Rehabilitation Evaluation System Research Articles

The development of telerehabilitation in China: a systematic survey

Background: In China, 70 million people suffer from chronic diseases and call for timely rehabilitation service [1]. This number is estimated to grow over 50% of the whole population by the year 2030 [2]. However, current medical resources cannot meet such huge demand. Furthermore, the distribution of these resources in China is not equal. Most of the rehabilitation professionals are centered in large tier 3 hospitals of the big cities. One of the studies shows that about 56% of local community hospitals do not have department of rehabilitation, and most community rehabilitation professionals are primary physicians, only one-fourth of them receive formal rehabilitation education and training [3]. Telerehabilitation, which provides timely rehabilitation services and education, was hence expected to meet this challenge. Aim: Through this systematic review, we aimed to understand the status of development of telerehabilitation in China, to discuss whether telerehabilitation is conducive to meet the challenges of Chinese rehabilitation service. Methods: A systematic review was conducted on the development status of Chinese telerehabilitation. The major representative databases were searched: PubMed, CNKI, Wanfang, and CQVIP. Additionally, we searched for published research protocols, conference proceedings and governmental reports on telerehabilitation since 2009. Findings and discussions: We have identified several large-scale telemedicine systems in China [4]. These systems have established a telecommunication platform for diagnose and supervision between tier 3 hospitals and other smaller hospitals. Patients and doctors hence can seek advice online from experienced rehabilitation specialist distantly. In addition, a growing number of telerehabilitation technologies are emerged in China, such as computer aided rehabilitation evaluation system based on the neural function assessment scale, cognitive rehabilitation training system based on virtual reality technology, exoskeleton remote rehabilitation system based on browser/server structure and rehabilitation robotics [5-12]. This indicates that telerehabilitation technology is receiving a growing attention in China. However, it is suggested that there should be more large scale random control trial in relation to the implementation of the technology. Evaluation on its economic effect should also be performed.

Ovarian function suppression, symptom burden, and quality of life in young women with breast cancer: A prospective study.

515 Background: Recent clinical trial data have demonstrated that ovarian function suppression (OS) in addition to tamoxifen (T) or aromatase inhibitors (AI) can improve breast cancer free survival in young women with hormone positive (HR+) breast cancer. We evaluated the impact of OS on quality of life (QOL) in young women, a population at risk for worse QOL outcomes and survival. Methods: Patient reported symptom and QOL data were collected 1 year after dx as part a cohort study enrolling women newly dx’d with breast cancer age ≤40. Severity of symptoms (Breast Cancer Prevention Trial checklist) was compared between women on OS+T vs. T alone by Fisher’s exact test. For QOL (Cancer Rehabilitation Evaluation System (CARES) physical, psychosocial, sexual subscales), differences in mean scores between groups were compared with t-tests. All were stratified by receipt of chemotherapy. Due to small numbers, women on AIs were excluded. Results: Of444 women with Stage 0-III, HR+ disease on T, 106 (24%) reported ...

Partner support and anxiety in young women with breast cancer.

Using a large prospective cohort of women age 40 or younger diagnosed with breast cancer, we examined the relationship between perceived partner support and anxiety. Six hundred seventy-five young women with breast cancer Stages I-III, median age 36, completed a self-report baseline questionnaire. Perceived partner support was assessed using items extracted from the marital subscale of the Cancer Rehabilitation Evaluation System; generalized social support was assessed with the Medical Outcomes Study-Social Support Survey. Anxiety was measured using the anxiety subscale of the Hospital Anxiety and Depression Scale. Multivariable logistic regression analyses evaluated the association between partner support, other sociodemographic factors, and anxiety. Mean age at diagnosis was 35.4 years. Fourteen percent of the women were not partnered, and among those who were partnered or in a significant relationship, 20% were categorized as unsupported. In univariate and multivariable analysis adjusting for sociodemographic factors, women in an unsupported-partnered relationship had higher odds of anxiety symptoms compared with women in a supported-partnered relationship. Young age and being financially insecure were also both independently associated with anxiety. Our findings suggest that partner support may play a key role in a young woman's adjustment to a serious stressor such as breast cancer. In addition, younger age increases vulnerability to anxiety as does struggling with finances. Because supportive efforts of a partner have potential to protect against the impact of stress, interventions to enhance partner support and reduce anxiety might be beneficial to address challenges experienced as a couple in this setting.

