Prior smoking and nasoseptal flap usage adversely impact quality of life and healing after endoscopic pituitary surgery

OBJECTIVEEndoscopic pituitary surgery (EPS) via the endonasal transsphenoidal approach is well established as an effective treatment modality for sellar masses. The objective of this study was to determine the relationship between key patient and operative variables and rhinological outcomes as determined by the 22-item Sino-Nasal Outcome Test (SNOT-22) and endoscopic scores following EPS.METHODSProspectively collected SNOT-22 scores and objective endoscopic data were analyzed from a cohort of 109 patients who underwent EPS and had at least 90 days of postoperative follow-up. Trends in postoperative SNOT-22 scores were analyzed using linear mixed-effects models. Time to return to baseline endoscopic score was analyzed using Cox regression.RESULTSAfter adjusting for age and sex, the authors found that prior smokers had higher total and rhinological subdomain SNOT-22 scores (p < 0.01, 95% CI 5.82–16.39; p = 0.01, 95% CI 1.38–5.09, respectively) following EPS. Nasoseptal flap use also showed higher total and rhinological subdomain SNOT-22 scores (p = 0.01, 95% CI 1.62–12.60; p = 0.02, 95% CI 0.42–4.30, respectively). Prior sinonasal surgery and concurrent septoplasty did not affect the change in SNOT-22 total scores over time (p = 0.08, 95% CI −0.40 to 0.02; p = 0.33, 95% CI −0.09 to 0.29).CONCLUSIONSThe findings suggest that the evolution of healing and patient-reported quality of life (QOL) measures are multifaceted with contributions from two key variables. Nasoseptal flap usage and prior smoking status may adversely impact postoperative QOL. No variables were found to be associated with objective postoperative endoscopic findings.

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Prediction of all-cause mortality from 24 month trajectories in patient-reported psychological, clinical and quality of life outcomes in uveal melanoma patients

Journal of Behavioral Medicine ◽

10.1007/s10865-021-00252-8 ◽

2021 ◽

Author(s):

Stephen L. Brown ◽

Peter L. Fisher ◽

Laura Hope-Stone ◽

Heinrich Heimann ◽

Rumana Hussain ◽

...

Keyword(s):

Quality Of Life ◽

Life Expectancy ◽

Uveal Melanoma ◽

Cox Regression ◽

Multivariate Analyses ◽

Tumor Diameter ◽

Control Variables ◽

Patient Reported ◽

All Cause Mortality

AbstractA number of patient-reported outcomes (PROs) predict increased mortality after primary cancer treatment. Studies, though, are sometimes affected by methodological limitations. They often use control variables that poorly predict life expectancy, examine only one or two PROs thus not controlling potential confounding by unmeasured PROs, and observe PROs at only a single point in time. To predict all-cause mortality, this study used control variables affording good estimates of life expectancy, conducted multivariate analyses of multiple PROs to identify independent predictors, and monitored PROs two years after diagnosis. We recruited a consecutive sample of 824 patients with uveal melanoma between April 2008 and December 2014. PROs were variables shown to predict mortality in previous studies; anxiety, depression, visual and ocular symptoms, visual function impairment, worry about cancer recurrence, and physical, emotional, social and functional quality of life (QoL), measured 6, 12 and 24 months after diagnosis. We conducted Cox regression analyses with a census date of December 2018. Covariates were age, gender, marital and employment status, self-reported co-morbidities, tumor diameter and thickness, treatment modality and chromosome 3 mutation status, the latter a genetic mutation strongly associated with mortality. Single predictor analyses (with covariates), showed 6-month depression and poorer functional QoL predicting mortality, as did 6–12 month increases in anxiety and 6–12 month decreases in physical and functional QoL. Multivariate analyses using all PROs showed independent prediction by 6-month depression and decreasing QoL over 6–12 months and 12–24 months. Elevated depression scores six months post-diagnosis constituted an increased mortality risk. Early intervention for depressive symptoms may reduce mortality.

