Long-term consequences of exenterative surgery for people with pelvic cancer.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 118-118 ◽  
Author(s):  
Jane Young ◽  
Michael Solomon ◽  
Daniel Steffens ◽  
Cherry Koh
Keyword(s):  
Quality Of Life ◽  
Locally Advanced ◽  
Resection Margins ◽  
R0 Resection ◽  
Personal Goals ◽  
Pelvic Cancer ◽  
Patient Reported ◽  
Ongoing Pain

118 Background: For people with recurrent or locally advanced pelvic cancer with no evidence of metastatic spread, pelvic exenteration (PE) surgery that achieves clear (R0) resection margins is the only potentially curative treatment option. This extensive, radical surgery can involve removal of the pelvic organs, muscles, nerves and bone, resulting in significant impairment for patients. The aim of this study is to describe the long-term quality of life outcomes for this procedure, specifically to investigate levels of pain, vitality, depression and ability to achieve personal goals among survivors three or more years after surgery. Methods: The Royal Prince Alfred Hospital in Sydney is a national referral center for PE in Australia. Patient-reported outcome measures, including generic (SF36) and colorectal cancer-specific (FACT-C) measures of quality of life (QoL), pain, vitality, depression and self-reported ability to achieve personal goals are assessed pre-surgery, every six months to three years and then annually. Consecutive patients who were three or more years after PE comprised the sample for this study. Trajectories for patient reported outcomes were plotted and the proportion of survivors who experienced ongoing pain, vitality and depression at each time point were calculated. Results: Among 241 patients who were 3 years post-PE, 63 (26%, 95% CI: 21-32%) had died and 3-year QoL assessments were completed by 65 (51%) of survivors. Three years after surgery, mean QoL scores were similar to baseline and remained fairly stable among survivors to 5 years. There was a small decrease over time in the proportion of survivors reporting ongoing pain. From 3 years onwards, approximately 70% (95% CI: 58-79%) of survivors reported ongoing pain and 44% (95% CI: 34-57%) reported some level of depression. However, SF-36 vitality scores increased slightly from a mean of 46.2 pre-PE to 54.0 at 3 years. Conclusions: Despite the extensive nature of PE surgery, the majority of survivors achieved reasonable long-term quality of life. However, high levels of chronic pain and depression indicate ongoing needs for supportive care in this patient group.

scholarly journals Long-Term Consequences of Exenterative Surgery for People With Pelvic Cancer

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 228s-228s
Author(s):  
J.M. Young ◽  
D. Steffens ◽  
R.L. Venchiarutti ◽  
C.E. Koh ◽  
M.J. Solomon
Keyword(s):  
Quality Of Life ◽  
Locally Advanced ◽  
Patient Reported Outcome Measures ◽  
Resection Margins ◽  
R0 Resection ◽  
Pelvic Cancer ◽  
Patient Reported ◽  
Ongoing Pain

Background: For people with recurrent or locally advanced pelvic cancer with no evidence of metastatic spread, pelvic exenteration (PE) surgery that achieves clear (R0) resection margins is the only potentially curative treatment option. This extensive, radical surgery can involve removal of the pelvic organs, muscles, nerves and bone, resulting in significant impairment for patients. Aim: The aim of this study was to describe the long-term quality of life outcomes for this procedure, specifically to investigate levels of pain, vitality and depression among survivors 3 or more years after surgery. Methods: The Royal Prince Alfred Hospital in Sydney is a national referral center for PE in Australia. Patient-reported outcome measures, including generic (SF36) and colorectal cancer-specific (FACT-C) measures of quality of life (QoL), pain, vitality and depression were assessed presurgery, every 6 months to 3 years and then annually. Consecutive patients who were 3 or more years after PE comprised the sample for this study. Trajectories for patient-reported outcomes were plotted and the proportion of survivors who experienced ongoing pain, vitality and depression at each time point were calculated. Results: Among 251 patients who were 3 years post-PE, 131 (52%, 95% CI: 46%-58%) had died and 3-year QoL assessments were completed by 69 (58%) of survivors. Three years after surgery, mean QoL scores were similar to baseline and remained fairly stable among survivors to 5 years. There was a small decrease over time in the proportion of survivors reporting ongoing pain. From 3 years onwards, ∼77% (95% CI: 67%-87%) of survivors reported ongoing pain and 44% (95% CI: 32%-56%) reported some level of depression. However, SF-36 vitality scores increased slightly from a mean of 47.2 pre-PE to 49.0 at 3 years. Conclusion: Despite the extensive nature of PE surgery, the majority of survivors achieved reasonable long-term quality of life. However, high levels of chronic pain and depression indicate ongoing needs for supportive care in this patient group.

