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Granroth G, Khera N, Arana Yi C. Progress and Challenges in Survivorship After Acute Myeloid Leukemia in Adults. Curr Hematol Malig Rep 2022; 17:243-253. [PMID: 36117228 PMCID: PMC9483315 DOI: 10.1007/s11899-022-00680-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Acute myeloid leukemia (AML) survivors face unique challenges affecting long-term outcomes and quality of life. There is scant literature on the long-term impact of AML treatment in physical and mental health, disease recurrence, and financial burden in survivors. RECENT FINDINGS Fatigue, mental health concerns, infections, sexual dysfunction, and increase cancer recurrence occur after AML treatment. Chronic graft-versus-host disease (GVHD) and infections are common concerns in AML after hematopoietic stem cell transplantation (HCT). Survivorship guidelines encompass symptoms and complications but fail to provide an individualized care plan for AML survivors. Studies in patient-reported outcomes (PROs) and health-related quality of life (HRQoL) are sparse. Here we discuss the most common aspects pertaining to AML survivorship, late complications, care delivery, prevention of disease recurrence, and potential areas for implementation.
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Affiliation(s)
- Ginna Granroth
- grid.417468.80000 0000 8875 6339Mayo Clinic Arizona, Phoenix, AZ USA
| | - Nandita Khera
- grid.417468.80000 0000 8875 6339Mayo Clinic Arizona, Phoenix, AZ USA
| | - Cecilia Arana Yi
- grid.417468.80000 0000 8875 6339Mayo Clinic Arizona, Phoenix, AZ USA
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Tsai YT, Chen WC, Hsu CM, Tsai MS, Chang GH, Lee YC, Huang EI, Fang CC, Lai CH. Survival-Weighted Health Profiles in Patients Treated for Advanced Oral Cavity Squamous Cell Carcinoma. Front Oncol 2021; 11:754412. [PMID: 34660322 PMCID: PMC8511634 DOI: 10.3389/fonc.2021.754412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/15/2021] [Indexed: 01/22/2023] Open
Abstract
Objectives For patients with oral cavity squamous cell carcinoma (OSCC), particularly for those with advanced disease, quality of life (QoL) is a key outcome measure. Therefore, we estimated survival-weighted psychometric scores (SWPS), life expectancy (LE), and quality-adjusted LE (QALE) in patients with advanced OSCC. Methods and Materials For estimation of survival function, we enrolled 2313 patients with advanced OSCC diagnosed between January 1, 2007, and December 31, 2013. The patients were followed until death or December 31, 2014. To acquire the QoL data, data from 194 patients were collected by employing the Taiwan Chinese versions of the Quality of Life Questionnaire Core 30 and Quality of Life Questionnaire Head and Neck 35 developed by the European Organisation for Research and Treatment of Cancer and the EQ-5D-3L between October 1, 2013, and December 31, 2017. The LE of the patients with OSCC were estimated through linear extrapolation of a logit-transformed curve. SWPS and QALE were determined by integrating the LE and corresponding QoL outcomes. Results For the patients with advanced OSCC, the estimated LE and QALE were 8.7 years and 7.7 quality-adjusted life years (QALYs), respectively. The loss of LE and QALE was 19.0 years and 20.0 QALYs, respectively. The estimated lifetime impairments of swallowing, speech, cognitive functioning, physical functioning, social functioning, and emotional functioning were 8.3, 6.5, 6.5, 6.1, 5.7, and 5.4 years, respectively. The estimated lifetime problems regarding mouth opening, teeth, social eating, and social contact were 6.6, 6.1, 7.5, and 6.1 years, respectively. The duration of feeding tube dependency was estimated to be 1.6 years. Conclusions Patients with advanced OSCC had an estimated LE of 8.7 years and QALE of 7.7 QALYs. SWPS provided useful information regarding how advanced OSCC affects the subjective assessment of QoL. Our study results may serve as a reference for the allocation of cancer treatment resources.
