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Park JY, Kim MS, Ryu JM. Predictors of sleep quality components in patients undergoing transarterial chemoembolisation: a cross-sectional study. Support Care Cancer 2024; 32:149. [PMID: 38329591 DOI: 10.1007/s00520-024-08338-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/20/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE Patients undergoing transarterial chemoembolisation experience postembolisation symptoms and interferences affecting sleep quality, which require intervention. The study aimed to identify the predictors of sleep quality components in patients undergoing transarterial chemoembolisation. METHODS This study included two groups of participants: 50 patients undergoing transarterial chemoembolisation and 45 nurses caring for them. Data were collected from September to November 2022 using a structured questionnaire, and analysed using descriptive statistics, the t-test, analysis of variance, Spearman's rank correlation, and multiple regression analysis using the SPSS 27.0 program (IBM Corp., Armonk, NY, USA). RESULTS The mean sleep quality score was 40.28±14.10. Heat sensation (t=-2.08, p=.043) and fatigue (t=-4.47, p<.001) predicted sleep fragmentation in 38.6% of the patients. Abdominal pain (t=-2.54, p=.014), vomiting (t=-2.21, p=.032), and the expected fatigue by the nurses (t=2.68, p=.014) predicted sleep length in 41.7% of patients. Abdominal pain (t=-2.05, p=.046) explained 42.9% of sleep depth. CONCLUSION Based on the predictors of sleep quality components obtained in this study, strategies to improve sleep quality tailored to patients undergoing transarterial chemoembolisation should be developed. This study highlighted the need to bridge the gap between patients' and nurses' expected fatigue and its contribution to sleep fragmentation and sleep length. It also highlighted the importance of noncontact temperature measurement, controlling vomiting, and pain relief for improving sleep length in patients undergoing transarterial chemoembolisation.
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Affiliation(s)
- Ji Young Park
- Gastrointestinal Surgery Ward, Pusan National University Hospital, Busan, South Korea
| | - Myoung Soo Kim
- Department of Nursing, Pukyong National University, 599-1, Daeyeon 3 dong, Namgu, Busan, 48513, South Korea.
| | - Jung Mi Ryu
- Department of Nursing, Busan Institute of Science and Technology, Busan, South Korea
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Larsen EN, Marsh N, Rickard CM, Mihala G, Walker RM, Byrnes J. Health-related quality of life and experience measures, to assess patients' experiences of peripheral intravenous catheters: a secondary data analysis. Health Qual Life Outcomes 2024; 22:1. [PMID: 38167165 PMCID: PMC10762939 DOI: 10.1186/s12955-023-02217-8] [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: 07/10/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) are essential for successful administration of intravenous treatments. However, insertion failure and PIVC complications are common and negatively impact patients' health-outcomes and experiences. We aimed to assess whether generic (not condition-specific) quality of life and experience measures were suitable for assessing outcomes and experiences of patients with PIVCs. METHODS We undertook a secondary analysis of data collected on three existing instruments within a large randomised controlled trial, conducted at two adult tertiary hospitals in Queensland, Australia. Instruments included the EuroQol Five Dimension - Five Level (EQ5D-5L), the Functional Assessment of Chronic Illness Therapy - Treatment Satisfaction - General measure (FACIT-TS-G, eight items), and the Australian Hospital Patient Experience Question Set (AHPEQS, 12 items). Responses were compared against two clinical PIVC outcomes of interest: all-cause failure and multiple insertion attempts. Classic descriptives were reported for ceiling and floor effects. Regression analyses examined validity (discrimination). Standardised response mean and effect size (ES) assessed responsiveness (EQ5D-5L, only). RESULTS In total, 685 participants completed the EQ5D-5L at insertion and 526 at removal. The FACIT-TS-G was completed by 264 and the AHPEQS by 262 participants. Two FACIT-TS-G items and one AHPEQS item demonstrated ceiling effect. Instruments overall demonstrated poor discrimination, however, all-cause PIVC failure was significantly associated with several individual items in the instruments (e.g., AHPEQS, 'unexpected physical and emotional harm'). EQ5D-5L demonstrated trivial (ES < 0.20) responsiveness. CONCLUSIONS Initial investigation of an existing health-related quality of life measure (EQ5D-5L) and two patient-reported experience measures (FACIT-TS-G; AHPEQS) suggest they are inadequate (as a summary measure) to assess outcomes and experiences for patients with PIVCs. Reliable instruments are urgently needed to inform quality improvement and benchmark standards of care.
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Affiliation(s)
- Emily N Larsen
- School of Nursing and Midwifery, Griffith University, Nathan, Australia.
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Building 34, Corner Bowen Bridge Rd and Butterfield St, Herston, QLD, 4029, Australia.
- Patient-Centred Health Services, Menzies Health Institute Queensland, NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Nathan, Australia.
- Alliance for Vascular Access Teaching and Research, Griffith University, Nathan, Australia.
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, QLD, Australia.
| | - Nicole Marsh
- School of Nursing and Midwifery, Griffith University, Nathan, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Building 34, Corner Bowen Bridge Rd and Butterfield St, Herston, QLD, 4029, Australia
- Patient-Centred Health Services, Menzies Health Institute Queensland, NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Nathan, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Nathan, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, QLD, Australia
| | - Claire M Rickard
- School of Nursing and Midwifery, Griffith University, Nathan, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Building 34, Corner Bowen Bridge Rd and Butterfield St, Herston, QLD, 4029, Australia
- Patient-Centred Health Services, Menzies Health Institute Queensland, NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Nathan, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Nathan, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, QLD, Australia
- Herston Infectious Diseases Institute, Metro North Health, Herston, QLD, Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research, Griffith University, Nathan, Australia
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, QLD, Australia
| | - Rachel M Walker
- School of Nursing and Midwifery, Griffith University, Nathan, Australia
- Patient-Centred Health Services, Menzies Health Institute Queensland, NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Nathan, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Nathan, Australia
- Division of Surgery, Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, Australia
| | - Joshua Byrnes
- Alliance for Vascular Access Teaching and Research, Griffith University, Nathan, Australia
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, QLD, Australia
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Bhardwaj T, Arora N, Paul A, Chowdhary P. Cultural Adaptation of Patient Health Questionnaire-9 in Hindi for Use with Patients with Cancer in Community Palliative Care Settings. Indian J Palliat Care 2023; 29:292-311. [PMID: 37700900 PMCID: PMC10493686 DOI: 10.25259/ijpc_96_2023] [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: 04/14/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Abstract
Objectives Patient Health Questionnaire-9 (PHQ-9) in Indian settings is yet not very often used in palliative care with the Hindi-speaking population. The Hindi version of PHQ-9 is available but its cultural adaptation to the Hindi-speaking population in North India receiving palliative care services is required to be tested. PHQ-9 as a depression screening questionnaire may help to identify depression symptoms among patients with cancer. This study aimed to examine the cultural equivalence of PHQ-9 Hindi for use with patients with cancer receiving palliative care services in North India. Material and Methods Based on the standard methodology of translation and adaptation of the scale, the following process was used: (i) Two focused group discussions with 17 experts working in a cancer palliative care setting, (ii) qualitative interviewing with 11 patients, and (iii) research team review. All interviews were audio recorded, transcribed, and item-wise content analysis was conducted. Results A few difficult phrases in the original PHQ-9 were 'dilchaspi', 'avasadgrast', 'kam urja', 'nakaam', parivar ko neecha dhikhana and 'ashthir' which were changed to Kam Mann Lagna, Mann Dukhi hona, kamjori, saksham nahi hain' 'asafal', Parivar ko nirash karna' and 'bechain,' respectively. Two items, namely no. 6 and 8 were changed to shorten the length for appropriately conveying the meaning. Conclusion Hindi language involves various dialects which change from region to region bringing variations in understanding the meaning of the words. It is recommended that culturally equivalent scales are used in practice and research. PHQ-9 is now culturally adapted for the Hindi-speaking population in North India. PHQ-9 will help identidy depressive symptoms at an early stage. Psychometric testing of PHQ-9 is underway.
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Affiliation(s)
- Tushti Bhardwaj
- Department of Social Work, Dr. Bhim Rao Ambedkar College, University of Delhi, New Delhi, India
| | - Neha Arora
- Department of Psychology, Dr. Bhim Rao Ambedkar College, University of Delhi, New Delhi, India
| | - Anu Paul
- Home Care, CanSupport, New Delhi, India
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Systematic self-reporting of patients’ symptoms: improving oncologic care and patients’ satisfaction. JOURNAL OF RADIOTHERAPY IN PRACTICE 2022. [DOI: 10.1017/s1460396922000255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background:
In recent years, there has been a growing interest to enhance patients’ symptom management during routine cancer care using patient-reported outcome measures. The goal of this study is to analyse patients’ responses to the Edmonton Symptom Assessment System (ESAS) to determine whether patient-reported outcomes could help characterise those patients with the highest supportive care needs and symptom burden in order to help provide targeted support for patients.
Methods:
In this study, we analysed ESAS questionnaire responses completed by patients as part of their routine care and considered part of patients’ standard of care. Statistical analyses were performed using the IBM SPSS Statistics version 26.0. Descriptive statistics are used to summarise patient demographics, disease characteristics and patient-reported symptom severity and prevalence.
Results:
The overall mean age is 65.2 ± 12.8 years comprising 43.8% male and 56.2% female patients. The five common primary disease sites are breast (26.2%), haematology (21.1%), gastrointestinal (15.3%), genitourinary (12.7%) and lung (12.0%) cancers. The mean severity for each symptom is all mild (score: 1–3). The three most common reported symptoms causing distress are tiredness, poor overall wellbeing and anxiety, and the least reported symptom is nausea.
Conclusions:
Systematic self-reporting of patients’ symptoms is important to improve symptom management, timely facilitation of appropriate intervention, patient experience, and patient and family satisfaction. The awareness of disease site, gender and age-related symptom variations should help in the design and provision of appropriate symptom-directed, tumour-specific and patient-focused interventions to meet patients’ immediate needs.
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Aiba H, Watanabe N, Inagaki T, Fukuoka M, Murakami H. Differences among the observers in the assessments of Japanese orthopedic association hip scores between surgeons and physical therapists and the correlations to patients' reported outcomes after total hip arthroplasty. BMC Musculoskelet Disord 2022; 23:27. [PMID: 34980081 PMCID: PMC8725241 DOI: 10.1186/s12891-021-04980-5] [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: 03/17/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to assess the utility of a clinician-reported outcome (the Japanese Orthopedic Association [JOA] hip score) as evaluated by clinicians and physiotherapists. This assessment was made by comparing these scores to those of the JOA hip disease evaluation questionnaire (JHEQ), which is a measurement of patient-reported outcomes after total hip arthroplasty. METHODS In this retrospective case-control study, 52 hips that underwent primary total hip arthroplasty were included in the analyses. The mean age of the participants was 66.8 years (sex, seven male and 45 female participants). The JOA hip score included four categories: pain, range of motion, ability to walk, and active daily living. The JHEQ included three categories: pain, movement, and mental health. These scores were evaluated preoperatively and postoperatively by clinicians or physiotherapists. Pearson's correlation coefficients were utilized to analyze the association of the JOA hip scores to those of the JHEQ. RESULTS The JOA hip scores were determined by clinicians and physiotherapists (scores of 46.8 and 57.3, respectively) preoperatively and at 24 months (scores of 94.4 and 91.7, respectively) postoperatively. The JHEQ points were 28.8 and 66.2 preoperatively and at 24 months postoperatively, respectively. The correlation coefficients between the JOA hip and JHEQ scores were .66 and .69 preoperatively and .57 and .76 at 24 months postoperatively, as evaluated by clinicians and physiotherapists, respectively. CONCLUSIONS Although the JHEQ scores were positively correlated to the JOA hip scores by clinicians and physiotherapists preoperatively and postoperatively, this study implies that clinicians may interpret the results in a way that might have been beneficial to them. To comprehend a patients' health status, we should inclusively understand the varying range of information among different evaluators.
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Affiliation(s)
- Hisaki Aiba
- Department of Orthopedic Surgery, Tosei General Hospital, 160, Nishioiwake-cho, Seto, Aichi, 489-8642, Japan.,Department of Orthopedic Surgery, Nagoya City University, 1, Azakawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Nobuyuki Watanabe
- Department of Orthopedic Surgery, Tosei General Hospital, 160, Nishioiwake-cho, Seto, Aichi, 489-8642, Japan. .,Department of Orthopedic Surgery, Nagoya City University, 1, Azakawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
| | - Toshiaki Inagaki
- Department of Rehabilitation Medicine, Tosei General Hospital, 160, Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Muneyoshi Fukuoka
- Department of Orthopedic Surgery, Tosei General Hospital, 160, Nishioiwake-cho, Seto, Aichi, 489-8642, Japan.,Department of Orthopedic Surgery, Nagoya City University, 1, Azakawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Tosei General Hospital, 160, Nishioiwake-cho, Seto, Aichi, 489-8642, Japan.,Department of Orthopedic Surgery, Nagoya City University, 1, Azakawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
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Patient-reported outcomes: Is this the missing link in patient-centered perioperative care? Best Pract Res Clin Anaesthesiol 2021; 35:565-573. [PMID: 34801218 PMCID: PMC9879129 DOI: 10.1016/j.bpa.2020.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 10/26/2020] [Indexed: 01/28/2023]
Abstract
Patient-reported outcomes (PROs) have been increasingly recognized as valuable information for delivery of optimal perioperative care to high-risk surgical patients in recent years. However, progress from clinical research on PROs has not been widely adopted in routine patient care. This review discusses the current concepts and practice status regarding PROs and addresses the missing links from research to practice adoption to further improve patient's experiences and clinical outcomes in perioperative care. Insufficient empirical research on appropriate PROs and its methodologies, insufficient implementation research to solve the practical issues, and insufficient data collection methods and experiences on ePROs are also discussed. Future research agenda should focus on evidence-supported, PRO-based symptom monitoring systems for early diagnosis and management of impending compromised clinical outcomes.
