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Hu X, Kaplan CM, Martin MY, Walker MS, Stepanski E, Schwartzberg LS, Vidal GA, Graetz I. Race Differences in Patient-Reported Symptoms during Chemotherapy among Women with Early-Stage Hormone Receptor-Positive Breast Cancer. Cancer Epidemiol Biomarkers Prev 2023; 32:167-174. [PMID: 36166516 PMCID: PMC9905215 DOI: 10.1158/1055-9965.epi-22-0692] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/22/2022] [Accepted: 09/20/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Symptom burden differences may contribute to racial disparities in breast cancer survival. We compared symptom changes from before to during chemotherapy among women with breast cancer. METHODS This observational study followed a cohort of Black and White women diagnosed with Stage I-III, hormone receptor-positive breast cancer from a large cancer center in 2007 to 2015, and reported symptoms before and during chemotherapy. We identified patients who experienced a one-standard deviation (SD) increase in symptom burden after starting chemotherapy using four validated composite scores (General Physical Symptoms, Treatment Side Effects, Acute Distress, and Despair). Kitagawa-Blinder-Oaxaca decomposition was used to quantify race differences in symptom changes explained by baseline characteristics (sociodemographic, baseline scores, cancer stage) and first-line chemotherapy regimens. RESULTS Among 1,273 patients, Black women (n = 405, 31.8%) were more likely to report one-SD increase in General Physical Symptoms (55.6% vs. 48.2%, P = 0.015), Treatment Side Effects (74.0% vs. 63.4%, P < 0.001), and Acute Distress (27.4% vs. 20.0%, P = 0.010) than White women. Baseline characteristics and first-line chemotherapy regimens explained a large and significant proportion of the difference in Acute Distress changes (93.7%, P = 0.001), but not General Physical Symptoms (25.7%, P = 0.25) or Treatment Side Effects (16.4%, P = 0.28). CONCLUSIONS Black women with early-stage breast cancer were more likely to experience significant increases in physical and psychological symptom burden during chemotherapy. Most of the difference in physical symptom changes remained unexplained by baseline characteristics, which suggests inadequate symptom management among Black women. IMPACT Future studies should identify strategies to improve symptom management among Black women and reduce differences in symptom burden. See related commentary by Rosenzweig and Mazanec, p. 157.
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Affiliation(s)
- Xin Hu
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Cameron M Kaplan
- Gehr Family Center for Health Systems Science and Innovation, Keck School of Medicine of USC, Los Angeles, California
| | - Michelle Y Martin
- Center for Innovation in Health Equity Research, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | | | | | - Gregory A Vidal
- West Cancer Center and Research Institute, Germantown, Tennessee.,School of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ilana Graetz
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Barbosa-Leiker C, Burduli E, Arias-Losado R, Muller C, Noonan C, Suchy-Dicey A, Nelson L, Verney SP, Montine TJ, Buchwald D. Testing gender and longitudinal measurement invariance of the SF-36 in American Indian older adults: The strong heart study. Psychol Assess 2022; 34:870-879. [PMID: 35787064 PMCID: PMC9962347 DOI: 10.1037/pas0001153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Information about the equality of psychometric properties of the medical outcomes study (MOS) Short Form-36 (SF-36), a health status measure, across gender and across the lifespan for American Indian adults is lacking. We tested measurement invariance (configural, metric, scalar invariance) of the physical and mental components between gender and over time in a sample of 2,709 (1,054 men, 1,654 women) American Indian older adults at three time points, and across a 6-year time frame. Measurement invariance of a 2-factor higher-order model was demonstrated between gender at each time point. Tests of longitudinal invariance indicated longitudinal measurement invariance over time. Multiple-group latent means analysis indicated men had significantly higher physical and mental component latent means compared to women at each time point, and longitudinal latent means analysis found physical and mental component latent means decreased over time. The 2-factor higher-order model SF-36 is valid for American Indian older adults over a 6-year time frame. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Clemma Muller
- Elson S. Floyd College of Medicine, Washington State University
- Institute for Research and Education to Advance Community Health, Washington State University
| | - Carolyn Noonan
- Elson S. Floyd College of Medicine, Washington State University
- Institute for Research and Education to Advance Community Health, Washington State University
| | - Astrid Suchy-Dicey
- Elson S. Floyd College of Medicine, Washington State University
- Institute for Research and Education to Advance Community Health, Washington State University
| | - Lonnie Nelson
- College of Nursing, Washington State University
- Institute for Research and Education to Advance Community Health, Washington State University
| | | | | | - Dedra Buchwald
- Elson S. Floyd College of Medicine, Washington State University
- Institute for Research and Education to Advance Community Health, Washington State University
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Quality of Life (QoL) among Health Care Workers with Diabetes Mellitus: A Literature Review. Clin Pract 2021; 11:801-826. [PMID: 34842622 PMCID: PMC8628687 DOI: 10.3390/clinpract11040096] [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] [Received: 09/30/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This scoping literature review explores the impact of diabetes mellitus (DM) on the health-related quality of life (HRQoL) of health care workers (HCWs). HCWs play a vital role in the global health care system, with the COVID-19 pandemic demonstrating their effectiveness and worth beyond any doubt. However, HCWs are among the most vulnerable members of the health care system because they are most susceptible to stress, exhaustion, and occupational health risks. METHOD The review was conducted in 2021 and included articles published in English in the past five years that explore diabetic HCWs' QoL and studies intended to assess the relationship between work stress and DM. In total, 27 relevant articles were found that satisfied the inclusion criteria and were critically and thematically analyzed. RESULTS Most DM studies have focused on the clinical management of patients, but researchers have paid little attention to the high-risk group of HCWs with diabetes. In addition to fulfilling their job mandate, HCWs are burdened with various sociological stressors that affect their QoL. CONCLUSION This literature review suggests DM has a significant impact on QoL in the work-life context. However, there is limited evidence to demonstrate the impact of DM on the QoL of HCWs. Thus, further research is needed in this area to improve the provision of integrated care.
