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In 1986, the European Organization for Research and Treatment (EORTC) initiated a research program to develop an integrated, modular approach for evaluating the quality of life of patients participating in international clinical trials. The questionnaire was designed to measure cancer patients' physical, psychological and social functions. The questionnaire is composed of 5 multiitem scales (physical, role, social, emotional and cognitive functioning) and 9 single items (pain, fatigue, financial impact, appetite loss, nausea/vomiting, diarrhea, constipation, sleep disturbance and quality of life). It was administered to the patients before the initiation of palliative treatment and then once again during the treatment. The validation of the questionnaire took place at Areteion Hospital, while the translation was conducted by the EORTC bureau. The final validation sample consisted of 120 cancer patients. The clinical variable assessed was the performance status. The aim of our study was to assess the applicability of this quality of life measurement on a Hellenic sample of cancer patients receiving palliative care. The results showed that the questionnaire was well accepted in the present patient population. In addition, the questionnaire was found to be useful in detecting the effectiveness of palliative treatment over time. The scale reliability was very good (pretreatment from 0.57-0.79, ontreatment from 0.56-0.75), especially for the functioning scale. In addition, very good validity was found in all the approaches used. Moreover, the factor analysis results in a 6-factor solution that satisfies the criteria of reproducibility, interpretability and confirmatory setting. Performance status showed an improvement (p < 0.0025) during the studied period. These results support that the QLQ-C30 (version 3.0) has proven to be a reliable and valid measure of the quality of life in Greek cancer patients receiving palliative care treatment.
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PMID:The EORTC core quality of life questionnaire (QLQ-C30, version 3.0) in terminally ill cancer patients under palliative care: validity and reliability in a Hellenic sample. 1166 88

Questionnaires on the quality of life and tolerance of different parts of maintenance treatment were sent to a total of 83 patients with multiple myeloma. All patients were for more than one year on maintenance treatment which involved either interferon alpha monotherapy (I), 3 million u. three times per week till signs of relapse developed or sequence administration of interferon alpha and dexamethazone 40 mg on day 1 to 4, 10 to 13 and 20 to 23 and then after a four-week interval again interferon alpha, again till progression of the disease occurred. The patients evaluated the presence or absence of different undesirable effects of treatment during the first two weeks of treatment and throughout the year and listed their intensity into four categories defined in the questionnaire. The quality of life was evaluated by means of a basic module of the questionnaire of the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire version 3.0 (EORTC QLQ-C30). The results of the questionnaire are to a certain extent surprising as from the patients' answers ensues that this maintenance treatment is associated with more numerous undesirable effects than the physicians realized when in contact with the patient. In this summary we can list only the most frequent effects (deterioration of eyesight, impaired sleep, depressions, irritability and unrest, chill, pain in muscles and joints, general weakness and dyspnoea). From the questionnaires on the quality of life ensues a markedly poorer quality of life of these patients as compared with the healthy population. There are however no basic differences between individual groups. The questionnaires were handed only to patients who had maintenance treatment for more than one year and thus patients were eliminated where maintenance treatment was discontinued because of undesirable effects. To give a general idea of the tolerance of the above maintenance treatment the authors mention that to the date of Aug. 31, 2001 113 patients were randomized into one of the branches of maintenance treatment. Maintenance treatment had to be discontinued in 6% patients (in two instances on account of severe hypothyroidism, in one case on account of hallucinations, in three instances on account of severe mental depression caused by this treatment). Reduction of interferon doses in 20% patients usually because of cytopenia but also on account of psychic problem. To the question what length of prolongation of life compensates the undesirable effects of maintenance treatment the following replies were obtained from patients receiving ID, possibly I: 3 months--47.6 and 38.3%, 6 months--4.3 and 10.6%, 9 months--0 and 4.3%, 12 months--47.6 and 46.8% of the addressed patients. In reply to the question whether the patients would prefer, assuming equal effectiveness, a maintenance monotherapy with interferon alpha or dexamethazone more patients preferred interferon to dexamethasone. For practice ensues from this article informing on undesirable effects of maintenance treatment and the effect of maintenance treatment on the quality of life: 1. the necessity of thorough knowledge of physicians of all possible undesirable effects as only a doctor knowing possible undesirable effects of treatment can recognize them, 2. regular monitoring not only of the activity of the basic disease, but also undesirable effects of maintenance treatment and the influence of treatment on the patients' quality of life, 3. the necessity to assess the quality of life in clinical trials as an important parameter for deciding on the way of treatment.
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PMID:[Quality of life and tolerance of maintenance therapy in patients with multiple myeloma]. 1196 83

