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Bozcuk HŞ, Alemdar MS. Solving the puzzle of quality of life in cancer: integrating causal inference and machine learning for data-driven insights. Health Qual Life Outcomes 2024; 22:60. [PMID: 39113111 PMCID: PMC11304933 DOI: 10.1186/s12955-024-02274-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/11/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Understanding the determinants of global quality of life in cancer patients is crucial for improving their overall well-being. While correlations between various factors and quality of life have been established, the causal relationships remain largely unexplored. This study aimed to identify the causal factors influencing global quality of life in cancer patients and compare them with known correlative factors. METHODS We conducted a retrospective analysis of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire data, alongside demographic and disease-related features, collected from new cancer patients during their initial visit to an oncology outpatient clinic. Correlations with global quality of life were identified using univariate and multivariate regression analyses. Causal inference analysis was performed using two approaches. First, we employed the Dowhy Python library for causal analysis, incorporating prior information and manual characterization of an acyclic graph. Second, we utilized the Linear Non-Gaussian Acyclic Model (LiNGAM) machine learning algorithm from the Lingam Python library, which automatically generated an acyclic graph without prior information. The significance level was set at p < 0.05. RESULTS Multivariate analysis of 469 new admissions revealed that disease stage, role functioning, emotional functioning, social functioning, fatigue, pain and diarrhea were linked with global quality of life. The most influential direct causal factors were emotional functioning, social functioning, and physical functioning, while the most influential indirect factors were physical functioning, emotional functioning, and fatigue. Additionally, the most prominent total causal factors were identified as type of cancer (diagnosis), cancer stage, and sex, with total causal effect ratios of -9.47, -4.67, and - 1.48, respectively. The LiNGAM algorithm identified type of cancer (diagnosis), nausea and vomiting and social functioning as significant, with total causal effect ratios of -9.47, -0.42, and 0.42, respectively. CONCLUSIONS This study identified that causal factors for global quality of life in new cancer patients are distinct from correlative factors. Understanding these causal relationships could provide valuable insights into the complex dynamics of quality of life in cancer patients and guide targeted interventions to improve their well-being.
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Affiliation(s)
- Hakan Şat Bozcuk
- Dept. of Medical Oncology, Medical Park Hospital, Antalya, Turkey.
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Elsman EBM, Mokkink LB, Abma IL, Aiyegbusi OL, Chiarotto A, Haywood KL, Matvienko-Sikar K, Oosterveer DM, Pool JJM, Swinkels-Meewisse IEJ, Offringa M, Terwee CB. Methodological quality of 100 recent systematic reviews of health-related outcome measurement instruments: an overview of reviews. Qual Life Res 2024:10.1007/s11136-024-03706-z. [PMID: 38961010 DOI: 10.1007/s11136-024-03706-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE Systematic reviews evaluating and comparing the measurement properties of outcome measurement instruments (OMIs) play an important role in OMI selection. Earlier overviews of review quality (2007, 2014) evidenced substantial concerns with regards to alignment to scientific standards. This overview aimed to investigate whether the quality of recent systematic reviews of OMIs lives up to the current scientific standards. METHODS One hundred systematic reviews of OMIs published from June 1, 2021 onwards were randomly selected through a systematic literature search performed on March 17, 2022 in MEDLINE and EMBASE. The quality of systematic reviews was appraised by two independent reviewers. An updated data extraction form was informed by the earlier studies, and results were compared to these earlier studies' findings. RESULTS A quarter of the reviews had an unclear research question or aim, and in 22% of the reviews the search strategy did not match the aim. Half of the reviews had an incomprehensive search strategy, because relevant search terms were not included. In 63% of the reviews (compared to 41% in 2014 and 30% in 2007) a risk of bias assessment was conducted. In 73% of the reviews (some) measurement properties were evaluated (58% in 2014 and 55% in 2007). In 60% of the reviews the data were (partly) synthesized (42% in 2014 and 7% in 2007); evaluation of measurement properties and data syntheses was not conducted separately for subscales in the majority. Certainty assessments of the quality of the total body of evidence were conducted in only 33% of reviews (not assessed in 2014 and 2007). The majority (58%) did not make any recommendations on which OMI (not) to use. CONCLUSION Despite clear improvements in risk of bias assessments, measurement property evaluation and data synthesis, specifying the research question, conducting the search strategy and performing a certainty assessment remain poor. To ensure that systematic reviews of OMIs meet current scientific standards, more consistent conduct and reporting of systematic reviews of OMIs is needed.
