scholarly journals Dynamics of quality of life of head and neck cancer patients after treatment. Clinical significance

2019 ◽  
Vol 8 (4) ◽  
pp. 39-47
Author(s):  
A. V. Karpenko ◽  
R. R. Sibgatullin ◽  
A. A. Boyko ◽  
M. G. Kostova ◽  
O. M. Nikolayeva ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Head And Neck ◽  
Clinical Significance ◽  
Mouth Opening ◽  
Emotional Function ◽  
Eortc Qlq C30 ◽  
Eortc Qlq ◽  
Taste And Smell ◽  
Sticky Saliva

The study objective is to evaluate the quality of life as one of the main parameters that determines the effectiveness of treatment of patients with head and neck squamous cell carcinoma.Materials and methods. Thirty-three stage III—IV oral cancer patients aged between 39 and 70 years were asked to fill EORTC QLQ-C30 (European Organisation for Research and Treatment of Cancer quality of life questionnaire core 30-questions) and QLQ-H&N35 (head and neck cancer-specific module) before and 12—18 months after completion of the treatment that consisted of surgery followed by radiation with or without chemotherapy. Surgery included neck dissection with removal of the primary tumor via transoral (n = 5) or combined (n = 28) approach. Reconstruction was performed by primary closure (n = 5), with pedicled (n = 8) or free (n = 20) flaps.Results. According to EORTC QLQ-C30 questionnaire only positive shifts turned out to be statistically significant: general health, emotional function, pain, insomnia and diarrhea. Site-specific EORTC QLQ-H&N35 questionnaire revealed several positive (pain in the head and neck, feeling ill, use of painkillers and weight gain) and negative (public eating, problems with taste and smell, sticky saliva and dry mouth) changes. Applying algorithms for determining clinical significance changed the number and value of several scales and domains. Changes in general health, emotional function, pain, insomnia, pain in the head and neck, taste and smell disorders, mouth opening, sticky saliva, dry mouth, painkillers and weight gain were found to have some clinical relevance. Moreover, for one of them (mouth opening) statistical significance was not reached.Conclusions. Further research of clinical significance of changes and differences in scales and domains that determine and affect quality of life are needed. They will allow to understand more fully problems that every patient with oral cavity cancer tries to cope with.

Does Palliative Chemotherapy Palliate? Evaluation of Expectations, Outcomes, and Costs in Women Receiving Chemotherapy for Advanced Ovarian Cancer

2001 ◽  
Vol 19 (5) ◽  
pp. 1266-1274 ◽  
Author(s):  
Catherine Doyle ◽  
Michael Crump ◽  
Melania Pintilie ◽  
Amit M. Oza
Keyword(s):  
Quality Of Life ◽  
Ovarian Cancer ◽  
Palliative Chemotherapy ◽  
Advanced Ovarian Cancer ◽  
Patient Expectations ◽  
Global Function ◽  
Emotional Function ◽  
Eortc Qlq C30 ◽  
Eortc Qlq

PURPOSE: The value of palliative chemotherapy in women with refractory and recurrent ovarian cancer is difficult to quantify, and little is known about patient expectations from these treatments. We evaluated in the current prospective study patient expectations, palliative outcomes of chemotherapy, and the inherent resource utilization in patients undergoing second- or third-line chemotherapy for recurrent or refractory advanced ovarian cancer. METHODS: The European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30 (EORTC QLQ C30) and Functional Assessment of Cancer Therapy-Ovarian (FACT-O) questionnaires were used to assess palliative benefit and an in-house questionnaire was used to gauge patient expectations. The minimal clinically important difference (MCID) was calculated by asking women to make a global rating of change and correlating this to the EORTC QLQ C30. Resource use was recorded and costs were calculated. RESULTS: Twenty-seven patients were accrued. Objective response was documented on seven of 27. The median survival was 11 months. Sixty-five percent of women expected that chemotherapy would make them live longer and 42% that it would cure them. After two cycles, quality-of-life (QL) improvement was seen particularly in global function (11 of 21) and emotional function (13 of 21) with EORTC QLQ C-30. Improvement was sustained for a median of 2 and 3 months, respectively, in these categories. The MCID was calculated to be 0.39 on a seven-point scale for physical function and 0.13 for global function. The mean total cost per patient for the study period was Can $12,500. CONCLUSION: Patient expectations from these treatments are often unrealistic. Although objective responses are low, active palliation with chemotherapy is associated with substantive improvement in patients’ emotional function and global QL, with overall costs that seem relatively modest.

