51
|
Jeong K, Cairns J. Systematic review of health state utility values for economic evaluation of colorectal cancer. HEALTH ECONOMICS REVIEW 2016; 6:36. [PMID: 27541298 PMCID: PMC4991979 DOI: 10.1186/s13561-016-0115-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 08/12/2016] [Indexed: 05/30/2023]
Abstract
Cost-utility analyses undertaken to inform decision making regarding colorectal cancer (CRC) require a set of health state utility values (HSUVs) so that the time CRC patients spend in different health states can be aggregated into quality-adjusted life-years (QALY). This study reviews CRC-related HSUVs that could be used in economic evaluation and assesses their advantages and disadvantages with respect to valuation methods used and CRC clinical pathways. Fifty-seven potentially relevant studies were identified which collectively report 321 CRC-related HSUVs. HSUVs (even for similar health states) vary markedly and this adds to the uncertainty regarding estimates of cost-effectiveness. There are relatively few methodologically robust HSUVs that can be directly used in economic evaluations concerned with CRC. There is considerable scope to develop new HSUVs which improve on those currently available either by expanded collection of generic measures or by making greater use of condition-specific data, for example, using mapping algorithms.
Collapse
Affiliation(s)
- Kim Jeong
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - John Cairns
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| |
Collapse
|
52
|
Quality of life in patients with colorectal cancer in Iran. Arab J Gastroenterol 2016; 17:127-130. [DOI: 10.1016/j.ajg.2016.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 03/13/2016] [Accepted: 06/05/2016] [Indexed: 12/11/2022]
|
53
|
Experiences of colorectal cancer patients in the 2-years post-diagnosis and patient factors predicting poor outcome. Support Care Cancer 2016; 24:4921-4928. [DOI: 10.1007/s00520-016-3348-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 07/10/2016] [Indexed: 11/12/2022]
|
54
|
Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, Stein KD, Alteri R, Jemal A. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 2016; 66:271-89. [PMID: 27253694 DOI: 10.3322/caac.21349] [Citation(s) in RCA: 3404] [Impact Index Per Article: 425.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The number of cancer survivors continues to increase because of both advances in early detection and treatment and the aging and growth of the population. For the public health community to better serve these survivors, the American Cancer Society and the National Cancer Institute collaborate to estimate the number of current and future cancer survivors using data from the Surveillance, Epidemiology, and End Results cancer registries. In addition, current treatment patterns for the most prevalent cancer types are presented based on information in the National Cancer Data Base and treatment-related side effects are briefly described. More than 15.5 million Americans with a history of cancer were alive on January 1, 2016, and this number is projected to reach more than 20 million by January 1, 2026. The 3 most prevalent cancers are prostate (3,306,760), colon and rectum (724,690), and melanoma (614,460) among males and breast (3,560,570), uterine corpus (757,190), and colon and rectum (727,350) among females. More than one-half (56%) of survivors were diagnosed within the past 10 years, and almost one-half (47%) are aged 70 years or older. People with a history of cancer have unique medical and psychosocial needs that require proactive assessment and management by primary care providers. Although there are a growing number of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care. CA Cancer J Clin 2016;66:271-289. © 2016 American Cancer Society.
Collapse
Affiliation(s)
- Kimberly D Miller
- Epidemiologist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Rebecca L Siegel
- Strategic Director, Surveillance Information, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Chun Chieh Lin
- Director, Health Services Research, Intramural Research Department, American Cancer Society, Atlanta, GA
| | - Angela B Mariotto
- Branch Chief, Surveillance Research Program, National Cancer Institute, Bethesda, MD
| | - Joan L Kramer
- Assistant Professor, Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Julia H Rowland
- Director, Office of Cancer Survivorship, National Cancer Institute, Bethesda, MD
| | - Kevin D Stein
- Vice President, Behavioral Research Center, American Cancer Society, Atlanta, GA
| | - Rick Alteri
- Medical Editor, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| |
Collapse
|
55
|
Abstract
BACKGROUND Up to 37% of colorectal cancer (CRC) survivors report depressive and anxiety symptoms. The identification of risk factors for depressive or anxiety symptoms might help focus supportive care resources on those patients most in need. The present study aims to explore which factors are associated with heightened anxiety or depression symptom severity. METHODS In this cross-sectional study, individuals diagnosed with CRC 3.5 to 6 years ago completed questionnaires on sociodemographic information, medical comorbidities, anxiety symptoms (Beck Anxiety Inventory), and depressive symptoms (Inventory of Depressive Symptomatology). The general linear model analysis of covariance was used to identify factors associated with heightened anxiety or depressive symptom severity. RESULTS The sample included 91 CRC survivors, 40.7% women, mean age 69.1 years. A minority of CRC survivors had moderate (3.4%) or severe (2.3%) anxiety symptoms, and moderate (7.7%) or severe (0%) depressive symptoms. Shorter time since diagnosis and higher number of comorbid diseases were associated with higher anxiety symptom severity. Female sex and higher number of comorbid diseases were associated with higher depressive symptom severity. CONCLUSION From this explorative study, it follows that survivors with multiple comorbid diseases, shorter time since diagnosis, and female survivors might be at risk for higher anxiety and/or depressive symptom severity. Survivors with these characteristics might need extra monitoring.
Collapse
|
56
|
Zhou J, Zhao R, Wen F, Zhang P, Tang R, Chen H, Zhang J, Li Q. Economic evaluation study (CHEER-compliant): Cost-effectiveness analysis of RAS screening for treatment of metastatic colorectal cancer based on the CALGB 80405 trial. Medicine (Baltimore) 2016; 95:e3762. [PMID: 27399059 PMCID: PMC5058788 DOI: 10.1097/md.0000000000003762] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Cetuximab (Cetux)/Bevacizumab (Bev) treatments have shown considerably survival benefits for patients with metastatic colorectal cancer (mCRC) in the last decade. But they are costly. Currently, no data is available on the health economic implications of testing for extended RAS wild-type (wt) prior to Cetux/Bev treatments of patients with mCRC. This paper aimed to evaluate the cost-effectiveness of predictive testing for extended RAS-wt status in mCRC in the context of targeting the use of Cetux/Bev.Markov model 1 was conducted to provide evidence evaluating the cost-effectiveness of predictive testing for KRAS-wt or extended RAS-wt status based on treatments of chemotherapy plus Cetux/Bev. Markov model 2 assessed the cost-effectiveness of FOLFOX plus Cetux/Bev or FOLFIRI plus Cetux/Bev in extended RAS-wt population. Primary base case data were identified from the CALGB 80405 trial and the literatures. Costs were estimated from West China Hospital, Sichuan University, China. Survival benefits were reported in quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio (ICER) was calculated.In analysis 1, the cost per QALY was $88,394.09 for KRAS-Cetux, $80,797.82 for KRAS-Bev, $82,590.72 for RAS-Cetux, and $75,358.42 for RAS-Bev. The ICER for RAS-Cetux versus RAS-Bev was $420,700.50 per QALY gained. In analysis 2, the cost per QALY was $81,572.61, $80,856.50, $80,592.22, and $66,794.96 for FOLFOX-Cetux, FOLFOX-Bev, FOLFIRI-Cetux, and FOLFIRI-Bev, respectively. The analyses showed that the extended RAS-wt testing was less costly and more effective versus KRAS-wt testing before chemotherapy plus Cetux/Bev. Furthermore, FOLFIRI plus Bev was the most cost-effective strategy compared with others in extended RAS-wt population.It was economically favorable to identify patients with extended RAS-wt status. Furthermore, FOLFIRI plus Bev was the preferred strategy in extended RAS-wt patients.
Collapse
Affiliation(s)
- Jing Zhou
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy
| | - Rongce Zhao
- Division of Liver Transplantation, Department of Liver Surgery, West China Hospital, Sichuan University, China
| | - Feng Wen
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy
| | - Pengfei Zhang
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy
| | - Ruilei Tang
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy
| | - Hongdou Chen
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy
| | - Jian Zhang
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy
| | - Qiu Li
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy
- Correspondence: Qiu Li, Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, China (e-mail: , )
| |
Collapse
|
57
|
Hamidou Z, Chibaudel B, Hebbar M, Hug de Larauze M, André T, Louvet C, Brusquant D, Garcia-Larnicol ML, de Gramont A, Bonnetain F. Time to Definitive Health-Related Quality of Life Score Deterioration in Patients with Resectable Metastatic Colorectal Cancer Treated with FOLFOX4 versus Sequential Dose-Dense FOLFOX7 followed by FOLFIRI: The MIROX Randomized Phase III Trial. PLoS One 2016; 11:e0157067. [PMID: 27310205 PMCID: PMC4910973 DOI: 10.1371/journal.pone.0157067] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/23/2016] [Indexed: 01/03/2023] Open
Abstract
Purpose We previously showed that a sequential chemotherapy with dose-dense oxaliplatin (FOLFOX7) and irinotecan (FOLFIRI; irinotecan plus 5-fluorouracil/leucovorin) is not superior to FOLFOX4 in patients at advanced stage of colorectal cancer with liver metastases. Here we aimed to determine whether time to health-related quality of life (HRQoL) score definitive deterioration (TUDD) differs by study arm. Methods HRQoL was evaluated using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 at baseline and every 4 cycles until the end of the study or death. Functional scale, symptom scale, global health status, and financial difficulties were analyzed. The TUDD was defined as the time interval between randomization and the first decrease in HRQoL score ≥ 5-point with no further improvement in HRQoL score ≥ 5 points or any further HRQoL data. TUDD was estimated using the Kaplan-Meier method and the long-rank test. Cox regression analyses were used to identify HRQoL items influencing TUDD. Sensitivity analyses were done using a multiple imputation method and different definitions of TUDD. Results Of the 284 patients, 171 (60.2%) completed HRQoL questionnaires. Cox multivariate analysis showed no statistically significant difference in TUDD for most of the QLQ-C30 scales between treatments. Patients with dyspnea and those without symptoms at baseline had a significantly longer TUDD when there was a delay >12 months between diagnosis of the primary tumor and metastases (HR 0.48 [0.26–0.89]) and when there was diarrhea (HR 0.59 [0.36–0.96]), respectively. Conclusion This study shows that TUDD does not differ significantly according to type of treatment. The TUDD method produces meaningful longitudinal HRQoL results that may facilitate effective clinical decision making in patients with mCRC. Trial Registration ClinicalTrials.gov NCT00268398
Collapse
Affiliation(s)
- Zeinab Hamidou
- National clinical research Platform for Quality of life in Oncology, Marseille, France.,Public health laboratory, College of Medicine, Marseille, France
| | - Benoist Chibaudel
- Saint-Antoine Hospital, Department of Medical Oncology, Paris, France
| | - Mohamed Hebbar
- Centre Hospitalier Régional Universitaire, Claude Huriez Hospital, Service of Medical Oncology, Lille, France
| | | | - Thierry André
- Saint-Antoine Hospital, Department of Medical Oncology, Paris, France
| | - Christophe Louvet
- Institut Mutualiste Montsouris, Department of Medical Oncology, Paris, France
| | - David Brusquant
- Groupe Coopérateur Multidisciplinaire en Oncologie (GERCOR), Paris, France
| | | | - Aimery de Gramont
- Centre Hospitalier Régional Universitaire, Claude Huriez Hospital, Service of Medical Oncology, Lille, France
| | - Franck Bonnetain
- National clinical research Platform for Quality of life in Oncology, Marseille, France.,University Hospital of Besançon, Methodology and quality of life unit in oncology (EA3181), Besançon, France
| |
Collapse
|
58
|
Jefford M, Gough K, Drosdowsky A, Russell L, Aranda S, Butow P, Phipps-Nelson J, Young J, Krishnasamy M, Ugalde A, King D, Strickland A, Franco M, Blum R, Johnson C, Ganju V, Shapiro J, Chong G, Charlton J, Haydon A, Schofield P. A Randomized Controlled Trial of a Nurse-Led Supportive Care Package (SurvivorCare) for Survivors of Colorectal Cancer. Oncologist 2016; 21:1014-23. [PMID: 27306909 DOI: 10.1634/theoncologist.2015-0533] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/08/2016] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) and its treatments can cause distressing sequelae. We conducted a multicenter randomized controlled trial aiming to improve psychological distress, supportive care needs (SCNs), and quality of life (QOL) of patients with CRC. The intervention, called SurvivorCare (SC), comprised educational materials, needs assessment, survivorship care plan, end-of-treatment session, and three follow-up telephone calls. METHODS At the end of treatment for stage I-III CRC, eligible patients were randomized 1:1 to usual care (UC) or to UC plus SC. Distress (Brief Symptom Inventory 18), SCNs (Cancer Survivors' Unmet Needs measure), and QOL (European Organization for Research and Treatment of Cancer [EORTC] QOL questionnaires C30 and EORTC CRC module CR29) were assessed at baseline and at 2 and 6 months (follow-up 1 [FU1] and FU2, respectively). The primary hypothesis was that SC would have a beneficial effect on distress at FU1. The secondary hypotheses were that SC would have a beneficial effect on (a) SCN and QOL at FU1 and on (b) distress, SCNs, and QOL at FU2. A total of 15 items assessed experience of care. RESULTS Of 221 patients randomly assigned, 4 were ineligible for the study and 1 was lost to FU, leaving 110 in the UC group and 106 in the SC group. Patients' characteristics included the following: median age, 64 years; men, 52%; colon cancer, 56%; rectal cancer, 35%; overlapping sites of disease, 10%; stage I disease, 7%; stage II, 22%; stage III, 71%. Baseline distress and QOL scores were similar to population norms. Between-group differences in distress at FU1 (primary outcome) and at FU2, and SCNs and QOL at FU1 and FU2 were small and nonsignificant. Patients in the SC group were more satisfied with survivorship care than those in the UC group (significant differences on 10 of 15 items). CONCLUSION The addition of SC to UC did not have a beneficial effect on distress, SCNs, or QOL outcomes, but patients in the SC group were more satisfied with care. IMPLICATIONS FOR PRACTICE Some survivors of colorectal cancer report distressing effects after completing treatment. Strategies to identify and respond to survivors' issues are needed. In a randomized controlled trial, the addition of a nurse-led supportive care package (SurvivorCare) to usual post-treatment care did not impact survivors' distress, quality of life, or unmet needs. However, patients receiving the SurvivorCare intervention were more satisfied with survivorship care. Factors for consideration in the design of subsequent studies are discussed.
