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Payne A, Horne A, Bayman N, Blackhall F, Bostock L, Chan C, Coote J, Eaton M, Fenemore J, Gomes F, Halkyard E, Harris M, Lindsay C, McEntee D, Neal H, Pemberton L, Sheikh H, Woolf D, Price J, Yorke J, Faivre-Finn C. Patient and clinician-reported experiences of using electronic patient reported outcome measures (ePROMs) as part of routine cancer care. J Patient Rep Outcomes 2023; 7:42. [PMID: 37140730 PMCID: PMC10160312 DOI: 10.1186/s41687-023-00544-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/05/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Cancer and its treatment can have significant impacts on health status, quality of life and functioning of patients. Direct information from patients regarding these aspects can be collected via electronic platforms in the form of electronic Patient Reported Outcome Measures (ePROMs). Research has shown that the use of ePROMS in cancer care leads to improved communication, better symptom control, prolonged survival and a reduction in hospital admissions and emergency department attendance. Acceptability and feasibility of routine ePROM collection has been reported by both patients and clinicians but to date their use has predominantly been limited to clinical trials. MyChristie-MyHealth is an initiative from a UK comprehensive cancer centre The Christie NHS Foundation Trust which incorporates the regular collection of ePROMs into routine cancer care. This study, carried out as part of a service evaluation, explores patient and clinician experiences of using the MyChristie-MyHealth ePROMs service. RESULTS 100 patients with lung and head and neck cancers completed a Patient Reported Experience questionnaire. All patients reported that MyChristie-MyHealth was easy to understand and, almost all found it timely to complete and easy to follow. Most patients (82%) reported it improved their communication with their oncology team and helped them to feel more involved with their care (88%). A large proportion of clinicians (8/11) felt ePROMs helped communication with their patients and over half (6/10) felt they led to consultations being more patient focused. Clinicians also felt that the use of ePROMs resulted in patients being more engaged in consultations (7/11) and their cancer care in general (5/11). Five clinicians reported that the use of ePROMs altered their clinical decision making. CONCLUSIONS Regular ePROMs collection as part of routine cancer care is acceptable to both patients and clinicians. Both patients and clinicians feel their use improved communication and increased the feeling of patient involvement with their care. Further work is needed to explore the experiences of patients that did not complete the ePROMs as part of the initiative and to continue to optimize the service for both patients and clinicians.
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Affiliation(s)
| | - Ashley Horne
- University of Manchester, Manchester, UK
- Christie NHS Foundation Trust, Manchester, UK
| | - Neil Bayman
- Christie NHS Foundation Trust, Manchester, UK
| | - Fiona Blackhall
- University of Manchester, Manchester, UK
- Christie NHS Foundation Trust, Manchester, UK
| | | | - Clara Chan
- Christie NHS Foundation Trust, Manchester, UK
| | | | - Marie Eaton
- Christie NHS Foundation Trust, Manchester, UK
| | | | - Fabio Gomes
- Christie NHS Foundation Trust, Manchester, UK
| | | | | | | | | | - Hilary Neal
- Christie NHS Foundation Trust, Manchester, UK
| | | | | | - David Woolf
- Christie NHS Foundation Trust, Manchester, UK
| | - James Price
- Christie NHS Foundation Trust, Manchester, UK
| | - Janelle Yorke
- University of Manchester, Manchester, UK
- Christie NHS Foundation Trust, Manchester, UK
| | - Corinne Faivre-Finn
- University of Manchester, Manchester, UK
- Christie NHS Foundation Trust, Manchester, UK
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Jim HSL, Brady-Nicholls R, Hershman DL. The importance of patient-reported outcomes in pragmatic clinical trials. J Natl Cancer Inst 2023; 115:352-354. [PMID: 36805254 PMCID: PMC10086620 DOI: 10.1093/jnci/djad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023] Open
Affiliation(s)
- Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Renee Brady-Nicholls
- Department of Integrated Mathematical Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Dawn L Hershman
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
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Girgis A, Bamgboje-Ayodele A, Rincones O, Vinod SK, Avery S, Descallar J, Smith A‘B, Arnold B, Arnold A, Bray V, Durcinoska I, Rankin NM, Chang CF, Eifler B, Elliott S, Hardy C, Ivimey B, Jansens W, Kaadan N, Koh ES, Livio N, Lozenkovski S, McErlean G, Nasser E, Ryan N, Smeal T, Thomas T, Tran T, Wiltshire J, Delaney GP. Stepping into the real world: a mixed-methods evaluation of the implementation of electronic patient reported outcomes in routine lung cancer care. J Patient Rep Outcomes 2022; 6:70. [PMID: 35723827 PMCID: PMC9207870 DOI: 10.1186/s41687-022-00475-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To realize the broader benefits of electronic patient-reported outcome measures (ePROMs) in routine care, we used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to inform the translation of a clinically effective ePROM system (hereafter referred to as the PRM system) into practice. The study aimed to evaluate the processes and success of implementing the PRM system in the routine care of patients diagnosed with lung cancer.
Method
A controlled before-and-after mixed-methods study was undertaken. Data sources included a self-report questionnaire and interviews with healthcare providers, electronic health record data for PRMs patients and historical controls, and field notes. Descriptive statistics, logistic regression modelling, negative binomial models, generalized estimating equations and repeated measures ANOVA were used to analyze quantitative data. Qualitative data was thematically analyzed.
Results
A total of 48/79 eligible people diagnosed with lung cancer completed 90 assessments during the 5-month implementation period (RE-AIM reach). Every assessment breached the pre-defined threshold and care coordinators reviewed and actioned 95.6% of breaches, resulting in 146 referrals to allied health services, most frequently for social work (25.3%), dietetics (18.5%), physiotherapy (18.5%) and occupational therapy (17.1%). PRMs patients had significantly fewer visits to the cancer assessment unit for problematic symptoms (M = 0.23 vs. M = 0.43; p = 0.035), and were significantly more likely to be offered referrals (71% vs. 29%, p < 0.0001) than historical controls (RE-AIM effect). The levels of ‘organizational readiness for implementing change’ (ORIC) did not show much differences between baseline and follow-up, though this was already high at baseline; but significantly more staff reported improved confidence when asking patients to complete assessments (64.7% at baseline vs. 88.2% at follow-up, p = 0.0046), and when describing the assessment tool to patients (64.7% at baseline vs. 76.47% at follow-up, p = 0.0018) (RE-AIM adoption). A total of 78 staff received PRM system training, and 95.6% of the PRM system alerts were actioned (RE-AIM implementation); and all lung cancer care coordinators were engaged with the PRM system beyond the end of the study period (RE-AIM maintenance).
Conclusion
This study demonstrates the potential of the PRM system in enhancing the routine care of lung cancer patients, through leveraging the capabilities of automated web-based care options.
Plain English summary
Research has shown the clear benefits of using electronically collected patient-reported outcome measures (ePROMs) for cancer patients and health services. However, we need to better understand how to implement ePROMs as part of routine care. This study evaluated the processes and outcomes of implementing an ePROMs system in the routine care of patients diagnosed with lung cancer. Key findings included: (a) a majority of eligible patients completed the scheduled assessments; (b) patient concerns were identified in every assessment, and care coordinators reviewed and actioned almost all of these, including making significantly more referrals to allied health services; (c) patients completing assessments regularly were less likely to present to the cancer assessment unit with problematic symptoms, suggesting that ePROMs identified patient concerns early and this led to a timely response to concerns; (d) staff training and engagement was high, and staff reporting increased confidence when asking patients to complete assessments and when describing the assessment tool to patients at the end of the implementation period. This study shows that implementing ePROMs in routine care is feasible and can lead to improvements in patient care.
