Szu Chun Yang

Rasch models suggested the satisfactory psychometric properties of the World Health Organization Quality of Life-Brief among lung cancer patients.

The study examined whether the items of the World Health Organization Quality of Life—Brief questionnaire can assess its four underlying domains (Physical, Psychological, Social, and Environment) in a sample of lung cancer patients. All patients (n = 1150) were recruited from a medical center in Tainan, and each participant completed the World Health Organization Quality of Life—Brief. Several Rasch rating scale models were used to examine the data-model fit, and Rasch analyses corroborated that each domain of the World Health Organization Quality of Life—Brief could be unidimensional. Although three items were found to have a poor fit, all the other items fit the unidimensionality with ordered thresholds.

Comparison of global initiative for chronic obstructive pulmonary disease 2013 classification and body mass index, airflow obstruction, dyspnea, and exacerbations index in predicting mortality and exacerbations in elderly adults with chronic obstructive pulmonary disease.

To examine whether the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) 2013 revision offers greater predictive ability than the body mass index, airflow obstruction, dyspnea, and exacerbations (BODEx) index in elderly adults with chronic obstructive pulmonary disease (COPD).

Positive blood culture is not associated with increased mortality in patients with sepsis‐induced acute respiratory distress syndrome

Previous studies have demonstrated that positive blood culture could contribute to poorer outcomes in patients with pneumonia. However, the impact of positive blood culture on the outcomes of patients with sepsis‐induced acute respiratory distress syndrome (ARDS) has not been evaluated.

Cost-effectiveness of implementing computed tomography screening for lung cancer in Taiwan

BACKGROUND A screening program for lung cancer requires more empirical evidence. Based on the experience of the National Lung Screening Trial (NLST), we developed a method to adjust lead-time bias and quality-of-life changes for estimating the cost-effectiveness of implementing computed tomography (CT) screening in Taiwan. METHODS The target population was high-risk (≥30 pack-years) smokers between 55 and 75 years of age. From a nation-wide, 13-year follow-up cohort, we estimated quality-adjusted life expectancy (QALE), loss-of-QALE, and lifetime healthcare expenditures per case of lung cancer stratified by pathology and stage. Cumulative stage distributions for CT-screening and no-screening were assumed equal to those for CT-screening and radiography-screening in the NLST to estimate the savings of loss-of-QALE and additional costs of lifetime healthcare expenditures after CT screening. Costs attributable to screen-negative subjects, false-positive cases and radiation-induced lung cancer were included to obtain the incremental cost-effectiveness ratio from the public payers perspective. RESULTS The incremental costs were US

Dynamic changes in quality of life after three first-line therapies for EGFR mutation-positive advanced non-small-cell lung cancer:

22,755 per person. After dividing this by savings of loss-of-QALE (1.16 quality-adjusted life year (QALY)), the incremental cost-effectiveness ratio was US

Estimating the lifelong health impact and financial burdens of different types of lung cancer

19,683 per QALY. This ratio would fall to US

Health-related quality of life after first-line anti-cancer treatments for advanced non-small cell lung cancer in clinical practice

10,947 per QALY if the stage distribution for CT-screening was the same as that of screen-detected cancers in the NELSON trial. CONCLUSIONS Low-dose CT screening for lung cancer among high-risk smokers would be cost-effective in Taiwan. As only about 5% of our women are smokers, future research is necessary to identify the high-risk groups among non-smokers and increase the coverage.

Estimation of loss of quality-adjusted life expectancy (QALE) for patients with operable versus inoperable lung cancer: Adjusting quality-of-life and lead-time bias for utility of surgery

Background: Three different tyrosine kinase inhibitors have been approved as first-line therapies for epidermal growth factor receptor (EGFR) mutation-positive advanced non-small-cell lung cancer with similar overall survival. This study determined dynamic changes in quality of life (QoL) for patients using these therapies after controlling for potential confounders. Methods: From 2011 to 2016, we prospectively assessed the utility values and QoL scores of patients using the EuroQol five-dimension and World Health Organization Quality-of-Life – Brief questionnaires. QoL functions after initiation of treatment were estimated using a kernel-smoothing method. Dynamic changes in major determinants were repeatedly assessed for constructing mixed models. Results: A total of 344 patients were enrolled, with 934 repeated assessments. After controlling for performance status, disease progression, EGFR mutation subtype and other confounders, the mixed models showed significantly lower QoL scores for afatinib versus gefitinib in the physical, psychological and social domains, and 10 facets. The differences seemed to appear 10 months after initiation of treatment. In contrast, there was no significant difference between erlotinib and gefitinib in the scores of all domains and facets. Conclusion: QoL in patients receiving afatinib seemed to be lower than in those receiving gefitinib. Since the sample sizes in this study were relatively small, more studies are warranted to corroborate these results.