Quality Of Life In Survivors Research Articles

Patterns of family management for adolescent and young adult brain tumor survivors.

Little is known about how families systemically incorporate the work of caring for adolescent and young adult (AYA) survivors of childhood brain tumors who often remain dependent on their families well into adulthood. The primary aim of this study was to develop a typology of family management (FM) patterns for AYA survivors. The secondary aims were to compare them with FM patterns previously described for children with chronic health conditions and to validate the patterns using quantitative and qualitative data. Guided by the Family Management Styles Framework, a sequential, mixed-methods design was used to gather quantitative data from 186 mothers (primary caregivers) and 134 AYA survivors. FM patterns (family focused; somewhat family focused; somewhat condition focused; and condition focused) were identified using cluster analysis of data from the Family Management Measure. FM patterns were found to be similar to those for children with chronic health physical conditions and were significantly related to maternal quality of life, survivor quality of life (health-related quality of life [self- and mother proxy report]), cancer-related variables (treatment intensity, medical late effects), and family functioning in theoretically meaningfully ways. Significant demographic characteristics included private insurance and AYA survivors' engagement in school or employment. Qualitative analysis of data from 45 interviews with mothers from the larger sample provided additional support for and elaborated descriptions of FM patterns. Identification of FM patterns moves the science of family caregiving forward by aggregating data into a conceptually based typology, thereby taking into account the complex intersection of the condition, the family, and condition management. (PsycINFO Database Record

Burn Survivor Quality of Life and Barriers to Support Program Participation.

After a serious burn, re-entry into family life, society, and work can be incredibly difficult. Support services such as professional counseling and peer support play a key role for recovering survivors. Herein, we sought to identify support service participation rates, barriers to participation, and quality of life (QOL) among burn survivors treated at a regional burn center. A survey of burn survivors over 18 years old treated for a burn for 5 days or greater between 2006 and 2016 were invited to participate in a survey. The three-part survey contained sections covering demographics, questions regarding support program (SP) awareness, needs and participation, and QOL surveys. Univariate and multivariate regression analyses were performed to identify factors related to SP participation and QOL scores. Nine hundred sixty-eight patients were eligible; 150 responses were received. Over one third (40, 31%) of the responding survivors wanted support, but only half of those (23, 17%) participated in SPs. Distance and awareness of the available programs were two barriers to participation. Those attending SPs were more likely to have had larger burns (OR = 3.7, P = 0.05) and visible burns (OR = 7.5, P = 0.031). Lower scores on selected QOL scales were associated with burns more than 30%, visible burns, female gender, time from burn, and age group. A sizable number of burn survivors want SPs. However, access to these services and advertising their existence are hurdles to overcome. Future burn survivor SPs should focus on psychosocial stresses identified in the QOL assessments.

Quality of life of survivors of malignant pleural mesothelioma in Japan: a cross sectional study

BackgroundPrevious studies have indicated that people with malignant pleural mesothelioma (MPM) have a poor quality of life (QOL); however, information about the QOL of people with MPM in Japan is anecdotal. The aims of this study were to investigate the QOL of survivors of MPM in Japan and to determine the factors that correlate with their QOL.MethodsThis was a cross sectional study. The included patients were those diagnosed with MPM in Japan. We created a self-administered questionnaire consisting of 64 questions. The questionnaires were sent to hospitals and patient advocacy groups, distributed to the patients, completed, and sent back to the researchers by postal mail. QOL was assessed with the European Organization for Research and Treatment of Cancer 16 questionnaire (QLQ) and the short version of the core domains of the Comprehensive Quality of Life Outcome questionnaire (CoQoLo).ResultsIn total, 133 questionnaires were collected. The QLQ assessments demonstrated that the survivors of MPM most frequently complained of fatigue, pain, sleep disturbances, and dyspnea. The symptom scales were acceptable, but the functional scales were significantly poorer for the patients with poor performance statuses (PSs). The short CoQoLo assessment was very unfavorable for ‘Being free from physical pain.’ Being a long-term survivor and a survivor with a poor PS were significantly correlated with poor global health status.ConclusionsSurvivors of MPM have impaired function, a variety of symptoms, and lower QOL. Survivors of MPM, even those in good physical condition, need broad support.

