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Fukushima T, Suzuki K, Tanaka T, Okayama T, Inoue J, Morishita S, Nakano J. Global quality of life and mortality risk in patients with cancer: a systematic review and meta-analysis. Qual Life Res 2024; 33:2631-2643. [PMID: 38811448 DOI: 10.1007/s11136-024-03691-3] [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: 05/20/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE This systematic review and meta-analysis aimed to examine the impact of global quality of life (QOL) on mortality risk in patients with cancer, considering cancer type and timepoint of QOL assessment. METHODS A systematic search was conducted using Cumulated Index to Nursing and Allied Health Literature, PubMed/MEDLINE, and Scopus databases from inception to December 2022. Observational studies that assessed QOL and examined mortality risk in patients with cancer were extracted. Subgroup analyses were performed for cancer types and timepoints of QOL assessment. RESULTS Overall, global QOL was significantly associated with mortality risk (hazard ratio: 1.06, 95% confidence interval: 1.05-1.07; p < 0.00001). A subgroup analysis based on cancer type demonstrated that lung, head and neck, breast, esophagus, colon, prostate, hematologic, liver, gynecologic, stomach, brain, bladder, bone and soft tissue, and mixed type cancers were significantly associated with mortality risk; however, melanoma and pancreatic cancer were not significantly associated with mortality risk. Additionally, global QOL was associated with mortality risk at all timepoints (pretreatment, posttreatment, and palliative phase); pretreatment QOL had the largest impact, followed by posttreatment QOL. CONCLUSION These findings provide evidence that QOL is associated with mortality risk in patients with cancer at any timepoint. These results indicate the importance of evaluating the QOL and supportive interventions to improve QOL in any phase.
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Affiliation(s)
- Takuya Fukushima
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan.
| | - Katsuyoshi Suzuki
- Division of Rehabilitation Medicine, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takashi Tanaka
- Department of Rehabilitation, Hyogo Medical University Hospital, Nishinomiya, Japan
| | - Taro Okayama
- Division of Rehabilitation Medicine, Shizuoka Cancer Center, Shizuoka, Japan
| | - Junichiro Inoue
- Division of Rehabilitation Medicine, Kobe University Hospital International Clinical Cancer Research Center, Kobe, Japan
| | - Shinichiro Morishita
- Department of Physical Therapy, School of Health Science, Fukushima Medical University, Fukushima, Japan
| | - Jiro Nakano
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
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de Medeiros GOC, da Rocha IMG, Marcadenti A, Bezerra RA, Barbalho ER, de Sousa Júnior CA, Fayh APT. The additional benefit of computed tomography in cancer patients: impacts of sarcopenia and cachexia on quality of life during chemotherapy. Radiol Bras 2024; 57:e20240012. [PMID: 39268045 PMCID: PMC11392432 DOI: 10.1590/0100-3984.2024.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 06/14/2024] [Accepted: 06/30/2024] [Indexed: 09/15/2024] Open
Abstract
Objective This study evaluates the effects of sarcopenia and cachexia on the quality of life (QoL) of patients with gastrointestinal cancer during their initial cycle of chemotherapy, emphasizing the significance of computed tomography (CT) in assessing muscle mass. Materials and Methods In this prospective study, we evaluated 60 adult patients with gastrointestinal cancer who started chemotherapy between January and December of 2017. Sarcopenia was diagnosed on the basis of CT findings, and QoL was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30. Results The mean age was 60.9 years, and 33 (55.0%) of the patients were men. Of the 60 patients, 33 (55.0%) had cachexia and 14 (23.3%) had sarcopenia. Chemotherapy significantly reduced QoL, particularly in the physical, role functioning, and social domains, with no differences between the cachexia and sarcopenia groups. Conclusion Among patients with gastrointestinal cancer submitted to chemotherapy, the chemotherapy-induced decline in QoL does not seem to differ significantly between those with cachexia or sarcopenia, as classified by CT-measured muscle mass, and those without. However, CT-based muscle mass evaluation remains crucial for guiding customized intervention strategies. Integrating this evaluation in radiological reports can provide valuable insights for planning specific care, thus improving patient QoL during treatment.
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Affiliation(s)
| | | | - Aline Marcadenti
- Instituto de Pesquisa do Hospital do Coração (IP-HCor), São Paulo, SP, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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Kris MG, Mitsudomi T, Peters S. Adjuvant therapies in stages I-III epidermal growth factor receptor-mutated lung cancer: current and future perspectives. Transl Lung Cancer Res 2023; 12:824-836. [PMID: 37197636 PMCID: PMC10183392 DOI: 10.21037/tlcr-22-723] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/08/2023] [Indexed: 05/19/2023]
Abstract
Surgical resection followed by adjuvant cisplatin-based chemotherapy is the recommended treatment for patients with completely resected stage IB-IIIA non-small cell lung cancer (NSCLC). Even with the best management, recurrence is common and increases with disease stage (stage I: 26-45%; stage II: 42-62%; stage III: 70-77%). For patients with metastatic lung cancer and tumours that harbour epidermal growth factor receptor (EGFR) mutations, EGFR-tyrosine kinase inhibitors (TKIs) have improved survival. Their effectiveness in advanced stages of NSCLC raises the possibility that these agents may improve outcomes for patients with resectable EGFR-mutated lung cancer. In the ADAURA study, adjuvant osimertinib provided a significant improvement in disease-free survival (DFS) and reduced central nervous system (CNS) disease recurrence in patients with resected stage IB-IIIA EGFR-mutated NSCLC, with or without prior adjuvant chemotherapy. To reap the maximum benefits of EGFR-TKIs for patients with lung cancer, the early and rapid identification of EGFR mutations [and other oncogenic drivers, such as programmed cell death-ligand 1 (PD-L1), with matched targeted therapies] in diagnostic pathologic specimens has become essential. To ensure patients receive the most appropriate treatment, routine, comprehensive histological, immunohistochemical, and molecular analyses (with multiplex next generation sequencing) should be undertaken at the time of diagnosis. The potential for personalised treatments to cure more patients with early-stage lung cancer can only be realised if all therapies are considered when the care plan is formulated, by the multi-specialty experts managing patients. In this review, we discuss the progress and prospects for adjuvant treatments as part of a comprehensive plan of care for patients with resected stages I-III EGFR-mutated lung cancer, and explore how the field could go beyond DFS and overall survival to make cure a more frequent outcome of treatment in patients with resected EGFR-mutated lung cancer.
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Affiliation(s)
- Mark G. Kris
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Solange Peters
- Centre Hospitalier Universitaire Vaudois, Lausanne University Hospital, Lausanne, Switzerland
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Jim HSL, Brady-Nicholls R, Hershman DL. The importance of patient-reported outcomes in pragmatic clinical trials. J Natl Cancer Inst 2023; 115:352-354. [PMID: 36805254 PMCID: PMC10086620 DOI: 10.1093/jnci/djad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023] Open
Affiliation(s)
- Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Renee Brady-Nicholls
- Department of Integrated Mathematical Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Dawn L Hershman
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
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John T, Majem M, Legg D, Goldman J. Current and Future Perspectives of Health-Related Quality of Life in Resectable EGFR-Mutated Non-Small Cell Lung Cancer: A Podcast. Target Oncol 2023; 18:1-8. [PMID: 36534268 PMCID: PMC9928809 DOI: 10.1007/s11523-022-00927-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Thomas John
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Margarita Majem
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Diane Legg
- Founder of LUNGSTRONG, Amesbury, MA, USA
| | - Jonathan Goldman
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
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Liao K, Wang T, Coomber-Moore J, Wong DC, Gomes F, Faivre-Finn C, Sperrin M, Yorke J, van der Veer SN. Prognostic value of patient-reported outcome measures (PROMs) in adults with non-small cell Lung Cancer: a scoping review. BMC Cancer 2022; 22:1076. [PMID: 36261794 PMCID: PMC9580146 DOI: 10.1186/s12885-022-10151-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/08/2022] [Indexed: 11/24/2022] Open
Abstract
Background There is growing interest in the collection and use of patient-reported outcome measures (PROMs) to support clinical decision making in patients with non-small cell lung cancer (NSCLC). However, an overview of research into the prognostic value of PROMs is currently lacking. Aim To explore to what extent, how, and how robustly the value of PROMs for prognostic prediction has been investigated in adults diagnosed with NSCLC. Methods We systematically searched Medline, Embase, CINAHL Plus and Scopus for English-language articles published from 2011 to 2021 that report prognostic factor study, prognostic model development or validation study. Example data charting forms from the Cochrane Prognosis Methods Group guided our data charting on study characteristics, PROMs as predictors, predicted outcomes, and statistical methods. Two reviewers independently charted the data and critically appraised studies using the QUality In Prognosis Studies (QUIPS) tool for prognostic factor studies, and the risk of bias assessment section of the Prediction model Risk Of Bias ASsessment Tool (PROBAST) for prognostic model studies. Results Our search yielded 2,769 unique titles of which we included 31 studies, reporting the results of 33 unique analyses and models. Out of the 17 PROMs used for prediction, the EORTC QLQ-C30 was most frequently used (16/33); 12/33 analyses used PROM subdomain scores instead of the overall scores. PROMs data was mostly collected at baseline (24/33) and predominantly used to predict survival (32/33) but seldom other clinical outcomes (1/33). Almost all prognostic factor studies (26/27) had moderate to high risk of bias and all four prognostic model development studies had high risk of bias. Conclusion There is an emerging body of research into the value of PROMs as a prognostic factor for survival in people with NSCLC but the methodological quality of this research is poor with significant bias. This warrants more robust studies into the prognostic value of PROMs, in particular for predicting outcomes other than survival. This will enable further development of PROM-based prediction models to support clinical decision making in NSCLC. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-10151-z.
