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Dinkel A, Jahnen M. [Patient-reported outcomes-the role of the patient's subjective perspective for research and clinical care]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:886-892. [PMID: 39110186 PMCID: PMC11343820 DOI: 10.1007/s00120-024-02405-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 08/24/2024]
Abstract
Because only patients can adequately assess symptoms, disability, and quality of life, concordance between a patient's and physician's assessment is often low. Accordingly, patient-reported outcomes (PROs) are increasingly used in research and routine clinical care. In daily practice, PROs are not only applied to measure the patient's perceived outcome of medical treatments, but also to assess their health status before intervention starts. Typically, several patient-reported outcome measures (PROMs), which are reliable and valid, are available for the assessment of the most important PROMs. In daily clinical practice, the integration of PROs can be useful for clinical assessment and treatment planning or for quality management. Currently, the most promising application is routine patient monitoring using digital PROMs (ePROMs). Systematic reviews have revealed that the routine use of PROMs in daily clinical care is associated with, among others, improved physician-patient communication, higher patient satisfaction, reduced symptom burden, higher quality of life, and improved survival. This effect is especially strong if health care professionals continuously receive the results of the PRO monitoring. Patients are usually inclined to disclose their health status, and the positive effects of routine patient monitoring are widely recognized. However, several barriers to using PROs and PROMs still exist.
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Affiliation(s)
- Andreas Dinkel
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar, School of Medicine and Health, Technische Universität München, Langerstr. 3, 81675, München, Deutschland.
| | - Matthias Jahnen
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar, School of Medicine and Health, Technische Universität München, Langerstr. 3, 81675, München, Deutschland
- Klinik und Poliklinik für Urologie, Klinikum rechts der Isar, School of Medicine and Health, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
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Qiao J, Liu B, Xin J, Shen S, Ma H, Pan S. Prediction of Prognosis and Response to Androgen Deprivation Therapy in Intermediate to High-Risk Prostate Cancer Using 18F-FDG PET/CT Radiomics. Acad Radiol 2024:S1076-6332(24)00420-3. [PMID: 39019687 DOI: 10.1016/j.acra.2024.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/10/2024] [Accepted: 06/22/2024] [Indexed: 07/19/2024]
Abstract
RATIONALE AND OBJECTIVES This study aims to predict intermediate to high-risk prostate cancer (PCa) prognosis based on 18-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) radiomics. Additionally, subgroup analysis will be performed on the androgen deprivation therapy (ADT) group and the metastatic PCa group. MATERIALS AND METHODS In the retrospective analysis of 104 intermediate to high-risk PCa patients who underwent 18F-FDG PET/CT prior to treatment. The data set was divided into a training set (n = 72) and a testing set (n = 32). Two different PET/CT models were constructed using multivariate logistic regression with cross-validation: radiomics model A and an alternative ensemble learning-based model B. The superior model was then selected to develop a radiomics nomogram. Separate models were also developed for the ADT and metastatic PCa subgroups. RESULTS Model A, which integrates eight radiomics features showed excellent performance with an area under curve (AUC) of 0.844 in the training set and 0.804 in the testing set. The radiomics nomogram incorporating the radiomics score (radscore) from model A and the tumor-to-liver ratio (TLR) showed good prognostic accuracy in the testing set with an AUC of 0.827. In the subgroup analyses for endocrine therapy and metastatic cancer, the PET/CT radiomics model showed AUCs of 0.845 and 0.807 respectively, suggesting its potential effectiveness. CONCLUSION The study establishes the utility of the 18F-FDG PET/CT radiomics nomogram in predicting the prognosis of intermediate to high-risk PCa patients, indicating its potential for clinical application.
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Affiliation(s)
- Jianyi Qiao
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bitian Liu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jun Xin
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China; Department of Nuclear Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Siang Shen
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Han Ma
- Department of Nuclear Medicine, People's Hospital of Liaoning Province, Shenyang, China
| | - Shen Pan
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China; Department of Nuclear Medicine, Shengjing Hospital of China Medical University, Shenyang, China.