Long-term Quality of Life in Survivors of Brain Metastases: A Roller Coaster of Perspective.

Longevity in cancer patients with brain metastases is increasingly being observed. This raises discussions about how best to maintain a good quality of life for these patients. Recent data suggest that post-treatment quality of life (QoL) can be maintained using new treatment options, but little data exist regarding the QoL in long-term survivors. This study of 19 patients surviving greater than two years from the initial treatment of brain metastases suggests that long-term QoL can be better than at the start of treatment and perhaps even better than normal, especially between three and five years post-treatment. This improved QoL seems mostly attributable to improved functional and social well-being and is possible as long as emotional and physical well-being are maintained within the normal range.

Pre-surgical chemotherapy for breast cancer may be associated with improved outcomes

BackgroundHistorical studies suggest no difference in disease outcome between neoadjuvant and adjuvant approaches in breast cancer. We hypothesize neoadjuvant chemotherapy (NCT) may offer several benefits, possibly improving quality of life outcomes. MethodsRetrospective review of Tumor Registry data of breast cancer patients from 2011 to 2015. Pathologists reviewed cases from 2012 to 2013 to provide additional RCB (residual cancer burden) scores. ResultsFrom 2011 to 2015 there were 2707 breast cancer cases and 455 patients received NCT. RCB score was documented in 348 with excellent outcome in 41% (pCR in 115 patients, 28 RCB I). There were 137 RCB II and 68 RCB III. Clinically positive nodes were present in 202 of 455 and 77 (38%) had clearance of nodal disease. Of these 45 had axillary dissections. DiscussionNeoadjuvant therapy was associated with excellent response rates. Thirty eight percent of patients with positive nodes converted to node negative although over 50% underwent axillary dissection. Higher utilization of NCT could decrease need for axillary dissection thereby lowering incidence of lymphedema and improving quality of life for survivors.

Quality of life in thyroid cancer—assessment of physician perceptions

BackgroundThyroid cancer is the fastest growing malignancy in the United States. Previous studies have shown a decrease in quality of life (QoL) after the treatment of thyroid cancer. To date, there have been no studies assessing physician perceptions regarding how a diagnosis of thyroid cancer affects QoL. Based on this and other findings from our study, we aim to assess physician perceptions on the effect of thyroid cancer on QoL. Materials and methodsPhysicians were recruited from two national organizations comprised physicians focusing on thyroid cancer. A 37-question survey was administered evaluating physician's perceptions of thyroid cancer patient satisfaction in various aspects of treatment, complications, and overall effects on QoL. QoL responses were categorized into overall QoL, physical, psychological, social, and spiritual well-being. ResultsOne hundred five physicians completed the survey. Physician's estimates of patient's overall QoL after thyroid cancer treatment was similar to overall QoL reported by patients. However, medical physicians overestimated the decrease in thyroid cancer survivor's QoL in several subcategories including physical, psychological, and social (P < 0.05). Both surgeons and medical physicians underestimated the percentage of patients with reported symptoms of temporary and permanent voice changes, temporary dry mouth, cold/heat sensitivity, and temporary and permanent hypocalcemia (P = 0.01-0.04). ConclusionsPhysicians have a varied estimation of the detrimental impact of thyroid cancer treatment on QoL. In addition, physicians underestimated the amount of physical symptoms associated with thyroid cancer treatments. Increased physician awareness of the detrimental effects of a thyroid cancer diagnosis on QoL should allow for a more accurate conversation about expected outcomes after thyroid cancer treatment.

