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Pabón-Salazar YK, Vela-Prieto CJ, Mera-Urbano GA, García-Perdomo HA, Polanco-Pasaje JE. Advanced breast, cervical and prostate cancer- Patient needs: systematic review. BMJ Support Palliat Care 2023:spcare-2023-004186. [PMID: 37527914 DOI: 10.1136/spcare-2023-004186] [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: 01/23/2023] [Accepted: 07/14/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND There are high rates registered globally of breast cancer, cervical and prostate. People going through have needs that cause an impact in their life's quality, especially in the final stages of the illness. GOAL To characterise the most evaluated and afflicted physical, emotional, roll, cognitive, social and spiritual needs of patients in the final stages of breast, cervical and prostate cancer. INTERVENTIONS/METHODS A thorough systematic search of databases such as Medline (Ovid) and Embase, from databases' creation throughout 31 December 2021. Quantitative studies were included to evaluate, from the adoption of tools, the dimensions or needs of people going under three types of cancer on final stages. RESULTS Twelve studies were included. More common symptoms such as nausea/vomiting and pain were the most evaluated with 83%. Fifty-eight per cent of papers studied the emotional function of people with breast and prostate cancer. Other 42% included roll, cognitive and social appreciations. Sexual, cognitive and physical, in that line, were the most affected. The most common questionnaires used to measure oncological patients on final stages were those from European Organisation for Research and Treatment of Cancer on its C-30, BR-23, C-15 PAL and CR-25 versions. CONCLUSIONS On breast and prostate cancer, the most affected aspect was the sexual dysfunction, while for cervical cancer, the physical function was the most altered one. Spiritual dimension was not included in any of the evaluated literature.
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Affiliation(s)
| | - César José Vela-Prieto
- Nursing, TJENG Research Group, Universidad del Cauca Facultad de Ciencias de la Salud, Popayán, Cauca, Colombia
| | - Gladys Amanda Mera-Urbano
- Nursing, TJENG Research Group, Universidad del Cauca Facultad de Ciencias de la Salud, Popayán, Cauca, Colombia
| | - Herney Andrés García-Perdomo
- Division of Urology/Urooncology, Departament of Surgery, School of Medicine, Universidad del Valle Facultad de Salud, Cali, Valle del Cauca, Colombia
| | - Jhon Edwin Polanco-Pasaje
- Nursing, TJENG Research Group, Universidad del Cauca Facultad de Ciencias de la Salud, Popayán, Cauca, Colombia
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Okumura H, Inoue S, Naidoo S, Holmstrom S, Akaza H. Cost-effectiveness analysis of enzalutamide for patients with chemotherapy-naïve metastatic castration-resistant prostate cancer in Japan. Jpn J Clin Oncol 2021; 51:1319-1329. [PMID: 34037235 PMCID: PMC8326386 DOI: 10.1093/jjco/hyab071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 04/24/2021] [Accepted: 04/29/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We aimed to evaluate cost-effectiveness of enzalutamide in chemotherapy-naïve metastatic castration-resistant prostate cancer patients in Japan. METHODS A Markov model was developed to capture time spent by patients in various health states: stable, progression and death. Abiraterone acetate and docetaxel were set as active comparators. Clinical outcomes were obtained from the PREVAIL, COU-AA-302 and TAX327 trials. Treatment sequence, concomitant drugs and therapies for adverse events were estimated from responses to a survey by 14 Japanese prostate cancer experts. The analytic perspective was public healthcare payer, with a 10-year time horizon. The incremental cost-effectiveness ratio was estimated from quality-adjusted life-years and Japanese public healthcare costs. Probabilistic sensitivity analysis was performed to assess the robustness of the findings. RESULTS According to the survey, the most common treatment sequences were (i) enzalutamide → docetaxel → cabazitaxel (enzalutamide-first sequencing), (ii) abiraterone → enzalutamide → docetaxel (abiraterone-first sequencing) and (iii) docetaxel→ enzalutamide → cabazitaxel (docetaxel-first sequencing). In the base-case analysis, enzalutamide-first sequencing saved 1.74 million Japanese Yen versus abiraterone-first sequencing, with a 0.129 quality-adjusted life-year gain (dominant). Enzalutamide-first sequencing had a cost increase of 4.44 million Japanese Yen over docetaxel-first sequencing, with a 0.371 quality-adjusted life-years gain. The incremental cost-effectiveness ratio of enzalutamide-first sequencing versus docetaxel-first sequencing was estimated as 11.94 million Japanese Yen/quality-adjusted life-years. Probabilistic sensitivity analyses demonstrated that, compared with abiraterone-first sequencing, enzalutamide-first sequencing had an 87.4% probability of being dominant. CONCLUSIONS Results modeled herein suggest that the enzalutamide-first sequencing is more cost-effective than the abiraterone-first sequencing, but less cost-effective than docetaxel-first sequencing for chemotherapy-naïve patients with metastatic castration-resistant prostate cancer.
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Affiliation(s)
| | - Sachie Inoue
- CRECON Medical Assessment Inc., Shibuya-ku, Tokyo, Japan
| | | | | | - Hideyuki Akaza
- Strategic Investigation on Comprehensive Cancer Network, The University of Tokyo, Tokyo, Japan
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Ghijben P, Petrie D, Zavarsek S, Chen G, Lancsar E. Healthcare Funding Decisions and Real-World Benefits: Reducing Bias by Matching Untreated Patients. PHARMACOECONOMICS 2021; 39:741-756. [PMID: 33834425 DOI: 10.1007/s40273-021-01020-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 06/12/2023]
Abstract
Governments and health insurers often make funding decisions based on health gains from randomised controlled trials. These decisions are inherently uncertain because health gains in trials may not translate to practice owing to differences in the population, treatment use and setting. Post-market analysis of real-world data can provide additional evidence but estimates from standard matching methods may be biased when unobserved characteristics explain whether a patient is treated and their outcomes. We propose a new untreated matching approach that can reduce this bias. Our approach utilises the outcomes of contemporaneous untreated patients to improve the matching of treated and historical control patients. We assess the performance of this new approach compared to standard matching using a simulation study and demonstrate the steps required using a funding decision for prostate cancer treatments in Australia. Our simulation study shows that our new matching approach eliminates nearly all bias when unobserved treatment selection is related to outcomes, and outperforms standard matching in most scenarios. In our empirical example, standard matching overestimated survival by 15% (95% confidence interval 2-34) compared to our untreated matching approach. The health gains estimated using our approach were slightly lower than expected based on the trial evidence, but we also found evidence that in practice prescribers ceased prior therapies earlier, treated a more vulnerable population and continued treatment for longer. Our untreated matching approach offers researchers a new tool for reducing uncertainty in healthcare funding decisions using real-world data.
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Affiliation(s)
- Peter Ghijben
- Centre for Health Economics, Monash Business School, Monash University, Caulfield East, VIC, Australia.
| | - Dennis Petrie
- Centre for Health Economics, Monash Business School, Monash University, Caulfield East, VIC, Australia
| | - Silva Zavarsek
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, VIC, Australia
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Caulfield East, VIC, Australia
| | - Emily Lancsar
- Department of Health Services Research and Policy, College of Health and Medicine, The Australian National University, Acton, ACT, Australia
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Hird AE, Magee DE, Cheung DC, Matta R, Kulkarni GS, Nam RK. Abiraterone vs. docetaxel for metastatic hormone-sensitive prostate cancer: A microsimulation model. Can Urol Assoc J 2020; 14:E418-E427. [PMID: 32223875 PMCID: PMC7492043 DOI: 10.5489/cuaj.6234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Our aim was to determine whether androgen deprivation therapy (ADT) with abiraterone acetate (AA) or ADT with docetaxel chemotherapy (DC) resulted in improved quality-adjusted life years (QALYs) among men with de novo metastatic castration-sensitive prostate cancer (mCSPC) and the cost effectiveness of the preferred strategy using decision analytic techniques. METHODS A microsimulation model with a lifetime time horizon was constructed. Our primary outcome was QALYs. Secondary outcomes included cost, incremental cost effectiveness ratio (ICER), unadjusted overall survival (OS), rates of second- and third-line therapy, and adverse events. A systematic literature review was used to generate probabilities and utilities to populate the model. The base case was a 65-year-old patient with de novo mCSPC. RESULTS A total of 100 000 microsimulations were generated. Initial AA resulted in a gain of 0.45 QALYs compared to DC (3.36 vs. 2.91 QALYs) with an ICER of $276 251.82 per QALY gained with initial AA therapy. Median crude OS was 51 months with AA and 48 months with DC. Overall, 46.6% and 42.6% of patients received second-line therapy and 8.7% and 7.9% patients received third-line therapy in the AA and DC groups, respectively. Grade 3/4 adverse events were experienced in 17.6% of patients receiving initial AA and 22.3% of patients receiving initial DC. CONCLUSIONS Although ADT with AA results in a gain in QALYs and crude OS compared to DC, AA therapy is not a cost-effective treatment strategy to apply uniformly to all patients. The availability of AA as a generic medication may help to close this gap. The ultimate choice should be based on patient and tumor factors.
