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Chung KC, Muthutantri A, Goldsmith GG, Watts MR, Brown AE, Patrick DL. Symptom impact and health-related quality of life (HRQoL) assessment by cancer stage: a narrative literature review. BMC Cancer 2024; 24:884. [PMID: 39039461 PMCID: PMC11265440 DOI: 10.1186/s12885-024-12612-z] [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: 12/22/2023] [Accepted: 07/08/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Cancer stage at diagnosis is an important prognostic indicator for patient outcomes, with detection at later stages associated with increased mortality and morbidity. The impact of cancer stage on patient-reported outcomes is poorly understood. This research aimed to understand symptom burden and health related quality of life (HRQoL) impact by cancer stage for ten cancer types: 1) ovarian, 2) lung, 3) pancreatic, 4) esophageal, 5) stomach, 6) head and neck, 7) colorectal, 8) anal, 9) cervical, and 10) liver and bile duct. METHODS Ten narrative literature reviews were performed to identify and collate published literature on patient burden at different stages of disease progression. Literature searches were conducted using an AI-assisted platform to identify relevant articles published in the last five (2017-2022) or ten years (2012-2022) where articles were limited. Conference abstracts were searched for the last two years (2020-2022). The geographic scope was limited to the United States, Canada, Europe, and global studies, and only journal articles written in English were included. RESULTS A total of 26 studies with results stratified by cancer stage at diagnosis (and before treatment) were selected for the cancer types of lung, pancreatic, esophageal, stomach, head and neck, colorectal, anal, and cervical cancers. Two cancer types, ovarian cancer, and liver and bile duct cancer did not return any search results with outcomes stratified by disease stage. A general trend was observed for worse patient-reported outcomes in patients with cancer diagnosed at an advanced stage of disease compared with diagnosis at an earlier stage. Advanced disease stage was associated with greater symptom impact including general physical impairments such as pain, fatigue, and interference with functioning, as well as disease/region-specific symptom burden. Poorer HRQoL was also associated with advanced disease with commonly reported symptoms including anxiety and depression. CONCLUSIONS Overall, the general trend for greater symptom burden and poorer HRQoL seen in late stage versus early-stage disease across the included cancer types supports the importance for early diagnosis and treatment to improve patient survival and decrease negative impacts on disease burden and HRQoL.
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Affiliation(s)
- Karen C Chung
- GRAIL, Inc., 1525 O'Brien Dr, Menlo Park, CA, 94025, USA.
| | | | - Grace G Goldsmith
- Genesis Research Group, West One, Forth Banks, Newcastle upon Tyne, NE1 3PA, UK
| | - Megan R Watts
- Genesis Research Group, West One, Forth Banks, Newcastle upon Tyne, NE1 3PA, UK
| | - Audrey E Brown
- Genesis Research Group, West One, Forth Banks, Newcastle upon Tyne, NE1 3PA, UK
| | - Donald L Patrick
- University of Washington, 1959 NE Pacific St, Box 357660, Seattle, WA, 98195, USA
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Viñolas N, Mezquita L, Corral J, Cobo M, Gil-Moncayo F, Paz-Ares L, Remon J, Rodríguez M, Ruano-Raviña A, Conde E, Majem M, Garrido P, Felip E, Isla D, de Castro J. The role of sex and gender in the diagnosis and treatment of lung cancer: the 6th ICAPEM Annual Symposium. Clin Transl Oncol 2024; 26:352-362. [PMID: 37490262 DOI: 10.1007/s12094-023-03262-x] [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: 02/28/2023] [Accepted: 06/20/2023] [Indexed: 07/26/2023]
Abstract
The incidence and mortality of lung cancer in women are rising, with both increasing by 124% between 2003 and 2019. The main risk factor for lung cancer is tobacco use, but indoor radon gas exposure is one of the leading causes in nonsmokers. The most recent evidence demonstrates that multiple factors can make women more susceptible to harm from these risk factors or carcinogens. For this consensus statement, the Association for Lung Cancer Research in Women (ICAPEM) invited a group of lung cancer experts to perform a detailed gender-based analysis of lung cancer. Clinically, female patients have different lung cancer profiles, and most actionable driver alterations are more prevalent in women, particularly in never-smokers. Additionally, the impact of certain therapies seems to be different. In the future, it will be necessary to carry out specific studies to improve the understanding of the role of certain biomarkers and gender in the prognosis and evolution of lung cancer.
