Subsequent Quality Of Life Research Articles

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Introduction: Delirium in medical and surgical ICU patients is a predictor of worse clinical outcomes, but there are few data concerning neurological ICU patients. Hypothesis: We tested the hypothesis that delirium is associated with length of stay, functional outcomes and domain-specific quality of life in patients with acute intraparenchymal hemorrhage (IPH) and subarachnoid hemorrhage (SAH). Methods: This is a prospective, observational cohort study. Delirium was routinely assessed twice daily using the Confusion Assessment Method for the ICU (CAM-ICU) by trained staff. Delirium was defined as a change from the “new baseline” of neurologic status at hospital admission as previously published. Functional outcomes were recorded with modified Rankin Scale (mRS, scored from 0, no symptoms to 6, dead), and quality of life (QOL) outcomes were assessed with NIH Patient Reported Outcomes Measurement Information System (PROMIS) and Neuro-QOL at 28 days, 3 months and one year. Results: We enrolled a total 143 patients, 84 with IPH and 59 with SAH. Sixteen patients were not assessable due to persistent coma. Of 127 remaining, 41 (32%) had delirium. ICU and hospital length of stay, when considered as time-dependent covariates, were associated with delirium (P<0.001) after correction for Glasgow Coma Scale (GCS), any benzodiazepine use, and admitting diagnosis. In patients with SAH, levetiracetam was associated with delirium, although seizures were rare. Delirium was associated with worse mRS at 28 days (4 [3-5] vs. 3 [1-5], P=0.008) and 3 months (3 [2-5.75] vs. 2 [0-4], P=0.004). In mixed models, delirium was associated with worse QOL scores in the domains of applied cognition – executive function and general concerns after adjustment for age, admission diagnosis, point of follow-up and GCS. Conclusions: Delirium was common after SAH and IPH and predictive of subsequent worse functional and QOL outcomes (especially applied cognition) although benzodiazepine use and infection were uncommon. Further study should determine if the underlying risk factors for delirium are modifiable, and this may lead to better outcomes.

P82 Effect of Hospitalisation For Acute Exacerbations of COPD on Subsequent Quality of Life

BackgroundThe longitudinal change in quality of life (QoL) following hospitalisation for acute exacerbations of COPD (AECOPD) is uncertain. Current guidelines suggest that non-invasive ventilation (NIV) should not be considered if...

New Reconstructive Technologies after Decompressive Craniectomy in Traumatic Brain Injury: The Role of Three-Dimensional Titanium Mesh

Functional and aesthetic reconstruction after wide decompressive craniectomy directly correlates with subsequent quality of life. Advancements in the development of biomaterials have now made three-dimensional (3-D) titanium mesh a new option for the repair of skull defects after craniectomy. The purpose of this study was to review aesthetic and surgical outcomes and complications of patients who had skull defects repaired with 3-D titanium mesh. The records of 40 adult patients (31 unilateral craniectomies and 9 bilateral craniectomies) who underwent a computer-assisted designed titanium mesh implant at a university hospital from January 2008 to January 2010 were retrospectively reviewed. Aesthetic outcomes, cranial nerve V and VII function, and complications (hardware extrusions, meningitis, osteomyelitis, brain abscess, and pneumocephalus) were evaluated. The craniofacial symmetry, implant stability, and functional outcomes were excellent for all patients. No patients had trigeminal or facial dysfunction. All had excellent cosmetic results as measured by post-reduction radiographs and personal and family perceptions of the forehead contour. Two patients had delayed wound healing and subsequent subclinical wound infections, which resolved after treatment with antibiotics for 2 weeks. Craniofacial skeletal reconstruction with 3-D titanium mesh results in excellent forehead contour and cosmesis, and subsequently a better quality of life with few complications. Titanium mesh reconstruction offers a favorable alternative to other graft materials in the repair of large skull defects.

