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Vilaplana A, Morell M, Valero-Arrese L, Marshall LV, Saló A, Crowe T, Romero L, de Rojas T, Carceller F, Moreno L. Incorporation of patient-reported outcomes in early-phase clinical trials for childhood and adolescent cancer. Pediatr Blood Cancer 2024; 71:e31165. [PMID: 38961582 DOI: 10.1002/pbc.31165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION The assessment of quality of life (QoL) should be one of the main objectives in paediatric clinical trials. Even though researchers, regulators and advocates support the use of patient-reported outcomes (PROs), this has not been fully implemented. The aim of this study is to assess the measurement of QoL and the usage of PROs, palatability assessments and medication diaries in early-phase clinical trials for childhood and adolescent cancer. METHODS Early-phase clinical trials for children and adolescents with cancer opened between 2005 and 2022 at the Royal Marsden Hospital (London, UK) and Vall d'Hebron University Hospital (Barcelona, Spain) were interrogated for trial characteristics and the use of QoL questionnaires, PROs, palatability assessments and medication diaries. RESULTS Overall, 72 clinical trials were analysed: 12 (16.7%) evaluated QoL and eight (11.1%) evaluated PROs. Palatability was tested in 21/40 (52.5%) trials of oral drugs and 23/72 (31.9%) incorporated medication diaries. No studies mentioned patient involvement in the trial protocol. Use of PROs increased from one of 36 (2.8%) to seven of 36 (19.4%) between the first period (2005-2016) and the second period (2017-2022) (p = .02). Implementation of medication diaries increased from seven of 36 (19.4%) to 16/36 (44.4%) in each period, respectively (p = .02). CONCLUSION Only a minor proportion of the international/multicentric early-phase trials evaluated included QoL/PROs and medication diaries or palatability questionnaires to help assess these, although this trend seems to be increasing over recent years. Greater implementation of QoL/PROs has the potential to improve the patient's wellbeing and facilitate symptom control, to enhance patient/parent involvement in future trial designs and to provide information for drug prioritisation.
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Affiliation(s)
- Andrea Vilaplana
- Childhood Cancer and Blood Disorders Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Mariona Morell
- Childhood Cancer and Blood Disorders Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
- Paediatric Haematology and Oncology Division, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Lorena Valero-Arrese
- Childhood Cancer and Blood Disorders Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
- Paediatric Haematology and Oncology Division, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Lynley V Marshall
- Paediatric & Adolescent Oncology Drug Development Unit, The Royal Marsden NHS Foundation Trust and Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Anna Saló
- Paediatric Haematology and Oncology Division, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Tracey Crowe
- Paediatric & Adolescent Oncology Drug Development Unit, The Royal Marsden NHS Foundation Trust and Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Laura Romero
- Paediatric Haematology and Oncology Division, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Fernando Carceller
- Paediatric & Adolescent Oncology Drug Development Unit, The Royal Marsden NHS Foundation Trust and Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Lucas Moreno
- Childhood Cancer and Blood Disorders Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
- Paediatric Haematology and Oncology Division, Vall d'Hebron University Hospital, Barcelona, Spain
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Serrano D, Cella D, Husereau D, King-Kallimanis B, Mendoza T, Salmonson T, Stone A, Zaleta A, Dhanda D, Moshyk A, Liu F, Shields AL, Taylor F, Spite S, Shaw JW, Braverman J. Administering selected subscales of patient-reported outcome questionnaires to reduce patient burden and increase relevance: a position statement on a modular approach. Qual Life Res 2024; 33:1075-1084. [PMID: 38265747 PMCID: PMC10973071 DOI: 10.1007/s11136-023-03587-8] [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] [Accepted: 12/11/2023] [Indexed: 01/25/2024]
Abstract
Patient-reported outcome (PRO) questionnaires considered in this paper contain multiple subscales, although not all subscales are equally relevant for administration in all target patient populations. A group of measurement experts, developers, license holders, and other scientific-, regulatory-, payer-, and patient-focused stakeholders participated in a panel to discuss the benefits and challenges of a modular approach, defined here as administering a subset of subscales out of a multi-scaled PRO measure. This paper supports the position that it is acceptable, and sometimes preferable, to take a modular approach when administering PRO questionnaires, provided that certain conditions have been met and a rigorous selection process performed. Based on the experiences and perspectives of all stakeholders, using a modular approach can reduce patient burden and increase the relevancy of the items administered, and thereby improve measurement precision and eliminate wasted data without sacrificing the scientific validity and utility of the instrument. The panelists agreed that implementing a modular approach is not expected to have a meaningful impact on item responses, subscale scores, variability, reliability, validity, and effect size estimates; however, collecting additional evidence for the impact of context may be desirable. It is also important to recognize that adequate rationale and evidence (e.g., of fit-for-purpose status and relevance to patients) and a robust consensus process that includes patient perspectives are required to inform selection of subscales, as in any other measurement circumstance, is expected. We believe that the considerations discussed within (content validity, administration context, and psychometric factors) are relevant across multiple therapeutic areas.
