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Kim A, Jeon E, Lee H, Heo H, Woo K. Risk factors for prediabetes in community-dwelling adults: A generalized estimating equation logistic regression approach with natural language processing insights. Res Nurs Health 2024. [PMID: 38961672 DOI: 10.1002/nur.22413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 05/11/2024] [Accepted: 06/22/2024] [Indexed: 07/05/2024]
Abstract
The global prevalence of prediabetes is expected to reach 8.3% (587 million people) by 2045, with 70% of people with prediabetes developing diabetes during their lifetimes. We aimed to classify community-dwelling adults with a high risk for prediabetes based on prediabetes-related symptoms and to identify their characteristics, which might be factors associated with prediabetes. We analyzed homecare nursing records (n = 26,840) of 1628 patients aged over 20 years. Using a natural language processing algorithm, we classified each nursing episode as either low-risk or high-risk for prediabetes based on the detected number and category of prediabetes-symptom words. To identify differences between the risk groups, we employed t-tests, chi-square tests, and data visualization. Risk factors for prediabetes were identified using multiple logistic regression models with generalized estimating equations. A total of 3270 episodes (12.18%) were classified as potentially high-risk for prediabetes. There were significant differences in the personal, social, and clinical factors between groups. Results revealed that female sex, age, cancer coverage as part of homecare insurance coverage, and family caregivers were significantly associated with an increased risk of prediabetes. Although prediabetes is not a life-threatening disease, uncontrolled blood glucose can cause unfavorable outcomes for other major diseases. Thus, medical professionals should consider the associated symptoms and risk factors of prediabetes. Moreover, the proposed algorithm may support the detection of individuals at a high risk for prediabetes. Implementing this approach could facilitate proactive monitoring and early intervention, leading to reduced healthcare expenses and better health outcomes for community-dwelling adults.
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Affiliation(s)
- Aeri Kim
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Eunjoo Jeon
- Technology Research, Samsung SDS, Seoul, South Korea
| | - Hana Lee
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Hyunsook Heo
- Seoul National University Hospital, Seoul, South Korea
| | - Kyungmi Woo
- College of Nursing, Seoul National University, Seoul, South Korea
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Yip R, Arnolda G, Lamprell K, Nic Giolla Easpaig B, Chittajallu R, Delaney G, Olver I, Liauw W, Braithwaite J. Experience of patients considering or using checkpoint inhibitors in cancer treatment: a systematic review of qualitative research. J Immunother Cancer 2024; 12:e007555. [PMID: 38212121 PMCID: PMC10806553 DOI: 10.1136/jitc-2023-007555] [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] [Accepted: 10/30/2023] [Indexed: 01/13/2024] Open
Abstract
Increasing numbers of patients with cancer are considering or undergoing immunotherapy, however, little is known about patients' perspectives on this treatment. We undertook a systematic review for use by clinicians and researchers, consolidating published qualitative research studies on patient experience of checkpoint inhibitor therapy. A search of Medline, Embase, and PsycINFO was carried out for publications in English to 30 June 2022. Publications were selected if they reported a qualitative study of patient experience with checkpoint inhibitor therapy for cancer, either by patients or their families or carers. Quality was appraised using the Johanna Briggs Institute quality assessment tool for qualitative studies. A thematic synthesis was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standard was followed. We identified 17 eligible studies published between 2017 and 2022, 9 using mixed methods, and 8 solely using qualitative methods. Most studies reported on the experiences of patients with advanced stage melanoma and were using the earliest approved checkpoint inhibitors for cancer therapy. Studies met most formal quality criteria but varied in the extent of their qualitative explorations of data; some mixed methods studies had limited reporting of qualitative results. Through thematic synthesis, we categorized study findings into four domains: (1) treatment decision-making; (2) success with immunotherapy; (3) treatment-related adverse events (AEs); and (4) quality of life on immunotherapy. Our review identified several areas with potential for improving the care system. These include, for example: routinely linking patients to peers who have experienced this therapy; improving the capacity of patients and carers to identify and report AEs faster; and supporting patients and carers to live with changed circumstances after successful treatment. Most studies focused on patients who had successful treatment, effectively excluding those who do not respond or who discontinue due to serious side effects; future research targets are suggested.
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Affiliation(s)
- Raphael Yip
- Centre for Healthcare Resilience and Implementation (CHRIS), Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
- Medicine, North Sydney Local Health District, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Centre for Healthcare Resilience and Implementation (CHRIS), Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
- Centre for Healthcare Resilience and Implementation (CHRIS), Australian Institute of Health Innovation, Sydney, New South Wales, Australia
| | - Klay Lamprell
- Centre for Healthcare Resilience and Implementation (CHRIS), Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
- Centre for Healthcare Resilience and Implementation (CHRIS), Australian Institute of Health Innovation, Sydney, New South Wales, Australia
| | - Bróna Nic Giolla Easpaig
- Centre for Healthcare Resilience and Implementation (CHRIS), Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
- Centre for Healthcare Resilience and Implementation (CHRIS), Australian Institute of Health Innovation, Sydney, New South Wales, Australia
- School of Nursing, Charles Darwin University Faculty of Health, Darwin, Northern Territory, Australia
| | - Renuka Chittajallu
- Centre for Healthcare Resilience and Implementation (CHRIS), Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
- Centre for Healthcare Resilience and Implementation (CHRIS), Australian Institute of Health Innovation, Sydney, New South Wales, Australia
- Medical Oncology, Riverina Cancer Care Centre, Wagga Wagga, New South Wales, Australia
- Medical Oncology, GenesisCare, Kingswood, New South Wales, Australia
| | - Geoff Delaney
- South-Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Radiation Oncology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Ian Olver
- School of Psychology, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Winston Liauw
- St George Cancer Centre, Saint George Hospital, Kogarah, New South Wales, Australia
- St. George Hospital Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation (CHRIS), Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
- Centre for Healthcare Resilience and Implementation (CHRIS), Australian Institute of Health Innovation, Sydney, New South Wales, Australia
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Parikh RB, Schriver E, Ferrell WJ, Wakim J, Williamson J, Khan N, Kopinsky M, Balachandran M, Gabriel PE, Schuchter LM, Patel MS, Shulman LN, Manz CR. Remote Patient-Reported Outcomes and Activity Monitoring to Improve Patient-Clinician Communication Regarding Symptoms and Functional Status: A Randomized Controlled Trial. JCO Oncol Pract 2023; 19:1143-1151. [PMID: 37816198 PMCID: PMC10732505 DOI: 10.1200/op.23.00048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/08/2023] [Accepted: 08/29/2023] [Indexed: 10/12/2023] Open
Abstract
PURPOSE Routine collection of patient-generated health data (PGHD) may promote earlier recognition of symptomatic and functional decline. This trial assessed the impact of an intervention integrating remote PGHD collection with patient nudges on symptom and functional status understanding between patients with advanced cancer and their oncology team. METHODS This three-arm randomized controlled trial was conducted from November 19, 2020, to December 17, 2021, at a large tertiary oncology practice. We enrolled patients with stage IV GI and lung cancers undergoing chemotherapy. Over 6 months, patients in two intervention arms received PROStep-weekly text message-based symptom surveys and passive activity monitoring using a wearable accelerometer. PGHD were summarized in dashboards given to patients' oncology team before appointments. One intervention arm received an additional text-based active choice prompt to discuss worsening symptoms or functional status with their clinician. Control patients did not receive PROStep. The coprimary outcomes patient perceptions of oncology team symptom and functional understanding at 6 months were measured on a 1-5 Likert scale (5 = high understanding). RESULTS One hundred eight patients enrolled: 55% male, 81% White, and 77% had GI cancers. Patient-reported clinician understanding did not differ between control and intervention arms for symptoms (4.5 v 4.5; P = .87) or functional status (4.5 v 4.3; P = .31). In the intervention arms, combined patient adherence to weekly symptom reports and daily activity monitoring was 64% and 53%, respectively. Intervention patients in the PROStep versus PROStep + active choice arms reported low burden from wearing the accelerometer (mean burden [standard deviation], 2.7 [1.3] v 2.1 [1.3]; P = .15) and completing surveys (2.1 [1.2] v 1.9 [1.3]; P = .44). CONCLUSION Patients receiving PROStep reported high understanding of symptoms and functional status from their oncology team, although this did not differ from controls.
