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Govindaraj R, Agar M, Currow D, Luckett T. Assessing Patient-Reported Outcomes in Routine Cancer Clinical Care Using Electronic Administration and Telehealth Technologies: Realist Synthesis of Potential Mechanisms for Improving Health Outcomes. J Med Internet Res 2023; 25:e48483. [PMID: 38015606 PMCID: PMC10716761 DOI: 10.2196/48483] [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: 04/25/2023] [Revised: 07/13/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The routine measurement of patient-reported outcomes in cancer clinical care using electronic patient-reported outcome measures (ePROMs) is gaining momentum worldwide. However, a deep understanding of the mechanisms underpinning ePROM interventions that could inform their optimal design to improve health outcomes is needed. OBJECTIVE This study aims to identify the implicit mechanisms that underpin the effectiveness of ePROM interventions and develop program theories about how and when ePROM interventions improve health outcomes. METHODS A realist synthesis of the literature about ePROM interventions in cancer clinical care was performed. A conceptual framework of ePROM interventions was constructed to define the scope of the review and frame the initial program theories. Literature searches of Ovid MEDLINE, Ovid Embase, Scopus, and CINAHL, supplemented by citation tracking, were performed to identify relevant literature to develop, refine, and test program theories. Quality appraisal of relevant studies was performed using the Mixed Methods Appraisal Tool. RESULTS Overall, 61 studies were included in the realist synthesis: 15 (25%) mixed methods studies, 9 (15%) qualitative studies, 13 (21%) descriptive studies, 21 (34%) randomized controlled trials, and 3 (5%) quasi-experimental studies. In total, 3 initial program theories were developed regarding the salient components of ePROM interventions-remote self-reporting, real-time feedback to clinicians, and clinician-patient telecommunication. The refined theories posit that remote self-reporting enables patients to recognize and report symptoms accurately and empowers them to communicate these to clinicians, real-time feedback prompts clinicians to manage symptoms proactively, and clinician-patient telephone interactions and e-interactions between clinic encounters improve symptom management by reshaping how clinicians and patients communicate. However, the intervention may not achieve the intended benefit if ePROMs become a reminder to patients of their illness and are not meaningful to them and when real-time feedback to clinicians lacks relevance and increases the workload. CONCLUSIONS The key to improving health outcomes through ePROM interventions is enabling better symptom reporting and communication through remote symptom self-reporting, promoting proactive management of symptoms through real-time clinician feedback, and facilitating clinician-patient interactions. Patient engagement with self-reporting and clinician engagement in responding to feedback are vital and may reinforce each other in improving outcomes. Effective ePROM interventions might fundamentally alter how clinicians and patients interact between clinic encounters.
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Affiliation(s)
- Ramkumar Govindaraj
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Meera Agar
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - David Currow
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Sydney, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Tim Luckett
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Birgin E, Müller M, Woll C, Klompmaker A, Téoule P, Reißfelder C, Rahbari NN. Development of a conceptual framework to detect perioperative symptom burden following abdominal surgery for cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106933. [PMID: 37211468 DOI: 10.1016/j.ejso.2023.05.008] [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: 04/11/2023] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Abdominal surgery for gastrointestinal malignancies has a significant impact on patients' health-related quality of life. However, there is so far no patient-reported outcome measures (PROM) in the immediate postoperative period to detect the perioperative symptom burden and patients' needs which may precede occult and severe complications. The aim of the study was to create a conceptual framework for the development of a PROM to measure perioperative symptom burden in abdominal cancer patients. METHODS This mixed method study was performed between March 2021, and July 2021 as part of a multiphase approach to develop a new PROM. A systematic review of the literature was performed health domains were identified. The relevance of the health domains was assessed in a two-round Delphi study with clinical experts. Qualitative interviews were performed in patients who underwent abdominal surgery for cancer. RESULTS The systematic literature review yielded 12 different PROM with 168 items and 55 health domains. The most common health domains involved the "digestive system" and "pain". In total, 30 patients (median age 66 years, 20 men [60%]) were included for qualitative patient interviews. Of 16 health domains identified by the Delphi study, a total 15 health domains were confirmed during patients' interviews. The final conceptual framework included 20 health domains. CONCLUSION This study provides the essential groundwork to develop and validate a new PROM for the immediate postoperative period of patients undergoing abdominal surgery for cancer.