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Predictors of sinonasal quality of life and nasal morbidity after fully endoscopic transsphenoidal surgery

Journal of Neurosurgery ◽

10.3171/2014.10.jns141624 ◽

2015 ◽

Vol 122 (6) ◽

pp. 1458-1465 ◽

Cited By ~ 34

Author(s):

Andrew S. Little ◽

Daniel Kelly ◽

John Milligan ◽

Chester Griffiths ◽

Daniel M. Prevedello ◽

...

Keyword(s):

Quality Of Life ◽

Clinical Trial ◽

Health Status ◽

Transsphenoidal Surgery ◽

Pituitary Surgery ◽

Nasal Packing ◽

Nasal Endoscopy ◽

Endoscopic Transsphenoidal Surgery ◽

Patient Reported

OBJECT Despite the increasing application of endoscopic transsphenoidal surgery for pituitary lesions, the prognostic factors that are associated with sinonasal quality of life (QOL) and nasal morbidity are not well understood. The authors examine the predictors of sinonasal QOL and nasal morbidity in patients undergoing fully endoscopic transsphenoidal surgery. METHODS An exploratory post hoc analysis was conducted of patients who underwent endoscopic pituitary surgery and were enrolled in a prospective multicenter QOL study. End points of the study included patient-reported sinonasal QOL and objective nasal endoscopy findings. Multivariate models were developed to determine the patient and surgical factors that correlated with QOL at 2 weeks through 6 months after surgery. RESULTS This study is a retrospective review of a subgroup of patients studied in the clinical trial “Rhinological Outcomes in Endonasal Pituitary Surgery” (clinical trial no. NCT01504399, clinicaltrials.gov). Data from 100 patients who underwent fully endoscopic transsphenoidal surgery were included. Predictors of a lower postoperative sinonasal QOL at 2 weeks were use of nasal splints (p = 0.039) and female sex at the trend level (p = 0.061); at 3 months, predictors of lower QOL were the presence of sinusitis (p = 0.025), advancing age (p = 0.044), and use of absorbable nasal packing (p = 0.014). Health status (multidimensional QOL) was also predictive at 2 weeks (p = 0.001) and 3 months (p < 0.001) and was the only significant predictor of sinonasal QOL at 6 months (p < 0.001). A Kaplan-Meier analysis was performed to study time to resolution of nasal crusting, mucopurulence, and synechia as observed during nasal endoscopy after surgery. The mean time (± SEM) to absence of nasal crusting was 16.3 ± 2.1 weeks, mucopurulence was 6.2 ± 1.1 weeks, and synechia was 4.4 ± 0.5 weeks. Use of absorbable nasal packing was associated with more severe mucopurulence. CONCLUSIONS Sinonasal QOL following endoscopic pituitary surgery reaches a nadir at 2 weeks and recovers by 3 months postoperatively. Use of absorbable packing and nasal splints, while used in a minority of patients, negatively correlates with early sinonasal QOL. Sinonasal QOL and overall health status are well correlated in the postoperative period, suggesting the important influence of sinonasal QOL on the patient experience.

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Predictors of favorable quality of life outcome following kyphoplasty and vertebroplasty

Journal of Neurosurgery Spine ◽

10.3171/2019.3.spine18419 ◽

2019 ◽

Vol 31 (3) ◽

pp. 389-396 ◽

Cited By ~ 2

Author(s):

Jaes C. Jones ◽

Jacob A. Miller ◽

Dattanand M. Sudarshana ◽

Nicolas R. Thompson ◽

Edward C. Benzel ◽

...

Keyword(s):

