The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30): translation and validation study of the Iranian version

Comparison of different urinary diversions after radical cystectomy in Iran: Assessment of health-related quality of life and financial burden in a Middle Eastern country

OBJECTIVES

To compare health-related quality of life (HRQOL), cost-effectiveness, and survival among different types of urinary diversion (UD) utilized after radical cystectomy (RC) for bladder cancer with consideration of the unique economic and cultural context in Iran.

PATIENTS AND METHODS

In this retrospective study, we examined all patients who underwent RC from May 2017 to December 2021 at two specialized centers by the same surgical team. Patients were grouped based on their UD. Post-surgical HRQOL (obtained from EORTC QLQ-C30 and QLQBLM-30), financial burden, surgical complications, and survival were compared. Kruskal-Wallis H test, One-way ANOVA, and Kaplan-Meier analyses were utilized; accordingly.

RESULTS AND LIMITATIONS

In total 187 patients were identified-orthotopic neobladder (ONB) (N = 75), ileal conduit (IC) (N = 57), and cutaneous ureterostomy (CU) (N = 55)-and were followed for a median 17.5 (Interquartile range: 7.0, 47.0) months. ONB was associated with better HRQOL, especially in the domains addressing physical, role and social functioning (p = 0.003, 0.011, 0.045) as well as better body image (p < 0.001), lower short- and long-term financial burden (p = 0.034 and <0.001, respectively), marginally lower complication rate (p = 0.049), and better 5-year overall survival (p < 0.001), in comparison with other UDs. Patients who underwent CU had the lowest HRQOL and worst survival. Limitations were retrospective design and possibility of selection bias.

CONCLUSIONS

In this first study that assesses a Middle Eastern collective; ONB seems to be the UD of choice with regard to HRQOL and economic burden when there is no contraindication.

A randomized clinical trial: Efficacy of group-based acceptance and commitment therapy program for breast cancer patients with high fear of progression

BACKGROUND

Fear of progression (FOP) is a common and significant concern among cancer patients, encompassing worries about cancer progression during active treatment. Elevated levels of FOP can be dysfunctional. This study aims to assess the efficacy of an Acceptance and Commitment Therapy (ACT)-based intervention on FOP, anxiety sensitivity (AS), and quality of life (QOL) in breast cancer patients.

METHODS

A clinical trial was conducted involving 80 stage I-III active-treatment breast cancer patients with a score greater than 34 on the Fear of Progression Questionnaire-Short Form scale. These patients were randomly assigned in a 1:1 ratio to either an intervention group, which received weekly 70-min sessions of 5-ACT-bsed group-therapy, or a control group that received usual treatment. Variables including FOP, AS, QOL, and ACT-related factors were assessed using ASQ, QLQ-C30, Cognitive Fusion Questionnaire, and Acceptance and Action Questionnaire-II at three time points: baseline, post-intervention, and 3-month follow-up. The efficacy of the intervention was evaluated using mixed model analysis across all time-points.

RESULTS

The fidelity and acceptability of the ACT-based manual were confirmed using significant methods. A significant reduction in FOP was observed only in the ACT group at post-intervention (P-valueACT < 0.001; Cohen dACT = 1.099). Furthermore, the ACT group demonstrated a more significant reduction in FOP at follow-up. Furthermore, all secondary and ACT-related variables, except for the physical symptoms subscale, showed significant improvement in the ACT group compared to the control group.

CONCLUSIONS

Our ACT-based manual showed promise for reducing FOP, AS, and improving QOL, and ACT-related variables in breast cancer patients 3 months following the intervention.

Mirror therapy effect on shoulder pain and disability and quality of life of mastectomy women: a randomized clinical trial

PURPOSE

To investigate mirror therapy (MT) influence on shoulder pain/disability and quality of life in mastectomy women.

MATERIALS AND METHODS

Sixty unilateral mastectomy women were recruited and randomly assigned to an MT group (N = 30) or a sham therapy (ST) (N = 30). Women in the MT and ST group attended a nurse-led, unsupervised, 30 min a day, five days a week, and at home training program for three weeks with and without a mirror, respectively. Shoulder pain and disability scale and QOL outcomes were assessed at baseline and 3 months after intervention.

RESULTS

Shoulder pain and disability were significantly improved in the MT group but there was not meaningful difference between groups in the EORTC-QOL scales except for some functional scores of QLQ-BR23 scale in the MT group after 3 months follow-up.

CONCLUSIONS

Nurses should instruct MT as a rehabilitation program to mastectomy patients during or after hospitalization to reduce their post-op shoulder pain and disability. This intervention may have also positive impact on their self-care outcomes. It is recommended that further studies should be performed with nurse-supervised exercises, a validated tool for measuring QOL for a long period after surgery, and a longer follow-up period at least for 6 months.Implication for rehabilitationThis study aimed to investigate whether an unsupervised, nurse-led mirror therapy (MT) can alleviate shoulder pain and disability of mastectomy patients and improve their quality of life.Our findings indicated that nurse-led MT as a novel rehabilitation option for mastectomy patients, may reduce shoulder pain and disability even after long period after the surgery.Rehabilitation centers can equip rooms for MT so breast cancer women can use it immediately after mastectomy.Mirror therapy can be used as a rehabilitation method for mastectomy patients because it is easy-to-use, inexpensive, and without the need to attend a rehabilitation center.Rehabilitation centers can provide mirrors along with nursing instructions to women who want to use this method at home.

The supportive care needs survey short form 34 (SCNS-SF34): translation and cultural adaptation into the Nepali language among patients with cervical cancer in Nepal

BACKGROUND

A questionnaire developed in one language must be translated and adapted when it will be used with patients speaking a different language and care should be taken to maintain equivalence between the source language (SL) version and its translated version. The objective of this study was to test the linguistic and cultural validity of a Nepali language version of the Supportive Care Need Survey - Short Form 34 (SCNS-SF34) used with the Nepali population.

METHODS

Translation of the SCNS-SF34 was carried out by following Beaton's guidelines and Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) by a research team. The translated version was administered to patients with cervical cancer in Nepal. The following steps were performed as part of the study: translation, content validity assessment, reliability assessment and measurement of errors.

RESULTS

The study reports item content validity (I-CVI) was > 0.78 and scale content validity (S-CVI) was - 0.89, 0.91 and 0.90 respectively in semantic, cultural, and conceptual aspects. The study found a content validity ratio (CVR) of 0.9 to 1, Cronbach's α of 0.90, correlation significant at the 0.01 level (2-tailed), and clarity of the questionnaire at 91.29%. The standard error of measurement (SEM) and small detectable changes (SDC) for overall care need scores were measured 2.70 and 7.47 respectively. All items were accepted as per the original SCNS-SF34. Following the respondents' suggestions, simpler Nepali words were chosen in some items to replace the words in the preliminary Nepali version of SCNS-SF34.

CONCLUSION

Preliminary findings show that the Nepali translation of SCNS-SF34 is practical and applicable to the Nepali population. Financial supportive care needs, supportive care for caretakers and problems during patient hospital stays are essential to include in the questionnaire to further explore supportive care needs.

Construction of a system for head and neck tumor traceless resection with non-inflatable transaxillary total endoscopic surgery

Radical cure and functional preservation of tumors are the fundamental goals of surgical treatment of head and neck tumors, and the preservation of good aesthetics is a higher pursuit on this basis. Fully hiding the surgical incision and reducing the visibility of scars are important goals of cosmetic surgery. Using complete endoscopy for the head and neck is an effective method. CO₂-free transaxillary total endoscopic surgery is a method with many advantages, which has been widely used in the resection of thyroid tumors, but for other parts and types of tumors in the head and neck, this surgical method is rarely used. The research team expanded its application scope and applied it to submandibular gland tumor resection and other head and neck surgeries for the first time. Through this exploration, it improved traction devices such as retractors, strictly limited the surgical indications, analyzed and summarized the key points, steps and methods of surgery, and built a treatment system for head and neck tumor surgery under complete endoscopy using the non-inflatable transaxillary approach. In this article, we introduce the system and select typical cases to share.

Integrated radiomics, dose-volume histogram criteria and clinical features for early prediction of saliva amount reduction after radiotherapy in nasopharyngeal cancer patients

PURPOSE

Previously, the evaluation of xerostomia depended on subjective grading systems, rather than the accurate saliva amount reduction. Our aim was to quantify acute xerostomia with reduced saliva amount, and apply radiomics, dose-volume histogram (DVH) criteria and clinical features to predict saliva amount reduction by machine learning techniques.

MATERIAL AND METHODS

Computed tomography (CT) of parotid glands, DVH, and clinical data of 52 patients were collected to extract radiomics, DVH criteria and clinical features, respectively. Firstly, radiomics, DVH criteria and clinical features were divided into 3 groups for feature selection, in order to alleviate the masking effect of the number of features in different groups. Secondly, the top features in the 3 groups composed integrated features, and features selection was performed again for integrated features. In this study, feature selection was used as a combination of eXtreme Gradient Boosting (XGBoost) and SHapley Additive exPlanations (SHAP) to alleviate multicollinearity. Finally, 6 machine learning techniques were used for predicting saliva amount reduction. Meanwhile, top radiomics features were modeled using the same machine learning techniques for comparison.

