Quality of life after laparoscopic vs open sphincter-preserving resection for rectal cancer

AIM: To compare quality of life (QoL) outcomes in Chinese patients after curative laparoscopic vs open surgery for rectal cancer. METHODS: Eligible Chinese patients with rectal cancer undergoing curative laparoscopic or open sphincterpreserving resection between July 2006 and July 2008 were enrolled in this prospective study. The QoL outcomes were assessed longitudinally using the validated Chinese versions of the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQCR38 questionnaires before surgery and at 4, 8, and 12 mo after surgery. The QoL scores at the different time points were compared between the laparoscopic and open groups. A higher score on a functional scale indicated better functioning, whereas a higher score on a symptom scale indicated a higher degree of symptoms.RESULTS: Seventy-four patients (49 laparoscopic and 25 open) were enrolled. The two groups of patients were comparable in terms of sociodemographic data, types of surgery, tumor staging, and baseline mean QoL scores. There was no significant decrease from baseline in global QoL for the laparoscopic group at different time points, whereas the global QoL was worse compared to baseline beginning at 4 mo but returned to baseline by 12 mo for the open group (P = 0.019, Friedman test). Compared to the open group, the laparoscopic group had significantly better physical (89.9±1.4 vs 79.2±3.7, P = 0.016), role (85.0±3.4 vs 63.3±6.9, P = 0.005), and cognitive (73.5±3.4 vs 50.7±6.2, P = 0.002) functioning at 8 mo, fewer micturition problems at 4-8 mo (4 mo: 32.3±4.7 vs 54.7±7.1, P = 0.011; 8 mo: 22.8±4.0 vs 40.7±6.9, P = 0.020), and fewer male sexual problems from 8 mo onward (20.0±8.5 vs 76.7±14.5, P = 0.013). At 12 mo after surgery, no significant differences were observed in any functional or symptom scale between the two groups, with the exception of male sexual problems, which remained worse in the open group (29.2±11.3 vs 80.0±9.7, P = 0.026). CONCLUSION: Laparoscopic sphincter-preserving resection for rectal cancer is associated with better preservation of QoL and fewer male sexual problems when compared with open surgery in Chinese patients. These findings, however, should be interpreted with caution because of the small sample size of the study.

Value of quality of life analysis in liver cancer: A clinician's perspective

Health related quality of life(HRQOL) is increasingly recognized as an important clinical parameter and research endpoint in patients with hepatocellular carcinoma(HCC). HRQOL in HCC patients is multifaceted and affected by medical factor which encompasses HCC and its complications, oncological and palliative treatment for HCC, underlying liver disease, as well as the psychological, social or spiritual reaction to the disease. Many patients presented late with advanced disease and limited survival, plagued with multiple symptoms, rendering QOL a very important aspect in their general well being. Various instruments have been developed and validated to measure and report HRQOL in HCC patients, these included general HRQOL instruments, e.g., Short form(SF)-36, SF-12, Euro Qo L-5D, World Health Organization Quality of Life Assessment 100(WHOQOL-100), World Health Organization Quality of Life Assessment abbreviated version; general cancer HRQOL instruments, e.g., the European Organisation for Research and Treatment of Cancer(EORTC) QLQ-C30, Functional Assessment of Cancer Therapy(FACT)-General, Spitzer Quality of Life Index; and liver-cancer specific HRQOL instruments, e.g., EORTC QLQ-HCC18, FACT-Hepatobiliary(FACT-Hep), FACT-Hep Symptom Index, Trial Outcome Index. Important utilization of HRQOL in HCC patients included description of symptomatology and HRQOL of patients, treatment endpoint in clinical trial, prognostication of survival, benchmarking of palliative care service and health care valuation. In this review, difficulties regarding the use of HRQOL data in research and clinical practice, including choosing a suitable instrument, problems of missing data, data interpretation, analysis and presentation are examined. Potential solutions are also discussed.