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Affiliation(s)
- Daniel Serrano
- Pharmerit International, Bethesda, MD, USA.
- The Psychometrics Team, Sheridan, WY, USA.
| | | | | | | | - Tito Mendoza
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Center for Cancer Research, National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA
| | | | - Arthur Stone
- University of Southern California, Los Angeles, CA, USA
| | - Alexandra Zaleta
- Independent Consultant, Philadelphia, PA, USA
- CancerCare, New York, NY, USA
| | | | | | - Fei Liu
- Bristol Myers Squibb, Princeton, NJ, USA
| | | | | | - Sasha Spite
- Adelphi Values, Boston, MA, USA
- Private Consultant, Escondido, CA, USA
| | | | - Julia Braverman
- Bristol Myers Squibb, Princeton, NJ, USA
- CSL Behring, King of Prussia, PA, USA
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Aiyegbusi OL, Cruz Rivera S, Roydhouse J, Kamudoni P, Alder Y, Anderson N, Baldwin RM, Bhatnagar V, Black J, Bottomley A, Brundage M, Cella D, Collis P, Davies EH, Denniston AK, Efficace F, Gardner A, Gnanasakthy A, Golub RM, Hughes SE, Jeyes F, Kern S, King-Kallimanis BL, Martin A, McMullan C, Mercieca-Bebber R, Monteiro J, Peipert JD, Quijano-Campos JC, Quinten C, Rantell KR, Regnault A, Sasseville M, Schougaard LMV, Sherafat-Kazemzadeh R, Snyder C, Stover AM, Verdi R, Wilson R, Calvert MJ. Recommendations to address respondent burden associated with patient-reported outcome assessment. Nat Med 2024; 30:650-659. [PMID: 38424214 DOI: 10.1038/s41591-024-02827-9] [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: 12/05/2023] [Accepted: 01/23/2024] [Indexed: 03/02/2024]
Abstract
Patient-reported outcomes (PROs) are increasingly used in healthcare research to provide evidence of the benefits and risks of interventions from the patient perspective and to inform regulatory decisions and health policy. The use of PROs in clinical practice can facilitate symptom monitoring, tailor care to individual needs, aid clinical decision-making and inform value-based healthcare initiatives. Despite their benefits, there are concerns that the potential burden on respondents may reduce their willingness to complete PROs, with potential impact on the completeness and quality of the data for decision-making. We therefore conducted an initial literature review to generate a list of candidate recommendations aimed at reducing respondent burden. This was followed by a two-stage Delphi survey by an international multi-stakeholder group. A consensus meeting was held to finalize the recommendations. The final consensus statement includes 19 recommendations to address PRO respondent burden in healthcare research and clinical practice. If implemented, these recommendations may reduce PRO respondent burden.