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Affiliation(s)
- Nuria Viñolas
- Department of Medical Oncology, Barcelona Clinic Hospital, Translational Genomics and Targeted Therapies in Solid Tumours, IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - Laura Mezquita
- Department of Medical Oncology, Barcelona Clinic Hospital, Translational Genomics and Targeted Therapies in Solid Tumours, IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Jesús Corral
- Department of Medical Oncology, Jerez de la Frontera University Hospital, Cádiz, Spain
| | - Manuel Cobo
- Department of Medical Oncology, Virgen de la Victoria University Hospital, Málaga, Spain
| | - Francisco Gil-Moncayo
- Department of Psycho-Oncology, Catalan Institute of Oncology-Hospitalet, Barcelona, Spain
| | - Luis Paz-Ares
- Department of Medical Oncology, 12 de Octubre University Hospital, Madrid, Spain
| | - Jordi Remon
- Department of Medical Oncology, HM Nou Delfos Hospital, Barcelona, Spain
| | - María Rodríguez
- Department of Thoracic Surgery, Clínica Universidad de Navarra, Madrid, Spain
| | - Alberto Ruano-Raviña
- Department of Medicine and Public Health, Santiago de Compostela University, Santiago de Compostela, Spain
| | - Esther Conde
- Pathology Department, 12 de Octubre University Hospital, Universidad Complutense de Madrid, Research Institute 12 de Octubre University Hospital (Imas12), CIBERONC, Madrid, Spain
| | - Margarita Majem
- Department of Medical Oncology, Santa Creu y Sant Pau University Hospital, Barcelona, Spain
| | - Pilar Garrido
- Department of Medical Oncology, Ramón y Cajal University Hospital, Madrid, Spain
| | - Enriqueta Felip
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Dolores Isla
- Department of Medical Oncology, Lozano Blesa University Clinical Hospital, Saragossa, Spain
| | - Javier de Castro
- Department of Medical Oncology, La Paz University Hospital, Madrid, Spain
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Servetto A, Di Maio M, Salomone F, Napolitano F, Paratore C, Di Costanzo F, Viscardi G, Santaniello A, Formisano L, Bianco R. Analysis of phase III clinical trials in metastatic NSCLC to assess the correlation between QoL results and survival outcomes. BMC Med 2023; 21:234. [PMID: 37400832 DOI: 10.1186/s12916-023-02953-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND In addition to improving survival outcomes, new oncology treatments should lead to amelioration of patients' quality of life (QoL). Herein, we examined whether QoL results correlated with PFS and OS outcomes in phase III randomized controlled trials (RCTs) investigating new systemic treatments in metastatic non-small cell lung cancer (NSCLC). METHODS The systematic search of PubMed was conducted in October 2022. We identified 81 RCTs testing novel drugs in metastatic NSCLC and published in the English language in a PubMed-indexed journal between 2012 and 2021. Only trials reporting QoL results and at least one survival outcome between OS and PFS were selected. For each RCT, we assessed whether global QoL was "superior," "inferior," or with "non-statistically significant difference" in the experimental arm compared to the control arm. RESULTS Experimental treatments led to superior QoL in 30 (37.0%) RCTs and inferior QoL in 3 (3.7%) RCTs. In the remaining 48 (59.3%) RCTs, a statistically significant difference between the experimental and control arms was not found. Of note, we found a statistically significant association between QoL and PFS improvements (X2 = 3.93, p = 0.0473). In more detail, this association was not significant in trials testing immunotherapy or chemotherapy. On the contrary, in RCTs testing target therapies, QoL results positively correlated with PFS outcomes (p = 0.0196). This association was even stronger in the 32 trials testing EGFR or ALK inhibitors (p = 0.0077). On the other hand, QoL results did not positively correlate with OS outcomes (X2 = 0.81, p = 0.368). Furthermore, we found that experimental treatments led to superior QoL in 27/57 (47.4%) trials with positive results and in 3/24 (12.5%) RCTs with negative results (p = 0.0028). Finally, we analyzed how QoL data were described in publications of RCTs in which QoL outcomes were not improved (n = 51). We found that a favorable description of QoL results was associated with sponsorship by industries (p = 0.0232). CONCLUSIONS Our study reveals a positive association of QoL results with PFS outcomes in RCTs testing novel treatments in metastatic NSCLC. This association is particularly evident for target therapies. These findings further emphasize the relevance of an accurate assessment of QoL in RCTs in NSCLC.
