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Jacobson LP, Parker CB, Cella D, Mroczek DK, Lester BM. Approaches to protocol standardization and data harmonization in the ECHO-wide cohort study. Pediatr Res 2024:10.1038/s41390-024-03039-0. [PMID: 38365871 DOI: 10.1038/s41390-024-03039-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 02/18/2024]
Abstract
The United States (U.S.) National Institutes of Health-funded Environmental influences on Child Health Outcomes (ECHO)-wide Cohort was established to conduct high impact, transdisciplinary science to improve child health and development. The cohort is a collaborative research design in which both extant and new data are contributed by over 57,000 children across 69 cohorts. In this review article, we focus on two key challenging issues in the ECHO-wide Cohort: data collection standardization and data harmonization. Data standardization using a Common Data Model and derived analytical variables based on a team science approach should facilitate timely analyses and reduce errors due to data misuse. However, given the complexity of collaborative research designs, such as the ECHO-wide Cohort, dedicated time is needed for harmonization and derivation of analytic variables. These activities need to be done methodically and with transparency to enhance research reproducibility. IMPACT: Many collaborative research studies require data harmonization either prior to analyses or in the analyses of compiled data. The Environmental influences on Child Health Outcomes (ECHO) Cohort pools extant data with new data collection from over 57,000 children in 69 cohorts to conduct high-impact, transdisciplinary science to improve child health and development, and to provide a national database and biorepository for use by the scientific community at-large. We describe the tools, systems, and approaches we employed to facilitate harmonized data for impactful analyses of child health outcomes.
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Affiliation(s)
- Lisa P Jacobson
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | - David Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Daniel K Mroczek
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Barry M Lester
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA
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Zaniletti I, Gunn HJ, Hallemeier CL, Laughlin BS, Leavitt TR, Haddock MG, Merrell KW, Leenstra JL, May BC, Ashman JB, DeWees TA. Determining the Minimal Clinically Important Difference of the Functional Assessment of Cancer Therapy Hepatobiliary Questionnaire to Evaluate the Change in the Quality of Life of Patients With Pancreatic Cancer During Radiation Therapy. Int J Radiat Oncol Biol Phys 2024; 118:137-141. [PMID: 37586614 DOI: 10.1016/j.ijrobp.2023.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/01/2023] [Accepted: 08/05/2023] [Indexed: 08/18/2023]
Affiliation(s)
| | - Heather J Gunn
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | | | - James L Leenstra
- Department of Radiation Oncology, Mayo Clinic, Northfield, Minnesota
| | - Byron C May
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Jonathan B Ashman
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Todd A DeWees
- Department of Computational and Quantitative Medicine, City of Hope, Duarte, California.
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Martin D, Alberti P, Wigmore SJ, Demartines N, Joliat GR. Pancreatic Cancer Surgery: What Matters to Patients? J Clin Med 2023; 12:4611. [PMID: 37510726 PMCID: PMC10380608 DOI: 10.3390/jcm12144611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 06/28/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
Pancreatic cancer is a leading cause of cancer-related death, with a poor overall survival rate. Although certain risk factors have been identified, the origins of pancreatic cancer are still not fully understood. Surgical resection remains the primary curative treatment, but pancreatic surgery is still associated with high morbidity and mortality rates, and most patients will experience recurrence. The impact of pancreatic cancer on patients' quality of life is significant, with an important loss of healthy life in affected individuals. Traditional outcome parameters, such as length of hospital stay, do not fully capture what matters to patients during recovery. Patient-centered care is therefore central, and the patient's perspective should be considered in pre-operative discussions. Patient-reported outcome and experience measures (PROMs and PREMs) could play an important role in assessing patient perspectives, but standardized methodology for evaluating and reporting them is needed. This narrative review aims to provide a comprehensive overview of patient perspectives and different patient-reported measures in pancreatic cancer surgery. Understanding the patient perspective is crucial for delivering patient-centered care and improving outcomes for patients with pancreatic cancer.
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Affiliation(s)
- David Martin
- Department of Visceral Surgery, University Hospital CHUV, University of Lausanne (UNIL), 1005 Lausanne, Switzerland
- Department of Surgery, Hepatobiliary and Pancreatic Unit, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Piero Alberti
- Department of Surgery, Hepatobiliary and Pancreatic Unit, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Stephen J Wigmore
- Department of Surgery, Hepatobiliary and Pancreatic Unit, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Nicolas Demartines
- Department of Visceral Surgery, University Hospital CHUV, University of Lausanne (UNIL), 1005 Lausanne, Switzerland
| | - Gaëtan-Romain Joliat
- Department of Visceral Surgery, University Hospital CHUV, University of Lausanne (UNIL), 1005 Lausanne, Switzerland
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Wani EK, Angurana SL, Kumar D, Bala K, Jehangir M, Chowdhary S. Pre and post treatment quality of life among patients of hepatobiliary and pancreatic cancers in North India: A prospective study. J Cancer Res Ther 2023; 19:1109-1114. [PMID: 37787271 DOI: 10.4103/jcrt.jcrt_225_21] [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] [Indexed: 10/04/2023]
Abstract
Context Studies reporting quality of life (QOL) measures alongside conventional measures of effectiveness of interventions and outcome are essential. Aims We aimed to compare QOL and mental well-being in hepatobiliary and pancreatic cancer patients before and after receiving treatment. Settings and Design This was a hospital-based prospective study. Methods and Materials The study was conducted in North India for a period of 1 year. QOL was assessed in 118 patients using the Functional Assessment of Cancer Therapy-Hepatobiliary Scale and Diagnostic and Statistical Manual of Mental Disorders Fifth Edition Level 1 Cross-Cutting Symptom Measure-Adult was used to assess the psychiatric domains of subjects. Statistical Analysis Used The data were analyzed using MS Excel and SPSS version 23. Statistical significance between QOL scores at baseline and 12 weeks was evaluated by Student's t-test. Pre- and post-Cronbach's alpha reliability coefficient was also calculated. Results 59.4% of subjects were females and 40.6% were males. Carcinoma gallbladder was the predominant cancer (2/3rd) followed by carcinoma pancreas (1/3rd). Both pre- and posttreatment reliability coefficients showed values ≥ 0.75, indicating that the questionnaire reliably measured different domains of health-related QOL, both on generic and disease-specific scales. Using paired t-test, a significant difference was observed only in the physical (P = 0.001) and functional (P = 0.0002) domains. There was a slight increase in proportion of patients demonstrating improvement in severity of depression and anxiety at 6-12 weeks and the number of patients experiencing moderate symptoms of sleep disorders and somatic disorders. The number of patients experiencing severe symptoms of anger decreased posttreatment. Conclusions QOL is amenable to improvement with timely interventions including counseling.
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Affiliation(s)
| | | | - Dinesh Kumar
- Government Medical College, Doda, Jammu and Kashmir, India
| | - Kiran Bala
- Department of Community Medicine, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Majid Jehangir
- Department of Anaesthesia, SKIMS, Jammu, Jammu and Kashmir, India
| | - Shoket Chowdhary
- Department of Gastroenterology, Super Speciality Hospital Government Medical College, Jammu, Jammu and Kashmir, India
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Kim CA, Lelond S, Daeninck PJ, Rabbani R, Lix L, McClement S, Chochinov HM, Goldenberg BA. The impact of early palliative care on the quality of life of patients with advanced pancreatic cancer: The IMPERATIVE case-crossover study. Support Care Cancer 2023; 31:250. [PMID: 37022483 PMCID: PMC10078032 DOI: 10.1007/s00520-023-07709-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/27/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE Pancreatic cancer is a lethal disease. Many patients experience a heavy burden of cancer-associated symptoms and poor quality of life (QOL). Early palliative care alongside standard oncologic care results in improved QOL and survival in some cancer types. The benefit in advanced pancreatic cancer (APC) is not fully quantified. METHODS In this prospective case-crossover study, patients ≥ 18 years old with APC were recruited from ambulatory clinics at a tertiary cancer center. Patients underwent a palliative care consultation within 2 weeks of registration, with follow up visits every 2 weeks for the first month, then every 4 weeks until week 16, then as needed. The primary outcome was change in QOL between baseline (BL) and week 16, measured by Functional Assessment of Cancer Therapy - hepatobiliary (FACT-Hep). Secondary outcomes included symptom control (ESAS-r), depression, and anxiety (HADS, PHQ-9) at week 16. RESULTS Of 40 patients, 25 (63%) were male, 28 (70%) had metastatic disease, 31 (78%) had ECOG performance status 0-1, 31 (78%) received chemotherapy. Median age was 70. Mean FACT-hep score at BL was 118.8, compared to 125.7 at week 16 (mean change 6.89, [95%CI (-1.69-15.6); p = 0.11]). On multivariable analysis, metastatic disease (mean change 15.3 [95%CI (5.3-25.2); p = 0.004]) and age < 70 (mean change 12.9 [95%CI (0.5-25.4); p = 0.04]) were associated with improved QOL. Patients with metastatic disease had significant improvement in symptom burden (mean change -7.4 [95%CI (-13.4 to -1.4); p = 0.02]). There was no difference in depression or anxiety from BL to week 16. CONCLUSION Palliative care should be integrated early in the journey for patients with APC, as it can improve QOL and symptom burden. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT03837132.
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Affiliation(s)
- Christina A Kim
- CancerCare Manitoba Research Institute, Winnipeg, MB, Canada
- CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Stephanie Lelond
- CancerCare Manitoba, Winnipeg, MB, Canada.
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Paul J Daeninck
- CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Winnipeg Regional Health Authority, Palliative Care Program, Winnipeg, MB, Canada
| | - Rasheda Rabbani
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lisa Lix
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Susan McClement
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Harvey Max Chochinov
- CancerCare Manitoba Research Institute, Winnipeg, MB, Canada
- CancerCare Manitoba, Winnipeg, MB, Canada
- Winnipeg Regional Health Authority, Palliative Care Program, Winnipeg, MB, Canada
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Benjamin A Goldenberg
- CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Manisundaram N, Portuondo JI, Erstad D, Silberfein E, Hsu C, Barakat O, Wood A, Navarro-Cagigas M, Van Buren G, Fisher WE, Camp ER. Pretreatment Health-Related Quality-of-Life Status and Survival in Pancreatobiliary Surgical Patients. J Am Coll Surg 2023; 236:861-870. [PMID: 36728341 DOI: 10.1097/xcs.0000000000000549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pancreatobiliary (PB) disorders, especially cancer, negatively affect patients' health-related quality of life (HRQoL). However, the influence of baseline, preintervention HRQoL on perioperative and oncologic outcomes has not been well defined. We hypothesized that low baseline HRQoL is associated with worse perioperative and long-term survival outcomes for PB surgical patients. STUDY DESIGN Pretreatment Functional Assessment of Cancer Therapy - Hepatobiliary Survey results and clinical data from PB patients (2008 to 2016) from a single center's prospective database were analyzed. Survey responses were aggregated into composite scores and divided into quintiles. Patients in the highest quintile of HRQoL were compared to patients in the bottom four quintiles combined. Overall survival (OS) and disease-free survival (DFS) were analyzed using the Kaplan-Meier method. Logistic and Cox regressions were used to determine associations between quintiles of HRQoL scores and 30-day complications and long-term survival, respectively. RESULTS Of 162 patients evaluated, 99 had malignancy, and 63 had benign disease. Median follow-up was 31 months. Baseline HRQoL scores were similar for benign and malignant disease (p = 0.42) and were not associated with the development of any (p = 0.08) or major complications (p = 0.64). Patients with highest quintile HRQoL scores had improved 3-year OS (84.6 vs 61.7%, p = 0.03) compared to patients in the lowest four quintiles of HRQoL. Among cancer patients only, those with the highest quintile scores had improved 3-year OS (81.6 vs 47.4%, p = 0.02). On multivariable analysis, highest quintile HRQoL scores were associated with longer OS and DFS for patients with malignancy. CONCLUSIONS Pretreatment HRQoL was associated with both OS and DFS among PB patients and might have prognostic utility. Future studies are necessary to determine whether patients with poorer HRQoL may benefit from targeted psychosocial interventions.
