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Comparison of Patient-Reported Outcomes in Laparoscopic and Open Right Hemicolectomy: A Retrospective Cohort Study. Dis Colon Rectum 2019; 62:1439-1447. [PMID: 31567922 DOI: 10.1097/dcr.0000000000001485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Open and laparoscopic resections for colon cancer have equivalent perioperative morbidity and mortality. However, there are little data concerning patient-reported outcomes in the early postdischarge period. OBJECTIVE We examined patient-reported outcomes in the early postdischarge period for open and laparoscopic right hemicolectomy for colon cancer. DESIGN This was a retrospective cohort study. SETTINGS The study was conducted using linked administrative healthcare databases in the province of Ontario, Canada. PATIENTS Patients undergoing laparoscopic or open right hemicolectomy for colon cancer between January 2010 and December 2014 were identified using the Ontario Cancer Registry and physician billing data. MAIN OUTCOME MEASURES The primary outcome was the presence of moderate-to-severe symptom scores on the Edmonton Symptom Assessment System (≥4 of 10) within 6 weeks of hospital discharge after right hemicolectomy. RESULTS A total of 1022 patients completed ≥1 Edmonton Symptom Assessment System survey within 6 weeks of surgery and were included in the study. Patients undergoing laparoscopic resection were more likely to have an urban residence, to have undergone planned resections, and to have had proportionally more stage 1 disease compared with patients undergoing open resection. On multivariable analyses, adjusting for patient demographics, cancer stage, and planned versus unplanned admission status, there were no differences in the adjusted odds of moderate-to-severe symptom scores between the laparoscopic and open approaches. LIMITATIONS Edmonton Symptom Assessment System scores are not collected for inpatients and thus only represent outpatient postoperative visits. Scores were reported by 19% of all resections in the population, with a bias to patients treated at cancer centers, and therefore they are not fully representative of the general population of right hemicolectomy. The Edmonton Symptom Assessment System is not a disease-specific tool and may not measure all relevant outcomes for patients undergoing right hemicolectomy. CONCLUSIONS Receipt of the open or laparoscopic surgical technique was not associated with increased risk of elevated symptom burden in the early postdischarge period. See Video Abstract at http://links.lww.com/DCR/B27. REPORTE COMPARATIVO DE RESULTADOS INFORMADOS DE PACIENTES CON HEMICOLECTOMÍA DERECHA LAPAROSCÓPICA Y ABIERTA: UN ESTUDIO DE COHORTE RETROSPECTIVO: Las resecciones abiertas y laparoscópicas para el cáncer de colon, presentan semejante morbilidad y mortalidad perioperatoria. Sin embargo, en el período inicial posterior al alta, hay pocos datos sobre los resultados informados por los pacientes.Examinamos los resultados informados por los pacientes, en el período temprano posterior al alta, para hemicolectomía derecha abierta y laparoscópica en cáncer de colon.Estudio de cohorte retrospectivo.El estudio se realizó utilizando bases de datos administrativas de atención médica en la provincia de Ontario, Canadá.Pacientes sometidos a hemicolectomía derecha abierta o laparoscópica para cáncer de colon, de enero 2010 a diciembre 2014, se identificaron mediante el Registro de cáncer de Ontario y de los datos médicos de facturación.El resultado primario, después de la hemicolectomía derecha, fue la presencia de síntomas de moderados a graves en el Sistema de evaluación de síntomas de Edmonton (≥4 de cada 10) dentro de las seis semanas posteriores al alta hospitalaria.Un total de 1022 pacientes completaron al menos una encuesta del Sistema de evaluación de síntomas de Edmonton, dentro de las seis semanas de la cirugía y se incluyeron en el estudio. Los pacientes sometidos a resección laparoscópica fueron más propensos a residir en zona urbana, a resecciones planificadas y proporcionalmente más enfermedad en estadio 1; en comparación con los pacientes sometidos a resecciones abiertas. En los análisis multivariables, que se ajustaron a la demografía del paciente, al estadio del cáncer y del estado de ingreso planificado versus no planificado, no hubo diferencias en las probabilidades ajustadas de las puntuaciones de los síntomas moderados a severos entre el abordaje abierto o laparoscópico.Las puntuaciones del Sistema de evaluación de síntomas de Edmonton no se recopilan para pacientes hospitalizados y por lo tanto, solo representan las visitas postoperatorias de pacientes ambulatorios. Las puntuaciones informadas fueron del 19% de todas las resecciones en la población, con un sesgo en los pacientes tratados en los Centros de Cáncer y por lo tanto, no son totalmente representativos de la población general de hemicolectomía derecha. El Sistema de evaluación de síntomas de Edmonton no es una herramienta específica de la enfermedad y puede no medir todos los resultados relevantes para los pacientes que se someten a una hemicolectomía derecha.La recepción entre una técnica quirúrgica abierta o laparoscópica, no se asoció con un aumento del riesgo de síntomas en el período temprano posterior al alta. Vea el Resumen del Video en http://links.lww.com/DCR/B27.
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Disparities in Postmastectomy Breast Reconstruction: A Systematic Review of the Literature and Modified Framework for Advancing Research Toward Intervention. Ann Plast Surg 2019; 81:495-502. [PMID: 29851727 DOI: 10.1097/sap.0000000000001503] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND As the United States' population diversifies, eliminating disparities in health and healthcare has become increasingly important across all disciplines of medicine, including plastic and reconstructive surgery. This is evidenced by the growing body of literature in recent years focusing on disparities in postmastectomy breast reconstruction. No study to date has evaluated whether this research is progressing appropriately to promote tangible evidence-based interventions to reduce these disparities. METHODS A systematic literature review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was performed to identify studies focusing on disparities in postmastectomy breast reconstruction. A previously established public health framework for advancing health disparities research was used to inform analysis of the quality and progression of the included studies. This triphasic framework categorizes disparities research as follows: detecting (identifies and measures disparities in vulnerable populations), understanding (establishes determinants of disparities), or reducing (proposes and evaluates interventions for eliminating disparities). RESULTS Ninety-five studies were identified between 1979 and 2016, with 61 (64.2%) published after 2010. The majority of studies (51.6%) were retrospective cohort or case-control studies (American Society of Plastic Surgery level III evidence). Fifty-eight (63.7%), 31 (34.1%), and 2 (2.2%) studies provided detecting-, understanding- and reducing-phase disparities research, respectively. Non-plastic and reconstructive surgery journals accounted for 70.5% of all articles and for most higher phase research articles, publishing 83.9% and 100% of second and third phase studies, respectively. Disparity categories investigated included race/ethnicity, age, income, insurance status/type, geography, and education level, with race/ethnicity being the most common (73.7%). The most commonly measured outcome was percent of subpopulation receiving reconstruction (63, 66.3%), followed by reconstruction type (14, 16.7%). Patient-, provider-, system-, and research-level factors were all identified as potential targets for interventions to reduce disparities. CONCLUSIONS Despite a recent increase in literature focusing on postmastectomy breast reconstruction disparities, the majority focuses on identifying vulnerable populations with inadequate progression to second (understanding) and third (reducing) phases. Increasing research funding, availability of language-concordant and culturally concordant educational materials, and advocacy and sociopolitical awareness within the plastic surgery community is necessary to advance research on postmastectomy breast reconstruction and, ultimately, eliminate it.
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Lubas MM, Lu Y, Gehr AW, Ghabach B, Tanna B, Narra K, Brinkman TM, Ojha RP. Adult Cancer Survivors' Engagement and Interest in Patient-Centered Research. Cancer Epidemiol Biomarkers Prev 2019; 29:329-335. [PMID: 31740520 DOI: 10.1158/1055-9965.epi-19-0689] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/30/2019] [Accepted: 11/12/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Limited information is available about the representativeness of survivors engaging in patient-centered research, despite the potential for threats to generalizability. We thus aimed to assess the representativeness of survivors engaged or interested in research development. METHODS We used data from the Health Information National Trends Survey, a nationally representative survey, to identify survivors of adult cancers. Our outcomes of interest were based on responses to questions about engagement or interest in developing patient-centered research. We estimated the ratio of relative frequencies (RRF) and corresponding 95% confidence limits (CL) of sociodemographic and survivorship characteristics between survivors engaged or interested in patient-centered research and the overall survivor population. RESULTS Our study population comprised 934 survivors, of whom 5% reported being engaged in patient-centered research and 26% reported an interest in participating. Relative frequencies of characteristics were discordant for engaged survivors but largely similar for interested survivors compared with all survivors. In particular, engaged survivors had a higher relative frequency of individuals ages 50 to 64 years (RRF = 1.7; 95% CL, 1.1-2.5), Hispanic (RRF = 2.9; 95% CL, 1.2-6.9), non-Hispanic Black (RRF = 2.9; 95% CL, 1.1-2.5), and unemployment (RRF = 4.7; 95% CL, 1.4-16). CONCLUSIONS We observed several meaningful differences in the characteristics of survivors engaged in patient-centered research compared with all survivors, which raises concerns about the generalizability of findings from such studies. IMPACT Patient-centered research may not benefit the broader survivor community if survivors engaging in research development are not representative of all survivors. Greater attention to recruiting mechanisms is necessary to avoid creating disparities.
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Affiliation(s)
- Margaret M Lubas
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yan Lu
- Center for Outcomes Research, JPS Health Network, Fort Worth, Texas
| | - Aaron W Gehr
- Center for Outcomes Research, JPS Health Network, Fort Worth, Texas
| | - Bassam Ghabach
- JPS Oncology and Infusion Center, JPS Health Network, Fort Worth, Texas
| | - Bhavna Tanna
- JPS Oncology and Infusion Center, JPS Health Network, Fort Worth, Texas
| | - Kalyani Narra
- JPS Oncology and Infusion Center, JPS Health Network, Fort Worth, Texas
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Rohit P Ojha
- Center for Outcomes Research, JPS Health Network, Fort Worth, Texas. .,Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
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Prospective trial on telemonitoring of geriatric cancer patients using handheld devices. Strahlenther Onkol 2019; 196:205-212. [DOI: 10.1007/s00066-019-01548-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/30/2019] [Indexed: 01/20/2023]
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105
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Roydhouse JK, Suzman DL, Menapace LA, Mishra-Kalyani PS, Sridhara R, Blumenthal GM, Beaver JA, Pazdur R, Kluetz PG. Global Variation in Opioid Use in Prostate Cancer Trials. JAMA Oncol 2019; 5:e192971. [PMID: 31513232 DOI: 10.1001/jamaoncol.2019.2971] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance Regional variation in opioid use may be attenuated when pharmaceutical-sponsored trials include care that is often standardized by protocols. Understanding such variation is important for global trials that sometimes include time to opioid use as an end point. Objective To identify whether regional and country-level variation in opioid use exists among prostate cancer clinical trials across the world. Design, Setting, and Participants International phase 3 randomized clinical trials with patients with metastatic prostate cancer and initiation from January 1, 2008, or later were identified through internal databases of the US Food and Drug Administration. Data of patients in the intention-to-treat population from each trial were pooled. Descriptive and regression analyses of the collected data were conducted from September 2018 to February 2019. Exposures Cancer therapy. Main Outcomes and Measures Opioid use data were from concomitant medications reported in the database for each trial. Logistic regression models, descriptive statistics, and χ2 tests were used to compare opioid use across world regions while adjusting for patient age, presence of visceral disease, bony disease, and baseline Eastern Cooperative Oncology Group Performance Status score and pain score. Results In total, 9670 patients (mean [SD] age of 69.2 [8.3] years) from 8 prostate cancer clinical trials in 46 countries were included. Patients in Eastern Europe (adjusted odds ratio [AOR], 0.19; 95% CI, 0.16-0.22) and Asia (AOR, 0.31; 95% CI, 0.25-0.38) were less likely to use opioids compared with patients in North America. These findings held even when the analysis was restricted to patients who reported moderate to high pain levels at baseline (Eastern Europe: AOR, 0.16 [95% CI, 0.12-0.22]; Asia: AOR, 0.47 [95% CI, 0.29-0.79]). Within North America, rates of opioid use were similar between the United States and Canada (AOR, 1.13; 95% CI, 0.93-1.37). Conclusions and Relevance This study found that, despite the clinical trial setting, opioid use appeared to vary by world regions, suggesting that this variability should be considered in international clinical trials.
