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Yang GM, Lee Y, Ke Y, Neo PSH, Cheung YB. Feasibility of Weekly Integrated Palliative Care Outcome Scale (IPOS) Within a Stepped Care Model. J Pain Symptom Manage 2024; 68:e174-e182. [PMID: 38878909 DOI: 10.1016/j.jpainsymman.2024.06.004] [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: 04/10/2024] [Revised: 05/31/2024] [Accepted: 06/09/2024] [Indexed: 07/01/2024]
Abstract
CONTEXT Patients with advanced cancer may experience symptoms and concerns that are inadequately identified by the healthcare team, leading to calls for patient-reported symptom monitoring. OBJECTIVES Assess the feasibility of administering weekly patient-reported online Integrated Palliative care Outcome Scale (IPOS) questionnaires within the context of a stepped care model in the outpatient care setting. METHODS Analysis of intervention group data in a randomized controlled trial to assess the effectiveness of a stepped care model of palliative care for patients with advanced cancer. Patients in the intervention group were invited to complete the IPOS weekly for 16 weeks through a remotely-administered online questionnaire. At the end of the 16-week period, patients were invited to complete a feedback survey. Multivariable logistic regression was used to assess factors associated with more versus less than 70% completion of weekly questionnaires. RESULTS Among 111 patients who survived more than 16 weeks, the mean number of questionnaires completed was 9.2/16 (58%). A total of 53 out of the 111 patients (48%) completed more than 70% of the questionnaires. Higher education level was found to be associated with higher completion of the questionnaires. A total of 79 out of 111 (71%) patients responded to the feedback survey, of which 67 (85%) felt comfortable with completing the online questionnaire and 11 (14%) felt it was troublesome to complete it on a weekly basis. CONCLUSION In our study, there was suboptimal completion of patient-reported IPOS questionnaire. Further research is needed to improve the uptake of patient-reported outcomes in real-world clinical settings.
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Affiliation(s)
- Grace Meijuan Yang
- Division of Supportive and Palliative Care (G.M.Y., Y.K., P.S.H.N., Y.B.), National Cancer Centre Singapore, Singapore; Lien Centre for Palliative Care (G.M.Y., Y.K., P.S.H.N., Y.B.), Duke-NUS Medical School, Singapore, Singapore; Programme in Health Services and Systems Research (G.M.Y., Y.K., P.S.H.N., Y.B.), Duke-NUS Medical School, Singapore, Singapore.
| | - Yixuan Lee
- Duke-NUS Medical School (Y.L.), Singapore, Singapore
| | - Yu Ke
- Division of Supportive and Palliative Care (G.M.Y., Y.K., P.S.H.N., Y.B.), National Cancer Centre Singapore, Singapore
| | - Patricia Soek Hui Neo
- Division of Supportive and Palliative Care (G.M.Y., Y.K., P.S.H.N., Y.B.), National Cancer Centre Singapore, Singapore
| | - Yin Bun Cheung
- Programme in Health Services and Systems Research (G.M.Y., Y.K., P.S.H.N., Y.B.), Duke-NUS Medical School, Singapore, Singapore; Centre for Quantitative Medicine (Y.B.C.), Duke-NUS Medical School, Singapore, Singapore; Tampere Center for Child (Y.B.C.), Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
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Figueroa D, Guiloff R, Figueroa F, Stocker E, Rocha Piedade S. 4 Domain Sports PROM in Spanish: Cross-cultural adaptation in the Chilean population and reliability analysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:497-501. [PMID: 38340964 DOI: 10.1016/j.recot.2024.02.001] [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: 10/11/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Patient-Reported Outcome Measures (PROMs) are tools of increasing interest in the sports population. The purpose of this study was to perform the cross-cultural adaptation and reliability analysis of the 4 Domain Sports Patient-Reported Outcome Measure (4DSP) into Spanish. METHODS A six-stage cross-cultural adaptation protocol was executed to obtain the Spanish version of the 4DSP (S-4DSP). Subsequently, the questionnaire was administered to a population of 108 postoperative athletes with ACL (Anterior Cruciate Ligament) injuries. The questionnaire was administered again after 30 days. Acceptability, floor and ceiling effects, internal consistency (Cronbach's alpha), and reproducibility (Intraclass Correlation) were evaluated. RESULTS The S-4DSP was fully completed by 108 participants (mean age 34±10.75, 26% women), achieving 100% acceptability. No floor effect was detected. The statistical analysis yielded a global Cronbach's alpha for the questionnaire of 0.65, and domain-specific alphas of 0.88, 0.72, 0.27, and 0.68 for the first, second, third, and fourth domains, respectively. The Intraclass Correlation test reached a maximum of 0.94 and a minimum of 0.48 for the first and fifth questions, respectively. CONCLUSIONS The S-4DSP is a reliable and useful tool for evaluating Spanish-speaking athletes after ACL reconstruction.