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Affiliation(s)
- Naveen Manisundaram
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Manisundaram)
- the Department of Surgery, Baylor College of Medicine, Houston, TX (Manisundaram, Portuondo, Erstad, Silberfein, Hsu, Barakat, Wood, Navarro-Cagigas, Van Buren, Fisher, Camp)
| | - Jorge I Portuondo
- the Department of Surgery, Baylor College of Medicine, Houston, TX (Manisundaram, Portuondo, Erstad, Silberfein, Hsu, Barakat, Wood, Navarro-Cagigas, Van Buren, Fisher, Camp)
| | - Derek Erstad
- the Department of Surgery, Baylor College of Medicine, Houston, TX (Manisundaram, Portuondo, Erstad, Silberfein, Hsu, Barakat, Wood, Navarro-Cagigas, Van Buren, Fisher, Camp)
| | - Eric Silberfein
- the Department of Surgery, Baylor College of Medicine, Houston, TX (Manisundaram, Portuondo, Erstad, Silberfein, Hsu, Barakat, Wood, Navarro-Cagigas, Van Buren, Fisher, Camp)
| | - Cary Hsu
- the Department of Surgery, Baylor College of Medicine, Houston, TX (Manisundaram, Portuondo, Erstad, Silberfein, Hsu, Barakat, Wood, Navarro-Cagigas, Van Buren, Fisher, Camp)
| | - Omar Barakat
- the Department of Surgery, Baylor College of Medicine, Houston, TX (Manisundaram, Portuondo, Erstad, Silberfein, Hsu, Barakat, Wood, Navarro-Cagigas, Van Buren, Fisher, Camp)
| | - Amy Wood
- the Department of Surgery, Baylor College of Medicine, Houston, TX (Manisundaram, Portuondo, Erstad, Silberfein, Hsu, Barakat, Wood, Navarro-Cagigas, Van Buren, Fisher, Camp)
| | - Martina Navarro-Cagigas
- the Department of Surgery, Baylor College of Medicine, Houston, TX (Manisundaram, Portuondo, Erstad, Silberfein, Hsu, Barakat, Wood, Navarro-Cagigas, Van Buren, Fisher, Camp)
| | - George Van Buren
- the Department of Surgery, Baylor College of Medicine, Houston, TX (Manisundaram, Portuondo, Erstad, Silberfein, Hsu, Barakat, Wood, Navarro-Cagigas, Van Buren, Fisher, Camp)
| | - William E Fisher
- the Department of Surgery, Baylor College of Medicine, Houston, TX (Manisundaram, Portuondo, Erstad, Silberfein, Hsu, Barakat, Wood, Navarro-Cagigas, Van Buren, Fisher, Camp)
| | - E Ramsay Camp
- the Department of Surgery, Baylor College of Medicine, Houston, TX (Manisundaram, Portuondo, Erstad, Silberfein, Hsu, Barakat, Wood, Navarro-Cagigas, Van Buren, Fisher, Camp)
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The Imperative of Assessing Quality of Life in Patients Presenting to a Pancreaticobiliary Surgery Clinic. Ann Surg 2023; 277:e136-e143. [PMID: 34225301 DOI: 10.1097/sla.0000000000005049] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to determine baseline health-related quality of life (QoL) in patients with pancreatic adenocarcinoma, periampullary cancers, and benign pancreaticobiliary (PB) conditions at the time of the first visit to a PB surgery clinic, and to explore the relationship between QoL, demographics, clinical parameters, complications, and survival. SUMMARY BACKGROUND DATA Few studies have examined baseline QoL measures, the impact of comorbidities, age, sex, and smoking on subsequent postoperative complications and survival in patients with pancreatic adenocarcinoma, related PB cancers, and with benign PB conditions. METHODS Data were collected from scheduled patients at a PB surgery clinic between 2013 and 2018. The Brief Pain Inventory, Fact-Hepatobiliary Scale, and Facit-Fatigue questionnaires were administered. QoL parameters were compared between PB cancer patients and those with benign disease. RESULTS A total of 462 individuals with PB cancers and benign diseases exhibited baseline physical well-being, functional well-being, fatigue, and overall QoL at or below the 75th percentile of wellness at the time of the first office visit. Younger age, smoking, and mental health comorbidities contributed significantly to decreased QoL. PA patients were 7 times more likely to die in the follow-up period than the benign disease group. Black patients had higher pain scores and were 3 times more likely to have a postsurgery complication. Sex differences were identified regarding fatigue, pain, and overall QoL. CONCLUSIONS This large cohort of PB cancer and benign disease patients exhibited significantly impaired baseline QoL. GI problems, weight loss, smoking, cardiovascular, pulmonary disease, and history of anxiety and depression contributed significantly to reduced QoL. The study sheds a cautionary light on the burden of PB disease at the time of surgical evaluation and its relationship to diminished QoL.
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Zhang J, Zhan Y, Chen J, Kang D, Xiang R, Zhang R, Zhang Y, Pu Y, Zhang J, Zhang L, Huang Y, Gong R, Su X, Nie Y, Shi Q. Development of a Patient-Reported Symptom Item Bank for Patients with Hepatobiliary or Pancreatic Malignancies: A Systematic Review. Patient Prefer Adherence 2023; 17:199-207. [PMID: 36698859 PMCID: PMC9869794 DOI: 10.2147/ppa.s398666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/12/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Patients with hepatobiliary or pancreatic cancers often experience severe symptoms, resulting in a sharp decline in functioning, poor quality of life, and increased mortality risk. Early and effective management of symptoms allows a better quality of life and reduced mortality, depending on the selection of appropriate assessment of specific symptoms for a defined purpose. We aimed to develop a symptom measurement item bank for hepatobiliary or pancreatic cancers. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was applied to organize this systematic review. The articles validated patient-reported outcome measures (PROMs) for hepatobiliary or pancreatic cancer and published before December 2021 were retrieved from the Web of Science, PubMed, Embase databases and Cochrane Library. Items from the existing PROMs were selected and classified into different patient-reported symptoms based on the concepts and specific underlying constructs of the objects measured. RESULTS Sixteen unique PROMs were identified across the 29 eligible studies included in our analysis. Items from the literature review (14 PROMs with 421 items for which information was obtained) were selected and classified. As a result of this study, we developed a symptom item bank with 40 patient-reported symptoms and 229 assessment items for hepatobiliary or pancreatic cancer, and fatigue, pain and nausea were the most common symptom items. CONCLUSION We developed an item bank to assess the patient-reported symptoms of hepatobiliary or pancreatic cancer. This item bank could allow researchers to select appropriate measures of symptom and provide a basis for the development of a single-item symptom-measurement system.
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Affiliation(s)
- Jingyu Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Yinxia Zhan
- School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Jiaojiao Chen
- School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Dan Kang
- School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Rumei Xiang
- School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Ruoyi Zhang
- School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Yubo Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Yang Pu
- School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Jiayuan Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Lijun Zhang
- School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Yanyan Huang
- School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Ruoyan Gong
- School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xueyao Su
- School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Yuxian Nie
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Qiuling Shi
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People’s Republic of China
- School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China
- Correspondence: Qiuling Shi, State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, No. 1, Medical College Road, Yuzhong District, Chongqing, 400016, People’s Republic of China, Tel +86-18290585397, Email
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Yoo HK, Patel N, Joo S, Amin S, Hughes R, Chawla R. Health-Related Quality of Life of Patients with Metastatic Pancreatic Cancer: A Systematic Literature Review. Cancer Manag Res 2022; 14:3383-3403. [PMID: 36510575 PMCID: PMC9738117 DOI: 10.2147/cmar.s376261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/13/2022] [Indexed: 12/12/2022] Open
Abstract
Background Metastatic pancreatic cancer (mPaC) has a poor prognosis and available treatments provide only moderate improvements in survival. Preserving or improving health-related quality of life (HRQoL) is therefore an important treatment outcome for patients with mPaC. This systematic review identified HRQoL data in patients with mPaC before and after treatment, compared these with data from the general population, and reported the effects of different mPaC treatments on HRQoL. Methods Searches were performed in Embase, PubMed, and the Cochrane Library from January 2008 to May 2021, and the articles identified were screened for HRQoL data in patients with mPaC. Abstracts from relevant congresses were also manually searched. Publications included were randomized controlled trials and observational studies written in English that reported HRQoL data for adult patients with non-resectable mPaC who were on or off treatment. Results Thirty relevant publications were identified and HRQoL scores were collected. Overall, baseline mean scores from the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), 5-dimension EuroQol questionnaire (EQ-5D), and Functional Assessment of Cancer Therapy-General (FACT-G) for newly diagnosed and previously treated patients with mPaC were worse than those of the general population. Baseline scores were generally better for previously treated patients than for newly diagnosed patients, indicating that mPaC treatments preserve or improve HRQoL. Identified publications also reported changes in HRQoL following first- or subsequent-line chemotherapy. When reported, 10 studies found improvements in overall HRQoL compared with baseline scores, four reported no changes in overall HRQoL after treatment, and six found deteriorations in overall HRQoL. Conclusion Patients with mPaC had worse HRQoL than the general population. Available anti-cancer therapies can improve or preserve HRQoL.
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Affiliation(s)
- Hyun Kyoo Yoo
- Health Economics & Payer Evidence AstraZeneca, Cambridge, UK,Correspondence: Hyun Kyoo Yoo, Global Value, Access and Pricing, Alexion, AstraZeneca Rare Disease, City House, 130 Hills Road, Cambridge, CB2 1RE, UK, Email
| | - Nikunj Patel
- Oncology Business Unit, AstraZeneca, Gaithersburg, MD, USA
| | - Seongjung Joo
- MRL, Center for Observational & Real-World Evidence (CORE), Oncology, Merck Sharp & Dohme LLC, a Subsidiary of Merck & Co., Inc, Rahway, NJ, USA
| | - Suvina Amin
- Oncology Business Unit, AstraZeneca, Gaithersburg, MD, USA
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Abstract
Gallbladder cancer (GBC) is the most common cancer of the biliary tract, characterized by a very poor prognosis when diagnosed at advanced stages owing to its aggressive behaviour and limited therapeutic options. Early detection at a curable stage remains challenging because patients rarely exhibit symptoms; indeed, most GBCs are discovered incidentally following cholecystectomy for symptomatic gallbladder stones. Long-standing chronic inflammation is an important driver of GBC, regardless of the lithiasic or non-lithiasic origin. Advances in omics technologies have provided a deeper understanding of GBC pathogenesis, uncovering mechanisms associated with inflammation-driven tumour initiation and progression. Surgical resection is the only treatment with curative intent for GBC but very few cases are suitable for resection and most adjuvant therapy has a very low response rate. Several unmet clinical needs require to be addressed to improve GBC management, including discovery and validation of reliable biomarkers for screening, therapy selection and prognosis. Standardization of preneoplastic and neoplastic lesion nomenclature, as well as surgical specimen processing and sampling, now provides reproducible and comparable research data that provide a basis for identifying and implementing early detection strategies and improving drug discovery. Advances in the understanding of next-generation sequencing, multidisciplinary care for GBC, neoadjuvant and adjuvant strategies, and novel systemic therapies including chemotherapy and immunotherapies are gradually changing the treatment paradigm and prognosis of this recalcitrant cancer.