Quality of life analysis of HPV-positive oropharyngeal cancer patients in a randomized trial of reduced-dose (rdCRT) versus standard (sdCRT) chemoradiotherapy: Five-year follow-up.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6062-6062
Author(s):  
Mai Takahashi ◽  
Michael Hwang ◽  
Krzysztof Misiukiewicz ◽  
Richard Lorne Bakst ◽  
Brett A. Miles ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Randomized Trial ◽  
Head And Neck ◽  
Oropharyngeal Cancer ◽  
Locally Advanced ◽  
Patient Reported ◽  
Md Anderson

6062 Background: Human papillomavirus-positive oropharyngeal cancer (HPV OPC) portends a more favorable prognosis compared to HPV-negative cases. To prevent overtreatment, long-term morbidity and deterioration in functionality and quality of life (QoL), multiple studies have focused on de-intensification techniques for HPV OPC treatment. To this end, we prospectively assessed differences in patient reported QoL in locally advanced HPV OPC patients receiving rdCRTversus sdCRT)in a randomized trial using a sequential therapy plan. Methods: Patients were enrolled between December 2012 and February 2016; received 3 cycles of induction docetaxel, cisplatin, and 5-FU; and were randomized to sdCRT (70 Gy) or rdCRT (56 Gy) with weekly carboplatin. Patients were followed for Progression Free Survival (PFS), Overall Survival (OS), and changes in QoL as assessed by the MD Anderson Dysphagia Inventory (MDADI), MD Anderson Symptom Inventory (MDASI Head and Neck), Xerostomia Questionnaire (XQ), and the European Organization for Research and Treatment of Cancer Questionnaire (EORTC QLQ-C30) with the head and neck module (EORTC HN). A mixed model ANOVA was used to estimate changes from baseline QoL to that at each follow-up timepoint and to compare the difference in QoL changes between the treatment arms. Results: We randomized 20 HPV+ locally advanced (LA) patients (median age: 56.5 yrs) to rdCRT (12 subjects) or sdCRT (8 subjects). 70% had high risk features. At a median follow-up of 81.5 mos, PFS and OS were 87.5% and 83.3% for sdCRT and rdCRT, respectively with a median OS of 76 mos in both arms. One patient in the sdCRT arm developed an HPV negative retromolar trigone squamous cell cancer in the radiation field 7 yrs after therapy. Baseline QoL was identical in the 15 patients who completed the QoL modules. Patients receiving rdCRT hadsignificantly lower declines in QoL scores at 3-6 month follow-up. At 5 yrs, differences in QoL changes all favored the rdCRT arm (Table) and two QoL scales reached statistical significance (P<0.05). Conclusions: In HPV OPC patients, rdCRT resulted in comparable long-term survival and greater improvement in specific domains of QoL when compared to sdCRT. Our results support the need for a larger, long-term Phase 3 study in LA HPVOPC to assess these two treatments with respect to survival, QoL, and safety. Clinical trial information: NCT02945631. [Table: see text]

Quality of life after pelvic radiotherapy with hypofractionated IMRT boost and long-term hormone therapy for locally advanced prostate cancer.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 75-75
Author(s):  
H. C. Quon ◽  
P. Cheung ◽  
D. A. Loblaw ◽  
G. Morton ◽  
E. Szumacher ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Hormonal Therapy ◽  
Patient Reported Outcomes ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Summary Score ◽  
Patient Reported

