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Persistence of Late Substantial Patient-Reported Symptoms (LAPERS) After Radiochemotherapy Including Image Guided Adaptive Brachytherapy for Locally Advanced Cervical Cancer: A Report From the EMBRACE Study. Int J Radiat Oncol Biol Phys 2020; 109:161-173. [PMID: 32853710 DOI: 10.1016/j.ijrobp.2020.08.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/19/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE This report describes the persistence of late substantial treatment-related patient-reported symptoms (LAPERS) in the multi-institutional EMBRACE study on magnetic resonance image guided adaptive brachytherapy in locally advanced cervical cancer (LACC). METHODS AND MATERIALS Patient-reported symptoms (European Organization for Research and Treatment of Cancer [EORTC]-C30/CX24) and physician-assessed morbidity (Common Terminology Criteria for Adverse Events [CTCAE], version 3.0) were assessed at baseline and regular timepoints during follow-up. Patients with sufficient EORTC follow-up (baseline and ≥3 late follow-up visits) were analyzed. LAPERS events were defined as the presence of substantial EORTC symptoms (quite a bit/very much) for at least half of the assessments (persistence) and progression beyond baseline condition (treatment-related). For each EORTC symptom, the ratio between LAPERS rates and crude incidence rates of substantial symptoms was calculated to represent the proportion of symptomatic patients with persisting symptoms. For 9 symptoms with a corresponding EORTC/CTCAE assessment, the overlap of LAPERS and severe morbidity events (grades 3-5) was evaluated. RESULTS Of 1047 patients with EORTC available, 741 had sufficient follow-up for the LAPERS analyses. The median follow-up was 59 months (interquartile range, 42-70 months). Across all symptoms, the proportion of patients with LAPERS events (LAPERS rates) was in median 4.6% (range, 0.0% vaginal bleeding to 20.4% tiredness). Urinary frequency, neuropathy, fatigue, insomnia, and menopausal symptoms revealed LAPERS rates of >10%. Vomiting, blood in stool, urinary pain/burning, and abnormal vaginal bleeding displayed LAPERS rates of <1%. A median of 19% of symptomatic patients (interquartile range, 8.0%-28.5%) showed persistent long-term symptoms (LAPERS events). In symptoms with a corresponding EORTC/CTCAE assessment, 12% of LAPERS events were accompanied by a severe CTCAE event. CONCLUSIONS Within this large cohort of survivors of LACC, a subgroup of patients with persistent symptoms (LAPERS events) was identified. For symptoms with a corresponding EORTC/CTCAE assessment, the vast majority of LAPERS events occurred in patients without corresponding severe physician-assessed morbidity. These findings emphasize the importance of distinguishing between transient and persisting symptoms in the aftercare of LACC survivors.
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152
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Bell SG, Dalton L, McNeish BL, Fang F, Henry NL, Kidwell KM, McLean K. Aromatase inhibitor use, side effects and discontinuation rates in gynecologic oncology patients. Gynecol Oncol 2020; 159:509-514. [PMID: 32847676 PMCID: PMC8036903 DOI: 10.1016/j.ygyno.2020.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/11/2020] [Indexed: 01/29/2023]
Abstract
Objective. Aromatase inhibitors (AI) are frequently prescribed in gynecologic oncology. We sought to define the frequency and duration of AI use, characterize AI side effects and determine the reasons for discontinuation in these patients. Methods. Uterine and ovarian cancer patients with AI use for gynecologic cancer therapy were identified retrospectively. Data were abstracted from the electronic medical record, including cancer type, stage, prior cancer treatments, body mass index, concurrent medications, prevalence of AI side effects before and during AI therapy, length of AI treatment and reason for AI discontinuation. Results. 146 women received AI therapy, with 68 for ovarian cancer (46.6%) and 78 for uterine cancer (53.4%). The majority (71.9%) had advanced stage disease at diagnosis. 54.1% noted AI-associated side effects within the first three visits after starting AI therapy. The most common side effects were arthralgias (29.5%), hot flashes (25.3%), new/worsening fatigue (16.4%), muscle or joint stiffness (8.2%) and myalgias (6.8%). The mean duration of therapy was 14.7 months. Gabapentin or selective serotonin reuptake inhibitor (SSRI) use was associated with decreased musculoskeletal side effects (gabapentin: p < .001, OR 0.88, 95% CI 0.83–0.94; SSRI: p < .001, OR 0.82, 95% CI 0.77–0.89). The most common reason for AI discontinuation was disease progression (87.9%), with 5.0% discontinuing due to side effects and 7.1% for other reasons. Conclusion. AI therapy for gynecologic cancers is frequently associated with musculoskeletal side effects, but rarely leads to treatment discontinuation. Thus, AI side effects should be assessed in gynecologic cancer patients to allow potential mitigation of symptoms through adjunct therapies.
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Affiliation(s)
- Sarah G Bell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Liam Dalton
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Brendan L McNeish
- Department of Physical Medicine and Rehabilitation, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Fang Fang
- Department of Biostatistics, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - N Lynn Henry
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Karen McLean
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
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153
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Park EJ, Baek JH, Choi GS, Park WC, Yu CS, Kang SB, Min BS, Kim JH, Kim HR, Lee BH, Oh JH, Jeong SY, Jung M, Ahn JB, Baik SH. The Role of Primary Tumor Resection in Colorectal Cancer Patients with Asymptomatic, Synchronous, Unresectable Metastasis: A Multicenter Randomized Controlled Trial. Cancers (Basel) 2020; 12:cancers12082306. [PMID: 32824392 PMCID: PMC7464811 DOI: 10.3390/cancers12082306] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/07/2020] [Accepted: 08/13/2020] [Indexed: 12/13/2022] Open
Abstract
We aimed to assess the survival benefits of primary tumor resection (PTR) followed by chemotherapy in patients with asymptomatic stage IV colorectal cancer with asymptomatic, synchronous, unresectable metastases compared to those of upfront chemotherapy alone. This was an open-label, prospective, randomized controlled trial (ClnicalTrials.gov Identifier: NCT01978249). From May 2013 to April 2016, 48 patients (PTR, n = 26; upfront chemotherapy, n = 22) diagnosed with asymptomatic colorectal cancer with unresectable metastases in 12 tertiary hospitals were randomized (1:1). The primary endpoint was two-year overall survival. The secondary endpoints were primary tumor-related complications, PTR-related complications, and rate of conversion to resectable status. The two-year cancer-specific survival was significantly higher in the PTR group than in the upfront chemotherapy group (72.3% vs. 47.1%; p = 0.049). However, the two-year overall survival rate was not significantly different between the PTR and upfront chemotherapy groups (69.5% vs. 44.8%, p = 0.058). The primary tumor-related complication rate was 22.7%. The PTR-related complication rate was 19.2%, with a major complication rate of 3.8%. The rates of conversion to resectable status were 15.3% and 18.2% in the PTR and upfront chemotherapy groups. While PTR followed by chemotherapy resulted in better two-year cancer-specific survival than upfront chemotherapy, the improvement in the two-year overall survival was not significant.
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Affiliation(s)
- Eun Jung Park
- Division of Colon and Rectal Surgery, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea;
| | - Jeong-Heum Baek
- Department of Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Korea;
| | - Gyu-Seog Choi
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu 41404, Korea;
| | - Won Cheol Park
- Department of Surgery, Wonkwang University School of Medicine, Iksan 54538, Korea;
| | - Chang Sik Yu
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea;
| | - Byung Soh Min
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Jae Hwang Kim
- Department of Surgery, Yeungnam University College of Medicine, Daegu 42415, Korea;
| | - Hyeong Rok Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun 58128, Korea;
| | - Bong Hwa Lee
- Department of Surgery, Hallym University Sacred Heart Hospital, Anyang 14068, Korea;
| | - Jae Hwan Oh
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang 10408, Korea;
| | - Seung-Yong Jeong
- Department of Surgery, Seoul National University College of Medicine, Colorectal Cancer Center, Seoul National University Cancer Hospital, Seoul 03080, Korea;
| | - Minkyu Jung
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul 03722, Korea; (M.J.); (J.B.A.)
| | - Joong Bae Ahn
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul 03722, Korea; (M.J.); (J.B.A.)
| | - Seung Hyuk Baik
- Division of Colon and Rectal Surgery, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea;
- Correspondence: ; Tel.: +82-2-2019-3378; Fax: +82-2-3462-5994
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Kelly M, O'Connor R, Townsend L, Coghlan M, Relihan E, Moriarty M, Carr B, Melanophy G, Doyle C, Bannan C, O'Riordan R, Merry C, Clarke S, Bergin C. Clinical outcomes and adverse events in patients hospitalised with COVID-19, treated with off-label hydroxychloroquine and azithromycin. Br J Clin Pharmacol 2020; 87:1150-1154. [PMID: 32687645 DOI: 10.1111/bcp.14482] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS To assess clinical outcomes and adverse drug events in patients hospitalised with COVID-19 treated with off-label hydroxychloroquine (HCQ) and azithromycin (Az). METHODS We performed a retrospective analysis of hospitalised patients who had a positive polymerase chain reaction test for SARS-CoV-2 and received HCQ plus Az or no targeted therapy. The primary end point was clinical improvement on day 7 defined as either hospital discharge or an improvement of 2 points on a 6-category ordinal scale. Secondary outcomes included mortality at day 28, intensive care admission, requirement for mechanical ventilation and incidence of adverse events. RESULTS Data from a total of 134 patients were evaluated; 82 patients received HCQ/Az and 52 patients received no targeted therapy. Clinical improvement was seen in 26.8% of patients who received HCQ/Az but this was not significant. The rates of intensive care transfer and mechanical ventilation were higher in the treatment group, but these differences were not significant. Mortality at day 28 was significantly higher in the treatment group (P = .03). Hypoglycaemia elevated liver function tests and QT prolongation were monitored in both groups. The risk of QT prolongation was significantly higher in the treatment group. Treatment was stopped early in 6 (7.3%) patients due to adverse events. CONCLUSION Although patients who received HCQ/Az were more severely ill the administration of these repurposed drugs did not result in clinical improvement and was associated with a significant increase in toxicity. This descriptive study highlights the importance of monitoring all repurposed agents for adverse events.
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Affiliation(s)
- Mary Kelly
- Pharmacy Department, St James's Hospital, Dublin, Ireland
| | - Ròisìn O'Connor
- Pharmacy Department, St James's Hospital, Dublin, Ireland.,Department of Genitourinary Medicine and Infectious Disease (GUIDe), Hospital 5 St James's Hospital, Dublin, Ireland
| | - Liam Townsend
- Department of Genitourinary Medicine and Infectious Disease (GUIDe), Hospital 5 St James's Hospital, Dublin, Ireland.,Trinity College Dublin, Ireland
| | - Miriam Coghlan
- Pharmacy Department, St James's Hospital, Dublin, Ireland
| | - Eileen Relihan
- Pharmacy Department, St James's Hospital, Dublin, Ireland
| | | | - Bernard Carr
- Pharmacy Department, St James's Hospital, Dublin, Ireland
| | - Gail Melanophy
- Pharmacy Department, St James's Hospital, Dublin, Ireland
| | - Caitriona Doyle
- Department of Genitourinary Medicine and Infectious Disease (GUIDe), Hospital 5 St James's Hospital, Dublin, Ireland
| | - Ciaran Bannan
- Department of Genitourinary Medicine and Infectious Disease (GUIDe), Hospital 5 St James's Hospital, Dublin, Ireland.,Trinity College Dublin, Ireland
| | - Ruth O'Riordan
- Department of Genitourinary Medicine and Infectious Disease (GUIDe), Hospital 5 St James's Hospital, Dublin, Ireland
| | - Concepta Merry
- Department of Genitourinary Medicine and Infectious Disease (GUIDe), Hospital 5 St James's Hospital, Dublin, Ireland
| | - Susie Clarke
- Department of Genitourinary Medicine and Infectious Disease (GUIDe), Hospital 5 St James's Hospital, Dublin, Ireland
| | - Colm Bergin
- Department of Genitourinary Medicine and Infectious Disease (GUIDe), Hospital 5 St James's Hospital, Dublin, Ireland.,Trinity College Dublin, Ireland
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155
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Lyashchenko AK, Cremers S. On precision dosing of oral small molecule drugs in oncology. Br J Clin Pharmacol 2020; 87:263-270. [PMID: 32621551 DOI: 10.1111/bcp.14454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/06/2020] [Accepted: 06/17/2020] [Indexed: 12/17/2022] Open
Abstract
Personalization of oral small molecule anticancer drug doses based on individual patient blood drug levels, also known as therapeutic drug monitoring (TDM), has the potential to significantly improve the effectiveness of treatment by maximizing drug efficacy and minimize toxicity. However, this option has not yet been widely embraced by the oncology community. Some reasons for this include increased logistical complexity of dose individualization, the lack of clinical laboratories that measure small molecule drug concentrations in support of patient care, and the lack of reimbursement of costs. However, the main obstacle may be the lack of studies clearly demonstrating that monitoring of oral small molecule anticancer drug levels actually improves clinical outcomes. Without unequivocal evidence in support of TDM-guided dose individualization, especially demonstration of improved survival with TDM in randomized controlled trials, wide acceptance of this approach by oncologists and reimbursement by insurance companies is unlikely, and patients may continue to suffer as a result of receiving incorrect drug doses. This article reviews the current status of TDM of oral small molecule drugs in oncology and intends to provide strategic insights into the design of studies for evaluating the utility of TDM in this clinical context.
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Affiliation(s)
- Alex K Lyashchenko
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Serge Cremers
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
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156
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Colomer-Lahiguera S, Bryant-Lukosius D, Rietkoetter S, Martelli L, Ribi K, Fitzpatrick-Lewis D, Sherifali D, Orcurto A, Juergens R, Eicher M. Patient-reported outcome instruments used in immune-checkpoint inhibitor clinical trials in oncology: a systematic review. J Patient Rep Outcomes 2020; 4:58. [PMID: 32676785 PMCID: PMC7364679 DOI: 10.1186/s41687-020-00210-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 05/28/2020] [Indexed: 12/14/2022] Open
Abstract
Context Immune-checkpoint inhibitors (ICI) have shown significant benefits for overall survival across various cancer types. Patient-reported outcomes (PROs) are assessed in clinical trials as a measure of efficacy. However, it remains unclear to what extent current PRO instruments capture symptoms specific to ICI toxicities. We conducted a systematic review to identify the use and content validity of PRO instruments in ICI clinical trials in oncology. Methods Literature was retrieved from PubMed, Embase, PsycINFO, Medline and CINAHL databases. Articles presenting ICI clinical trials’ PRO results, clinical trial study protocols, and conference abstracts stating the use of PRO measures were assessed. We evaluated the validity of identified instruments by comparing their symptom-related content with the adverse events reported in each ICI clinical trial. Results From database inception until January 2020, we identified 191 ICI clinical trials stating the use of PRO measures of which 26 published PRO results. The cancer-specific EORTC QLQ-C30 and the generic EQ-5D questionnaires were the most widely used instruments, often in combination with disease-specific PROs. Instruments used to report PRO symptom-related toxicities covered 45% of the most frequently reported AEs, whereas 23% of AEs were partially covered and 29% were not covered at all. Of non-covered AEs, 59% referred to the dermatologic system. Partially covered AEs related to endocrine and specific types of pain. Conclusion Despite the high frequency of symptom-related toxicities related to ICI, these events are only partially covered (or not addressed) by current PRO instruments, even when combined. Further research is needed to develop new strategies to tailor PRO instruments to specific ICI toxicities.
