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Carrera PM, Curigliano G, Santini D, Sharp L, Chan RJ, Pisu M, Perrone F, Karjalainen S, Numico G, Cherny N, Winkler E, Amador ML, Fitch M, Lawler M, Meunier F, Khera N, Pentheroudakis G, Trapani D, Ripamonti CI. ESMO expert consensus statements on the screening and management of financial toxicity in patients with cancer. ESMO Open 2024; 9:102992. [PMID: 38626634 PMCID: PMC11033153 DOI: 10.1016/j.esmoop.2024.102992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/28/2024] [Accepted: 03/10/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Financial toxicity, defined as both the objective financial burden and subjective financial distress from a cancer diagnosis and its treatment, is a topic of interest in the assessment of the quality of life of patients with cancer and their families. Current evidence implicates financial toxicity in psychosocial, economic and other harms, leading to suboptimal cancer outcomes along the entire trajectory of diagnosis, treatment, supportive care, survivorship and palliation. This paper presents the results of a virtual consensus, based on the evidence base to date, on the screening and management of financial toxicity in patients with and beyond cancer organized by the European Society for Medical Oncology (ESMO) in 2022. METHODS A Delphi panel of 19 experts from 11 countries was convened taking into account multidisciplinarity, diversity in health system contexts and research relevance. The international panel of experts was divided into four working groups (WGs) to address questions relating to distinct thematic areas: patients with cancer at risk of financial toxicity; management of financial toxicity during the initial phase of treatment at the hospital/ambulatory settings; financial toxicity during the continuing phase and at end of life; and financial risk protection for survivors of cancer, and in cancer recurrence. After comprehensively reviewing the literature, statements were developed by the WGs and then presented to the entire panel for further discussion and amendment, and voting. RESULTS AND DISCUSSION A total of 25 evidence-informed consensus statements were developed, which answer 13 questions on financial toxicity. They cover evidence summaries, practice recommendations/guiding statements and policy recommendations relevant across health systems. These consensus statements aim to provide a more comprehensive understanding of financial toxicity and guide clinicians globally in mitigating its impact, emphasizing the importance of further research, best practices and guidelines.
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Affiliation(s)
- P M Carrera
- German Cancer Research Center, Heidelberg, Germany; Healtempact: Health/Economic Insights-Impact, Hengelo, The Netherlands.
| | - G Curigliano
- European Institute of Oncology, IRCCS, Milan; Department of Oncology and Hemato-Oncology, University of Milano, Milan
| | - D Santini
- Oncologia Medica A, Policlinico Umberto 1, La Sapienza Università di Roma, Rome, Italy
| | - L Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - R J Chan
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - M Pisu
- University of Alabama in Birmingham, Birmingham, USA
| | - F Perrone
- National Cancer Institute IRCCS G. Pascale Foundation, Naples, Italy
| | | | - G Numico
- Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - N Cherny
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - E Winkler
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg University, Medical Faculty, Department of Medical Oncology, Heidelberg, Germany
| | - M L Amador
- Spanish Association Against Cancer (AECC), Madrid, Spain
| | - M Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - M Lawler
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - F Meunier
- European Initiative on Ending Discrimination against Cancer Survivors and Belgian Royal Academy of Medicine (ARMB), Brussels, Belgium
| | | | | | - D Trapani
- European Institute of Oncology, IRCCS, Milan; Department of Oncology and Hemato-Oncology, University of Milano, Milan
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Maldonado J, Arrarás I, Iriarte M, Otano C, Carvajal A, Centeno C. Unlocking the Hidden Dimensions of Cancer Care: Cross-Cultural Adaptation and Feasibility Study of ESAS-FS, Assessing Spiritual Pain and Financial Distress in a Spanish-speaking Population with Advanced Cancer. J Pain Symptom Manage 2024; 67:290-295. [PMID: 38185194 DOI: 10.1016/j.jpainsymman.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/03/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Spiritual pain and financial distress are two important dimensions of cancer care that are often overlooked. Both dimensions can have a significant impact on the quality of life of patients with cancer and their families. METHODS This study conducted a cross-cultural adaptation, feasibility study, and psychometric properties of the Edmonton Symptom Assessment System-Financial and Spiritual (ESAS-FS) in a Spanish-speaking population with advanced cancer. The ESAS-FS is a patient-reported outcome measure that assesses 12 symptoms, including spiritual pain and financial distress. RESULTS In the cross-cultural adaptation process, the terms "spiritual pain" and "financial distress" were refined to "sufrimiento espiritual" and "preocupación por asuntos económicos" respectively, with strong professional consensus and high patients' acceptancy (relevant questions 80%, appropriate terms 91%). A cohort of 100 onco-hematologic patients revealed that 70% experienced spiritual pain (mean 2.9/10), while 49% reported financial distress (mean 2.2/10). Symptomatic analyses illustrated significant associations of spiritual pain with various symptoms like fatigue, drowsiness, and depression. Similarly, financial distress correlated notably with drowsiness, depression, and anxiety. Moreover, a distinct correlation was observed between spiritual pain and financial distress. CONCLUSION The findings of this study suggest that the ESAS-FS is a valuable tool for assessing spiritual pain and financial distress in Spanish-speaking patients with advanced cancer. The tool can be used to identify patients who are experiencing these dimensions of distress and to provide them with appropriate care.
