The EORTC Modular Approach to Quality of Life Assessment in Oncology

Development and validation of the rheumatoid arthritis scale among the system of quality of life instruments for chronic diseases QLICD-RA (V2.0)

Rheumatoid Arthritis is a more serious threatening to people and suitable for QOL measurement. A few specific QOL instruments are available without considering Chinese culture. The present study was aimed to develop and validate the Rheumatoid Arthritis Scale among the System of Quality of Life Instruments for Chronic Diseases (QLICD-RA V2.0). The data collected from 379 patients with RA was used to evaluate the psychometric properties of the scale. The reliability was evaluated by the internal consistency Cronbach's α, test-retest reliability Pearson correlation r and intra-class correlation (ICC). We evaluated the construct validity and criteria-related validity by correlation analysis and structural equation modeling. We compared the differences in scores of QLICD-RA before and after treatment and used the Standard Response Mean (SRM) to assess the responsiveness. The results showed that the internal consistency coefficient Cronbach's α values were greater than 0.70. The correlations r and ICCs were greater than 0.80. The correlation analysis and structural equation modeling confirmed good construct validity and criterion-related validity. The SRM ranges from 0.07 to 0.27 for significant domains/facets. It concluded that QLICD-RA (2.0) is a reliable and valid instrument to measure QOL among patients with RA.

Factors influencing the implementation of shared decision-making in breast cancer care: protocol for a mixed-methods study

INTRODUCTION

Chile is committed to actively involving patients in their healthcare. However, little is known about how this is translated into clinical encounters. Breast cancer (BC) is the first cause of cancer-related death in Chilean women. National policy guarantees standard care, and treatment decisions should be made along this process that can have long-term consequences for women. So, BC is a particularly well-suited case study to understand the complexity of patient participation in decision-making.

OBJECTIVE

To identify the factors that affect the active involvement of patients in the BC treatment decision-making process, considering the perspectives and practices of health professionals and women facing the disease.

METHOD AND ANALYSIS

We will conduct a mixed-method study through a convergent parallel design in three stages: (1) A qualitative study: non-participant observation of the tumour board (TB) meetings; semi-structured interviews with key informants from TBs; documentary analyses; semi-structured interviews with women facing BC; and non-participant observations of clinical encounters; (2) a cross-sectional study with 445 women facing BC stages I-III from three hospitals in Santiago, Chile. We will measure the level of expected participation, experienced participation, decisional conflict, quality of life (QoL) and satisfaction with healthcare. Descriptive analysis will be performed, and multivariable binary logistic regression models will be adjusted to identify factors associated with high levels of QoL or satisfaction; (3) an integration study will bring together the data through a joint display technique.

ETHICS AND DISSEMINATION

The study has been conceived and will be conducted according to international and local agreements for ethical research. Ethical approval has been granted by two Ethics Committees in Chile.The results will be disseminated to scientific and lay audiences (publications in scientific journals and conferences, seminars and a website for plain language dissemination).

Medi-Cinema: A Pilot Study on Cinematherapy and Cancer as A New Psychological Approach on 30 Gynecological Oncological Patients

Background: Several subjects affected by cancer experience a significant level of multidimensional disease. This longitudinal study aims to evaluate the effectiveness of psycho-oncological support using Cinema as an emotional mediator and to promote perceived well-being by personalized psychological treatment. Methods: Thirty women diagnosed with gynecological cancer watched 12 movies and participated in a psychotherapy group co-conducted by two psychotherapists. Patients completed nine questionnaires at T0 (baseline), T1 (3 months) and T2 (6 months). Results: Patients observed significant improvements (CORE-OM: p < 0.001) in psychological well-being. The results showed statistically significant differences, even in several other dimensions, such as Anxiety (STAY-Y1-2: p < 0.001), Empathy (BEES, p < 0.001), Coping (COPE: p < 0.001), QoL (QLQ-C30, p: 0.026), couple relationship (DAS, Satisfaction: p: 0.013; Cohesion: p: 0.004) and alexithymia (TAS-20, Difficulty Identifying Feeling: p: 0.002; Externally-Oriented Thinking: p: 0.003). Conclusions: The data show that cinema, as an innovative psychological approach, could be a valid instrument to support patients in oncological pathways as well as facilitating the process of recognizing themselves in other patients and communicating about their own feelings.

CA-PROM: Validation of a general patient-reported outcomes measure for Chinese patients with cancer

BACKGROUND

Based the important role of patient-reported outcome in measuring patients' QoL, a general PRO instrument was designed for Chinese patients with cancer.

METHODS

The instrument was administered in eight hospitals. Based on PRO guidelines, a conceptual framework and item pool were generated after literature review and patients' interviews. Via two-item selection process, the original version of a cancer PRO measure (CA-PROM) was generated. Patients' responsiveness was evaluated in four disease systems by item response theory. The reliability, validity, and feasibility of CA-PROM were assessed. The minimum clinically important differences (MCIDs) and risk thresholds of PRO were calculated.

RESULTS

A total of 2213 valid questionnaires were collected. After expert opinions and cognitive tests, 11 items were deleted. In the pre-survey and formal survey, 19 items were deleted based on six methods of classical test theory. In the respiratory, digestive, hematological, and endocrine systems, four items with poor responsiveness were deleted by item response theory. The final CA-PROM included four domains, 13 subdomains, and 49 items. Reliability coefficients of 13 subdomain was > 0.7. The framework of CA-PROM met required criteria by CFA and OBID. The average response time was 14.2 min, indicating feasibility of CA-PROM. The MCIDs were 5.63, 3.42, 4.16 in the physiological, psychological, social domain, respectively. The risk thresholds of PRO for six subdomains were 71.74, 71.28, 66.29, 65.16, 59.56, 66.60, in that order.

CONCLUSION

The developed CA-PROM exhibited good reliability, validity, and feasibility, and can be used as an effective evaluation tool in cancer patients.

When do defecation function and quality of life recover for patients with non-ostomy and ostomy surgery of rectal cancer?

Background

Rectal cancer (RC) surgery often results in permanent colostomy, seriously limiting the quality of life (QOL) in patients in terms of bowel function. This study aimed to examine defecation function and QOL in RC patients who underwent non-ostomy or ostomy surgery, at different time-points after surgery.

Methods

In total, 82 patients who underwent an ostomy and 141 who did not undergo an ostomy for the treatment of RC at our colorectal surgery department between January 2013 and January 2015 were enrolled. Surgical methods, tumor distance from the anal margin (TD), anastomosis distance from the anal margin (AD) and complications were compered between the non-ostomy and ostomy surgery groups. QOL was compared between the two groups at years 2, 3, and 4 after surgery. The Wexner score and the validated cancer-specific European Organization for Research and Treatment of Cancer (EORTC QLQ-CR30) questionnaire scores were assessed for all patients in January 2017. SPSS 21.0 was utilized for all data analyses.

