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Gurgenci T, O'Leary C, Philip J, Bruera E, Davis M, Agar MR, Hui D, Zimmermann C, Yennu S, Hardy J, Mercadante S, Rosa WE, Good P. Top Ten Tips Palliative Care Clinicians Should Know About Designing a Clinical Trial in Palliative Care. J Palliat Med 2024. [PMID: 39167532 DOI: 10.1089/jpm.2024.0259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024] Open
Abstract
The palliative care field is experiencing substantive growth in clinical trial-based research. Randomized controlled trials provide the necessary rigor and conditions for assessing a treatment's efficacy in a controlled population. It is therefore important that a trial is meticulously designed from the outset to ensure the integrity of the ultimate results. In this article, our team discusses ten tips on clinical trial design drawn from collective experiences in the field. These ten tips cover a range of topics that can prove challenging in trial design, from developing initial methodologies to planning sample size and powering the trial, as well as collaboratively navigating the ethical issues of trial initiation and implementation as a cohesive team. We aim to help new researchers design sound trials and continue to grow the evidence base for our specialty. The guidance provided here can be used independently or in addition to the ten tips provided by this team in a separate article focused on what palliative care clinicians should know about interpreting a clinical trial.
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Affiliation(s)
- Taylan Gurgenci
- Department of Palliative and Supportive Care, Brisbane, Queensland, Australia
- Cancer Program, Mater Research Institute-University of Queensland, Brisbane, Queensland, Australia
| | - Cian O'Leary
- Cancer Services, Mater Health, Brisbane, Queensland, Australia
| | - Jennifer Philip
- Department of Palliative Care, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Palliative Care, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
- Department of Palliative Care, Palliative Care Service, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, & Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Mellar Davis
- Director of Palliative Care Research at Geisinger Medical Center, Geisinger Commonwealth School of Medicine, Scranton PA, Danville, Pennsylvania, USA
| | - Meera R Agar
- Faculty of Health,IMPACCT, University of Technology Sydney, Sydney, New South Wales, Australia
| | - David Hui
- Department of Palliative, Rehabilitation, & Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Sriram Yennu
- Department of Palliative, Rehabilitation, & Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Janet Hardy
- Cancer Program, Mater Research Institute-University of Queensland, Brisbane, Queensland, Australia
| | - Sebastiano Mercadante
- Pain Relief and Supportive-Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy
| | - William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Phillip Good
- Department of Palliative and Supportive Care, Brisbane, Queensland, Australia
- Department of Palliative Care, St Vincent's Private Hospital, Brisbane, Queensland, Australia
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La Rosa GRM. Rethinking dental research: the importance of patient-reported outcomes and minimally clinically important difference. Evid Based Dent 2024:10.1038/s41432-024-01034-2. [PMID: 38961312 DOI: 10.1038/s41432-024-01034-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Affiliation(s)
- Giusy Rita Maria La Rosa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, Catania, Italy.
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Robertson EG, Hetherington K, Daly R, Donoghoe MW, Handelsman N, Ziegler DS, Wakefield CE. The feasibility and acceptability of collecting psychosocial outcome measures embedded within a precision medicine trial for childhood cancer. Cancer Med 2024; 13:e7339. [PMID: 38898768 PMCID: PMC11187165 DOI: 10.1002/cam4.7339] [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: 10/15/2023] [Revised: 05/07/2024] [Accepted: 05/18/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Patient-reported outcomes measures (PROMs) are increasingly being collected within cancer clinical trials, yet limited literature on the feasibility and acceptability of doing so. METHODS We collected parent-proxy and adolescent (≥12 years old) PROMs through a longitudinal, psychosocial sub-study ('PRISM-Impact') embedded in a precision medicine trial for children with poor prognosis cancer ('PRISM'). We report on feasibility (response, participation, and attrition rates; follow-up and responding to elevated distress) and acceptability (parents' perceived benefit/burden of participation; and impact on decision to participate in PRISM) of PRISM-Impact. RESULTS Over the reporting period, 462 families were eligible for PRISM-Impact. Family and adolescent response rates were 53% and 45%, respectively. Parents whose child had relapsed were more likely to participate in PRISM-Impact than parents whose child had not (p < 0.001). Parent and adolescent attrition rates were 30% and 56% respectively. We conducted 478 calls for intake and to follow-up on missing questionnaires, and 122 calls to respond to elevated distress. Parents reported wanting to participate in PRISM-Impact for altruistic reasons and because they valued psychosocial research. Parents reported little-to-no burden and some benefit from participating in PRISM-Impact, with little change in ratings overtime. Most parents felt that participating in PRISM-Impact did not impact their desire to participate in PRISM (72%), with some feeling more eager to participate (19%). CONCLUSIONS PRISM-Impact response rates were comparable to other psycho-oncology studies, despite the poor prognosis population. Integration of PROMs within a paediatric oncology trial is acceptable to parents, and may provide a more comprehensive assessment of the impact of trial participation.
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Affiliation(s)
- Eden G. Robertson
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & HealthUNSW SydneyKensingtonNew South WalesAustralia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia
- Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia
| | - Kate Hetherington
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & HealthUNSW SydneyKensingtonNew South WalesAustralia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia
- Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia
| | - Rebecca Daly
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & HealthUNSW SydneyKensingtonNew South WalesAustralia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia
- Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia
| | - Mark W. Donoghoe
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & HealthUNSW SydneyKensingtonNew South WalesAustralia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia
- Stats Central, Mark Wainwright Analytical CentreUNSW SydneyKensingtonNew South WalesAustralia
| | - Nicholas Handelsman
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & HealthUNSW SydneyKensingtonNew South WalesAustralia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia
- Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia
| | - David S. Ziegler
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & HealthUNSW SydneyKensingtonNew South WalesAustralia
- Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia
- Children's Cancer InstituteUNSW SydneySydneyNew South WalesAustralia
| | - Claire E. Wakefield
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & HealthUNSW SydneyKensingtonNew South WalesAustralia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia
- Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia
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Raj P, Cho Y, Jiang Y, Gong Y. Selecting patient-reported outcome measures for a patient-facing technology. JAMIA Open 2023; 6:ooad104. [PMID: 38098479 PMCID: PMC10719077 DOI: 10.1093/jamiaopen/ooad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/11/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023] Open
Abstract
Objective This article provides insight into our process and considerations for selecting patient-reported outcome measures (PROMs) designed for self-reporting symptoms and quality-of-life among breast cancer (BCA) patients undergoing oral anticancer agent treatment via a patient-facing technology (PFT) platform. Methods Following established guidelines, we conducted a thorough assessment of a specific set of PROMs, comparing their content to identify the most suitable options for studying BCA patients. Results We recommend utilizing the combination of EORTC QLQ-C30 + EORTC QLQ-BR45 as the preferred instrument, especially when developing a dedicated "breast cancer-only" application. Discussion When developing and maintaining a dashboard for a PFT platform that includes multiple cancer types, it is important to consider the feasibility of interface design and workload. To achieve this, we recommend using PRO-CTCAE+PROMIS 10 GH for the PFT. Moreover, it is important to consider adding ad hoc items to complement the chosen PROM(s). Conclusion This article describes our efforts to identify PROMs for self-reported data while considering patient and developer burdens, providing guidance to PFT developers facing similar challenges in PROM selection.
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Affiliation(s)
- Priyank Raj
- D. Bradley McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Youmin Cho
- D. Bradley McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Yun Jiang
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, United States
| | - Yang Gong
- D. Bradley McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
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Furumaya A, van Rosmalen BV, de Graeff JJ, van der Poel MJ, Ramsoekh DS, Kazemier G, Verheij J, Takkenberg RB, Besselink MG, Erdmann JI, van Gulik TM. Relief of symptoms and quality of life after conservative versus surgical treatment of benign liver tumors (CONSULT): a retrospective propensity score matched study. HPB (Oxford) 2023:S1365-182X(23)00073-4. [PMID: 36990916 DOI: 10.1016/j.hpb.2023.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/22/2023] [Accepted: 02/28/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Surgery can be considered for selected patients with benign liver tumours (BLT). The aim of this study was to compare symptoms and quality of life (QoL) after conservative and surgical management of BLT. METHODS In this dual-site cross-sectional retrospective study, adult patients with BLT diagnosed between 2000 and 2019 completed EORTC QLQ-C30 questionnaires on current symptoms and symptoms at diagnosis. Summary scores (SumScores) and QoL scores at follow-up were compared between surgically and conservatively treated patients by matched t-tests. Propensity score matching attempted to reduce confounding. Higher scores indicate less symptoms and higher QoL. RESULTS Fifty surgically (22.6%) and 171 (77.4%) conservatively treated patients were included at median 95 (IQR:66-120) and 91 (IQR:52-129) months, respectively. Most surgically treated patients reported stable, improved or disappeared symptoms (87%) and would undergo surgery again (94%). After propensity score matching, surgical patients had higher SumScores (mean difference 9.2, 95%CI:1.0-17.4, p = 0.028) but not higher QoL scores (p = 0.331) at follow-up than conservatively treated counterparts (31 patients in both groups). DISCUSSION Patients who had undergone surgery often reported they would undergo surgery again. Moreover, they had less symptoms than conservatively managed patients while they were propensity score matched on relevant variables, including baseline symptoms.
