1
|
Karamanidou C, Natsiavas P, Koumakis L, Marias K, Schera F, Schäfer M, Payne S, Maramis C. Electronic Patient-Reported Outcome-Based Interventions for Palliative Cancer Care: A Systematic and Mapping Review. JCO Clin Cancer Inform 2021; 4:647-656. [PMID: 32697604 DOI: 10.1200/cci.20.00015] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Capitalizing on the promise of patient-reported outcomes (PROs), electronic implementations of PROs (ePROs) are expected to play an important role in the development of novel digital health interventions targeting palliative cancer care. We performed a systematic and mapping review of the scientific literature on the current ePRO-based approaches used for palliative cancer care. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines, the conducted review answered the research questions: "What are the current ePRO-based approaches for palliative cancer care; what is their contribution/value in the domain of palliative cancer care; and what are the potential gaps, challenges, and opportunities for further research?" After a screening step, the corpus of included articles indexed in PubMed or the Web of Science underwent full text review, which mapped the articles across 15 predefined axes. RESULTS The corpus of 24 mapped studies includes 9 study protocols, 7 technical tools/solutions, 7 pilot/feasibility/acceptability studies, and 1 evaluation study. The review of the corpus revealed (1) an archetype of ePRO-enabled interventions for palliative cancer care, which most commonly use ePROs as study end point assessment instruments rather than integral intervention components; (2) the fact that the literature has not fully embraced the modern definitions that expand the scope of palliative care; (3) the striking shortage of promising ubiquitous computing devices (eg, smart activity trackers); and (4) emerging evidence about the benefits of narrowing down the target cancer population, especially when combined with modern patient-centered intervention design methodologies. CONCLUSION Although research on exploiting ePROs for the development of digital palliative cancer care interventions is considerably active and demonstrates several successful cases, there is considerable room for improvement along the directions of the aforementioned findings.
Collapse
Affiliation(s)
- Christina Karamanidou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Pantelis Natsiavas
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Lefteris Koumakis
- Institute of Computer Science, Foundation for Research & Technology Hellas, Heraklion, Greece
| | - Kostas Marias
- Institute of Computer Science, Foundation for Research & Technology Hellas, Heraklion, Greece
| | - Fatima Schera
- Fraunhofer Institute for Biomedical Engineering IBMT, St Ingbert, Germany
| | - Michael Schäfer
- Fraunhofer Institute for Biomedical Engineering IBMT, St Ingbert, Germany
| | - Sheila Payne
- International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom
| | - Christos Maramis
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| |
Collapse
|
2
|
Brandes F, Striefler JK, Dörr A, Schmiester M, Märdian S, Koulaxouzidis G, Kaul D, Behzadi A, Thuss-Patience P, Ahn J, Pelzer U, Bullinger L, Flörcken A. Impact of a specialised palliative care intervention in patients with advanced soft tissue sarcoma - a single-centre retrospective analysis. BMC Palliat Care 2021; 20:16. [PMID: 33446180 PMCID: PMC7809873 DOI: 10.1186/s12904-020-00702-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 12/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Soft tissue sarcomas (STS) account for less than 1% of all malignancies. Approximately 50% of the patients develop metastases with limited survival in the course of their disease. For those patients, palliative treatment aiming at symptom relief and improvement of quality of life is most important. However, data on symptom burden and palliative intervention are limited in STS patients. AIM Our study evaluates the effectiveness of a palliative care intervention on symptom relief and quality of life in STS patients. DESIGN/SETTING We retrospectively analysed 53 inpatient visits of 34 patients with advanced STS, admitted to our palliative care unit between 2012 and 2018. Symptom burden was measured with a standardised base assessment questionnaire at admission and discharge. RESULTS Median disease duration before admission was 24 months, 85% of patients had metastases. The predominant indication for admission was pain, weakness and fatigue. Palliative care intervention led to a significant reduction of pain: median NRS for acute pain was reduced from 3 to 1 (p < 0.001), pain within the last 24 h from 5 to 2 (p < 0.001) and of the median MIDOS symptom score: 18 to 13 (p < 0.001). Also, the median stress level, according to the distress thermometer, was reduced significantly: 7.5 to 5 (p = 0.027). CONCLUSIONS Our data underline that specialised palliative care intervention leads to significant symptom relief in patients with advanced STS. Further efforts should aim for an early integration of palliative care in these patients focusing primarily on the identification of subjects at high risk for severe symptomatic disease.
