Trends In Quality Of Life Research Articles

Quality of Life in Patients with Malignant Wounds Treated at a Wound Care Clinic.

Malignant wounds can present in up to 14.5% of patients with advanced cancer, significantly reducing quality of life (QoL). Management of malignant wounds is generally palliative, with the goal of improving or maintaining QoL. There is a lack of data on the impact of wound care clinics on QoL in patients with malignant wounds. We sought to assess the QoL in patients with malignant wounds attending a wound care clinic. We also aimed to describe the baseline QoL, trends in QoL, physical symptoms, and treatment modalities that affect QoL in patients with malignant wounds over time. This retrospective observational study included 36 patients attending a wound care clinic at an oncologic hospital from 1/1/2016-4/1/2023. As part of the standard of care, these patients complete a Skindex-16 QoL survey at each visit. The Skindex-16 is a validated instrument to measure the effects of skin diseases on QoL. Data were extracted from the electronic medical record. Descriptive statistics, graphical methods, and random effects models for change were used to describe the patient population and the QoL measures over time. Of the 36 patients who completed at least one Skindex-16 questionnaire, 69.4% were female, and 50.0% developed malignant wounds from breast cancer, 30.5% from nonmelanoma skin cancer, and 8.3% from sarcoma. At the initial visit, 86.1% of patients had exudate associated with their malignant wound, 52.7% of patients had malodor, 63.9% had bleeding, 69.4% had pain, and 50% had pruritus. The mean baseline Skindex-16 score was 54.5, falling into the "extremely severe" category, with a mean score of 15.4, 18.8, and 20.3 for the symptoms, emotions, and functioning domains, respectively. Nineteen patients completed at least one additional Skindex-16 questionnaire at follow-up visits (visit two 52.8%, visit three 33.3%, visit four 19.4%, visit five or greater 13.9%). Compared to the mean Skindex-16 score at baseline, there was an 18.5 point improvement at visit 2 (95% CI: 3.3-33.7, p = 0.018). Malignant wounds severely adversely affect patients' quality of life. However, patients experienced improved quality of life after being treated at a dedicated wound clinic.

Report from Health Professionals and Cancer Patients: Experiences and Wishes from Clinical Practice About the Integration of Quality of Life with a Health App.

Advanced cancer treatments increase survival rates and with that the importance of Quality of Life (QoL). QoL is well studied in trials, but the transition to standard care is little. For this reason, we identified the challenges for a regular integration to conceptualize an applicable solution together with patients and health professionals (HP). We conducted two meetings based on the design thinking method. Two Physicians, one employee of cancer counseling centers, one psycho-oncologists, and five patients were included. Based on the discussions a system was conceptualized to solve current thresholds. All participants had experience with the documentation of QoL, but none had shared it digitally from home. Therefore, the main threshold was the lack of system for data transition between agents, followed by lack of time for HP and acceptance of QoL for patients. HP were mainly interested in data on the trend of QoL whereas patients preferred information on their activity, energy level and social contacts. The conceptualized solution is based on a health app on the patients' side with a browser-based implementation for HP. Within the system, automatized data interpretation, alarm systems, support information, standardized input fields as an orientation for documentation with expandable options for specific restrictions as well as interinstitutional networking for HP to better refer patients to others was wished for. This article describes the concept of such a system developed with HP and patients. Implementation and transfer to clinical care has yet to be done.

Introducing the Mellorater-The Five Domains Model in a Welfare Monitoring App for Animal Guardians.

When monitoring an animal's welfare, it helps to have comprehensive and day-to-day information about the animal's life. The goal is to ensure that animal guardians (carers, keepers, and owners) use such information to act in the animals' best interests. This article introduces the Mellorater, an animal welfare monitoring app based on the 2020 Five Domains Model. This framework provides a means of capturing comprehensive information about the world in which individual animals exist. The Mellorater asks animal guardians to rate their agreement with 18 statements covering any focal animal's nutrition, environment, health, and behavioural interactions using a five-point Likert scale. No specialist training is required other than following straightforward instructions on using the app, which are provided. The Mellorater is not proposed as a validated welfare auditing tool because it relies on reflective self-reporting and, thus, is vulnerable to the user's subjectivity. If users' subjectivity is stable over time, then the longitudinal data may be considered useful proxies for trends in quality of life. That said, it has the potential to be used by trained auditors if scientifically validated, species-specific indicators are applied. The Mellorater collects anonymous data and has been approved for a study to explore how the use of such scales may differ among guardians of different species and in different contexts. In this paper, we conduct the following: (1) summarise the app's purposes; (2) clarify its capabilities and limitations; and (3) invite animal welfare scholars, veterinarians, health and welfare professionals, and animal guardians to use it.