Abstract P6-12-15: The psychosocial impact of surgical scars in survivorship: Findings from a nationwide survey of women breast cancer survivors

Abstract Background: Surgery is an integral component of comprehensive breast cancer therapy, but leaves physical scars that may have psychosocial consequences in survivorship. Previous studies have shown that breast cancer treatment has a negative impact on body image, sexual function, mental health and social adjustment. As overall survival from early staged breast cancer approaches 99%, more data is needed on the late and long term consequences of breast cancer treatment and quality of life in survivorship. The aim of this research was to explore how women are affected specifically by physical scars from breast cancer surgery. Methods: A nationwide internet survey was conducted among women who reported being surgically treated by lumpectomy only (n=215), mastectomy only (n=140), or both procedures (n=132) for breast cancer. To improve generalizability, census-based enrollment quotas were applied for geographic region, health insurance, and income. Results: A solid majority of women in each of the three study groups agreed somewhat or strongly that they “do not like the location of my surgical scar” (table 1). Younger women were more likely to agree strongly with that statement (table 2). Results for the Main Outcome, “I do not like the location of my surgical scar”. n%Lower 95% CIUpper 95%CILumpectomy only (n=215) Agree strongly43201525Agree somewhat94443850Disagree somewhat46211627Disagree strongly32151121 Mastectomy only (n=140) Agree strongly46332441Agree somewhat47342642Disagree somewhat33241631Disagree strongly1410515 Both surgeries (n=132) Agree strongly31241731Agree somewhat89675875Disagree somewhat108413Disagree strongly2204 Table 2. Regression Analyses for Strong Agreement with the Statement, “I do not like the location of my surgical scar”. ORlower 95% CIUpper 95% CIpLumpectomy only (n=215) Age (years)0.960.940.9990.010Significant Other2.30.866.30.098Income0.90.71.20.5College Graduate0.70.31.80.5 Mastectomy Only (n=140) College Graduate0.30.10.70.006Age0.970.940.990.04Income0.80.61.20.4Significant Other1.20.62.70.6 Both Surgeries (n=132) College Graduate155.044&amp;lt;0.001Significant Other0.60.21.90.4Age0.990.941.030.5 In each of the three study groups, the majority of women agreed that they did not realize how uncomfortable the scars would make them feel when undressed or when seen undressed by someone else. The majority of women in each of the three study groups also felt self-conscious some or all of the time due to the surgical scars and avoided certain pieces of clothing some or all of the time because they revealed the scars. Conclusion: Consistent with previous literature, this survey shows that surgical scars from lumpectomy and mastectomy are not merely “cosmetic” but have a substantial impact on the lives and well-being of women in survivorship. Surgeons may be able to improve the breast survivorship journey for women buy employing techniques that minimize visibility of surgical scars. Efforts to minimize the iatrogenic impact of surgery and provide comprehensive care may ensure good psychosocial survivorship. Citation Format: Gass JS, Mitchell S, Hanna M. The psychosocial impact of surgical scars in survivorship: Findings from a nationwide survey of women breast cancer survivors [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-15.

Abstract P6-12-02: Racial/ethnic differences in sleep quality and duration among breast cancer survivors: Results from the women's health initiative (WHI)

