Quality Of Life Trajectories Research Articles

The importance of using ordinal scores for patient classification based on health-related quality of life trajectories.

Changes in health-related quality of life (HRQoL) over time are not necessarily homogeneous within a population of interest. Our study aim was twofold: to determine homogeneous patient subpopulations distinguished by HRQoL trajectories, and to identify the particular patient profile associated with each subpopulation. To classify patients according to HRQoL dimension scores, we compared mixtures of linear mixed models (LMMs) classically applied to scores defined by the EORTC procedure, and mixtures of random effect cumulative models (CMs) applied to scores treated as ordinal variables. A simulation study showed that the mixture of LMMs overestimated the number of subpopulations and was less able to correctly classify patients than the mixture of CMs. Considering HRQoL scores as ordinal rather than continuous variables is relevant when classifying patients. The mixture of CMs for ordinal scores is able to identify homogeneous subpopulations and their associated trajectories. The application focused on changes over time in HRQoL data (collected using the EORTC QLQ-C30 questionnaire) from 132 breast cancer patients from the Moral study. Once the classification is obtained only from HRQoL scores, class membership was then explained through a logistic regression model, given a large panel of variables collected at baseline. Analysis of data revealed that deterioration over time of role functioning and insomnia was closely related to patient anxiety: anxiety at baseline is a prognostic factor for a poor level and/or a deterioration over time of HRQoL. For functional dimensions, large tumor size and high education level were associated with worse HRQoL scores.

Longitudinal Trajectories of Quality of Life Among People With Mild-to-Moderate Dementia: A Latent Growth Model Approach With IDEAL Cohort Study Data.

ObjectivesWe aimed to examine change over time in self-rated quality of life (QoL) in people with mild-to-moderate dementia and identify subgroups with distinct QoL trajectories.MethodsWe used data from people with mild-to-moderate dementia followed up at 12 and 24 months in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort study (baseline n = 1,537). A latent growth model approach examined mean change over time in QoL, assessed with the QoL-AD scale, and investigated associations of baseline demographic, cognitive, and psychological covariates with the intercept and slope of QoL. We employed growth mixture modeling to identify multiple growth trajectories.ResultsOverall mean QoL scores were stable and no associations with change over time were observed. Four classes of QoL trajectories were identified: 2 with higher baseline QoL scores, labeled Stable (74.9%) and Declining (7.6%), and 2 with lower baseline QoL scores, labeled Stable Lower (13.7%) and Improving (3.8%). The Declining class had higher baseline levels of depression and loneliness, and lower levels of self-esteem and optimism, than the Stable class. The Stable Lower class was characterized by disadvantage related to social structure, poor physical health, functional disability, and low psychological well-being. The Improving class was similar to the Stable Lower class but had lower cognitive test scores.DiscussionUnderstanding individual trajectories can contribute to personalized care planning. Efforts to prevent decline in perceived QoL should primarily target psychological well-being. Efforts to improve QoL for those with poorer QoL should additionally address functional impairment, isolation, and disadvantage related to social structure.

Abstract 7: Quality Of Life Trajectories In The Year After Large Vessel Occlusion Stroke And Their Association With 90-day Functional Outcome

Background: While research has focused on the trajectory of functional recovery after ischemic stroke, the trajectory of quality of life (QoL) has not been fully explored, nor has its relation to functional recovery. Methods: In a post hoc analysis of the IMS-III trial, we included patients with an imaging-confirmed large vessel occlusion and QoL assessed as EQ-5D at 5 study visits up to 1 year after ischemic stroke onset. We used group-based trajectory modelling (GBTM) to identify trajectories of EQ-5D index values with US-based weights and report patient demographics in each trajectory and the modified Rankin Scale (mRS) score at 90 days. Results: We included 266 patients, who had QoL measured at a mean of 4.6, 93.0, 184.3, 274.3, and 367.6 days after stroke onset. GBTM identified four trajectories with excellent fit (Figure). These QoL trajectories can be described as [1] persistent low, [2] low to medium, [3] persistent medium, and [4] medium to high. The corresponding mRS at 90 days are shown in the Figure, demonstrating a clustering of trajectories by mRS but also a diversity of trajectories. In particular, low to medium and persistent medium trajectories are represented across all mRS scores. Patient demographics are shown by trajectory in the Table, with significant differences in sex, baseline NIHSS, infarct volume, WMH burden, and diabetes. Conclusion: We demonstrate four distinct trajectories of QoL in the year after large vessel occlusion stroke, with a diversity of functional recovery and unique demographic compositions. Early recognition of a likely future QoL trajectory could suggest patient-specific rehabilitation therapies and inform prognostication and goals of care.