Grasping the Nettle and Femoral Artery Stenting

When brushed against, needles on the leaves of nettles inject a noxious toxin into the skin. However, grasping the nettle firmly bends the needles away from the skin, rendering it is less painful. The expression “to grasp the nettle” is to boldly confront an issue in order to seek its resolution. The advice warns us against half measures and is timely as we gather scientific evidence to assess the value of percutanous (and surgical approaches) to treating peripheral artery disease (PAD). Article see p 495 Claudication and critical limb ischemia are the 2 symptomatic manifestations of PAD. Although they share a common pathology (atherosclerosis) and a high risk of death from cardiovascular causes, their natural histories differ. Claudication impairs patient quality of life by causing painful cramps and dysfunction (eg, limping) while walking. Patients learn to avoid walking or to stop and rest when they claudicate until the discomfort eases. Over several years, symptoms may improve with collateral flow or metabolic adaption in muscle.1 However, many patients experience a progressive decline in walking and subsequent quality of life and independence. Fortunately, claudication rarely progresses to critical limb ischemia and limb loss (<2% per year).2 On the other hand, critical limb ischemia is characterized by rest pain, nonhealing or poorly healing ulcers, or gangrene and more extensive tissue loss. Although this is a smaller group of symptomatic PAD, the immediate risks are to the limb, with subsequent loss of function and independence related to the level of amputation.3 Vascular bypass surgery offers a viable treatment for patients with critical limb ischemia, but traditional surgical practice limits bypass surgery to all but the most severe cases of claudication. This hesitancy is based on small, but definite perioperative risks of death and cardiovascular events,4 the long-term risks of graft …

Fertility Preservation in Prepubertal Girls Prior to Chemotherapy and Radiotherapy—Review of the Literature

Significant improvement in the survival rates of children with pediatric cancers has been achieved over the last 25 years, so the number of long-term survivors is increasing and their subsequent quality of life is of increasing importance. One of the most serious side effects of chemotherapy or radiotherapy is damage to the ovarian function, which can lead to loss of fertility. The degree of this damage depends on the substances used, the dose of radiotherapy reaching the ovaries, and the age of the girl at the time of treatment. Up to now, the only established method of fertility preservation has been cryoconservation of fertilized egg cells or embryos, but this is not possible in prepubertal girls because of their sexual immaturity.Removal of ovarian tissue and subsequent cryoconservation with the option of later orthotopic retransplantation is therefore an option to these girls. This method can lead to pregnancy and birth in adult women. Up to now there are no studies about the retransplantation of ovarian tissue which was removed before puberty.Displacement of the ovaries away from the radiation field before radiation to the pelvic area can be considered; however, the data is controversial.One problem in the use of fertility preservation methods in these very young patients is that they undergo procedures which, because of their age, they mostly do not understand and the parents must make a decision based on the assumed later wishes of their daughter.

Active Patient Decision Making Regarding Nerve Sparing During Radical Prostatectomy: A Novel Approach

The motivation to preserve sexual function can vary widely among patients before prostatectomy. Increasing patient involvement may allow a more personalized experience and may improve satisfaction. We assessed a strategy of surgeon deference to patient choice in regard to nerve sparing to determine to what degree patients are rational actors and capable of active decision making. A total of 150 patients treated with prostatectomy participated in a standardized preoperative discussion regarding the concept of nerve sparing, extracapsular extension and the potential need for adjuvant radiation in the event of local recurrence. Each patient was given his nomogram predicted risk of extracapsular extension and then elected nerve sparing or nonnerve sparing. The corresponding procedure was performed unless grossly invasive disease was encountered. Of the 150 patients 109 chose nerve sparing (73%) and 41 chose nonnerve sparing (27%). In patients with a nomogram predicted risk of extracapsular extension less than 20%, 20% to 50% and greater than 50%, nerve sparing was elected by 88%, 41% and 25%, respectively. Patients with lower risks of extracapsular extension electing nonnerve sparing were older and had higher rates of erectile dysfunction. Empowering patients to decide on their nerve sparing status is a reasonable strategy that did not lead to a high rate of patients with a high risk of extracapsular extension electing nerve sparing. With proper counseling informed patients made reasonable decisions, and appeared to be conservative, prioritizing cancer control in the majority of instances where extracapsular extension risk was high. In addition, they may have been overly conservative in electing nonnerve sparing when the risk was low.