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Hu X, Chehal PK, Kaplan C, Krukowski RA, Lan RH, Stepanski E, Schwartzberg L, Vidal G, Graetz I. Characterization of Clinical Symptoms by Race Among Women With Early-Stage, Hormone Receptor-Positive Breast Cancer Before Starting Chemotherapy. JAMA Netw Open 2021; 4:e2112076. [PMID: 34061200 PMCID: PMC8170541 DOI: 10.1001/jamanetworkopen.2021.12076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Race disparities persist in breast cancer mortality rates. One factor associated with these disparities may be differences in symptom burden, which may reduce chemotherapy tolerance and increase early treatment discontinuation. OBJECTIVES To compare symptom burden by race among women with early-stage breast cancer before starting chemotherapy and quantify symptom differences explained by baseline characteristics. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional analysis of symptom burden differences by race among Black and White women with a diagnosis of stage I to III, hormone receptor-positive breast cancer who had a symptom report collected before chemotherapy initiation in a large cancer center in the southern region of the US from January 1, 2007, through December 31, 2015. Analyses were conducted from November 1, 2019, to March 31, 2021. Blinder-Oaxaca decomposition was used, adjusting for baseline sociodemographic and clinical characteristics. MAIN OUTCOMES AND MEASURES Four symptom composite scores with a mean (SD) of 50 (10) were reported before starting chemotherapy (baseline) and were derived from symptom items: general physical symptoms (11 items), treatment adverse effects (8 items), acute distress (4 items), and despair (7 items). Patients rated the severity of each symptom they experienced in the past week on a scale of 0 to 10 (where 0 indicates not a problem and 10 indicates as bad as possible). RESULTS A total of 1338 women (mean [SD] age, 54.6 [11.6] years; 420 Black women [31.4%] and 918 White women [68.6%]) were included in the study. Before starting chemotherapy, Black women reported a statistically significantly higher (ie, worse) symptom composite score than White women for adverse effects (44.5 vs 43.8) but a lower acute distress score (48.5 vs 51.0). Decomposition analyses showed that Black patients' characteristics were associated with higher symptom burden across all 4 scores. However, these differences were offset by relatively greater, statistically significant, unexplained physical, distress, and despair symptom reporting by White patients. CONCLUSIONS AND RELEVANCE In this study, before starting chemotherapy, Black patients with early-stage breast cancer reported significantly higher burden for symptoms that may be exacerbated with chemotherapy and lower distress symptoms compared with White patients. Future studies should explore how symptoms change before and after treatment and differ by racial/ethnic groups and how they are associated with treatment adherence and mortality disparities.