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Affiliation(s)
- Amanda E. Hird
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Diana E. Magee
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of Urology, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada
| | - Douglas C. Cheung
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of Urology, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada
| | - Rano Matta
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Girish S. Kulkarni
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of Urology, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada
| | - Robert K. Nam
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
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Kuppen MCP, Westgeest HM, van den Eertwegh AJM, Coenen JLLM, van Moorselaar RJA, van den Berg P, Geenen MM, Mehra N, Hendriks MP, Lampe MI, van de Luijtgaarden ACM, Peters FPJ, Roeleveld TA, Smilde TJ, de Wit R, van Oort IM, Gerritsen WR, Uyl-de Groot CA. Health-related Quality of Life and Pain in a Real-world Castration-resistant Prostate Cancer Population: Results From the PRO-CAPRI Study in the Netherlands. Clin Genitourin Cancer 2019; 18:e233-e253. [PMID: 31883940 DOI: 10.1016/j.clgc.2019.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/18/2019] [Accepted: 11/27/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND The purpose of this study was to determine generic, cancer-specific, and prostate cancer-specific health-related quality of life (HRQoL), pain and changes over time in patients with metastatic castration-resistant prostate cancer (mCRPC) in daily practice. PATIENTS AND METHODS PRO-CAPRI is an observational, prospective study in 10 hospitals in the Netherlands. Patients with mCRPC completed the EQ-5D, European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and Brief Pain Inventory-Short Form (BPI-SF) every 3 months and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-Prostate Cancer Module (EORTC QLQ-PR25) every 6 months for a maximum of 2 years. Subgroups were identified based on chemotherapy pretreatment. Outcomes were generic, cancer-specific, and prostate cancer-specific HRQoL and self-reported pain. Descriptive statistics were performed including changes over time and minimal important differences (MID) between subgroups. RESULTS In total, 151 included patients answered 873 questionnaires. The median follow-up from the start of the study was 19.5 months, and 84% were treated with at least 1 life-prolonging agent. Overall, patients were in good clinical condition (Eatern Cooperative Oncology Group performance status 0-1 in 78%) with normal baseline hemoglobin, lactate dehydrogenase, and alkaline phosphatase. At inclusion, generic HRQoL was high with a mean EQ visual analog score of 73.2 out of 100. The lowest scores were reported on role and physical functioning (mean scores of 69 and 76 of 100, respectively), and fatigue, pain, and insomnia were the most impaired domains. These domains deteriorated in > 50% of patients. CONCLUSION Although most patients were treated with new treatments during follow-up, mCRPC has a negative impact on HRQoL with deterioration in all domains over time, especially role and physical functioning. These domains need specific attention during follow-up to maintain HRQoL as long as possible by timely start of adequate supportive care management.
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Affiliation(s)
- Malou C P Kuppen
- Institute for Medical Technology Assessment, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
| | - Hans M Westgeest
- Department of Internal Medicine, Amphia Hospital, Breda, the Netherlands
| | | | | | | | - Pieter van den Berg
- Department of Internal Medicine, TerGooi Ziekenhuizen, Hilversum, the Netherlands
| | - Maud M Geenen
- Department of Internal Medicine, OLVG, Amsterdam, the Netherlands
| | - Niven Mehra
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mathijs P Hendriks
- Department of Internal Medicine, Northwest Clinics, Alkmaar, the Netherlands
| | - Menuhin I Lampe
- Department of Urology, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Addy C M van de Luijtgaarden
- Department of Internal Medicine, Reinier de Graaf Gasthuis and Reineir Haga Prostate Cancer Center, Delft, the Netherlands
| | - Frank P J Peters
- Department of Internal Medicine, Zuyderland Medical Center, Heerlen-Sittard-Geleen, the Netherlands
| | - Ton A Roeleveld
- Department of Urology, Northwest Clinics, Alkmaar, the Netherlands
| | - Tineke J Smilde
- Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Ronald de Wit
- Department of Medical Oncology, Erasmus MC Daniel den Hoed Cancer Center, Rotterdam, the Netherlands
| | - Inge M van Oort
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Winald R Gerritsen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Carin A Uyl-de Groot
- Institute for Medical Technology Assessment, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
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De Vincentis G, Frantellizzi V, Follacchio GA, Farcomeni A, Pani A, Samaritani R, Schinzari G, Santini D, Cortesi E. No evidence of association between psychological distress and pain relief in patients with bone metastases from castration-resistant prostate cancer treated with 223Radium. Eur J Cancer Care (Engl) 2019; 28:e13112. [PMID: 31148330 DOI: 10.1111/ecc.13112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 01/24/2019] [Accepted: 05/14/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Painful bone metastases cause reduced quality of life (QoL) in patients with castration-resistant prostate cancer (CRPC). Alpha-emitter 223Radium is associated with a clear survival benefit and significant bone pain palliation in CRPC patients with symptomatic bone metastases. The aim of this study was to evaluate the association between pain relief and psychological distress during the time course of therapy in patients treated with 223Radium. METHODS A total of 63 patients with mCRPC undergoing 223Radium treatment in our Nuclear Medicine Unit, carefully instructed on the possibility of improving the pain and increasing the survival by the treatment, were retrospectively evaluated. Pain response during treatment was assessed with the Brief Pain Inventory Numeric Rating Scale. Psychological distress was evaluated through the analysis of specific items from EORTC QoL questionnaires C30 and BM22, submitted to patients at baseline and after each 223Radium cycle. RESULTS Pain intensity showed a significant decrease after first 223Radium administration (-1.03 points, p = 0.0032), with a subsequent stability through the course of treatment (-1.30 points, p = <0.001). Psychological status did not show significant variations during 223Radium treatment, and no association was found between psychological status and pain relief in our population. CONCLUSIONS In our experience, bone pain palliation provided by 223Radium do not correlate with an improved psychological status in patients with advanced PC. This observation emphasises the role of the psychological aspect in the evaluation of the QoL and the necessity of a multidisciplinary approach in which the emotional aspect of the patient is carefully evaluated.
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Affiliation(s)
- Giuseppe De Vincentis
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Rome, Italy
| | - Viviana Frantellizzi
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Rome, Italy.,PhD Program: Angio-Cardio-Thoracic Pathophisiology and Imaging, "Sapienza" University of Rome, Rome, Italy
| | - Giulia Anna Follacchio
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Rome, Italy
| | - Alessio Farcomeni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Arianna Pani
- Postgraduate School of Clinical Pharmacology, University of Milan "La Statale", Milan, Italy
| | | | - Giovanni Schinzari
- Institute of Internal Medicine, Clinical Oncology Unit, Catholic University of Sacred Heart, Rome, Italy
| | - Daniele Santini
- Medical Oncology Department, Campus Bio-Medico University, Rome, Italy
| | - Enrico Cortesi
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Rome, Italy
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Knox-Rice T, Xuan L, Wadsworth H, Halm EA, Rhodes RL. Examining the Association between Healthcare Utilization and Clinical Characteristics among Cancer Patients in a Safety Net Health System. J Palliat Med 2018; 22:80-83. [PMID: 30265596 DOI: 10.1089/jpm.2018.0202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The goal of this study was to examine the association between available patient and clinical characteristics and healthcare utilization in a cohort of breast, lung, and colorectal cancer patients within a safety-net hospital system. METHODS Data for 979 breast, lung, and colorectal cancer patients admitted to a large, urban hospital for the year 2010 were extracted from the electronic medical record (EMR). Univariate and multivariate logistic regression analyses were performed to examine the association between relevant independent variables that were able to be captured from the EMR in discrete fields, emergency room (ER) utilization, and hospitalizations among members of the cohort. Spearman correlation coefficients to test the correlations between nonsteroidal anti-inflammatory drug and opioid prescriptions and healthcare utilization were also calculated. RESULTS Of the 979 patients, 22% were 65 years and older, 43% were non-Hispanic black, 42% had Medicare, and 56% had colorectal cancer. Patient and clinical characteristics that were associated with increased ER utilization, included Hispanic ethnicity (adjusted odds ratio; AOR: 2.21, 95% confidence interval; CI: 1.52-3.21), non-Hispanic black race (AOR: 2.01, 95% CI: 1.43-2.82), and referral to palliative care (AOR: 2.15, 95% CI: 1.36-3.41). Referral to palliative care (AOR: 3.84, 95% CI: 1.47-10.0), low albumin (AOR: 2.42, 95% CI: 1.20-4.89), and presence of metastases (AOR: 1.98, 95% CI: 1.29-3.06) were associated with greater odds of hospitalization. Number of opioids prescribed strongly correlated with number of hospitalizations (ρ correlation = 0.74). Only 10.6% of patients had been referred to outpatient palliative care during the study period. CONCLUSIONS Some patient and clinical characteristics associated with increased ER visits and hospitalizations in this cohort include race/ethnicity, palliative care referral, markers of advanced disease, and number opioids prescribed. Increasing knowledge of palliative care and access to palliative care among the underserved should be a focus of future research.
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Affiliation(s)
- Tori Knox-Rice
- 1 Department of Psychiatry, University of Texas (UT) Southwestern Medical Center , Dallas, Texas
| | - Lei Xuan
- 2 Department of Clinical Services, University of Texas (UT) Southwestern Medical Center , Dallas, Texas
| | - Hanna Wadsworth
- 1 Department of Psychiatry, University of Texas (UT) Southwestern Medical Center , Dallas, Texas
| | - Ethan A Halm
- 3 Division of General Internal Medicine, University of Texas (UT) Southwestern Medical Center , Dallas, Texas
| | - Ramona L Rhodes
- 4 Division of Geriatric Medicine, University of Texas (UT) Southwestern Medical Center , Dallas, Texas
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Tan SH, Abrams KR, Bujkiewicz S. Bayesian Multiparameter Evidence Synthesis to Inform Decision Making: A Case Study in Metastatic Hormone-Refractory Prostate Cancer. Med Decis Making 2018; 38:834-848. [PMID: 30102868 PMCID: PMC6156771 DOI: 10.1177/0272989x18788537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In health technology assessment, decisions are based on complex cost-effectiveness models that require numerous input parameters. When not all relevant estimates are available, the model may have to be simplified. Multiparameter evidence synthesis combines data from diverse sources of evidence, which results in obtaining estimates required in clinical decision making that otherwise may not be available. We demonstrate how bivariate meta-analysis can be used to predict an unreported estimate of a treatment effect enabling implementation of a multistate Markov model, which otherwise needs to be simplified. To illustrate this, we used an example of cost-effectiveness analysis for docetaxel in combination with prednisolone in metastatic hormone-refractory prostate cancer. Bivariate meta-analysis was used to model jointly available data on treatment effects on overall survival and progression-free survival (PFS) to predict the unreported effect on PFS in a study evaluating docetaxel with prednisolone. The predicted treatment effect on PFS enabled implementation of a 3-state Markov model comprising stable disease, progressive disease, and dead states, while lack of the estimate restricted the model to a 2-state model (with alive and dead states). The 2-state and 3-state models were compared by calculating the incremental cost-effectiveness ratio (which was much lower in the 3-state model: £22,148 per quality-adjusted life year gained compared to £30,026 obtained from the 2-state model) and the expected value of perfect information (which increased with the 3-state model). The 3-state model has the advantage of distinguishing surviving patients who progressed from those who did not progress. Hence, the use of advanced meta-analytic techniques allowed obtaining relevant parameter estimates to populate a model describing disease pathway in more detail while helping to prevent valuable clinical data from being discarded.