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Affiliation(s)
- Jessica K Roydhouse
- Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Daniel L Suzman
- Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Laurel A Menapace
- Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Pallavi S Mishra-Kalyani
- Office of Biostatistics, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Rajeshwari Sridhara
- Office of Biostatistics, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Gideon M Blumenthal
- Oncology Center of Excellence, Food and Drug Administration, Silver Spring, Maryland
| | - Julia A Beaver
- Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Richard Pazdur
- Oncology Center of Excellence, Food and Drug Administration, Silver Spring, Maryland
| | - Paul G Kluetz
- Oncology Center of Excellence, Food and Drug Administration, Silver Spring, Maryland
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106
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Ngô C, Dinut A, Bochaton A, Charreire H, Desprès C, Baffert S, Lécuru F, Chatellier G. From prospective clinical trial to reducing social inequalities in health: The DESSEIN trial, concept and design of a multidisciplinary study in precarious patients with breast cancer. BMC Public Health 2019; 19:1450. [PMID: 31684919 PMCID: PMC6829797 DOI: 10.1186/s12889-019-7611-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In France during the last 15 years, precariousness among women has increased. In breast cancer, precariousness has been associated with an increase in mortality, but the links between precariousness, stage at diagnosis and care pathway are little explored. Our study aims to evaluate the impact of precariousness on care pathways, treatment and recovery phase according to a multidisciplinary analysis. METHODS AND DESIGN Comparative prospective observational multicenter study of exposed / unexposed category. Patients with breast cancer are recruited in the Ile de France area. Three scores are used to identify precarious patients. Precarious patients are matched to non-precarious patients by age group. Questionnaires are distributed to patients at different times of care. The main objective is to compare the stage of the disease at diagnosis between two groups. The secondary objectives are: comparison of socio-economic and geographical characteristics, direct and indirect costs, personal trajectories of care and health. Analysis include multidisciplinary approaches. A geographical information systems method will evaluate the accessibility to health facilities and the characteristics of the places of residence of the patients. An anthropological analysis will be conducted through observation of consultations and semi-directed interviews with patients. These methods will allow to analyze the diagnostic and therapeutic routes, placing it in a life history and an economic, socio-cultural and health environment. The economic analysis will include a comparison of direct, indirect costs and out-off pocket costs, from the patient's point of view and from the societal perspective. DISCUSSION Conducted in a clinical setting and coupled with a qualitative study, this study will provide a better understanding of how contextual factors, combined with individual factors, can influence the course of health and thus the stage of the disease at diagnosis. The multidisciplinary approach, involving clinicians, geographers, an anthropologist, an economist and a health epidemiologist, will allow a multidimensional approach to the impact of precariousness on breast cancer. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02948478 registered October 28, 2016. ID RCB 2016-A00589-42. protocol version: 2.1. decembre 13, 2018.
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Affiliation(s)
- Charlotte Ngô
- Centre Expert Oncologie Gynécologique et Sénologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France. .,Faculté de Médecine, Université Paris-Descartes, Sorbonne Paris Cité, Paris, France.
| | - Aurélia Dinut
- Clinical Research Unit and CIC 1418 INSERM Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Audrey Bochaton
- Health Geography, Université Paris Nanterre (UPN), UMR7533 Ladyss, Nanterre, France
| | | | - Caroline Desprès
- Faculté de Médecine, Université Paris-Descartes, Sorbonne Paris Cité, Paris, France
| | - Sandrine Baffert
- Health Economist, Department of Health Economy, Cemka, Paris, France
| | - Fabrice Lécuru
- Centre Expert Oncologie Gynécologique et Sénologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Gilles Chatellier
- Faculté de Médecine, Université Paris-Descartes, Sorbonne Paris Cité, Paris, France.,Epidemiologist, Clinical Research Unit, and CIC 1418 INSERM Hôpital Européen Georges Pompidou, AP-HP, Paris, France
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107
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George GC, Buford A, Hess K, Piha-Paul SA, Zinner R, Subbiah V, Hinojosa C, Cleeland CS, Meric-Bernstam F, Bernstam EV, Hong DS. Cancer-Related Internet Use and Online Social Networking Among Patients in an Early-Phase Clinical Trials Clinic at a Comprehensive Cancer Center. JCO Clin Cancer Inform 2019; 2:1-14. [PMID: 30652565 DOI: 10.1200/cci.17.00030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE We examined patterns, correlates, and the impact of cancer-related Internet use among patients with advanced cancer in a phase I clinical trials clinic for molecularly targeted oncologic agents. METHODS An anonymous questionnaire on Internet use for cancer-related purposes that incorporated input from phase I clinical trial oncologists and patients was self-administered by patients age ≥ 18 years in a phase I clinic. Multivariable modeling was used. Data were analyzed for the overall sample and by generation, which was defined by year of birth. RESULTS Of 291 patients (52% women, 82% non-Hispanic white, 50% age ≤ 60 years), 62% were cancer-related Internet users (CIUs). Cancer-related Internet use was associated with an income of ≥ $60,000 (odds ratio, 2.42; P = .004). CIUs used the Internet to learn about their cancer (85%), treatment adverse effects (65%), clinical trials (52%), new alternative treatments (42%), and symptom management (41%). CIUs most frequently used the hospital Web site (70%) to learn about clinical trials, followed by ClinicalTrials.gov (42%) and search engines (41%). The emotional impact of Internet-derived cancer information on CIUs varied-56% felt empowered, 34% anxious, 29% relieved, and 17% confused. Cancer-related Internet information made 51% of patients from the Millennial (born after 1990) and Generation X/Y (born 1965 to 1990) CIU populations anxious compared with < 29% of CIUs from older generations (born 1964 and before). Most CIUs desired more online information about new experimental drugs (91%) and US Food and Drug Administration-approved drugs for cancer (72%). CONCLUSION As most phase I patients use the Internet for cancer-related purposes, the Internet overall and hospital Web sites should provide more extensive, pertinent, and helpful information on clinical trials and cancer treatment to phase I patients.
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Affiliation(s)
- Goldy C George
- Goldy C. George, Adrianna Buford, Kenneth Hess, Sarina A. Piha-Paul, Ralph Zinner, Vivek Subbiah, Christina Hinojosa, Charles S. Cleeland, Funda Meric-Bernstam, and David S. Hong, The University of Texas MD Anderson Cancer Center; and Elmer V. Bernstam, The University of Texas School of Biomedical Informatics, Houston, TX
| | - Adrianna Buford
- Goldy C. George, Adrianna Buford, Kenneth Hess, Sarina A. Piha-Paul, Ralph Zinner, Vivek Subbiah, Christina Hinojosa, Charles S. Cleeland, Funda Meric-Bernstam, and David S. Hong, The University of Texas MD Anderson Cancer Center; and Elmer V. Bernstam, The University of Texas School of Biomedical Informatics, Houston, TX
| | - Kenneth Hess
- Goldy C. George, Adrianna Buford, Kenneth Hess, Sarina A. Piha-Paul, Ralph Zinner, Vivek Subbiah, Christina Hinojosa, Charles S. Cleeland, Funda Meric-Bernstam, and David S. Hong, The University of Texas MD Anderson Cancer Center; and Elmer V. Bernstam, The University of Texas School of Biomedical Informatics, Houston, TX
| | - Sarina A Piha-Paul
- Goldy C. George, Adrianna Buford, Kenneth Hess, Sarina A. Piha-Paul, Ralph Zinner, Vivek Subbiah, Christina Hinojosa, Charles S. Cleeland, Funda Meric-Bernstam, and David S. Hong, The University of Texas MD Anderson Cancer Center; and Elmer V. Bernstam, The University of Texas School of Biomedical Informatics, Houston, TX
| | - Ralph Zinner
- Goldy C. George, Adrianna Buford, Kenneth Hess, Sarina A. Piha-Paul, Ralph Zinner, Vivek Subbiah, Christina Hinojosa, Charles S. Cleeland, Funda Meric-Bernstam, and David S. Hong, The University of Texas MD Anderson Cancer Center; and Elmer V. Bernstam, The University of Texas School of Biomedical Informatics, Houston, TX
| | - Vivek Subbiah
- Goldy C. George, Adrianna Buford, Kenneth Hess, Sarina A. Piha-Paul, Ralph Zinner, Vivek Subbiah, Christina Hinojosa, Charles S. Cleeland, Funda Meric-Bernstam, and David S. Hong, The University of Texas MD Anderson Cancer Center; and Elmer V. Bernstam, The University of Texas School of Biomedical Informatics, Houston, TX
| | - Christina Hinojosa
- Goldy C. George, Adrianna Buford, Kenneth Hess, Sarina A. Piha-Paul, Ralph Zinner, Vivek Subbiah, Christina Hinojosa, Charles S. Cleeland, Funda Meric-Bernstam, and David S. Hong, The University of Texas MD Anderson Cancer Center; and Elmer V. Bernstam, The University of Texas School of Biomedical Informatics, Houston, TX
| | - Charles S Cleeland
- Goldy C. George, Adrianna Buford, Kenneth Hess, Sarina A. Piha-Paul, Ralph Zinner, Vivek Subbiah, Christina Hinojosa, Charles S. Cleeland, Funda Meric-Bernstam, and David S. Hong, The University of Texas MD Anderson Cancer Center; and Elmer V. Bernstam, The University of Texas School of Biomedical Informatics, Houston, TX
| | - Funda Meric-Bernstam
- Goldy C. George, Adrianna Buford, Kenneth Hess, Sarina A. Piha-Paul, Ralph Zinner, Vivek Subbiah, Christina Hinojosa, Charles S. Cleeland, Funda Meric-Bernstam, and David S. Hong, The University of Texas MD Anderson Cancer Center; and Elmer V. Bernstam, The University of Texas School of Biomedical Informatics, Houston, TX
| | - Elmer V Bernstam
- Goldy C. George, Adrianna Buford, Kenneth Hess, Sarina A. Piha-Paul, Ralph Zinner, Vivek Subbiah, Christina Hinojosa, Charles S. Cleeland, Funda Meric-Bernstam, and David S. Hong, The University of Texas MD Anderson Cancer Center; and Elmer V. Bernstam, The University of Texas School of Biomedical Informatics, Houston, TX
| | - David S Hong
- Goldy C. George, Adrianna Buford, Kenneth Hess, Sarina A. Piha-Paul, Ralph Zinner, Vivek Subbiah, Christina Hinojosa, Charles S. Cleeland, Funda Meric-Bernstam, and David S. Hong, The University of Texas MD Anderson Cancer Center; and Elmer V. Bernstam, The University of Texas School of Biomedical Informatics, Houston, TX
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Uppal A, Smieliauskas F, Sharma MR, Maron SB, Polite BN, Posner MC, Turaga K. Facilities that service economically advantaged neighborhoods perform surgical metastasectomy more often for patients with colorectal liver metastases. Cancer 2019; 126:281-292. [PMID: 31639217 DOI: 10.1002/cncr.32529] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/13/2019] [Accepted: 08/14/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Metastasectomy of isolated colorectal liver metastases (CRLM) requires significant clinical expertise and may not be readily available or offered. The authors hypothesized that hospitals that treat a greater percentage of patients from higher income catchment areas are more likely to perform metastasectomies regardless of patient or tumor characteristics. METHODS Using the National Cancer Data Base, the authors classified facilities into facility income quartiles (FIQs) based on the percentage of patients from the wealthiest neighborhoods (by zip code). Quartile 1 included facilities with <2.1% of the patients residing within the highest income zip codes, quartile 2 included facilities with 2.2% to 15.6% of patients residing within the highest income zip codes, quartile 3 included facilities with 15.7% to 40.2% of patients residing within the highest income zip codes, and quartile 4 included facilities with 40.3% to 90.5% of patients residing within the highest income ZIP codes. Patient, tumor, and facility characteristics were analyzed using a multivariate logistic regression to identify associations between metastasectomy and FIQ. RESULTS Patients with CRLM were more likely to undergo metastasectomy at facilities in the highest FIQ compared with the lowest FIQ (18% vs 11% in FIQ4; P = .001). This trend was not observed in the resection of primary tumors for nonmetastatic CRLM (rates of 95% vs 93%; P = .94). After adjusting for individual insurance status, distance traveled, zip code-level individual income, tumor, and host, patients who were treated at the highest FIQ facilities were found to be more likely to undergo metastasectomy (odds ratio, 1.29; 95% CI, 1.02-1.72 [P = .03]). CONCLUSIONS Metastasectomy for CRLM is more likely to occur at facilities that serve a greater percentage of patients from high-income catchment areas, regardless of individual patient characteristics. This disparity uniquely affects those patients with advanced cancers for which specialized expertise for therapy is necessary.