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Affiliation(s)
- Alberto Servetto
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, Naples, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Division of Medical Oncology, Ordine Mauriziano Hospital, Turin, Italy
| | - Fabio Salomone
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, Naples, Italy
| | - Fabiana Napolitano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, Naples, Italy
| | - Chiara Paratore
- Department of Oncology, University of Turin, Division of Medical Oncology, Ordine Mauriziano Hospital, Turin, Italy
- Department of Oncology, ASL TO4, Ivrea Community Hospital, Ivrea, Italy
| | - Fabrizio Di Costanzo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, Naples, Italy
| | - Giuseppe Viscardi
- Department of Pneumology and Oncology, AORN Ospedali Dei Colli-Monaldi, Naples, Italy
| | - Antonio Santaniello
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, Naples, Italy
| | - Luigi Formisano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, Naples, Italy
| | - Roberto Bianco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, Naples, Italy.
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Ozdilekcan C, Turkkani MH, Ozdemir T, Goksel F, Akyol M. Determination of the factors contributing to depression and anxiety in advanced stage lung cancer patients. J Cancer Res Ther 2023; 19:359-365. [PMID: 37313911 DOI: 10.4103/jcrt.jcrt_967_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background The diagnosis of cancer and initiation of treatment disrupt physical, emotional, and socio-economical stability of the patients by reducing the quality of lives and ultimately leading to depression and anxiety. We aimed to observe the indicators for anxiety and depression among lung cancer (LC) patients by comparing with other cancer (OC) patients. Methods This study has been conducted between 2017 and 2019. Questionnaires were provided for both LC and OC patients. Results Two hundred and thirty patients with the ages varied between 18 and 86 (median: 64.0) were included in the study. A total of 115 patients (case group) were diagnosed as LC, and the remaining were with OC diagnosis (control). No difference was determined between the groups in means of median anxiety and depression scores. Patients who required assistance in hospital procedures, daily life activities, and self-care had higher depression and anxiety scores (p < 0.05) compared to those did not require assistance. Anxiety and depression scores in OC groups showed a remarkable difference according to performance status (p < 0.001). The depression score of the patients who stated that they did not know their social rights was remarkably higher than those of the patients who stated that they know their social rights. We found no relationship between depression and anxiety scores because of disease caused income loss and expense increase. Conclusion For LC patients, declaration of requirement for assistance and supportive care in daily life can be an important indication for anxiety and depression. Lung cancer patients, especially those informed by health care professionals and provided psychosocial support following the information, require a patient-specific professional management approach.
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Affiliation(s)
- Cigdem Ozdilekcan
- Department of Pulmonology, University of Health Sciences Dr. Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey
| | - Mustafa H Turkkani
- Department of Pulmonology, Sincan Dr. Nafiz Körez State Hospital, Ankara, Turkey
| | - Tarkan Ozdemir
- Department of Pulmonology, University of Health Sciences Dr. Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey
| | - Fatih Goksel
- Department of Radiation Oncology, University of Health Sciences Dr. Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey
| | - Mesut Akyol
- Department of Department of Biostatistics, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
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Salomone F, Di Costanzo F, Pecoraro G, Viscardi G, Viggiano A, Napolitano F, Santaniello A, Formisano L, Bianco R, Servetto A. Health-related quality of life is underestimated and underreported in phase III clinical trials in NSCLC. Lung Cancer 2022; 174:36-44. [PMID: 36302311 DOI: 10.1016/j.lungcan.2022.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/07/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
Major associations of medical oncologists remark that novel anticancer treatments should guarantee improvement of survival outcomes as well as of patients' quality of life (QoL). Herein, we investigated QoL assessment and reporting in phase III randomized controlled trials (RCTs) testing new drugs in metastatic non-small cell lung cancer (NSCLC), published between 2010 and 2021. We selected 172 RCTs for further analysis. Only 2/172 (1.2%) trial included QoL among primary study endpoints. Of note, 40/172 (23.3%) trials did not include QoL assessment among endpoints. The majority of RCTs (102/172, 59.3%) did not report QoL results in primary publications. Particularly, RCTs testing immunotherapy, target therapy and chemotherapy did not disclose QoL data in primary publications in 97.0%, 51.5% and 46.5% of cases, respectively. Next, we found that only 43/95 (45.3%) positive studies reported QoL results in primary articles. Of the 102 trials missing QoL data in primary manuscripts, only 21 (20.6%) disclosed QoL results in a secondary publication. Finally, we found a common fail in adherence to CONSORT-PROs items in publications reporting QoL results. In summary, our study reveals a relevant inadequate assessment and under-reporting of QoL in RCTs of novel systemic treatments for patients with metastatic NSCLC.