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Affiliation(s)
- Kuan Liao
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
| | - Tianxiao Wang
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Jake Coomber-Moore
- Patient-Centred Research Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - David C Wong
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Department of Computer Science, University of Manchester, Manchester, UK
| | - Fabio Gomes
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK
| | - Corinne Faivre-Finn
- The Christie NHS foundation Trust, Manchester, UK.,Division of Cancer Science, The University of Manchester, Manchester, UK
| | - Matthew Sperrin
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Janelle Yorke
- Patient-Centred Research Centre, The Christie NHS Foundation Trust, Manchester, UK.,Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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Messina G, Tartaglia N, Ambrosi A, Porro C, Campanozzi A, Valenzano A, Corso G, Fiorelli A, Polito R, Santini M, Monda M, Tafuri D, Messina G, Messina A, Monda V. The Beneficial Effects of Physical Activity in Lung Cancer Prevention and/or Treatment. Life (Basel) 2022; 12:782. [PMID: 35743815 PMCID: PMC9225473 DOI: 10.3390/life12060782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/06/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022] Open
Abstract
Lung cancer is the most lethal cancer: it has a significant incidence and low survival rates. Lifestyle has an important influence on cancer onset and its progression, indeed environmental factors and smoke are involved in cancer establishment, and in lung cancer. Physical activity is a determinant in inhibiting or slowing lung cancer. Certainly, the inflammation is a major factor responsible for lung cancer establishment. In this scenario, regular physical activity can induce anti-inflammatory effects, reducing ROS production and stimulating immune cell system activity. On lung function, physical activity improves lung muscle strength, FEV1 and forced vital capacity. In lung cancer patients, it reduces dyspnea, fatigue and pain. Data in the literature has shown the effects of physical activity both in in vivo and in vitro studies, reporting that its anti-inflammatory action is determinant in the onset of human diseases such as lung cancer. It has a beneficial effect not only in the prevention of lung cancer, but also on treatment and prognosis. For these reasons, it is retained as an adjuvant in lung cancer treatment both for the administration and prognosis of this type of cancer. The purpose of this review is to analyze the role of physical activity in lung cancer and to recommend regular physical activity and lifestyle changes to prevent or treat this pathology.
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Affiliation(s)
- Gaetana Messina
- Department of Translational Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.); (M.S.)
| | - Nicola Tartaglia
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy; (N.T.); (A.A.); (A.C.)
| | - Antonio Ambrosi
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy; (N.T.); (A.A.); (A.C.)
| | - Chiara Porro
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (C.P.); (A.V.); (G.C.); (G.M.)
| | - Angelo Campanozzi
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy; (N.T.); (A.A.); (A.C.)
| | - Anna Valenzano
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (C.P.); (A.V.); (G.C.); (G.M.)
| | - Gaetano Corso
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (C.P.); (A.V.); (G.C.); (G.M.)
| | - Alfonso Fiorelli
- Department of Translational Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.); (M.S.)
| | - Rita Polito
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (C.P.); (A.V.); (G.C.); (G.M.)
| | - Mario Santini
- Department of Translational Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.); (M.S.)
| | - Marcellino Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.M.); (A.M.); (V.M.)
| | - Domenico Tafuri
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Università degli Studi della Campania, Luigi Vanvitelli, 81100 Naples, Italy;
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (C.P.); (A.V.); (G.C.); (G.M.)
| | - Antonietta Messina
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.M.); (A.M.); (V.M.)
| | - Vincenzo Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.M.); (A.M.); (V.M.)
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Joseph J, Rani R, Dhankhar R. Brief psychological intervention among treatment-seeking cancer patients: A randomized controlled trial. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_319_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Association Between Physician and Patient Reported Symptoms in Patients Treated with Definitive Radiotherapy for Locally Advanced Lung Cancer in a Statewide Consortium. Int J Radiat Oncol Biol Phys 2021; 112:942-950. [PMID: 34838865 DOI: 10.1016/j.ijrobp.2021.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/08/2021] [Accepted: 11/19/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Little data have been reported about the patient experience during curative radiotherapy for lung cancer in routine clinical practice, or how this relates to treatment toxicity reported by clinicians. The purpose of this study was to compare clinician-reported adverse events (AEs) with patient-reported outcomes (PROs) including both specific symptoms/side effects as well as overall quality of life (QOL) during and after definitive radiotherapy (RT) for locally advanced lung cancer (LALC) in a large statewide cohort. METHODS AND MATERIALS Patient-reported outcomes (PROs) were prospectively collected from patients treated with definitive radiotherapy for LALC at 24 institutions within the XXXX Radiation Oncology Quality Consortium between 2012-2018 using the Functional Assessment of Cancer Therapy Trial Outcome Index (FACT-TOI). Physicians prospectively recorded adverse events (AEs) using CTCAE version 4.0. Patient-reported quality of life (QOL) changes from baseline were assessed during and after radiotherapy using the FACT-TOI. Spearman correlation coefficients were calculated for AEs and similar PROs, and multivariable analysis was used to assess associations with QOL. RESULTS 1361 patients were included and 53% of respondents reported clinically meaningful declines in QOL at the end of RT. Correlation between clinician-reported esophagitis and patient-reported trouble swallowing was moderate (R=0.67) while correlations between clinician-reported pneumonitis and patient-reported shortness of breath (R=0.13) and cough (R=0.09) were weak. Clinician-reported AEs were significantly associated with clinically meaningful declines inpatient-reported QOL, with R=-0.46 for a summary AE-score. QOL was more strongly associated with fatigue (R=-0.41) than lung-specific AEs. CONCLUSIONS AEs are associated with clinically meaningful declines in QOL during and after RT for LALC, but associations between AEs and QOL are only modest. This highlights the importance of PRO data, and future research should assess whether earlier detection of PRO changes could allow for interventions that reduce the frequency of treatment-related clinically meaningful declines in QOL.
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Efficace F, Collins GS, Cottone F, Giesinger JM, Sommer K, Anota A, Schlussel MM, Fazi P, Vignetti M. Patient-Reported Outcomes as Independent Prognostic Factors for Survival in Oncology: Systematic Review and Meta-Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:250-267. [PMID: 33518032 DOI: 10.1016/j.jval.2020.10.017] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 08/05/2020] [Accepted: 10/19/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Assessment of patient-reported outcomes (PROs) in oncology is of critical importance because it provides unique information that may also predict clinical outcomes. METHODS We conducted a systematic review of prognostic factor studies to examine the prognostic value of PROs for survival in cancer. A systematic literature search was performed in PubMed for studies published between 2013 and 2018. We considered any study, regardless of the research design, that included at least 1 PRO domain in the final multivariable prognostic model. The protocol (EPIPHANY) was published and registered in the International Prospective Register of Systematic Reviews (CRD42018099160). RESULTS Eligibility criteria selected 138 studies including 158 127 patients, of which 43 studies were randomized, controlled trials. Overall, 120 (87%) studies reported at least 1 PRO to be statistically significantly prognostic for overall survival. Lung (n = 41, 29.7%) and genitourinary (n = 27, 19.6%) cancers were most commonly investigated. The prognostic value of PROs was investigated in secondary data analyses in 101 (73.2%) studies. The EORTC QLQ-C30 questionnaire was the most frequently used measure, and its physical functioning scale (range 0-100) the most frequent independent prognostic PRO, with a pooled hazard ratio estimate of 0.88 per 10-point increase (95% CI 0.84-0.92). CONCLUSIONS There is convincing evidence that PROs provide independent prognostic information for overall survival across cancer populations and disease stages. Further research is needed to translate current evidence-based data into prognostic tools to aid in clinical decision making.