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Affiliation(s)
- Xin Hu
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Puneet K. Chehal
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Cameron Kaplan
- Gehr Family Center for Health Systems Science and Innovation, Keck School of Medicine of University of Southern California, Los Angeles
| | | | - Roy H. Lan
- College of Medicine, University of Tennessee Health Science Center, Memphis
| | | | - Lee Schwartzberg
- West Cancer Center and Research Institute, Germantown, Tennessee
| | - Gregory Vidal
- West Cancer Center and Research Institute, Germantown, Tennessee
- Division of Hematology and Oncology, University of Tennessee Health Science Center, Memphis
| | - Ilana Graetz
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Giordano A, Testa S, Bassi M, Cilia S, Bertolotto A, Quartuccio ME, Pietrolongo E, Falautano M, Grobberio M, Niccolai C, Allegri B, Viterbo RG, Confalonieri P, Giovannetti AM, Cocco E, Grasso MG, Lugaresi A, Ferriani E, Nocentini U, Zaffaroni M, De Livera A, Jelinek G, Solari A, Rosato R. Assessing measurement invariance of MSQOL-54 across Italian and English versions. Qual Life Res 2019; 29:783-791. [PMID: 31707695 DOI: 10.1007/s11136-019-02352-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The Multiple Sclerosis Quality of Life-54 (MSQOL-54) is a specific multiple sclerosis (MS) health-related quality of life inventory consisting of 52 items organized into 12 subscales plus two single items. No study was found in literature assessing its measurement invariance across language versions. We investigated whether MSQOL-54 items provide unbiased measurements of underlying constructs across Italian and English versions. METHODS Three constrained levels of measurement invariance were evaluated: configural invariance where equivalent numbers of factors/factor patterns were required; metric invariance where equivalent factor loadings were required; and scalar invariance where equivalent item intercepts between groups were required. Comparative fit index (CFI), root mean square error of approximation (RMSEA), and standardized root mean square residual (SRMR) fit indices and their changes between nested models were used to assess tenability of invariance constraints. RESULTS Overall, the dataset included 3669 MS patients: 1605 (44%) Italian, mean age 41 years, 62% women, 69% with mild level of disability; 2064 (56%) English-speaking (840 [41%] from North America, 797 [39%] from Australasia, 427 [20%] from UK and Ireland), mean age 46 years, 83% women, 54% with mild level of disability. The configural invariance model showed acceptable fit (RMSEA = 0.052, CFI = 0.904, SRMR = 0.046); imposing loadings and intercepts equality constraints produced negligible worsening of fit (ΔRMSEA < 0.001, ΔCFI = - 0.002, ΔSRMR = 0.002 for metric invariance; ΔRMSEA = 0.003, ΔCFI = - 0.013, ΔSRMR = 0.003 for scalar invariance). CONCLUSIONS These findings support measurement invariance of the MSQOL-54 across the two language versions, suggesting that the questionnaire has the same meaning and the same measurement paramaters in the Italian and English versions.
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Affiliation(s)
- Andrea Giordano
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
- Department of Psychology, University of Turin, Turin, Italy
| | - Silvia Testa
- Department of Psychology, University of Turin, Turin, Italy
- Department of Human and Social Sciences, University of Aosta Valley , Aosta, Italy
| | - Marta Bassi
- Department of Biomedical and Clinical Sciences L. Sacco, Università di Milano, Milan, Italy
| | - Sabina Cilia
- Multiple Sclerosis Center, University Polyclinic Hospital G. Rodolico, Catania, Italy
| | - Antonio Bertolotto
- Neurology & Regional Referral Multiple Sclerosis Centre (CReSM), University Hospital San Luigi Gonzaga, Orbassano, Italy
| | | | - Erika Pietrolongo
- Department of Neurosciences, Imaging and Clinical Sciences, University G. D'Annunzio, Chieti, Italy
| | - Monica Falautano
- Servizio di Psicologia e Neuropsicologia, UO di Neurologia e Riabilitazione Specialistica, San Raffaele Hospital, Milan, Italy
| | - Monica Grobberio
- Laboratory of Clinical Neuropsychology, Psychology Unit, ASST Lariana, Como, Italy
| | - Claudia Niccolai
- IRCCS Fondazione Carlo Gnocchi, Florence, Italy
- Department of NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy
| | - Beatrice Allegri
- Multiple Sclerosis Center, Neurology Unit, Hospital of Vaio, Fidenza, Italy
| | - Rosa Gemma Viterbo
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Paolo Confalonieri
- Unit of Neuroimmunology and Neuromuscular Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ambra Mara Giovannetti
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
- Unit of Neuroimmunology and Neuromuscular Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Eleonora Cocco
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
- Multiple Sclerosis Center, ASSL Cagliari, ATS Sardegna, Cagliari, Italy
| | | | - Alessandra Lugaresi
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Elisa Ferriani
- UOC Psicologia Ospedaliera, AUSL di Bologna, Bologna, Italy
| | - Ugo Nocentini
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Neurology and Neurorehabilitation Unit, IRCCS S. Lucia Foundation, Rome, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Centre, ASST Valle Olona, Gallarate, Italy
| | - Alysha De Livera
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
| | - George Jelinek
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Rosalba Rosato
- Department of Psychology, University of Turin, Turin, Italy
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Khatami F, Shafiee G, Kamali K, Ebrahimi M, Azimi M, Ahadi Z, Sharifi F, Tanjani PT, Heshmat R. Correlation between malnutrition and health-related quality of life (HRQOL) in elderly Iranian adults. J Int Med Res 2019; 48:300060519863497. [PMID: 31502490 PMCID: PMC7140194 DOI: 10.1177/0300060519863497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives We aimed to evaluate the association of nutritional status and health-related
quality of life (HRQOL) among elderly Iranian residents. Methods We used the 36-item Short Form Health Survey (SF-36) to assess HRQOL among
participants with normal nutrition status, at risk of malnutrition, and
malnourished. Results Mean group scores for the Physical Component Summary (PCS) of the SF-36 were
44, 36.5, and 29.0 for normal, at-risk, and malnourished groups,
respectively; for the Mental Component Summary (MCS), these were 47.1, 40.7,
and 34.8, respectively. The PCS and MCS displayed significant positive
correlation with malnutrition in three models: crude (I); age- and
sex-adjusted (II); and adjusted for age, sex, education, occupation, marital
status, and residence. Standardized beta coefficients of PCS in Models I–III
were 1.35, 1.27, and 1.14, respectively; for MCS, these were 1.11 in all
three models; all results were statistically significant. Estimated results
of logistic regression were −6.023 for malnourished versus well-nourished
and −2.652 for malnourished versus at risk of malnutrition. Conclusion Our analyses revealed the crucial impact of nutritional status on both mental
and physical components of HRQOL.
