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Kalloger SE, Ho C, Mitton C, Regier DA. Mapping the experiences of people with advanced cancer across multiple cancer types-a scoping review. J Cancer Surviv 2024; 18:318-324. [PMID: 36180762 DOI: 10.1007/s11764-022-01263-3] [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] [Received: 07/01/2022] [Accepted: 09/23/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Through the introduction of tumor agnostic therapies, people with metastatic cancer and their treating physicians are facing new treatment choices that have differing side effect and efficacy profiles from conventional chemotherapy. OBJECTIVE The present study undertakes a scoping review of research into the experiences of people with advanced or metastatic cancer across various solid tumor types with the goal of developing a tumor-agnostic conceptual model. DESIGN Automated queries on three internet search engines were performed to identify qualitative interview studies that focused on people with metastatic cancer. No limits were imposed for dates nor location of studies. RESULTS Of the 173 hits generated from the searches, 25 peer-reviewed papers were selected for the review with dates that ranged from 2007 to 2022. All papers originated from the USA, Europe, Australia, or Japan. Three major themes emerged that formed the basis for the tumor-agnostic conceptual model: symptoms, loss of autonomy, and adaptation/coping. CONCLUSIONS The explication of the interplay between the physical and emotional symptoms experienced by those with advanced and metastatic cancer using a multi-tumor approach provides the potential to make generalizations about the needs of this population. An opportunity exists to potentially address these needs through matching patient needs and preferences with the characteristics of novel therapeutics. IMPLICATIONS FOR CANCER SURVIVORS In the era of tumor agnostic therapies, the elicitation of patient preferences across the spectrum of anatomical origins has the potential to enhance shared decision making in the setting of metastatic disease.
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Affiliation(s)
- Steve E Kalloger
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
- Cancer Control Research, BC Cancer, Vancouver, Canada.
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada.
| | - Cheryl Ho
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Department of Medical Oncology, BC Cancer, Vancouver, Canada
| | - Craig Mitton
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Dean A Regier
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Cancer Control Research, BC Cancer, Vancouver, Canada
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Kappel C, Elliott MJ, Kumar V, Nadler MB, Desnoyers A, Amir E. Comparative overall survival of CDK4/6 inhibitors in combination with endocrine therapy in advanced breast cancer. Sci Rep 2024; 14:3129. [PMID: 38326452 PMCID: PMC10850180 DOI: 10.1038/s41598-024-53151-8] [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: 07/10/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024] Open
Abstract
Individual trials of abemaciclib, palbociclib, and ribociclib show a similar impact on progression-free survival yet differing statistical significance for overall survival (OS). A robust comparative evaluation of OS, safety, and tolerability of the three drugs is warranted. A systematic literature search identified phase 3 randomized clinical trials reporting OS of CDK4/6 inhibitors (CDK4/6i) in combination with endocrine therapy in ER-positive/HER2-negative advanced breast cancer. Trial-level data on OS and common and serious adverse events (AE) were extracted for each drug. In the absence of direct comparisons, a network meta-analysis was performed to evaluate pairwise comparative efficacy, safety, and tolerability of each of the CDK4/6i. Seven studies comprising of 4415 patients met the inclusion criteria. Median follow-up was 73.3 months (range: 48.7-97.2 months). There were no statistically significant differences in OS between any of the CDK4/6i. Compared to palbociclib, ribociclib and abemaciclib both showed significantly higher GI toxicity (grade 1-2 vomiting OR 1.87 [95% CI 1.37-2.56] and OR 2.27 [95% CI 1.59-3.23] respectively). Compared to palbociclib, abemaciclib was associated with more grade 3-4 diarrhea OR 118.06 [95% CI 7.28-1915.32]. In contrast, palbociclib was associated with significantly more neutropenia than ribociclib and abemaciclib but significantly lower risk of grade 3-4 infections. Abemaciclib had significantly less grade 3-4 transaminitis and grade 3-4 neutropenia than ribociclib. Treatment discontinuation and death due to AE were significantly higher with abemaciclib than palbociclib and ribociclib. There is no statistically significant difference in OS between CDK4/6i despite differing statistical significance levels of individual trials. Real-world data analyses may help to identify if there is a meaningful inter-drug difference in efficacy. Significant differences between CDK4/6i are observed for safety and tolerability outcomes.
