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Sakaguchi T, Maeda K, Takeuchi T, Mizuno A, Kato R, Ishida Y, Ueshima J, Shimizu A, Amano K, Mori N. Validity of the diagnostic criteria from the Asian Working Group for Cachexia in advanced cancer. J Cachexia Sarcopenia Muscle 2024; 15:370-379. [PMID: 38115133 PMCID: PMC10834352 DOI: 10.1002/jcsm.13408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/31/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Recently, the Asian Working Group for Cachexia (AWGC) published a consensus statement on diagnostic criteria for cachexia in Asians. We aimed to validate the criteria in adult patients in Japan with advanced cancer. METHODS We conducted a single-institution retrospective cohort study between April 2021 and October 2022. The AWGC criteria include chronic comorbidities and either a weight loss of >2% over 3-6 months or a body mass index (BMI) of <21 kg/m2 . In addition, any of the following items were required: anorexia as a subjective symptom, decreased grip strength as an objective measurement and an elevated C-reactive protein (CRP) level as a biomarker. We used the cut-off value of grip strength of 28/18 kg for male/female individuals and CRP level of 5 mg/L. RESULTS Of the 449 consecutive patients, 85 of those who could not be evaluated because of end-of-life or refractory symptoms (n = 41) or missing data (n = 44) were excluded from the primary analysis. The prevalence of the AWGC-defined cachexia was 76% (n = 277), and the median survival time (MST) for all patients was 215 (95% confidence interval [CI] 145-270) days. The prevalence of the following criteria was significantly higher in patients with cachexia than in those without cachexia: a BMI of <21 kg/m2 (65% vs. 15%, P < 0.001), a weight loss of >2% in 6 months (87% vs. 14%, P < 0.001), anorexia (75% vs. 47%, P < 0.001), a grip strength of <28 kg in male individuals (63% vs. 28%, P < 0.001) and CRP level of >5 mg/L (85% vs. 56%, P < 0.001). Overall survival was significantly shorter in patients with cachexia than in those without cachexia (MST 157 days, 95% CI 108-226 days vs. MST 423 days, 95% CI 245 days to not available, P = 0.0023). The Cox proportional hazards analysis showed that best supportive care (hazard ratio [HR] 2.91, P ≤ 0.001), lung cancer (HR 1.67, P = 0.0046), an Eastern Cooperative Oncology Group Performance Status score of ≥3 (HR 1.58, P = 0.016), AWGC-defined cachexia (HR 1.56, P = 0.015), an age of ≥70 years (HR 1.53, P = 0.0070), oedema (HR 1.31, P = 0.022) and head/neck cancer (HR 0.44, P = 0.023) were found to be the significant predictors for mortality. CONCLUSIONS We demonstrated that AWGC-defined cachexia has a significant prognostic value in advanced cancer.
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Affiliation(s)
- Tatsuma Sakaguchi
- Palliative Care Center, Aichi Medical University, Nagakute, Aichi, Japan
| | - Keisuke Maeda
- Nutrition Therapy Support Center, Aichi Medical University Hospital, Nagakute, Aichi, Japan
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology University, Obu, Aichi, Japan
| | - Tomoko Takeuchi
- Department of Nutrition, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Ai Mizuno
- Department of Nutrition, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Ryoko Kato
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Yuria Ishida
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
- Department of Nutrition, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Junko Ueshima
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
- Department of Nutritional Service, NTT Medical Center Tokyo, Shinagawa-ku, Tokyo, Japan
| | - Akio Shimizu
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
- Department of Health Science, Faculty of Health and Human Development, University of Nagano, Nagano-shi, Nagano, Japan
| | - Koji Amano
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
- Palliative and Supportive Care Center, Osaka University Hospital, Suita, Osaka, Japan
- Department of Psycho-Oncology and Palliative Medicine, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
- Department of Palliative Medicine, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Naoharu Mori
- Palliative Care Center, Aichi Medical University, Nagakute, Aichi, Japan
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
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Consolo L, Basile I, Colombo S, Rusconi D, Pasquot L, Campa T, Caraceni A, Lusignani M. Exploring patient perspectives on electronic patient-reported outcome measures in home-based cancer palliative care: A qualitative study. Digit Health 2024; 10:20552076241249962. [PMID: 38665884 PMCID: PMC11044777 DOI: 10.1177/20552076241249962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background Electronic patient-reported outcomes (ePROMs) enhance symptom management and patients' engagement in palliative cancer care. However, integrating them into this setting brings challenges, including patients' familiarity with technological devices and declining health status. Prioritizing the patient's acceptability and feasibility is crucial for their adoption. However, more knowledge is needed about patients' perspectives on the adoption of ePROMs in the community, especially for home-based palliative care. Aim Explore patient viewpoints on utilizing ePROMs for symptom reporting in home-based oncology palliative care. Design A qualitative interpretative approach was used to evaluate patients' points of view on using ePROMs in this specific care setting. Semistructured interviews were carried out. Data were analyzed using a reflexive thematic analysis. Setting/participants A total of 25 patients receiving oncological home palliative care from the advanced palliative care unit of the Fondazione IRCCS Istituto Nazionale dei Tumori in Milan, Italy, were invited to participate. Twenty interviews were conducted, as five patients declined due to deteriorating health. Results Four themes were identified: (1) strategic value of ePROMs and subjective appreciation; (2) enhancing patient centeredness through ePROMs; (3) exploring and addressing concerns about the use of ePROMs and (4) intersecting factors influencing the efficacy of ePROMs. Conclusion Despite initial reticence, home palliative care patients consider ePROMs as potentially valuable allies monitoring symptoms, enhancing their quality of life, and amplifying their voices on less explored aspects of care. Continuous dialog between healthcare professionals and patients is crucial for addressing patient skepticism about ePROMs and their impact on the human aspect of care.
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Affiliation(s)
- Letteria Consolo
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
- Bachelor School of Nursing, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Ilaria Basile
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Stella Colombo
- Intensive Care Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Daniele Rusconi
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Loredana Pasquot
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Tiziana Campa
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Augusto Caraceni
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Consolo L, Colombo S, Basile I, Rusconi D, Campa T, Caraceni A, Lusignani M. Barriers and facilitators of electronic patient-reported outcome measures (e-PROMs) for patients in home palliative cancer care: a qualitative study of healthcare professionals' perceptions. BMC Palliat Care 2023; 22:111. [PMID: 37542264 PMCID: PMC10401773 DOI: 10.1186/s12904-023-01234-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/26/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Patient-reported outcomes in palliative care enable early monitoring and management of symptoms that most impact patients' daily lives; however, there are several barriers to adopting electronic Patient-reported Outcome Measures (e-PROMs) in daily practice. This study explored the experiences of health care professionals (HCPs) regarding potential barriers and facilitators in implementing e-PROMs in palliative cancer care at home. METHODS This was a qualitative descriptive study. The data were collected from two focus groups structured according to the conceptual framework of Grol. HCPs involved in home palliative cancer care of Fondazione IRCCS Istituto Nazionale dei Tumori of Milan were enrolled. Data were analyzed using a reflexive thematic analysis. RESULTS A total of 245 codes were generated, 171 for the first focus group and 74 for the second focus group. The results were subdivided into subthemes according to Grol's themes: Innovation, Individual professional, Patient, Social context, Organizational context, except Economic Political context. Nine HCPs attended the first focus group, and ten attended the second. According to these participants, e-PROMs could be integrated into clinical practice after adequate training and support of HCPs at all stages of implementation. They identified barriers, especially in the social and organizational contexts, due to the uniqueness of the oncological end-of-life setting and the intangible care interventions, as well as many facilitators for the innovation that these tools bring and for improved communication with the patient and the healthcare team. CONCLUSIONS e-PROMs are perceived by HCPs as adding value to patient care and their work; however, barriers remain especially related to the fragility of these patients, the adequacy of technological systems, lack of education, and the risk of low humanization of care.
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Affiliation(s)
- Letteria Consolo
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.
- Bachelor School of Nursing, IRCCS, National Cancer Institute, Milan, Italy.
| | - Stella Colombo
- Intensive Care Unit, IRCCS, National Cancer Institute, Milan, Italy
| | - Ilaria Basile
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, IRCCS, National Cancer Institute, Milan, Italy
| | - Daniele Rusconi
- Urology Unit, IRCCS, National Cancer Institute, Milan, Italy
| | - Tiziana Campa
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, IRCCS, National Cancer Institute, Milan, Italy
| | - Augusto Caraceni
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, IRCCS, National Cancer Institute, Milan, Italy
- University of Milan, Milan, Italy
| | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Gahr S, Brunner S, Heckel M, Ostgathe C. Gibt es entitätsspezifische Kriterien für den Beginn der spezialisierten Palliativversorgung für nicht heilbare Krebserkrankungen? Ein Scoping Review. ZEITSCHRIFT FÜR PALLIATIVMEDIZIN 2023. [DOI: 10.1055/a-2054-1201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Zusammenfassung
Hintergrund/Ziel Patienten mit nicht heilbaren Krebserkrankungen eine spezialisierte Palliativversorgung zum richtigen Zeitpunkt anzubieten, stellt eine Herausforderung dar. Ziel des Scoping Reviews war, geeignete entitätsspezifische Kriterien zu finden.
Methode Im Februar 2020 wurde in den Online-Datenbanken PubMed und Scopus ein Scoping Review durchgeführt. Ziel der Literatursuche war die Identifikation von englisch- und deutschsprachigen Originalarbeiten, die zwischen 2009 und Februar 2020 veröffentlicht wurden und Hinweise darauf geben, welche entitätsspezifischen und entitätsunabhängigen Kriterien nicht heilbarer Krebserkrankungen herangezogen werden, um betroffene Patienten zeitgerecht in die spezialisierte Palliativversorgung zu integrieren. Insgesamt wurden 13 relevante Artikel identifiziert. Der Methode des Scoping Reviews entsprechend, wurde auf eine formale Bewertung der methodischen Qualität der eingeschlossenen Literatur verzichtet.
Ergebnisse Unter den relevanten Publikationen waren 6 Reviews und 7 Originalarbeiten. In keiner der analysierten Publikationen wurden explizit charakteristische Kriterien zu spezifischen Krebsentitäten angeführt. Für die Integration in eine spezialisierte Palliativversorgung wurden unabhängig der Krebsentität als Kriterien Unheilbarkeit/fortgeschrittenes Tumorleiden, Lebensqualität, belastende Symptome, ECOG-Status, psychosoziale Bedürfnisse, Komorbiditäten, tumorassoziierte Komplikationen, Behandlungsentscheidung/keine Behandlungsmöglichkeiten und begrenzte Lebenszeitprognose herangezogen oder vorgeschlagen. Die Erhebung der Kriterien erfolgte mittels Instrumenten, für die keine konkreten Kennwerte angegeben waren, die eine zur Einbindung in spezialisierte Palliativversorgung relevante Ausprägung der Kriterien detektieren könnten.
Schlussfolgerung Für den Zeitpunkt einer zeitgerechten Integration der spezialisierten Palliativversorgung bei nicht heilbaren Krebserkrankungen gibt es bislang keine entitätsspezifischen Kriterien und Kennwerte. Aus der Analyse lässt sich jedoch ableiten, dass entitätsunabhängig alle Patienten mit einer nicht heilbaren bzw. fortgeschrittenen Krebserkrankung, die unter Verminderung/Verlust ihrer Lebensqualität und einer komplexen Symptomlast, v.a. Depressionen und Schmerzen leiden, das Angebot einer spezialisierten Palliativversorgung erhalten sollten. Kriterien generell als Kennwerte festzulegen und konsekutiv einen Messwert bzw. Cut-off-Wert zu definieren, könnte eine Möglichkeit sein, über z.B. ein Scoringsystem eine zeitgerechte Integration der Palliativmedizin zu erleichtern. Unklar ist bislang, welche Kombinationen von Erhebungsinstrumenten oder Screeningtools der Erfassung einer zeitgerechten Integration dienen könnten.
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Affiliation(s)
- Susanne Gahr
- Palliativmedizinische Abteilung, Universitätsklinikum Erlangen, Comprehensive Cancer Center EMN-Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Sarah Brunner
- Palliativmedizinische Abteilung, Universitätsklinikum Erlangen, Comprehensive Cancer Center EMN-Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
- Medizinisches Zentrum für Informations- und Kommunikationstechnik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Maria Heckel
- Palliativmedizinische Abteilung, Universitätsklinikum Erlangen, Comprehensive Cancer Center EMN-Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Christoph Ostgathe
- Palliativmedizinische Abteilung, Universitätsklinikum Erlangen, Comprehensive Cancer Center EMN-Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
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Consolo L, Castellini G, Cilluffo S, Basile I, Lusignani M. Electronic patient-reported outcomes (e-PROMs) in palliative cancer care: a scoping review. J Patient Rep Outcomes 2022; 6:102. [PMID: 36138279 PMCID: PMC9500127 DOI: 10.1186/s41687-022-00509-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In palliative oncology settings, electronic patient-reported outcome (PRO) assessment can play an important role in supporting clinical activities for clinicians and patients. This scoping review aims to map the technological innovation of electronic patient-reported outcome measures (e-PROMs) in cancer palliative care and how PRO data collected through e-PROMs can influence the monitoring and management of symptoms and enable better communication between health professionals and patients.