Online Cognitive Stimulation Therapy for Dementia in Brazil and India: Acceptability, Feasibility, and Lessons for Implementation.

Cognitive stimulation therapy (CST) is an evidence-based, group psychosocial intervention for people with dementia, and it has a positive impact on cognition and quality of life. CST has been culturally adapted for use globally. It was developed as a face-to-face intervention but has recently been adapted for online delivery. In this study, we aimed to explore the feasibility and acceptability of online or virtual CST (vCST) delivery in India and Brazil, emphasizing barriers and facilitators to implementation. A single-group, multisite, mixed methods, feasibility study was conducted, with nested qualitative interviews. Primary feasibility outcomes were recruitment rate, attendance, attrition, acceptability, and outcome measure completion. Exploratory pre- and postintervention measures, including cognition and quality of life, were assessed. Qualitative interviews were conducted with people with dementia, family caregivers, and group and organizational leaders following intervention delivery, and the data were analyzed using the Consolidated Framework for Implementation Research. A total of 17 vCST group sessions with 59 participants were conducted for 7 weeks, with 53% (31/59) of participants attending all 14 sessions. Attrition rate was 7% (4/59), and outcome measure completion rate at follow-up was 68% (40/59). Interviews took place with 36 stakeholders. vCST was acceptable to participants and group leaders and enabled vital access to services during pandemic restrictions. While online services broadened geographic access, challenges emerged concerning inadequate computer literacy, poor technology access, and establishing interpersonal connections online. Exploratory, uncontrolled analyses indicated positive trends in quality of life but negative trends in cognition and activities of daily living, but these results were not statistically significant. vCST demonstrated feasibility and acceptability, serving as a crucial resource during the pandemic but raised challenges related to technology access, computer literacy, and long-term implementation. The study highlights the potential of vCST while emphasizing ongoing development and solutions to address implementation challenges.

F-25 | Trends in Quality of Life and Biomarkers in patients with Chronic Thromboembolic Pulmonary Hypertension after Pulmonary Balloon Angioplasty

F-25 | Trends in Quality of Life and Biomarkers in patients with Chronic Thromboembolic Pulmonary Hypertension after Pulmonary Balloon Angioplasty

A Longitudinal Study of the Effect of Memory on the Quality of life of European Adults and Older Adults

Among studies conceptualizing quality of life (QoL) as the subjective measure of one’s well-being, evidence suggests a link between cognitive impairment and diminished quality of life. However, the direction of the association is not clear, and most studies have employed a global measure of cognition, which can mask subtle domain-specific declines. In this study, we aim at examining the longitudinal associations between memory and QoL in a representative sample of adults and older adults in Europe and Israel, employing data from the Survey of Health, Ageing and Retirement in Europe (SHARE). The sample was composed by 56,616 respondents aged 50 or older at the beginning of the study period. A Parallel-Process Latent Growth Model (PP LGM) of memory and QoL conditioned on the effects of age, gender, educational level, physical inactivity, depressive symptomatology and social activity participation, was tested. Results displayed a trajectory of decline for both memory and QoL, with higher initial levels of memory associated with higher initial levels of QoL, and steeper decline in memory associated with steeper decline in QoL. Moreover, a positive effect of initial memory onto QoL trend over time was found, indicating that better memory is associated to better QoL in the future, but the opposite did not occur. Results also provide evidence of gender differences. All in all, this work found evidence supporting the longitudinal effect of memory on QoL, which may have consequences for intervention implementation, given that actions for alleviating age-related memory impairment could also have a positive impact onto older adults’ QoL.

National long-term trends in health-related quality of life using EQ-5D-3L in South Korea, 2008-2021, including the COVID-19 pandemic: a representative serial study of 2.8 million people.