RESULT

17 integrated features (10 radiomics, 4 clinical, 3 DVH criteria) were selected to predict saliva amount reduction, with a mean square error (MSE) of 0.6994 and a R² score of 0.9815. Top 17 and 10 selected radiomics features predicted saliva amount reduction, with MSE of 0.7376, 0.7519, and R² score of 0.9805, 0.9801, respectively.

CONCLUSION

With the same number of features, integrated features (radiomics + DVH criteria + clinical) performed better than radiomics features alone. The important DVH criteria and clinical features mainly included, white blood cells (WBC), parotid_glands_Dmax, Age, parotid_glands_V15, hemoglobin (Hb), BMI and parotid_glands_V45.

Self-care behaviors mediates the relationship between resilience and quality of life in breast cancer patients

Previous studies have shown that resilience could play an important role in enhancing the quality of life in women with breast cancer; however, the mediating role of self-care behaviors have not been studied. This study aims to explore the mediating role of self-care behaviors in the relationship between resilience and quality of life in breast cancer patients. A sample of 195 women with breast cancer (aged from 21 to 60 years; M = 45.32 ± 8.2) from three hospitals in Tehran, Iran completed online questionnaires measuring resilience, self-care and quality of life. The results of structural equation modeling showed that resilience (β = 0.546, p < .01) and self-care behaviors (β = 0.621, p < .01) positively predicted the quality of life in breast cancer patients. The bootstrapping analysis showed that self-care behaviors acted as a partial mediator between resilience and quality of life. The present study brings to light an underlying mechanism of the relationship between resilience and quality of life via the mediating variable of self-care behaviors for patients with breast cancer.

Psychometric properties of the EQ-5D-5L compared with EQ-5D-3L in cancer patients in Iran

Background and Objective

Psychometric evidence to support the validity and reliability of the EuroQol-5 Dimensions (EQ-5D) in cancer patients is limited. This study aimed to test the validity and reliability of the EQ-5D-5L (5L) in comparison with EQ-5D-3L (3L) in cancer patients.

Methods

Data of 650 cancer patients were collected through consecutive sampling method from three largest governmental cancer centers in Iran between June 2021 and January 2022. The data were gathered using the 3L, 5L, and the European Organization for Research and Treatment of Cancer quality of life questionnaire (QLQ-C30) instruments. The 3L and 5L were compared in terms of ceiling effect, discriminatory power, convergent and known-groups validity, relative efficiency, inconsistency, agreement, and reliability.

Results

Compared with the 3L, ceiling effect decreased by 27.86%. Absolute and relative informativity of discriminatory power improved by 45.93% and 22.92% in the 5L, respectively. All convergent validity coefficients with 5L were stronger than with 3L. Both 3L and 5L demonstrated good known-groups validity, and the relative efficiency was higher for 5L in 4 out of 7 patients' characteristics. The two instruments showed low overall inconsistency (1.45%) and 92.57% of the differences of observations between the 3L and 5L were within the 95% limit of agreement. The interclass correlation coefficient (ICC) for 3L and 5L indexes were 0.88 and 0.85, respectively, and kappa coefficients in the 3L dimensions (range=0.66-0.92) were higher than the 5L(range=0.64-0.79).

Conclusions

The 5L demonstrated to be better than the 3L in terms of ceiling effect, inconsistency, discriminatory power, convergent validity, relative efficiency.

Translational Genomic Research: The Association between Genetic Profiles and Cognitive Functioning or Cardiac Function Among Breast Cancer Survivors Completing Chemotherapy

Introduction: Emerging evidence suggests that Chemotherapy (CT) treated breast cancer survivors (BCS) who have "risk variants" in genes may be more susceptible to cognitive impairment (CI) and/or poor cardiac phenotypes. The objective of this preliminary study was to examine whether there is a relationship between genetic variants and objective/subjective cognitive or cardiac phenotypes. Methods and Analysis: BCS were recruited from Moffitt Cancer Center, Morsani College of Medicine, AdventHealth Tampa and Sarasota Memorial Hospital. Genomic DNA were collected at baseline for genotyping analysis. A total of 16 single nucleotide polymorphisms (SNPs) from 14 genes involved in cognitive or cardiac function were evaluated. Three genetic models (additive, dominant, and recessive) were used to test correlation coefficients between genetic variants and objective/subjective measures of cognitive functioning and cardiac outcomes (heart rate, diastolic blood pressure, systolic blood pressure, respiration rate, and oxygen saturation). Results: BCS (207 participants) with a mean age of 56 enrolled in this study. The majority were non-Hispanic white (73.7%), married (63.1%), and received both CT and radiation treatment (77.3%). Three SNPs in genes related to cognitive functioning (rs429358 in APOE, rs1800497 in ANKK1, rs10119 in TOMM40) emerged with the most consistent significant relationship with cognitive outcomes. Among five candidate SNPs related to cardiac functioning, rs8055236 in CDH13 and rs1801133 in MTHER emerged with potential significant relationships with cardiac phenotype. Conclusions: These preliminary results provide initial targets to further examine whether BCS with specific genetic profiles may preferentially benefit from interventions designed to improve cognitive and cardiac functioning following CT.

Sexual health promotion interventional program for women undergoing breast cancer treatment: Protocol for a mix-methods study

BACKGROUND

Women undergoing breast cancer treatment, especially those of reproductive age, experience sexual health challenges. The aim of this study is to design an interventional program for promoting the sexual health of women undergoing breast cancer treatment.

MATERIALS AND METHODS

This is a mixed qualitative-quantitative exploratory study consisting of four phases. In the first phase, the needs and strategies for promoting sexual health of Iranian women with breast cancer in Isfahan city will be identified through a qualitative study. The patients will be selected using purposive sampling method and the data will be collected through semi-structured interviews. In the second phase of the study, the relevant literature will be reviewed. In the third phase, the initial version of the program will be designed based on the results of qualitative study and review of literature, the appropriate strategies are prioritized by the members of the panel of experts, and then, the final interventional program is prepared. In the fourth phase, the designed interventional program will be conducted as a quasi-experimental study in two groups of intervention and control and the effectiveness of the program on sexual quality of life, sexual satisfaction, and sexual function of women undergoing breast cancer treatment will be evaluated. The type of the intervention will be selected based on the results of the previous phases and the opinion of the expert panel.

CONCLUSIONS

The results of this study are expected to contribute to the design of an interventional program based on the needs of women undergoing breast cancer treatment and promote health and meet the sexual health needs of breast cancer patients.

Psychometric Properties of the Persian Version of the Short-Form Survivor Unmet Needs Survey (SF-SUNS) among Cancer Patients

Objective

Accurate identification of the unmet needs of patients with cancer and with a valid and reliable scale leads to the improvement of planning and implementation of nursing care. Thus, this study aims to translate the Short-Form Survivor Unmet Needs Survey (SF-SUNS) into Persian and to assess the psychometric properties of the Persian version among patients with cancer in Iran.

Methods

This study was conducted by methodological design. The translation of SF-SUNS was performed by translation protocol of the Quality of Life Assessment. Qualitative assessment of the face validity was conducted through cognitive interview and content validity was assessed through expert panel. This study used a convenience sampling method for 757 patients with cancer referring to Omid and Imam Reza hospitals in Mashhad, Iran. To determine the construct validity, confirmatory factor analysis and convergent validity were employed. Cronbach's alpha and intraclass correlation coefficient were calculated for reliability.

Results

Total score of unmet needs was 2.20 ​± ​0.73, which indicates the average level of unmet needs in patients with cancer. Content validity ratio and content validity index scores were 0.88 and 0.91, respectively, Cronbach's alpha coefficient was 0.89, and intraclass correlation coefficient was 0.91. Based on confirmatory factor analysis, goodness-of-fit indices confirmed the model fit (χ²/df ​= ​4.43, GFI ​= ​0.90, TLI/NNFI ​= ​0.91, CFI ​= ​0.90, RMSEA ​= ​0.067). In the subscale of unmet work and financial needs, 4 items had a factor loading lower than 0.4, which were omitted from the Persian version. The results revealed a significant difference in the unmet needs and quality of life of patients with cancer (P ​< ​0.001).

Conclusions

The Persian version of SF-SUNS has desirable psychometric properties. It can be used to design and assess interventions to improve the quality of caring, cancer management, and as well as interaction between patients and healthcare providers.

Serum and gene expression profile of cytokines following combination of yoga training and vitamin D supplementation in breast cancer survivors: a randomized controlled trial

Background

This study aimed to examine the effect of the combination of yoga training with high vitamin D dose supplementation on the expression and systemic levels of inflammatory cytokines and psychophysical status of breast cancer survivors.