Targeted-cryosurgical ablation of the prostate with androgen deprivation therapy:quality of life in high-risk prostate cancer patients

Aim： To present preliminary results on health-related quality of life （QoL）, prostate-associated symptoms and therapeutic effects of targeted-cryosurgical ablation of the prostate （TCSAP） with androgen deprivation therapy （ADT） in high-risk prostate cancer （PCa） patients. Methods： Thirty-four men with high-risk PCa features underwent TCSAP, and ADT was added to improve the treatment outcomes. High-risk parameters were defined as either prostate-specific antigen （PSA） ≥ 10ng/mL, or Gleason score 〉 8, or both. The Genito-Urinary Group of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 （EORTC QLQ-C30） with prostate-cancer-specific module （QLQ-PR25） was used for evaluating morbidities and PSA levels were recorded every 3 months. PSA failure was defined as the inability to reach a nadir of 0.4 ng/mL or less. Results： Although it was not statistically significant, the global health status scores increased after TCSAP with ADT. The scores for five functional scales also became higher after treatment. The most prominent symptom after treatment was sexual dysfunction, followed by treatment-related and irritative voiding symptoms. Conclusion： TCSAP with ADT appears to be minimally invasive with high QoL except for sexual dysfunction. Long-term follow-up of PSA data and survival is necessary before any conclusions can be made on the efficacy of this promising new therapeutic modality in the treatment of PCa.

Quality of Life in Women with Endometriosis Pelvic Pain Treated with the Levonorgestrel-Releasing Intrauterine System

Objective: To evaluate the quality of life in patients with endometriosis pelvic pain before and after the application of the levonorgestrel-releasing intrauterine system (LNG-IUS). Design: Open non-comparative study. Setting: Obstetrics and Gynecology Hospital at Monterrey, Mexico. Sample: 29 women aged 18 to 40 years with pelvic pain associated with endometriosis confirmed by laparoscopy. Methods: After laparoscopy but before LNG-IUS insertion (basal visit) and 6 months afterwards, modified Endometriosis Health Profile (EHP-30) was applied. Main outcomes measures: Size of change of questionnaire scores, need of additional analgesic therapy and adverse effects. Statistical Analysis: Differences in the questionnaire scores before and after intervention were analyzed by Student t-test. Results: Final analysis set included 29 women aged 31.7 ± 4.7 years years. The ASRM surgical staging of endometriosis was mild in 19.3 moderate in 13.7 and severe in 76% of the patients. The general perception of quality of life improved from 52 at baseline to 98% at six months (p < 0.001). Adverse events were mild in nature, 19 patients reported no adverse events during the study (65.5%). Two patients (6.9%) required the use of concomitant therapy with non-steroidal analgesics for relief of pain. Conclusion: The application of LNG-IUS in patients with pelvic pain associated with endometriosis improved significatively all aspects related with quality of life as measured with Endometriosis Health Profile (EHP-30). We concluded that LNGIUS may be an effective and convenient therapeutic alternative for the management of pain associated with endometriosis.

QLQ-30量表在乳腺癌化疗患者中的应用

应用EORTC QLQ-30核心量表调查初治乳腺癌化疗患者的生存质量。运用自身对比的队列研究方式,调查了42名乳腺癌化疗患者。结果显示化疗带来的生存质量的下降是显著但短暂的;某些因素对生存质量的影响较大,值得针对性地采取干预措施;对一些调查项目的修改,可以使EORTC QLQ-30量表更好地适应我国的国情和文化。

非洛地平缓释片治疗肾性高血压的临床疗效及对生活质量的改善作用

目的探讨钙离子拮抗剂非洛地平缓释片治疗肾性高血压的临床疗效及对生活质量的影响。方法将100例肾性高血压患者随机分为2组,每组50例。对照组给予福辛普利钠片,观察组给予非洛地平缓释片。比较2组患者总体疗效,血压、尿蛋白、血肌酐、生活质量的改善以及不良反应发生率。结果观察组总有效率显著高于对照组;2组患者治疗后血压、尿蛋白及血肌酐水平均较治疗前显著改善,而观察组尿蛋白水平的改善幅度显著大于对照组;观察组生活质量核心问卷-30(QLQC-30)各项评分均显著高于对照组。观察组不良反应发生率有低于对照组的趋势,但差异无统计学意义。结论钙离子拮抗剂非洛地平缓释片治疗肾性高血压疗效显著,可明显提高患者治疗后生活质量,应在临床上加以推广应用。