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Affiliation(s)
- Juan C Roa
- Department of Pathology, Millennium Institute on Immunology and Immunotherapy, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Patricia García
- Department of Pathology, Millennium Institute on Immunology and Immunotherapy, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Vinay K Kapoor
- Department of Hepato-pancreato-biliary (HPB) Surgery, Mahatma Gandhi Medical College & Hospital (MGMCH), Jaipur, India
| | - Shishir K Maithel
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Milind Javle
- Department of Gastrointestinal Medical Oncology, UT M.D. Anderson Cancer Center, Houston, TX, USA
| | - Jill Koshiol
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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Association of patient-reported outcomes after robotic-assisted pancreatectomy. HPB (Oxford) 2022; 24:1813. [PMID: 35717431 DOI: 10.1016/j.hpb.2022.05.1342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/18/2022] [Accepted: 05/25/2022] [Indexed: 12/12/2022]
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Liu JB, Tam V, Zenati MS, Schwartz D, Ali A, Low CA, Smith LJ, Zeh HJ, Zureikat AH, Hogg ME. Association of robotic approach with patient-reported outcomes after pancreatectomy: a prospective cohort study. HPB (Oxford) 2022; 24:1659-1667. [PMID: 35568654 DOI: 10.1016/j.hpb.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/22/2022] [Accepted: 04/20/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Robotic-assisted pancreatectomy continues to proliferate despite limited evidence supporting its benefits from the patient's perspective. We compared patient-reported outcomes (PROs) between patients undergoing robotic and open pancreatectomies. METHODS PROs, measured with the FACT-Hep, FACT-G, and HCS, were assessed in the immediate postoperative (i.e., preoperative to discharge) and recovery (i.e., discharge to three months postoperative) periods. Linear mixed models estimated the association of operative approach on PROs. Minimally important differences (MIDs) were also considered. RESULTS Among 139 patients, 105 (75.5%) underwent robotic pancreatectomies. Compared to those who underwent open operations, those who underwent robotic operations experienced worse FACT-Hep scores that were both statistically and clinically significant (mean difference [MD] 8.6 points, 95% CI 1.0-16.3). Declines in FACT-G (MD 4.3, 95% CI -1.0 to 9.6) and HCS (MD 4.3, 95% CI 0.8-7.9) scores appeared to contribute equally in both operative approaches to the decline in total FACT-Hep score. Patients who underwent robotic versus open operations both statistically and clinically significantly improved due to improvements in HCS (MD 6.1, 95% CI 2.3-9.9) but not in FACT-G (MD 1.2, 95% CI - 5.1-7.4). CONCLUSION The robotic approach to pancreas surgery might offer, from the patient's perspective, greater improvement in symptoms over the open approach by three months postoperatively.
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Affiliation(s)
- Jason B Liu
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Vernissia Tam
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Mazen S Zenati
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Danielle Schwartz
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Areej Ali
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Carissa A Low
- Departments of Medicine and Psychology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Lillian J Smith
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Herbert J Zeh
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Amer H Zureikat
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Melissa E Hogg
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
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Dunne RF, Roeland EJ. The Interplay Among Pancreatic Cancer, Cachexia, Body Composition, and Diabetes. Hematol Oncol Clin North Am 2022; 36:897-910. [PMID: 36154783 DOI: 10.1016/j.hoc.2022.07.001] [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] [Indexed: 11/18/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is associated with complex changes in body composition. Visceral obesity and type 2 diabetes mellitus are established risk factors for developing PDAC; however, clinical and metabolic features of PDAC commonly lead to cancer cachexia, a hypermetabolic syndrome characterized by weight loss secondary to muscle and adipose tissue wasting. Reduction in muscle mass in patients with PDAC is associated with poorer survival in patients undergoing surgical resection and increased chemotherapy toxicity. Although no standardized treatment exists, a multidisciplinary, tailored, symptom-based approach is recommended to improve outcomes and quality of life for patients with PDAC and cachexia.
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Affiliation(s)
- Richard F Dunne
- Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY 14642, USA.
| | - Eric J Roeland
- Division of Hematology/Oncology, Oregon Health and Science University, Knight Cancer Institute, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
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14
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Cella D, Hays RD. A Patient Reported Outcome Ontology: Conceptual Issues and Challenges Addressed by the Patient-Reported Outcomes Measurement Information System® (PROMIS®). Patient Relat Outcome Meas 2022; 13:189-197. [PMID: 35990594 PMCID: PMC9390886 DOI: 10.2147/prom.s371882] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/28/2022] [Indexed: 12/02/2022] Open
Abstract
We briefly review the history of measuring perceptions of health and quality of life, followed by an examination of conceptual issues related to terminology that have led to potentially conflicting ontologies. Then, we discuss challenges posed by the lack of consensus on common meaning and the proliferation of measures. Next, we suggest a solution grounded in an ontology adopted by the National Institutes of Health (NIH) funded Patient-Reported Outcomes Measurement Information System (PROMIS) project. We conclude by discussing issues associated with mapping the PROMIS domain framework onto other familiar ontologies and recommend a way forward for PROMIS to provide a sustainable ontological structure to enable coherent common measurement.
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Affiliation(s)
- David Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Correspondence: David Cella, Email
| | - Ron D Hays
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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15
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Bou-Samra P, Scott P, Cheng H, Kallem C, Pathak R, Geller DA, Marsh W, Wang Y, Antoni M, Penedo F, Tsung A, Steel JL. Social Support is Associated with Survival in Patients Diagnosed with Gastrointestinal Cancer. J Gastrointest Cancer 2021; 53:854-861. [PMID: 34806126 DOI: 10.1007/s12029-021-00741-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to examine the link between psychological, behavioral, and social factors and survival in patients diagnosed with gastrointestinal cancer. METHODS A cohort of gastrointestinal cancer patients were administered a battery of questionnaires that assessed trauma, depression, social support, sleep, diet, exercise, quality of life, tobacco and alcohol use, pain, and fatigue. Analyses included Pearson's correlations, analyses of variance, Kaplan Meier survival, and Cox regression analyses. RESULTS Of the 568 patients, the majority were male (57.9%) and Caucasian (91.9%), with a mean age of 61 (S.D. = 10.7). The level of perceived social support was comparable to patients with other medical conditions. Sociodemographic predictors of social support included the number of years of education (r = 0.109, p = 0.05), marital status (F(6,387) = 5.465, p ≤ 0.001), and whether the patients' income met the family's basic needs (F(1,377) = 25.531, p < 0.001). Univariate analyses revealed that older age (p < 0.001), male gender (p = 0.007), being black (p = 0.005), diagnosis of hepatocellular carcinoma (p = 0.046), higher body mass index (p = 0.022), larger tumor size (p = 0.032), initial treatment including chemotherapy rather than surgery (p < 0.001), and lower level of perceived social support (p = 0.037) were associated with poorer survival. Using multivariate Cox regression and adjusting for all factors found to be significant in univariate survival analyses, older age (p = 0.024) and lower perceived social support (HR = 0.441, 95% CI = 0.233, 0.833; p = 0.012) were the factors that remained significantly associated with poorer survival. CONCLUSION There are several biological and psychosocial factors that predict cancer mortality. Social support appears to be a robust factor affecting mortality in gastrointestinal cancer patients.
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Affiliation(s)
- Patrick Bou-Samra
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Paul Scott
- Department of Psychology, School of Education, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hannah Cheng
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Cramer Kallem
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ritambhara Pathak
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - David A Geller
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Wallis Marsh
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yisi Wang
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael Antoni
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Frank Penedo
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Allan Tsung
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jennifer L Steel
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. .,Department of Psychiatry, University of Pittsburgh, 3459 Fifth Avenue; Montefiore 7S, Pittsburgh, PA, 15213, USA. .,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
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Garin E, Pinaquy JB, Bailly C, Sengel C, Mariano-Goulart D, Edeline J, Blanc JF, Bouvier A, Tordo J, Rode A, Becker S, Sefrioui D, de Baere T, Somma C, Mastier C, Goupil J, Chevallier P, Regnault H, Vibert E, Manfredi S, Vicaut E, Patel B, Boucher E, Guiu B. Evaluating the Effectiveness of Yttrium-90 Glass Microspheres in the Treatment of Hepatocellular Carcinoma, Intrahepatic Cholangiocarcinoma, and Metastatic Colorectal Cancer in Practice: Protocol for the Prospective PROACTIF Phase IV Registry Study in France. Cardiovasc Intervent Radiol 2021; 45:1-11. [PMID: 34796373 DOI: 10.1007/s00270-021-03002-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/29/2021] [Indexed: 10/19/2022]
Abstract
PRIMARY OBJECTIVE Recently, selective internal radiation therapy using yttrium-90 (Y90) glass microspheres (TheraSphere™) was approved for reimbursement by health authorities in France. The PROACTIF study aims to gather data on effectiveness, patient quality of life, and safety with use of Y90 glass microspheres in real-world clinical settings in France. INCLUSION CRITERIA Patient with a diagnosis of hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (iCC), and/or metastatic colorectal cancer (mCRC) who was treated with a dose of Y90 glass microspheres that has been reimbursed in France and who do not oppose use of their personal medical data. EXCLUSION CRITERIA If data collection is opposed, treatment is reimbursed but not administered, or treatment is administered but not reimbursed. OUTCOME MEASURES Primary outcome measures include overall survival from time of Y90 glass microsphere treatment and quality of life, as assessed using the Functional Assessment of Cancer Therapy- Hepatobiliary questionnaire. ESTIMATED NUMBER OF PATIENTS TO BE INCLUDED This is an open study and there is no set number of patients; 115 have already been enrolled. PLANNED SUBGROUP ANALYSES Analyses will be stratified by disease state (HCC, iCC, or mCRC). Subgroups to be analyzed include age group, unilobar/bilobar disease at baseline, Eastern Cooperative Oncology Group (ECOG) status at baseline, liver tumor burden at baseline, target lesion size, and standard versus multi-compartment personalized dosimetry treatment. PLANNED RECRUITMENT AND OBSERVATION PERIOD Recruitment includes patients who are prescribed and treated with a commercial vial of Y90 glass microspheres between 01 January 2019 and 31 December 2024. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04069468.
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Affiliation(s)
- Etienne Garin
- Nuclear Medicine Unit, Centre Eugene Marquis, Rennes, France
| | | | - Clement Bailly
- Nuclear Medicine Unit, University Hospital, Nantes, France
| | - Christian Sengel
- Radiology and Medical Imaging, CHU Hospital Michallon, Grenoble, France
| | | | | | - Jean-Frederic Blanc
- Hepatology, Gastroenterology, and Digestive Oncology, CHU Bordeaux, Bordeaux, France
| | - Antoine Bouvier
- Department of Radiology, University Hospital, Angers, France
| | - Jeremie Tordo
- Department of Nuclear Medicine, CHU Lyon Sud, Lyon, France
| | - Agnes Rode
- Department of Medical Imaging, CHU Lyon, Lyon, France
| | - Stéphanie Becker
- Departments of Medical Imaging and Nuclear Medicine, Centre Henri Bequerel, Rouen, France
| | - David Sefrioui
- Department of Hepatogastroenterology, Rouen University Hospital, Rouen, France
| | - Thierry de Baere
- Department of Interventional Radiology, Gustave Roussy Cancer Center, Villejuif, France
| | - Claude Somma
- Department of Nuclear Medicine, CHU La Timone, Marseille, France
| | - Charles Mastier
- Department of Radiology, CRLCC Centre Léon Bérard, Lyon, France
| | - Jean Goupil
- Department of Radiology and Medical Imaging, CHU Nimes, Nimes, France
| | | | - Helene Regnault
- Department of Hepatology, Henri Mondor Hospital, Creteil, France
| | - Eric Vibert
- Department of Hepatology and Surgery, Paul Brousse Hospital, Villejuif, France
| | - Sylvain Manfredi
- Department of Digestive Oncology, University Hospital, Dijon, France
| | - Eric Vicaut
- Clinical Trial Unit, AP-HP Groupe Hospitalier Lariboisière - Fernand-Widal, Paris, France
| | - Binal Patel
- Biostatistics, Boston Scientific Corporation, Marlborough, MA, USA
| | - Eveline Boucher
- Interventional Oncology, Boston Scientific Corporation, Marlborough, MA, USA
| | - Boris Guiu
- Department of Radiology, St. Eloi University Hospital - Montpellier School of Medicine, 80 avenue Augustin Fliche, 34295, Montpellier, France.
