Phase III study of the European Organisation for Research and Treatment of Cancer satisfaction with cancer care core questionnaire (EORTC PATSAT-C33) and specific complementary outpatient module (EORTC OUT-PATSAT7).

Advances in cancer care delivery require revision and further development of questionnaires assessing patients' perceived quality of care. This study pre-tested the revised EORTC satisfaction with cancer care core questionnaire applicable in both the cancer inpatient and outpatient settings, and its new, outpatient-specific complementary module. The process of revision, development of the extended application, and pre-testing of these questionnaires was based on phases I to III of the "EORTC Quality of Life Group Module Development Guidelines." In phase III, patients in 11 countries in four European regions, South America and Asia completed provisional versions of the questionnaires. Fifty-seven relevant issues selected from literature reviews and input from experts were operationalized into provisional items, and subsequently translated into ten languages. Assessment of understanding, acceptability, redundancy and relevance by patients (n = 151) from oncology inpatient wards, and outpatient chemotherapy, radiotherapy and consultation settings, led to retention of, deletion of and merging of 40, 14 and 6 items respectively. Cronbach's alpha coefficients for hypothesized questionnaire scales were above 0.80. Our results provide preliminary support for the 33-item EORTC Satisfaction with cancer care core questionnaire and the 7-item complementary module specific for the outpatient care setting. A large scale phase IV cross-cultural psychometric study is now underway.

An international study to revise the EORTC questionnaire for assessing quality of life in lung cancer patients.

BACKGROUND: The European Organization for Research and Treatment of Cancer (EORTC) QLQ-LC13 was the first module to be used in conjunction with the core questionnaire, the QLQ-C30. Since the publication of the LC13 in 1994, major advances have occurred in the treatment of lung cancer. Given this, an update of the EORTC QLQ-LC13 was undertaken. METHODS: The study followed phases I to III of the EORTC Module Development Guidelines. Phase I generated relevant quality-of-life issues using a mix of sources including the involvement of 108 lung cancer patients. Phase II transformed issues into questionnaire items. In an international multicenter study (phase III), patients completed both the EORTC QLQ-C30 and the 48-item provisional lung cancer module generated in phases I and II. Patients rated each of the items regarding relevance, comprehensibility, and acceptance. Patient ratings were assessed against a set of prespecified statistical criteria. Descriptive statistics and basic psychometric analyses were carried out. RESULTS: The phase III study enrolled 200 patients with histologically confirmed lung cancer from 12 centers in nine countries (Cyprus, Germany, Italy, Israel, Spain, Norway, Poland, Taiwan, and the UK). Mean age was 64 years (39 - 91), 59% of the patients were male, 82% had non-small-cell lung cancer, and 56% were treated with palliative intent. Twenty-nine of the 48 questions met the criteria for inclusion. CONCLUSIONS: The resulting module with 29 questions, thus currently named EORTC QLQ-LC29, retained 12 of the 13 original items, supplemented with 17 items that primarily assess treatment side-effects of traditional and newer therapies.

Trends in hip fracture rates in Taiwan: a nationwide study from 1996 to 2010.

There was an initial increase and a later decrease in hip fracture rates in Taiwan between 1996 and 2010 (457.9 to 390.0 fractures per 100,000 people per year). Mortality rates decreased but re-emerged later (2.26 to 1.91 deaths per 100 hip fracture admissions). The turning point for change in trends was 2003. INTRODUCTION: Fractures of the proximal femur remain a major cause of mortality and morbidity. We aimed to examine recent trends in hip fracture rates, in-hospital mortality rates, and length of hospital stay (LOS) due to hip fractures in people aged 55 and over in Taiwan. METHODS: This is a time-trend study. We used data from the National Health Insurance Research Database between 1996 and 2010 in Taiwan. Insurants aged 55 and over were included. The outcome measures were age-adjusted hip fracture rates, age-adjusted in-hospital mortality rates, and LOS due to hip fractures. We classified hip fractures into femoral neck, trochanteric, and subtrochanteric fractures. RESULTS: We identified 250,919 hospitalizations for hip fractures. The total number of hip fractures increased steadily from 12,479 to 19,841 cases. There was a trend towards initial increase and then later decrease in hip fracture rates (from 457.9 to 390.0 fractures per 100,000 people per year). LOS decreased by 46.5 % (17.53 to 9.38 days). By contrast, mortality rates for hip fractures decreased initially, but re-emerged later with a total decrement of 15.5 % (2.26 to 1.91 deaths per 100 hip fracture admissions). Women outnumbered men in all types of hip fractures, but men had higher in hospital mortality rates. LOS was similar between genders and among age groups. The turning point for change in trends was year 2003. CONCLUSIONS: While LOS shortened gradually since 1996, the absolute number of hip fractures in Taiwan continues to rise. There is still room for improvement in reducing mortality due to hip fractures.

