Health-related Quality Of Life Values Research Articles

Health-Related Quality of Life in Patients with Breast Cancer in Latin America and the Caribbean: A Systematic Review and Meta-Analysis.

Background and ObjectivesBreast cancer (BC) is the most common cancer in women. It imposes a huge disease burden and a significant impact on health‐related quality of life (HRQoL). Our study focused on HRQoL of patients with BC in Latin America and the Caribbean (LAC). We conducted a systematic review to identify relevant articles published between 2008 and August 2018. We conducted several meta‐analyses and subgroup analyses by country, disease stage, and instrument used (Prospective Register Of Systematic Reviews registration number: CRD42018106835).ResultsFrom 2,265 initial references, we finally included 75 articles (8,806 participants) that assessed HRQoL. The European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire C30 and B23 modules (34 studies; 8 countries; 4,866 participants) were the most used instruments, followed by the Short Form 36‐item, the abbreviated version of the World Health Organization Quality of Life instrument, and the Functional Assessment of Cancer Therapy – Breast instrument. Only four studies reported specific HRQoL data of patients with metastatic disease. Half the studies were rated as having moderate quality (38/75), and 38% (29/75) as high quality. We identified substantial heterogeneity. As expected, the meta‐analyses revealed that patients with metastatic disease reported lower HRQoL values and high symptom burden compared with patients at earlier stages. Similar results can be observed when we compared patients with early breast cancer in active treatment phases versus those in follow‐up.ConclusionThis study provides a synthesis of breast cancer HRQoL reported in LAC and exposes existing evidence gaps. Patients with BC in active treatment or with metastatic disease had worse HRQoL compared with survivors during the follow‐up period.Implications for PracticeThis systematic review provides an exhaustive synthesis of breast cancer health‐related quality of life in women in the Latin American and Caribbean region. Patients with breast cancer in active treatment or with metastatic disease had worse health‐related quality of life compared with survivors during the different follow‐up periods. This study also shows important evidence and methods gaps that can help inform future research.

Response Evaluation on Single Common and Uncommon EGFR Mutation on First-Generation EGFR-TKI Therapy in NSCLC Patients

Objective: To compare the response of first-generation EGFR-TKI (epidermal growth factor receptortyrosine kinase inhibitors) in non-small cell lung cancer (NSCLC) patients with single common anduncommon EGFR mutation.Methods: Patients were divided into two groups, the uncommon (exon 21 L861Q, exon 18 G719X, exon18 delE709) and common EGFR mutation group (exon 19 deletion, exon 21 L858R). Health-related qualityof life (HRQOL) using EuroQol EQ-5D® questionnaire, body weight, performance status (PS), ResponseEvaluation Criteria in Solid Tumors (RECIST) on chest CT, progression-free survival (PFS) and overallsurvival (OS) was recorded during TKI therapy.Results: The value of HRQOL was stable and PS was constant in both groups, body weight was constantin uncommon group (42.1%) and increased in common group (44.1%; p=0.165). The uncommon groupshowed mostly progressive disease in RECIST (47.4%) while the common group showed mostly partialresponse (42.2%; p=0.007). PFS in the uncommon group was 4 (2.0-6.0) months and 7.0 (2.0-21.0) monthsin the common group (p=0.001). OS in the uncommon and common group were 4.00±1.71 months and10.00±6.94 months (p<0.001), respectively.Conclusion: NSCLC patients with common EGFR mutations showed a better response and survival ratecompared to uncommon EGFR mutations on first-generation TKI therapy.

Changes in cervical sagittal alignment and the effects on cervical parameters in patients with cervical spondylotic myelopathy after laminoplasty.

Objective:To monitor changes in cervical parameters before and after laminoplasty surgery. Cervical parameters and health-related quality-of-life (HRQOL) values that may be affected after laminoplasty were examined before and after surgery. The clinical and radiological course of these values was monitored, and their interaction with all spinal radiological parameters was revealed.Materials and Methods:Nineteen patients who underwent clinical and radiological evaluation for 2 years were followed in this study. Neck disability index, visual analog scale, and short form 36 scores were determined to evaluate HRQOL. For radiological parameters, the C0-C2 angle, C2-C7 angle, cervical sagittal vertical axis, T1 slope angle, neck tilt (NT) and thoracic inlet angle were used. The results of the 4-month, 1 year and 2-year follow-ups were statistically evaluated.Results:Both the HRQOL and cervical radiological parameters deteriorated in the first 4 months and returned to normal in the 2nd year. Statistically, all parameters were meaningful (P < 0.05), except for NT.Conclusion:Cervical parameters and HRQOL values, which deteriorated in the early period, recovered in the late period in the long-term follow-up of patients undergoing laminoplasty. The important point is that preoperative cervical parameters suitable for laminoplasty should be present, and spinopelvic parameters should be normal.

