Health-related quality of life in patients with advanced colorectal cancer: a predictive nomogram including BMI, sex and age.

BACKGROUND: Health-related quality of life (HRQoL) is not universally assessed in metastatic colorectal cancer (mCRC) patients. We tried to identify patient subgroups for whom HRQoL assessment should be strongly encouraged. METHODS: Consecutive mCRC patients who had been deemed candidates for first-line chemotherapy were enrolled in a prospective study (NCT03873064) and asked to complete the HRQoL questionnaire EORTC QLQ-C30. Primary endpoint was the Global Health Status (GHS) of EORTC QLQ-C30. A nomogram was built for prediction of low GHS (i.e., <67%). RESULTS: Among recruited patients (n=173), a univariable logistic regression analysis (LRA) found that body mass index (BMI <23), age (>65 years) and sex (female) were significantly associated with low GHS. The multivariable LRA confirmed they were independently associated with the outcome (P values of 0.04-0.004). BMI, age and sex were included in a final predictive model (C-statistics, 67%; P=0.001) and used to build a nomogram. A total nomogram score ≥72 was associated with a risk of 28% or higher of having a low GHS. The 28% risk cut-off had a sensitivity of 90% and a specificity of 34% for identifying low GHS. A decision curve analysis revealed that a risk threshold of 28% of the model was associated to an added net benefit of ≥4% when using the nomogram. Low GHS was recorded in 58% vs. 23% of patients with >28% vs. <28% risk according to the nomogram, respectively (odds ratio 3.54, P=0.0004). CONCLUSIONS: High BMI together with young age and male sex were protective against HRQoL deterioration. In centers where HRQoL is not routinely assessed, such an assessment should be at least made for mCRC patients at risk according to the proposed nomogram (i.e., over 65-year-old females with BMI <23).

Caregiver distress in the early phases of cancer.

BACKGROUND: Principal caregivers (PCs) of cancer patients experience high levels of stress that may significantly impact their quality of life (QoL). PCs' QoL during early phases of the disease (when patients were still on chemotherapy) were assessed. PATIENTS AND METHODS: The PCs of all patients meeting the inclusion criteria (chemotherapy, performance status 0/1) treated at our institution between June 2007 and March 2008 were asked to answer a dedicated questionnaire. RESULTS: One hundred and four PC-patient pairs participated in the study. Most of the caregivers (52%) spent more than 8 h daily caring for the patient, they also frequently reported the occurrence of new psychosomatic disorders, with the most reported symptoms being sleep disruption (24%), headaches (20%) and asthenia (16%). High levels of anxiety and depression were demonstrated in nearly a quarter of the study subjects. In nearly half of the cases, a substantial increase in monthly family expenses and restriction of recreation activities were reported. The overall gravity of the medical situation was perceived as severe by 86% of the PCs. CONCLUSION: Demonstrable PC QoL impairment occurs even at early phases of disease, therefore intervention strategies for caregivers should be considered early during cancer treatment.

[Assessment of simulation and dissimulation in the MMPI-2 test profiles]. / La valutazione della simulazione e della dissimulazione nei profili del test MMPI-2.

UNLABELLED: The aim of this study is to identify the criteria which would allow a differentiation between the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) profiles, obtained from patients who present with problems of minimization of attitude (dissembling) who have shown a minimization of their problems; from patients who answered in a spontaneous and genuine fashion. METHODS: Six hundred and fifty five MMPI profiles of outpatients of the Clinical Psychology Unit, University Hospital, Sapienza University of Rome. Patients were subdivided into two groups, based on the reason for attending: those who submitted voluntarily to a psychodiagnostic assessment and those who were assessed by request of an outside authority, e.g., in the case of those whose driving license was suspended. It has hypothesized that the latter group would not present with problems which would preclude obtaining the benefits required. The variables analyzed were the clinical scale and the validity scale MMPI-2, index F-K and the Ds scale of Gough. On the basis of the values of the F-K index and Ds scale, the patients were reclassified into three simulation categories: spontaneous registration; defended and doubtful's. RESULTS: All indexes, validity scales and clinical scales of the standard profile were found to have significant differences between the "dissimulation" and "normal" groups. Sensibility and specificity of profile classification was according to both indexes 76%. CONCLUSIONS: Current evidence indicates that simulation of pathology is identifiable in MMPI-2 profiles. Our data demonstrate that it is possible to identify case of defensive minimization. These results confirm the hypothesis that simulation is a dimensional characteristic of MMPI which can reach extreme values in both ways: worsening of slight problems or suppression of existing problems.