title: Cloud-Based Service Information System for Evaluating Quality of Life after Breast Cancer Surgery.
abstract: OBJECTIVE
  Although recent studies have improved understanding of quality of life (QOL) outcomes of breast conserving surgery, few have used longitudinal data for more than two time points, and few have examined predictors of QOL over two years. Additionally, the longitudinal data analyses in such studies rarely apply the appropriate statistical methodology to control for censoring and inter-correlations arising from repeated measures obtained from the same patient pool. This study evaluated an internet-based system for measuring longitudinal changes in QOL and developed a cloud-based system for managing patients after breast conserving surgery.
  
  
  METHODS
  This prospective study analyzed 657 breast cancer patients treated at three tertiary academic hospitals. Related hospital personnel such as surgeons and other healthcare professionals were also interviewed to determine the requirements for an effective cloud-based system for surveying QOL in breast cancer patients. All patients completed the SF-36, Quality of Life Questionnaire (QLQ-C30) and its supplementary breast cancer measure (QLQ-BR23) at baseline, 6 months, 1 year, and 2 years postoperatively. The 95% confidence intervals for differences in responsiveness estimates were derived by bootstrap estimation. Scores derived by these instruments were interpreted by generalized estimating equation before and after surgery.
  
  
  RESULTS
  All breast cancer surgery patients had significantly improved QLQ-C30 and QLQ-BR23 subscale scores throughout the 2-year follow-up period (p<0.05). During the study period, QOL generally had a negative association with advanced age, high Charlson comorbidity index score, tumor stage III or IV, previous chemotherapy, and long post-operative LOS. Conversely, QOL was positively associated with previous radiotherapy and hormone therapy. Additionally, patients with high scores for preoperative QOL tended to have high scores for QLQ-C30, QLQ-BR23 and SF-36 subscales. Based on the results of usability testing, the five constructs were rated on a Likert scale from 1-7 as follows: system usefulness (5.6±1.8), ease of use (5.6±1.5), information quality (5.4±1.4), interface quality (5.5±1.4), and overall satisfaction (5.5±1.6).
  
  
  CONCLUSIONS
  The current trend in clinical medicine is applying therapies and interventions that improve QOL. Therefore, a potentially vast amount of internet-based QOL data is available for use in defining patient populations that may benefit from therapeutic intervention. Additionally, before undergoing breast conserving surgery, patients should be advised that their postoperative QOL depends not only on the success of the surgery, but also on their preoperative functional status.
authors.affiliation: Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.
authors.forename: Hao-Yun
authors.initials: HY
authors.lastname: Kao
authors.affiliation: Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.
authors.forename: Wen-Hsiung
authors.initials: WH
authors.lastname: Wu
authors.affiliation: Department of Electrical Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan, R.O.C.
authors.forename: Tyng-Yeu
authors.initials: TY
authors.lastname: Liang
authors.affiliation: Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.
authors.forename: King-The
authors.initials: KT
authors.lastname: Lee
authors.affiliation: Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.; Cancer Center, Kaohsiung Medical University Hospital, 807 Kaohsiung, Taiwan, R.O.C.; National Sun Yat-Sen University-Kaohsiung Medical University Joint Research Center, 80708 Kaohsiung, Taiwan, R.O.C.
authors.forename: Ming-Feng
authors.initials: MF
authors.lastname: Hou
authors.affiliation: Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.
authors.forename: Hon-Yi
authors.initials: HY
authors.lastname: Shi
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D020407:Internet; D008137:Longitudinal Studies; D015412:Mastectomy, Segmental / Q000009:adverse effects; D008490:Medical Informatics / Q000379:methods*; D008499:Medical Records; D008875:Middle Aged; D015233:Models, Statistical; D011788:Quality of Life