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Kashyap K, Singh V, Dwivedi SN, Gielen J, Bhatnagar S. Scrambler Therapy Enhances Quality of Life in Cancer Patients in a Palliative Care Setting: A Randomised Controlled Trial. Indian J Palliat Care 2022; 28:287-294. [PMID: 36072252 PMCID: PMC9443118 DOI: 10.25259/ijpc_94_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 04/03/2022] [Indexed: 12/04/2022] Open
Abstract
Objectives: Given the known side effects of opioids and the negative impact of these side effects on quality of life (QOL), there is a need for therapies that can reduce opioid intake and improve QOL in patients suffering from cancer pain. Scrambler therapy (ST) is a neuromodulatory therapy that has been shown to reduce cancer pain, but its effect on QOL is not well understood. This study intended to evaluate the efficacy of ST for enhancing QOL in cancer patients through minimising pain and opioid intake. Material and Methods: This was a randomised controlled trial including 80 patients with head, neck and thoracic cancer. In both arms, patients were given pain management drugs following the WHO analgesic ladder for ten consecutive days. In the intervention arm each day ST was given. Pain, morphine intake, and QOL (WHOQOL-BREF) were assessed. Results: All domains of QOL improved significantly in the intervention arm in comparison to the control arm. In comparison to baseline, pain improved in both the intervention and the control arm on day 10 and at follow-up. However, QOL significantly improved in the intervention arm, while morphine intake decreased. In the control arm, QOL deteriorated, while morphine intake increased. Conclusion: ST significantly improved QOL. Since the increase in QOL took place along with a significantly lower morphine intake, the improvement in QOL may not only be explained by lower pain scores but, also, by a reduced intake of morphine, because the lower dosages of morphine will decrease the likelihood of side effects associated with the drug.
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Affiliation(s)
- Komal Kashyap
- Department of Oncoanaesthesia and Palliative Medicine, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India,
| | - Vishwajeet Singh
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India,
| | - Sada Nand Dwivedi
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India,
| | - Joris Gielen
- Center for Global Health Ethics, Duquesne University, Pittsburgh, Pennsylvania, United States,
| | - Sushma Bhatnagar
- Department of Oncoanaesthesia and Palliative Medicine, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India,
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Gielen J, Kashyap K, Singh SP, Bhatnagar S, Chaturvedi SK. Psychometric Assessment of SpiDiscI: Spiritual Distress Scale for Palliative Care Patients in India. Indian J Palliat Care 2022; 28:13-20. [PMID: 35673385 PMCID: PMC9165459 DOI: 10.25259/ijpc_50_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 01/09/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives: Spirituality has an impact on the quality of life of palliative care patients and it influences the way in which they experience their disease. Spiritual distress is a common issue among palliative care patients in India that is best assessed through a tool specifically designed for them. This study presents the findings of a psychometric assessment of SpiDiscI: a 16-item spiritual distress scale for Hindi speaking palliative care patients in India. Materials and Methods: This study used a non-experimental cross-sectional sample survey design. 400 cancer patients undergoing pain treatment at the pain and palliative care unit of a tertiary cancer hospital in New Delhi enrolled in the study and completed the study’s questionnaire. The questionnaire contained a section on demographic information, a numerical rating scale (NRS) for pain, SpiDiscI, FACIT-Sp-12, and WHOQOL-BREF. A subset of 50 patients with stable pain completed SpiDiscI a 2nd time 2 weeks after the first administration of the scale to assess test-retest reliability. Results: The scale’s internal consistency is very good (Cronbach’s Alpha 0.85). Spiritual distress scores ranged from 0 to 93.8 (mean 37.1, SD 23.6). Significant negative correlations between SpiDiScI and both FACIT-Sp-12 (R = –0.16, P = 0.001) and WHOQOL-BREF (R = –0.27, P < 0.001) confirmed convergent validity. There was no significant association with NRS pain scores (R = 0.06, P = 0.224). The highly significant association (R = 0.75, P < 0.001) of the scores on assessments 2 weeks apart confirmed test-retest reliability. Conclusion: SpiDiScI is a reliable and valid measure to assess spiritual distress in research among Hindi speaking palliative care patients in India.
