Dissociating breathlessness symptoms from mood in asthma

AbstractAsthma is one of many chronic diseases in which discordance between objectively measured pathophysiology and symptom burden is well recognised. Understanding the influences on symptom burden beyond pathophysiology could improve our ability to treat symptoms. While co-morbidities such as anxiety and depression may play a role, the impact of this relationship with symptoms on our ability to perceive bodily sensations (termed ‘interoception’), or even our general and symptom-specific attention is not yet understood. Here we studied 63 individuals with asthma and 30 healthy controls. Alongside physiological tests including spirometry, bronchodilator responsiveness, expired nitric oxide and blood eosinophils, we collected self-reported questionnaires covering affective factors such as anxiety and depression, as well as asthma symptoms and asthma-related quality of life (individuals with asthma only). Participants additionally completed a breathing-related interoception task and two attention tasks designed to measure responsiveness to general temporal/spatial cues and specific asthma-related threatening words. We conducted an exploratory factor analysis across the questionnaires which gave rise to key components of ‘Mood’ and ‘Symptoms’, and compared these to physiological, interoceptive and attention measures. While no relationships were found between symptoms and physiological measures in asthma alone, negative mood was related to both decreased interoceptive metacognitive sensitivity (‘insight’ into interoceptive performance) and metacognitive bias (confidence in interoceptive decisions), as well as increased effects of spatial orienting cues in both asthma and controls. Furthermore, the relationship between the extent of symptoms and negative mood revealed potential sub-groups within asthma, with those who displayed the most severe symptoms without concurrent negative mood also demonstrating altered physiological, interoceptive and attention measures. Our findings are a step towards understanding how both symptoms and mood are related to our ability to interpret bodily symptoms, and to explore how the balance between mood and symptoms may help us understand the heterogeneity in conditions such as asthma.

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Patient reported outcomes in patients with desmoid type fibromatosis.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.11574 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 11574-11574

Author(s):

VIKAS GARG ◽

Sameer Rastogi ◽

Adarsh Barwad ◽

Rambha Panday ◽

Sandeep Kumar Bhoriwal ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Symptom Burden ◽

Benign Neoplasm ◽

Anxiety And Depression ◽

Appendicular Skeleton ◽

Healthy Controls ◽

Symptom Scale ◽

Cross Sectional ◽

Patient Reported ◽

The Impact

11574 Background: Desmoid type fibromatosis (DTF) is a rare benign neoplasm with infiltrative growth and high local recurrences. Due to long disease course, unpredictable growth pattern, and low mortality, using only survival outcomes may be inappropriate. In this study we assessed the impact of DTF on health related quality of life (HRQoL). Methods: This was a cross-sectional study done in patients with DTF. The study participants were asked to fill the EORTC QLQ-C30, GAD-7 and PHQ- 9 q uestionnaires to assess HRQoL, anxiety and depression . Outcomes were also compared with healthy controls. Results: 204 subjects (102 DTF patients and 102 healthy controls) were recruited. Study parameters have been summarized in Table. Appendicular skeleton (limbs + girdle) was most commonly involved in 59 % patients and abdominal wall or mesentery was involved in 22.5 %. Patients have received median of 2 lines of therapy. 54 % patients were currently on sorafenib and 41 % were under active surveillance. Mean global health status in DTF patient 65.58 ± 22.64, was significantly lower than healthy controls. Similarly, DTF patients scored low on all functional scales except cognitive functioning. Symptom scale showed significantly higher symptom burden of fatigue, pain, insomnia and financial difficulties. Anxiety & depression was observed in 39.22 % and 50 % of DTF patients respectively. DTF patients had higher rates of mild, moderate and severe anxiety and depression compared to healthy controls. No difference was observed based on site of disease. Conclusions: DTF patients have significant symptom burden, poor functioning, and heightened anxiety and depression. Patient reported outcomes should be routinely used to assess treatment efficacy in DTF patients.[Table: see text]