Quality Of Life ◽

Smoking Status ◽

A Priori ◽

Current Smoker ◽

Smoking History ◽

Vertebral Augmentation ◽

Pain Disability ◽

Patient Reported ◽

Patient Health

OBJECTIVEIn 2009, 2 randomized controlled trials demonstrated no improvement in pain following vertebral augmentation compared with sham surgery. However, a recent randomized trial demonstrated significant pain relief in patients following vertebroplasty compared to controls treated with conservative medical management. This study is a retrospective review of prospectively collected patient-reported quality of life (QOL) outcomes. The authors hypothesized that vertebral augmentation procedures offer a QOL benefit, but that this benefit would be diminished in patients with a history of depression and/or in patients undergoing vertebral augmentation at more than 1 level.METHODSMultivariable linear regression was used to identify predictors of postoperative pain assessed using the Pain Disability Questionnaire (PDQ), Patient Health Questionnaire 9 (PHQ-9), and EQ-5D scores. Eleven candidate predictors were selected a priori: age, sex, smoking history, coronary artery disease, depression, diabetes, procedure location (thoracic, lumbar), BMI, prior spine surgery, procedure indication (metastases, osteoporosis/osteopenia, other), and number of levels (1, 2, 3, or more).RESULTSA total of 143 patients were included in the study. For each 10-year increase in age, postoperative PDQ scores decreased (improved) by 9.7 points (p < 0.001). Patients with osteoporosis/osteopenia had significantly higher (worse) postoperative PDQ scores (+17.97, p = 0.028) than patients with metastatic lesions. Male sex was associated with higher (worse) postoperative PHQ-9 scores (+2.48, p = 0.010). Compared to single-level augmentation, operations at 2 levels were associated with significantly higher PHQ-9 scores (+2.58, p = 0.017). Current smokers had significantly lower PHQ-9 scores (−1.98, p = 0.023) than never smokers. No predictors were associated with significantly different EQ-5D score.CONCLUSIONSVariables associated with worse postoperative PDQ scores included younger age and osteoporosis/osteopenia. Variables associated with decreased (better) postoperative PHQ-9 scores included female sex, single operative vertebral level, and positive smoking status (i.e., current smoker). These clinically relevant predictors may permit identification of patients who may benefit from vertebral augmentation.

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The association of baseline anxiety and depression with overall survival (OS) in colorectal cancer (CRC).

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.706 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 706-706

Author(s):

Pierre Y. Cheung ◽

Tian Yang Darren Liu ◽

Jason D. Kim ◽

Winson Y. Cheung

Keyword(s):

Quality Of Life ◽

Cancer Survival ◽

Cox Regression ◽

Significant Proportion ◽

Vital Statistics ◽

Anxiety And Depression ◽

Psychosocial Wellbeing ◽

Patient Reported ◽

The Impact

706 Background: Patient-reported measures such as psychosocial wellbeing and quality of life have been reported to correlate with cancer survival, but the specific factors within these constructs that associate with outcomes remains poorly defined. Our aim was to examine the effect of baseline anxiety and depression on OS in a population-based cohort of CRC patients. Methods: Patients diagnosed with CRC in 2008, referred to any 1 of 5 regional cancer centers in British Columbia, and who completed a baseline questionnaire to evaluate anxiety and depression were reviewed. We developed a scoring system based on these patient-reported survey data to characterize intensity and subsequently categorized patients as having no, mild, moderate or severe anxiety and/or depression. Vital statistics were captured by medical records. Unadjusted Kaplan-Meier methods and multivariate Cox regression models that controlled for additional socio-demographic and clinical characteristics were constructed to correlate anxiety and depression with OS. Results: A total of 449 patients were included: median age was 66 years (range 26-92), 52% were men, and 69% were white. A significant proportion of respondents reported anxiety (58%) or depression (45%) at baseline. Among them, the majority indicated their anxiety and depressive symptoms were severe (43% and 43%, respectively). Women and those who were single or unmarried were more likely to have anxiety and depression (p<0.001 and p=0.02, respectively). In unadjusted analyses, we observed a trend where increased severity of anxiety (p=0.07) and depression (p=0.04) correlated with worse outcomes. In Cox regression that considered other prognostic factors, however, this observation failed to persist, and neither anxiety nor depression associated with OS (Table). Conclusions: The impact of psychosocial wellbeing and quality of life on CRC outcomes that have been previously described in the literature are unlikely to be mediated through baseline anxiety or depression. [Table: see text]

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Impact of patient-reported nasal symptoms on quality of life after endoscopic pituitary surgery: a prospective cohort study

Pituitary ◽

10.1007/s11102-021-01199-4 ◽

2022 ◽

Author(s):

Merel van der Meulen ◽

Marco J. T. Verstegen ◽

Daniel J. Lobatto ◽

Maarten C. Kleijwegt ◽

Alberto M. Pereira ◽

...

