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Leidy L, Dickinson A, Ramulu P, Ehrlich J, Kaleem MA. Clinical outcome measures in vision and eye care. Surv Ophthalmol 2024; 69:632-637. [PMID: 38484982 DOI: 10.1016/j.survophthal.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024]
Abstract
Traditionally, clinical outcome assessments have focused on the patient's perspective through patient-reported outcome assessments; however, given the complexity, integration, and interactions of various participants within the clinical ophthalmology setting, we propose that additional diverse clinical perspectives should be explored in order to appreciate fully the value of care provided to patients. In this review we introduce a framework by which clinical outcome assessments (COAs) can be organized. Our COA framework is composed of five outcome measurements that encompass the perspectives of each player in a patient's care: clinical data-reported outcomes, patient-reported outcomes, clinician-reported outcomes, observer-reported outcomes, and reviewer-reported outcomes. By establishing a standard for evaluating patient care, we hope to address gaps in expectations of patient care and encourage more thoughtful patient-clinician relationships.
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Affiliation(s)
- Luke Leidy
- Eastern Virginia Medical School, Norfolk, VA, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anna Dickinson
- Eastern Virginia Medical School, Norfolk, VA, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pradeep Ramulu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University Faculty of Medicine, Baltimore, MD, USA
| | - Joshua Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Mona A Kaleem
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University Faculty of Medicine, Baltimore, MD, USA.
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2
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Ciani O, Meregaglia M, Battaglia MA, Brichetto G, Conte A, Gasperini C, Sansone V. Patient-reported outcome measures in drugs for neurological conditions approved by European Medicines Agency 2017-2022. Neurol Sci 2023:10.1007/s10072-023-06825-6. [PMID: 37145229 DOI: 10.1007/s10072-023-06825-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Regulatory agencies have been responsive to public demand for inclusion of the patient experience in evaluating and approving therapies. Over the years, patient-reported outcome measures (PROMs) have become increasingly prevalent in clinical trial protocols; however, their influence on regulators, payers, clinicians, and patients' decision-making is not always clear. We recently conducted a cross-sectional study aimed at investigating the use of PROMs in new regulatory approvals of drugs for neurological conditions between 2017 and 2022 in Europe. METHODS We reviewed European Public Assessment Reports (EPARs) and recorded on a predefined data extraction form whether they considered PROMs, their characteristics (e.g., primary/secondary endpoint, generic/specific instrument) and other relevant information (e.g., therapeutic area, generic/biosimilar, orphan status). Results were tabulated and summarized by means of descriptive statistics. RESULTS Of the 500 EPARs related to authorized medicines between January 2017 and December 2022, 42 (8%) concerned neurological indications. Among the EPARs of these products, 24 (57%) reported any use of PROMs, typically considered as secondary (38%) endpoints. In total, 100 PROMs were identified, of which the most common were the EQ-5D (9%), the SF-36 (6%), or its shorter adaptation SF-12, the PedsQL (4%). CONCLUSIONS Compared to other disease areas, neurology is one where the use of patient-reported outcomes evidence is inherently part of the clinical evaluation and for which core outcome sets exist. Better harmonization of the instruments recommended for use would facilitate the consideration of PROMs at all stages in the drug development process.
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Affiliation(s)
- Oriana Ciani
- Government, Health & Not-for-Profit Division, Center for Research On Health and Social Care Management, SDA Bocconi School of Management, Health Economics & HTA, MEO Building, Room W210, II Floor, Via Sarfatti 10, 20136, Milan, Italy.