Research on Pronunciation Assessment Detection Method Based on 3D Modeling and Sensor Technology

It is necessary for hearing-impaired children after hearing compensation for language rehabilitation, Rehabilitation evaluation system can timely understanding of the effect of rehabilitation, rehabilitation program reasonable.This paper presents multiple feedback method and system for hearing-impaired children pronunciation evaluation based on 3D technology, information technology, the use of modern means of measuring real-time speech. The evaluation system collect the tongue palate, lip face and voice pronunciation information of hearing-impaired children through sensor and voice input devices.The reference value to compare the data with the standard output,The system can overcome the shortcomings of traditional method is subjective.To assess abnormal and the degree of abnormal of hearing-impaired children s function. Provide the basis for the development of language rehabilitation training plan, establish a scientific evaluation method and evaluation system.

Treatment-related amenorrhea and sexual functioning in young breast cancer survivors.

Sexual dysfunction is a known complication of adjuvant therapy for breast cancer and an important determinant of quality of life. However, few studies have explored how treatment and other factors affect sexual functioning in young breast cancer survivors. Four hundred sixty-one premenopausal women with stage 0 through III breast cancer were surveyed an average of 1 year after diagnosis as part of a prospective cohort study of women who were aged ≤40 years at diagnosis. Sexual interest and dysfunction were assessed using the Cancer Rehabilitation Evaluation System (CARES). Mean CARES scores were compared and multiple regression models were fit to assess treatment and a range of menopausal and somatic symptoms in relation to sexual functioning. Mean CARES sexual interest and dysfunction scores were both highest (indicating poorer functioning) among women who received chemotherapy and were amenorrheic from treatment. After accounting for menopausal and somatic symptoms, treatment-associated amenorrhea remained associated with decreased interest but was no longer an independent predictor of dysfunction. In the multivariable analysis, independent predictors of dysfunction included vaginal pain symptoms, poorer body image, and fatigue. Sexual interest was associated with vaginal pain symptoms, body image, and weight problems. Factors associated with decreased sexual functioning in young breast cancer survivors can often be ameliorated. The current findings have implications for premenopausal women with other types of cancer who might be experiencing amenorrhea because of chemotherapy or surgery. Increased awareness and early intervention is essential to help improve sexual functioning and associated quality of life for all young cancer survivors.

Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial

Patients with advanced cancer have reduced quality of life, which tends to worsen towards the end of life. We assessed the effect of early palliative care in patients with advanced cancer on several aspects of quality of life. The study took place at the Princess Margaret Cancer Centre (Toronto, ON, Canada), between Dec 1, 2006, and Feb 28, 2011. 24 medical oncology clinics were cluster randomised (in a 1:1 ratio, using a computer-generated sequence, stratified by clinic size and tumour site [four lung, eight gastrointestinal, four genitourinary, six breast, two gynaecological]), to consultation and follow-up (at least monthly) by a palliative care team or to standard cancer care. Complete masking of interventions was not possible; however, patients provided written informed consent to participate in their own study group, without being informed of the existence of another group. Eligible patients had advanced cancer, European Cooperative Oncology Group performance status of 0-2, and a clinical prognosis of 6-24 months. Quality of life (Functional Assessment of Chronic Illness Therapy--Spiritual Well-Being [FACIT-Sp] scale and Quality of Life at the End of Life [QUAL-E] scale), symptom severity (Edmonton Symptom Assessment System [ESAS]), satisfaction with care (FAMCARE-P16), and problems with medical interactions (Cancer Rehabilitation Evaluation System Medical Interaction Subscale [CARES-MIS]) were measured at baseline and monthly for 4 months. The primary outcome was change score for FACIT-Sp at 3 months. Secondary endpoints included change score for FACIT-Sp at 4 months and change scores for other scales at 3 and 4 months. This trial is registered with ClinicalTrials.gov, number NCT01248624. 461 patients completed baseline measures (228 intervention, 233 control); 393 completed at least one follow-up assessment. At 3-months, there was a non-significant difference in change score for FACIT-Sp between intervention and control groups (3·56 points [95% CI -0·27 to 7·40], p=0·07), a significant difference in QUAL-E (2·25 [0·01 to 4·49], p=0·05) and FAMCARE-P16 (3·79 [1·74 to 5·85], p=0·0003), and no difference in ESAS (-1·70 [-5·26 to 1·87], p=0·33) or CARES-MIS (-0·66 [-2·25 to 0·94], p=0·40). At 4 months, there were significant differences in change scores for all outcomes except CARES-MIS. All differences favoured the intervention group. Although the difference in quality of life was non-significant at the primary endpoint, this trial shows promising findings that support early palliative care for patients with advanced cancer. Canadian Cancer Society, Ontario Ministry of Health and Long Term Care.

