Quality Of Life Trajectories Research Articles

Dynamics trajectory of patient-reported quality of life and its associated risk factors among hepatocellular carcinoma patients receiving immune checkpoint inhibitors: a prospective cohort study

ObjectiveWe aimed to characterize quality of life (QOL) trajectories among patients with intermediate and advanced hepatocellular carcinoma patients treated with immunotherapy.MethodsBarcelona Clinic Liver Cancer (BCLC) stage B-C HCC patients receiving immunotherapy at Guangxi Medical University Cancer Hospital were included. Trajectories of QOL, assessed using the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) questionnaire, were identified through iterative estimations of group-based trajectory models. Associations with trajectory group membership were analyzed using multivariable multinomial logistic regression.ResultsThree trajectory groups were identified (n=156): excellent (35.3%), poor (43.6%), and deteriorating (21.1%) QOL. The deteriorating trajectory group reported a mean QOL score of 124.79 (95% CI, 116.58–133.00), but then declined significantly at month-2 (estimated QOL score 98.67 [95% CI, 84.33–113.00]), and the lowest mean score is reached at month-6 (estimated QOL score 16.58 [95% CI, 0–46.07]). Factors associated with membership to the deteriorating group included no drinking (odds ratio [OR] vs yes [95% CI], 3.70 [1.28–11.11]), no received radiotherapy (OR vs yes [95% CI], 8.33 [1.41–50.00]), diabetes (OR vs no [95% CI], 6.83 [1.57–29.73]), and extrahepatic metastasis (OR vs no [95% CI], 3.08 [1.07–8.87]). Factors associated with membership to the poor group also included body mass index ≤24.0 kg/m2 (OR vs no [95% CI], 4.49 [1.65–12.22]).ConclusionsThis latent-class analysis identified a high-risk cluster of patients with severe, persistent post-immunotherapy QOL deterioration. Screening relevant patient-level characteristics may inform tailored interventions to mitigate the detrimental impact of immunotherapy and preserve QOL.

A longitudinal study of within-person trajectories in quality of life in patients receiving early palliative care.

To reveal the within-person trajectories in quality of life (QOL) in patients receiving early palliative care. Previous studies have mostly focused aggregated trajectories, based on all research participants combined, whereas this study focused on within-person trajectories in QOL and on whether the variability in QOL trajectories across patients is substantial enough to raise doubts about aggregated trajectories. Twenty-five older persons in early palliative care completed the McGill Quality of Life Questionnaire multiple times. Reliable change analyses provided estimates of the occurrence of statistically significant within-person change. There was reliable, within-person variation in QOL scores across time, more so for physical than for psychological aspects of well-being. Changes in QOL scores occurred for most patients but the trajectories were not linear and there was no common trend in the nonlinear patterns. Reliable change across time can be identified in persons receiving early palliative care. However, the trajectories are notably variable and patient-specific. The high degrees of within-person variability across time suggests the importance of repeated QOL assessments and of dynamic tailoring of clinical treatments.

Qualiy of life in displaced earthquake survivors

IntroductionWe investigated Quality of Life (QOL) in a sample of individuals (n = 341) who experienced different consequences in terms of displacement from their house after earthquake. MethodsThree groups were studied: those who had been displaced but are no longer so, those still displaced, and those who were never displaced. QOL for four time points was assessed: pre-earthquake, during displacement, at the time of the survey, and in ten years. ResultsDifferent trajectories of QOL were observed in the three groups: not displaced individuals showed no significant variation, those who were displaced had a significant decline in QOL after the earthquake but a significant recovery after the displacement experience, and those who were still displaced at the time of the survey reported lowest QOL both after the earthquake and in the future, with no recovery. Predictors of perceived QOL decline were quality and type of temporary accommodation, place attachment, and perceived health impairment. Subsequent QOL perceived improvement was predicted by quality and type of temporary accommodation, risk awareness, and emotional well-being. DiscussionOur findings highlight the importance of minimizing the duration of temporary displacement and providing high-quality temporary accommodations, considering individual needs in the local contexts and communities.