IDEAL CARDIOVASCULAR HEALTH STATUS AND HEALTH-RELATED QUALITY OF LIFE IN ADOLESCENTS: THE LABMED PHYSICAL ACTIVITY STUDY.

ABSTRACTObjective: Adolescent’s ideal cardiovascular health index (ICVH) seems to be an important indicator of youth’s lifestyles and cardiometabolic health with potential positive consequences for their Health-Related Quality of Life (HRQoL). The purpose of this study was to examine the associations between the ICVH index and HRQoL in adolescents.Methods: This was a cross-sectional study based on secondary analyses from the LabMed Physical Activity Study (n=407 adolescents, 53% girls). ICVH, as defined by the American Heart Association, was determined as meeting ideal behaviors (physical activity, body mass index, smoking status, and diet intake) and health factors (blood pressure, total glucose, and cholesterol). HRQoL was measured with the Kidscreen-10 self-report questionnaire.Results: Analysis of covariance (ANCOVA) showed a significant association between the accumulation of ideal cardiovascular health metrics and HRQoL (F(4,403)=4.160; p=0.003). In addition, the higher the number of ideal health behaviors accumulated, the higher the mean values of HRQoL (p-value for trend=0.001), after adjustments for age, sex, socioeconomic status and pubertal stage.Conclusions: ICVH index was positively associated with HRQoL in adolescents. Ideal health behaviors metrics seem to have a stronger association with HRQoL than the ideal health factors metrics in adolescents.

Predictors of health-related quality of life in musculoskeletal disease patients: a longitudinal analysis.

Introduction:Rheumatic and musculoskeletal diseases (RMDs) have a significant impact on patients’ health-related quality of life (HRQoL) exacerbating disability, reducing independence and work capacity, among others. Predictors’ identification affecting HRQoL could help to place efforts that minimize the deleterious impact of these conditions on patients’ wellbeing. This study evaluates the influence of demographic and clinical predictors on the HRQoL of a cohort of RMD patients, measured using the Rosser classification index (RCI).Methods:We included patients attending the Hospital Clínico San Carlos (HCSC) rheumatology outpatient clinic from 1 April 2007 to 30 November 2017. The primary outcome was the HRQoL assessed in each of the patient’s visits using the RCI. Demographic and clinical variables extracted from a departmental electronic health record (EHR) were used as predictors: RMD diagnoses, treatments, comorbidities, and averaged HRQoL values from previous periods (for this last variable, values were imputed if no information was available). Association between predictors and HRQoL was analyzed using penalized generalized estimating equations (PGEEs). To account for imputation bias, the PGEE model was repeated excluding averaged HRQoL predictors, and common predictors were considered.Discussion:A total of 18,187 outpatients with 95,960 visits were included. From 410 initial predictors, 19 were independently associated with patients’ HRQoL in both PGEE models. Chronic kidney disease (CKD), an episode of prescription of third level analgesics, monoarthritis, and fibromyalgia diagnoses were associated with worse HRQoL. Conversely, the prescription in the previous visit of acid-lowering medication, colchicine, and third level analgesics was associated with better HRQoL.Conclusion:We have identified several diagnoses, treatments, and comorbidities independently associated with HRQoL in a cohort of outpatients attending a rheumatology clinic.

Health-related quality of life and overall survival: a prospective study in patients with head and neck cancer treated with radiotherapy

PurposeWe aimed to examine whether pre-treatment, post-treatment and change in health-related quality of Life (HRQoL) is associated with survival, in patients with head and neck cancer (HNC).MethodsWe included 948 newly diagnosed HNC patients treated with primary or adjuvant (chemo)radiotherapy with curative intent. The EORTC QLQ-C30 questionnaire was assessed pre-treatment and at 6 weeks, 6 months and 12 months post-treatment. Multivariable Cox regression analyses were performed to examine whether HRQoL at all time points and changes in HRQoL over time were associated with survival, after adjusting for demographic, clinical and lifestyle-related variables.ResultsHigher HRQoL scores were significantly associated with improved 5-year overall survival at all time points, except for the subscale global QoL at 6 weeks. Changes in HRQoL at 6 weeks post-treatment compared to pre-treatment were not significantly associated with survival. Changes in physical (HR: 0.88 95% CI: 0.82–0.96) and emotional functioning (HR: 0.90 95% CI: 0.85–0.96) from pre-treatment to 6 months post-treatment and changes in global QOL, and physical, emotional, and social functioning from pre-treatment to 12 months post-treatment were significantly associated with survival.ConclusionHigher HRQoL reported pre-treatment and post-treatment (6 weeks, 6 months and 12 months) are significantly associated with improved survival, as well as changes in HRQoL at 6 and 12 months compared to pre-treatment. Our results highlight the value of monitoring HRQoL and to identify those patients that report decreased or deteriorated HRQOL. This may help to further improve cancer care in a timely and efficient manner.