Collapse
Affiliation(s)
- Michael Jefford
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Karla Gough
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Allison Drosdowsky
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Lahiru Russell
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Deakin University, Melbourne, Victoria, Australia
| | - Sanchia Aranda
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Cancer Institute NSW, Sydney, New South Wales, Australia
| | - Phyllis Butow
- University of Sydney, Sydney, New South Wales, Australia
| | - Jo Phipps-Nelson
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Jane Young
- Cancer Institute NSW, Sydney, New South Wales, Australia University of Sydney, Sydney, New South Wales, Australia
| | - Mei Krishnasamy
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Anna Ugalde
- Deakin University, Melbourne, Victoria, Australia
| | - Dorothy King
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | | | | | - Robert Blum
- Bendigo Health, Bendigo, Victoria, Australia
| | | | - Vinod Ganju
- Peninsula and Southeast Oncology, Melbourne, Victoria, Australia
| | | | - Geoffrey Chong
- Ballarat Regional Integrated Cancer Centre, Ballarat, Victoria, Australia
| | - Julie Charlton
- Newcastle Private Hospital, Newcastle, New South Wales, Australia
| | | | - Penelope Schofield
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia Department of Psychology, Swinburne University of Technology, Melbourne, Victoria, Australia
| |
Collapse
|
59
|
Quality of Life and Mortality of Long-Term Colorectal Cancer Survivors in the Seattle Colorectal Cancer Family Registry. PLoS One 2016; 11:e0156534. [PMID: 27253385 PMCID: PMC4890809 DOI: 10.1371/journal.pone.0156534] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 05/15/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND AIM Because most colorectal cancer patients survive beyond five years, understanding quality of life among these long-term survivors is essential to providing comprehensive survivor care. We sought to identify personal characteristics associated with reported quality of life in colorectal cancer survivors, and sub-groups of survivors potentially vulnerable to very low quality of life. METHODS We assessed quality of life using the Veterans RAND 12-item Health Survey within a population-based sample of 1,021 colorectal cancer survivors in the Seattle Colorectal Cancer Family Registry, approximately 5 years post-diagnosis. In this case-only study, mean physical component summary scores and mental component summary scores were examined with linear regression. To identify survivors with substantially reduced ability to complete daily tasks, logistic regression was used to estimate odds ratios for "very low" summary scores, defined as a score in the lowest decile of the reference US population. All cases were followed for vital status following QoL assessment, and mortality was analyzed with Cox proportional hazards regression. RESULTS Lower mean physical component summary score was associated with older age, female sex, obesity, smoking, and diabetes or other co-morbidity; lower mean mental component summary score was associated with younger age and female sex. Higher odds of very low physical component summary score was associated with older age, obesity, less education, smoking, co-morbidities, and later stage at diagnosis; smoking was associated with higher odds of very low mental component summary score. A very low physical component score was associated with higher risk of mortality (hazard ratio (95% confidence interval): 3.97 (2.95-5.34)). CONCLUSIONS Our results suggest that identifiable sub-groups of survivors are vulnerable to very low physical components of quality of life, decrements that may represent meaningful impairment in completing everyday tasks and are associated with higher risk of death.
Collapse
|
60
|
Bours MJL, van der Linden BWA, Winkels RM, van Duijnhoven FJ, Mols F, van Roekel EH, Kampman E, Beijer S, Weijenberg MP. Candidate Predictors of Health-Related Quality of Life of Colorectal Cancer Survivors: A Systematic Review. Oncologist 2016; 21:433-52. [PMID: 26911406 PMCID: PMC4828113 DOI: 10.1634/theoncologist.2015-0258] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 12/16/2015] [Indexed: 12/23/2022] Open
Abstract
UNLABELLED The population of colorectal cancer (CRC) survivors is growing and many survivors experience deteriorated health-related quality of life (HRQoL) in both early and late post-treatment phases. Identification of CRC survivors at risk for HRQoL deterioration can be improved by using prediction models. However, such models are currently not available for oncology practice. As a starting point for developing prediction models of HRQoL for CRC survivors, a comprehensive overview of potential candidate HRQoL predictors is necessary. Therefore, a systematic literature review was conducted to identify candidate predictors of HRQoL of CRC survivors. Original research articles on associations of biopsychosocial factors with HRQoL of CRC survivors were searched in PubMed, Embase, and Google Scholar. Two independent reviewers assessed eligibility and selected articles for inclusion (N = 53). Strength of evidence for candidate HRQoL predictors was graded according to predefined methodological criteria. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) was used to develop a biopsychosocial framework in which identified candidate HRQoL predictors were mapped across the main domains of the ICF: health condition, body structures and functions, activities, participation, and personal and environmental factors. The developed biopsychosocial ICF framework serves as a basis for selecting candidate HRQoL predictors, thereby providing conceptual guidance for developing comprehensive, evidence-based prediction models of HRQoL for CRC survivors. Such models are useful in clinical oncology practice to aid in identifying individual CRC survivors at risk for HRQoL deterioration and could also provide potential targets for a biopsychosocial intervention aimed at safeguarding the HRQoL of at-risk individuals. IMPLICATIONS FOR PRACTICE More and more people now survive a diagnosis of colorectal cancer. The quality of life of these cancer survivors is threatened by health problems persisting for years after diagnosis and treatment. Early identification of survivors at risk of experiencing low quality of life in the future is thus important for taking preventive measures. Clinical prediction models are tools that can help oncologists identify at-risk individuals. However, such models are currently not available for clinical oncology practice. This systematic review outlines candidate predictors of low quality of life of colorectal cancer survivors, providing a firm conceptual basis for developing prediction models.
Collapse
Affiliation(s)
- Martijn J L Bours
- Department of Epidemiology, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Bernadette W A van der Linden
- Department of Epidemiology, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Renate M Winkels
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | | | - Floortje Mols
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands Netherlands Comprehensive Cancer Organization, Netherlands Cancer Registry, Eindhoven, The Netherlands
| | - Eline H van Roekel
- Department of Epidemiology, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Ellen Kampman
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands Department of Health Sciences, VU University Amsterdam, Amsterdam, The Netherlands Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sandra Beijer
- Netherlands Comprehensive Cancer Organization, Netherlands Cancer Registry, Eindhoven, The Netherlands
| | - Matty P Weijenberg
- Department of Epidemiology, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
61
|
|
62
|
Lester-Coll NH, Rutter CE, Bledsoe TJ, Goldberg SB, Decker RH, Yu JB. Cost-Effectiveness of Surgery, Stereotactic Body Radiation Therapy, and Systemic Therapy for Pulmonary Oligometastases. Int J Radiat Oncol Biol Phys 2016; 95:663-72. [PMID: 27055395 DOI: 10.1016/j.ijrobp.2016.01.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/06/2016] [Accepted: 01/12/2016] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Pulmonary oligometastases have conventionally been managed with surgery and/or systemic therapy. However, given concerns about the high cost of systemic therapy and improvements in local treatment of metastatic cancer, the optimal cost-effective management of these patients is unclear. Therefore, we sought to assess the cost-effectiveness of initial management strategies for pulmonary oligometastases. METHODS AND MATERIALS A cost-effectiveness analysis using a Markov modeling approach was used to compare average cumulative costs, quality adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) among 3 initial disease management strategies: video-assisted thoracic surgery (VATS) wedge resection, stereotactic body radiation therapy (SBRT), and systemic therapy among 5 different cohorts of patient disease: (1) melanoma; (2) non-small cell lung cancer adenocarcinoma without an EGFR mutation (NSCLC AC); (3) NSCLC with an EGFR mutation (NSCLC EGFRm AC); (4) NSCLC squamous cell carcinoma (NSCLC SCC); and (5) colon cancer. One-way sensitivity analyses and probabilistic sensitivity analyses were performed to analyze uncertainty with regard to model parameters. RESULTS In the base case, SBRT was cost effective for melanoma, with costs/net QALYs of $467,787/0.85. In patients with NSCLC, the most cost-effective strategies were SBRT for AC ($156,725/0.80), paclitaxel/carboplatin for SCC ($123,799/0.48), and erlotinib for EGFRm AC ($147,091/1.90). Stereotactic body radiation therapy was marginally cost-effective for EGFRm AC compared to erlotinib with an incremental cost-effectiveness ratio of $126,303/QALY. For colon cancer, VATS wedge resection ($147,730/2.14) was the most cost-effective strategy. Variables with the greatest influence in the model were erlotinib-associated progression-free survival (EGFRm AC), toxicity (EGFRm AC), cost of SBRT (NSCLC SCC), and patient utilities (all histologies). CONCLUSIONS Video-assisted thoracic surgery wedge resection or SBRT can be cost-effective in select patients with pulmonary oligometastases, depending on histology, efficacy, and tolerability of treatment and patient preferences.