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Affiliation(s)
- Coralea Kappel
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Mitchell J Elliott
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Vikaash Kumar
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Michelle B Nadler
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | - Eitan Amir
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.
- Princess Margaret Cancer Centre, 610 University Ave, 700U, 7-721, Toronto, ON, M5G 2M9, Canada.
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Wei Q, Xu Y, Liu W, Guan X. Cost-effectiveness of abemaciclib plus endocrine therapy in high-risk HR+/HER2-early breast cancer in China. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:91. [PMID: 38012661 PMCID: PMC10683222 DOI: 10.1186/s12962-023-00499-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/17/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE The aim of this article is to evaluate the cost-effectiveness of abemaciclib plus endocrine therapy (ABE + ET) vs. ET as adjuvant treatment for high-risk hormone receptor-positive and human epidermal growth factor receptor 2-negative (HR+/HER2-) early breast cancer in China. METHODS From the perspective of the Chinese health care system, a 5-state Markov model was developed with a lifetime horizon. Data of the monarchE phase III clinical trial were used to model the invasive disease-free survival (iDFS) and standard parameters models were used for data extrapolation. Costs were obtained from national data sources, expert opinions and published literature using 2023 US dollars and discounted by 5%. The results were evaluated in terms of life-years (LYs) and quality-adjusted life-years (QALYs). Sensitivity analyses and scenario analyses were performed to test the robustness of the basic results. RESULTS In the base-case analysis result, the model projected improved outcomes (by 0.65 LYs and 0.72 QALYs) and increased costs (by $16,057.72) for incremental cost-effectiveness ratios (ICERs) of $24,841/LY and $22,385/QALY for ABE + ET vs. ET patients. The results in scenario analysis estimated the ICERs of ABE + ET treatment to be $16,959/LY and $15,264/QALY in a mixture cure model, and $13,560/LY and $12,191/QALY in a non-mixture cure model. The model was sensitive to outcome discount rate and utility of iDFS. CONCLUSION ABE + ET might not have an economic advantage over ET at a willingness-to-pay (WTP) threshold of one time the per capita GDP in China, but was expected to be more cost-effective at a WTP threshold of three times the per capita GDP. Further analysis will be conducted once data from longer-term studies become available.
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Affiliation(s)
- Qiran Wei
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, Jiangsu, China
- Center for Pharmacoeconomics and Outcomes Research of China Pharmaceutical University, Nanjing, 211198, Jiangsu, China
| | - YuTing Xu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, Jiangsu, China
- Center for Pharmacoeconomics and Outcomes Research of China Pharmaceutical University, Nanjing, 211198, Jiangsu, China
| | - Wei Liu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, Jiangsu, China
- Center for Pharmacoeconomics and Outcomes Research of China Pharmaceutical University, Nanjing, 211198, Jiangsu, China
| | - Xin Guan
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, Jiangsu, China.
- Center for Pharmacoeconomics and Outcomes Research of China Pharmaceutical University, Nanjing, 211198, Jiangsu, China.
