The EORTC QLQ43 and FACT H&N questionnaires of quality of life at 1 and 5 years after treatment and dental care in head and neck cancer patients: a pilot study.

PURPOSE: This study aimed to examine health-related quality of life (HRQoL) in head and neck cancer patients at 1 and 5 years after successful treatment of their tumors, and to explore the usefulness of 2 instruments for assessing the need of dental care services. METHODS: This cross-sectional pilot study included 20 adult patients with head and neck cancer who completed the Functional Assessment of Cancer Therapy-Head and Neck (FACT H&N) Symptom Index and the European Organization for Research and Treatment of Cancer Quality of Life Head and Neck Module (EORTC QLQ-H&N43) after 1 and 5 years of treatment. RESULTS: Mean (standard deviation, SD) scores of the FACT H&N Symptom Index were higher (better HRQoL) at 5 years than at 1 year (24.1 [4.4] vs. 21.1 [6.4]; p = 0.236). Only three of the ten items of FACT H&N (swallow, pain in mouth/throat or neck, and solid foods) evaluated oral health. In the EORTC QLQ-H&N43 questionnaire, scores were lower at 5 years (better HRQoL) in almost all multi- and single-item symptoms. This questionnaire includes four multi-item scales (pain in the mouth, social eating, swallowing, and problems with teeth) measuring dental and orthodontic needs. CONCLUSION: HRQoL in patients with head and neck cancer improved with the length of follow-up. The EORTC QLQ-H&N43 has more items addressing oral health compared to the FACT H&N Symptom Index and may be more adequate to assess the need of dental therapy in clinical practice.

Validation of the Mexican version of the EORTC QLQ-CR29 in patients with colorectal cancer.

BACKGROUND: The evaluation of the quality of life (QoL) of patients with colorectal cancer (CRC) is an essential measure to measure the impact of the disease and treatments on the lives of patients. However, in Latin America there is no validated and reliable instrument to assess this construct. OBJECTIVES: This study aims to validate the EORTC QLQ-CR29 instrument in the Mexican population with CRC. METHODS: This study aims to validate the EORTC QLQ-CR29 instrument in the Mexican population with CRC. The study used an instrumental design and a nonprobabilistic sample due to availability, made up of 251 patients with CRC, with an average age of 54.7 ± 12.28 years. Exploratory and confirmatory factor analyses were performed, as well as concurrent validity tests. RESULTS: The exploratory factorial analysis yielded 4 factors that explained 51.64% of the variance, with a Cronbach reliability coefficient of .766 and an Omega index of .725. The confirmatory factor analysis indicated that the proposed theoretical model fits the data almost perfectly, with an error close to 0, which shows that it is a balanced and parsimonious instrument to measure the QoL of the patients with CRC. SIGNIFICANCE OF RESULTS: The EORTC QLQ-CR29 instrument proved to be a valid and reliable instrument for use in clinical care and research directed at patients with CRC in Mexico. Its use is recommended by multidisciplinary health teams in oncology in Mexico, since it allows knowing the patient's perspective on the impact of CRC on their life, guiding therapeutic decision-making and being a primary outcome measure.

Health-Related Quality of Life Outcomes With Two Different Starting Doses of Lenvatinib in Combination With Everolimus for Previously Treated Renal Cell Carcinoma.

BACKGROUND: Preserving health-related quality of life (HRQOL) is an important goal during renal cell carcinoma treatment. We report HRQOL outcomes from a phase II trial (NCT03173560). PATIENTS AND METHODS: HRQOL data were collected during a multicenter, randomized, open-label phase II study comparing the safety and efficacy of 2 different starting doses of lenvatinib (18 mg vs. 14 mg daily) in combination with everolimus (5 mg daily), following one prior vascular endothelial growth factor-targeted treatment. HRQOL was measured using 3 different instruments-FKSI-DRS, EORTC QLQ-C30, and EQ-5D-3L-which were all secondary endpoints. Change from baseline was assessed using linear mixed-effects models. Deterioration events for time to deterioration (TTD) analyses were defined using established thresholds for minimally important differences in the change from baseline for each scale. TTD for each treatment arm was estimated using the Kaplan-Meier method. RESULTS: Baseline characteristics of the 343 participants randomly assigned to 18 mg lenvatinib (n = 171) and 14 mg lenvatinib (n = 172) were well balanced. Least-squares mean estimates for change from baseline were favorable for the 18 mg group over the 14 mg group for the FKSI-DRS and most EORTC QLQ-C30 scales, but differences between treatments did not exceed the minimally important thresholds. Median TTD was longer among participants in the 18 mg group than those in the 14 mg group for most scales. CONCLUSIONS: Participants who received an 18 mg lenvatinib starting dose had favorable HRQOL scores and longer TTD on most scales compared with those who received a 14 mg starting dose.