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Affiliation(s)
- Alicia Furumaya
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands.
| | - Belle V van Rosmalen
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Jan Jaap de Graeff
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Marcel J van der Poel
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - D Sandjai Ramsoekh
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Department of Gastroenterology and Hepatology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Geert Kazemier
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Joanne Verheij
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Department of Pathology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - R Bart Takkenberg
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Department of Gastroenterology and Hepatology, Amsterdam UMC Location University of Amsterdam, the Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Joris I Erdmann
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands.
| | - Thomas M van Gulik
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
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Snyder Valier AR, Huxel Bliven KC, Lam KC, Valovich McLeod TC. Patient-reported outcome measures as an outcome variable in sports medicine research. Front Sports Act Living 2022; 4:1006905. [PMID: 36406772 PMCID: PMC9666499 DOI: 10.3389/fspor.2022.1006905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/26/2022] [Indexed: 11/23/2022] Open
Abstract
Injury prevention and rehabilitation research often address variables that would be considered clinician-oriented outcomes, such as strength, range of motion, laxity, and return-to-sport. While clinician-oriented variables are helpful in describing the physiological recovery from injury, they neglect the patient perspective and aspects of patient-centered care. Variables that capture patient perspective are essential when considering the impact of injury and recovery on the lives of patients. The inclusion of patient-reported outcome measures (PROMs) as dependent variables in sports medicine research, including injury prevention and rehabilitation research, provides a unique perspective regarding the patient's perception of their health status, the effectiveness of treatments, and other information that the patient deems important to their care. Over the last 20 years, there has been a significant increase in the use of PROMs in sports medicine research. The growing body of work gives opportunity to reflect on what has been done and to provide some ideas of how to strengthen the evidence moving forward. This mini-review will discuss ideas for the inclusion of PROMs in sports medicine research, with a focus on critical factors, gaps, and future directions in this area of research. Important elements of research with PROMs, including instrument selection, administration, and interpretation, will be discussed and areas for improvement, consideration, and standardization will be provided.
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Affiliation(s)
- Alison R. Snyder Valier
- Department of Athletic Training, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, United States,School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ, United States
| | - Kellie C. Huxel Bliven
- Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, United States
| | - Kenneth C. Lam
- Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, United States
| | - Tamara C. Valovich McLeod
- Department of Athletic Training, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, United States,School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ, United States,*Correspondence: Tamara C. Valovich McLeod
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Rutherford C, Boehnke JR. Introduction to the special section "Reducing research waste in (health-related) quality of life research". Qual Life Res 2022; 31:2881-2887. [PMID: 35907111 DOI: 10.1007/s11136-022-03194-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Claudia Rutherford
- Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Cancer Care Research Unit (CCRU), The University of Sydney, Sydney, Australia. .,Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Sydney, Australia. .,The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia.
| | - Jan R Boehnke
- School of Health Sciences, University of Dundee, Dundee, UK
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Alrubaiy L, Hutchings HA, Hughes SE, Dobbs T. Saving time and effort: Best practice for adapting existing patient-reported outcome measures in hepatology. World J Hepatol 2022; 14:896-910. [PMID: 35721294 PMCID: PMC9157705 DOI: 10.4254/wjh.v14.i5.896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/29/2021] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
It is increasingly recognised that collecting patient reported outcome measures (PROMs) data is an important part of healthcare and should be considered alongside traditional clinical assessments. As part of a more holistic view of healthcare provision, there has been an increased drive to implement PROM collection as part of routine clinical care in hepatology. This drive has resulted in an increase in the number of PROMs currently developed to be used in various liver conditions. However, the development and validation of a new PROM is time-consuming and costly. Therefore, before deciding to develop a new PROM, researchers should consider identifying existing PROMs to assess their appropriateness and, if necessary, make adaptations to existing PROMs to ensure their rigour when used with the target population. Little is written in the literature on how to identify and adapt the existing PROMs in hepatology. This article aims to provide a summary of the current literature and guidance regarding identifying and adapting existing PROMs in clinical practice.
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Affiliation(s)
- Laith Alrubaiy
- Department of Gastroenterology, St Mark's Hospital, London HA1 3UJ, United Kingdom
| | - Hayley A Hutchings
- Institute of Life Sciences 2, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, United Kingdom
| | - Sarah E Hughes
- Swansea University Medical School, Swansea University, Swansea SA2 8PP, United Kingdom
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Thomas Dobbs
- Swansea University, Swansea SA2 8PP, United Kingdom
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Al Sayah F, Jin X, Johnson JA. Selection of patient-reported outcome measures (PROMs) for use in health systems. J Patient Rep Outcomes 2021; 5:99. [PMID: 34637010 PMCID: PMC8511255 DOI: 10.1186/s41687-021-00374-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/30/2022] Open
Abstract
Many healthcare systems around the world have been increasingly using patient-reported outcome measures (PROMs) in routine outcome measurement to enhance patient-centered care and incorporate the patient's perspective in health system performance evaluation. One of the key steps in using PROMs in health systems is selecting the appropriate measure(s) to serve the purpose and context of measurement. However, the availability of many PROMs makes this choice rather challenging. Our aim was to provide an integrated approach for PROM(s) selection for use by end-users in health systems.The proposed approach was based on relevant literature and existing guidebooks that addressed PROMs selection in various areas and for various purposes, as well as on our experience working with many health system users of PROMs in Canada. The proposed approach includes the following steps: (1) Establish PROMs selection committee; (2) Identify the focus, scope, and type of PROM measurement; (3) Identify potential PROM(s); (4) Review practical considerations for each of the identified PROMs; (5) Review measurement properties of shortlisted PROMs; (6) Review patient acceptance of shortlisted PROMs; (7) Recommend a PROM(s); and (8) Pilot the selected PROM(s). The selection of appropriate PROMs is one step in the successful implementation of PROMs within health systems, albeit, an essential step. We provide guidance for the selection of PROMs to satisfy all potential usages at the micro (patient-clinician), meso (organization), and macro (system) levels within the health system. Selecting PROMs that satisfy all these purposes is essential to ensure continuity and standardization of measurement over time. This is an iterative process and users should consider all the available information from all presented steps in selecting PROMs. Each of these considerations has a different weight in diverse clinical contexts and settings with various types of patients and resources.
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Affiliation(s)
- Fatima Al Sayah
- Alberta PROMs & EQ-5D Research & Support Unit (APERSU), School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB T6G 2E1 Canada
| | - Xuejing Jin
- Centre for Evidence-Based Medicine, School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jeffrey A. Johnson
- Alberta PROMs & EQ-5D Research & Support Unit (APERSU), School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB T6G 2E1 Canada
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Maguiness S, Berman Y, Rubin N, Dodds M, Plotkin SR, Wong C, Moertel C. Measuring the Effect of Cutaneous Neurofibromas on Quality of Life in Neurofibromatosis Type 1. Neurology 2021; 97:S25-S31. [PMID: 34230204 DOI: 10.1212/wnl.0000000000012427] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 04/23/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In order to explore the use of Skindex scoring in patients with neurofibromatosis type 1 (NF1) across multiple clinical sites and inform design of additional quality of life measures, we analyzed correlations between Skindex, site, and clinical measures for 79 patients with NF1 from specialized clinics in Sydney, Australia (Royal North Shore Hospital [RNS]) and Minneapolis, Minnesota (University of Minnesota [UMN]). METHODS The relationship between clinical factors and Skindex scores were explored by clinic site and overall. RESULTS A total of 40 participants were recruited from RNS and 39 from UMN. Female sex, total number of cutaneous neurofibroma (cNF), and whether cNF were present on the face correlated highly with Skindex and not Riccardi scores. The UMN site had lower average scores, but these differences were almost entirely removed after adjusting for age, sex, facial cNF, and total cNF number. CONCLUSIONS The development of cNF in adolescence and adulthood in NF1 often leads to progressive disfigurement and discomfort and is among one of the most common reasons for patients to seek medical treatment. Skindex has been used to assess skin-related quality of life in NF1 previously but is not specific to NF1. These findings highlight the need for a low threshold for referral to dermatologists for all patients with NF1 regardless of the severity of disease. The finding that facial cNF and higher total number of cNF correlates with poorer skin-related quality of life may benefit design of more specific NF1 skin-related quality of life measures.