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Shunmugasundaram C, Dhillon HM, Butow PN, Sundaresan P, Rutherford C. Enabling cross-cultural data pooling in trials: linguistic validation of head and neck cancer measures for Indian patients. Qual Life Res 2021; 30:2649-2661. [PMID: 33797687 DOI: 10.1007/s11136-021-02837-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Head and neck cancers (HNC) and their treatments cause dysfunction and distress. Ongoing psychological assessment using disease-specific patient-reported measures may optimize clinical decision-making, facilitate interventions to reduce psychosocial burden. As most such measures are developed in English, non-English speaking patients are disadvantaged. This study translated HNC-specific measures (Body Image Scale, Patient Concerns Inventory, Zung's Self-Rating Anxiety and Depression Scales and Patient Health Questionnaire-9) into three Indian languages (Hindi, Tamil and Telugu) and linguistically validated them. METHODS Translation followed established guidelines on translation and linguistic validation of measures. Process involved two independent forward translations, reconciliation, two independent backward translations by bilingual experts, and cognitive debriefing interviews with nine healthcare professionals (HCPs) and 29 HNC patients. Translated versions were compared with the original versions for semantic, cultural and conceptual equivalence. RESULTS Overall, 17 Hindi items, 19 Tamil items and 13 Telugu items were identified to have semantic, cultural and/or conceptual issues. These were resolved to achieve equivalence with the original measures. Interviews with HCPs indicated that equivalent terms for words such as anxiety, panicky, sexuality, and self-conscious might be difficult to understand. Interviews with patients indicated all items were understandable, easy, sensitive, unambiguous and relevant. Hence, no further revisions were made. CONCLUSIONS The translated Hindi, Tamil and Telugu versions of the Body image scale, Patient concerns inventory, Zung's self-rating anxiety and depression scales and Patient health questionnaire-9 measures are conceptually and linguistically validated and equivalent with the original English versions. Psychometric validation of these measures with relevant patient populations is needed.
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Affiliation(s)
- Chindhu Shunmugasundaram
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia. .,Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, Australia.
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia.,Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, Australia
| | - Phyllis N Butow
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia.,Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, Australia
| | - Puma Sundaresan
- Radiation Oncology Network, Western Sydney Local Health District, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Claudia Rutherford
- Quality of Life Office, School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia.,Sydney Nursing School, Cancer Nursing Research Unit (CNRU), University of Sydney, Sydney, Australia
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Adjei AA, Lopez CL, Schaid DJ, Sloan JA, Le-Rademacher JG, Loprinzi CL, Norman AD, Olson JE, Couch FJ, Beutler AS, Vachon CM, Ruddy KJ. Genetic Predictors of Chemotherapy-Induced Peripheral Neuropathy from Paclitaxel, Carboplatin and Oxaliplatin: NCCTG/Alliance N08C1, N08CA and N08CB Study. Cancers (Basel) 2021; 13:1084. [PMID: 33802509 PMCID: PMC7959452 DOI: 10.3390/cancers13051084] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 12/14/2022] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common and potentially permanent adverse effect of chemotherapeutic agents including taxanes such as paclitaxel and platinum-based compounds such as oxaliplatin and carboplatin. Previous studies have suggested that genetics may impact the risk of CIPN. We conducted genome-wide association studies (GWASs) for CIPN in two independent populations who had completed European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ)-CIPN20 assessments (a CIPN-specific 20-item questionnaire which includes three scales that evaluate sensory, autonomic, and motor symptoms). The study population N08Cx included 692 participants from three clinical trials (North Central Cancer Treatment Group (NCCTG) N08C1, N08CA, and N08CB) who had been treated with paclitaxel, paclitaxel plus carboplatin, or oxaliplatin. The primary endpoint for the GWAS was the change from pre-chemotherapy CIPN20 sensory score to the worse score over the following 18 weeks. Study population The Mayo Clinic Breast Disease Registry (MCBDR) consisted of 381 Mayo Clinic Breast Disease Registry enrollees who had been treated with taxane or platinum-based chemotherapy. The primary endpoint for the GWAS assessed was the earliest CIPN20 sensory score available after the completion of chemotherapy. In multivariate model analyses, chemotherapy regimen (p = 3.0 × 10-8) and genetic ancestry (p = 0.007) were significantly associated with CIPN in the N08Cx population. Only age (p = 0.0004) was significantly associated with CIPN in the MCBDR population. The SNP most associated with CIPN was rs56360211 near PDE6C (p =7.92 × 10-8) in N08Cx and rs113807868 near TMEM150C in the MCBDR (p = 1.27 × 10-8). Due to a lack of replication, we cannot conclude that we identified any genetic predictors of CIPN.
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Affiliation(s)
- Araba A. Adjei
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA; (A.A.A.); (C.L.L.); (A.S.B.)
- Alliance Cancer Control Program, Mayo Clinic, Rochester, MN 55905, USA
| | - Camden L. Lopez
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA; (C.L.L.); (D.J.S.); (J.A.S.); (J.G.L.-R.); (J.E.O.); (C.M.V.); (A.D.N.)
| | - Daniel J. Schaid
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA; (C.L.L.); (D.J.S.); (J.A.S.); (J.G.L.-R.); (J.E.O.); (C.M.V.); (A.D.N.)
| | - Jeff A. Sloan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA; (C.L.L.); (D.J.S.); (J.A.S.); (J.G.L.-R.); (J.E.O.); (C.M.V.); (A.D.N.)
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Jennifer G. Le-Rademacher
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA; (C.L.L.); (D.J.S.); (J.A.S.); (J.G.L.-R.); (J.E.O.); (C.M.V.); (A.D.N.)
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Charles L. Loprinzi
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA; (A.A.A.); (C.L.L.); (A.S.B.)
- Alliance Cancer Control Program, Mayo Clinic, Rochester, MN 55905, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA; (C.L.L.); (D.J.S.); (J.A.S.); (J.G.L.-R.); (J.E.O.); (C.M.V.); (A.D.N.)
| | - Aaron D. Norman
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA; (C.L.L.); (D.J.S.); (J.A.S.); (J.G.L.-R.); (J.E.O.); (C.M.V.); (A.D.N.)
| | - Janet E. Olson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA; (C.L.L.); (D.J.S.); (J.A.S.); (J.G.L.-R.); (J.E.O.); (C.M.V.); (A.D.N.)
| | - Fergus J. Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Andreas S. Beutler
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA; (A.A.A.); (C.L.L.); (A.S.B.)
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA; (C.L.L.); (D.J.S.); (J.A.S.); (J.G.L.-R.); (J.E.O.); (C.M.V.); (A.D.N.)
| | - Celine M. Vachon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA; (C.L.L.); (D.J.S.); (J.A.S.); (J.G.L.-R.); (J.E.O.); (C.M.V.); (A.D.N.)
| | - Kathryn J. Ruddy
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA; (A.A.A.); (C.L.L.); (A.S.B.)
- Alliance Cancer Control Program, Mayo Clinic, Rochester, MN 55905, USA
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Viganò A, De Felice F, Iacovelli NA, Alterio D, Facchinetti N, Oneta O, Bacigalupo A, Tornari E, Ursino S, Paiar F, Caspiani O, Di Rito A, Musio D, Bossi P, Steca P, Jereczek-Fossa BA, Greco A, Orlandi E. M. D. Anderson symptom inventory head neck (MDASI-HN) questionnaire: Italian language psychometric validation in head and neck cancer patients treated with radiotherapy ± systemic therapy - A study of the Italian Association of Radiotherapy and Clinical Oncology (AIRO). Oral Oncol 2021; 115:105189. [PMID: 33549926 DOI: 10.1016/j.oraloncology.2021.105189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/24/2020] [Accepted: 01/08/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE Head and neck cancer (HNC) patients are likely to develop severe side effects, which may persist long after the end of treatment and may be responsible for decrease patient's quality of life. The M.D. Anderson Symptom Inventory- Head and Neck Module (MDASI-HN) is a questionnaire developed to detect patient's symptom burden. To conduct an Italian language psychometric validation of MDASI-HN among Italian HNC patients on behalf of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Head and Neck Working Group. METHOD AND MATERIALS To assess construct validity, it was performed a confirmatory factor analysis (CFA) with both a five-factor solution and three-factor solution, which were compared by a chi-square difference test. The concurrent validity was evaluated by the correlation with EORTC QLQ-C30 and HN35, and it was also assessed known-group validity. The internal consistency was tested using Cronbach's alpha coefficient. RESULTS In total 166 patients (71.7% male) were included in the study, most of patients (56.2%) had an oropharynx cancer and received definitive chemoradiotherapy (51.2%). The chi-square difference test was significant and indicated that the five-factor solution fits the data better than the other one. Regarding CFA, all items had a significant saturation with their respective factors; besides, significant and strong correlations were found among factors. Most of the correlations between MDASI-HN factors and EORTC QLQ-C30 and HN35 were significant. It was found a good internal consistency. CONCLUSION The MDASI-HN is a valid, short, and easy patient-reported outcome questionnaire which would be useful and efficient in clinical setting.
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Affiliation(s)
- Anna Viganò
- Department of Human and Social Sciences, University of Bergamo, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy.
| | | | - Daniela Alterio
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Nadia Facchinetti
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Olga Oneta
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | | | - Elena Tornari
- Radiation Oncology Policlinico San Martino IRCCS, Genova, Italy
| | - Stefano Ursino
- Department of Radiation Oncology, S. Chiara University Hospital, Pisa, Italy
| | - Fabiola Paiar
- Department of Radiation Oncology, S. Chiara University Hospital, Pisa, Italy
| | - Orietta Caspiani
- Radiation Oncology Department - Ospedale "S. Giovanni Calibita" Fatebenefratelli, Rome, Italy
| | | | - Daniela Musio
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - Patrizia Steca
- Department of Psychology, University of Milan "Bicocca", Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Andrea Greco
- Department of Human and Social Sciences, University of Bergamo, Italy
| | - Ester Orlandi
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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Wang J, Wang Q, Dong J, Yang K, Ji S, Fan Y, Wang C, Ma Q, Wei Q, Ji G. Total Laparoscopic Uncut Roux-en-Y for Radical Distal Gastrectomy: An Interim Analysis of a Randomized, Controlled, Clinical Trial. Ann Surg Oncol 2020; 28:90-96. [PMID: 32556870 DOI: 10.1245/s10434-020-08710-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The traditional Billroth II and Roux-en-Y anastomosis after laparoscopic distal gastrectomy for gastric cancer are associated with bile reflux gastritis and roux stasis syndrome, respectively. The uncut Roux-en-Y gastrojejunostomy can decrease the incidence of these complications by blocking the entry of bile and pancreatic juice into the residual stomach and retaining the impulses originating from the duodenum. The purpose of the present study was to compare the short-term outcomes of uncut Roux-en-Y (URY) and Billroth II combined Braun (BB) anastomosis. METHODS In this prospective, multi-center, two-arm randomized controlled trial, 124 patients with advanced distal gastric cancer were randomized into two groups: URY (n = 62) and BB (n = 62) groups. RESULTS The mean gastric juice pH was significantly lower in the URY group compared with the BB group (3.94 ± 0.71 vs. 5.83 ± 0.91, P < 0.0001). The bile reflux gastritis at 3 months (P < 0.0001) and 6 months (P = 0.002) was significantly more frequent in the BB group. No recanalization occurred in the URY group, and no significant difference was found between the two groups in terms of mean operative time (P = 0.69), mean time to perform anastomosis (P = 0.86), mean estimated blood loss (P = 0.77), mean number of harvested lymph nodes (P = 0.90), time to first passage of flatus or defecation (P = 0.87), postoperative hospital stay (P = 0.83), and the incidence of postoperative complications (P = 0.70). CONCLUSIONS URY anastomosis is associated with a significantly lower incidence of bile reflux gastritis and roux stasis syndrome compared with BB anastomosis.
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Affiliation(s)
- Juan Wang
- Department of Digestive Surgery, State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Quan Wang
- Department of Digestive Surgery, State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Junqiang Dong
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Kelu Yang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Sheqing Ji
- Henan Cancer Hospital and Zhengzhou University Cancer Hospital, Zhengzhou University, Zhengzhou, China
| | - Yong Fan
- Department of Minimally Invasive Surgery, the Second Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Chen Wang
- Department of Minimally Invasive Surgery, the Second Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Qi Ma
- Henan Cancer Hospital and Zhengzhou University Cancer Hospital, Zhengzhou University, Zhengzhou, China
| | - Qiuya Wei
- Department of Minimally Invasive Surgery, the Second Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Gang Ji
- Department of Digestive Surgery, State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
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11
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Maddalo M, Buglione M, Pasinetti N, Triggiani L, Costa L, Magrini SM, Murphy BA. The linguistic validation process of the Vanderbilt Head and Neck Symptom Survey - Italian Version (VHNSS-IT). Radiol Med 2019; 125:228-235. [PMID: 31784925 DOI: 10.1007/s11547-019-01105-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To linguistically validate the Italian translation of the Vanderbilt Head and Neck Symptom Survey (VHNSS), there is a patient-reported outcome measure to screen for symptoms in the head and neck cancer (HNC) patients population. The goal was to ensure conceptually equivalence with the original version and maintain clarity, ease of use and understanding. METHODS We conducted a multi-step linguistic process (forward translation, backward translation and patient testing) to generate and validate an Italian translation of the VHNSS. RESULTS Two intermediate Italian versions were created: The first Italian version was derived from a reconciliation of the three forward translations, and the second Italian version was derived from changes in the first version after the backward translation step. All investigators involved actively discussed possible solutions to produce a translated instrument that maintained a reading and comprehension level accessible by most respondents, without altering the meaning and content of the original source. During the patient testing step, only two patients reported problems with items comprehension and the rate of comprehension problems per single item was lower than expected. This phase allowed patients to give suggestion in order to make items clearer and easier to understand: 43% of patients proposed a revision of the survey during the face-to-face interview, and most of these suggestions were retained. CONCLUSIONS A valid multi-step process leads to the creation of the final version of the VHNSS-IT, a suitable instrument to screen for symptoms in the Italian HNC patients population and an official measurement tool that can be used in cooperative research group.
