THE QUALITY OF WOMEN'S LIFE AFTER MASTECTOMY IN POLAND Quality of life as subjective experience: reframing of perception in patients with colon cancer undergoing radical resection with or without adjuvant chemotherapy. Swiss Group for Clinical Cancer Research (SAKK) Trial design: The St. Jude Children's Research Hospital Cancer Survivors Tobacco Quit Line study. Initial prognostic factors in small-cell lung cancer patients predicting quality of life during chemotherapy. Swiss Group for Clinical Cancer Research (SAKK). Impact of radiotherapy on the quality of life of elderly patients with localized breast cancer. A prospective study Impact of computerized quality of life screening on physician behaviour and patient satisfaction in lung cancer outpatients. Quality of life assessment in patients receiving adjuvant therapy for breast cancer: the IBCSG approach. The International Breast Cancer Study Group. A self-administered quality-of-life questionnaire after acute myocardial infarction. [Quality of life and coping with illness in patients with acute myeloid leukemia]. Prognostic value of quality-of-life scores during chemotherapy for advanced breast cancer. Australian New Zealand Breast Cancer Trials Group. Quality of life benefits of paid work activity in schizophrenia. Characteristics of two alternative schizophrenia remission definitions: Relationship to clinical and quality of life outcomes Quality of life in oncology practice: prognostic value of EORTC QLQ-C30 scores in patients with advanced malignancy. Quality of Life of Patients with Newly Diagnosed Poor Prognosis M1 Prostate Cancer Undergoing Orchiectomy without or with Mitomycin C [Diagnosis and therapy of illness-related quality of life in breast cancer patients. Protocol of a randomized clinical trial at the Regensburg Tumour Centre]. Flutamide versus prednisone in patients with prostate cancer symptomatically progressing after androgen-ablative therapy: a phase III study of the European organization for research and treatment of cancer genitourinary group. Quality of life of patients with advanced cancer and acquired immune deficiency syndrome and their family caregivers. Cost-Effectiveness of Comprehensive, Integrated Care for First Episode Psychosis in the NIMH RAISE Early Treatment Program. Effects of medroxyprogesterone acetate on appetite, weight, and quality of life in advanced-stage non-hormone-sensitive cancer: a placebo-controlled multicenter study. Predictors of poor outcome in chronic dialysis patients: The Netherlands Cooperative Study on the Adequacy of Dialysis. The NECOSAD Study Group. Psychological consequences of screening for abdominal aortic aneurysm and conservative treatment of small abdominal aortic aneurysms. Quality of life of palliative chemotherapy naive patients with advanced adenocarcinoma of the stomach or esophagogastric junction treated with irinotecan combined with 5-fluorouracil and folinic acid: results of a randomised phase III trial Health-Related Quality of Life in Patients with Oesophageal Cancer: Analysis at Different Steps of the Treatment Pathway
From the increasing number of women who recovered from breast cancer arises more academic interest in their subjective opinions about the quality of their life ( QL ) , particularly the physical , psychological , and social aspects of it . Our aim in this study was to evaluate the QL of Polish women after mastectomy .  The research was performed on 480 r and omly chosen patients who had been subjected to surgical treatment .  The  functional assessment of cancer therapy ( FACT ) scale version 4 and hospital anxiety and depression scale ( HADS )  were used during the research procedure . The lowest results within the global opinion of QL were obtained within the emotional sphere . The most frequent mental states experienced by the examined patients were worry , sadness , nervousness , fear , and depression PURPOSE AND BACKGROUND We examined whether patients with colon cancer undergoing surgery with or without adjuvant chemotherapy  change the internal st and ards on which they base their quality -of-life ( QL ) estimation , and , if they do so , whether this reframing alters interpretation of QL findings . These questions were addressed within a r and omized clinical trial of the Swiss Group for Clinical Cancer Research ( SAKK 40/93 ) . PATIENTS AND METHODS After radical resection of adenocarcinoma of the colon ( pT1 - 4pN > 0M0 and pT3 - 4pN0M0 ) and perioperative chemotherapy , patients were r and omized to three treatment arms : observation only ( A ) , 5-FU 450 mg/m2 plus Levamisol ( B ) , or 5-FU 600 mg/m2 ( C ) . QL was measured by linear analogue self- assessment indicators .  Patients estimated their pre-surgery QL both before surgery and retrospectively thereafter , and their pre-adjuvant QL both at the beginning of r and omly assigned chemotherapy or observation and retrospectively about two months later . Thereafter , current QL was assessed . Paired t-tests were used to test the hypotheses of no change . RESULTS Overall , 187 patients with at least one pair of corresponding question naires were analyzed . Patients estimated their pre-surgery QL after surgery significantly lower than before and their pre-adjuvant QL under treatment or observation also lower than at the beginning . In the adjuvant phase , in contradiction to our hypothesis , chemotherapy had almost no impact on these changes attributed to reframing . Conventionally assessed changes indicated an improvement in QL . Patients with treatment C reported less improvement in functional performance than those with B or those under observation ( P = 0.04 ) . Patients with treatment B