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Affiliation(s)
- Abhineet Uppal
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Fabrice Smieliauskas
- Department of Economics, Wayne State University, Detroit, Michigan.,Department of Pharmacy Practice, Wayne State University, Detroit, Michigan
| | - Manish R Sharma
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Steven B Maron
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Blase N Polite
- Department of Medicine, University of Chicago, Chicago, Illinois
| | | | - Kiran Turaga
- Department of Surgery, University of Chicago, Chicago, Illinois
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Loree JM, Anand S, Dasari A, Unger JM, Gothwal A, Ellis LM, Varadhachary G, Kopetz S, Overman MJ, Raghav K. Disparity of Race Reporting and Representation in Clinical Trials Leading to Cancer Drug Approvals From 2008 to 2018. JAMA Oncol 2019; 5:e191870. [PMID: 31415071 DOI: 10.1001/jamaoncol.2019.1870] [Citation(s) in RCA: 331] [Impact Index Per Article: 66.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Representative racial/ethnic participation in research, especially in clinical trials that establish standards of care, is necessary to minimize disparities in outcomes and to uphold societal equity in health care. Objective To evaluate the frequency of race reporting and proportional race representation in trials supporting US Food and Drug Administration (FDA) oncology drug approvals. Design, Setting, and Participants Database study of all reported trials supporting FDA oncology drug approvals granted between July 2008 and June 2018. Primary reports of trials were obtained from PubMed and ClinicalTrials.gov. Food and Drug Administration approvals were identified using the FDA archives. The US population-based cancer estimates by race were calculated using National Cancer Institute-Surveillance, Epidemiology, and End Results and US Census databases. Main Outcomes and Measures Primary outcomes were the proportion of trials reporting race and the proportion of patients by race participating in trials. Secondary outcomes included race subgroup analyses reporting and gaps between race proportion in trials and the US population. Descriptive statistics, Fisher exact, and χ2 tests were used to analyze the data. Proportions and odds ratios (OR) with 95% CIs were reported. Results Among 230 trials with a total of 112 293 participants, 145 (63.0%) reported on at least 1 race, 18 (7.8%) documented the 4 major races in the United States (white, Asian, black, and Hispanic), and 58 (25.2%) reported race subgroup analyses. Reporting on white, Asian, black, and Hispanic races was included in 144 (62.6%), 110 (47.8%), 88 (38.2%), and 23 (10.0%) trials, respectively. Between July 2008 and June 2013 vs July 2013 and June 2018, the number of trials reporting race (45 [56.6%] vs 100 [67.1%]; OR, 1.63; 95% CI, 0.93-2.87; P = .09) and race subgroup analysis (13 [16.1%] vs 45 [30.2%]; OR, 2.26, 95% CI, 1.16-4.67; P = .03) changed minimally and varied across races. Whites, Asians, blacks, and Hispanics represented 76.3%, 18.3%, 3.1% and 6.1% of trial participants, respectively, and the proportion for each race enrolled over time changed nominally (blacks, 3.6% vs 2.9% and Hispanics, 5.3% vs 6.7%) from July 2008 to June 2013 vs July 2013 to June 2018. Compared with their proportion of US cancer incidence, blacks (22% of expected) and Hispanics (44% of expected) were underrepresented compared with whites (98% of expected) and Asians (438% of expected). Conclusions and Relevance Race and race subgroup analysis reporting occurs infrequently, and black and Hispanic races are consistently underrepresented compared with their burden of cancer incidence in landmark trials that led to FDA oncology drug approvals. Enhanced minority engagement is needed in trials to ensure the validity of results and reliable benefits to all.
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Affiliation(s)
| | - Seerat Anand
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Arvind Dasari
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | | | | | | | - Gauri Varadhachary
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Scott Kopetz
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Michael J Overman
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Kanwal Raghav
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
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Almanza-Sepulveda ML, Smith ML, Widjaja E. Influence of patient, caregiver, and family factors on unmet healthcare needs in children with drug-resistant epilepsy undergoing epilepsy surgery evaluation. Epilepsy Behav 2019; 99:106502. [PMID: 31493734 DOI: 10.1016/j.yebeh.2019.106502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/03/2019] [Accepted: 08/14/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to assess whether patient, caregiver, and family factors correlate with unmet healthcare needs in children with drug-resistant epilepsy (DRE) who were evaluated for epilepsy surgery. METHODS Caregivers of children with DRE completed questions on unmet healthcare needs, including physical and mental needs. Patient (demographic, seizure severity, and comorbidities), caregiver (sociodemographics, depression, and anxiety), and family (family functioning, resources, and demands) factors were evaluated. A series of bivariable regression was conducted to assess the associations with unmet needs (overall, physical, and mental needs), followed by multivariable regression. RESULTS Of the 86 children with DRE, 32 (37.2%) reported having overall unmet healthcare needs, 21 (24.4%) have unmet physical, and 13 (15.1%) have unmet mental healthcare needs. Multivariable regression showed that the odds of overall unmet needs in children were higher in patients with higher depressive symptoms (odds ratio [OR] = 1.7, p = 0.03), and caregivers who were unemployed (OR = 3.8, p = 0.008). The odds of unmet physical needs in children were higher among patients with higher depressive symptoms (OR = 2.0, p = 0.02), caregivers who were older (OR = 1.1, p = 0.02), and caregivers who were unemployed (OR = 6.5, p = 0.008). There were no significant correlates between patient, caregiver, and family factors with unmet mental needs (all p > 0.05). INTERPRETATION Children with DRE were at risk for not receiving needed healthcare. Patient factors such as patient depressive symptoms, and caregiver factors such as caregivers' age and employment status were associated with unmet needs. Identifying the predictors of unmet healthcare needs is a necessary step in addressing unmet needs in this population with DRE.
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Affiliation(s)
| | - Mary Lou Smith
- Program in Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Canada; Department of Psychology, University of Toronto Mississauga, Toronto, Canada
| | - Elysa Widjaja
- Program in Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Canada; Department of Diagnostic Imaging, University of Toronto, Toronto, Canada; Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Canada; Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
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Lee EQ, Chukwueke UN, Hervey-Jumper SL, de Groot JF, Leone JP, Armstrong TS, Chang SM, Arons D, Oliver K, Verble K, Musella A, Willmarth N, Alexander BM, Bates A, Doherty L, Galanis E, Gaffey S, Halkin T, Friday BE, Fouladi M, Lin NU, Macdonald D, Mehta MP, Penas-Prado M, Vogelbaum MA, Sahebjam S, Sandak D, van den Bent M, Weller M, Reardon DA, Wen PY. Barriers to accrual and enrollment in brain tumor trials. Neuro Oncol 2019; 21:1100-1117. [PMID: 31175826 PMCID: PMC7594546 DOI: 10.1093/neuonc/noz104] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Many factors contribute to the poor survival of malignant brain tumor patients, some of which are not easily remedied. However, one contributor to the lack of progress that may be modifiable is poor clinical trial accrual. Surveys of brain tumor patients and neuro-oncology providers suggest that clinicians do a poor job of discussing clinical trials with patients and referring patients for clinical trials. Yet, data from the Cancer Action Network of the American Cancer Society suggest that most eligible oncology patients asked to enroll on a clinical trial will agree to do so. To this end, the Society for Neuro-Oncology (SNO) in collaboration with the Response Assessment in Neuro-Oncology (RANO) Working Group, patient advocacy groups, clinical trial cooperative groups, including the Adult Brain Tumor Consortium (ABTC), and other partners are working together with the intent to double clinical trial accrual over the next 5 years. Here we describe the factors contributing to poor clinical trial accrual in neuro-oncology and offer possible solutions.
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Affiliation(s)
- Eudocia Q Lee
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ugonma N Chukwueke
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Jose Pablo Leone
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Susan M Chang
- University of California San Francisco, San Francisco, California, USA
| | - David Arons
- National Brain Tumor Society, Newton, Massachusetts, USA
| | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth, Surrey, UK
| | - Kay Verble
- The Sontag Foundation and Brain Tumor Network, Ponte Vedre Beach, Florida, USA
| | - Al Musella
- The Musella Foundation for Brain Tumor Research and Information, Hewlett, New York, USA
| | | | | | - Amanda Bates
- National Brain Tumor Society, Newton, Massachusetts, USA
| | - Lisa Doherty
- National Brain Tumor Society, Newton, Massachusetts, USA
| | | | - Sarah Gaffey
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Thomas Halkin
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Maryam Fouladi
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nancy U Lin
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | | | - Marta Penas-Prado
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | - David Sandak
- Accelerate Brain Cancer Cure (ABC2), Washington, DC, USA
| | | | - Michael Weller
- University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Patrick Y Wen
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Cancer survivors who fully participate in the PROFILES registry have better health-related quality of life than those who drop out. J Cancer Surviv 2019; 13:829-839. [PMID: 31493162 PMCID: PMC6881419 DOI: 10.1007/s11764-019-00793-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 07/15/2019] [Indexed: 01/10/2023]
Abstract
Purpose Attrition and subsequent missing data pose a challenge in longitudinal research in oncology. This study examined factors associated with attrition in the PROFILES registry, and its impact on observed health-related quality of life (HRQOL) estimates. Methods Sociodemographic, clinical, and HRQOL data were collected annually from a cohort of 2625 colorectal cancer survivors between 2010 and 2015. Participant characteristics according to time of dropout were compared using analysis of variance and chi-square tests. Predictors of attrition were examined in logistic regression analysis. Multilevel linear mixed models were constructed to investigate associations between attrition and HRQOL over time. Results Participants who dropped out were more likely to be female (OR = 1.23, CI = 1.02–1.47), older (OR = 1.20, CI = 1.09–1.33), less educated (OR = 1.64, CI = 1.30–2.11), and to have depressive symptoms (OR = 1.84, CI = 1.39–2.44) than full responders, and less likely to have high socioeconomic status (OR = 0.74, CI = 0.61–0.94). Participants who dropped out earlier reported significantly worse HRQOL, functioning, and psychosocial symptoms, which declined at a steeper rate over time, than full responders. Conclusions Cancer survivors’ HRQOL may be overestimated in longitudinal research due to attrition of the most unwell participants. Implications for Cancer Survivors Cancer survivors with the poorest health are at risk of dropping out of PROFILES and possibly withdrawing from other activities. Optimizing participation in PROFILES—a potential mechanism for providing information and access to support—is an avenue for keeping this group engaged. Electronic supplementary material The online version of this article (10.1007/s11764-019-00793-7) contains supplementary material, which is available to authorized users.
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Winestone LE, Getz KD, Rao P, Li Y, Hall M, Huang YSV, Seif AE, Fisher BT, Aplenc R. Disparities in pediatric acute myeloid leukemia (AML) clinical trial enrollment. Leuk Lymphoma 2019; 60:2190-2198. [PMID: 30732497 PMCID: PMC6685754 DOI: 10.1080/10428194.2019.1574002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/22/2018] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
Abstract
Equal access to clinical trial enrollment is important to ensure that findings are generalizable to the broader population. This study aimed to evaluate disparities in enrollment on pediatric oncology clinical trials. We assessed the relationship between patient characteristics and enrollment on COG trial AAML1031 in a cohort of pediatric patients with AML in the Pediatric Health Information System. The associations of enrollment with outcomes were evaluated. Non-Hispanic Black patients, infants, and patients from zip codes with a lower proportion of poverty were less likely to enroll (30% vs. 61%, p = .004; 34% vs. 58%, p = .003; 46% vs. 58%, p = .02). On-therapy mortality was similar among enrolled and nonenrolled patients (7.3% vs. 8.9%, p = .47). Differences in early mortality were more pronounced among nonenrolled patients compared to enrolled patients (3.0% vs. 0.5%, p = .03). Understanding the etiology of these disparities will inform strategies to ensure balanced access to clinical trials across patient populations.