Methods
A scoping review study was designed according to the Arksey and O'Malley framework. Medline, Embase, Web of Science, SCOPUS, PsycINFO and CINAHL and gray literature sources were consulted. The inclusion criteria were people over 18 years old receiving palliative and/or end-of-life care using e-PROMs.
Results
Thirteen primary studies were included: nine quantitative studies, two qualitative studies, and two mixed-method studies. The recently developed software that supports e-PROMs allows patients to receive feedback on their symptoms, helps clinicians prioritize care needs and monitors patients’ conditions as their symptoms change. Electronic PRO data prompt difficult, end-of-life communication between clinicians and patients to better organize care in the last phase of life.
Conclusion
This work shows that electronic PRO data assessment provides valuable tools for patients’ well-being and the management of symptoms; only one study reported conflicting results. However, with studies lacking on how clinicians can use these tools to improve communication with patients, more research is needed.
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Bennett MI, Allsop MJ, Allen P, Allmark C, Bewick BM, Black K, Blenkinsopp A, Brown J, Closs SJ, Edwards Z, Flemming K, Fletcher M, Foy R, Godfrey M, Hackett J, Hall G, Hartley S, Howdon D, Hughes N, Hulme C, Jones R, Meads D, Mulvey MR, O’Dwyer J, Pavitt SH, Rainey P, Robinson D, Taylor S, Wray A, Wright-Hughes A, Ziegler L. Pain self-management interventions for community-based patients with advanced cancer: a research programme including the IMPACCT RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background
Each year in England and Wales, 150,000 people die from cancer, of whom 110,000 will suffer from cancer pain. Research highlights that cancer pain remains common, severe and undertreated, and may lead to hospital admissions.
Objective
To develop and evaluate pain self-management interventions for community-based patients with advanced cancer.
Design
A programme of mixed-methods intervention development work leading to a pragmatic multicentre randomised controlled trial of a multicomponent intervention for pain management compared with usual care, including an assessment of cost-effectiveness.
Participants
Patients, including those with metastatic solid cancer (histological, cytological or radiological evidence) and/or those receiving anti-cancer therapy with palliative intent, and health professionals involved in the delivery of community-based palliative care.
Setting
For the randomised controlled trial, patients were recruited from oncology outpatient clinics and were randomly allocated to intervention or control and followed up at home.
Interventions
The Supported Self-Management intervention comprised an educational component called Tackling Cancer Pain, and an eHealth component for routine pain assessment and monitoring called PainCheck.
Main outcome measures
The primary outcome was pain severity (measured using the Brief Pain Inventory). The secondary outcomes included pain interference (measured using the Brief Pain Inventory), participants’ pain knowledge and experience, and cost-effectiveness. We estimated costs and health-related quality-of-life outcomes using decision modelling and a separate within-trial economic analysis. We calculated incremental cost-effectiveness ratios per quality-adjusted life-year for the trial period.
Results
Work package 1 – We found barriers to and variation in the co-ordination of advanced cancer care by oncology and primary care professionals. We identified that the median time between referral to palliative care services and death for 42,758 patients in the UK was 48 days. We identified key components for self-management and developed and tested our Tackling Cancer Pain resource for acceptability. Work package 2 – Patients with advanced cancer and their health professionals recognised the benefits of an electronic system to monitor pain, but had reservations about how such a system might work in practice. We developed and tested a prototype PainCheck system. Work package 3 – We found that strong opioids were prescribed for 48% of patients in the last year of life at a median of 9 weeks before death. We delivered Medicines Use Reviews to patients, in which many medicines-related problems were identified. Work package 4 – A total of 161 oncology outpatients were randomised in our clinical trial, receiving either supported self-management (n = 80) or usual care (n = 81); their median survival from randomisation was 53 weeks. Primary and sensitivity analyses found no significant treatment differences for the primary outcome or for other secondary outcomes of pain severity or health-related quality of life. The literature-based decision modelling indicated that information and feedback interventions similar to the supported self-management intervention could be cost-effective. This model was not used to extrapolate the outcomes of the trial over a longer time horizon because the statistical analysis of the trial data found no difference between the trial arms in terms of the primary outcome measure (pain severity). The within-trial economic evaluation base-case analysis found that supported self-management reduced costs by £587 and yielded marginally higher quality-adjusted life-years (0.0018) than usual care. However, the difference in quality-adjusted life-years between the two trial arms was negligible and this was not in line with the decision model that had been developed. Our process evaluation found low fidelity of the interventions delivered by clinical professionals.
Limitations
In the randomised controlled trial, the low fidelity of the interventions and the challenge of the study design, which forced the usual-care arm to have earlier access to palliative care services, might explain the lack of observed benefit. Overall, 71% of participants returned outcome data at 6 or 12 weeks and so we used administrative data to estimate costs. Our decision model did not include the negative trial results from our randomised controlled trial and, therefore, may overestimate the likelihood of cost-effectiveness.
Conclusions
Our programme of research has revealed new insights into how patients with advanced cancer manage their pain and the challenges faced by health professionals in identifying those who need more help. Our clinical trial failed to show an added benefit of our interventions to enhance existing community palliative care support, although both the decision model and the economic evaluation of the trial indicated that supported self-management could result in lower health-care costs.
Future work
There is a need for further research to (1) understand and facilitate triggers that prompt earlier integration of palliative care and pain management within oncology services; (2) determine the optimal timing of technologies for self-management; and (3) examine prescriber and patient behaviour to achieve the earlier initiation and use of strong opioid treatment.
Trial registration
Current Controlled Trials ISRCTN18281271.
Funding
This project was funded by the National Institute for Health Research Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | - Bridgette M Bewick
- Psychological and Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | - Julia Brown
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - S José Closs
- School of Healthcare, University of Leeds, Leeds, UK
| | - Zoe Edwards
- School of Pharmacy, University of Bradford, Bradford, UK
| | - Kate Flemming
- Department of Health Sciences, University of York, York, UK
| | - Marie Fletcher
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Robbie Foy
- Division of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Mary Godfrey
- Academic Unit of Elderly Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Julia Hackett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Geoff Hall
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Daniel Howdon
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Claire Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Richard Jones
- Yorkshire Centre for Health Informatics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matthew R Mulvey
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - John O’Dwyer
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sue H Pavitt
- School of Dentistry, University of Leeds, Leeds, UK
| | | | | | - Sally Taylor
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Angela Wray
- Psychological and Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Lucy Ziegler
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Martin L, Muscaritoli M, Bourdel-Marchasson I, Kubrak C, Laird B, Gagnon B, Chasen M, Gioulbasanis I, Wallengren O, Voss AC, Goldwasser F, Jagoe RT, Deans C, Bozzetti F, Strasser F, Thoresen L, Kazemi S, Baracos V, Senesse P. Diagnostic criteria for cancer cachexia: reduced food intake and inflammation predict weight loss and survival in an international, multi-cohort analysis. J Cachexia Sarcopenia Muscle 2021; 12:1189-1202. [PMID: 34448539 PMCID: PMC8517347 DOI: 10.1002/jcsm.12756] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/26/2021] [Accepted: 06/15/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cancer-associated weight loss (WL) associates with increased mortality. International consensus suggests that WL is driven by a variable combination of reduced food intake and/or altered metabolism, the latter often represented by the inflammatory biomarker C-reactive protein (CRP). We aggregated data from Canadian and European research studies to evaluate the associations of reduced food intake and CRP with cancer-associated WL (primary endpoint) and overall survival (OS, secondary endpoint). METHODS The data set included a total of 12,253 patients at risk for cancer-associated WL. Patient-reported WL history (% in 6 months) and food intake (normal, moderately, or severely reduced) were measured in all patients; CRP (mg/L) and OS were measured in N = 4960 and N = 9952 patients, respectively. All measures were from a baseline assessment. Clinical variables potentially associated with WL and overall survival (OS) including age, sex, cancer diagnosis, disease stage, and performance status were evaluated using multinomial logistic regression MLR and Cox proportional hazards models, respectively. RESULTS Patients had a mean weight change of -7.3% (±7.1), which was categorized as: ±2.4% (stable weight; 30.4%), 2.5-5.9% (19.7%), 6.0-10.0% (23.2%), 11.0-14.9% (12.0%), ≥15.0% (14.6%). Normal food intake, moderately, and severely reduced food intake occurred in 37.9%, 42.8%, and 19.4%, respectively. In MLR, severe WL (≥15%) (vs. stable weight) was more likely (P < 0.0001) if food intake was moderately [OR 6.28, 95% confidence interval (CI 5.28-7.47)] or severely reduced [OR 18.98 (95% CI 15.30-23.56)]. In subset analysis, adjusted for food intake, CRP was independently associated (P < 0.0001) with ≥15% WL [CRP 10-100 mg/L: OR 2.00, (95% CI 1.58-2.53)] and [CRP > 100 mg/L: OR 2.30 (95% CI 1.62-3.26)]. Diagnosis, stage, and performance status, but not age or sex, were significantly associated with WL. Median OS was 9.9 months (95% CI 9.5-10.3), with median follow-up of 39.7 months (95% CI 38.8-40.6). Moderately and severely reduced food intake and CRP independently predicted OS (P < 0.0001). CONCLUSIONS Modelling WL as the dependent variable is an approach that can help to identify clinical features and biomarkers associated with WL. Here, we identify criterion values for food intake impairment and CRP that may improve the diagnosis and classification of cancer-associated cachexia.
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Affiliation(s)
- Lisa Martin
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | - Catherine Kubrak
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Barry Laird
- University of Edinburgh, European Palliative Care Research Center, Edinburgh, UK
| | - Bruno Gagnon
- Department of Family Medicine and Emergency Medicine, Université Laval, Laval, Quebec, Canada
| | - Martin Chasen
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ioannis Gioulbasanis
- Department of Medical Oncology, Αnimus-Κyanous Stavros General Clinic - Larissa, Thessaly, Greece
| | - Ola Wallengren
- Clinical Nutrition Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anne C Voss
- Global Research and Development (retired), Abbott Nutrition, Columbus, Ohio, USA
| | - Francois Goldwasser
- Medical Oncology, Cochin Hospital, APHP 5, University of Paris, Paris, France
| | - R Thomas Jagoe
- McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec, Canada
| | - Chris Deans
- Clinical and Surgical Sciences, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, UK
| | | | - Florian Strasser
- Oncological Palliative Medicine, Division of Oncology, Department of Internal Medicine and Palliative Care Center, Cantonal Hospital, St. Gallen, Switzerland
| | - Lene Thoresen
- Oncology Clinic, St. Olavs University Hospital, Trondheim, Norway
| | - Sean Kazemi
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Vickie Baracos
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Pierre Senesse
- Clinical Nutrition and Gastroenterology Unit, Institut de recherche en Cancérologie de Montpellier (IRCM) Inserm U1194, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
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Lazaro-Escudero MI, Burgos-Cardona CA, Acevedo-Fernández K, Castro-Figueroa EM. Technology-assisted depression screening tools for patients with cancer: a systematic review protocol. BMJ Open 2021; 11:e041878. [PMID: 33658259 PMCID: PMC7931762 DOI: 10.1136/bmjopen-2020-041878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Among patients with cancer, depression is still under-detected. The use of technology-assisted screening tools is rising; however, little is known about the uptake of these devices as depression screening tools among patients with cancer. METHODS AND ANALYSIS A systematic review will be conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P). The review is registered with PROSPERO and any adjustments to the protocol will be traced. The aims of this systematic review are to (1) identify the most common and feasible depression screening information technology (IT) delivery models among patients with cancer, (2) identify the most common depression screening instrument used in IT devices and (3) describe the published technology-assisted depression screening tools for patients with cancer. PubMed, EBSCOhost and Google Scholar databases will be used. PICO (Patient/Population, Intervention, Comparison, Outcomes) guidelines will inform the inclusion criteria. Two researchers will independently review titles and abstracts, followed by full article review and data extraction. In the case of a disagreement, a third reviewer will make the final decision. Title/abstract screening will be conducted using a screening tool prepared by the researchers. Articles will be included for review if: (1) the study includes patients with cancer, cancer survivors and/or patients on remission, (2) depression is screened using technology and (3) technology-assisted depression screening effectiveness, efficacy, feasibility and/or acceptance is addressed. The quality of the articles will be assessed using the Methodological Index For Non-Randomised Studies (MINORS, maximum score 24) through independent coding of reviewers. ETHICS AND DISSEMINATION This research is exempt from ethics approval given that this is a protocol for a systematic review, which uses published data. Findings from this review will be disseminated through peer-reviewed publications and scientific conferences. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42019121048.
