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Grahvendy M, Brown B, Wishart LR. Adverse Event Reporting in Cancer Clinical Trials: Incorporating Patient-Reported Methods. A Systematic Scoping Review. THE PATIENT 2024; 17:335-347. [PMID: 38589749 PMCID: PMC11189958 DOI: 10.1007/s40271-024-00689-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND AND OBJECTIVE The history of clinical trials is fraught with unethical practices. Since 1945, robust frameworks have evolved to standardise the collection and reporting of safety data, most notably, the Common Terminology Criteria for Adverse Events (CTCAE) from the National Cancer Institute; used by investigators to report side effects experienced by participants. As medicine moves into the patient-centred model, interest has been growing to collect data on adverse events directly from participants (patient-reported adverse events). The aim of this systematic scoping review was to investigate the inclusion of patient-reported adverse event data within safety/tolerability analyses and explore the collection and reporting of patient-reported adverse event data. METHODS AND RESULTS A database search was undertaken and the Covidence platform was used to manage the review; results were analysed descriptively. Sixty-eight studies were included in the analysis. An increase in the number of studies that incorporate patient-reported adverse event data was seen by year. Seventy instruments were used for the collection of patient-reported adverse event data with recall period, mode, frequency and site of administration varying across studies; the duration of data collection ranged from 28 days to 6 years. Frequently, information on these details was omitted from publications. The number of instruments used by studies to collect patient-reported adverse event data ranged from one to seven instruments. CONCLUSIONS Despite growing calls for the inclusion of patient-reported adverse events, this has not yet translated into published reports. The collection and reporting of these data were variable and conducted using instruments that were not designed for purpose. To address these inconsistencies, standardisation of data collection and reporting using a purpose-built validated instrument is required.
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Affiliation(s)
- Minna Grahvendy
- Cancer Trials Unit, Princess Alexandra Hospital, Queensland Health, Brisbane, QLD, 4102, Australia.
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.
| | - Bena Brown
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait, Islander Primary Health Care, Metro South Health, Brisbane, QLD, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Laurelie R Wishart
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, QLD, Australia
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, QLD, Australia
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Sorah JD, Deal AM, Stein SI, Jonsson M, Innocenti F, Turk A, Boles JC, Irvin W, Basch EM, Sanoff HK, Wood WA. Longitudinal patient-reported outcomes on genotype-guided irinotecan dosing: feasibility and clinical relevance. Oncologist 2024:oyae121. [PMID: 38828490 DOI: 10.1093/oncolo/oyae121] [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: 02/23/2024] [Accepted: 05/02/2024] [Indexed: 06/05/2024] Open
Abstract
INTRODUCTION Standard investigator-based adverse events (AE) assessment is via CTCAE for clinical trials. However, including the patient perspective through PRO (patient-reported outcomes) enhances clinicians' understanding of patient toxicity and fosters early detection of AEs. We assessed longitudinal integration of PRO-CTCAE within clinical workflow in a phase II trial. MATERIALS AND METHODS As a sub-study in a phase II trial of genotype-directed irinotecan dosing evaluating efficacy in patients with metastatic colorectal cancer receiving FOLFIRI and bevacizumab, patients reported on 13 AEs generating a PRO-CTCAE form. The primary objective was to estimate forms completed by patients and clinicians at least 80% of time. Secondary objectives were estimating concordance and time to first score of specific symptoms between patient and clinician pairs. RESULTS Feasibility of longitudinal PRO-CTCAE integration was met as 96% of patients and clinician-patient pairs completed at least 80% of PRO-CTCAE forms available to them with 79% achieving 100% completion. Concordance between patient and clinician reporting a severe symptom was 73% with 24 disconcordant pairs, 21 involved patients who reported a severe symptom that the clinician did not. Although protocol-mandated dose reductions were guided by CTCAE not PRO-CTCAE responses, the median time to dose reduction of 2.53 months, and the time-to-event curve closely approximated time to patient-reported toxicity. CONCLUSION Longitudinal integration of PRO-CTCAE paired CTCAE proved feasible. Compared to clinicians, patients reported severe symptoms more frequently and earlier. Patient-reported toxicity more closely aligned with dose decreases indicating incorporation into routine clinical practice may enhance early detection of toxicity improving patient safety and quality of life.
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Affiliation(s)
- Jonathan D Sorah
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, United States
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, United States
| | - Sophia I Stein
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, United States
| | - Mattias Jonsson
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, United States
| | - Federico Innocenti
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Anita Turk
- Division of Hematology/Oncology, Indiana University, Indianapolis, IN 46202, United States
| | | | - William Irvin
- Bon Secours Cancer Institute, Richmond, VA 23114, United States
| | - Ethan M Basch
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, United States
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Hanna K Sanoff
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, United States
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States
| | - William A Wood
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, United States
- Division of Hematology, Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States
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Gani C, Bickenbach P, Tenev A, Niyazi M, Festl-Wietek T, Herrmann-Werner A. Impact of electronic patient-reported outcome measures on patients' perception of the physician - the randomized ePREFERENCE study. Radiother Oncol 2024; 194:110192. [PMID: 38428640 DOI: 10.1016/j.radonc.2024.110192] [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: 01/02/2024] [Revised: 02/15/2024] [Accepted: 02/25/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Electronic Patient-reported outcome measures (ePROMs) are increasingly used in radiotherapy departments. However, the impact of ePROM integration on patients' perceptions of healthcare providers, particularly in terms of empathy and professionalism, remains unclear. Thus, this study aims to assess the patients' views on healthcare professionals during ePROM-based consultations. METHODS In this randomized trial, radiotherapy patients were enrolled and asked to evaluate video vignettes of consultations between a radiation oncologist and a patient. Two scenarios were shown in random order, one vignette portrayed a paper-chart-based clinic visit, and the other a consultation in which ePROMs were implemented. Established questionnaires such as Physician Compassion Questionnaire (PCQ), Jefferson Patient Perception of Physician Empathy (JPP), Physician Professionalism Questionnaire (PPQ) and Global Consultation Rating Scale (GCRS) were used to rate the healthcare professional. The primary endpoint was physician compassion. RESULTS Between May and August 2022, 152 patients, predominantly with malignancies of the breast, prostate, and brain participated. Patients rated the physician in ePROM-based consultations with higher mean scores for physician compassion compared to paper chart-based ones (36.4 vs. 34.2, p = 0.029). No negative impact of ePROMs was observed in terms of professionalism, global rating or physician empathy. Despite a shorter duration of the visit and reduced eye contact, 63 % of patients ultimately favored ePROM-based consultations. CONCLUSION The ePREFERENCE trial shows that the implementation of ePROMs in clinic visits during radiotherapy treatment positively impacts the patients' perception of the physician's compassion. ePROMs can therefore not only be considered a useful tool to improve workflows but are also broadly accepted by patients.
