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Hill-Kayser C, Yorke E, Jackson A, Gracia C, Ginsberg J, Keene K, Ronckers C, Metzger ML, Li Z, Constine LS, Hua CH. Effects of Radiation Therapy on the Female Reproductive Tract in Childhood Cancer Survivors: A PENTEC Comprehensive Review. Int J Radiat Oncol Biol Phys 2024; 119:588-609. [PMID: 37804257 DOI: 10.1016/j.ijrobp.2023.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/27/2023] [Accepted: 08/06/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE The PENTEC (Pediatric Normal Tissue Effects in the Clinic) task force aimed to quantify effects of radiation therapy (RT) dose to the female reproductive organs after treatment for childhood cancer. METHODS AND MATERIALS Relevant studies published 1970 to 2017 were identified systematically through PubMed, Medline, and Cochrane databases with additional articles before 2021 identified by the group. Two large studies reported sufficient data to allow modeling of acute ovarian failure (AOF; loss of function ≤5 year from diagnosis) and premature ovarian insufficiency (POI; loss of function at attained age <40 years) based on maximum dose to least affected ovary. Although normal tissue complication probability modeling was not feasible for the uterus due to limited data, the relationship between ultrasound-measured uterine volume and estimated amount of RT was plotted. Limited data regarding vaginal toxicity were available. RESULTS The risk of AOF increases with RT dose to least affected ovary, alkylating agent cumulative dose (cyclophosphamide equivalent dose [CED] in g/m2), age at RT, and stem cell transplantation: Two Gy to the least affected ovary resulted in AOF risk of 1% to 5% (CED = 0, risk increasing with age), 4% to 7% (CED = 10 g/m2, risk increasing with age), and 6% to 13% (CED = 30 g/m2, risk increasing with age). For patients aged 1 and 20 years at time of RT, AOF risk was ≥50% at doses of 24 Gy and 20 Gy with no alkylating chemotherapy, 22.5 Gy and 17 Gy with intermediate alkylator dose (10 g/m2), and 17 Gy and 13 Gy with high alkylator dose (30 g/m2). Risk of POI increases with survivor (attained) age (rather than age at time of RT), radiation dose to least affected ovary, and alkylator dose. Data review suggested that higher radiation doses to the uterus are associated with uterine toxicity, with uterine size considerably restricted after 12 Gy. Vaginal radiation in children is associated with high toxicity risk, although dose-volume data are not available for quantification. CONCLUSIONS Risk of AOF increases with age at RT, CED exposure, and RT dose; risk of POI likewise increases with RT dose, CED exposure, and survivor age. Both AOF and POI are expected to affect fertility and estrogen production. Data suggest that RT uterine dose >12 Gy may be associated with uterine size restriction. Adult literature suggests that maintaining vaginal dose <5 Gy may limit toxicity. Treatment of life-threatening malignancy remains a priority over reproductive preservation; however, when possible, radiation and surgical techniques should be considered to minimize dose to least affected ovary, uterus, and vagina. Survivors should receive endocrine and gynecologic support; those desiring pregnancy should be counseled early to maximize reproductive options.
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Affiliation(s)
- Christine Hill-Kayser
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew Jackson
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Clarisa Gracia
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jill Ginsberg
- Department of Pediatrics, Division of Oncology, Perelman School of Medicine, University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kimberly Keene
- Department of Radiation Oncology, University of Alabama, Birmingham, Alabama
| | - Cecile Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany
| | - Monika L Metzger
- Department of Pediatric Hematology & Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Zhenghong Li
- Department of Epidemiology & Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Louis S Constine
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Chia-Ho Hua
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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Wu D, He J, Shi P, Wang Z, Liu M, Liu A. Quality of life in ovarian cancer patients treated with bevacizumab: a meta-analysis. Expert Opin Drug Saf 2024; 23:269-276. [PMID: 37842980 DOI: 10.1080/14740338.2023.2271830] [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: 08/22/2023] [Accepted: 10/13/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Bevacizumab is widely used in ovarian cancer due to its ability to extend survival. The addition of bevacizumab to chemotherapy may increase the toxicities that affect quality of life (QOL). To investigate the impact of bevacizumab on QOL during the increased survival, we conducted a meta-analysis of randomized controlled trial (RCT). METHODS We systematically searched PubMed, Embase, Cochrane Library, Web of Science and ClinicalTrials.gov. for RCTs comparing the QOL of bevacizumab plus chemotherapy (BEV-CT) versus chemotherapy (CT) in ovarian cancer. The primary outcome was the difference in change in QOL from baseline to follow-up between groups. RESULTS Four RCTs involving 3454 patients were included in this meta-analysis. There was no difference in change in QOL between patients treated with BEV-CT and CT at the end of follow-up (pooled SMD= -00.05; 95%CI = -00.34 to 0.23; P = 0.71). Subgroup analyses showed similar results in the frontline and recurrent setting of ovarian cancer. CONCLUSIONS This is the first meta-analysis investigating QOL in ovarian cancer patients treated with bevacizumab. The extended survival associated with bevacizumab is not accompanied by a significant deterioration in QOL. Combined with the efficacy and safety outcomes, these results further support the clinical benefit of bevacizumab for ovarian cancer.