This study evaluated the Korean version of the EORTC QLQ-C30 (version 3.0) in terms of psychometric properties and its validation. One hundred and seventy patients completed three questionnaires EORTC QLQ-C30, the Beck depression inventory (BDI), and a brief pain inventory (BPI). Multitrait scaling analyses demonstrated that all scales met multidimensional conceptualization criteria, in terms of convergence and discrimination validity. Cronbach's alpha coefficients for eight multiple-item scales were greater than 0.70, with the exception of cognitive functioning. All interscale correlations were statistically significant in the expected direction (p < 0.01). Multivariate analyses showed that physical and emotional functioning were significant explanatory variables for the global quality-of-life (QOL) scale (regression coefficients: 0.36, p < 0.001; and 0.37, p < 0.001; respectively). All scales were significantly associated with pain severity and interference of the BPI, and with the cognitive-affective and somatic scales of the BDI. The emotional-functioning scale was substantially correlated with the cognitive-affective scale and somatic scale of the BDI. These results demonstrate that the Korean version of the EORTC QLQ-C30 is a valid instrument for evaluating Korean-speaking patients with cancer, and can be used to distinguish clearly between subgroups of patients of differing performance status.
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PMID:Validation of the Korean version of the EORTC QLQ-C30. 1512 96

The growing interest in the mental health and quality of life of cancer patients, has been the major reason for conducting this study. The aims were to compare advanced cancer patients' responses to Hospital Anxiety and Depression (HAD) scale with those to European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30, version 3.0), as well as the impact of quality of life dimensions (as measured by EORTC QLQ-C30) on the levels of anxiety and depression. The analysis, conducted in 120 advanced cancer patients, showed that the most significant associations were found between emotional functioning and HAD-T (total sum of scores) (r=-0.747; p < 0.0005), HAD-A (anxiety) (r=-0.725; p < 0.0005) and HAD-D (depression) (r=-0.553; p < 0.0005). In the prediction of HAD-T, the contribution of physical, emotional, role, and social functioning along with nausea-vomiting, dyspnea, sleep disturbance and gender is high. For anxiety, the predictor variables were physical, role, cognitive, emotional, and social functioning, followed by dyspnea, sleep disturbance, and appetite loss, while depression was predicted by physical, role, emotional, and social functioning, the symptoms of nausea-vomiting, pain, sleep disturbance, constipation, as well as the variables of age, gender, anticancer treatment and performance status. Concluding, psychological morbidity, in this patient population, was predominantly predicted by the emotional functioning dimension of EORTC QLQ-C30.
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PMID:Assessment of anxiety and depression in advanced cancer patients and their relationship with quality of life. 1615 70

Breast cancer, the commonest malignancy in women, is now the most common cancer in Nigeria, but little is known about the quality of life (QOL) of Nigerian women breast cancer survivors and the predictive factors that may influence their QOL. Health-related QOL (HRQOL) was evaluated in 35 Nigerian women receiving radiotherapy for breast cancer at the University College Hospital, Ibadan by using the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ - C30 version 3). Linear regression procedures were used to evaluate the association of HRQOL outcomes with medical and socio-demographic factors. Physical functioning (PF), Emotional functioning (EF) and Cognitive functioning (CF) scores were above average (76.9 +/- 20.6, 61.9 +/- 30.3 and 60.0 +/- 32.1 respectively) while Role functioning (RF) and Social functioning (SF) scores were below average (46.2 +/- 36.6 and 40.9 +/- 42.8 respectively). High symptom scale scores were recorded for fatigue, pain and financial difficulties (52.7 +/- 32.8, 59.1 +/- 34.4 and 71.4 +/- 38.8 respectively). Age had no significant influence on any of the functional and symptom scale scores as well as the overall QOL. The overall QOL was significantly related to PF, CF and SF. It was also significantly and inversely related to the scores of fatigue, nausea and vomitng, pain, insomnia and financial difficulty. The findings of this study provide important information on QOL and their correlates among Nigerian women undergoing radiotherapy for breast cancer and are helpful in developing treatment strategies accordingly.
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PMID:Health related quality of life and its determinants in Nigerian breast cancer patients. 1839 66