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Affiliation(s)
- Sheilagh Maguiness
- From the Department of Dermatology (S.M., M.D.), Biostatistics Core, Masonic Cancer Center (N.R.), and Department of Pediatrics (C.M.), University of Minnesota, Minneapolis; Department of Clinical Genetics (Y.B., C.W.), Royal North Shore Hospital; Faculty of Medicine (Y.B.), University of Sydney, Australia; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston
| | - Yemima Berman
- From the Department of Dermatology (S.M., M.D.), Biostatistics Core, Masonic Cancer Center (N.R.), and Department of Pediatrics (C.M.), University of Minnesota, Minneapolis; Department of Clinical Genetics (Y.B., C.W.), Royal North Shore Hospital; Faculty of Medicine (Y.B.), University of Sydney, Australia; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston.
| | - Nathan Rubin
- From the Department of Dermatology (S.M., M.D.), Biostatistics Core, Masonic Cancer Center (N.R.), and Department of Pediatrics (C.M.), University of Minnesota, Minneapolis; Department of Clinical Genetics (Y.B., C.W.), Royal North Shore Hospital; Faculty of Medicine (Y.B.), University of Sydney, Australia; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston
| | - Melissa Dodds
- From the Department of Dermatology (S.M., M.D.), Biostatistics Core, Masonic Cancer Center (N.R.), and Department of Pediatrics (C.M.), University of Minnesota, Minneapolis; Department of Clinical Genetics (Y.B., C.W.), Royal North Shore Hospital; Faculty of Medicine (Y.B.), University of Sydney, Australia; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston
| | - Scott R Plotkin
- From the Department of Dermatology (S.M., M.D.), Biostatistics Core, Masonic Cancer Center (N.R.), and Department of Pediatrics (C.M.), University of Minnesota, Minneapolis; Department of Clinical Genetics (Y.B., C.W.), Royal North Shore Hospital; Faculty of Medicine (Y.B.), University of Sydney, Australia; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston
| | - Claire Wong
- From the Department of Dermatology (S.M., M.D.), Biostatistics Core, Masonic Cancer Center (N.R.), and Department of Pediatrics (C.M.), University of Minnesota, Minneapolis; Department of Clinical Genetics (Y.B., C.W.), Royal North Shore Hospital; Faculty of Medicine (Y.B.), University of Sydney, Australia; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston
| | - Christopher Moertel
- From the Department of Dermatology (S.M., M.D.), Biostatistics Core, Masonic Cancer Center (N.R.), and Department of Pediatrics (C.M.), University of Minnesota, Minneapolis; Department of Clinical Genetics (Y.B., C.W.), Royal North Shore Hospital; Faculty of Medicine (Y.B.), University of Sydney, Australia; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston
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Quality of Life in Vulnerable Older Patients with Metastatic Colorectal Cancer Receiving Palliative Chemotherapy-The Randomized NORDIC9-Study. Cancers (Basel) 2021; 13:cancers13112604. [PMID: 34073363 PMCID: PMC8198682 DOI: 10.3390/cancers13112604] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 11/17/2022] Open
Abstract
Quality of life data from randomized trials are lacking in older patients with metastatic colorectal cancer (mCRC). In the randomized NORDIC9-study, reduced-dose S1+oxaliplatin (SOx) showed superior efficacy compared to full-dose S1 monotherapy. We hypothesized that treatment with SOx does not result in inferior quality of life. Patients with mCRC aged ≥70 years and that were not a candidate for standard combination chemotherapy were included and randomly assigned to receive either S1 or SOx. The EORTC QLQ-C30 questionnaire was completed at baseline, after 9, and 18 weeks. The primary endpoint was global Quality of Life (QoL) at 9 weeks. For statistical analysis, a non-inferiority design was chosen applying linear mixed effects models for repeated measurements. The results were interpreted according to statistical significance and anchor-based, clinically relevant between-group minimally important differences (MID). A total of 160 patients aged (median (Interquartile range (IQR))) 78 years (76-81) were included. The QLQ-C30 questionnaire was completed by 150, 100, and 60 patients at baseline, at 9, and 18 weeks, respectively. The difference at 9 weeks in global QoL was 6.85 (95%CI-1.94; 15.65) and 7.37 (0.70; 14.05) in the physical functioning domain in favor of SOx exceeding the threshold for MID. At 18 weeks, the between-group MID in physical functioning was preserved. Dose-reduced combination chemotherapy may be recommended in vulnerable older patients with mCRC, rather than full-dose monotherapy.
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12
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Hong K, Majercak KR, Villalonga-Olives E, Perfetto EM. Patient-reported outcomes in breast cancer FDA drug labels and review documents. J Patient Rep Outcomes 2021; 5:36. [PMID: 33881661 PMCID: PMC8060367 DOI: 10.1186/s41687-021-00308-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/01/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient-reported outcomes (PROs) can provide valuable information about drug benefit-risk tradeoffs from the patient perspective and are particularly important to patients with breast cancer due to its symptoms and adverse events from breast cancer treatments. The United States Food and Drug Administration (U.S. FDA) has acknowledged PROs as important approval endpoints used in clinical trials of cancer drugs. However, previous studies found that PROs are rarely mentioned in cancer drug labels, a widely used and trusted source of information about drugs. Our objectives were to compare PRO data reported in FDA labeling versus FDA medical review documents for breast cancer drugs approved in the U.S. between 2000 and 2019 to identify possible causes for PRO-data labeling exclusions. METHODS We included new molecular entities (NMEs) and biologic license applications (BLAs) initially approved for breast cancer treatment by the FDA between 1/1/2000 and 12/31/2019. Product labeling and FDA medical review documents were collected from the FDA-Approved Drugs database (Drugs@FDA). From these resources, details on PRO measures used in trials, design of trials using PRO measures, PRO-endpoint status, analytical methods, and FDA reviewer comments regarding PRO measurement were extracted. RESULTS Of 633 FDA-approved drugs, 13 were indicated for breast cancer treatment; none of their prescribing information contained information about PROs. However, 11 of 13 (85%) included PRO measures and endpoint information in FDA medical review documents. PRO measures were used in 14 different clinical trials, and FDA reviewers' comments regarding PRO measurement were related to lack of meaningfulness and clinical significance, lack of content validity, and inadequate analytical methods. CONCLUSIONS Despite the importance of PROs to patients with breast cancer, PRO measures were only described in FDA medical review documents of breast cancer drugs, but not in drug product labeling. Therefore, it appears that PRO data are often collected in breast cancer trials, but have not been methodologically acceptable to FDA reviewers. Collaborative efforts between the FDA and industry are warranted to increase the number of breast cancer drug applications with appropriate use of PRO measures and endpoints.
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Affiliation(s)
- Kyungwan Hong
- Department of Pharmaceutical Health Services Research, University of Maryland, School of Pharmacy, 220 Arch Street, 12th Floor, Room: 01-328, Baltimore, MD, 21201, USA.
| | - Kayleigh R Majercak
- Department of Pharmaceutical Health Services Research, University of Maryland, School of Pharmacy, 220 Arch Street, 12th Floor, Room: 01-328, Baltimore, MD, 21201, USA
| | - Ester Villalonga-Olives
- Department of Pharmaceutical Health Services Research, University of Maryland, School of Pharmacy, 220 Arch Street, 12th Floor, Room: 01-328, Baltimore, MD, 21201, USA
| | - Eleanor M Perfetto
- Department of Pharmaceutical Health Services Research, University of Maryland, School of Pharmacy, 220 Arch Street, 12th Floor, Room: 01-328, Baltimore, MD, 21201, USA
- National Health Council, Washington DC, USA
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13
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Paucity of data evaluating patient centred outcomes following sentinel lymph node dissection in endometrial cancer: A systematic review. Gynecol Oncol Rep 2021; 36:100763. [PMID: 33869716 PMCID: PMC8042432 DOI: 10.1016/j.gore.2021.100763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/10/2021] [Accepted: 03/22/2021] [Indexed: 12/24/2022] Open
Abstract
SLND has potentially favourable patient-centred outcomes over systematic LND. High-quality evidence comparing SLND with other methods of staging is lacking. SLND was associated with shorter operating times and lower estimated blood loss. Intraoperative and postoperative complications were not conclusively different.