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Affiliation(s)
- Joris Gielen
- Center for Global Health Ethics, Duquesne University, Pitsburgh, PA, United States,
| | - Komal Kashyap
- Department of Onco-anesthesia and Palliative Medicine, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India,
| | - Suraj Pal Singh
- Department of Onco-anesthesia and Palliative Medicine, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India,
| | - Sushma Bhatnagar
- Department of Onco-anesthesia and Palliative Medicine, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India,
| | - Santosh K. Chaturvedi
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India,
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Kao YL, Ou CH, Lin SH, Chang SM, Wang JD, Tsai YS. Dynamic Changes of Generic Quality of Life after Different Treatments for Localized Prostate Cancer. J Clin Med 2021; 10:jcm10010158. [PMID: 33466363 PMCID: PMC7795146 DOI: 10.3390/jcm10010158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 11/24/2022] Open
Abstract
Generic quality of life (QoL) is an important issue in decision making related to the primary treatment of localized prostate cancer (PC). This study assessed the dynamic changes of QoL in patients with localized PC under different treatment modalities. From 2013 to 2018, we prospectively assessed QoL scores in patients with localized PC under unitary treatment using the World Health Organization Quality of Life (WHOQOL) BREF version. The trajectories of the QoL scores after different treatments were estimated using a kernel-smoothing method. Dynamic changes in the major determinants were analyzed using a mixed effects model. The clinical features of the participants in our institute were compared with PC patients in Taiwan’s cancer registry. A total of 196 patients were enrolled with 491 repeated assessments. The participants shared similar clinical characteristics with the PC patients in Taiwan as a whole. Patients with lower household incomes showed statistically significant lower scores on all four domains and related facets, while PC survivors with comorbidities of anxiety and/or diabetes appeared to be affected on the physical domain and related facets. After controlling for these determinants, patients under active surveillance or observation demonstrated significantly higher QoL scores in the physical and social domains, as well as several facets belonging to these domains, in mixed models compared with patients undergoing radical prostatectomy or radiotherapy within the first year. The generic QoL scores were higher within the first year in patients receiving active surveillance or observation after controlling other significant factors. The difference diminished after one year of post management. More studies are needed to corroborate our findings.
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Affiliation(s)
- Yao-Lin Kao
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-L.K.); (C.-H.O.)
| | - Chien-Hui Ou
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-L.K.); (C.-H.O.)
| | - Sheng-Hsiang Lin
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Sheng-Mao Chang
- Department of Statistics, National Cheng Kung University, Tainan 701, Taiwan;
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Yuh-Shyan Tsai
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-L.K.); (C.-H.O.)
- Correspondence: ; Tel.: +886-6-235-3535 (ext. 5251); Fax: +886-6-238-3678
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Chung CH, Hu TH, Wang JD, Hwang JS. Estimation of Quality-Adjusted Life Expectancy of Patients With Oral Cancer: Integration of Lifetime Survival With Repeated Quality-of-Life Measurements. Value Health Reg Issues 2019; 21:59-65. [PMID: 31655464 DOI: 10.1016/j.vhri.2019.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 06/05/2019] [Accepted: 07/23/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Quality-adjusted life year is widely applied nowadays, which consider both survival and quality of life (QoL). When most diseases are becoming chronic, it is imperative to quantify the overall health impact of a disease in lifetime perspective. OBJECTIVE The purpose of this study is to introduce methods for estimating quality-adjusted life expectancy (QALE) and loss of QALE in patients with a disease or specific conditions. METHODS The QALE of an index cohort can be represented as the integration of the product of lifetime survival function and mean QoL function. We introduce a robust extrapolation approach for estimating lifetime survival function and propose an approach for estimating lifetime mean QoL function for studies with limited follow-up. The best part of the proposed method is that the survival data and QoL data can be collected separately. A cohort of patients with a specific condition can be identified by databases that regularly collect data for the control of diseases, and their survival status is verified by linking to a mortality registry. Although nationwide QoL data are not available, researchers can implement a relative short-term follow-up interview on a random sample of patients to collect QoL data. For demonstration, we applied the proposed methods to estimate QALE and loss of QALE of oral cancer patients. RESULTS The estimates (95% confidence interval) of QALE for oral cancer patients were 11.0 (10.5-11.6) and 14.2 (12.7-15.5) quality-adjusted life years (QALYs) for men and women, respectively. The estimates of loss of QALE for the male and female patients with oral cancer were 14.4 (13.8-14.9) and 7.5 (6.2-9.0) QALYs, respectively. CONCLUSIONS The methods for estimating QALE and loss of QALE can be applied to economic evaluation of cancer control, including screening.