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Affiliation(s)
- J Maldonado
- Fundación CUDECA (J.M.), Benalmádena, Andalucía, Spain.
| | - I Arrarás
- Facultad de Medicina (I.A.), Universidad de Navarra, Pamplona, Navarra, Spain
| | - M Iriarte
- Servicio de Medicina Paliativa (M.I., C.O., C.C.), Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - C Otano
- Servicio de Medicina Paliativa (M.I., C.O., C.C.), Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - A Carvajal
- Facultad de Enfermería (A.C.), Universidad de Navarra, Pamplona, Navarra, Spain
| | - C Centeno
- Servicio de Medicina Paliativa (M.I., C.O., C.C.), Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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Monsen RE, Lerdal A, Nordgarden H, Gay CL, Herlofson BB. A comparison of the prevalence of dry mouth and other symptoms using two different versions of the Edmonton Symptom Assessment System on an inpatient palliative care unit. BMC Palliat Care 2024; 23:75. [PMID: 38493155 PMCID: PMC10943902 DOI: 10.1186/s12904-024-01405-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 03/05/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Symptom assessment is key to effective symptom management and palliative care for patients with advanced cancer. Symptom prevalence and severity estimates vary widely, possibly dependent on the assessment tool used. Are symptoms specifically asked about or must the patients add them as additional symptoms? This study compared the prevalence and severity of patient-reported symptoms in two different versions of a multi-symptom assessment tool. In one version, three symptoms dry mouth, constipation, sleep problems were among those systematically assessed, while in the other, these symptoms had to be added as an "Other problem". METHODS This retrospective cross-sectional study included adult patients with advanced cancer at an inpatient palliative care unit. Data were collected from two versions of the Edmonton Symptom Assessment System (ESAS): modified (ESAS-m) listed 11 symptoms and revised (ESAS-r) listed 9 and allowed patients to add one "Other problem". Seven similar symptoms were listed in both versions. RESULTS In 2013, 184 patients completed ESAS-m, and in 2017, 156 completed ESAS-r. Prevalence and severity of symptoms listed in both versions did not differ. In ESAS-m, 83% reported dry mouth, 73% constipation, and 71% sleep problems, but on ESAS-r, these symptoms were reported by only 3%, 15% and < 1%, respectively. Although ESAS-r severity scores for these three symptoms were higher than on ESAS-m, differences did not reach statistical significance. CONCLUSION We identified significant differences in patient symptom reporting based on whether symptoms like dry mouth, obstipation and sleep problems were specifically assessed or had to be added by patients as an "Other problem".
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Affiliation(s)
- Ragnhild Elisabeth Monsen
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1089 Blindern, Oslo, 0317, Norway.
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway.
| | - Anners Lerdal
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1089 Blindern, Oslo, 0317, Norway
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Hilde Nordgarden
- National Resource Centre for Oral Health in Rare Disorders, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Caryl L Gay
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, USA
| | - Bente Brokstad Herlofson
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
- Unit of Oral and Maxillofacial Surgery, Department of Otorhinolaryngology - Head and Neck Surgery Division for Head, Neck and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
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Grassi L, Zachariae R, Caruso R, Palagini L, Campos-Ródenas R, Riba MB, Lloyd-Williams M, Kissane D, Rodin G, McFarland D, Ripamonti CI, Santini D. Insomnia in adult patients with cancer: ESMO Clinical Practice Guideline. ESMO Open 2023; 8:102047. [PMID: 38158225 PMCID: PMC10774975 DOI: 10.1016/j.esmoop.2023.102047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 01/03/2024] Open
Abstract
•Insomnia is common in patients with cancer, with a higher prevalence than observed in the general population. •Insomnia is often under-recognised and inadequately treated in patients with cancer. •Brief validated screening tools are available for the evaluation of insomnia in clinical practice. •First-line therapy should be based on international guidelines recommending cognitive behavioural therapy for insomnia.