Results

Surgical methods, TD, and AD significantly differed between the non-ostomy and ostomy surgery groups (all P < .001). However, no differences were found in the number of complications between the groups (P = .483). For the 192 patients undergoing Dixon surgery, role function (RF), global QOL (GQOL), sleep disturbance, and the incidence of constipation showed significant differences between the two groups (P = .012, P = .025, P = .036, and P = .015, respectively). In the 31 cases of permanent ostomy, we observed significant differences in GQOL scores, dyspnea incidence, and financial difficulties across the different years (P = .002, P = .036, and P < .01, respectively). Across all 223 cases, there were significant differences in social function and GQOL scores in the second year after surgery (P = .014 and P < .001, respectively). However, no differences were observed in the other indices across the three time-points.

Conclusions

RC patients undergoing ostomy surgery, especially those with low and super-low RC, revealed poorer defecation function and QOL in the present study. However, 2 years after surgery, most of the defecation and QOL indicators showed recovery.

The EORTC QLQ-ELD14 questionnaire for elderly cancer patients. Validation study for elderly Spanish breast cancer patients

BACKGROUND AND OBJECTIVES

Quality of life (QoL) is a key outcome for elderly cancer patients. The EORTC has developed QLQ-ELD14, a questionnaire that assesses important age-specific issues for older patients with cancer. This study aims to validate QLQ-ELD14 for use with elderly Spanish breast cancer patients.

MATERIALS AND METHODS

A consecutive sample of breast cancer patients with localized disease (age ≥65) who had received surgery ≥5 years earlier, were disease-free, and may have received adjuvant treatments was included. Patients completed the QLQ-ELD14, QLQ-C30 and QLQ-BR23 questionnaires. A subsample of patients completed QLQ-ELD14 six months later. Psychometric evaluation of the structure, reliability and validity of QLQ-ELD14 was conducted.

RESULTS

87 patients completed the first assessment and 30 the second. Multitrait scaling analysis showed that all items except two met the standards for convergent and divergent validity. Cronbach's coefficient met the 0.7 alpha criterion on all scales except worries about others. Areas of QLQ-ELD14 and QLQ-C30 whose contents are conceptually related correlated substantially (Spearman's Rho >0.40). Conversely, areas of QLQ-ELD14 that had less in common with those of QLQ-C30 and QLQ-BR23 had low correlations (Spearman's Rho <0.1). Differences in QLQ-ELD14 were found in groups based on age, disease duration, living arrangement, presence of limiting comorbidity, and level of performance status. Patients had a higher level of worries at the second assessment.

CONCLUSIONS

QLQ-ELD14 is a reliable and valid instrument when applied to a sample of Spanish patients. Our results are in line with those of other validation studies.

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.

Development of Improved Version of Quality of Life Assessment Instrument for Lung Cancer Patients Based on Traditional Chinese Medicine (QLASTCM-Lu)

OBJECTIVE

To develop an improved version of the Quality-of-Life Assessment instrument for Lung Cancer Patients Based on Traditional Chinese Medicine (QLASTCM-Lu) and to evaluate its psychometric property.

METHODS

The structured group method and the theory in developing rating scale were employed to revise the preliminary scale. The psychometric property (reliability, validity, and responsiveness) of the established QLASTCM-Lu (modified) were evaluated by quality of life data measured in 100 lung cancer patients. Statistical analyses were made accordingly by way of correlation analysis, factor analysis and paired t-test.

RESULTS

The internal consistency reliability of the overall scale and all domains was from 0.80 to 0.94. Correlation and factor analyses demonstrated that the scale was good in construct validity. The criterion validity was formed with European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire-Lung Cancer (EORTC QLQ-LC43) as the criterion. Statistically significant changes were found apart from such domain as "mental condition" and "social function", with the standardized response means being close to those of QLQ-LC43.

CONCLUSION

QLASTCM-Lu (modified) could be used to measure the quality of life of lung cancer patients with good reliability, validity and a certain degree of responsiveness.

A large scale prospective clinical and psychometric validation of the EORTC colorectal (QLQ-CR29) module in Polish patients with colorectal cancer

The purpose of our study was to assess if the Polish translation of the European Organisation for Research and Treatment of Cancer (EORTC) Colorectal Cancer (CRC)-Specific Quality of Life Questionnaire (QLQ-CR29) is an acceptable and psychometrically valid measure to collect quality of life (QoL) data in Polish patients with CRC for use in clinical trials and clinical practice. A total of 150 patients undergoing treatment for CRC were prospectively enrolled in the study. Psychometric assessment of the translated QLQ-CR29 structure, reliability, convergent and divergent validity, and clinical validity was subsequently performed. The Cronbach's alpha coefficient ranged from 0.70-0.89, indicating acceptable internal consistency. For test-retest reliability, the ICCs for each item ranged from 0.59-0.91, with exceptions for urinary incontinence and dysuria, indicating good to excellent reproducibility. In multi-trait scaling analyses, the criterion for item convergent and divergent validity was satisfied. The correlations between the EORTC QLQ-CR29 and QLQ-C30 scales were mostly low (r < .40), with a few items demonstrating higher correlations. The known group comparisons analyses demonstrated the ability of the questionnaire to distinguish between patients' differing age, stoma status, and treatment intent. The Polish translation of the QLQ-CR29 is a psychometrically reliable and valid tool. The results of this study are congruent with that of EORTC validation.

Web-based remote psychological intervention improves cancer treatment

Web-based-remote (WBR) intervention is a new approach that incorporates smart control technology and modern medicine to monitor patient compliance. It is based on computer control and communication technology. This study is to explore the benefits of WBR psychological intervention for cancer treatment. 128 patients diagnosed with cancer by Pathology Department of our hospital between 1 February 2013 and 1 August 2013 were included. Patients were randomly assigned to intervention and control group (n = 64). The Questionnaire-Core 30 (QLQ-C30) was used for the survey. Intervention group received WBR psychological intervention in addition to regular clinical follow-up care. Control group only received regular clinical follow-up care. The QLQ-C30 score was significantly better in the intervention group than the control group when the intervention and control groups were followed for three months. In conclusion, WBR psychological intervention substantially improves the quality of life in patients during cancer treatment.

Depression symptom trends and health domains among lung cancer patients in the CanCORS study

OBJECTIVES

Among lung cancer patients depression symptoms are common and impact outcomes. The aims of this study were to determine risk factors that contribute to persistent or new onset depression symptoms during lung cancer treatment, and examine interactions between depression symptoms and health domains that influence mortality.

