Risk For Poor Health-related Quality Of Life Research Articles

Advances in Treatment and Health-Related Quality of Life: A Cohort Study of Older Adult Survivors of Breast Cancer.

To determine whether there are differences in the health-related quality of life (HRQOL) of older adult survivors of breast cancer (BC) diagnosed in different time periods and to gain insight into whether advances in BC treatment have improved HRQOL. Three cohorts of older adult survivors of BC diagnosed before 1995, from 1996 to 2005, and from 2006 to 2015 were examined using the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey linked databases. HRQOL was measured using the Veterans RAND 12-Item Health Survey. Mean cohort HRQOL scores were compared using analysis of variance, then multivariate regression models were used to examine the effects of cohort membership and covariates on mental and physical HRQOL. Adjusted mean HRQOL scores trended significantly lower with each successive cohort. Higher comorbidity count and increased functional limitations were negatively associated with HRQOL, and income, education level, and better general health perceptions were positively associated with HRQOL. Regardless of time since diagnosis, older survivors of BC are at risk for poor HRQOL and should be regularly assessed. Maximizing HRQOL requires consideration of the survivor's resources, comorbidities, and functional limitations when planning care.

Language and quality of life in Swedish children with mild hearing loss

ABSTRACT This study explored the impact of mild bilateral sensorineural hearing loss (MBHL) on language development and health-related quality of life (HRQoL) and investigated the relationship between these outcomes in school-aged children. Participants comprised 16 children (9 girls, 7 boys) between 9–12 years (mean 11.2 years) with MBHL born in Sweden. Language was assessed by a Speech Pathologist and children self-reported their HRQoL. Results showed mean scores for language and HRQoL were not significantly different to normative means. Two children (12.5%) met the criterion for language disorder (LD) and another two children were considered at risk for poor HRQoL. The participants scored poorest on the language skills of formulating of sentences and following concepts and directions, and on the HRQoL domain of psychosocial wellbeing, although none significantly below normative means. A trend in the data showed a moderate positive correlation between overall language ability and HRQoL scores. Participant demographic factors of sex and hours of hearing aid use explained 15% of the variation in HRQoL outcomes; however, this was not statistically significant (p = .65). The hours of hearing aid use accounted for 27.5% of the variance in outcomes for language which was significant (p = .05). Overall, these results indicate that some children with MBHL are at risk of LD and poor HRQoL as they progress through school.

Abstract P085: Racism, Resilience, And Quality Of Life In Black Stroke Survivors: A Mixed-methods Cohort Study Protocol

Introduction: Annual age-adjusted incidence and death rates for stroke are significantly higher among Black Americans than among White Americans. Racism, which operates at structural, cultural and interpersonal levels, exerts significant stress on Black Americans and contributes to health disparities, including those related to stroke. Health-related quality of life (HRQoL) encompasses an individual’s self-perception of physical, mental, and social health. The combined effects of racism, stroke-related stress, and psychosocial stressors can result in negative outcomes, including poor HRQoL for Black stroke survivors. Resilience refers to maintaining relatively stable, healthy psychological and physical functioning in the aftermath of a stressful event like stroke. The purpose of this study will be to examine the effects of racism, resilience, and key psychosocial variables on Black stroke-survivor HRQoL. Hypothesis: We hypothesize racism and lower resilience will be associated with lower HRQoL. Methods: We will conduct a mixed-methods cohort study to examine the effects of racism and resilience on HRQoL of Black stroke survivors recruited from a stroke clinic in a large metropolitan area in the southeast US. Adult community-dwelling stroke survivors who self-identify as Black or African American and who have experienced a stroke event in the past 1 to 2 months will be eligible for study inclusion. Baseline quantitative data collection will occur at the initial clinic visit, with follow-up data collection at 5 to 6 months’ post-stroke. The exposure variables will be racism and resilience, and the outcome variable will be physical, mental, and social HRQoL. Qualitative data will be collected via focus groups. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines will be followed to report study results. Results: Power calculations for a two-tailed linear regression analysis with α ≤ .05, β .80, and an effect size of .15 (medium) resulted in a required sample size of 68. Our targeted sample size of 82 participants (41 males and 41 females) accounts for an attrition rate of 20%. The statistical approach to test the direct effects of each exposure variable on HRQoL will be multiple-level models. An interaction term for resilience will be included in the racism model. Qualitative data will be audio recorded, transcribed, and analyzed for themes regarding racism and resilience. Conclusions: Studies of the effects of racism on outcomes for Black stroke survivors are largely absent. This study will provide a first step toward identifying Black stroke survivors at risk for poor HRQoL in early stroke recovery.