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Affiliation(s)
- Emrullah Birgin
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Mitho Müller
- Department of Psychology, Ludwig Maximilian University, Munich, Germany
| | - Christian Woll
- Department of Psychology, Ludwig Maximilian University, Munich, Germany
| | - Annika Klompmaker
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Patrick Téoule
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christoph Reißfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nuh N Rahbari
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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3
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Feinberg J, Zivanovic O, Hannon M, McCready T, Desai P, Kim SH, Aviki EM, Mueller JJ, Jewell EL, Roche KL, Gardner GJ, Chi DS, Sonoda Y, Brown CL, Abu-Rustum NR, Cracchiolo JR, Leitao MM, Broach V. Patient-reported symptoms after minimally invasive hysterectomy and association with postoperative complications. Gynecol Oncol 2023; 175:163-168. [PMID: 37390597 PMCID: PMC10939506 DOI: 10.1016/j.ygyno.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE To describe patient-reported postoperative symptoms and to evaluate the use of digital symptom tracking and alerts to detect postoperative complications. METHODS We retrospectively reviewed patients who underwent a minimally invasive hysterectomy and enrolled in our Recovery Tracker program from 4/5/17-12/31/21. The Recovery Tracker is an at-home virtual tool used to track patient-reported postoperative symptoms for 10 days. Predefined thresholds for "red" and "yellow" alerts are based on symptom severity and timing. Data on patient demographics, surgery, and postoperative course were collected to evaluate the association of alerts with complications and compare outcomes of patients who did/did not enroll in the program. RESULTS Of 2362 eligible patients, 1694 (71.7%) enrolled in the Recovery Tracker program. Pain was the most severe symptom, followed by fatigue. Eighty-seven patients experienced 102 complications (5.1% complication rate) and 32 experienced 39 grade ≥ 2 complications (1.9% severe complication rate). Excluding complications that occurred prior to Recovery Tracker use, 1673 patients experienced 28 grade ≥ 2 complications. Of 345 patients (20.6%) who triggered a red alert, 13 (3.8%) had a grade ≥ 2 complication. Of 1328 patients (79.4%) with no red alerts, 15 (1.13%) had a grade ≥ 2 complication. Relative risk of a grade ≥ 2 complication if a red alert was triggered was 3.25 (95% CI: 1.6-6.9, P = .002). Rate of severe complications was significantly higher among patients who did not use the tool (3.3% vs 1.9%; P = .04). CONCLUSIONS The Recovery Tracker tool may assist in early identification of postoperative symptoms after minimally invasive hysterectomy.
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Affiliation(s)
- Jacqueline Feinberg
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Michael Hannon
- Patient-Reported Outcomes Center, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Taylor McCready
- Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Priyanka Desai
- Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sarah H Kim
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Emeline M Aviki
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Jennifer J Mueller
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Elizabeth L Jewell
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Carol L Brown
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Jennifer R Cracchiolo
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Vance Broach
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA.