Health-related quality of life in long-term Caribbean prostate cancer survivors: comparisons with prostate cancer-free men.

PURPOSE: Prostate cancer (PCa) and its treatment can impact health-related quality of life (HRQoL). There are few studies of HRQoL in long-term PCa survivors of African ancestry from low- and middle-income countries. We examined the effect of PCa treatment on HRQoL of Jamaican PCa survivors compared with cancer-free controls and explored the effect of demographic and clinical factors on these outcomes. METHODS: PCa survivors (n = 64) treated with and without ADT along with PCa-free controls (n = 88) from a case-control study of 10 years post enrolment. HRQoL was measured using the European Organisation for Research and Treatment of Cancer Quality of Life (EORTC-QLQ-C30). Effects of demographic and clinical variables on HRQoL on PCa and type of therapy were evaluated in multivariable linear regression models. RESULTS: HRQoL of PCa survivors (overall and by treatment group) indicated a high quality of life, comparable to PCa-free men. However, ADT-treated survivors had lower physical functioning that was of small clinical relevance compared with those not on ADT. Symptom burden scores of PCa survivors and controls were similar excluding fatigue and dyspnoea which were highest in men on ADT and controls. In multivariable models, PCa was not an important determinant of overall HRQoL, functioning or symptom burdens. Underlying medical conditions and marital status were the main contributors to HRQoL in PCa survivors. CONCLUSION: PCa cancer status was not an independent determinant of long-term HRQoL in Jamaican men. Interventions addressing social factors and comorbid illnesses could improve HRQOL in long-term PCa survivors.

Translation and psychometric validity of the Brazilian version of the European Organisation for Research and Treatment of Cancer-colorectal liver metastases module.

Patients with liver metastasis of colorectal cancer (CRC) experience important lifestyle changes that impair the quality of life (QoL). The use of instruments is important to assess the cancer patients' QoL. To develop a Brazilian translation of the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Colorectal Liver Metastases (QLQ-LMC21) questionnaire, and to investigate psychometric validity in patients with CRC with liver metastases, patients with liver metastasis from CRC answered the Brazilian versions of EORTC core Quality of Life Questionnaire-Core 30 (QLQ-C30) and the QLQ-LMC21 module, a demographic data questionnaire and a questionnaire to assess understanding against the translated QLQ-LMC21. Data collection was performed in three Southern hospitals in Brazil, from August 2017 to August 2019. Descriptive analyses and Spearman's correlation tests were performed for construct and criterion validity. The Cronbach's alpha test was performed to assess reliability. Significant values were p < 0.05. Ten patients participated in the study for the pilot test and 106 for validation, with a mean age of 58.2 + 12.4 years old. The translated questionnaire was easy to understand for the participants in the pilot test phase, with no need for modification. In the validation of the convergent construct, all the correlations were significant (p < 0.001) and with coefficients above 0.53. In the discriminant validity, among items of different scales, the values of the divergent correlations were pain scale (0.005 to 0.186) and fatigue (-0.01 to 0.186), all non-significant. In the criterion validation, the correlations were significant, p < 0.05, and higher among similar scales of the QLQ-LMC21 and QLQ-C30, p-value < 0.001. The total internal consistency of the questionnaire was adequate, with a Cronbach's alpha value of 0.790. The Brazilian version of the QLQ LMC21 proved to be a valid reliable questionnaire to be used in conjunction with the QLQ-C30.

Validation of the QLQ-EN24 instrument for the assessment of health-related quality of life for women with endometrial cancer in México.

PURPOSE: The impact of disease activity or treatments on health-related quality of life (HRQL) is crucial in Oncology, but adequate instruments for this assessment are scarce. Our aim is to validate the Mexican-Spanish version of the QLQ-EN24 questionnaire to evaluate HRQL in women with endometrial cancer (EC). METHODS: This is a prospective study of Mexican women with EC, attending a single cancer centre, who responded the QLQ-C30 and QLQ-EN24 instruments; usual psychometric analysis were performed as well as the association of HRQL scales and relevant clinical data. Correlation analysis was performed with the Spearman's method, reliability analysis with the Cronbach's alpha, known-group comparisons with the Kruskal-Wallis test, and survival analysis with the Kaplan-Meier method and Log-rank test. RESULTS: One hundred and eighty-nine women with EC were assessed. Most functional scales reported high values, and most symptom scales, low. Questionnaire compliance rates were high and internal consistency tests demonstrated adequate convergent and divergent validity. Cronbach's α coefficients of the five multi-item scales the QLQ-EN24 instruments were from 0.659 to 0.887. Scales of the QLQ-C30 and QLQ-EN24 instruments distinguished among clinically distinct groups of patients, particularly based on serum albumin levels. The Urological symptoms, Gastrointestinal symptoms, Body image, Pelvic pain and Taste change scales were significantly associated with OS. CONCLUSION: The Mexican-Spanish version of the QLQ-EN24 questionnaire is reliable and valid for the assessment of HRQL in patients with EC and can be broadly used in multi-national clinical trials. However, conclusions derived from scales evaluating sexual function should be handled carefully.

