Health-related Quality Of Life Subscales Research Articles

English

This cross-sectional study examined the influence of illness perception of health-related quality of life (HRQoL) in end stage renal disease (ESRD) patients on either hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD). The Short Form-36 (SF-36) was used to measure HRQoL which comprised the Physical Component Summary (PCS) and Mental Component Summary (MCS). Illness perception was evaluated using Revised Illness Perception Questionnaire (IPQ-R). Both questionnaires were administered on 183 HD and 93 CAPD patients. The results showed that almost all HRQoL subscales except physical functioning and bodily pain were found to be significantly different between HD and CAPD patients. There are significant correlations between most components of illness perception with HRQoL. Significant illness perception predictors of PCS among HD patients were time line, consequences, cyclical and identity, whereas on CAPD patients were time line, illness coherence, emotional, cyclical and identity. Significant illness perception predictors of MCS among HD patients included time line, cyclical and identity and only time line was significant predictor of MCS on CAPD patients. These should be considered when developing intervention programmes to improve their HRQoL.

Cancer-related information needs and cancer's impact on control over life influence health-related quality of life among adolescents and young adults with cancer.

Adolescents and young adults (AYAs) diagnosed with cancer between 15 and 39 years of age often report need for greater amounts of cancer-related information and perceive that cancer has had a negative impact on control over their life. We examined whether unmet information need and perceived control over life are associated with health-related quality of life (HRQOL). We examined data from 484 AYA cancer survivors recruited from population-based cancer registries in 2007-2008. Participants completed surveys a median of 11 months after diagnosis. Multivariable linear regression analyses estimated associations of unmet cancer-related information needs and impact of cancer on control over life on HRQOL (SF-12). Two-thirds of AYAs reported an intermediate or high level of unmet information need, and half (47%) reported a negative impact of cancer on control. Greater unmet information need was associated with lower overall mental and physical HRQOL and lower levels of all HRQOL subscales except vitality. A negative impact on control over life was associated with lower overall mental HRQOL as well as lower HRQOL across all subscales except general health perceptions (all p <0.05). In multivariable analyses, perceived control and unmet information need were independently associated with HRQOL (p-values for interaction >0.1). Adolescent and young adult patients with cancer have high levels of unmet cancer-related information needs and perceived negative impact of cancer on control over life; both were independently associated with lower HRQOL. Addressing unmet information needs among AYA cancer survivors and finding ways to increase their sense of control may help improve HRQOL in this understudied population.

Development and validation of an arrhythmia-specific scale in tachycardia and arrhythmia with focus on health-related quality of life.

Arrhythmias can cause a profoundly negative impact on a person's daily life, leading to impaired health-related quality of life (HRQOL). Assessment of HRQOL can provide valuable information before, during, and after healthcare interventions for arrhythmias. The aim was to develop and validate a disease-specific scale evaluating HRQOL in patients with different forms of arrhythmia. The Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (ASTA HRQOL) was developed from a literature review, patient interviews, and expert panel evaluations. This version was then psychometrically evaluated in patients treated with radiofrequency catheter ablation because of different forms of arrhythmias and patients who sought emergency care because of atrial fibrillation. Construct validity was evaluated with item-total correlations, confirmatory factor analyses, and convergent and discriminant validity. Internal consistency was evaluated using Cronbach's α. All items reached the expected level of item-total correlations of greater than 0.3 for the total scale. The content validity index was sufficient for all items, as was the total scale (0.86-1.0). The 2-factor confirmatory factor analysis model that included the physical and mental factors showed a better fit between model and data than the 1-factor model did (P < .001). Convergent and discriminant validities were evaluated in the correlation analyses between the ASTA HRQOL subscales and SF-36 physical and mental dimensions. A strong correlation was found between the hypothesized physical and mental scales. Internal consistency was satisfactory with a lower bound confidence interval (95%) for Cronbach's α .70 or greater for all the ASTA HRQOL scales. The ASTA HRQOL questionnaire can be a valuable contribution to HRQOL assessments in patients with different forms of arrhythmia. Until there is more evidence regarding validity and reliability, using both the total and subscale scores is recommended.

