Showing papers on "Quality of life published in 2002"
TL;DR: Long-term, disease-free breast cancer survivors reported high levels of functioning and QOL many years after primary treatment, however, past systemic adjuvant treatment was associated with poorer functioning on several dimensions of QOL.
Abstract: Background: Women with breast cancer are the largest group of female survivors of cancer. There is limited information about the long-term quality of life (QOL) in diseasefree breast cancer survivors. Methods: Letters of invitation were mailed to 1336 breast cancer survivors who had participated in an earlier survey and now were between 5 and 10 years after their initial diagnosis. The 914 respondents interested in participating were then sent a survey booklet that assessed a broad range of QOL and survivorship concerns. All P values were two-sided. Results: A total of 817 women completed the follow-up survey (61% response rate), and the 763 disease-free survivors in that group, who had been diagnosed an average of 6.3 years earlier, are the focus of this article. Physical well-being and emotional well-being were excellent; the minimal changes between the baseline and follow-up assessments reflected expected age-related changes. Energy level and social functioning were unchanged. Hot flashes, night sweats, vaginal discharge, and breast sensitivity were less frequent. Symptoms of vaginal dryness and urinary incontinence were increased. Sexual activity with a partner declined statistically significantly between the two assessments (from 65% to 55%, P = .001). Survivors with no past systemic adjuvant therapy had a better QOL than those who had received systemic adjuvant therapy (chemotherapy, tamoxifen, or both together) (physical functioning, P = .003; physical role function, P = .02; bodily pain, P = .01; social functioning, P = .02; and general health, P = .03). In a multivariate analysis, past chemotherapy was a statistically significant predictor of a poorer current QOL (P = .003). Conclusions: Long-term, disease-free breast cancer survivors reported high levels of functioning and QOL many years after primary treatment. However, past systemic adjuvant treatment was associated with poorer functioning on several dimensions of QOL. This information may be useful to patients and physicians who are engaging in discussion of the risks and benefits of systemic adjuvant therapy. [J Natl Cancer Inst 2002;94:39–49]
1,020 citations
TL;DR: Almost 50% of the community-dwelling stroke population lived with sequelae of stroke such that, unless there was a full-time and able-bodied caregiver at home, they needed some form of home help.
772 citations
TL;DR: Though NYHA functional class was the most dominant predictor among the somatic variables studied, the major determinants of reduced quality of life remain unknown.
Abstract: Objective: To assess health related quality of life of patients with congestive heart failure; to compare their quality of life with the previously characterised general population and in those with other chronic diseases; and to correlate the different aspects of quality of life with relevant somatic variables. Setting: University hospital. Patients and design: A German version of the generic quality of life measure (SF-36) containing eight dimensions was administered to 205 patients with congestive heart failure and systolic dysfunction. Cardiopulmonary evaluation included assessment of New York Heart Association (NYHA) functional class, left ventricular ejection fraction, peak oxygen uptake, and the distance covered during a standardised six minute walk test. Results: Quality of life significantly decreased with NYHA functional class (linear trend: p < 0.0001). In NYHA class III, the scores of five of the eight quality of life domains were reduced to around one third of those in the general population. The pattern of reduction was different in patients with chronic hepatitis C and major depression, and similar in patients on chronic haemodialysis. Multiple regression analysis showed that only the NYHA functional class was consistently and closely associated with all quality of life scales. The six minute walk test and peak oxygen uptake added to the explanation of the variance in only one of the eight quality of life domains (physical functioning). Left ventricular ejection fraction, duration of disease, and age showed no clear association with quality of life. Conclusions: In congestive heart failure, quality of life decreases as NYHA functional class worsens. Though NYHA functional class was the most dominant predictor among the somatic variables studied, the major determinants of reduced quality of life remain unknown.
731 citations
TL;DR: Only minimal short-term QOL benefits were found with LAC for colon cancer compared with standard open colectomy, and until ongoing trials establish that LAC is as effective as openColectomy in preventing recurrence and death from colon cancer, this procedure should not be offered to patients with colon cancer.
Abstract: ContextLaparoscopic-assisted colectomy (LAC) has emerged as the preferred minimally
invasive surgical strategy for diseases of the colon. The safety and efficacy
of LAC for colon cancer are unknown, and the nature and magnitude of any quality-of-life
(QOL) benefit resulting from LAC for colon cancer is also unknown.ObjectiveTo compare short-term QOL outcomes after LAC vs open colectomy for colon
cancer.Design, Setting, and ParticipantsMulticenter, randomized controlled trial (Clinical Outcomes of Surgical
Therapy [COST]). Between September 1994 and February 1999, 37 of 48 centers
provided data for the QOL component of the trial for 449 consecutive patients
with clinically resectable colon cancer.Main Outcome MeasuresScores on the Symptoms Distress Scale (SDS), Quality of Life Index,
and a single-item global rating scale at 2 days, 2 weeks, and 2 months postoperative;
duration of postoperative in-hospital analgesic use; and length of stay.ResultsOf 449 patients, 428 provided QOL data. In an intention-to-treat analysis
comparing SDS pain intensity, SDS summary, QOL Index summary, and global rating
scale scores at each time point, the only statistically significant difference
observed between groups was the global rating scale score for 2 weeks postsurgery.