| | - Michela Meregaglia
- Government, Health & Not-for-Profit Division, Center for Research On Health and Social Care Management, SDA Bocconi School of Management, Health Economics & HTA, MEO Building, Room W210, II Floor, Via Sarfatti 10, 20136, Milan, Italy
| | | | - Gianpaolo Brichetto
- Associazione Italiana Sclerosi Multipla (AISM) Rehabilitation Center, Genoa, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
- Italian Society of Neurology (SIN), Siena, Italy
| | - Claudio Gasperini
- Italian Society of Neurology (SIN), Siena, Italy
- Department of Neurosciences, S. Camillo Forlanini Hospital, Rome, Italy
| | - Valeria Sansone
- NeMO Clinical Center, Neurorehabilitation Unit, University of Milan, Milan, Italy
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Armstrong TS, Gilbert MR. Clinical trial challenges, design considerations, and outcome measures in rare CNS tumors. Neuro Oncol 2021; 23:S30-S38. [PMID: 34725696 PMCID: PMC8561126 DOI: 10.1093/neuonc/noab209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Clinical research for patients with rare cancers has been very challenging. First and foremost, patient accrual to clinical trials typically requires a network, cooperative group, or even international collaboration in order to achieve the necessary numbers of patients to adequately evaluate a new treatment or intervention. Similar limitations in preclinical models and in the understanding the natural history of the disease or pertinent prognostic factors further impede the development of hypothesis-based, appropriately powered clinical trials. However, despite these challenges, several studies in rare cancers, including ependymoma and subependymal giant cell astrocytoma, have helped to establish new treatment regimens. Importantly, in these seminal trials, patient outcomes measures were critical in describing the clinical benefit derived from the therapy, underscoring the need to incorporate these measures in future trials. While obstacles still remain, novel and creative approaches to clinical trial designs have been developed that can be used to study new treatments for patients with rare cancers, thereby addressing a significant unmet need.
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Affiliation(s)
- Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Affiliation(s)
- Marta Penas-Prado
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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5
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Endocrine Therapy With or Without CDK4/6 Inhibitors in Women With Hormone-receptor Positive Breast Cancer: What do we Know About the Effects on Cognition? Clin Breast Cancer 2021; 22:191-199. [PMID: 34556423 DOI: 10.1016/j.clbc.2021.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/01/2021] [Accepted: 08/10/2021] [Indexed: 12/17/2022]
Abstract
Adjuvant endocrine therapy (ET) is the cornerstone of treatment for hormone-receptor positive breast cancer. Recently, ET is increasingly combined with "cyclin-dependent kinases 4 and 6'' (CDK4/6) inhibitors. Given the importance of estrogens in neural processes and the role of cyclin D in hippocampal cell proliferation, it is plausible that these therapies affect cognition, but studies on these potential cognitive effects are sparse. In this review, we summarize existing knowledge on the cognitive effects of ET and CDK4/6 inhibitors in pre-, peri- and postmenopausal patients with breast cancer. We show that several clinical studies support adverse cognitive effects, especially on verbal memory, after ET-induced decrease of estrogen-levels or inactivation of estrogen-receptors. Clinical studies on the cognitive effects of CDK4/6 inhibitors are virtually non-existent and no conclusions can yet be drawn. Longitudinal studies on the cognitive effects of the combined ET-CDK4/6 inhibitors are highly needed to properly inform patients about potential short-term and long-term cognitive side effects. These studies should preferably include cognitive assessments (including a measurement prior to ET), and be designed in such a way that they can account for variables such as type and duration of ET, CDK4/6 inhibition, menopausal status, and other disease- and treatment-related symptoms that can impact cognition, such as fatigue and distress.