Four-Year Trajectories of Symptoms and Quality of Life in Individuals Hospitalized After Mild Traumatic Brain Injury

ObjectivesTo (1) detect distinct trajectories of symptoms and quality of life (QoL) over the first 4 years after mild traumatic brain injury (mTBI); (2) assess the relationship between symptom trajectory membership and QoL trajectory membership; and (3) identify participant characteristics associated with QoL trajectory membership. DesignProspective longitudinal cohort study. Assessments occurred at 4, 8, 12, 24, 36, and 48 months after mTBI. SettingRecruitment occurred in Level 1 Trauma Centers; follow-up was completed in the community. ParticipantsParticipants were 143 adults (aged 18-65y) who sustained an mTBI and were hospitalized (≥24h) at a Level 1 Trauma Center. InterventionsNot applicable. Main Outcome MeasuresFatigue Severity Scale, Hospital Anxiety and Depression Scale, Insomnia Severity Index, Medical Outcomes Study Cognitive Functioning Scale, Quality of Life after Brain Injury questionnaire, presence/absence of headaches or dizziness. ResultsGroup-based trajectory modeling revealed relatively stable symptom and QoL trajectories over time. Considerable percentages of participants were classified in trajectories of clinically significant symptoms throughout the full follow-up period: 62% for subjective cognitive issues, 54% for fatigue, 44% for anxiety, 43% for insomnia, 27% for depression, 23% for headaches, and 17% for dizziness. Sixty-six percent of participants belonged to trajectories of persistently poor QoL. For all symptoms, trajectories of greater severity were associated with trajectories of poorer QoL. None of the sociodemographic or injury-related variables examined were associated with QoL trajectory membership. ConclusionsA substantial proportion of individuals hospitalized after mTBI experiences clinically significant persistent symptoms ≤4 years after injury, and those with more severe symptoms have poorer QoL. Further research is required to better understand the factors leading to symptom persistence and poor QoL.

The influence of postoperative morbidity on long-term quality of life outcomes following pelvic exenteration

IntroductionPelvic exenteration provides significant survival benefits for selected patients diagnosed with locally advanced rectal cancer. However, in-hospital postoperative morbidity such as abdominal abscess, sepsis, and anastomotic leak remain highly prevalent, which can have short/long-term impacts on patient quality of life (QoL). The aim of this study was to determine the influence of postoperative morbidity on QoL outcomes in patients following pelvic exenteration. MethodsThis prospective cohort study included patients who underwent pelvic exenteration at a tertiary teaching hospital in Sydney, between 2008 and 2023. QoL measures were collected at baseline, 6, 12, 18, 24, 36, 48, and 60 months using the short-form 36 (SF-36v2) survey. The predictors included variables relating to postoperative morbidity, including hospital and ICU length of stay (LOS), post-discharge mortality and the number of postoperative complications. Mixed-effects analyses were used to determine the influence of these postoperative outcomes on physical and mental QoL trajectories. ResultsThis study included 674 patients, with a median age of 61 years. Shorter hospital and ICU LOS, and fewer or no postoperative complications were associated with higher physical QoL scores across all time points. Conversely, postoperative morbidity did not exhibit a significant impact on mental QoL scores. Furthermore, there was a longitudinal improvement in mental QoL outcomes compared to baseline, independent of postoperative morbidity. ConclusionPostoperative morbidity significantly impacted physical QoL outcomes after pelvic exenteration, whereas mental QoL outcomes were not influenced. Interventions aimed at mitigating postoperative morbidity may hold the potential to enhance long-term QoL outcomes following pelvic exenteration.

Dynamics of Long-Term Quality of Life After Treatment for Esophageal Cancer: A Community-Based Patient Study.

To characterize the pattern of post-treatment quality of life (QoL) for esophageal cancer (EC) survivors and construct models predicting their long-term QoL. On the basis of a randomized trial in an EC high-risk region in China, we interviewed 363 EC survivors and 25,245 permanent residents matched with the survivors on age, sex, and township as the baseline. QoL was measured using three-level version of European Quality of Life 5-Dimensions instrument. We constructed piecewise mixed models estimating the QoL of EC survivors that varied by age, sex, patient type, hospital level, and therapy to ascertain QoL determinants. The post-treatment QoL of EC survivors dropped by 15.7% within the first year and recovered by 9.3% between 1 and 9 years compared with the baseline. Therapy was found to be a determinant of QoL, and a series of therapy-specific models were fitted accordingly, which all showed the pattern of decreasing rapidly and recovering gradually. Endoscopic treatment had the least impact on post-treatment QoL (7.5% drop within 5 years) compared with esophagectomy (12.2% drop within 1 year) and chemoradiotherapy (37.8% drop within 2 years). The usual activities dimension showed the greatest impairment among those patients (34.4% drop within 1 year). This community-based study described the long-term QoL trajectory for EC survivors after different therapeutic modalities and constructed models to predict therapy-specific QoL at different time points after treatment. It provided new insights into decision making in treatment for EC from the perspective of QoL protection, offering a convenient tool for estimating quality-adjusted life-years.