替扎尼定联合文拉法辛缓释片治疗紧张性头痛的疗效分析

目的探讨替扎尼定联合文拉法辛缓释片治疗紧张性头痛的临床疗效。方法选取在我院神经科住院治疗的98例临床确诊的紧张性头痛患者,随机分为治疗组和对照组,每组49例,治疗组采用替扎尼定联合文拉法辛缓释片治疗,对照组采用替扎尼定治疗,两组均于治疗前、治疗后第2周、第4周分别采用视觉模拟评分法(VAS)记录疼痛分值,且于治疗结束前及治疗后用生活质量核心量表(QLQ-C30)对患者生活质量改善情况进行评定。结果治疗前治疗组及对照组VAS、QLQ-C30评分比较差异无统计学意义(P>0.05)。治疗后第2周、第4周VAS评分与治疗前相比,结果示治疗组、对照组VAS评分差异均有统计学意义(P<0.05),但治疗组VAS评分改善明显优于对照组,差异有统计学意义(P<0.05)。治疗后第4周治疗组、对照组QLQ-C30评分与治疗前比较,差异有统计学意义(P<0.05),但治疗组QLQ-C30评分改善优于对照组,差异有统计学意义(P<0.05)。结论替扎尼定联合文拉法辛缓释片治疗紧张性头痛安全、可靠,值得临床推荐。

贲门癌根治性全胃切除术与根治性近端胃切除术的临床效果对比

〔目的〕探讨贲门癌根治性全胃切除术与根治性近端胃切除术的临床效果。〔方法〕病例来源于我院2009年5月至2012年5月收治确诊的贲门癌患者142例。依据随机数字表法将这些患者均分为观察组和对照组,每组各71例。给予观察组根治性全胃切除切除手术,给予对照组则进行根治性近端胃切除术,观察比较两组患者的QLQC-30、并发症等指标。〔结果〕观察组手术时间、术中出血量、术后3 d胃管引流量、术后排气时间及术后3 d白蛋白值与对照组比较差异不明显,不存在统计学意义(P>0.05);观察组术后吻合口狭窄、反流性食管炎以及总的并发症发生情况与对照组比较差异明显,存在统计学意义(P<0.01);观察组术后短期内生活质量评分中QLQC-30问卷的各个项目以及术后1a、3 a生存率均明显优于对照组,比较差异存在统计学意义(P<0.01)。〔结论〕根治性全胃切除术与根治性近端胃切除术相比,临床疗效较好,安全有效,具有重要的临床应用价值。

Impaired of Sexuality in Premenopausal Breast Cancer Patients

Introduction: The treatment modalities for Breast cancer may impair the sexual function of women, especially in the pre-menopausal period. Treatment in this group of women has a huge impact in quality of life. The main objective of this study was to evaluate the prevalence of sexual dysfunction (SD) after treatment for breast cancer among women who were premenopausal at the diagnosis of neoplasia. Material and Methods: All women diagnosed with premenopausal breast cancer at one outpatient clinic from March 2019 to September 2020 were selected. Participants answered two sexual function questionnaires (the Female Sexual Function Index [FSFI-19] and Female Sexual Quotient [QS-F]) and a quality of life [QOL] questionnaire [EORTC QLQ-C30]). Sociodemographic and tumor characteristics were also studied. Results: Fifty-eight pre-menopausal women were included. Sexual dysfunction (SD) was observed in 43 participants (74.1%) according to the FSFI-19, while 31 (53.4%) had SD according to the QS-F. The functional and general health scales of the EORTC QLQ-C30 were positively related to the FSFI-19 and QS-F scores, while the symptom scale was negatively related to the FSFI-19 and QS-F scores. There was no relationship between chemotherapy, hormone therapy, or surgery with the FSFI-19 and QSF scores. A diagnosis of depression was negatively related to the total FSFI-19 scores. Conclusion: Pre-menopausal breast cancer women showed high rates of female SD. None breast cancer treatment modality was related to SD. The only studied variable associated with SD was depression.