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Affiliation(s)
- Ravi B. Parikh
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Emily Schriver
- Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA
- Penn Medicine Predictive Healthcare, University of Pennsylvania Health System, Philadelphia, PA
| | - William J. Ferrell
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jonathan Wakim
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joelle Williamson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Neda Khan
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Health Care Innovation, Penn Medicine, Philadelphia, PA
| | - Michael Kopinsky
- Center for Health Care Innovation, Penn Medicine, Philadelphia, PA
| | | | - Peter E. Gabriel
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Lynn M. Schuchter
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | | | | | - Christopher R. Manz
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Harvard University, Boston, MA
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Lehmann J, de Ligt KM, Tipelius S, Giesinger JM, Sztankay M, Voigt S, van de Poll-Franse LV, Rumpold G, Weger R, Willenbacher E, Willenbacher W, Holzner B. Adherence to Patient-Reported Symptom Monitoring and Subsequent Clinical Interventions for Patients With Multiple Myeloma in Outpatient Care: Longitudinal Observational Study. J Med Internet Res 2023; 25:e46017. [PMID: 37606979 PMCID: PMC10481208 DOI: 10.2196/46017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The use of software to monitor patient-reported outcome measures (PROMs) can improve outcomes for patients with cancer receiving anticancer therapy; however, evidence from applications used in routine clinical practice is lacking. OBJECTIVE We aimed to investigate adherence to and patient perceptions of a weekly, web-based PROM symptom monitoring program in routine clinical practice for patients with Multiple Myeloma. Moreover, we aimed to capture how clinical alerts prompted by the system influenced clinical care. METHODS We conducted a single-center longitudinal observational study to evaluate patient adherence to and perceptions of the PROM monitoring software in routine practice. Patients with Multiple Myeloma remotely completed weekly treatment-specific PROMs to monitor key symptoms via a dedicated web-based platform. Alarming symptoms triggered clinical alerts in the application for the treatment team, which could initiate clinical interventions. The primary outcomes were the web-based assessment completion rate and patients' perceptions of the monitoring program, as assessed by an evaluation questionnaire. Moreover, clinical alerts prompted by the system and consequential clinical interventions were analyzed. RESULTS Between July 2021 and June 2022, a total of 55 patients were approached for participation; 39 patients participated (24, 61% male, mean age 63.2, SD 9.2 years). The median assessment completion rate out of all weekly scheduled assessments was 70.3% (IQR 41.2%-89.6%). Most patients (77%) felt that the health care team was better informed about their health status due to the web-based assessments. Clinical alerts were triggered for 1758 of 14,639 (12%) reported symptoms. For 548 of 1758 (31.2%) alerts, the symptom had been registered before and no further action was required; for 348 of 1758 (19.9%) alerts, telephone consultation and self-management advice sufficed. Higher-level interventions were seldom needed in response to alerts: referral to a doctor or specialist (88/1758, 5% alerts), medication changes (22/1758, 1.3%), scheduling additional diagnostics (9/1758, 0.5%), or unplanned emergency visits (7/1758, 0.4%). Most patients (55%) reported the calls in response to alerts gave them "quite a bit" or "very much" of an added feeling of security during therapy. CONCLUSIONS Our study shows that high adherence to regular and tailored PROM monitoring can be achieved in routine clinical care. The findings provide valuable insight into how the PROM monitoring program and the clinical alerts and resulting interventions shaped clinical practice. TRIAL REGISTRATION ClinicalTrials.gov NCT05036863; https://clinicaltrials.gov/study/NCT05036863.
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Affiliation(s)
- Jens Lehmann
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
- Syndena GmbH, Innsbruck, Austria
| | - Kelly M de Ligt
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | | | - Johannes M Giesinger
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Monika Sztankay
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Sandra Voigt
- Syndena GmbH, Innsbruck, Austria
- Internal Medicine V: Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Lonneke V van de Poll-Franse
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, Netherlands
| | - Gerhard Rumpold
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
- Evaluation Software Development GmbH, Innsbruck, Austria
| | | | - Ella Willenbacher
- Internal Medicine V: Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Willenbacher
- Syndena GmbH, Innsbruck, Austria
- Internal Medicine V: Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Holzner
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
- Evaluation Software Development GmbH, Innsbruck, Austria
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Wreyford L, Gururajan R, Zhou X. When can cancer patient treatment nonadherence be considered intentional or unintentional? A scoping review. PLoS One 2023; 18:e0282180. [PMID: 37134109 PMCID: PMC10155980 DOI: 10.1371/journal.pone.0282180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/10/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Treatment nonadherence in cancer patients remains high with most interventions having had limited success. Most studies omit the multi-factorial aspects of treatment adherence and refer to medication adherence. The behaviour is rarely defined as intentional or unintentional. AIM The aim of this Scoping Review is to increase understanding of modifiable factors in treatment nonadherence through the relationships that physicians have with their patients. This knowledge can help define when treatment nonadherence is intentional or unintentional and can assist in predicting cancer patients at risk of nonadherence and in intervention design. The scoping review provides the basis for method triangulation in two subsequent qualitative studies: 1. Sentiment analysis of online cancer support groups in relation to treatment nonadherence; 2. A qualitative validation survey to refute / or validate claims from this scoping review. Thereafter, framework development for a future (cancer patient) online peer support intervention. METHODS A Scoping Review was performed to identify peer reviewed studies that concern treatment / medication nonadherence in cancer patients-published between 2000 to 2021 (and partial 2022). The review was registered in the Prospero database CRD42020210340 and follows the PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Searches. The principles of meta-ethnography are used in a synthesis of qualitative findings that preserve the context of primary data. An aim of meta-ethnography is to identify common and refuted themes across studies. This is not a mixed methods study, but due to a limited qualitativevidence base and to broaden findings, the qualitative elements (author interpretations) found within relevant quantitative studies have been included. RESULTS Of 7510 articles identified, 240 full texts were reviewed with 35 included. These comprise 15 qualitative and 20 quantitative studies. One major theme, that embraces 6 sub themes has emerged: 'Physician factors can influence patient factors in treatment nonadherence'. The six (6) subthemes are: 1. Suboptimal Communication; 2. The concept of Information differs between Patient and Physician; 3.Inadequate time. 4. The need for Treatment Concordance is vague or missing from concepts; 5. The importance of Trust in the physician / patient relationship is understated in papers; 6. Treatment concordance as a concept is rarely defined and largely missing from studies. LINE OF ARGUMENT WAS DRAWN Treatment (or medication) nonadherence that is intentional or unintentional is often attributed to patient factors-with far less attention to the potential influence of physician communication factors. The differentation between intentional or unintentional nonadherence is missing from most qualitative and quantitative studies. The holistic inter-dimensional / multi-factorial concept of 'treatment adherence' receives scant attention. The main focus is on medication adherence / nonadherence in the singular context. Nonadherence that is unintentional is not necessarily passive behaviour and may overlap with intentional nonadherence. The absence of treatment concordance is a barrier to treatment adherence and is rarely articulated or defined in studies. CONCLUSION This review demonstrates how cancer patient treatment nonadherence is often a shared outcome. An equal focus on physican and patient factors can increase understanding of the two main types of nonadherence (intentional or unintentional). This differentation should help improve the fundamentals of intervention design.
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Affiliation(s)
- Leon Wreyford
- University of Southern Queensland (USQ), Toowoomba, Qld, Australia
| | - Raj Gururajan
- University of Southern Queensland (USQ), Toowoomba, Qld, Australia
| | - Xujuan Zhou
- University of Southern Queensland (USQ), Toowoomba, Qld, Australia
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Associations of Age and Sex with the Efficacy of Inpatient Cancer Rehabilitation: Results from a Longitudinal Observational Study Using Electronic Patient-Reported Outcomes. Cancers (Basel) 2023; 15:cancers15061637. [PMID: 36980523 PMCID: PMC10046728 DOI: 10.3390/cancers15061637] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 03/09/2023] Open
Abstract
Cancer rehabilitation is thought to increase the quality of life (QOL) and functioning of cancer survivors. It remains, however, uncertain whether subgroups benefit equally from rehabilitation. We wished to investigate the outcomes of multimodal rehabilitation according to age, sex and functioning. Patients of an Austrian rehabilitation center routinely completed the EORTC QLQ-C30 and the hospital anxiety and depression scale (HADS) questionnaires prior to (T1), and after rehabilitation (T2). To compare the outcomes between age groups (i.e., <40, 41–69, and ≥70 years), sex, and the Norton scale risk status, repeated measures of analyses of variance were calculated. A total of 5567 patients with an average age of 60.7 years were included, of which 62.7% were female. With T1 indicating the cancer survivors’ needs, older and high-risk patients reported lower functioning (all p < 0.001) and a higher symptom burden for most scales (all p < 0.05) before rehabilitation. Regardless of age, sex or risk status, the patients showed at a least small to medium improvement during rehabilitation for anxiety, depression, and most functioning and symptom scales. Some between-group differences were observed, none of which being of a relevant effect size as determined with the Cohen’s d. In conclusion, QOL is improved by rehabilitation in all patients groups, independently from age, sex, or the risk status.