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Affiliation(s)
- Chia-Hua Chung
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Tsuey-Hwa Hu
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
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Zhang W, Wei Y, Yu D, Xu J, Peng J. Gefitinib provides similar effectiveness and improved safety than erlotinib for east Asian populations with advanced non-small cell lung cancer: a meta-analysis. BMC Cancer 2018; 18:780. [PMID: 30068310 PMCID: PMC6090934 DOI: 10.1186/s12885-018-4685-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/22/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The first-generation epidermal growth factor receptor tyrosine kinase inhibitors gefitinib and erlotinib have both been proven effective for treating advanced non-small cell lung cancer (NSCLC), especially in East Asian patients. We conducted this meta-analysis to compare their efficacy and safety in treating advanced NSCLC in this population. METHODS We systematically searched PubMed, ScienceDirect, The Cochrane Library, Scopus, Ovid MEDLINE, Embase, Web of Science, and Google Scholar for the relevant studies. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and adverse effects (AEs) were analyzed as primary endpoints. RESULTS We identified 5829 articles, among which 31 were included in the final analysis. Both gefitinib and erlotinib were effective for treating advanced NSCLC, with comparable PFS (95% confidence interval [CI]: 0.97-1.10, p = 0.26), OS (95% CI: 0.89-1.21, p = 0.61), ORR (95% CI: 1.00-1.18, p = 0.06), and DCR (95% CI: 0.93-1.05, p = 0.68). Erlotinib induced a significantly higher rate of dose reduction (95% CI: 0.13-0.65, p = 0.002) and grade 3-5 AEs (95% CI: 0.27-0.71, p = 0.0008). In subgroup analysis of AEs, the erlotinib group had a significantly higher rate and severity of skin rash, nausea/vomiting, diarrhea, fatigue and stomatitis. CONCLUSIONS With equal anti-tumor efficacy and fewer AEs compared with erlotinib, gefitinib is more suitable for treating advanced NSCLC in East Asian patients. Further large-scale, well-designed randomized controlled trials are warranted to confirm our findings.
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Affiliation(s)
- Wenxiong Zhang
- Department of thoracic surgery, The second affiliated hospital of Nanchang University, 1 Min De Road, Nanchang, 330006 China
| | - Yiping Wei
- Department of thoracic surgery, The second affiliated hospital of Nanchang University, 1 Min De Road, Nanchang, 330006 China
| | - Dongliang Yu
- Department of thoracic surgery, The second affiliated hospital of Nanchang University, 1 Min De Road, Nanchang, 330006 China
| | - Jianjun Xu
- Department of thoracic surgery, The second affiliated hospital of Nanchang University, 1 Min De Road, Nanchang, 330006 China
| | - Jinhua Peng
- Department of thoracic surgery, The second affiliated hospital of Nanchang University, 1 Min De Road, Nanchang, 330006 China
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Zhang W, Wei Y, Yu D, Xu J, Peng J. Gefitinib provides similar effectiveness and improved safety than erlotinib for advanced non-small cell lung cancer: A meta-analysis. Medicine (Baltimore) 2018; 97:e0460. [PMID: 29668619 PMCID: PMC5916648 DOI: 10.1097/md.0000000000010460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The epidermal growth factor receptor tyrosine kinase inhibitors gefitinib and erlotinib are effective for advanced non-small cell lung cancer (NSCLC). This meta-analysis compared their effectiveness and safety. METHODS We searched systematically in PubMed, ScienceDirect, The Cochrane Library, Scopus, Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar for relevant clinical trials regarding gefitinib versus erlotinib for NSCLC. Antitumor effectiveness (overall survival [OS], progression-free survival [PFS], objective response rate [ORR] and disease control rate [DCR]) and adverse effects [AEs]) were assessed. RESULTS Forty studies comprising 9376 participants were included. The results suggested that gefitinib and erlotinib are effective for advanced NSCLC with comparable PFS (95% confidence intervals [CI]: 0.98-1.11, P = .15), OS (95% CI: 0.93-1.19, P = .45), ORR (95% CI: 0.99-1.16, P = .07), and DCR (95% CI: 0.92-1.03, P = .35). For erlotinib, dose reduction was significantly more frequent (95% CI: 0.10-0.57, P = .001) as were grade 3 to 5 AEs (95% CI: 0.36-0.79, P = .002). In the subgroup analysis, the erlotinib group had a significant higher rate and severity of skin rash, nausea/vomiting, fatigue, and stomatitis. CONCLUSIONS Gefitinib was proven to be the better choice for advanced NSCLC, with equal antitumor effectiveness and fewer AEs compared with erlotinib. Further large-scale, well-designed randomized controlled trials are warranted to confirm our validation.