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Affiliation(s)
- Yao-Te Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wen-Cheng Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Cheng-Ming Hsu
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ming-Shao Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Geng-He Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yi-Chan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ethan I Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chiung-Cheng Fang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chia-Hsuan Lai
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
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Lai WW, Chung CH, Lin CN, Yang SC, Hwang JS, Wang JD. QALYs and medical costs saved from prevention of a cancer: Analysis of nation-wide real-world data of Taiwan with lifetime horizon. J Formos Med Assoc 2021; 120:2089-2099. [PMID: 34020855 DOI: 10.1016/j.jfma.2021.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/11/2021] [Accepted: 04/26/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/PURPOSE To quantify savings of loss-of-QALE (quality-adjusted life expectancy) and lifetime medical costs from prevention of different cancers. METHODS We collected nation-wide data on 808,700 new cancer cases of 14 different organ systems and followed them from 1998 to 2014 in Taiwan. We also collected 13,005 cancer patients from a medical center and 47,320 repeated measurements of quality of life (QoL) of EQ-5D to obtain utility values and multiplied them with the corresponding survival rates to calculate QALE. With Kaplan-Meier estimation to survival function to the end of follow-up, we extrapolated to lifetime through a rolling over algorithm on the logit transform of the survival ratio between the index cohort and age-, sex, and calendar year matched referents simulated from vital statistics. Lifetime costs for each cancer were estimated by multiplying survival with average monthly costs after adjustment with annual discount rate. The loss-of-QALE was estimated by the difference in QALE between the index cancer cohort and corresponding referents. RESULTS The dynamic changes and weighted averages of the QoL utility values of 14 different cancers ranged from 0.82 to 0.95. Successful prevention of liver, lung, esophagus, or nasopharynx cancer would save more than 10 quality-adjusted life years and more than 21,000 USD per case for both genders. Since the saving of loss-of-QALE was adjusted for different age, sex, and calendar-year distributions, it could be used in cost effectiveness evaluation. CONCLUSION Savings of loss-of-QALE and lifetime costs could be used for comparison of prevention, diagnosis, treatment and rehabilitation from a lifetime horizon.
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Affiliation(s)
- Wu-Wei Lai
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Hua Chung
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Chia-Ni Lin
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Szu-Chun Yang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Lai CH, Chen WC, Fang CC, Chen MF. Survival-Weighted Health Profiles in Nasopharyngeal Cancer Patients. Front Oncol 2021; 11:635667. [PMID: 33791219 PMCID: PMC8006446 DOI: 10.3389/fonc.2021.635667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/03/2021] [Indexed: 02/03/2023] Open
Abstract
Introduction In treating nasopharyngeal cancer (NPC) patients, excellent tumor control and patient survival rates can be achieved in the era of intensity-modulated radiotherapy (IMRT). However, treatment-related toxicities affect the quality of life (QoL) of NPC survivors. This study was devised to estimate the life expectancy (LE), quality-adjusted life expectancy (QALE) and survival-weighted psychometric scores (SWPS) in NPC patients. Methods A sample of 875 non-metastatic NPC patients diagnosed between January 1, 2009 and June 30, 2013 was collected for estimation of lifetime survival function. All patients were followed up until death or censored on December 31, 2015. To obtain the utility and psychometric score for estimation of LE, QALE, and SWPS, 99 patients were measured with the Taiwanese version of the EuroQol instrument (EQ-5D) and the Taiwan Chinese versions of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 and QLQ-H&N35 between October 1, 2013 and December 31, 2017. By utilizing linear extrapolation of a logit-transformed curve, the LE of NPC patients can be estimated. The QALE and SWPS can be obtained by combining the LE and the corresponding QOL function. Results The mean age of the 875 non-metastatic NPC patients was 50.3 years. The estimated average LE and QALE for NPC patients and for the reference population were 15.5 years and 14.3 quality-adjusted life years (QALYs) and 29.5 years and 29.5 QALYs, respectively. On average, the estimated lifelong duration of pain and painkiller use were 6.0 years and 2.2 years. The estimated lifelong duration of impairment of swallowing, speech, smell and taste were 14.0, 9.8, 8.7, and 7.5 years, respectively. The estimated lifelong duration of problems with dry mouth, teeth, emotion, fatigue, sleep, and social contact were 13.4, 10.1, 9.1, 12.3, 6.7, and 4.5 years, respectively. The estimated lifelong duration of tube-feeding was 1.3 months. Conclusions The estimated LE and QALE for NPC patients were 15.5 years and 14.3 QALYs. Furthermore, SWPS could help people understand more about the impact of radiotherapy on NPC patients. These data could also be useful for policy makers to allocate limited resources in health care.