Collapse
Affiliation(s)
- Nataniel H Lester-Coll
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut.
| | - Charles E Rutter
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Trevor J Bledsoe
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Sarah B Goldberg
- Department of Medicine (Medical Oncology), Yale University School of Medicine, New Haven, Connecticut
| | - Roy H Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - James B Yu
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
63
|
Wang JW, Sun L, Ding N, Li J, Gong XH, Chen XF, Yu DH, Luo ZN, Yuan ZP, Yu JM. The association between comorbidities and the quality of life among colorectal cancer survivors in the People's Republic of China. Patient Prefer Adherence 2016; 10:1071-7. [PMID: 27366053 PMCID: PMC4913535 DOI: 10.2147/ppa.s100873] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cancer survivors with certain comorbidities had lower quality of life (QOL). This study was performed to investigate the prevalence of comorbidities and the association between comorbidities and the QOL among Chinese colorectal cancer survivors (CCS). METHODS A cross-sectional study was conducted among 1,398 CCS between April and July 2013 in Shanghai, People's Republic of China. All the participants were asked to complete a simplified Chinese version of the European Organization for Research and Treatment quality of life version 3 questionnaire and questions on sociodemographic characteristics and comorbidities. In order to mitigate the bias caused by confounding factors, multiple linear regression models were employed to calculate the adjusted means of QOL scores. RESULTS The proportion of participants without any comorbidity was only 20.2%. The CCS with comorbidities except hypertension scored significantly lower on the European Organization for Research and Treatment quality of life version 3 questionnaire global health and functioning scales and Functional Assessment of Cancer Therapy-General scales but higher on the European Organization for Research and Treatment quality of life version 3 questionnaire symptom scores, indicating that they had poorer QOL, particularly for cardiovascular, respiratory, digestive, and musculoskeletal diseases. CONCLUSION There exists a significant association between comorbidities and QOL among Chinese CCS, and participants with comorbidities generally reported lower QOL scores. These findings suggested comprehensive care for CCS.
Collapse
Affiliation(s)
- Ji-Wei Wang
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, People's Republic of China
| | - Li Sun
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, People's Republic of China; Changzhou Center for Disease Control and Prevention, Changzhou, Jiangsu Province, People's Republic of China
| | - Ning Ding
- Centre for Research and Action in Public Health, The University of Canberra, Canberra, ACT, Australia
| | - Jiang Li
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Xiao-Huan Gong
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, People's Republic of China
| | - Xue-Fen Chen
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, People's Republic of China
| | - Dong-Hui Yu
- College of Clinical Medicine, Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Zheng-Nian Luo
- Shanghai Health Education Association, Shanghai, People's Republic of China
| | - Zheng-Ping Yuan
- Shanghai Cancer Rehabilitation Club, Shanghai, People's Republic of China
| | - Jin-Ming Yu
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, People's Republic of China
| |
Collapse
|
64
|
Factors Associated with Health-Related Quality of Life Among Colorectal Cancer Survivors. Am J Prev Med 2015; 49:S518-27. [PMID: 26590647 PMCID: PMC6334761 DOI: 10.1016/j.amepre.2015.08.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/04/2015] [Accepted: 08/12/2015] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Assessment of health-related quality of life (HRQOL) can provide insights into cancer survivors' physical and mental functioning, their social relationships, and perceptions of their health and well-being. Understanding factors associated with HRQOL may help identify those who are at greater risk for diminished functioning and improve targeted delivery of health promotion programs. This analysis sought to assess sociodemographic and medical factors associated with HRQOL among colorectal cancer survivors and factors that may put survivors at risk for poor functioning. In addition, associations between BMI and physical activity and HRQOL were explored. METHODS Data from a cross-sectional study of health behaviors among 593 long-term colorectal cancer survivors recruited through the California Cancer Registry in early 2010 were analyzed in late 2014 to early 2015. Multivariable linear and logistic regression models were used to assess factors associated with physical, mental, and overall HRQOL. RESULTS The mean physical and mental HRQOL scores of survivors were 46.88 and 42.28, respectively, and lower than the population norm (50). Being older, having more comorbid conditions, and having had a recurrence were associated with lower physical and overall HRQOL, whereas being physically active was associated with higher physical and overall HRQOL. CONCLUSIONS Findings highlight the need to encourage healthcare providers to promote physical activity among sedentary cancer survivors, even at modest levels. In addition, lower mental HRQOL scores may indicate a greater need to screen cancer survivors for psychosocial issues and link them with appropriate services.
Collapse
|
65
|
Rohan EA, Townsend JS, Fairley TL, Stewart SL. Health behaviors and quality of life among colorectal cancer survivors. J Natl Compr Canc Netw 2015; 13:297-302. [PMID: 25736006 DOI: 10.6004/jnccn.2015.0041] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine, at the population level, health behaviors, comorbidities, and health-related quality of life among colorectal cancer (CRC) survivors compared with other cancer survivors and persons without cancer. METHODS We used data from the 2009 and 2010 Behavioral Risk Factor Surveillance System cancer survivor modules. We calculated descriptive statistics, conducted chi-square tests for comparisons, and used multivariable logistic regression analysis to compare CRC survivors with other cancer survivors and persons without cancer. RESULTS Of the 52,788 cancer survivors included in this analysis, 4001 reported being CRC survivors. When compared with other cancer survivors, CRC survivors reported higher percentages of obesity and lack of physical activity; however, they had lower levels of current smoking. Adjusted results show that CRC survivors were significantly more likely to report lack of physical activity, fair/poor health, and other chronic health conditions compared with persons without a cancer diagnosis. Conversely, CRC survivors reported lower levels of current smoking than persons without cancer. CONCLUSIONS CRC survivors have a higher proportion of heath conditions and behaviors that may significantly increase their risks for recurrence or development of a second cancer. Targeted interventions to address these health issues should be considered.
Collapse
Affiliation(s)
- Elizabeth A Rohan
- From the Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, Chamblee, Georgia
| | - Julie S Townsend
- From the Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, Chamblee, Georgia
| | - Temeika L Fairley
- From the Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, Chamblee, Georgia
| | - Sherri L Stewart
- From the Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, Chamblee, Georgia
| |
Collapse
|
66
|
McNair AGK, Whistance RN, Forsythe RO, Rees J, Jones JE, Pullyblank AM, Avery KNL, Brookes ST, Thomas MG, Sylvester PA, Russell A, Oliver A, Morton D, Kennedy R, Jayne DG, Huxtable R, Hackett R, Dutton SJ, Coleman MG, Card M, Brown J, Blazeby JM. Synthesis and summary of patient-reported outcome measures to inform the development of a core outcome set in colorectal cancer surgery. Colorectal Dis 2015; 17:O217-29. [PMID: 26058878 PMCID: PMC4744711 DOI: 10.1111/codi.13021] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 05/05/2015] [Indexed: 12/14/2022]
Abstract
AIM Patient-reported outcome (PRO) measures (PROMs) are standard measures in the assessment of colorectal cancer (CRC) treatment, but the range and complexity of available PROMs may be hindering the synthesis of evidence. This systematic review aimed to: (i) summarize PROMs in studies of CRC surgery and (ii) categorize PRO content to inform the future development of an agreed minimum 'core' outcome set to be measured in all trials. METHOD All PROMs were identified from a systematic review of prospective CRC surgical studies. The type and frequency of PROMs in each study were summarized, and the number of items documented. All items were extracted and independently categorized by content by two researchers into 'health domains', and discrepancies were discussed with a patient and expert. Domain popularity and the distribution of items were summarized. RESULTS Fifty-eight different PROMs were identified from the 104 included studies. There were 23 generic, four cancer-specific, 11 disease-specific and 16 symptom-specific questionnaires, and three ad hoc measures. The most frequently used PROM was the EORTC QLQ-C30 (50 studies), and most PROMs (n = 40, 69%) were used in only one study. Detailed examination of the 50 available measures identified 917 items, which were categorized into 51 domains. The domains comprising the most items were 'anxiety' (n = 85, 9.2%), 'fatigue' (n = 67, 7.3%) and 'physical function' (n = 63, 6.9%). No domains were included in all PROMs. CONCLUSION There is major heterogeneity of PRO measurement and a wide variation in content assessed in the PROMs available for CRC. A core outcome set will improve PRO outcome measurement and reporting in CRC trials.
Collapse
Affiliation(s)
- A. G. K. McNair
- Centre for Surgical ResearchSchool of Social and Community MedicineUniversity of BristolBristolUK,Severn School of SurgeryUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - R. N. Whistance
- Centre for Surgical ResearchSchool of Social and Community MedicineUniversity of BristolBristolUK,Division of Surgery Head and NeckUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - R. O. Forsythe
- Centre for Surgical ResearchSchool of Social and Community MedicineUniversity of BristolBristolUK,Division of Surgery Head and NeckUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - J. Rees
- Centre for Surgical ResearchSchool of Social and Community MedicineUniversity of BristolBristolUK
| | - J. E. Jones
- Colorectal Cancer Patient RepresentativeNorth Bristol NHS TrustBristolUK
| | | | - K. N. L. Avery
- Centre for Surgical ResearchSchool of Social and Community MedicineUniversity of BristolBristolUK
| | - S. T. Brookes
- Centre for Surgical ResearchSchool of Social and Community MedicineUniversity of BristolBristolUK
| | - M. G. Thomas
- Colorectal Surgery UnitUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - P. A. Sylvester
- Colorectal Surgery UnitUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - A. Russell
- Colorectal Consumer Liaison GroupNational Cancer Research InstituteLondonUK
| | - A. Oliver
- Colorectal Consumer Liaison GroupNational Cancer Research InstituteLondonUK
| | - D. Morton
- Academic Department of SurgeryUniversity of BirminghamBirminghamUK
| | - R. Kennedy
- Department of SurgerySt Mark's Hospital and Academic InstituteHarrowUK
| | - D. G. Jayne
- Academic Surgical UnitSt James' University Hospital NHS TrustLeedsUK
| | - R. Huxtable
- Centre for Ethics in MedicineUniversity of BristolBristolUK
| | - R. Hackett
- Colorectal Network Site Specific GroupAvon, Somerset and Wiltshire Cancer ServicesBristolUK
| | - S. J. Dutton
- Centre for Statistics in Medicine and Oxford Clinical Trials Research UnitNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesUniversity of OxfordOxfordUK
| | - M. G. Coleman
- Department of Colorectal SurgeryPlymouth Hospitals NHS TrustPlymouthUK
| | - M. Card
- Colorectal Surgery UnitUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - J. Brown
- Clinical Trials Research UnitUniversity of LeedsLeedsUK
| | - J. M. Blazeby
- Centre for Surgical ResearchSchool of Social and Community MedicineUniversity of BristolBristolUK,Division of Surgery Head and NeckUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | | |
Collapse
|
67
|
El-Shami K, Oeffinger KC, Erb NL, Willis A, Bretsch JK, Pratt-Chapman ML, Cannady RS, Wong SL, Rose J, Barbour AL, Stein KD, Sharpe KB, Brooks DD, Cowens-Alvarado RL. American Cancer Society Colorectal Cancer Survivorship Care Guidelines. CA Cancer J Clin 2015; 65:428-55. [PMID: 26348643 PMCID: PMC5385892 DOI: 10.3322/caac.21286] [Citation(s) in RCA: 286] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 01/05/2023] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer and third leading cause of cancer death in both men and women and second leading cause of cancer death when men and women are combined in the United States (US). Almost two-thirds of CRC survivors are living 5 years after diagnosis. Considering the recent decline in both incidence and mortality, the prevalence of CRC survivors is likely to increase dramatically over the coming decades with the increase in rates of CRC screening, further advances in early detection and treatment and the aging and growth of the US population. Survivors are at risk for a CRC recurrence, a new primary CRC, other cancers, as well as both short-term and long-term adverse effects of the CRC and the modalities used to treat it. CRC survivors may also have psychological, reproductive, genetic, social, and employment concerns after treatment. Communication and coordination of care between the treating oncologist and the primary care clinician is critical to effectively and efficiently manage the long-term care of CRC survivors. The guidelines in this article are intended to assist primary care clinicians in delivering risk-based health care for CRC survivors who have completed active therapy.