Methods

Thirty volunteered breast cancer survivors (48 ± 8 years) were randomly allocated to a high dose (4000 IU) of vitamin D supplementation (HD) group (n = 10), yoga with a high dose of vitamin D (YHD) group (n = 10), and yoga with a low dose (2000 IU) of vitamin D (YLD) group (n = 10). Participants performed the Hatha yoga style for 12 weeks, twice a week. Blood samples, quality of life (QoL) questionnaire, and physical performance tests were taken before and after the intervention.

Results

Body fat percentage (ηp² = 0.36), handgrip strength (ηp² = 0.41) and QoL indicators include global health (ηp² = 0.54), functional scales (ηp² = 0.49), and symptoms scales (ηp² = 0.50) were significantly improved in the both YHD and YLD groups compared to the HD group (p < 0.05). Also, interleukin-10 (IL-10) levels were markedly increased in the Y-HVD group compared to the Y-LVD and HVD groups. Moreover, there were significant decreases in tumor necrosis factor-α (TNF-α) and interleukin-6 levels in the Y-HVD group after the intervention. The anti-inflammatory index (IL-10/TNF-α) was significantly increased in both the yoga groups (P < 0.05).

Conclusion

Yoga promotes physical and psychological fitness and, in combination with a high dose of vitamin D, improves the cytokine profile, which can effectively manage the side effects associated with cancer.

Trial registration IRCT20210726051993N2. Registration date: 2022/02/27. URL: https://www.irct.ir/trial/62079

Translation and validation of the Urdu version of the European organization for research and treatment of cancer core quality of life questionnaire (EORTC QLQ-C30) and brain module (QLQ-BN20) in primary brain tumor patients

Introduction

This study translated and validated the Urdu version of the European Organization for Research and Treatment of Cancer Quality of Life (QoL) Questionnaire (EORTC QLQ-C30) and Brain Module (QLQ-BN20) amongst patients with primary brain tumors (PBT) in Pakistan, and assessed the correlation of QoL with resilience, depression, and anxiety.

Methods

Translation of the EORTC QLQ-C30 and QLQ-BN20 was performed as per EORTC guidelines. A survey comprising of Urdu translations of EORTC QLQ-C30, QLQ-BN20, Wagnild and Young Resilience Scale (RS-14) and Hospital Anxiety and Depression Scale was administered to patients with PBT at a tertiary care hospital in Pakistan. Reliability (via Cronbach alpha), content validity index (CVI) scores, construct validity, and inter-scale correlations were assessed.

Results

Our sample consisted of 250 patients with PBT, most commonly glioma (46.8%) and meningioma (21.2%). All patients were able to understand the Urdu translations. The Cronbach alphas for the QLQ-C30 and the QLQ-BN20 were 0.860 and 0.880, respectively. The CVI scores for clarity and relevance were high for both the EORTC QLQ-C30 (0.98 and 0.96, respectively) and the QLQ-BN20 tool (0.81 and 0.95, respectively). The global QoL domain (EORTC QLQ-C30) showed significant positive correlations with resilience (r = 0.422), and significant negative correlations with depression (r =  − 0.541) and anxiety (r =  − 0.502). Strong inter-scale correlations were observed between physical functioning and insomnia (r =  − 0.690) and role functioning and insomnia (r =  − 0.641).

Conclusion

Our study confirms the Urdu versions of the EORTC QLQ-C30 and QLQ-BN20 as valid clinical tools for the measurement of QoL in primary brain tumors patients within the cultural and socioeconomic context of Pakistan.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41687-021-00354-6.

Quality of life (QoL) is an important facet of well-being for patients with primary brain tumors (PBTs), as these individuals face significant distress during the course of their illness and treatment. It is important to have valid and reliable tools to accurately measure the QoL of patients with PBTs. The EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) and its brain tumor-specific module EORTC QLQ-BN20 (EORTC QLQ-Brain Neoplasms 20) are exactly that.

However, the use of the EORTC QLQ-C30 and QLQ-BN20 is limited in Pakistan, where the national language is Urdu, and the majority of patients are of low socioeconomic backgrounds. Since no Urdu translations of the EORTC QLQ-C30 and QLQ-BN20 exist, we aimed to translate and validate these tools to enable their applicability in Pakistan.

The Urdu versions of the EORTC QLQ-C30 and QLQ-BN20 demonstrated good validity amongst patients with PBTs. Thus, our study confirms the EORTC QLQ-C30 and QLQ-BN20 as valuable clinical tools for the measurement of QoL in primary brain tumors patients within the linguistic, cultural and socioeconomic context of Pakistan.

Relationship between perceived social support and psychological hardiness with family communication patterns and quality of life of oncology patients

AIM

The purpose of this study was to determine the relationship between PSS, PH, FCP and QoL of oncology patients.

METHODS

In this descriptive-correlational study, 340 oncology patients were selected with convenience sampling method from the hospitals in Tehran 2018-2019. Data were collected using, "PSS," "PH," "FCP" and "European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, EORTC QLQ-C30." Data were analysed using descriptive and inferential statistics using SPSS21 and Amos.

RESULTS

The direct effect and the total effect of PSS and FCP on QoL were significant (p < .001), but their indirect effect was not significant (p > .05) and the effect of PH on QoL was not significant (p = .96). The Root Mean Squares of Error Approximations (RMSEA), Non-Normed Fit Index (NNFI), Comparative Fit Index (CFI) and Goodness of Fit Index (GFI) were estimated 0.07, 0.97, 0.98 and 0.91, respectively.

Apatinib plus camrelizumab (anti-PD1 therapy, SHR-1210) for advanced osteosarcoma (APFAO) progressing after chemotherapy: a single-arm, open-label, phase 2 trial

Background

Results of our previous study showed high objective response but short-term activity of apatinib in advanced osteosarcoma. We aimed to investigate the activity of apatinib in combination with camrelizumab in patients with inoperable high-grade osteosarcoma progressing after chemotherapy.

Methods

This open-label, phase 2 trial was conducted at Peking University People’s Hospital. We enrolled patients with advanced osteosarcoma progressed after chemotherapy. Patients received 500 mg apatinib orally once daily plus 200 mg camrelizumab by intravenous infusion every 2 weeks until disease progression or unacceptable toxicity. The primary endpoint was progression-free survival (PFS) and clinical benefit rate at 6 months, which were based on RECIST V.1.1.

Results

43 patients were enrolled between January 25 and September 4, 2018. With median follow-up time of 48.3 (Q1, Q3, 30.6, 66.6) weeks, 13 (30.23%, 95% CI 17.2%, 40.1%) of 43 patients were progression free at 6 months and the 6-month PFS rate was 50.9% (95% CI 34.6%, 65.0%). Until final follow-up, the objective response rate was 20.9% (9/43) and two patients with durable disease control were observed. Patients with programmed cell death 1 ligand-1 (PD-L1) tumor proportion score ≥5% and pulmonary metastases tended to have a longer PFS in comparison to the others (p=0.004 and 0.017, respectively). Toxic effects led to dose reductions, or interruptions, or both in 24 (55.8%) of 43 patients and permanent discontinuation in 4 (9.3%) patients. There were no treatment-related deaths.

Conclusions

Although the combination of apatinib and camrelizumab seemed to prolong PFS in comparison to single agent apatinib in treating advanced osteosarcoma, it did not reach the prespecified target of 6-month PFS of 60% or greater. Overexpression of PD-L1 and the presence of pulmonary metastases only were associated with longer PFS.

Trial registration number

NCT03359018.

A comprehensive literature review of patient-reported outcome measures (PROMs) among common breast reconstruction options: What types of breast reconstruction score well?

PURPOSE

Breast cancer continues to be the most prevalent cancer affecting women. Many reconstructive options exist after oncologic resection. Breast reconstruction can have a lasting impact on many areas of the patient's life, and therefore, a high consideration for patient satisfaction is crucial. Patient-reported outcome measures (PROMs) provide an important tool in the evaluation of different surgical methodologies. The aim of this comprehensive systematic review is to look at various surgical modalities in breast reconstruction as they relate to patient satisfaction.

METHODS

A PubMed PRISMA search was performed. Criteria for inclusion included nipple-sparing or skin-sparing mastectomy with autologous or implant-based reconstruction, level 2 volume displacement or volume replacement oncoplastic surgery, and measurement of patient-reported outcomes using the BREAST-Q or other validated PROMs. From the data set, weighted proportions were generated and analyzed using the Kruskal-Wallis rank sum test and a post hoc Dunn's test.

RESULTS

After obtaining 254 full text copies, 43 articles met inclusion criteria and were included. Analysis of BREAST-Q data showed oncoplastic breast surgery was significantly preferred over mastectomy regardless of the type of reconstruction. Nipple-sparing was significantly preferred over skin-sparing mastectomy, autologous reconstruction was significantly preferred over implant-based reconstruction, and prepectoral implant placement was preferred over subpectoral implant placement. Validated PROMs other than BREAST-Q showed similar trends in all but type of mastectomy.

CONCLUSIONS

In this comprehensive systematic review, oncoplastic surgery showed the most favorable PROMs when compared to other reconstructive modalities. Autologous was preferred over implant-based reconstruction, and prepectoral was preferred over subpectoral implant placement.