Health-Related Quality of Life in a Biologic Assignment Trial of Reduced Intensity Hematopoietic Cell Transplantation Based on Donor Availability in Patients Aged 50-75 with Advanced Myelodysplastic Syndrome

Health-Related Quality of Life in a Biologic Assignment Trial of Reduced Intensity Hematopoietic Cell Transplantation Based on Donor Availability in Patients Aged 50-75 with Advanced Myelodysplastic Syndrome

Quality of Life in Young Adults With Cerebral Palsy: A Longitudinal Analysis of the SPARCLE Study.

Introduction: While most people with cerebral palsy (CP) will have a life expectancy similar to that of the general population, international research has primarily focused on childhood and adolescence; and knowledge about the quality of life (QoL) of young adults with CP, its trajectories, and associated factors remains scarce.Methods: This longitudinal study included young adults with CP living in five European regions and who had previously participated in the SPARCLE cohort as children and/or adolescents. Their QoL in the psychological well-being and social relationships domains was estimated using age-appropriate validated instruments (KIDSCREEN-52 in childhood/adolescence and WHOQOL-Bref in young adulthood). We used generalized linear mixed-effect models with random intercept to estimate long-term trajectories of QoL in both domains and to investigate whether severity of impairment, pain, and seizure influenced these trajectories. We sought to identify potentially different trajectories of QoL from childhood to adulthood using a shape-based clustering method.Results: In total, 164 young adults with CP aged 22–27 years participated in the study. Psychological well-being linearly decreased by 0.78 points (scale 0–100) per year (95% confidence interval (CI) −0.99 to −0.56) from childhood to young adulthood, whereas QoL in the social relationships domain increased (β coefficient 1.24, 95% CI 0.92–1.55). Severity of impairment was associated with reduced QoL in all life periods of the study (childhood, adolescence, and young adulthood): motor impairment with social relationships, and more nuancedly intellectual disability with psychological well-being and social relationships. At all periods, frequent pain significantly reduced psychological well-being, and seizures were associated with lower QoL in the social relationships domain. In both domains, we identified a group of individuals with CP who presented a reverse trajectory compared with the general QoL trajectory.Conclusion: Identification of QoL trajectories and their associated factors yields improved knowledge about the experience of individuals with CP until young adulthood. Further studies are needed to better understand the determinants that have the greatest influence on the different shapes of long-term trajectories of QoL.

Quality of life in individuals newly diagnosed with multiple sclerosis or clinically isolated syndrome.

Little is known about quality of life (QOL) at the time of multiple sclerosis (MS) or clinically isolated syndrome (CIS) diagnosis and how it evolves in the critical adjustment period immediately following a new diagnosis. To (1) describe QOL trajectory in the first year post-MS/CIS diagnosis and (2) examine associations of demographic and biopsychosocial factors with QOL at baseline and as it evolves over the first year post-MS/CIS diagnosis. Participants were N = 250 individuals newly diagnosed with MS or CIS. Participants completed self-report assessments of QOL, demographics, and biopsychosocial factors at 1, 2, 3, 6, 9, and 12months post-diagnosis using validated measures. At 1-month post-diagnosis, QOL M = 75.2/100 with subsequent assessments revealing consistent ratings on average. Modelling revealed a small number of variables that were predictive of QOL at baseline and/or change in QOL over time. QOL in the first year post-MS/CIS diagnosis was, on average, high and stable. A subset of modifiable factors across the biopsychosocial spectrum was associated with baseline level of QOL and change in QOL over time. The stability in QOL suggests that patients can be assessed early after diagnosis for key variables that are predictive of both current and future QOL.

