Showing papers on "Quality of life published in 2008"

Quality of life and satisfaction with outcome among prostate-cancer survivors.

Abstract: Background We sought to identify determinants of health-related quality of life after primary treatment of prostate cancer and to measure the effects of such determinants on satisfaction with the outcome of treatment in patients and their spouses or partners. Methods We prospectively measured outcomes reported by 1201 patients and 625 spouses or partners at multiple centers before and after radical prostatectomy, brachytherapy, or external-beam radiotherapy. We evaluated factors that were associated with changes in quality of life within study groups and determined the effects on satisfaction with the treatment outcome. Results Adjuvant hormone therapy was associated with worse outcomes across multiple quality-of-life domains among patients receiving brachytherapy or radiotherapy. Patients in the brachytherapy group reported having long-lasting urinary irritation, bowel and sexual symptoms, and transient problems with vitality or hormonal function. Adverse effects of prostatectomy on sexual function were ...

A video game improves behavioral outcomes in adolescents and young adults with cancer: a randomized trial.

Abstract: OBJECTIVE.Suboptimal adherence to self-administered medications is a common problem. The purpose of this study was to determine the effectiveness of a video-game intervention for improving adherence and other behavioral outcomes for adolescents and young adults with malignancies including acute leukemia, lymphoma, and soft-tissue sarcoma. METHODS.A randomized trial with baseline and 1- and 3-month assessments was conducted from 2004 to 2005 at 34 medical centers in the United States, Canada, and Australia. A total of 375 male and female patients who were 13 to 29 years old, had an initial or relapse diagnosis of a malignancy, and currently undergoing treatment and expected to continue treatment for at least 4 months from baseline assessment were randomly assigned to the intervention or control group. The intervention was a video game that addressed issues of cancer treatment and care for teenagers and young adults. Outcome measures included adherence, self-efficacy, knowledge, control, stress, and quality of life. For patients who were prescribed prophylactic antibiotics, adherence to trimethoprim-sulfamethoxazole was tracked by electronic pill-monitoring devices (n 200). Adherence to 6-mercaptopurine was assessed through serum metabolite assays (n 54). RESULTS.Adherence to trimethoprim-sulfamethoxazole and 6-mercaptopurine was greater in the intervention group. Self-efficacy and knowledge also increased in the intervention group compared with the control group. The intervention did not affect self-report measures of adherence, stress, control, or quality of life. CONCLUSIONS.The video-game intervention significantly improved treatment adherence and indicators of cancer-related self-efficacy and knowledge in adolescents and young adults who were undergoing cancer therapy. The findings support current efforts to develop effective video-game interventions for education and training in health care. Pediatrics 2008;122:e305‐e317

Quality of life and satisfaction with outcome among prostate-cancer survivors.

Abstract: To the Editor: The quality of life is an important consideration in treatment for prostate cancer. The study by Sanda et al. (March 20 issue) 1 provides valuable information regarding this aspect of treatment. Unfortunately, the abstract highlights two of the least relevant observations made in this study. First, although the authors show that hormone therapy diminishes the quality of life, class I evidence supports its use in intermediaterisk and high-risk patients receiving radio therapy. 2-5 Highlighting a small effect on the quality of life, given the survival advantages, seems inappropriate. Second, the decision to offer nervesparing radical prostatectomy is usually dictated more by efforts to control disease than by qualityof-life concerns. Finally, as shown in Figure 1 of the article, at 24 months, the mean sexual score for patients undergoing prostatectomy was similar to that for patients receiving radiotherapy or brachytherapy, even though the patients in the prostatectomy group started with a higher mean sexual score and were 5 to 10 years younger. The relative decline in sexual function was significantly worse in the patients who underwent prostatectomy, even with the use of nerve-sparing techniques. This finding should have been emphasized in the abstract and should be considered in making informed treatment decisions.

