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Rau A, Yannitsos D, Grendarova P, Qi S, Watson L, Barbera L. High Symptom Burden in Patients Receiving Radiotherapy and Factors Associated with Being Offered an Intervention. Curr Oncol 2024; 31:1253-1265. [PMID: 38534927 PMCID: PMC10969673 DOI: 10.3390/curroncol31030094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/16/2024] [Accepted: 02/24/2024] [Indexed: 05/26/2024] Open
Abstract
Patient report outcomes are commonly collected during oncology visits to elicit symptom burden and guide management. We aimed to determine the frequency of intervention for patients undergoing radiotherapy with high symptom complexity scores and identify which factors are associated with being offered an intervention. A retrospective chart audit was completed of adult patients with cancer who had at least one radiotherapy appointment and were assigned a high symptom complexity. A total of 200 patients were included; 150 (75.0%) patients were offered an intervention for the main symptom. The most offered intervention was medications. Multivariable logistic regression showed factors associated with being offered an intervention were the following: symptom score of 9 (OR = 9.56, 95% CI 1.64-62.8) and 10 (OR = 7.90, 95% CI 1.69-38.2); palliative intent radiation (OR 3.87, 96% CI 1.46-11.1); and last review appointment (OR 6.22, 95% CI 1.84-23.3). Symptoms associated with being offered an intervention included pain (OR 22.6, 95% CI 6.47-91.1), nausea (OR 15.7, 95% CI 1.51-412), shortness of breath (OR 7.97, 95% CI 1.20-63.7), and anxiety (OR 6.69, 95% CI 1.58-31.6). This knowledge will help guide clinical practice to understand symptom burden and how we can improve our management of patients' symptoms.
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Affiliation(s)
- Allison Rau
- Division of Radiation Oncology, University of Calgary, Calgary, AB T2N 4N1, Canada; (A.R.); (D.Y.); (P.G.); (L.W.)
- Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
| | - Demetra Yannitsos
- Division of Radiation Oncology, University of Calgary, Calgary, AB T2N 4N1, Canada; (A.R.); (D.Y.); (P.G.); (L.W.)
- Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
| | - Petra Grendarova
- Division of Radiation Oncology, University of Calgary, Calgary, AB T2N 4N1, Canada; (A.R.); (D.Y.); (P.G.); (L.W.)
| | - Siwei Qi
- Cancer Care Alberta, Calgary, AB T4N 4E7, Canada;
| | - Linda Watson
- Division of Radiation Oncology, University of Calgary, Calgary, AB T2N 4N1, Canada; (A.R.); (D.Y.); (P.G.); (L.W.)
- Cancer Care Alberta, Calgary, AB T4N 4E7, Canada;
| | - Lisa Barbera
- Division of Radiation Oncology, University of Calgary, Calgary, AB T2N 4N1, Canada; (A.R.); (D.Y.); (P.G.); (L.W.)
- Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
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Safavi AH, Bryson E, Delibasic V, Tjong MC, Hallet J, Mahar A, Davis LE, Wright FC, Parmar A, Coburn NG, Louie AV. Enhancing Symptom Screening and Patient Education Among Patients with Metastatic Lung Cancer: a Qualitative Analysis. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024; 39:86-95. [PMID: 37962792 DOI: 10.1007/s13187-023-02379-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 11/15/2023]
Abstract
We explored perspectives of patients with metastatic non-small cell lung cancer (mNSCLC) on symptom screening and population-level patient-reported outcome (PRO) data regarding common symptom trajectories in the year after diagnosis. A qualitative study of patients with mNSCLC was conducted at a Canadian tertiary cancer centre. English-speaking patients diagnosed ≥ 6 months prior to study invitation were recruited, and semi-structured one-on-one interviews were conducted. Patient and treatment characteristics were obtained via chart review. Anonymized interview transcripts underwent deductive-inductive coding and thematic content analysis. Among ten participants (5 (50%) females; median (range) age, 68 (56-77) years; median (range) time since diagnosis, 28.5 (6-72) months; 6 (60%) with smoking histories), six themes were identified in total. Two themes were identified regarding symptom screening: (1) screening is useful for symptom self-monitoring and disclosure to the healthcare team, (2) screening of additional quality-of-life (QOL) domains (smoking-related stigma, sexual dysfunction, and financial toxicity) is desired. Four themes were identified regarding population-level symptom trajectory PRO data: (1) data provide reassurance and motivation to engage in symptom self-management, (2) data should be disclosed after an oncologic treatment plan is developed, (3) data should be communicated via in-person discussion with accompanying patient-education resources, and (4) communication of data should include reassurance about symptom stabilization, acknowledgement of variability in patient experience, and strategies for symptom self-management. The themes and recommendations derived from the patient experience with mNSCLC provide guidance for enhanced symptom screening and utilization of population-level symptom trajectory data for patient education.