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Affiliation(s)
| | | | - Karina Acevedo-Fernández
- Clinical Psychology Department, Department of Psychiatry, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Eida Maria Castro-Figueroa
- Clinical Psychology Department, Department of Psychiatry, Ponce Health Sciences University, Ponce, Puerto Rico
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9
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Hansen MB, Petersen MA, Ross L, Groenvold M. Should analyses of large, national palliative care data sets with patient reported outcomes (PROs) be restricted to services with high patient participation? A register-based study. BMC Palliat Care 2020; 19:89. [PMID: 32576171 PMCID: PMC7313093 DOI: 10.1186/s12904-020-00596-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an increased interest in the analysis of large, national palliative care data sets including patient reported outcomes (PROs). No study has investigated if it was best to include or exclude data from services with low response rates in order to obtain the patient reported outcomes most representative of the national palliative care population. Thus, the aim of this study was to investigate whether services with low response rates should be excluded from analyses to prevent effects of possible selection bias. METHODS Data from the Danish Palliative Care Database from 24,589 specialized palliative care admittances of cancer patients was included. Patients reported ten aspects of quality of life using the EORTC QLQ-C15-PAL-questionnaire. Multiple linear regression was performed to test if response rate was associated with the ten aspects of quality of life. RESULTS The score of six quality of life aspects were significantly associated with response rate. However, in only two cases patients from specialized palliative care services with lower response rates (< 20.0%, 20.0-29.9%, 30.0-39.9%, 40.0-49.9% or 50.0-59.9) were feeling better than patients from services with high response rates (≥60%) and in both cases it was less than 2 points on a 0-100 scale. CONCLUSIONS The study hypothesis, that patients from specialized palliative care services with lower response rates were reporting better quality of life than those from specialized palliative care services with high response rates, was not supported. This suggests that there is no reason to exclude data from specialized palliative care services with low response rates.
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Affiliation(s)
- Maiken Bang Hansen
- Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, DK-2400, Copenhagen, Denmark. .,Department of Public Health, University of Copenhagen, DK-1014, Copenhagen, Denmark.
| | - Morten Aagaard Petersen
- Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, DK-2400, Copenhagen, Denmark
| | - Lone Ross
- Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, DK-2400, Copenhagen, Denmark
| | - Mogens Groenvold
- Department of Public Health, University of Copenhagen, DK-1014, Copenhagen, Denmark
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10
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Pittman JOE, Afari N, Floto E, Almklov E, Conner S, Rabin B, Lindamer L. Implementing eScreening technology in four VA clinics: a mixed-method study. BMC Health Serv Res 2019; 19:604. [PMID: 31462280 PMCID: PMC6712612 DOI: 10.1186/s12913-019-4436-z] [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] [Received: 03/05/2019] [Accepted: 08/16/2019] [Indexed: 11/10/2022] Open
Abstract
Background Technology-based self-assessment (TB-SA) benefits patients and providers and has shown feasibility, ease of use, efficiency, and cost savings. A promising TB-SA, the VA eScreening program, has shown promise for the efficient and effective collection of mental and physical health information. To assist adoption of eScreening by healthcare providers, we assessed technology-related as well as individual- and system-level factors that might influence the implementation of eScreening in four diverse VA clinics. Methods This was a mixed-method, pre-post, quasi-experimental study originally designed as a quality improvement project. The clinics were selected to represent a range of environments that could potentially benefit from TB-SA and that made use of the variety eScreening functions. Because of limited resources, the implementation strategy consisted of staff education, training, and technical support as needed. Data was collected using pre- and post-implementation interviews or focus groups of leadership and clinical staff, eScreening usage data, and post-implementation surveys. Data was gathered on: 1) usability of eScreening; 2) knowledge about and acceptability and 3) facilitators and barriers to the successful implementation of eScreening. Results Overall, staff feedback about eScreening was positive. Knowledge about eScreening ranged widely between the clinics. Nearly all staff felt eScreening would fit well into their clinical setting at pre-implementation; however some felt it was a poor fit with emergent cases and older adults at post-implementation. Lack of adequate personnel support and perceived leadership support were barriers to implementation. Adequate training and technical assistance were cited as important facilitators. One clinic fully implemented eScreening, two partially implemented, and one clinic did not implement eScreening as part of normal practice after 6 months as measured by usage data and self-report. Organizational engagement survey scores were higher among clinics with full or partial implementation and low in the clinic that did not implement. Conclusions Despite some added work load for some staff and perceived lack of leadership support, eScreening was at least partially implemented in three clinics. The technology itself posed no barriers in any of the settings. An implementation strategy that accounts for increased work burden and includes accountability may help in future eScreening implementation efforts. Note. This abstract was previously published (e.g., Annals of Behavioral Medicine 53: S1–S842, 2019). Electronic supplementary material The online version of this article (10.1186/s12913-019-4436-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- James O E Pittman
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA, 92161, USA. .,Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
| | - Niloofar Afari
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA, 92161, USA.,Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Elizabeth Floto
- VA Roseburg Health Care System, 913 NW Garden Valley Blvd, Roseburg, OR, 97470, USA
| | - Erin Almklov
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA, 92161, USA
| | - Susan Conner
- Gallup Inc., 901 F Street, NW, Washington, DC, 20004, USA
| | - Borsika Rabin
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA, 92161, USA.,Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Laurie Lindamer
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA, 92161, USA.,Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
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11
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Krogstad H, Brunelli C, Sand K, Andersen E, Garresori H, Halvorsen T, Haukland EC, Jordal F, Kaasa S, Loge JH, Løhre ET, Raj SX, Hjermstad MJ. Development of EirV3: A Computer-Based Tool for Patient-Reported Outcome Measures in Cancer. JCO Clin Cancer Inform 2019; 1:1-14. [PMID: 30657392 DOI: 10.1200/cci.17.00051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Immediate transfer of patient-reported outcome measures (PROMs) for use in medical consultations is facilitated by electronic assessments. We aimed to describe the rationale and development of Eir version 3 (EirV3), a computer-based symptom assessment tool for cancer, with emphasis on content and user-friendliness. METHODS EirV3's specifications and content were developed through multiprofessional, stepwise, and iterative processes (from 2013 to 2016), with literature reviews on traditional and electronic assessment and classification methods, formative iterative usability tests with end-users, and assessment of patient preferences for paper versus electronic assessments. RESULTS EirV3 has the following two modules: Eir-Patient for PROMs registration on tablets and Eir-Doctor for presentation of PROMs in a user-friendly interface on computers. Eir-Patient starts with 19 common cancer symptoms followed by specific, in-depth questions for endorsed symptoms. The pain section includes a body map for pain location and intensity, whereas physical functioning, nutritional intake, and well-being are standard questions for all. Data are wirelessly transferred to Eir-Doctor. Symptoms with intensity scores ≥ 3 (on a 0 to 10 scale) are marked in red, with brighter colors corresponding to higher intensity, and supplemented with graphs displaying symptom development over time. Usability results showed that patients and health care providers found EirV3 to be intuitive, easy to use, and relevant. When comparing PROM assessments on paper versus tablets (n = 114), 19% of patients preferred paper, 41% preferred tablets, and 40% had no preference. Median intraclass correlation coefficient between paper and tablets (0.815) was excellent. CONCLUSION Iterative test rounds followed by continuous improvements led to a user-friendly, applicable symptom assessment tool, EirV3, developed for and by end-users. EirV3 is undergoing international testing of clinical and cross-cultural adaptability.
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Affiliation(s)
- Hilde Krogstad
- Hilde Krogstad, Cinzia Brunelli, Kari Sand, Tarje Halvorsen, Stein Kaasa, Jon Håvard Loge, Erik Torbjørn Løhre, Sunil X. Raj, and Marianne Jensen Hjermstad, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU) and St Olavs Hospital, Trondheim University Hospital; Hilde Krogstad, Tarje Halvorsen, Erik Torbjørn Løhre, and Sunil X. Raj, Cancer Clinic, St Olavs Hospital, Trondheim University Hospital; Eivind Andersen, NTNU Technology Transfer AS, Trondheim; Stein Kaasa, Jon Håvard Loge, and Marianne Jensen Hjermstad, Oslo University Hospital, Oslo; Herish Garresori, Stavanger University Hospital, Stavanger; Ellinor C. Haukland, Nordland Hospital Trust, Bodø; Frode Jordal, Østfold Hospital Trust, Grålum, Norway; and Cinzia Brunelli, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano, Italy
| | - Cinzia Brunelli
- Hilde Krogstad, Cinzia Brunelli, Kari Sand, Tarje Halvorsen, Stein Kaasa, Jon Håvard Loge, Erik Torbjørn Løhre, Sunil X. Raj, and Marianne Jensen Hjermstad, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU) and St Olavs Hospital, Trondheim University Hospital; Hilde Krogstad, Tarje Halvorsen, Erik Torbjørn Løhre, and Sunil X. Raj, Cancer Clinic, St Olavs Hospital, Trondheim University Hospital; Eivind Andersen, NTNU Technology Transfer AS, Trondheim; Stein Kaasa, Jon Håvard Loge, and Marianne Jensen Hjermstad, Oslo University Hospital, Oslo; Herish Garresori, Stavanger University Hospital, Stavanger; Ellinor C. Haukland, Nordland Hospital Trust, Bodø; Frode Jordal, Østfold Hospital Trust, Grålum, Norway; and Cinzia Brunelli, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano, Italy
| | - Kari Sand
- Hilde Krogstad, Cinzia Brunelli, Kari Sand, Tarje Halvorsen, Stein Kaasa, Jon Håvard Loge, Erik Torbjørn Løhre, Sunil X. Raj, and Marianne Jensen Hjermstad, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU) and St Olavs Hospital, Trondheim University Hospital; Hilde Krogstad, Tarje Halvorsen, Erik Torbjørn Løhre, and Sunil X. Raj, Cancer Clinic, St Olavs Hospital, Trondheim University Hospital; Eivind Andersen, NTNU Technology Transfer AS, Trondheim; Stein Kaasa, Jon Håvard Loge, and Marianne Jensen Hjermstad, Oslo University Hospital, Oslo; Herish Garresori, Stavanger University Hospital, Stavanger; Ellinor C. Haukland, Nordland Hospital Trust, Bodø; Frode Jordal, Østfold Hospital Trust, Grålum, Norway; and Cinzia Brunelli, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano, Italy
| | - Eivind Andersen
- Hilde Krogstad, Cinzia Brunelli, Kari Sand, Tarje Halvorsen, Stein Kaasa, Jon Håvard Loge, Erik Torbjørn Løhre, Sunil X. Raj, and Marianne Jensen Hjermstad, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU) and St Olavs Hospital, Trondheim University Hospital; Hilde Krogstad, Tarje Halvorsen, Erik Torbjørn Løhre, and Sunil X. Raj, Cancer Clinic, St Olavs Hospital, Trondheim University Hospital; Eivind Andersen, NTNU Technology Transfer AS, Trondheim; Stein Kaasa, Jon Håvard Loge, and Marianne Jensen Hjermstad, Oslo University Hospital, Oslo; Herish Garresori, Stavanger University Hospital, Stavanger; Ellinor C. Haukland, Nordland Hospital Trust, Bodø; Frode Jordal, Østfold Hospital Trust, Grålum, Norway; and Cinzia Brunelli, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano, Italy
| | - Herish Garresori
- Hilde Krogstad, Cinzia Brunelli, Kari Sand, Tarje Halvorsen, Stein Kaasa, Jon Håvard Loge, Erik Torbjørn Løhre, Sunil X. Raj, and Marianne Jensen Hjermstad, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU) and St Olavs Hospital, Trondheim University Hospital; Hilde Krogstad, Tarje Halvorsen, Erik Torbjørn Løhre, and Sunil X. Raj, Cancer Clinic, St Olavs Hospital, Trondheim University Hospital; Eivind Andersen, NTNU Technology Transfer AS, Trondheim; Stein Kaasa, Jon Håvard Loge, and Marianne Jensen Hjermstad, Oslo University Hospital, Oslo; Herish Garresori, Stavanger University Hospital, Stavanger; Ellinor C. Haukland, Nordland Hospital Trust, Bodø; Frode Jordal, Østfold Hospital Trust, Grålum, Norway; and Cinzia Brunelli, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano, Italy
| | - Tarje Halvorsen