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Affiliation(s)
- Fabio Salomone
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabrizio Di Costanzo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giovanna Pecoraro
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe Viscardi
- Department of Pneumology and Oncology, AORN Ospedali dei Colli-Monaldi, Naples, Italy
| | - Angela Viggiano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabiana Napolitano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Antonio Santaniello
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luigi Formisano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Roberto Bianco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
| | - Alberto Servetto
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
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6
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Emidio OM, Cutrona SL, Person SD, Mazor KM, Frisard C, Lemon SC. Association of neighborhood-level social determinants of health with psychosocial distress in patients newly diagnosed with lung cancer. Cancer Rep (Hoboken) 2022; 5:e1734. [PMID: 36250328 PMCID: PMC9675366 DOI: 10.1002/cnr2.1734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND AIM Patients with lung cancer experience high rates of psychosocial distress. They are also more likely to have unresolved, unmet social needs which may contribute to psychosocial distress. Despite this, neighborhood-level social determinants of health (SDOH) in relation to psychosocial distress have not been adequately investigated in patients with lung cancer. The goal of this study is to examine the association between neighborhood-level SDOH and psychosocial distress among a sample of newly diagnosed patients with lung cancer. METHODS This cross-sectional study included newly diagnosed, adult lung cancer patients from an accredited cancer center. Psychosocial distress was measured with the Distress Thermometer. Neighborhood-level SDOH indicators for income and education were used to create a composite SDOH variable categorized into low, medium, and high deprivation levels. Covariates were age, gender, race/ethnicity, comorbidity index, cancer stage, and insurance status. Using multivariate logistic regression modeling, the association of psychosocial distress with the neighborhood-level SDOH was examined. RESULTS The prevalence of psychosocial distress in the sample was 58.4%. Neighborhood-level SDOH indicators were not significantly associated with psychosocial distress. Higher odds of psychosocial distress were significantly associated with being female and having distant or regional cancer versus localized cancer. The age group 66-75 years was significantly associated with lower distress compared with those aged <65 years. CONCLUSIONS Psychosocial distress was consistently high across all the SDOH deprivation categories; but these neighborhood-level SDOH indicators do not appear to be predictive of psychosocial distress at the time of diagnosis of lung cancer.
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Affiliation(s)
- Oluwabunmi M Emidio
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Sarah L Cutrona
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Sharina D Person
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Kathleen M Mazor
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Christine Frisard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Stephenie C Lemon
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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7
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Jang H, Lee K, Kim S, Kim S. Unmet needs in palliative care for patients with common non-cancer diseases: a cross-sectional study. Palliat Care 2022; 21:151. [PMID: 36038840 PMCID: PMC9426270 DOI: 10.1186/s12904-022-01040-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background Non-cancer patients experience the chronic process of disease that increases the patients’ suffering as well as families’ care burden. Although two-thirds of deaths are caused by non-cancer diseases, there is a lack of studies on palliative care for non-cancer patients. This study identified the palliative care needs and satisfaction, anxiety and depression, and health-related quality of life (HRQOL) of non-cancer patients and identified the factors influencing their HRQOL. Methods A cross-sectional survey design was employed. Participants were 114 non-cancer patients with chronic heart failure, stroke, end-stage renal disease, or end-stage liver disease who were admitted to the general ward of a tertiary hospital in South Korea. Measures included the Palliative Care Needs and Satisfaction Scale, the Hospital Anxiety and Depression Scale, and the Medical Outcome Study 36-items Short Form Health Survey version 2. Data were analysed with descriptive statistics, independent t-tests, analyses of variance, Pearson’s correlations, and multiple linear regression analyses. Results The average score of palliative care needs was 3.66 ± 0.62, which falls between ‘moderate’ and ‘necessary’. Among the four domains, the average score of palliative care needs in the psychosocial domain was the highest: 3.83 ± 0.67. Anxiety was nearly in the normal range (7.48 ± 3.60; normal range = 0–7) but depression was higher than normal (9.17 ± 3.71; normal range = 0–7). Similar to patients with cancer, physical HRQOL (38.89 ± 8.69) and mental HRQOL (40.43 ± 11.19) were about 80% of the general population’s score (50 points). Duration of disease and physical performance were significant factors associated with physical HRQOL, whereas physical performance, anxiety, and depression were significant factors associated with mental HRQOL. Conclusion It is necessary to maintain non-cancer patients’ physical performance and assess and manage their mental health in advance for effective palliative care. This study provides relevant information that can be used to develop a tailored palliative care model for non-cancer patients.
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Affiliation(s)
- Hyoeun Jang
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Kyunghwa Lee
- College of Nursing, Konyang University, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, Republic of Korea
| | - Sookyung Kim
- School of Nursing, Soonchunhyang University, 50, Suncheonhyang 4-gil, Dongnam-gu, Chungcheongnam-do, 31151, Cheonan-si, Republic of Korea
| | - Sanghee Kim
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.