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Affiliation(s)
- Marta Maddalo
- Department of Radiation Oncology, ASST Spedali Civili di Brescia - Brescia University, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
| | - Michela Buglione
- Department of Radiation Oncology, ASST Spedali Civili di Brescia - Brescia University, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Nadia Pasinetti
- Department of Radiation Oncology, Ospedale di Esine - ASL Vallecamonica-Sebino, Esine, Italy
| | - Luca Triggiani
- Department of Radiation Oncology, ASST Spedali Civili di Brescia - Brescia University, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Loredana Costa
- Department of Radiation Oncology, ASST Spedali Civili di Brescia - Brescia University, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Stefano M Magrini
- Department of Radiation Oncology, ASST Spedali Civili di Brescia - Brescia University, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Barbara A Murphy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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12
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Wang Q, Ni Q, Yang K, Ji S, Fan Y, Wang C, Zhang W, Yan S, Ma Q, Wei Q, Zhang D, Yu J, Ji G. Laparoscopic uncut Roux-en-Y for radical distal gastrectomy: the study protocol for a multirandomized controlled trial. Cancer Manag Res 2019; 11:1697-1704. [PMID: 30863178 PMCID: PMC6389003 DOI: 10.2147/cmar.s170355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Gastric cancer is the third most common cause of cancer-related deaths and is the fifth highest incidence of cancer worldwide, especially in Eastern Asia, Central and Eastern Europe, and South America. Currently, surgery is the only curative treatment for gastric cancer; however, digestive tract reconstruction after distal gastrectomy for gastric cancer is controversial due to the postoperative complications such as reflux gastritis. There is an increasing trend toward laparoscopic uncut Roux-en-Y (URY) for radical gastrectomy. However, evidence on the feasibility of this procedure in patients undergoing laparoscopic radical distal gastrectomy is still absent. Thus, a prospective randomized trial is warranted. This is a prospective, multicenter, two-arm randomized controlled trial in which 210 patients will be randomly assigned to two groups: laparoscopic URY (n=105) and laparoscopic Billroth II plus Braun anastomosis (n=105). Each participant must be pathologically diagnosed with gastric cancer and undergo laparoscopic radical gastrectomy at Xijing Hospital and other four hospitals. The laparoscopic URY procedure is based on the Billroth II gastrojejunostomy plus Braun anastomosis, and then blocked the jejunum input loop at the stump–jejunal anastomosis. The patients’ demographic and pathological characteristics will be recorded. The total and oral nutritional intake, general data, total serum protein, serum albumin, blood glucose, and temperature will be recorded before surgery and at the time of hospitalization. Postoperative adverse events will also be recorded, as well as at follow-up appointments at three months and six months after surgery. The rate of reflux gastritis will represent the primary endpoint, and other secondary endpoints, which are all recorded.
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Affiliation(s)
- Quan Wang
- Department of Digestive Surgery, Xijing Hospital of Digestive Disease, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China,
| | - Qingrong Ni
- Department of Digestive Surgery, Xijing Hospital of Digestive Disease, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China,
| | - Kelu Yang
- Department of Digestive Surgery, Xijing Hospital of Digestive Disease, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China,
| | - Sheqing Ji
- Department of General Surgery, Henan Cancer Hospital& Zhengzhou University Cancer Hospital, Zhengzhou University, Zhengzhou 450003, China
| | - Yong Fan
- Department of Minimally Invasive Surgery, The Second Hospitalof Lanzhou University, Lanzhou University, Lanzhou 730000, China
| | - Chen Wang
- Department of Minimally Invasive Surgery, The Second Hospitalof Lanzhou University, Lanzhou University, Lanzhou 730000, China
| | - Wenbin Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospitalof Xinjiang Medical University, Xinjiang Medical University, Urumqi 830000, China
| | - Su Yan
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qinghai University, Qinghai University, Xining 810000, China
| | - Qi Ma
- Department of General Surgery, Henan Cancer Hospital& Zhengzhou University Cancer Hospital, Zhengzhou University, Zhengzhou 450003, China
| | - Qiuya Wei
- Department of Minimally Invasive Surgery, The Second Hospitalof Lanzhou University, Lanzhou University, Lanzhou 730000, China
| | - Di Zhang
- Department of Digestive Surgery, Xijing Hospital of Digestive Disease, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China,
| | - Juan Yu
- Department of Digestive Surgery, Xijing Hospital of Digestive Disease, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China,
| | - Gang Ji
- Department of Digestive Surgery, Xijing Hospital of Digestive Disease, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China,
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Galipeau N, Klooster B, Krohe M, Tang DH, Revicki DA, Cella D. Understanding key symptoms, side effects, and impacts of HR+/HER2- advanced breast cancer: qualitative study findings. J Patient Rep Outcomes 2019; 3:10. [PMID: 30734110 PMCID: PMC6367496 DOI: 10.1186/s41687-019-0098-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 01/15/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Patients with breast cancer experience a variety of disease symptoms and treatment-related side effects that can adversely affect functioning. The breast cancer experience may differ across disease stages and biomarker subtypes. This study identified relevant disease symptoms, treatment-related side effects, and physical functioning impacts in women with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer. METHODS One-on-one concept elicitation interviews were conducted with 15 patients with HR+/HER2- advanced breast cancer. Open-ended questions about patient experience with breast cancer and its treatment were drawn from a semi-structured interview guide. All interviews were audio-recorded and transcribed verbatim, and codes were used to document and organize patient descriptions of their experiences. Coded concepts were defined, supported by exemplary patient quotes, and analyzed for frequency of mention and saturation. Five interviews with experienced oncologists were conducted to supplement the concept elicitation interviews. RESULTS The average age of the patients was 66 years. Most (53%) self-identified as White/Caucasian; 40%, as Black/African American. Patients were reported to have metastases to bone (87%), liver (20%), lung (13%), skin (7%), and lymph nodes (7%). The most frequently reported disease-related concepts were fatigue and lump in breast (47% each) and pain (40%), while the most frequently reported treatment-related side effects were hair loss (67%), fatigue/tiredness (47%), and nausea (40%). Patients identified 10 concepts associated with both breast cancer and its treatment, including fatigue/tiredness, shortness of breath, weakness, and nausea. The most frequently reported impacts on physical function included working around home (73%), walking (73%), and cooking (53%). The most frequently reported symptoms and side effects from the expert perspective included fatigue, pain, and hot flashes (n = 5 each, 100%), while the ability to work (n = 5, 100%) and walk (n = 3, 60%) were reported impacts, aligning with those concepts reported by patients. The resulting concepts were organized into a patient-based conceptual model. CONCLUSIONS Patients have varied experiences due to HR+/HER2- advanced breast cancer and its treatment, and commonly experience fatigue/tiredness, hair loss, general pain, lump in breast, and nausea, as well as impacts to physical functioning (specifically, activities of daily living and mobility).
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Affiliation(s)
- Nina Galipeau
- Patient-Centered Outcomes, Adelphi Values, 290 Congress St., 7th Floor, Boston, MA, 02210, USA
| | - Brittany Klooster
- Patient-Centered Outcomes, Adelphi Values, 290 Congress St., 7th Floor, Boston, MA, 02210, USA
| | - Meaghan Krohe
- Patient-Centered Outcomes, Adelphi Values, 290 Congress St., 7th Floor, Boston, MA, 02210, USA.
| | - Derek H Tang
- Health Economics and Outcomes Research, Novartis Inc., One Health Plaza Bldg 345, East Hanover, NJ, 07936, USA
| | - Dennis A Revicki
- Outcomes Research, Evidera, 7101 Wisconsin Ave., Suite 1400, Bethesda, MD, 20814, USA
| | - David Cella
- Northwestern University Feinberg School of Medicine, 633 N. Saint Clair St., 19th Floor, Chicago, IL, 60611, USA
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Pratt-Chapman M, Bhadelia A. Patient-Reported Outcomes in Health Economic Decision-Making: A Changing Landscape in Oncology. Recent Results Cancer Res 2019; 213:67-83. [PMID: 30543008 DOI: 10.1007/978-3-030-01207-6_6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cancer causes significant death and disability globally. However, costs of more personalized cancer care continue to climb, while access to basic cancer screening and treatment is not available to much of the world. This chapter provides an overview of the status of patient-reported outcomes (PROs) in cancer clinical care and research. PROs are valuable for health care and health economic decision-making at institutional, regional, national, and international levels. PRO data should be considered along with cost and survival data when approving new therapies. PRO data can also be helpful when assessing existing treatment options for patients, particularly for drugs with minor outcome and toxicity differences. Finally, PROs can be useful in reimbursement algorithms to ensure delivery of quality cancer care in value-based financing environments. The authors advocate for reframing the concept of health value, aligning PRO measures with societal values, and broadening the definition of society to extend beyond national boundaries.
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Affiliation(s)
| | - Afsan Bhadelia
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Johns Hopkins School of Public Health, Baltimore, MD, USA
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15
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Van Cleave JH, Fu MR, Bennett AV, Persky MS, Li Z, Jacobson A, Hu KS, Most A, Concert C, Kamberi M, Mojica J, Peyser A, Riccobene A, Tran A, Persky MJ, Savitski J, Liang E, Egleston BL. The development, usability, and reliability of the Electronic Patient Visit Assessment (ePVA) for head and neck cancer. Mhealth 2019; 5:21. [PMID: 31463307 PMCID: PMC6691072 DOI: 10.21037/mhealth.2019.06.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/24/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Annually, over 65,000 persons are diagnosed with head and neck cancer in the United States. During treatment, up to 50% of patients become severely symptomatic with pain, fatigue, mouth sores, and inability to eat. Long term complications are lymphedema, fibrosis, dysphagia, and musculoskeletal impairment. Patients' ability to perform daily activities and to interact socially may be impaired, resulting in poor quality of life. A pragmatic, clinically useful assessment is needed to ensure early detection and intervention for patients to report symptoms and functional limitations over time. We developed the Electronic Patient Visit Assessment (ePVA) that enables patients to report 42 symptoms related to head and neck cancer and 17 limitations of functional status. This manuscript reports (I) the development of the ePVA, (II) the content validity of the ePVA, and (III) the usability and reliability of the ePVA. METHODS Usability was evaluated using the "Think Aloud" technique to guide the iterative process to refine the ePVA based on participants' evaluations. After signing the informed consent, 30 participants with head and neck cancer completed the ePVA using digital tablet devices while thinking aloud about ease of use. All patient conversations were recorded and professionally transcribed. Reliability of the ePVA symptom and functional limitation measures was estimated using the Kuder-Richardson test. Convergent validity of the ePVA was evaluated using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 global QoL/health scale. Transcribed qualitative data were analyzed using directed content analysis approach. Quantitative analyses consisted of descriptive statistics and correlation analyses. RESULTS Among participants, 90% strongly agreed or agreed that the ePVA system was easy to use and 80% were very satisfied. Only minor usability problems were reported due to formatting and software "bugs". Reporting of usability problems decreased in frequency over the study period and no usability problems were reported by the last 3 participants who completed the ePVA. Based on participants' suggestions during the iterative process, refinement of the ePVA included increased touch sensitivity of the touch screen technology and customized error messages to improve ease of use. The ePVA also recorded patient reported symptoms (mouth symptoms: 93%, fibrosis: 60%, fatigue: 60%). The ePVA demonstrated acceptable reliability (alpha =0.82-0.85) and convergent validity (ePVA total number of reported symptoms and function limitations was negatively correlated with EORTC QLQ-C30 global QOL/health scale: r=-0.55038, P<0.01). CONCLUSIONS The ePVA was rigorously developed, accepted by patients with satisfaction, and demonstrated acceptable reliability and convergent validity. Future research will use data generated by the ePVA to determine the impact of symptom trajectories on functional status, treatment interruptions and terminations, and health resource use in head and neck cancer.