Collapse
Affiliation(s)
- Khaled El-Shami
- Assistant Professor of Medicine, The George Washington University, School of Medicine and Health Sciences, Washington, DC
| | - Kevin C Oeffinger
- Director, Cancer Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nicole L Erb
- Program Manager, National Cancer Survivorship Resource Center, American Cancer Society, Atlanta, GA
| | - Anne Willis
- Director, Patient-Centered Programs, The George Washington University Cancer Institute, Washington, DC
| | - Jennifer K Bretsch
- Director, Performance Improvement, American Society of Clinical Oncology, Alexandria, VA
| | | | - Rachel S Cannady
- Behavioral Scientist, Behavioral Research Center/National Cancer Survivorship Resource Center, American Cancer Society, Atlanta, GA
| | - Sandra L Wong
- Associate Professor of Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Johnie Rose
- Assistant Professor, Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine/Case Comprehensive Cancer Center, Cleveland, OH
| | - April L Barbour
- Associate Professor of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Kevin D Stein
- Vice President, Behavioral Research, Director, Behavioral Research Center, American Cancer Society, Atlanta, GA
| | - Katherine B Sharpe
- Senior Vice President, Patient and Caregiver Support, American Cancer Society, Atlanta, GA
| | - Durado D Brooks
- Director, Cancer Control Intervention, American Cancer Society, Atlanta, GA
| | - Rebecca L Cowens-Alvarado
- Vice President, Behavioral Research, South Atlantic Health Systems, American Cancer Society, Atlanta, GA
| |
Collapse
|
68
|
Investigation of body image as a mediator of the effects of bowel and GI symptoms on psychological distress in female survivors of rectal and anal cancer. Support Care Cancer 2015; 24:1795-802. [PMID: 26446699 DOI: 10.1007/s00520-015-2976-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 09/28/2015] [Indexed: 01/07/2023]
Abstract
PURPOSE Treatment for rectal and anal cancer (RACa) can result in persistent bowel and gastrointestinal (GI) dysfunction. Body image problems may develop over time and exacerbate symptom-related distress. RACa survivors are an understudied group, however, and factors contributing to post-treatment well-being are not well understood. This study examined whether poorer body image explained the relation between symptom severity and psychological distress. METHODS Participants (N = 70) completed the baseline assessment of a sexual health intervention study. Bootstrap methods tested body image as a mediator between bowel and GI symptom severity and two indicators of psychological distress (depressive and anxiety symptoms), controlling for relevant covariates. Measures included the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-QLQ-CR38) Diarrhea, GI Symptoms, and Body Image subscales and Brief Symptom Index Depression and Anxiety subscales. RESULTS Women averaged 55 years old (SD = 11.6), White (79 %), and were 4 years post-treatment. Greater Depression was related to poorer Body Image (r = -.61) and worse Diarrhea (r = .35) and GI Symptoms (r = .48). Greater Anxiety was related to poorer Body Image (r = -.42) and worse GI Symptoms (r = .45), but not Diarrhea (r = .20). Body Image mediated the effects of bowel and GI symptoms on Depression, but not on Anxiety. CONCLUSIONS Long-term bowel and GI dysfunction are distressing and affect how women perceive and relate to their bodies, exacerbating survivorship difficulties. Interventions to improve adjustment post-treatment should address treatment side effects, but also target body image problems to alleviate depressive symptoms. Reducing anxiety may require other strategies. Body image may be a key modifiable factor to improve well-being in this understudied population. Longitudinal research is needed to confirm findings.
Collapse
|
69
|
Grosse SD. When is Genomic Testing Cost-Effective? Testing for Lynch Syndrome in Patients with Newly-Diagnosed Colorectal Cancer and Their Relatives. Healthcare (Basel) 2015; 3:860-78. [PMID: 26473097 PMCID: PMC4604059 DOI: 10.3390/healthcare3040860] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Varying estimates of the cost-effectiveness of genomic testing applications can reflect differences in study questions, settings, methods and assumptions. This review compares recently published cost-effectiveness analyses of testing strategies for Lynch Syndrome (LS) in tumors from patients newly diagnosed with colorectal cancer (CRC) for either all adult patients or patients up to age 70 along with cascade testing of relatives of probands. Seven studies published from 2010 through 2015 were identified and summarized. Five studies analyzed the universal offer of testing to adult patients with CRC and two others analyzed testing patients up to age 70; all except one reported incremental cost-effectiveness ratios (ICERs) < $ 100,000 per life-year or quality-adjusted life-year gained. Three studies found lower ICERs for selective testing strategies using family history-based predictive models compared with universal testing. However, those calculations were based on estimates of sensitivity of predictive models derived from research studies, and it is unclear how sensitive such models are in routine clinical practice. Key model parameters that are influential in ICER estimates included 1) the number of first-degree relatives tested per proband identified with LS and 2) the cost of gene sequencing. Others include the frequency of intensive colonoscopic surveillance, the cost of colonoscopy, and the inclusion of extracolonic surveillance and prevention options.
Collapse
Affiliation(s)
- Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; Tel.: +404-498-3074
| |
Collapse
|
70
|
Mazanec SR, Sattar A, Delaney CP, Daly BJ. Activation for Health Management in Colorectal Cancer Survivors and Their Family Caregivers. West J Nurs Res 2015; 38:325-44. [PMID: 26385501 DOI: 10.1177/0193945915604055] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Activation, the state of possessing the skills, knowledge, and confidence to manage one's own health, is associated with positive self-management behaviors in individuals with chronic illness. Little is known about its role in cancer survivorship. The aims of this study were to describe activation in patients with colorectal cancer and their family caregivers, examine the relationship between patient and caregiver activation, and determine whether activation is related to symptom distress, depression, anxiety, fatigue, physical activity, and work productivity. Using a longitudinal, correlational design, a convenience sample of 62 patients and 42 family caregivers completed surveys during postoperative hospitalization, and at 6 weeks and 4 months postop. Activation scores for both patients and caregivers were stable over time, were not correlated, and were at the third level of activation. Linear mixed effects models revealed that negative emotions were associated with less patient activation and lower caregiver self-efficacy for caring for oneself.
Collapse
Affiliation(s)
- Susan R Mazanec
- Case Western Reserve University, Cleveland, OH, USA University Hospitals, Cleveland, OH, USA
| | - Abdus Sattar
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Barbara J Daly
- Case Western Reserve University, Cleveland, OH, USA University Hospitals, Cleveland, OH, USA
| |
Collapse
|
71
|
Chongpison Y, Hornbrook MC, Harris RB, Herrinton LJ, Gerald JK, Grant M, Bulkley JE, Wendel CS, Krouse RS. Self-reported depression and perceived financial burden among long-term rectal cancer survivors. Psychooncology 2015; 25:1350-1356. [PMID: 26365584 DOI: 10.1002/pon.3957] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 08/05/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Types of surgery for rectal cancer (RC), including permanent ostomy (PO) or temporary ostomy followed by anastomosis (TO) or initial anastomosis (AN), can affect psychological and financial well-being during active treatment. However, these relationships have not been well studied among long-term survivors (≥5 years post-diagnosis). METHODS A mailed survey with 576 long-term RC survivors who were members of Kaiser Permanente was conducted in 2010-2011. Prevalence of current depression was ascertained using a score of ≤45.6 on the Short Form-12 version 2 mental component summary. Perceived financial burden was assessed using a Likert scale ranging from 0 (none) to 10 (severe). Regression analyses were used to measure associations after adjustment for covariates. RESULTS The overall prevalence of depression was 24% among RC survivors with the highest prevalence among those with a history of PO (31%). The adjusted odds of depression among TO and AN survivors were lower than that among PO survivors, 0.42 (CI95% 0.20-0.89) and 0.59 (CI95% 0.37-0.93), respectively. Twenty-two percent perceived moderate-to-high current financial burden (≥4 points). PO survivors also reported higher mean financial burden than AN survivors (2.6 vs. 1.6, respectively; p = 0.002), but perceived burden comparably to TO survivors (2.3). Self-reported depression was associated with higher perceived financial burden (p < 0.001); surgical procedure history did not modify this relationship. CONCLUSIONS Depression was reported frequently among these long-term RC survivors, particularly among PO survivors. Depression was associated with greater perception of financial burden. Screening for depression and assessing financial well-being might improve care among long-term RC survivors.Copyright © 2015 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Yuda Chongpison
- The University of Arizona College of Public Health, 1295 N. Martin Ave., Tucson, AZ, 85724, USA.
| | - Mark C Hornbrook
- Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Robin B Harris
- The University of Arizona College of Public Health, 1295 N. Martin Ave., Tucson, AZ, 85724, USA
| | - Lisa J Herrinton
- Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Joe K Gerald
- The University of Arizona College of Public Health, 1295 N. Martin Ave., Tucson, AZ, 85724, USA
| | - Marcia Grant
- City of Hope Medical Center/Beckman Research Institute, 1500 East Duarte Road Duarte, CA, 91010, USA
| | - Joanna E Bulkley
- Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Christopher S Wendel
- Southern Arizona Veterans Affairs Health Care System, 3601 S. 6th Ave., Tucson, AZ, 85723, USA.,The University of Arizona College of Medicine, 1501 N. Campbell Ave., Tucson, AZ, 85724, USA
| | - Robert S Krouse
- Southern Arizona Veterans Affairs Health Care System, 3601 S. 6th Ave., Tucson, AZ, 85723, USA.,The University of Arizona College of Medicine, 1501 N. Campbell Ave., Tucson, AZ, 85724, USA
| |
Collapse
|
72
|
Snowsill T, Huxley N, Hoyle M, Jones-Hughes T, Coelho H, Cooper C, Frayling I, Hyde C. A systematic review and economic evaluation of diagnostic strategies for Lynch syndrome. Health Technol Assess 2015; 18:1-406. [PMID: 25244061 DOI: 10.3310/hta18580] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Lynch syndrome (LS) is an inherited autosomal dominant disorder characterised by an increased risk of colorectal cancer (CRC) and other cancers, and caused by mutations in the deoxyribonucleic acid (DNA) mismatch repair genes. OBJECTIVE To evaluate the accuracy and cost-effectiveness of strategies to identify LS in newly diagnosed early-onset CRC patients (aged < 50 years). Cascade testing of relatives is employed in all strategies for individuals in whom LS is identified. DATA SOURCES AND METHODS Systematic reviews were conducted of the test accuracy of microsatellite instability (MSI) testing or immunohistochemistry (IHC) in individuals with CRC at risk of LS, and of economic evidence relating to diagnostic strategies for LS. Reviews were carried out in April 2012 (test accuracy); and in February 2012, repeated in February 2013 (economic evaluations). Databases searched included MEDLINE (1946 to April week 3, 2012), EMBASE (1980 to week 17, 2012) and Web of Science (inception to 30 April 2012), and risk of bias for test accuracy was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) quality appraisal tool. A de novo economic model of diagnostic strategies for LS was developed. RESULTS Inconsistencies in study designs precluded pooling of diagnostic test accuracy results from a previous systematic review and nine subsequent primary studies. These were of mixed quality, with significant methodological concerns identified for most. IHC and MSI can both play a part in diagnosing LS but neither is gold standard. No UK studies evaluated the cost-effectiveness of diagnosing and managing LS, although studies from other countries generally found some strategies to be cost-effective compared with no testing. The de novo model demonstrated that all strategies were cost-effective compared with no testing at a threshold of £20,000 per quality-adjusted life-year (QALY), with the most cost-effective strategy utilising MSI and BRAF testing [incremental cost-effectiveness ratio (ICER) = £5491 per QALY]. The maximum health benefit to the population of interest would be obtained using universal germline testing, but this would not be a cost-effective use of NHS resources compared with the next best strategy. When the age limit was raised from 50 to 60 and 70 years, the ICERs compared with no testing increased but remained below £20,000 per QALY (except for universal germline testing with an age limit of 70 years). The total net health benefit increased with the age limit as more individuals with LS were identified. Uncertainty was evaluated through univariate sensitivity analyses, which suggested that the parameters substantially affecting cost-effectiveness: were the risk of CRC for individuals with LS; the average number of relatives identified per index patient; the effectiveness of colonoscopy in preventing metachronous CRC; the cost of colonoscopy; the duration of the psychological impact of genetic testing on health-related quality of life (HRQoL); and the impact of prophylactic hysterectomy and bilateral salpingo-oophorectomy on HRQoL (this had the potential to make all testing strategies more expensive and less effective than no testing). LIMITATIONS The absence of high-quality data for the impact of prophylactic gynaecological surgery and the psychological impact of genetic testing on HRQoL is an acknowledged limitation. CONCLUSIONS Results suggest that reflex testing for LS in newly diagnosed CRC patients aged < 50 years is cost-effective. Such testing may also be cost-effective in newly diagnosed CRC patients aged < 60 or < 70 years. Results are subject to uncertainty due to a number of parameters, for some of which good estimates were not identified. We recommend future research to estimate the cost-effectiveness of testing for LS in individuals with newly diagnosed endometrial or ovarian cancer, and the inclusion of aspirin chemoprevention. Further research is required to accurately estimate the impact of interventions on HRQoL. STUDY REGISTRATION This study is registered as PROSPERO CRD42012002436. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
- Tristan Snowsill
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Nicola Huxley
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Martin Hoyle
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Tracey Jones-Hughes
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Helen Coelho
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Chris Cooper
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Ian Frayling
- Institute of Medical Genetics, Cardiff University, Cardiff, UK
| | - Chris Hyde
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| |
Collapse
|
73
|
Wong EYT, Chua C, Beh SY, Koh D, Chong D, Tan IB. Addressing the needs of colorectal cancer survivors: current strategies and future directions. Expert Rev Anticancer Ther 2015; 15:639-48. [PMID: 25927672 DOI: 10.1586/14737140.2015.1038248] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Colorectal cancer (CRC) is one of the three topmost common cancers in men and the second most common cancer in women worldwide. With current advances in the medical and surgical treatment of CRC, care has slowly transformed to curative treatment. With these advances, CRC survivors are increasing in numbers and these patients have a unique range of medical, physical and psychological needs that require regular follow-up. In 2006, the Institute of Medicine recommended that cancer survivors who are completing primary treatment receive a survivorship care plan. There are many different programs of different complexity that are implemented for CRC survivors. This review outlines the needs of CRC survivors, the current surveillance techniques used in the continuing care of patients with CRC after curative treatment and the evidence behind these strategies.