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Govindan R, Aggarwal C, Antonia SJ, Davies M, Dubinett SM, Ferris A, Forde PM, Garon EB, Goldberg SB, Hassan R, Hellmann MD, Hirsch FR, Johnson ML, Malik S, Morgensztern D, Neal JW, Patel JD, Rimm DL, Sagorsky S, Schwartz LH, Sepesi B, Herbst RS. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of lung cancer and mesothelioma. J Immunother Cancer 2022; 10:jitc-2021-003956. [PMID: 35640927 PMCID: PMC9157337 DOI: 10.1136/jitc-2021-003956] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 12/24/2022] Open
Abstract
Immunotherapy has transformed lung cancer care in recent years. In addition to providing durable responses and prolonged survival outcomes for a subset of patients with heavily pretreated non-small cell lung cancer (NSCLC), immune checkpoint inhibitors (ICIs)— either as monotherapy or in combination with other ICIs or chemotherapy—have demonstrated benefits in first-line therapy for advanced disease, the neoadjuvant and adjuvant settings, as well as in additional thoracic malignancies such as small-cell lung cancer (SCLC) and mesothelioma. Challenging questions remain, however, on topics including therapy selection, appropriate biomarker-based identification of patients who may derive benefit, the use of immunotherapy in special populations such as people with autoimmune disorders, and toxicity management. Patient and caregiver education and support for quality of life (QOL) is also important to attain maximal benefit with immunotherapy. To provide guidance to the oncology community on these and other important concerns, the Society for Immunotherapy of Cancer (SITC) convened a multidisciplinary panel of experts to develop a clinical practice guideline (CPG). This CPG represents an update to SITC’s 2018 publication on immunotherapy for the treatment of NSCLC, and is expanded to include recommendations on SCLC and mesothelioma. The Expert Panel drew on the published literature as well as their clinical experience to develop recommendations for healthcare professionals on these important aspects of immunotherapeutic treatment for lung cancer and mesothelioma, including diagnostic testing, treatment planning, immune-related adverse events, and patient QOL considerations. The evidence- and consensus-based recommendations in this CPG are intended to give guidance to cancer care providers using immunotherapy to treat patients with lung cancer or mesothelioma.
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Affiliation(s)
- Ramaswamy Govindan
- Department of Medicine, Oncology Division, Medical Oncology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Charu Aggarwal
- Division of Hematology-Oncology, Department of Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scott J Antonia
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute Center for Cancer Immunotherapy, Durham, North Carolina, USA
| | - Marianne Davies
- Yale School of Nursing, Yale Cancer Center, New Haven, Connecticut, USA
| | - Steven M Dubinett
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | | | - Patrick M Forde
- Upper Aerodigestive Division, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Edward B Garon
- Division of Hematology/Oncology, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Sarah B Goldberg
- Section of Medical Oncology, Yale University School of Medicine, Yale Cancer Center, New Haven, Connecticut, USA
| | - Raffit Hassan
- Thoracic and GI Malignancies Branch, National Cancer Institute, Bethesda, Maryland, USA
| | | | - Fred R Hirsch
- Center for Thoracic Oncology, Tisch Cancer Institute and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Melissa L Johnson
- Sarah Cannon Research Institute, Nashville, Tennessee, USA
- Tennessee Oncology/One Oncology, Nashville, Tennessee, USA
| | - Shakun Malik
- Division of Cancer Treatment & Diagnosis, CTEP, National Cancer Institute, Rockville, Maryland, USA
| | - Daniel Morgensztern
- Department of Medicine, Oncology Division, Medical Oncology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Joel W Neal
- Stanford Cancer Institute, Stanford University, Stanford, California, USA
| | - Jyoti D Patel
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Evanston, Illinois, USA
| | - David L Rimm
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sarah Sagorsky
- Upper Aerodigestive Division, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lawrence H Schwartz
- Department of Radiology, Vagelos College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roy S Herbst
- Section of Medical Oncology, Yale University School of Medicine, Yale Cancer Center, New Haven, Connecticut, USA
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9
