1
|
Rosato R, Ferrero A, Mosconi P, Ciccone G, Di Cuonzo D, Evangelista A, Fuso L, Piovano E, Pagano E, Laudani ME, Pace L, Zola P. Impact of different follow-up regimens on health-related quality of life and costs in endometrial cancer patients: Results from the TOTEM randomized trial. Gynecol Oncol 2024; 184:150-159. [PMID: 38309033 DOI: 10.1016/j.ygyno.2024.01.050] [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: 09/04/2023] [Revised: 01/16/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
PURPOSE To investigate whether intensive follow-up (INT) after surgery for endometrial cancer impact health-related quality of life (HRQoL) and healthcare costs compared to minimalist follow-up (MIN), in the absence of evidence supporting any benefit on 5-year overall survival. METHODS In the TOTEM trial, HRQoL was assessed using the SF-12 and the Psychological General Well-Being (PGWB) questionnaires at baseline, after 6 and 12 months and then annually up to 5 years of follow-up. Costs were analyzed after 4 years of follow-up from a National Health Service perspective, stratified by risk level. The probability of missing data was analyzed for both endpoints. RESULTS 1847 patients were included in the analyses. The probability of missing data was not influenced by the study arms (MIN vs INT OR: 0.97 95%CI: 0.87-1.08). Longitudinal changes in HRQoL scores did not differ between the two follow-up regimens (MIN vs INT SF-12 PCS: -0.573, CI95%: -1.31; 0.16; SF-12 MCS: -0.243, CI95%: -1.08; 0.59; PGWB: -0.057, CI95%: -0,88; 0,77). The mean cost difference between the intensive and minimalist arm was €531 for low-risk patients and €683 for high-risk patients. CONCLUSION In the follow-up of endometrial cancer after surgery, a minimalist treatment regimen did not affect quality of life and was cost-saving in both low-risk and high-risk recurrence patients. As previous results showed no survival benefit, a minimalist approach is justified. The relevant proportion of missing data on secondary outcomes of interest could be a critical point that deserves special attention.
Collapse
Affiliation(s)
- Rosalba Rosato
- Department of Psychology, University of Turin, Italy; Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO, Piemonte, Torino, Italy.
| | - Annamaria Ferrero
- SCDU Ginecologia e Ostetricia, AO Ordine Mauriziano Torino, Dipartimento di Scienze Chirurgiche, Università degli studi di Torino, Torino, Italy
| | - Paola Mosconi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Giovannino Ciccone
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO, Piemonte, Torino, Italy
| | - Daniela Di Cuonzo
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO, Piemonte, Torino, Italy
| | - Andrea Evangelista
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO, Piemonte, Torino, Italy
| | - Luca Fuso
- SCDU Ginecologia e Ostetricia, AO Ordine Mauriziano Torino, Dipartimento di Scienze Chirurgiche, Università degli studi di Torino, Torino, Italy
| | - Elisa Piovano
- SCDU Ginecologia e Ostetricia 2U, Ospedale Sant'Anna, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Eva Pagano
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO, Piemonte, Torino, Italy
| | - Maria Elena Laudani
- Dipartimento di Scienze Chirurgiche, Università degli studi di Torino, Torino, Italy
| | - Luca Pace
- SCDU Ginecologia e Ostetricia, AO Ordine Mauriziano Torino, Dipartimento di Scienze Chirurgiche, Università degli studi di Torino, Torino, Italy
| | - Paolo Zola
- Dipartimento di Scienze Chirurgiche, Università degli studi di Torino, Torino, Italy
| |
Collapse
|
2
|
Jeppesen MM, Bergholdt SH, Bentzen AG, de Rooij BH, Skorstad M, Ezendam NPM, van de Poll-Franse LV, Vistad I, Jensen PT. Cancer worry is associated with increased use of supportive health care-results from the multinational InCHARGE study. J Cancer Surviv 2024; 18:165-175. [PMID: 36705796 DOI: 10.1007/s11764-023-01337-w] [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: 12/21/2022] [Accepted: 01/17/2023] [Indexed: 01/28/2023]
Abstract