Comparison of patient-reported late treatment toxicity (LENT–SOMA) with quality of life (EORTC QLQ-C30 and QLQ-H&N35) assessment after head and neck radiotherapy

2010 ◽  
Vol 97 (2) ◽  
pp. 270-275 ◽  
Author(s):  
Kean Fatt Ho ◽  
Damien J.J. Farnell ◽  
Jacqueline A. Routledge ◽  
Meriel P. Burns ◽  
Andrew J. Sykes ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Head And Neck ◽  
Treatment Toxicity ◽  
Patient Reported ◽  
Eortc Qlq C30 ◽  
Late Treatment ◽  
Eortc Qlq ◽  
Head And Neck Radiotherapy

Health-Related Quality of Life As a Survival Predictor for Patients With Localized Head and Neck Cancer Treated With Radiation Therapy

2009 ◽  
Vol 27 (18) ◽  
pp. 2970-2976 ◽  
Author(s):  
François Meyer ◽  
André Fortin ◽  
Michel Gélinas ◽  
Abdenour Nabid ◽  
François Brochet ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Radiation Therapy ◽  
Head And Neck ◽  
Prognostic Value ◽  
Health Related Quality ◽  
Related Quality ◽  
Eortc Qlq C30 ◽  
Health Related ◽  
Eortc Qlq

Purpose To assess the added prognostic value for overall survival (OS) of baseline health-related quality of life (HRQOL) and of early changes in HRQOL among patients with localized head and neck cancer (HNC) treated with radiation therapy. Patients and Methods All 540 patients with HNC who participated in a randomized trial completed two HRQOL instruments before radiation therapy: the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) and the Head and Neck Radiotherapy Questionnaire. Six months after the end of radiation therapy, 497 trial participants again completed the two HRQOL instruments. During the follow-up, 179 deaths were observed. Multivariate Cox proportional hazards models were used to test whether HRQOL variables, baseline and change, provided additional prognostic value beyond recognized prognostic factors. Results The baseline EORTC QLQ-C30 physical functioning (PF) score was an independent predictor of OS. The hazard ratio (HR) associated with a 10-point increment in baseline PF was 0.87 (95% CI, 0.81 to 0.94). In multivariate models, the change in HRQOL was significantly associated with OS for most HRQOL dimensions. Among these, PF change was the strongest predictor. The magnitude of the association between PF change and survival decreased over time. At 1 year, the HR associated with a positive PF change of 10 points was 0.75 (95% CI, 0.68 to 0.83). After PF is taken into account, no other HRQOL variable was associated with survival. Conclusion Our findings indicate that both baseline PF and PF change provide added prognostic value for OS beyond established predictors in patients with HNC. Assessing HRQOL could help better predict survival of cancer patients.

Prospective, Longitudinal Quality-of-Life Study of Patients With Head and Neck Cancer: A Feasibility Study Including the EORTC QLQ-C30

1997 ◽  
Vol 116 (6) ◽  
pp. 666-673 ◽  
Author(s):  
Eva Hammerlid ◽  
Kristin Bjordal ◽  
Marianne Ahlner-ELMQVIST ◽  
Magnus Jannert ◽  
Stein Kaasa ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Head And Neck Cancer ◽  
Psychological Distress ◽  
Pilot Study ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Eortc Qlq C30 ◽  
Eortc Qlq