- Hilde Krogstad, Cinzia Brunelli, Kari Sand, Tarje Halvorsen, Stein Kaasa, Jon Håvard Loge, Erik Torbjørn Løhre, Sunil X. Raj, and Marianne Jensen Hjermstad, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU) and St Olavs Hospital, Trondheim University Hospital; Hilde Krogstad, Tarje Halvorsen, Erik Torbjørn Løhre, and Sunil X. Raj, Cancer Clinic, St Olavs Hospital, Trondheim University Hospital; Eivind Andersen, NTNU Technology Transfer AS, Trondheim; Stein Kaasa, Jon Håvard Loge, and Marianne Jensen Hjermstad, Oslo University Hospital, Oslo; Herish Garresori, Stavanger University Hospital, Stavanger; Ellinor C. Haukland, Nordland Hospital Trust, Bodø; Frode Jordal, Østfold Hospital Trust, Grålum, Norway; and Cinzia Brunelli, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano, Italy
| | - Ellinor C Haukland
- Hilde Krogstad, Cinzia Brunelli, Kari Sand, Tarje Halvorsen, Stein Kaasa, Jon Håvard Loge, Erik Torbjørn Løhre, Sunil X. Raj, and Marianne Jensen Hjermstad, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU) and St Olavs Hospital, Trondheim University Hospital; Hilde Krogstad, Tarje Halvorsen, Erik Torbjørn Løhre, and Sunil X. Raj, Cancer Clinic, St Olavs Hospital, Trondheim University Hospital; Eivind Andersen, NTNU Technology Transfer AS, Trondheim; Stein Kaasa, Jon Håvard Loge, and Marianne Jensen Hjermstad, Oslo University Hospital, Oslo; Herish Garresori, Stavanger University Hospital, Stavanger; Ellinor C. Haukland, Nordland Hospital Trust, Bodø; Frode Jordal, Østfold Hospital Trust, Grålum, Norway; and Cinzia Brunelli, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano, Italy
| | - Frode Jordal
- Hilde Krogstad, Cinzia Brunelli, Kari Sand, Tarje Halvorsen, Stein Kaasa, Jon Håvard Loge, Erik Torbjørn Løhre, Sunil X. Raj, and Marianne Jensen Hjermstad, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU) and St Olavs Hospital, Trondheim University Hospital; Hilde Krogstad, Tarje Halvorsen, Erik Torbjørn Løhre, and Sunil X. Raj, Cancer Clinic, St Olavs Hospital, Trondheim University Hospital; Eivind Andersen, NTNU Technology Transfer AS, Trondheim; Stein Kaasa, Jon Håvard Loge, and Marianne Jensen Hjermstad, Oslo University Hospital, Oslo; Herish Garresori, Stavanger University Hospital, Stavanger; Ellinor C. Haukland, Nordland Hospital Trust, Bodø; Frode Jordal, Østfold Hospital Trust, Grålum, Norway; and Cinzia Brunelli, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano, Italy
| | - Stein Kaasa
- Hilde Krogstad, Cinzia Brunelli, Kari Sand, Tarje Halvorsen, Stein Kaasa, Jon Håvard Loge, Erik Torbjørn Løhre, Sunil X. Raj, and Marianne Jensen Hjermstad, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU) and St Olavs Hospital, Trondheim University Hospital; Hilde Krogstad, Tarje Halvorsen, Erik Torbjørn Løhre, and Sunil X. Raj, Cancer Clinic, St Olavs Hospital, Trondheim University Hospital; Eivind Andersen, NTNU Technology Transfer AS, Trondheim; Stein Kaasa, Jon Håvard Loge, and Marianne Jensen Hjermstad, Oslo University Hospital, Oslo; Herish Garresori, Stavanger University Hospital, Stavanger; Ellinor C. Haukland, Nordland Hospital Trust, Bodø; Frode Jordal, Østfold Hospital Trust, Grålum, Norway; and Cinzia Brunelli, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano, Italy
| | - Jon Håvard Loge
- Hilde Krogstad, Cinzia Brunelli, Kari Sand, Tarje Halvorsen, Stein Kaasa, Jon Håvard Loge, Erik Torbjørn Løhre, Sunil X. Raj, and Marianne Jensen Hjermstad, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU) and St Olavs Hospital, Trondheim University Hospital; Hilde Krogstad, Tarje Halvorsen, Erik Torbjørn Løhre, and Sunil X. Raj, Cancer Clinic, St Olavs Hospital, Trondheim University Hospital; Eivind Andersen, NTNU Technology Transfer AS, Trondheim; Stein Kaasa, Jon Håvard Loge, and Marianne Jensen Hjermstad, Oslo University Hospital, Oslo; Herish Garresori, Stavanger University Hospital, Stavanger; Ellinor C. Haukland, Nordland Hospital Trust, Bodø; Frode Jordal, Østfold Hospital Trust, Grålum, Norway; and Cinzia Brunelli, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano, Italy
| | - Erik Torbjørn Løhre
- Hilde Krogstad, Cinzia Brunelli, Kari Sand, Tarje Halvorsen, Stein Kaasa, Jon Håvard Loge, Erik Torbjørn Løhre, Sunil X. Raj, and Marianne Jensen Hjermstad, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU) and St Olavs Hospital, Trondheim University Hospital; Hilde Krogstad, Tarje Halvorsen, Erik Torbjørn Løhre, and Sunil X. Raj, Cancer Clinic, St Olavs Hospital, Trondheim University Hospital; Eivind Andersen, NTNU Technology Transfer AS, Trondheim; Stein Kaasa, Jon Håvard Loge, and Marianne Jensen Hjermstad, Oslo University Hospital, Oslo; Herish Garresori, Stavanger University Hospital, Stavanger; Ellinor C. Haukland, Nordland Hospital Trust, Bodø; Frode Jordal, Østfold Hospital Trust, Grålum, Norway; and Cinzia Brunelli, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano, Italy
| | - Sunil X Raj
- Hilde Krogstad, Cinzia Brunelli, Kari Sand, Tarje Halvorsen, Stein Kaasa, Jon Håvard Loge, Erik Torbjørn Løhre, Sunil X. Raj, and Marianne Jensen Hjermstad, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU) and St Olavs Hospital, Trondheim University Hospital; Hilde Krogstad, Tarje Halvorsen, Erik Torbjørn Løhre, and Sunil X. Raj, Cancer Clinic, St Olavs Hospital, Trondheim University Hospital; Eivind Andersen, NTNU Technology Transfer AS, Trondheim; Stein Kaasa, Jon Håvard Loge, and Marianne Jensen Hjermstad, Oslo University Hospital, Oslo; Herish Garresori, Stavanger University Hospital, Stavanger; Ellinor C. Haukland, Nordland Hospital Trust, Bodø; Frode Jordal, Østfold Hospital Trust, Grålum, Norway; and Cinzia Brunelli, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano, Italy
| | - Marianne Jensen Hjermstad
- Hilde Krogstad, Cinzia Brunelli, Kari Sand, Tarje Halvorsen, Stein Kaasa, Jon Håvard Loge, Erik Torbjørn Løhre, Sunil X. Raj, and Marianne Jensen Hjermstad, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU) and St Olavs Hospital, Trondheim University Hospital; Hilde Krogstad, Tarje Halvorsen, Erik Torbjørn Løhre, and Sunil X. Raj, Cancer Clinic, St Olavs Hospital, Trondheim University Hospital; Eivind Andersen, NTNU Technology Transfer AS, Trondheim; Stein Kaasa, Jon Håvard Loge, and Marianne Jensen Hjermstad, Oslo University Hospital, Oslo; Herish Garresori, Stavanger University Hospital, Stavanger; Ellinor C. Haukland, Nordland Hospital Trust, Bodø; Frode Jordal, Østfold Hospital Trust, Grålum, Norway; and Cinzia Brunelli, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano, Italy
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Løhre ET, Hjermstad MJ, Brunelli C, Knudsen AK, Kaasa S, Klepstad P. Pain Intensity Factors Changing Breakthrough Pain Prevalence in Patients with Advanced Cancer: A Secondary Analysis of a Cross-Sectional Observational International Study. Pain Ther 2018; 7:193-203. [PMID: 30415462 PMCID: PMC6251829 DOI: 10.1007/s40122-018-0107-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Different definitions of breakthrough pain (BTP) influence the observed BTP prevalence. This study examined BTP prevalence variability due to use of different cutoffs for controlled background pain, different assessment periods for background pain, and difference between worst and average pain intensity (PI). METHODS Cancer patients from the EPCRC-CSA study who reported flare-ups of pain past 24 h were potential BTP cases. BTP prevalence was calculated for different cutoffs for background PI on numeric rating scales (NRS 0-10) for the past week, past 48 and past 24 h period. Furthermore, BTP cases were categorized based on the difference between maximum and average PI past 24 h (range, 0 to > 2 points, NRS 0-10). RESULTS Of 696 respondents, 302 patients (43.4%) reported pain flares the past 24 h. The BTP prevalence when using a defined background PI ≤ 4 for the past week was 19.8%. This number varied for different defined cutoffs for background PI. Actual background PI and BTP prevalence also varied between the assessment periods "past week", "past 48 h", and "past 24 h" (PI 4.0, 3.6, and 3.4; BTP prevalence 19.8, 22.7, and 24.9% for background PI ≤ 4). For patients with background PI ≤ 4 past week, 105 had a difference between maximum and average PI ≥ one point and 48 had a difference > two points. CONCLUSIONS The reported BTP prevalence is dependent on the cutoff for background PI in the BTP definition, population background PI during the assessment period, and defined cutoff for the difference between worst and average PI. FUNDING NTNU, Norwegian University of Science and Technology.
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Affiliation(s)
- Erik Torbjørn Løhre
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway. .,Cancer Clinic, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Marianne Jensen Hjermstad
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Cinzia Brunelli
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Anne Kari Knudsen
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stein Kaasa
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pål Klepstad
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Anesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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13
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Krogstad H, Sundt-Hansen SM, Hjermstad MJ, Hågensen LÅ, Kaasa S, Loge JH, Raj SX, Steinsbekk A, Sand K. Usability testing of EirV3-a computer-based tool for patient-reported outcome measures in cancer. Support Care Cancer 2018; 27:1835-1844. [PMID: 30173402 DOI: 10.1007/s00520-018-4435-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Eir version 3 (V3) is an electronic tool for administration of patient-reported outcome measures (Eir-Patient) that immediately presents patient scores on the physician's computer (Eir-Doctor). Perceived usability is an important determinant for successful implementation. The aim of this study was to answer the following research question evaluated at the cancer outpatient clinics, in the patients' home, and at general practitioners' (GPs) offices: What are the number, type, and severity of usability issues evaluated by the patient (Eir-Patient module) and by the physician (Eir-Doctor module)? METHODS A usability evaluation using observations, think-aloud sessions, individual interviews and focus group interviews in cancer patients and their physicians was conducted. Identified usability issues were graded on a severity scale from 1 (irritant) to 4 (unusable). RESULTS Overall, 73 Eir registrations were performed by 37 patients, and used by 17 physicians in clinical consultations. All patients were able to complete the Eir-Patient symptom registration. Seventy-two usability issues were identified. None of them were graded as unusable. For the Eir-Patient module, 62% of the identified usability issues was graded as irritant (grade 1), 18% as moderate (grade 2), and 20% as severe (grade 3). For the Eir-Doctor module, 46% of the identified usability issues were graded as irritant, 36% as moderate and 18% as severe. CONCLUSIONS In the updated Eir version, issues in the severe and moderate categories have been changed, to optimize the usability of using real-time PROMs in clinical practice.
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Affiliation(s)
- Hilde Krogstad
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, and St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. .,Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Stine Marie Sundt-Hansen
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, and St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marianne Jensen Hjermstad
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Jon Håvard Loge
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sunil X Raj
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, and St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kari Sand
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, and St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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14
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Wadhwa D, Popovic G, Pope A, Swami N, Le LW, Zimmermann C. Factors Associated with Early Referral to Palliative Care in Outpatients with Advanced Cancer. J Palliat Med 2018; 21:1322-1328. [DOI: 10.1089/jpm.2017.0593] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Deepa Wadhwa
- BC Cancer–Center for the Southern Interior, Kelowna, British Colombia, Canada
| | - Gordana Popovic
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Ashley Pope
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Nadia Swami
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Lisa W. Le
- Department of Biostatistics, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Research Institute, University Health Network, Toronto, Ontario, Canada
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15
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Zeman JE, Moon PS, McMahon MJ, Holley AB. Developing a Mobile Health Application to Assist With Clinic Flow, Documentation, Billing, and Research in a Specialty Clinic. Chest 2018; 154:440-447. [PMID: 29689261 DOI: 10.1016/j.chest.2018.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 02/28/2018] [Accepted: 04/05/2018] [Indexed: 12/17/2022] Open
Abstract
In specialty clinics, a staff physician is often required to direct patient flow through the clinic and performs all documentation for coding/billing. In response to the workload created by increased patient volume, many specialty clinics have implemented protocols for both disease treatment and coordination of clinic flow. In this article, we review the literature on using mobile technology to assist with patient care, clinic flow, disease treatment, and documentation/billing. We also describe the development and implementation of a mobile application in our pulmonary clinic designed to automate patient flow, assist the physician in documentation/billing, and gather research data including review of initial user data and lessons learned.
