1
|
Zhang J, Duan H, Zhang J, Qiao H, Jiang J. Symptom clusters and nutritional status in primary liver cancer patients receiving transcatheter arterial chemoembolization. NUTR HOSP 2024; 41:815-823. [PMID: 38501819 DOI: 10.20960/nh.04936] [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] [Indexed: 03/20/2024] Open
Abstract
Introduction Introduction: symptom clusters (SCs) are highly prevalent among patients diagnosed with primary liver cancer. Malnutrition poses a heightened risk for a more pronounced total symptom cluster score. Objective: this study aimed to identify SCs and assess the nutritional status of patients undergoing transcatheter arterial chemoembolization (TACE). Furthermore, it aimed to investigate the association between nutritional status and symptom clusters. Methods: primary liver cancer patients who were scheduled to receive TACE were recruited. Symptoms data were collected using the MD Anderson Symptom Inventory (MDASI-C) and the Symptom Module specific to Primary Cancer (TSM-PLC). Nutritional assessment relied on the Nutritional Risk Screening-2002 (NRS-2002) and blood biochemistry. The SCs were extracted using exploratory factor analysis, while the relationship between SCs and nutritional status was evaluated using Spearman correlation analysis. Results: the study included 226 patients, four distinct symptom clusters emerged: emotional-psychological symptom cluster, upper gastrointestinal symptom cluster, post-embolization-related symptom cluster, and liver function impairment symptom cluster. 68.14 % of patients were found to be at high risk of malnutrition. Our study revealed significant differences in Scs scores between patients at risk of malnutrition and those without such risk (p < 0.050). Notably, we observed a positive correlation between NRS-2002 scores and the scores of all symptom clusters (r = 0.205 to 0.419, p < 0.001), while a negative correlation was observed between prealbumin levels and the scores of all symptom clusters (r = -0.183 to -0.454, p < 0.001). Conclusion: the study highlights the high risk of malnutrition among liver cancer patients receiving TACE and the positive correlation between high malnutrition risk and Scs scores.
Collapse
Affiliation(s)
| | - Hongyan Duan
- Third Hospital of Shanxi Medical University. Shanxi Bethune Hospital. Shanxi Academy of Medical Sciences. Tongji Shanxi Hospital
| | - Jie Zhang
- Department of Medical Imaging. The Affiliated Hospital of Jiangnan University
| | - Hongyan Qiao
- Department of Medical Imaging. The Affiliated Hospital of Jiangnan University
| | - Jianwei Jiang
- Department of Medical Imaging. The Affiliated Hospital of Jiangnan University
| |
Collapse
|
2
|
Sebri V, Marzorati C, Dorangricchia P, Monzani D, Grasso R, Prelaj A, Provenzano L, Mazzeo L, Dumitrascu AD, Sonnek J, Szewczyk M, Watermann I, Trovò F, Dollis N, Sarris E, Garassino MC, Bestvina CM, Pedrocchi A, Ambrosini E, Kosta S, Felip E, Soleda M, Roca AA, Rodríguez‐Morató J, Nuara A, Lourie Y, Fernandez‐Pinto M, Aguaron A, Pravettoni G. The impact of decision tools during oncological consultation with lung cancer patients: A systematic review within the I3LUNG project. Cancer Med 2024; 13:e7159. [PMID: 38741546 PMCID: PMC11091486 DOI: 10.1002/cam4.7159] [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: 11/10/2023] [Revised: 03/17/2024] [Accepted: 03/22/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION To date, lung cancer is one of the most lethal diagnoses worldwide. A variety of lung cancer treatments and modalities are available, which are generally presented during the patient and doctor consultation. The implementation of decision tools to facilitate patient's decision-making and the management of their healthcare process during medical consultation is fundamental. Studies have demonstrated that decision tools are helpful to promote health management and decision-making of lung cancer patients during consultations. The main aim of the present work within the I3LUNG project is to systematically review the implementation of decision tools to facilitate medical consultation about oncological treatments for lung cancer patients. METHODS In the present study, we conducted a systematic review following the PRISMA guidelines. We used an electronic computer-based search involving three databases, as follows: Embase, PubMed, and Scopus. 10 articles met the inclusion criteria and were included. They explicitly refer to decision tools in the oncological context, with lung cancer patients. RESULTS The discussion highlights the most encouraging results about the positive role of decision aids during medical consultations about oncological treatments, especially regarding anxiety, decision-making, and patient knowledge. However, no one main decision aid tool emerged as essential. Opting for a more recent timeframe to select eligible articles might shed light on the current array of decision aid tools available. CONCLUSION Future review efforts could utilize alternative search strategies to explore other lung cancer-specific outcomes during medical consultations for treatment decisions and the implementation of decision aid tools. Engaging with experts in the fields of oncology, patient decision-making, or health communication could provide valuable insights and recommendations for relevant literature or research directions that may not be readily accessible through traditional search methods. The development of guidelines for future research were provided with the aim to promote decision aids focused on patients' needs.