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Bamgboje-Ayodele A, Avery S, Pearson J, Mak M, Smith K, Rincones O, Vinod S, Bray V, Ducinoska I, McCarthy K, Williamson K, Delaney GP, Girgis A. Adapting an integrated care pathway for implementing electronic patient reported outcomes assessment in routine oncology care: Lessons learned from a case study. J Eval Clin Pract 2022; 28:1072-1083. [PMID: 35470525 DOI: 10.1111/jep.13688] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 12/16/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVE Details of the development and implementation of integrated care pathways (ICPs) in the context of electronic collection of patient reported outcomes (ePROs) for cancer patients are largely lacking in the literature. This study describes what, why and how decisions were made to adapt and implement an ePROs ICP for patients with lung cancer. METHODS A consensus process was utilized, with the implementation advisory group including multidisciplinary representation from three participating hospitals, to identify local champions and adapt and incorporate the ePRO ICP into the local contexts. Engagement meetings were documented via meeting transcripts, and detailed notes from October 2019 to November 2020 were content-analysed to identify decision-making themes based on the Consolidated Framework for Implementation Research; workflows and process maps were reviewed and modified to integrate ePROs. RESULTS In total, 55 engagement activities were held (24 meetings, 20 workshops 11 educational sessions), with n = 96 staff from multiple disciplines participating in the ePROs implementation through advisory meetings, process mapping, change management and staff education. Decisions were made regarding eligible patient cohorts to include, the process for onboarding patients onto the ePRO system, and follow-up and referral pathways. Rationales for decisions included alignment with existing workflows, utilizing available staff, minimizing staff and patient burden and maximizing patient engagement. CONCLUSION Existing resources, staff input and technical and logistical reasons often guided the ICP decisions, highlighting the need for in-depth engagement across all stakeholders for optimal implementation of ePRO ICPs. The ePRO implementation required substantial dialogue and systematic resolution to reach agreement on the final processes. Adapting the local ICP through rigorous engagement facilitated the successful implementation of ePROs as business-as-usual at all three cancer centres. Involving all relevant stakeholders is critical to the successful adaptation of ICPs before their introduction into routine care.
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Affiliation(s)
- Adeola Bamgboje-Ayodele
- UNSW Medicine & Health, University of New South Wales (UNSW Sydney), Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Sandra Avery
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Macarthur Cancer Therapy Centre, South Western Sydney Local Health District, Campbelltown, New South Wales, Australia.,Bankstown Cancer Therapy Centre, South Western Sydney Local Health District, Bankstown, New South Wales, Australia
| | - Joanne Pearson
- Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Macarthur Cancer Therapy Centre, South Western Sydney Local Health District, Campbelltown, New South Wales, Australia.,Bankstown Cancer Therapy Centre, South Western Sydney Local Health District, Bankstown, New South Wales, Australia
| | - May Mak
- Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Kylie Smith
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Macarthur Cancer Therapy Centre, South Western Sydney Local Health District, Campbelltown, New South Wales, Australia.,Bankstown Cancer Therapy Centre, South Western Sydney Local Health District, Bankstown, New South Wales, Australia
| | - Orlando Rincones
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Shalini Vinod
- UNSW Medicine & Health, University of New South Wales (UNSW Sydney), Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Victoria Bray
- UNSW Medicine & Health, University of New South Wales (UNSW Sydney), Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Ivana Ducinoska
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Karina McCarthy
- Cancer Institute New South Wales (CINSW), St Leonards, New South Wales, Australia
| | - Kimberley Williamson
- Cancer Institute New South Wales (CINSW), St Leonards, New South Wales, Australia
| | - Geoff P Delaney
- UNSW Medicine & Health, University of New South Wales (UNSW Sydney), Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | | | - Afaf Girgis
- UNSW Medicine & Health, University of New South Wales (UNSW Sydney), Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
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Coghill AE, Brownstein NC, Sinha S, Thompson ZJ, Dickey BL, Hoogland AI, Johnstone PA, Suneja G, Jim HS. Patient-Reported Outcomes in Cancer Patients with HIV. Cancers (Basel) 2022; 14:cancers14235889. [PMID: 36497369 PMCID: PMC9739107 DOI: 10.3390/cancers14235889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 12/02/2022] Open
Abstract
Elevated cancer-specific mortality in PWH has been demonstrated for non-AIDS-defining malignancies. However, additional clinical endpoints of interest, including patient-reported outcomes (PROs), have not been systematically examined in PWH and cancer. We evaluated differences in patient-reported symptomology between cancer patients with versus without HIV using data from 12,529 patients at the Moffitt Cancer Center, including 55 with HIV. The symptoms were assessed using the Edmonton Symptom Assessment Scale (ESAS), which asks patients to rank 12 symptoms on a scale of 1−10, with scores ≥7 considered severe. The responses across all questions were summed to create a composite score. Vital status through t July 2021 was determined through linkage to the electronic health record. PWH reported a higher composite ESAS score on average (44.4) compared to HIV-uninfected cancer patients (30.7, p-value < 0.01). In zero-inflated negative binomial regression models adjusted for cancer site, sex, and race, the composite ESAS scores and the count of severe symptoms were 1.41 times (95% CI: 1.13−1.77) and 1.45 times (95% CI: 1.09−1.93) higher, respectively, in cancer patients with HIV. Among PWH, higher ESAS scores were associated with mortality (p-value = 0.02). This is the first demonstration of uniquely poor PROs in PWH and cancer and suggests that patient symptom monitoring to improve clinical endpoints deserves further study.
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Affiliation(s)
- Anna E. Coghill
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
- Correspondence: ; Tel.: +1-813-745-7147
| | - Naomi C. Brownstein
- Biostatistics and Bioinformatics Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Sweta Sinha
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Zachary J. Thompson
- Biostatistics and Bioinformatics Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Brittney L. Dickey
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Aasha I. Hoogland
- Health Outcomes & Behavior Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Peter A. Johnstone
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Gita Suneja
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT 84108, USA
| | - Heather S. Jim
- Health Outcomes & Behavior Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
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Wald T, Zebralla V, Boege M, Kunz V, Neumuth T, Dietz A, Wichmann G, Wiegand S. Web-Based Patient-Reported Outcomes for ENT Patients-Evaluation of the Status Quo, Patients' View, and Future Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811773. [PMID: 36142048 PMCID: PMC9517261 DOI: 10.3390/ijerph191811773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/10/2022] [Accepted: 09/16/2022] [Indexed: 05/05/2023]
Abstract
BACKGROUND Patient-reported outcomes (PRO) assess disease burden and indicate unmet needs. Home-based electronic PRO measures (ePROMs) can support tumor aftercare (TAC). Creating an ePROM is the next step after implementing the software "OncoFunction" to assess PROs during TAC of head- and neck-cancer patients (HNC). Therefore, internet use and perception on ePROMs of ENT and TAC patients were evaluated. METHODS From May-July 2020, ENT patients at a high-volume outpatient department aged >18 without need for emergency treatment were invited to complete a questionnaire concerning internet use and access, hardware, and opinion on the chances, requirements, and designs of ePROMs. RESULTS 415 questionnaires were evaluated; 46.3% of the respondents visited the common consultation hour (CCH) and 44.3% TAC; 71.9% were internet users, being younger than non-internet users; and 36.4% of TAC patients were non-internet users and 16.3% of them were without a web-enabled device. Significant differences existed in age and assessment of future perspectives between internet-/non-internet users and TAC/CCH patients, respectively. Regarding the design of ePROMs, patients preferred quarterly and short surveys. Data safety and feedback were important. CONCLUSIONS ePROMs are not suitable for everyone because of missing internet access and experience. A tailored approach to implement ePROMs in TAC is needed.