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Flood E, Krasnow A, Orbegoso C, Karantzoulis S, Bailey J, Bayet S, Elghouayel A, Foxley A, Sommavilla R, Schiavon G. Using qualitative interviews to identify patient-reported clinical trial endpoints and analyses that are the most meaningful to patients with advanced breast cancer. PLoS One 2023; 18:e0280259. [PMID: 36649275 PMCID: PMC9844842 DOI: 10.1371/journal.pone.0280259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Designing clinical trials with the emphasis on the patient-centered approach and focusing on clinical outcomes that are meaningful to patients is viewed as a priority by drug developers, regulatory agencies, payers, clinicians, and patients. This study aimed to capture information on clinical trial endpoints that would be most important and relevant for patients with advanced breast cancer, based on patient-reported outcomes. METHODS Patients with either advanced triple-negative breast cancer [TNBC] and a maximum of two lines of systemic therapy or hormone receptor-positive/human epidermal growth factor receptor 2-negative [HR+/HER2-] breast cancer and a maximum of three lines of systemic therapy, participated in semi-structured concept elicitation interviews. Concept saturation was assessed. A sign, symptom, or impact was defined as "salient" if mentioned by ≥ 60% of participants, with an average bother rating of ≥ 5 (0-10 Scale). Participants were also asked about treatment priorities and to evaluate hypothetical scenarios showing different health-related functioning and quality-of-life treatment outcomes, using graphical representations. RESULTS Thirty-two participants (97% women; aged 29+ years) with TNBC (n = 17) or HR+/HER2- breast cancer (n = 15) provided generally similar reports on symptom experience, with fatigue and pain being most salient, though importance of certain treatment-related symptoms varied between the two groups. Patients reported consistent perspectives on the importance of treatment outcomes: when considering a new treatment, they prioritized efficacy of the therapy, acceptable tolerability, stability, predictability of symptoms over time, and the duration of preserved health-related quality of life and physical functioning. The meaningful difference in preserved physical functioning was 2-3 months for 46% of participants with TNBC, whereas for most participants with HR+/HER2- breast cancer it started from 6-7 months. Both groups of participants found it easier to accept some toxicity at the beginning of therapy if it was followed by improvement, as opposed to improvement followed by deterioration. CONCLUSION The results may help to inform the design of patient-centered clinical trials, to interpret health-related quality of life and/or patient-reported outcomes, and to optimize care for patients with advanced breast cancer.
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Affiliation(s)
- Emuella Flood
- AstraZeneca plc, Patient-Centered Science, Gaithersburg, Maryland, United States of America
| | - Anna Krasnow
- IQVIA Real World Solutions, Patient-Centered Solutions, London, United Kingdom
| | | | - Stella Karantzoulis
- IQVIA Real World Solutions, Patient-Centered Solutions, New York, New York, United States of America
| | - Julie Bailey
- IQVIA Real World Solutions, Patient-Centered Solutions, New York, New York, United States of America
| | - Solène Bayet
- IQVIA Real World Solutions, Patient-Centered Solutions, Courbevoie, France
| | - Arthur Elghouayel
- IQVIA Real World Solutions, Patient-Centered Solutions, New York, New York, United States of America
| | - Andrew Foxley
- AstraZeneca plc, R&D Oncology, Cambridge, United Kingdom
| | | | - Gaia Schiavon
- AstraZeneca plc, R&D Oncology, Cambridge, United Kingdom
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Sunilkumar MM, Finni CG, Lijimol AS, Rajagopal MR. Health-Related Suffering and Palliative Care in Breast Cancer. CURRENT BREAST CANCER REPORTS 2021; 13:241-246. [PMID: 34804375 PMCID: PMC8593626 DOI: 10.1007/s12609-021-00431-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2021] [Indexed: 12/24/2022]
Abstract
Purpose of Review Breast cancer continues to be the most frequently diagnosed cancer in women and the leading cause of cancer death worldwide. By the suffering that it causes in various domains of life, breast cancer seriously impacts the quality of life of affected individuals and causes a major burden of suffering in the community. The objectives of the review were to understand the health-related suffering in patients with breast cancer and to identify the scope of palliative care in improving the quality of life of patients with breast cancer. Recent Findings Breast cancer causes suffering in physical, psychological, social, financial, and spiritual domains of the lives of the patient and family. Management of breast cancer with surgery, chemotherapy, and radiation could have adverse effects, such as pain, nausea and vomiting, fatigue, shortness of breath, depression, and constipation. Both cancer and its treatment can impact the psychosocial and spiritual well-being of the patient and family members. Integrating palliative care into existing breast cancer treatment programs seems to be the best approach to diminish these sufferings. Summary In addition to pain and other physical symptoms, breast cancer can cause major psychological, social, and spiritual suffering. In the context of developing countries, out-of-pocket expenditure can cause major financial destruction which can impact generations. Integration of palliative care to breast cancer treatment is essential.