A Retrospective Cohort Study of Myosteatosis and Quality of Life in Head and Neck Cancer Patients

Simple SummaryQuality of life (QOL) is an important patient reported outcome that effects both care and life outside of treatment. There is a shortage of nontaxing ways to determine which patients may need enhanced care over the course of their therapy and beyond to help avoid long-term declines in QOL. Therefore, we investigated whether myosteatosis as determined through existing diagnostic imaging could be used to predict QOL trajectories. In this study, patients with pretreatment myosteatosis were more likely to have lower physical and global QOL scores than patients with normal muscle density. In conclusion, myosteatosis may be a way of determining patients in need of extra assistance over the course of treatment and afterwards.Head and neck cancer (HNC) treatment-related morbidity can be detrimental to quality of life (QOL). Myosteatosis is associated with poor QOL in multiple cancers. If predictive of poor QOL trajectories, myosteatosis would be a tool for clinicians to determine which patients may require additional support during treatment. The purpose of this study was to determine if pretreatment myosteatosis is associated with a poor QOL trajectory following treatment completion. Methods: In a retrospective cohort design, myosteatosis was determined from pretreatment CT scans. Both physical and global QOL score was assessed through patient interview on follow-up appointment. Demographic, cancer-specific, and social covariates were collected, reported, and considered as potential confounders. Results: The population of 163 patients was mostly male (82.2%) and white (91.4%) with oropharyngeal cancer (55.8%). Males with myosteatosis had a physical QOL score 46.84 points lower at one-year following treatment completion (p = 0.01) than those with normal muscle density (p = 0.01). Males with myosteatosis averaged 57.57 points lower at one-year post-treatment (p = 0.01) in global QOL scores. Conclusions: Over one year following completion of treatment, patients with myosteatosis reported worse physical and global QOL scores than patients with normal muscle density.

Prognostic Impact of Pretransplantation Quality of Life and Its Post-Transplantation Longitudinal Change after Allogeneic Hematopoietic Cell Transplantation: A Prospective Study That Administered the Short-Form Health Survey (SF-12) and EuroQol 5

In allogeneic hematopoietic cell transplantation (allo-HCT), investigator-based clinical variables have been used for pretransplantation prognostic prediction, risk adjustment, and post-transplantation long-term screenings. Although several studies have investigated the prognostic significance of pretransplantation patient-reported outcomes (PROs) and longitudinal trends in PROs after allo-HCT, few have assessed these outcomes using the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12) and EuroQol 5 Dimension (EQ-5D) index. The present study used 18 items from the SF-12 and EQ-5D index to evaluate the prognostic impact of pretransplantation quality of life (QOL) on allo-HCT outcomes and longitudinal changes in QOL in allo-HCT recipients. This single-center prospective study included consecutive patients who underwent allo-HCT at our center between October 2014 and September 2016. All participants were followed up until October 2017. The SF-12 and EQ-5D index were administered to assess patient-reported QOL before allo-HCT and at 3 months, 6 months, 1 year, and 2 years after allo-HCT when participants visited the long-term follow-up clinic. Longitudinal trends in the QOL-adjusted means were estimated using linear mixed-effects, adjusting for pretransplantation covariates and reasons for missing QOL data. Among 157 patients who underwent allo-HCT, 145 (92%) were registered in this study, and 143 with available QOL data were analyzed. The median pretransplantation scores were 45.3 for the SF-12 physical component score (PCS), 55.6 for the mental component score (MCS), 38.8 for the role/social component score (RCS), 70.0 for the visual analog scale (VAS), and 49.0 for the EQ-5D index. Overall survival (OS) was significantly improved in patients with higher pretransplantation scores on the PCS, RCS, and EQ-5D index, and multivariable analyses showed that the median pretransplantation RCS was significantly associated with OS after allo-HCT (hazard ratio, 3.66; P=.003). The longitudinal trends in the SF-12 score showed that the PCS was improved at 2 years after allo-HCT and was comparable to the normative score for the general population. The MCS remained comparable to or higher than the normative score after allo-HCT. The RCS improved significantly beginning at 6 months after allo-HCT but remained lower than the normative score at 2 years. The VAS and EQ-5D index values showed a drop at 3 months after allo-HCT. Patient-reported QOL assessed by 18 questions on the SF-12 and EQ-5D predicted prognosis, and may be used as a prognosticator to determine treatment strategies, including preparative regimens. Although we experienced a certain amount of patient attrition in the longitudinal follow-up of QOL data, we demonstrated characteristic trajectories of QOL in different domains after adjusting for background covariates and reasons for the lack of QOL data.