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Affiliation(s)
- Sze Huey Tan
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, University Road, Leicester, UK (SHT, KRA, SB).,Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore (SHT)
| | - Keith R Abrams
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, University Road, Leicester, UK (SHT, KRA, SB)
| | - Sylwia Bujkiewicz
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, University Road, Leicester, UK (SHT, KRA, SB)
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Moryl N, Dave V, Glare P, Bokhari A, Malhotra VT, Gulati A, Hung J, Puttanniah V, Griffo Y, Tickoo R, Wiesenthal A, Horn SD, Inturrisi CE. Patient-Reported Outcomes and Opioid Use by Outpatient Cancer Patients. THE JOURNAL OF PAIN 2018; 19:278-290. [PMID: 29154919 PMCID: PMC5811357 DOI: 10.1016/j.jpain.2017.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 10/23/2017] [Accepted: 11/03/2017] [Indexed: 11/21/2022]
Abstract
The Memorial Sloan Kettering Pain Registry contains patient characteristics, treatments, and outcomes for a prospective cohort of 1,534 chronic pain cancer patients who were seen at outpatient pain service clinics. Average pain intensity (Brief Pain Inventory) was reported as mild by 24.6% of patients, moderate by 41.5%, and severe by 33.9%. The patient's report of average percent pain relief and health state (EuroQOL 5 dimensions) was inversely related to average pain intensity category, whereas measures of pain interference, number of worst pain locations, and physical and psychological distress were directly related to pain intensity category. Eighty-six percent of patients received an opioid at 1 or more clinic encounters. Regression analysis revealed that male sex or being younger (65 years of age or younger) was associated with a greater likelihood of an opioid ordered. Male sex nearly doubled the likelihood of a higher dose being ordered than female sex. Bivariate analysis found that patients receiving opioids reported significantly more pain relief than no-opioid patients. However, patients receiving opioids had higher pain interference scores, lower index of health state, and more physical distress than no-opioid patients Our results identify the need to consider opioid use and dosage when attempting to understand patient-reported outcomes (PROs) and factors affecting pain management. PERSPECTIVE This report describes the results of the analyses of PROs and patient-related electronic health record data collected under standard of care from cancer patients at outpatient pain management clinics of Anesthesiology and Palliative Care at the Memorial Sloan Kettering Cancer Center. Consideration of sex and age as predictors of opioid use is critical in attempting to understand PROs and their relationship to pain management.
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Affiliation(s)
- Natalie Moryl
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vinnidhy Dave
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul Glare
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ali Bokhari
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vivek T Malhotra
- Anesthesia Pain Services, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amitabh Gulati
- Anesthesia Pain Services, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph Hung
- Anesthesia Pain Services, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vinay Puttanniah
- Anesthesia Pain Services, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yvona Griffo
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Roma Tickoo
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alison Wiesenthal
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Susan D Horn
- Health System Innovation and Research Division, University of Utah School of Medicine, Salt Lake City, Utah
| | - Charles E Inturrisi
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pharmacology, Weill Cornell Medical College, New York, New York.
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Gagliano-Jucá T, Travison TG, Nguyen PL, Kantoff PW, Taplin ME, Kibel AS, Manley R, Hally K, Bearup R, Beleva YM, Huang G, Edwards RR, Basaria S. Effects of Androgen Deprivation Therapy on Pain Perception, Quality of Life, and Depression in Men With Prostate Cancer. J Pain Symptom Manage 2018; 55:307-317.e1. [PMID: 28941963 PMCID: PMC5794536 DOI: 10.1016/j.jpainsymman.2017.09.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/12/2017] [Accepted: 09/14/2017] [Indexed: 02/05/2023]
Abstract
CONTEXT Previous animal and human research suggests that testosterone has antinociceptive properties. Castration in male rodents increases pain perception which is reversed by testosterone replacement. Pain perception also improves in hypogonadal men with testosterone therapy. However, it remains unclear whether androgen deprivation therapy (ADT) in men with prostate cancer (PCa) is associated with an increase in pain perception. OBJECTIVES To evaluate the effects of ADT on pain perception, depression and quality of life (QOL) in men with PCa. METHODS Thirty-seven men with PCa about to undergo ADT with leuprolide acetate (ADT group) were followed prospectively for six months to evaluate changes in clinical and experimental pain. Forty men who had previously undergone prostatectomy for localized PCa and were in remission served as controls (non-ADT group). All participants were eugonadal at study entry. Primary outcomes were changes in clinical pain (assessed with Brief Pain Inventory questionnaire) and experimental pain (assessed with quantitative sensory testing). Secondary outcomes included evaluation of depression, anxiety levels, and quality of life. RESULTS Serum testosterone levels significantly decreased in the ADT group but remained unchanged in the non-ADT group. There were no significant changes in pain thresholds, ratings, or other responses to quantitative sensory tests over the 6-month course of the study. Clinical pain did not differ between the two groups, and no changes from baseline were observed in either group. Men undergoing ADT did experience worsening of depression (0.93; 95% CI = 0.04-1.82; P = 0.042) and QOL related to physical role limitation (-18.28; 95% CI = -30.18 to -6.37; P = 0.003). CONCLUSION ADT in men with PCa is associated with worsening of depression scores and QOL but is not associated with changes in clinical pain or pain sensitivity.
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Affiliation(s)
- Thiago Gagliano-Jucá
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Philip W Kantoff
- Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York, USA
| | - Mary-Ellen Taplin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Adam S Kibel
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Manley
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathleen Hally
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Richelle Bearup
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yusnie M Beleva
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Grace Huang
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert R Edwards
- Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Shehzad Basaria
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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11
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Devlin N, Herdman M, Pavesi M, Phung D, Naidoo S, Beer TM, Tombal B, Loriot Y, Ivanescu C, Parli T, Balk M, Holmstrom S. Health-related quality of life effects of enzalutamide in patients with metastatic castration-resistant prostate cancer: an in-depth post hoc analysis of EQ-5D data from the PREVAIL trial. Health Qual Life Outcomes 2017. [PMID: 28645287 PMCID: PMC5481866 DOI: 10.1186/s12955-017-0704-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background The effect of enzalutamide on health-related quality of life (HRQoL) in the PREVAIL trial in chemotherapy-naïve men with metastatic castration-resistant prostate cancer was analyzed using the generic EQ-5D instrument. Methods Patients received oral enzalutamide 160 mg/day (n = 872) or placebo (n = 845). EQ-5D index and EQ-5D visual analogue scale (EQ-5D VAS) scores were evaluated at baseline, week 13, and every 12 weeks until week 61 due to sample size reduction thereafter. Changes on individual dimensions were assessed, and Paretian Classification of Health Change (PCHC) and time-to-event analyses were conducted. Results With enzalutamide, EQ-5D index and EQ-5D VAS scores declined more slowly versus placebo and time to diverge from full health was prolonged. Average decline in EQ-5D index (−0.042 vs. –0.070; P < .0001) and EQ-5D VAS (−1.3 vs. –4.4; P < .0001) was significantly smaller with enzalutamide. There were significant (P < .05) between-group differences favoring enzalutamide in Pain/Discomfort to week 37, Anxiety/Depression at week 13, and Usual Activities at week 25, but no significant differences for Mobility and Self-care. The PCHC analysis showed more enzalutamide patients reporting improvement than placebo patients at weeks 13, 25, and 49 (all P < .05) and week 37 (P = .0512). Enzalutamide was superior (P ≤ .0003) to placebo for time to diverge from full health and time to first deterioration on Pain/Discomfort and Anxiety/Depression dimensions. Conclusions This in-depth post hoc analysis showed that enzalutamide delayed HRQoL deterioration and had beneficial effects on several HRQoL domains, including Pain/Discomfort and the proportion of patients in full health, compared with placebo, and may help to support future analyses of this type. Trial registration NCT01212991
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Affiliation(s)
- Nancy Devlin
- Office of Health Economics, Southside, 7th Floor, 105 Victoria Street, London, SW1E 6QT, UK
| | - Michael Herdman
- Office of Health Economics, Southside, 7th Floor, 105 Victoria Street, London, SW1E 6QT, UK.