Cancer rehabilitation evaluation system questionnaire: a disease-specific and treatment-specific measure of rehabilitation needs and self-reported quality of life

Cancer rehabilitation evaluation system questionnaire: a disease-specific and treatment-specific measure of rehabilitation needs and self-reported quality of life

The ability of informal primary caregivers to accurately report cancer patients' difficulties

In cancer care, informal primary caregivers provide healthcare professionals with key information regarding patient difficulties. The aim of this study was to assess their ability to report cancer patients' physical, psychological, and social difficulties. We recruited 208 consecutive patients and their informal primary caregivers in 10 oncology units. Patients reported their difficulties on the CAncer Rehabilitation Evaluation System (CARES-P), whereas caregivers reported their perception of patient difficulties on an adapted CARES questionnaire (CARES-C). On the basis of CARES-P and CARES-C questionnaire answers, correct report rates were defined by the percentage of difficulties reported at least 'a little' by patients and by caregivers. False report rates were defined by the percentage of difficulties not reported at least 'a little' by patients and reported by caregivers. Patients and their caregivers also provided their distress levels (Hospital Anxiety and Depression Scale) and coping strategies. Caregivers correctly reported 67% of physical, 69% of psychological, and 40% of social difficulties experienced in patients. Caregivers falsely reported 28% of physical, 37% of psychological, and 22% of social difficulties not experienced by patients. Significant correlations were found between all correct and false reported rates. Patient and caregiver characteristics were weakly associated with caregivers' correct and false reports. Family primary caregivers correctly reported approximately two thirds of physical and psychological patients' difficulties; however, they had less accurate reports of patients' social difficulties. Correct report rates increased the probability of false report rates. Healthcare professionals should carefully evaluate the accuracy of a primary informal caregiver's report in regards to patient experiences.

Illness Uncertainty and Quality of Life of Patients with Small Renal Tumors Undergoing Watchful Waiting: A 2-year Prospective Study

BackgroundFew studies have examined factors associated with the quality of life (QOL) of patients with renal tumors. Illness uncertainty may influence QOL. ObjectiveTo prospectively examine the influence of uncertainty on general and cancer-specific QOL and distress in patients undergoing watchful waiting (WW) for a renal mass. Design, setting, and participantsIn 2006–2010, 264 patients were enrolled in a prospective WW registry. The decision for WW was based on patient, tumor, and renal function characteristics at the discretion of the urologist and medical oncologist in the context of the physician–patient interaction. Participants had suspected clinical stage T1–T2 disease, were aged ≥18 yr, and spoke and read English. The first 100 patients enrolled in the registry participated in this study. Outcome measurements and statistical analysisPatients completed questionnaires on demographics, illness uncertainty (Mishel Uncertainty in Illness Scale), general QOL (Medical Outcomes Study 36-item short-form survey), cancer-specific QOL (Cancer Rehabilitation Evaluation System–Short Form), and distress (Impact of Events Scale) at enrollment and at 6, 12, and 24 mo. Age, gender, ethnicity, tumor size, estimated glomerular filtration rate, comorbidities, and assessment time point were controlled for in the models. Results and limitationsAmong the sample, 27 patients had biopsies, and 17 patients had proven renal cell carcinoma. Growth rate was an average of 0.17cm/yr (standard deviation: 0.35). Mean age was 72.5 yr, 55% of the patients were male, and 84% of the patients were Caucasian. Greater illness uncertainty was associated with poorer general QOL scores in the physical domain (p=0.008); worse cancer-related QOL in physical (p=0.001), psychosocial (p<0.001), and medical (p=0.034) domains; and higher distress (p<0.001). ConclusionsThis study is among the first to prospectively examine the QOL of patients with renal tumors undergoing WW and the psychosocial factors that influence QOL. Illness uncertainty predicted general QOL, cancer-specific QOL, and distress. These factors could be targeted in psychosocial interventions to improve the QOL of patients on WW.