FC 068QUALITY OF LIFE OVER TIME IN OLDER MEN AND WOMEN WITH ADVANCED CKD - RESULTS FROM THE EQUAL STUDY

Abstract Background and Aims Differences between the sexes are apparent in the epidemiology of CKD. Cross-sectional studies show that women consistently report a poorer health-related quality of life (QoL) than men, however, longitudinal studies are lacking. Here we investigate the sex-specific evolution of QoL over time in advanced CKD. As a secondary aim, we explore the sex-specific determinants of QoL. Method EQUAL is an observational prospective cohort study in stages 4 and 5 CKD patients ≥65 years not on dialysis with an incident estimated glomerular filtration rate (eGFR) < 20 ml/min/1.73m². Data on QoL (measured using the RAND-36), clinical and demographic patient characteristics were collected between April 2012 and September 2020. QoL trajectories were modelled by sex using linear mixed models, and joint models were applied to deal with informative censoring. We followed patients until death or dialysis initiation. Results We included 5151 QoL measurements in 1416 patients over a total of 1986 person years of follow-up. Overall, the physical component summary (PCS) declined with 2.0 (95% CI 1.4-2.6) points and the mental component summary (MCS) by 2.4 (95% CI 1.8-3.0) points per year. Although women had overall lower QoL scores, figure 1 demonstrates that PCS and MCS declined more than twice as fast in men (PCS: 2.4 per year, 95% CI 1.7 – 3.1, MCS: 2.9 per year, 95% CI 2.2 – 3.6) compared with women (PCS: 1.1 per year, 95% CI -0.2 – 2.0, MCS: 1.5 per year, 95% CI 0.5 – 2.4). We identified a non-linear interaction effect between sex and eGFR levels on QoL, demonstrating a stronger negative effect of decreased eGFR on both PCS (p=0.02) and MCS (p=0.04) in men compared with women. Subsequent adjustment for renal decline attenuated the difference in rate of QoL decline between men and women (difference after adjustment; PCS: 1.1, 95% CI -0.1 – 2.2, MCS: 1.2, 95% 0.0 – 2.3). In univariable analyses, higher serum haemoglobin was more beneficial to QoL in men compared to women (p-value for interaction; PCS: p=0.03, MCS: p=0.01). Higher serum phosphate had a strong harmful effect on both PCS and MCS in men, but not in women (PCS & MCS: p<0.001). The presence of pre-existing diabetes had a negative effect on PCS and MCS in men, but to a lesser extent in women (PCS: p=0.02, MCS: p=0.01). Conclusion Despite the higher overall QoL reported by men, both their physical and mental QoL declined approximately twice as fast compared with women. The faster decline in men was mediated in part by their lower levels of renal function, which had a stronger impact on their QoL as compared with women. Furthermore, in exploratory analyses we identified that high levels of phosphate, low levels of haemoglobin, and pre-existing diabetes were more detrimental to QoL in men than in women.

European Society of Thoracic Surgeons electronic quality of life application after lung resection: field testing in a clinical setting.

Technology has the potential to assist healthcare professionals in improving patient-doctor communication during the surgical journey. Our aims were to assess the acceptability of a quality of life (QoL) application (App) in a cohort of cancer patients undergoing lung resections and to depict the early perioperative trajectory of QoL. This multicentre (Italy, UK, Spain, Canada and Switzerland) prospective longitudinal study with repeated measures used 12 lung surgery-related validated questions from the European Organisation for Research and Treatment of Cancer Item Bank. Patients filled out the questionnaire preoperatively and 1, 7, 14, 21 and 28 days after surgery using an App preinstalled in a tablet. A one-way repeated measures analysis of variance was run to determine if there were differences in QoL over time. A total of 103 patients consented to participate in the study (83 who had lobectomies, 17 who had segmentectomies and 3 who had pneumonectomies). Eighty-three operations were performed by video-assisted thoracoscopic surgery (VATS). Compliance rates were 88%, 90%, 88%, 82%, 71% and 56% at each time point, respectively. The results showed that the operation elicited statistically significant worsening in the following symptoms: shortness of breath (SOB) rest (P = 0.018), SOB walk (P < 0.001), SOB stairs (P = 0.015), worry (P = 0.003), wound sensitivity (P < 0.001), use of arm and shoulder (P < 0.001), pain in the chest (P < 0.001), decrease in physical capability (P < 0.001) and scar interference on daily activity (P < 0.001) during the first postoperative month. SOB worsened immediately after the operation and remained low at the different time points. Worry improved following surgery. Surgical access and forced expiratory volume in 1 s (FEV1) are the factors that most strongly affected the evolution of the symptoms in the perioperative period. We observed good early compliance of patients operated on for lung cancer with the European Society of Thoracic Surgeons QoL App. We determined the evolution of surgery-related QoL in the immediate postoperative period. Monitoring these symptoms remotely may reduce hospital appointments and help to establish early patient-support programmes.