Collapse
|
74
|
Akyol M, Ulger E, Alacacioglu A, Kucukzeybek Y, Yildiz Y, Bayoglu V, Gumus Z, Yildiz I, Salman T, Varol U, Ayakdas S, Tarhan MO. Sexual satisfaction, anxiety, depression and quality of life among Turkish colorectal cancer patients [Izmir Oncology Group (IZOG) study]. Jpn J Clin Oncol 2015; 45:657-64. [DOI: 10.1093/jjco/hyv051] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 03/17/2015] [Indexed: 01/06/2023] Open
|
75
|
Goldstein DA, Chen Q, Ayer T, Howard DH, Lipscomb J, El-Rayes BF, Flowers CR. First- and second-line bevacizumab in addition to chemotherapy for metastatic colorectal cancer: a United States-based cost-effectiveness analysis. J Clin Oncol 2015; 33:1112-8. [PMID: 25691669 PMCID: PMC4881313 DOI: 10.1200/jco.2014.58.4904] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE The addition of bevacizumab to fluorouracil-based chemotherapy is a standard of care for previously untreated metastatic colorectal cancer. Continuation of bevacizumab beyond progression is an accepted standard of care based on a 1.4-month increase in median overall survival observed in a randomized trial. No United States-based cost-effectiveness modeling analyses are currently available addressing the use of bevacizumab in metastatic colorectal cancer. Our objective was to determine the cost effectiveness of bevacizumab in the first-line setting and when continued beyond progression from the perspective of US payers. METHODS We developed two Markov models to compare the cost and effectiveness of fluorouracil, leucovorin, and oxaliplatin with or without bevacizumab in the first-line treatment and subsequent fluorouracil, leucovorin, and irinotecan with or without bevacizumab in the second-line treatment of metastatic colorectal cancer. Model robustness was addressed by univariable and probabilistic sensitivity analyses. Health outcomes were measured in life-years and quality-adjusted life-years (QALYs). RESULTS Using bevacizumab in first-line therapy provided an additional 0.10 QALYs (0.14 life-years) at a cost of $59,361. The incremental cost-effectiveness ratio was $571,240 per QALY. Continuing bevacizumab beyond progression provided an additional 0.11 QALYs (0.16 life-years) at a cost of $39,209. The incremental cost-effectiveness ratio was $364,083 per QALY. In univariable sensitivity analyses, the variables with the greatest influence on the incremental cost-effectiveness ratio were bevacizumab cost, overall survival, and utility. CONCLUSION Bevacizumab provides minimal incremental benefit at high incremental cost per QALY in both the first- and second-line settings of metastatic colorectal cancer treatment.
Collapse
Affiliation(s)
- Daniel A Goldstein
- Daniel A. Goldstein, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA.
| | - Qiushi Chen
- Daniel A. Goldstein, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA
| | - Turgay Ayer
- Daniel A. Goldstein, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA
| | - David H Howard
- Daniel A. Goldstein, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA
| | - Joseph Lipscomb
- Daniel A. Goldstein, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA
| | - Bassel F El-Rayes
- Daniel A. Goldstein, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA
| | - Christopher R Flowers
- Daniel A. Goldstein, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA
| |
Collapse
|
76
|
Agborsangaya CB, Majumdar SR, Sharma AM, Gregg EW, Padwal RS. Multimorbidity in a prospective cohort: prevalence and associations with weight loss and health status in severely obese patients. Obesity (Silver Spring) 2015; 23:707-12. [PMID: 25682926 DOI: 10.1002/oby.21008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 11/01/2014] [Accepted: 11/23/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To examine the prevalence of multimorbidity (≥2 chronic conditions) in severely obese patients and its associations with weight loss and health status over 2 years. METHODS In a prospective cohort including 500 severely obese adults, self-reported prevalence of 20 chronic conditions was calculated at baseline and 2 years. Multivariable logistic regression models were fitted to test the covariate-adjusted associations between ≥5% weight reduction and reduction in multimorbidity and the association between health status (visual analogue scale [VAS]) and reduction in multimorbidity over 2 years. RESULTS After 2 years, mean weight change was -12.9 ±18.7 kg, 53% had ≥5% weight reduction, mean change in VAS was 11.5 ± 21.2, and 53.5% had ≥10% increase in VAS. Multimorbidity was reported in 95.4% and 92.8% patients at baseline and 2 years, respectively. Weight loss (≥5%) over 2 years was associated with reduction in multimorbidity (adjusted OR = 1.7, 95% CI 1.1-2.7). Reduction in multimorbidity was associated with clinically important improvements (≥10% increase in VAS) in health status (adjusted OR = 2.5, 95% CI 1.6, 4.0). CONCLUSIONS Multimorbidity is common in severely obese patients. Having ≥5% weight reduction over 2 years was associated with a reduction in multimorbidity, which was also associated with improvements in health status.
Collapse
Affiliation(s)
- Calypse B Agborsangaya
- Department of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Alberta Diabetes Institute, Edmonton, Alberta, Canada
| | | | | | | | | |
Collapse
|
77
|
Lee J, Lee M, Hong S, Kim JY, Park H, Oh M, Yang HI, Kang DW, Park J, Kim DI, Chu S, Lee J, Hur H, Kim NK, Jeon JY. Association between physical fitness, quality of life, and depression in stage II-III colorectal cancer survivors. Support Care Cancer 2015; 23:2569-77. [PMID: 25688034 DOI: 10.1007/s00520-015-2615-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 01/13/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE The impact of cancer on quality of life and depression is an important issue. The purpose of this study was to identify the impact of physical fitness on quality of life and depression in stage II-III colorectal cancer survivors. METHODS Participants in the current study included 122 stage II-III colorectal cancer survivors (57 females; 56.67 ± 9.16 years of age and 55 males; 54.69 ± 9.78 years of age). Fitness was assessed using the 6-min walk test, chair stand test, and push-up test. Quality of life and depression were measured using the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) scale and a 9-item patient health questionnaire interview, respectively. RESULTS There was a significant association between physical fitness and quality of life and depression in colorectal cancer survivors. The 6-min walk test results were associated with FACT-C total (r = 0.298, p < 0.05), physical well-being (r = 0.230, p < 0.05), functional well-being (r = 0.234, p < 0.05), colorectal cancer concern (r = 0.229, p < 0.05), and depression (r = -0.228, p < 0.05), and the chair stand test results were associated with functional well-being (r = 0.231, p < 0.05), colorectal cancer concern (r = 0.242, p < 0.05), and depression (r = -0.227, p < 0.05) even after controlling for all potentially confounding variables. A multiple regression analysis indicated that the 6-min walk was a significant predictor of health-related quality of life, and participants in the lowest tertile of the 6-min walk test results had lower quality of life and greater depression than those in the highest tertile. CONCLUSION Improving and maintaining physical fitness are important for quality of life and depression in stage II-III colorectal cancer survivors.
Collapse
Affiliation(s)
- Junga Lee
- Department of Sport and Leisure Studies, Yonsei University, 134 Seodaemun-Gu, Shinchon-Dong, Seoul, Korea, 120-749
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
78
|
Abu-Helalah MA, Alshraideh HA, Al-Hanaqta MM, Arqoub KH. Quality of Life and Psychological Well-Being of Colorectal Cancer Survivors in Jordan. Asian Pac J Cancer Prev 2014; 15:7653-64. [DOI: 10.7314/apjcp.2014.15.18.7653] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
79
|
Thomas AA, Gallagher P, O'Céilleachair A, Pearce A, Sharp L, Molcho M. Distance from treating hospital and colorectal cancer survivors' quality of life: a gendered analysis. Support Care Cancer 2014; 23:741-51. [PMID: 25179691 DOI: 10.1007/s00520-014-2407-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 08/18/2014] [Indexed: 11/12/2022]
Abstract
PURPOSE Distance from residence to hospital has been associated with clinical outcomes for colorectal cancer patients. However, little is known about the association of remoteness with quality of life (QoL) for colorectal cancer survivors. We examined the relationship between distance from hospital and colorectal cancer survivors' QoL, with a specific focus on gender. METHODS Colorectal cancer survivors in Ireland who were more than 6-months postdiagnosis completed the European Organization for Research and Treatment of Cancer QLQ-C30, measuring global health status (GHS) and physical, role, cognitive, social, and emotional functioning. Bootstrap linear regression was used to evaluate the association between remoteness and QoL scales, controlling for demographic and clinical variables. Separate models were generated for the full sample, for women, and for men. RESULTS The final analytical sample was 496 colorectal cancer survivors; 186 women and 310 men. Living remote from the treating hospital was associated with lower physical functioning (coefficient -4.38 [95 % confidence interval -8.13, -0.91]) and role functioning (coeff. -7.78 [-12.64, -2.66]) among all colorectal cancer survivors. In the separate gender models, remoteness was significantly associated with lower physical (coeff. -7.00 [-13.47, -1.49]) and role functioning (coeff. -11.50 [-19.66, -2.65]) for women, but not for men. Remoteness had a significant negative relationship to GHS (coeff. -4.31 [-8.46, -0.27]) for men. CONCLUSIONS Aspects of QoL are lower among colorectal cancer survivors who live far from their treating hospital. There are gender differences in how remoteness is related to QoL domains. The results of this study suggest that policy makers, service providers, and health care professionals should consider the specific QoL needs of remote colorectal cancer survivors, and be attuned to and prepared to address the differing needs of men and women.