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Health-Related Quality of Life in Severely Injured Trauma Patients with Positive and Negative Blood Alcohol Level on Admission

10.21203/rs.3.rs-45381/v1 ◽

2020 ◽

Author(s):

Antti Riuttanen ◽

Jarkko Jokihaara ◽

Tuomas T. Huttunen ◽

Ville M. Mattila

Keyword(s):

Alcohol Use ◽

Relative Number ◽

Reference Population ◽

Anxiety And Depression ◽

Trauma Patients ◽

Severely Injured ◽

Post Injury ◽

Related Quality ◽

Negative Effect ◽

The Impact

Abstract PurposeThe objectives of this study were to evaluate whether pre-injury alcohol use has an influence on an injured patient’s HR-QoL and reported problems.MethodsRetrospective analysis of 227 severely injured trauma patients (age ≥ 18 years, NISS ≥ 16) treated at Tampere University Hospital’s (TAUH) Intensive Care Unit (ICU) or High Dependence Unit (HDU) in 2013. HR-QoL was assessed with the EQ-5D questionnaire, and was further compared with index values of population norms of Finland.ResultsPatients with positive BAL expressed notably more anxiety and depression (45%) before trauma compared to both patients with negative BAL (11%) and the reference population (14%). Overall, pre-injury HR-QoL was also poorer in BAL positive patients than BAL negative patients. The amount of anxiety and depression in BAL positive patients decreased after injury. In both groups, the relative number of reported problems after injury exceeded the relative number of reported problems of the reference population in all five EQ-5D dimensions.ConclusionsPatients with positive BAL upon admission report overall lower pre-injury HR-QoL than patients with negative BAL, which is most likely explained by the alcohol’s negative effect on mental health. As reported anxiety and depression decreased one year after injury, we speculate that this may partly be explained by a possible reduction in alcohol use, which has been reported to happen in injury patients. As has previously been reported, the impact of severe injury on post-injury QoL in general is detrimental and long-lasting and overall HR-QoL remains lower than the population norm.

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Beyond Survival in AL amyloidosis: Identifying and Satisfying Patients’ Needs

Hemato ◽

10.3390/hemato3010004 ◽

2022 ◽

Vol 3 (1) ◽

pp. 38-46

Author(s):

Hamza Hassan ◽

Vaishali Sanchorawala

Keyword(s):

Cell Clone ◽

Symptom Burden ◽

Well Being ◽

Future Research ◽

Al Amyloidosis ◽

Patient Centered ◽

Related Quality ◽

Health Related ◽

Delays In Diagnosis ◽

The Impact

The survivorship needs of patients with light-chain (AL) amyloidosis are complex, as is the diagnosis and treatment itself. Early diagnosis is critical in improving patient outcomes; however, given the nonspecific nature of the symptoms, most patients with AL amyloidosis require evaluation by multiple specialists, resulting in significant delays in diagnosis of up to 3 years. An early and accurate diagnosis can help reduce the psychological toll of the patient’s journey to diagnosis. Given the high symptom burden and complex process of diagnosis, it is not surprising that patients with AL amyloidosis report worse health-related quality of life than the general population. Organ dysfunction associated with AL amyloidosis also may make the treatment directed towards plasma cell clone difficult to tolerate, leading to morbidity and mortality. Furthermore, supportive care requires an integrated, multidimensional and patient-centered approach to improve survival and feelings of well-being, as organ responses lag behind hematologic responses. The impact of AL amyloidosis is often devastating for the patient and may last beyond the effects of treatment. Future research is needed to study and assess the needs of survivors of AL amyloidosis utilizing valid, reliable and standardized measures.

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Exercise-based cardiac rehabilitation improves exercise capacity and health-related quality of life in people with atrial fibrillation: a systematic review and meta-analysis of randomised and non-randomised trials

Open Heart ◽

10.1136/openhrt-2018-000880 ◽

2018 ◽

Vol 5 (2) ◽

pp. e000880 ◽

Cited By ~ 7

Author(s):

Neil A Smart ◽

Nicola King ◽

Jeffrey D Lambert ◽

Melissa J Pearson ◽

John L Campbell ◽

...