Despite modern advances in the treatment of head and neck cancer, the survival rate fails to improve. Considering the different treatment modalities involved, quality of life has been thought of as an additional end point criterion for use in clinical trials. A Nordic protocol to measure the quality of life of head and neck cancer patients before, during, and after treatment was established. Before the study, a pilot study was done with this protocol. The main purpose of this pilot study was to find out whether this cancer population would answer quality-pf-life questionnaires repeatedly (six times) over a 1-year period and whether the chosen questionnaires—a core questionnaire (European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30)), a tumor-specific questionnaire, and a psychological distress measure (Hospital Anxiety and Depression scale (HAD))—were sensitive for changes to functions and symptoms during the study year. The results presented in this article all refer to the pilot study. Forty-eight consecutive patients agreed to participate in the study. The most common tumor locations were the oral cavity (17) and the larynx (12). Almost all patients received combined treatment: 45 of 48 radiation therapy, 18 of 48 chemotherapy, and 17 of 48 surgery. After the primary treatment, 40 patients had complete tumor remission. Four of the 48 patients did not answer any questionnaires and were therefore excluded from the study. Of the remaining 44 patients, 3 died during the study year, and another 6 withdrew for various reasons. Thirty-five (85%) of the 41 patients alive at the 1-year follow-up answered all six questionnaires and thus completed the study. Mailed questionnaires were used throughout the study. All questionnaires were well accepted and found to be sensitive to changes during the study year. The greatest variability was found for symptoms and functions related specifically to head and neck cancer. The symptoms were swallowing difficulties, hoarse voice, sore mouth, dry mouth, and problems with taste. They all showed the same pattern, with an increase of symptoms during and just after finishing the treatment. The HAD scale revealed a high level of psychological distress, with 21% probable cases of psychiatric morbidity at diagnosis. In conclusion, it was shown that the study design and questionnaires were feasible for the forthcoming prospective quality-of-life assessment of Swedish and Norwegian head and neck cancer patients.

scholarly journals Assessment of Quality of Life in Recurrent and Metastatic Head and Neck Cancer after Oral Metronomic Chemotherapy: A Prospective Interventional Study

2021 ◽  
Author(s):  
Vipul Nautiyal ◽  
Viney Kumar ◽  
Anshika Arora ◽  
Meenu Gupta ◽  
Shivani Mehra ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Head And Neck ◽  
Symptom Score ◽  
Eastern Cooperative Oncology Group ◽  
Metronomic Chemotherapy ◽  
P Value ◽  
Life Questionnaire ◽  
Eortc Qlq C30 ◽  
Eortc Qlq

Introduction: Most of the Recurrent or Metastatic (R/M) Head and Neck Squamous Cell Carcinomas (HNSCC) patients are treated only by palliative treatment. Metronomic Chemotherapy (MC) low doses is an emerging therapeutic option in these patients. It exerts tumour angiogenesis, stimulate anticancer immune response, induces tumour dormancy and offers a significant improvement in Quality of Life (QoL) with minimal toxicity. Aim: To assess the changes in QoL in patients with Metastatic, Recurrent (M/R) HNSCC receiving MC. Materials and Methods: This was a prospective interventional hospital-based study from February 2015 to September 2018, conducted at Cancer Research Institute, Himalayan Institute of Medical Sciences, SRHU University, Dehradun, Uttarakhand, India. A total of 175 patients more than 18 years, with Eastern Cooperative Oncology Group (ECOG) performance status score <2, with M/R HNSCC, not amenable to any radical treatment, were equally distributed by lottery method in three arms, in those receiving Capecitabine (Arm A, n: 59), Celecoxib and Methotrexate (Arm B, n: 62); and placebo with best supportive care (Arm C, n: 54). In addition to demographic and baseline clinical characteristics, patients were assessed for physical examination and questioned to score their QoL by European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) at presentation and followed every month for two months. Results: A total of 175 patients enrolled for the study, the mean age of study population was 56.73±6.84 years with male preponderance 77.71%. A 60% suffered from carcinoma oral cavity (n=105), followed by carcinoma oropharynx (24%) (n=42), carcinoma larynx and carcinoma hypopharynx consisted rest 16% (n=28). Altogether the QoL was quite divergent amongst the three arms. Symptom score for fatigue, dyspnoea, loss of appetite, nausea and vomiting showed rise representing worsening in Arm A and Arm C; whilst these symptoms also showed fall in symptom score in Arm B (fatigue: p-value=0.007; dyspnoea; p-value=0.042; Appetite loss: p-value=0.008 Nausea: p-value=0.02; Vomiting: p-value=0.03). There was a statistically significant improvement in overall EORTC QLQ-C30 score from baseline in the Methotrexate and Celecoxib arm (Arm B) compared with Capecitabine and with placebo. Conclusion: Metronomic Chemotherapy (MC) with Methotrexate and Celecoxib seems promising and well tolerated in patients with metastatic or advanced HNSCC as compared to Capecitabine or keeping on symptomatic treatment solely.