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Affiliation(s)
- C Gani
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany; German Cancer Consortium (DKTK), partner site Tübingen, a partnership between DKFZ and University Hospital, Tübingen, Germany.
| | - P Bickenbach
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany; German Cancer Consortium (DKTK), partner site Tübingen, a partnership between DKFZ and University Hospital, Tübingen, Germany
| | - A Tenev
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany; German Cancer Consortium (DKTK), partner site Tübingen, a partnership between DKFZ and University Hospital, Tübingen, Germany
| | - M Niyazi
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany; German Cancer Consortium (DKTK), partner site Tübingen, a partnership between DKFZ and University Hospital, Tübingen, Germany
| | - T Festl-Wietek
- Tuebingen Institute for Medical Education, University of Tuebingen, Tuebingen, Germany
| | - A Herrmann-Werner
- Tuebingen Institute for Medical Education, University of Tuebingen, Tuebingen, Germany
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Wiranata JA, Hutajulu SH, Astari YK, Leo B, Bintoro BS, Hardianti MS, Taroeno-Hariadi KW, Kurnianda J, Purwanto I. Patient-reported outcomes and symptom clusters pattern of chemotherapy-induced toxicity in patients with early breast cancer. PLoS One 2024; 19:e0298928. [PMID: 38394281 PMCID: PMC10890761 DOI: 10.1371/journal.pone.0298928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVE This study aims to characterize patient-reported chemotherapy-induced toxicity in patients with breast cancer, determine its association with treatment regimens and patient characteristics, identify toxicity symptom clusters within a specific chemotherapy timeframe and analyze the correlation between symptom clusters within and between the timeframe to understand the changes and influences across chemotherapy. METHODS Forty-six patient-reported toxicities during neoadjuvant/adjuvant chemotherapy for breast cancer were evaluated using adapted CTCAE version 4.0. Chi-Square/Fisher's Exact test was performed to analyze the difference in the incidence of toxicity symptoms by chemotherapy regimens. Poisson regression performed to assess factors associated with patient's total chemotherapy toxicity. Exploratory factor analysis (EFA) conducted to identify symptom clusters at T1 (first half) and T2 (second half of planned cycle). Factor scores were generated and Spearman correlation performed to explore the factor scores correlation between symptom clusters. RESULTS A total of 142 patients with stage I-III breast cancer were included. The incidence of several toxicities differed significantly among three chemotherapy regimens. Subjects age ≥51 years are associated with lower number of reported toxicity (IRR/incidence rate ratio = 0.94, 95% confidence interval/CI 0.88 to 0.99, p = 0.042). Receiving more chemotherapy cycles are associated with higher number of reported toxicity (IRR = 1.06, 95% CI 1.03 to 1.10, p<0.001). Two symptom clusters identified at T1 (psychoneurological-pain/PNP-T1 and gastrointestinal-psychological/GIP-T1 cluster) and three at T2 (psychoneurological-pain/PNP-T2, epithelial/EPI-T2, and gastrointestinal cluster/GI-T2), with moderate-strong positive correlation between PNP-T1 and GIP-T2 (p<0.001), PNP-T1 and PNP-T2 (p<0.001), and GIP-T1 and PNP-T2 (p<0.001). CONCLUSIONS This study investigated 46 patient-reported toxicities prospectively during adjuvant/neoadjuvant chemotherapy for early breast cancer. Anthracycline-taxane combination regimen had higher proportions of toxicity incidence. Subject's age and number of chemotherapy cycles significantly associated with total number of toxicity symptoms. Two symptom clusters at T1 and three at T2 were identified, with significant correlation between symptom clusters within and between chemotherapy timeframe.
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Affiliation(s)
- Juan Adrian Wiranata
- Clinical Epidemiology Study Program, Master of Clinical Medicine Postgraduate Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Academic Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Susanna Hilda Hutajulu
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Yufi Kartika Astari
- Research Scholar, Division of Hematology and Medical Oncology, Department of Internal Medicine, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Benedreky Leo
- Specialty Program in Internal Medicine, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Bagas Suryo Bintoro
- Department of Health Behaviour, Environment, and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Center of Health Behaviour and Promotion, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Mardiah Suci Hardianti
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Kartika Widayati Taroeno-Hariadi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Johan Kurnianda
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Ibnu Purwanto
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
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Galvin A, Soubeyran P, Brain E, Cheung KL, Hamaker ME, Kanesvaran R, Mauer M, Mohile S, Montroni I, Puts M, Rostoft S, Wildiers H, Mathoulin-Pélissier S, Bellera C. Assessing patient-reported outcomes (PROs) and patient-related outcomes in randomized cancer clinical trials for older adults: Results of DATECAN-ELDERLY initiative. J Geriatr Oncol 2024; 15:101611. [PMID: 37679204 DOI: 10.1016/j.jgo.2023.101611] [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: 03/06/2023] [Revised: 08/01/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
As older adults with cancer are underrepresented in randomized clinical trials (RCT), there is limited evidence on which to rely for treatment decisions for this population. Commonly used RCT endpoints for the assessment of treatment efficacy are more often tumor-centered (e.g., progression-free survival). These endpoints may not be as relevant for the older patients who present more often with comorbidities, non-cancer-related deaths, and treatment toxicity. Moreover, their expectation and preferences are likely to differ from younger adults. The DATECAN-ELDERLY initiative combines a broad expertise, in geriatric oncology and clinical research, with interest in cancer RCT that include older patients with cancer. In order to guide researchers and clinicians coordinating cancer RCT involving older patients with cancer, the experts reviewed the literature on relevant domains to assess using patient-reported outcomes (PRO) and patient-related outcomes, as well as available tools related to these domains. Domains considered relevant by the panel of experts when assessing treatment efficacy in RCT for older patients with cancer included functional autonomy, cognition, depression and nutrition. These were based on published guidelines from international societies and from regulatory authorities as well as minimum datasets recommended to collect in RCT including older adults with cancer. In addition, health-related quality of life, patients' symptoms, and satisfaction were also considered by the panel. With regards to tools for the assessment of these domains, we highlighted that each tool has its own strengths and limitations, and very few had been validated in older adults with cancer. Further studies are thus needed to validate these tools in this specific population and define the minimum clinically important difference to use when developing RCTs in this population. The selection of the most relevant tool should thus be guided by the RCT research question, together with the specific properties of the tool.