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4
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McCready TM, Stabile C, Vickers A, Ancker JS, Pusic A, Temple LK, Simon BA, Carter J. A Remote Symptom Monitoring Tool As Part of Ambulatory Cancer Surgery Recovery: A Qualitative Analysis of Patient Experience. JCO Oncol Pract 2023; 19:595-601. [PMID: 37235840 PMCID: PMC10424896 DOI: 10.1200/op.23.00017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/06/2023] [Accepted: 04/12/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE Patients recovering from ambulatory cancer surgery at home may find it difficult to determine whether their postoperative symptoms are normal or potentially serious. We developed the Recovery Tracker to help patients navigate such issues. The Recovery Tracker is a 10-day, web-based electronic survey that monitors symptoms daily and provides feedback as to whether reported symptoms are expected or require follow-up. We sought to examine patient perceptions using this tool. METHODS Semistructured interviews were conducted from August 2017 to September 2019 with a convenience sample of patients from a larger randomized controlled trial of the Recovery Tracker. Patients undergoing surgery at an ambulatory cancer center dedicated to the surgical treatment of breast, gynecologic, urologic, head, and neck cancers and benign tumors were included. Thematic analysis was applied to derive key themes and codes via NVivo qualitative analysis software. Recruitment was conducted iteratively until thematic saturation. RESULTS Forty-three patients were interviewed. Interview responses were organized into five main themes: (1) The Recovery Tracker led to more seamless communication with the care team; (2) symptoms not expected or not listed on the Recovery Tracker caused stress; (3) the Recovery Tracker was perceived as an extension of care, prompting reflection about symptoms and recovery; (4) Enhanced Feedback provided reassurance and helped set expectations; and (5) the Recovery Tracker was easy to use. CONCLUSION The patient experience of electronic symptom monitoring and feedback is congruent with the aims of such monitoring and feedback. Further qualitative research is required in more diverse populations.
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Affiliation(s)
- Taylor M. McCready
- Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, NY
- Current Address: Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Cara Stabile
- Department of Surgery, Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jessica S. Ancker
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN
| | - Andrea Pusic
- Department of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard University, Boston, MA
| | - Larissa K.F. Temple
- Department of Surgery, Colorectal Surgery Division, University of Rochester Medical Center, Rochester, NY
| | - Brett A. Simon
- Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY
| | - Jeanne Carter
- Department of Surgery, Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Psychiatry, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Psychology, Weill Cornell Medical College, New York, NY
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5
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Perez F, Nolde M, Crane TE, Kebria M, Chan K, Dellinger T, Sun V. Integrative review of remote patient monitoring in gynecologic and urologic surgical oncology. J Surg Oncol 2023; 127:1054-1061. [PMID: 36821093 DOI: 10.1002/jso.27222] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
Patients with cancer facing complex and invasive urologic and gynecologic cancer surgery often experience symptoms and rapid declines in functional capacity postoperatively. Remote patient monitoring that leverages patient-generated health data is a potential approach to assess and promote postoperative recovery. This integrative review aims to provide an overview of the current literature and research on remote patient monitoring in gynecologic and urologic surgical oncology.
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Affiliation(s)
- Fernanda Perez
- Department of Population Sciences, City of Hope, Duarte, California, USA
| | | | - Tracy E Crane
- Division of Medical Oncology, Miller School of Medicine, University of Miami Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Mehdi Kebria
- Department of Surgery, Division of Gynecologic Oncology, City of Hope, Duarte, California, USA.,Department of Surgery, City of Hope, Duarte, California, USA
| | - Kevin Chan
- Department of Surgery, Division of Urologic Oncology, City of Hope, Duarte, California, USA.,Department of Surgery, City of Hope, Duarte, California, USA
| | - Thanh Dellinger
- Department of Surgery, Division of Gynecologic Oncology, City of Hope, Duarte, California, USA.,Department of Surgery, City of Hope, Duarte, California, USA
| | - Virginia Sun
- Department of Population Sciences, City of Hope, Duarte, California, USA.,Department of Surgery, City of Hope, Duarte, California, USA
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Thomas TH, Murray PJ, Rosenzweig M, Taylor S, Brufsky A, Bender C, Larkin M, Schenker Y. "I was never one of those people who just jumped right in for me": patient perspectives on self-advocacy training for women with advanced cancer. Support Care Cancer 2023; 31:96. [PMID: 36598659 PMCID: PMC9811054 DOI: 10.1007/s00520-022-07531-3] [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: 03/24/2022] [Accepted: 11/19/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Patients with advanced cancer experience many complicated situations that can make self-advocacy (defined as the ability speak up for yourself in the face of a challenge) difficult. Few self-advocacy interventions exist, and most are atheoretical with minimal patient engagement. The purpose of this study is to describe participant perspectives of a novel, self-advocacy serious game intervention called Strong Together. METHODS This was a qualitative cross-sectional descriptive study among women receiving cancer care at an academic cancer center within 3 months of an advanced gynecologic or breast cancer diagnosis. Participants randomized to receive the intervention completed one-on-one semi-structured interviews 3-months post Strong Together and had the option to share voice journals about their experiences. Inductive qualitative approaches were used to descriptively analyze transcripts and voice journals. Descriptive content analysis approaches were used to group similar codes together into themes summarizing participants' experiences engaging with the Strong Together intervention. RESULTS Participants (N = 40) reported that the Strong Together intervention was acceptable, noting that it was realistic and reflective of their personal experiences. Overarching themes included seeing myself in most scenarios and wanting more content; giving me the go ahead to expect more; offering ideas for how to stand up for myself; reinforcing what I am already doing; and reminding me of what I have. Participants suggested adding additional content including diverse characters. CONCLUSION This study demonstrated that women with advanced cancer were receptive to a self-advocacy skills-building intervention. Future research should explore the mechanisms linking serious games to learning and health outcomes.