Difficulties with Measuring the Patient's Perspective in Non Hodgkin's Lymphoma - a Review of Patient Reported Outcome Measures

AbstractAbstract 4703 Aims:Patients with NHL present with a classic array of symptoms reflecting the origin of the cancer itself. Symptoms include painless swelling of lymph nodes, increased sensitivity to alcohol, weight loss which can be substantial, persistent fever, soaking night sweats, itchy skin, coughing, difficulty breathing, chest or upper back pain and persistent weakness and tiredness. The severity of symptoms alters the patient's perception of quality of life, their capacity to perform usual activities, and results in seeking medical attention. Due to profound symptoms, it is critical to use excellent measurement tools to record change and demonstrate clinical benefit in trials. The objective of the study was to describe and assess the PRO instruments used in lymphoma, summarize PROs used in ongoing clinical trials, identify gaps in existing PRO measures and evaluate the potential for labeling when using these measures for patient self-report in advanced NHL, particularly as it relates to selecting and implementing PROs. Methods:An in depth literature review was conducted. Elsevier and Medline databases were consulted using Embase platform. Studies were included if they were: published from 01/01–12/11, in English, and included terms related to lymphoma disease and PROs. A thorough review of abstracts was performed. Studies where PRO instruments were used and/or psychometric validation was performed were included. References for selected articles were used to identify other relevant sources. Clinical trials.gov was also used to search for lymphoma trials from 2001–2011. Results:Of 1278 hits, 17 articles met the search criteria. 7 PRO instruments were reported or used in NHL: 2 lymphoma specific questionnaires FACT-Lym (Functional Assessment of Cancer Therapy-Lymphoma module), FACT FLymSI-18 (FACT-Lymphoma Symptom Index), 5 cancer-specific instruments (EORTC-QLQ-C30, FACT-G, CARES (Cancer Rehabilitation Evaluation System), CARES-SF, QOL-CS (Quality of Life-Cancer Survivors), IOC (Impact Of Cancer scale). The 2 most widely used PROs were FACT-Lym and the EORTC QLQ C30. PRO instruments have been included in ongoing phase 2 and 3 clinical trials (Table 1) as secondary endpoints, including 2 in Diffuse Large B-cell lymphoma (DLBCL), 4 in Follicular lymphoma (FL), and 1 each in indolent NHL or mantle cell lymphoma (MCL). EORTC QLQ C30 was the most common instrument followed by FACT-Lym. No specific labeling claims were found in labels made to date for NHL related compounds to FDA or EMA.Table 1Summary of PRO instruments used in ongoing clinical trialsPRO instrumentsComparatorPopulation/PhaseEORTC QLQ C30Bendamustine Hydrochloride + Rituximab (R)/R, Cyclophosphamide, Vincristine, and Prednisone (R-CVP) or R-Cyclophosphamide Hydroxydaunorubicin Oncovin Prednisone (R-CHOP)Advanced indolent NHL or MCL/P3FACT- Lym EORTC QLQ C30 EQ-5DGA101 (RO5072759) + CHOP/R-CHOPPreviously untreated CD20-positive DLBCL/P3EORTC QLQ C30 EQ-5DLenalidomide (Revlimid®)/Gemcitabine, Oxaliplatin, R, or EtoposideRelapsed or refractory DLBCL/P2-3FACT-Lym FACT-fatigue FACTGOG -NTXBendamustine-R (BR) followed by R/Bortezomib-BR (BVR) followed by R/BR followed by Lenalidomide+RHigh risk FL/P2EORTC QLQ C30R + Fludarabine + Mitoxantrone/NARelapsed or primary failing advanced FL/P2FACT-Lym EQ-5DR + Galiximab/R + PlaceboRelapsed or refractory FL/P3EORTC QLQ C30R, lenalidomide/Any chemotherapyPreviously Untreated FL/P3FACT-G2 Salvage Chemotherapy Regimens (Gemcitabine, Dexamethasone, and Cisplatin versus Dexamethasone, Cytarabine, And Cisplatin) before autologous SCT with or without maintenance RRelapsed or Refractory Aggressive NHL/P3 Conclusions:While there are some lymphoma specific measures, most ongoing trials are using only cancer specific instruments such as EORTC QLQ C30. Several instruments contain only general cancer related symptoms, but not NHL specific symptoms. To more completely understand the burden of disease and treatment effects with NHL through the eyes of patients, evaluation of existing instruments as well as potential instrument development/modification may be warranted. NHL symptom-specific measures could demonstrate therapeutic effectiveness, enhance our understanding of the impact of NHL and provide more evidence of clinical benefit for developing treatments. Disclosures:Mehta:Sanofi: Employment. Joulain:Sanofi: Employment, Equity Ownership. Trask:Sanofi: Employment.

