Significant Difference In Quality Of Life Research Articles

The Comparison of The Quality of Life Between Conventional Orthognathic Surgery and Surgery-first Orthognathic Surgery in Skeletal Class III Deformity Patients

Objectives: This prospective cohort study aimed to compare the quality of life (QoL) of patients with skeletal Class III deformities undergoing either conventional orthognathic surgery (CS) or surgery-first orthognathic surgery (SF) using the Orthognathic Quality of Life Questionnaire (OQLQ) and the Oral health Impact (OHIP-14) tools. Methods: The OQLQ was translated into Thai. Thirty-four patients were enrolled, with 17 in each group according to their orthodontic treatment plans. Patients completed the OQLQ and OHIP-14 assessments on the day before surgery (T1) and at 1 month (T2), 3 months (T3), and 6 months (T4) post-surgery. Data collection occurred from October 2021 to April 2022. Independent sample T-tests and one-way repeated measures ANOVA were used for statistical analysis (p<0.05). Results: At T1, the QoL was significantly lower in the CS group compared to the SF group. The CS group exhibited significant QoL improvements at T2 (OQLQ) and T3 (OHIP-14) compared to T1. The SF group had a lower QoL at T2 but showed significant improvement at T4 (OQLQ and OHIP-14). Conclusions: There was no significant difference in QoL between the two groups after surgery. Both surgical approaches led to improvements in patients' QoL. Thus, the choice of surgical method should be based on appropriate indications and patient-doctor agreement.

Quality of Life in Mild Cognitive Impairment and Mild Dementia Associated with Alzheimer's Disease: A Systematic Review.

Mild cognitive impairment (MCI) and Alzheimer's disease (AD) have a profound impact on patients' quality of life (QoL), with progressive declines occurring as the disease advances. This systematic review aims to summarize the published evidence on patient-reported outcomes (PROs) in individuals with MCI due to AD and mild AD dementia. Comprehensive searches were conducted across five major databases to identify studies reporting on utility values, disutilities, and QoL measures in these patient populations. A total of 23 studies were included that utilized various QoL assessment tools, including EQ-5D (n = 14), SF-36/SF-12 (n = 4), and QOL-AD (n = 11). Reported EQ-5D scores ranged from 0.81 to 0.92 for patients with MCI and from 0.67 to 0.85 for those with mild AD, indicating a noticeable decline in QoL as the disease progresses. QOL-AD scores ranged from 33.8 to 42.5 for MCI and from 32.4 to 38.1 for mild AD, equally reflecting the greater impairment in QoL with disease advancement. Interventions were generally associated with smaller declines in PROs compared to placebo, suggesting a positive impact of treatment in mitigating QoL deterioration. The findings underscore the significant QoL differences between MCI and mild AD, emphasizing the potential benefit of early intervention to preserve QoL and delay disease progression. This review highlights the importance of continued research to better understand QoL in patients with MCI and mild AD dementia, particularly in terms of capturing comprehensive patient-reported outcomes and evaluating the effectiveness of interventions over time. These findings can contribute to a more informed approach in clinical practice and support decision-making in the management of early-stage AD.

The effectiveness of various intensity interval training compared to continuous training in patients with heart failure: a systematic review and network meta-analysis

Abstract Background/Introduction Cardiac rehabilitation including exercise therapy is beneficial for improving exercise tolerance, physical function, quality of life (QOL), and life expectancy in patients with heart failure. High-intensity interval training (HIIT) is increasingly reported as a new training modality to improve exercise tolerance more effectively than conventional moderate-intensity continuous aerobic training (MCT). However, the optimal intensity of HIIT for achieving the greatest effects in patients with heart failure remain controversial. Purpose This systematic review and network meta-analysis aimed to examine the effectiveness of HIIT compared to MCT on exercise tolerance in patients with heart failure. Methods We searched for studies published up to 30 January 2024 in Embase, MEDLINE via Ovid SP, PubMed, and the Cochrane Library via Wiley Online Library with no limitations on data, language, or publication status. We included randomised controlled trials comparing the efficacy of HIIT and MCT on peak oxygen uptake (VO2), as a measure of exercise tolerance, aerobic threshold (AT) VO2, ventilatory equivalent of carbon dioxide (VE/VCO2) slope, and QOL. We categorized HIIT into three different intensities [> 80% heart rate max (HRM), 60-80% HRM, < 60% HRM] and compared the outcomes with those of MCT. Results We identified 15 randomised controlled trials with 557 patients from a total of 27,931 records. Our network meta-analysis revealed that the following results of peak VO2 from the comparisons among the three intensities of HIIT and MCT: > 80% HRM (10 studies, mean difference 1.27 ml/min/kg, 95% confidence interval -0.20 to 2.73), 60-80% HRM (3 studies, 1.47, -0.89 to 3.83), < 60% HRM (2 studies, 2.10, -1.22 to 5.43) (Fig. 1). Regarding AT VO2, HIIT at 60-80% HRM demonstrated significant improvements compared to MCT: > 80% HRM (8 studies, 0.18, -0.83 to 1.18), 60-80% HRM (2 studies, 2.50, 0.72 to 4.28), < 60% HRM (2 studies, 1.14, -0.93 to 3.20) (Fig. 2). Regarding VE/VCO2 slope, HIIT at 60-80% HRM also demonstrated significant improvements compared to MCT: > 80% HRM (7 studies, 0.29, -1.89 to 2.47), 60-80% HRM (2 studies, -3.26, -6.18 to -0.35), < 60% HRM (no study). The network meta-analysis did not reveal any significant differences in QOL between the various intensities of HIIT and MCT. Conclusions Our systematic review and network meta-analysis revealed that HIIT prescribed at a sub-maximal intensity, 60-80% heart rate max, is most effective in improving exercise tolerance. Higher intensity does not necessarily yield better outcomes, and future research on interval training should include detailed methodologies that account for the training intensity.Fig.1 Network meta-analysis on peak VO2Fig.2 Network meta-analysis on AT VO2