Underlying dimensions of the EORTC QLQ-C30 in a Cuban population of patients with advanced non-small cell lung cancer.

BACKGROUND: Quality of Life Core Questionnaire of the European Organization for the Research and Treatment of Cancer (EORTC QLQ-C30) is one of the most used quality of life questionnaires in cancer studies. It provides scores for five functional scales, nine symptom scales, and two single items which assess overall health status and quality of life. However, high correlations among QLQ-C30 items suggest a reduced dimensionality for the scale. OBJECTIVE: To assess the dimensionality of the EORTC QLQ-C30 using item response theory (IRT) in a training sample and confirmatory factor analysis (CFA) in a test sample. METHODS: We analyzed responses to QLQ-C30 from 1,107 patients with advanced lung cancer who were included in five clinical trials of immunotherapy. We used non-parametric and parametric IRT models (Mokken, and Samejima's graded response) in a random training set (n = 332) for initial assessment of dimensions and item characteristics of the QLQ-C30. Finally, we used CFA in the test set (n = 775) to confirm the measurement domains. RESULTS: Mokken model showed that QLQ-C30 fits a unidimensional scale, whereas Samejima model showed that most QLQ-C30 items present adequate difficulty and discrimination. All items showed adequate scalability indexes with an overall scalability of 0.47 (medium scale). The QLQ-C30-reduced dimensionality was confirmed by CFA (comparative fit index = 0.98, root mean square error of approximation = 0.055) with all items presenting factorial loadings > 0.40. CONCLUSIONS: The EORTC QLQ-C30 fits a unidimensional latent construct identified with perceived quality of life in advanced lung cancer patients. TRIAL REGISTRATION: RPCEC00000161, RPCEC00000181 and RPCEC00000205.

Validation of the Mexican-Spanish Version of the EORTC QLQ-OV28 Instrument for the Assessment of Quality of Life in Women with Ovarian Cancer.

BACKGROUND: Health-related quality of life (HRQL) is an important outcome measure in Oncology. AIM OF THE STUDY: To validate the Mexican-Spanish version of the QLQ-OV28 questionnaire to assess HRQL in women with ovarian cancer (OC). METHODS: The QLQ-C30 and QLQ-OV28 instruments were applied to women with OC attending a cancer center in Mexico. The usual psychometric analyses were performed; the Spearman's method was used for correlation analysis, reliability analysis with the Cronbach's alpha, known-group comparisons with the Kruskal-Wallis test, responsiveness was tested employing repeated measures ANOVA, and the association of scale scores and overall survival (OS) were analyzed with the Kaplan-Meier method and Cox's model. RESULTS: Two hundred fifty-two women with OC were included in this cohort. The instruments were well accepted and compliance rates were high; patients responded both instruments in <30 min. The QLQ-OV28 internal consistency tests demonstrated good convergent (Correlation coefficients [CC] 0.154‒0.694) and divergent validity (CC 0.003‒0.69). Cronbach's α coefficients of six of eight scales of the QLQ-OV28 instruments were >0.7 (range, 0.567‒0.857). Scales QLQ-OV28 instruments distinguished among clinically distinct groups of patients, particularly after basal serum albumin and basal Ca‒125 levels. The evaluation of responsiveness demonstrated that two scales of the QLQ-OV28 were sensitive to change over time during induction chemotherapy. Six scales of the QLQ-OV28 were associated with OS. CONCLUSIONS: The Mexican-Spanish version of the QLQ-OV28 questionnaire is reliable and valid for the assessment of HRQL in patients with OC and can be broadly used in clinical trials.

Total skin electron beam therapy for primary cutaneous T-cell lymphomas: clinical characteristics and outcomes in a Mexican reference center.

AIM: The aim of this study was to assess treatment modalities, treatment response, toxicity profile, disease progression and outcomes in 14 patients with a confirmed diagnosis of primary cutaneous T-cell lymphoma (PCTCL) treated with total skin electron beam therapy (TSEBT). BACKGROUND: Primary cutaneous lymphomas (PCLs) are extranodal non-Hodgkin lymphomas originating in the skin without evidence of extracutaneous disease at diagnosis. Despite advances in systemic and local therapy options, the management of advanced stages remains mostly palliative. MATERIALS AND METHODS: This is a retrospective study of patients with PCTCL, diagnosed and treated in a reference center in Mexico City, analyzing treatment modalities, response to treatment, long-term outcome, and mortality. RESULTS: Eight males (57%) and 6 (43%) females were identified. Most patients were stage IVA (n = 5, 36%) followed by stage IB and IIB (28.5% and 21.4%, respectively). Eleven patients received the low-dose RT scheme (12 Gy), 1 patient, the intermediate-dose RT scheme (24 Gy), and 2 patients, the conventional-dose RT scheme (36 Gy). Mean follow-up time was 4.6 years. At first follow-up examination, 6-8 weeks after radiotherapy, the overall response rate (ORR) for the cohort was 85%. The median PFS for the whole cohort was 6 months. CONCLUSION: This study reinforces the role of TSEBT when compared with other treatment modalities and novel agents. Low-dose TSEBT is now widely used because of the opportunity for retreatment.