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Affiliation(s)
- Di Wu
- Department of Pharmacy, Qilu Hospital of Shandong University, Jinan, China
- Department of Pharmacy, Shanxi Yuncheng Central Hospital, Eighth Clinical Medical College of Shanxi Medical University, Yuncheng, China
| | - Jianrong He
- Department of Pharmacy, Shanxi Yuncheng Central Hospital, Eighth Clinical Medical College of Shanxi Medical University, Yuncheng, China
| | - Ping Shi
- Department of Pharmacy, Shanxi Yuncheng Central Hospital, Eighth Clinical Medical College of Shanxi Medical University, Yuncheng, China
| | - Zirong Wang
- Department of Stomatology, Changzhi Medical College, Changzhi, China
| | - Min Liu
- Department of Pharmacy, Qilu Hospital of Shandong University, Jinan, China
| | - Anchang Liu
- Department of Pharmacy, Qilu Hospital of Shandong University, Jinan, China
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Goncalves BT, Dos Reis R, Ribeiro R, Moretti-Marques R, Schamme FK, Oliveira GS, Tsunoda AT, Alvarenga-Bezerra V, Lopes A, Pastore CBP, Kumagai LY, Faloppa CC, Mantoan H, Badiglian-Filho L, De Brot L, Andrade CEMC, Baiocchi G. Does sentinel node mapping impact morbidity and quality of life in endometrial cancer? Int J Gynecol Cancer 2023; 33:1548-1556. [PMID: 37699707 DOI: 10.1136/ijgc-2023-004555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVES To evaluate the prevalence of post-operative complications and quality of life (QoL) related to sentinel lymph node (SLN) biopsy vs systematic lymphadenectomy in endometrial cancer. METHODS A prospective cohort included women with early-stage endometrial carcinoma who underwent lymph node staging, grouped as follows: SLN group (sentinel lymph node only) and SLN+LND group (sentinel lymph node biopsy with addition of systematic lymphadenectomy). The patients had at least 12 months of follow-up, and QoL was assessed by European Organization for Research and Treatment of Cervical Cancer Quality of Life Questionnaire 30 (EORTC-QLQ-C30) and EORTC-QLQ-Cx24. Lymphedema was also assessed by clinical evaluation and perimetry. RESULTS 152 patients were included: 113 (74.3%) in the SLN group and 39 (25.7%) in the SLN+LND group. Intra-operative surgical complications occurred in 2 (1.3%) cases, and all belonged to SLN+LND group. Patients undergoing SLN+LND had higher overall complication rates than those undergoing SLN alone (33.3% vs 14.2%; p=0.011), even after adjusting for confound factors (OR=3.45, 95% CI 1.40 to 8.47; p=0.007). The SLN+LND group had longer surgical time (p=0.001) and need for admission to the intensive care unit (p=0.001). Moreover, the incidence of lymphocele was found in eight cases in the SLN+LND group (0 vs 20.5%; p<0.001). There were no differences in lymphedema rate after clinical evaluation and perimetry. However, the lymphedema score was highest when lymphedema was reported by clinical examination at 6 months (30.1 vs 7.8; p<0.001) and at 12 months (36.3 vs 6.0; p<0.001). Regarding the overall assessment of QoL, there was no difference between groups at 12 months of follow-up. CONCLUSIONS There was a higher overall rate of complications for the group undergoing systematic lymphadenectomy, as well as higher rates of lymphocele and lymphedema according to the symptom score. No difference was found in overall QoL between SLN and SLN+LND groups.
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Affiliation(s)
| | - Ricardo Dos Reis
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, Brazil
| | - Reitan Ribeiro
- Department of Gynecologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil
| | | | | | | | - Audrey Tieko Tsunoda
- Department of Gynecologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil
- HCor Oncology, Sao Paulo, Brazil
- PPGTS/Pontificia Universidade Catolica do Parana, Curitiba, Brazil
| | | | - Andre Lopes
- Department of Gynecologic Oncology, Sao Camilo Oncologia, Sao Paulo, Brazil
| | | | | | | | - Henrique Mantoan
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | | | - Louise De Brot
- Department of Anatomic Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | | | - Glauco Baiocchi
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
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Philp L, Alimena S, Sullivan M, Del Carmen M, Bregar A, Eisenhauer E, Goodman A, Sisodia RC. Black and hispanic women have less support during cancer evaluation and treatment: results from a prospective patient reported outcomes program in gynecologic malignancy. Int J Gynecol Cancer 2023; 33:770-777. [PMID: 36639193 DOI: 10.1136/ijgc-2022-004113] [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: 01/15/2023] Open
Abstract
OBJECTIVE Race remains a significant predictor of poor outcomes in women with gynecologic cancer and minority patients consistently report worse quality of life during cancer treatment. Disparities between patients in strength of social and emotional supports may contribute to these outcomes. This study's objective was to describe the racial differences in patient reported outcomes of women being evaluated or treated for a gynecologic malignancy at a large tertiary cancer hospital. METHODS In this prospective cohort study, all patients presenting for care at a tertiary care gynecologic oncology clinic between January 2018 and September 2019 were evaluated for inclusion. All patients were administered validated patient reported outcome measure questionnaires at serial visits. Demographic data was gathered including self-reported race. Patients were characterized as White, Black, Asian, Hispanic/Latino, or Other. Patient reported outcomes were compared between respondents of different races using linear and logistic regression. RESULTS Between January 2018 to September 2019, 2022 patients with a known race completed questionnaires. Of these patients, 86.7% were White, 4.3% Black, and 4.9% Hispanic/Latino and 58.7% had a known cancer diagnosis. Non-White patients were significantly less likely to complete questionnaires (p<0.001). Non-White patients reported significantly lower levels of emotional support on all questions (Patient-Reported Outcomes Measurement Information System (PROMIS) emotional support: Q1 p<0.001, Q2 p<0.001, Q3 p=0.013, Q4 p=0.002), and lower overall emotional (p=0.005) and instrumental (p=0.005) support scores when compared with White patients. Hispanic/Latino patients reported the lowest levels of emotional and instrumental support and more cognitive (p=0.043) and financial (p=0.040) difficulties associated with treatment. Black women reported having less support with chores while sick (p=0.014) and being less likely to have someone to talk to (p=0.013). CONCLUSIONS Significant differences exist in patient reported outcomes between women of different racial backgrounds. Hispanic/Latino and Black women have less support during gynecologic cancer evaluation and treatment as compared with White women.