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Affiliation(s)
- L Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - R Zachariae
- Unit for Psychooncology and Health Psychology (EPoS), Department of Oncology, Aarhus University Hospital, Aarhus; Danish Center for Breast Cancer Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark
| | - R Caruso
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - L Palagini
- Sleep Clinic, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - R Campos-Ródenas
- Department of Psychiatry, Hospital Clínico Universitario Lozano Blesa, University of Zaragoza, Zaragoza, Spain
| | - M B Riba
- Department of Psychiatry, University of Michigan, Ann Arbor; University of Michigan Rogel Cancer Center, University of Michigan, Ann Arbor, USA
| | - M Lloyd-Williams
- Academic Palliative and Supportive Care Studies Group (APSCSG), Primary Care and Mental Health, University of Liverpool, Liverpool; Department of Supportive and Palliative Care, Liverpool John Moores University, Liverpool, UK
| | - D Kissane
- Department of Psychiatry, Monash University and Monash Medical Centre, Monash Health, Clayton, Australia
| | - G Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - D McFarland
- Department of Psychiatry, University of Rochester, Rochester; Wilmont Cancer Institute, University of Rochester Medical Center, Rochester, USA
| | - C I Ripamonti
- School of Speciality in Palliative Medicine, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - D Santini
- Medical Oncology A, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Miccinesi G, Ripamonti C, Leoni S, Gandelli M, Di Pede P, Visani V, Ambrosini P, De Feo G, Bellandi L, Toffolatti L, Chelazzi C, Trinci C, Chiesi F. Assessing suffering of patients on cancer treatment and of those no longer treated using ESAS-Total Care (TC). Support Care Cancer 2023; 31:579. [PMID: 37715838 PMCID: PMC10505109 DOI: 10.1007/s00520-023-08035-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/02/2023] [Indexed: 09/18/2023]
Abstract
AIM The aim of the study was to assess the suffering of patients on oncologic treatment and of those no longer on treatment. Preliminarily, we aimed to confirm the psychometric properties of Edmonton Symptom Assessment System-Total Care (ESAS-TC) in different stages of the disease. The ESAS-TC screens physical and psychological symptoms, but also spiritual pain, discomfort deriving from financial problems associated with illness, and suffering related to social isolation. METHODS A sample of consecutive advanced cancer patients on oncologic therapies treated at the Internistic and Geriatric Supportive Care Unit (IGSCU) of Istituto Nazionale dei Tumori, Milano, and of terminal patients no longer on treatment and cared for by the Fondazione ANT palliative home care team were asked to fill the ESAS-TC. In order to strengthen the previous validation study of the ESAS-TC, 3-ULS (to assess social isolation), JSWBS (to assess spiritual well-being), COST-IT (to assess financial distress), and KPS (to assess functional status) were administered too. RESULTS The questionnaires were self-reported by 108 patients on treatment (52% >60 years old, female 53%, and 61% with KPS 90-100) and by 94 home care patients (71% >60 years old, female 51%, and 68% with KPS 10-50). The sound psychometric characteristics of ESAS-TC were confirmed. Patients on treatment showed lower total ESAS-TC score (19.3 vs 52.7, p<.001) after controlling for age and functional status, and lower financial distress (p.<001). Financial distress, spiritual suffering, and social isolation, after controlling for age, showed a significantly higher score in home care patients. CONCLUSIONS Only through an adequate routine assessment with validated tools is it possible to detect total suffering, the "Total pain" of patients, and treat it through a multidisciplinary approach. The study confirms the reliability and validity of the Italian version of ESAS-TC and the importance of supportive and early palliative care fully integrated with oncological treatment.
