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Health-related quality of life (HRQL) is important in assessing sarcoidosis; quality of life issues are important in determining the need for treatment.
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HRQL can be assessed accurately using established patient-reported outcome measures (PROs).
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Recently, several sarcoidosis-specific PROs assessing HRQL have been developed for clinical use.
Quality of Life Assessment in Sarcoidosis
Section snippets
Key points
The importance of quality of life assessment in sarcoidosis
Sarcoidosis may involve any organ. The disease course is highly variable, ranging from an asymptomatic state to a progressive condition that may, occasionally, be life threatening. The pathologic hallmark of sarcoidosis is the granuloma that may resolve spontaneously or with antisarcoidosis therapy. Approximately 10% to 30% of sarcoidosis patients develop significant fibrosis that may result in permanent organ injury.1
Regardless of the clinical course, the decision to treat sarcoidosis is
The assessment of health-related quality of life
The assessment of HRQL does not necessarily mandate the use of objective measures. Clinicians often use qualitative measures by asking the patient to describe his or her symptoms and inquiring about how those symptoms affect their ability to function and their quality of life. Although such an approach is often reliable when therapy results in changes of great magnitude that lead to substantial improvements in HRQL, such an approach may be less reliable in detecting small but significant
Problems in the assessment of health-related quality of life in sarcoidosis
Despite the aforementioned rationale for using PROs to assess HRQL in sarcoidosis, there is often resistance in performing such an assessment for many reasons. Some of these reasons relate to the general concept of using such PROs, whereas others specifically relate to PRO use for sarcoidosis.
Characteristics of patient-reported outcome measures
The development of appropriate PROs to measure HRQL is a complex process that is beyond the scope of this article and is well-outlined in the FDA guidance document concerning PROs.8 The PRO should ideally measure traits that are unidimensional constructs, meaning that they can be measured on 1 scale from completely lacking the trait to having the trait in abundance (eg, dyspnea). The items used to construct the PRO should be based on expert opinion and rigorous patient input, usually involving
Specific health-related quality of life measures used in sarcoidosis
Table 1 shows some common HRQL PROs that have been used in sarcoidosis trials. General HRQL measures that are not specific for sarcoidosis have been studied in sarcoidosis patients, including the Short Form-36 (SF-36),28, 29, 30, 31 World Health Organization – Quality of Life 100 (WHOQOL-100),32, 33, 34 and WHOQOL-BREF.35 The SF-36, although a general HRQL measure, has been shown to have a good correlation with sarcoidosis-specific PROs.36, 37, 38 Sarcoidosis-specific general HRQL measures
Summary
HRQL is important to sarcoidosis patients. Ideally, most indications for the treatment of sarcoidosis relate to disease-associated HRQL. However, clinicians often focus on objective clinical and laboratory tests that often do not reflect HRQL well. PROs have been constructed that can reliably quantify HRQL. Many of these PROs are disease specific and have had minimally important clinical differences established that allows for a determination of clinically relevant changes in these measures.
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Cited by (21)
Health-Related Quality of Life Assessment in Sarcoidosis
2024, Clinics in Chest MedicineQuantifying the relationship between symptoms at presentation and the prognosis of sarcoidosis
2019, Respiratory MedicineCitation Excerpt :Patients were included in this analysis if they fulfilled the following criteria: a) met diagnostic criteria for sarcoidosis [7,8]; b) had undergone a tissue biopsy revealing granulomatous inflammation consistent with sarcoidosis; c) an estimated date of sarcoidosis symptom onset and description of these symptoms, including the absence of symptoms, had been recorded. The following data was included in the analysis: a) demographic information (sex, race, age at most recent follow-up visit); b) estimated date of symptom onset of sarcoidosis; c) description of these symptoms, including the absence of symptoms; d) percent predicted forced vital capacity (FVC) and forced expired volume in 1 s (FEV1) measurements at the most recent follow-up clinic visit using percent predicted criteria of The Third National Health and Nutrition Examination Survey (NHANES III) [9]; e) Scadding stage [10] of the most recent chest radiograph (we used the official radiology report of the board-certified radiologist who interpreted the radiograph for clinical purposes); f) anti-sarcoidosis medication and doses over the entire period of follow-up; g) the specific organs involved with sarcoidosis according to the A Case Control Etiologic Study of Sarcoidosis (ACCESS) instrument [11] until August 29, 2014 and according to the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) [12] instrument after that date; h) results of the Sarcoidosis Assessment Tool (SAT) [13], a validated sarcoidosis-specific health related quality of life (HRQOL) patient reported outcome measure (PRO) that was administered to all patients at all clinic visits after June 28, 2016. We used the SAT at the most recent patient visit for the analyses.
Can the Sarcoidosis Health Questionnaire predict the long-term outcomes in Japanese sarcoidosis patients?
2019, Respiratory MedicineCitation Excerpt :Analysis in larger multi-center cohorts and enrichment of more severe cases would be more definitive. None of the questionnaires used in this study specifically addresses fatigue, although fatigue impairs the health status of sarcoidosis patients [34–36]. In fact, the SF-36 vitality subscale score was predictive for 5-year deterioration in this study.
Randomised, placebo-controlled trial of dexamethasone for quality of life in pulmonary sarcoidosis
2020, Respiratory MedicineCitation Excerpt :It is estimated that one-third to one-half of patients with sarcoidosis gets treatment with corticosteroids [1]. Clinicians often initiate therapy based on the presence of granulomatous inflammation or physiologic change, even when there are no dangerous consequences and the patients quality of life is not affected appreciably [14]. On the other hand, treatment based on an unacceptably impaired quality of life in the absence of a large burden of systemic disease is highly subjective [10].
Disclosures: The author is a consultant for Mallinckrodt, Celgene, and Mitsubishi-Tanabe.