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Affiliation(s)
- Chia-Hsuan Lai
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wen-Cheng Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chiung-Cheng Fang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Miao-Fen Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Wang Y, Chiang CJ, Lee WC. Age-standardized expected years of life lost: quantification of cancer severity. BMC Public Health 2019; 19:486. [PMID: 31046731 PMCID: PMC6498471 DOI: 10.1186/s12889-019-6843-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/16/2019] [Indexed: 01/04/2023] Open
Abstract
Background The critical implications of the expected years of life lost (EYLL) index of cancer for health policy assessments have been largely overlooked. We advocate to standardize life lost indices. Methods Using the Taiwan Cancer Registry database as an example, we calculated the EYLL and the age-standardized EYLL to facilitate comparisons among cancer types (a total of 903,935 patients from the database). The International Cancer Survival Standard was used for calculating age-standardized EYLL. Results Pancreatic cancer is the most severe cancer in Taiwan, with the greatest age-standardized EYLL for the men (15.6 years) and women (18.0 years) as well as for the men and women combined (16.6 years). Negative correlations were observed between unstandardized EYLL of cancer and mean age at diagnosis. Conclusions The unstandardized EYLL represents an overall assessment of disease burden, whereas the age-standardized EYLL is a suitable measure of disease severity. We suggest that both measures be incorporated into routine annual reports of cancer statistics alongside the usual incidence and mortality rates and their age-standardized counterparts. Electronic supplementary material The online version of this article (10.1186/s12889-019-6843-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yueh Wang
- Taiwan Cancer Registry, Rm 506, No. 17, Xuzhou Rd., Taipei, 100, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chun-Ju Chiang
- Taiwan Cancer Registry, Rm 506, No. 17, Xuzhou Rd., Taipei, 100, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Wen-Chung Lee
- Taiwan Cancer Registry, Rm 506, No. 17, Xuzhou Rd., Taipei, 100, Taiwan. .,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. .,Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Buckley SA, Kirtane K, Walter RB, Lee SJ, Lyman GH. Patient-reported outcomes in acute myeloid leukemia: Where are we now? Blood Rev 2017; 32:81-87. [PMID: 28888621 DOI: 10.1016/j.blre.2017.08.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/03/2017] [Accepted: 08/23/2017] [Indexed: 11/12/2022]
Abstract
Outcomes for acute myeloid leukemia remain poor, and treatment decisions must consider not just quantity, but also quality of life (QOL). We conducted a systematic review of studies in patients with acute myeloid leukemia or high-risk myelodysplastic syndrome that incorporated patient-reported outcome (PRO) measures. PubMed and PsycINFO were searched for articles published from January 2000 through June 2016. Forty-one were relevant for our review with more published in recent years. There was considerable inter-study heterogeneity in which instruments were used, and many studies employed multiple (often overlapping) instruments. Longitudinal studies in particular suffered from both high attrition rates due to disease-related mortality as well as waning compliance with questionnaire completion. There remain significant challenges to incorporation of PROs into leukemia trials. Despite these limitations, however, well-implemented PROs can provide important information beyond objective response outcomes and highlight areas of focus for clinicians caring for patients and for future research endeavors.