Sentinel lymph node dissection (SLND) is presently used by the majority of gynaecologic oncologists for surgical staging of endometrial cancer. SLND assimilated into routine surgical practice because it increases precision of surgical staging and may reduce morbidity compared to a full, systematic LND. Previous research focussed on the accuracy of SLND. Patient centred outcomes have never been conclusively demonstrated. The objective of this systematic review was to evaluate patient centred outcomes of SLND for endometrial cancer patients. Literature published in the last five years (January 2015 to April 2020) was retrieved from PubMed, EMBASE, and Cochrane library, across five domains: (1) perioperative outcomes; (2) adjuvant treatment; (3) patient-reported outcomes (PROs); (4) lymphedema, and (5) cost. Covidence software ascertained a standardised and monitored review process. We identified 21 eligible studies. Included studies were highly heterogeneous, with widely varying outcome measures and reporting. SLND was associated with shorter operating times and lower estimated blood loss compared to systematic LND, but intra-operative and post-operative complications were not conclusively different. There was either no impact, or a trend towards less adjuvant treatment used in patients with SLND compared to systematic LND. SLND had lower prevalence rates of lymphedema compared to systematic LND, although this was shown only in three retrospective studies. Costs of surgical staging were lowest for no node sampling, followed by SLND, then LND. PROs were unable to be compared because of a lack of studies. The quality of evidence on patient-centred outcomes associated with SLND for surgical staging of endometrial cancer is poor, particularly in PROs, lymphedema and cost. The available studies were vulnerable to bias and confounding. Registration of Systematic Review: PROSPERO (CRD42020180339)
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14
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Gilchrist F, Marshman Z. Patient-reported Outcomes (PROs) in clinical trials in paediatric dentistry. Int J Paediatr Dent 2020; 31 Suppl 1:31-37. [PMID: 33458920 DOI: 10.1111/ipd.12768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/13/2020] [Accepted: 12/03/2020] [Indexed: 01/13/2023]
Abstract
Patient-reported outcomes (PROs) are reports directly from patients without interpretation by clinicians or others and captured using validated patient-reported outcome measures (PROMs). These measures are increasingly employed in clinical practice and can be incorporated into clinical trials. Benefits of using PROs include reducing observer bias; eliciting unique views on aspects important to patients and increasing public accountability. Despite inclusion in clinical trials PRO data is often under-reported and the results may not be adopted into clinical practice due to concerns about the data generated. This review discusses what PROs are and how to measure them; the benefits of using PROs; how to choose an appropriate PROM to answer the research question; considerations for using PROs in paediatric dentistry and reporting guidelines. Finally, some examples of how PROs have been included in paediatric dentistry trials are given along with discussion of the development of core outcome sets and how these may improve reporting of PROs in the future.
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Affiliation(s)
- Fiona Gilchrist
- Paediatric Dentistry, University of Sheffield, Sheffield, UK
| | - Zoe Marshman
- Dental Public Health, University of Sheffield, Sheffield, UK
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15
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International guidance on the selection of patient-reported outcome measures in clinical trials: a review. Qual Life Res 2020; 30:21-40. [PMID: 32926299 DOI: 10.1007/s11136-020-02625-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Patient-reported outcomes (PROs) are increasingly used in clinical trials to provide patients' perspectives regarding symptoms, health-related quality of life, and satisfaction with treatments. A range of guidance documents exist for the selection of patient-reported outcome measures (PROMs) in clinical trials, and it is unclear to what extent these documents present consistent recommendations. METHODS We conducted a targeted review of publications and regulatory guidance documents that advise on the selection of PROMs for use in clinical trials. A total of seven guidance documents from the US Food and Drug Administration, European Medicines Agency, and scientific consortia from professional societies were included in the final review. Guidance documents were analyzed using a content analysis approach comparing them with minimum standards recommended by the International Society for Quality of Life Research. RESULTS Overall there was substantial agreement between guidance regarding the appropriate considerations for PROM selection within a clinical trial. Variations among the guidance primarily related to differences in their format and differences in the perspectives and mandates of their respective organizations. Whereas scientific consortia tended to produce checklist or rating-type guidance, regulatory groups tended to use more narrative-based approaches sometimes supplemented with lists of criteria. CONCLUSION The consistency in recommendations suggests an emerging consensus in the field and supports use of any of the major guidance documents available to guide PROM selection for clinical trials without concern of conflicting recommendations. This work represents an important first step in the international PROTEUS Consortium's ongoing efforts to optimize the use of PROs in clinical trials.
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16
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Marandino L, Necchi A, Aglietta M, Di Maio M. COVID-19 Emergency and the Need to Speed Up the Adoption of Electronic Patient-Reported Outcomes in Cancer Clinical Practice. JCO Oncol Pract 2020; 16:295-298. [PMID: 32364846 PMCID: PMC7292478 DOI: 10.1200/op.20.00237] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Laura Marandino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology, University of Turin, Turin, Italy
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Andrea Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Massimo Aglietta
- Department of Oncology, University of Turin, Turin, Italy
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Turin, Italy
- Medical Oncology, Azienda Ospedaliera Ordine Mauriziano, Turin, Italy
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17
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Ren QP, Luo YL, Xiao FM, Wen TF, Wu MH, Juan-Wan, Xie ZR. Effect of enhanced recovery after surgery program on patient-reported outcomes and function recovery in patients undergoing liver resection for hepatocellular carcinoma. Medicine (Baltimore) 2020; 99:e20062. [PMID: 32443312 PMCID: PMC7254517 DOI: 10.1097/md.0000000000020062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to investigate the effect of enhanced recovery after surgery (ERAS) on perioperative outcomes, with an emphasis on patient-reported outcomes (PROs) and functional recovery.We compared the clinical outcomes in a cohort of 275 patients undergoing liver resection before and after the implementation of ERAS. The PROs were preoperatively and postoperatively compared until 14 days after surgery using the MD Anderson Symptom Inventory.The patients in the ERAS group experienced fewer symptoms and a shorter functional recovery time than the patients in the non-ERAS group. The group × time interactions were different between the groups for pain (F = 4.70, P = .001) and walking (F = 2.75, P = .03). On the 3rd, 4, and 5th days after surgery, the ERAS group experienced less pain and more walking than the non-ERAS group. The ERAS group experienced less fatigue (0.407 [95% confidence interval, CI: -0.795, -0.020], P = .035), less sleep interference (0.615 [95% CI: -1.215, -0.014], P = .045), a lower rate of reduced appetite (0.281 [95% CI: -0.442, -0.120], P = .001), and less abdominal distension (0.262 [95% CI: -0.504, -0.020], P = .034) than the non-ERAS group. Those in the ERAS group had a significantly shorter median time from surgery to mild fatigue (5.41 vs 6.87 days, P = .003), mild pain (4.45 vs 6.09 days, P = .001), mild interference when walking (3.85 vs 5.54 days, P < .001), and mild interference when sleeping (5.49 vs 7.43 days, P < .001). ERAS patients were more likely than non-ERAS patients to achieve a functional recovery (5.70 vs 6.79 days, P < .001) status in a shorter time period. The ERAS pathway, operation time, and the minimally invasive approach were independent predictors of functional recovery time.In hepatocellular carcinoma liver resection patients, the primary mechanism of ERAS is to reduce the postoperative interference burden and promote rapid functional recovery.
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18
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Gripp KW, Schill L, Schoyer L, Stronach B, Bennett AM, Blaser S, Brown A, Burdine R, Burkitt-Wright E, Castel P, Darilek S, Dias A, Dyer T, Ellis M, Erickson G, Gelb BD, Green T, Gross A, Ho A, Holder JL, Inoue SI, Jelin AC, Kennedy A, Klein R, Kontaridis MI, Magoulas P, McConnell DB, McCormick F, Neel BG, Prada CE, Rauen KA, Roberts A, Rodriguez-Viciana P, Rosen N, Rumbaugh G, Sablina A, Solman M, Tartaglia M, Thomas A, Timmer WC, Venkatachalam K, Walsh KS, Wolters PL, Yi JS, Zenker M, Ratner N. The sixth international RASopathies symposium: Precision medicine-From promise to practice. Am J Med Genet A 2019; 182:597-606. [PMID: 31825160 DOI: 10.1002/ajmg.a.61434] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/05/2019] [Indexed: 12/19/2022]
Abstract
The RASopathies are a group of genetic disorders that result from germline pathogenic variants affecting RAS-mitogen activated protein kinase (MAPK) pathway genes. RASopathies share RAS/MAPK pathway dysregulation and share phenotypic manifestations affecting numerous organ systems, causing lifelong and at times life-limiting medical complications. RASopathies may benefit from precision medicine approaches. For this reason, the Sixth International RASopathies Symposium focused on exploring precision medicine. This meeting brought together basic science researchers, clinicians, clinician scientists, patient advocates, and representatives from pharmaceutical companies and the National Institutes of Health. Novel RASopathy genes, variants, and animal models were discussed in the context of medication trials and drug development. Attempts to define and measure meaningful endpoints for treatment trials were discussed, as was drug availability to patients after trial completion.