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Affiliation(s)
- M M Sunilkumar
- Palliative care center & Academics, Trivandrum Institute of Palliative Sciences (TIPS), WHO Collaborating Centre for Training and Policy On Access To Pain Relief, Pallium India, Aisha Memorial Hospital Building, Manacaud P.O., Paruthikkuzhy, Thiruvananthapuram, 695009 Kerala India
| | - Charles G Finni
- Projects (Ex-staff), Trivandrum Institute of Palliative Sciences (TIPS), WHO Collaborating Centre for Training and Policy On Access To Pain Relief, Pallium India, Aisha Memorial Hospital Building, Manacaud P.O., Paruthikkuzhy, Thiruvananthapuram, 695009 Kerala India
| | - A S Lijimol
- Academics, Trivandrum Institute of Palliative Sciences (TIPS), WHO Collaborating Centre for Training and Policy On Access To Pain Relief, Pallium India, Aisha Memorial Hospital Building, Manacaud P.O., Paruthikkuzhy, Thiruvananthapuram, 695009 Kerala India
| | - M R Rajagopal
- Director, Trivandrum Institute of Palliative Sciences (TIPS), WHO Collaborating Centre for Training and Policy On Access To Pain Relief, Pallium India, Aisha Memorial Hospital Building, Manacaud P.O., Paruthikkuzhy, Thiruvananthapuram, 695009 Kerala India
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Hong K, Majercak KR, Villalonga-Olives E, Perfetto EM. Patient-reported outcomes in breast cancer FDA drug labels and review documents. J Patient Rep Outcomes 2021; 5:36. [PMID: 33881661 PMCID: PMC8060367 DOI: 10.1186/s41687-021-00308-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/01/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient-reported outcomes (PROs) can provide valuable information about drug benefit-risk tradeoffs from the patient perspective and are particularly important to patients with breast cancer due to its symptoms and adverse events from breast cancer treatments. The United States Food and Drug Administration (U.S. FDA) has acknowledged PROs as important approval endpoints used in clinical trials of cancer drugs. However, previous studies found that PROs are rarely mentioned in cancer drug labels, a widely used and trusted source of information about drugs. Our objectives were to compare PRO data reported in FDA labeling versus FDA medical review documents for breast cancer drugs approved in the U.S. between 2000 and 2019 to identify possible causes for PRO-data labeling exclusions. METHODS We included new molecular entities (NMEs) and biologic license applications (BLAs) initially approved for breast cancer treatment by the FDA between 1/1/2000 and 12/31/2019. Product labeling and FDA medical review documents were collected from the FDA-Approved Drugs database (Drugs@FDA). From these resources, details on PRO measures used in trials, design of trials using PRO measures, PRO-endpoint status, analytical methods, and FDA reviewer comments regarding PRO measurement were extracted. RESULTS Of 633 FDA-approved drugs, 13 were indicated for breast cancer treatment; none of their prescribing information contained information about PROs. However, 11 of 13 (85%) included PRO measures and endpoint information in FDA medical review documents. PRO measures were used in 14 different clinical trials, and FDA reviewers' comments regarding PRO measurement were related to lack of meaningfulness and clinical significance, lack of content validity, and inadequate analytical methods. CONCLUSIONS Despite the importance of PROs to patients with breast cancer, PRO measures were only described in FDA medical review documents of breast cancer drugs, but not in drug product labeling. Therefore, it appears that PRO data are often collected in breast cancer trials, but have not been methodologically acceptable to FDA reviewers. Collaborative efforts between the FDA and industry are warranted to increase the number of breast cancer drug applications with appropriate use of PRO measures and endpoints.