To validate the Greek version of the Brief Fatigue Inventory (BFI-Gr) in a sample of cancer patients, the scale was translated with the "forward-backward" procedure to Greek. It was administered twice, at a three-day interval, to 102 eligible patients with cancer. Together with the BFI-Gr scale, the patients also completed the European Organization for Research and Treatment of Cancer QLQ-C30 (version 3.0) subscales of fatigue and emotional functioning, and the M. D. Anderson Symptom Inventory. The BFI-Gr had an overall Cronbach alpha for the nine items of 0.954. The assessment of the relationships between the BFI-Gr and the other measurements showed statistically significant correlations between all the assessed measurements (r values between 0.47 and 0.76, P<0.0005), except with the emotional subscale of the European Organization for Research and Treatment of Cancer scale. Factor analysis yielded a one-factor solution, explaining 73.6% of the variance. Interitem correlations were high and ranged from 0.567 to 0.882 (P<0.0005). The test-retest reliability of scale showed that the coefficient agreement was 0.901 (P<0.0005). Univariate analysis revealed significant correlations between hemoglobin and fatigue (r=-0.21, P=0.037), and between performance status (P<0.0005) and opioids (P=0.009). These results support that the BFI-Gr is an instrument with satisfactory psychometric properties, and is a valid research tool for cancer-related fatigue in Greek cancer patients.
J Pain Symptom Manage 2008 Oct
PMID:Psychometric properties of the brief fatigue inventory in Greek patients with advanced cancer. 1844 Jul 70

The aim of palliation in patients with inoperable esophageal cancer is to relieve dysphagia with minimal morbidity and mortality, and thus improve quality of life (QOL). The use of a self-expanding metal stent (SEMS) is a well-established modality for palliation of dysphagia in such patients. We assessed the QOL after palliative stenting in patients with inoperable esophageal cancer. Thirty-three patients with dysphagia due to inoperable esophageal cancer underwent SEMS insertion between October 2004 and December 2006. All patients had grade III/IV dysphagia and locally advanced unresectable cancer (n = 13), distant metastasis (n = 14), or comorbid conditions/poor general health status precluding a major surgical procedure (n = 6). Patients with grade I/II dysphagia and those with carcinoma of the cervical esophagus were excluded. The QOL was assessed using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 (version 3) and EORTC QLQ-Esophagus (OES) 18 questionnaire (a QOL scale specifically designed for esophageal diseases) before and at 1, 4, and 8 weeks after placement of the stent. The mean age of the patients was 56 (range 34-78) years, and 22 were men. A covered SEMS was used in all patients. The most common site of malignancy was the lower third of the esophagus (n = 18, 55%). In 23 (77%) patients, the stent crossed the gastroesophageal junction. Seven patients required a reintervention for stent block (n = 5) and stent migration (n = 2). Dysphagia improved significantly immediately after stenting, and this improvement persisted until 8 weeks (16.5 vs. 90.6; P < 0.01). The global health status (5.8 vs. 71.7; P < 0.01) and all functional scores improved significantly after stenting from baseline until 8 weeks. Except pain (14.1 vs. 17.7; P = 0.67), there was significant improvement in deglutition (22.7 vs. 2.0; P < 0.01), eating (48 vs. 12.6; P < 0.01), and other symptom scales (19.7 vs. 12.1; P = 0.04) following stenting. The median survival was 4 months (3-7 months). Palliative stenting using SEMS resulted in significant improvement in all scales of QOL without any mortality and acceptable morbidity.
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PMID:Palliative stenting for relief of dysphagia in patients with inoperable esophageal cancer: impact on quality of life. 1947 11

