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  • 1
    ISSN: 1573-2649
    Keywords: Cancer ; CARES ; quality of life
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In spite of the prevalence of neoplastic disorders as a cause of chronic illness, very few of the currently available generic measures of health-related quality of life or health status have been utilized with cancer patients. In this paper we reviewed our studies with the Cancer Rehabilitation Evaluation System (CARES), a cancer-specific measure of rehabilitation needs and quality of life. We present data to demonstrate that the CARES is a generic measure of health-related quality of life, suitable for use in the many different diseases called cancer. The data that form the basis for this paper were collected during a decade of research on the CARES. This paper represents the first discussion of the performance of the CARES across separate cancer sites and phases of the disease. In addition, we demonstrated that the CARES is responsive to changes in health-related quality of life over time. Finally, we will discuss the application of the CARES in clinical and research settings.
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  • 2
    ISSN: 1573-2649
    Keywords: Aortocoronary bypass ; depression ; health promotion ; leisure activities ; quality of life ; rehabilitation ; sexual behaviour
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The effect of a three-phase comprehensive rehabilitation programme on the quality of life during the first postoperative year after coronary artery bypass surgery was studied in 205 male patients randomly allocated into a rehabilitation (R) and a hospital-based treatment (H) group. The rehabilitation programme included physical exercise, relaxation training, psychological group sessions, dietary advice and discussions about postoperative treatment of coronary disease. There was no difference between R and H groups in the frequency of postoperative complaints, number of hospital admissions and satisfaction of sexual life. An almost significantly greater number of subjects in R group than in H group perceived their health as good 12 months after surgery. The Beck Depression Index score decreased significantly in R group but not in H group during follow-up. A greater increase in hobby activities was observed in R group than in H group. More subjects in R group than in H group considered rehabilitation important for recovery, whereas more patients in H group considered support by the spouse and family, the subjective mental strength and a secure income as important.
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  • 3
    ISSN: 1573-2649
    Keywords: Anxiety ; CABG ; clinical outcome ; depression ; quality of life
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In order to evaluate clinical and psychosocial results of isolated coronary artery by-pass graft (CABG) we studied 626 consecutive patients, mean age 61±8 years (86% men), in a follow-up (median: 58 months) with a complete questionnaire about cardiosurgical problems (post-operative vital status, angine relapse, infarction, heart failure, PTCA, redo, PM) and psychosocial variables (mood, irritableness, job satisfaction, hobby satisfaction, family relations, sexual activity, general well-being and work status). Global evaluation improvement of psychosocial variables was found in 71% of patients without cardiac events (group A) and 11% of patients with cardiac events (group B); worsening was found in 2% of group A and 1% of group B; no referred variations in 13% and 2% respectively (p≤0.05. Interests (in work, hobbies and sexual activities) demonstrate an improvement in 20% (group A) and 2% (group B); worsening in 12% (group A) and 4% (group B); no variations in 51% (group A) and 11% (group B) (p≤0.005). Patients reported a well-being evaluation improvement about 66% in the group returning to work without restriction, 13% in those with limitation, 6% no further working; worse or unchanged well-being evaluation was found in 9% of patients returning to work without restriction, 3% with limitation, 3% no further working (p≤0.001). In the last 2 years we have collected pre-operative and post-operative data in a sample of 58 patients by using standardized self-evaluated rating scales about state and trait anxiety (STAI X1, STAI X2), depression (ZUNG) and quality of life, examining social relationships, interests and affective disturbances. Trait anxiety had no change (T0=38.69±9.20 vs. T1=38.75±9.90; n.s.); state anxiety improved (T0=41.20±9.30 vs. T1=38.34±9.68;p≤0.018); depression had significantly worsened (T0=37.90±7.59 vs. T1=46.65±4.75;p≤0.0005). No statistical differences emerged between pre-operative and post-operative self-evaluation of the quality of life. Cardiac events were reported in 7 out of 58 patients (group B: 12%); these patients were characterized by significantly higher levels of state anxiety than group A patients at the pre-operative evaluation (group A: 39.9±8.2; group B: 49.6±11.8;t=0.933; df=56;p≤0.005) and at the post-operative evaluations (group A: 36.7±8.4; group B: 48.7±11.4;t=−3.6; df=56;p≤0.001). The trait anxiety was significantly lower at the postoperative control in the group A patients than in the group B (group A: 37.5±9.3; group B: 46.9±10.5;t=−2.602; df=56;p≤0.012). The pre-operative depression of group B was higher than group A (group A: 37.1±7.6; group B: 43.1±5.5;t=−2.155; df=56;p≤0.035). The discordance between the improvement of subjective global evaluation versus the worsening of depression (ZUNG Scale) can be related to the importance of physical improvement as much as to some psychosocial variables. Further hypotheses can be represented by the influence of a short pre-operative period in our institution (maximum 30 days) on anxiety and depression levels, the difference between pre-surgical and post-surgical expectations, the removal of pre-operative psychological state; the stress related to psychosocial reintegration etc. In our opinion, taking into consideration the results of the sample of 58 patients, a high level of pre-operative state anxiety and depression and a post-operative higher status of anxiety could be considered as a possible predictor of functional cardiac complications.
