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Barbieri A, Cousson-Gélie F, Baussard L, Gourgou S, Lavergne C, Mollevi C. The importance of using ordinal scores for patient classification based on health-related quality of life trajectories. Pharm Stat 2022; 21:919-931. [PMID: 35289497 DOI: 10.1002/pst.2205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 01/29/2022] [Accepted: 02/26/2022] [Indexed: 11/12/2022]
Abstract
Changes in health-related quality of life (HRQoL) over time are not necessarily homogeneous within a population of interest. Our study aim was twofold: to determine homogeneous patient subpopulations distinguished by HRQoL trajectories, and to identify the particular patient profile associated with each subpopulation. To classify patients according to HRQoL dimension scores, we compared mixtures of linear mixed models (LMMs) classically applied to scores defined by the EORTC procedure, and mixtures of random effect cumulative models (CMs) applied to scores treated as ordinal variables. A simulation study showed that the mixture of LMMs overestimated the number of subpopulations and was less able to correctly classify patients than the mixture of CMs. Considering HRQoL scores as ordinal rather than continuous variables is relevant when classifying patients. The mixture of CMs for ordinal scores is able to identify homogeneous subpopulations and their associated trajectories. The application focused on changes over time in HRQoL data (collected using the EORTC QLQ-C30 questionnaire) from 132 breast cancer patients from the Moral study. Once the classification is obtained only from HRQoL scores, class membership was then explained through a logistic regression model, given a large panel of variables collected at baseline. Analysis of data revealed that deterioration over time of role functioning and insomnia was closely related to patient anxiety: anxiety at baseline is a prognostic factor for a poor level and/or a deterioration over time of HRQoL. For functional dimensions, large tumor size and high education level were associated with worse HRQoL scores.
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Affiliation(s)
| | - Florence Cousson-Gélie
- Institut régional du Cancer Montpellier/Val d'Aurelle, Epidaure, Montpellier, France.,Université Paul-Valéry Montpellier 3, Univ. Montpellier, EPSYLON, Montpellier, EA, France
| | | | - Sophie Gourgou
- Institut régional du Cancer Montpellier/Val d'Aurelle, Biometrics Unit, Montpellier, France
| | - Christian Lavergne
- Université Paul-Valéry Montpellier 3, Montpellier, France.,Institut Montpelliérain Alexander Grothendieck, Montpellier, France
| | - Caroline Mollevi
- Institut régional du Cancer Montpellier/Val d'Aurelle, Biometrics Unit, Montpellier, France.,Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP), Univ. Montpellier, INSERM, ICM, Montpellier, France.,National Platform Quality of Life and Cancer, Montpellier, France
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Santos M, Oliveira e Silva LF, Kohler HF, Curioni O, Vilela R, Fang M, Passos Lima CS, Gomes JP, Chaves A, Resende B, Trindade K, Collares M, Obs F, Brollo J, Cavalieri R, Ferreira E, Brust L, Rabello D, Domenge C, Kowalski LP. Health-Related Quality of Life Outcomes in Head and Neck Cancer: Results From a Prospective, Real-World Data Study With Brazilian Patients Treated With Intensity Modulated Radiation Therapy, Conformal and Conventional Radiation Techniques. Int J Radiat Oncol Biol Phys 2021; 109:485-494. [DOI: 10.1016/j.ijrobp.2020.09.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/13/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022]
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Corneloup M, Maurier F, Wahl D, Muller G, Aumaitre O, Seve P, Blaison G, Pennaforte JL, Martin T, Magy-Bertrand N, Berthier S, Arnaud L, Bourredjem A, Amoura Z, Devilliers H. Disease-specific quality of life following a flare in systemic lupus erythematosus: an item response theory analysis of the French EQUAL cohort. Rheumatology (Oxford) 2020; 59:1398-1406. [PMID: 31620787 DOI: 10.1093/rheumatology/kez451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/30/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To explore, at an item-level, the effect of disease activity (DA) on specific health-related quality of life (HRQoL) in SLE patients using an item response theory longitudinal model. METHODS This prospective longitudinal multicentre French cohort EQUAL followed SLE patients over 2 years. Specific HRQoL according to LupusQoL and SLEQOL was collected every 3 months. DA according to SELENA-SLEDAI flare index (SFI) and revised SELENA-SLEDAI flare index (SFI-R) was evaluated every 6 months. Regarding DA according to SFI and each SFI-R type of flare, specific HRQoL of remitting patients was compared with non-flaring patients fitting a linear logistic model with relaxed assumptions for each domain of the questionnaires. RESULTS Between December 2011 and July 2015, 336 patients were included (89.9% female). LupusQoL and SLEQOL items related to physical HRQoL (physical health, physical functioning, pain) were most affected by musculoskeletal and cutaneous flares. Cutaneous flares had significant influence on self-image. Neurological or psychiatric flares had a more severe impact on specific HRQoL. Patient HRQoL was impacted up to 18 months after a flare. CONCLUSION Item response theory analysis is able to pinpoint items that are influenced by a given patient group in terms of a latent trait change. Item-level analysis provides a new way of interpreting HRQoL variation in SLE patients, permitting a better understanding of DA impact on HRQoL. This kind of analysis could be easily implemented for the comparison of groups in a clinical trial. TRIAL REGISTRATION ClinicalTrials.gov, http://clinicaltrials.gov, NCT01904812.
