Reference values of EORTC QLQ-C30, EORTC QLQ-BR23, and EQ-5D-5L for women with non-metastatic breast cancer at diagnosis and 2 years after

Purpose To obtain reference norms of EORTC QLQ-C30, EORTC QLQ-BR23, and EQ-5D-5L, based on a population of Spanish non-metastatic breast cancer patients at diagnosis and 2 years after, according to relevant demographic and clinical characteristics. Methods Multicentric prospective cohort study including consecutive women aged ≥ 18 years with a diagnosis of incident non-metastatic breast cancer from April 2013 to May 2015. Health-related quality of life (HRQoL) questionnaires were administered between diagnosis and beginning the therapy, and 2 years after. HRQoL differences according to age, comorbidity and stage were tested with ANOVA or Chi Square test and multivariate linear regression models. Results 1276 patients were included, with a mean age of 58 years. Multivariate models of EORTC QLQ-C30 summary score and EQ-5D-5L index at diagnosis and at 2-year follow-up show the independent association of comorbidity and tumor stage with HRQoL. The standardized multivariate regression coefficient of EORTC QLQ-C30 summary score was lower (poorer HRQoL) for women with stage II and III than for those with stage 0 at diagnosis (− 0.11 and − 0.07, p < 0.05) and follow-up (− 0.15 and − 0.10, p < 0.01). The EQ-5D-5L index indicated poorer HRQoL for women with Charlson comorbidity index ≥ 2 than comorbidity 0 both at diagnosis (− 0.13, p < 0.001) and follow-up (− 0.18, p < 0.001). Therefore, we provided the reference norms at diagnosis and at the 2-year follow-up, stratified by age, comorbidity index, and tumor stage. Conclusion These HRQoL reference norms can be useful to interpret the scores of women with non-metastatic breast cancer, comparing them with country-specific reference values for this population.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. This study has been funded by the Instituto de Salud Carlos III FEDER (PI21/00026 and PI12/01842), by the Basque Government Health Department (2012111045) and by Generalitat de Catalunya (2017 SGR 452). OG and MF acknowledge CIBER de Epidemiologia y Salud Publica (CIBERESP) for partial funding to their research

Anxiety, depression, health-related quality of life, and mortality among colorectal patients: 5-year follow-up

Purpose Health-related quality of life (HRQoL) measurement represents an important outcome in cancer patients. We describe the evolution of HRQoL over a 5-year period in colorectal cancer patients, identifying predictors of change and how they relate to mortality. Methods Prospective observational cohort study including colorectal cancer (CRC) patients having undergone surgery in nineteen public hospitals who were monitored from their diagnosis, intervention and at 1-, 2-, 3-, and 5-year periods thereafter by gathering HRQoL data using the EuroQol-5D-5L (EQ-5D-5L), European Organization for Research and Treatment of Cancer's Quality of Life Questionnaire-Core 30 (EORTC-QLQ-C30), and Hospital Anxiety and Depression Scale (HADS) questionnaires. Multivariable generalized linear mixed models were used. Results Predictors of Euroqol-5D-5L (EQ-5D-5L) changes were having worse baseline HRQoL; being female; higher Charlson index score (more comorbidities); complications during admission and 1 month after surgery; having a stoma after surgery; and needing or being in receipt of social support at baseline. For EORTC-QLQ-C30, predictors of changes were worse baseline EORTC-QLQ-C30 score; being female; higher Charlson score; complications during admission and 1 month after admission; receiving adjuvant chemotherapy; and having a family history of CRC. Predictors of changes in HADS anxiety were being female and having received adjuvant chemotherapy. Greater depression was associated with greater baseline depression; being female; higher Charlson score; having complications 1 month after intervention; and having a stoma. A deterioration in all HRQoL questionnaires in the previous year was related to death in the following year. Conclusions These findings should enable preventive follow-up programs to be established for such patients in order to reduce their psychological distress and improve their HRQoL to as great an extent as possible.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. This work was supported in part by grants from the Instituto de Salud Carlos III and the European Regional Development Fund (PS09/00314, PS09/00910, PS09/00746, PS09/00805, PI09/90460, PI09/90490, PI09/90453, PI09/90441, PI09/90397); the Departments of Health (2010111098) and Education, Language Policy and Culture (IT620-13) of the Basque Government; the Research Committee of Hospital Galdakao; and the thematic network-REDISSEC (Red de Investigacion en Servicios de Salud en Enfermedades Cronicas)-of the Instituto de Salud Carlos III

