Durable usage of patient-reported outcome measures in clinical practice to monitor health-related quality of life in head and neck cancer patients

Purpose

To investigate the long-term follow-up (5 years) of implementing patient-reported outcome measures (PROMs) in clinical practice to monitor health-related quality of life (HRQOL) in head and neck cancer (HNC) patients.

Methods

A mixed method design was used. The usage rate of OncoQuest (a touch screen computer system to monitor HRQOL) and the subsequent nurse consultation was calculated among HNC patients who visited the outpatient clinic for regular follow-up, as well as differences between ever users and never users (sociodemographic and clinical characteristics). The content of the nurse consultation was investigated. Reasons for not using (barriers) or using (facilitators) OncoQuest and the nurse consultation were explored from the perspective of HNC patients, and of head and neck surgeons.

Results

Usage rate of OncoQuest was 67% and of the nurse consultation 79%. Usage of OncoQuest was significantly related to tumor subsite and tumor stage. Topics most frequently (>40%) discussed during the nurse consultation were global quality of life (97%), head and neck cancer related symptoms (82%), other physical symptoms such as pain (61%), and psychological problems such as anxiety (44%). Several barriers and facilitators to implement PROMs in clinical practice were reported by both patients and head and neck surgeons.

Conclusion

Usage of PROMs in clinical practice and a nurse consultation is durable, even 5 years after the introduction. This study contributes to better insight into long-term follow-up of implementation, thereby guiding future research and projects that aim to implement PROMs in clinical practice to monitor HRQOL among (head and neck) cancer patients.

Clinical evaluation of whole-body oncologic PET with time-of-flight and point-spread function for the hybrid PET/MR system

PURPOSE

Hybrid positron emission tomography/magnetic resonance (PET/MR) imaging is a new multimodality imaging technology that can provide structural and functional information simultaneously. The aim of this study was to investigate the effects of the time-of-flight (TOF) and point-spread function (PSF) on small lesions observed in PET/MR images from clinical patient image sets.

MATERIALS AND METHODS

This study evaluated 54 small lesions in 14 patients who had undergone ¹⁸F-fluorodeoxyglucose (FDG) PET/MR. Lesions up to 30mm in diameter were included. The PET data were reconstructed with a baseline ordered-subsets expectation-maximization (OSEM) algorithm, OSEM+PSF, OSEM+TOF and OSEM+TOF+PSF. PET image quality and small lesions were visually evaluated and scored by a 3-point scale. A quantitative analysis was then performed using the mean and maximum standardized uptake value (SUV) of the small lesions (SUV_mean and SUV_max). The lesions were divided into two groups according to the long-axis diameter and the location respectively and evaluated with each reconstruction algorithm. We also evaluated the background signal by analyzing the SUV_liver.

RESULTS

OSEM+TOF+PSF provided the highest value and OSEM+TOF or PSF showed a higher value than OSEM for the visual assessment and quantitative analysis. The combination of TOF and PSF increased the SUV_mean by 26.6% and the SUV_max by 30.0%. The SUV_liverwas not influenced by PSF or TOF. For the OSEM+TOF+PSF model, the change in SUV_mean and SUV_max for lesions <10mm in diameter was 31.9% and 35.8%, and 24.5% and 27.6% for lesions 10-30mm in diameter, respectively. The abdominal lesions obtained the higher SUV than those of chest on the images with TOF and/or PSF.

CONCLUSION

Application of TOF and PSF significantly increased the SUV of small lesions in hybrid PET/MR images, potentially improving small lesion detectability.

Design Features and Mutual Compatibility Studies of the Time-of-Flight PET Capable GE SIGNA PET/MR System

A recent entry into the rapidly evolving field of integrated PET/MR scanners is presented in this paper: a whole body hybrid PET/MR system (SIGNA PET/MR, GE Healthcare) capable of simultaneous acquisition of both time-of-flight (TOF) PET and high resolution MR data. The PET ring was integrated into an existing 3T MR system resulting in a (patient) bore opening of 60 cm diameter, with a 25 cm axial FOV. PET performance was evaluated both on the standalone PET ring and on the same detector integrated into the MR system, to assess the level of mutual interference between both subsystems. In both configurations we obtained detector performance data. PET detector performance was not significantly affected by integration into the MR system. The global energy resolution was within 2% (10.3% versus 10.5%), and the system coincidence time resolution showed a maximum change of < 3% (385 ps versus 394 ps) when measured outside MR and during simultaneous PET/MRI acquisitions, respectively. To evaluate PET image quality and resolution, the NEMA IQ phantom was acquired with MR idle and with MR active. Impact of PET on MR IQ was assessed by comparing SNR with PET acquisition on and off. B0 and B1 homogeneities were acquired before and after the integration of the PET ring inside the magnet. In vivo brain and whole body head-to-thighs data were acquired to demonstrate clinical image quality.