| | - Marco Pavesi
- European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) Consortium, C/Mallorca 183, 08036, Barcelona, Spain
| | - De Phung
- Astellas Pharma Global Development, J.H. Oortweg 62, 2333 BE, Leiden, The Netherlands
| | - Shevani Naidoo
- Astellas Medical Affairs, Global Health Economic Outcomes Research (HEOR), 2000 Hillswood Dr, Chertsey, Surrey, KT16 0PS, UK
| | - Tomasz M Beer
- OHSU Knight Cancer Institute, Oregon Health & Science University, 3303 SW Bond Ave., CH14R, Portland, OR, 97239, USA
| | - Bertrand Tombal
- Institut de Recherche Clinique (IREC), Cliniques Universitaires Saint Luc, Av Hippocrate, 10 - 1200 Bruxelles - Belgique, Brussels, Belgium
| | - Yohann Loriot
- Institut Gustave Roussy, University of Paris Sud, 114, rue Edouard-Vaillant, 94805, Villejuif Cedex, France
| | - Cristina Ivanescu
- Quintiles, Siriusdreef 10 Beukenhorst Zuid 2132, WT, Hoofddorp, The Netherlands
| | - Teresa Parli
- Medivation, Inc., 525 Market St, Fl 36, San Francisco, CA, 94105, USA
| | - Mark Balk
- Medivation, Inc., 525 Market St, Fl 36, San Francisco, CA, 94105, USA
| | - Stefan Holmstrom
- Astellas Medical Affairs, Global HEOR, J.H. Oortweg 62, 2333 BE, Leiden, The Netherlands
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12
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Ramsay CR, Adewuyi TE, Gray J, Hislop J, Shirley MDF, Jayakody S, MacLennan G, Fraser C, MacLennan S, Brazzelli M, N'Dow J, Pickard R, Robertson C, Rothnie K, Rushton SP, Vale L, Lam TB. Ablative therapy for people with localised prostate cancer: a systematic review and economic evaluation. Health Technol Assess 2016; 19:1-490. [PMID: 26140518 DOI: 10.3310/hta19490] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND For people with localised prostate cancer, active treatments are effective but have significant side effects. Minimally invasive treatments that destroy (or ablate) either the entire gland or the part of the prostate with cancer may be as effective and cause less side effects at an acceptable cost. Such therapies include cryotherapy, high-intensity focused ultrasound (HIFU) and brachytherapy, among others. OBJECTIVES This study aimed to determine the relative clinical effectiveness and cost-effectiveness of ablative therapies compared with radical prostatectomy (RP), external beam radiotherapy (EBRT) and active surveillance (AS) for primary treatment of localised prostate cancer, and compared with RP for salvage treatment of localised prostate cancer which has recurred after initial treatment with EBRT. DATA SOURCES MEDLINE (1946 to March week 3, 2013), MEDLINE In-Process & Other Non-Indexed Citations (29 March 2013), EMBASE (1974 to week 13, 2013), Bioscience Information Service (BIOSIS) (1956 to 1 April 2013), Science Citation Index (1970 to 1 April 2013), Cochrane Central Register of Controlled Trials (CENTRAL) (issue 3, 2013), Cochrane Database of Systematic Reviews (CDSR) (issue 3, 2013), Database of Abstracts of Reviews of Effects (DARE) (inception to March 2013) and Health Technology Assessment (HTA) (inception to March 2013) databases were searched. Costs were obtained from NHS sources. REVIEW METHODS Evidence was drawn from randomised controlled trials (RCTs) and non-RCTs, and from case series for the ablative procedures only, in people with localised prostate cancer. For primary therapy, the ablative therapies were cryotherapy, HIFU, brachytherapy and other ablative therapies. The comparators were AS, RP and EBRT. For salvage therapy, the ablative therapies were cryotherapy and HIFU. The comparator was RP. Outcomes were cancer related, adverse effects (functional and procedural) and quality of life. Two reviewers extracted data and carried out quality assessment. Meta-analysis used a Bayesian indirect mixed-treatment comparison. Data were incorporated into an individual simulation Markov model to estimate cost-effectiveness. RESULTS The searches identified 121 studies for inclusion in the review of patients undergoing primary treatment and nine studies for the review of salvage treatment. Cryotherapy [3995 patients; 14 case series, 1 RCT and 4 non-randomised comparative studies (NRCSs)], HIFU (4000 patients; 20 case series, 1 NRCS) and brachytherapy (26,129 patients; 2 RCTs, 38 NRCSs) studies provided limited data for meta-analyses. All studies were considered at high risk of bias. There was no robust evidence that mortality (4-year survival 93% for cryotherapy, 99% for HIFU, 91% for EBRT) or other cancer-specific outcomes differed between treatments. For functional and quality-of-life outcomes, the paucity of data prevented any definitive conclusions from being made, although data on incontinence rates and erectile dysfunction for all ablative procedures were generally numerically lower than for non-ablative procedures. The safety profiles were comparable with existing treatments. Studies reporting the use of focal cryotherapy suggested that incontinence rates may be better than for whole-gland treatment. Data on AS, salvage treatment and other ablative therapies were too limited. The cost-effectiveness analysis confirmed the uncertainty from the clinical review and that there is no technology which appears superior, on the basis of current evidence, in terms of average cost-effectiveness. The probabilistic sensitivity analyses suggest that a number of ablative techniques are worthy of further research. LIMITATIONS The main limitations were the quantity and quality of the data available on cancer-related outcomes and dysfunction. CONCLUSIONS The findings indicate that there is insufficient evidence to form any clear recommendations on the use of ablative therapies in order to influence current clinical practice. Research efforts in the use of ablative therapies in the management of prostate cancer should now be concentrated on the performance of RCTs and the generation of standardised outcomes. STUDY REGISTRATION This study is registered as PROSPERO CRD42012002461. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Craig R Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Joanne Gray
- Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Jenni Hislop
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mark D F Shirley
- School of Biology, Newcastle University, Newcastle upon Tyne, UK
| | | | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Sara MacLennan
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Robert Pickard
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Kieran Rothnie
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Luke Vale
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Thomas B Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
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13
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Lloyd AJ, Kerr C, Penton J, Knerer G. Health-Related Quality of Life and Health Utilities in Metastatic Castrate-Resistant Prostate Cancer: A Survey Capturing Experiences from a Diverse Sample of UK Patients. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:1152-1157. [PMID: 26686802 DOI: 10.1016/j.jval.2015.08.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 08/07/2015] [Accepted: 08/14/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND The collection of preference-based health outcomes data (or utility values) is required to support cost-effectiveness analyses. OBJECTIVE This study aimed to collect health-related quality of life (HRQOL) data in men with metastatic castration-resistant prostate cancer (CRPC) stratified by disease states. METHODS Men with metastatic CRPC were recruited via UK patient associations, patient panels, and specialist recruiters and classified into four subgroups reflecting disease state: asymptomatic/mildly symptomatic before chemotherapy, symptomatic before chemotherapy, receiving chemotherapy, and postchemotherapy. HRQOL data (including five-level EuroQol five-dimensional questionnaire [EQ-5D-5L], European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire [EORTC QLQ-C30], and 25-item prostate cancer-specific questionnaire module designed to supplement the EORTC QLQ-C30) along with background and medical history data were collected via an online survey. The EQ-5D-5L and the EORTC-8D (EORTC-8D is an 8 dimensional utility index scored from QLQ-C30 data) were both used to estimate utilities. RESULTS Data were collected from a total sample of 163 men with metastatic CRPC. Utility values elicited by the EQ-5D-5L ranged from 0.830 for the asymptomatic/mildly symptomatic before chemotherapy disease state (95% confidence interval [CI] 0.795-0.865) to 0.625 for the symptomatic before chemotherapy disease state (95% CI 0.577-0.673). EORTC-8D utilities ranged from 0.856 (95% CI 0.831-0.882) to 0.697 (95% CI 0.664-0.731) for the same disease/treatment states. CONCLUSIONS This online survey was designed to capture real-world HRQOL data describing men with CRPC. The study estimated utilities using two alternative methods, and the results show good agreement, suggesting that they are robust. This methodology offers a potentially higher quality alternative to vignette-based methods that are commonly used in oncology submissions.
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Affiliation(s)
| | - Cicely Kerr
- ICON Patient Reported Outcomes, Oxford, UK; Janssen-Cilag Ltd, High Wycombe, UK.
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14
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Simpson EL, Davis S, Thokala P, Breeze PR, Bryden P, Wong R. Sipuleucel-T for the Treatment of Metastatic Hormone-Relapsed Prostate Cancer: A NICE Single Technology Appraisal; An Evidence Review Group Perspective. PHARMACOECONOMICS 2015; 33:1187-1194. [PMID: 26017401 DOI: 10.1007/s40273-015-0296-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The National Institute for Health and Care Excellence (NICE) invited Dendreon, the company manufacturing sipuleucel-T, to submit evidence for the clinical and cost effectiveness of sipuleucel-T for asymptomatic or minimally symptomatic, metastatic, non-visceral hormone-relapsed prostate cancer patients in whom chemotherapy is not yet clinically indicated, as part of NICE's single technology appraisal process. The comparator was abiraterone acetate (AA) or best supportive care (BSC). The School of Health and Related Research at the University of Sheffield was commissioned to act as the Evidence Review Group (ERG). This paper describes the company submission (CS), ERG review, and subsequent decision of the NICE Appraisal Committee (AC). The ERG produced a critical review of the clinical and cost-effectiveness evidence of sipuleucel-T based upon the CS. Clinical-effectiveness data relevant to the decision problem were taken from three randomised controlled trials (RCTs) of sipuleucel-T and a placebo (PBO) comparator of antigen-presenting cells (APC) being re-infused (APC-PBO) (D9901, D9902A and D9902B), and one RCT (COU-AA-302) of AA plus prednisone vs. PBO plus prednisone. Two trials reported a significant advantage for sipuleucel-T in median overall survival compared with APC-PBO: for trial D9901, an adjusted hazard ratio (HR) 0.47; (95 % confidence interval [CI] 0.29, 0.76) p < 0.002; for D9902B, adjusted HR 0.78 (95 % CI 0.61, 0.98) p = 0.03. There was no significant difference between groups in D9902A, unadjusted HR 0.79 (95 % CI 0.48, 1.28) p = 0.331. Sipuleucel-T and APC-PBO groups did not differ significantly in time to disease progression, in any of the three RCTs. Most adverse events developed within 1 day of the infusion, and resolved within 2 days. The CS included an indirect comparison of sipuleucel-T (D9902B) and AA plus prednisone (COU-AA-302). As trials differed in prior use of chemotherapy, an analysis of only chemotherapy-naïve patients was included, in which the overall survival for sipuleucel-T and AA was not significantly different, HR 0.94 (95 % CI 0.69, 1.28) p = 0.699. The ERG had several concerns regarding the data and assumptions incorporated within the company's cost-effectiveness analyses and conducted exploratory analyses to quantify the impact of making alternative assumptions or using alternative data inputs. The deterministic incremental cost-effectiveness ratio (ICER) for sipuleucel-T vs. BSC when using the ERG's preferred data and assumptions was £ 108,585 per quality-adjusted life-year (QALY) in the whole licensed population and £ 61,204/QALY in the subgroup with low prostate-specific antigen at baseline. The ERG also conducted an incremental analysis comparing sipuleucel-T with both AA and BSC in the chemotherapy-naïve subgroup. Sipuleucel-T had a deterministic ICER of £ 111,682/QALY in this subgroup, when using the ERG's preferred assumptions, and AA was extendedly dominated. The ERG also concluded that estimates of costs and benefits for AA should be interpreted with caution given the limitations of the indirect comparison. The AC noted that the ICER for sipuleucel-T was well above the range usually considered cost effective, and did not recommend sipuleucel-T for the treatment of asymptomatic or minimally symptomatic, metastatic, non-visceral hormone-relapsed prostate cancer.