Body image in recently diagnosed young women with early breast cancer

To assess body image concerns among young women following a breast cancer diagnosis. A total of 419 women with recently diagnosed stage 0-III breast cancer were surveyed following enrollment as part of a prospective cohort study of women age 40 or younger at diagnosis. Body image was assessed using three items from the psycho-social scale of the Cancer Rehabilitation Evaluation System (CARES). CARES scores range from 0 to 4, with higher scores indicative of greater image concerns. Mean CARES scores were calculated and compared between treatment groups using t-tests and analysis of variance. Multiple linear regression models were fit to evaluate the relationship between physical and psychological factors and body image. Mean time from diagnosis to completion of the baseline survey was 5.2 months. The mean CARES score for all women was 1.28. Mean CARES scores in the mastectomy-only group (1.87) and in the mastectomy with reconstruction group (1.52) were significantly higher (p < 0.0001) compared with the scores in the lumpectomy group (0.85), indicating that radical surgery was associated with more body image concerns. Radiation (p = 0.01), anxiety (p = 0.0001), depression (p < 0.0001), fatigue (p = 0.04), musculoskeletal pain symptoms (p < 0.0001), weight gain (p = 0.01), and weight loss (p = 0.02), in addition to surgery type (p < 0.0001), were all associated with more body image concerns in the multi-variable analysis. This analysis highlights the impact of treatment, along with physical and psychological factors, on body image early in the survivorship period. Our findings provide targets for potential future intervention and may aid young women in the surgical decision-making process.

Sexual functioning in young women with breast cancer.

9100 Background: Sexual dysfunction is a known complication of adjuvant therapy for breast cancer and an important determinant of quality of life. Little is known about the frequency and magnitude of this problem among very young women with breast cancer during the year following diagnosis. Methods: 298 sexually-active women enrolled in an ongoing multi-center cohort study with Stage 0-III breast cancer at or before age 40 were included in this analysis. Treatment data was self-reported on a survey mailed to participants at enrollment. Sexual functioning was assessed using the sexual interest and dysfunction subscales from the Cancer Rehabilitation Evaluation System (CARES). Scores range from 0-4, with higher scores indicative of poorer function. The survey included a measure of anxiety and depression (Hospital Anxiety and Depression Scale), of body image (CARES) and of physical and menopausal symptoms (Breast Cancer Prevention Trial Symptom Checklist). Mean differences in CARES scores between treatment groups (chemotherapy vs. none; hormone therapy vs. none; lumpectomy vs. mastectomy vs. mastectomy + reconstruction vs. no surgery; radiation vs. none) were compared using T-tests and ANOVA. Multiple regression models were fit to assess symptoms thought to be mediators of the treatment-sexual functioning association. Results: Mean age at diagnosis was 36 (range: 22-40) years and mean time from diagnosis to survey completion was 5 months (range: 1-16). Mean CARES sexual interest and dysfunction scores were higher in women who received chemotherapy compared to those who did not (p&lt;0.0001). In the multivariate analysis, chemotherapy was no longer associated with decreased sexual interest or function. Anxiety, depression, musculoskeletal pain, and poorer body image were predictive of both decreased sexual interest and function. Vaginal pain symptoms were associated with greater dysfunction, while unhappiness with appearance was associated with decreased interest. Conclusions: Young women who receive chemotherapy are at risk for problems related to sexual functioning early in the survivorship period. This effect appears to be mediated through several physiologic and psychologic mechanisms, underscoring the need for interventions that target both.

Multidisciplinary rehabilitation in women following breast cancer treatment: A randomized controlled trial

To assess the effectiveness of a multidisciplinary ambulatory rehabilitation programme for women following definitive breast cancer treatment in an Australian community cohort. Eighty-five women in the community randomized to a treatment group (n = 43) for individualized high-intensity programme, or a control group (n = 42) comprising usual activity. The primary outcome Depression Anxiety Stress Scale (DASS) scale measured restriction in participation. Secondary measures included Perceived Impact Problem Profile (PIPP) and Cancer Rehabilitation Evaluation System Short-Form (CARES-SF); and Functional Independence Measure (FIM) motor subscale for activity limitation. Assessments were at baseline and 4 months. Intention-to-treat analysis of data showed a significant difference between both groups in DASS Depression scores (p = 0.006) (moderate effect size, r > 0.3), PIPP Mobility (p = 0.05) and Participation (p = 0.04) scales, and CARES-SF Global score (p = 0.02) (small effect size, r < 0.3). The treatment group, compared with control group, showed significant improvement in the DASS Depression scores: 22/42 (52.4%) vs 12/37 (32.4%) (p = 0.02). No difference between groups was noted in the FIM scale. Rehabilitation can benefit participation in breast cancer survivors. Evidence for specific rehabilitation interventions is needed. Integrated cancer programmes allow opportunities to evaluate patients in various settings, but require outcome research to develop service models for survivorship issues.