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Affiliation(s)
- Sara Colomer-Lahiguera
- Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland. .,Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Denise Bryant-Lukosius
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Juravinski Hospital and Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada.,Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Sarah Rietkoetter
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Juravinski Hospital and Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada
| | - Lorraine Martelli
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Trillium Health Partners, Mississauga, ON, Canada
| | - Karin Ribi
- Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,International Breast Cancer Study Group (IBCSG), Coordinating Center, Bern, Switzerland
| | - Donna Fitzpatrick-Lewis
- McMaster Evidence and Review Synthesis Team, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Diana Sherifali
- Population Health Research Institute, Hamilton Health Sciences, McMaster Evidence and Review Synthesis Team, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Angela Orcurto
- Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Rosalyn Juergens
- Juravinski Hospital and Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada.,Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Manuela Eicher
- Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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157
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Sexual Function, Quality of Life, and Mood After Radiation Therapy in Patients with Anal Cancer. J Gastrointest Cancer 2020; 51:204-210. [PMID: 30980294 DOI: 10.1007/s12029-019-00233-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE/OBJECTIVE(S) Definitive chemoradiation (CRT) results in high cure rates of anal cancer, with advanced radiation (RT) techniques improving toxicity. However, there is limited data regarding these patients' sexual function (SF), quality of life (QOL), and mood. We hypothesized that anal cancer treatment would result in detrimental effects on SF, QOL, and mood. MATERIALS/METHODS We prospectively surveyed patients with anal cancer treated with definitive CRT. We assessed SF for women with the Female Sexual Function Index (FSFI) and for men with the International Index of Erectile Function (IIEF). For all patients, we assessed QOL using EORTC QLQ-C30 and CR29 and mood using the Hospital Anxiety and Depression Scale (HADS). We reported descriptive statistics for SF, QOL, and mood and used univariate analysis to evaluate predictors of SF for women. RESULTS Of 50 eligible patients, 84% completed the surveys. Median time from RT until survey was 36 months (1-97 months). Women (n = 34) reported poor SF overall (mean FSFI score = 15, scale 2-36, standard deviation (SD) 10.4). Most women reported poor SF related to satisfaction, desire, orgasm, arousal, pain, and lubrication. Men (n = 8) also had poor overall satisfaction (mean IIEF score = 6.1, scale 2-10, SD 3.6). Men reported poor erectile function and lower satisfaction with intercourse. Mean QLQ-C30 QOL score was 86.5 (SD 16.3). Results from EORTC QLQ-CR-20 demonstrated patients experienced poor sexual interest. Per HADS, 2.5% reported depression and 18% anxiety. CONCLUSION Patients with anal cancer experience sexual dysfunction after RT, with QOL and mood symptoms similar to patients with other cancers. Our data support the need for ongoing efforts to understand and address issues with SF, QOL, and mood following RT for these patients.
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158
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Liu L, Suo T, Shen Y, Geng C, Song Z, Liu F, Wang J, Xie Y, Zhang Y, Tang T, Zhang L, Wang W. Clinicians versus patients subjective adverse events assessment: based on patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE). Qual Life Res 2020; 29:3009-3015. [PMID: 32564293 DOI: 10.1007/s11136-020-02558-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Adverse events (AEs) assessment by clinicians is a standard practice in a clinical setting. However, studies have found clinicians tend to report fewer AEs, especially subjective AEs. We aimed to explore the difference of subjective AEs assessment between clinicians and patients based on PRO-CTCAE, and to discuss the necessity of incorporating patient into the evaluation of AEs. METHODS Between April and July 2019, two different questionnaires with the same subjective AEs were given to patients and clinicians in the Day Chemotherapy ward of Breast Center in the Fourth Hospital of HeBei Medical University. Patients completed a Simplified Chinese version of PRO-CTCAE, including six common subjective AEs of chemotherapy: nausea, vomiting, diarrhea, fatigue, pain, and constipation. Clinicians completed the common terminology criteria for adverse events (CTCAE) with the same AEs. General information of enrolled patients and results from the questionnaires were collected and analyzed. RESULTS 384 paired questionnaires were collected. Clinicians reported less subjective AEs than patients, and the general agreement between patients and clinicians was poor. When considering the grade difference, we utilize weighted kappa coefficient to analysis, and agreement between patients and clinicians was poor (k < 0.4) regardless of the frequency, the severity and interfering with daily life of AEs, and the most discrepancies were within one point. Patients tended to grade severer than the clinician. CONCLUSIONS The results of this study showed that there were differences between clinicians and patients in subjective adverse events evaluation. Patient reporting of symptoms can be used as a supplementary method to incorporate the current approach to monitor subjective AEs, to improve the timeliness and accuracy of clinical evaluation of subjective AEs.
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Affiliation(s)
- Lei Liu
- Community Care Teaching and Research Department, Hebei University of Chinese Medicine, Xinshi Road, Shijiazhuang, Hebei Province, China.,Breast Center of the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Tingting Suo
- Community Care Teaching and Research Department, Hebei University of Chinese Medicine, Xinshi Road, Shijiazhuang, Hebei Province, China
| | - Yongqing Shen
- Community Care Teaching and Research Department, Hebei University of Chinese Medicine, Xinshi Road, Shijiazhuang, Hebei Province, China.
| | - Cuizhi Geng
- Breast Center of the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Zhengchuan Song
- Breast Center of the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Fengxia Liu
- Breast Center of the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Jianxin Wang
- Breast Center of the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Yanli Xie
- Breast Center of the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Yanshou Zhang
- Breast Center of the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Tiantian Tang
- Breast Center of the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Lina Zhang
- Breast Center of the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Weina Wang
- Breast Center of the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
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Nakano M, Kuromatsu R, Niizeki T, Okamura S, Iwamoto H, Shimose S, Shirono T, Noda Y, Kamachi N, Koga H, Torimura T. Primary Treatment with Molecular-Targeted Agents for Hepatocellular Carcinoma: A Propensity Score-matching Analysis. Hepatol Commun 2020; 4:1218-1228. [PMID: 32766480 PMCID: PMC7395064 DOI: 10.1002/hep4.1535] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/13/2020] [Accepted: 04/28/2020] [Indexed: 12/22/2022] Open
Abstract
Sorafenib and lenvatinib, as molecular-targeted agents, constitute effective primary treatment options for advanced hepatocellular carcinoma (HCC). However, the choice of optimal primary treatment agent remains controversial. Here, we aimed to assess the respective outcomes between these agents as primary treatment in patients with advanced HCC through use of propensity score-matching analysis (PSMA). We enrolled 670 consecutive patients who were diagnosed with advanced HCC and received sorafenib (n = 524) or lenvatinib (n = 146) as the primary treatment among 18 participating institutions between May 2009 and October 2019. To reduce confounding, we used PSMA regarding seven variables related to advanced HCC prognosis, resulting in the selection of 292 patients (n = 146 for each agent). Following PSMA, no significant difference was observed in the outcome of overall survival time between patients treated with sorafenib or lenvatinib (median survival time 15.3 or 14.9 months, respectively; P = 0.2358). Patients treated with lenvatinib exhibited significantly greater therapeutic effects (response rate: 5% and 31%; disease control rate: 46% and 69% for sorafenib and lenvatinib, respectively; P < 0.0001), but showed significantly lower probability of transition to secondary treatment (sorafenib, 60%; lenvatinib, 45%; P < 0.0269) and higher any adverse events rate (sorafenib, 86%; lenvatinib, 95%; P = 0.0207). Conclusion: As a primary molecular-targeted agent-based treatment for advanced HCC, our findings suggested that sorafenib is generally appropriate as it offers significantly lower frequency of adverse events and higher probability of transition to secondary treatment, in consideration of the enhanced postprogression survival mediated by sequential treatment. Alternatively, lenvatinib affords a significantly higher therapeutic effect and should be used when immediate tumor reduction is required.
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Affiliation(s)
- Masahito Nakano
- Division of Gastroenterology Department of Medicine Kurume University School of Medicine Kurume Japan
| | - Ryoko Kuromatsu
- Division of Gastroenterology Department of Medicine Kurume University School of Medicine Kurume Japan
| | - Takashi Niizeki
- Division of Gastroenterology Department of Medicine Kurume University School of Medicine Kurume Japan
| | - Shusuke Okamura
- Division of Gastroenterology Department of Medicine Kurume University School of Medicine Kurume Japan
| | - Hideki Iwamoto
- Division of Gastroenterology Department of Medicine Kurume University School of Medicine Kurume Japan
| | - Shigeo Shimose
- Division of Gastroenterology Department of Medicine Kurume University School of Medicine Kurume Japan
| | - Tomotake Shirono
- Division of Gastroenterology Department of Medicine Kurume University School of Medicine Kurume Japan
| | - Yu Noda
- Division of Gastroenterology Department of Medicine Kurume University School of Medicine Kurume Japan
| | - Naoki Kamachi
- Division of Gastroenterology Department of Medicine Kurume University School of Medicine Kurume Japan
| | - Hironori Koga
- Division of Gastroenterology Department of Medicine Kurume University School of Medicine Kurume Japan
| | - Takuji Torimura
- Division of Gastroenterology Department of Medicine Kurume University School of Medicine Kurume Japan
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Shimose S, Kawaguchi T, Tanaka M, Iwamoto H, Miyazaki K, Moriyama E, Suzuki H, Niizeki T, Shirono T, Nakano M, Suga H, Yamaguchi T, Yokokura Y, Noguchi K, Koga H, Torimura T. Lenvatinib prolongs the progression-free survival time of patients with intermediate-stage hepatocellular carcinoma refractory to transarterial chemoembolization: A multicenter cohort study using data mining analysis. Oncol Lett 2020; 20:2257-2265. [PMID: 32782543 PMCID: PMC7400966 DOI: 10.3892/ol.2020.11758] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/09/2020] [Indexed: 12/13/2022] Open
Abstract
Tyrosine kinase inhibitors are considered for use in patients with hepatocellular carcinoma (HCC) refractory to transarterial chemoembolization (TACE). The aim of the present retrospective study was to identify factors associated with progression-free survival (PFS) and to evaluate the indications for lenvatinib treatment in patients with intermediate-stage HCC refractory to TACE using a data-mining analysis. A total of 171 patients with intermediate-stage HCC refractory to TACE were included. All patients were classified into three groups according to their HCC treatment: Lenvatinib (n=45), sorafenib (n=53) and TACE (n=73) groups. PFS time was calculated using the Kaplan-Meier method and analyzed using a log-rank test. Factors associated with PFS time were evaluated using multivariate and decision-tree analyses. The median PFS time was 5.8, 3.2 and 2.4 months in the lenvatinib, sorafenib and TACE groups, respectively (P<0.001). In the Cox regression analysis, lenvatinib treatment and being within the up-to-seven criteria were identified as independent factors for PFS (lenvatinib, P<0.0001; within up-to-seven, P=0.001). The decision-tree analysis revealed that patients beyond the up-to-seven criteria, treated with lenvatinib and with albumin-bilirubin (ALBI) grade 1 had a longer PFS time (245.2±107.9 days) than patients beyond the up-to-seven criteria, treated with lenvatinib and with ALBI grade 2 (147.1±78.6 days). Additionally, lenvatinib was independently associated with longer PFS time in patients with intermediate-stage HCC refractory to TACE. Therefore, lenvatinib may be recommended for patients who have intermediate-stage HCC refractory to TACE, ALBI grade 1 and who are within the up-to-seven criteria.
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Affiliation(s)
- Shigeo Shimose
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Masatoshi Tanaka
- Department of Gastroenterology and Hepatology, Yokokura Hospital, Miyama, Fukuoka 839-0295, Japan
| | - Hideki Iwamoto
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Ken Miyazaki
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Etsuko Moriyama
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Hiroyuki Suzuki
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Takashi Niizeki
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Tomotake Shirono
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Masahito Nakano
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Hideya Suga
- Department of Gastroenterology and Hepatology, Yanagawa Hospital, Yanagawa, Fukuoka 832-0077, Japan
| | - Taizo Yamaguchi
- Department of Gastroenterology and Hepatology, Iwamoto Internal Medical Clinic, Kitakyushu, Fukuoka 802-0832, Japan
| | - Yoshinori Yokokura
- Department of Gastroenterology and Hepatology, Yokokura Hospital, Miyama, Fukuoka 839-0295, Japan
| | - Kazunori Noguchi
- Department of Gastroenterology and Hepatology, Omuta City Hospital, Omuta, Fukuoka 836-8567, Japan
| | - Hironori Koga
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Takuji Torimura
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
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A prospective study of oral 5-aminolevulinic acid to prevent adverse events in patients with localized prostate cancer undergoing low-dose-rate brachytherapy: Protocol of the AMBER study. Contemp Clin Trials Commun 2020; 19:100593. [PMID: 32637724 PMCID: PMC7327239 DOI: 10.1016/j.conctc.2020.100593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/07/2020] [Accepted: 06/14/2020] [Indexed: 12/14/2022] Open
Abstract
Background Radiotherapy is one of the most frequently selected treatment options for patients with prostate cancer. However, adverse effects related to the irradiated surrounding normal organs are significant clinical concerns. Specifically, genitourinary and gastrointestinal toxicities can lead to a dramatically reduced quality of life. The aim of this clinical trial is to determine the efficacy of oral 5-aminolevulinic acid (ALA) phosphate with sodium ferrous citrate (SFC) in patients treated with low-dose-rate brachytherapy (LDR-BT) using an iodine-125 seed source. Methods The AMBER study is a prospective, single-center trial in patients with localized prostate cancer undergoing LDR-BT. Patients who undergo supplementary extra-beam radiotherapy are excluded, whereas those who undergo pre-implantation short-term (4–6 months) androgen deprivation therapy to decrease the prostate volume and/or improve oncological outcomes are included. After the screening and registration, the patients will be instructed to take capsules of ALA-SFC twice a day (200 mg and 229.42 mg per day) for 6 months from the day of seed implantation (prescribed radiation dose of 160 Gy). Patient data will be collected before the implantation; during oral ALA-SFC treatment; and 1, 3, 6, 9, and 12 month(s) after seed implantation. The primary endpoint of this trial is the urinary frequency 3 months after seed implantation. At each visit, the 24-h urinary frequency, total voided volume, and mean voided volume on a frequency volume chart and other patient-reported outcomes are recorded. The data of the trial cases will be compared with those of historical controls, who are consecutive patients undergoing LDR-BT without supplementary extra-beam radiotherapy between January 2016 and January 2019. The number of subjects has been set to be 50 for trial cases and 150 for the historical control cases. Pre- and post-treatment clinicopathologic factors are compared between two groups. Discussion The goal of this trial is to determine the potential benefit of ALA-SFC in patients who undergo LDR-BT. To the best of our knowledge, this is the first study investigating the potential clinical benefit of oral ALA-SFC after radiotherapy. More evidence from a further randomized controlled trial is needed to change the standard of care and lead to better post-radiotherapy management. Trial registration This clinical trial was prospectively registered with the Japan Registry of Clinical Trials on 5 December 2019. The reference number is jRCTs051190077, nara0013 (Certified Review Board of Nara Medical University).