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Affiliation(s)
- Angéline Galvin
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, Bordeaux, France
| | - Pierre Soubeyran
- Univ. Bordeaux, Inserm, UMR 1312, SIRIC BRIO, France; Department of medical oncology, Bergonie Institute, Comprehensive Cancer Center, Bordeaux, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie/Saint-Cloud, Saint-Cloud, France
| | - Kwok-Leung Cheung
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht/ Zeist/Doorn, Zeist, the Netherlands
| | | | - Murielle Mauer
- Statistics Department, European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Supriya Mohile
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Isacco Montroni
- Division of Colorectal Surgery, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Siri Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hans Wildiers
- Department of General Medical Oncology and Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven Cancer Institute, Belgium
| | - Simone Mathoulin-Pélissier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, Bordeaux, France; INSERM CIC1401, Clinical and Epidemiological Research Unit, Bergonie Institute, Comprehensive Cancer Center, F-33000 Bordeaux, France
| | - Carine Bellera
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, Bordeaux, France; INSERM CIC1401, Clinical and Epidemiological Research Unit, Bergonie Institute, Comprehensive Cancer Center, F-33000 Bordeaux, France.
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Nyrop KA, Page A, Deal AM, Wagoner C, Kelly EA, Kimmick GG, Copeland A, Speca J, Wood WA, Muss HB. Association of self-directed walking with toxicity moderation during chemotherapy for the treatment of early breast cancer. Support Care Cancer 2023; 32:68. [PMID: 38153568 DOI: 10.1007/s00520-023-08275-4] [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: 06/07/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND In the field of exercise oncology, there is a need to quantify the potential benefits of moderate, self-directed physical activity during active treatment. In a pooled analysis of three identical single-arm intervention studies, we investigate the association of activity tracker steps with patient-reported toxicities during chemotherapy. METHODS Women with early breast cancer who were enrolled in the intervention studies reported their symptom severity every 2-3 weeks throughout chemotherapy, and daily steps were documented through a Fitbit activity tracker. Relative risks (RR) and 95% confidence intervals (CI) were calculated using Poisson regression models with robust variance. For outcomes significant in unadjusted models, adjusted RRs were calculated controlling for race, age, and education level. Tracker step cut point (high step, low step) was determined by the means. Cumulative incidence functions of moderate, severe, and very severe (MSVS) symptoms were estimated using the Kaplan-Meier method and compared using a Cox proportional hazard model. RESULTS In a sample of 283 women, mean age was 56 years and 76% were White. Mean tracker-documented steps/week were 29,625, with 55% walking below the mean (low step) and 45% above (high step). In multivariable analysis, high step patients had lower risk for fatigue [RR 0.83 (0.70, 0.99)] (p = 0.04), anxiety [RR 0.59 (0.42, 0.84)] (p = 0.003), nausea [RR 0.66 (0.46, 0.96)] (p = 0.03), depression [RR 0.59 (0.37, 0.03)] (p = 0.02), and ≥ 6 MSVS symptoms [RR 0.73 (0.54, 1.00)] (p = 0.05) and had 36% lower risk for dose reductions [RR 0.64 (95% CI 0.43, 0.97)] (p = 0.03). CONCLUSION Self-directed walking at a rate of at least 30,000 steps/week may moderate the severity of treatment side effects during chemotherapy for early breast cancer. TRIAL NUMBERS NCT02167932, NCT02328313, NCT03761706.
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Affiliation(s)
- K A Nyrop
- Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - A Page
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - A M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - C Wagoner
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - E A Kelly
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | | | - JoEllen Speca
- UNC Rex Cancer Care, UNC Rex Healthcare, Raleigh, USA
| | - William A Wood
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Division of Hematology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - H B Muss
- Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Padamsee TJ, Phommasathit C, Swinehart-Hord P, Chettri S, Clevenger K, Rayo MF, Agnese DM, Bazan JG, Jones N, Lee CN. Patient-driven decisions and perceptions of the 'safest possible choice': insights from patient-provider conversations about how some breast cancer patients choose contralateral prophylactic mastectomy. Psychol Health 2023:1-25. [PMID: 38044547 DOI: 10.1080/08870446.2023.2290170] [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: 08/11/2022] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE Observe patient-clinician communication to gain insight about the reasons underlying the choice of patients with unilateral breast cancer to undergo contralateral prophylactic mastectomy (CPM), despite lack of survival benefit, risk of harms, and cautions expressed by surgical guidelines and clinicians. METHODS & MEASURES WORDS is a prospective study that explored patient-clinician communication and patient decision making. Participants recorded clinical visits through a downloadable mobile application. We analyzed 44 recordings from 22 patients: 9 who chose CPM, 8 who considered CPM but decided against it, and 5 who never considered CPM. We used abductive analysis combined with constructivist grounded theory methods. RESULTS Decisions to undergo CPM are patient-driven and motivated by perceptions that CPM is the most aggressive, and therefore safest, treatment option available. These decisions are shaped not primarily by the content of conversations with clinicians, but by the history of cancer in patients' families, their own first-hand experiences with cancers among loved ones, fear for their children, and anxiety about cancer recurrence. CONCLUSION The perception that CPM is the safest, most aggressive option strongly influences patients, despite scientific evidence to the contrary. Future efforts to address high CPM rates should focus on patient-driven decision making and cancer-related fears.