Keyword(s):

Quality Of Life ◽

Exercise Capacity ◽

Symptom Burden ◽

Health Related Quality ◽

Randomised Trials ◽

Sf 36 ◽

Related Quality ◽

Health Related ◽

The Impact

ObjectiveThe aim of this study was to undertake a contemporary review of the impact of exercise-based cardiac rehabilitation (CR) targeted at patients with atrial fibrillation (AF).MethodsWe conducted searches of PubMED, EMBASE and the Cochrane Library of Controlled Trials (up until 30 November 2017) using key terms related to exercise-based CR and AF. Randomised and non-randomised controlled trials were included if they compared the effects of an exercise-based CR intervention to a no exercise or usual care control group. Meta-analyses of outcomes were conducted where appropriate.ResultsThe nine randomised trials included 959 (483 exercise-based CR vs 476 controls) patients with various types of AF. Compared with control, pooled analysis showed no difference in all-cause mortality (risk ratio (RR) 1.08, 95% CI 0.77 to 1.53, p=0.64) following exercise-based CR. However, there were improvements in health-related quality of life (mean SF-36 mental component score (MCS): 4.00, 95% CI 0.26 to 7.74; p=0.04 and mean SF-36 physical component score: 1.82, 95% CI 0.06 to 3.59; p=0.04) and exercise capacity (mean peak VO2: 1.59 ml/kg/min, 95% CI 0.11 to 3.08; p=0.04; mean 6 min walk test: 46.9 m, 95% CI 26.4 to 67.4; p<0.001) with exercise-based CR. Improvements were also seen in AF symptom burden and markers of cardiac function.ConclusionsExercise capacity, cardiac function, symptom burden and health-related quality of life were improved with exercise-based CR in the short term (up to 6 months) targeted at patients with AF. However, high-quality multicentre randomised trials are needed to clarify the impact of exercise-based CR on key patient and health system outcomes (including health-related quality of life, mortality, hospitalisation and costs) and how these effects may vary across AF subtypes.

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Development of a functional assessment of side-effects to therapy (FAST) questionnaire to assess dermatology-related quality of life in patients treated with EGFR inhibitors (EGFRI): The FAST-EGFRI

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.19532 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 19532-19532 ◽

Cited By ~ 3

Author(s):

L. Wagner ◽

S. E. Lai ◽

M. Aneja ◽

P. Lorusso ◽

R. Perez-Soler ◽

...

Keyword(s):

Quality Of Life ◽

Social Life ◽

Symptom Burden ◽

Physical Symptoms ◽

Self Report ◽

Antitumor Effects ◽

Related Quality ◽

The Impact ◽

Skin Pain

19532 Background: Despite their beneficial antitumor effects, 75–87% patients who undergo EGFRI therapy develop dermatological toxicities (derm tox), including rash, paronychia, hair alterations, and pruritus. The purpose of this study was to develop a patient (pts) self-report questionnaire based on pts and expert (exp) input and to identify the most significant skin tox health-related quality of life (HRQL) factors. Methods: To generate the questionnaire, 20 pts with derm tox to EGFRIs and 12 expert clinicians (>50 treated pts) were asked interview questions and rated 62 items to assess the most bothersome aspects of derm tox and the impact on pts’ skin-specific HRQL. The questionnaire included items from the Skindex-29, a validated skin disease-specific HRQL questionnaire. Items were rated from 0 (not at all important) to 3 (extremely important) (range = 0–3) based on the items’ significance to patients’ HRQL. Both groups were also asked to circle 20 of the most concerning HRQL factors. Results: Eighteen pts and 11 exp completed the questionnaire. Symptoms reported frequently by both pts and exp that affected patients’ HRQL included painful (mean score 2.29 (pts), 2.70, (exp), burning (2.41 (pts), 2.70 (exp)), itchy (2.00 (pts), 2.20 (exp) skin, pain in fingers/toes (2.00 (pts), 2.40 (exp)) increased facial hair (1.93(pts), 1.70 (exp)). Both pts and exp also frequently reported that the patient’s skin condition makes them feel depressed (1.88 (pts), 2.60 (exp)) and makes work or hobbies difficult (2.00 (pts), 2.20 (exp)). The top three most concerning HRQL factors for pts were skin pain, burning and stinging, and irritation, while exp reported depression, skin pain, and derm tox affecting pts’ social life. Conclusions: These results document the trajectory of symptom burden and derm tox HRQL in EGFRI treated pts. These findings underscore that in addition to the psychosocial discomfort, physical symptoms impact HRQL. Further studies to validate the FAST-EGFRI, so that effects on HRQL of interventions against derm tox and differences between agents can be assessed are underway. No significant financial relationships to disclose.