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Dirven L, Vos ME, Walbert T, Armstrong TS, Arons D, van den Bent MJ, Blakeley J, Brown PD, Bulbeck H, Chang SM, Coens C, Gilbert MR, Grant R, Jalali R, Leach D, Leeper H, Mendoza T, Nayak L, Oliver K, Reijneveld JC, Le Rhun E, Rubinstein L, Weller M, Wen PY, Taphoorn MJB. Systematic review on the use of patient-reported outcome measures in brain tumor studies: part of the Response Assessment in Neuro-Oncology Patient-Reported Outcome (RANO-PRO) initiative. Neurooncol Pract 2021; 8:417-425. [PMID: 34277020 DOI: 10.1093/nop/npab013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The Response Assessment in Neuro-Oncology Patient-Reported Outcome (RANO-PRO) working group aims to provide guidance on the use of PROs in brain tumor patients. PRO measures should be of high quality, both in terms of relevance and other measurement properties. This systematic review aimed to identify PRO measures that have been used in brain tumor studies to date. Methods A systematic literature search for articles published up to June 25, 2020 was conducted in several electronic databases. Pre-specified inclusion criteria were used to identify studies using PRO measures assessing symptoms, (instrumental) activities of daily living [(I)ADL] or health-related quality of life (HRQoL) in adult patients with glioma, meningioma, primary central nervous system lymphoma, or brain metastasis. Results A total of 215 different PRO measures were identified in 571 published and 194 unpublished studies. The identified PRO measures include brain tumor-specific, cancer-specific, and generic instruments, as well as instruments designed for other indications or multi- or single-item study-specific questionnaires. The most frequently used instruments were the EORTC QLQ-C30 and QLQ-BN20 (n = 286 and n = 247), and the FACT-Br (n = 167), however, the majority of the instruments were used only once or twice (150/215). Conclusion Many different PRO measures assessing symptoms, (I)ADL or HRQoL have been used in brain tumor studies to date. Future research should clarify whether these instruments or their scales/items exhibit good content validity and other measurement properties for use in brain tumor patients.
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Affiliation(s)
- Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Maartje E Vos
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tobias Walbert
- Department of Neurology and Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - David Arons
- National Brain Tumor Society, Newton, Massachusetts, USA
| | - Martin J van den Bent
- Department of Neurology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Jaishri Blakeley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Helen Bulbeck
- Brainstrust - The Brain Cancer People, Cowes, Isle of Wight, UK
| | - Susan M Chang
- Division of Neuro-Oncology, University of California San Francisco, San Francisco, California, USA
| | - Corneel Coens
- Statistical Department, European Organization for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - Robin Grant
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Rakesh Jalali
- Neuro-Oncology Disease Management Group, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Danielle Leach
- National Brain Tumor Society, Newton, Massachusetts, USA
| | - Heather Leeper
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - Tito Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lakshmi Nayak
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth, Surrey, UK
| | - Jaap C Reijneveld
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Emilie Le Rhun
- Departments of Neurosurgery, Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Larry Rubinstein
- Biometric Research Program, National Cancer Institute, Bethesda, Maryland, USA
| | - Michael Weller
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
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Kotecha R, Gondi V, Ahluwalia MS, Brastianos PK, Mehta MP. Recent advances in managing brain metastasis. F1000Res 2018; 7:F1000 Faculty Rev-1772. [PMID: 30473769 PMCID: PMC6234720 DOI: 10.12688/f1000research.15903.1] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2018] [Indexed: 12/13/2022] Open
Abstract
Brain metastases are the most common malignancy encountered in the central nervous system (CNS), with up to 30-40% of cancer patients developing brain metastases at some point during the course of their disease. The management of brain metastasis is rapidly evolving and the roles of local therapies such as whole-brain radiation therapy, stereotactic radiosurgery, and resection along with systemic therapies are in flux. An emphasis on the neurocognitive side effects associated with treatment has gained prominence. Novel molecular studies have demonstrated important evolutionary patterns underpinning the development of brain metastasis and leptomeningeal disease, which may be key to unlocking new therapeutic strategies. This article provides a framework for incorporating the results of recent randomized radiotherapy clinical trials into practice, expounds upon the emphasis on cognition being an important driver in therapeutic selection, describes the importance of CNS-penetrating systemic therapies, and provides an overview of the novel molecular insights that will likely set the stage for future developments in this field.
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Affiliation(s)
- Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Vinai Gondi
- Northwestern Medicine Cancer Center Warrenville, Warrenville, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Manmeet S Ahluwalia
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Priscilla K Brastianos
- Divisions of Hematology/Oncology and Neuro-Oncology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Minesh P Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
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Brown PD, Ahluwalia MS, Khan OH, Asher AL, Wefel JS, Gondi V. Whole-Brain Radiotherapy for Brain Metastases: Evolution or Revolution? J Clin Oncol 2018; 36:483-491. [PMID: 29272161 PMCID: PMC6075843 DOI: 10.1200/jco.2017.75.9589] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
An estimated 20% of patients with cancer will develop brain metastases. Approximately 200,000 individuals in the United States alone receive whole-brain radiotherapy (WBRT) each year to treat brain metastases. Historically, the prognosis of patients with brain metastases has been poor; however, with new therapies, this is changing. Because patients are living longer following the diagnosis and treatment of brain metastases, there has been rising concern about treatment-related toxicities associated with WBRT, including neurocognitive toxicity. In addition, recent clinical trials have raised questions about the use of WBRT. To better understand this rapidly changing landscape, this review outlines the treatment roles and toxicities of WBRT and alternative therapies for the management of brain metastases.