International validation of the EORTC QLQ-ELD14 questionnaire for assessment of health-related quality of life elderly patients with cancer.

BACKGROUND: Older people represent the majority of cancer patients but their specific needs are often ignored in the development of health-related quality of life (HRQOL) instruments. The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-ELD15 was developed to supplement the EORTC's core questionnaire, the QLQ-C30, for measuring HRQOL in patients aged >70 years in oncology studies. METHODS: Patients (n=518) from 10 countries completed the QLQ-C30, QLQ-ELD15 and a debriefing interview. Eighty two clinically stable patients repeated the questionnaires 1 week later (test-retest analysis) and 107 others, with an expected change in clinical status, repeated the questionnaires 3 months later (response to change analysis, RCA). RESULTS: Information from the debriefing interview, factor analysis and item response theory analysis resulted in the removal of one item (QLQ-ELD15QLQ-ELD14) and revision of the proposed scale structure to five scales (mobility, worries about others, future worries, maintaining purpose and illness burden) and two single items (joint stiffness and family support). Convergent validity was good. In known-group comparisons, the QLQ-ELD14 differentiated between patients with different disease stage, treatment intention, number of comorbidities, performance status and geriatric screening scores. Test-retest and RCA analyses were equivocal. CONCLUSION: The QLQ-ELD14 is a validated HRQOL questionnaire for cancer patients aged 70 years. Changes in elderly patients' self-reported HRQOL may be related to both cancer evolution and non-clinical events.

Predicting methicillin resistance among community-onset Staphylococcus aureus bacteremia patients with prior healthcare-associated exposure.

To develop and validate prediction rules to identify the risk of methicillin-resistant Staphylococcus aureus (MRSA) infection among community patients who have healthcare-associated (HA) exposure and S. aureus bacteremia. A total of 1,166 adults with community-onset S. aureus bacteremia were retrospectively enrolled. The background prevalence of community MRSA infection was extrapolated from 392 community-associated S. aureus bacteremia (CA-SAB) patients without HA exposure. Complete and clinical risk scores were derived and tested using data from 774 healthcare-associated S. aureus bacteremia (HA-SAB) patients. The risk scores were modeled with and without incorporating previous microbiological data as a model predictor and stratified patients to low-, intermediate-, and high-risk groups for MRSA infection. The clinical risk score included five independent predictors and the complete risk score included six independent predictors. The clinical and complete risk scores stratified 32.7 % and 42.0 % of HA-SAB patients to the low-risk group for MRSA infection respectively. The prevalence of MRSA infection in score-stratified low-risk groups ranged from 16.3 % to 23.3 %, comparable to that of CA-SAB patients (13.8 %). Simple decision rules allow physicians to stratify the risk of MRSA infection when treating community patients with prior HA exposure and possible S. aureus infection.

Nationwide periodic health examinations promote early treatment of hypertension, diabetes and hyperlipidemia in adults: experience from Taiwan.