Early taxane exposure and neurotoxicity in breast cancer patients

IntroductionBreast cancer is the most diagnosed tumor and a leading cause of cancer death in women worldwide. Taxanes are the most used chemotherapeutic agents and are strictly connected to neurotoxicity. Taxane-induced neuropathy (TIN) significantly impacts patients’ quality of life (QOL). Early identification and management of TIN could improve preventive strategies to preserve patients’ QOL during and after breast cancer treatment.ObjectiveThis prospective, observational study aimed to evaluate the taxane-induced neuropathy (TIN) in early breast cancer patients treated with weekly paclitaxel at an earlier stage and identify any correlation between TIN and QOL.MethodsData from stage I-III breast cancer patients treated with taxane-based therapy between 2018 and 2022 were collected at the Medical Oncology Unit of the University Hospital of Cagliari. Peripheral neuropathy was evaluated using the NCI-CTCAE scale (National Cancer Institute, Common Terminology Criteria for Adverse Events) at every drug administration. In contrast, QOL was assessed using EORTC QLC-CIPN20 and FACT-Taxane questionnaire at baseline (T0), after 4 weeks (T1) and 12 (T2) weeks of treatment. Statistical analysis was performed to evaluate the correlation between neurotoxicity and QOL.ResultsNeurotoxicity incidence peaked at the third, fourth, and sixth week of treatment, with patients reporting grade 1 and 2 neurotoxicity. Simultaneously with increasing doses of paclitaxel, significant differences in QOL were observed in early treatment cycles relating to TIN presentation. Patients with higher neurotoxicity grades reported lower QOL scores.ConclusionsDespite the absence of effective treatments to prevent paclitaxel-induced neurotoxicity, symptoms are managed through dosage reduction, delay, or treatment interruption. Future research should focus on identifying neuroprotective measures to avoid an irreversible decline in the quality of life for breast cancer survivors.

The Quality of Life of Former Portuguese Football Players.

The demands of playing professional football can have an impact on an individual's quality of life (QoL), which may remain into retirement. Given limited evidence exists regarding the QoL in former football players, this study aimed to assess QoL among Portuguese former players according to career duration, career end period, competitive level, tactical-positional status, international status, academic qualifications, serious injuries in career, and current professional football connection. The study included 84 Portuguese former football players (48.8 ± 8.2 years old) who transitioned to retirement between 1988 and 2018. The WHOQOL-BREF questionnaire was used to assess QoL perceptions, and the Portuguese version was validated. The former players have positive QoL indicators, both in general and across the four domains, namely in terms of the physical, psychological, and social relationship and environment. There were no statistically significant differences in QoL between the defined categories for career end period, competitive level, tactical-positional status, international status, and current professional football connection. Likewise, there was no significant correlation between QoL and career duration. In contrast, there were significant differences in general QoL (p < 0.023) and in the physical domain (p < 0.001) between former players with different academic qualifications. A significant correlation was found between the number of severe injuries sustained in a career and QoL in the physical domain (R = -0.300, p = 0.006). There are no concerning QoL results presented by former players. However, the number of severe injuries sustained during the career was associated with a lower QoL, while holding higher academic qualifications demonstrated higher general and physical QoL. Studies with larger samples should be conducted to confirm these trends.

Axial Ablation versus Terminal Interruption of the Reflux Source (AAVTIRS): A Randomised Controlled Trial.