Health Care Utilization, Transition Readiness, and Quality of Life: A Latent Class Analysis.

To identify possible subgroups of health care utilization (HCU) patterns among adolescents and young adults (AYAs) with a chronic medical condition (CMC), and examine how these patterns relate to transition readiness and health-related quality of life (HRQoL). Undergraduates (N = 359; Mage=19.51 years, SD = 1.31) with a self-reported CMC (e.g., asthma, allergies, irritable bowel syndrome) completed measures of demographics, HCU (e.g., presence of specialty or adult providers, recent medical visits), transition readiness, and mental HRQoL (MHC) and physical HRQoL (PHC). Latent class analysis identified four distinct patterns of HCU. The BCH procedure evaluated how these patterns related to transition readiness and HRQoL outcomes. Based on seven indicators of HCU, a four-class model was found to have optimal fit. Classes were termed High Utilization (n = 95), Adult Primary Care Physician (PCP)-Moderate Utilization (n = 107), Family PCP-Moderate Utilization (n = 81), and Low Utilization (n = 76). Age, family income, and illness controllability predicted class membership. Class membership predicted transition readiness and PHC, but not MHC. The High Utilization group reported the highest transition readiness and the lowest HRQoL, while the Low Utilization group reported the lowest transition readiness and highest HRQoL. The present study characterizes the varying degrees to which AYAs with CMCs utilize health care. Our findings suggest poorer PHC may result in higher HCU, and that greater skills and health care engagement may not be sufficient for optimizing HRQoL. Future research should examine the High Utilization subgroup and their risk for poorer HRQoL.

Psychosocial and neighborhood correlates of health-related quality of life: A multi-level study among Hispanic adults.

Improvement in health-related quality of life (HRQoL) is a public health goal of Healthy People 2020. Hispanics living in the United States are at risk for poor HRQoL, but the causes and correlates of this risk are not well understood. Thus, the present study examined individual-level psychosocial and neighborhood-level built environment correlates of physical and mental HRQoL among Hispanic adults. A community sample of Hispanic adults (N = 383) completed self-report health-related questionnaires, and census tract was used to collect data on neighborhood-level built environment variables. Multilevel modeling was used to examine individual-level psychosocial (language preference, religiosity, subjective social status, discrimination, and number of years lived in the United States) and neighborhood-level built-environment (the retail food environment, proximity to alcohol retailers, and tobacco retailer density) correlates of physical and mental HRQoL. Higher subjective social status was significantly associated with better HRQoL, and more experiences with discrimination were significantly associated with lower HRQoL. For physical HRQoL, these relationships were stronger in neighborhoods with a higher density of tobacco retail outlets. Findings from this study suggest that subjective social status and discrimination play important roles in HRQoL among Hispanics, in particular in neighborhoods with a higher density of tobacco retail outlets. This study highlights the importance of considering neighborhood context, and in particular neighborhood disadvantage, when examining the relationship between social status, discrimination and HRQoL among Hispanics. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Personality functioning in adults with refractory epilepsy and community adults: Implications for health-related quality of life