Impact of Late Treatment-Related Toxicity on Quality of Life Among Patients With Head and Neck Cancer Treated With Radiotherapy

Abstract: Purpose To investigate the impact of treatment-related toxicity on health-related quality of life (HRQoL) among patients with head and neck squamous cell carcinoma treated with radiotherapy either alone or in combination with chemotherapy or surgery. Patients and Methods The study sample was composed of 425 disease-free patients. Toxicity was scored according to the European Organisation for Research and Treatment of Cancer (EORTC)/Radiation Therapy Oncology Group (RTOG) late radiation-induced morbidity scoring system. HRQoL was assessed using the EORTC Quality of Life Questionnaire C30. These assessments took place at 6, 12, 18, and 24 months after completion of radiotherapy. The analysis was performed using a multivariate analysis of variance. Results Of the six RTOG scales investigated, two significantly affected self-reported HRQoL, salivary gland (RTOGxerostomia) and esophagus/pharynx (RTOGswallowing). Although RTOGxerostomia was reported most frequently, HRQoL was most affected by RTOGswallowing, pa...

Quality of life in Parkinson's disease: the relative importance of the symptoms.

Abstract: A body of literature now exists, which demonstrates that idiopathic Parkinson's disease (PD) has a major negative impact on quality of life (QoL), and that depression and cognitive impairment are among the main predictors of poor QoL in this disorder. Relatively little work has been done to assess the differential contribution of the specific symptoms of PD to QoL, which was the aim of this study. One hundred thirty patients with PD completed a booklet of questionnaires, which included the PDQ39 as a disease-specific measure of QoL, a symptom checklist, a mobility checklist, as well as patient ratings of disease stage and disability. The results indicated that the contribution of physical, medication-related, and cognitive/psychiatric symptoms to QoL can be significant. Sudden unpredictable on/off states, difficulty in dressing, difficulty in walking, falls, depression, and confusion were PD symptoms, which significantly influenced QoL scores. Among the mobility problems associated with PD, start hesitation, shuffling gait, freezing, festination, propulsion, and difficulty in turning had a significant effect on QoL scores. In addition to depression and anxiety, the major predictors of QoL were shuffling, difficulty turning, falls, difficulty in dressing, fatigue, confusion, autonomic disturbance particularly urinary incontinence, unpredictable on/off fluctuations, and sensory symptoms such as pain. The implications of these results for the medical management of PD are discussed.

Quality of life of family caregivers of cancer survivors: across the trajectory of the illness.

Abstract: BACKGROUND. Cancer affects not only the quality of life (QOL) of individuals with the disease but also that of their family members and close friends. The impact on various aspects of the family caregivers' QOL is significant throughout the trajectory of the illness. The authors reviewed literature on the QOL of family caregivers at the acute and middle- to long-term survivorship phases as well as the bereavement phase. METHODS. By using several databases, the authors searched the literature published in English from 1996 through July 2007. Keywords searched included cancer, carcinoma, family, family member, caregivers, and quality of life. Several criteria were used to guide the literature review: Articles had to be published in refereed journals and had to use rigorous methods, sample, and validated measures. RESULTS. The findings suggested that the QOL of family caregivers of individuals with cancer varies along the illness trajectory. This highlights were importance of assessing the ongoing adjustment of the caregivers over time. However, there were few theory-driven studies, and significant gaps remain in the current understanding of the effects of family caregiving beyond the time of diagnosis and treatment. CONCLUSIONS. Accumulating evidence has supported the concept that cancer affects not only the patients/survivors but also their family members. However, theoretically and methodologically rigorous research on various aspects of the family's QOL, including not only the psychological but also the physical, spiritual, and behavioral adjustment to cancer in the family, remains sparse. Family-based interventions across the trajectory of the illness also are needed. Cancer 2008. © 2008 American Cancer Society.

Psychosocial Outcomes and Health-Related Quality of Life in Adult Childhood Cancer Survivors: A Report from the Childhood Cancer Survivor Study

