The aim of this review was to describe quality of life (QoL) questionnaires relevant to interventional radiology.
Interventional radiologists perform a large number of palliative procedures. The effect of these therapies on QoL is important. This is particularly true for cancer therapies where procedures with marginal survival benefits may result in tremendous QoL benefits. Image-guided minimally invasive procedures should be compared to invasive procedures, with respect to QoL, as part of comparative effectiveness assessment. A large number of questionnaires have been validated for measurement of overall and disease-specific quality of life.
Use of applicable QoL assessments can aid in evaluating clinical outcomes and help to further substantiate the need for minimally invasive image-guided procedures.
Many therapies affect quality of life (QoL) and survival. QoL measurements have become increasingly important end points in patient care and clinical trials. These measurements may be more relevant to patient well-being compared to traditional disease-specific end points, such as laboratory or imaging-based end points particularly when procedures are being performed for symptomatic relief. For example, catheter-directed and percutaneous ablative cancer therapies may result in marginal survival benefits but tremendous improvements in QoL. QoL metrics are now commonplace in cancer therapeutic clinical trials. Interventional radiologists can easily incorporate QoL assessments into periprocedural clinical care. QoL assessments may also aid in procedural selection. For example, Salem et al. recently used the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) ( http://www.facit.org ) survey as well as their embolotherapy-specific score to compare QoL in patients with hepatocellular carcinoma (HCC) undergoing transarterial chemo embolization (TACE) versus radioembolization. They found that patients undergoing radioembolization had improved QoL whereas TACE treatment was associated with worsening of QoL.
Because of the relative paucity of literature regarding QoL measurements in interventional radiology, it can be difficult to determine the suitable QoL measurement tool. The purpose of this article is to describe commonly used QoL tools that the interventional radiologist may incorporate into clinical care and comparative effectiveness assessment.
Methods
A systematic literature review of general and disease-specific QoL assessment questionnaires, relevant to interventional radiology, was conducted to identify those most frequently used. MEDLINE (National Center for Biotechnology Information, U.S. National Library of Medicine 8600 Rockville Pike, Bethesda MD, 20894 USA) was used to identify a comprehensive group of relevant articles. All articles that addressed interventional radiology and QoL were included. The reference lists of included articles were also assessed for additional publications. The most commonly used, previously validated, QOL surveys were included.
Quality of life questionnaire design and conduct
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Table 1
Non–Disease-Specific Tools
Instrument Content Number of Items/Response Option Completion Time Visual analog scale (VAS) Mark location on a ruler (ranging from 0 to 10) indicating progressive levels of pain N/A <5 minutes Short Form 36 version 2 Physical functioning, role limitations as the result of physical health problems, body pain, general health perception, vitality, social functioning, role limitations as the result of emotional problems, mental health, and health transition Thirty-six questions among 11 sections, each can be answered on a 1–5 scale with the past 4 weeks in mind. Score is reported out of an optimal health score of 100 20 minutes EuroQol-5D Section 1: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression
Section 2: VAS over a 0–100 visualized scale The questions within section 1 can be marked with one of three degrees of severity—no problems, some/moderate problems, or extreme problems 20 minutes Quality of Well-Being Self-Administered Part 1: frequency of acute and chronic symptoms
Part 2: self-care
Part 3: mobility Scores on individual questions totaled to create composite score between 0 and 1, representing death and “asymptomatic optimum functioning”, respectively 30 minutes
N/A, not applicable.
Table 2
Disease-Specific Tools
Instrument Content Number of Items/Response Option Completion Time Quality of Life Tool for Assessing Patients with Neuroendocrine Tumors Domains include symptom severity and frequency, ADLs, somatostatin injection frequency, and emotional status Seventy-two questions 20 minutes QLQ-GINET21 (Quality of Life Questionnaire - Gastrointestinal-related neuroendocrine tumors) Addresses gastrointestinal (GI) symptoms, cancer-related factors, psychosocial issues, treatment side effects and other occurrences including weight loss and bone pain Sixty-five questions, each with scores of 1–4, representing responses of “not at all”, “a little”, “quite a bit”, and “very much” 10 minutes Carcinoid Symptom Severity Score Five scales addressing symptoms (flushing, diarrhea, wheezing, and so forth) Scores range from 1 to 5, representing no symptoms, mild symptoms, symptoms impact daily living, severe symptoms, or disabling symptoms 5 minutes Functional Assessment of Cancer Therapy-Hepatobiliary Five domains encompassing physical well-being, social/family well-being, emotional well-being, functional well-being, and additional concerns Forty-five total questions with individual responses ranging from 0 to 5 representing responses of “not at all” to “very much” 25 minutes Oswestry Disability Index Pain intensity, interference with sleep, self-care, walking, sitting, standing, lifting, sex life, traveling, and social life Overall score 0–100. ten items, six response options per item 5 minutes Roland Morris Disability Questionnaire Physical activities, housework, mobility, dressing, getting help, appetite, irritability, and pain severity Overall score 0–24.