Psychometric validation of the Moroccan version of the EORTC QLQ-C30 in colorectal Cancer patients: cross-sectional study and systematic literature review

Background

Health-related quality of life is mainly impacted by colorectal cancer which justified the major importance addressed to the development and validation of assessment questionnaires. We aimed to assess the validity and reliability of the Moroccan Arabic Dialectal version of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) in patients with colorectal cancer.

Methods

We conducted a cross-sectional study using the Moroccan version of the EORTC QLQ-C30 on colorectal cancer patients from the National Oncology Institute of Rabat, in the period from February 2015 to June 2017. The QLQ-C30 was administered to 120 patients. Statistical analysis included reliability, convergent, and discriminant validity as well as known-groups comparisons.

Results

In total, 120 patients with colorectal cancer were included in the study with 38 (32%) patients diagnosed with colon cancers. Eighty-two patients (68%) had rectal cancer, among which 29 (24%) patients with a stoma. The mean age of diagnosis was 54 years (+/− 13.3). The reliability and validity of the Arabic dialectal Moroccan version of the EORTC QLQ-C30 were satisfactory. [Cronbach’s alpha (α =0.74)]. All items accomplished the criteria for convergent and discriminant validity except for question number 5, which did not complete the minimum required correlation with its own scale (physical functioning). Patients with rectal cancer presented with bad Global health status and quality of life (GHS/QOL), emotional functioning as well as higher fatigue symptoms compared to patients with colon cancer. The difference between patients with and without stoma was significant for diarrhea and financial difficulty.

Conclusions

The Moroccan Arabic Dialectal version of the QLQ-C30 is a valid and reliable measure of health-related quality of life (HRQOL) in patients with colorectal cancer.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-07793-w.

The use of acupuncture for advanced cancer care: Protocol for a systematic review and meta-analysis

AIM

To assess the up-to-date evidence of acupuncture for the management of cancer-related and cancer treatment-related outcomes among people with advanced cancer.

DESIGN

Systematic review with meta-analyses involving multidimensional outcomes.

METHODS

The protocol of this systematic review has been registered in PROSPERO with the registration number CRD42020212982. Six databases (including Pubmed, EMBASE, Cochrane Library, SinoMed, ClinicalTrials.gov and Chinese Clinical Trial Registry) will be searched from inception through November 2020 to identify relevant interventional trials examining acupuncture management on multidimensional outcomes in patients with advanced cancer. Main outcomes will include cancer and treatment-related symptoms, quality of life, sleep quality and adverse events. DerSimonian & Laird random-effects meta-analysis will be applied to calculate pooled relative risks for binary data and pooled weighted mean differences (WMDs) or standardized mean differences (SMDs) for continuous data. Trial quality ratings and risk of bias will be evaluated using the Cochrane Risk of Bias Tool and the Grading of Recommendations Assessment, Development and Evaluation approach.

DISCUSSION

The efficacy of acupuncture on advanced cancer care and outcomes has not yet been determined. Palliative care for patients with advanced cancer may involve multiple challenges that include physical and mental health care. This systematic review will offer updated and comprehensive evidence of acupuncture on specific outcomes induced by advanced cancer and cancer-related treatment, which can give high level clinical recommendations to improve patient care and clinical outcomes.

Functional status of women after cancer and its related factors: A study based on Roy adaptation model

BACKGROUND

The role strain is still high for women within Iranian families. This can be further compounded by diseases such as cancer. The aim of this study was to investigate the functional status of women with cancer and its relationship with symptoms experienced by women during the period of the disease.

METHODS

This cross-sectional study was carried out with 150 women with the cancer diagnosis who were referred to the Cancer Clinic of Shahid Ghazi Tabatabai Hospital in Tabriz, Iran. The Comprehensive Inventory of Functioning (CIF-CA) was used to evaluate their functional status.

RESULT

The mean total performance of participants was 3.06(± 0.51), and the range of mean variation scores was between 1.83 and 5. Regarding the housework dimension, women reported less function in all of activities while in the social dimension, participation in social and religious activities waned. In the dimension of personal activities, majority of women reported rest and sleep during the day.

CONCLUSION

Clinicians should explore the use of rehabilitation programmes to ensure that a holistic approach to care for women with cancer is given priority in order to improve the quality of life of these women and subsequently their roles in family and society.

Mapping EORTC-QLQ-C30 and QLQ-CR29 onto EQ-5D-5L in Colorectal Cancer Patients

PURPOSE

Patient-level utility data are needed for cost-utility analysis; in oncology, however, the data are commonly gathered using disease-specific questionnaires that are often not appropriate. Present study aimed to derive an algorithm which can map the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) scales and the Colorectal Cancer-Specific Quality Of Life Questionnaire (QLQ-CR29) scales onto the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) values in patients with colorectal cancer (CRC).

METHODS

Using the Ordinary Least Square (OLS) model, a cross-sectional dataset of 252 patients with CRC were gathered from three academic centers of cancer treatment in Tehran in 2017. The predicted R² (Pred R²) and adjusted R² (Adj R²) are used to evaluate model goodness of fit. Additionally, mean absolute error (MAE), root mean square error (RMSE), Spearman's correlation coefficients (ρ), and intraclass correlation (ICC) are applied to assess predictive ability of models. The tenfold cross-validation procedure was applied for validation models.

RESULTS

According to the results of our study, the model C4 from EORTC QLQ-C30 was the best predictive model (Pred R² = 66.57%, Adj R² = 67.67%, RMSE = 0.10173, MAE = 0.07840). Also, the model R4 from QLQ-CR29 performed the best for EQ-5D-5L (Adj R2 = 48.42%, Pred R² = 45.54%, MAE = 0.10051, RMSE = 0.12997).

CONCLUSIONS

The mapping algorithm successfully mapped the EORTC QLQ-C30 and QLQ-CR29 scales onto the EQ-5D-5L values; therefore, it enables policymakers to convert cancer-specific questionnaires scores to the preference-based scores.

The Role of Trigonella, Cichorium, and Foeniculum Herbal Combination in the Treatment of Cancer-Induced Anorexia/Cachexia: A Quasi-Experimental Study

Background: Anorexia and cachexia are one of the major problems in patients suffering from advanced malignancies. Objectives: This study aimed at evaluating the efficacy of herbal combination containing Fenugreek, Fennel, and Chicory supplementation to the high-dose megestrol for the treatment of cancer-induced cachexia and anorexia. Methods: This quasi-experimental study was performed on 47 adult patients with advanced malignancy; they experienced anorexia and weight loss over the 2 past months and referred to a university-affiliated hospital (Omid) in Isfahan, Iran. Patients who had met the inclusion criteria were assigned to take either herbal combination or placebo tablets in addition to megestrol (160 mg daily) for a 2-month follow-up. All patients’ demographic information, weight changes, anthropometric indices, as well as the quality of life criteria were recorded at the baseline and after the duration of follow-up. Results: Patients in the herbal combination group experienced a mean weight gain of 1.5 kg, while patients in the placebo group had an average weight loss of 0.6 kg. Anthropometric indices including triceps skinfold thickness, mid-arm muscle circumference index, and grip strength were significantly improved in the herbal combination group. The other evaluated criteria such as quality of life, functional assessment of anorexia/cachexia therapy (FAACT), and some factors of Anderson criteria were significantly improved in the herbal combination group than the placebo group. Conclusions: Given the ameliorated results of the herbal combination supplementation in terms of weight gain and appetite improvement, as well as physical and quality of life enhancement, it seems that the herbal combination can be used as an adjunctive treatment for the management of patients suffering from cancer-induced cachexia and anorexia.

Does a ketogenic diet have beneficial effects on quality of life, physical activity or biomarkers in patients with breast cancer: a randomized controlled clinical trial

Introduction

Despite recent interest in the use of ketogenic diets (KDs) for cancer, evidence of beneficial effects is lacking. This study examined the impact of a randomly assigned KD on quality of life, physical activity and biomarkers in patients with breast cancer.

Method

A total of 80 patients with locally advanced or metastatic breast cancer and without a history of renal disease or diabetes were randomly assigned to either a KD or a control group for this 12-week trial. Concurrent with the first, third, and fifth chemotherapy sessions, quality of life, physical activity, and biomarkers (thyroid function tests, electrolytes, albumin, ammonia, ALP, lactate and serum ketones) were assessed. Dietary intake was also recorded on admission and the end of the treatment.

Results

No significant differences were seen in quality of life or physical activity scores between the two groups after 12 weeks; however, the KD group showed higher global quality of life and physical activity scores compared to the control group at 6 weeks (P = 0.02 P = 0.01). Also, serum lactate and ALP levels decreased significantly in the KD group compared to the control group at the end of the intervention (10.7 ± 3 vs 13.3 ± 4, 149 ± 71 vs 240 ± 164, P = 0.02 and P = 0.007, respectively). A significant inverse association was observed between total carbohydrate intake and serum beta-hydroxybutyrate at 12 weeks (r = − 0.77 P < 0.001). No significant differences between groups were observed in thyroid hormones, electrolytes, albumin, LDH or ammonia. Compliance among KD subjects ranged from 66.7 to 79.2% as assessed by dietary intake and serum ketones levels of > 0.5.