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17
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Go SI, Lee SC, Bae WK, Zang DY, Lee HW, Jang JS, Ji JH, Kim JH, Park S, Sym SJ, Yang Y, Jeon SY, Hwang IG, Oh SY, Kang JH. Modified FOLFIRINOX versus S-1 as second-line chemotherapy in gemcitabine-failed metastatic pancreatic cancer patients: A randomised controlled trial (MPACA-3). Eur J Cancer 2021; 157:21-30. [PMID: 34464782 DOI: 10.1016/j.ejca.2021.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/08/2021] [Accepted: 08/03/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND The efficacy of modified FOLFIRINOX (mFOLFIRINOX) as a second-line chemotherapy treatment for metastatic pancreatic adenocarcinoma (mPAC), remains unclear. This multi-center randomised phase III trial aimed to elucidate the efficacy of mFOLFIRINOX as a second-line chemotherapy treatment for mPAC patients with good performance status. PATIENTS AND METHODS Eighty mPAC patients (age, 19-75 years) refractory to first-line gemcitabine-based chemotherapy were randomly selected to receive mFOLFIRINOX or S-1. mFOLFIRINOX comprised oxaliplatin (65 mg/m2), irinotecan (135 mg/m2), and leucovorin (400 mg/m2) on day 1 and continuous 5-FU infusion (1000 mg/m2) over 24 h on days 1-2 every 2 weeks. S-1 comprised body surface area-dependent oral S-1, divided into two doses per day on days 1-28 every 6 weeks. RESULTS Overall survival was the primary endpoint. The objective response and disease control rates were higher in the mFOLFIRINOX than in the S-1 group (15% versus 2%; p = .04 and 67% versus 37%; p = .007). The median progression-free survival rates were 5.2 and 2.2 months in the mFOLFIRINOX and S-1 groups, respectively (adjusted hazard ratio [HR]: .4; 95% confidence interval [CI]: .2-.6; p < .001). The median overall survival rates were 9.2 and 4.9 months in the mFOLFIRINOX and S-1 groups, respectively (adjusted HR: .4; 95% CI: .2-.7; p = .002). Grade 3-4 adverse events occurred in 56% and 17% of the patients in the mFOLFIRINOX and S-1 groups, respectively (p < .001). CONCLUSION Administration of mFOLFIRINOX as a second-line chemotherapy treatment for mPAC patients refractory to gemcitabine-based chemotherapy resulted in increased survival rates than S-1 treatment alone.
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Affiliation(s)
- Se-Il Go
- Division of Hematology and Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea
| | - Sang-Cheol Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Soonchunhyang University Hospital Cheonan, Cheonan, Republic of Korea
| | - Woo Kyun Bae
- Division of Hematology-Oncology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Republic of Korea
| | - Dae Young Zang
- Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Hyun Woo Lee
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Joung Soon Jang
- Division of Hematology/Oncology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jun Ho Ji
- Division of Hematology-Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Jung Hoon Kim
- Division of Hematology/Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Sanggon Park
- Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, Gwangju, Republic of Korea
| | - Sun Jin Sym
- Division of Medical Oncology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Yaewon Yang
- Department of Internal Medicine, Chungbuk University Hospital, Chungbuk University College of Medicine, Cheongju, Republic of Korea
| | - So Yeon Jeon
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - In Gyu Hwang
- Division of Hematology/Oncology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Sung Yong Oh
- Department of Internal Medicine, Dong-A University Hospital, Busan, Republic of Korea.
| | - Jung Hun Kang
- Division of Hematology/Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea.
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18
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King-Kallimanis BL, Lederer NM, Kim J, Nair A, Horodniceanu E, Bhatnagar V, Kluetz PG. Patient-Reported Outcomes After Treatment Discontinuation: Commercial Clinical Trial Data From Four Cancer Types. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1302-1307. [PMID: 34452710 DOI: 10.1016/j.jval.2021.04.1279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/02/2021] [Accepted: 04/13/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES How frequently patient-reported outcome (PRO) data are collected in commercial cancer clinical trials after treatment discontinuation and the quality of that data are poorly understood. We reviewed treatment discontinuation follow-up PRO data collection to learn about trials collecting these data and understand data quality. The review included 4 cancer types representing potential for long- (prostate cancer), medium-/long- (breast cancer), and short-term (pancreatic cancer and hepatocellular carcinoma) follow-up owing to disease trajectory. METHODS We reviewed registration trials in US Food and Drug Administration databases between January 2010 and January 2019. Protocols were reviewed to determine whether PROs were collected and, if so, whether these included the follow-up phase. Clinical study reports were reviewed when follow-up PROs were collected to determine completion rates. Results were summarized using descriptive analyses. RESULTS Of the 46 trials containing PRO data, 46% had at least 1 follow-up PRO assessment. Follow-up schedules of assessment were wide ranging; the first assessment occurred between 30 days and 6 months after stopping treatment with follow-up for as long as 3 years. PRO completion rates were reported in 57% of 21 trials; at the first follow-up assessment, completion rates for the treatment arm ranged from 38% to 91% and from 41% to 100% in the control arm. CONCLUSIONS The quality of the follow-up PRO data, based on completion rates, was variable, as was the duration of follow-up. A clear research objective should be developed for follow-up PRO data, accounting for patient burden. If PRO data are collected, monitoring should be implemented to improve completion because poor completion limits data use in the benefit-risk assessment.
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Affiliation(s)
| | | | - Janice Kim
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Abhilasha Nair
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Erica Horodniceanu
- Oncology Center of Excellence, US Food and Drug Administration, Silver Spring, MD, USA
| | - Vishal Bhatnagar
- Oncology Center of Excellence, US Food and Drug Administration, Silver Spring, MD, USA
| | - Paul G Kluetz
- Oncology Center of Excellence, US Food and Drug Administration, Silver Spring, MD, USA
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Moser M, Radu IP, Dufour JF. Effects of Home Care on patients with hepatocellular carcinoma treated with sorafenib. JGH OPEN 2021; 5:864-870. [PMID: 34386593 PMCID: PMC8341184 DOI: 10.1002/jgh3.12533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 11/12/2022]
Abstract
Background and Aim Treatment with sorafenib causes diverse side effects, which limits adherence. This work assesses whether Home Care, a psychosocial nursing intervention, prolongs the duration of treatment in patients with advanced hepatocellular carcinoma (HCC) and if it influences health-related quality of life (HRQL). Methods and Results This is a cohort study using data from patients receiving sorafenib in the prospective Bern HCC Cohort at the University Hospital. Duration of treatment, overall survival, and HRQL using the Functional Assessment of Cancer Therapy-Hepatobiliary questionnaire were compared in the two groups. A total of 173 patients were eligible for the analysis. Among them, 141 were in the Home Care program, and 32 were not. Patients with Home Care had a significantly longer duration of treatment (265 days vs 152 days, P = 0.003) and a better functional well-being (17.7 vs 12.5, P = 0.015). Conclusion Psychosocial interventions such as Home Care are a valid method in improving adherence to sorafenib and can therefore be recommended.
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Affiliation(s)
- Monika Moser
- Hepatology, Department of Clinical Research University of Bern Bern Switzerland.,University Clinic for Visceral Surgery and Medicine, Inselspital Bern Switzerland
| | - Iuliana-Pompilia Radu
- Hepatology, Department of Clinical Research University of Bern Bern Switzerland.,University Clinic for Visceral Surgery and Medicine, Inselspital Bern Switzerland
| | - Jean-François Dufour
- Hepatology, Department of Clinical Research University of Bern Bern Switzerland.,University Clinic for Visceral Surgery and Medicine, Inselspital Bern Switzerland
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20
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Understanding the patient experience in hepatocellular carcinoma: a qualitative patient interview study. Qual Life Res 2021; 31:473-485. [PMID: 34115280 PMCID: PMC8847294 DOI: 10.1007/s11136-021-02903-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 02/07/2023]
Abstract
Purpose This study aimed to elucidate the patient experience of hepatocellular carcinoma (HCC) to guide patient-centered outcome measurement in drug development. Methods Patients with HCC participated in qualitative interviews to elicit disease-related signs/symptoms and impacts, using discussion guides developed from literature searches and discussions with oncologists. Interview participants rated the disturbance of their experiences (0–10 scale). A conceptual model was developed and mapped against patient-reported outcome (PRO) instruments identified from database reviews. Results Interviews were conducted with 25 individuals with HCC (68% were men; median age: 63 years; 12% Barcelona clinic liver cancer (BCLC) stage A; 32% stage B; and 56% stage C) in the USA. Fifty-one HCC-related concepts were identified from the interviews and were grouped into eight sign/symptom categories (eating behavior/weight changes; extremities [arms, legs]; fatigue and strength; gastrointestinal; pain; sensory; skin; other) and four impact categories (emotional; physical; cognitive function; other) for the conceptual model. The most prevalent and disturbing experiences across the disease stages were fatigue/lack of energy and emotional impacts such as frustration, fear, and depression. Abdominal pain and skin-related issues were particularly common and disturbing in individuals with HCC stage C. The EORTC QLQ-C30 and HCC18 were identified as commonly used PRO instruments in HCC studies and captured the relevant signs/symptoms associated with the patient experience. Conclusion Patients with HCC reported a range of signs/symptoms and impacts that negatively affect daily functioning and quality of life. Including PRO measures in HCC clinical trials can provide meaningful patient perspectives during drug development. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-021-02903-4.
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21
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Renal Protective Effect of Everolimus in Liver Transplantation: A Prospective Randomized Open-Label Trial. Transplant Direct 2021; 7:e709. [PMID: 34124345 PMCID: PMC8191692 DOI: 10.1097/txd.0000000000001159] [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: 03/12/2021] [Revised: 03/18/2021] [Accepted: 03/20/2021] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. Renal dysfunction is associated with poor long-term outcomes after liver transplantation. We examined the renal sparing effect of everolimus (EVR) compared to standard calcineurin inhibitor (CNI) immunosuppression with direct measurements of renal function over 24 months.
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22
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Development of a patient-reported outcome tool for assessing symptom burden during perioperative care in liver surgery: The MDASI-PeriOp-Hep. Eur J Oncol Nurs 2021; 52:101959. [PMID: 33964632 DOI: 10.1016/j.ejon.2021.101959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/01/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE Based on the MD Anderson Symptom Inventory (MDASI), we developed a Patient-reported outcomes tool for hepatectomy perioperative care (MDASI-PeriOp-Hep). METHODS To establish the content validity, we generated PeriOp-Hep-specific candidate items from qualitative interviews of patients (n = 30), and removed items that lacked clinical relevance on the basis of input from panels of patients, caregivers, and clinicians. The psychometric properties of the MDASI-PeriOp-Hep were validated (n = 150). The cognitive debriefing and clinical interpretability were assessed to confirm the ease of comprehension, relevance, and acceptability of the tool. RESULTS Five symptoms specific to hepatectomy (abdominal bloating, tightness, or fullness; abdominal cramping; muscle weakness, instability, or vertigo; constipation; and incisional tightness) were identified as module items to form the MDASI-PeriOp-Hep. The Cronbach αs for symptoms and for interference were 0.898 and 0.861, respectively. The test-retest reliability was 0.887 for all 18 symptom severity items. Compared to other commonly used tools, correlation of MDASI-PeriOp-Hep scores to performance status (all, P < 0.001) and to the phase of perioperative care confirmed known-group validity. Convergent validity was excellent against other standard Patient-reported outcomes tools. Cognitive debriefing demonstrated that the MDASI-PeriOp-Hep was an easy to use and understandable tool. CONCLUSIONS For integrating patient-reported outcomes in perioperative patient care, a procedure-specific tool is desirable. The MDASI-PeriOp-Hep is a valid, reliable, concise tool for measuring symptom severity and functional interference in patients undergoing liver surgery.