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Affiliation(s)
- Kyungwan Hong
- Department of Pharmaceutical Health Services Research, University of Maryland, School of Pharmacy, 220 Arch Street, 12th Floor, Room: 01-328, Baltimore, MD, 21201, USA.
| | - Kayleigh R Majercak
- Department of Pharmaceutical Health Services Research, University of Maryland, School of Pharmacy, 220 Arch Street, 12th Floor, Room: 01-328, Baltimore, MD, 21201, USA
| | - Ester Villalonga-Olives
- Department of Pharmaceutical Health Services Research, University of Maryland, School of Pharmacy, 220 Arch Street, 12th Floor, Room: 01-328, Baltimore, MD, 21201, USA
| | - Eleanor M Perfetto
- Department of Pharmaceutical Health Services Research, University of Maryland, School of Pharmacy, 220 Arch Street, 12th Floor, Room: 01-328, Baltimore, MD, 21201, USA
- National Health Council, Washington DC, USA
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Wardley A, Canon JL, Elsten L, Peña Murillo C, Badovinac Crnjevic T, Fredriksson J, Piccart M. Flexible care in breast cancer. ESMO Open 2021; 6:100007. [PMID: 33450658 PMCID: PMC7811121 DOI: 10.1016/j.esmoop.2020.100007] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/03/2020] [Indexed: 12/30/2022] Open
Abstract
Treatment of patients with cancer in hospitals or clinics is resource-intensive and imposes a burden on patients. 'Flexible care' is a term that can be used to describe treatment administered outside the oncology ward, oncological outpatient clinic or office-based oncologist setting. Programmes that reduce travel burden by bringing cancer treatment to the patient's home, workplace or closer to the patient's home, in the form of satellite clinics or mobile cancer units, expand treatment capacity and are well received. Clinical trial data show that, compared with intravenous administration, subcutaneous (s.c.) administration of trastuzumab is preferred by patients with breast cancer (BC), saves healthcare professionals' (HCPs) time, reduces drug preparation and administration time and reduces direct and indirect costs. As such, s.c. trastuzumab is well suited to flexible care. The results of a Belgian study (BELIS) show that home administration of s.c. trastuzumab is feasible and preferred by patients with BC. Numerous programmes and pilot studies in Europe show that s.c. trastuzumab can be administered effectively in the patient's home, in primary care settings or local hospitals. Such programmes require planning, training, careful patient selection and technology to link patients, caregivers and specialists in oncology clinics. Once these elements are in place, flexible care offers patients with BC a choice of how treatment may be delivered and lead to improved quality of life, while reducing pressure on HCPs and hospitals. The concept of flexible care is particularly relevant amid the COVID-19 pandemic where guidelines have been developed encouraging remote care.
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Affiliation(s)
- A Wardley
- NIHR Manchester Clinical Research Facility at The Christie and Division of Cancer Sciences and University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - J-L Canon
- Service d'Oncologie-Hématologie, Site Notre-Dame, Grand Hôpital de Charleroi (GHdC), Charleroi, Belgium
| | - L Elsten
- Department of Medical Oncology, Amphia Hospital, Breda, The Netherlands
| | - C Peña Murillo
- Global Product Development, Medical Affairs, Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - J Fredriksson
- Global Product Development, Medical Affairs, Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - M Piccart
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium.
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Davie A, Carter GC, Rider A, Pike J, Lewis K, Bailey A, Price GL, Ringeisen F, Pivot X. Real-world patient-reported outcomes of women receiving initial endocrine-based therapy for HR+/HER2- advanced breast cancer in five European countries. BMC Cancer 2020; 20:855. [PMID: 32894087 PMCID: PMC7487722 DOI: 10.1186/s12885-020-07294-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 08/11/2020] [Indexed: 12/24/2022] Open
Abstract
Background Endocrine therapy (ET)-based regimens are the mainstay of treatment for patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2−) advanced breast cancer. With the introduction of new treatment classes, it is important to examine patient symptoms and health-related quality of life (HRQoL) at the start of this changing therapeutic landscape. This real-world study describes the patient-reported outcomes (PROs) of women with HR+/HER2− advanced breast cancer receiving ET-based regimens who were naïve to systemic treatment in the advanced setting across five European countries (EU5). Methods Data were collected between March and July 2017 from surveyed oncologists and their patients at a single time point using the multinational Adelphi Advanced Breast Cancer Disease Specific Programme™. Patients completed PRO questionnaires on HRQoL (EORTC QLQ-C30), pain severity and interference, and work and activity impairment. A multiple linear regression model explored factors associated with HRQoL. Results Across EU5, 226 physicians provided data on 781 women with HR+/HER2− advanced breast cancer taking their first ET-based regimen for advanced disease, of whom 252 provided PRO data. This subset had a mean age of 67.1 years, 94% were postmenopausal, 89% were diagnosed with advanced breast cancer at initial presentation, 79% had stage IV disease (66% of these patients had bone metastases and 38% had visceral metastases, including 18% with liver metastases) and 77% were on endocrine-only therapy as their initial treatment for advanced disease. The mean EORTC QLQ-C30 global health score (50.9) was worse than the reference value for patients with advanced breast cancer (60.2). Fatigue, pain, and insomnia were the most severe symptoms, and mean functioning scores were also worse than reference values. “Worst pain” and “pain interference” were moderate/severe for 42 and 80% of patients. Mean activity impairment was 44%, and greater activity impairment was associated with poorer HRQoL. Conclusions Despite receiving first-line ET-based regimens for advanced disease, these women had a poor HRQoL and high levels of symptoms, pain, pain interference and activity impairment. New treatments that maintain a stable disease state and reduce activity impairment may have a positive effect on the HRQoL of those living with advanced breast cancer.