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Affiliation(s)
- Karen W Gripp
- Al duPont Hospital for Children, Wilmington, Delaware
| | - Lisa Schill
- RASopathies Network USA, Altadena, California
| | | | | | | | - Susan Blaser
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amanda Brown
- Noonan Syndrome Foundation, Farmington, Connecticut
| | | | - Emma Burkitt-Wright
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust and University of Manchester, Manchester, UK
| | - Pau Castel
- UCSF, Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | | | - Alwyn Dias
- Bridge Group Consulting, Morristown, New Jersey
| | - Tuesdi Dyer
- CFC International, Saint Petersburg, Florida
| | | | | | - Bruce D Gelb
- Department of Pediatrics, Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Genetics and Genomic Sciences, Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Alan Ho
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - Annie Kennedy
- Parent Project Muscular Dystrophy, Hackensack, New Jersey
| | | | | | | | | | - Frank McCormick
- UCSF, Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Benjamin G Neel
- Perlmutter Cancer Center and NYU School of Medicine, NYU Langone Health, New York, New York
| | - Carlos E Prada
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, School of Medicine, Cincinnati, Ohio
| | - Katherine A Rauen
- Department of Pediatrics, Division of Genomic Medicine, University of California Davis, Sacramento, California
| | - Amy Roberts
- Department of Cardiology, Division of Genetics, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Division of Genetics, Boston Children's Hospital, Boston, Massachusetts
| | | | - Neal Rosen
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Anna Sablina
- VIB-KU Leuven Center for Cancer Biology, Leuven, Belgium
| | - Maja Solman
- Hubrecht Institute-KNAW and University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù-IRCCS, Rome, Italy
| | | | | | - Kartik Venkatachalam
- McGovern Medical School, University of Texas Health Science Center, Houston, Texas
| | - Karin S Walsh
- Children's National Hospital & The George Washington School of Medicine, Washington, District of Columbia
| | - Pamela L Wolters
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Jae-Sung Yi
- Yale University School of Medicine, New Haven, Connecticut
| | - Martin Zenker
- University Hospital Magdeburg, Institute of Human Genetics, Magdeburg, Germany
| | - Nancy Ratner
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, School of Medicine, Cincinnati, Ohio
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Abstract
Continuous improvements in the diagnosis and treatment of cancer lead to improved cure rates and longer survival. However, in many patients, the disease becomes chronic. In this context, the patients' quality of life (QOL) becomes a crucial issue. After an introduction about QOL, results from different areas of cancer treatment are presented considering their impact on QOL. Finally, implications are discussed for researchers, clinicians, and patients.
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20
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King MT, Agar M, Currow DC, Hardy J, Fazekas B, McCaffrey N. Assessing quality of life in palliative care settings: head-to-head comparison of four patient-reported outcome measures (EORTC QLQ-C15-PAL, FACT-Pal, FACT-Pal-14, FACT-G7). Support Care Cancer 2019; 28:141-153. [DOI: 10.1007/s00520-019-04754-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 03/18/2019] [Indexed: 01/22/2023]
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21
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Rutherford C, Campbell R, Brown JM, Smith I, Costa DSJ, McGinnis E, Wilson L, Gilberts R, Brown S, Coleman S, Collier H, Nixon JE. Comparison of generic and disease-specific measures in their ability to detect differences in pressure ulcer clinical groups. Wound Repair Regen 2019; 27:396-405. [PMID: 30868673 DOI: 10.1111/wrr.12716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 03/11/2019] [Indexed: 11/28/2022]
Abstract
Patient-reported outcomes can be included as end points in pressure ulcer (PU) intervention trials to provide information to inform decision-making and improve the lives of patients. However, the challenge for researchers and clinicians is identifying and choosing an appropriate instrument for each particular application that suits their research questions and clinical context. To provide researchers and clinicians with the information needed to inform choice of patient-reported outcome measures, we compared a generic and disease-specific measures' ability to discriminate between clinical groups known to differ, and determined their responsiveness to change. We performed analyses on a subset of patients recruited to the PRESSURE 2 trial that completed the pressure ulcer quality of life instrument-prevention version (PU-QOL-P) and Short Form 12 Questionnaire (SF12) measures at baseline and 30-day posttreatment. Known-group validity and responsiveness-to-change analyses were conducted. The analysis sample consisted of 617 patients that completed both measures at baseline. Known-group validity revealed that some PU-QOL-P symptoms and function scales differentiated between people with category 2 PUs and those without PUs. A less meaningful pattern of results was observed for the SF12 scales, suggesting that the PU-QOL-P is more sensitive to differences between PU and non-PU populations. Responsiveness analysis revealed that the PU-QOL-P was more responsive in detecting disease severity than the SF12. The PU-QOL-P provides a standardized method for assessing PU-specific symptoms and functioning outcomes and is suitable for quantifying the benefits of PU interventions from the patient's perspective. Generic measures are useful for group comparisons of global quality of life domains. Choice of measure for each particular application should be determined by the purpose of the measurement and the information required.
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Affiliation(s)
- Claudia Rutherford
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachel Campbell
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Julia M Brown
- Leeds Institute of Clinical Trials Research, Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom
| | - Isabelle Smith
- Leeds Institute of Clinical Trials Research, Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom
| | - Daniel S J Costa
- Pain Management Research Institute, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia.,The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
| | - Elizabeth McGinnis
- Leeds Institute of Clinical Trials Research, Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom.,Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Lyn Wilson
- Leeds Institute of Clinical Trials Research, Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom.,Mid Yorkshire Hospitals NHS Trust, Wakefield, United Kingdom
| | - Rachael Gilberts
- Leeds Institute of Clinical Trials Research, Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom
| | - Sarah Brown
- Leeds Institute of Clinical Trials Research, Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom
| | - Susanne Coleman
- Leeds Institute of Clinical Trials Research, Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom
| | - Howard Collier
- Leeds Institute of Clinical Trials Research, Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom
| | - Jane E Nixon
- Leeds Institute of Clinical Trials Research, Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom
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22
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Besson A, Deftereos I, Chan S, Faragher IG, Kinsella R, Yeung JM. Understanding patient-reported outcome measures in colorectal cancer. Future Oncol 2019; 15:1135-1146. [PMID: 30880455 DOI: 10.2217/fon-2018-0723] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Quality of life has become increasingly regarded as a key outcome measurement for cancer patients. Patient-reported outcome measures (PROMs) represent the tools used to ascertain self-reported quality of life. This review provides a summary of the literature regarding the use of PROMs in colorectal cancer and evaluates the advantages and limitations of generic and disease specific questionnaires that can be utilized in clinical practice. Factors that influence PROMs are outlined, including cancer characteristics, patient factors and treatment methods. Finally, future directions for the use of PROMs in colorectal cancer to inform healthcare delivery at an individual- and systems-based level are discussed.
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Affiliation(s)
- Alex Besson
- Department of Surgery, Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Irene Deftereos
- Department of Surgery, Western Health, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Nutrition, Western Health, Footscray, Victoria, Australia
| | - Steven Chan
- Department of Surgery, Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ian G Faragher
- Department of Colorectal Surgery, Western Health, Footscray, Victoria, Australia
| | - Rita Kinsella
- Department of Surgery, Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Justin Mc Yeung
- Department of Surgery, Western Health, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Colorectal Surgery, Western Health, Footscray, Victoria, Australia
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Rutherford C, King MT, Butow P, Legare F, Lyddiatt A, Souli I, Rincones O, Stacey D. Is quality of life a suitable measure of patient decision aid effectiveness? Sub-analysis of a Cochrane systematic review. Qual Life Res 2018; 28:593-607. [DOI: 10.1007/s11136-018-2045-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2018] [Indexed: 10/27/2022]
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Mercieca-Bebber R, King MT, Calvert MJ, Stockler MR, Friedlander M. The importance of patient-reported outcomes in clinical trials and strategies for future optimization. Patient Relat Outcome Meas 2018; 9:353-367. [PMID: 30464666 PMCID: PMC6219423 DOI: 10.2147/prom.s156279] [Citation(s) in RCA: 305] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Patient-reported outcomes (PROs) can be included in clinical trials as primary or secondary endpoints and are increasingly recognized by regulators, clinicians, and patients as valuable tools to collect patient-centered data. PROs provide unique information on the impact of a medical condition and its treatment from the patient's perspective; therefore, PROs can be included in clinical trials to ensure the impact of a trial intervention is comprehensively assessed. This review first discusses examples of how PRO endpoints have added value to clinical trial interpretation. Second, it describes the problems with current practices in designing, implementing, and reporting PRO studies, and how these problems may be addressed by complying with guidance for protocol development, selecting appropriate PRO measures to match clinically motivated PRO hypotheses, minimizing the rates of avoidable missing PRO data, analyzing and interpreting PRO data, and transparently reporting PRO findings.
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Affiliation(s)
| | - Madeleine T King
- Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Melanie J Calvert
- Centre for Patient-Reported Outcomes Research and NIHR Birmingham Biomedical Research Centre, University of Birmingham, Edgbaston, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Martin R Stockler
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia, ;
| | - Michael Friedlander
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia, ;
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia,
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25
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Nielsen LK, Klausen TW, Jarden M, Frederiksen H, Vangsted AJ, Do T, Kristensen IB, Frølund UC, Andersen CL, Abildgaard N, Gregersen H. Clarithromycin added to bortezomib-cyclophosphamide-dexamethasone impairs health-related quality of life in multiple myeloma patients. Eur J Haematol 2018; 102:70-78. [PMID: 30230047 DOI: 10.1111/ejh.13175] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The Danish Myeloma Study Group initiated a randomized, placebo-controlled, double-blinded phase II study to investigate the efficacy of adding clarithromycin to cyclophosphamide-bortezomib-dexamethasone (VCD) induction therapy in transplant eligible, newly diagnosed multiple myeloma patients. The study was prematurely terminated due to severe complications, and no effect of adding clarithromycin was found. The aim of this study was to compare health-related quality of life (HRQoL) between the two groups and to explore the coherence hereof with adverse event (AE) registration by clinicians. METHODS Patients completed three validated HRQoL questionnaires at inclusion, before cyclophosphamide priming, and two months after high-dose therapy (HDT). The mean score difference was interpreted by clinically relevant differences between groups. Spearman's correlation analysis was used to compare patient-reported toxicities with AEs. RESULTS Of 58 included patients, 55 participated in the HRQoL reporting. Before cyclophosphamide priming, patients in the clarithromycin group reported clinically relevant reduced HRQoL for eleven domains with persistent reduction in four domains two months after HDT. Poor correlation between patient-reported toxicities and clinician-reported AEs was observed. CONCLUSIONS Despite the premature study termination, our data demonstrate impaired HRQoL when clarithromycin was added to the VCD regimen. We found clear underreporting of toxicities by clinicians. ClinicalTrials.gov number NCT02573935.