MATERIALS AND METHODS

Prospective observational study in five healthcare systems and 15 Veterans Affairs medical centers. Patients in the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium with lung cancer were eligible. The 8-item Center for Epidemiologic Studies Depression (CES-D) scale was administered at baseline and follow-up. Scores ≥4 indicated elevated depressive symptoms. Health domains were measured using validated instruments. We applied logistic regression and Cox proportional hazards modeling to explore the association between depression symptoms, health domains, and mortality.

RESULTS

Of 1790 participants, 38% had depression symptoms at baseline and among those still alive, 31% at follow-up. Risk factors for depression symptoms at follow-up included younger age (OR=2.81), female sex (OR=1.59), low income (OR=1.45), not being married (OR=1.74) and current smoking status (OR=1.80); high school education was associated with reduced odds of depression symptoms at follow-up, compared with lesser educational attainment (OR=0.74) (all p values <0.05). Patients with depression symptoms had worse health-related quality of life, vitality, cancer-specific symptoms, and social support than patients without depression symptoms (all p<0.001). The association between depression symptoms and increased mortality is greater among patients with more lung cancer symptoms (p=0.008) or less social support (p=0.04).

CONCLUSIONS

Patient risk factors for depression symptoms at follow-up were identified and these subgroups should be targeted for enhanced surveillance. Patients with depression symptoms suffer across all health domains; however, only more lung cancer symptoms or less social support are associated with worse mortality among these patients. These potentially modifiable health domains suggest targets for possible intervention in future studies.

Introduction of Questionnaires for Quality of Life of Patients with Malignant Tumors of the Central Nervous System into Neurosurgical Practice in the Republic of Kazakhstan

BACKGROUND

Studies of quality of life (QoL) of oncological patients is carried out using questionnaires approved in many international clinical studies. The European Organization for Research and Treatment of Cancer EORTC QLQ-C30 (Quality of Life Questionnary-Core 30) and its special brain cancer module EORTC QLQ-BN20 are widely used in the world neurooncologic practice. They are available in more than 80 official versions of 30 languages of the world. Previously we used the official versions in Russian, which often causes difficulty in understanding for native Kazakh language speakers, who comprise more than 60% of our respondents. This was the reason for creating a version of Kazakh language. Therefore, in 2014 for the first time the process of adaptation of questionnaires to the Kazakh language was initiated.

MATERIALS AND METHODS

The translation process of questionnaires to Kazakh language was held in accordance with the requirements of the European Organization for Research and Treatment of Cancer EORTC on QoL and consisted of the following stages: preparation - translation - pilot testing - approval. The official permission of authors and "Guideline on translation" was obtained which was developed by the working group of the EORTC on QoL. The pilot testing of EORTC QLQ-C30 and QLQ-BN20 questionnaires was conducted on the basis of the Department of Central Nervous System Pathology of the "National Centre for Neurosurgery" in patients with malignant tumors of the central nervous system.

RESULTS

The official versions of the EORTC QLQ-C30 and QLQ-BN20 questionnaires in Kazakh language were introduced and adapted in practical neurosurgical operations in Kazakhstan.

CONCLUSIONS

The approved versions of the questionnaires in Kazakh language are now available for mainstream use on the official website EORTC.com. The versions of these questionnaires can be used in domestic cohort studies and clinical practice in the Republic of Kazakhstan. The use of these tools for assessing QoL will help professionals in the planning of individual treatment strategies and selection of the necessary therapy.

Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology-2): a multicentre randomised controlled effectiveness trial

BACKGROUND

Medical conditions are often complicated by major depression, with consequent additional impairment of quality of life. We aimed to compare the effectiveness of an integrated treatment programme for major depression in patients with cancer (depression care for people with cancer) with usual care.

METHODS

SMaRT Oncology-2 is a parallel-group, multicentre, randomised controlled effectiveness trial. We enrolled outpatients with major depression from three cancer centres and their associated clinics in Scotland, UK. Participants were randomly assigned in a 1:1 ratio to the depression care for people with cancer intervention or usual care, with stratification (by trial centre) and minimisation (by age, primary cancer, and sex) with allocation concealment. Depression care for people with cancer is a manualised, multicomponent collaborative care treatment that is delivered systematically by a team of cancer nurses and psychiatrists in collaboration with primary care physicians. Usual care is provided by primary care physicians. Outcome data were collected up until 48 weeks. The primary outcome was treatment response (≥50% reduction in Symptom Checklist Depression Scale [SCL-20] score, range 0-4) at 24 weeks. Trial statisticians and data collection staff were masked to treatment allocation, but participants could not be masked to the allocations. Analyses were by intention to treat. This trial is registered with Current Controlled Trials, number ISRCTN40568538.

FINDINGS

500 participants were enrolled between May 12, 2008, and May 13, 2011; 253 were randomly allocated to depression care for people with cancer and 247 to usual care. 143 (62%) of 231 participants in the depression care for people with cancer group and 40 (17%) of 231 in the usual care group responded to treatment: absolute difference 45% (95% CI 37-53), adjusted odds ratio 8·5 (95% CI 5·5-13·4), p<0·0001. Compared with patients in the usual care group, participants allocated to the depression care for people with cancer programme also had less depression, anxiety, pain, and fatigue; and better functioning, health, quality of life, and perceived quality of depression care at all timepoints (all p<0·05). During the study, 34 cancer-related deaths occurred (19 in the depression care for people with cancer group, 15 in the usual care group), one patient in the depression care for people with cancer group was admitted to a psychiatric ward, and one patient in this group attempted suicide. None of these events were judged to be related to the trial treatments or procedures.

INTERPRETATION

Our findings suggest that depression care for people with cancer is an effective treatment for major depression in patients with cancer. It offers a model for the treatment of depression comorbid with other medical conditions.

FUNDING

Cancer Research UK and Chief Scientist Office of the Scottish Government.