Collapse
Affiliation(s)
- Audrey Alforque Thomas
- Health Promotion Research Centre, National University of Ireland, Aras na Coiribe, Galway, Ireland,
| | | | | | | | | | | |
Collapse
|
80
|
Rees JR, Blazeby JM, Brookes ST, John T, Welsh FK, Rees M. Patient-reported outcomes in long-term survivors of metastatic colorectal cancer needing liver resection. Br J Surg 2014; 101:1468-74. [DOI: 10.1002/bjs.9620] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/12/2014] [Accepted: 06/27/2014] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Five-year survival after hepatic resection for colorectal cancer (CRC) liver metastases is good, but data on patient-reported outcomes are lacking. This study describes the long-term impact of liver surgery for CRC metastases on patient-reported outcomes.
Methods
The study used the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ) C30 and the disease-specific module, EORTC QLQ-LMC21. For functional scales, mean scores out of 100 with 95 per cent c.i. were calculated; differences of 10 points or more were considered clinically significant. Responses to symptom scales and items were categorized as ‘minimal’ or ‘severe’. Proportions and 95 per cent c.i. for symptoms were calculated.
Results
A total of 241 patients were recruited; nine (3·7 per cent) had unresectable disease and were excluded. Some 68 (42 men) of 80 long-term survivors participated; their mean age was 69·5 years and median follow-up was 8·0 (range 6·9–9·2) years. Values for baseline and 1-year patient-reported outcome data were similar. Scores for functional scales were excellent (emotional function: 92, 95 per cent c.i. 87 to 96; social function: 94, 89 to 99; role function: 94, 90 to 98), reflecting clinically significant improvements from baseline values of 17 (10 to 24), 12 (3 to 21) and 12 (3 to 20) respectively. Severe symptoms were uncommon (affected less than 5 per cent of patients) for most patient-reported outcome scales or items, but persistent severe symptoms were noted for sexual function (2 per cent increase from baseline), peripheral neuropathy (2 per cent increase), constipation (10 per cent increase) and diarrhoea (5 per cent increase).
Conclusion
Long-term survivors of metastatic colorectal cancer who have undergone liver surgery have excellent global quality of life, high levels of function and few symptoms.
Collapse
Affiliation(s)
- J R Rees
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Basingstoke, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, Basingstoke, UK
| | - J M Blazeby
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Basingstoke, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, Basingstoke, UK
| | - S T Brookes
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Basingstoke, UK
| | - T John
- Department of Hepatobiliary Surgery, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - F K Welsh
- Department of Hepatobiliary Surgery, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - M Rees
- Department of Hepatobiliary Surgery, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| |
Collapse
|
81
|
Djalalov S, Rabeneck L, Tomlinson G, Bremner KE, Hilsden R, Hoch JS. A Review and Meta-analysis of Colorectal Cancer Utilities. Med Decis Making 2014; 34:809-18. [PMID: 24903121 DOI: 10.1177/0272989x14536779] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 04/29/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To perform a systematic review of utility weights for colorectal cancer (CRC) health states reported in the scientific literature and to determine the effects of disease factors, patient characteristics, and utility methods on utility values. METHODS We identified 26 articles written in English and published from January 1980 to January 2013, providing 351 unique utilities for CRC health states elicited from 6546 unique respondents. The CRC utility data were analyzed using linear mixed-effects models with CRC type, stage, time to or from initial care, utility measurement instrument, and administration method as independent variables. RESULTS In the base case model, the estimated utility for a patient with stage I to III CRC more than 1 year after surgery, rated using a self-administered time tradeoff instrument, was 0.90. Stage, time to or from initial care, and utility measurement instrument were associated with statistically significant utility differences ranging from -0.19 to 0.02. Utilities for patients with stage IV cancer were 0.19 lower (P < 0.001) than for those with stage I to III cancer. Utilities elicited at more than 1 year after surgery were 0.05 higher than those elicited at 3 months after surgery (P = 0.008). Estimates of differences between utility measurement instruments were sensitive to how repeated scores in the same patient group were treated, and other findings were sensitive to how the disease stage was modeled and method of administration. CONCLUSIONS Variations in reported utilities are associated with factors such as cancer stage, time to or from initial care, and utility measurement instrument. More research is needed to study why apparently similar patients report different quality of life.
Collapse
Affiliation(s)
- Sandjar Djalalov
- Centre for Excellence in Economic Analysis Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada (SD, JSH),Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, ON, Canada (SD, LR, JSH),Canadian Centre for Applied Research in Cancer Control (ARCC), Toronto, ON, Canada (SD, JSH)
| | - Linda Rabeneck
- Institute of Health Policy, Management and Evaluation and Department of Medicine, University of Toronto, Toronto, ON, Canada (LR, GT, JSH),Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, ON, Canada (SD, LR, JSH)
| | - George Tomlinson
- Institute of Health Policy, Management and Evaluation and Department of Medicine, University of Toronto, Toronto, ON, Canada (LR, GT, JSH),Department of Medicine, University Health Network/Mt. Sinai Hospital, Toronto, ON, Canada (GT)
| | | | | | - Jeffrey S Hoch
- Centre for Excellence in Economic Analysis Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada (SD, JSH),Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, ON, Canada (SD, LR, JSH),Canadian Centre for Applied Research in Cancer Control (ARCC), Toronto, ON, Canada (SD, JSH)
| |
Collapse
|
82
|
Salz T, Baxi SS, Blinder VS, Elkin EB, Kemeny MM, McCabe MS, Moskowitz CS, Onstad EE, Saltz LB, Temple LKF, Oeffinger KC. Colorectal cancer survivors' needs and preferences for survivorship information. J Oncol Pract 2014; 10:e277-82. [PMID: 24893610 DOI: 10.1200/jop.2013.001312] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Before developing a survivorship care plan (SCP) that colorectal cancer (CRC) survivors will value, understanding the informational needs of CRC survivors is critical. METHODS We surveyed survivors treated for nonmetastatic CRC at two hospitals in New York about their needs and preferences for survivorship information. Participants completed treatment 6 to 24 months before the interview and had not received an SCP. We evaluated whether survivors knew their treatment history (10 topics), whether they understood ongoing risks (four topics), and their preferences for receiving 16 topics of survivorship information. RESULTS One hundred seventy-five survivors completed the survey. Most survivors remembered information about past treatment (98% to 99% for each treatment). Fewer survivors knew their risks of local recurrence, distant recurrence, or developing a new CRC (69%, 77%, and 40%, respectively). Most participants reported receiving information about their cancer history and ongoing oncology visits (77% to 86% across topics). Across all topics, 93% to 99% of those who reported receiving information found the information useful. A minority of survivors reported they received information about symptoms to report to doctors, returning to work, or financial or legal issues (5% to 48% across topics), but those who did found the information useful (89% to 100% across topics). CONCLUSIONS In the absence of an SCP, CRC survivors still generally understood their cancer history. However, many lacked knowledge of ongoing risks and prevention. Most survivors stated that they found the survivorship information they received useful. SCPs for CRC survivors should focus less on past care and more on helping survivors understand their risks and plan for the future.
Collapse
Affiliation(s)
- Talya Salz
- Memorial Sloan-Kettering Cancer Center; Queens Cancer Center of Queens Hospital, New York, NY; and Harvard School of Public Health, Boston, MA
| | - Shrujal S Baxi
- Memorial Sloan-Kettering Cancer Center; Queens Cancer Center of Queens Hospital, New York, NY; and Harvard School of Public Health, Boston, MA
| | - Victoria S Blinder
- Memorial Sloan-Kettering Cancer Center; Queens Cancer Center of Queens Hospital, New York, NY; and Harvard School of Public Health, Boston, MA
| | - Elena B Elkin
- Memorial Sloan-Kettering Cancer Center; Queens Cancer Center of Queens Hospital, New York, NY; and Harvard School of Public Health, Boston, MA
| | - Margaret M Kemeny
- Memorial Sloan-Kettering Cancer Center; Queens Cancer Center of Queens Hospital, New York, NY; and Harvard School of Public Health, Boston, MA
| | - Mary S McCabe
- Memorial Sloan-Kettering Cancer Center; Queens Cancer Center of Queens Hospital, New York, NY; and Harvard School of Public Health, Boston, MA
| | - Chaya S Moskowitz
- Memorial Sloan-Kettering Cancer Center; Queens Cancer Center of Queens Hospital, New York, NY; and Harvard School of Public Health, Boston, MA
| | - Erin E Onstad
- Memorial Sloan-Kettering Cancer Center; Queens Cancer Center of Queens Hospital, New York, NY; and Harvard School of Public Health, Boston, MA
| | - Leonard B Saltz
- Memorial Sloan-Kettering Cancer Center; Queens Cancer Center of Queens Hospital, New York, NY; and Harvard School of Public Health, Boston, MA
| | - Larissa K F Temple
- Memorial Sloan-Kettering Cancer Center; Queens Cancer Center of Queens Hospital, New York, NY; and Harvard School of Public Health, Boston, MA
| | - Kevin C Oeffinger
- Memorial Sloan-Kettering Cancer Center; Queens Cancer Center of Queens Hospital, New York, NY; and Harvard School of Public Health, Boston, MA
| |
Collapse
|
83
|
McDougall GJ, Oliver JS, Scogin F. Memory and cancer: a review of the literature. Arch Psychiatr Nurs 2014; 28:180-6. [PMID: 24856270 PMCID: PMC4033831 DOI: 10.1016/j.apnu.2013.12.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 12/30/2013] [Indexed: 12/31/2022]
Abstract
The mental health of cancer survivors has not always been the primary emphasis of treatment protocols since physical health outcomes have taken precedence. Older cancer survivors experience a double jeopardy since they are at risk for memory impairments and mild cognitive impairment and because they are greater than 55 years of age. Of the 9.6 million cancer survivors in the US who have completed active treatment, many report cognitive difficulties, with labels such as "chemo brain," "not as sharp," "woolly-headedness," or the "mind does not work as quickly". To date, most of our knowledge of cognitive impairment in cancer survivors comes from female breast cancer survivors. Studies indicate that these survivors have diminished executive function, verbal memory, and motor function. Cancer survivors want to live independently in the community for as long as possible however, these cognitive deficits may prevent this desired lifestyle. To broaden our understanding this paper reviews the literature on the cognitive impairment and memory deficits experienced by three groups of cancer survivors breast, colorectal, and prostate cancer, that make up 60% of all survivors nationally. Even though mental health declined after a cancer diagnosis, the long-term outcomes of cancer survivors did not differ from persons without cancer in depression or cognitive function.
Collapse
Affiliation(s)
| | - JoAnn S Oliver
- The University of Alabama, Capstone College of Nursing, Tuscaloosa, AL
| | - Forrest Scogin
- The University of Alabama, Department of Psychology, Tuscaloosa, AL
| |
Collapse
|
84
|
Sakellakis M, Makatsoris T, Gkermpesi M, Peroukidis S, Kalofonos H. Ulcerative colitis six years after colon cancer: only a coincidence? Int Med Case Rep J 2014; 7:85-8. [PMID: 24855393 PMCID: PMC4011808 DOI: 10.2147/imcrj.s61950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The association between inflammatory bowel disease and colorectal cancer is well known. Ulcerative colitis is a risk factor for the development of colorectal cancer, and this risk increases with the activity and duration of bowel inflammation. Here we describe the case of a 52-year-old man who developed ulcerative colitis 6 years after the diagnosis and treatment of colon cancer. Although this could be a coincidence, there could be additional possibilities, like pre-existence of quiescent colitis, late effect of therapy, or maybe the existence of common pathogenetic factors contributing to the development of ulcerative colitis and colorectal cancer.