Abstract BACKGROUND: Sleep is a crucial factor for optimal health, but breast cancer survivors often report poor sleep quality. It is estimated 20-70% of survivors have at least one sleep problem, which contribute to quality of life and health differences among survivors. Minority groups tend to have poorer sleep quality and shorter sleep duration than Non-Hispanic Whites (NHW). African-Americans (AA) with breast cancer have a poorer prognosis than NHW for each stage-specific diagnosis and are twice as likely as NHW to report short sleep duration, yet survivor studies are still lacking in AA participants. The purpose of this study was to examine sleep quality and duration patterns before and after cancer diagnosis by race/ethnicity among WHI breast cancer survivors. METHODS: There were 12,098 postmenopausal women diagnosed with invasive breast cancer after WHI enrollment who were eligible for this secondary analysis. Baseline demographic and clinical characteristics were described. The WHI Insomnia Rating Scale (WHIIRS) was measured at multiple time points pre- and post-diagnosis. A higher WHIIRS scores (0-20 points) indicates greater sleep disturbance and ≥9 points identifies clinical insomnia. A linear mixed model was fit to the WHIIRS sleep quality data to examine if the trend in sleep quality with time changed following a cancer diagnosis. For short (&amp;lt;6hrs) and long (≥9hrs) sleep duration, we fit a logistic regression model with multilevel mixed effects. RESULTS: The majority of participants were NHW (87.4%), mean age at diagnosis was 70.3 years, and 75% had localized breast cancer at diagnosis. At baseline, 30% of women had insomnia. The lowest average WHIIRS score was 5.6 among Asians, and the highest was 6.6 among American-Indians and NHWs (p=0.02). AAs had the most women sleeping ≤5 hrs/night and NHW had the least (19.6% vs 5.7%, p&amp;lt;0.01). At diagnosis, the average WHIIRS score was 7.2. After diagnosis, sleep quality improved in the overall study population (p=0.03). Short sleep duration ranged from 6% before diagnosis, 9% at diagnosis and 11% after diagnosis (p=0.29). Long sleep duration ranged from 3% before diagnosis, 6% at diagnosis and 15% after diagnosis (p=0.43). There was no difference in sleep quality across race after diagnosis (p=0.53). The probability of short sleep and long sleep after diagnosis did not differ significantly across race (p=0.12, p=0.90), however racial minorities tended to have higher probabilities of short sleep at diagnosis compared to NHWs. DISCUSSION: Sleep is an appealing area to target for improvement due to the multiple ways it can be treated. With increasing survival rates, there is an emphasis on improving quality of life in survivors. Our results span 20 years pre-diagnosis to 15 years post-diagnosis and are similar to shorter follow-up studies which found most women's sleep problems resolve within a few years of treatment completion. The lack of difference by race was an unexpected finding in another similar longitudinal study, which suggested most differences are seen in cross-sectional sleep studies. This study adds to the literature on longitudinal sleep data, especially to the little data on sleep trajectories in minority breast cancer survivors. Citation Format: Beverly CM, Naughton M, Foraker R, Pennell M, Young G, Hale L, Crane T, Pan K, Danhauer S, Feliciano E, Paskett E. Racial/ethnic differences in sleep quality and duration among breast cancer survivors: Results from the women's health initiative (WHI) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-02.

The association between post-diagnosis health behaviors and long-term quality of life in survivors of ductal carcinoma in situ: a population-based longitudinal cohort study.

Women diagnosed with ductal carcinoma in situ (DCIS) often experience adverse changes in health-related behaviors following diagnosis. The impact of health behaviors on long-term quality of life (QoL) in DCIS survivors has not been investigated. We examined the association of post-diagnosis body mass index (BMI), physical activity, alcohol, and smoking with QoL among 1448 DCIS survivors aged 20-74 enrolled in the population-based Wisconsin in situ Cohort from 1997 to 2006. Health behaviors and QoL were self-reported during biennial post-diagnosis interviews. Physical and mental QoL were measured using the validated SF-36 questionnaire. Generalized linear regression was used to determine the association between behaviors and QoL with adjustment for confounders. Lagged behavior variables were used to predict QoL during follow-up and avoid reverse causation. Women reported 3,536 QoL observations over an average 7.9years of follow-up. Women maintaining a healthy BMI had on average a significantly higher summary measure score of physical QoL than obese women (normal versus obese: β = 3.02; 2.18, 3.85). Physical QoL scores were also elevated among those who were physically active (5 + h/week vs. none: β = 1.96; 0.72, 3.20), those consuming at least seven drinks/week of alcohol (vs. none; β = 1.40; 0.39, 2.41), and nonsmokers (vs. current smokers: β = 1.80; 0.89, 2.71). Summary measures of mental QoL were significantly higher among women who were moderately physically active (up to 2h/week vs. none: β = 1.11; 0.30, 1.92) and nonsmokers (vs. current smokers: β = 1.49;0.45, 2.53). Our results demonstrate that maintaining healthy behaviors following DCIS treatment is associated with modest improvements in long-term QoL. These results inform interventions aimed at promoting healthy behaviors and optimizing QoL in DCIS survivors.

Long-term outcome after the acute respiratory distress syndrome: different from general critical illness?