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Zamora V, Garin O, Suárez JF, Jové J, Castells M, Ferrer F, Gutiérrez C, Guedea F, Boladeras A, Fumadó L, Roselló A, Pastor J, Samper P, Pont À, Ferrer M. Psychometric validation of the Spanish version of the Expanded Prostate Cancer Index Composite-26. World J Urol 2023; 41:3511-3518. [PMID: 37947846 PMCID: PMC10693511 DOI: 10.1007/s00345-023-04691-7] [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: 07/31/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE To assess the validity, reliability, and responsiveness of the Spanish version of the Expanded Prostate cancer Index Composite (EPIC) with 26 items. METHODS Multicentric longitudinal study of patients diagnosed with localized or locally advanced prostate cancer (any T, any N, M0) treated with active surveillance, surgery, external radiotherapy, or brachytherapy. The EPIC-50 was administered initially to the cohort (n = 324 patients), until it was replaced in November 2019 by the EPIC-26 (n = 543), in both groups before treatment and 12 months after. We assessed confirmatory factor analysis (CFA), reliability with Cronbach's alpha coefficient, criterion validity with the intraclass correlation coefficient (ICC), and responsiveness by testing a priori hypotheses on deterioration effect size (ES). RESULTS The CFA confirmed the five-domain structure of the EPIC-26 proposed by the original instrument (comparative fit index = 0.95). The agreement between EPIC-50 (gold standard) and EPIC-26 domains was excellent (ICC > 0.90). Cronbach's alpha was > 0.7 in almost all domains, and the floor effect was near zero, although ceiling effect was higher than 50% in urinary incontinence and bowel domains. Hypothesized changes between before and 12 months after treatment were confirmed: ES > 0.8 in both urinary incontinence and sexual domains among patients who underwent surgery; and ES ranging 0.44-0.48 for bowel and sexual domains in patients treated with external radiotherapy. CONCLUSION The Spanish version of the EPIC-26 has demonstrated adequate metric properties, similar to those of the original version, with acceptable goodness-of-fit indices, good criterion validity, reliability, and responsiveness to detect changes after radical prostatectomy or external radiotherapy.
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Affiliation(s)
- Víctor Zamora
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona Biomedical Research Park, Office 144. Doctor Aiguader, 88, 08003, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Olatz Garin
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona Biomedical Research Park, Office 144. Doctor Aiguader, 88, 08003, Barcelona, Spain.
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.
- Universitat Pompeu Fabra, Barcelona, Spain.
| | - José Francisco Suárez
- Urology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Josep Jové
- Radiation Oncology Department, Institut Català d'Oncologia, Badalona, Spain
| | - Manuel Castells
- Urology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Ferran Ferrer
- Radiation Oncology Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain
| | - Cristina Gutiérrez
- Radiation Oncology Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain
| | - Ferran Guedea
- Radiation Oncology Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain
| | - Ana Boladeras
- Radiation Oncology Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain
| | - Lluis Fumadó
- Urology Department, Hospital del Mar, Barcelona, Spain
| | - Alvar Roselló
- Radiation Oncology Department, Institut Català d'Oncologia, Girona, Spain
| | - Jorge Pastor
- Radiation Oncology Department, ASCIRES GRUPO BIOMÉDICO, Valencia, Spain
| | - Pilar Samper
- Radiation Oncology Department, Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | - Àngels Pont
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona Biomedical Research Park, Office 144. Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Montse Ferrer
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona Biomedical Research Park, Office 144. Doctor Aiguader, 88, 08003, Barcelona, Spain.
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.
- Universitat Pompeu Fabra, Barcelona, Spain.