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What is the health-related quality of life for women with metastatic breast cancer?

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.7_suppl.70 ◽

2016 ◽

Vol 34 (7_suppl) ◽

pp. 70-70

Author(s):

Deepa Lalla ◽

Amye Tevaarwerk ◽

Hans-Peter Goertz ◽

Mary Lou Smith ◽

Preeti S. Bajaj ◽

...

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Metastatic Breast Cancer ◽

Metastatic Breast ◽

Symptom Burden ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

The Impact

70 Background: Metastatic breast cancer (MBC) and its treatments can have a significant impact on patients’ health-related quality of life (HRQoL) and daily functioning. To better assess the impact of MBC on HRQoL, we conducted an online survey among women with MBC. Methods: We developed and administered a cross-sectional, web-based survey, and invited registered members of three advocacy groups currently living with MBC to participate. Respondents completed an informed consent and completed assessments on symptom burden using an overall QOL question (1 item), the MD Anderson Symptom Inventory Survey (MDASI), activities of daily living (ADLs, Rotterdam Scale), and impacts on work productivity. Results: We received 1285 complete responses to the survey. Over half the respondents were between 40-49yrs (37%) or 30-39 yrs (26%). The majority were white (87.7%), well-educated (70.7% had a bachelor’s degree or higher), and working at the time of the survey (55%), with private health insurance (63%). After diagnosis with MBC, most patients had received endocrine therapy (44.2% aromatase inhibitors, 27.3% fulvestrant). The most common chemotherapy agents received after diagnosis with MBC were capecitabine (30.1%) and docetaxel (26.9%). The overall mean HRQoL score was 74 (0-100, higher is better). Mean respondent-reported MDASI scores for symptom severity (SS) and symptom interference (SI) were 4.2 and 4.5 (0-10, higher is worse). Mean Rotterdam scale scores to assess ADLs were 23.7 (0-32, higher better). On average, working women with MBC missed 9.3 hours of work in the past 7 days due to their MBC. As symptom burden increased, respondents reported a lower ability to perform ADLs (p < 0.0001) and lower overall HRQoL (p < 0.0001). The ability to perform ADLs decreased with increase in the total number of agents received (p < 0.0001) and time since diagnosis (p < 0.0001). Conclusions: This survey provides valuable insights into health status, ability to perform ADLs, and lost productivity among patients with MBC. Future analyses will present results by tumor subtypes and drug treatments received.

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The Impact of Type D Personality on Health-Related Quality of Life in Tinnitus Patients Is Mainly Mediated by Anxiety and Depression

Otology & Neurotology ◽

10.1097/mao.0b013e3181bc3dd1 ◽

2010 ◽

Vol 31 (1) ◽

pp. 11-18 ◽

Cited By ~ 45

Author(s):

Hilke Bartels ◽

Susanne S. Pedersen ◽

Bernard F. A. M. van der Laan ◽

Michiel J. Staal ◽

Frans W. J. Albers ◽

...