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Key Words
- 5-Aminolevulinic acid
- ALA, 5-aminolevulinic acid
- Adverse event
- CTCAE, Common Toxicity Criteria for Adverse Events
- EBRT, extra-beam radiotherapy
- EPIC, Expanded Prostate Cancer Index Composite
- GI, gastrointestinal
- GU, genitourinary
- I-125, iodine-125
- IPSS, International Prostate Symptom Score
- J-POPS, Japanese nationwide prospective cohort study
- LDR-BT, low-dose-rate brachytherapy
- Low-dose-rate brachytherapy
- OABSS, overactive bladder symptom score
- PCa, prostate cancer
- PRO, patient reported outcome
- PSA, prostate-specific antigen
- Prostate cancer
- QOL, quality of life
- Radioprotection
- Radiotherapy
- SFC, sodium ferrous citrate
- SHIM, Sexual Health Inventory for Men
- Urinary frequency
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162
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AMTRA: a multicentered experience of a web-based monitoring and tailored toxicity management system for cancer patients. Support Care Cancer 2020; 29:859-867. [PMID: 32519044 DOI: 10.1007/s00520-020-05550-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 05/25/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Technology-based interventions are increasingly being introduced in routine clinical cancer care. There is a need for reliable systems to monitor treatment-related toxicity in a standardized manner. Such electronic tools bridge the gap in providing quality home-based monitoring. METHODS From July 2017 to December 2017, we performed a multicentered, non-randomized prospective cohort analysis with patients who were receiving routine chemotherapy for various solid tumors, using a web-based patient-reported toxicity registration, management, and intervention system called AMTRA (ambulatory Monitoring of cancer Therapy using an interactive Application) linked to the homecare nursing organization Remedus®. Twelve common toxicities plus pain and two biometrics could be registered daily or more frequently as required. These were processed centrally to generate tailored advice for lesser symptoms or a phone call from a dedicated nurse in case of severe or prolonged toxicity. A compliance tool to monitor oral therapies was incorporated in the system. RESULTS One hundred sixty-eight patients (92%) were enrolled, with 31,514 registrations analyzed. One hundred eight patients reported severe toxicity (> 1461 registrations), resulting in 102 clinical interventions ranging from self-management advice, supplemental consultations to hospitalizations. Compliance to oral chemotherapy was high using AMTRA with a median of 98.7% (95 confidence interval (CI) [93.5-100.0%]). Seventy-nine percent of patients stated that the availability of AMTRA self-reports was useful in communication with the care provider, while 75% felt more in control while managing their treatment. CONCLUSIONS The application of an interactive PRO-system in routine symptom management of cancer patients allowed standardized documentation of toxicities and recorded a high compliance with oral treatment. It allows for rapid interaction for toxicities and cancer-related symptoms experienced at home.
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163
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Kessel KA, Grosser RCE, Kraus KM, Hoffmann H, Oechsner M, Combs SE. Stereotactic body radiotherapy (SBRT) in patients with lung metastases - prognostic factors and long-term survival using patient self-reported outcome (PRO). BMC Cancer 2020; 20:442. [PMID: 32429940 PMCID: PMC7236290 DOI: 10.1186/s12885-020-6635-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/14/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The present study aims to evaluate long-term side-effects and outcomes and confirm prognostic factors after stereotactic body radiotherapy (SBRT) of pulmonary lesions. This is the first work that combines the investigated data from patient charts and patient-reported outcome (PRO) up to 14 years after therapy. MATERIALS AND METHODS We analyzed 219 patients and 316 lung metastases treated between 2004 and 2019. The pulmonary lesions received a median dose and dose per fraction of 35 Gy (range: 14-60.5 Gy) and 8 Gy (range: 3-20 Gy) to the surrounding isodose. During the last 1.5 years of monitoring, we added PRO assessment to our follow-up routine. We sent an invitation to a web-based survey questionnaire to all living patients whose last visit was more than 6 months ago. RESULTS Median OS was 27.6 months. Univariate analysis showed a significant influence on OS for KPS ≥90%, small gross tumor volume (GTV) and planning target volume (PTV), the absence of external metastases, ≤3 pulmonary metastases, and controlled primary tumor. The number of pulmonary metastases and age influenced local control (LC) significantly. During follow-up, physicians reported severe side-effects ≥ grade 3 in only 2.9% within the first 6 months and in 2.5% after 1 year. Acute symptomatic pneumonitis grade 2 was observed in 9.7%, as grade 3 in 0.5%. During PRO assessment, 39 patients were contacted, 38 patients participated, 14 participated twice during follow-up. Patients reported 15 cases of severe side effects (grade ≥ 3) according to PROCTCAE classification. Severe dyspnea (n = 6) was reported mostly. CONCLUSION We could confirm excellent local control and low toxicity rates. PROs improve and complement follow-up care. They are an essential measure in addition to the physician-reported outcomes. Future research must be conducted regarding the correct interpretation of PRO data.
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Affiliation(s)
- Kerstin A Kessel
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany. .,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany. .,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany.
| | - Rebekka C E Grosser
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany
| | - Kim Melanie Kraus
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany
| | - Hans Hoffmann
- Division of Thoracic Surgery, Technical University of Munich (TUM), Munich, Germany
| | - Markus Oechsner
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
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164
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Penedo FJ, Oswald LB, Kronenfeld JP, Garcia SF, Cella D, Yanez B. The increasing value of eHealth in the delivery of patient-centred cancer care. Lancet Oncol 2020; 21:e240-e251. [PMID: 32359500 PMCID: PMC7643123 DOI: 10.1016/s1470-2045(20)30021-8] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/02/2020] [Accepted: 01/14/2020] [Indexed: 12/23/2022]
Abstract
The increasing use of eHealth has ushered in a new era of patient-centred cancer care that moves beyond the traditional in-person care model to real-time, dynamic, and technology-assisted assessments and interventions. eHealth has the potential to better the delivery of cancer care through improved patient-provider communication, enhanced symptom and toxicity assessment and management, and optimised patient engagement across the cancer care continuum. In this Review, we provide a brief, narrative appraisal of the peer reviewed literature over the past 10 years related to the uses of patient-centred eHealth to improve cancer care delivery. These uses include the addressal of symptom management, health-related quality of life, and other patient-reported outcomes across cancer care. In addition, we discuss the challenges of, and opportunities for, accessibility, scalability, and implementation of these technologies, important areas for further development, and future research directions.
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Affiliation(s)
- Frank J Penedo
- Department of Psychology, University of Miami, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.
| | - Laura B Oswald
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
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165
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Nyrop KA, Deal AM, Reeve BB, Basch E, Chen YT, Park JH, Shachar SS, Carey LA, Reeder-Hayes KE, Dees EC, Jolly TA, Kimmick GG, Karuturi MS, Reinbolt RE, Speca JC, Lee JT, Wood WA, Muss HB. Congruence of patient- and clinician-reported toxicity in women receiving chemotherapy for early breast cancer. Cancer 2020; 126:3084-3093. [PMID: 32315091 DOI: 10.1002/cncr.32898] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/14/2020] [Accepted: 03/15/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The National Cancer Institute's Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events, collected alongside the clinician-reported Common Terminology Criteria for Adverse Events, enables comparisons of patient and clinician reports on treatment toxicity. METHODS In a multisite study of women receiving chemotherapy for early-stage breast cancer, symptom reports were collected on the same day from patients and their clinicians for 17 symptoms; their data were not shared with each other. The proportions of moderate, severe, or very severe patient-reported symptom severity were compared with the proportions of clinician-rated grade 2, 3, or 4 toxicity. Patient-clinician agreement was assessed via κ statistics. Chi-square tests investigated whether patient characteristics were associated with patient-clinician agreement. RESULTS Among 267 women, the median age was 58 years (range, 24-83 years), and 26% were nonwhite. There was moderate scoring agreement (κ = 0.413-0.570) for 53% of symptoms, fair agreement for 41% (κ = 0.220-0.378), and slight agreement for 6% (κ = 0.188). For example, patient-reported and clinician-rated percentages were 22% and 8% for severe or very severe fatigue, 41% and 46% for moderate fatigue, 32% and 39% for mild fatigue, and 6% and 7% for none. Clinician severity scores were lower for nonwhite patients in comparison with white patients for peripheral neuropathy, nausea, arthralgia, and dyspnea. CONCLUSIONS Although clinician reporting of symptoms is common practice in oncology, there is suboptimal agreement with the gold standard of patient self-reporting. These data provide further evidence supporting the integration of patient-reported outcomes into oncological clinical research and clinical practice to improve monitoring of symptoms as well as timely interventions for symptoms.
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Affiliation(s)
- Kirsten A Nyrop
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Bryce B Reeve
- Duke University School of Medicine, Durham, North Carolina
| | - Ethan Basch
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yi Tang Chen
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ji Hye Park
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Lisa A Carey
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Katherine E Reeder-Hayes
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elizabeth C Dees
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Trevor A Jolly
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Meghan S Karuturi
- The University of Texas MD Anderson Cancer Center, University of Texas, Houston, Texas
| | | | - JoEllen C Speca
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jordan T Lee
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - William A Wood
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hyman B Muss
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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166
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Tolstrup LK, Pappot H, Bastholt L, Zwisler AD, Dieperink KB. Patient-Reported Outcomes During Immunotherapy for Metastatic Melanoma: Mixed Methods Study of Patients' and Clinicians' Experiences. J Med Internet Res 2020; 22:e14896. [PMID: 32271150 PMCID: PMC7180512 DOI: 10.2196/14896] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 10/16/2019] [Accepted: 01/24/2020] [Indexed: 12/11/2022] Open
Abstract
Background The benefits of electronic patient reported outcomes (PRO) questionnaires have been demonstrated in many settings, including in hospitals and patient homes. However, it remains to be investigated how melanoma patients and their treating clinicians experience the electronic self-reporting of side effects and the derived communication. Objective The primary objective of this study was to examine patients’ and clinicians’ experiences with an eHealth intervention for weekly monitoring of side effects during treatment with immunotherapy. Methods An eHealth intervention based on questions from the PRO-Common Terminology Criteria for Adverse Events (CTCAE) library was used and tested in a randomized clinical trial with patients receiving immunotherapy for malignant melanoma and clinicians at a university hospital in Denmark. On a weekly basis, patients reported their symptoms from home during the treatment via a provided tablet. The electronic patient reports were available to clinicians in the outpatient clinic. A mixed methods approach was applied to investigate the patients’ and clinicians’ experiences with the intervention. Data from patient experiences were collected in a short survey, the Patient Feedback Form. Moreover, a subset of the patients participating in the survey was interviewed about their experience. Furthermore, one focus group interview with clinicians was carried out to elucidate their views. Results A total of 57 patients completed the Patient Feedback Form, and 14 patients were interviewed. The focus group interview included 5 clinicians. Overall, patients and clinicians were satisfied with the tool. They believed it enhanced patients’ awareness of side effects and increased their feeling of involvement. The patients reported that it was easy to fill out the questionnaire and that it made sense to do so. However, a minority of the patients expressed in the interviews that they did not believe that the health care professionals had seen their reports when they came to the clinic, and that the reporting did not lead to increased contact with the department. Conclusions Overall, satisfaction with the eHealth intervention was high among patients and their treating clinicians. The tool was easy to use and contributed to greater symptom awareness and patient involvement. Thus, in terms of patient and clinician satisfaction with the tool, it makes sense to continue using the tool beyond the project period. Trial Registration ClinicalTrials.gov NCT03073031; https://tinyurl.com/tjx3gtu
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Affiliation(s)
- Lærke K Tolstrup
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Helle Pappot
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Bastholt
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Ann-Dorthe Zwisler
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,The Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
| | - Karin B Dieperink
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Oncology, Odense University Hospital, Odense, Denmark
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167
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Garassino MC, Gadgeel S, Esteban E, Felip E, Speranza G, Domine M, Hochmair MJ, Powell S, Cheng SYS, Bischoff HG, Peled N, Reck M, Hui R, Garon EB, Boyer M, Wei Z, Burke T, Pietanza MC, Rodríguez-Abreu D. Patient-reported outcomes following pembrolizumab or placebo plus pemetrexed and platinum in patients with previously untreated, metastatic, non-squamous non-small-cell lung cancer (KEYNOTE-189): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Oncol 2020; 21:387-397. [PMID: 32035514 DOI: 10.1016/s1470-2045(19)30801-0] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pembrolizumab plus pemetrexed-platinum led to superior overall survival and progression-free survival, and a higher proportion of patients with a confirmed complete or partial response over placebo plus pemetrexed-platinum in the KEYNOTE-189 study. We aimed to evaluate prespecified exploratory patient-reported outcomes (PROs) in patients in KEYNOTE-189. METHODS In the multicentre, double-blind, randomised, placebo-controlled, phase 3 KEYNOTE-189 study done at 126 cancer centres in 16 countries, eligible patients aged 18 years or older with histologically or cytologically confirmed metastatic non-squamous non-small-cell lung cancer without sensitising EGFR or ALK alterations, measurable disease as per Response Evaluation Criteria in Solid Tumors (version 1.1), and an Eastern Cooperative Oncology Group performance status of 0 or 1 were enrolled. Patients were randomly assigned (2:1) to receive intravenous pembrolizumab (200 mg) or saline placebo every 3 weeks for up to 2 years (35 cycles); all patients received four cycles of intravenous pemetrexed (500 mg/m2) with carboplatin (5 mg/mL per min) or cisplatin (75 mg/m2; investigator's choice) every 3 weeks for four cycles, followed by pemetrexed maintenance therapy every 3 weeks. Permuted block randomisation (block size six) was done with an interactive voice-response system and stratified by PD-L1 expression, choice of platinum, and smoking status. Patients, investigators, and other study personnel were unaware of treatment assignment. The European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire-Core 30 (QLQ-C30) and Lung Cancer 13 (QLQ-LC13) were administered at cycles 1-5, every three cycles thereafter during year 1, and every four cycles during years 2-3. The primary endpoints (overall survival and progression-free survival) have been published previously. Key PRO endpoints were change from baseline to week 12 (during chemotherapy) and week 21 (following chemotherapy) in QLQ-C30 global health status/quality of life (GHS/QOL) score, and time to deterioration in cough, chest pain, or dyspnoea. PROs were analysed in all randomly assigned patients who received at least one dose of study medication and who completed at least one PRO assessment, and the results are provided with two-sided, nominal p values. This ongoing study is registered with ClinicalTrials.gov, number NCT02578680. FINDINGS Between Feb 26, 2016, and March 6, 2017, 616 patients were enrolled; median follow-up was 10·5 months (range 0·2-20·4) as of data cutoff on Nov 8, 2017. 402 (99%) of 405 patients in the pembrolizumab plus pemetrexed-platinum group and 200 (99%) of 202 patients in the placebo plus pemetrexed-platinum-treated group completed at least one PRO assessment. At baseline, 359 (89%) of 402 patients in the pembrolizumab plus pemetrexed-platinum group and 180 (90%) of 200 in the placebo plus pemetrexed-platinum group were compliant with QLQ-C30; at week 12, 319 (90%) of 354 and 149 (89%) of 167 patients were compliant, respectively; and at week 21, 249 (76%) of 326 and 91 (64%) of 143 patients were compliant, respectively. From baseline to week 12, GHS/QOL scores were maintained with both pembrolizumab plus pemetrexed-platinum (least-squares mean change: 1·0 point [95% CI -1·3 to 3·2] increase) and placebo plus pemetrexed-platinum (-2·6 points [-5·8 to 0·5] decrease; between-group difference: 3·6 points [-0·1 to 7·2]; p=0·053). From baseline to week 21, GHS/QOL scores were better maintained with pembrolizumab plus pemetrexed-platinum (least-squares mean change: 1·3 points [95% CI -1·2 to 3·6] increase) than with placebo plus pemetrexed-platinum (-4·0 points [-7·7 to -0·3] decrease; between-group difference: 5·3 points [1·1 to 9·5]; p=0·014). Median time to deterioration in cough, chest pain, or dyspnoea was not reached (95% CI 10·2 months to not reached) with pembrolizumab plus pemetrexed-platinum, and was 7·0 months (4·8 months to not reached) with placebo plus pemetrexed-platinum (hazard ratio 0·81 [95% CI 0·60-1·09], p=0·16). INTERPRETATION The addition of pembrolizumab to standard chemotherapy maintained GHS/QOL, with improved GHS/QOL scores at week 21 in the pembrolizumab plus chemotherapy group compared with the placebo plus chemotherapy group. These data further support use of pembrolizumab plus pemetrexed-platinum as first-line therapy for patients with metastatic non-squamous non-small-cell lung cancer. FUNDING Merck Sharp & Dohme.