Conclusion

According to our results, besides a higher global quality of life and physical activity scores compared to the control group at 6 weeks, KD diet combined to chemotherapy in patients with breast cancer does not bring additional benefit about quality of life and physical activity at 12 weeks. However, decreases seen in levels of lactate and ALP in the KD group suggest that a KD may benefit patients with breast cancer.

Trial registration

This trial has been registered on Iranian Registry of Clinical Trials (IRCT) under the identification code: IRCT20171105037259N2 https://www.irct.ir/trial/30755

Quality of Life in Patients with Gynecological Cancers: A Web-Based Study

Introduction:

Gynecological cancers are common in adult women. One of the most important goals in the management of these patients is to improve quality of life, along with survival as a traditional outcome. The aim of this study was to evaluate quality of life in gynecological cancers in Iran.

Methods:

This cross-sectional study was performed on a sample of patients with gynecological cancers including uterine, ovarian, cervical, and vulvovaginal attending a teaching hospital affiliated to Tehran University of Medical Sciences between 2014 and 2019. The data was collected by a web-based platform with validated self-administered questionnaires including demographic information, the EORTC QLQ-C30 and the Hospital Anxiety and Depression (HADS). The data were analyzed using appropriate tests.

Results:

In all 251 patients were studied. The mean age of patients was 52.8±12.4 years and 43% had uterine, 30% had ovarian, 25% had cervical, and 2% had vulvovaginal cancer. The mean global quality of life score as measured by the EORTC QLQ-C30 was 59.8 ± 24.9. Women with ovarian cancer had the highest and women with cervical cancer had the lowest global quality of life score. There were significant differences in emotional, cognitive and global quality of life by cancer diagnosis (p <0.05). Although not significant, overall physical, role, cognitive and social functioning was found to be better in women who had been treated with surgery. The mean anxiety and depression score were 8.7± 5.0 and 7.1 ± 5.2, respectively.

Conclusion:

The results demonstrated that patients with gynecological cancers had a low quality of life, and experience higher anxiety and depression.

The Effect of ACE Inhibitor on the Quality of Life amongst Patients with Cancer Cachexia

Background:

ACEI (Angiotensin Converting Enzyme Inhibitors) inhibits tumor growth and development. Different mechanisms have been proposed for this matter, including the inhibition of enzymes that are involved in extracellular matrix degradation, matrix metalloproteinase (MMP) and etc. The present study was designed with the aim to investigate the effects of low dose ACEI on the Quality of Life (QoL) of non-hospitalized gastric cancer patients with cachexia.

Materials and Methods:

This study was a single-blinded randomized controlled clinical trial conducted in clinics affiliated with Shiraz University of Medical Sciences (SUMS). All participants were patients with gastric cancer in cancer cachexia step aged 40-80 years old who had referred to our clinics from October 2013 to April 2014. In the intervention group, patients were assigned to receive ACEI (Captopril) and the placebo group served as control and received placebo during the same time course. They were asked questions in order to fill out QLQ-C30 (Persian Version) questionnaire 3 times; baseline, 1 and 2 months after their first visit.

Results:

The mean age of patients was 60.55 ± 12.07 (range 31-80) years and the mean BMI of the patients was 17.21 ± 2.31. In the ACEI group, physical functioning and fatigue score changes were significant 1 and 2 months after treatment. The mean of fatigue score decreased significantly in the placebo group. Overall, global health status scores significantly increased in both groups, but other items of QoL did not change significantly.

Conclusion:

Overall, our results showed that Captopril does not have a significant positive effect on QoL of patients with cancer cachexia.

Taxane-induced peripheral neuropathy and quality of life in breast cancer patients

PURPOSE

Taxane-induced peripheral neuropathy (TIPN) is a common and bothersome toxicity. This study aimed to determine the incidence and severity of TIPN in patients with breast cancer and to investigate the relationship between TIPN and quality of life.

METHODS

A total of 82 breast cancer patients with TIPN symptoms were included in this study. The criteria of National Cancer Institute-Common Terminology Criteria for Adverse Events (NCI-CTCAE v4.03) and the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30, version 3.0) were used to evaluate grading of sensory neuropathy and quality of life, respectively. Analysis of the data was done by IBM SPSS statistics version 23.

RESULTS

A total of 346 patients received taxane-based chemotherapy and 82 patients (23.7%) experience TIPN. The mean (SD) global health status/quality of life, physical functioning, role functioning, and pain subscales were 60.63 (5.26), 80.64 (9.05), 81.77 (10.41), and 43.88 (11.27), respectively. There were significant negative correlations between global health status/quality of life, physical functioning, and role functioning subscales with the grade of neuropathy (r = -0.33, -0.80, and -0.61, respectively) and positive correlation between pain subscale and the grade of neuropathy (r = 0.70).

CONCLUSION

This study shows a clear association between TIPN and worsened quality of life. These findings emphasize on detecting and management of TIPN in an effort to improve the quality of life of breast cancer patients.

The Azeri Version of European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30): Translation and Validation

OBJECTIVE

Quality of life in cancer patients has become an important outcome measure. This study aimed to translate and validate the European Cancer Research and Treatment Core Quality of Life Questionnaire (EORTC QLQ-C30) in Azerbaijan.

METHODS

Forward-backward procedure was applied to translate the EORTC QLQ-C30 from English into Azeri. Then a cross sectional study was conducted to validate the questionnaire in Azerbaijan. A sample of patients with confirmed diagnosis of oral cancer completed the Azeri version of the questionnaire from January 2017 to December 2018. Construct validity was assessed by performing know groups comparison and item-scale correlation matrix. Reliability was examined by estimating the Cronbach's alpha coefficient for internal consistency.

RESULTS

In all 141 patients with oral cancer participated in the study. Known groups comparison indicated that the Azeri version of EORTC QLQ-C30 well differentiated between patients who differed in the disease stage. Those with higher stage reported lower functioning and higher symptoms. In addition item-scale correlation matrix showed a good correlation between items and its own hypothesized subscales as expected (Pearson correlation coefficient ranging from 0.735-0.978). The Cronbach's alpha coefficient ranged form 0.68 to 0.94 indicating acceptable results for the internal consistency of the questionnaire.

CONCLUSION

This preliminary validation study proved that the Azeri version of EORTC QLQ-C30 is a valid measure of quality of life in cancer patients. However, studies with other cancer patients and stronger psychometric evaluations are recommended.

Comparative Study Between the Effects of Kinesio Taping and Pressure Garment on Secondary Upper Extremity Lymphedema and Quality of Life Following Mastectomy: A Randomized Controlled Trial

Background:

Breast cancer stands out among the most widely recognized forms of cancer among women. It has been observed that upper extremity lymphedema is one of the most risky and prevalent complication following breast cancer surgery that prompts functional impairment, psychological, and social problems.

Purpose:

To compare the effects of Kinesio taping and the application of the pressure garment on secondary lymphedema of the upper extremity.

Methods:

66 women were randomly allocated to the Kinesio taping (KT) group (n=33) and pressure garment (PG) group (n=33). The KT group received Kinesio taping application (2 times per week for 3 weeks), while the PG group received pressure garment (20- 60 mmHg) for at least 15-18 hours per day for 3 weeks. The outcome measures were limb circumference, Shoulder Pain and Disability Index questionnaire (SPADI), hand grip strength, and quality of life at the baseline and end of intervention.

Results:

The sum of limb circumferences, SPADI, hand grip strength, and quality of life significantly improved after treatment in the KT group (P<0.05). While the PG group showed no significant improvement in SPADI, hand grip strength, physical, role, pain, and fatigue score p>0.05, while the sum of limb circumferences significantly decreased (P<0.05). Significant differences were observed between the KT and PG groups at the end of the intervention (P<0.05).

Conclusion:

KT had significant changes in limb circumference, SPADI, hand grip strength and overall quality of life than PG in the treatment of subjects diagnosed with lymphedema after mastectomy.

Investigating the effect of Integrated Educational Program on the Quality of Life among Cancer Patients: A Clinical Trial Study

Background:

cancer is one of the most common causes of death around the world. The process of this disease and the resulting complications reduce the quality of life of cancer patients. Taking the necessary measures for improving the quality of life of these patients seems to be essential. This study was performed to investigate the effect of integrated educational program on the quality of life of cancer patients.

Methods:

in this clinical trial study, 64 patients hospitalized in the specialized cancer hospital affiliated with Ahvaz Jundishapur University of Medical Sciences, Iran, were selected according to the inclusion criteria. Then, through blocked randomization method, they were assigned into intervention and control groups. The intervention group received the necessary trainings over four 60-min sessions (one session per week). The data collection in this study included demographic questionnaire and quality-of-life questionnaire of cancer patients (QLQ-C30). The quality of life was examined before the training as well as one and two months after the training. The data were analyzed by SPSS 20. Independent t-test was used to compare the means of the life quality dimensions of the studied groups.