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Affiliation(s)
- Olalekan Lee Aiyegbusi
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC), University Hospital Birmingham and University of Birmingham, Birmingham, UK.
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK.
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK.
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.
| | - Samantha Cruz Rivera
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Jessica Roydhouse
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Department of Health Services Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | | | - Yvonne Alder
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nicola Anderson
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC), University Hospital Birmingham and University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Vishal Bhatnagar
- Oncology Center of Excellence, US Food and Drug Administration, Silver Spring, MD, USA
| | | | | | | | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Philip Collis
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Alastair K Denniston
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC), University Hospital Birmingham and University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Adrian Gardner
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
- Aston University, Birmingham, UK
| | | | - Robert M Golub
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah E Hughes
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC), University Hospital Birmingham and University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
| | - Flic Jeyes
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | | | - Christel McMullan
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
| | - Rebecca Mercieca-Bebber
- The NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Juan Carlos Quijano-Campos
- William Harvey Research Institute, Queen Mary University of London, London, UK
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | | | | | | | | | | | - Claire Snyder
- Johns Hopkins Schools of Medicine and Public Health, Baltimore, MD, USA
| | - Angela M Stover
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Rav Verdi
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Roger Wilson
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Cancer Research Advocacy Forum, London, UK
| | - Melanie J Calvert
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC), University Hospital Birmingham and University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
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MacDonald I, de Goumoëns V, Marston M, Alvarado S, Favre E, Trombert A, Perez MH, Ramelet AS. Effectiveness, quality and implementation of pain, sedation, delirium, and iatrogenic withdrawal syndrome algorithms in pediatric intensive care: a systematic review and meta-analysis. Front Pediatr 2023; 11:1204622. [PMID: 37397149 PMCID: PMC10313131 DOI: 10.3389/fped.2023.1204622] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/15/2023] [Indexed: 07/04/2023] Open
Abstract
Background Pain, sedation, delirium, and iatrogenic withdrawal syndrome are conditions that often coexist, algorithms can be used to assist healthcare professionals in decision making. However, a comprehensive review is lacking. This systematic review aimed to assess the effectiveness, quality, and implementation of algorithms for the management of pain, sedation, delirium, and iatrogenic withdrawal syndrome in all pediatric intensive care settings. Methods A literature search was conducted on November 29, 2022, in PubMed, Embase, CINAHL and Cochrane Library, ProQuest Dissertations & Theses, and Google Scholar to identify algorithms implemented in pediatric intensive care and published since 2005. Three reviewers independently screened the records for inclusion, verified and extracted data. Included studies were assessed for risk of bias using the JBI checklists, and algorithm quality was assessed using the PROFILE tool (higher % = higher quality). Meta-analyses were performed to compare algorithms to usual care on various outcomes (length of stay, duration and cumulative dose of analgesics and sedatives, length of mechanical ventilation, and incidence of withdrawal). Results From 6,779 records, 32 studies, including 28 algorithms, were included. The majority of algorithms (68%) focused on sedation in combination with other conditions. Risk of bias was low in 28 studies. The average overall quality score of the algorithm was 54%, with 11 (39%) scoring as high quality. Four algorithms used clinical practice guidelines during development. The use of algorithms was found to be effective in reducing length of stay (intensive care and hospital), length of mechanical ventilation, duration of analgesic and sedative medications, cumulative dose of analgesics and sedatives, and incidence of withdrawal. Implementation strategies included education and distribution of materials (95%). Supportive determinants of algorithm implementation included leadership support and buy-in, staff training, and integration into electronic health records. The fidelity to algorithm varied from 8.2% to 100%. Conclusions The review suggests that algorithm-based management of pain, sedation and withdrawal is more effective than usual care in pediatric intensive care settings. There is a need for more rigorous use of evidence in the development of algorithms and the provision of details on the implementation process. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021276053, PROSPERO [CRD42021276053].
