• A qualitative exploration of a respiratory distress symptom cluster in lung cancer: cough, breathlessness and fatigue.

      Molassiotis, A; Lowe, M; Blackhall, Fiona H; Lorigan, Paul C; School of Nursing, Midwifery & Social Work, University of Manchester, University Place, Manchester M13 9PL, UK. alex.molassiotis@manchester.ac.uk (2011-01)
      There is a growing awareness that symptoms frequently co-occur in 'symptom clusters' and that understanding these clusters may improve the management of unrelieved symptoms in patients. In-depth longitudinal exploration of lung cancer patients' symptom experiences is used to examine patient symptom experiences and distress across the disease trajectory of lung cancer.
    • A qualitative study exploring perceptions and experiences of patients and clinicians of Palliative Medicine Outpatient Clinics in different settings.

      Cawley, Declan; Waterman, D; Roberts, D; Caress, A; Christie Hospital NHS Foundation Trust, UK. (2010-08-18)
      Palliative care exists in a variety of settings and palliative care teams form many guises within this. A Palliative Medicine Outpatient Clinic (PMOC) exists to meet the flexible provision of the needs and preferences of individuals within whatever care setting they reside. This explorative study used a qualitative methodology, capturing patients' actual experience of care in preference to their satisfaction, as this is a more accurate measure of how and what patients judge as important in their healthcare. The overall themes in this paper point to the 'value' that patients perceived from attending the PMOC and how important the clinics were to clinicians that provided the care. The clinic facilitates much more than symptom control and here lies the challenge in how we convert the very positive experience of individuals into a language of outcome measures that captures the 'essence' of our work in this fiscally driven health economy.
    • Qualitätssicherung der Analytik von Wachstumshormon und Insulin-Like Growth Factor I bei Erkrankungen der somatotropen Achse

      Bidlingmaier, M; Hauffa, B P; Trainer, Peter J; Etzrodt-Walter, G; Sauer, J; Kratzsch, J; Petersenn, S; Ranke, M B; Wallaschofski, H; Strasburger, C J; et al. (De Gruyter, 2015-01-01)
      Zusammenfassung Hintergrund: Eine zuverlässige Laboranalytik bildet einen Grundpfeiler für die Diagnostik, Therapie und Verlaufskontrolle von Wachstumsstörungen und Störungen der Sekretion von Wachstumshormon (GH) und Insulin-Like Growth Factor I (IGF-I). Die gegenwärtig verfügbaren kommerziellen Assays weisen jedoch Defizite auf, die zu großen Unterschieden der gemessenen Hormonkonzentrationen führen. Methode: Empfehlungen eines Expertenworkshops mit klinisch tätigen Endokrinologen aus Pädiatrie und Innerer Medizin sowie mit Labormedizinern unter Bezugnahme auf die Ergebnisse der interdisziplinären Konsensus-Konferenz in Keswick (Virginia, USA) aus dem Jahr 2009. Ergebnisse: Zu den von den Workshopteilnehmern geforderten Qualitätskriterien für GH- und IGF-I-Assays zählen die Verwendung einheitlicher Referenzstandards, die Dokumentation der analytischen Bedingungen – unter anderem in Bezug auf Kalibratoren, Bindungsepitope, Kreuzreaktivität und Methoden zur Trennung von Bindungsproteinen –, die Chargenkonstanz und eine geringe Interassay-Variabilität. Die Teilnehmer empfehlen, Grenzwerte und Referenzintervalle assayspezifisch unter Verwendung großer und gut charakterisierter Referenzpopulationen zu erarbeiten und die Assayqualität insbesondere im Bereich klinisch wichtiger Entscheidungsgrenzen zu beschreiben. Schlussfolgerungen: Diagnostikahersteller sollten verpflichtet werden, die Umsetzung der Qualitätskriterien regelmäßig zu überwachen und darüber Bericht zu erstatten. Nur Assays, die nach einheitlichen Qualitätsstandards evaluiert sind und im klinischen Kontext eingesetzt werden, erlauben eine rational begründete Diagnostik und Therapie von Patienten mit Störungen der GH-Sekretion und vermeiden unnötige Belastungen der Patienten und Kostenträger.
    • Quality and quality assurance in the health care setting: an equitable life?