Purpose of reviewTo review the current research data on long-term outcome and health-related quality of life in survivors of the acute respiratory distress syndrome (ARDS) and to compare these findings with those from non-ARDS patients surviving critical illness.Recent findingsBetween 6 months and 2 years after discharge from ICU, survivors of ARDS present with substantial impairments of the levels of body function (muscle strength, walking capacity and/or physical activity (physical SF-36 score). In contrast to non-ARDS patients from surgical ICUs, a standardized intensified physical therapy during early course of illness in ARDS patients could not show an improvement of long-term physical function performance. Furthermore, a substantial part of further ARDS patients suffer from depression (26–33%), anxiety (38–44%) or posttraumatic stress disorder (22–24%). In general, the level of functional autonomy and daily life activities was reduced, and in one study, 6 months after ICU-discharge this level was significantly lower in ARDS patients compared with non-ARDS patients. In a recent study, 44% of ARDS survivors were jobless 1 year after critical illness, whereas half of previously employed patients returned to work within 4 months after hospital discharge. General health-related quality of life was significantly reduced compared with a matched population in all studies.SummarySurviving ARDS is associated with a long-term substantial reduction in health-related quality of life and such a reduction does not differ from findings in patients surviving other critical illness. In further research, a special attention should be paid to prevention measures of the ‘post intensive care syndrome’ as well as to patient important domains, which might better explain the patient's and families’ demands.

Health related quality of life in survivors of acute respiratory illness who required invasive respiratory support in a tertiary Pediatric ICU - A Prospective observational study

Objectives: To assess long term health related quality of life in all PICU survivors with acute respiratory illness requiring invasive respiratory support, three to eight years after discharge Materials and Methods: All premorbidly well children between 1month to 15years of age who were ventilated for more than 48 hours for acute respiratory illness between March 2008- February 2014 and who were survived and discharged were included in our study. Neonates, children with acute neurological dysfunction, premorbidly unwell children, readmission to PICU were excluded.Data was collected from medical records. Those who were non contactable were written a postal letter. Quality of life assessment was done with the help of the Health Utility Index 2 which has 6 domains; sensation, mobility, emotion, cognition, self care and pain. Functioning within each attribute is represented by four or five levels. The assessment was done either by telephone questionnaire or by objective assessment in PICU office/Out patient department(OPD) by using HUI2 index. By using this,the outcome is classified as NORMAL(Score>0.99),FAIR(0.89-0.99) and POOR(Score<0.89). Results: In our study we had total 259 children who were admitted with acute respiratory illness requiring invasive ventilation in PICU for more than 48 hours during our study period. Out of these, 67 children (26%) died during PICU stay due to various complications and 46 (18%) were discharged against medical advice. Among 146 children, we were able to contact 66 children and the remaining 74 children could not be contacted through telephone or postal service. In the study group, six children died after discharge due to various causes . HUI2 questionnaire details were obtained either through personal interview (n=24) or by telephonic interview (n=42). HUI2 assesment was done for 66 children (Mean age 7.8± 2.6 years). Mean HUI2 score was 0.94±0.062. Majority of children are having good quality of life (84%) and 16% having poor quality of life who were affected in more than one domain. Of these 66 children, only one child was having learning disability and was affected badly in 4 domains(Score of 0.69) of quality of life. He needs spectacles to see and can walk with some limitation and often anxious and studies less compared to peer groups. Most common affected domain in our study group is ‘Cognition’. 23(35%) children are able to learn and remember school work less than their peer groups at school otherwise there were normal in all other domains. This is based on their parents perspective. Second most common affected domain is ‘Emotion’. 12(19%) children in our study group (66) are occasionally irritable, angry, depressed, anxious due to various reasons. Third most common affected domain is ‘Sensation’. Eleven(17%) children among our study group required either spectacles or hearing aid. In the ‘Pain’ domain, only 7 children (11%) out of 66 has occasional pain and discomfort. In the ‘selfcare’ domain, only 5 children (8%) out of 66 children are affected. These children have some difficulty to handle their day to day activities. Least commonly affected domain is ‘Mobility’(1.5%) where only one child was affected who needs some assistance while walking. In our study, duration of PICU stay, complications of ventilation (VAP, Pneumothorax, Pneumo-mediastinum) and multiorgan dysfunction (ARF,ALF,DIC-9) had influence on the long term outcome but it is not statistically significant (P value 0.128, 0.206 and 0.638 respectively). This may be due to the decrease in effect of acute illness in long term quality of life. In our study there was no correlation noted between maternal and paternal education and quality of life. Majority of PICU survivors(84%) have a good long term Quality of life (HUI mean score 0.94+/0.06). Even though, factors (Duration of PICU stay, complications of ventilation and multiorgan dysfunction) influencing long term quality of life were present more in the Poor outcome group, they are not statistically significant. This may be due to the decrease in effect of acute illness in long term quality of life.