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Affiliation(s)
- Teresa Hagan Thomas
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Suite 440, Pittsburgh, PA 15261 USA ,Palliative Research Center (PaRC), University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213 USA
| | - Patty Jo Murray
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Suite 440, Pittsburgh, PA 15261 USA
| | - Margaret Rosenzweig
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Suite 440, Pittsburgh, PA 15261 USA ,Palliative Research Center (PaRC), University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213 USA ,University of Pittsburgh Medical Center Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213 USA
| | - Sarah Taylor
- University of Pittsburgh Medical Center Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213 USA ,Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of Pittsburgh, 1218 Scaife Hal, 3550 Terrace Street, Pittsburgh, PA 15261 USA
| | - Adam Brufsky
- University of Pittsburgh Medical Center Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213 USA ,Division of Hematology/Oncology, School of Medicine, University of Pittsburgh, 1218 Scaife Hal, 3550 Terrace Street, Pittsburgh, PA 15261 USA
| | - Catherine Bender
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Suite 440, Pittsburgh, PA 15261 USA
| | - Mikayla Larkin
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, 100 Technology Drive, Pittsburgh, PA 15219 USA
| | - Yael Schenker
- Palliative Research Center (PaRC), University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213 USA ,Division of General Internal Medicine, School of Medicine, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213 USA
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You H, Lei A, Li X, Liao X, Chang J. Discharge teaching, patient-reported discharge readiness and postsurgical outcomes in gynecologic patients undergoing day surgery: a generalized estimating equation. BMC Surg 2022; 22:166. [PMID: 35538567 PMCID: PMC9092867 DOI: 10.1186/s12893-022-01607-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: 02/05/2022] [Accepted: 04/18/2022] [Indexed: 12/02/2022] Open
Abstract
Background Gynecologic patients undergoing day surgery are discharged in an intermediate stage of recovery. The quality of discharge teaching and discharge readiness are important to patients’ postsurgical outcomes, but little research has focused on them. Methods Quality of discharge teaching and discharge readiness were measured, and Spearman correlations were conducted. Postsurgical outcomes were recorded on postoperative Day 1, postoperative Day 7, and postoperative Day 28. Generalized estimating equations were used to explore factors that influence postsurgical outcomes. Results Discharge teaching was verified to be positively correlated with the discharge readiness of participants. The generalized estimating equations indicated that discharge teaching skills, effects of doctors and nurses, patient-reported physical conditions and social support following discharge were protective factors for postsurgical outcomes. Conclusions Doctors and nurses should improve discharge teaching skills and effects to improve the postsurgical outcomes of gynecological patients undergoing day surgery. At discharge, doctors and nurses should assess patients’ physical condition and facilitate a social support system.