Collapse
Affiliation(s)
| | | | - Maria Gkermpesi
- Department of Pathology, University, Hospital of Patras, Patras, Greece
| | | | | |
Collapse
|
85
|
Andreyev J. Late Effects of Cancer Treatment in Adult Patients. Nutr Cancer 2013. [DOI: 10.1002/9781118788707.ch9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
86
|
Marventano S, Forjaz M, Grosso G, Mistretta A, Giorgianni G, Platania A, Gangi S, Basile F, Biondi A. Health related quality of life in colorectal cancer patients: state of the art. BMC Surg 2013; 13 Suppl 2:S15. [PMID: 24267735 PMCID: PMC3851259 DOI: 10.1186/1471-2482-13-s2-s15] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Colorectal cancer (CRC) is the third most commonly diagnosed cancer in males and the second in females with a progressive increase in prevalence in industrialized countries. The loss of health due to the cancer and/or the consequence of the treatment may result in psychophysical, functional and social impairment; all of these affect health-related quality of life (QoL). Description The most frequently CRC-specific QoL questionnaires is the FACT-C. QoL is not only important for the well-being of cancer patient but it also influences survival and response to therapy. Many studies investigated various determinants involved in the assessment of QoL in CRC, suggesting that symptoms, surgical procedures and the number of comorbidity significantly affected QoL. Conclusion Despite that CRC patients have a relatively good QoL compared with the general population, a wide range of intervention could be undertaken to improve their QoL. The finding of this review may be useful for cancer clinicians in taking therapy and surveillance-related decisions. However, future research should be directed to large-scale prospective studies using well validated QoL instruments to facilitate comparison of results.
Collapse
|
87
|
Gray NM, Hall SJ, Browne S, Johnston M, Lee AJ, Macleod U, Mitchell ED, Samuel L, Campbell NC. Predictors of anxiety and depression in people with colorectal cancer. Support Care Cancer 2013; 22:307-14. [DOI: 10.1007/s00520-013-1963-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 08/27/2013] [Indexed: 01/06/2023]
|
88
|
Jefford M, Aranda S, Gough K, Lotfi-Jam K, Butow P, Krishnasamy M, Young J, Phipps-Nelson J, Russell L, King D, Schofield P. Evaluating a nurse-led survivorship care package (SurvivorCare) for bowel cancer survivors: study protocol for a randomized controlled trial. Trials 2013; 14:260. [PMID: 23958184 PMCID: PMC3765148 DOI: 10.1186/1745-6215-14-260] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 08/01/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the most common cancer affecting both men and women in Australia. The illness and related treatments can cause distressing adverse effects, impact on emotional and psychological well-being, and adversely affect social, occupational and relationship functioning for many years after the end of treatment or, in fact, lifelong. Current models of follow-up fail to address the complex needs arising after treatment completion. Strategies to better prepare and support survivors are urgently required. We previously developed a nurse-led supportive care program (SurvivorCare) and tested it in a pilot study involving 10 CRC survivors. The intervention was found to be highly acceptable, appropriate, relevant and useful. METHODS/DESIGN This study is a multisite, randomised controlled trial, designed to assess the impact of the addition of the SurvivorCare intervention to usual post-treatment care, for people with potentially cured CRC. SurvivorCare comprises the provision of survivorship educational materials, a tailored survivorship care plan, an individually tailored nurse-led, face-to-face end of treatment consultation and three subsequent telephone calls. Eligible patients have completed treatment for potentially cured CRC. Other eligibility criteria include stage I to III disease, age greater than 18 years and adequate understanding of English. All consenting patients complete questionnaires at three time points over a six-month period (baseline, two and six months). Measures assess psychological distress, unmet needs and quality of life. DISCUSSION This supportive care package has the potential to significantly reduce individual suffering, whilst reducing the burden of follow-up on acute cancer services through enhanced engagement with and utilisation of general practitioners and community based services. If the intervention is successful in achieving the expected health benefits, it could be disseminated readily. All training and supporting materials have been developed and standardised. Furthermore, the intervention could easily be adapted to other cancer or chronic disease settings. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry ACTRN12610000207011.
Collapse
Affiliation(s)
- Michael Jefford
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, VIC 3002, Australia.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
89
|
Pita-Fernández S, Pértega-Díaz S, López-Calviño B, Seoane-Pillado T, Gago-García E, Seijo-Bestilleiro R, González-Santamaría P, Pazos-Sierra A. Diagnostic and treatment delay, quality of life and satisfaction with care in colorectal cancer patients: a study protocol. Health Qual Life Outcomes 2013; 11:117. [PMID: 23845102 PMCID: PMC3710493 DOI: 10.1186/1477-7525-11-117] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 07/09/2013] [Indexed: 01/12/2023] Open
Abstract
Background Due to recent improvements in colorectal cancer survival, patient-reported outcomes, including health-related quality of life and satisfaction with care, have become well-established endpoints to determine the impact of the disease on the lives of patients. The aim of this study is to determine prospectively, in a cohort of colorectal cancer incident cases: a) health-related quality of life, b) satisfaction with hospital-based care, and c) functional status. A secondary objective is to determine whether diagnostic/therapeutic delay influence quality of life or patients’ satisfaction levels. Methods/design Single-centre prospective follow-up study of colorectal cancer patients diagnosed during the period 2011–2012 (n = 375). This project was approved by the corresponding ethics review board, and informed consent is obtained from each patient. After diagnosis, patients are interviewed by a trained nurse, obtaining information on sociodemographic characteristics, family history of cancer, first symptoms, symptom perception and reaction to early symptoms. Quality of life is assessed with the EORTC QLQ-C30 and QLQ-CR29 questionnaires, and patients’ satisfaction with care is determined using the EORTC IN-PATSAT32. Functional status is measured with the Karnofsky Performance Status Scale. Clinical records are also reviewed to collect information on comorbidity, tumour characteristics, treatment, hospital consultations and exploratory procedures. Symptoms-to-diagnosis interval is defined as the time from the date of first symptoms until the cytohistological confirmation of cancer. Treatment delay is defined as the time between diagnosis and surgical treatment. All the patients will be followed-up for a maximum of 2 years. For survivors, assessments will be re-evaluated at one and two years after the diagnosis. Multiple linear/logistic regression models will be used to identify variables associated with the patients’ functional status, quality of life and satisfaction with care score. Changes in quality of life over time will be analysed with linear mixed-effects regression models. Discussion The results will provide a deeper understanding of the impact of colorectal cancer from a more patient-centred approach, allowing us to identify groups of patients in need of additional attention, as well as areas for improvement. Special attention will be given to the relationship between diagnostic/therapeutic delay and patients’ quality of life and satisfaction with the care received.
Collapse
Affiliation(s)
- Salvador Pita-Fernández
- Clinical Epidemiology and Biostatistics Unit, Complexo Hospitalario Universitario A Coruña, Universidade de A Coruña, Hotel de Pacientes 7a Planta, As Xubias 84, A Coruña, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
90
|
Mitchell AJ, Ferguson DW, Gill J, Paul J, Symonds P. Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: a systematic review and meta-analysis. Lancet Oncol 2013; 14:721-32. [PMID: 23759376 DOI: 10.1016/s1470-2045(13)70244-4] [Citation(s) in RCA: 459] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cancer survival has improved in the past 20 years, affecting the long-term risk of mood disorders. We assessed whether depression and anxiety are more common in long-term survivors of cancer compared with their spouses and with healthy controls. METHODS We systematically searched Medline, PsycINFO, Embase, Science Direct, Ingenta Select, Ovid, and Wiley Interscience for reports about the prevalence of mood disorders in patients diagnosed with cancer at least 2 years previously. We also searched the records of the International Psycho-oncology Society and for reports that cited relevant references. Three investigators independently extracted primary data. We did a random-effects meta-analysis of the prevalences of depression and anxiety in cancer patients compared with spouses and healthy controls. FINDINGS Our search returned 144 results, 43 were included in the main analysis: for comparisons with healthy controls, 16 assessed depression and ten assessed anxiety; of the comparisons with spouses, 12 assessed depression and five assessed anxiety. The prevalence of depression was 11·6% (95% CI 7·7-16·2) in the pooled sample of 51 381 cancer survivors and 10·2% (8·0-12·6) in 217 630 healthy controls (pooled relative risk [RR] 1·11, 95% CI 0·96-1·27; p=0·17). The prevalence of anxiety was 17·9% (95% CI 12·8-23·6) in 48 964 cancer survivors and 13·9% (9·8-18·5) in 226 467 healthy controls (RR 1·27, 95% CI 1·08-1·50; p=0·0039). Neither the prevalence of depression (26·7% vs 26·3%; RR 1·01, 95% CI 0·86-1·20; p=0·88) nor the prevalence of anxiety (28·0% vs 40·1%; RR 0·71, 95% CI 0·44-1·14; p=0·16) differed significantly between cancer patients and their spouses. INTERPRETATION Our findings suggest that anxiety, rather than depression, is most likely to be a problem in long-term cancer survivors and spouses compared with healthy controls. Efforts should be made to improve recognition and treatment of anxiety in long-term cancer survivors and their spouses. FUNDING None.
Collapse
Affiliation(s)
- Alex J Mitchell
- Department of Psycho-oncology, Leicester Partnership Trust, Leicester, UK.
| | | | | | | | | |
Collapse
|
91
|
Thong MSY, Mols F, Stein KD, Smith T, Coebergh JWW, van de Poll-Franse LV. Population-based cancer registries for quality-of-life research. Cancer 2013; 119 Suppl 11:2109-23. [PMID: 23695923 DOI: 10.1002/cncr.28056] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 01/22/2013] [Accepted: 01/31/2013] [Indexed: 12/22/2022]
Affiliation(s)
- Melissa S. Y. Thong
- Center of Research on Psychology in Somatic Diseases (C o RPS) Tilburg University; Tilburg the Netherlands
- Comprehensive Cancer Center South (CCCS); Eindhoven Cancer Registry; Eindhoven the Netherlands
| | - Floortje Mols
- Center of Research on Psychology in Somatic Diseases (C o RPS) Tilburg University; Tilburg the Netherlands
- Comprehensive Cancer Center South (CCCS); Eindhoven Cancer Registry; Eindhoven the Netherlands
| | - Kevin D. Stein
- Behavioral Research Center; American Cancer Society; Atlanta Georgia
- Rollins School of Public Health; Emory University; Atlanta Georgia
| | - Tenbroeck Smith
- Behavioral Research Center; American Cancer Society; Atlanta Georgia
| | - Jan-Willem W. Coebergh
- Comprehensive Cancer Center South (CCCS); Eindhoven Cancer Registry; Eindhoven the Netherlands
- Department of Public Health; Erasmus University Medical Center; Rotterdam the Netherlands
| | - Lonneke V. van de Poll-Franse
- Center of Research on Psychology in Somatic Diseases (C o RPS) Tilburg University; Tilburg the Netherlands
- Comprehensive Cancer Center South (CCCS); Eindhoven Cancer Registry; Eindhoven the Netherlands
| |
Collapse
|
92
|
Clinical correlates of health preference and generic health-related quality of life in patients with colorectal neoplasms. PLoS One 2013; 8:e58341. [PMID: 23516465 PMCID: PMC3596378 DOI: 10.1371/journal.pone.0058341] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 02/03/2013] [Indexed: 11/21/2022] Open
Abstract
Background The aims of the study were to assess the health preference and health-related quality of life (HRQOL) in patients with colorectal neoplasms (CRN), and to determine the clinical correlates that significantly influence the HRQOL of patients. Methods Five hundred and fifty-four CRN patients, inclusive of colorectal polyp or cancer, who attended the colorectal specialist outpatient clinic at Queen Mary Hospital in Hong Kong between October 2009 and July 2010, were included. Patients were interviewed with questionnaires on socio-demographic characteristics, and generic and health preference measures of HRQOL using the SF-12 and SF-6D Health Surveys, respectively. Clinical information on stage of disease at diagnosis, time since diagnosis, primary tumour site was extracted from electronic case record. Mean HRQOL and health preference scores of CRN patients were compared with age-sex matched controls from the Chinese general population using independent t-test. Multiple linear regression analyses were conducted to explore the associations of clinical characteristics with HRQOL measures with the adjustment of socio-demographic characteristics. Results Cross-sectional data of 515 eligible patients responded to the whole questionnaires were included in outcome analysis. In comparison with age-sex matched normative values, CRN patients reported comparable physical-related HRQOL but better mental-related HRQOL. Amongst CRN patients, time since diagnosis was positively associated with health preference score whilst patients with rectal neoplasms had lower health preference and physical-related HRQOL scores than those with sigmoid neoplasms. Health preference and HRQOL scores were significantly lower in patients with stage IV colorectal cancer than those with other less severe stages, indicating that progressive decline from low-risk polyp to stage IV colorectal cancer was observed in HRQOL scores. Conclusion In CRN patients, a more advanced stage of disease was associated with worse HRQOL scores. Despite potentially adverse effect of disease on physical-related HRQOL, the mental-related HRQOL of CRN patients were better than that of Chinese general population.