Prognostic value of health-related quality of life in patients with acute dyspnea

Abstract Background Previous studies have shown the prognostic value of health-related quality of life (HRQL) in stable and ambulatory chronic heart failure patients. However, it is unknown whether HRQL can predict all-cause mortality in patients presenting to the emergency department (ED) after acute onset of symptoms. In order to address this unmet need, the aim of this study was to assess the prognostic value of HRQL in patients with acute dyspnea caused by acute heart failure (AHF) and other dyspnea aetiologies for 360-day mortality. Purpose To assess prognostic value of HRQL using the generic EQ-5D and visual analogue scale (EQ VAS) in patients with acute dyspnea. Methods Basics in Acute Shortness of Breath EvaLuation (BASEL V) is a prospective, multicenter, diagnostic study enrolling adult patients presenting with acute dyspnea to the ED. For this analysis, only patients with a complete set of variables necessary for calculation of EQ-5D (range 0–10; with higher score indicating worse HRQL) and EQ VAS (range 0–100; with 100 being the best imaginable health state) at baseline were included. The endpoint was the prognostic value of EQ-5D and EQ VAS at 360 days of follow-up regarding all-cause death. Prognostic accuracy was calculated using c-statistics. In a cox regression analysis EQ-5D was treated as both, a continuous and categorical variable. Adjustments were made for clinically relevant covariates (age, sex, orthopnoea, edema, level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) at presentation, history of coronary artery disease and chronic obstructive pulmonary disease, diuretics, β-blockers and ACE-inhibitors at discharge). Results Among 2605 patients enrolled, 1141 (43,8%) had a complete set of variables allowing the calculation of EQ-5D and EQ VAS. Of these patients 594 (52.1%) had an adjudicated final diagnosis of AHF. 211 (18.5%) patients died within 360 days of follow-up. Median EQ-5D was 3 (interquartile range (IQR) 1.5–5) and median EQ VAS was 50 (IQR 40–70). The prognostic accuracy for 360-day mortality was 0.65 (95% confidence interval ((CI) 0.61–0.69) and 0.58 (95% CI 0.54–0.62) for EQ-5D and EQ VAS, respectively (p=0.002). After combining EQ-5D and EQ VAS in a logistic regression model c-statistics regarding all-cause mortality within 360 days did not improve. The prognostic accuracy of EQ-5D was comparable to that of NT-proBNP (c-statistics 0.69, p=0.385). In an adjusted cox regression analysis the hazard ratio for patients with EQ-5D &amp;gt;4 was 2.2 (95% CI 1.7–2.9; p&amp;lt;0.001). Conclusions In patients presenting with acute dyspnea HRQL is a strong prognostic instrument. Independently of the aetiology of the dyspnea the prognostic value of the generic EQ-5D for 360-day mortality is comparable to NT-proBNP. Patients with an EQ-5D &amp;gt;4 are at significantly higher risk for mortality within 360 days. Figure 1. Prognostic value of HRQL Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation

Frailty is associated with decline in health-related quality of life of patients treated for head and neck cancer.

To determine the effect of frailty on Health Related Quality of Life (HRQoL) after treatment for Head and Neck Cancer (HNC). Patients were prospectively included in OncoLifeS, a data-biobank. Before treatment, patients underwent geriatric screening, including the Groningen Frailty Indicator (GFI) and Geriatric 8 (G8). Patients' HRQoL was measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLQ-C30) at three, six, twelve and twenty four months after treatment. Linear mixed models were used for statistical analysis. All models were adjusted for baseline HRQoL values, relevant confounders at baseline and yielded estimates (β), 95% confidence intervals and p-values. 288 patients were included. The mean age was 68.4years and 68.8% were male. During follow-up, 84 patients had tumor recurrence and 66 died. Response to EORTC-QLQ-C30 ranged from 77.3% to 87.8%. Frail patients, defined by GFI, had significantly worse Global Health Status/Quality of Life (GHS/QoL) (β=-8.70(-13.54;-3.86), p<0.001), physical functioning (β=-4.55(-8.70;-0.40), p<0.032), emotional functioning (β=-20.06(-25.65;-15.86), p<0.001), and social functioning (β=-8.44(-13.91;-2.98), p<0.003) three months after treatment compared to non-frail patients. Furthermore, frail patients had a significantly worse course of GHS/QoL (β=-7.47(-11.23;-3.70), p=0.001), physical functioning (β=-3.28(-6.26;-0.31), p=0.031) and role functioning (β=-7.27(-12.26;-2.28), p=0.005) over time, compared to non-frail patients. When frailty was determined by G8, frailty was significantly associated with worse GHS/QoL (β=-6.68(-11.00;-2.37), p=0.003) and emotional functioning (β=-5.08(-9.43;-0.73), p=0.022) three months after treatment. Frail patients are at increased risk for decline in HRQoL, and further deterioration during follow-up after treatment for HNC.