Results:

all of the functional dimensions [physical, role function, emotional, cognitive, social(P≤0.05)] and symptomatic [fatigue, nausea and vomiting, pain, dyspnea, sleep disorders, diminished appetite, constipation, and diarrhea (P≤0.05)] of the quality of life of the intervention group increased significantly one and two months after running the integrated educational program.

Conclusion:

integrated training causes improved symptoms and enhanced quality of life in cancer patients. Thus, it is recommended that integrated training be conducted alongside the routine care of cancer patients. This can improve the therapeutic outcomes, and also highlights the important role of nurses as well as nursing cares.

Evaluation of quality of life in patients with oral cancer after mandibular resection: Comparing no reconstruction, reconstruction with plate, and reconstruction with flap

This cross-sectional study aimed to assess and compare quality of life in patients with advanced oral cavity tumors after mandibular resection in 3 groups (no reconstruction, reconstruction with plate, and reconstruction with flap) at the Cancer Institute, affiliated to Tehran University of Medical Sciences. Quality of life was measured using the European Organization for Research and Treatment of Cancer core quality of life questionnaire and European Organization for Research and Treatment of Cancer head and neck cancer-specific quality of life questionnaire-35 items. The comparison was tested using Kurskal-Wallis analysis. All 120 patients were entered into the study. The mean age of patients was 48.5 (standard deviation = 18.1) years. Patients presented with advanced stage of the disease and underwent mandibular resection with no reconstruction (n = 40), reconstruction with plate (n = 41), and reconstruction with flap (n = 39). The findings showed that in general, there were no statistically significant differences in quality of life among 3 groups except for speech problem (P = .4), dry mouth (P = .03), and feeling ill (P = .04). Although there were no significant differences in quality of life among patients in 3 groups, overall patients who received reconstruction with flap reported better functioning and fewer symptoms. Those who did not receive any reconstruction reported the worse conditions.

The Effect of Foot Reflexology on Hospital Anxiety and Depression in Female Older Adults: a Randomized Controlled Trial

BACKGROUND

Patients with cardiovascular diseases usually suffer from hospital anxiety and depression.

AIM

This study aimed to investigate the effect of foot reflexology massage on anxiety and depression in female older adults suffering from acute coronary syndrome.

PARTICIPANTS

Ninety older women with acute coronary syndrome were randomly assigned into intervention and control groups (n=45 in each group).

RESEARCH DESIGN

A randomized controlled trial.

INTERVENTION

The intervention and control groups received foot reflexology massage and routine care, respectively.

MAIN OUTCOMES MEASURES

The levels of anxiety and depression were evaluated using the hospital's anxiety and depression scale (HADS) before and immediately after foot reflexology massage.

RESULTS

Foot reflexology massage reduced both anxiety (F(1.44)=19.11, p = .001) and depression (F(1.44)=16.76, p = .001) in acute coronary patients relative to control patients. The intervention had a large effect on hospital anxiety and depression.

CONCLUSIONS

Foot reflexology massage is an efficient and safe intervention for alleviating psychological responses among female older adults suffering from acute coronary syndrome during hospitalization.

Patient reported outcome measures (PROMs) following mastectomy with breast reconstruction or without reconstruction: a systematic review

The cornerstone of reconstructive surgery following mastectomy is to restore cosmesis and improve physical and psychological health. Consequently, it has become essential for instruments that measure surgical outcomes to include the direct perspective of patients. Many reviews have failed to show significant improvements in quality of life domains following breast reconstruction compared to mastectomy alone. However, with advances in surgical techniques and patient reported outcome measure (PROM) assessment tools designed precisely for breast reconstruction patients, a modern systematic review is warranted. An electronic literature review was performed using CINAHL, Cochrane Library and Medline (using PubMed) comparing patient reported outcome measures of patients undergoing mastectomy alone versus patients undergoing mastectomy with breast reconstruction. Studies in the English and Portuguese languages since the year 2000 were included. The review was undertaken adhering to PRISMA guidelines with last entry on the 31/5/2018. Full text review yield 42 articles of relevance to the inclusion criteria. The most widely used PROM instruments such as Breast-Q, EORTC-Q30/Q23, Short Form 36, FACT-B and others are explored. The specific difficulties conducting such studies and biases identified are investigated further. Studies comparing mastectomy alone against mastectomy with reconstruction show difficulties forming groups with similar clinical and epidemiological characteristics. There are inherent limitations to performing a randomised controlled trial on this topic, including matching patient groups in terms of age, socioeconomical background and cancer staging, and this affects the results of the PROM instruments. Within these limitations, the literature suggests that PROM support the use of breast reconstruction following mastectomy but care must be made selecting patients. The finding is supported by the National Institute for Health and Clinical Excellence (NICE) guidelines which state that breast reconstruction should be offered to all women undergoing breast cancer surgery.

Quality of Life in Women with Cancer and Its Influencing Factors

Introduction: Studies show that some of the factors such as pain and psychological changes could decrease the quality of life of patients with cancer. The understanding of these factors can enhance the effectiveness and process of cancer treatment. Therefore this study was conducted to investigate the quality of life in women with cancer and its influencing factors.

Methods: This was a cross-sectional study which was carried out in the city of Tabriz in the northwestern part of Iran in 2016. The sample consisted of 150 women diagnosed with cancer. The EORTC QLQ-C30 (version 3) was used for evaluating the quality of life of the women. The collected data were analyzed in the SPSS ver. 13 using descriptive and inferential statistics. Also, t-test and ANOVA test were applied to investigate the correlation between the dimensions of quality of life and socio-demographic variables. P < 0.05 denoted as statistically significant.

Results: The results showed that the quality of life in the function and symptoms dimensions were in acceptable levels. In the function dimension, the highest and lowest scores belonged to the cognitive and emotional domains, respectively. Also, those women who had the symptoms of insomnia and fatigue, and reported the pressure due to financial burden of cancer treatment had a significantly lower quality of life. A low score was reported in general health dimension. No statistically significant relationships were reported between the socio-demographic characteristics and the women’s quality of life and its dimensions.

Conclusion: Since sleeplessness and fatigue reduce the quality of life in women with cancer, nursing interventions are required to relieve cancer-related symptoms. The financial burden of cancer treatment is high. Therefore, governmental and insurance agencies should help with the costs paid by the patients and prevent from reducing their quality of life.

Alerting the illusion of smoking improves quality of life in Chinese male cancer survivors

OBJECTIVE

To examine the association between smoking status and quality of life (QOL) among cancer survivors in China.

METHODS

A cross-sectional study was performed in 2725 male cancer survivors who were members of Cancer Rehabilitation Club and completed the questionnaires in 2013. Using linear regression models adjusted for confounders, we measured the association between QOL and former smokers as well as current (occasional, <10 cigarettes/day, and ≥ 10 cigarettes/day) smokers compared with never smokers.

RESULTS

Current smokers were reported to have higher scores in social, role, cognitive functioning, and had lower scores in nausea/vomiting, pain, dyspnea, and insomnia (P < 0.05). Former smokers had higher global health status and experienced less appetite loss and constipation (P < 0.05). Compared with never smokers, those former smokers and current smokers had significantly high scores on the global health status, social functioning, role functioning, and cognitive functioning (P < 0.05). And they had lower scores in some aspects of symptom scale (P < 0.05). Considering the dose of smoking, the scores were increased in functional subscales and decreased in symptom subscales with the increase of tobacco use, though few variables had statistical significance. As for smoking cessation, the proportion of lung cancer survivors who quit smoking was higher than that of other types of cancer survivors.

CONCLUSION

Our study suggested the possibility that in China, where smoking prevalence is still high, continued smoking was associated with high QOL scores. The phenomenon may be obscured by some potential reasons, including subjectivity of questionnaire, special substances of cigarettes, Chinese unique culture of tobacco use, and much more. The results reminded researchers and clinicians some underlying situations among smokers in China and prompted a strong call for the implementation of a comprehensive tobacco-control policy and specific public health educational strategies among not only lung cancer survivors but other types of cancers survivors.

Assessing whether EORTC QLQ-30 and FACT-G measure the same constructs of quality of life in patients with total laryngectomy

BACKGROUND

The European Organization for Research and Treatment of Cancer QOL Core Questionnaire 30 (EORTC QLQ-30) and the Assessment of Cancer Therapy-General (FACT-G) are the two most widely used measures of cancer-specific health-related quality of life (HRQOL). This study aims to assess whether the two instruments measure the same constructs of HRQOL in patients with total laryngectomy.

METHODS

The EORTC QLQ-30 and the FACT-G was completed by 132 patients with total laryngectomy. Convergent, discriminant, and construct validity of the EORTC QLQ-C30 and the FACT-G were assessed by Spearman's correlation and explanatory factor analysis.

RESULTS

The results of factor analysis showed that the EORTC QLQ-C30 and the FACT-G measure different aspects of HRQOL. Moreover, both instruments showed excellent convergent and discriminant validity, except for nausea and vomiting symptom subscale in the EORTC QLQ-C30 questionnaire. The internal consistency was close or greater than 0.7 for all domains of both instruments except for functional wellbeing in FACT-G.

