PS02.229: ASSESSMENT OF VARYING QUALITY OF LIFE OUTCOMES BASED ON A STRATEGY OF ORGAN PRESERVATION VERSUS SURGERY FOR UPPER GASTROINTESTINAL MALIGNANCIES

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 187-187
Author(s):  
Lauren O Connell ◽  
Mary Coleman ◽  
Natalia Kharyntiuk ◽  
Thomas Walsh
Keyword(s):  
Quality Of Life ◽  
Conflicts Of Interest ◽  
External Validation ◽  
Neoadjuvant Chemoradiotherapy ◽  
Complete Response ◽  
Disease Stage ◽  
Control Group ◽  
Gastrointestinal Malignancies ◽  
Upper Gastrointestinal

Abstract Background: Background Neoadjuvant chemoradiotherapy (naCRT) for upper gastrointestinal malignancies induces a pathological complete response (pCR) in 25–85% of patients, depending on disease stage and regimen chosen. All patients with a pCR will have a clinical complete response (cCR). Avoidance of surgery is desirable where feasible, as operative intervention entails morbidity and mortality risks and a reduction in lifelong health related quality of life (HRQoL). Pursuant on a policy of permitting selected patients with a cCR to opt for surveillance, this study aims to compare the QoL of patients who chose surveillance over adjuvant surgery following a cCR to naCRT. Methods: Methods One hundred and fourteen patients participated in the study. These comprised 4 groups; Group 1 (n = 31) were healthy controls; Group 2 (n = 26) had chemoradiotherapy only; Group 3 (n = 31) had oesophagectomy post naCRT and Group 4(n = 26) had gastrectomy alone. A novel 33 point questionnaire assessing 5 functional domains was completed focusing on symptoms of antro-pyloric function, respiratory reflux and post-vagotomy symptoms, as well as a previously validated questionnaire instrument for purposes of comparison and external validation. The data was aggregated to produce a total score ranging from 20–93 with 20 representing the least symptomatic. Results: Results Mean(± sd) overall QoL scores were significantly better in patients avoiding resection (28.9 ± 4.5) vs oesophagectomy (32.3 ± 58. P = 0.042) and vs gastrectomy(33.19 ± 5.9, P = 0.004. Scores did not differ between patients undergoing oesophagectomy or gastrectomy (P = 0.889). Oesophagectomy was associated with a trend towards increased reflux-related respiratory symptoms (7.3 ± 2.2 vs 6.5 ± 1.9; P = 0.396) while gastrectomy patients reported more symptoms related to vagotomy (1.82 ± 0.9 vs 1.4 ± 0.6; P = 0.438) and early dumping (8.2 ± 1.4 vs 7.1 ± 1.7; P = 0.239). The mean score for the control group administered the novel questionnaire was 20.74, approaching the lowest possible score of 20. This was significantly lower than any of the scores recorded for the treatment groups (P = < 0.001). Conclusion: Discussion A strategy of active surveillance in complete responders to neoadjuvant chemoradiotherapy is rewarded with a superior quality of life than in those undergoing surgery. Disclosure All authors have declared no conflicts of interest.

scholarly journals Evidence Based Recommendations for Supportive Care in Multiple Myeloma

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1952-1952
Author(s):  
Anum Qureshi ◽  
Muhammad Junaid Tariq ◽  
Zunairah Shah ◽  
Muhammad Abu Zar ◽  
Shehroz Aslam ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Multiple Myeloma ◽  
Supportive Care ◽  
Conflicts Of Interest ◽  
Control Group ◽  
Cell Transplant ◽  
Clodronic Acid ◽  
Management Of Complications ◽  
Reduced Risk

