Karen Lien

University of Toronto, Toronto, Ontario, Canada

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Publications (4)7.88 Total impact

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    ABSTRACT: Well-being falls within a broad category of quality of life indicators and encompasses both physical and emotional factors. Identification of the most important factors affecting overall well-being may allow health care practitioners to target these symptoms and improve patients' quality of life. The purpose of this study was to determine factors most predictive of well-being in advanced cancer patients. Patients referred to the Rapid Response Radiotherapy Program completed the Edmonton Symptom Assessment System (ESAS) at consultation. ESAS scores and demographics were analysed for their predictive ability for well-being via regression analysis of the raw and categorical scores. In total, 1439 ESAS assessments were analysed; the median age was 69 years (range 21-95). The most common primary cancers were of the lung (36%), breast (21%) and prostate (18%). Greater distress in all ESAS items, lower Karnofsky performance status (KPS) and referral for bone metastases significantly predicted for worse well-being (all P < 0.0001). However, referral for brain metastases predicted for better well-being. In multivariate analysis, the most predictive factors for worse well-being were lower KPS (P = 0.003) and greater distress in drowsiness (P = 0.01), pain (P < 0.0001), fatigue (P < 0.0001), depression (P < 0.0001) and appetite loss (P < 0.0001). Repeated analyses with categorical scores led to similar results. Greater distress in physical and emotional symptoms assessed by ESAS contributes significantly to poorer well-being. Management for patients with advanced cancer should be directed towards these symptoms, as they form the basis for well-being. Although emotional symptoms may be scored lower than physical symptoms by patients, both significantly affect well-being.
    Clinical Oncology 08/2012; 24(6):443-51. · 2.86 Impact Factor
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    ABSTRACT: Brain metastases occur in approximately 20-40% of cancer patients during the course of disease. As treatment for brain metastases is palliative over curative, quality of life (QoL) is emphasized over prolonged survival. The European Organization for Research and Treatment of Cancer (EORTC) QLQ-BN20 is a QoL assessment specific to brain neoplasms. We aim to provide a review of the current use of the EORTC QLQ-BN20 for patients with brain metastases. All studies utilizing the QLQ-BN20 for QoL assessment in patients receiving treatments related to brain metastases were included. Study information including treatment type, assessment periods, patient enrolment and all information pertaining to the QLQ-BN20 were extracted. A total of 13 studies were identified, five of which were randomized trials assessing prophylactic whole brain radiation for patients with small-cell lung cancer. The QLQ-BN20 was used in conjunction with the core QLQ-C30 questionnaire in all but one of the studies and together these comprised the entire QoL assessments for 11 of the 13 studies. Neurocognitive function assessments supplemented QoL in four studies and accompanying performance status indices used with the QLQ-BN20 varied. Compliance issues were commonly cited. QoL changes during study periods varied as improvements, deteriorations and stabilizations were all observed. QoL assessments should be conducted using disease-specific tools. Future studies should minimize patient burden in order to maximize data collection and accrual. A common set of QoL end points for patients with brain metastases should be created.
    Expert Review of Pharmacoeconomics & Outcomes Research 12/2011; 11(6):693-700. · 1.67 Impact Factor
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    ABSTRACT: Brain metastases are a significant cause of morbidity and mortality for patients with advanced cancers, and quality-of-life (QoL) end points are most appropriate for this population. The Functional Assessment of Cancer Therapy (FACT) questionnaires are commonly used to assess cancer-related QoL issues. The FACT-Brain (FACT-Br) provides an additional set of disease-specific questions pertaining to brain neoplasms. We aim to provide a comprehensive review to examine the use of the FACT-Br as a QoL assessment for patients with brain metastases. A review of the literature was conducted and all studies utilizing the FACT-Br for QoL assessment of patients with brain metastases were included. Study information and relevant information regarding the FACT-Br were extracted. A total of 14 studies were identified representing various treatment options (radiation, chemotherapy and surgery) for patients with brain metastases. All studies utilized at least part of the FACT-Br as the main QoL assessment. In addition, neurocognitive and performance status assessments were performed in nine and 12 out of 14 studies, respectively. Issues of poor accrual, compliance and attrition were common and posed problems in reaching statistically significant changes in QoL despite changes in raw QoL scores. Studies involving patients with brain metastases should continue to utilize QoL tools such as the FACT-Br; however, this tool still requires validation for use in this patient population. Additional studies should observe the relationship between neurocognitive function and QoL, and attempt to minimize poor accrual and compliance issues through modifications of trial design and reduction of patient burden.
    Expert Review of Pharmacoeconomics & Outcomes Research 12/2011; 11(6):701-8. · 1.67 Impact Factor
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    ABSTRACT: Shorter quality-of-life (QoL) assessments are beneficial for palliative patients as they reduce burden associated with completing personal, and at times stressful, questionnaires. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative (QLQ-C15-PAL) and the Functional Assessment of Chronic Illness Therapy - Palliative Care (FACIT-Pal) are two palliative QoL tools that have been validated for use in this population. The purpose of this article was to conduct a review of studies utilizing these two palliative-specific QoL instruments, their development and their relative strengths for use in advanced cancer patients. Studies detailing the development process for the QLQ-C15-PAL and the FACIT-Pal were identified. A comparison between both questionnaires in terms of development, characteristics, validation and use was conducted. The QLQ-C15-PAL was developed via structured shortening of the longer core instrument, the Quality of Life Questionnaire Core 30 (QLQ-C30), whereas the FACIT-Pal includes the Functional Assessment of Cancer Therapy - General tool plus a new 19-item palliative scale created through interviews with patients and healthcare professionals. Although significant overlap exists between both tools, there is a marked difference in the aspects of QoL assessed. Scoring, organization and item format are different; however, response options and recall period are the same. Both tools cover the core items relevant to patients with advanced cancers and can be supplemented with disease-specific tools. Both QLQ-C15-PAL and FACIT-Pal allow for assessment of QoL issues specific to patients with advanced diseases. Each instrument has unique strengths and weaknesses and choice between these tools is dependent on the investigator and study needs. Future studies should directly compare these two tools and validate their use through a number of administration modes.
    Expert Review of Pharmacoeconomics & Outcomes Research 10/2011; 11(5):541-7. · 1.67 Impact Factor