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Mueller S, Kline C, Franson A, van der Lugt J, Prados M, Waszak SM, Plasschaert SLA, Molinaro AM, Koschmann C, Nazarian J. Rational combination platform trial design for children and young adults with diffuse midline glioma: A report from PNOC. Neuro Oncol 2024; 26:S125-S135. [PMID: 38124481 PMCID: PMC11066905 DOI: 10.1093/neuonc/noad181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Indexed: 12/23/2023] Open
Abstract
Background Diffuse midline glioma (DMG) is a devastating pediatric brain tumor unresponsive to hundreds of clinical trials. Approximately 80% of DMGs harbor H3K27M oncohistones, which reprogram the epigenome to increase the metabolic profile of the tumor cells. Methods We have previously shown preclinical efficacy of targeting both oxidative phosphorylation and glycolysis through treatment with ONC201, which activates the mitochondrial protease ClpP, and paxalisib, which inhibits PI3K/mTOR, respectively. Results ONC201 and paxalisib combination treatment aimed at inducing metabolic distress led to the design of the first DMG-specific platform trial PNOC022 (NCT05009992). Conclusions Here, we expand on the PNOC022 rationale and discuss various considerations, including liquid biome, microbiome, and genomic biomarkers, quality-of-life endpoints, and novel imaging modalities, such that we offer direction on future clinical trials in DMG.
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Affiliation(s)
- Sabine Mueller
- Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, California, USA
| | - Cassie Kline
- Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Andrea Franson
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Michael Prados
- Department of Neurosurgery and Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Sebastian M Waszak
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
- Laboratory of Computational Neuro-Oncology, Swiss Institute for Experimental Cancer Research, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | | | - Annette M Molinaro
- Division of Biomedical Statistics and Informatics, Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - Carl Koschmann
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Javad Nazarian
- Research Center for Genetic Medicine, Children’s National Health System, Washington, District of Columbia, USA
- Brain Tumor Institute, Children’s National Health System, Washington, District of Columbia, USA
- DMG Research Center, Department of Pediatrics, University Children’s Hospital, University of Zurich, Zürich, Switzerland
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2
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Forbes C, Tanner S, Engstrom T, Lee WR, Patel D, Walker R, Bradford N, Pole JD. Patient Reported Fatigue Among Adolescent and Young Adult Cancer Patients Compared to Non-Cancer Patients: A Systematic Review and Meta-Analysis. J Adolesc Young Adult Oncol 2024; 13:242-250. [PMID: 37902970 DOI: 10.1089/jayao.2023.0094] [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: 11/01/2023] Open
Abstract
Adolescent and young adult (AYA) cancer patients and survivors are a growing population due to more frequent diagnoses and improved survival. Fatigue is a common symptom experienced by cancer patients and it is often missed by health care professionals. Patient reported outcome measures (PROMs) can assist in evaluating patient reported fatigue. This systematic review aims to determine if AYA cancer patients report more fatigue than AYAs who have not been diagnosed with cancer. We used a subset of articles from a larger review that searched PubMed, EMBASE, CINAHL, and PsycINFO to determine which PROMs and domains are currently being used to evaluate AYA cancer. This study identified 175 articles related to PROMs in the AYA cancer population. Articles with PROMs reporting on fatigue/vitality were used in this review. From the original 175 articles, we identified 8 fatigue/vitality articles for this review. All eight articles found an increase in fatigue/decrease in vitality in the AYA cancer population compared to healthy controls. A meta-analysis was performed on four articles that used the same PROM tool (EORTC QLQ-C30). This found a statistically significant and clinically meaningful increase in mean fatigue of 12.5 95% confidence interval: 3.3-21.8 points (scale 0-100, higher number indicates more fatigue) in the AYA cancer group compared to healthy noncancer controls. Fatigue in the AYA cancer population is a significant issue, it is often undetected and underreported, and early interventions are needed to prevent the negative subsequent sequelae.
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Affiliation(s)
- Cheryl Forbes
- Centre for Health Services Research, and The University of Queensland, Herston, Australia
| | - Sarah Tanner
- Centre for Health Services Research, and The University of Queensland, Herston, Australia
| | - Teyl Engstrom
- Centre for Health Services Research, and The University of Queensland, Herston, Australia
| | - Wen Ray Lee
- Centre for Health Services Research, and The University of Queensland, Herston, Australia
| | - Dhaval Patel
- Centre for Health Services Research, and The University of Queensland, Herston, Australia
| | - Rick Walker
- School of Medicine, The University of Queensland, Herston, Australia
- Oncology Service, Queensland Children's Hospital, Brisbane, Australia
- Cancer Care, Princess Alexandra Hospital, Brisbane, Australia
| | - Natalie Bradford
- Cancer and Palliative Care Outcomes Centre at Centre for Children's Health Research, Queensland University of Technology, Brisbane, Australia
| | - Jason D Pole
- Centre for Health Services Research, and The University of Queensland, Herston, Australia
- Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada
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3
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Ford S, Vaughn J, Subramaniam A, Gundala A, Hensley E, Shah N. Supporting data driven translational patient-centered care using network analysis to visualize symptom distress in children with serious illness. J SPEC PEDIATR NURS 2024; 29:e12422. [PMID: 38284219 DOI: 10.1111/jspn.12422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/21/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE There are an increasing number of techniques and tools to improve the capacity for children to relay their perceptions of their symptom experience while undergoing blood and marrow transplant (BMT). Network analysis (NA) is a tool that can illustrate associations between symptoms and the distress they cause. We aimed to develop a biopsychosocial assessment clinical analytic tool to examine symptom relationships for children undergoing BMT to find actionable relationships for intervention to improve clinical outcomes including mood. DESIGN AND METHODS This pilot study used an analytical mobile application tool to support a wide scope of 15 biopsychosocial symptom distress levels and five mood assessments. Children recorded their symptom distress and mood using the app. NA was used to explore relationships between symptom distress and mood. RESULTS Four children, 11-14 years old, undergoing BMT used the app daily during hospitalization. We found a strong presence of emotional distress and its associations symptom distress and mood. Multiple symptom associations were identified including associations between the set of symptoms difficulty breathing and fever (0.557), sad and worried (0.429). Of note, pain distress had a strong capacity to bridge other symptoms and was connected directly to many symptoms. PRACTICE IMPLICATIONS We found the significance of patient struggles with emotional and symptom distress and the importance of this relationship to other clinical outcomes. This provides valuable insights and an improved understanding of the child's symptoms. Our findings support early assessment, intervention, and improved symptom communication to enhance sense of well-being and the child's care experience.
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Affiliation(s)
- Shannon Ford
- School of Nursing, College of Health and Human Services, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Jacqueline Vaughn
- School of Nursing, College of Health and Human Services, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Arvind Subramaniam
- East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
| | - Abhinav Gundala
- North Carolina State University, Raleigh, North Carolina, USA
| | - Elizabeth Hensley
- University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nirmish Shah
- Duke University Medical Center, Durham, North Carolina, USA
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Grinde K, Raybin JL, Ward J, Smith C, Brown R, Montgomery KE. Symptom Adverse Events and Quality of Life of Children With Advanced Cancer: Results From a Longitudinal Study Using the Pediatric Patient-Reported Outcomes-Common Terminology Criteria for Adverse Events. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2024; 41:5-15. [PMID: 37697734 DOI: 10.1177/27527530231168588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Background: The presence of poorly controlled symptoms negatively impacts the quality of life (QoL) throughout cancer treatment. The purpose of this multisite study was to explore the relationship between QoL and symptom adverse events (AEs) in children with advanced cancer over 6 months. Method: A prospective and longitudinal descriptive study design was used to collect QoL and symptom AE data from children aged 2 to 18 with advanced cancer. QoL was measured using the Pediatric Quality of Life Inventory (PedsQLTM) Cancer Module 3.0 and symptom AEs were measured using the Pediatric Patient-Reported Outcome-Common Terminology Criteria for AEs (PRO-CTCAEs®). Descriptive statistics were used to describe QoL and symptom AE data. Correlational analyses and generalized linear mixed models were used to examine the relationship between symptom AEs and QoL. Results: Forty-nine children participated in the study. The mean total PedsQLTM score was 73.86 for the sample across all time points. Children diagnosed with a central nervous system (CNS) tumor reported poorer QoL compared to children diagnosed with a hematologic malignancy or non-CNS solid tumor. Symptom frequency AEs of anxiety, pain, nausea, insomnia, hot flashes, and fatigue severity demonstrated the strongest and most significant negative correlation with total QoL scores. Analyses of the relationship between QoL and symptom AEs over time revealed time-specific significant differences with children who experienced frequency AEs of nausea, and anxiety reporting poorer QoL at time point 4 (week 8). Discussion: The Ped PRO-CTCAE® and PedsQLTM can be used to evaluate the relationship between symptom AEs and QoL in practice and in future research.
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Affiliation(s)
- Krista Grinde
- University of Wisconsin-Madison School of Medicine and Public Health, WI, USA
| | - Jennifer L Raybin
- Schools of Medicine and Nursing, Doernbecher Children's Hospital, Oregon Health & Sciences University, Portland, OR, USA
| | - Jessica Ward
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Corey Smith
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA
| | - Roger Brown
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA
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McKelvey ER, Zelikovksy N, Psihogios AM. Grit and Health-Related Quality of Life in Adolescents and Young Adults with Cancer: Mediating Role of Health Self-Efficacy and Treatment Adherence. J Pediatr Psychol 2023; 48:952-959. [PMID: 37794751 PMCID: PMC10653349 DOI: 10.1093/jpepsy/jsad066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE Challenges with health-related quality of life (HRQOL) are common among adolescents and young adults (AYA) with cancer. Literature on HRQOL has largely been focused on individual deficits, rather than individual strengths. The present study investigated the relations between a strengths-based concept called grit (i.e., perseverance and passion for long-term goals), self-management (i.e., health self-efficacy and adherence), and HRQOL among AYA with cancer. METHODS Sixty-seven AYA receiving cancer treatment (Mage=17.1; 50.7% female; 25.4% Black, Hispanic, Asian, or a race other than white) and their caregivers (73.0% mothers) completed a semistructured, validated interview about adherence. AYA also completed self-report questionnaires about perceptions of their grit, health self-efficacy, and HRQOL. RESULTS After controlling for sex, health self-efficacy (i.e., a cognitive self-management variable) mediated the relation between grit and HRQOL (95% confidence interval = .74-6.52). When testing adherence to medications, diet, or physical activity as mediators of the relation between grit and HRQOL, mediation models were non-significant. CONCLUSIONS Among AYA with cancer, this study identified grit as an individual strength associated with more positive self-management beliefs, which in turn, related to better HRQOL. This adds to a growing body of literature supporting the need for resiliency-oriented, strengths-based approaches to AYA HRQOL research. Future directions include exploring the role of caregiver grit in relation to AYA cancer self-management, given that caregivers have demonstrated a high degree of involvement in AYA cancer care.
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Affiliation(s)
- Elise R McKelvey
- Children’s Hospital of Philadelphia, USA
- La Salle University, USA
| | | | - Alexandra M Psihogios
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, USA
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Levine DR, Epperly R, Collins G, Talleur AC, Mandrell B, Pritchard M, Sarvode Mothi S, Li C, Lu Z, Baker JN. Integration of Palliative Care in Hematopoietic Cell Transplant: Pediatric Patient and Parent Needs and Attitudes. J Pain Symptom Manage 2023; 66:248-257. [PMID: 37302531 DOI: 10.1016/j.jpainsymman.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023]
Abstract
CONTEXT Early integration of palliative care (PC) in hematopoietic cell transplantation (HCT) has demonstrated benefits, yet barriers remain, including perceived lack of patient/caregiver receptivity despite no data on attitudes toward PC and limited patient/caregiver reported outcomes in pediatric HCT. OBJECTIVES This study aimed to evaluate perceived symptom burden and patient/parent attitudes toward early PC integration in pediatric HCT. METHODS Following IRB approval, consent/assent, eligible participants were surveyed at St. Jude Children's Research Hospital including English-speaking patients aged 10-17, 1-month to 1-year from HCT, and their parents/primary-caregivers, as well as parent/primary-caregivers of living HCT recipients RESULTS Eighty one participants, within one year of HCT, at St. Jude Children's Research Hospital were enrolled including: 36 parents of patients CONCLUSION Our findings suggest that patient/family receptivity should not be a barrier to early PC in pediatric HCT; obtaining patient reported outcomes is a priority in the setting of high symptom burden; and robust quality-of-life directed care with early PC integration is both indicated and acceptable to patients/caregivers.
