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Zeng M, Verma V, Chen X, Li S, Sun Y, Liu G, Tian X, Zhang D, Li J, Liu Y, Liao X, Liu Y, Wang L, Wang X, Shi H, Li B, Xue B, Luo X. Stereotactic radiotherapy vs whole brain radiation therapy in EGFR mutated NSCLC: Results & reflections from the prematurely closed phase III HYBRID trial. Radiother Oncol 2024; 197:110334. [PMID: 38801945 DOI: 10.1016/j.radonc.2024.110334] [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: 11/22/2023] [Revised: 04/22/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND All known randomized trials of stereotactic radiotherapy (SRT) versus whole brain radiotherapy (WBRT) for brain metastases (BMs) comprise mixed histologies. The phase III HYBRID trial (NCT02882984) attempted to evaluate the non-inferiority of SRT vs. WBRT specifically for EGFR-mutated non-small cell lung cancer (EGFRm NSCLC) BMs. METHODS Inclusion criteria were ≤ 5 BMs (any size) from treatment-naïve EGFRm NSCLC. All patients started a first-generation tyrosine kinase inhibitor on the first day of WBRT (37.5 Gy/15 fractions) or SRT (25-40 Gy/5 fractions per tumor volume). The primary endpoint was 18-month intracranial progression-free survival (iPFS; intention-to-treat). RESULTS The trial commenced in June 2015 and was closed in April 2021 after screening 208 patients but enrolling 85 (n = 41 WBRT, n = 44 SRT; median follow-up 31 and 36 months, respectively). Respectively, 9.5 % vs. 10.2 % of patients experienced intracranial progression at 18 months, and the median iPFS was 21.4 vs. 22.3 months (p > 0.05 for all). The SRT arm experienced higher overall survival and cognitive preservation (p < 0.05 for all). The most notable reason for low enrollment was patients not wishing to risk neurocognitive decline from WBRT. CONCLUSIONS Although this phase III trial was underpowered, there was no evidence that SRT yielded outcome detriments compared to WBRT for EGFRm NSCLC BMs. Lessons from prematurely closed trials are valuable, as they often provide important experiential perspectives for investigators designing/executing future trials. In the current era, randomized trials involving WBRT without cognitive sparing measures may be at high risk of underaccrual; trial investigators are encouraged to carefully consider our experience when attempting to design such trials. However, trials of molecular-/biologically-stratified patients are highly recommended as the notion of "individualized medicine/oncology" continues to expand.
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Affiliation(s)
- Ming Zeng
- Cancer Center, Sichuan Taikang Hospital, Tianfu New Area, #881 Xiang He First Street, Chengdu, Sichuan Province, China.
| | - Vivek Verma
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Xue Chen
- Cancer Center, Sichuan Taikang Hospital, Tianfu New Area, #881 Xiang He First Street, Chengdu, Sichuan Province, China
| | - Simin Li
- Cancer Center, Sichuan Taikang Hospital, Tianfu New Area, #881 Xiang He First Street, Chengdu, Sichuan Province, China
| | - Yongliang Sun
- Cancer Center, Sichuan Taikang Hospital, Tianfu New Area, #881 Xiang He First Street, Chengdu, Sichuan Province, China
| | - Guotao Liu
- Cancer Center, Sichuan Taikang Hospital, Tianfu New Area, #881 Xiang He First Street, Chengdu, Sichuan Province, China
| | - Xiaoman Tian
- Cancer Center, Sichuan Taikang Hospital, Tianfu New Area, #881 Xiang He First Street, Chengdu, Sichuan Province, China
| | - Deng Zhang
- Cancer Center, Sichuan Taikang Hospital, Tianfu New Area, #881 Xiang He First Street, Chengdu, Sichuan Province, China
| | - Jingqiu Li
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, 55 South Renmin Ave, Fourth Section, Chengdu, Sichuan Province, China
| | - Yi Liu
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, 55 South Renmin Ave, Fourth Section, Chengdu, Sichuan Province, China
| | - Xingyu Liao
- Familial & Hereditary Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Yingyi Liu
- Department of Oncology, 416 Hospital, North Fourth Section of the Second Ring Road, Chengdu, Sichuan Province, China
| | - Ling Wang
- Department of Oncology, Sichuan Friendship Hospital, No. 96, Shangshahepu Street, Jinjiang District, Chengdu, Sichuan Province, China
| | - Xiao Wang
- Department of Oncology, Sichuan Friendship Hospital, No. 96, Shangshahepu Street, Jinjiang District, Chengdu, Sichuan Province, China
| | - Huibing Shi
- Department of Oncology, Sichuan Friendship Hospital, No. 96, Shangshahepu Street, Jinjiang District, Chengdu, Sichuan Province, China
| | - Bin Li