IntroductionPrior research has shown that people with epilepsy are at risk for a poorer health-related quality of life (HRQOL). However, patients differ greatly in how well they adjust to their epilepsy. To better understand these differences, the present study examined the role of personality. More specifically, we examined mean-level differences in Big Five personality traits between adults with refractory epilepsy and a community sample and related these traits to patients’ HRQOL. MethodsA total of 121 adults with refractory epilepsy (18–40 years old, 56% women) completed questionnaires on the Big Five personality traits, HRQOL, and seizure frequency and severity. Patients’ Big Five scores were compared to those of a community sample matched on sex and age using paired samples t-tests. We conducted hierarchical regression analyses to examine associations between personality and HRQOL, while controlling for the effects of sex, age, age at diagnosis, seizure frequency, and seizure severity. ResultsPatients reported higher levels of neuroticism and lower levels of openness as compared to controls. In patients, seizure severity was positively related to neuroticism and negatively related to agreeableness. Finally, patients high in neuroticism and low in conscientiousness generally reported a poorer HRQOL. ConclusionIn the present study, small personality differences were observed between adults with refractory epilepsy and a community sample. Patients’ personality was found to play an important role in adjusting to epilepsy, even after controlling for seizure frequency and severity. Personality assessment may help healthcare professionals in identifying patients at risk for poor HRQOL later in life.

Developmental differences in health-related quality of life (HRQL) in adolescent and young adult (AYA) survivors of childhood cancer.

e21524 Background: AYAs experience many distinct periods of developmental transition within this life stage. AYA survivors of childhood cancer are at risk for chronic physical and psychosocial health conditions due to treatment-related exposures. Few studies have evaluated HRQL differences that may exist among developmental subgroups of AYA cancer survivors. This study examined HRQL differences across AYA developmental subgroups (early teens 12-14 years; late teens 15-17; emerging adults 18-24; young adults 25-39) of long term childhood cancer survivors. Methods: Cancer survivors ages 12-39 years who were seen in a long term follow up clinic at time of survey completion (as part of larger HRQL study) and completed therapy ≥2 years ago were included. HRQL was assessed using PedsQL (< 18) and FACT-G (> 18) measures. Demographic and treatment data were obtained from EMR. Analyses compared HRQL measure scores among AYA age subgroups and investigated predictors of HRQL outcomes. Results: A total of 155 patients were included in analysis. Mean age at survey completion was 17.9 [range 12-33] years. PedsQL school functioning was significantly lower for 15-17 year-old compared to 12-14 year-old survivors (M = 77.60, p = 0.01). There were no differences between 18-24 and 25-39 year-old survivors on the FACT-G. PedsQL school functioning was significantly lower for survivors (< 18) compared to normative data (p = 0.004). FACT-G scores for survivors were significantly higher compared to population norms in all domains (p≤0.001) except emotional well-being. Regression CART analysis indicated survivors who were ≤15 years-old and had not relapsed and survivors who were > 15 years old and had ≥2 late effects had lower PedsQL scores. Survivors who were ≥21 years-old had lower FACT-G scores compared to < 21 years. Survivors who were < 21 years-old, > 7 years-old at diagnosis, and > 6 years from end of treatment had lower FACT-G scores. Conclusions: Adolescent survivors may be at risk for school problems years after cancer treatment. Young adult survivors may be at greater risk of poor HRQL. This study highlights potential developmental differences in HRQL predictors and outcomes in long term AYA cancer survivors.

Health-related quality of life of survivors of childhood acute lymphoblastic leukemia: a systematic review.

Acute lymphoblastic leukemia (ALL) survivors are the largest group of childhood cancer survivors; however, their risk for late effects is high. Cancer-related late effects have the potential to compromise health-related quality of life (HRQL) long into survivorship. None of the reviews so far have focused on ALL solely, but described HRQL for all childhood cancers. We aimed to identify ALL survivors at risk for poor HRQL and identify possible risk factors. Following PRISMA guidelines, we performed a systematic review, searching published literature in Pubmed, PsycInfo, Embase, and the Cochrane database including all publications up to December 16, 2016. Two independent reviewers (JV and ER) screened eligible articles and assessed article quality. We found 31 studies representing 4356 survivors and 901 proxies. Thirteen studies found worse, eight found no difference, and three better, overall HRQL scores compared with healthy controls or norms. ALL survivors typically had better overall HRQL scores than survivors of other childhood cancers. Clinical variables (e.g., treatment received) were not consistently associated with HRQL; however, experiencing worse late effects was associated with lower HRQL. Survivor and parent socio-demographic factors and psychological factors such as resilience and depression were also associated with HRQL. ALL survivors appeared to have worse or equivalent HRQL compared with controls, but better HRQL than survivors of other cancer types. However, studies reported a wide variability in HRQL and potential risk factors for poor HRQL. Measuring ALL survivors' HRQL longitudinally and comprehensively assessing potential risk factors might identify future avenues to intervene early.