There is a scarcity of literature investigating the impact of the coronavirus disease 2019 (COVID-19) pandemic on long-term trends in health-related quality of life (HrQoL) using large-scale and representative data. Thus, we aimed to investigate the nationwide and long-term trends in quality of life (QoL) using the European Quality of Life- 5 dimensions, 3-level version (EQ-5D-3L) from a Korean representative serial study of 2.8 million people, 2008-2021. This Korean study used data on adults between 2008 and 2021 who participated in the Community Health Survey. Timeframes were categorized as COVID-19 mid-pandemic (2021) and pre-pandemic (2008-2019). The mean EQ-5D-3L index for the whole population and subgroups stratified by demographic characters was evaluated for each timeframe, and differences between before and during the COVID-19 pandemic were also analyzed. 2,827,240 adults who responded to the survey, 2008-2021, were eligible for this study. Overall EQ-5D index persistently decreased from 2008-2016, then minimally decreased during the pandemic, still being much higher than forecasted before the COVID-19 pandemic. The reduction in the rate of decline in QoL after the COVID-19 outbreak was especially marked in white-collared, young adults, people with 'good' or 'very good' subjective health, and college-educated or above group. On the other hand, the previously increasing trend of QoL in the elderly group has decelerated during the pandemic, and QoL of the 'very bad' subjective health group recorded the lowest in the whole study period. The present study investigated the long-term trend of QoL in Korean adults using serial data over the past 14 years, with a special emphasis on comparing the pre- and mid-COVID-19 pandemic periods.

Evaluation of the quality of life 10 years after bilateral thoracoscopic sympathicotomy in subjects with primary focal hyperhidrosis

Introduction/Objective. Primary focal hyperhidrosis (PFH) is an idiopathic condition where excessive sweating affects one or more body regions, including axillae, palms, soles, and/or face. Most studies on quality-of-life focus on the period up to one year after bilateral thoracoscopic sympathectomy (BTS). This study aims to determine the 10-year trend in quality of life among patients from the Republic of Serbia with palmar-plantar-axillary primary focal hyperhidrosis, treated with BTS at the R3-R4 level. A secondary goal is to ascertain the existence of compensatory sweating. Methods. All patients underwent a standardized BTS in a single act, through the cutting of ganglia with ultrasonic scissors at the R3-R4 level. For data collection, patients completed the "Hyperhidrosis Quality of Life Questionnaire (HQLQ)," and the Hyperhidrosis Disease Severity Scale (HDSS), preoperatively, postoperatively within 30 days, and 10 years after BTS. Results. The total sample consisted of 103 subjects who completed all three questionnaires. Considering the improvement in Quality of Life (QoL) from the group excellent, good, and average, the postoperative improvement was immediately postoperative in 88.4% of patients, while in the ten-year period, it was 87.4%. No statistically significant differences were found between the assessment of life satisfaction after 30 days and 10 years after BTS. Out of the total number of operated patients, two patients (1.94%) characterized their compensatory sweating as very pronounced. Conclusion. After 10 years from BTS, the QoL remains at an exceptionally high level, with an annual trend of decline of about 0.1%.

16 Does Cognitive Test Performance Upon Admission to Nursing Homes Predict Long Term Care Residents’ Psychological Functioning?

Objective:The current study investigated whether older adults’ cognitive test scores at the time of long-term care nursing home admission are associated with psychological well-being over the first six months. We analyzed the link between Mattis Dementia Rating Scale (DRS-2) subscale scores and anxiety, depression, quality of life, and positive/negative affect.Participants and Methods:Participants were recently admitted long-term care residents from 13 nursing homes in the Louisville, KY area. Sixty-two older adults were administered the DRS-2 shortly after nursing home admission. Using a cutoff of less than 6 scaled score on the DRS-2, 52% of participants scored as cognitively impaired. Self-report measures of anxiety (RAID), depression (PHQ9), quality of life (QoL-AD), and positive/negative affect (Philadelphia Geriatric Center Affect Rating Scale) were collected at time of admission, and 3 and 6 months later.Results:The DRS-2 attention subscale significantly correlated with baseline depression symptoms. No other DRS-2 subscale or the DRS-2 total score correlated with anxiety, depression, quality of life, or affect ratings at admission. Baseline DRS-2 attention, initiation/perseveration, and memory had significant correlations with self-report measures at 3 and 6 months; these DRS-2 scores were selected for further analysis. Mixed ANOVAs found a significant main effect of group (impaired vs. not-impaired) for the initiation/perseveration subscale, memory subscale, and DRS-2 total score on negative affect; impairment in any of these domains was associated with lower reported negative affect at all three time points. There was no significant effect of cognitive scores on any other self-report measure. There was a significant, positive linear trend in quality of life over time. There was a significant quadratic trend in depression symptoms, with decreased depression reported at 3 months and increase at 6 months.Conclusions:Impaired performance on the DRS-2 was associated with lower negative affect over time. Cognitive impairment was not associated with anxiety, depression, quality of life, or positive affect. There appear to be reliable trends in some psychological factors regardless of cognitive scores, with an increase in quality of life over time and a temporary decrease in reported depression captured at 3 months. The relationship between cognitive impairment and negative affect should be interpreted with caution, as only 22 residents completed the affect self-report at all three time points. Overall, we found limited evidence of an association between cognitive scores at time of admission and self-reported psychological factors at 3 and 6 months.