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Affiliation(s)
| | - Mei R. Fu
- New York University Meyers College of Nursing, New York, NY, USA
| | - Antonia V. Bennett
- Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Mark S. Persky
- Department of Otolaryngology – Head and Neck Surgery, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Zujun Li
- Department of Medicine, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Adam Jacobson
- Department of Otolaryngology – Head and Neck Surgery, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Kenneth S. Hu
- Department of Radiation Oncology, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Allison Most
- Department of Otolaryngology – Head and Neck Surgery, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Catherine Concert
- Department of Radiation Oncology, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Maria Kamberi
- Department of Otolaryngology – Head and Neck Surgery, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Jacqueline Mojica
- Department of Otolaryngology – Head and Neck Surgery, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Amanda Peyser
- Department of Medicine, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Ann Riccobene
- Department of Medicine, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Anh Tran
- Department of Medicine, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Michael J. Persky
- Department of Otolaryngology – Head and Neck Surgery, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Justin Savitski
- Department of Otolaryngology – Head and Neck Surgery, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Eva Liang
- New York University Meyers College of Nursing, New York, NY, USA
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Haryani H, Hsu YY, Warsini S, Wang ST. Measuring the Symptom Experience of Patients With Cancer in Indonesia: Cross-Cultural Adaptation and Validation of the Memorial Symptom Assessment Scale-Indonesian Version. J Pain Symptom Manage 2018; 56:920-927. [PMID: 30176284 DOI: 10.1016/j.jpainsymman.2018.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 11/25/2022]
Abstract
CONTEXT Little is known about cancer-related symptoms in terms of prevalence, severity, and distress among patients with cancer in Indonesia because of a lack of a valid and reliable scale. OBJECTIVES To translate and validate the Memorial Symptom Assessment Scale (MSAS) among cancer patients in Indonesia. METHODS Two procedures consisting of forward-backward translation and validation were conducted. The validation process including pretesting involved 34 cancer patients, and the psychometric testing of the Indonesian version of MSAS (MSAS-I) involved 207 cancer patients. Internal consistency, test-retest reliability, construct, and concurrent validity of the MSAS-I were established. RESULTS Cronbach's alpha coefficients for the total scale and subscales of the MSAS-I ranged from 0.75 to 0.87. The interclass correlations for test-retest reliability ranged from 0.80 to 0.89. A two-factor structure in the MSAS-I was produced by exploratory factor analysis, and the two factors accounted for 28.34% of the cumulative variance. In addition, the concurrent validity was demonstrated by the significant associations between the subscales of the MSAS-I and their corresponding subscales in the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30, with r = -0.25 to -0.65 (all P < 0.001). CONCLUSION The MSAS-I presents a valid and reliable scale for assessing symptom frequency, severity, and distress among patients with cancer in Indonesia. IMPLICATION FOR NURSING The MSAS-I can assess physical and psychological symptoms during cancer treatment. In addition, the MSAS-I may facilitate in measuring the effectiveness of symptom management strategies.
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Affiliation(s)
- Haryani Haryani
- Department of Medical Surgical Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia
| | - Yu-Yun Hsu
- Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan.
| | - Sri Warsini
- Department of Mental Health Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia
| | - Shan-Tair Wang
- Department of Gerontology, College of Medicine, National Cheng Kung University, Taiwan
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Leysen L, Adriaenssens N, Nijs J, Pas R, Bilterys T, Vermeir S, Lahousse A, Beckwée D. Chronic Pain in Breast Cancer Survivors: Nociceptive, Neuropathic, or Central Sensitization Pain? Pain Pract 2018; 19:183-195. [DOI: 10.1111/papr.12732] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 07/07/2018] [Accepted: 07/29/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Laurence Leysen
- Pain in Motion International Research Group; Brussels Belgium
- Department of Physiotherapy, Human Physiology and Anatomy; Faculty of Physical Education & Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
| | - Nele Adriaenssens
- Department of Physiotherapy, Human Physiology and Anatomy; Faculty of Physical Education & Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
- Department of Oncology; University Hospital Brussels; Brussels Belgium
| | - Jo Nijs
- Pain in Motion International Research Group; Brussels Belgium
- Department of Physiotherapy, Human Physiology and Anatomy; Faculty of Physical Education & Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
- Department of Physical Medicine and Physiotherapy; University Hospital Brussels; Brussels Belgium
| | - Roselien Pas
- Pain in Motion International Research Group; Brussels Belgium
- Department of Physiotherapy, Human Physiology and Anatomy; Faculty of Physical Education & Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
| | - Thomas Bilterys
- Department of Physiotherapy, Human Physiology and Anatomy; Faculty of Physical Education & Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
| | - Sofie Vermeir
- Department of Physiotherapy, Human Physiology and Anatomy; Faculty of Physical Education & Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
| | - Astrid Lahousse
- Department of Physiotherapy, Human Physiology and Anatomy; Faculty of Physical Education & Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
| | - David Beckwée
- Department of Physiotherapy, Human Physiology and Anatomy; Faculty of Physical Education & Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
- Frailty in Ageing Research Department; Vrije Universiteit Brussel; Brussels Belgium
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
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18
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Kamal M, Rosenthal DI, Volpe S, Goepfert RP, Garden AS, Hutcheson KA, Al Feghali KA, Meheissen MAM, Eraj SA, Dursteler AE, Williams B, Smith JB, Aymard JM, Berends J, White AL, Frank SJ, Morrison WH, Cardoso R, Chambers MS, Sturgis EM, Mendoza TR, Lu C, Mohamed ASR, Fuller CD, Gunn GB. Patient reported dry mouth: Instrument comparison and model performance for correlation with quality of life in head and neck cancer survivors. Radiother Oncol 2018; 126:75-80. [PMID: 29229507 PMCID: PMC5957088 DOI: 10.1016/j.radonc.2017.10.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/28/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To identify a clinically meaningful cut-point for the single item dry mouth question of the MD Anderson Symptom Inventory-Head and Neck module (MDASI-HN). METHODS Head and neck cancer survivors who had received radiation therapy (RT) completed the MDASI-HN, the University of Michigan Hospital Xerostomia Questionnaire (XQ), and the health visual analog scale (VAS) of the EuroQol Five Dimension Questionnaire (EQ-5D). The Bayesian information criteria (BIC) were used to test the prediction power of each tool for EQ-5D VAS. The modified Breiman recursive partitioning analysis (RPA) was used to identify a cut point of the MDASI-HN dry mouth score (MDASI-HN-DM) with EQ-5D VAS, using a ROC-based approach; regression analysis was used to confirm the threshold effect size. RESULTS Two-hundred seven respondents formed the cohort. Median follow-up from the end of RT to questionnaire completion was 88 months. The single item MDASI-HN-DM score showed a linear relationship with the XQ composite score (ρ = 0.80, p < 0.001). The MDASI-HN-DM displayed improved model performance for association with EQ-5D VAS as compared to XQ (BIC of 1803.7 vs. 2016.9, respectively). RPA showed that an MDASI-HN-DM score of ≥6 correlated with EQ-5D VAS decline (LogWorth 5.5). CONCLUSION The single item MDASI-HN-DM correlated with the multi-item XQ and performed favorably in the prediction of QOL. A MDASI-HN-DM cut point of ≥6 correlated with decline in QOL.
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Affiliation(s)
- Mona Kamal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Stefania Volpe
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; University of Milan, Department of Oncology and Hemato-Oncology, Milano, Italy
| | - Ryan P Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Karine A Al Feghali
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; The Naef K. Basile Cancer Institute at the American University of Beirut Medical Center, Lebanon
| | - Mohamed Ahmed Mohamed Meheissen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Egypt
| | - Salman A Eraj
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; School of Medicine, The University of Texas Health Science Center at Houston, McGovern School of Medicine, USA
| | - Amy E Dursteler
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; School of Medicine, The University of Texas Health Science Center at Houston, McGovern School of Medicine, USA
| | - Bowman Williams
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Joshua B Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; School of Medicine, The University of Texas Health Science Center at Houston, McGovern School of Medicine, USA
| | - Jeremy M Aymard
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Abilene Christian University, USA
| | - Joel Berends
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; University of Texas Health Science Center at San Antono, USA
| | - Aubrey L White
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; School of Medicine, The University of Texas Health Science Center at Houston, McGovern School of Medicine, USA
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - William H Morrison
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Richard Cardoso
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Mark S Chambers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Erich M Sturgis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Epidemiology, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Tito R Mendoza
- Department of Symptom Research, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Charles Lu
- Department of Symptom Research, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Egypt; MD Anderson Cancer Center/UTHealth Graduate School of Biomedical Sciences, Houston, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; MD Anderson Cancer Center/UTHealth Graduate School of Biomedical Sciences, Houston, USA
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
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Ferris MJ, Zhong J, Switchenko JM, Higgins KA, Cassidy RJ, McDonald MW, Eaton BR, Patel KR, Steuer CE, Baddour HM, Miller AH, Bruner DW, Xiao C, Beitler JJ. Brainstem dose is associated with patient-reported acute fatigue in head and neck cancer radiation therapy. Radiother Oncol 2018; 126:100-106. [PMID: 28826628 PMCID: PMC5841457 DOI: 10.1016/j.radonc.2017.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 07/17/2017] [Accepted: 08/05/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Radiation (RT) dose to the central nervous system (CNS) has been implicated as a contributor to treatment-related fatigue in head and neck cancer (HNC) patients undergoing radiation therapy (RT). This study evaluates the association of RT dose to CNS structures with patient-reported (PRO) fatigue scores in a population of HNC patients. MATERIALS AND METHODS At pre-RT (baseline), 6th week of RT, and 1-month post-RT time points, Multidimensional Fatigue Inventory (MFI-20) scores were prospectively obtained from 124 patients undergoing definitive treatment for HNC. Medulla, pons, midbrain, total brainstem, cerebellum, posterior fossa, and pituitary dosimetry were evaluated using summary statistics and dose-volume histograms, and associations with MFI-20 scores were analyzed. RESULTS Maximum dose (Dmax) to the brainstem and medulla was significantly associated with MFI-20 scores at 6th week of RT and 1-month post-RT time points, after controlling for baseline scores (p<0.05). Each 1Gy increase in medulla Dmax resulted in an increase in total MFI-20 score over baseline of 0.30 (p=0.026), and 0.25 (p=0.037), at the 6th week of RT and 1-month post-RT, respectively. Each 1Gy increase in brainstem Dmax resulted in an increase in total MFI-20 score over baseline of 0.30 (p=0.027), and 0.25 (p=0.037) at the 6th week of RT, 1-month post-RT, respectively. Statistically significant associations were not found between dosimetry for the other CNS structures and MFI-20 scores. CONCLUSIONS In this analysis of PRO fatigue scores from a population of patients undergoing definitive RT for HNC, maximum dose to the brainstem and medulla was associated with a significantly increased risk of acute patient fatigue.
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Affiliation(s)
- Matthew J Ferris
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA.
| | - Jim Zhong
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA
| | - Jeffrey M Switchenko
- Winship Cancer Institute of Emory University, Atlanta, USA; Department of Biostatistics & Bioinformatics, Emory University, Atlanta, USA
| | - Kristin A Higgins
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA
| | - Richard J Cassidy
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA
| | - Mark W McDonald
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA
| | - Bree R Eaton
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA
| | - Kirtesh R Patel
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA
| | - Conor E Steuer
- Winship Cancer Institute of Emory University, Atlanta, USA; Department of Hematology and Medical Oncology, Emory University, Atlanta, USA
| | - H Michael Baddour
- Winship Cancer Institute of Emory University, Atlanta, USA; Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, USA
| | - Andrew H Miller
- Winship Cancer Institute of Emory University, Atlanta, USA; Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, USA
| | - Deborah W Bruner
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, USA
| | - Canhua Xiao
- Winship Cancer Institute of Emory University, Atlanta, USA; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, USA
| | - Jonathan J Beitler
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA
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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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21
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Engler K, Lessard D, Toupin I, Lènàrt A, Lebouché B. Engaging stakeholders into an electronic patient-reported outcome development study: On making an HIV-specific e-PRO patient-centered. HEALTH POLICY AND TECHNOLOGY 2017. [DOI: 10.1016/j.hlpt.2016.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Xu N, Li Z, Wei F, Liu X, Jiang L, Meng N, Jiang P, Yu M, Wu F, Dang L, Zhou H, Li Y, Liu Z. A Cross-sectional Study on the Symptom Burden of Patients With Spinal Tumor: Validation of the Chinese Version of the M.D. Anderson Symptom Inventory-Spine Tumor Module. J Pain Symptom Manage 2017; 53:605-613. [PMID: 28042067 DOI: 10.1016/j.jpainsymman.2016.10.360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/28/2016] [Accepted: 10/07/2016] [Indexed: 11/12/2022]
Abstract
CONTEXT Tumors involving the spine are associated with unique symptoms affecting both patient survival and health-related quality of life. Currently, there is no disease-specific instrument in Chinese to assess the symptom burden of these patients. OBJECTIVES The objective of this study was to translate and validate a Chinese version of the M.D. Anderson Symptom Inventory-Spine Tumor Module (MDASI-SP-C) to assess the symptom burden of Chinese-speaking patients with spinal tumors. METHODS MDASI-SP-C was forward-and-backward translated according to standard protocols and administered to patients fulfilling study criteria at a major referral center of spine tumor between November 2014 and September 2015. The generic instruments of Short Form 36 Quality of Life Questionnaire (SF-36), Functional Assessment of Cancer Therapy-General Version (FACT-G), and Karnofsky Performance Scale were used along with MDASI-SP-C. Prevalence and severity distribution of each item were analyzed. Psychometric assessment and hierarchical cluster analysis were performed for the translated instrument. RESULTS One hundred forty-two patients were enrolled. High interdependency and relatively low intra-cluster distances were identified. Cronbach's alpha of the entire instrument, the symptom severity subscale, and the interference subscale was 0.93, 0.91, and 0.92, respectively. Principal axis factoring resulted in a four-factor solution, which was reduced to a three-factor (general symptoms, spine-specific symptoms, and gastrointestinal symptoms) solution on account of clinical interpretation. Correlation coefficients between MDASI-SP-C items and their corresponding domains in SF-36 and/or FACT-G were all greater than 0.3. MDASI-SP-C was able to distinguish patients with different Karnofsky Performance Scale levels. CONCLUSION MDASI-SP-C demonstrated satisfactory psychometric properties and could be used to better assess the symptom burden of Chinese-speaking patients with spine tumors for improved management of their medical needs.
