1
|
Yip R, Arnolda G, Lamprell K, Nic Giolla Easpaig B, Chittajallu R, Delaney G, Olver I, Liauw W, Braithwaite J. Experience of patients considering or using checkpoint inhibitors in cancer treatment: a systematic review of qualitative research. J Immunother Cancer 2024; 12:e007555. [PMID: 38212121 PMCID: PMC10806553 DOI: 10.1136/jitc-2023-007555] [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] [Accepted: 10/30/2023] [Indexed: 01/13/2024] Open
Abstract
Increasing numbers of patients with cancer are considering or undergoing immunotherapy, however, little is known about patients' perspectives on this treatment. We undertook a systematic review for use by clinicians and researchers, consolidating published qualitative research studies on patient experience of checkpoint inhibitor therapy. A search of Medline, Embase, and PsycINFO was carried out for publications in English to 30 June 2022. Publications were selected if they reported a qualitative study of patient experience with checkpoint inhibitor therapy for cancer, either by patients or their families or carers. Quality was appraised using the Johanna Briggs Institute quality assessment tool for qualitative studies. A thematic synthesis was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standard was followed. We identified 17 eligible studies published between 2017 and 2022, 9 using mixed methods, and 8 solely using qualitative methods. Most studies reported on the experiences of patients with advanced stage melanoma and were using the earliest approved checkpoint inhibitors for cancer therapy. Studies met most formal quality criteria but varied in the extent of their qualitative explorations of data; some mixed methods studies had limited reporting of qualitative results. Through thematic synthesis, we categorized study findings into four domains: (1) treatment decision-making; (2) success with immunotherapy; (3) treatment-related adverse events (AEs); and (4) quality of life on immunotherapy. Our review identified several areas with potential for improving the care system. These include, for example: routinely linking patients to peers who have experienced this therapy; improving the capacity of patients and carers to identify and report AEs faster; and supporting patients and carers to live with changed circumstances after successful treatment. Most studies focused on patients who had successful treatment, effectively excluding those who do not respond or who discontinue due to serious side effects; future research targets are suggested.
Collapse
Affiliation(s)
- Raphael Yip
- Centre for Healthcare Resilience and Implementation (CHRIS), Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
- Medicine, North Sydney Local Health District, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Centre for Healthcare Resilience and Implementation (CHRIS), Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
- Centre for Healthcare Resilience and Implementation (CHRIS), Australian Institute of Health Innovation, Sydney, New South Wales, Australia
| | - Klay Lamprell
- Centre for Healthcare Resilience and Implementation (CHRIS), Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
- Centre for Healthcare Resilience and Implementation (CHRIS), Australian Institute of Health Innovation, Sydney, New South Wales, Australia
| | - Bróna Nic Giolla Easpaig
- Centre for Healthcare Resilience and Implementation (CHRIS), Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
- Centre for Healthcare Resilience and Implementation (CHRIS), Australian Institute of Health Innovation, Sydney, New South Wales, Australia
- School of Nursing, Charles Darwin University Faculty of Health, Darwin, Northern Territory, Australia
| | - Renuka Chittajallu
- Centre for Healthcare Resilience and Implementation (CHRIS), Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
- Centre for Healthcare Resilience and Implementation (CHRIS), Australian Institute of Health Innovation, Sydney, New South Wales, Australia
- Medical Oncology, Riverina Cancer Care Centre, Wagga Wagga, New South Wales, Australia
- Medical Oncology, GenesisCare, Kingswood, New South Wales, Australia
| | - Geoff Delaney
- South-Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Radiation Oncology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Ian Olver
- School of Psychology, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Winston Liauw
- St George Cancer Centre, Saint George Hospital, Kogarah, New South Wales, Australia
- St. George Hospital Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation (CHRIS), Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