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Affiliation(s)
- Emma L Simpson
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA, UK.
| | - Sarah Davis
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA, UK
| | - Praveen Thokala
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA, UK
| | - Penny R Breeze
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA, UK
| | | | - Ruth Wong
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA, UK
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15
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Tang ST, Liu LN, Lin KC, Chung JH, Hsieh CH, Chou WC, Su PJ. Trajectories of the multidimensional dying experience for terminally ill cancer patients. J Pain Symptom Manage 2014; 48:863-74. [PMID: 24742788 DOI: 10.1016/j.jpainsymman.2014.01.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 12/24/2013] [Accepted: 01/08/2014] [Indexed: 11/18/2022]
Abstract
CONTEXT Studies exploring the trajectories of physical-psychological-social-spiritual dying experiences frequently treat changes in these experiences as consistent across different domains and over time. OBJECTIVE This prospective, longitudinal investigation was designed to characterize trajectories of the multidimensional dying experience for cancer patients in their last year of life. METHODS Trajectories of physical-psychological-social-spiritual/existential dimensions and overall quality of life (QOL) were identified among 313 cancer patients using mixed-effects models to test for linear, quadratic, or cubic changes. Changes in each variable were evaluated for clinical significance using minimal important difference. RESULTS When patients transitioned to their end of life, symptom distress, functional dependence, anxiety, and depressive symptoms slightly increased, followed by a stable status for approximately four to six months, and accelerated dramatically to the first clinically significant changes at three to four months before death. Perceived social support and post-traumatic growth declined gradually to clinically significant changes at one and four months before death, respectively. Perceived sense of burden to others increased steadily in the last year of life, with no clinically significant changes identified. Overall QOL deteriorated gradually in the last year but did not reach a clinically significant change until 2.5 months before death. CONCLUSION All dimensions deteriorated in the last year of life but with distinctive physical-psychological-social-spiritual/existential and overall QOL trajectories. Recognizing trajectory patterns and tipping points of accelerating deterioration in each dimension can help clinicians anticipate times of increased distress, initiate timely, effective interventions to relieve patient suffering, and facilitate high-quality end-of-life care tailored to patients' needs and preferences.
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Affiliation(s)
- Siew T Tang
- School of Nursing, Chang Gung University, Tao-Yuan, Taiwan, Republic of China.
| | - Li N Liu
- Department of Nursing, Fu Jen Catholic University, Taipei, Taiwan, Republic of China
| | - Kuan-Chia Lin
- Department of Health Care and Management, National Taipei University of Nursing and Health Science, Taipei, Taiwan, Republic of China
| | - Jui-Hung Chung
- Department of Health Care and Management, National Taipei University of Nursing and Health Science, Taipei, Taiwan, Republic of China
| | - Chia-Hsun Hsieh
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taipei, Taiwan, Republic of China
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taipei, Taiwan, Republic of China
| | - Po-Jung Su
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taipei, Taiwan, Republic of China
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16
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Diels J, Hamberg P, Ford D, Price PW, Spencer M, Dass RN. Mapping FACT-P to EQ-5D in a large cross-sectional study of metastatic castration-resistant prostate cancer patients. Qual Life Res 2014; 24:591-8. [PMID: 25326871 PMCID: PMC4349944 DOI: 10.1007/s11136-014-0794-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2014] [Indexed: 11/23/2022]
Abstract
Purpose To construct a model to predict preference-adjusted EuroQol 5D (EQ-5D) health utilities for patients with metastatic castrate-resistant prostate cancer (mCRPC) using the disease-specific health-related quality of life (HRQoL) measure, functional assessment of cancer therapy-prostate (FACT-P). Methods HRQoL data were collected from patients with mCRPC who were enrolled in an observational study conducted in 47 centers across six European Union countries. Utility values were generated using a UK-specific EQ-5D value set. The predictive validity of the five FACT-P subscales, patient demographics, comorbidities and prior chemotherapy was tested using ordinary least squares (OLS), median, Gamma and Tobit multivariate regression models. Results FACT-P and EQ-5D questionnaires were completed by 602 (86 %) patients. Mean age [standard deviation (SD)] was 72.1 (7.9) years, mean time from diagnosis (SD) was 5.4 (4.4) years, and mean time since failure of androgen deprivation therapy (SD) was 1.0 (1.6) years. At study inclusion, 39 % of patients were chemotherapy-naïve, 37 % were undergoing chemotherapy, and 24 % were post-chemotherapy. Mean FACT-P and EQ-5D utility values were 104 and 0.66, respectively. OLS regression was the best-performing model, explaining 61.2 % of the observed EQ-5D variation. All FACT-P subscales were significantly predictive; the physical and functional well-being subscales had the highest explanatory value (coefficient 0.023 and 0.001, respectively, p < 0.0001). The other variables did not add additional explanatory value. Conclusions The algorithm developed enables translation of cancer-specific HRQoL measures to preference-adjusted health status in patients with mCRPC. The function may be useful in calculating EQ-5D scores when EQ-5D data have not been gathered directly.
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Affiliation(s)
- J Diels
- Janssen Pharmaceutica NV, Beerse, Belgium,
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17
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Lee D, Nielsen SK, van Keep M, Andersson F, Greene D. Quality of life improvement in patients treated with degarelix versus leuprorelin for advanced prostate cancer. J Urol 2014; 193:839-46. [PMID: 25264336 DOI: 10.1016/j.juro.2014.09.098] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2014] [Indexed: 12/15/2022]
Abstract
PURPOSE We used responses to questionnaires included in the CS21 degarelix trial and published mapping algorithms to address the paucity of evidence for health related quality of life in patients with advanced hormone dependent prostate cancer treated with degarelix. MATERIALS AND METHODS We measured health related quality of life in 610 patients enrolled in the CS21 trial using SF-12® and EORTC QLQ-C30. Based on responses to these questionnaires we estimated patient utility using 4 published mapping algorithms. Utility was tested for relationships with aspects of the symptom and side effect burden that may be affected by degarelix treatment, that is prostate specific antigen progression and adverse events. RESULTS Average utility in patients without prostate specific antigen progression or an adverse event was 0.742, similar to previously published utilities for nonprogressed prostate cancer states. Prostate specific antigen progression was associated with a utility decrement of between 0.062 and 0.134 depending on the mapping algorithm used. Of adverse events considered in our analysis musculoskeletal events were associated with the greatest effects on patient utility with a decrement of between 0.029 and 0.086. The 4 mapping algorithms generated similar utility estimates, although values derived from SF-12 were consistently lower than those derived from EORTC QLQ-C30. CONCLUSIONS Prostate specific antigen progression status and the incidence of treatment and disease related adverse events result in significant decrements to patient health related quality of life. By slowing prostate specific antigen progression degarelix may improve patient utility and the health related quality of life burden.
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Affiliation(s)
- Dawn Lee
- BresMed, Sheffield, United Kingdom.
| | | | | | - Fredrik Andersson
- Ferring International PharmaScience Center, Copenhagen, Denmark; Center for Medical Technology Assessment, Linköping University, Linköping, Sweden
| | - Damien Greene
- Sunderland Royal Hospital, Sunderland, United Kingdom
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18
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Thong MSY, Mols F, Stein KD, Smith T, Coebergh JWW, van de Poll-Franse LV. Population-based cancer registries for quality-of-life research. Cancer 2013; 119 Suppl 11:2109-23. [PMID: 23695923 DOI: 10.1002/cncr.28056] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 01/22/2013] [Accepted: 01/31/2013] [Indexed: 12/22/2022]
Affiliation(s)
- Melissa S. Y. Thong
- Center of Research on Psychology in Somatic Diseases (C o RPS) Tilburg University; Tilburg the Netherlands
- Comprehensive Cancer Center South (CCCS); Eindhoven Cancer Registry; Eindhoven the Netherlands
| | - Floortje Mols
- Center of Research on Psychology in Somatic Diseases (C o RPS) Tilburg University; Tilburg the Netherlands
- Comprehensive Cancer Center South (CCCS); Eindhoven Cancer Registry; Eindhoven the Netherlands
| | - Kevin D. Stein
- Behavioral Research Center; American Cancer Society; Atlanta Georgia
- Rollins School of Public Health; Emory University; Atlanta Georgia
| | - Tenbroeck Smith
- Behavioral Research Center; American Cancer Society; Atlanta Georgia
| | - Jan-Willem W. Coebergh
- Comprehensive Cancer Center South (CCCS); Eindhoven Cancer Registry; Eindhoven the Netherlands
- Department of Public Health; Erasmus University Medical Center; Rotterdam the Netherlands
| | - Lonneke V. van de Poll-Franse
- Center of Research on Psychology in Somatic Diseases (C o RPS) Tilburg University; Tilburg the Netherlands
- Comprehensive Cancer Center South (CCCS); Eindhoven Cancer Registry; Eindhoven the Netherlands
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Flynn K. Metastatic castrate-resistant prostate cancer: a discussion of the physical and psychosocial effects. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2013. [DOI: 10.1111/ijun.12002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Underwood DJ, Zhang J, Denton BT, Shah ND, Inman BA. Simulation optimization of PSA-threshold based prostate cancer screening policies. Health Care Manag Sci 2012; 15:293-309. [PMID: 22302420 DOI: 10.1007/s10729-012-9195-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 01/23/2012] [Indexed: 10/14/2022]
Abstract
We describe a simulation optimization method to design PSA screening policies based on expected quality adjusted life years (QALYs). Our method integrates a simulation model in a genetic algorithm which uses a probabilistic method for selection of the best policy. We present computational results about the efficiency of our algorithm. The best policy generated by our algorithm is compared to previously recommended screening policies. Using the policies determined by our model, we present evidence that patients should be screened more aggressively but for a shorter length of time than previously published guidelines recommended.