The mean (median) global rating scale scores for 2 weeks postsurgery were
76.9 (80) for LAC vs 74.4 (75) for open colectomy (P
= .009). While in the hospital, patients assigned to LAC required fewer days
of both parenteral analgesics compared with patients assigned to open colectomy
(mean [median], 3.2 [3] vs 4.0 [4] days; P<.001)
and oral analgesics (mean [median], 1.9 [1] vs 2.2 [2] days; P = .03).ConclusionOnly minimal short-term QOL benefits were found with LAC for colon cancer
compared with standard open colectomy. Until ongoing trials establish that
LAC is as effective as open colectomy in preventing recurrence and death from
colon cancer, this procedure should not be offered to patients with colon
cancer.
651 citations
TL;DR: The most parsimonious approach to assessment includes modular assessment of generic and disease-specific QoL, which is increasingly recognised by both researchers and clinicians.
638 citations
TL;DR: ICD and AAD therapy are associated with similar alterations in self-perceived QoL over 1-year follow-up, and sporadic shocks were associated with reducedQoL in ICD recipients.
Abstract: Background— Implantable cardioverter defibrillator (ICD) use reduces mortality in patients with serious ventricular arrhythmias compared with antiarrhythmic drug (AAD) use. However, the relative impact of these therapies on self-perceived quality of life (QoL) is unknown. Methods and Results— Three self-administered instruments were used to measure generic and disease-specific QoL in Antiarrhythmics Versus Implantable Defibrillators trial participants. Generalized linear models were used to assess the relationships between self-perceived QoL and treatment (AAD versus ICD) and adverse symptoms and ICD shocks. To minimize the impact of missing data, only patients surviving 1 year were included in the primary analyses. Baseline characteristics among QoL participants (n=905) and nonparticipants (n=111) were similar, but participants who survived 1 year (n=800) were healthier at baseline than nonsurvivors (n=105). Of the 800 patients in the primary analysis, characteristics of those randomized to AAD (n=384) v...
623 citations
TL;DR: The Uterine Fibroid Symptom and Quality of Life (UFS‐QOL) questionnaire subscales discriminated not only from normal controls but also among leiomyomata patients with varying degrees of symptom severity, and appears to be a useful new tool for detecting differences in symptom severity and health‐related quality of life among patients with uterine leiomata.
553 citations
TL;DR: It is demonstrated that fatigue and depression are independently associated with impaired QOL in MS, after accounting for physical disability, suggesting that their recognition and treatment can potentially improve QOL.
476 citations
TL;DR: Screening by questionnaire seems to assess anxiety symptoms adequately but discriminates abnormal anxiety inadequately, and criteria such as disruption from anxiety, as illustrated by the impact of anxiety disorders on QOL may need to be used.
Abstract: PURPOSE: We aimed to estimate the prevalence and types of anxiety disorders diagnosed according to standardized criteria in cancer patients, to compare screening tools in detecting them, and to examine their demographic, oncologic, and psychosocial associations. METHODS: In this cross-sectional observational study of 178 subjects with lymphoma, renal cell carcinoma, malignant melanoma, or plasma cell dyscrasia, we related responses to questionnaires (administered by computer touch-screen) measuring psychological symptoms, quality of life (QOL), and social support to standardized psychiatric interviews and cancer management. RESULTS: Forty-eight percent of subjects reported sufficient anxiety for anxiety disorder to be considered. At subsequent diagnostic interview, 18% fulfilled International Classification of Disorders, 10th Revision criteria for anxiety disorder, including 6% of patients who reported low levels of anxiety by questionnaire. When subjects reported anxiety by questionnaire, if disruptive s...
472 citations
TL;DR: The authors carried out a survey in 100 patients with cancer with the objectives of investigating the changes in patient perceptions that have occurred and evaluating the impact of new treatments on the profile of chemotherapy side effects among patients receiving anticancer drugs.
Abstract: BACKGROUND
Quality-of-life (QoL) issues have become increasingly important as the number of newly diagnosed patients with cancer increases and survival improves. In 1983, Coates et al. reported a survey of patient perceptions of the side effects of cancer chemotherapy and showed the importance of including patient feedback for the accurate assessment of QoL (Eur J Cancer Clin Oncol. 1983;19:203–208.). The authors carried out a similar survey in 100 patients with cancer with the objectives of 1) investigating the changes in patient perceptions that have occurred and 2) evaluating the impact of new treatments on the profile of chemotherapy side effects among patients receiving anticancer drugs.
METHODS
One hundred patients attending the outpatient Medical Oncology Department of the Pitie Salpetriere Hospital Group were surveyed between August 1998 and February 2000 by trained interviewers who were blinded to the patients' treatment. Patients identified all side effects associated with their treatment using a set of 45 cards that named physical side effects (Group A) and a set of 27 cards that named nonphysical side effects (Group B), and the patients ranked these side effects according to severity. The top 5 cards from each group were then combined, and the resulting 10 cards were rated again by severity, regardless of group. Results were analyzed for the entire cohort and for demographic, social, and clinical subgroups.