Transitioning from conformal radiotherapy to intensity-modulated radiotherapy after radical prostatectomy: Clinical benefit, oncologic outcomes and incidence of gastrointestinal and urinary toxicities.

AIM: The purpose of this study was to review genitourinary (GU) and gastrointestinal (GI) toxicity associated with high-dose radiotherapy (RT) delivered with 3-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) or volumetric arc therapy (VMAT) following radical prostatectomy (RP). BACKGROUND: RP is a therapeutic option for the management of prostate cancer (PrCa). When assessing postoperative RT techniques for PrCa, the published literature focuses on patients treated with 2-dimensional conventional methods without reflecting the implementation of 3D-CRT, IMRT, or VMAT. MATERIALS AND METHODS: A total of 83 patients were included in this analysis; 30 patients received 3D-CRT, and 53 patients received IMRT/VMAT. Acute and late symptoms of the GU and lower GI tract were retrospectively graded according to the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer radiation toxicity grading systems. The relapse failure-free rate and overall survival were also evaluated. RESULTS: The rate of acute GU toxicity was 9.4% vs. 13.3% for the IMRT/VMAT and 3D-CRT groups (p = 0.583). The 5-year actuarial rates of late GI toxicity for IMRT/VMAT and 3D-CRT treatments were 1.9% and 6.7%, respectively. The rate of late GU toxicity for the IMRT/VMAT and 3D-CRT treatment groups was 7.5% and 16.6%, respectively (p = 0.199). We found no association between acute or late toxicity and the RT technique in univariate and multivariate analyses. CONCLUSION: Postprostatectomy IMRT/VMAT and 3D-CRT achieved similar morbidity and cancer control outcomes. The clinical benefit of highly conformal techniques in this setting is unclear although formal analysis is needed.

Content validation of the EORTC QLQ-C15-PAL with advanced cancer patients and health care professionals from palliative care services in Chile.

BACKGROUND: The assessment of patients' quality of life (QOL) is essential when evaluating the outcome of palliative care; however, no instruments have been validated for measuring symptoms and QOL in patients receiving palliative care in Chile. We aimed to investigate the content validity of the EORTC Quality of Life Questionnaire Core 15 Palliative Care (QLQ-C15-PAL), replicating the methods used previously to shorten the EORTC Quality of Life Questionnaire Core 30 (QLQ-C30) for use among patients in palliative care. METHODS: This cross-sectional study was conducted from October to November 2017 in four palliative care services. Patients with advanced cancer and health care professionals (HCPs) were invited to individual interviews to determine the relevance, appropriateness and relative importance of the 30 items of the QLQ-C30 for evaluating the outcome of palliative care, and whether relevant additional issues should be included. RESULTS: A total of 48 patients and 35 HCPs participated. The most important dimensions selected were pain, physical functioning, sleeping difficulties, emotional functioning, nausea/vomiting, fatigue, social functioning, lack of appetite, role functioning and constipation. Qualitative data identified important additional issues not covered by the questionnaire such as satisfaction with care, emotions and psychological support, as well as linguistic issues in the dyspnea and constipation items. CONCLUSIONS: The EORTC QLQ-C15-PAL showed good content validity in the assessment of symptoms and QOL of advanced cancer patients; therefore, we recommend the use of this questionnaire in palliative care in Chile. Dyspnea and constipation items were revised by the EORTC group. More research is needed to add a social dimension for a comprehensive assessment of patients' QOL.