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Affiliation(s)
- Guido Miccinesi
- Clinical Epidemiology Unit, Oncological Network Prevention and Research Institute (ISPRO), Florence, Italy
| | - Carla Ripamonti
- Palliative Medicine, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Universita' degli Studi di Brescia, Brescia, Italy.
| | | | - Monica Gandelli
- Internistic and Geriatric Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Patricia Di Pede
- Internistic and Geriatric Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | - Paolo Ambrosini
- Department of Medical Oncology, IRCCS Fondazione Istituto Nazionale dei Tumori, Milan, Italy
| | - Giulia De Feo
- Internistic and Geriatric Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | - Luisa Toffolatti
- Internistic and Geriatric Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Cosimo Chelazzi
- Palliative Medicine, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Universita' degli Studi di Brescia, Brescia, Italy
| | | | - Francesca Chiesi
- Department of Neuroscience, Psychology, Drug, and Child's Health (NEUROFARBA), Section of Psychology, University of Florence, Florence, Italy
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Bovero A, Zerbinati L, Grassi L, Mah K, Rodin G, Hales S, Malfitano C, TIberto E, Leombruni P, Miniotti M, Caruso R. The Italian validation of the Death and Dying Distress Scale. Palliat Support Care 2022; 21:1-9. [PMID: 36476559 DOI: 10.1017/s1478951522001638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Death anxiety (DA), a condition characterized by fear, angst, or panic related to the awareness of one's own death, is commonly observed in advanced cancer patients. The aim of this study was to examine the psychometric properties of the Italian version of the Death and Dying Distress Scale (DADDS-IT) in a sample of patients with advanced cancer. METHODS The sample included 200 Italian advanced cancer patients meeting eligibility criteria to access palliative care. Patients' levels of DA were assessed by using the DADDS-IT, while the levels of depression, anxiety, demoralization, spiritual well-being, and symptom burden were assessed using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Demoralization Scale, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale, and the Edmonton Symptom Assessment System, respectively; Karnofsky Performance Status was used to measure functional impairment. Confirmatory factor analyses (CFA) of previous structures and exploratory factor analyses (EFA) were conducted. RESULTS CFA revealed that none of the previous structures adequately fitted data from our sample. EFA revealed a 4-factor model comprising Finitude (α = 0.91), Regret (α = 0.86), Dying (α = 0.88), and Relational Burden (α = 0.73), accounting for the 77.1% of the variance. Dying subscore was higher in hospice patients than in those recruited in medical wards. SIGNIFICANCE OF RESULTS The present study provides further evidence that DA is a condition that deserves attention and that DADDS-IT shows good psychometric properties to support its use in research and clinical settings.
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Affiliation(s)
- Andrea Bovero
- Clinical Psychology Unit, Department of Neuroscience, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Kenneth Mah
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Gary Rodin
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sarah Hales
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Carmine Malfitano
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Elisa TIberto
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Paolo Leombruni
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Marco Miniotti
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Rosangela Caruso
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
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Caccialanza R, Cereda E, Agustoni F, Klersy C, Casirati A, Montagna E, Carnio S, Novello S, Milella M, Pilotto S, Trestini I, Buffoni L, Ferrari A, Pedrazzoli P. Multicentre, randomised, open-label, parallel-group, clinical phase II study to evaluate immunonutrition in improving efficacy of immunotherapy in patients with metastatic non-small cell lung cancer, undergoing systematic nutritional counseling. BMC Cancer 2022; 22:1212. [PMID: 36434615 PMCID: PMC9700895 DOI: 10.1186/s12885-022-10296-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Nutritional support, including nutritional counseling and oral nutritional supplements (ONS), has been recommended as a first-line strategy in patients with non-small cell lung cancer (NSCLC). Evidence on the efficacy of immunonutrition during immunotherapy in these patients is positive, but still limited some secondary endpoints, such as treatment toxicity and tolerance. We hypothesize that early systematic provision of ONS with a high-protein-high calorie mixture containing immunonutrients (Impact®) in addition to nutritional counseling, compared to nutritional counseling alone, is beneficial to patients with NSCLC receiving immunotherapy with or without chemotherapy. We designed the present study to evaluate the efficacy of early systematic provision of ONS enriched with immunonutrients compared to nutritional counseling alone, in patients with NSCLC undergoing immunotherapy. Study endpoints were: treatment response (primary endpoint: progression-free survival), treatment tolerance and toxicity, body weight, body composition, protein-calorie intake, quality of life, fatigue, muscle strength and immunological profile. METHODS This is a pragmatic, multicentre, randomized (1:1), parallel-group, open label, controlled, pilot clinical trial (N = 180). DISCUSSION The improvement of efficacy of nutritional support in oncology still deserves many efforts. Immunonutrition represents a promising approach also in patients with NSCLC, but evidence on its efficacy on clinical outcomes during immunotherapy is still inconclusive. The present pilot study, which guarantees early high-quality nutritional care (assessment and treatment) to all patients in agreement with current guidelines and recommendations, could represent one of the first proofs of efficacy of early oral immunonutrition in patients with cancer undergoing immunotherapy. Further large randomized trials addressing the improvement of supportive care could be hypothesized, accordingly. TRIAL REGISTRATION This study is registered on ClinicalTrials.gov Identifier: NCT05384873.