RESULTS
The participants included 65 women and 35 men; the most common malignancies were breast carcinoma (40 patients), gastrointestinal carcinoma (19 patients), lung carcinoma (7 patients), and ovarian carcinoma (9 patients). Patients rated affects my family or partner as the most severe side effect, alopecia was second, and fatigue was the third most severe. Effects on work or home responsibilities, effects on social activities, and loss of interest in sex were ranked fourth, fifth, and sixth, respectively. The results contrasted with those of Coates et al., in which affects my family or partner was ranked 10th, and fatigue was ranked 8th.
CONCLUSIONS
Patient perceptions of the side effects of cancer chemotherapy have changed markedly. In the current study, fatigue and psychosocial QoL concerns predominated, compared with emesis, nausea, and negative reactions to the treatment visit in the original survey. The current findings are consistent with the progress that has been made in reducing certain chemotherapy-associated toxicities. Fatigue, however, although it often is related to anemia and is treatable with recombinant human erythropoietin, remains a major concern. The emotional, social, and sexual consequences of cancer treatment present continuing challenges in efforts to optimize QoL and to develop effective supportive care. Cancer 2002;95:155–63. © 2002 American Cancer Society.
DOI 10.1002/cncr.10630
438 citations
TL;DR: Long-term HRQOL after prostate brachytherapy showed no benefit relative to radical prostatectomy or external-beam radiation and may be less favorable in some domains, and hormonal adjuvants can be associated with significant impairment.
Abstract: PURPOSE: Health-related quality-of-life (HRQOL) concerns are pivotal in choosing prostate cancer therapy. However, concurrent HRQOL comparison between brachytherapy, external radiation, radical prostatectomy, and controls is hitherto lacking. HRQOL effects of hormonal adjuvants and of cancer control after therapy also lack prior characterization. PATIENTS AND METHODS: A cross-sectional survey was administered to patients who underwent brachytherapy, external-beam radiation, or radical prostatectomy during 4 years at an academic medical center and to age-matched controls. HRQOL among controls was compared with therapy groups. Comparison between therapy groups was performed using regression models to control covariates. HRQOL effects of cancer progression were evaluated. RESULTS: One thousand fourteen subjects participated. Compared with controls, each therapy group reported bothersome sexual dysfunction; radical prostatectomy was associated with adverse urinary HRQOL; external-beam radiation was associated...
TL;DR: Quality of life in patients found to have heart failure, LVSD, and other cardiac and medical conditions are compared with the randomly selected general population sample and optimising treatment to improve NYHA class appears to improve perceptions of quality of life for patients with heart failure.
Abstract: Background Heart failure and left ventricular systolic dysfunction (LVSD) are increasingly common disorders, with outcomes worse than many cancers. Evidence-based therapies, such as ACE inhibitors and beta-blockers, improve prognosis and symptoms, and reduce healthcare expenditure. However, despite the high prevalence and malignant prognosis, few studies have reported the impact of heart failure and LVSD on overall quality of life and, more crucially, have not researched the elderly or those in the community. Methods All patients attending the Echocardiographic Heart of England Screening (ECHOES) study of the prevalence of heart failure and LVSD in the community were assessed by clinical history and examination, electrocardiogram and echocardiography, and also completed the SF36 health status questionnaire. Quality of life in patients found to have heart failure, LVSD, and other cardiac and medical conditions are compared with the randomly selected general population sample. Data are generalisable to the UK. Results 6162 people in the community were screened in the ECHOES study, of whom 5961 (97%) completed the SF36. The health perceptions of 3850 people aged 45 years or older selected randomly from the population were compared with those of 426 patients diagnosed as having definite heart failure. Those with heart failure had significant impairment of all the measured aspects of physical and mental health, in addition to declines in physical functioning. Significantly worse impairment was found in those with more severe heart failure by NYHA class: indeed, NYHA functional class was closely correlated to SF36 score. Patients with asymptomatic left ventricular dysfunction and patients rendered asymptomatic by treatment had similar scores to the random population sample. Those with heart failure reported more severe physical impairment of quality of life than people giving a history of chronic lung disease or arthritis, with less impact on mental health than patients reporting depression. Conclusions Patients with heart failure have statistically significant impairment of all aspects of quality of life, not simply physical functioning. The physical (role and functioning) health burden was significantly greater than that suffered in other serious common chronic disorders, whether cardiac or other systems. Optimising treatment to improve NYHA class appears to improve perceptions of quality of life for patients with heart failure. Given the dramatic decline in quality of life with heart failure, this end-point should be a much more important target for healthcare interventions, especially treatments such as ACE inhibitors and beta-blockers that are shown to improve quality of life.
Journal Article•
TL;DR: Insomnia is independently associated with worsened HRQOL to almost the same extent as chronic conditions such as congestive heart failure and clinical depression.