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Yang SC, Lin CC, Lai WW, Chang SM, Hwang JS, Su WC, Wang JD. Dynamic changes in quality of life after three first-line therapies for EGFR mutation-positive advanced non-small-cell lung cancer. Ther Adv Med Oncol 2018; 10:1758834018755072. [PMID: 29434678 PMCID: PMC5802707 DOI: 10.1177/1758834018755072] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 12/01/2017] [Indexed: 12/28/2022] Open
Abstract
Background Three different tyrosine kinase inhibitors have been approved as first-line therapies for epidermal growth factor receptor (EGFR) mutation-positive advanced non-small-cell lung cancer with similar overall survival. This study determined dynamic changes in quality of life (QoL) for patients using these therapies after controlling for potential confounders. Methods From 2011 to 2016, we prospectively assessed the utility values and QoL scores of patients using the EuroQol five-dimension and World Health Organization Quality-of-Life - Brief questionnaires. QoL functions after initiation of treatment were estimated using a kernel-smoothing method. Dynamic changes in major determinants were repeatedly assessed for constructing mixed models. Results A total of 344 patients were enrolled, with 934 repeated assessments. After controlling for performance status, disease progression, EGFR mutation subtype and other confounders, the mixed models showed significantly lower QoL scores for afatinib versus gefitinib in the physical, psychological and social domains, and 10 facets. The differences seemed to appear 10 months after initiation of treatment. In contrast, there was no significant difference between erlotinib and gefitinib in the scores of all domains and facets. Conclusion QoL in patients receiving afatinib seemed to be lower than in those receiving gefitinib. Since the sample sizes in this study were relatively small, more studies are warranted to corroborate these results.
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Affiliation(s)
- Szu-Chun Yang
- Department of Internal Medicine, National Cheng Kung University Hospital and Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Chung Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wu-Wei Lai
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Mao Chang
- Department of Statistics, College of Management, National Cheng Kung University, Tainan, Taiwan
| | | | - Wu-Chou Su
- Department of Internal Medicine, National Cheng Kung University Hospital, 138 Sheng-Li Road, Tainan 704, Taiwan
| | - Jung-Der Wang
- Department of Internal Medicine, National Cheng Kung University Hospital and Department of Public Health, College of Medicine, National Cheng Kung University, 1 University Road, Tainan 701, Taiwan
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Abstract
PURPOSE Occupational injuries have considerable impact on workers' lives. However, data regarding workers' health-related quality of life (HRQOL) at several years after the injury are lacking. This study assessed workers' HRQOL at 6 years after occupational injury and determined related factors in each HRQOL domain. METHODS Workers who sustained an occupational injury in 2009 and who responded to a previous survey at 3 or 12 months after their injury were followed up in 2015. A total of 1715 participants were candidates for this study. The Taiwanese version of the World Health Organization Quality of Life scale-abbreviated version (WHOQOL-BREF) was used to assess their HRQOL. Multiple linear regression analysis identified predictive factors for HRQOL at 6 years after occupational injury. RESULTS A total of 563 workers completed the questionnaire (response rate, 32.8%). Adverse life events and additional severe occupational injuries that occurred within the follow-up period, and decreased salary after the injury were significant factors for low scores in all domains of the WHOQOL-BREF. In addition, unmarried participants had low scores in the social relationship domain. Workers with family members requiring care scored low in the physical and environment domains. Workers whose injuries had major effects on their physical appearance had low scores in the physical and psychological domains. Workers with unstable employment had low scores in physical, psychological, and environment domains. CONCLUSION At 6 years after occupational injury, workers' HRQOL was poor among those whose salaries decreased after the injury, after adjustment for other factors.
