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Faithfull S, Greenfield D. Cancer survivor late-effects, chronic health problems after cancer treatment: what's the evidence from population and registry data and where are the gaps? Curr Opin Support Palliat Care 2024; 18:55-64. [PMID: 38170192 DOI: 10.1097/spc.0000000000000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Improvements in cancer treatment have led to more people living with and beyond a cancer diagnosis but survivors may have increased health problems as they age. The purpose of this review is to critically evaluate population data exploring incidence of late effects for cancer survivors. RECENT FINDINGS 18 studies were identified between 2013 and 2023 that explored the impact on survivors' physical and emotional health. Patients who had been treated at least 2 years previously for cancer had significant cardiovascular risk factors compared with age-matched controls. Women with breast cancer were more likely to have cardiovascular disease, including hypertension, arrythmias and congestive heart failure. This was associated with anthracyclines and/or trastuzumab as part of systemic anti-cancer therapy. Survivors of colorectal cancer were three times more likely to have acute kidney injury than age-matched controls. Stress and mood disorders were higher in survivors of testicular cancer and prostate cancer. SUMMARY Population studies are important to identify the 'real world' consequences of cancer and its treatment beyond clinical trials. Knowledge is critical for managing an ageing cancer population. Data to personalise cancer survivorship care, not only helps determine potential health risks, but can improve secondary prevention, emotional health, recovery, and long-term outcomes.
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Affiliation(s)
- Sara Faithfull
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, the University of Dublin, Trinity Centre for Health Sciences St. James's Hospital Campus Dublin 8, Ireland
| | - Diana Greenfield
- Specialised Cancer Services, Sheffield Teaching Hospitals NHS Foundation Trust
- Medicine and Population Health, University of Sheffield, Sheffield, UK
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Wilson BE, Hay AE, Chan KKW, Cheung MC, Hanna TP. Augmenting clinical trial economic analysis by linking cancer trial data to administrative data: current landscape and future opportunities. BMJ Open 2023; 13:e073353. [PMID: 37567744 PMCID: PMC10423795 DOI: 10.1136/bmjopen-2023-073353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Economic analyses based on clinical trial data are costly and time consuming, and alternative methods for performing economic analyses should be explored. OBJECTIVE AND METHODS In this perspective, we examine the emerging role of administrative data for economic analyses in cancer. RESULTS Compared with routinely collected clinical trial data, routinely collected administrative data have several strengths including high capture rates for healthcare encounters, less resource utilisation, low rates of misclassification, long follow-up periods and the opportunity to collect data points not traditionally captured in clinical trials. However, there are also limitations including the need for accurate data linkage across multiple databases and systems, the costs and time associated with data linkage, the potential time lag between trial data collection and the availability of administrative data, and limited data on quality of life, toxicity and indirect costs. In this perspective, we identify important barriers and potential solutions to performing economic analyses for oncology using administrative data, and outline strategies to increase research in this field. CONCLUSION The use of routinely collected administrative data sets for economic analyses of clinical trials presents a unique opportunity that could complement and validate economic analyses based on trial-level data.
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Affiliation(s)
- Brooke E Wilson
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
- Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
| | - Annette E Hay
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Kelvin Kar-Wing Chan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Division of Hematology and Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Matthew C Cheung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Division of Hematology and Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Timothy P Hanna
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
- Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
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Alexander S, Oelfke U, McNair H, Tree A. GI factors, potential to predict prostate motion during radiotherapy; a scoping review. Clin Transl Radiat Oncol 2023; 40:100604. [PMID: 36936470 PMCID: PMC10020110 DOI: 10.1016/j.ctro.2023.100604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/27/2023] Open
Abstract
Purpose A scoping literature review was conducted to identify gastrointestinal (GI) factors most likely to influence prostate motion during radiotherapy. We proffer that patient specific measurement of these GI factors could predict motion uncertainty during radiotherapy, facilitating personalised care by optimising treatment technique e.g., daily adaption or via bespoke patient pre-habilitation and preparation. Methods The scoping review was undertaken as per JBI guidelines. Searches were conducted across four databases: Ovid Medline®, EMBASE, CINAHL and EBSCO discovery. Articles written in English from 2010-present were included. Those pertaining to paediatrics, biological women exclusively, infectious and post-treatment GI morbidity and diet were excluded.Common GI factors impacting men were identified and related symptoms, incidence and measurement tools examined. Prevalence among persons with prostate cancer was explored and suitable assessment tools discussed. Results A preliminary search identified four prominent GI-factors: mental health, co-morbidity and medication, physical activity, and pelvic floor disorder. The scoping search found 3644 articles; 1646 were removed as duplicates. A further 1249 were excluded after title and abstract screening, 162 remained subsequent to full text review: 42 mental health, 53 co-morbidity and medication, 39 physical activity and 28 pelvic floor disorder.Six GI factors prevalent in the prostate cancer population and estimated most likely to influence prostate motion were identified: depression, anxiety, diabetes, obesity, low physical activity, and pelvic floor disorder. Reliable, quick, and easy to use tools are available to quantify these factors. Conclusion A comprehensive GI factor assessment package suitable to implement into the radiotherapy clinic has been created. Unveiling these GI factors upfront will guide improved personalisation of radiotherapy.