- Cancer Center, Sichuan Taikang Hospital, Tianfu New Area, #881 Xiang He First Street, Chengdu, Sichuan Province, China
| | - Binyue Xue
- Department of Oncology, Sichuan Friendship Hospital, No. 96, Shangshahepu Street, Jinjiang District, Chengdu, Sichuan Province, China
| | - Xing Luo
- Department of Oncology, First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan Province, China; Clinical Medical School, Chengdu Medical College, Chengdu, Sichuan Province, China
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Wu A, Colón GR, Lim M. Quality of Life and Role of Palliative and Supportive Care for Patients With Brain Metastases and Caregivers: A Review. Front Neurol 2022; 13:806344. [PMID: 35250815 PMCID: PMC8893046 DOI: 10.3389/fneur.2022.806344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/07/2022] [Indexed: 12/25/2022] Open
Abstract
Brain metastases (BM) are the most commonly diagnosed secondary brain lesions in adults, influencing these patients' symptoms and treatment courses. With improvements in oncologic treatments, patients with BM are now living longer with their advanced cancers, and issues pertaining to quality of life become more pressing. The American Society of Clinical Oncology has recommended early implementation of palliative care for cancer patients, though incorporation and implementation of palliative and other supportive services in the setting of true multidisciplinary care requires additional attention and research for patients with intracranial metastases. We review the physical, cognitive, and psychosocial challenges patients with BM and their caregivers face during their cancer course as well as the current published research on quality of life metrics relating to this patient population and the diverse roles specialty palliative care, rehabilitation services, and other healthcare providers play in a comprehensive multidisciplinary care model.
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Affiliation(s)
- Adela Wu
- Department of Neurosurgery, Stanford Healthcare, Stanford, CA, United States
- *Correspondence: Adela Wu
| | - Gabriela Ruiz Colón
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Michael Lim
- Department of Neurosurgery, Stanford Healthcare, Stanford, CA, United States
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Mitchell KAR, Brassil KJ, Rodriguez SA, Tsai E, Fujimoto K, Krause KJ, Shay LA, Springer AE. Operationalizing patient-centered cancer care: A systematic review and synthesis of the qualitative literature on cancer patients' needs, values, and preferences. Psychooncology 2020; 29:1723-1733. [PMID: 32715542 PMCID: PMC7901502 DOI: 10.1002/pon.5500] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 07/06/2020] [Accepted: 07/22/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Efficiently addressing patient priorities and concerns remains a challenge in oncology. Systematic operationalization of patient-centered care (PCC) can support improved assessment and practice of PCC in this unique care setting. This review aimed to synthesize the qualitative empirical literature exploring the National Academy of Medicine (NAM)'s PCC constructs of values, needs, and preferences among patients' during their cancer treatment experiences. METHODS A systematic review of qualitative studies published between 2002 and 2018 addressing adult patient values, needs, and preferences during cancer treatment was conducted. Medline, EMBASE, PsycINFO, and SCOPUS databases were searched on September 10, 2018. Methodological rigor was assessed using a modified version of the Evaluation Tool for Qualitative Studies. Included study findings were analyzed using line-by-line coding; and the emergent themes were compared to the National Academy of Medicine (NAM)'s PCC dimensions. RESULTS Twenty-nine primary studies were included in the synthesis. Descriptive themes for values (autonomy, being involved, family, hope, normality, and sincerity), needs (care coordination, information, privacy, support of physical well-being, emotional support (family/friends, peer, provider), and self-support), and preferences (care coordination, decision-making, information delivery, source of social support, and treatment) were identified. "Cancer care context" emerged as an important domain in which these constructs are operationalized. This thematic framework outlines PCC attributes that oncology care stakeholders can evaluate to improve patient experiences. CONCLUSIONS These findings build on previous PCC research and may contribute to the systematic assessment of patient priorities and the improvement of oncology care quality from the patient perspective.