One slope does not fit all: longitudinal trajectories of quality of life in older adulthood.

Maintaining or improving quality of life (QoL) in later life has become a major policy objective. Yet we currently know little about how QoL develops at older ages. The few studies that have modelled QoL change across time for older adults have used 'averaged' trajectories. However, this ignores the variations in the way QoL develops between groups of older adults. We took a theoretically informed 'capabilities approach' to measuring QoL. We used four waves of data, covering 6years, from the New Zealand Health, Work and Retirement Study (NZHWR) (N = 3223) to explore whether distinct QoL trajectories existed. NZHWR is a nationally representative longitudinal study of community-dwelling adults aged 50 + in New Zealand. Growth mixture modelling was applied to identify trajectories over time and multinomial regressions were calculated to test baseline differences in demographic variables (including age, gender, ethnicity, education and economic living standards). We found five QoL trajectories: (1) high and stable (51.94%); (2) average and declining (22.74%); (3) low and increasing (9.62%); (4) low and declining (10.61%); (5) low and stable (5.09%). Several differences across profiles in baseline demographic factors were identified, with economic living standards differentiating between all profiles. The trajectory profiles demonstrate that both maintaining and even improving QoL in later life is possible. This has implications for our capacity to develop nuanced policies for diverse groups of older adults.

Outcome Measures and Quality of Life in Vestibular Schwannomas

This review summarizes existing vestibular schwannoma (VS) disease-specific and non-disease-specific patient-reported outcome measure (PROM) tools for quality of life (QoL) and audio-vestibular symptoms, compares QoL across treatment modalities, and discusses the potential role of psychological variables in QoL and recovery after surgical resection of VS. VS treatment success was previously assessed according to various factors such as the extent of tumor resection, facial nerve function, and hearing preservation. However, the literature demonstrates recent shifts away from using such physician-reported “objective” outcomes as benchmarks for success towards more patient-perceived “subjective” measures. A number of PROM tools have been developed to assess QoL and other measures in patients with VS. This has allowed us to better understand and quantify the impact of the disease and of the treatments on our patient population. However, there are important considerations to be made when applying PROM in clinical settings such as understanding the concept of Minimal Clinically Important Difference (MCID). The use of disease-specific PROMs, such as the PANQOL, as a primary outcome in VS research is encouraged. When doing so, PROM scales should incorporate the concept of MCID to distinguish statistically significant from clinically significant findings and should further investigate the role of non-medical variables, such as psychological variables, on QoL and recovery trajectories in patients with VS. Actual literature does not seem to indicate a clinically significant difference in patient-reported outcomes among treatment modalities.

Trajectory and profile of quality of life in patients undergoing lung resection for lung cancer during hospitalization according to the EQ-5D.

To clarify the trajectory and profile of quality of life (QOL) in lung cancer patients undergoing surgery during hospitalization. Among prospectively enrolled 279 patients between 2015 and 2018, we used the EQ-5D-5 levels (EQ-5D-5L), which consist of a descriptive system of five dimensions and a visual analog scale (VAS) (from 0 to 100). The five dimensions are mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, which are rated according to a 5-grade evaluation. QOL assessments were performed preoperatively (Pre) and on postoperative day 1/3/5/7 (D1/D3/D5/D7). To observe the trajectory of QOL, the EQ-5D VAS was used. To define the profile of QOL, we applied univariate linear regression analysis to predict EQ-5D VAS based on the five dimensions of EQ-5D as explanatory variables and to determine the rank of absolute values of the standardized coefficient of each dimension that represented strength of the effect on the EQ-5D VAS. The means of VAS scores were as follows: Pre/D1/D3/D5/D7 = 79/45/58/64/71. Younger age, fewer comorbidities, and surgical indications decreased the VAS at D1. More comorbidities, advanced cancer stage, postoperative adverse events, and chest tube placements hampered restoration of the VAS. Regarding QOL profiles, anxiety/depression was the highest rank preoperatively while usual activity, but not pain/discomfort, was the highest postoperatively. This is the first study to visualize the trajectory of QOL in surgical patients with lung cancer during hospitalization. This information may help improve perioperative patient care.