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Affiliation(s)
- Sarah A Buckley
- Hematology/Oncology Fellowship Program, University of Washington, Seattle, WA, USA.
| | - Kedar Kirtane
- Hematology/Oncology Fellowship Program, University of Washington, Seattle, WA, USA
| | - Roland B Walter
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Stephanie J Lee
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Gary H Lyman
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Lai CH, Chen MF, Fang FM, Chen WC. Estimation of life expectancy and quality-adjusted life expectancy in non-metastatic nasopharyngeal cancer patients treated by intensity-modulated radiotherapy with or without chemotherapy. Oral Oncol 2014; 50:646-50. [PMID: 24747031 DOI: 10.1016/j.oraloncology.2014.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/24/2014] [Accepted: 03/28/2014] [Indexed: 11/12/2022]
Abstract
PURPOSE This study was designed to estimate the life expectancy (LE) and quality-adjusted life expectancy (QALE) in non-metastatic nasopharyngeal cancer (NPC) patients. METHODS AND MATERIALS Patients were eligible for the present study if they were diagnosed with NPC and had been treated with intensity-modulated radiotherapy (IMRT) between January 1, 2003 and December 31, 2010. The quality of life (QOL) data were collected using the questionnaires of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-H&N35. The LE of NPC patients was obtained using linear extrapolation of a logit-transformed curve and was adjusted by the corresponding QOL function to calculate the QALE. RESULTS During the study period, 110 patients met the inclusion criteria, and 53 of these completed questionnaires. The median follow-up was 65.2 months (range 4.0-117.3 months). The average LE and QALE were estimated to be 20.6 years and 11.6 quality-adjusted life years (QALYs) for NPC patients and 24.4 years and 24.4 QALYs for the reference population, respectively. Compared to the reference population, the loss of LE and QALE for NPC patients were 3.8 years and 12.8 QALYs, respectively. CONCLUSIONS This study offers a quick overview of the LE and the QALE of NPC patients treated with IMRT. Moreover, the results appear more understandable than the 5 year survival outcomes when communicating with patients or the general population regarding cancer risk. In the future, evaluating the robustness of comparative assessments for the outcome of NPC patients undergoing different treatment protocols will be possible.
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Affiliation(s)
- Chia-Hsuan Lai
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Miao-Fen Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taiwan
| | - Fu-Min Fang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wen-Cheng Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taiwan.
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Hou WH, Liang HW, Hsieh CL, Sheu CF, Hwang JS, Chuang HY. Integrating health-related quality of life with sickness leave days for return-to-work assessment in traumatic limb injuries. Qual Life Res 2013; 22:2307-14. [DOI: 10.1007/s11136-013-0364-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2013] [Indexed: 11/30/2022]
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Cheng TF, Wang JD, Uen WC. Cost-utility analysis of adjuvant goserelin (Zoladex) and adjuvant chemotherapy in premenopausal women with breast cancer. BMC Cancer 2012; 12:33. [PMID: 22264299 PMCID: PMC3296644 DOI: 10.1186/1471-2407-12-33] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 01/21/2012] [Indexed: 12/02/2022] Open
Abstract
Background Increased health care costs have made it incumbent on health-care facilities and physicians to demonstrate both clinical and cost efficacy when recommending treatments. Though studies have examined the cost-effectiveness of adjuvant goserelin with radiotherapy for locally advanced prostate cancer, few have compared the cost-effectiveness of adjuvant goserelin to adjuvant chemotherapy alone in premenopausal breast cancer. Methods In this retrospective study at one hospital, the records of 152 patients with stage Ia to IIIa ER + breast cancer who received goserelin or chemotherapy were reviewed. Survival analysis was assessed by the Kaplan-Meier method. Patients were interviewed to evaluate their quality of life using the European Organization for Research and Treatment Quality of Life questionnaire (EORTC-QLQ-C30, version 4.0), and to obtain the utility value by the standard gamble (SG) and visual scale (VS) methods. Total medical cost was assessed from the (National Health Insurance) NHI payer's perspective. Results Survival at 11 years was significantly better in the groserelin group (P < 0.0012). The lifetime lost was lower in the goserelin group (42 months vs. 66 months). The quality adjusted survival (QAS) of patients who received goserelin was longer (122.5 ± 6.3 vs. 112.2 ± 6.7 months). Total expenses of goserelin were more than cyclophosphamide, methotrexate, 5-fluorouracil (CMF) or 5-fluorouracil, epirubicin, cyclophosphamide (FEC) chemotherapy regimes, but less than docetaxel, epirubicin (TE) or docetaxel, epirubicin, cyclophosphamide (TEC) regimes. The quality-adjusted life-year was higher in the goserelin group. Conclusions Goserelin therapy results in better survival and higher utility-weighted life-years, and is more cost-effective than TC or TEC chemotherapy.