Collapse
|
93
|
Gray NM, Allan JL, Murchie P, Browne S, Hall S, Hubbard G, Johnston M, Lee AJ, McKinley A, Macleod U, Presseau J, Samuel L, Wyke S, Campbell NC. Developing a community-based intervention to improve quality of life in people with colorectal cancer: a complex intervention development study. BMJ Open 2013; 3:bmjopen-2013-002596. [PMID: 23585391 PMCID: PMC3641512 DOI: 10.1136/bmjopen-2013-002596] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To develop and pilot a theory and evidence-based intervention to improve quality of life (QoL) in people with colorectal cancer. DESIGN A complex intervention development study. SETTING North East Scotland and Glasgow. PARTICIPANTS Semistructured interviews with people with colorectal cancer (n=28), cancer specialists (n=16) and primary care health professionals (n=14) and pilot testing with patients (n=12). INTERVENTIONS A single, 1 h nurse home visit 6-12 weeks after diagnosis, and telephone follow-up 1 week later (with a view to ongoing follow-up in future). PRIMARY AND SECONDARY OUTCOME MEASURES Qualitative assessment of intervention feasibility and acceptability. RESULTS Modifiable predictors of QoL identified previously were symptoms (fatigue, pain, diarrhoea, shortness of breath, insomnia, anorexia/cachexia, poor psychological well-being, sexual problems) and impaired activities. To modify these symptoms and activities, an intervention based on Control Theory was developed to help participants identify personally important symptoms and activities; set appropriate goals; use action planning to progress towards goals; self-monitor progress and identify (and tackle) barriers limiting progress. Interview responses were generally favourable and included recommendations about timing and style of delivery that were incorporated into the intervention. The pilot study demonstrated the feasibility of intervention delivery. CONCLUSIONS Through multidisciplinary collaboration, a theory-based, acceptable and feasible intervention to improve QoL in colorectal cancer patients was developed, and can now be evaluated.
Collapse
Affiliation(s)
- Nicola M Gray
- Division of Applied Health Sciences, Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Julia L Allan
- Division of Applied Health Sciences, Aberdeen Health Psychology Group, University of Aberdeen, Aberdeen, UK
| | - Peter Murchie
- Division of Applied Health Sciences, Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Susan Browne
- General Practice & Primary Care, University of Glasgow, Glasgow, UK
| | - Susan Hall
- Division of Applied Health Sciences, Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Gill Hubbard
- Cancer Care Research Centre, School of Nursing, Midwifery and Health, University of Stirling, Stirling, UK
| | - Marie Johnston
- Division of Applied Health Sciences, Aberdeen Health Psychology Group, University of Aberdeen, Aberdeen, UK
| | - Amanda J Lee
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Una Macleod
- Hull York Medical School, University of Hull, UK
| | - Justin Presseau
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Sally Wyke
- Institute of Health and Wellbeing, College of Social Science, University of Glasgow, Glasgow, UK
| | - Neil C Campbell
- Division of Applied Health Sciences, Academic Primary Care, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
94
|
Prospective evaluation of health-related quality of life after laparoscopic colectomy for cancer. Tech Coloproctol 2012; 17:27-38. [DOI: 10.1007/s10151-012-0869-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 07/24/2012] [Indexed: 12/14/2022]
|
95
|
Heins MJ, Korevaar JC, Rijken PM, Schellevis FG. For which health problems do cancer survivors visit their General Practitioner? Eur J Cancer 2012; 49:211-8. [PMID: 22897842 DOI: 10.1016/j.ejca.2012.07.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 07/13/2012] [Accepted: 07/16/2012] [Indexed: 01/19/2023]
Abstract
Primary health care use of cancer patients is increased, even years after active treatment. Insight into the reasons for this could help in developing and improving guidelines and planning of health care, which is important given the expected increase in cancer survivors. Using data from the Netherlands Information Network of Primary Care, we selected 1256 adult breast cancer, 503 prostate cancer and 487 colorectal cancer patients diagnosed between 2001 and 2006. We compared diseases and complaints for which they contacted their General Practitioner (GP) 2-5 years after diagnosis to age and sex matched non-cancer controls from the same practice. Cancer patients consulted their GP more often than controls for acute symptoms such as abdominal pain and fatigue (18% more in breast cancer, 26% more in prostate cancer) and infections, such as cystitis or respiratory infections (45% in breast cancer and 17% in colorectal cancer). Consultations for chronic diseases and psychosocial problems were slightly increased: breast cancer patients had more contacts related to diabetes (55%), sleep disturbance (60%) and depression (64%), prostate cancer patients had more contacts related to hypertension (53) and chronic obstructive pulmonary disease (COPD, 34%). Adverse drug effects were almost twice as often observed in prostate and colorectal cancer patients than in controls. Fear of cancer recurrence was noted as the reason for consulting the GP in only 20 patients. Concluding, increased primary health care use in cancer survivors is mostly related to common infections and acute symptoms, which may be due to direct effects of cancer treatment or increased health concerns.
Collapse
Affiliation(s)
- M J Heins
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
| | | | | | | |
Collapse
|
96
|
Taylor C. Reach for recovery: evaluating a pilot study of a colorectal cancer survivorship programme. Eur J Oncol Nurs 2012; 17:131-7. [PMID: 22704857 DOI: 10.1016/j.ejon.2012.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 05/09/2012] [Accepted: 05/15/2012] [Indexed: 01/24/2023]
Abstract
PURPOSE More people are living with and beyond a cancer diagnosis and new models of care are required which not only help cancer survivors meet their needs after cancer treatment but also offer guidance on how they might optimize their future quality of life. METHODS 'Reach for recovery' is a programme of educational group support which was designed specifically for colorectal cancer patients on completion of treatment. This new initiative consisted of weekly sessions offering group support and information to promote recovery from treatment and transition into cancer survivorship. The first two programmes constituted a pilot study and were evaluated to inform future content and development. RESULTS A total of seventeen patients participated in the first two programmes. Completed evaluations (n = 13) revealed that the content of the programme was perceived to be beneficial, the sessions were rated as informative and relevant to individual needs and participants had enjoyed meeting others in a similar situation. While nearly all eligible patients expressed interest in the programme, less than half of those invited attended more than one session. Establishing the resources for the programme and recruiting participants to the programme proved resource-intensive and this may limit its sustainability. CONCLUSION This initiative was well received by both cancer survivors and clinicians and offered both support and education at a critical transition time in colorectal cancer patients entry into survivorship. Careful consideration must be given to the programme venue, frequency and timing for the successful delivery of such initiatives.
Collapse
Affiliation(s)
- Claire Taylor
- Florence Nightingale School of Nursing and Midwifery, King's College London, London, United Kingdom.
| |
Collapse
|
97
|
Sinclair P, Singh A, Riaz AA, Amin A. An unsolved conundrum: the ideal follow-up strategy after curative surgery for colorectal cancer. Gastrointest Endosc 2012; 75:1072-9. [PMID: 22520880 DOI: 10.1016/j.gie.2012.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 01/03/2012] [Indexed: 12/15/2022]
Affiliation(s)
- Piriyah Sinclair
- Department of General Surgery, West Hertfordshire NHS Trust, United Kingdom
| | | | | | | |
Collapse
|
98
|
Zucca AC, Boyes AW, Linden W, Girgis A. All's well that ends well? Quality of life and physical symptom clusters in long-term cancer survivors across cancer types. J Pain Symptom Manage 2012; 43:720-31. [PMID: 22277904 DOI: 10.1016/j.jpainsymman.2011.04.023] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 04/28/2011] [Accepted: 05/05/2011] [Indexed: 01/08/2023]
Abstract
CONTEXT Little is known about the presentation of multiple concurrent symptoms (symptom clusters) in long-term cancer survivors, with few studies adequately powered to compare quality of life (QoL) and symptom presentation by cancer type. OBJECTIVES This research aimed to 1) assess patient-reported QoL and 2) identify clusters of cancer-related physical symptoms by cancer type among long-term breast, prostate, colorectal, and melanoma cancer survivors. METHODS A population-based cross-sectional sample of 863 adult cancer survivors five to six years post-diagnosis completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), assessing global QoL and frequency of presentation of cancer-related physical symptoms. RESULTS Long-term survivors reported higher levels of global QoL than 1) the general population (age-adjusted mean=79.4 vs. 71.1, small clinical difference) and 2) cancer patients early in the care trajectory (age-adjusted mean=77.1 vs. 61.3, moderate clinical difference). The majority (71%) did not report any cancer-related physical symptoms; 18% reported multiple (two or more) symptoms in the past month. Factor analysis found that cognitive functioning, fatigue, insomnia, pain, dyspnea, appetite loss, constipation, diarrhea, nausea, and vomiting formed a cluster (α=0.48). No symptom clusters were identified that were specific to just one cancer type. However, individual symptoms (including diarrhea, pain, constipation, and insomnia) modestly discriminated between cancer types. CONCLUSION Contrary to expectations, no symptom clusters specific to one type of cancer were identified and survivors reported few cancer-related symptoms and high QoL. These results convey a strong "good news" message, providing health professionals with a sound foundation for making encouraging predictions about their patients' long-term physical recovery after cancer. Cancer patients also will welcome the news that only a minority of five-year survivors experience long-term and late effects.
Collapse
Affiliation(s)
- Alison C Zucca
- Centre for Health Research & Psycho-oncology (CHeRP), Cancer Council NSW, University of Newcastle, Callaghan, New South Wales, Australia.
| | | | | | | |
Collapse
|
99
|
S.W.Samarasinghe B, Wiles L. Meeting patient needs with a risk-stratified colorectal cancer follow-up. ACTA ACUST UNITED AC 2012. [DOI: 10.12968/gasn.2012.10.3.37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
100
|
Faul LA, Rivers B, Shibata D, Townsend I, Cabrera P, Quinn GP, Jacobsen PB. Survivorship care planning in colorectal cancer: feedback from survivors & providers. J Psychosoc Oncol 2012; 30:198-216. [PMID: 22416956 PMCID: PMC3767406 DOI: 10.1080/07347332.2011.651260] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The Institute of Medicine recommended that all patients receive survivorship care plans (SCPs) post-treatment to improve quality of follow-up care. However, little is known regarding how survivors utilize SCPs and the congruency between providers' and survivors' perspectives. Feedback from colorectal cancer survivors (in receipt of a personalized/individualized SCP) and oncology providers was obtained via interviews. Survivors noted SCPs benefits of reduced duplicative procedures and cancer worry with the synthesized treatment information. Providers noted billing/reimbursement and time investiture (for form completion) as potential barriers. Further investigation of SCPs is warranted regarding utility prior to widespread adoption in follow-up care.
Collapse
Affiliation(s)
- Leigh Anne Faul
- Cancer Control Program, Georgetown University/Lombardi Cancer Center, Washington, DC 20007, USA.
| | | | | | | | | | | | | |
Collapse
|