Benefit of temozolomide compared to procarbazine in treatment of glioblastoma multiforme at first relapse: effect on neurological functioning, performance status, and health related quality of life.

Since high-grade malignant gliomas can seldom be treated curatively, the main aim of first line therapy is to improve progression free survival (PFS), to reduce morbidity, and to preserve, if not restore neurological functions and the capacity to perform daily activities. Focusing on a single clinical efficacy parameter in clinical trials may provide a potentially biased result, as for patients the overall result of treatment entails a more complex picture of weighing and balancing gains and losses on different outcome measures. In this paper we address different clinical outcomes measures separately and we illustrate the value of multiple outcome measures using the results of a recent clinical trial comparing temozolomide with procarbazine in the treatment of Glioblastoma Multiforme. Compared with procarbazine, temozolomide not only prolonged PFS, but also maintained neurological functioning and performance status for a longer period of time, and also improved health-related quality of life (HRQL). All these statistically significant outcomes demonstrate a remarkable consistency. In addition, temozolomide showed a trend of extending overall survival over procarbazine.

Health-related quality of life in patients with advanced metastatic melanoma: results of a randomized phase III study comparing temozolomide with dacarbazine.

Health-related quality of life (HRQL) is a crucial endpoint in the evaluation of treatments that have limited survival benefits. The HRQL evaluations help ensure that patients are not sacrificing life quality for quantity. Current treatments for metastatic melanoma are primarily palliative, because cure is unattainable. The purpose of this article is to report detailed HRQL results of a phase III clinical trial comparing temozolomide to dacarbazine (DTIC) in patients with metastatic melanoma. Patients were randomized to receive either oral temozolomide for 5 days every 4 weeks or intravenous DTIC for 5 days every 3 weeks. The HRQL was evaluated on day 1 cycle 1 and after each subsequent treatment cycle using the EORTC QLQ-C-30. The HRQL was compared between groups at weeks 12 and 24. Patients treated with temozolomide reported significantly better physical functioning and less fatigue and sleep disturbances than patients treated with DTIC at week 12. For all but two function and symptom subscales, EORTC QLQ-C30 subscale scores were numerically better for patients treated with temozolomide at week 12. All subscales except diarrhea were better for temozolomide at week 24. Analyses of change scores revealed that patients treated with temozolomide reported statistically significant improvements in emotional well-being and sleep disturbance. Patients also reported near significant change in cognitive functioning (3.9, p = 0.06). Patients treated with DTIC deteriorated on most function subscales and many symptom subscales at week 12. Deterioration in physical functioning approached significance (-6.8, p = 0.06). At week 24, patients treated with DTIC improved on the emotional functioning subscale and deteriorated on the physical, role, and global HRQL subscales, although many of the symptom scores improved. The results of this study suggest that treatment with temozolomide leads to important functional improvements and decreased symptoms compared to treatment with DTIC in patients being treated for metastatic melanoma.

Atopic dermatitis is associated with a decrement in health-related quality of life.

BACKGROUND: Although atopic dermatitis is a chronic skin disease that can have a major impact on a patient's life, the burden of illness associated with this condition has not been well characterized. OBJECTIVE: To determine the health-related quality of life (HRQL) of patients with atopic dermatitis by disease severity and to compare it with that of the general public and of patients suffering from other chronic illnesses or skin disorders. METHODS: Two hundred and thirty-nine atopic dermatitis patients aged 4-70 years completed the Medical Outcomes Study Short Form-36 Health Survey (SF-36) and the Dermatology Life Quality Index (DLQI) or the Children's Dermatology Life Quality Index. These HRQL scores were compared by self-reported patient disease severity ratings. Health-related quality of life scores were compared with those of the general population and those of patients with other chronic conditions (clinical depression, hypertension, type 2 diabetes) or skin disease (psoriasis). Dermatology Life Quality Index scores were also compared with those of other skin diseases (such as psoriasis, Darier's disease, and Hailey-Hailey disease). RESULTS: Patients with atopic dermatitis had inferior scores on the SF-36 vitality, social functioning, and mental health subscales compared with individuals in the general population. In seven of eight subscales, individuals reporting more severe disease had inferior DLQI and SF-36 scores. Patients with atopic dermatitis had inferior mental health scores compared with those with diabetes or hypertension, and inferior social functioning scores compared with patients with hypertension. When compared with a psoriasis cohort, patients with atopic dermatitis had inferior scores in the role-physical, vitality, social functioning, role-emotional, and mental health SF-36 domains. Patients with atopic dermatitis had similar DLQI scores to patients with other chronic dermatologic diseases. CONCLUSIONS: These results demonstrate that atopic dermatitis has an impact on HRQL, particularly in social functioning and psychological wellbeing. Patient-assessed severity of atopic dermatitis correlates with HRQL decrements, indicating greater HRQL impact with greater disease severity. Atopic dermatitis has as large an impact on HRQL as several chronic conditions and other dermatologic conditions.