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Affiliation(s)
- Marie Corneloup
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon
| | - François Maurier
- Department of Internal Medicine and Clinical Immunology, Site Belle Isle, Metz
| | - Denis Wahl
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, CHRU de Nancy.,Inserm UMR_S 1116 at Lorraine University, Nancy
| | - Geraldine Muller
- Internal Medicine and Systemic Diseases Unit, University Hospital Centre Dijon, Dijon
| | - Olivier Aumaitre
- Department of Internal Medicine, Centre Hospitalier Universitaire, Hôpital Gabriel Montpied, Clermont-Ferrand
| | - Pascal Seve
- Department of Internal Medicine, University Hospital, Hôpital Croix Rousse, Lyon
| | - Gilles Blaison
- Department of Internal Medicine, Hopital Louis Pasteur, Colmar, Alsace
| | | | - Thierry Martin
- Internal Medicine and Clinical Immunology Department, Strasbourg University Hospital, Strasbourg
| | | | - Sabine Berthier
- Internal Medicine and Clinical Immunology Unit, University Hospital Dijon-Burgundy, Dijon
| | - Laurent Arnaud
- Department of Rheumatology, Hôpitaux Universitaires de Strasbourg.,INSERM UMR-S 1109, Strasbourg
| | - Abderrahmane Bourredjem
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon
| | - Zahir Amoura
- Department of Internal Medicine, National Referral Center for Systemic Lupus Erythematosus and Anti-Phospholipid Syndrome, Pitie-Salpetriere University Hospital, Paris, France
| | - Hervé Devilliers
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon
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Bascoul-Mollevi C, Barbieri A, Bourgier C, Conroy T, Chauffert B, Hebbar M, Jacot W, Juzyna B, De Forges H, Gourgou S, Bonnetain F, Touraine C, Anota A. Longitudinal analysis of health-related quality of life in cancer clinical trials: methods and interpretation of results. Qual Life Res 2020; 30:91-103. [PMID: 32809099 DOI: 10.1007/s11136-020-02605-3] [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] [Accepted: 08/06/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Health-related quality of life (HRQoL) is assessed by self-administered questionnaires throughout the care process. Classically, two longitudinal statistical approaches were mainly used to study HRQoL: linear mixed models (LMM) or time-to-event models for time to deterioration/time until definitive deterioration (TTD/TUDD). Recently, an alternative strategy based on generalized linear mixed models for categorical data has also been proposed: the longitudinal partial credit model (LPCM). The objective of this article is to evaluate these methods and to propose recommendations to standardize longitudinal analysis of HRQoL data in cancer clinical trials. METHODS The three methods are first described and compared through statistical, methodological, and practical arguments, then applied on real HRQoL data from clinical cancer trials or published prospective databases. In total, seven French studies from a collaborating group were selected with longitudinal collection of QLQ-C30. Longitudinal analyses were performed with the three approaches using SAS, Stata and R software. RESULTS We observed concordant results between LMM and LPCM. However, discordant results were observed when we considered the TTD/TUDD approach compared to the two previous methods. According to methodological and practical arguments discussed, the approaches seem to provide additional information and complementary interpretations. LMM and LPCM are the most powerful methods on simulated data, while the TTD/TUDD approach gives more clinically understandable results. Finally, for single-item scales, LPCM is more appropriate. CONCLUSION These results pledge for the recommendation to use of both the LMM and TTD/TUDD longitudinal methods, except for single-item scales, establishing them as the consensual methods for publications reporting HRQoL.