Treatment of reflux has been shown to improve time to healing of Venous Leg Ulcers (VLU). Terminal Interruption of the Reflux Source (TIRS) treats reflux within the plexus of veins around an active VLU using foam sclerotherapy. The efficacy of TIRS in managing VLU has never been tested. We performed a pragmatic, single centre, assessor-blinded, randomised controlled trial comparing endovenous ablation of the axial superficial veins (Axial Ablation-AA) vs TIRS. Patients of any age with VLU of any duration were eligible. 98 Participants were randomised to AA or TIRS. 39/55, 70.9% (95%CI; 57.1-82.37) healed their VLU in the AA group, while 29/39, 74.36% (95%CI; 57.87-86.96) healed their VLU in the TIRS group, P = 0.45.4 were lost to follow-up. Median time to ulcer healing was 84 days (95%CI; 74.67-93.33) in the axial ablation group and 84 days (95%CI; 73.02-94.98) in the TIRS group. Hazard Ratio for ulcer healing with AA vs TIRS was 0.96 (95%CI 0.59-1.56). There were no significant quality of life differences. The AAVTIRS trial did not show that axial ablation was superior to TIRS in the primary outcome of number of VLU healed in 6 months, or time to VLU healing. This trial is not powered to show non-inferiority. TIRS is a viable option for treatment of VLU. Further investigation is necessary before it can be recommended as an alternative to axial ablation.Trial registered at clinicaltrials.gov NCT04484168.

Effect of a Thermosensitive Hydroxybutyl Chitosan Hydrogel on Postoperative Sequalae and Quality of Life After Impacted Mandibular Third Molar Extraction

BackgroundThird molar (M3) extraction is a common surgery in oral and maxillofacial surgery, and composite wound dressings such as hydroxybutyl chitosan (HBC) may improve postoperative sequala following M3 removal. PurposeThe study purpose was to measure and compare differences in pain, swelling, trismus, wound healing and quality of life (QOL) between the HBC and the control sides in patients undergoing M3 removal. Study design, setting and sampleThis study is a double-blind, split-mouth, randomized clinical trial. Patients who required M3 removal between June 2022 and May 2023 were included. Exclusion criteria included seafood allergies, smoking, poor oral hygiene, and systemic diseases. Predictor variableThe predictor variable was the socket treatment technique. Subjects were randomly assigned to the HBC or control (physiologic saline) side. Primary outcome variableThe primary outcome variables, including pain assessed by visual analog scale, swelling, and maximal incisional opening (MIO), were measured on the first, third, and seventh postoperative days. The secondary outcome variables included QOL and wound healing score measured on the third and seventh days after surgery. CovariatesThe covariates included age, sex and operation time. AnalysesThe Shapiro‒Wilk test was used to evaluate the normality of the data distribution. The paired t test or Wilcoxon signed-rank test was adopted. Statistical significance was set at P <0.05. ResultsThe study included 60 patients (mean age: 25.81 ± 4.91;23 (38%) males, 37(62%) females). A statistically significant difference in the level of pain (HBC: 37.58 ± 4.39 mm, control: 47.00 ± 4.33 mm, day 1, P < 0.001; 21.88 ± 3.25 mm, 35.95 ± 1.57 mm, day 3, P < 0.001), MIO (23.92 ± 1.38 mm, 18.22 ± 1.82 mm, day 1, P<0.001; 30.00 ± 1.61 mm, 23.78 ± 1.70 mm, day 3, P <0.001) and swelling (6.86 ± 0.70 mm, 7.15±0.80 mm, day 3, P=0.006) was detected after surgery. A statistically significant difference in QOL was detected (HBC: 13.70 ± 1.65, control: 18.60 ±2.14, day 3, P<0.001). ConclusionThe application of HBC hydrogels to wounds after impacted mandibular M3 extraction reduces postoperative sequalae, promotes wound healing and improves postoperative quality of life.

Randomized double-blind placebo-controlled trial evaluating pregabalin for chronic cough in patients with lung cancer.