Collapse
Affiliation(s)
- F Brandes
- Department of Hematology, Oncology, and Tumor Immunology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - J K Striefler
- Department of Hematology, Oncology, and Tumor Immunology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - A Dörr
- Department of Hematology, Oncology, and Tumor Immunology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - M Schmiester
- Department of Hematology, Oncology, and Tumor Immunology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - S Märdian
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Centre for Musculoskeletal Surgery, Campus Virchow-Klinikum, Berlin, Germany
| | - G Koulaxouzidis
- Department of Surgery, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Plastic and Reconstructive Surgery, Berlin, Germany
| | - D Kaul
- Department of Radiation Oncology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - A Behzadi
- Department of Hematology, Oncology, and Tumor Immunology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - P Thuss-Patience
- Department of Hematology, Oncology, and Tumor Immunology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - J Ahn
- Department of Hematology, Oncology, and Tumor Immunology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - U Pelzer
- Department of Hematology, Oncology, and Tumor Immunology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - L Bullinger
- Department of Hematology, Oncology, and Tumor Immunology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
- German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Flörcken
- Department of Hematology, Oncology, and Tumor Immunology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| |
Collapse
|
3
|
Hentschel L, Richter S, Kopp HG, Kasper B, Kunitz A, Grünwald V, Kessler T, Chemnitz JM, Pelzer U, Schuler U, Freitag J, Schilling A, Hornemann B, Arndt K, Bornhäuser M, Schuler MK. Quality of life and added value of a tailored palliative care intervention in patients with soft tissue sarcoma undergoing treatment with trabectedin: a multicentre, cluster-randomised trial within the German Interdisciplinary Sarcoma Group (GISG). BMJ Open 2020; 10:e035546. [PMID: 32859662 PMCID: PMC7454199 DOI: 10.1136/bmjopen-2019-035546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The choice of drug treatment in advanced soft tissue sarcoma (STS) continues to be a challenge regarding efficacy, quality of life (QoL) and toxicity. Unlike other cancer types, where integrating patient-reported outcomes (PRO) has proven to be beneficial for QoL, there is no such evidence in patients with STS as of now. The YonLife trial aimed to explore the effect of a tailored multistep intervention on QoL, symptoms and survival in patients with advanced STS undergoing treatment with trabectedin as well as identifying predictors of QoL. DESIGN YonLife is a cluster-randomised, open-label, proof-of-concept study. The intervention incorporates electronic PRO assessment, a case vignette and expert-consented treatment recommendations. PARTICIPANTS Six hospitals were randomised to the control arm (CA) or interventional arm (IA). Seventy-nine patients were included of whom 40 were analysed as per-protocol analysis set. PRIMARY AND SECONDARY OUTCOME MEASURES The primary end point was the change of Functional Assessment for Cancer Therapy (FACT-G) total score after 9 weeks. Secondary outcomes included QoL (FACT-G subscales), anorexia and cachexia (Functional Assessment of Anorexia/Cachexia Therapy (FAACT)), symptoms (MD Anderson Symptom Inventory (MDASI)), anxiety and depression (HADS), pain intensity and interference (Brief Pain Inventory (BPI)) and survival assessment. RESULTS After 9 weeks of treatment, QoL declined less in the IA (ΔFACT-G total score: -2.4, 95% CI: -9.2 to 4.5) as compared with CA (ΔFACT-G total score: -3.9; 95% CI:-11.3 to 3.5; p=0.765). In almost all FACT-G subscales, average declines were lower in IA, but without reaching statistical significance. Smaller adverse trends between arms were observed for MDASI, FAACT, HADS and BPI scales. These trends failed to reach statistical significance. Overall mean survival was longer in IA (648 days) than in CA (389 days, p=0.110). QoL was predicted by symptom severity, symptom interference, depression and anxiety. CONCLUSION Our data suggest a potentially favourable effect of an electronic patient-reported outcomes based intervention on QoL that needs to be reappraised in confirmatory studies. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier (NCT02204111).