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Affiliation(s)
- S.E. Alexander
- The Royal Marsden NHS Foundation Trust, United Kingdom and The Institute of Cancer Research, United Kingdom
| | - U. Oelfke
- The Joint Department of Physics, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, United Kingdom
| | - H.A. McNair
- The Royal Marsden NHS Foundation Trust, United Kingdom and The Institute of Cancer Research, United Kingdom
| | - A.C. Tree
- The Royal Marsden NHS Foundation Trust, United Kingdom and The Institute of Cancer Research, United Kingdom
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Pisana A, Wettermark B, Kurdi A, Tubic B, Pontes C, Zara C, Van Ganse E, Petrova G, Mardare I, Fürst J, Roig-Izquierdo M, Melien O, Bonanno PV, Banzi R, Marković-Peković V, Mitkova Z, Godman B. Challenges and Opportunities With Routinely Collected Data on the Utilization of Cancer Medicines. Perspectives From Health Authority Personnel Across 18 European Countries. Front Pharmacol 2022; 13:873556. [PMID: 35865969 PMCID: PMC9295616 DOI: 10.3389/fphar.2022.873556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/18/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Rising expenditure for new cancer medicines is accelerating concerns that their costs will become unsustainable for universal healthcare access. Moreover, early market access of new oncology medicines lacking appropriate clinical evaluation generates uncertainty over their cost-effectiveness and increases expenditure for unknown health gain. Patient-level data can complement clinical trials and generate better evidence on the effectiveness, safety and outcomes of these new medicines in routine care. This can support policy decisions including funding. Consequently, there is a need for improving datasets for establishing real-world outcomes of newly launched oncology medicines. Aim: To outline the types of available datasets for collecting patient-level data for oncology among different European countries. Additionally, to highlight concerns regarding the use and availability of such data from a health authority perspective as well as possibilities for cross-national collaboration to improve data collection and inform decision-making. Methods: A mixed methods approach was undertaken through a cross-sectional questionnaire followed-up by a focus group discussion. Participants were selected by purposive sampling to represent stakeholders across different European countries and healthcare settings. Descriptive statistics were used to analyze quantifiable questions, whilst content analysis was employed for open-ended questions. Results: 25 respondents across 18 European countries provided their insights on the types of datasets collecting oncology data, including hospital records, cancer, prescription and medicine registers. The most available is expenditure data whilst data concerning effectiveness, safety and outcomes is less available, and there are concerns with data validity. A major constraint to data collection is the lack of comprehensive registries and limited data on effectiveness, safety and outcomes of new medicines. Data ownership limits data accessibility as well as possibilities for linkage, and data collection is time-consuming, necessitating dedicated staff and better systems to facilitate the process. Cross-national collaboration is challenging but the engagement of multiple stakeholders is a key step to reach common goals through research. Conclusion: This study acts as a starting point for future research on patient-level databases for oncology across Europe. Future recommendations will require continued engagement in research, building on current initiatives and involving multiple stakeholders to establish guidelines and commitments for transparency and data sharing.