To measure the prevalence of non-pain physical symptoms and psychological symptoms in patients with cancer, to investigate the impact of physical and psychological symptoms on their quality of life (QoL), and to inquire whether treatment had been received for the complaints/symptoms, a representative sample of 1,429 cancer patients were recruited and classified according to tumor type and treatment status [i.e., (1a) curative treatment >6 months ago, (1b) curative treatment <or=6 months ago, (2) palliative antitumor treatment, and (3) treatment no longer feasible]. QoL and non-pain symptoms were measured by the European Organisation for Research and Treatment of Cancer (EORTC)-C30 version 3. We added two items: (1) Did you have a dry mouth? and (2) Did you feel listless? We also asked whether the patients had received treatment for their symptoms. Depression and anxiety were measured by the Dutch version of the Hospital Anxiety and Depression Scale. One-way analysis of variance (ANOVA) was used to detect differences in global QoL between patients with different types of cancer. When ANOVA was significant, post hoc tests (Tukey) were performed to identify significant differences among cancer types. Linear regression analyses (forced entrance procedure) were performed to investigate the influence of physical and psychological symptoms on global QoL. The prevalence of moderate-to-severe symptoms increased significantly with each disease group. Vomiting and irritability were the least prevalent symptoms, and fatigue and worries were the most prevalent symptoms in all groups. Patients in Group 1 (curative treatment) experienced symptoms that were independent of cancer type. Patients in Group 2 (palliative treatment) experienced symptoms that varied with cancer type. QoL decreased significantly each step from Group 1 through 3. Fatigue, appetite loss, constipation, dry mouth, depression, and anxiety had independent negative influences on QoL. Patients with gastrointestinal cancer, malignant lymphoma, and other hematological malignancies had significantly poorer QoL than patients with prostate cancer. In 45%-90% of patients, symptoms remained untreated. Non-pain physical symptoms and psychological symptoms are frequent in patients with cancer at all disease phases. Many symptoms remain untreated. Systematic recording of symptom intensity should be mandatory, irrespective of the phase of disease.
J Pain Symptom Manage 2009 Aug
PMID:Quality of life and non-pain symptoms in patients with cancer. 1956 94

Peripheral nerve injury causes a variety of alterations in pain-related gene expression in primary afferent, which underlie the neuronal plasticity in neuropathic pain. One of the characteristic alterations is a long-lasting downregulation of voltage-gated potassium (K(v)) channel, including K(v)4.3, in the dorsal root ganglion (DRG). The present study showed that nerve injury reduces the messenger RNA (mRNA) expression level of K(v)4.3 gene, which contains a conserved neuron-restrictive silencer element (NRSE), a binding site for neuron-restrictive silencer factor (NRSF). Moreover, we found that injury causes an increase in direct NRSF binding to K(v)4.3-NRSE in the DRG, using chromatin immunoprecipitation (ChIP) assay. ChIP assay further revealed that acetylation of histone H4, but not H3, at K(v)4.3-NRSE is markedly reduced at day 7 post-injury. Finally, the injury-induced K(v)4.3 downregulation was significantly blocked by antisense-knockdown of NRSF. Taken together, these data suggest that nerve injury causes an epigenetic silencing of K(v)4.3 gene mediated through transcriptional suppressor NRSF in the DRG.
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PMID:Neuron-restrictive silencer factor causes epigenetic silencing of Kv4.3 gene after peripheral nerve injury. 2000 71

Peripheral nerve injury causes neuropathic pain, which is characterized by the paradoxical sensations of positive and negative symptoms. Clinically, negative signs are frequently observed; however, their underlying molecular mechanisms are largely unknown. Dysfunction of C-fibers is assumed to underlie negative symptoms and is accompanied by long-lasting downregulation of Na(v)1.8 sodium channel and mu-opioid receptor (MOP) in the dorsal root ganglion (DRG). In the present study, we found that nerve injury upregulates neuron-restrictive silencer factor (NRSF) expression in the DRG neurons mediated through epigenetic mechanisms. In addition, chromatin immunoprecipitation analysis revealed that nerve injury promotes NRSF binding to the neuron-restrictive silencer element within MOP and Na(v)1.8 genes, thereby causing epigenetic silencing. Furthermore, NRSF knockdown significantly blocked nerve injury-induced downregulations of MOP and Na(v)1.8 gene expressions, C-fiber hypoesthesia, and the losses of peripheral morphine analgesia and Na(v)1.8-selective blocker-induced hypoesthesia. Together, these data suggest that NRSF causes pathological and pharmacological dysfunction of C-fibers, which underlies the negative symptoms in neuropathic pain.
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PMID:Epigenetic gene silencing underlies C-fiber dysfunctions in neuropathic pain. 2035 31


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