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Affiliation(s)
- Theresa Wald
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Leipzig Medical Centre, 04103 Leipzig, Germany
- Correspondence:
| | - Veit Zebralla
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Leipzig Medical Centre, 04103 Leipzig, Germany
| | - Maren Boege
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Leipzig Medical Centre, 04103 Leipzig, Germany
| | - Viktor Kunz
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Leipzig Medical Centre, 04103 Leipzig, Germany
| | - Thomas Neumuth
- Innovation Center Computer Assisted Surgery, University of Leipzig, 04103 Leipzig, Germany
| | - Andreas Dietz
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Leipzig Medical Centre, 04103 Leipzig, Germany
| | - Gunnar Wichmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Leipzig Medical Centre, 04103 Leipzig, Germany
| | - Susanne Wiegand
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Leipzig Medical Centre, 04103 Leipzig, Germany
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Prasongsook N, Seetalarom K, Saichaemchan S, Udomdamrongkul K. A Pilot Study of Using Smartphone Application vs. Routine Follow-Up for Patient Care in Advanced Non-Small Cell Lung Cancer During the COVID-19 Pandemic Era. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:900172. [PMID: 35800468 PMCID: PMC9253575 DOI: 10.3389/fmedt.2022.900172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionCancer care monitoring should be adapted regarding COVID-19 pandemic preparedness plans. Lung Cancer Care application was a mobile application program to monitor adverse events and report outcomes. This study is aimed to invent a new mobile application evaluating patient-reported outcome (PRO) for patients with non-small cell lung cancer (NSCLC) and to evaluate the validity of a mobile application, particularly during the COVID-19 pandemic era.MethodsThe validity of the application was tested, and Functional Assessment of Cancer Therapy-Lung (FACT-L) questionnaires were contained in the mobile application-based PRO. Patients were randomly assigned to use mobile application-based PRO vs. routine follow-up. The primary end point was to compare the quality of life (QoL) scores between two groups. A secondary end point was overall survival (OS) and the outcomes of progressive disease (PD) between the two groups.ResultsIn total, 33 patients with advanced NSCLC were enrolled. Patients in the mobile application group had higher FACT-L scores at 3 months than patients with a routine follow-up arm (106 ± 5.97 vs. 99.96 ± 5.74, p-value = 0.07). The median follow-up time was 5.43 months; patients with mobile application had an insignificant increase in median OS when compared with patients using routine follow-up (4.53 vs. 2.93 months, p-value = 0.85). The sensitivity, specificity, positive predictive value (PPV), and negative predictive (NPV) value of this application for predicting disease progression were 50, 83.3, 66.7, and 70%, respectively.ConclusionSelf-reported symptoms by Lung Cancer Care application improved QoL and were similar in monitoring outcomes to face-to-face follow-up. This tool is applicable for patients with cancer to make monitoring as safe as possible for physical distancing during the COVID-19 pandemic era.
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Bamgboje-Ayodele A, Arnold B, Durcinoska I, Avery S, Vinod S, Rincones O, Thomas T, Descallar J, Smith B, Delaney GP, Girgis A. Implementing patient-reported outcomes into routine care: an audit of cancer patients from two local health districts in New South Wales to understand their capabilities and preferences. AUST HEALTH REV 2022; 46:331-337. [PMID: 35545809 DOI: 10.1071/ah21270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/03/2022] [Indexed: 11/23/2022]
Abstract
ObjectiveIt has been established that the implementation of patient-reported outcome measures (PROMs) in routine care provides significant benefits to patients, providers and health services. However, there are patient-level barriers that must be identified and addressed for the successful implementation of PROMs. This study aimed to understand the capabilities and preferences of our cancer patient population prior to implementation of electronically collected PROMs (ePROMs). Specifically, we conducted a clinic audit to determine the proportion of patients in clinics with access to out-of-clinic internet; those preferring to complete PROMs on paper or via an electronic device; those capable of completing PROMs in English; and those anticipating requiring assistance to complete PROMs.MethodsPatients receiving cancer treatment or follow-up care at two Local Health Districts (LHDs) in New South Wales, Australia, completed a questionnaire (audit form) with items about internet and mobile access, communication preferences and assistance needed to complete PROMs. Participant demographic and treatment information were extracted from their electronic medical records.ResultsAcross both LHDs, 637 of 1668 participants (38%) completed the audit forms. Mean participant age was 65 years (range = 23-98), 53% were female, and 92% were outpatients. Patients in the two LHDs differed in their levels of internet and email access, and ability to complete PROMs independently in English, suggesting that some LHD-specific tailoring of implementation strategies is necessary to optimise ePROMs uptake.ConclusionThis study highlights the importance of understanding the specific local contexts and patient populations, including potential technology and language barriers, which can influence patient ability to complete ePROMs.
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Affiliation(s)
- Adeola Bamgboje-Ayodele
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia; and South Western Sydney Clinical School, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; and Present address: Faculty of Medicine and Health, School of Medical Sciences, Biomedical Informatics and Digital Health, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Belinda Arnold
- Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, NSW 2500, Australia
| | - Ivana Durcinoska
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia
| | - Sandra Avery
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia; and South Western Sydney Clinical School, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; and Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW 1871, Australia
| | - Shalini Vinod
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia; and South Western Sydney Clinical School, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; and Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW 1871, Australia
| | - Orlando Rincones
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia
| | - Tien Thomas
- Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW 1871, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia; and South Western Sydney Clinical School, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia
| | - Ben Smith
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia; and South Western Sydney Clinical School, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia
| | - Geoff P Delaney
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia; and South Western Sydney Clinical School, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; and Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW 1871, Australia
| | - Afaf Girgis
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia; and South Western Sydney Clinical School, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia
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Lotte VDW, Barrera E. Miguel A, David A, Patrick B, Pierre B, Erik B, Renée B, Patricia CC, Jenny CC, Ananya C, Gilles D, Sylvian D, Dunning Alison M, Elliott Rebecca M, Dawn E, Corinne FF, Marzia F, Sara GE, Carsten H, Higginson Daniel S, Kerns Sarah L, Kerstie J, Meritxell M, Maarten L, Mónica R, Tiziana R, Andreas R, Rosenstein Barry S, Ruysscher Dirk D, Ahmed S, Claudia S, Petra S, Paloma SF, Elena S, Hilary S, Holly S, Veerle S, Paul S, Begoña TL, Talbot Christopher J, Riccardo V, Ana V, Liv V, Veldwijk Marlon R, Tim W, Adam W, West Catharine M, Yolande L. Overview of health-related quality of life and toxicity of non-small cell lung cancer patients receiving curative-intent radiotherapy in a real-life setting (the REQUITE study). Lung Cancer 2022; 166:228-241. [PMID: 35334417 PMCID: PMC9698940 DOI: 10.1016/j.lungcan.2022.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 02/08/2022] [Accepted: 03/08/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Radiotherapy-induced toxicity may negatively impact health-related quality of life (HRQoL). This report investigates the impact of curative-intent radiotherapy on HRQoL and toxicity in early stage and locally-advanced non-small cell lung cancer patients treated with radiotherapy or chemo-radiotherapy enrolled in the observational prospective REQUITE study. MATERIALS AND METHODS HRQoL was assessed using the European Organisation for Research and Treatment of Cancer QLQ-C30 questionnaire up to 2 years post radiotherapy. Eleven toxicities were scored by clinicians using the Common Terminology Criteria for Adverse Events (CTCAE) version 4. Toxicity scores were calculated by subtracting baseline values. Mixed model analyses were applied to determine statistical significance (p ≤ 0.01). Meaningful clinical important differences (MCID) were determined for changes in HRQoL. Analysis was performed on the overall data, different radiotherapy techniques, multimodality treatments and disease stages. RESULTS Data of 510 patients were analysed. There was no significant change in HRQoL or its domains, except for deterioration in cognitive functioning (p = 0.01). Radiotherapy technique had no significant impact on HRQoL. The addition of chemotherapy was significantly associated with HRQoL over time (p <.001). Overall toxicity did not significantly change over time. Acute toxicities of radiation-dermatitis (p =.003), dysphagia (p =.002) and esophagitis (p <.001) peaked at 3 months and decreased thereafter. Pneumonitis initially deteriorated but improved significantly after 12 months (p =.011). A proportion of patients experienced meaningful clinically important improvements and deteriorations in overall HRQoL and its domains. In some patients, pre-treatment symptoms improved gradually. CONCLUSIONS While overall HRQoL and toxicity did not change over time, some patients improved, whereas others experienced acute radiotherapy-induced toxicities and deteriorated HRQoL, especially physical and cognitive functioning. Patient characteristics, more so than radiotherapy technique and treatment modality, impact post-radiotherapy toxicity and HRQoL outcomes. This stresses the importance of considering the potential impact of radiotherapy on individuals' HRQoL, symptoms and toxicity in treatment decision-making.