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Affiliation(s)
- Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center and Health Outcomes Research Unit, Rome, Italy.
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Francesco Cottone
- Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Johannes M Giesinger
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Kathrin Sommer
- Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Amelie Anota
- French National Platform Quality of Life and Cancer, Besançon, France; Methodology and Quality of Life in Oncology Unit (INSERM UMR 1098), University Hospital of Besançon, Besançon, France
| | - Michael Maia Schlussel
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Paola Fazi
- Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Marco Vignetti
- Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center and Health Outcomes Research Unit, Rome, Italy
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Zeng J, Mao WM, Chen QX, Luo TB, Wu YL, Zhou Q, Yang XN, Yan HH, Zhong WZ, Wang Q, Xu ST, Wu L, Shen Y, Liu YY, Chen C, Cheng Y, Xu L, Wang J, Fei K, Li XF, Li J, Huang C, Liu ZD, Xu S, Chen KN, Xu SD, Liu LX, Yu P, Wang BH, Ma HT. Quality of life with adjuvant gefitinib versus vinorelbine plus cisplatin in patients with completely resected stage II-IIIA (N1-N2) EGFR-mutant non-small-cell lung cancer: Results from the ADJUVANT (CTONG1104) study. Lung Cancer 2020; 150:164-171. [PMID: 33186858 DOI: 10.1016/j.lungcan.2020.09.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/12/2020] [Accepted: 09/22/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Health-related quality of life (HRQoL) data complement conventional clinical endpoints when comparing adjuvant gefitinib with chemotherapy in patients with early-stage non-small-cell lung cancer (NSCLC) and epidermal growth factor receptor (EGFR) mutations. This study aimed to assess changes in HRQoL with adjuvant gefitinib vs chemotherapy in this patient group. MATERIALS AND METHODS In the phase III ADJUVANT trial, patients with completely resected, stage II-IIIA (N1-N2), EGFR-mutant NSCLC were randomized (1:1) to receive either gefitinib for 24 months or vinorelbine plus cisplatin (VP) every 3 weeks for four cycles. HRQoL was assessed as a secondary endpoint using the Functional Assessment of Cancer Therapy-Lung Cancer (FACT-L), Lung Cancer Symptom Scale (LCSS) questionnaires, and Trial Outcome Index (TOI) composite score. HRQoL dynamics, improvements, and time to deterioration were compared between groups. RESULTS At baseline, 104 of 106, and 80 of 87 patients receiving gefitinib and VP, respectively, completed two questionnaires (FACT-L and LCSS). Baseline scores were balanced between groups. Although HRQoL fluctuated and gradually improved in both groups, longitudinally higher scores were reported with gefitinib than VP (FACT-L, odds ratio 418.16, 95 % confidence interval [CI] 2.75-63509.05, p = 0.019; LCSS, 1.13, 1.04-1.22, p = 0.003; TOI, 88.39, 4.40-1775.05, p = 0.003). Time to deterioration in HRQoL was delayed with gefitinib compared with VP (FACT-L, median 69 vs 6 weeks, hazard ratio 0.62, 95 % CI 0.42-0.90, p = 0.013; LCSS, median 45 vs 6 weeks, 0.63, 0.43-0.93, p = 0.020; TOI, median 164 vs 9 weeks, 0.51, 0.33-0.77, p = 0.001). CONCLUSION Adjuvant gefitinib is associated with improved HRQoL over VP, supporting its use in patients with stage II-IIIA (N1-N2), EGFR-mutant NSCLC.
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Affiliation(s)
- Jian Zeng
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, University of Chinese Academy of Sciences, Hangzhou, China
| | - Wei-Min Mao
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, University of Chinese Academy of Sciences, Hangzhou, China.
| | - Qi-Xun Chen
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, University of Chinese Academy of Sciences, Hangzhou, China
| | - Tao-Bo Luo
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, University of Chinese Academy of Sciences, Hangzhou, China
| | - Yi-Long Wu
- Department of Pulmonary Cancer, Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qing Zhou
- Department of Pulmonary Cancer, Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xue-Ning Yang
- Department of Pulmonary Cancer, Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hong-Hong Yan
- Department of Pulmonary Cancer, Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wen-Zhao Zhong
- Department of Pulmonary Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qun Wang
- Department of Thoracic Surgery, Fudan University Affiliated Zhongshan Hospital, Shanghai, China
| | - Song-Tao Xu
- Department of Thoracic Surgery, Fudan University Affiliated Zhongshan Hospital, Shanghai, China
| | - Lin Wu
- Department of Pulmonary Medicine, Hunan Cancer Hospital, Changsha, China
| | - Yi Shen
- Department of Thoracic Surgery, The Affiliated Hospital of Medical College Qingdao University, Qingdao, China
| | - Yong-Yu Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ying Cheng
- Department of Oncology, Jilin Provincial Tumor Hospital, Changchun, China
| | - Lin Xu
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Nanjing, China
| | - Jun Wang
- Department of Thoracic Surgery, The People's Hospital of Peking University, Beijing, China
| | - Ke Fei
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | - Xiao-Fei Li
- Department of Thoracic Surgery, Tangdu Hospital, Xi'an, China
| | - Jian Li
- Department of Thoracic Surgery, Peking University First Hospital, Beijing, China
| | - Cheng Huang
- Department of Pulmonary Oncology, Fujian Cancer Hospital, Fuzhou, China
| | - Zhi-Dong Liu
- Department of Thoracic Surgery, Beijing Chest Hospital, Beijing, China
| | - Shun Xu
- Department of Thoracic Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Ke-Neng Chen
- Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing, China
| | - Shi-Dong Xu
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Lun-Xu Liu
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Ping Yu
- Department of Thoracic Oncology, Sichuan Cancer Hospital, Chengdu, China
| | - Bu-Hai Wang
- Department of Oncology, The Northern Jiangsu People's Hospital, Yangzhou, China
| | - Hai-Tao Ma
- Department of Thoracic Surgery, The First Affiliated Hospital of Suzhou University, Suzhou, China
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12
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Trejo MJ, Bell ML, Dhillon HM, Vardy JL. Baseline quality of life is associated with survival among people with advanced lung cancer. J Psychosoc Oncol 2020; 38:635-641. [PMID: 32410506 PMCID: PMC10836051 DOI: 10.1080/07347332.2020.1765065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Lung cancer patients presenting with advanced cancer face low survival rates and a high symptom burden. There have been mixed findings for the association between survival and various patient reported outcomes (PROs). METHODS We used prospective data from 111 lung cancer patients with advanced stage III/IV disease to investigate the association of survival with PROs (European Organization for Research and Treatment of Cancer Core-30 and Lung Module). Cox proportional hazard models were used to examine the individual association between several PRO measures and survival. RESULTS Pain in chest and global quality of life (QoL) were found to have the strongest association with survival with a 20% increased hazard of death per 10% increase in pain in chest and 14% decrease in hazard of death per 10% increase in global QoL. CONCLUSION Our results provide more evidence for the value of PRO data to inform clinical and patient decision-making.
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Affiliation(s)
- Mario J Trejo
- Department Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Arizona, USA
| | - Melanie L Bell
- Department Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Arizona, USA
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-Based Decision-Making, University of Sydney, Sydney, Australia
| | - Janette L Vardy
- Centre for Medical Psychology and Evidence-Based Decision-Making, University of Sydney, Sydney, Australia
- Concord Cancer Centre, Concord Repatriation General hospital, Concord, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
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13
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Chen YL, Ho HY, Hsiao RC, Lu WH, Yen CF. Correlations between Quality of Life, School Bullying, and Suicide in Adolescents with Attention-Deficit Hyperactivity Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093262. [PMID: 32392842 PMCID: PMC7246627 DOI: 10.3390/ijerph17093262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 12/24/2022]
Abstract
Although adolescents with attention-deficit hyperactivity disorder (ADHD) have a higher risk of suicidality and more problems related to school bullying, and quality of life (QoL) is reportedly associated with school bullying, suicide, and ADHD, no study has examined their correlation. This study examined the complex relationships between QoL, school bullying, suicide, and ADHD symptoms. A total of 203 adolescents with ADHD aged between 12 and 18 years were recruited. School bullying and QoL were examined using the Chinese version of the School Bullying Experience Questionnaire and the Taiwanese Quality of Life Questionnaire for Adolescents. Network model analysis was conducted to graphically present their relationships. We identified triangular correlations between school bullying, QoL, and suicidality, indicating possible pathways from school bullying to suicidality, and the originating or mediating roles of personal competence and psychological well-being. Furthermore, the ADHD symptoms of inattention and hyperactivity/impulsivity may differentially regulate these pathways. Longitudinal studies are warranted to confirm these findings.