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Affiliation(s)
- Tasleem J Padamsee
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, Ohio, USA
- James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Crystal Phommasathit
- James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Paige Swinehart-Hord
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, Ohio, USA
| | - Shibani Chettri
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio, USA
| | - Kaleigh Clevenger
- James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Michael F Rayo
- Department of Integrated Systems Engineering, The Ohio State University College of Engineering, Columbus, Ohio, USA
| | - Doreen M Agnese
- James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Jose G Bazan
- Department of Radiation Oncology, City of Hope, Duarte, California, USA
| | | | - Clara N Lee
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, Ohio, USA
- James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
- Department of Plastic and Reconstructive Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Kuniyoshi O, Sano M, Nakano Y, Kawaguchi T, Hatakeyama T, Tsuchiya Y, Inada Y, Harada T, Kurosaki M, Mashiko T, Miyaji T, Yamaguchi T. Protocol for the ASTRO study (SSOP-01): a multicentre prospective cohort study investigating adverse events based on electronic patient-reported outcomes in patients with breast cancer after adjuvant chemotherapy. BMJ Open 2023; 13:e071500. [PMID: 37709306 PMCID: PMC10503369 DOI: 10.1136/bmjopen-2022-071500] [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: 01/04/2023] [Accepted: 08/20/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Symptom-related adverse events associated with perioperative chemotherapy in patients with breast cancer include short-term adverse events such as nausea and vomiting. However, changes in the severity and duration of prolonged symptom-related adverse events have not been fully investigated. We present a protocol of a study that aims to clarify the prevalence of symptom-related adverse events in patients with breast cancer 1 year after neoadjuvant or adjuvant chemotherapy using an electronic patient-reported outcomes (ePRO) system. METHODS AND ANALYSIS This multicentre prospective observational cohort study will include patients with breast cancer who have received preoperative or postoperative adjuvant chemotherapy. The final injection date of the cytotoxic agent will be the study initiation date. Patients will report every 2 weeks from the initiation date to 12 weeks and every 4 weeks from 12 weeks to 1 year, and they can enter this information into the ePRO system from anywhere. The primary outcome will be the prevalence of symptom-related adverse events according to the ePRO system 1 year after the date of the last injection of the cytotoxic drug used in neoadjuvant or adjuvant chemotherapy for breast cancer. To increase multi-institutional enrolment, two cohorts will be included. Cohort 1 will comprise patients with acquisition of baseline patient information regarding preoperative chemotherapy and presurgery characteristics. Cohort 2 will comprise patients without acquisition of baseline patient information. The target sample size is ≥250 per year. ETHICS AND DISSEMINATION The study protocol has been approved by the ethics committee at each participating institution. The results will be presented at major national and international conferences and submitted to peer-reviewed journals. TRIAL STATUS Registration was started in October 2021. By August 2022, a total of 132 participants were enrolled. Follow-up will be continued through December 2024. TRIAL REGISTRATION NUMBER UMIN000045422.
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Affiliation(s)
- Ouki Kuniyoshi
- Pharmaceutical Department, Ageo Central General Hospital, Ageo, Japan
| | - Motohiko Sano
- Division of Applied Pharmaceutical Education and Research, Hoshi University, Shinagawa-ku, Japan
- Department of Pharmacy Services, Saitama Medical University, Iruma-gun, Japan
| | - Yasuhiro Nakano
- Pharmaceutical Department, Cancer Institute Hospital, Koto-ku, Japan
| | - Takashi Kawaguchi
- Department of Practical Pharmacy, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | | | - Yusuke Tsuchiya
- Pharmaceutical Department, Ageo Central General Hospital, Ageo, Japan
| | - Yusuke Inada
- Pharmaceutical Department, Yokohama Rosai Hospital, Yokohama, Japan
| | - Tomohiko Harada
- Pharmaceutical Department, Kanagawa Cancer Center, Yokohama, Japan
| | - Miyuki Kurosaki
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tomoe Mashiko
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tempei Miyaji
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Trask PC, Holt T, Pearman T. Psychometrics of patient-reported bother from side effects of treatment single-items in industry-sponsored oncology trials. Qual Life Res 2023:10.1007/s11136-023-03426-w. [PMID: 37119353 DOI: 10.1007/s11136-023-03426-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Improvements in cancer treatment have increased the number of cancer survivors, but also increased the long-term and late effects from cancer therapy. Patient reported "side effect bother" could be used to measure the burden of treatment, and the risk for negative outcomes such as dose reduction, treatment delay or discontinuation. The current study addresses the psychometric properties of a single item, determines what represents a "meaningful change", and evaluates the correlation to safety endpoints and functioning. METHODS Results from 5911 patients enrolled in 8 clinical trials representing 5 disease types in oncology and hematology who completed either the Functional Assessment of Cancer Therapy (FACT) GP5 item or a modified bother item (MBI) were assessed. RESULTS Patients ranged in age from 18 to 93 years, with all cancer stages represented and approximately equal numbers of males and females. Test-retest reliability was acceptable, as were convergent and known groups validity. The GP5 and MBI effectively demonstrated sensitivity to change over time and established meaningful thresholds. CONCLUSIONS The results indicate that these single-items are psychometrically sound, capable of distinguishing known groups, responsive to change and can identify meaningful change over time in terms of treatment-related symptoms. It extends the findings of recent scientific groups by providing analyses not included in prior studies, and further supports the FDA's recommendation to include a single item question in clinical trials.
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Affiliation(s)
| | - Tracy Holt
- Genentech, 1 DNA Way, South San Francisco, CA, USA
- PAREXEL International, Billerica, MA, USA
| | - Timothy Pearman
- Supportive Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, School of Medicine, 625 N. Michigan Avenue, Chicago, IL, USA.
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10
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Sodium New Houttuyfonate Induces Apoptosis of Breast Cancer Cells via ROS/PDK1/AKT/GSK3β Axis. Cancers (Basel) 2023; 15:cancers15051614. [PMID: 36900408 PMCID: PMC10000396 DOI: 10.3390/cancers15051614] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Sodium new houttuyfonate (SNH) has been reported to have anti-inflammatory, anti-fungal, and anti-cancer effects. However, few studies have investigated the effect of SNH on breast cancer. The aim of this study was to investigate whether SNH has therapeutic potential for targeting breast cancer. METHODS Immunohistochemistry and Western blot analysis were used to examine the expression of proteins, flow cytometry was used to detect cell apoptosis and ROS levels, and transmission electron microscopy was used to observe mitochondria. RESULTS Differentially expressed genes (DEGs) between breast cancer-related gene expression profiles (GSE139038 and GSE109169) from GEO DataSets were mainly involved in the immune signaling pathway and the apoptotic signaling pathway. According to in vitro experiments, SNH significantly inhibited the proliferation, migration, and invasiveness of MCF-7 (human cells) and CMT-1211 (canine cells) and promoted apoptosis. To explore the reason for the above cellular changes, it was found that SNH induced the excessive production of ROS, resulting in mitochondrial impairment, and then promoted apoptosis by inhibiting the activation of the PDK1-AKT-GSK3β pathway. Tumor growth, as well as lung and liver metastases, were suppressed under SNH treatment in a mouse breast tumor model. CONCLUSIONS SNH significantly inhibited the proliferation and invasiveness of breast cancer cells and may have significant therapeutic potential in breast cancer.