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Affiliation(s)
- Lauren Philp
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada .,Division of Gynecologic Oncology, University Health Network / Sinai Health System, Toronto, Ontario, Canada
| | - Stephanie Alimena
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mackenzie Sullivan
- Department of Obstetrics and Gynecology, Massachusetts General Hospital / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marcela Del Carmen
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amy Bregar
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eric Eisenhauer
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Annekathryn Goodman
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rachel Clark Sisodia
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Warsame R, Cook J, Fruth B, Hubbard J, Croghan K, Price KA, Jatoi A, Kumar S, Thompson C, Buckner J, Dispenzieri A, Sloan J, Dueck AC. A prospective, randomized trial of patient-reported outcome measures to drive management decisions in hematology and oncology. Contemp Clin Trials Commun 2022; 29:100964. [PMID: 35928285 PMCID: PMC9344350 DOI: 10.1016/j.conctc.2022.100964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022] Open
Abstract
Background Clinicians have limited time during patient encounters which can result in patients' concerns not being addressed. This study's objective was to test whether an electronic patient-reported outcome quality of life tool (PROQOL) in which patients identify their primary concern during clinic visits improves cancer patient quality of life (QOL). Patients and methods This single center non-blinded prospective clinical trial randomized patients (2:1) to PROQOL versus usual care (UC). Two patient cohorts were enrolled: those with hematologic malignancies (multiple myeloma [MM] or light chain amyloidosis [AL]) and solid tumors (head and neck [H/N] or gynecologic [GYN] malignancies). Primary endpoint was patient-reported QOL at 12 months measured by a single-item Linear Analog Self-Assessment. Value to patients and impact on clinician workflow was measured using a "was it worth it" survey. The study was powered to detect a 0.5 standard deviation difference between groups. Results Overall 383 patients were enrolled, 171 with MM, 62 AL, 113 GYN, and 37 H/N between July 2016 and April 2018, with 12-month follow-up. There were 171 (44.6%) male patients and median age was 62 years (range 31-87). The most often selected concern was physical health (30.9%), and second was cancer diagnosis and treatment (29.1%). Mean QOL was 7.12 for PROQOL and 6.98 for UC (0-10 scale) at 12 months, with no between-group difference overall (p = 0.56) or within hematologic or solid tumor cohorts, respectively. Among patients, 74% thought the PROQOL tool was worthwhile, 86% would choose PROQOL again, and 81% would recommend it to others. Among clinicians, 95% responded that PROQOL was worthwhile and did not think that PROQOL negatively impacted their workflow. Conclusions Although we did not demonstrate a QOL difference between PROQOL and UC groups; the PROQOL tool held considerable value in identifying patients' main concerns over time and was worthwhile for patients and clinicians.
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Affiliation(s)
- Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Patricia and Robert Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Joselle Cook
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Briant Fruth
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Joleen Hubbard
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Aminah Jatoi
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Jan Buckner
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Jeff Sloan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Amylou C. Dueck
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
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Boban SA, Bulsara C, Codde J, Cohen PA, Downs J. Employing cognitive interviewing to evaluate, improve and validate items for measuring the health-related quality of life of women diagnosed with ovarian cancer. BMC Womens Health 2022; 22:391. [PMID: 36163023 PMCID: PMC9512969 DOI: 10.1186/s12905-022-01966-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 09/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Use of patient-reported outcome measures in clinical settings facilitate the delivery of better health care to improve patient health outcomes. Previously collected qualitative data indicated themes that could inform items for a health-related quality of life measure. This study investigated the content validity of items for inclusion in a new health-related quality of life measure suitable for patients with ovarian cancer. Methods Cognitive interviewing techniques were used with fourteen women diagnosed with ovarian cancer and at different times since diagnosis, to evaluate items derived from the previously collected qualitative dataset. A set of draft items was administered via telephone, Zoom and WhatsApp app together with questions on item meaning and wording. Interviews were transcribed and thematically analysed. Results Four broad themes emerged in relation to the questionnaire construction and comprehension of items: intent and clarity, wording, relevance and context, and overall questionnaire construct. All draft items were adjusted based on the interview findings. A final set of 38 health-related quality of life items comprised 7 items describing physical health and functioning, 21 describing emotional wellbeing and 10 items describing social wellbeing; each rated on a five-point frequency response scale.
Conclusion The items reflected a range of personal experiences associated with the patient clinical journey, creating a health-related quality of life tool specific to women diagnosed with ovarian cancer. The cognitive interviewing process established content validity for the tool, thereby, preparing it for field testing and evaluation of its psychometric properties. This study highlighted the fundamental role of cognitive interviewing during health-related quality of life questionnaire development to ensure that item content is grounded in patient feelings, functioning and meaning. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01966-w.
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de Vasconcelos Silva ACP, Araujo BM, Spiegel T, da Cunha Reis A. May value-based healthcare practices contribute to comprehensive care for cancer patients? A systematic literature review. J Cancer Policy 2022; 34:100350. [DOI: 10.1016/j.jcpo.2022.100350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/28/2022] [Accepted: 07/30/2022] [Indexed: 12/30/2022]
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Kowa CY, Jin Z, Gan TJ. Framework, component, and implementation of enhanced recovery pathways. J Anesth 2022; 36:648-660. [PMID: 35789291 PMCID: PMC9255474 DOI: 10.1007/s00540-022-03088-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 06/15/2022] [Indexed: 12/01/2022]
Abstract
The introduction of enhanced recovery pathways (ERPs) has led to a considerable paradigm shift towards evidence-based, multidisciplinary perioperative care. Such pathways are now widely implemented in a variety of surgical specialties, with largely positive results. In this narrative review, we summarize the principles, components and implementation of ERPs, focusing on recent developments in the field. We also discuss ‘special cases’ in ERPs, including: surgery in frail patients; emergency procedures; and patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2/COVID-19).
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Affiliation(s)
- Chao-Ying Kowa
- Department of Anaesthesia, Whittington Hospital, Magdala Ave, London, N19 5NF, UK
| | - Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA
| | - Tong J Gan
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA.
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Eriksen J, Bygholm A, Bertelsen P. The association between patient-reported outcomes (PROs) and patient participation in chronic care: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:1852-1864. [PMID: 35090802 DOI: 10.1016/j.pec.2022.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Patient-reported outcomes (PROs) are increasingly applied in chronic care due to their many functionalities and synergies with current healthcare policies. The participatory potential of PROs is especially emphasised in the Danish context. This review scrutinises the association between PRO and patient participation in chronic care. METHODS This scoping review adheres to PRISMA-ScR guidelines, and the synthesis is based on narrative and thematic analyses. RESULTS Eighty-four articles were deemed eligible. The association between PRO and patient participation regards seven themes: PRO development, response rates and patient burden, patient empowerment and self-management, display and quality of data, patient-clinician communication, shared decision-making, and organisational and attitudinal aspects. Lack of knowledge, actor attitudes, organisational setup, and technological infrastructure act as the main barriers. CONCLUSION The connection between PROs and patient participation is dialectic and unfolds in three phases-before, during, and after patient-clinician consultation. Knowledge regarding the last phase is particularly scarce. Henceforth, studies should address how to include a broader segment of patients, PROs participatory effects over time and PROs impact on patients' everyday lives. PRACTICE IMPLICATIONS The review provides knowledge concerning the association between PROs and patient participation to enhance future chronic care, research, and discussions in the area.