- Centre for Healthcare Resilience and Implementation (CHRIS), Australian Institute of Health Innovation, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Sisk BA, Keenan MA, Schulz GL, Bakitas M, Currie ER, Gilbertson-White S, Lindley LC, Roeland EJ, Mack JW. Bereaved Caregivers Perspectives of Negative Communication Experiences Near the End of Life for Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2022; 11:498-505. [PMID: 34870475 PMCID: PMC9595604 DOI: 10.1089/jayao.2021.0154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: High-quality communication is a standard of palliative care for adolescents and young adults (AYAs) with cancer. Yet, few studies have characterized the negative communication experiences of AYAs near the end of life (EOL). Methods: We performed a secondary analysis of 27 qualitative interviews with bereaved caregivers of AYAs with cancer who died between 2013 and 2016 at 1 of 3 sites. Interviews focused on barriers to optimal EOL care for AYAs. We used thematic analysis using iterative consensus coding to analyze transcripts. Results: Participants were predominantly white (85%), non-Hispanic (93%), and female (74%). Half of the participants were bereaved parents, and 37% were bereaved partners or spouses. Overall, 23/27 (85%) caregivers described at least one negative communication experience related to one of three themes: (1) Insensitivity to patients' needs, preferences, and values; (2) Insufficient discussions of prognosis and/or EOL; and (3) Loss of support from the clinical team near EOL. Both clinician- and patient-related factors contributed to limited EOL discussions. Lack of care continuity related to both clinician factors and systems of care that required new or changing clinical care teams near the EOL. Conclusions: Caregivers report a desire for clinician sensitivity to their needs and values, information about the future, and longitudinal connections with individual clinicians. Clinicians might improve caregivers' EOL experiences by eliciting patient preferences, engaging in EOL discussions, adapting to the AYA's developmental and emotional needs, and demonstrating a commitment to AYAs and caregivers as they approach the EOL.
Collapse
Affiliation(s)
- Bryan A. Sisk
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Medicine, Bioethics Research Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Megan A. Keenan
- Department of Medicine, Bioethics Research Center, Washington University School of Medicine, St. Louis, Missouri, USA
- Brown School of Social Work, Washington University, St. Louis, Missouri, USA
| | - Ginny L. Schulz
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Erin R. Currie
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Lisa C. Lindley
- College of Nursing, University of Tennessee, Knoxville, Tennessee, USA
| | - Eric J. Roeland
- Division of Hematology/Oncology, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Jennifer W. Mack
- Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Billingy NE, Tromp VNMF, van den Hurk CJG, Becker-Commissaris A, Walraven I. Health-Related Quality of Life and Survival in Metastasized Non-Small Cell Lung Cancer Patients with and without a Targetable Driver Mutation. Cancers (Basel) 2021; 13:4282. [PMID: 34503092 PMCID: PMC8428358 DOI: 10.3390/cancers13174282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of this study is to compare long-term health-related quality of life (HRQOL) and survival in metastatic NSCLC patients with (M+) and without (M-) a targetable driver mutation. METHODS An observational study was performed within the prospective SYMPRO-lung study (NL7897). HRQOL questionnaires were completed at baseline, 15 weeks, and 6 months. Generalized estimating equations (GEE) were used to assess clinically significant declines in HRQOL (>10 points) over time. Kaplan-Meier survival curves were plotted for both progression-free survival (PFS) and overall survival (OS). RESULTS 81 metastatic NSCLC patients were included (M+ patients; 16 (20%)). M+ patients had a significantly better global HRQOL (mean difference 12.8, ES 0.61), physical functioning (mean difference 13.4, ES 0.63), and less appetite loss (mean difference 23.1, ES 0.73) at 15 weeks of follow-up compared to M- patients. Patients with a clinically relevant decline in HRQOL at 6 months of follow-up had a significantly shorter PFS (5 months vs. 12 months, p-value < 0.001) and OS (11 months vs. 16 months, p-value 0.002). CONCLUSIONS M- NSCLC patients have less favorable HRQOL over time compared to M+ patients. Furthermore, clinically relevant HRQOL declines over time were significantly associated with worse survival. HRQOL can therefore play an important role in in shaping patients' expectations of their prognosis.
Collapse
Affiliation(s)
- Nicole E. Billingy
- Department of Pulmonology, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, 1081 HV Amsterdam, The Netherlands; (N.E.B.); (A.B.-C.)
| | - Vashti N. M. F. Tromp
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Amsterdam Public Health Research Institute, 1081 HV Amsterdam, The Netherlands;
| | - Corina J. G. van den Hurk
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), 3511 DT Utrecht, The Netherlands;
| | - Annemarie Becker-Commissaris
- Department of Pulmonology, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, 1081 HV Amsterdam, The Netherlands; (N.E.B.); (A.B.-C.)
| | - Iris Walraven
- Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| |
Collapse
|