Preoperative predictors of restoration in quality of life after surgery for lung cancer.

BackgroundThe preoperative predictors of quality of life (QOL) in patients who undergo lung resection for lung cancer are poorly known. Here, we investigated these predictors in such patients using two QOL measures.MethodsIn this single‐institutional prospective cohort study, we administered the EQ‐5D‐5 levels (EQ‐5D‐5L) from January 2015, and the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire with 30 items from April 2015 to April 2018 preoperatively (Pre) and at one month postoperatively (M1), and one year postoperatively (Y1). General health status was measured by the EQ‐5D visual analogue scale (VAS) and EORTC global health status/QOL (GHS) scores. Multivariable linear regression analyses were used to explore the preoperative predictors of QOL at Y1.ResultsA total of 223 patients were included in the study. The EQ‐5D VAS and EORTC GHS scores, at Pre, M1, and Y1, were 80 ± 15, 77 ± 15, and 84 ± 11; and 74 ± 19, 65 ± 20, and 78 ± 17, respectively. In the multivariable analyses, the albumin level, preoperative VAS score, and preoperative pain/discomfort and anxiety/depression were identified as predictors by the EQ‐5D VAS score. The preoperative EORTC GHS score, absence of diabetes mellitus, preoperative cognitive function score, and preoperative symptom score of pain were identified as predictors by the EORTC GHS score.ConclusionsThe EQ‐5D VAS and EORTC GHS scores traced similar trajectories of QOL. In both QOL measures, preoperative pain was found as a common predictor. These predictors may help improve patient/survivor care in the future.

Psychological risk factors that\xa0characterize the trajectories of quality of life after a physical trauma: a longitudinal study using latent class analysis

BackgroundThe course and corresponding characteristics of quality of life (QOL) domains in trauma population are unclear. Our aim was to identify longitudinal QOL trajectories and determine and predict the sociodemographic, clinical, and psychological characteristics of trajectory membership in physical trauma patients using a biopsychosocial approach.MethodsPatients completed a questionnaire set after inclusion, and at 3, 6, 9, and 12 months follow-up. Trajectories were identified using repeated-measures latent class analysis. The trajectory characteristics were ranked using Cohen’s d effect size or phi coefficient.ResultsAltogether, 267 patients were included. The mean age was 54.1 (SD = 16.1), 62% were male, and the median injury severity score was 5.0 [2.0—9.0]. Four latent trajectories were found for psychological health and environment, five for physical health and social relationships, and seven trajectories were found for overall QOL and general health. The trajectories seemed to remain stable over time. For each QOL domain, the identified trajectories differed significantly in terms of anxiety, depressive symptoms, acute stress disorder, post-traumatic stress disorder, Neuroticism, trait anxiety, Extraversion, and Conscientiousness.DiscussionPsychological factors characterized the trajectories during 12 months after trauma. Health care providers can use these findings to identify patients at risk for impaired QOL and offer patient-centered care to improve QOL.

Stroke disease-specific quality of life trajectories after rehabilitation discharge and their sociodemographic and clinical associations: A longitudinal, multicentre study.