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Affiliation(s)
- D Figueroa
- Departamento de Ortopedia y Traumatología, Clínica Alemana, Santiago, Chile; Universidad del Desarrollo, Santiago, Chile.
| | - R Guiloff
- Departamento de Ortopedia y Traumatología, Clínica Alemana, Santiago, Chile; Universidad del Desarrollo, Santiago, Chile; Hospital Sótero del Río, Santiago, Chile
| | - F Figueroa
- Departamento de Ortopedia y Traumatología, Clínica Alemana, Santiago, Chile; Universidad del Desarrollo, Santiago, Chile; Hospital Sótero del Río, Santiago, Chile
| | - E Stocker
- Departamento de Ortopedia y Traumatología, Clínica Alemana, Santiago, Chile; Universidad del Desarrollo, Santiago, Chile
| | - S Rocha Piedade
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP, Campinas, Brasil
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Xu C, Sidey-Gibbons C, Lacourt TE. Development of a PROMIS multidimensional cancer-related fatigue (mCRF) form using modern psychometric techniques. Qual Life Res 2024; 33:2361-2373. [PMID: 38980641 DOI: 10.1007/s11136-024-03705-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE To develop a PRO assessment of multidimensional cancer-related fatigue based on the PROMIS fatigue assessments. METHOD Cancer patients reporting fatigue were recruited from a comprehensive cancer care center and completed a survey including 39 items from the PROMIS Cancer Item Bank-Fatigue. Component and factor structures of the fatigue items were explored with Monte Carlo parallel factor and Mokken analyses, respectively. Psychometric properties were determined using item response theory, ensuring unidimensionality, scalability, and item independence. RESULTS Fatigue scores from a sample of 333 fatigued cancer patients (mean age = 59.50, SD = 11.62, 67% women) were used in all scale development analyses. Psychometric analyses yielded 3 dimensions: motivational fatigue (15 items), cognitive fatigue (9 items), and physical fatigue (9 items). The subscales showed strong unidimensionality, were scalable, and were free of differential item function. Confirmatory factor analyses in a new sample of 182 patients confirmed the findings. CONCLUSION The resulting 33-item PROMIS multidimensional cancer-related fatigue (mCRF) form provides a novel measure for the assessment of the different dimensions of cancer-related fatigue. It is the only multidimensional scale specific for cancer patients that has been developed using modern psychometric approaches. With its 3 dimensions (motivational, cognitive, and physical fatigue), this scale accurately captures the fatigue experienced by cancer patients, allowing clinicians to optimize fatigue management and improve patient care. The scale could also advance research on the nature and experience of cancer-related fatigue.