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Affiliation(s)
- Huaxuan You
- Department of Obstetrics and Gynecology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Anjiang Lei
- Department of Obstetrics and Gynecology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xin Li
- Department of Obstetrics and Gynecology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
| | - Xu Liao
- Department of Obstetrics and Gynecology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
| | - Jing Chang
- Department of Obstetrics and Gynecology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
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Carter J, Abu-Rustum NR, Saban S, Chen LY, Vickers AJ, Tin AL, Billanti G, Connors NA, Broach V, Brown CL, Chi DS, Gardner GJ, Goldfrank DJ, Jewell EL, Leitao MM, Long Roche KC, Mueller JJ, Sonoda Y, Zivanovic O. Gynecologic Survivorship Tool: Development, Implementation, and Symptom Outcomes. JCO Clin Cancer Inform 2022; 6:e2100154. [PMID: 35239413 PMCID: PMC8920469 DOI: 10.1200/cci.21.00154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To describe the development and implementation of a new digital health clinical tool (Gynecologic Survivorship Tool [GST]) for symptom management of women surgically treated for gynecologic cancer; to assess its feasibility; and to conduct a retrospective review of the data. MATERIALS AND METHODS The GST was developed on the basis of a comprehensive review of the literature, multidisciplinary expert opinion, and feedback from women with a history of gynecologic cancer. It is composed of 17 questions addressing six main categories-gynecologic health (abnormal bleeding/pain), lymphedema, vaginal/vulvar dryness, sexual health, menopause (hot flushes/sleep difficulties), and bowel/urinary issues. An electronic version using the Memorial Sloan Kettering Cancer Center Engage platform was piloted in two clinics for patients with endometrial or cervical cancer. Health information was generated into clinical summaries and identified concerns for actionable response. Associations of symptom and survey time point were assessed by longitudinal models using generalized estimating equations. RESULTS From January 1, 2019, to February 29, 2020, 3,357 GST assessments were assigned to 1,405 patients, with a 71% completion rate (90% within 5 minutes). Sixty-eight percent were performed at home via a patient portal, 32% at follow-ups using a clinic iPad. The most common symptoms were bowel problems, swelling/fluid, pain during examination, vaginal or vulvar dryness, and vaginal bleeding. Implementation challenges included improving patient compliance and ensuring that reports were reviewed by all clinical teams. We developed screening e-mails detailing patients whose assessments were due, planned training sessions for multidisciplinary teams, and incorporated feedback on methods for reviewing symptoms reports. CONCLUSION The GST demonstrated feasibility, a high completion rate, and minimal time commitment. It was an effective electronic reporting mechanism for patients, enabling the medical team to develop specific strategies for alleviating bothersome symptoms during follow-up.
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Affiliation(s)
- Jeanne Carter
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Psychiatry, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Psychiatry, Weill Cornell Medical College, New York, NY,Jeanne Carter, PhD, Gynecology Service, Department of Surgery Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, Floor 7, New York, NY 10022; e-mail:
| | - Nadeem R. Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY
| | - Sally Saban
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ling Y. Chen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew J. Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amy L. Tin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gabriela Billanti
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nicole A. Connors
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vance Broach
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY
| | - Carol L. Brown
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY
| | - Dennis S. Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY
| | - Ginger J. Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY
| | - Deborah J. Goldfrank
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY
| | - Elizabeth L. Jewell
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY
| | - Mario M. Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY
| | - Kara C. Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY
| | - Jennifer J. Mueller
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY
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Guerra-Londono CE, Kim D, Ramirez Manotas MF. Ambulatory surgery for cancer patients: current controversies and concerns. Curr Opin Anaesthesiol 2021; 34:683-689. [PMID: 34456269 DOI: 10.1097/aco.0000000000001049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW This review aims to describe the main concerns and controversies of ambulatory surgery in cancer patients while providing an overview of ambulatory cancer anaesthesia. RECENT FINDINGS Cancer patients can undergo a variety of ambulatory surgeries. The introduction of robotic approach and the implementation of enhanced recovery programmes have allowed patients to avoid hospital admissions after more complex or invasive surgeries. In this context, the anaesthesiologist plays a key role in ensuring that the ambulatory surgical centre or the hospital-based ambulatory department is equipped for the perioperative challenges of the cancer population. Cancer patients tend to be older and with more comorbidities than the general population. In addition, these individuals may suffer from chronic conditions solely because of the cancer itself, or the treatment. Consequently, frailty is not uncommon and should be screened on a routine basis. Regional analgesia plays a key role in the provision of opioid-sparing multimodal analgesia. SUMMARY Neither regional anaesthesia or general anaesthesia have proven to affect the long-term oncological outcomes of cancer patients undergoing ambulatory surgery. In addition, there is insufficient evidence to suggest the use of total intravenous anaesthesia or inhalational anaesthesia over the other to decrease cancer recurrence.