75 Background: Combined radiotherapy (RT) and long-term hormonal therapy (HT) is a standard treatment option for high-risk prostate cancer. Dose escalated RT alone has been shown to improve disease free survival. Increased sensitivity of prostate cancer to high doses per fraction has led to hypofractionation as a method to radiobiologically escalate dose.We report on the quality of life of patients treated with combined hypofractionated RT and HT. Methods: A prospective phase I/II study enrolling patients with any of: clinical T3, PSA ≥20, or Gleason 8-10. Forty-five Gy (1.8 Gy/fraction) was delivered to the pelvic nodes with a concomitant 22.5 Gy intensity-modulated RT boost to the prostate, for a total of 67.5 Gy (2.7 Gy/fraction) in 25 fractions over 5 weeks. Hormonal therapy was administered for 2-3 years. Patient reported outcomes were measured at baseline and every 6 months using the validated Expanded Prostate Cancer Index Composite (EPIC) questionnaire, which measures urinary, bowel, sexual, and hormonal domains. Results: Sixty patients with a minimum 24 months of patient-reported outcomes were analyzed. Mean scores comparing baseline to 24 month values are reported. There were no statistically significant changes in the urinary summary scores (86.3 vs. 86.0, p=0.45) or any of the urinary subscales (function, bother, incontinence, irritative/obstructive). Domain summary score decreases were observed in: bowel by 4.4% (94.7 vs. 90.3, p<0.01), sexual by 27% (44.5 vs. 17.5, p<0.01), and hormonal by 11.9% (93.1 vs. 81.2, p<0.01). Examining time trends in outcomes, most changes occurred within the first 6 months with smaller changes thereafter. Conclusions: Hypofractionated RT combined with long-term HT is associated with good patient-reported urinary and bowel outcomes at 24 months. Sexual and hormonal summary scores are affected, largely due to continued androgen deprivation therapy. Further follow-up is needed to document patient reported outcomes after testosterone recovery. No significant financial relationships to disclose.

scholarly journals Prospective observational study to examine health-related quality of life and develop models to predict long-term patient-reported outcomes 6 months after hospital discharge with blunt thoracic injuries

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e049292
Author(s):  
Edward Baker ◽  
Ceri Battle ◽  
Abhishek Banjeri ◽  
Edward Carlton ◽  
Christine Dixon ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Hospital Discharge ◽  
Brief Pain Inventory ◽  
Thoracic Injuries ◽  
Patient Reported ◽  
Related Quality ◽  
Paindetect Questionnaire ◽  
Health Related

ObjectiveThis study aimed to examine the long-term outcomes and health-related quality of life in patients with blunt thoracic injuries over 6 months from hospital discharge and develop models to predict long-term patient-reported outcomes.DesignA prospective observational study using longitudinal survey design.SettingThe study recruitment was undertaken at 12 UK hospitals which represented diverse geographical locations and covered urban, suburban and rural areas across England and Wales.Participants337 patients admitted to hospital with blunt thoracic injuries were recruited between June 2018–October 2020.MethodsParticipants completed a bank of two quality of life surveys (Short Form-12 (SF-12) and EuroQol 5-Dimensions 5-Levels) and two pain questionnaires (Brief Pain Inventory and painDETECT Questionnaire) at four time points over the first 6 months after discharge from hospital. A total of 211 (63%) participants completed the outcomes data at 6 months after hospital discharge.Outcomes measuresThree outcomes were measured using pre-existing and validated patient-reported outcome measures. Outcomes included: Poor physical function (SF-12 Physical Component Score); chronic pain (Brief Pain Inventory Pain Severity Score); and neuropathic pain (painDETECT Questionnaire).ResultsDespite a trend towards improving physical functional and pain at 6 months, outcomes did not return to participants perceived baseline level of function. At 6 months after hospital discharge, 37% (n=77) of participants reported poor physical function; 36.5% (n=77) reported a chronic pain state; and 22% (n=47) reported pain with a neuropathic component. Predictive models were developed for each outcome highlighting important data collection requirements for predicting long-term outcomes in this population. Model diagnostics including calibration and discrimination statistics suggested good model fit in this development cohort.ConclusionsThis study identified the recovery trajectories for patients with blunt thoracic injuries over the first 6 months after hospital discharge and present prognostic models for three important outcomes which after external validation could be used as clinical risk stratification scores.