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Affiliation(s)
- Ellen B M Elsman
- Department of Epidemiology & Data Science, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Lidwine B Mokkink
- Department of Epidemiology & Data Science, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands
| | - Inger L Abma
- IQ Health, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Kirstie L Haywood
- Warwick Applied Health, Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Jan J M Pool
- University of Applied Sciences, Utrecht, The Netherlands
| | | | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Caroline B Terwee
- Department of Epidemiology & Data Science, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands.
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Kregting LM, Vrancken Peeters NJMC, Clarijs ME, Koppert LB, Korfage IJ, van Ravesteyn NT. Health utility values of breast cancer treatments and the impact of varying quality of life assumptions on cost-effectiveness. Int J Cancer 2024; 155:117-127. [PMID: 38478916 DOI: 10.1002/ijc.34899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/01/2023] [Accepted: 02/06/2024] [Indexed: 05/04/2024]
Abstract
In breast cancer research, utility assumptions are outdated and inconsistent which may affect the results of quality adjusted life year (QALY) calculations and thereby cost-effectiveness analyses (CEAs). Four hundred sixty four female patients with breast cancer treated at Erasmus MC, the Netherlands, completed EQ-5D-5L questionnaires from diagnosis throughout their treatment. Average utilities were calculated stratified by age and treatment. These utilities were applied in CEAs analysing 920 breast cancer screening policies differing in eligible ages and screening interval simulated by the MISCAN-Breast microsimulation model, using a willingness-to-pay threshold of €20,000. The CEAs included varying sets on normative, breast cancer treatment and screening and follow-up utilities. Efficiency frontiers were compared to assess the impact of the utility sets. The calculated average patient utilities were reduced at breast cancer diagnosis and 6 months after surgery and increased toward normative utilities 12 months after surgery. When using normative utility values of 1 in CEAs, QALYs were overestimated compared to using average gender and age-specific values. Only small differences in QALYs gained were seen when varying treatment utilities in CEAs. The CEAs varying screening and follow-up utilities showed only small changes in QALYs gained and the efficiency frontier. Throughout all variations in utility sets, the optimal strategy remained robust; biennial for ages 40-76 years and occasionally biennial 40-74 years. In sum, we recommend to use gender and age stratified normative utilities in CEAs, and patient-based breast cancer utilities stratified by age and treatment or disease stage. Furthermore, despite varying utilities, the optimal screening scenario seems very robust.
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Affiliation(s)
- Lindy M Kregting
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Noëlle J M C Vrancken Peeters
- Academic Breast Cancer Center, Department of Oncologic and Gastro-intestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marloes E Clarijs
- Academic Breast Cancer Center, Department of Oncologic and Gastro-intestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Linetta B Koppert
- Academic Breast Cancer Center, Department of Oncologic and Gastro-intestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Omar MT, Al-Malki MH, Bindawas SM, Alnahdi AH, Aljehan GH, M Al-Omari BN, Alhammad SA. Cross-cultural adaptation and validation of the Arabic version of McGill quality of life: revised questionnaire in the patients with cancer. Disabil Rehabil 2024; 46:1878-1887. [PMID: 37144328 DOI: 10.1080/09638288.2023.2207220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 04/23/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE The aims of this study were to translate and culturally adapt the McGill Quality of Life Questionnaire-revised (MQOL-R) to modern standard Arabic and to examine its reliability, construct, and discriminative validity in Arab patients with cancer. MATERIALS AND METHODS Translation and cultural adaptation of the English MQOL-R to modern standard Arabic were performed according to international guidelines. For psychometric evaluation, 125 participants with cancer were selected and completed the MQOL-R along with Global Health Status/QoL and functional subscales of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), and Eastern Cooperative Oncology Group performance status rating (ECOG-PS). The MQOL-R was tested for internal consistency, test-retest reliability, and construct validity. RESULTS The Arabic MQOL-R questionnaire had adequate internal consistency with Cronbach's alphas between 0.75 and 0.91. Test-retest reliability was very strong (ICC2.1 =0.91 to 0.96, p < 0.001). As hypothesized, the Arabic MQOL-R subscales demonstrated moderate to excellent correlation with functional subscales of EORTC QLQ-C30, and moderate to good correlation with Global health status/QoL. CONCLUSION The Arabic MQOL-R Questionnaire has adequate psychometric properties. Hence, it can be utilized in rehabilitation settings and research to measure health-related quality of life in the Arabic-speaking cancer population.