      Timpson, Joanne R; Manchester College of Midwifery and Nursing Stanley House, Christie Hospital, Wilmslow Road, Withington, Manchester M20 4BX, UK. (1996-01)
      Research studies alluding to quality and quality assurance within the health care arena are increasingly utilized to justify management initiatives, particularly in relation to the provision and resourcing of patient services, both within the institutional and community setting. The following paper considers the role and utility of quality indicators and presents a critical analysis of the literature pertaining to the concept of quality as it applies to the provision and organization of health care and the relationship between quality assurance and patient satisfaction per se. The paper concludes with a dual challenge not only to nurses to better understand and articulate the specific contribution of the discipline, particularly in relation to positive patient outcomes, but also to current, narrow focused interpretations of quality assurance and calls for definitions of quality to reflect an appreciation of the particular involvement and role of the patient in determining policy affecting care provision.
    • Quality assurance of the dose delivered by small radiation segments.

      Hansen, V N; Evans, P M; Budgell, Geoff J; Mott, Judith; Williams, Peter C; Brugmans, M J; Wittkämper, F W; Mijnheer, B J; Brown, K; Joint Department of Physics, Royal Marsden NHS Trust and Institute of Cancer Research, Sutton, Surrey, UK. (1998-09)
      The use of intensity modulation with multiple static fields has been suggested by many authors as a way to achieve highly conformal fields in radiotherapy. However, quality assurance of linear accelerators is generally done only for beam segments of 100 MU or higher, and by measuring beam profiles once the beam has stabilized. We propose a set of measurements to check the stability of dose delivery in small segments, and present measured data from three radiotherapy centres. The dose delivered per monitor unit, MU, was measured for various numbers of MU segments. The field flatness and symmetry were measured using either photographic films that are subsequently scanned by a densitometer, or by using a diode array. We performed the set of measurements at the three radiotherapy centres on a set of five different Philips SL accelerators with energies of 6 MV, 8 MV, 10 MV and 18 MV. The dose per monitor unit over the range of 1 to 100 MU was found to be accurate to within +/-5% of the nominal dose per monitor unit as defined for the delivery of 100 MU for all the energies. For four out of the five accelerators the dose per monitor unit over the same range was even found to be accurate to within +/-2%. The flatness and symmetry were in some cases found to be larger for small segments by a maximum of 9% of the flatness/symmetry for large segments. The result of this study provides the dosimetric evidence that the delivery of small segment doses as top-up fields for beam intensity modulation is feasible. However, it should be stressed that linear accelerators have different characteristics for the delivery of small segments, hence this type of measurement should be performed for each machine before the delivery of small dose segments is approved. In some cases it may be advisable to use a low pulse repetition frequency (PRF) to obtain more accurate dose delivery of small segments.
    • Quality control aspects of the Philips multileaf collimator.

      Hounsell, Alan R; Jordan, Thomas J; North Western Medical Physics, Christie Hospital NHS Trust, Manchester, UK. (1997-12)
      BACKGROUND AND PURPOSE: Linear accelerators equipped with multileaf collimators (MLCs) are becoming more common and are widely available from most commercial manufacturers. There is a need to ensure they retain their commissioning specification using a preventative maintenance and quality control (QC) programme. This paper considers the design criteria of the Philips MLC which are important to the production of a comprehensive quality control programme. MATERIALS AND METHODS: The specific QC problems related to MLCs are identified as the positional accuracy of the leaves and their relationship to the back-up collimators, leakage considerations, the relationship of X-ray to light field and the influence of gravity on the positioning and leakage characteristics of the leaves. These problems are considered in relation to the general design considerations of the MLC, and methods of performing routine quality control checks are discussed. RESULTS AND CONCLUSIONS: The introduction of MLCs into clinical use results in new QC procedures being developed but it can be concluded that for the Philips MLC only an extra 30 min of QC time is needed per month and that its use has added little to the general down-time of this department.
    • Quality control in cervical cytology.