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Affiliation(s)
- Amir H Safavi
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Emily Bryson
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Victoria Delibasic
- Department of Surgery, Sunnybrook Health Sciences Centre-Odette Cancer Centre, 2075 Bayview Avenue, Toronto, ON, T2 163M4N 3M5, Canada
| | - Michael C Tjong
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Julie Hallet
- Department of Surgery, Sunnybrook Health Sciences Centre-Odette Cancer Centre, 2075 Bayview Avenue, Toronto, ON, T2 163M4N 3M5, Canada
| | - Alyson Mahar
- School of Nursing, Queen's University, 92 Barrie Street, Kingston, ON, K7L 3N6, Canada
| | - Laura E Davis
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 2001 McGill College Suite 1200, Montreal, QC, H3A 1G1, Canada
| | - Frances C Wright
- Department of Surgery, Sunnybrook Health Sciences Centre-Odette Cancer Centre, 2075 Bayview Avenue, Toronto, ON, T2 163M4N 3M5, Canada
| | - Ambica Parmar
- Division of Medical Oncology and Hematology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Natalie G Coburn
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
- Department of Surgery, Sunnybrook Health Sciences Centre-Odette Cancer Centre, 2075 Bayview Avenue, Toronto, ON, T2 163M4N 3M5, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
- Department of Surgery, Sunnybrook Health Sciences Centre-Odette Cancer Centre, 2075 Bayview Avenue, Toronto, ON, T2 163M4N 3M5, Canada.
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3
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Sampieri G, Li H, Ataalla P, Merriman K, Noel CW, Hallet J, Coburn N, Karam I, Smoragiewicz M, Wong B, Fu R, Eskander A. Interventions for Concerning Patient-Reported Outcomes in Routine Cancer Care: A Systematic Review. Ann Surg Oncol 2024; 31:1148-1170. [PMID: 37996640 DOI: 10.1245/s10434-023-14576-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/25/2023] [Indexed: 11/25/2023]
Abstract
IMPORTANCE Collecting patient-reported outcomes (PROs) in routine cancer care improves patient-clinician communication, decision making, and overall patient satisfaction. Recommendations exist regarding standardized ways to collect, store, and interpret PRO data. However, evidence on incorporating PROs into cancer process of care, especially the type of HIs that are warranted after observing a concerning PRO and the effectiveness of these HIs are lacking. OBJECTIVE This study summarizes HIs triggered after PRO completion and their effectiveness in improving patient outcomes for adults being treated for cancer types that are resource intensive and associated with high symptom burden [i.e., gastrointestinal (GI), lung, and head and neck cancer (HNC)]. Secondary outcomes included factors associated with poor implementation of PROs. EVIDENCE REVIEW A literature search of peer-reviewed publications on MEDLINE, CINAHL Plus, APA PsycInfo, Scopus, and Cochrane was conducted following PRISMA guidelines from 1 January 2012, to 31 July 2022. Trial and real-world studies describing HIs after PRO completion for adult patients being treated for GI, lung, and HNC were included. Sixteen studies involving 144,496 patients were included. The Joanna Briggs Institute critical appraisal checklist was used to assess risk of bias. FINDINGS Of the 16 included studies, 5 included patients with HNC. Commonly used PRO measurement tools were the PRO-CTCAE and ESAS. Only three studies reported specific HIs delivered in response to concerning PROs and measured their effectiveness on patient outcomes. In all three studies, these HIs significantly improved cancer-related care. The most common HIs undertaken in response to concerning PROs were referrals to other specialists/allied healthcare professionals, medication changes, or self-management advice. Provider-related barriers to PRO measurement and delivery included the overwhelming number of alerts, the time required to address each PRO and the unclear role of healthcare providers in response to these alerts. Patient-related barriers included lower digital literacy and socioeconomic status, older age, rural living, and patients suffering from GI and HNC. CONCLUSIONS AND RELEVANCE This review highlights that PRO-triggered HIs are heterogenous and can improve patient quality of life. Further studies are necessary to determine the types of interventions with the greatest impact on patient care and outcomes.