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Affiliation(s)
- Joseph E Zeman
- Walter Reed National Military Medical Center, Bethesda, MD.
| | - Patrick S Moon
- Walter Reed National Military Medical Center, Bethesda, MD
| | | | - Aaron B Holley
- Walter Reed National Military Medical Center, Bethesda, MD
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16
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Tang FW, Chan CW, Choy YP, Loong HH, Chow KM, So WK. A feasibility study on using tablet personal computers for self-reported symptom assessment in newly diagnosed lung cancer patients. Int J Nurs Pract 2018; 24:e12658. [DOI: 10.1111/ijn.12658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/06/2018] [Accepted: 03/06/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Fiona W.K. Tang
- The Nethersole School of Nursing, Faculty of Medicine; The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Shatin New Territories Hong Kong
| | - Carmen W.H. Chan
- The Nethersole School of Nursing, Faculty of Medicine; The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Shatin New Territories Hong Kong
| | - Yin-Ping Choy
- Department of Oncology; Princess Margaret Hospital, Hospital Authority. Hong Kong Special Administrative Region; Kowloon Hong Kong
| | - Herbert H.F. Loong
- Department of Clinical Oncology, Faculty of Medicine; The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Shatin New Territories Hong Kong
| | - Ka Ming Chow
- The Nethersole School of Nursing, Faculty of Medicine; The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Shatin New Territories Hong Kong
| | - Winnie K.W. So
- The Nethersole School of Nursing, Faculty of Medicine; The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Shatin New Territories Hong Kong
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17
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Patients with advanced cancer and depression report a significantly higher symptom burden than non-depressed patients. Palliat Support Care 2018; 17:143-149. [DOI: 10.1017/s1478951517001183] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveClinical observations indicate that patients with advanced cancer and depression report higher symptom burden than nondepressed patients. This is rarely examined empirically. Study aim was to investigate the association between self-reported depression disorder (DD) and symptoms in patients with advanced cancer controlled for prognostic factors.MethodThe sample included 935 patients, mean age 62, 52% males, from an international multicentre observational study (European Palliative Care Research Collaborative – Computerised Symptom Assessment and Classification of Pain, Depression and Physical Function). DD was assessed by the Patient Health Questionnaire-9 and scored with Diagnostic and Statistical Manual of Mental Disorder-5 algorithm for major depressive disorder, excluding somatic symptoms. Symptom burden was assessed by summing scores on somatic Edmonton Symptom Assessment Scale (ESAS) symptoms, excluding depression, anxiety, and well-being. Item-by-item scores and symptom burden of those with and without DD were compared using nonparametric Mann-Whitney U tests. The relative importance of sociodemographic, medical, and prognostic factors and DD in predicting symptom burden was assessed by hierarchical, multiple regression analyses.ResultPatients with DD reported significantly higher scores on ESAS items and a twofold higher symptom burden compared with those without. Factors associated with higher symptom burden were as follows. Diagnosis: lung (β = 0.15, p < 0.001) or breast cancer (β = 0.08, p < 0.05); poorer prognosis: high C-reactive protein (β = 0.08, p < 0.05), lower Karnofsky Performance Status (β = −0.14, p < 0.001), and greater weight loss (β = −0.15, p < 0.001); taking opioids (β = 0.11, p < 0.01); and having DD (β = 0.23, p < 0.001). The full model explained 18% of the variance in symptom burden. DD explained 4.4% over and above that explained by all the other variables.Significance of resultsDepression in patients with advanced cancer is associated with higher symptom burden. These results encourage improved routines for identifying and treating those suffering from depression.
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18
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Grotmol KS, Lie HC, Hjermstad MJ, Aass N, Currow D, Kaasa S, Moum TÅ, Pigni A, Loge JH. Depression-A Major Contributor to Poor Quality of Life in Patients With Advanced Cancer. J Pain Symptom Manage 2017; 54:889-897. [PMID: 28803091 DOI: 10.1016/j.jpainsymman.2017.04.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/12/2017] [Accepted: 04/20/2017] [Indexed: 11/26/2022]
Abstract
CONTEXT Quality of life (QoL) and depression are important patient-reported outcomes in cancer care. However, the relative importance of depression severity in predicting QoL remains unclear because of few methodologically sound studies. OBJECTIVES To examine whether depression contributes to impairment of QoL irrespective of prognostic factors and symptom burden. METHODS A total of 563 patients were included from the European Palliative Care Research Collaborative-Computerized Symptom Assessment Study, an international, multi-center, cross-sectional study. The relative importance of prognostic factors (systemic inflammation [modified Glasgow Prognostic Score-mGPS]), co-morbidities and physical performance (Karnofsky Performance Status), symptom burden (loss of appetite, breathlessness, nausea [Edmonton Symptom Assessment Scale], and pain [Brief Pain Inventory]), and depression severity (Patient Health Questionnaire 9) in predicting Global Health/QoL (European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire [EORTC-QLQ-C30]) were assessed using hierarchical multiple regression models. RESULTS Fifty-five percent were women, median age was 64 years, 87% had metastatic disease, median Karnofsky Performance Status was 70, and mean global QoL was 50.5 (SD = 23.3). Worse QoL was associated with increased systemic inflammation (mGPS = 1 β = -0.12, P = 0.003; mGPS = 2 β = -0.09, P = 0.023), lower physical performance (β = 0.17, P < 0.001), reduced appetite (β = -0.15, P < 0.001), breathlessness (β = -0.11, P = 0.004), pain (β = -0.14, P = 0.002), and higher depression severity (β = -0.27, P < 0.001). The full model accounted for 29% of the observed variance in QoL scores. The strongest predictor was depression severity, accounting for 5.8% of the variance. CONCLUSION Depression severity was the strongest single predictor of poorer QoL in this sample of patients with advanced cancer, after accounting for a wide range of clinically relevant variables. Future studies should investigate the contribution of psychosocial variables on QoL. Our findings emphasize the importance of managing depression to achieve the best possible QoL for these patients.
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Affiliation(s)
- Kjersti S Grotmol
- Department of Oncology, Regional Advisory Unit for Palliative Care, Oslo University Hospital, Oslo, Norway.
| | - Hanne C Lie
- Department of Paediatric Medicine, Oslo University Hospital, Oslo, Norway; Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway
| | - Marianne J Hjermstad
- Department of Oncology, Regional Advisory Unit for Palliative Care, Oslo University Hospital, Oslo, Norway; Department of Cancer Research and Molecular Medicine, European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Nina Aass
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - David Currow
- Discipline Palliative and Supportive Services, Flinders University, Adelaide, Australia
| | - Stein Kaasa
- Department of Cancer Research and Molecular Medicine, European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Torbjørn Å Moum
- Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Alessandra Pigni
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Jon Håvard Loge
- Department of Oncology, Regional Advisory Unit for Palliative Care, Oslo University Hospital, Oslo, Norway; Department of Cancer Research and Molecular Medicine, European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Oncology, Oslo University Hospital, Oslo, Norway
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19
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Hjermstad MJ, Kaasa S, Caraceni A, Loge JH, Pedersen T, Haugen DF, Aass N. Characteristics of breakthrough cancer pain and its influence on quality of life in an international cohort of patients with cancer. BMJ Support Palliat Care 2016; 6:344-52. [PMID: 27342412 DOI: 10.1136/bmjspcare-2015-000887] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 05/31/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Breakthrough cancer pain (BTP) represents a treatment challenge. Objectives were to examine the prevalence and characteristics of BTP in an international sample of patients with cancer, and to investigate the relationship between BTP and quality of life (QoL). METHODS This was an observational cross-sectional multicentre study. Participating patients completed self-report questionnaires on a touch-screen laptop computer, including the Brief Pain Inventory, Alberta Breakthrough Pain Assessment Tool (ABPAT) and European Organisation for Research and Treatment of Cancer 30-item Core Quality of Life Questionnaire (EORTC QLQ-C30). The study was performed in 17 centres in 8 countries and involved 4 languages (Norwegian, Italian, German and English). RESULTS Records from a convenience sample of 978 patients with advanced cancer were analysed; mean age was 62.2 years, 48.3% were women and 84.4% had metastatic disease. A total of 296 patients (30%) had no pain, defined as worst pain in the past 24 hours <1 on a 0-10 scale. Of the 682 patients with a pain score ≥1, 393 (58%) reported no BTP on the screening item, while 289 (30%) confirmed flare ups of BTP. Patients with BTP reported significantly higher pain intensity scores (<0.001) than patients without BTP; 57.1% of patients rated BTP at its worst as being severe: ≥7 on a 0-10 scale. Time from onset to peak intensity was <10 min for 42.9%, and average time to pain relief was 27.1 min. BTP was commonly triggered by medication wearing off (28%). Patients with BTP had significantly worse mean outcomes on 10 of 15 functional and symptom scales of the EORTC QLQ-C30 (<0.001). Severe pain intensity in the last week was a powerful predictor of BTP (OR 4.1) and poor QoL (OR 1.9). CONCLUSIONS BTP is highly prevalent with prolonged episodes despite analgaesics, and has a pervasive impact on QoL. Patients reporting high pain intensity should be carefully evaluated for BTP and efficacy of analgaesic treatment, to provide optimal pain management and improve QoL. TRIAL REGISTRATION NUMBER NCT00972634; Results.
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Affiliation(s)
- Marianne Jensen Hjermstad
- Department of Oncology, Regional Advisory Unit for Palliative Care, Oslo University Hospital, Oslo, Norway Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Stein Kaasa
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Department of Oncology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Augusto Caraceni
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Department of Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS, Istituto Nazionale Dei Tumori, Milano, Italy
| | - Jon H Loge
- Department of Oncology, Regional Advisory Unit for Palliative Care, Oslo University Hospital, Oslo, Norway Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | - Tore Pedersen
- Bjørknes University College, Oslo, Norway National Institute of Occupational Health, Oslo, Norway
| | - Dagny Faksvåg Haugen
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
| | - Nina Aass
- Department of Oncology, Regional Advisory Unit for Palliative Care, Oslo University Hospital, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway
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20
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Laird BJA, Fallon M, Hjermstad MJ, Tuck S, Kaasa S, Klepstad P, McMillan DC. Quality of Life in Patients With Advanced Cancer: Differential Association With Performance Status and Systemic Inflammatory Response. J Clin Oncol 2016; 34:2769-75. [PMID: 27354484 DOI: 10.1200/jco.2015.65.7742] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Quality of life is a key component of cancer care; however, the factors that determine quality of life are not well understood. The aim of this study was to examine the relationship between quality of life parameters, performance status (PS), and the systemic inflammatory response in patients with advanced cancer. METHODS An international biobank of patients with advanced cancer was analyzed. Quality of life was assessed at a single time point by using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C-30 (EORTC QLQ-C30). PS was assessed by using the Eastern Cooperative Oncology Group (ECOG) classification. Systemic inflammation was assessed by using the modified Glasgow Prognostic Score (mGPS), which combines C-reactive protein and albumin. The relationship between quality of life parameters, ECOG PS, and the mGPS was examined. RESULTS Data were available for 2,520 patients, and the most common cancers were GI (585 patients [22.2%]) and pulmonary (443 patients [17.6%]). The median survival was 4.25 months (interquartile range, 1.36 to 12.9 months). Increasing mGPS (systemic inflammation) and deteriorating PS were associated with deterioration in quality-of-life parameters (P < .001). Increasing systemic inflammation was associated with deterioration in quality-of-life parameters independent of PS. CONCLUSION Systemic inflammation was associated with quality-of-life parameters independent of PS in patients with advanced cancer. Further investigation of these relationships in longitudinal studies and investigations of possible effects of attenuating systemic inflammation are now warranted.