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11
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Nyrop KA, Monaco J, Vohra S, Deal AM, Wood WA, Shachar SS, Dees EC, Kimmick GG, Speca JC, Muss HB. Body mass index and patient-reported function, quality of life and treatment toxicity in women receiving adjuvant chemotherapy for breast cancer. Support Care Cancer 2023; 31:196. [PMID: 36859693 DOI: 10.1007/s00520-023-07637-2] [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: 07/21/2022] [Accepted: 02/08/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND This study investigates whether high body mass index (BMI) in women diagnosed with early breast cancer (BC) is associated with patient-reported symptom severity during chemotherapy. METHODS Women with Stage I-III BC completed toxicity reports for 17 side effects throughout regularly scheduled chemotherapy infusions. Toxicity reports were compared in women with obesity (BMI > = 30) versus no obesity (BMI < 30). Fisher's exact tests and 2-sample t-tests compared baseline patient characteristics. Risk ratios (RR) for women with obesity as compared to no obesity were estimated for individual symptoms that were patient-rated as moderate, severe or very severe (MSVS) severity, adjusting for marital status and race. RESULTS In a sample of 286 patients, Black women comprised 23% of the sample. The obesity rate was 76% among Black patients and 31% among White patients (p < .0001). Women with obesity rated an average of 6.9 side effects (standard deviation, SD 4.2) as MSVS vs 5.5 side effects (SD 3.7) among women with no obesity (p = .003). In adjusted analysis, women with obesity had significantly greater risk for MSVS fatigue (RR 1.18, 95% CI 1.01-1.36), dyspnea (RR 1.71, 95% CI 1.09-2.69), arthralgia (RR 1.47, 95% CI 1.10-1.97), peripheral neuropathy (RR 1.45, 95% CI 1.01-2.08), edema of limbs (RR 1.84, 95% CI 1.18-2.88), and abdominal pain (RR 1.75, 95% CI 1.07-2.87). There were no inter-group differences in BC stage or phenotype, chemotherapy treatment modifications, or hospitalizations. CONCLUSIONS Among women with early BC, patients with obesity reported higher chemotherapy toxicity as compared to patients without obesity; however, this did not result in differences in treatment completion.
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Affiliation(s)
- Kirsten A Nyrop
- School of Medicine, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA.
| | - Jane Monaco
- Gillings School of Global Public Health, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sanah Vohra
- Gillings School of Global Public Health, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA
| | - William A Wood
- School of Medicine, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA
| | | | - E Claire Dees
- School of Medicine, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA
| | | | - JoEllen C Speca
- School of Medicine, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA
| | - Hyman B Muss
- School of Medicine, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA
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12
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Kammire MS, Deal AM, Damone EM, Rosen V, Nyrop KA, Mitin N, Muss HB. Does walking during chemotherapy impact p16 INK4a levels in women with early breast cancer. J Clin Lab Anal 2022; 36:e24753. [PMID: 36336905 PMCID: PMC9757016 DOI: 10.1002/jcla.24753] [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: 08/08/2022] [Revised: 10/14/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Increased p16INK4a (p16) expression is directly related to cellular senescence and is a robust biomarker of aging in humans. Prior studies have shown that levels of p16 dramatically increase in breast cancer patients who have received adjuvant chemotherapy. This study investigated whether moderate physical activity during chemotherapy would attenuate the expected rise in p16 expression. METHODS Participants were women with Stage I-III breast cancer enrolled in a walking study for the duration of their chemotherapy (NCT02167932, NCT02328313, NCT03761706). Participants were asked to walk at least 30 min or 6200 steps/day following a structured walking program and to wear an activity tracker. p16 mRNA levels were measured in peripheral blood T-cells before chemotherapy initiation and at approximately 6 months after last chemotherapy treatment (mean 200 days, SD 40 days). RESULTS In total, 141 participants met inclusion criteria and 10% (n = 14) averaged > 6200 steps/day. There was no significant association of daily steps with change in p16 levels pre- to post-chemotherapy (Pearson correlation coefficient = 0.11, p = 0.17). After adjusting for age, stage, anthracycline-based chemotherapy, and baseline p16, the change in log2 p16 for each 1000 steps was estimated to be 0.03 (p = 0.35). Most participants were sedentary prior to chemotherapy and achieved modest levels of physical activity during treatment. CONCLUSION A self-guided walking program achieved only modest levels of physical activity and was unable to ameliorate chemotherapy-induced change in p16 levels in women undergoing chemotherapy for early-stage breast cancer. More structured and vigorous exercise programs should be tested for a more definitive exploration of their impact on post-chemotherapy p16 levels.
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Affiliation(s)
- Maria S. Kammire
- School of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Allison M. Deal
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Emily M. Damone
- Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Vanessa Rosen
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Kirsten A. Nyrop
- School of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | | | - Hyman B. Muss
- School of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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13
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Lapen K, King C, Braunstein LZ, Khan AJ, Kamrava MR, Gillespie EF, Cook KA. A Comparison of Patient- and Clinician-Reported Acute Toxic Effects During Radiation Therapy for Primary Breast Cancer. Int J Radiat Oncol Biol Phys 2022; 114:301-309. [PMID: 35675851 PMCID: PMC10281649 DOI: 10.1016/j.ijrobp.2022.05.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Evidence suggests that cancer treatment-related toxic effects are underreported by clinicians. We sought to compare patient- and clinician-reported acute toxic effects among patients undergoing radiation therapy for primary breast cancer and to determine factors associated with patient-clinician discordance. METHODS AND MATERIALS Patient responses from a weekly Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events based assessment were matched to clinician assessments of acute toxic effects during treatment. Weighted κ statistics were used to evaluate agreement between patient and clinician assessments. Linear regression, logistic regression, and generalized estimating equation models were used to identify covariates associated with discordance. RESULTS Overall, 842 patient-clinician assessment pairs from 376 unique patients were analyzed. Total symptom burden score was higher for patients than clinicians (4.7 vs 2.3, P < .01). Dermatitis, pruritis, pain, and edema items were classified as having minimal agreement (κ of 0.25, 0.23, 0.20, and 0.25, respectively). Fatigue (κ 0.17) and psychosocial (0.03) patient-clinician pairs were found to have no agreement. The linear regression demonstrated that assessments by patients who identified as Black or African American were associated with a 0.13-point decrease in discordance (95% confidence interval, -0.25 to -0.01), while time from the start of treatment was associated with increased discordance (95% confidence interval, 0.07-0.12). CONCLUSIONS For patients undergoing breast radiation therapy, discordance in patient and clinician symptom reporting is high and increases as treatment progresses. The mechanism of reduced discordance among Black or African American patients warrants further investigation. Prospective studies are needed to determine whether interventions for lower severity symptoms, which are commonly overlooked by clinicians, can reduce symptom burden and improve patient quality of life during radiation therapy.