Quality of life and health of breast cancer woman survivors in Popayan-Colombia / Calidad de vida y salud en mujeres sobrevivientes al cáncer de mama en Popayán- Colombia / Qualidade de vida e saúde em mulheres sobreviventes ao câncer de mama em Popayán, Colômbia

Objective: Identify the quality of life and its association with health parameters for breast cancer women survivors in Popayan, Colombia. Methods: Analytic crosssectional descriptive correlated study, with nonprobability sampling, according to the inclusion criteria of 39 women who survived breast cancer, who received a survey made by the authors which included sociodemographic aspects, evaluation of the quality of life through the questionnaire EORTC QLQ ­ BR23 and measurements such as the Body Mass Index (BMI), blood pressure and blood sugar levels, according to international standards. Results: The health indicators (blood pressure and blood sugar) are found under the normal ranges, while the BMI has a tendency for overweight. Regarding quality of life, high measurements for body image and sexual function were evidenced, while the dimensions of sexual pleasure and future perception showed intermediate measures. Regarding association, moderate correlations were observed between blood pressure and blood sugar levels, with body image and the sexual aspect. Conclusions: An association between the health indicators and the quality of life was observed, demonstrating the need to formulate prevention and intervention actions from an interdisciplinary vision. Also, it was observed that the quality of life requires a review toward self-confidence and relationship with oneself, through workshops or talks that allow to overcome limitations proper of the disease and to move on.

Objetivo: Identificar la calidad de vida y su asociación con parámetros de salud en mujeres sobrevivientes al cáncer de mama en Popayán, Colombia. Métodos: Estudio descriptivo-correlacional de corte transversal analítico, con una muestra no probabilística, de acuerdo con criterios de inclusión de 39 mujeres sobrevivientes al cáncer, a quienes se les aplicó una encuesta de elaboración propia con aspectos socio-demográficos, valoración de la calidad de vida mediante el cuestionario EORTC QLQ - BR23 y mediciones como el Índice de Masa corporal (IMC), presión arterial y niveles de glucemia, según estándares internacionales. Resultados: Los índices de salud (presión arterial y glucemia) se encontraron bajo los rangos de normalidad, mientras que para IMC hay tendencia de sobrepeso. Respecto a la calidad de vida, se evidenciaron mediciones elevadas para la imagen corporal y la función sexual, mientras que las dimensiones de disfrute sexual y percepción a futuro presentaron mediciones intermedias. Respecto a la asociación, se observaron correlaciones moderadas entre la presión arterial y los niveles de glucemia, con la imagen corporal y la parte sexual. Conclusiones: Se evidenció una asociación entre los indicadores de salud y calidad de vida, demostrando la necesidad de plantear acciones de prevención e intervención desde una visión interdisciplinaria. De la misma manera, se observó que la calidad de vida requiere una revisión hacia la autoconfianza y relación consigo misma, a través de talleres o charlas que permitan superar las limitaciones propias de la enfermedad y salir adelante.

Objetivo: Identificar a qualidade de vida e a sua associação com parâmetro de saúde em mulheres sobreviventes ao câncer de mama em Popayán, Colômbia. Métodos: Estudo descritivo-correlacional de corte transversal analítico, estudando uma a mostra probabilística de 39 mulheres sobreviventes ao câncer de mama, que responderam um instrumento de formulação própria com aspectos sociais e demográficos, avaliação da qualidade de vida empregando o questionário EORTC QLQ - BR23 e foram estabelecidos o índice de massa corporal (IMC), a pressão arterial e níveis de glicemia segundo padrões internacionais. Resultados: Os níveis de pressão arterial e glicemia encontraram-se nos rangos de normalidade, entretanto, o IMC mostrou a tendência ao sobrepeso. Na aferição da qualidade de vida, observaram-se medições elevadas na imagem corporal e função sexual, enquanto que as dimensões desfrute sexual e percepção do futuro presentaram aferições intermediarias. Na associação de variáveis houve uma moderada relação entre a pressão arterial e os níveis de glicemia com a imagem corporal e a parte sexual. Conclusões: Evidenciou-se a associação entre os indicadores de saúde e a qualidade de vida, demostrando a necessidade de formular ações de prevenção e intervenção desde uma perspectiva interdisciplinar. Do mesmo modo, observou-se que a qualidade de vida requer uma revisão dirigida à autoconfiança e relação com se mesma, através de oficinas ou conferencias que permitam superar as limitações próprias da doença e seguir em frente.

Comparison of overall survival and quality of life between patients undergoing anal reconstruction and patients undergoing traditional lower abdominal stoma after radical resection.