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10
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Veldhuijzen E, Walraven I, Belderbos J. Selecting a Subset Based on the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events for Patient-Reported Symptom Monitoring in Lung Cancer Treatment: Mixed Methods Study. JMIR Cancer 2021; 7:e26574. [PMID: 34519658 PMCID: PMC8479599 DOI: 10.2196/26574] [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: 12/17/2020] [Revised: 06/13/2021] [Accepted: 07/07/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) item library covers a wide range of symptoms relevant to oncology care. There is a need to select a subset of items relevant to specific patient populations to enable the implementation of PRO-CTCAE-based symptom monitoring in clinical practice. OBJECTIVE The aim of this study is to develop a PRO-CTCAE-based subset relevant to patients with lung cancer that can be used for monitoring during multidisciplinary clinical practice. METHODS The PRO-CTCAE-based subset for patients with lung cancer was generated using a mixed methods approach based on the European Organization for Research and Treatment of Cancer guidelines for developing questionnaires, comprising a literature review and semistructured interviews with both patients with lung cancer and health care practitioners (HCPs). Both patients and HCPs were queried on the relevance and impact of all PRO-CTCAE items. The results were summarized, and after a final round of expert review, a selection of clinically relevant items for patients with lung cancer was made. RESULTS A heterogeneous group of patients with lung cancer (n=25) from different treatment modalities and HCPs (n=22) participated in the study. A final list of eight relevant PRO-CTCAE items was created: decreased appetite, cough, shortness of breath, fatigue, constipation, nausea, sadness, and pain (general). CONCLUSIONS On the basis of the literature and both professional and patient input, a subset of PRO-CTCAE items has been identified for use in patients with lung cancer in clinical practice. Future work is needed to confirm the validity and effectiveness of this PRO-CTCAE-based lung cancer subset internationally and in real-world clinical practice settings.
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Affiliation(s)
- Evalien Veldhuijzen
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Iris Walraven
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - José Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
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11
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Girgis A, Durcinoska I, Arnold A, Descallar J, Kaadan N, Koh ES, Miller A, Ng W, Carolan M, Della-Fiorentina SA, Avery S, Delaney GP. Web-Based Patient-Reported Outcome Measures for Personalized Treatment and Care (PROMPT-Care): Multicenter Pragmatic Nonrandomized Trial. J Med Internet Res 2020; 22:e19685. [PMID: 33118954 PMCID: PMC7661255 DOI: 10.2196/19685] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/04/2020] [Accepted: 08/18/2020] [Indexed: 12/16/2022] Open
Abstract
Background Despite the acceptability and efficacy of e–patient-reported outcome (ePRO) systems, implementation in routine clinical care remains challenging. Objective This pragmatic trial implemented the PROMPT-Care (Patient Reported Outcome Measures for Personalized Treatment and Care) web-based system into existing clinical workflows and evaluated its effectiveness among a diverse population of patients with cancer. Methods Adult patients with solid tumors receiving active treatment or follow-up care in four cancer centers were enrolled. The PROMPT-Care intervention supported patient management through (1) monthly off-site electronic PRO physical symptom and psychosocial well-being assessments, (2) automated electronic clinical alerts notifying the care team of unresolved clinical issues following two consecutive assessments, and (3) tailored online patient self-management resources. Propensity score matching was used to match controls with intervention patients in a 4:1 ratio for patient age, sex, and treatment status. The primary outcome was a reduction in emergency department presentations. Secondary outcomes were time spent on chemotherapy and the number of allied health service referrals. Results From April 2016 to October 2018, 328 patients from four public hospitals received the intervention. Matched controls (n=1312) comprised the general population of patients with cancer, seen at the participating hospitals during the study period. Emergency department visits were significantly reduced by 33% (P=.02) among patients receiving the intervention compared with patients in the matched controls. No significant associations were found in allied health referrals or time to end of chemotherapy. At baseline, the most common patient reported outcomes (above-threshold) were fatigue (39%), tiredness (38.4%), worry (32.9%), general wellbeing (32.9%), and sleep (24.1%), aligning with the most frequently accessed self-management domain pages of physical well-being (36%) and emotional well-being (23%). The majority of clinical feedback reports were reviewed by nursing staff (729/893, 82%), largely in response to the automated clinical alerts (n=877). Conclusions Algorithm-supported web-based systems utilizing patient reported outcomes in clinical practice reduced emergency department presentations among a diverse population of patients with cancer. This study also highlighted the importance of (1) automated triggers for reviewing above-threshold results in patient reports, rather than passive manual review of patient records; (2) the instrumental role nurses play in managing alerts; and (3) providing patients with resources to support guided self-management, where appropriate. Together, these factors will inform the integration of web-based PRO systems into future models of routine cancer care. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12616000615482; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370633 International Registered Report Identifier (IRRID) RR2-10.1186/s12885-018-4729-3
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Affiliation(s)
- Afaf Girgis
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Ivana Durcinoska
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Anthony Arnold
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia
| | - Joseph Descallar
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Nasreen Kaadan
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
| | - Eng-Siew Koh
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
| | - Andrew Miller
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia.,Centre for Oncology Informatics, University of Wollongong, Wollongong, Australia
| | - Weng Ng
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia.,School of Medicine, Western Sydney University, Sydney, Australia
| | - Martin Carolan
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia
| | - Stephen A Della-Fiorentina
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,School of Medicine, Western Sydney University, Sydney, Australia.,Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, Australia
| | - Sandra Avery
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
| | - Geoff P Delaney
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
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12
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Lundy JJ, Coon CD, Fu AC, Pawar V. Collection of Post-treatment PRO Data in Oncology Clinical Trials. Ther Innov Regul Sci 2020; 55:111-117. [PMID: 32643079 PMCID: PMC7785546 DOI: 10.1007/s43441-020-00195-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/23/2020] [Indexed: 12/21/2022]
Abstract
As patient-reported outcome (PRO) measures are being included more frequently in oncology clinical trials, regulatory and health technology assessment agencies have begun to request long-term, post-treatment PRO data to supplement traditional survival/progression endpoints. These data may be collected as part of cohort extension or registry studies to describe long-term outcomes of study participants after concluding their cancer treatment. While post-treatment PRO data may be expected to satisfy regulatory and payer expectations, significant practical barriers exist for the efficient incorporation of these data into oncology clinical trials, such as subject attrition, protocol deviations, and treatment crossover. The incorporation of post-treatment PRO assessments is a resource-intensive task requiring clear objectives for how the data will be analyzed and interpreted by both sponsors and regulators. Incorporating PRO data collection via electronic modalities (e.g., smartphone, web) may be a less expensive and more feasible option for incorporating long-term follow-up, reducing the frequency of manual study staff follow-up and expensive clinic visits. It is essential to include well-defined estimands for the statistical analysis, as well as to document limitations associated with the long-term follow-up data-collection approach. Analytical techniques will likely rely on descriptive and model-based statistics, and conclusions about treatment differences will likely be limited to preliminary findings of effectiveness (instead of efficacy). Finally, communications with health authorities and regulatory agencies regarding the LTFU study design and analysis should occur as early as possible to ensure that the PRO data to be collected offer an opportunity to properly evaluate the research question(s) of interest.