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Affiliation(s)
- Kaitlyn Lapen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Caroline King
- Department of Biomedical Engineering, School of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Lior Z Braunstein
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Atif J Khan
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mitchell R Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Erin F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kiri A Cook
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon.
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14
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Mahoney DE, Pierce JD. Ovarian Cancer Symptom Clusters: Use of the NIH Symptom Science Model for Precision in Symptom Recognition and Management. Clin J Oncol Nurs 2022; 26:533-542. [PMID: 36108208 PMCID: PMC9951395 DOI: 10.1188/22.cjon.533-542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND In the United States, ovarian cancer remains the deadliest gynecologic cancer because most women are diagnosed with advanced disease. Although early-stage ovarian tumors are considered asymptomatic, women experience symptoms throughout disease. OBJECTIVES This review identifies ovarian cancer symptom clusters and explores the applicability of the National Institutes of Health Symptom Science Model (NIH-SSM) for prompt symptom recognition and clinical intervention. METHODS A focused CINAHL® and PubMed® database search was conducted for studies published from January 2000 to May 2022 using combinations of key terms. FINDINGS The NIH-SSM can guide the delivery of precision-focused interventions that address racial disparities and foster equity in symptom- focused care. Enhanced understanding of symptom biology can support clinical oncology nurses in ambulatory and inpatient settings.
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15
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Communication in Oncology Outpatient Clinic Settings: Congruence of Quality of Life Assessment between Patient-Physician and Patient-Caregiver Dyads. JOURNAL OF ONCOLOGY 2022; 2022:5463896. [PMID: 36059805 PMCID: PMC9436590 DOI: 10.1155/2022/5463896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/26/2022] [Accepted: 07/30/2022] [Indexed: 11/17/2022]
Abstract
Objectives The aims of this study were to investigate the congruence of HRQOL reports between patient-physician and patient-caregiver dyads and to determine the association of variables, if any, with the congruence between dyads. Methods This correlational study with a cross-sectional design first approached physicians who provided care for patients with advanced cancer at the participating institution. Then, participating physicians' patients and their caregivers were recruited. All participants were required to independently fill out an HRQOL questionnaire during their outpatient visits. Descriptive statistics, weighted kappa, Wilcoxon signed-rank test, and linear regression were employed for data analysis. Results A total of 52 patient-physician and 27 patient-caregiver dyads were examined. Patients suffered from considerable problems in all three HRQOL domains: symptom, functioning, and overall HRQOL. The patients' level of agreement was moderate with the caregivers and fair with the physicians. A significant relationship was found between several patient-related variables and disagreement. Conclusion These patients with advanced cancer experienced a compromised HRQOL, warranting immediate attention. When there are barriers to obtaining a patient's self-report, clinicians may consider caregivers as a reasonable source. Patients with special characteristics need additional attention because their problems may be at a greater risk of being overlooked.
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16
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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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17
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McKenzie H, Hayes L, Acret L, Boustany C, Kim B, Fethney J, Simpson JM, McLeod J, Willcock S, Cook N, White K. Patient perceptions of a community-based intervention designed to provide support post administration of anti-cancer systemic treatments: A qualitative evaluation. Eur J Oncol Nurs 2022; 58:102148. [DOI: 10.1016/j.ejon.2022.102148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/23/2022] [Accepted: 05/03/2022] [Indexed: 11/25/2022]
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18
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Nakamura ZM, Damone EM, Herrick HP, Nyrop KA, Deal AM, Brenizer AT, Muss HB. Anticipating mental health needs after chemotherapy in early-stage breast cancer using patient-reported symptom screening. Support Care Cancer 2022; 30:3933-3941. [PMID: 35044483 PMCID: PMC8957600 DOI: 10.1007/s00520-022-06827-8] [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] [Received: 11/05/2021] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Many patients with breast cancer experience depression and anxiety for years after completing systemic chemotherapy, which negatively impact overall symptom burden, quality of life, and treatment outcomes. The objective of this study was to examine the utility of patient-reported outcome (PRO) measures to predict mental health needs in patients with breast cancer during post-chemotherapy follow-up care. METHODS In a sample of women with non-metastatic breast cancer, associations between patient-reported depression and anxiety at end of chemotherapy and post-chemotherapy mental health needs were evaluated using log-binomial regression adjusted for functional status, social activity limitations, and time from chemotherapy. RESULTS In a sample of 149 women, 40% reported at least mild depressive symptoms and 52% reported at least mild anxiety at the end of chemotherapy. Over an average 3.2 years post-chemotherapy (range: 0.7-5.6 years), 23% received new psychiatric diagnoses, 21% engaged in mental health specialty care, and 62% were prescribed psychotropic medications. End of chemotherapy depression and anxiety were associated with future prescription of psychotropic medications (RR 1.52; 95% CI 1.14-2.03), as well as greater number of psychotropics. Associations were strongest with serotonin-norepinephrine reuptake inhibitors [(depression: RR 4.75; 95% CI 2.06-10.95); (anxiety: RR 3.68; 95% CI 1.62-8.36); (depression and anxiety: RR 2.98; 95% CI 1.65-5.36)]. CONCLUSION Diagnosis of and treatment for depression and anxiety are common among women with breast cancer after completing chemotherapy. Prescriptions for psychotropic medications during the initial years after systemic chemotherapy can be anticipated by depression and anxiety screening at end of chemotherapy.
