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Biomedical subjects

J C de Haes

Publications and source records attributed to J C de Haes.

12 recordsLinked to original sources
PubMed1992

The distinction between affect and cognition in the quality of life of cancer patients--sensitivity and stability.

The distinction between affect and cognition has been put forward to clarify the lack of differences found in studies describing quality of life under deteriorated circumstances, such as serious illness. In the study reported here, cancer patients under treatment (n = 201) were compared with a random sample from the normal population (n = 200). As hypothesized, the affective component of life quality turned out to be more severely impaired than the cognitive component. Besides, it was investigated which factors contribute to the affective and the cognitive component of the quality of life of cancer patients under treatment. In cancer patients affect proved more strongly related to the physical domain. Cognition on the other hand was more strongly related to coping resources, especially personality characteristics like the level of self-esteem. It is concluded that an affective measure of quality of life is more sensitive to change in patients. The stability of life quality is attributed to the rather strong relation the affective and the cognitive component both have to coping resources.

Activities of Daily Living↗
PubMed1992

Advanced breast cancer and its prevention by screening.

In discussions on breast cancer screening, much attention has been focussed on the possible morbidity generated by screening. Favourable effects like the prevention of advanced disease seem underestimated, probably because quantification is that difficult. To analyse the amount of care and treatment given to women with advanced breast cancer, we report on patients followed from first recurrence until death using patient files and national sources. A random sample of 60 female cases from computerised registries of two cancer centres and a sample of 20 cases from a non-computerised hospital registry was taken. A total of 68 patient files were sufficiently documented. A woman with advanced breast cancer is estimated to have a 39% loss in utility compared to a healthy woman (range 27-45%). Hormonal treatment is the main modality during 14 and chemotherapy during 4 months. Total medical cost from diagnosis of advanced disease until death amounts to 17,100 US dollars, or 21,000 when including extramural cost. The effect of breast cancer screening by preventing the occurrence of advanced disease is quantified. The resulting gain in quality of life contributes 70% of the total gain in quality of life. In the long run, almost half of the annual cost of screening will be offset by savings in the cost for advanced disease. Only the changes in palliative surgery and/or radiotherapy will be small in contrast to primary treatment changes. Besides the mortality reduction, screening is justified by the improvements in quality of life and cost savings for women prevented from reaching advanced disease.

Breast Neoplasms↗
PubMed1991

Breast cancer screening and cost-effectiveness; policy alternatives, quality of life considerations and the possible impact of uncertain factors.

Mammographic screening for women aged 50-70 is effective in reducing breast cancer mortality, but the impact on quality of life and the attainable mortality reduction remain to be discussed. The consequences of expanding screening programmes to include women in other age groups are uncertain. We have predicted the effects and costs for 5 popular screening variants, differing in age group and screening interval, on the basis of our analysis of the Dutch screening trials and of the reported mortality reductions in other trials. We have also investigated the influence of a large number of uncertain factors. Screening for women aged 50 and over with a 2- or 3-year interval is very cost-effective and will result in reductions of respectively 16% or 10% in breast cancer mortality in a real population. Variation of most variables keeps the cost-effectiveness (CE) ratio limited to the range of US $3,000 to 5,000 per life-year gained. A 2- to 3-fold change in CE ratio would only occur if the extreme estimates of mortality reduction in the Swedish screening trials were applied. The impact on quality of life (QoL) is limited: for the 2-yearly screening policy for women aged 50-70, the cost per Quality-Adjusted Life-Year (QALY) gained is 4,050, whereas the cost per life-year gained is US $3,825. The CE ratio for 2-yearly screening of women aged 40-70 is 5,400, but the additional cost per additional life-year gained is US $35,000. It would be preferable by far to extend the screening programme to women over the age of 70 or to shorten the screening interval for women aged 50-70. Screening performances, the demand for mammograms outside screening and the possibility of a survival improvement irrespective of screening have a strong impact on QoL and CE.

Adult↗
PubMed1991

The impact of a breast cancer screening programme on quality-adjusted life-years.

Trials have shown that breast cancer screening is effective in reducing breast cancer mortality and gaining life-years. The question is whether taking into account the impact of a screening programme on quality of life would lead to a less positive view. Screening may have effects on quality of life in the short run for women participating and effects in the long run as a result of the expected shift in the number of women experiencing early and advanced phases of the disease, after the initiation of the programme. In this study 4 steps have been taken: (I) published studies on quality of life and breast cancer (screening) up to 1989 have been reviewed and summarized and, based on these data, the consequences of breast cancer and treatment have been described; (2) values have been assigned to the disease and treatment phases by experts in breast cancer and public health (N = 31, response 87%); (3) these values have been inserted in the MISCAN model predicting the prevalence of disease/treatment phases with and without a 2-yearly screening programme for women aged 50-70 and multiplied by the duration of these phases; (4) analyses have been done to establish the sensitivity of the results for the values inserted. The programme of 2-yearly mammographic screening for women aged 50-70 is predicted to be 8% "less effective" (range -19.7 to +3.2%) when computing quality-adjusted life-years. We conclude that this adjustment is too small to attribute a major role to quality of life in the decision to undertake a large-scale breast cancer screening programme.