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Affiliation(s)
- Lena E. Winestone
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Division of AIBMT, Department of Pediatrics, University of California – San Francisco (UCSF) Benioff Children’s Hospital, San Francisco, CA, USA
| | - Kelly D. Getz
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Pooja Rao
- Division of Pediatric Hematology/Oncology, Penn State Children’s Hospital, Hershey, PA, USA
| | - Yimei Li
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Matt Hall
- Children’s Hospital Association, Lenexa, KS, USA
| | - Yuan-Shung V. Huang
- Healthcare Analytics Unit, Department of General Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alix E. Seif
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Brian T. Fisher
- Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Richard Aplenc
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Dobra R, Scott S, Davies JC, Simmonds NJ. Who and why; sharing our experiences of developing a standard operating procedure (SOP) to allocate screening slots for highly competitive cystic fibrosis trials. J Cyst Fibros 2019; 18:e45-e46. [DOI: 10.1016/j.jcf.2019.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 10/26/2022]
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115
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Ellis SD, Geana M, Mackay CB, Moon DJ, Gills J, Zganjar A, Brekke G, Thrasher JB, Griebling TL. Science in the Heartland: Exploring determinants of offering cancer clinical trials in rural-serving community urology practices. Urol Oncol 2019; 37:529.e9-529.e18. [PMID: 30935846 PMCID: PMC6661185 DOI: 10.1016/j.urolonc.2019.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/24/2019] [Accepted: 03/10/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Engaging community urologists in referring patients to clinical trials could increase the reach of cancer trials and, ultimately, alleviate cancer disparities. We sought to identify determinants of referring patients to clinical trials among urology practices serving rural communities. METHODS We conducted semistructured qualitative interviews based on the Theoretical Domains Framework at nonmetropolitan urology practices located in communities offering urological cancer trials. Participants were asked to consider barriers and strategies that might support engaging their patients in discussions about urological cancer clinical trials and referring them appropriately. Recorded interviews were transcribed and coded using template analysis. RESULTS Most participants were not aware of available trials and had no experience with trial referral. Overall, participants held positive attitudes toward clinical trials and recognized their potential roles in accrual, but limited local resources reduced opportunities for offering trials. Most participants expressed a need for increased human, financial, and other resources to support this role. Many participants requested information and training to increase their knowledge of clinical trials and confidence in offering them to patients. Participants highlighted the need to build efficient pathways to identify available trials, match eligible patients, and facilitate communication and collaboration with cancer centers for patient follow-up and continuity of care. CONCLUSIONS With adequate logistical and informational support, community urology practices could play an important role in clinical trial accrual, advancing cancer research and increasing treatment options for rural cancer patients. Future studies should explore the effectiveness of strategies to optimize urology practices' role in clinical trial accrual.
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Affiliation(s)
- Shellie D Ellis
- Department of Health Policy & Management, University of Kansas School of Medicine, Kansas City, KS; University of Kansas Cancer Center, Kansas City, KS.
| | - Mugur Geana
- School of Journalism and Mass Communications, University of Kansas, Lawrence, KS; University of Kansas Cancer Center, Kansas City, KS
| | - Christine B Mackay
- Department of Health Policy & Management, University of Kansas School of Medicine, Kansas City, KS; University of Kansas Cancer Center, Kansas City, KS
| | - Deborah J Moon
- Department of Health Policy & Management, University of Kansas School of Medicine, Kansas City, KS
| | - Jessie Gills
- Department of Urology, Louisiana State University, New Orleans, LA
| | - Andrew Zganjar
- Department of Urology, University of Kansas School of Medicine, Kansas City, KS
| | - Gayle Brekke
- Department of Health Policy & Management, University of Kansas School of Medicine, Kansas City, KS
| | - J Brantley Thrasher
- Department of Urology, University of Kansas School of Medicine, Kansas City, KS
| | - Tomas L Griebling
- Department of Urology, University of Kansas School of Medicine, Kansas City, KS; The Landon Center on Aging, Kansas University Medical Center, Kansas City, KS
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Unger JM, Fleury ME. Reimbursing Patients for Participation in Cancer Clinical Trials. JAMA Oncol 2019; 5:932-934. [PMID: 31169875 DOI: 10.1001/jamaoncol.2019.0141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Joseph M Unger
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mark E Fleury
- American Cancer Society Cancer Action Network Inc, Washington, DC
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117
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Jiang S, Liu P, Yang S, Yang J, Wu D, Fang H, Qin Y, Zhou S, Xu J, Sun Y, Mo H, Gui L, Xing P, Lan B, Zhang B, Tang L, Sun Y, Shi Y. Evaluating stress, satisfaction and the associated influencing factors of participants in cancer clinical trials: a cross-sectional study in China. BMJ Open 2019; 9:e028589. [PMID: 31154312 PMCID: PMC6549607 DOI: 10.1136/bmjopen-2018-028589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 04/05/2019] [Accepted: 04/29/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Patients' stress and satisfaction concerning cancer clinical trials (CCT) may affect study accrual and quality. Our study aimed to evaluate stress and satisfaction in CCT and the influencing factors. DESIGN Cross-sectional analysis done by a questionnaire after informed consent. SETTING Cancer Hospital, Chinese Academy of Medical Sciences. PARTICIPANTS 199 CCT participants. Primary and secondary outcome measures self-assessed stress and satisfaction in CCT. RESULTS Among 199 participants, 83.9% would join CCT again; 72.9% had enough time to decide on trial participation; 73.9% claimed complete awareness of CCT; 3.5% doubted CCT's significance and scientific quality; 33.2% deemed CCT time-consuming; 73.9% scored satisfaction ≥9/10; and 25.6% claimed moderate to severe stress. Positive factors for satisfaction were enough decision time (OR=0.36, p=0.0003), better impressions of doctors (OR=0.41, p=0.047) and less time-consuming trials (OR=0.43, p<0.0001). Individuals with more prior uninsured medical expenses (OR=1.23, p=0.026), less time consumption (OR=2.35, p<0.0001) and more tests in CCT (OR=0.64, p=0.035) were less likely to experience stress. Phase III study participants bore less stress than phase II (OR=0.29, p=0.032) but more than phase I (OR=1.18, p=0.009). CONCLUSIONS Our study addressed factors influencing CCT participants' stress and satisfaction. We suggested measures to improve patients' experiences in CCT. TRIAL REGISTRATION NUMBER NCT03412344; Pre-results.
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Affiliation(s)
- Shiyu Jiang
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Peng Liu
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sheng Yang
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianliang Yang
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dawei Wu
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National GCP Center for Anticancer Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Fang
- National GCP Center for Anticancer Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Qin
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shengyu Zhou
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianping Xu
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongkun Sun
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongnan Mo
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Gui
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Puyuan Xing
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Lan
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Zhang
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Le Tang
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Sun
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National GCP Center for Anticancer Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuankai Shi
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National GCP Center for Anticancer Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Clinical trial participation of patients with glioblastoma at The University of Texas MD Anderson Cancer Center. Eur J Cancer 2019; 112:83-93. [DOI: 10.1016/j.ejca.2019.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 02/04/2019] [Accepted: 02/08/2019] [Indexed: 11/19/2022]
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119
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Persad G, Fernandez Lynch H, Largent E. Differential payment to research participants in the same study: an ethical analysis. JOURNAL OF MEDICAL ETHICS 2019; 45:318-322. [PMID: 30846490 DOI: 10.1136/medethics-2018-105140] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/29/2019] [Accepted: 02/13/2019] [Indexed: 06/09/2023]
Abstract
Recognising that offers of payment to research participants can serve various purposes-reimbursement, compensation and incentive-helps uncover differences between participants, which can justify differential payment of participants within the same study. Participants with different study-related expenses will need different amounts of reimbursement to be restored to their preparticipation financial baseline. Differential compensation can be acceptable when some research participants commit more time or assume greater burdens than others, or if inter-site differences affect the value of compensation. Finally, it may be permissible to offer differential incentive payments if necessary to advance the goals of a study. We encourage investigators and Institutional Review Boards to think about whether to offer payment, in what amounts and for what purpose, and also to consider whether differential payment can help promote the scientific and ethical goals of clinical research.
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Affiliation(s)
- Govind Persad
- Sturm College of Law, University of Denver, Denver, Colorado, USA
| | - Holly Fernandez Lynch
- Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Emily Largent
- Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Gad KT, Johansen C, Duun-Henriksen AK, Krøyer A, Olsen MH, Lassen U, Mau-Sørensen M, Oksberg Dalton S. Socioeconomic Differences in Referral to Phase I Cancer Clinical Trials: A Danish Matched Cancer Case-Control Study. J Clin Oncol 2019; 37:1111-1119. [DOI: 10.1200/jco.18.01983] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In this nationwide registry study, we investigated socioeconomic and structural patterns in referral to phase I cancer trials in a case-control study design. METHODS Personal identification numbers on all Danish patients referred to the Danish Phase I Unit at Rigshospitalet from 2005 to 2016, and a control group matched on age, sex, type of cancer, year of diagnosis, and time from diagnosis to referral ensured individual-level linkage between several registries. We examined the association between nonclinical factors—indicators of socioeconomic position and distance to the Phase I Unit—and referral using a conditional logistic regression analysis adjusted for several clinical factors. Association between nonclinical factors and enrollment once referred was examined with a Cox proportional hazards regression analysis in an historical cohort study design. RESULTS Complete data were available for 1,026 (84%) of 1,220 referred patients. Significantly decreased odds for referral were identified for patients with long distance to the Phase I Unit compared with short distance (adjusted odds ratio [OR], 0.35; 95% CI, 0.30 to 0.41), for less education (less than 9 years) compared with more (more than 12 years; OR, 0.69; 95% CI, 0.56 to 0.91), and for belonging to the lowest income quintile compared with the highest (OR, 0.78; 95% CI, 0.62 to 0.97). Medium education (9 to 12 years) compared with more, being outside the workforce compared with being within, and living alone compared with living with a partner were also negatively associated with referral. Among patients referred, 252 enrolled in a trial. Nonclinical factors were not associated with enrollment. CONCLUSION On the basis of individual long-term registry data from an unselected cohort, novel anticancer therapies seem to be tested on a socially selected group of patients with cancer.
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Affiliation(s)
| | - Christoffer Johansen
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- The Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Anja Krøyer
- The Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Ulrik Lassen
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Susanne Oksberg Dalton
- The Danish Cancer Society Research Center, Copenhagen, Denmark
- Zealand University Hospital, Næstved, Denmark
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Kripalani S, Heerman WJ, Patel NJ, Jackson N, Goggins K, Rothman RL, Yeh VM, Wallston KA, Smoot DT, Wilkins CH. Association of Health Literacy and Numeracy with Interest in Research Participation. J Gen Intern Med 2019; 34:544-551. [PMID: 30684202 PMCID: PMC6445877 DOI: 10.1007/s11606-018-4766-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/03/2018] [Accepted: 11/20/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND There is much attention to recruitment of diverse populations in research, but little is known about the influence of health literacy and numeracy skills. OBJECTIVE To determine if health literacy and numeracy affect individuals' interest to participate in research studies. DESIGN Cross-sectional survey data were pooled from 3 large studies conducted in the Mid-South Clinical Data Research Network. PARTICIPANTS Adult patients enrolled in 1 of 3 Mid-South Clinical Data Research Network studies. MAIN MEASURES The survey domains included demographic items, the 3-item Brief Health Literacy Screen (range 3-15), and the 3-item Subjective Numeracy Scale (range 3-18). The outcome was a sum index measure of a 7-item instrument (range 7-21) assessing individuals' interest in participating in different types of research, including research that involves taking surveys, giving a blood sample, participating via phone or internet, taking an investigational medication, meeting at a local community center or school, including family, or staying overnight at a hospital. KEY RESULTS Respondents (N = 15,973) were predominately women (65.5%), White (81.4%), and middle aged (M = 52.8 years, SD = 16.5); 32.4% previously participated in research. Self-reported health literacy was relatively high (M = 13.5 out of 15, SD = 2.1), and subjective numeracy skills were somewhat lower (M = 14.3 out of 18, SD = 3.6). After adjustment for age, gender, race, income, education, and other characteristics, lower health literacy and numeracy skills were each independently associated with less interest in research participation (p < 0.001 for each). Prior research participation was associated with greater interest in future research participation (p < 0.001). CONCLUSIONS After adjustment for factors known to be predictive of interest, individuals with lower health literacy or numeracy scores were less interested in participating in research. Additional work is needed to elucidate reasons for this finding and to determine strategies to engage these populations.
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Affiliation(s)
- Sunil Kripalani
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, USA.