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Affiliation(s)
- Mohammed Ta Omar
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
- Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Majed Hassan Al-Malki
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
- Rehabilitation Department, Prince Mishari Bin Saoud Hospital, Kingdom of Saudi Arabia
| | - Saad M Bindawas
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
| | - Ali H Alnahdi
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
| | - Ghaidaa H Aljehan
- Rehabilitation Department, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Badr Nasser M Al-Omari
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
- Rehabilitation Department, Prince Mishari Bin Saoud Hospital, Kingdom of Saudi Arabia
| | - Saad A Alhammad
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
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Kar S, Shrivastava V, Meena JK, Mohapatra I, Sahoo SR, Kar M. A Pilot Study to Show Longitudinal Trends in Health-Related Quality of Life (HRQOL) in a Cohort of Breast Cancer Patients Under Treatment at a Tertiary Healthcare Facility in Bhubaneswar, India. Indian J Community Med 2024; 49:501-507. [PMID: 38933792 PMCID: PMC11198538 DOI: 10.4103/ijcm.ijcm_390_23] [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: 06/13/2023] [Accepted: 02/28/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction Breast cancer incidence has overtaken that of cervical cancer among women in India according to the Globacon 2020 reports. Cancer management is also being streamlined at the Center and district levels, such that comprehensive integrated management is offered to cases to optimize the best results. In breast cancer, there are two modes of surgery namely Breast Conservation Surgery(BCS) and Modified Radical Mastectomy (MRM) now over 2 decades, with recommended Chemo radiation depending on the extent of the disease. HRQOL (Health-related Quality of Life) studies have been done in these groups of patients, due to their added relevance in terms of the loss of a vital organ like the breast. EORTC 30 and BR23 are standardized and detailed tools that have been seen to estimate QOL, keeping in mind a whole array of domains that are affected by the disease. Objective To evaluate the "Body Image" and "Quality of life" (QOL) in operated breast cancer patients using BR -23 and EORTC - QLQ- questionnaire at 1month (after surgery) and then 3 to 4 months after surgery. Methods This article attempts to draw a comparison among of EORTC30 and BR 23 scores calculated for 46 breast cancer patients operated during the pandemic time in one center and consenting to repeat the measures at pre-decided three time periods during the course of management. Results No significant differences are noted in the mean scores for EORTC 30 and BR23 for the two types of surgeries. Visit 1 scores for both modes of surgery are over 75 and by Visit 3 become less than 55 for EORTC. BR 23 (which measures the symptoms core to Breast cancer) at all 3 visits are between 45 to 55. Friedman's test shows that the scores are not significant for age groups, the number of living children, or lifestyle factors like alcohol or tobacco chewing, though quadratic graphs depict the distinct variations in the scores at the 3 times reinforcing the need for follow-up of mental health in these subjects at intervals. The study largely brings out a strong need for repeated follow-up and counseling at regular and short intervals, post-surgery in breast cancer patients. EORTC 30 and BR 23 tools are excellent to use to essay information on the mental health of patients with breast cancer.
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Affiliation(s)
- Sonali Kar
- Department of Community Medicine, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Varsha Shrivastava
- Department of Community Medicine, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
| | | | - Ipsa Mohapatra
- Department of Surgical Oncology, KIMS, KIIT University and ED AIIMS Darbhanga, Bihar, India
| | - Saroj Ranjan Sahoo
- Department of Surgical Oncology, KIMS, KIIT University and ED AIIMS Darbhanga, Bihar, India
| | - Madhabananda Kar
- Department of Surgical Oncology, KIMS, KIIT University and ED AIIMS Darbhanga, Bihar, India
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Agussalim NQ, Ahmad M, Prihantono P, Usman AN, Rafiah S, Agustin DI. Physical activity and quality of life in breast cancer survivors. Breast Dis 2024; 43:161-171. [PMID: 38875025 PMCID: PMC11191433 DOI: 10.3233/bd-249005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
OBJECTIVES We reviewed the literature on breast cancer patients' physical activity and quality of life. This paper should urge health services and breast cancer survivors to continue appropriate physical activity and assess its advantages. DESIGN A systematic review was conducted. DATA SOURCES This systematic review used online databases: PubMed, Web of Science, Scopus, and Google Scholar. A search from the beginning of 2018-2024 was conducted. REVIEW METHOD Medical Subject Headings (MESH) were used for keyword selection along with other target keywords, such as "Quality of life", "Breast cancer", "Chemotherapy", "Treatment side effects", "Patient experience", "Psychosocial well-being", "Physical functioning", "Emotional distress", and "Supportive care". We reviewed and included all English-language publications. A narrative synthesis was conducted to present the results of the studies. RESULTS The search using the keywords yielded a total of 135 studies. Each result was filtered again according to the inclusion and exclusion criteria, resulting in a final total of 15 studies to be included in the systematic review. CONCLUSION The evidence supports the benefits of physical activity in enhancing the quality of life for breast cancer survivors, indicating that further prospective and intervention studies are needed.