Stepped care targeting psychological distress in head and neck cancer and lung cancer patients: a randomized, controlled trial

BACKGROUND

This study aimed to evaluate the efficacy of stepped care (SC) targeting psychological distress in head and neck cancer (HNC) and lung cancer (LC) patients.

PATIENTS AND METHODS

Patients with untreated distress [Hospital Anxiety and Depression Scale (HADS; HADS-D > 7, HADS-A > 7, or HADS-total > 14)] were randomized to SC (n = 75) or care-as-usual (CAU) (n = 81). SC consisted of watchful waiting, guided self-help, problem-solving therapy, and psychotherapy and/or psychotropic medication. The primary outcome measure was the HADS; secondary outcome measures were recovery rate, EORTC QLQ-C30, QLQ-HN35/QLQ-LC13, and IN-PATSAT32. Measures were assessed at baseline, after completion of care, and at 3, 6, 9, and 12 months follow-up. Linear mixed models, t-tests, and effect sizes (ES) were used to assess group differences.

RESULTS

Patients with untreated distress were randomized to SC (n = 75) or care-as-usual (CAU) (n = 81). The course of psychological distress was better after SC compared with CAU (HADS-total, P = 0.005; HADS-A, P = 0.046; HADS-D, P = 0.007). The SC group scored better post-treatment (HADS-total, ES = 0.56; HADS-A, ES = 0.38; HADS-D, ES = 0.64) and at 9 months follow-up (HADS-total, ES = 0.42 and HADS-A, ES = 0.40). The recovery rate post-treatment was 55% after SC compared with 29% after CAU (P = 0.002), and 46% and 37% at 12 months follow-up (P = 0.35). Within SC, 28% recovered after watchful waiting, 34% after guided self-help, 9% after problem-solving therapy, and 17% after psychotherapy and/or psychotropic medication. The effect of SC was stronger for patients with a depressive or anxiety disorder compared with patients without such a disorder (HADS-total, P = 0.001; HADS-A, P = 0.003; HADS-D, P = 0.041).

CONCLUSIONS

SC is effective and speeds up recovery among HNC and LC patients with untreated psychological distress.

TRIAL REGISTRATION

Netherlands Trial Register (NTR1868).

[Acute coronary syndrome in acute stroke]

BACKGROUND

Elevated troponin levels are commonly found in patients with acute stroke and approximately 60 % of stroke patients suffer from an accompanying coronary artery disease. Troponin release can be caused either by an acute thrombotic myocardial infarction or by insufficient coronary perfusion due to neurocardiogenic causes like blood pressure or heart rate variability without thrombotic coronary occlusion. Due to the often unclear pathological cause of troponin release and the risk of secondary hemorrhage during dual antiplatelet therapy, the determination of the best time point for coronary diagnostics and therapy in stroke patients is a common challenge in clinical daily routine.

MATERIALS AND METHODS

Based on the current literature, we describe a potential diagnostic and therapeutic approach in stroke patients with increased troponin levels.

RESULTS

First, the probability of an acute thrombotic myocardial infarction should be evaluated based on clinical, laboratory, and electrocardiographic parameters. In case of suspected myocardial infarction, a diagnostic coronary angiography/CT angiography should be performed and dual antiplatelet therapy should be given depending on the intracranial bleeding risk. In patients with high risk of intracranial bleeding, thrombus aspiration and balloon dilatation should be considered.

CONCLUSION

In patients with acute stroke and elevated troponin levels, a thorough diagnostic workup is necessary to estimate the probability for a thrombotic myocardial infarction and to prevent cardiac and neurologic complications.

Measurements of the branching fractions of [Formula: see text] decays

The branching fractions of the decay [Formula: see text] for different intermediate states are measured using data, corresponding to an integrated luminosity of 1.0 fb^-1, collected by the LHCb experiment. The total branching fraction, its charmless component [Formula: see text] and the branching fractions via the resonant [Formula: see text] states η_c (1S) and ψ(2S) relative to the decay via a J/ψ intermediate state are [Formula: see text] Upper limits on the B⁺ branching fractions into the η_c (2S) meson and into the charmonium-like states X(3872) and X(3915) are also obtained.