Objectively measured sedentary behavior and moderate-to-vigorous physical activity on the health-related quality of life in US adults: The National Health and Nutrition Examination Survey 2003-2006.

Health-related quality of life (HRQOL) represents an individual's perception of physical, mental, and social well-being and is a strong predictor of health status. Few studies have examined associations of sedentary behavior (SB) and moderate-to-vigorous physical activity (MVPA) with HRQOL in the general population. This study aimed to determine combined associations of objectively measured SB and MVPA on the risk of poor HRQOL in the general US population, after controlling for potential confounding factors. We analyzed data from 5359 adults from the National Health and Nutrition Examination Survey 2003-2006. HRQOL was measured using a HRQOL-4 consisting of four questions focused on the self-perception of general health, physical health, mental health, and activity limitation. We dichotomized each HRQOL-4 component as good versus poor and defined poor overall HRQOL when participants had any poor HRQOL components. SB and MVPA were measured using an accelerometer. Survey logistic models were examined to estimate the odds ratio (OR) and 95% confidence interval (CI) for poor HRQOL by SB and MVPA as tertiles. When examined as a combination of SB and MVPA, a substantial decrease in the risk of poor overall HRQOL was found in individuals with low SB/high MVPA [OR 0.69 (95% CI 0.51-0.94) and moderate SB/high MVPA (OR 0.56 (95% CI 0.40-0.78)], but no significant decrease was found in individuals with high SB/high MVPA (vs. high SB/low MVPA). Our findings suggest that both increasing MVPA and reducing time spent in SB may be useful strategies to improve HRQOL.

Health-Related Quality of Life among Pediatric Hematopoietic Stem Cell Donors

To examine health-related quality of life (HRQoL) among sibling pediatric hematopoietic stem cell donors from predonation through 1 year postdonation, to compare donor-reported HRQoL scores with proxy-reports by parents/guardians and those of healthy norms, and to identify predonation factors (including donor age) potentially associated with postdonation HRQoL, to better understand the physical and psychosocial effects of pediatric hematopoietic stem cell donation. A random sample of 105 pediatric donors from US centers and a parent/guardian were interviewed by telephone predonation and 4 weeks and 1 year postdonation. The interview included sociodemographic, psychosocial, and HRQoL items. A sample of healthy controls matched to donors by age, gender, and race/ethnicity was generated. Key findings included (1) approximately 20% of donors at each time point had very poor HRQoL; (2) child self-reported HRQoL was significantly lower than parent proxy-reported HRQoL at all 3 time points and significantly lower than that of norms at predonation and 4 weeks postdonation; and (3) younger children were at particular risk of poor HRQoL. Additional research to identify the specific sources of poorer HRQoL among at-risk donors (eg, the donation experience vs having a chronically ill sibling) and the reasons that parents may be overestimating HRQoL in their donor children is critical and should lead to interventions and policy changes that ensure positive experiences for these minor donors.

Factors that impact health-related quality of life over time for individuals with head and neck cancer.