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Affiliation(s)
- Yi-Lung Chen
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan; (Y.-L.C.); (H.-Y.H.)
- Department of Psychology, Asia University, Taichung 41354, Taiwan
| | - Hsing-Ying Ho
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan; (Y.-L.C.); (H.-Y.H.)
| | - Ray C. Hsiao
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Children’s Hospital, Seattle, WA 98105, USA;
| | - Wei-Hsin Lu
- Department of Psychiatry, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City 60002, Taiwan
- Department of Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan 71710, Taiwan
- Correspondence: (W.-H.L.); (C.-F.Y.); Tel.: +886-5-2765041 (W.-H.L.); +886-7-3121101 (ext. 6816) (C.-F.Y.)
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Psychiatry, School of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Correspondence: (W.-H.L.); (C.-F.Y.); Tel.: +886-5-2765041 (W.-H.L.); +886-7-3121101 (ext. 6816) (C.-F.Y.)
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14
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Nordic Pole Walking for Individuals With Cancer: A Feasibility Randomized Controlled Trial Assessing Physical Function and Health-Related Quality of Life. REHABILITATION ONCOLOGY 2020. [DOI: 10.1097/01.reo.0000000000000204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Vollmann M, Matsuda A, Kroep JR, Kobayashi K, Kubota K, Inoue K, Yamaoka K, Putter H, Ramai R, Nortier JWR, Fischer MJ, Kaptein AA. Illness Perceptions and Quality of Life in Patients with Non-Small-Cell Lung Cancer: A 3-Month Follow-Up Pilot Study. PATIENT-RELATED OUTCOME MEASURES 2020; 11:67-71. [PMID: 32161510 PMCID: PMC7051802 DOI: 10.2147/prom.s238009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 02/06/2020] [Indexed: 12/24/2022]
Abstract
Purpose Examine illness perceptions, functional health and quality of life of lung cancer patients throughout chemotherapy treatment. Patients and Methods Longitudinal design with baseline measure 12 days after the first chemotherapy and follow-up measure 3 months later, where illness perceptions (BIPQ), functional health, and quality of life (EORTC QLQ-C-30) were measured. A total of 21 patients with non-small-cell lung cancer took part. Non-parametric testing was performed given the pilot nature of the study and the associated relatively small sample size. Results Small to medium changes in illness perceptions and functional health between the two measurement points were detected, with both becoming more positive. More negative illness perceptions at the beginning of the treatment were associated with less functioning and lower quality of life at both beginning and end of treatment. Conclusion Addressing illness perceptions seems a clinically relevant approach in improving functioning and quality of life of patients with non-small-cell lung cancer.
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Affiliation(s)
- Manja Vollmann
- Socio-Medical Sciences ESHPM, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Ayako Matsuda
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Judith R Kroep
- Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | | | - Kazue Yamaoka
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Hein Putter
- Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands
| | - Rajen Ramai
- Respiratory Medicine, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Maarten J Fischer
- Medical Psychology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ad A Kaptein
- Medical Psychology, Leiden University Medical Center, Leiden, the Netherlands
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16
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Prognostic Value of Functional Assessment of Cancer Therapy-General (FACT-G) in Advanced Non-Small-Cell Lung Cancer Treated with Korean Medicine. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:2845401. [PMID: 32454853 PMCID: PMC7212313 DOI: 10.1155/2020/2845401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 01/02/2020] [Indexed: 12/24/2022]
Abstract
Objectives The impact of health-related quality of life (HRQoL) on survival has been investigated in patients with various cancers. Here, we evaluated the prognostic value of HRQoL using the Functional Assessment of Cancer Therapy-General (FACT-G) in advanced non-small-cell lung cancer (NSCLC) patients treated with Korean medicine. Methods A retrospective review of medical records and FACT-G scores of patients with advanced NSCLC who received treatment with Korean medicine was conducted. The reliability of the FACT-G was determined using Cronbach's alpha and calculating floor-and-ceiling effects. Correlations between FACT-G scores were estimated using Pearson's correlation analysis. Overall survival was calculated using the Kaplan-Meier method, and the prognostic impact of FACT-G scores and patients' characteristics was evaluated with Cox proportional hazards regression. Results Of the 165 enrolled patients, 115 (70%) had extrathoracic metastasis and 139 (84%) had undergone prior anticancer treatment. The median overall survival was 10.1 months. The mean FACT-G score was 65.0, and Cronbach's alpha for the FACT-G was 0.917. Age ≥65 years, male sex, smoking history, squamous-cell carcinoma, Eastern Cooperative Oncology Group Performance Status (ECOG-PS) ≥2, and presence of extrathoracic metastasis were associated with an increased risk of mortality. High FACT-G total scores, physical well-being (PWB), emotional well-being, and functional well-being were associated with prolonged survival. After adjusting for age, sex, smoking history, ECOG-PS, histological type, and presence of extrathoracic metastasis, a high FACT-G total score (hazard ratio (HR): 0.99, p=0.032) and high PWB score (HR: 0.94, p < 0.001) were associated with prolonged survival as independent prognostic factors in patients with advanced NSCLC. Conclusion The FACT-G total score and PWB score as HRQoL measurements were significant prognostic factors for survival in advanced NSCLC patients treated with Korean medicine. This finding implies that the FACT-G can be used in clinical practice as a predictor of survival in patients with advanced NSCLC.
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17
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Avancini A, Sartori G, Gkountakos A, Casali M, Trestini I, Tregnago D, Bria E, Jones LW, Milella M, Lanza M, Pilotto S. Physical Activity and Exercise in Lung Cancer Care: Will Promises Be Fulfilled? Oncologist 2019; 25:e555-e569. [PMID: 32162811 PMCID: PMC7066706 DOI: 10.1634/theoncologist.2019-0463] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/21/2019] [Indexed: 12/25/2022] Open
Abstract
Lung cancer remains the leading cause of cancer‐related death worldwide. Affected patients frequently experience debilitating disease‐related symptoms, including dyspnea, cough, fatigue, anxiety, depression, insomnia, and pain, despite the progresses achieved in term of treatment efficacy. Physical activity and exercise are nonpharmacological interventions that have been shown to improve fatigue, quality of life, cardiorespiratory fitness, pulmonary function, muscle mass and strength, and psychological status in patients with lung cancer. Moreover, physical fitness levels, especially cardiorespiratory endurance and muscular strength, are demonstrated to be independent predictors of survival. Nevertheless, patients with lung cancer frequently present insufficient levels of physical activity and exercise, and these may contribute to quality of life impairment, reduction in functional capacity with skeletal muscle atrophy or weakness, and worsening of symptoms, particularly dyspnea. The molecular bases underlying the potential impact of exercise on the fitness and treatment outcome of patients with lung cancer are still elusive. Counteracting specific cancer cells’ acquired capabilities (hallmarks of cancer), together with preventing treatment‐induced adverse events, represent main candidate mechanisms. To date, the potential impact of physical activity and exercise in lung cancer remains to be fully appreciated, and no specific exercise guidelines for patients with lung cancer are available. In this article, we perform an in‐depth review of the evidence supporting physical activity and exercise in lung cancer and suggest that integrating this kind of intervention within the framework of a global, multidimensional approach, taking into account also nutritional and psychological aspects, might be the most effective strategy. Implications for Practice Although growing evidence supports the safety and efficacy of exercise in lung cancer, both after surgery and during and after medical treatments, most patients are insufficiently active or sedentary. Engaging in exercise programs is particularly arduous for patients with lung cancer, mainly because of a series of physical and psychosocial disease‐related barriers (including the smoking stigma). A continuous collaboration among oncologists and cancer exercise specialists is urgently needed in order to develop tailored programs based on patients’ needs, preferences, and physical and psychological status. In this regard, benefit of exercise appears to be potentially enhanced when administered as a multidimensional, comprehensive approach to patients’ well‐being. The potential effect of physical activity in lung cancer is not fully understood, and no specific exercise guidelines for lung cancer patients are available. This article reviews the evidence supporting physical activity and exercise in lung cancer and suggests that this type of intervention, along with considerations for the nutritional and psychological aspects of such an intervention, might be the most effective strategy.