Abstract PO2-12-01: Five-year quality of life (QOL) trajectories among young breast cancer (BC) survivors

Abstract Background: Young BC survivors are at risk for impaired QOL in part due to issues that are unique to their life stage. We sought to characterize trajectories of QOL in the 5 years following diagnosis among young BC survivors as well as evaluate patient and clinical characteristics associated with poorer or deteriorating QOL trajectories over time. Methods: Women diagnosed with stage I-III BC at age ≤40 enrolled in the Young Women’s BC Study, a prospective cohort in North America, who completed ≥2 study surveys through 5 years of post-diagnosis follow-up. QOL was evaluated with the Cancer Rehabilitation Evaluation System (CARES) physical, psychosocial, and sexual subscale scores. Demographic, treatment, and clinical characteristics were ascertained through surveys and chart review. Longitudinal trajectories for each CARES subscale were defined using group-based trajectory modeling; associations between patient/clinical characteristics and trajectory group membership were estimated for each subscale using multivariable multinomial logistic regression. Results: Among 900 women, median age at diagnosis was 36 (range: 17-40) 89% were white, 2% Black, and 4% Hispanic. At baseline, 73% were partnered, 61% parous and 49% perceived themselves as financially comfortable. Most had hormone-receptor positive (74%), HER2-negative (70%) BC, and most received chemotherapy (82%); 36% underwent mastectomy with radiation. Physical and psychosocial scores each clustered into 4 trajectories, with >75% of participants clustering in groups reflecting excellent or good QOL that was stable over time and few (6% for physical and 4% for psychosocial) clustering into groups that reflected poorer QOL at baseline that did not improve over time. Sexual health trajectories were more variable, clustering into 5 trajectories, with over half of participants clustered into groups reflecting good (35%) or excellent (20%) QOL that remained relatively stable over time, 22% clustered into a trajectory that was poor at baseline but moderately improved over follow-up, 13% in a group that reflected deteriorating from moderate-to-poor QOL and 11% in a group with poor QOL at baseline that did not improve over time. In multivariable regression analyses (Table), factors associated with clustering in a poorer trajectory (vs. clustering in an excellent trajectory), in multiple QOL domains included baseline financial discomfort (associated with poorer QOL across all 3 domains), mastectomy+radiation (vs. lumpectomy, associated with poorer QOL across all 3 domains); chemotherapy receipt (associated with poorer physical and sexual health trajectories); and baseline BMI >25 (vs. 18.5-24.9, associated with poorer physical and poorer/deteriorating sexual health trajectories). Conclusions: Young BC survivors follow distinct QOL trajectories in survivorship. While most will not experience substantial QOL impairment through the first 5 years following diagnosis, a substantial minority report persistently poor or deteriorating QOL. The association between more extensive local therapy and poorer physical/psychosocial/sexual health trajectories underscores the importance of communicating the potential for negative QOL outcomes when women are making surgical decisions. Additionally, the pervasive impact of financial wellbeing on multiple QOL domains supports the potential value of systematic screening for and addressing of financial distress to prevent or mitigate financial toxicity in survivorship Factors associated with clustering in poorer/deteriorating (vs. excellent) QOL trajectories *Reference trajectory=excellent QOL Citation Format: Tal Sella, Zheng Yue, Kathryn Ruddy, Shari Gelber, Rulla Tamimi, Jeffrey Peppercorn, Lidia Schapira, Virginia Borges, Steven Come, Eric Winer, Ann Partridge, Shoshana Rosenberg. Five-year quality of life (QOL) trajectories among young breast cancer (BC) survivors [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-12-01.