Keyword(s):

Quality Of Life ◽

Type D Personality ◽

Anxiety And Depression ◽

Health Related Quality ◽

Type D ◽

Related Quality ◽

Health Related ◽

The Impact

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The Impact of Enzalutamide on the Prostate Cancer Patient Experience: A Summary Review of Health-Related Quality of Life across Pivotal Clinical Trials

Cancers ◽

10.3390/cancers13235872 ◽

2021 ◽

Vol 13 (23) ◽

pp. 5872

Author(s):

Bertrand Tombal ◽

Arnulf Stenzl ◽

David Cella ◽

Yohann Loriot ◽

Andrew J. Armstrong ◽

...

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Symptom Burden ◽

Health Related Quality ◽

Castration Resistant Prostate Cancer ◽

Castration Resistant ◽

Related Quality ◽

Health Related ◽

The Impact

This review examines the impact of treatment with enzalutamide on health-related quality of life (HRQoL) in prostate cancer patients across the disease continuum based on pivotal clinical trials. We assessed the effect of enzalutamide on pain, symptom burden and overall HRQoL from randomized controlled trials. Patient experience was evaluated in men with metastatic hormone-sensitive prostate cancer (mHSPC), non-metastatic castration-resistant prostate cancer (nmCRPC) and metastatic castration-resistant prostate cancer (mCRPC) (pre-chemotherapy and post-chemotherapy). Patients across the disease continuum reported a generally positive status at baseline, with relatively low levels of pain and impairment due to cancer-related symptoms and high HRQoL. For patients with earlier-state prostate cancer, pain and symptom-related burden were low at study entry and remained so, regardless of whether patients received enzalutamide or control treatment. Patients with more advanced disease reported mitigation in pain and symptom burden while receiving treatment with enzalutamide. Enzalutamide was observed to slow deterioration of overall HRQoL most for patients with nmCRPC or mCRPC (statistical significance for between-group difference in median time to deterioration: mHSPC (confirmed) p = 0.2998; nmCRPC (confirmed) p = 0.0044; mCRPC (unconfirmed) p < 0.0001). Across the prostate cancer continuum, enzalutamide is well-tolerated and delays the negative impact that disease progression has on quality of life.

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Recovery from aortic valve surgery: the trajectory of muscle mass, strength, and quality, and health-related quality of life (HRQoL)

European Journal of Cardiovascular Nursing ◽

10.1093/eurjcn/zvab060.050 ◽

2021 ◽

Vol 20 (Supplement_1) ◽

Author(s):

A Thomas ◽

M Griffiths ◽

A Kalakoutas ◽

M Yates ◽

J Sanders

Keyword(s):