Poor health-related quality of life and proactive primary control strategy may act as risk factors for acute coronary syndrome.

Background and ObjectivesIncreasing evidence supports that psychological factors may be related to development of coronary artery disease (CAD). Although psychological well-being, ill-being, and control strategy factors may play a significant role in CAD, rarely have these factors been simultaneously examined previously. We assessed comprehensive psychological factors in patients with acute coronary syndrome (ACS).Subjects and MethodsA total of 85 ACS patients (56 unstable angina, 29 acute myocardial infarction; 52.6±10.2 years; M/F=68/17) and 63 healthy controls (48.7±6.7 years, M/F=43/20) were included. Socio-demographic information, levels of psychological maladjustment, such as anxiety, hostility, and job stress, health-related quality of life (HRQoL), and primary and secondary control strategy use were collected through self-report questionnaires.ResultsThere was no significant difference between the ACS group and control group in levels of anxiety, hostility, and job stress. However, ACS patients had significantly lower scores on the general health perception and bodily pain subscales of HRQoL than the control group. The ACS group, as compared with the controls, tended to use primary control strategies more, although not reaching statistical significance by univariate analysis. Multivariate logistic regression analysis after adjusting age and gender identified the physical domain of HRQoL {odds ratio (OR)=0.40}, primary control strategy (OR=1.92), and secondary control strategy (OR=0.53) as independent predictors of ACS.ConclusionPoor HRQoL and primary control strategy, proactive behaviors in achieving ones' goal, may act as risk factors for ACS, while secondary control strategy to conform to current situation may act as a protective factor for ACS.

Quality of life and stressors in patients with chronic kidney disease depending on treatment.

This study evaluated health-related quality of life (HRQOL) in a Spanish sample of chronic kidney disease patients (n = 90) undergoing different renal replacement therapies, considering the influence of treatment stressors, mood, anxiety and quality of sleep. While all patients had worse physical functioning than controls (p < .01), only those undergoing haemodialysis (HD) showed worse physical well-being, occupational functioning, spiritual fulfillment and more health interference with work (p < .05). They also obtained higher depression scores than renal transplant patients (TX) (p = .005). Those TX receiving the immunosuppressor sirolimus exhibited more cardiac/renal, cognitive and physical limitations than the rest (p < .05). Dialysis vintage correlated positively with sleep disturbances and depression scores and negatively with total Quality of Life (QLI) (p < .05). HD patients experienced more psychological distress than peritoneal dialysis patients (PD) (p = .036). Regression models including sleep, anxiety and depression were estimated for subscales of HRQOL. In TX patients, low depressive scores related to an optimal QLI in almost all subscales, while in HD patients they explained part of the variability in psychological well-being, interpersonal functioning and personal fulfillment. HD condition results in a QLI more distant to the standards of controls.

Quality of life in children with CF: Psychometrics and relations with stress and mealtime behaviors.

The purpose of this study was to evaluate the utility of the Cystic Fibrosis Questionnaire-Revised (CFQ-R) with toddlers and preschool-aged children. Clinically relevant relations between health-related quality of life (HRQOL), stress, and mealtime behaviors have not been examined. It was hypothesized that problematic mealtime behaviors and increased stress would be negatively associated with HRQOL. Parents of 73 children (2-6 years) with CF completed questionnaires assessing their children's generic (PedsQL) and CF-specific HRQOL, parenting and CF-specific stress, and mealtime behaviors. CFQ-R Physical, Eating, and Respiratory HRQOL subscales had acceptable to strong reliability (alphas = 0.73-0.86); other scales approached acceptable reliability. Lower CF-specific stress was associated with higher CFQ-R Eating HRQOL (B = -0.84; P < 0.05) scores. Fewer eating problems were associated with higher CFQ-R Eating (B = -1.17; P < 0.0001) and Weight HRQOL (B = -0.78; P < 0.01) scores. As hypothesized, problematic eating and higher CF-specific stress was associated with lower CF-specific HRQOL. The CFQ-R has promise for use in young children with CF, but will need to be modified to exchange items not relevant to preschoolers with items that are more relevant to this age group.

Weight loss is not mandatory for exercise-induced effects on health indices in females with metabolic syndrome.