Beneficial Effects of Pranic Meditation on the Mental Health and Quality of Life of Breast Cancer Survivors

Background. Breast cancer survivors frequently present long-lasting impairments, caused either by the disease or its treatment, capable of compromising their emotional health and quality of life. Meditation appears to be a valuable complementary measure for overcoming some of these impairments. The purpose of the present investigation was to assess the effect of pranic meditation on the quality of life and mental health of breast cancer survivors. Design. This study was a prospective single-arm observational study using before and after measurements. Methods. The subjects were 75 women submitted either to breast cancer therapy or to posttherapy control who agreed to practice pranic meditation for 20 minutes, twice a day, during 8 weeks, after receiving a formal training. The quality of life of the practitioners was assessed by the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and EORTC BR-023 questionnaires, and the mental health status by the Goldberg’s General Health Questionnaire. Results. After 8 weeks of pranic meditation practice, the subjects showed a significant improvement of their quality of life scores that included physical ( P = .0007), role ( P = .01), emotional ( P = .002), and social functioning ( P = .004), as well as global health status ( P = .005), fatigue ( P < .0001), pain ( P = .007), sleep disturbances ( P = .01), body image ( P = .001), arm symptoms ( P = .007), and breast symptoms ( P = .002). They also showed a reduction of the side effects of systemic therapy ( P = .02) and being upset by hair loss ( P = .02). Moreover, meditation was associated with improvement of the mental health parameters of the practitioners that included psychic stress ( P = .001), death ideation ( P = .02), performance diffidence ( P = .001), psychosomatic disorders ( P = .02), and severity of mental disorders ( P = .0003). The extension of the meditation period from 8 to 15 weeks caused no substantial extra benefits in practitioners. Conclusions. The results of this pilot study showed that breast cancer survivors presented significant benefits related to their mental health and quality of life scores after a short period of practice of pranic meditation, consisting of simple and easy-to-learn exercises. However, because of the limitations of the study, further research is required using a more rigorous experimental design to ascertain whether pranic meditation may be an acceptable adjunct therapy for cancer patients.

The quality of life after a total gastrectomy with extended lymphadenectomy and omega type oesophagojejunostomy for gastric adenocarcinoma without distant metastases

BACKGROUND

To evaluate the quality of life (QOL) in relation to age, sex, clinical stage, postoperative complication, and adjuvant chemotherapy in patients who underwent curative total gastrectomy with D2 lymphadenectomy and Omega type esophagojejunostomy for gastric adenocarcinoma.

METHODS

69 patients were included. Lithuanian version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Cancer 30 was sent to all of them from six months to two years after gastric surgery for self-completion. 34 questionnaires were filled and were used as material for further analysis. Influence of age (≥ 65 vs < 65), sex, clinical stage (I-II vs III), surgical complication, and adjuvant chemotherapy was assessed on QOL in this retrospective cross-sectional case series study.

RESULTS

The global health status was better in the group of patients aged over 65 (63.0 points vs 46.4, P = 0.0509). The functional scales were higher in the same group of patients. Significant difference was only observed on the social scale in favour of elders (P = 0.0039). Sex, clinical stage, surgical complications, and postoperative chemotherapy had no significant influence on any aspect of QOL.

CONCLUSION

The global QOL and the social functioning was better in patients aged 65 years and over, compared to patients under the age of 65 in the period of 6 to 18 months after a total gastrectomy with D2 lymphadenectomy and Omega esophagojejunostomy.

Validation of the Chinese version of Multidimensional Fatigue Inventory-20 in Chinese patients with cancer

GOALS OF WORK

The purpose of this research is to study the validation of the Chinese version of Multidimensional Fatigue Inventory-20 in measuring fatigue status of the patients with cancer in China.

MATERIALS AND METHODS

The original English version of the Multidimensional Fatigue Inventory-20 was translated into a Chinese version, which was applied to measure the fatigue status of cancer patients prior to commencing chemotherapy and during the last week of chemotherapy, respectively. The reliability and criterion-related validity of the Chinese version of the Multidimensional Fatigue Inventory-20 were assessed by calculating Cronbach's α and Pearson correlation coefficients. The construct validity was analyzed by employing factor analysis.

MAIN RESULTS

There were three dimensions in the Chinese version of the MFI-20, which measures the physical, mental, and spiritual fatigue of patients with cancer. All of the correlation coefficients between EORTC QLQ-C30V3.0 and MFI-20 were statistically significant (P < 0.0001). The Cronbach's α coefficient was more than 0.8 and 0.7 for total MFI-20 and for the three dimensions of the Chinese version of the MFI-20, respectively.

CONCLUSIONS

The Chinese version of the MFI-20 is a reliable and valid instrument to assess fatigue in Chinese patients with cancer.

Measuring the relationship of quality of life and health status, including tumor burden, symptoms, and biochemical measures in patients with neuroendocrine tumors

The measurement of health-related quality of life (HRQOL) has become essential for evaluating the impact of neuroendocrine tumors (NETs) on symptoms and social, emotional, psychological, and physical functioning of patients who harbor these tumors. This article describes instruments that have been developed to capture the spectrum of symptoms and the impact of the disease on their overall well-being. The authors discuss the importance of adequate sensitivity, specificity, and reproducibility and the value of psychometric factor analysis to explore the domains that embrace the manifestations of these tumors as well as aspects of the instruments that reflect tumor burden, biochemical, and hormonal status.

The EORTC cancer outpatient satisfaction with care questionnaire in ambulatory radiotherapy: EORTC OUT-PATSAT35 RT. Validation study for Spanish patients

OBJECTIVES

The EORTC OUT-PATSAT35 RT questionnaire evaluates the satisfaction with care (SC) expressed by cancer outpatients treated with radiotherapy. In this study we assess the psychometric properties of the OUT-PATSAT35 RT when applied to a sample of Spanish patients.

METHODS

A total of 100 patients with different tumor sites completed the EORTC core questionnaire, QLQ-C30, the OUT-PATSAT35 RT, the Oberst patients' perception of care quality and satisfaction scale (OS) and the item on intention to recommend the hospital (IR). Psychometric evaluation of the structure, reliability and validity of the questionnaire was conducted.

RESULTS

Multitrait-scaling analysis showed that 33 out of 34 item-scale correlation coefficients met the standards for convergent validity and that many of them met the standards for discriminant validity. Cronbach's coefficients were good (0.70-0.97) for all scales except environment. Correlations between the areas of the QLQ-C30 and OUT-PATSAT35 RT were generally low (<0.40). Correlations between the OS and the IR were moderate with the EORTC OUT-PATSAT35 RT. Areas whose contents were more related had higher correlation coefficients (>0.50), and vice versa (<0.20). Patients with higher scores on the OS and the IR, patients who had more visits to the doctor and patients who had a better performance status showed higher SC levels in 12, 8 and 1 OUT-PATSAT35 RT areas, respectively.

CONCLUSIONS

The OUT-PATSAT35 RT appears to be a reliable and valid instrument when applied to a sample of Spanish cancer patients. These results are in line with those of the validation study conducted by the authors of the questionnaire.