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Affiliation(s)
- Fatemeh Khatami
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gita Shafiee
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Koorosh Kamali
- Department of Public Health, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mehdi Ebrahimi
- Department of Internal Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Zeinab Ahadi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Sharifi
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa Taheri Tanjani
- Department of Internal Medicine, Ayatollah Taleghani Hospital, Research Development Unit, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Hopman WM, Berger C, Joseph L, Morin SN, Towheed T, Anastassiades T, Adachi JD, Hanley DA, Prior JC, Goltzman D. Longitudinal assessment of health-related quality of life in osteoporosis: data from the population-based Canadian Multicentre Osteoporosis Study. Osteoporos Int 2019; 30:1635-1644. [PMID: 31069440 DOI: 10.1007/s00198-019-05000-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/22/2019] [Indexed: 01/22/2023]
Abstract
UNLABELLED Little is known about the association between health-related quality of life (HRQOL) and osteoporosis in the absence of fracture, and how HRQOL may change over time. This study provides evidence of substantially reduced HRQOL in women and men with self-reported and/or BMD-confirmed osteoporosis, even in the absence of fragility fracture. INTRODUCTION Fragility fractures have a detrimental effect on the health-related quality of life (HRQOL) of those with osteoporosis. Less is known about the association between HRQOL and osteoporosis in the absence of fracture. METHODS Canadian Multicentre Osteoporosis Study participants completed the SF-36, a detailed health questionnaire and measures of bone mineral density (BMD) at baseline and follow-up. We report the results of participants ≥ 50 years with 10-year follow-up. Self-reported osteoporosis at baseline and BMD-based osteoporosis at follow-up were ascertained. Multivariable linear regression models were developed for baseline SF-36 domains, component summaries, and change over time, adjusting for relevant baseline information. RESULTS Baseline data were available for 5266 women and 2112 men. Women in the osteoporosis group had substantially lower SF-36 baseline scores, particularly in the physically oriented domains, than those without osteoporosis. A similar but attenuated pattern was evident for the men. After 10-year follow-up (2797 women and 1023 men), most domain scores dropped for women and men regardless of osteoporosis status, with the exception of mentally-oriented ones. In general, a fragility fracture was associated with lower SF-36 scores and larger declines over time. CONCLUSIONS This study provides evidence of substantially reduced HRQOL in women and men with self-reported and/or BMD-confirmed osteoporosis, even in the absence of fragility fracture. HRQOL should be thoroughly investigated even prior to fracture, to develop appropriate interventions for all stages of the disease.
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Affiliation(s)
- W M Hopman
- Kingston General Health Research Institute, Kingston Health Sciences Centre, Kingston, Ontario, Canada.
- Department of Public Health Sciences, Faculty of Medicine, Queen's University, Kingston, Ontario, Canada.