LBA12082 Background: Chronic cough is a distressing symptom that detracts from the quality of life (QoL) of patients with cancer. Developing effective therapies for cough is an unmet need, with no approved medicines available. Neuromodulators like pregabalin may act centrally as cough suppressants. Methods: Randomized double-blind placebo-controlled study in the Department of Medical Oncology at Tata Memorial Hospital (Mumbai, India) in patients with locally advanced/metastatic non-small-cell lung cancer (NSCLC) with at least 2 weeks history of moderate or severe cough. Patients had ECOG PS 0-2, and creatinine clearance &gt; 60 mL/min. Randomization was 1:1 to pregabalin 300 mg orally daily or matching placebo, both administered for 9 weeks. Primary endpoint was the difference in cough severity as measured by Visual Analog Scale (VAS) after 9 weeks treatment with pregabalin versus placebo. Secondary endpoints included cough severity on day 7 and week 9 measured by VAS, and Manchester Cough in Lung Cancer Scale (MCLCS); side-effects, and QoL assessed by EORTC QLQ C30 and LC13. Means of the change from baseline scores were calculated for patients in each arm, and compared between two arms by independent samples Mann Whitney U test. P &lt; 0.05 was considered significant. Results: Between Jul 2022 and Dec 2023, we enrolled 166 patients: 83 to each arm. Median age was 56 years (IQR, 47-62.5); 112 (67.5%) were male, and 149 (89.8%) had metastatic NSCLC. Baseline cough severity was grade 2 in 127 (76.5%) and grade 3 in 37 (22.6%); median cough duration was 163 days. The therapy (pregabalin/placebo) was well tolerated in both arms, with no difference in grade &gt; 3 toxicities between the two arms; P=0.908. Systemic cancer-directed therapy was started in 95.2% and 91.4% of patients in the pregabalin and placebo arms, respectively; P=0.328. By week 9, subjective improvement in cough was reported by 45 (57%) patients in pregabalin arm, and 40 (52.6%) patients in placebo arm; P=0.846. The mean VAS score (in mm) decreased from 71.58 at baseline, to 45.32 at day 7, and 19.73 by week 9 in the pregabalin arm; corresponding values in the placebo arm were 71.74, 46.23, and 21.18, respectively; P=0.530. Cough assessment by mean MCLCS scores showed a similar decrease throughout the course of the study, with no statistically significant differences between the two arms (Pregabalin-Baseline: 27.63, Day 7: 23.49, Week 9: 17.39; Placebo-Baseline: 27.28, Day 7: 23, Week 9: 17.34); P=0.455. There was no significant difference in QoL between the two arms. Mean LCCO (cough symptom question on QLQ LC13) score decreased from 75.9 (baseline) to 54.2 (day 7) to 36.4 (week 9) in pregabalin arm, vs 66.3, 54, and 31.4, respectively, in placebo arm; P=0.150. Conclusions: Pregabalin does not lead to a significant decrease in cough in patients with lung cancer. Systemic cancer-directed therapy is the most effective antitussive therapy for cancer-induced cough. Clinical trial information: CTRI/2020/11/029275 .

Radiation dose esclation with contact X-ray brachytherapy (Papillon) and quality of life in patients with rectal cancer: Results from the phase 3 randomised trial OPERA.

e23180 Background: Organ preservation has been increasingly offered to patients with rectal cancer as most patients wish to avoid extirpative surgery and a stoma if they have a choice. The standard of care is to offer external beam chemo radiotherapy (EBCRT) to those who are fit. OPERA (Organ Preservation in Early Rectal Adenocarcinoma) has shown improved organ preservation rate with addition of contact X-ray brachytherapy(CXB-Arm B) compared to EBCRT with EBRT boost. We evaluate whether addition od CXB boost compromise the patients Quality of Life (QOL) compared to EBRT boost and if so by how much. We report our results at 38.2 months follow up. Methods: From June 2015 to June 2020, there were 148 patients randomised of which 141 were evaluable. We used EORCT QLQ -C30, QLQ -CR29 and modified LARS score at FU visits every 3 months during FU visit 1(8 weeks)-9 (32 weeks). Results: At screening (baseline) we enrolled 126 patients (Arm A: 59, Arm B: 66). At FU -1 we received questionnaire back from 78 patients (Arm A: 35, Arm B: 43). At FU-5 there were 55 patients (Arm A:18, Arm B: 37). Finally, at FU 8 there were 43 patients (Arm A: Arm B xx). Using EORTC QOL-C30 and QOL CR-29, global QOL score for Arm A was 77.6 vs Arm B 72.22 (p = 0.14). Mean functional scale (1-5) for Arm A was 95.2 vs Arm B 92.1 (p = 0.09). Role functioning scale (6-7) for Arm A was 91.2 vs Arm B 93.18 (p = 0.57). Emotional functioning (21-24) for Arm A was 77.5 vs Arm B 73.99 (p = 0.33). Cognitive functioning (20-25) for Arm A 87.85 vs Arm B 91.92(p = 0.17). Social functioning (26-27) for Arm A 95.2 vs Arm B 92.93 (p = 0.31). Conclusions: In our analysis so far, we do not detect significant difference in QOL between Arm A and Arm B. Consider Contact x-ray brachytherapy first in patients with rectal cancer &lt; 3cm (Arm B1) which has shown higher organ preservation rate without effecting their QOL compare to EBCRT (Arm A1). Clinical trial information: NCT02505750 .

Technology-enhanced palliative care for patients with advanced cancer undergoing phase I therapies: A pilot randomized clinical trial (RCT).