Aging well? Exploring self-reported quality of life in the older Austrian population

Abstract Background The increase of life expectancy around the world sets an ageing society with all its challenges on the global Public Health agenda. In Austria, the additional years of life gained are not spent in good health, as the healthy life expectation is far below the European average. This study aimed to examine the change in self-reported quality of life (QoL) over time in the Austrian older-aged population and explore associated factors. Methods Repeated cross-sectional data was retrieved from three waves of the Austrian Health Interview Survey conducted in 2006, 2014 and 2019, including a total of 10 056 participants aged 65 years and above. To estimate QoL in this age group, domain scores of the WHOQOL-BREF were used. Trends in QoL were descriptively analysed across different age groups, sex and survey years. Adjusted Wald tests were conducted to compare means of older women and men. Linear regression models were estimated to explore the impact of age, sex, family status, education, income, residence and survey year on QoL domains. Results While WHOQOL-BREF domain scores increased over time, a steady decrease with age was observable in all survey waves. Mean scores were significantly higher in men than in women in all QoL domains and in each survey year except for the social domain. In the regression analyses, sex differences disappeared in most domains after adjusting for income and education. Factors associated with significantly higher QoL scores in all domains included younger age, higher education, higher income and living in Western Austria. Conclusions Observed sex differences in QoL seem to be driven mainly by income and education differences in the older-aged Austrian population. Following the WHO's and UN's 10-year global plan of action - The United Nations Decade of Healthy Ageing 2021-2030 - further efforts towards developing sustainable strategies and policies to reduce socioeconomic inequalities also with attention to sex/gender gap are strongly needed. Key messages • This study provides a first in-depth analysis of quality of life in Austrian senior citizens. • Younger age, higher education, higher income and living in Western Austria are associated with better quality of life.

Pain and quality of life in nursing home residents with dementia after admission – a longitudinal study

BackgroundPain in nursing home (NH) residents with dementia is commonly reported and may affect Quality of Life (QoL) negatively. Few longitudinal studies have explored how pain and QoL develop in NH residents with dementia starting from their admission to the NH.AimThe aim was to explore pain, QoL, and the association between pain and QoL over time in persons with dementia admitted to a NH.MethodsA convenience sample, drawn from 68 non-profit NHs, included a total of 996 Norwegian NH residents with dementia (mean age 84.5 years, SD 7.6, 36.1% men) at NH admission (A1), with annual follow-ups for two years (A2 and A3). Pain and QoL were assessed using the Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) Pain Scale and the Quality of Life in Late-Stage Dementia (QUALID) scale, respectively, at all assessments. Severity of dementia, personal level of activities of daily living, general medical health, neuropsychiatric symptoms, and the prescription of psychotropic drugs and analgesics (opioids and/or paracetamol) were also assessed at all assessments.ResultsMean (SD) MOBID-2 pain intensity scores were 2.1 (2.1), 2.2 (2.2), and 2.4 (2.1) at A1, A2, and A3, respectively. Participants who were prescribed analgesics had higher pain intensity scores at all assessments than participants not prescribed analgesics. The mean (SD) QUALID scores at each assessment were 19.8 (7.1), 20.8 (7.2), and 22.1 (7.5) at A1, A2, and A3, respectively. In the adjusted linear mixed model, higher pain intensity score, prescription of opioids, and prescription of paracetamol were associated with poorer QoL (higher QUALID total score and higher scores in the QoL dimensions of sadness and tension) when assessed simultaneously. No time trend in QoL was found in these adjusted analyses.ConclusionNH residents with dementia who have higher pain intensity scores or are prescribed analgesics are more likely to have poorer QoL. Clinicians, NH administrators, and national healthcare authorities need to look into strategies and actions for pharmacological and non-pharmacological pain treatment to reduce pain intensity while simultaneously avoiding negative side effects of pain treatment that hamper QoL.

Quality of life and cost-effectiveness of different breast cancer surgery procedures: a Markov decision tree-based approach in the framework of Predictive, Preventive, and Personalized Medicine.

