Symptom burden, health-related quality of life, and treatment preference over time as reported by patients with metastatic colorectal cancer (mCRC).

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 82-82
Author(s):  
Amy Little Jones ◽  
Nrupen Anjan Bhavsar ◽  
Amy Pickar Abernethy ◽  
Yousuf Zafar
Keyword(s):  
Quality Of Life ◽  
Pilot Study ◽  
Life Expectancy ◽  
Symptom Burden ◽  
Treatment Preference ◽  
Change Over Time ◽  
Limited Life Expectancy ◽  
Limited Life ◽  
Over Time

82 Background: Clinicians have difficulty predicting longitudinal changes in patient symptom burden and quality of life, and then how those changes might affect treatment preference. The primary aim of this pilot study was to investigate how self-reported symptom burden, quality of life, and treatment preference change over time in mCRC patients with limited life expectancy. Methods: Eligible mCRC patients had incurable disease, received chemotherapy at Duke or Duke Raleigh, were > = 18 years old, and spoke English. Patients were surveyed at each clinic visit and followed for up to 3.8 years on study. Measures included FACT-C (Functional Assessment of Cancer Therapy-Colorectal), PCM (Patient Care Monitor; a validated, 87-item review of systems survey; items measured on a 0-10 scale), and QQQ (Quality-Quantity Questionnaire; a validated, 8-item measure of cancer patient preference for quantity vs. quality of life; items measured on a 1-5 Likert scale). Demographic, disease, and treatment data were abstracted from the medical record. Results: The 56 patients were primarily male (68%) and Caucasian (79%) with a mean age of 55 at diagnosis of metastatic disease. Patients answered surveys a mean of 6.8 times each, with a median 364 days between first and last surveys. Over time, patients reported most symptoms improved or stayed the same (72%, n = 63 symptoms). Mean symptom scores that improved the most from first to last survey were fatigue (3.92 to 3.03) and nausea (2.1 to 1.4), while pain (1.9 to 2.5) and cough (0.4 to 0.7) worsened the most. Decision making about treatment preference also did not change over time, with mean QQQ scores from first survey (22, n = 28) to last survey (22, n = 16) remaining stable. Mean QQQ length and quality scores likewise were unchanged (12.9 to 12.8; 12.4 to 12.2 respectively). Conclusions: In this pilot study of mCRC patients with limited life expectancy, reported symptom burden scores remained stable or modestly improved over time, while preferences for quality vs. quantity of life remained stable. These findings suggest that patients with advanced cancer might perceive symptom burden differently over the course of their treatment.

Physicians' Opinions on Anticoagulant Therapy in Patients with a Limited Life Expectancy

2021 ◽  
Author(s):  
Bregje A.A. Huisman ◽  
Eric C.T. Geijteman ◽  
Nathalie Kolf ◽  
Marianne K. Dees ◽  
Lia van Zuylen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Life Expectancy ◽  
End Of Life ◽  
Bleeding Complications ◽  
Mixed Method Research ◽  
Limited Life Expectancy ◽  
Limited Life ◽  
Increased Risk

AbstractPatients with a limited life expectancy have an increased risk of thromboembolic and bleeding complications. Anticoagulants are often continued until death, independent of their original indication. We aimed to identify the opinions of physicians about the use of anticoagulants at the end of life. A mixed-method research design was used. A secondary analysis was performed on data from a vignette study and an interview study. Participants included general practitioners and clinical specialists. Physicians varied in their opinions: some would continue and others would stop anticoagulants at the end of life because of the risk of thromboembolic or bleeding complications. The improvement or preservation of patients' quality of life was a reason for both stopping and continuing anticoagulants. Other factors considered in the decision-making were the types of anticoagulant, the indication for which the anticoagulant was prescribed, underlying diseases, and the condition and life expectancy of the patient. Factors that made decision-making difficult were the lack of evidence on either strategy, uncertainty about patients' life expectancy, and the fear of harming patients. Which decision was eventually made seems largely dependent on the choice of the patient. In conclusion, there is a substantial variation in physicians' opinions regarding the use of anticoagulants in patients with a limited life expectancy. Physicians agree that the primary goal of medical care at end of life is the improvement or preservation of patients' quality of life. An important barrier to decision-making is the lack of evidence about the risks and benefits of stopping anticoagulants.