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Verleye L, De Gendt C, Vrijens F, Schillemans V, Camberlin C, Silversmit G, Stordeur S, Van Eycken E, Dubois C, Robays J, Wauters I, Van Meerbeeck JP. Patterns of care for non-small cell lung cancer patients in Belgium: A population-based study. Eur J Cancer Care (Engl) 2017; 27. [PMID: 28833865 DOI: 10.1111/ecc.12747] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2017] [Indexed: 12/25/2022]
Abstract
Guidelines recommend surgery for Stage I-II, chemoradiation for Stage III and systemic therapy for Stage IV non-small cell lung cancer (NSCLC). However, patient related factors and patient preferences influence treatment decisions. We investigated patterns of care for Belgian NSCLC patients in 2010-2011, based on population-based data from the Belgian Cancer Registry and administrative databases. The relationship between patient characteristics, institutional diagnostic volume, type of treatment and survival was investigated. Overall, 20.8% of patients received no oncological treatment. 59% and 22.1% of Stage I-II patients received primary surgery or (chemo)radiation respectively. 34% of Stage III patients received chemoradiation and 17% of Stage IIIA patients had surgery. 70% of Stage IV patients received chemotherapy or targeted therapy. Moderate variability between centres was observed. For Stage IV, systemic therapy was less frequently used in higher volume centres and 1-year survival was lower in centres that had ≥ 50 new patients yearly. Although not all NSCLC patients received treatment as ideally recommended by guidelines, these results do not necessarily represent poor quality of care as patient characteristics and preferences need to be taken into account. Treatment options targeted towards patients with co-morbidity or unfit patients is warranted to improve outcomes of all NSCLC patients.
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Affiliation(s)
- L Verleye
- KCE - Belgian Health Care Knowledge Centre, Brussels, Belgium
| | - C De Gendt
- Belgian Cancer Registry, Brussels, Belgium
| | - F Vrijens
- KCE - Belgian Health Care Knowledge Centre, Brussels, Belgium
| | | | - C Camberlin
- KCE - Belgian Health Care Knowledge Centre, Brussels, Belgium
| | | | - S Stordeur
- KCE - Belgian Health Care Knowledge Centre, Brussels, Belgium
| | | | - C Dubois
- KCE - Belgian Health Care Knowledge Centre, Brussels, Belgium
| | - J Robays
- KCE - Belgian Health Care Knowledge Centre, Brussels, Belgium
| | - I Wauters
- Department of Respiratory Medicine, University Hospitals KU Leuven, Leuven, Belgium
| | - J P Van Meerbeeck
- Center for Oncological Research, University of Antwerp, Antwerp University Hospital, Antwerp Edegem, Belgium.,Thoraic Oncology, Antwerp University Hospital, Edegem, Belgium
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Chang CY, Lee LJH, Wang JD, Lee CT, Tai CM, Tang TQ, Lin JT. Health-related quality of life in patients with Barrett's esophagus. Health Qual Life Outcomes 2016; 14:158. [PMID: 27842547 PMCID: PMC5109675 DOI: 10.1186/s12955-016-0551-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 10/12/2016] [Indexed: 01/01/2023] Open
Abstract