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Affiliation(s)
- Ibo MacDonald
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Véronique de Goumoëns
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Bureau d’Echange des Savoirs pour des praTiques exemplaires de soins (BEST) a JBI Center of Excellence, Lausanne, Switzerland
| | - Mark Marston
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Silvia Alvarado
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Eva Favre
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
- Department of Adult Intensive Care, Lausanne University Hospital, Lausanne, Switzerland
| | - Alexia Trombert
- Medical Library, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Maria-Helena Perez
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Anne-Sylvie Ramelet
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
- Bureau d’Echange des Savoirs pour des praTiques exemplaires de soins (BEST) a JBI Center of Excellence, Lausanne, Switzerland
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
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van Gorp M, Grootenhuis MA, Darlington AS, Wakeling S, Jenney M, Merks JHM, Hjalgrim LL, Adams M. Patient Reported Outcomes and Measures in Children with Rhabdomyosarcoma. Cancers (Basel) 2023; 15:cancers15020420. [PMID: 36672371 PMCID: PMC9856469 DOI: 10.3390/cancers15020420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
In addition to optimising survival of children with rhabdomyosarcoma (RMS), more attention is now focused on improving their quality of life (QOL) and reducing symptoms during treatment, palliative care or into long-term survivorship. QOL and ongoing symptoms related to the disease and its treatment are outcomes that should ideally be patient-reported (patient-reported outcomes, PROs) and can be assessed using patient-reported outcome measures (PROMS). This commentary aims to encourage PRO and PROM use in RMS by informing professionals in the field of available PROMs for utilisation in paediatric RMS and provide considerations for future use in research and clinical practice. Despite the importance of using PROMs in research and practice, PROMs have been reported scarcely in paediatric RMS literature so far. Available literature suggests lower QOL of children with RMS compared to general populations and occurrence of disease-specific symptoms, but a lack of an RMS-specific PROM. Ongoing developments in the field include the development of PROMs targeted at children with RMS specifically and expansion of PROM evaluation within clinical trials.
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Affiliation(s)
- Marloes van Gorp
- Princes Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | | | | | - Sara Wakeling
- Founder, Alice’s Arc, Rhabdomyosarcoma Children’s Cancer Charity, London E4 7RW, UK
| | | | | | - Lisa Lyngsie Hjalgrim
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Madeleine Adams
- Children’s Hospital for Wales, Cardiff CF14 4XW, UK
- Correspondence:
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Key considerations to reduce or address respondent burden in patient-reported outcome (PRO) data collection. Nat Commun 2022; 13:6026. [PMID: 36224187 PMCID: PMC9556436 DOI: 10.1038/s41467-022-33826-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/05/2022] [Indexed: 11/30/2022] Open
Abstract
Patient-reported outcomes (PROs) are used in clinical trials to provide evidence of the benefits and risks of interventions from a patient perspective and to inform regulatory decisions and health policy. The collection of PROs in routine practice can facilitate monitoring of patient symptoms; identification of unmet needs; prioritisation and/or tailoring of treatment to the needs of individual patients and inform value-based healthcare initiatives. However, respondent burden needs to be carefully considered and addressed to avoid high rates of missing data and poor reporting of PRO results, which may lead to poor quality data for regulatory decision making and/or clinical care. The collection of patient-reported outcomes (PROs) may capture patients’ assessments of their health status. Here authors highlight PRO-specific issues that should be considered to minimise respondent burden in clinical trials and routine care.
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Jones RL. On the road to improved outcomes by capturing leiomyosarcoma patients' views. Future Oncol 2022; 18:3-11. [PMID: 36189762 DOI: 10.2217/fon-2022-0635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
An international collaborative project set up as a 'priority setting partnership' used a questionnaire to capture the views of patients, carers and clinicians about the sarcoma research agenda. Responses from 25 patients with leiomyosarcoma (LMS) in eight countries provided useful insight from the patient's perspective. Unmet needs identified by patients were in the areas of: LMS-specific trial design; exploring new therapeutic avenues; avoiding morcellation; exploring the immune system in LMS; investigating circulating tumor DNA; implementing molecular characterization of LMS; conducting basic research and a translational pipeline; evaluating imaging modalities; improving early diagnosis; identifying patient-reported outcomes; improving communication, information and support; and addressing survivorship and end-of-life care. Each of the unmet needs is described in more detail.