Breast cancer is a complex disease with heterogeneous outcomes that may benefit from the implementation of Predictive, Preventive, and Personalized Medicine (PPPM/3PM) strategies. In this study, we aimed to explore the potential of PPPM approaches by investigating the 10-year trends in quality of life (QOL) and the cost-effectiveness of different types of surgeries for patients with breast cancer. This prospective cohort study recruited 144 patients undergoing breast conserving surgery (BCS), 199 undergoing modified radical mastectomy (MRM), and 44 undergoing total mastectomy with transverse rectus abdominis myocutaneous flap (TRAMF) from three medical centers in Taiwan between June 2007 and June 2010. All patients exhibited a significant decrease in most QOL dimension scores from before surgery to 6months postoperatively (p < 0.05); however, from postoperative year 1 to 2, improvement in most QOL dimension scores was significantly better in the TRAMF group than in the BCS and MRM groups (p < 0.05). At 2, 5, and 10years after surgery, the patients' QOL remained stable. In the Markov decision tree model, the TRAMF group had higher total direct medical costs than the MRM and BCS groups (US$ 32,426, US$ 29,487, and US$ 28,561, respectively) and higher average QALYs gained (7.771, 6.773, and 7.385, respectively), with an incremental cost-utility ratio (ICUR) of US$ 2,944.39 and US$ 10,013.86 per QALY gained. TRAMF appeared cost effective compared with BCS and MRM, and it has been proved with considerable QOL improvements in the framework of PPPM. Future studies should continue to explore the potential of PPPM approaches in breast cancer care. By incorporating predictive models, personalized treatment plans, and preventive strategies into routine clinical practice, we can further optimize patient outcomes and reduce healthcare costs associated with breast cancer treatment. The online version contains supplementary material available at 10.1007/s13167-023-00326-4.

Longitudinal study of the relationship between number of prior miscarriages or stillbirths and changes in quality of life of pregnant women: the Japan Environment and Children’s Study (JECS)

BackgroundAlthough a history of miscarriage or stillbirth has been reported to negatively affect quality of life (QOL) during the subsequent pregnancy, the association between the number of previous miscarriages or stillbirths and QOL, as well as trends in QOL during pregnancy, has not been clarified. This study sought to determine this association during early and mid- to late pregnancy.MethodsData from 82,013 pregnant women who participated in the Japan Environment and Children’s Study (JECS) from January 2011 to March 2014 were analyzed. In early and mid/late pregnancy, participants completed questionnaires and QOL was assessed using the Physical and Mental Component Summary (PCS and MCS, respectively) scores from the 8-item Short-Form Health Survey (SF-8). The pregnant women were divided into four groups according to number of previous miscarriages or stillbirths (0, 1, 2, and ≥ 3), and the PCS and MCS scores in early pregnancy and mid/late pregnancy were compared between group 0 and groups 1, 2, and ≥ 3. Generalized linear mixed models were used for analysis.ResultsPCS score in early pregnancy was lower in group 1 (β = − 0.29, 95% confidence interval [CI] − 0.42 to − 0.15), group 2 (β = − 0.45, 95% CI − 0.73 to − 0.18), and group ≥ 3 (β = − 0.87, 95% CI − 1.39 to − 0.35) than in group 0. Group 1 and group ≥ 3 showed a trend for increased PCS score during pregnancy (β = 0.22, 95% CI 0.07 to 0.37 and β = 0.75, 95% CI 0.18 to 1.33, respectively) compared with group 0.ConclusionsPCS score in early pregnancy was lower with a more frequent history of miscarriage or stillbirth. However, in terms of changes in QOL during pregnancy, pregnant women with a history of miscarriage or stillbirth showed greater increases in PCS score during mid/late pregnancy than pregnant women with no history of miscarriage or stillbirth.

Immunosuppressant drugs and quality-of-life outcomes in kidney transplant recipients: An international cohort study (EU-TRAIN).