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Affiliation(s)
- Paul D. Brown
- Paul D. Brown, Mayo Clinic, Rochester, MN; Manmeet S. Ahluwalia, Cleveland Clinic, Cleveland, OH; Osaama H. Khan and Vinai Gondi, Northwestern University Feinberg School of Medicine, Chicago; Vinai Gondi, Northwestern Medicine Cancer Center, Warrenville, IL; Anthony L. Asher, Carolina Neurosurgery and Spine Associates and Neurosciences Institute, Carolinas HealthCare System, Charlotte, NC; and Jeffrey S. Wefel, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Manmeet S. Ahluwalia
- Paul D. Brown, Mayo Clinic, Rochester, MN; Manmeet S. Ahluwalia, Cleveland Clinic, Cleveland, OH; Osaama H. Khan and Vinai Gondi, Northwestern University Feinberg School of Medicine, Chicago; Vinai Gondi, Northwestern Medicine Cancer Center, Warrenville, IL; Anthony L. Asher, Carolina Neurosurgery and Spine Associates and Neurosciences Institute, Carolinas HealthCare System, Charlotte, NC; and Jeffrey S. Wefel, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Osaama H. Khan
- Paul D. Brown, Mayo Clinic, Rochester, MN; Manmeet S. Ahluwalia, Cleveland Clinic, Cleveland, OH; Osaama H. Khan and Vinai Gondi, Northwestern University Feinberg School of Medicine, Chicago; Vinai Gondi, Northwestern Medicine Cancer Center, Warrenville, IL; Anthony L. Asher, Carolina Neurosurgery and Spine Associates and Neurosciences Institute, Carolinas HealthCare System, Charlotte, NC; and Jeffrey S. Wefel, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anthony L. Asher
- Paul D. Brown, Mayo Clinic, Rochester, MN; Manmeet S. Ahluwalia, Cleveland Clinic, Cleveland, OH; Osaama H. Khan and Vinai Gondi, Northwestern University Feinberg School of Medicine, Chicago; Vinai Gondi, Northwestern Medicine Cancer Center, Warrenville, IL; Anthony L. Asher, Carolina Neurosurgery and Spine Associates and Neurosciences Institute, Carolinas HealthCare System, Charlotte, NC; and Jeffrey S. Wefel, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey S. Wefel
- Paul D. Brown, Mayo Clinic, Rochester, MN; Manmeet S. Ahluwalia, Cleveland Clinic, Cleveland, OH; Osaama H. Khan and Vinai Gondi, Northwestern University Feinberg School of Medicine, Chicago; Vinai Gondi, Northwestern Medicine Cancer Center, Warrenville, IL; Anthony L. Asher, Carolina Neurosurgery and Spine Associates and Neurosciences Institute, Carolinas HealthCare System, Charlotte, NC; and Jeffrey S. Wefel, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vinai Gondi
- Paul D. Brown, Mayo Clinic, Rochester, MN; Manmeet S. Ahluwalia, Cleveland Clinic, Cleveland, OH; Osaama H. Khan and Vinai Gondi, Northwestern University Feinberg School of Medicine, Chicago; Vinai Gondi, Northwestern Medicine Cancer Center, Warrenville, IL; Anthony L. Asher, Carolina Neurosurgery and Spine Associates and Neurosciences Institute, Carolinas HealthCare System, Charlotte, NC; and Jeffrey S. Wefel, University of Texas MD Anderson Cancer Center, Houston, TX
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