参莲抗癌合剂联合化疗治疗结肠癌晚期患者临床研究

目的:观察参莲抗癌合剂联合化疗对结肠癌晚期患者的临床效果,探讨其可能的作用机制。方法:选取104例晚期结肠癌患者作为研究对象,按照随机数字表法分为对照组和观察组各52例。对照组给予FOLFIRI方案化疗,观察组则在对照组基础上加用自拟参莲抗癌合剂内服治疗,2周为1个疗程,连续治疗4个疗程。观察2组患者的近期临床疗效,治疗前后检测免疫功能相关指标T淋巴细胞亚群、免疫球蛋白水平,采用欧洲癌症研究治疗组织的生命质量核心问卷(EORTC QLQ-C30)评价生活质量,监测血清白细胞介素-17 (IL-17)、低氧诱导因子-1α(HIF-1α)、血管内皮生长因子(VEGF)水平,记录2组患者的不良反应。结果:观察组的近期疗效总有效率为51.92%,高于对照组的28.85%,差异有统计学意义(χ~2=7.329,P <0.05)。治疗后,2组T淋巴细胞群指标CD4^+、CD4^+/CD8^+及免疫球蛋白IgA、IgG、IgM水平较治疗前明显升高,且观察组各项指标均高于对照组,差异均有统计学意义(P <0.05);CD8^+水平较治疗前明显降低,且观察组低于对照组,差异有统计学意义(P <0.05)。治疗后,2组症状量表评分较治疗前明显降低,功能量表评分较治疗前明显升高;且观察组症状量表评分低于对照组,功能量表评分高于对照组;差异均有统计学意义(P <0.05)。治疗后,2组血清IL-17、HIF-1α、VEGF水平较治疗前降低,且观察组各项指标均低于对照组,差异均有统计学意义(P <0.05)。观察组白细胞减少、贫血、血小板减少、恶心呕吐、口腔溃疡、肝功能异常、神经毒性等不良反应的发生率明显低于对照组(P <0.05)。结论:参莲抗癌合剂联合化疗能明显提高患者的机体免疫功能及生活质量,减毒增效作用突出,其机制可能与通过降低血清IL-17、HIF-1α、VEGF水平而抑制炎症反应、抑制肿瘤血管增殖有关,有一定的临床推广运用价值。

Nutritional Supplement Ocoxin® Combined with Gemcitabine-Based Chemotherapy in Patients with Advanced Pancreatic Adenocarcinoma

Background: the quality of life (QoL) of patients with pancreatic ductal adenocarcinoma (PDAC), with its limited survival, can be affected by chemotherapy-induced toxicity. The main objective was to evaluate the effect of introducing ocoxin oral solution (OOS) in combination with standard therapy on quality of life. Methods: Thirty patients were enrolled in an exploratory, prospective, single-centre clinical trial in the oncology department of “Hermanos Ameijeiras” University Hospital in Havana, Cuba. Quality of life was measured using the EORTC QLQ-C30 questionnaire and toxicity was assessed using the NCI-CTC-AE classification version 5.0. Results: There was stability in the scores over time for overall QoL and the functional scale criteria, while in terms of symptoms, fatigue, pain and loss of appetite were reduced. No grade 3 - 4 adverse events (AEs) were recorded, and only 14.9% of toxicities were classified as grade 2, and these were considered to be unrelated to OOS. Biochemical and nutritional parameters were normalised at 12 months compared to the baseline values. Conclusions: This clinical study is the first report of the use of OOS in patients with advanced pancreatic cancer, and demonstrates that it is able to maintain optimal quality of life with reduced severity of toxicity during and after combination treatment with gemcitabine-based chemotherapy.

乳癌康复汤对乳腺癌术后患者生命质量的影响

目的 探讨乳癌康复汤对乳腺癌术后患者生命质量的影响.方法 将符合入选标准的107例乳腺癌术后患者,采用随机数字表法分为对照组54例和观察组53例.对照组给予常规放化疗及对症支持治疗,观察组在对照组基础上加服乳癌康复汤治疗.2组均治疗12个月,随访6个月.采用欧洲癌症研究与治疗组织生命质量量表（quality of life questionnaire-core 30,QLQ-C30）和乳腺癌生存质量量表（quality of life questionnaire-breast cancer module 23,QLQ-BR23）评价乳腺癌术后患者生命质量.结果 治疗后,观察组QLQ-C30量表功能维度中躯体功能[（76.4±16.6）分比（70.4±16.4）分,t=-2.087]、角色功能[（59.2±12.8）分比（54.6±12.8）分,t=-2.085]、情绪功能[（77.2±17.0）分比（71.2±16.7）分,t=-2.075]、认知功能[（38.5±14.7）分比（34.3±11.6）分,t=2.104]、社会功能[（59.3±12.4）分比（54.6±12.8）分,t=-2.105]评分及总体健康状况[（76.7±19.7）分比（65.5±18.6）分,t=-2.152]评分均高于对照组（P〈0.05）;症状维度中疲乏[（40.9±8.4）分比（45.3±9.6）分,t=2.149]、恶心呕吐[（42.9±8.8）分比（47.5±10.1）分,t=2.145]、疼痛[（36.9±7.6）分比（40.9±8.7）分,t=2.143]、呼吸困难[（44.8±9.2）分比（49.6±10.6）分,t=2.148]、失眠[（41.8±8.6）分比（46.3±9.9）分,t=2.152]、食欲丧失[（35.0±7.2）分比（38.7±8.2）分,t=2.113]、便秘[（15.9±3.3）分比（17.6±3.8）分,t=2.057]、腹泻[（15.2±3.1）分比（16.9±3.6）分,t=2.092]评分均低于对照组（P〈0.05）.观察组QLQ-BR23量表中体型[（74.7±18.5）分比（64.8±15.4）分,t=-2.153]、性功能[（36.3±9.0）分比（42.8±10.2）分,t=2.045]、性乐趣[（41.4±10.2）分比（48.9±11.6）分,t=2.046]、未来看法[（67.6±16.7）分比（58.6±14.0）分,t=-2.132]、系统疗法副作用[（48.2±10.4）分比（55.2±12.2）分,t=2.149]、乳房症状[（39.6±8.6）分比（45.5±10.2）分,t=2.127]、手臂症状[（30.3±6.6）分比（34.8±7.7）分,t=2.129],脱发引起的烦恼[（36.1±7.8）分比（41.4±9.1）分,t=2.113]评分均高于对照组（P〈0.05）.结论 乳癌康复汤可调整乳腺癌术后患者的精神状态,提高生命质量.