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Affiliation(s)
| | - Shirish Gadgeel
- Department of Medical Oncology 1, University of Michigan, Ann Arbor, MI, USA
| | - Emilio Esteban
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Enriqueta Felip
- Vall d'Hebron University, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Giovanna Speranza
- Centre Intégré de Cancérologie de la Montérégie, Hôpital Charles-Le Moyne, Greenfield Park, QC, Canada
| | - Manuel Domine
- Hospital Universitario Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain
| | - Maximilian J Hochmair
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | | | | | | | - Nir Peled
- Clalit Health Services, Soroka Medical Center, Beer-Sheeva, Israel
| | - Martin Reck
- LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | - Rina Hui
- Westmead Hospital and University of Sydney, Sydney, NSW, Australia
| | - Edward B Garon
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | | | | | | | - Delvys Rodríguez-Abreu
- Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Patil VM, Noronha V, Thiagarajan S, Joshi A, Chandrasekharan A, Talreja V, Agarwal J, Ghosh-Laskar S, Budrukkar A, Juvekar S, Mahajan A, Agarwal A, Purandare N, Bhattacharjee A, D'Cruz AK, Chaturvedi P, Pai PS, Chaukar D, Prabhash K. Salvage surgery in head and neck cancer: Does it improve outcomes? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:1052-1058. [PMID: 32014275 DOI: 10.1016/j.ejso.2020.01.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/18/2019] [Accepted: 01/12/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Studies reporting outcomes of salvage surgery in locally advanced head and neck squamous cell carcinoma (LAHNSCC) have inherent biases like biological and temporal selection. Our study considered all patients deemed fit for salvage surgery and compared to those who underwent surgery versus those who refused it thus throwing light on the real world benefit of salvage surgery. METHODS This was a post hoc analysis of a phase 3 randomized trial conducted between 2012 and 2018. Out of 536 LAHNSCC patients randomised in the study, 113 patients had residual disease or recurrent disease and were planned for salvage surgery in a multidisciplinary clinic. Patients were divided into 2 cohorts for comparison, willing for salvage surgery (n = 91) and unwilling for salvage surgery(n = 22). The primary endpoint was overall survival. RESULTS The median follow up was 28.7 months (95%CI 23.9-33.5 months). Out of the 91 patients who were willing for salvage surgery, 78 underwent same. The median survival in cohort of patients willing for salvage surgery was 22.0 months (95%CI 10.1-33.9) while it was 9.7 months (95%CI 6.6-12.8) in patients who were unwilling for salvage surgery (HR = 0.262 95%CI HR 0.147-0.469, p = 0.000). CONCLUSION Salvage surgery leads to a substantial improvement in outcomes in head and neck cancers and should be the de facto standard of care in patients who are eligible for the same.
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Affiliation(s)
- Vijay Maruti Patil
- Department of Medical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | | | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | | | - Vikas Talreja
- Department of Medical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Jaiprakash Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | | | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | | | - Abhishek Mahajan
- Department of Radiology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Archi Agarwal
- Department of Nuclear Medicine, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Nilendu Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Atanu Bhattacharjee
- Department of Epidemiology, Advanced Centre for Treatment, Research and Education in Cancer, Navi Mumbai, India
| | - Anil K D'Cruz
- Department of Head and Neck Surgery, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Prathamesh S Pai
- Department of Head and Neck Surgery, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Devendra Chaukar
- Department of Head and Neck Surgery, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India.
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169
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The clinical value and usage of inflammatory and nutritional markers in survival prediction for gastric cancer patients with neoadjuvant chemotherapy and D2 lymphadenectomy. Gastric Cancer 2020; 23:540-549. [PMID: 32072387 PMCID: PMC7165147 DOI: 10.1007/s10120-019-01027-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 11/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The clinical values of inflammatory and nutritional markers remained unclear for gastric cancer with neoadjuvant chemotherapy (NACT). METHODS The inflammatory, nutritional markers and their changes were analyzed for locally advanced gastric cancer with NACT. The predictive value was evaluated by the Cox proportional hazards regressions under three hypothesized scenarios. The nomograms including independent prognostic factors were plotted for survival prediction. RESULTS A total of 225 patients were included in the study. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index, and hemoglobin (Hgb) were significantly reduced, and the body mass index was significantly increased after NACT (all P < 0.05). The pre-NACT NLR [hazard ratio (HR) = 1.176, P = 0.059] showed a trend to correlate with the overall survival (OS) when only pre-NACT markers available; The post-NACT Hgb (HR = 0.982, P = 0.015) was the independent prognostic factor when only post-NACT markers available; The post-NACT Hgb (HR = 0.984, P = 0.025) and the change value of LMR (HR = 1.183, P = 0.036) were the independent prognostic factors when both pre- and post-NACT markers available. The nomogram had a similar Harrell's C-statistic compared to ypTNM stage (0.719 vs. 0.706). CONCLUSION For locally advanced gastric cancer, the NACT could significantly decrease some inflammatory markers. The pre-NACT NLR, the post-NACT Hgb and the change value of LMR had some values in survival prediction combined with age, sex, tumor location and the clinical stages under different clinical scenarios. The elevated initial NLR, the preoperative anemia and the greater change value of LMR implied a poor prognosis.
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170
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Scotté F, Bossi P, Carola E, Cudennec T, Dielenseger P, Gomes F, Knox S, Strasser F. Addressing the quality of life needs of older patients with cancer: a SIOG consensus paper and practical guide. Ann Oncol 2019; 29:1718-1726. [PMID: 30010772 DOI: 10.1093/annonc/mdy228] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Around 60% of people living with cancer are aged 65 years or older. Older cancer patients face a unique set of age-associated changes, comorbidities and circumstances that impact on their quality of life (QoL) in ways that are different from those affecting younger patients. A Task Force of the International Society of Geriatric Oncology recommends and encourages all healthcare professionals involved in cancer care to place greater focus on the QoL of older people living with cancer. This paper summarizes current thinking on the key issues of importance to addressing QoL needs of older cancer patients and makes a series of recommendations, together with practical guidance.
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Affiliation(s)
- F Scotté
- Department of Medical Oncology and Supportive Care, Foch Hospital, Suresnes, France.
| | - P Bossi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - E Carola
- Groupe Hospitalier Public Sud de L'Oise, Creil, France
| | - T Cudennec
- Service de Médecine Gériatrique, HU-PIFO site Ambroise Paré, AP-HP, Boulogne Billancourt, France
| | - P Dielenseger
- Département des Innovations Thérapeutiques et Essais Précoces, Gustave Roussy Cancer Campus, French Oncology Nursing Society, Paris, France
| | - F Gomes
- Medical Oncology Department, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - S Knox
- EUROPA DONNA - The European Breast Cancer Coalition, Milan, Italy
| | - F Strasser
- Oncological Palliative Medicine, Clinic Medical Oncology and Hematology, Department of Internal Medicine, Cantonal Hospital St Gallen, St Gallen, Switzerland
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171
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Kessel KA, Diehl CD, Oechsner M, Meyer B, Gempt J, Zimmer C, Schmidt-Graf F, Combs SE. Patient-Reported Outcome (PRO) as an Addition to Long-Term Results after High-Precision Stereotactic Radiotherapy in Patients with Secreting and Non-Secreting Pituitary Adenomas: A Retrospective Cohort Study up to 17-Years Follow-Up. Cancers (Basel) 2019; 11:cancers11121884. [PMID: 31783579 PMCID: PMC6966568 DOI: 10.3390/cancers11121884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/10/2019] [Accepted: 11/18/2019] [Indexed: 12/11/2022] Open
Abstract
High-precision radiotherapy has been established as a valid and effective treatment option in patients with pituitary adenomas. We report on outcome after fractionated stereotactic radiotherapy (FSRT) in correlation with patient-reported outcomes (PROs). We analyzed 69 patients treated between 2000 and 2019. FSRT was delivered with a median total dose of 54 Gy (single fraction: 1.8 Gy). PRO questionnaires were sent to 28 patients. Median overall survival was 17.2 years; mean local control was 15.6 years (median not reached). Median follow-up was 5.8 years. Twenty (71%) patients participated in the PRO assessment. Physicians reported symptoms grade ≥3 in 6 cases (9%). Of all, 35 (51%) patients suffered from hypopituitarism at baseline, and during follow-up, new or progressive hypopituitarism was observed in 11 cases (16%). Patients reported 10 cases of severe side effects. Most of these symptoms were already graded as CTCAE (Common Terminology Criteria for Adverse Events) grade 2 by a physician in a previous follow-up exam. PROs are an essential measure and only correlate to a certain extent with the physician-reported outcomes. For high-precision radiotherapy of pituitary adenomas, they confirm excellent overall outcomes and low toxicity. In the future, the integration of PROs paired with high-end treatment will further improve outcomes.
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Affiliation(s)
- Kerstin A. Kessel
- Department of Radiation Oncology, Technical University of Munich (TUM), 81675 Munich, Germany; (C.D.D.); (M.O.); (S.E.C.)
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, 85764 Neuherberg, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site, 81675 Munich, Germany; (B.M.); (J.G.); (C.Z.)
- Correspondence: ; Tel.: +49-089-4140-4502
| | - Christian D. Diehl
- Department of Radiation Oncology, Technical University of Munich (TUM), 81675 Munich, Germany; (C.D.D.); (M.O.); (S.E.C.)
| | - Markus Oechsner
- Department of Radiation Oncology, Technical University of Munich (TUM), 81675 Munich, Germany; (C.D.D.); (M.O.); (S.E.C.)
| | - Bernhard Meyer
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site, 81675 Munich, Germany; (B.M.); (J.G.); (C.Z.)
- Department of Neurosurgery, Technical University of Munich (TUM), 81675 Munich, Germany
| | - Jens Gempt
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site, 81675 Munich, Germany; (B.M.); (J.G.); (C.Z.)
- Department of Neurosurgery, Technical University of Munich (TUM), 81675 Munich, Germany
| | - Claus Zimmer
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site, 81675 Munich, Germany; (B.M.); (J.G.); (C.Z.)
- Department of Neuroradiology, Technical University of Munich (TUM), 81675 Munich, Germany
| | | | - Stephanie E. Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), 81675 Munich, Germany; (C.D.D.); (M.O.); (S.E.C.)
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, 85764 Neuherberg, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site, 81675 Munich, Germany; (B.M.); (J.G.); (C.Z.)
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172
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Mombo-Ngoma G, Remppis J, Sievers M, Zoleko Manego R, Endamne L, Kabwende L, Veletzky L, Nguyen TT, Groger M, Lötsch F, Mischlinger J, Flohr L, Kim J, Cattaneo C, Hutchinson D, Duparc S, Moehrle J, Velavan TP, Lell B, Ramharter M, Adegnika AA, Mordmüller B, Kremsner PG. Efficacy and Safety of Fosmidomycin-Piperaquine as Nonartemisinin-Based Combination Therapy for Uncomplicated Falciparum Malaria: A Single-Arm, Age De-escalation Proof-of-Concept Study in Gabon. Clin Infect Dis 2019; 66:1823-1830. [PMID: 29293893 PMCID: PMC5982710 DOI: 10.1093/cid/cix1122] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/23/2017] [Indexed: 12/03/2022] Open
Abstract
Background Fosmidomycin–piperaquine is being developed as nonartemisinin-based combination therapy to meet the challenge of emerging artemisinin resistance. Methods The study was a phase 2, single-arm, proof-of-concept study of the efficacy, tolerability, and safety of fosmidomycin–piperaquine for the treatment of uncomplicated Plasmodium falciparum monoinfection in Gabon. Adults and children of both sexes with initial parasite counts between 1000 and 150000/µL received oral treatment with fosmidomycin (twice daily doses of 30 mg/kg) and piperaquine (once daily dose of 16 mg/kg) for 3 days and followed-up for 63 days. The primary efficacy endpoint was the per-protocol polymerase chain reaction (PCR)–corrected day 28 adequate clinical and parasitological response (ACPR). Results One hundred patients were enrolled. The PCR-corrected day 28 ACPR rate was 83/83, or 100% (95% confidence interval, 96–100). Fourteen patients had asexual parasitaemia between day 28 and day 63; all were typed by PCR as new infections. Fosmidomycin–piperaquine therapy led to rapid parasite clearance (median, 36 hours; interquartile range [IQR], 6–60) and fever clearance time (median, 12 hours; IQR, 6–48). The electrocardiogram assessments showed 2 patients with prolonged QT interval >500 msec following study drug administration. The majority of adverse events affected the gastrointestinal and respiratory tracts and were transient and mild to moderate in severity. Conclusions This is the first report of the use of the combination fosmidomycin–piperaquine. The combination appeared to have high efficacy and be safe and well tolerated despite observed transient changes in electrocardiogram with prolongation of the QT interval. Clinical Trials Registration. NCT02198807.