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Cherkaoui Z, González C, Wakabayashi T, Delattre B, Léost E, Serra S, Huppertz J, Klein F, Stéphan M, Meyer JM, Schaff A, Martinis E, Bangoura E, Kieffer S, Blanès S, Haddad E, De Guio G, Felli E, Pernot S, Marescaux J, Mutter D, Lugiez C, Pessaux P. A Standard Set of Value-Based Patient-Centered Outcomes for Pancreatic Carcinoma: An International Delphi Survey. Ann Surg Oncol 2021; 28:1069-1078. [PMID: 32514806 DOI: 10.1245/s10434-020-08679-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Global health systems are shifting toward value-based health care to improve patient outcomes in the face of rising health care costs. The challenge is to identify standardized outcome measurements that allow optimal quality-of-care monitoring and comparison to optimize medical practices and patient pathways. A common outcomes definition is required, including medical results (Clinical Reported Outcomes Measurements [CROMs]) and quality-of-life components that matter most to patients (Patient-Reported Outcomes Measurements [PROMs]), which are particularly important for severe pathologies with short life expectancy such as pancreatic cancer. This study aimed to create standardized metrics that could be used for outcomes analysis of pancreatic cancer care. METHODS A multidisciplinary working group (WG) was assembled. A systematic review was performed to collect the most used outcomes in clinical studies of pancreatic cancers. The study reviewed 570 studies published in the last 10 years. From these studies, 3370 outcomes, including CROMs, and PROMs, were listed and prioritized. The WG reached a consensus on key outcomes, proposed groupings for CROMs and PROMs, identified existing questionnaires that could be used for PROMs collection, and set the timeline for data collection. To refine and validate the final outcomes set, an international external committee completed a Delphi process (two rounds for both CROMS and PROMs). RESULTS After the systematic literature review, the WG selected 102 outcomes (92 CROMs and 10 PROMs) for submission to the international Delphi vote committee. The committee retrained 89 outcomes (78 CROMs and 11 PROMs). For the PROMs, the WG and the international external committee chose a validated questionnaire, the Functional Assessment of Cancer Therapy-Hepatobiliary, which covers all of the 11 selected PROMs. CONCLUSIONS A standardized set of outcome measures that need to be validated through international health outcome comparisons and quality-of-care assessments was built. Pilot projects are underway to test and optimize the approach in real-life conditions.
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Affiliation(s)
- Zineb Cherkaoui
- Institute of Image-Guided Surgery (IHU Strasbourg), Université de Strasbourg, Strasbourg, France
- Digestive and Endocrine Surgery Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
- SSPC (Simplification of Surgical Patient Care), UR UPJV 7518, University of Picardie Jules Verne, Amiens, France
| | - Cristians González
- Institute of Image-Guided Surgery (IHU Strasbourg), Université de Strasbourg, Strasbourg, France
- Digestive and Endocrine Surgery Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Taiga Wakabayashi
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - Bastien Delattre
- Integrated Health Solutions (IHS), Medtronic France, Boulogne-Billancourt, France
| | - Elodie Léost
- Integrated Health Solutions (IHS), Medtronic France, Boulogne-Billancourt, France
| | - Sébastien Serra
- Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Jerôme Huppertz
- Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Francine Klein
- Digestive and Endocrine Surgery Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Marie Stéphan
- Digestive and Endocrine Surgery Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Jean-Michel Meyer
- CISS Alsace (Collectif Inter Associatif Sur la Santé), Strasbourg, France
| | - Alain Schaff
- Digestive and Endocrine Surgery Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Elisa Martinis
- Digestive and Endocrine Surgery Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Elena Bangoura
- Digestive and Endocrine Surgery Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Sophie Kieffer
- Digestive and Endocrine Surgery Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Sophie Blanès
- Digestive and Endocrine Surgery Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Elham Haddad
- Oncology Unit, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | | | - Emanuele Felli
- Digestive and Endocrine Surgery Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Sophie Pernot
- Institute of Image-Guided Surgery (IHU Strasbourg), Université de Strasbourg, Strasbourg, France
| | - Jacques Marescaux
- Institute of Image-Guided Surgery (IHU Strasbourg), Université de Strasbourg, Strasbourg, France
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - Didier Mutter
- Institute of Image-Guided Surgery (IHU Strasbourg), Université de Strasbourg, Strasbourg, France
- Digestive and Endocrine Surgery Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - Constance Lugiez
- Integrated Health Solutions (IHS), Medtronic France, Boulogne-Billancourt, France
| | - Patrick Pessaux
- Institute of Image-Guided Surgery (IHU Strasbourg), Université de Strasbourg, Strasbourg, France.
- Digestive and Endocrine Surgery Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France.
- Hepatobiliary and Pancreatic Surgical Unit, Nouvel Hôpital Civil (NHC), Strasbourg, France.
- Unité Inserm UMR_S1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Strasbourg, France.
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Patient-Reported Quality of Life Before and After Chemoradiation for Intact Pancreas Cancer: A Prospective Registry Study. Pract Radiat Oncol 2020; 11:e63-e69. [PMID: 32712461 DOI: 10.1016/j.prro.2020.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/04/2020] [Accepted: 06/28/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE Our purpose was to determine the effect of chemoradiotherapy (CRT) on patient-reported quality of life (QOL) for patients with intact pancreas cancer. METHODS AND MATERIALS We reviewed a prospective QOL registry for patients with intact, clinically localized pancreatic ductal adenocarcinoma treated with CRT between June 2015 and November 2018. QOL was assessed pre-CRT (immediately before CRT, after neoadjuvant chemotherapy) and at the completion of CRT with the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) and its component parts: FACT-General (FACT-G) and hepatobiliary cancer subscore (HCS). A minimally important difference from pre-CRT was defined as ≥ 6, 5, and 8 points for FACT-G, HCS, and FACT-Hep, respectively. RESULTS Of 157 patients who underwent CRT, 100 completed both pre- and post-CRT surveys and were included in the primary analysis. Median age at diagnosis was 65 years (range, 23-90). National Comprehensive Cancer Network resectability status was resectable (3%), borderline resectable (40%), or locally advanced (57%). Folinic acid, 5-fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX) (75%) or gemcitabine and nab-paclitaxel (42%) were given for a median of 6 cycles (range, 0-42) before CRT. Radiation therapy techniques included 3-dimensional conformal (22%), intensity modulated photon (55%), and intensity modulated proton (23%) radiation therapy to a median dose of 50 Gy (range, 36-62.5). Concurrent chemotherapy was most commonly capecitabine (82%). Sixty-three patients (63%) had surgery after CRT. The mean decline in FACT-G, HCS subscale, and FACT-Hep from pre- to post-CRT was 3.5 (standard deviation [SD], 13.7), 1.7 (SD 7.8), and 5.2 (SD 19.4), respectively. Each of these changes were statistically significant, but did not meet the minimally important difference threshold. Pancreatic head tumor location was associated with decline in FACT-Hep. Nausea was the toxicity with the greatest increase from pre- to post-CRT by both physician-assessment and patient-reported QOL. CONCLUSIONS For patients with intact pancreatic adenocarcinoma, modern CRT is well tolerated with minimal decline in QOL during treatment.
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Chen Q, Terhorst L, Geller DA, Marsh W, Antoni M, Dew MA, Biala M, Weinstein J, Tsung A, Steel J. Trajectories and predictors of stress and depressive symptoms in spousal and intimate partner cancer caregivers. J Psychosoc Oncol 2020; 38:527-542. [PMID: 32367788 DOI: 10.1080/07347332.2020.1752879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE The objective of the study is to investigate trajectories of stress and depressive symptoms of spousal and intimate partner caregivers in the context of cancer. We also examined the patient-related predictors of caregiver stress and depression. DESIGN This is a longitudinal cohort study. PARTICIPANTS Patients diagnosed with cancers affecting the hepatobiliary and pancreatic system and their spousal or intimate partner caregivers were recruited at a large tertiary cancer center. METHODS The patients and caregivers were assessed for their level of stress, depressive symptoms, relationship quality, and quality of life at the time of the patients' diagnosis, every 2 months for 12 months and then at 18 months. FINDINGS One hundred and seventy-nine caregivers were included in the trajectory analyses. Amongst the 179 caregivers, 120 patient and caregiver dyads had complete data at baseline to 6-months. The majority of the spousal caregivers were female (84%) and the mean age was 57 years. 25% of caregivers reported high levels of chronic depressive symptoms. However, significant reductions were observed at 6 months. High and moderate levels of caregiver stress were also reported in 21% and 36% of caregivers, respectively. The caregivers who reported moderate levels of stress had a decrease in stress over time while those in the high stress group reported stable levels of stress over time. Caregivers' stress is predicted by the cancer patients' depressive symptoms but not patients' quality of life. CONCLUSIONS Caregivers who reported high levels of stress and depressive symptoms at patients' cancer diagnosis remain high even after the initial adjustment. A bidirectional relationship between the caregivers' stress and the patients' depressive symptoms was observed. IMPLICATIONS The development of dyadic interventions focusing on the patients' and caregivers' distress is warranted to decrease psychological morbidities of the dyad.
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Affiliation(s)
- Qi Chen
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - David A Geller
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Wallis Marsh
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michael Antoni
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology, and Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michelle Biala
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Josh Weinstein
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Allan Tsung
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jennifer Steel
- Departments of Surgery, Psychiatry, and Psychology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Streck BP, Wardell DW, LoBiondo-Wood G, Beauchamp JES. Interdependence of physical and psychological morbidity among patients with cancer and family caregivers: Review of the literature. Psychooncology 2020; 29:974-989. [PMID: 32227401 DOI: 10.1002/pon.5382] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 03/01/2020] [Accepted: 03/13/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Caregivers for patients with cancer have an integral role in maintaining patients' health. Although patients and caregivers experience the impact of cancer individually, studies suggest their health is interdependent. The objective of this review was to synthesize the literature on interdependent physical and psychological morbidity in patient-caregiver dyads published since 2016. METHODS A search of PubMed, CINAHL, Embase, and PsycInfo databases was performed using Cooper's recommendations and the Preferred Reporting Items for Systematic Reviews And Meta-Analyses Guidelines. Studies were included if they measured individual physical or psychological morbidity in cancer patient-caregiver dyads, evaluated interdependence, and were published in a peer-reviewed journal. RESULTS Twenty-three studies met criteria, characterized by mainly spousal dyads. Studies included a variety of cancers and methodologies. Findings were inconsistent, indicating varying interdependence. However, the studies demonstrated a stronger relationship between patients' and caregivers' psychological morbidity than between their physical morbidity. CONCLUSIONS This review revealed a need for continued exploration of dyadic health interdependence. Future studies should consider samples of patients with a single type of cancer, testing cultural mediators/moderators, and using longitudinal designs.
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Maharaj AD, Samoborec S, Evans SM, Zalcberg J, Neale RE, Goldstein D, Merrett N, White K, Croagh D, Pilgrim CHC, Evans P, Knowles B, Leong T, Philip J, Smith M, Ioannou L. Patient-reported outcome measures (PROMs) in pancreatic cancer: a systematic review. HPB (Oxford) 2020; 22:187-203. [PMID: 31635959 DOI: 10.1016/j.hpb.2019.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 09/02/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this systematic review is to examine patient-reported outcome measures (PROMs), their attributes and application in patients with pancreatic cancer (PC). METHOD A systematic literature search was undertaken of articles published to June 2018 to identify PROMs applied in primary studies in PC. Characteristics of the included studies and PROMs were described with identified scales grouped into five domains. The psychometric properties of the identified PROMs were further assessed for reliability and validity among patients with PC. RESULTS From 1688 studies screened, 170 were included. Almost half (48%) were conducted in patients with unresectable PC; the majority of these (68%) were evaluated in randomized controlled trials. Median questionnaire completion rates fell below 10% of the original cohort within 12 months in patients with unresectable PC compared to 75% in patients with resectable PC. Seventy PROMs were identified, 32 measuring unidimensional parameters (e.g. pain) and 35 measuring multidimensional (e.g. quality of life) constructs. Only five (7%) PROMs were disease-specific and 13 (19%) were validated in patients with PC. Fifty scales were grouped into 19 physical, 9 psychological, 6 psychiatric, 9 social and 7 other domains. CONCLUSION Three multidimensional PROMs, the: (i) FACT-HEP in unresectable PC; (ii) QLQ-PAN26 (in conjunction with its core QLQ-C30 PROM) in resectable PC; and (iii) MDASI-GI are recommended as instruments to capture quality of life in patients with PC. Summarised scales and psychometric evaluation provide a framework to choose PROMs for scales not captured by the recommended PROMs.