OBJECTIVES: To investigate the effectiveness of nationwide periodic health examinations in promoting early treatment of hypertension, diabetes and hyperlipidemia in adults aged ≥40 years. STUDY DESIGN: Seven-year, retrospective, cohort study. METHODS: Based on a large and representative claims dataset in Taiwan, cohort analysis was undertaken among three disease-free cohorts for hypertension, diabetes and hyperlipidemia (n = 26,661, 29,872 and 30,712 subjects, respectively) in 2000. Each cohort was observed from January 2001 to December 2007. Logistic regression, Cox proportional hazards analysis and the extended Cox model with counting process were employed in data analysis. Covariates such as age, gender, level of premium, beneficiary category, comorbidities and geographic factors were adjusted at baseline. RESULTS: For the hypertension, diabetes and hyperlipidemia cohorts, those who had ever used the preventive service between 1998 and 2000 had higher probabilities of being treated as new patients for these target diseases; the hazard ratios were 1.65, 1.32 and 1.57, respectively. Using the extended Cox model, associations for use of each service with treatment within a 1-year follow-up period between 2001 and 2007 were 1.68, 2.41 and 3.48. CONCLUSIONS: In adults who were initially disease-free, those who used the preventive service had higher probabilities of early treatment of these target diseases. These findings indicate the effectiveness of nationwide periodic health examinations.

Development of a questionnaire (EORTC module) to measure quality of life in patients with cholangiocarcinoma and gallbladder cancer, the EORTC QLQ-BIL21.

BACKGROUND: Quality of life measurement in cholangiocarcinoma and gallbladder cancer involves the assessment of patient-reported issues related to the symptoms, disease and treatment of these tumours. This study describes the development of the disease-specific quality of life (QoL) questionnaire for patients with cholangiocarcinoma and gallbladder cancer to supplement the European Organization for Research and Treatment of Cancer (EORTC)-QLQ C30 core cancer questionnaire. METHODS: Phases 1-3 of the guidelines for module development published by the EORTC were followed, with adaptations for incorporation of questions from existing modules. RESULTS: A total of 47 QoL issues (questions) were identified; 44 questions from the two related validated questionnaires, the EORTC QLQ-PAN26 (pancreatic module) and the EORTC QLQ-LMC21 (liver metastases module), two from the Functional Assessment of Cancer Therapy hepatobiliary module questionnaire in the literature search and one from healthcare professional interviews. Following phase 1 and 2 interviews with patients (n=101) and health care professionals (n=6), a 23-question provisional questionnaire was formulated. There were five questions from PAN26, 15 from LMC21 and three extra questions. In phase 3, the provisional item list was pre-tested in 52 patients in four languages and this resulted in a 21-item module. CONCLUSION: This is the only disease-specific QoL questionnaire for patients with cholangiocarcinoma and gallbladder cancer, and initial assessments show it to be accurate and acceptable to patients in reflecting QoL in these diseases.

Determinants of patient satisfaction in oncology settings from European and Asian countries: preliminary results based on the EORTC IN-PATSAT32 questionnaire.

The aim of this study was to identify factors associated significantly with hospitalised cancer patients' satisfaction with care. Patients were recruited from four geographical/cultural groups, including five European countries and Taiwan. They rated their level of satisfaction by completing the EORTC IN-PATSAT32 questionnaire at home. Additionally, data were collected on the sociodemographic and clinical characteristics and the quality of life of the patients, as well as on institutional characteristics. Of 762 patients recruited, 647 (85%) returned a completed questionnaire. The number of nurses and doctors per bed, institution size, geo-cultural origin, ward setting, teaching/non-teaching setting, treatment toxicity, global health status, participation in clinical trials and education level were all associated significantly at the multivariate level with satisfaction with doctor and nurse interpersonal skills, information provision, availability, and/or overall satisfaction. A number of patient-, institutional- and culture-related factors are associated with the perceived quality of cancer care. Future studies, with appropriate sampling frames and stratification procedures, are needed to better understand cross-national and cross-cultural differences in cancer patient satisfaction.

Comparative impact of hospital-acquired infections on medical costs, length of hospital stay and outcome between community hospitals and medical centres.