BACKGROUND: Miles procedure is often necessary for patients with low rectal carcinoma. However, this operation often affects the quality of life of patients, to evaluate the advantages of improved operation (anal reconstruction), the quality of life and survival between patients undergoing anal reconstruction and patients undergoing traditional lower abdominal stoma after radical resection were analyzed. METHODS: The clinical data of 43 patients with low situated rectal carcinoma were retrospectively analyzed. 23 patients with left lower abdominal stoma after radical resection (Miles procedure) were divided into group A, and 20 patients with reconstruction of the anus in situ after radical resection were in group B. All patients were investigated by the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR38 questionnaire, the clinical data are recorded. Independent sample T test was used to analyze the difference in quality of life between group A and group B at 3, 6, and 12 months after surgery, and Kaplan-Meier was used to compare the difference in overall survival between group A and group B. RESULTS: The results of T test showed that there were statistical significance in global health status and physical functioning between group A and group B at 3 and 6 months, but no statistical significance at 12 months (P = 0.024, P = 0.019, P = 0.115 for global health status; P = 0.004, P = 0.006, P = 0.065 for physical functioning, respectively). Emotional functioning and social functioning were also statistically significant between group A and group B at 3, 6, and 12 months (P = 0.041, P = 0.040, P = 0.034 for Emotional functioning; P = 0.020, P = 0.009, P = 0.032 for social functioning, respectively). This study also found that there was no statistical significance in body image and sexual functioning between group A and group B at 3 months, but there was statistical significance at 6 and 12 months(P = 0.098, P = 0.035, P = 0.045 for body image; P = 0.110, P = 0.048, P = 0.047 for sexual functioning, respectively). There were statistically significant about sexual enjoyment and defecation problems at 3, 6, and 12 months (P = 0.023, P = 0.028, P = 0.050 for sexual enjoyment; P = 0.013, P = 0.011, P = 0.050 for defecation problems, respectively).The results of Kaplan-Meier showed that the overall survival (OS) between group A and group B was not statistically significant (χ2 = 0.600, P = 0.439). CONCLUSIONS: There was no difference in survival time between group A and group B, but compared with the patients with left lower abdominal stoma(group A), the quality of life was better in patients with reconstruction of the anus in situ (group B). It is significant to improve the traditional lower abdominal stoma operation.

Quality of life of cancer patients living in Trinidad and Tobago.

PURPOSE: To determine quality of life (QoL) of cancer patients in The Republic of Trinidad and Tobago using the European Organization for Research and Treatment of Cancer Care Quality of Life Instrument (EORTC QLQ-C30) and examine relationships between QoL and socioeconomic and medical variables. METHOD: A cross-sectional study, consisting of 480 cancer patients being managed at the National Radiotherapy Centre, was conducted. One-way, multiple analysis of variance (MANOVA) with post hoc testing was used to analyze relationships between socioeconomic and medical variables and scales on the EORTC QLQ-C30. Stepwise linear regression was used to evaluate which independent variables contributed to the global QoL and function scores. RESULTS: Participants were of mean age 64.1 ± 12.1 years (males) and 56.7 ± 16.6 years (females). Mean values for global QoL and function scales were below 75. Persons in younger age groups had significantly better physical and cognitive function scores (p < 0.05). Males had higher emotional function scores than females (p < 0.05). Persons with higher income and education had better scores on all function scales, except social, and less symptoms (p < 0.05). Persons receiving chemotherapy had more nausea/vomiting, appetite loss, and constipation (p < 0.05). CONCLUSION: Age, income, education, and cancer treatment were factors most associated with scores on the EORTC QLQ-C30. Further research is required in this population to examine these variables in more depth and explore methods to improve QoL of cancer patients in this population.

Health-Related Quality of Life and Satisfaction With Health Care: Relation to Clinical Stage in Mexican Patients With Multiple Myeloma.

Multiple myeloma (MM) is characterized by bone pain, pathologic fractures, bone destruction, and secondary hypercalcemia, all these conditions impact on health-related quality of life of patients. The objective was to evaluate the global health state and health-related quality of life in a group of patients with MM who attended a tertiary health-care center of the Instituto Mexicano del Seguro Social in Mexico, through the questionnaires designed by European Organization for Research and Treatment of Cancer (EORTC) quality of life group. Exploratory cross-sectional study in patients with MM treated in a Department of Hematology in a High-Specialty Medical Unit was conducted. Patients older than 18 years of age, men and women, were selected, and their informed written consent was obtained. We included all consecutive cases treated from January 2012 to December 2014. Questionnaires EORTC QLQ-C30, EORTC QLQ-MY20, and EORTC IN-PATSAT-32 were used. We studied 37 patients, 19 (51%) men and 18 women. The mean age was 61.9 years. Twenty-two (59.46%) patients presented with clinical stage III. The mean time for diagnosis was 33.11 months. The most used first-line treatment schedule was melphalan/prednisone/thalidomide (15; 40%). The global health median was 66.67, and symptoms showed a median score of 22.22. Treatment side effects score was 16.67; for general satisfaction, the median score was 75. In conclusion, the patients showed an advanced clinical stage and poor prognosis but had scores higher than 50 in functional scales and lower than 50 for symptom scales. The scores for symptom scales were related to age, renal failure, and disease-free survival. Identification of quality of life and satisfaction of care markers allow for early therapeutic intervention and efficiency and enable a change in quality of life and perception of care in Health Services.

Incidence of sleep problems and their mediating role on depression and anxious preoccupation in patients with resected, non-advanced cancer: data from NEOcoping study.