Twenty-four items; yes/no response for each 5 minutes Vertebral Compression Fracture Pain and Functional Disability Questionnaire Section 1: prior and current magnitude of back pain and distress, overall general health, use of prescription medications for conditions unrelated to the fracture, and expected treatment-related relief of back pain.
Section 2: assessment of ADLs Section 1: eleven items + Visual analog scale.
Section 2: twenty-four ADLs, assess whether can be performed before and after back pain 20 minutes QoL Questionnaire of the European Foundation for Osteoporosis Domains include assessment of pain, physical functions, social functions, general health, and mental health Forty-one total questions 20 minutes Venous Clinical, Etiology, Anatomy, Pathophysiology score Four categories (clinical, etiologic, anatomic, and pathophysiological) and classification within those groups, that is, C1, telengiectasias or reticular veins; C2, varicose veins; C3, edema; Ep, primary; Es, secondary (postthrombotic); As, superficial veins; Ap, perforator veins; Pr, reflux; Po, obstruction Summarized clinical data used to categorize patient and clinical category can follow treatment response 20 minutes Venous Severity Scoring System Three components: venous clinical severity score, venous disability score, and venous segmental disease score Surveys pain, varicosities, edema, pigmentation, inflammation, induration, ulcers, disability and imaging characteristics on ranges from 0 to 3 reflecting “none” to “severe” 30 minutes VascuQol Five domains including activities, symptoms, pain, emotions, and social functioning Twenty-five total questions with responses varying from 1 to 7. 15 minutes Uterine Fibroid Symptom and QoL questionnaire Two general sections: fibroid symptoms and general health Thirty-seven total questions with six ranged responses per question 20 minutes
ADLs, activities of daily living; QOL, quality of life.
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Non–disease-specific Tools
SF-36 v2
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EQ-5d
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QWB-SA
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Disease-specific Tools
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Interventional oncology
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Vertebroplasty
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Venous disorders of the leg
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Arterial interventions
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Uterine leiomyoma
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Conclusion
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References
1. Salem R., Gilbertsen M., Butt Z., et. al.: Increased quality of life among hepatocellular carcinoma patients treated with radioembolization, compared with chemoembolization. Clin Gastroenterol Hepatol 2013; 10: pp. 1358-1365.
2. Testa M.A., Simonson D.C.: Assessment of quality-of-life outcomes. N Engl J Med 1996; 334: pp. 835-840.
3. Aitken R.C.: Measurement of feelings using visual analogue scales. Proc R Soc Med 1969; 62: pp. 989-993.
4. Basch E.: New frontiers in patient-reported outcomes: adverse event reporting, comparative effectiveness, and quality assessment. Annu Rev Med 2013; Nov 20. [Epub ahead of print]
5. Carr A.J., Higginson I.J.: Are quality of life measures patient centred?. BMJ 2001; 322: pp. 1357-1360.
6. Gibbons R.J., Gardner T.J., Anderson J.L., et. al.: The American Heart Association’s principles for comparative effectiveness research: a policy statement from the American Heart Association. Circulation 2009; 119: pp. 2955-2962.
7. Ware J.E., Kosinski M.: Interpreting SF-36 summary health measures: a response. Qual Life Res 2001; 10: pp. 405-413.
8. Zhuang Z., Teng G.J., Jeffery R.F., et. al.: Long-term results and quality of life in patients treated with transjugular intrahepatic portosystemic shunts. AJR Am J Roentgenol 2002; 179: pp. 1597-1603.
9. Burstrom K.M., Johannesson M., Diderichsen F.: Swedish population health-related quality of life results using the EQ-5D. Qual Life Res 2001; 10: pp. 621-635.
10. Andresen E.M., Rothenberg B.M., Kaplan R.M.: Performance of a self-administered mailed version of the Quality of Well-Being (QWB-SA) questionnaire among older adults. Med Care 1998; 36: pp. 1349-1360.
11. Gold M., Franks P., Erickson P.: Assessing the health of the nation. The predictive validity of a preference-based measure and self-rated health. Med Care 1996; 34: pp. 163-177.
12. Vinik E., Carlton C.A., Silva M.P., et. al.: Development of the Norfolk quality of life tool for assessing patients with neuroendocrine tumors. Pancreas 2009; 38: pp. e87-e95.
13. Davies A.H., Larsson G., Ardill J., et. al.: Development of a disease-specific Quality of Life questionnaire module for patients with gastrointestinal neuroendocrine tumours. Eur J Cancer 2006; 42: pp. 477-484.