To understand the impact of hospital-acquired infections on mortality and medical costs in modern medical care systems in different healthcare settings, we performed a case-control study at a medical centre and two community hospitals. A total of 144 and 129 adult case-control pairs who received care in a 2000-bed tertiary referral medical centre and two 800-bed community hospitals, respectively, between October 2002 and December 2002 were enrolled. Prolongation of hospital stay, extra costs and complications associated with hospital-acquired infections were analysed. Patients in the medical centre had more severe underlying disease status (P < 0.001), more malignancies (P < 0.001), more multiple episodes of hospital-acquired infection (p = 0.03), and more infections with multidrug-resistant bacteria (P < 0.001) than patients in community hospitals. The additional length of hospital stay and extra costs were similar for patients with hospital-acquired infections in the community hospitals and the medical centre (mean 19.2 days vs. 20.1 days, P = 0.79; mean 5335 US dollars vs. 5058 US dollars, P = 0.83; respectively). The additional length of hospital stay and extra costs in both the medical centre and the community hospitals were not related to the sites of infection or the bacterial pathogens causing hospital-acquired infections, although medical costs attributable to hospital-acquired fungal infections due to Candida spp. were much higher for patients in the medical centre. Prevalence of hospital-acquired-infection-related complications, such as adult respiratory distress syndrome, disseminated intravascular coagulation, organ failure or shock, was similar between the two groups, but patients in the medical centre had a higher mortality rate because of their underlying co-morbidities.

How diabetic patients think about and manage their illness in Taiwan.

AIMS: Type 2 diabetes is becoming more prevalent in Taiwan. Growing evidence suggests a patient-centred approach is more effective in facilitating self-management than a professional-centred one. The aim of this qualitative study was to investigate Chinese diabetic patients' perceptions about their illness and treatment strategies to facilitate patient-centred, culture-sensitive clinical skills. METHODS: We used in-depth interviews to collect perspectives from 22 participants recruited from a rural Taiwan community. All interviews were audio-taped and the transcripts were analysed by editing and immersion/crystallization. Emerging themes were compared with current medical knowledge to determine their clinical significance. RESULTS: Generally, Chinese diabetic patients had variable perceptions about different treatment strategies. All agreed that dietary restriction and exercise were beneficial. The former, mainly understood as reducing carbohydrate intake, was thought to be most important; exercise, to the point of sweating, was seen as a way to eliminate pharmaceutical toxins. Taking medicine was regarded with ambivalent attitudes due to concerns about adverse effects (especially renal injury). CONCLUSIONS: Patients regarded all treatment strategies as integrative and intertwined in daily life. There are three misconceptions which we found should be clarified during medical consultations: (i) focusing on sugar-control only; (ii) benefit of sweating to eliminate toxins; (iii) fear of renal toxicity of hypoglycaemic agents. The renaming of diabetes, to such as 'metabolic syndrome', may bring new, acceptable insight to Chinese diabetic patients.

High incidence rate of hip fracture in Taiwan: estimated from a nationwide health insurance database.

The objective of this study was to describe the incidence rate of hip fracture from 1996 to 2000 in Taiwan, based on an inpatient database of the National Health Insurance Program. A total of 54,199 patients, who had a first-time admission for a diagnosis of hip fracture (ICD9 code 820.0 through 820.9, 820.21, 820.22, and 820.31) on discharge from January 1996 through December 2000 and aged 50 to 100 years, were identified and included in the study. The results showed that the age-specific incidence rates of hip fractures were higher with increasing age in both genders, in an exponential manner after 65 years of age. The incidence was 1.6 times higher and rose about 5 years earlier among women than among men. Thus in these 5 years the age-adjusted incidence rates (95% confidence interval) of hip fracture in Taiwan were 225 (95% CI, 188-263) per 100,000 in men and 505 (95% CI, 423-585) per 100,000 in women (adjusted to US white population of 1989), as compared with US white rate of 187 in men and 535 in women. More than half of the fractures were peritrochanteric, and the recorded cause in most cases was a fall on the same level, from slipping, tripping, or stumbling (ICD9 E885). A total of 37.8% patients had hip hemiarthroplasty, 51.2% had open reduction of fracture with internal fixation, and 10.5% had closed reduction of fracture with internal fixation. We concluded that, using the data from a nationwide health insurance database of Taiwan, we found a high annual incidence rate of hip fracture for both men and women in 5 consecutive years. These incidence rates were higher than other reports on Chinese populations reported in the past 10 years and similar to that of Western countries. With the rapid aging of the populations of Taiwan and other Asian countries in the years to come, our results clearly demonstrated the impact of osteoporosis and hip fracture in this region.

Quality of life in patients of nasopharyngeal carcinoma: validation of the Taiwan Chinese version of the EORTC QLQ-C30 and the EORTC QLQ-H&N35.

