Marker states and a health state prompt provide modest improvements in the reliability and validity of the standard gamble and rating scale in prostate cancer patients

Psychological flexibility and fear of recurrence in prostate cancer

OBJECTIVE

Psychological flexibility and fear of cancer recurrence are important variables that influence psychosocial outcomes in individuals diagnosed with a range of different types of cancer. Their role and how they impact on psychological distress and quality of life in men with prostate cancer specifically have not been established.

METHODS

A cross-sectional sample of 144 men with prostate cancer was recruited. Multiple regression and conditional process analysis were used to assess whether psychological flexibility moderates the relationship between fear of recurrence and distress and quality of life.

RESULTS

Psychological flexibility significantly predicted psychological distress (β = -0.56, p < 0.0001) and quality of life (β = 0.21, p < 0.0001), appearing a stronger predictor of psychological distress than fear of recurrence (β = 0.25, p < 0.0001). Fear of recurrence was a stronger predictor of quality of life (β = -0.41, p < 0.0001) than psychological flexibility. Psychological flexibility moderated the relationship between fear of recurrence and psychological distress (β = -0.01, p < 0.001). At low and average levels of psychological flexibility, psychological distress mediated the relationship between fear of recurrence and quality of life (β = -0.33 to -0.16, p < 0.05). At high levels of psychological flexibility, distress no longer mediated this relationship (β = 0.01, ns), supporting the role of psychological flexibility as a moderator.

CONCLUSIONS

These findings suggest that psychological flexibility might be a useful treatment target, through interventions such as Acceptance and Commitment Therapy, to buffer the effects of fear of recurrence and distress and improve psychosocial outcomes in this population.

Patient values and preferences regarding VTE disease: a systematic review to inform American Society of Hematology guidelines

Values and preferences relate to the importance that patients place on health outcomes (eg, bleeding, having a deep venous thrombosis) and are essential when weighing benefits and harms in guideline recommendations. To inform the American Society of Hematology guidelines for management of venous thromboembolism (VTE) disease, we conducted a systematic review of patients' values and preferences related to VTE. We searched Medline, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature from inception to April of 2018 (PROSPERO-CRD42018094003). We included quantitative and qualitative studies. We followed Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance for rating the certainty and presenting findings for quantitative research about the relative importance of health outcomes and a grounded theory approach for qualitative thematic synthesis. We identified 14 quantitative studies (2465 participants) describing the relative importance of VTE-related health states in a widely diverse population of patients, showing overall small to important impact on patients' lives (certainty of the evidence from low to moderate). Additionally, evidence from 34 quantitative studies (6424 participants) and 15 qualitative studies (570 participants) revealed that patients put higher value on VTE risk reduction than on the potential harms of the treatment (certainty of evidence from low to moderate). Studies also suggested a clear preference for oral medication over subcutaneous medication (moderate certainty). The observed variability in health state values may be a result of differences in the approaches used to elicit them and the diversity of included populations rather than true variability in values. This finding highlights the necessity to explore the variability induced by different approaches to ascertain values.

A Systematic Review and Meta-Analysis of Prostate Cancer Utility Values of Patients and Partners Between 2007 and 2016

Background. There is widespread agreement that both the length and quality of life matter when assessing new technologies and/or models of care in the treatment for cancer patients. Quality of life for partners/carers also matters, particularly for prostate cancer. Purpose. This systematic review aims to provide up-to-date utility values along the prostate cancer care continuum (i.e., from prescreening through to palliative care) for use where future trial-based or modelled economic evaluations cannot collect primary data from men and/or partners. Data Sources. A protocol was developed and registered on the international register of systematic reviews—PROSPERO. Databases searched included EBSCO Information Services (CINAHL, EconLit, Global Health, HEED, MEDLINE Complete, PsycINFO), Cochrane Database of Systematic Reviews, Web of Science, and Embase. Study Selection. Study selection terms included health-related quality of life, prostate cancer, and partners or carers. Data Extraction. The authors identified articles published between 2007 and 2016 that provided health state utility values, with statistical uncertainty, for men with or at risk of prostate cancer and/or their partner/carers. Data Synthesis and Results. Study quality and generalizability of utilities was evaluated and meta-analysis conducted against prespecified criteria. From 906 original articles, 29 recent primary studies met the inclusion/exclusion criteria. We tabulate all the utility values with uncertainty, along with considerable methodological detail and patient population characteristics. Limitations. Utility values pertaining to carers/partners were limited to one study. Conclusions. Studies varied in design, measurement instruments utilized, quality, and generalizability. There is sufficient qualitative and quantitative detail for the reported utility values to be readily incorporated into economic evaluations. More research is needed with carers/partners and with newly developing prostate cancer-specific quality of life tools.