The aim of this study was to investigate the impact of moderate aerobic training on functional, anthropometric, biochemical, and health-related quality of life (HRQOL) parameters on women with metabolic syndrome (MS). Fifteen untrained women with MS performed moderate aerobic training for 15 weeks, without modifications of dietary behaviours. Functional, anthropometric, biochemical, control diet record and HRQOL parameters were assessed before and after the training. Despite body weight maintenance, the patients presented decreases in waist circumference (P = 0.001), number of MS components (P = 0.014), total cholesterol (P = 0.049), HDL cholesterol (P = 0.004), LDL cholesterol (P = 0.027), myeloperoxidase activity (P = 0.002) and thiobarbituric acid-reactive substances levels (P = 0.006). There were no differences in total energy, carbohydrate, protein and lipid intake pre- and post-training. Furthermore, improvements in the HRQOL subscales of physical functioning (P = 0.03), role-physical (P = 0.039), bodily pain (P = 0.048), general health (P = 0.046) and social functioning scoring (P = 0.011) were reported. Despite the absence of weight loss, aerobic training induced beneficial effects on functional, anthropometric, biochemical and HRQOL parameters in women with MS.

Psychosocial factors related to the use of InterStim® for the treatment of refractory overactive bladder.

Sacral neuromodulation is a well-established treatment of refractory overactive bladder (OAB). Although literature exists on the psychosocial impact of other implanted medical devices, data do not exist for InterStim therapy. We aim to evaluate the relationship between optimism and treatment satisfaction in women undergoing InterStim for refractory OAB and change in OAB symptoms. Adult women undergoing InterStim therapy for refractory OAB completed a series of validated questionnaires before test stimulation assessing optimism, urinary symptom severity, depression, and body image. Questionnaires included the Life Orientation Test-Revised, OAB Questionnaire-Short Form, Major Depression Inventory, and a body image scale. Three months postoperatively, participants repeated the questionnaires to assess urinary symptoms, depression, and body image and completed the OAB Satisfaction with Treatment Questionnaire (OAB-SAT-q). Correlations assessed the relationship between the Life Orientation Test-Revised score and OAB-SAT-q subscale scores, and the OAB questionnaire subscale change scores. Subjects also completed the nonvalidated questions aimed at patients concerns regarding the implanted devices preoperatively and postoperatively. Twenty-eight women were included. Level of optimism was weakly correlated with subject satisfaction across all OAB-SAT-q subscales (r value of -0.11, -0.21, -0.42, and -0.20 for satisfaction, endorsement, adverse effects, and convenience, respectively). Optimism had a weak correlation with change in OAB symptoms in symptom severity and health-related quality of life subscales. Comparison of preoperative and postoperative questionnaires demonstrated statistically significant improvements in depression, body image, symptom severity, and health-related quality of life. Patients concerns regarding implanted devices changed only marginally. The level of optimism did not correlate with satisfaction with InterStim treatment, change in OAB symptoms, or OAB-related quality of life. Health-related quality of life, OAB symptoms, depression, and body image improved after InterStim treatment.

Improvements in Health-Related Quality of Life by Comprehensive Cancer Pain Therapy: A Pilot Study with Breast Cancer Outpatients under Palliative Chemotherapy

Background: Cancer-related pain is highly prevalent among outpatients with metastatic breast cancer affecting their health-related quality of life (HRQoL). This study evaluates potential effects of comprehensive pharmacologic cancer pain therapy (CPT) on HRQoL. Patients and Methods: 52 outpatients with metastatic breast cancer undergoing palliative chemotherapy participated. 28 patients suffering from moderate to severe cancer pain were offered CPT. 13 patients participated (intervention group), and 15 declined participation (control group). HRQoL was assessed with the Quality of Life Questionnaire (EORTC QLQ-C30) and the breast module QLQ-BR23 at baseline and after 3 weeks. Results: At baseline, 83% of the patients experienced cancer-related pain, of whom 35% were not prescribed any pain medication. HRQoL of all patients was reduced compared to reference scores. After CPT, the intervention group reported significantly alleviated pain and improvement in several HRQoL subscales (Global QoL, Emotional Functioning, Physical Functioning, Future Perspective, Sleeplessness). The control group did not change significantly. Conclusion: This study emphasizes the demand for sufficient pain management in palliative breast cancer outpatients. The combination of CPT as a guidance for the pharmacological aspects of cancer pain management and the EORTC QLQ-C30 as an assessment and surveillance tool appears to be a method that warrants further research.

