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Northrop A, Christofferson A, Umashankar S, Melisko M, Castillo P, Brown T, Heditsian D, Brain S, Simmons C, Hieken T, Ruddy KJ, Mainor C, Afghahi A, Tevis S, Blaes A, Kang I, Asare A, Esserman L, Hershman DL, Basu A. Implementation and impact of an electronic patient reported outcomes system in a phase II multi-site adaptive platform clinical trial for early-stage breast cancer. J Am Med Inform Assoc 2024:ocae190. [PMID: 39158353 DOI: 10.1093/jamia/ocae190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/30/2024] [Accepted: 07/08/2024] [Indexed: 08/20/2024] Open
Abstract
OBJECTIVES We describe the development and implementation of a system for monitoring patient-reported adverse events and quality of life using electronic Patient Reported Outcome (ePRO) instruments in the I-SPY2 Trial, a phase II clinical trial for locally advanced breast cancer. We describe the administration of technological, workflow, and behavior change interventions and their associated impact on questionnaire completion. MATERIALS AND METHODS Using the OpenClinica electronic data capture system, we developed rules-based logic to build automated ePRO surveys, customized to the I-SPY2 treatment schedule. We piloted ePROs at the University of California, San Francisco (UCSF) to optimize workflow in the context of trial treatment scenarios and staggered rollout of the ePRO system to 26 sites to ensure effective implementation of the technology. RESULTS Increasing ePRO completion requires workflow solutions and research staff engagement. Over two years, we increased baseline survey completion from 25% to 80%. The majority of patients completed between 30% and 75% of the questionnaires they received, with no statistically significant variation in survey completion by age, race or ethnicity. Patients who completed the screening timepoint questionnaire were significantly more likely to complete more of the surveys they received at later timepoints (mean completion of 74.1% vs 35.5%, P < .0001). Baseline PROMIS social functioning and grade 2 or more PRO-CTCAE interference of Abdominal Pain, Decreased Appetite, Dizziness and Shortness of Breath was associated with lower survey completion rates. DISCUSSION AND CONCLUSION By implementing ePROs, we have the potential to increase efficiency and accuracy of patient-reported clinical trial data collection, while improving quality of care, patient safety, and health outcomes. Our method is accessible across demographics and facilitates an ease of data collection and sharing across nationwide sites. We identify predictors of decreased completion that can optimize resource allocation by better targeting efforts such as in-person outreach, staff engagement, a robust technical workflow, and increased monitoring to improve overall completion rates. TRIAL REGISTRATION https://clinicaltrials.gov/study/NCT01042379.
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Affiliation(s)
- Anna Northrop
- Department of Surgery, University of California San Francisco, San Francisco, CA 94158, United States
| | - Anika Christofferson
- Department of Surgery, University of California San Francisco, San Francisco, CA 94158, United States
| | - Saumya Umashankar
- Department of Surgery, University of California San Francisco, San Francisco, CA 94158, United States
| | - Michelle Melisko
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA 94158, United States
| | - Paolo Castillo
- Department of Surgery, University of California San Francisco, San Francisco, CA 94158, United States
| | - Thelma Brown
- Patient Advocate, Breast Science Advocacy Core, University of California San Francisco, San Francisco, CA 94158, United States
| | - Diane Heditsian
- Patient Advocate, Breast Science Advocacy Core, University of California San Francisco, San Francisco, CA 94158, United States
| | - Susie Brain
- Patient Advocate, Breast Science Advocacy Core, University of California San Francisco, San Francisco, CA 94158, United States
| | - Carol Simmons
- Patient Advocate, Breast Science Advocacy Core, University of California San Francisco, San Francisco, CA 94158, United States
| | - Tina Hieken
- Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN 55905, United States
| | - Kathryn J Ruddy
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, United States
| | - Candace Mainor
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, United States
| | - Anosheh Afghahi
- Department of Medicine, University of Colorado, Aurora, CO 80045, United States
| | - Sarah Tevis
- Department of Surgery, University of Colorado, Aurora, CO 80045, United States
| | - Anne Blaes