Health-related quality of life aspects in patients with low-grade glioma

Standard therapeutic options for brain tumors include surgery, radiotherapy, and chemotherapy. Unfortunately, these same therapies pose risks of neurotoxicity, the most common long-term complications being radiation necrosis, chemotherapy-associated leukoencephalopathy, and cognitive deficits. Currently, there is no consensus on the treatment strategy for these tumors. Because of the relatively slow growth rate of low-grade gliomas, patients have a relatively long expected survival. Compared to traditional outcome measures like (progression-free) survival, evaluation of health-related quality of life may be time-consuming and burdensome for both the patient and the doctor. Besides, given the relatively low incidence of brain tumors and the ultimately fatal outcome of the disease, the interest in HRQOL emerged relatively late in these patients. Moreover, the notion that the disease itself may affect the patient's ability to judge his or her own functioning may hinder the use of patient self-reported measures. The studies presented in this chapter describe outcomes of both single dimensional and multidimensional methods of studying HRQOL. Although only few studies incorporated HRQOL as outcome measure, most studies have embraced the notion that an accurate assessment of HRQOL must be based on patient self-report. HRQOL instruments from other cancer groups are adapted for use with brain tumor patients. The multidimensional scales used to study changes in HRQOL studies in brain tumor patients provide a more comprehensive view of what is important to the patient concerning living with their disease and receiving treatment. In future trials, more sensitive measures of long-term cognitive, functional, and HRQOL outcomes on LGG patients at important time points over the disease trajectory are needed to better understand the changing needs that take place over time.

The EORTC Quality of Life Questionnaire for patients with prostate cancer: EORTC QLQ-PR25. Validation study for Spanish patients

OBJECTIVES

The EORTC Quality of Life (QL) Group has developed a questionnaire, the EORTC QLQ-PR25, for evaluating QL in prostate cancer. The aim of this study is to assess the psychometric properties of the EORTC QLQPR25 when applied to a sample of Spanish patients.

MATERIALS AND METHODS

One hundred and thirty-seven prostate cancer patients with localised disease who started radiotherapy with radical intention combined with or without hormonotherapy prospectively completed the EORTC QLQ-C30 and EORTC QLQ-PR25 questionnaires three times: on the first and last day of radiotherapy and in the follow-up period. Psychometric evaluation of the questionnaires' structure, reliability and validity was conducted.

RESULTS

Multitrait scaling analysis showed that many of the item-scale correlation coefficients met the standards of convergent and discriminant validity. Exceptions appeared mainly in the scales for bowel symptoms and for hormonal- treatment-related symptoms. Cronbach's coefficients of the scales were good (0.72-0.86) for the urinary symptoms and sexual function scales but they were lower (<0.70) for the bowel and hormonal treatment scales. Most scales of the EORTC QLQ-PR25 had low to moderate intercorrelations. Correlations between the scales of the QLQ-C30 and the module were generally low. Group comparison analyses showed better QL in patients with higher Performance Status. Changes in QL appeared throughout the measurements. These were in line with the treatment process.

CONCLUSIONS

The EORTC QLQ-PR25 was a reliable and valid instrument when applied to a sample of Spanish prostate cancer patients. These results are in line with those of the EORTC validation study.

Short forms of subjective quality of life assessments from cross-cultural studies for use in surveys with different populations

Among several advances in quality of life (QOL) assessment development, such as cross-cultural comparability of measurements, inclusion of more specific target populations, and assessment on different levels of QOL generality, economy of measurement has become of increasing importance. As a consequence, construction of short forms and indices of original measures is common in QOL assessment development. The present paper puts special emphasis upon the issue of shortening measures and developing short forms in QOL assessment in relation to this development. Some basic principles and procedures of short-form development in general are outlined, and selected prominent examples of short-form development as applied to QOL assessment are described.

Development of the Norfolk quality of life tool for assessing patients with neuroendocrine tumors

OBJECTIVE

To develop a disease-specific questionnaire for identifying domains having the greatest impact on the quality of life (QOL) of patients with neuroendocrine tumors (NETS).

METHODS

Patient responses to clinical interviews provided an 80-item initial pool for the development of the QOL-NET. The Delphi panel reviewed the items for content validity; the patient focus group reviewed the items for content/readability. Domains were derived from analysis of224 questionnaire responses. After principal components analysis, a scree plot suggested 7 domains. Exploratory factor analysis with forced 7-factor varimax rotation determined an ideal structure. Reliability/reproducibility was determined by test/retest 4 to 6 weeks apart. Logistic regression determined each domain score.

RESULTS

All 7 domains exhibited strong internal consistency (Cronbach alpha = 0.86-0.97). Physical functioning contributed 40% of the total QOL score, followed by flushing, gastrointestinal symptoms, respiratory, cardiovascular, depression, and attitude domains. Most items loaded 0.40 or higher. No significant differences in test and retest scores. The mean values for the total QOL and 4 of 7 factor scores were significantly higher (P < 0.05) for NETS than controls: sensitivity was 71.4% and specificity was 69.6% to discriminate the NETS from the controls.

CONCLUSIONS

We developed a 7-domain tool to determine QOL in NETS. Strong internal consistency exists within each domain of the QOL-NET. The QOL-NET is reliable and reproducible but weakly identifies NETS. Physical functioning is a greatest contributor to QOL impairment in NETS.

Improving the health and well-being of cancer survivors: past as prologue

During the past two decades, there have been a number of unsuccessful replication attempts of our finding that group psychotherapy improves cancer survival. One explanation for this failure is that the wrong phenomenon has been studied. Rather than focusing on the effects of the psychotherapeutic relationship, perhaps, the focus should have been on the social support provided and networks developed by these groups. Since the late 1970s, a growing body of research indicates the importance of social networks and social support on reductions in not only all cause mortality, but also disease specific mortality including cancer. We have learned about how the health, well-being, and ultimate survival of cancer patients is improved by social support and social networks. The social milieu within which we live can provide resources that facilitate reintegration into society. These resources at the individual level, such as one's perception of social and emotional support, at the level of one's social ties with family and friends, and at the community level appear to improve survival across disease conditions including cancer. Even though, the mechanisms by which these endpoints are achieved remain elusive, there is much that can be done. The challenge of our time is to translate what we already know into programs to improve quality of life and to focus research toward increasing our understanding the mechanisms.

Validation of the simplified Chinese version of the quality of life instrument EORTC QLQ-LC43 for patients with lung cancer

PURPOSE

To validate the simplified Chinese version of the EORTC QLQ-LC43 for lung cancer patients.

METHODS

The simplified Chinese version of the QLQ-LC43 was used to measure quality of life (QOL) of 181 in-patients with lung cancer at three time points before and after treatment. Psychometric properties of the instrument were evaluated based on the QOL data collected from the patients using correlation analysis, factor analysis and paired t-test.

RESULTS

The test-retest reliability r for most domains was higher than 0.60 with a range from 0.53 to 0.80. The internal consistency alpha for all domains was higher than 0.65 except for cognitive functioning (0.32). Correlation analysis and factor analysis demonstrated good construct validity. The instrument reflected the differences in QOL scores among different age groups, indicating known-groups validity, and revealed good criterion-related validity when FACT-L was used as the criterion. The instrument detected changes of QOL with higher standardized response mean for the patients before and after treatment.