PD04-05: Body Image Issues in Young Breast Cancer Patients: The Impact of Chemotherapy, Hormone Treatment, and Surgery.

Abstract Background: While there is evidence that younger women with breast cancer are more likely to experience compromised quality of life compared to older women, few studies have prospectively explored the impact of treatment, including surgery, chemotherapy, and hormone therapy, on body image, in particular, in very young women (≤40 years old). This analysis examined treatment-associated differences in self-reported body image among a large cohort of young women diagnosed with breast cancer. Methods: 431 women enrolled in an ongoing multi-center prospective cohort study with Stage 0-Stage III breast cancer were included in this analysis. Body image was measured at baseline (1-12 months following diagnosis) using three items from the Cancer Rehabilitation Evaluation System (CARES) survey. CARES scores range from 0–4, with higher scores indicative of greater image concerns. Mean differences in CARES scores between treatment groups (chemotherapy within the last month vs. none; hormone therapy vs. none; lumpectomy vs. mastectomy alone vs. mastectomy + reconstruction) were estimated using T-tests and one-way ANOVA. To control for concurrent treatment, stage, and time since diagnosis, multiple linear regression models were fit and least squares means estimated and compared between treatment groups. Multiple comparisons were adjusted for using the Bonferroni correction. Results: Median age at diagnosis was 37 (range: 17–40) and median time from diagnosis to study enrollment was 5 months (range: 1–12 months). In the unadjusted analysis, there were no significant differences in scores between women who had received chemotherapy within the last month and those who did not (p=0.80), while women who reported hormone treatment had higher mean CARES scores compared to women who did not (p=0.04). Among women who had undergone surgery (n=370), women who had lumpectomies had a mean CARES score of 0.95, which was significantly lower (p&amp;lt;.0001) compared to both women who had undergone mastectomy alone (CARES: 1.89) and women who reported mastectomy + reconstruction (CARES: 1.53). After adjusting for concurrent treatment (including radiation), time since diagnosis, and stage of disease, only differences between surgical groups remained significant (p&amp;lt;.0001), with mean scores among women who had either undergone mastectomy alone (CARES: 2.02) or together with reconstruction (CARES: 1.58) higher compared to those who had a breast conserving procedure (CARES: 0.92) Conclusion: To the best of our knowledge, this is the largest analysis of treatment-related body image issues in young women with breast cancer. Treatment with chemotherapy and hormonal therapy did not appear to affect short-term body image. However, women who had a breast conserving procedure had the fewest body image concerns as measured by the CARES, while women undergoing more radical surgery appear to be at increased risk for low perceived body image though this may be mitigated to a degree by reconstruction. Further analyses will explore whether differences between surgical groups persist over time as well as examine the trajectory of change over the course of follow-up. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD04-05.

Hospital Costs, Length of Stay and Readmission Rates for C. difficile Colitis: Comparing Outcomes Between CDC as the Primary and Secondary Admission Diagnosis