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Affiliation(s)
- Deena R Levine
- Division of Quality-of-life and Palliative Care, Department of Oncology (D.R.L., G.C., J.N.B.), St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Rebecca Epperly
- Department of Bone Marrow Transplantation and Cellular Therapy (R.E., A.C.T.), St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Griffin Collins
- Division of Quality-of-life and Palliative Care, Department of Oncology (D.R.L., G.C., J.N.B.), St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Aimee C Talleur
- Department of Bone Marrow Transplantation and Cellular Therapy (R.E., A.C.T.), St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Belinda Mandrell
- Division of Nursing Research, Department of Pediatric Medicine (B.M., M.P.), St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Michele Pritchard
- Division of Nursing Research, Department of Pediatric Medicine (B.M., M.P.), St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Suraj Sarvode Mothi
- Department of Biostatistics (S.S.M., C.L., Z.L.), St. Jude Children's Research Hospital, Memphis, TN
| | - Chen Li
- Department of Biostatistics (S.S.M., C.L., Z.L.), St. Jude Children's Research Hospital, Memphis, TN
| | - Zhaohua Lu
- Department of Biostatistics (S.S.M., C.L., Z.L.), St. Jude Children's Research Hospital, Memphis, TN
| | - Justin N Baker
- Division of Quality-of-life and Palliative Care, Department of Oncology (D.R.L., G.C., J.N.B.), St. Jude Children's Research Hospital, Memphis, TN, USA
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7
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Merz A, Feifer D, Avery M, Tsuchiyose E, Eche I, Awofeso O, Wolfe J, Dussel V, Requena ML. Patient-Reported Outcome Benefits for Children with Advanced Cancer and Parents: A Qualitative Study. J Pain Symptom Manage 2023; 66:e327-e334. [PMID: 37290730 PMCID: PMC10527560 DOI: 10.1016/j.jpainsymman.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/11/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
CONTEXT Electronic patient-reported outcomes (e-PROs) in pediatric oncology may be useful to track patients' symptoms and quality of life (QoL). However, implementation in the clinical setting is limited and few studies have examined child and parent perspectives on e-PRO usage. OBJECTIVES This brief report aims to explore child and parent perspectives on the benefits of using e-PROs to routinely report on symptoms and QoL. METHODS We analyzed qualitative data embedded within the PediQUEST Response trial, a randomized controlled trial aimed at early palliative care integration for children with advanced cancer and their parents. Study dyads, made up of a child and their parent, completed weekly surveys assessing symptoms and QoL for 18 weeks, and were invited to participate in an audio-recorded exit interview to share study feedback. Interview transcripts were analyzed with a thematic analysis approach, with emergent themes centered on the benefits of e-PRO usage reported here. RESULTS Of 154 total randomized participants, we collected 147 exit interviews representing 105 child participants. Interviewed children (n=47) and parents (n=104) were mostly White and non-Hispanic. Two predominant themes emerged regarding e-PRO benefits:1) raised reflection and awareness of self and others' experiences, and 2) increased communication and connection between parents and children or between study dyads and care teams through survey prompted discussion. CONCLUSION Advanced pediatric cancer patients and their parents found benefit in completing routine e-PROs as they promoted greater reflection and awareness and increased communication. These results may inform further integration of e-PROs in routine pediatric oncology care.
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Affiliation(s)
- Alexandra Merz
- Department of Psychosocial Oncology and Palliative Care (A.M., D.F., E.T., I.E., OA, J.W., M.L.R.), Dana-Farber Cancer Institute, Boston, MA, USA
| | - Deborah Feifer
- Department of Psychosocial Oncology and Palliative Care (A.M., D.F., E.T., I.E., OA, J.W., M.L.R.), Dana-Farber Cancer Institute, Boston, MA, USA
| | - Madeline Avery
- Pediatric Palliative Care, Department of Pediatrics (M.A., J.W., V.D.), Massachusetts General Hospital, Boston, MA, USA
| | - Erika Tsuchiyose
- Department of Psychosocial Oncology and Palliative Care (A.M., D.F., E.T., I.E., OA, J.W., M.L.R.), Dana-Farber Cancer Institute, Boston, MA, USA; Department of Community Health (E.T.), Tufts University, Medford, MA, USA
| | - Ijeoma Eche
- Department of Psychosocial Oncology and Palliative Care (A.M., D.F., E.T., I.E., OA, J.W., M.L.R.), Dana-Farber Cancer Institute, Boston, MA, USA
| | - Opeyemi Awofeso
- Department of Psychosocial Oncology and Palliative Care (A.M., D.F., E.T., I.E., OA, J.W., M.L.R.), Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School (O.A., J.W.), Boston, MA, USA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care (A.M., D.F., E.T., I.E., OA, J.W., M.L.R.), Dana-Farber Cancer Institute, Boston, MA, USA; Pediatric Palliative Care, Department of Pediatrics (M.A., J.W., V.D.), Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School (O.A., J.W.), Boston, MA, USA
| | - Veronica Dussel
- Pediatric Palliative Care, Department of Pediatrics (M.A., J.W., V.D.), Massachusetts General Hospital, Boston, MA, USA.
| | - Maria Laura Requena
- Department of Psychosocial Oncology and Palliative Care (A.M., D.F., E.T., I.E., OA, J.W., M.L.R.), Dana-Farber Cancer Institute, Boston, MA, USA; Center for Research and Implementation in Palliative Care (M.L.R.), Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
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Sasseville M, Supper W, Gartner JB, Layani G, Amil S, Sheffield P, Gagnon MP, Hudon C, Lambert S, Attisso E, Bureau Lagarde V, Breton M, Poitras ME, Pluye P, Roux-Levy PH, Plaisimond J, Bergeron F, Ashcroft R, Wong S, Groulx A, Beaudet N, Paquette JS, D'Anjou N, Langlois S, LeBlanc A. Clinical Integration of Digital Patient-Reported Outcome Measures in Primary Health Care for Chronic Disease Management: Protocol for a Systematic Review. JMIR Res Protoc 2023; 12:e48155. [PMID: 37594780 PMCID: PMC10474503 DOI: 10.2196/48155] [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: 04/13/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Health measurement guides policies and health care decisions are necessary to describe and attain the quintuple aim of improving patient experience, population health, care team well-being, health care costs, and equity. In the primary care setting, patient-reported outcome measurement allows outcome comparisons within and across settings and helps improve the clinical management of patients. However, these digital patient-reported outcome measures (PROMs) are still not adapted to the clinical context of primary health care, which is an indication of the complexity of integrating these tools in this context. We must then gather evidence of their impact on chronic disease management in primary health care and understand the characteristics of effective implementation. OBJECTIVE We will conduct a systematic review to identify and assess the impact of electronic PROMs (ePROMs) implementation in primary health care for chronic disease management. Our specific objectives are to (1) determine the impact of ePROMs in primary health care for chronic disease management and (2) compare and contrast characteristics of effective ePROMs' implementation strategies. METHODS We will conduct a systematic review of the literature in accordance with the guidelines of the Cochrane Methods Group and in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for its reporting. A specific search strategy was developed for relevant databases to identify studies. Two reviewers will independently apply the inclusion criteria using full texts and will extract the data. We will use a 2-phase sequential mixed methods synthesis design by conducting a qualitative synthesis first, and use its results to perform a quantitative synthesis. RESULTS This study was initiated in June 2022 by assembling the research team and the knowledge transfer committee. The preliminary search strategy will be developed and completed in September 2022. The main search strategy, data collection, study selection, and application of inclusion criteria were completed between October and December 2022. CONCLUSIONS Results from this review will help support implementation efforts to accelerate innovations and digital adoption for primary health care and will be relevant for improving clinical management of chronic diseases and health care services and policies. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42022333513; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=333513. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48155.
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Affiliation(s)
- Maxime Sasseville
- Université Laval, Québec, QC, Canada
- VITAM Research Center, Québec, QC, Canada
| | | | | | | | | | | | - Marie-Pierre Gagnon
- Université Laval, Québec, QC, Canada
- VITAM Research Center, Québec, QC, Canada
| | | | - Sylvie Lambert
- Université McGill, Montréal, QC, Canada
- St. Mary's Research Center, Montréal, QC, Canada
| | | | | | | | | | | | | | | | | | | | - Sabrina Wong
- Division of Intramural Research, National Institute of Nursing Research, National Institute of Health, Bethesda, WA, United States
| | | | | | | | | | | | - Annie LeBlanc
- Université Laval, Québec, QC, Canada
- VITAM Research Center, Québec, QC, Canada
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9
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Thornton CP, Perrin N, Kozachik S, Lukkahatai N, Ruble K. Biobehavioral Influences of Stress and Inflammation on Mucositis in Adolescents and Young Adults with Cancer: Results from a Pilot Study. J Adolesc Young Adult Oncol 2023; 12:340-348. [PMID: 36169621 PMCID: PMC10282803 DOI: 10.1089/jayao.2022.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
Purpose: Chemotherapy-induced mucositis is a prevalent and burdensome toxicity among adolescent and young adults (AYAs) with cancer and impedes the delivery of optimal therapy. Its development is not well understood, but baseline stress and inflammation may be contributory factors. This pilot study evaluates stress and inflammation as risk factors for mucositis, identifies effect size estimates, and evaluates the feasibility of a prospective study to investigate mucositis development. Methods: Thirty AYAs receiving chemotherapy with substantial risk of mucositis completed baseline stress measures, and serum was collected for inflammatory biomarker analysis. Regression and mediation analyses determined the relationship between stress/inflammation and mucositis. Results: Stress appears to be a significant risk factor for incidence of mucositis (odds ratio 1.13, p = 0.125) and predicts total mucositis score (β = 0.281, p = 0.023) as well as peak incidence (β = 0.052, p = 0.018). Baseline levels of interleukin (IL)-1a and epidermal growth factor (EGF) predicted mucositis development, and EGF and IL-8 may mediate the relationship between stress and mucositis. Findings suggest that stress-induced inflammation exacerbates symptom development. Conclusion: Results from this pilot study inform mucositis symptom models, suggesting that psychosocial and physiologic factors are involved in development. Importantly, this pilot study provides initial effect size estimates, including magnitude and direction of relationships, that are essential to informing larger, more robustly powered studies. High enrollment, low attrition, and minimal missing data in this study suggest this model is feasible for research in this population. Importantly, this work is a first step in identifying new risk factors for mucositis and targets for nurse-led interventions to prevent toxicity development.
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Affiliation(s)
- Clifton P. Thornton
- Division of Pediatric Hematology/Oncology, Herman and Walter Samuelson Children's Hospital at Sinai, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Nancy Perrin
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Sharon Kozachik
- Medical University of South Carolina College of Nursing, Charleston, South Carolina, USA
| | - Nada Lukkahatai
- Division of Pediatric Hematology/Oncology, Herman and Walter Samuelson Children's Hospital at Sinai, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Kathy Ruble
- Division of Pediatric Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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10
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Cheng L, Reeve BB, Withycombe JS, Jacobs SS, Mack JW, Weaver M, Mann CM, Waldron MK, Maurer SH, Baker JN, Wang J, Hinds PS. Profiles of Symptom Suffering and Functioning in Children and Adolescents Receiving Chemotherapy. Cancer Nurs 2023; 46:E129-E137. [PMID: 35816032 PMCID: PMC9941076 DOI: 10.1097/ncc.0000000000001122] [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: 12/13/2022]
Abstract
BACKGROUND Some children and adolescents receiving chemotherapy experience few symptom-related adverse events, whereas others experience multiple adverse events. If oncology nurses could identify patients likely to have pronounced chemotherapy-related adverse events, tailored supportive care could be matched to these patients' symptom burdens. OBJECTIVE The aim of this study was to identify symptom profiles in children and adolescents before and after chemotherapy, and the sociodemographic and psychological factors associated with profile classification and change. METHODS Participants ranging from 7 to 18 years (n = 436) completed 6 Patient-Reported Outcomes Measurement Information System pediatric symptom measures within 72 hours preceding (T1) and 1 to 2 weeks after (T2) chemotherapy. Profile membership and change were determined by latent profile/latent transition analyses. Associations with profiles and profile transitions were examined using multinomial logit models and logistic regression. RESULTS Three symptom suffering profiles were identified at T1 and T2: high, medium, and low. The high symptom suffering profile included the fewest participants (T1, n = 70; T2, n = 55); the low symptom suffering profile included the most participants (T1, n = 200; T2, n = 207). Of the participants, 57% remained in the same profile from T1 to T2. Psychological stress was significantly associated with T1 and T2 profile classifications and profile transition; age was associated with profile classification at T1. CONCLUSION Three symptom suffering profiles existed in a sample of pediatric patients undergoing chemotherapy, indicating that children and adolescents have differing cancer treatment experiences. IMPLICATIONS FOR PRACTICE Oncology nurses could screen pediatric oncology patients for their symptom suffering profile membership and subsequently prioritize care efforts for those with a high suffering profile.