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Affiliation(s)
- Gianluca Sampieri
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Huaqi Li
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Philopateer Ataalla
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Kaitlyn Merriman
- Insitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
- Insitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Julie Hallet
- Insitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Natalie Coburn
- Insitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Irene Karam
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Martin Smoragiewicz
- Department of Medical Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Brian Wong
- Insitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Rui Fu
- Insitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Antoine Eskander
- Insitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- ICES, Toronto, Canada.
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.
- Department of Otolaryngology-Head and Neck Surgery, Michael Garron Hospital, University of Toronto, Toronto, Canada.
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Zhong X, Cui Y, Wen L, Li S, Gao Z, Zang S, Zhang M, Bai X. Health information-seeking experience in people with head and neck neoplasms undergoing treatment: a qualitative study. Support Care Cancer 2024; 32:128. [PMID: 38261108 DOI: 10.1007/s00520-024-08329-1] [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: 08/24/2023] [Accepted: 01/16/2024] [Indexed: 01/24/2024]
Abstract
PURPOSE To describe the health information-seeking experience and its influencing factors of people with head and neck neoplasms undergoing treatment. METHODS This was a descriptive phenomenology study. Participants were recruited by purposive sampling. The semistructured interviews and all observation results were recorded. The data were analysed using Colaizzi's method. RESULTS Fourteen participants were selected. We identified four themes that illustrate factors that influence the health information-seeking behaviour of participants: patients' awareness of health information needs, patients' competence, doctor-patient communication, and online advertising interference. We also determined the value of different types of information and patients' information needs and sources. CONCLUSION These findings can help professionals understand patients' behaviours and think about how to deliver practical information support in a network environment to guide patients in continuous information seeking while taking specific factors into account.
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Affiliation(s)
- Xia Zhong
- Department of Radiation Oncology, The First Hospital of China Medical University, No.210, Baita 1st Street, Shenyang, Liaoning Province, 110167, People's Republic of China
| | - Yuanyuan Cui
- School of Nursing, Dalian University, Dalian, Liaoning Province, 116000, People's Republic of China
| | - Liying Wen
- Department of Operating Room, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, 110167, People's Republic of China
| | - Siyu Li
- Department of Radiation Oncology, The First Hospital of China Medical University, No.210, Baita 1st Street, Shenyang, Liaoning Province, 110167, People's Republic of China
| | - Zhuoran Gao
- Department of Radiation Oncology, The First Hospital of China Medical University, No.210, Baita 1st Street, Shenyang, Liaoning Province, 110167, People's Republic of China
| | - Shuang Zang
- Department of Community Nursing, School of Nursing, China Medical University, Shenyang, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Miao Zhang
- Department of Radiation Oncology, The First Hospital of China Medical University, No.210, Baita 1st Street, Shenyang, Liaoning Province, 110167, People's Republic of China
| | - Xinghua Bai
- Department of Radiation Oncology, The First Hospital of China Medical University, No.210, Baita 1st Street, Shenyang, Liaoning Province, 110167, People's Republic of China.