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Affiliation(s)
- Robin L Jones
- Sarcoma Unit, Royal Marsden Hospital & Institute of Cancer Research, 203 Fulham Road, London, SW3 6JJ, UK
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8
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Gnanasakthy A, Russo J, Gnanasakthy K, Harris N, Castro C. A review of patient-reported outcome assessments in registration trials of FDA-approved new oncology drugs (2014-2018). Contemp Clin Trials 2022; 120:106860. [PMID: 35901962 DOI: 10.1016/j.cct.2022.106860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/17/2022] [Accepted: 07/21/2022] [Indexed: 11/03/2022]
Abstract
The Food and Drug Administration (FDA) encourages the assessment of patient-reported outcomes (PROs) in oncology clinical trials. A 2015 review showed that approximately 26% of industry-sponsored oncology trials included assessment of PROs. However, the proportion of recent trials that supported new oncology drug approvals and assessed PROs is unknown. This review found that assessment of PROs was included in about 75% of registration trials that supported 55 new FDA drug approvals during 2014-2018. Patient-reported outcome assessment was included more in randomized controlled trials than in open-label trials (88% vs. 69%, respectively) and more in phase 3 than in phase 2 trials (89% vs. 66%, respectively).
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Cruz Rivera S, Aiyegbusi OL, Ives J, Draper H, Mercieca-Bebber R, Ells C, Hunn A, Scott JA, Fernandez CV, Dickens AP, Anderson N, Bhatnagar V, Bottomley A, Campbell L, Collett C, Collis P, Craig K, Davies H, Golub R, Gosden L, Gnanasakthy A, Haf Davies E, von Hildebrand M, Lord JM, Mahendraratnam N, Miyaji T, Morel T, Monteiro J, Zwisler ADO, Peipert JD, Roydhouse J, Stover AM, Wilson R, Yap C, Calvert MJ. Ethical Considerations for the Inclusion of Patient-Reported Outcomes in Clinical Research: The PRO Ethics Guidelines. JAMA 2022; 327:1910-1919. [PMID: 35579638 DOI: 10.1001/jama.2022.6421] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Patient-reported outcomes (PROs) can inform health care decisions, regulatory decisions, and health care policy. They also can be used for audit/benchmarking and monitoring symptoms to provide timely care tailored to individual needs. However, several ethical issues have been raised in relation to PRO use. OBJECTIVE To develop international, consensus-based, PRO-specific ethical guidelines for clinical research. EVIDENCE REVIEW The PRO ethics guidelines were developed following the Enhancing the Quality and Transparency of Health Research (EQUATOR) Network's guideline development framework. This included a systematic review of the ethical implications of PROs in clinical research. The databases MEDLINE (Ovid), Embase, AMED, and CINAHL were searched from inception until March 2020. The keywords patient reported outcome* and ethic* were used to search the databases. Two reviewers independently conducted title and abstract screening before full-text screening to determine eligibility. The review was supplemented by the SPIRIT-PRO Extension recommendations for trial protocol. Subsequently, a 2-round international Delphi process (n = 96 participants; May and August 2021) and a consensus meeting (n = 25 international participants; October 2021) were held. Prior to voting, consensus meeting participants were provided with a summary of the Delphi process results and information on whether the items aligned with existing ethical guidance. FINDINGS Twenty-three items were considered in the first round of the Delphi process: 6 relevant candidate items from the systematic review and 17 additional items drawn from the SPIRIT-PRO Extension. Ninety-six international participants voted on the relevant importance of each item for inclusion in ethical guidelines and 12 additional items were recommended for inclusion in round 2 of the Delphi (35 items in total). Fourteen items were recommended for inclusion at the consensus meeting (n = 25 participants). The final wording of the PRO ethical guidelines was agreed on by consensus meeting participants with input from 6 additional individuals. Included items focused on PRO-specific ethical issues relating to research rationale, objectives, eligibility requirements, PRO concepts and domains, PRO assessment schedules, sample size, PRO data monitoring, barriers to PRO completion, participant acceptability and burden, administration of PRO questionnaires for participants who are unable to self-report PRO data, input on PRO strategy by patient partners or members of the public, avoiding missing data, and dissemination plans. CONCLUSIONS AND RELEVANCE The PRO ethics guidelines provide recommendations for ethical issues that should be addressed in PRO clinical research. Addressing ethical issues of PRO clinical research has the potential to ensure high-quality PRO data while minimizing participant risk, burden, and harm and protecting participant and researcher welfare.
