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ENGLISH VERSION: QUALITY OF LIFE ASSESSMENT IN PATIENTS WITH HEMOBLASTOSIS WITH IMPAIRMENT OF NERVOUS SYSTEM*
Piddubna O.O., Lytvynenko N.V.
HSEEU «Ukrainian Medical Stomatological Academy», Poltava, Ukraine
Neurological disorders in oncohematologic diseases are among the secondary impairment of the nervous system and combine pathological conditions of the nervous system with different mechanisms of development and iocaiization associated with neoplastic diseases of the blood system, which slgnfficantly exacerbates the course of the basic disease. The study of quality of life (QOL) in medicine provides information about the state of physical, emotional and psychological functioning of patient, allows to examine the dynamics of the disease and to evaluate the effectiveness of treatment. We investigated quaity of lffe in patients with hemobiastosis and syndromologic features of the nervous system impairment. To accompiish this aim we conducted a complex of clinical and neurological examination with research of QOL by the questionnaire SF-36 in 77 patients with hemobiastosis. Depending on the type of underlying disease, patients were divided into 3 groups: patients with chronic lymphocytic leukemia (27 persons), patients with multiple myeloma (24 people) and patients with chronic myeloid leukemia (26 people). Control group consisted of 23 patients with appropriate age and gender allocation. According to the results of research, a significant decrease in all indicators of questionnaire SF-36 has been revealed in patients with hemoblastosis and impairment of the nervous system as compared to the control group. Impairment of the nervous system in patients with hemobiastosis was due to the influence of various aggregate factors, one of which can be regarded as lesion of the central and peripheral nervous system.
Key words: hemoblastosis, quality of life, Impairment of the nervous system
Introduction
Recently, the problem of malignant myeloid-lymphoproliferative diseases is becoming increasingly important, due to the progressive increase in the frequency of the structure of hemoblastoses [1]. Hemoblas-tosis is a malignant neoplasm of hematopoietic tissue, in which the primary tumor lesions begin in the stem, myeloid or lymphoid hematopoietic cells of bone marrow. To the nosological forms of hemoblastoses, acute and chronic leukemia (leukemia), myelodysplastic syndromes (multiple myeloma) are included [2]. According to World Health Organization, oncological diseases rank the second among all causes of mortality in the world. Neurological disorders in oncohematologic diseases are among the secondary lesions of the nervous system and combine pathological conditions of the nervous system with different mechanisms of development and localization associated with neoplastic diseases of the blood system, which significantly exacerbates the course of the basic disease [11].
The study of quality of life (QOL) in medicine provides information about the state of physical, emotional and psychological functioning of patient, allows to examine the dynamics of the disease and to evaluate the effectiveness of treatment. In the sociological sense, "quality of life" can be defined as a comfort grade of a person within himself/herself and the community [3,4]. The quality of life studies have been conducted in oncohematol-ogy over thirty years. National Cancer Institute (NCI) and the American Society of Clinical Oncology (ASCO) determined that QOL is the second most important criterion for survival with the evaluation of results of anticancer therapy [5]. According to the recommendations of the Food and Drug Administration (FDA) (USA, 1985, 2009), a patient's QOL evaluation should be included to the clinical research protocols related to the launch of new drugs in oncohematology [6]. Even though the evaluation methods of QOL in foreign hematology are being used since 1986, unified criteria and standard norms of this
parameter do not exist; for each region and different population groups they have their conventional rate [6]. Changes in QOL parameters, which are detected within surveys should be compared with the clinical condition of the patient [3,7]. To evaluate the QOL of patients with hemoblastosis both general and specific questionnaires are used [6]. General and specific questionnaires developed by experts from leading clinical centers in accordance with the principles of evidence-based medicine and the requirements of Good Clinical Practice (GCP), created the possibility of quantitative assessment of this subjective concept, allowed to extend the idea of medical condition of the patient as a whole. In the modern literature there are no studies on the quality of life in patients with disorders of the nervous system against the background of hemoblastoses.
The aim of this study was the comparison of quality of life in patients with hemoblastosis and syndromologic features of the nervous system impairment.