Function Inventory (BSFI) for men, and sexual function module of the Cancer Rehabilitation Evaluation System (CARES) for women were mailed to 219 patients who underwent APR between 1994 and 2004. Male sexual function was compared to previously published normative data (OLeary MP, Urology 1995). 143 patients responded (response rate 65%; 71% male) of whom 53 (37%) received preoperative, 35 (25%) postoperative XRT, and 55 (38%) were treated with surgery alone. Data: median [range] or mean (SD). Results Patients treated without XRT were older compared to both other groups (66 [38-93] years vs. preoperative XRT 57 [25-92] and postoperative XRT 60 [37-88]; p<0.05) while patients who underwent postoperative XRT had the longest follow-up (91 [6-137] months vs. preoperative XRT 47 [1-104] and no XRT 56 [1-134]; p<0.05). Gender distribution was comparable between groups (NS) while XRT patients had higher tumor stages (p<0.05). Urinary function was impaired after preoperative XRT compared to patients treated with surgery alone (p<0.05), while postoperative XRT had no effect. Patients reporting that their “QOL was worse after APR” showed higher AUASI symptom scores (13.2 (8.6) vs. better 7.2 (5.7) and similar 8.8 (6.4); p=0.02) and AUASI satisfaction scale scores (2.8 (1.2) vs. better 1.8 (1.5) and similar 2.2 (1.2); p=0.01), demonstrating correlation of deteriorated urinary function with perception of impaired QOL after APR. Preand postoperative XRT increased sexual dysfunction in female patients (p<0.05), while sexual function inmale patients was unaffected by preand postoperative XRT (NS). However, male APR patients had impaired sexual function on all domains of the BSFI compared to previously published, age-stratified controls (all p<0.05). 33% of patients were sexually inactive at follow-up with higher age, preoperative vs. no XRT, and not living in a relationship being associated with sexual inactivity in multivariable analysis (p<0.05). In sexually inactive patients, younger age, female gender, and preoperative vs. no XRT were associated with the feeling that surgery for rectal cancer caused sexual inactivity (p<0.05). Postoperative vs. no XRT had no such effect (NS). Conclusions Although urinary and sexual function might be impaired after APR, effects of XRT appear to be limited. Indication and timing of XRT should be based on oncological aspects rather than on QOL and functional outcome considerations.

Virtual Reality Simulation of 5dof Upper-Limb Rehabilitation Robot Based on Fuzzy Neural Network

In this paper, aiming at the structure of upper-limb rehabilitation robot, establish the model of algorithmic control based on fuzzy neural network and virtual reality simulation model for 5dof upper-limb rehabilitant robot, and take the elbow joint for example to do simulation analysis. The result of simulation shows the fuzzy neural network control is practicable and its control accuracy takes the precedence over the traditional methods. The virtual-reality simulation of 5dof upper-limb rehabilitation robot, which is benefit to understand the complex relationships among the objects, can emulate the features of real rehabilitation robot, laying a solid foundation for rehabilitation evaluation system and telemedicine.

Assessing Health-Related Quality of Life in Gynecologic Oncology

Researchers wishing to assess the health-related quality of life (HRQoL) of women with gynecologic cancers have a range of questionnaires to choose from. In general, disease-, treatment-, or symptom-specific questionnaires are assumed to be better able to identify between-group differences (sensitivity) and changes over time (responsiveness) than are cancer-specific or generic questionnaires. However, little work has tested this assumption in oncology. We set out to (a) identify all multidimensional HRQoL questionnaires used in studies with women with gynecologic cancer and (b) evaluate their track records in identifying minimal clinically important differences (MCIDs), with a view to making recommendations. We searched MEDLINE using the term quality of life and each gynecologic cancer type, as well as the names of identified questionnaires. We used 10% of the scale range as the threshold for an MCID. We identified 1 generic (SF-36/SF-12), 3 cancer-specific (European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ] C30, Functional Assessment of Cancer Therapy-General [FACT-G], and short-form Cancer Rehabilitation Evaluation System [CARES-SF]), and 1 disease-specific (QOL-Ovarian Cancer Patient Version) HRQoL questionnaires and 5 disease-specific (QLQ-OV28, FACT-O for ovarian, QLQ-CX24, FACT-Cx for cervical and FACT-V for vulvar), 1 treatment-specific (FACT and Gynecologic Oncology Group-Ntx for neurotoxicity), and 2 symptom-specific (FACT-Anemia and Functional Assessment of Chronic Illness and Therapy [FACIT]-Fatigue) modules. Twenty-seven articles reported results from 26 studies in which an MCID had been identified. The FACIT's anemia and fatigue subscales were more sensitive, and the neurotoxicity subscale more sensitive and responsive than the FACT-G on at least 1 comparison. However, we found no evidence for superior performance by the FACT-G compared with the SF-36 or EORTC and FACIT disease-specific modules versus the QLQ-C30 and FACT-G. There was also little evidence to favor EORTC versus FACIT questionnaires or vice versa. The evidence we reviewed offered little support for the hypothesis that disease-, symptom-, or treatment-specific instruments are more sensitive and responsive than cancer-specific or generic questionnaires. However, conclusions were limited by the small number of head-to-head comparisons available. We summarize the clinical contexts in which each instrument identified an MCID to inform choice of questionnaire(s), sample size calculations, and interpretation of results in future studies.