scholarly journals Health-Related Quality of Life in Waldenstrom Macroglobulinemia (WM) and IgM Monoclonal Gammopathy of Undeterminated Significance (IgM-MGUS)

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3593-3593
Author(s):  
Anna Maria Frustaci ◽  
Michele Nichelatti ◽  
Marina Deodato ◽  
Maddalena Mazzucchelli ◽  
Marco Montillo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Status ◽  
Global Health ◽  
Global Health Status ◽  
Emotional Function ◽  
Vas Score ◽  
Eortc Qlq C30 ◽  
Eortc Qlq ◽  
The Impact

Abstract The clinical course of WM widely differs among patients, with some manifesting symptoms as a consequence of the monoclonal IgM component or lymphoma infiltration. IgM-MGUS is generally asymptomatic while, in some cases, paraprotein-related manifestations may occur. Patients with IgM-MGUS should perform a regular follow-up as they are at risk of developing WM or other B-cell lymphoproliferative disorders (1.5-2% per year). Although WM typically afflicts the elderly, there are no studies addressing the impact of ECOG performance status and comorbidities on patients' outcome. Furthermore, to our knowledge health-related quality of life (HRQOL) has never been evaluated in this category. The aim of this study is to analyze the impact of diagnosis and patients' characteristics on quality of life. From October 2017, HRQOL was assessed in 103 patients (37 WM with previous or ongoing treatment [tWM]; 29 asymptomatic MW [aWM]; 37 IgM-MGUS) by the administration of EORTC QLQ-C30, HADS, FACT-GOG neurotoxicity and EQ-5D-5L questionnaires. Demographic anamnestic and disease-related data were also collected for each patient. The same questionnaires continue to be administered every 6 months for 3 years, in order to capture changes in HRQOL over time. Patients features are reported in table 1. No significant differences in terms of age, sex distribution, age at diagnosis, months from diagnosis, ECOG performance status, CIRS or number of concomitant medications, were detected among the 3 groups (table 1). As regards CIRS, the organ systems mainly involved resulted: vascular and genitourinary for tWM, genitourinary for aWM and vascular, respiratory and genitourinary for IgM-MGUS. Among the 3 groups no statistical differences were reported when analyzing: EORTC QLQ-C30 global health status, functional scales (physical, role, emotional, cognitive and social functioning) and symptoms scale, EQ-5D VAS score, HADS anxiety and depression scores or FACT-GOG neurotoxicity score. Males had higher global health status and emotional function when compared to females both in IgM-MGUS and WM patients. Higher CIRS score and ECOG status negatively impacted on global health status, physical function, EQ-5D VAS score and anxiety both in WM and IgM-MGUS. WM patients with longer time from diagnosis showed a significantly worse emotional function. Patients-reported symptoms that could be referred to peripheral neuropathy (PN, 39 patients) resulted the only significant parameter negatively impacting on HRQOL (global health status, functional and symptoms scales according to EORTC QLQ-C30 and EQ-5D VAS score) and also affecting HADS anxiety score. The diagnosis of PN was confirmed by neurologic tests only in 16/39 subjects that, compared with the rest of the population, showed older age (p .019), older age at diagnosis (p . 015) and higher ECOG status (p .005). In these patients, EORTC QLQ-C30 detected a reduced cognitive function (p .0031), while HADS a greater perception of anxiety (p .0015). No differences were recorded for EQ-5D VAS score or HADS depression scale. In conclusion, in our series diagnosis per se didn't seem to affect HRQOL which was negatively influenced by high ECOG status and comorbidities. Emotional function meaningfully deteriorated as the time lapse from diagnosis became longer. Quality of life was significantly altered in patients reporting symptoms of PN and this was confirmed by all the questionnaires. Longer follow up is needed to confirm these preliminary data. Disclosures Montillo: Roche: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria; AbbVie: Consultancy, Honoraria, Speakers Bureau; Gilead: Consultancy, Honoraria, Speakers Bureau. Tedeschi:Janssen: Consultancy, Speakers Bureau; AbbVie: Consultancy; Gilead: Consultancy.

