Computergestütztes Patient-reported Outcome Monitoring in der Neuroonkologie: Lebensqualität und Rezidiv beim Glioblastom

Reporting of patient-reported health-related quality of life in adults with diffuse low-grade glioma: a systematic review

BACKGROUND

Patient-reported health-related quality of life (HRQoL) analysis can provide important information for managing the balance between treatment benefits and treatment-related adverse effects on quality of life (QoL). This systematic review sought to identify the range of HRQoL measures used for patients with diffuse hemispheric WHO grade II glioma (DLGG) and assess the quality of HRQoL reporting.

METHODS

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases were searched for full-text English articles reporting HRQoL outcomes in adult patients with DLGG.

RESULTS

Eleven different QoL measures were used across the 26 included studies, none of which has been validated in patients with DLGG. Heterogeneity of study design prevented pooled analysis of data investigating the effect of interventions or establishing long-term HRQoL. Low rates of participation at baseline (mean: 64.0%) and high rates of subsequent dropout (2.1% per month) were identified. Five studies gave statistical methods to deal with missing data or provided evidence of clinical significance of HRQoL results.

CONCLUSIONS

The results demonstrate a paucity and heterogeneity of reporting of HRQoL in the DLGG literature, highlighting the need for a standardized assessment schedule and set of validated quality-of-life measures for future studies.

Current standards and new concepts in MRI and PET response assessment of antiangiogenic therapies in high-grade glioma patients

Despite multimodal treatment, the prognosis of high-grade gliomas is grim. As tumor growth is critically dependent on new blood vessel formation, antiangiogenic treatment approaches offer an innovative treatment strategy. Bevacizumab, a humanized monoclonal antibody, has been in the spotlight of antiangiogenic approaches for several years. Currently, MRI including contrast-enhanced T1-weighted and T2/fluid-attenuated inversion recovery (FLAIR) images is routinely used to evaluate antiangiogenic treatment response (Response Assessment in Neuro-Oncology criteria). However, by restoring the blood-brain barrier, bevacizumab may reduce T1 contrast enhancement and T2/FLAIR hyperintensity, thereby obscuring the imaging-based detection of progression. The aim of this review is to highlight the recent role of imaging biomarkers from MR and PET imaging on measurement of disease progression and treatment effectiveness in antiangiogenic therapies. Based on the reviewed studies, multimodal imaging combining standard MRI with new physiological MRI techniques and metabolic PET imaging, in particular amino acid tracers, may have the ability to detect antiangiogenic drug susceptibility or resistance prior to morphological changes. As advances occur in the development of therapies that target specific biochemical or molecular pathways and alter tumor physiology in potentially predictable ways, the validation of physiological and metabolic imaging biomarkers will become increasingly important in the near future.

Quality of life in patients with primary and metastatic brain cancer as reported in the literature using the EORTC QLQ-BN20 and QLQ-C30

The objective of this study is to compare the differences in quality of life (QoL) as assessed by the QLQ-BN20 and QLQ-C30 in patients with primary and metastatic brain neoplasms. A systematic literature search was conducted over the OvidSP platform in MEDLINE (1980-2012) and EMBASE (1980-2012). Studies in which the QLQ-BN20 was used as a QoL assessment for patients with malignant brain tumors (either metastatic or primary) were included in the study. Articles were included if they reported scores of at least one subscale of the QLQ-C30 or QLQ-BN20. The weighted means of the QLQ-BN20 and QLQ-C30 subscales were calculated based on sample size for included studies. Weighted analysis of variance was conducted to compare these scores in primary and metastatic brain patients. A p-value of < 0.05 was considered statistically significant. A total of 14 studies (16 arms: three brain metastases and 13 primary brain tumors) were identified and included in the data analysis. Fifteen of the 16 arms included QLQ-C30 scores along with QLQ-BN20 scores. Performance status of patients in both cohorts was similar. Patients with primary brain tumors and brain metastases had the following findings: physical functioning (weighted mean: 79.18 vs 74.93), global QoL (61.88 vs 59.44), role functioning (67.37 vs 75.00) and emotional functioning (70.44 vs 71.86); but none of them were statistically significantly different. Only cognitive functioning from the QLQ-C30 was significantly worse in patients with primary brain tumors (p-value = 0.0199). Despite cognitive function being significantly worse in patients with primary brain tumors, patients with metastatic brain tumors and patients with primary brain tumors have very similar QoL profiles. The study is limited by the large discrepancy in cohort sizes (1260 patients with primary brain cancer vs 183 patients with brain metastases) and the lack of clinical data.

[The benefits of using patient-reported outcomes in cancer treatment: an overview]

The patient's perspective evaluated by patient-reported outcomes (PROs) gains more and more importance, since treatment efficacy is no longer solely linked to clinical outcomes like cure and overall survival. Ailments like pain, fatigue and social isolation can only be assessed by patients' direct expression without any interpretation made by medical staff. PROs facilitate the disclosure of quality of life issues and patients feel a stronger support due to improved communication. PROs offer many further advantages like saving of time, cost and staff, targeted intervention and sensitizing of clinicians. Also, internationally validated questionnaires are available and the development of electronic PROs eases data-collection, calculation and storage. PROs collected within clinical routine are versatile concerning their applicability: They can be used for scientific analyses, quality assurance, and health technology assessment.

Qualitative and quantitative evaluation of EHR-integrated mobile patient questionnaires regarding usability and cost-efficiency

OBJECTIVES

The objective of this evaluation study is to assess a web-based application, currently available on iPad, to document questionnaires regarding patient reported outcomes such as quality of life. Based on the single source approach, the results of these questionnaires are available in the electronic health record to be used for treatment and research purposes. The assessment focuses on the usability and efficiency of the system.

METHODS

The system usability scale questionnaire with seven additional items was used to rate the usability by the patients. It was formally validated by a Cronbach Alpha test. In addition, semi-structured interviews were conducted with patients and medical staff. Time and cost measures, based on official tables of costs, were taken through workflow observations. This study was conducted in the department of dermatology at the University Hospital of Münster, Germany from April to June 2011.

RESULTS

Using the web-based application questionnaire, results about patient reported outcomes like quality of life are immediately available in the electronic health record and can be used for treatment or research purposes. 118 patients and four staff members participated in the study. The usability score reached 80 from 100 points and patients as well as medical staff stated in the interviews that the usability of the web-based system was high, and they preferred it to the previously used paper-based questionnaires. In the setting of our pilot department the mobile devices amortized their costs after 6.7 months. In general, depending on the professional group who are going to post process the paper-based forms, the earliest break-even point to use mobile questionnaires is at 1737 paper sheets per year.

CONCLUSION

The mobile patient questionnaires, integrated into the electronic health record, were well accepted in our pilot setting with high usability scores from patients and medical staff alike. The system has also proved to be cost-efficient compared to the paper-based workflow, given that a certain number of questionnaires is used per year.