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Affiliation(s)
- Riccardo Caccialanza
- grid.419425.f0000 0004 1760 3027Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Emanuele Cereda
- grid.419425.f0000 0004 1760 3027Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Francesco Agustoni
- grid.419425.f0000 0004 1760 3027Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- grid.419425.f0000 0004 1760 3027Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Amanda Casirati
- grid.419425.f0000 0004 1760 3027Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Elisabetta Montagna
- grid.419425.f0000 0004 1760 3027Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Simona Carnio
- grid.7605.40000 0001 2336 6580Department of Oncology, AOU San Luigi-Orbassano, University of Turin, Turin, Italy
| | - Silvia Novello
- grid.7605.40000 0001 2336 6580Department of Oncology, AOU San Luigi-Orbassano, University of Turin, Turin, Italy
| | - Michele Milella
- grid.411475.20000 0004 1756 948XMedical Oncology, Department of Medicine, University of Verona Hospital Trust, 37134 Verona, Italy
| | - Sara Pilotto
- grid.411475.20000 0004 1756 948XMedical Oncology, Department of Medicine, University of Verona Hospital Trust, 37134 Verona, Italy
| | - Ilaria Trestini
- grid.411475.20000 0004 1756 948XMedical Oncology, Department of Medicine, University of Verona Hospital Trust, 37134 Verona, Italy
| | - Lucio Buffoni
- Medical Oncology Unit, Humanitas Gradenigo, Turin, Italy
| | - Alessandra Ferrari
- grid.419425.f0000 0004 1760 3027Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Pedrazzoli
- grid.419425.f0000 0004 1760 3027Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy ,grid.8982.b0000 0004 1762 5736Internal Medicine Department, University of Pavia, Pavia, Italy
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Zhu Z, Xing W, Wen H, Sun Y, So WKW, Lizarondo L, Peng J, Hu Y. Psychometric properties of self-reported financial toxicity measures in cancer survivors: a systematic review. BMJ Open 2022; 12:e057215. [PMID: 35750459 PMCID: PMC9234804 DOI: 10.1136/bmjopen-2021-057215] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The aim of this systematic review was to summarise the psychometric properties of patient-reported outcome measures (PROMs) measuring financial toxicity (FT) in cancer survivors. DESIGN This systematic review was conducted according to the guidance of the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology. DATA SOURCES Comprehensive searches were performed in PubMed, MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, ProQuest and Cochrane Library from database inception to February 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included studies that reported any PROMs for measuring FT in cancer survivors who were ≥18 years old. FT was defined as perceived subjective financial distress resulting from objective financial burden. Studies that were not validation studies and that used a PROM only as an outcome measurement were excluded. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data from the included papers. We used the COSMIN criteria to summarise and evaluate the psychometric properties of each study regarding structural validity, internal consistency, reliability, measurement error, hypothesis testing for construct validity, cross-cultural validity/measurement invariance, criterion validity and responsiveness. RESULTS A total of 23 articles (21 PROMs) were eligible for inclusion in this study. The findings highlighted that the Comprehensive Score for Financial Toxicity (COST) had an adequate development process and showed better psychometric properties than other PROMs, especially in internal consistency (Cronbach's α=0.92), reliability (intraclass correlation coefficient=0.80) and hypothesis testing (r=0.42-0.20). CONCLUSIONS From a psychometric property perspective, the COST could be recommended as the most suitable worldwide available measure for use in research and clinical practice across different contexts. We suggest that PROMs should be selected only after careful consideration of the local socioeconomic context. Future studies are warranted to develop various FT PROMs based on different social and cultural backgrounds and to clarify the theoretical grounds for assessing FT.
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Affiliation(s)
- Zheng Zhu
- School of Nursing, Fudan University, Shanghai, China
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Fudan University, Shanghai, China
| | - Weijie Xing
- School of Nursing, Fudan University, Shanghai, China
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Fudan University, Shanghai, China
| | - Huan Wen
- School of Public Health, Fudan University, Shanghai, China
| | - Yanling Sun
- School of Public Health, Fudan University, Shanghai, China
| | - Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Lucylynn Lizarondo
- The Joanna Briggs Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Jian Peng
- School of Nursing, Fudan University, Shanghai, China
| | - Yan Hu
- School of Nursing, Fudan University, Shanghai, China
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Fudan University, Shanghai, China
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