- Department of Medicine, Division of Hematology/Oncology, University of Minnesota, Minneapolis, MN 55455, United States
| | - Irene Kang
- Department of Medical Oncology & Therapeutics Research, City of Hope Orange County, Irvine, CA 92618, United States
- Department of Medicine, University of Southern California, Los Angeles, CA 90089, United States
| | - Adam Asare
- Department of Surgery, University of California San Francisco, San Francisco, CA 94158, United States
- Quantum Leap Healthcare Collaborative, San Francisco, CA 94158, United States
| | - Laura Esserman
- Department of Surgery, University of California San Francisco, San Francisco, CA 94158, United States
| | - Dawn L Hershman
- Division of Hematology/Oncology, Department of Medicine, Columbia University, New York, NY 10032, United States
| | - Amrita Basu
- Department of Surgery, University of California San Francisco, San Francisco, CA 94158, United States
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Chen X, Chaimongkol N, Hengudomsub P. Effects of a Phone-Based Support Program for Women With Breast Cancer Undergoing Chemotherapy: A Pilot Study. SAGE Open Nurs 2024; 10:23779608241231176. [PMID: 38415216 PMCID: PMC10898293 DOI: 10.1177/23779608241231176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/21/2023] [Accepted: 01/20/2024] [Indexed: 02/29/2024] Open
Abstract
Introduction The increasing number of women with breast cancer undergoing chemotherapy may result in long-lasting, adverse physical side effects and reduced quality of life. Objective This study aimed to develop and assess the feasibility and preliminary effects of the Phone-Based Support Program for women with breast cancer undergoing chemotherapy. The primary outcome was self-care self-efficacy; secondary outcomes were symptom distress and quality of life. Methods This pilot study was conducted at a tertiary hospital in Jiangsu province, China, from February to March 2023. The Phone-Based Support Program was delivered to 20 participants through the smartphone application WeChat, consisting of learning, discussion, ask-the-expert, and personal stories components. Outcome measures were assessed at three time points: preintervention, postintervention, and follow-up. Results The Phone-Based Support Program was feasible and could improve self-care self-efficacy, decrease symptom distress, and promote quality of life. The program was well-accepted, and participants engaged actively in the online discussion and sought expert advice. Conclusions The Phone-Based Support Program showed feasibility and effectiveness in improving self-care self-efficacy, reducing symptom distress, and enhancing quality of life.
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Affiliation(s)
- Xi Chen
- Faculty of Nursing, Burapha University, Chon Buri, Thailand
- Yancheng NO.1 People's Hospital in Jiangsu, Jiangsu, China
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Cristian A, Rubens M, Cristian C, Wang G, Mendez J. Characterization of Physical Function and Cancer-Related Physical Impairments in Hispanic Women With Breast Cancer: A Descriptive Study. HISPANIC HEALTH CARE INTERNATIONAL 2023; 21:195-202. [PMID: 37340714 DOI: 10.1177/15404153231183447] [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] [Indexed: 06/22/2023]
Abstract
Introduction: This study reports characteristics of Hispanic women with breast cancer with respect to physical function, body mass index (BMI), and depression. Methods: This retrospective study included 322 Hispanic women with breast cancer. Physical function and fatigue were assessed using the Patient Reported Outcomes Measurement System-Physical Function (PROMIS-PF) short form and PROMIS-Fatigue (PROMISE-F) short form. In addition, Timed Up and Go (TUG) test, sit to stand in 30 s (STS30) test, four-stage balance test (4SB), and grip strength (GS) were measured. Depression was identified using Patient Health Questionnaire (PHQ)-2 and extracted from medical chart. Results: Nearly 40.8% were obese, and 20.8% had depression. Compared to normal BMI patients, mean PROMIS-F score was significantly higher among overweight and obese patients. The mean STS30 score was significantly lower in obese patients, compared to normal BMI patients. Regression analysis showed that the odds of depression were higher with increasing TUG and lower PROMIS-F, STS30, and GS. Conclusion: Hispanic women with breast cancer have substantial loss of physical function, and this is exaggerated if they are obese, overweight, or depressed. Clinicians caring for this population should screen them for the presence of loss of physical function, BMI, and depression.