scholarly journals Patient-Reported Outcomes, Health-Related Quality of Life, and Clinical Outcomes for Urothelial Cancer Patients Receiving Chemo- or Immunotherapy: A Real-Life Experience

2021 ◽  
Vol 10 (9) ◽  
pp. 1852
Author(s):  
Gry Assam Taarnhøj ◽  
Henriette Lindberg ◽  
Christoffer Johansen ◽  
Helle Pappot
Keyword(s):  
Quality Of Life ◽  
Cancer Patients ◽  
Patient Reported Outcomes ◽  
Life Experience ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Real Life ◽  
Oncological Treatment ◽  
Patient Reported

Patients with urothelial cell carcinoma (UCC) often have comorbidities, which cause trouble for the completion of oncological treatment, and little is known about their quality of life (QoL). The aim of the present study was to obtain and describe patient-reported outcomes (PRO) and QoL data from UCC patients in the treatment for locally advanced muscle-invasive or metastatic UCC. A total of 79 patients with UCC completed four questionnaires (EORTC QLQ-C30, QLQ-BLM30, HADS, and select PRO-CTCAE™ questions) once weekly during their treatment. From those, 26 patients (33%) underwent neoadjuvant treatment for local disease while 53 patients (67%) were treated for metastatic disease. Of all patients, 54% did not complete the planned treatment due to progression, nephrotoxicity, death, or intolerable symptoms during treatment. The five most prevalent PRO-CTCAE grade ≥ 2 symptoms were frequent urination (37%), fatigue (35%), pain (31%), dry mouth (23%), and swelling of the arms or legs (23%). The baseline mean overall QoL was 61 (±SD 24) for all patients (neoadjuvant (73, ±SD 19) and metastatic (54, ±SD 24)) and remained stable over the course of treatment for both groups. A stable overall QoL was observed for the patients in this study. More than half of the patients did not, however, complete the planned treatment. Further supportive care is warranted for bladder cancer patients.

scholarly journals Determinants of Cancer-specific Quality of Life in Veteran Lung Cancer Survivors Eligible for Long-Term Cure

2019 ◽  
Author(s):  
Duc Ha ◽  
Andrew L. Ries ◽  
Jeffrey J. Swigris
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Cancer Survivors ◽  
Summary Score ◽  
European Organization ◽  
Specific Patient ◽  
Patient Reported ◽  
Sleep Difficulties

AbstractRationale/ObjectiveQuality of life (QoL) is an important issue in lung cancer survivors. We aimed to identify determinants of QoL in lung cancer survivors eligible for long-term cure.MethodsWe performed an exploratory analysis of a cross-sectional study of consecutive lung cancer survivors who completed curative-intent treatment ≥1 month previously. Variables tested included demographic, clinical, physiologic, and symptom-specific patient-reported outcome measures. We defined the primary outcome as a previously-validated cancer-specific QoL measure – the European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 (C30) summary score. We also verified our findings with the C30 global health status/QoL subscale and a summated score of lung cancer-specific QoL from the EORTC-Lung Cancer Module 13.ResultsIn 75 enrolled participants, measures of fatigue, depression, sleep difficulties, and dyspnea were statistically significant determinants of the C30 summary score in multivariable linear regression analyses. Together, these four symptoms accounted for approximately 85% of the variance in cancer-specific QoL (p<0.001). When we verified our findings with global QoL and lung cancer-specific QoL, fatigue and dyspnea were consistent determinants of QoL.ConclusionsWe found four symptoms – dyspnea, fatigue, depression, and sleep difficulties – that are important determinants of and together accounted for almost all of the variance in cancer-specific QoL in lung cancer survivors eligible for long-term cure. These findings have implications to reduce symptom burden and improve function and QoL in these patients.