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Affiliation(s)
- Tsui Fen Cheng
- Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
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Saini L, Alibhai SMH, Brandwein JM. Quality of life issues in elderly acute myeloid leukemia patients. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ahe.11.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The median age of acute myeloid leukemia (AML) is 70 years. Treatment approaches include standard chemotherapy, palliative chemotherapy and investigational agents, depending upon disease biology and patient factors. In this article, we highlight the issues involved in the treatment of AML in older patients, focusing on the quality of life changes associated with each treatment modality at different stages of their disease course. We further discuss recent insights into the biological basis of quality of life changes, and examine potential ways to improve these through pharmacological and nonpharmacological means. Finally, we explore avenues for future research into the quality of life of the older AML patient.
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Affiliation(s)
- Lalit Saini
- Department of Medical Oncology & Hematology, Princess Margaret Hospital, 610 University Avenue, Rm. 5–109, Toronto, ON M5G 2M9, Canada
| | - Shabbir MH Alibhai
- Department of Medicine, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada
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Grulke N, Albani C, Bailer H. Quality of life in patients before and after haematopoietic stem cell transplantation measured with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire QLQ-C30. Bone Marrow Transplant 2011; 47:473-82. [PMID: 21602898 DOI: 10.1038/bmt.2011.107] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The EORTC Quality of Life Core Questionnaire QLQ-C30 is widely used, but no reference values are available for patients receiving HSCT. We retrieved data for 38 samples from 33 papers in English and German that provided evaluable information on QLQ-C30 scores (mean, s.d.) covering about 2800 patients. Results are presented as a table that provides reference data that allow QLQ-C30 scores at different points during the disease trajectory to be put in context. With respect to their central tendency and their variance, scores vary over time. Quality of life is lowest during inpatient time. About 1 year after HSCT, the pre-transplant level is reached. Physical functioning is the scale reaching the highest level of all scales. Fatigue, dyspnoea and insomnia are symptoms that remain at an elevated level and should thus be considered as persisting problems after HSCT. For the interpretation of differences between scores, a very conservative recommendation would be to set the s.d. at 30 points. Doing so, one could be quite sure of having found a clinically significant change if the difference of two scores exceeds 15 points. Differences below 5 points should be interpreted with caution.
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Affiliation(s)
- N Grulke
- Luisenklinik-Zentrum für Verhaltensmedizin, Bad Dürrheim, Germany
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Chang CY, Huang CK, Chang YY, Tai CM, Lin JT, Wang JD. Prospective study of health-related quality of life after Roux-en-Y bypass surgery for morbid obesity. Br J Surg 2010; 97:1541-6. [PMID: 20645295 DOI: 10.1002/bjs.7179] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the effects of Roux-en-Y gastric bypass for morbid obesity on health-related quality of life (QOL) during the first year of follow-up. METHODS The World Health Organization Quality of Life-Brief (WHOQOL-BREF) was administered 1 month before operation, and at 1, 3, 6 and 12 months after surgery. Body mass index, co-morbidities and operation-related complications were measured at these times. A mixed-effect model was constructed to analyse repeated measurements and determine the relationships between body mass index, WHOQOL-BREF scores and other variables. RESULTS A total of 102 patients were enrolled. The mixed-effect model showed that the physical, psychological and social domains improved after bariatric surgery, with simultaneous reduction in weight and improvement in co-morbidities. There was a dip in scores in physical and psychological domains 3-6 months after surgery, significantly related to complications. All patients gradually improved between 6 and 12 months after surgery, reaching levels similar to those of healthy subjects. CONCLUSION Health-related QOL improved dramatically after bariatric surgery, dipped slightly between 3 and 6 months, and improved again up to the end of the first year.