Physical Self-Perceptions, Body Size, and Exercise Among Breast Cancer Survivors

The diagnosis of breast cancer and subsequent treatment often results in physical and psychological challenges. Because cancer treatment can have a negative effect on physical self-perceptions (PSP) and quality of life (QOL), it is important to investigate this relationship and develop strategies to help survivors address these factors. PURPOSE: To explore the relationship of exercise behavior, fitness, body size and PSP among women recently diagnosed with Stage II and III breast cancer receiving neoadjuvant chemotherapy and to examine the association between PSP and QOL. METHODS: Women (n=40) participated in a pilot study of a weight gain prevention intervention for breast cancer survivors combining exercise and dietary approaches. We analyzed baseline data using correlation analysis to examine associations among PSP, exercise, fitness measures, body size, and QOL measures. RESULTS: There were significant negative correlations between Body Mass Index (BMI) and PSP for attractive body, physical function, self-worth and (rs= -.52, -.56, -.58); however, fitness measures were not associated with PSP scores. Women who reported participating in ≥150 minutes of moderate physical activity per week had significantly higher PSP physical function scores (t(13)=2.43, p=.01). We found significant positive associations between PSP for physical function and QOL including vitality (r=.48), role emotional (r=.43), general health (r =.42) social (r=.39) and physical (r=.37) functioning as measured by the MOS SF-36. CONCLUSION: Women participating ≥150 per week of moderate physical activity had significantly higher perceptions physical function, and PSP of physical function was associated with QOL among women recently diagnosed with Stage II and III breast cancer. Examining how PSP might affect survivors' receptivity to a weight gain prevention intervention during treatment, and the influence of such an intervention on subsequent self-perceptions and QOL could inform future weight management intervention development for survivors.

Evaluation and Preservation of Fertility in Patients with Testicular Cancer.

Young men presenting with testicular cancer enjoy a very high prospect of cure and look forward to an average of 40 additional years of life. As such, emphasis has focused on care algorithms that are not only curative, but also minimize the consequences of the disease and associated treatments on subsequent quality of life. Concerns regarding therapy-related second malignancies and cardiovascular disease have led to management strategies emphasizing the reduction or elimination of chemotherapy and radiation therapy and increase utilization of surveillance for early-stage patients. Germ cell tumors present typically in the late 20s or early 30s, occurring in a timeframe when many young men begin to consider their families seriously. Indeed, more than 80% of young patients report significant concerns regarding diminished fertility. The biology and anatomy of most germ cell tumors lead to significant potential for disrupted fertility from both disease-related factors-hypogonadism and diminished native spermatogenesis-and manifold treatment-related complications such as ejaculatory dysfunction, chemotherapy, and radiation effects on spermatogenesis and testosterone production. Despite these unique challenges of managing fertility in patients with germ cell tumors, such efforts are rewarded with a high rate of fertility preservation for most patients with no evidence that subsequent progeny are affected by the parent's disease or treatments. Herein, we review the biological and clinical issues associated with reduced fertility potential in patients with germ cell tumors, methods for evaluating and preserving fertility in such patients, and anticipated overall success rates.

In home or at home? How collective decision making in a new care facility enhances social interaction and wellbeing amongst older adults

ABSTRACTBenevolent, long-term care can threaten older adults' sense of autonomy in a residential home environment. Increasing reliance on a hotel style of living has been seen to erode social identity, life satisfaction and even survival or lifespan. Drawing on evidence from both gerontological and social psychological literature, this paper examines the links between the empowerment of residents and their subsequent quality of life in the context of a move into a new care facility in a medium-sized town in South-West England. A longitudinal experiment was conducted during which 27 residents on one floor of a new facility were involved in decisions surrounding its décor, while those on another floor were not. The residents' attitudes and behaviour were monitored at three points over five months (four weeks pre-move, four weeks post-move, and four months post-move). Consistent with the social identity literature, members of the empowered group reported increased identification with staff and fellow residents in the new home, displayed enhanced citizenship, reported improved wellbeing, and made more use of the communal space. Moreover the staff found the empowered residents to be more engaged with their environment and the people around them, to be generally happier and to have better health. These patterns were observed one month after the move and remained four months later. Some implications for theory and practice are discussed.