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Affiliation(s)
- Zev M Nakamura
- Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive, Campus Box #7160, Chapel Hill, NC, 27599, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Emily M Damone
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hannah P Herrick
- College of Arts & Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kirsten A Nyrop
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medicine, Division of Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A Tucker Brenizer
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hyman B Muss
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medicine, Division of Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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19
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Nyrop KA, Damone EM, Deal AM, Wheeler SB, Charlot M, Reeve BB, Basch E, Shachar SS, Carey LA, Reeder-Hayes KE, Dees EC, Jolly TA, Kimmick GG, Karuturi MS, Reinbolt RE, Speca JC, Wood WA, Muss HB. Patient-reported treatment toxicity and adverse events in Black and White women receiving chemotherapy for early breast cancer. Breast Cancer Res Treat 2021; 191:409-422. [PMID: 34739658 DOI: 10.1007/s10549-021-06439-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE It is not known whether chemotherapy-related symptom experiences differ between Black and White women with early breast cancer (Stage I-III) receiving current chemotherapy regimens and, in turn, influences dose delay, dose reduction, early treatment discontinuation, or hospitalization. METHODS Patients self-reported their race and provided symptom reports for 17 major side effects throughout chemotherapy. Toxicity and adverse events were analyzed separately for anthracycline and non-anthracycline regimens. Fisher's exact tests and two-sample t-tests compared baseline patient characteristics. Modified Poisson regression estimated relative risks of moderate, severe, or very severe (MSVS) symptom severity, and chemotherapy-related adverse events.Please check and confirm that the authors and their respective affiliations have been correctly identified and amend if necessary.no changes RESULTS: In 294 patients accrued between 2014 and 2020, mean age was 58 (SD13) and 23% were Black. For anthracycline-based regimens, the only significant difference in MSVS symptoms was in lymphedema (41% Black vs 20% White, p = .04) after controlling for axillary surgery. For non-anthracycline regimens, the only significant difference was MSVS peripheral neuropathy (41% Blacks vs. 23% White) after controlling for taxane type (p = .05) and diabetes (p = .05). For all other symptoms, severity scores were similar. Dose reduction differed significantly for non-anthracycline regimens (49% Black vs. 25% White, p = .01), but not for anthracycline regimens or in dose delay, early treatment discontinuation, or hospitalization for either regimen. CONCLUSION Except for lymphedema and peripheral neuropathy, Black and White patients reported similar symptom severity during adjuvant chemotherapy. Dose reductions in Black patients were more common for non-anthracycline regimens. In this sample, there were minimal differences in patient-reported symptoms and other adverse outcomes in Black versus White patients.
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Affiliation(s)
- K A Nyrop
- Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA. .,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - E M Damone
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S B Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Charlot
- Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - B B Reeve
- Duke University School of Medicine, Durham, NC, USA
| | - E Basch
- Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S S Shachar
- Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L A Carey
- Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K E Reeder-Hayes
- Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - E C Dees
- Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - T A Jolly
- Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - G G Kimmick
- Duke University School of Medicine, Durham, NC, USA
| | - M S Karuturi
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - R E Reinbolt
- Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - J C Speca
- Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA
| | - W A Wood
- Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - H B Muss
- Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kowalchuk RO, Hillman D, Daniels TB, Vargas CE, Rwigema JCM, Wong WW, Stish BJ, Dueck AC, Choo R. Assessing concordance between patient-reported and investigator-reported CTCAE after proton beam therapy for prostate cancer. Clin Transl Radiat Oncol 2021; 31:34-41. [PMID: 34604551 PMCID: PMC8463742 DOI: 10.1016/j.ctro.2021.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/27/2021] [Accepted: 09/08/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE We report acute patient-reported outcomes using CTCAE (PRO-CTCAE) of proton beam radiotherapy for high-risk or unfavorable intermediate-risk prostate cancer in a prospective clinical trial. PRO-CTCAE were correlated with investigator reported-CTCAE (IR-CTCAE) to assess the degree of concordance. METHODS AND MATERIALS 11 PRO-CTCAE questions assessed gastrointestinal (GI), genitourinary (GU), or erectile function side effects. The correlation scheme between PRO-CTCAE and IR-CTCAE was independently developed by two physicians. Analyses of PRO-CTCAE and IR-CTCAE were conducted using both descriptive terms and the converted grade scores. The Kappa statistic described the degree of concordance. RESULTS 55 patients were included. IR-CTCAE underestimated diarrhea compared to PRO-CTCAE at the end of treatment (EOT), with a 28% rate of underestimation (11% by ≥ 2 toxicity grades). Similarly, urinary tract pain was underestimated in 45% of cases (17% by ≥ 2 grades) at EOT. Differences were less pronounced at baseline or 3 months after radiotherapy. The incidence of urinary urgency and frequency tended to be overestimated prior to treatment (36% and 24%, respectively) but underestimated at EOT (35% and 31%, respectively). The degree of interference with daily activities was consistently overestimated by investigators (45%-85%). Finally, erectile dysfunction showed a 36-56% rate of discordance by ≥ 2 toxicity grades. CONCLUSIONS Our study shows a low agreement between IR-CTCAE and PRO-CTCAE in the setting of proton therapy for prostate cancer. Compared to patient-reported outcomes, physicians underestimated the frequency and severity of urinary symptoms and diarrhea at the end of treatment. Continued use of PROs should be strongly encouraged.
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Affiliation(s)
| | - David Hillman
- Department of Statistics, Mayo Clinic, Rochester, MN, USA
| | - Thomas B. Daniels
- Department of Radiation Oncology, NYU Langone Health, New York, NY, USA,Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Carlos E. Vargas
- Department of Radiation Oncology, NYU Langone Health, New York, NY, USA,Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Jean-Claude M. Rwigema
- Department of Radiation Oncology, NYU Langone Health, New York, NY, USA,Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - William W. Wong
- Department of Radiation Oncology, NYU Langone Health, New York, NY, USA,Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Bradley J. Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Richard Choo
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA,Corresponding author at: Department of Radiation Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA.