Abstract: Objectives To determine the association between insomnia and health-related quality of life (HRQOL) in patients with chronic illness after accounting for the effects of depression, anxiety, and medical comorbidities. Study design We used a cross-sectional analysis of Medical Outcomes Study (MOS) data. Population The sample consisted of 3445 patients who completed a self-administered questionnaire and who were given a diagnosis of 1 or more of 5 chronic medical and psychiatric conditions by an MOS clinician. Patients were recruited from the offices of clinicians practicing family medicine, internal medicine, endocrinology, cardiology, and psychiatry in 3 US cities. Outcomes measured Outcomes were sleep items, health-related quality of life as measured by the Medical Outcomes Study Short Form Health Survey (SF-36), chronic medical comorbidity, depression, and anxiety. Insomnia was defined as the complaint of difficulty initiating or maintaining sleep. Results Insomnia was severe in 16% and mild in 34% of study patients. Patients with insomnia demonstrated significant global decrements in HRQOL. Differences between patients with mild insomnia versus no insomnia showed small to medium decrements across SF-36 subscales ranging from 4.1 to 9.3 points (on a scale of 0 to 100); the corresponding decrements for severe insomnia (versus no insomnia) ranged from 12.0 to 23.9 points. Conclusions Insomnia is independently associated with worsened HRQOL to almost the same extent as chronic conditions such as congestive heart failure and clinical depression.
TL;DR: Women with recurrent breast cancer are in need of programs to assist them with the severe effects of the disease on their quality of life, and programs need to include family members to help counteract the negative effects ofThe recurrent disease onTheir mental health, and to enable them to continue as effective caregivers.
Abstract: PURPOSE: Little information is available about the effects of recurrent breast cancer on the quality of life of women and their family members. The present study assessed patients’ and family members’ quality of life within 1 month after recurrence, and effects of multiple factors on quality-of-life scores. PATIENTS AND METHODS: Patient/family member dyads (N = 189) participated in this study. A stress-appraisal model guided selection of person factors, social/family factors, illness-related factors, appraisal factors, and quality of life, measured with psychometrically sound instruments. Quality of life was measured with both generic (Medical Outcomes Study SF-36) and cancer-specific (Functional Assessment of Cancer Therapy) scales. RESULTS: Patients reported significant impairments in physical, functional, and emotional well-being. Family members reported significant impairments in their own emotional well-being. Structural equation modeling revealed that self-efficacy, social support, and family hardin...
TL;DR: Hemoglobin increases have been associated with quality of life (QOL) improvements in anemic cancer patients treated with epoetin alfa, but intervention generally has been reserved for symptomatic anemia or hemoglobin < 10 g/dL.
Abstract: BACKGROUND
Hemoglobin increases have been associated with quality of life (QOL) improvements in anemic cancer patients treated with epoetin alfa, but intervention generally has been reserved for symptomatic anemia or hemoglobin < 10 g/dL. Relationships among hemoglobin, functional status, and patient reported QOL have not been well characterized.
METHODS
Data from two open-label, community-based trials of epoetin alfa therapy that enrolled 4382 anemic cancer patients undergoing chemotherapy were used to evaluate the relationship between hemoglobin changes and QOL changes. The authors measured QOL using the Linear Analog Scale Assessment (LASA) and the more detailed, disease-specific Functional Assessment of Cancer Therapy-Anemia (FACT-An) instrument. Analyses were performed to determine the incremental change in QOL associated with hemoglobin increases (1 g/dL increments).
RESULTS
Cross-sectional analyses showed a nonlinear relationship and significant positive correlation between high hemoglobin levels and high LASA and FACT-An scores (r = 0.25 and 0.29, respectively, P < 0.01). Patients with hemoglobin increases of ≥ 2 g/dL reported statistically significant improvements in five FACT-An items selected a priori specifically to reflect functional capacity. An incremental analysis used regression methods to identify the longitudinal relationship between incremental changes in hemoglobin and QOL scores. This relationship was found to be nonlinear, with the maximum QOL gain occurring at a hemoglobin level of 12 g/dL (range, 11–13 g/dL). Patients with low baseline QOL scores and longer time periods between baseline and final QOL assessments experienced significantly (P < 0.05) greater increases in overall QOL. Progressive disease at baseline, change in disease status from baseline to end of study, and increase in self-reported pain or nausea all had significant (P < 0.05) negative effects on QOL scores.
CONCLUSIONS
A direct relationship exists between hemoglobin increases during epoetin alfa therapy and corresponding QOL improvements in cancer patients receiving chemotherapy across the clinically relevant hemoglobin range of 8–14 g/dL. These data suggest that the maximal incremental gain in QOL occurs when hemoglobin is in the range of 11–13 g/dL. Cancer 2002;95:888–95. © 2002 American Cancer Society.
DOI 10.1002/cncr.10763
TL;DR: Major diabetes complications are associated with worse health-related quality of life and the health utility scores provided should facilitate studies of the health burden of diabetes and the cost-utility of alternative strategies for the prevention and treatment of diabetes.