12017 Background: Outpatient palliative care (PC) has been found to improve quality of life (QOL). It is not known if more frequent symptom monitoring and PC nursing contacts between clinic visits would offer additional benefits. We conducted a pilot RCT to examine the effect of a specialist PC referral with and without technology-enhancement (TEC) on symptoms in patients undergoing Phase I cancer therapies. Methods: This single-center parallel group RCT enrolled adult patients with advanced solid tumors prior to starting Phase I therapies and at least 1 Edmonton Symptom Assessment Scale (ESAS) symptom ≥4/10 and ESAS Global Distress Score (GDS) ≥20/90. Patients were randomized to PC alone or PC + TEC in a 1:1 ratio. Over the 12 w period, the PC group had in person or virtual outpatient visits with a PC physician, nurse, and as needed psychotherapist every 4 weeks; the PC + TEC group also received weekly symptom monitoring with ESAS electronically and weekly nursing phone call. The primary outcome was within-group change of GDS from baseline to 2 w; secondary outcomes included change in GDS over 4, 8, and 12 w, and change in QOL (FACIT-Sp) over 2, 4, 8 and 12 w. We estimated that a sample size of 50 patients per group would provide 90% power to detect a within-group GDS difference of 6 units with a 2-sided α of 2.5% and 20% attrition. Results: Between 12/15/2020 and 12/21/2022, 115 patients were enrolled and 101 were randomized (PC + TEC n = 57, PC n = 44). By 2 w, PC + TEC showed a significant within-group improvement in GDS (mean change -5 [95% CI -8.9, -1.2]; P= 0.01) but not PC alone (Table). PC+TEC group also had a significant improvement in GDS at 8 w and 12 w and in FACIT-SP at 2 w, 8 w and 12 w. PC alone group had a significant within-group improvement in GDS at 4 w and 12 w but no significant differences in QOL were detected. This study was not powered for between group comparison; however, FACIT-SP at 12 w was significantly higher in PC+TEC vs. PC alone (Table; mean difference 13.9; P= 0.02). Conclusions: Higher intensity of PC with closer monitoring showed within-group improvement in symptoms and QOL, while PC alone had some symptom reduction but no QOL improvement. Further studies are needed to confirm the QOL benefit of PC + TEC over PC alone. Clinical trial information: NCT04989556 . [Table: see text]

The influence of delayed gastric emptying on quality of life after partial duodenopancreatectomy.

Quality of life (QoL) is temporarily compromised after pancreatic surgery, but no evidence for a negative impact of postoperative complications on QoL has been provided thus far. Delayed gastric emptying (DGE) is one of the most common complications after pancreatic surgery and is associated with a high level of distress. Therefore, the aim of this study was to analyse the influence of DGE on QoL. This single-centre retrospective study analysed QoL after partial duodenopancreatectomy (PD) via the European Organization for Research and Treatment of Cancer core questionnaire (QLQ-C30). The QoL of patients with and without postoperative DGE was compared. Between 2010 and 2022, 251 patients were included, 85 of whom developed DGE (34%). Within the first postoperative year, compared to patients without DGE, those with DGE had a significantly reduced QoL, by 9.0 points (95% CI: -13.0 to -5.1, p < 0.001). Specifically, physical and psychosocial functioning (p = 0.020) decreased significantly, and patients with DGE suffered significantly more from fatigue (p = 0.010) and appetite loss (p = 0.017) than patients without DGE. After the first postoperative year, there were no significant differences in QoL or symptom scores between patients with DGE and those without DGE. Patients who developed DGE reported a significantly reduced QoL and reduced physical and psychosocial functioning within the first year after partial pancreatoduodenectomy compared to patients without DGE.

Effect of Structured Exercise-Based Intervention on Upper Quadrant Dysfunction among Fish Processing Workers with Work-Related Musculoskeletal Disorders.

Musculoskeletal disorders (MSDs) are one of the major causes of morbidity, which affect particularly the upper quadrant in industrial settings and so upset the quality of life (QoL). The influence of the protocol of exercise-based programs at the workplace on the well-being of the worker is contradictory. The objective of the study was to find the effect of the structured exercise-based intervention on upper quadrant dysfunction among fish processing workers with work-related MSDs. The intervention group (n = 91) participated in an individually tailored structured exercise-based intervention (SEBI) program for three months, which consisted of stretching, strengthening, and active exercises. The control group (n = 93) was instructed to continue routine daily activities. The outcome measures of the cluster-randomized controlled trial were Neck Disability Index (NDI), Disabilities of Arm, Shoulder, and Hand (DASH), Visual Analog Scale (VAS), and Short Form-36, used to evaluate at baseline, eighth, and twelfth week. The data were analyzed by repeated analysis of variance and Student's t-tests. The results for the overall perception of upper quadrant dysfunction showed statistically significant differences (P < 0.0001) for NDI, DASH, and VAS. Further, we obtained a significant difference in QoL between the intervention and control groups for physical and psychological health sub-domains. SEBI effectively enhanced the general health of fish processing workers by showing improvements in the measures of NDI, DASH, VAS, and QoL. Hence, SEBI can be recommended in the fish processing industries to achieve potential impact on upper quadrant dysfunction and improve the QoL.

Patients with diabetes and obesity exhibit characteristics in eating and coping behaviors and personality traits.