Abstract: Purpose: Psychological outcomes, health-related quality of life (HRQOL), and life satisfaction are compared between 7,147 adult childhood cancer survivors and 388 siblings from the Childhood Cancer Survivor Study, examining demographic and diagnosis/treatment outcome predictors. Methods: Psychological distress, HRQOL, and life satisfaction were measured by the Brief Symptom Inventory-18, the Medical Outcomes Survey Short Form-36, and Cantril Ladder of Life, respectively. A self-report questionnaire provided demographic/health information and medical record abstraction provided cancer/treatment data. Siblings' and survivors' scores were compared using generalized linear mixed models, and predictor effects of demographic and cancer/treatment variables were analyzed by multivariate logistic regression. Results: Although survivors report greater symptoms of global distress (mean, 49.17; SE, 0.12) than do siblings (mean, 46.64; SE, 0.51), scores remain below population norms, indicating that survivors and siblings remain psychologically healthy. Survivors scored worse than siblings on overall physical (51.30 ± 0.10 versus 54.98 ± 0.44; P < 0.001) but not emotional aspects of HRQOL, but effect sizes were small, other than in vitality. Most survivors reported present (mean, 7.3; SD, 0.02) and predicted future (mean, 8.6; SD, 0.02) life satisfaction. Risk factors for psychological distress and poor HRQOL were female gender, lower educational attainment, unmarried status, annual household income <$20,000, unemployment, lack of medical insurance, having a major medical condition, and treatment with cranial radiation. Conclusion: Compared with population norms, childhood cancer survivors and siblings report positive psychological health, good HRQOL, and life satisfaction. The findings identify targeted subgroups of survivors for intervention. (Cancer Epidemiol Biomarkers Prev 2008;17(2):435–46)

Quality of life in older ages

Abstract: Background: The quality of life of elderly people has become relevant with the demographic shift that has resulted in greying of population. There are indications that concepts and concerns related to quality of life in older ages are different from the general population. Methods: A narrative review of selected literature. Results: Quality of life is described often with both objective and subjective dimensions. The majority of the elderly people evaluate their quality of life positively on the basis of social contacts, dependency, health, material circumstances and social comparisons. Adaptation and resilience might play a part in maintaining good quality of life. Although there are no cultural differences in the subjective dimension of quality of life, in the objective dimension such differences exist. Two major factors to be considered with regard to quality of life in old age are dementia and depression. Discussion: With all other influences controlled, ageing does not influence quality of life negatively; rather a long period of good quality of life is possible. Therefore, the maintenance and improvement quality of life should be included among the goals of clinical management.

Chemotherapy-induced alopecia and effects on quality of life among women with breast cancer: a literature review.

Abstract: Background: Alopecia is a common side effect of chemotherapies used in the treatment of breast cancer. The aim of this review is to describe the effects of alopecia on quality of life (QOL) in this population. Methods: We conducted a literature review using Medline, Embase, Cumulative Index to Nursing and Allied Health Literature and PsycInfo databases. We searched for studies on the effects of alopecia on various aspects of QOL in breast cancer patients including anxiety and distress, body image, sexuality, self-esteem, social functioning, global QOL and return to work outcomes. Results: A total of 38 articles were included in the review. Hair loss consistently ranked amongst the most troublesome side effects, was described as distressing, and may affect the body image. Conclusions: We found very little quantitative data on other aspects of QOL. More research is needed to determine the presence and extent of negative effects on chemotherapy-induced alopecia on various aspects of QOL. Copyright © 2007 John Wiley & Sons, Ltd.

Lymphedema and Quality of Life in Breast Cancer Survivors: The Iowa Women's Health Study

Abstract: Purpose The impact of lymphedema or related arm symptoms on health-related quality of life (HRQOL) in breast cancer (BrCa) survivors has not been examined using a large population-based cohort. Patients and Methods The Iowa Women’s Health Study (IWHS) collected self-report data for lymphedema, arm symptoms, and HRQOL (Medical Outcomes Study Short Form-36) in 2004 and data for cancer diagnosis, treatment, and behavioral and health characteristics between 1986 and 2003. We studied 1,287 women, age 55 to 69 years at baseline, who developed unilateral BrCa. We used cross-sectional analyses to describe the prevalence of lymphedema and arm symptoms and multivariate-adjusted generalized linear models to compare HRQOL (physical functioning, bodily pain, general health, physical and emotional role limitations, vitality, social functioning, and mental health) between the following three survivor groups: women with lymphedema (n 104), women with arm symptoms without diagnosed lymphedema (n 475), and women without lymphedema or arm symptoms (n 708).