Quality of Life and Symptoms of Anxiety and Depression of Patients Receiving Cancer Chemotherapy

The overall survival gain of cancer chemotherapy is estimated to be small, and some claim that it rarely improves quality of life (QOL). The purpose of this population-based study was to describe QOL and symptoms of anxiety and depression, over time, in a group of Icelandic cancer patients receiving chemotherapy. Quality of life was measured with the Icelandic version of Cancer Rehabilitation Evaluation System, Short Form (CARES-SF), and symptoms of anxiety and depression, with the Icelandic version of Hospital Anxiety and Depression Scale (HADS). Enrolled into the study were 144 patients, 90 women and 54 men; mean (SD) age was 55 (12.1) years. Although QOL was found relatively good during the period of chemotherapy, it was significantly worse after 3 and 6 months compared to baseline. Quality of life was found worst in the sexual and physical domains. At all time points, a significant association was found between symptoms of anxiety and depression and QOL with those reporting symptoms of either anxiety or depression experiencing worse QOL. The good QOL found during the period of chemotherapy is a positive finding. The results, however, call for an intense assessment, over time, of physical symptoms, anxiety, and depression, as well as sexuality issues.

Cancer patients' desire for psychological support: prevalence and implications for screening patients' psychological needs

To investigate cancer patients' desire for psychological support and to identify patients' sociodemographic, disease-related and psychological factors associated with this desire. The study is part of a multicenter, cross-sectional study assessing cancer patients' needs and desire for psychological support. Patients completed the Hospital Anxiety and Depression Scale, the Ways of Coping Checklist, the Cancer Rehabilitation Evaluation System and reported their desire for psychological support. Among the 381 included patients, women (26%) desired psychological support significantly more often than men (11%) (p<0.001). Patients' desire for psychological support was associated with being younger (OR=0.94; p<0.001 for women and OR=0.93; p=0.007 for men) and having a support-seeking coping (OR=1.10; p=0.010 for women and OR=1.36; p=0.003 for men). Other contextual factors such as difficulties encountered and treatment modalities were diversely associated with women and men's desire for psychological support. Neither women's, nor men's psychological distress was associated with their desire for psychological support. One female cancer patient out of four and one male cancer patient out of ten desire psychological support. Results emphasize the need to screen not only for cancer patients' distress but also for their desire for psychological support. This will allow implementing psychological interventions according to patients' needs and desire.

Underestimated “toxicity”: the psychosocial impact of cancer treatment on primary caregivers

Dans le cadre d’une etude belge multicentrique, cet article rapporte l’evaluation qualitative et quantitative des besoins psychosociaux des proches aidants principaux des patients atteints d’un cancer, ainsi que les difficultes vecues par ces proches a faire face aux besoins psychosociaux des malades. De janvier a novembre 2004, l’ensemble des proches aidants principaux des patients atteints d’un cancer et hospitalises au sein de sept unites de soins en oncologie, ainsi que le proche aidant principal d’un patient sur deux consultant au sein de ces memes unites ont eteinvites a prendre part a l’etude. Les proches aidants principaux ont rempli une adaptation du questionnaire Cancer Rehabilitation Evaluation System (CARES) permettant l’investigation de 24 types de difficultes ayant pu etre rencontrees au cours du dernier mois, ainsi qu’une seconde adaptation du CARES permettant d’evaluer leur perception de 38 types de difficultes potentielles chez leur proche malade au cours du dernier mois. Les sujets ont egalement eteinvites a indiquer s’ils avaient eu des difficultes a faire face a chaque difficulte percue chez leur proche malade. Les informations medicales relatives aux patients ont eterecoltees aupres de leurs oncologues. Parmi les 284 proches aidants principaux inclus, une grande majoritea rencontre au cours du dernier mois une a plusieurs difficultes physiques, psychosociales, sexuelles de meme que des difficultes de communication avec leur partenaire. La majorite des proches aidants principaux percoit de nombreuses difficultes chez leur proche malade et 20 a 60 % d’entre eux rapportent eprouver au moins un peu de difficulte a faire face a ces difficultes. A cotede leurs nombreuses difficultes personnelles, les proches aidants principaux des patients atteints d’un cancer percoivent donc de nombreuses difficultes psychosociales chez leur proche malade. Les proches aidants principaux eprouvent egalement de nombreuses difficultes a gerer ces difficultes percues. Le nombre et l’importante variete des difficultes rapporteesdans cette etude refletent une « toxicite » sous-estimee : celle liee aux impacts et consequences psychosociaux des traitements sur les proches aidants principaux.