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Affiliation(s)
- Kerri-Anne R. Mitchell
- Department of Health Behavior and Policy, Virginia
Commonwealth University School of Medicine, Richmond, Virginia
| | | | - Serena A. Rodriguez
- Department of Population and Data Sciences, University of
Texas Southwestern Medical Center, Dallas, Texas
| | - Edward Tsai
- Division of Public Health Sciences, Department of Surgery,
Washington University School of Medicine, St. Louis, Missouri
| | - Kayo Fujimoto
- Department of Health Promotion & Behavioral Sciences,
The University of Texas Health Science Center at Houston (UTHealth) School of Public
Health, Houston, Texas
| | - Kate J. Krause
- Research Medical Library, The University of Texas MD
Anderson Cancer Center, Houston, Texas
| | - L. Aubree Shay
- Department of Health Promotion & Behavioral Sciences,
UTHealth School of Public Health, San Antonio, Texas
| | - Andrew E. Springer
- Michael & Susan Dell Center for Healthy Living,
Department of Health Promotion & Behavioral Sciences, UTHealth School of Public
Health, Austin, Texas
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Werner RN, Gaskins M, Dressler C, Nast A, Schaefer C, Aigner F, Siegel R. Measuring importance of outcomes to patients: a cross-sectional survey for the German anal cancer guideline. J Clin Epidemiol 2020; 129:40-50. [PMID: 32987160 DOI: 10.1016/j.jclinepi.2020.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/04/2020] [Accepted: 09/03/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We aimed to generate evidence on patients' values and preferences to inform the development of the German national Evidence-based Anal Cancer Guideline. STUDY DESIGN AND SETTING We developed a list of health outcomes based on a systematic search. We then asked anal cancer patients and experts of the guideline development group in an online survey to (a) rate the relative importance of the outcomes in different clinical situations using a nine-point, three-category scale, and (b) select seven outcomes they considered most important for decision-making in each situation. RESULTS Participants rated almost half of the outcomes (45%) as critical for decision-making, and more than half (53%) as important. Only two outcomes (2%) were rated as low in importance. Agreement between expert and patient ratings was low to fair, and we found important discrepancies in how the relative importance of the outcomes was perceived. However, the rankings of outcomes were highly correlated. CONCLUSION Determining the relative importance placed by anal cancer patients on outcomes provided useful information for developing guideline recommendations. Our approach may be useful for guideline developers who aim to include the patient perspective. Moreover, our findings may help health professionals caring for anal cancer patients in joint decision-making.
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Affiliation(s)
- Ricardo N Werner
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Venerology and Allergy, Berlin, Germany.
| | - Matthew Gaskins
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Venerology and Allergy, Berlin, Germany
| | - Corinna Dressler
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Venerology and Allergy, Berlin, Germany
| | - Alexander Nast
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Venerology and Allergy, Berlin, Germany
| | - Corinna Schaefer
- German Agency for Quality in Medicine (AEZQ), Department of Evidence Based Medicine and Guidelines, Department of Patient Information, Berlin, Germany
| | - Felix Aigner
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Virchow-Klinikum and Charité Mitte, Berlin, Germany; Department of Surgery, St. John of God Hospital (Krankenhaus der Barmherzigen Brüder) Graz, Graz, Austria
| | - Robert Siegel
- Department of General, Visceral and Oncological Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany; Department of Visceral, Vascular, and Transplantation Surgery, Faculty of Health, Witten/Herdecke University, Witten, Germany
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5
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Gu X, Chen M, Liu M, Zhang Z, Zhao W, Cheng W. Referral Characteristics of Palliative Care Service in Patients With Advanced Non-Small Cell Lung Cancer in a Tertiary Cancer Center. Am J Hosp Palliat Care 2019; 37:266-271. [PMID: 31378075 DOI: 10.1177/1049909119867281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The American Society of Clinical Oncology recently recommends patients with metastatic non-small cell lung cancer (NSCLC) should be offered palliative care services earlier. We sought to investigate the timing of palliative care referral of Chinese patients with NSCLC in our center. METHOD Retrospective medical data including demographic characteristics and referral information were collected for analysis. Overall survival (OS) was calculated as the time since cancer diagnosis till patient's death. The time interval from palliative care (PC) referral to a patient's death (PC-D) was calculated. The PC-D/OS ratio was calculated to illustrate the comparison of the duration of PC in the overall length of disease. RESULTS The mean age of 155 patients with advanced NSCLC was 62.83 years. Before referral to PC, 128 patients received anticancer treatment including surgeon (46.5%). Sixty-three (40.6%) patients died in palliative care unit. The median OS of 144 patients with end cutoff was 19 months (mean = 31.49, 95% confidence interval [CI] = 25.86-37.12). The median PC-D was 41 days (mean = 73.84, 95% CI = 60.37-87.40). The mean interval of PC-D/OS of 144 patients with definitely death time was 0.22 (SD: 0.27, 95% CI: 0.17-0.26). The median interval was 0.089. More than half of patients (n = 75, 51.8%) underwent PC less than 1% time (PC-D/OS < 0.1) of their whole disease course. Patients who were indigenous to Shanghai (P = .013) and who had brain metastasis (P = .072) had the potential longer PC-D/OS ratio. A high proportion of patients reported loss of appetite (92.8%) and fatigue (91.4%) at the initial of referral to PC. CONCLUSION This retrospective study, in a population of patients with advanced NSCLC, gave detailed information about PC services in a tertiary cancer center.