Aortic Valve ◽

Muscle Mass ◽

Preoperative Assessment ◽

Muscle Quality ◽

Anxiety And Depression ◽

Post Surgery ◽

Related Quality ◽

Health Related ◽

The Impact

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Barts Charity OnBehalf Queen Mary University of London (QMUL) and Barts Health NHS Trust Background/Introduction: The impact of intensive care unit-acquired weakness (ICUAW) is considerable and is associated with reduced physical function and impaired health-related quality of life (HRQoL). Patients’ undergoing elective cardiac surgery are known to lose significant muscle mass and strength in the first seven days after surgery, but little is known beyond that time. Purpose We sought to investigate the effect of cardiac surgery on ICUAW (including muscle mass, strength, muscle quality) and HRQoL (including anxiety and depression and reintegration into society) until out-patient follow-up. Methods Eligible patients included adults undergoing a surgical elective aortic valve replacement without any pre-existing causes of severe muscle weakness or wasting. Muscle mass was measured using ultrasound of the rectus femoris cross-sectional area (RFcsa). Muscle quality was calculated using histogram analysis, specifically pixel intensity (PI), whereby a lower value is indicative of healthier muscle tissue. Muscle strength was measured using hand-held dynamometry specifically grip strength. HRQoL (EQ5D), anxiety and depression (hospital anxiety and depression scale (HADS)) and reintegration to normal living (RNLI index) were also collected. Measurements were assessed preoperatively, at day 7 and at out-patient follow-up. Results Thirty-one patients were recruited, with 22 (70.9%) patients attending follow-up. Patients lost 6.5% RFcsa (p= <0.0001) in the first seven days post-surgery and 10.1% (p = 0.0014) between preoperative assessment and follow-up. Hand-held grip strength decreased significantly (10.6%, p= <0.0001) in the first seven days post-surgery, however, differing to RFcsa, recovered considerably between day 7 and follow-up (7.7%, p = 0.018). Decreased muscle quality was observed solely in the first seven days after surgery (8.3%, p = 0.0094). The EQ5D visual analogue scale and crosswalk index increased significantly from preoperative assessment to follow-up (10%, p = 0.0250; 17.6%, p = 0.022 respectively) and day 7 to follow-up (11.7%, p = 0.0311; 27.9%, p = 0.011 respectively). While depression scores significantly decreased between the same time points as the EQ5D, changes in anxiety and RNLI scores, were non-significant. Conclusion Patients undergoing surgical aortic valve replacements lose considerable muscle mass in hospital, failing to recover even at out-patient follow-up. Furthermore, muscle quality decreases in the first seven days after surgery in line with the acute muscle loss. However, the impact on strength is less extensive as patients appear to recover the loss by follow-up. Patients’ health scores, function index and depression scores also improve, suggesting that muscle mass is the only outcome to not recover at follow-up. Therefore, patients appear to recover well from AVR surgery even surpassing some of their preoperative results, with the exception of the RFcsa.

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Health-related quality of life (HRQoL) in patients with untreated higher-risk myelodysplastic syndromes (MDS), acute myeloid leukemia (AML), and chronic myelomonocytic leukemia (CMML) receiving glasdegib + azacitidine (AZA).

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.7527 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 7527-7527 ◽

Cited By ~ 1

Author(s):

Eunice S. Wang ◽

Timothy Bell ◽

Amer Methqal Zeidan ◽

Helen Bhattacharyya ◽

Art Kudla ◽

...

Keyword(s):

Symptom Burden ◽

Minimal Change ◽

Intensive Chemotherapy ◽

Treatment Data ◽

Related Quality ◽

Health Related ◽

Md Anderson ◽

Global Impression Of Change ◽

The Impact ◽

Over Time

7527 Background: Glasdegib + AZA showed promising remission rates and overall survival in an analysis of BRIGHT MDS & AML 1012 in patients (pts) with MDS, AML and CMML. Here we assess the impact of glasdegib + AZA on HRQoL in this ongoing Phase Ib study. Methods: Untreated pts with MDS, AML and CMML ineligible for intensive chemotherapy received glasdegib (100 mg QD) + AZA (75 mg/m2/D on D1–7 q28D). Pt-reported outcomes (PRO) that characterize HRQoL were measured using the MD Anderson Symptom Inventory (MDASI)-AML/MDS, Pt Global Impression of Severity (PGI-S), and Pt Global Impression of Change (PGIC) tools. PRO were assessed at baseline (BL; except the PGIC), D7 and D15 of cycle (Cyc) 1, D1 of each subsequent Cyc and at end of treatment. Data cutoff: Sept 11, 2019. Results: For the MDS (n=30, including 3 with CMML) and AML (n=30) cohorts, median (range) number of Cyc started was 5 (1–14) and 5 (1–15), respectively. HRQoL over time, as determined by MDASI-AML/MDS, is shown in the Table, with mean scores indicating low symptom burden over time. For the PGI-S, both cohorts showed similar trends in pt’s impression of current leukemia symptoms remaining constant over time (i.e. absent to mild). For the PGIC, pt’s impression of change of leukemia symptoms since starting study medication remained constant over time (i.e. no to minimal change) for the MDS cohort and showed improvement in the AML cohort (i.e. minimal change to much improved). Conclusions: Glasdegib + AZA is a promising first-line treatment option that does not negatively impact the HRQoL of pts with MDS, AML and CMML ineligible for intensive chemotherapy. Clinical trial information: NCT02367456 . [Table: see text]

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