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Affiliation(s)
- Ghyslain Mombo-Ngoma
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Département de Parasitologie-Mycologie, Université des Sciences de la Santé, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Jonathan Remppis
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Moritz Sievers
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Rella Zoleko Manego
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Lilian Endamne
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Lumeka Kabwende
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon
| | - Luzia Veletzky
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - The Trong Nguyen
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Mirjam Groger
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Felix Lötsch
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Johannes Mischlinger
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Lena Flohr
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Johanna Kim
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Chiara Cattaneo
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - David Hutchinson
- DMG Deutsche Malaria GmbH, formerly Jomaa Pharma GmbH, Hamburg, Germany
| | | | | | - Thirumalaisamy P Velavan
- Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany.,Vietnamese-German Center for Medical Research, Hanoi and Faculty of Medicine, Duy Tan University DaNang, Vietnam
| | - Bertrand Lell
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Michael Ramharter
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany.,Bernhard Nocht Hospital for Tropical Diseases, Bernhard Nocht Institute for Tropical Medicine and University Medical Center Hamburg-Eppendorf, Germany
| | - Ayola Akim Adegnika
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Benjamin Mordmüller
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Peter G Kremsner
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
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173
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The performance of three oncogeriatric screening tools - G8, optimised G8 and CARG - in predicting chemotherapy-related toxicity in older patients with cancer. A prospective clinical study. J Geriatr Oncol 2019; 10:937-943. [DOI: 10.1016/j.jgo.2019.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/27/2019] [Accepted: 04/04/2019] [Indexed: 12/20/2022]
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174
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Late, Persistent, Substantial, Treatment-Related Symptoms After Radiation Therapy (LAPERS): A New Method for Longitudinal Analysis of Late Morbidity-Applied in the EMBRACE Study. Int J Radiat Oncol Biol Phys 2019; 106:300-309. [PMID: 31669565 DOI: 10.1016/j.ijrobp.2019.10.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/30/2019] [Accepted: 10/18/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE Current incidence methods for reporting mild or moderate symptoms capture the (first) occurrence of an event and do not allow distinguishing between patients who suffer from long-lasting versus transient morbidity. This paper introduces a new methodological approach that identifies cancer survivors who have clinically relevant, long-lasting symptoms (patients with late, persistent, substantial and treatment-related symptoms, [LAPERS]). METHODS AND MATERIALS LAPERS can be evaluated in patients with baseline information and at least 3 late follow-up assessments after treatment. LAPERS identifies individual patients with a given symptom that is substantial (above a predefined clinically relevant threshold) and must be present in at least half of the follow-ups. Baseline morbidity is accounted for by requiring the median of the late symptom score to be worse than the baseline condition. The LAPERS approach was applied to 4 relevant patient-reported genito-urinary/gastrointestinal symptoms within the prospective, longitudinal EMBRACE study (An intErnational study on MRI-guided BRachytherapy in locally Advanced CErvical cancer, www.embracestudy.dk). LAPERS was compared with crude incidence and prevalence rates. RESULTS Within the EMBRACE cohort, 651/1044 patients (62%) had baseline and long-term follow-up available (median follow-up: 42 months). There was a considerable gap between LAPERS, crude incidence, and prevalence rates. The proportion of patients with LAPERS events was 3.8-4.8 times lower than crude incidences. The highest prevalence rates across follow-up times were 1.8-2.6 times lower than crude incidences. CONCLUSIONS These findings indicate limitations of incidence methods for reporting substantial patient-reported symptoms because a considerable proportion of patients with symptoms do not experience them persistently over time, as they may fluctuate or get successfully treated. In contrast, the LAPERS method for longitudinal analysis identifies patients with clinically relevant, long-lasting symptoms.
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175
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Gross MD, Al Hussein Al Awamlh B, Hu JC. Assessing Treatment-Related Toxicity Using Administrative Data, Patient-Reported Outcomes, or Physician-Graded Toxicity: Where Is the Truth? Semin Radiat Oncol 2019; 29:333-337. [DOI: 10.1016/j.semradonc.2019.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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176
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Milota T, Bloomfield M, Kralickova P, Jilek D, Novak V, Litzman J, Posova H, Mrazova L, Poloniova J, Prucha M, Rozsival P, Rauschova V, Philipp G, Sediva A. Czech Hizentra Noninterventional Study With Rapid Push: Efficacy, Safety, Tolerability, and Convenience of Therapy With 20% Subcutaneous Immunoglobulin. Clin Ther 2019; 41:2231-2238. [PMID: 31564514 DOI: 10.1016/j.clinthera.2019.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/12/2019] [Accepted: 08/19/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE Immunoglobulin substitution therapy is an essential therapeutic approach for patients with primary antibody deficiencies. Different methods of administration, including intravenous immunoglobulin (IVIG) or subcutaneous immunoglobulin (SCIG) preparations, provide effective and tolerable treatment and enable the adjustment of therapy to patients' needs. A new 20% SCIG represents a new therapeutic option and a new route of administration using rapid-push application. The aim of the Czech Hizentra Noninterventional Study With Rapid Push (CHHINSTRAP) is to evaluate patient satisfaction with as well as the tolerability and efficacy of nonmedical switch to 20% SCIG from previous treatment with IVIG or SCIG and rapid push as a new way to administer SCIG. CHHINSTRAP is the first Phase IV, noninterventional, open-label, prospective, multicentric study of this type conducted in Central and Eastern Europe. METHODS Primary end points, including efficacy, adverse effects, convenience of use, and overall satisfaction, were evaluated by Treatment Satisfaction Questionnaire for Medication version II. Secondary end points, such as serum IgG trough levels, infusion duration, number of application sites, frequency of infections, related hospital admissions, and antibiotic consumption, were obtained from patients at each follow-up visit. FINDINGS Together, 50 eligible patients with primary antibody deficiency were switched from SCIG or IVIG to an equivalent dose of 20% SCIG and were followed up for 12 months during 5 consecutive visits. The results indicate that patients switched from previous IVIG or SCIG preparations had significantly higher serum trough IgG levels and a lower incidence of infections and related events, such as hospital admissions or consumption of antibiotics. These findings were also reflected in gradually increasing convenience of use and overall satisfaction reported by patients. Apart from duration of application, no differences were found between patients previously receiving SCIG or IVIG. Moreover, our study found a high level of safety of 20% SCIG rapid push, which was comparable to other preparations and application methods. IMPLICATIONS On the basis of the results of CHHINSTRAP study, we conclude that 20% SCIG is a tolerable and effective immunoglobulin preparation, representing a new therapeutic approach in patients with primary antibody deficiencies. Its efficacy and tolerability have been found in patients on nonmedical switch from previous treatment with IVIG or SCIG.
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Affiliation(s)
- Tomas Milota
- Department of Immunology, Motol University Hospital, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Marketa Bloomfield
- Department of Immunology, Motol University Hospital, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Pediatrics, Thomayer's Hospital, Prague, Czech Republic and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pavlina Kralickova
- Institute of Clinical Immunology and Allergy, University Hospital Hradec Kralove, Faculty of Medicine, Charles University, Hradec Kralove, Czech Republic
| | - Dalibor Jilek
- Centre of Immunology and Microbiology, Regional Institute of Public Health, Usti nad Labem, Czech Republic
| | - Vitezslav Novak
- Department of Immunology and Allergy, Public Health Institute Ostrava, Ostrava, Czech Republic
| | - Jiri Litzman
- Department of Clinical Immunology Allergy, St Annés University Hospital, Brno, Czech Republic; Faculty of Medicicne, Masaryk University, Brno, Czech Republic
| | - Helena Posova
- Institute of Immunology 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Lucie Mrazova
- Allergy and Clinical Immunology, Regional Hospital in Ceske Budejovice, Czech Republic
| | - Jana Poloniova
- Allergy and Clinical Immunology, Regional Hospital in Ceske Budejovice, Czech Republic
| | - Miroslav Prucha
- Department of Clinical Biochemistry, Haematology and Immunology, Na Homolce Hospital, Prague, Czech Republic
| | - Pavel Rozsival
- Department of Pediatrics, University Hospital Hradec Kralove, Faculty of Medicine, Charles University, Hradec Kralove, Czech Republic
| | | | | | - Anna Sediva
- Department of Immunology, Motol University Hospital, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
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Lehmann LH, Katus HA, Scholz EP. [Cardiac arrhythmias in oncological diseases, during radiotherapy, chemotherapy]. Herzschrittmacherther Elektrophysiol 2019; 30:268-273. [PMID: 31463582 DOI: 10.1007/s00399-019-00634-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 06/10/2023]
Abstract
Patients with oncological diseases frequently show cardiac arrhythmias. This is explained by an increased risk in this specific patient cohort and is frequently associated with specific oncological therapies. So far, it is unclear how to deal with the occurrence of arrhythmias diagnostically and therapeutically, since the current clinical data do not provide satisfying answers to these questions. Clinical care of high-risk patients in specialized teams with a focus on cardio-oncology is recommended. Based on the current clinical studies and the position papers of the European Society of Cardiology (ESC), we give a brief overview of arrhythmias in malignant diseases and their therapies.
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Affiliation(s)
- Lorenz H Lehmann
- Abteilung für Innere Medizin III, Kardiologie, Angiologie, Pneumologie, Sektion Kardio-Onkologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland.
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Heidelberg/Mannheim, Heidelberg/Mannheim, Deutschland.
- Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland.
| | - Hugo A Katus
- Abteilung für Innere Medizin III, Kardiologie, Angiologie, Pneumologie, Sektion Kardio-Onkologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Heidelberg/Mannheim, Heidelberg/Mannheim, Deutschland
| | - Eberhard P Scholz
- Abteilung für Innere Medizin III, Kardiologie, Angiologie, Pneumologie, Sektion Kardio-Onkologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Heidelberg/Mannheim, Heidelberg/Mannheim, Deutschland
- Heidelberger Zentrum für Herzrhythmusstörungen (HCR), Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
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178
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Vittrup AS, Kirchheiner K, Fokdal LU, Bentzen SM, Nout RA, Pötter R, Tanderup K. Reporting of Late Morbidity After Radiation Therapy in Large Prospective Studies: A Descriptive Review of the Current Status. Int J Radiat Oncol Biol Phys 2019; 105:957-967. [PMID: 31470092 DOI: 10.1016/j.ijrobp.2019.08.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 07/29/2019] [Accepted: 08/19/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this review was to evaluate the current status of reporting prospectively assessed late morbidity after curative radiation therapy in large clinical studies. METHODS AND MATERIALS A descriptive review on publications from 10 high-impact journals with a primary or partial focus on radiation therapy published between December 1, 2015, and November 30, 2017, was conducted. Publications were considered eligible if they reported prospectively assessed late morbidity after curative radiation therapy and included ≥200 patients with cancer of any type. Full text publication and supplementary material were analyzed according to items based on extensions to the Consolidated Standards of Reporting Trials (CONSORT) statement regarding reporting of harms and patient reported outcomes. RESULTS Overall, 802 publications were identified in PubMed; of these, 69 met the eligibility criteria. Mild and moderate morbidity were reported in 40% and 57% of publications; aggregated endpoints instead of individual endpoints were reported in 23%. In 43% of publications, crude incidence of worst grade of morbidity was used as the only statistical method for summarizing physician-assessed morbidity. Duration of morbidity or recurrent events were not reported in any of the publications. CONCLUSIONS Comprehensive, quantitative reporting of late morbidity after radiation therapy is challenging because of the high dimensionality and time evolution of the range of normal tissue effects. The following suggestions and recommendations are proposed: (1) report on individual severity grades, including moderate and mild; (2) use patient reported outcomes in complement to physician-assessed morbidity; (3) report on individual symptoms/endpoints on top of aggregated endpoints; (4) report on duration of morbidity or recurrent events; (5) take steps toward a consensus on severity grading scales/patient questionnaires; (6) use time to event analysis and prevalence rates; (7) report or use statistical methods accounting for pretreatment morbidity when relevant.
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Affiliation(s)
| | - Kathrin Kirchheiner
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/General Hospital of Vienna, Austria
| | - Lars U Fokdal
- Department of Oncology, Aarhus University Hospital, Denmark
| | - Søren M Bentzen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Remi A Nout
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Richard Pötter
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/General Hospital of Vienna, Austria
| | - Kari Tanderup
- Department of Oncology, Aarhus University Hospital, Denmark
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179
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Valentini V, Marijnen C, Beets G, Bujko K, De Bari B, Cervantes A, Chiloiro G, Coco C, Gambacorta MA, Glynne-Jones R, Haustermans K, Meldolesi E, Peters F, Rödel C, Rutten H, van de Velde C, Aristei C. The 2017 Assisi Think Tank Meeting on rectal cancer: A positioning paper. Radiother Oncol 2019; 142:6-16. [PMID: 31431374 DOI: 10.1016/j.radonc.2019.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/06/2019] [Accepted: 07/01/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSES To describe current practice in the management of rectal cancer, to identify uncertainties that usually arise in the multidisciplinary team (MDT)'s discussions ('grey zones') and propose next generation studies which may provide answers to them. MATERIALS AND METHODS A questionnaire on the areas of controversy in managing T2, T3 and T4 rectal cancer was drawn up and distributed to the Rectal-Assisi Think Tank Meeting (ATTM) Expert European Board. Less than 70% agreement on a treatment option was indicated as uncertainty and selected as a 'grey zone'. Topics with large disagreement were selected by the task force group for discussion at the Rectal-ATTM. RESULTS The controversial clinical issues that had been identified within cT2-cT3-cT4 needed further investigation. The discussions focused on the role of (1) neoadjuvant therapy and organ preservation on cT2-3a low-middle rectal cancer; (2) neoadjuvant therapy in cT3 low rectal cancer without high risk features; (3) total neoadjuvant therapy, radiotherapy boost and the best chemo-radiotherapy schedule in T4 tumors. A description of each area of investigation and trial proposals are reported. CONCLUSION The meeting successfully identified 'grey zones' and, in the light of new evidence, proposed clinical trials for treatment of early, intermediate and advanced stage rectal cancer.