| | - C Berger
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - L Joseph
- Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
| | - S N Morin
- Department of Medicine, McGill University, Montréal, QC, Canada
| | - T Towheed
- Division of Rheumatology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - T Anastassiades
- Division of Rheumatology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - J D Adachi
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - D A Hanley
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada
| | - J C Prior
- Department of Medicine/Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - D Goltzman
- Department of Medicine, McGill University, Montréal, QC, Canada
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Development of a Traditional Chinese Medicine Syndrome-Specific Scale for Ulcerative Colitis: The Large Intestine Dampness-Heat Syndrome Questionnaire. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:4039019. [PMID: 30108653 PMCID: PMC6077564 DOI: 10.1155/2018/4039019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/21/2018] [Accepted: 06/28/2018] [Indexed: 01/15/2023]
Abstract
The aim of this study was to develop and validate the large intestine dampness-heat syndrome questionnaire (LIDHSQ) for patients with ulcerative colitis (UC). The domains and items of the LIDHSQ were developed according to standard procedures, namely, construct definition, item generation, language testing, content validity, pilot study, and validation study. At first, a total of 20 items in 3 domains were generated based on literature review and expert consultation. After the item selection, the LIDHSQ contains 11 items in three domains: disease-related domain (diarrhoea, abdominal pain, bloody purulent stool, and mucus stool), heat domain (fever, dry mouth, red tongue, yellow fur, and anal burning), and dampness domain (greasy fur and defecation disorder). The Cronbach's alphas of all domains were greater than 0.6. All of the intraclass correlation coefficients were greater than 0.8. The LIDHSQ and domain scores of the patients with LIDHS were higher than those of the patients with other syndromes (P < 0.001). The area under the receiver operating characteristic curve of the LIDHSQ was 0.900, with a 95% confidence interval of 0.872–0.928. When the cut-off value of the LIDHSQ was ≥ 7, the sensitivity and specificity were 0.867 and 0.854, respectively. The LIDHSQ is valid and reliable for measuring LIDHS in UC patients with good diagnostic efficacy. We recommend the use of the LIDHSQ in Chinese UC patients.
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Wu X, Sawatzky R, Hopman W, Mayo N, Sajobi TT, Liu J, Prior J, Papaioannou A, Josse RG, Towheed T, Davison KS, Lix LM. Latent variable mixture models to test for differential item functioning: a population-based analysis. Health Qual Life Outcomes 2017; 15:102. [PMID: 28506313 PMCID: PMC5433241 DOI: 10.1186/s12955-017-0674-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 05/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Comparisons of population health status using self-report measures such as the SF-36 rest on the assumption that the measured items have a common interpretation across sub-groups. However, self-report measures may be sensitive to differential item functioning (DIF), which occurs when sub-groups with the same underlying health status have a different probability of item response. This study tested for DIF on the SF-36 physical functioning (PF) and mental health (MH) sub-scales in population-based data using latent variable mixture models (LVMMs). METHODS Data were from the Canadian Multicentre Osteoporosis Study (CaMos), a prospective national cohort study. LVMMs were applied to the ten PF and five MH SF-36 items. A standard two-parameter graded response model with one latent class was compared to multi-class LVMMs. Multivariable logistic regression models with pseudo-class random draws characterized the latent classes on demographic and health variables. RESULTS The CaMos cohort consisted of 9423 respondents. A three-class LVMM fit the PF sub-scale, with class proportions of 0.59, 0.24, and 0.17. For the MH sub-scale, a two-class model fit the data, with class proportions of 0.69 and 0.31. For PF items, the probabilities of reporting greater limitations were consistently higher in classes 2 and 3 than class 1. For MH items, respondents in class 2 reported more health problems than in class 1. Differences in item thresholds and factor loadings between one-class and multi-class models were observed for both sub-scales. Demographic and health variables were associated with class membership. CONCLUSIONS This study revealed DIF in population-based SF-36 data; the results suggest that PF and MH sub-scale scores may not be comparable across sub-groups defined by demographic and health status variables, although effects were frequently small to moderate in size. Evaluation of DIF should be a routine step when analysing population-based self-report data to ensure valid comparisons amongst sub-groups.
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Affiliation(s)
- Xiuyun Wu
- School of Public Health, University of Alberta, Edmonton, AB, Canada.,School of Public Health and Health Management, Weifang Medical University, Weifang, Shandong Province, China
| | - Richard Sawatzky
- School of Nursing, Trinity Western University & Centre for Health Evaluation and Outcomes Sciences, Providence Health Care, Langley, BC, Canada
| | - Wilma Hopman
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Nancy Mayo
- McGill University Health Centre, Montréal, QC, Canada
| | - Tolulope T Sajobi
- Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Juxin Liu
- Department of Mathematics and Statistics, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jerilynn Prior
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Robert G Josse
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tanveer Towheed
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - K Shawn Davison
- Faculty of Graduate Studies, University of Victoria, Victoria, BC, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB, R3E 0W3, Canada.