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Affiliation(s)
| | | | - Sue M Evans
- Monash University, Melbourne, VIC, Australia
| | | | - Rachel E Neale
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | | | - Neil Merrett
- Western Sydney University, Penrith, NSW, Australia
| | - Kate White
- University of Sydney, Camperdown, NSW, Australia
| | - Daniel Croagh
- Monash University, Melbourne, VIC, Australia; Monash Health, Clayton, VIC, Australia; Epworth HealthCare, Richmond, VIC, Australia
| | - Charles H C Pilgrim
- Monash University, Melbourne, VIC, Australia; Peninsula Private Hospital, Melbourne, VIC, Australia; Alfred Health, Melbourne, VIC, Australia; Cabrini Health, Malvern, VIC, Australia; Peninsula Health, Frankston, VIC, Australia
| | - Peter Evans
- Monash University, Melbourne, VIC, Australia; Cabrini Health, Malvern, VIC, Australia
| | - Brett Knowles
- Royal Melbourne Hospital, Parkville, VIC, Australia; St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Trevor Leong
- Monash University, Melbourne, VIC, Australia; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; University of Melbourne, Parkville, VIC, Australia
| | - Jennifer Philip
- Royal Melbourne Hospital, Parkville, VIC, Australia; St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; University of Melbourne, Parkville, VIC, Australia; Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - Marty Smith
- Alfred Health, Melbourne, VIC, Australia; Cabrini Health, Malvern, VIC, Australia
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Lamarca A, Frizziero M, McNamara MG, Valle JW. Clinical and Translational Research Challenges in Biliary Tract Cancers. Curr Med Chem 2020; 27:4756-4777. [PMID: 31971102 DOI: 10.2174/0929867327666200123090153] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 11/27/2019] [Accepted: 01/13/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Biliary Tract Cancers (BTC) are rare malignancies with a poor prognosis. There are many challenges encountered in treating these patients in daily practice as well as in clinical, translational and basic research. OBJECTIVE This review summarises the most relevant challenges in clinical and translational research in BTCs and suggests potential solutions towards an improvement in quality of life and outcomes of patients diagnosed with such malignancies. FINDINGS The main challenge is the low number of patients with BTCs, complicated by the aggressive natural behaviour of cancer and the lack of funding sources for research. In addition, the clinical characteristics of these patients and the specific cancer-related complications challenge clinical research and clinical trial recruitment. It is worth highlighting that BTCs are a group of different malignancies (cholangiocarcinoma, gallbladder cancer and ampullary cancer) rather than a unique homogeneous disease. These subgroups differ not only in molecular aspects, but also in clinical and demographic characteristics. In addition, tailored imaging and quality of life assessment are required to tackle some of the issues specific to BTCs. Finally, difficulties in tissue acquisition both in terms of biopsy size and inclusion of sufficient tumour within the samples, may adversely impact translational and basic research. CONCLUSION Increasing awareness among patients and clinicians regarding BTC and the need for further research and treatment development may address some of the main challenges in BTC research. International collaboration is mandatory to progress the field.
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Affiliation(s)
- Angela Lamarca
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Melissa Frizziero
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Mairéad G McNamara
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Juan W Valle
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
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Heiberg T, Baekelandt B, Kvien TK, Buanes T. Psychometric performance of the PAncreatic CAncer disease impact (PACADI) score. Pancreatology 2019; 19:971-978. [PMID: 31530448 DOI: 10.1016/j.pan.2019.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 08/30/2019] [Accepted: 09/01/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVE Pancreatic Cancer Disease Impact (PACADI) score measures the impact of pancreatic cancer (PC) on important health dimensions, selected by patients. The aim of this single center study was to test the psychometric performance of the Pancreatic Cancer Disease Impact (PACADI) score. METHODS Patients with suspected pancreatic cancer (PC) completed PACADI, the EuroQol-5D (EQ-5D index) and Edmonton Symptom Assessment System (ESAS) in this longitudinal observational study. Measures were compared across patients with PC (n = 210), other malignant lesions (OML) (n = 109) and non-malignant lesions (NML) (n = 41). Associations, test-retest and internal consistency reliability, longitudinal changes, sensitivity to change and prediction of mortality during the first year were examined in patients with PC. RESULTS The three measures discriminated between PC and OML. The PACADI score correlated strongly at baseline (n = 199)/after three months (n = 85) with the EQ-5D index and ESAS "sense of well-being" (0.64 and 0.66/0.73 and 0.69, p < 0.001, respectively), showed high test-retest reliability (ICC 0.84) and very good internal consistency reliability (Cronbach's alpha 0.81-0.85) across all visits. Scores improved over time at 3, 6, 9 and 12 months for survivors, and standardized response mean (SRM) for improvement between 2 and 3 months (n = 44) was 0.80 (PACADI), -0.59 (EQ-5D index) and 0.69 (ESAS "sense of well-being"). The PACADI score significantly predicted mortality within the first year (p = 0.02) in contrast to the EQ-5D index and ESAS "sense of well-being". CONCLUSION This study showed satisfactory psychometric performance of the PACADI score. The results support its use in clinical practice and intervention trials.
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Affiliation(s)
- Turid Heiberg
- Regional Research Support, Oslo University Hospital, Oslo, Norway; Østfold University College, Halden, Norway.
| | - Bart Baekelandt
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tore K Kvien
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Trond Buanes
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
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Torphy RJ, Chapman BC, Friedman C, Nguyen C, Bartsch CG, Meguid C, Ahrendt SA, McCarter MD, Del Chiaro M, Schulick RD, Edil BH, Gleisner A. Quality of Life Following Major Laparoscopic or Open Pancreatic Resection. Ann Surg Oncol 2019; 26:2985-2993. [DOI: 10.1245/s10434-019-07449-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Indexed: 12/22/2022]
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Li D, Sedano S, Allen R, Gong J, Cho M, Sharma S. Current Treatment Landscape for Advanced Hepatocellular Carcinoma: Patient Outcomes and the Impact on Quality of Life. Cancers (Basel) 2019; 11:E841. [PMID: 31216701 PMCID: PMC6627588 DOI: 10.3390/cancers11060841] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 12/24/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer mortality worldwide. Heterogeneity of clinical conditions contributes to the complex management of care for patients with advanced HCC. Recently, the treatment landscape for advanced HCC has expanded rapidly, with the additional FDA approvals of several oral tyrosine kinase inhibitors (lenvatinib, regorafenib, and cabozantinib), as well as immunotherapies such as immune check point inhibitors (nivolumab and pembrolizumab) and the monoclonal IgG1 antibody, ramucirumab. This expansion has generated a need for novel treatment sequencing strategies in this patient population. In light of these developments, an evaluation of the impact of FDA-approved therapeutics on patient-centered outcomes such as health-related quality of life (HRQoL) is warranted. An increased understanding of HRQoL in patients included in advanced HCC clinical trials could potentially help physician decision-making for treatment sequencing in patients with advanced HCC.
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Affiliation(s)
- Daneng Li
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA 91010, USA.
| | - Sabrina Sedano
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA 91010, USA.
| | - Rebecca Allen
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA 91010, USA.
| | - Jun Gong
- Department of Gastrointestinal Malignancies, Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA 90048, USA.
| | - May Cho
- Department of Internal Medicine, UC Davis Comprehensive Cancer Center, Sacramento, CA 95817, USA.
| | - Sunil Sharma
- Division of Clinical Sciences, Translational Genomics Research Institute, Phoenix, AZ 85004, USA.
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Lee HH, Chiu CC, Lin JJ, Wang JJ, Lee KT, Sun DP, Shi HY. Impact of preoperative anxiety and depression on quality of life before and after resection of hepatocellular carcinoma. J Affect Disord 2019; 246:361-367. [PMID: 30597297 DOI: 10.1016/j.jad.2018.12.085] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/15/2018] [Accepted: 12/24/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The impact of anxiety and depression symptoms (ADS) is often estimated in terms of clinical endpoints such as the risk of complications and probabilities of readmission and survival. The purpose of this study was to provide a benchmark for capturing the negative effects of ADS on quality of life after hepatocellular carcinoma (HCC) surgery and to provide an evidence base for future research and clinical interventions aimed at understanding and remediating these effects. METHODS This prospective study analyzed 410 HCC patients at three tertiary academic hospitals. The Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Functional Assessment of Cancer Therapy- Hepatobiliary (FACT-H) were administered before HCC surgery and at 6 months, 1 year, and 2 years after HCC surgery. Generalized estimating equations were used to estimate differences-in-differences models for examining the effects of ADS. RESULTS At baseline, 9.0% of the participants had anxiety symptom (BAI > 10), 17.1% had depression symptom (BDI > 13), and 7.1% had ADS. Throughout the study period, anxiety and depression (differences-in-differences value) had significant (P < 0.001) negative net effects on mean scores for all FACT-H dimensions, and the differences gradually increased over time. From baseline through all follow-up years, the two groups significantly (P < 0.001) differed in scores for all FACT-H dimensions, and the differences increased over time. CONCLUSIONS For healthcare providers, this study highlights the need for continued monitoring for ADS in patients who have undergone hepatic resection and the need for timely and appropriate psychological care for these patients.
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Affiliation(s)
- Hao-Hsien Lee
- Department of Surgery, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
| | - Chong-Chi Chiu
- Department of Surgery, Chi Mei Medical Center, Liouying, Tainan, Taiwan; Department of Surgery, Chi Mei Medical Center, Yongkang, Tainan, Taiwan; Department of Electrical Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Jin-Jia Lin
- Department of Psychiatry, Chi-Mei Medical Center, Yongkang, Tainan, Taiwan; Department of Psychiatry, Chi-Mei Hospital, Liouying, Tainan, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Yongkang, Tainan, Taiwan
| | - King-Teh Lee
- Division of Hepatobiliary Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, 100-Shih-Chun 1st Road, Kaohsiung 80708, Taiwan
| | - Ding-Ping Sun
- Department of Surgery, Chi Mei Medical Center, Yongkang, Tainan, Taiwan
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, 100-Shih-Chun 1st Road, Kaohsiung 80708, Taiwan; Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Gmür A, Kolly P, Knöpfli M, Dufour JF. FACT-Hep increases the accuracy of survival prediction in HCC patients when added to ECOG Performance Status. Liver Int 2018; 38:1468-1474. [PMID: 29389088 DOI: 10.1111/liv.13711] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 01/18/2018] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND AIM The Eastern Cooperative Oncology Group Performance Status (ECOG PS) is a strong predictor of survival for patients with hepatocellular carcinoma (HCC), and is used with liver function and tumour burden in the Barcelona Clinic Liver Cancer (BCLC) staging system. This work assesses whether the health-related quality of life (HRQL), measured by the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) questionnaire, discriminates HCC patients in terms of survival and adds prognostic information to ECOG PS. METHODS A total of 242 patients participating in the prospective Bern HCC Cohort at the University Hospital Bern were analysed. The relationship between FACT-Hep and sociodemographic and clinical factors, including survival, were assessed. An analysis on treatment subgroups was performed using Kaplan-Meier curves and Long-Rank test. Additionally, the ability to predict overall survival was compared between the ECOG PS and FACT-Hep total and subscales using Nagelkerke pseudo-R2 . RESULTS FACT-Hep subscales were significantly worse in females and in patients with limited liver function. FACT-Hep total and all subscales, except the social/family well-being subscale showed significant differences between ECOG PS groups and were significant predictors of survival. ECOG PS groups, followed by the functional well-being subscale, were the best at predicting survival. In the resection subgroup, significant differences in OS regarding to HRQL were found. When adding the functional well-being subscale to ECOG PS, the accuracy of the survival prediction was significantly increased. CONCLUSION HRQL assessed by the FACT-Hep questionnaire is a reliable prognostic predictor of survival for patients with HCC and it adds prognostic information to the ECOG PS.