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Affiliation(s)
- Alice Avancini
- Section of Clinical and Experimental Biomedical Science, Department of Medicine, University of VeronaItaly
| | - Giulia Sartori
- Section of Medical Oncology, Department of Medicine, University of VeronaItaly
- Azienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Anastasios Gkountakos
- Department of Diagnostics and Public Health, University and Hospital Trust of VeronaVeronaItaly
| | - Miriam Casali
- Section of Medical Oncology, Department of Medicine, University of VeronaItaly
- Azienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Ilaria Trestini
- Section of Medical Oncology, Department of Medicine, University of VeronaItaly
- Azienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Daniela Tregnago
- Section of Medical Oncology, Department of Medicine, University of VeronaItaly
- Azienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Emilio Bria
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)RomeItaly
- Università Cattolica Del Sacro CuoreRomeItaly
| | - Lee W. Jones
- Department of Medicine, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
- Weill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Michele Milella
- Section of Medical Oncology, Department of Medicine, University of VeronaItaly
- Azienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Massimo Lanza
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of VeronaItaly
| | - Sara Pilotto
- Section of Medical Oncology, Department of Medicine, University of VeronaItaly
- Azienda Ospedaliera Universitaria IntegrataVeronaItaly
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18
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Daroszewski C, Stasiewicz M, Jaźwińska-Tarnawska E, Rachwalik A, Mura E, Luboch-Kowal J, Dryś A, Bogucki ZA, Brzecka A. Quality of Life in Patients with Advanced Non-Small-Cell Lung Cancer Receiving Palliative Chemotherapy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1160:11-18. [PMID: 30825114 DOI: 10.1007/5584_2019_346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The goal of this study was to explore quality of life in patients with advanced non-small-cell lung cancer (NSCLC) in an attempt to single out features that could help predict the possibility of non-completion of chemotherapy. The survey tool was the Quality of Life Questionnaire Core-30 (QLQ-C30) with the module Lung Cancer 13 (LC-13) developed by the European Organization for Research and Treatment of Cancer. The assessment of quality of life (QoL) was performed in 58 patients with advanced NSCLC before palliative chemotherapy and it was repeated in 43 patients who completed at least three cycles of chemotherapy. We found that the patients who failed to complete the chemotherapy course distinctly showed, in contradistinction to those who completed it, poor physical functioning in (67.6 ± 16.3 vs. 78.3 ± 21.3 points, respectively, p < 0.05) and the lack of appetite (27.1 ± 38.0 vs. 48.9 ± 37.5 points, respectively p < 0.05). At the end of palliative chemotherapy alopecia, sore throat, and constipation significantly worsened QoL, but global health status remained unchanged. In conclusion, poor physical functioning and loss of appetite seem to harbinger a risk of non-completion of chemotherapy in advanced NSCLC.
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Affiliation(s)
- Cyryl Daroszewski
- Department of Pulmonology and Lung Cancer, Wrocław Medical University, Wrocław, Poland
| | | | | | - Anna Rachwalik
- Student's Scientific Association, Wrocław Medical University, Wrocław, Poland
| | - Ewa Mura
- Student's Scientific Association, Wrocław Medical University, Wrocław, Poland
| | - Joanna Luboch-Kowal
- Department of Physical Chemistry, Wrocław Medical University, Wrocław, Poland
| | - Andrzej Dryś
- Department of Physical Chemistry, Wrocław Medical University, Wrocław, Poland
| | - Zdzisław A Bogucki
- Department of Dental Prosthetics, Wrocław Medical University, Wrocław, Poland
| | - Anna Brzecka
- Department of Pulmonology and Lung Cancer, Wrocław Medical University, Wrocław, Poland
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19
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Van Der Weijst L, Lievens Y, Schrauwen W, Surmont V. Health-Related Quality of Life in Advanced Non-small Cell Lung Cancer: A Methodological Appraisal Based on a Systematic Literature Review. Front Oncol 2019; 9:715. [PMID: 31456938 PMCID: PMC6699450 DOI: 10.3389/fonc.2019.00715] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/18/2019] [Indexed: 12/24/2022] Open
Abstract
Background: The majority of lung cancer patients are diagnosed with advanced non-small cell lung cancer (NSCLC), the bulk of which receive palliative systemic treatment with the goal to provide effective symptom palliation and safeguard health-related quality of life (HRQoL). Advanced NSCLC trials with HRQoL endpoints face methodological constraints limiting interpretability. Objectives: We provide a comprehensive overview of recent clinical trials evaluating the impact of systemic therapies on HRQoL in advanced NSCLC, focusing on the methodological quality, with the ultimate goal to improve interpretation, comparison and reporting of HRQoL data. Methods: A systematic literature review was performed. Prospective studies published over the last decade evaluating the impact of systemic treatments on HRQoL in advanced NSCLC were included. Methodological quality of HRQoL reporting was assessed with the CONSORT-PRO extension. Results: Hundred-twelve manuscripts describing 85 trials met all criteria. No formal conclusion can be drawn regarding the impact on HRQoL of different treatments. We report an important variety in methodological quality in terms of definitions of HRQoL, missing data points, lack of standardization of analyzing and presenting HRQoL and no standard follow-up time. The quality of HRQoL data reporting varies substantially between studies but improves over time. Conclusion: This review shows that in the heterogeneous landscape of trials addressing HRQoL in advanced stage NSCLC. Methodology reporting remains generally poor. Adequate reporting of HRQoL outcome data is equally important to support clinical decision-making as to correctly inform health policy regarding direct approval and reimbursement of the new drugs and combinations that will come online.
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Affiliation(s)
| | - Yolande Lievens
- Department of Radiotherapy-Oncology, Ghent University Hospital, Ghent, Belgium
| | - Wim Schrauwen
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Veerle Surmont
- Department of Thoracic Oncology, Ghent University Hospital, Ghent, Belgium
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20
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Abstract
Continuous improvements in the diagnosis and treatment of cancer lead to improved cure rates and longer survival. However, in many patients, the disease becomes chronic. In this context, the patients' quality of life (QOL) becomes a crucial issue. After an introduction about QOL, results from different areas of cancer treatment are presented considering their impact on QOL. Finally, implications are discussed for researchers, clinicians, and patients.
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Klein J, Bodner W, Garg M, Kalnicki S, Ohri N. Pretreatment financial toxicity predicts progression-free survival following concurrent chemoradiotherapy for locally advanced non-small-cell lung cancer. Future Oncol 2019; 15:1697-1705. [DOI: 10.2217/fon-2018-0874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Financial toxicity (FT) describes patients’ burden from out-of-pocket medical treatment costs. We studied associations between patient-reported pretreatment FT, socioeconomic status and clinical outcomes for locally advanced non-small-cell lung cancer (LA-NSCLC) patients. Methods: Patients received chemoradiotherapy for locally advanced non-small-cell lung cancer and completed the European Organization for the Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) quality of life assessment before treatment. One question asks whether patients experience ‘financial difficulties’. We tested FT and socioeconomic status (SES) as predictors of progression-free survival (PFS) and overall survival (OS). Results: A total of 43 patients were included. Median follow-up for surviving patients was 15 months. A total of 19 patients (44%) experienced disease progression and 17 patients (40%) died. Increasing FT was associated with shorter PFS (p = 0.011). FT did not predict overall survival (p = 0.67). Conclusion: Higher pretreatment FT is associated with shorter PFS.