To investigate the longitudinal growth trajectories of disease-specific quality of life (QoL) dimensions and their associations over 1year. A longitudinal design. Data were collected between February 2015-May 2017. Four hundred and fifteen stroke survivors (mean age 70.6years; 81% ischaemic stroke) were recruited after discharge from rehabilitation hospitals and were followed up every 3months for 1year. Changes in Stroke Impact Scale (SIS) dimension scores were evaluated using hierarchical linear models (HLMs) and linear, logarithmic, quadratic, and cubic time slope. We observed a significant linear and quadratic increase in most SIS dimensions from the baseline to 12-month follow-up, especially in physical dimensions. The communication dimension was stable over time, while the memory dimension increased only linearly. Higher physical dimension scores were significantly associated with lower age, hypercholesterolaemia, and better physical functioning at baseline, while higher communication was associated with lower age, better physical functioning, and a diagnosis of peripheral vascular disease. Better memory was associated with lower age, married status, better physical functioning, and left-hemisphere stroke. Better participation was associated with lower age and better physical functioning. No significant associations were observed for emotion. This study provides important information about the trajectories of stroke survivors' specific QoL and their associated variables. Stroke has a great impact on stroke survivors' QoL. Disease-specific QoL significantly increases from the baseline to 12-month follow-up, especially in physical dimensions. Lower age, hypercholesterolaemia, better physical functioning, and diagnosis of peripheral vascular disease seem to be associated with better QoL. Through the analyses of associated variables, we identified stroke survivors who are more at risk and who need more tailored interventions to improve their physical, psychological, emotional, and social dimensions.

QOL-22. MACHINE-LEARNING INFERENCE MAY PREDICT QUALITY OF LIFE SUBGROUPS OF ADAMANTINOMATOUS CRANIOPHARYNGIOMA

BACKGROUNDDue to disease and/or treatment-related injury, such as hypothalamic, visual, and endocrine damage, quality of life (QoL) scores after childhood-onset Adamantinomatous Craniopharyngioma (ACP) are among the lowest of all pediatric brain tumors. Decision-making regarding management would be aided by more complete understanding of a patients likely QoL trajectory following intervention.METHODSWe retrospectively analyzed caregiver and patient-reported QoL-instruments from the first 50 patients (ages 1–17 years at diagnosis) enrolled in the international Advancing Treatment for Pediatric Craniopharyngioma (ATPC) consortium. Surveys included 205 pediatric-relevant questions and were completed at diagnosis, and 1- and 12-months following diagnosis. Using Multiple Correspondence Analysis (MCA), these categorical QoL surveys were interrogated to identify time-dependent patient subgroups. Additionally, custom deep learning classifiers were developed using Google’s TensorFlow framework.RESULTSBy representing QoL data in the reduced dimensionality of MCA-space, we identified QoL subgroups that either improved or declined over time. We assessed differential trends in QoL responses to identify variables that were subgroup specific (Kolmogorov-Smirnov p-value < 0.1; n=20). Additionally, our optimized deep learning classifier achieved a mean 5-fold cross-validation area under precision-recall curve score > 0.99 when classifying QoL subgroups at 12 month follow-up, using only baseline data.CONCLUSIONsThis work demonstrates the existence of time-dependent QoL-based ACP subgroups that can be inferred at time-of-diagnosis via machine learning analyses of baseline survey responses. The ability to predict an ACP patient’s QoL trajectory affords caregivers valuable information that can be leveraged to maximize that patient’s psychosocial state and therefore improve overall therapy.

Mental Health and Quality of Life of Women One Year after Maternal Near-Miss in Low and Middle-Income Countries: The Case of Zanzibar, Tanzania.

Women who experienced a maternal near-miss are at risk of mental health complications and lower quality of life, but long-term consequences are largely unknown. The aim of this study is to assess whether mental health symptoms and quality of life change over time and to examine associations with risk factors among post-partum women. In this cohort study, women with maternal near-miss were matched to women without or with mild complications at Mnazi Mmoja Hospital in Zanzibar. Depressive and post-traumatic stress disorder symptoms, and quality of life were measured at three, six, and twelve-months follow-up. A linear mixed-effects model was used for data analysis. Postpartum women in Zanzibar reported low levels of depressive and post-traumatic stress disorder symptoms. While depressive symptoms and quality of life trajectories were similar among women with and without maternal near-miss, differences for trajectories of post-traumatic stress disorder symptoms and physical quality of life were found. Social support, perinatal loss, and intercurrent illness were strongly associated with both depressive symptoms and quality of life in this group of Islamic women. These findings suggest that social support, embedded in the cultural context, should be considered in helping women cope with mental health issues in the aftermath of severe maternal complications.

Two-year Outcome of Quality of Life and Health Status for the Elderly with Chronic Limb-threatening Ischemia.