Materials and methods
We examined 77 patients with hemoblastosis who were hospitalized in the Hematology Department of the M.V. Sklifosovskyi Poltava Regional Clinical Hospital in 2015-2016. Patients were divided into 3 groups: the first group consisted of patients with chronic lymphocytic leukemia (CLL - 27 people), the second group included 24 patients with multiple myeloma (MM), 26 patients with chronic myeloid leukemia (CML) made up the third group. The average age of the first group reached 61.2 ± 2.33, in the second group - 57.4 ± 1.95, in the third group -63.1 ± 3.61. Gender allocation in the groups was as follows: the first group included 15 men (55.5%) and 12 women (44.4%), the second group consisted of 7 males (29.1%) and 17 females (70, 9%), the third group - 13 men (50%) and 13 women (50%). Median of disease duration in the first group was 3 years (range from 9 months up to 8 years), in the second group - 3 years (range from
* To cite this English version: O.O. Piddubna, N.V. Lytvynenko. Quality of life assessment in patients with hemoblastosis with impairment of nervous system //Problemy ekologii ta medytsyny. - 2016. - Vol 20, № 1-2. - P. 13-15.
7 months up to 9 years), in the third group - 4 years (range from 1 year up to 22 years) .
Comparison group for the SF-36 questionnaire was group of 23 patients with appropriate age and gender allocation, average age reached 60.9 ± 1.7. In this group discirculatory encephalopathy of I-II stage was diagnosed in 16 patients.
To evaluate the QOL, the SF-36 questionnaire has been used [8-9]. The questionnaire consisted of 36 questions that formed 8 scales (Table 1).
Table 1
The scales of the SF-36 questionnaire
№ Scale of the question- Scale's short name / Max
naire points
1 physical functioning PF/100
2 role-physical functioning RPF / 100
3 pain P / 100
4 overall health OH / 100
5 active way of life AWL / 100
6 social functioning SF/100
7 role-emotional functioning REF / 100
8 psychological health PH / 100
The number of questions in each of the scales ranged from 2 to 10. Each of questions offered 2-6 answers. Answers to the questions were submitted in the form of Likert's scales (with horizontally or vertically located answers to questions). Respondent answered the questions, choosing one of these options. After transferring
Comparison of the QOL by the SF-36 questionnaire in different types of hemoblastoses among patients with the nervous system impairment revealed decline of the foremost indicators in the number of scales as compared to the control group. Identified differences indicated that the process of impairment of oncohematological nervous system led to the deterioration of the overall physical condition of the patient. The negative dynamics of Sf indicator (which is based on the satisfaction level of social activity) testified that during hemoblastoses not only physical, but also psychological states of patients have suffered. REF and RPF indicators reflected the impact of physical and emotional state on role-functioning, i.e. the predicted assessment of the degree to which physical and emotional state interfered with work performance or
obtained data to the marks of QOL, survey results for each of the eight scales were expressed in points (0 to 100). The number of points on a scale in SF-36 questionnaire was directly proportional to the quality of life indicator.
All patients underwent comprehensive clinical and neurological examination with determination of the frequency of basic neurological syndromes. It should be noted that in all patients the pathology of the nervous system before the onset of basic disease was excluded retrospectively (according to patient's anamnesis and medical records data).
Quantitative indicators received during the evaluation of patients have been processed with methods of mathematical statistics with calculation of average sample values (M) and errors of average values (m) in the groups of examined patients. Probability of differences for the results obtained in different groups was determined using Student's reliability t-creteria. Differences were considered statistically significant at error p <0.05, conventional in biomedical research of probability [10]. Statistical analysis of the material was performed using the spreadsheet software Microsoft Excel.
Results and Discussions
The analysis of obtained results according to the SF-36 questionnaire showed that among patients with hemoblastosis with the nervous system impairment, all of QOL parameters were statistically significantly lower than the control group performance. The results are presented in Table 2.
other daily activities. The maximum decline in the PF, AWL, REF scales is established at CML with damage to the nervous system. Multiple myeloma value most scales (PFP, AWL, REF, PH) were significantly higher as compared to the hemoblastoses of other types. It has also been discovered that the scale of physical functioning and role limitations, that reflected the grade corresponding to which health limited exercise (routine work) among patients with hemoblastosis, had the lowest numbers as compared to other scales of questionnaire.