Quality of life in survivors after a period of hospitalization in the intensive care unit: a systematic review.

ObjectiveTo assess the long-term, health-related quality of life of intensive care unit survivors by systematic review.MethodsThe search for, and selection and analysis of, observational studies that assessed the health-related quality of life of intensive care unit survivors in the electronic databases LILACS and MEDLINE® (accessed through PubMed) was performed using the indexed MESH terms "quality of life [MeSH Terms]" AND "critically illness [MeSH Terms]". Studies on adult patients without specific prior diseases published in English in the last 5 years were included in this systematic review. The citations were independently selected by three reviewers. Data were standardly and independently retrieved by two reviewers, and the quality of the studies was assessed using the Newcastle-Ottawa scale.ResultsIn total, 19 observational cohort and 2 case-control studies of 57,712 critically ill patients were included. The follow-up time of the studies ranged from 6 months to 6 years, and most studies had a 6-month or 1-year follow up. The health-related quality of life was assessed using two generic tools, the EuroQol and the Short Form Health Survey. The overall quality of the studies was low.ConclusionsLong-term, health-related quality of life is compromised among intensive care unit survivors compared with the corresponding general population. However, it is not significantly affected by the occurrence of sepsis, delirium, and acute kidney injury during intensive care unit admission when compared with that of critically ill patient control groups. High-quality studies are necessary to quantify the health-related quality of life among intensive care unit survivors.

Intracerebral Hemorrhage in Mice.

Intracerebral hemorrhage is the most devastating stroke subtype with high rates of mortality and morbidity. Furthermore, no clinically approved treatment exists that effectively increases survival or improves quality of life for survivors. Effective modeling is necessary to elucidate the pathophysiological mechanisms of intracerebral hemorrhage and evaluate potential therapeutic approaches. Rodent models are most utilized because of their cost-effectiveness, and because rodent brain development and structures are well documented. Herein, we describe two intracerebral hemorrhage mouse models: the autologous blood double-injection and collagenase infusion models.

Diet Quality, Inflammation, and Quality of Life in Breast Cancer Survivors: A Cross-Sectional Analysis of Pilot Study Data

BackgroundModifiable lifestyle factors, such as diet quality, could reduce inflammation and improve quality of life (QOL) in breast cancer survivors, but data are inconclusive. ObjectiveTo determine whether diet quality, as measured by Healthy Eating Index-2010 (HEI-2010) score, is associated with inflammation, health status, or functional outcomes affecting QOL in survivors of early-stage breast cancer. DesignThis is a cross-sectional, secondary analysis of baseline data collected from breast cancer survivors after completion of primary therapy and before random assignment to a pilot nutritional intervention aimed at reducing side effects of aromatase inhibitor treatment. Participants/settingParticipants were 44 postmenopausal women with stage I to III endocrine receptor–positive breast cancer receiving outpatient care at a midwestern cancer center between November 2011 and October 2013. Main outcome measuresPrimary outcomes were serum proinflammatory cytokines (interleukin-6 [IL-6], IL-17, and tumor necrosis factor-α receptor 2 [TNFR-2]). Secondary outcomes included QOL measured by the Stanford Health and Disability Questionnaire and the Functional Assessment of Cancer Therapy–Breast with Endocrine Subscale. Statistical analyses performedPearson correlation coefficients (r) and linear regression models were used to evaluate the relationship of dietary variables with inflammatory cytokines and QOL measures. ResultsA higher overall HEI-2010 score (healthier diet) was associated with lower IL-6 (r=−0.46; P=0.002) and TNFR-2 (r=−0.41; P=0.006); however, associations were attenuated by body mass index (BMI) (IL=6 [r=−0.26; P=0.10]; TNFR-2 [r=−0.30; P=0.06]). In women with prior chemotherapy, a higher HEI-2010 score was strongly associated with lower IL-6 (r=−0.67; P=0.009) and TNFR-2 (r=−0.59; P=0.03) after BMI adjustment. There were no significant correlations between HEI-2010 score and QOL measures after adjustment for BMI. ConclusionsThese data suggest the need for more rigorous investigation into the relationship of diet quality, BMI, and inflammation in breast cancer survivors.

