Comparison of the quality of life between patients with non-small-cell lung cancer and healthy controls.

PURPOSE: We explored covariates of the quality of life (QOL) in non-small-cell lung cancer (NSCLC) patients and made a comparison with healthy controls. METHODS: We assessed the QOL of 220 consecutive NSCLC patients at a university hospital. The QOL data were measured by the brief version of the World Health Organization's Quality of Life and by utility using the standard gamble method. We selected demographically matched healthy controls from the 2001 National Health Interview Survey for comparison. Multiple linear regression models were constructed to explore significant factors of QOL after controlling for covariates. RESULTS: Patients with more advanced stages of NSCLC had poorer scores than did the healthy controls in the physical and psychological domains. Patients with disease duration of longer than 1 year tended to report higher physical and environment QOL than did those with NSCLC diagnosed for less than 1 year. Insight into one's own illness was associated with a higher utility, better social support, and improved financial resources. CONCLUSIONS: QOL was significantly associated with staging and duration of NSCLC. Disease insight appears to be a positive factor for operable NSCLC patients of the Taiwanese culture, which implies that clinicians should respect patient autonomy in diagnosis disclosure.

Lifetime medical expenditure and life expectancy lost attributable to smoking through major smoking related diseases in Taiwan.

OBJECTIVE: To estimate the lifetime financial burden on Taiwan's national health insurance (NHI) system, life expectancy and years of life expectancy lost (YLEL) attributable to smoking from major smoking related diseases. METHODS: 10 major smoking related diseases (seven cancers, stroke, acute myocardial infarction and chronic obstructive pulmonary disease) were selected for this study. A survival analysis was conducted on linked cohorts from the National Death Registry database and the National Cancer Registry (NCR) and patients at the National Taiwan University Hospital (NTUH). Estimation of the smoking attributable fraction (SAF) for the study diseases was undertaken by combining the relative risks of smokers against non-smokers and the prevalence of smoking in Taiwan. The YLEL attributable to smoking was calculated for the study diseases by combining the survival analysis results, the SAF and the annual incidences of each disease. The lifetime medical expenditure for the study diseases was estimated by integrating the survival curve and the mean annual medical costs calculated from NHI reimbursement records. RESULTS: There were 241 280 incidents of the 10 study diseases in 2001, of which about 53 648 cases (22.2%) were attributable to smoking, with a total YLEL of 191 313 at an average of about 3.6 YLEL per case. For each case, the average survival time was about 10.2 years. Under two different annual discount rates, the total lifetime financial burden on the NHI was estimated at between $291 million ( pound 147 million; euro 216 million) (3% discount) and $336 million (1% discount) for all diseases attributable to smoking in 2001, accounting for about 24.6% of the total estimated lifetime medical expenditure for all incidents of the 10 study diseases. CONCLUSIONS: Smoking places tremendous financial and health burdens upon both society and individuals. A much more stringent tobacco control strategy is needed to curb the damage from smoking.

Cultural adaptation of the WHOQOL questionnaire for Taiwan.

This brief report describes cultural adaptation of the WHOQOL-100 questionnaire for Taiwan. The standard cultural adaptation procedure was used for questionnaire translation, response scale generation, and national items design. A field test was conducted on 1068 participants randomly selected from 17 hospitals all over Taiwan. Several psychometric criteria were used for selecting 12 out of the 20 national items previously proposed from three focus groups. In terms of reliability and validity, the psychometric properties of the culturally adapted WHOQOL questionnaire are good and the values are comparable with those in studies conducted in 15 countries.

Quality of life in patients with hepatocellular carcinoma received surgical resection.