PURPOSE To assess use of health care following a diagnosis of endometrial, cervical, and ovarian cancer in the Netherlands, Norway, and Denmark. Furthermore, to analyze the association between cancer worry and use of supportive care. METHODS An international multicenter cross-sectional questionnaire study was undertaken among female cancer survivors with endometrial, cervical, or ovarian cancer 1-7 years post diagnosis. We investigated different aspects of cancer survivorship and follow-up care. Health care use included information on the use of supportive health care, general practitioner (GP), and follow-up visits to the department of gynecology. Cancer worry was assessed with the Impact of Cancer (IoCv2) questionnaire. RESULTS A total of 1433 women completed the questionnaire. Health care use decreased from time of diagnosis and was higher among cervical and ovarian cancer survivors than endometrial cancer survivors. Twenty-five percent of the women with ovarian cancer reported severe cancer worry, in contrast to 10 and 15% of women diagnosed with endometrial and cervical cancer, respectively. Women with severe worry had significantly higher use of supportive care activities. In a multivariable regression analysis, cancer worry remained a significant correlate for use of supportive health care services irrespective of disease severity or prognosis. The strongest association was found for use of a psychologist (OR 2.1 [1.71-2.58]). CONCLUSION Cancer worry is associated with increased use of supportive care. IMPLICATIONS FOR CANCER SURVIVORS Targeted, timely, and accessible psychological support aimed at severe cancer worry may improve survivorship care and ensure optimal referral of patients in need of additional care.
Collapse
Affiliation(s)
- M M Jeppesen
- Department of Gynecology and Obstetrics, Lillebaelt Hospital, Kolding, Denmark.
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
| | - S H Bergholdt
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - A G Bentzen
- Department of Oncology, University Hospital of Northern Norway, Tromsø, Norway
| | - B H de Rooij
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - M Skorstad
- Department of Obstetrics and Gynaecology, Sørlandet Hospital, Kristiansand, Norway
| | - N P M Ezendam
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - L V van de Poll-Franse
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - I Vistad
- Department of Obstetrics and Gynaecology, Sørlandet Hospital, Kristiansand, Norway
- Clinical Institute II, Medical Department, University of Bergen, Bergen, Norway
| | - P T Jensen
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Health, Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
3
|
Rulanda MC, Mogensen O, Jensen PT, Hansen DG, Wu C, Jeppesen MM. Patient-initiated follow-up in women with early-stage endometrial cancer: A long-term follow-up of the OPAL trial. BJOG 2023; 130:1593-1601. [PMID: 37277320 DOI: 10.1111/1471-0528.17567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE A long-term follow-up of the OPAL trial to compare the effect of patient-initiated (PIFU) versus hospital-based (HBFU) follow-up on fear of cancer recurrence (FCR), quality of life (QoL) and healthcare use after 34 months of follow-up. DESIGN Pragmatic, multicentre randomised trial. SETTING Four Danish departments of gynaecology between May 2013 and May 2016. POPULATION 212 women diagnosed with stage I low-intermediate risk endometrial carcinoma. METHODS The control group attended HBFU with regular outpatient visits (i.e., 8) for 3 years after primary treatment. The intervention group underwent PIFU with no prescheduled visits but with instructions about alarm symptoms and options of self-referral. MAIN OUTCOME MEASURES The endpoints were FCR as measured by the Fear of Cancer Recurrence Inventory (FCRI) and QoL as measured by the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire C-30 (EORTC QLQ C-30), and healthcare use as measured by questionnaires and chart reviews after 34 months of follow-up. RESULTS FCR decreased from baseline to 34 months in both groups and no difference was found between allocations (difference -6.31 [95% confidence interval -14.24 to 1.63]). QoL remained stable with no difference in any domains between the two arms at 34 months using a linear mixed model analysis. The use of healthcare was significantly lower in the PIFU group (P < 0.01). CONCLUSION Patient-initiated follow-up is a valid alternative to hospital-based follow-up for people who have been treated for endometrial cancer and have low risk of recurrence.