Measurement of the forward energy flow in pp collisions at [Formula: see text]

The energy flow created in pp collisions at [Formula: see text] is studied within the pseudorapidity range 1.9<η<4.9 with data collected by the LHCb experiment. The measurements are performed for inclusive minimum-bias interactions, hard scattering processes and events with an enhanced or suppressed diffractive contribution. The results are compared to predictions given by Pythia-based and cosmic-ray event generators, which provide different models of soft hadronic interactions.

Measurement of the Λ(b)(0), Ξ (b)(-), and Ω(b((-) Baryon masses

Bottom baryons decaying to a J/ψ meson and a hyperon are reconstructed using 1.0 fb(-1) of data collected in 2011 with the LHCb detector. Significant Λ(b)(0) → J/ψΛ, Ξ(b((-) → J/ψΞ(-) and Ω(b)(-) → J/ψΩ(-) signals are observed and the corresponding masses are measured to be M(Λ(b)(0))=5619.53 ± 0.13(stat.) ± 0.45(syst.) MeV/c(2), M(Ξ(b)(-)) = 5795.8 ± 0.9(stat.) ± 0.4(syst.) MeV/c(2), M(Ω(b)(-)) = 6046.0 ± 2.2(stat.) ± 0.5(syst.) MeV/c(2) , while the differences with respect to the Λ(b)(0) mass are M(Ξ(b)(-))-M(Λ(b)(0))=176.2 ± 0.9(stat.) ± 0.1(syst.) MeV/c(2), M(Ω(b)(-))-M(Λ(b)(0))=426.4 ± 2.2(stat.) ± 0.4(syst.) MeV/c(2). These are the most precise mass measurements of the Λ(b)(0), Ξ(b)(-) and Ω(b)(-) baryons to date. Averaging the above Λ(b)(0) mass measurement with that published by LHCb using 35 pb(-1) of data collected in 2010 yields M(Λ(b)(0)) = 5619.44 ± 0.13(stat.)± 0.38(syst.) MeV/c(2).

First observation of the decay Bs2*(5840)(0)→B*+ K- and studies of excited Bs(0) mesons

The properties of the orbitally excited (L=1) Bs(0) states are studied by using 1.0  fb(-1) of pp collisions at sqrt[s]=7  TeV collected with the LHCb detector. The first observation of the Bs2*(5840)(0) meson decaying to B*+ K- is reported, and the corresponding branching fraction measured relative to the B+ K- decay mode. The Bs1(5830)(0)→B*+ K- decay is observed as well. The width of the Bs2*(5840)(0) state is measured for the first time, and the masses of the two states are determined with the highest precision to date. The observation of the Bs2*(5840)(0)→B*+ K- decay favors the spin-parity assignment J(P)=2+ for the Bs2*(5840)(0) meson. In addition, the most precise measurement of the mass difference m(B*+)-m(B+)=45.01±0.30(stat)±0.23(syst)  MeV/c(2) is obtained.

Observation of D0-D0 oscillations

We report a measurement of the time-dependent ratio of D(0) → K(+) π- to D(0) → K(-) π(+) decay rates in D(*+)-tagged events using 1.0 fb(-1) of integrated luminosity recorded by the LHCb experiment. We measure the mixing parameters x('2) = (-0.9 ± 1.3) × 10(-4), y' = (7.2 ± 2.4) × 10(-3), and the ratio of doubly-Cabibbo-suppressed to Cabibbo-favored decay rates R(D) = (3.52 ± 0.15) × 10^{-3}, where the uncertainties include statistical and systematic sources. The result excludes the no-mixing hypothesis with a probability corresponding to 9.1 standard deviations and represents the first observation of D0-D0 oscillations from a single measurement.

Measurement of the CP asymmetry in B(0)→K(*0)μ(+)μ(-) decays

A measurement of the CP asymmetry in B(0)→K(*0)μ(+)μ(-) decays is presented, based on 1.0 fb(-1) of pp collision data recorded by the LHCb experiment during 2011. The measurement is performed in six bins of invariant mass squared of the μ(+)μ(-) pair, excluding the J/ψ and ψ(2S) resonance regions. Production and detection asymmetries are removed using the B(0)→J/ψK(*0) decay as a control mode. The integrated CP asymmetry is found to be -0.072±0.040(stat)±0.005(syst), consistent with the standard model.