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - William J Heerman
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of General Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Niral J Patel
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Natalie Jackson
- Division of General Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Kathryn Goggins
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Russell L Rothman
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Vivian M Yeh
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kenneth A Wallston
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, USA
- School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Duane T Smoot
- Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA
| | - Consuelo H Wilkins
- Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Providing Patients with Critical or Life-Threatening Illnesses Access to Experimental Drug Therapy: A Guide to Clinical Trials and the US FDA Expanded Access Program. Pharmaceut Med 2019; 33:89-98. [DOI: 10.1007/s40290-019-00274-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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123
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Evaluating the decisions of glioma patients regarding clinical trial participation: a retrospective single provider review. Med Oncol 2019; 36:34. [DOI: 10.1007/s12032-019-1259-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/26/2019] [Indexed: 01/19/2023]
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124
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Mishkin G, Arnaldez F, Ivy SP. Drivers of Clinical Trial Participation—Demographics, Disparities, and Eligibility Criteria. JAMA Oncol 2019; 5:305-306. [DOI: 10.1001/jamaoncol.2018.5949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Grace Mishkin
- Cancer Therapy Evaluation Program, Clinical Investigations and Investigational Drug Branches, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Fernanda Arnaldez
- Cancer Therapy Evaluation Program, Clinical Investigations and Investigational Drug Branches, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - S. Percy Ivy
- Cancer Therapy Evaluation Program, Clinical Investigations and Investigational Drug Branches, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
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Flocke SA, Nock NL, Fulton S, Margevicius S, Manne S, Meropol NJ, Daly BJ. A National Study of Oncology Nurses Discussing Cancer Clinical Trials With Patients. West J Nurs Res 2019; 41:1747-1760. [PMID: 30782111 DOI: 10.1177/0193945919829145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the United States less than 10% of cancer patients engage in clinical trials. Although most oncology nurses have multiple opportunities to discuss clinical trials with patients, barriers including attitudes and social norms may impede these discussions. Guided by the Theory of Planned Behavior, we developed and evaluated measures for attitudes, subjective norms, and perceived behavioral control of nurses for discussing clinical trials with cancer patients. Of the 18,000 Oncology Nurse Society members invited, 1,964 completed the survey. Structural equation modeling and internal consistency reliability were used to evaluate items and constructs. We found that overall model fit and reliability was good: Confirmatory Fit Index (CFI) = 0.91, Root Mean Square Error of Approximation (RMSEA) = 0.05; attitudes, 21 items, alpha = 0.84; perceived behavioral control, 10 items, alpha = 0.85; and subjective norms, 9 items, alpha = 0.89. These measures of attitudes, subjective norms, and perceived behavioral control show good reliability and initial evidence of validity.
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Affiliation(s)
| | - Nora L Nock
- Case Western Reserve University, Cleveland, OH, USA
| | - Sarah Fulton
- Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Neal J Meropol
- Case Western Reserve University, Cleveland, OH, USA.,Flatiron Health, New York, NY, USA
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Webster J, Smith BD. The Case for Real-world Evidence in the Future of Clinical Research on Chronic Myeloid Leukemia. Clin Ther 2019; 41:336-349. [DOI: 10.1016/j.clinthera.2018.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 01/28/2023]
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Abstract
Financial barriers to clinical trial enrollment are an area of active investigation. Financial toxicity as a concept describes how high costs and financial burden can lead to compromised care and outcomes. Despite the potential to yield large survival benefits and improved access to cutting-edge therapies, less than 5% of adult patients with cancer are enrolled in a clinical trial. Disparities in trial enrollment exist along age, ethnic, and sociodemographic lines, with younger, poorer, nonwhite patients with private insurance-the exact population who may be at highest risk for financial toxicity-less likely to participate. Cost and insurance concerns remain an obstacle for clinical trial enrollment for certain patient populations. Changing the clinical trial paradigm with a focus on addressing structural and clinical barriers to clinical trial enrollment is paramount. This includes expanding access to clinical trials within community populations, advocating for health policy changes to guarantee insurance coverage of clinical trial standard-of-care health care, and considering noncoercive financial assistance (particularly for indirect costs like travel and lodging) for participants to defray their additional costs of participation. Additional steps toward education, cost transparency, and expansion of foundation assistance may also improve equitable access to clinical trials for all.
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Affiliation(s)
- Fumiko Chino
- 1 Duke University Radiation Oncology, Durham, NC
| | - S Yousuf Zafar
- 2 Sanford School of Public Policy, Duke Cancer Institute, Durham, NC
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Cózar JM, Miñana B, Gómez-Veiga F, Rodríguez-Antolín A. Three-year interim results of overall and progression-free survival in a cohort of patients with prostate cancer (GESCAP group). Actas Urol Esp 2019; 43:4-11. [PMID: 29891440 DOI: 10.1016/j.acuro.2018.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 03/13/2018] [Accepted: 03/13/2018] [Indexed: 12/24/2022]
Abstract
AIMS To describe the 3-year progression-free survival (PFS), overall survival (OS) and disease-specific mortality in the prospective prostate cancer GESCAP cohort, as well as the progression to castration resistance in patients on hormone therapy. MATERIAL AND METHODS Prospective, observational, epidemiological, multicentre study. Of the 4087 patients recruited, 3843 were evaluable. The variables analysed were the risk group (localized, locally advanced, lymph involvement, metastatic), age, prostate-specific antigen (PSA) levels, Gleason score and initial treatment. Kaplan Meier survival analysis, the log-rank test and the Cox model were used to evaluate the survival data. RESULTS Three-year PFS was 81.4% and OS was 92.4%. During the 3 years of follow-up, 303 patients died (7.9%), 110 of them (36.3%) due to disease-related causes. The probability of castration resistance for all patients on hormone therapy (n=715) was 14.2%: 5%, 9.9%, 26.1% and 44.4% in localized, locally advanced, lymph involvement and metastatic cancer, respectively (log-rank P<.0001). Patients with metastases had poorer outcomes with respect to PFS, OS, disease-specific mortality and castration resistance. In the multivariate analysis, the Gleason score, PSA and presence of metastases were associated with shorter OS and PFS. CONCLUSIONS Our study showed stratification of risk, with a more unfavourable prognosis for patients with metastases. Patients with locally advanced disease differed with respect to those with localized disease due to their higher risk as regards disease-specific mortality. (Controlled-trials.com ISRCTN19893319).
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Affiliation(s)
- J M Cózar
- Servicio de Urología, Hospital Virgen de las Nieves, Granada, España.
| | - B Miñana
- Servicio de Urología, Hospital Morales Meseguer, Murcia, España
| | - F Gómez-Veiga
- Servicio de Urología, Hospital Universitario de Salamanca-IBSAL-GITUR, Salamanca, España
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Woodford J, Wikman A, Einhorn K, Cernvall M, Grönqvist H, Romppala A, von Essen L. Attitudes and Preferences Toward a Hypothetical Trial of an Internet-Administered Psychological Intervention for Parents of Children Treated for Cancer: Web-Based Survey. JMIR Ment Health 2018; 5:e10085. [PMID: 30563814 PMCID: PMC6318150 DOI: 10.2196/10085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 10/05/2018] [Accepted: 10/22/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Clinical trials are often challenged with issues of recruitment and retention. Little is known concerning general attitudes and preferences toward trial design and willingness to participate among parents of children treated for cancer. Furthermore, willingness to participate in internet-administered psychological interventions remains unexplored. In this study, we examined attitudes and preferences of the population regarding study procedures for a hypothetical trial of an internet-administered psychological intervention. In addition, differences in the response rate between modes of study invitation and willingness to engage in internet-administered interventions were examined. OBJECTIVE The primary objective of this study was to examine attitudes and preferences toward participating in an internet-administrated psychological intervention. The secondary objective was to examine the response rates and help-seeking behavior among parents of children treated for cancer. METHODS A cross-sectional, Web-based survey was conducted with parents of children who had completed cancer treatment. This Web-based survey examined self-reported emotional distress, prior help-seeking and receipt of psychological support, past research participation, attitudes toward research, preferences concerning recruitment procedures, and attitudes toward different types of trial design. RESULTS Of all the parents invited, 32.0% (112/350) completed the survey, with no difference in response rate between modes of study invitation (χ21=0.6, P=.45). The majority (80/112, 71.4%) of parents responded that they had experienced past emotional distress. Responses indicated high (56/112, 50.0%) or somewhat high trust in research (51/112, 45.5%), and the majority of parents would accept, or maybe accept, internet-administered psychological support if offered (83/112, 74.1%). In addition, responses showed a preference for postal study invitation letters (86/112, 76.8%), sent by a researcher (84/112, 75.0%) with additional study information provided on the Web via text (81/112, 72.3%) and video (66/112, 58.9%). Overall, parents responded that trials utilizing a waiting list control, active alternative treatment control, or a patient-preference design were acceptable. CONCLUSIONS Parents of children treated for cancer appear willing to participate in trials examining internet-administered psychological support. Findings of this study will inform the design of a feasibility trial examining internet-administered psychological support for the population.
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Affiliation(s)
- Joanne Woodford
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna Wikman
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Kim Einhorn
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Martin Cernvall
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Helena Grönqvist
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Amanda Romppala
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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130
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Ameli R, Sinaii N, Luna MJ, Cheringal J, Gril B, Berger A. The National Institutes of Health measure of Healing Experience of All Life Stressors (NIH-HEALS): Factor analysis and validation. PLoS One 2018; 13:e0207820. [PMID: 30540764 PMCID: PMC6291293 DOI: 10.1371/journal.pone.0207820] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 11/06/2018] [Indexed: 11/18/2022] Open
Abstract
Two hundred patients with severe and/or life-threatening disease were recruited form the NIH Clinical Center and participated in the validation of the NIH-HEALS, which included exploratory factor analysis, principal component analysis, reliability, convergent validity, and divergent validity analyses. Item-reducing principal components analysis and internal consistency and split-half reliability demonstrated excellent internal consistency and split-half reliability (Cronbach's alpha = 0.89, split-half reliability = 0.95). Exploratory factor analysis revealed a three-factor structure, namely Connection (including religious, spiritual, and interpersonal), Reflection & Introspection, and Trust & Acceptance. Seven items were not retained. Convergent and divergent validity of 35-item NIH-HEALS against other validated measures of healing and spirituality provided strong evidence for its validity. As predicted, the Healed factor of the Self-Integration Scale (SIS), and Meaning, Peace, and Faith factors of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being-12 Scale (FACIT-SP12) were all positively and significantly correlated with the NIH-HEALS and its three factors. Divergent validity was also confirmed by the significant negative correlation between the NIH-HEALS and the Codependent factor on the SIS. Confirmatory Factor Analyses revealed good model fit by GFI (0.96), adjusted GFI (0.95), SRMR (0.077), and RMSEA (0.065), supporting the use of the NIH-HEALS with 35 items.
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Affiliation(s)
- Rezvan Ameli
- National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Ninet Sinaii
- Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - María José Luna
- Northwestern University, Chicago, Illinois, United States of America
| | - Julia Cheringal
- Walter Reed National Military Medical Center, Bethesda, MD, United States of America
| | - Brunilde Gril
- National Cancer Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Ann Berger
- Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
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131
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Kronish IM, Fenn K, Cohen L, Hershman DL, Green P, Jenny Lee SA, Suls J. Extent of Exclusions for Chronic Conditions in Breast Cancer Trials. JNCI Cancer Spectr 2018; 2:pky059. [PMID: 31825011 DOI: 10.1093/jncics/pky059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/15/2018] [Accepted: 10/05/2018] [Indexed: 01/05/2023] Open
Abstract
Experts have expressed concerns that patients with chronic conditions are being excessively excluded from cancer randomized clinical trials (RCTs), limiting generalizability. Accordingly, we queried clinicaltrials.gov to determine the extent to which patients with chronic conditions were excluded from phase III cancer trials, using National Cancer Institute-sponsored breast cancer RCTs as a test case. Two physicians independently coded for the presence of 19 prevalent chronic conditions within eligibility criteria. They also coded for exclusions based on performance status and vague criteria that could have broadly excluded patients with chronic conditions. The search identified 58 RCTs, initiated from 1993 to 2012. Overall, 88% of trials had at least one exclusion for a chronic condition, performance status, or vague criterion. The three most commonly excluded conditions were chronic kidney disease, heart failure, and ischemic heart disease. Our study demonstrated that patients with prevalent chronic conditions were commonly excluded from National Cancer Institute-sponsored RCTs.
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Affiliation(s)
- Ian M Kronish
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Kathleen Fenn
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Laura Cohen
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Dawn L Hershman
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Paige Green
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Sung A Jenny Lee
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Jerry Suls
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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Barrios CH, Reinert T, Werutsky G. Global Breast Cancer Research: Moving Forward. Am Soc Clin Oncol Educ Book 2018; 38:441-450. [PMID: 30231347 DOI: 10.1200/edbk_209183] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Breast cancer is a major global health problem and major cause of mortality. Although mortality trends are declining in high-income countries, trends are increasing in low- and middle-income countries (LMICs). Addressing global breast cancer research is a challenging endeavor, as notable disparities and extremely heterogeneous realities exist in different regions across the world. Basic global cancer health care needs have been addressed by the World Health Organization's (WHO) proposed list of essential medicines and by resource-stratified guidelines for screening and treatment. However, specific strategies are needed to address disparities in access to health care, particularly access to new therapies. Discussions about global research in breast cancer should take into account the ongoing globalization of clinical trials. Collaboration fostered by well-established research organizations in North America and Europe is essential for the development of infrastructure and human resources in LMICs so that researchers in these countries can begin to address regional questions. Specific challenges that impact the future of global breast cancer research include increasing the availability of trials in LMICs, developing strategies to increase patient participation in clinical trials, and creation of clear guidelines for the development of real-world evidence-based research. The main objective of this review is to encourage the discussion of challenges in global breast cancer research with the hope that collectively we will be able to generate workable proposals to advance the field.