Association of 25(OH)D Serum Concentrations on Health-Related Quality of Life among Patients with Low Vitamin D

Objective. To determine the association between 25-hydroxyvitamin D [25(OH)D] serum concentrations and health-related quality of life (HRQoL) among patients with low vitamin D levels. Methodology. This prospective cohort study included 76 patients (ages 18 to 59; 54 females and 22 males) who had baseline 25(OH)D below 30 ng/ml and were prescribed a Vitamin D supplement for eight weeks. HRQoL was assessed at baseline and after 8 weeks through the Functional Assessment of Non-Life Threatening Conditions (FANLTC) questionnaire. Results. HRQoL of the participants who were Vitamin D deficient and insufficient at baseline were basically the same (p-values > 0.05). After supplementation, the personal well-being and overall HRQoL of the participants who were Vitamin D sufficient were significantly higher than those who were Vitamin D deficient or insufficient (p-values < 0.05). Moreover, after supplementation, all the HRQoL subscale scores as well as the total HRQoL scores of the participants were significantly higher than their baseline HRQoL scores (p-values < 0.05). Conclusion. The improved HRQoL scores after Vitamin D supplementation showed that there is a significant association between 25(OH)D serum concentrations and HRQoL.

Impact of psychological and cancer-related factors on HRQoL for Korean childhood cancer survivors.

The purposes of this study were (1) to compare health-related quality of life (HRQoL) between Korean childhood cancer survivors and healthy controls and (2) to examine the impact of demographic, diagnosis/treatment, and psychological variables on physical and psychosocial health in survivors. The HRQoL (PedsQL), Self-Concept Inventory, and Child Behavior Checklist were administered to childhood cancer survivors, age/gender-matched healthy counterparts, and their parents. Independent-samples t tests and hierarchical multiple regression analyses were conducted. Compared with healthy controls, childhood cancer survivors reported significantly lower scores across physical and psychosocial HRQoL. For survivors, demographic, diagnosis/treatment, current health status, and psychological variables explained more than 50 % of the variance in both subscales of HRQoL. Especially, self-concept, a psychological variable, explained a significant portion of the variance in physical and psychosocial HRQoL after controlling for cancer-related factors. Several cancer-related factors including time since treatment completion, having a history of allogeneic hematopoietic stem cell transplantation, multiple treatment modalities, and suffering from severe late effects also associated with specific dimension of HRQoL. Childhood cancer survivors do experience lower level of QoL and psychological factors, especially self-concept, should be considered when supporting the well-being of childhood cancer survivors.

P0132 A longitudinal prospective analysis of depression, anxiety, and quality of life in patients with hepatocellular carcinoma

Background Despite an increased focus on health-related quality of life (HRQoL) among patients after hepatocellular carcinoma (HCC) surgery, less attention has been given to the psychological well-being of these patients. We aimed to evaluate long-term trends of each subscale of HRQoL and to explore the association between depression, anxiety, and HRQoL. Methods This prospective study analysed 284 HCC patients at three tertiary academic hospitals. All patients completed the FACT-Hep, EORCT QLQ-C30, SF-36, Beck Depression Inventory II (BDI), and Beck Anxiety Inventory (BAI) at baseline and at 6 months, 1 year, and 2 years postoperatively. Higher scores indicated better functional status or worse symptomatic problems. Generalised estimating equations (GEE) model was used to assess trends and derived post-operative 6-month BDI and BAI to predict HRQoL. Findings A 2-year follow-up survey of the examined population revealed significant improvement in each subscale of HRQoL (p Interpretation When evaluating changes in trend of HRQoL after HCC surgery, we found almost all HRQoL subscale scores were improved after 6 months to 1 year, but that HRQoL scores after 2 years were lower than those after 1 year. After HCC surgery, many patients experienced anxiety and depressive symptoms that are strongly associated with poor HRQoL. More attention should be focused on surgical/medical approaches that minimise the negative impact of HRQoL outcomes.

