Health-related quality of life among cancer survivors in rural China.

PURPOSE: The purpose of the study was to examine health-related quality of life (HRQoL) about the most common cancers survivors (lung, stomach, colorectal, breast, and esophageal cancer) in rural China. METHODS: We administrated a cross-sectional study in three counties in Shandong province from August to September 2017. The five-level EuroQol-5-dimension (EQ-5D-5L) questionnaire was used to measure the HRQoL among cancer patients at least 8 months post-diagnosis. The Chinese population-based preference trade-off time (TTO) model and discrete choice experiment (DCE) were used to convert the EQ-5D-5L utility score. Tobit regression model was used to identify independent associations between socio-demographic, clinical variables with the HRQoL. RESULTS: In total, 452 cancer survivors were included. The mean EQ-5D-5L utility scores and Visual Analog Scale (EQ-VAS) scores were 0.841 (SD = 0.233) and 70.35 (SD = 18.80) for cancer survivors, respectively. Among the five dimensions, 58.6% of survivors had at least slight levels of pain/discomfort, and 39.2% showed at least slight levels of anxiety/depression. The influencing factors of HRQoL included cancer stage at diagnosis, tumor site, comorbidities, annual household income, and migrant worker status (rural-to-urban migration). Compared to other cancer patients, lung cancer patients had the lowest HRQoL. Higher household income and being a migrant worker were associated with a higher HRQoL for cancer survivors. CONCLUSIONS: Cancer survivors in rural China have deteriorated HRQoL, and a substantial number of survivors have pain/discomfort problems. Our study provides detailed data on HRQoL of rural cancer survivors for future supportive and survivorship care in China.

Pharmacological therapy and blood pressure control in primary health care sites in China: data from 254,848 hypertensive patients.

BACKGROUND: Studies on pharmacological therapy and blood pressure (BP) control in primary health care sites of China are limited. We aimed to investigate drug use and compliance as well as compare BP control between pharmacological therapies for lowering BP in hypertensive population serviced by these sites. METHODS: This is a 1-year cohort study using electronic health care records from the National Primary Public Health Services of China. For patients with antihypertensive drugs at the first follow-up, we defined compliance with treatment as a continued treatment with the same specified class of agents at next three follow-ups. In those with compliance, BP control was defined as systolic BP <140 mmHg and diastolic BP <90 mmHg in four follow-ups within 1 year. RESULTS: Primary health care sites of four areas managed 254,848 hypertensive patients aged ≥35 years. At the first follow-up, 50.2% of the patients took medicines for lowering BP. In those, calcium channel antagonist monotherapy was the most common medicine in urban areas (57.1% vs 15.6% in rural areas, P<0.001); however, the most common one was single-pill combinations including diuretics and non-first-line drugs in rural areas (34.4% vs 10.7% in urban areas, P<0.001). Compliance was 79.9% and 53.2% for single- and multiple-pill combinations in first-line drugs; this rate was 69.5% and 45.0% in regimens combined with non-first-line drugs, respectively. Compared with calcium channel antagonists, diuretics monotherapy increased the overall BP control by 11% (risk ratio, 1.11; 95% confidence interval, 1.08 to 1.13), but it was used in few patients (3.3%); first-line multiple-pill combinations significantly decreased BP control by 20% to 28% in three less urbanized areas, but a similar BP control was achieved in the highly urbanized area. CONCLUSION: Our study indicated that drug use such as diuretics could be strengthened in primary health care sites and combined therapy may be improved particularly in less urbanized areas.