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Affiliation(s)
| | - Muni Rubens
- Miami Cancer Institute, Miami, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Universidad Espíritu Santo, Samborondón, Ecuador
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Patient Reported Outcomes in Metastatic Spine Disease: Concurrent Validity of PROMIS with the Spine Oncology Study Group Outcome Questionnaire. Spine (Phila Pa 1976) 2022; 47:591-596. [PMID: 35102119 DOI: 10.1097/brs.0000000000004327] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional prospective study. OBJECTIVE To evaluate the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), Pain Interference (PI), and Depression domains in comparison to the Spine Oncology Study Group-Outcomes Questionnaire (SOSG-OQ) in patients with metastatic spine disease. SUMMARY OF BACKGROUND DATA While there remains a significant movement toward incorporating patient-reported outcome measures (PROMs) into clinical care, there are few validated PROMs for patients with metastatic spine disease. The SOSG-OQ was designed and validated for metastatic spine tumor patients. However, the use of general symptom-based PROMs, such as PROMIS domains, may reduce both patient and physician burden and improve interdisciplinary care if shown to be concurrently valid. METHODS Metastatic spine tumor patients from January 2017 to July 2021 at a single academic medical center were asked to complete PROMIS PF, PI, and Depression domains and the SOSG-OQ. Spearman correlation (p) coefficients were calculated. RESULTS A total of 103 unique visits, representing 79 patients met our inclusion criteria. A majority were men (59; 57%) and Caucasian (93; 90%), and the average age was 64-years-old (range: 34-87). There were 13 different types of histologies reported, with multiple myeloma, breast cancer, and prostate cancer representing 28 (27%), 26 (25%), and 13 (13%), respectively. Additional cancers included renal cell carcinoma, lung cancer, colon cancer, thyroid cancer, large B-cell lymphoma, nonHodgkin lymphoma, esophageal cancer, plasmacytoma, metastatic paraganglioma, and metastatic spindle cell sarcoma. SOSG-OQ was strongly correlated with PROMIS PI (ρ = 0.78) and PROMIS PF (ρ = 0.71), and moderately correlated with PROMIS Depression (ρ = 0.58). CONCLUSION PROMIS PF, PI, and Depression appear to capture similar clinical insight as the SOSG-OQ. Spine surgeons can consider using these PROMIS domains in lieu of the SOSG-OQ in metastatic spine tumor patients. UNLABELLED Level of Evidence: NA.
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Mazanec SR, Park S, Connolly MC, Rosenzweig MQ. Factors associated with symptom distress in women with breast cancer prior to initiation of chemotherapy. Appl Nurs Res 2021; 62:151515. [PMID: 34815009 DOI: 10.1016/j.apnr.2021.151515] [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: 07/16/2021] [Revised: 10/13/2021] [Accepted: 10/17/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Symptom distress in women with breast cancer is associated with early discontinuation of chemotherapy and may influence treatment outcomes. Describing racial differences in prechemotherapy symptom distress and examining contextual variables of the symptom experience may inform our understanding of the complex problem of racial disparities in breast cancer. AIM To determine if perceived social support, healthcare system distrust, and economic hardship predict symptom distress in women with breast cancer prior to their first chemotherapy treatment. DESIGN Descriptive, correlational, cross-sectional. METHODS Baseline data (N = 119) was used from a multisite, longitudinal study comparing the symptom experience and ability to receive chemotherapy of Black and White women with breast cancer (R01MD012245; Rosenzweig, PI). Measures included the Symptom Distress Scale, Interpersonal Support Evaluation List, Health Care System Distrust Scale, and Psychological Sense of Economic Hardship scale. The analysis consisted of multiple regression and a t-test. RESULTS On average, participants reported five symptoms prior to chemotherapy. Black women reported higher symptoms distress than White women; t(68.34) = 2.15, p = 0.035. The model explained 26% of variance in symptom distress; F(5, 112) = 9.01, p < 0.001. While controlling for age and race, greater perceived economic hardship contributed to higher symptom distress (β = 0.36, p = 0.001, 95% CI: 0.34 to 1.34). Race, health care system distrust and social support did not significantly predict symptom distress. CONCLUSION Assessment of perceived financial hardship prior to beginning chemotherapy is critical to identify those patients at risk for greater symptom distress.