Abstract Introduction: Multiple myeloma (MM) is associated with end organ damage that negatively impacts the quality of life (QOL)and supportive care has a potential to improve symptoms. Methods: After detailed search on Pubmed, Cochrane, Embase and Clinical Trials.gov, we finalized total 36 articles on supportive care published after 2004. Results: Management of skeletal events: Mhaskar et al. (2017, n=3257) compared bisphosphonates (BPs) with placebo (PBO) in preventing pathological vertebral fractures, skeletal-related events (SRE), reported risk ratio (RR) of 0.74 in each; 95% CI 0.62-0.89 and 0.63-0.88 respectively. Both zoledronic acid (ZA) and clodronic acid prevent SRE, but mortality rate was better reduced with ZA (hazard ratio [HR]=0.84; p=0.0118), (Gareth et al. 2010, n=1960). In a study by Zuradelli et al. (2009, n= 240); hypocalcemia developed in 93 (38.8%) patients on ZA for a median of 2.3 months (range, 0-34.9). Vitamin D and calcium replacement is essential in patients developing hypocalcemia with BPs, (Kennel et al. 2009). Vertebral augmentation procedures improved pain after compression fracture (n=923) by 4.8, 4.6 and 4.4 points at 1 week, 1 year and beyond 1 year respectively, (Khan et al. 2014). Valerie et al. (2011, n=84) analyzed improvement in bone pain with radiotherapy (median 45 grays) in 92 % patients. Prophylaxis of infections: Leng et al. (2018, n=70,687) observed reduced risk of herpes zoster (HZ) reactivation in patients on bortezomib or carfilzomib + HZ prophylaxis (2.4%) vs 5.8% in non-prophylactic group, (attributable risk reduction: 0.42; 95% CI 0.31-0.56). Teh et al. (2016, n=199) reported reduced risk of varicella zoster virus reactivation with valacyclovir (500 mg) in patients on bortezomib based therapy and following autologous stem cell transplant (ASCT) vs no prophylaxis (HR=0.06 vs 16.9; p<0.01). Dimopoulos et al. (2016, n=569) found higher risk of pneumonia, 8.2% in daratumumab group (n=286) vs 7.8% in control group (n=283). Prophylactic trimethoprim-sulfamethoxazole reduced risk of PCP in 85% patients after ASCT (RR=0.15; 95% CI 0.04-0.62), Stern et al. (2014, n=1000). Incidence of Community-acquired pneumonia (CAP), noninvasive CAP and invasive pneumococcal disease in elderly population (≥65 years) was seen in 49, 33 and 7 patients on Pneumococcal polysaccharide conjugate vaccine group as compared to 90, 60 and 28 patients in placebo group respectively, (Bonten et al. 2015, n=84,496). Role of plasmapheresis in renal impairment (RI): Alkhatib et al. (2017) showed that plasmapheresis reduced dialysis dependency by removing serum free light chains (sFLC) in patients with RI (n=147), (RR 0.45; P = 0.02). Yu-X et al. (2015, n=147), showed lower 6-month dialysis dependency ratio with plasmapheresis and chemotherapy (PP + CTH) vs CTH alone, (15.6% vs 37.2%; RR=2.02; p = 0.04). High cut-off hemodialysis lowered sFLC level in 61% (n=42) and 63% patients at day 12 and 21 respectively. Out of these, 71% and 69% patients became dialysis independent, (Hutchison et al. 2012, n=67). Peripheral neuropathy (PN): Bortezomib caused PN in 124/331 (37%) patients (Richardson et al. 2009) whereas with thalidomide, the incidence of PN was 38% and 73% at 6 and 12 months, respectively, (Mileshkin et al. 2006, n=75). PN improved in 68% patients on bortezomib with dose modifications (n=72) vs 47% patients, without dose modification (n=19). (Table 1 and 2). Significant improvement in PN was seen with duloxetine vs placebo (1.06 vs. 0.34; p= 0.003), (Smith et al. 2013, n=231). Arbaiza et al. (2007, n=36) showed improvement in neuropathic pain with tramadol (p= < 0.001). Epoetin and derivates for anemia: Castelli et al. (2017, n= 31; median creatinine 1.2 mg/dL (0.8-3.0)) reported hemoglobin (Hb) increase of ≥1g/dL and ≥2g/dL in 71% and 31.7% patients respectively with epoetin α, transfusions requirement reduced from 2.39 ± 1.05 to 1.23 ± 1.36 (p < 0.001). Begiun et al. (2013, n= 72) compared the effect of darbepoetin (D) ± iron (Fe) vs placebo on erythroid recovery after ASCT. All patients receiving D + Fe achieved Hb ≥13 g/dL (p<0.0001). Tonia et al. (2012, n= 16,093) showed 35% decrease in transfusion need with erythropoietin stimulating agents (RR=0.65; 95% CI 0.62-0.68). (Table 3) Conclusion: Along with anti-myeloma chemotherapy therapy, management of complications (anemia, infections, renal insufficiency) and other associated symptoms is necessary to improve the quality of life. Disclosures No relevant conflicts of interest to declare.