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Campbell R, King MT, Stockler MR, Lee YC, Roncolato FT, Friedlander ML. Patient-Reported Outcomes in Ovarian Cancer: Facilitating and Enhancing the Reporting of Symptoms, Adverse Events, and Subjective Benefit of Treatment in Clinical Trials and Clinical Practice. Patient Relat Outcome Meas 2023; 14:111-126. [PMID: 37188148 PMCID: PMC10178904 DOI: 10.2147/prom.s297301] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/25/2023] [Indexed: 05/17/2023] Open
Abstract
Patient-reported outcomes (PROs) provide a valid, standardized way of assessing symptoms, adverse events and the subjective benefit of treatment from the patient's perspective. Assessment of PROs is critical in ovarian cancer due to the high morbidity of the disease and its treatments. Several well-validated PRO measures are available to assess PROs in ovarian cancer. Their inclusion in clinical trials can provide evidence on the benefits and harms of new treatments based on patients' experiences to guide improvements in clinical practice and health policy. Aggregate PRO data collected in clinical trials can be used to inform patients about likely treatment impacts and assist them to make informed treatment decisions. In clinical practice, PRO assessments can facilitate monitoring of a patient's symptoms throughout treatment and follow-up to guide their clinical management; in this context, an individual patient's responses can facilitate communication with their treating clinician about troublesome symptoms and their impact on their quality of life. This literature review aimed to provide clinicians and researchers with a better understanding of why and how PROs can be incorporated into ovarian cancer clinical trials and routine clinical practice. We discuss the importance of assessing PROs throughout the ovarian cancer disease and treatment trajectory in both clinical trials and clinical practice, and provide examples from existing literature to illustrate the uses of PROs as the goals of treatment change in each setting.
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Affiliation(s)
- Rachel Campbell
- University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia
- Correspondence: Rachel Campbell, University of Sydney, Room 325, Brennan-Maccallum Building, Sydney, NSW, 2006, Australia, Tel +61 2 8627 7631, Email
| | - Madeleine T King
- University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia
| | - Martin R Stockler
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, NSW, Australia
| | - Yeh Chen Lee
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Department of Medical Oncology, Prince of Wales and Royal Hospital for Women, Sydney, NSW, Australia
| | - Felicia T Roncolato
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, NSW, Australia
- MacArthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, NSW, Australia
| | - Michael L Friedlander
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Department of Medical Oncology, Prince of Wales and Royal Hospital for Women, Sydney, NSW, Australia
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Heumann P, Aguado-Barrera ME, Avuzzi B, Azria D, Briers E, Bultijnck R, Choudhury A, De Ruysscher D, Farcy-Jacquet MP, Fonteyne V, Gómez Caamaño A, Helmbold I, Johnson K, Kerns SL, Lambrecht M, Lingard Z, Rancati T, Rosenstein BS, Sperk E, Paul Symonds R, Talbot C, Valdagni R, Vega A, Veldeman L, Ward T, Webb A, West CM, Chang-Claude J, Seibold P. Comparing symptom reporting by prostate cancer patients and healthcare professionals in the international multicentre REQUITE study. Radiother Oncol 2023; 178:109426. [PMID: 36442608 DOI: 10.1016/j.radonc.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Previous studies showed that healthcare professionals and patients had only moderate to low agreement on their assessment of treatment-related symptoms. We aimed to determine the levels of agreement in a large cohort of prostate cancer patients. METHODS Analyses were made of data from 1,756 prostate cancer patients treated with external beam radiotherapy (RT) and/or brachytherapy in Europe and the USA and recruited into the prospective multicentre observational REQUITE study. Eleven pelvic symptoms at the end of RT were compared after translating patient-reported outcomes (PROs) into CTCAE-based healthcare professional ratings. Gwet's AC2 agreement coefficient and 95% confidence intervals were calculated for each symptom. To compare severity of grading between patients and healthcare professionals, percent agreement and deviations for each symptom were graphically depicted. Stratified and sensitivity analyses were conducted to identify potential influencing factors and to assess heterogeneity and robustness of results. RESULTS The agreement for the 11 pelvic symptoms varied from very good (AC2 > 0.8: haematuria, rectal bleeding, management of sphincter control) to poor agreement (AC2 ≤ 0.2: proctitis and urinary urgency). Fatigue had a negative impact on the agreement. Patients tended to grade symptoms more severely than healthcare professionals. Information on sexual dysfunction was missing more frequently in healthcare professional assessment than PROs. CONCLUSION Agreement was better for observable than subjective symptoms, with patients usually grading symptoms more severely than healthcare professionals. Our findings emphasize that PROs should complement symptom assessment by healthcare professionals and be taken into consideration for clinical decision-making to incorporate the patient perspective.
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Affiliation(s)
- Philipp Heumann
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany.
| | - Miguel E Aguado-Barrera
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Fundación Pública Galega de Medicina Xenómica (FPGMX), Santiago de Compostela, Spain.
| | - Barbara Avuzzi
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - David Azria
- Federation Universitaire d'Oncologie Radiothérapie d'Occitanie Méditerranée, Univ Montpellier, INSERM U1194 IRCM, Institut du Cancer Montpellier (ICM), Montpellier, France.
| | | | - Renée Bultijnck
- Ghent University Hospital, Belgium; Ghent University, Ghent, Belgium.
| | | | | | - Marie-Pierre Farcy-Jacquet
- Federation Universitaire d'Oncologie Radiothérapie d'Occitanie Méditerranée, Institut du Cancer Du Gard (ICG), CHU Carémeau, Nîmes, France.
| | - Valérie Fonteyne
- Ghent University Hospital, Belgium; Ghent University, Ghent, Belgium.
| | - Antonio Gómez Caamaño
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain.
| | - Irmgard Helmbold
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany.
| | - Kerstie Johnson
- Department of Genetics & Cancer Sciences, University of Leicester, UK.
| | | | | | - Zoe Lingard
- University of Manchester, Christie Hospital, Manchester, UK.
| | - Tiziana Rancati
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Barry S Rosenstein
- The Department of Radiation Oncology and the Department of Genetics & Genomic Sciences, Icahn School of Medicine, New York, USA.
| | - Elena Sperk
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
| | - R Paul Symonds
- Department of Genetics & Cancer Sciences, University of Leicester, UK.
| | | | - Riccardo Valdagni
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy.
| | - Ana Vega
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Fundación Pública Galega de Medicina Xenómica (FPGMX), Santiago de Compostela, Spain; Biomedical Network on Rare Diseases (CIBERER), Spain.
| | - Liv Veldeman
- Ghent University Hospital, Belgium; Ghent University, Ghent, Belgium.
| | | | - Adam Webb
- Department of Genetics & Cancer Sciences, University of Leicester, UK.
| | | | - Jenny Chang-Claude
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany; University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Germany.
| | - Petra Seibold
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany.
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9
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Pornrattanakavee P, Srichan T, Seetalarom K, Saichaemchan S, Oer-areemitr N, Prasongsook N. Impact of interprofessional collaborative practice in palliative care on outcomes for advanced cancer inpatients in a resource-limited setting. BMC Palliat Care 2022; 21:229. [PMID: 36581913 PMCID: PMC9798714 DOI: 10.1186/s12904-022-01121-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/16/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Palliative care for patients with advanced cancer improves suffering symptoms, and quality of life (QoL). However, routine implementation of palliative care by specialty palliative care consultation is still an unmet need among in-patients with advanced cancer. Our study aim is to evaluate the effectiveness of a team-based approach on QoLs and readmission rate when compared to routine practice by among medical oncologists. METHODS This study was a prospective, Quasi-Experimental design. In-patients with advanced cancer were non-randomly assigned to receive palliative care service by team-based approach or medical oncologists only. The primary endpoint was QoL. The secondary endpoint was the readmission rate at 7 and 30 days of hospital discharge. RESULTS One hundred twenty-two in-patients were enrolled. In-patients who were assessed by a team-based approach had significantly improved change scores of subjective well-being (SWB) when compared to another group (∆ SWB: -1 [-19 - 11] vs 0 [-9 - 15], p-value = 0.043). Furthermore, patients who were assessed under a team-based approach had significantly decreased in terms of readmission rate at 7 days of hospital discharge (4.92% in the team-based approach group vs. 19.67% in the medical oncologist group, p-value = 0.013). CONCLUSIONS Interdisciplinary collaboration is the key to success in establishing goals of care, which are supporting the best possible QoL and relieving suffering symptoms for those in-patients with advanced cancer. Furthermore, the readmission rate at 7 days of hospital discharge was significantly reduced by a team-based approach. Therefore, comprehensive palliative care assessment by interprofessional collaborative practice is required. TRIAL REGISTRATION Thai Clinical Trials Registry (TCTR): number 20200312001. Date of first registration on 09/03/2020.