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Affiliation(s)
- Daniel J Underwood
- Edward P. Fitts Department of Industrial & Systems Engineering, North Carolina State University, Raleigh, NC 27695, USA.
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21
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Heintzelman NH, Taylor RJ, Simonsen L, Lustig R, Anderko D, Haythornthwaite JA, Childs LC, Bova GS. Longitudinal analysis of pain in patients with metastatic prostate cancer using natural language processing of medical record text. J Am Med Inform Assoc 2012; 20:898-905. [PMID: 23144336 PMCID: PMC3756253 DOI: 10.1136/amiajnl-2012-001076] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives To test the feasibility of using text mining to depict meaningfully the experience of pain in patients with metastatic prostate cancer, to identify novel pain phenotypes, and to propose methods for longitudinal visualization of pain status. Materials and methods Text from 4409 clinical encounters for 33 men enrolled in a 15-year longitudinal clinical/molecular autopsy study of metastatic prostate cancer (Project to ELIminate lethal CANcer) was subjected to natural language processing (NLP) using Unified Medical Language System-based terms. A four-tiered pain scale was developed, and logistic regression analysis identified factors that correlated with experience of severe pain during each month. Results NLP identified 6387 pain and 13 827 drug mentions in the text. Graphical displays revealed the pain ‘landscape’ described in the textual records and confirmed dramatically increasing levels of pain in the last years of life in all but two patients, all of whom died from metastatic cancer. Severe pain was associated with receipt of opioids (OR=6.6, p<0.0001) and palliative radiation (OR=3.4, p=0.0002). Surprisingly, no severe or controlled pain was detected in two of 33 subjects’ clinical records. Additionally, the NLP algorithm proved generalizable in an evaluation using a separate data source (889 Informatics for Integrating Biology and the Bedside (i2b2) discharge summaries). Discussion Patterns in the pain experience, undetectable without the use of NLP to mine the longitudinal clinical record, were consistent with clinical expectations, suggesting that meaningful NLP-based pain status monitoring is feasible. Findings in this initial cohort suggest that ‘outlier’ pain phenotypes useful for probing the molecular basis of cancer pain may exist. Limitations The results are limited by a small cohort size and use of proprietary NLP software. Conclusions We have established the feasibility of tracking longitudinal patterns of pain by text mining of free text clinical records. These methods may be useful for monitoring pain management and identifying novel cancer phenotypes.
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Affiliation(s)
- Norris H Heintzelman
- Information Systems and Global Solutions, Lockheed Martin Corporation, Valley Forge, Pennsylvania, USA
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22
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Babaian K, Truong M, Cetnar J, Cross DS, Shi F, Ritter MA, Jarrard DF. Analysis of urological procedures in men who died from prostate cancer using a population-based approach. BJU Int 2012; 111:E65-70. [PMID: 23130676 DOI: 10.1111/j.1464-410x.2012.11517.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED What's known on the subject? and What does the study add? Very few studies have examined end-of-life urological studies in men with prostate cancer. These studies reported fewer procedures in men who received primary therapy for prostate cancer. However, these studies were typically single institution or had a short follow-up period. The present study is the first population-based study examining end-of-life urological procedures and uses a geographic region encompassing 385 000 patients. Furthermore, this study incorporates both hospital- and office-based procedures. This approach has not been previously undertaken. OBJECTIVE To determine using a population-based approach whether men with end-stage prostate cancer who had definitive primary therapy might require fewer urological interventions. Repeated urological procedures can impact health-related quality of life in patients dying from prostate cancer. PATIENTS AND METHODS Using the Marshfield Epidemiological Study Area (MESA) database and tumour registry, we compared end-of-life interventions in men who died from prostate cancer between 1991 and 2009. Patient charts were queried for urological procedures using International Classification of Disease Modification, 9th edition (ICD9) codes for 3 years before death. Clinicopathological information was examined including whether the patient had a history of primary therapy (radiation or radical prostatectomy). RESULTS Among 280 patients dying from prostate cancer, 52 (19%) required 153 urological procedures during the last 3 years of life. The frequency of procedures increased closer to death. The most common procedures involved nephrostomy tube (56%), Foley catheter (24%) and transurethral resection of the prostate (10%). Clinicopathological features did not predict the need for an end-of-life urological procedure. There was no difference in the frequency of upper or lower tract procedures in surgery or radiation patients compared with patients without primary therapy (P = 0.556 and P = 0.508). Using a Kaplan-Meier analysis, there were no differences between groups in the proportion of patients not requiring a procedure (n = 280; P = 0.179). CONCLUSIONS This is the first population-based study to examine the frequency of urological procedures in patients with end-stage prostate cancer. A minority of patients (19%) required urological procedures during the final 3 years of life. A history of surgery or radiation did not influence the overall risk for urological intervention.
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Affiliation(s)
- Kara Babaian
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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23
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Resnick MJ, Penson DF. Quality of Life with Advanced Metastatic Prostate Cancer. Urol Clin North Am 2012; 39:505-15. [DOI: 10.1016/j.ucl.2012.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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24
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Dyer M, Rinaldi F, George E, Adler AI. NICE guidance on abiraterone for castration-resistant metastatic prostate cancer previously treated with a docetaxel-containing regimen. Lancet Oncol 2012; 13:762-3. [DOI: 10.1016/s1470-2045(12)70289-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Weingart SN, Cleary A, Stuver SO, Lynch M, Brandoff D, Schaefer KG, Zhu J, Berry DL, Block S, Weeks JC. Assessing the quality of pain care in ambulatory patients with advanced stage cancer. J Pain Symptom Manage 2012; 43:1072-81. [PMID: 22651950 DOI: 10.1016/j.jpainsymman.2011.06.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 06/19/2011] [Accepted: 06/28/2011] [Indexed: 11/28/2022]
Abstract
CONTEXT Pain is common among patients with advanced cancer despite the dissemination of clinical pain care guidelines. OBJECTIVES We sought to assess the quality of pain care among patients with advanced disease. METHODS We reviewed the records of 85 adult ambulatory patients with advanced breast, lung, and gastrointestinal cancer treated in 2004-2006. Patients' screening pain intensity scores were at least 7 of 10. Nurse reviewers completed medical record reviews of care rendered at the index visit and over the subsequent 30 days based on the 2004 National Comprehensive Cancer Network pain guideline. An expert panel then rated the quality of the evaluation, treatment, and overall pain care. We used a multivariable model to analyze guideline compliance and resolution of severe pain. RESULTS Among advanced cancer patients with severe pain, clinicians adjusted pain medications only half the time and made few timely referrals for pain-related consultations. By 30 days after the index visit, 34% of patients continued to report severe pain. The expert panel judged the overall quality of pain care as "fair" or "poor" in about two-thirds of cases because more timely and effective intervention could have reduced the severity and duration of pain. Resolution of severe pain was associated with adjustment of pain medications at the index visit (adjusted odds ratio 3.8, 95% CI 1.3-10.6). CONCLUSION There is room for improvement in the pain care of patients with advanced cancer. Additional research is needed to understand the reasons for poor performance.
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Affiliation(s)
- Saul N Weingart
- Center for Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA.
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26
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Payne H, Pearcy R. Symptoms and health-related quality of life in castration-resistant prostate cancer: the patient's perspective. JOURNAL OF MEN'S HEALTH 2012. [DOI: 10.1016/j.jomh.2011.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Borglin G, Gustafsson M, Krona H. A theory-based educational intervention targeting nurses' attitudes and knowledge concerning cancer-related pain management: a study protocol of a quasi-experimental design. BMC Health Serv Res 2011; 11:233. [PMID: 21942991 PMCID: PMC3189876 DOI: 10.1186/1472-6963-11-233] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 09/23/2011] [Indexed: 11/23/2022] Open
Abstract
Background Pain is one of the most frequent problems among patients diagnosed with cancer. Despite the availability of effective pharmacological treatments, this group of patients often receives less than optimal treatment. Research into nurses' pain management highlights certain factors, such as lack of knowledge and attitudes and inadequate procedures for systematic pain assessment, as common barriers to effective pain management. However, educational interventions targeting nurses' pain management have shown promise. As cancer-related pain is also known to have a negative effect on vital aspects of the patient's life, as well as being commonly associated with problems such as sleep, fatigue, depression and anxiety, further development of knowledge within this area is warranted. Methods/design A quasi-experimental study design will be used to investigate whether the implementation of guidelines for systematic daily pain assessments following a theory-based educational intervention will result in an improvement in knowledge and attitude among nurses. A further aim is to investigate whether the intervention that targets nurses' behaviour will improve hospital patients' perception of pain. Data regarding nurses' knowledge and attitudes to pain (primary outcome), patient perception regarding pain (secondary outcome), together with socio-demographic variables, will be collected at baseline and at four weeks and 12 weeks following the intervention. Discussion Nursing care is nowadays acknowledged as an increasingly complicated activity and "nursing complexity is such that it can be seen as the quintessential complex intervention." To be able to change and improve clinical practice thus requires multiple points of attack appropriate to meet complex challenges. Consequently, we expect the theory-based intervention used in our quasi-experimental study to improve care as well as quality of life for this group of patients and we also envisage that evidence-based guidelines targeting this patient group's pain will be implemented more widely. Trial Registration Number ClinicalTrials.gov NCT01313234
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Affiliation(s)
- Gunilla Borglin
- School of Health Science, Blekinge Institute of Technology, SE-379 71 Blekinge, Sweden.