Collapse
Affiliation(s)
- Leopold Hentschel
- Department of Psychooncology of the University Cancer Center (NCT/UCC), University Hospital Carl Gustav Carus, Dresden, Germany
| | - Stephan Richter
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Hans-Georg Kopp
- Interdisciplinary Center for Soft-Tissue-Sarcoma, GIST and Bone-Tumor, Robert-Bosch-Center of Tumor Diseases, Stuttgart, Germany
| | - Bernd Kasper
- Sarcoma Unit, Interdisciplinary Tumor Center, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Viktor Grünwald
- Interdisciplinary Genitourinary Oncology/West-German Cancer Center, University Hospital Essen, Essen, Germany
| | - Torsten Kessler
- Hematology Oncology, University Hospital of Münster, Münster, Germany
| | | | - Uwe Pelzer
- Division of Hematology, Oncology and Tumor Immunology, Charité Medical University, Berlin, Germany
| | - Ulrich Schuler
- University Palliative Center, University Hospital Carl Gustav Carus, Dresden, Sachsen, Germany
| | - Janet Freitag
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Andrea Schilling
- Department of Social Work, University Hospital Carl Gustav Carus, Dresden, Sachsen, Germany
| | - Beate Hornemann
- Department of Psychooncology of the University Cancer Center (NCT/UCC), University Hospital Carl Gustav Carus, Dresden, Germany
| | - Karin Arndt
- Patient Advocacy, Das Lebenshaus e.V, Wölfersheim, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
- National Center for Tumor Diseases (NCT), Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Markus Kajo Schuler
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
- Department of Oncology, HELIOS Hospital Emil von Behring, Berlin, Germany
| |
Collapse
|
4
|
Jones RL, Le Cesne A, Ibrahim T, Garcia Del Muro X, Menge F. Preserving quality of life as a key treatment goal in advanced soft tissue sarcomas. Expert Rev Anticancer Ther 2018; 18:1241-1248. [PMID: 30220224 DOI: 10.1080/14737140.2018.1524298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Health-related quality of life (HRQoL) is a patient-reported outcome that addresses patients' perceptions of symptoms across physical, emotional, cognitive and social domains. As HRQoL is currently rarely measured outside clinical trials in oncology, it must be inferred from patients' everyday performance during treatment. To gain insight into the HRQoL of advanced STS patients receiving palliative treatment in clinical practice, three case studies of patients treated with trabectedin are examined. Areas covered: The patient in Case 1 has maintained complete remission for more than 8 years after receiving nine cycles of second-line trabectedin followed by secondary surgery for recurrent myxoid liposarcoma, and was able to resume normal activities during trabectedin treatment. Case 2 describes 10 years' follow-up of a patient with myxoid liposarcoma who remains well after many lines of chemotherapy including extended use of trabectedin in the second line. The third case illustrates the feasibility of extending survival time in an elderly patient with metastatic leiomyosarcoma who was able to maintain a busy and active lifestyle while receiving second-line trabectedin. Expert commentary: Owing to its relatively benign safety profile, trabectedin frequently permits prolonged therapy and is generally well tolerated, often allowing patients to carry on with normal daily activities.
Collapse
Affiliation(s)
- Robin L Jones
- a Sarcoma Unit, Royal Marsden Hospital , Institute of Cancer Research , London , UK
| | - Axel Le Cesne
- b Department of Medical Oncology , Gustave Roussy , Villejuif , France
| | - Tony Ibrahim
- b Department of Medical Oncology , Gustave Roussy , Villejuif , France
| | | | - Franka Menge
- d Division of Surgical Oncology & Thoracic Surgery , Mannheim University Medical Center , Mannheim , Germany
| |
Collapse
|