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Affiliation(s)
- C-Y Chang
- Department of Internal Medicine, I-Shou University, Kaohsiung, Taiwan
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Lee HY, Hwang JS, Jeng JS, Wang JD. Quality-Adjusted Life Expectancy (QALE) and Loss of QALE for Patients With Ischemic Stroke and Intracerebral Hemorrhage. Stroke 2010; 41:739-44. [DOI: 10.1161/strokeaha.109.573543] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hsin-Yi Lee
- From the Institute of Occupational Medicine and Industrial Hygiene (H.-Y.L.), College of Public Health, National Taiwan University, Taipei, Taiwan; the Institute of Statistical Science (J.-S.H.), Academia Sinica, Taipei, Taiwan; the Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital, Taipei, Taiwan; and the Departments of Internal Medicine and Environmental and Occupational Medicine (J.-D.W.), National Taiwan University Hospital, Taipei, Taiwan
| | - Jing-Shiang Hwang
- From the Institute of Occupational Medicine and Industrial Hygiene (H.-Y.L.), College of Public Health, National Taiwan University, Taipei, Taiwan; the Institute of Statistical Science (J.-S.H.), Academia Sinica, Taipei, Taiwan; the Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital, Taipei, Taiwan; and the Departments of Internal Medicine and Environmental and Occupational Medicine (J.-D.W.), National Taiwan University Hospital, Taipei, Taiwan
| | - Jiann-Shing Jeng
- From the Institute of Occupational Medicine and Industrial Hygiene (H.-Y.L.), College of Public Health, National Taiwan University, Taipei, Taiwan; the Institute of Statistical Science (J.-S.H.), Academia Sinica, Taipei, Taiwan; the Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital, Taipei, Taiwan; and the Departments of Internal Medicine and Environmental and Occupational Medicine (J.-D.W.), National Taiwan University Hospital, Taipei, Taiwan
| | - Jung-Der Wang
- From the Institute of Occupational Medicine and Industrial Hygiene (H.-Y.L.), College of Public Health, National Taiwan University, Taipei, Taiwan; the Institute of Statistical Science (J.-S.H.), Academia Sinica, Taipei, Taiwan; the Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital, Taipei, Taiwan; and the Departments of Internal Medicine and Environmental and Occupational Medicine (J.-D.W.), National Taiwan University Hospital, Taipei, Taiwan
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Cross-validation of the Taiwan version of the Moorehead-Ardelt Quality of Life Questionnaire II with WHOQOL and SF-36. Obes Surg 2009; 20:1568-74. [PMID: 19255812 PMCID: PMC2950928 DOI: 10.1007/s11695-009-9813-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Accepted: 02/10/2009] [Indexed: 12/04/2022]
Abstract
Background Obesity has become a major worldwide public health issue. There is a need for tools to measure patient-reported outcomes. The Moorehead–Ardelt Quality of Life Questionnaire II (MA II) contains six items. The objective of this study was to translate the MA II into Chinese and validate it in patients with morbid obesity. Methods The MA II was translated into Chinese and back-translated into English by two language specialists to create the Taiwan version, which was validated by correlations with two other generic questionnaires of health-related quality of life (HRQOL), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and World Health Organization Quality of Life (WHOQOL)-BREF Taiwan version. The convergent validity was accomplished by a series of Spearman rank correlations. Reliability of the MA II Taiwan version was determined by internal consistency obtained by Cronbach’s alpha coefficient and test–retest reliability obtained by intraclass correlation coefficient. Results One hundred subjects with morbid obesity were enrolled to test the MA II Taiwan version convergent validity and internal consistency. Test–retest studies (2 weeks apart) were applied to 30 morbidly obese patients. Satisfactory internal consistency was demonstrated by a Cronbach’s alpha coefficient of 0.79. Good test–retest reliability was shown by intraclass correlations ranging from 0.73 to 0.91. The total sum of MA II scores was significantly correlated with all four domains of the WHOQOL-BREF and two major components of SF-36 (all correlations, p < 0.01; range, 0.44–0.64). All six MA II items showed significant correlations with each other (r = 0.34–0.69, p < 0.01), and the total sum of MA II scores was negatively correlated with body mass index (r = −0.31, p < 0.01), indicating a one-dimensional questionnaire of HRQOL. Conclusions The MA II Taiwan version is an obesity-specific questionnaire for QOL evaluation with satisfactory reliability and validity. It has the advantages of extensive evaluation for HRQOL, cross-cultural application, rapid completion, high response rates, and an advanced scoring system.