Collapse
Affiliation(s)
| | - Ole Mogensen
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Pernille Tine Jensen
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Dorte Gilså Hansen
- Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Chunsen Wu
- The Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Odense University Hospital, Odense, Denmark
| | | |
Collapse
|
4
|
Karalliedde J, French O, Burnhill G, Malhotra B, Spellman C, Jessel M, Ayotunde A, Newcombe L, Smith A, Thomas S, Rajasingam D. A pragmatic digital health informatics based approach for aiding clinical prioritisation and reducing backlog of care: A study in cohort of 4022 people with diabetes. Diabetes Res Clin Pract 2023; 203:110834. [PMID: 37478978 DOI: 10.1016/j.diabres.2023.110834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/17/2023] [Accepted: 07/17/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND AND AIMS The backlog of care in resource stretched healthcare systems requires innovative approaches to aid clinical prioritisation. Our aim was to develop an informatics tool to identify and prioritise people with diabetes who are likely to deteriorate whilst awaiting an appointment to optimise clinical outcomes and resources. MATERIALS AND METHODS Using data from electronic health care records we identified 6 risk-factors that could be addressed in 4022 people (52% male, 30% non-Caucasian) with diabetes attending a large university hospital in London. The risk-factors were new clinical events/data occurring since their last routine clinic visit. To validate and compare data-led prioritisation tool to a traditional 'clinical approach' a sample of 450 patients were evaluated. RESULTS Of the 4022 people, 549 (13.6%) were identified as having one or more risk events/factors. People with risk were more likely to be non-Caucasian and had greater socio-economic deprivation. Taking clinical prioritisation as the gold standard, informatics tool identified high risk patients with a sensitivity of 83% and lower risk patients with a specificity of 81%. An operational pilot pathway over 3 months using this approach demonstrated in 101 high risk people that 40% received interventions/care optimisation to prevent deterioration in health. CONCLUSION A pragmatic data-driven method identifies people with diabetes at highest need for clinical prioritisation within restricted resources. Health informatics systems such as our can enhance care and improve operational efficiency and better healthcare delivery for people with diabetes.
Collapse
Affiliation(s)
- J Karalliedde
- Guy's & St Thomas' NHS Foundation Trust London UK; School of Cardiovascular Medicine and Sciences, King's College London, London UK.
| | - O French
- Factor 50 Limited, Nottingham UK
| | | | - B Malhotra
- Guy's & St Thomas' NHS Foundation Trust London UK
| | - C Spellman
- Guy's & St Thomas' NHS Foundation Trust London UK
| | - M Jessel
- Guy's & St Thomas' NHS Foundation Trust London UK
| | - A Ayotunde
- Guy's & St Thomas' NHS Foundation Trust London UK
| | | | - A Smith
- Factor 50 Limited, Nottingham UK
| | - S Thomas
- Guy's & St Thomas' NHS Foundation Trust London UK
| | - D Rajasingam
- Guy's & St Thomas' NHS Foundation Trust London UK
| |
Collapse
|
5
|
Amirthanayagam A, Boulter L, Millet N, McDermott HJ, Morrison J, Taylor A, Miles T, Coton L, Moss EL. Risk Stratified Follow-Up for Endometrial Cancer: The Clinicians' Perspective. Curr Oncol 2023; 30:2237-2248. [PMID: 36826134 PMCID: PMC9955652 DOI: 10.3390/curroncol30020173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/16/2023] Open
Abstract
Risk-stratified follow-up for endometrial cancer (EC) is being introduced in many cancer centres; however, there appears to be diversity in the structure and availability of schemes across the UK. This study aimed to investigate clinicians' and clinical specialist nurses' (CNS) experiences of follow-up schemes for EC, including patient-initiated follow-up (PIFU), telephone follow-up (TFU) and clinician-led hospital follow-up (HFU). A mixed-methods study was conducted, consisting of an online questionnaire to CNSs, an audience survey of participants attending a national "Personalising Endometrial Cancer Follow-up" educational meeting, and qualitative semi-structured telephone interviews with clinicians involved in the follow-up of EC. Thematic analysis identified three main themes to describe clinicians' views: appropriate patient selection; changing from HFU to PIFU schemes; and the future of EC follow-up schemes. Many participants reported that the COVID-19 pandemic impacted EC follow-up by accelerating the transition to PIFU/TFU. Overall, there was increasing support for non-HFU schemes for patients who have completed primary treatment of EC; however, barriers were identified for non-English-speaking patients and those who had communication challenges. Given the good long-term outcome associated with EC, greater focus is needed to develop resources to support patients post-treatment and individualise follow-up according to patients' personal needs and preferences.