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Affiliation(s)
- Xiaoli Gu
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Menglei Chen
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Minghui Liu
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhe Zhang
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weiwei Zhao
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wenwu Cheng
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Lippiett KA, Richardson A, Myall M, Cummings A, May CR. Patients and informal caregivers' experiences of burden of treatment in lung cancer and chronic obstructive pulmonary disease (COPD): a systematic review and synthesis of qualitative research. BMJ Open 2019; 9:e020515. [PMID: 30813114 PMCID: PMC6377510 DOI: 10.1136/bmjopen-2017-020515] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To identify, characterise and explain common and specific features of the experience of treatment burden in relation to patients living with lung cancer or chronic obstructive pulmonary disease (COPD) and their informal caregivers. DESIGN Systematic review and interpretative synthesis of primary qualitative studies. Papers were analysed using constant comparison and directed qualitative content analysis. DATA SOURCES CINAHL, EMBASE, MEDLINE, PsychINFO, Scopus and Web of Science searched from January 2006 to December 2015. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Primary qualitative studies in English where participants were patients with lung cancer or COPD and/or their informal caregivers, aged >18 years that contain descriptions of experiences of interacting with health or social care in Europe, North America and Australia. RESULTS We identified 127 articles with 1769 patients and 491 informal caregivers. Patients, informal caregivers and healthcare professionals (HCPs) acknowledged lung cancer's existential threat. Managing treatment workload was a priority in this condition, characterised by a short illness trajectory. Treatment workload was generally well supported by an immediacy of access to healthcare systems and a clear treatment pathway. Conversely, patients, informal caregivers and HCPs typically did not recognise or understand COPD. Treatment workload was balanced with the demands of everyday life throughout a characteristically long illness trajectory. Consequently, treatment workload was complicated by difficulties of access to, and navigation of, healthcare systems, and a fragmented treatment pathway. In both conditions, patients' capacity to manage workload was enhanced by the support of family and friends, peers and HCPs and diminished by illness/smoking-related stigma and social isolation. CONCLUSION This interpretative synthesis has affirmed significant differences in treatment workload between lung cancer and COPD. It has demonstrated the importance of the capacity patients have to manage their workload in both conditions. This suggests a workload which exceeds capacity may be a primary driver of treatment burden. PROSPERO REGISTRATION NUMBER CRD42016048191.