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Affiliation(s)
- Jonathan Klein
- Department of Radiation Oncology, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY 10461, USA
| | - William Bodner
- Department of Radiation Oncology, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY 10461, USA
| | - Madhur Garg
- Department of Radiation Oncology, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY 10461, USA
| | - Shalom Kalnicki
- Department of Radiation Oncology, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY 10461, USA
| | - Nitin Ohri
- Department of Radiation Oncology, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY 10461, USA
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22
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Lee K, Oh EG, Kim S, Kim S. Symptom experiences and health‐related quality of life among non‐small cell lung cancer patients participating in clinical trials. J Clin Nurs 2019; 28:2111-2123. [DOI: 10.1111/jocn.14803] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 01/11/2019] [Accepted: 01/14/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Kyunghwa Lee
- Department of Nursing Yonsei University Graduate School Seoul Korea
| | - Eui Geum Oh
- Mo‐Im Kim Nursing Research Institute Yonsei University College of Nursing Seoul Korea
| | - Sanghee Kim
- Mo‐Im Kim Nursing Research Institute Yonsei University College of Nursing Seoul Korea
| | - Sang‐We Kim
- Department of Oncology, Asan Medical Center University of Ulsan College of Medicine Seoul Korea
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23
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Dimunová L, Dankulincová Veselská Z, Raková J, Bednarek A. Relationship between quality of life of lung cancer patients and smoking. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2018. [DOI: 10.15452/cejnm.2018.09.0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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24
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Tamura N, Kuriyama A, Kaihara T. Health-related quality of life in trauma patients at 12 months after injury: a prospective cohort study. Eur J Trauma Emerg Surg 2018; 45:1107-1113. [PMID: 30167738 DOI: 10.1007/s00068-018-0993-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 08/18/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Health-related quality of life (HRQOL) is increasingly recognized as a benchmark in trauma outcome research, with few studies having evaluated the HRQOL in trauma patients. The aim of our study was to assess the change in trauma patients' HRQOL at 12 months post-injury and to describe their living situation and return to work status. METHODS A prospective cohort study was performed at a Japanese tertiary care hospital from September 2013 to September 2015. The short-form (SF-36) health survey was used at discharge, and 6 and 12 months post-injury. We obtained information regarding living situation at 12 months post-injury. RESULTS Complete data were collected from 129 patients. The median age and injury severity score were 66 years 17, respectively. The physical and role-social component scores improved significantly between hospital discharge and 6 months post-injury. However, the mental component score decreased significantly during this period. There was no significant increase in any of the 3 SF-36 component scores between 6 and 12 months post-injury. At 12 months post-injury, 106 (82%) patients were independent and 15 (12%) patients were dependent on home care services. The return to work rate was 65% (47/72). CONCLUSIONS Our study suggests that the quality-of-life of Japanese trauma patients generally improved over time, but remained lower than the Japanese national average. Most trauma patients return to home and work within 12 months post-injury.
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Affiliation(s)
- Nobuichiro Tamura
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki city, Japan.
| | - Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki city, Japan
| | - Toshie Kaihara
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki city, Japan
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25
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Cheng X, Wei S, Zhang H, Xue S, Wang W, Zhang K. Nurse-led interventions on quality of life for patients with cancer: A meta-analysis. Medicine (Baltimore) 2018; 97:e12037. [PMID: 30142854 PMCID: PMC6112931 DOI: 10.1097/md.0000000000012037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/01/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To compare the quality of life outcome between nurse-led and non-nurse-led interventions for patients with cancer using a meta-analysis. METHODS A systematic literature review was performed by searching randomized controlled trials about nurse-led interventions in PubMed, EMBASE, and Cochrane Library databases until June 2017. Pooled summary estimates for quality of life outcome was calculated as standardized mean difference (SMD) either on a fixed- or random-effect model via Stata 13.0 software. RESULTS Seven literatures involving 1110 patients (554 in the nurse-led group and 556 in the control group) were included. Pooled analysis showed there were no differences in the global quality of life, cognitive, emotional, role, social and physical functions, appetite loss, diarrhea, and dyspnea scales of Quality of Life Questionnaire C30 version 3.0 core (QLQ-C30) questionnaires between the nurse-led and control groups. However, the nurse-led management program significantly decreased the occurrence of constipation (SMD = -0.36, 95% CI = -0.71 to -0.00; P = .001) and insomnia (SMD = -0.33, 95% CI = -0.99 to 0.32; P = .011) and reduced the financial difficulty (SMD = -0.34, 95% CI = -0.65 to -0.03; P = .033) for patients with cancer. CONCLUSION The nurse-led disease management strategy seemed to be effective to improve constipation, insomnia, and financial impacts for patients with cancer in quality of life assessment.
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Affiliation(s)
| | | | | | | | | | - Kaikai Zhang
- Department of Interventional Therapy, Yidu Central Hospital of Weifang, Qingzhou City, Shandong, China
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Bragstad S, Flatebø M, Natvig GK, Eide GE, Skeie GO, Behbahani M, Pedersen PH, Enger PØ, Skeie BS. Predictors of quality of life and survival following Gamma Knife surgery for lung cancer brain metastases: a prospective study. J Neurosurg 2018; 129:71-83. [DOI: 10.3171/2017.2.jns161659] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVELung cancer (LC) patients who develop brain metastases (BMs) have a poor prognosis. Estimations of survival and risk of treatment-related deterioration in quality of life (QOL) are important when deciding on treatment. Although we know of several prognostic factors for LC patients with BMs, the role of QOL has not been established. Authors of this study set out to evaluate changes in QOL following Gamma Knife surgery (GKS) for BMs in LC patients and QOL as a prognostic factor for survival.METHODSForty-four of 48 consecutive LC patients with BMs underwent GKS in the period from May 2010 to September 2011, and their QOL was prospectively assessed before and 1, 3, 6, 9, and 12 months after GKS by using the Functional Assessment of Cancer Therapy–Brain (FACT-BR) questionnaire. A mixed linear regression model was used to identify potential predictive factors for QOL and to assess the effect of GKS and the disease course on QOL at follow-up.RESULTSMean QOL as measured by the brain cancer subscale (BRCS) of the FACT-BR remained stable from baseline (score 53.0) up to 12 months post-GKS (57.1; p = 0.624). The BRCS score improved for 32 patients (72.3%) with a total BM volume ≤ 5 cm3. Mean improvement in these patients was 0.45 points each month of follow-up, compared to a decline of 0.50 points each month despite GKS treatment in patients with BM volumes > 5 cm3 (p = 0.04). Asymptomatic BMs (p = 0.01), a lower recursive partitioning analysis (RPA) classification (p = 0.04), and a higher Karnofsky Performance Scale (KPS) score (p < 0.01) at baseline were predictors for a high, stable QOL after GKS. After multivariate analysis, a high KPS score (p < 0.01) remained the only positive predictor of a high, stable QOL post-GKS.Median survival post-GKS was 5.6 months (95% CI 1.0–10.3). A higher BRCS score (p = 0.01), higher KPS score (p = 0.01), female sex (p = 0.01), and the absence of liver (p = 0.02), adrenal (p = 0.02), and bone metastases (p = 0.03) predicted longer survival in unadjusted models. However, in multivariate analyses, a higher BRCS score (p < 0.01), female sex (p = 0.01), and the absence of bone metastases (p = 0.02) at GKS remained significant predictors. Finally, the BRCS score’s predictive value for survival was compared with the values for the variables behind well-known prognostic indices: age, KPS score, extracranial disease status, and number and volume of BMs. Both BRCS score (p = 0.01) and BM volume (p = 0.05) remained significant predictors for survival in the final model.CONCLUSIONSPatient-reported QOL according to the BRCS is a predictor of survival in patients with BMs and may be helpful in deciding on the optimal treatment. Gamma Knife surgery is a safe and effective therapeutic modality that improves QOL for LC patients with a BM volume ≤ 5 cm3 at treatment. Careful follow-up and salvage therapy on demand seem to prevent worsening of QOL due to relapse of BMs.
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Affiliation(s)
- Sidsel Bragstad
- Departments of 1Neurosurgery,
- 2Department of Global Public Health and Primary Care
| | | | | | - Geir Egil Eide
- 2Department of Global Public Health and Primary Care
- 4Centre for Clinical Research, Haukeland University Hospital
| | | | - Maziar Behbahani
- Departments of 1Neurosurgery,
- 6Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway
| | | | - Per Øyvind Enger
- Departments of 1Neurosurgery,
- 8Oncomatrix, Institute of Biomedicine, University of Bergen; and
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Moon DH, Chera BS, Deal AM, Wang Y, Muss HB, VanderWalde NA. Clinician-observed and patient-reported toxicities and their association with poor tolerance to therapy in older patients with head and neck or lung cancer treated with curative radiotherapy. J Geriatr Oncol 2018; 10:42-47. [PMID: 29903673 DOI: 10.1016/j.jgo.2018.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/20/2018] [Accepted: 05/22/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The agreement between clinician- and patient-reported toxicities and their association with poor tolerance to therapy were assessed in an older population receiving curative radiotherapy (RT). MATERIALS AND METHODS Patients ≥ 65 years old with newly-diagnosed head and neck or lung cancer receiving curative RT ± chemotherapy were enrolled on a prospective, observational study. Agreement between clinician (CTCAEv4.02) and patient (PRO-CTCAE, EORTC QLQ-C30) report of toxicities were assessed at baseline, during treatment, and post-treatment. The association of clinician- and patient-reported symptoms with poor tolerance to therapy (defined as hospitalization, >3-day treatment delay, change in treatment regimen, or death) was assessed. RESULTS Among 45 patients, median age was 71, 60% had head and neck cancer, and 47% received concurrent chemotherapy with RT. In comparing CTCAE vs PRO-CTCAE, there was good agreement at baseline except for fatigue, anorexia, and pain, where clinicians under-reported the severity. The discrepancy increased during treatment with clinicians reporting lower severity in ≥50% of matched pairs for 4/10 symptoms assessed. At follow-up, clinicians under-reported severity in ≥50% of pairs for 7/10 symptoms. CTCAE vs EORTC QLQ-C30 mirrored these findings. Patient-reported symptoms of nausea and dysphagia at 2 weeks and clinician-observed symptoms of nausea and dysphagia at 4 weeks were associated with poor tolerance to therapy. CONCLUSION Clinicians under-report toxicities during and after curative RT in older patients with head and neck or lung cancer. Select toxicities reported by patients early in treatment and clinicians later in treatment were associated with poor tolerance to cancer therapy, providing valuable complementary information.