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Affiliation(s)
- Nurul Qisti Agussalim
- Midwifery Study Program, Graduate School, Hasanuddin University, Makassar, Indonesia
| | - Mardiana Ahmad
- Midwifery Study Program, Graduate School, Hasanuddin University, Makassar, Indonesia
| | - Prihantono Prihantono
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Andi Nilawati Usman
- Midwifery Study Program, Graduate School, Hasanuddin University, Makassar, Indonesia
| | - Sitti Rafiah
- Department of Anatomy, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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Raj P, Cho Y, Jiang Y, Gong Y. Selecting patient-reported outcome measures for a patient-facing technology. JAMIA Open 2023; 6:ooad104. [PMID: 38098479 PMCID: PMC10719077 DOI: 10.1093/jamiaopen/ooad104] [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: 03/31/2023] [Revised: 09/11/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023] Open
Abstract
Objective This article provides insight into our process and considerations for selecting patient-reported outcome measures (PROMs) designed for self-reporting symptoms and quality-of-life among breast cancer (BCA) patients undergoing oral anticancer agent treatment via a patient-facing technology (PFT) platform. Methods Following established guidelines, we conducted a thorough assessment of a specific set of PROMs, comparing their content to identify the most suitable options for studying BCA patients. Results We recommend utilizing the combination of EORTC QLQ-C30 + EORTC QLQ-BR45 as the preferred instrument, especially when developing a dedicated "breast cancer-only" application. Discussion When developing and maintaining a dashboard for a PFT platform that includes multiple cancer types, it is important to consider the feasibility of interface design and workload. To achieve this, we recommend using PRO-CTCAE+PROMIS 10 GH for the PFT. Moreover, it is important to consider adding ad hoc items to complement the chosen PROM(s). Conclusion This article describes our efforts to identify PROMs for self-reported data while considering patient and developer burdens, providing guidance to PFT developers facing similar challenges in PROM selection.
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Affiliation(s)
- Priyank Raj
- D. Bradley McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Youmin Cho
- D. Bradley McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Yun Jiang
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, United States
| | - Yang Gong
- D. Bradley McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
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Omar MTA, Alnahdi AH. Psychometric Properties and Factorial Analysis of the Arabic McGill-QoL Questionnaire in Breast Cancer. BREAST CANCER (DOVE MEDICAL PRESS) 2023; 15:813-824. [PMID: 38020050 PMCID: PMC10656849 DOI: 10.2147/bctt.s422369] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023]
Abstract
Purpose This study aimed to assess the psychometric properties of the Arabic McGill Quality of Life Questionnaire-Revised (MQOL-R) in breast cancer survivors. Patients and Methods One-hundred-forty breast cancer survivors were recruited and completed the questionnaire. The construct validity was assessed using confirmatory factor analysis (CFA). MQOL-R scores were correlated with Global Health Status/QoL and functional subscales of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) for convergent validity. Reliability was estimated using Cronbach's alpha and intraclass correlation coefficients (ICC). Results CFA reproduced a four-factor model (ie, physical, psychological, existential, and social) with good fit indices (comparative fitting index = 0.980; root mean square error of approximation = 0.091), with all items significantly loading on their respective subscales. The total MQOL-R scores were correlated with the global health status/QoL and functional subscales of the EORTC QLQ-C30 (r = -0.172, P < 0.01). Known-group validity was proven by different MQOL-R scores according to functional status (50.62 ± 6.35 vs 45.98 ± 7.19, P < 0.01). Reliability was supported by good internal consistency and high test-retest correlation coefficients for the Arabic MQOL-R and its subscales (ICC range, 0.83-0.95). Conclusion The Arabic MQOL-R demonstrated adequate construct validity, factor structure, excellent test-retest reliability, and good internal consistency. This tool is valuable for assessing the quality of life in research and physical therapy rehabilitation settings among Arabic-speaking breast cancer survivors.
