The measurement of response shift in patients with advanced prostate cancer and their partners

BACKGROUND: There is increasing evidence to support the phenomenon of response shift (RS) in quality of life (QoL) studies, with many current QoL measures failing to allow for this. If significant response shift occurs amongst prostate cancer patients, it will be necessary to allow for this in the design of future clinical research and to reassess the conclusions of previous studies that have not allowed for this source of bias. This study therefore aimed to assess the presence of RS and psychosocial morbidity in patients with advanced prostate cancer and their partners. METHODS: 55 consecutive advanced prostate cancer patients and their partners completed the Prostate Cancer Patient & Partner questionnaire (PPP), shortly after diagnosis and again at 3 months and 6 months. At the follow-up visits, both patients and partners also completed a then-test in order to assess RS. RESULTS: Partners consistently showed greater psychological morbidity than patients in relation to the prostate cancer. This was most marked on the General Cancer Distress (GCD) subscale (p < 0.001, paired t-test), and regarding worries about treatment (p = 0.01). Significant RS was identified in partners and patients by the use of the then-test technique, particularly on the GCD subscale, the concerns about treatment and the concerns about urinary symptoms items. CONCLUSION: These results suggest the presence of RS in patients with advanced prostate cancer and their partners, with higher levels of psychosocial morbidity noted amongst partners. This is the first study to identify RS in partners and calls into question the interpretation of all studies assessing changes in QoL that fail to allow for this phenomenon

Investigating the effectiveness of oral ketamine on pain, mood and quality of life in treatment resistant chronic pain

IntroductionChronic pain is defined as pain lasting longer than 3 months. This often causes persistent emotional distress and functional disability that is refractory to conventional treatments. Emerging evidence suggests that oral Ketamine therapy may have a specific role in managing treatment-resistant chronic pain. This study aimed to assess the effectiveness of oral ketamine within a tertiary chronic pain management clinic.MethodsThis study was a clinic-based retrospective descriptive study of 79 patients with a broad range of chronic pain diagnoses and treated with oral ketamine over a period up to 12 years. Changes in pain, mood and quality of life (QoL) were assessed using a numerical pain severity score, the Brief Pain Inventory (BPI), the Public Health Questionnaire (PHQ-9) and American Chronic Pain Association Quality of Life (QoL) scale.Results73 patients were accessible for follow-up (mean daily dose and treatment duration were 193.84 mg and 22.6 months respectively). Pain scores decreased (p &lt; 0.0001) on both numerical scores (41.6% decrease) and BPI scoring (mean decrease 2.61). Mood improved (p &lt; 0.0001) across both PHQ-9 and BPI measurements. Patients also reported less difficulty with daily activities and improved QoL. The most common adverse reaction was drowsiness (21.9%), with 30.1% reporting no adverse reactions from Ketamine.DiscussionThis work adds to the growing body of evidence that under the supervision of a pain specialist, oral ketamine therapy may be a safe, tolerable and effective treatment for chronic pain conditions which have not responded to other management options. Further research is required to produce a more accurate understanding of its chronic use. Key messageThis real-world study shows that patients being treated with oral ketamine for chronic pain report decreased severity of pain, improved mood and increased quality of life across all conditions

De drie gezichten van Pieter Bruegel de Oude (ca. 1525-1569)

Modern approaches to patient treatment and personalized medicine increasingly recognize the importance of the patient’s quality of life outcome. The art of assessing and using quality of life information in routine practice remains a challenge and poses a stumbling block for clinicians. This critical review of the literature identifies useful measures to minimize those challenges and guide nurses and researchers in selecting the correct tool for measuring quality of life in their clinical settingThis publication is supported by Mayo roscommon Hospice Foundation, Knock, Co. Mayo, Ireland and supported by an educational grant from the Irish Hospice Foundation, Dublin Ireland.peer-reviewe

An intervention using quality of life and symptom information as a clinical tool in patients with advanced cancer

The Schedule for Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW) recognizes the individuals’ values with no pre-judgement. The objective of this study was to determine if clinician awareness and understanding of individual patients’ subjective quality of life (SQoL), bothersome symptoms and symptom interference on SQoL, would lead to improvement over time in the SQoL of patients with advanced cancer. Methods: SEIQoL-DW and symptom bother/interference with SQoL was measured up to 4 time points on Sixty-five (n=65) patients receiving chemotherapy for advanced cancer. Measurements from the intervention group (n=33) was reported to the clinical team at each time point via an info-graph placed in the clinical notes. Measurements from the control group (n=32) was not reported to the clinical team. Results: SEIQoL-DW of all patients improved from baseline to time point 4 (p >0.05).A significant improvement in patient’s perception of health functioning was seen in the intervention group compared to the control group (51% v 19%, p=0.014). Symptom interference in SQoL reduced by 9% in the intervention group versus 37% increase in the control group. In totality, a 46% difference was observed between groups (p < 0.05). Interpretation: Translating SEIQoL-DW and symptom bother/interference into a format for use as a ‘Clinical Tool’ in routine practice improves patient reported health functioning and symptom interference on their SQoL. This patient centered approach could lead to a paradigm shift in our understanding of patient’s needs and in harmony with other clinical interventions, should be considered a valuable step towards personalized medicine.peer-reviewe

An intervention using quality of life and symptom information as a clinical tool in patients with advanced cancer