The authors followed the guidelines of translation and pilot testing of the EORTC QLQ-C30 and EORTC-QLQ-H&N35 questionnaires. The questionnaires were given to 50 nasopharyngeal carcinoma patients under active treatment and 50 under follow-up at our institution from November 2000 to June 2001. A retest was conducted 2 weeks after the first interview/form completion for the follow-up group. The intraclass correlation coefficients of the two questionnaires were moderate to high in the follow-up group. Cronbach's alpha coefficients of all scales of the two questionnaires were > or = 0.70 except that of cognitive functioning. Correlation of scales measuring similar dimensions of the QLQ-C30 and the SF-36 were moderate to high, while that of the QLQ-H&N35 and the QLQ-C30 and the SF-36 were moderate to low. Patients in the active treatment group had more serious acute problems due to disease and chemotherapy. Patients in the follow-up group had more serious chronic problems due to radiation therapy. We concluded that the Taiwan Chinese version of the EORTC QLQ-C30 and the EORTC QLQ-H&N35 had moderate to high test-retest reliability, high internal consistency in most scales, and could show the expected differences between patients in active treatment and follow-up group.

Rates and characteristics of lower limb amputations in Taiwan, 1997.

This study aims to describe the national incidence rate and characteristics of lower limb amputations (LLA) in 1997 from an island-wide database of the national health insurance programme in Taiwan. Some 117,647 discharge records from a sampled database (1 in 20) of the National Health Insurance Research Database were analysed. This study included records (n=171) containing LLA procedures. The LLA procedure rates were obtained by multiplying the number of identified procedures by 20 as the numerator and mid-year total population of Taiwan in 1997 as the denominator. Each procedure was further analysed according to the demographic characteristics of the patients, cause and level of amputation. Summarised gender ratios of LLA procedure rates were obtained by Poisson regression analysis. The crude LLA procedure rate was 18.1 per 100,000 population per year and the crude major LLA procedure rate was 8.8 per 100,000 population per year in Taiwan in 1997. The major cause of LLA procedures was peripheral vascular disease (72%), and the toe was most frequently amputated (48%). The LLA procedure rates, which increased logarithmically with age of patients, were significantly higher in men with a summarised male to female rate ratio of 1.65. The age-standardised LLA procedure rate in Taiwan was lower than that reported in the United States, Finland, the Netherlands, the United Kingdom (Leeds, Middlesborough, and Newcastle), but higher than Spain, Italy, and Japan. The trend of an increasing proportion of PVD-related LLA procedures will prompt the health professionals to develop strategies for LLA prevention.

Disability-adjusted life years for breast cancer patients in Taiwan.

BACKGROUND AND PURPOSE: The incidence and mortality of breast cancer in Taiwan have increased rapidly in the past several decades, but the societal impact of deaths and disabilities due to breast cancer has not been assessed. This study estimated the disability-adjusted life years (DALYs) for breast cancer patients during 1994, and compared the results with similar data from other areas of the world. METHODS: DALYs for breast cancer patients in Taiwan were calculated using the equation developed by Murray and Lopez. The incidence and mortality of breast cancer and the population structure were obtained from national statistics maintained by the Department of Health and the Ministry of the Interior. The age-specific mean survival time for breast cancer patients was estimated using the exponential distribution from incidence-mortality linkage of the incidence file at National Taiwan University Hospital and the National Mortality File maintained by the Department of Health. RESULTS: There were 11,963 years of life lost (YLL) due to breast cancer during 1994, 2677 years lived with disability (YLD), and 14,640 DALYs. The YLL and DALYs per 1000 population (1.17 and 1.44) were in the middle of the world spectrum, while the YLD value per 1000 population (0.26) was closer to those of developed countries. The proportion of DALYs contributed by younger patients (< 45 years) was higher than in developed countries and similar to those in developing countries other than Sub-Saharan Africa. The DALYs per 1000 population of women younger than 45 years of age in Taiwan were also higher than those in India, China, other regions of Asia and Islands, Sub-Saharan Africa, and the Middle Eastern Crescent. CONCLUSIONS: The disability portion (YLD) of the DALYs for breast cancer patients in Taiwan was higher than in other regions of the world. Moreover, patients younger than 45 years contributed a higher proportion of DALYs than in developed countries. The DALY value per 1000 population younger than 45 years of age was also higher than in developing countries. These results suggest that health professionals should focus more attention on programs for education, screening, and treatment of younger women.

