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Dörner L, Grosse L, Stange F, Hille H, Kurz S, Becker H, Volkmer S, Hippler M, Rieger D, Bombach P, Rieger J, Weinert L, Svensson L, Anders C, Cekin S, Paulsen F, Öner Ö, Ruhm K, Malek HS, Möller Y, Tatagiba M, Wallwiener M, Eckert N, Escher P, Pfeifer N, Forschner A, Bauer A, Zips D, Bitzer M, Malek N, Gani C, Tabatabai G, Renovanz M. App-based assessment of patient-reported outcomes in the Molecular Tumor Board in the Center for Personalized Medicine-(TRACE). Neurooncol Pract 2024; 11:336-346. [PMID: 38737615 PMCID: PMC11085831 DOI: 10.1093/nop/npae002] [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] [Indexed: 05/14/2024] Open
Abstract
Background Biomarker-based therapies are increasingly used in cancer patients outside clinical trials. Systematic assessment of patient-reported outcomes (PRO) is warranted to take patients' perspectives during biomarker-based therapies into consideration. We assessed the feasibility of an electronic PRO assessment via a smartphone application. Methods An interdisciplinary expert panel developed a smartphone application based on symptom burden and health-related quality of life (HRQoL) metrics reported in a retrospective analysis of 292 neuro-oncological patients. The app included validated assessments of health-related quality of life (HRQoL), the burden of symptoms, and psychological stress. Feasibility and usability were tested in a pilot study. Semi-structured interviews with patients and health care professionals (HCP) were conducted, transcribed, and analyzed according to Mayring´s qualitative content analysis. Furthermore, we assessed compliance and descriptive data of ePROs. Results A total of 14 patients have been enrolled, (9 female, 5 male). A total of 4 HCPs, 9 patients, and 1 caregiver were interviewed regarding usability/feasibility. The main advantages were the possibility to complete questionnaires at home and comfortable implementation in daily life. Compliance was high, for example, 82% of the weekly distributed NCCN distress thermometer questionnaires were answered on time, however, with interindividual variability. We observed a median distress score of 5 (range 0-10, 197 results, n = 12, weekly assessed) and a median Global health score of 58.3 according to the EORTC QLQ-C30 instrument (range 16.7-100, 77 results, n = 12, monthly assessed). Conclusions This pilot study proved the feasibility and acceptance of the app. We will therefore expand its application during biomarker-guided therapies to enable systematic PRO assessments.
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Affiliation(s)
- Lorenz Dörner
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine Tübingen, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Lucia Grosse
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine Tübingen, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Felix Stange
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine Tübingen, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Hanni Hille
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine Tübingen, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Sylvia Kurz
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine Tübingen, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Hannes Becker
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine Tübingen, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Sebastian Volkmer
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine Tübingen, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Melina Hippler
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine Tübingen, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - David Rieger
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine Tübingen, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Paula Bombach
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine Tübingen, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Johannes Rieger
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine Tübingen, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Lina Weinert
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
- Section for Translational Health Economics, Department for Conservative Dentistry, Heidelberg University Hospital, Heidelberg, Germany
| | - Laura Svensson
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Carolin Anders
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Sila Cekin
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine Tübingen, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Frank Paulsen
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine Tübingen, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Öznur Öner
- Center for Personalized Medicine Tübingen, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Kristina Ruhm
- Center for Personalized Medicine Tübingen, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Holly Sundberg Malek
- Center for Personalized Medicine Tübingen, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Yonne Möller
- Center for Personalized Medicine Tübingen, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Marcos Tatagiba
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine Tübingen, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Markus Wallwiener
- Department of Gynecology, University Hospital Heidelberg, University Heidelberg, Heidelberg, Germany
| | - Nils Eckert
- Eckert & Partner — IT Consulting, Stuttgart, Germany