Estimating prognosis and palliation based on tumour marker CA 19-9 and quality of life indicators in patients with advanced pancreatic cancer receiving chemotherapy

Background:To investigate the prognostic value of quality of life (QOL) relative to tumour marker carbohydrate antigen (CA) 19-9, and the role of CA 19-9 in estimating palliation in patients with advanced pancreatic cancer receiving chemotherapy.Methods:CA 19-9 serum concentration was measured at baseline and every 3 weeks in a phase III trial (SAKK 44/00–CECOG/PAN.1.3.001). Patients scored QOL indicators at baseline, and before each administration of chemotherapy (weekly or bi-weekly) for 24 weeks or until progression. Prognostic factors were investigated by Cox models, QOL during chemotherapy by mixed-effect models.Results:Patient-rated pain (P<0.02) and tiredness (P<0.03) were independent predictors for survival, although less prognostic than CA 19-9 (P<0.001). Baseline CA 19-9 did not predict QOL during chemotherapy, except for a marginal effect on pain (P<0.05). Mean changes in physical domains across the whole observation period were marginally correlated with the maximum CA 19-9 decrease. Patients in a better health status reported the most improvement in QOL within 20 days before maximum CA 19-9 decrease. They indicated substantially less pain and better physical well-being, already, early on during chemotherapy with a maximum CA 19-9 decrease of ⩾50% vs <50%.Conclusion:In advanced pancreatic cancer, pain and tiredness are independent prognostic factors for survival, although less prognostic than CA 19-9. Quality of life improves before best CA 19-9 response but the maximum CA 19-9 decrease has no impact on subsequent QOL. To estimate palliation by chemotherapy, patient's perception needs to be taken into account.

Weekly rituximab followed by monthly rituximab treatment for steroid-refractory chronic graft-versus-host disease: results from a prospective, multicenter, phase II study

Since it was suggested that B cells play a role in the pathogenesis of chronic graft-versus-host disease, rituximab, an anti-CD20 monoclonal antibody targeting B cells, has been shown to be effective in steroid-refractory, chronic graft-versus-host disease. However, most of the data were from small numbers of patients or retrospective analyses. We, therefore, conducted a multicenter phase II study to confirm the efficacy of this treatment strategy that targets B cells. We diagnosed and evaluated chronic graft-versus-host disease according to the National Institute of Health criteria for clinical trials on this condition. The treatment consisted of weekly intravenous infusions of rituximab for 4 weeks followed by monthly rituximab for 4 months. We evaluated the patients' responses and monitored their disease activity until their final visit, which was on day 365. We also assessed the patients' subsequent quality of life and serum levels of B-cell-activating factor of the tumor necrosis factor family. Among 37 patients enrolled (median age, 29 years; range 8-57 years), 32 patients responded to rituximab with 8 complete and 24 partial responses. Twenty-one patients maintained their response for 1 year, so their steroid treatment was discontinued or its dose reduced (21/37, or 56.8%), and their scores representing quality of life were improved although these changes were not statistically significant. The responses were better for clinical manifestations of the skin, oral cavity and musculoskeletal system (response rate, 71.4-100%) than for other organs. However, infectious complications and primary disease relapse accounted for the majority of treatment failure. The pre-treatment serum level of B cell-activating factor of the tumor necrosis factor family was not associated with better treatment outcome (P=0.147). Rituximab could improve clinical responses and quality of life of patients with steroid-refractory chronic graft-versus-host disease, although such patients may need active prophylaxis against infection.

Early identification of students with support needs in mental health

In Australia 14 percent of adolescents will have mental health problems, but unfortunately, only a quarter of these adolescents will be identified and therefore will be able to access help. It is for this reason that schools must strive to identify mental health problems in their students, while at the same time offer appropriate treatment, or referral to other agencies which can provide appropriate treatment.If these students are not identified, they are not referred and therefore are left untreated, often with compounding problems. Commitment to identification of student mental health needs must be a priority to ensure that young people have the access to support which is needed to improve their mental health and subsequent quality of life.