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Affiliation(s)
- Lene Kongsgaard Nielsen
- Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark
| | | | - Mary Jarden
- Department of Haematology, University Hospital of Copenhagen at Rigshospitalet, Copenhagen, Denmark
| | - Henrik Frederiksen
- Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark.,Department of Haematology, Odense University Hospital, Odense, Denmark
| | - Annette Juul Vangsted
- Department of Haematology, University Hospital of Copenhagen at Rigshospitalet, Copenhagen, Denmark
| | - Trung Do
- Department of Haematology, University Hospital of Copenhagen at Herlev, Copenhagen, Denmark
| | | | | | | | - Niels Abildgaard
- Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark.,Department of Haematology, Odense University Hospital, Odense, Denmark
| | - Henrik Gregersen
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
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Assessment of content validity for patient-reported outcome measures used in patients with non-muscle invasive bladder cancer: a systematic review. Support Care Cancer 2018; 26:1061-1076. [PMID: 29392479 DOI: 10.1007/s00520-018-4058-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/15/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Non-muscle invasive bladder cancer (NMIBC) is a chronic condition requiring ongoing treatment and endoscopic examinations that are frequent and can be life-long. To ensure the comprehensive assessment of the benefits and harms of treatments for NMIBC, the impact on important and relevant patient-reported outcomes (PROs) should be determined. We systematically reviewed the NMIBC PRO literature to determine the suitability of available PRO measures (PROMs) for use in evaluating patient outcomes in NMIBC research. METHODS We searched six electronic databases, reference lists, and key authors. Two reviewers independently applied inclusion and quality criteria and extracted findings. PROM domains, item content, and content coverage and relevance were determined for identified PROMs. Content validity was assessed against an empirically derived NMIBC-specific conceptual framework that includes 11 PRO domains and 19 sub-domains. RESULTS Seventeen studies assessed PROs related to NMIBC and treatment impact. From these studies, 11 PROMs were identified, including three generic, three cancer-specific, and five symptom-specific. None of the PROMs cover all PRO domains important in NMIBC as assessed against our conceptual framework. The EORTC QLQ-C30 plus the NMIBC24 module was best aligned to the conceptual model, but failed to represent six outcomes important to NMIBC patients. CONCLUSIONS Currently, some outcomes important in NMIBC are inadequately covered by generic and cancer-specific measures despite similar conceptual models. This review identified gaps in the literature regarding assessment of symptoms and other PROs considered important by NMIBC patients. Careful consideration of PROM item content is required when selecting outcome measures for use in future NMIBC clinical trials to ensure that appropriate measures are used to assess outcomes that matter to patients.
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Abstract
Key issues of treatment for patients with breast cancer such as patient satisfaction with treatments, compliance, and some side effects are essential for evaluating quality of life by patient-reported outcomes in clinical trials. The study aimed to develop and evaluate a specific patient-reported measure which included physical, psychological, social, and therapeutic domain for assessing the survival of patients with breast cancer.The pool of items was drafted after a theoretical revision and cognitive interviews with women with breast cancer. The draft scale was formed after the adjustment of the items and dimensions, and the selected items were submitted to expert's judgments. Five statistical methods were used to select these items by 2 validation samples. The final scale was administered to a sample of 417 patients from 8 hospitals and 135 controls for reliability, validity, and responsive analyses.The final BC-PROM consisted of 52 items, 13 subdomains, and 4 domains, being developed after preexamination and formal examination. Cronbach alpha coefficient was 0.902 and 0.712 for the full scale and therapeutic domain. The structural validity results showed that the multidimensional measurement of the scale fulfilled expectations. Differences in the BC-PROM mean scores were significant between cancer patients and healthy participants in 13 subdomains (P < .05), indicating good responsiveness. Among the sample survey of patients, the scale copy acceptance rate was 98.2%, completion rate 94.6%, and average filling time 10 minutes.The new and reliable BC-PROM was developed in patients with breast cancer and applied to clinical treatment evaluation and clinical trials for such patients.
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Evaluating patients for psychosocial distress and supportive care needs based on health-related quality of life in primary brain tumors: a prospective multicenter analysis of patients with gliomas in an outpatient setting. J Neurooncol 2016; 131:135-151. [DOI: 10.1007/s11060-016-2280-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/07/2016] [Indexed: 01/06/2023]
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Sébille V, Hardouin JB, Giral M, Bonnaud-Antignac A, Tessier P, Papuchon E, Jobert A, Faurel-Paul E, Gentile S, Cassuto E, Morélon E, Rostaing L, Glotz D, Sberro-Soussan R, Foucher Y, Meurette A. Prospective, multicenter, controlled study of quality of life, psychological adjustment process and medical outcomes of patients receiving a preemptive kidney transplant compared to a similar population of recipients after a dialysis period of less than three years--The PreKit-QoL study protocol. BMC Nephrol 2016; 17:11. [PMID: 26785745 PMCID: PMC4719683 DOI: 10.1186/s12882-016-0225-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 01/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment of end stage renal disease has an impact on patients' physical and psychological health, including quality of life (QoL). Nowadays, it is known that reducing the dialysis period has many advantages regarding QoL and medical outcomes. Although preemptive transplantation is the preferred strategy to prevent patients undergoing dialysis, its psychological impact is unknown. Moreover, transplantation can be experienced in a completely different manner among patients who were on dialysis and those who still had a functioning kidney at the time of surgery. Longitudinal data are often collected to allow analyzing the evolution of patients' QoL over time using questionnaires. Such data are often difficult to interpret due to the patients' changing standards, values, or conceptualization of what the questionnaire is intended to measure (e.g. QoL). This phenomenon is referred to as response shift and is often linked to the way the patients might adapt or cope with their disease experience. Whether response shift is experienced in a different way among patients who were on dialysis and those who still had a functioning kidney at time of surgery is unknown and will be studied in the PreKit-QoL study (trial registration number: NCT02154815). Understanding the psychological impact of pre-emptive transplantation is an important issue since it can be associated with long-term patient and graft survival. METHODS/DESIGN Adult patients with a pre-emptive transplantation (n = 130) will be prospectively included along with a control group of patients with a pre-transplant dialysis period < 36 months (n = 260). Only first and single kidney transplantation will be considered. Endpoints include: comparison of change between groups in QoL, anxiety and depressive disorders, perceived stress, taking into account response shift. These criteria will be evaluated every 6 months prior to surgery, at hospital discharge, at three and six months, one and two years after transplantation. DISCUSSION The PreKit-QoL study assesses and compares the evolution of QoL and other psychological criteria in preemptive and dialyzed patients taking patients' adaptation into account through response shift analyses. Our study might help to conceive specific, adapted educational programs and psychological support to prevent a possible premature loss of the kidney as a consequence of non-compliance in patients that may be insufficiently prepared for transplantation. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02154815 , registered on May 28, 2014.
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Affiliation(s)
- Véronique Sébille
- EA 4275 SPHERE, methodS in Patient-centered outcomes and HEalth ResEarch, Nantes University, Nantes, France. .,Biostatistics Unit, CHU Nantes, Nantes, France.
| | - Jean-Benoit Hardouin
- EA 4275 SPHERE, methodS in Patient-centered outcomes and HEalth ResEarch, Nantes University, Nantes, France. .,Biostatistics Unit, CHU Nantes, Nantes, France.
| | - Magali Giral
- ITUN and Inserm U1064, Nantes University, CHU Nantes, Nantes, France.
| | - Angélique Bonnaud-Antignac
- EA 4275 SPHERE, methodS in Patient-centered outcomes and HEalth ResEarch, Nantes University, Nantes, France.
| | - Philippe Tessier
- EA 4275 SPHERE, methodS in Patient-centered outcomes and HEalth ResEarch, Nantes University, Nantes, France.
| | | | - Alexandra Jobert
- Délégation à la recherche clinique et à l'innovation, CHU Nantes, Nantes, France.
| | - Elodie Faurel-Paul
- Délégation à la recherche clinique et à l'innovation, CHU Nantes, Nantes, France.
| | - Stéphanie Gentile
- Laboratoire de santé publique, SPMC EA3279, Aix-Marseille université, 13385, Marseille, France. .,Service de santé publique et information médicale, hôpital de la Conception, 13005, Marseille, France.
| | | | - Emmanuel Morélon
- Néphrologie, Transplantation et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France.
| | - Lionel Rostaing
- Department of Nephrology, Dialysis and Transplantation, Hôpital de Rangueil, Toulouse, France.
| | - Denis Glotz
- Hôpital Saint Louis - Nephrology and Transplantation, Paris, France.
| | - Rebecca Sberro-Soussan
- Department of Nephrology and Transplantation, Hôpital Necker Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, Paris, France.
| | - Yohann Foucher
- EA 4275 SPHERE, methodS in Patient-centered outcomes and HEalth ResEarch, Nantes University, Nantes, France.
| | - Aurélie Meurette
- ITUN and Inserm U1064, Nantes University, CHU Nantes, Nantes, France.