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Cruzado JA, Martínez-García V, González IP, Gutiérrez VS, Jarabo-Sarceda JR, Calatayud-Gastardi J, Teresa LDV, Fernández-Martín E, Gómez-Martínez AM, Hernando-Trancho F. Preoperative detection and evaluation of the need for psychological intervention in cancer and non-cancer patients referred to thoracic surgery. Cir Esp 2022; 100:359-366. [PMID: 35718372 DOI: 10.1016/j.cireng.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 03/13/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVES (a) to evaluate and compare the psychological treatment needs of patients with cancer and non-cancer, who are going to undergo scheduled thoracic surgery, and (b) evaluate and compare the diagnostic accuracy of the screening tests of psychological treatment needs for cancer and non-cancer patients. METHOD The need for psychological treatment was evaluated in a total of 169 patients prior to thoracic surgery, through a clinical interview. The screening tests used were: the physician's judgment (yes/no), the Hospital Anxiety and Depression Scale (HADS) and, the single-item interview to assess depression "Do you feel depressed?" (DEPQ). RESULTS The number of patients who needed psychological treatment in the total sample was 47 (27.81%), in non-cancer-patients: 22 (30.99%) and in cancer patients: 25 (25.51%). The participants with treatment needs were more often young women with primary education levels, with more fears and concerns regarding their disease. With respect to the screening tests, the HADS-T (cut-off point ≥13) obtained a sensitivity (SE) of 0.75 and Specificity (SP) of 0.81 in the total sample. In patients with cancer, the HADS total score (cut-off point ≥10) obtained an SE=0.84 and SP=0.80, and, in non-cancer patients, the HADS total score (cut-off point ≥13) showed an SE=0.59 and SP=0.84. The DEPQ and the physician's judgment did not achieve adequate levels of precision. CONCLUSIONS A high percentage of patients have psychological treatment needs before performing thoracic surgery, which are similar for cancer and non-cancer patients. Preoperative detection of patients who need psychological intervention is feasible with a simple screening test: HADS, which achieves greater precision in cancer patients.
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Affiliation(s)
- Juan Antonio Cruzado
- Facultad de Psicología, Universidad Complutense de Madrid, Campus Somosaguas, 28040 Madrid, Spain.
| | - Vanesa Martínez-García
- Facultad de Psicología, Universidad Complutense de Madrid, Campus Somosaguas, 28040 Madrid, Spain
| | - Irene Pacheco González
- Facultad de Psicología, Universidad Complutense de Madrid, Campus Somosaguas, 28040 Madrid, Spain
| | - Verónica Salas Gutiérrez
- Facultad de Psicología, Universidad Complutense de Madrid, Campus Somosaguas, 28040 Madrid, Spain
| | - José Ramón Jarabo-Sarceda
- Thoracic Surgery Service, Hospital Clínico San Carlos de Madrid, Departamento Cirugía, Universidad Complutense de Madrid, Madrid, Spain
| | - Joaquín Calatayud-Gastardi
- Thoracic Surgery Service, Hospital Clínico San Carlos de Madrid, Departamento Cirugía, Universidad Complutense de Madrid, Madrid, Spain
| | - Laura Del Valle Teresa
- Facultad de Psicología, Universidad Complutense de Madrid, Campus Somosaguas, 28040 Madrid, Spain
| | - Elena Fernández-Martín
- Thoracic Surgery Service, Hospital Clínico San Carlos de Madrid, Departamento Cirugía, Universidad Complutense de Madrid, Madrid, Spain
| | - Ana María Gómez-Martínez
- Thoracic Surgery Service, Hospital Clínico San Carlos de Madrid, Departamento Cirugía, Universidad Complutense de Madrid, Madrid, Spain
| | - Florentino Hernando-Trancho
- Thoracic Surgery Service, Hospital Clínico San Carlos de Madrid, Departamento Cirugía, Universidad Complutense de Madrid, Madrid, Spain
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Cruzado JA, Martínez-García V, González IP, Gutiérrez VS, Jarabo-Sarceda JR, Calatayud-Gastardi J, Teresa LDV, Fernández-Martín E, Gómez-Martínez AM, Hernando-Trancho F. Preoperative detection and evaluation of the need for psychological intervention in cancer and non-cancer patients referred to thoracic surgery. Cir Esp 2021; 100:S0009-739X(21)00113-5. [PMID: 33972062 DOI: 10.1016/j.ciresp.2021.03.010] [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: 07/20/2020] [Revised: 02/16/2021] [Accepted: 03/13/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES (a) to evaluate and compare the psychological treatment needs of patients with cancer and non-cancer, who are going to undergo scheduled thoracic surgery, and (b) evaluate and compare the diagnostic accuracy of the screening tests of psychological treatment needs for cancer and non-cancer patients. METHOD The need for psychological treatment was evaluated in a total of 169 patients prior to thoracic surgery, through a clinical interview. The screening tests used were: the physician's judgment (yes/no), the Hospital Anxiety and Depression Scale (HADS) and, the single-item interview to assess depression "Do you feel depressed?" (DEPQ). RESULTS The number of patients who needed psychological treatment in the total sample was 47 (27.81%), in non-cancer-patients: 22 (30.99%) and in cancer patients: 25 (25.51%). The participants with treatment needs were more often young women with primary education levels, with more fears and concerns regarding their disease. With respect to the screening tests, the HADS-T (cut-off point ≥13) obtained a sensitivity (SE) of 0.75 and Specificity (SP) of 0.81 in the total sample. In patients with cancer, the HADS total score (cut-off point ≥10) obtained an SE=0.84 and SP=0.80, and, in non-cancer patients, the HADS total score (cut-off point ≥13) showed an SE=0.59 and SP=0.84. The DEPQ and the physician's judgment did not achieve adequate levels of precision. CONCLUSIONS A high percentage of patients have psychological treatment needs before performing thoracic surgery, which are similar for cancer and non-cancer patients. Preoperative detection of patients who need psychological intervention is feasible with a simple screening test: HADS, which achieves greater precision in cancer patients.