Literature review of the burden of prostate cancer in Germany, France, the United Kingdom and Canada

BACKGROUND

Prostate cancer is the most frequently reported cancer in males in Europe, and is associated with substantial morbidity and mortality. The aim of the current review was to characterize the clinical, economic and humanistic burden of disease associated with prostate cancer in France, Germany, the UK and Canada.

METHODS

Literature searches were conducted using the PubMed, EMBASE and Cochrane Library databases to identify studies reporting incidence and/or mortality rates, costs and health state utilities associated with prostate cancer in the settings of interest. For inclusion, studies were required to be published in English in full-text form from 2006 onwards.

RESULTS

Incidence studies showed that in all settings the incidence of prostate cancer has increased substantially over the past two decades, driven in part by increased uptake of prostate specific antigen (PSA) screening leading to earlier identification of tumors, but which has also led to over-treatment, compounding the economic burden of disease. Mortality rates have declined over the same time frame, driven by earlier detection and improvements in treatment. Both prostate cancer itself, as well as treatment and treatment-related complications, are associated with reduced quality of life.

CONCLUSIONS

Prostate cancer is associated with a significant clinical and economic burden, whilst earlier detection and aggressive treatment is associated with improved survival, over-treatment of men with indolent tumors compounds the already significant burden of disease and treatment can lead to long-term side effects including impotence and impaired urinary and/or bowel function. There is currently an unmet clinical need for diagnostic and/or prognostic tools that facilitate personalized prostate cancer treatment, and potentially reduce the clinical, economic and humanistic burden of invasive cancer treatment.

"Like No One Is Listening to Me": A Qualitative Study of Patient-Provider Discordance Between Global Assessments of Disease Activity in Rheumatoid Arthritis

OBJECTIVE

To explore the perspectives and experiences of patients with rheumatoid arthritis (RA) whose assessments of their disease differ from those of their rheumatology care provider.

METHODS

A total of 20 adult RA patients with patient-provider discordance at their most recent rheumatology appointment (within 4 weeks) were recruited. Discordance was defined by an absolute difference of 25 or more between patient and provider global assessments on a visual analog scale (VAS) of disease activity. For descriptive purposes, participants completed the Health Assessment Questionnaire II, pain VAS, and Patient Health Questionnaire 9 depression scale. Interviews were conducted in person and individually with each patient with a semistructured interview guide. Topics ranged widely, including participants' perspectives and experiences with living with RA, clinical disease assessments, patient-provider communication, and psychosocial or other needs. Data from the interviews were analyzed using interpretive phenomenological analysis.

RESULTS

Six major themes emerged from the patient interviews describing patient-provider discordance and disease assessment: being misunderstood by others, limitations of provider assessments, discrepancy with provider findings, inadequate active listening on the part of health care providers, unmet psychosocial needs, and lack of patient empowerment.

CONCLUSION

Patients described discordance in terms of symptom assessment and understanding how RA affects everyday life. Typical clinical assessments did not capture their experience. The resulting conceptual framework should inform future interventional studies seeking to enhance concordance of patient-physician communication and to optimize satisfaction with care and health-related quality-of-life outcomes for patients with RA.

Development and validation of a utility weighting function for the patient-oriented prostate utility scale (PORPUS)

BACKGROUND

Previously, we developed a prostate cancer (PC)-specific health state classification system, the Patient Oriented Prostate Utility Scale (PORPUS). In this study, we developed a scoring system to allow indirect calculation of utilities from the PORPUS.

METHODS

We interviewed 234 PC outpatients, including those with newly diagnosed and metastatic disease, to obtain rating scale (RS) values on 4 to 6 levels of each of the 10 attributes of the PORPUS, and on 10 corner states (worst level on 1 attribute, best on 9). Patients also completed standard gamble (SG) and RS tasks on 4 multiattribute states (impotence and pain corner states, mild and severe PC symptoms). We used the RS and SG scores for multiattribute states to determine a risk aversion function for mapping values to utilities. We then tested 15 different strategies to estimate the multiattribute utility function (MAUF), using the single attribute disutilities for each level of the 10 PORPUS attributes, and the disutilities for the corner states. The root mean squared error (RMSE) of prediction of the SG on the 4 multiattribute states was used to identify the optimal strategy and scoring system.

