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Kowalchuk RO, Hillman D, Daniels TB, Vargas CE, Rwigema JCM, Wong WW, Stish BJ, Dueck AC, Choo R. Assessing concordance between patient-reported and investigator-reported CTCAE after proton beam therapy for prostate cancer. Clin Transl Radiat Oncol 2021; 31:34-41. [PMID: 34604551 PMCID: PMC8463742 DOI: 10.1016/j.ctro.2021.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/27/2021] [Accepted: 09/08/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE We report acute patient-reported outcomes using CTCAE (PRO-CTCAE) of proton beam radiotherapy for high-risk or unfavorable intermediate-risk prostate cancer in a prospective clinical trial. PRO-CTCAE were correlated with investigator reported-CTCAE (IR-CTCAE) to assess the degree of concordance. METHODS AND MATERIALS 11 PRO-CTCAE questions assessed gastrointestinal (GI), genitourinary (GU), or erectile function side effects. The correlation scheme between PRO-CTCAE and IR-CTCAE was independently developed by two physicians. Analyses of PRO-CTCAE and IR-CTCAE were conducted using both descriptive terms and the converted grade scores. The Kappa statistic described the degree of concordance. RESULTS 55 patients were included. IR-CTCAE underestimated diarrhea compared to PRO-CTCAE at the end of treatment (EOT), with a 28% rate of underestimation (11% by ≥ 2 toxicity grades). Similarly, urinary tract pain was underestimated in 45% of cases (17% by ≥ 2 grades) at EOT. Differences were less pronounced at baseline or 3 months after radiotherapy. The incidence of urinary urgency and frequency tended to be overestimated prior to treatment (36% and 24%, respectively) but underestimated at EOT (35% and 31%, respectively). The degree of interference with daily activities was consistently overestimated by investigators (45%-85%). Finally, erectile dysfunction showed a 36-56% rate of discordance by ≥ 2 toxicity grades. CONCLUSIONS Our study shows a low agreement between IR-CTCAE and PRO-CTCAE in the setting of proton therapy for prostate cancer. Compared to patient-reported outcomes, physicians underestimated the frequency and severity of urinary symptoms and diarrhea at the end of treatment. Continued use of PROs should be strongly encouraged.
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Affiliation(s)
| | - David Hillman
- Department of Statistics, Mayo Clinic, Rochester, MN, USA
| | - Thomas B. Daniels
- Department of Radiation Oncology, NYU Langone Health, New York, NY, USA,Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Carlos E. Vargas
- Department of Radiation Oncology, NYU Langone Health, New York, NY, USA,Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Jean-Claude M. Rwigema
- Department of Radiation Oncology, NYU Langone Health, New York, NY, USA,Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - William W. Wong
- Department of Radiation Oncology, NYU Langone Health, New York, NY, USA,Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Bradley J. Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Richard Choo
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA,Corresponding author at: Department of Radiation Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA.
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Horn ME, George SZ, Li C, Luo S, Lentz TA. Derivation of a Risk Assessment Tool for Prediction of Long-Term Pain Intensity Reduction After Physical Therapy. J Pain Res 2021; 14:1515-1524. [PMID: 34093037 PMCID: PMC8169054 DOI: 10.2147/jpr.s305973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/28/2021] [Indexed: 11/28/2022] Open
Abstract
Rationale Risk assessment tools can improve clinical decision-making for individuals with musculoskeletal pain, but do not currently exist for predicting reduction of pain intensity as an outcome from physical therapy. Aims and Objective The objective of this study was to develop a tool that predicts failure to achieve a 50% pain intensity reduction by 1) determining the appropriate statistical model to inform the tool and 2) select the model that considers the tradeoff between clinical feasibility and statistical accuracy. Methods This was a retrospective, secondary data analysis of the Optimal Screening for Prediction of Referral and Outcome (OSPRO) cohort. Two hundred and seventy-nine individuals seeking physical therapy for neck, shoulder, back, or knee pain who completed 12-month follow-up were included. Two modeling approaches were taken: a longitudinal model included demographics, presence of previous episodes of pain, and regions of pain in addition to baseline and change in OSPRO Yellow Flag scores to 12 months; two comparison models included the same predictors but assessed only baseline and early change (4 weeks) scores. The primary outcome was failure to achieve a 50% reduction in pain intensity score at 12 months. We compared the area under the curve (AUC) to assess the performance of each candidate model and to determine which to inform the Personalized Pain Prediction (P3) risk assessment tool. Results The baseline only and early change models demonstrated lower accuracy (AUC=0.68 and 0.71, respectively) than the longitudinal model (0.79) but were within an acceptable predictive range. Therefore, both baseline and early change models were used to inform the P3 risk assessment tool. Conclusion The P3 tool provides physical therapists with a data-driven approach to identify patients who may be at risk for not achieving improvements in pain intensity following physical therapy.