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Affiliation(s)
- Carlos E Guerra-Londono
- Department of Anesthesiology and Perioperative Medicine, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
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Billingy NE, Tromp VNMF, Veldhuijzen E, Belderbos J, Aaronson NK, Feldman E, Hoek R, Bogaard HJ, Onwuteaka-Philipsen BD, van de Poll-Franse L, Hugtenburg JG, van den Hurk CJG, Becker-Commissaris A, Walraven I. SYMptom monitoring with Patient-Reported Outcomes using a web application among patients with Lung cancer in the Netherlands (SYMPRO-Lung): study protocol for a stepped-wedge randomised controlled trial. BMJ Open 2021; 11:e052494. [PMID: 34518276 PMCID: PMC8438957 DOI: 10.1136/bmjopen-2021-052494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/16/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Lung cancer and its treatment cause a wide range of symptoms impacting the patients' health-related quality of life (HRQoL). The use of patient-reported outcomes (PRO) to monitor symptoms during and after cancer treatment has been shown not only to improve symptom management but also to improve HRQoL and overall survival (OS). Collectively, these results favour implementation of PRO-symptom monitoring in daily clinical care. However, these promising outcomes have been obtained under trial conditions in which patients were selected based on stringent inclusion criteria, and in countries with a dissimilar healthcare system than in the Netherlands.The primary aim of the SYMptom monitoring with Patient-Reported Outcomes using a web application among patients with Lung cancer in the Netherlands (SYMPRO-Lung) study is to evaluate the effect of PRO-symptom monitoring during and after lung cancer treatment on HRQoL in daily clinical practice. Secondary objectives include assessing the effect of PRO-symptom monitoring on progression-free survival, OS, the incidence and grade of PRO symptoms, medication adherence, implementation fidelity and cost-effectiveness. METHODS AND ANALYSIS The SYMPRO-Lung study is a prospective, multicentre trial with a stepped wedge cluster randomised design. Study participants (n=292 intervention, n=292 controls) include patients with lung cancer (stages I-IV) starting treatment with surgery, systemic treatment, targeted treatment and/or radiotherapy.Every participating centre will consecutively switch from the control period to the intervention period, in which patients report their symptoms weekly via an online tool. In the intervention group, we evaluate two alert approaches: the active and reactive approach. If the symptoms exceed a predefined threshold, an alert is sent to the healthcare provider (active approach) or to the patient (reactive approach). Both the control and intervention group complete HRQoL questionnaires at 4 time points: at baseline, 15 weeks, 6 months and 1-year post treatment). Differences in HRQoL between the groups will be compared using linear mixed modelling analyses, accounting for within-centre clustering, potential time effects and confounding. ETHICS AND DISSEMINATION The study protocol was approved by the Institutional Review Board and the Medical Ethics Committee of the Amsterdam UMC (under number NL 68440.029.18) and the institutional review boards of the participating study sites. The dissemination of the results will be conducted through publication in peer-reviewed journals and through scientific conferences. TRIAL REGISTRATION NUMBER Trial register identifier: Netherlands Trial register Trial NL7897. Date of registration: 24 July 2019. https://www.trialregister.nl/trial/7897.