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Affiliation(s)
- J Jason Lundy
- Outcometrix, St. Petersburg, FL, USA. .,Outcometrix, 433 Central Avenue, Suite 300, St. Petersburg, FL, 33701, USA.
| | | | - An-Chen Fu
- EMD Serono Research & Development Institute, Inc., Billerica, MA, USA
| | - Vivek Pawar
- EMD Serono Research & Development Institute, Inc., Billerica, MA, USA
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13
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Friis RB, Hjollund NH, Mejdahl CT, Pappot H, Skuladottir H. Electronic symptom monitoring in patients with metastatic lung cancer: a feasibility study. BMJ Open 2020; 10:e035673. [PMID: 32554725 PMCID: PMC7304800 DOI: 10.1136/bmjopen-2019-035673] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To design an electronic questionnaire for symptom monitoring and to evaluate the feasibility, usability and acceptability when applied to patients with metastatic lung cancer. SETTING Single-centre feasibility study. PARTICIPANTS Patients with stage IV lung cancer in antineoplastic treatment. INTERVENTIONS This study describes the first three phases of a complex intervention design: phase 1, development of the intervention; phase 2, feasibility testing and phase 3, evaluation of the intervention. In phase 1, items were selected for the questionnaire and adjusted following patient interviews. In phase 2, patients completed the electronic questionnaire weekly during a 3-week feasibility test. In case of symptom deterioration, a nurse was notified with the aim to contact the patient. In phase 3, patients evaluated phase 2 by paper questionnaires, and interviews were conducted with the participating nurses. PRIMARY OUTCOME MEASURES The study outcomes: phase 1, usability and relevance; phase 2, recruitment rate, compliance and threshold functionality and phase 3, usability, acceptability and relevance. RESULTS In phase 1, a questionnaire was designed and reviewed by patients (n=8). The interviews revealed high usability and relevance of the intervention.For phases 2 and 3, 20 of 29 approached patients (69%) responded to the questionnaire on a weekly basis. Two patients did not complete any questionnaires (compliance 90%). The remaining 18 patients completed 65 of a total of 72 possible questionnaires (7 missed, 93% completed). Reported symptoms led to a phone call from a nurse in 30% of the responses.The patients reported high usability and acceptability of questionnaire and software. The substance of the telephonic conversations was relevant, and the study set-up was logistically acceptable. CONCLUSIONS An electronic questionnaire designed for symptom monitoring revealed high usability, acceptability and relevance in the target population. In conclusion, the study set-up was considered feasible for a randomised controlled trial. TRIAL REGISTRATION NUMBER NCT03529851.
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Affiliation(s)
| | - Niels Henrik Hjollund
- AmbuFlex, Occupational Medicine, University Research Clinic, Aarhus University, Hospital Unit West Jutland, Herning, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Caroline Trillingsgaard Mejdahl
- AmbuFlex, Occupational Medicine, University Research Clinic, Aarhus University, Hospital Unit West Jutland, Herning, Denmark
| | - Helle Pappot
- Department of Oncology, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Halla Skuladottir
- Department of Oncology, Hospital Unit West Jutland, Herning, Denmark
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14
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Jim HSL, Hoogland AI, Brownstein NC, Barata A, Dicker AP, Knoop H, Gonzalez BD, Perkins R, Rollison D, Gilbert SM, Nanda R, Berglund A, Mitchell R, Johnstone PAS. Innovations in research and clinical care using patient-generated health data. CA Cancer J Clin 2020; 70:182-199. [PMID: 32311776 PMCID: PMC7488179 DOI: 10.3322/caac.21608] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 12/17/2022] Open
Abstract
Patient-generated health data (PGHD), or health-related data gathered from patients to help address a health concern, are used increasingly in oncology to make regulatory decisions and evaluate quality of care. PGHD include self-reported health and treatment histories, patient-reported outcomes (PROs), and biometric sensor data. Advances in wireless technology, smartphones, and the Internet of Things have facilitated new ways to collect PGHD during clinic visits and in daily life. The goal of the current review was to provide an overview of the current clinical, regulatory, technological, and analytic landscape as it relates to PGHD in oncology research and care. The review begins with a rationale for PGHD as described by the US Food and Drug Administration, the Institute of Medicine, and other regulatory and scientific organizations. The evidence base for clinic-based and remote symptom monitoring using PGHD is described, with an emphasis on PROs. An overview is presented of current approaches to digital phenotyping or device-based, real-time assessment of biometric, behavioral, self-report, and performance data. Analytic opportunities regarding PGHD are envisioned in the context of big data and artificial intelligence in medicine. Finally, challenges and solutions for the integration of PGHD into clinical care are presented. The challenges include electronic medical record integration of PROs and biometric data, analysis of large and complex biometric data sets, and potential clinic workflow redesign. In addition, there is currently more limited evidence for the use of biometric data relative to PROs. Despite these challenges, the potential benefits of PGHD make them increasingly likely to be integrated into oncology research and clinical care.