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Affiliation(s)
- Lei Cheng
- Author Affiliations: School of Nursing, Fudan University (Dr Cheng), Shanghai, China; Departments of Population Health Sciences and Pediatrics, Duke Cancer Institute, Duke University School of Medicine (Dr Reeve and Ms Mann), Durham, North Carolina; School of Nursing, Clemson University (Dr Withycombe), South Carolina; Division of Oncology, Children's National Hospital (Dr Jacobs); and Department of Pediatrics, The George Washington University (Dr Jacobs), Washington, DC; Department of Pediatric Oncology and Center for Population Sciences, Dana-Farber Cancer Institute and Boston Children's Hospital (Dr Mack), Boston, Massachusetts; Division of Pediatric Palliative Care and Division of Pediatric Oncology, Children's Hospital and Medical Center (Dr Weaver), Omaha, Nebraska; Department of Nursing Science, Professional Practice and Quality, Children's National Hospital (Drs Waldron and Hinds); and Department of Pediatrics, The George Washington University (Drs Waldron and Hinds), Washington, DC; Department of Pediatrics, University of Pittsburgh School of Medicine (Dr Mauer); and Division of Palliative Medicine and Supportive Care, UPMC Children's Hospital of Pittsburgh (Dr Mauer), Pennsylvania; Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital (Dr Baker), Memphis, Tennessee; and Division of Biostatistics & Study Methodology, Children's National Hospital (Dr Wang); and The George Washington University School of Medicine and Health Sciences (Dr Wang), Washington, DC
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11
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Ten Considerations for Integrating Patient-Reported Outcomes into Clinical Care for Childhood Cancer Survivors. Cancers (Basel) 2023; 15:cancers15041024. [PMID: 36831370 PMCID: PMC9954048 DOI: 10.3390/cancers15041024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/28/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
Patient-reported outcome measures (PROMs) are subjective assessments of health status or health-related quality of life. In childhood cancer survivors, PROMs can be used to evaluate the adverse effects of cancer treatment and guide cancer survivorship care. However, there are barriers to integrating PROMs into clinical practice, such as constraints in clinical validity, meaningful interpretation, and technology-enabled administration of the measures. This article discusses these barriers and proposes 10 important considerations for appropriate PROM integration into clinical care for choosing the right measure (considering the purpose of using a PROM, health profile vs. health preference approaches, measurement properties), ensuring survivors complete the PROMs (data collection method, data collection frequency, survivor capacity, self- vs. proxy reports), interpreting the results (scoring methods, clinical meaning and interpretability), and selecting a strategy for clinical response (integration into the clinical workflow). An example framework for integrating novel patient-reported outcome (PRO) data collection into the clinical workflow for childhood cancer survivorship care is also discussed. As we continuously improve the clinical validity of PROMs and address implementation barriers, routine PRO assessment and monitoring in pediatric cancer survivorship offer opportunities to facilitate clinical decision making and improve the quality of survivorship care.
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12
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van Gorp M, Grootenhuis MA, Darlington AS, Wakeling S, Jenney M, Merks JHM, Hjalgrim LL, Adams M. Patient Reported Outcomes and Measures in Children with Rhabdomyosarcoma. Cancers (Basel) 2023; 15:cancers15020420. [PMID: 36672371 PMCID: PMC9856469 DOI: 10.3390/cancers15020420] [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: 11/22/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
In addition to optimising survival of children with rhabdomyosarcoma (RMS), more attention is now focused on improving their quality of life (QOL) and reducing symptoms during treatment, palliative care or into long-term survivorship. QOL and ongoing symptoms related to the disease and its treatment are outcomes that should ideally be patient-reported (patient-reported outcomes, PROs) and can be assessed using patient-reported outcome measures (PROMS). This commentary aims to encourage PRO and PROM use in RMS by informing professionals in the field of available PROMs for utilisation in paediatric RMS and provide considerations for future use in research and clinical practice. Despite the importance of using PROMs in research and practice, PROMs have been reported scarcely in paediatric RMS literature so far. Available literature suggests lower QOL of children with RMS compared to general populations and occurrence of disease-specific symptoms, but a lack of an RMS-specific PROM. Ongoing developments in the field include the development of PROMs targeted at children with RMS specifically and expansion of PROM evaluation within clinical trials.
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Affiliation(s)
- Marloes van Gorp
- Princes Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | | | | | - Sara Wakeling
- Founder, Alice’s Arc, Rhabdomyosarcoma Children’s Cancer Charity, London E4 7RW, UK
| | | | | | - Lisa Lyngsie Hjalgrim
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Madeleine Adams
- Children’s Hospital for Wales, Cardiff CF14 4XW, UK
- Correspondence:
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13
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Engstrom T, Tanner S, Lee WR, Forbes C, Walker R, Bradford N, Pole JD. Patient reported outcome measure domains and tools used among adolescents and young adults with cancer: A scoping review. Crit Rev Oncol Hematol 2023; 181:103867. [PMID: 36427770 DOI: 10.1016/j.critrevonc.2022.103867] [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: 09/27/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 11/23/2022] Open
Abstract
Adolescent and young adult (AYA) cancer patients and survivors are growing and face with distinct issues from paediatric and older cancer survivors. Hence it is important the issues they encounter are measured using appropriate Patient Reported Outcome Measures (PROMs). We searched PubMed, EMBASE, CINAHL, and PsycINFO for articles including: (1) AYAs (ages 15-39), (2) Malignant neoplasms, and (3) PROMs. This resulted in 3566 unique articles, 523 were included for full text review, of which 175 were included. These studies included 203 distinct tools to measure PROMs across 31 domains. Physical function was most frequently measured domain, followed by social, emotional and mental health. The most commonly used tools were the EORTC QLQ-C30, HADS and SF-36. PROMs used in AYA cancer patients is a complex topic, this comprehensive review serves as a useful reference for researchers, clinicians and health services who want to better understand, and improve, outcomes among their patients.
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Affiliation(s)
- Teyl Engstrom
- Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
| | - Sarah Tanner
- Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
| | - Wen Ray Lee
- Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
| | - Cheryl Forbes
- Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
| | - Rick Walker
- School of Medicine, The University of Queensland, Herston, QLD, Australia; Queensland Children's Hospital, Brisbane, QLD, Australia; Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Natalie Bradford
- Cancer and Palliative Care Outcomes Centre at Centre for Children's Health Research, Queensland University of Technology, Australia
| | - Jason D Pole
- Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia; The University of Toronto, Dalla Lana School of Public Health, Toronto, ON, Canada.
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14
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Lecci L, Dugan K, Zeiger K, Keith J, Taravath S, Tseh W, Williams M. Validation of an accelerometer-based gait assessment: Establishing test-retest reliability, convergent validity, and predictive validity for concussion symptom endorsement. JOURNAL OF CONCUSSION 2023. [DOI: 10.1177/20597002231157947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Background Gait accelerometer (sensor) technology has proven effective in predicting several medical outcomes, but less is known regarding its prediction of concussion symptoms relative to conventional measures of gait and balance. Objective To establish the reliability and validity of gait accelerometer data. We first examine test-retest reliability and the impact of footwear and walking surfaces on gait. We then examine the convergent validity between gait accelerometer data and the NIH 4-meter gait test. Finally, we compare gait accelerometer data to gait speed and balance measures for predicting concussion symptoms. Methods Study 1 used a crossover study design with 60 participants to evaluate retest reliability and examine the effects of footwear (shoes/no-shoes) and walking surface (tile floor/grass) on gait accelerometer data. Study 2 employed a cross-sectional design with 1008 participants to assess gait accelerometer correlations with NIH 4-meter gait and the prediction of Centers for Disease Control and Prevention (CDC) concussion symptoms relative to previously validated gait and balance measures. Results Retest reliability (4-day average retest interval) for the no shoes/tile surface condition ranged from .72-.91 (mean = .80). Significant effects of footwear and especially walking surface revealed by Analysis of Variances (ANOVAs) on gait accelerometer data for the power, stride, balance, and symmetry domains indicate the need to standardize these variables. Gait accelerometer data correlates significantly with NIH 4-meter gait scores. Regression analyses found that gait accelerometer data predicts CDC concussion symptom endorsement, outperforming the BESS and NIH 4-meter gait at least three-fold. Conclusions When standardized on footwear and walking surface, gait accelerometers achieve strong test-retest reliability, converge with established measures of gait speed, and are superior to established measures of gait speed and balance when predicting concussion symptoms. Gait accelerometers represent a rapid tool for collecting additional gait information to quantify the behavioral sequelae of concussion and potentially inform return-to-play decision-making.
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Affiliation(s)
- Len Lecci
- Department of Psychology, University of North Carolina Wilmington (UNCW), Wilmington, USA
| | | | | | - Julian Keith
- Department of Psychology, University of North Carolina Wilmington (UNCW), Wilmington, USA
| | | | - Wayland Tseh
- Department of Psychology, University of North Carolina Wilmington (UNCW), Wilmington, USA
| | - Mark Williams
- New Hanover Regional Medical Center (now Novant), Wilmington, USA
- University of North Carolina Chapel Hill, Chapel Hill, USA
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15
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Bradford N, Slater P, Fielden P, Condon P, Skrabal Ross X, Douglas M, Radford C, Carter A, Walker R, Badat A, Edwards R, Spencer B, Herbert A. Care at Your Fingertips: Codesign, Development, and Evaluation of the Oncology Hub App for Remote Symptom Management in Pediatric Oncology. JCO Clin Cancer Inform 2023; 7:e2200134. [PMID: 36706346 DOI: 10.1200/cci.22.00134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To codesign, develop, and evaluate a smartphone app that includes patient-reported measures of symptoms and real-time advice in children's cancer. METHODS The Oncology Hub is a comprehensive approach to symptom management that includes a suite of codesigned tools and resources including clinical algorithms to determine the level of concern, symptom management advice, and resources for families of children with cancer. The evaluation involved Think Aloud interviews with parent and adolescent patients to complete tasks in the app as well as a User Experience questionnaire (score range, 0-120) and qualitative feedback. The accuracy of algorithms was determined by repeated testing of inputs and outputs over 4 weeks. RESULTS Design and wireframes were iteratively refined through consultation with parents and adolescents confirming the final design. Beta testing evaluation was then completed by 25 participants including two adolescents. Across all participants, 84% of tasks were easy to navigate, and the Oncology Hub demonstrated high usability, usefulness, and acceptability with participants' scores ranging between 90 and 120 (mean = 112.2, standard deviation = 9.43). Qualitative feedback was positive. Testing of algorithms identified inconsistencies in understanding between clinical research and coding teams; refinements were made until the expected response notifications were returned with 100% accuracy. CONCLUSION Technology offers new ways to think about how clinicians and families communicate and share information to harness the best of community and hospital services. Understanding how information is exchanged using health apps, and how this affects clinical workflow is critical to successful implementation, and optimizing symptom assessment and management in children with cancer.
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Affiliation(s)
- Natalie Bradford
- Queensland University of Technology, Brisbane, Australia.,Children's Health Queensland, South Brisbane, Australia
| | | | | | - Paula Condon
- Children's Health Queensland, South Brisbane, Australia
| | | | | | | | - Amanda Carter
- Children's Health Queensland, South Brisbane, Australia
| | - Rick Walker
- Children's Health Queensland, South Brisbane, Australia
| | - Ashraf Badat
- Children's Health Queensland, South Brisbane, Australia
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16
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Horan MR, Sim JA, Krull KR, Baker JN, Huang IC. A Review of Patient-Reported Outcome Measures in Childhood Cancer. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101497. [PMID: 36291433 PMCID: PMC9601091 DOI: 10.3390/children9101497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/07/2022] [Accepted: 09/23/2022] [Indexed: 11/20/2022]
Abstract
Patient-reported outcomes (PROs) are used in clinical work and research to capture the subjective experiences of childhood cancer patients and survivors. PROs encompass content domains relevant and important to this population, including health-related quality-of-life (HRQOL), symptoms, and functional status. To inform future efforts in the application of PRO measures, this review describes the existing generic and cancer-specific PRO measures for pediatric cancer populations and summarizes their characteristics, available language translations, content coverage, and measurement properties into tables for clinicians and researchers to reference before choosing a PRO measure that suits their purpose. We have identified often unreported measurement properties that could provide evidence about the clinical utility of the PRO measures. Routine PRO assessment in pediatric cancer care offers opportunities to facilitate clinical decision-making and improve quality of care for these patients. However, we suggest that before implementing PRO measures into research or clinical care, the psychometric properties and content coverage of the PRO measures must be considered to ensure that PRO measures are appropriately assessing the intended construct in childhood cancer patients.
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Affiliation(s)
- Madeline R. Horan
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Jin-ah Sim
- School of AI Convergence, Hallym University, Chuncheon 200160, Korea
| | - Kevin R. Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Justin N. Baker
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
- Correspondence: ; Tel.: +1-(901)-595-8369
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17
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Silveira A, Sequeira T, Gonçalves J, Lopes Ferreira P. Patient reported outcomes in oncology: changing perspectives-a systematic review. Health Qual Life Outcomes 2022; 20:82. [PMID: 35597948 PMCID: PMC9124403 DOI: 10.1186/s12955-022-01987-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/10/2022] [Indexed: 12/24/2022] Open
Abstract
In public health context, oncology is associated with severe negative impact on patients and on their relatives’ quality of life. Over the last decades, survival has remained at 50% worldwide for some tumor locations. Patient reported outcomes (PROs) assessment and, the corresponding use in clinical practice, help establishing patient individualized profiling involving caregivers. The purpose of this systematic review was to examine critical success factors for PROs assessment in daily clinical oncology practice. Additionally, we investigated how PROs collection can change oncology perspectives for patients and caregivers. According to PRISMA guidelines, 83 studies were included in this systematic review, whether related with implementation in daily clinical practice or associated with its use in oncology. PROs assessment gathers multi-professional teams, biomedical and clinical expertise, patients, families and caregivers. Institutional involvement, first line for caregiver’s adherence, team continuous formation, encompassing training and support, design of clear workflows, continuous monitoring, and data analysis are crucial for implementation. PROs measures are decisive in oncology. Several items were improved, including caregiver–patient–physician communication, patient risk groups identification, unmet problems and needs detection, disease course and treatment tracking, prognostic markers, cost-effectiveness measurement and comfort/support provision for both patients and caregivers. Routine assessment and implementation of PROs in clinical practice are a major challenge and a paradigm transformation for future.