Spontaneous Intraventricular Hemorrhage: When Should Intraventricular tPA Be Considered?

Spontaneous intracerebral hemorrhage (ICH) is the most common cause of intraventricular hemorrhage (IVH) in adults. Complicating approximately 40% of ICH cases, IVH adds to the morbidity and mortality of this often fatal form of stroke. It is also a severity factor that complicates subarachnoid hemorrhage and traumatic brain injury, along with other less common causes of intracranial bleeding. Medical and surgical interventions to date have focused on limiting ICH and IVH expansion, controlling intracranial pressure, and relieving obstructive hydrocephalus. The placement of an external ventricular drain (EVD) can achieve the latter two goals but has not demonstrated improvement in clinical outcomes beyond mortality reduction. More recently, intraventricular fibrinolysis, utilizing the EVD, has gained interest as a safe and potentially effective method to maintain catheter patency and facilitate hematoma removal. A recent phase III clinical trial evaluating the efficacy of intraventricular alteplase versus intraventricular saline showed a mortality benefit, but failed to meet the primary endpoint of significant functional improvement. However, planned subgroup analysis focusing on patients with IVH volume > 20 mL, and those with IVH removal > 85% suggest that significant functional benefits may be attainable with this therapy. The practice of intraventricular fibrinolysis for spontaneous IVH is not the standard of care; however, based on 20 years of experience, it meets thresholds as a safe intervention, and in those patients with a high burden of intraventricular blood, aggressive clearance may lead to improved quality of life in survivors of this morbid syndrome.

Multidisciplinary rehabilitation across the esophageal cancer journey.

Weight loss, malnutrition, and sarcopenia are prevailing side effects of esophageal cancer and its treatments, resulting in significant deficits in quality of life (QOL) and physical functioning from diagnosis into survivorship. However, as survival rates start to improve, a growing emphasis has been placed on strategies to improve the QOL of survivors. Our research group strongly agree with the argument put forward in the editorial by Gockel et al. that there is a clear rationale for multidisciplinary rehabilitative measures, both in preparation for, and in recovery following esophagectomy.

A dyadic analysis of stress processes in Latinas with breast cancer and their family caregivers.

Breast cancer diagnosis and treatment negatively affect quality of life for survivors and their family caregivers. The stress process model has been useful for describing the cascade of social and psychological experiences that culminate in degraded quality of life for both survivors and their family caregivers. This study is designed to test theoretically specified predictors of negative psychosocial outcomes in a dyadic context. Participants were 230 dyads composed of Latinas recently diagnosed with breast cancer and their primary family caregiver, who completed measures of socioeconomic status, stress, family conflict, depression, and anxiety. Data were analyzed following the Actor-Partner Interdependence Mediation Model in structural equation modeling. For both survivors and caregivers, there were significant direct and indirect actor effects (through family conflict) of perceived stress on depression and anxiety. Several indirect partner effects were also evident in this sample. Specifically, caregivers' stress was predictive of survivors' depression and anxiety through survivors' increased perceptions of family conflict. As predicted by the stress process model, stress and family conflict were predictive of psychological distress in breast cancer survivors and their family caregivers. Significant partner effects in the Actor-Partner Interdependence Mediation Model suggest that there are some dyadic influences, particularly from caregivers' stress to survivors' perceptions of exacerbated family conflict. These findings show how strained family relationships can aggravate the well-being of cancer survivors and their family caregivers through this challenging experience.