indicated a greater worsening in nausea/vomiting than those with C , whereas patients with observation only showed an improvement ( P = 0.0009 ) . After adjustment of current QL scores under treatment or observation to patients ' retrospective estimation , the treatment effects were diluted but the overall improvement was substantially amplified in most QL indicators . CONCLUSIONS Patients with colon cancer substantially reframe their perception in estimating QL both under radical resection and under adjuvant chemotherapy or observation . This effect is an integral part of patients ' adaptation to disease and treatment . An underst and ing of this phenomenon is of particular relevance for patient care . Its role in evaluating QL endpoints in clinical trials needs further investigation Nearly , one-fifth of childhood cancer survivors ( CCSs ) smoke cigarettes . Because CCSs are already at greater medical smoking-related risks , targeting them for smoking cessation efforts is a high priority . One of the major challenges with smoking cessation in CCSs is how to reach such a geographically dispersed population . This study aims to demonstrate that these challenges can be overcome through the use of telephone-based tobacco quit lines ( QLs ) . This report describes the design of the St. Jude Cancer Survivor Tobacco QL study , which is a r and omized controlled clinical trial that will examine the long-term ( 1-year ) efficacy of a counselor initiated vs. participant initiated tobacco QL with adjunctive nicotine replacement therapy ( NRT ) in both groups . Participants ( N=950 ) will be recruited nationally and r and omly assigned to one of the two interventions . The counselor initiated intervention includes six scheduled telephone sessions of a behavioral intervention and provision of 8 weeks of NRT . The participant initiated intervention allows the participant to call the QL at their convenience , but includes the same six telephone sessions and provision of 2 weeks of NRT . Both groups will receive two follow-up phone calls at 8 weeks and 1 year after enrollment to assess their smoking status . The primary outcome measure is cotinine-vali date d self-reported smoking abstinence at 1-year follow-up . Results from this study will provide the first evidence about the efficacy of intensive QL cessation intervention in this high-risk population . Such evidence can lead as well to the dissemination of this intervention to other medically compromised population The question of whether initial prognostic factors in small-cell lung cancer patients have a predictive value for patients ' quality of life ( QL ) during chemotherapy is addressed in the context of a r and omised clinical trial comparing early and late alternating chemotherapy ( SAKK protocol 15/84 ) . The relative impact of initial tumour stage and performance status , previous weight loss , sex and age on patient-rated QL was analysed over six chemotherapy cycles in 124 - 130 patients ( according to available QL data ) with more than 400 question naires .  Fatigue/malaise , personal functioning , emotional and general well-being were prospect ively selected as QL indicators . Predefined summary measures ( average QL score over chemotherapy cycles , ' minimum ' , ' maximum ' and ' final ' improvement ) were analysed separately by scale in various patient groups . General linear models adjusted for treatment arm and response were used to confirm the univariate findings . Within the overall sample , the average QL scores over six cycles were predicted by initial prognostic factors . Patients with poor prognostic factors reported worse QL . Within a limited sample ( with baseline QL ) , patients with poor prognostic factors reported worse QL at baseline and greater improvement under treatment . Graphical comparison of QL patterns over cycles showed permanent discrimination by levels of prognostic factors . The impact of initial prognostic factors was consistently confirmed in the three analyses . Levels of performance status and weight loss best discriminated QL . Initial tumour stage , performance status and previous weight loss can predict QL in small-cell lung cancer during chemotherapy , even after controlling for response to treatment . Our results may contribute to clinical decision-making with regard to the intensity of chemotherapy and QL outcome , especially in patients with extensive disease Introduction There are few studies on the effect on quality of life ( QL ) of cancer-related illness and treatment in elderly patients . The aim of this work was to evaluate prospect ively QL in a sample of elderly patients with stages I – III breast cancer who started radiotherapy treatment and compare their QL with that of a sample of younger patients . Material s and methods Forty-eight patients , ≥ 65 years of age completed the European Organization for Research and Treatment of Cancer ( EORTC ) QL question naires QLQ-C30 and QLQ-BR23 , and the Interview for Deterioration in Daily Living Activities in Dementia  ( IDDD )  daily activities scale three times throughout treatment and follow-up periods . Clinical and demographic data were also recorded . Fifty patients ages 40–64 years with the same disease stage and treatment modality had previously completed the QL question naires . QL scores , changes in them among the three assessment s , differences between groups based on clinical factors , and differences between the two sample s were calculated . Results QL scoring was good and stable ( > 70/100 points ) in most areas , in line with clinical data . Light and moderate limitations occurred in global QL and some emotional , sexual , and