CONCLUSIONS

This study revealed that neither of the two instruments can be replaced by the other in the assessment of HRQOL in Iranian patients with total laryngectomy. Accordingly, clinicians should exactly define their research questions related to patient-reported outcomes before choosing which instrument to use.

Mapping the cancer-specific QLQ-C30 onto the generic EQ-5D-5L and SF-6D in colorectal cancer patients

INTRODUCTION

Economic evaluation of healthcare interventions usually needs accurate data on utility and health-related quality-of-life scores. The aim of this study is to map QLQ-C30 scale score onto EQ-5D-5L and SF-6D utility values in colorectal cancer (CRC) patients.

METHODS

EQ-5D-5L, SF-6D, and QLQ-C30 were completed by 252 patients with CRC who were referred to three cancer centers in Tehran between May and September 2017. Moreover, OLS, Tobit, and CLAD models were used to predict EQ-5D-5L and SF-6D values. The goodness of fit of models was evaluated using Pred R² and Adj R². In addition, their predictive performance was assessed by MAE, RMSE, ICC, MID, and Spearman's correlation coefficients between observed and predicted EQ-5D-5L and SF-6D values. Models were validated using a 10-fold cross-validation method.

RESULTS

Considering the goodness of fit and predictive ability of models, the OLS Model 2 performed best for EQ-5D-5L (Adj R² = 58.09%, Pred R² = 58.93%, MAE = 0.0932, RMSE = 0.129) and the OLS Model 3 performed best for SF-6D (Adj R² = 54.90%, Pred R² = 55.62%, MAE = 0.0485, RMSE = 0.0634).

CONCLUSION

Our results demonstrated that algorithms developed based on OLS Models 1 and 2 are the best for predicted EQ-5D-5L and SF-6D values, respectively.

Function and quality of life among primary osteosarcoma survivors in Iran: amputation versus limb salvage

PURPOSE

This study aimed to evaluate the psychometric properties of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) in Iranian osteosarcoma patients and apply this to compare the functional level, quality of life, symptoms and financial burden of the patients who underwent amputation and limb-salvage operations.

METHODS

This study was conducted at the main referral orthopedic centers in the southwest of Iran from 2006 to 2016. After complete review of medical records, 48 patients were invited to attend the outpatient clinic and participate in the study via initial telephone interview. All data were entered in the Statistical Package for the Social Sciences version 15.0, and p values <0.05 were considered statistically significant.

RESULTS

In total, 48 patients with extremities osteosarcoma completed the study. Of these, 31 had been treated with limb-salvage operation and 17 had undergone amputation. In functioning subscale, all the mean score of items, except social function, were higher in the limb salvage group than the amputee group. The mean scores (SD) of global health and quality of life were 64.5(13.2) and 61.2± 12.4 in the limb salvage and amputee groups, respectively. In the financial impact subscale, the mean score (SD) in the limb salvage group was 68.8± (29.7) compared to 74.5(25.0) in the amputee group.

CONCLUSION

Results support the responsiveness of the EORTC QLQ-C30 for Iranian osteosarcoma patients. Applying this questionnaire revealed similar functional outcome, quality of life, symptoms and financial burden between amputation and limb-salvage groups.

Response shift in quality of life assessment among cancer patients: A study from Iran

Background: During the course of disease, particularly of chronic diseases, changes in internal standards cause certain changes in the estimation of quality of life (QOL). These changes indicate the phenomenon of ‘response shift’. The present study aimed at assessing response shift in different scales of QOL in Iranian cancer patients.

Methods: To assess response shift through the ‘then test’ approach, we asked 211 cancer patients to complete the EORTC QLQ-C30 questionnaire at pretest (at the beginning of the study), posttest (3 months later), and then test (administered immediately after the posttest). Paired t test and Cohen’s effect size were used for comparison.

Results: Response shift was significant in all 4 scales under study, i.e. fatigue, pain, emotional functioning, and general QOL (p<0.001). Fatigue, pain, and global QOL have deteriorated significantly with then test approach and emotional function was significantly improved.

Conclusion: We observed a response shift in Iranian cancer patients in our study. Thus, in light of the multifactorial nature of QOL and the effect of the response shift bias on different aspects of QOL changes, it is of utmost importance to keep this bias in mind when interpreting the results and managing cancer patients’ treatment regimens.

Psychometric evaluation of the Persian version of the Lymphedema Life Impact Scale (LLIS, version 1) in breast cancer patients

Background

Despite the high prevalence of lymphedema in Iranian breast cancer patients, there is no valid instrument for measuring quality of life in this population. The aim of this study was to assess reliability and validity of the Persian version of Lymphedema Life Impact Scale (LLIS) in breast cancer patients.

Methods

Forward-backward procedure was applied to translate The LLIS from English into Persian. The LLIS is an 18-item measure of physical, psychosocial, and functional impairments caused by lymphedema. Experts and patients assessed content and face validity, respectively. Discriminant validity was evaluated by comparing breast cancer patients with and without lymphedema. Convergent validity was assessed by comparing LLIS score with SF-36 (functional component) and the EORTC-QLQ-C30 (functional component). The construct validity also was evaluated using confirmatory and exploratory factor analyses. Internal consistency was evaluated by Cronbach’s alpha coefficient. Stability was assessed by test-retest analysis over a one-week interval in 13 patients.

Results

In all 446 breast cancer patients were entered into the study. The content and face validity of Persian version of LLIS were acceptable and minor corrections were applied in final version. The questionnaire differentiated well in patients’ with and without lymphedema and not lending support to its discriminant validity. Confirmatory factor analysis showed a good fit for the data. Cronbach’s alpha coefficient in physical, psychosocial and functional subscales were 0.873, 0.854 and 0.884 respectively. Intra-class correlation coefficient of total score of the LLIS was 0.96.

Conclusions

The findings of this study suggest a first indication that reliability and validity of the Persian version of LLIS in patients with breast cancer induced lymphedema was good. Application of this instrument for identifying problems of patients with upper extremity lymphedema may be helpful in designing interventions to improve quality of life.

Health-related quality of life of Iranian breast cancer patients: a meta-analysis and systematic review

PURPOSE

Quality of life is the most important psychological factor affecting breast cancer patients. This study aimed to examine the health related quality of life of breast cancer patients in Iran.

METHODS

International (PubMed, Web of science, Scopus and Google scholar) and national (SID, Magiran) databases were searched for related studies to September 2017. The quality of the articles was evaluated using the Hoy tool.

RESULTS

Out of 232 initial studies, 18 studies performed on 2263 people were included in the final stage of the study. Based on the EORTC-QLQ-C30 and random effect method, the pooled mean score of quality of life in 1073 people was 57.88 (95% CI 48.26-67.41, I² = 97.90%) and the pooled mean score of quality of life based on WHOQOL-BREF in 357 people was 66.79 (95% CI 45.96-87.62, I² = 99.50%).

CONCLUSION

According to the results of the study, a moderate level of quality of life in women with breast cancer was indicated. Therefore, the use of multidimensional approaches can improve their quality of life.

Psychometric properties and measurement equivalence of the Multidimensional Fatigue Syndrome Inventory- Short Form (MFSI-SF) amongst breast cancer and lymphoma patients in Singapore

Background

Currently, several fatigue measurement instruments are available to evaluate and measure cancer-related fatigue. Amongst them, Multidimensional Fatigue Syndrome Inventory-Short Form (MFSI-SF) is a self-reported instrument and a multidimensional scale that aims to capture the global, somatic, affective, cognitive and behavioural symptoms of fatigue. This study examines the psychometric properties and measurement equivalence of the English and Chinese versions of MFSI-SF in breast cancer and lymphoma patients in Singapore.

Methods

Patients were recruited from National Cancer Centre Singapore. Validity, reliability and responsiveness of MFSI-SF were evaluated in this study. Convergent validity was evaluated by correlating total and subscales of MFSI-SF to known related constructs in EORTC QLQ-C30. Known group validity was assessed based on patients’ cancer stage, pain, insomnia and depression symptoms. Reliability was evaluated by Cronbach’s α. Responsiveness analyses were performed with patients who have undergone at least one cycle of chemotherapy. Multiple regression was used to compare the total and subscale scores of MSFI-SF between the two language versions.

Results

Data from 246 (160 English and 86 Chinese version) breast cancer and lymphoma patients were included in the study. Moderate to high correlations were observed between correlated MFSI-SF subscales and EORTC QLQ-C30 domains (|r| = 0.524 to 0.774) except for a poor correlation (r = 0.394) observed between MFSI-SF vigour subscale and EORTC QLQ-C30 role functioning subscale. Total MFSI-SF scores could differentiate between patients with higher depression, pain and insomnia status. Internal consistency of MFSI-SF was also high (α = 0.749 to 0.944). Moderate correlation was observed between change in total MFSI-SF score and change in fatigue symptom scale score and global QoL score on EORTC QLQ-C30 (|r| = 0.478 and 0.404 respectively). Poor correlations were observed between change in scores of hypothesised subscales (|r| = 0.202 to 0.361) except for a moderate correlation between change in MFSI-SF emotional fatigue score and change in EORTC QLQ-C30 emotional functioning domain score. Measurement equivalence was established for all subscales and total MFSI-SF score except for the emotional and vigour subscales.