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Chu PC, Wang JD, Hwang JS, Chang YY. Estimation of life expectancy and the expected years of life lost in patients with major cancers: extrapolation of survival curves under high-censored rates. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2008; 11:1102-1109. [PMID: 18489497 DOI: 10.1111/j.1524-4733.2008.00350.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES There exists a lack of extrapolation methods for long-term survival analysis when censored rates are high (25-50%). This study aimed at estimating life expectancy (LE) after the diagnosis of cancer and the expected years of life lost (EYLL) using a newly developed semiparametric method. METHODS Patients (n = 425,294) diagnosed with 17 different types of major cancer were enrolled. All of the patients were registered with the Taiwan Cancer Registry between 1990 and 2001; their survivals were followed through the end of 2004. The survival function for an age- and sex-matched reference population was generated using the Monte Carlo method from the life table of the general population. Lifetime survival of the cancer patients (up to 50 years) were obtained using linear extrapolation of a logit-transformed curve of the survival ratio between the cancer and reference populations. The estimates were compared with the results from the extrapolation of fitted Weibull models. RESULTS The 15-year survival, LE, and EYLL for 17 different types of cancer were determined, of which the LE of breast, cervical, ovarian, and skin cancers exceeded 15 years; nasopharyneal, leukemia, bladder, kidney, and colorectal cancers exceeded 10 years. Validity tests indicated that the relative biases of the extrapolated estimates were usually <5% under high censoring rates. CONCLUSIONS The newly developed method is feasible and relatively accurate to project LE and EYLL, which could also be merged with data pertaining to quality of life, for a more detailed outcome assessment in the future.
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Affiliation(s)
- Po-Ching Chu
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taiwan
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Chang CY, Hung CK, Chang YY, Tai CM, Lin JT, Wang JD. Health-related quality of life in adult patients with morbid obesity coming for bariatric surgery. Obes Surg 2008; 20:1121-7. [PMID: 18463932 PMCID: PMC2910893 DOI: 10.1007/s11695-008-9513-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2008] [Accepted: 03/19/2008] [Indexed: 11/24/2022]
Abstract
Background Obesity has become a major health issue not only in the West but also in Asia. Morbid obesity can lead to much comorbidity and can markedly interfere with quality of life. The aim of this study was to compare the health-related quality of life (HRQL) between patients with morbid obesity coming for bariatric surgery and the healthy population in Taiwan. Methods Patients were between age 18 and 65 years. Patients had a BMI between 32 and 40 kg/m2 with obesity-related comorbidities or a BMI > 40 kg/m2. Patients were enrolled for bariatric surgery by a modified recommendation of the Asia-Pacific consensus. Physical and psychiatric evaluations were accomplished simultaneously. The World Health Organization Quality of Life (WHOQOL-BREF), Taiwan version, was administered 1 month before the operation. The quality of life of the obese patients was compared with age-, sex-, education-, marriage-, and municipality-matched healthy control patients taken from a national survey in Taiwan. Multiple regression analyses were conducted to study risk factors for impairment of HRQL. Results A total of 114 consecutive patients with obesity coming for bariatric surgery at our hospital were enrolled in 2007. Obese subjects had poorer WHOQOL-BREF scores than those of the healthy referents in physical, psychological, and social domains but not in environmental domain (P < 0.05). Patients with BMI levels above 32 kg/m2 had consistently poorer scores in various facets after adjusting for other risk factors. Conclusions The higher the BMI level the poorer the HRQL. Our findings seem to support the recommendations of Asia-Pacific consensus based on HRQL considerations.