Abstract PO2-09-12: The magnitude and temporal variations of socioeconomic inequalities in quality of life after early breast cancer: results from the multicentric French CANTO cohort

Abstract Objective Previous studies showed that various outcomes in patients with early breast cancer (EBC), from incidence to survival, were influenced by social factors. However, there is limited research on the socioeconomic inequalities in quality of life (QoL) after treatment for EBC, and the magnitude and changes over time of these inequalities have not been quantified. This study examines the socioeconomic inequalities in QoL and their time trends among a large cohort of patients with EBC. Methods We conducted a comprehensive longitudinal analysis using data from the prospective multicentric CANTO study (CANcer TOxicity, NCT01993498), which included participants with EBC enrolled between 2012 and 2018. QoL was assessed using the summary score of the EORTC QLQ-C30 questionnaire at the time of diagnosis and 1 and 2 years post-diagnosis. We included patients with complete QoL data at diagnosis and 2 years post-diagnosis. Analyses were conducted for three indicators of socioeconomic status separately: self-reported financial difficulties, household income and educational level. We first analyzed trajectories of QoL by socioeconomic status from diagnosis to Year 1 and Year 2. Then, social inequalities in QoL were estimated using the regression-based slope indexes of inequality (SII) and compared across the follow-up periods. The SII represents the absolute change in the QLQ-C30 summary score along the two extremes of the socioeconomic gradient, taking into account the intermediate groups and their relative sizes. The analyses were adjusted for age at diagnosis, Charlson comorbidity index, disease stage, use and type of endocrine therapy, use and type of chemotherapy, breast surgery, radiotherapy use, and lymph node management. Results In the 5915 analyzed patients, compared to those with higher socioeconomic status, those reporting a high level of financial difficulty, lower income, or lower education were younger, most often premenopausal, with comorbidities, diagnosed with stage III BC, and treated with mastectomy and axillary lymph node dissection. There were no differences between socioeconomically-defined groups concerning BC histology, grade and IHC-defined subtype. Social inequalities in QoL at baseline were statistically significant for all socioeconomic status indicators (SIIfinancial difficulties = -7.6 [-8.9;-6.2], SIIincome= -4.0 [-5.2;-2.8]) and SIIeducation= -1.9 [-3.1;-0.7]). In multivariable analyses, social inequalities significantly increased (interaction p< 0.05) in Year 1 (SIIfinancial difficulties = -11.1 [-12.8;-9.4], SIIincome= -6.5 [-8.0;-5.0] and SIIeducation= -5.0 [-6.6;-3.5]) and Year 2 (SIIfinancial difficulties = -10.7 [-12.2;-9.1], SIIincome= -6.7 [-8.0;-5.3] and SIIeducation= -4.7 [-6.1;-3.3]) suggesting a widening socioeconomic gap in QoL outcomes irrespective of pre-diagnosis health, tumor characteristics and treatment. Similar results were observed in subgroups defined by menopausal status (pre/postmenopausal) and type of systemic treatment (chemotherapy, endocrine therapy). Conclusion Our study highlights and quantifies the association of several individual socioeconomic indicators with the QoL of patients with EBC in France. The magnitude of socioeconomic inequalities in QoL increased over time after EBC diagnosis in a country with a strong welfare system and universal healthcare coverage. In the era of precision medicine, these results underscore the importance of developing interventions to improve precision care, considering the conditions in which people are born, grow, work, live and age and the wider set of forces and systems shaping the conditions of daily life. Citation Format: José Luis Sandoval, Antonio Di Meglio, Arlindo Ferreira, Maria Alice Franzoi, Fabrice André, Barbara Pistilli, Christelle Jouannaud, Marion Fournier, Philippe Rouanet, Asma Dhaini Mermeche, Paul Cottu, Sibille Everhard, Anne-Laure Martin, Silvia Stringhini, Idris Guessous, Ines Vaz Luis, Gwenn Menvielle. The magnitude and temporal variations of socioeconomic inequalities in quality of life after early breast cancer: results from the multicentric French CANTO cohort [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-09-12.