treatment-related areas . Moderate decreases ( 10–20 ) appeared in some toxicity-related areas , which recovered during the follow-up period . Breast-conservation and sentinel-node patients presented higher scores in emotional areas . There were few QL differences among age-based sample s. Conclusions QL and clinical data indicate radiotherapy was well tolerated . Age should not be the only factor evaluated when deciding upon treatment for breast cancer patients The purpose of this paper was to determine if providing patient specific Quality of Life ( QL ) information to clinic staff before a clinic appointment improved patient care in a lung cancer outpatient clinic . Patients were sequentially assigned to either a usual care control group or the experimental group  , which completed a computerized version of the European Organization for Research and Treatment of Cancer ( EORTC ) QLQ-C30 question naire in order to provide the clinic staff with QL information prior to the clinic appointment . The control group completed the EORTC QLQ-C30 paper version after the clinic appointment . Outcome measures were patient satisfaction , the degree to which issues identified on the QL question naire were addressed in the appointment , and a chart audit , which measured charting of QL issues and actions taken by the clincian relating to QL . In the experimental group , more QL issues identified by the patient on the EORTC QLQ-C30 were addressed during the clinic appointment than in the control group . As well , marginally more categories were charted and a trend towards more actions being taken was seen in the experimental group . Patients reported being equally and highly satisfied with the treatment in both groups . The clinical implication is that the computerized administration of the EORTC QLQ-C30 question naire and providing staff with a report highlighting patient-specific QL deficits is a simple , time-effective and acceptable means of improving patient-provider communication in a busy outpatient clinic . Large trials study ing its effectiveness in different patient population s and regions would further eluci date the nature of this effect and potentially improve the overall quality of care that patients receive BACKGROUND AND PURPOSE The International Breast Cancer Study Group ( IBCSG ) has developed and approach for assessing the impact of adjuvant therapy on quality of life ( QL ) within the framework of international , multilingual clinical trials . The major steps are summarized . Conceptual , method ological and practical issues are discussed with reference to results of two trials closed to accrual ( IBCSG VI , VII ) and one subsequent ongoing trial ( IBCSG IX ) . PATIENTS AND METHODS QL was assessed in pre- and post-menopausal patients with operable breast cancer . Various  single-item linear analogue self- assessment ( LASA ) scales  were used as indicators of components of QL , including global indicators of well-being , functioning and health perception , and specific indicators of symptoms of disease and treatment . In trials VI and VII , QL was assessed at baseline , during adjuvant treatment and follow-up , and at recurrence . Based on this experience , the QL form was revised for subsequent trials and further investigated in a sub sample of patients r and omized into trial IX . RESULTS In trials VI and VII , the QL indicators were responsive to the impact of biomedical factors at baseline , various adjuvant treatments , changes over the first 18 months , and recurrence . In trial IX , the revised QL form was well accepted by patients and staff . Completing this form did not exceed five minutes . QL differences between on and off cytotoxic treatment strengthen the cl aim that these measures are responsive . Correlations and logistic regression analyses show the expected relationship among the various global and specific indicators . CONCLUSION Results from two trials closed to accrual and an ongoing trial confirm the feasibility , validity and clinical relevance of the IBCSG approach for study ing the impact of adjuvant breast cancer therapy on QL in international clinical trials A slightly modified version of the Quality -of-Life after Myocardial Infa rct ion ( QLMI ) question naire developed by Oldridge and colleagues was applied in a self-administered mode to patients with suspected acute myocardial infa rct ion ( AMI ) in a r and omized controlled trial of secondary prevention .  Acceptability of the question naire was good , with 93 % of responders answering all items . Factor analysis suggested three quality -of-life ( QL ) dimensions which we called " emotional " , " physical " and " social " . These differed somewhat from the dimensions proposed by Oldridge and colleagues . However , a sensitivity analysis showed relative invariance of results to weighting schemes . Scores on our three dimensions were responsive to differences between the treatment groups , and demonstrated construct validity based on associations between the measured QL and variables expected to affect QL . We conclude that the QLMI question naire has good potential as an instrument for assessing QL in post-AMI patients and that it can be successfully self-administered Advances in chemotherapy significantly prolong survival of patients with acute myeloid leukemia ( AML ) and may cure a significant percentage of patients . Therefore , the assessment of quality of life ( QL ) of patients undergoing chemotherapy  is of growing interest . This study was design ed to evaluate  QL  in patients with AML treated according to the protocol of the German AML-Cooperative Group ( Münster , FRG ) . Based on conceptual , method