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Affiliation(s)
- Samantha Cruz Rivera
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, United Kingdom
- DEMAND Hub, University of Birmingham, Birmingham, United Kingdom
| | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, United Kingdom
- National Institute for Health and Care Research (NIHR) Applied Research Centre West Midlands, Birmingham, United Kingdom
| | - Jonathan Ives
- Centre for Ethics in Medicine, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Heather Draper
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Rebecca Mercieca-Bebber
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Carolyn Ells
- School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | | | - Jane A Scott
- PRO Center of Excellence, Global Commercial Strategy Organization, Janssen Global Services, Warrington, United Kingdom
| | - Conrad V Fernandez
- Division of Pediatric Haematology-Oncology, IWK Health Care Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew P Dickens
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Observational and Pragmatic Research Institute, Midview City, Singapore
| | - Nicola Anderson
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | | | - Andrew Bottomley
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Lisa Campbell
- Medicines and Healthcare Products Regulatory Agency, London, United Kingdom
| | | | - Philip Collis
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Patient partner, University of Birmingham, Birmingham, United Kingdom
| | - Kathrine Craig
- Fast Track Research Ethics Committee, Health Research Authority, London, United Kingdom
| | - Hugh Davies
- Fast Track Research Ethics Committee, Health Research Authority, London, United Kingdom
| | | | - Lesley Gosden
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Patient partner, University of Birmingham, Birmingham, United Kingdom
| | | | | | - Maria von Hildebrand
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Patient partner, University of Birmingham, Birmingham, United Kingdom
| | - Janet M Lord
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, United Kingdom
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, United Kingdom
| | | | - Tempei Miyaji
- Department of Clinical Trial Data Management, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Thomas Morel
- Global Patient-Centred Outcomes Research & Policy, UCB, Belgium, Brussels
| | | | - Ann-Dorthe Olsen Zwisler
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jessica Roydhouse
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
| | | | - Roger Wilson
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Consumer Forum, National Cancer Research Institute, London, United Kingdom
- Patient Involvement Network, Health Research Authority, London, United Kingdom
| | - Christina Yap
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Melanie J Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, United Kingdom
- DEMAND Hub, University of Birmingham, Birmingham, United Kingdom
- National Institute for Health and Care Research (NIHR) Applied Research Centre West Midlands, Birmingham, United Kingdom
- NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, United Kingdom
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, United Kingdom
- Health Data Research United Kingdom, London, United Kingdom
- UK SPINE, University of Birmingham, Birmingham, United Kingdom
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Improving the patient-reported outcome sections of clinical trial protocols: a mixed methods evaluation of educational workshops. Qual Life Res 2022; 31:2901-2916. [PMID: 35553325 PMCID: PMC9470723 DOI: 10.1007/s11136-022-03127-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/12/2022]
Abstract