Background Gastroesophageal reflux disease (GERD) has become a major health problem globally, affecting patients’ health-related quality of life (HRQOL). Barrett’s esophagus (BE) is a precancerous lesion associated with GERD. BE patients might not only suffer from HRQOL losses by GERD but also face psychological distress due to the increased risk of developing cancer. However, the majority of patients in Asia have shorter BE segment which is different from the West. This study aimed to determine whether the HRQOL in BE patients were worse than in healthy referents in Taiwan. Methods Patients who received referral esophagogastroduodenoscopy for various symptoms were evaluated for the existence of BE. Lesions were judged as endoscopically suspected esophageal metaplasia (ESEM) if they showed morphological resemblances to BE by endoscopy. The diagnosis of BE was confirmed by histology with intestinal metaplasia or gastric metaplasia based on the Montreal definition. The World Health Organization Quality of Life (WHOQOL-BREF) was administered to BE patients before treatment. For each BE patient, we selected 2 age-, sex-, educational background and municipality-matched healthy referents, sampled by simple randomization method from a national survey in Taiwan. Multiple linear regression models were constructed to control the potential confounders. Results A total of 84 patients diagnosed with BE were enrolled as BE group and then compared with 168 healthy referents. The BE group had significantly lower WHOQOL-BREF scores than those of healthy referents in the physical domain (P < 0.05) but higher scores in the environment domain (P < 0.05). In the physical domain, the BE group had significantly lower scores in various facets, including pain, discomfort, sleep and rest and dependence on medications or treatments. There was no significant difference in social and psychological domains between the BE group and healthy referents. Conclusions BE patients suffer from poor sleep and rest and high dependence on medications, which significantly reduce their quality of life. Individual facets of each domain warrants a better clinical healthcare to improve quality of life of BE patients.
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Affiliation(s)
- Chi-Yang Chang
- Department of Internal Medicine, E-Da Hospital, I-Shou University, No.1, Yi-Da Rd., Kaohsiung, 824, Taiwan.,School of Medicine and Big Data Research Centre, Fu Jen Catholic University, No.510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City, 24205, Taiwan
| | - Lukas Jyuhn-Hsiarn Lee
- National Health Research Institutes, National Institute of Environmental Health Sciences, No.35, Keyan Rd., Zhunan Township, Miaoli County, 35053, Taiwan.,Department of Environmental and Occupational Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Taipei, 10002, Taiwan.,Department of Neurology, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Taipei, 10002, Taiwan.,Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, No.7, Chung Shan S. Rd., Taipei, 10002, Taiwan
| | - Jung-Der Wang
- Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 1, University Rd., Tainan, Taiwan.,Department of Internal Medicine, National Cheng Kung University Hospital, No. 1, University Rd., Tainan, Taiwan.,Department of Environmental and Occupational Medicine, National Cheng Kung University Hospital, No. 1, University Rd., Tainan, Taiwan
| | - Ching-Tai Lee
- Department of Internal Medicine, E-Da Hospital, I-Shou University, No.1, Yi-Da Rd., Kaohsiung, 824, Taiwan
| | - Chi-Ming Tai
- Department of Internal Medicine, E-Da Hospital, I-Shou University, No.1, Yi-Da Rd., Kaohsiung, 824, Taiwan
| | - Tao-Qian Tang
- Department of Internal Medicine, E-Da Hospital, I-Shou University, No.1, Yi-Da Rd., Kaohsiung, 824, Taiwan
| | - Jaw-Town Lin
- School of Medicine, Fu Jen Catholic University, No.510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City, 24205, Taiwan.