RESULTS

The optimal strategy gave an RMSE of 0.06. Comparison of mean MAUF-predicted utilities to directly elicited SG utilities for the 2 multiattribute states from patients in 2 previously published studies (n = 248 and n = 141) supported the validity of the MAUF.

CONCLUSIONS

The scoring system together with the PORPUS comprise an indirect utility instrument, the PORPUS-U, which can be used in clinical and research settings.

Comparison of the construct validity and sensitivity to change of the visual analog scale and a modified rating scale as measures of patient global assessment in rheumatoid arthritis

OBJECTIVE

Patient global assessment (PGA) is commonly measured using a visual analog scale (VAS). The VAS asks patients to integrate many dimensions of rheumatoid arthritis (RA) activity, yet its scope is poorly defined and its endpoints are vague. We investigated whether a modified Rating Scale that used marker states and more defined endpoints would provide a more valid measure of PGA.

METHODS

In our prospective longitudinal study, 164 patients with active RA rated their global arthritis activity using the VAS and Rating Scale before and after treatment. To compare construct validity, we correlated each score with 2 reference measures of RA activity, the 28-joint count Disease Activity Score (DAS28) and the physician global assessment, and examined how each measure was associated with different aspects of RA activity, including pain, functioning, and depressive symptoms, in multivariate regression analyses. We also examined sensitivity to change.

RESULTS

Both measures were correlated with the DAS28 (r = 0.39 for VAS; r = 0.35 for Rating Scale) and physician global assessment (r = 0.41 for VAS; r = 0.26 for Rating Scale) at the baseline visit. Pain and depressive symptoms had the strongest association with the VAS, while functional limitations and depressive symptoms had the strongest association with the Rating Scale. Residual analysis showed no differences in heterogeneity of patients' ratings. VAS was more sensitive to change than the Rating Scale (standardized response means of 0.55 and 0.45).

CONCLUSION

As measures of PGA, the VAS and Rating Scale had comparable construct validity, but differed in which aspects of arthritis activity influenced scores. VAS was more sensitive to change.

Measuring prostate-specific quality of life in prostate cancer patients scheduled for radiotherapy or radical prostatectomy and reference men in Germany and Canada using the Patient Oriented Prostate Utility Scale-Psychometric (PORPUS-P)

BACKGROUND

The PORPUS-P is a short questionnaire for measuring prostate-specific quality of life (QoL), which was designed in Canada for use in prostate cancer (PC) patients. We aimed to generate a German version and compare PORPUS-P scores of German reference men from the general population, and German and Canadian patients with newly diagnosed PC who were scheduled to receive radical prostatectomy (RP) or radiotherapy (RT).

METHODS

The study sample consisted of 988 reference men, 121 German and 66 Canadian PC patients scheduled for RT, and 371 German and 68 Canadian PC patients scheduled for RP. All men completed the PORPUS-P (German postal questionnaire, Canada personal interview). Data were gathered from PC patients before the start of therapy.

RESULTS

Canadian patients were better educated than the German patients, and fewer were retired. Patients scheduled to receive RT were older and more were retired. German RT patients had lower D'Amico risk scores and pre-treatment Gleason scores than RP patients, and Canadian RT patients had higher pre-treatment PSA than RP patients. Urinary and sexual dysfunction were seen in PC patients (especially RT patients), but were also common in the German reference men. Crude mean PORPUS-P scores differed statistically significant between German RT and RP and Canadian RP and RT patients, with RT patients having higher QoL scores. The differences in age-adjusted mean PORPUS-P scores between reference men and RP patients were not clinically significant, while RT patients had (clinically) significantly lower scores than the reference men.

CONCLUSION

The German translation of the PORPUS-P appears to be a short and feasible tool for assessing prostate-specific QoL. Although we found a similar response pattern, Canadian and German PC patients scheduled to receive RT or RP rated their pre-treatment quality of life on different levels, which reveals the need for national reference data. Problems in several QoL domains exist before treatment, and differ between PC patients scheduled for RT and RP.