CONCLUSION

The Chinese version of QLQ-LC43 can be used to measure QOL for Chinese patients with lung cancer with good validity, reliability and responsiveness.

Management of depression for people with cancer (SMaRT oncology 1): a randomised trial

BACKGROUND

Major depressive disorder severely impairs the quality of life of patients with medical disorders such as cancer, but evidence to guide its management is scarce. We aimed to assess the efficacy and cost of a nurse-delivered complex intervention that was designed to treat major depressive disorder in patients who have cancer.

METHODS

We did a randomised trial in a regional cancer centre in Scotland, UK. 200 outpatients who had cancer with a prognosis of greater than 6 months and major depressive disorder (identified by screening) were eligible and agreed to take part. Their mean age was 56.6 (SD 11.9) years, and 141 (71%) were women. We randomly assigned 99 of these participants to usual care, and 101 to usual care plus the intervention, with minimisation for sex, age, diagnosis, and extent of disease. The intervention was delivered by a cancer nurse at the centre over an average of seven sessions. The primary outcome was the difference in mean score on the self-reported Symptom Checklist-20 depression scale (range 0 to 4) at 3 months after randomisation. Analysis was by intention to treat. This trial is registered as ISRCTN84767225.

FINDINGS

Primary outcome data were missing for four patients. For 196 patients for whom we had data at 3 months, the adjusted difference in mean Symptom Checklist-20 depression score, between those who received the intervention and those who did not, was 0.34 (95% CI 0.13-0.55). This treatment effect was sustained at 6 and 12 months. The intervention also improved anxiety and fatigue but not pain or physical functioning. It cost an additional pound sterling 5278 (US$10 556) per quality-adjusted life-year gained.

INTERPRETATION

The intervention-Depression Care for People with Cancer-offers a model for the management of major depressive disorder in patients with cancer and other medical disorders who are attending specialist medical services that is feasible, acceptable, and potentially cost effective.

Validation of the simplified Chinese version of the FACT-B for measuring quality of life for patients with breast cancer

The simplified Chinese version of the FACT-B was evaluated by QOL data measured from 376 patients with breast cancer. The results showed that test-retest reliability for five domains: physical well-being, social/family well-being, emotional well-being, functional well-being, additional concerns, and the overall scales and trial outcome index were 0.82, 0.85, 0.91, 0.86, 0.90, 0.84 and 0.91, 0.89 respectively. The internal consistency alpha for the five domains mentioned above were 0.85, 0.82, 0.84, 0.84 and 0.59 respectively. Correlation analysis, factor analysis and structural equation model showed good construct validity. Criterion-related validity was also confirmed using QLICP-BR as a criterion. The instrument can find the change of QOL for cancer patients after treatment. It's concluded that the simplified Chinese version of FACT-B can be used to measure QOL for Chinese patients with breast cancer with good validity, reliability and responsiveness.

Psychometric properties of the simplified Chinese version of the EORTC QLQ-BR53 for measuring quality of life for breast cancer patients

A Simplified Chinese version of the EORTC QLQ-BR53 was evaluated using responses from 233 patients with breast cancer in China by assessing the construct and criterion-related validity, internal consistency and test-retest reliability, and responsiveness as measured by score changes of the scales. Internal consistency reliability measured by Cronbach's coefficient alpha is greater than 0.75 for most multi-item scales except cognitive functioning (0.41) and breast symptoms (0.71). Test-retest reliability coefficients for all domains are greater than 0.80 with the exception of physical functioning (0.65), social functioning (0.75), appetite loss (0.75), diarrhea (0.72), and body image (0.72). Correlation and factor analysis among domains and items showed good construct validity for both QLQ-C30 and QLQ-BR23. Score changes over time were observed in most domains except emotional functioning, global health status/QOL, dyspnoea, constipation, diarrhea, financial difficulties, sexual functioning, sexual enjoyment, and breast symptoms. Therefore, the Simplified Chinese version of QLQ-BR53 shows reasonable validity, reliability, and responsiveness and can be used to measure QOL for Chinese patients with breast cancer.

Quality of Life assessment through the EORTC questionnaires of colorectal cancer patients in advanced disease stages

PURPOSE

The purpose of the present work is to evaluate Quality of Life in a group of colorectal cancer patients in advanced stages of their disease, along a standard chemotherapy treatment protocol, through the EORTC core questionnaire QLQ-C30 and the colorectal cancer module QLQ-CR38. These two questionnaires had previously been validated in our country. The present study has the novelty of its use during the chemotherapy treatment.

MATERIALS AND METHODS

A consecutive sample of 44 colon o rectal cancer patients in stage IV, from an initial group of 46 patients who were addressed, have filled in the questionnaires, in three moments during their treatment process. Clinical and demographic data have also been recorded. Quality of Life scores and changes in them among the three assessments have been calculated.

RESULTS

The quality of life scores of patients who have followed the treatment have been >70 points (100) in most dimensions, and has shown similar to the clinical data. Changes of >20 points in the quality of life scores during the treatment process appear in areas related to toxicity, fatigue and insomnia. Quality of life has been stable or has had small changes (between 10 and 20 points) in most dimensions.

CONCLUSIONS

Quality of Life in the present sample has been good in general. The treatment has been administered to patients who could tolerate it adequately.

Quality of Life assessment through the EORTC questionnaires of locally advanced rectal cancer patients treated with preoperative chemo-radiotherapy

PURPOSE

To assess the quality of life in a group of rectal cancer patients during the treatment period.

MATERIAL AND METHODS

A sample of 83 rectal cancer patients in Dukes' stages B2 or C who started a chemoradiotherapy treatment followed by surgery, have filled in the EORTC core questionnaire QLQC30 and the colorectal module QLQ-CR38, in three moments during the treatment and follow-up periods: at the beginning of the treatment, at the end of the chemoradiotherapy, and after surgery. Clinical and demographic data have also been recorded. Quality of Life scores and changes in them among the three assessments have been calculated.

RESULTS

Quality of life scores of patients who have followed the treatment has been good in most dimensions, and has shown similar to the clinical data. Soft and moderate alterations have appeared in the areas of disease symptoms, treatment toxicity, fatigue, emotional and sexual functioning, and also in functional areas after surgery. Quality of life has been stable or has had small changes in most dimensions. A worsening in toxicity areas has appeared after the neoadyuvant treatment. After surgery there has been a worsening in functional areas, fatigue and appetite loss, and an improvement in diarrhoea.

CONCLUSIONS

Quality of life scores and clinical data indicate that the situation of the patients who have received the treatments has been good. Patients under treatment stood it adequately.