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Gnanasakthy A, DeMuro C. Overcoming Organizational Challenges of Integrating Patient-Reported Outcomes in Oncology Clinical Trials. Ther Innov Regul Sci 2015; 49:822-830. [PMID: 30222383 DOI: 10.1177/2168479015608413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with cancer frequently experience multiple symptoms that may cause significant distress and may impair physical, emotional, and social functioning and health-related quality of life. Drug development in oncology is characterized by a high attrition rate of new compounds, faster development times encouraged by the regulatory process, studies that are often open and single-arm, and emphasis on survival-related endpoints, creating unique challenges for the inclusion of patient reported outcomes (PROs). These challenges to include PRO-related endpoints in oncology research are further exacerbated by downward pressure on budget and resources and also an overly rigorous application of the US Food and Drug Administration's PRO guidance, which can in turn prevent study teams from optimally including PROs in oncology clinical trials. With increasing calls for demonstration of value of new cancer drugs from payers, patients, and their caregivers, study teams should consider the utility of PROs beyond regulatory needs. Optimal implementation of a PRO strategy in oncology research can be achieved by applying the PRO guidance to the greatest extent possible, making use of off-the-shelf PRO measures to capture concepts of interest, discussing plans with the regulatory bodies early in the process, and treating PRO-related endpoints with the same level of rigor as other endpoints.
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Affiliation(s)
| | - Carla DeMuro
- 1 RTI Health Solutions, Research Triangle Park, NC, USA
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Faithfull S, Lemanska A, Chen T. Patient-reported Outcome Measures in Radiotherapy: Clinical Advances and Research Opportunities in Measurement for Survivorship. Clin Oncol (R Coll Radiol) 2015; 27:679-85. [DOI: 10.1016/j.clon.2015.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 07/20/2015] [Indexed: 12/23/2022]
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Jones J, Kane P, Polson R, Leslie SJ, Hulbert-Williams NJ, Simard S, Ozakinci G, Hubbard G. Protocol for a systematic review of screening tools for fear of recurrent illness in common life-threatening diseases. Syst Rev 2015; 4:10. [PMID: 26187633 PMCID: PMC4506406 DOI: 10.1186/2046-4053-4-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 12/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A myocardial infarction (MI) ('heart attack') can be intensely stressful, and the impact of this event can leave patients with clinically significant post-MI stress symptoms. Untreated stress can make heart disease worse. Few tools are available that screen for specific thoughts or beliefs that can trigger post-MI stress responses. In other life-threatening illnesses, fear of recurrence (FoR) of illness has been identified as a key stressor, and screening tools have been developed to identify this. The aim of this review is to identify FoR screening tools used in other common life-threatening diseases that report on the development of the tool, to assess if there are any that can be adapted for use in MI survivors so that those with high levels of FoR can be identified and helped. METHODS/DESIGN The review will evaluate full FoR screening tools and methods of measurement used in common life-threatening disease clinical populations. The Campbell and Cochrane Libraries, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycINFO, MEDLINE, Embase, Applied Social Sciences Index and Abstracts (ASSIA), Published International Literature on Traumatic Stress (PILOTS), Social Services Abstracts, Sociological Abstracts, Web of Knowledge, Health and Psychosocial Instruments and SCOPUS databases will be searched for relevant studies published from database inception. Reference lists and published reviews/meta-analyses will also be searched. All titles and abstracts will be screened and relevant full-text versions retrieved by two reviewers, who will then extract all the data. Each will independently review all data extracted by the other. Selected studies will also be assessed by two independent researchers using the COnsensus-based standards for the Selection of health status measurement INstruments (COSMIN) checklist and other quality criteria. This will be done to evaluate the degree to which their measurement properties meet the standards for good methodological quality. Disagreement will be resolved through consensus. DISCUSSION Untreated post-MI stress has a considerable psychological and physical impact on MI survivors. Therefore, there is a critical need to develop a screening tool to identify fear of recurrent MI so that those affected can be identified and directed to appropriate support interventions. This proposed research will enable a tool to be developed and adapted for use in the MI survivor patient population. PROSPERO CRD42014010500.
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Affiliation(s)
- Jenny Jones
- School of Nursing & Midwifery, Plymouth University, Plymouth, PL4 8AA, UK.
| | - Paul Kane
- School of Health Sciences, University of Stirling, Old Perth Road, Inverness, IV2 3JH, UK.
| | - Rob Polson
- Highland Health Sciences Library, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH, UK.
| | - Stephen J Leslie
- School of Health Sciences, University of Stirling, Old Perth Road, Inverness, IV2 3JH, UK. .,Highland Heartbeat Centre, Cardiology Unit, Raigmore Hospital, Inverness, IV2 3UJ, USA.
| | - Nicholas J Hulbert-Williams
- Chester Research Unit for the Psychology of Health, University of Chester, Parkgate Road, Chester, CH1 4BJ, UK.
| | - Sébastien Simard
- Institut Universitaire de Cardiologie et de Pneumologie, Hospital Laval, Québec, Canada.
| | - Gozde Ozakinci
- University of St Andrews, School of Medicine, St Andrews, KY16 9TF, UK.
| | - Gill Hubbard
- School of Health Sciences, University of Stirling, Old Perth Road, Inverness, IV2 3JH, UK.
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Costa DSJ, King MT. Conceptual, classification or causal: models of health status and health-related quality of life. Expert Rev Pharmacoecon Outcomes Res 2014; 13:631-40. [PMID: 24138648 DOI: 10.1586/14737167.2013.838024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Instruments intended to assess health-related quality of life (HRQOL) and health status are widely used in research and clinical practice, but with little conceptual guidance there is some uncertainty about what it is that these instruments are actually tapping. Causal models have the potential to provide the required conceptual guidance, not only placing commonly discussed health concepts on a firm scientific foundation, but also allowing medical and psychosocial interventions to be developed in a more focused and efficient manner. Several models, some postulating causal relations, have been proposed over many years, and some have been supported by data. The development and validation of these models has, however, been conducted in a piecemeal fashion. The imperative to develop tailored, cost-effective interventions requires a synthesized approach to developing and testing causal models.
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Affiliation(s)
- Daniel S J Costa
- Psycho-oncology Co-operative Research Group, University of Sydney, NSW, Australia
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King M. Tackling the "quality of life" conundrum. Asia Pac J Clin Oncol 2014; 10:99-100. [PMID: 24862502 DOI: 10.1111/ajco.12210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Madeleine King
- Cancer Australia Chair in Cancer Quality of Life, University of Sydney, Sydney, New South Wales, Australia
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Wolters PL, Martin S, Merker VL, Gardner KL, Hingtgen CM, Tonsgard JH, Schorry EK, Baldwin A. Patient-reported outcomes in neurofibromatosis and schwannomatosis clinical trials. Neurology 2014; 81:S6-14. [PMID: 24249806 DOI: 10.1212/01.wnl.0000435747.02780.bf] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Neurofibromatosis (NF) is a genetic disease with multiple clinical manifestations that can significantly impact quality of life (QOL). Clinical trials should include patient-reported outcomes (PROs) as endpoints to assess treatment effects on various aspects of QOL, but there is no consensus on the selection and use of such measures in NF. This article describes the PRO Working Group of the Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) Collaboration, its main goals, methods for identifying appropriate PRO measures for NF clinical trials, and recommendations for assessing pain intensity. METHODS The REiNS PRO group selected core endpoint domains important to assess in NF. The members developed criteria to rate PRO measures, including patient characteristics, psychometric properties, and feasibility, and utilized a systematic process to evaluate PROs for NF clinical trials. Within the subdomain of pain intensity, the group reviewed the Numerical Rating Scale-11 (NRS-11), the Visual Analogue Scale, and the Faces Pain Scale-Revised using this process. RESULTS Based on the review criteria, each of these pain intensity scales is brief, reliable, valid, and widely used. However, the NRS-11 was given the highest rating for use in NF clinical trials due to recommendations from pain experts and other consensus groups, its extensive use in research, strong psychometric data including sensitivity to change, and excellent feasibility in ages ≥ 8 years. CONCLUSIONS The systematic review criteria and process are effective for identifying appropriate PRO measures and provide information utilized by the REiNS Collaboration to achieve consensus regarding PROs in NF clinical trials.