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Affiliation(s)
- Caroline Bascoul-Mollevi
- Biometrics Unit - CTD INCa, Institut du Cancer Montpellier, Univ. Montpellier, Montpellier, France. .,Institut de Recherche en Cancérologie de Montpellier Inserm U1194, University Montpellier, 208 rue des Apothicaire, Montpellier Cedex 5, 34298, Montpellier, France. .,National Platform Quality of Life and Cancer, Montpellier, France.
| | | | - Céline Bourgier
- Institut de Recherche en Cancérologie de Montpellier Inserm U1194, University Montpellier, 208 rue des Apothicaire, Montpellier Cedex 5, 34298, Montpellier, France.,Department of Radiation Oncology, Institut du Cancer Montpellier, University Montpellier, Montpellier, France
| | - Thierry Conroy
- Medical Oncology Department, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France.,Lorraine University, APEMAC, Team MICS, Nancy, France
| | - Bruno Chauffert
- Medical Oncology Department, Amiens University Hospital, Amiens, France
| | - Mohamed Hebbar
- Department of Medical Oncology, University Hospital, Lille, France
| | - William Jacot
- Institut de Recherche en Cancérologie de Montpellier Inserm U1194, University Montpellier, 208 rue des Apothicaire, Montpellier Cedex 5, 34298, Montpellier, France.,Department of Medical Oncology, Institut du Cancer Montpellier, University Montpellier, Montpellier, France
| | | | - Hélène De Forges
- Clinical Research and Innovation Department, Institut du Cancer Montpellier, University Montpellier, Montpellier, France
| | - Sophie Gourgou
- Biometrics Unit - CTD INCa, Institut du Cancer Montpellier, Univ. Montpellier, Montpellier, France.,National Platform Quality of Life and Cancer, Montpellier, France
| | - Franck Bonnetain
- National Platform Quality of Life and Cancer, Montpellier, France.,Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France.,UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, Bourgogne Franche-Comté University, Inserm, EFS BFC, Fédération Hospitalo-Universitaire INCREASE, Besançon, France
| | - Célia Touraine
- Biometrics Unit - CTD INCa, Institut du Cancer Montpellier, Univ. Montpellier, Montpellier, France.,National Platform Quality of Life and Cancer, Montpellier, France
| | - Amélie Anota
- National Platform Quality of Life and Cancer, Montpellier, France.,Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France.,UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, Bourgogne Franche-Comté University, Inserm, EFS BFC, Fédération Hospitalo-Universitaire INCREASE, Besançon, France
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Barbieri A, Tami M, Bry X, Azria D, Gourgou S, Bascoul-Mollevi C, Lavergne C. EM algorithm estimation of a structural equation model for the longitudinal study of the quality of life. Stat Med 2018; 37:1031-1046. [PMID: 29250835 DOI: 10.1002/sim.7557] [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] [Received: 07/30/2016] [Revised: 08/17/2017] [Accepted: 10/17/2017] [Indexed: 11/12/2022]
Abstract
Health-related quality of life (HRQoL) data are measured via patient questionnaires, completed by the patients themselves at different time points. We focused on oncology data gathered through the use of European Organization for Research and Treatment of Cancer questionnaires, which decompose HRQoL into several functional dimensions, several symptomatic dimensions, and the global health status (GHS). We aimed to perform a global analysis of HRQoL and reduce the number of analyses required by using a two-step approach. First, a structural equation model (SEM) was used for each time point; in these models, the GHS is explained by two latent variables. Each latent variable is a factor that summarizes, respectively, the functional dimensions and the symptomatic dimensions to the global measurement. This is achieved through the maximization of the likelihood of each SEM using the EM algorithm, which has the advantage of giving an estimation of the subject-specific factors and the influence of additional explanatory variables. Then, to consider the longitudinal aspect, the GHS variable and the two factors were concatenated for each patient visit at which the questionnaire was completed. The GHS and the two factors estimated in the first step can then be explained by additional explanatory variables using a linear mixed model.