      Husain, O A; Butler, E B; Evans, D M; Macgregor, J E; Yule, R; St. Stephen's Hospital, London (1974-12)
      From surveys conducted by the authors it is concluded that the best and most acceptable quality control methods in cytology are those from within the laboratory. Most of these have results which can be reported centrally. Where the overall control and codes of practice are high, there the results are the most reliable, as sources of error from whatever cause are quickly brought to light. These conclusions are illustrated by data from the five centres and correlated in the tables.
    • Quality control in cone-beam computed tomography (CBCT) EFOMP-ESTRO-IAEA protocol (summary report).

      de Las Heras Gala, H; Torresin, A; Dasu, A; Rampado, O; Delis, H; Hernández Girón, I; Theodorakou, Chrysoula; Andersson, J; Holroyd, J; Nilsson, M; et al. (2017-06-08)
      The aim of the guideline presented in this article is to unify the test parameters for image quality evaluation and radiation output in all types of cone-beam computed tomography (CBCT) systems. The applications of CBCT spread over dental and interventional radiology, guided surgery and radiotherapy. The chosen tests provide the means to objectively evaluate the performance and monitor the constancy of the imaging chain. Experience from all involved associations has been collected to achieve a consensus that is rigorous and helpful for the practice. The guideline recommends to assess image quality in terms of uniformity, geometrical precision, voxel density values (or Hounsfield units where available), noise, low contrast resolution and spatial resolution measurements. These tests usually require the use of a phantom and evaluation software. Radiation output can be determined with a kerma-area product meter attached to the tube case. Alternatively, a solid state dosimeter attached to the flat panel and a simple geometric relationship can be used to calculate the dose to the isocentre. Summary tables including action levels and recommended frequencies for each test, as well as relevant references, are provided. If the radiation output or image quality deviates from expected values, or exceeds documented action levels for a given system, a more in depth system analysis (using conventional tests) and corrective maintenance work may be required.
    • Quality of life (QOL) in patients with acromegaly is severely impaired: use of a novel measure of QOL: acromegaly quality of life questionnaire.

      Rowles, Susannah V; Prieto, L; Badia, Xavier; Shalet, Stephen M; Webb, Susan M; Trainer, Peter J; Department of Endocrinology, Christie Hospital, Wilmslow Road, Manchester M20 4BX, United Kingdom. (2005-06)
      Acromegaly Quality of Life Questionnaire (AcroQoL) is a new disease-generated quality of life (QOL) questionnaire comprising 22 questions covering physical and psychological aspects of acromegaly and subdivided into "appearance" and "personal relations" categories. We have performed a cross-sectional study of QOL in 80 patients [43 male (mean age, 54.2 yr; range, 20-84); median GH, 0.93ng/ml (range, <0.3 to 23.7); IGF-I, 333.1 ng/ml (range, 47.7-899)] with acromegaly. In addition to AcroQoL, patients completed three generic QOL questionnaires: Psychological General Well-Being Schedule (PGWBS), EuroQol, and a signs and symptoms score (SSS). All three generic questionnaires confirmed impairment in QOL [mean scores: PGWBS, 69.6; EuroQol, visual analog scale, 66.4 (range, 20-100) and utility index, 0.7 (range, -0.07 to 0.92); and SSS, 12 (range, 0-27)]. There was no correlation between biochemical control and any measure of QOL. AcroQoL (57.3%; range, 18.2-93.2) correlated with PGWBS (r = 0.73; P < 0.0001); and in patients with active disease, AcroQoL-physical dimension correlated with SSS (r = -0.67; P < 0.0003). In all questionnaires, prior radiotherapy was associated with impaired QOL. In conclusion, these data underline the marked impact that acromegaly has on patients' QOL and provide the first evidence validating AcroQoL against well-authenticated measures of QOL. This indicates the potential of AcroQoL as a patient-friendly measure of disease activity.
    • Quality of life (QOL) results of the UK TACT2 trial: more intensive chemotherapy for early breast cancer (EBC) has a measurable impact on patient-reported symptoms and functioning (CRUK/05/019)

      Velikova, G; Morden, J; Barrett-Lee, P; Bloomfield, D; Brunt, M; Canney, P; Coleman, P; Russel, S; Verrill, M; Wardley, Andrew M; et al. (2015)
    • Quality of life after postmastectomy radiotherapy in patients with intermediate-risk breast cancer (SUPREMO): 2-year follow-up results of a randomised controlled trial.