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Affiliation(s)
- Pamela L Wolters
- From the Pediatric Oncology Branch (P.L.W., S.M., A.B.), National Cancer Institute; Department of Neurology and Cancer Center (V.L.M.), Massachusetts General Hospital; Veterans Administration Pittsburgh Healthcare System and University of Pittsburgh (K.L.G.); Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University; University of Chicago Pritzker School of Medicine (J.H.T.); and Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital
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Hamoen EHJ, De Rooij M, Witjes JA, Barentsz JO, Rovers MM. Measuring health-related quality of life in men with prostate cancer: A systematic review of the most used questionnaires and their validity. Urol Oncol 2014; 33:69.e19-28. [PMID: 24433753 DOI: 10.1016/j.urolonc.2013.10.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 10/05/2013] [Accepted: 10/07/2013] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To identify and study the psychometric properties of the most used health-related quality-of-life (HRQoL) instruments in men with prostate cancer. METHODS We performed a literature search using PubMed and EMBASE to identify all studies on prostate cancer using a HRQoL instrument. The most often used HRQoL instruments were investigated in detail by 2 independent reviewers. Data were extracted regarding the characteristics and psychometric values of the instruments, i.e., content validity, internal consistency, criterion validity, construct validity, reproducibility, responsiveness, floor and ceiling effects, and interpretability. Good psychometric outcomes indicate a high methodological quality of the instrument. RESULTS Our systematic search revealed 13,812 potential relevant articles, of which 2,258 appeared relevant after screening the titles and reading the abstracts. We studied the psychometric properties of the 20 most often used HRQoL instruments, the first 3 of which were the Expanded Prostate Index Composite, University of California-Los Angeles Prostate Cancer Index, and Short Form-36 (SF-36). Content validity, internal consistency (α>0.70), criterion validity, construct validity, and reproducibility were good in 60%, 90%, 10%, 35%, and 65% of the 20 instruments, respectively. Responsiveness was not reported for 12 of 20 instruments (60%). Floor and ceiling effects and the interpretability of the questionnaires were only reported in 3 (15%) and 6 (30%) instruments. CONCLUSIONS Considering the psychometric properties, we advise to use the SF-12 as a generic instrument, the Cancer Rehabilitation Evaluation System-SF or the Functional Assessment of Cancer Therapy-General as cancer-specific HRQoL instruments, and the University of California-Los Angeles Prostate Cancer Index, the QUFW94, or the Functional Assessment of Cancer Therapy-Prostate as prostate cancer-specific instruments.
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Affiliation(s)
- Esther H J Hamoen
- Department of Urology, Radboud University Nijmegen Medical Centre, The Netherlands; Department of Radiology, Radboud University Nijmegen Medical Centre, The Netherlands.
| | - Maarten De Rooij
- Department of Radiology, Radboud University Nijmegen Medical Centre, The Netherlands; Department of Operating Rooms, Radboud University Nijmegen Medical Centre, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Nijmegen Medical Centre, The Netherlands
| | - Jelle O Barentsz
- Department of Radiology, Radboud University Nijmegen Medical Centre, The Netherlands
| | - Maroeska M Rovers
- Department of Operating Rooms, Radboud University Nijmegen Medical Centre, The Netherlands; Department of Health Evidence, Radboud University Nijmegen Medical Centre, The Netherlands
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Abstract
Continuous improvements in the diagnosis and treatment of cancer lead to improved cure rates and longer survival. However, in many patients, the disease becomes chronic. In this context, the patients' quality of life (QOL) becomes a crucial issue. After an introduction about QOL, results from different areas of cancer treatment are presented considering their impact on QOL. Finally, implications are discussed for researchers, clinicians, and patients.
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Affiliation(s)
- Ute Goerling
- Department of Psychooncology, Charité Comprehensive Cancer Center, Berlin, Germany,
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King MT, Bell ML, Costa D, Butow P, Oh B. The Quality of Life Questionnaire Core 30 (QLQ-C30) and Functional Assessment of Cancer-General (FACT-G) differ in responsiveness, relative efficiency, and therefore required sample size. J Clin Epidemiol 2014; 67:100-7. [DOI: 10.1016/j.jclinepi.2013.02.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 02/04/2013] [Accepted: 02/18/2013] [Indexed: 12/01/2022]
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Friedlander M, King M. Patient-reported outcomes in ovarian cancer clinical trials. Ann Oncol 2013; 24 Suppl 10:x64-x68. [DOI: 10.1093/annonc/mdt474] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Abstract
PURPOSE OF REVIEW The aim of this review is to summarize the current state of the science in physical symptoms and other end-of-life care domains and/or illness-specific outcomes in palliative care. The review includes progress in outcome measure development and interpretation, with specific reference to the clinical trial context. RECENT FINDINGS There are validated measures in a wide range of domains, which can measure outcomes specific to palliative care interventions; which are sufficiently validated to ensure the results of the trial are robust and measuring differences which are both clinically meaningful. In several areas, consensus is emerging which will allow consolidation of outcome measurement and the ability to extend measurement from the clinical trial setting into routine clinical practice. Potential exists for composite measures covering areas prioritized by patients to improve comparability and efficiency. Adverse events need to be measured with the same degree of rigor as efficacy outcomes. SUMMARY Clinical trials of palliative care interventions need to consider a range of outcomes, however, the choice and timing of measurement of the primary outcome need to be guided by the domain most likely to be influenced by the intervention.
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Carlson LE, Waller A, Mitchell AJ. Screening for Distress and Unmet Needs in Patients With Cancer: Review and Recommendations. J Clin Oncol 2012; 30:1160-77. [PMID: 22412146 DOI: 10.1200/jco.2011.39.5509] [Citation(s) in RCA: 373] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose This review summarizes the need for and process of screening for distress and assessing unmet needs of patients with cancer as well as the possible benefits of implementing screening. Methods Three areas of the relevant literature were reviewed and summarized using structured literature searches: psychometric properties of commonly used distress screening tools, psychometric properties of relevant unmet needs assessment tools, and implementation of distress screening programs that assessed patient-reported outcomes (PROs). Results Distress and unmet needs are common problems in cancer settings, and programs that routinely screen for and treat distress are feasible, particularly when staff are supported and links with specialist psychosocial services exist. Many distress screening and unmet need tools have been subject to preliminary validation, but few have been compared head to head in independent centers and in different stages of cancer. Research investigating the overall effectiveness of screening for distress in terms of improved recognition and treatment of distress and associated problems is not yet conclusive, but screening seems to improve communication between patients and clinicians and may enhance psychosocial referrals. Direct effects on quality of life are uncertain, but screening may help improve discussion of quality-of-life issues. Conclusion Involving all stakeholders and frontline clinicians when planning screening for distress programs is recommended. Training frontline staff to deliver screening programs is crucial, and continuing to rigorously evaluate outcomes, including PROs, process of care, referrals, and economic costs and benefits is essential.
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Affiliation(s)
- Linda E. Carlson
- Linda E. Carlson, Tom Baker Cancer Centre; Linda E. Carlson and Amy Waller, University of Calgary, Calgary, Alberta, Canada; and Alex J. Mitchell, Leicestershire Partnership Trust and University of Leicester, Leicester, United Kingdom
| | - Amy Waller
- Linda E. Carlson, Tom Baker Cancer Centre; Linda E. Carlson and Amy Waller, University of Calgary, Calgary, Alberta, Canada; and Alex J. Mitchell, Leicestershire Partnership Trust and University of Leicester, Leicester, United Kingdom
| | - Alex J. Mitchell
- Linda E. Carlson, Tom Baker Cancer Centre; Linda E. Carlson and Amy Waller, University of Calgary, Calgary, Alberta, Canada; and Alex J. Mitchell, Leicestershire Partnership Trust and University of Leicester, Leicester, United Kingdom
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Chase DM, Wenzel L. Health-related quality of life in ovarian cancer patients and its impact on clinical management. Expert Rev Pharmacoecon Outcomes Res 2011; 11:421-31. [PMID: 21831023 DOI: 10.1586/erp.11.41] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although the incidence of ovarian cancer is less than that of other female cancers, the morbidity and mortality associated with the disease course is high. Because treatment involves radical surgery and intense courses of chemotherapy, health-related quality of life (HRQOL) is often compromised. Most patients recur post-first-line therapy and undergo multiple rounds of chemotherapy. Thus, HRQOL is further disrupted. As the ongoing search for optimal therapies in both the first-line and recurrent setting continues, much attention is paid towards clinical trial design and implementation. Over the last decade, patient-reported outcomes and HRQOL measurement have become an integral part of these trials. HRQOL data are valued in examining the extent of treatment benefit and therefore can aid in decision-making during active treatment and palliative care. HRQOL and patient-reported outcome measurement is also useful in determining symptom prevalence, severity and management. This article highlights the state of the science of HRQOL measurement in clinical trial design and outcomes. In addition, symptom management in ovarian cancer and its ability to modulate quality of life will be explored.
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Affiliation(s)
- Dana M Chase
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Creighton University School of Medicine at St Joseph's Hospital, Catholic Healthcare West, 500 W. Thomas Road, Suite 800, Phoenix, AZ 85013, USA.
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