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Shinde R, Cao X, Kothari S. Biopsy Procedures and Molecular Testing Utilization and Related Costs in Patients with Metastatic Lung Cancer. J Manag Care Spec Pharm 2016; 22:1194-203. [PMID: 27668568 PMCID: PMC10397943 DOI: 10.18553/jmcp.2016.15404] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) gene mutations and anaplastic lymphoma kinase (ALK) gene rearrangements are key therapeutic targets for biomarker-driven treatment with an EGFR or ALK tyrosine kinase inhibitor (TKI) in patients with metastatic non-small cell lung cancer (NSCLC). To appropriately guide treatment decisions, since 2011, the National Comprehensive Cancer Network and the American Society of Clinical Oncology therefore recommend EGFR and ALK analysis in tumor samples obtained at the time of diagnosis in patients with non-squamous NSCLC. Currently, there are limited data on utilization patterns and cost of biopsy procedures and biomarker tests in patients with metastatic NSCLC who receive an EGFR or ALK TKI. OBJECTIVES To (a) describe utilization patterns and costs associated with biopsy procedures and biomarker testing in patients with NSCLC who received erlotinib or crizotinib between 2009 and 2012 and (b) investigate the timing of these procedures relative to the erlotinib or crizotinib index date. METHODS Adult patients with metastatic lung cancer were identified by ICD-9-CM diagnostic codes within the Truven Health Analytic MarketScan database. Patients were included in the analysis if they had an index erlotinib or crizotinib claim between January 1, 2009, and September 30, 2012 (index period) and were continuously enrolled for ≥ 12 months before the index claim. Because there is no specific ICD-9-CM diagnostic code for NSCLC, patients with metastatic lung cancer who received erlotinib or crizotinib were considered to have metastatic NSCLC. Using CPT and ICD-9-CM codes, lung biopsy procedures performed during the 24 months before or 12 months after the index claim date were identified. For every patient, biomarker testing claims for EGFR and ALK were identified using the molecular pathology stacked CPT code during the 2 months before or 1 month after the index date. The frequency of claims for biopsy procedures and biomarker testing was analyzed descriptively. The overall summary measures for biomarker testing, especially frequency of EGFR testing in patients receiving erlotinib, was also described as before and after 2011, the year when biomarker testing became part of the guidelines. Per patient and overall costs for biopsy procedures and biomarker testing were calculated from payer and patient perspectives. RESULTS Of the 4,926 identified patients, 4,801 (97.5%) received erlotinib, and 125 (2.5%) received crizotinib. Biopsy procedure claims were identified for 3,579 (72.7%) patients, including 3,503 (73.0%) erlotinib recipients and 76 (60.8%) crizotinib recipients. Biomarker testing claims were identified for 675 (13.7%) patients, including 634 (13.2%) erlotinib recipients and 41 (32.8%) crizotinib recipients. Overall, most biomarker testing procedures (476 of 741) were identified in 435 (of 675) patients after year 2011. Also, among erlotinib recipients, percentage of patients receiving EGFR testing was increased over the index period. Per patient mean (SD) numbers of biopsy procedures and biomarker tests were 1.2 (1.1) and 0.2 (0.4), respectively. In the outpatient setting, per patient mean (SD) cost per biopsy procedure was $1,223 ($1,899) from the payer perspective and $60 ($147) from the patient perspective, whereas in the inpatient setting, it was $8,163 ($18,712) and $180 ($691), respectively. Among patients receiving at least 1 biomarker test, the per patient mean (SD) cost for the overall population was $891 ($1,062) and $43 ($229); for erlotinib recipients, it was $906 ($1,084) and $42 ($228); and for crizotinib recipients, it was $664 ($576) and $55 ($243) in payer and patient perspectives, respectively. CONCLUSIONS This study provides insight into the use and cost of biopsy and biomarker testing procedures in patients with metastatic NSCLC. The low frequency of biomarker testing highlights the need for more awareness of testing to guide treatment decisions in these patients. Costs associated with biopsy procedures and biomarker testing provide insight into the economic impact on metastatic NSCLC patients treated with targeted therapy. DISCLOSURES This study was sponsored by Merck & Co. Shinde is a study manager working for Merck under contract with AllSourcePPS, an Agile 1 company in Huntington Beach, California. Cao and Kothari are employees of Merck & Co., Kenilworth, New Jersey. Study concept and design were contributed primarily by Shinde and Kothari. Data analysis was performed by Cao. Data interpretation was performed by Shinde, Cao, and Kothari. Shinde wrote the manuscript with assistance from Cao and Kothari. The revision was completed primarily by Shinde and Kothari.
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