La dermatitis atópica se asocia con unadisminución de la calidad de vida relacionadacon la salud / Atopic dermatitis is associated with a decrement in health-related quality of life

Antecedentes: Aunque la dermatitis atópica es una enfermedad crónica de la piel que puede ejercer un impacto importante sobre la vida del paciente, la carga de enfermedad asociada con esta situación no se ha definido totalmente. Objetivo: Determinar la calidad de vida relacionada con la salud (CVRS) de los pacientes con dermatitis atópica en relación con la gravedad de la enfermedad y compararla con la de la población general y con la de pacientes que padecen otras enfermedades crónicas o trastornos de la piel. Métodos: Doscientos trece y nueve pacientes con dermatitis atópica de 4 a 70 años rellenaron el Cuestionario de Formato Corto para el Estudio de Variables Médicas (SF-36), el Índice de Calidad de Vida en Dermatología (ICVD) y el Índice de Calidad de Vida Infantil en Dermatología. Estas puntuaciones de CVRS se compararon mediante puntuaciones de la gravedad de la enfermedad autodefinidas por los pacientes. Las puntuaciones de calidad de vida relacionadas con la salud de los pacientes se compararon con las de la población general y con la de los pacientes con otras enfermedades crónicas (depresión clínica, hipertensión, diabetes tipo 2) o de la piel (psoriasis).Las puntuaciones del Índice de Calidad de Vida en Dermatología (ICVD) también se compararon con las de otras enfermedades de la piel (como psoriasis, enfermedad de Darier y enfermedad de Hailey-Hailey).Resultados: Los pacientes con dermatitis atópica tuvieron puntuaciones menores en el SF-36 y en las subescalas de vitalidad, funcionamiento social y salud mental que los individuos de la población general. En siete de ocho subescalas, los individuos con mayor gravedad de la enfermedad tuvieron un ICVD menor y puntuaciones SF-36 menores. Los pacientes con dermatitis atópica tuvieron puntuaciones de salud mental inferiores que los pacientes con diabetes o hipertensión y puntuaciones de funcionamiento social inferiores que los pacientes con hipertensión. Cuando se compararon con una serie de pacientes con psoriasis, los pacientes con dermatitis atópica tuvieron puntuaciones inferiores en las subescalas de rendimiento físico, vitalidad, funcionamiento social, rol emocional y salud mental de la SF-36. Los pacientes con dermatitis atópica tuvieron puntuaciones ICVD similares a las de los pacientes con otras enfermedades dermatológicas crónicas. Conclusiones: Estos resultados demuestran que la dermatitis atópica puede ejercer algún impacto sobre la CVRS, particularmente en el funcionamiento social y en el bienestar social. La dermatitis atópica valorada por el paciente se correlaciona con los descensos de CVRS, lo que indica el mayor impacto de la CVRS al aumentar la gravedad de la enfermedad. La dermatitis atópica ejerce un gran impacto en la CVRS, igual que algunas enfermedades crónicas y otras enfermedades dermatológicas (AU)