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Garin O, Kowalski C, Zamora V, Roth R, Ferrer M, Breidenbach C, Pont A, Belin TR, Elashoff D, Wilhalme H, Nguyen AV, Kwan L, Pearman EK, Bolagani A, Sampurno F, Papa N, Moore C, Millar J, Connor SE, Villanti P, Litwin MS. Patient-reported outcomes before treatment for localized prostate cancer: are there differences among countries? Data from the True North Global Registry. BMC Urol 2023; 23:178. [PMID: 37919726 PMCID: PMC10623840 DOI: 10.1186/s12894-023-01344-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Similar Patient-Reported Outcomes (PROs) at diagnosis for localized prostate cancer among countries may indicate that different treatments are recommended to the same profile of patients, regardless the context characteristics (health systems, medical schools, culture, preferences…). The aim of this study was to assess such comparison. METHODS We analyzed the EPIC-26 results before the primary treatment of men diagnosed of localized prostate cancer from January 2017 onwards (revised data available up to September 2019), from a multicenter prospective international cohort including seven regions: Australia/New Zealand, Canada, Central Europe (Austria / Czech Republic / Germany), United Kingdom, Italy, Spain, and the United States. The EPIC-26 domain scores and pattern of three selected items were compared across regions (with Central Europe as reference). All comparisons were made stratifying by treatment: radical prostatectomy, external radiotherapy, brachytherapy, and active surveillance. RESULTS The sample included a total of 13,483 men with clinically localized or locally advanced prostate cancer. PROs showed different domain patterns before treatment across countries. The sexual domain was the most impaired, and the one with the highest dispersion within countries and with the greatest medians' differences across countries. The urinary incontinence domain, together with the bowel and hormonal domains, presented the highest scores (better outcomes) for all treatment groups, and homogeneity across regions. CONCLUSIONS Patients with localized or locally advanced prostate cancer undergoing radical prostatectomy, EBRT, brachytherapy, or active surveillance presented mainly negligible or small differences in the EPIC-26 domains before treatment across countries. The results on urinary incontinence or bowel domains, in which almost all patients presented the best possible score, may downplay the baseline data role for evaluating treatments' effects. However, the heterogeneity within countries and the magnitude of the differences found across countries in other domains, especially sexual, support the need of implementing the PRO measurement from diagnosis.
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Affiliation(s)
- O Garin
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute) Barcelona Biomedical Research Park, Office 144, Doctor Aiguader 88, Barcelona, 08003, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | | | - V Zamora
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute) Barcelona Biomedical Research Park, Office 144, Doctor Aiguader 88, Barcelona, 08003, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - R Roth
- Institute of Medical Statistics and Computational Biology (IMSB), Medical Faculty, University of Cologne, Cologne, Germany
| | - M Ferrer
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute) Barcelona Biomedical Research Park, Office 144, Doctor Aiguader 88, Barcelona, 08003, Spain.
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.
| | | | - A Pont
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute) Barcelona Biomedical Research Park, Office 144, Doctor Aiguader 88, Barcelona, 08003, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - T R Belin
- University of California, Los Angeles, USA
| | - D Elashoff
- University of California, Los Angeles, USA
| | - H Wilhalme
- University of California, Los Angeles, USA
| | - A V Nguyen
- University of California, Los Angeles, USA
| | - L Kwan
- University of California, Los Angeles, USA
| | | | - A Bolagani
- University of California, Los Angeles, USA
| | - F Sampurno
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - N Papa
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - C Moore
- University College London, London, UK
| | - J Millar
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - S E Connor
- University of California, Los Angeles, USA
| | - P Villanti
- Movember Foundation, Melbourne, Australia
| | - M S Litwin
- University of California, Los Angeles, USA
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A Contemporary Report of Low-Dose-Rate Brachytherapy for Prostate Cancer Using MRI for Risk Stratification: Disease Outcomes and Patient-Reported Quality of Life. Cancers (Basel) 2023; 15:cancers15041336. [PMID: 36831677 PMCID: PMC9953871 DOI: 10.3390/cancers15041336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/08/2023] [Accepted: 02/11/2023] [Indexed: 02/22/2023] Open