Conclusions

This study supports the use of MFSI-SF as a reasonably valid scale with good internal consistency for measuring fatigue levels in the Singapore cancer population.

Electronic supplementary material

The online version of this article (10.1186/s12955-018-0846-6) contains supplementary material, which is available to authorized users.

Prediction of Response to Irinotecan and Drug Toxicity Based on Pharmacogenomics Test: A Prospective Case Study in Advanced Colorectal Cancer

Background:

FOLFIRI regimen, which is composed of 5-FU, Leucovorin, and Irinotecan, is used in the first-line chemotherapy of metastatic colorectal cancer. Irinotecan life threatening toxicity is partly related to cytotoxic drug metabolite which is primarily inactivated by the UGT1A1 enzyme. The primary aim of the present research was to find the correlation between UGT1A1-genotype and clinical toxicity of irinotecan.

Methods:

In a prospective study from March 2011 to December 2013, all patients with metastatic colorectal cancer who had been referred to Medical Oncology Department of Iran Cancer Institute were genotyped for UGT1A1*28 before the first cycle of chemotherapy. All of the patients signed informed consent and trial approved by Ethics Committee of the Tehran University of Medical Sciences. Reduction of the standard dose of Irinotecan (180 mg/m2 body surface area) was measured based on NCI toxicity criteria after the first cycle of chemotherapy. Patients with previous treatment with Oxaliplatin and fluorouracil (5-FU) in the adjuvant setting and adequate liver, kidney, and heart function were included in the trial. Both synchronous and metachronous metastatic disease were noticeable.

Results:

A total of 50 patients with median age of 52 years were included. Most (70%) of the patients had more than one site of metastases in peritoneum, liver, and/or lung. Thirty-one patients had UGT1A1*1 normal genotype, 13 were in heterozygote and 6 were in homozygote state ofUGT1A1*28/*28. A clinically relevant increase in early toxicity was found in patients carrying the UGT1A1*28/*28 genotype with odds Ratio (OR) of 2.6 (95%CI 2.5-27.28). Similarly, there was a trend of lower overall survival in homozygote group with an HR (Hazardous Ratio) of 2.76 (95%CI .88-.61). No statistically significant relationship was found between UGT1A1genotypes and response to therapy.

Conclusions:

UGT1A1 28*/28* is strongly associated with drug’s life-threatening toxicity even in a moderate dose of Irinotecan. On the other hand, UGT1A1 genotype data was not helpful to differentiate response to treatment.

Efficacy, Safety, and Overall Quality of Life of Endoscopic Submucosal Dissection for Early Colorectal Cancer in Elderly Patients

Purpose

Studies reporting the treatment of early colorectal cancer (ECC) by endoscopic submucosal dissection (ESD) in elderly patients are lacking in China. The aim was to evaluate the efficacy, safety and overall quality of life of elderly patients with ECC who undergoing ESD.

Methods

Three hundred and seventy-nine patients with 401 colorectal lesions entered into our study from March 2013 to March 2016 (Patients with an age 70 years old or older were divided into the elderly group and those who were less than 70-year-old entered the non-elderly group).

Results

No significant differences were found in sex ratio, body mass index, location, endoscopic classification, pathological pattern, lesion size, mean procedure time, hospitalization days, complete excision, and en bloc resection rate between the two groups (P > 0.05). No significant differences were observed between the groups in terms of complications during and after ESD procedure (P > 0.05). There were no statistical differences between two groups in Quality of life index (QL-Index) and European Organization for Research and Treatment quality of life version 3.0 questionnaire (EORTC QLQ-C30) scores (P > 0.05).

Conclusion

ESD was relatively safe and effective for elderly patients with ECC, and it may be an recommended first-line treatment.

Depression, anxiety, and health related quality of life among colorectal cancer survivors

BACKGROUND

The aim of this study was to examine the relationship between psychological distress and quality of life (QOL) dimensions in colorectal cancer (CRC) patients.

METHODS

This cross-sectional study was conducted in the North of Iran. A total of 157 CRC survivors were selected from the registry database and included in this study. Psychological distress was measured using the Hospital Anxiety and Depression Scale (HADS) and QOL was estimated using the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30 (EORTC QLQ C-30). The association between the patients' emotional functioning (EF) score on EORTC QLQ-C30 and their HADS scores was analysed through multiple linear regression.

RESULTS

In statistical terms, there were significantly negative relationships between EF and HADS-A (anxiety), and between HADS-D (depression) and HADS-T (total score). However, compared with HADS-A, the correlation between HADS-D and other QOL dimensions was significantly higher. By the same token, depression rather than anxiety was more strongly associated with reduced QOL.

CONCLUSIONS

The EF dimension of the EORTC QLQ-C30 predominantly assesses anxiety; however, depression has a stronger impact on the global QOL of patients than anxiety. Therefore, the use of an additional instrument is recommended for the assessment of depression in outpatients with CRC.

Spiritual Needs and Quality of Life of Patients with Cancer

Background and Aim

Information about spiritual needs and quality of life (QoL) is limited in Iranian cancer patients. This study was conducted to determine the relationship between spiritual needs and QoL among cancer patients in Iran.

Methods

This correlational study included a convenience sample of 150 eligible cancer patients who were hospitalized in the oncology wards and outpatient clinics. Using two questionnaires; the spiritual needs survey and the European Organization for Research and Treatment of Cancer QoL Questionnaire-C30 data were collected. The data were analyzed by SPSS software version 19.

Results

Our findings showed that the total mean score of spiritual needs was (64.32 ± 22.22). Among the categories, the lowest score belonged to "morality and ethics" component (2.18 ± 1.64), and the highest score belonged to "positivity/gratitude/hope/peace" component (15.95 ± 5.47). The mean score of QoL was (79.28 ± 19.20). Among the categories, the lowest score belonged to "global health status" component (8.44 ± 3.64), and the highest score belonged to "functional" component (36.57 ± 10.28). Pearson correlation coefficient showed that spiritual needs score positively correlated with QoL (r = 0.22; P = 0.006).

Conclusion

The results of the present study suggest that information about the relationship between spiritual needs and QoL in patients with cancer. It should be improve QoL to meet spiritual need of these patients. In addition, the continuous and in-service education of cancer patients and nurses who work with them can be helpful in this area.

Cost-Utility of "Doxorubicin and Cyclophosphamide" versus "Gemcitabine and Paclitaxel" for Treatment of Patients with Breast Cancer in Iran

PURPOSE

A cost-utility analysis was performed to assess the cost-utility of neoadjuvant chemotherapy regimens containing doxorubicin and cyclophosphamide (AC) versus paclitaxel and gemcitabine (PG) for locally advanced breast cancer patients in Iran.

MATERIALS AND METHODS

This cross-sectional study in Namazi hospital in Shiraz, in the south of Iran covered 64 breast cancer patients. According to the random numbers, the patients were divided into two groups, 32 receiving AC and 32 PG. Costs were identified and measured from a community perspective. These items included medical and non-medical direct and indirect costs. In this study, a data collection form was used. To assess the utility of the two regimens, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core30 (EORTC QLQ-C30) was applied. Using a decision tree, we calculated the expected costs and quality adjusted life years (QALYs) for both methods; also, the incremental cost-effectiveness ratio was assessed.

RESULTS

The results of the decision tree showed that in the AC arm, the expected cost was 39,170 US$ and the expected QALY was 3.39 and in the PG arm, the expected cost was 43,336 dollars and the expected QALY was 2.64. Sensitivity analysis showed the cost effectiveness of the AC and ICER=-5535 US$.

CONCLUSIONS

Overall, the results showed that AC to be superior to PG in treatment of patients with breast cancer, being less costly and more effective.

Relationship between Spiritual Health and Quality of Life in Patients with Cancer

As the essence of health in humans, spiritual health is a fundamental concept for discussing chronic diseases such as cancer and a major approach for improving quality of life in patients is through creating meaningfulness and purpose. The present descriptive analytical study was conducted to assess the relationship between spiritual health and quality of life in 210 patients with cancer admitted to the Cancer Institute of Iran, selected through convenience sampling in 2014. Data were collected using Spiritual Health Questionnaire and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ). Patients' performance was assessed through the Karnofsky Performance Status Indicator and their cognitive status through the Mini-Mental State Examination (MMSE). Data were analyzed in SPSS-16 using descriptive statistics and stepwise linear regression. The results obtained reported the mean and standard deviation of the patients' spiritual health scoreas 78.4±16.1and the mean and standard deviation of their quality of life score as 58.1±18.7. The stepwise linear regression analysis confirmed a positive and significant relationship between spiritual health and quality of life in patients with cancer (β=0.688 and r=0.00). The results of the study show that spiritual health should be more emphasized and reinforced as a factor involved in improving quality of life in patients with cancer. Designing care therapies and spiritual interventions is a priority in the treatment of these patients.