The Influence of Adverse Effects on Quality of Life of Survivors of Gynecologic Cancer.

The objective of this observational study was to investigate correlations between adverse effects (lower-extremity lymphedema [LEL], dysuria, and severe gastrointestinal symptoms) and quality of life (QOL) (physical well-being [PWB], social well-being, emotional well-being [EWB], and functional well-being) before treatment, at least 6 weeks after treatment (posttreatment1), and 3 or 6 months after treatment (posttreatment2) of patients with gynecologic cancer (GC). From August 2012 to October 2016, questionnaire responses and clinical data of 75 patients with GC were collected and assessed by treatment received. The χ test was used to determine the significance of correlations. Participants with LEL had significantly poorer QOL than did those without it in the domains of PWB at posttreatment1 (P = 0.026) and EWB at posttreatment2 (P = 0.020). Moreover, patients with 2 adverse effects (LEL plus dysuria or severe gastrointestinal symptoms) had significantly poorer QOL than did those with no or single adverse effect in the domains of PWB at posttreatment1 and posttreatment2 (posttreatment1: P = 0.049, P = 0.001; posttreatment2: P = 0.002, P = 0.028) and poorer QOL compared with those with no adverse effect in the domain of EWB at posttreatment1 (P = 0.017). Poorer QOL in emotional and physical domains is associated with adverse effects of treatment in patients with GC. It is important to consider the effects of radical therapy not only on survival but also on the QOL of survivors.

408P - Radiation-induced lung toxicity and tumor progression in patients with non-small-cell lung cancer

Background: Lung cancer is the leading cause of cancer death worldwide, and non-small cell lung cancer (NSCLC) accounts for 85% of all lung cancer cases. Radiotherapy is an important treatment modality, approximately two-thirds of lung cancer patients receive radiation therapy (RT) during the course of treatment with either definitive or palliative intent. However, radiation-induced lung toxicity, including radiation pneumonitis (RP) and subsequent lung fibrosis limits the therapeutic ratio and can also complicate quality of life for survivors. Meanwhile, most treated individuals develop disease recurrence that affects disease prognosis. Here we investigate the relationship between the radiation-induced lung toxicity and tumor progression in patients with non-small-cell lung cancer. Methods: From Jan. 2009 to Dec. 2014, patients who received definitive radiation therapy (RT) for stages I-III lung cancer and who were diagnosed with radiation-induced lung toxicity (RILT) were retrospectively analyzed. The primary endpoint was tumor progression (local progress and distant metastasis). The effect of RILT on overall survival (OS) and progression-free survival (PFS) of patients with different clinico-pathological factors were evaluated with Kaplan-Meier method and log-rank test. Results: Among 91 patients, tumor progression was observed in 73 (80%). RILT effect on the OS between no tumor progression and tumor progression (median OS 40.6 months versus 36.3 months, P < 0.01), and the PFS indicates that the patients with no tumor progression have a longer median progression-free survival (median PFS 26.7 versus 22.7 months, P < 0.01). Then RILT was divided into two grades, the severe RILT (60%) and mild RILT (40%), and stratified analysis revealed that the mild RILTs resulted in a favorable prognosis compared with the severe RILT (median PFS 39.5 v 22.7 months, P = 0.022). Meanwhile, through further analysis we found a close connection between the degrees of RILT and tumor progression (local progress and distant metastasis) (P < 0.001). Conclusions: Radiation-induced lung toxicity (RILT) is linked to tumor progression in patients with non-small-cell lung cancer received definitive radiation therapy (RT). Legal entity responsible for the study: Nannan Wang Funding: None Disclosure: All authors have declared no conflicts of interest.

Narrative review of quality of life in survivors of colorectal cancer

Narrative review of quality of life in survivors of colorectal cancer