ological and practical criteria , the EORTC-QLQ C 30 question naire was used . In addition , patients ' coping strategies were assessed by the FQCI . Patients ' individual perception of their disease and therapy was evaluated by a semi-structured interview . Currently , 61 patients are enrolled in the protocol . For those patients having completed the course of inpatient treatment , individual assessment of Global Health Status and Subjective QL improves significantly . The content analysis of the interviews shows to what extent aspects of the inpatient setting influence patients ' QL . Although only a minority of patients with AML remain in continuous complete remission , the evaluation of QL in patients undergoing treatment shows that subjective benefit outweighs the effects of antileukemic therapy PURPOSE We observed that quality -of-life ( QL ) scores , collected to evaluate treatment in a r and omized trial in advanced breast cancer , predicted survival duration . This report explores the prognostic associations between QL and survival in more detail . PATIENTS AND METHODS In a r and omized clinical trial comparing intermittent and continuous therapy policies for patients with advanced breast cancer ,  QL  was measured by linear analog self- assessment ( LASA ) and the Quality -of-Life Index ( QLI ) .  Baseline scores and subsequent changes were included in statistical models of survival duration , with and without other prognostic factors . RESULTS Physician assessment of QLI and patient LASA scores for physical well-being ( PWB ) , mood , nausea and vomiting , appetite , and overall QL ( but not pain ) at the commencement of treatment were significant predictors of subsequent survival . Scores for PWB and QLI were independent of other prognostic factors . Changes in scores were also prognostically important . Both baseline and change in scores for PWB , mood , pain , and QLI after the first three treatment cycles , but before an arbitrary 180-day time point , were significantly predictive of survival beyond that time . Both QLI and PWB were prognostically independent of tumor response . Although QL improvement was correlated with tumor response , continuous therapy yielded significantly better QL scores , even in nonresponders . CONCLUSION These findings support the validity of the simple QL measures used in the trial . They are compatible with the simple explanation that patients perceive disease progression before it is clinical ly evident , but also with a causal relationship between QL and survival duration In a study of work rehabilitation , 97 participants with schizophrenia or schizoaffective disorder were r and omized into either a Pay or a No Pay condition to determine the impact of work activity and pay on rehabilitation outcomes . This report specifically investigates the relationship between work rehabilitation and quality of life ( QOL ) measures for people with schizophrenia . Previous reports have described improvements in symptoms and work outcomes for participants in the Pay condition . Results in this report reveal that r and omization to the Pay condition improved ratings on the Heinrichs Quality of Life Scale ( QLS ) . The improvements are found both in overall QLS and in the domain of Intrapsychic Foundations ( motivation , sense of purpose , anhedonia , and empathy ) . For a larger sample ( n = 114 ) we assessed the relationship between amount of participation and QLS improvement . Degree of participation was related to improvement on the QLS total and Intrapsychic Foundations domain . Finally , improvement in the Interpersonal Relations scale was associated with weeks of participation for the most consistent participants . How participation in work rehabilitation and its interaction with pay improves motivation , interpersonal relatedness , and overall quality of life is discussed BACKGROUND The goal of these secondary analyses of clinical trial data was to characterize clinical outcomes in patients with schizophrenia who met symptom severity or duration thresholds for two alternative definitions of remission , and to explore their relationships to improvement duration and quality of life outcomes . METHODS Definition 1 used threshold criteria for selected PANSS items sustained over at least 6-months Definition 2 used Brief Psychiatric Rating Scale ( BPRS ) % change , a threshold score for the Clinical Global Improvement-Severity ( CGI-S ) maintained for at least 8 weeks , and threshold scores for selected BPRS items . Positive and Negative Symptom Scale ( PANSS ) and Quality of Life scale ( QLS ) total scores were pooled from 6 clinical trials . The extent to which the alternative severity thresholds from these two definitions and duration of clinical improvement were associated with different clinical and QLS outcomes was explored . Regression analysis also assessed the relative contribution of each of the components of the two definition severity thresholds to improvements in QLS Total score . RESULTS Increases in QLS scores were greater for those patients who met either threshold criteria relative to those who met neither ( p<.0001 ) . Significantly greater improvements in QLS scores were observed for patients who met either threshold criteria at the 8- , 16- and 24-week visits relative to those who met criteria at weeks 16 and 24 , or at week 24 only ( p<0.001 ) , as well as for the subset of patients who met threshold criteria at both 24 and 52 weeks relative to those who met criteria at only one of these 2 time points . Only 31 % to 47 % of patients meeting threshold criteria for either definition at the 8- , 16- or 24-week visits remained in remission at the 