scholarly journals EVALUATION OF QUALITY OF LIFE IN PATIENTS TREATED FOR METASTATIC DISEASE OF THE PROXIMAL FEMUR

2018 ◽  
Vol 26 (4) ◽  
pp. 248-251
Author(s):  
Marcos Hajime Tanaka ◽  
Marcello Martins de Souza ◽  
Daniel Luiz Ceroni Gibson ◽  
Monica Paschoal Nogueira
Keyword(s):  
Quality Of Life ◽  
Life Expectancy ◽  
Proximal Femur ◽  
Lower Limbs ◽  
Bone Lesions ◽  
Limited Life Expectancy ◽  
Limited Life ◽  
Toronto Extremity Salvage Score ◽  
Significant Difference

ABSTRACT Objective: Patients with metastatic bone lesions have a limited life expectancy. These metastatic lesions compromise the proximal femur, and fractures are quite common. The survival of these patients depends on the behavior of the primary tumor. The aim of this study was to evaluate the quality of life of patients with extensive metastatic lesion of the proximal femur with pathological or imminent fracture, treated with non-conventional endoprosthesis. Methods: From May 2008 to August 2012, twenty-five (25) patients with bone metastases of the proximal femur, with pathological or imminent fracture were recruited into this study. These patients had survived for at least six weeks after surgery and the TESS questionnaire (Toronto Extremity Salvage Score) was administered. Results: The final score of the TESS was an average of 57 points (SD 23.78 points). There was no significant difference in TESS values considering: sex, presence of fracture, or site of the bone lesion. Conclusion: The TESS questionnaire provides information about the function and quality of life of patients with malignant tumors of the lower limbs, from the patient's perspective. The results can be considered positive, when compared to the limited life expectancy and complexity of this group of patients. Level of evidence III, Therapeutic studies, retrospective comparative study.

Deprescribing in Older Adults With Cancer and Limited Life Expectancy: An Integrative Review

2021 ◽  
pp. 104990912110030
Author(s):  
Edwin J. Brokaar ◽  
Frederiek van den Bos ◽  
Loes E. Visser ◽  
Johanneke E. A. Portielje
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Life Expectancy ◽  
Antihypertensive Drugs ◽  
Lipid Lowering ◽  
Potentially Inappropriate Medications ◽  
Limited Life Expectancy ◽  
Limited Life ◽  
Preventive Medication

Polypharmacy is common in older adults with cancer and deprescribing potentially inappropriate medications becomes very relevant when life expectancy decreases due to metastatic disease. Especially preventive medications may no longer be beneficial, because they may decrease quality of life and reduction in morbidity and mortality may be futile. Although deprescribing of preventive medication is common in the last period of life, it is still unusual during active cancer treatment for advanced disease, although life expectancy is often limited to less than 1 to 2 years in that stage. We performed a systematic search of the literature in Pubmed and Embase on the discontinuation of commonly utilized groups of preventive medication and evaluated the evidence of potential benefits and harms in patients aged 65 years or older with cancer and a limited life expectancy (LLE). From 21 included studies, it can be concluded that deprescribing lipid lowering drugs, antihypertensive drugs, osteoporosis drugs and antihyperglycemic drugs is feasible in a considerable part of patients with a LLE. Discontinuation may be performed safely, without the occurrence of serious adverse events or decrease of survival. The only study that addressed quality of life after deprescribing showed that discontinuation of statins improves quality of life in patients with a LLE. Recurrence of symptoms requiring reintroduction occurred in 0-13% of patients on antihyperglycemic treatment and 8-60% of patients using antihypertensive drugs. In order to reduce pill burden and futile treatment clinicians should discuss deprescribing of preventive medication with older patients with advanced cancer and a LLE.

Change over time in patient-reported symptoms and quality of life in Edmonton interdisciplinary menopause clinics

2019 ◽  
Vol 26 (9) ◽  
pp. 1031-1037
Author(s):  
Beate C. Sydora ◽  
Nese Yuksel ◽  
Vikas Chadha ◽  
Lori Battochio ◽  
Lori Reich-Smith ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Change Over Time ◽  
Patient Reported ◽  
Over Time

Assessing meaningful change over time in quality of life: A user's guide for clinicians

2002 ◽  
Vol 24 ◽  
pp. 8
Author(s):  
MirjamA.G. Sprangers ◽  
CarolM. Moinpour ◽  
TimothyJ. Moynihan ◽  
DonaldL. Patrick ◽  
DennisA. Revicki
Keyword(s):  
Quality Of Life ◽  
Meaningful Change ◽  
Change Over Time ◽  
Over Time