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10
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Wang L, Xu X, Zhang Y, Hao H, Chen L, Su T, Zhang Y, Ma W, Xie Y, Wang T, Yang F, He L, Wang W, Fu X, Ma Y. A model of health education and management for osteoporosis prevention. Exp Ther Med 2016; 12:3797-3805. [PMID: 28105113 DOI: 10.3892/etm.2016.3822] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/23/2016] [Indexed: 01/29/2023] Open
Abstract
Osteoporosis, a chronic disease with no therapeutic cure, affects a growing number of people as the aging population in China rapidly increases. Therefore, developing an evidence-based model of health education and management for osteoporosis prevention is required. In the present study, an osteoporosis club was established, which is a novel model of health education and management for osteoporosis prevention. A unified management of membership was used based on a digitized database. A total of 436 patients with osteoporosis were randomly assigned to the osteoporosis club group or the self-management control group. For the osteoporosis club group, multiple activities of health education were performed, including monthly systematic health education lectures, exercise programs and communication parties once a year. For the control group, the participants took charge of their own musculoskeletal health. All data of the participants were collected and evaluated prior to and following intervention. In the pre-intervention assessment, no significant difference was identified in the health education between the two groups. Through the four-year intervention, the osteoporosis knowledge, health beliefs, living behavior, medication compliance, quality of life and bone mineral density of the osteoporosis club group were improved significantly compared with the control group (P<0.001), while the pain degree of the osteoporosis club group was relieved significantly more compared with the control group (P<0.001). The results in the present study suggest that setting up an osteoporosis club is an evidence-based model of health education and management for osteoporosis prevention in China.
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Affiliation(s)
- Liang Wang
- Center of Orthopedics, The 309th Hospital of People's Liberation Army, Beijing 100091, P.R. China
| | - Xiaowen Xu
- Center of Orthopedics, The 309th Hospital of People's Liberation Army, Beijing 100091, P.R. China
| | - Yan Zhang
- Center for Systems Biomedical Sciences, University of Shanghai for Science and Technology, Shanghai 200093, P.R. China
| | - Hongxia Hao
- Center of Orthopedics, The 309th Hospital of People's Liberation Army, Beijing 100091, P.R. China
| | - Liying Chen
- Center of Orthopedics, The 309th Hospital of People's Liberation Army, Beijing 100091, P.R. China
| | - Tianjiao Su
- Center of Orthopedics, The 309th Hospital of People's Liberation Army, Beijing 100091, P.R. China
| | - Yan Zhang
- Center of Orthopedics, The 309th Hospital of People's Liberation Army, Beijing 100091, P.R. China
| | - Weifeng Ma
- Center of Orthopedics, The 309th Hospital of People's Liberation Army, Beijing 100091, P.R. China
| | - Yuanyuan Xie
- Center of Orthopedics, The 309th Hospital of People's Liberation Army, Beijing 100091, P.R. China
| | - Tiantian Wang
- Center of Orthopedics, The 309th Hospital of People's Liberation Army, Beijing 100091, P.R. China
| | - Fan Yang
- Center of Orthopedics, The 309th Hospital of People's Liberation Army, Beijing 100091, P.R. China
| | - Li He
- Division of Science and Technology, National Institute for Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing 100050, P.R. China
| | - Wenjiao Wang
- Center of Orthopedics, The 309th Hospital of People's Liberation Army, Beijing 100091, P.R. China
| | - Xuemei Fu
- Center of Orthopedics, The 309th Hospital of People's Liberation Army, Beijing 100091, P.R. China
| | - Yuanzheng Ma
- Center of Orthopedics, The 309th Hospital of People's Liberation Army, Beijing 100091, P.R. China
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Measurement equivalence across gender and education in the WHOQOL-BREF for community-dwelling elderly Taiwanese. Int Psychogeriatr 2016; 28:1375-82. [PMID: 27097756 DOI: 10.1017/s1041610216000594] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The WHOQOL-BREF, a generic quality of life (QoL) instrument, has been widely used clinically and for research on older populations. However, its measurement equivalence/invariance (ME/I) has not been well examined for the elderly (≥ 65 years) across some different demographics. METHODS The data were derived from a cross-sectional study with a convenience sampling design in Taiwan. We enrolled 244 elderly participants: men = 143 (58.6%); educational level ≤ primary school = 121 (49.6%). The ME/I was examined using multiple group confirmatory factor analysis (MGCFA) across gender and educational level. RESULTS The fit indices were satisfactory for the configural models of gender and educational level (standardized root mean square residual [SRMR] = 0.0742 and 0.0770; root mean square error of approximation [RMSEA] = 0.0655 and 0.0686; comparative fit index [CFI] = 0.953). In addition, MGCFAs showed that ME/I was supported across gender (ΔSRMR = 0.001 to 0.019; ΔRMSEA = -0.003 to 0.001; ΔCFI = -0.003 to 0.000) and educational level (ΔSRMR = 0.002 to 0.006; ΔRMSEA = -0.002 to 0.004; ΔCFI = -0.007 to 0.000). CONCLUSION The WHOQOL-BREF Taiwan version is appropriate for combined use and for comparisons in older people across gender and different educational levels.