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Affiliation(s)
- Juan Antonio Cruzado
- Facultad de Psicología, Universidad Complutense de Madrid, Campus Somosaguas, 28040 Madrid, Spain.
| | - Vanesa Martínez-García
- Facultad de Psicología, Universidad Complutense de Madrid, Campus Somosaguas, 28040 Madrid, Spain
| | - Irene Pacheco González
- Facultad de Psicología, Universidad Complutense de Madrid, Campus Somosaguas, 28040 Madrid, Spain
| | - Verónica Salas Gutiérrez
- Facultad de Psicología, Universidad Complutense de Madrid, Campus Somosaguas, 28040 Madrid, Spain
| | - José Ramón Jarabo-Sarceda
- Thoracic Surgery Service, Hospital Clínico San Carlos de Madrid, Departamento Cirugía, Universidad Complutense de Madrid, Madrid, Spain
| | - Joaquín Calatayud-Gastardi
- Thoracic Surgery Service, Hospital Clínico San Carlos de Madrid, Departamento Cirugía, Universidad Complutense de Madrid, Madrid, Spain
| | - Laura Del Valle Teresa
- Facultad de Psicología, Universidad Complutense de Madrid, Campus Somosaguas, 28040 Madrid, Spain
| | - Elena Fernández-Martín
- Thoracic Surgery Service, Hospital Clínico San Carlos de Madrid, Departamento Cirugía, Universidad Complutense de Madrid, Madrid, Spain
| | - Ana María Gómez-Martínez
- Thoracic Surgery Service, Hospital Clínico San Carlos de Madrid, Departamento Cirugía, Universidad Complutense de Madrid, Madrid, Spain
| | - Florentino Hernando-Trancho
- Thoracic Surgery Service, Hospital Clínico San Carlos de Madrid, Departamento Cirugía, Universidad Complutense de Madrid, Madrid, Spain
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Presley CJ, Arrato NA, Janse S, Shields PG, Carbone DP, Wong ML, Han L, Gill TM, Allore HG, Andersen BL. Functional Disability Among Older Versus Younger Adults With Advanced Non-Small-Cell Lung Cancer. JCO Oncol Pract 2021; 17:e848-e858. [PMID: 33939536 DOI: 10.1200/op.20.01004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To determine patient and disease characteristics associated with functional disability among adults with advanced non-small-cell lung cancer (NSCLC). METHODS In a prospective cohort of participants newly diagnosed with advanced NSCLC and beginning systemic treatment, functional disability in usual activities, mobility, and self-care was measured using the EuroQol-5D-5L at baseline. Demographics, comorbidities, brain metastases, Eastern Cooperative Oncology Group performance status (ECOG PS), and psychologic variables (depression [Patient Health Questionnaire-9] and anxiety [Generalized Anxiety Disorder 7-item scale]) were captured. Patients were classified into two disability groups (none-slight or moderate-severe) on the basis of total functional status scores. Differences between disability groups were determined (chi-square and t tests). Associations between patient characteristics and baseline disability were assessed using logistic regression. RESULTS Among 173 participants, mean age was 63.3 years, 56% were male, 83% had ECOG PS 0-1, and 41% had brain metastases. Baseline disability was present in 39% of participants, with patients having moderate to severe disability in usual activities (37.6%), mobility (26.6%), and self-care (5.2%). Depressive and/or anxiety symptoms ranged from none to severe (Patient Health Questionnaire 9-item scale M = 6.5, SD = 5.3). Depressive symptoms were the only characteristic associated with a higher odds of baseline disability (adjusted odds ratio [aOR]: 1.26; 95% CI, 1.15 to 1.38; P < .001). Participants with poorer ECOG PS (aOR: 4.64; 95% CI, 1.84 to 11.68; P = .001) and depressive symptoms (aOR: 1.15; 95% CI, 1.07 to 1.24; P < .001) had higher odds of moderate-severe mobility disability compared with the none-slight disability group. CONCLUSION More than one third of all adults with advanced NSCLC have moderate-severe functional disability at baseline. Psychologic symptoms were significantly associated with moderate-severe baseline disability.