Collapse
Affiliation(s)
- Valeria Sebri
- Applied Research Division for Cognitive and Psychological ScienceIEO, European Institute of Oncology IRCCSMilanItaly
| | - Chiara Marzorati
- Applied Research Division for Cognitive and Psychological ScienceIEO, European Institute of Oncology IRCCSMilanItaly
| | - Patrizia Dorangricchia
- Applied Research Division for Cognitive and Psychological ScienceIEO, European Institute of Oncology IRCCSMilanItaly
| | - Dario Monzani
- Laboratory of Behavioral Observation and Research on Human Development, Department of Psychology, Educational Science and Human MovementUniversity of PalermoPalermoItaly
| | - Roberto Grasso
- Applied Research Division for Cognitive and Psychological ScienceIEO, European Institute of Oncology IRCCSMilanItaly
- Department of Oncology and Hemato‐OncologyUniversity of MilanMilanItaly
| | - Arsela Prelaj
- Thoracic Oncology Unit, Medical Oncology Department 1Fondazione IRCCS Istituto Nazionale TumoriMilanItaly
- Department of Electronics, Information, and BioengineeringPolitecnico di MilanoMilanItaly
| | - Leonardo Provenzano
- Medical Oncology DepartmentFondazione IRCCS Istituto Nazionale dei Tumori di MilanoMilanItaly
| | - Laura Mazzeo
- Thoracic Oncology Unit, Medical Oncology Department 1Fondazione IRCCS Istituto Nazionale TumoriMilanItaly
- Department of Electronics, Information, and BioengineeringPolitecnico di MilanoMilanItaly
| | - Andra Diana Dumitrascu
- Thoracic Oncology Unit, Medical Oncology Department 1Fondazione IRCCS Istituto Nazionale TumoriMilanItaly
| | - Jana Sonnek
- Lungen Clinic Grosshansdorf, Airway Research Center NorthGerman Center for Lung ResearchGrosshansdorfGermany
| | - Marlen Szewczyk
- Lungen Clinic Grosshansdorf, Airway Research Center NorthGerman Center for Lung ResearchGrosshansdorfGermany
| | - Iris Watermann
- Lungen Clinic Grosshansdorf, Airway Research Center NorthGerman Center for Lung ResearchGrosshansdorfGermany
| | | | | | | | - Marina Chiara Garassino
- Knapp Center for Biomedical DiscoveryUniversity of Chicago Medicine & Biological SciencesChicagoIllinoisUSA
| | - Christine M. Bestvina
- Knapp Center for Biomedical DiscoveryUniversity of Chicago Medicine & Biological SciencesChicagoIllinoisUSA
| | - Alessandra Pedrocchi
- Department of Electronics, Information and BioengineeringNeuroengineering and Medical Robotics Laboratory NearLabMilanItaly
| | - Emilia Ambrosini
- Department of Electronics, Information and BioengineeringNeuroengineering and Medical Robotics Laboratory NearLabMilanItaly
| | - Sokol Kosta
- Department of Electronic SystemsAalborg UniversityCopenhagenDenmark
| | - Enriqueta Felip
- Vall d'Hebron University HospitalBarcelonaSpain
- Vall d'Hebron Institute of OncologyBarcelonaSpain
| | | | | | | | | | | | | | | | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological ScienceIEO, European Institute of Oncology IRCCSMilanItaly
- Department of Oncology and Hemato‐OncologyUniversity of MilanMilanItaly
| |
Collapse
|
3
|
Yackel HD, Halpenny B, Abrahm JL, Ligibel J, Enzinger A, Lobach DF, Cooley ME. A qualitative analysis of algorithm-based decision support usability testing for symptom management across the trajectory of cancer care: one size does not fit all. BMC Med Inform Decis Mak 2024; 24:63. [PMID: 38443870 PMCID: PMC10913367 DOI: 10.1186/s12911-024-02466-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Adults with cancer experience symptoms that change across the disease trajectory. Due to the distress and cost associated with uncontrolled symptoms, improving symptom management is an important component of quality cancer care. Clinical decision support (CDS) is a promising strategy to integrate clinical practice guideline (CPG)-based symptom management recommendations at the point of care. METHODS The objectives of this project were to develop and evaluate the usability of two symptom management algorithms (constipation and fatigue) across the trajectory of cancer care in patients with active disease treated in comprehensive or community cancer care settings to surveillance of cancer survivors in primary care practices. A modified ADAPTE process was used to develop algorithms based on national CPGs. Usability testing involved semi-structured interviews with clinicians from varied care settings, including comprehensive and community cancer centers, and primary care. The transcripts were analyzed with MAXQDA using Braun and Clarke's thematic analysis method. A cross tabs analysis was also