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Dürsch H, Boltenhagen U, Mahler C, Joos S, Joachim S, Klafke N. A Qualitative Investigation of Factors Influencing the Integration of Complementary and Integrative Healthcare Recommendations in the Daily Lives of Patients with Cancer. Integr Cancer Ther 2024; 23:15347354241252195. [PMID: 38812440 PMCID: PMC11143848 DOI: 10.1177/15347354241252195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 04/14/2024] [Accepted: 04/14/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Many patients diagnosed with cancer use complementary and integrative healthcare (CIH) approaches to manage their cancer- and treatment-related symptoms and improve their well-being. Evidence suggests that counseling on CIH can improve health outcomes and decrease healthcare costs by increasing patient activation. This qualitative study explores the experiences of cancer patients who underwent interprofessional counseling on CIH to gain insights into how these patients were able to integrate recommended CIH measures into their daily lives while undergoing conventional cancer treatment. METHODS Forty semi-structured interviews were conducted with cancer patients participating in the CCC-Integrativ study and its process evaluation. The interviews were audio-recorded, transcribed verbatim, and analyzed using content analysis following Kuckartz and Rädiker. A purposeful sampling strategy was used to achieve a balanced sample regarding gender, age, cancer diagnosis, and treatment approach. RESULTS Most patients with cancer reported largely implementing the CIH recommendations. Participants acknowledged the efficacy of CIH recommendations in managing their symptoms. They felt strengthened and empowered to actively take part in their healthcare decisions. However, the patients encountered obstacles in incorporating the recommended CIH applications into their daily routines. These challenges encompassed the effort required for treatment application (e.g., baths, compresses), limitations imposed by the cancer disease (e.g., fatigue, pain), difficulties acquiring necessary materials, associated costs, and lack of infrastructure for CIH. Facilitators of CIH implementation included the availability of easily manageable CIH measures (e.g., herbal teas), informative materials on their application, distribution of samples, family support, and a high level of self-efficacy. The patient-centered approach and strong patient-provider partnership within the counseling context were perceived as empowering. Participants expressed a desire for a consistent point of contact to address their CIH concerns. CONCLUSIONS The findings underscore the benefits of CIH counseling for cancer patients' symptom management and overall well-being. Healthcare professionals providing CIH counseling to patients with cancer may recognize the barriers identified to better support their patients in the regular use of CIH.
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Affiliation(s)
- Helena Dürsch
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Ursula Boltenhagen
- Department of Nursing Science, Institute of Health Sciences, University Hospital Tuebingen, Tuebingen, Germany
| | - Cornelia Mahler
- Department of Nursing Science, Institute of Health Sciences, University Hospital Tuebingen, Tuebingen, Germany
| | - Stefanie Joos
- Institute of General Practice and Interprofessional Care, University Hospital Tuebingen, Tuebingen, Germany
| | - Szecsenyi Joachim
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Nadja Klafke
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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Noel CW, Sutradhar R, Chan WC, Fu R, Philteos J, Forner D, Irish JC, Vigod S, Isenberg-Grzeda E, Coburn NG, Hallet J, Eskander A. Gaps in Depression Symptom Management for Patients With Head and Neck Cancer. Laryngoscope 2023; 133:2638-2646. [PMID: 36748910 DOI: 10.1002/lary.30595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/27/2022] [Accepted: 01/16/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To understand practice patterns and identify care gaps within a large-scale depression screening program for patients with head and neck cancer (HNC). STUDY DESIGN Retrospective cohort study. METHODS This was a population-based study of adults diagnosed with a HNC between January 2007 and October 2020. Each patient was observed from time of first symptom assessment until end of study date, or death. The exposure of interest was a positive depressive