Abstract: OBJECTIVE —Cost-utility analyses use information on health utilities to compare medical treatments that have different clinical outcomes and impacts on survival. The purpose of this study was to describe the health utilities associated with diabetes and its treatments, complications, and comorbidities. RESEARCH DESIGN AND METHODS —We studied 2,048 subjects with type 1 and type 2 diabetes recruited from specialty clinics at a university medical center. We administered a questionnaire to each individual to assess demographic characteristics, type and duration of diabetes, treatments, complications, and comorbidities, and we used the Self-Administered Quality of Well Being index (QWB-SA) to calculate a health utility score. We then created regression models to fit the QWB-SA-derived health utility scores to indicator variables for type 1 and type 2 diabetes and each demographic variable, treatment, and complication. The coefficients were arranged in clinically meaningful ways to develop models to describe penalties from the health utility scores for nonobese diabetic men without additional treatments, complications, or comorbidities. RESULTS —The utility scores for nonobese diet-controlled men and women with type 2 diabetes and no microvascular, neuropathic, or cardiovascular complications were 0.69 and 0.65, respectively. The utility scores for men and women with type 1 diabetes and no complications were slightly lower (0.67 and 0.64, respectively). Blindness, dialysis, symptomatic neuropathy, foot ulcers, amputation, debilitating stroke, and congestive heart failure were associated with lower utility scores. CONCLUSIONS —Major diabetes complications are associated with worse health-related quality of life. The health utility scores provided should facilitate studies of the health burden of diabetes and the cost-utility of alternative strategies for the prevention and treatment of diabetes.
TL;DR: This paper reviews the published literature on QOL and psychological functioning of ICD patients and outlines the clinical and research implications of these findings.
Abstract: The use of the implantable cardioverter-defibrillator (ICD) for life threatening ventricular arrhythmias is standard therapy, in large part because clinical trials data have consistently demonstrated its superiority over medical treatment in preventing sudden cardiac death.1 This success prompts closer examination and refinement of quality of life (QOL) outcomes in ICD patients. Although no universal definition of QOL exists, most researchers agree that “quality of life” is a generic term for a multi-dimensional health outcome in which biological, psychological, and social functioning are interdependent.2 To date, the clinical trials demonstrating the efficacy of the ICD have focused primarily on mortality differences between the ICD and medical treatment. While the majority of the QOL data from these trials is yet to be published, many small studies are available for review and support the concept that ICD implantation results in desirable QOL for most ICD recipients.3 In some patients, however, these benefits may be attenuated by symptoms of anxiety and depression when a shock is necessary to accomplish cardioversion or defibrillation. This paper reviews the published literature on QOL and psychological functioning of ICD patients and outlines the clinical and research implications of these findings.
Definitive conclusions about QOL differences between patients managed with an ICD and those treated with antiarrhythmic drugs are difficult to make in the absence of large, randomised, controlled trials. Available evidence indicates that ICD recipients experience a brief decline in QOL from baseline but improve to pre-implant levels after one year of follow up.4 The largest clinical trial data published in final form is from the coronary artery bypass graft (CABG) Patch trial which randomised patients to ICD (n = 262) versus no ICD (n = 228) while undergoing CABG surgery.5 In contrast to May and colleagues,4 data from this trial indicate …
TL;DR: Treatment for breast cancer is associated with considerable arm morbidity, which has a negative impact on QOL, andArm morbidity should be carefully monitored in future studies involving local treatment modalities for Breast cancer.
Abstract: PURPOSE: To determine the prevalence of and contributing factors for chronic arm morbidity including lymphedema in breast cancer patients after treatment and to assess the impact of arm morbidity on quality of life (QOL). PATIENTS AND METHODS: A four-question screening questionnaire was developed and mailed to a random sample of 744 breast cancer patients treated curatively in two cancer centers from 1993 to 1997. Patients were without recurrence and at least 2 years from diagnosis. Respondents were classified as with or without arm-related symptoms on the basis of the survey. Stratified random samples from each group were then invited for a detailed assessment of their symptoms and signs, including the presence of lymphedema. Their QOL was assessed by the European Organization for Research and Treatment of Cancer QOL Questionnaire C-30 and by a detailed arm problem questionnaire that assessed various aspects of daily arm functioning. RESULTS: Approximately half of all screened patients were symptomatic a...
TL;DR: Although scores reflecting depression, fatigue, emotional distress, and existential problems were interrelated, the presence of depressive symptoms was the single most important independent predictor of QOL in this cohort of brain tumor patients.
Abstract: Neuropsychiatric problems, and how they interact to impact on quality of life (QOL) in brain tumor patients, are generally poorly understood The objectives of this study were: (1) to document the prevalence of depression, fatigue, emotional distress, and existential issues in a sample of brain tumor patients (2) to examine the interconnectedness of these problems, and (3) to explore their relationship with disease-related variables and QOL This is a cross-sectional, questionnaire-based survey of 73 patients with primary brain tumors who presented to a neurological clinic at a tertiary cancer centre for ongoing care Data for 60 participants (29 women, 31 men) who completed validated questionnaires were retained for analysis Results showed that there was a high burden of depressive symptoms as measured by the Beck Depression Inventory-II (mean score 111, SD 74), with 38% of the sample scoring in the clinically depressed range Overall QOL scores for this sample were similar to a reference sample of brain tumor patients The scores on the existential subscale of the McGill Quality of Life questionnaire were comparable to those of a reference sample of cancer patients receiving ongoing care (mean score 72; SD 17) Fifty per cent of the sample could be classified as struggling with existential issues Although scores reflecting depression, fatigue, emotional distress, and existential problems were interrelated, the presence of depressive symptoms was the single most important independent predictor of QOL in this cohort of brain tumor patients Implications for treatment are discussed
TL;DR: This is the first study in asthma to combine rigorous independent classification of grades of severity in statistically valid numbers of patients of grades receiving “real-world” treatment and followed-up prospectively for 1 yr, allowing severity to be accurately related to direct, indirect and intangible costs of asthma.