performed to assess the prevalence of themes and subthemes by cancer care setting. RESULTS A total of 17 clinicians (physicians, nurse practitioners, and physician assistants) were interviewed for usability testing. Three main themes emerged: (1) Algorithms as useful, (2) Symptom management differences, and (3) Different target end-users. The cross-tabs analysis demonstrated differences among care trajectories and settings that originated in the Symptom management differences theme. The sub-themes of "Differences between diseases" and "Differences between care trajectories" originated from participants working in a comprehensive cancer center, which tends to be disease-specific locations for patients on active treatment. Meanwhile, participants from primary care identified the sub-theme of "Differences in settings," indicating that symptom management strategies are care setting specific. CONCLUSIONS While CDS can help promote evidence-based symptom management, systems providing care recommendations need to be specifically developed to fit patient characteristics and clinical context. Findings suggest that one set of algorithms will not be applicable throughout the entire cancer trajectory. Unique CDS for symptom management will be needed for patients who are cancer survivors being followed in primary care settings.
Collapse
Affiliation(s)
| | - Barbara Halpenny
- Dana-Farber Cancer Institute, 450 Brookline Ave, LW-508, 02215, Boston, MA, USA
| | - Janet L Abrahm
- Dana-Farber Cancer Institute, 450 Brookline Ave, LW-508, 02215, Boston, MA, USA
| | - Jennifer Ligibel
- Dana-Farber Cancer Institute, 450 Brookline Ave, LW-508, 02215, Boston, MA, USA
| | - Andrea Enzinger
- Dana-Farber Cancer Institute, 450 Brookline Ave, LW-508, 02215, Boston, MA, USA
| | - David F Lobach
- Elimu Informatics, 1709 Julian Court, 94530, El Cerrito, CA, USA
| | - Mary E Cooley
- Dana-Farber Cancer Institute, 450 Brookline Ave, LW-508, 02215, Boston, MA, USA.
| |
Collapse
|
4
|
Liu M, Chen X, Ma P, Yang Z, Jiang M, Deng M. Application of IMB model in preventing venous thromboembolism in elderly lung cancer patients. Front Cardiovasc Med 2024; 11:1352515. [PMID: 38433756 PMCID: PMC10904599 DOI: 10.3389/fcvm.2024.1352515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
Objective This study aims to explore the effects of the Information-Motivation-Behavioral (IMB) Skills Model on the prevention of Venous Thromboembolism (VTE) in elderly lung cancer patients. Methods A convenience sampling method was used to select study participants who were hospitalized for treatment between November 2022 and August 2023 at a tertiary hospital in Neijiang and met the inclusion and exclusion criteria. The control group (n = 41) received conventional health education, while the intervention group (n = 40) received health education based on the IMB Skills Model over three months. The scores of the Venous Thrombosis Knowledge, Participation in Thrombosis Prevention Willingness and Behavior Questionnaire, and Quality of Life Measurement Scale (QLQ-C30) were compared before the intervention and after three months. After three months of intervention, the hospital satisfaction and VTE incidence rates in both groups were investigated and compared. Results After three months of intervention, the scores for the Venous Thrombosis Knowledge, (Participation in Thrombosis Prevention Willingness and Behavior Questionnaire in the intervention group were higher than those in the control group (P < 0.05). The QLQ-C30 scores in the intervention group for physical function, role function, emotional function, insomnia, appetite loss, and overall health status were higher than those in the control group (P < 0.05). The intervention group rated higher in doctor's professional skills, information provision, accessibility; nurse's professional skills, humanistic care, information provision, accessibility; team communication, services of other personnel, overall satisfaction compared to the control group (P < 0.05). The rate of VTE in the intervention group was 2.5%(1/40), and that in the control group was 19.5%(8/41). There was a significant difference (χ2 = 4.336, P = 0.037). Conclusion Nursing interventions based on the IMB Skills Model for elderly lung cancer patients can enhance patients' understanding of venous thrombosis, increase willingness and active participation in thrombosis prevention, improve quality of life, increase hospital satisfaction, and reduce the incidence of VTE.