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21
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Trojan A, Leuthold N, Thomssen C, Rody A, Winder T, Jakob A, Egger C, Held U, Jackisch C. The Effect of Collaborative Reviews of Electronic Patient-Reported Outcomes on the Congruence of Patient- and Clinician-Reported Toxicity in Cancer Patients Receiving Systemic Therapy: Prospective, Multicenter, Observational Clinical Trial. J Med Internet Res 2021; 23:e29271. [PMID: 34383675 PMCID: PMC8380582 DOI: 10.2196/29271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/13/2021] [Accepted: 06/03/2021] [Indexed: 01/22/2023] Open
Abstract
Background Electronic patient-reported outcomes (ePRO) are a relatively novel form of data and have the potential to improve clinical practice for cancer patients. In this prospective, multicenter, observational clinical trial, efforts were made to demonstrate the reliability of patient-reported symptoms. Objective The primary objective of this study was to assess the level of agreement κ between symptom ratings by physicians and patients via a shared review process in order to determine the future reliability and utility of self-reported electronic symptom monitoring. Methods Patients receiving systemic therapy in a (neo-)adjuvant or noncurative intention setting captured ePRO for 52 symptoms over an observational period of 90 days. At 3-week intervals, randomly selected symptoms were reviewed between the patient and physician for congruency on severity of the grading of adverse events according to the Common Terminology Criteria of Adverse Events (CTCAE). The patient-physician agreement for the symptom review was assessed via Cohen kappa (κ), through which the interrater reliability was calculated. Chi-square tests were used to determine whether the patient-reported outcome was different among symptoms, types of cancer, demographics, and physicians’ experience. Results Among the 181 patients (158 women and 23 men; median age 54.4 years), there was a fair scoring agreement (κ=0.24; 95% CI 0.16-0.33) for symptoms that were entered 2 to 4 weeks before the intended review (first rating) and a moderate agreement (κ=0.41; 95% CI 0.34-0.48) for symptoms that were entered within 1 week of the intended review (second rating). However, the level of agreement increased from moderate (first rating, κ=0.43) to substantial (second rating, κ=0.68) for common symptoms of pain, fever, diarrhea, obstipation, nausea, vomiting, and stomatitis. Similar congruency levels of ratings were found for the most frequently entered symptoms (first rating: κ=0.42; second rating: κ=0.65). The symptom with the lowest agreement was hair loss (κ=–0.05). With regard to the latency of symptom entry into the review, hardly any difference was demonstrated between symptoms that were entered from days 1 to 3 and from days 4 to 7 before the intended review (κ=0.40 vs κ=0.39, respectively). In contrast, for symptoms that were entered 15 to 21 days before the intended review, no congruency was demonstrated (κ=–0.15). Congruency levels seemed to be unrelated to the type of cancer, demographics, and physicians’ review experience. Conclusions The shared monitoring and review of symptoms between patients and clinicians has the potential to improve the understanding of patient self-reporting. Our data indicate that the integration of ePRO into oncological clinical research and continuous clinical practice provides reliable information for self-empowerment and the timely intervention of symptoms. Trial Registration ClinicalTrials.gov NCT03578731; https://clinicaltrials.gov/ct2/show/NCT03578731
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Affiliation(s)
| | - Nicolas Leuthold
- Clinic for Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
| | | | - Achim Rody
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Thomas Winder
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.,University of Zurich, Zurich, Switzerland
| | - Andreas Jakob
- Tumor Zentrum Aarau, Hirslanden Medical Center, Aarau, Switzerland
| | | | - Ulrike Held
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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22
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Flannery MA, Culakova E, Canin BE, Peppone L, Ramsdale E, Mohile SG. Understanding Treatment Tolerability in Older Adults With Cancer. J Clin Oncol 2021; 39:2150-2163. [PMID: 34043433 PMCID: PMC8238902 DOI: 10.1200/jco.21.00195] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/15/2021] [Accepted: 04/05/2021] [Indexed: 01/03/2023] Open
Affiliation(s)
- Marie A. Flannery
- University of Rochester Medical Center, School of Nursing, Rochester, NY
| | - Eva Culakova
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Beverly E. Canin
- SCOREboard Stakeholder Advisory Group, University of Rochester Medical Center, Rochester, NY
| | - Luke Peppone
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Erika Ramsdale
- Department of Medicine, University of Rochester, Rochester, NY
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23
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Nyrop KA, Deal AM, Chen YT, Reeve BB, Basch EM, Wood WA, Shachar SS, Carey LA, Reeder-Hayes KE, Dees EC, Jolly TA, Kimmick GG, Karuturi MS, Reinbolt RE, Speca JC, Lee JT, Brenizer A, Muss HB. Patient-reported symptom severity, interference with daily activities, and adverse events in older and younger women receiving chemotherapy for early breast cancer. Cancer 2020; 127:957-967. [PMID: 33216355 DOI: 10.1002/cncr.33329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/01/2020] [Accepted: 10/23/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND To the authors' knowledge, it is unknown whether patient-reported symptom severity and symptom interference with daily activities differ between younger (aged <65 years) and older (aged ≥65 years) women receiving similar chemotherapy regimens for early breast cancer (EBC). METHODS Study participants rated 17 side effects of chemotherapy regimens currently in use in clinical practice (2014-2019). RESULTS Of 284 women with EBC (stage I-III), approximately 57% were aged <65 years and 43% were aged ≥65 years. For anthracycline-based regimens, a higher percentage of younger women reported moderate, severe, or very severe (MSVS) hot flashes (49% vs 18%) (P < .001). For nonanthracycline regimens, a higher percentage of younger women reported MSVS hot flashes (38% vs 19%) (P = .009) and a lower percentage reported MSVS arthralgia (28% vs 49%) (P = .005). With regard to symptom interference with daily activities, a higher percentage of younger women being treated with anthracycline-based regimens reported MSVS hot flashes (32% vs 7%) (P = .001) and myalgia (38% vs 18%) (P = .02). For nonanthracycline chemotherapy, a higher percentage of younger women reported MSVS interference for hot flashes (26% vs 9%) (P = .006) and lower percentages reported abdominal pain (13% vs 28%) (P = .02). Overall, there were no significant differences noted among younger versus older patients with regard to hospitalizations (19% vs 12%; P = .19), dose reductions (34% vs 31%; P = .50), dose delays (22% vs 25%; P = .59), or early treatment discontinuation (16% vs 16%; P = .9546). CONCLUSIONS Older and younger women with EBC who were treated with identical chemotherapy regimens generally experienced similar levels of symptom severity, symptom-related interference with daily activities, and adverse events. LAY SUMMARY In this study, women receiving chemotherapy for early breast cancer rated the severity of 17 symptoms and symptom interference with their activities of daily living. Older (aged ≥65 years) and younger (aged <65 years) women who received identical chemotherapy regimens generally experienced similar levels of symptom severity, symptom-related interference with daily activities, and adverse events.
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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
| | - Yi Tang Chen
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Bryce B Reeve
- Duke University School of Medicine, Durham, North Carolina
| | - Ethan M 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
| | - 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
| | | | - 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
| | - E Claire 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
| | | | | | | | - 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
| | - Addison Brenizer
- 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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