52-week visit . Among the severity threshold components analyzed , BPRS total % change from baseline was the strongest predictor of improvement in QLS scores . CONCLUSIONS Quality of life improved most for patients who achieved severity thresholds associated with either remission criteria and who stayed improved for longer periods . Total BPRS change scores accounted for the greatest percentage of the QLS scores variance . Only a fraction of patients who meet severity criteria for either remission definition early in treatment will remain at that level of improvement within the subsequent 9 - 12 months Quality  of life ( QL ) scores  may be used to assess the impact of disease and treatment , and to predict survival of cancer patients in prospect i ve clinical trials . The aim of this study was to evaluate the prognostic association of  QL scores  among patients with advanced malignancies in routine practice . Adult patients with advanced malignancy from 12 institutions in 10 countries completed the EORTC QLQ-C30 question naire , in their native language , once at study entry . Baseline patient and disease characteristics were recorded . We used a proportional hazards model stratified on diagnostic category to test whether QL scores  from the QLQ-C30 were significantly and independently predictive of overall survival duration from the time of QL measurement . In all , 735 eligible patients were entered between November 1989 and September 1995 . On 1 October 1995 , follow-up information was obtained on 656 patients , of whom 411 had died . Patient and disease factors predictive of worse survival were age and performance status . The global scale and the scales of physical , role , emotional , cognitive and social function were each significantly predictive of subsequent survival duration in univariate analyses . Single-item  QL scores for overall physical condition ( question 29 ) , overall quality of life ( question 30 ) , and the global and social functioning scales remained independently prognostic after allowing for performance status and age , and , among solid tumour patients , metastatic site . QL can be measured in an international setting based on routine oncology practice . QL scores carry prognostic information independent of other recorded factors Objectives : To compare the quality of life ( QL ) of patients with poor prognosis M1 prostate cancer treated with orchiectomy alone ( ORCH ) or orchiectomy combined with adjuvant mitomycin C ( MMC ;  15 mg/m2 i.v . q 6 weeks : ORCH+MMC ; EORTC trial 30893 ) . Methods : Patients with newly diagnosed M1 poor prognosis prostate cancer completed a truncated version of the EORTC QLQ – C30 ( V 1.0 ) at r and omization ( baseline ) and every 6–12 weeks thereafter until going off the protocol . Five ad hoc questions assessing lower urinary tract symptoms were included in the QL question naire . Results : At least one QL form was completed by 177 of the 189 patients included in the trial , with baseline question naires available for 113 patients ( ORCH n = 52 ; ORCH+MMC n = 61 ) . In both arms , pain and urinary dysfunction improved during treatment . Compared with patients from the ORCH arm , the use of adjuvant MMC was associated with a significant reduction in global health status/QL and with impairment in 7 of 11 QL dimensions covered by the question naire . Some improvement in QL was observed after discontinuation of MMC . A survival benefit was not observed in the ORCH+MMC arm . Conclusions : Intravenous MMC ( 15 mg/m2 q 6 weeks ) can not be recommended as adjuvant treatment in M1 poor prognosis prostate cancer due to its negative impact on QL and lack of efficacy . In general , QL assessment s should be m and atory when adjuvant chemotherapy is evaluated in patients with metastatic prostate cancer BACKGROUND The project conducted at the Tumour Centre in Regensburg aims to integrate quality of life ( QL ) diagnostics with the therapy of breast cancer patients and to evaluate the efficacy of QL diagnostics in the context of a r and omized clinical trial . METHODS The Regensburg Tumour Centre provides the infrastructure of the present project ( telemedicine , project groups , quality circle ) . The treatment of breast cancer patients is based on the recent national breast cancer therapy guideline , including assorted QL-enhancing therapy options such as pain therapy , physiotherapy and lymphatic drainage , psychotherapy , social counselling and rehabilitation , nutrition and sports . During an implementation phase a new method of QL diagnostics has been developed . Five experts with varying professional background use the individual patient 's QL profile and clinical and socio-demographic information in order to generate a QL report including a treatment recommendation . The study is design ed as a two- arm r and omized clinical trial with one test group ( communication of the QL findings to the co-ordinating physician ) and a control group ( no communication ) . Patients with newly diagnosed breast cancer who are treated in the study region by one of the co-ordinating doctors will be included in this r and omized study . At design ated points in time QL assessment s ( EORTC QLQ-C30 plus BR23 ) will be conducted over a 12-months period . EXPECTED RESULTS We expect that patients in the test group will experience a lower amount of QL deficits at the end of the study period ( M = 1 , SD = 2 ) than patients in the control group ( M = 2 , SD = 2 ) . The statistical confirmation of this expected effect requires a total sample size of N = 200 ( n = 100 vs. n = 100 , alpha = 5 % [ two-tailed ] , beta = 10 % ) . CONCLUSIONS This is the first study to