Utility assessment for different clinical phases of breast cancer in Taiwan.

BACKGROUND AND PURPOSE: Utility is an important index of health-related quality of life (HRQoL). The purpose of this study was to assess utility in different clinical phases of breast cancer in patients in Taiwan. METHODS: Based on a review of HRQoL literature pertaining to breast cancer and medical records of 979 breast cancer patients admitted to National Taiwan University Hospital from 1991 to 1995, a semi-open checklist describing the diagnosis and treatment activities and impacts of different clinical phases of breast cancer was constructed. The checklist was then reviewed and revised in consultation with surgeons, medical oncologists, radiation oncologists, nurses, and breast cancer patients. Thirty-one clinical and public health experts were invited to assess the utility of each phase with the visual analog scale (VAS), standard gamble (SG), and time trade-off (TTO) methods, according to the description of the average patient's life in the checklist. The Delphi technique was used to reach expert consensus. RESULTS: The VAS utility scores were highest during screening phases (100 or 90), lower in phases of incidental finding of a tumor (75) and diagnosis (70), and lower still in the initial treatment phases, especially during adjuvant chemotherapy (50). The scores improved during the follow-up phases. There was a higher score for breast-conserving surgery (65) than modified radical mastectomy (60) only in the early follow-up phase. The scores for recurrence or metastasis (30) and terminal stage were considerably lower and reached the lowest level (10 in a general ward and 12.5 at home or in a hospice) among all phases. The utility scores assessed by SG and TTO were higher than those assessed by VAS. CONCLUSIONS: In this study, we established a consensus among clinical and public health experts on the impact of different clinical phases of breast cancer on utility. The results of this study may be useful in cross-cultural comparisons and cost-utility analyses for breast cancer.

Height and weight change across menarche of schoolgirls with early menarche.

OBJECTIVE: To describe growth before and after menarche. DESIGN: Nine hundred five fourth grade school girls were identified as a closed cohort from the first semester of 1993 for the observational study of the onset of menarche and its predictive factors. SETTINGS: Eight elementary schools in Taipei City and Taipei County, Taiwan. MAIN OUTCOME MEASURES: Data were collected from self-administered questionnaires and school records. Height and weight were measured in September, January, February, and June, or only in September and February of each year. RESULTS: All subjects remained in the cohort until sixth grade, 410 of whom had their first menstruation before graduating from elementary school. Height, weight, and body mass index (calculated as weight in kilograms divided by the square of height in meters) at each time point were plotted against 2 time scales: chronological age and time from the onset of menarche. Growth velocity of height and weight across the onset of menarche was assessed with slope change using the mixed-effect model analysis. CONCLUSIONS: The results support the hypothesis that height velocity reaches a peak 1 year before menarche but height velocity stopped increasing within 1 year after menarche. The change in weight velocity reveals no obvious growth spurt at age of menarcheal onset.

Age at any full-term pregnancy and breast cancer risk.

The authors analyzed data from two multistate, population-based case-control studies to investigate the association between age at any full-term pregnancy (FP) and breast cancer risk. Study subjects included breast cancer cases aged 20-79 years identified from four statewide cancer registries and randomly selected controls interviewed from 1988 to 1996. Complete information on a comprehensive set of risk factors for breast cancer was available for 9,891 cases and 12,271 controls. The large number of subjects enabled simultaneous adjustment of the covariates and efficient application of various modeling approaches. Overall, each 5-year increase in age at first FP was associated with an odds ratio of 1.07 (95% confidence interval (CI): 1.01, 1.13) for breast cancer. The corresponding estimates were odds ratio = 1.02 (95% CI: 1.00, 1.05) for age at second through ninth FPs. For age at last FP, the effect estimate (odds ratio = 1.01, 95% CI: 0.97, 1.06) was indistinguishable from that for other FPs after the first. In this analysis, a modest and transient increase in breast cancer risk after childbirth was also observed. The relatively greater effect of age at first FP is consistent with the existence of a long-term effect of early first FP on the differentiation of mammary cells, causing them to become less susceptible to carcinogenesis.

