, the omission of radiotherapy (RT) can be considered. It is thereby of great importance to correctly foresee the side effects attributed to RT. Data from longitudinal studies with contemporary techniques however are sparse. The purpose of the present study was to evaluate patient-reported outcome measures (PROMs) and long-term aesthetic outcome (AO) related to RT in the breast-conserving therapy (BCT) setting for breast cancer over time. Patients treated with BCT between April 2015 and April 2016 were prospectively included in the cohort. Evaluations were made at six time points: at baseline (before RT), during and at the end of RT, between 3 and 6months, 1year and 2years after RT. AO was scored by the patient and by the BCCT.core software. Further PROMs were measured with the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire QLQ-C30/-BR23 and the Body Image after Breast Cancer Questionnaire BIBCQ. Patients were evaluated over 2years. First, we assessed the evolution in time. Second, we tested the differences in mean scale scores of the PROMs between patients with a favourable and an unfavourable AO. One hundred seventy-five patients were included in the analysis. At baseline, unsatisfactory levels were already present for several scales. Most unsatisfactory PROMs improved up to 1year after RT. Complaints of fatigue increased at the start but decreased up to a lower level than that at baseline up to 1year after RT (mean difference (MD) 7.6, - 12.3, respectively). Cognitive functioning showed a small decrease at the start with no further significant decrease (MD - 4.73, - 0.21, respectively). Breast symptoms significantly increased during RT but decreased afterwards up to 2years after RT to lower values than those at baseline and were then considered satisfactory (MD 15.6, - 19.7, - 4.1, respectively). AO scored as PROM associated with BCCT.core and with the body image measures. The study suggests that quality of life and body image are temporarily impaired due to RT. Around one third of patients score their long-term AO as unfavourable. These results should be discussed with the patient and could help in the decision making of the treatment plan and in the clarification of the patient's expectations.

Implementation of comprehensive rehabilitation therapy in postoperative care of patients with cholangiocarcinoma and its impact on patients' quality of life.

Implementation of comprehensive rehabilitation therapy in postoperative care of patients with cholangiocarcinoma was studied to explore its impact on patients' quality of life. Two hundred and nineteen patients with cholangiocarcinoma who underwent surgery in Yidu Central Hospital of Weifang from April 2014 to June 2017 were selected as study subjects. Of these patients, 116 received comprehensive rehabilitation therapy, in addition to chemotherapy, after surgery and were assigned to the experimental group. The remaining 103 patients received routine treatment after surgery and were assigned to the control group. Under the guidance of experts, patients in the experimental group carried out multiple comprehensive rehabilitation activities, such as exercises on general physical function, adjustment of psychological state and recovery of social family function. The outcome after 1 month of treatment was evaluated for the two groups according to the RECIST 1.1 guidelines. Nutritional status of patients before surgery, at 1 day and at 1 month after surgery was measured according to the Nutritional Risk Screening endorsed by the European Society for Clinical Nutrition and Metabolism (ESPEN). The quality of life at 1 month after surgery was assessed based on the QLQ-C30 quality of life questionnaire. The negative emotions that patients experienced at 1 month after surgery were assessed using the self-rating anxiety scale (SAS) and the self-rating depression scale (SDS). The response rate in the experimental group was 76.72%, which was significantly higher than 46.60% in the control group (P<0.05). At 1 month after surgery, the nutritional status and quality of life, as well as SAS/SDS scores, were significantly better in the experimental group than in the control group, and the differences were statistically significant (P<0.05). In clinical anticancer treatment, synergistic implementation of comprehensive rehabilitation therapy can improve patients' psychological health status, nutritional status and the overall quality of life, and reduce the impact of negative emotions on the physical state.

Examining the Inter Hemispheric Transfer Time Test: A new computerized cognitive test to incorporate into therapeutic strategy for patients with brain metastases? A pilot study

ObjectiveTo evaluate the computerized Inter Hemispheric Transfer Time Test (IHTTT), a cognitive test designed for the detection of information processing speed impairment in patients undergoing stereotactic radiation therapy for brain metastases. MethodsInclusion criteria: age ≥18 years, brain metastases treated by stereotactic radiotherapy (SRT) with dose schedule: 33 Gy in 3 fractions, solid tumour, ≥70 Karnofsky Performance Status, Mini-Mental State Evaluation (MMSE) ≥ 24, no history of stroke brain injury. Twenty-nine patients were recruited from June 2014 to April 2015. All recruited patients were administered Frontal Assessment Battery at Bedside (FAB), IHTTT and QLQ-C30 quality of life questionnaire before SRT, at one-month, six-month and one-year follow-up. The primary endpoint was Interhemispheric Transfer Index (IHTI). Secondary endpoints included Interhemispheric Transfer Time (IHTT), MMSE, FAB, and quality of life. ResultsA significant evolution of cognitive function over time was assessed by the IHTTT: IHTT = 720 ± 27 ms at baseline, 728 ± 20 at one month, 736 ± 36 at 6 months, 799 ± 111 at one-year follow-up (p = 0.0010); IHTI = 13.1 ± 31.4, 11.5 ± 24.3, 50.6 ± 57.9, 91.0 ± 59.4 (p < 0.0001). There was also a significant evolution over time for MMSE (p = 0.014) but neither for FAB score nor the quality of life scores. IHTI was strongly related to progression-free survival (p = 0.0091). ConclusionOur results suggest that IHTTT is able to detect the evolution of cognitive function over time. IHTTT could be an interesting sensitive cognitive test to include in evaluation of patients with brain metastases irradiated by SRT.