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Affiliation(s)
- Pitchayapa Pornrattanakavee
- grid.414965.b0000 0004 0576 1212Division of Medical Oncology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Tassaya Srichan
- grid.414965.b0000 0004 0576 1212Division of Nursing, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Kasan Seetalarom
- grid.414965.b0000 0004 0576 1212Division of Medical Oncology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Siriwimon Saichaemchan
- grid.414965.b0000 0004 0576 1212Division of Medical Oncology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Nittha Oer-areemitr
- grid.414965.b0000 0004 0576 1212Division of Pulmonary and Critical Care Medicine, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Naiyarat Prasongsook
- grid.414965.b0000 0004 0576 1212Division of Medical Oncology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
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10
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Westerink HJ, Kosse LJ, Jessurun NT, van Tubergen A, Vonkeman HE, Nurmohamed MT, van den Bemt BJF, de Vries M. Patients' and health care professionals' perspectives on adverse drug reaction burden attributed to the use of biological DMARDs: a qualitative study. Expert Opin Drug Saf 2022:1-8. [PMID: 36269284 DOI: 10.1080/14740338.2023.2134344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Previous studies showed a discrepancy between health care professionals' (HCPs') and patients' perspective on adverse drug reaction (ADR) burden. However, it is unclear which factors make an ADR burdensome. We aimed to give insight in why ADRs are perceived as burdensome by inflammatory rheumatic disease (IRD) patients, and whether this differs from the HCPs' perspective. RESEARCH DESIGN AND METHODS A qualitative study was conducted using XXX. Participants received bimonthly questionnaires on experienced ADRs attributed to biological DMARDs and were asked to elaborate on ADR burden using a Likert-type scale and an open-ended question for clarification. Data of 440 IRD patients were analysed following thematic analysis. Similar analysis was done with semi-structured interviews with 13 HCPs. RESULTS We identified seven themes associated with ADR burden: 'effect on medication prescription', 'impact on appearance', 'impact on autonomy', 'impact on daily life', 'psychological consequences', 'distressing aspects of ADR', and 'physical consequences'. Identical themes were identified by HCPs, although they identified most subthemes in 'psychological consequences', and less subthemes in 'impact on daily life' and 'impact on autonomy'. CONCLUSION Patients describe perceived ADR burden in both physical and psychological themes. The HCPs' perspective is comparable, but mostly focuses on psychological impact.
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Affiliation(s)
- Henrike J Westerink
- IQ Health, Radboud University Medical Center, Nijmegen, the Netherlands.,Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, the Netherlands
| | - Leanne J Kosse
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, the Netherlands.,Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Naomi T Jessurun
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, the Netherlands
| | - Astrid van Tubergen
- Department of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Harald E Vonkeman
- Department of Rheumatology, Medisch Spectrum Twente, Enschede, the Netherlands.,Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands
| | - Mike T Nurmohamed
- Amsterdam Rheumatology & Immunology Center, Reade, Amsterdam, the Netherlands
| | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Ubbergen, the Netherlands.,Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marieke de Vries
- Institute for computing and Information Sciences (iCIS), Radboud University, Nijmegen, the Netherlands
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11
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Jiang Y, Mason M, Cho Y, Chittiprolu A, Zhang X, Harden K, Gong Y, Harris MR, Barton DL. Tolerance to oral anticancer agent treatment in older adults with cancer: a secondary analysis of data from electronic health records and a pilot study of patient-reported outcomes. BMC Cancer 2022; 22:950. [PMID: 36057578 PMCID: PMC9440580 DOI: 10.1186/s12885-022-10026-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/16/2022] [Indexed: 12/27/2022] Open
Abstract
Background More than 60% of cancer cases occur in older adults, and many are treated with oral anticancer agents. Yet, the treatment tolerability in older adults has not been fully understood due to their underrepresentation in oncology clinical trials, creating challenges for treatment decision-making and symptom management. The objective of this study was to investigate the tolerance of capecitabine, an example of oral chemotherapy, among older adults with cancer and explore factors associated with capecitabine-related side effects and treatment changes, to enhance supportive care. Methods A secondary analysis used combined data from electronic health records and a pilot study of patient-reported outcomes, with a total of 97 adult patients taking capecitabine during 2016–2017, including older adult patients aged 65 years or older (n = 43). The data extracted included patient socio-demographics, capecitabine information, side effects, and capecitabine treatment changes (dose reductions and dose interruptions). Bivariate correlations, negative binomial regression, and multiple linear regression were conducted for data analysis. Results Older adults were more likely to experience fatigue (86% vs. 51%, p = .001) and experienced more severe fatigue (β = 0.44, p = 0.03) and hand-foot syndrome (HFS) (β = 1.15, p = 0.004) than younger adults. The severity of fatigue and HFS were associated with the number of outpatient medications (β = 0.06, p = 0.006) and the duration of treatment (β = 0.50, p = 0.009), respectively. Correlations among side effects presented different patterns between younger and older adults. Although more older adults experienced dose reductions (21% vs. 13%) and dose interruptions (33% vs. 28%) than younger adults, the differences were not statistically different. Female sex, breast cancer diagnosis, capecitabine monotherapy, and severe HFS were found to be associated with dose reductions (p-values < 0.05). Conclusions Older adults were less likely to tolerate capecitabine treatment and had different co-occurring side effects compared to younger adults. While dose reductions are common among older adults, age 65 years or older may not be an independent factor of treatment changes. Other socio-demographic and clinical factors may be more likely to be associated. Future studies can be conducted to further explore older adults’ tolerance to a variety of oral anticancer agents to generate more evidence to support optimal treatment decision-making and symptom management.
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Affiliation(s)
- Yun Jiang
- University of Michigan School of Nursing, Ann Arbor, MI, USA. .,Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, 400 North Ingalls Building, Room 4160, Ann Arbor, MI, 48109, USA.
| | - Madilyn Mason
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Youmin Cho
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | | | - Xingyu Zhang
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Karen Harden
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Yang Gong
- The University of Texas Health Science Center at Houston School of Biomedical Informatics, Houston, TX, USA
| | | | - Debra L Barton
- University of Michigan School of Nursing, Ann Arbor, MI, USA
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12
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Parikh RB, Basen-Enquist KM, Bradley C, Estrin D, Levy M, Lichtenfeld JL, Malin B, McGraw D, Meropol NJ, Oyer RA, Sheldon LK, Shulman LN. Digital Health Applications in Oncology: An Opportunity to Seize. J Natl Cancer Inst 2022; 114:1338-1339. [PMID: 35640986 PMCID: PMC9384132 DOI: 10.1093/jnci/djac108] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/13/2022] [Accepted: 05/03/2022] [Indexed: 11/23/2022] Open
Abstract
Digital health advances have transformed many clinical areas including psychiatric and cardiovascular care. However, digital health innovation is relatively nascent in cancer care, which represents the fastest growing area of health-care spending. Opportunities for digital health innovation in oncology include patient-facing technologies that improve patient experience, safety, and patient-clinician interactions; clinician-facing technologies that improve their ability to diagnose pathology and predict adverse events; and quality of care and research infrastructure to improve clinical workflows, documentation, decision support, and clinical trial monitoring. The COVID-19 pandemic and associated shifts of care to the home and community dramatically accelerated the integration of digital health technologies into virtually every aspect of oncology care. However, the pandemic has also exposed potential flaws in the digital health ecosystem, namely in clinical integration strategies; data access, quality, and security; and regulatory oversight and reimbursement for digital health technologies. Stemming from the proceedings of a 2020 workshop convened by the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine, this article summarizes the current state of digital health technologies in medical practice and strategies to improve clinical utility and integration. These recommendations, with calls to action for clinicians, health systems, technology innovators, and policy makers, will facilitate efficient yet safe integration of digital health technologies into cancer care.