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Affiliation(s)
- Dominic H Moon
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Bhishamjit S Chera
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Yue Wang
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Hyman B Muss
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Noam A VanderWalde
- Department of Radiation Oncology, University of Tennessee Health Sciences Center/West Cancer Center, Germantown, TN, United States.
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Chino F, Stephens SJ, Choi SS, Marin D, Kim CY, Morse MA, Godfrey DJ, Czito BG, Willett CG, Palta M. The role of external beam radiotherapy in the treatment of hepatocellular cancer. Cancer 2018; 124:3476-3489. [PMID: 29645076 DOI: 10.1002/cncr.31334] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/10/2018] [Accepted: 01/17/2018] [Indexed: 12/13/2022]
Abstract
Hepatocellular carcinoma (HCC) is increasing in incidence and mortality. Although the prognosis remains poor, long-term survival has improved from 3% in 1970 to an 18% 5-year survival rate today. This is likely because of the introduction of well tolerated, oral antiviral therapies for hepatitis C. Curative options for patients with HCC are often limited by underlying liver dysfunction/cirrhosis and medical comorbidities. Less than one-third of patients are candidates for surgery, which is the current gold standard for cure. Nonsurgical treatments include embolotherapies, percutaneous ablation, and ablative radiation. Technological advances in radiation delivery in the past several decades now allow for safe and effective ablative doses to the liver. Conformal techniques allow for both dose escalation to target volumes and normal tissue sparing. Multiple retrospective and prospective studies have demonstrated that hypofractionated image-guided radiation therapy, used as monotherapy or in combination with other liver-directed therapies, can provide excellent local control that is cost effective. Therefore, as the HCC treatment paradigm continues to evolve, ablative radiation treatment has moved from a palliative treatment to both a "bridge to transplant" and a definitive treatment.
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Affiliation(s)
- Fumiko Chino
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Sarah Jo Stephens
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Steve S Choi
- Department of Medicine, Gastroenterology, Duke University Medical Center, Durham, North Carolina
| | - Daniele Marin
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Charles Y Kim
- Department of Radiology, Interventional Radiology, Duke University Medical Center, Durham, North Carolina
| | - Michael A Morse
- Department of Medicine, Medical Oncology, Duke University Medical Center, Durham, North Carolina
| | - Devon J Godfrey
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Brian G Czito
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Christopher G Willett
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Manisha Palta
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
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van der Weijst L, Surmont V, Schrauwen W, Lievens Y. Systematic literature review of health-related quality of life in locally-advanced non-small cell lung cancer: Has it yet become state-of-the-art? Crit Rev Oncol Hematol 2017; 119:40-49. [PMID: 29065984 DOI: 10.1016/j.critrevonc.2017.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/04/2017] [Accepted: 09/26/2017] [Indexed: 01/13/2023] Open
Abstract
Lung cancer and its treatment have an important impact on the patients' health-related quality-of-life (HRQoL). A systematic literature review of prospective clinical studies published since 2005 and measuring HRQoL in patients with locally-advanced non-small cell lung cancer (LA- NSCLC) was performed. Besides reviewing the HRQoL impact of LA-NSCLC treatment, it critically examined the frequency, methodology and quality of HRQoL data collection and analysis in LA-NSCLC clinical studies. Out of 814 potentially eligible publications, only 27 (representing 19 individual studies) met the inclusion criteria. Eight studies documented an impact on HRQoL. Large variability in use of HRQoL instruments, statistical analysis and methodological quality was observed. Reporting of HRQoL data lacks standardization, but recent initiatives establishing recommendations to standardize the analysis and reporting of HRQoL in cancer trials are expected to address these issues. Overall, more research is needed to evaluate the treatment impact on HRQoL in both clinical trials and daily care.
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Affiliation(s)
- Lotte van der Weijst
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium.
| | - Veerle Surmont
- Department of Respiratory Medicine, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Wim Schrauwen
- Department of Medical Psychology, Ghent University Hospital, Ghent, Belgium
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
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Thomas AA, Pearce A, O'Neill C, Molcho M, Sharp L. Urban–rural differences in cancer-directed surgery and survival of patients with non-small cell lung cancer. J Epidemiol Community Health 2016; 71:468-474. [DOI: 10.1136/jech-2016-208113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/26/2016] [Accepted: 11/15/2016] [Indexed: 11/04/2022]
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Lobach DF, Johns EB, Halpenny B, Saunders TA, Brzozowski J, Del Fiol G, Berry DL, Braun IM, Finn K, Wolfe J, Abrahm JL, Cooley ME. Increasing Complexity in Rule-Based Clinical Decision Support: The Symptom Assessment and Management Intervention. JMIR Med Inform 2016; 4:e36. [PMID: 27826132 PMCID: PMC5120240 DOI: 10.2196/medinform.5728] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 08/16/2016] [Accepted: 09/03/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Management of uncontrolled symptoms is an important component of quality cancer care. Clinical guidelines are available for optimal symptom management, but are not often integrated into the front lines of care. The use of clinical decision support (CDS) at the point-of-care is an innovative way to incorporate guideline-based symptom management into routine cancer care. OBJECTIVE The objective of this study was to develop and evaluate a rule-based CDS system to enable management of multiple symptoms in lung cancer patients at the point-of-care. METHODS This study was conducted in three phases involving a formative evaluation, a system evaluation, and a contextual evaluation of clinical use. In Phase 1, we conducted iterative usability testing of user interface prototypes with patients and health care providers (HCPs) in two thoracic oncology clinics. In Phase 2, we programmed complex algorithms derived from clinical practice guidelines into a rules engine that used Web services to communicate with the end-user application. Unit testing of algorithms was conducted using a stack-traversal tree-spanning methodology to identify all possible permutations of pathways through each algorithm, to validate accuracy. In Phase 3, we evaluated clinical use of the system among patients and HCPs in the two clinics via observations, structured interviews, and questionnaires. RESULTS In Phase 1, 13 patients and 5 HCPs engaged in two rounds of formative testing, and suggested improvements leading to revisions until overall usability scores met a priori benchmarks. In Phase 2, symptom management algorithms contained between 29 and 1425 decision nodes, resulting in 19 to 3194 unique pathways per algorithm. Unit testing required 240 person-hours, and integration testing required 40 person-hours. In Phase 3, both patients and HCPs found the system usable and acceptable, and offered suggestions for improvements. CONCLUSIONS A rule-based CDS system for complex symptom management was systematically developed and tested. The complexity of the algorithms required extensive development and innovative testing. The Web service-based approach allowed remote access to CDS knowledge, and could enable scaling and sharing of this knowledge to accelerate availability, and reduce duplication of effort. Patients and HCPs found the system to be usable and useful.
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Affiliation(s)
- David F Lobach
- School of Medicine, Department of Community & Family Medicine, Duke University, Durham, NC, United States.,Klesis Healthcare, Durham, NC, United States
| | - Ellis B Johns
- Family Medicine of Albemarle, Charlottesville, VA, United States.,Medengineers Informatics, Charlottesville, VA, United States
| | - Barbara Halpenny
- Dana-Farber Cancer Institute, The Phyllis F. Cantor Center, Boston, MA, United States
| | - Toni-Ann Saunders
- Dana-Farber Cancer Institute, The Phyllis F. Cantor Center, Boston, MA, United States
| | - Jane Brzozowski
- Independent Clinical Informatics Consultant, Boston, MA, United States
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Donna L Berry
- Dana-Farber Cancer Institute, The Phyllis F. Cantor Center, Boston, MA, United States
| | - Ilana M Braun
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Kathleen Finn
- City of Hope, Clinical Trials Office, Duarte, CA, United States
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Janet L Abrahm
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Mary E Cooley
- Dana-Farber Cancer Institute, The Phyllis F. Cantor Center, Boston, MA, United States
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Carnio S, Di Stefano RF, Novello S. Fatigue in lung cancer patients: symptom burden and management of challenges. LUNG CANCER (AUCKLAND, N.Z.) 2016; 7:73-82. [PMID: 28210163 PMCID: PMC5310693 DOI: 10.2147/lctt.s85334] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Lung cancer (LC) remains the most common cause of cancer death in several countries across the world. Fatigue is the most frequently reported symptom in LC patients throughout the entire course of disease, and all international guidelines recommend early screening for cancer-related fatigue (CRF) and symptoms that can affect patients' quality of life. In patients with LC, fatigue belongs to the symptom cluster of pain, depression, and insomnia, which are commonly observed simultaneously, but are typically treated as separate although they may have common biological mechanisms. The treatment of CRF remains one of the difficult areas in the oncology field: scarce evidence supports pharmacological therapies, while some interesting data arising indicates alternative remedies and physical exercise seem to be one of the most effective approaches for CRF at any stage of LC.