      Velikova, G; Williams, L; Willis, S; Dixon, J; Loncaster, Juliette A; Hatton, M; Clarke, J; Kunkler, I; Russell, N; Leeds Institute of Cancer and Pathology, University of Leeds, Leeds Cancer Centre, St James's University Hospital, Leeds, UK (2018-10-15)
      Postmastectomy radiotherapy in patients with four or more positive axillary nodes reduces breast cancer mortality, but its role in patients with one to three involved nodes is controversial. We assessed the effects of postmastectomy radiotherapy on quality of life (QOL) in women with intermediate-risk breast cancer.
    • Quality of life and ability to work in patients at different disease stages of HER2+ breast cancer.

      Verrill, M; Wardley, Andrew M; Retzler, J; Smith, A; McNicol, D; Dando, S; Tran, I; Leslie, I; Schmid, P; The Newcastle Upon Tyne Hospitals NHS Foundation, Newcastle (2018-02-14)
    • Quality of life and patient-reported early adverse effects in prostate cancer patients treated with radiotherapy in the multi-center observational REQUITE study.

      Seibold, P; Rancati, T; Vega, A; Azria, D; Symonds, R; Johnson, K; Talbot, C; Veldeman, L; Choudhury, Ananya; De Ruysscher, D; et al. (2018)
    • Quality of life and utility in patients with metastatic soft tissue and bone sarcoma: the sarcoma treatment and burden of illness in North America and Europe.

      Reichardt, P; Leahy, Michael G; Garcia Del Muro, X; Ferrari, S; Martin, J; Gelderblom, H; Wang, J; Krishna, A; Eriksson, J; Staddon, A; et al. (2012)
      The aim of the study was to assess health-related quality of life (HRQoL) among metastatic soft tissue (mSTS) or bone sarcoma (mBS) patients who had attained a favourable response to chemotherapy. We employed the EORTC QLQ-C30, the 3-item Cancer-Related Symptoms Questionnaire, and the EQ-5D instrument. HRQoL was evaluated overall and by health state in 120 mSTS/mBS patients enrolled in the SABINE study across nine countries in Europe and North America. Utility was estimated from responses to the EQ-5D instrument using UK population-based weights. The mean EQ-5D utility score was 0.69 for the pooled patient sample with little variation across health states. However, patients with progressive disease reported a clinically significant lower utility (0.56). Among disease symptoms, pain and respiratory symptoms are common. This study showed that mSTS/mBS is associated with reduced HRQoL and utility among patients with metastatic disease.
    • Quality of life assessment in chemotherapy trials for non-small cell lung cancer: are theory and practice significantly different?

      Hopwood, Penelope; CRC Psychological Medicine Group, Christie Hospital NHS Trust, Withington, Manchester, UK. (1996-10)
      The problems inherent in quality of life (QL) research reviewed in this report support the view that theory and practice are significantly different. Quality of life data could be collected in many non-small cell lung cancer patients, yet this happens only for a few. Well-defined and constructed QL instruments are available to measure QL, yet clinicians seem reluctant to turn the emphasis away from traditional end points of response and survival. Quality of life study design guidelines exist, yet instrument selection, timing of assessments, and sample size calculations become more difficult in clinical practice. When assessing palliation, symptoms can be quantified by QL measures and analyzed statistically, but there is no agreement regarding the definition of palliation and the clinical correlates for changes in QL scores are unknown. Quality of life data collection assumes that patients attend per protocol and that personnel are available to implement QL assessments; however, compliance is problematic in palliative patients because centers are often lacking resources to collect good quality and quantity data. Although QL data can be summarized numerically to show treatment differences, these differences may not be clear-cut and numerical scores may be of little value to clinicians in discussing treatment with patients. Despite these practical difficulties, considerable experience and expertise now exist to direct QL trials successfully and to better address the challenges that are emerging. There are huge numbers of patients with non-small cell lung cancer, and there has to be a real commitment from clinicians to ensure that the opportunity is taken to logically implement QL research and thereby improve patient care.
    • Quality of life assessment in clinical trials--guidelines and a checklist for protocol writers: the U.K. Medical Research Council experience. MRC Cancer Trials Office.