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Affiliation(s)
- Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Naomi C Brownstein
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Anna Barata
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Adam P Dicker
- Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Randa Perkins
- Department of Clinical Informatics and Clinical Systems, Moffitt Cancer Center, Tampa, Florida
| | - Dana Rollison
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida
| | - Scott M Gilbert
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Ronica Nanda
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
- BayCare Health Systems Inc, Morton Plant Hospital, Clearwater, Florida
| | - Anders Berglund
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Ross Mitchell
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
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15
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Henson LA, Maddocks M, Evans C, Davidson M, Hicks S, Higginson IJ. Palliative Care and the Management of Common Distressing Symptoms in Advanced Cancer: Pain, Breathlessness, Nausea and Vomiting, and Fatigue. J Clin Oncol 2020; 38:905-914. [PMID: 32023162 PMCID: PMC7082153 DOI: 10.1200/jco.19.00470] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Good symptom management in oncology is associated with improved patient and family quality of life, greater treatment compliance, and may even offer survival advantages. With population growth and aging, the proportion of patients with multiple symptoms—both related and unrelated to their cancer—is anticipated to increase, supporting calls for a more routine and integrated approach to symptom management. This article presents a summary of the literature for the use of symptom assessment tools and reviews the management of four common and distressing symptoms commonly experienced by people with advanced cancer: pain, breathlessness, nausea and vomiting, and fatigue. We also discuss the role of palliative care in supporting a holistic approach to symptom management throughout the cancer trajectory.
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Affiliation(s)
- Lesley A Henson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Catherine Evans
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Martin Davidson
- King's College Hospital National Health Service Foundation Trust, Denmark Hill, London, United Kingdom
| | - Stephanie Hicks
- King's College Hospital National Health Service Foundation Trust, Denmark Hill, London, United Kingdom
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, United Kingdom
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16
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Bertucci F, Le Corroller-Soriano AG, Monneur A, Fluzin S, Viens P, Maraninchi D, Goncalves A. [E-health and "Cancer outside the hospital walls", Big Data and artificial intelligence]. Bull Cancer 2019; 107:102-112. [PMID: 31543271 DOI: 10.1016/j.bulcan.2019.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/15/2019] [Accepted: 07/04/2019] [Indexed: 12/25/2022]
Abstract
To heal otherwise in oncology has become an imperative of Public Health and an economic imperative in France. Patients can therefore receive live most of their care outside of hospital with more ambulatory care. This ambulatory shift will benefit from the digital revolution and the development of digital health or e-health. Cancer research will also benefit with Big Data and artificial intelligence, which gather and analyze a huge amount of data. In this synthesis, we describe the different e-health tools and their potential impacts in oncology, at the levels of education and information of patients and caregivers, prevention, screening and diagnosis, treatment, follow-up, and research. A few randomized studies have already demonstrated clinical benefits. Large Big Data projects such as ConSoRe and Health Data Hub have been launched in France. We also discuss the issues and limitations of "cancer outside the hospital walls and e-health" from the point of view of patients, health care professionals, health facilities and government. This new organization will have to provide remote support "outside the walls" with care and follow-up of quality, continuous and prolonged in total safety and equity. Ongoing and future randomized clinical trials will need to definitively demonstrate areas of interest, advantages and drawbacks not only for patients, but also for caregivers, health facilities and governments.
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Affiliation(s)
- François Bertucci
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France; Aix-Marseille université, Centre de recherche en cancérologie de Marseille, Inserm U1068-CNRS U7258, 13009 Marseille, France.
| | - Anne-Gaëlle Le Corroller-Soriano
- Aix-Marseille université, SESSTIM, Sciences économiques & sociales de la santé & traitement de l'information médicale, Inserm UMR912, 13009 Marseille, France
| | - Audrey Monneur
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France
| | - Sylvain Fluzin
- Institut Paoli-Calmettes, direction du système d'information et de l'organisation, 13009 Marseille, France
| | - Patrice Viens
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France; Aix-Marseille université, Centre de recherche en cancérologie de Marseille, Inserm U1068-CNRS U7258, 13009 Marseille, France
| | - Dominique Maraninchi
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France; Aix-Marseille université, Centre de recherche en cancérologie de Marseille, Inserm U1068-CNRS U7258, 13009 Marseille, France
| | - Anthony Goncalves
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France; Aix-Marseille université, Centre de recherche en cancérologie de Marseille, Inserm U1068-CNRS U7258, 13009 Marseille, France
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17
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Outpatient Cancer Care Delivery in the Context of E-Oncology: A French Perspective on "Cancer outside the Hospital Walls". Cancers (Basel) 2019; 11:cancers11020219. [PMID: 30769858 PMCID: PMC6406853 DOI: 10.3390/cancers11020219] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/06/2019] [Accepted: 02/10/2019] [Indexed: 01/21/2023] Open
Abstract
In oncology, the treatment of patients outside of hospitals has become imperative due to an increasing number of patients who are older and live longer, along with issues such as medical desertification, oncologist hyperspecialization, and difficulties in financing mounting health expenditures. Treatments have become less "invasive", with greater precision and efficiency. Patients can therefore receive most of their care outside of hospitals. The development of e-health can address these new imperatives. In this letter, we describe the different e-health tools and their potential clinical impacts in oncology, as already reported at every level of care, including education, prevention, diagnosis, treatment, and monitoring. A few randomized studies have yet demonstrated the clinical benefit. We also comment on issues and limits of "cancer outside the hospital walls" from the point of view of patients, health care professionals, health facilities, and public authorities. Care providers in hospitals and communities will have to adapt to these changes within well-coordinated networks in order to better meet patient expectations regarding increasing education and personalizing management. Ultimately, controlled studies should aim to definitively demonstrate areas of interest, benefits, and incentives, for not only patients, but also caregivers (formal and informal) and health care providers, health care facilities, and the nation.
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18
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Giordano FA, Welzel G, Siefert V, Jahnke L, Ganslandt T, Wenz F, Grosu AL, Heinemann F, Nicolay NH. Digital Follow-Up and the Perspective of Patient-Centered Care in Oncology: What's the PROblem? Oncology 2018; 98:379-385. [PMID: 30517946 DOI: 10.1159/000495294] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/29/2018] [Indexed: 11/19/2022]
Abstract
There is accumulating evidence from randomized trials suggesting that digital patient-centered care allows a more reliable detection of tumour-related symptoms and adverse events - with a direct impact on overall survival. Consequently, a variety of unsynchronized approaches were kicked off to (electronically) measure patient-reported outcomes (PROs). Despite increasing evidence that PRO data are highly relevant for patient care, the data generated in these initial projects lack standardized processing pathways in order to impact clinical routine; therefore, potential future routine PRO assessments require adequate analysis, storage and processing to allow a robust, reproducible and reliable incorporation into routine clinical decision-making. Here, we discuss relevant challenges of digital follow-up that need to be tackled to render PRO data as relevant to physicians as laboratory or biomarker data.
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Affiliation(s)
- Frank A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany,
| | - Grit Welzel
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Victor Siefert
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Lennart Jahnke
- Digitalization Office, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Thomas Ganslandt
- Heinrich Lanz Center for Digital Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany.,German Cancer Consortium, Partner Site Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Felix Heinemann
- Department of Radiation Oncology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany.,German Cancer Consortium, Partner Site Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nils H Nicolay
- Department of Radiation Oncology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany.,German Cancer Consortium, Partner Site Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Denis F, Voog E, Pointreau Y, Bourgeois H, Seegers V, Le Du K. Prospective study of a web-mediated management of febrile neutropenia related to chemotherapy (Bioconnect). Support Care Cancer 2018; 27:2189-2194. [PMID: 30306327 DOI: 10.1007/s00520-018-4505-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/05/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND We aimed to investigate whether patient self-evaluated symptoms transmitted via Internet is feasible between planned visits to provide an early management of fever and neutropenia induced by chemotherapy, and if it can reduce hospitalizations for severe neutropenia. METHODS Patients who received a chemotherapy regimen with an overall risk of febrile neutropenia ≥ 20% had to report daily temperature between physician planned visits using a web application. Fever and clinical signs of seriousness were reported to the physician (if some criteria were fulfilled in a specific algorithm) via automatic email notifications by the web application. Patients could be hospitalized quickly or could take over at home, make blood count, and take predefined oral antibiotics if indicated. Primary outcome was patient's compliance and satisfaction. The number and the cost of hospitalization were also assessed and compared with an historical cohort of patients with similar clinical conditions and treatment. RESULTS Among the 41 patients included, 36 (87.8%) used the web application with 88% of daily compliance and 90% (28/33) of satisfaction. One patient (2.7%) had planned hospitalization after the web application alert. In the historical cohort, the rate of unplanned hospitalization for febrile neutropenia was 17% (6 patients) and 2.7% (1 patient) in users of the web application cohort. The cumulative cost of hospitalization for neutropenia was USD 28,827 in the historical cohort and USD 6563 in the web application cohort. CONCLUSION Web-mediated follow-up of febrile neutropenia is feasible. It led to high patient satisfaction, high compliance, and a possible reduction of the number and the cost of hospitalizations.