BACKGROUND: Our study analyzes the incidence of sleep problems and their mediating role on depression and anxious preoccupation in patients with resected, non-advanced cancer. METHODS: A multi-institutional, prospective, observational study was conducted with 750 participants of 14 hospitals in Spain. Participants' socio-demographic and clinical characteristics were collected using a standardized self-report form and using EORTC QoL-QLQ-C30, BSI, Mini-MAC questionnaires. RESULTS: In women, sleep problems, depression and anxious preoccupation were observed in 65, 41 and 21%, respectively. In men, sleep problems, depression and anxious preoccupation were reported in 51, 29 and 61%, respectively. More sleep problems, depression and anxious preoccupation were found among women than males. Depression was a significant predictor of anxious preoccupation. In males, sleep problems partially mediated this association. This was not confirmed in women. CONCLUSION: Our findings point toward the importance of developing interventions that decrease depression and sleep problems in cancer.

Quality of life in elderly breast cancer patients with localized disease receiving endocrine treatment: a prospective study.

PURPOSE: In this paper we study the quality of life (QoL) of elderly breast cancer patients receiving endocrine treatment (ET). More QoL data on elderly patients treated with ET are needed. Our aims are to study QoL in early-stage breast cancer patients throughout the treatment period and compare the QoL of ET groups. METHODS: 148 patients > 65 years who began ET with either tamoxifen or aromatase inhibitor (AI) completed the EORTC QLQ-C30 and QLQ-BR23 and the Interview for Deterioration in Daily Living Activities in Dementia (IDDD) questionnaires three times over 3 years of ET. Linear mixed-effect models were used to evaluate longitudinal QoL changes. ET group comparisons were conducted after 3 years of treatment via ANCOVA adjusted by basal QoL. RESULTS: QoL scores were high (> 80/100 points) in most QoL areas, with moderate limitations (> 30) in sexual functioning and enjoyment and in future perspective. After 3 years of ET, four QoL areas improved (< 6 points) compared to baseline and 3-month assessments. Hot flushes worsened (8 points) at the 3-month assessment but by 3 years had recovered. AI patients showed more hot flushes, pain and diarrhea and less sexual enjoyment than tamoxifen patients after 3 years of ET (differences 3-12 points). CONCLUSIONS: Results indicate that elderly early-stage breast cancer patients adapted well to their disease and ET treatment over the 3 years. Few QoL differences were observed between ET groups.

Risk of malnutrition and emotional distress as factors affecting health-related quality of life in patients with resected cancer.

INTRODUCTION: This study analyzes the prevalence of malnutrition, depression, anxiety, and somatization and which factor has the biggest effect on quality of life (QoL) in individuals with resected cancer. METHODS: A prospective study was conducted among 747 participants. Participants completed the EORTC-QLQ30, MST, and BSI-18 questionnaires. RESULTS: Prevalence for risk of malnutrition, depression, anxiety, and somatization were 36.4%, 35.5%, 35.2%, and 48.8%, respectively. Hierarchical multiple regression analyses revealed that malnutrition risk, somatization, depression, and anxiety accounted for 50.8% of the variance in functional scale, 45.3% in symptom scale, and 52.2% in global health. Malnutrition, somatization, depression, and anxiety displayed high explanatory power on all health-related QoL (HRQoL) scales. CONCLUSION: The risk of malnutrition and psychological symptoms is strongly associated with HRQoL in cancer patients; thus, medical oncologists should develop effective interventions that contribute to lowering the risk of malnutrition and psychological distress, thereby improving subjects' HRQoL before initiating adjuvant chemotherapy.

Impacto del diagnóstico y tratamiento del cáncer de mama en la calidad de vida de las pacientes / Impact of breast cancer diagnosis and treatment on patients' quality of life

Introducción El cáncer de mama (cm) es la principal causa de muerte por enfermedad oncológica en mujeres. Con el aumento de su incidencia y de las tasas de sobrevida, resulta importante evaluar los efectos de la enfermedad en la calidad de vida (cv) de las pacientes. Objetivos Medir el impacto del diagnóstico y tratamientos del cm en la cv de las pacientes e identificar factores de riesgo (fr) para la afectación de las distintas dimensiones de la cv, a fin de brindar mejor contención e implementar medidas específicas. Material y método Es un estudio observacional, analítico, transversal. Se incluyeron pacientes con diagnóstico y tratamientos por cm en tiempos y lugares variables, tratadas actualmente en el Centro Mamario del Hospital Universitario Austral. La información se obtuvo a través de encuestas anónimas, que incluían dos cuestionarios que evaluaban cv en cáncer (eortc qlq-c30) y en cm específicamente (eortc qlq-br23) y un cuestionario propio. Resultados Se obtuvieron 171 encuestas. El promedio de cv fue bueno en todos los grupos. La escala de funcionamiento emocional fue la más afectada. Los síntomas más frecuentes fueron: fatiga e insomnio. El funcionamiento sexual y la preocupación por el futuro fueron las áreas de mayor afectación en el cuestionario específico de cm. Los síntomas específicos más reportados fueron las molestias por la pérdida del cabello. Logramos identificar al menos 10 fr con diferencias estadísticamente significativas. Conclusiones Resulta fundamental el conocimiento de la población tratada para medir el impacto de la enfermedad y de sus tratamientos y para reconocer los grupos más vulnerables. Esto permite no solo implementar medidas para mejorar la cv de las pacientes sino también mejorar la relación médicopaciente