Collapse
Affiliation(s)
- Mengdan Liu
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
| | - Xushu Chen
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
| | - Peng Ma
- Intensive Care Unit, Longquanyi District Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Zhuoxin Yang
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
| | - Min Jiang
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
| | - Min Deng
- The Publicity Division, Neijiang First People’s Hospital, Neijiang, Sichuan, China
| |
Collapse
|
5
|
Sampieri G, Li H, Ataalla P, Merriman K, Noel CW, Hallet J, Coburn N, Karam I, Smoragiewicz M, Wong B, Fu R, Eskander A. Interventions for Concerning Patient-Reported Outcomes in Routine Cancer Care: A Systematic Review. Ann Surg Oncol 2024; 31:1148-1170. [PMID: 37996640 DOI: 10.1245/s10434-023-14576-z] [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: 08/24/2023] [Accepted: 10/25/2023] [Indexed: 11/25/2023]
Abstract
IMPORTANCE Collecting patient-reported outcomes (PROs) in routine cancer care improves patient-clinician communication, decision making, and overall patient satisfaction. Recommendations exist regarding standardized ways to collect, store, and interpret PRO data. However, evidence on incorporating PROs into cancer process of care, especially the type of HIs that are warranted after observing a concerning PRO and the effectiveness of these HIs are lacking. OBJECTIVE This study summarizes HIs triggered after PRO completion and their effectiveness in improving patient outcomes for adults being treated for cancer types that are resource intensive and associated with high symptom burden [i.e., gastrointestinal (GI), lung, and head and neck cancer (HNC)]. Secondary outcomes included factors associated with poor implementation of PROs. EVIDENCE REVIEW A literature search of peer-reviewed publications on MEDLINE, CINAHL Plus, APA PsycInfo, Scopus, and Cochrane was conducted following PRISMA guidelines from 1 January 2012, to 31 July 2022. Trial and real-world studies describing HIs after PRO completion for adult patients being treated for GI, lung, and HNC were included. Sixteen studies involving 144,496 patients were included. The Joanna Briggs Institute critical appraisal checklist was used to assess risk of bias. FINDINGS Of the 16 included studies, 5 included patients with HNC. Commonly used PRO measurement tools were the PRO-CTCAE and ESAS. Only three studies reported specific HIs delivered in response to concerning PROs and measured their effectiveness on patient outcomes. In all three studies, these HIs significantly improved cancer-related care. The most common HIs undertaken in response to concerning PROs were referrals to other specialists/allied healthcare professionals, medication changes, or self-management advice. Provider-related barriers to PRO measurement and delivery included the overwhelming number of alerts, the time required to address each PRO and the unclear role of healthcare providers in response to these alerts. Patient-related barriers included lower digital literacy and socioeconomic status, older age, rural living, and patients suffering from GI and HNC. CONCLUSIONS AND RELEVANCE This review highlights that PRO-triggered HIs are heterogenous and can improve patient quality of life. Further studies are necessary to determine the types of interventions with the greatest impact on patient care and outcomes.
Collapse
Affiliation(s)
- Gianluca Sampieri
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Huaqi Li
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Philopateer Ataalla
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Kaitlyn Merriman
- Insitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
- Insitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Julie Hallet
- Insitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Natalie Coburn
- Insitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Irene Karam
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Martin Smoragiewicz
- Department of Medical Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Brian Wong
- Insitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Rui Fu
- Insitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Antoine Eskander
- Insitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- ICES, Toronto, Canada.
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.