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Affiliation(s)
- Augusta Silveira
- Health Sciences Faculty, Fernando Pessoa University (UFP-FCS), Rua Carlos da Maia, 296, 4200-150, Porto, Portugal.,Centre for Health Studies and Research of University of Coimbra, Centre for Innovative Biomedicine and Biotechnology, Avenida Dias da Silva, 165, 3004-512, Coimbra, Portugal
| | - Teresa Sequeira
- Health Sciences Faculty, Fernando Pessoa University (UFP-FCS), Rua Carlos da Maia, 296, 4200-150, Porto, Portugal.,Centre for Health Studies and Research of University of Coimbra, Centre for Innovative Biomedicine and Biotechnology, Avenida Dias da Silva, 165, 3004-512, Coimbra, Portugal
| | - Joaquim Gonçalves
- 2Ai - Applied Artificial Intelligence Laboratory, School of Technology of Polytechnic Institute of Cávado and Ave, R. de São Martinho, 4750-810, Vila Frescainha, Barcelos, Portugal
| | - Pedro Lopes Ferreira
- Centre for Health Studies and Research of University of Coimbra, Centre for Innovative Biomedicine and Biotechnology, Avenida Dias da Silva, 165, 3004-512, Coimbra, Portugal. .,Faculty of Economics, University of Coimbra, Av. Dr. Dias da Silva, 165, 3004-512, Coimbra, Portugal.
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18
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Hayase T, Mieno MN, Kobayashi K, Mori N, Lebowitz AJ, Kato Y, Saito Y, Yuza Y, Sano H, Osone S, Hori T, Shinkoda Y, Yamamoto N, Hasegawa D, Yano M, Ashiarai M, Hasegawa D, Sawada A, Yamaguchi T, Morimoto A, Fukushima K. Reliability and Validity of the Japanese Pediatric Version of Memorial Symptom Assessment Scale. J Pain Symptom Manage 2022; 63:e495-e504. [PMID: 35031501 DOI: 10.1016/j.jpainsymman.2021.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 11/23/2022]
Abstract
CONTEXT Few instruments in Japanese assess health-related quality of life in pediatric cancer patients. OBJECTIVES To translate the Memorial Symptom Assessment Scale (MSAS) into Japanese pediatric and proxy versions (MSAS-J 7-12, MSAS-J 13-18, and MSAS-J-Proxy) and assess validity and reliability. METHODS Phase I comprised forward-backward translation and pilot testing in 13 children and 16 guardians. Phase II consisted of psychometric testing of the three MSAS-J versions in 162 children and 238 guardians. Internal consistency, test-retest reliability, and construct and known-group validity of the MSAS-J were assessed. RESULTS Cronbach's alpha coefficients for the total and subscale scores were over 0.70, excluding the psychological symptom (PSYCH) subscale score of the MSAS-J 7-12. Most MSAS-J scores significantly inversely correlated with two versions of the Pediatric Quality of Life Inventory. A strong child-guardian correlation was shown in the total and subscale scores (ICC range 0.66-0.83). Kappa estimates showed acceptable child-guardian symptom agreement. MSAS-J 7-12 and proxy differentiated patients according to clinical status. CONCLUSION MSAS-J is a reliable and valid instrument to assess symptoms among Japanese children with cancer.
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Affiliation(s)
- Tomomi Hayase
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan.
| | - Makiko N Mieno
- Department of Medical Informatics, Center for Information, Jichi Medical University, Shimotsuke, Japan
| | - Kyoko Kobayashi
- Department of Child Health Nursing, St. Luke's International University Graduate School of Nursing Science, Tokyo, Japan
| | - Naoko Mori
- Department of Pediatrics, Akabane Zaitaku Clinic, Tokyo, Japan; Departments of Hematology/Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Adam Jon Lebowitz
- Department of General Education, Jichi Medical University, Shimotsuke, Japan
| | - Yoko Kato
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuya Saito
- Departments of Hematology/Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yuki Yuza
- Departments of Hematology/Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hirozumi Sano
- Department of Pediatrics, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Shinya Osone
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tsukasa Hori
- Department of Pediatrics, Sapporo Medical University, Sapporo, Japan
| | - Yuichi Shinkoda
- Department of Pediatrics, Kagoshima City Hospital, Kagoshima, Japan
| | - Nobuyuki Yamamoto
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daiichiro Hasegawa
- Department of Hematology and Oncology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Michihiro Yano
- Department of Pediatrics, Akita University School of Medicine, Akita, Japan
| | - Miho Ashiarai
- Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan
| | - Daisuke Hasegawa
- Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan
| | - Akihisa Sawada
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan
| | - Keitaro Fukushima
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Mibu, Japan
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19
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Wiljén A, Chaplin JE, Crine V, Jobe W, Johnson E, Karlsson K, Lindroth T, Schwarz A, Stenmarker M, Thunberg G, Öhlén J, Nilsson S. The Development of an mHealth Tool for Children With Long-term Illness to Enable Person-Centered Communication: User-Centered Design Approach. JMIR Pediatr Parent 2022; 5:e30364. [PMID: 35258466 PMCID: PMC8941441 DOI: 10.2196/30364] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/19/2021] [Accepted: 11/07/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Children with long-term illnesses frequently experience symptoms that could negatively affect their daily lives. These symptoms are often underreported in health care. Despite a large number of mobile health (mHealth) tools, few are based on a theoretical framework or supported by scientific knowledge. Incorporating universal design when developing a product can promote accessibility and facilitate person-centered communication. OBJECTIVE The aim of this study is to identify the symptom-reporting needs of children with cancer and congenital heart defects that could be satisfied by using a mobile app. Another aim is to evaluate how the child might interact with the app by considering universal design principles and to identify parents' views and health care professionals' expectations and requirements for an mHealth tool. METHODS User-centered design is an iterative process that focuses on an understanding of the users. The adapted user-centered design process includes 2 phases with 4 stages. Phase 1 involved interviews with 7 children with long-term illnesses, 8 parents, and 19 health care professionals to determine their needs and wishes for support; a workshop with 19 researchers to deepen our understanding of the needs; and a workshop with developers to establish a preliminary tool to further investigate needs and behaviors. Phase 2 involved interviews with 10 children with long-term illnesses, 9 parents, and 21 health care professionals to evaluate the mock-up (prototype) of the mHealth tool. Data were synthesized using the interpretive description technique. RESULTS A total of 4 aspects of needs emerged from the synthesis of the data, as follows: different perspectives on provided and perceived support; the need for an easy-to-use, non-clinic-based tool to self-report symptoms and to facilitate communication; the need for safety by being in control and reaching the child's voice; and a way of mapping the illness journey to facilitate recall and improve diagnostics. The children with long-term illnesses expressed a need to not only communicate about pain but also communicate about anxiety, fatigue, fear, and nausea. CONCLUSIONS The findings of this study indicated that the PicPecc (Pictorial Support in Person-Centered Care for Children) app is a potential solution for providing communicative support to children with long-term illnesses dealing with multiple symptoms and conditions. The interview data also highlighted symptoms that are at risk of being overlooked if they are not included in the mobile app. Further studies are needed to include usability testing and evaluation in hospitals and home care settings.
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Affiliation(s)
- Angelica Wiljén
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Paediatrics, Region Västra Götaland, Södra Älvsborg Hospital, Borås, Sweden
| | - John Eric Chaplin
- Department of Paediatrics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Vanessa Crine
- University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - William Jobe
- Department of Informatics, School of Business, Economics and IT, University West, Trollhättan, Sweden
| | - Ensa Johnson
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa.,Department of Inclusive Education, University of South Africa, Pretoria, South Africa
| | - Katarina Karlsson
- Department of Health Sciences, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Tomas Lindroth
- Department of Applied Information Technology, University of Gothenburg, Gothenburg, Sweden
| | - Anneli Schwarz
- Department of Research, Education and Innovation, Region Västra Götaland, Södra Älvsborg Hospital, Borås, Sweden
| | - Margaretha Stenmarker
- Department of Paediatrics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Paediatrics, Region Jönköping County, Jönköping, Sweden.,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Gunilla Thunberg
- University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Dart Centre for Augmentative and Alternative Communication and Assistive Technology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Speech and Language Pathology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Palliative Centre, Sahlgrenska University Hospital Region Västra Götaland, Gothenburg, Sweden
| | - Stefan Nilsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Ananth P, Mun S, Reffat N, Kang SJ, Pitafi S, Ma X, Gross CP, Wolfe J. Refining Patient-Centered Measures of End-of-Life Care Quality for Children With Cancer. JCO Oncol Pract 2022; 18:e372-e382. [PMID: 34613797 PMCID: PMC8932486 DOI: 10.1200/op.21.00447] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE There are no existing quality measures (QMs) to optimize end-of-life care for children with cancer. Previously, we developed a set of 26 candidate QMs. Our primary objective in this study was to achieve stakeholder consensus on priority measures. METHODS We conducted an iterative, cross-sectional electronic survey, using a modified Delphi method to build consensus among clinician and family stakeholders. In each of the two rounds of surveys, stakeholders were asked to rate QMs on a 9-point Likert scale, on the basis of perceived importance. Health care professionals were additionally asked to rate measures on perceived feasibility. After each round, we computed median scores on importance and feasibility of measurement, retaining QMs with median importance scores ≥ 8. RESULTS Twenty-five participants completed both rounds of the survey. In round 1, participants were asked to rate 26 QMs; nine QMs, including QMs pertaining to health care use, were removed because of median importance scores < 8. Two new measures were proposed for consideration in round 2, on the basis of participant feedback. Following round 2, 17 QMs were ultimately retained. QMs related to symptom screening and palliative care consultation were rated highly in importance and feasibility. QMs related to communication were rated highly important, yet less feasible. Measuring whether a patient's needs were heard by their health care team was rated among the least feasible. CONCLUSION Childhood cancer stakeholders prioritized QMs pertaining to patient-reported outcomes, deeming measures of health care resource use less important. Future research should seek to develop novel tools for quality assessment to enhance feasibility of implementing priority measures.
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Affiliation(s)
- Prasanna Ananth
- Department of Pediatrics, Yale School of Medicine, New Haven, CT,Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT,Prasanna Ananth, MD, MPH, Department of Pediatrics, Section of Pediatric Hematology/Oncology, Yale School of Medicine, 330 Cedar St, LMP 2082C, New Haven, CT 06510; e-mail:
| | - Sophia Mun
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT
| | - Noora Reffat
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT
| | - Soo Jung Kang
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT
| | - Sarah Pitafi
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Cary P. Gross
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT,Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA,Department of Pediatrics, Boston Children's Hospital, Boston, MA,Harvard Medical School, Boston, MA
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21
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The predictive trifecta? Fatigue, pain, and anxiety severity forecast the suffering profile of children with cancer. Support Care Cancer 2022; 30:2081-2089. [PMID: 34661748 PMCID: PMC8919269 DOI: 10.1007/s00520-021-06622-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/08/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Fatigue, pain, and anxiety, symptoms commonly experienced by children with cancer, may predict pediatric symptom suffering profile membership that is amenable to treatment. METHODS Three latent profiles (Low, Medium, and High symptom suffering) from 436 pediatric patients undergoing cancer care were assessed for association with three single-item symptoms and socio-demographic variables. RESULTS Pediatric-PRO-CTCAE fatigue, pain, and anxiety severity scores at baseline were highly and significantly associated with the Medium and High Suffering profiles comprised of PROMIS pediatric symptom and function measures. The likelihood of membership in the Medium Suffering group was 11.37 times higher for patients who experienced fatigue severity than those with did not, while experience of pain severity increased the likelihood of the child's membership in the Medium Suffering profile by 2.59 times and anxiety by 3.67 times. The severity of fatigue increased the likelihood of presence in the High Suffering group by 2.99 times while pain severity increased the likelihood of the child's membership in the High Suffering profile by 6.36 times and anxiety by 16.75 times. Controlling for experience of symptom severity, older patients were more likely to be in the Higher or Medium Suffering profile than in the Low Suffering profile; no other socio-demographic or clinical variables had a significant effect on the latent profile classification. CONCLUSION Clinician knowledge of the strong association between fatigue, pain, and anxiety severity and suffering profiles may help focus supportive care to improve the cancer experience for children most at risk from time of diagnosis through treatment.