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Affiliation(s)
- Carolyn J Presley
- Division of Medical Oncology, Department of Internal Medicine, Columbus, OH
| | - Nicole A Arrato
- Department of Psychology, The Ohio State University, Columbus, OH
| | - Sarah Janse
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH
| | - Peter G Shields
- Division of Medical Oncology, Department of Internal Medicine, Columbus, OH
| | - David P Carbone
- Division of Medical Oncology, Department of Internal Medicine, Columbus, OH
| | - Melisa L Wong
- Divisions of Hematology/Oncology and Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Ling Han
- Section of Geriatric Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Thomas M Gill
- Section of Geriatric Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Heather G Allore
- Section of Geriatric Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
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Srikanthan A, Leung B, Shokoohi A, Smrke A, Bates A, Ho C. Psychosocial Distress Scores and Needs among Newly Diagnosed Sarcoma Patients: A Provincial Experience. Sarcoma 2019; 2019:5302639. [PMID: 31354383 PMCID: PMC6636442 DOI: 10.1155/2019/5302639] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/29/2019] [Accepted: 06/11/2019] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Information on the psychosocial distress and needs of sarcoma patients at diagnosis is sparse. The Canadian Problem Checklist (CPC) and Psychosocial Screen for Cancer-Revised (PSSCAN-R) are validated tools to identify cancer patients' distress and are administered to all new patients referred to BC Cancer prior to their consultation. We used the CPC and PSSCAN-R to understand sarcoma patients' needs at the initial oncology consultation in British Columbia, Canada. MATERIALS AND METHODS All sarcoma patients who completed the CPC and PSSCAN-R within 6 months of diagnosis between 2011 and 2016 were included. The retrospective chart review identified baseline demographics: age, performance status, disease location, resectability, and histology. Analysis was conducted using descriptive statistics, chi-squared test, Fisher's exact test, and Kaplan-Meier method. RESULTS 413 sarcoma patients were identified. The majority of patients were over the age of 40 (83.3%) with ECOG performance status 0-1 (82.6%) and lower extremity tumors (55.4%). The most common diagnoses were liposarcoma 21.3%, undifferentiated pleomorphic sarcoma 12.1%, and myxofibrosarcoma 11.1%. At the initial consultation, 42.6% of patients were deemed resectable, 8.5% unresectable/metastatic, and 48.9% required further staging investigations. The top three patient-reported distress symptoms were feeling tense and unable to relax (50%), feeling nervous and shaky (48%), and experiencing repetitive and scary thoughts (42%). 38% of patients had subclinical/clinical anxiety symptoms, and 21% of patients had subclinical/clinical depression symptoms. 5% of patients expressed suicidal ideation. The top three concerns/needs were understanding of illness/treatment (45.5%), fear/worries (45.3%), and worry about family (23%). No differences in overall survival were identified for patients displaying symptoms of depression or anxiety versus no symptoms. DISCUSSION Up to 45% of sarcoma patients experience some form of psychological distress at disease presentation. Patients desire information about their diagnosis and treatment. Tailored interventions to individual psychological comorbidity and improved patient education resources would be beneficial.
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Affiliation(s)
- Amirrtha Srikanthan
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Ontario K1H 8L6, Canada
| | - Bonnie Leung
- Medical Oncology, BC Cancer, Vancouver Centre, Vancouver, British Columbia V5Z4E6, Canada
| | - Aria Shokoohi
- Medical Oncology, BC Cancer, Vancouver Centre, Vancouver, British Columbia V5Z4E6, Canada
| | - Alannah Smrke
- Medical Oncology, BC Cancer, Vancouver Centre, Vancouver, British Columbia V5Z4E6, Canada
| | - Alan Bates
- Psychosocial Oncology, BC Cancer, Vancouver Centre, Vancouver, British Columbia V5Z4E6, Canada
| | - Cheryl Ho
- Medical Oncology, BC Cancer, Vancouver Centre, Vancouver, British Columbia V5Z4E6, Canada
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