evaluate a new form of QL diagnostics in the complexity of a real patient care environment , and it promises to make the inclusion of the quality of life concept into the current breast cancer treatment guideline more tangible PURPOSE Time to progression ( TTP ) , overall survival , and quality of life ( QL ) were compared in patients with hormone-resistant prostate cancer ( HRPC ) treated with prednisone ( 5 mg orally , four times a day ) or flutamide ( 250 mg orally , three times a day ) . PATIENTS AND METHODS Symptomatic patients were r and omized to receive either prednisone ( 101 patients ) or flutamide ( 100 patients ) . Subjective response was assessed based on performance status , the use of analgesics , and the need to apply alternative palliative treatment . Prostate-specific antigen (PSA)-based biochemical response ( > or= 50 % reduction of baseline PSA ) was recorded . At baseline and at 6-week intervals during follow-up , patients completed the European Organization for Research and Treatment of Cancer Quality of Life Question naire C-30 . RESULTS There was no difference between the groups in median TTP  ( prednisone , 3.4 months ; flutamide , 2.3 months ) or overall survival  ( prednisone , 10.6 months ; flutamide , 11.2 months ) . In the prednisone group , 56 % of the patients experienced a subjective response , compared with 45 % in the flutamide group ( P : = .18 ) . The median response duration was 4.8 months for prednisone and 4.2 months for flutamide . A biochemical response was observed in 21 % and 23 % of the prednisone and flutamide groups , respectively . Gastrointestinal toxicity was the reason for trial discontinuation in seven patients receiving flutamide and two patients receiving prednisone . The QL assessment parameters favored the use of prednisone with statistically significant differences in pain , fatigue , role functioning , appetite loss , gastrointestinal distress , and overall QL . CONCLUSION In symptomatic HRPC , treatment with prednisone or flutamide leads to similar rates of TTP and overall survival and no difference in subjective or biochemical response . The QL results favor the use of low-cost prednisone in patients with HRPC BACKGROUND Although definitions of palliative care include quality of life as a central concern , little research has been published about both the quality of life of patients with advanced illness and their family members , and particularly the changes in their quality of life over time . OBJECTIVES The aims of this prospect i ve longitudinal pilot study were to : ( 1 ) establish the reliability of multidimensional quality of life instruments based on patients with acquired immune deficiency syndrome ( AIDS ) and patients with cancer and caregivers ; ( 2 ) identify differences in quality of life between patients with advanced AIDS and cancer , and their family caregivers with consideration of mortality , attrition , and compliance rates ; and ( 3 ) examine differences in demographic variables and their potential confounding effect when measuring quality of life . METHODS The sample included 101 patients with advanced illness ( 63 patients with advanced AIDS and 38 with advanced cancer ) and 81 family caregivers ( 43 caregivers for patients with AIDS and 38 caregivers for patients with cancer ) . Data collection involved the monthly completion of the McGill  Quality of Life Question naire ( MQOL ) for patients , and the Quality of Life Scale  ( QLS ) for family caregivers . RESULTS Reliability of the MQOL and QLS were established for patients with AIDS and patients with cancer and caregivers . Based on the MQOL , patients with advanced AIDS reported a lower total quality of life , and lower psychological quality of life , and a higher physical quality of life compared to patients with advanced cancer . There were no significant differences between patient groups on the one-item physical well-being subscale , or the existential well-being , and support subscales . Based on the QLS , AIDS caregivers reported greater overall quality of life , greater psychological well-being , and greater spiritual well-be- ing than cancer caregivers . There were no significant differences between AIDS and cancer caregivers with respect to physical or social well-being . From baseline entry into the study to third month of participation , there were no significant changes in total quality of life scores for patient or caregiver groups , although trends indicated a moderately high total quality of life over time for all patient and caregiver groups . Fourteen of 63 ( 22 % ) patients with AIDS patients died , while 19 of 38 ( 50 % ) patients with advanced cancer died after enrollment . Forty-six of 63 ( 73 % ) patients with advanced AIDS withdrew for various reasons other than death at some point during the 12 month time frame of the study , while 15 of 38 ( 39 % ) patients with advanced cancer withdrew . There were significant differences on all demographic variables for patients with advanced cancer and AIDS . Only religious affiliation was significantly related to quality of life for patients with AIDS , while gender was the only variable associated with quality of life for patients with cancer . There were significant differences on all demographic variables between caregivers with the exception of gender and living arrangements . Only the relationship between patients and caregivers and marital status were significantly associated with quality of life for cancer caregivers . CONCLUSIONS In palliative care research , the challenge is to design studies that will capture changes in the domains of quality of life over time , yet will minimize participant