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22
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Murugappan MN, King-Kallimanis BL, Reaman GH, Bhatnagar V, Horodniceanu EG, Bouchkouj N, Kluetz PG. Patient-Reported Outcomes in Pediatric Cancer Registration Trials: A US Food and Drug Administration Perspective. J Natl Cancer Inst 2022; 114:12-19. [PMID: 33930159 PMCID: PMC8755487 DOI: 10.1093/jnci/djab087] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/10/2021] [Accepted: 04/20/2021] [Indexed: 09/21/2023] Open
Abstract
Pediatric patient-reported outcome (PRO) data can help inform the US Food and Drug Administration's (FDA's) benefit-risk assessment of cancer therapeutics by quantifying symptom and functional outcomes from the patient's perspective. This study assessed use of PROs in commercial pediatric oncology trials submitted to the FDA for regulatory review. FDA databases were searched to identify pediatric oncology product applications approved between 1997 and 2020. Sponsor-submitted documents were reviewed to determine whether PRO data were collected, which instruments were used, and the quality of collected data (ie, sample size, completion rates, and use of fit-for-purpose instruments). The role of PROs in each trial (endpoint hierarchy) was also recorded in addition to whether any PRO endpoints were included in product labeling. We reviewed 17 pediatric oncology applications, 4 of which included PRO data: denosumab, tisagenlecleucel, larotrectinib, and selumetinib. In these 4 instances, PROs served as exploratory endpoints and were not incorporated in product labeling. Trials that collected PRO data were phase II or phase I/II single-arm studies with sample sizes of 28 to 88 patients. Symptomatic adverse events (AEs) were characterized using clinician-reported Common Terminology Criteria for Adverse Events (CTCAE) without additional patient self-report. PROs were infrequently used in pediatric cancer registration trials. When PROs were used, PRO data were limited by lack of a clear research objective and corresponding prospective statistical analysis plan. Contemporary PRO symptom libraries, such as the National Cancer Institute's Pediatric PRO-CTCAE, may provide an opportunity to better evaluate the occurrence and impact of symptomatic AEs, from the patient's perspective, in pediatric oncology trials.
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Affiliation(s)
- Meena N Murugappan
- Office of Oncologic Diseases, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - Gregory H Reaman
- Oncology Center for Excellence, US Food and Drug Administration, Silver Spring, MD, USA
| | - Vishal Bhatnagar
- Oncology Center for Excellence, US Food and Drug Administration, Silver Spring, MD, USA
| | - Erica G Horodniceanu
- Oncology Center for Excellence, US Food and Drug Administration, Silver Spring, MD, USA
| | - Najat Bouchkouj
- Oncology Center for Excellence, US Food and Drug Administration, Silver Spring, MD, USA
| | - Paul G Kluetz
- Oncology Center for Excellence, US Food and Drug Administration, Silver Spring, MD, USA
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23
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Berkman AM, Murphy KM, Siembida EJ, Lau N, Geng Y, Parsons SK, Salsman JM, Roth ME. Inclusion of Patient-Reported Outcomes in Adolescent and Young Adult Phase III Therapeutic Trials: An Analysis of Cancer Clinical Trials Registered on ClinicalTrials.gov. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1820-1827. [PMID: 34838280 PMCID: PMC8630401 DOI: 10.1016/j.jval.2021.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 06/12/2021] [Accepted: 06/21/2021] [Indexed: 05/03/2023]
Abstract
OBJECTIVES There is a paucity of research on the impact of cancer treatment on the health-related quality of life (HRQOL) of adolescent and young adult (AYA) patients with cancer. Patient-reported outcomes (PROs) are self-report measures used to assess HRQOL and symptom burden. The extent to which PROs have been included in trials that include common AYA cancer types has not been previously assessed. METHODS Therapeutic phase 3 trials among common AYA cancer types (Hodgkin lymphoma, non-Hodgkin lymphoma, acute lymphoblastic leukemia, sarcomas, and germ cell tumors) initiated between 2007 and 2020 were identified on ClinicalTrials.gov. The proportions and characteristics of trials including a PRO endpoint were assessed. For comparison with an older population, the proportion of breast and colorectal therapeutic phase 3 trials including PRO endpoints were assessed. RESULTS Eighty-seven studies met the inclusion criteria. Overall, 20.7% of therapeutic phase 3 AYA trials included a PRO endpoint, and only one trial published PRO data. Germ cell tumors (42.9%) and non-Hodgkin lymphoma (40%) trials had the highest proportions of PRO inclusion. The European Organization for Research and Treatment of Cancer generic, cancer-specific quality of life questionnaire was the most commonly used PRO measure; nevertheless, the measures used varied within and between cancer types. The proportion of trials including a PRO endpoint did not change significantly between 2007 to 2013 and 2014 to 2020 (18.6% vs 22.7%, P=.79). CONCLUSIONS Few therapeutic phase 3 AYA cancer trials include PRO endpoints, fewer publish PRO data, and there is no homogeneity in the measures administered. Therapeutic trials represent an underused opportunity to capture PRO data in the AYA population with the goal of improving HRQOL outcomes.
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Affiliation(s)
- Amy M Berkman
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Karly M Murphy
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Elizabeth J Siembida
- Center for Health Innovation and Outcomes Research, Northwell Health, Manhasset, NY, USA
| | - Nancy Lau
- Center for Clinical and Translational Research, Palliative Care and Resilience Research Center, Seattle Children's Research Institute, Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Yimin Geng
- Research Medical Library, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies and the Division of Hematology/Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Michael E Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Psychosocial risk, symptom burden, and concerns in families affected by childhood cancer. Support Care Cancer 2021; 30:2283-2292. [PMID: 34719739 DOI: 10.1007/s00520-021-06646-3] [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: 07/20/2021] [Accepted: 10/18/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The revised Psychosocial Assessment Tool (PATrev) is a common family-level risk-based screening tool for pediatric oncology that has gained support for its ability to predict, at diagnosis, the degree of psychosocial support a family may require throughout the treatment trajectory. However, ongoing screening for symptoms and concerns (e.g., feeling alone, understanding treatment) remains underutilized. Resource limitations necessitate triaging and intervention based on need and risk. Given the widespread use of the PATrev, we sought to explore the association between family psychosocial risk, symptom burden (as measured by the revised Edmonton Symptom Assessment System (ESAS-r)), and concerns (as measured by the Canadian Problem Checklist (CPC)). METHODS Families (n = 87) with children ≤ 18 years of age (M = 11.72, male: 62.1%) on or off treatment for cancer were recruited from the Alberta Children's Hospital. One parent from each family completed the PATrev and the CPC. Participants 8-18 years of age completed the ESAS-r. RESULTS Risk category (universal/low risk = 67.8%, targeted/intermediate risk = 26.4%, clinical/high risk = 5.7%) predicted symptom burden (F[2, 63.07] = 4.57, p = .014) and concerns (F[2, 82.06] = 16.79, p < .001), such that universal risk was associated with significantly lower symptom burden and fewer concerns. CONCLUSION Family psychosocial risk is associated with cross-sectionally identified concerns and symptom burden, suggesting that resources might be prioritized for families with the greatest predicted need. Future research should evaluate the predictive validity of the PATrev to identify longitudinal concerns and symptom burden throughout the cancer trajectory.
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Crane S, DiValerio Gibbs K, Nosich R, Yang Y, Pawelek E. Challenges in the implementation of electronic systems for patient report of symptoms in oncology: a scoping review. JOURNAL OF HOSPITAL MANAGEMENT AND HEALTH POLICY 2021; 5:31. [PMID: 38919373 PMCID: PMC11198977 DOI: 10.21037/jhmhp-20-108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Background Under-recognition and under-treatment of symptoms are prevalent throughout the health care system in the United States. While the reasons for this are complex, it is widely recognized that electronic symptom reports can improve clinicians' ability to manage symptoms. However, electronic symptom reporting has yet to be widely implemented. Electronic systems are most effective when tailored to the specific patient population or clinical setting. For example, numerous oncology-focused electronic symptom reporting systems have been developed for patients with cancer undergoing treatment in the United States. The objective of this scoping review was to identify challenges that arose in the implementation of electronic systems for patient-reported symptoms in oncology clinical practice, and approaches that were taken or recommended to overcome those challenges. Methods This scoping review involved comprehensive searches of Medline, CINAHL, and the Cochrane Central Register of Controlled Trials, which yielded 3,133 articles. Following screening, 20 research studies met the inclusion criteria and were included in this review. Data were systematically extracted from the articles using a qualitative content analysis. Results Challenges identified were thematically categorized as technical issues, system usability issues, patient lack of comfort/knowledge of technology, incomplete/missing data, lack of patient use of the system, other patient issues, difficulties timing completion with clinical processes, lack of clinic staff involvement/engagement, and lack of clinician comfort/knowledge regarding the use of patient-reported outcome data. Discussion The findings of this review highlight challenges that need to be addressed when implementing an electronic symptom reporting system for patients with cancer, and potential strategies for overcoming these challenges. This review may help hospital administrators and clinicians prepare for and improve the implementation of electronic symptom reporting systems into clinical practice, thereby providing evidence to enable their broader use.
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Affiliation(s)
- Stacey Crane
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Karen DiValerio Gibbs
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rebecca Nosich
- Harris College of Nursing & Health Sciences, Texas Christian University, Houston, TX, USA
| | - Yijiong Yang
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Elizabeth Pawelek
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, USA
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Bradford N, Condon P, Pitt E, Tyack Z, Alexander K. Optimising symptom management in children with cancer using a novel mobile phone application: protocol for a controlled hybrid effectiveness implementation trial (RESPONSE). BMC Health Serv Res 2021; 21:942. [PMID: 34503489 PMCID: PMC8427146 DOI: 10.1186/s12913-021-06943-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 08/26/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Intense and aggressive treatment regimens for most children's cancer have achieved vast improvements in survival but are also responsible for both a high number and burden of symptoms. The use of Patient Reported Outcome Measures (PROMs) demonstrates a range of benefits for improved symptom management in adults with cancer. There are, however, multiple barriers to integrating PROMs into routine care in children and adolescents with cancer. This study aims to evaluate: (1) the effectiveness of electronic PROMs to generate stratified alerts, symptom management recommendations and graphical summaries (the RESPONSE system) to improve health outcomes and (2) the implementation of the RESPONSE system by assessing feasibility, acceptability, satisfaction, and sustainability. METHODS A pragmatic hybrid II effectiveness-implementation controlled trial, using mixed methods, will be undertaken, advancing both knowledge of the effectiveness of the intervention and implementation factors. One-hundred and sixty children with cancer receiving active treatment will be recruited 1:1 to a non-randomised study involving two groups with an equal number of participants in each group. The intervention group (n = 80) will be prospectively recruited to receive the RESPONSE system intervention over eight weeks, versus the historical matched control group (n = 80) who will complete the ePROMs without access to the RESPONSE system. The primary outcome of the effectiveness trial is change between groups in total symptom burden. Secondary outcomes include child health-related quality-of-life and implementation outcomes. Trial data will be analysed using linear mixed-effects models. Formative implementation evaluation is informed by CFIR and ERIC frameworks and implementation outcomes will be mapped to the RE-AIM framework and include interviews, field notes, as well as administrative data to evaluate feasibility, acceptability, satisfaction and sustainability. TRIAL REGISTRATION NUMBER ACTRN12621001084875 . Retrospectively Registered 16 August 2021.
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Affiliation(s)
- Natalie Bradford
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Brisbane, Australia.
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, 62 Graham St, South Brisbane, QLD, 4101, Brisbane, Australia.
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Brisbane, Australia.
| | - Paula Condon
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, 62 Graham St, South Brisbane, QLD, 4101, Brisbane, Australia
| | - Erin Pitt
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Brisbane, Australia
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Brisbane, Australia
| | - Zephanie Tyack
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Brisbane, Australia
| | - Kimberly Alexander
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Brisbane, Australia
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Brisbane, Australia
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Ananth P, Mun S, Reffat N, Li R, Sedghi T, Avery M, Snaman J, Gross CP, Ma X, Wolfe J. A Stakeholder-Driven Qualitative Study to Define High Quality End-of-Life Care for Children With Cancer. J Pain Symptom Manage 2021; 62:492-502. [PMID: 33556497 PMCID: PMC8339188 DOI: 10.1016/j.jpainsymman.2021.01.134] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 02/07/2023]
Abstract
CONTEXT Among adults with cancer, measures for high quality end-of-life care (EOLC) include avoidance of hospitalizations near end of life. For children with cancer, no measures exist to evaluate or improve EOLC, and adult quality measures may not apply. OBJECTIVE We engaged key stakeholders to explore EOLC priorities for children with cancer and their families, and to examine relevance of existing adult EOLC quality measures for children with cancer. METHODS In a multicenter qualitative study, we conducted interviews and focus groups with: adolescents and young adults (AYAs) with advanced cancer, parents of children with advanced cancer, bereaved parents, and interdisciplinary healthcare professionals. We transcribed, coded, and employed thematic analysis to summarize findings. RESULTS We enrolled 54 stakeholders (25 parents [including 12 bereaved parents], 10 AYAs, and 19 healthcare professionals). Participants uniformly prioritized direct communication with children about preferences and prognosis, interdisciplinary care, symptom management, and honoring family preference for location of death. Many participants valued access to the emergency department or hospital for symptom management or supportive care, which diverges from measures for high quality EOLC in adults. Most wished to avoid mechanical ventilation and cardiopulmonary resuscitation. Notably, participants generally valued hospice; however, few understood hospice care or had utilized its services. CONCLUSION Childhood cancer stakeholders define high quality EOLC primarily through person-centered measures, characterizing half of existing adult-focused measures as limited in relevance to children. Future research should focus on developing techniques for person-centered quality measurement to capture attributes of greatest importance to children with cancer and their families.