The conducted condition examination of the nervous system in patients with hemoblastosis has revealed certain differences between groups of patients surveyed. The data are presented in Table 3.
Table 2
Quality of life according to the SF-36 among different types of hemoblastoses.
Indicators the QOL, points Groups of Patients
Control group (n=23) 1 group (CLL, n=27) II group (MM, n=24) III group (CML, n=26)
physical functioning 60.43±2.41 41.66±2.10* 54.37±1.93 * ** 26. 73±5.47* ** ***
role-physical functioning 60.63±4.01 35.18±4.06 * 46.87±5.06* ** 33.65±7.71* ***
pain 79.56±2.51 50.11 ±3.62* 49.25±2.39* 42.92±5.89*
overall health 67.95±2.13 48.59±1.99* 53.16±2.41* 48.15±2.94*
active way of life 68.47±1.21 49.44±1.54* 55.0±1.16* ** 25.38±4.64* ** ***
social functioning 83.69±1.13 47.77±4.57* 65.10±4.38* ** 40.09±6.03* ***
role-emotional functioning 92.73±2.11 51.81 ±5.71* 56.90±6.17* 32.03±1.50* ** ***
psychological health 70.13±0.97 46.07±2.79* 56.16±0.81* ** 42.00±3.33* ***
Note: * - Significant differences in comparison with the control group (P1 <0.05);
** - Significant differences in comparison with the first group (p2 <0.05); *** - Significant differences in comparison with the second group (p3 <0.05).
Table 3
Comparative characteristics of syndromologic features of the nervous system impairment in patients with hemoblastosis
Syndroms Groups of patients total % of the total cohort
1 group (CLL, n = 27) II group (MM, n = 24) III group (CML, n = 26)
n % N % N %
encephalopathic 25 92.5 19 79.2 20 76.9 64 83.1
myelopathic - - 4 16.6 2 7.7 6 7.8
neuropathic 20 74.1 11 45.8 10 41.6 41 53.2
polyneuropathic 4 14.8 20 83.3 - - 24 31.2
radiculopathic 15 55.5 9 37.5 6 25 30 38.9
The obtained data about syndromologic features of the nervous system impairment showed that in the first group of patients (CLL) disrupted cerebral functions, root lesions and mononeuropathy (encephalopathic, neuropathic, radiculopathic syndromes) prevailed. In the second group of patients (MM) multiple lesions of peripheral nerves (polyneuropathic syndrome) dominated. The clinical course of CML in patients of the third group was accompanied by a relatively high incidence of brain damage (encephalopathic syndrome in 76.9% of patients), lack of clear signs of polyneuropathy and lowest frequency of mononeuropathy and radiculopathy as compared with other types of hemoblastoses.
Conclusions
1. In the quality of life study of patients with hemoblastosis with nervous system impairment as compared to the control group, the decrease of SF-36 questionnaire's indicators was found as compared to all indicators within the control group.
2. Among patients with CML the lowest rates quality of life scales of physical functioning, vitality and role emotional functioning were revealed.
3. Among patients with MM is found the highest level of quality of life by the indexes of physical functioning, role-physical functioning, vitality, social functioning and mental health.
4. Comparison of the syndromologic features of the nervous system impairment in patients with hemoblastosis reported that the patients with CLL encephalopathic (92.5%), neuropathic (74.1%) and radiculopathic (55.5%) syndromes predominated; for patients with MM - poly-neuropathic syndrome (83.3%); for patients with CML much less signs of lesions of the peripheral nervous system were identified.
5. Impairment of the nervous system in patients with hemoblastosis were due to the influence of various aggregate factors, one of which can be regarded as lesion of the central and peripheral nervous system.
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MaTepian HagiiiinoB go pegamiï 30.09.2016