Persistent environmental lead exposures disrupting black children’s neurodevelopment and quality of life trajectories: an under-recognized ACE in the hole

Persistent environmental lead exposures disrupting black children’s neurodevelopment and quality of life trajectories: an under-recognized ACE in the hole

The Impact of Delirium on Recovery in Geriatric Rehabilitation after Acute Infection

ObjectivesDelirium is common during acute infection in older patients and is associated with functional decline. Geriatric rehabilitation (GR) can help older patients to return to their premorbid functional level. It is unknown whether delirium affects GR outcomes in patients with acute infection. We evaluated whether delirium affects trajectories of activities of daily living (ADL) and quality of life (QoL) recovery in GR after COVID-19 infection. DesignThis study was part of the EU-COGER study, a multicenter cohort study conducted between October 2020 and October 2021. Setting and ParticipantsParticipants were recruited after COVID-19 infection from 59 GR centers in 10 European countries. MethodsData were collected at GR admission, discharge, and at the 6-week and 6-month follow-ups. Trajectories of ADL [using the Barthel index (BI)] and QoL [using the EuroQol–5 Dimensions–5 Level (EQ-5D-5L)] recovery were examined using linear mixed models. ResultsOf the 723 patients included (mean age 75.5 ± 9.9 years; 52.4% male), 28.9% had delirium before or during GR admission. Participants with delirium recovered in ADL at approximately the same rate as those without (linear slope effect = −0.13, SE 0.16, P = .427) up to an estimated BI score of 16.1 at 6 months. Similarly, participants with delirium recovered in QoL at approximately the same rate as those without (linear slope effect = −0.017, SE 0.015, P = .248), up to an estimated EQ-5D-5L score of 0.8 at 6 months. Conclusions and ImplicationsPresence of delirium during the acute phase of infection or subsequent GR did not influence the recovery trajectory of ADL functioning and QoL.

The influence of postoperative morbidity on medium to long-term quality of life trajectories following cytoreductive surgery for peritoneal malignancy – A prospective cohort study

PurposeCytoreductive surgery (CRS) improves survival of selected patients with peritoneal malignancy. However, postoperative morbidity rates remain high. The aim of this study was to determine the impact of postoperative morbidity on the quality of life (QOL) trajectories of patients undergoing CRS. MethodsThis prospective cohort study included consecutive patients undergoing CRS for peritoneal malignancy between April 2017 and March 2023. QOL measures were collected at baseline, pre-discharge, 3, 6, 12, 18 and 24 months postoperatively using the short-form 36 (SF-36v2) survey. Postoperative in-hospital complications were defined according to the Clavien-Dindo Classification. Differences in QOL trajectories for patients with, and without, postoperative complications, length of stay (short versus long) were determined using mixed effects analyses. ResultsA total of 368 patients were included. Mean age was 55 years and 56.2% were female. The main indications for CRS were colorectal peritoneal metastases (46.9%) and appendix adenocarcinoma (23.9%). Overall, QOL decreased sharply from baseline to pre-hospital discharge, returning to baseline 6 to 12 months post-surgery. Severity of postoperative complication and longer length of stay were the main factors negatively impacting physical component trajectories. Postoperative complication, severity of complication and longer length of stay negatively influenced mental component scores, mostly at pre-discharge. ConclusionsQOL following CRS returns to baseline levels within 6 to 12 months. Postoperative morbidity was associated with poorer health related QOL trajectories. Interventions aimed at reducing postoperative morbidity and targeted support may enhance long-term QOL outcomes.

Longitudinal trajectories of depression and quality of life in a cohort of cancer survivors and individuals without cancer in Europe.

The long-term effects of cancer on psychological symptoms and quality of life (QoL) have been widely reported, but they were seldom examined over time compared to the general population. To investigate trajectories of depression and QoL over time among cancer survivors compared to individuals without cancer throughout Europe and identify associated factors. Data from five waves of the Survey of Health, Ageing and Retirement in Europe study were used. The study sample featured 1066 cancer survivors and 9655 individuals without cancer from 13 European countries. Group-based trajectory modeling was used to identify depression and QoL trajectories, and a linear mixed-effects model was used to characterize their correlates. Four depression trajectories-stable low, stable high, increasing, and decreasing-and four QoL trajectories were identified. All QoL trajectories were stable over time, but differed in their levels: low, low-medium, medium-high, and high. Depression and QoL trajectories were similar between cancer survivors and individuals without cancer. However, significantly more cancer survivors had high-depression and low-QoL trajectories. Further, better perceived health, activities of daily living, physical activity, and income adequacy levels were significantly associated with changes in depression and QoL levels over time. Although depression and QoL trajectories did not differ between cancer survivors and individuals without cancer, more cancer survivors were characterized by high-depression and low-QoL life trajectories. Providers should be aware and screen for cancer survivors with elevated depression and low QoL, and promoterelevant psychosocial interventions. Modifiable factors associated with depression and QoL can be targets forcancer survivors' long-term care plans.