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Affiliation(s)
- Prasanna Ananth
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA; Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, Connecticut, USA.
| | - Sophia Mun
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, Connecticut, USA
| | - Noora Reffat
- Biological Sciences Division, University of Chicago Medicine¸ Chicago, Illinois, USA
| | - Randall Li
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Tannaz Sedghi
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, Connecticut, USA
| | - Madeline Avery
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer Snaman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Cary P Gross
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, Connecticut, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, Connecticut, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Montgomery KE, Vos K, Raybin JL, Ward J, Balian C, Gilger EA, Li Z. Comparison of child self-report and parent proxy-report of symptoms: Results from a longitudinal symptom assessment study of children with advanced cancer. J SPEC PEDIATR NURS 2021; 26:e12316. [PMID: 33118275 DOI: 10.1111/jspn.12316] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/15/2020] [Accepted: 10/08/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE This report represents a subanalysis of data from a primary study and addresses a gap in understanding the similarities and differences of symptom reporting between children with advanced cancer and their parents. The objectives of this subanalysis were to (1) compare reports of symptom prevalence, symptom burden, and symptom frequency, severity, and distress between groups of children and adolescents and their parents, and (2) describe concordance of symptom reports within individual child-parent dyads. DESIGN AND METHODS Forty-six children with relapsed, refractory, or progressive cancer and their parents from five pediatric cancer centers prospectively reported symptoms every 2 weeks for up to 61 weeks. The abbreviated Pediatric Quality of Life and Evaluation of Symptoms Technology-Memorial Symptom Assessment Scales were used to measure symptom prevalence, frequency, severity, and distress. RESULTS Children and parents reported pain, fatigue, nausea, and sleeping difficulties as the most frequently occurring symptoms. With the exception of shortness of breath, parents reported symptom prevalence more often than children. The differences in parent reports were statistically significant for fatigue, nausea, lack of appetite, feeling nervous, and sadness. Parents reported higher symptom burden scores compared to children for all individual symptoms except shortness of breath. Children reported higher scores for 19 of 32 possible symptom frequency, severity, and distress ratings. Children's scores were higher for frequency and severity, while parents' scores were higher for distress. Sleeping difficulties, pain, nausea, and diarrhea demonstrated the highest concordance, while feeling nervous, sadness, irritability, and fatigue yielded the lowest concordance between children's and parents' symptom reports. PRACTICE IMPLICATIONS Eliciting the symptom experience from the child, when appropriate, rather than a parent proxy is best practice given evidence supporting the overestimation of symptom prevalence by parents and underestimation of symptom frequency and severity for some symptoms. When proxy raters must be used, pediatric nurses should educate proxy raters regarding symptom assessment, and assess and tend to symptoms that may not exhibit visual cues. Pediatric nurses should conduct a comprehensive symptom assessment and evaluate beyond the presence of symptoms and include an assessment of frequency, severity, and distress for physical and psychological symptoms to optimize symptom management strategies.
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Affiliation(s)
| | - Kaylee Vos
- American Family Children's Hospital, Madison, Wisconsin, USA
| | - Jennifer L Raybin
- Center for Cancer and Blood Disorders and Palliative Care, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jessica Ward
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Chelsea Balian
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Elizabeth A Gilger
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Zhanhai Li
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Nguyen H, Butow P, Dhillon H, Sundaresan P. A review of the barriers to using Patient-Reported Outcomes (PROs) and Patient-Reported Outcome Measures (PROMs) in routine cancer care. J Med Radiat Sci 2021; 68:186-195. [PMID: 32815314 PMCID: PMC8168064 DOI: 10.1002/jmrs.421] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Patient-reported outcomes (PROs) are direct reports from patients about the status of their health condition without amendment or interpretation by others. Patient-reported outcome measures (PROMs) are the tools used to measure PROs; they are usually validated questionnaires patients complete by self-assessing their health status. Whilst the benefits of using PROs and PROMs to guide real-time patient care are well established, they have not been adopted by many oncology institutions worldwide. This literature review aimed to examine the barriers associated with using PROs and PROMs in routine oncology care. METHODS A literature search was conducted across EMBASE, Medline and CINAHL databases. Studies detailing barriers to routine PRO use for real-time patient care were included; those focusing on PRO collection in the research setting were excluded. RESULTS Of 1165 records captured, 14 studies informed this review. At the patient level, patient time, incapacity and difficulty using electronic devices to complete PROMs were prominent barriers. At the health professional level, major barriers included health professionals' lack of time and knowledge to meaningfully interpret and integrate PRO data into their clinical practice and the inability for PRO data to be acted upon. Prominent barriers at the service level included difficulties integrating PROs and PROMs into clinical workflows and inadequate information technology (IT) infrastructures for easy PRO collection. CONCLUSION This review has outlined potential barriers to routine PRO use in the oncology setting. Such barriers should be considered when implementing PROs into routine clinical practice.
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Affiliation(s)
- Hanh Nguyen
- Western Sydney Local Health DistrictRadiation Oncology NetworkSydneyAustralia
| | - Phyllis Butow
- Centre for Medical Psychology & Evidence‐based Decision‐makingThe University of SydneySydneyAustralia
| | - Haryana Dhillon
- Centre for Medical Psychology & Evidence‐based Decision‐makingThe University of SydneySydneyAustralia
| | - Puma Sundaresan
- Western Sydney Local Health DistrictRadiation Oncology NetworkSydneyAustralia
- Sydney Medical SchoolThe University of SydneySydneyAustralia
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Shalabi H, Gust J, Taraseviciute A, Wolters PL, Leahy AB, Sandi C, Laetsch TW, Wiener L, Gardner RA, Nussenblatt V, Hill JA, Curran KJ, Olson TS, Annesley C, Wang HW, Khan J, Pasquini MC, Duncan CN, Grupp SA, Pulsipher MA, Shah NN. Beyond the storm - subacute toxicities and late effects in children receiving CAR T cells. Nat Rev Clin Oncol 2021; 18:363-378. [PMID: 33495553 PMCID: PMC8335746 DOI: 10.1038/s41571-020-00456-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 12/15/2022]
Abstract
As clinical advances with chimeric antigen receptor (CAR) T cells are increasingly described and the potential for extending their therapeutic benefit grows, optimizing the implementation of this therapeutic modality is imperative. The recognition and management of cytokine release syndrome (CRS) marked a milestone in this field; however, beyond the understanding gained in treating CRS, a host of additional toxicities and/or potential late effects of CAR T cell therapy warrant further investigation. A multicentre initiative involving experts in paediatric cell therapy, supportive care and/or study of late effects from cancer and haematopoietic stem cell transplantation was convened to facilitate the comprehensive study of extended CAR T cell-mediated toxicities and establish a framework for new systematic investigations of CAR T cell-related adverse events. Together, this group identified six key focus areas: extended monitoring of neurotoxicity and neurocognitive function, psychosocial considerations, infection and immune reconstitution, other end organ toxicities, evaluation of subsequent neoplasms, and strategies to optimize remission durability. Herein, we present the current understanding, gaps in knowledge and future directions of research addressing these CAR T cell-related outcomes. This systematic framework to study extended toxicities and optimization strategies will facilitate the translation of acquired experience and knowledge for optimal application of CAR T cell therapies.
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Affiliation(s)
- Haneen Shalabi
- Pediatric Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, MD, USA
| | - Juliane Gust
- Seattle Children's Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington Seattle, Seattle, WA, USA
| | - Agne Taraseviciute
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Pamela L Wolters
- Pediatric Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, MD, USA
| | - Allison B Leahy
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Carlos Sandi
- Pediatric Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, MD, USA
- St. Baldrick's Foundation, Monrovia, CA, USA
| | - Theodore W Laetsch
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pediatrics and Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Lori Wiener
- Pediatric Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, MD, USA
| | - Rebecca A Gardner
- Seattle Children's Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington Seattle, Seattle, WA, USA
| | - Veronique Nussenblatt
- National Institute of Allergy and Infectious Disease, Clinical Center, NIH, Bethesda, MD, USA
| | - Joshua A Hill
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kevin J Curran
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Timothy S Olson
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Colleen Annesley
- Seattle Children's Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington Seattle, Seattle, WA, USA
| | - Hao-Wei Wang
- Laboratory of Pathology, NCI, NIH, Bethesda, MD, USA
| | - Javed Khan
- Oncogenomics Section, Genetics Branch, NCI, NIH, Bethesda, MD, USA
| | - Marcelo C Pasquini
- Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for International Blood and Marrow Transplant Research, Milwaukee, WI, USA
| | - Christine N Duncan
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Stephan A Grupp
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael A Pulsipher
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, MD, USA.
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Validating a Short Conners CPT 3 as a Screener: Predicting Self-reported CDC Concussion Symptoms in Children, Adolescents, and Adults. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2021. [DOI: 10.1007/s40817-021-00107-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Meyerheim M, Karamanidou C, Payne S, Garani-Papadatos T, Sander A, Downing J, Stamatopoulos K, Ling J, Payne C, Scarfò L, Lokaj P, Maramis C, Graf N. MyPal-Child study protocol: an observational prospective clinical feasibility study of the MyPal ePRO-based early palliative care digital system in paediatric oncology patients. BMJ Open 2021; 11:e045226. [PMID: 33849855 PMCID: PMC8051393 DOI: 10.1136/bmjopen-2020-045226] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Electronic patient-reported outcomes (ePROs) have tremendous potential to optimise palliative and supportive care for children with cancer, their families and healthcare providers. Particularly, these children and their families are subjected to multiple strains caused by the disease and its treatment. The MyPal digital health platform is designed to address these complex demands by offering pursuant ePRO-based functionalities via two mobile applications, one developed for children and the other for their parents. METHODS AND ANALYSIS In this observational prospective feasibility study, 100 paediatric oncology patients aged between 6 and 17 years and at least one of their parents/legal guardians will be recruited at three clinical sites in two European countries (Germany and Czech Republic). They will use the mobile applications which are part of the novel digital health platform. During a 6-month study period, participants will complete various ePROs via the applications addressing quality of life, satisfaction with care and impact of the disease on the family at monthly intervals. Additionally, priority-based symptom reporting is integrated into a serious game for children. Outcomes that will be assessed concern the feasibility and the evaluation of the newly designed digital health platform to contribute to the evidence base of clinical ePRO use in paediatric oncology and palliative care process. ETHICS AND DISSEMINATION The MyPal-Child study obtained ethical approval from the Ethics Committee responsible for the University of Saarland, that is, the Ärztekammer des Saarlandes, the Ethics Committee of the Medical School Hannover and the Ethics Committee of the University of Brno. Study results will be disseminated through scientific publications, presentations at international conferences, congresses and a final report to the European Commission. General publicly accessible information can be found on the project website (www.mypal-project.eu) and social media. TRIAL REGISTRATION NUMBERS U1111-1251-0043, DRKS00021458, NCT04381221.
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Affiliation(s)
- Marcel Meyerheim
- Clinic of Pediatric Oncology and Hematology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
| | - Christina Karamanidou
- Institute of Applied Biosciences, Centre for Research and Technology-Hellas, Thessaloniki, Central Macedonia, Greece
| | - Sheila Payne
- International Observatory on End of Life Care, Institute for Health Research, Lancaster University, Lancaster, Lancashire, UK
| | - Tina Garani-Papadatos
- Department of Public Health Policy, University of West Attica, Athens, Attica, Greece
| | - Annette Sander
- Clinic for Paediatric Oncology and Haematology, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Julia Downing
- International Children's Palliative Care Network, Bristol, Avon, UK
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology-Hellas, Thessaloniki, Central Macedonia, Greece
| | - J Ling
- Head Office, European Association for Palliative Care, Vilvoorde, Belgium
| | - Cathy Payne
- Head Office, European Association for Palliative Care, Vilvoorde, Belgium
| | - Lydia Scarfò
- Department of Onco-Haematology, Division of Experimental Oncology, Università Vita Salute San Raffaele, Milano, Italy
| | - Petr Lokaj
- Department of Pediatric Oncology, University Hospital Brno, Brno, Jihomoravský, Czech Republic
| | - Christos Maramis
- Institute of Applied Biosciences, Centre for Research and Technology-Hellas, Thessaloniki, Central Macedonia, Greece
| | - Norbert Graf
- Clinic of Pediatric Oncology and Hematology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
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Weaver MS, Shostrom VK, Neumann ML, Robinson JE, Hinds PS. Homestead together: Pediatric palliative care telehealth support for rural children with cancer during home-based end-of-life care. Pediatr Blood Cancer 2021; 68:e28921. [PMID: 33522720 DOI: 10.1002/pbc.28921] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/14/2020] [Accepted: 01/08/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Children with terminal cancer and their families describe a preference for home-based end-of-life care. Inadequate support outside of the hospital is a limiting factor in home location feasibility, particularly in rural regions lacking pediatric-trained hospice providers. METHODS The purpose of this longitudinal palliative telehealth support pilot study was to explore physical and emotional symptom burden and family impact assessments for children with terminal cancer receiving home based-hospice care. Each child received standard of care home-based hospice care from an adult-trained rural hospice team with the inclusion of telehealth pediatric palliative care visits at a scheduled minimum of every 14 days. RESULTS Eleven children (mean age 11.9 years) received pediatric palliative telehealth visits a minimum of every 14 days, with an average of 4.8 additional telehealth visits initiated by the family. Average time from enrollment to death was 21.6 days (range 4-95). Children self-reported higher physical symptom prevalence than parents or hospice nurses perceived the child was experiencing at time of hospice enrollment with underrecognition of the child's emotional burden. At the time of hospice enrollment, family impact was reported by family caregivers as 46.4/100 (SD 18.7), with noted trend of improved family function while receiving home hospice care with telehealth support. All children remained at home for end-of-life care. CONCLUSION Pediatric palliative care telehealth combined with adult-trained rural hospice providers may be utilized to support pediatric oncology patients and their family caregivers as part of longitudinal home-based hospice care.