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Affiliation(s)
- Antoine Barbieri
- Biometrics Unit, Institut du Cancer Montpellier (ICM), Montpellier, France.,Université de Montpellier, Montpellier, France.,Institut Montpelliérain Alexander Grothendieck (IMAG), Montpellier, France.,Institute of Statistics, Biostatistics and Actuarial sciences, Université catholique de Louvain, Belgium
| | - Myriam Tami
- Université de Montpellier, Montpellier, France.,Institut Montpelliérain Alexander Grothendieck (IMAG), Montpellier, France
| | - Xavier Bry
- Université de Montpellier, Montpellier, France.,Institut Montpelliérain Alexander Grothendieck (IMAG), Montpellier, France
| | - David Azria
- Université de Montpellier, Montpellier, France.,Department of Radiation Oncology, Institut du Cancer Montpellier (ICM), Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier (IRCM), Inserm U1194, Montpellier, France
| | - Sophie Gourgou
- Biometrics Unit, Institut du Cancer Montpellier (ICM), Montpellier, France.,French National Platform Quality of Life and Cancer, Montpellier, France
| | - Caroline Bascoul-Mollevi
- Biometrics Unit, Institut du Cancer Montpellier (ICM), Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier (IRCM), Inserm U1194, Montpellier, France.,French National Platform Quality of Life and Cancer, Montpellier, France
| | - Christian Lavergne
- Institut Montpelliérain Alexander Grothendieck (IMAG), Montpellier, France.,Université Paul-Valéry Montpellier 3, Montpellier, France
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Barbieri A, Peyhardi J, Conroy T, Gourgou S, Lavergne C, Mollevi C. Item response models for the longitudinal analysis of health-related quality of life in cancer clinical trials. BMC Med Res Methodol 2017; 17:148. [PMID: 28950850 PMCID: PMC5615461 DOI: 10.1186/s12874-017-0410-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 08/28/2017] [Indexed: 01/05/2023] Open
Abstract
Background The use of health-related quality of life (HRQoL) as an endpoint in cancer clinical trials is growing rapidly. Hence, research into the statistical approaches used to analyze HRQoL data is of major importance, and could lead to a better understanding of the impact of treatments on the everyday life and care of patients. Amongst the models that are used for the longitudinal analysis of HRQoL, we focused on the mixed models from item response theory, to directly analyze raw data from questionnaires. Methods We reviewed the different item response models for ordinal responses, using a recent classification of generalized linear models for categorical data. Based on methodological and practical arguments, we then proposed a conceptual selection of these models for the longitudinal analysis of HRQoL in cancer clinical trials. Results To complete comparison studies already present in the literature, we performed a simulation study based on random part of the mixed models, so to compare the linear mixed model classically used to the selected item response models. As expected, the sensitivity of the item response models to detect random effects with lower variance is better than that of the linear mixed model. We then used a cumulative item response model to perform a longitudinal analysis of HRQoL data from a cancer clinical trial. Conclusions Adjacent and cumulative item response models seem particularly suitable for HRQoL analysis. In the specific context of cancer clinical trials and the comparison between two groups of HRQoL data over time, the cumulative model seems to be the most suitable, given that it is able to generate a more complete set of results and gives an intuitive illustration of the data. Electronic supplementary material The online version of this article (doi:10.1186/s12874-017-0410-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Antoine Barbieri
- Biometrics Unit, Institut du Cancer Montpellier, 208 Avenue des Apothicaires, Montpellier, 34298, France. .,Université de Montpellier, Place Eugène Bataillon, Montpellier, 34090, France. .,Institut Montpelliérain Alexander Grothendieck, Montpellier, France.