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Affiliation(s)
- Nanfang Xu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Zhehuang Li
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Feng Wei
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Liang Jiang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Na Meng
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Ping Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Miao Yu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Fengliang Wu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Lei Dang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Hua Zhou
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Yan Li
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China.
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Banerjee G, Rose A, Briggs M, Johnson MI. Could kinesiology taping help mitigate pain, breathlessness and abdominal-related symptoms in cancer? BMJ Case Rep 2017; 2017:bcr-2016-216695. [PMID: 28237944 PMCID: PMC5337641 DOI: 10.1136/bcr-2016-216695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
We present the case of a woman who was an amateur athlete diagnosed with primary breast cancer, and 10 years later with terminal metastatic cancer. This case report was prepared posthumously in co-operation with her next of kin (husband). The patient first presented to a sports physiotherapist (AR) for her pain-management and to help maintain physical fitness so that she could continue with sports and an active lifestyle. The patient continued with physiotherapy for several months to enable her to be active. However, when her health deteriorated significantly due to advancing cancer, the treatment was modified and aimed at improving the patient's general well-being. The physiotherapist applied kinesiology tape over the patient's lower rib cage, diaphragm and abdomen in an attempt to manage pain, breathlessness and abdominal bloating. The patient reported alleviation of pain, breathlessness, abdominal discomfort and nausea, accompanied by improvements in eating, drinking, energy levels and physical function.
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Affiliation(s)
- Gourav Banerjee
- Centre for Pain Research, School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
| | - Alison Rose
- Coach House Sports Physiotherapy Clinic, Leeds, UK
| | - Michelle Briggs
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Research and Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre; Jean McFarlane Building, Manchester, UK
| | - Mark I Johnson
- Centre for Pain Research, School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
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In pursuit of empirically supported assessment for use in medical settings. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2016. [DOI: 10.1111/cpsp.12176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Patient Reported Outcomes (PROs) are sensitive outcome-variables in patients with chronic pain: Importance of self-efficacy. Scand J Pain 2016; 13:25-26. [DOI: 10.1016/j.sjpain.2016.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Gunn GB, Atalar B, Mendoza TR, Cleeland CS, Selek U, Özyar E, Rosenthal DI. Linguistic Validation of the Turkish Version of the M.D. Anderson Symptom Inventory - Head and Neck Cancer Module. Balkan Med J 2016; 33:339-43. [PMID: 27308079 DOI: 10.5152/balkanmedj.2015.150148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 06/12/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The use of patient symptom reports with frequent symptom assessment may be preferred over the more commonly used health-related quality of life questionnaires. AIMS We sought to linguistically validate the Turkish version of the M.D. Anderson Symptom Inventory-Head and Neck module (MDASI-HN) patient reported outcome questionnaire. STUDY DESIGN Validation study. METHODS Following standard forward and backward translation of the original and previously validated English MDASI-HN into a Turkish version (T-MDASI-HN), it was administered to patients with head and neck cancer able to read and understand Turkish. Patients were then cognitively debriefed to evaluate their understanding and comprehension of the T-MDASI-HN. Individual and group responses are presented using descriptive statistics. RESULTS Twenty-six participants with head and neck cancer completed the T-MDASIHN and accompanying cognitive debriefing. Overall, 97 percent of the individual TMDASI-HN items were completed. Average recorded time to complete the 28 item TMDASI-HN questionnaire was 5.4 minutes (range 2-10). Average overall ease of completion, understandability, and acceptability were favorably rated at 1.0, 1.1, and 0.2, respectively, on scales from 0 to 10. Only 5 of the 26 of participants reported trouble completing any single questionnaire items, namely the "difficulty remembering" item for 3 individuals. CONCLUSION The T-MDASI-HN is linguistically valid with ease of completion, relevance, comprehensibility, and applicability and it can be a useful clinical and research tool.
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Affiliation(s)
- G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - Banu Atalar
- Department of Radiation Oncology, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Tito R Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - Charles S Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - Uğur Selek
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Texas, USA; Department of Radiation Oncology, Koç University School of Medicine, İstanbul, Turkey
| | - Enis Özyar
- Department of Radiation Oncology, Acıbadem University School of Medicine, İstanbul, Turkey
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Texas, USA
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Kelleher SA, Somers TJ, Locklear T, Crosswell AD, Abernethy AP. Using Patient Reported Outcomes in Oncology Clinical Practice. Scand J Pain 2016; 13:6-11. [PMID: 27818717 DOI: 10.1016/j.sjpain.2016.05.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Patient reported outcomes (PROs) are increasingly being implemented into the care of patients with cancer. The use of a standard set of PROs (e.g., pain) in cancer is becoming established and there is interest in what additional PROs might provide valuable information. The goal of this observational study was to examine how the PROs of self-efficacy for pain and other symptoms assessed at the point of service were associated with pain, symptom severity and distress, and physical and psychosocial functioning in a sample of breast and gastrointestinal patients. We also sought to examine differences in these relationships by cancer type (breast and gastrointestinal) as well as understand differences in self-assessment mode (paper/pencil or electronic tablet). METHODS 178 patients with breast (n=65) and gastrointestinal cancer (n = 113) completed the Chronic Pain Self Efficacy Scale, M.D. Anderson Symptom Inventory, and Functional Assessment of Cancer Therapy-General questionnaires. Measures were completed with paper and pencil and electronically using a tablet computer while patients waited for their clinical appointment. Responses from the initial completed questionnaires on both the paper and electronic instruments were analyzed. RESULTS Patients' self-efficacy scores for pain and other symptoms correlated positively with pain, symptom severity and distress, and physical and psychosocial functioning; patients with lower levels of self-efficacy reported poorer outcomes and functioning overall. The results were independent of cancer type and mode of assessment. No statistically significant differences were found in the PROs when collected by electronic technology versus paper-pencil mode; patients were very satisfied with using the tablet computer to complete the PRO measures. CONCLUSIONS AND IMPLICATIONS Our results suggest that self-efficacy for pain and symptom management may be a beneficial addition to clinic-based PRO assessment batteries for patients with cancer and other chronic diseases. Existing short, validated symptom self-efficacy scales could easily be integrated into clinical practice to help healthcare providers identify patients that might benefit from intervention. Study results also support existing research that suggests electronic approaches are a practical way to collect PRO data, including self-efficacy data, in the clinic. Overall, our data suggest that patients who have particularly low levels of self-efficacy for pain and symptom management may be at risk for higher levels of pain and disability. Thus, if self-efficacy for pain and symptom management were routinely collected at the time of clinical service, psychosocial interventions to improve self-efficacy for pain and symptom management, and in turn overall quality of life, could be implemented in a timely fashion.
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Affiliation(s)
- Sarah A Kelleher
- Department Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, United States
| | - Tamara J Somers
- Department Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, United States
| | - Tracie Locklear
- Center for Learning Health Care, Duke University Medical Center, Durham, NC 27705, United States
| | - Alexandra D Crosswell
- Center for Health and Community, University of California San Francisco, San Francisco, CA 94143, United States
| | - Amy P Abernethy
- Center for Learning Health Care, Duke University Medical Center, Durham, NC 27705, United States
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28
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Brenne E, Loge JH, Lie H, Hjermstad MJ, Fayers PM, Kaasa S. The Edmonton Symptom Assessment System: Poor performance as screener for major depression in patients with incurable cancer. Palliat Med 2016; 30:587-98. [PMID: 26763008 DOI: 10.1177/0269216315620082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Depressive symptoms are prevalent in patients with advanced cancer, sometimes of a severity that fulfil the criteria for a major depressive episode. AIM The aim of this study was to investigate how the item on depression in the Edmonton Symptom Assessment System with a 0-10 Numerical Rating Scale performed as a screener for major depressive episode. A possible improved performance by adding the Edmonton Symptom Assessment System-Anxiety item was also examined. DESIGN An international cross-sectional study including patients with incurable cancer was conducted. The Edmonton Symptom Assessment System score was compared against major depressive episode as assessed by the Patient Health Questionnaire-9. Screening performance was examined by sensitivity, specificity and the kappa coefficient. SETTING Patients with incurable cancer (n = 969), median age 63 years and from eight nationalities provided report. Median Karnofsky Performance Status was 70. Median survival was 229 days (205-255 days). RESULTS Patient Health Questionnaire-9 major depressive episode was present in 133 of 969 patients (13.7%). Edmonton Symptom Assessment System-Depression screening ability for Patient Health Questionnaire-9 major depressive episode was limited. Area under the receiver operating characteristic curve was 0.71 (0.66-0.76). Valid detection or exclusion of Patient Health Questionnaire-9 major depressive episode could not be concluded at any Edmonton Symptom Assessment System-Depression cut-off; by the cut-off Numerical Rating Scale ⩾ 2, sensitivity was 0.69 and specificity was 0.60. By the cut-off Numerical Rating Scale ⩾ 4, sensitivity was 0.51 and specificity was 0.82. Combined mean ratings by Edmonton Symptom Assessment System-Depression and Edmonton Symptom Assessment System-Anxiety revealed similar limited screening ability. CONCLUSION The depression and anxiety items of the Edmonton Symptom Assessment System, a frequently used assessment tool in palliative care settings, seem to measure a construct other than major depressive episode as assessed by the Patient Health Questionnaire-9 instrument.
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Affiliation(s)
- Elisabeth Brenne
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Cancer Clinic, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jon H Loge
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway Regional Centre for Excellence in Palliative Care, South Eastern Norway, Oslo University Hospital, Oslo, Norway
| | - Hanne Lie
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Marianne J Hjermstad
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Regional Centre for Excellence in Palliative Care, South Eastern Norway, Oslo University Hospital, Oslo, Norway
| | - Peter M Fayers
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Department of Public Health, Aberdeen University Medical School, Aberdeen City, UK
| | - Stein Kaasa
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Cancer Clinic, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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Van Cleave JH, Smith-Howell E, Naylor MD. Achieving a High-Quality Cancer Care Delivery System for Older Adults: Innovative Models of Care. Semin Oncol Nurs 2016; 32:122-33. [PMID: 27137469 PMCID: PMC4864983 DOI: 10.1016/j.soncn.2016.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To examine innovative models and other research-based interventions that hold potential to assure high-quality care for the growing older adult population living with cancer as one of multiple chronic conditions. Evidence from these care delivery approaches provides a roadmap for the development of future care models. DATA SOURCES Published peer-reviewed literature, policy analyses, and web-based resources. CONCLUSION Available evidence suggests the need for models that engage patients and their family caregivers, focus on patient's functional capacities, emphasize palliative care, and maximize the contributions of all team members. IMPLICATIONS FOR NURSING PRACTICE Nurses are uniquely positioned to lead or play a major role in the evolution and implementation of care models targeting older adults with cancer, but must increase their knowledge and skills related to both oncology and geriatrics to maximize their contributions.
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Affiliation(s)
- Janet H. Van Cleave
- New York University College of Nursing, 433 First Avenue, New York, NY 10010 U.S.A.
| | - Esther Smith-Howell
- University of Pennsylvania School of Nursing, 3615 Chestnut Street, Ralston-Penn Center RM327, Philadelphia, PA 19104 U.S.A.
| | - Mary D. Naylor
- Director, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, 418 Curie Blvd, Claire M. Fagin Hall RM341, Philadelphia, PA 19104-4217 U.S.A.
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Berman AT, DeCesaris CM, Simone CB, Vachani C, DiLullo G, Hampshire MK, Metz J, Hill-Kayser C. Use of Survivorship Care Plans and Analysis of Patient-Reported Outcomes in Multinational Patients With Lung Cancer. J Oncol Pract 2016; 12:e527-35. [PMID: 27048615 DOI: 10.1200/jop.2015.008904] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Lung cancer is the leading cause of cancer death and is a significant source of morbidity. Patient-reported outcomes (PROs) have been shown to be prognostic for survival. We have analyzed emerging patterns of longitudinal PROs collected in the development of survivorship care plans (SCPs). METHODS OncoLife and the LIVESTRONG Care Plans are Internet-based programs designed to generate unique SCPs. We selected SCPs from patients identifying as survivors of primary lung cancer. Patient-reported demographics and treatment and toxicity data were examined. Effects were categorized by the physiologic system that they affected. RESULTS Six hundred eighty-nine plans were created for users self-identifying as survivors of primary lung cancer. Average time from diagnosis to reporting was 1.68 years (range, 0 to 24 years). Most were white (85.9%), well educated (61.1% "some college" or higher), and lived in the United States (90.7%). Patients underwent chemotherapy (75.8%), radiotherapy (54.7%), and surgery (54.4%). Neurocognitive symptoms (eg, fatigue, cognitive changes) were the most common (48.8%), especially among those receiving chemotherapy, followed by musculoskeletal/dermatologic symptoms (14.1%) and thoracic symptoms (13.5%). Only 11.2% were initially offered an SCP. Of those offered SCPs, 54.5% were offered by their health care provider, and most often were at a non-university-based cancer center (66.2%). CONCLUSION For patients with lung cancer worldwide, it is feasible to obtain PROs and to create SCPs through an Internet-based program. As patients with lung cancer achieve improved survival, further attention should be paid to PROs. Surprisingly, neurocognitive symptoms seem to be the most common issues and therefore the most important to address. Increased effort should be made to provide SCPs, particularly in urban and university cancer center settings.