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Affiliation(s)
- Meaghann S Weaver
- Department of Pediatrics, Division of Pediatric Palliative Care, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Valerie K Shostrom
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska
| | - Marie L Neumann
- Department of Pediatrics, Division of Pediatric Palliative Care, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Jacob E Robinson
- Department of Pediatrics, Division of Pediatric Palliative Care, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Pamela S Hinds
- Department of Nursing Science, Professional Practice and Quality, Children's National Health System, Washington, District of Columbia.,Department of Pediatrics, George Washington University, Washington, District of Columbia
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Piette V, Beernaert K, Cohen J, Pauwels NS, Scherrens AL, van der Werff Ten Bosch J, Deliens L. Healthcare interventions improving and reducing quality of life in children at the end of life: a systematic review. Pediatr Res 2021; 89:1065-1077. [PMID: 32645707 DOI: 10.1038/s41390-020-1036-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/15/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Children with serious illness suffer from symptoms at the end of life that often fail to be relieved. An overview is required of healthcare interventions improving and decreasing quality of life (QOL) for children with serious illness at the end of life. METHODS A systematic review was performed in five databases, January 2000 to July 2018 without language limit. Reviewers selected quantitative studies with a healthcare intervention, for example, medication or treatment, and QOL outcomes or QOL-related measures, for example, symptoms, for children aged 1-17 years with serious illness. One author assessed outcomes with the QualSyst and GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) Framework; two authors checked a 25% sample. QOL improvement or reduction was categorized. RESULTS Thirty-six studies met the eligibility criteria studying 20 unique interventions. Designs included 1 randomized controlled trial, 1 cross-sectional study, and 34 cohort studies. Patient-reported symptom monitoring increased QOL significantly in cancer patients in a randomized controlled trial. Dexmedetomidine, methadone, ventilation, pleurodesis, and palliative care were significantly associated with improved QOL, and chemotherapy, stem cell transplant, and hospitalization with reduced QOL, in cohort studies. CONCLUSIONS Use of patient-controlled symptom feedback, multidisciplinary palliative care teams with full-time practical support, inhalation therapy, and off-label sedative medication may improve QOL. Curative therapy may reduce QOL. IMPACT QOL for children at the end of life may be improved with patient-controlled symptom feedback, multidisciplinary palliative care teams with full-time practical support, inhalation therapy, and off-label sedative medication. QOL for children at the end of life may be reduced with therapy with a curative intent, such as curative chemotherapy or stem cell transplant. A comprehensive overview of current evidence to elevate currently often-failing QOL management for children at the end of life. New paradigm-level indicators for appropriate and inappropriate QOL management in children at the end of life. New hypotheses for future research, guided by the current knowledge within the field. Various healthcare interventions (as described above) could or might be employed as tools to provide relief in QOL management for children with serious illness, such as cancer, at the end of life, and therefore could be discussed in pediatrician end-of-life training to limit the often-failed QOL management in this population, cave the one-size-fits-all approach for individual cases. Multidisciplinary team efforts and 24/7 presence, especially practical support for parents, might characterize effective palliative care team interventions for children with serious illness at the end of life, suggesting a co-regulating link between well-being of the child partly to that of the parents Hypothesis-oriented research is needed, especially for children with nonmalignant disorders, such as genetic or neurological disorders at the end of life, as well as QOL outcomes for intervention research and psychosocial or spiritual outcomes.
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Affiliation(s)
- Veerle Piette
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels Health Campus-Building K Laarbeeklaan 103, 1090, Brussels, Belgium. .,Department of Public Health and Primary Care, Universitair Ziekenhuis Gent, Ghent University, Entrance 42 (K3), 6th floor, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Kim Beernaert
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels Health Campus-Building K Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Public Health and Primary Care, Universitair Ziekenhuis Gent, Ghent University, Entrance 42 (K3), 6th floor, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels Health Campus-Building K Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Public Health and Primary Care, Universitair Ziekenhuis Gent, Ghent University, Entrance 42 (K3), 6th floor, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Nele S Pauwels
- Knowledge Centre for Health Ghent, Universitair Ziekenhuis Gent, Ghent University, Entrance 42 (K3), 1st floor Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Anne-Lore Scherrens
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels Health Campus-Building K Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Public Health and Primary Care, Universitair Ziekenhuis Gent, Ghent University, Entrance 42 (K3), 6th floor, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Jutte van der Werff Ten Bosch
- Department of Paediatrics, KidZ Health Castle Children's Hospital, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Dikke-Beuklaan 128, 1090, Brussels, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels Health Campus-Building K Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Public Health and Primary Care, Universitair Ziekenhuis Gent, Ghent University, Entrance 42 (K3), 6th floor, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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Bernier Carney KM, Jung SH, Iacob E, Lewis M, Linder LA. Communication of pain by school-age children with cancer using a game-based symptom assessment app: A secondary analysis. Eur J Oncol Nurs 2021; 52:101949. [PMID: 33813185 DOI: 10.1016/j.ejon.2021.101949] [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] [Received: 10/16/2020] [Revised: 01/18/2021] [Accepted: 03/14/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the self-reported pain experiences of school-age children with cancer participating in a feasibility trial of a game-based symptom assessment app. METHOD Nineteen children (median: 8 years, range 6-12 years old) receiving cancer treatment were recruited to complete five days of symptom tracking between clinical visits using a symptom assessment app. Children could report pain as a general symptom with the ability to further localize pain on an avatar. Children could also describe symptoms in response to the app's free-text questions or the app's diary. Descriptive statistics characterized reports of pain frequency, severity, bother, and location. Free-text responses were examined for pain-related statements and analyzed using content analysis. RESULTS All 19 children documented pain on at least one day of app reporting between clinical visits. Pain was most frequently recorded as of mild severity and mild bother. Participants localized pain most frequently to the head, followed by the stomach, chest, extremities, and mouth. Eleven children documented 32 qualitative statements which included rich descriptions of pain-related topics (i.e., "my port hurts a little") and location (i.e., "my vision aching"). CONCLUSIONS These results demonstrate that school-age children with cancer are willing to describe their ambulatory pain experiences on a game-based mobile app through quantitative reports and by using narrative descriptions. Additionally, these findings can potentially guide clinicians in using multiple approaches to elicit a clinically meaningful evaluation of pain in this population.
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Affiliation(s)
| | - Se-Hee Jung
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, 84112, USA.
| | - Eli Iacob
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, 84112, USA.
| | - Melina Lewis
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, 84112, USA.
| | - Lauri A Linder
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, 84112, USA; Primary Children's Hospital, Center for Cancer and Blood Disorders, Salt Lake City, UT, USA.
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Adaptation and evaluation of a child-friendly patient reported outcome measure for use in Australia. Collegian 2021. [DOI: 10.1016/j.colegn.2020.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Racioppi A, Dalton T, Ramalingam S, Romero K, Ren Y, Bohannon L, Arellano C, Jonassaint J, Miller H, Barak I, Fish LJ, Choi T, Gasparetto C, Long GD, Lopez RD, Rizzieri DA, Sarantopoulos S, Horwitz ME, Chao NJ, Shah NR, Sung AD. Assessing the Feasibility of a Novel mHealth App in Hematopoietic Stem Cell Transplant Patients. Transplant Cell Ther 2021; 27:181.e1-181.e9. [PMID: 33830035 PMCID: PMC10522407 DOI: 10.1016/j.jtct.2020.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 12/22/2022]
Abstract
Hematopoietic stem cell transplantation (HCT) is a curative treatment option for patients with hematologic conditions but presents many complications that must be managed as a complex, chronic condition. Mobile health applications (mHealth apps) may permit tracking of symptoms in HCT. In seeking strategies to manage the complexities of HCT, our team collaborated with Sicklesoft, Inc., to develop an mHealth app specifically for HCT patients to allow for daily evaluation of patient health, Technology Recordings to better Understand Bone Marrow Transplantation (TRU-BMT). The primary value of this application is that of potentially enhancing the monitoring of symptoms and general health of patients undergoing HCT, with the ultimate goal of allowing earlier detection of adverse events, earlier intervention, and improving outcomes. To first evaluate patient interest in mHealth apps, we designed and administered an interest survey to patients at the 2017 BMT-InfoNet reunion. As a follow-up to the positive feedback received, we began testing the TRU-BMT app in a Phase 1 pilot study. Thirty patients were enrolled in this single-arm study and were given the TRU-BMT mHealth app on a smartphone device in addition to a wearable activity tracker. Patients were followed for up to 180 days, all the while receiving daily app monitoring. Adherence to TRU-BMT was approximately 30% daily and 44% weekly, and greater adherence was associated with increased meal completion, decreased heart rate, and shorter hospital stay. TRU-BMT assessments of symptom severity were significantly associated with duration of hospital stay and development of chronic graft-versus-host disease. Our findings suggest that using TRU-BMT throughout HCT is feasible for patients and established a proof-of-concept for a future randomized control trial of the TRU-BMT application in HCT. © 2021 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
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Affiliation(s)
- Alessandro Racioppi
- Duke University School of Medicine, Durham, North Carolina; Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
| | - Tara Dalton
- Duke University School of Medicine, Durham, North Carolina
| | - Sendhilnathan Ramalingam
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Kristi Romero
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, North Carolina
| | - Yi Ren
- Duke Cancer Institute Biostatistics Shared Resources, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Lauren Bohannon
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Consuelo Arellano
- Department of Statistics, North Carolina State University, Raleigh, North Carolina
| | - Jude Jonassaint
- Division of Hematology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Hilary Miller
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Ian Barak
- Duke Cancer Institute Biostatistics Shared Resources, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Laura J Fish
- Family Medicine and Community Health, Duke University Medical Center, Durham, North, Carolina
| | - Taewoong Choi
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Gwynn D Long
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Richard D Lopez
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Nirmish R Shah
- Duke Cancer Institute Biostatistics Shared Resources, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
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Self-efficacy in symptom management for adolescents and young adults with cancer: a systematic review. Support Care Cancer 2021; 29:2851-2862. [PMID: 33403400 DOI: 10.1007/s00520-020-05960-6] [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: 08/28/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Adolescents and young adults (AYAs) have more frequent and intense adverse effects from cancer therapy than other age groups. Self-efficacy, the ability for persons to maintain health-related behavior change, may assist with symptom management but the role it plays in AYAs with cancer has not been thoroughly investigated. This review explores the role that self-efficacy has in symptom management for AYAs with cancer and provides guidance for clinicians to utilize self-efficacy as a means to reduce side effects of therapy. METHODS A systematic review of peer-reviewed literature was conducted to identify works discussing self-efficacy and symptom management for AYAs with cancer. Five databases were searched with key terms and articles that discussed relationships between self-efficacy and cancer therapy symptoms were retained for analysis. FINDINGS Twelve manuscripts representing 1180 individuals age 12 to 43 years were identified. Self-efficacy was found to be related to (1) health management behaviors, (2) psychosocial health, (3) sexual and reproductive health, and (4) physical symptoms. Self-efficacy had direct correlations with physical activity, nutritional intake, symptom regulation, mental health, sexual health, and fertility preservation. The included studies did not find significant relationships with medication adherence or pain management. DISCUSSION Self-efficacy is an attribute that impacts behavior change, health maintenance, and overall wellness and can be changed over time and through interventions to improve symptoms of cancer therapy. Self-efficacy should be evaluated as a construct in relevant studies aimed at improving side effects of cancer therapy to better understand outcomes from interventions. Symptoms, toxicities, and adverse effects of cancer therapy may be improved by increasing self-efficacy of patients.