Randomized Controlled Clinical Effectiveness Trial of Cognitive Behavior Therapy Compared With Treatment As Usual for Persistent Insomnia in Patients With Cancer

Abstract: Purpose Persistent insomnia is a common complaint in cancer survivors, but is seldom satisfactorily addressed. The adaptation to cancer care of a validated, cost-effective intervention may offer a practicable solution. The aim of this study was to investigate the clinical effectiveness of protocol-driven cognitive behavior therapy (CBT) for insomnia, delivered by oncology nurses. Patients and Methods Randomized, controlled, pragmatic, two-center trial of CBT versus treatment as usual (TAU) in 150 patients (103 females; mean age, 61 years.) who had completed active therapy for breast, prostate, colorectal, or gynecological cancer. The study conformed to CONSORT guidelines. Primary outcomes were sleep diary measures at baseline, post-treatment, and 6-month follow-up. Actigraphic sleep, health-related quality of life (QOL), psychopathology, and fatigue were secondary measures. CBT comprised five, small group sessions across consecutive weeks, after a manualized protocol. TAU represented normal clinical pract...

Determinants of disability and quality of life in mild to moderate Parkinson disease

Abstract: Objective: To identify factors that independently contribute to disability and quality of life (QoL) in patients with mild to moderate Parkinson disease (PD) Methods: A group of 190 patients with PD recruited from outpatient clinics and the Dutch Parkinson’s Disease Association participated in this cross-sectional study Data on demographic and clinical factors, motor symptoms, cognitive functions, affective symptoms, comorbidity, and social support were collected during neurologic and neuropsychological examinations Disability was rated using the Schwab and England Activities of Daily Living Scale (SE-ADL), the AMC Linear Disability Score (ALDS), and the Functional Independence Measure (FIM) QoL was assessed with the Parkinson’s Disease Quality of Life questionnaire (PDQL) and the Medical Outcome Study Short Form (SF-36) Multiple linear regression analyses were conducted to identify determinants of disability and poor QoL Results: Axial impairment (postural instability and gait difficulty) explained the largest proportion of variance in disability Bradykinesia and comorbidity contributed to disability, but to a lesser extent Self-reported mood symptoms and axial impairment were the two factors most closely associated with poorer QoL, but comorbidity and bradykinesia additionally contributed to the explanatory power Semantic fluency and psychomotor skills were the only cognitive variables related to some aspects of functional outcome Conclusion: Axial impairment is strongly associated with disability in patients with mild to moderate Parkinson disease (PD) Self-report indices of mood status and axial impairment are identified as the main determinants of poor quality of life (QoL) The results of this study may help to identify patients with PD at risk for functional dependence and reduced QoL

Patient-reported measurements of oral mucositis in head and neck cancer patients treated with radiotherapy with or without chemotherapy: Demonstration of increased frequency, severity, resistance to palliation, and impact on quality of life

Abstract: BACKGROUND. The risk, severity, and patient-reported outcomes of radiation-induced mucositis among head and neck cancer patients were prospectively estimated. METHODS. A validated, patient-reported questionnaire (OMDQ), the FACT quality of life (QOL), and the Functional Assessment of Chronic Illness Therapy (FACIT) fatigue scales were used to measure mucositis (reported as mouth and throat soreness), daily functioning, and use of analgesics. Patients were studied before radiotherapy (RT), daily during RT, and for 4 weeks after RT. RESULTS. Contrary to previous reports, the risk of mucositis was virtually identical in the 126 patients with oral cavity or oropharynx tumors (99% overall; 85% grade 3-4) compared with 65 patients with tumors of the larynx or hypopharynx (98% overall; 77% grade 3-4). The mean QOL score decreased significantly during RT, from 85.1 at baseline to 69.0 at Week 6, corresponding with the peak of mucositis severity. The mean functional status score decreased by 33% from 18.3 at baseline to 12.3 at Week 6. The impact of mucositis on QOL was proportional to its severity, although even a score of 1 or 2 (mild or moderate) was associated with a significant reduction in QOL (from 93.6 at baseline to 74.7 at Week 6). Despite increases in analgesic use from 34% at baseline to 80% at Week 6, mean mucositis scores exceeded 2.5 at Week 6. CONCLUSIONS. Mucositis occurs among virtually all patients who are undergoing radiation treatment of head and neck cancers. The detrimental effects on QOL and functional status are significant, and opioid analgesia provides inadequate relief. Preventive rather than symptom palliation measures are needed. Cancer 2008;113:2704–13. � 2008 American Cancer Society.