burden and subsequent attrition rates . By measuring quality of life as an outcome variable in palliative care , health professionals can identify changes in the domains of quality of life over time for various patient population s and their family caregivers , and respond with appropriate interventions , which promote or maintain their quality of life even as death approaches This study compares the cost-effectiveness of Navigate ( NAV ) , a comprehensive , multidisciplinary , team-based treatment approach for first episode psychosis ( FEP ) and usual Community Care ( CC ) in a cluster r and omization trial . Patients at 34 community treatment clinics were r and omly assigned to either NAV ( N = 223 ) or CC ( N = 181 ) for 2 years . Effectiveness was measured as a one st and ard deviation change on the Quality of Life Scale ( QLS-SD ) . Incremental cost effectiveness ratios were evaluated with bootstrap distributions . The Net Health Benefits Approach was used to evaluate the probability that the value of NAV benefits exceeded its costs relative to CC from the perspective of the health care system . The NAV group improved significantly more on the QLS and had higher outpatient mental health and antipsychotic medication costs . The incremental cost-effectiveness ratio was $ 12 081/QLS-SD , with a .94 probability that NAV was more cost-effective than CC at $ 40 000/QLS-SD . When converted to monetized Quality Adjusted Life Years , NAV benefits exceeded costs , especially at future generic drug prices PURPOSE To investigate the effects of medroxyprogesterone acetate ( MPA ) on appetite , weight , and quality of life ( QL ) in patients with advanced-stage , incurable , non-hormone-sensitive cancer . PATIENTS AND METHODS Two hundred six eligible patients were r and omized between double-blind MPA 500 mg twice daily or placebo .  Appetite ( 0 to 10 numerical rating scale ) , weight , and QL ( European Organization for Research and Treatment of Cancer Quality of Life Question naire [ EORTC-QLQ-C30 ] ) were assessed before the start of treatment ( t = 0 ) , and 6 weeks ( t = 6 ) and 12 weeks ( t = 12 ) thereafter . RESULTS One hundred thirty-four patients ( 68 MPA and 66 placebo ) were assessable at t = 6 and 99 patients ( 53 MPA and 46 placebo ) at t = 12 . A beneficial effect of MPA on appetite was observed after both 6 weeks ( P = .008 ) and 12 weeks ( P = .01 ) of treatment . After 12 weeks , a mean weight gain of 0.6 + /- 4.4 kg was seen in the MPA , versus an ongoing mean weight loss of 1.4 + /- 4.6 kg in the placebo group . This difference of 2.0 kg was statistically significant ( P = .04 ) . During the study , several areas of QL deteriorated in the total group of patients . With the exception of an improvement in appetite and possible also a reduction in nausea and vomiting , no measurable beneficial effects of MPA on QL could be demonstrated . The side effects profile of MPA was favorable : only a trend toward an increase in ( usually mild ) peripheral edema was observed . CONCLUSION In weight-losing , advanced-stage non-hormone-sensitive cancer patients , MPA exhibits a mild side effects profile , has a beneficial effect on appetite , and may prevent further weight loss . However , general QL in the present study was not measurably influenced by MPA treatment In a prospect i ve cohort study , we constructed a composite index of poor outcome that incorporates survival , morbidity , and quality of life ( QL ) . We identified baseline patient and treatment characteristics that predicted poor outcome 1 year after the start of  chronic dialysis .  Outcome was classified as poor if a patient had died or if at least two of the following criteria were present : ( 1 ) 30 days or greater of hospitalization per year , ( 2 ) serum albumin level of 30 g/L or less or a malnutrition index score of 11 or greater , ( 3 ) a 36-item Medical Outcomes Study (MOS)-Short Form Health Survey Question naire ( SF-36  ) physical summary QL score of 2 or more SDs less than the general population mean score , and ( 4 ) an SF-36 mental summary QL score of 2 or more SDs less than the general population mean score . Multivariate logistic regression analysis was used to identify independent predictors of poor outcome . Of 250 included patients , 189 were assessable with respect to poor outcome . Of these patients , 47 ( 25 % ) were classified as poor . A baseline presence of comorbidity , serum albumin level of 30 g/L or less , physical or mental QL score 2 or more SDs less than the general population mean score , and , to a lesser extent , residual glomerular filtration rate of 2.5 mL/min/1.73 m(2 ) or less were independently associated with a greater risk for poor outcome . A post hoc analysis indicated a mean arterial blood pressure greater than 107 mm Hg was predictive of poor outcome in patients undergoing peritoneal dialysis .  