Determinants Affecting Quality of Life: Implications for Pharmacist Counseling for Patients with Breast Cancer in Japan
Department of Practical Pharmacy, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Horinouchi, Hachioji, Tokyo, Japan.Biological & Pharmaceutical Bulletin (Impact Factor: 1.83). 01/2012; 35(1):59-64. DOI: 10.1248/bpb.35.59
Although pharmacist counseling assumes an important role in the clinical setting, oncology pharmacy practitioners worldwide currently lack adequate guidance. This study aimed to identify the determinants and causal relationships that affect quality of life (QOL) in breast cancer patients before adjuvant systemic therapy for improving pharmacist counseling and guidance. This study analyzed 93 postoperative patients with breast cancer before pharmacist counseling for adjuvant systemic therapy. Patients were asked to complete questionnaires to assess QOL (the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 [EORTC QLQ-C30] and its breast cancer module [EORTC QLQ-BR23]) before pharmacist counseling. We analyzed factors affecting QOL by stepwise multiple linear regression analysis and evaluated causal association using path analysis. In the multiple linear regression model using variables selected by stepwise analysis, the factors affecting global health status (GHS)/QOL included fatigue, emotional functioning, systemic therapy side effects, future perspectives, and appetite loss. In the path analysis model, GHS/QOL were strongly influenced by fatigue directly; and emotional functioning, directly and indirectly via other factors. Our results indicated that fatigue and emotional functioning are strong factors affecting QOL. These factors may be able to predict poor QOL before initiating adjuvant systemic therapy. Thus, our findings suggest that these factors may be potentially useful for pharmacist counseling at the beginning of adjuvant systemic therapy.
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ABSTRACT: Purposes: The purposes of this study are to evaluate the impact of cancer-related fatigue (CRF) on quality of life (QoL), and to identify its clinical predictors. In addition, the authors investigated the prognostic impact of CRF and its relationship with the inflammatory marker C-reactive protein. Method: Data regarding patient characteristics, symptom scores, and QoL indices were collected at the initial evaluation. At the same time, blood samples were collected in order to evaluate some laboratorial markers. Patients were followed by telephone interviews every 15 days until death. CRF was defined as ≥66.67 points on EORTC QLQ-C30 fatigue subscale. Results: The examined patients had a median age of 61 years (range, 21-86 years) and 50.7 % were male. Median Karnofsky performance score (KPS) was 75.5 (SD, 15.1). The prevalence of CRF was 25 % (55 out of 221). Overall, patients with CRF presented higher symptom burden and also worst QoL scores. The following variables were independently associated with CRF: nausea (OR 1.22, p = 0.009), dyspnea (OR 1.33, p = 0.002), KPS (OR 0.96, p = 0.009), body mass index (OR 0.93, p = 0.046), and C-reactive protein (OR 1.08, p = 0.004). The median overall survival (OS) was lower in CRF patients (p < 0.0001). Only KPS (HR = 0.96, p < 0.001) and C-reactive protein (HR = 1.07, p < 0.001) were independent prognostic factors for OS. Conclusions: Advanced cancer patients (ACP) with CRF had a higher burden of symptoms and impaired QoL. Our findings support the hypothesis that chronic inflammatory state (CIS) could play a role in the pathogenesis of fatigue in ACP. Moreover, CIS seems to have greater prognostic impact than the associated fatigue.
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ABSTRACT: Objective: This study examined which domains/symptoms from the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 15 Palliative (QLQ-C15-PAL), an abbreviated version of the health-related EORTC QLQ-C30 questionnaire designed for palliative cancer patients, were predictive of overall quality of life (QOL) in advanced cancer patients. Methods: Patients with advanced cancer from six countries completed the QLQ-C15-PAL at consultation and at one follow-up point. Univariate and multivariate regression analyses were conducted to determine the predictive value of the EORTC QLQ-C15-PAL functional/symptom scores for global QOL (question 15). Results: Three hundred forty-nine patients completed the EORTC QLQ-C15-PAL at baseline. In the total patient sample, worse emotional functioning, pain, and appetite loss were the most significant predictive factors for worse QOL. In the subgroup of patients with bone metastases (n = 240), the domains mentioned above were also the most significant predictors, whereas in patients with brain metastases (n = 109), worse physical and emotional functioning most significantly predicted worse QOL. One-month follow-up in 267 patients revealed that the significant predictors changed somewhat over time. For example, in the total patient sample, physical functioning, fatigue, and appetite loss were significant predictors at the follow-up point. A sub-analysis of predictive factors affecting QOL by primary cancer (lung, breast, and prostate) was also conducted for the total patient sample. Conclusion: Deterioration of certain EORTC QLQ-C15-PAL functional/symptom scores significantly contributes to worse overall QOL. Special attention should be directed to managing factors most influential on overall QOL to ensure optimal management of advanced cancer patients.
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ABSTRACT: Objective: To identify which domains/symptoms from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were predictive of overall quality of life (QoL) in advanced cancer patients. Methods: Four hundred and forty seven patients with brain metastases or bone metastases from seven countries were enrolled with regression analysis to determine the predictive value of the QLQ-C30 functional/symptom scores for patient reported overall QoL (question 30), overall health (question 29) and the global health status domain (questions 29 and 30). Results: Worse role functioning, social functioning, fatigue and financial problems were the most significant predictive factors for worse QoL. In the bone metastases subgroup (n = 400), role functioning, fatigue and financial problems were the most significant predictors. In patients with brain metastases (n = 47), none of the EORTC domains significantly predicted worse QOL. Conclusion: Deterioration of certain QLQ-C30 functional/symptom scores significantly contributes to worse QoL, overall health and global health status.
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