Introduction Breast cancer (bc) is the main cause of death due to malignancy in women. With its rising incidence and prolonged survival rates, it is important to assess its effect on quality of life (qol) on women. Objectives To measure the impact of bc diagnosis and treatments on patients' qol and to identify wich risk factors (rf) play a role on qol, in orther to better understand, improve and develop patient centered care strategies. Materials and method This is a cross-sectional observational study of women with a diagnosis of bc who received treatment at different institutions, with different followup times, that are currently treated at the Breast Center of the Hospital Universitario Austral. Patients were evaluated via anonymous surveys, which included two questionnaires that evaluated qol in cancer (eortc qlq-c30) and in bc specifically (eortc qlq-br23), and a personalized questionnaire of our own. Results 171 surveys were obtained. The average qol was scored good among all groups. The emotional functioning scale was the most affected. The most frequent symptoms experienced were fatigue and insomnia. Sexual functioning and future perspectives were the most affected areas in the specific bc questionnaire. The specific symptom most commonly reported was upset by hair loss. At least 10 rf with statistically significant differences were identified. Conclusions Knowledge of the treated population is essential to assess the impact of the disease and its treatments, and to know the most vulnerable groups. This allows, not only the implementation of actions to improve patients' qol, but also to improve the doctor-patient relationship

Adaptación transcultural de la escala Caregivers Quality Of Life Index-Cancer para cuidadores en Colombia / Cross-cultural adaptation of the Colombian version of the Caregiver Quality of Life Index-Cancer (CQOLC)

Resumen Introducción: La mayoría de las escalas que evalúan la calidad de vida en cuidadores de pacientes oncológicos han sido elaboradas y validadas en idiomas diferentes al español, lo cual disuade su uso en población hispano-hablante. La escala Caregiver Quality Of Life Index-Cancer (CQOLC), que evalúa este constructo en este grupo poblacional, es el instrumento más empleado para tal fin; sin embargo, no se encuentra validada en Colombia. Considerando la relevancia de la evaluación de este constructo en el tratamiento integral de la población con cáncer, se presenta la traducción y adaptación transcultural al español colombiano de la escala CQOLC, para su posterior validación. Materiales y Métodos: Tras obtener el permiso del autor de la escala, ésta se tradujo directa e inversamente. Luego, se ejecutó la prueba piloto con una versión provisional en español, que identificó dificultades en la comprensión de los ítems o posibles molestias provocadas por los mismos. Resultados: La prueba piloto se ejecutó en 21 cuidadores de pacientes con cáncer que asistieron al Instituto Nacional de Cancerología en mayo del 2016. Durante la prueba piloto, se presentaron dificultades en la comprensión del ítem 5, por lo cual se decidió cambiar la redacción del mismo. El resto de los ítems se comprendieron fácilmente y se produjo una versión final del instrumento. Conclusión: Se encuentra disponible la escala CQOLC en español colombiano. Ésta escala podrá emplearse en el proceso subsiguiente de validación, para así estimar la calidad de vida de los cuidadores de pacientes con cáncer en el país.

Abstract Introduction: Most of the scales that evaluate quality of life in cancer care-givers have been designed and validated in languages different from Spanish which limits their utilization in Spanish-speaking population. The Caregiver Quality of Life Index-Cancer (CQOLC), which evaluated this construct in this specific group, is the most commonly used instrument in assessing quality of life among cancer caregivers. However, it is not validated in Spanish nor in Colombia. Considering the relevance of this construct as part of the comprehensive treatment of cancer patients, we present the translation and cross-cultural adaptation of the scale into Colombian Spanish. Methods: We obtained the author's permission. Then, the instrument was translated and back-translated. After that, we executed a pilot test with a provisional Spanish version, in order to identify difficulties at understanding items. Results: Pilot test was executed in 21 cancer caregivers that visited the Instituto Nacional de Cancerología on May 2016. During the pilot test, there was difficulty at understanding the 5th item of the scale. Therefore, we paraphrased it. There were not additional problems at understanding the other items, and the final Spanish version of the scale was released. Conclusion: The CQOLC in Colombian Spanish is available. Now, it is possible to use it in the ulterior validation process, in order to estimate quality of life in Colombian cancer caregivers.