A prospective, observational study of frailty, quality of life and dialysis in older people with advanced chronic kidney disease

BackgroundFrailty is prevalent in older people with chronic kidney disease (CKD) and robust evidence supporting the benefit of dialysis in this setting is lacking. We aimed to measure frailty and quality of life (QOL) longitudinally in older people with advanced CKD and assess the impact of dialysis initiation on frailty, QOL and mortality.MethodsOutpatients aged ≥65 with an eGFR ≤ 20ml/minute/1.73m2 were enrolled in a prospective observational study and followed up four years later. Frailty status was measured using a Frailty Index (FI), and QOL was evaluated using the EuroQol 5D-5L instrument. Mortality and dialysis status were determined through inspection of electronic records.ResultsNinety-eight participants were enrolled. Between enrolment and follow-up, 36% of participants commenced dialysis and 59% died. Frailty prevalence increased from 47% at baseline to 86% at follow-up (change in median FI = 0.22, p < 0.001). Initiating dialysis was not significantly associated with change in FI. QOL declined from baseline to follow-up (mean EQ-5D-5L visual analogue score of 70 vs 63, p = 0.034), though commencing dialysis was associated with less decline in QOL. Each 0.1 increment in baseline FI was associated with 59% increased mortality hazard (HR = 1.59, 95%CI = 1.20 to 2.12, p = 0.001), and commencing dialysis was associated with 59% reduction in mortality hazard (HR = 0.41, 95%CI = 0.20 to 0.87, p = 0.020) irrespective of baseline FI.ConclusionsFrailty increased substantially over four years, and higher baseline frailty was associated with greater mortality. Commencing dialysis did not affect the trajectory of FI but positively influenced the trajectory of QOL from baseline to follow-up. Within the limitations of small sample size, our data suggests that frail participants received similar survival benefit from dialysis as non-frail participants.

Trajectories of quality of life and cognition in different multimorbidity patterns: Evidence from SHARE

ObjectivesThe study aimed to observe the trajectory of quality of life (QoL) and cognition, and to a analyze the bidirectional association between cognition and QoL for diverse multimorbidity patterns. MethodsIn total, 16,153 older participants age ≥50 years were included from the Survey of Health, Ageing and Retirement in Europe (SHARE). We used latent class analysis (LCA) to identify multimorbidity patterns in the baseline population. We used linear mixed models (LMM) to examine the trajectory of cognition and QoL in different multimorbidity patterns. A cross-lagged model was employed to analyze the bidirectional association between cognition and QoL in diverse multimorbidity patterns. ResultsLatent class analysis identified four multimorbidity patterns: high and low comorbidity burden (HC and LC), cardiometabolic (CA), and osteoarthrosis (OS). The HC group had the poorest cognitive function and QoL (p for trend < 0.001). Delayed and immediate episodic memory in the OS group declined at a highest rate (p for trend < 0.001). Additionally, a bidirectional association between cognition and QoL was observed. The effect of cognitive function on QoL was relatively stronger than the reverse in the CA and LC groups. ConclusionsThe rate of decline in cognition and QoL over the time differs in diverse multimorbidity patterns, and patients with four or more chronic diseases should be specially considered. Notably, early monitoring of cognitive function and can help break the vicious cycle between cognitive deterioration and poor QoL in patients with OS or CA diseases.

