Evaluation of Quality of Life in Patients Receiving Treatment for Advanced Breast Cancer

249

176

Eighty-one patients with advanced breast cancer completed the Hospital Anxiety and Depression Scale (HADS) and Rotterdam Symptom Checklist (RSCL) to determine how well these questionnaires identified patients suffering from an anxiety state or depressive illness, compared with an independent interview by a psychiatrist who used the Clinical Interview Schedule. A threshold score was defined for each questionnaire which gave the optimal sensitivity and specificity. Seventy-five per cent of patients were correctly identified as suffering from an affective disorder by both the Rotterdam Symptom Checklist and by the Hospital Anxiety and Depression Scale. Twenty-one per cent of 'normal' patients were misclassified by the Rotterdam Checklist and 26% by the Hospital Anxiety and Depression Scale. When the HADs anxiety and depression subscales were analysed separately, the performance of the anxiety items was superior to that of the depression items. Both questionnaires were found to have good predictive value and could be used in patients with advanced cancer to help screen out those with an affective disorder.

Section: Discussionmentioning

confidence: 99%

Screening for psychiatric morbidity in patients with advanced breast cancer: validation of two self-report questionnaires

Hopwood

Howell²,

Maguire³

1991

249

176

“…4 LASA indicators were incorporated in the IBCSG QL form: physical well-being (PWB) (Priestman and Baum, 1976), mood (Priestman and Baum, 1976;Hürny et al, 1996a) and effort to cope (PACIS) (Hürny et al, 1993) were designed as global indicators, appetite as a more specific indicator for cytotoxic side-effects (Bernhard et al, 1997). All indicators were scored by measuring in millimetres from 0 to 100 and were reversed, with higher numbers reflecting better QL (e.g., less effort to cope).…”

Section: Indicator and Standard Measuresmentioning

confidence: 99%

“…The Australian New Zealand Breast Cancer Trials Group (ANZBCTG) and the International Breast Cancer Study Group (IBCSG) use a limited set of patient-rated indicators for assessing the impact of chemo-and endocrine therapy on QL in breast cancer clinical trials. These are single-item measures in the linear analogue self-assessment (LASA) format (Priestman and Baum, 1976), also known in social sciences as visual analogue scales (VAS).…”

mentioning

confidence: 99%

Clinical relevance of single item quality of life indicators in cancer clinical trials

Bernhard

Sullivan

Hürny³

et al. 2001

SummaryWe investigated the hypothesis that global single-item quality-of-life indicators are less precise for specific treatment effects (discriminant validity) than multi-item scales but similarly efficient for overall treatment comparisons and changes over time (responsiveness) because they reflect the summation of the individual meaning and importance of various factors. Linear analogue self-assessment (LASA) indicators for physical well-being, mood and coping were compared with the Hospital Anxiety and Depression Scale (HAD), the Mood Adjective Check List (MACL) and the emotional behaviour and social interaction scales of the Sickness Impact Profile (SIP) in 84 patients with early breast cancer receiving adjuvant therapy. Discriminant validity was investigated by multitrait-multimethod correlation, responsiveness by standardized response mean (SRM). Discriminant validity of the indicators was present at baseline but less under treatment. Responsiveness was demonstrated by the expected pattern among treatments (P = 0.008). In patients without chemotherapy, the SRMs indicated moderate (0.5-0.8) to large (>0.8) improvements in physical well-being (0.70), coping (0.92), HAD anxiety (0.89) and depression (1.19), and MACL mental well-being (0.68). In patients with chemotherapy for the first 3 months, small but clinically significant improvements (>).2) included mood (0.38), coping (0.41), HAD axiety (0.31) and MACL mental well-being (0.35). Patients with 6 months chemotherapy showed no changes. The indicators also reflected mood disorders (HAD) and marked psychosocial dysfunction (SIP) at baseline and under treatment according to pre-defined cut-off levels. Global indicators were confirmed to be efficient for evaluating treatments overall and changes over time. The lower reliability of single as opposed to multi-item scales affects primarily their discriminant validity. This is less decisive in large sample sizes. PATIENTS AND METHODS SampleThis study included a consecutive sample of patients with operable breast cancer from Sahlgrenska University Hospital in Göteborg which were randomized into one of the following IBCSG adjuvant therapy trials: Trial VI, for pre-and peri-menopausal, nodepositive (N+) patients; Trial VII, for postmenopausal N+ patients; Trial VIII, for pre-and peri-menopausal, node-negative (N-) patients; Trial IX, for postmenopausal N-patients. In these trials, varying schedules of chemotherapy, endocrine therapy and their combinations were studied. The chemotherapy consisted of CMF (cyclophosphamide, methotrexate and 5-fluorouricil); the endocrine therapy was Tamoxifen or LH-RH (luteinizing hormone-releasing hormone) analogue. In patients with conservative surgery (quadrantectomy or lumpectomy) radiotherapy was started 2 weeks after the last chemotherapy course, or within 3 months in case of endocrine therapy alone. The randomization in Trials VI and VII was stratified by institution, type of surgery and oestrogen receptor (ER) status. The randomization in Trials VIII and IX was stratified by i...

“…The use of the LASA scales of Priestman and Baum (1976), the GLQ-8 scales of Coates et al (1983) and the QL index of Spitzer et al (1981) showed no differences from the results of the EORTC scales. Physical well-being (LASA) was rated high at baseline (median 1 cm on a 10 cm scale) with nonsignificant deterioration over time (median 2.2 cm at 8 months) with no difference between immediate-and delayed-treatment groups (data not shown).…”

Section: Quality Of Lifementioning

confidence: 79%

“…Additional instruments used in Australasia included the linear analogue self-assessment (LASA) scales of Priestman and Baum (1976), the GLQ-8 scales of Coates et al (1983) and the QL index of Spitzer et al (1981).…”

Section: Evaluations Of Patientsmentioning

confidence: 99%

A meta-analysis of two randomised trials of early chemotherapy in asymptomatic metastatic colorectal cancer

Jones

et al. 2005

This report constitutes a prospectively planned meta-analysis combining two almost identical trials undertaken in Australasia and Canada to study the effect of starting chemotherapy immediately in asymptomatic patients with metastatic colorectal cancer. Patients (n ¼ 168) were randomised to receive either immediate or delayed treatment (at onset of predefined symptoms). Australasian patients received either weekly 5-fluorouracil and leucovorin (500 and 20 mg m À2 , respectively) (n ¼ 59) or the daily Â 5 Mayo Clinic schedule (425 and 20 mg m À2 , respectively) (n ¼ 42). Canadian patients were treated with the Mayo schedule (n ¼ 67). Otherwise, the two studies were almost identical in design and each used the European Organisation for the Research and Treatment of Cancer (EORTC) QLQ-C30 instrument for measuring quality of life (QoL). Treatment was continued until 6 months had elapsed or disease progression occurred. Low accrual led to trial suspension before the predetermined sample size for either study was reached. Median survival was not significantly better with immediate treatment (median 13.0 vs 11.0 months; hazard ratio, 1.15; 95% confidence interval (CI) 0.79 -1.72; P ¼ 0.49). There was no statistically significant difference in progression-free survival (time from randomisation until first evidence of progression after chemotherapy, 10.2 vs 10.8 months; hazard ratio, 1.08; 95% CI 0.71 -1.64; P ¼ 0.73). There was no difference in overall QoL or its individual domains between the two treatment strategies at baseline or at any subsequent time point. Early treatment of asymptomatic patients with metastatic colorectal cancer did not provide a survival benefit or improved QoL compared to withholding treatment until symptoms occurred.