Testis Tümörü Tedavisinde Hayat Kalitesi Dr. Cenk ACAR Pamukkale Üniversitesi Üroloji Anabilim Dalı SAĞLIĞIN TANIMI (WHO) Sağlık sadece hastalığın bulunmaması değil, tam bir fiziksel,mental ve sosyal iyilik halidir. HRQoL • Hastalar tarafından bildirilen en önemli sonuç, “Sağlıkla İlişkili Yaşam Kalitesi(HRQoL)”dir. • Sadece genel iyilik hali değil, ▫ ▫ ▫ ▫ ▫ Somatik semptomlar Fonksiyonellik Duygusal iyilik Sosyallik Vücut İmajı HRQoL Araştırmaları • Temel Amaç: ▫ Tıbbi bakımı iyileştirmek ▫ Tıbbi açıdan karar vermeye yardımcı olmak Üroloji’deki HRQoL araçları www.proqolid.org HRQoL Araçları HRQoL • Birbirlerinden etkilenirler Genel Kansere Özgü • HRQoL verilerini yazarken aralarındaki etkileşimler önemlidir. HRQoL GENEL KANSERE ÖZGÜ • RAND Medical Outcomes Study-36 item Health Survey (SF-36) • European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQC-30) • Quality of Well-Being Scale (QWB) • Sickness Impact Profile (SIP) • Notthingam Health Profile • Functional Assessment of Cancer Therapy (FACT) • Cancer Rehabilitation Evaluation System (CARES) SF-36 • • • • Altın Standart 8 farklı yaşam başlığını 36 soruda ele alır. 10 dakika civarında doldurma süresi Daha da kısaltılmış formu : SF-12 • Üroonkoloji Derneği tarafından hesaplama formülü mevcut. EORTC QLQC-30 • 30 sorudan oluşmaktadır. ▫ 6 fonksiyonel skala ▫ 3 genel sağlık skalası ▫ 6 tek soru ( dispne, insomnia, iştah azalması, konstipasyon/diyare, maddi zorluk • Üroonkoloji Derneği tarafından türkçe validasyonu yapılmıştır. Literatür Taraması • Testis Tm. Hayat Kalitesi • 1989-2011 tarihleri arasında ▫ 32 orijinal makale ▫ 1 AUA meeting 2011 abstract ▫ 4 derleme HRQoL Instruments Author Year Spiegel et al. Patient Number Patient Groups 2011 seminom, non-seminom Wefel et al. NSGCT before Chemo, healthy 2011 population norms Kim et al. 2011 Testis tm, non-testis tm Osmanska et al. 2010 during Chemo, 6 mo. After Chemo Baseline,post-Chemo or 3 mo. after Vidrine et diagnosis in surveillance group, 12 al. 2010 mo after diagnosis sf-36 eortc qlqc30 phq-9 gad-7 iief 193 NA Journal AUA meeting neuropsyhcological tests anxiety (STAIS) depression (CES-D) Sf-36 WHOQoL-BREF Hospital Anxiety Depression Scale (HADS) 69 Cancer 482 Qual Life Res 111 Psyciatr Pol 116 Urology Sf-36 Testis tm, age-matched population Dahl et al. 2010 control sf-36 HADS Rosenberg Self-esteem scale(RSES) BMI Rossen et al. eortc qlqc30 Depression ( Beck Depression Inventory-2) Fatigue (Multidimensional Fatigue Inventory-20) neurotoxic symptoms Raynaud-like phenomena 2009 Surveillance, RT, Chemo Follow-up (year) 1291(testis tm) 401 11 J cancer Surviv 12,2 J Clin Oncol HRQoL Instruments Patient Follow-up Number (year) Author Year Patient Groups Skaali et al. 2009 testis tm Testis tm, general Orre et al. 2008 population before Chemo, after Tuinman completion, 1 year et al. 2007 after Chemo sf-36 HADS RSES Brief Approach/Avoiding Coping Questionnaire (BACQ) Fatigue Questionnaire(FQ) Cancer Related stress:Impact of Event Scale (IES) Mini- International Neuropsychiatric Interview (MINI) Neuroticism: Eysenck Personality Questionnaire (EPQ18) sf-36 FQ EPQ-18 HADS IES Brief Sexual Function Inventory (BSFI) SF-36 IES sf-36 Conventional Chemo, Visual analog scale Rotterdam Symptom Checklist Buijs et al. 2007 high dose Chemo Fleer et al. 2006 Testis tm Fleer et al. 2006 Testis tm Fleer et al. 2006 Testis tm IES Impact of Traumatic Stressors Interview Schedule (ITSIS) IES SF-36 The Happiness index SF-36 Journal 1336 11,4 Psycho-Oncology 1431 j Psychosomatic 11 Res 70 Support Care Cancer 804 4,8 J Clin Oncol 354 Patient ed and NA counseling 354 354 NA Qual Life Res Support Care 10 Cancer HRQoL Instruments Author Year Patient