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Affiliation(s)
| | | | | | | | | | | | - James Metz
- University of Pennsylvania, Philadelphia, PA
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Dreyer RP, Jones PG, Kutty S, Spertus JA. Quantifying clinical change: discrepancies between patients' and providers' perspectives. Qual Life Res 2016; 25:2213-20. [PMID: 26995561 DOI: 10.1007/s11136-016-1267-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Interpreting the clinical significance of changes in patient-reported outcomes (PROs) is critically important. The most commonly used approach is to anchor mean changes on PRO scores against a global assessment of change. Whether the assessor of global change should be patients or their physicians is unknown. We compared patients' and physicians' assessments of change over time to examine which was more aligned with patients' changes in PRO measures. METHODS A total of 459 chronic heart failure patients aged >30 years were enrolled from 13 US centers. Data were obtained by medical record abstraction, physical assessments, and patient interviews at a baseline clinic visit and 6 weeks later. Health status was measured with the disease-specific Kansas City Cardiomyopathy Questionnaire (KCCQ), and both patients and physicians completed a validated 15-level global assessment of change, ranging from large deterioration to large improvement. RESULTS There was substantial variation between physicians/patients' global assessment of clinical change (weighted kappa = 0.36, 95 % CI 0.28, 0.43). Overall, physician assessments were more strongly correlated with change on the KCCQ summary score than were patients' assessments (physician R = 0.37, patient R = 0.29). CONCLUSION There was substantial variation between patients' and physicians' global assessment of 6-week change in heart failure status. Physician assessments of the importance of clinical changes were more strongly associated with changes in all domains of patient-reported health status, as assessed by the KCCQ, and may provide a more consistent method for defining the clinical importance of changes in patients' health status.
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Affiliation(s)
- Rachel P Dreyer
- Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, CT, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Philip G Jones
- School of Medicine, Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City, MO, USA.,Saint Luke's Mid America Heart Institute, University of Missouri - Kansas City, 4401 Wornall Road, Kansas City, MO, 64111, USA
| | - Shelby Kutty
- Department of Pediatrics, Children's Hospital and Medical Center, Omaha, NE, USA
| | - John A Spertus
- School of Medicine, Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City, MO, USA. .,Saint Luke's Mid America Heart Institute, University of Missouri - Kansas City, 4401 Wornall Road, Kansas City, MO, 64111, USA.
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PRO-ONKO-selection of patient-reported outcome assessments for the clinical use in cancer patients-a mixed-method multicenter cross-sectional exploratory study. Support Care Cancer 2015; 24:2503-12. [PMID: 26676238 DOI: 10.1007/s00520-015-3055-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/07/2015] [Indexed: 11/12/2022]
Abstract
PURPOSE Cancer patients frequently suffer from multiple symptoms often impairing functional status and health-related quality of life (HRQOL). A comprehensive assessment including patient-reported outcomes (PROs) is recommended to enable individualized supportive care. However, PRO assessments are still not part of routine clinical practice. Therefore, this project aimed to compile an item pool from validated assessment instruments to facilitate the use of PROs for clinical decision-making in oncology clinics. METHODS This qualitative dominant mixed-method cross-sectional exploratory study was carried out in four centers and comprised two stages. Stage I: Six interdisciplinary focus groups were conducted to choose questionnaires meeting particular clinical requirements. Stage II: Adult patients with heterogeneous cancer diagnoses, receiving in- or out-patient treatment were asked to participate and complete the chosen questionnaires (participation 71/74). Resulting PROs were compared with clinical records. Health care professionals (HCPs) and patients rated the usefulness for routine clinical practice. RESULTS The European Organisation of Research and Treatment of Cancer (EORTC) QLQ-C30 and Distress Thermometer were chosen for screening and M.D. Anderson Symptom Inventory (MDASI) and EORTC single items for monitoring. Comparison of n = 88 PRO assessments with clinical records showed consistent documentation of side effects like fever and emesis. Symptoms like fatigue, sadness, or sleep disturbance were not documented regularly in the medical records but captured by PRO assessments. Patients and HCPs judged the chosen questionnaires and electronic data collection as useful. CONCLUSIONS Future studies should examine how PROs can complement or substitute routine documentation in order to achieve standardized assessment and documentation during the treatment process in different settings and examine possible benefits for patients.
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Armstrong TS, Vera-Bolanos E, Acquaye AA, Gilbert MR, Ladha H, Mendoza T. The symptom burden of primary brain tumors: evidence for a core set of tumor- and treatment-related symptoms. Neuro Oncol 2015; 18:252-60. [PMID: 26289592 DOI: 10.1093/neuonc/nov166] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 07/21/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A set of symptoms common across cancers has been proposed to enhance quality of care and clinical research in solid tumor patients. Using data from several clinical studies, this study evaluated these symptoms in primary brain tumor patients. METHODS Symptom report data using the MD Anderson Symptom Instrument -Brain Tumor (MDASI-BT) from 621 patients enrolled in 8 clinical studies was used. The prevalence and severity of symptoms were reported as they relate to tumor grade, treatment stage and KPS. RESULTS The sample was primarily white (82.5%) males (59%) with high-grade gliomas (75%). More than 50% of patients reported at least 10 concurrent symptoms, and 40% of patients reporting having at least 3 moderate-to-severe symptoms. Fatigue, drowsiness, difficulty remembering, disturbed sleep, and distress were the most severe symptoms reported by all tumor grades. Functional interference of symptoms with ability to work, perform activities, walk, and enjoy life was reported by more than 25% of patients. CONCLUSIONS These results support a core set of symptoms, common in other solid tumor patients, that may impact clinical care and assessment of treatment benefit. Although only 5 of the Center for Medical Technology Policy list of proposed core symptoms met criteria for inclusion in this sample, 5 of the other proposed core symptoms were also reported in similar frequency as reported in the other cancer populations. This primary brain tumor population differed from other solid tumor patients in that other symptoms, which could be disease related, were more prevalent and thus should also be collected for these patients.
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Affiliation(s)
- Terri S Armstrong
- University of Texas Health Science Center at Houston, Houston, Texas (T.S.A., H.L.); The University of Texas MD Anderson Cancer Center, Houston, Texas (T.S.A., E.V.-B., A.A.A., M.R.G., T.M.)
| | - Elizabeth Vera-Bolanos
- University of Texas Health Science Center at Houston, Houston, Texas (T.S.A., H.L.); The University of Texas MD Anderson Cancer Center, Houston, Texas (T.S.A., E.V.-B., A.A.A., M.R.G., T.M.)
| | - Alvina A Acquaye
- University of Texas Health Science Center at Houston, Houston, Texas (T.S.A., H.L.); The University of Texas MD Anderson Cancer Center, Houston, Texas (T.S.A., E.V.-B., A.A.A., M.R.G., T.M.)
| | - Mark R Gilbert
- University of Texas Health Science Center at Houston, Houston, Texas (T.S.A., H.L.); The University of Texas MD Anderson Cancer Center, Houston, Texas (T.S.A., E.V.-B., A.A.A., M.R.G., T.M.)
| | - Harshad Ladha
- University of Texas Health Science Center at Houston, Houston, Texas (T.S.A., H.L.); The University of Texas MD Anderson Cancer Center, Houston, Texas (T.S.A., E.V.-B., A.A.A., M.R.G., T.M.)
| | - Tito Mendoza
- University of Texas Health Science Center at Houston, Houston, Texas (T.S.A., H.L.); The University of Texas MD Anderson Cancer Center, Houston, Texas (T.S.A., E.V.-B., A.A.A., M.R.G., T.M.)
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Mendoza TR, Wang XS, Williams LA, Shi Q, Vichaya EG, Dougherty PM, Thomas SK, Yucel E, Bastida CC, Woodruff JF, Cleeland CS. Measuring Therapy-Induced Peripheral Neuropathy: Preliminary Development and Validation of the Treatment-Induced Neuropathy Assessment Scale. THE JOURNAL OF PAIN 2015. [PMID: 26210041 DOI: 10.1016/j.jpain.2015.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
UNLABELLED Various sensory and motor effects are associated with cancer treatment-induced peripheral neuropathy. The current method for capturing the multifaceted nature of neuropathy includes a combination of objective tests, clinician evaluation, and subjective patient report, an approach that is often not logistically feasible, especially for multisite trials. We report the performance of a brief yet comprehensive, easily administered measure, the Treatment-Induced Neuropathy Assessment Scale (TNAS), for assessing the severity and course of neuropathy across various cancer treatments. Data were derived from 4 longitudinal or cross-sectional patient cohorts (N = 573). Patients with multiple myeloma treated primarily with bortezomib and patients with colorectal cancer receiving oxaliplatin evaluated candidate items. Cognitive debriefing showed that all items were easy to understand, and this preliminary TNAS demonstrated reliability, validity, and sensitivity. Numbness/tingling was the most severe item, regardless of therapeutic agent. Although numbness and general pain were moderately correlated, patients perceived them as distinct. Most TNAS items were more severe at follow-up, demonstrating the sensitivity of the instrument to accumulating dose. The TNAS will be refined with further patient input, with final psychometric evaluation conducted in a new patient sample receiving treatments known to be associated with peripheral neuropathy. The nonpainful component of neuropathy may be more disabling than the pain component. PERSPECTIVE Our data suggest that the nonpainful components of neuropathy may be more disabling than the pain component during cancer treatment. Here we report data on sensory and motor symptoms reported by patients receiving neurotoxic cancer therapy, and we detail the development of a neuropathy assessment scale that follows regulatory guidance for patient-reported outcomes.
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Affiliation(s)
- Tito R Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Xin Shelley Wang
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Loretta A Williams
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Qiuling Shi
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elisabeth G Vichaya
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Patrick M Dougherty
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sheeba K Thomas
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Emre Yucel
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Christel C Bastida
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeanie F Woodruff
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Charles S Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Moens K, Siegert RJ, Taylor S, Namisango E, Harding R. Symptom Clusters in People Living with HIV Attending Five Palliative Care Facilities in Two Sub-Saharan African Countries: A Hierarchical Cluster Analysis. PLoS One 2015; 10:e0126554. [PMID: 25966420 PMCID: PMC4429062 DOI: 10.1371/journal.pone.0126554] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 04/03/2015] [Indexed: 11/18/2022] Open
Abstract
Background Symptom research across conditions has historically focused on single symptoms, and the burden of multiple symptoms and their interactions has been relatively neglected especially in people living with HIV. Symptom cluster studies are required to set priorities in treatment planning, and to lessen the total symptom burden. This study aimed to identify and compare symptom clusters among people living with HIV attending five palliative care facilities in two sub-Saharan African countries. Methods Data from cross-sectional self-report of seven-day symptom prevalence on the 32-item Memorial Symptom Assessment Scale-Short Form were used. A hierarchical cluster analysis was conducted using Ward’s method applying squared Euclidean Distance as the similarity measure to determine the clusters. Contingency tables, X2 tests and ANOVA were used to compare the clusters by patient specific characteristics and distress scores. Results Among the sample (N=217) the mean age was 36.5 (SD 9.0), 73.2% were female, and 49.1% were on antiretroviral therapy (ART). The cluster analysis produced five symptom clusters identified as: 1) dermatological; 2) generalised anxiety and elimination; 3) social and image; 4) persistently present; and 5) a gastrointestinal-related symptom cluster. The patients in the first three symptom clusters reported the highest physical and psychological distress scores. Patient characteristics varied significantly across the five clusters by functional status (worst functional physical status in cluster one, p<0.001); being on ART (highest proportions for clusters two and three, p=0.012); global distress (F=26.8, p<0.001), physical distress (F=36.3, p<0.001) and psychological distress subscale (F=21.8, p<0.001) (all subscales worst for cluster one, best for cluster four). Conclusions The greatest burden is associated with cluster one, and should be prioritised in clinical management. Further symptom cluster research in people living with HIV with longitudinally collected symptom data to test cluster stability and identify common symptom trajectories is recommended.
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Affiliation(s)
- Katrien Moens
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, United Kingdom
- * E-mail:
| | | | - Steve Taylor
- Auckland University of Technology, Auckland, New Zealand
| | - Eve Namisango
- African Palliative Care Association, Kampala, Uganda
| | - Richard Harding
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, United Kingdom
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Greco A, Orlandi E, Mirabile A, Takanen S, Fallai C, Iacovelli NA, Rimedio A, Russi E, Sala M, Monzani D, Rosenthal DI, Gunn GB, Steca P, Licitra L, Bossi P. Italian version of the M.D. Anderson Symptom Inventory—Head and Neck Module: linguistic validation. Support Care Cancer 2015; 23:3465-72. [DOI: 10.1007/s00520-015-2701-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/09/2015] [Indexed: 11/29/2022]
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Sheu T, Fuller CD, Mendoza TR, Garden AS, Morrison WH, Beadle BM, Phan J, Frank SJ, Hanna EY, Lu C, Cleeland CS, Rosenthal DI, Gunn GB. Nomogram for predicting symptom severity during radiation therapy for head and neck cancer. Otolaryngol Head Neck Surg 2014; 151:619-26. [PMID: 25104816 PMCID: PMC4184965 DOI: 10.1177/0194599814545746] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 07/11/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Radiation therapy (RT), with or without chemotherapy, can cause significant acute toxicity among patients treated for head and neck cancer (HNC), but predicting, before treatment, who will experience a particular toxicity or symptom is difficult. We created and evaluated 2 multivariate models and generated a nomogram to predict symptom severity during RT based on a patient-reported outcome (PRO) instrument, the MD Anderson Symptom Inventory-Head and Neck Module (MDASI-HN). STUDY DESIGN This was a prospective, longitudinal, questionnaire-based study. SETTING Tertiary cancer care center. SUBJECTS AND METHODS Subjects were 264 patients with HNC (mostly oropharyngeal) who had completed the MDASI-HN before and during therapy. Pretreatment variables were correlated with MDASI-HN symptom scores during therapy with multivariate modeling and then were correlated with the composite MDASI-HN score during week 5 of therapy. RESULTS A multivariate model incorporating pretreatment PROs better predicted MDASI-HN symptom scores during treatment than did a model based on clinical variables and physician-rated patient performance status alone (Akaike information criterion = 1442.5 vs 1459.9). In the most parsimonious model, pretreatment MDASI-HN symptom severity (P < .001), concurrent chemotherapy (P = .006), primary tumor site (P = .016), and receipt of definitive (rather than adjuvant) RT (P = .044) correlated with MDASI-HN symptom scores during week 5. That model was used to construct a nomogram. CONCLUSION Our model demonstrates the value of incorporating baseline PROs, in addition to disease and treatment characteristics, to predict patient symptom burden during therapy. Although additional investigation and validation are required, PRO-inclusive prediction tools can be useful for improving symptom interventions and expectations for patients being treated for HNC.