Huachansu Injection Combined With Cemt Regimen On Patients With Relapsed Or Refractory Multiple Myeloma

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5384-5384
Author(s):  
Qingchi Liu ◽  
Huimin Zhang ◽  
Xinwang Feng ◽  
Shujie Wang
Keyword(s):  
Quality Of Life ◽  
Multiple Myeloma ◽  
Complete Remission ◽  
Conflicts Of Interest ◽  
Life Quality ◽  
Control Group ◽  
Short Term Treatment ◽  
European Organization ◽  
Refractory Multiple Myeloma

Abstract Objective To observe the short-term treatment effect of Huachansu Injection combined with CEMT regimen on patients with relapsed or refractory multiple myeloma and evaluate the quality of life of the patients. Methods The 40 patients of relapsed or refractory multiple myeloma were divided into two groups, 20 patients were in the Chinese and western medicine treatment group, the rest in the control group. The patients in the control group received the CEMT regimen (Carboplatin, Etoposide, Methotrexate, and Thalidomide);and those in the Huachansu group received Huachansu injection on the basis of the CEMT treatment. The Huachansu injection in the 500ml 5% Glucose injection was given by intravenous drop once daily, 10'20ml for each time. The general treatment lasted 3 months and one treatment period was 4 weeks,during each period the patients received the  medicine treatment for 7 days and had a rest for 2 days. The patients in each group were given the syndrome differentiation type of traditional chinese medicinal broth,decoction, once a day. The QLQ-C30 Quality of Life Questionaire(Chinese Version V3.0for clinical use) worked out by EORTC(European Organization For Research And Treatment Of Cancer) was adopted to evaluate and research the patients’ quality of life before and after the treatment. Results 5 cases had complete remission,6 had part remission, 2 had stable and 7 cases had progresss and the total effectiveness reaches 65.0%  in the Huachansu group group. In the control group, 3 cases had complete remission,4 had part remission, 1 had stable and 12 had progress and the total effectiveness reaches 40.0%. The effective rate of Huachansu group is higher than the control group,and the differences was statistically significant(P<0.05).  The quality of life questionaire result also shows that the overall health status and the overall life quality of the patients in both groups have been improved as well as the patients’ physical and mental status. The difference in the patients’ life quality is less obvious in both groups. The 3-month treatment on their role functions and social functions have no outstanding effects after comparation. Conclusion The Huachansu Injection combined with CEMT regimen not only  has excellent effect on on patients with relapsed or refractory multiple myeloma,but also improves the quality of life of patient. Disclosures: No relevant conflicts of interest to declare.

PS02.027: EXERCISE TRAINING DURING NEO-ADJUVANT THERAPY IN PATIENTS UNDERGOING SURGERY FOR CANCER OF THE GASTRO-ESOPHAGEAL JUNCTION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 127-128
Author(s):  
Pieter De Heer ◽  
Jesper Christensen ◽  
Caper Simonsen ◽  
Anna Banck-Petersen ◽  
Thomas Kristensen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Muscle Strength ◽  
Treatment Failure ◽  
Conflicts Of Interest ◽  
Tumor Resection ◽  
Exercise Adherence ◽  
Exercise Group ◽  
Control Group ◽  
Risk Of Treatment