To identify sociodemographic, behavioral, and clinical factors associated with health-related quality of life (HRQOL) for head and neck cancer (HNC) patients over time. A population-based longitudinal cohort study. Newly diagnosed HNC patients (N = 587) were administered the Functional Assessment of Cancer Therapy-Head and Neck questionnaire at baseline (median 3 months postdiagnosis) and two follow-up assessments (median 22 and 42 months). Linear mixed-effect models were used with backward variable selection to identify factors associated with HRQOL over time (P < .05). Adjusted means reported at 2 years postdiagnosis. African Americans reported better Functional Well-Being than whites (mean of 20.01 vs. 18.53) and fewer HNC symptoms over time. Older patients (75+ years) reported better HRQOL than younger patients (< 50 years). Current tobacco use compared to no tobacco use had worse Physical (20.20 vs. 21.50), Emotional (17.55 vs. 19.06), Social (21.28 vs. 22.88), and Functional (17.32 vs. 19.29) Well-Being and more HNC symptoms (21.50 vs. 23.71). Radiation therapy was associated with worse Physical and Functional Well-Being and more head and neck symptoms over time, but HRQOL was similar to those who were not irradiated by 2 to 4 years postdiagnosis. This study identified key factors for individuals at risk for poorer HRQOL that may help clinicians and caregivers find solutions to address these decrements. Smoking cessation programs can be encouraged for survivors who use tobacco. Psychological and social support and medications may help for dealing with emotional distress and dealing with the physical symptoms from treatment. 4. Laryngoscope, 126:2718-2725, 2016.

Major motor-functional determinants associated with poor self-reported health-related quality of life in myasthenia gravis patients.

Myasthenia gravis (MG) is an autoimmune neuromuscular disorder in which disabling muscle weakness may affect health-related quality of life (HRQoL). The aim of this study was to investigate which common motor-functional deficits and corresponding severity are most determinant of poor HRQoL in these patients. In 41 patients, the dichotomized first item of the Italian Myasthenia Gravis Questionnaire (IMGQ), categorizing patients who report "good" and "poor" HRQoL, was chosen as dependent-outcome variable. All items composing the myasthenia gravis-specific scale (MG-ADL), i.e. talking, chewing, swallowing, breathing, impairment of ability to brush teeth or comb hair, impairment of ability to rise from chair, double vision, and eyelid droop were acquired as independent variables and dichotomized. Stepwise backward LR multivariable logistic regression analysis was performed. In addition, the main characteristics of patients were compared. MG-ADL items "chewing" ≥1, i.e. "fatigue chewing solid food", and "breathing" ≥2, i.e. "shortness of breath at rest" proved to be significant determinants. Higher dose of corticosteroid therapy was significantly (p=0.027; r s =-0.35), correlated with poor HRQoL. At diagnosis, a decremental response to repetitive nerve stimulation (RNS) from the abductor pollicis brevis was significantly more frequent in patients with poor HRQoL. In conclusion, impaired "chewing" and "breathing" functions indicate the need for careful planning of rehabilitation, re-education and patient management. Moreover, decremental response to RNS at diagnosis may identify patients at risk for poor HRQoL.

A longitudinal examination of health-related quality of life in children and adolescents with spina bifida.

The current study examined (1) spina bifida (SB) youths' health-related quality of life (HRQOL) compared with nonclinical and chronic health condition (CHC) samples, (2) parent-child agreement regarding HRQOL, and (3) prospective changes in HRQOL. Child and parent-proxy reports of Pediatric Quality of Life were collected at two time waves (Time 1: N = 134, ages 8-15 years; Time 2: N = 109, ages 10-17 years) as part of a larger longitudinal study. SB youth had statistically and clinically reduced physical HRQOL compared with the nonclinical and CHC samples at both time points. There were significant discrepancies between youth and parent-proxy reports of HRQOL; youth reported higher levels of physical and social HRQOL than parents. The majority of parent- and child-reported HRQOL domains remained stable, yet youth-reported social HRQOL increased over time. Youth with SB are at risk for poor HRQOL. Examining modifiable condition and social-environmental predictors of youth HRQOL will be important in informing future interventions.

