A short multilingual quality of life questionnaire--practicability, reliability and interlingual homogeneity

Patient Satisfaction and Quality of Life in People with Schizophrenia-Spectrum Disorders in a Rural Area

People suffering from schizophrenia-spectrum disorders often endorse a reduced quality of life (QoL) as compared to the general population. There appears to be a lack of studies for rural catchment areas for this patient population. We conducted a cross-sectional study with 94 people with schizophrenia-spectrum disorders in a mainly rural alpine area. We used multilevel models controlled for covariates to analyze the data. Total service satisfaction was associated with psychological aspects of subjective QoL and physical well-being in our model. Variables characterizing autonomy and empowerment of the person seem crucial concerning the QoL in this population.

Cardioprotective interventions for cancer patients receiving anthracyclines

BACKGROUND

Anthracyclines are among the most effective chemotherapeutic agents in the treatment of numerous malignancies. Unfortunately, their use is limited by a dose-dependent cardiotoxicity. In an effort to prevent this cardiotoxicity, different cardioprotective agents have been studied.

OBJECTIVES

The objective of this review was to assess the efficacy of different cardioprotective agents in preventing heart damage in cancer patients treated with anthracyclines.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 10), MEDLINE (1966 to November 2010) and EMBASE (1980 to November 2010) databases. In addition, we handsearched reference lists, conference proceedings of the International Society of Paediatric Oncology (SIOP) and American Society of Clinical Oncology (ASCO) meetings (1998 to 2010) and ongoing trials registers.

SELECTION CRITERIA

Randomised controlled trials (RCTs) in which any cardioprotective agent was compared to no additional therapy or placebo in cancer patients (children and adults) receiving anthracyclines.

DATA COLLECTION AND ANALYSIS

Two review authors independently performed the study selection, risk of bias assessment and data extraction including adverse effects.

MAIN RESULTS

We identified RCTs for the eight cardioprotective agents N-acetylcysteine, phenethylamines, coenzyme Q10, a combination of vitamins E and C and N-acetylcysteine, L-carnitine, carvedilol, amifostine and dexrazoxane (mostly for adults with advanced breast cancer). All studies had methodological limitations and for the first seven agents there were too few studies to allow pooling of results. None of the individual studies showed a cardioprotective effect. The 10 included studies on dexrazoxane enrolled 1619 patients. The meta-analysis for dexrazoxane showed a statistically significant benefit in favour of dexrazoxane for the occurrence of heart failure (risk ratio (RR) 0.29, 95% CI 0.20 to 0.41). No evidence was found for a difference in response rate or survival between the dexrazoxane and control groups. The results for adverse effects were ambiguous. No significant difference in the occurrence of secondary malignancies was identified.

AUTHORS' CONCLUSIONS

No definitive conclusions can be made about the efficacy of cardioprotective agents for which pooling of results was impossible. Dexrazoxane prevents heart damage and no evidence for a difference in response rate or survival between the dexrazoxane and control groups was identified. The evidence available did not allow us to reach any definite conclusions about adverse effects. We conclude that if the risk of cardiac damage is expected to be high, it might be justified to use dexrazoxane in patients with cancer treated with anthracyclines. However, clinicians should weigh the cardioprotective effect of dexrazoxane against the possible risk of adverse effects for each individual patient.

Cardioprotective interventions for cancer patients receiving anthracyclines

BACKGROUND

Anthracyclines are among the most effective chemotherapeutic agents in the treatment of numerous malignancies. Unfortunately, their use is limited by a dose-dependent cardiotoxicity. In an effort to prevent this cardiotoxicity, different cardioprotective agents have been studied.

OBJECTIVES

The objective of this review was to assess the efficacy of different cardioprotective agents in preventing heart damage in cancer patients treated with anthracyclines.

SEARCH STRATEGY

We searched the databases of the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 2, 2007), MEDLINE (1966 to April 2007) and EMBASE (1980 to April 2007). In addition, we handsearched reference lists and conference proceedings of the SIOP and ASCO meetings (1998 to 2006).

SELECTION CRITERIA

Randomised controlled trials (RCTs) in which any cardioprotective agent was compared to no additional or placebo therapy in cancer patients (children and adults) receiving anthracyclines.

DATA COLLECTION AND ANALYSIS

Two review authors independently performed the study selection, quality assessment and data-extraction including adverse effects.

MAIN RESULTS

We identified RCTs for seven cardioprotective agents: N-acetylcysteine, phenetylamines, coenzyme Q10, combination of vitamins E and C and N-acetylcysteine, L-carnitine, carvedilol and dexrazoxane (mostly adults with advanced breast cancer). All studies had methodological limitations. For the first six agents, there were too few studies to allow pooling of results. None of the individual studies showed a cardioprotective effect. The nine included studies of dexrazoxane enrolled 1403 patients. The meta-analysis of dexrazoxane showed a statistically significant benefit in favour of dexrazoxane for the occurrence of heart failure (Relative Risk (RR) 0.29, 95% CI 0.20 to 0.41). No evidence was found for a difference in response rate or survival between the dexrazoxane and control group. Only for one adverse effect (abnormal white blood cell count at nadir) a difference in favour of the control group was identified.