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Affiliation(s)
- Carlos H Barrios
- From the Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | - Tomás Reinert
- From the Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | - Gustavo Werutsky
- From the Latin American Cooperative Oncology Group, Porto Alegre, Brazil
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133
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Kelpin SS, Ondersma SJ, Weaver M, Svikis DS. Representativeness of patients enrolled in a primary care clinical trial for heavy/problem substance use. Subst Abus 2018; 39:469-475. [PMID: 30373488 DOI: 10.1080/08897077.2018.1526843] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The extent to which participants in randomized clinical trials (RCTs) resemble their broader target groups is of particular concern when studying stigmatized conditions such as substance use disorders (SUDs). The present study compared patients who enrolled in a 4-arm clinical trial of SBIRT (screening, brief intervention, and referral to treatment) with eligible patients who declined study participation. METHODS Participants (N = 1338) were primary care patients who anonymously completed a computer-delivered health survey and screened positive for heavy/problem alcohol or drug use. Those who consented to the RCT (n = 713) were compared with those who declined (n = 625) on a variety of demographic, substance use, and psychosocial characteristics. Variables significant at P < .20 in univariate analyses were then examined using multivariate logistic regression to determine their combined effect. RESULTS The sample was 60% female and 76% African American, with a mean age of 45.2 years. Patients who consented to participate differed from those who declined on 34 (60%) of the 57 variables studied. The most parsimonious model by multivariate regression found that those who consented were older, more likely to be unemployed, and more likely to endorse prescription drug misuse, problems related to drug use, family history of alcohol problems, trouble falling asleep, and a health professional recommendation to lose weight. CONCLUSION Patients consenting to the RCT reported a greater number and more severe psychosocial and mental health problems than those who declined study participation. If the higher level of risk among study participants was found in other studies as well, it would raise questions regarding the generalizability of RCT results to broader clinic samples.
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Affiliation(s)
- Sydney S Kelpin
- a Department of Psychology , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Steven J Ondersma
- b Merrill-Palmer Skillman Institute and Department of Psychiatry & Behavioral Neurosciences , Wayne State University , Detroit , Michigan , USA.,c Department of Obstetrics & Gynecology , Wayne State University , Detroit , Michigan , USA
| | - Michael Weaver
- d Center for Neurobehavioral Research on Addiction , The University of Texas Health Science Center at Houston , Houston , Texas , USA
| | - Dace S Svikis
- a Department of Psychology , Virginia Commonwealth University , Richmond , Virginia , USA.,e Institute for Women's Health , Virginia Commonwealth University , Richmond , Virginia , USA
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Freedman RA, Dockter TJ, Lafky JM, Hurria A, Muss HJ, Cohen HJ, Jatoi A, Kemeny MM, Ruddy KJ. Promoting Accrual of Older Patients with Cancer to Clinical Trials: An Alliance for Clinical Trials in Oncology Member Survey (A171602). Oncologist 2018; 23:1016-1023. [PMID: 29674441 PMCID: PMC6192613 DOI: 10.1634/theoncologist.2018-0033] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/14/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND There are multiple known individual- and practice-level barriers to enrollment of older patients with cancer to clinical trials, but little is known about how the clinical research workforce feels about potential higher-level strategy changes aimed to promote increased enrollment of older patients. SUBJECTS, MATERIALS, AND METHODS We invited all 11,351 Alliance for Clinical Trials in Oncology ("Alliance") members to participate in an anonymous, web-based survey to examine awareness of current accrual patterns for older patients to clinical trials, to ascertain consensus on how to tackle enrollment challenges, and to provide the impetus for high-level changes to improve clinical trial accrual of older patients with cancer. RESULTS During the period from February 28, 2017, to June 16, 2017, 1,146 Alliance members participated (response rate = 10%), including a national diverse sample of physicians, nurses, administrative/clinical research staff, and patient advocates with representation from community, academic, and rural sites. Overall, one third felt that >50% of clinical trial enrollees should be age ≥65, and 64.9% felt the Alliance could improve upon enrollment of older patients. The four most commonly ranked strategies to improve enrollment of older patients were creating more dedicated trials for this population (36.3%), minimizing exclusion criteria focused on comorbidity (35.5%), developing independent strategies for those aged ≥65 and for those aged ≥70 (33.2%), and requiring that most/all Alliance trials have a specific expansion cohort of older patients (30.0%). CONCLUSION We anticipate that the recommendations from >1,000 Alliance members will continue to propel important strategy changes aimed to improve accrual of older patients with cancer to clinical trials. IMPLICATIONS FOR PRACTICE This survey of the Alliance for Clinical Trials membership sought opinions on potential, large-scale, national strategies to improve accrual of older adults with cancer. Consensus was found around multiple strategies, including creating more dedicated trials for older patients, developing less stringent eligibility criteria, and mandating expansion cohorts of older patients within broader Alliance trials. It is anticipated that the recommendations from >1,000 Alliance members will continue to propel important strategy changes aimed to improve accrual of older patients with cancer to clinical trials.
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Affiliation(s)
| | - Travis J Dockter
- Alliance Statistics and Data Center, Mayo Clinic and Mayo Cancer Center, Rochester, Minnesota, USA
| | | | | | - Hyman J Muss
- University of North Carolina, Chapel Hill, North Carolina, USA
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Khunger M, Rakshit S, Hernandez AV, Pasupuleti V, Glass K, Galsky MD, Grivas P. Premature Clinical Trial Discontinuation in the Era of Immune Checkpoint Inhibitors. Oncologist 2018; 23:1494-1499. [PMID: 30068783 DOI: 10.1634/theoncologist.2018-0003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/31/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Clinical trial completion is critical for new cancer therapies. Premature trial termination or withdrawal is common and impairs progress. We assessed factors of early terminated/withdrawn oncology trials focusing on trials with immune checkpoint inhibitors (ICI), hypothesizing that the latter may be associated with lower rates of premature discontinuation. MATERIALS AND METHODS We reviewed all adult, intervention, oncology trials registered in ClinicalTrials.gov (November 16, 2011, to April 16, 2015) to identify all terminated/withdrawn trials and reasons for termination. Logistics regression model was used to identify factors associated with early termination/withdrawal. Discontinuation rate was compared in trials with and without ICI. RESULTS We identified 12,875 trials (35% industry funded, 12% federal funded), of which 8.5% were prematurely terminated (5%) or withdrawn (3.5%); the main reasons were poor accrual (33%) and logistical (24%). ICI trials (n = 350) had a nonsignificant lower rate of termination or withdrawal compared with all other oncology trials (5.4% vs. 8.5%; p = .9) and were less likely to discontinue due to poor accrual (nonsignificant difference: 21% vs. 33%; p = .4). ICI trials were also less likely to discontinue compared with all other oncology drug trials (e.g., chemotherapy, targeted inhibitors, antiangiogenesis, biologics; 5.4% vs. 7.9%, respectively, nonsignificant difference). The 4-year cumulative incidence of failing to complete for reasons unrelated to toxicity or efficacy was 18% (95% confidence interval 16%-20%). There was no association between annual incidence across different tumor types or accrual goal and rate of trial termination. CONCLUSION Poor accrual represents the main cause of early cancer trial termination. Premature termination/withdrawal rate was not significantly lower in ICI compared with other trials. Clinical trial completion remains a high priority and can be influenced by provider and patient factors. IMPLICATIONS FOR PRACTICE Clinical trial completion is critical for new cancer therapies. Premature trial termination or withdrawal is common and impairs progress. This study assessed factors of early terminated/withdrawn oncology trials, focusing on trials with immune checkpoint inhibitors (ICI), and found that poor accrual represents the main cause of early cancer trial termination. Premature termination/withdrawal rate was not significantly lower in immune checkpoint inhibitor trials compared to other trials. The discussion herein is focused on measures taken by the National Cancer Institute and other institutions to improve clinical trial accrual and prevent premature clinical trial discontinuation.
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Affiliation(s)
- Monica Khunger
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sagar Rakshit
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Adrian V Hernandez
- University of Connecticut/Hartford Hospital Evidence-based Practice Center, Hartford, Connecticut, USA
- School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | - Kate Glass
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew D Galsky
- Department of Hematology/Oncology, Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Petros Grivas
- Department of Medicine, Division of Oncology, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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Martini C, Buxbaum S, Rodrigues M, Nilica B, Scarpa L, Holzner B, Virgolini I, Gamper EM. Quality of Life in Patients with Metastatic Gastroenteropancreatic Neuroendocrine Tumors Receiving Peptide Receptor Radionuclide Therapy: Information from a Monitoring Program in Clinical Routine. J Nucl Med 2018; 59:1566-1573. [PMID: 30042164 DOI: 10.2967/jnumed.117.204834] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/31/2018] [Indexed: 12/16/2022] Open
Abstract
In patients with metastatic gastroenteropancreatic neuroendocrine tumors (NETs), we evaluated health-related quality of life (HRQoL) from the first peptide receptor radionuclide therapy (PRRT) to the first restaging and compared the scores with general-population (GP) norms. Methods: The data were from routine HRQoL monitoring using the core quality-of-life questionnaire of the European Organization for Research and Treatment of Cancer (EORTC QLQ-C30). Patients received 4-6 cycles of 177Lu-DOTATATE or 90Y-DOTATOC. To be eligible for analysis, patients had to have at least one HRQoL assessment before PRRT and at least one HRQoL assessment at the end of or after treatment completion. Linear mixed models were used to consider HRQoL changes over time. Results: In total, 61 gastroenteropancreatic NET patients (small-intestine NETs, n = 37; pancreatic NETs, n = 24) were eligible for analysis. Clear improvements from baseline to the first restaging were found for diarrhea in small-intestine NET patients, showing a decrease of 16 points, which represents a moderately large change. We observed a clinically relevant decrease in appetite loss (17 points), but for female small-intestine NET patients only. Other HRQoL changes were also restricted to sociodemographic or clinical subgroups and mainly reflected improvements, except for physical and social functioning, which showed decreasing scores in older small-intestine NET patients. Compared with HRQoL GP norms, patients had impairments consisting of diarrhea; fatigue; appetite loss; reduced physical, social, and role functioning; and reduced global HRQoL. Except for diarrhea and appetite loss, patient scores at the first restaging did not reach GP levels. Conclusion: Our analyses support previous findings of overall stable HRQoL under PRRT. Yet, significant HRQoL impairments compared with the GP and potentially specific subgroup patterns need to be considered.
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Affiliation(s)
- Caroline Martini
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| | - Sabine Buxbaum
- Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Margarida Rodrigues
- Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Nilica
- Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Lorenza Scarpa
- Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria.,Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria; and
| | - Irene Virgolini
- Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Eva-Maria Gamper
- Innsbruck Institute of Patient-Centered Outcome Research (IIPCOR), Innsbruck, Austria
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Flocke SA, Antognoli E, Daly BJ, Jackson B, Fulton SE, Liu TM, Surdam J, Manne S, Meropol NJ. The Role of Oncology Nurses in Discussing Clinical Trials. Oncol Nurs Forum 2018; 44:547-552. [PMID: 28820515 DOI: 10.1188/17.onf.547-552] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe oncology nurses' experiences discussing clinical trials with their patients, and to assess barriers to these discussions.
. RESEARCH APPROACH A qualitative study designed to elicit narratives from oncology nurses.
. SETTING Community- and academic-based oncology clinics throughout the United States.
. PARTICIPANTS 33 oncology nurses involved in direct patient care in community-based and large hospital-based settings. The sample was drawn from members of the Oncology Nursing Society.
. METHODOLOGIC APPROACH In-depth interviews were conducted and analyzed using a
immersion/crystallization approach to identify themes and patterns. The analyses highlight specific issues, examples, and contexts that present challenges to clinical trial discussions with patients.
. FINDINGS Oncology nurses view their roles as patient educators and advocates to be inclusive of discussion of clinical trials. Barriers to such discussions include lack of knowledge and strategies for addressing patients' common misconceptions and uncertainty about the timing of discussions.
. INTERPRETATION These data indicate that enabling nurses to actively engage patients in discussions of clinical trials requires educational interventions to build self-efficacy and close knowledge gaps.