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Affiliation(s)
- Jeppe Eriksen
- Department of Planning, Techno-Anthropology, Aalborg University, Aalborg, Denmark.
| | - Ann Bygholm
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark.
| | - Pernille Bertelsen
- Department of Planning, Techno-Anthropology, Aalborg University, Aalborg, Denmark.
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Alimena S, Philp L, Orav EJ, Sullivan MW, Del Carmen M, Goodman A, Growdon WB, Bregar A, Eisenhauer E, Sisodia RC. Patient-reported outcomes and chemotherapy-related cognitive impairment in gynecologic malignancy. Int J Gynecol Cancer 2022; 32:781-787. [DOI: 10.1136/ijgc-2021-003094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
ObjectiveChemotherapy has multiple adverse effects, including chemotherapy-related cognitive impairment, the phenomenon colloquially referred to as ‘chemobrain’. The objective of this study was to understand patient-reported experiences of this phenomenon in relation to chemotherapy administration among gynecologic oncology patients.MethodsA prospective patient-reported outcomes program was implemented in the Gynecologic Oncology clinic of a tertiary academic institution in January 2018. Patients with endometrial or ovarian cancer who received chemotherapy were included through September 2019 in this cohort study. Patients completed the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire. Serial responses were compared before, during, and after chemotherapy using a mixed effects linear regression with random effects for repeated measures within patients and a fixed effect for endometrial versus ovarian cancer.ResultsFifty patients were included who completed a total of 152 patient-reported outcome measures. Thirty-five questionnaires were administered before chemotherapy, 59 during treatment, and 58 at a median of 161 days after the final cycle of chemotherapy. Seventy-one percent of patients reported no difficulties with concentration before chemotherapy, which remained stable after chemotherapy (72%). Sixty-six percent reported no difficulty with memory before chemotherapy versus 52% after chemotherapy. There were significant differences in feeling tension (p<0.001), worry (p<0.001), and depression (p=0.02) before and after chemotherapy on mixed effects linear regression, with higher levels of adverse emotional symptoms before chemotherapy administration compared with after. Women reported more interference with their social lives during chemotherapy (mean 1.08) compared with before (mean 0.85) and after chemotherapy (0.75, p=0.04).ConclusionsWhile no overt memory issues were discovered with serial administration of patient-reported outcome measures, rates of adverse emotional symptoms such as depression, tension, and worry diminished after chemotherapy administration. Further study is needed about the phenomenon of chemotherapy-related cognitive impairment using a larger cohort.
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Philp L, Alimena S, Ferris W, Saini A, Bregar AJ, Del Carmen MG, Eisenhauer EL, Growdon WB, Goodman A, Dorney K, Mazina V, Sisodia RC. Patient reported outcomes after risk-reducing surgery in patients at increased risk of ovarian cancer. Gynecol Oncol 2021; 164:421-427. [PMID: 34953629 DOI: 10.1016/j.ygyno.2021.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/12/2021] [Accepted: 12/12/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To describe the quality of life of women at an increased risk of ovarian cancer undergoing risk-reducing bilateral salpingo-oophorectomy (RRBSO). METHODS Patients evaluated in our gynecologic oncology ambulatory practice between January 2018-December 2019 for an increased risk of ovarian cancer were included. Patients received the EORTC QLQ-C30 and PROMIS emotional and instrumental support questionnaires along with a disease-specific measure (PROM). First and last and pre- and post-surgical PROM responses in each group were compared as were PROMs between at-risk patients and patients with other ovarian diseases. RESULTS 195 patients with an increased risk of ovarian cancer were identified, 155 completed PROMs (79.5%). BRCA1 or BRCA2 mutations were noted in 52.8%. Also included were 469 patients with benign ovarian disease and 455 with ovarian neoplasms. Seventy-two at-risk patients (46.5%) had surgery and 36 had both pre- and post-operative PROMs. Post-operatively, these patients reported significantly less tension (p = 0.011) and health-related worry (p = 0.021) but also decreased levels of health (p = 0.018) and quality of life <7d (0.001), less interest in sex (p = 0.014) and feeling less physically attractive (p = 0.046). No differences in body image or physical/sexual health were noted in at-risk patients who did not have surgery. When compared to patients with ovarian neoplasms, at-risk patients reported lower levels of disease-related life interference and treatment burden, less worry, and better overall health. CONCLUSIONS In patients with an increased risk of ovarian cancer, RRBSO is associated with decreased health-related worry and tension, increased sexual dysfunction and poorer short-term quality of life. Patients with ovarian neoplasms suffer to a greater extent than at-risk patients and report higher levels of treatment burden and disease-related anxiety.
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Affiliation(s)
- L Philp
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, USA.
| | - S Alimena
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, USA
| | - W Ferris
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, USA
| | - A Saini
- University of Massachusetts School of Medicine, Worcester, USA
| | - A J Bregar
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, USA
| | - M G Del Carmen
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, USA
| | - E L Eisenhauer
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, USA
| | - W B Growdon
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, USA
| | - A Goodman
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, USA
| | - K Dorney
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, USA
| | - V Mazina
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, USA
| | - R C Sisodia
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, USA
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12
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Chen Q, Mariano ER, Lu AC. Enhanced recovery pathways and patient-reported outcome measures in gynaecological oncology. Anaesthesia 2021; 76 Suppl 4:131-138. [PMID: 33682089 DOI: 10.1111/anae.15422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 12/14/2022]
Abstract
Comprehensive peri-operative care for women with gynaecological malignancy is essential to ensure optimal clinical outcomes and maximise patient experience through the continuum of care. Implementation of peri-operative enhanced recovery pathways in gynaecological oncology have been repeatedly shown to improve postoperative recovery, decrease complications and reduce healthcare costs. With increasing emphasis being placed on patient-centred care in the current healthcare environment, incorporation of patient-reported outcome data collection and analysis within the enhanced recovery pathway as part of quality measurement is not only useful, but necessary. Inclusion of patient-reported outcome enhanced recovery pathway evaluation enables clinicians to capture authentic patient-reported parameters such as subtle symptoms, changes in function and multiple dimensions of well-being, directly from the source. These data guide the treatment course by encouraging shared decision-making between the patient and clinicians and provide the necessary foundation for ongoing peri-operative quality improvement efforts. Elements of the gynaecological oncology enhanced recovery pathway are divided into five phases of care: pre-admission; pre-operative; intra-operative; postoperative; and post-discharge. The development process starts with detailing each step of the patient's journey in all five phases, then identifying stakeholder groups responsible for care at each of these phases and assembling a multidisciplinary team including: gynaecologists; anaesthetists; nurses; nutritionists; physical therapists; and others, to provide input into the institutional pathway. To practically integrate patient-reported outcomes into an enhanced recovery pathway, a validated measurement tool should be incorporated into the peri-operative workflow. The ideal tool should be concise to facilitate longitudinal assessments by the clinical staff.