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Affiliation(s)
- Maggie E Horn
- Duke University, Department of Orthopaedic Surgery, Durham, NC, 27701, USA
| | - Steven Z George
- Duke University, Department of Orthopaedic Surgery and Duke Clinical Research Institute, Durham, NC, 27701, USA
| | - Cai Li
- Yale University, Department of Biostatistics, New Haven, CT, USA
| | - Sheng Luo
- Duke University, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Trevor A Lentz
- Duke University, Department of Orthopaedic Surgery and Duke Clinical Research Institute, Durham, NC, 27701, USA
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Yang TK, Wu CC, Chang CH, Muo CH, Huang CY, Chung CJ. Subsequent risk of acute urinary retention and androgen deprivation therapy in patients with prostate cancer: A population-based retrospective cohort study. Medicine (Baltimore) 2020; 99:e18842. [PMID: 32049786 PMCID: PMC7035125 DOI: 10.1097/md.0000000000018842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Acute urinary retention (AUR) is associated with hormone imbalance in men. However, limited studies focused on exploring the complications of AUR in patients with prostate cancer (PC) who receive androgen deprivation therapy (ADT). Therefore, we aim to evaluate the subsequent risk of AUR in ADT-treated PC patients. We collected data from 24,464 male patients who were newly diagnosed with prostate malignancy from a longitudinal health insurance database of catastrophic illness in 2000 to 2008. All PC patients were categorized into 2 cohorts, namely, ADT cohort and non-ADT cohort, based on whether or not the patient receives ADT. The patients were followed up until the occurrence of AUR. Multivariate Cox proportional hazard regression and Kaplan-Meier analysis were performed. After a 12-year follow-up, the incidence rates of AUR were 12.49 and 9.86 per 1000 person-years in ADT and non-ADT cohorts, respectively. Compared with the non-ADT cohort, the ADT cohort had a 1.21-fold increase in AUR risk based on the adjusted model (95% CI = 1.03-1.43). In addition, PC patients receiving early ADT treatment within 6 months or receiving only luteinizing hormone-releasing hormone treatment also had significantly increased risk of AUR. ADT was positively associated with AUR risk. PC patients receiving ADT should be informed about the risks of bladder outlet obstruction and AUR, and they may benefit from screening for related risk factors. New guidelines and treatments should be proposed in the future to manage ADT-related lower urinary tract symptoms and reduce the risk of AUR.
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Affiliation(s)
- Teng-Kai Yang
- Department of Surgery, Yonghe Cardinal Hospital
- School of Medicine, College of Medicine, Fu-Jen Catholic University
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University
| | - Chia-Chang Wu
- Department of Urology, Shuang-Ho Hospital
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University
| | | | | | - Chao-Yuan Huang
- Department of Urology, Taipei
- Department of Urology, National Taiwan University Hospital, Hsin Chu Branch, Hsin Chu City
| | - Chi-Jung Chung
- Department of Public Health, College of Public Health, China Medical University
- Department of Medical Research, China Medical University and Hospital, Taichung, Taiwan
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Campbell JM, Raymond E, O'Callaghan ME, Vincent AD, Beckmann KR, Roder D, Evans S, McNeil J, Millar J, Zalcberg J, Borg M, Moretti KL. Optimum Tools for Predicting Clinical Outcomes in Prostate Cancer Patients Undergoing Radical Prostatectomy: A Systematic Review of Prognostic Accuracy and Validity. Clin Genitourin Cancer 2017; 15:e827-e834. [DOI: 10.1016/j.clgc.2017.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/25/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
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