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Affiliation(s)
- Fabrice Denis
- Institut Inter-régional de Cancérologie Jean Bernard, 9 rue Beauverger, Le Mans, France. .,CORIA UMR 6614-Normandie Université, CNRS - Université et INSA de Rouen, Campus Universitaire du Madrillet, F-76800, Saint-Étienne-du-Rouvray, France.
| | - Eric Voog
- Institut Inter-régional de Cancérologie Jean Bernard, 9 rue Beauverger, Le Mans, France
| | - Yoann Pointreau
- Institut Inter-régional de Cancérologie Jean Bernard, 9 rue Beauverger, Le Mans, France
| | - Hugues Bourgeois
- Institut Inter-régional de Cancérologie Jean Bernard, 9 rue Beauverger, Le Mans, France
| | - Valérie Seegers
- Institut de Cancérologie de l'Ouest Paul Papin, 15 rue A Boquel, 49100, Angers, France
| | - Katell Le Du
- Institut Inter-régional de Cancérologie Jean Bernard, 9 rue Beauverger, Le Mans, France
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Denis F, Koontz BF, Letellier C. Application and Benefits of Web-Mediated Symptom Reporting for Patients Undergoing Immunotherapy: A Clinical Example. Case Rep Oncol 2018; 11:763-768. [PMID: 30627090 PMCID: PMC6323363 DOI: 10.1159/000494829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 10/23/2018] [Indexed: 12/21/2022] Open
Abstract
Two randomized studies of symptom monitoring during chemotherapy or during second line treatment and follow-up via web-based patient-reported outcomes (PROs) was previously demonstrated to lengthen survival. We are presenting here a patient with advanced and recurrent lung cancer who was followed for 4 years by PROs for relapse and adverse events detection. We report how the web-mediated follow-up helped to detect dangerous pulmonary embolism, relapse and pseudo-progression to immunotherapy by self-reported symptom tracking and specific algorithms triggering notifications to medical team, allowing early management of events. We particularly describe how a discordance between objective clinical improvement under immunotherapy assessed by the application allowed to detect pseudo-progression on imaging and allowed maintenance of the treatment during more than 1-year, although imaging report could have led to stop an effective therapy. The progression observed in the routine imaging was indeed in clear contradiction with improvements in patient's global status as assessed by the reduced PRO-score computed from patient self-reported symptoms. The ability of e-health tools based on symptoms reporting for tumor response assessment should be assessed in trials to help physician in decision of stopping or continuing therapy.
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Affiliation(s)
- Fabrice Denis
- Institut Inter-régional de Cancérologie Jean Bernard, 9 rue Beauverger, Le Mans, France
- Normandie Université - CORIA, Campus Universitaire du Madrillet, Saint-Etienne du Rouvray, France
| | - Bridget F. Koontz
- Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina, USA
| | - Christophe Letellier
- Normandie Université - CORIA, Campus Universitaire du Madrillet, Saint-Etienne du Rouvray, France
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[A close web-based patient follow-up improves overall survival in lung cancer patients]. Strahlenther Onkol 2018; 194:604-606. [PMID: 29582091 DOI: 10.1007/s00066-018-1297-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
E-health is fashionable, but clinical evidence of its usefulness is rare and limited to reporting symptoms without specific analysis. The Chaos theory is applicable to the dynamics of the cancer and brings possibilities of use of its properties to develop useful, relevant and validated tools for cancer patients monitoring. The Chaos theory is applicable to the understanding of tumor dynamics due to interactions between tumor, host, endothelial and immune cells. Observability theory is one of its properties which suggests that the follow-up of the host (the patient via its symptoms and its weight) is a strong variable to evaluate the dynamics of the disease and its impact. Intensive follow-up and analysis of patients' symptoms to detect recurrences and clinical complications via a web-application (MoovcareTM) demonstrated its interest in nearly 300 patients in 4 prospective studies including 1 pilot trial showing a benefit of 27% survival rate at 1 year, and a randomized phase 3 trial with a 26% 1-year survival improvement as compared to a conventional follow-up. Six other intensive follow-up studies show favorable results in oncology for a total of more than 2,000 randomized patients.
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Affiliation(s)
- Fabrice Denis
- Institut inter-régional de cancérologie Jean Bernard, 9, rue Beauverger, 72000 Le Mans, France - CORIA UMR 6614-Normandie université, CNRS - université et INSA de Rouen, campus universitaire du Madrillet, F-76800 Saint-Étienne du Rouvray, France
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Improving Survival in Patients Treated for a Lung Cancer Using Self-Evaluated Symptoms Reported Through a Web Application. Am J Clin Oncol 2017; 40:464-469. [DOI: 10.1097/coc.0000000000000189] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Domblides C, Chaabane N, Wislez M. Vers de nouvelles modalités de surveillance des patients ayant un cancer du poumon ? Bull Cancer 2017; 104:703-704. [DOI: 10.1016/j.bulcan.2017.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 10/19/2022]
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25
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Denis F, Lethrosne C, Pourel N, Molinier O, Pointreau Y, Domont J, Bourgeois H, Senellart H, Trémolières P, Lizée T, Bennouna J, Urban T, El Khouri C, Charron A, Septans AL, Balavoine M, Landry S, Solal-Céligny P, Letellier C. Randomized Trial Comparing a Web-Mediated Follow-up With Routine Surveillance in Lung Cancer Patients. J Natl Cancer Inst 2017; 109:3573360. [PMID: 28423407 DOI: 10.1093/jnci/djx029] [Citation(s) in RCA: 274] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 02/07/2017] [Indexed: 11/13/2022] Open
Abstract
Background The use of web-based monitoring for lung cancer patients is growing in interest because of promising recent results suggesting improvement in cancer and resource utilization outcomes. It remains an open question whether the overall survival (OS) in these patients could be improved by using a web-mediated follow-up rather than classical scheduled follow-up and imaging. Methods Advanced-stage lung cancer patients without evidence of disease progression after or during initial treatment were randomly assigned in a multicenter phase III trial to compare a web-mediated follow-up algorithm (experimental arm), based on weekly self-scored patient symptoms, with routine follow-up with CT scans scheduled every three to six months according to the disease stage (control arm). In the experimental arm, an alert email was automatically sent to the oncologist when self-scored symptoms matched predefined criteria. The primary outcome was OS. Results From June 2014 to January 2016, 133 patients were enrolled and 121 were retained in the intent-to-treat analysis; 12 deemed ineligible after random assignment were not subsequently followed. Most of the patients (95.1%) had stage III or IV disease. The median follow-up was nine months. The median OS was 19.0 months (95% confidence interval [CI] = 12.5 to noncalculable) in the experimental and 12.0 months (95% CI = 8.6 to 16.4) in the control arm (one-sided P = .001) (hazard ratio = 0.32, 95% CI = 0.15 to 0.67, one-sided P = .002). The performance status at first detected relapse was 0 to 1 for 75.9% of the patients in the experimental arm and for 32.5% of those in the control arm (two-sided P < .001). Optimal treatment was initiated in 72.4% of the patients in the experimental arm and in 32.5% of those in the control arm (two-sided P < .001). Conclusions A web-mediated follow-up algorithm based on self-reported symptoms improved OS due to early relapse detection and better performance status at relapse.