Abstract: Asthma prevalence is increasing and asthma-related costs are likely to increase, but few studies have analysed the relationship of asthma costs and severity. The impact of severity on costs was quantified in a cohort of 318 asthmatic patients followed up prospectively for 1 yr. Patients presenting with a broad range of severity of the disease (intermittent, mild persistent, moderate persistent, severe persistent) were recruited by chest physicians throughout France and treated for 1 yr according to customary clinical practice and following international guidelines. Severity, direct and indirect costs, and quality of life (QoL) were assessed. A multivariate analysis was conducted to relate factors contributing to the costs measured. Mean direct costs for goods and services excluding hospitalization, numbers of consultations, supplementary examinations, and the use and cost of bronchodilators and corticosteroids, indirect costs of days lost from work, and adverse QoL parameters all increased significantly with increasing severity. This also applied to mean age, body weight, asthma duration, depression of forced expiratory volume in one second, and inhaled corticosteroid posology in the 234 patients completing the study. There was a significant relationship (r=0.614, p<0.001) between direct costs (hospitalization and cures were excluded) and three domains of the QoL questionnaire (mobility, pain and energy). Overall costs of asthma (including individual direct costs, indirect costs, and intangible quality of life costs) are clearly related to severity. This is the first study in asthma to combine rigorous independent classification of grades of severity in statistically valid numbers of patients of grades receiving "real-world" treatment and followed-up prospectively for 1 yr. It allowed severity to be accurately related to direct, indirect and intangible costs of asthma. Quality of life explained a significant part of these costs.
TL;DR: The negative impact of diabetes on QoL has been observed despite high levels of treatment satisfaction (as measured by the DTSQ), and the greatest negative impact was observed for the domain ‘Freedom to eat as I wish’, indicating the strong influence of dietary restrictions onQoL.
Abstract: Efforts to prevent complications of diabetes often overlook the impact of the condition and its treatment on current quality of life (QoL). The Diabetes Treatment Satisfaction Questionnaire (DTSQ) has proved valuable for understanding and measuring patients' treatment satisfaction in assessments of new treatments and strategies. For example, the DTSQ has demonstrated improved patient satisfaction with fast-acting insulin lispro versus standard soluble insulin and with long-acting insulin glargine versus NPH insulin. However, improvements in treatment satisfaction are often inferred to be improvements in overall QoL without recognizing the limited scope of the satisfaction measure. It is necessary to evaluate not only satisfaction with treatment per se but also the impact of diabetes and its treatment on a broad range of life domains in order to assess the impact on QoL. The Audit of Diabetes-Dependent Quality of Life (ADDQoL) measure is a diabetes-specific instrument that assesses the impact of diabetes on 18 life domains. Use of the ADDQoL with people with type 1 or type 2 diabetes has shown, on average, almost universally negative impact of diabetes on all domains. Significant differences have also been shown in the magnitude of effect between insulin-treated and non-insulin-treated patients and patients with and without complications. The negative impact of diabetes on QoL has been observed despite high levels of treatment satisfaction (as measured by the DTSQ). The greatest negative impact was observed for the domain 'Freedom to eat as I wish', indicating the strong influence of dietary restrictions on QoL. Studies to assess the outcomes of treatment approaches designed to improve dietary flexibility are under way.
TL;DR: The literature on the effects of prostate cancer and its treatment on health‐related quality of life (HRQoL) is reviewed and evidence from three sources is outlined: studies that compare men with the disease with an age‐matched sample of men without the disease, and cross‐sectional studies that highlight predictors of HRZoL.
Abstract: With the established effectiveness of diverse treatments for prostate cancer, identification of the physical and psychosocial consequences of the disease and various treatments becomes critical. We review the literature on the effects of prostate cancer and its treatment on health-related quality of life (HRQoL). Studies show that prostate cancer and its treatment affect both disease-specific HRQoL (i.e. urinary, sexual, and bowel function) as well as general HRQoL (i.e. energy/vitality, performance in physical and social roles). Yet, these effects appear to differ across stage of disease and type of treatment. We outline evidence from three sources: (1) studies that compare men with the disease with an age-matched sample of men without the disease, (2) studies that assess men with the disease across time, and (3) cross-sectional studies that highlight predictors of HRQoL. Future research directions are discussed.
TL;DR: Results indicated that obesity-specific HRQOL was significantly more impaired in the treatment-seeking groups than in the nontreatment-seeking group across comparable gender and body mass index (BMI) categories.