First evidence for the decay B(s)(0)→μ+ μ-

A search for the rare decays B(s)(0)→μ+ μ- and B(0)→μ+ μ- is performed with data collected in 2011 and 2012 with the LHCb experiment at the Large Hadron Collider. The data samples comprise 1.1  fb(-1) of proton-proton collisions at sqrt[s]=8  TeV and 1.0  fb(-1) at sqrt[s]=7  TeV. We observe an excess of B(s)(0)→μ+ μ- candidates with respect to the background expectation. The probability that the background could produce such an excess or larger is 5.3×10(-4) corresponding to a signal significance of 3.5 standard deviations. A maximum-likelihood fit gives a branching fraction of B(B(s)(0)→μ+ μ-)=(3.2(-1.2)(+1.5))×10(-9), where the statistical uncertainty is 95% of the total uncertainty. This result is in agreement with the standard model expectation. The observed number of B(0)→μ+ μ- candidates is consistent with the background expectation, giving an upper limit of B(B(0)→μ+ μ-)<9.4×10(-10) at 95% confidence level.

Measurements of B(c)+ production and mass with the B(c)+ → J/ψπ+ decay

Measurements of B(c)(+) production and mass are performed with the decay mode B(c)(+)→J/ψπ(+) using 0.37 fb(-1) of data collected in pp collisions at √[s]=7 TeV by the LHCb experiment. The ratio of the production cross section times branching fraction between the B(c)(+)→J/ψπ(+) and the B(+)→J/ψK(+) decays is measured to be (0.68±0.10(stat)±0.03(syst)±0.05(lifetime))% for B(c)(+) and B(+) mesons with transverse momenta p(T)>4 GeV/c and pseudorapidities 2.5<η<4.5. The B(c)(+) mass is directly measured to be 6273.7±1.3(stat)±1.6(syst) MeV/c(2), and the measured mass difference with respect to the B(+) meson is M(B(c)(+))-M(B(+))=994.6±1.3(stat)±0.6(syst) MeV/c(2).

Observation of excited Λ(b)(0) baryons

Using pp collision data corresponding to 1.0 fb(-1) integrated luminosity collected by the LHCb detector, two narrow states are observed in the Λ(b)(0)π(+)π(-) spectrum with masses 5911.97±0.12(stat)±0.02(syst)±0.66(Λ(b)(0) mass) MeV/c(2) and 5919.77±0.08(stat)±0.02(syst)±0.66(Λ(b)(0) mass) MeV/c(2). The significances of the observations are 5.2 and 10.2 standard deviations, respectively. These states are interpreted as the orbitally excited Λ(b)(0) baryons, Λ(b)(*0)(5912) and Λ(b)(*0)(5920).

Measurement of the B¯(s)(0) effective lifetime in the J/ψf0(980) final state

The effective lifetime of the B ¯(s)(0) meson in the decay mode B¯(s)(0)→J/ψf(0)(980) is measured using 1.0 fb(-1) of data collected in pp collisions at √s=7 TeV with the LHCb detector. The result is 1.700±0.040±0.026 ps, where the first uncertainty is statistical and the second systematic. As the final state is CP-odd, and CP violation in this mode is measured to be small, the lifetime measurement can be translated into a measurement of the decay width of the heavy B¯(s)(0) mass eigenstate, Γ(H)=0.588±0.014±0.009 ps(-1).

Observation of B0→D¯(0)K(+)K(-) and evidence for B(s)(0)→D¯(0)K(+)K(-)

The first observation of the decay B0→D¯(0)K(+)K(-) is reported from an analysis of 0.62 fb(-1) of pp collision data collected with the LHCb detector. Its branching fraction is measured relative to that of the topologically similar decay B(0)→D ¯(0)π(+)π(-) to be (B(B(0)→D¯(0)K(+)K(-))/B(B(0)→D¯(0)π(+)π(-))=0.056±0.011±0.007,where the first uncertainty is statistical and the second is systematic. The significance of the signal is 5.8σ. Evidence, with 3.8σ significance, for B(s)(0)→D¯(0)K(+)K(-) decays is also presented. The relative branching fraction is measured to be B(B(s)(0)→D¯(0)K(+)K(-))/B(B(0)→D¯(0)K(+)K(-))=0.90±0.27±0.20. These channels are of interest to study the mechanisms behind hadronic B decays, and open new possibilities for CP violation analyses with larger data sets.