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Affiliation(s)
- Q Chen
- Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - E R Mariano
- Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Anesthesiology and Peri-operative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - A C Lu
- Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Quality, Safety and Clinical Effectiveness, Stanford Health Care, Stanford, CA, USA
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13
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Boban S, Downs J, Codde J, Cohen PA, Bulsara C. Women Diagnosed with Ovarian Cancer: Patient and Carer Experiences and Perspectives. PATIENT-RELATED OUTCOME MEASURES 2021; 12:33-43. [PMID: 33623464 PMCID: PMC7896761 DOI: 10.2147/prom.s272688] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/15/2020] [Indexed: 01/04/2023]
Abstract
Purpose By directly engaging with women diagnosed with ovarian cancer, this study aimed to explore and identify their view of the health symptoms and outcomes that matter most to them as they traverse their disease pathway. Background Patient-reported outcome measures in ovarian cancer have tended to focus on physical symptoms rather than the more complex psychosocial aspects of living with the disease. Using a "ground-up approach", this study sought to comprehensively understand the health concerns that matter most to women with ovarian cancer as a first step in generating items for development into an ovarian cancer-specific patient-reported outcome measure. Patients and Methods Following an extensive literature review, we sought to capture the "patient voice" through a qualitative descriptive approach including a community conversation with ovarian cancer patients, their carers and clinicians, and interviews and focus groups with women with ovarian cancer. Thirteen women were interviewed individually, and two focus groups were conducted. A template thematic analysis was used to analyze the data. Results Key themes included challenges related to clinical diagnosis, treatment phase, altered relationships with family/friends, financial issues, relationships with health professionals and coping strategies. Within each key theme, several sub-themes emerged that were identified as various challenges experienced by participants. Diagnostic delay, chemotherapy and surgery-related challenges, negative impact of sexual well-being on partner relationship, communicational challenges with health professionals were among the few issues identified. In addition, self-empowerment was identified as a coping mechanism among participants. Conclusion By identifying priorities for women diagnosed with ovarian cancer we have highlighted the need for strategies to reduce diagnostic delays and improve quality of life for these women. Data will inform the development of an ovarian cancer-specific patient-reported outcome measure.
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Affiliation(s)
- Sharolin Boban
- School of Health Sciences, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Jenny Downs
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Jim Codde
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia.,Division of Obstetrics and Gynecology, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Paul A Cohen
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia.,Division of Obstetrics and Gynecology, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Caroline Bulsara
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
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14
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Sisodia RC, Dewdney SB, Fader AN, Wethington SL, Melamed A, Von Gruenigen VE, Zivanovic O, Carter J, Cohn DE, Huh W, Wenzel L, Doll K, Cella D, Dowdy SC. Patient reported outcomes measures in gynecologic oncology: A primer for clinical use, part I. Gynecol Oncol 2021; 158:194-200. [PMID: 32580886 DOI: 10.1016/j.ygyno.2020.04.696] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/18/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Rachel C Sisodia
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, United States of America.
| | - Summer B Dewdney
- Division of Gynecologic Oncology, Rush University Medical Center, Chicago, IL, United States of America
| | - Amanda N Fader
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Stephanie L Wethington
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Alexander Melamed
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | - Vivian E Von Gruenigen
- Department of Obstetrics and Gynecology, University Hospitals of Cleveland, United States of America
| | - Oliver Zivanovic
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, 8th Floor, New York, NY, 10065, United States of America
| | - Jeanne Carter
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, 8th Floor, New York, NY, 10065, United States of America
| | - David E Cohn
- Department of Obstetrics and Gynecology, Ohio State University College of Medicine, Columbus, OH 43210, United States of America
| | - Warner Huh
- Department of Obstetrics and Gynecology, University and Alabama, Birmingham, AL, United States of America
| | - Lari Wenzel
- Universtiy of California, Irvine, United States of America
| | - Kemi Doll
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America
| | - David Cella
- Department of Medical Social Sciences and Robert H Lurie Comprehensive Cancer Center, Northwestern University, United States of America
| | - Sean C Dowdy
- Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN 55905, United States of America
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15
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Alimena S, Sullivan MW, Philp L, Dorney K, Hubbell H, Del Carmen MG, Goodman A, Bregar A, Growdon WB, Eisenhauer EL, Sisodia RC. Patient reported outcome measures among patients with vulvar cancer at various stages of treatment, recurrence, and survivorship. Gynecol Oncol 2020; 160:252-259. [PMID: 33139040 DOI: 10.1016/j.ygyno.2020.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/16/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Our goal was to pragmatically describe patient reported outcomes (PROs) in a typical clinic population of vulvar cancer patients, as prior studies of vulvar cancer PROs have examined clinical trial participants. METHODS A prospective PRO program was implemented in the Gynecologic Oncology clinic of a tertiary academic institution in January 2018. Vulvar cancer patients through September 2019 were administered the European Organization for the Research and Treatment of Cancer Quality of life Questionnaire, the Patient Reported Outcome Measurement Information System Instrumental and Emotional Support Scales, and the Functional Assessment of Cancer Therapy-Vulvar questionnaire. Binary logistic regressions were performed to determine adjusted odds ratios for adverse responses to individual questions by insurance, stage, age, time since diagnosis, recurrence, radiation, and surgical radicality. RESULTS Seventy vulvar cancer patients responded to PROs (85.4% response rate). Seventy-one percent were > 1 year since diagnosis, 61.4% had stage I disease, and 28.6% recurred. Publicly insured women had less support and worse quality of life (QOL, aOR 4.15, 95% CI 1.00-17.32, p = 0.05). Women who recurred noted more interference with social activities (aOR 4.45, 95% CI 1.28-15.41, p = 0.019) and poorer QOL (aOR 5.22 95% CI 1.51-18.10, p = 0.009). There were no major differences by surgical radicality. Those >1 year since diagnosis experienced less worry (aOR 0.17, 95% CI 0.04-0.63, p = 0.008). CONCLUSIONS Surgical radicality does not affect symptoms or QOL in vulvar cancer patients, whereas insurance, recurrence, and time since diagnosis do. This data can improve counseling and awareness of patient characteristics that would benefit from social services referral.