Use of the long and short forms of the Depression in the Medically Ill questionnaire in Spanish population

This study aimed to translate the original (DMI-18) and the short (DMI-10) version of the Depression in the Medically Ill into Spanish, validate them and determine the best cut-off points for detecting depression. A back-translation procedure was used. Patients with somatic disorders (N=366) completed the translated DMI-18 and another depression questionnaire. Of these, 167 were also assessed by a mental health professional. Reliability (Cronbach alpha > 0.90) and convergent validity (r > 0.74) were satisfactory. The CFA results supported the one factor model (depression). The best cut-off of the Spanish version was 15 for the DMI-18 and 9 for the DMI-10. Sensitivity and specificity were 93% and 73% for the DMI-18 and 87% and 74% for the DMI-10. Our data confirm the validity of the Spanish-language versions of both DMI versions. Their use in a clinical context may help non-psychiatric professionals to detect affective comorbidities in their patients

Detecting depression in medically ill patients: comparative accuracy of four screening questionnaires and physicians' diagnoses in Spanish population

Objective: To compare the diagnostic accuracy of four depression screening tools commonly used in patients with medical disorders, relative to a reference diagnostic standard – a structured psychiatric interview. Methods: The Depression in the Medically Ill-18 (DMI-18) questionnaire was administered to 167 patients with medical disorders, of those 53 completed the Beck Depression Inventory for Primary Care (BDI-PC), 67 the Hospital Anxiety and Depression Scale (HADS) and 46 the Patient Health questionnaire-9 (PHQ-9). The entire sample was also interviewed with a structured psychiatric interview conducted by a mental health professional. Sensitivity, specificity, likelihood ratios (LR) and area under the curve (AUC) were calculated and compared for the different measures. Results: At their respective recommended cut-off points, sensitivities (95% CI) were 86% (70-95), 82% (63-94), 93% (86-97) and 68% (47-85) for the HADS-D, BDI-PC, DMI-18, and PHQ-9 respectively, while specificities ranged from 72% (47-90) for BDI-PC to 89% (72-98) for PHQ-9. The sensitivities of DMI-18 were significantly higher compared to those of HADS-D (p= 0.045) and PHQ-9 (p= 0.01). The PHQ-9 questionnaire obtained the most favourable positive LR (6.35; 95% CI: 2.48-18.36). In contrast, the DMI-18 showed the best negative LR (0.09; 95% CI: 0.04-0.18). AUCs (95% CI) ranged from 0.92 (0.83-1.02) to 0.84 (0.74-0.94). Staistically significant differences were found between the AUCs of the DMI-10 and the BDI-PC. Conclusion: Our results suggest that all evaluated scales have acceptable abilities and can be used as screening instruments for depression in patients with medical disorders. The DMI stands out for its sensitivity.This study was supported by a grant from the Salud Carlos III Institute (PI06/90421

Anxiety and depression among caregivers of patients with eating disorders and their change over 1 year

Purpose. Limited data are available on the difficulties experienced over time by caregivers of patients eating disorders (CPED). The aim of this study was to describe changes in anxiety and depression among such caregivers over one year and to identify factors predicting any changes in both. Methods. At recruitment, 145 ED patients and their 246 caregivers completed sociodemographic and clinical instruments, including the Hospital Anxiety and Depression Scale (HADS) , and the Short-Form 12 (SF-12). Patients also completed the Eating Attitudes Test-26 (EAT-26), and their psychiatrists assessed clinical variables. Patients and caregivers completed the same instruments one year later. Results. At baseline, prevalence of anxiety and depression among caregivers was 56% and 32%, respectively. Scores were essentially the same one year later. Factors associated with changes in anxiety were higher anxiety level at baseline and caring for a patient with a restrictive ED. Factors associated with changes in depression included higher depression at baseline and caring for a patient with a restrictive ED. Neither health-related quality of life among patients and caregivers, or patients’ eating attitudes were related to caregivers anxiety or depression. Conclusions. These findings confirm the presence of substantial and continuing emotional distress among caregivers of patients with ED, highlighting the importance of offering them more extended follow up and treatment.This study was partly funded by the Carlos III Health Institute (project PI06/0921 ‘‘The caring experience and its impact on the quality of life of ED patient caregivers. A follow-up study’’, awarded to principal investigator Angel Padierna)