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Affiliation(s)
- Simona Carnio
- Oncology Department, University of Turin, AOU San Luigi, Orbassano, Italy
| | | | - Silvia Novello
- Oncology Department, University of Turin, AOU San Luigi, Orbassano, Italy
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Rauma V, Salo J, Sintonen H, Räsänen J, Ilonen I. Patient features predicting long-term survival and health-related quality of life after radical surgery for non-small cell lung cancer. Thorac Cancer 2016; 7:333-9. [PMID: 27148419 PMCID: PMC4846622 DOI: 10.1111/1759-7714.12333] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 12/14/2015] [Indexed: 12/03/2022] Open
Abstract
Background This study presents a retrospective evaluation of patient, disease, and treatment features predicting long‐term survival and health‐related quality of life (HRQoL) among patients who underwent surgery for non‐small cell lung cancer (NSCLC). Methods Between January 2000 and June 2009, 586 patients underwent surgery at the Helsinki University Hospital. The 276 patients still alive in June 2011 received two validated quality of life questionnaires (QLQ): the generic 15D and the cancer‐specific EORTC QLQ‐C30 + QLQ‐LC13. We used binary and linear regression analysis modeling to identify patient, disease, and treatment characteristics that predicted survival and long‐term HRQoL. Results When taking into account patient, disease, and treatment characteristics, long‐term survival was quite predictable (69.5% correct), but not long‐term HRQoL (R2 between 0.041 and 0.119). Advanced age at the time of surgery, male gender, comorbidity (measured with the Charlson comorbidity index), clinical and pathological stages II‐IV, and postoperative infectious complications predicted a lower survival rate. Features associated with poorer long‐term HRQoL (measured with the 15D) were comorbidity, postoperative complications, and the use of the video‐assisted thoracoscopic surgery (VATS) technique. Conclusions Long‐term HRQoL is only moderately predictable, while prediction of long‐term survival is more reliable. Lower HRQoL is associated with comorbidities, complications, use of the VATS technique, and reduced pulmonary function, while adjuvant therapy is associated with higher HRQoL.
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Affiliation(s)
- Ville Rauma
- Department of General Thoracic and Esophageal Surgery Helsinki University Hospital Heart and Lung Center Helsinki Finland
| | - Jarmo Salo
- Department of General Thoracic and Esophageal Surgery Helsinki University Hospital Heart and Lung Center Helsinki Finland
| | - Harri Sintonen
- Department of Public Health Helsinki University Hospital, Heart and Lung Center Helsinki Finland
| | - Jari Räsänen
- Department of General Thoracic and Esophageal Surgery Helsinki University Hospital Heart and Lung Center Helsinki Finland
| | - Ilkka Ilonen
- Department of General Thoracic and Esophageal Surgery Helsinki University Hospital Heart and Lung Center Helsinki Finland
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Khan I, Bashir Z, Forster M. Interpreting small treatment differences from quality of life data in cancer trials: an alternative measure of treatment benefit and effect size for the EORTC-QLQ-C30. Health Qual Life Outcomes 2015; 13:180. [PMID: 26573600 PMCID: PMC4647515 DOI: 10.1186/s12955-015-0374-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 10/28/2015] [Indexed: 12/25/2022] Open
Abstract
Background The EORTC-QLQ-C30 is a widely used health related quality of life (HRQoL) questionnaire in lung cancer patients. Small HRQoL treatment effects are often reported as mean differences (MDs) between treatments, which are rarely justified or understood by patients and clinicians. An alternative approach using odds ratios (OR) for reporting effects is proposed. This may offer advantages including facilitating alignment between patient and clinician understanding of HRQoL effects. Methods Data from six CRUK sponsored randomized controlled lung cancer trials (2 small cell and 4 in non-small cell, in 2909 patients) were used to HRQoL effects. Results from Beta-Binomial (BB) standard mixed effects were compared. Preferences for ORs vs MDs were determined and Time to Deterioration (TD) was also compared. Results HRQoL effects using ORs offered coherent interpretations: MDs >0 resulted in ORs >1 and vice versa; effect sizes were classified as ‘Trivial’ if the OR was between 1 ± 0.05 (i.e. 0.95 to 1.05); ‘Small’: for 1 ± 0.1; ‘Medium’: 1 ± 0.2 and ‘Large’: OR <0.8 or >1.20. Small HRQoL effects on the MD scale may translate to important treatment differences on the OR scale: for example, a worsening in symptoms (MD) by 2.6 points (p = 0.1314) would be a 17 % deterioration (p < 0.0001) with an OR. Hence important differences may be missed with MD; conversely, small ORs are unlikely to yield large MDs because methods based on OR model skewed data well. Initial evidence also suggests oncologists prefer ORs over MDs since interpretation is similar to hazard ratios. Conclusion Reporting HRQoL benefits as MDs can be misleading. Estimates of HRQoL treatment effects in terms of ORs are preferred over MDs. Future analysis of QLQ-C30 and other HRQoL measures should consider reporting HRQoL treatment effects as ORs. Electronic supplementary material The online version of this article (doi:10.1186/s12955-015-0374-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Iftekhar Khan
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Zahid Bashir
- School of Cancer Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Martin Forster
- University College London, University College Hospital, 235 Euston Rd, London, NW1 2BU, UK
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Avelino CUR, Cardoso RM, Aguiar SSD, Silva MJSD. Assessment of quality of life in patients with advanced non-small cell lung carcinoma treated with a combination of carboplatin and paclitaxel. J Bras Pneumol 2015; 41:133-42. [PMID: 25972967 PMCID: PMC4428850 DOI: 10.1590/s1806-37132015000004367] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 12/12/2014] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE: Non-small cell lung carcinoma (NSCLC) is the most common type of lung cancer. Most patients are diagnosed at an advanced stage, palliative chemotherapy therefore being the only treatment option. This study was aimed at evaluating the health-related quality of life (HRQoL) of advanced-stage NSCLC patients receiving palliative chemotherapy with carboplatin and paclitaxel. METHODS: This was a multiple case study of advanced-stage NSCLC outpatients receiving chemotherapy at a public hospital in Rio de Janeiro, Brazil. The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire was used in conjunction with its supplemental lung cancer-specific module in order to assess HRQoL. RESULTS: Physical and cognitive functioning scale scores differed significantly among chemotherapy cycles, indicating improved and worsened HRQoL, respectively. The differences regarding the scores for pain, loss of appetite, chest pain, and arm/shoulder pain indicated improved HRQoL. CONCLUSIONS: Chemotherapy was found to improve certain aspects of HRQoL in patients with advanced-stage NSCLC.
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Affiliation(s)
- Camila Uanne Resende Avelino
- José Alencar Gomes da Silva National Cancer Institute, Rio de Janeiro, Brazil. Multiprofessional Residence Program in Oncology, José Alencar Gomes da Silva National Cancer Institute, Rio de Janeiro, Brazil
| | - Rafael Marques Cardoso
- José Alencar Gomes da Silva National Cancer Institute, Rio de Janeiro, Brazil. Chemotherapy Center, Cancer Hospital I, José Alencar Gomes da Silva National Cancer Institute, Rio de Janeiro, Brazil
| | - Suzana Sales de Aguiar
- José Alencar Gomes da Silva National Cancer Institute, Rio de Janeiro, Brazil. Department of Clinical Epidemiology, José Alencar Gomes da Silva National Cancer Institute, Rio de Janeiro, Brazil
| | - Mário Jorge Sobreira da Silva
- José Alencar Gomes da Silva National Cancer Institute, Rio de Janeiro, Brazil. José Alencar Gomes da Silva National Cancer Institute, Rio de Janeiro, Brazil
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