Abstract Background Neoadjuvant chemo- or chemo-radiotherapy before tumor resection is first-line treatment in patients with GEJ but associated with considerable symptom burden and complication risk which may impair treatment efficacy and quality of life. Strategies to improve treatment tolerability are therefore warranted. Methods Fifty GEJ cancer patients were allocated without randomization to an exercise-group or usual care control-group. The exercise-group was prescribed 2 weekly sessions including aerobic interval exercise and resistance training for 12 weeks. The primary endpoint was risk of treatment failure defined as any serious adverse event (SAE) precluding surgery. Risk of other SAEs and quality of life (in both groups); and exercise-adherence and change in aerobic fitness, muscle strength, and body composition (in the exercise-group) was recorded. Results Risk of treatment failure was 5% in the EX-group and 21% in the CON-group, and risk of pre-operative hospitalization was 15% in the EX-group and 38% in the CON-group. Risk of post-operative complications was similar between groups. The exercise-group attended on average 17.4 sessions and improved fitness (+ 8%), muscle strength (+ 15–22%) and FACT-E total score (+ 12-points). Conclusion Pre-operative exercise was feasible and led to favorable changes in fitness, strength and quality of life. Further, it may be associated with lower risk of treatment failure and hospitalization during neoadjuvant therapy, which could have important implications for future perioperative management of patients with GEJ cancer. Disclosure All authors have declared no conflicts of interest.

“Quality of Life (QoL) in the Randomised HD10-12 Trials of the German Hodgkin Study Group (GHSG): Sexual Functions (SX) in Hodgkin Lymphoma (HL) Patients Decrease by Disease Stage and Improve After Therapy Depending On Stage and Treatment Modality.”.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 896-896
Author(s):  
Karolin Behringer ◽  
Horst Mueller ◽  
Hans-Henning Flechtner ◽  
Corinne Brillant ◽  
Teresa Halbsguth ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Social Relationships ◽  
Treatment Modality ◽  
Conflicts Of Interest ◽  
Disease Stage ◽  
Sexual Life ◽  
Treatment Modalities ◽  
Fourth Generation ◽  
The Impact

Abstract Abstract 896 Purpose: Current research in HL is focusing on long-term consequences of therapy. Among these, especially health related quality of life (HRQoL) needs thorough investigation since it becomes increasingly important for HL survivors. HRQoL is complex and incorporates different aspects such as general QoL, fatigue, emotional, physical, role, social, cognitive, and sexual functions. In this analysis, we focus on sexual functions (SX) in the HD10-12 trials of the GHSG and the influence of stage, treatment modality, social relationships (SF), and fatigue (FA). Methods: Between 1998 and 2002, the GHSG has conducted the fourth generation of clinical trials for the treatment of early favourable, early unfavourable and advanced stage HL (HD 10-12) involving a total of 4610 patients. Patients completed the QLQ-C30, the MFI20 and additional items for SX at the time of diagnosis, after chemotherapy, after radiotherapy, and at follow-up examinations. We describe SX with means and 95%-CI for each measurement point and compare them with t-tests when appropriate. In multiple regressions, we analysed the role of the following prespecified set of predictors on SX at baseline: sex, age, stage, FA, and SF. These predictors were also included in the analyses on SX 2 years after treatment and further supplemented with SX baseline score and treatment modality. Full information maximum likelihood estimations (FIML) were used to account for missing data. Results: QoL data from 919 patients in early favourable (HD10), 1065 patients in early unfavourable (HD11), and 1126 patients in advanced stages (HD12) were analysed. For patients included in HD10, mean SX before and after therapy were equally high in both treatment arms. Initial SX scores for patients enrolled into HD11 and HD12 were significantly lower than in the HD10 trial (p<.001). In HD11, the SX scores after 2 years remarkably improved compared to the initial values (p<.001) and, interestingly, reached the same level as in HD10. In contrast, SX scores in HD12 also significantly improved after two years (p<.05) but improvement was lower and did not reach the same level as in HD10 and HD11. With regard to the randomly assigned treatment modalities in HD10 (4xABVD vs. 2xABVD) and HD12 (8xBEACOPPescalated vs. 4xBEACOPPescalated + 4xBEACOPPbaseline), SX scores did not differ after 2 years. However, in HD11, the SX scores 2 years after 4xBEACOPPbaseline were significantly lower (p<.05) compared with 4xABVD after adjustment for sex, age, and initial SX scores. At baseline, SX was significantly related to age, sex and stage, as well as to FA and SF. For SX after 2 years, the initial SX scores, age, FA, and SF were the strongest, significant predictors. Conclusion: This large prospective study shows that sexual functions are influenced by the lymphoma itself, treatment modality, age, fatigue, and social relationships. Sexual functions significantly improved after 2 years compared to baseline. Thus, patients with HL can expect that their sexual life after therapy will at least be as satisfying as before. ABVD led to more favourable sexual functioning than BEACOPP, probably due to less therapy-induced gonadal toxicity. In further studies, we will investigate the impact of chemotherapy on sex hormon levels and their influence on sexual life. Disclosures: No relevant conflicts of interest to declare.