Groups Patient Follow-up Number (year) Journal Lymphomas-breast-testis 2005 tm.,healthy control Astrand-Rhyming indirect bicycle ergometer test eortc qlqc30 HADS 111 J Clin Oncol Huddart et al. 2005 Chemo,RT, Surveillance, control eortc qlqc30 fertility, gonadal and sexual function LH,FSH,testosterone 640 4 Br J Cancer Tuinman et al. during testis tm treatment, after 2005 treatment (survivor) Maudsley Marital Questionnaire marital and sexual satisfaction 259 Support Care 9,3 Cancer SF-36 IES 1409 11 J Clin Oncol life style factor (Level of Physical Activity(LPA)) HADS 1260 Support Care NA Cancer 130 Oncol Rep Thorsen et al. Mykletun et al. 2005 Testis tm, general population Thorsen et al. 2005 Testis tm, general population Miyake et al. 2004 Chemo±RPLND,RT,Surveillance Tuinman Testis tm patients and their et al. 2004 spouses Miyake et standart-dose Chemo, high dose al. 2004 Chemo, surveillance Trask et al. Thorsen et al. SF-36 SF-36 IES 259 9,3 Eur J Cancer 102 3 Int J Urol 16 PsychoNA Oncology SF-36 2003 prior, during, after Chemo Brief Symptom Inventory-53 (BSI) Functional Assessment of Cancer Treatment-General (FACT-G) Chemo,RT, RPLND, general 2003 population LPA BMI Co-morbidity 1276 12 Eur J Cancer HRQoL Instruments Author Year Fegg et al. Rudberg et al. Caffo et al. Fossa et al. Özen et al. Patient Groups 2003 before Chemo, after Chemo 2002 Testis tm, general population 2001 RT for seminoma Sociodemographic data Questionnaire for germcell tumour patient in surveillance-33 Questionnaire on partnership and sexual functioning-19 Gothenburg Quality of life Instrument (GQL) Swedish HRQoL Questionnaire (SWEDQUAL) Symptom Checklist Questionnaire of Quality of Life-44( nonvalidated) Bialteral orchiectomy patients under androgen replacement 1999 therapy eortc qlqc30 General Health Questionnaire (GHQ-28) IES, LH, FSH,SHBG Physicosocial Adjustment to Illness scale (PAIS) 1998 various General Health questionnaire-28 general survey Patient Number Follow-up (year) Journal 341 9,6 Br J Cancer 392 98 11 Cancer Nursing Radiather and 10 Oncol 43 NA Eur J Cancer 140 NA J Urol Arai et al. 1996 Chemo±RPLND,RT,Surveillance psycosocial well-being working ability Satisfaction Relationship general health and fitness 83 NA J Urol Stuart et al. General health subjective side effect Employment Relationship reproduction and mood 62 NA Eur J Cancer Spitzer QL- index work activities emotional relationship 31 NA J Urol 1990 Chemo, RT Tamburin i et al. 1989 Chemo,RPLND, combination, RT Çalışma Önerileri • KESİTSEL ÇALIŞMA BÖBREK TÜMÖRÜ HAYAT KALİTESİ Dr. Cenk Acar Pamukkale Üniversitesi Üroloji Anabilim Dalı Literatür Taraması • Böbrek Tm. Hayat Kalitesi • 2002-2011 tarihleri arasında ▫ 8 orijinal makale HRQoL Instruments Author Year Novara et al. 2010 Patient Groups Radical nephrectomy (open and lap) vs partial nx Beemster et al. 201o Laparoscopic cryoablation Gratzke Retro radical nx, Open rad nx, et al. 2009 partial nx Onishi et al. 2007 percutaneous RFA, Lap radical nx Dillenbur Retro rad nx vs open rad nx (T2 g et al. 2006 and T3a) Patel et al. Poulakis et al. Retro rad nx vs hand assisted rad 2005 nx 2003 Radical nx vs partial nx sf-36 Postoperative 6. and 12. mo SF-36 eortc qlqc30 VAS Baseline and 1 year Sf-36 SF-36 Pre and postoperatively(1,4,12 and 24 weeks) sf-36 3 an 6 mo after surgery SF-36 Eortc qlqc30 Fear, stress and worry Patient Number Follow-up (year) Journal 129 NA Eur Urol 57 NA J Endourol 117 2 BJU Int 37 NA Jpn J Clin Oncol 48 1 Eur Urol 51 NA J Endourol 357 At least 1 year Urology SF-36 Radical nx vs partial nx Ficarra V 2003 88 NA Int Urol Nephrol Çalışma Önerileri • KESİTSEL ÇALIŞMA
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