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Affiliation(s)
- Kate Alice Lippiett
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Michelle Myall
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Amanda Cummings
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Carl R May
- London School of Hygiene and Tropical Medicine, London, UK
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7
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Papadakos J, Agarwal A, Charow R, Quartey NK, D'souza A, Giuliani M, Millar BA, Massey C, Shultz D, Chung C. Informational needs of brain metastases patients and their caregivers. Neurooncol Pract 2018; 6:47-60. [PMID: 31386069 DOI: 10.1093/nop/npy008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background In response to a dearth of formal health information targeted towards patients with brain metastases and their caregivers, a formal informational and supportive care needs assessment was conducted. Methods Brain metastases patients and caregivers who attended a clinic focused on the treatment of brain metastases at a tertiary medical center completed a self-report survey to assess informational needs across 6 domains: medical, physical, practical, social, emotional, and spiritual informational needs. Univariate and multivariate analyses of associations between variables was conducted using linear regression models. Results A total of 109 patients and 77 caregivers participated. Patients and caregivers both prioritized medical and physical informational domains, with a large focus on symptoms and side-effect profiles, significance of brain metastases locations and their implications, available treatment options and their risks and benefits, prognoses and follow-ups if treatment is completed, and end-of-life experiences and supports. One-on-one counseling was preferred by both caregivers and patients for these domains, as well as for practical informational needs; while patients preferred pamphlets to address social, emotional and spiritual informational needs, caregivers preferred one-on-one counseling for the former two domains as well. Conclusions Brain metastases patients and their caregivers prioritize medical and physical informational needs, with one-on-one counseling and pamphlets being the most preferred modalities for information provision. Further exploration regarding existing non-validated resources and the development of tailored resources to address the unique needs of these patient and caregiver populations are warranted.
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Affiliation(s)
- Janet Papadakos
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Patient Education, Cancer Care Ontario, Toronto, ON
| | - Arnav Agarwal
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Charow
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Naa Kwarley Quartey
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Anna D'souza
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Meredith Giuliani
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - Barbara-Ann Millar
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - Christine Massey
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David Shultz
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - Caroline Chung
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Radiation Oncology, MD Anderson Cancer Centre, Houston, Texas
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Maqbool T, Agarwal A, Sium A, Trang A, Chung C, Papadakos J. Informational and Supportive Care Needs of Brain Metastases Patients and Caregivers: a Systematic Review. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:914-923. [PMID: 27041700 DOI: 10.1007/s13187-016-1030-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
While brain metastases (BM) are associated with significant morbidity and mortality, the needs of BM patients and their caregivers (CGs) remain largely unknown. The purpose of this systematic review was to summarize (a) the informational needs of BM patients and CGs, (b) their supportive care needs, and (c) studies evaluating existing programs and resources addressing one or more of informational needs. A systematic search was conducted in four databases to identify studies, published from 2000 to April 2015, discussing informational or supportive care needs of BM patients and/or their CGs. Duplicate screening, data abstraction, and risk of bias assessments were conducted. Results were qualitatively summarized. From 973 references, seven studies fulfilled inclusion criteria. While physical and medical informational needs concerning prognosis, symptom management, treatment options, and side effects were reported, no studies exploring patient or CG social, emotional, or spiritual informational needs were identified. Discordance was observed between patient, CG, and health care professional perspectives on patient supportive care needs. One study evaluated an intervention addressing informational needs. Patients required information on prognosis, managing symptoms, and available treatment options and associated side effects. They needed support managing housework, pain, and fatigue. The findings of this study suggest an ongoing need to elicit psychosocial informational needs, supportive care needs, and a need for patient- and CG-centered resource development. Since ascertaining these needs is vital to the delivery of patient-centered care, efforts must be undertaken to explore these in the context of BM patients and CGs.
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Affiliation(s)
- Talha Maqbool
- Patient and Family Education Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Arnav Agarwal
- Patient and Family Education Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Aman Sium
- Patient and Family Education Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Aileen Trang
- Patient and Family Education Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Caroline Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Janet Papadakos
- Patient and Family Education Program, Princess Margaret Cancer Centre, Toronto, ON, Canada.
- ELLICSR: Health, Wellness & Cancer Survivorship Centre, Princess Margaret Cancer Centre, Toronto, ON, Canada.
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Boland JW, Dikomitis L, Gadoud A. Medical students writing on death, dying and palliative care: a qualitative analysis of reflective essays. BMJ Support Palliat Care 2016; 6:486-492. [DOI: 10.1136/bmjspcare-2016-001110] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 06/01/2016] [Accepted: 07/14/2016] [Indexed: 01/12/2023]
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10
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Schmidt K, Damm K, Prenzler A, Golpon H, Welte T. Preferences of lung cancer patients for treatment and decision-making: a systematic literature review. Eur J Cancer Care (Engl) 2015; 25:580-91. [PMID: 26676876 DOI: 10.1111/ecc.12425] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2015] [Indexed: 11/28/2022]
Abstract
The consideration of patient preferences in decision-making has become more important, especially for life-threatening diseases such as lung cancer. This paper aims to identify the preferences of lung cancer patients with regard to their treatment and involvement in the decision-making process. We conducted a systematic literature review from 12 electronic databases and included studies published between 2000 and 2012. A total of 20 studies were included in this review. These revealed that lung cancer patients do have preferences that should be considered in treatment decisions; however, these preferences are not homogenous. We found that patients often consider life extension to be more important than the health-related quality of life or undesirable side effects. This preference seems to depend on patient age. Nausea and vomiting are the most important side effects to be avoided; the relevance of other side effects differs highly between subgroups. The majority of lung cancer patients, nevertheless, seem to prefer a passive rather than an active role in decision-making, although the self-reported preferences differed partly from the physicians' perceptions. Overall, we identified an urgent need for larger studies that are suitable for subgroup analyses and incorporate multi-attributive measurement techniques.