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Affiliation(s)
- Vincenzo Valentini
- Department of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Corrie Marijnen
- Department of Radiotherapy, Leiden University Medical Centre, the Netherlands
| | - Geerard Beets
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW School of Oncology and Developmental Biology, University of Maastricht, the Netherlands
| | - Krzysztof Bujko
- Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Centre, Warsaw, Poland
| | - Berardino De Bari
- Service de Radio-oncologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Andres Cervantes
- Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Spain
| | - Giuditta Chiloiro
- Department of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudio Coco
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Italy
| | | | | | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals, Leuven, Belgium
| | - Elisa Meldolesi
- Department of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Femke Peters
- Department of Radiotherapy, Leiden University Medical Centre, the Netherlands
| | - Claus Rödel
- Department of Radiotherapy and Oncology, University Hospital Frankfurt, Goethe University, Germany
| | - Harm Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands; GROW School of Oncology and Developmental Biology, University of Maastricht, the Netherlands
| | | | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Italy
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Wilkie JR, Mierzwa ML, Yao J, Eisbruch A, Feng M, Weyburne G, Chen X, Holevinski L, Mayo CS. Big data analysis of associations between patient reported outcomes, observer reported toxicities, and overall quality of life in head and neck cancer patients treated with radiation therapy. Radiother Oncol 2019; 137:167-174. [DOI: 10.1016/j.radonc.2019.04.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 04/17/2019] [Accepted: 04/25/2019] [Indexed: 12/24/2022]
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181
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Hoang JM, Upadhyay N, Dike DN, Lee J, Johnson ML, Cleeland CS, Mendoza T, Chen H, Trivedi MV. Patient-reported outcomes in light of supportive medications in treatment-naïve lung cancer patients. Support Care Cancer 2019; 28:1809-1816. [PMID: 31338641 DOI: 10.1007/s00520-019-05004-8] [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] [Received: 01/08/2019] [Accepted: 07/17/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE The impact of supportive medications on patient-reported outcomes (PROs) has not been systematically evaluated. We describe the supportive medications used by treatment-naïve lung cancer patients and assess their association with PROs from MD Anderson Symptom Inventory (MDASI). METHODS Treatment-naïve lung cancer patients who completed PROs from MDASI at the initial visit to MD Anderson Cancer Center were included. Medications from the initial visit were abstracted from the electronic medical records system and categorized into therapeutic classes based on U.S. Pharmacopeia v7.0. A chi-square or Mann-Whitney U test was conducted as appropriate. RESULTS Among 459 patients, ~ 50% took any analgesics and 25% were on opioids. One-third of patients with moderate-severe pain were not on any analgesics. Patients taking opioids had significantly worse median pain scores (6 vs. 0) compared with those not taking any analgesics (p < 0.0001). Higher proportion of patients with moderate-severe pain took opioids compared with those with mild pain (52% vs. 16%, p < 0.0001). Patients on opioids also reported significantly worse scores for five other cancer-specific core symptoms and all six symptoms rating interference with daily life. Only 15% of patients with higher composite score for depression-related symptoms were on antidepressants. However, patients taking antidepressants did not significantly differ in any individual MDASI symptom scores compared with those not on antidepressants (p = 0.4858). CONCLUSIONS Our results suggest a need for better screening for pain and depression and optimization of pain management in treatment-naïve lung cancer patients since their poor functional status may result in suboptimal cancer therapy.
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Affiliation(s)
- Johnny M Hoang
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Health Building-2, 4849 Calhoun Rd., Houston, TX, 77204, USA
| | - Navneet Upadhyay
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Health Building-2, 4849 Calhoun Rd., Houston, TX, 77204, USA
| | - Dozie N Dike
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Health Building-2, 4849 Calhoun Rd., Houston, TX, 77204, USA
| | - Jaekyu Lee
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Health Building-2, 4849 Calhoun Rd., Houston, TX, 77204, USA
| | - Michael L Johnson
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Health Building-2, 4849 Calhoun Rd., Houston, TX, 77204, USA
| | - Charles S Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Tito Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Hua Chen
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Health Building-2, 4849 Calhoun Rd., Houston, TX, 77204, USA
| | - Meghana V Trivedi
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Health Building-2, 4849 Calhoun Rd., Houston, TX, 77204, USA.
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Image-Guided Robotic Radiosurgery for Treatment of Recurrent Grade II and III Meningiomas. A Single-Center Study. World Neurosurg 2019; 131:e96-e107. [PMID: 31306844 DOI: 10.1016/j.wneu.2019.07.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 07/05/2019] [Accepted: 07/06/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Stereotactic radiosurgery (SRS) has been increasingly applied for malignant meningiomas as an alternative to conventionally fractioned radiation therapy. We performed a retrospective analysis of an institutional patient cohort with malignant meningiomas treated by image-guided SRS. METHODS All patients with atypical or anaplastic meningiomas who were treated by SRS using CyberKnife (CK) were identified. Local failure and regional and/or distant recurrences were evaluated together with toxicity and overall survival. RESULTS We identified 127 treated lesions (105 atypical and 22 anaplastic) in 35 patients. The mean time interval between the last surgery and subsequent CK-SRS was 30.8 ± 24.5 months. Most lesions (83.5%) were treated using single-fraction CK-SRS. The median planning target volume of all 127 lesions was 1.71 cm3 (range, 0.06-22.5 cm3). The median follow-up period was 23 months (range, 2.1-60.3 months). The estimated local control rates were 97%, 77%, and 67% at 12, 36, and 60 months, respectively, in atypical meningiomas and 66% each at 12 and 24 months in anaplastic meningiomas. The regional progression-free survival was 93%, 73%, and 59% at 12, 36, and 60 months, respectively, in atypical lesions and 93% and 46% at 12 and 24 months in anaplastic lesions. The estimated distant tumor progression-free interval in atypical lesions was 80%, 44%, and 44% at 12, 36, and 60 months, respectively, and 49% and 24% at 12 and 24 months, respectively, in anaplastic lesions. Age was identified as a risk factor for local failure. CONCLUSIONS Although the real boundaries of efficacy of SRS have to be further evaluated in a prospective trial, it seems that aggressive treatment by high-dose single or multisession SRS of recurring malignant meningiomas provides satisfactory local control rates.
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183
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Sharma M, Schilero C, Peereboom DM, Hobbs BP, Elson P, Stevens GHJ, McCrae K, Nixon AB, Ahluwalia MS. Phase II study of Dovitinib in recurrent glioblastoma. J Neurooncol 2019; 144:359-368. [PMID: 31292802 DOI: 10.1007/s11060-019-03236-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Dovitinib is an oral, potent inhibitor of FGFR and VEGFR, and can be a promising strategy in patients with recurrent or progressive glioblastoma (GBM). METHODS This was an open label phase II study of two arms: Arm 1 included anti-angiogenic naïve patients with recurrent GBM and Arm 2 included patients with recurrent GBM that had progressed on prior anti-angiogenic therapy. Nineteen subjects were enrolled in Arm 1 and 14 subjects in Arm 2. The primary endpoint was 6-month progression-free survival (PFS-6) in Arm 1 and time to progression (TTP) in Arm 2. The secondary endpoints were toxicity, objective response rate (ORR) and overall survival. RESULTS Patients in Arm 2 (compared to Arm 1) tended to have longer intervals from diagnosis to study entry (median 26.9 vs. 8.9 months, p = 0.002), experienced more recurrences (64%, had 3-4 prior recurrences compared to 0, p < 0.0001) and tended to be heavily pretreated (71% vs. 26-32% p = 0.04 or 0.02). 6-month PFS was 12% ± 6% for the Arm 1 and 0% for Arm 2. TTP was similar in both treatment arms (median 1.8 months Arm 1 and 0.7-1.8 months Arm 2, p = 0.36). Five patients (15%) had grade 4 toxicities and 22 patients (67%) had grade 3 toxicities. There were no significant differences between the two arms with respect to the amount of change in the levels of biomarkers from baseline. CONCLUSION Dovitinib was not efficacious in prolonging the PFS in patients with recurrent GBM irrespective of prior treatment with anti-angiogenic therapy (including bevacizumab).
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Affiliation(s)
- Mayur Sharma
- Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, S73, Cleveland, OH, 44195, USA
| | - Cathy Schilero
- Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, S73, Cleveland, OH, 44195, USA
| | - David M Peereboom
- Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, S73, Cleveland, OH, 44195, USA.,Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian P Hobbs
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Paul Elson
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Glen H J Stevens
- Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, S73, Cleveland, OH, 44195, USA.,Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Keith McCrae
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew B Nixon
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Manmeet S Ahluwalia
- Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, S73, Cleveland, OH, 44195, USA. .,Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
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Simeone S, Esposito MR, Gargiulo G, Lanzuise A, Botti S, Serra N, Continisio GI, Rea T, Guillari A. The CiTAS scale for evaluating taste alteration induced by chemotherapy: state of the art on its clinical use. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:17-25. [PMID: 31292411 PMCID: PMC6776177 DOI: 10.23750/abm.v90i6-s.8278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cancer is the leading cause of death worldwide. Of the various therapeutic approaches, chemotherapy is the most widely used treatment. Among the various side effects associated with this treatment, taste alterations (TAs) have received little attention, even though they have a serious impact on the nutritional aspect and quality of life (QoL) of patients. TAs concern 75% of the patients receiving chemotherapy, and this figure is still considered to be underestimatedbeacuse could be due both to inadequate attention and to the absence of specific subjective tools able to fully evaluate TAs in patients undergoing chemotherapy. METHODS A review by querying CINAHL, PubMed, Scopus and Google Scholar databases about the current status of use of the CiTAS self-evaluation scale, was performed. RESULTS From critical reading of the selected reports, it can be said that until now CiTAS has not been used to a large extent for evaluating taste, even at a late stage in patients undergoing chemotherapy. However, the results and the selected reports seem to indicate hope for its wider use. CONCLUSIONS In literature, CITAS scale has been used on very heterogeneous populations and not adequately studied in specific care settings, its use within controlled trials could implement its spread.Correct and subjective evaluation of TAs would allow the planning of specific and personalized interventions aimed at providing adequate nutrition to support the maintenance and/or achievement of a correct body mass index. All this could contribute significantly to a better perception of QoL in patients undergoing chemotherapy.
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Affiliation(s)
- Silvio Simeone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, (Italy).
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Ling DC, Chen KS, Benoit RM, Beriwal S, Smith RP. Long-Term Patient-Reported Rectal Bleeding and Bowel-Related Quality of Life After Cs-131 Prostate Brachytherapy. Int J Radiat Oncol Biol Phys 2019; 104:622-630. [DOI: 10.1016/j.ijrobp.2019.02.056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/19/2019] [Accepted: 02/24/2019] [Indexed: 01/28/2023]
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186
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Hall ET, Singhal S, Dickerson J, Gabster B, Wong HN, Aslakson RA, Schapira L. Patient-Reported Outcomes for Cancer Patients Receiving Checkpoint Inhibitors: Opportunities for Palliative Care-A Systematic Review. J Pain Symptom Manage 2019; 58:137-156.e1. [PMID: 30905677 DOI: 10.1016/j.jpainsymman.2019.03.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/14/2019] [Accepted: 03/18/2019] [Indexed: 12/19/2022]
Abstract
CONTEXT Immune checkpoint inhibitors (ICIs) are increasingly used to treat a variety of cancers, but comparatively little is known about patient-reported outcomes (PROs) and health-related quality of life (HRQoL) among patients receiving these novel therapies. OBJECTIVES We performed a systematic review to examine PROs and HRQoL among cancer patients receiving ICIs as compared to other anticancer therapies. METHODS We systematically searched PubMed, CINAHL, Embase, Web of Science, and Scopus, using search terms representing ICIs, PROs, and HRQoL on August 10, 2018. Eligible articles were required to involve cancer patients treated with ICIs and to report PROs and/or HRQoL data. RESULTS We screened 1453 references and included 15 publications representing 15 randomized controlled trials in our analysis. Studies included several cancer types (melanoma, lung cancer, genitourinary cancer, and head/neck cancer), used four different ICIs (nivolumab, pembrolizumab, atezolizumab, and ipilimumab), and compared ICIs to a wide range of therapies (chemotherapy, targeted therapies, other immunotherapy strategies, and placebo). Studies used a total of seven different PROs to measure HRQOL, most commonly the European Organisation for the Research and Treatment of Cancer core quality of life questionnaire (EORTC QLQ-C30) (n = 12, 80%). PRO data were reported in a variety of formats and at a variety of time points throughout treatment, which made direct comparison challenging. Some trials (n = 11, 73%) reported PROs on specific symptoms. In general, patients receiving ICIs had similar-to-improved HRQoL and experiences when compared to other therapies. CONCLUSION Despite the broad clinical trials experience of ICI therapies across cancer types, relatively few randomized studies reported PROs and patient HRQoL data. Available data suggest that ICIs are well tolerated in terms of HRQoL compared to other anticancer therapies although the conclusions are limited by the heterogeneity of trial designs and outcomes. Currently used instruments may fail to capture important symptomatology unique to ICIs, underscoring a need for PROs designed specifically for ICIs.
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Affiliation(s)
- Evan T Hall
- Division of Medical Oncology, Department of Medicine, Stanford University, Stanford, California, USA
| | - Surbhi Singhal
- Department of Medicine, Stanford University, Stanford, California, USA
| | - James Dickerson
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Brooke Gabster
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Hong-Nei Wong
- Lane Medical Library & Knowledge Management Center, Stanford University School of Medicine, Stanford, California, USA
| | - Rebecca A Aslakson
- Department of Medicine, Stanford University, Stanford, California, USA; Department of Anesthesiology, Stanford University, Stanford, California, USA
| | - Lidia Schapira
- Division of Medical Oncology, Department of Medicine, Stanford University, Stanford, California, USA; Department of Medicine, Stanford University, Stanford, California, USA; Department of Anesthesiology, Stanford University, Stanford, California, USA.