Methadone treatment of chronic non-malignant pain and opioid dependence - A long-term follow-up

Iatrogenic opioid addiction among chronic pain patients was the initiative for starting a methadone programme for pain patients at the University Hospital of Uppsala. The aims were to improve pain relief and quality of life in pain patients with problematic opioid use and to investigate background factors explaining problems with opioid use.

METHODS

Records of all 60 patients included in the methadone programme 1994-2002 were studied. An interview was done after a mean of 34 months of methadone treatment regarding pain relief, quality of life and side effects on 48 patients.

RESULTS

Titration of oral methadone mixture in daily doses ranging from 10 to 350 mg (mean 99.5 mg) was done on all patients. Background factors were low back and musculoskeletal pain in 40%, psychiatric disease in 68%, and substance use disorder in 32% of the patients. Before methadone treatment all patients were on sick leave. After treatment five patients returned to work. Ten patients failed treatment, 4 due to intractable nausea, 4 to drug diversion, 1 because of methadone related arrhythmia and 1 because of insufficient analgesia. Pain relief was rated good by 75% and moderate by 25% of the patients. Global quality of life was rated at mean of 50(0-100), which favourably compares with Swedish chronic pain patients mean 33(0-100).

CONCLUSION

A structured methadone programme can be used for treating chronic pain patients with opioid dependence improving pain relief and quality of life. However, side effects and serious adverse events may limit the beneficial effects of the method.

Improvement of quality of life with Shenfu injection in non small cell lung cancer patients treated with gemcitabine plus cisplatin regimen

OBJECTIVE

To observe the effect of Shenfu injection (SFI) in treating non small cell lung cancer (NSCLC) patients on quality of life with gemcitabine (GEM) plus cisplatin (GP) regimen.

METHODS

Thirty-four patients were ready to receive GP regimen chemotherapy for treating NSCLC disease, according to lot-drawing, they were divided into SFI pre-treatment group (18 cases) and SFI post-treatment group (16 cases). SFI pre-treatment group: During the first treatment course, chemotherapy was begun with SFI 60 ml, intravenous dripping on the 3rd day, once daily, consecutively for 10 days; on the 1st day, GP regimen (GEM 1250 mg/m(2), intravenous dripping, on the 1st and 8th day; cisplatin 70 mg/m(2) on the 2nd day; 21 days as one cycle) was carried out; in the second treatment course GP regimen was merely given to serve as the self-control. SFI post-treatment group: the medicament sequence order was reversed from that of pre-treatment group. Using dual international quality of life (QOL) scores, the effect of SFI on the patients' QOL was observed through randomized self pre- and post-crossover control.

RESULTS

The QOL in the 34 patients after being treated by SFI in combination with GP chemotherapy regimen in one group, and GP chemotherapy regimen alone in the other, was improved in different degrees, with significant difference (P < 0.01); comparison of SFI combined with GP chemotherapy regimen with GP chemotherapy alone showed that QOL in patients was significantly different (P < 0.01).

CONCLUSION

SFI could improve QOL in patients with NSCLC who were treated with GP regimen.

Understanding cancer patients' experience and outcomes: development and pilot study of the Cancer Care Outcomes Research and Surveillance patient survey

GOALS OF WORK

The National Cancer Institute's Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium is conducting a population-based study of newly diagnosed patients with lung and colorectal cancer to describe the experience of persons living with cancer and to understand which barriers present the most significant obstacles to their receipt of appropriate care. The keystone to this effort is the baseline patient survey administered approximately 4 months after diagnosis.

PATIENTS AND METHODS

We developed a survey to obtain information from patients newly diagnosed with lung and colorectal cancer about their personal characteristics, decision making, experience of care, and outcomes. We conducted a pilot study to evaluate the feasibility of a lengthy and clinically detailed interview in a convenience sample of patients within 8 months of diagnosis (n=71).

MAIN RESULTS

The median length of the interviews was 75 min for patients with lung cancer (range 43-130) and 82 min for patients with colorectal cancer (range 46-119). Most patients had received some form of treatment for their cancer: 66.1% had undergone surgery, 28.2% had received radiation therapy, and 54.9% were treated with chemotherapy. In addition, 26.7% reported their overall health was less than 70 on a 0-100 scale, demonstrating that patients with substantial health impairment were able to complete the survey.

CONCLUSIONS

A clinically detailed survey of newly diagnosed lung and colorectal cancer patients is feasible. A modified version of this survey is being fielded by the CanCORS Consortium and should provide much needed population-based data regarding patients' experiences across the continuum of cancer care and their outcomes.

Quality of life in patients with locally advanced head and neck cancer treated with chemoradiotherapy. Comparison of two protocols using the EORTC questionnaires (QLQ-C30, H&N35)

INTRODUCTION

The objective of this study is to assess the quality of life (QoL) of two groups of patients during treatment for locally advanced head and neck (H and N) cancer.

MATERIAL AND METHODS

Two samples of 30 patients each in AJCC stages III and IV undergoing either of two chemo-radiotherapy protocols completed the EORTC QLQ-C30 general questionnaire and the QLQ-H and N35 H and N module on three occasions during the treatment and follow-up periods. We also collected clinical data. The QoL scores and their evolution over the three measurements were calculated and both protocols were compared during the treatment period.

RESULTS

The QoL scores are acceptable in general. Limitations were observed in relation to toxicity, psycho-social and some functional areas during the treatment. QoL improved in the follow-up period. The clinical and QoL data are better in one of the two treatment protocols.

DISCUSSION

The QoL scores indicate that the condition of the patients receiving the protocols was acceptable, considering the severity of their disease. The treatments were reasonably-well tolerated.

[Pain experience and pain therapy of tumor patients in the view of general practitioners]

AIM

The aim of the study presented in this paper is to find out how general practitioners evaluate their cancer patients' health, quality of life and type and extent of pain. In addition the study aims to get information about the training in pain therapy and palliative medicine.

METHODS

A representative sample of 440 of all Austrian general practitioners was interviewed via a standardized questionnaire. The consent for the questioning had been obtained by telephone.

RESULTS

The state of health and quality of life of the treated cancer patients are described as little satisfying and most unfavourably affected by the disease. The physicians suppose that the patients experience pain more intense than could be expected of them as endurable. Nevertheless the cancer patients appreciate pain therapy.

CONCLUSION

As a result the medical training in pain therapy and palliative medicine should be improved. At the same time the future general practitioners should gain psychological competences, which would consequently provide them with a broad spectrum of treatment needed when dealing with pain patients (suffering from cancer).

Development of a questionnaire to evaluate the information needs of cancer patients: the EORTC questionnaire

Information disclosure is one of the key areas of support that patients may receive. The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group has a group working on the development of a questionnaire that evaluates information received by cancer patients at different stages of their disease--EORTC QLQ-INFO30. This instrument is being developed by professionals from most European regions. The questionnaire aims to evaluate the information received by cancer patients on different areas of the disease, diagnosis, treatment and care. Besides, the instrument also assesses qualitative aspects of the information they have received. The present paper presents the first two phases of the module development process that include literature review, interviews with patients and professionals, and formulation of the items. All these steps have been carried out in different countries and have been approved by the EORTC QLG.