- Department of Otolaryngology-Head and Neck Surgery, Michael Garron Hospital, University of Toronto, Toronto, Canada.
| |
Collapse
|
6
|
O'Regan A, Fish LJ, Makarushka C, Somers T, Fitzgerald Jones K, Merlin JS, Dinan M, Oeffinger K, Check D. Managing Chronic Pain in Cancer Survivorship: Communication Challenges and Opportunities as Described by Cancer Survivors. Am J Hosp Palliat Care 2024; 41:78-86. [PMID: 36927121 DOI: 10.1177/10499091231164634] [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] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES Many cancer survivors experience chronic pain after completing curative-intent treatment. Based on available data, chronic pain may be undertreated in this context; however, little is known about cancer survivors' experiences with clinical management of chronic pain. The purpose of this study was to better understand cancer survivors' pain management experiences after curative-intent treatment. METHODS We conducted 13 semi-structured interviews with a convenience sample of cancer survivors who had completed treatment for stage I-III breast, head/neck, lung or colorectal cancer. We used a thematic approach to qualitative data analysis. RESULTS Participants described that chronic pain often goes unrecognized by their providers, potentially due to limitations in how pain is assessed clinically and the tendency of both cancer survivors and providers to minimize or invalidate the pain experience. To improve communication, participants suggested that providers ask more open-ended questions about their pain, help them to establish functional goals, and provide patients with options for pain management. SIGNIFICANCE OF RESULTS This study demonstrates the importance of provider-initiated communication around pain management for cancer survivors to make them feel more supported in their care. Communication and shared decision-making interventions may improve cancer survivor-provider communication around chronic pain management, addressing an important gap in survivorship care.
Collapse
Affiliation(s)
- Amy O'Regan
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Laura J Fish
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
- Department of Family Medicine and Community Health, Duke School of Medicine Durham, NC, USA
| | - Christina Makarushka
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Tamara Somers
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Katie Fitzgerald Jones
- Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Harvard Medical School, Harvard University, Cambridge, MA, USA
| | - Jessica S Merlin
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michaela Dinan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT, USA
| | - Kevin Oeffinger
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Devon Check
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
| |
Collapse
|
7
|
Nafees A, Khan M, Chow R, Fazelzad R, Hope A, Liu G, Letourneau D, Raman S. Evaluation of clinical decision support systems in oncology: An updated systematic review. Crit Rev Oncol Hematol 2023; 192:104143. [PMID: 37742884 DOI: 10.1016/j.critrevonc.2023.104143] [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: 05/03/2023] [Revised: 09/17/2023] [Accepted: 09/21/2023] [Indexed: 09/26/2023] Open
Abstract
With increasing reliance on technology in oncology, the impact of digital clinical decision support (CDS) tools needs to be examined. A systematic review update was conducted and peer-reviewed literature from 2016 to 2022 were included if CDS tools were used for live decision making and comparatively assessed quantitative outcomes. 3369 studies were screened and 19 were included in this updated review. Combined with a previous review of 24 studies, a total of 43 studies were analyzed. Improvements in outcomes were observed in 42 studies, and 34 of these were of statistical significance. Computerized physician order entry and clinical practice guideline systems comprise the greatest number of evaluated CDS tools (13 and 10 respectively), followed by those that utilize patient-reported outcomes (8), clinical pathway systems (8) and prescriber alerts for best-practice advisories (4). Our review indicates that CDS can improve guideline adherence, patient-centered care, and care delivery processes in oncology.
Collapse
Affiliation(s)
- Abdulwadud Nafees
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada
| | - Maha Khan
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada
| | - Ronald Chow
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada; Institute of Biomedical Engineering, Faculty of Applied Sciences & Engineering, University of Toronto, Toronto, Canada; Library and Information Services, Princess Margaret Cancer Centre, Toronto, Canada
| | - Rouhi Fazelzad
- Institute of Biomedical Engineering, Faculty of Applied Sciences & Engineering, University of Toronto, Toronto, Canada; Library and Information Services, Princess Margaret Cancer Centre, Toronto, Canada
| | - Andrew Hope
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Geoffrey Liu
- Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Daniel Letourneau
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Srinivas Raman
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada.