Cognitive performance is associated with worse prognosis in patients with heart failure with reduced ejection fraction.

AimsHeart failure (HF) is a complex clinical syndrome with multiple comorbidities. Cognitive impairment, stress, anxiety, depression, and lower quality of life are prevalent in HF. Herein, we explore the interplay between these parameters and study their value to predict major adverse cardiovascular events (MACEs) and health‐related quality of life (HrQoL) in patients with HF with reduced ejection fraction using guideline recommended assessment tools.Methods and resultsWe conducted a longitudinal study using a sample of 65 patients from two hospitals. A battery of tests was applied to assess cognition [Montreal Cognitive Assessment (MoCA)], stress (Perceived Stress Scale‐10), anxiety, and depression (Hospital Anxiety and Depression Scale) at baseline. MACEs were registered using clinical records. HrQoL was estimated using the Kansas City Cardiomyopathy Questionnaire (KCCQ). A descriptive statistical analysis was conducted, and multiple linear and Cox regression models conducted to determine the predictive value of neurocognitive parameters and HrQoL in MACE. Both MoCA [hazard ratio = 0.906 (0.829–0.990); P = 0.029] and KCCQ scores were predictors of MACE, but not of overall mortality. Anxiety, depression, and stress scores did not predict MACE. However, anxiety (β = −0.326; P = 0.012) and depression levels (β = −0.309; P = 0.014) were independent predictors of the KCCQ score.ConclusionsThe MoCA score and HrQoL were predictors of MACE‐free survival. Anxiety and depression were good predictors of HrQoL, but not of MACE‐free survival.

Abstract 2035: Listen to the patients: Assessing the prognostic value of pre-treatment health-related quality of life in 1L DLBCL patients

Abstract Background: Identifying patients with high-risk of progression or death is important in developing novel treatment strategies in diffuse large B-cell lymphoma (DLBCL). The International Prognostic Index (IPI) is a commonly used score to classify the prognostic risk of previously untreated (1L) DLBCL patients. Although perceived as important in understanding the health status of patients, patient-reported health-related quality-of-life (HRQoL) measures have not been studied extensively as prognostic factors in DLBCL. In this study, we explored the prognostic value of pretreatment HRQoL in progression free survival (PFS) and overall survival (OS) in 1L DLBCL patients, using data from the phase III GOYA study (NCT01287741, Obinutuzumab-CHOP vs Rituximab-CHOP). Method: Four preselected pretreatment HRQoL subscale scores (lymphoma specific [LYMS], physical functioning [PF2], role functioning [RF2], and fatigue [FA]) were derived from two HRQoL questionnaires (EORTC-QLQ C30 and FACT-Lym) in the GOYA study. Each subscale was dichotomized to indicate low or high HRQoL based on their respective median scores (table). Sensitivity analyses were similarly evaluated. The prognostic value of each HRQoL subscale was evaluated using Cox proportional hazard models, adjusted for the five components of IPI. Table. Summary of prognostic value for the four pre-treatment HRQoL subscales Summary 3-year OS estimate2 (95% CI) Cox proportional hazard model Subscale(n1) Questionnaire Median (min-max) Low HRQoL High HRQoL OS HR3 (95% CI) PFS HR3(95% CI) Lymphoma specific(n = 1246) FACT-LYM 47 (7-60) 0.78 (0.74, 0.81) 0.85 (0.82, 0.87) 0.7 (0.51, 0.95) 0.81(0.63, 1.03) Physical functioning(n = 1254) EORTC-QLQ C30 87(0-100) 0.77 (0.74, 0.80) 0.86 (0.83, 0.89) 0.6 (0.43, 0.85) 0.72(0.56, 0.93) Role functioning(n = 1256) EORTC-QLQ C30 83(0-100) 0.78 (0.75, 0.81) 0.84 (0.81, 0.88) 0.72(0.52, 0.99) 0.84(0.65, 1.07) Fatigue(n = 1256) EORTC-QLQ C30 33(0-100) 0.74(0.70, 0.78) 0.84 (0.82, 0.87) 0.68 (0.5, 0.92) 0.94(0.73, 1.2) 1Only patients with valid respective pretreatment HRQoL scores were included in each analysis 2OS estimated using the Kaplan-Meier method 3HR = hazard ratio representing high HRQoL vs. low HRQoL, adjusted for the five components of IPI: age(≤60 vs &amp;gt;60), ECOG PS(0-1 vs 2-3), lactate dehydrogenase level (LDH)(≤1 normal vs &amp;gt;1 normal), Ann Arbor stage (Stage I or II vs III or IV disease), and extranodal sites(≤1 vs &amp;gt;1 extranodal site) Results: All four HRQoL subscales contributed independent prognostic value to patient outcome (table). Results show that high HRQoL is associated with better survival outcome (higher 3-year OS estimate and lower risk [HR]) compared with low HRQoL. Among the four subscales, PF2 had the highest estimated contribution to prognosis (OS: HR = 0.59, 95% CI: [0.42, 0.84], PFS: HR = 0.71, 95% CI [0.55, 0.93]). Conclusion: Our findings demonstrate the potential of patient-reported HRQoL measures in providing prognostic value in addition to IPI, which may contribute to improved risk stratification and inform treatment decisions for DLBCL patients. Citation Format: Huang Huang, Asim Datye, Ming Fan, Andrea Knapp, Rama Balakrishnan, Sandhya Balasubramanian, Julia Chae, Emma Roth, Tina Nielsen, Joseph N. Paulson, Peter Trask. Listen to the patients: Assessing the prognostic value of pre-treatment health-related quality of life in 1L DLBCL patients [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2035.