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Affiliation(s)
- Stephanie Alimena
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Mackenzie W Sullivan
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lauren Philp
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Katelyn Dorney
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Harrison Hubbell
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marcela G Del Carmen
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Annekathryn Goodman
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Amy Bregar
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Whitfield B Growdon
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric L Eisenhauer
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rachel Clark Sisodia
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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16
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Jim HSL, Hoogland AI, Brownstein NC, Barata A, Dicker AP, Knoop H, Gonzalez BD, Perkins R, Rollison D, Gilbert SM, Nanda R, Berglund A, Mitchell R, Johnstone PAS. Innovations in research and clinical care using patient-generated health data. CA Cancer J Clin 2020; 70:182-199. [PMID: 32311776 PMCID: PMC7488179 DOI: 10.3322/caac.21608] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 12/17/2022] Open
Abstract
Patient-generated health data (PGHD), or health-related data gathered from patients to help address a health concern, are used increasingly in oncology to make regulatory decisions and evaluate quality of care. PGHD include self-reported health and treatment histories, patient-reported outcomes (PROs), and biometric sensor data. Advances in wireless technology, smartphones, and the Internet of Things have facilitated new ways to collect PGHD during clinic visits and in daily life. The goal of the current review was to provide an overview of the current clinical, regulatory, technological, and analytic landscape as it relates to PGHD in oncology research and care. The review begins with a rationale for PGHD as described by the US Food and Drug Administration, the Institute of Medicine, and other regulatory and scientific organizations. The evidence base for clinic-based and remote symptom monitoring using PGHD is described, with an emphasis on PROs. An overview is presented of current approaches to digital phenotyping or device-based, real-time assessment of biometric, behavioral, self-report, and performance data. Analytic opportunities regarding PGHD are envisioned in the context of big data and artificial intelligence in medicine. Finally, challenges and solutions for the integration of PGHD into clinical care are presented. The challenges include electronic medical record integration of PROs and biometric data, analysis of large and complex biometric data sets, and potential clinic workflow redesign. In addition, there is currently more limited evidence for the use of biometric data relative to PROs. Despite these challenges, the potential benefits of PGHD make them increasingly likely to be integrated into oncology research and clinical care.
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Affiliation(s)
- Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Naomi C Brownstein
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Anna Barata
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Adam P Dicker
- Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Randa Perkins
- Department of Clinical Informatics and Clinical Systems, Moffitt Cancer Center, Tampa, Florida
| | - Dana Rollison
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida
| | - Scott M Gilbert
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Ronica Nanda
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
- BayCare Health Systems Inc, Morton Plant Hospital, Clearwater, Florida
| | - Anders Berglund
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Ross Mitchell
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
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17
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Carlson JW, Kauderer J, Hutson A, Carter J, Armer J, Lockwood S, Nolte S, Stewart BR, Wenzel L, Walker J, Fleury A, Bonebrake A, Soper J, Mathews C, Zivanovic O, Richards WE, Tan A, Alberts DS, Barakat RR. GOG 244-The lymphedema and gynecologic cancer (LEG) study: Incidence and risk factors in newly diagnosed patients. Gynecol Oncol 2019; 156:467-474. [PMID: 31837831 DOI: 10.1016/j.ygyno.2019.10.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To evaluate the incidence and risk factors for lymphedema associated with surgery for gynecologic malignancies on GOG study 244. METHODS Women undergoing a lymph node dissection for endometrial, cervical, or vulvar cancer were eligible for enrollment. Leg volume was calculated from measurements at 10-cm intervals starting 10 cm above the bottom of the heel to the inguinal crease. Measurements were obtained preoperatively and postoperatively at 4-6 weeks, and at 3-, 6-, 9-, 12-, 18-, and 24- months. Lymphedema was defined as a limb volume change (LVC) ≥10% from baseline and categorized as mild: 10-19% LVC; moderate: 20-40% LVC; or severe: >40% LVC. Risk factors associated with lymphedema were also analyzed. RESULTS Of 1054 women enrolled on study, 140 were inevaluable due to inadequate measurements or eligibility criteria. This left 734 endometrial, 138 cervical, and 42 vulvar patients evaluable for LVC assessment. Median age was 61 years (range, 28-91) in the endometrial, 44 years (range, 25-83) in the cervical, and 58 years (range, 35-88) in the vulvar group. The incidence of LVC ≥10% was 34% (n = 247), 35% (n = 48), and 43% (n = 18), respectively. The peak incidence of lymphedema was at the 4-6 week assessment. Logistic regression analysis showed a decreased risk with advanced age (p = 0.0467). An exploratory analysis in the endometrial cohort showed an increased risk with a node count >8 (p = 0.033). CONCLUSIONS For a gynecologic cancer, LVC decreased with age greater than 65, but increased with a lymph node count greater than 8 in the endometrial cohort. There was no association with radiation or other risk factors.
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Affiliation(s)
- Jay W Carlson
- Cancer Research for the Ozarks, 1235 E. Cherokee, Springfield, MO, 65804, USA.
| | - James Kauderer
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Elm & Carlton Sts., Buffalo, NY, 14263, USA.
| | - Alan Hutson
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Elm & Carlton Sts., Buffalo, NY, 14263, USA.
| | - Jeanne Carter
- Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, 10022, USA.
| | - Jane Armer
- Sinclair School of Nursing, DC 116.05, Mizzou North Suite 415, 115 Business Loop 70 West, Columbia, MO, 65010, USA.
| | - Suzy Lockwood
- Texas Christian University, Harris College of Nursing & Health Sciences, TCU Box 298620, Ft Worth, TX, 76129, USA.
| | - Susan Nolte
- Abington Memorial Hospital, 1200 Old York Road, Abington, PA, 19001, USA.
| | - Bob R Stewart
- Sinclair School of Nursing, DC 116.05, Mizzou North Suite 415, 115 Business Loop 70 West, Columbia, MO, 65010, USA.
| | - Lari Wenzel
- Program in Public Health, University of California, Irvine, Irvine, CA, USA; Department of Medicine, Division of Hematology/Oncology, University of California, Irvine, Irvine, CA, USA; Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA.
| | - Joan Walker
- Stephenson Cancer Center, OUHSC, Oklahoma City, OK, 73104, USA.