大连地区存活5年以上肺癌患者生活质量调查

目的调查和分析辽宁省大连地区存活≥5年非小细胞肺癌患者的生活质量现状。方法 2007年1月—2011年8月在大连医科大学附属第一医院肿瘤科就诊的39例存活≥5年非小细胞肺癌患者,对其进行肿瘤患者生活质量核心问卷QLQ-C30(EORTC-QOL30)评估,并与42例确诊后1年内仍存活的同龄、同性别非小细胞肺癌患者(对照组)的测试结果进行比较。结果长期存活组患者EORTC-QLQ-C30生活质量问卷功能部分各指标得分[躯体功能(68.12±12.90)分、角色功能(63.44±11.05)分、认知功能(72.51±13.26)分、情绪功能(70.38±13.69)分、社会功能(62.46±10.73)分]均高于对照组患者的(56.47±10.85)、(52.83±10.96)、(58.64±11.39)、(57.42±12.17)、(53.91±9.25)分(P<0.05);长期存活组患者EORTC-QLQ-C30生活质量问卷整体质量分和经济困难条目得分分别为(68.35±14.70)和(50.22±11.46)分,分别高于和低于对照组患者的(42.61±10.59)和(74.05±15.93)分(均P<0.01)。结论大连地区存活≥5年非小细胞肺癌患者生活质量现状较好。

心理康复护理对脑卒中后吞咽障碍患者功能恢复影响的Meta分析

目的采用Meta分析的方法评估心理康复护理对脑卒中后吞咽障碍患者功能恢复的影响。方法采用计算机检索PubMed、Cochrane Library、Web of Science、维普、万方数据网、中国知识基础设施工程和中国生物医学文献数据库,收集1956年6月至2020年8月发表的关于心理康复护理对于脑卒中后吞咽障碍患者功能的随机对照研究文献,采用Revman 5.3进行Meta分析。结果共纳入采用生命质量核心量表(QLQ-C30)和治疗疗效调查心理康复护理对脑卒中后吞咽障碍患者功能恢复影响及生命质量影响对照研究文献7篇,共660个样本。Meta分析结果显示:心理康复护理干预后心理功能均分差异有统计学意义[加权均数差(WMD)=-16.66,95%CI -18.09~-15.22,P<0.001];在躯体功能得分中,干预组表现相较于对照组差异有统计学意义(WMD=-14.10,95%CI -16.26~-11.95,P<0.001);心理康复护理干预后社会功能均分差异有统计学意义(WMD=-13.52,95%CI -15.64~-11.41,P<0.001);在生命质量评分中,对照组较干预组表现差(WMD=-14.58,95%CI -15.86~-13.31,P<0.001);干预组的治疗效果优于对照组的治疗效果,差异有统计学意义[比值比(OR)=0.16,95%CI 0.08~0.32,P<0.001]。结论通过心理康复护理的干预,脑卒中患者的吞咽障碍获得缓解同时,生命质量也会得到改善。