Keyword(s):

Quality Of Life ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Pituitary Surgery ◽

Nasal Symptoms ◽

Patient Reported

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Association of Quality of Life Measures and Otolaryngologic Care in Cystic Fibrosis Patients

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211045636 ◽

2021 ◽

pp. 000348942110456

Author(s):

Stephen Leong ◽

Rahul K. Sharma ◽

Chetan Safi ◽

Emily DiMango ◽

Claire Keating ◽

...

Keyword(s):

Quality Of Life ◽

Cystic Fibrosis ◽

Demographic Data ◽

Critical Role ◽

Sinus Surgery ◽

Coordinated Care ◽

Quality Of Life Measures ◽

Patient Reported ◽

Snot 22

Objectives: Appropriate management of chronic rhinosinusitis (CRS) among patients with cystic fibrosis (CF) is important in improving quality of life. Otolaryngologists play a critical role in reducing CRS symptom burden. This study seeks to evaluate the role of patient-reported quality-of-life measures in guiding interventions for CF-related sinus disease. Methods: We performed a prospective, cross-sectional study of 105 patients presenting to a CF-accredited clinic between July and September 2018. Demographic data and sinus surgery history were collected, in addition to Sino-Nasal Outcome Test (SNOT-22) and Questionnaire of Olfactory Disorders (QOD-NS) scores. Statistical analysis was conducted using correlation and non-parametric Mann-Whitney U tests. Results: Baseline well-care visits accounted for 71.4% of all clinical evaluations. Prior otolaryngology intervention was noted in 69 (66%) patients, where the majority of these patients (63/69; 91%) underwent endoscopic sinus surgery (ESS). Patients with a history of otolaryngology intervention had an average SNOT-22 score of 33.2 (SD = 20.6) compared to 24.9 (SD = 18.5) for patients without prior intervention ( P = .048). The average QOD-NS score was 5.5 (SD = 6.4) among patients referred to otolaryngologists and 3.1 (SD = 5.7) for non-referred patients ( P = .012). SNOT-22 and QOD-NS scores were modestly correlated ( R of .43). Conclusion: CF patients with symptoms resulting in worse quality-of-life assessments were more likely to have established coordinated care with an otolaryngologist. Further validation of the utility of SNOT-22 and QOD-NS questionnaires as care coordination metrics is necessary in the CF population.

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Patient related outcomes in cancer patients in Croatia.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.tps6650 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. TPS6650-TPS6650

Author(s):

Dragan Trivanovic ◽

Irena Hrstic ◽

Anuska Budisavljevic ◽

Boris Kopic ◽

Bruno Nincevic

Keyword(s):

Quality Of Life ◽

Cancer Treatment ◽

Cancer Care ◽

Cox Regression ◽

Prospective Trial ◽

Cancer Type ◽

Risk Of Death ◽

Patient Reported ◽

Clinic Visits

TPS6650 Background: Accurate evaluation of symptom intensities is essential for optimal cancer care and improving the quality of life of patients. An inappropriate interpretation of symptoms may lead to treatment outcomes failure, overdose of medication, or may leave the patients undertreated. However, the perception of symptoms can vary between the treating physician and patient. Physicians appear to underestimate the patient symptoms. And this variation in the perception of side effects can lead to wrong assumptions and subsequent treatment changes, affecting treatment effectiveness and quality of life. There is growing interest to enhance symptom monitoring during routine cancer care using patient-reported outcomes, leaving open the question of whether the benefits of systems to reveal self-reports outweigh their added cost. There are several tools for assessment of symptoms in oncology. In cancer treatment clinical trials, the standard source of adverse symptom data is clinician reporting by use of items from PRO-CTCAE, developed by NCI. To address these questions, we conducted a single-center prospective trial to test whether systematic tablet computer-based collection of patient-reported symptoms during chemotherapy treatment, with automated alerts to clinicians for severe adverse events (grade 3-4) will change in questionnaire score at 6 months compared with baseline. Secondary endpoints will include difference in unscheduled clinic visits frequency, and survival. Methods: Patients initiating chemotherapy at General Hospital Pula Oncology Clinic for advanced or metastatic gastrointestinal, lung, breast, genitourinary, or gynecologic cancers will be enrolled in a nonblinded, prospective trial of self-reporting of symptoms, compare with usual care. Patients receiving chemotherapy and their clinicians will be independently asked on the same day to complete 10 symptoms (including fatigue, pain, nausea, vomiting, diarrhea, dysgeusia, appetite, sleep disturbance, fever and hair loss). Participants will remain on study until discontinuation of cancer treatment, withdrawal, or death. All participants will provide written informed consent and followed for up to 28 months or until death. To compare how patient’s vs clinician’s reports relate to clinical events, a time-dependent Cox regression model adjusted for covariates including cancer type, age, sex, and education level will be used to measure associations between reaching particular grade severity thresholds with the risk of death and unscheduled clinic visits. Clinical trial information: 2019-000855-15.