The Quality of Life Benefit Associated with Epoetin Treatment in Malignant Blood Disease Is Small. (Overview).

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5286-5286
Author(s):  
Finn G. Wisloff
Keyword(s):  
Quality Of Life ◽  
Cancer Patients ◽  
Clinical Significance ◽  
Numerical Data ◽  
Breast Cancer Patients ◽  
Eortc Qlq C30 ◽  
Patient Groups ◽  
Moderate Change ◽  
Eortc Qlq

Abstract EPO (epoetin alfa or beta or darbepoetin alfa) is widely prescribed for cancer patients with anemia on the assumption that it will increase hemoglobin, reduce transfusion needs and improve quality of life (QOL). As EPO is expensive, its merits need to be critically examined. Statistically significant differences in QOL scores are not necessarily clinically meaningful. We evaluated the clinical significance of the QOL benefits reported in the three largest randomized trials, using two approaches. Effect sizes (ESs) (score difference divided by the standard deviation (SD)) were calculated, using the population derived SDs for the FACT-An questionnaire reported by Cella (2003). According to Cohen (1977), ESs of 0.2–0.5 are considered small, 0.5–0.8 moderate and above 0.8 large. We also used the results obtained by Osoba (1998), where breast cancer patients evaluated score changes (EORTC QLQ-C30 questionnaire) of 5–10 on the 0–100 scale as “a little” change, 10–20 as “moderate" change and above 20 as “very much” change. To facilitate comparison, the score differences reported in the three EPO trials with the FACT-An questionnaire and its subscales were transformed to a 0–100 scale. The table shows the maximum score differences between EPO and placebo groups, and their ESs. The ESs in Littlewood’s paper are small for the general part of the questionnaire (FACT-G) and somewhat larger, but still small for the fatigue and anemia subscales. The ESs in the Osterborg trial barely reach the level of “small” for the fatigue subscale while the score differences for the entire FACT-An, the FACT-G and the anemia subscale are unlikely to be clinically meaningful. In the Hedenus paper, only the results obtained with the fatigue subscale are reported; the ES is small. The score differences for the Fatigue and Anemia subscales in Littlewood’s paper are the only ones that would be considered meaningful (but small) according the subjective significance rating of Osoba. Whether these results reflect differences between the erythropoietin products is impossible to determine since the results have not been confirmed in independent trials and no comparisons have been performed. Although there are obvious caveats (e.g. the importance of score differences may vary across scales and between patient groups, the interpretation of ESs is a matter of debate, results obtained with the EORTC QLQ-C30 may not be transferable to the FACT-An), these data do suggest that the average QOL benefit obtained with EPO in hematological malignancies is small and of uncertain clinical significance. Fundamental issues as to who should be treated with EPO and how need to be resolved. FACT-An questionnaire FACT-G subscale Fatigue subscale Anemia subscale NDR= no data reported. *7 items only, no SD available. **calculated from Fig 3 of that paper, no numerical data reported Score diff (ES) Score diff (ES) Score diff (ES) Score diff (ES) Littlewood 2001 NDR 4.5 (0.27) 10.0 (0.50) 7.9 (0.45) Osterborg 2002 3.1 (0.19) 2.9 (0.18) 4.2 (0.21) 1.8* Hedenus 2003 NDR NDR 4.4 (0.22)** NDR

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