Health-related quality of life (FACT-GP) in Sweden

BackgroundMany studies have used disease-specific instruments, such as the Functional Assessment of Cancer Therapy (FACT), when studying health-related quality of life (HRQOL) in patients. Few studies however, have described normative HRQOL values in the general population using FACT - General Population (FACT-GP). The general aim of the present study is thus to describe the normative HRQOL values in the general Swedish population by using the FACT-GP instrument and to investigate to what degree sociodemographic factors and status of self-rated health (SRH) correlate with HRQOL.MethodsThe participants consisted of a pre-stratified (gender, age and education) sample of Swedish citizens that previously had enrolled to be a part of a web panel hosted by a research institute (SOM Institute) at the University of Gothenburg in Sweden. The HRQOL was assessed by using the FACT-GP and SRH.ResultsA higher FACT-GP score was mainly associated with males, higher age, higher income and better SRH. The results showed that the Swedish sample scored lower on FACT-GP than previous studies.ConclusionsSince HRQOL is frequently used as an important endpoint in healthcare research, there is an increasing need for normative data. The results from this study serve as a general population standard against which other studied HRQOL-data could be evaluated.

PIT13 A SYSTEMATIC REVIEW OF STUDIES MEASURING HEALTH-RELATED QUALITY OF LIFE OF GENERAL INJURY POPULATIONS: UPDATE 2010-2018

Studies examining the impact of injury on health-related quality of life (HRQL) over time are necessary to understand the short- and long-term consequences of injury for population health. The aim of this systematic review was to provide an evidence update on studies that have measured HRQL over time in general injury populations using a generic (general) health state measure. Studies conducted between 2010 and 2018 that assessed HRQL at more than one time point among general injury populations were eligible for inclusion. Two reviewers independently extracted information from each study on design, HRQL measure used, method of HRQL measure administration, timing of assessment(s), predictive variables, ability to detect change, and findings. Quality appraisals of each study were also completed by two reviewers using items from the RTI Item Bank on Risk of Bias and Precision of Observational Studies. Twenty-nine studies (43 articles) that met the inclusion criteria were identified. HRQL was measured using fourteen different generic measures; the SF-36, SF-12, and EQ-5D were used most frequently. A varying number of follow-up assessments were undertaken, ranging from one to five. Follow-up often occurred 12 months post-injury. Fewer studies (n = 11) examined outcomes two or more years post-injury, and only one to 10 years post-injury. While most studies documented improvements in HRQL over time since the injury event, study populations had not returned to pre-injury status or reached general population norm HRQL values at post-injury follow-ups. Since 2010 there has been a substantial increase in the number of studies evaluating the HRQL of general injury populations. However, significant variability in study design continues to impede quantification of the impact of injury on population health over time. Variation between studies is particularly evident with respect to timing and number of follow-up assessments, and selection of instruments to evaluate HRQL.