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Affiliation(s)
- K Schmidt
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Hannover, Germany
| | - K Damm
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - A Prenzler
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - H Golpon
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.,Hannover Medical School, Clinic for Pneumology, Hannover, Germany
| | - T Welte
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.,Hannover Medical School, Clinic for Pneumology, Hannover, Germany
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Mühlbacher AC, Bethge S. Patients' preferences: a discrete-choice experiment for treatment of non-small-cell lung cancer. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2015; 16:657-70. [PMID: 25135768 PMCID: PMC4464047 DOI: 10.1007/s10198-014-0622-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 07/11/2014] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Lung cancer is a major cause of cancer-related deaths and thus represents a global health problem. According to World Health Organization (WHO) estimates, approximately 1.37 million people die each year from lung cancer. Different therapeutic approaches as well as several treatment options exist. To date decisions on which therapies to use have largely been made by clinical experts. Comparative preference studies show that underlying weighting of treatment goals by experts is not necessarily congruent with the preferences of affected patients. AIM AND METHODS The aim of this empirical study was to ascertain patient preferences in relation to treatment of non-small-cell lung cancer (NSCLC). After identification of patient-relevant treatment attributes via literature review and qualitative interviews(ten) a discrete-choice experiment including seven patient-relevant attributes was conducted using a fractional factorial NGene-design. Statistical data analysis was performed using latent class models. RESULTS The qualitative part of this study identified outcome measures related to efficacy, side effects and mode of administration. A total of 211 NSCLC patients (N = 211) participated in the computer-assisted personal interview. A clear preference for an increase in "progression-free survival" (coef.: 1.087) and a reduction of "tumor-associated symptoms"(cough, shortness of breath and pain); coef.: 1.090) was demonstrated, followed by the reduction of side effects: "nausea and vomiting" (coef.: 0.605); "rash" (coef.: 0.432); "diarrhea" (coef.: 0.427); and, "tiredness and fatigue" (coef.: 0.423). The "mode of administration" was less important for participants (coef.: 0.141). CONCLUSION Preference measurement showed "progression-free survival" and "tumor-associated symptoms" had a significant influence on the treatment decision. Subgroup analysis revealed that the importance of "progression-free survival" increases with increased therapy experience. Based on the presented results therapies can be designed, assessed and chosen on the basis of patient-oriented findings. As such, more effective and efficient care of patients can be achieved and benefits increased.