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Affiliation(s)
- Nicole E Billingy
- Department of Pulmonary Diseases, Amsterdam UMC Location VUmc, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Vashti N M F Tromp
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Evalien Veldhuijzen
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Jose Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Esther Feldman
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Rianne Hoek
- Department of Pulmonary Diseases, Amsterdam UMC Location VUmc, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Harm-Jan Bogaard
- Department of Pulmonary Diseases, Amsterdam UMC Location VUmc, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Cancer Center Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Lonneke van de Poll-Franse
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
- CoRPS - Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Noord-Brabant, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Tilburg, Noord-Brabant, The Netherlands
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Corina J G van den Hurk
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Tilburg, Noord-Brabant, The Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, Amsterdam UMC Location VUmc, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Iris Walraven
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
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Simon BA, Assel MJ, Tin AL, Desai P, Stabile C, Baron RH, Cracchiolo JR, Twersky RS, Vickers AJ, Laudone VP. Association Between Electronic Patient Symptom Reporting With Alerts and Potentially Avoidable Urgent Care Visits After Ambulatory Cancer Surgery. JAMA Surg 2021; 156:740-746. [PMID: 34076691 DOI: 10.1001/jamasurg.2021.1798] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Importance Increasingly complex surgical procedures are being performed in the outpatient setting, increasing the burden on patients and caregivers to manage their postoperative symptoms. Electronic patient-reported symptom tracking may reduce this burden and help patients distinguish between expected symptoms and those requiring intervention. Objective To determine whether electronic symptom reporting with clinical alerts for 10 days after ambulatory cancer surgery is associated with a reduction in potentially avoidable urgent care visits, defined as a visit not leading to admission. Design, Setting, and Participants This retrospective cohort study was conducted at the Josie Robertson Surgery Center (JRSC), Memorial Sloan Kettering Cancer Center's ambulatory surgery center with overnight stay capacity from September 20, 2016, to December 31, 2018. Patients undergoing prostatectomy, nephrectomy, mastectomy with or without immediate reconstruction, hysterectomy, or thyroidectomy at the surgery center before (n = 4195) and after (n = 2970) implementation of the Recovery Tracker (RT) electronic postoperative symptom survey were included. Data analyses were conducted from February 1 to November 24, 2020. Exposures A short electronic survey assessing symptoms daily for 10 days after surgery, administered via the patient portal, with alerts to the clinical team and follow-up for concerning responses. Main Outcomes and Measures The main outcome was Memorial Sloan Kettering urgent care center visits with and without readmission and any readmission within 30 days after surgery. Nursing workload was measured by patient phone calls, emails, and secure messages as documented in the electronic medical record. Results A total of 7165 patients were analyzed, including 4195 (median age, 53 [interquartile range (IQR), 44-63] years; 3490 women [83%]) from the pre-RT implementation period and 2970 (median age, 56 [IQR, 46-65] years; 2221 women [75%]) from after full implementation. On multivariable, intent-to-treat analysis by study period, having surgery in the post-RT period was associated with a 22% decrease in the odds of an urgent care center visit without readmission (OR, 0.78; 95% CI, 0.60-1.00; P = .047). Having responded to at least 1 survey was associated with a 42% reduction in the odds of an urgent care center visit without readmission (OR, 0.58; 95% CI, 0.39-0.87; P = .007). There was no change in the risk of admission. Nursing calls increased by a mean of 0.86 (95% CI, 0.75-0.98) calls per patient after RT implementation (P < .001), a 34% increase. Conclusions and Relevance In this cohort study, electronic symptom reporting with nursing follow-up for clinical alerts was associated with a reduction in potentially avoidable urgent care visits. The low risk and high benefit of this intervention suggest that these systems should be more broadly implemented.
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Affiliation(s)
- Brett A Simon
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Anesthesiology, Weill Cornell Medical College, New York, New York
| | - Melissa J Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amy L Tin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Priyanka Desai
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cara Stabile
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Roberta H Baron
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Rebecca S Twersky
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Anesthesiology, Weill Cornell Medical College, New York, New York
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vincent P Laudone
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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