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Affiliation(s)
- Mohammed T A Omar
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ali H Alnahdi
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Mishra A, Nair J, Sharan AM. Coping in Post-Mastectomy Breast Cancer Survivors and Need for Intervention: Systematic Review. Breast Cancer (Auckl) 2023; 17:11782234231209126. [PMID: 37954028 PMCID: PMC10638885 DOI: 10.1177/11782234231209126] [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: 10/27/2022] [Accepted: 10/04/2023] [Indexed: 11/14/2023] Open
Abstract
Background Breast cancer is the most prominent cancer type to affect women. Surgical treatment of invasive breast cancers involves mastectomy. Due to mastectomy, women are subjected to social, emotional, and cultural problems which need to be addressed. Objective The objective of the study is to understand how women cope with body image-related issues, trauma, anxiety, and depression post-mastectomy. Design A systematic literature review was conducted for understanding the coping in post-mastectomy patients. The methods for identifying the studies were based on Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) guidelines. Databases Medline/PubMed, PsycInfo, and Cochrane databases were used for searching relevant articles. A final of 19 studies were analyzed for the work. Methods Search strings such as "coping strategies and post mastectomy," "body image coping and post mastectomy" and "anxiety coping and post mastectomy" were used for identification of references from databases. Eligibility criteria were used for finalizing the references. Results Analysis of the 19 studies has clearly shown that women who undergo mastectomy suffer from anxiety, stress, and trauma. This study has observed that women have problems with their body image post-mastectomy along with bouts of depression. Self-coping has been observed in relatively few studies. Psychological interventions before surgery have been observed to be a better coping strategy. In most of the studies, women opted for breast reconstruction to overcome the trauma associated with mastectomy. Conclusion Mastectomy has a severe impact on women's appearance and psychology. Breast reconstruction and acceptance have played an important role in coping among these women. However, breast reconstruction is not accepted by many women due to a multitude of factors. Thus, it is essential to have proper intervention programs in place to ensure women can cope with this situation and can lead healthy lives. Registration Systematic literature review (SLR) is submitted to PROSPERO. The application confirmation number is 449135.Registration awaited from the database.
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Lund-Jacobsen T, Bentsen L, Schwarz P, Knop AS, Pappot H, Piil K. Aromatase Inhibitor-Related Symptoms Reported by Postmenopausal Women with Nonmetastatic, Estrogen Receptor-Positive Breast Cancer: A Systematic Review. Semin Oncol Nurs 2023; 39:151487. [PMID: 37612223 DOI: 10.1016/j.soncn.2023.151487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE The objective of this systematic review was to establish an overview of aromatase inhibitor-related symptoms reported by postmenopausal women with nonmetastatic, estrogen receptor-positive breast cancer. DATA SOURCES Eight databases (PubMed, Cochrane, Cumulative Index to Nursing and Allied Health Literature [CINAHL], Ovid EMBASE, Ovid MEDLINE, PsycINFO, Scopus, and Web of Science) were searched for trials published between January 2004 and November 2021. Inclusion criteria were studies exploring patient-reported aromatase inhibitor-related symptoms in postmenopausal women with nonmetastatic estrogen receptor-positive breast cancer. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Mixed Method Appraisal Tool were used to rate the quality of the trials included. Of 325 full-text papers, 10 were included. Patient-reported symptoms were clustered by using the European Organization for Research and Treatment of Cancer Quality of Life C30 questionnaire domains. Additional domains were used to cluster other symptoms mentioned: menopausal, sex-related, body alteration, and eye-related. The following clusters were the most frequently presented: sex-related (14 symptoms), pain (9 symptoms), insomnia (5 symptoms), and menopausal (5 symptoms). CONCLUSION The target group reported a variety of symptoms related to aromatase inhibitors. No tools are currently available to measure all the symptoms reported, indicating a need to revise the tools to acknowledge additional symptoms. Prospective studies are needed to investigate the prevalence of aromatase inhibitor-related symptoms in women with breast cancer. IMPLICATION FOR NURSING PRACTICE Identification of patient-reported clinically relevant symptoms can enable targeted symptom assessment and management strategies for women with breast cancer undergoing aromatase inhibitor treatment.