Measurement of the quality of life during different clinical phases of breast cancer.

This cross-sectional study was designed to evaluate the self-rated quality of life of Taiwanese breast cancer patients at the time of diagnosis and during various phases of treatment. A total of 115 patients at different clinical stages of breast cancer completed the study. The questionnaires consisted of the Medical Outcome Survey 36-Item Short Form Health Surveys (SF-36), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire--Cancer 30 (EORTC QLQ-C30), and questions measuring utility using visual analog scale (VAS), standard gamble (SG), and time trade-off (TTO) methods. The patients filled out the questionnaires, with interviewers' assistance as requested. Cronbach's alpha coefficients of internal consistency for the SF-36, based on the US factor structure, were 0.84 for raw scores and 0.87 and 0.88 for the physical and mental components, respectively. Cronbach's alpha for the EORTC QLQ-C30 was 0.86. The correlations between items in the SF-36 and the EORTC QLQ-C30 that examined similar dimensions were high. Significant differences were found in most dimensions of quality of life across different clinical stages. The three utility scores, however, showed no significant differences among patients in different clinical stages. Patients in the chemotherapy and recurrence phases usually had the lowest quality of life scores, while those in the follow-up phase had the highest. The results of this study demonstrate the applicability of quality of life measurements in helping health professionals identify the physical, mental, and social problems of breast cancer patients in different phases of the clinical process.

Mortality trends of elderly people in Taiwan from 1974 to 1994.

BACKGROUND: the hypothesis that disability and death will eventually be compressed to a period late in life needs empirical confirmation. OBJECTIVES: we have examined the secular trends of life expectancy and common causes of death in the aged population of Taiwan. METHOD: we compared the life expectancy, causes of death and probability of death for people at birth, at age 65 and at age 85 for both sexes from 1974 to 1994 using data from Taiwan government statistics. RESULTS: there has been a substantial gain in life expectancy, especially for men age 85 and over, in the past 20 years. . Mortality due to stroke, ischaemic heart disease, hypertension and chronic pulmonary disease has declined. There has been a steep increase in cancer deaths and deaths associated with diabetes mellitus. Tuberculosis and injury-related deaths have declined but pneumonia deaths have increased. For elderly people, the probability of dying from cancer and ischaemic heart disease increased with time. However, the probability of dying from stroke decreased. Although there was a decrease in probability of deaths associated with falls, there was an increase of deaths due to 'frailty' (as judged by falls, pneumonia and septicaemia). CONCLUSIONS: cancer is a major cause of death in the elderly population of Taiwan. This rapidly expanding elderly population seemed to suffer from poorer health in the later period of their life.

High prevalence of voiding symptoms in Taiwanese women.

OBJECTIVE: To describe the voiding symptoms of Taiwanese women using the International Prostate Symptom Score (IPSS). SUBJECTS AND METHODS: A self-administered questionnaire was used to collect information on demographic characteristics and the IPSS used to determine the voiding symptoms of 583 consecutive women undergoing a health examination. The symptom scores of different age groups were compared using a one-way analysis of variance with a posteriori comparisons made using Scheffe's test. RESULTS: The seven symptom scores could be separated by factor analysis into two factors which corresponded with obstructive (incomplete emptying, intermittency, weak stream, and hesitancy) and irritative (frequency, urgency, and nocturia) symptoms. Various degrees of frequency and nocturia were commonly reported by the respondents, whereas obstructive symptoms were infrequently reported, except in the elderly (age > or = 65 years). The irritative scores, obstructive scores and total scores increased significantly with age (all P<0.001). The total symptom scores correlated significantly with the quality-of-life score (Pearson's r = 0.70, P < 0.001). Overall, 124 (21%) of the respondents reported an IPSS of > 7, and 98 (17%) of the respondents reported being 'mostly dissatisfied' with their urination. However, only nine (1.5%) of the respondents had ever consulted a urologist about their voiding problems. CONCLUSIONS: There was an age-dependent change in voiding symptoms in these Taiwanese women. The prevalence of voiding symptoms in women is much higher than encountered in clinical practice.