705 SIGNIFICANCE OF CLEAR CIRCUMFERENTIAL RESECTION MARGIN IN ESOPHAGEAL CANCER

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Catherine Cheang ◽  
Pradeep Patil
Keyword(s):  
Esophageal Cancer ◽  
Multimodal Therapy ◽  
Resection Margin ◽  
Locally Advanced ◽  
Radical Resection ◽  
Resection Margins ◽  
R0 Resection ◽  
Term Survival ◽  
R1 Resection

Abstract   Circumferential resection margins (CRM) of an esophagectomy specimen for oesophageal cancer is a key prognostic factor of overall survival (OS). This retrospective study aims to compare OS of post-esophagectomy patients with CRM of &gt;1 mm (R0) and &lt; 1 mm (R1) with further subgroup analysis of locally advanced T3R0 vs T3R1 resection. Methods A total of 110 esophagectomies conducted between 2010 and 2020 were analysed. We recorded R stage based on pathological CRM &gt;1 mm (R0) or &lt; 1 mm (R1). OS was calculated from the day of surgery to day of death or otherwise censored. All patients underwent multimodal therapy including chemotherapy and similar pre-surgical and post-surgical management. 58 of these patients with pT3 stage esophageal cancer (EC) were selected and compared. Statistical analysis was carried out using SPSS. Results Of 110 patients, 78 (71.5%) patients had a R0 resection. Mean OS in R0 resections was 73 months (6 years) compared to 25.2 months (2 years) in R1 resection (p = 0.001). 58 of the 110 patients were pathological stage T3(pT3) despite downstaging with chemotherapy showing the burden of advanced disease. In patients with stage pT3 (n = 58), 32 patients were R0 resections, and 26 patients had R1 resections. Mean OS in T3R0 resections was 51.5 months compared to 28.5 months in T3R1 resection. OS comparison is significant (p = 0.011). Conclusion This study emphasizes the importance of clear CRM in all patients and especially in locally advanced pT3/T4a esophageal cancer in achieving long term survival. Techniques used to ensure a clear CRM such multimodality therapy combined with surgical radical resection concepts such as mesoesophagectomy should be employed.

275 POSTOPERATIVE COMPLICATIONS DO NOT AFFECT QUALITY OF LIFE AFTER ESOPHAGECTOMY

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
E Jezerskyte ◽  
H Laarhoven ◽  
M Sprangers ◽  
W Eshuis ◽  
M Hulshof ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Postoperative Complications ◽  
Term Survival ◽  
Radio Therapy ◽  
Significant Difference ◽  
Patient Reported ◽  
Short And Long Term ◽  
Over Time

Abstract   Despite the attempts to reduce postoperative complication incidence after esophageal cancer surgery, up to 60% of patients endure postoperative complications. These patients often have a reduced health related quality of life (HR-QoL) and it may also have a negative effect on long-term survival. The aim of this study is to investigate the difference in short- and long-term HR-QoL in patients with and without a complicated postoperative course. Methods A retrospective comparative cohort study was performed with data from the Dutch Cancer Registry (IKNL) and QoL questionnaires from POCOP, a longitudinal patient reported outcomes study. All patients with esophageal and gastroesophageal junction (GEJ) cancer after an esophagectomy with or without neoadjuvant chemo(radio) therapy in the period of 2015–2018 were included. Exclusion criteria were palliative surgery, patients with a recurrence, reconstruction with a colonic or jejunal interposition, no reconstruction and emergency surgery. HR-QoL was investigated at baseline and at 3, 6, 9, 12, 18 and 24 months postoperatively between patients with and without complications following an esophagectomy. Results A total of 486 patients were included: 270 with and 216 without postoperative complications. The majority of patients were male (79.8%) with a median age of 66 years (IQR 60–70.25). Significantly more patients had comorbidities in the group with postoperative complications (69.6% vs 57.3%, p = 0.001). A significant difference in HR-QoL over time was found between the two groups in “choked when swallowing” score (p = 0.028). Patients that endured postoperative complications reported more problems with choking when swallowing at 9 months follow-up (mean score 12.9 vs 8.4, p = 0.047). This difference was not clinically relevant with a mean score difference of 4.6 points. Conclusion Postoperative complications do not significantly influence the short- and long-term HR-QoL in patients following an esophagectomy. Only one HR-QoL domain showed difference over time, however, this was not clinically relevant.

Sign in / Sign up

Export Citation Format

Share Document