| | - Aimee Fleury
- Women's Cancer Center of Nevada, 3131 la Canada St. Ste 241, Las Vegas, NV, 89169, USA.
| | - Albert Bonebrake
- Cancer Research for the Ozarks-Cox Health. Ferrell Duncan Clinic GYN-ONC, Springfield, MO, 65807, USA.
| | - John Soper
- B110 Physicians' Office BLDG, 170 Manning Drive, UNC School of Medicine, Chapel Hill, NC, 27599, USA.
| | - Cara Mathews
- Division of Gynecologic Oncology, Women & Infants Hospital of Rhode Island, Alpert School of Medicine at Brown University, 101 Dudley St., Providence, RI, 02905, USA.
| | - Oliver Zivanovic
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Wm Edward Richards
- Director of Gynecologic Oncology and Surgical Specialists, St. Joseph's/Candler Health System, 225 Candler Dr., Savannah, GA, 31405, USA.
| | - Annie Tan
- Minnesota Oncology, 11850 Blackfoot Street, NW, Suite 100, Coon Rapids MN 55433, USA.
| | - David S Alberts
- Department of Medicine, University of Arizona College of Medicine, 1501 N. Campbell Avenue, Tucson, AZ, 85724, USA.
| | - Richard R Barakat
- Northwell Health Cancer Institute, 1111 Marcus Avenue, New Hyde Park, NY, 11042, USA.
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18
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Development and initial validation of an electronic personal assessment questionnaire for menstrual, pelvic pain and gynaecological hormonal disorders (ePAQ-MPH). Eur J Obstet Gynecol Reprod Biol 2019; 238:148-156. [PMID: 31132692 DOI: 10.1016/j.ejogrb.2019.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/15/2019] [Accepted: 05/18/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Menstrual disorders, pelvic-pain and gynaecological hormonal conditions in women can have a significant impact on quality-of-life. Reliable assessment and monitoring of these intimate conditions is challenging. Patient reported outcome measures (PROMs) can be invaluable in providing objective assessment, but no comprehensive PROM assessing all of these conditions and their impact on quality of life is currently available. The purpose of this study was to develop and undertake initial psychometric testing of a comprehensive interactive electronic patient reported outcome measure for these conditions. STUDY DESIGN A prototype electronic PROM (ePAQ-MPH) was developed following systematic literature review, semi structured interviews with 25 patients and expert panel review. Exploratory factor analysis was undertaken in 291 women attending a menstrual-disorders clinic; establishing a domain structure and enabling item reduction. Two validated PROMS (Women's Health Questionnaire and Menstrual Distress Questionnaire) were completed to assess criterion validity in 213 patients. Test-retest reliability was carried out in 30 women completing ePAQ-MPH at least one week apart. Patients' views on 'Value' and 'Burden' were assessed in 278 women using a validated 10-item survey measuring questionnaire utility (QQ-10). Confirmatory factor analysis (CFA) of the revised version of ePAQ-MPH following item reduction was undertaken in a different sample of 254 women. RESULTS Exploratory factor analysis identified 18 domains (Cronbach's α > 0.7) and 30 redundant items. Test-retest analysis found acceptable intra-class correlations of 0.6-0.9 (p < 0.05). Eight domains were compared with Menstrual Distress Questionnaire showing moderate or strong correlation in seven domains. Ten domains were compared with Women's Health Questionnaire, six of which showed moderate correlation. Mean QQ-10 Value and Burden scores were 76 and 25, respectively (SD=15.8 and 15.5). The mean completion time for ePAQ-MPH was 31 min. CFA of the revised version 2 instrument with 15 domains showed good model fit. CONCLUSIONS Whilst wider psychometric testing of the revised version of ePAQ-MPH is required, including in different settings and in assessments of data quality and responsiveness, initial analysis provides some evidence for reliability, validity and acceptability of this multi-dimensional electronic PROM. ePAQ-MPH shows potential for both patient assessment and roles in service evaluation and research.
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Silveira A, Monteiro E, Sequeira T. Head and Neck Cancer: Improving Patient-Reported Outcome Measures for Clinical Practice. Curr Treat Options Oncol 2018; 19:59. [PMID: 30276480 DOI: 10.1007/s11864-018-0578-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OPINION STATEMENT Head and neck cancer includes a wide range of tumors that occur in several areas of the upper aerodigestive tract. Most head and neck cancer patients report treatment-related late effects (both physical and psycho-social). High-quality and patient-centered care in head and neck cancer depend on the understanding of the continuum patient's experience-the disease pathway. Healthcare has been improved by involving patients more actively in the disease process, and a few reports support that patient-reported outcomes-built around the patient's experience-given in a timely manner to oncologists are extremely valuable in oncology clinical care. Implementation and clinical use of patient-reported outcomes requires some procedures involving head and neck cancer patients, clinicians, researchers, and institutional leaders The unified and integrated vision is still absent and some current concerns are being discussed to optimize benefits of patient-reported outcomes use in clinical practice. The inclusion of all first-line caregivers, team formation and training, continuous monitoring improvement, and analysis are critical success factors to consider. Our team developed a broader and inclusive understanding of patient-reported outcomes. Patient-reported outcome (Health-Related Quality of Life) assessment is implemented as a systematic and routine process in Head and Neck Unit. Head and neck cancer patients consider the questionnaire administration as part of the clinical approach. We are currently working in a program (PROimp) using mathematical models to identify common head and neck cancer patterns and building prognostic predictive models, to predict future outcomes, to appraise risk/benefit of treatments (standard or new), and to estimate patient's risk of future disease development. It is our aim to better comprehend the singular and unexpected perceptions to really provide directed and personalized cancer care defining the patient pathway. The future holds promising for PROs that are ascending as a nuclear outcome in head and neck oncology.