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Affiliation(s)
- Alice Pisana
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Alice Pisana, ; Brian Godman,
| | - Björn Wettermark
- Department of Pharmacy, Faculty of Pharmacy, Disciplinary Domain of Medicine and Pharmacy, Uppsala University, Uppsala, Sweden
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde, Glasgow, United Kingdom
- Department of Pharmacology and Toxicology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Biljana Tubic
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Caridad Pontes
- Catalan Health Service, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Eric Van Ganse
- RESHAPE, INSERM U1290 & Claude Bernard University Lyon 1, Lyon, France
- Asthma Self Care Training Unit, Respiratory Medicine, Croix Rousse University Hospital, Lyon, France
| | | | - Ileana Mardare
- Public Health and Management Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Jurij Fürst
- Health Insurance Institute, Ljubljana, Slovenia
| | | | - Oyvind Melien
- Head of Section for Drug Therapeutics and Safety, Oslo University Hospital, Oslo, Norway
- Head of National Center for Drug Shortage in Specialist Health Care, Department of Pharmacology, Oslo University Hospital, Oslo, Norway
| | - Patricia Vella Bonanno
- Division of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Health Systems Management and Leadership, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Rita Banzi
- Center for Health Regulatory Policies, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Vanda Marković-Peković
- Department of Social Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | | | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde, Glasgow, United Kingdom
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- *Correspondence: Alice Pisana, ; Brian Godman,
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Hay AE, Mittmann N, Crump M, Cheung MC, Sleeth J, Needham J, Broekhoven M, Djurfeldt M, Shepherd LE, Meyer RM, Chen BE, Pater JL. A Canadian Prospective Study of Linkage of Randomized Clinical Trial to Cancer and Mortality Registry Data. ACTA ACUST UNITED AC 2021; 28:1153-1160. [PMID: 33800281 PMCID: PMC8025743 DOI: 10.3390/curroncol28020111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/20/2021] [Accepted: 03/03/2021] [Indexed: 01/11/2023]
Abstract
In a prospective study, we sought to determine acceptability of linkage of administrative and clinical trial data among Canadian patients and Research Ethics Boards (REBs). The goal is to develop a more harmonized approach to data, with potential to improve clinical trial conduct through enhanced data quality collected at reduced cost and inconvenience for patients. On completion of the original LY.12 randomized clinical trial in lymphoma (NCT00078949), participants were invited to enrol in the Long-term Innovative Follow-up Extension (LIFE) component. Those consenting to do so provided comprehensive identifying information to facilitate linkage with their administrative data. We prospectively designed a global assessment of this innovative approach to clinical trial follow-up including rates of REB approval and patient consent. The pre-specified benchmark for patient acceptability was 80%. Of 16 REBs who reviewed the research protocol, 14 (89%) provided approval; two in Quebec declined due to small patient numbers. Of 140 patients invited to participate, 115 (82%, 95% CI 76 to 88%) from across 9 Canadian provinces provided consent and their full name, date of birth, health insurance number and postal code to facilitate linkage with their administrative data for long-term follow-up. Linkage of clinical trial and administrative data is feasible and acceptable. Further collaborative work including many stakeholders is required to develop an optimized secure approach to research. A more coordinated national approach to health data could facilitate more rapid testing and identification of new effective treatments across multiple jurisdictions and diseases from diabetes to COVID-19.
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Affiliation(s)
- Annette E Hay
- Department of Medicine, Queen’s University, Kingston, ON K7L 2V6, Canada
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.S.); (J.N.); (M.B.); (M.D.); (L.ES.); (B.EC.); (J.LP.)
- Correspondence:
| | - Nicole Mittmann
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON M4N 3M5, Canada; (N.M.); (M.CC.)
| | - Michael Crump
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2C1, Canada;
| | - Matthew C Cheung
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON M4N 3M5, Canada; (N.M.); (M.CC.)
| | - Jessica Sleeth
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.S.); (J.N.); (M.B.); (M.D.); (L.ES.); (B.EC.); (J.LP.)
| | - Judy Needham
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.S.); (J.N.); (M.B.); (M.D.); (L.ES.); (B.EC.); (J.LP.)
| | - Mike Broekhoven
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.S.); (J.N.); (M.B.); (M.D.); (L.ES.); (B.EC.); (J.LP.)
| | - Marina Djurfeldt
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.S.); (J.N.); (M.B.); (M.D.); (L.ES.); (B.EC.); (J.LP.)
| | - Lois E Shepherd
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.S.); (J.N.); (M.B.); (M.D.); (L.ES.); (B.EC.); (J.LP.)
| | - Ralph M Meyer
- Juravinski Cancer Centre/Hamilton Health Sciences, McMaster University, Hamilton, ON L8V 5C2, Canada;
| | - Bingshu E Chen
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.S.); (J.N.); (M.B.); (M.D.); (L.ES.); (B.EC.); (J.LP.)
| | - Joseph L Pater
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.S.); (J.N.); (M.B.); (M.D.); (L.ES.); (B.EC.); (J.LP.)
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