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Marques RP, Heudtlass P, Pais HL, Quintela A, Martins AP. Patient-reported outcomes and health-related quality of life for cetuximab versus bevacizumab in metastatic colorectal cancer: a prospective cohort study. J Cancer Res Clin Oncol 2019; 145:1719-1728. [PMID: 31037398 DOI: 10.1007/s00432-019-02924-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 04/20/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Uncertainty exists regarding Patient-Reported Outcomes (PROs) and Health-Related Quality of Life (HRQoL) of patients with metastatic colorectal cancer (mCRC) treated with cetuximab or bevacizumab. We conducted a prospective cohort study comparing PROs and HRQoL from both therapies. METHODS We assessed PROs and HRQoL from patients treated with cetuximab or bevacizumab using QLQ-C30 and QLQ-CR29 questionnaires at three sequential time points, including baseline. Global Health Status (GHS), functional and symptom scales, and Overall Treatment Utility (derived from clinical and patient-reported outcomes) were compared for the two treatment strategies. RESULTS Between January 2017 and April 2018, 44 patients were allocated to cetuximab (n = 19) or bevacizumab (n = 25). Except for RAS mutation status, patient baseline characteristics were generally well balanced across treatment groups. A higher proportion of patients experienced a deterioration in GHS (≥ 10%) in cetuximab arm - 53.8% (95% CI 25.1-80.8%) at 6 weeks and 66.7% (95% CI 29.9-92.5%) at 12 weeks-comparing to bevacizumab cohort: 18.2% (95% CI 5.2-40.3%) at 6 weeks and 12.5% (95% CI:1.6-38.3%) at 12 weeks. Treatment utility rates at 6 and 12 weeks were, respectively, 88.6% and 69.8% for bevacizumab, compared to 49% and 19.1% for cetuximab (p = 0.004), a difference confirmed in subset analyses. CONCLUSIONS In patients with mCRC, cetuximab-containing regimens led to a progressive negative impact on PROs and global HRQoL, when compared to baseline and bevacizumab. Future research is needed to confirm these results. Our findings demonstrate the value of PROs when assessing comparative effectiveness of different treatment regimens.
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Affiliation(s)
- Rui Pedro Marques
- Research Institute of Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Avenida Professor Gama Pinto, 1649-003, Lisbon, Portugal. .,Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte (CHULN), Lisbon, Portugal.
| | - Peter Heudtlass
- Centre for Health Evaluation and Research (CEFAR), Portuguese Pharmacy Association (ANF), Lisbon, Portugal
| | - Helena Luna Pais
- Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte (CHULN), Lisbon, Portugal
| | - António Quintela
- Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte (CHULN), Lisbon, Portugal
| | - Ana Paula Martins
- Research Institute of Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Avenida Professor Gama Pinto, 1649-003, Lisbon, Portugal
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Horvath Walsh LE, Rider A, Piercy J, Pike J, Wilson S, Pandya BJ, Medeiros BC. Real-World Impact of Physician and Patient Discordance on Health-Related Quality of Life in US Patients with Acute Myeloid Leukemia. Oncol Ther 2019; 7:67-81. [PMID: 32700197 PMCID: PMC7359962 DOI: 10.1007/s40487-019-0094-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Indexed: 12/14/2022] Open
Abstract
Introduction There is limited understanding concerning the health-related quality of life (HRQoL) in acute myeloid leukemia (AML) patients. Due to an overlap of symptoms, it can be difficult to separate disease versus treatment-related effects. Study objectives were to understand the impact of factors that might influence patients’ HRQoL, assess the degree of concordance in symptom reporting by patients and physicians, and assess the impact of any discordance on HRQoL in AML patients. Methods Physicians in the USA captured demographics, current AML treatment and symptoms for 82 AML patients who completed the Functional Assessment of Cancer Therapy-Leukemia (FACT-Leu), 5-Dimension EuroQol Questionnaire (EQ-5D-3L) and Cancer Treatment Satisfaction Questionnaire (CTSQ). Effect size (ES) and clinically meaningful differences between AML subgroups were assessed, as was the impact of disagreement between patients and physicians regarding symptom recognition. Results Clinically meaningful lower overall FACT-Leu scores were observed for: relapsed/refractory versus non-relapsed/refractory AML patients (92.5 vs. 103.7; P = 0.09; ES = 0.439), hypomethylating agent (HMA) monotherapy versus other therapies in patients with low treatment intensity (89.9 vs. 112.9; P = 0.0021; ES = 0.971) and presence/absence of FLT3-ITD mutation (85.5 vs. 100; P = 0.148; ES = 0.816). Differences in health state were also clinically meaningful between patients with/without FLT3-ITD; EQ-5D-Visual Analog Scale (VAS) (47.6 vs. 63.7; P = 0.0428; ES = 0.816). Patients were more likely than physicians to report bruising (κ = 0.1292), fatigue (κ = 0.0836), bleeding (κ = 0.0177), weight loss (κ = 0.0821) and appetite loss (κ = − 0.0246). FACT-Leu was associated with patient-physician discordance on bleeding (difference − 14.12; P = 0.046), weight loss (− 21.22; P = 0.001) and appetite loss (− 12.58; P = 0.027). Conclusions HRQoL is generally low for AML patients, especially for particular subgroups. Discordance in symptom reporting between patients and physicians was common and associated with further negative impacts on HRQoL. There may be many reasons for this but better communication between physicians and patients may lead to shared objectives and improvement in patients’ HRQoL. Funding Astellas Pharma, Inc. Electronic supplementary material The online version of this article (10.1007/s40487-019-0094-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Alex Rider
- Adelphi Real World, Adelphi Group, Macclesfield, UK
| | - James Piercy
- Adelphi Real World, Adelphi Group, Macclesfield, UK
| | - James Pike
- Adelphi Real World, Adelphi Group, Macclesfield, UK
| | - Samuel Wilson
- Health Economics and Outcomes Research, Astellas Pharma, Inc., Northbrook, IL, USA
| | - Bhavik J Pandya
- Health Economics and Outcomes Research, Astellas Pharma, Inc., Northbrook, IL, USA.
| | - Bruno C Medeiros
- Stanford Comprehensive Cancer Center, Stanford University, Stanford, CA, USA
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189
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Cho J, Yoon J, Kim Y, Oh D, Kim SJ, Ahn J, Suh GY, Nam SJ, Mitchell SA. Linguistic Validation of the US National Cancer Institute's Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events in Korean. J Glob Oncol 2019; 5:1-10. [PMID: 30917069 PMCID: PMC6449075 DOI: 10.1200/jgo.18.00193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The aim of this study was to translate and linguistically validate a Korean-language version of the US National Cancer Institute's Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). METHODS All 124 PRO-CTCAE items were translated into Korean (PRO-CTCAE-Korean) using International Society for Pharmacoeconomics and Outcomes Research best practices and linguistically validated in a diverse sample of patients undergoing cancer treatment (n = 120) to determine whether the Korean translation captured the original concepts. During the cognitive interviews, participants first completed approximately 60 PRO-CTCAE-Korean questions and were then interviewed to evaluate the conceptual equivalence of the translation to the original PRO-CTCAE English-language source. Interview probes addressed comprehension, clarity, and ease of judgement. Three rounds of interviews were conducted. Items that met the a priori threshold of 10% or more of respondents with comprehension difficulties were considered for rephrasing and retesting. RESULTS A majority of PRO-CTCAE-Korean items were well comprehended in round 1; 14 items posed comprehension difficulties for at least 10% of respondents in round 1. Four symptom terms (mouth and throat sores, feeling like nothing could cheer you up, frequent urination, and pain, swelling, redness at drug injection or intravenous insertion site) were revised and retested in rounds 2 and 3. For the other 10 symptom terms, no suitable alternative phrasing was identified, and the terms were retested in rounds 2 and 3. After rounds 2 and 3, no item presented difficulties in 20% or more of participants. CONCLUSION PRO-CTCAE-Korean has been linguistically validated for use in Korean-speaking populations. Quantitative evaluation of this new measure to establish its measurement properties and responsiveness in Korean speakers undergoing cancer treatment is in progress.
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Affiliation(s)
- Juhee Cho
- Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea.,Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Junghee Yoon
- Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea.,Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Youngha Kim
- Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Dongryul Oh
- Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Seok Jin Kim
- Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Jinseok Ahn
- Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Gee Young Suh
- Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Seok Jin Nam
- Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
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Sparano F, Aaronson NK, Cottone F, Piciocchi A, La Sala E, Anota A, Deliu N, Kieffer JM, Efficace F. Clinician-reported symptomatic adverse events in cancer trials: are they concordant with patient-reported outcomes? J Comp Eff Res 2019; 8:279-288. [PMID: 30838883 DOI: 10.2217/cer-2018-0092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM We investigate the concordance, in terms of favoring the same treatment arm, between clinician-reported symptomatic adverse events (AEs) and information obtained via patient-reported outcomes (PRO) measures in cancer randomized controlled trials (RCTs). METHODS We conducted a systematic literature search to identify all RCTs conducted in breast, colorectal, lung and prostate cancer, published between 2004 and 2017. RESULTS We identified 207 RCTs. In the majority of RCTs (n=133, 64.2%) a discordance between PROs and AEs was found. In 104 studies (50.2%), PRO data favored the experimental arm when AEs did not, while the opposite situation was found in 29 trials (14.0%). CONCLUSION Frequently, information obtained via PRO measures and clinician-reported AEs do not favor the same treatment arm in RCT settings.
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Affiliation(s)
- Francesco Sparano
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center & Health Outcomes Research Unit, Rome, Italy
| | - Neil K Aaronson
- Department of Psychosocial Research, Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, The Netherlands
| | - Francesco Cottone
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center & Health Outcomes Research Unit, Rome, Italy
| | - Alfonso Piciocchi
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center & Health Outcomes Research Unit, Rome, Italy
| | - Edoardo La Sala
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center & Health Outcomes Research Unit, Rome, Italy
| | - Amelie Anota
- Quality of Life in Oncology French National Platform, Methodological & Quality of Life in Oncology Unit (INSERM UMR 1098), University Hospital of Besançon, Besançon, France
| | - Nina Deliu
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center & Health Outcomes Research Unit, Rome, Italy
| | - Jacobien M Kieffer
- Department of Psychosocial Research, Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, The Netherlands
| | - Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center & Health Outcomes Research Unit, Rome, Italy
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191
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New insights into early recovery after robotic surgery for endometrial cancer. Gynecol Oncol 2019; 153:271-276. [PMID: 30808516 DOI: 10.1016/j.ygyno.2019.02.006] [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] [Received: 10/18/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess early recovery of physical health after robotic minimally invasive surgery (RMIS) for early-stage endometrial cancer using the European Organisation of Research and Treatment of Cancer Computer Adaptive Test Core questionnaire (EORTC CAT Core). The EORTC CAT Core provides individualised measurements while maintaining comparability. A hypothesis of individual complete recovery to baseline within three post-surgical weeks was evaluated. METHODS Ninety-four women who underwent RMIS for early-stage endometrial cancer were included consecutively. The EORTC CAT Core was distributed before surgery and prospectively every week during the first post-operative month. Repeated measures models were fitted for each of the four domains (physical functioning, role function, fatigue, and pain) and tested for impact of age, ASA score, minor/major surgery, and the individual baseline scores (poorest, intermediate, best). RESULTS Women with the lowest physical functioning, lowest role function, highest fatigue level, and highest pain level at baseline all recovered within three weeks. Women with the highest physical functioning, highest role function, lowest level of fatigue, and lowest level of pain at baseline did not reach their individual baselines within the first post-operative month but had the most favourable domain-scores three weeks post-operatively. CONCLUSION The individual woman's physical health baseline score is predictive for her postoperative recovery following RMIS for early-stage endometrial cancer. Women with the best physical health had the best postoperative functions and lowest level of symptoms; however their recovery to baseline was prolonged. Computer adaptive testing may be a valuable tool for individualised pre-operative information and supportive care during surveillance.
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Mouillet G, Fritzsch J, Paget-Bailly S, Pozet A, Es-Saad I, Meurisse A, Vernerey D, Mouyabi K, Berthod D, Bonnetain F, Anota A, Thiery-Vuillemin A. Health-related quality of life assessment for patients with advanced or metastatic renal cell carcinoma treated with a tyrosine kinase inhibitor using electronic patient-reported outcomes in daily clinical practice (QUANARIE trial): study protocol. Health Qual Life Outcomes 2019; 17:25. [PMID: 30717745 PMCID: PMC6360763 DOI: 10.1186/s12955-019-1085-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 01/07/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Two main therapies, pazopanib and sunitinib, are used in the first-line setting for metastatic renal cell carcinoma (mRCC). These two tyrosine kinase inhibitors (TKI) are equally effective in terms of survival; however, they frequently induce adverse events. In this setting, Health-Related Quality of life (HRQoL) is a key element in the choice between these two treatments and the evaluation of treatment effectiveness. It could be of interest to evaluate HRQoL in daily clinical practice to aid adequate therapy choice and management. Currently, the development of information and communication technology may allow HRQoL monitoring in routine practice. The objective of the QUANARIE study is to evaluate the use of HRQoL assessment in daily clinical practice for patients with mRCC treated with TKI using electronic patient-reported outcomes (e-PRO). The present article describes the key elements of the study protocol. METHODS The QUANARIE study is an interventional, prospective, multicentre trial. Patients diagnosed with mRCC initiating sunitinib or pazopanib treatment will be invited to complete the EORTC QLQ-C30 questionnaire, nine additional questions from the EORTC items library, and the EuroQoL EQ-5D, prior to each visit with the physician. Questionnaires will be completed by patients using tablets and/or computer terminals via the e-PRO software. The physician will have real-time access to a visual summary of the HRQoL evaluation. The primary objective is to assess the proportion of patients having good compliance with Routine Electronic Monitoring of HRQoL (REMOQOL) during the first 12 months. Physicians' satisfaction with REMOQOL will be assessed as a secondary objective. We hypothesise that 80% of patients having good compliance with REMOQOL would be meaningful. A sample size of 56 patients would be needed. DISCUSSION The results of this study will show whether REMOQOL is feasible on a large scale and whether patients are receptive to this new practice. This study will also determine how real-time multidimensional evaluation of patient perception can help physicians in their daily practice and how they used it in conjunction with other clinical information to manage patient care. TRIAL REGISTRATION ClinicalTrials.gov; Identifier: NCT03062410 ; First Posted: February 23, 2017; Last Update Posted: August 9, 2017.
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Affiliation(s)
- Guillaume Mouillet
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, F-25000 Besançon, France
- Methodological and Quality of Life Unit, University Hospital of Besançon, F-25000 Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Joëlle Fritzsch
- Methodological and Quality of Life Unit, University Hospital of Besançon, F-25000 Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Sophie Paget-Bailly
- Methodological and Quality of Life Unit, University Hospital of Besançon, F-25000 Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Astrid Pozet
- Methodological and Quality of Life Unit, University Hospital of Besançon, F-25000 Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Ikram Es-Saad
- Methodological and Quality of Life Unit, University Hospital of Besançon, F-25000 Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Aurelia Meurisse
- Methodological and Quality of Life Unit, University Hospital of Besançon, F-25000 Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Dewi Vernerey
- Methodological and Quality of Life Unit, University Hospital of Besançon, F-25000 Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Kristina Mouyabi
- Clinical Research and Innovation Office, University Hospital of Besançon, F-25000 Besançon, France
| | - Diane Berthod
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, F-25000 Besançon, France
| | - Franck Bonnetain
- Methodological and Quality of Life Unit, University Hospital of Besançon, F-25000 Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Amélie Anota
- Methodological and Quality of Life Unit, University Hospital of Besançon, F-25000 Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, F-25000 Besançon, France
- French National Platform Quality of Life and Cancer, Besançon, France
| | - Antoine Thiery-Vuillemin
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, F-25000 Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, F-25000 Besançon, France
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Brandt J, Scotté F, Jordan K. Patient-reported outcomes (PROs) as a routine measure for cancer inpatients: the final missing piece of the puzzle? Ann Oncol 2019; 30:167-169. [PMID: 30481270 DOI: 10.1093/annonc/mdy524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- J Brandt
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - F Scotté
- Medical Oncology and Supportive Care Department, Foch Hospital, Suresnes, France
| | - K Jordan
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany.