Trajectories of post-stroke quality of life and long-term prognosis: Results from an eleven-year prospective study

PurposeThe relationship between quality of life (QoL) and long-term prognosis in stroke patients is still unclear. We explored physical and mental QoL trajectories during the first six months after stroke and determined the associations between trajectories and long-term prognosis in patients with first-ever ischemic stroke. MethodsIncluded were 733 participants from a prospective study. QoL was assessed with the 12-item Short Form Survey (SF-12) at baseline, 3 and 6 months. Patients' prognoses (stroke recurrence and death) were identified from 2010 to 2021. The latent class growth model (LCGM) was used to identify distinct trajectories of physical and mental QoL measured over the first 6 months. We employed the Cox model or Fine-Gray model for prognoses to examine the associations between QoL trajectories and prognosis. ResultsFive trajectories of physical QoL and five trajectories of mental QoL were identified. For physical QoL of the Poor-Improved, and Moderate-Impaired trajectory versus Moderate-Improved trajectory, the hazard ratio (HR) for death was 2.39 (1.14 to 5.02), and 2.03(0.93 to 4.44); the HR for recurrence was 1.56 (0.83 to 2.94) and 2.33 (1.28 to 4.24). For mental QoL of the Moderate-Impaired trajectory versus the Moderate-Improved trajectory, the HR for death was 2.48 (1.21 to 5.07). The results were robust in the sensitivity analysis. ConclusionQoL during the first six months after ischemic stroke can be categorized into distinct groups. Change in QoL was associated with long-term survival. Secondary prevention of recurrent strokes might rely more on improving patients' physical QoL.

Quality of Life of Mothers and Fathers 4 to 6 Months After Birth: The Effect of a Very Preterm Delivery.

The sparse literature on the effect of a preterm delivery on parents' quality of life (QoL) yields inconsistent results, restricting their analysis to mothers. The present study aimed to assess the effect of a very preterm delivery on parents' gender-specific perception of QoL, 4 to 6 months after birth. A total of 117 parents of very preterm infants hospitalized at birth in a level III Neonatal Intensive Care Unit, and 214 parents of never hospitalized full-term infants born in a public maternity, both located in the North of Portugal, participated in the study, 4 to 6 months after delivery (November 2013-June 2015). The Portuguese version of the World Health Organization Quality of Life - BREF Inventory was applied and scores were transformed to reflect a 0 to 100 scale. The mean [standard deviation (SD)] of overall QoL ranged between 72.1 (13.3) among mothers of full-term infants and 74.6 (12.5) among mothers of very preterm infants. The perception of QoL was not significantly different among parents of very preterm and full-term infants, according to gender. The highest scores were observed in the psychological and physical dimensions, for both mothers and fathers. The lack of differences on the perception of QoL among mothers and fathers of very preterm and full-term infants, highlights the need to deeply understand and explore the influence of accommodation mechanisms, the extended family/community and health policies on parental QoL trajectories.

Long-term longitudinal patterns of patient-reported quality of life (QOL) after breast cancer (BC) to inform the implementation of personalized pathways of care.

12081 Background: There is substantial inter individual variability in long-term trajectories of patient-reported quality of life (QOL) after early BC. Previous work focused on a selected group of patients (pts) treated with chemotherapy (CT) identified a cluster of pts with upfront poor QOL but also pts with severe, persistent post-chemotherapy QOL deterioration. We aimed to expand this work to a non-selected group of pts with early BC to identify latent clusters of pts at risk for QOL deterioration, and to assess the relationship of actionable host factors and health behaviors with trajectory group membership. Methods: We performed a detailed longitudinal analysis of QOL using a large ongoing national prospective clinical cohort (CANcer TOxicity, NCT01993498) of pts with stage I-III BC treated from 2012-2018. QOL (EORTC QLQ-C30 summary score) was assessed at diagnosis (dx, baseline) and year 1, 2, 4 and 6 post-dx. Baseline clinical, sociodemographic, behavioral, tumor-related, and treatment-related characteristics were available. Trajectories of QOL and group membership associations were identified by iterative estimations of group-based trajectory models and multivariable multinomial logistic regression, respectively, among the whole cohort. Results: Among 10,792 pts, 5,695 received adjuvant CT and 8,805 received adjuvant endocrine therapy (ET). Four QOL trajectory groups were identified: excellent (N = 4,934, 45.8%), very good (N = 3,596, 33.3%), deteriorating (N = 1,745, 16.1%), and poor (N = 517, 4.8%). The deteriorating trajectory group reported fairly good baseline QOL (73.3 [95% CI], [72.4 to 74.2]), which significantly worsened at year-1 (63.0 [62.1 to 63.9]) and never recovered to pretreatment values through year-6 (64.7 [63.3 to 66.0]) post diagnosis. Factors associated with membership to the deteriorating group included younger age (aOR, 10-years decrement 1.10 [95% CI, 1.05 to 1.16]), overweight or obesity (aOR v lean, 1.90 [95% CI, 1.60 to 2.25]; 1.25 [95% CI, 1.07 to 1.46], respectively), physical inactivity (aOR v active, 1.13 [95% CI, 1.04 to 1.35]), former smoking behavior (aOR v never, 2.14 [95% CI, 1.80 to 2.54]), Charlson comorbidity score ≥1 (aOR v 0, 1.56 [95% CI, 1.33 to 1.83]), lower household income ( &lt; 3000 EU/month) (aOR v ≥3000, 1.50 [95% CI, 1.30 to 1.72]), receipt of adjuvant CT (aOR v no, 1.35 [95% CI, 1.14 to 1.59]) and receipt of adjuvant ET (aOR v no, 1.46 [95% CI, 1.22 to 1.75]). Conclusions: This study will help identify latent clusters of pts who are at risk of persistent QOL deterioration after BC, independently of receipt of CT. Trajectory clustering can help facilitate the creation of personalized pathways that may include early addressal of actionable factors, including referral to social work and healthy lifestyle interventions. Clinical trial information: NCT01993498 .