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Affiliation(s)
- Ravi B Parikh
- Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA
| | - Karen M Basen-Enquist
- Center for Energy Balance in Cancer Prevention and Survivorship, The University of Texas MD Anderson Cancer Center, Texas Medical Center, Houston, Texas, USA
| | - Cathy Bradley
- University of Colorado Cancer Center, Aurora, Colorado, USA
| | | | - Mia Levy
- Division of Hematology, Oncology and Cell Therapy, Rush University, Chicago, Illinois, USA
| | | | - Bradley Malin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Randall A Oyer
- Ann B. Barshinger Cancer Institute, Lancaster, Pennsylvania, USA
| | - Lisa Kennedy Sheldon
- College of Nursing and Health Sciences, University of Massachusetts, Boston, Massachusetts, USA
| | - Lawrence N Shulman
- Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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13
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Parikh RB, Ferrell W, Wakim J, Williamson J, Khan N, Kopinsky M, Balachandran M, Gabriel PE, Zhang Y, Schuchter LM, Shulman LN, Chen J, Patel MS, Manz CR. Patient and clinician nudges to improve symptom management in advanced cancer using patient-generated health data: study protocol for the PROStep randomised controlled trial. BMJ Open 2022; 12:e054675. [PMID: 35551088 PMCID: PMC9109034 DOI: 10.1136/bmjopen-2021-054675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Patients with advanced cancers often face significant symptoms from their cancer and adverse effects from cancer-associated therapy. Patient-generated health data (PGHD) are routinely collected information about symptoms and activity levels that patients either directly report or passively record using devices such as wearable accelerometers. The objective of this study was to test the impact of an intervention integrating remote collection of PGHD with clinician and patient nudges to inform communication between patients with advanced cancer and their oncology team regarding symptom burden and functional status. METHODS AND ANALYSIS This single-centre prospective randomised controlled trial randomises patients with metastatic gastrointestinal or lung cancers into one of three arms: (A) usual care, (B) an intervention that integrates PGHD (including weekly text-based symptom surveys and passively recorded step counts) into a dashboard delivered to oncology clinicians at each visit and (C) the same intervention as arm B but with an additional text-based active choice intervention to patients to encourage discussing their symptoms with their oncology team. The study will enrol approximately 125 participants. The coprimary outcomes are patient perceptions of their oncology team's understanding of their symptoms and their functional status. Secondary outcomes are intervention utility and adherence. ETHICS AND DISSEMINATION This study has been approved by the institutional review board at the University of Pennsylvania. Study results will be disseminated using methods that describe the results in ways that key stakeholders can best understand and implement. TRIAL REGISTRATION NUMBERS NCT04616768 and 843 616.
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Affiliation(s)
- Ravi B Parikh
- Abramson Cancer Center, Philadelphia, Pennsylvania, USA
- Departments of Medical Ethics and Health Policy and Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - William Ferrell
- Departments of Medical Ethics and Health Policy and Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jonathan Wakim
- Departments of Medical Ethics and Health Policy and Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joelle Williamson
- Departments of Medical Ethics and Health Policy and Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Neda Khan
- Departments of Medical Ethics and Health Policy and Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Michael Kopinsky
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Mohan Balachandran
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | | | - Yichen Zhang
- Departments of Medical Ethics and Health Policy and Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | | | - Jinbo Chen
- Abramson Cancer Center, Philadelphia, Pennsylvania, USA
| | - Mitesh S Patel
- Departments of Medical Ethics and Health Policy and Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Christopher R Manz
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medical Oncology, Harvard Medical School, Boston, Massachusetts, USA
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14
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Stern BZ. Clinical Potential of Patient-Reported Outcome Measures in Occupational Therapy. Am J Occup Ther 2022; 76:23200. [PMID: 35157753 DOI: 10.5014/ajot.2022.049367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This column advocates the clinical potential of patient-reported outcome measures (PROMs) to advance value for occupational therapy patients and the profession. It positions PROMs in the context of value-based health care, provides an overview of emerging applications of PROMs for individual patient care, and introduces clinical advantages of the Patient-Reported Outcomes Measurement Information System. Occupational therapy practitioners should leverage the opportunities afforded by regulatory initiatives that include PROMs to meaningfully and equitably amplify the patient's voice in clinical contexts. What This Article Adds: This column highlights why occupational therapy practitioners should consider using patient-reported outcome measures in their everyday clinical practice.
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Affiliation(s)
- Brocha Z Stern
- Brocha Z. Stern, PhD, OTR, is Postdoctoral Fellow, Icahn School of Medicine at Mount Sinai, New York, NY; . At the time this column was written, Stern was Postdoctoral Fellow, Northwestern University Feinberg School of Medicine, Chicago, IL
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15
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Lee YC, King MT, O'Connell RL, Lanceley A, Joly F, Hilpert F, Davis A, Roncolato FT, Okamoto A, Bryce J, Donnellan P, Oza AM, Avall-Lundqvist E, Berek JS, Ledermann JA, Berton D, Sehouli J, Feeney A, Kaminsky MC, Diamante K, Stockler MR, Friedlander ML. Symptom burden and quality of life with chemotherapy for recurrent ovarian cancer: the Gynecologic Cancer InterGroup-Symptom Benefit Study. Int J Gynecol Cancer 2022; 32:761-768. [PMID: 35086926 PMCID: PMC9185817 DOI: 10.1136/ijgc-2021-003142] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective The Gynecologic Cancer InterGroup (GCIG)-Symptom Benefit Study was designed to evaluate the effects of chemotherapy on symptoms and health-related quality of life (HRQL) in women having chemotherapy for platinum resistant/refractory recurrent ovarian cancer (PRR-ROC) and potentially platinum sensitive with ≥3 lines of chemotherapy (PPS-ROC ≥3). Methods Participants completed the Measure of Ovarian Cancer Symptoms and Treatment (MOST) and European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire QLQ-C30 questionnaires at baseline and every 3–4 weeks until progression. Participants were classified symptomatic if they rated ≥4 of 10 in at least one-third of symptoms in the MOST index. Improvement in MOST was defined as two consecutive scores of ≤3 in at least half of the symptomatic items at baseline. Improvement in HRQL was defined as two consecutive scores ≥10 points above baseline in the QLQ-C30 summary score scale (range 0–100). Results Of 948 participants enrolled, 910 (96%) completed baseline questionnaires: 546 with PRR-ROC and 364 with PPS-ROC ≥3. The proportions of participants symptomatic at baseline as per MOST indexes were: abdominal 54%, psychological 53%, and disease- or treatment-related 35%. Improvement was reported in MOST indexes: abdominal 40%, psychological 35%, and disease- or treatment-related 38%. Median time to improvement in abdominal symptoms occurred earlier for PRR-ROC than for PPS-ROC ≥3 (4 vs 6 weeks, p=0.044); median duration of improvement was also similar (9.0 vs 11.7 weeks, p=0.65). Progression-free survival was longer among those with improvement in abdominal symptoms than in those without (median 7.2 vs 2.5 months, p<0.0001). Improvements in HRQL were reported by 77/448 (17%) with PRR-ROC and 61/301 (20%) with PPS-ROC ≥3 (p=0.29), and 102/481 (21%) of those with abdominal symptoms at baseline. Conclusion Over 50% of participants reported abdominal and psychological symptoms at baseline. Of those, 40% reported an improvement within 2 months of starting chemotherapy. Approximately one in six participants reported an improvement in HRQL. Symptom monitoring and supportive care is important as chemotherapy palliated less than half of symptomatic participants.