Coexistence of urinary incontinence and major depressive disorder with health-related quality of life in older Americans with and without cancer.

This study evaluates the prevalence and factors associated with major depressive disorder (MDD) in a population of cancer survivors and the impact of co-occurring MDD and urinary incontinence (UI) on health-related quality of life (HRQOL). The prevalence of MDD risk among cancer survivors (breast, prostate, bladder, colorectal, lung, and endometrial/uterine cancers) and those without cancer was estimated using the Surveillance, Epidemiology and End Results Program-Medicare Health Outcomes Survey (SEER-MHOS) linked database (n = 9,282 with cancer/n = 289,744 without cancer). Risk for MDD was measured using three items from the Diagnostic Interview Schedule, and HRQOL was measured by the SF-36. UI was defined as self-reported leakage of urine causing a problem in previous 6 months. Factors associated with MDD were investigated using logistic regression, and the impact of co-occurring MDD and UI on HRQOL scores was determined using linear regression. The prevalence of MDD risk ranged from 19.2 % for prostate to 34.1 % for lung. Lung cancer diagnosis was associated with risk of MDD. Being ≥5 years from diagnosis was associated with decreased risk of MDD (prevalence odds ratio (POR) = 0.82, 95 % confidence interval (95 % CI) 0.71, 0.95). The coexistence of both UI and MDD was associated with a decrease across HRQOL subscales; including 40 points on role-emotional (RE) score. Cancer survivors reporting co-occurrence of UI and MDD experienced significant decrements in HRQOL. Understanding the combined effect of UI and MDD may help clinicians to better recognize and alleviate their effects on cancer survivors' HRQOL.

Gender Differences in Psychological Distress and Quality of Life in Patients with an ICD 1‐Year Postimplant

Gender differences in patient-reported outcomes in patients with an implantable cardioverter defibrillator (ICD) have been researched, but findings are inconclusive and mostly based on cross-sectional study designs. To gain a better insight into potential determinants of psychological distress and health-related quality of life (HQOL), we examined the relationship between gender and patient-reported outcomes in patients with an ICD in the first year after ICD implantation. Consecutive patients (N = 300) receiving an ICD between September 2007 and February 2010 at Medisch Spectrum Twente hospital, the Netherlands, completed several questionnaires to assess psychological distress and HQOL prior to ICD implantation and at 2 months, 5 months, 8 months, and 12 months postimplantation. Correcting for clinical confounders (e.g., left ventricular ejection fraction, ICD indication, comorbidities, ICD shocks), women reported higher levels of anxiety (P = 0.021) and shock-related anxiety (P = 0.047) than men in the course of a year. On most HQOL subscales, no gender differences were found, except for subscale Physical functioning, where women reported higher levels of improvement compared to men (P = 0.008). Gender was independently associated with poorer device-related acceptance, but only on the Florida Patient Acceptance Scale domain Body image concerns (P = 0.043), with women expressing higher levels of concerns about their body image compared to men. Women report higher levels of general and shock-related anxiety, and higher levels of body image concerns than men. Women showed more improvement in physical functioning. Screening patients before and after ICD implantation for general and shock anxiety may help determine patients who could benefit from psychological counseling.

Visualization and dynamics of multidimensional health-related quality-of-life-adjusted overall survival: a new analytic approach

Vesnarinone Trial (VesT) was a three-armed, placebo-controlled, randomized clinical trial designed to study the effects of 30 mg or 60 mg/day vesnarinone. Certain contradictory results involving patient health-related quality-of-life (HRQOL) and overall survival (OS) have made a definitive and unified conclusion difficult. To reconcile these findings, we have focused on the HRQOL-adjusted OS, commonly known as quality-adjusted life years (QALYs). Currently, analyses of QALYs incorporate a single HRQOL subscale. However, the VesT HRQOL instrument had two subscales: physical (PHYS) and emotional (EMOT). We have developed new ways to visualize and compare EMOT- and PHYS-adjusted OS. In each VesT arm, there was an increased probability of superior EMOT-adjusted OS, compared to PHYS-adjusted OS. The magnitude of these findings was comparable across trial arms. Despite inferior survival and superior EMOT and PHYS scores, the 60-mg/day arm presents similar EMOT- and PHYS-adjusted OS compared to the placebo arm. We have provided a fresh perspective on the complex interactions between multiple HRQOL dimensions and OS. These novel methods address the burgeoning need for robust information on the interplay between OS and HRQOL from a patient, clinical care and public policy perspective.