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Murtagh FEM, Sheerin NS, Addington-Hall J, Higginson IJ. Trajectories of illness in stage 5 chronic kidney disease: a longitudinal study of patient symptoms and concerns in the last year of life. Clin J Am Soc Nephrol 2011; 6:1580-90. [PMID: 21685021 DOI: 10.2215/cjn.09021010] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES The illness trajectory in the last year of life in advanced (stage 5) chronic kidney disease is poorly understood. Mapping the trajectory of patient-centered outcomes could facilitate better care. The objectives of this study were to determine trajectories of symptoms and wider health-related concerns in the last year of life in stage 5 chronic kidney disease, managed without dialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A longitudinal symptom survey in three UK renal units was used, using the Memorial Symptom Assessment Scale-Short Form and core Palliative Care Outcome Scale. Average (using mean scores over time) and individual (using individual scores over time, with visual graphical analysis) trajectories were mapped. RESULTS Seventy-four patients (mean age, 81 ± 6.8 years) were recruited; 49 died during follow-up. Average trajectories showed moderate symptom distress and health-related concerns, with marked increase in the last 2 months of life. Visual graphical analysis enabled stable, increasing, or fluctuant individual trajectories to be identified. The proportion following these trajectories varied between outcome measures; regarding symptoms, 50% followed a stable pattern, 24% increased, and 21% fluctuated compared with 26%, 57%, and 21%, respectively, for health-related concerns. Inter-rater agreement in grouping trajectories was high (κ statistic, 0.80 and 0.86, respectively). CONCLUSIONS In the 2 months before death, patients reported a sharp increase in symptom distress and health-related concerns. Health care should anticipate and address this increase, which may indicate the patients is approaching death. Considerable individual variation and flexibility/responsiveness of care is important: one size of service does not fit all.
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Affiliation(s)
- Fliss E M Murtagh
- Department of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.
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29
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Danielson B, Fairchild A. Beyond palliative radiotherapy: a pilot multidisciplinary brain metastases clinic. Support Care Cancer 2011; 20:773-81. [PMID: 21479525 DOI: 10.1007/s00520-011-1149-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 03/28/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study is to determine the feasibility of a multidisciplinary palliative radiotherapy clinic for patients with brain metastases. METHODS We designed a 6-month pilot Rapid Access Palliative Radiotherapy Program (RAPRP) brain metastases clinic. The main goals of the clinic were: (1) to provide timely consultation and treatment, (2) to provide multidisciplinary assessment and care, (3) to facilitate accrual of patients to research studies, and (4) to be a positive experience for patients. Team members included a radiation oncologist, radiation therapist, nurse practitioner, social worker (SW), occupational therapist (OT), and registered dietitian (RD). Patients underwent multidimensional assessment with patient-reported questionnaires and completed a patient satisfaction survey. Data were collected in a prospective database and collated in a standardized fashion with descriptive statistics recorded as percentages, medians, and ranges. RESULTS The pilot brain metastases clinic ran weekly from August 5, 2009 to January 27, 2010. In total, 33 patients were seen. The median time from referral date to clinic date was 6 days, with 76% of patients seen within 1 week. Most patients (94%) started their radiotherapy on clinic day. Fifteen patients (45%) required assessment by a SW, 36% by an OT, and 33% by a RD. Ninety-one percent of patients participated in a research study. Eighty-six percent of patients reported being very satisfied with the clinic experience, and 97% would recommend the clinic to a patient in a similar situation. CONCLUSIONS The pilot RAPRP Brain Metastases Clinic was successful in providing patients with timely and multidisciplinary care and will continue beyond the pilot phase.
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Affiliation(s)
- Brita Danielson
- Department of Oncology, University of Alberta Division on Radiation Oncology, Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, Canada T6G 1Z2.
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Shaheen PE, Legrand SB, Walsh D, Estfan B, Davis MP, Lagman RL, Riaz M, Cheema B. Errors in opioid prescribing: a prospective survey in cancer pain. J Pain Symptom Manage 2010; 39:702-11. [PMID: 20413057 DOI: 10.1016/j.jpainsymman.2009.09.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Revised: 09/11/2009] [Accepted: 09/28/2009] [Indexed: 11/16/2022]
Abstract
CONTEXT Cancer pain is debilitating and has multidimensional consequences. It can be treated adequately in up to 90% of patients by following pain management guidelines. Nevertheless, inadequate pain control remains a global problem. OBJECTIVES We surveyed prescribing patterns in patients referred to our Palliative Medicine Program (PMP) to identify common errors in opioid use. METHODS Consecutive cancer patients seen by our PMP were prospectively surveyed for the presence of pain and errors in opioid prescribing at the time of initial consultation. Our recommendations to correct and optimize pain management also were recorded. RESULTS One hundred eighty-six consecutive cancer patients were screened. One hundred seventeen (63%) had cancer pain, 151 opioid prescribing errors were detected, and 147 different recommendations were made. Most common were failure to order around-the-clock opioids for constant pain, and the failure to treat or prevent opioid side effects. Multiple errors were more common in females, but the sex difference did not reach statistical significance. There was no difference in the errors by pain severity or reason for consultation. CONCLUSION Opioid prescribing errors were common. Females may be at greater risk of multiple errors. A PM consultation program is effective in identifying and correcting a wide variety of opioid prescribing errors.
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Affiliation(s)
- Philip E Shaheen
- The Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, The Cleveland Clinic, Cleveland, Ohio 44195, USA
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Colloca G, Colloca P. Health-related quality of life assessment in prospective trials of systemic cytotoxic chemotherapy for metastatic castration-resistant prostate cancer: which instrument we need? Med Oncol 2010; 28:519-27. [PMID: 20354822 DOI: 10.1007/s12032-010-9495-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Accepted: 03/11/2010] [Indexed: 01/29/2023]
Abstract
Knowledge about psychological health of men with prostate cancer is still limited. HRQoL assessment adds value in symptom management by allowing a broader understanding of the impact of symptom management beyond the targeted symptom, on functioning, and on overall QoL. In this paper, the results of the commonly used HRQoL questionnaires in phase III randomized clinical trials of chemotherapy in metastatic castration-resistant prostate cancer has been discussed. An overview about symptom burden, treatments and HRQoL domains, a description of available HRQoL instruments used for patients with metastatic castration-resistant prostate cancer were reported. Finally, the characteristics of most commonly used HRQoL instruments were identified and compared. To provide better empirical justification for the selection of HRQoL instruments, head-to-head comparisons of them within the same studies are needed. Estimating a minimal important difference could be significant when interpreting trial results. The impact of HRQoL scores in clinical practice remains unclear; poor communication of clinical significance of the results and limited training of clinicians are the most important barriers to a widespread use of HRQoL questionnaires.
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Affiliation(s)
- Giuseppe Colloca
- Division of Medical Oncology, ASL-1 Imperiese, Via G. Borea 56, 18038, Sanremo, Imperia, Italy.
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Varenhorst E, Garmo H, Holmberg L, Adolfsson J, Damber JE, Hellström M, Hugosson J, Lundgren R, Stattin P, Törnblom M, Johansson JE. The National Prostate Cancer Register in Sweden 1998—2002: Trends in incidence, treatment and survival. ACTA ACUST UNITED AC 2009; 39:117-23. [PMID: 16019764 DOI: 10.1080/00365590510007793] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To provide a descriptive review of the establishment of the National Prostate Cancer Register (NPCR) in Sweden, to present clinical characteristics at diagnosis and to calculate the relative survival of different risk groups after 5 years. MATERIAL AND METHODS Since 1998, data on all newly diagnosed prostate cancers, including TNM classification, grade of malignancy, prostate-specific antigen (PSA) level and treatment, have been prospectively collected. For the 35,223 patients diagnosed between 1998 and 2002, relative survival in different risk groups has been calculated. RESULTS Between 1998 and 2002, 96% of all prostate cancer cases diagnosed in Sweden were registered in the NPCR. The number of new cases increased from 6137 in 1998 to 7385 in 2002. The age-standardized rate rose in those aged < 70 years, while it was stable, or possibly declining from 1999, in the older age groups. The proportion of T1c tumours increased from 14% to 28% of all recorded cases. The age-adjusted incidence of advanced tumours (M1 or PSA > 100 ng/ml) decreased by 17%. The proportion of patients receiving curative treatment doubled. Patients with N1 or M1 disease or poorly differentiated tumours (G3 or Gleason score 8-10) had a markedly reduced relative 5-year survival rate. CONCLUSIONS It is possible to establish a nationwide prostate cancer register including basic data for assessment of the disease in the whole of Sweden. The introduction of PSA screening has increased the detection of early prostate cancer in younger men and, to a lesser extent, decreased the incidence of advanced disease. The effect of these changes on mortality is obscure but the NPCR in Sweden will serve as an important tool in such evaluation.
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Affiliation(s)
- Eberhard Varenhorst
- Department of Urology, Faculty of Health Sciences, University Hospital Linköping, Linköping, Sweden.
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Adolfsson J, Garmo H, Varenhorst E, Ahlgren G, Ahlstrand C, Andrén O, Bill-Axelson A, Bratt O, Damber JE, Hellström K, Hellström M, Holmberg E, Holmberg L, Hugosson J, Johansson JE, Petterson B, Törnblom M, Widmark A, Stattin P. Clinical characteristics and primary treatment of prostate cancer in Sweden between 1996 and 2005. ACTA ACUST UNITED AC 2008; 41:456-77. [PMID: 17934985 DOI: 10.1080/00365590701673625] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The incidence of prostate cancer is rising rapidly in Sweden and there is a need to better understand the pattern of diagnosis, tumor characteristics and treatment. MATERIAL AND METHODS Between 1996 and 2005, all new cases of adenocarcinoma of the prostate gland were intended to be registered in the National Prostate Cancer Register (NPCR). This register contains information on diagnosing unit, date of diagnosis, cause of diagnosis, tumor grade, tumor stage according to the TNM classification in force, serum prostate-specific antigen (PSA) levels at diagnosis and primary treatment given within the first 6 months after diagnosis. RESULTS In total, 72,028 patients were registered, comprising >97% of all pertinent incident cases of prostate cancer in the Swedish Cancer Register (SCR). During the study period there was a considerable decrease in median age at the time of diagnosis, a stage migration towards smaller tumors, a decrease in median serum PSA values at diagnosis, a decrease in the age-standardized incidence rate of men diagnosed with distant metastases or with a PSA level of > 100 ng/ml at diagnosis and an increase in the proportion of tumors with Gleason score <6. Relatively large geographical differences in the median age at diagnosis and the age-standardized incidence of cases with category T1c tumors were observed. Treatment with curative intent increased dramatically and treatment patterns varied according to geographical region. In men with localized tumors and a PSA level of <20 ng/ml at diagnosis, expectant treatment was more commonly used in those aged > or =75 years than in those aged <75 years. Also, the pattern of endocrine treatment varied in different parts of Sweden. CONCLUSIONS All changes in the register seen over time are consistent with increased diagnostic activity, especially PSA testing, resulting in an increased number of cases with early disease, predominantly tumors in category T1c. The patterns of diagnosis and treatment of prostate cancer vary considerably in different parts of Sweden. The NPCR continues to be an important source for research, epidemiological surveillance of the incidence, diagnosis and treatment of prostate cancer.
