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Quality of life and its health-relations

Quality of life and its health-relations. Definitions. Definitions. Subjective. Multi-dimensional. Dynamic. Physical Functioning. Social Functioning. Emotional Functioning. Outcome Assessment. Disease level (lab data) (clinical data). Patient level (lab data) (clinical data).

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Quality of life and its health-relations

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  1. Quality of life and its health-relations

  2. Definitions

  3. Definitions Subjective Multi-dimensional Dynamic Physical Functioning Social Functioning Emotional Functioning

  4. Outcome Assessment Disease level (lab data) (clinical data) Patient level (lab data) (clinical data)

  5. Why assess health-related quality of life in cancer patients • Consumerism and outcome research drive • Helps design new approaches/monitor effectiveness • Improve clinicians’ knowledge of patients’ subjective experience • Health economic evaluation • Reliable HRQOL outcome can help give a comprehensive picture of the treatment outcome supporting decision-making policy

  6. Who can best assess QOL • Doctor and nurses consistently underestimate patients’ levels of QOL • Patients are the best judge of their subjective well-being BUT • Difficult scientific methodology • Requires good doctor-patient communication • Requires collaboration with other experts • Resource intensive (assistants, nurses)

  7. How should we assess QOL • EORTC QLQ-C30 Questionnaire • FACT-G – Functional Assessment of Cancer Therapy • FLIC – Functional Living Index for Cancer • Rotterdam Symptom Checklist

  8. EORTC-QLQ C30

  9. Minimum important difference (MID) • The smallest difference in score in the outcome of interest • Which patients perceive as beneficial • And which would mandate, in the absence of troublesome side effects and excessive cost, a change in the patient’s management

  10. MID • 10 point difference on a 0-100 scale, EORTC’s QLQ suite, widely used as threshold for clinically important different

  11. MID

  12. Measuring Quality of Life in Routine Oncology Practice Improves Communication and Patient Well-Being • Velikova et al. J Clin Oncol 2004; 22: 714-724. The intervention QOL evaluated by EORTC QLQ-C30 before seeing the doctor QOL graphs attached to medical notes; Physicians review QOL results After each intervention the physicians filled visit-specific checklist Patients imopression on communucation was recorded

  13. Discussion • Regular QOL measurements has positive impact on: • Physician-patient communication • Patient well-being • Symptom control and emotional well-being • Improvement in patient well-being was associated with explicit use of QOL information during consultations

  14. Opinions • Participating patient: • I felt that people were still interested in me. People were still wanting to know. I wasn’t written off altogether. • Participating physician: • I actually think that’s the most powerful thing.

  15. Baseline quality of life as prognostic indicator of survival: a meta-analysis of individual patient data from EORTC clinical trials. • Quinten C et al. Lancet Oncology, 2009; 10: 865-71. Trial Data: 30 EORTC Trials 11 cancer sites 10.108 patients Pre-intervanetion QOL measures

  16. Results

  17. Conclusion • QOL parameters: pain, physical functioning, appetite loss provide prognostic information beyond clinical measures. • This effect holds across the different diseases sites and therefore taking into account QOL parameters can improve survival prediction of cancer patients

  18. Genetics and QOL • The heritability of self-reported health • 4.638 male-male twins • Regression model • Genetic variables accounted for 33% of the variability in self-reported health

  19. QOLenomics? • The study of how inherited genetic variations affect aspects of patient quality of life as well as the use of that knowledge in treatment discovery and development • Could genetic variation explain why one person experiences profound deficits in QOL while another person reports no QOL deficits from the same disease?

  20. Preliminary Evidence of Relationship Between Genetic Markers and Oncology Patient QOL Prior to Treatment • JA Sloan et al. Mayo Clinic Camprehensive Cancer Center • Background • Genetic predispositions exist for depression, suicide, alcoholism, smoking and other psychological variables • 5-HT receptor • APOE epsilon 4 allele • Androgen-regulator genes

  21. Study plan • 22 candidate genes variants in 11 genes ebaluated • 494 patients with both genetic samples and QOL data at baseline

  22. Results • DPYD*5 was significantly associated with patient-reported fatigue (p=0.008) • The homozygous variant was associated with lower fatigue scores (worse QOL)

  23. DPYD • DPYD gene: • Involved in pyrimidine base degradation • Catalyzes the reduction of uracil and thymine • Only endogenous source of neurotransmitter B-alanine • DPYD*5/*6 polymorphism: • Could be in linkage disequilibrium with another genetic variant that directly affects cellular metabolism, and thus QOL.

  24. Implications • Identify cancer patients with genetic predisposition for deficits in QOL • Effective pharmacologic and psychosocial interventions exist for QOL • Genetically-targeted, individualized treatments for QOL might be possible

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