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Affiliation(s)
- Barry J A Laird
- Barry J.A. Laird, Marianne J. Hjermstad, Stein Kaasa, and Pål Klepstad, Norwegian University of Science and Technology; Pål Klepstad, Trondheim University Hospital, Trondheim; Marianne J. Hjermstad and Stein Kaasa, Oslo University Hospital, Oslo, Norway; Barry J.A. Laird, Marie Fallon, and Sharon Tuck, University of Edinburgh, Edinburgh; and Donald C. McMillan, University of Glasgow, Glasgow, United Kingdom.
| | - Marie Fallon
- Barry J.A. Laird, Marianne J. Hjermstad, Stein Kaasa, and Pål Klepstad, Norwegian University of Science and Technology; Pål Klepstad, Trondheim University Hospital, Trondheim; Marianne J. Hjermstad and Stein Kaasa, Oslo University Hospital, Oslo, Norway; Barry J.A. Laird, Marie Fallon, and Sharon Tuck, University of Edinburgh, Edinburgh; and Donald C. McMillan, University of Glasgow, Glasgow, United Kingdom
| | - Marianne J Hjermstad
- Barry J.A. Laird, Marianne J. Hjermstad, Stein Kaasa, and Pål Klepstad, Norwegian University of Science and Technology; Pål Klepstad, Trondheim University Hospital, Trondheim; Marianne J. Hjermstad and Stein Kaasa, Oslo University Hospital, Oslo, Norway; Barry J.A. Laird, Marie Fallon, and Sharon Tuck, University of Edinburgh, Edinburgh; and Donald C. McMillan, University of Glasgow, Glasgow, United Kingdom
| | - Sharon Tuck
- Barry J.A. Laird, Marianne J. Hjermstad, Stein Kaasa, and Pål Klepstad, Norwegian University of Science and Technology; Pål Klepstad, Trondheim University Hospital, Trondheim; Marianne J. Hjermstad and Stein Kaasa, Oslo University Hospital, Oslo, Norway; Barry J.A. Laird, Marie Fallon, and Sharon Tuck, University of Edinburgh, Edinburgh; and Donald C. McMillan, University of Glasgow, Glasgow, United Kingdom
| | - Stein Kaasa
- Barry J.A. Laird, Marianne J. Hjermstad, Stein Kaasa, and Pål Klepstad, Norwegian University of Science and Technology; Pål Klepstad, Trondheim University Hospital, Trondheim; Marianne J. Hjermstad and Stein Kaasa, Oslo University Hospital, Oslo, Norway; Barry J.A. Laird, Marie Fallon, and Sharon Tuck, University of Edinburgh, Edinburgh; and Donald C. McMillan, University of Glasgow, Glasgow, United Kingdom
| | - Pål Klepstad
- Barry J.A. Laird, Marianne J. Hjermstad, Stein Kaasa, and Pål Klepstad, Norwegian University of Science and Technology; Pål Klepstad, Trondheim University Hospital, Trondheim; Marianne J. Hjermstad and Stein Kaasa, Oslo University Hospital, Oslo, Norway; Barry J.A. Laird, Marie Fallon, and Sharon Tuck, University of Edinburgh, Edinburgh; and Donald C. McMillan, University of Glasgow, Glasgow, United Kingdom
| | - Donald C McMillan
- Barry J.A. Laird, Marianne J. Hjermstad, Stein Kaasa, and Pål Klepstad, Norwegian University of Science and Technology; Pål Klepstad, Trondheim University Hospital, Trondheim; Marianne J. Hjermstad and Stein Kaasa, Oslo University Hospital, Oslo, Norway; Barry J.A. Laird, Marie Fallon, and Sharon Tuck, University of Edinburgh, Edinburgh; and Donald C. McMillan, University of Glasgow, Glasgow, United Kingdom
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21
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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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22
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Hjermstad MJ, Aass N, Aielli F, Bennett M, Brunelli C, Caraceni A, Cavanna L, Fassbender K, Feio M, Haugen DF, Jakobsen G, Laird B, Løhre ET, Martinez M, Nabal M, Noguera-Tejedor A, Pardon K, Pigni A, Piva L, Porta-Sales J, Rizzi F, Rondini E, Sjøgren P, Strasser F, Turriziani A, Kaasa S. Characteristics of the case mix, organisation and delivery in cancer palliative care: a challenge for good-quality research. BMJ Support Palliat Care 2016; 8:456-467. [PMID: 27246166 DOI: 10.1136/bmjspcare-2015-000997] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 02/05/2016] [Accepted: 05/10/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Palliative care (PC) services and patients differ across countries. Data on PC delivery paired with medical and self-reported data are seldom reported. Aims were to describe (1) PC organisation and services in participating centres and (2) characteristics of patients in PC programmes. METHODS This was an international prospective multicentre study with a single web-based survey on PC organisation, services and academics and patients' self-reported symptoms collected at baseline and monthly thereafter, with concurrent registrations of medical data by healthcare providers. Participants were patients ≥18 enrolled in a PC programme. RESULTS 30 centres in 12 countries participated; 24 hospitals, 4 hospices, 1 nursing home, 1 home-care service. 22 centres (73%) had PC in-house teams and inpatient and outpatient services. 20 centres (67%) had integral chemotherapy/radiotherapy services, and most (28/30) had access to general medical or oncology inpatient units. Physicians or nurses were present 24 hours/7 days in 50% and 60% of centres, respectively. 50 centres (50%) had professorships, and 12 centres (40%) had full-time/part-time research staff. Data were available on 1698 patients: 50% females; median age 66 (range 21-97); median Karnofsky score 70 (10-100); 1409 patients (83%) had metastatic/disseminated disease; tiredness and pain in the past 24 hours were most prominent. During follow-up, 1060 patients (62%) died; 450 (44%) <3 months from inclusion and 701 (68%) within 6 months. ANOVA and χ2 tests showed that hospice/nursing home patients were significantly older, had poorer performance status and had shorter survival compared with hospital-patients (p<.0.001). CONCLUSIONS There is a wide variation in PC services and patients across Europe. Detailed characterisation is the first step in improving PC services and research. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT01362816.
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Affiliation(s)
- M J Hjermstad
- Department of Oncology, Regional Centre for Excellence in Palliative Care, Oslo University Hospital, Ullevål, Oslo, Norway.,Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - N Aass
- Department of Oncology, Regional Centre for Excellence in Palliative Care, Oslo University Hospital, Ullevål, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - F Aielli
- Medical Oncology Department, University of L'Aquila, L'Aquila, Italy
| | - M Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - C Brunelli
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Pain Therapy and Rehabilitation Unit, Department of Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Caraceni
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Pain Therapy and Rehabilitation Unit, Department of Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - L Cavanna
- Oncology-Hematology Department, Hospital of Piacenza, Piacenza, Italy
| | - K Fassbender
- Cross Cancer Institute, Regional Cancer Centre Northern Alberta, Edmonton, Alberta, Canada
| | - M Feio
- Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - D F Haugen
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
| | - G Jakobsen
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - B Laird
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - E T Løhre
- Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - M Martinez
- Clínica Universidad de Navarra, Pamplona, Spain
| | - M Nabal
- Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | | | - K Pardon
- End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - A Pigni
- Pain Therapy and Rehabilitation Unit, Department of Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - L Piva
- Unità di Cure Palliative Azienda Ospedaliera San Paolo, Milan, Italy
| | - J Porta-Sales
- Palliative Care Service, Catalan Institute of Oncology (ICO), Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), WeCare Chair: end of life care, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - F Rizzi
- U.O. Complessa Cure Palliative e Terapia del Dolore Istituti Clinici di Perfezionamento, Milan, Italy
| | - E Rondini
- Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - P Sjøgren
- Section of Palliative Medicine, Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - F Strasser
- Oncological Palliative Medicine, Oncology Department, Internal Medicine & Palliative Centre Cantonal Hospital, St. Gallen, Switzerland
| | - A Turriziani
- Hospice Villa Speranza, Università Cattolica S. Cuore, Rome, Italy
| | - S Kaasa
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Thomas S, Walsh D, Shrotriya S, Aktas A, Hullihen B, Estfan B, Budd GT, Hjermstad MJ, O'Connor B. Symptoms, Quality of Life, and Daily Activities in People With Newly Diagnosed Solid Tumors Presenting to a Medical Oncologist. Am J Hosp Palliat Care 2016; 34:611-621. [PMID: 27217423 DOI: 10.1177/1049909116649948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Symptom and Quality of Life (QOL) data are important patient reported outcomes. Early identification of these is critical for appropriate interventions. Data collection may be helped by modern information technology. AIM This study examined symptoms and QOL in people with solid tumors at their first visit to a medical oncologist. We also evaluated the clinical utility of tablet computers (TC) to collect this data. METHODS This was a prospective study of 105 consecutive patients in the cancer outpatient clinic of a tertiary level academic medical center. Symptom and QOL data was collected by TC with wireless database upload. RESULTS One-third participants had moderate to severe pain; almost half clinically significant pain that interfered with daily activities. Tiredness, anxiety, and drowsiness were common (prevalence - 79%, 63% and 50% respectively). One-third of those who had items identified from the Edmonton System Assessment System also volunteered other symptoms, mostly gastrointestinal problems. Many of those affected also reported impaired Global Wellbeing and low Overall QOL. There was a 98% completion rate, which took on average ten minutes. Direct observation and informal feedback from patients and physicians regarding the acceptability of TC in this setting was uniformly positive. CONCLUSIONS Amongst people with newly diagnosed solid tumors clinically important psychological and physical symptoms, QOL problems and difficulties with daily activities were commonly present in the 24-hour period and in the week before a first Medical Oncology visit. Symptom and QOL data collection by TC in busy outpatient clinics showed good clinical utility.
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Affiliation(s)
- Shirley Thomas
- 1 The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Cleveland, OH, USA.,2 Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Declan Walsh
- 1 The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Cleveland, OH, USA.,2 Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.,3 The Harry R Horvitz Chair in Palliative Medicine.,4 Faculty of Health Sciences, Trinity College, Dublin 2, Ireland
| | - Shiva Shrotriya
- 1 The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Cleveland, OH, USA.,2 Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Aynur Aktas
- 1 The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Cleveland, OH, USA.,2 Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Barbara Hullihen
- 1 The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Cleveland, OH, USA.,2 Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Bassam Estfan
- 2 Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - G Thomas Budd
- 2 Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Marianne Jensen Hjermstad
- 5 Department of Cancer Research and Molecular Medicine, Norway and European Palliative Care Research Centre, Oslo Universitetssykehus, Oslo, Norway.,6 Department of Oncology, Regional Centre for Excellence in Palliative Care, Norwegian University of Science and Technology, Trondheim, Norway
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Bausewein C, Daveson BA, Currow DC, Downing J, Deliens L, Radbruch L, Defilippi K, Lopes Ferreira P, Costantini M, Harding R, Higginson IJ. EAPC White Paper on outcome measurement in palliative care: Improving practice, attaining outcomes and delivering quality services - Recommendations from the European Association for Palliative Care (EAPC) Task Force on Outcome Measurement. Palliat Med 2016; 30:6-22. [PMID: 26068193 DOI: 10.1177/0269216315589898] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Outcome measurement plays an increasing role in improving the quality, effectiveness, efficiency and availability of palliative care. AIM To provide expert recommendations on outcome measurement in palliative care in clinical practice and research. METHODS Developed by a European Association for Palliative Care Task Force, based on literature searches, international expert workshop, development of outcome measurement guidance and international online survey. A subgroup drafted a first version and circulated it twice to the task force. The preliminary final version was circulated to wider expert panel and 28 international experts across 20 European Association for Palliative Care member associations and the European Association for Palliative Care Board of Directors and revised according to their feedback. The final version was approved by the European Association for Palliative Care Board for adoption as an official European Association for Palliative Care position paper. RESULTS In all, 12 recommendations are proposed covering key parameters of measures, adequate measures for the task, introduction of outcome measurement into practice, and national and international outcome comparisons and benchmarking. Compared to other recommendations, the White Paper covers similar aspects but focuses more on outcome measurement in clinical care and the wider policy impact of implementing outcome measurement in clinical palliative care. Patient-reported outcome measure feedback improves awareness of unmet need and allows professionals to act to address patients' needs. However, barriers and facilitators have been identified when implementing outcome measurement in clinical care that should be addressed. CONCLUSION The White Paper recommends the introduction of outcome measurement into practice and outcomes that allow for national and international comparisons. Outcome measurement is key to understanding different models of care across countries and, ultimately, patient outcome having controlled for differing patients characteristics.
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Affiliation(s)
- Claudia Bausewein
- Department of Palliative Medicine, Munich University Hospital, Munich, Germany
| | | | | | | | - Luc Deliens
- Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Kath Defilippi
- Hospice Palliative Care Association of South Africa, Cape Town, South Africa
| | | | | | - Richard Harding
- King's College London, Cicely Saunders Institute, London, UK
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25
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Masel E, Berghoff A, Schur S, Maehr B, Schrank B, Simanek R, Preusser M, Marosi C, Watzke H. The PERS2ON score for systemic assessment of symptomatology in palliative care: a pilot study. Eur J Cancer Care (Engl) 2015; 25:544-50. [DOI: 10.1111/ecc.12419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2015] [Indexed: 01/06/2023]
Affiliation(s)
- E.K. Masel
- Clinical Division of Palliative Care; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - A.S. Berghoff
- Clinical Division of Oncology; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - S. Schur
- Clinical Division of Palliative Care; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - B. Maehr
- Clinical Division of Palliative Care; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - B. Schrank
- Department of Psychiatry and Psychotherapy; Medical University of Vienna; Vienna Austria
| | - R. Simanek
- Department of Internal Medicine, Hematology and Oncology; Hanusch Hospital; Vienna Austria
| | - M. Preusser
- Clinical Division of Oncology; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - C. Marosi
- Clinical Division of Oncology; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - H.H. Watzke
- Clinical Division of Palliative Care; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
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Abstract
In Germany, approximately half a million people suffer from cancer pain, which is one of the most common first symptoms of tumor disease in 20-40% of the patients. The prevalence increases during the course of the disease to approximately 90% among patients in a palliative care unit. Treatment in the field of cancer pain is often provided by interdisciplinary teams of different pain or palliative care services. Due to the high availability of opioids and also, in European comparison, of a high number of specialized services in hospice and palliative care provision, Germany plays a special role next to Great Britain. There is a great need for the further development of the coordination and networking of these services within Germany, which is regulated by the Hospice and Palliative Act. The cross-sectional curricula QB 13 (palliative medicine) and QB 14 (pain medicine) were implemented in German medical faculties in order to improve integration of cancer pain management into the teaching of medical students. Research in the area of cancer pain addresses clinical topics such as the availability of opioids, but also basic research including genetic variability as a predictor for the efficacy of opioids and the neurobiology of cancer pain.