On subjective well-being and quality of life

Abstract: We integrate the multi-disciplinary fields of quality of life (QoL) and well-being (WB) and appraise the impacts of health factors Theoretical and methodological limitations are discussed and new conceptual and technical advances identified, These are informed by cross-cultural and community perspectives Following a definitional review, social inequalities, and links with happiness are examined Demographic, experiential and personal factors are outlined Implications for poverty research are addressed As the concept of SWB recently converged with the longstanding international QoL definition (WHOQOL Group, 1995), we discuss the separate need for SWB Future collaborative conceptual and pragmatic research is recommended

The impact of peripheral arterial disease on health-related quality of life in the Peripheral Arterial Disease Awareness, Risk, and Treatment: New Resources for Survival (PARTNERS) Program

Abstract: This study tested the hypothesis that patients with PAD have impaired health-related quality of life (HRQoL) to a degree similar to that of patients with other types of cardiovascular disease (other-CVD), and also evaluated the clinical features of PAD associated with impaired HRQoL. This was a cross-sectional study in 350 primary care practice sites nationwide with 6,499 participants. The reference group had no clinical or hemodynamic evidence of PAD or other-CVD; the PAD group had an ankle-brachial index < 0.90 or a prior history of PAD; the other-CVD group had a clinical history of cardiac or cerebral vascular disease (but no PAD), and the combined PAD-other-CVD group included both diagnoses. Individuals were assessed using four HRQoL questionnaires including the Walking Impairment Questionnaire (WIQ), Medical Outcomes Study SF-36 (SF-36), Cantril Ladder of Life and the PAD Quality of Life questionnaire. PAD patients had lower WIQ distance scores than the other-CVD group. Both the PAD and other-CVD groups had significantly lower SF-36 Physical Function scores compared with the reference group. The WIQ revealed that PAD patients were more limited by calf pain, whereas other-CVD patients were more limited by chest pain, shortness of breath and palpitations. In conclusion, in this nationwide study, one of the first to directly compare the HRQoL burden of CVD with that of PAD, the evaluation of PAD in office practice revealed a HRQoL burden as great in magnitude as in patients with other forms of CVD.

Determinants of health-related quality of life in elderly in Tehran, Iran

Abstract: As Iran started to experience population ageing, it is important to consider and address the elderly people's needs and concerns, which might have direct impacts on their well-being and quality of life. There have been only a few researches into different aspects of life of the elderly population in Iran including their health-related quality of life. The purpose of this study was to measure health-related quality of life (HRQoL) of elderly Iranians and to identify its some determinant factors. This was a cross-sectional survey of a random sample of community residents of Tehran aged 65 years old and over. HRQoL was measured using the Short From Health Survey (SF-36). The study participants were interviewed at their homes. Uni-variate analysis was performed for group comparison and logistic regression analysis conducted to predict quality of life determinants. In all, 400 elderly Iranian were interviewed. The majority of the participants were men (56.5%) and almost half of the participants were illiterate (n = 199, 49.8%). Eighty-five percent of the elderly were living with their family or relatives and about 70% were married. Only 12% of participants evaluated their economic status as being good and most of people had moderate or poor economic status. The mean scores for the SF-36 subscales ranged from 70.0 (SD = 25.9) for physical functioning to 53.5 (SD = 29.1) for bodily pain and in general, the respondents significantly showed better condition on mental component of the SF-36 than its physical component (mean scores 63.8 versus 55.0). Performing uni-variate analysis we found that women reported significantly poorer HRQoL. Multiple logistic regression analysis showed that for the physical component summary score of the SF-36, age, gender, education and economic status were significant determinants of poorer physical health-related quality of life; while for the mental component summary score only gender and economic status were significant determinants of poorer mental health-related quality of life. The analysis suggested that the elderly people's economic status was the most significant predictor of their HRQoL. The study findings, although with a small number of participants, indicate that elderly people living in Tehran, Iran suffer from relatively poor HRQoL; particularly elderly women and those with lower education. Indeed to improve quality of life among elderly Iranians much more attention should be paid to all aspects of their life including their health, and economic status.