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Affiliation(s)
- Trine Lund-Jacobsen
- BSN, MSc, PhD student, Department of Endocrinology and Metabolism, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Line Bentsen
- MD, PhD student, Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Peter Schwarz
- Professor, MD, DMSc, Department of Endocrinology and Metabolism, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Denmark, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ann Søegaard Knop
- MD, PhD, Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Helle Pappot
- Professor, MD, DMSc, Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Karin Piil
- MHScN, associate professor, Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark and Department of Publich Health, Faculty of Health, University of Aarhus, Aarhus C, Denmark
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Spencer KL, Absolom KL, Allsop MJ, Relton SD, Pearce J, Liao K, Naseer S, Salako O, Howdon D, Hewison J, Velikova G, Faivre-Finn C, Bekker HL, van der Veer SN. Fixing the Leaky Pipe: How to Improve the Uptake of Patient-Reported Outcomes-Based Prognostic and Predictive Models in Cancer Clinical Practice. JCO Clin Cancer Inform 2023; 7:e2300070. [PMID: 37976441 PMCID: PMC10681558 DOI: 10.1200/cci.23.00070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/08/2023] [Accepted: 09/29/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE This discussion paper outlines challenges and proposes solutions for successfully implementing prediction models that incorporate patient-reported outcomes (PROs) in cancer practice. METHODS We organized a full-day multidisciplinary meeting of people with expertise in cancer care delivery, PRO collection, PRO use in prediction modeling, computing, implementation, and decision science. The discussions presented here focused on identifying challenges to the development, implementation and use of prediction models incorporating PROs, and suggesting possible solutions. RESULTS Specific challenges and solutions were identified across three broad areas. (1) Understanding decision making and implementation: necessitating multidisciplinary collaboration in the early stages and throughout; early stakeholder engagement to define the decision problem and ensure acceptability of PROs in prediction; understanding patient/clinician interpretation of PRO predictions and uncertainty to optimize prediction impact; striving for model integration into existing electronic health records; and early regulatory alignment. (2) Recognizing the limitations to PRO collection and their impact on prediction: incorporating validated, clinically important PROs to maximize model generalizability and clinical engagement; and minimizing missing PRO data (resulting from both structural digital exclusion and time-varying factors) to avoid exacerbating existing inequalities. (3) Statistical and modeling challenges: incorporating statistical methods to address missing data; ensuring predictive modeling recognizes complex causal relationships; and considering temporal and geographic recalibration so that model predictions reflect the relevant population. CONCLUSION Developing and implementing PRO-based prediction models in cancer care requires extensive multidisciplinary working from the earliest stages, recognition of implementation challenges because of PRO collection and model presentation, and robust statistical methods to manage missing data, causality, and calibration. Prediction models incorporating PROs should be viewed as complex interventions, with their development and impact assessment carried out to reflect this.
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Affiliation(s)
- Katie L. Spencer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Kate L. Absolom
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Matthew J. Allsop
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Samuel D. Relton
- Leeds Institute of Data Analytics, University of Leeds, Leeds, United Kingdom
| | - Jessica Pearce
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Kuan Liao
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Centre for Health Informatics, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Sairah Naseer
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Omolola Salako
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - Daniel Howdon
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Jenny Hewison
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Galina Velikova
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Corinne Faivre-Finn
- Institute of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Hilary L. Bekker
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Sabine N. van der Veer
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Centre for Health Informatics, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
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Zhou X, Liu Y, Tan J, Hu L, Chen H, Wan C. Exploration of the methods of establishing the minimum clinical important difference based on anchors and their applications in the quality of life measurement scale QLICP-BR (V2.0) for breast cancer. Front Oncol 2023; 13:1123258. [PMID: 37051543 PMCID: PMC10083364 DOI: 10.3389/fonc.2023.1123258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
ObjectiveThe measurement of the quality of life (QOL) in patients with breast cancer can evaluate the therapeutic effects of medical treatments and help to provide reference for clinical decisions. The minimum clinically important difference (MCID) can be better used in clinical interpretation than the traditional statistical significance. Based on the anchors, a variety of ways including traditional and updated anchor-based methods were used to explore most suitable MCID, so that to find better interpretation on scores of the scale QLICP-BR(V2.0) (Quality of Life Instruments for Cancer Patients-Breast cancer).MethodsAccording to the investigation data of breast cancer patients before and after treatment, the most relevant indicators in various domains of QLICP-BR (V2.0) was found as an anchor to statistically analyze the value of MCID, and three analysis methods of anchors were used: Traditional anchor-based method, ROC curve method, multiple linear regression model analysis. Anchors are divided into four standards according to the degree of change in the treatment effect: one grade difference (Standard A), at least one grade difference (Standard B), one grade better (Standard C), better (Standard D). The final MCID value is selected from different statistical methods and classification standards that are most suitable for clinicians to use.ResultsUsing Q29 of the EORTC QLQ-C30 as an anchor has the highest correlation with each domain of QLICP. The order of magnitude of MCID values among the four standard groups is: standard A< Standard C< Standard B< Standard D. The MCID value obtained by the ROC curve method is the most stable and is least affected by the sample size, and the MCID value obtained by the multiple linear regression model is the least. After comparisons and discussions, Standard C in the multiple linear regression model is used to determine the final MCID, which is the closest to other methods. After integer the MCID values of Physical domain (PHD), Psychological domain (PSD), Social domain (SOD), Common symptoms and side effect domain (SSD), Core/general module (CGD), Specific domain (SPD), Total score(TOT) can be taken as 15,10, 10, 11, 10, 9 and 9, respectively.ConclusionIn the evaluation of the QOL of breast cancer patients, although the results of MCID values produced by different methods are different, the results are relatively close. The anchor-based methods make the results of MCID more clinically interpretable by introducing clinical variables, and clinicians and researchers can choose the appropriate method according to the research purpose.