Autonomic and diastolic dysfunction association with quality of life impairment in cirrhotic patients

Background and study aimsCirrhosis is a multisystem disorder characterized by hyperdynamic circulation which can progress to multiple organ dysfunctions. Recent studies have demonstrated autonomic dysfunction and cirrhotic cardiomyopathy including diastolic dysfunction, systolic dysfunction with electrophysiologic abnormalities in patients with cirrhosis. Due to the long and complicated course of the disease, health related quality of life is affected. We aimed to evaluate the frequency of diastolic dysfunction and autonomic dysfunction in cirrhosis, and the effects on health-related quality of life. Patients and methodsHundred cirrhotic patients were enrolled in the study. According to the Child-Pugh classification 35 patients were of Child A, 36 of Child B and 29 of Child C. The proportion of autonomic dysfunction was 52%, and diastolic dysfunction 51%. Autonomic dysfunction was diagnosed using bedside maneuvers and tests; diastolic dysfunction was diagnosed using the E/A ratio in echocardiographic findings. Health-related quality of life measurements was obtained from an SF-36 questionnaire. ResultsPatients with advanced Child-Pugh classifications were found to have significantly lower health-related quality of life values (p < 0.05). Likewise, health-related quality of life values were observed to be significantly lower in patients with autonomic dysfunction (p < 0.05). No significant difference was found in health related quality of life measurements between patients with and without diastolic dysfunction. ConclusionOur study showed that autonomic dysfunction and diastolic dysfunction are found in patients with cirrhosis. Further studies are needed to assess the effects of autonomic dysfunction and diastolic dysfunction on health-related quality of life.

Prognostic Value of Functional Assessment of Cancer Therapy-General (FACT-G) in Advanced Non-Small-Cell Lung Cancer Treated with Korean Medicine.

Objectives The impact of health-related quality of life (HRQoL) on survival has been investigated in patients with various cancers. Here, we evaluated the prognostic value of HRQoL using the Functional Assessment of Cancer Therapy-General (FACT-G) in advanced non-small-cell lung cancer (NSCLC) patients treated with Korean medicine. Methods A retrospective review of medical records and FACT-G scores of patients with advanced NSCLC who received treatment with Korean medicine was conducted. The reliability of the FACT-G was determined using Cronbach's alpha and calculating floor-and-ceiling effects. Correlations between FACT-G scores were estimated using Pearson's correlation analysis. Overall survival was calculated using the Kaplan–Meier method, and the prognostic impact of FACT-G scores and patients' characteristics was evaluated with Cox proportional hazards regression. Results Of the 165 enrolled patients, 115 (70%) had extrathoracic metastasis and 139 (84%) had undergone prior anticancer treatment. The median overall survival was 10.1 months. The mean FACT-G score was 65.0, and Cronbach's alpha for the FACT-G was 0.917. Age ≥65 years, male sex, smoking history, squamous-cell carcinoma, Eastern Cooperative Oncology Group Performance Status (ECOG-PS) ≥2, and presence of extrathoracic metastasis were associated with an increased risk of mortality. High FACT-G total scores, physical well-being (PWB), emotional well-being, and functional well-being were associated with prolonged survival. After adjusting for age, sex, smoking history, ECOG-PS, histological type, and presence of extrathoracic metastasis, a high FACT-G total score (hazard ratio (HR): 0.99, p=0.032) and high PWB score (HR: 0.94, p < 0.001) were associated with prolonged survival as independent prognostic factors in patients with advanced NSCLC. Conclusion The FACT-G total score and PWB score as HRQoL measurements were significant prognostic factors for survival in advanced NSCLC patients treated with Korean medicine. This finding implies that the FACT-G can be used in clinical practice as a predictor of survival in patients with advanced NSCLC.

Correlation between Health-Related Quality of Life and Hand Grip Strength among Older Adults

ABSTRACTBackground: With advanced age, the progressive loss of muscle strength estimated by the handgrip strength (HGS) may result in a poorer health-related quality of life (HRQoL). Studying this association becomes a vital area of research for promoting aging-well. The aim of this study was to examine the correlation between HRQoL and HGS among community-dwelling older adults above 60 years old.Methods: Participants comprised of 176 older adults (mean age: 68.15 ± 6.74). The HGS was tested with Jamar® Dynamometer, and the EuroQuol-5 Dimensions 5Levels (EQ-5D-5L) questionnaire was used to assess HRQoL.Results: Both HGS and HRQoL were negatively correlated with age (p < .001). Lower values of HGS and HRQoL were recorded among older adults who had diagnosed with one or more chronic diseases (p < .001). Significant correlations were recorded between HGS and functioning, and subjective well-being domains of EQ-5D-5L. A relatively higher association was recorded between the functioning variables of EQ-5D-5L and HGS compared to subjective well- being variables.Conclusion: Handgrip strength is a simple and practical measure in identifying older adults at risk of physical decline. Maintaining handgrip strength may contribute to improving HRQoL, and can add an imperative dimension to promote aging-well in older adults ≥60 years old.