| |
Collapse
|
8
|
Sripetthong S, Nalinbenjapun S, Basit A, Surassmo S, Sajomsang W, Ovatlarnporn C. Preparation of Self-Assembled, Curcumin-Loaded Nano-Micelles Using Quarternized Chitosan-Vanillin Imine (QCS-Vani Imine) Conjugate and Evaluation of Synergistic Anticancer Effect with Cisplatin. J Funct Biomater 2023; 14:525. [PMID: 37888190 PMCID: PMC10607333 DOI: 10.3390/jfb14100525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/08/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
Nano-micelles are self-assembling colloidal dispersions applied to enhance the anticancer efficacy of chemotherapeutic agents. In this study, the conjugate of quarternized chitosan and vanillin imine (QCS-Vani imine) was synthesized using the reaction of a Schiff base characterized by proton-NMR (1HNMR), UV-Vis spectroscopy, and FT-IR. The critical micelle concentration (CMC), particle size, and zeta potential of the resulting product were determined. The QCS-Vani imine conjugate was used as a carrier for the development of curcumin-loaded nano-micelles, and their entrapment efficiency (%EE), drug-loading capacity (%LC) and in vitro release were investigated using HPLC analysis. Moreover, the nano-micelles containing curcumin were combined with various concentrations of cisplatin and evaluated for a possible anticancer synergistic effect. The anticancer activity was evaluated against lung cancer A549 and mouse fibroblast L929 cell lines. The percent yield (%) of the QCS-Vani imine conjugate was 93.18%. The curcumin-loaded QCS-Vani imine nano-micelles were characterized and found to have a spherical shape (by TEM) with size < 200 nm (by DLS) with high %EE up to 67.61% and %LC up to 6.15 ± 0.41%. The loaded lyophilized powder of the nano-micelles was more stable at 4 °C than at room temperature during 120 days of storage. pH-sensitive release properties were observed to have a higher curcumin release at pH 5.5 (cancer environment) than at pH 7.4 (systemic environment). Curcumin-loaded QCS-Vani imine nano-micelles showed higher cytotoxicity and selectivity toward lung cancer A549 cell lines and exhibited lower toxicity toward the normal cell (H9C2) than pure curcumin. Moreover, the curcumin-loaded QCS-Vani imine nano-micelles exhibited an enhanced property of inducing cell cycle arrest during the S-phase against A549 cells and showed prominently induced apoptosis in lung cancer cells compared to that with curcumin. The co-treatment of cisplatin with curcumin-loaded QCS-Vani imine nano-micelles presented an enhanced anticancer effect, showing 8.66 ± 0.88 μM as the IC50 value, in comparison to the treatment with cisplatin alone (14.22 ± 1.01 μM). These findings suggest that the developed QCS-Vani imine nano-micelle is a potential drug delivery system and could be a promising approach for treating lung cancer in combination with cisplatin.
Collapse
Affiliation(s)
- Sasikarn Sripetthong
- Department of Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai 90112, Thailand; (S.S.); (S.N.); (A.B.)
- Drug Delivery System Excellent Center, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai 90112, Thailand
| | - Sirinporn Nalinbenjapun
- Department of Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai 90112, Thailand; (S.S.); (S.N.); (A.B.)
- Drug Delivery System Excellent Center, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai 90112, Thailand
| | - Abdul Basit
- Department of Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai 90112, Thailand; (S.S.); (S.N.); (A.B.)
- Drug Delivery System Excellent Center, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai 90112, Thailand
| | - Suvimol Surassmo
- Nano-Delivery System Laboratory, National Nanotechnology Center, National Science and Technology Development Agency, Thailand Science Park, Pathum Thani 12120, Thailand; (S.S.); (W.S.)
| | - Warayuth Sajomsang
- Nano-Delivery System Laboratory, National Nanotechnology Center, National Science and Technology Development Agency, Thailand Science Park, Pathum Thani 12120, Thailand; (S.S.); (W.S.)
| | - Chitchamai Ovatlarnporn
- Department of Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai 90112, Thailand; (S.S.); (S.N.); (A.B.)