| | - Jean Peyhardi
- Université de Montpellier, Place Eugène Bataillon, Montpellier, 34090, France.,Institut de génomique fonctionnelle, Montpellier, France
| | - Thierry Conroy
- French National Platform Quality of Life and Cancer, Nancy, France.,Institut de Cancérologie de Lorraine, Nancy, France
| | - Sophie Gourgou
- Biometrics Unit, Institut du Cancer Montpellier, 208 Avenue des Apothicaires, Montpellier, 34298, France.,French National Platform Quality of Life and Cancer, Montpellier, France
| | - Christian Lavergne
- Institut Montpelliérain Alexander Grothendieck, Montpellier, France.,University Paul-Valéry Montpellier 3, Montpellier, France
| | - Caroline Mollevi
- Biometrics Unit, Institut du Cancer Montpellier, 208 Avenue des Apothicaires, Montpellier, 34298, France.,Institut de Recherche en Cancérologie de Montpellier (IRCM) - Inserm U1194, Montpellier, France.,French National Platform Quality of Life and Cancer, Montpellier, France
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Tapi Nzali MD, Bringay S, Lavergne C, Mollevi C, Opitz T. What Patients Can Tell Us: Topic Analysis for Social Media on Breast Cancer. JMIR Med Inform 2017; 5:e23. [PMID: 28760725 PMCID: PMC5556259 DOI: 10.2196/medinform.7779] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/16/2017] [Accepted: 06/17/2017] [Indexed: 11/13/2022] Open
Abstract
Background Social media dedicated to health are increasingly used by patients and health professionals. They are rich textual resources with content generated through free exchange between patients. We are proposing a method to tackle the problem of retrieving clinically relevant information from such social media in order to analyze the quality of life of patients with breast cancer. Objective Our aim was to detect the different topics discussed by patients on social media and to relate them to functional and symptomatic dimensions assessed in the internationally standardized self-administered questionnaires used in cancer clinical trials (European Organization for Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire Core 30 [QLQ-C30] and breast cancer module [QLQ-BR23]). Methods First, we applied a classic text mining technique, latent Dirichlet allocation (LDA), to detect the different topics discussed on social media dealing with breast cancer. We applied the LDA model to 2 datasets composed of messages extracted from public Facebook groups and from a public health forum (cancerdusein.org, a French breast cancer forum) with relevant preprocessing. Second, we applied a customized Jaccard coefficient to automatically compute similarity distance between the topics detected with LDA and the questions in the self-administered questionnaires used to study quality of life. Results Among the 23 topics present in the self-administered questionnaires, 22 matched with the topics discussed by patients on social media. Interestingly, these topics corresponded to 95% (22/23) of the forum and 86% (20/23) of the Facebook group topics. These figures underline that topics related to quality of life are an important concern for patients. However, 5 social media topics had no corresponding topic in the questionnaires, which do not cover all of the patients’ concerns. Of these 5 topics, 2 could potentially be used in the questionnaires, and these 2 topics corresponded to a total of 3.10% (523/16,868) of topics in the cancerdusein.org corpus and 4.30% (3014/70,092) of the Facebook corpus. Conclusions We found a good correspondence between detected topics on social media and topics covered by the self-administered questionnaires, which substantiates the sound construction of such questionnaires. We detected new emerging topics from social media that can be used to complete current self-administered questionnaires. Moreover, we confirmed that social media mining is an important source of information for complementary analysis of quality of life.
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Affiliation(s)
- Mike Donald Tapi Nzali
- Institut Montpelliérain Alexander Grothendieck (IMAG), Department of Mathematics, Montpellier University, Montpellier, France.,Laboratoire d'Informatique, de Robotique et de Microélectronique de Montpellier (LIRMM), Department of Computer Science, Montpellier University, Montpellier, France
| | - Sandra Bringay
- Laboratoire d'Informatique, de Robotique et de Microélectronique de Montpellier (LIRMM), Department of Computer Science, Montpellier University, Montpellier, France.,Paul Valery University, Montpellier, France
| | - Christian Lavergne
- Institut Montpelliérain Alexander Grothendieck (IMAG), Department of Mathematics, Montpellier University, Montpellier, France.,Paul Valery University, Montpellier, France
| | - Caroline Mollevi
- Biometrics Unit, Institut du Cancer Montpellier (ICM), Montpellier, France
| | - Thomas Opitz
- BioSP Unit, Institut National de la Recherche Agronomique (INRA), Avignon, France
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