Quality of life of inguinal hernia patients in Taiwan: The application of the hernia-specific quality of life assessment instrument.

With the development of prosthetic mesh and tension free techniques, the recurrence rate following inguinal hernia repair has been reduced, and hernia outcomes research should focus on post-operative quality of life and potential complications.A novel hernia quality of life assessment instrument, HERQL, was developed. The HERQL questionnaire comprises a 4-item summative pain score measuring pain and discomfort resulting from various strenuous activities. Symptomatic and functional domains, as well as post-operative satisfaction are evaluated as well.A total of 386 HERQL surveys were completed by 183 patients with inguinal hernias. Internal consistency reliability of the summative pain score was satisfactory, with a Cronbach's alpha of 0.85. Criterion validity was examined by concomitant assessment of the pain/discomfort and health impact subscales of the EQ-5D questionnaire, with substantial to moderate correlations. Pre-operative patients reported more severe hernia protrusion, more pain during mild to heavy exercise, and worse activity restriction and health impairment than the follow-up patients, indicating clinical validity. The conceptual structure of the HERQL demostrated the causal relationship between the formative symptomatic subscales and the reflective functional status indicators. Repeated measurement of the summative pain scores revealed an estimated time effect of -1.63, which was the rate of change in the summative pain score across the pre-operative, immediately post-operative, and follow-up 3-month periods suggesting the clinical responsiveness of the HERQL.This study will facilitate inguinal hernia outcomes research and enhance the quality of care for this common disease by providing a validated HERQL instrument with enhanced sensitivity

Quality of Life in Taiwanese Breast Cancer Survivors With Breast-conserving Therapy

Breast cancer is the most common female malignancy in Taiwan; however, quality of life (QOL) following breast cancer therapy remains rarely studied. The aim of the present study was to evaluate QOL among Taiwanese breast cancer patients with and without breast-conserving therapy. Methods: A total of 130 women with breast cancer (37 with breast-conserving therapy and 93 with modified radical mastectomy) were enrolled between August, 2004 and December, 2007 in a single center. Patients who underwent breast-conserving therapy were younger, less likely to be married, had a higher educational level, and were at an earlier clinical stage than those who underwent modified radical mastectomy. The traditional Chinese version of the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-BR23 questionnaires were used as measuring instruments. Structural equation modeling with mean structural analysis, which evaluates configuration invariance and compares groups for latent functional/symptomatic factors, was constructed using a multi-indicators approach. Results: Patients with breast-conserving therapy reported worse global QOL status and role function scores and higher symptomatic scores for fatigue, pain, dyspnea, insomnia, appetite loss, breast and arm problem subscales than those without conserving therapy. In addition, age, marital status, hormone manipulation and postoperative adjuvant therapy were significant confounders for QOL. Measurement invariance was ascertained and the same QOL construct could be applied to Taiwanese subjects with and without breast-conserving therapy. Conclusion: Our study suggests that breast-conserving therapy might be associated with worse perceived QOL for Taiwanese breast cancer survivors

Prediction consistency and clinical presentations of breast cancer molecular subtypes for Han Chinese population

<p>Abstract</p> <p>Background</p> <p>Breast cancer is a heterogeneous disease in terms of transcriptional aberrations; moreover, microarray gene expression profiles had defined 5 molecular subtypes based on certain intrinsic genes. This study aimed to evaluate the prediction consistency of breast cancer molecular subtypes from 3 distinct intrinsic gene sets (Sørlie 500, Hu 306 and PAM50) as well as clinical presentations of each molecualr subtype in Han Chinese population.</p> <p>Methods</p> <p>In all, 169 breast cancer samples (44 from Taiwan and 125 from China) of Han Chinese population were gathered, and the gene expression features corresponding to 3 distinct intrinsic gene sets (Sørlie 500, Hu 306 and PAM50) were retrieved for molecular subtype prediction.</p> <p>Results</p> <p>For Sørlie 500 and Hu 306 intrinsic gene set, mean-centring of genes and distance-weighted discrimination (DWD) remarkably reduced the number of unclassified cases. Regarding pairwise agreement, the highest predictive consistency was found between Hu 306 and PAM50. In all, 150 and 126 samples were assigned into identical subtypes by both Hu 306 and PAM50 genes, under mean-centring and DWD. Luminal B tended to show a higher nuclear grade and have more HER2 over-expression status than luminal A did. No basal-like breast tumours were ER positive, and most HER2-enriched breast tumours showed HER2 over-expression, whereas, only two-thirds of ER negativity/HER2 over-expression tumros were predicted as HER2-enriched molecular subtype. For 44 Taiwanese breast cancers with survival data, a better prognosis of luminal A than luminal B subtype in ER-postive breast cancers and a better prognosis of basal-like than HER2-enriched subtype in ER-negative breast cancers was observed.</p> <p>Conclusions</p> <p>We suggest that the intrinsic signature Hu 306 or PAM50 be used for breast cancers in the Han Chinese population during molecular subtyping. For the prognostic value and decision making based on intrinsic subtypes, further prospective study with longer survival data is needed.</p

The conceptual structure of the HERQL.

<p>Circles: latent factors, rectangles: measured variables (questionnaire items). Q01: pain at rest, Q02: hernia protrusion, Q03: pain from mild activity, Q04: pain from moderate activity, Q05: pain from heavy activity, Q08: analgesic usage, Q09: activity restriction, Q11: hernia’s impact on health, Q12: economic burden, Q13: quality of life/global health. Arrows indicate the direction of regressive relationships. Numeric values are regression weights. *P<0.05, **P<0.01.</p

Repeated measures of the summative pain scores.

<p>Mean and 95% confidence interval of the summative pain scores are depicted at three time points. Vertical axis: summative pain score, horizontal axis: pre-operative (time = 0), immediately post-operative (time = 1), and post-operative 3-month of interval (time = 3).</p

Distributions of the HERQL scores with Likert’s type scales in the field study (n = 386).

<p>Distributions of the HERQL scores with Likert’s type scales in the field study (n = 386).</p

Demographic and clinical features of enrolled patients.

<p>Demographic and clinical features of enrolled patients.</p

Known-group comparisons of the HERQL.

<p>Known-group comparisons of the HERQL.</p

The conceptual structure of the extended model of the HERQL with the auxiliary post-operative patient satisfaction module.

<p>Circles: latent factors, rectangles: measured variables (questionnaire items). Q01-05, Q08-09, and Q11-13 are the same as in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0183138#pone.0183138.g001" target="_blank">Fig 1</a>. Q15: foreign body sensation, Q17: complication severity, Q18: overall satisfaction, Q19: confidence in hernia repair, Q20: quality of life improvement by hernia repair. Arrows indicate the direction of regressive relationships. Numeric values are regression weights. *P<0.05, **P<0.01.</p

Disease-free survival in 126 ER-negative Han Chinese breast cancer patients.

<p>(A) Stratified by intrinsic subtypes (proportional hazards assumption violated) and (B) stratified by the 16-concurrent gene signature (Log-rank test: <i>P</i> <0.001). SSP: single sample prediction, Her2: HER2-enriched, LumA: luminal A, LumB: luminal B subtype breast cancer. X-axis: survival time in years.</p