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27
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Depression in advanced cancer--assessment challenges and associations with disease load. J Affect Disord 2015; 173:176-84. [PMID: 25462414 DOI: 10.1016/j.jad.2014.11.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 11/07/2014] [Accepted: 11/07/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Patients with advanced cancer commonly experience multiple somatic symptoms and declining functioning. Some highly prevalent symptoms also overlap with diagnostic symptom-criteria of depression. Thus, assessing depression in these patients can be challenging. We therefore investigated 1) the effect of different scoring-methods of depressive symptoms on detecting depression, and 2) the relationship between disease load and depression amongst patients with advanced cancer. METHODS The sample included 969 patients in the European Palliative Care Research Collaborative-Computer Symptom Assessment Study (EPCRC-CSA). Inclusion criteria were: incurable metastatic/locally advanced cancer and ≥ 18 years. Biomarkers and length of survival were registered from patient-records. Depression was assessed using the Patient Health Questionnaire (PHQ-9) and applying three scoring-methods: inclusive (algorithm scoring including the somatic symptom-criteria), exclusive (algorithm scoring excluding the somatic symptom-criteria) and sum-score (sum of all symptoms with a cut-off ≥ 8). RESULTS Depression prevalence rates varied according to scoring-method: inclusive 13.7%, exclusive 14.9% and sum-score 45.3%. Agreement between the algorithm scoring-methods was excellent (Kappa = 0.81), but low between the inclusive and sum scoring-methods (Kappa = 0.32). Depression was significantly associated with more pain (OR-range: 1.09-1.19, p < 0.001-0.04) and lower performance status (KPS-score, OR-range = 0.68-0.72, p < 0.001) irrespective of scoring-method. LIMITATIONS Depression was assessed using self-report, not clinical interviews. CONCLUSIONS The scoring-method, not excluding somatic symptoms, had the greatest effect on assessment outcomes. Increasing pain and poorer than expected physical condition should alert clinicians to possible co-morbid depression. The large discrepancy in prevalence rates between scoring-methods reinforces the need for consensus and validation of depression definitions and assessment in populations with high disease load.
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28
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Etkind SN, Daveson BA, Kwok W, Witt J, Bausewein C, Higginson IJ, Murtagh FEM. Capture, transfer, and feedback of patient-centered outcomes data in palliative care populations: does it make a difference? A systematic review. J Pain Symptom Manage 2015; 49:611-24. [PMID: 25135657 DOI: 10.1016/j.jpainsymman.2014.07.010] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 07/14/2014] [Accepted: 07/23/2014] [Indexed: 01/22/2023]
Abstract
CONTEXT Patient-centered outcome measures (PCOMs) are an important way of promoting patient-professional communication. However, evidence regarding their implementation in palliative care is limited, as is evidence of the impact on care quality and outcomes. OBJECTIVES The aim was to systematically review evidence on capture and feedback of PCOMs in palliative care populations and determine the effects on processes and outcomes of care. METHODS We searched Medline, Embase, CINAHL, BNI, PsycINFO, and gray literature from 1985 to October 2013 for peer-reviewed articles focusing on collection, transfer, and feedback of PCOMs in palliative care populations. Two researchers independently reviewed all included articles. Review articles, feasibility studies, and those not measuring PCOMs in clinical practice were excluded. We quality assessed articles using modified Edwards criteria and undertook narrative synthesis. RESULTS One hundred eighty-four articles used 122 different PCOMs in 70,466 patients. Of these, 16 articles corresponding to 13 studies met the full inclusion criteria. Most evidence was from outpatient oncology. There was strong evidence for an impact of PCOMs feedback on processes of care including better symptom recognition, more discussion of quality of life, and increased referrals based on PCOMs reporting. There was evidence of improved emotional and psychological patient outcomes but no effect on overall quality of life or symptom burden. CONCLUSION In palliative care populations, PCOMs feedback improves awareness of unmet need and allows professionals to act to address patients' needs. It consequently benefits patients' emotional and psychological quality of life. However, more high-quality evidence is needed in noncancer populations and across a wider range of settings.
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Affiliation(s)
- Simon Noah Etkind
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom.
| | - Barbara A Daveson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Wingfai Kwok
- King's College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Jana Witt
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Claudia Bausewein
- Institute of Palliative Care, Oldenburg and Department for Palliative Medicine, University Hospital Munich, Munich, Germany
| | - Irene J Higginson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Fliss E M Murtagh
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
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Abstract
PURPOSE OF REVIEW Adequate cancer pain assessment using valid and reliable tools is essential for proper cancer pain management. Because cancer pain can be a complex construct, assessment of its many domains should be conducted using multidimensional tools. Furthermore, there is a need to develop a standard, consensus classification system for prognosis of cancer pain. RECENT FINDINGS Unidimensional tools for assessing cancer pain are useful for measuring cancer pain intensity. Other domains and symptoms of the cancer pain experience are assessed using a variety of multidimensional tools. There is a lack of agreement on a standard assessment tool or a standard classification system for cancer pain, although research continues to be undertaken to develop such resources for clinical and research purposes. SUMMARY Many pain and symptom assessment tools exist for use in the cancer patient, including the Brief Pain Inventory, the McGill Pain Questionnaire, the MD Anderson Symptom Inventory, and the Edmonton Symptom Assessment System, among others. Recent literature reveals the move toward translating these and other tools to electronic applications. Further study is also underway to create a standard, prognostic classification system for cancer pain.
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30
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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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Confirming neuropathic pain in cancer patients: Applying the NeuPSIG grading system in clinical practice and clinical research. Pain 2014; 155:859-863. [DOI: 10.1016/j.pain.2013.11.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 11/17/2013] [Indexed: 11/19/2022]
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Mulvey MR, Bennett MI, Liwowsky I, Freynhagen R. The role of screening tools in diagnosing neuropathic pain. Pain Manag 2014; 4:233-43. [DOI: 10.2217/pmt.14.8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
SUMMARY: Neuropathic pain affects 6–8% of the general adult population. It is reported by 27% of chronic pain patients and 40% of cancer patients, yet there is no standardized diagnostic test for neuropathic pain. A number of screening tools have been developed based on verbal pain descriptors, with or without limited clinical examination, to identify individuals with neuropathic pain. Over the past decade these neuropathic pain screening tools have been validated in a wide range of pain populations, as well as translated into many languages, to discriminate between neuropathic and non-neuropathic pain. We describe here the five most commonly used neuropathic pain screening tools and discuss current assessment guidelines, the use of screening tools in novel clinical contexts and their potential use in personalized therapy.
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Affiliation(s)
- Matthew R Mulvey
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, UK
| | - Iris Liwowsky
- Department of Anesthesiology, Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Tutzing, Germany
| | - Rainer Freynhagen
- Department of Anesthesiology, Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Tutzing, Germany
- Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Janberidze E, Hjermstad MJ, Brunelli C, Loge JH, Lie HC, Kaasa S, Knudsen AK. The use of antidepressants in patients with advanced cancer-results from an international multicentre study. Psychooncology 2014; 23:1096-102. [DOI: 10.1002/pon.3541] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/10/2014] [Accepted: 03/14/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Elene Janberidze
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- Department of Oncology, St. Olavs Hospital; Trondheim University Hospital; Trondheim Norway
| | - Marianne Jensen Hjermstad
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- Regional Centre for Excellence in Palliative Care, Department of Oncology; Oslo University Hospital; Oslo Norway
| | - Cinzia Brunelli
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- Palliative Care, Pain Therapy and Rehabilitation Unit; Fondazione IRCCS Istituto Nazionale Tumori Milano; Milano Italy
| | - Jon Håvard Loge
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- National Resource Centre for Late Effects After Cancer Treatment; Oslo University Hospital; Oslo Norway
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine; University of Oslo; Oslo Norway
| | - Hanne Cathrine Lie
- National Resource Centre for Late Effects After Cancer Treatment; Oslo University Hospital; Oslo Norway
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine; University of Oslo; Oslo Norway
| | - Stein Kaasa
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- Department of Oncology, St. Olavs Hospital; Trondheim University Hospital; Trondheim Norway
| | - Anne Kari Knudsen
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- Department of Oncology, St. Olavs Hospital; Trondheim University Hospital; Trondheim Norway
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Blum D, Koeberle D, Omlin A, Walker J, Von Moos R, Mingrone W, deWolf-Linder S, Hayoz S, Kaasa S, Strasser F, Ribi K. Feasibility and acceptance of electronic monitoring of symptoms and syndromes using a handheld computer in patients with advanced cancer in daily oncology practice. Support Care Cancer 2014; 22:2425-34. [DOI: 10.1007/s00520-014-2201-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 03/04/2014] [Indexed: 10/25/2022]
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Solheim TS, Blum D, Fayers PM, Hjermstad MJ, Stene GB, Strasser F, Kaasa S. Weight loss, appetite loss and food intake in cancer patients with cancer cachexia: three peas in a pod? - analysis from a multicenter cross sectional study. Acta Oncol 2014; 53:539-46. [PMID: 23998647 DOI: 10.3109/0284186x.2013.823239] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND How to assess cachexia is a barrier both in research and in clinical practice. This study examines the need for assessing both reduced food intake and loss of appetite, to see if these variables can be used interchangeably. A secondary aim is to assess the variance explained by food intake, appetite and weight loss by using tumor-related factors, symptoms and biological markers as explanatory variables. MATERIAL AND METHODS One thousand and seventy patients with incurable cancer were registered in an observational, cross sectional multicenter study. A total of 885 patients that had complete data on food intake (PG-SGA), appetite (EORTC QLQ-C30) and weight loss were included in the present analysis. The association between reduced food intake and appetite loss was assessed using Spearman's correlation. To find the explained variance of the three symptoms a multivariate analysis was performed. RESULTS The mean age was 62 years with a mean survival of 247 days and a mean Karnofsky performance status of 72. Thirteen percent of the patients who reported eating less than normal had good appetite and 25% who had unchanged or increased food intake had reduced appetite. Correlation between appetite loss and food intake was 0.50. Explained variance for the regression models was 44% for appetite loss, 27% for food intake and only 13% for weight loss. CONCLUSION Both appetite loss and food intake should be assessed in cachectic patients since conscious control of eating may sometimes overcome appetite loss. The low explained variance for weight loss is probably caused by the need for more knowledge about metabolism and inflammation, and is consistent with the cancer cachexia definition that claims that in cachexia weight loss is not caused by reduced food intake alone. The questions concerning appetite loss from EORTC-QLQ C30 and food intake from PG-SGA seem practical and informative when dealing with advanced cancer patients.
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Affiliation(s)
- Tora S. Solheim
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU),
Trondheim, Norway
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology,
Trondheim, Norway
| | - David Blum
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU),
Trondheim, Norway
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology,
Trondheim, Norway
| | - Peter M. Fayers
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU),
Trondheim, Norway
- Institute of Applied Health Sciences, University of Aberdeen,
Foresterhill, Aberdeen, UK
| | - Marianne J. Hjermstad
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology,
Trondheim, Norway
- Regional Centre for Excellence in Palliative Care, South Eastern Norway, Oslo University Hospital,
Oslo, Norway
| | - Guro B. Stene
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology,
Trondheim, Norway
| | - Florian Strasser
- Oncological Palliative Medicine, Division of Oncology, Department of Internal Medicine and Palliative Care Center, Cantonal Hospital,
St. Gallen, Switzerland
| | - Stein Kaasa
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU),
Trondheim, Norway
- Department of Oncology, St. Olavs University Hospital,
Trondheim, Norway
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology,
Trondheim, Norway
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Allsop MJ, Taylor S, Mulvey MR, Bennett MI, Bewick BM. Information and communication technology for managing pain in palliative care: a review of the literature. BMJ Support Palliat Care 2014; 5:481-9. [PMID: 24644214 DOI: 10.1136/bmjspcare-2013-000625] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 01/19/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND Information and communication technology (ICT) systems are being developed for electronic symptom reporting across different stages of the cancer trajectory with research in palliative care at an early stage. AIM/DESIGN This paper presents the first systematic search of the literature to review existing ICT systems intended to support management of pain in palliative care patients with cancer. The review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analyses. DATA SOURCES Four databases (Embase, MEDLINE, PsycINFO and Healthcare Management Information Consortium) from 1990 to December 2012 were searched, with exclusion of papers based on their description of ICT systems and language used. RESULTS 24 articles met the inclusion criteria, many of which reported the use of non-experimental research designs. Studies were identified at different stages of development with no systems having reached implementation. Most systems captured pain as part of quality-of-life measurement with wide variation in approaches to pain assessment. CONCLUSIONS ICT systems for symptom reporting are emerging in the palliative care context. Future development of ICT systems need to increase the quality and scale of development work, consider how recommendations for pain measurement can be integrated and explore how to effectively use system feedback with patients.