Collapse
Affiliation(s)
| | - Louise Boulter
- Department of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - Nessa Millet
- Leicester Cancer Research Centre, University of Leicester, Leicester LE1 7RH, UK
| | - Hilary J. McDermott
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
| | - Jo Morrison
- Somerset NHS Foundation Trust, Taunton TA1 5DA, UK
| | | | - Tracie Miles
- Royal United Hospital Bath NHS Foundation Trust, Bath BA1 3NG, UK
| | - Lorna Coton
- Royal United Hospital Bath NHS Foundation Trust, Bath BA1 3NG, UK
| | - Esther L. Moss
- Leicester Cancer Research Centre, University of Leicester, Leicester LE1 7RH, UK
- Department of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
- Correspondence:
| |
Collapse
|
6
|
Relton A, Collins A, Guttery DS, Gorsia DN, McDermott HJ, Moss EL. Patient acceptability of circulating tumour DNA testing in endometrial cancer follow-up. Eur J Cancer Care (Engl) 2021; 30:e13429. [PMID: 33616269 DOI: 10.1111/ecc.13429] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/15/2020] [Accepted: 01/11/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Circulating tumour DNA (ctDNA) is emerging as a potential option to detect disease recurrence in many cancer types, however, ensuring patient acceptability of changing clinical practice and the introduction of new technology is paramount. METHODS Patients enrolled in a non-intervention cohort study determining the ability of ctDNA to detect recurrent endometrial cancer (EC) were invited to participate in a semi-structured interview. Analysis was performed by Template Analysis. RESULTS Eighteen patients were interviewed. A ctDNA blood test was viewed by participants as more physically and psychologically acceptable than clinical examination to monitor for EC recurrence. In particular, participants expressed overwhelming preference for a blood test rather than pelvic examination. Although participants acknowledged that an abnormal ctDNA result could cause anxiety, they expressed a preference to be informed of their results, even if a recurrence was too small to detect radiologically. Explanations for these opinions were a desire for certainty whether their cancer would recur or not, and knowledge would help them be more aware of symptoms that should be reported to their clinician. CONCLUSIONS ctDNA monitoring to identify EC recurrence appears to be acceptable to patients, and for many, it may be preferable to clinical examination.
Collapse
Affiliation(s)
- Anna Relton
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, Leicestershire, UK
| | - Anna Collins
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - David S Guttery
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - Diviya N Gorsia
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - Hilary J McDermott
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, Leicestershire, UK
| | - Esther L Moss
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| |
Collapse
|
7
|
Collins A, Taylor A, Guttery DS, Moss EL. Innovative Follow-up Strategies for Endometrial Cancer. Clin Oncol (R Coll Radiol) 2021; 33:e383-e392. [PMID: 34172343 DOI: 10.1016/j.clon.2021.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/26/2021] [Accepted: 06/01/2021] [Indexed: 01/22/2023]
Abstract
Increasing recognition of the heterogeneous nature of endometrial cancer, the excellent prognosis of low-risk cases and improvements in risk stratification offer opportunities for innovative, personalised follow-up strategies. This review article outlines the evidence base for alternative follow-up strategies in the different risk categories of endometrial cancer, cancer survivorship programmes and considers future directions in endometrial cancer follow-up, including emerging new techniques, such as the liquid biopsy, and opportunities for combining molecular and clinicopathological features to personalise endometrial cancer follow-up.
Collapse
Affiliation(s)
- A Collins
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - A Taylor
- Royal Marsden NHS Foundation Trust, London, UK
| | - D S Guttery
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - E L Moss
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK.
| |
Collapse
|