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Affiliation(s)
- Axel C Mühlbacher
- IGM Institut Gesundheitsökonomie und Medizinmanagement, Hochschule Neubrandenburg, Brodaer Straße 2, 17033, Neubrandenburg, Germany,
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Lowe SS, Danielson B, Beaumont C, Watanabe SM, Baracos VE, Courneya KS. Associations between objectively measured physical activity and quality of life in cancer patients with brain metastases. J Pain Symptom Manage 2014; 48:322-32. [PMID: 24630754 DOI: 10.1016/j.jpainsymman.2013.10.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 10/20/2013] [Accepted: 10/20/2013] [Indexed: 11/25/2022]
Abstract
CONTEXT Physical activity has demonstrated benefits for quality of life (QoL) and cancer-related fatigue earlier in the cancer trajectory; however, less is known regarding its role in patients with end-stage cancer. OBJECTIVES The primary aim of this study was to examine the association between objectively measured physical activity and QoL in cancer patients with brain metastases. METHODS Patients diagnosed with brain metastases, aged 18 years or older, cognitively intact, and with Palliative Performance Scale scores greater than 30%, were recruited from a multidisciplinary brain metastases clinic. A cross-sectional survey interview assessed self-reported QoL (McGill Quality of Life Questionnaire), self-reported physical function (Late-Life Function and Disability Instrument), and symptoms (Edmonton Symptom Assessment System). Participants wore activPAL™ (PAL Technologies, Ltd., Glasgow, UK) accelerometers recording triaxial movement for seven days during palliative whole brain radiotherapy. RESULTS A total of 31 patients were recruited. Median survival was 171 days from time of study consent, with 90% (28 of 31) of deaths by two year follow-up. Participants who stood for 1.6 hours or more per day had better QoL (mean=1.0; 95% confidence interval [CI]=0.1 to 1.9; P=0.034). Participants who stood for 1.6 hours or more per day had better QoL (mean=1.0; 95% CI=0.1 to 1.9; P=0.034). Participants who sat or were supine for 20.7 hours or more per day had better advanced lower extremity functioning (mean=-6.1; 95% CI=-11.9 to -0.3; P=0.040) and total functioning (mean=-10.6; 95% CI=-21.1 to -0.04; P=0.049), but worse depression (mean=2.1; 95% CI=0.3 to 3.9; P=0.028), anxiety (mean=2.8; 95% CI=0.7 to 5.0; P=0.012), and feeling of well-being (mean=1.9; 95% CI=0.2 to 3.6; P=0.028). CONCLUSION Sedentary behavior appears to be associated with better physical functioning but worse psychosocial functioning in cancer patients with brain metastases.
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Affiliation(s)
- Sonya S Lowe
- Department of Symptom Control and Palliative Care, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada.
| | - Brita Danielson
- Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Crystal Beaumont
- Department of Symptom Control and Palliative Care, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Sharon M Watanabe
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Vickie E Baracos
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Kerry S Courneya
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
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Lowe SS, Danielson B, Beaumont C, Watanabe SM, Baracos VE, Courneya KS. Correlates of objectively measured sedentary behavior in cancer patients with brain metastases: an application of the theory of planned behavior. Psychooncology 2014; 24:757-62. [DOI: 10.1002/pon.3641] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 06/23/2014] [Accepted: 07/09/2014] [Indexed: 01/19/2023]
Affiliation(s)
- Sonya S. Lowe
- Department of Symptom Control and Palliative Care; Cross Cancer Institute; Edmonton Alberta Canada
| | - Brita Danielson
- Department of Oncology; University of Alberta; Edmonton Alberta Canada
| | - Crystal Beaumont
- Department of Symptom Control and Palliative Care; Cross Cancer Institute; Edmonton Alberta Canada
| | | | - Vickie E. Baracos
- Department of Oncology; University of Alberta; Edmonton Alberta Canada
| | - Kerry S. Courneya
- Faculty of Physical Education & Recreation; University of Alberta; Edmonton Alberta Canada
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Comparison of time trade-off utility with neurocognitive function, performance status, and quality of life measures in patients with metastatic brain disease. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s13566-013-0093-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Managing brain metastases patients with and without radiotherapy: initial lessonsfrom a team-based consult service through a multidisciplinary integrated palliative oncology clinic. Support Care Cancer 2013; 21:3379-86. [PMID: 23934224 DOI: 10.1007/s00520-013-1917-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 07/22/2013] [Indexed: 12/13/2022]
Abstract
PURPOSE A new ambulatory consultative clinic with integrated assessments by palliative care, radiation oncology, and allied health professionals was introduced to (1) assess patients with brain metastases at a regional comprehensive cancer center and (2) inform and guide patients on management strategies, including palliative radiotherapy, symptom control, and end-of-life care issues. We conducted a quality assurance study to inform clinical program development. METHODS Between January 2011 and May 2012, 100 consecutive brain metastases patients referred and assessed through a multidisciplinary clinic were evaluated for baseline characteristics, radiotherapy use, and supportive care decisions. Overall survival was examined by known prognostic groups. Proportion of patients receiving end-of-life radiotherapy (death within 30 and 14 days of brain radiotherapy) was used as a quality metric. RESULTS The median age was 65 years, with non-small cell lung cancer (n = 38) and breast cancer (n = 23) being the most common primary cancers. At least 57 patients were engaged in advance care planning discussions at first consult visit. In total, 75 patients eventually underwent brain radiotherapy, whereas 25 did not. The most common reasons for nonradiotherapy management were patient preference and rapid clinical deterioration. Overall survival for prognostic subgroups was consistent with literature reports. End-of-life brain radiotherapy was observed in 9 % (death within 30 days) and 1 % (within 14 days) of treated patients. CONCLUSIONS By integrating palliative care expertise to address the complex needs of patients with newly diagnosed brain metastases, end-of-life radiotherapy use appears acceptable and improved over historical rates at our institution. An appreciable proportion of patients are not suitable for palliative brain radiotherapy or opt against this treatment option, but the team approach involving nurses, palliative care experts, allied health, and clinical oncologists facilitates patient-centered decision making and transition to end-of-life care.