      Fayers, P M; Hopwood, Penelope; Harvey, A; Girling, D J; Machin, D; Stephens, R; CRC Psychological Medicine Group, Christie Hospital NHS Trust, Withington, Manchester, U.K. (1997-01)
      Many clinical trials groups now routinely consider including Quality of Life (QoL) assessment in trials. Indeed, several have policies stating that QoL should be considered as a potential endpoint in all new trials and that if it is not to be evaluated the applicants should justify not doing so. However, inclusion of QoL in clinical trials presents a number of difficult organisational issues, and serious problems in compliance have frequently been reported. Thus, in multicentre clinical trials many of the expected QoL questionnaires fail to be successfully completed and returned, although a few groups have claimed high success rates. However, it is well recognised that if questionnaires are missing, there may be bias in the interpretation of trial results, and the estimates of treatment differences and the overall level of QoL may be inaccurate and misleading. Hence it is important to seek methods of improving compliance, at the level of both the participating institution and the patient. We describe a number of methods for addressing these issues, which we suggest should be considered by all those writing clinical trial protocols involving QoL assessment. These are based upon over a decade of experience with assessing QoL in Medical Research Council (MRC) cancer clinical trials. In particular, we provide a checklist for points that should be covered in protocols. Examples are given from a range of current MRC Cancer Trials Office protocols, which it is proposed might act as templates when writing new protocols.
    • Quality of life during high dose chemotherapy for breast cancer

      Griffiths, Audrey; Beaver, K; Day Ward, Christie Hospital NHS Trust, Manchester, UK (1997)
    • Quality of life effect of the Anti-CCR4 monoclonal antibody mogamulizumab versus vorinostat in patients with cutaneous t-cell lymphoma

      Porcu, P.; Hudgens, S.; Horwitz, S.; Quaglino, P.; Cowan, Richard A; Geskin, L.; Beylot-Barry, M.; Floden, L.; Bagot, M.; Tsianakas, A.; et al. (2020)
      Background: Sézary syndrome (SS) and mycosis fungoides (MF), 2 types of cutaneous T-cell lymphoma, cause significant morbidity and adversely affect patients' quality of life (QoL). The present study assessed the QoL measurement changes in patients receiving mogamulizumab versus vorinostat. Patients and methods: A multicenter phase III trial was conducted of patients with stage IB-IV MF/SS with ≥ 1 failed systemic therapy. The QoL measures included Skindex-29 and the Functional Assessment of Cancer Therapy-General. The symptoms, function, and QoL subdomains were longitudinally modeled using mixed models with prespecified covariates. Meaningful change thresholds (MCTs) were defined using distribution-based methods. The categorical changes by group over time and the time to clinically meaningful worsening were analyzed. Results: Of the 372 randomized patients, mogamulizumab demonstrated improvement in Skindex-29 symptoms (cycles 3, 5, and 7; P < .05) and functional (cycles 3 and 5; P < .05) scales. A significantly greater proportion of mogamulizumab-treated patients improved by MCTs or more from baseline in the Skindex-29 symptoms domain (cycles 3, 5, 7, and 11) and functioning domain (cycle 5). Significant differences in the Functional Assessment of Cancer Therapy-General physical well-being (cycles 1, 3, and 5; P < .05) were observed in favor of mogamulizumab and a greater proportion of patients had declined by MCTs or more at cycles 1, 3, 5, and 7 with vorinostat treatment. The median time to symptom worsening using Skindex-29 was 27.4 months for mogamulizumab versus 6.6 months for vorinostat. In the patients with SS, the time to worsening favored mogamulizumab (P < .005) for all Skindex-29 domains. The time to worsening was similar for the 2 MF treatment arms. Conclusion: The symptoms, function, and overall QoL of patients with MF/SS favored mogamulizumab over vorinostat across all time points. Patients with the greatest symptom burden and functional impairment derived the most QoL benefit from mogamulizumab.
    • Quality of life evaluation in patients receiving steroids (the QuESt tool): initial development in children and young people with acute lymphoblastic leukaemia.

      Adams, M; Robling, M; Grainger, J; Tomlins, Jo; Johnson, A; Morris, S; Velangi, M; Jenney, M; Department of Paediatric Oncology, Children's Hospital for Wales, Cardiff (2015-12-23)
      The powerful cytotoxic and immunomodulatory effects of corticosteroids are an important element of the success that has been achieved in the treatment of acute lymphoblastic leukaemia (ALL). In addition to physical side effects, corticosteroids can adversely influence behaviour, cognitive function and mood leading to significantly impaired quality of life (QoL). A number of tools exist for assessing QoL, but none of these specifically examines changes attributable to steroids.