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Su Y, Mo CW, Cheng WQ, Wang L, Xu Q, Wu ZC, Wu ZL, Liu LZ, Chen XL. Development and validation of quality of life scale of nasopharyngeal carcinoma patients: the QOL-NPC (version 2). Health Qual Life Outcomes 2016; 14:76. [PMID: 27164979 PMCID: PMC4862168 DOI: 10.1186/s12955-016-0480-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/03/2016] [Indexed: 11/12/2022] Open
Abstract
Background The aim was to develop and validate the quality of life scale for nasopharyngeal carcinoma (NPC) patients, the QOL-NPC (version 2), a specific instrument to measure quality of life for NPC patients. Methods The QOL-NPC was developed and validated according to standard procedures. The patients were assessed using the QOL-NPC, FACT-G, and FACT-H&N. Classical test theory was used to evaluate the reliability, validity, and responsiveness of the QOL-NPC. Results A total of 487 patients (97.4 %) completed the questionnaire. The QOL-NPC comprised four domains, as follows: physical function (eight items); psychological function (five items); social function (five items); and side effects (eight items). All of the items had a lower proportion of missing data. Cronbach's alpha values of the domains ranged from 0.72 to 0.84. The split-half reliability coefficients ranged from 0.77 to 0.84. All of the intra-class correlation coefficients were > 0.8. The normed fit index, non-normed fit index, and comparative fit index were >0.89. The root mean square error of approximation was 0.097, with a 90 % confidence interval (0.093, 0.100). The domain scores of the QOL-NPC were significantly correlated with the FACT-G and FACT-H&N (P < 0.05). All of the domain scores of patients using different amounts of radiotherapy were significantly different (P < 0.001). All domain scores decreased at the completion of radiotherapy, with effect sizes ranging from −0.82 to −0.22. Conclusions The QOL-NPC is valid for measuring QOL with good reliability, validity, and responsiveness. The QOL-NPC is recommended to measure the QOL for Chinese NPC patients.
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Affiliation(s)
- Yong Su
- Department of Radiation Oncology, Cancer Centre, Sun Yat-sen University, Guangzhou, Guangdong Province, China.,Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, Guangdong Province, China
| | - Chuan-Wei Mo
- Department of Biostatistics and Preventive Medicine, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Wan-Qin Cheng
- Department of Radiation Oncology, Cancer Centre, Sun Yat-sen University, Guangzhou, Guangdong Province, China.,Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, Guangdong Province, China
| | - Lei Wang
- Department of Radiation Oncology, Cancer Centre, Sun Yat-sen University, Guangzhou, Guangdong Province, China.,Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, Guangdong Province, China
| | - Qian Xu
- Department of Biostatistics and Preventive Medicine, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Zu-Chun Wu
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Zhe-Li Wu
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Li-Zhi Liu
- Department of Radiation Oncology, Cancer Centre, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Xin-Lin Chen
- Department of Biostatistics and Preventive Medicine, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China.
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13
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Differential Item Functioning in the SF-36 Physical Functioning and Mental Health Sub-Scales: A Population-Based Investigation in the Canadian Multicentre Osteoporosis Study. PLoS One 2016; 11:e0151519. [PMID: 26998611 PMCID: PMC4801323 DOI: 10.1371/journal.pone.0151519] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 02/29/2016] [Indexed: 11/24/2022] Open
Abstract
Background Self-reported health status measures, like the Short Form 36-item Health Survey (SF-36), can provide rich information about the overall health of a population and its components, such as physical, mental, and social health. However, differential item functioning (DIF), which arises when population sub-groups with the same underlying (i.e., latent) level of health have different measured item response probabilities, may compromise the comparability of these measures. The purpose of this study was to test for DIF on the SF-36 physical functioning (PF) and mental health (MH) sub-scale items in a Canadian population-based sample. Methods Study data were from the prospective Canadian Multicentre Osteoporosis Study (CaMos), which collected baseline data in 1996–1997. DIF was tested using a multiple indicators multiple causes (MIMIC) method. Confirmatory factor analysis defined the latent variable measurement model for the item responses and latent variable regression with demographic and health status covariates (i.e., sex, age group, body weight, self-perceived general health) produced estimates of the magnitude of DIF effects. Results The CaMos cohort consisted of 9423 respondents; 69.4% were female and 51.7% were less than 65 years. Eight of 10 items on the PF sub-scale and four of five items on the MH sub-scale exhibited DIF. Large DIF effects were observed on PF sub-scale items about vigorous and moderate activities, lifting and carrying groceries, walking one block, and bathing or dressing. On the MH sub-scale items, all DIF effects were small or moderate in size. Conclusions SF-36 PF and MH sub-scale scores were not comparable across population sub-groups defined by demographic and health status variables due to the effects of DIF, although the magnitude of this bias was not large for most items. We recommend testing and adjusting for DIF to ensure comparability of the SF-36 in population-based investigations.