Is mode of delivery a determinant of postpartum health-related quality of life in Nigerian Women?

Background: Women experience many changes that might affect their well-being during the postpartum period. In some climes, there is an established association between mode of delivery (MOD) and postpartum health-related quality of life (HRQoL), but there is a dearth of related literature in southeastern Nigeria. Such information will guide health-care providers on health promotion strategies for improved maternal and infant well-being. Aim: The aim of this study was to assess the influence of MOD on HRQoL of Nigerian postpartum women. Material and Methods: This was a cross-sectional descriptive survey of 200 postpartum women in Enugu, Nigeria. Information on maternal characteristics was collected with a structured questionnaire, while the investigation of their postpartum HRQoL was with the Short Form 36 health survey questionnaire. Results: In general, the majority of the respondents had moderate HRQoL values in most domains, including physical function, bodily pain, general health (GH), energy and fatigue, social function, and perceived mental health. Values for role limitations as a result of physical and emotional problems were predominantly low. HRQoL scores did not significantly vary between the cesarean section (CS) and spontaneous vaginal delivery (SVD) groups. MOD was a correlate of respondents' GH with women in the CS group showing lower values, as compared to those with SVD. Conclusion: In general, postpartum women in this study recorded low-to-moderate HRQoL scores. MOD was a determinant of their GH scores. Follow-up interprofessional health care is recommended in the postpartum period to improve HRQoL.

PCN481 METHODOLOGICAL ASPECTS OF HEALTH-RELATED QUALITY OF LIFE MEASUREMENT IN PATIENTS WITH HER2-POSITIVE METASTATIC BREAST CANCER IN CLINICAL TRIALS: A SYSTEMATIC REVIEW.

HER2-positive breast cancer is characterized by the overexpression of human epidermal growth factor receptor 2 (HER2) and is associated with poor prognosis. While there is no cure for HER2-positive metastatic breast cancer (MBC), survival outcomes have improved over the last decade due to the availability of novel agents. Health-related quality of life (HRQoL) data is becoming increasingly important to understand the long-term treatment impact on patients’ well-being. This systematic review aimed to identify the methodological aspects of HRQoL measurement among HER2+ MBC patients and critically appraise their strengths and weaknesses. A comprehensive search was conducted using PubMed, Embase, and Cochrane from database initiations to March 30, 2019, to identify publications of HER2+ MBC clinical trials that have reported HRQoL data in the English language. Following the PRISMA guideline, we screened 1566 articles and identified 14 studies that met our inclusion and exclusion criteria. Seven HRQoL instruments (EORTC QLQ-C30, FACT-G, FACT-B, FACT-B TOI, EORTC QLQ-BR23, FACT-Br, and EORTC QLQ-BN20) were identified, among which FACT-Br and EORTC QLQ-BN20 were used in breast cancer with brain metastasis. Five out of the fourteen studies used more than one instrument. Across the seven instruments, EORTC QLQ-C30 (9/14 studies) was most frequently used. All publications reported HRQoL as secondary endpoints. The literature demonstrates the complementary value of HRQoL when assessing clinical effectiveness and safety outcomes. However, significant diversity in the applied HRQoL instruments, the HRQoL assessment strategies, the timing of HRQoL data collection, and the data analysis methods was noted. Notably, non-response(NR) rates to HRQoL questionnaire as high as 26-38% were observed, but the impact of NR was not discussed in most of the studies. The development of standardized best practice guidelines in breast cancer HRQoL data collection and analysis is recommended to improve data quality to assist evidence-based clinical decision making.

Cardiorespiratory fitness and health-related quality of life in adolescents: A longitudinal analysis from the LabMed Physical Activity Study.