Quality of Life Assessment in Post-Operative Patients with Upper Gastrointestinal Malignancies

2010 ◽  
Vol 158 (2) ◽  
pp. 174-175
Author(s):  
N.J. Gusani ◽  
J.R. Schubart ◽  
I. Deshaies ◽  
E.T. Kimchi ◽  
K.F. Staveley-O'Carroll
Keyword(s):  
Quality Of Life ◽  
Life Assessment ◽  
Quality Of Life Assessment ◽  
Gastrointestinal Malignancies ◽  
Upper Gastrointestinal

Results of osteopathic correction of patients with post-traumatic coccygodynia

2019 ◽  
pp. 19-27
Author(s):  
Yu. V. Antonova ◽  
A. M. Iskandarov ◽  
I. B. Mizonova
Keyword(s):  
Quality Of Life ◽  
Emotional State ◽  
Pain Syndrome ◽  
Control Group ◽  
Life Questionnaire ◽  
Treatment Area ◽  
Diffi Cult ◽  
Osteopathic Treatment ◽  
Post Traumatic

Introduction.Coccygodynia is a multidisciplinary disease which is diffi cult to treat. It seriously limits the ability to work and signifi cantly affects the quality of life of patients. The study of somatic dysfunctions in patients with coccygodynia and the analysis of the results of osteopathic treatment of such patients makes it possible to justify the necessity of osteopathic correction of coccygodynia.Goal of the study— to determine the structure of the leading somatic dysfunctions in patients with coccygodynia and to study the effectiveness of osteopathic treatment of this pathology.Materials and methods.The study involved 44 patients from 25 to 65 years old, randomly divided into two groups. The main group of 24 people (20 women and 4 men) received osteopathic treatment, in accordance with the identifi ed leading somatic dysfunctions. Patients of the control group (16 women and 4 men) were treated locally with soft manual techniques (the treatment area was limited by the pelvic region). In order to assess the results of the treatment, we examined the intensity of the pain syndrome and the psycho-emotional state of patients. The severity of the pain syndrome was assessed in accordance with the visual analogue scale (VAS). The psycho-emotional state (with physical and mental components) was assessed with the help of the SF-36 quality of life questionnaire.Results.Somatic dysfunctions typical for patients with coccygodynia have been identifi ed. Osteopathic treatment has proven to be more effective in comparison with local manual therapy of coccygodynia both in early periods and in 3 months after the end of the treatment course.Conclusion.Osteopathic treatment of post-traumatic coccygodynia is effective, and can be recommended for treatment of such patients.

COMPARISON OF THE QUALITY OF LIFE OF PATIENTS IN THE LOCALY ADVANCED BREAST CANCER FORMS AFTER SYSTEM AND INTRALYMPHATIC POLYCHEMOTHERAPY

2018 ◽  
Vol 4 ◽  
pp. 3-13
Author(s):  
Yuriy Dumanskiy ◽  
Oleksandr Bondar ◽  
Oleksandr Tkachenko ◽  
Evhenii Stoliachuk ◽  
Vasilii Ermakov
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Locally Advanced ◽  
Developed Countries ◽  
Control Group ◽  
Preoperative Treatment ◽  
Discrete Elements ◽  
Important Indicator ◽  
Significant Difference