Introduction: Patient-Reported Outcomes (PRO) integrate a wide range of holistic dimensions that arenot captured within clinical outcomes. Particularly, from induction treatment to maintenance therapy, patient quality-of-life (QoL) of kidney transplant recipients have been sparsely investigated in international settings. Methods: In a prospective, multi-centric cohort study, including nine transplant centers in four countries, we explored the QoL during the year following transplantation using validated elicitation instruments (EQ-5D-3L index with VAS) in a population of kidney transplant patients receiving immunosuppressive therapies. Calcineurin inhibitors (tacrolimus and ciclosporin), IMPD inhibitor (mycophenolate mofetil), and mTOR inhibitors (everolimus and sirolimus) were the standard-of-care (SOC) medications, together with tapering glucocorticoid therapy. We used EQ-5D and VAS data as QoL measures alongside descriptive statistics at inclusion, per country and hospital center. We computed the proportions of patients with different immunosuppressive therapy patterns, and using bivariate and multivariate analyses, assessed the variations of EQ-5D and VAS between baseline (i.e., inclusion Month 0) and follow up visits (Month 12). Results: Among 542 kidney transplant patients included and followed from November 2018 to June 2021, 491 filled at least one QoL questionnaire at least at baseline (Month 0). The majority of patients in all countries received tacrolimus and mycophenolate mofetil, ranging from 90.0% in Switzerland and Spain to 95.8% in Germany. At M12, a significant proportion of patients switched immunosuppressive drugs, with proportion varying from 20% in Germany to 40% in Spain and Switzerland. At visit M12, patients who kept SOC therapy had higher EQ-5D (by 8 percentage points, p < 0.05) and VAS (by 4 percentage points, p < 0.1) scores than switchers. VAS scores were generally lower than EQ-5D (mean 0.68 [0.5-0.8] vs. 0.85 [0.8-1]). Discussion: Although overall a positive trend in QoL was observed, the formal analyses did not show any significant improvements in EQ-5D scores or VAS. Only when the effect of a therapy use was separated from the effect of switching, the VAS score was significantly worse for switchers during the follow up period, irrespective of the therapy type. If adjusted for patient characteristics and medical history (e.g., gender, BMI, eGRF, history of diabetes), VAS and EQ-5D delivered sound PRO measures for QoL assessments during the year following renal transplantation.

The trend in quality of life of Chinese population: analysis based on population health surveys from 2008 to 2020

BackgroundQuality of life (QoL) is one of the most important indicators for evaluating an individual’s overall health status. However, evidence exploring the trend in QoL of the Chinese population is still lacking. This study aimed to investigate the trend in QoL of the Chinese population measured by the EQ-5D from 2008 to 2020, as well as compare the changing trends in QoL categorized by populations with different socio-demographic characteristics.MethodsData were obtained from the 2008, 2013, and 2020 waves of the Health Services Surveys conducted in Tianjin, China. Respondents completed the EQ-5D (EQ-5D-3L in 2008 and 2013 and EQ-5D-5L in 2020) through face-to-face interviews or self-administration. Responses of the EQ-5D-3L in 2008 and 2013 were mapped onto the EQ-5D-5L responses, and then converted to utility values using the Chinese value set. The trend in QoL was explored by comparing the percentage of any reported problems on each EQ-5D dimension and the corresponding utility values across the three waves. Subgroup analyses were performed to compare trends in utility values stratified by socio-demographic indicators. The effect of the time variable (year) on utility values was assessed by multiple linear regression analyses using the pooled data.ResultsBy analyzing and comparing the three waves of the data (N = 25,939 in the 2008 wave, N = 22,138 in 2013, and N = 19,177 in 2020), an upward trend was observed in the percentages of reporting problems on all five dimensions (p < 0.001), resulting in a decreasing trend in utility values (2008: 0.948, 2013: 0.942, 2020: 0.939, p < 0.001). Utility values declined more over time among the female, the elder, the recipients of medical assistance, the widowed, the unemployed, and respondents with primary or lower education. The effect of the year (Coef. for 2013 = − 0.009, p < 0.001; Coef. for 2020 = − 0.010, p < 0.001) confirmed the downward trend in the utility values.ConclusionsThe overall QoL of the Chinese population decreased over the period from 2008 to 2020. The QoL of the disadvantaged or vulnerable populations in terms of socioeconomic characteristics declined more over time.

The role of frailty in modifying physical function and quality of life over time in older men with metastatic castration-resistant prostate cancer