In conclusion , our prognostic model provides a useful tool to identify  chronic dialysis patients at risk for poor health status . Strategies aim ed at preserving residual renal function , controlling blood pressure , monitoring QL , and consequently giving psychosocial support may reduce the risk for poor outcome OBJECTIVE To describe the potential psychological consequences of screening for abdominal aortic aneurysms ( AAAs ) . METHODS The participants were prospect ively and r and omly sample d from a r and omised screening trial for AAA and asked to complete a vali date d generic and global anonymous quality of life ( QL ) question naire by self- assessment ( ScreenQL ) . Material case-control study : ScreenQL was completed once by 168 ( 48 % ) of 350 non-responders to screening  , 271 ( 81 % ) of 335 attenders before screening , 286 ( 85 % ) of 335 attenders after screening , 127 ( 85 % ) of 149 with a small AAA diagnosed at screening , and 231 ( 66 % ) of 350 who were r and omised not to be offered screening for AAA ( controls ) . Prospect i ve study ( paired data ): 127 men having a small AAA diagnosed . Twenty-nine ( 81 % ) of 36 men operated after initial conservative treatment . RESULTS Initially , the QL score was 5 % lower among men with a small AAA compared to the controls ( p<0.05 ) , mainly because of poorer health perception . The QL score declined significantly further to 7 % below control values during the period of conservative treatment . This impairment was mainly due to a 21 % and 15 % reduction in scores relating to health perception and psychosomatic distress , respectively . However , all scores improved to control levels in patients operated on . The QL of attending men for screening was significantly lower than that of the controls and the attenders after the screening . No differences were noticed concerning the non-attenders . CONCLUSION The offer of screening causes transient psychological stress in subjects found not to have AAA . However , diagnosis of an AAA seems to impair QL permanently and progressively in conservatively treated cases . This impairment seems reversible by operation . Nevertheless , the impairment seems considerable , and must be considered in the management of AAA and in the final evaluation of screening for AAA Purpose The quality of life ( QL ) of advanced gastric cancer patients receiving irinotecan , folinic acid and 5-fluorouracil ( 5-FU ) ( IF arm ) or cisplatin with 5-FU ( CF arm ) is presented . Methods Patients with measurable or evaluable advanced gastric cancer received IF weekly for 6/7 weeks or CF q4 weeks . QL was assessed using the EORTC QLQ-C30 at baseline , subsequently every 8 weeks until progression and thereafter every 3 months until death . The QL data were analysed using several statistical methods including summary measures and pattern-mixture modelling . Results A total of 333 patients were r and omised and treated ( IF 170 , CF 163 ) . The time-to-progression for IF and CF was 5.0 and 4.2 months ( P = 0.088 ) , respectively . The overall compliance rates for QL question naire completion were 60 and 56 % in the IF and CF arms , respectively . Significant treatment differences were observed for the physical functioning scale ( P = 0.024 ) , nausea\vomiting ( P = 0.001 ) and EQ-5D thermometer ( P = 0.020 ) in favour of the IF treatment arm . Conclusion There was a trend in favour of IF over CF in time-to-progression . The IF group also demonstrated a better safety profile than CF and a better QL on a number of multi-item scales , suggesting that IF offers an alternative first-line platinum-free treatment option for advanced gastric cancer Background The main outcome parameters in oesophageal surgery have traditionally been morbidity and mortality , but  quality of life ( QL ) has become an important consideration in view of the severity and persistence of postoperative symptoms . The aim of this study was to analyse QL before and after oesophagectomy for oesophageal cancer and to explore possible association with patient ’s and disease characteristics . Patients and Methods One hundred twenty-six consecutive patients presenting with oesophageal cancer to the Oncological Surgery Unit of the Veneto Institute of Oncology between 2009 and 2011 were enrolled in this prospect i ve study . The patients were asked to answer three QL question naires ( the Italian versions of the QLQ-C30 , the QLQ-OES18 , and the IN-PATSAT32 modules developed by the European Organization for Research and Treatment of Cancer ) at the time of disease diagnosis , after neoadjuvant therapy , immediately after surgery and at 1 , 3 , 6 and 12 months postoperatively . Results Global quality of life ( QL2 item ) seemed to improve after neoadjuvant therapy but it dropped markedly after surgery . It then rose to a value in between the one registered after neoadjuvant therapy and the one at diagnosis . Emotional function and dysphagia were associated to QL2 at diagnosis . After neoadjuvant therapy , age , oesophageal stenosis , emotional function and dysphagia were associated to good quality of life at that stage . After surgery , pain was associated to quality of life at that stage . During the early follow-up phase ( 1–3 months after surgery ) , role function and postoperative urinary complications were associated to QL2 . In the long-term follow-up ( 6–12 months ) , adjuvant therapy , eating disorders and postoperative complications were associated to poor quality of life . Conclusions Postoperative complications are associated to long-term emotional and physical function impairment which can lead to a significantly impaired global quality of life . Postoperative pain relief plays a key role in achieving a good postoperative quality of life . Finally , HRQL after oesophagectomy seems to be a function of therapeutic efficacy rather than of the specific surgical procedure used
The systematic review revealed widespread utilization of developmentally appropriate QL instruments but less frequent use of both self and proxy reports and an inconsistent approach to age group specificities .
Research on the quality of life ( QL ) of children/adolescents with psychological disorders has flourished over the last few decades .
Given the developmental challenges of QL measurements in pediatric population s , the aim of this study was to ascertain the extent to which a developmental approach to  QL assessment has been applied to pedopsychiatric QL research .