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Affiliation(s)
- Susan R Mazanec
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106-4904, United States of America; University Hospitals Seidman Cancer Center, 11100 Euclid Ave., Cleveland, OH 44106, United States of America.
| | - Sumin Park
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106-4904, United States of America.
| | - Mary C Connolly
- School of Nursing, University of Pittsburgh, 3500 Victoria St., Victoria Building, Pittsburgh, PA 15261, United States of America.
| | - Margaret Quinn Rosenzweig
- School of Nursing, University of Pittsburgh, 3500 Victoria St., Victoria Building, Pittsburgh, PA 15261, United States of America; UPMC Hillman Cancer Center, 5115 Centre Ave, Pittsburgh, PA 15232, United States of America.
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Stalpaert J, Miatton M, Sieben A, Van Langenhove T, van Mierlo P, De Letter M. The Electrophysiological Correlates of Phoneme Perception in Primary Progressive Aphasia: A Preliminary Case Series. Front Hum Neurosci 2021; 15:618549. [PMID: 34149376 PMCID: PMC8206281 DOI: 10.3389/fnhum.2021.618549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 04/30/2021] [Indexed: 12/03/2022] Open
Abstract
Aims: This study aimed to investigate phoneme perception in patients with primary progressive aphasia (PPA) by using the event-related potential (ERP) technique. These ERP components might contribute to the diagnostic process of PPA and its clinical variants (NFV: nonfluent variant, SV: semantic variant, LV: logopenic variant) and reveal insights about phoneme perception processes in these patients. Method: Phoneme discrimination and categorization processes were investigated by the mismatch negativity (MMN) and P300 in eight persons with early- and late-stage PPA (3 NFV, 2 LV, 2 SV, and 1 PPA-NOS; not otherwise specified) and 30 age-matched healthy adults. The mean amplitude, the onset latency, and the topographic distribution of both components in each patient were compared to the results of the control group. Results: The MMN was absent or the onset latency of the MMN was delayed in the patients with the NFV, LV, and PPA-NOS in comparison to the control group. In contrast, no differences in mean amplitudes and onset latencies of the MMN were found between the patients with the SV and the control group. Concerning the P300, variable results were found in the patients with the NFV, SV, and PPA-NOS, but the P300 of both patients with the LV was delayed and prolonged with increased mean amplitude in comparison to the control group. Conclusion: In this preliminary study, phoneme discrimination deficits were found in the patients with the NFV and LV, and variable deficits in phoneme categorization processes were found in all patients with PPA. In clinical practice, the MMN might be valuable to differentiate the SV from the NFV and the LV and the P300 to differentiate the LV from the NFV and the SV. Further research in larger and independent patient groups is required to investigate the applicability of these components in the diagnostic process and to determine the nature of these speech perception deficits in the clinical variants of PPA.
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Affiliation(s)
- Jara Stalpaert
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Marijke Miatton
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Anne Sieben
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | | | - Pieter van Mierlo
- Department of Electronics and Information Systems, Medical Image and Signal Processing Group, Ghent University, Ghent, Belgium
| | - Miet De Letter
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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