Abstract
PURPOSE We examined a prospective consecutive cohort of low dose rate (LDR) brachytherapy for prostate cancer to evaluate the efficacy of monotherapy for unfavorable-intermediate risk (UIR) disease, and explore factors associated with toxicity and quality of life (QOL). METHODS 149 men with prostate cancer, including 114 staged with MRI, received Iodine-125 brachytherapy alone (144-145 Gy) or following external beam radiation therapy (110 Gy; EBRT). Patient-reported QOL was assessed by the Expanded Prostate Index Composite (EPIC) survey, and genitourinary (GU) and gastrointestinal (GI) toxicity were prospectively recorded (CTC v4.0). Global QOL scores were assessed for decline greater than the minimum clinically important difference (MCID). Univariate analysis (UVA) was performed, with 30-day post-implant dosimetry covariates stratified into quartiles. Median follow-up was 63 mo. RESULTS Men with NCCN low (n = 42) or favorable-intermediate risk (n = 37) disease were treated with brachytherapy alone, while most with high-risk disease had combined EBRT (n = 17 of 18). Men with UIR disease (n = 52) were selected for monotherapy (n = 42) based on clinical factors and MRI findings. Freedom from biochemical failure-7 yr was 98%. Of 37 men with MRI treated with monotherapy for UIR disease, all 36 men without extraprostatic extension were controlled. Late Grade 2+/3+ toxicity occurred in 55/3% for GU and 8/2% for GI, respectively. Fifty men were sexually active at baseline and had 2 yr sexual data; 37 (74%) remained active at 2 yr. Global scores for urinary incontinence (UC), urinary irritation/obstruction (UIO), bowel function, and sexual function (SF) showed decreases greater than the MCID (p < 0.05) in UC at 2 mo, UIO at 2 and 6 mo, and SF at 2-24 mo, and >5 yr. Analysis did not reveal any significant associations with any examined rectal or urethral dosimetry for late toxicity or QOL. CONCLUSION Disease outcomes and patient-reported QOL support LDR brachytherapy, including monotherapy for UIR disease.
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Mortality and biochemical recurrence after surgery, brachytherapy, or external radiotherapy for localized prostate cancer: a 10-year follow-up cohort study. Sci Rep 2022; 12:12589. [PMID: 35869124 PMCID: PMC9307750 DOI: 10.1038/s41598-022-16395-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/08/2022] [Indexed: 11/18/2022] Open
Abstract
To compare the effectiveness at ten years of follow-up of radical prostatectomy, brachytherapy and external radiotherapy, in terms of overall survival, prostate cancer-specific mortality and biochemical recurrence. Cohort of men diagnosed with localized prostate cancer (T1/T2 and low/intermediate risk) from ten Spanish hospitals, followed for 10 years. The treatment selection was decided jointly by patients and physicians. Of 704 participants, 192 were treated with open radical retropubic prostatectomy, 317 with 125I brachytherapy alone, and 195 with 3D external beam radiation. We evaluated overall survival, prostate cancer-specific mortality, and biochemical recurrence. Kaplan–Meier estimators were plotted, and Cox proportional-hazards regression models were constructed to estimate hazard ratios (HR), adjusted by propensity scores. Of the 704 participants, 542 patients were alive ten years after treatment, and a total of 13 patients have been lost during follow-up. After adjusting by propensity score and Gleason score, brachytherapy and external radiotherapy were not associated with decreased 10-year overall survival (aHR = 1.36, p = 0.292 and aHR = 1.44, p = 0.222), but presented higher biochemical recurrence (aHR = 1.93, p = 0.004 and aHR = 2.56, p < 0.001) than radical prostatectomy at ten years of follow-up. Higher prostate cancer-specific mortality was also observed in external radiotherapy (aHR = 9.37, p = 0.015). Novel long-term results are provided on the effectiveness of brachytherapy to control localized prostate cancer ten years after treatment, compared to radical prostatectomy and external radiotherapy, presenting high overall survival, similarly to radical prostatectomy, but higher risk of biochemical progression. These findings provide valuable information to facilitate shared clinical decision-making. Study identifier at ClinicalTrials.gov: NCT01492751.
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Patel KR, Saad W, Heller T, Turkbey B, Citrin DE. Post-prostatectomy Radiotherapy in the Setting of a Rectal Vascular Malformation. Adv Radiat Oncol 2022; 7:101043. [PMID: 36060633 PMCID: PMC9436711 DOI: 10.1016/j.adro.2022.101043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022] Open
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A comparative study of patient-reported outcomes after contemporary radiation techniques for prostate cancer. Radiother Oncol 2022; 171:164-172. [DOI: 10.1016/j.radonc.2022.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 11/19/2022]
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