14. Schell S., Camp E.R., Caridi J.G., et. al.: Hepatic artery embolization for control of symptoms, octreotide requirements, and tumor progression in metastatic carcinoid tumors. J Gastrointest Surg 2002; 6: pp. 664-670.
15. Kvols L.K., Turaga K.K., Strosberg J., et. al.: Role of interventional radiology in the treatment of patients with neuroendocrine metastases in the liver. J Natl Compr Canc Netw 2009; 7: pp. 765-772.
16. Henn A.R., Levine E.A., McNulty W., et. al.: Percutaneous radiofrequency ablation of hepatic metastases for symptomatic relief of neuroendocrine syndromes. AJR Am J Roentgenol 2003; 181: pp. 1005-1010.
17. Cella D.F., Tulsky D.S., Gray G., et. al.: The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol 1993; 11: pp. 570-579.
18. Heffernan N., Cella D., Webster K., et. al.: Measuring health-related quality of life in patients with hepatobiliary cancers: the functional assessment of cancer therapy-hepatobiliary questionnaire. J Clin Oncol 2002; 20: pp. 2229-2239.
19. Evans A.J., Kip K.E., Boutin S.M.: Development and psychometric properties of the Vertebral Compression Fracture Pain and Functional Disability Questionnaire. J Neurosurg Spine 2006; 5: pp. 217-223.
20. Fairbank J.C., Pynsent P.B.: The Oswestry Disability Index. J Neurosurg Spine 2000; 25: pp. 2940-2953.
21. Tadic I., Vujasinovic Stupar N., Tasic L., et. al.: Validation of the osteoporosis quality of life questionnaire QUALEFFO-41 for the Serbian population. Health Qual Life Outcomes 2012; 10: pp. 74-82.
22. Voormolen M., Mali W.P., Lohle P.N., et. al.: Percutaneous vertebroplasty compared with optimal pain medication treatment: short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The VERTOS study. AJNR Am J Neuroradiol 2007; 28: pp. 555-560.
23. Davidson M., Keating J.L.: A comparison of five low back disability questionnaires: reliability and responsiveness. Physical Ther 2002; 82: pp. 8-24.
24. Eklof B., Rutherford R.B., Bergan J.J., et. al.: Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg 2004; 40: pp. 1248-1252.
25. Vasquez M.A., Rabe E., McLafferty R.B., et. al.: Revision of the venous clinical severity score: venous outcomes consensus statement: special communication of the American Venous Forum Ad Hoc Outcomes Working Group. J Vasc Surg 2010; 52: pp. 1387-1396.
26. Meissner M.H., Natiello C., Nicholls S.C.: Performance characteristics of the venous clinical severity score. J Vasc Surg 2002; 36: pp. 889-895.
27. Kakkos S.K., Rivera M.A., Matsagas M.I., et. al.: Validation of the new venous severity scoring system in varicose vein surgery. J Vasc Surg 2003; 38: pp. 224-228.
28. Ricci M.A., Emmerich J., Callas P.W., et. al.: Evaluating chronic venous disease with a new venous severity scoring system. J Vasc Surg 2003; 38: pp. 909-915.
29. Masuda E.M., Kessler D.M., Lurie F., et. al.: The effect of ultrasound-guided sclerotherapy of incompetent perforator veins on venous clinical severity and disability scores. J Vasc Surg 2006; 43: pp. 551-557.
30. Vasquez M.A., Wang J., Mahathanaruk M., et. al.: The utility of the venous clinical severity score in 682 limbs treated by radiofrequency saphenous vein ablation. J Vasc Surg 2007; 45: pp. 1008-1015.
31. Morgan M.B., Crayford T., Murrin B., et. al.: Developing the Vascular Quality of Life Questionnaire: a new disease-specific quality of life measure for use in lower limb ischemia. J Vasc Surg 2001; 33: pp. 679-687.
32. Keeling A.N., Naughton P.A., O’Connell A., et. al.: Does percutaneous transluminal angioplasty improve quality of life?. J Vasc Interv Radiol 2008; 19: pp. 169-176.
33. Remes L., Isoaho R., Vahlberg T., et. al.: Quality of life among lower extremity peripheral arterial disease patients who have undergone endovascular or surgical revascularization: a case-control study. Eur J Vasc Endovasc Surg 2010; 40: pp. 618-625.
34. Soulez G., Therasse E., Monfared A.A., et. al.: Pain and quality of life assessment after endovascular versus open repair of abdominal aortic aneurysms in patients at low risk. J Vasc Interv Radiol 2005; 16: pp. 1093-1100.
35. Spies J.B., Coyne K., Guaou Guaou N., et. al.: The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol 2002; 99: pp. 290-300.