Relationship between neurocognitive function and quality of life after whole-brain radiotherapy in patients with brain metastasis

Abstract: Purpose To examine the relationship between neurocognitive function (NCF) and quality of life (QOL) in patients with brain metastases after whole-brain radiotherapy. Patients and Methods A total of 208 patients from the whole-brain radiotherapy arm of a Phase III trial (PCI-P120-9801), who underwent regular NCF and QOL (ADL [activities of daily living] and FACT-Br [Functional Assessment of Cancer Therapy–Brain-specific]) testing, were analyzed. Spearman's rank correlation was calculated between NCF and QOL, using each patient's own data, at each time point. To test the hypothesis that NCF declines before QOL changes, the predictive effect of NCF from previous visits on QOL was studied with a linear mixed-effects model. Neurocognitive function or QOL deterioration was defined relative to each patient's own baseline. Lead or lag time, defined as NCF deterioration before or after the date of QOL decline, respectively, was computed. Results At baseline, all NCF tests showed statistically significant correlations with ADL, which became stronger at 4 months. A similar observation was made with FACT-Br. Neurocognitive function scores from previous visits predicted ADL ( p Conclusions Neurocognitive function and QOL are correlated. Neurocognitive function scores from previous visits are predictive of QOL. Neurocognitive function deterioration precedes QOL decline. The sequential association between NCF and QOL decline suggests that delaying NCF deterioration is a worthwhile treatment goal in brain metastases patients.

Quality of life in patients with breast cancer before and after diagnosis: an eighteen months follow-up study

Abstract: Measuring quality of life in breast cancer patients is of importance in assessing treatment outcomes. This study examined the impact of breast cancer diagnosis and its treatment on quality of life of women with breast cancer. This was a prospective study of quality of life in breast cancer patients. Quality of life was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its breast cancer supplementary measure (QLQ-BR23) at three points in time: baseline (pre diagnosis), three months after initial treatment and one year after completion of treatment (in all 18 months follow-up). At baseline the questionnaires were administered to all suspected identified patients while both patients and the interviewer were blind to the final diagnosis. Socio-demographic and clinical data included: age, education, marital status, disease stage and initial treatment. Repeated measure analysis was performed to compare quality of life differences over the time. In all, 167 patients diagnosed with breast cancer. The mean age of breast cancer patients was 47.2 (SD = 13.5) years and the vast majority (82.6%) underwent mastectomy. At eighteen months follow-up data for 99 patients were available for analysis. The results showed there were significant differences in patients' functioning and global quality of life at three points in time (P < 0.001). Although there were deteriorations in patients' scores for body image and sexual functioning, there were significant improvements for breast symptoms, systematic therapy side effects and patients' future perspective (P < 0.05). The findings suggest that overall breast cancer patients perceived benefit from their cancer treatment in long-term. However, patients reported problems with global quality of life, pain, arm symptoms and body image even after 18 months following their treatments. In addition, most of the functional scores did not improve.

Meta-analysis of Quality of Life Outcomes Following Diabetes Self-management Training

Abstract: Purpose The purpose of this meta-analysis was to meet the need to quantify the influence of diabetes self-management training on quality of life (QOL) of adult diabetes patients. Methods Extensive literature searching located published and unpublished diabetes self-management intervention studies that measured QOL outcomes among at least 5 subjects with type 1 or 2 diabetes. Data were extracted from primary study reports which included interventions designed to improve diabetes self-management and adequate data to calculate effect sizes. Random-effects meta-analytic procedures were used to estimate overall effects between treatment and control groups at outcome assessment and between baseline and outcome data for both treatment subjects and control subjects. Results Exhaustive searching yielded 20 comparisons across 1892 subjects. The comparisons between treatment and control group outcomes following interventions yielded an effect size of 0.281. The comparisons between treatment group at baseline and outcome measurement yielded an effect size of 0.312 to 0.313. Each of these effect sizes were statistically significant, meaning that the hypothesis that interventions to improve diabetes self-management results in increased QOL was supported. Control subjects did not experience improved QOL while participating in studies. Conclusions These findings document that people with diabetes experience improved QOL from participation in diabetes self-management training programs. Future diabetes self-management intervention studies should include quality of life outcomes so that this important outcome can be further studied. After more primary studies are available, future meta-analyses can explore important moderator analyses.

Fatigue after traumatic brain injury and its impact on participation and quality of life.