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Leahy AB, Steineck A. Patient-Reported Outcomes in Pediatric Oncology: The Patient Voice as a Gold Standard. JAMA Pediatr 2020; 174:e202868. [PMID: 32832974 PMCID: PMC8103813 DOI: 10.1001/jamapediatrics.2020.2868] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Allison Barz Leahy
- Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania
| | - Angela Steineck
- Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, Washington
- Department of Pediatrics, University of Washington School of Medicine, Seattle
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
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van Oers HA, Teela L, Schepers SA, Grootenhuis MA, Haverman L. A retrospective assessment of the KLIK PROM portal implementation using the Consolidated Framework for Implementation Research (CFIR). Qual Life Res 2020; 30:3049-3061. [PMID: 32803626 PMCID: PMC8528752 DOI: 10.1007/s11136-020-02586-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2020] [Indexed: 12/02/2022]
Abstract
Purpose The KLIK Patient-Reported Outcome Measure (PROM) portal is an evidence-based intervention implemented in clinical practice in > 25 Dutch hospitals for patients (children and adults) who regularly visit the outpatient clinic. Implementation science frameworks can be used to understand why implementation succeeded or failed, to structure barriers and enablers, and to develop implementation strategies to overcome barriers. This paper aimed to (A) retrospectively describe determinants of successful KLIK PROM implementation using the Consolidated Framework for Implementation Research (CFIR), and (B) identify current barriers and match implementation strategies. Methods (A) The KLIK implementation process was described retrospectively based on literature and experience, using the 39 CFIR constructs organized in five general domains: intervention characteristics, outer setting, inner setting, characteristics of individuals, and implementation process. (B) The CFIR-Expert Recommendations for Implementing Change (ERIC) Implementation Strategy Matching tool identified current barriers in the KLIK implementation and matched implementation strategies that addressed the identified barriers. Results (A) The most prominent determinants of successful KLIK PROM implementation lie in the following CFIR domains: intervention characteristics (e.g., easy to use), characteristics of individuals (e.g., motivation), and process of implementation (e.g., support). (B) 13 CFIR constructs were identified as current barriers for implementing the KLIK PROM portal. The highest overall advised ERIC strategy for the specific KLIK barriers was to identify and prepare champions. Conclusion Using an implementation science framework, e.g., CFIR, is recommended for groups starting to use PROMs in clinical care as it offers a structured approach and provides insight into possible enablers and barriers. Electronic supplementary material The online version of this article (10.1007/s11136-020-02586-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hedy A van Oers
- Psychosocial Department, G8-136, Emma Children's Hospital/Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Postbox 2266, 1100 DD, Amsterdam, The Netherlands.
| | - Lorynn Teela
- Psychosocial Department, G8-136, Emma Children's Hospital/Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Postbox 2266, 1100 DD, Amsterdam, The Netherlands
| | - Sasja A Schepers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Lotte Haverman
- Psychosocial Department, G8-136, Emma Children's Hospital/Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Postbox 2266, 1100 DD, Amsterdam, The Netherlands
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Nguyen H, Butow P, Dhillon H, Morris L, Brown A, West K, Sundaresan P. Using patient‐reported outcomes (PROs) and patient‐reported outcome measures (PROMs) in routine head and neck cancer care: What do health professionals perceive as barriers and facilitators? J Med Imaging Radiat Oncol 2020; 64:704-710. [DOI: 10.1111/1754-9485.13048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Hanh Nguyen
- Radiation Oncology Network Sydney Local Health District Western Sydney New South Wales Australia
| | - Phyllis Butow
- Centre for Medical Psychology & Evidence‐based Decision‐making The University of Sydney Sydney New South Wales Australia
| | - Haryana Dhillon
- Centre for Medical Psychology & Evidence‐based Decision‐making The University of Sydney Sydney New South Wales Australia
| | - Lucinda Morris
- Radiation Oncology Network Sydney Local Health District Western Sydney New South Wales Australia
| | - Alison Brown
- Radiation Oncology Network Sydney Local Health District Western Sydney New South Wales Australia
| | - Katrina West
- Radiation Oncology Network Sydney Local Health District Western Sydney New South Wales Australia
| | - Puma Sundaresan
- Radiation Oncology Network Sydney Local Health District Western Sydney New South Wales Australia
- Sydney Medical School The University of Sydney Sydney New South Wales Australia
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Steineck A, Wiener L, Mack JW, Shah NN, Summers C, Rosenberg AR. Psychosocial care for children receiving chimeric antigen receptor (CAR) T-cell therapy. Pediatr Blood Cancer 2020; 67:e28249. [PMID: 32159278 PMCID: PMC8396063 DOI: 10.1002/pbc.28249] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/21/2020] [Accepted: 02/22/2020] [Indexed: 12/11/2022]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy has transformed the treatment of relapsed/refractory B-cell acute lymphoblastic leukemia (ALL). However, this new paradigm has introduced unique considerations specific to the patients receiving CAR T-cell therapy, including prognostic uncertainty, symptom management, and psychosocial support. With increasing availability, there is a growing need for evidence-based recommendations that address the specific psychosocial needs of the children who receive CAR T-cell therapy and their families. To guide and standardize the psychosocial care offered for patients receiving CAR T-cell therapy, we propose the following recommendations for addressing psychosocial support.
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Affiliation(s)
- Angela Steineck
- Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, Washington, USA, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA, Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington, USA, Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA,Correspondence to: Angela Steineck, MD, Seattle Children’s Research Institute, 4800 Sand Point Way NE, MB 8.501 PO Box 5371, Seattle, WA 98145, Tel: 206-987-2106, Fax: 206-987-3946,
| | - Lori Wiener
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer W. Mack
- Dana Farber Cancer Institute, Boston, MA, USA, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Nirali N. Shah
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Corinne Summers
- Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, Washington, USA, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Abby R. Rosenberg
- Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, Washington, USA, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA, Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington, USA, Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
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Vaughn J, Gollarahalli S, Shaw RJ, Docherty S, Yang Q, Malhotra C, Summers-Goeckerman E, Shah N. Mobile Health Technology for Pediatric Symptom Monitoring: A Feasibility Study. Nurs Res 2020; 69:142-148. [PMID: 31972852 DOI: 10.1097/nnr.0000000000000403] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pediatric blood and marrow transplant (PBMT) patients experience significant symptom distress. Mobile health (mHealth) technologies can be leveraged to improve understanding of the patient's symptom experience by providing continuous, real-time, in situ, patient-generated symptom data. This rich data stream can subsequently enhance symptom management strategies. However, limited research has been conducted in this area. OBJECTIVES This pilot study seeks to (a) explore the feasibility of integrating mHealth technologies to monitor symptom data for PBMT patients and (b) evaluate the study design, measures, and procedures. METHODS An exploratory longitudinal design was employed to assess the feasibility of monitoring 10 PBMT patients' symptoms using data from two mHealth technologies: (a) a smartphone mHealth application (app) to collect symptom data and (b) a wearable tracking device (Apple watch) to collect physiological data. Feasibility was measured as usability and acceptability. Monthly patient interviews and an end-of-study feasibility survey were employed and analyzed to further understand reasons for sustained interest in and attrition from the study. RESULTS Overall usability of the wearable was 51%, and app was 56%. Children reported devices were easy to use and acceptable. The study demonstrated acceptability with an enrollment rate of 83% and an attrition rate of 30%, with 70% of the children remaining in the study for at least 40 days. DISCUSSION This pilot study is among the first to explore the feasibility of using mobile technologies to longitudinally obtain patient-generated symptom data to enhance understanding of the PBMT symptom experience. In addition, it will improve our understanding of how these data present, interact, and cluster together throughout the posttransplant period.
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Affiliation(s)
- Jacqueline Vaughn
- Jacqueline Vaughn, BSN, RN, CHSE, is PhD Candidate, Duke University School of Nursing, Durham, North Carolina. Ryan J. Shaw, PhD, RN, is Associate Professor, Duke University School of Nursing, Durham, North Carolina. Sharron Docherty, PhD PNP-BC, FAAN, is Associate Professor, Duke University School of Nursing, Durham, North Carolina. Qing Yang, PhD, is Assistant Professor, Duke University School of Nursing, Durham, North Carolina. Sid Gollarahalli, BA, is Clinical Research Specialist, Duke Health, Durham, North Carolina. Chandni Malhotra, BS, is Undergraduate Research Assistant, Department of Statistics, North Carolina State University, Raleigh. Erika Summers-Goeckerman, MSN, RN, CPNP-AC, is Pediatric Blood and Marrow Transplant Nurse Practitioner, Hematology-Oncology, Duke Health, Durham, North Carolina. Nirmish Shah, MD, is Assistant Professor of Medicine, Hematology-Oncology, Duke Health, Durham, North Carolina
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Snaman J, McCarthy S, Wiener L, Wolfe J. Pediatric Palliative Care in Oncology. J Clin Oncol 2020; 38:954-962. [PMID: 32023163 DOI: 10.1200/jco.18.02331] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Pediatric palliative care aims to alleviate suffering and improve the quality of life of children with serious disease and increase support for their parents and other family members. Integration of palliative care into the routine care of children, adolescents, and young adults with cancer has resulted in improved outcomes in patients and their families. The field of pediatric palliative oncology-encompassing primary palliative care provided by the multidisciplinary oncology team as well as subspecialty palliative care provided by the palliative care team for more complex cases-is unique from palliative care in adults given its focus on care of the child and the larger family. In this review, we focus on advancements in the specific domains within pediatric palliative oncology care including family-centered communication, assessment and management of physical symptoms and distress, psychosocial concerns, and spiritual considerations of the patient, parents, and siblings.
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Affiliation(s)
- Jennifer Snaman
- Dana-Farber Cancer Institute, Boston, MA.,Boston Children's Hospital, Boston, MA
| | | | - Lori Wiener
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Joanne Wolfe
- Dana-Farber Cancer Institute, Boston, MA.,Boston Children's Hospital, Boston, MA
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Marcus KL, Santos G, Ciapponi A, Comandé D, Bilodeau M, Wolfe J, Dussel V. Impact of Specialized Pediatric Palliative Care: A Systematic Review. J Pain Symptom Manage 2020; 59:339-364.e10. [PMID: 31404638 PMCID: PMC6989377 DOI: 10.1016/j.jpainsymman.2019.08.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 11/22/2022]
Abstract
CONTEXT Specialized pediatric palliative care (SPPC) is increasingly involved in the care of seriously ill children, yet the evidence on its impact has not been comprehensively reviewed. OBJECTIVE The objective of this study was to assess the effects of providing SPPC to seriously ill children on patient-, caregiver-, and systems-level outcomes. METHODS We performed a Systematic Review following Cochrane methods. DATA SOURCES Medline, Embase, PsycINFO, Global Health, The Cochrane Central Register of Controlled Trials, LILACS, and Web of Science were searched from January 1996 to June 2018. STUDY SELECTION/DATA EXTRACTION We included randomized controlled, cohort, case-control, and before-after studies in which exposure to SPPC services was the intervention of interest. All outcomes reported in these studies were included. Two investigators independently selected articles, extracted data, and assessed risk of bias of included studies using standardized criteria. RESULTS Twenty-four studies were included in qualitative synthesis: one nonrandomized controlled trial, 16 cohort studies, and seven before-after studies. Evidence certainty was low. Twenty-one studies had one or more area with high risk of bias, most commonly selection bias, low group comparability, risk for confounding, and inadequate statistical reporting. Studies analyzed 46 domains, operationalized as 136 distinct outcomes. SPPC was associated with better child quality of life scores in all four studies that assessed this outcome. No other outcome showed this consistency. CONCLUSION Receiving SPPC was associated with better child quality of life. However, the paucity and low certainty of the evidence precluded any firm recommendations about SPPC practice. Larger collaborative networks and greater consensus regarding SPPC research standards are needed.
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Affiliation(s)
- Katherine L Marcus
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Gisella Santos
- Center for Research and Implementation in Palliative Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
| | - Agustín Ciapponi
- Cochrane Center, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
| | - Daniel Comandé
- Cochrane Center, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
| | - Madeline Bilodeau
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Joanne Wolfe
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Veronica Dussel
- Center for Research and Implementation in Palliative Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
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A Feasibility Study of a Social Robot Collecting Patient Reported Outcome Measurements from Older Adults. Int J Soc Robot 2020. [DOI: 10.1007/s12369-019-00561-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kaur G, Kyte D, Reeve BB, Basch E, Calvert M. Patient-reported outcome monitoring in a routine paediatric oncology setting: challenges and opportunities. Lancet Oncol 2019; 20:19-20. [DOI: 10.1016/s1470-2045(18)30785-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 12/16/2022]
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Linder LA, Wawrzynski SE. Staff Perceptions of Symptoms, Approaches to Assessment, and Challenges to Assessment Among Children With Cancer. J Pediatr Oncol Nurs 2018; 35:332-341. [PMID: 29652214 PMCID: PMC6319255 DOI: 10.1177/1043454218767888] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Nurses are often the first to recognize and respond to children's symptoms. This descriptive, exploratory study characterized how pediatric oncology health care providers characterize and assess children's cancer-related symptoms. The study also explored challenges associated with symptom assessment and information perceived as helpful in planning interventions. The setting was a Children's Oncology Group-affiliated hospital in the Intermountain West of the United States. Twenty-two pediatric oncology health care providers (95% female; 68% nurses) participated in one of four focus group sessions. Sessions were facilitated by two individuals and included six open-ended questions addressing participants' perspectives of cancer-related symptoms, approaches to symptom assessment, challenges and frustrations encountered when assessing symptoms, and information needed to plan interventions. Participants identified 75 physical and psychosocial responses that included both subjectively experienced symptoms and other consequences of the cancer experience. Qualitative content analysis procedures organized other responses into categories and subcategories. Participants most frequently reported using observational approaches including physical assessment findings and observation of the child's behavior to identify symptoms. Strategies that sought the child's input such as the use of a rating scale or seeking the child's verbal description were less frequently named. Participants related discerning and interpreting the child's behaviors as a challenge to symptom assessment. They also reported attention to symptom characteristics as important to planning interventions. Future directions include building capacity to support child-centric symptom assessment. Development of reliable and valid resources for use in clinical settings may support a more child-centric approach to symptom assessment.
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Affiliation(s)
- Lauri A. Linder
- University of Utah, Salt Lake City, UT, USA
- Primary Children’s Hospital, Salt Lake City, UT, USA
| | - Sarah E. Wawrzynski
- University of Utah, Salt Lake City, UT, USA
- Primary Children’s Hospital, Salt Lake City, UT, USA
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