Samarium-153 effectiveness in the quality of life of bone metastatic cancer patients.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20635-e20635
Author(s):  
Grecory Tsoukalas ◽  
Alexandros Tzovaras ◽  
Nikolaos Tsoukalas ◽  
Sofia Stamatopoulou ◽  
George Gatsos ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Metastatic Cancer ◽  
Pain Severity ◽  
Pain Interference ◽  
Control Group ◽  
Bone Lesions ◽  
Satisfaction Scale ◽  
Change Over Time ◽  
Over Time

e20635 Background: Osseous metastases in patients suffering from cancer, is a multifactor symptom which affects quality of life. Methods: The Samarium group (SG) n=53 patients received a single bolus infusion of (153)Sm (37 MBq/kg), and we compared with a Control group(CG) n=37. Both groups of patients who had metastatic bone cancer requiring analgesia answered the following questionnaires: Greek Brief Pain Inventory (GBPI), Brief Multidimensional Life Satisfaction Scale (BMLSS), Hospital Anxiety Depression Scale (HADS), ECOG/WHO/Zubrod score and Hospital Satisfaction Scale (HSS),day 0 and 30±3 days after the intervention start.There was no statistically significant(SS) difference for the variables(V-) sex, age, pain’s localization and lodging. Results: Pain severity and pain interference change over time was the same for both groups P= 0.0005. For the V- HADS-anxiety, SG showed no SS improvementP= 0.397, something which was achieved for the CG,P= 0.031. The V- HADS improved SS for both groups P= 0.031 and P= 0.003 respectively which changed over time with the same way. This may show the strong relation between pain and depression. The V- ECOG also changed over time in the same way for both SG(P=0.005) and CG (P=0.014). The percentage of patients who changed scale towards improvement for their quality of life was 24,3% for the CG and 15,1% for the SG. The V-BMLSS change over time was similar for both groups. There was no SS difference for the V-HSS towards medical and nursing personnel for both groups (P=1.000). Myelotoxicity for the SG was moderate and reversible, as well as the side effects for the CG. Finally an equivalence test between the two groups, showing that both treatment regimens were equivalent for all variables: Pain severity=0.034, Pain interference=0.009, HAD-anxiety P=0.048, HAD-depression=0.033, BMLSS=0.016, ECOG=0.0005. During our study among the patients of the SG in some cases the stabilization of bone lesions was observed, and in one case partial and/or complete remission. Conclusions: Administration of (153)Sm is another equivalent option for those patients who are intolerant or resistant to medication treatment having a better cost-effectiveness result.

scholarly journals Quality of Life Among Long-Term Survivors of Non-Hodgkin Lymphoma: A Follow-Up Study

2013 ◽  
Vol 31 (2) ◽  
pp. 272-279 ◽  
Author(s):  
Sophia K. Smith ◽  
Deborah K. Mayer ◽  
Sheryl Zimmerman ◽  
Christianna S. Williams ◽  
Habtamu Benecha ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Social Support ◽  
Hodgkin Lymphoma ◽  
Symptom Burden ◽  
Non Hodgkin Lymphoma ◽  
The Impact ◽  
Long Term Survivors ◽  
Over Time

Purpose Little is known about change in quality of life (QOL) among long-term cancer survivors. We examined change over time in QOL among long-term survivors of non-Hodgkin lymphoma and identified demographic, clinical, and psychosocial risk factors for poor outcomes. Methods Surveys were mailed to 682 lymphoma survivors who participated in a study 5 years earlier, when on average they were 10.4 years postdiagnosis. Standardized measures of QOL, perceptions of the impact of cancer, symptoms, medical history, and demographic variables were reported at both time points and examined using linear regression modeling to identify predictors of QOL over time. Results A total of 566 individuals participated (83% response rate) who were a mean of 15.3 years postdiagnosis; 52% were women, and 87% were white. One third of participants (32%) reported persistently high or improved QOL, yet a notable proportion (42%) reported persistently low or worsening QOL since the earlier survey. Participants who received only biologic systemic therapy reported improvement in physical health despite the passage of time. Older age, more comorbidity, and more or increasing negative and decreasing positive perceptions of cancer's impact were independent predictors of poor QOL. Lymphoma symptom burden, less social support, and having received a transplantation were related to negative perceptions of cancer's impact. Conclusion Moderate to severe symptom burden, limited social support, or having received a transplantation should alert the clinician to potential need for supportive services. Perceptions of cancer's impact are associated with QOL cross-sectionally and longitudinally; modifying these perceptions may thus provide a strategy for improving QOL.