IntroductionAs treatment options for metastatic castration-resistant prostate cancer (mCRPC) expand and its patient population ages, consideration of frailty is increasingly relevant. Using a novel frailty index (FI) and two common frailty screening tools, we examined quality of life (QoL) and physical function (PF) in frail versus non-frail men receiving treatment for mCRPC. Materials and MethodsMen aged 65+ starting docetaxel chemotherapy, abiraterone, or enzalutamide for mCRPC were enrolled in a multicenter prospective cohort study. QoL, fatigue, pain, and mood were measured with the Functional Assessment of Cancer Therapy-General scale, the Edmonton Symptom Assessment System tiredness and pain subscales, and the Patient Health Questionnaire-9. PF was evaluated with grip strength, four-meter gait speed, five times Sit-to-Stand Test, and instrumental activities of daily living. Frailty was determined using the Vulnerable Elders Survey (VES-13), the Geriatric 8 (G8), and an FI constructed from 36 variables spanning laboratory abnormalities, geriatric syndromes, functional status, social support, as well as emotional, cognitive, and physical deficits. We categorized patients as non-frail (FI ≤ 0.2, VES < 3, G8 > 14), pre-frail (FI > 0.20, ≤0.35), or frail (FI > 0.35, VES ≥ 3, G8 ≤ 14); assessed correlation between the three tools; and performed linear mixed-effects regression analyses to examine longitudinal differences in outcomes (0, 3, 6 months) by frailty status. A sensitivity analysis with worst-case imputation was conducted to explore attrition. ResultsWe enrolled 175 men (mean age 74.9 years) starting docetaxel (n = 71), abiraterone (n = 37), or enzalutamide (n = 67). Our FI demonstrated moderate correlation with the VES-13 (r = 0.607, p < 0.001) and the G8 (r = −0.520, p < 0.001). Baseline FI score was associated with worse QoL (p < 0.001), fatigue (p < 0.001), pain (p < 0.001), mood (p < 0.001), PF (p < 0.001), and higher attrition (p < 0.01). Over time, most outcomes remained stable, although pain improved, on average, regardless of frailty status (p = 0.007), while fatigue (p = 0.045) and mood (p = 0.015) improved in frail patients alone. DiscussionAmong older men receiving care for mCRPC, frailty may be associated with worse baseline QoL and PF, but over time, frail patients may experience largely similar trends in QoL and PF as their non-frail counterparts. Further study with larger sample size and longer follow-up may help elucidate how best to incorporate frailty into treatment decision-making for mCRPC.

A co-morbid patient of a phthisiologist, pulmonologist and cardiologist: focus on quality of life

The objective: to assess the impact of tuberculosis (TB), chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) on the quality of life (QOL) and the need to manage each disease to improve the physical and mental components of QOL.Subjects and Methods. A simple prospective study included 80 patients, men – 53.9%, women – 46.1% who were divided into 3 groups: Group 1 – COPD (n = 35), median age [Me (25.0; 75.0 )] 56.0 (54.0; 60.0) years old, Group 2 – COPD + TB (n = 25), 58.0 (56.0; 59.0) years old, Group 3 – COPD + TB + CHF with preserved ejection fraction (n = 20), 60.0 (57.0; 64.0) years old. QOL was assessed using the SF-36 questionnaire. There were no statistically signifcant differences between the compared groups in terms of COPD severity and TB forms.Results. Low QOL indices were observed in TB + COPD + CHF Group assessed by all scores especially for physical (30 points) and social functioning (35 points) and general health (35 points). After 3 months of therapy aimed to manage all pathological conditions, a positive trend in QOL was achieved in TB + COPD + CHF Group in terms of physical and mental health scores.Conclusion. QOL in co-morbid patients is determined not only by the quality and severity of individual nosologies but also by their number. Comprehensive therapy improves the general subjective state of the patient that helps to improve adherence to drug therapy thereby increasing the chance of recovery.

Early quality of life (QOL) and symptom analysis from the DREAMseq phase III randomized control trial of combination immunotherapy versus targeted therapy in patients (pts) with BRAF-mutant metastatic melanoma (MM) (ECOG-ACRIN EA6134).