symptom screen on the Edmonton Symptom Assessment System (ESAS). Outcomes of interest included psychiatry/psychology assessment, social work referral, or palliative care assessment. Cause specific hazard models with a time-varying exposure were used to investigate the exposure-outcome relationships. RESULTS Of 14,054 patients with HNC, 9016 (64.2%) reported depressive symptoms on at least one ESAS assessment. Within 60 days of first reporting depressive symptoms, 223 (2.7%) received a psychiatry assessment, 646 (7.9%) a social work referral, and 1131 (13.9%) a palliative care assessment. Rates of psychiatry/psychology assessment (HR 3.15 [95% CI 2.67-3.72]), social work referral (HR 1.83 [95% CI 1.64-2.02]), and palliative care assessment (HR 2.34 [95% CI 2.19-2.50]) were higher for those screening positive for depression. Certain patient populations were less likely to receive an assessment including the elderly, rural residents, and those without a prior psychiatric history. CONCLUSION A high proportion of head and neck patients report depressive symptoms, though this triggers a referral in a small number of cases. These data highlight areas for improvement in depression screening care pathways. LEVEL OF EVIDENCE 3 Laryngoscope, 133:2638-2646, 2023.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | - Rui Fu
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Justine Philteos
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David Forner
- Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Simone Vigod
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Natalie G Coburn
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Hallet
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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7
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He Y, Pang Y, Su Z, Zhou Y, Wang Y, Lu Y, Jiang Y, Han X, Song L, Wang L, Li Z, Lv X, Wang Y, Yao J, Liu X, Zhou X, He S, Zhang Y, Song L, Li J, Wang B, Tang L. Symptom burden, psychological distress, and symptom management status in hospitalized patients with advanced cancer: a multicenter study in China. ESMO Open 2022; 7:100595. [PMID: 36252435 PMCID: PMC9808454 DOI: 10.1016/j.esmoop.2022.100595] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The management of physical symptoms and psychological distress of cancer patients is an important component of cancer care. The purpose of this study was to evaluate the symptom burden, psychological distress, and management status of hospitalized patients with advanced cancer in China and explore the potential influencing factors of undertreatment and non-treatment of symptoms. PATIENTS AND METHODS A total of 2930 hospitalized patients with advanced cancer (top six types of cancer in China) were recruited from 10 centers all over China. Patient-reported MD Anderson Symptom Inventory, Hospital Anxiety and Depression Scale (HADS), and Patient Health Questionnaire-9 (PHQ-9) scales and symptom management-related information were collected and linked with the patient's clinical data. The proportion of patients reporting moderate-to-severe (MS) symptoms and whether they were currently well managed were examined. Multivariable logistic regression models were applied to explore the factors correlated to undertreatment and non-treatment of symptoms. RESULTS About 27% of patients reported over three MS symptoms, 16% reported over five, and 9% reported over seven. Regarding psychological distress, the prevalence of HADS-anxiety was 29% and that of PHQ-9 depression was 11%. Sixty-one percent of patients have at least one MS symptom without any treatment. Sex [odds ratio (OR) = 2.238, 95% confidence interval (95% CI) 1.502-3.336], Eastern Cooperative Oncology Group (ECOG; OR = 0.404, 95% CI 0.241-0.676), and whether currently undergoing anticancer treatment (OR = 0.667, 95% CI 0.503-0.886) are the main factors correlated with the undertreatment of symptoms. Age (OR = 1.972, 95% CI 1.263-3.336), sex (OR = 0.626, 95% CI 0.414-0.948), ECOG (OR = 0.266, 95% CI 0.175-0.403), whether currently undergoing anticancer treatment (OR = 0.356, 95% CI 0.249-0.509), and comorbidity (OR = 0.713, 95% CI 0.526-0.966) are the main factors correlated with the non-treatment of symptoms. CONCLUSIONS This study shows that hospitalized patients with advanced cancer had a variety of physical and psychological symptoms but lacked adequate management and suggests that a complete symptom screening and management system is needed to deal with this complex problem.