. IMPLICATIONS FOR NURSING Oncology nurses can play a critical role in advancing cancer care by supporting patients in decision making about clinical trial participation. This will require training and education to build their knowledge, reduce barriers, and increase their self-efficacy to fulfill this responsibility in various clinical settings.
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Affiliation(s)
- Susan A Flocke
- Department of Family Medicine and Epidemiology and Biostatistics at CWRU, Behavioral Measurement Core Facility, Case Comprehensive Center
| | | | - Barbara J Daly
- Frances Payne Bolton School of Nursing, Case Western Reserve University in Cleveland, OH
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138
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Howlader N, Cronin KA, Kurian AW, Andridge R. Differences in Breast Cancer Survival by Molecular Subtypes in the United States. Cancer Epidemiol Biomarkers Prev 2018; 27:619-626. [PMID: 29593010 DOI: 10.1158/1055-9965.epi-17-0627] [Citation(s) in RCA: 306] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/30/2017] [Accepted: 03/20/2018] [Indexed: 12/30/2022] Open
Abstract
UNLABELLED Background: Although incidence rates of breast cancer molecular subtypes are well documented, effects of molecular subtypes on breast cancer-specific survival using the largest population coverage to date are unknown in the U.S. POPULATION Methods: Using Surveillance, Epidemiology and End Results cancer registry data, we assessed survival after breast cancer diagnosis among women diagnosed during 2010 to 2013 and followed through December 31, 2014. Breast cancer molecular subtypes defined by joint hormone receptor [HR, estrogen receptor (ER) and/or progesterone receptor (PR)] and HER2 status were assessed. Multiple imputation was used to fill in missing receptor status. Four-year breast cancer-specific survival per molecular subtypes and clinical/demographic factors were calculated. A Cox proportional hazards model was used to evaluate survival while controlling for clinical and demographic factors.Results: The best survival pattern was observed among women with HR+/HER2- subtype (survival rate of 92.5% at 4 years), followed by HR+/HER2+ (90.3%), HR-/HER2+ (82.7%), and finally worst survival for triple-negative subtype (77.0%). Notably, failing to impute cases with missing receptor status leads to overestimation of survival because those with missing receptor status tend to have worse prognostic features. Survival differed substantially by stage at diagnosis. Among de novo stage IV disease, women with HR+/HER2+ subtype experienced better survival than those with HR+/HER2- subtype (45.5% vs. 35.9%), even after controlling for other factors.Conclusions: Divergence of survival curves in stage IV HR+/HER2+ versus HR+/HER2- subtype is likely attributable to major advances in HER2-targeted treatment.Impact: Contrary to conventional thought, HR+/HER2+ subtype experienced better survival than HR+/HER2- in advanced-stage disease. Cancer Epidemiol Biomarkers Prev; 27(6); 619-26. ©2018 AACR.
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Affiliation(s)
- Nadia Howlader
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.
| | - Kathleen A Cronin
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | | | - Rebecca Andridge
- The Ohio State University College of Public Health, Columbus, Ohio
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Potential Role of the Quality Assurance Review Center Platform in Global Radiation Oncology. Int J Radiat Oncol Biol Phys 2018; 99:956-962. [PMID: 29063855 DOI: 10.1016/j.ijrobp.2017.06.2461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/14/2017] [Accepted: 06/22/2017] [Indexed: 11/22/2022]
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Smith A, Howell D, Crouch S, Painter D, Blase J, Wang HI, Hewison A, Bagguley T, Appleton S, Kinsey S, Burton C, Patmore R, Roman E. Cohort Profile: The Haematological Malignancy Research Network (HMRN): a UK population-based patient cohort. Int J Epidemiol 2018; 47:700-700g. [PMID: 29618056 PMCID: PMC6005016 DOI: 10.1093/ije/dyy044] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/28/2018] [Accepted: 03/06/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
| | - Debra Howell
- Department of Health Sciences, University of York, York, UK
| | - Simon Crouch
- Department of Health Sciences, University of York, York, UK
| | - Dan Painter
- Department of Health Sciences, University of York, York, UK
| | - John Blase
- Department of Health Sciences, University of York, York, UK
| | - Han-I Wang
- Department of Health Sciences, University of York, York, UK
| | - Ann Hewison
- Department of Health Sciences, University of York, York, UK
| | | | - Simon Appleton
- Department of Health Sciences, University of York, York, UK
| | - Sally Kinsey
- Paediatric Haematology and Oncology Unit, Leeds General Infirmary
| | - Cathy Burton
- St James's Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Russell Patmore
- Queens Centre for Oncology, Castle Hill Hospital, Cottingham, UK
| | - Eve Roman
- Department of Health Sciences, University of York, York, UK
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Abstract
Real-world evidence has played an important role in expanding our knowledge on the treatment and prognostication of advanced renal cell carcinoma. This type of data has been particularly helpful in providing a better understanding of groups that are traditionally excluded from randomized controlled trials. The International mRCC Database Consortium (IMDC) represents the largest collection of real-world data on patients with advanced kidney cancer treated with targeted therapies. The IMDC prognostic model has been used to stratify patients in contemporary clinical trials and to provide risk-directed treatment selection in everyday clinical practice. More recently, it has been shown to predict response to first-line combination immunotherapy in the phase III CheckMate 214 clinical trial. In this review, we highlight the real-world evidence associated with the treatment of mRCC. We focus on first-line therapy, as well as second-line and third-line therapeutic options, including novel immuno-oncology agents. We also address the real-world evidence for the use of cytoreductive nephrectomy in advanced renal cell carcinoma in the targeted therapy era.
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Affiliation(s)
- Jeffrey Graham
- Department of Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Daniel Yc Heng
- Department of Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
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142
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Mitchell JM, Hadley J. Treatments and Health Outcomes of Medicare Patients With Back Pain. Med Care Res Rev 2018; 77:121-130. [PMID: 29298545 DOI: 10.1177/1077558717751209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Back pain treatments are costly and frequently involve use of procedures that may have minimal benefit on improving patients' functional status. Two recent studies evaluated adverse outcomes (mortality and major medical complications) following receipt of spinal surgery but neither examined whether such treatments affected functional ability. Using a sample composed of Medicare patients with persistent back pain, we examined whether functional ability improved after treatment, comparing patients treated with back surgery or spinal injections to nonrecipients. We analyzed four binary variables that measure whether the ability to perform routine tasks improved. We used instrumental variables analysis to address the nonrandom selection of treatment received due to unobservable confounding. Contrary to the observational results, the instrumental variable estimates suggest that receipt of either back surgery or spinal injections does not improve back patients' functional ability. Failure to account for selection into treatment can lead to overestimating the benefits of specific treatments.
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143
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Ibraheem A, Polite B. Improving the accrual of racial and ethnic minority patients in clinical trials: Time to raise the stakes. Cancer 2017; 123:4752-4756. [DOI: 10.1002/cncr.31073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 09/03/2017] [Accepted: 09/06/2017] [Indexed: 01/08/2023]
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Carey M, Boyes AW, Smits R, Bryant J, Waller A, Olver I. Access to clinical trials among oncology patients: results of a cross sectional survey. BMC Cancer 2017; 17:653. [PMID: 28923028 PMCID: PMC5604159 DOI: 10.1186/s12885-017-3644-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 09/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical trials are necessary for the advancement of cancer treatment and care, however low rates of participation in such trials limit the generalisability of findings. The objective of this study was to examine the proportion of medical oncology outpatients in Australia who are invited and consent to participate in clinical trials and the factors associated with this. METHODS A sample of adult medical oncology patients was recruited from three Australian cancer treatment centres. Consenting patients completed two paper-and-pencil surveys; one at the time of consent and another approximately 1 month later. A multivariate logistic regression was conducted to explore factors associated with invitation and participation in a trial. RESULTS Thirty-eight percent (n = 146) of the 383 participants reported they had been invited to take part in a clinical trial. Of those invited, 93% reported consenting to participate in the trial, with the majority indicating that they did not regret their decision (89%). Treatment centre and time since diagnosis were significantly associated with being invited to take part in a clinical trial. None of the factors examined were associated with clinical trial consent rates. CONCLUSIONS The main barrier to clinical trial participation is not being invited to do so, with the centre the patient attends being a modifiable determinant of whether or not they are invited. Increasing the resources available to treatment centres to ensure all patients are offered participation in trials they are eligible for may help to improve rates of trial participation.
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Affiliation(s)
- Mariko Carey
- Priority Research Centre for Health Behaviour, School of Medicine & Public Health, Faculty of Health, University of Newcastle, W4, HMRI Building, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, New Lambton, NSW Australia
| | - Allison W. Boyes
- Priority Research Centre for Health Behaviour, School of Medicine & Public Health, Faculty of Health, University of Newcastle, W4, HMRI Building, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, New Lambton, NSW Australia
| | - Rochelle Smits
- Priority Research Centre for Health Behaviour, School of Medicine & Public Health, Faculty of Health, University of Newcastle, W4, HMRI Building, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, New Lambton, NSW Australia
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour, School of Medicine & Public Health, Faculty of Health, University of Newcastle, W4, HMRI Building, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, New Lambton, NSW Australia
| | - Amy Waller
- Priority Research Centre for Health Behaviour, School of Medicine & Public Health, Faculty of Health, University of Newcastle, W4, HMRI Building, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, New Lambton, NSW Australia
| | - Ian Olver
- Samson Institute for Health Research, University of South Australia, Adelaide, South Australia Australia
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Sztankay M, Giesinger JM, Zabernigg A, Krempler E, Pall G, Hilbe W, Burghuber O, Hochmair M, Rumpold G, Doering S, Holzner B. Clinical decision-making and health-related quality of life during first-line and maintenance therapy in patients with advanced non-small cell lung cancer (NSCLC): findings from a real-world setting. BMC Cancer 2017; 17:565. [PMID: 28835219 PMCID: PMC5569463 DOI: 10.1186/s12885-017-3543-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/14/2017] [Indexed: 12/19/2022] Open
Abstract
Background Maintenance therapy (MT) with pemetrexed has been shown to improve overall and progression-free survival of patients with non-squamous non-small cell lung cancer (NSCLC), without impairing patients’ health-related quality of life (HRQOL) substantially. Comprehensive data on HRQOL under real-life conditions are necessary to enable informed decision-making. This study aims to (1) assess HRQOL during first-line chemotherapy and subsequent MT and (2) record patients’ and physicians’ reasons leading to clinical decisions on MT. Methods Patients treated for NSCLC at three Austrian medical centres were included. HRQOL was assessed at every chemotherapy cycle using the EORTC QLQ-C30/+LC13 questionnaire. Semi-structured interviews were conducted before MT initiation and at the time of discontinuation to evaluate patients’ and physicians’ reasons for treatment decisions. Longitudinal QOL analysis was based on linear mixed models. Results Sixty-one (73%) out of 84 patients were considered for MT. Thirty-six patients (43%) received MT and 29 (35%) discontinued therapy. Decisions on MT initiation (in 20 cases by the physician vs 4 by the patient) and discontinuation (19 vs 10) were mainly voiced by the physician. Treatment toxicity of first-line chemotherapy was the main reason for rejection of MT in patients with stable disease and was more often indicated by patients than clinicians. HRQOL data were collected from 83 patients at 422 assessment time points and indicated significantly lower symptom severity during MT compared with first-line therapy for nausea and vomiting (p = 0.006), sleep disturbances (p < 0.001), appetite loss (p = 0.043), constipation (p = 0.017) and chest pain (p = 0.022), and a deterioration in emotional functioning (p = 0.023) and cognitive functioning (p = 0.044) during MT. Conclusions Our results indicate that HRQOL and symptom burden improve between first-line treatment to MT in some respects, although some late toxicity persists. Discrepancies between patients’ and physicians’ perception of reasons for rejecting MT were evident. Thus, the integration of patient-reported outcomes, such as HRQOL, is required to enable shared decision-making and personalised healthcare based on mutual understanding of treatment objectives.