The health-related quality-of-life impact of histamine dihydrochloride plus interleukin-2 compared with interleukin-2 alone in patients with metastatic melanoma

The aim of this study was to compare the quality-of-life (QOL) effects of interleukin-2 (IL-2) alone with those of IL-2 plus histamine dihydrochloride in the setting of a multicenter, randomized trial for patients with metastatic melanoma. QOL data were collected from July 1997 to March 2000 during a phase III trial comparing subcutaneous histamine plus IL-2 and IL-2 alone. Prior to each treatment cycle, patients completed the 76-item Quality-of-Well-Being Scale-Self-Administered (QWB-SA) questionnaire, the Overall State of Health (OSH) item, and the General Health Perception (GHP) item. A longitudinal data analysis using the generalized estimating equations approach was performed to compare changes in QWB-SA scores over time between treatment groups, and predicted QWB-SA scores from the regression analysis were used to calculate quality-adjusted survival duration over the 12-month study period. QOL analyses were conducted for all randomized patients (intent-to-treat overall population, ITT-OA) and all patients who had liver metastases at randomization (ITT-LM population). In the ITT-OA population, differences in QWB-SA scores over time between the histamine plus IL-2 group (150 patients) and the IL-2 alone group (151 patients) were not significant (P=0.511, type III F test). In the ITT-LM population (53 histamine plus IL-2 patients and 73 IL-2 alone patients), changes in QWB-SA scores over time favored the histamine plus IL-2 group (P=0.018, type III F-test). In both the ITT-OA and ITT-LM populations, QWB-SA scores deteriorated more quickly over time in the IL-2 alone group than in the histamine plus IL-2 group, resulting in a significant difference in median quality-adjusted survival duration in favor of the histamine plus IL-2 group by 31.3 days in the ITT-OA population (P=0.007, Mann-Whitney U-test), and 50.2 days in the ITT-LM population (P=0.011). OSH and GHP scores did not differ between groups. The addition of subcutaneous histamine dihydrochloride to IL-2 treatment improved median quality-adjusted survival duration and did not adversely affect QOL in patients with malignant melanoma.

Health-related quality-of-life measurement in randomized clinical trials in breast cancer--taking stock

Measurement of health-related quality-of-life (HRQOL) in randomized clinical trials in breast cancer has become common. In this review, we take stock of the contribution that HRQOL measurement in breast cancer clinical trials makes to clinical decision making regarding selection of optimal treatment. A series of MEDLINE searches was conducted to identify all randomized trials in breast cancer that included self-reported HRQOL or psychosocial outcomes. A total of 256 citations were identified that included HRQOL or psychosocial outcomes in breast cancer patients, and 66 of these involved randomized clinical trials of treatment. These 66 reports of breast cancer clinical trials of treatment are discussed in this review. Forty-six of the trials evaluated biomedical interventions, and 20 evaluated psychosocial interventions. Among the biomedical trials, eight trials evaluated HRQOL in primary management of breast cancer, seven trials evaluated HRQOL in adjuvant therapy of breast cancer patients, 20 trials involved metastatic breast cancer, eight trials involved symptom control/supportive care, and three trials evaluated different approaches to investigation or follow-up of breast cancer patients. Among the psychosocial trials, 13 trials evaluated HRQOL in adjuvant therapy of breast cancer patients, and their partners or spouses, six trials involved metastatic breast cancer, and one trial focused on symptom control. We found that the contribution of HRQOL measurement to clinical decision making depended on the clinical setting. In primary management of breast cancer, where medical outcomes of several treatment options are equivalent, HRQOL measurement provided added information for clinical decision making beyond that of traditional medical outcomes. In trials in the adjuvant setting, HRQOL measurement did not influence clinical decision making. In metastatic disease, HRQOL outcomes provided little information beyond that obtained from traditional medical outcomes, including toxicity. In the symptom control/supportive care setting, results of HRQOL questionnaires targeting specific symptoms (e.g., emesis) guided treatment decisions. In psychosocial intervention trials, psychosocial and/or HRQOL measurements often provided the only outcome information; therefore, selection of instruments that captured attributes likely to be altered by the intervention was essential. Until results of ongoing trials in breast cancer are available, caution is recommended in initiating new HRQOL studies unless treatment equivalency is expected, or unless the HRQOL questions target unique or specific issues that can only be addressed through patient self-report, including outcomes of psychosocial interventions.

Quality of life in palliative care: principles and practice

In healthcare, most researchers and clinicians agree that quality of life (QOL) is related to symptoms, functioning, psychological and social wellbeing, and probably to a lesser extent to meaning and fulfillment. This multidimensional health-oriented concept has been named health-related quality of life (HRQOL). However, during end-of-life care spirituality and existential issues become more prominent, as well as family members' perception of quality of care. Outcome measures in palliative care require constructs that reflect the specific goals of palliative care, such as improving QOL before death, symptom control, family support and satisfaction, as well as patients' perceptions of 'purpose' and 'meaning of life'. It is generally recommended that internationally developed and validated patient-rated multidimensional questionnaires should be used when assessing HRQOL in research. However, 'multidimensionality', with often more than 10 possible outcomes, is a threat both to statistical analysis and clinical interpretation of data. Preferentially, a more limited number of outcomes based upon the research question(s) should be defined prior to data collection in the study protocol. The researcher needs to carefully evaluate the content of the questionnaire, in addition to other properties, such as the validity and reliability, before the final decision is made with regards to which instrument to use in a given study.

The EORTC QLQ-C30 (version 3.0) Quality of Life questionnaire: validation study for Spain with head and neck cancer patients

The EORTC Quality of Life Study Group has developed a questionnaire for evaluating Quality of Life in international clinical trials: QLQ-C30. The purpose of the present work is to validate the third version of this questionnaire (3.0) for use in Spain. Two hundred and one head and neck cancer patients completed the QLQ-C30 at one or two time points during the treatment and follow-up periods, and a subsample completed the questionnaire on three occasions. Psychometric evaluation of the structure, reliability and validity of the questionnaire was undertaken. The data support the structure and the reliability of the scales. Validity was confirmed in three ways: the interscale correlations are statistically significant and moderate, several scales and items discriminate among groups of patients with different scores on the clinical variables, and some scales reflect significant changes during treatment and the follow-up period. The EORTC QLQ-C30 (version 3.0) is a reliable and valid questionnaire when applied to a sample of Spanish head and neck cancer patients. These results are in line with previous studies.