PurposeIn elderly patients with chronic limb-threatening ischemia (CLTI), there is little scientific understanding of the long-term changes of quality of life (QoL) and health status (HS) after treatment. The primary goal of this study was to provide long-term QoL and HS results for elderly CLTI patients after therapy. Treatments consisted of endovascular revascularization, surgical revascularization, or conservative treatment. Furthermore, the aim of this study was to identify the distinctive trajectories of QoL and HS.Patients and MethodsCLTI patients aged ≥70 years were included in a prospective observational cohort study with a two-year follow-up. The WHOQOL-BREF was used to asses QoL. The 12-Item Short Form Health Survey was used to measure HS. The QoL and HS scores were compared to the scores in the general elderly Dutch population. Latent class trajectory analysis was used.ResultsA total of 195 patients were included in this study. After two years, in all treatment groups patients showed significantly higher physical QoL score compared to baseline and there was no significant difference with the corresponding values in the elderly Dutch population. In the latent class trajectory analysis, there were no overlapping risk factors for poorer QoL or HS.ConclusionThis study shows that QoL levels in surviving elderly CLTI patients in the long-term do not differ from the corresponding values for elderly in the general population. There were no disparities in sociodemographic, clinical and treatment characteristics associated with poorer QoL and HS. This study was carried out to encourage further analysis of the influence of biopsychosocial characteristics on QoL and HS in elderly CLTI patients.

Abstract PO-085: The impact of socioeconomic position and chronic stress burden on the quality of life among Black breast cancer survivors in California

Abstract Background: Breast cancer survivors constitute a significant percentage of cancer survivors in the United States, a population that is expected to grow with enhanced surgical procedures, improved cancer therapeutics and new radiation approaches. Although advances in diagnostics and treatment modalities have led to improved quality of life outcomes for breast cancer survivors, evidence suggest that this is not the case for all women. Black women are more likely to be diagnosed with luminal subtypes which are associated with higher mortality rates compared to other women. Additional evidence suggest that Black women experience a multitude of emotional challenges during their breast cancer trajectory which may be further compounded with the burden of chronic stressors coupled with their socioeconomic position (SEP). Given these inequities, the impact of cancer on the lives of black breast cancer survivors (BBCS) is underexplored and warrants further investigation so that we can have a better understanding of their health and well-being over time. To that end, the purpose of this study was to investigate the contribution of psychosocial predictors (SEP, chronic stress burden) on the quality of life in a sample of middle-income BBCS. We hypothesize that higher stress burden would negatively impact life course and higher SEP will positively enhance life course. Methods: A sample of 155 BBCS were recruited using a variety of recruitment strategies, including flyers, direct appeals to BBCS support groups and word-of-mouth across the state of California. Inclusion criteria were women who self-identified as African/Black American, age 25 year or older, diagnosis of breast cancer and at least 1-year post-active treatment. The women completed a demographic data questionnaire, including age, ethnicity, marital status, education, and income and the latter was used to establish SEP. In addition, level of chronic stress was measured with the chronic burden scale (CBS) (Gurung, Taylor, Kemeny, Myers, 2004) and the impact of cancer scale (IOCv2) (Crespi, Ganz, Peterson, Castillo, Caan, 2008) was used to assess quality of life for cancer survivors. Results: The sample of black women were relatively young when diagnosed (mean age at diagnosis 51.67 (SD=10.03). Most (38%) were married and were homeowners, approximately 48.4% reported having a college degree or higher. Results indicated that education was a significant predictor of quality of life for this cohort R2= .234 and Adjusted R Squared=.088. These survivors reported low to moderate levels of chronic stress (mean: 25.3), high positive impact of cancer ratings (mean: 4.10), and relatively low ratings of negative impact of breast cancer on their well-being (mean: 2.27). Conclusion: The study findings indicate a more positive quality of life trajectory in middle-class BBCS. Future studies are needed to confirm these results and to test whether there are differences in quality of life trajectory among black women who may differ on chronic stress and SEP. Citation Format: Claudia M. Davis, Hector F. Myers, Camille I. Davis, Amarachi C. Ihemedu, Nalo Hamilton. The impact of socioeconomic position and chronic stress burden on the quality of life among Black breast cancer survivors in California [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-085.