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Affiliation(s)
- Yeh Chen Lee
- Australia New Zealand Gynaecological Oncology Group (ANZGOG), Camperdown, New South Wales, Australia.,University of Sydney, NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia.,Prince of Wales Clinical School, Faculty of Medicine and Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Madeleine T King
- University of Sydney, Quality of Life Office of Psycho-Oncology Research Group (PoCoG), Camperdown, New South Wales, Australia
| | - Rachel L O'Connell
- University of Sydney, NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Anne Lanceley
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Florence Joly
- GINECO-Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Paris, France.,Oncology, Ctr Francois Baclesse, Caen, France
| | - Felix Hilpert
- Arbeitsgesmeinschaft Gynäkologische Onkologie Studiengruppe (AGO) und North-Eastern German Society of Gynecologcial Oncology (NOGGO), Kiel, Germany.,Onkologisches Therapiezentrum, Krankenhaus Jerusalem, Hamburg, Germany
| | - Alison Davis
- Australia New Zealand Gynaecological Oncology Group (ANZGOG), Camperdown, New South Wales, Australia.,Medical Oncology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Felicia T Roncolato
- Australia New Zealand Gynaecological Oncology Group (ANZGOG), Camperdown, New South Wales, Australia.,University of Sydney, NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Aikou Okamoto
- Japanese Gynecologic Oncology Group (JGOG), Tokyo, Japan.,Department of Obstetrics and Gynecology, Jikei University School of Medicine, Minato-ku, Japan
| | - Jane Bryce
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy.,Ascension St John Clinical Research Institute, Tulsa, Oklahoma, USA.,MITO Multicentre Italian Trials in Ovarian and gynecologic cancer, Italy
| | - Paul Donnellan
- Cancer Trials Ireland, Galway University Hospital, Galway, Ireland
| | - Amit M Oza
- Princess Margaret Consortium (PMHC), Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Elisabeth Avall-Lundqvist
- Nordic Society of Gynaecological Oncology (NSGO), Copenhagen, Denmark.,Department of Oncology and Department of Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Jonathan S Berek
- Cooperative Gynecologic Oncology Investigators (COGI), Stanford, California, USA.,Stanford Women's Cancer Centre, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
| | | | - Dominique Berton
- GINECO-Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Paris, France.,Institut de Cancérologie de l'Ouest, Centre René Gauducheau, Saint Herblain, France
| | - Jalid Sehouli
- Arbeitsgesmeinschaft Gynäkologische Onkologie Studiengruppe (AGO) und North-Eastern German Society of Gynecological Oncology (NOGGO), Berlin, Germany.,Department of Gynecology and Oncological Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Amanda Feeney
- The Cancer Research UK and UCL Cancer Trials Centre, NCRI UK, London, UK
| | - Marie-Christine Kaminsky
- GINECO-Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Paris, France.,Institut de Cancérologie de Lorraine, Vandoeuvre Les Nancy, France
| | - Katrina Diamante
- University of Sydney, NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Martin R Stockler
- University of Sydney, NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Michael L Friedlander
- Australia New Zealand Gynaecological Oncology Group (ANZGOG), Camperdown, New South Wales, Australia .,Prince of Wales Clinical School, Faculty of Medicine and Health, University of New South Wales, Randwick, New South Wales, Australia
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16
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What matters to patients and clinicians when discussing the impact of cancer medicines on health-related quality of life? Consensus-based mixed methods approach in prostate cancer. Support Care Cancer 2021; 30:3141-3150. [PMID: 34878587 PMCID: PMC8857102 DOI: 10.1007/s00520-021-06724-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/27/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To identify what matters to clinicians and patients when discussing cancer medicines' impact on health-related quality of life (HRQoL). METHODS A framework of HRQoL domain/domain elements was developed, informed by analysis of published patient reported outcome measures (PROMs), applicable to prostate cancer. Using mixed methods (eDelphi, Nominal Group Technique and questionnaire), prostate cancer clinicians and patients attending prostate cancer clinics and support groups were asked which domains/domain elements would be important to them when discussing the impact prostate cancer medicines have on their HRQoL. RESULTS Twenty-one clinicians and 71 patients participated from the West of Scotland. Clinicians and patients identified 53/62 domain elements across seven domains as important, of which 32 (60%) were common to both groups. Clinicians placed more importance than patients on Mood & Emotion; in contrast, patients placed importance on a broader range of Symptoms & Side Effects, being informed about their care, and having effective healthcare professional collaboration. CONCLUSION This study provides insight into the similarities and differences between what clinicians and patients think is important when discussing the impact of cancer medicines on HRQoL. Future research should involve exploring the potential for consistency of medicines PROMs across different cancer types to support patient-clinician communication and drive improvements in care.
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17
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Shah AM, Muhammad W, Lee K, Naqvi RA. Examining Different Factors in Web-Based Patients' Decision-Making Process: Systematic Review on Digital Platforms for Clinical Decision Support System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111226. [PMID: 34769745 PMCID: PMC8582809 DOI: 10.3390/ijerph182111226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 01/22/2023]
Abstract
(1) Background: The appearance of physician rating websites (PRWs) has raised researchers’ interest in the online healthcare field, particularly how users consume information available on PRWs in terms of online physician reviews and providers’ information in their decision-making process. The aim of this study is to consistently review the early scientific literature related to digital healthcare platforms, summarize key findings and study features, identify literature deficiencies, and suggest digital solutions for future research. (2) Methods: A systematic literature review using key databases was conducted to search published articles between 2010 and 2020 and identified 52 papers that focused on PRWs, different signals in the form of PRWs’ features, the findings of these studies, and peer-reviewed articles. The research features and main findings are reported in tables and figures. (3) Results: The review of 52 papers identified 22 articles for online reputation, 15 for service popularity, 16 for linguistic features, 15 for doctor–patient concordance, 7 for offline reputation, and 11 for trustworthiness signals. Out of 52 studies, 75% used quantitative techniques, 12% employed qualitative techniques, and 13% were mixed-methods investigations. The majority of studies retrieved larger datasets using machine learning techniques (44/52). These studies were mostly conducted in China (38), the United States (9), and Europe (3). The majority of signals were positively related to the clinical outcomes. Few studies used conventional surveys of patient treatment experience (5, 9.61%), and few used panel data (9, 17%). These studies found a high degree of correlation between these signals with clinical outcomes. (4) Conclusions: PRWs contain valuable signals that provide insights into the service quality and patient treatment choice, yet it has not been extensively used for evaluating the quality of care. This study offers implications for researchers to consider digital solutions such as advanced machine learning and data mining techniques to test hypotheses regarding a variety of signals on PRWs for clinical decision-making.
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Affiliation(s)
- Adnan Muhammad Shah
- Department of Computing Engineering, Gachon University, Seoul 13120, Korea
- Department of Physics, Charles E. Schmidt College of Science, Florida Atlantic University, Boca Raton, FL 33431-0991, USA; (A.M.S.); (W.M.)
- Department of Management Sciences, Shaheed Zulfikar Ali Bhutto Institute of Science and Technology, Islamabad 44320, Pakistan
| | - Wazir Muhammad
- Department of Physics, Charles E. Schmidt College of Science, Florida Atlantic University, Boca Raton, FL 33431-0991, USA; (A.M.S.); (W.M.)
| | - Kangyoon Lee
- Department of Computing Engineering, Gachon University, Seoul 13120, Korea
- Correspondence:
| | - Rizwan Ali Naqvi
- Department of Unmanned Vehicle Engineering, Sejong University, Seoul 05006, Korea;
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18
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Licht T, Nickels A, Rumpold G, Holzner B, Riedl D. Evaluation by electronic patient-reported outcomes of cancer survivors' needs and the efficacy of inpatient cancer rehabilitation in different tumor entities. Support Care Cancer 2021; 29:5853-5864. [PMID: 33755805 PMCID: PMC8410699 DOI: 10.1007/s00520-021-06123-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/02/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE We investigated cancer survivors' health-related quality of life (HRQOL), specific deficiencies related to underlying disease or treatment, and benefits of rehabilitation in a large variety of cancer entities. PATIENTS AND METHODS Electronic patient-reported outcomes were performed as clinical routine procedures. Cancer survivors underwent a 3-week multidisciplinary inpatient rehabilitation. Twenty-one different cancer entities were analyzed separately before (T0) and by the end (T1) of rehabilitation. HRQOL, symptoms, and functions were assessed with EORTC-QLQ-C30 questionnaire, psychological distress with Hospital Anxiety and Depression Scale (HADS). RESULTS Four thousand four hundred one of 5912 rehabilitants were evaluable, having completed both questionnaires at T0 and T1. All function mean scores and HRQOL were lower than in Austrian normal population, while levels of anxiety, depression, and all symptom scores were higher. HRQOL was particularly low in lung, liver, and bladder cancer patients. Maximum anxiety levels were observed in patients with breast and thyroid cancer patients, the highest levels of depression in liver and brain cancer patients. Fatigue was severe in patients with lung, liver, esophageal, bladder cancer, and myeloma patients. Mean scores were also high for pain and insomnia. In the group of all rehabilitants, a highly significant improvement of global HRQOL, anxiety, depression, and all function and symptom scores was observed at T1 (p < 0.001). We noted significant improvement of HRQOL, anxiety, depression, fatigue, emotional, social, role, and physical functions in each cancer entity with medium to large effect sizes. Other recorded symptoms were reduced in the majority of cancers. CONCLUSION Rehabilitation effectively improves psychological distress and HRQOL as a part of treatment for various cancers.