Abstract: Objectives To examine the relationships between post-TBI fatigue (PTBIF) and comorbid conditions, participation in activities, quality of life, and demographic and injury variables. Participants 223 community-dwelling individuals with mild to severe TBI and 85 noninjured controls. Measures Global Fatigue Index (GFI), Beck Depression Inventory (BDI-II), McGill Pain Questionnaire (MPQ), Pittsburgh Sleep Quality Inventory (PSQI), Participation Objective Participation Subjective (POPS), SF-36, Life-3. Method Data were collected through interviews and administration of self-report measures as part of a study of PTBIF. Results Fatigue was more severe and prevalent in individuals with TBI, and more severe among women. It was not correlated with other demographic and injury variables. Once overlap in measurement instruments' content was removed, depression, pain, and sleep problems accounted for approximately 23% of the variance in fatigue in those with TBI compared to 58% of the variance in the control group. PTBIF was correlated with health-related quality of life and overall quality of life, but was not generally related to participation in major life activities. Conclusions PTBIF has significant impact on well-being and quality of life and cannot be accounted for by comorbid conditions alone, suggesting that it is related to brain injury itself. It appears to be unrelated to demographic and injury variables other than gender. PTBIF does not limit the quantity and frequency of participation. Future research should focus on the relationship between fatigue and the quality of participation.

Impact of Major Depression and Subsyndromal Symptoms on Quality of Life and Attitudes Toward Aging in an International Sample of Older Adults

Abstract: Purpose: The impact of major depression on quality of life (QOL) and aging experiences in older adults has been reported. Studies have demonstrated that the clinical diagnosis of major depression is the strongest predictor for QOL. We postulate that some findings are biased because of the use of inadequate instruments. Although subsyndromal depression is more prevalent than major depression, there are no reports on its impact on QOL or attitudes toward aging. In the present study we aim at assessing the association of major and subsyndromal depression on QOL and attitudes toward aging in a large international sample. Design and Methods: Our cross-sectional study assessed 4,316 respondents in 20 countries from five continents. The study used the World Health Organization Quality of Life (WHOQOL) Assessment for Older Adults, known as the WHOQOL-OLD; the brief version of the WHOQOL instrument, known as the WHOQOL-BREF; and the Attitudes to Ageing Questionnaire. Statistical analyses involved hierarchical multiple regression, as well as comparison of means. Results: Even relatively minor levels of depression are associated with a significant decrease in all QOL domains and with a pattern of negative attitudes toward aging (overall WHOQOL-OLD R 2 change = .421). QOL and attitudes toward aging scores are lower as depression intensity is increased, even in subsyndromal levels (overall WHOQOL-OLD mean scores of 95.7 vs 86.4, p , .001). This phenomenon happens not only for clinically depressed individuals but also for subsyndromic individuals. Implications: Present findings suggest that classifying a respondent as nondepressed is not sufficient and is still not informative about his or her QOL and attitudes toward aging status.

Quality of life with defibrillator therapy or amiodarone in heart failure.

Abstract: Background Implantable cardioverter–defibrillator (ICD) therapy significantly prolongs life in patients at increased risk for sudden death from depressed left ventricular function. However, whether this increased longevity is accompanied by deterioration in the quality of life is unclear. Methods In a randomized trial, we compared ICD therapy or amiodarone with state-of-theart medical therapy alone in 2521 patients who had stable heart failure with depressed left ventricular function. We prospectively measured quality of life at baseline and at months 3, 12, and 30; data collection was 93 to 98% complete. The Duke Activity Status Index (which measures cardiac physical functioning) and the Medical Outcomes Study 36-Item Short-Form Mental Health Inventory 5 (which measures psychological well-being) were prespecified primary outcomes. Multiple additional quality-of-life outcomes were also examined. Results Psychological well-being in the ICD group, as compared with medical therapy alone, was significantly improved at 3 months (P = 0.01) and at 12 months (P = 0.003) but not at 30 months. No clinically or statistically significant differences in physical functioning among the study groups were observed. Additional quality-of-life measures were improved in the ICD group at 3 months, 12 months, or both, but there was no significant difference at 30 months. ICD shocks in the month preceding a scheduled assessment were associated with a decreased quality of life in multiple domains. The use of amiodarone had no significant effects on the primary quality-of-life outcomes. Conclusions In a large primary-prevention population with moderately symptomatic heart failure, single-lead ICD therapy was not associated with any detectable adverse quality-oflife effects during 30 months of follow-up.