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Affiliation(s)
- Tommy Sheu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA Baylor College of Medicine, Houston, Texas, USA
| | - Clifton David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tito R Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - William H Morrison
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Beth M Beadle
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Charles Lu
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Charles S Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Reeve BB, Mitchell SA, Dueck AC, Basch E, Cella D, Reilly CM, Minasian LM, Denicoff AM, O'Mara AM, Fisch MJ, Chauhan C, Aaronson NK, Coens C, Bruner DW. Recommended patient-reported core set of symptoms to measure in adult cancer treatment trials. J Natl Cancer Inst 2014; 106:dju129. [PMID: 25006191 PMCID: PMC4110472 DOI: 10.1093/jnci/dju129] [Citation(s) in RCA: 203] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 04/01/2014] [Accepted: 04/11/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The National Cancer Institute's Symptom Management and Health-Related Quality of Life Steering Committee held a clinical trials planning meeting (September 2011) to identify a core symptom set to be assessed across oncology trials for the purposes of better understanding treatment efficacy and toxicity and to facilitate cross-study comparisons. We report the results of an evidence-synthesis and consensus-building effort that culminated in recommendations for core symptoms to be measured in adult cancer clinical trials that include a patient-reported outcome (PRO). METHODS We used a data-driven, consensus-building process. A panel of experts, including patient representatives, conducted a systematic review of the literature (2001-2011) and analyzed six large datasets. Results were reviewed at a multistakeholder meeting, and a final set was derived emphasizing symptom prevalence across diverse cancer populations, impact on health outcomes and quality of life, and attribution to either disease or anticancer treatment. RESULTS We recommend that a core set of 12 symptoms--specifically fatigue, insomnia, pain, anorexia (appetite loss), dyspnea, cognitive problems, anxiety (includes worry), nausea, depression (includes sadness), sensory neuropathy, constipation, and diarrhea--be considered for inclusion in clinical trials where a PRO is measured. Inclusion of symptoms and other patient-reported endpoints should be well justified, hypothesis driven, and meaningful to patients. CONCLUSIONS This core set will promote consistent assessment of common and clinically relevant disease- and treatment-related symptoms across cancer trials. As such, it provides a foundation to support data harmonization and continued efforts to enhance measurement of patient-centered outcomes in cancer clinical trials and observational studies.
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Affiliation(s)
- Bryce B Reeve
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo).
| | - Sandra A Mitchell
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
| | - Amylou C Dueck
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
| | - Ethan Basch
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
| | - David Cella
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
| | - Carolyn Miller Reilly
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
| | - Lori M Minasian
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
| | - Andrea M Denicoff
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
| | - Ann M O'Mara
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
| | - Michael J Fisch
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
| | - Cynthia Chauhan
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
| | - Neil K Aaronson
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
| | - Corneel Coens
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
| | - Deborah Watkins Bruner
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
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Donovan KA, Donovan HS, Cella D, Gaines ME, Penson RT, Plaxe SC, von Gruenigen VE, Bruner DW, Reeve BB, Wenzel L. Recommended patient-reported core set of symptoms and quality-of-life domains to measure in ovarian cancer treatment trials. J Natl Cancer Inst 2014; 106:dju128. [PMID: 25006190 PMCID: PMC4110471 DOI: 10.1093/jnci/dju128] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 04/01/2014] [Accepted: 04/11/2014] [Indexed: 02/02/2023] Open
Abstract
There is no consensus as to what symptoms or quality-of-life (QOL) domains should be measured as patient-reported outcomes (PROs) in ovarian cancer clinical trials. A panel of experts convened by the National Cancer Institute reviewed studies published between January 2000 and August 2011. The results were included in and combined with an expert consensus-building process to identify the most salient PROs for ovarian cancer clinical trials. We identified a set of PROs specific to ovarian cancer: abdominal pain, bloating, cramping, fear of recurrence/disease progression, indigestion, sexual dysfunction, vomiting, weight gain, and weight loss. Additional PROs identified in parallel with a group charged with identifying the most important PROs across cancer types were anorexia, cognitive problems, constipation, diarrhea, dyspnea, fatigue, nausea, neuropathy, pain, and insomnia. Physical and emotional domains were considered to be the most salient domains of QOL. Findings of the review and consensus process provide good support for use of these ovarian cancer-specific PROs in ovarian cancer clinical trials.
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Affiliation(s)
- Kristine A Donovan
- Affiliations of authors: Supportive Care Medicine Department, Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL (KAD); Acute and Tertiary Care Department, University of Pittsburgh School of Nursing, Pittsburgh, PA (HSD); Department of Medical Social Sciences and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (DC); Center for Patient Partnership, University of Wisconsin Law School, Madison, WI (MEG); Department of Medicine, Massachusetts General Hospital, Boston, MA (RTP); Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California-San Diego, San Diego, CA (SCP); Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Summa Akron City Hospital, Akron, OH (VEvG); School of Nursing, Emory University, Atlanta, GA (DWB); Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC (BBR); Department of Medicine, University of California, Irvine, Irvine, CA (LW)
| | - Heidi S Donovan
- Affiliations of authors: Supportive Care Medicine Department, Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL (KAD); Acute and Tertiary Care Department, University of Pittsburgh School of Nursing, Pittsburgh, PA (HSD); Department of Medical Social Sciences and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (DC); Center for Patient Partnership, University of Wisconsin Law School, Madison, WI (MEG); Department of Medicine, Massachusetts General Hospital, Boston, MA (RTP); Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California-San Diego, San Diego, CA (SCP); Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Summa Akron City Hospital, Akron, OH (VEvG); School of Nursing, Emory University, Atlanta, GA (DWB); Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC (BBR); Department of Medicine, University of California, Irvine, Irvine, CA (LW)
| | - David Cella
- Affiliations of authors: Supportive Care Medicine Department, Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL (KAD); Acute and Tertiary Care Department, University of Pittsburgh School of Nursing, Pittsburgh, PA (HSD); Department of Medical Social Sciences and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (DC); Center for Patient Partnership, University of Wisconsin Law School, Madison, WI (MEG); Department of Medicine, Massachusetts General Hospital, Boston, MA (RTP); Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California-San Diego, San Diego, CA (SCP); Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Summa Akron City Hospital, Akron, OH (VEvG); School of Nursing, Emory University, Atlanta, GA (DWB); Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC (BBR); Department of Medicine, University of California, Irvine, Irvine, CA (LW)
| | - Martha E Gaines
- Affiliations of authors: Supportive Care Medicine Department, Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL (KAD); Acute and Tertiary Care Department, University of Pittsburgh School of Nursing, Pittsburgh, PA (HSD); Department of Medical Social Sciences and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (DC); Center for Patient Partnership, University of Wisconsin Law School, Madison, WI (MEG); Department of Medicine, Massachusetts General Hospital, Boston, MA (RTP); Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California-San Diego, San Diego, CA (SCP); Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Summa Akron City Hospital, Akron, OH (VEvG); School of Nursing, Emory University, Atlanta, GA (DWB); Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC (BBR); Department of Medicine, University of California, Irvine, Irvine, CA (LW)
| | - Richard T Penson
- Affiliations of authors: Supportive Care Medicine Department, Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL (KAD); Acute and Tertiary Care Department, University of Pittsburgh School of Nursing, Pittsburgh, PA (HSD); Department of Medical Social Sciences and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (DC); Center for Patient Partnership, University of Wisconsin Law School, Madison, WI (MEG); Department of Medicine, Massachusetts General Hospital, Boston, MA (RTP); Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California-San Diego, San Diego, CA (SCP); Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Summa Akron City Hospital, Akron, OH (VEvG); School of Nursing, Emory University, Atlanta, GA (DWB); Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC (BBR); Department of Medicine, University of California, Irvine, Irvine, CA (LW)
| | - Steven C Plaxe
- Affiliations of authors: Supportive Care Medicine Department, Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL (KAD); Acute and Tertiary Care Department, University of Pittsburgh School of Nursing, Pittsburgh, PA (HSD); Department of Medical Social Sciences and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (DC); Center for Patient Partnership, University of Wisconsin Law School, Madison, WI (MEG); Department of Medicine, Massachusetts General Hospital, Boston, MA (RTP); Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California-San Diego, San Diego, CA (SCP); Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Summa Akron City Hospital, Akron, OH (VEvG); School of Nursing, Emory University, Atlanta, GA (DWB); Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC (BBR); Department of Medicine, University of California, Irvine, Irvine, CA (LW)
| | - Vivian E von Gruenigen
- Affiliations of authors: Supportive Care Medicine Department, Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL (KAD); Acute and Tertiary Care Department, University of Pittsburgh School of Nursing, Pittsburgh, PA (HSD); Department of Medical Social Sciences and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (DC); Center for Patient Partnership, University of Wisconsin Law School, Madison, WI (MEG); Department of Medicine, Massachusetts General Hospital, Boston, MA (RTP); Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California-San Diego, San Diego, CA (SCP); Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Summa Akron City Hospital, Akron, OH (VEvG); School of Nursing, Emory University, Atlanta, GA (DWB); Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC (BBR); Department of Medicine, University of California, Irvine, Irvine, CA (LW)
| | - Deborah Watkins Bruner
- Affiliations of authors: Supportive Care Medicine Department, Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL (KAD); Acute and Tertiary Care Department, University of Pittsburgh School of Nursing, Pittsburgh, PA (HSD); Department of Medical Social Sciences and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (DC); Center for Patient Partnership, University of Wisconsin Law School, Madison, WI (MEG); Department of Medicine, Massachusetts General Hospital, Boston, MA (RTP); Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California-San Diego, San Diego, CA (SCP); Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Summa Akron City Hospital, Akron, OH (VEvG); School of Nursing, Emory University, Atlanta, GA (DWB); Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC (BBR); Department of Medicine, University of California, Irvine, Irvine, CA (LW)
| | - Bryce B Reeve
- Affiliations of authors: Supportive Care Medicine Department, Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL (KAD); Acute and Tertiary Care Department, University of Pittsburgh School of Nursing, Pittsburgh, PA (HSD); Department of Medical Social Sciences and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (DC); Center for Patient Partnership, University of Wisconsin Law School, Madison, WI (MEG); Department of Medicine, Massachusetts General Hospital, Boston, MA (RTP); Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California-San Diego, San Diego, CA (SCP); Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Summa Akron City Hospital, Akron, OH (VEvG); School of Nursing, Emory University, Atlanta, GA (DWB); Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC (BBR); Department of Medicine, University of California, Irvine, Irvine, CA (LW)
| | - Lari Wenzel
- Affiliations of authors: Supportive Care Medicine Department, Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL (KAD); Acute and Tertiary Care Department, University of Pittsburgh School of Nursing, Pittsburgh, PA (HSD); Department of Medical Social Sciences and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (DC); Center for Patient Partnership, University of Wisconsin Law School, Madison, WI (MEG); Department of Medicine, Massachusetts General Hospital, Boston, MA (RTP); Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California-San Diego, San Diego, CA (SCP); Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Summa Akron City Hospital, Akron, OH (VEvG); School of Nursing, Emory University, Atlanta, GA (DWB); Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC (BBR); Department of Medicine, University of California, Irvine, Irvine, CA (LW).
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de Souza JA, Yap BJ, Hlubocky FJ, Wroblewski K, Ratain MJ, Cella D, Daugherty CK. The development of a financial toxicity patient-reported outcome in cancer: The COST measure. Cancer 2014; 120:3245-53. [PMID: 24954526 DOI: 10.1002/cncr.28814] [Citation(s) in RCA: 378] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/29/2014] [Accepted: 04/17/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Considering patients' experience is essential for optimal decision-making. However, despite increasing recognition of the impact of costs on oncology care, there is no patient-reported outcome measure (PROM) that specifically describes the financial distress experienced by patients. METHODS The content for a comprehensive score for financial toxicity (COST) was developed with a stepwise approach: step 1) a literature review and semistructured, qualitative interviews with patients for content generation; step 2) patients' assessment of the items for importance to their quality of life; step 3) pilot testing assessing interitem (IIC) and item-total (ITC) correlations to identify redundancy (Spearman rho, > 0.7) and statistically unrelated content (P > .05); and step 4) exploratory factor analysis. Sociodemographic data were collected. RESULTS In total, 155 patients with advanced cancer who were receiving treatment (20 patients in step 1, 35 patients in step 2, and 100 patients in steps 3 and 4) participated in the PROM development. In step 1, the literature was reviewed, and 20 patients generated 147 items, which were reduced to 58 items because of redundancy. In step 2, 35 patients rated the 58 items on importance, and 30 items were retained. In step 3, 46 patients assessed the 30 items, 14 items were excluded because of high IIC, and 3 were excluded because of nonsignificant ITC. In step 4, 2 items were discarded because of poor loadings in a factor analysis of 100 patients, resulting in an 11-item PROM. CONCLUSIONS The content for a financial toxicity PROM was developed in 155 patients. The provisional COST measure demonstrated face and content validity as well as internal consistency and should be validated in larger samples.