Abstract: OBJECTIVE: To compare the health-related quality of life (HRQOL) of overweight/obese individuals from different subgroups that vary in treatment-seeking status and treatment intensity RESEARCH METHODS AND PROCEDURES: Participants were from five distinct groups, representing a continuum of treatment intensity: overweight/obese community volunteers who were not enrolled in weight-loss treatment, clinical trial participants, outpatient weight-loss program/studies participants, participants in a day treatment program for obesity, and gastric bypass patients The sample was large (n = 3353), geographically diverse (subjects were from 13 different states in the US), and demographically diverse (age range, 18 to 90 years; at least 14% African Americans; 326% men) An obesity-specific instrument, the Impact of Weight on Quality of Life-Lite questionnaire, was used to assess health-related quality of life (HRQOL) RESULTS: Results indicated that obesity-specific HRQOL was significantly more impaired in the treatment-seeking groups than in the nontreatment-seeking group across comparable gender and body mass index (BMI) categories Within the treatment groups, HRQOL varied by treatment intensity Gastric bypass patients had the most impairment, followed by day treatment patients, followed by participants in outpatient weight-loss programs/studies, followed by participants in clinical trials Obesity-specific HRQOL was more impaired for those with higher BMIs, whites, and women in certain treatment groups DISCUSSION: There are differences in HRQOL across subgroups of overweight/obese individuals that vary by treatment-seeking status, treatment modality, gender, race, and BMI
TL;DR: An overview of the results of studies into the quality of life (QL) of young adult survivors of childhood cancer and suggest areas for future research is given.
Abstract: In recent years the necessity of measuring quality of life in childhood cancer survivors has been stressed. This paper gives an overview of the results of studies into the quality of life (QL) of young adult survivors of childhood cancer and suggest areas for future research. The review located 30 empirical studies published up to 2001. The results are described in terms of the following QL dimensions: physical functioning (QL, general health), psychological functioning (overall emotional functioning, depression and anxiety, self-esteem), social functioning (education, employment, insurance, living situation, marital status and family), and sexual functioning. Factors related to survivors' QL are reported: demographics and illness- and treatment related variables. Although the literature yields some inconsistent findings, a number of clear trends can be identified: (a) most survivors reported being in good health, with the exception of some bone tumour survivors; (b) most survivors function well psychologically; (c) survivors of CNS tumours and survivors of acute lymphoblastic leukaemia (ALL) are at risk for educational deficits; (d) job discrimination, difficulties in obtaining work and problems in obtaining health and life insurance were reported; (e) survivors have lower rates of marriage and parenthood; (f) survivors worry about their reproductive capacity and/or about future health problems their children might experience as a result of their cancer history. There is a need for methodological studies that measure QL among survivors of childhood cancer more precisely by taking into account the effects of the severity of the cancer and the long-term impact of different treatments. Additional data are needed to help us understand the needs of survivors and to identify those subgroups of survivors who are at greatest risk for the adverse sequelae of the disease and its treatment.
TL;DR: The main independent predictors of self-rated global quality of life were: social comparisons and expectations, personality and psychological characteristics, health and functional status and personal and neighbourhood social capital, which explained the highest proportion of the variance between groups in theirquality of life ratings.
Abstract: The broad aim of the research presented here was to define the constituents and indicators of quality of life (QoL) in older age, in order to offer a more multidimensional and useful model of quality of life, based on the perspectives of older people themselves. This paper focuses on the extent to which self-evaluations of global QoL are influenced by health, psychological and social variables, and social circumstances. It reports the results of a national survey of the quality of life in people aged 65 and over, living at home in Britain. Multiple regression analysis with the self-evaluation of quality of life rating as the dependent variable showed that the overall model (Model 9) of QoL indicators explained 26.7% of the variance in quality of life ratings. This is sizeable given the amorphous nature of this concept. The main independent predictors of self-rated global quality of life were: social comparisons and expectations, personality and psychological characteristics (optimism-pessimism), health and functional status and personal and neighbourhood social capital. These variables explained the highest proportion of the variance between groups in their quality of life ratings. Socio-economic indicators contributed relatively little to the model.
TL;DR: A systematic review of the literature is performed to compare the health related quality of life of patients with irritable bowel syndrome with that of healthy controls and to examine therapy‐associated changes in HRQoL of irritated bowel syndrome patients.
Abstract: Summary
Aim : To perform a systematic review of the literature with three objectives: (1) to compare the health related quality of life (HRQoL) of patients with irritable bowel syndrome with that of healthy controls; (2) to compare the HRQoL of irritable bowel syndrome patients to those with other diseases; and (3) to examine therapy-associated changes in HRQoL of irritable bowel syndrome patients.
Methods : Searches of all English and non-English articles from 1980 to 2001 were performed in Medline and Embase, and two investigators performed independent data abstraction.
Results : Seventeen articles met our selection criteria. 13 studies addressed objective no. 1; 11 showed a significant reduction in HRQoL among irritable bowel syndrome patients. Of these, only one study was considered of high quality. Four studies addressed objective no. 2, none of which was considered to be high quality in addressing this objective. Four trials (three of high quality) addressed objective no. 3. One showed that symptomatic improvement with Leupron compared to placebo was accompanied an improvement only in the comparative health domain of the HRQoL. The second study reported significant positive changes in HRQoL after 12 weeks of cognitive behavioural therapy. The third report of two placebo-controlled studies indicated significant improvement with alosetron on most domains of Irritable Bowel Syndrome Quality of Life Questionnaire.
Conclusions : (i) There is reasonable evidence for a decrease in HRQoL in patients with moderate to severe irritable bowel syndrome; however, the data are conflicting regarding the impact of irritable bowel syndrome on HRQoL in population-based studies of nonconsulters. (ii) HRQoL in irritable bowel syndrome patients is impaired to a degree comparable to other chronic disorders such as GERD and depression. (iii) A therapeutic response in irritable bowel syndrome-related pain has a corresponding improvement in HRQoL. (iv) Limitations of the literature include focusing on moderate-severe irritable bowel syndrome in referral centres, and lack of appropriate controls
TL;DR: Recent pulmonary exacerbations have a profound negative impact on HRQOL that is not explained by differences in lung function, nutritional status, or demographic factors, and may not be generalizable to the entire CF population.