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Affiliation(s)
- Chi-Yang Chang
- Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan, ROC
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Oliansky DM, Appelbaum F, Cassileth PA, Keating A, Kerr J, Nieto Y, Stewart S, Stone RM, Tallman MS, McCarthy PL, Hahn T. The role of cytotoxic therapy with hematopoietic stem cell transplantation in the therapy of acute myelogenous leukemia in adults: an evidence-based review. Biol Blood Marrow Transplant 2008; 14:137-80. [PMID: 18215777 DOI: 10.1016/j.bbmt.2007.11.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Accepted: 11/09/2007] [Indexed: 10/22/2022]
Abstract
Clinical research examining the role of hematopoietic stem cell transplantation (HSCT) in the therapy of acute myelogenous leukemia (AML) in adults is presented and critically evaluated in this systematic evidence-based review. Specific criteria were used for searching the published literature and for grading the quality and strength of the evidence and the strength of the treatment recommendations. Treatment recommendations based on the evidence are presented in Table 3, entitled Summary of Treatment Recommendations Made by the Expert Panel for Adult Acute Myelogenous Leukemia, and were reached unanimously by a panel of AML experts. The identified priority areas of needed future research in adult AML include: (1) What is the role of HSCT in treating patients with specific molecular markers (eg, FLT3, NPM1, CEBPA, BAALC, MLL, NRAS, etc.) especially in patients with normal cytogenetics? (2) What is the benefit of using HSCT to treat different cytogenetic subgroups? (3) What is the impact on survival outcomes of reduced intensity or nonmyeloablative versus conventional conditioning in older (>60 years) and intermediate (40-60 years) aged adults? (4) What is the impact on survival outcomes of unrelated donor HSCT vesus chemotherapy in younger (<40 years) adults with high risk disease?
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Estimation of the Financial Burden to the National Health Insurance for Patients with Major Cancers in Taiwan. J Formos Med Assoc 2008; 107:54-63. [DOI: 10.1016/s0929-6646(08)60008-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Sharp LK, Kinahan KE, Didwania A, Stolley M. Quality of life in adult survivors of childhood cancer. J Pediatr Oncol Nurs 2007; 24:220-6. [PMID: 17588894 DOI: 10.1177/1043454207303885] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
More children are surviving childhood cancer than ever before; however, little is known about these survivors' long-term quality of life (QOL). This study explores factors that might influence QOL in adult childhood cancer survivors. In a cross-sectional design, 70 of 100 eligible survivors from 1 long-term follow-up clinic completed a QOL and depression symptom measure. Medical information was abstracted from charts. Analysis revealed that survivors with elevated depressive symptoms had significantly lower QOL across all domains than those with lower levels of depressive symptoms. Regression analyses were conducted to further explore relationships. Depressive symptoms appear to be a major factor contributing to adverse QOL outcomes in adult survivors. Additional research should focus on the prevention of depression symptoms and effective treatment modalities for this unique population.
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Affiliation(s)
- Lisa K Sharp
- University of Illinois at Chicago, Department of Medicine, Section of Health Promotion Research, Chicago, IL 60608, USA.
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