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Affiliation(s)
- Andrea Gmür
- Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland.,University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Philippe Kolly
- Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland.,University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Marina Knöpfli
- University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Jean-François Dufour
- Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland.,University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
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Jethwa KR, Tryggestad EJ, Whitaker TJ, Giffey BT, Kazemba BD, Neben-Wittich MA, Merrell KW, Haddock MG, Hallemeier CL. Initial experience with intensity modulated proton therapy for intact, clinically localized pancreas cancer: Clinical implementation, dosimetric analysis, acute treatment-related adverse events, and patient-reported outcomes. Adv Radiat Oncol 2018; 3:314-321. [PMID: 30202800 PMCID: PMC6128024 DOI: 10.1016/j.adro.2018.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/25/2018] [Accepted: 04/04/2018] [Indexed: 12/22/2022] Open
Abstract
Purpose Pencil-beam scanning intensity modulated proton therapy (IMPT) may allow for an improvement in the therapeutic ratio compared with conventional techniques of radiation therapy delivery for pancreatic cancer. The purpose of this study was to describe the clinical implementation of IMPT for intact and clinically localized pancreatic cancer, perform a matched dosimetric comparison with volumetric modulated arc therapy (VMAT), and report acute adverse event (AE) rates and patient-reported outcomes (PROs) of health-related quality of life. Methods and materials Between July 2016 and March 2017, 13 patients with localized pancreatic cancer underwent concurrent capecitabine or 5-fluorouracil-based chemoradiation therapy (CRT) utilizing IMPT to a dose of 50 Gy (radiobiological effectiveness: 1.1). A VMAT plan was generated for each patient to use for dosimetric comparison. Patients were assessed prospectively for AEs and completed PRO questionnaires utilizing the Functional Assessment of Cancer Therapy-Hepatobiliary at baseline and upon completion of CRT. Results There was no difference in mean target coverage between IMPT and VMAT (P > .05). IMPT offered significant reductions in dose to organs at risk, including the small bowel, duodenum, stomach, large bowel, liver, and kidneys (P < .05). All patients completed treatment without radiation therapy breaks. The median weight loss during treatment was 1.6 kg (range, 0.1-5.7 kg). No patients experienced grade ≥3 treatment-related AEs. The median Functional Assessment of Cancer Therapy-Hepatobiliary scores prior to versus at the end of CRT were 142 (range, 113-163) versus 136 (range, 107-173; P = .18). Conclusions Pencil-beam scanning IMPT was feasible and offered significant reductions in radiation exposure to multiple gastrointestinal organs at risk. IMPT was associated with no grade ≥3 gastrointestinal AEs and no change in baseline PROs, but the conclusions are limited due to the patient sample size. Further clinical studies are warranted to evaluate whether these dosimetric advantages translate into clinically meaningful benefits.
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Affiliation(s)
- Krishan R Jethwa
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Broc T Giffey
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Bret D Kazemba
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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Lewis AR, Pihlak R, McNamara MG. The importance of quality-of-life management in patients with advanced pancreatic ductal adenocarcinoma. Curr Probl Cancer 2018; 42:26-39. [PMID: 29631711 DOI: 10.1016/j.currproblcancer.2018.01.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 12/15/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) carries a poor prognosis, and as such, a focus on quality of life is vital. This review will discuss various aspects of quality of life in patients with PDAC and their treatment. Pancreatic exocrine and endocrine insufficiency may result in issues related to nutrition, and pain and fatigue are other common symptoms, and may be managed with pharmaceutical or nonpharmaceutical methods. It has also been reported that low mood is a particular problem for patients with PDAC compared to patients with other cancers; however, the data supporting this is inconsistent. Data regarding improvements in quality of life in patients with PDAC receiving chemotherapy is also reviewed, which in some cases suggests a benefit to chemotherapy, particularly in the presence of a radiological response. Furthermore, the importance of early palliative care is discussed and the benefits reported including improved quality of life and mood, reduced aggressive interventions at the end of life and improved survival. Areas for future development may include increased use of quality of life as a trial outcome and the use of patient-reported outcomes to improve symptomatic care of patients, and particularly in those receiving active systemic treatment.
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Affiliation(s)
- Alexandra R Lewis
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Rille Pihlak
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Mairéad G McNamara
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK.
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Tian L, Cao XY. Systematic review of the psychometric properties of disease-specific, quality-of-life questionnaires for patients with hepatobiliary or pancreatic cancers. Jpn J Nurs Sci 2017; 15:99-112. [PMID: 29057615 DOI: 10.1111/jjns.12188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 03/04/2017] [Accepted: 07/21/2017] [Indexed: 02/05/2023]
Abstract
AIM To systematically review the quality of the psychometric properties of disease-specific quality-of-life questionnaires for patients with hepatobiliary or pancreatic cancers in order to help researchers and clinicians to select the most appropriate health-related quality-of-life (HRQoL) instruments. METHODS MEDLINE from 1950, CINAHL from 1960, EMBASE from 1980, and PsycINFO from 1967, as well as additional sources were searched. The quality of the psychometric properties of the included instruments was evaluated by using the quality criteria for measurement properties of health status questionnaires. RESULTS Ten studies that examined seven instruments were identified. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Biliary Cancer, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Liver Metastases of Colorectal Cancer, the Functional Assessment of Cancer Therapy-Hepatobiliary Questionnaire, and the Quality of Life for Patients with Liver Cancer Instrument achieved satisfactory results in relation to the quality of their psychometric properties. CONCLUSION Several well-validated instruments exist to adequately assess disease-specific HRQoL in patients with hepatobiliary or pancreatic cancers. Further improvement of the already-existing, promising measures is recommended.
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Affiliation(s)
- Lang Tian
- Department of Hepatobiliary Surgery, Sichuan Cancer Hospital, Chengdu, China
| | - Xiao-Yi Cao
- Department of Nephrology, Hemodialysis Center, West China Hospital, Sichuan University, Chengdu, China
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Association between pancreatic cancer patients' perception of their care coordination and patient-reported and survival outcomes. Palliat Support Care 2017; 16:534-543. [PMID: 28669376 DOI: 10.1017/s1478951517000608] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE People with pancreatic cancer have poor survival, and management is challenging. Pancreatic cancer patients' perceptions of their care coordination and its association with their outcomes have not been well-studied. Our objective was to determine if perception of care coordination is associated with patient-reported outcomes or survival. METHODS People with pancreatic cancer who were 1-8 months postdiagnosis (52 with completed resection and 58 with no resection) completed a patient-reported questionnaire that assessed their perceptions of care coordination, quality of life, anxiety, and depression using validated instruments. Mean scores for 15 care-coordination items were calculated and then ranked from highest (best experience) to lowest (worst experience). Associations between care-coordination scores (including communication and navigation domains) and patient-reported outcomes and survival were investigated using general linear regression and Cox regression, respectively. All analyses were stratified by whether or not the tumor had been resected. RESULTS In both groups, the highest-ranked care-coordination items were: knowing who was responsible for coordinating care, health professionals being informed about their history, and waiting times. The worst-ranked items related to: how often patients were asked about visits with other health professionals and how well they and their family were coping, knowing the symptoms they should monitor, having sufficient emotional help from staff, and access to additional specialist services. For people who had a resection, better communication and navigation scores were significantly associated with higher quality of life and less anxiety and depression. However, these associations were not statistically significant for those with no resection. Perception of cancer care coordination was not associated with survival in either group. SIGNIFICANCE OF RESULTS Our results suggest that, while many core clinical aspects of care are perceived to be done well for pancreatic cancer patients, improvements in emotional support, referral to specialist services, and self-management education may improve patient-reported outcomes.
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Janda M, Neale RE, Klein K, O'Connell DL, Gooden H, Goldstein D, Merrett ND, Wyld DK, Rowlands IJ, Beesley VL. Anxiety, depression and quality of life in people with pancreatic cancer and their carers. Pancreatology 2017; 17:321-327. [PMID: 28153446 DOI: 10.1016/j.pan.2017.01.008] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND People with pancreatic cancer have high levels of anxiety and depression and reduced quality of life (QoL), but few studies have assessed these outcomes for patient-carer dyads. We therefore investigated these issues in an Australian population-based study. METHODS Patients with pancreatic cancer (n = 136) and many of their carers (n = 84) completed the Hospital Anxiety and Depression Scale (HADS) and Functional Assessment of Cancer Therapy QoL questionnaire at a median of three months after diagnosis. Overall QoL and well-being subscales (physical, social, emotional, functional) were compared with general population norms. Intraclass correlation coefficients were used to compare anxiety, depression and QoL scores of patients and their respective carers. RESULTS Fifteen percent of patients and 39% of carers had HADS scores indicative of anxiety and 15% of patients and 14% of carers of depression, respectively. Overall, 70% of patients and 58% of carers had QoL scores below the Queensland population average. Patients' anxiety, depression, overall QoL, social, emotional and functional wellbeing scores were significantly related to those scores in their carers. Among patients and carers, accessing psychological help was associated with elevated anxiety. Not receiving chemotherapy was associated with elevated depression among patients and younger age was associated with poorer outcomes in carers. CONCLUSIONS More carers had symptoms of anxiety than patients with pancreatic cancer, but symptoms of depression were similarly common in patients and carers. Further research is needed to assess whether interventions to reduce patients' distress could also improve QoL among carers, or whether carer-focussed interventions are required.
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Affiliation(s)
- Monika Janda
- Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Rachel E Neale
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Kerenaftali Klein
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Helen Gooden
- Cancer Nursing Research Unit, University of Sydney, Sydney, Australia
| | - David Goldstein
- University of New South Wales, Sydney, Australia; Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia
| | - Neil D Merrett
- South Western Sydney Upper GI Surgical Unit, Bankstown Hospital, Sydney, Australia; Discipline of Surgery, University of Western Sydney, Sydney, Australia
| | - David K Wyld
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Ingrid J Rowlands
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Vanessa L Beesley
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
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Cloyd JM, Tran Cao HS, Petzel MQ, Denbo JW, Parker NH, Nogueras-González GM, Liles JS, Kim MP, Lee JE, Vauthey JN, Aloia TA, Fleming JB, Katz MH. Impact of pancreatectomy on long-term patient-reported symptoms and quality of life in recurrence-free survivors of pancreatic and periampullary neoplasms. J Surg Oncol 2016; 115:144-150. [DOI: 10.1002/jso.24499] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 10/16/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Jordan M. Cloyd
- Department of Surgical Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Hop S. Tran Cao
- Division of Surgical Oncology; Michael E. DeBakey VA Medical Center; Baylor College Medicine; Houston Texas
| | - Maria Q.B. Petzel
- Department of Surgical Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Jason W. Denbo
- Department of Surgical Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Nathan H. Parker
- Department of Surgical Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | | | - Joseph S. Liles
- Division of Surgical Oncology; Department of Surgery; University of South Alabama; Mobile Alabama
| | - Michael P. Kim
- Department of Surgical Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Jeffrey E. Lee
- Department of Surgical Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Thomas A. Aloia
- Department of Surgical Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Jason B. Fleming
- Department of Surgical Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Matthew H.G. Katz
- Department of Surgical Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
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Kleeff J, Korc M, Apte M, La Vecchia C, Johnson CD, Biankin AV, Neale RE, Tempero M, Tuveson DA, Hruban RH, Neoptolemos JP. Pancreatic cancer. Nat Rev Dis Primers 2016; 2:16022. [PMID: 27158978 DOI: 10.1038/nrdp.2016.22] [Citation(s) in RCA: 1145] [Impact Index Per Article: 143.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pancreatic cancer is a major cause of cancer-associated mortality, with a dismal overall prognosis that has remained virtually unchanged for many decades. Currently, prevention or early diagnosis at a curable stage is exceedingly difficult; patients rarely exhibit symptoms and tumours do not display sensitive and specific markers to aid detection. Pancreatic cancers also have few prevalent genetic mutations; the most commonly mutated genes are KRAS, CDKN2A (encoding p16), TP53 and SMAD4 - none of which are currently druggable. Indeed, therapeutic options are limited and progress in drug development is impeded because most pancreatic cancers are complex at the genomic, epigenetic and metabolic levels, with multiple activated pathways and crosstalk evident. Furthermore, the multilayered interplay between neoplastic and stromal cells in the tumour microenvironment challenges medical treatment. Fewer than 20% of patients have surgically resectable disease; however, neoadjuvant therapies might shift tumours towards resectability. Although newer drug combinations and multimodal regimens in this setting, as well as the adjuvant setting, appreciably extend survival, ∼80% of patients will relapse after surgery and ultimately die of their disease. Thus, consideration of quality of life and overall survival is important. In this Primer, we summarize the current understanding of the salient pathophysiological, molecular, translational and clinical aspects of this disease. In addition, we present an outline of potential future directions for pancreatic cancer research and patient management.