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Affiliation(s)
- Jan Adolfsson
- Oncological Centre, Karolinska University Hospital, CLINTEC, Karolinska Institute, Stockholm, Sweden.
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Age-related differences in quality of life in cancer patients: a pilot study of a cancer care coordination/home-telehealth program. Cancer Nurs 2007; 30:434-40. [PMID: 18025915 DOI: 10.1097/01.ncc.0000300167.80466.91] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The cancer care dialogues model emphasizes daily telehealth interactions between patients and a care coordinator (a registered nurse serving as a liaison to the oncologist) to assist patients in the management of common chemotherapy-related symptoms at home. We examined the impact of the dialogues on age-related differences in health-related quality of life (HRQOL) among newly diagnosed cancer patients receiving chemotherapy. We assessed HRQOL among 34 patients, including 15 older adults (65 years or older) and 19 younger adults who were followed for 6 months. Older patients consistently reported better HRQOL scores over the treatment period. In multivariate analysis, older patients reported 10.35 points higher in HRQOL (P = .007). In addition, patients who reported no nervousness while undergoing chemotherapy had an 8.60-point increase in HRQOL scores (P = .012). The dialogues model can make important improvement in symptom management and HRQOL, especially in older adults receiving chemotherapy. Older and younger adults with cancer may benefit equally in cancer treatment in a setting with appropriately managed symptoms. The dialogues model offers promising potential for promoting nurses' better understanding of both the patient needs as the patient receives treatment and innovative technologies in patient management.
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Ramsey SD, Zeliadt SB, Hall IJ, Ekwueme DU, Penson DF. On the Importance of Race, Socioeconomic Status and Comorbidity When Evaluating Quality of Life in Men With Prostate Cancer. J Urol 2007; 177:1992-9. [PMID: 17509278 DOI: 10.1016/j.juro.2007.01.138] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Indexed: 01/12/2023]
Abstract
PURPOSE Clear and accurate information about health related quality of life outcomes for men diagnosed with prostate cancer is essential for men and their physicians to make appropriate care decisions. To determine the completeness and quality of available health related quality of life information we performed a review of health related quality of life studies, assessing what information was and was not reported. MATERIALS AND METHODS A structured literature search identified 184 relevant health related quality of life studies representing 40,931 subjects. RESULTS More than 95% of health related quality of life studies did not provide key information about factors known to influence outcomes. The most common omissions included information about treatments received, followup, socioeconomic status or demographic characteristics. Most data were obtained from well educated, high income socioeconomic groups, who are generally quite healthy. More than 60% of subjects were college graduates, 85% were currently married and 43% were currently employed. While black Americans comprised 15% of men studied in the 80% of studies reporting race, little information is available on Hispanic or Asian men. CONCLUSIONS Most of the available prostate cancer health related quality of life literature does not describe or does not account for factors known to influence health outcomes. These omissions limit their interpretability for patients trying to make decisions about treatment. More attention should be given to fully characterizing all dimensions of care that may influence quality of life outcomes and evaluating health related quality of life in Asian and Hispanic populations. Men and physicians should exercise caution when interpreting results that do not fully account for multiple factors that influence health related quality of life.
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Affiliation(s)
- Scott D Ramsey
- Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Seattle, WA 98109, USA.
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Sullivan PW, Mulani PM, Fishman M, Sleep D. Quality of life findings from a multicenter, multinational, observational study of patients with metastatic hormone-refractory prostate cancer. Qual Life Res 2007; 16:571-5. [PMID: 17294287 DOI: 10.1007/s11136-006-9156-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Accepted: 12/08/2006] [Indexed: 11/12/2022]
Abstract
BACKGROUND The assessment of health-related quality of life (HRQL) for patients with hormone-refractory prostate cancer (HRPC) is of paramount importance because new treatments have a modest impact on survival but side effects of treatment and disease symptoms can significantly impact HRQL. METHODS This was an observational, non-interventional, multi-center, multi-national cohort study of patients with metastatic HRPC. Health-related quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C30), the Functional Assessment of Cancer Therapy-Prostate (FACT-P) and the EQ-5D index. Mean changes from baseline to month 3, 6, and 9 were computed and tested using paired t-tests. RESULTS FACT-P PCS, EQ-5D index and 10 of 14 EORTC domains were statistically significantly lower (P < 0.05) than the baseline scores at the 3, 6 and 9 month visits. The domains that did not reach statistical significance were cognitive functioning, insomnia, diarrhea and financial difficulties. CONCLUSIONS These data demonstrate that patients with metastatic HRPC experience rapid, significant deterioration in HRQL, highlighting the need for effective palliative therapy for men with HRPC.
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Affiliation(s)
- Patrick W Sullivan
- Pharmaceutical Outcomes Research Program, University of Colorado School of Pharmacy, 4200 East Ninth Avenue, Box C238, Denver, CO, 80262, USA.
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Pickard AS, Wilke CT, Lin HW, Lloyd A. Health utilities using the EQ-5D in studies of cancer. PHARMACOECONOMICS 2007; 25:365-84. [PMID: 17488136 DOI: 10.2165/00019053-200725050-00002] [Citation(s) in RCA: 214] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Cancer is one of the most frequent disease-specific applications of the EQ-5D. The objective of this review was to summarise evidence to support the validity and reliability of the EQ-5D in cancer, and to provide a catalogue of utility scores based on the use of the EQ-5D in clinical trials and in studies of patients with cancer. A structured literature search was conducted in EMBASE and MEDLINE to identify papers using key words related to cancer and the EQ-5D. Original research studies of patients with cancer that reported EQ-5D psychometric properties, responses and/or summary scores were included. Of 57 identified articles, 34 were selected for inclusion, where 12 studies reported evidence of validity or reliability and 31 reported EQ-5D responses or summary scores. The majority of investigations using the EQ-5D concerned patients with prostate cancer (n = 4), breast cancer (n = 4), cancers of the digestive system (n = 7) and Hodgkin and/or non-Hodgkin lymphoma (n = 3). Mean index-based scores ranged from 0.33 (SD 0.4) to 0.93 (SD 0.12) and visual analogue scale scores ranged from 43 (SD 13.3) to 84 (SD 12.0) across subtypes of cancer. A substantial and growing body of literature using the EQ-5D in cancer that supports the validity and reliability of EQ-5D in cancer has emerged. This review provides utility estimates for cancer patients across a wide range of cancer subtypes, treatment regimens and tumour stage(s) that may inform the modelling of outcomes in economic evaluations of cancer treatment.
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Affiliation(s)
- A Simon Pickard
- College of Pharmacy, Center for Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
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Andersson M, Hallberg IR, Halberg IR, Edberg AK, Edberg K. The final period of life in elderly people in Sweden: Factors associated with QOL. Int J Palliat Nurs 2006; 12:286-93. [PMID: 16926739 DOI: 10.12968/ijpn.2006.12.6.21454] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Whether elderly people in the final period of life have a high quality of life (QOL) and what factors relate QOL in this context, is not well known. The aim of this study was to examine the final period in life in elderly people (75 years or older) in need of help with instrumental activities of daily living (ADL), with the focus on quality of life, sense of coherence (SOC), health complaints and self-reported diseases. Also to investigate factors associated with QOL and factors predicting mortality. The sample consisted of 411 people, fifty of the respondents (the study group) had died within 1 year of data collection. The results showed that the study group had lower QOL than the comparison group. More admissions to hospital as well as the number of health complaints present negatively affected QOL for all respondents. Factors that predicted mortality included older age and higher number of health complaints.
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Affiliation(s)
- Magdalena Andersson
- Department of Health Sciences, Division of Gerontology and Caring Sciences, The Vardal Institute, The Swedish Institute for Health Sciences, Lund University, PO Box 157, SE-221 00 Lund, Sweden.
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Cella D, Petrylak DP, Fishman M, Teigland C, Young J, Mulani P. Role of Quality of Life in Men with Metastatic Hormone-Refractory Prostate Cancer: How Does Atrasentan Influence Quality of Life? Eur Urol 2006; 49:781-9. [PMID: 16458417 DOI: 10.1016/j.eururo.2005.12.058] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2005] [Accepted: 12/30/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Progression of hormone-refractory prostate cancer (HRPC) is associated with skeletal complications and bone pain, which contribute to deterioration in quality of life (QOL). The effects of new HRPC therapies on patients' QOL need to be studied. Patient-based assessments that help quantify the risk-benefit profile of HRPC therapies are warranted. This review summarizes the known QOL literature and estimates the potential effect of atrasentan, a novel, selective endothelin A receptor antagonist (SERA), on the QOL of HRPC patients. METHODS Published studies were identified through a structured, detailed literature review. Clinical studies that report QOL data were reviewed, along with recent QOL data from atrasentan studies. RESULTS HRPC studies have begun to use QOL assessments as primary endpoints, but different assessments and therapies are not comparable. Very few data integrate QOL with clinical endpoints. Atrasentan clinical trials demonstrated a statistically significant difference in the prostate cancer-specific QOL in favor of atrasentan (p=.032) and an increased quality-adjusted time to progression in men with HRPC. CONCLUSIONS Atrasentan provides QOL benefits relevant to HRPC. The quality-adjusted analyses applied in the atrasentan studies have begun to lay the foundation for interpreting clinical endpoints in conjunction with QOL. These analyses will facilitate better QOL comparisons within studies and across trials. Further evaluation of atrasentan in HRPC is warranted.
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Affiliation(s)
- David Cella
- Northwestern University, Chicago, Illinois 60201, USA.
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