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Affiliation(s)
- Jonas A de Souza
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago Medicine, Chicago, Illinois
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Rosenthal DI, Mendoza TR, Fuller CD, Hutcheson KA, Wang XS, Hanna EY, Lu C, Garden AS, Morrison WH, Cleeland CS, Gunn GB. Patterns of symptom burden during radiotherapy or concurrent chemoradiotherapy for head and neck cancer: a prospective analysis using the University of Texas MD Anderson Cancer Center Symptom Inventory-Head and Neck Module. Cancer 2014; 120:1975-84. [PMID: 24711162 DOI: 10.1002/cncr.28672] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 02/18/2014] [Accepted: 02/20/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND A prospective longitudinal study to profile patient-reported symptoms during radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) for head and neck cancer was performed. The goals were to understand the onset and trajectory of specific symptoms and their severity, identify clusters, and facilitate symptom interventions and clinical trial design. METHODS Participants in this questionnaire-based study received RT or CCRT. They completed the University of Texas MD Anderson Cancer Center Symptom Inventory-Head and Neck Module before and weekly during treatment. Symptom scores were compared between treatment groups, and hierarchical cluster analysis was used to depict clustering of symptoms at treatment end. Variables believed to predict symptom severity were assessed using a multivariate mixed model. RESULTS Among the 149 patients studied, the majority (47%) had oropharyngeal tumors, and nearly one-half received CCRT. Overall symptom severity (P < .001) and symptom interference (P < .0001) became progressively more severe and were more severe for those receiving CCRT. On multivariate analysis, baseline Eastern Cooperative Oncology Group performance status (P < .001) and receipt of CCRT (P < .04) correlated with higher symptom severity. Fatigue, drowsiness, lack of appetite, problem with mouth/throat mucus, and problem tasting food were more severe for those receiving CCRT. Both local and systemic symptom clusters were identified. CONCLUSIONS The findings from this prospective longitudinal study identified a pattern of local and systemic symptoms, symptom clusters, and symptom interference that was temporally distinct and marked by increased magnitude and a shift in individual symptom rank order during the treatment course. These inform clinicians about symptom intervention needs, and are a benchmark for future symptom intervention clinical trials.
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Affiliation(s)
- David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Measuring symptoms as a critical component of drug development and evaluation in hematological diseases. ACTA ACUST UNITED AC 2013; 3:1127-1138. [PMID: 24910769 DOI: 10.4155/cli.13.108] [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: 12/16/2022]
Abstract
With the rapid development of new therapies for patients with hematological malignancies, there is an increasing need for patient report of symptom status during all phases of drug testing. The patient's perspective on new treatments reflects treatment tolerability as well as symptom benefit, and may assist patients and clinicians in choosing treatments. Inclusion of patient-reported outcomes, more common in solid-tumor than hematological trials, provides early information about symptoms to guide decisions about appropriate dosing and supportive care needs. We provide a historical overview of the use of patient-reported outcomes and symptom assessment in solid-tumor and hematological drug development, and offer recommendations about methodological issues in the monitoring of symptoms in the drug development process in hematological clinical trials.
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Fodeh SJ, Lazenby M, Bai M, Ercolano E, Murphy T, McCorkle R. Functional impairments as symptoms in the symptom cluster analysis of patients newly diagnosed with advanced cancer. J Pain Symptom Manage 2013; 46:500-10. [PMID: 23380336 PMCID: PMC4321795 DOI: 10.1016/j.jpainsymman.2012.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 09/24/2012] [Accepted: 10/03/2012] [Indexed: 10/27/2022]
Abstract
CONTEXT Symptoms and subsequent functional impairment have been associated with the biological processes of disease, including the interaction between disease and treatment in a measurement model of symptoms. However, hitherto cluster analysis has primarily focused on symptoms. OBJECTIVES This study among patients within 100 days of diagnosis with advanced cancer explored whether self-reported physical symptoms and functional impairments formed clusters at the time of diagnosis. METHODS We applied cluster analysis to self-reported symptoms and activities of daily living of 111 patients newly diagnosed with advanced gastrointestinal (GI), gynecological, head and neck, and lung cancers. Based on content expert evaluations, the best techniques and variables were identified, yielding the best solution. RESULTS The best cluster solution used a K-means algorithm and cosine similarity and yielded five clusters of physical as well as emotional symptoms and functional impairments. Cancer site formed the predominant organizing principle of composition for each cluster. The top five symptoms and functional impairments in each cluster were Cluster 1 (GI): outlook, insomnia, appearance, concentration, and eating/feeding; Cluster 2 (GI): appetite, bowel, insomnia, eating/feeding, and appearance; Cluster 3 (gynecological): nausea, insomnia, eating/feeding, concentration, and pain; Cluster 4 (head and neck): dressing, eating/feeding, bathing, toileting, and walking; and Cluster 5 (lung): cough, walking, eating/feeding, breathing, and insomnia. CONCLUSION Functional impairments in patients newly diagnosed with late-stage cancers behave as symptoms during the diagnostic phase. Health care providers need to expand their assessments to include both symptoms and functional impairments. Early recognition of functional changes may accelerate diagnosis at an earlier cancer stage.
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Gunn GB, Mendoza TR, Fuller CD, Gning I, Frank SJ, Beadle BM, Hanna EY, Lu C, Cleeland CS, Rosenthal DI. High symptom burden prior to radiation therapy for head and neck cancer: a patient-reported outcomes study. Head Neck 2013; 35:1490-8. [PMID: 23169304 PMCID: PMC3788079 DOI: 10.1002/hed.23181] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2012] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND As a first step toward developing effective strategies to control symptoms associated with head and neck cancer (HNC) and its treatment, we sought to describe the pattern of symptoms experienced before radiation therapy. METHODS Subjects completed the MD Anderson Symptom Inventory-Head and Neck Module before beginning radiation therapy. RESULTS In all, 270 patients participated. Symptom severity and interference varied between treatment-naïve patients and those with prior treatment. Cluster analyses revealed that 33% of patients had high symptom burden. Symptoms most often rated moderate-to-severe were fatigue, sleep disturbance, distress, pain, and problems chewing and swallowing. Poorer performance status, higher T classification, and receipt of previous treatment correlated with higher symptom burden. CONCLUSIONS A substantial proportion of patients were experiencing high symptom burden. Because few interventions currently exist for several of the most problematic symptoms, research in symptom reduction that targets the pattern of symptoms described here is greatly needed.
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Affiliation(s)
- G. Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tito R. Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ibrahima Gning
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Steven J. Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Beth M. Beadle
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ehab Y. Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Charles Lu
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Charles S. Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David I. Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Russo S, Cinausero M, Gerratana L, Bozza C, Iacono D, Driol P, Deroma L, Sottile R, Fasola G, Puglisi F. Factors affecting patient's perception of anticancer treatments side-effects: an observational study. Expert Opin Drug Saf 2013; 13:139-50. [DOI: 10.1517/14740338.2013.830710] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sailors MH, Bodurka DC, Gning I, Ramondetta LM, Williams LA, Mendoza TR, Agarwal S, Sun CC, Cleeland CS. Validating the M. D. Anderson Symptom Inventory (MDASI) for use in patients with ovarian cancer. Gynecol Oncol 2013; 130:323-8. [PMID: 23685012 PMCID: PMC3713195 DOI: 10.1016/j.ygyno.2013.05.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 05/03/2013] [Accepted: 05/08/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The M. D. Anderson Symptom Inventory (MDASI) captures the severity of common cancer symptoms from the patient's perspective. We describe the validity and sensitivity of a module of the MDASI to be used with patients having ovarian cancer (MDASI-OC). METHODS Ovarian cancer-specific module items were developed from 14 qualitative patient interviews. 128 patients with invasive epithelial ovarian, peritoneal, or fallopian-tube cancer treated at The University of Texas MD Anderson Cancer Center were recruited. Patients completed the MDASI-OC, socio-demographic questionnaires, the Functional Assessment of Cancer Therapy-Ovary (FACT-O), and a global quality-of-life (QOL) item. Reliability was assessed using Cronbach α, and sensitivity using a known group was assessed. Construct validity was tested using exploratory factor analysis. RESULTS The sample was primarily white (85.2%), had a mean age of 57.5 years (±12.7 years), and had previously been treated with chemotherapy (75.0%) and/or surgery (93.8%). Approximately 30% of patients reported disturbed sleep, fatigue, or numbness/tingling of at least moderate severity (≥5 on a 0-10 scale). On the ovarian-cancer-specific symptoms, approximately 20% reported back pain, feeling bloated, or constipation of at least moderate severity. Factor analysis revealed six underlying constructs (pain/sleep; cognitive; disease-related and numbness; treatment-related; affective; gastrointestinal-specific). MDASI-OC symptom and interference items had Cronbach α values of 0.90 and 0.89, respectively. The MDASI-OC was sensitive to symptom severity by performance status (p=0.009), QOL (p=0.002), and FACT-O scores (p<0.001). CONCLUSIONS The 27-item MDASI-OC meets common criteria for validation and reliability and is sensitive to expected changes in symptoms related to differences in disease and treatment status.
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Affiliation(s)
- Mary H. Sailors
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1450, Houston, TX 77030, USA
| | - Diane C. Bodurka
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1362, Houston, TX 77030, USA
| | - Ibrahima Gning
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1450, Houston, TX 77030, USA
| | - Lois M. Ramondetta
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1362, Houston, TX 77030, USA
| | - Loretta A. Williams
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1450, Houston, TX 77030, USA
| | - Tito R. Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1450, Houston, TX 77030, USA
| | - Sonika Agarwal
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1450, Houston, TX 77030, USA
| | - Charlotte C. Sun
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1362, Houston, TX 77030, USA
| | - Charles S. Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1450, Houston, TX 77030, USA
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Mazanec S, Daly B, Meropol NJ, Step M. Facilitating enrollment in a Cancer Registry through modified consent procedures: a pilot study. J Empir Res Hum Res Ethics 2013; 7:71-5. [PMID: 23324206 DOI: 10.1525/jer.2012.7.5.71] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Research registries are increasingly important in medical research and are essential to the mission of cancer centers. However, designing enrollment and data collection procedures that are consistent with ethical norms and regulatory requirements yet are efficient and cost effective is a major challenge. Current standard consent forms can be a barrier to enrollment because of their length, multiple components, and technical language. We pilot tested an IRB-approved registry booklet and simplified one-page, tiered consent form, allowing for choice of extent of participation. The booklet was mailed to patients with breast cancer as part of their routine information packet prior to the first clinic appointment. A research nurse met with 27 patients at initial treatment to review the booklet, answer questions, obtain informed consent, and collect quality of life data. The consent rate was 78% with 21 patients enrolling in the study. Twelve of the 21 patients (57%) did not read the booklet prior to the visit. The 9 patients (43%) who had read the booklet prior to arrival found it easy to understand. The multi-stage, simplified consent process and data collection were acceptable to these patients and readily integrated into clinical operations. An easy-to-read registry booklet may be an effective guide for discussion, but in-person consent procedures and further testing of the approach are required.
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Affiliation(s)
- Susan Mazanec
- School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH44106-4904, USA. susan.
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Søreide K, Søreide AH. Using patient-reported outcome measures for improved decision-making in patients with gastrointestinal cancer - the last clinical frontier in surgical oncology? Front Oncol 2013; 3:157. [PMID: 23785670 PMCID: PMC3682158 DOI: 10.3389/fonc.2013.00157] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 06/03/2013] [Indexed: 11/18/2022] Open
Abstract
The genomic era has introduced concepts of “personalized medicine” and “targeted therapy” in the field of oncology. Medicine has become increasingly complex with a plethora of potential dilemmas in diagnosis, treatment, and management. The focus on classical outcomes for clinical decision-making is now increasingly being replaced by patient-reported outcome measures (PROMs). PROMs should increasingly now be in the center of patient-centered decision-making, based on valid, reliable, and clinically useful measures delivered directly by the patient to the caregiver. Surgeons’ ability to interpret and apply PROMs and quality of life results must improve by education and further research, and has an unreleased potential to contribute to a better understanding of the patients’ well-being. A number of caveats must be addressed before this can be brought to fruition; standardization for valid items; appropriate use of instruments; correct timing of the application; missing data handling, compliance, and respondent drop-outs are but a few issues to be addressed. Based on the apparent lack of use in both research and clinical work, it should call for an educational effort to address this among surgeons caring for patients with cancer.
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Affiliation(s)
- Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital , Stavanger , Norway ; Department of Clinical Medicine, University of Bergen , Bergen , Norway
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Schwartz CE, Sajobi TT, Lix LM, Quaranto BR, Finkelstein JA. Changing values, changing outcomes: the influence of reprioritization response shift on outcome assessment after spine surgery. Qual Life Res 2013; 22:2255-64. [DOI: 10.1007/s11136-013-0377-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2013] [Indexed: 11/24/2022]
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