TL;DR: The results indicated that patients with cancer had higher mean scores on the Barriers Questionnaire‐II than did nurses trained in pain management, and the BQ‐II is a reliable and valid measure of patient‐related barriers to cancer pain management.
Abstract: Patients' beliefs can act as barriers to optimal management of cancer pain. The Barriers Questionnaire (BQ) is a tool used to evaluate such barriers. Here, the BQ has been revised to reflect changes in pain management practices, resulting in the Barriers Questionnaire-II (BQ-II), a 27-item, self report instrument. This paper presents the results from two studies where the psychometric properties of the BQ-II were evaluated. In the first study, the responses of 27 nurses trained in pain management were compared to responses of a convenience sample of 12 patients with cancer. The results indicated that patients with cancer had higher mean scores on the BQ-II than did nurses trained in pain management. In the second study, a convenience sample of 172 patients with cancer responded to the BQ-II and a set of pain and quality of life (QOL) measures. A factor analysis supported four factors. Factor one, physiological effects, consists of 12 items addressing the beliefs that side effects of analgesics are inevitable and unmanageable, concerns about tolerance, and concerns about not being able to monitor changes in one's body when taking strong pain medications. Factor two, Fatalism, consists of three items addressing fatalistic beliefs about cancer pain and its management. Factor three, Communication, consists of six items addressing the concern that reports of pain distract the physician from treating the underlying disease, and the belief that 'good' patients do not complain of pain. The fourth and final factor, harmful effects, consists of six items addressing fear of becoming addicted to pain medication and the belief that pain medications harm the immune system. The BQ-II total had an internal consistency of 0.89, and alpha for the subscales ranged from 0.75 to 0.85. Mean (SD) scores on the total scale was 1.52 (0.73). BQ-II scores were related to measures of pain intensity and duration, mood, and QOL. Patients who used adequate analgesics for their levels of pain had lower scores on the BQ-II than did patients who used inadequate analgesics. The BQ-II is a reliable and valid measure of patient-related barriers to cancer pain management.
TL;DR: The TICS may be a useful alternative to more detailed neuropsychological testing for detecting clinically relevant global cognitive impairment after SAH and impacts broadly on functional status, emotional health, and QOL afterSAH.
Abstract: Background: Cognitive dysfunction is the most common form of neurologic impairment after subarachnoid hemorrhage (SAH). Objective: To evaluate the impact of global and domain-specific cognitive impairment on functional recovery and quality of life (QOL) after SAH. Methods: One hundred thirteen patients (mean age 49 years; 68% women) were evaluated 3 months after SAH. Three simple tests of global mental status and neuropsychological tests to assess seven specific cognitive domains were administered. Four aspects of outcome (global handicap, disability, emotional status, and QOL) were compared between cognitively impaired and unimpaired patients with analysis-of-covariance models controlling for age, race/ethnicity, and education. Multiple linear regression was used to evaluate the relative contribution of global and domain-specific cognitive status for predicting concurrent modified Rankin Scale (mRS) and Sickness Impact Profile (SIP) scores. Results: Impairment of global mental status on the Telephone Interview of Cognitive Status (TICS) was associated with poor performance in all seven cognitive domains (all p p ≤ 0.005). Cognitive impairment in four specific domains was also associated with functional disability or reduced QOL. After accounting for global cognitive impairment with the TICS, however, neuropsychological testing did not contribute additional predictive value for concurrent mRS or SIP total scores. Conclusions: Cognitive impairment impacts broadly on functional status, emotional health, and QOL after SAH. The TICS may be a useful alternative to more detailed neuropsychological testing for detecting clinically relevant global cognitive impairment after SAH.
TL;DR: In this article, the authors examine data from the 1972-1996 General Social Survey Cumulative File and find that happiness is associated with the frequency of attendance at religious services, with denominational preference, and with doctrinal preference.
Abstract: Subjective and objective indicators of the quality of life (QOL) are used to test relationships with religious involvement, participation, and belief. Findings from other studies show religious involvement to be associated with longer life. The percent of religious adherents in a state is correlated with the harmony domain of the QOL and negatively with an indicator of stress. After reviewing relevant previous studies, I examine data from the 1972–1996 General Social Survey Cumulative File. It shows happiness to be associated with the frequency of attendance at religious services, with denominational preference, and with doctrinal preference. Happiness also is associated with certain religious-related beliefs: belief that the world is evil or good but not belief in immortality. In a discussion of these and other findings, hypotheses are suggested to explain and to further explore the effects of religion upon the QOL. Among the conclusions: our conception of the "good life" rests heavily upon Judeo-Christian ideals; religious organizations contribute to the integration of the community, hence enhancing the QOL; since frequency of attendance is imperfectly associated with the QOL, other influences are at work; the doctrine of the religion may attract persons of happy disposition; religion may explain a purpose in life that fosters well-being; and others. I suggest implications of the findings for programs of religious organizations.