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Maguire R, Papadopoulou C, Kotronoulas G, Simpson MF, McPhelim J, Irvine L. A systematic review of supportive care needs of people living with lung cancer. Eur J Oncol Nurs 2013; 17:449-64. [PMID: 23246484 DOI: 10.1016/j.ejon.2012.10.013] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 10/23/2012] [Accepted: 10/30/2012] [Indexed: 11/18/2022]
Affiliation(s)
- Roma Maguire
- School of Nursing & Midwifery, University of Dundee, 11 Airlie Place, Dundee DD1 4HJ, UK.
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Gofton TE, Graber J, Carver A. Identifying the palliative care needs of patients living with cerebral tumors and metastases: a retrospective analysis. J Neurooncol 2012; 108:527-34. [DOI: 10.1007/s11060-012-0855-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 03/20/2012] [Indexed: 10/28/2022]
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Bridges JFP, Mohamed AF, Finnern HW, Woehl A, Hauber AB. Patients' preferences for treatment outcomes for advanced non-small cell lung cancer: a conjoint analysis. Lung Cancer 2012; 77:224-31. [PMID: 22369719 DOI: 10.1016/j.lungcan.2012.01.016] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 01/13/2012] [Accepted: 01/30/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Treatment decisions for advanced non-small cell lung cancer (NSCLC) are complex and require trade-offs between the benefits and risks experienced by patients. We evaluated the benefits that patients judged sufficient to compensate for the risks associated with therapy for NSCLC. METHODS Participants with a self-reported diagnosis of NSCLC (n=100) were sampled from an online panel in the United Kingdom. Eligible and consenting participants then completed a self-administered online survey about their disease and their treatment preferences were assessed. This involved respondents choosing among systematically paired profiles that spanned eight attributes: progression-free survival [PFS], symptom severity, rash, diarrhoea, fatigue, nausea and vomiting, fever and infection, and mode of treatment administration (infusion and oral). A choice model was estimated using mixed-logit regression. Estimates of importance for each attribute level and attribute were then calculated and acceptable tradeoffs among attributes were explored. RESULTS A total of 89 respondents (73% male) completed all choice tasks appropriately. Increases in PFS together with improvements in symptom severity were judged most important and increased with PFS benefit - 4 months: 5.7; 95% CI: 3.5-7.9; 5 months: 7.1; 95% CI: 4.4-9.9; and 7 months: 10.0; 95% CI: 6.1-13.9. However, improvements in PFS were viewed as most beneficial when disease symptoms were mild and as detrimental when patients had severe symptoms. Fatigue (5.0; 95% CI: 2.7-7.3) was judged to be the most important risk, followed by diarrhoea (2.8; 95% CI: 0.7-4.9), nausea and vomiting (2.1; 95% CI: 0.1-4.1), fever and infection (2.1; 95% CI: 0.2-4.1), and rash (2.0; 95% CI: 0.2-3.9). Oral administration was preferred to infusion (1.8; 95% CI: 0.0-3.6). Patients with mild and moderate symptoms traded PFS for less risks or more convenience if the severe symptoms were not experienced. CONCLUSION This study demonstrates the value of conjoint analysis in the study of patient preferences for cancer treatments. In this small sample of patients with NSCLC from the UK, we demonstrate that the value of improvements in PFS is conditional upon the severity of disease symptoms; and that risks are valued differently.
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Affiliation(s)
- John F P Bridges
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Alt-Epping B, Nauck F. Der Wunsch des Patienten – ein eigenständiger normativer Faktor in der klinischen Therapieentscheidung? Ethik Med 2011. [DOI: 10.1007/s00481-011-0147-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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