Psychological Reactions, Quality of Life, and Body Image After Bilateral Prophylactic Mastectomy in Women At High Risk for Breast Cancer: A Prospective 1-Year Follow-Up Study

Abstract: Purpose To prospectively evaluate body image, sexuality, emotional reactions (anxiety, depression), and quality of life in a sample of women having increased risk for breast cancer before and 6 months and 1 year after bilateral prophylactic mastectomy (BPM), and to compare preoperative expectations of the operation with postoperative reactions concerning the impact on six areas of the women's lives. Patients and Methods A total of 90 of 98 consecutive women who underwent BPM during October 1997 to December 2005 were included. Data were collected by self-administered questionnaires (eg, Hospital Anxiety and Depression scale, Swedish Short Term-36 Health Survey, Body Image Scale, Sexual Activity Questionnaire) before the operation (n = 81), and 6 (n = 71) and 12 months (n = 65) after BPM. Results Anxiety decreased over time (P = .0004). No corresponding difference was found for depression. No differences in health-related quality of life over time were found, with one exception. A substantial proportion of ...

Effect of Esthetic Outcome After Breast-Conserving Surgery on Psychosocial Functioning and Quality of Life

Abstract: Purpose Although breast-conserving surgery (BCS) is often assumed to result in minimal deformity, many patients report postoperative breast asymmetry. Understanding the effect of asymmetry on psychosocial functioning is essential for patients to make an informed choice for surgery. Patients and Methods All women who underwent BCS at the University of Michigan Medical Center (Ann Arbor, MI) during a 4-year period were surveyed using a mailed questionnaire (N 714; response rate 79.5%). Women were queried regarding five aspects of psychosocial functioning: quality of life (QOL), depression, fear of recurrence, stigmatization, and perceived change in health status. Postoperative breast asymmetry was assessed using items from the Breast Cancer Treatment and Outcomes Survey. Multiple regression was used to examine the relationship between breast asymmetry and each outcome, controlling for age, time from surgery in years, race, education level, disease stage, surgical treatment, and the occurrence of postoperative complications. Results Women with pronounced breast asymmetry were significantly more likely to feel stigmatized as a result of their breast cancer treatment (odds ratio [OR] 4.58; 95% CI, 2.77 to 7.55) and less likely to report unchanged or improved health after treatment (OR 0.43; 95% CI, 0.27 to 0.66). Minimal breast asymmetry was associated with higher QOL scores (86.3 v 82.4, P .001). Finally, women with pronounced breast asymmetry were more likely to exhibit depressive symptoms (minimal asymmetry, 16.2%; moderate asymmetry, 18.0%; pronounced asymmetry, 33.7%, Wald test 16.6; P .002).

The interaction of post-traumatic growth and post-traumatic stress symptoms in predicting depressive symptoms and quality of life

Abstract: Objective: We sought to explore whether post-traumatic growth (PTG) (positive change orbenefit finding resulting from trauma) moderates relationships between post-traumatic stresssymptoms (PTSS) and both depression and quality of life (QOL) among breast cancersurvivors.Methods: We interviewed 161 women previously treated for early stage breast cancer. Weassessed PTG using the Post-traumatic Growth Inventory, PTSS using the PTSD Checklist,depressive symptoms using the CES-D and QOL using the FACT-B.Results: Higher PTSS was associated with greater depressive symptoms and lower QOL(p50.01). The relationship between PTSS and depression was attenuated among women withhigher levels of PTG (PTSS PTG interaction, p50.05). The same pattern of results wasfound for QOL (interaction p50.01).Conclusions: We report the novel finding that PTG moderated relationships between PTSSand both depression and QOL. We speculate that finding positive meaning in response to adistressing event, such as diagnosis of cancer, may be psychologically protective and couldindirectly influence the long-term occurrence of depressive symptoms and impaired QOL.Copyright # 2007 John Wiley & Sons, Ltd.Keywords: cancer; oncology; post-traumatic growth; post-traumatic stress; quality of life; depression