LONGITUDINAL QUALITY OF LIFE AFTER MARROW TRANSPLANT

描述：该项目将使用改进的纵向方法 生命质量多维过程评价分析 (QOL)在骨髓移植（BMT）后的四年中， 更好地描述BMT后QOL的变化， 让患者在竞争中做出更明智的选择， 治疗。这些方法所提供的更高的精确度和准确度 可以使临床医生进行前瞻性干预， 并发症和顺利的道路恢复。的新方法 纵向评估是通用的，并将扩展到其他癌症 人口。 基于现有的125个极端（6 - 18年）长期 幸存者和新的一年幸存者的广泛试点工作， 每年将招募约150名新患者（总计600名） 对于四年内每隔6个月进行的QOL评估， 比以前研究的纵向BMT样本大得多。的 成套问卷评估身体功能，角色， 情感，认知和社会领域，包括一般 情感和健康感知的心理测量评估。在 此外，电池包括BMT特定库存，由 项目人员，评估后期医疗并发症和需求 通过回收。参与患者将完成所有 在他们的住所，接收和返回的数据包， 邮寄。 为该项目收集的新的纵向数据将增强 心理测量学的发展，通过（a）发展一种更简短的形式， 适于更频繁施用的工具，和（B）使用 结构方程建模技术，建立和完善 对电池中关键指标变化的敏感性。因为 大型预测样本，标准的纵向分析将精确地 描述患者的预期生活质量，条件是 每一次评估的生存。然而，幸存的子样本可能 选择性地高估了一般人群的预期趋势， 新患者;因此，本研究的主要重点是开发 不受此约束的QOL趋势的无条件估计 损耗偏误 获得生活质量的无条件估计 趋势，作者将a）采用混合效应模型，如 唐纳森;和B）开发终点，形式上类似于Q TWIST， 使用心理测量学标准来衡量生存时间， 在BMT恢复过程中。

DESCRIPTION: This project will use improved methods of longitudinal analysis to evaluate the multidimensional course of quality of life (QOL) in the four years following bone marrow transplantation (BMT), providing better descriptions of how QOL changes following BMT, thereby allowing patients to make more informed choices among competing treatments. The increased precision and accuracy offered by these methods may enable clinicians to intervene prospectively to minimize complications and smooth the path to recovery. The new methods for longitudinal evaluation are general, and will extend to other cancer populations. Building on an existing survey of 125 extreme (6 18 years) long term survivors and on extensive pilot work with new one year survivors, approximately 150 new patients will be recruited each year (600 total) for QOL assessments at 6 month intervals over four years, yielding a much larger longitudinal BMT sample than any previously studied. The questionnaire battery assesses functioning in the physical, role, emotional, cognitive, and social domains, and includes general psychometric assessments of affective and health perceptions. In addition, the battery includes BMT specific inventories, developed by project personnel, assessing late medical complications and demands imposed by recovery. Participating patients will complete all questionnaires in their residences, receiving and returning the packets by mail. The new longitudinal data collected for this project will enhance psychometric development by a (a) developing a briefer form of existing instruments amenable to more frequent administration, and (b) using structural equation modeling techniques to establish and improve the sensitivity to change of key indicators in the battery. Because of the large projected sample, standard longitudinal analyses will precisely describe the expected quality of life for patients conditional on survival to each assessment. Surviving subsamples, however, may selectively overestimate expected trends for the general population of new patients; thus a major focus of this study is the development of unconditional estimates of QOL trends that are not subject to this attrition bias. To obtain unconditional estimates of quality of life trends, the authors will a) employ mixed effects models as discussed by Donaldson; and b) develop endpoints, formally similar to Q TWIST, that use psychometric norms to weight survival times for QOL experienced during BMT recovery.