Introduction Failure to incorporate key patient-reported outcome (PRO) content in trial protocols affects the quality and interpretability of the collected data, contributing to research waste. Our group developed evidence-based training specifically addressing PRO components of protocols. We aimed to assess whether 2-day educational workshops improved the PRO completeness of protocols against consensus-based minimum standards provided in the SPIRIT-PRO Extension in 2018. Method Annual workshops were conducted 2011–2017. Participants were investigators/trialists from cancer clinical trials groups. Although developed before 2018, workshops covered 15/16 SPIRIT-PRO items. Participant feedback immediately post-workshop and, retrospectively, in November 2017 was summarised descriptively. Protocols were evaluated against SPIRIT-PRO by two independent raters for workshop protocols (developed post-workshop by participants) and control protocols (contemporaneous non-workshop protocols). SPIRIT-PRO items were assessed for completeness (0 = not addressed, 10 = fully addressed). Mann–Whitney U tests assessed whether workshop protocols scored higher than controls by item and overall. Results Participants (n = 107) evaluated the workshop positively. In 2017, 16/41 survey responders (39%) reported never applying in practice; barriers included role restrictions (14/41, 34%) and lack of time (5/41, 12%). SPIRIT-PRO overall scores did not differ between workshop (n = 13, median = 3.81/10, interquartile range = 3.24) and control protocols (n = 9, 3.51/10 (2.14)), (p = 0.35). Workshop protocols scored higher than controls on two items: ‘specify PRO concepts/domains’ (p = 0.05); ‘methods for handling missing data’ (p = 0.044). Conclusion Although participants were highly satisfied with these workshops, the completeness of PRO protocol content generally did not improve. Additional knowledge translation efforts are needed to assist protocol writers address SPIRIT-PRO guidance and avoid research waste that may eventuate from sub-optimal PRO protocol content. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-022-03127-w.
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Gnanasakthy A. FDA Guidance on Assessment of Patient-Reported Outcomes in Cancer Trials: A Breath of Fresh Air or a Storm in a Teacup? PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 14:695-697. [PMID: 34337673 DOI: 10.1007/s40271-021-00542-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 11/28/2022]
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Retzer A, Calvert M, Ahmed K, Keeley T, Armes J, Brown JM, Calman L, Gavin A, Glaser AW, Greenfield DM, Lanceley A, Taylor RM, Velikova G, Brundage M, Efficace F, Mercieca‐Bebber R, King MT, Kyte D. International perspectives on suboptimal patient-reported outcome trial design and reporting in cancer clinical trials: A qualitative study. Cancer Med 2021; 10:5475-5487. [PMID: 34219395 PMCID: PMC8366078 DOI: 10.1002/cam4.4111] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/04/2021] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Evidence suggests that the patient-reported outcome (PRO) content of cancer trial protocols is frequently inadequate and non-reporting of PRO findings is widespread. This qualitative study examined the factors influencing suboptimal PRO protocol content, implementation, and reporting, and use of PRO data during clinical interactions. METHODS Semi-structured interviews were conducted with four stakeholder groups: (1) trialists and chief investigators; (2) people with lived experience of cancer; (3) international experts in PRO cancer trial design; (4) journal editors, funding panelists, and regulatory agencies. Data were analyzed using directed thematic analysis with an iterative coding frame. RESULTS Forty-four interviews were undertaken. Several factors were identified that could influenced effective integration of PROs into trials and subsequent findings. Participants described (1) late inclusion of PROs in trial design; (2) PROs being considered a lower priority outcome compared to survival; (3) trialists' reluctance to collect or report PROs due to participant burden, missing data, and perceived reticence of journals to publish; (4) lack of staff training. Strategies to address these included training research personnel and improved communication with site staff and patients regarding the value of PROs. Examples of good practice were identified. CONCLUSION Misconceptions relating to PRO methodology and its use may undermine their planning, collection, and reporting. There is a role for funding, regulatory, methodological, and journalistic institutions to address perceptions around the value of PROs, their position within the trial outcomes hierarchy, that PRO training and guidance is available, signposted, and readily accessible, with accompanying measures to ensure compliance with international best practice guidelines.