9559 Background: Combinations of either immune checkpoint inhibitors (anti-PD-1/anti-CTLA-4) or BRAF/MEK-targeted therapies have shown significant clinical benefit in pts with BRAFV600 mutant MM. Until recently, little prospective data existed to guide the choice of initial therapy or sequence. Results of the DREAMseq Trial showed that the treatment sequence beginning with nivolumab/ipilimumab (Nivo/Ipi) immunotherapy produced a clinically meaningful 20% improvement in 2-year overall survival (OS) compared to the sequence beginning with dabrafenib/trametinib (Dab/Tram) targeted therapy. The OS and progression-free survival (PFS) curves were biphasic crossing at 10 and 6 months, respectively. Our aim is to characterize QOL trends within and between the initial therapies through 24 weeks (wks). Methods: 265 pts were randomly assigned to Nivo/Ipi for up to 12 wks then Nivo alone (Arm A) or Dab/Tram continuously (Arm B) and at disease progression (PD) received the alternate therapy. QOL was assessed by the PROMIS Profile 29 at baseline, wk 12 (end of cycle (C) 2), and wk 24 (end of C4). Wilcoxon Signed Rank test was used to examine changes over time within treatment arms. OS was estimated by Kaplan-Meier method to compare between pts who stopped treatment for toxicity on Arm A by C2 and who continued on Arm A therapy to C4. A complete case analysis compared QOL domain means for (C2) vs. (C4). Pt-reported adverse events were also collected. Results: Baseline completion rates for the PROMIS-29 for Arm A (n = 108, 81.2%) and Arm B (n = 117, 88.6%) and decreased to 28.6% and 53.8%, respectively at C4. Through C4, the principal reasons for dropout were toxicity (35.2% for Arm A and 11.9% for Arm B) and PD (26.1% for Arm A and 18.6% for Arm B). From Baseline to C2: Arm B reported statistically significant improvements in Pain Interference (-3.45, P = 0.007), Sleep (-2.11, P = 0.014), and Anxiety (-3.74, P &lt; 0.001). By C4, these early differences had dissipated (mean diff. = 0.73 – 1.73, all p = NS). For pts remaining on treatment to C4 (n = 157), a complete case analysis indicates no significant QOL differences between C2 vs C4. Pts stopping for toxicity on Arm A after C2 had similar 2-yr OS to pts who continued on Arm A to C4. QOL at C2 (Arm A: stopping for toxicity vs. on treatment) were meaningful, but underpowered (Physical Health (PH) mean difference = -3.5, p = 0.18). Conclusions: Over the first 12 wks, Dab/Tram is associated with significant improvement in overall function and less disturbance in in sleep, pain, physical function, and PH than Nivo/Ipi as expected by PFS curves and toxicity profiles. These differences dissipate by 24 wks when Arm A therapy has switched to Nivo alone and PFS curves cross. Early QOL and treatment cessation due to Nivo/Ipi toxicity was not associated with differences in 2-yr OS. Clinical trial information: NCT02224781.

The impact of a structured rehabilitation program for uninsured individuals.

Health disparities in rehabilitation have been identified in brain injury (BI), spinal cord injury (SCI), stroke, and amputee populations. A free clinic was established to serve such uninsured individuals. The purpose of this exploratory study was to characterize the sample of patients attending a free rehabilitation clinic by investigating their demographics, access to care, trends in quality of life, and satisfaction with the rehabilitation program. This is a retrospective chart review of data from 15 individuals admitted to the free clinic program who were administered an admission questionnaire, the abbreviated World Health Organization Quality of Life assessment (WHOQOL-BREF), and a postcare assessment survey. A majority of patients reported not having a primary care provider nor a checkup within the past 5 years. This sample also reported extensive physical needs at admission. Seventy-three percent of the sample improved on the WHOQOL-BREF physical domain by discharge with a large effect size. The psychological, social, and environmental domain scores did not show a reliable pattern of change in this sample. Conclusions/Implication: These results support previously noted gaps in care among individuals with BI, SCI, stroke, and amputation and suggest that a monthly clinic can improve physical quality of life. This exploratory study aims to lay the foundation for future research that is needed to understand the factors that exclude these individuals from the health care system and to help key stakeholders to advocate for these patients and improve their early access to rehabilitation care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychosocial Interventions for Patients With Heart Failure and Their Impact on Depression, Anxiety, Quality of Life, Morbidity, and Mortality: A Systematic Review and Meta-Analysis.

The purpose of this systematic review and meta-analysis was to evaluate the ability of psychosocial interventions to reduce depression and anxiety, improve quality of life, and reduce hospitalization and mortality rates in patients with heart failure. Studies of psychosocial interventions published from 1970 to 2021 were identified through four databases (PubMed, Ovid MEDLINE, PsycINFO, Cochrane). Two authors independently conducted a focused analysis and reached a final consensus on the studies to include, followed by a quality check by a third author. A risk of bias assessment was conducted. Twenty-three studies were identified, but only 15 studies of mostly randomized controlled trials with a total of 1370 patients with heart failure were included in the meta-analysis. Interventions were either cognitive behavioral therapy (CBT) or stress management. The pooled intervention effect was in favor of the intervention for depression (combined difference in standardized mean change [DSMC]: -0.41; 95% confidence interval [CI] = -0.66 to -0.17; p = .001) and anxiety (combined DSMC: -0.33; 95% CI = -0.51 to -0.15; p < .001) but was only a trend for quality of life (combined DSMC: 0.14; 95% CI = -0.00 to 0.29; p = .053). Evidence was limited that interventions produced lower rates of hospitalization (5 of 5 studies showing a beneficial effect) or death (1 of 5 with a beneficial effect). CBT and stress management interventions significantly reduced depression and anxiety compared with control conditions. CBT significantly improved quality of life compared with controls, but stress management did not. Longer treatment duration seemed to be an important factor related to treatment success.