Quality of life in war-related hip disarticulation in Iran.

The aim of the study was to evaluate health-related quality of life in veterans with hip disarticulation suffered during the Iran-Iraq War. All war-related injured with hip disarticulation were invited to a 7-day recreational camp. Of 183 subjects, 76 participated in this study. The impact of hip disarticulation on quality of life was measured using the 36-item short form health survey and compared with the scores of the general public. Mean age at the time of interview was 44.1±6.98 years. The lowest score of health-related quality of life subscales was bodily pain (32.88±33.20). The health-related quality of life in veterans with hip disarticulation was significantly lower than the general public in all subscales (p<0.05), with the exception of vitality (p=0.114). Veterans with hip disarticulation due to war suffer from poor health-related quality of life. Appropriate interventions and rehabilitation programs are recommended to enhance quality of life in such patients.

Factors Associated with Health-Related Quality of Life among Saudi Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Survey.

BackgroundDiabetes mellitus (DM) is associated with high mortality, morbidity, poor general health, and loss of health-related quality of life (HRQOL). The objective of the study was to assess the factors associated with HRQOL among patients with type 2 diabetes mellitus (T2DM).MethodsThis was a cross sectional study conducted among 283 T2DM patients during June 2011 and September 2012 at a major tertiary hospital in Riyadh, Saudi Arabia. The respondents were purposively and conveniently selected according to their availability during their routine visit to the outpatient clinics and they were interviewed using the Arabic version of the Short-Form 36-item survey (SF-36) to assess the HRQOL.ResultsThe mean age of the participants was 56.4±13.2 years. Around 63% (178) were males and 37% (105) were females. Glycosylated hemoglobin level was found to be significantly higher among female and HRQOL was higher among male. Respondents who were more than 50 years old had poor HRQOL than less than 50 years age group. Poor economic status, reported diabetic complications and longer duration of diabetes were significantly associated with poor HRQOL. The respondents treated with combination of therapies (oral medication plus insulin) indicated better HRQOL than patients with insulin therapy alone. Multivariate analysis indicated that gender, economic status (except subscale energy), and complications of DM (except subscale energy) as independent risk factor for HRQOL.ConclusionGender, economic status, and complication of DM were independent risk factors for majority of the subscales of HRQOL.

Body mass index (BMI)‐for‐age and health‐related quality of life (HRQOL) among high school students in Tehran

The study aimed to determine the association between body mass index (BMI)-for-age and health-related quality of life (HRQOL) among high school students in Tehran. A total of 465 high school students (227 girls and 238 boys) and their parents were participated in this cross-sectional study. Body weight and height of the students were measured. For assessing HRQOL, both adolescent self-report and parent proxy-report of the Persian version of Pediatric Quality of Life Inventory (PedsQL™4.0) questionnaire were completed by adolescents and their parents respectively. The prevalence of overweight and obesity (38.5%) was higher than severe thinness and thinness (2.8%). Mean of adolescent self-reported and parent proxy-reported HRQOL total score were 80.26 ± 12.07 and 81.30 ± 14.08 respectively. In terms of HRQOL subscale scores, the highest subscale score of HRQOL was reported in social functioning (87.27 ± 14.40) and the lowest score was reported in emotional functioning (69.83 ± 18.69). Based on adolescent self-report, adolescent boys had significantly higher mean score for total and all subscale scores of HRQOL compared with girls (P < 0.05). BMI-for-age was inversely correlated to adolescent self-reported HRQOL total score (r = -0.25, P < 0.05). Based on adolescents self-report, HRQOL total score was significantly different by body weight status (F = 16.16, P < 0.05). Normal weight adolescents had significantly higher HRQOL total score compared with overweight (mean difference: 7.32; P < 0.05) and obese adolescents (mean difference: 9.10, P < 0.05). The HRQOL total score was not significantly different between normal weight and underweight adolescents (mean difference: 1.65, P = 0.96). However, based on parent proxy-reports, HRQOL total score was not significantly different by body weight status (F = 2.64, P = 0.059). More than one-third of adolescents were overweight and obese. BMI-for-age was inversely correlated to adolescent self-reported HRQOL. Based on adolescents' perspective, overweight and obese adolescents had poorer HRQOL compared with normal weight adolescents. Intervention studies are needed to improve the HRQOL of overweight and obese adolescents in Tehran.