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Affiliation(s)
- Monika Sztankay
- Department of Psychiatry, Psychotherapy & Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria. .,Leopold-Franzens-University of Innsbruck, Innsbruck, Austria.
| | - Johannes Maria Giesinger
- Department of Psychiatry, Psychotherapy & Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - August Zabernigg
- Department of Internal Medicine, Kufstein County Hospital, Kufstein, Austria
| | - Elisabeth Krempler
- Department of Psychiatry, Psychotherapy & Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Pall
- Waldburg-Zeil Akutkliniken GmbH & Co. KG, Wangen, Germany
| | - Wolfgang Hilbe
- Department of Internal Medicine I (Haematology and Oncology), Wilhelminenspital Wien, Vienna, Austria
| | - Otto Burghuber
- Respiratory Oncology Unit, Department of Respiratory and Critical Care Medicine, Otto-Wagner-Spital, Vienna, Austria
| | - Maximilian Hochmair
- Respiratory Oncology Unit, Department of Respiratory and Critical Care Medicine, Otto-Wagner-Spital, Vienna, Austria
| | - Gerhard Rumpold
- Department of Psychiatry, Psychotherapy & Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Stephan Doering
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy & Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
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Howlader N, Mariotto AB, Besson C, Suneja G, Robien K, Younes N, Engels EA. Cancer-specific mortality, cure fraction, and noncancer causes of death among diffuse large B-cell lymphoma patients in the immunochemotherapy era. Cancer 2017; 123:3326-3334. [DOI: 10.1002/cncr.30739] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/20/2017] [Accepted: 02/08/2017] [Indexed: 01/24/2023]
Affiliation(s)
- Nadia Howlader
- Surveillance Research Program, Division of Cancer Control and Population Sciences; National Cancer Institute; Bethesda Maryland
- Department of Epidemiology and Biostatistics; George Washington University Milken Institute School of Public Health; Washington DC
| | - Angela B. Mariotto
- Surveillance Research Program, Division of Cancer Control and Population Sciences; National Cancer Institute; Bethesda Maryland
| | - Caroline Besson
- Faculty of Medicine; University of Paris Sud; Le Kremlin-Bicêtre France
| | - Gita Suneja
- Department of Radiation Oncology; University of Utah; Salt Lake City Utah
| | - Kim Robien
- Department of Epidemiology and Biostatistics; George Washington University Milken Institute School of Public Health; Washington DC
| | - Naji Younes
- Department of Epidemiology and Biostatistics; George Washington University Milken Institute School of Public Health; Washington DC
| | - Eric A. Engels
- Division of Cancer Epidemiology and Genetics; National Cancer Institute; Bethesda Maryland
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147
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Graham SS, Harley A, Kessler MM, Roberts L, DeVasto D, Card DJ, Neuner JM, Kim SY. Catalyzing Transdisciplinarity: A Systems Ethnography of Cancer-Obesity Comorbidity and Risk Coincidence. QUALITATIVE HEALTH RESEARCH 2017; 27:877-892. [PMID: 27378132 DOI: 10.1177/1049732316656162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Effectively addressing wicked health problems, that is, those arising from complex multifactorial biological and socio-economic causes, requires transdisciplinary action. However, a significant body of research points toward substantial difficulties in cultivating transdisciplinary collaboration. Accordingly, this article presents the results of a study that adapts Systems Ethnography and Qualitative Modeling (SEQM) in response to wicked health problems. SEQM protocols were designed to catalyze transdisciplinary responses to national defense concerns. We adapted these protocols to address cancer-obesity comorbidity and risk coincidence. In so doing, we conducted participant-observations and interviews with a diverse range of health care providers, community health educators, and health advocacy professionals who target either cancer or obesity. We then convened a transdisciplinary conference designed to catalyze a coordinated response. The findings offer productive insights into effective ways of catalyzing transdisciplinarity in addressing wicked health problems action and demonstrate the promise of SEQM for continued use in health care contexts.
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Affiliation(s)
- S Scott Graham
- 1 University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Amy Harley
- 1 University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Molly M Kessler
- 1 University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Laura Roberts
- 2 North Carolina State University, Raleigh, North Carolina, USA
| | | | - Daniel J Card
- 1 University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Joan M Neuner
- 3 Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sang-Yeon Kim
- 1 University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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Lalla RV, Long-Simpson L, Hodges JS, Treister N, Sollecito T, Schmidt B, Patton LL, Brennan MT. Clinical registry of dental outcomes in head and neck cancer patients (OraRad): rationale, methods, and recruitment considerations. BMC Oral Health 2017; 17:59. [PMID: 28241807 PMCID: PMC5327511 DOI: 10.1186/s12903-017-0344-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 02/08/2017] [Indexed: 01/25/2023] Open
Abstract
Background Most head and neck (H&N) cancer patients receive high-dose external beam radiation therapy (RT), often in combination with surgery and/or chemotherapy. Unfortunately, high-dose RT has significant adverse effects on the oral and maxillofacial tissues, some of which persist for the life of the patient. However, dental management of these patients is based largely on individual and expert opinion, as few studies have followed patients prospectively to determine factors that predict adverse oral sequelae. In addition, many previous studies were conducted before wide-spread adoption of intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy. The objective of this multi-center study is to systematically evaluate the oral health of subjects for 2 years after commencement of RT, with the goal of identifying risk factors that predict adverse oral outcomes post-RT. Methods This is a prospective multi-center longitudinal cohort study of H&N cancer patients who receive high-dose RT with curative intent. Planned enrollment is 756 subjects at 6 primary clinical sites (and their affiliated sites) in the USA. A baseline visit is conducted prior to the beginning of RT. Follow-up visits are conducted at 6, 12, 18 and 24 months from the start of RT. The primary outcome measure is the 2-year rate of tooth loss in patients who have received at least one session of external beam RT for H&N cancer. Secondary outcome measures include the incidence of exposed intraoral bone; incidence of post-extraction complications; change in Decayed Missing and Filled Surfaces (DMFS); change in periodontal measures; change in stimulated whole salivary flow rates; change in mouth opening; topical fluoride utilization; chronic oral mucositis incidence; changes in RT-specific quality of life measures; and change in oral pain scores. Discussion This study will contribute to a better understanding of the dental complications experienced by these patients. It will also enable identification of risk factors associated with adverse outcomes such as tooth loss and osteoradionecrosis. These findings will support the development of evidence-based guidelines and inform the planning of future interventional studies, with the goal of advancing improvements in patient care and outcomes. Trial registration ClinicalTrials.gov Identifier NCT02057510, registered 5 February 2014.
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Affiliation(s)
- Rajesh V Lalla
- Section of Oral Medicine, MC1605, University of Connecticut Health, 263, Farmington Avenue, Farmington, CT, 06030-1605, USA.
| | - Leslie Long-Simpson
- Division of Biostatistics, School of Public Health, University of Minnesota, 2221 University Ave SE Suite 200, Minneapolis, MN, 55414, USA
| | - James S Hodges
- Division of Biostatistics, School of Public Health, University of Minnesota, 2221 University Ave SE Suite 200, Minneapolis, MN, 55414, USA
| | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, 1620 Tremont Street, 3rd Floor, Boston, MA, 02120, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA
| | - Thomas Sollecito
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA, 19104, USA
| | - Brian Schmidt
- Department of Oral & Maxillofacial Surgery and Bluestone Center for Clinical Research, New York University College of Dentistry, 421 First Avenue, New York, NY, 10010, USA
| | - Lauren L Patton
- Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill, NC, CB 7450, USA
| | - Michael T Brennan
- Department of Oral Medicine, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
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Freedman RA, Foster JC, Seisler DK, Lafky JM, Muss HB, Cohen HJ, Mandelblatt J, Winer EP, Hudis CA, Partridge AH, Carey LA, Cirrincione C, Moreno-Aspitia A, Kimmick G, Jatoi A, Hurria A. Accrual of Older Patients With Breast Cancer to Alliance Systemic Therapy Trials Over Time: Protocol A151527. J Clin Oncol 2017; 35:421-431. [PMID: 27992272 PMCID: PMC5455700 DOI: 10.1200/jco.2016.69.4182] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose Despite increasing awareness of accrual challenges, it is unknown if accrual of older patients to breast cancer treatment trials is improving. Methods We examined accrual of older patients to Alliance for Clinical Trials in Oncology systemic therapy breast cancer trials during 1985-2012 and compared disease characteristics and reasons for therapy cessation for older (age ≥ 65 years and ≥ 70 years) versus younger (age < 65 years and < 70 years) participants. To examine accrual trends, we modeled age as a function of time, using logistic regression. Results Overall, 17% of study participants were ≥ 65 years of age. Approximately 15%, 24%, and 24% of participants in adjuvant, neoadjuvant, and metastatic trials were age ≥ 65 years, and 7%, 15%, and 13% were age ≥ 70 years, respectively. The odds of a patient age ≥ 65 years enrolling significantly increased over time for adjuvant trials (odds ratio [OR] per year, 1.04; 95% CI, 1.04 to 1.05) but decreased significantly for neoadjuvant and metastatic trials (OR, 0.62; 95% CI, 0.58 to 0.67 and OR, 0.98, 95% CI, 0.97 to 1.00). Similar trends were seen for those age ≥ 70 years but these were statistically significant for adjuvant and neoadjuvant trials only (OR, 1.05, 95% CI, 1.04 to 1.07; and OR, 0.57, 95% CI, 0.52 to 0.62). In general, those age ≥ 65 years ( v those < 65 years) in adjuvant studies had a higher mean number of lymph nodes involved and more hormone receptor-negative tumors, although tumor sizes were similar. Early protocol treatment cessation was also more frequent in those age ≥ 65 years (50%) versus < 65 years (35.9%) across trials. Conclusion Older patients with breast cancer remain largely underrepresented in cooperative group therapeutic trials. We observed some improvement in accrual to adjuvant trials but worsening of accrual for neoadjuvant/metastatic trials. Novel strategies to increase accrual of older patients are critical to meaningfully change the evidence base for this growing patient population.
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Affiliation(s)
- Rachel A. Freedman
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Jared C. Foster
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Drew K. Seisler
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Jacqueline M. Lafky
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Hyman B. Muss
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Harvey J. Cohen
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Jeanne Mandelblatt
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Eric P. Winer
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Clifford A. Hudis
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Ann H. Partridge
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Lisa A. Carey
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Constance Cirrincione
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Alvaro Moreno-Aspitia
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Gretchen Kimmick
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Aminah Jatoi
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Arti Hurria
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
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Unger JM, Cook E, Tai E, Bleyer A. The Role of Clinical Trial Participation in Cancer Research: Barriers, Evidence, and Strategies. AMERICAN SOCIETY OF CLINICAL ONCOLOGY EDUCATIONAL BOOK. AMERICAN SOCIETY OF CLINICAL ONCOLOGY. ANNUAL MEETING 2017. [PMID: 27249699 DOI: 10.14694/edbk_156686] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Fewer than one in 20 adult patients with cancer enroll in cancer clinical trials. Although barriers to trial participation have been the subject of frequent study, the rate of trial participation has not changed substantially over time. Barriers to trial participation are structural, clinical, and attitudinal, and they differ according to demographic and socioeconomic factors. In this article, we characterize the nature of cancer clinical trial barriers, and we consider global and local strategies for reducing barriers. We also consider the specific case of adolescents with cancer and show that the low rate of trial enrollment in this age group strongly correlates with limited improvements in cancer population outcomes compared with other age groups. Our analysis suggests that a clinical trial system that enrolls patients at a higher rate produces treatment advances at a faster rate and corresponding improvements in cancer population outcomes. Viewed in this light, the issue of clinical trial enrollment is foundational, lying at the heart of the cancer clinical trial endeavor. Fewer barriers to trial participation would enable trials to be completed more quickly and would improve the generalizability of trial results. Moreover, increased accrual to trials is important for patients, because trials provide patients the opportunity to receive the newest treatments. In an era of increasing emphasis on a treatment decision-making process that incorporates the patient perspective, the opportunity for patients to choose trial participation for their care is vital.
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Affiliation(s)
- Joseph M Unger
- From the Fred Hutchinson Cancer Research Center, Seattle, WA; The University of Texas MD Anderson Cancer Center, Houston, TX; Centers for Disease Control and Prevention, Atlanta, GA; St. Charles Health System, Quality Department, Bend, OR
| | - Elise Cook
- From the Fred Hutchinson Cancer Research Center, Seattle, WA; The University of Texas MD Anderson Cancer Center, Houston, TX; Centers for Disease Control and Prevention, Atlanta, GA; St. Charles Health System, Quality Department, Bend, OR
| | - Eric Tai
- From the Fred Hutchinson Cancer Research Center, Seattle, WA; The University of Texas MD Anderson Cancer Center, Houston, TX; Centers for Disease Control and Prevention, Atlanta, GA; St. Charles Health System, Quality Department, Bend, OR
| | - Archie Bleyer
- From the Fred Hutchinson Cancer Research Center, Seattle, WA; The University of Texas MD Anderson Cancer Center, Houston, TX; Centers for Disease Control and Prevention, Atlanta, GA; St. Charles Health System, Quality Department, Bend, OR
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