The purpose of this study was to examine the longitudinal associations between cardiorespiratory fitness and health-related quality of life (HRQoL) in a sample of adolescents, and to determine whether changes in cardiorespiratory fitness were associated with HRQoL over a 2-year follow-up. This is a longitudinal analysis with 571 Portuguese adolescents (274 boys and 297 girls) aged 12-18 years. HRQoL was measured with the Kidscreen-10 questionnaire; the 20 m shuttle-run was used to estimate cardiorespiratory fitness; socioeconomic status was assessed with the Family Affluence Scale; and pubertal stage was assessed with Tanner stages. Linear regression and analysis of covariance (ancovas) were used to examine the associations between cardiorespiratory fitness and HRQoL. HRQoL decreased over a 2-year period both in boys and girls (P < .05). Moreover, girls at baseline and at follow-up reported significantly lower HRQoL values than boys (between subjects P < .001). After adjustments for potential confounders, regression analyses showed significant cross-sectional associations between cardiorespiratory fitness and HRQoL both at baseline (B = 0.095; P = .023) and at follow-up (B = 0.090; P = .012). ancova showed that adolescents whose cardiorespiratory fitness decreased over time exhibited lower scores of HRQoL at follow-up, compared to those with persistent high cardiorespiratory fitness; this held after adjustments for age, sex, socioeconomic status, and pubertal stage. Changes in cardiorespiratory fitness during adolescence were associated with HRQoL over a 2-year period. This study suggests that improving cardiorespiratory fitness could be an important strategy in improving the HRQoL of adolescents.

Patient-assigned health utility values for controlled and uncontrolled pemphigus vulgaris and foliaceus.

The assessment of health-related quality of life (HRQoL) in patients with pemphigus is now of increasing interest due to the availability of highly effective new therapies. Preference-based HRQoL values or health utilities required for medical and financial decision-making are not yet available directly from pemphigus patients. To obtain health utility values for current health and hypothetical health states from the perspective of pemphigus patients. A cross-sectional questionnaire survey was carried out with pemphigus patients. Disease severity was rated by Autoimmune Bullous Skin Disorder Intensity Score (ABSIS). Patients were asked to evaluate their current health as well as three common hypothetical pemphigus health states [uncontrolled pemphigus vulgaris (PV), uncontrolled pemphigus foliaceus (PF) and controlled PV/PF] by using composite time trade-off (cTTO). Multiple regression was applied to explore determinants of utility values. Responses of 108 patients (64.8% women, mean age 57.4years) were analysed. Mean ABSIS score was 11.6. The mean utility values for the hypothetical uncontrolled PV, uncontrolled PF and controlled PV/PF health states were 0.41, 0.52 and 0.66 with cTTO. The mean cTTO scores for current health were higher compared with the hypothetical health states (0.76; P<0.001). Patients with higher ABSIS, worse pain intensity scores and those having a caregiver reported lower utility values for current health (P<0.05). In pemphigus, HRQoL impairment expressed in utility values seems to be considerable, especially in comparison with other chronic dermatological conditions (e.g. psoriasis, atopic eczema, chronic hand eczema). These health utilities inform physicians, policymakers and funders about the overall extent of health loss in pemphigus and provide evidence to guide medical decisions and cost-effectiveness analyses of treatment strategies. Future research is needed to evaluate the caregiver burden in pemphigus.

The added value of health-related quality of life as a prognostic indicator of overall survival and progression-free survival in glioma patients: a meta-analysis based on individual patient data from randomised controlled trials

ObjectivePrognostic value of health-related quality of life (HRQoL) data may be important to inform patients in clinical practice and to guide clinical decision-making. Our study investigated the added prognostic value of HRQoL for overall survival (OS) and progression-free survival (PFS) in a large heterogeneous sample of glioma patients, besides known prognostic factors. MethodsWe included individual baseline data from previously published randomised controlled trials (RCTs) in glioma patients in which HRQoL was assessed through the European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-BN20 questionnaires. Multivariable Cox regression models (stratified for newly diagnosed versus recurrent disease) were constructed, first with clinical variables (age, sex, tumour type, performance status, allocated treatment and extent of resection) only and subsequently with HRQoL variables added, separately for OS and PFS. The added prognostic value of HRQoL was calculated using C-indices. ResultsBaseline HRQoL and clinical data from 15 RCTs were included, comprising 5217 patients. In the model including both clinical and HRQoL variables, better cognitive and role functioning and less motor dysfunction were independently associated with longer OS, whereas better role and cognitive functioning, less nausea and vomiting and more appetite loss were independently associated with prolonged PFS. However, C-indices indicated only a small prognostic improvement of the models for OS and PFS when adding HRQoL to the clinical prognostic variables (+1.1% for OS and +.7% for PFS). ConclusionOur findings demonstrate that several baseline HRQoL variables are independently prognostic for OS and PFS, yet the added value of HRQoL to the known clinical prognostic variables was small.