In patients with diabetes, obesity is an aggravating factor for glycemic control and its vascular complications. However, the psychological and behavioral characteristics of those patients with obesity have not been fully clarified. This study investigated eating and coping behavior, personality traits, quality of life (QOL), and depression status in patients with diabetes with or without obesity. Questionnaires obtained from 567 patients with diabetes at Dokkyo Medical University were analyzed. Eating behavior, coping behavior, personality traits, QOL, and depression status were evaluated by the Eating Behavior Questionnaire, Brief COPE, Japanese Ten-Item Personality Inventory, EuroQol 5 Dimensions-5 Level, and Patient Health Questionnaire-9, respectively. Participants were divided according to body mass index (BMI) into a non-obese group (BMI<25), obese group (BMI 25-35), and high-degree obese group (BMI≥35), and results were compared between groups. On all items of the Eating Behavior Questionnaire, scores were higher in the obese and high-degree obese groups than non-obese group, indicating worse eating behavior. In coping behavior, significant intergroup differences were found in self-distraction, substance use, using emotional support, using instrumental support, and venting. As for personality traits, the obese group had significantly lower conscientiousness and higher emotional instability than the non-obese group. There was no significant difference in QOL or depression status. These results suggest that there are some characteristics in eating and coping behaviors and some personality traits between obese and non-obese patients with diabetes. Treatment based on such characteristics may be useful for patients with diabetes and obesity. The online version contains supplementary material available at 10.1007/s13340-024-00721-w.

Understanding quality of life's challenges in sarcoma patients: A mixed-methods study

PurposeSarcoma, a highly aggressive form of cancer, profoundly affects patients both physically and psychologically. This study aimed to assess sarcoma patients' health-related quality of life and explore their experiences of living with the disease and their specific care requirements. MethodsThis research employed a convergent parallel mixed-methods design. Fifty-two sarcoma patients completed the European Portuguese version of the EORTC QLQ-C30 questionnaire, and seven of them participated in semi-structured interviews. Descriptive measures, Cronbach alpha for internal consistency, t-teste-Anova and stepwise regression were employed in the quantitative analysis. Qualitative data was analysed thematically. ResultsThe most affected Quality of life (QoL) dimensions were role functioning and global health, areas of functioning that were also described as impacted in patients’ experiences. Symptoms like insomnia, pain, and fatigue were frequently reported. Symptoms such as fatigue, pain, and financial difficulty explain QoL variance. No significant differences in QoL were found according to the different forms of treatment. Analysis of the interviews revealed three overarching themes: (1) disruption of daily life, (2) adaptation to life with sarcoma, and (3) the demand for more personalized care, allowing to gain a deeper understanding of living with sarcoma. ConclusionThe results underscore the significance of delivering care that enhances the quality of life for sarcoma patients, addressing both their physical and psychosocial needs, and providing personalized support throughout all stages of the disease.

Effects of a nurse-led therapeutic conversations intervention in stroke patient-family caregiver dyads: A randomized control trial.

Few studies have evaluated the effectiveness of family functional care interventions among stroke caregiver dyads. This study aimed to examine the effect of a nurse-led therapeutic conversation intervention on resilience, family function, self-efficacy in managing the disease, and quality of life (QoL) in stroke family caregiver dyads. This study aimed to examine the effect of a nurse-led therapeutic conversation intervention on resilience, family function, self-efficacy in managing the disease, and QoL in stroke-family caregiver dyads. This study was a single-blind (evaluator) randomized controlled trial. The planned execution time was from August 2021 to December 2022, in the rehabilitation ward of a medical university hospital. A total of 82 dyads were included in this analysis. Dyads randomized to the intervention group received nurse-led therapeutic conversations intervention one at four weeks after the patient's hospitalization for a stroke. The family caregiver dyads of stroke survivors in the control group received routine care. An effectiveness analysis that included patients' resilience, self-efficacy, and patient-family caregiver dyads' family function and QoL was conducted at one month. We used the CONSORT Checklist for reporting parallel group randomized trials in this study. The patients in the intervention group showed improvement in resilience and self-efficacy after one month. Furthermore, the effects on resilience (Cohen's d = 0.49) and self-efficacy (Cohen's d = 0.46) were significantly higher than in the control group. Family functioning was significantly higher in patient-family caregiver dyads in the intervention group than in the control group (Cohen's d = 0.55; Cohen's d = 0.50). However, no significant difference in QoL was found between patients and caregivers in either group. The intervention was effective in promoting family functioning and can also promote patient resilience and self-efficacy in disease management. However, the intervention did not have a significant effect on the QoL of patient-family caregiver dyads.

Longitudinal quality of life after sublobar resection and stereotactic body radiation therapy for early-stage non-small cell lung cancer.