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Affiliation(s)
- Jorg Kleeff
- NIHR Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Duncan Building, Daulby Street, Liverpool L69 3GA, UK
- Department of General, Visceral and Pediatric Surgery, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Murray Korc
- Departments of Medicine, and Biochemistry and Molecular Biology, Indiana University School of Medicine, the Melvin and Bren Simon Cancer Center, and the Pancreatic Cancer Signature Center, Indianapolis, Indiana, USA
| | - Minoti Apte
- SWS Clinical School, University of New South Wales, and Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Colin D Johnson
- University Surgical Unit, University Hospital Southampton, Southampton, UK
| | - Andrew V Biankin
- Institute of Cancer Sciences, Wolfson Wohl Cancer Research Centre, University of Glasgow, Garscube Estate, Bearsden, Glasgow, Scotland, UK
| | - Rachel E Neale
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Margaret Tempero
- UCSF Pancreas Center, University of California San Francisco - Mission Bay Campus/Mission Hall, San Francisco, California, USA
| | - David A Tuveson
- Cold Spring Harbor Laboratory, Cold Spring Harbor, New York, New York, USA
| | - Ralph H Hruban
- The Sol Goldman Pancreatic Cancer Research Center, Departments of Pathology and Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John P Neoptolemos
- NIHR Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Duncan Building, Daulby Street, Liverpool L69 3GA, UK
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Pilot study of an interdisciplinary supportive care planning intervention in pancreatic cancer. Support Care Cancer 2016; 24:3417-24. [PMID: 26984248 DOI: 10.1007/s00520-016-3155-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 03/07/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE A diagnosis of pancreatic cancer is often associated with higher symptom burden, lower functional status, and worse quality of life (QOL). To date, few interventions have focused on the unique QOL needs of patients with pancreatic cancer. The purpose of this pilot study is to determine the feasibility of an interdisciplinary supportive care planning intervention in patients with pancreatic cancer during disease-focused treatments. METHODS Patients enrolled in this prospective, pre- and post-intervention pilot study received a supportive care intervention that included the following three components: comprehensive QOL assessment, case presentation at interdisciplinary care meetings, and two nurse-administered educational sessions on QOL concerns. Patients completed outcome measures that included the FACT-Hep, FACIT-Sp-12, and self-report of finances and out-of-pocket costs since diagnosis. Measures were completed at baseline prior to receiving the intervention, and follow-up occurred at 1 and 2 months post-intervention. RESULTS A total of 10 patients were enrolled during a 4-month period who provided informed consent, received the intervention, and completed the study (58 % accrual). Examination of pre- and post-intervention QOL outcomes revealed changes across the three evaluation time points that were not statistically significant. Patients were highly satisfied with the intervention, with 80 % reporting that the intervention was "excellent." Discussions during the interdisciplinary care meetings and educational sessions were largely focused on physical and psychosocial needs. CONCLUSIONS An interdisciplinary supportive care planning intervention was potentially feasible and acceptable for pancreatic cancer patients in an ambulatory care setting.
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Yang Z, Wan C, Li W, Cun Y, Meng Q, Ding Y, Chen P. Development and Validation of the Simplified Chinese Version of EORTC QLQ-HCC18 for Patients with Hepatocellular Carcinoma. Cancer Invest 2015; 33:340-6. [PMID: 26046473 DOI: 10.3109/07357907.2015.1036280] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study aimed to develop and validate the Simplified Chinese Version of the Quality of Life Questionnaire for Hepatocellular Carcinoma (the QLQ-HCC18). It was developed by the strict translation procedure of EORTC guidelines, and the psychometrics were evaluated on a sample of 114 patients. The internal consistency Cronbach's α were greater than 0.60 for all domains (exception of Jaundice 0.38), and all test-retest reliability coefficients were greater than 0.80. Four out of eight domains had statistically significant changes with effect size standardized response mean (SRM) ranging from 0.31 to 0.73. The Simplified Chinese version of QLQ-HCC18 demonstrates good validity, reliability, and responsiveness.
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Affiliation(s)
- Zheng Yang
- a School of Public Health and Tropical Medicine , Southern Medical University , Guanghzou , China.,b School of Public Health , Guangdong Medical University , Dongguan , China
| | - Chonghua Wan
- c School of Humanities and Management, Research Center on Quality of Life and Applied Psychology , Guangdong Medical University , Dongguan , China
| | - Wei Li
- d School of Public Health , Kunming Medical University , Kunming , Yunnan , China
| | - Yingli Cun
- e Yunnan Tumor Hospital , Kunming , China
| | - Qiong Meng
- d School of Public Health , Kunming Medical University , Kunming , Yunnan , China
| | - Yuanlin Ding
- b School of Public Health , Guangdong Medical University , Dongguan , China
| | - Pingyan Chen
- a School of Public Health and Tropical Medicine , Southern Medical University , Guanghzou , China
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A prospective, randomized, double-blind, placebo controlled trial on the efficacy of ethanol celiac plexus neurolysis in patients with operable pancreatic and periampullary adenocarcinoma. J Am Coll Surg 2014; 220:497-508. [PMID: 25667135 PMCID: PMC4448126 DOI: 10.1016/j.jamcollsurg.2014.12.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 12/09/2014] [Indexed: 12/16/2022]
Abstract
Background Ethanol celiac plexus neurolysis (ECPN) has been shown to be effective in reducing cancer-related pain in patients with locally advanced pancreatic and periampullary adenocarcinoma (PPA). This study examined its efficacy in patients undergoing PPA resection. Study Design 485 patients participated in this prospective, randomized, double blind placebo controlled trial. Patients were stratified by preoperative pain and disease resectability. They received either ECPN (50% ethanol) or 0.9% normal saline placebo control. The primary endpoint was short and long-term pain and secondary endpoints included postoperative morbidity, QOL and overall survival. Results Data from 467 patients were analyzed. The primary endpoint, the percentage of PPA patients experiencing a worsening of pain compared to preoperative baseline for resectable patients, was not different between the ethanol and saline groups in either the resectable/pain stratum (22% vs 18%, RR 1.23 (0.34, 4.46)), or the resectable/no pain stratum (37% vs 34%, RR 1.10 (0.67, 1.81)). On multivariable analysis of resected pancreatic ductal adenocarcinoma (PDA) patients, there was a significant reduction in pain in the resectable/pain group, suggesting that surgical resection of the malignancy alone (independent of ECPN) decrements pain to a significant degree. Conclusions In this study, we have demonstrated a significant reduction in pain following surgical resection of PPA. However the addition of ECPN did not synergize to result in a further reduction in pain, and in fact its effect may have been masked by surgical resection. Given this, we cannot recommend the use of ECPN to mitigate cancer related pain in resectable PPA patients.
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Important and relevant symptoms including pain concerns in hepatocellular carcinoma (HCC): a patient interview study. Support Care Cancer 2013; 22:919-26. [PMID: 24258355 DOI: 10.1007/s00520-013-2039-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 10/28/2013] [Indexed: 02/08/2023]
Abstract
PURPOSE We examined the health-related quality of life (HRQOL) and pain experiences of patients with hepatocellular carcinoma (HCC) and assessed content validity of existing patient-reported pain items for patients with HCC. METHODS Semi-structured interviews to elicit symptoms, side effects and concerns were conducted with ten patients with HCC. Symptom and side effect importance was ranked on a 0 to 10 scale. Patients completed pain items from the Functional Assessment of Cancer Therapy--Hepatocellular (FACT-Hep) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire--Hepatocellular-18 (EORTC QLQ-HCC18). RESULTS Mean age was 58 years (range 33-77). Spontaneously reported symptoms included fatigue (n = 5), diarrhea (n = 5), skin toxicities (n = 5), and loss of appetite (n = 4). Upon questioning, nine of ten patients reported experiencing pain over the course of their treatment. Over half of the importance rankings given for pain were 8 or higher on a 0 to 10 scale. Abdomen (n = 7) and lower back (n = 3) were the most common sites of pain. Pain onset varied from 6 months pre-diagnosis to over 2 years post-diagnosis. All patients indicated that FACT-Hep and EORTC items adequately assessed their pain. CONCLUSIONS Results support the content validity of FACT-Hep pain items for patients with HCC. The finding that patients typically did not spontaneously report pain but often ranked it as very important for their HRQOL upon questioning suggests a need for systematic, routine pain and other symptom assessment and management as an integral component of patient care in advanced HCC.
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Butt Z, Parikh ND, Beaumont JL, Rosenbloom SK, Syrjala KL, Abernethy AP, Benson AB, Cella D. Development and validation of a symptom index for advanced hepatobiliary and pancreatic cancers: the National Comprehensive Cancer Network Functional Assessment of Cancer Therapy (NCCN-FACT) Hepatobiliary-Pancreatic Symptom Index (NFHSI). Cancer 2012; 118:5997-6004. [PMID: 22605658 PMCID: PMC3424375 DOI: 10.1002/cncr.27588] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 03/13/2012] [Indexed: 01/16/2023]
Abstract
BACKGROUND The 45-item Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) questionnaire assesses health-related quality of life in patients with liver, bile duct, and pancreatic cancers. Although the FACT-Hep was initially derived from patient input, this study's researchers sought to verify adequate coverage of items by soliciting open-ended input from patients with advanced disease. METHODS As part of a larger study in collaboration with the National Comprehensive Cancer Network (NCCN), 50 people (60% male, 80% caucasian, average age 60.4 years) with stage 3 or 4 hepatobiliary or pancreatic cancer were recruited. Participants generated and ranked up to 10 important symptoms and concerns that physicians should monitor when assessing the value of chemotherapy. Patients were also able to provide open-ended, qualitative information that was evaluated systematically. Ten expert physicians also provided input on priority symptoms. RESULTS The resulting 18-item NCCN-FACT Hepatobiliary-Pancreatic Symptom Index (NFHSI-18) demonstrated high internal consistency (α = .89) and moderate to strong correlations with measures of physical well-being (ρ = .76), emotional well-being (ρ = 0.52), and functional well-being (ρ = 0.57). Scores on the NFHSI-18 were also highly correlated with the original hepatobiliary scale of the FACT-Hep (ρ = .82; all P < .001). Compared with patients with better performance status, patients with poor performance status had worse NFHSI-18 symptom scores, F(3,47) = 9.74; P = .0003. CONCLUSIONS The NFHSI-18 assesses symptoms of importance to patients with hepatobiliary and pancreatic cancers and demonstrates promising measurement properties. The scale is a good candidate for brief symptom assessment in clinical trials.
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Affiliation(s)
- Zeeshan Butt
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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