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  • 4
    ISSN: 1573-2649
    Keywords: Canada ; clinical trials ; quality of life
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The Quality of Life Committee of the National Cancer Institute of Canada Clinical Trials Group has successfully advocated the adoption of quality of life outcomes in Canadian clinical trials in patients with cancer. It has developed a policy promoting quality of life assessment in phase III trials and developed writing guidelines to assist clinical investigators when developing protocols for proposed studies. As a result, all phase III clinical trials instituted since the policy was developed have quality of life assessment as a part of their objectives. It has assisted the Clinical Trials Group office personnel in the development of procedures for the conduct of quality of life assessments in clinical trials with the result that the completion rate of self-report questionnaires is very high. The Committee maintains contact with other clinical trials groups and organizations having an interest in measuring quality of life in cancer.
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  • 5
    ISSN: 1573-2649
    Keywords: Longitudinal analysis ; missing data ; quality of life
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The statistical analysis of longitudinal quality of life data in the presence of missing data is discussed. In cancer trials missing data are generated due to the fact that patients die, drop out, or are censored. These missing data are problematic in the monitoring of the quality of life during the trial. However, by means of assuming that the cause of the missing data lies in the observed history of the patients and not in their unobserved future, the missing data are ignorable. Consequently, all available data can be used to estimate quality of life change patterns with time. The computations that are required are illustrated with real quality of life data and three commonly used computer packages for statistical analysis.
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  • 6
    ISSN: 1573-2649
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 7
    ISSN: 1573-2649
    Keywords: Functional status ; social support ; stressful life events ; well-being
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract There is substantial evidence of individual variation in health-related quality of life measures that is not accounted for by age or disease condition. An understanding of factors that determine good health is necessary for maintained function and improved quality of life. This study examines the extent to which social support and stressful life events were more or less beneficial for the long-term physical functioning and emotional well-being of 1402 chronically ill patients. Analyses, conducted separately in three age groups, showed that social support was beneficial for health over time regardless of age. In addition, low levels of support were particularly damaging for the physical functioning of older patients. Stressful life events impacted differentially on health-related quality of life: relationship events had an immediate effect on well-being which diminished with time; financial events had an immediate negative effect on functioning and well-being which persisted over time for middle-aged patients; bereavement had a delayed impact on quality of life, with the youngest patients especially vulnerable to its negative effects; work-related events had both negative and positive effects, depending on age group. Results reinforce the importance of identifying and dealing with psychosocial problems among patients with chronic disease.
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  • 8
    ISSN: 1573-2649
    Keywords: Functional assessment ; health status
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study was designed to test the short-term effects of health assessment on the process of care and patient satisfaction. The 29 Chart physicians used the Dartmouth COOP Charts to measure their adult patients' health status during a single clinical encounter; the 27 control clinicians used no measure of health status. We compared the change between baseline and post-intervention information for a sample of all study clinicians' patients. Most of the patients were female (67%), well educated (70% had at least a college education) and young (approximately 90% were aged 59 years or younger). We found that the ordering of tests and procedures for women was increased by exposure to the COOP Charts (52% vs. 35%; p〈0.01); the effect in men was not as significant (37% vs. 23%: p=0.06). Although women reported no change in satisfaction with care, men claimed that the clinician helped in the management of pain (p=0.02). We conclude that the use of health status measures during a single clinical encounter in an HMO changes clinician test ordering behaviour and may improve the help male patients receive for pain conditions. The long-term impact of these management changes is not known.
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Quality of life research 1 (1992), S. 278-278 
    ISSN: 1573-2649
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1573-2649
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The effect of increased nurse support on patients below 70 years of age attending an out-patient clinic following acute myocardial infarction was evaluated. Patients who saw a nurse 14 days after discharge (n=56) were compared to a control group (n=47) who, following the ordinary routines, were first seen 8 weeks after discharge. Increased nurse support had positive effects on psychosocial variables such as depressive feelings, expected quality of life in the future, and satisfaction with contact with the staff. However, no effects were found on any of the cardiac variables. Patients in the intervention group showed a decrease in depressive feelings during the 8 weeks follow-up period, whereas there was an increase for the control group. The patients in the intervention group also tended to have a better belief in the future compared to the control group. Patients in the intervention group were more satisfied with the staff contact than were the control group.
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