Many patients with early-stage lung cancer are not candidates for lobectomy because of various factors, with treatment options including sublobar resection or stereotactic body radiation therapy (SBRT). Limited information exists regarding patient-centered outcomes after these treatments. Subjects with stage I-IIA non-small cell lung cancer (NSCLC) at high risk for lobectomy who underwent treatment with sublobar resection or SBRT were recruited from five medical centers. Quality of life (QOL) was compared with the Short Form 8 (SF-8) for physical and mental health and Functional Assessment of Cancer Therapy-Lung (FACT-L) surveys at baseline (pretreatment) and 7 days, 30 days, 6 months, and 12 months after treatment. Propensity score methods were used to control for confounders. Of 337 subjects enrolled before treatment, 63% received SBRT. Among patients undergoing resection, 89% underwent minimally invasive video-assisted thoracic surgery or robot-assisted resection. Adjusted analyses showed that SBRT-treated patients had both higher physical health SF-8 scores (difference in differences [DID], 6.42; p=.0008) and FACT-L scores (DID, 2.47; p=.004) at 7 days posttreatment. Mental health SF-8 scores were not different at 7 days (p=.06). There were no significant differences in QOL at other time points, and all QOL scores returned to baseline by 12 months for both groups. SBRT is associated with better QOL immediately posttreatment compared with sublobar resection. However, both treatment groups reported similar QOL at later time points, with a return to baseline QOL. These findings suggest that sublobar resection and SBRT have a similar impact on the QOL of patients with early-stage lung cancer deemed ineligible for lobectomy.

Parastomal Hernia Following Ileal Conduit: Incidence, Risk Factors, and Health-Related Quality of Life.

The purpose of this study was to measure the incidence of parastomal hernia (PH) after radical cystectomy and ileal conduit. Secondary aims were the identification of risk factors for PH and to compare the health-related quality of life (QOL) between patients with and without PH. Retrospective review of medical records combined with cross-sectional administration of the QOL instrument and telephone follow-up. The study sample comprised 219 patients who underwent radical cystectomy and ileal conduit for urothelial cancer between February 2014 and December 2018. The study setting was Peking University First Hospital (Beijing, China). Demographic and pertinent clinical data, including development of PH, were gathered via the retrospective review of medical records. Participants were also asked to complete the traditional Chinese language version of the City of Hope Quality of Life-Ostomy Questionnaire (C-COH). Multiple linear regression analysis was used to identify the effect of PH on C-COH scores. Logistic regression analysis was used to identify risk factors for PH development. At a median follow-up of 34 months (IQR = 21-48), 43 of 219 (19.63%) patients had developed a PH. A body mass index (BMI) indicating overweight (OR = 3.548; 95% CI, 1.562-8.061; P = .002), a prior history of hernia (OR = 5.147; 95% CI, 1.195-22.159; P = .028), and chronic high abdominal pressure postdischarge (CHAP-pd) (OR = 3.197; 95% CI, 1.445-7.075; P = .004) were predictors of PH after operation. There was no significant difference between C-COH scores of patients with or without PH. No significant differences were found when participants with PH were compared to those without PH on 4 factors of the C-COH: physical scores (β= .347, P = .110), psychological scores (β= .316, P = .070), spiritual scores (β=-.125, P = .714), and social scores (β= .054, P = .833). Parastomal hernia is prevalent in patients undergoing radical cystectomy and ileal conduit urinary diversion. Overweight, hernia history, and CHAP-pd were predictors of PH development. No significant differences in QOL were found when patients with PH were compared to those without PH.

Psychological factors may affect the quality of life in irritable bowel syndrome patients more than the gut itself? A multicenter cross-sectional study.

Both intestinal symptoms and comorbidities exist in irritable bowel syndrome (IBS) patients and influence their quality of life (QOL). More research is needed to determine how these variables impact the QOL of IBS patients. This study aimed to determine which specific factors had a higher influence on QOL and to further compare the effects of intestinal symptoms and comorbidities on QOL. IBS patients were recruited from six tertiary hospitals in different regions of China. QOL, gastrointestinal symptoms, and comorbidities were assessed by different scales. Correlation analysis, multiple linear regression, and mediation model were used for statistics. Four hundred fifty-three IBS patients (39.7% women, mean age 45 years) were included and no significant differences in QOL were found across demographic characteristics. Abnormal defecation (r = -0.398), fatigue (r = -0.266), and weakness (r = -0.286) were found to show higher correlation with QOL. More than 40% of IBS patients were found to suffer from varying degrees of anxiety or depression, and anxiety (r = -0.564) and depression (r = -0.411) were significantly negatively correlated with QOL (P < 0.001). Psychological factors showed the strongest impact (β' = -0.451) and play a strong mediating role in the impact of physiological symptoms on QOL. Anxiety was found to be the strongest factor (β' = -0.421). Compared with other symptoms, psychological symptoms, particularly anxiety, are more common and have a more negative influence on QOL. The QOL of IBS patients is also significantly impacted by abnormal defecation, abdominal distension, and systemic extraintestinal somatic symptoms. In the treatment of IBS patients with unhealthy mental status, psychotherapy might be prioritized.