| | - Pascal Escher
- Department of Computer Science, Methods in Medical Informatics, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Innovative Care, Tübingen, Germany
| | - Nico Pfeifer
- Department of Computer Science, Methods in Medical Informatics, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Innovative Care, Tübingen, Germany
| | - Andrea Forschner
- Department of Dermatology, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Armin Bauer
- Department of Women`s Health, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Michael Bitzer
- Department of Internal Medicine I, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Cluster of Excellence (EXC 2180) “Image Guided and Functionally Instructed Tumor Therapies”, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Nisar Malek
- Department of Internal Medicine I, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Cluster of Excellence (EXC 2180) “Image Guided and Functionally Instructed Tumor Therapies”, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Cihan Gani
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine Tübingen, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Ghazaleh Tabatabai
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine Tübingen, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Cluster of Excellence (EXC 2180) “Image Guided and Functionally Instructed Tumor Therapies”, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Mirjam Renovanz
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine Tübingen, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
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Weiss Lucas C, Renovanz M, Jost J, Sabel M, Wiewrodt D, Rapp M. Assessment Practice of Patient-Centered Outcomes in Surgical Neuro-Oncology: Survey-Based Recommendations for Clinical Routine. Front Oncol 2021; 11:702017. [PMID: 34458144 PMCID: PMC8386174 DOI: 10.3389/fonc.2021.702017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
The psycho-oncological burden related to the diagnosis of an intracranial tumor is often accompanied by neurocognitive deficits and changes in character, overall affecting health-related quality of life (HRQoL) and activities of daily living. Regular administration of adequate screening tools is crucial to ensure a timely detection of needs for support and/or specific interventions. Although efforts have been made to assure the quality of neuro-oncological care, clinical assessment practice of patient-reported outcomes (PROs) remains overall heterogeneous, calling for a concise recommendation tailored to neuro-oncological patients. Therefore, this survey, promoted by the German Society of Neurosurgery, was conducted to evaluate the status quo of health care resources and PRO/neurocognition assessment practices throughout departments of surgical neuro-oncology in Germany. 72/127 (57%) of registered departments participated in the study, including 83% of all university hospital units. A second aim was to shed light on the impact of quality assurance strategies (i.e., department certification as part of an integrative neuro-oncology cancer center; CNOC) on the assessment practice, controlled for interacting structural factors, i.e., university hospital status (UH) and caseload. Despite an overall good to excellent availability of relevant health care structures (psycho-oncologist: 90%, palliative care unit: 97%, neuropsychology: 75%), a small majority of departments practice patient-centered screenings (psycho-oncological burden: 64%, HRQoL: 76%, neurocognition: 58%), however, much less frequently outside the framework of clinical trials. In this context, CNOC affiliation, representing a specific health care quality assurance process, was associated with significantly stronger PRO assessment practices regarding psycho-oncological burden, independent of UH status (common odds ratio=5.0, p=0.03). Nevertheless, PRO/neurocognitive assessment practice was not consistent even across CNOC. The overall most commonly used PRO/neurocognitive assessment tools were the Distress Thermometer (for psycho-oncological burden; 64%), the EORTC QLQ-C30 combined with the EORTC QLQ-BN20 (for HRQoL; 52%) and the Mini-Mental Status Test (for neurocognition; 67%), followed by the Montreal Cognitive Assessment (MoCA; 33%). Accordingly, for routine clinical screening, the authors recommend the Distress Thermometer and the EORTC QLQ-C30 and QLQ-BN20, complemented by the MoCA as a comparatively sensitive yet basic neurocognitive test. This recommendation is intended to encourage more regular, adequate, and standardized routine assessments in neuro-oncological practice.
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Affiliation(s)
- Carolin Weiss Lucas
- Center of Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Mirjam Renovanz
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tuebingen, Tuebingen, Germany.,Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Johanna Jost
- Department of Neurosurgery, Muenster University Hospital, Muenster, Germany
| | - Michael Sabel
- Department of Neurosurgery, Heinrich Heine University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Dorothee Wiewrodt
- Department of Neurosurgery, Muenster University Hospital, Muenster, Germany
| | - Marion Rapp
- Department of Neurosurgery, Heinrich Heine University Hospital of Duesseldorf, Duesseldorf, Germany
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