BACKGROUND: Hepatocellular carcinoma (HCC) is one the most common malignancies in the world. As the prognosis for HCC patients is poor, the quality of life (QOL) is becoming more important on the outcome assessments. The aim of this study was to evaluate QOL in HCC patients. METHODS: A total of 161 patients with HCC were enrolled at a university hospital. Most of these patients received surgical resections. They were assessed with Taiwan versions of WHOQOL-BREF, EORTC QLQ-C30, and utility measures. The WHOQOL-BREF domain scores for the HCC patients were compared to healthy normative Taiwan population, using general linear models controlling for gender and age. Multiple logistic regressions were applied to explore association between a better QOL and clinical/sociodemographic variables. RESULTS: Compared with healthy people, the HCC patients had reduced QOL in physical domains, but better environmental QOL. After controlling gender, age, education, and employment, duration of HCC more than 1 year was associated with better QOL scores. WHOQOL-BREF could be cross-validated with EORTC QLQ-C30. CONCLUSIONS: Survival over 1 year was associated with better QOL in HCC patients. WHOQOL-BREF could be a valid QOL instrument for the assessments of QOL in HCC patients.

Development and verification of validity and reliability of the WHOQOL-BREF Taiwan version.

BACKGROUND AND PURPOSE: The World Health Organization (WHO) initiated a cross-cultural project to develop the World Health Organization Quality of Life (WHOQOL) questionnaire. This paper describes how the brief version of this questionnaire was adapted for use in Taiwan and the results of validity and reliability testing. SUBJECTS AND METHODS: Data were collected from 1,068 subjects randomly sampled from 17 hospitals throughout Taiwan. According to the psychometric criteria of the WHO, two (culturally relevant) national items were selected, each from a culture-specific facet that was proposed for Taiwan in a previous study. psychometric properties (factor structures and various types of reliability and validity) were assessed for this brief questionnaire. RESULTS: Exploratory and confirmatory factor analyses revealed a four-factor (physical, psychological, social, and environmental) model. The internal consistency (Cronbach's alpha) coefficients ranged from 0.70 to 0.77 for the four domains. The test-retest reliability coefficients with intervals of 2 to 4 weeks ranged from 0.41 to 0.79 at item/facet level and 0.76 to 0.80 at domain level (all p < 0.01). Content validity coefficients were in the range of 0.53 to 0.78 for item-domain correlations and 0.51 to 0.64 for inter-domain correlations (all p < 0.01). The four domains of the brief form can explain 88% of the variance of the total QOL score and 60% of the variance of the Facet G score (measuring overall quality of life and general health). CONCLUSIONS: This culture-specific study shows that this adaptation of the brief form is a good alternative to the long form of the WHOQOL questionnaire for use in Taiwan.

Health risk assessment on residents exposed to chlorinated hydrocarbons contaminated in groundwater of a hazardous waste site.

We conducted this study to estimate residents' chronic hazard and carcinogenic risk in a groundwater-contaminated community after on-site remediation in Taiwan during 1999-2000. We followed guidelines for assessing hazardous waste sites of the U.S. Environmental Protection Agency (EPA) and used empirically measured contaminant levels and exposure parameters to perform health risk assessment on seven chlorinated hydrocarbons. We measured groundwater concentrations of vinyl chloride, tetrachloroethylene, trichloroethylene, 1,1-dichloroethylene, 1,1,1-trichloroethane, cis-1,2-dichloroethylene, and 1,1-dichloroethane in 49 off-site residential wells by gas chromatography/mass spectrometry. Exposure parameters were mainly derived from our field survey of 382 residents, and partially from U.S. EPA default values. Total exposure dose estimation included routes of inhalation during showering and dermal absorption of showers and other activities involved with hand-water contacts. The ingestion route of water was not included because most residents drank boiled water with negligible contaminants. We calculated a hazard index (HI) for all seven chlorinated hydrocarbons and carcinogenic risks for known human carcinogen of vinyl chloride and probable human carcinogens of tetrachloroethylene and trichloroethylene, which had the same target organ, the liver. The HI values for reasonable maximal exposure (RME) and average exposure were 14.3 and 0.2, respectively. The cancer risks based on RME and average exposure (in parentheses) for vinyl chloride, tetrachloroethylene, and trichloroethylene were 8.4 x 10(-6) (7.3 x 10(-9)), 1.9 x 10(-4) (1.3 x 10(-7)), and 1.4 x 10(-4) (1.2 x 10(-6)), respectively. We applied Monte Carlo simulations to the sensitivity analysis, which showed that the contaminant levels, exposure duration, and time for showers were major determinants of health risks. We concluded that the contaminated groundwater was still unsafe for use even after the contaminated site underwent remediation by extraction and treatment in 1997.