Decision Tree Analyses for Prediction of QoL over a One-Year Period in Breast Cancer Patients: An Added Value of Patient-Reported Outcomes.

Despite the current shift in medicine towards patient-centered care, clinicians rarely utilize patient-reported outcomes (PROs) in everyday practice. We examined the predictors of quality- of-life (QoL) trajectories in breast cancer (BC) patients during the first year after primary treatment. A total of 185 BC patients referred for postoperative radiotherapy (RT) filled in the EORTC QLQ-C30 Questionnaire assessing global QoL, functioning and cancer-related symptoms before starting RT; directly after RT; and 3, 6 and 12 months after RT. We used decision tree analyses to examine which baseline factors best allowed for predicting the one-year trajectory of the global QoL after BC treatment. We tested two models: 'basic', including medical and sociodemographic characteristics, and 'enriched', additionally including PROs. We recognized three distinct trajectories of global QoL: 'high', 'U-shape' and 'low'. Of the two compared models, the 'enriched' model allowed for a more accurate prediction of a given QoL trajectory, with all indicators of model validation being better. In this model, baseline global QoL and functioning measures were the key discriminators of QoL trajectory. Taking PROs into account increases the accuracy of the prediction model. Collecting this information in the clinical interview is recommended, especially for patients with lower QoL.

Patient-Reported Outcome Measures in Physiotherapy: An Overview

High-quality patient-centered health care involves incorporating patient choice in the treatment plan. Patient engagement corresponds with the quality of life (QoL) and satisfaction, which can be achieved by including patient-reported outcome measures (PROMs) in physiotherapy practice. PROMs are instruments to evaluate health outcomes from the perspective of the patient and to determine whether the management plan enhances their QoL. PROMs in regular practice offer a structured way for clinicians to track patient symptoms, determine clinical outcomes, and facilitate collaborative decision-making. During the patient assessment, it aids in establishing a consistent framework, confirming the clinical results, and ascertaining the validity of the evaluation to the desired treatment. PROM data can be collected in several ways, including in-person interviews, questionnaires, and diaries. The use of PROMs in research increases both the research process as well as the validity of its findings. Integrating PROMs into physiotherapy management is an opportunity to rightly understand the patient’s QoL trajectory and broaden the range of PROMs estimated in shared decision-making. Although PROM administration by clinicians helps for tracking patients, for guiding treatment considerations, and for providing a more central viewpoint for patients, its usage remains unclear by including patients in shared decision-making. However, establishing a patient-centered, comprehensive prototype of treatment requires the regular application of authorized PROMs. Incorporation of PROMs in physiotherapy practice can facilitate a multidimensional and patient-centered evaluation of the disease, identify unfulfilled needs, direct physiotherapist attention to these needs, and better inform policymakers in the light of identifying patient goals.

(77) Defining the Temporal Relationship Between Peak Lung Function and Quality of Life Trajectories after Lung Transplantation in a Large Multi-Center Cohort

(77) Defining the Temporal Relationship Between Peak Lung Function and Quality of Life Trajectories after Lung Transplantation in a Large Multi-Center Cohort