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Affiliation(s)
- Fabrice Denis
- Institut Inter-régional de Cancérologie Jean Bernard, Le Mans, France.,CORIA UMR 6614-Normandie Université, CNRS Université et INSA de Rouen, Campus Universitaire du Madrillet, Saint-Etienne du Rouvray, France
| | - Claire Lethrosne
- Service de pneumologie, Centre Hospitalier, Le Coudray, Chartres, France
| | | | | | - Yoann Pointreau
- Institut Inter-régional de Cancérologie Jean Bernard, Le Mans, France
| | - Julien Domont
- Institut Inter-régional de Cancérologie Jean Bernard, Le Mans, France
| | - Hugues Bourgeois
- Institut Inter-régional de Cancérologie Jean Bernard, Le Mans, France
| | - Hélène Senellart
- Institut de Cancérologie de l'Ouest René Gauducheau, St Herblain, France
| | | | - Thibaut Lizée
- Institut de Cancérologie de l'Ouest Paul Papin, Angers, France
| | - Jaafar Bennouna
- Institut de Cancérologie de l'Ouest René Gauducheau, St Herblain, France
| | - Thierry Urban
- Service de pneumologie, Centre Hospitalier Universitaire, Angers, France
| | | | - Alexandre Charron
- Institut Inter-régional de Cancérologie Jean Bernard, Le Mans, France
| | | | | | - Sébastien Landry
- Institut Inter-régional de Cancérologie Jean Bernard, Le Mans, France
| | | | - Christophe Letellier
- CORIA UMR 6614-Normandie Université, CNRS Université et INSA de Rouen, Campus Universitaire du Madrillet, Saint-Etienne du Rouvray, France
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Nipp R, Temel J. Editorial: The Patient Knows Best: Incorporating Patient-Reported Outcomes Into Routine Clinical Care. J Natl Cancer Inst 2017; 109:3573363. [DOI: 10.1093/jnci/djx044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 02/24/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ryan Nipp
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA
| | - Jennifer Temel
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA
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Vogel MME, Combs SE, Kessel KA. mHealth and Application Technology Supporting Clinical Trials: Today's Limitations and Future Perspective of smartRCTs. Front Oncol 2017; 7:37. [PMID: 28348978 PMCID: PMC5346562 DOI: 10.3389/fonc.2017.00037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/27/2017] [Indexed: 11/13/2022] Open
Abstract
Nowadays, applications (apps) for smartphones and tablets have become indispensable especially for young generations. The estimated number of mobile devices will exceed 2.16 billion in 2016. Over 2.2 million apps are available in the Google Play store®, and about 1.8 million apps are available in the Apple App Store®. Google and Apple distribute nearly 70,000 apps each in the category Health and Fitness, and about 33,000 and 46,000 each in medical apps. It seems like the willingness to use mHealth apps is high and the intention to share data for health research is existing. This leads to one conclusion: the time for app-accompanied clinical trials (smartRCTs) has come. In this perspective article, we would like to point out the stones put in the way while trying to implement apps in clinical research. Further, we try to offer a glimpse of what the future of smartRCT research may hold.
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Affiliation(s)
- Marco M E Vogel
- Department of Radiation Oncology, Technische Universität München (TUM), Munich, Germany; Institute for Innovative Radiotherapy, Helmholtz Zentrum München, Neuherberg, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technische Universität München (TUM), Munich, Germany; Institute for Innovative Radiotherapy, Helmholtz Zentrum München, Neuherberg, Germany
| | - Kerstin A Kessel
- Department of Radiation Oncology, Technische Universität München (TUM), Munich, Germany; Institute for Innovative Radiotherapy, Helmholtz Zentrum München, Neuherberg, Germany
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Viger L, Denis F, Rosalie M, Letellier C. A cancer model for the angiogenic switch. J Theor Biol 2014; 360:21-33. [DOI: 10.1016/j.jtbi.2014.06.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 06/04/2014] [Accepted: 06/17/2014] [Indexed: 11/28/2022]
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Tendas A, Niscola P, Scaramucci L, Giovannini M, Dentamaro T, Perrotti AP, de Fabritiis P. Making quality of life assessment a dashboard for patient management. Support Care Cancer 2014; 22:2311-2. [PMID: 24993396 DOI: 10.1007/s00520-014-2342-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 06/23/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Andrea Tendas
- Hematology Division, S. Eugenio Hospital, Piazzale dell'Umanesimo 10, Rome, 00144, Italy,
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Denis F, Viger L, Charron A, Voog E, Dupuis O, Pointreau Y, Letellier C. Detection of lung cancer relapse using self-reported symptoms transmitted via an internet web-application: pilot study of the sentinel follow-up. Support Care Cancer 2014; 22:1467-73. [PMID: 24414998 DOI: 10.1007/s00520-013-2111-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 12/25/2013] [Indexed: 12/22/2022]
Abstract
PURPOSE We aimed to investigate whether patient self-evaluated symptoms transmitted via Internet can be used between planned visits to provide an early indication of disease relapse in lung cancer. METHODS Between 2/2013 and 8/2013, 42 patients with lung cancer having access to Internet were prospectively recruited to weekly fill a form of 11 self-assessed symptoms called "sentinel follow-up". Data were sent to the oncologist in real-time between planned visits. An alert email was sent to oncologist when self-scored symptoms matched some predefined criteria. Follow-up visit and imaging were then organized after a phone call for confirming suspect symptoms. Weekly and monthly compliances, easiness with which patients used the web-application and the accuracy of the sentinel follow-up for relapse detection were assessed and compared to a routine visit and imaging follow-up. RESULTS Median follow-up duration was 18 weeks (8-32). Weekly and monthly average compliances were 79 and 94 %, respectively. Sixty percents of patients declared to be less anxious during the few days before planned visit and imaging with the sentinel follow-up than without. Sensitivity, specificity, positive, and negative predictive values provided by the sentinel (planned imaging) follow-up were 100 %(84 %), 89 %(96 %), 81 %(91 %), and 100 %(93 %), respectively and well correlated with relapse (pχ (2) < 0.001). On average, relapses were detectable 5 weeks earlier with sentinel than planned visit. CONCLUSION An individualized cancer follow-up that schedule visit and imaging according to the patient status based on weekly self-reported symptoms transmitted via Internet is feasible with high compliance. It may even provide earlier detection of lung cancer relapse and care.
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Affiliation(s)
- Fabrice Denis
- Private Institut of Cancer, 9 rue Beauverger, Le Mans, France,
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