Aged↗
PubMed1991

The impact of breast-conserving treatment and mastectomy on the quality of life of early-stage breast cancer patients: a review.

In recent years, doubt has been shed on the necessity of mastectomy for women with early-stage breast cancer. Apart from purely medical studies comparing (radical) mastectomy to less intruding surgical treatment, a number of studies (N = 18) have been published investigating the impact of breast-conserving treatment versus mastectomy on quality of life. We review these studies with respect to medical issues (treatment modality, stage of disease), methodologic issues (design, measurement moment, sample size), and results (psychologic discomfort, changes in life patterns, fears and concerns). It is concluded that there is no solid proof of a better psychologic adjustment after breast-conserving treatment and that there are no substantial differences between the different treatment modalities in changes of life patterns and fears and concerns. However, the results with respect to body image and sexual functioning favor the use of breast-conserving treatment.

Activities of Daily Living↗
PubMed1990

Measuring psychological and physical distress in cancer patients: structure and application of the Rotterdam Symptom Checklist.

Use of the Rotterdam Symptom Checklist (RSCL) to measure psychological and physical distress as experienced by cancer patients, is discussed in this paper. The stability of the structure of the RSCL was assessed in principal component analyses in three studies: one concerning cancer patients during either chemotherapy or follow-up (n = 86), one done in patients undergoing chemotherapy for advanced ovarian cancer (n = 56), and the third dealing with cancer patients under treatment, disease-free 'patients', and 'normal' controls (n = 611). The psychological dimension proved to be stable across populations. A scale based on this factor was highly reliable (Cronbach's alpha 0.88-0.94). The physical distress is reflected by several dimensions in a homogeneous population (pain, fatigue, gastrointestinal complaints) and undimensionally in a heterogeneous population. Reliability of the physical distress scales is good (0.71-0.88). The current components of the RSCL and the use of individual and disease specific symptoms are discussed.

Adult↗
PubMed1988

Measuring the quality of life of cancer patients: psychometric properties of instruments.

The importance of measuring the Quality of Life (QL) has become more and more apparent during the past 10 years. Traditionally, QL studies have investigated functional status and treatment side effects. In recent years more comprehensive instruments have been constructed to assess the QL of cancer patients. Most QL instruments take a certain degree of physical and psychological functioning into account as well as the level of activity and a global evaluation of life. The reliability and validity of these instruments are reviewed in this paper. Reliability has been well documented and seems satisfactory for most instruments. Only a few authors have discussed content validity. Predictive validity has also been established in most instances and the results from various studies are promising, however, the choice of criteria is seldom taken into account. It also seems difficult to draw conclusions about construct validity. In our view, the main problem is the lack of definitions and the absence of a theoretical framework. Therefore, some assumptions underlying QL research in cancer patients have been elucidated.

Humans↗
PubMed1986

The effect of radical and conserving surgery on the quality of life of early breast cancer patients.

In a randomized trial at the Leiden University Hospital, comparing (modified) radical mastectomy with tumorectomy followed by radiotherapy, all patients have been studied with respect to the quality of their lives 11 months and 18 months after surgery. The body image of women was more severely impaired after mastectomy than it was after breast conserving treatment (P less than 0.01). This was true for both younger and older women. Fear of recurrence of cancer was not related to the type of treatment. Thus, from a psychological point of view, breast conserving treatment is to be preferred in women of all ages. The overall quality of life improved and the suffering from psychological and physical complaints decreased with time in both groups of patients. This change may, therefore, have to be attributed to getting over the experience of having had cancer, and not to the treatment schedule.

Analysis of Variance↗
PubMed1985

Quality of life after breast cancer surgery.

All patients (N = 41) who participated in a randomized clinical trial in the Leiden University Hospital comparing mastectomy to tumorectomy have been studied with respect to their quality of life 11 months (+/- 5) after surgery. The body image of patients is more severely impaired after mastectomy than after tumorectomy (P less than .01). The studied groups did not differ, as has been suggested, with respect to fear of recurrence and death. These fears, however, turned out to be inversely related to the age of the patients (r = -.34, P = .02).

Body Image↗
PubMed1985

The quality of life of cancer patients: a review of the literature.

In recent years the necessity of including quality of life (QL) measurement in cancer research has been stressed. In this paper an overview is given of the results of studies into the QL of cancer patients. From descriptive studies it appears that the quality of certain domains of life is impaired by cancer treatment. Results from studies in which two or more groups of cancer patients are being compared are not consistent. The expectation that the QL of patients is impaired more negatively by certain treatment modalities is confirmed in some studies but not in several others. Even the assumption that the QL of cancer patients is worse than the QL of the normal population is not substantiated. In this paper explanations for these unexpected results are forwarded. First, the definition and operationalization of the concept QL differs from one study to another. QL may either refer to an overall evaluation or to the evaluation of certain domains of life, and, either to the subjective experience of the patient or the evaluation of the situation by others. Secondly, other methodological difficulties especially with respect to reliability, validity and design are described. Finally, it is suggested that psychological mechanisms may account for the absence of differences between cancer patients and others and may therefore, on theoretical grounds, explain the established inconsistencies.

Adaptation, Psychological↗