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The 22-Item Sinonasal Outcome Test as a Tool for the Assessment of Quality of Life and Symptom Control in Allergic Rhinitis

American Journal of Rhinology and Allergy ◽

10.1177/1945892419884789 ◽

2019 ◽

Vol 34 (2) ◽

pp. 209-216

Author(s):

Qasim Husain ◽

Lloyd Hoehle ◽

Katie Phillips ◽

David S. Caradonna ◽

Stacey T. Gray ◽

...

Keyword(s):

Quality Of Life ◽

Allergic Rhinitis ◽

Visual Analog Scale ◽

Symptom Control ◽

Patient Reported Outcome ◽

Analog Scale ◽

Patient Reported ◽

Sinonasal Outcome Test ◽

Snot 22

Background The 22-item Sinonasal Outcome Test (SNOT-22) is a validated patient-reported outcome measure for chronic rhinosinusitis and in many circumstances is used in rhinology/otolaryngology clinics to assess sinonasal symptoms in general when a formal diagnosis is not established, although with little support for such usage. Objective To assess the utility of the SNOT-22 as a reflection of quality of life (QOL) and symptom control for patients with allergic rhinitis (AR). Methods Retrospective review of 353 patients with persistent AR. Each patient completed a SNOT-22, 5-item EuroQol general health-related QOL (EQ-5D) questionnaire (from which the visual analog scale [VAS] was used), and Rhinitis Control Assessment Test (RCAT). In addition, 95 patients also completed these questionnaires 1 to 12 months later. Results The SNOT-22 was negatively correlated with the EuroQol 5-dimensional visual analog scale (EQ-5D VAS; r = −.45, 95% confidence interval [CI]: −0.53 to −0.36, P < .001) and RCAT ( r = −.62, 95% CI: −0.68 to −0.55, P < .001), with excellent internal consistency. The SNOT-22 demonstrated responsiveness, with mean change of −5.8 (95% CI: −8.9 to −2.6, P < .001) from pre- to posttreatment. The change in SNOT-22 over the treatment period was correlated with change in EQ-5D VAS ( r = −.28, 95% CI: −0.46 to −0.07, P = .008) and RCAT ( r = −.56, 95% CI: −0.69 to −0.41, P < .001). The minimal clinically important difference was calculated to be between 6 and 11. Conclusion The SNOT-22 has utility to assess QOL and symptom control in AR, and it is both reliable and responsive in its application to patients with AR. The SNOT-22 may therefore be a convenient and versatile tool in the clinical assessment of patients with AR.

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COVID-19 Status Differentially Affects Olfaction: A Prospective Case-Control Study

OTO Open ◽

10.1177/2473974x20970176 ◽

2020 ◽

Vol 4 (4) ◽

pp. 2473974X2097017

Author(s):

Kolin Rubel ◽

Dhruv Sharma ◽

Vincent Campiti ◽

Grace Yedlicka ◽

Sarah J. Burgin ◽

...