Adaptation and Validation of the World Health Organization Quality of Life – BREF (WHOQOL-BREF) for People with Aphasia

ABSTRACT Background It is essential to consider the well-being and quality of life (QoL) of the person as part of an effective intervention in health. To this end, the World Health Organization developed an instrument to assess the QoL, the World Health Organization Quality of Life – BREF (WHOQOL-BREF). However, it is not adapted to the comprehension and expression difficulties a person with aphasia must face. Aims To create and validate a version of the WHOQOL-BREF, Portuguese version, which is adapted to the needs of people with aphasia (PWA). Methods & Resources For the adaptation and validation phase, two participatory workshops were held with a group of five PWA and then, individual interviews were carried out with the same experts. For the validation phase (concurrent validity and assessing group differences), the study included a sample of 45 people (15 PWA and 30 neurologically healthy participants – NHP). To evaluate the test-retest (intra-rater) reliability, the t-test was used, and the Pearson correlation was calculated. To compare the two groups (PWA and NHP), the Chi-Square Test was used for categorical variables and the independent t test (or the Mann-Whitney test) for the numerical variables. Outcomes & Results The results obtained are in line with what is reported in the literature regarding the aphasia-friendly adaptions of health assessment instruments: It is relevant to provide graphic support and to highlight specific information. There were no differences between test-retest (moderate to strong correlations between the two testing points: 0.56-0.79). Contrary to expectations, PWA did not present significant differences in QoL when compared to NHP, except for the physical domain (p=0.01). During concurrent validation, the following correlation values were obtained in the specific domains of WHOQOL-BREF and SAQOL-39: WHOQOL-BREF Physical/ SAQOL-39 Physical (0.55) and WHOQOL-BREF Physical/ SAQOL-39 Communication (0.53). Conclusion The adaptations carried out to facilitate the understanding and expression of PWA and the aphasia-friendly support materials produced for WHOQOL-BREF were well received by a group with mild aphasia and may be useful for the broader population of PWA. The WHOQOL-BREF could be used without communicative support by PWA, facilitating the collection of clinically relevant data about this population.

Is Ultrahypofractionated Whole Pelvis Radiation Therapy (WPRT) as Well Tolerated as Conventionally Fractionated WPRT in Patients With Prostate Cancer? Early Results From the HOPE Trial

ObjectiveTo evaluate acute toxicity and quality of life (QOL) impact of ultra-hypofractionated whole pelvis radiotherapy (WPRT) compared to conventional WPRT fractionation post high-dose rate (HDR) prostate brachytherapy (BT). MethodsBLINDED FOR REVIEW is a phase 2, multi-institutional randomized controlled trial involving men with prostate-confined disease and NCCN unfavorable intermediate, high, or very-high-risk prostate cancer. Patients were randomly assigned to receive conventionally fractionated WPRT (standard arm) or ultra-hypofractionated WPRT (experimental arm) in a 1:1 ratio. All patients underwent radiotherapy with 15 Gy HDR-BT boost in a single fraction followed by WPRT delivered with conventional fractionation (45 Gy in 25 daily fractions or 46 Gy in 23 fractions) or ultra-hypofractionation (25 Gy in 5 fractions delivered on alternate days). Acute toxicities, measured during radiotherapy and at 6 weeks post-treatment, were assessed using the clinician-reported Common Terminology Criteria for Adverse Events (CTCAE) version 5.0, and QOL was measured using the Expanded Prostate Cancer Index Composite (EPIC-50) and International Prostate Symptom Score (IPSS). ResultsA total of 80 patients were enrolled and treated across three Canadian institutions. A total of 39 and 41 patients received external radiotherapy with conventionally fractionated and ultra-hypofractionated WPRT, respectively. All patients received androgen deprivation therapy, except for 2 patients treated in the ultra-hypofractionated arm. Baseline clinical characteristics were similar between the two arms, with 51 (63.8%) patients having high or very high-risk prostate cancer disease. Treatment was well tolerated with no significant differences in the rate of acute adverse events between arms. No grade 4 adverse events or treatment-related deaths were reported. Ultra-hypofractionated WPRT had a less detrimental impact in the EPIC-50 bowel total, function and bother domain scores when compared to conventional WPRT in the acute setting. On the contrary, more patients treated with ultra-hypofractionated WPRT reached the minimum clinical important difference on EPIC-50 urinary domains. No significant QOL differences between arms were noted in the sexual and hormonal domains. ConclusionUltra-hypofractionated WPRT following HDR-BT is a well-tolerated treatment strategy in the acute setting and leads to less detrimental impact on bowel QOL domains when compared to conventional WPRT.