- Drug Delivery System Excellent Center, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai 90112, Thailand
| |
Collapse
|
9
|
Pitt E, Bradford N, Robertson E, Sansom-Daly UM, Alexander K. The effects of cancer clinical decision support systems on patient-reported outcomes: A systematic review. Eur J Oncol Nurs 2023; 66:102398. [PMID: 37633024 DOI: 10.1016/j.ejon.2023.102398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/09/2023] [Accepted: 07/15/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE The implementation of high-quality decision-making support are integral to ensuring the delivery of quality cancer care and subsequently achieving positive patient outcomes. Decision Support Systems (DSS) are increasingly used, however it is not known what the effects are beyond supporting the decision-making process. We aimed to identify and synthesize the available literature regarding the effects of DSS on patient-reported outcomes both during and after cancer treatment. METHODS A systematic review was conducted using dual processes to identify empirical literature that reported an evaluation of DSS interventions and patient-reported outcomes. We appraised study quality using the Mixed Methods Appraisal Tool (MMAT). Data were narratively synthesized. RESULTS We included 15 studies, categorized as symptom assessment interventions or interactive educational interventions. Findings were mixed regarding the effectiveness of DSS interventions in improving total symptom distress and severity, whereas the majority were effective in reducing mean scores for worst and usual pain. Interventions were not effective in improving other health-related patient-reported outcomes including quality of life, global distress, depression, or self-efficacy and there were mixed effects for reducing decisional conflict. There was moderate to high patient adherence to the interventions and generally high satisfaction and acceptability, yet minimal evidence for the effect of DSS interventions in clinician adherence to intervention recommendations. CONCLUSIONS Including patient-reported outcomes in the evaluation of DSS is critical to understand their impact. Inconsistencies in reporting of interventions may, however, be a contributing factor to heterogeneous effects of clinical DSS regarding a broad range of patient-reported outcomes.
Collapse
Affiliation(s)
- Erin Pitt
- Cancer and Palliative Care Outcomes Centre and Centre for Healthcare Transformation, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia; Faculty of Health, Queensland University of Technology (QUT), Victoria Park Rd, Kelvin Grove, QLD, 4059, Australia; Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, 62 Graham St, South Brisbane, QLD, 4101, Australia.
| | - Natalie Bradford
- Cancer and Palliative Care Outcomes Centre and Centre for Healthcare Transformation, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia; Faculty of Health, Queensland University of Technology (QUT), Victoria Park Rd, Kelvin Grove, QLD, 4059, Australia; Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, 62 Graham St, South Brisbane, QLD, 4101, Australia.
| | - Eden Robertson
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, High St, Kensington, NSW, 2052, Australia.
| | - Ursula M Sansom-Daly
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, High St, Kensington, NSW, 2052, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, High St, Randwick, NSW, 2031, Australia; Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, High Street, Randwick, NSW, Australia.
| | - Kimberly Alexander
- Cancer and Palliative Care Outcomes Centre and Centre for Healthcare Transformation, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia; Faculty of Health, Queensland University of Technology (QUT), Victoria Park Rd, Kelvin Grove, QLD, 4059, Australia.
| |
Collapse
|
10
|
Application Value of Evidence-Based Care in Patients with Lung Cancer Chemotherapy. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5747712. [PMID: 35941897 PMCID: PMC9356818 DOI: 10.1155/2022/5747712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022]
Abstract
Objective The present research project is aimed at elucidating the application value of evidence-based care (EBC) in patients with lung cancer (LC) chemotherapy. Methods Ninety-four advanced LC patients visited between March 2019 and February 2021 were retrospectively selected. Based on the type of care, 44 cases who used routine nursing were set as the control group (CG), and 50 patients who received EBC were included in the research group (RG). The pain degree, adverse mood, and individual fatigue of patients were assessed, using the Visual Analogue Scale (VAS), Self-Rating Anxiety/Depression Scale (SAS/SDS), and Cancer Fatigue Scale (CFS), respectively. Besides, patients were assessed for treatment compliance, self-efficacy, and life quality using the treatment compliance questionnaire, General Self-Efficacy Scale (GSES), and Quality of Life Questionnaire Core 30 (QLQ-C30), respectively. Results The VAS, SAS, and SDS scores were lower in RG versus CG after nursing intervention. RG scored lower in the dimensions of physical, affective, and cognitive fatigue in terms of individual fatigue assessed by the CFS and higher in various domains of the QLQ-C30 score after nursing intervention. Besides, higher treatment compliance and self-efficacy were determined in RG as compared to CG. Conclusions In addition to improving the treatment compliance, self-efficacy, and life quality of patients with LC chemotherapy, EBC can effectively alleviate their pain, adverse psychological mood, and individual fatigue, which deserves to be promoted in clinical application.
Collapse
|