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Bandayrel K, Johnston BC. Recent advances in patient and proxy-reported quality of life research. Health Qual Life Outcomes 2014; 12:110. [PMID: 25169205 PMCID: PMC4159521 DOI: 10.1186/s12955-014-0110-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 06/24/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND A number of articles addressing various aspects of health-related quality of life (HRQoL) were published in the Health and Quality of Life Outcomes (HQLO) journal in 2012 and 2013. This review provides a summary of studies describing recent methodological advances and innovations in HRQoL felt to be of relevance to clinicians and researchers. METHODS Scoping review of original research articles, reviews and short reports published in the HQLO journal in 2012 and 2013. Publications describing methodological advances and innovations in HRQoL were reviewed in detail, summarized and grouped into thematic categories. RESULTS 358 titles and abstracts were screened initially, and 16 were considered relevant and incorporated in this review. Two studies discussed development and interpretation of HRQoL outcomes; two described pediatric HRQoL measurement; four involved incorporation of HRQoL in economic evaluations; and eight described methodological issues and innovations in HRQoL measures. CONCLUSIONS Several studies describing important advancements and innovations in HRQoL, such as the development of the PROMIS pediatric proxy-item bank and guidelines for constructing patient-reported outcome (PRO) instruments, were published in the HQLO journal in 2012 and 2013. Proposed future directions for the majority of these studies include extension and further validation of the research across a diverse range of health conditions.
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Affiliation(s)
- Kristofer Bandayrel
- />Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario Canada
- />Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario Canada
- />Peter Gilgan Centre for Research and Learning, Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9848, Toronto, ON M5G 0A4 Canada
| | - Bradley C Johnston
- />Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario Canada
- />Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario Canada
- />Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Canada
- />Peter Gilgan Centre for Research and Learning, Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9848, Toronto, ON M5G 0A4 Canada
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Chen XL, Qiu ZW, Gu MF, Su Y, Liu LZ, Liu Y, Mo CW, Xu Q, Sun J, Li DH. Translation and validation of the Chinese version of the Quality OF Life Radiation Therapy Instrument and the Head & Neck Module (QOL-RTI/H&N). Health Qual Life Outcomes 2014; 12:51. [PMID: 24731442 PMCID: PMC4022371 DOI: 10.1186/1477-7525-12-51] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 04/08/2014] [Indexed: 12/03/2022] Open
Abstract
Background To translate and validate the Chinese version of the Quality Of Life Radiation Therapy Instrument and the Head & Neck Module (QOL-RTI/H&N), a disease-specific scale to measure quality of life (QOL) for patients with head and neck cancer (HNC) who received radiotherapy. Methods The QOL-RTI/H&N was translated and validated according to the standard process: a translation and back-translation procedure, pilot testing and a validation study. HNC patients were enrolled from the Cancer Center of Sun Yat-sen University and assessed using the QOL-RTI/H&N, QLQ-C30 and QLQ-H&N35. Reliability (internal consistency reliability, split-half reliability and test-retest reliability), validity (content validity, construct validity, criterion validity and discriminant validity), and responsiveness analysis were performed to evaluate the psychometric characteristics of the QOL-RTI/H&N. Results A total of 238 patients (99.2%) completed the questionnaire. Item RTI23 had 16.0% missing data. Other items had low percentages of missing data (0.4% or 0.8%) or no missing data. The average time to finish the scale was 9.8 minutes. Cronbach's alpha of the domains ranged from 0.41 to 0.77. The split-half reliability coefficients ranged from 0.43 to 0.77. All of the intra-class correlation coefficients were equal to or greater than 0.8. All of the item-own domain correlation coefficients were greater than those of the item-other domain. Confirmatory factor analysis showed that Comparative Fit Index, Normed Fit Index and Non-Normed Fit Index were equal to 1.00. Root Mean Square Error of Approximation was 0.01, with 90% CI (0.00, 0.10). The domain scores of the QOL-RTI/H&N were significantly correlated with those of the QLQ-C30 or QLQ-H&N3. All domain scores of patients in different radiotherapy stages were statistically significant (P < 0.05), apart from the speech domain. Conclusions The Chinese version of the QOL-RTI/H&N is a valid, reliable and responsive scale to measure QOL in HNC patients and can be used to assess the effects of radiotherapy treatment on these patients.
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Affiliation(s)
| | | | - Mo-fa Gu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong province, China.
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