The Schedule for Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW) recognizes the individuals’ values with no pre-judgement. The objective of this study was to determine if clinician awareness and understanding of individual patients’ subjective quality of life (SQoL), bothersome symptoms and symptom interference on SQoL, would lead to improvement over time in the SQoL of patients with advanced cancer. Methods: SEIQoL-DW and symptom bother/interference with SQoL was measured up to 4 time points on Sixty-five (n=65) patients receiving chemotherapy for advanced cancer. Measurements from the intervention group (n=33) was reported to the clinical team at each time point via an info-graph placed in the clinical notes. Measurements from the control group (n=32) was not reported to the clinical team. Results: SEIQoL-DW of all patients improved from baseline to time point 4 (p >0.05).A significant improvement in patient’s perception of health functioning was seen in the intervention group compared to the control group (51% v 19%, p=0.014). Symptom interference in SQoL reduced by 9% in the intervention group versus 37% increase in the control group. In totality, a 46% difference was observed between groups (p < 0.05). Interpretation: Translating SEIQoL-DW and symptom bother/interference into a format for use as a ‘Clinical Tool’ in routine practice improves patient reported health functioning and symptom interference on their SQoL. This patient centered approach could lead to a paradigm shift in our understanding of patient’s needs and in harmony with other clinical interventions, should be considered a valuable step towards personalized medicine

Mycobacterium goodii pneumonia: An unusual presentation of nontuberculous mycobacterial infection requiring a novel multidisciplinary approach to management

Background: Mycobacterium goodii is a rapidly growing nontuberculous mycobacterium which has been associated with several infections including cellulitis, osteomyelitis, lymphadenitis, infected pacemakers and bursitis but it is a rare cause of respiratory infection. Case presentation: In this case report we describe a 51-year-old woman who presented with a 6-week history of non-productive cough, pleuritic chest pain and weight loss. She had a history of gastric adenocarcinoma managed with a distal oesophagectomy and total gastrectomy and consequentially suffered severe post-operative gastric reflux. Initial cultures were negative but following a VATS lung biopsy Mycobacterium goodii was cultured and histology revealed an organising pneumonia. Treatment was with a prolonged course of steroids, amikacin and meropenem followed by oral ciprofloxacin and doxycycline. Ongoing gastric dysmotility and weight loss showed clinical improvement with a novel approach of a combination of prokinetics and somatostatin analogues controlling risk of repeat aspiration and improving symptom control. Conclusions: This is an unusual case of organising pneumonia related to Mycobacterium goodii infection and highlights the importance of mycobacterial culture in unusual and unresolving cases of organising pneumonia. The importance of controlling symptoms related to gastric dysmotility and aspiration is also addressed. Keywords: Mycobacterium goodii, Nontuberculous mycobacteria, Atypical pneumonia, Symptom control, Quality of lif

Exploring the innate human potential for positive adaptation in the ace of impending mortality: Is there a response shift in subjective quality of life over time in a group of patients with lung cancer receiving palliative treatment?

Traditionally changes in quality of life (QoL) are assessed using self report questionnaires. They rely on the assumption that the patient’s point of reference does not change over time. However in reality patients with chronic and life threatening illness appear to undergo an adaptation to their disease or “Response Shift” (RS). In this study of a population of patients with advanced lung cancer receiving palliative chemotherapy we examine for a RS in subjective QoL. Methods: 33 patients completed the Schedule for the Evaluation of Individual Quality of Life (SEIQoL), SEIQOL–DW and the EORTC-QLQ C-30 at diagnosis. At 1, 3 and 6 months patients completed SEIQoL/ SEIQOL–DW and retrospectively re-assessed their baseline QoL (the “then” test) using SEIQoL-DW. Results: The initial mean SEIQoL-DW score was 67.48 changing to 66.71 at one month. Retrospectively, patients reassessed their initial mean SEIQoL-DW score as 59.61, suggesting a RS of 7.87 (p ≤0.0001) and an actual improvement in QoL of 7.1 points. At three months the mean SEIQoL-DW score was 65.13; retrospectively patients rated their QoL at one month much lower, mean SEIQoL-DW then – test’ score was 59.92, suggesting a RS of 6.79 (p = 0.0013). At six months patients’ mean SEIQoL-DW score was 61.86. Again, when retrospectively rating their QoL at three months they rated it lower, mean SEIQoL-DW score of 58.84, indicating a ‘positive’ RS of 6.28 (p = 0.0007). Conclusion: Traditional pre/post SEIQOL–DW scores show little change in subjective QOL however by incorporating the ‘then-test’ we can see that patients have undergone a RS and a significant positive change in subjective QOL. By explicitly measuring RS it may be possible to assess changes in QoL with greater validity and sensitivity.peer-reviewe

Investigating the effectiveness of oral ketamine on pain, mood and quality of life in treatment resistant chronic pain

Introduction: Chronic pain is defined as pain lasting longer than 3 months. This often causes persistent emotional distress and functional disability that is refractory to conventional treatments. Emerging evidence suggests that oral Ketamine therapy may have a specific role in managing treatment-resistant chronic pain. This study aimed to assess the effectiveness of oral ketamine within a tertiary chronic pain management clinic. Methods: This study was a clinic-based retrospective descriptive study of 79 patients with a broad range of chronic pain diagnoses and treated with oral ketamine over a period up to 12 years. Changes in pain, mood and quality of life (QoL) were assessed using a numerical pain severity score, the Brief Pain Inventory (BPI), the Public Health Questionnaire (PHQ-9) and American Chronic Pain Association Quality of Life (QoL) scale. Results: 73 patients were accessible for follow-up (mean daily dose and treatment duration were 193.84 mg and 22.6 months respectively). Pain scores decreased (p p Discussion: This work adds to the growing body of evidence that under the supervision of a pain specialist, oral ketamine therapy may be a safe, tolerable and effective treatment for chronic pain conditions which have not responded to other management options. Further research is required to produce a more accurate understanding of its chronic use. Key message: This real-world study shows that patients being treated with oral ketamine for chronic pain report decreased severity of pain, improved mood and increased quality of life across all conditions.</p