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Affiliation(s)
- Alison Davie
- Eli Lilly and Co Ltd, Windlesham, Surrey, GU20 6PH, UK.
| | | | - Alex Rider
- Adelphi Real World, Bollington, Macclesfield, Cheshire, SK10 5JB, UK
| | - James Pike
- Adelphi Real World, Bollington, Macclesfield, Cheshire, SK10 5JB, UK
| | - Katie Lewis
- Adelphi Real World, Bollington, Macclesfield, Cheshire, SK10 5JB, UK
| | - Abigail Bailey
- Adelphi Real World, Bollington, Macclesfield, Cheshire, SK10 5JB, UK
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Linder LA, Stegenga K, Erickson J, Ameringer S, Newman AR, Chiu YS, Macpherson CF. Priority Symptoms, Causes, and Self-Management Strategies Reported by AYAs With Cancer. J Pain Symptom Manage 2019; 58:774-783. [PMID: 31319104 PMCID: PMC6823142 DOI: 10.1016/j.jpainsymman.2019.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/08/2019] [Accepted: 07/08/2019] [Indexed: 12/28/2022]
Abstract
CONTEXT Cancer and symptom experiences of adolescents and young adults (AYAs) with cancer can be highly variable, creating challenges for clinicians and researchers who seek to optimize AYAs' health outcomes. Understanding the heuristics AYAs use to designate priority symptoms can provide insight into the meaning they assign to their symptoms and self-management behaviors. OBJECTIVES This study described the frequency and characteristics of priority symptoms. It qualitatively explored reasons for a symptom's designation as a priority symptom, perceived causes of priority symptoms, and strategies AYAs use to manage priority symptoms. METHODS Participants in this single-group, longitudinal study reported symptoms using a heuristics-based symptom reporting tool, the Computerized Symptom Capture Tool, at two scheduled visits for chemotherapy. AYAs designated priority symptoms and responded to three short answer questions: What makes this a priority symptom?, What do you think causes it?, and What do you do to make it better? RESULTS Eighty-six AYAs, 15-29 years of age (median 19 years), identified 189 priority symptoms. Priority symptoms were of greater severity (t = 3.43; P < 0.01) and distress (t = 4.02; P < 0.01) compared with nonpriority symptoms. Lack of energy, nausea, difficulty sleeping, and pain comprised 39% of priority symptoms. Reasons for priority designation included the impact of the symptom and the attributes of the symptom. Categories of self-management strategies included "Physical Care Strategies," "Things I take (or not)," and "Psychosocial Care Strategies." CONCLUSION Supporting AYAs to identify their priority symptoms may facilitate a more personalized approach to care. Seeking the patient's perspective regarding priority symptoms could enhance patient-clinician collaboration in symptom management.
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Affiliation(s)
- Lauri A Linder
- University of Utah & Primary Children's Hospital, Salt Lake City, Utah, USA.
| | | | - Jeanne Erickson
- University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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