Keyword(s):

Quality Of Life ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Case Control ◽

Negative Group ◽

Positive Group ◽

Patient Reported ◽

Olfactory Ability ◽

Snot 22

Objective The symptoms and long-term sequelae of SARS-CoV-2 infection have yet to be determined, and evaluating possible early signs is critical to determine which patients should be tested and treated. The objective of this ongoing study is to evaluate initial and short-term rhinologic symptoms, olfactory ability, and general quality of life in patients undergoing SARS-CoV-2 testing. Study Design Prospective case-control. Setting Academic institute. Methods Adult patients tested for SARS-CoV-2 were prospectively enrolled and separated into positive and negative groups. Each participant completed 4 validated patient-reported outcome measures. The UPSIT (University of Pennsylvania Smell Identification Test) was distributed to patients who were SARS-CoV-2 positive. Results The positive group reported significantly decreased sense of smell and taste on the 22-item Sinonasal Outcome Test (SNOT-22) as compared with the negative group (mean ± SD: 3.4 ± 1.7 vs 1.2 ± 1.4, P < .001). The positive group had a much higher probability of reporting a decrease in smell/taste as “severe” or “as bad as it can be” (63.3% vs 5.8%) with an odds ratio of 27.6 (95% CI, 5.9-128.8). There were no differences between groups for overall SNOT-22 domain scores, PHQ-4 depression/anxiety (Patient Health Questionnaire−4), and 5-Level EQ-5D quality-of-life scores. Mean Self-MOQ (Self-reported Mini Olfactory Questionnaire) scores were 7.0 ± 5.6 for the positive group and 1.8 ± 4.0 for the negative group ( P < .001). The mean UPSIT score was 28.8 ± 7.2 in the positive group. Conclusion Symptomatic patients who are SARS-CoV-2 positive report severe olfactory and gustatory dysfunction via the Self-MOQ and SNOT-22 as compared with symptomatic patients testing negative.

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Quality of Life Outcomes in Frontal Sinus Surgery

Journal of Clinical Medicine ◽

10.3390/jcm9072145 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2145

Author(s):

Christos Georgalas ◽

Marios Detsis ◽

Ioannis Geramas ◽

Dimitris Terzakis ◽

Andreas Liodakis

Keyword(s):

Quality Of Life ◽

Endoscopic Sinus Surgery ◽

Frontal Sinus ◽

Sinus Surgery ◽

Frontal Sinus Surgery ◽

Patient Reported ◽

The Mean ◽

Snot 22 ◽

Postoperative Quality

Introduction: Although significant experience has been gained in the technical nuances of endoscopic sinus surgery procedures, the patient-reported outcomes of frontal endoscopic sinus surgery procedures are still poorly understood. In this study we used the validated patient outcome measure Sino Nasal Outcome Test-22 (SNOT-22) to assess the preoperative and postoperative quality of life in patients undergoing extended endoscopic frontal sinus surgery (Draf type 2 and Draf type 3 procedures). Methods: Out of a total of 680 patients undergoing endoscopic sinus and skull base surgery and 186 patients undergoing frontal sinus surgery, 99 chronic rhinosinusitis patients with (CRSwNP) or without (CRSnNP) nasal polyps undergoing Draf 2 or Draf 3 were assessed. Results: The mean preoperative SNOT-22 was 45.6 points for patients undergoing Draf 2 and 59 for patients undergoing Draf 3, while the mean radiological Lund–Mackay Score was 14.3 and 14.5, respectively. Mean SNOT 22 improvement was 22.9 points for Draf 2 and 37 points for Draf 3 respectively and remained significant in all time intervals, including at 4 years after surgery. With the exception of loss of smell/taste, all symptoms improved by a far bigger extent in Draf 3 group, despite the considerably worse starting point. Effect size (Cohen / Standard Deviations) of Draf 3 was greatest in the following symptoms: “being frustrated/restless/irritable” (1.63), “nasal blockage” (1.43), “reduced concentration” (1.35), “fatigue” (1.29) “runny nose” (1.26) and “need to blow nose” (1.17). Frontal sinus (neo) ostium was patent (fully or partly) at last follow up in 98% of Draf 2 patients and in 88% of patients following Draf 3. Patients with non-patent frontal (neo-) ostium however had a mean postoperative SNOT 22 score of 43 compared to 20 of those with patent frontal sinus (neo-) ostium, although the difference was not statistically significant. Conclusion: Patients undergoing Draf 3 have a greater burden of disease, including both nasal and emotional/general symptoms compared to Draf 2 patients; surgery results in improvement in both groups, although Draf 3 patients have the greatest benefit, especially in emotional / general symptons. In this way both groups achieve similar postoperative quality of life, despite the different starting points.

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