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Affiliation(s)
- Thomas Licht
- Onkologisches Rehabilitationszentrum St. Veit im Pongau, St. Veiter St. 48, A-5621, St. Veit im Pongau, Austria. .,Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria.
| | - Alain Nickels
- Onkologisches Rehabilitationszentrum St. Veit im Pongau, St. Veiter St. 48, A-5621, St. Veit im Pongau, Austria
| | - Gerhard Rumpold
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - David Riedl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
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Lin J, Nakamura Y, Mikami H, Kusakabe M, Saruki N, Wakao F, Nagase H. Matters of data openness and KapWeb, a web tool of multi-cancer survival analysis for cancer survivors. Cancer Sci 2021; 112:2060-2062. [PMID: 33690908 PMCID: PMC8088959 DOI: 10.1111/cas.14788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/24/2020] [Accepted: 12/26/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jason Lin
- Laboratory of Cancer Genetics, Chiba Cancer Center Research Institute, Chiba, Japan
| | - Yohko Nakamura
- Cancer Prevention Center, Chiba Cancer Center Research Institute, Chiba, Japan
| | - Haruo Mikami
- Cancer Prevention Center, Chiba Cancer Center Research Institute, Chiba, Japan
| | - Miho Kusakabe
- Cancer Prevention Center, Chiba Cancer Center Research Institute, Chiba, Japan
| | - Nobuhiro Saruki
- Gunma Prefectural Institute of Public Health and Environmental Sciences, Maebashi, Japan
| | - Fumihiko Wakao
- Center for Cancer Control and Information Services, National Cancer Center Japan, Tokyo, Japan
| | - Hiroki Nagase
- Laboratory of Cancer Genetics, Chiba Cancer Center Research Institute, Chiba, Japan
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20
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Alelayan H, Liang L, Ye R, Meng J, Liao X. Assessing health-related quality of life in Chinese children and adolescents with cancer: validation of the DISABKIDS chronic generic module (DCGM-37). BMC Cancer 2021; 21:204. [PMID: 33639887 PMCID: PMC7913225 DOI: 10.1186/s12885-021-07910-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 02/12/2021] [Indexed: 11/25/2022] Open
Abstract
Background With increasing cancer incidence and decreasing cancer mortality, there is a growing need for a valid and culturally adapted tool to measure health-related quality of life in children with cancer. This study validated the DISABKIDS Chronic Generic Module (DCGM-37) in Chinese children and adolescents with cancer. Methods The DCGM-37 was translated and adapted for use in China following the guidelines from its copyright holders. In total, 140 children and adolescents with cancer and their guardians were included in this cross-sectional study. Internal consistency and test-retest reliability were evaluated. Convergent validity was examined using Pearson correlation between the DCGM-37 and the PedsQL 4.0 Generic Core Scale. Dimensionality was clarified using exploratory factor analysis. Discriminant validity was evaluated by comparing DCGM-37 scores by sex, age, family income, and clinical characteristics. Results Internal consistency (Cronbach’s alpha 0.91) and test–retest reliability were good (intraclass correlation coefficient 0.87, 95% confidence interval 0.73–0.94). Strong correlations between the DCGM-37 and the PedsQL 4.0 (r = 0.83) suggest good convergent validity. Six factors explained 51.94% of the total variance. Children with leukemia scored higher than those with sarcoma in all subscales (effect size ranged from 0.39 to 0.83), especially the “social exclusion” subscales (effect size 0.83). Small to moderate differences (effect size ranged from 0.38 to 0.58) were observed by sex, age, and family income. Neither floor nor ceiling effects were observed. Conclusion The DCGM-37 is reliable and valid for measuring health-related quality of life in Chinese children and adolescents with cancer. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-07910-9.
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Affiliation(s)
- Hasan Alelayan
- Nursing Department of Zengcheng Branch, Nanfang Hospital, Southern Medical University, No. 28 Innovation Avenue, Zengcheng, Guangzhou, 511300, China.,School of Nursing, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou , 510515, China
| | - Lizhu Liang
- Nursing Department of Zengcheng Branch, Nanfang Hospital, Southern Medical University, No. 28 Innovation Avenue, Zengcheng, Guangzhou, 511300, China.,School of Nursing, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou , 510515, China
| | - Rui Ye
- Nursing Department of Zengcheng Branch, Nanfang Hospital, Southern Medical University, No. 28 Innovation Avenue, Zengcheng, Guangzhou, 511300, China.,School of Nursing, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou , 510515, China
| | - Jiangnan Meng
- Pediatric Department, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, 510515, China
| | - Xiaoyan Liao
- Nursing Department of Zengcheng Branch, Nanfang Hospital, Southern Medical University, No. 28 Innovation Avenue, Zengcheng, Guangzhou, 511300, China.
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21
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Ooki A, Morita S, Tsuji A, Iwamoto S, Hara H, Tanioka H, Satake H, Kataoka M, Kotaka M, Kagawa Y, Nakamura M, Shingai T, Ishikawa M, Miyake Y, Suto T, Hashiguchi Y, Yabuno T, Ando M, Sakamoto J, Yamaguchi K. Disagreement between patient- and physician-reported outcomes on symptomatic adverse events as poor prognosis in patients treated with first-line cetuximab plus chemotherapy for unresectable metastatic colorectal cancer: Results of Phase II QUACK trial. Cancer Med 2020; 9:9419-9430. [PMID: 33222406 PMCID: PMC7774728 DOI: 10.1002/cam4.3564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 12/27/2022] Open
Abstract
The status and prognostic value of the disagreement between physician and patient assessments of symptomatic adverse events (AEs) remain unclear for patients with metastatic colorectal cancer treated with first-line cetuximab plus chemotherapy. Paired data on patient-reported outcomes using the EORTC QLQ-C30 and physician-reported outcomes using the NCI-CTCAE for eight symptomatic AEs (fatigue, pain, insomnia, dyspnea, constipation, appetite loss, nausea/vomiting, and diarrhea) were collected from a prospective trial assessing the relationships between treatment efficacy, AEs, and quality of life. The overall agreement rates between patient and physician reporting at 4 weeks ranged from 40.2% to 76.5% for 129 patients. The level of agreement based on Cohen's κ statistics was slight to poor for dyspnea, pain, fatigue, and insomnia, while it was moderate to fair for the remaining AEs. No clinicopathological characteristics of disagreement were found. The underreporting by physicians ranged from 12.5% (nausea/vomiting) to 56.7% (fatigue). The 2-year overall survival (OS) rate was more favorable for patients with high agreement than for those with low agreement (71.2% vs. 46.5%, p = .016), and the agreement status was an independent factor of OS (HR, 2.31; 95% CI, 1.13-4.71; p = .022). For patients who were reported as asymptomatic by the physician, the presence of patient-reported symptoms resulted in a trend toward poor prognostic outcomes for appetite loss, dyspnea, diarrhea, and constipation. These findings provide the clinical importance of the monitoring of patient-reported symptoms that can be complementary to physician-reported data to ensure more accurate clinical outcomes.
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Affiliation(s)
- Akira Ooki
- Department of Gastroenterological ChemotherapyCancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
| | - Satoshi Morita
- Department of Biomedical Statistics and BioinformaticsKyoto UniversityKyotoJapan
| | - Akihito Tsuji
- Department of Medical OncologyKagawa UniversityKitaJapan
| | - Shigeyoshi Iwamoto
- Department of SurgeryKansai Medical University Kouri HospitalNeyagawaJapan
| | - Hiroki Hara
- Department of GastroenterologySaitama Cancer CenterSaitamaJapan
| | - Hiroaki Tanioka
- Department of Clinical OncologyKawasaki Medical SchoolKurashikiJapan
| | - Hironaga Satake
- Cancer Treatment CenterKansai Medical University HospitalOsakaJapan
| | - Masato Kataoka
- Department of SurgeryNational Hospital Organization Nagoya Medical CenterNagoyaJapan
| | | | | | | | | | | | - Yasuhiro Miyake
- Department of SurgeryOsaka Minato Central HospitalOsakaJapan
| | - Takeshi Suto
- Department of SurgeryYamagata Prefectural Central HospitalYamagataJapan
| | | | - Taichi Yabuno
- Department of SurgeryYokohama Municipal Citizen’s HospitalYokohamaJapan
| | - Masahiko Ando
- Department of Advanced MedicineNagoya University HospitalNagoyaJapan
| | | | - Kensei Yamaguchi
- Department of Gastroenterological ChemotherapyCancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
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22
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Cusimano MC, Sajewycz K, Nelson M, Jivraj N, Lee YC, Bowering V, Oza A, Lheureux S, Ferguson SE. Supported self-management as a model for end-of-life care in the setting of malignant bowel obstruction: A qualitative study. Gynecol Oncol 2020; 157:745-753. [DOI: 10.1016/j.ygyno.2020.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/07/2020] [Indexed: 01/18/2023]
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23
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Shain LM, Pao M, Tipton MV, Bedoya SZ, Kang SJ, Horowitz LM, Wiener L. Comparing Parent and Child Self-report Measures of the State-Trait Anxiety Inventory in Children and Adolescents with a Chronic Health Condition. J Clin Psychol Med Settings 2020; 27:173-181. [PMID: 31127422 PMCID: PMC6874919 DOI: 10.1007/s10880-019-09631-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Anxiety symptoms in children and adolescents with a chronic health condition have been estimated as high as 40% lifetime prevalence. Clinicians often rely on parent/caregiver information to supplement or substitute child self-report related to pediatric physical and mental health. We developed a caregiver proxy version (STAI-P) for the State-Trait Anxiety Inventory (STAI) State Anxiety Scale that was compared with a child self-report version in 201 parent-child dyads to evaluate its utility in measuring state anxiety in chronically ill youth. For patients aged 7-12, self-reports of state anxiety were moderately associated with parent distress and health provider-reported functional status, but negatively associated with parent STAI-P scores. For patients aged 13-17, self-reports of state anxiety were significantly associated with STAI-P scores, parent distress, and health provider-reported functional status. The STAI-P parent version may be a useful tool in identifying and addressing anxiety symptoms in youth living with a chronic health condition.