In recent years, breast cancer (BC) is the most common cancer pathology and the most common cause of disability among women in developed countries. Finding the most effective ways of interaction between the patient and the doctor creates the preconditions for the necessary analysis of the treatment process from an objective and subjective point of view. Therefore, an important indicator to be taken into account is the quality of life of a patient. To compare the indicators of a comprehensive assessment of the quality of life of patients to the adverse locally advanced forms (LA) of breast cancer before and after systemic intravenous polychemotherapy (SPCTx) and selective endolymphatic polychemotherapy (ELPCTx) in neoadjuvant mode. The study was conducted on the basis of a random analysis of outpatient cards from 112 patients with LA BC T4A-DN0-3M0 who received a comprehensive antitumor treatment on the basis of the Donetsk regional antitumor center and the University Clinic of the Odessa National Medical University from 2000 to 2017, which was proposed a questionnaire at various stages of preoperative treatment. The first (control) group consisted of 65 patients (58 %) with inoperable forms of LA BC, which was performed in neoadjuvant mode by SPCTx. The second (study group) included 47 patients (42 %) with inoperable forms of LA BC, which was performed as a neoadjuvant course ELPCTx. According to the integral indicators of quality of life and quality of health between patients in the control and study groups, there was no statistically significant difference. In a detailed analysis of the indicators of symptomatic scales, the difference between the groups did not exceed the critical. Based on the results of a study conducted among patients receiving endolymphatic chemotherapy in a neoadjuvant mode, the subjective evaluations of treatment in absolute numbers have better reference values without statistical superiority. The study of the integrative indicator of quality of life and its discrete elements is an ergonomic and economical means of heuristic assessment of the health of patients in order to further develop more rational and convenient ways of solving urgent issues of modern oncology by increasing compliance and finding a compromise between the physician and the patient.

Effectiveness of mobile applications on healthy lifestyles aimed at diabetic patients: review of systematic reviews. (Preprint)

2019 ◽  
Author(s):  
Francisco Jesús Represas Carrera Sr ◽  
Ángel Alfredo Martínez Ques Sr ◽  
Ana Clavería Fontán Sr
Keyword(s):  
Quality Of Life ◽  
Diabetes Mellitus ◽  
Systematic Reviews ◽  
Mobile Applications ◽  
Control Group ◽  
Diabetic Patients ◽  
Healthy Lifestyles ◽  
Major Public Health Problem

BACKGROUND Diabetes mellitus is currently a major public health problem worldwide. It is traditionally approached in a clinical inpatient relationship between the patient and the healthcare professional. However, the rise of new technologies, particularly mobile applications, is revolutionizing the traditional healthcare model through the introduction of telehealthcare. OBJECTIVE (1) To assess the effects of mobile applications for improving healthy lifestyles on the quality of life and metabolic control of diabetes mellitus in adult patients. (2) To describe the characteristics of the mobile applications used, identify the healthy lifestyles they target, and describe any adverse effects their use may have. METHODS Review of systematic reviews and meta-analysis, following the guidelines of the Cochrane Collaboration and the Joanna Briggs Institute. We included studies that used any mobile application aimed at helping patients improve self-management of diabetes mellitus by focusing on healthy lifestyles. Studies needed to include a control group receiving regular care without the use of mobile devices. In May 2018, a search was conducted in Medline, Embase, Cochrane, LILACS, PsychINFO, Cinahl and Science Direct, updated in May 2019. The methodological quality of the studies was assessed using the Amstar-2 tool. RESULTS Seven systematic reviews of 798 articles were initially selected for analysis. The interventions had a duration of between 1 and 12 months. Mobile applications focused singly or simultaneously on different lifestyles aspects (diet, physical exercise, motivation, blood glucose levels, etc.). There are significant changes in HbA1c values, body weight and BMI, although in others, such as lipid profile, quality of life, or blood pressure, there is no clear improvement. CONCLUSIONS There is clear evidence that the use of mobile applications improves glycemic control in diabetic patients in the short term. There is a lack of evidence in its long-term benefits. It is thus necessary to carry out further studies to learn about the long-term effectiveness of mobile applications aimed at promoting the healthy lifestyles of diabetic patients. CLINICALTRIAL PROSPERO Register: CRD42019133685

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