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Affiliation(s)
- Ameeta Retzer
- Centre for Patient‐Reported Outcomes ResearchInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
- NIHR ARC West MidlandsLondonUK
| | - Melanie Calvert
- Centre for Patient‐Reported Outcomes ResearchInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
- NIHR ARC West MidlandsLondonUK
- Birmingham Health Partners Centre for Regulatory Science and InnovationUniversity of BirminghamBirminghamUK
- NIHR Birmingham Biomedical Research Centre and NIHR Surgical Reconstruction and Microbiology Research CentreUniversity Hospitals Birmingham NHS Foundation Trust and University of BirminghamBirminghamUK
| | - Khaled Ahmed
- Centre for Patient‐Reported Outcomes ResearchInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Thomas Keeley
- Centre for Patient‐Reported Outcomes ResearchInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
- GlaxoSmithKline (formerly of CPROR, University of BirminghamBirminghamUK
| | - Jo Armes
- UK National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship CSG Subgroup: Understanding and Measuring the Consequences of Cancer and its TreatmentLondonUK
- School of Health SciencesUniversity of SurreyGuildfordUK
- NIHR ARC KentLondonUK
| | | | - Lynn Calman
- UK National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship CSG Subgroup: Understanding and Measuring the Consequences of Cancer and its TreatmentLondonUK
- Macmillan Survivorship Research GroupHealth SciencesUniversity of SouthamptonSouthamptonUK
| | - Anna Gavin
- UK National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship CSG Subgroup: Understanding and Measuring the Consequences of Cancer and its TreatmentLondonUK
- N. Ireland Cancer RegistryCentre for Public HealthQueens UniversityBelfastUK
| | - Adam W. Glaser
- UK National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship CSG Subgroup: Understanding and Measuring the Consequences of Cancer and its TreatmentLondonUK
- Leeds Institute of Medical Research at St James’sUniversity of LeedsLeedsUK
| | - Diana M. Greenfield
- UK National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship CSG Subgroup: Understanding and Measuring the Consequences of Cancer and its TreatmentLondonUK
- Sheffield Teaching Hospital NHS Foundation Trust and University of SheffieldSheffieldUK
| | - Anne Lanceley
- UK National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship CSG Subgroup: Understanding and Measuring the Consequences of Cancer and its TreatmentLondonUK
- UCL Elizabeth Garrett Anderson Institute for Women’s HealthMedical School BuildingUniversity College LondonLondonUK
| | - Rachel M. Taylor
- UK National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship CSG Subgroup: Understanding and Measuring the Consequences of Cancer and its TreatmentLondonUK
- Centre for Nurse, Midwife and Allied Health Profession Led Research (CNMARUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Galina Velikova
- Leeds Institute of Medical Research at St James’sUniversity of LeedsLeedsUK
| | - Michael Brundage
- Queen’s Department of OncologyQueen’s Cancer Research InstituteKingstonONCanada
| | - Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMAHealth Outcomes Research UnitRomeItaly
| | - Rebecca Mercieca‐Bebber
- School of PsychologyUniversity of SydneySydneyNSWAustralia
- University of SydneyNHMRC Clinical Trials CentreSydneyNSWAustralia
| | | | - Derek Kyte
- Centre for Patient‐Reported Outcomes ResearchInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
- NIHR Birmingham Biomedical Research Centre and NIHR Surgical Reconstruction and Microbiology Research CentreUniversity Hospitals Birmingham NHS Foundation Trust and University of BirminghamBirminghamUK
- UK National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship CSG Subgroup: Understanding and Measuring the Consequences of Cancer and its TreatmentLondonUK
- School of Applied Health & CommunityUniversity of WorcesterWorcesterUK
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