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Affiliation(s)
- Augusta Silveira
- Health Sciences Faculty, Fernando Pessoa University (UFP-FCS), Rua Carlos da Maia, 296, 4200-150, Porto, Portugal. .,Center for Health Studies and Research of the University of Coimbra, Center for Innovation in Biomedicine and Biotechnology, Avenida Dias da Silva, 165, 3004-512, Coimbra, Portugal.
| | - Eurico Monteiro
- Health Sciences Faculty, Fernando Pessoa University (UFP-FCS), Rua Carlos da Maia, 296, 4200-150, Porto, Portugal.,Portuguese Oncology Institute - Porto, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal
| | - Teresa Sequeira
- Health Sciences Faculty, Fernando Pessoa University (UFP-FCS), Rua Carlos da Maia, 296, 4200-150, Porto, Portugal.,Center for Health Studies and Research of the University of Coimbra, Center for Innovation in Biomedicine and Biotechnology, Avenida Dias da Silva, 165, 3004-512, Coimbra, Portugal
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20
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Webster EM, Burke WM, Ware HM, Jones BA, Vattakalam R, Tergas AI, Wright JD, Hou JY. Patient reported outcomes in evaluation of chemotherapy toxicity in women with gynecologic malignancies: A pilot study. Gynecol Oncol 2018; 150:487-493. [PMID: 30037492 DOI: 10.1016/j.ygyno.2018.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/05/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Patient reported outcomes (PRO) relating to treatment toxicities have been demonstrated to reliably evaluate adverse events in clinical trials. We assessed the user satisfaction of implementing a focused PRO questionnaire for patients with gynecologic cancers undergoing chemotherapy. METHODS Patients with gynecologic cancers undergoing chemotherapy were prospectively identified after IRB approval from April 2017 to August 2017. We administered a 24-symptom questionnaire, adapted from the validated PRO version of the Common Terminology Criteria for Adverse Event, to enrolled participants at the beginning of two outpatient visits. Patient and provider satisfaction with use of PRO was assessed afterwards. Descriptive statistics were performed. RESULTS A total of 44 patients were enrolled. Patients were racially diverse: 52% Caucasian, 18% African-American, 9% Asian, and 20% other; 27% were of Hispanic origin. The majority of patients had ovarian cancer (54%), followed by uterine (29%) and cervical cancer (15%). Ninety-five percent of patient and 97% of provider satisfaction survey responses indicated the PRO questionnaire addressed important symptoms. Nearly all patient and provider responses indicated the PRO questionnaire was easy to use. Sixty-nine percent of patient and 97% of provider responses indicated the questionnaire positively impacted clinical care; 85% of patients wished to use a similar questionnaire throughout treatment. CONCLUSIONS We have shown that incorporating a focused patient-reported symptom questionnaire into routine outpatient care of gynecological oncology patients undergoing chemotherapy was met with a high degree of patient and provider satisfaction regarding questionnaire content, feasibility, and perception of care improvement.
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Affiliation(s)
- Emily M Webster
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | - Hannah M Ware
- Washington University in St. Louis/Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Bayley A Jones
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Reena Vattakalam
- Herbert Irving Comprehensive Cancer Center, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA
| | - Ana I Tergas
- Columbia University College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA
| | - June Y Hou
- Columbia University College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA.
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21
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Barnes D, Rivera R, Gibson S, Craig C, Cragun J, Monk B, Chase D. The utility of patient reported data in a gynecologic oncology clinic. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2018; 5:4. [PMID: 30009038 PMCID: PMC6044081 DOI: 10.1186/s40661-018-0062-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 06/27/2018] [Indexed: 12/04/2022]
Abstract
BACKGROUND Measuring QoL is essential to the field of gynecologic oncology but there seems to be limited standardized data regarding collecting QoL assessments throughout a patient's cancer treatment especially in non-clinical trial patients. The aim of this study is to explore patient characteristics that may be associated with poor quality of life (QoL) in women with gynecologic cancers at two University of Arizona Cancer Center (UACC) sites. METHODS A cross-sectional survey was conducted among English speaking women with gynecologic malignancies at the University of Arizona Cancer Centers in Phoenix and Tucson from April 2012 to July 2015. The survey was a paper packet of questions that was distributed to cancer patients at the time of their clinic visit. The packet contained questions on demographic information, treatment, lifestyle characteristics, pelvic pain and Health-related quality of life (HRQoL). Measures included the generic and cancer-specific scores on the Functional Assessment of Cancer Therapy-General (FACT-G) and the Female Genitourinary Pain Index (GUPI). The total scores and subdomains were compared with descriptive variables (age, body mass index (BMI), diet, exercise, disease status, treatment and support group attendance) using Cronbach alpha (α), Spearman rank correlations (ρ), and Holm's Bonferroni method. RESULTS One-hundred and forty-nine women completed the survey; 55% (N = 81) were older than 60 years, 38% (N = 45) were obese (BMI > 30), 46% (N = 66) exercised daily, and 84% (N = 111) ate one or more daily serving of fruit and vegetables. Women in remission, those who exercised daily and ate fruits/vegetables were less likely to have their symptoms impact their QoL. Younger women were more likely to report genitourinary issues (p = - 0.22) and overall problems with QoL (p = - 0.29) than older women. Among FACT-G support group responses, we found those that did not attend support groups had a significantly higher emotional wellbeing (p = 0.05). CONCLUSIONS This study identified potential areas of clinical focus, which aid in understanding our approach to caring for gynecologic cancer patients and improvement of their HRQoL. We identified that age, pelvic pain, and lifestyle characteristics have indicators to poor QoL in women with gynecologic cancers. In this population, younger women and those with pelvic pain complaints, poor diet and exercise habits should be targeted early for supportive care interventions to improve QoL throughout both treatment and survivorship.
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Affiliation(s)
- D. Barnes
- Department of Gynecologic Oncology, Creighton University School of Medicine at St. Joseph’s Hospital and Medical Center, Phoenix, AZ USA
| | - R. Rivera
- Department of Gynecologic Oncology, Creighton University School of Medicine at St. Joseph’s Hospital and Medical Center, Phoenix, AZ USA
| | - S. Gibson
- University of Arizona Cancer Center, Tucson, AZ USA
| | - C. Craig
- Department of Gynecologic Oncology, Creighton University School of Medicine at St. Joseph’s Hospital and Medical Center, Phoenix, AZ USA
| | - J. Cragun
- University of Arizona Cancer Center, Tucson, AZ USA
| | - B. Monk
- Department of Gynecologic Oncology, Creighton University School of Medicine at St. Joseph’s Hospital and Medical Center, Phoenix, AZ USA
| | - D. Chase
- Department of Gynecologic Oncology, Creighton University School of Medicine at St. Joseph’s Hospital and Medical Center, Phoenix, AZ USA
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22
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Patient Reported Outcomes: Recent Successes and Future Opportunities. Gynecol Oncol 2018; 148:1-2. [PMID: 29304953 DOI: 10.1016/j.ygyno.2017.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 08/09/2017] [Accepted: 08/21/2017] [Indexed: 01/16/2023]
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