Cancer Survivorship Across the Healthcare Continuum

Cancer Survivorship Across the Healthcare Continuum

A Longitudinal Analysis of Patient Satisfaction and Subsequent Quality of Life in Hong Kong Chinese Breast and Nasopharyngeal Cancer Patients

We evaluated the longitudinal course of the relationship between patient satisfaction and quality of life (QoL) in Chinese breast and nasopharyngeal cancer patients. A sample of Chinese breast (n = 250) and nasopharyngeal (n = 242) cancer patients were assessed during their first outpatient visit (baseline) and at 2 follow-up interviews (FU1 and FU2). The Chinese version of the Functional Assessment of Cancer Therapy-General Scale (FACT-G (Ch)) was adopted to assess QoL. Patient satisfaction was assessed by the 9-item Chinese Patient Satisfaction Questionnaire (ChPSQ-9) and the cognitive subscale of the Medical Interview Satisfaction Scale (MISS-Cog). Linear mixed effects models were fitted to identify predictors of patient satisfaction and QoL. Recurrence after baseline (std beta = 0.58; 95% CI: 0.17, 0.98; P < 0.05) was the only predictor of MISS-Cog, age (std beta = 0.01; 95% CI: 0.00, 0.02; P < 0.05) and depressed mood (std beta = 0.20; 95% CI: 0.10, 0.30; P < 0.001) of ChPSQ-9. After adjusting for sociodemographic and psychosocial variables, both ChPSQ-9 (std beta = 0.13; 95% CI: 0.07, 0.19; P < 0.001) and MISS-Cog (std beta = 0.07; 95% CI: 0.02, 0.12; P < 0.05) independently predicted FACT-G (Ch) scores. These findings suggest both general emotional support and informational support are important in predicting QoL among Chinese breast and nasopharyngeal cancer patients.

The fertility-related concerns, needs and preferences of younger women with breast cancer: a systematic review

Breast cancer is the most commonly diagnosed type of cancer in reproductive aged women. Adjuvant systemic therapy is recommended in most women and has been demonstrated to reduce the risk of recurrence and increase survival. However, there may be a negative impact of adjuvant systemic therapy on fertility as well as on subsequent quality of life. There are a number of fertility preservation options currently available and relevant information regarding these options should be provided prior to commencing adjuvant treatment. The aim of the review is to identify the fertility-related needs, concerns and preferences of young women with early breast cancer. The databases MEDLINE and EMBASE were searched from 1988 onwards using keywords, and examining reference lists. Of the 499 articles identified, 20 met eligibility criteria and were reviewed. Multiple fertility-related information needs specific to this group regarding menstrual changes and potential infertility attitudes to, and actual decisions made regarding, pregnancy breastfeeding and contraception emerged. Information on fertility-related decisions was rated as important, and the preferred methods for obtaining this information was consultation with a specialist or a decision aid early in the treatment plan. There is limited research about fertility-related needs, and even less on contraceptive preferences and the attitudes of health care providers towards fertility-related issues. No studies describing the development of tools to assist with decisions about fertility-related choices were identified. Young women with early breast cancer have specific fertility- and menopause-related needs and concerns, which are commonly not adequately addressed or discussed prior to commencing adjuvant therapy.

A longitudinal investigation of coping strategies and quality of life among younger women with breast cancer

It is generally assumed that coping strategies impact quality of life (QOL). It is plausible that QOL determines use of coping strategies. This research examines coping strategies over time and the reciprocal relationship between coping strategies and QOL among younger women with breast cancer. Women with breast cancer (N = 267; mean age = 43 years) completed surveys within 6 months of diagnosis and 6 weeks and 6 months later. Surveys included questions on coping strategies, QOL, medical factors, and sociodemographics. Positive cognitive restructuring was the most frequently used strategy. Over time, use of seeking social support, spirituality, and wishful thinking declined, while detachment increased. Prior QOL predicted three subsequent coping strategies (seeking social support, keeping feelings to self, wishful thinking). Coping strategies were minimally related to subsequent QOL. Coping strategies and QOL are dynamic processes. QOL may predict coping strategies equally or more than vice versa.

Illness perception interventions for heart attack patients and their spouses: Invited commentary

While there is evidence of a recent decline in the incidence of heart attack in several Western countries, heart disease is still the leading cause of death [1]. In the UK, for example, about 146,000 people had heart attacks in 2006 and the estimated health care costs of coronary heart disease were over £3 billion [2]. A substantial proportion of patients who have a heart attack are of working age [3]. Return to work after a heart attack is associated with better subsequent quality of life [4], but many patients fail to return to work [5]. The first of the two linked papers by Broadbent et al. [14] which appear in this issue describes a randomized controlled trial, carried out in Auckland, New Zealand, of an intervention to increase rates of return to work after heart attack. The experience of a heart attack can be more distressing for patients' relatives than for the patients themselves [6]. A growing literature suggests that relatives, particularly spouses, of heart attack patients experience high levels of anxiety and worry, which impact negatively on their quality of life [7]. A recent systematic review suggested that there is dearth of research on interventions to alleviate the distress of relatives of heart patients in general [8]. The second paper discussed here describes an additional component of the intervention targeted at reducing anxiety in spouses of heart attack patients. Both of these interventions were informed by the Common-Sense Model (CSM) of illness representations

Does ICD Indication Affect Quality of Life and Levels of Distress?