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Affiliation(s)
- Y. He
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Y. Pang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Z. Su
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Y. Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Y. Wang
- Department of Breast Cancer Radiotherapy, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Y. Lu
- The Fifth Department of Chemotherapy, The Affiliated Cancer Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning, China
| | - Y. Jiang
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - X. Han
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - L. Song
- Department of Breast Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - L. Wang
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Z. Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - X. Lv
- Department of Oncology, Xiamen Humanity Hospital, Xiamen, China
| | - Y. Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - J. Yao
- Department of Integrated Chinese and Western Medicine, Shaanxi Provincial Cancer Hospital Affiliated to Medical College of Xi'an Jiaotong University, Xi'an, China
| | - X. Liu
- Department of Clinical Spiritual Care, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - X. Zhou
- Radiotherapy Center, Hubei Cancer Hospital, Wuhan, China
| | - S. He
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Y. Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - L. Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - J. Li
- Department of Psycho-oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - B. Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - L. Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China,Correspondence to: Dr Lili Tang, Fu-Cheng Road 52, Hai-Dian District, Beijing 100142, China. Tel: +86-1088196648
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Noel CW, Sutradhar R, Gotlib Conn L, Forner D, Chan WC, Fu R, Hallet J, Coburn NG, Eskander A. Development and Validation of a Machine Learning Algorithm Predicting Emergency Department Use and Unplanned Hospitalization in Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2022; 148:764-772. [PMID: 35771564 DOI: 10.1001/jamaoto.2022.1629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Patient-reported symptom burden was recently found to be associated with emergency department use and unplanned hospitalization (ED/Hosp) in patients with head and neck cancer. It was hypothesized that symptom scores could be combined with administrative health data to accurately risk stratify patients. Objective To develop and validate a machine learning approach to predict future ED/Hosp in patients with head and neck cancer. Design, Setting, and Participants This was a population-based predictive modeling study of patients in Ontario, Canada, diagnosed with head and neck cancer from January 2007 through March 2018. All outpatient clinical encounters were identified. Edmonton Symptom Assessment System (ESAS) scores and clinical and demographic factors were abstracted. Training and test cohorts were randomly generated in a 4:1 ratio. Various machine learning algorithms were explored, including (1) logistic regression using a least absolute shrinkage and selection operator, (2) random forest, (3) gradient boosting machine, (4) k-nearest neighbors, and (5) an artificial neural network. Data analysis was performed from September 2021 to January 2022. Main Outcomes and Measures The main outcome was any 14-day ED/Hosp event following symptom assessment. The performance of each model was assessed on the test cohort using the area under the receiver operator characteristic (AUROC) curve and calibration plots. Shapley values were used to identify the variables with greatest contribution to the model. Results The training cohort consisted of 9409 patients (mean [SD] age, 63.3 [10.9] years) undergoing 59 089 symptom assessments (80%). The remaining 2352 patients (mean [SD] age, 63.3 [11] years) and 14 193 symptom assessments were set aside as the test cohort (20%). Several models had high predictive accuracy, particularly the gradient boosting machine (validation AUROC, 0.80 [95% CI, 0.78-0.81]). A Youden-based cutoff corresponded to a validation sensitivity of 0.77 and specificity of 0.66. Patient-reported symptom scores were consistently identified as being the most predictive features within models. A second model built only with symptom severity data had an AUROC of 0.72 (95% CI, 0.70-0.74). Conclusions and Relevance In this study, machine learning approaches predicted with a high degree of accuracy ED/Hosp in patients with head and neck cancer. These tools could be used to accurately risk stratify patients and may help direct targeted intervention.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Lesley Gotlib Conn
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - David Forner
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Rui Fu
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Hallet
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Natalie G Coburn
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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