AUTHORS' CONCLUSIONS

For cardioprotective agents for which pooling was impossible, no definitive conclusions can be made about their efficacy. Dexrazoxane prevents heart damage and no evidence for a difference in response rate or survival between the dexrazoxane and control group was identified. Only for an abnormal white blood cell count at nadir a clearly significant difference in favour of the control group was identified. We conclude that if the risk of cardiac damage is expected to be high, it might be justified to use dexrazoxane in patients with cancer treated with anthracyclines. However, for each individual patient clinicians should weigh the cardioprotective effect of dexrazoxane against the possible risk of adverse effects.

Effects of doxorubicin-containing chemotherapy and a combination with l-carnitine on oxidative metabolism in patients with non-Hodgkin lymphoma

PURPOSE

Chemotherapy regimens based on anthracycline (doxorubicin) are well established in lymphoma therapy. The purpose of this study was to examine the effects of L-carnitine with a view to reducing cytotoxic side-effects.

METHODS

20 patients were scheduled to receive 3 g L-carnitine before each chemotherapy cycle, followed by 1 g L-carnitine/day during the following 21 days, while 20 patients received a placebo (randomized controlled trial). The plasma lipid profile and relative mRNA levels of key enzymes of oxidative metabolism (carnitine acyltransferases) were measured at three points of time. In addition to the clinical parameters we used the mRNA of white blood cells to evaluate the toxic effects on cardiomyocytes.

RESULTS

In the present study no cardiotoxicity of anthracycline therapy was detected. Carnitine treated patients showed a rise in plasma carnitine which led to an increase of relative mRNA levels from CPT1A (liver isoform of carnitine palmitoyltransferase) and OCTN2 (carnitine transporter). Following chemotherapy, an activation of carnitine acyltransferases was associated with a stimulation of OCTN2 in both groups.

CONCLUSION

Biochemical and molecular analyses indicated a stimulation of oxidative metabolism in white blood cells through carnitine uptake.

Determination of loss of quality of life

Physiatrists are a valuable resource in legal settings, where assessment of functional capacity to perform work and of future medical needs must be determined. Physiatrists help determine what future medical care is needed to restore and maintain an individual at the maximum level of life function. This article focuses on the use of a quality of life (QOL) rehabilitation model, rather than a medical model, for enhancing functional performance, modifying environments, and facilitating patient coping. We discuss use of the QOL model to describe and influence a patient's physical, psychological, cognitive, vocational/economic, and social/leisure domains.

Multidimensional scaling as a tool for analysing quality of life data

Multidimensional scaling (MDS) is introduced and discussed as a graphical method to complement conventional descriptive and confirmatory methods in the validation and analysis of quality of life (QOL) data. An outline of M DS as a statistical technique is given, and its application in the context of QOL research is described. The use of MDS is then illustrated in an example based on a study of 300 cancer survivors who completed the functional assessment of cancer therapy-general (FACT-G) and the EORTC core quality of life questionnaire (QLQ-C30). The correlational structure of the two widely used QOL instruments is investigated by means of MDS, and differences between the two questionnaires are elaborated. Finally, the merits and drawbacks of MDS are discussed in the specific context of the example and in the general framework of QOL research.

Quality of life after surgery for rectal cancer: do we still need a permanent colostomy?

INTRODUCTION

A permanent colostomy is a serious limitation of the quality of life. Besides cure of cancer, preservation of sphincter function is an important goal of surgery for rectal cancer.

METHODS

In a prospective study a concept offering every patient with rectal cancer either sphincter salvage or a "neosphincter" was investigated, and the impact of this strategy on oncologic results, sphincter function, and quality of life was analyzed.

RESULTS

From 1992 to 1997, 276 patients were accepted for the study. Two hundred sixty-one patients had elective surgery, and 15 patients had emergency surgery for their rectal tumors. The postoperative mortality rate was 4 percent. A radical resection (R0) was possible in 197 patients (75 percent). Anterior resection was the most common procedure (n = 87), and intersphincteric resection with coloanal anastomosis was the preferred method for low tumors (n = 65). Abdominoperineal resection was necessary in 15 cases. Thirteen patients had an immediate restoration of sphincter function by means of a dynamic graciloplasty, and 2 patients needed emergency abdominoperineal resection for bleeding. The follow-up was relatively short (median, 36.4 months) at the time of data analysis and showed a local recurrence rate of 8 percent. Although postoperative continence according to the Williams score revealed satisfactory results, subjective quality of life and the scale for specific symptoms showed a significantly worse outcome in patients with ultralow (coloanal) anastomoses compared with those with anterior resection.

CONCLUSIONS

We conclude that for elective curative surgery of rectal cancer, a permanent colostomy is not necessary provided all presently available techniques of sphincter salvage and restoration are applied. However, the patient has to be informed about possible side effects associated with surgical procedures such as coloanal anastomosis or neosphincter reconstruction, to avoid severe psychological difficulties.

The World Health Organization Quality of Life Assessment Instrument (WHOQOL-100): Validation Study with the Dutch Version

In this study, we examine the reliability and validity of a new quality-of-life (QoL) instrument, the Field Trial Version of the World Health Organization Quality of Life assessment instrument (WHOQOL-100). Two-hundred-and-twenty persons, 147 healthy individuals, and 73 chronic fatigue syndrome (CFS) patients completed the WHOQOL-100 and a test battery of related measures. The WHOOQL-100 has a fairly good internal consistency and a good validity.