The implantable cardioverter defibrillator (ICD) is the treatment of choice for life-threatening arrhythmias, with ICD indications having recently been extended to include primary prophylaxis. Despite the medical benefits of the ICD, there is an ongoing debate as to the impact of the ICD on patients' lives, particularly whether primary prophylaxis implantation may impact adversely on patient-centered outcomes such as quality of life (QoL) and distress. We examined the evidence for a role of ICD indication on these patient-centered outcomes. A literature search was conducted on PubMed and Web of Science from 2002 to present, focusing on indication for ICD therapy and patient-centered outcomes (i.e., anxiety, depression, disease-specific, or general QoL). We identified five studies (seven articles) concerning the impact of indication on patient-centered outcomes. Sample sizes varied from 91-426 patients across studies, five of seven articles used a prospective design, and follow-up ranged from 2-12 months. No study reported an effect for indication on patient-centered outcomes. There is no evidence to suggest that patients receiving an ICD for primary prophylaxis have subsequent poorer QoL and greater distress than patients receiving an ICD for secondary prophylaxis. This knowledge may help cardiologists in the clinical management of patients, in particular when discussing ICD implantation with patients.

Longitudinal association between frequency of substance use and quality of life among adolescents receiving a brief outpatient intervention.

Recognition of the broad consequences of adolescent substance abuse has led to increased emphasis on balancing traditional measures of treatment effectiveness, such as frequency of substance use, with measures of patient functioning and quality of life (QOL). This study evaluated the longitudinal association between frequency of use and QOL among adolescent substance abusers receiving a brief outpatient intervention. Participants were 106 adolescents, aged 13 to 21 years, who met criteria for substance abuse or dependence and completed 4 assessments over a 12 month period. Results of a parallel-process latent growth curve model indicated a moderate longitudinal association, such that reduced frequency of use was associated with QOL improvement. Elaboration of the temporal ordering of this association via a cross-lagged panel model revealed that frequency of substance use predicted subsequent QOL, but that QOL did not predict subsequent frequency of use. Implications pertaining to the assessment of comprehensive outcomes and the setting of treatment expectations are discussed.

Eating ability predicts subsequent quality of life in Chinese patients with breast, liver, lung, or nasopharyngeal carcinoma: A longitudinal analysis

Eating dysfunction is a well-recognized consequence of orophagic tract cancers, but also occurs with other cancers. There is a relative absence of data assessing the impact of eating function on QoL in cancer populations other than those with disease of the oro-phagic tract. We assessed longitudinal changes in eating function and quality of life (QoL), and examined whether eating function predicted QoL over time in a sample of Chinese patients with breast, lung, liver, and nasopharyngeal cancers. Overall, 1 079 patients with breast, liver, lung, or nasopharyngeal carcinoma were assessed during their first outpatient visit (baseline) and at two follow-up interviews (FU1 and FU2). Three dimensions of eating function, including ability, appetite, and enjoyment, were assessed using three 11-point self-rated items. QoL was measured by the Chinese version of the Functional Assessment of Cancer Therapy-General Scale (FACT-G (Ch)). Linear mixed effects (LME) models evaluated mean differences on eating function and QoL scores across interviews and across cancer groups, and the effects of eating function on QoL. After adjustment for socio-demographic and medical variables, pain and depression, eating function significantly predicted patient overall (standardized βs ranged from 0.091 to 0.163, ps<0.05), physical (standardized βs ranged from 0.101 to 0.200, ps<0.05), and functional (standardized βs ranged from 0.120 to 0.162, ps<0.05) aspects of QoL scores over time. Eating dysfunction significantly impacts QoL in cancer populations other than those with orophagic disease. Change of eating function appears to be a common problem in cancer patients regardless of cancer site.