Long-term quality of life after liver donation in the adult to adult living donor liver transplantation cohort study (A2ALL)

There are few long-term studies of the health-related quality of life (HRQOL) in living liver donors. This study aimed to characterize donor HRQOL in the Adult to Adult Living Donor Liver Transplantation Study (A2ALL) up to 11 years post-donation. Between 2004 and 2013, HRQOL was assessed at evaluation, at 3 months, and yearly post-donation in prevalent liver donors using the short-form survey (SF-36), which provides a physical (PCS) and a mental component summary (MCS). Of the 458 donors enrolled in A2ALL, 374 (82%) had SF-36 data. Mean age at evaluation was 38 (range 18-63), 47% were male, 93% white, and 43% had a bachelor's degree or higher. MCS and PCS means were above the US population at all time points. However, at every time point there were some donors who reported poor scores (>1/2 standard deviation below the age and sex adjusted mean) (PCS: 5.3-26.8%, 10.0-25.0%). Predictors of poor PCS and MCS scores included recipient's death within the two years prior to the survey and education less than a bachelor's degree; poor PCS scores were also predicted by time since donation, Hispanic ethnicity, and at the 3-month post-donation time point. In summary, most living donors maintain above average HRQOL up to 11 years prospectively, supporting the notion that living donation does not negatively affect HRQOL. However, targeted support for donors at risk for poor HRQOL may improve overall HRQOL outcomes for living liver donors.

Health‐related quality of life among survivors of aggressive non‐Hodgkin lymphoma

Non-Hodgkin lymphoma (NHL) is the fifth most common cancer among men and women. Patients with aggressive NHL receive intense medical treatments that can significantly compromise health-related quality of life (HRQOL). However, knowledge of HRQOL and its correlates among survivors of aggressive NHL is limited. Self-reported data on HRQOL (physical and mental function, anxiety, depression, and fatigue) were analyzed for 319 survivors of aggressive NHL. Survivors 2 to 5 years postdiagnosis were selected from the Los Angeles County Cancer Registry. Bivariate and multivariable methods were used to assess the influence of sociodemographic, clinical, and cognitive health-appraisal factors on survivors' HRQOL. After accounting for other covariates, marital status was associated with all HRQOL outcomes (P < .05). Younger survivors reported worse mental function and higher levels of depression, anxiety, and fatigue (P < .01). Survivors who had more comorbid conditions or lacked private health insurance reported worse physical and mental function and higher levels of depression and fatigue (P < .05). Survivors who experienced a recurrence reported worse physical function and higher levels of depression and fatigue (P < .05). With the exception of a nonsignificant association between perceived control and physical function, greater perceptions of personal control and health competence were associated significantly with more positive HRQOL outcomes (P < .01). The current results indicated that survivors of aggressive NHL who are younger, are unmarried, lack private insurance, or experience greater illness burden may be at risk for poorer HRQOL. Cognitive health-appraisal factors were strongly related to HRQOL, suggesting potential benefits of interventions focused on these mutable factors for this population.

Developmental Differences in Psychological Adjustment and Health-Related Quality of Life in Pediatric Cancer Patients

The aims of this study were to investigate: (a) age differences in psychological adjustment (PA) and health-related quality of life (HRQOL) in pediatric cancer patients, and (b) identify predictors of PA and HRQOL. The sample included preschool, school age, and adolescent patients. Data were obtained at 3 (n = 69), 9 (n = 47), and 15 (n = 44) months after diagnosis, using standardized measures completed by the mother. Measures assessed the children's psychological adjustment (PA), health-related quality of life (HRQOL), temperament and maternal psychological adjustment. Age at diagnosis significantly affected both PA and HRQOL. At 3 months post-diagnosis, preschoolers had more externalizing behavior problems than did adolescents. Preschoolers had better HRQOL than adolescents at all 3 assessments. Maternal adjustment and child's temperament scores were the best predictors of PA; age was the best predictor of HRQOL. The results of this study suggest that preschoolers with cancer are at risk for behavior problems and adolescents are at risk for poor HRQOL. The results also highlight the importance of multi-factor models in predicting children's PA and HRQOL.