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Affiliation(s)
- Xuan Zhou
- Key Laboratory for Quality of Life and Psychological assessment and Intervention, School of Humanities and Management, Research Center for Quality of Life and Applied Psychology, Guangdong Medical University, Dongguan, China
| | - Yuxi Liu
- Key Laboratory for Quality of Life and Psychological assessment and Intervention, School of Humanities and Management, Research Center for Quality of Life and Applied Psychology, Guangdong Medical University, Dongguan, China
| | - Jianfeng Tan
- Key Laboratory for Quality of Life and Psychological assessment and Intervention, School of Humanities and Management, Research Center for Quality of Life and Applied Psychology, Guangdong Medical University, Dongguan, China
| | - Liren Hu
- School of Public Health, Guangdong Medical University, Dongguan, China
| | - Huanwei Chen
- Oncology Department, Central Hospital of Guangdong Nongken, Zhanjiang, China
| | - Chonghua Wan
- Key Laboratory for Quality of Life and Psychological assessment and Intervention, School of Humanities and Management, Research Center for Quality of Life and Applied Psychology, Guangdong Medical University, Dongguan, China
- *Correspondence: Chonghua Wan,
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Hammersen F, Fischer D, Pursche T, Strobel AM, Katalinic A, Labohm L, Waldmann A. Young Adult German Breast Cancer Patients Participating in a Three-Week Inpatient Mother–Child Rehab Program Have High Needs for Supportive Care. Cancers (Basel) 2023; 15:cancers15061770. [PMID: 36980656 PMCID: PMC10046589 DOI: 10.3390/cancers15061770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
A known cut-off problem hampers the interpretation of quality of life (QOL) scores. The purpose of this study was to apply a novel approach for the EORTC QLQ-C30 instrument to identify the proportion of breast cancer (BC) patients in need of supportive care. Changes in QOL during the COVID-19 pandemic were evaluated, as well as changes over time (after treatment termination and up to 4 years later). Data were obtained from a cohort study on young adult BC patients with minor children participating in a mother–child rehab program. Cross-sectional QOL data were collected from 2015 to 2021 (baseline). Follow-up data were available for up to 4 years after diagnosis for a subgroup. The baseline cohort included 853 women (mean age 35 years). More than 50% had a need for supportive care. In the subgroup with follow-up, this proportion remained at a high level up to several years after diagnosis. During the COVID-19 pandemic, changes regarding the proportion with this need were not as high as expected—with the exception of changes on the QLQ-C30 scale ‘role functioning’ (+15%). Even several years after diagnosis, every second BC patient with minor children had a need for supportive care, which is much higher than previously found. Healthcare staff should be aware of this potential need and should address this issue.
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Affiliation(s)
- Friederike Hammersen
- Institute for Social Medicine and Epidemiology, University of Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany; (A.K.); (L.L.)
- Correspondence: (F.H.); (A.W.)
| | - Dorothea Fischer
- Department of Obstetrics and Gynecology, Ernst von Bergmann Clinic, Charlottenstraße 72, 14467 Potsdam, Germany;
| | - Telja Pursche
- Department of Gynecology and Obstetrics, Hospital Dueren gem. GmbH, Roonstraße 30, 52351 Dueren, Germany;
| | - Angelika M. Strobel
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany
| | - Alexander Katalinic
- Institute for Social Medicine and Epidemiology, University of Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany; (A.K.); (L.L.)
- Institute for Cancer Epidemiology e.V., University of Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany
| | - Louisa Labohm
- Institute for Social Medicine and Epidemiology, University of Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany; (A.K.); (L.L.)
| | - Annika Waldmann
- Institute for Social Medicine and Epidemiology, University of Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany; (A.K.); (L.L.)
- Correspondence: (F.H.); (A.W.)