scholarly journals Fibroid vascularisation assessed with 3D Power Doppler as predictor for fibroid related symptoms and quality of life; a pilot study

2021 ◽  
Vol 13 (4) ◽  
pp. 387-394
Author(s):  
A.L. Keizer ◽  
L.L. Niewenhuis ◽  
W.J.K. Hehenkamp ◽  
J.W.R. Twisk ◽  
H.A.M. Brölmann ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pilot Study ◽  
Power Doppler ◽  
Uterine Fibroids ◽  
Expectant Management ◽  
Point Increase ◽  
3D Power Doppler ◽  
Fibroid Volume ◽  
Over Time

Background: Uterine fibroids present differently, from well vascularised up to calcified, with some causing heavy menstrual bleeding (HMB). Objectives: To investigate the association between fibroid vascularisation and HMB, other fibroid related symptoms and quality of life (QOL). Materials and Methods: A single centre pilot study was carried out in the Netherlands. Women with a maximum of two fibroids who chose expectant management were included. 3D sonography including power doppler was performed at baseline and at 3, 6 and 12 months follow up. Women were asked to complete the Pictorial Blood Assessment Chart (PBAC) and Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaires at every visit. Main outcome measure: The association between fibroid vascularisation and HMB. Results: 53 women were included in the study. Baseline fibroid vascularisation, measured as vascular index (VI) is associated with PBAC score; a 1% higher VI at baseline leads to an 11 point increase in PBAC score over time (RC 10.99, p=0.05, 95% CI -0.15 – 22.12). After correction for the baseline variables ethnicity and fibroid type the association becomes stronger (P<0.05). Fibroid volume at baseline and HMB are also associated: a 1 cm3 larger fibroid leads to 0.6 points increase in PBAC score over time (RC 0.56, p=0.03, 95% CI 0.05 – 1.07). Conclusions: This study highlights that both fibroid vascularisation and fibroid volume may be associated with an increase in menstrual blood loss, other fibroid related symptoms and QOL over time. What is new? We used 3D power doppler to predict symptomatic fibroids.

Ultramicronized Palmitoylethanolamide (um-PEA) as Add-on Treatment in Fibromyalgia Syndrome (FMS): Retrospective Observational Study on 407 Patients

2019 ◽  
Vol 18 (4) ◽  
pp. 326-333 ◽  
Author(s):  
Vittorio Schweiger ◽  
Alvise Martini ◽  
Paola Bellamoli ◽  
Katia Donadello ◽  
Carlo Schievano ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Observational Study ◽  
Fibromyalgia Syndrome ◽  
Fibromyalgia Impact Questionnaire ◽  
Retrospective Observational Study ◽  
Visual Analogue Scale Pain ◽  
Change Over Time ◽  
Ultramicronized Palmitoylethanolamide ◽  
Over Time

Background: Fibromyalgia syndrome is a chronic multifaceted disease characterized by widespread pain, muscle stiffness, fatigue, unrefreshing sleep and cognitive disorders. To date, no medication has been shown to significantly improve pain, associated symptoms and Quality of Life in fibromyalgic patients. Methods: In this retrospective observational study, we analyzed data regarding 407 patients with diagnosis of fibromyalgia syndrome who between 2013 and 2016 have been prescribed orally ultramicronized palmitoylethanolamide tablets (Normast® Epitech Group SpA, Saccolongo, Italy) regardless of the concomitant pharmacological therapy (add-on treatment). Results: Regarding efficacy, in the 359 analyzed patients, the change over time in Visual Analogue Scale pain score was statistically significant, ranging from 75.84 (±15.15) to 52.49 (±16.73) (p<0.001). Regarding quality of life, the change over time in Fibromyalgia Impact Questionnaire score was statistically significant, ranging from 68.4 (±14.1) to 49.1 (±19.6) (p<0.001). In the treated population, only 36 patients (13,7%) reported Adverse Events predominantly of gastrointestinal type (diarrhea, dyspepsia, bloating, constipation, vomiting). Globally, 151 patients (57,63%) left the treatment due to inefficacy. Conclusion: The results of ultramicronized palmitoylethanolamide treatment in this retrospective analysis represent an important step for the development of a new and well-tolerated therapy for fibromyalgia syndrome, mostly suitable for these patients who need long-term treatments. Further methodologically stronger studies will be necessary to validate our observation.

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