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Affiliation(s)
- Lindsey M Shain
- College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Maryland Pao
- Office of the Clinical Director, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Mary V Tipton
- Office of the Clinical Director, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Sima Zadeh Bedoya
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Sun J Kang
- Genetic Epidemiology Branch, National Institute of Mental Health, NIH, Bethesda, MD, USA
| | - Lisa M Horowitz
- Office of the Clinical Director, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA.
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24
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Heiberg T, Baekelandt B, Kvien TK, Buanes T. Psychometric performance of the PAncreatic CAncer disease impact (PACADI) score. Pancreatology 2019; 19:971-978. [PMID: 31530448 DOI: 10.1016/j.pan.2019.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 08/30/2019] [Accepted: 09/01/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVE Pancreatic Cancer Disease Impact (PACADI) score measures the impact of pancreatic cancer (PC) on important health dimensions, selected by patients. The aim of this single center study was to test the psychometric performance of the Pancreatic Cancer Disease Impact (PACADI) score. METHODS Patients with suspected pancreatic cancer (PC) completed PACADI, the EuroQol-5D (EQ-5D index) and Edmonton Symptom Assessment System (ESAS) in this longitudinal observational study. Measures were compared across patients with PC (n = 210), other malignant lesions (OML) (n = 109) and non-malignant lesions (NML) (n = 41). Associations, test-retest and internal consistency reliability, longitudinal changes, sensitivity to change and prediction of mortality during the first year were examined in patients with PC. RESULTS The three measures discriminated between PC and OML. The PACADI score correlated strongly at baseline (n = 199)/after three months (n = 85) with the EQ-5D index and ESAS "sense of well-being" (0.64 and 0.66/0.73 and 0.69, p < 0.001, respectively), showed high test-retest reliability (ICC 0.84) and very good internal consistency reliability (Cronbach's alpha 0.81-0.85) across all visits. Scores improved over time at 3, 6, 9 and 12 months for survivors, and standardized response mean (SRM) for improvement between 2 and 3 months (n = 44) was 0.80 (PACADI), -0.59 (EQ-5D index) and 0.69 (ESAS "sense of well-being"). The PACADI score significantly predicted mortality within the first year (p = 0.02) in contrast to the EQ-5D index and ESAS "sense of well-being". CONCLUSION This study showed satisfactory psychometric performance of the PACADI score. The results support its use in clinical practice and intervention trials.
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Affiliation(s)
- Turid Heiberg
- Regional Research Support, Oslo University Hospital, Oslo, Norway; Østfold University College, Halden, Norway.
| | - Bart Baekelandt
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tore K Kvien
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Trond Buanes
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
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25
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Peach MS, Trifiletti DM, Vachani C, Arnold-Korzeniowski K, Bach C, Hampshire M, Metz JM, Hill-Kayser CE. Patient-reported outcomes in head and neck cancer: prospective multi-institutional patient-reported toxicity. PATIENT-RELATED OUTCOME MEASURES 2018; 9:245-252. [PMID: 30100773 PMCID: PMC6067627 DOI: 10.2147/prom.s153919] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose Head and neck cancer is occurring in an increasingly younger patient population, with treatment toxicity that can cause significant morbidity. Using a patient guided, Internet-based survivorship care plan program, we obtained and looked at patterns of patient-reported outcomes data from survivors seeking information after treatment for head and neck cancer. Methods The Internet-based OncoLife and LIVESTRONG Care Plan programs were employed, which design unique survivorship care plans based on patient-reported data. Care plans created for survivors of head and neck cancer were used in this evaluation. Demographics, treatment modality, and toxicity were included in this evaluation. Toxicity was further analyzed, grouped into system-based subsets. Results A total of 602 care plans were created from self-identified head and neck cancer survivors, from which patient-reported outcome data were attained. A majority of patients were Caucasian (96.2%) with median age at diagnosis of 55 years, living in suburban locations (39.9%), with ~50% receiving care within 20 miles of their residence. There was an equal distribution of education levels from high school only to graduate school. The majority of patients received care through cancer centers (96.7%), with a split between academic and non-academic centers. Ninety-three percent of patients had radiation therapy as part of their treatment modality, with 70.3% having chemotherapy and 60.1% having surgery. The most common system toxicities affected the oropharynx, followed by epithelium (skin/hair/nail), and then general global health. Specifically, the most common side effects were difficulty swallowing (61.5%) and changes in skin color/texture (49.7%). One third of patients experienced hearing/tinnitus/vertigo, xerostomia, loss of tissue flexibility, or fatigue. Conclusion The current work demonstrates the ability to obtain patient-reported outcomes of head and neck cancer survivors through an Internet-based survivorship care plan program. For this group dysphagia and dermatitis were the most commonly reported toxicities, as was expected; however, global effects of therapy, such as fatigue, were also significant and should be addressed in future survivorship planning.
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Affiliation(s)
- M Sean Peach
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA
| | | | - Carolyn Vachani
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA,
| | | | - Christina Bach
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA,
| | - Margaret Hampshire
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA,
| | - James M Metz
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA,
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Zhao F, Cella D, Manola J, DiPaola RS, Wagner LI, Haas NSB. Fatigue among patients with renal cell carcinoma receiving adjuvant sunitinib or sorafenib: patient-reported outcomes of ECOG-ACRIN E2805 trial. Support Care Cancer 2017; 26:1889-1895. [PMID: 29274030 DOI: 10.1007/s00520-017-4027-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 12/18/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND E2805 was a phase III trial to test whether adjuvant sunitinib or sorafenib could improve disease-free survival compared to placebo in patients with renal cell carcinoma. Patient-reported outcomes (PRO), focusing on fatigue, were evaluated as a secondary endpoint. PATIENTS AND METHODS A total of 463 patients participated in the PRO study. Fatigue was measured by the FACIT Fatigue scale and PROMIS Fatigue SF1 measure at baseline, week 10, and week 22. The primary endpoint was change in fatigue score from baseline to week 22, measured by the FACIT Fatigue scale. Secondarily, the psychometric properties of PROMIS Fatigue SF1 were assessed in relation to the FACIT Fatigue scale. RESULTS Fatigue got significantly worse on all arms after 2 cycles of treatment, and especially so in patients on sunitinib (- 9.6 vs. - 5.6 on sorafenib vs. - 4.7 on placebo). Fatigue remained stable during week 10 and week 22. Overall, the mean score change between baseline and week 22 was - 7.9 (p < 0.001) on sunitinib, - 6.4 (p < 0.001) on sorafenib and - 5.6 (p < 0.001) on placebo arm. The difference in score change was not statistically significant between the two experimental arms and the placebo arm (difference = - 2.34 [p = 0.110] and - 0.87 [p = 0.535] for sunitinib vs. placebo and sorafenib vs. placebo). PROMIS Fatigue SF1 had good internal consistency reliability and construct and criterion validity, and was highly correlated with the FACIT Fatigue scale score. CONCLUSIONS Fatigue got worse during study period, especially in patients on sunitinib. The PROMIS Fatigue SF1 was highly correlated with FACIT Fatigue and produced similar results.
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Affiliation(s)
- Fengmin Zhao
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA.
| | - David Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Judith Manola
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | | | - Lynne I Wagner
- Social Sciences & Health Policy Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Naomi S B Haas
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
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