The impact of comorbidity on Health-Related Quality of Life among cancer survivors: analyses of data from the PROFILES registry

The aim of this study was to assess the difference in explained variance of Health-Related Quality of Life (HRQoL) between comorbidity, sociodemographic characteristics and cancer characteristics. This association was assessed among thyroid cancer, colorectal cancer, and (non-)Hodgkin's lymphoma patients. Data from three large population-based surveys on survivors of thyroid cancer, colorectal cancer, and (non-)Hodgkin's lymphoma were used. Cancer-specific HRQoL was assessed with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) of which physical function, emotional function, fatigue, and pain were included in the analyses. Comorbidity was assessed using the Self-reported Comorbidity Questionnaire. The association between comorbidity and HRQoL was assessed with multivariate linear regression models. Semi-partial R (2) was reported to assess the amount of variance in HRQoL explained by comorbidity in comparison with sociodemographic and cancer characteristics. In total, 3,792 cancer survivors were included in this analysis. The variance in HRQoL subscales explained by comorbidity was higher compared with sociodemographic and cancer characteristics for physical function (11-17 vs. 2-4 and 1-2%, respectively) and emotional function (7-17 vs. 1-3 and 1-3%, respectively), regardless of cancer type. In addition, comorbidity explained 7-20 and 11-13% of the variance in pain and fatigue, respectively, compared to 0-4% for both sociodemographic and cancer characteristics. Osteoarthritis and back pain were strongly associated with physical function and pain, while depression was strongly associated with emotional function. Depression and back pain were strongly associated with fatigue. This study showed that comorbidity explained more variance in physical and emotional function, pain, and fatigue in comparison with sociodemographic and cancer characteristics in cancer survivors, regardless of cancer type. Our findings emphasize the importance of adjusting for the presence of comorbid diseases when assessing HRQoL in cancer survivors. Cancer survivors suffering from comorbid diseases experience lower levels of health-related quality of life. Clinicians should become more aware of the impact of comorbidity on HRQoL and provide necessary psychological support to assist self-management of comorbid diseases.

Willingness to undergo surgery again validated clinically important differences in health-related quality of life after total hip replacement or total knee replacement surgery

ObjectivesTo determine clinically important differences (CIDs) in health-related quality of life (HRQoL) after total hip replacement (THR) or total knee replacement (TKR) surgery, using the Short Form 36 (SF-36). Study Design and SettingSF-36 scores were collected 2 weeks before and at 1.5–6 years after joint replacement in 586 THR and 400 TKR patients in a multicenter cohort study. We calculated distribution-based CIDs (0.8 standard deviations of the preoperative score) for each SF-36 subscale. Responders (patients with an improvement in HRQoL ≥ CID of a particular subscale) were compared with nonresponders using an external validation question: willingness to undergo surgery again. ResultsCIDs for THR/TKR were physical functioning (PF), 17.9/16.7; role-physical (RP), 31.1/33.4; bodily pain (BP), 16.8/16.2; general health, 15.5/15.7; vitality, 17.3/16.7; social functioning (SF), 22.0/19.9; role-emotional, 33.7/33.6; and mental health, 14.8/14.1. CIDs of PF, RP, BP, and SF were validated by the validation question. ConclusionValid and precise CIDs are estimated of PF, RP, BP, and SF, which are relevant in HRQoL subscales for THR and TKR patients. CIDs of all other subscales should be used cautiously.