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14
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Solikhah S, Perwitasari DA, Rejeki DSS. Cross-cultural adaptation and psychometric properties of the Indonesian version for quality of life among breast cancer patients. Front Public Health 2023; 11:1069422. [PMID: 36926172 PMCID: PMC10011654 DOI: 10.3389/fpubh.2023.1069422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/09/2023] [Indexed: 03/08/2023] Open
Abstract
Background Breast cancer is one of the most important health problems worldwide. Quality of life (QoL) is an important indicator to evaluate symptoms in cancer patients, including those with breast cancer. Culturally suitable, valid, reliable, and appropriate instruments to measure the QoL of breast cancer patients are needed, which is still rare in Indonesia. This study aimed to translate the EORTC QLQ-BR45 instrument into Indonesian and evaluate its psychometrics. Methods A cross-sectional study was performed on 635 patients conveniently selected from the oncology department in referral hospital. The first phase of this study involved translation of the existing EORTC QLQ-BR45 into Indonesian, and in the second phase, we evaluated its psychometric properties. Construct validity was evaluated using confirmatory factor analysis (CFA). Criterion validity was examined according to the association between disease stage and Karnofsky Performance Scale (KPS). Results A total of 635 (99.00%) completed the EORTC QLQ-BR45 successfully. The instrument indicated good readability and high content validity. All Cronbach's alpha coefficients were satisfactory (overall value, 0.87). For construct validity, patients with KPS ≥80% did better than those with KPS ≤70% as did two multi-item scales in functional scales (body image and breast satisfaction) and five multi-item scales in symptom scales (systemic therapy side effects, endocrine therapy, and arm, breast, and endocrine sexual symptoms). Body image score of late-stage patients was significantly higher. CFA indicated that the nine-factor structure of the Indonesian EORTC QLQ-BR45 was a good fit for the data. Conclusion The Indonesian EORTC QLQ-BR45 questionnaire is reliable and valid with good psychometric properties, thus can be used for breast cancer patients in Indonesia.
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Affiliation(s)
- Solikhah Solikhah
- Faculty of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia
| | | | - Dwi Sarwani Sri Rejeki
- Department of Public Health, Faculty of Health Sciences, Universitas Jenderal Soedirman, Purwokerto, Indonesia
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15
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Angioletti C, de Mattia E, Carloni LM, Morsella A, Fabi A, Orlandi A, Tortora G, de Belvis AG. Definition of a tool to assess shared decision-making (SDM) on women with breast cancer: A value-based approach. Health Sci Rep 2022; 5:e817. [PMID: 36172302 PMCID: PMC9470011 DOI: 10.1002/hsr2.817] [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: 01/27/2022] [Revised: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background and Aims In oncology, there is increasing talk of personalized treatment and shared decision-making (SDM), especially when multiple treatment options are available with different outcomes depending on patient preference. The present study aimed to define the set of main dimensions and relative tools to assess the Value brought to patients from a Breast Cancer's Clinical pathway structured according to a dynamic SDM framework. Methods Starting from our previous systematic review of the literature, a deep search of the main evidence-based and already validated questionnaires was carried out. In the second phase, to corroborate this grid, a Delphi survey was conducted to assess each questionnaire identified for each dimension, against the following seven value-based criteria: Clinical Benefit, Safety, Care Team Well Being, Patient Reported Outcomes Measures, Green Oncology, Impact on Health Budget, and Genomic Profile. Results The resulting 7-dimension questionnaire is composed of 72 questions. Of these, some quantitatively and objectively assess the evolution of the patient's disease state, whereas others aim to ask patients about their active involvement in decisions affecting them and to investigate whether they were free to explore their preferences. Furthermore, to frame the analyzed phenomenon at the right time, for each questionnaire section, the specific, evidence-based timing of administration is indicated. Conclusion The resulting questionnaire is validated in its entirety and it is composed of a set of questions and relative time point for data collections to assess the Value brought to patients undertaking a Breast Cancer's Clinical pathway, structured according to a dynamic SDM framework. It constitutes a quantitative instrument to integrate patient centeredness with a personalized perspective in the care management of women with breast cancer.
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Affiliation(s)
- Carmen Angioletti
- Critical Pathways and Outcomes Evaluation UnitFondazione Policlinico Universitario Agostino Gemelli IRCCSRomaLazioItaly
- Scuola Superiore Sant'Anna Istituto di ManagementPisaToscanaItaly
| | - Egidio de Mattia
- Critical Pathways and Outcomes Evaluation UnitFondazione Policlinico Universitario Agostino Gemelli IRCCSRomaLazioItaly
| | - Luca M. Carloni
- Università di PisaLungarno Antonio PacinottiPisaToscanaItaly
| | - Alisha Morsella
- Università Cattolica del Sacro Cuore‐Campus di RomaRomaLazioItaly
| | - Alessandra Fabi
- Breast Precision Medicine UnitFondazione Policlinico Universitario Agostino Gemelli IRCCSRomaLazioItaly
| | - Armando Orlandi
- Comprehensive Cancer Center, UOC di Oncologia MedicaFondazione Policlinico Universitario Agostino Gemelli IRCCSRomaLazioItaly
| | - Giampaolo Tortora
- Comprehensive Cancer Center, UOC di Oncologia MedicaFondazione Policlinico Universitario Agostino Gemelli IRCCSRomaLazioItaly
| | - Antonio G. de Belvis
- Critical Pathways and Outcomes Evaluation UnitFondazione Policlinico Universitario Agostino Gemelli IRCCSRomaLazioItaly
- Università Cattolica del Sacro Cuore‐Campus di RomaRomaLazioItaly
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