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Lor M, Koleck TA, Bakken S. Information visualizations of symptom information for patients and providers: a systematic review. J Am Med Inform Assoc 2019; 26:162-171. [PMID: 30535152 PMCID: PMC6657383 DOI: 10.1093/jamia/ocy152] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/09/2018] [Accepted: 10/24/2018] [Indexed: 12/25/2022] Open
Abstract
Objective To systematically synthesize the literature on information visualizations of symptoms included as National Institute of Nursing Research common data elements and designed for use by patients and/or healthcare providers. Methods We searched CINAHL, Engineering Village, PsycINFO, PubMed, ACM Digital Library, and IEEE Explore Digital Library to identify peer-reviewed studies published between 2007 and 2017. We evaluated the studies using the Mixed Methods Appraisal Tool (MMAT) and a visualization quality score, and organized evaluation findings according to the Health Information Technology Usability Evaluation Model. Results Eighteen studies met inclusion criteria. Ten of these addressed all MMAT items; 13 addressed all visualization quality items. Symptom visualizations focused on pain, fatigue, and sleep and were represented as graphs (n = 14), icons (n = 4), and virtual body maps (n = 2). Studies evaluated perceived ease of use (n = 13), perceived usefulness (n = 12), efficiency (n = 9), effectiveness (n = 5), preference (n = 6), and intent to use (n = 3). Few studies reported race/ethnicity or education level. Conclusion The small number of studies for each type of information visualization limit generalizable conclusions about optimal visualization approaches. User-centered participatory approaches for information visualization design and more sophisticated evaluation designs are needed to assess which visualization elements work best for which populations in which contexts.
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Affiliation(s)
- Maichou Lor
- School of Nursing, Columbia University, New York City, New York USA
| | - Theresa A Koleck
- School of Nursing, Columbia University, New York City, New York USA
| | - Suzanne Bakken
- School of Nursing, Columbia University, New York City, New York USA
- Department of Biomedical Informatics, Columbia University, New York City, New York USA
- Data Science Institute, Columbia University, New York City, New York, USA
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Can screening tools for potentially inappropriate prescriptions in older adults prevent serious adverse drug events? Eur J Clin Pharmacol 2019; 75:627-637. [PMID: 30662995 DOI: 10.1007/s00228-019-02624-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 01/02/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE The purpose of the study is to identify and explore risk factors of serious adverse drug events (SADE) and SADE-related admissions in acutely hospitalized multimorbid older adults and assess whether these could have been prevented by adherence to the prescription tools Screening Tool of Older Persons' Prescriptions (STOPP) and The Norwegian General Practice (NORGEP) criteria. METHODS Cross-sectional study of acutely admitted patients to a medical department in a Norwegian regional hospital. Eligible patients were community-dwelling, receiving home care services, and aged 75+, with ≥ 3 chronic diseases. Medications and information regarding the admission were retrieved from the referral letter and medical records, while an expert panel identified SADE using the Common Terminology Criteria for Adverse Events and SADE-related admissions. RESULTS We included 232 patients. Mean (SD) age was 86 (5.7) years, 137 (59%) were female, 121 (52%) used 5-9 drugs whereas 65 (28%) used ≥ 10. We identified SADEs in 72 (31%) of the patients, and in 49 (68%) of these cases, the SADE was considered to cause the hospital admission. A low body mass index (BMI) and a high Cumulative Illness Rating Scale-Geriatrics (CIRS-G) score were independent risk factors for SADEs. Among the SADEs identified, 32 (44%) and 11 (15%) were preventable by adherence to STOPP and NORGEP, respectively. CONCLUSIONS We found a high prevalence of SADE leading to hospitalization. Risk factors for SADE were high CIRS-G and low BMI. STOPP identified more SADEs than NORGEP, but adherence to the prescription tools could only to a limited degree prevent SADEs in this patient group.
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van Eenbergen MC, van den Hurk C, Mols F, van de Poll-Franse LV. Usability of an online application for reporting the burden of side effects in cancer patients. Support Care Cancer 2019; 27:3411-3419. [DOI: 10.1007/s00520-019-4639-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/07/2019] [Indexed: 12/16/2022]
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Atkinson TM, Reeve BB, Dueck AC, Bennett AV, Mendoza TR, Rogak LJ, Basch E, Li Y. Application of a Bayesian graded response model to characterize areas of disagreement between clinician and patient grading of symptomatic adverse events. J Patient Rep Outcomes 2018; 2:56. [PMID: 30515599 PMCID: PMC6279753 DOI: 10.1186/s41687-018-0086-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 11/18/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Traditional concordance metrics have shortcomings based on dataset characteristics (e.g., multiple attributes rated, missing data); therefore it is necessary to explore supplemental approaches to quantifying agreement between independent assessments. The purpose of this methodological paper is to apply an Item Response Theory (IRT) -based framework to an existing dataset that included unidimensional clinician and multiple attribute patient ratings of symptomatic adverse events (AEs), and explore the utility of this method in patient-reported outcome (PRO) and health-related quality of life (HRQOL) research. METHODS Data were derived from a National Cancer Institute-sponsored study examining the validity of a measurement system (PRO-CTCAE) for patient self-reporting of AEs in cancer patients receiving treatment (N = 940). AEs included 13 multiple attribute patient-reported symptoms that had corresponding unidimensional clinician AE grades. A Bayesian IRT Model was fitted to calculate the latent grading thresholds between raters. The posterior mean values of the model-fitted item responses were calculated to represent model-based AE grades obtained from patients and clinicians. RESULTS Model-based AE grades showed a general pattern of clinician underestimation relative to patient-graded AEs. However, the magnitude of clinician underestimation was associated with AE severity, such that clinicians' underestimation was more pronounced for moderate/very severe model-estimated AEs, and less so with mild AEs. CONCLUSIONS The Bayesian IRT approach reconciles multiple symptom attributes and elaborates on the patterns of clinician-patient non-concordance beyond that provided by traditional metrics. This IRT-based technique may be used as a supplemental tool to detect and characterize nuanced differences in patient-, clinician-, and proxy-based ratings of HRQOL and patient-centered outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT01031641 . Registered 1 December 2009.
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Affiliation(s)
- Thomas M. Atkinson
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY 10022 USA
| | | | | | | | - Tito R. Mendoza
- University of Texas M.D. Anderson Cancer Center, Houston, TX USA
| | - Lauren J. Rogak
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY 10022 USA
| | - Ethan Basch
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY 10022 USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Yuelin Li
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY 10022 USA
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Fares CM, Williamson TJ, Theisen MK, Cummings A, Bornazyan K, Carroll J, Spiegel ML, Stanton AL, Garon EB. Low Concordance of Patient-Reported Outcomes With Clinical and Clinical Trial Documentation. JCO Clin Cancer Inform 2018; 2:1-12. [PMID: 30652613 PMCID: PMC6724714 DOI: 10.1200/cci.18.00059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Health care research increasingly relies on assessment of data extracted from electronic medical records (EMRs). Clinical trial adverse event (AE) logs and patient-reported outcomes (PROs) are sources of data often available in the context of specific research projects. The aim of this study was to evaluate the extent of data concordance from these sources. PATIENTS AND METHODS Patients enrolled in clinical trials or receiving standard treatment for lung cancer (n = 62) completed validated questionnaires on physical and psychological symptoms at up to three assessment points. Temporally matched documentation was extracted from EMR notes and, for clinical trial participants (n = 41), AE logs. Evaluated data included symptom assessment, vital signs, medication logs, and laboratory values. Agreement (positive, negative) and Cohen's κ coefficients were calculated to assess concordance of symptoms among sources, with PROs considered the gold standard. RESULTS Patient-reported weight loss correlated significantly with clinical measurements ( t = 2.90; P = .02), and average number of PROs correlated negatively with albumin concentration, supporting PROs as the gold standard. Comparisons of PROs versus EMR yielded poor concordance across 11 physical symptoms, anxiety, and depressive symptoms (all κ < 0.40). Providers under-reported the presence of each symptom in the EMR compared with PROs. AE logs showed similarly poor concordance with PROs (all κ < 0.40, except shortness of breath). Negative agreement among sources was higher than positive agreement for all symptoms except pain. CONCLUSION There was poor concordance between EMR notes and AE logs with PROs. Findings suggest that EMR notes and AE logs may not be reliable sources for capturing physical and psychological symptoms experienced by patients with lung cancer, supporting use of PRO assessments in oncology practices.
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Affiliation(s)
| | | | | | - Amy Cummings
- All authors: University of California, Los Angeles, Los Angeles, CA
| | - Krikor Bornazyan
- All authors: University of California, Los Angeles, Los Angeles, CA
| | - James Carroll
- All authors: University of California, Los Angeles, Los Angeles, CA
| | | | | | - Edward B. Garon
- All authors: University of California, Los Angeles, Los Angeles, CA
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Barginear M, Dueck AC, Allred JB, Bunnell C, Cohen HJ, Freedman RA, Hurria A, Kimmick G, Le-Rademacher JG, Lichtman S, Muss HB, Shulman LN, Copur MS, Biggs D, Ramaswamy B, Lafky JM, Jatoi A. Age and the Risk of Paclitaxel-Induced Neuropathy in Women with Early-Stage Breast Cancer (Alliance A151411): Results from 1,881 Patients from Cancer and Leukemia Group B (CALGB) 40101. Oncologist 2018; 24:617-623. [PMID: 30409792 PMCID: PMC6516126 DOI: 10.1634/theoncologist.2018-0298] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/31/2018] [Indexed: 01/28/2023] Open
Abstract
PURPOSE A few previous studies report a direct relationship between older age and chemotherapy-induced neuropathy. This study further evaluated this adverse event's age-based risk. METHODS CALGB 40101 investigated adjuvant paclitaxel (80 mg/m2 once per week or 175 mg/m2 every 2 weeks) in patients with breast cancer and served as a platform for the current study that investigated age-based differences in neuropathy. Grade 2 or worse neuropathy, as per Common Terminology Criteria for Adverse Events version 4, was the primary endpoint; patients were assessed at baseline, every 6 months for 2 years, and then annually for 15 years. RESULTS Among these 1,881 patients, 230 were 65 years of age or older, 556 were 55-64 years, and 1,095 were younger than 55; 1,226 neuropathy events (commonly grade 1 or 2) were reported in 65% of the cohort. The number of grade 2 or worse events was 63 (27%), 155 (28%), and 266 (24%) within respective age groups (p = .14). In univariate analysis, only motor neuropathy had a higher age-based incidence: 19 (8%), 43 (8%), and 60 (5%), respectively (p = .04); in multivariate analyses, this association was no longer statistically significant. Other endpoints, such as time to onset of neuropathy (time from trial enrollment to neuropathy development) and time to improvement (time from maximal grade sensory neuropathy to a one-category improvement), showed no statistically significant age-based differences. In contrast, obesity was associated with neuropathy, and every 2-week paclitaxel was associated with trends toward neuropathy. CONCLUSION Although paclitaxel-induced neuropathy is common, older age is not an independent risk factor. Clinical trial identification number. NCT00041119 (CALGB 40101). IMPLICATIONS FOR PRACTICE Age alone is not an independent risk factor for paclitaxel-induced neuropathy.
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Affiliation(s)
- Myra Barginear
- Northwell Health Cancer Institute, New York New York, USA
| | - Amylou C Dueck
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona, USA
| | - Jacob B Allred
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Craig Bunnell
- Dana-Farber/Partners CancerCare, Boston, Massachusetts, USA
| | - Harvey J Cohen
- Center for the Study of Aging and Human Development and, Duke University Medical Center, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | | | | | - Gretchen Kimmick
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Jennifer G Le-Rademacher
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota, USA
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Stuart Lichtman
- Memorial Sloan Kettering Cancer Center, Commack, New York, USA
| | - Hyman B Muss
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lawrence N Shulman
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - M Sitiki Copur
- Saint Francis Cancer Treatment Center, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - David Biggs
- Christiana Care Health System-Christiana Hospital, Newark, Delaware, USA
| | | | | | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
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Sharma M, Meola A, Bellamkonda S, Jia X, Montgomery J, Chao ST, Suh JH, Angelov L, Barnett GH. Long-Term Outcome Following Stereotactic Radiosurgery for Glomus Jugulare Tumors: A Single Institution Experience of 20 Years. Neurosurgery 2018; 83:1007-1014. [PMID: 29228343 DOI: 10.1093/neuros/nyx566] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/17/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Glomus jugulare tumors (GJTs) are rare benign tumors, which pose significant treatment challenges due to proximity to critical structures. OBJECTIVE To evaluate the long-term clinical and radiological outcome in patients undergoing stereotactic radiosurgery (SRS) for GJTs through retrospective study. METHODS Forty-two patients with 43 GJTs were treated using Gamma Knife radiosurgery (GKRS; Elekta AB, Stockholm, Sweden) at our institute from 1997 to 2016. Clinical, imaging, and radiosurgery data were collected from an institutional review board approved database. RESULTS Most patients were females (n = 35, 83.3%) and median age was 61 yr (range 23-88 yr). Median tumor volume and diameter were 5 cc and 3 cm, respectively, with a median follow-up of 62.3 mo (3.4-218.6 mo). Overall, 20 patients (47.6%) improved clinically and 14 (33.3%) remained unchanged at last follow-up. New onset or worsening of hearing loss was noted in 6 patients (17.2%) after SRS. The median prescription dose to the tumor margin was 15 Gy (12-18 Gy). Median reduction in tumor volume and maximum tumor diameter at last follow-up was 33.3% and 11.54%, respectively. The 5-yr and 10-yr tumor control rates were 87% ± 6% and 69% ± 13%, respectively. There was no correlation between maximum or mean dose to the internal acoustic canal and post-GK hearing loss (P > .05). CONCLUSION SRS is safe and effective in patients with GJTs and results in durable, long-term control. SRS has lower morbidity than that associated with surgical resection, particularly lower cranial nerve dysfunction, and can be a first-line management option in these patients.
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Affiliation(s)
- Mayur Sharma
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Antonio Meola
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sushma Bellamkonda
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Xuefei Jia
- Department of Biostatistics, Cleveland Clinic, Cleveland, Ohio
| | - Joshua Montgomery
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samuel T Chao
- Cleveland Clinic Taussig Cancer Institute, Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - John H Suh
- Cleveland Clinic Taussig Cancer Institute, Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Lilyana Angelov
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gene H Barnett
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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