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Affiliation(s)
- Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, West Yorkshire, UK
| | - Sally Taylor
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, West Yorkshire, UK
| | - Matthew R Mulvey
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, West Yorkshire, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, West Yorkshire, UK
| | - Bridgette M Bewick
- Academic Unit of Psychiatry and Behavioural Sciences, Leeds Institute of Health Sciences, University of Leeds, Leeds, West Yorkshire, UK
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A cross-sectional study on prevalence of pain and breakthrough pain among an unselected group of outpatients in a tertiary cancer clinic. Support Care Cancer 2014; 22:1965-71. [DOI: 10.1007/s00520-014-2178-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 02/18/2014] [Indexed: 10/25/2022]
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Blum D, Stene GB, Solheim TS, Fayers P, Hjermstad MJ, Baracos VE, Fearon K, Strasser F, Kaasa S. Validation of the Consensus-Definition for Cancer Cachexia and evaluation of a classification model--a study based on data from an international multicentre project (EPCRC-CSA). Ann Oncol 2014; 25:1635-42. [PMID: 24562443 DOI: 10.1093/annonc/mdu086] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Weight loss limits cancer therapy, quality of life and survival. Common diagnostic criteria and a framework for a classification system for cancer cachexia were recently agreed upon by international consensus. Specific assessment domains (stores, intake, catabolism and function) were proposed. The aim of this study is to validate this diagnostic criteria (two groups: model 1) and examine a four-group (model 2) classification system regarding these domains as well as survival. PATIENTS AND METHODS Data from an international patient sample with advanced cancer (N = 1070) were analysed. In model 1, the diagnostic criteria for cancer cachexia [weight loss/body mass index (BMI)] were used. Model 2 classified patients into four groups 0-III, according to weight loss/BMI as a framework for cachexia stages. The cachexia domains, survival and sociodemographic/medical variables were compared across models. RESULTS Eight hundred and sixty-one patients were included. Model 1 consisted of 399 cachectic and 462 non-cachectic patients. Cachectic patients had significantly higher levels of inflammation, lower nutritional intake and performance status and shorter survival. In model 2, differences were not consistent; appetite loss did not differ between group III and IV, and performance status not between group 0 and I. Survival was shorter in group II and III compared with other groups. By adding other cachexia domains to the model, survival differences were demonstrated. CONCLUSION The diagnostic criteria based on weight loss and BMI distinguish between cachectic and non-cachectic patients concerning all domains (intake, catabolism and function) and is associated with survival. In order to guide cachexia treatment a four-group classification model needs additional domains to discriminate between cachexia stages.
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Affiliation(s)
- D Blum
- European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim
| | - G B Stene
- European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - T S Solheim
- European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim
| | - P Fayers
- European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - M J Hjermstad
- European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim Department of Oncology, Regional Centre for Excellence in Palliative Care, Oslo University Hospital, Ullevål, Oslo, Norway
| | - V E Baracos
- Department of Oncology, Division of Palliative Care Medicine, University of Alberta, Alberta, Canada
| | - K Fearon
- Clinical and Surgical Sciences (Surgery), University of Edinburgh, Royal Infirmary, Edinburgh, UK
| | - F Strasser
- European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim Department of Internal Medicine and Palliative Center Cantonal Hospital, Oncological Palliative Medicine, Oncology, St Gallen, Switzerland
| | - S Kaasa
- European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim
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Jaatun EAA, Hjermstad MJ, Gundersen OE, Oldervoll L, Kaasa S, Haugen DF. Development and testing of a computerized pain body map in patients with advanced cancer. J Pain Symptom Manage 2014; 47:45-56. [PMID: 23856098 DOI: 10.1016/j.jpainsymman.2013.02.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 02/25/2013] [Accepted: 03/19/2013] [Indexed: 10/26/2022]
Abstract
CONTEXT Pain localization is an important part of pain assessment. Development of pain tools for self-report should include expert and patient input, and patient testing in large samples. OBJECTIVES To develop a computerized pain body map (CPBM) for use in patients with advanced cancer. METHODS Three studies were conducted: 1) an international expert survey and a pilot study guiding the contents and layout of the CPBM, 2) clinical testing in an international symptom assessment study in eight countries and 17 centers (N = 533), and 3) comparing patient pain markings on computer and paper body maps (N = 92). RESULTS Study 1: 22 pain experts and 28 patients participated. A CPBM with anterior and posterior whole body views was developed for marking pain locations, supplemented by pain intensity ratings for each location. Study 2: 533 patients (286 male, 247 female, mean age 62 years) participated; 80% received pain medication and 81% had metastatic disease. Eighty-five percent completed CPBM as intended. Mean ± SD number of marked pain locations was 1.8 ± 1.2. Aberrant markings (15%) were mostly related to software problems. No differences were found regarding age, gender, cognitive/physical performance, or previous computer experience. Study 3: 70% of the patients had identical markings on the computer and paper maps. Only four patients had completely different markings on the two maps. CONCLUSION This first version of CPBM was well accepted by patients with advanced cancer. However, several areas for improvement were revealed, providing a basis for the development of the next version, which is subject to further international testing.
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Affiliation(s)
- Ellen Anna Andreassen Jaatun
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Otolaryngology and Head and Neck Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marianne Jensen Hjermstad
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Regional Centre for Excellence in Palliative Care, South Eastern Norway, Oslo University Hospital, Oslo, Norway.
| | - Odd Erik Gundersen
- Department of Computer and Information Science, Norwegian University of Science and Technology, Trondheim, Norway; Verdande Technology AS, Trondheim, Norway
| | - Line Oldervoll
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Research Centre for Health Promotion and Resources, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Dagny Faksvåg Haugen
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
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Brunelli C, Kaasa S, Knudsen AK, Hjermstad MJ, Pigni A, Caraceni A. Comparisons of Patient and Physician Assessment of Pain-Related Domains in Cancer Pain Classification: Results From a Large International Multicenter Study. THE JOURNAL OF PAIN 2014; 15:59-67. [DOI: 10.1016/j.jpain.2013.09.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 08/27/2013] [Accepted: 09/20/2013] [Indexed: 11/29/2022]
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Aktas A, Hullihen B, Shrotriya S, Thomas S, Walsh D, Estfan B. Connected Health: Cancer Symptom and Quality-of-Life Assessment Using a Tablet Computer. Am J Hosp Palliat Care 2013; 32:189-97. [DOI: 10.1177/1049909113510963] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Incorporation of tablet computers (TCs) into patient assessment may facilitate safe and secure data collection. We evaluated the usefulness and acceptability of a TC as an electronic self-report symptom assessment instrument. Research Electronic Data Capture Web-based application supported data capture. Information was collected and disseminated in real time and a structured format. Completed questionnaires were printed and given to the physician before the patient visit. Most participants completed the survey without assistance. Completion rate was 100%. The median global quality of life was high for all. More than half reported pain. Based on Edmonton Symptom Assessment System, the top 3 most common symptoms were tiredness, anxiety, and decreased well-being. Patient and physician acceptability for these quick and useful TC-based surveys was excellent.
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Affiliation(s)
- Aynur Aktas
- Department of Solid Tumor Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Barbara Hullihen
- Department of Solid Tumor Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shiva Shrotriya
- Department of Solid Tumor Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shirley Thomas
- Department of Solid Tumor Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Declan Walsh
- Department of Solid Tumor Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Cleveland, Ohio, USA
- Faculty of Health Sciences, Trinity College Dublin and University College Dublin, First Floor, Old Chemistry Building Extension, Trinity College, Dublin 2, Ireland
| | - Bassam Estfan
- Department of Solid Tumor Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Rayment C, Hjermstad MJ, Aass N, Kaasa S, Caraceni A, Strasser F, Heitzer E, Fainsinger R, Bennett MI. Neuropathic cancer pain: prevalence, severity, analgesics and impact from the European Palliative Care Research Collaborative-Computerised Symptom Assessment study. Palliat Med 2013; 27:714-21. [PMID: 23175513 DOI: 10.1177/0269216312464408] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neuropathic pain causes greater pain intensity and worse quality of life than nociceptive pain. There are no published data that confirm this in the cancer population. AIM We hypothesised that patients with neuropathic cancer pain had more intense pain, experienced greater suffering and were treated with more analgesics than those with nociceptive cancer pain, and a neuropathic pain screening tool, painDETECT, would perform as well in those with cancer pain as is reported in those with non-cancer pain. DESIGN The data were obtained from an international cross-sectional observational study. SETTING/PARTICIPANTS A total of 1051 patients from inpatients and outpatients, with incurable cancer completed a computerised assessment on symptoms, function and quality of life. In all, 17 centres within eight countries participated. Medical data were recorded by physicians. Pain type was a clinical diagnosis recorded on the Edmonton Classification System for Cancer Pain. RESULTS Of the patients, 670 had pain: 534 with nociceptive pain, 113 with neuropathic pain and 23 were unclassified. Patients with neuropathic cancer pain were significantly more likely to be receiving oncological treatment, strong opioids and adjuvant analgesia and have a reduced performance status. They reported worse physical, cognitive and social function. Sensitivity and specificity of painDETECT for identifying neuropathic cancer pain was less accurate than when used in non-cancer populations. CONCLUSIONS Neuropathic cancer pain is associated with a negative impact on daily living and greater analgesic requirements than nociceptive cancer pain. Validated assessment methods are needed to enable early identification of neuropathic cancer pain, leading to more appropriate treatment and reduced burden on patients.
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Affiliation(s)
- Clare Rayment
- Academic Unit of Palliative Care, St Gemma's Hospice, Leeds, UK.
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Laird BJ, Kaasa S, McMillan DC, Fallon MT, Hjermstad MJ, Fayers P, Klepstad P. Prognostic factors in patients with advanced cancer: a comparison of clinicopathological factors and the development of an inflammation-based prognostic system. Clin Cancer Res 2013; 19:5456-64. [PMID: 23938289 DOI: 10.1158/1078-0432.ccr-13-1066] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE In advanced cancer, oncological treatment is influenced by performance status (PS); however, this has limitations. Biomarkers of systemic inflammation may have prognostic value in advanced cancer. The study compares key factors in prognosis (performance status, patient-reported outcomes; PRO) with an inflammation-based score (Glasgow Prognostic Score, mGPS). A new method of prognosis in advanced cancer (combining performance status and mGPS) is tested and then validated. EXPERIMENTAL DESIGN Two international biobanks of patients with advanced cancer were analyzed. Key prognostic factors [performance status, PROs (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C-30), and mGPS (using C-reactive protein and albumin concentrations)] were examined. The relationship between these and survival was examined using Kaplan-Meier and Cox regression methods, in a test sample before independent validation. RESULTS Data were available on 1,825 patients (test) and 631 patients (validation). Median survival ranged from 3.2 months (test) to 7.03 months (validation). On multivariate analysis, performance status (HR 1.62-2.77) and mGPS (HR 1.51-2.27) were independently associated with, and were the strongest predictors of survival (P < 0.01). Survival at 3 months varied from 82% (mGPS 0) to 39% (mGPS 2) and from 75% (performance status 0-1) to 14% (performance status 4). When used together, survival ranged from 88% (mGPS 0, PS 0-1) to 10% (mGPS 2, performance status 4), P < 0.001. CONCLUSION A systemic inflammation-based score, mGPS, and performance status predict survival in advanced cancer. The mGPS is similar to performance status in terms of prognostic power. Used together, performance status and mGPS act synergistically improving prognostic accuracy. This new method may be of considerable value in the management of patients with advanced cancer.
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Affiliation(s)
- Barry J Laird
- Authors' Affiliations: European Palliative Care Research Centre; Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology; Departments of Oncology and Anaesthesiology and Emergency Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim; Department of Oncology, Regional Centre for Excellence in Palliative Care, Oslo University Hospital, Oslo, Norway; University of Edinburgh, Edinburgh; and University of Glasgow, Glasgow, United Kingdom
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Nekolaichuk CL, Fainsinger RL, Aass N, Hjermstad MJ, Knudsen AK, Klepstad P, Currow DC, Kaasa, for the European Palliative S. The Edmonton Classification System for Cancer Pain: Comparison of Pain Classification Features and Pain Intensity Across Diverse Palliative Care Settings in Eight Countries. J Palliat Med 2013; 16:516-23. [DOI: 10.1089/jpm.2012.0390] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Cheryl L. Nekolaichuk
- Division of Palliative Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Robin L. Fainsinger
- Division of Palliative Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Nina Aass
- Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Marianne J. Hjermstad
- Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Anne Kari Knudsen
- European Palliative Care Research Centre (PRC), Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Pål Klepstad
- European Palliative Care Research Centre (PRC), Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- St. Olav University Hospital, Trondheim, Norway
| | | | - Stein Kaasa, for the European Palliative
- European Palliative Care Research Centre (PRC), Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- St. Olav University Hospital, Trondheim, Norway
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