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Affiliation(s)
- Cai Xu
- Section of Patient Centered Analytics, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chris Sidey-Gibbons
- Section of Patient Centered Analytics, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tamara E Lacourt
- Department of Psychiatry, Unit1454, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
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4
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Aronson KI, Swigris JJ, Wijsenbeek M. Integrating the assessment of quality of life in care and research in pulmonary fibrosis. Curr Opin Pulm Med 2024; 30:508-515. [PMID: 38946547 DOI: 10.1097/mcp.0000000000001095] [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: 07/02/2024]
Abstract
PURPOSE OF REVIEW Pulmonary fibrosis (PF) negatively influences health-related quality of life (HRQOL). Patients living with PF have voiced the desire for a focus on symptoms and HRQOL in both disease monitoring and treatment decisions. RECENT FINDINGS Currently available disease modifying treatments do little to impact HRQOL. Newer studies evaluating pharmacologic and nonpharmacologic therapies targeting symptoms and HRQOL in PF have been conducted with some promising results. There is increasing recognition of the importance of incorporating HRQOL as a higher tier endpoint in clinical trials. Disease-specific measure of HRQOL have been developed for those living with PF, and there is ongoing work to better understand the validity and reliability characteristics of these tools. In addition to research, there is recognition of the potential benefits of measuring HRQOL and symptoms in clinical practice in facilitate integrating patient perspective into care and allow for more personalized treatment approaches. SUMMARY There is increased momentum to discover treatments that impact HRQOL in PF. More work is desperately needed to identify better treatment targets, and to incorporate HRQOL and symptoms as higher tier endpoints in clinical trials. Further work is also needed to address the practicalities of integrating HRQOL measurement into clinical care.
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Affiliation(s)
- Kerri I Aronson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Jeffrey J Swigris
- Center for Interstitial Lung Disease, National Jewish Health, Denver, Colorado, USA
| | - Marlies Wijsenbeek
- Centre of Interstitial Lung Diseases, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
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Figueroa D, Guiloff R, Figueroa F, Stocker E, Rocha Piedade S. [Translated article] 4 Domain Sports PROM in Spanish: Cross-cultural adaptation in the Chilean population and reliability analysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T497-T501. [PMID: 38969291 DOI: 10.1016/j.recot.2024.07.001] [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: 10/11/2023] [Accepted: 02/01/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Patient-Reported Outcome Measures (PROMs) are tools of increasing interest in the sports population. The purpose of this study was to perform the cross-cultural adaptation and reliability analysis of the 4 Domain Sports Patient-Reported Outcome Measure (4 DSP) into Spanish. METHODS A six-stage cross-cultural adaptation protocol was executed to obtain the Spanish version of the 4 DSP (S-4DSP). Subsequently, the questionnaire was administered to a population of 108 postoperative athletes with ACL (Anterior Cruciate Ligament) injuries. The questionnaire was administered again after 30 days. Acceptability, floor and ceiling effects, internal consistency (Cronbach's alpha), and reproducibility (Intraclass Correlation) were evaluated. RESULTS The S-4DSP was fully completed by 108 participants (mean age 34±10.75, 26% women), achieving 100% acceptability. No floor effect was detected. The statistical analysis yielded a global Cronbach's alpha for the questionnaire of 0.65, and domain-specific alphas of 0.88, 0.72, 0.27, and 0.68 for the first, second, third, and fourth domains, respectively. The Intraclass Correlation test reached a maximum of 0.94 and a minimum of 0.48 for the first and fifth questions, respectively. CONCLUSIONS The S-4DSP is a reliable and useful tool for evaluating Spanish-speaking athletes after ACL reconstruction.
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Affiliation(s)
- D Figueroa
- Departamento de Ortopedia y Traumatología, Clínica Alemana, Santiago, Chile; Universidad del Desarrollo, Santiago, Chile.
| | - R Guiloff
- Departamento de Ortopedia y Traumatología, Clínica Alemana, Santiago, Chile; Universidad del Desarrollo, Santiago, Chile; Hospital Sótero del Río, Santiago, Chile
| | - F Figueroa
- Departamento de Ortopedia y Traumatología, Clínica Alemana, Santiago, Chile; Universidad del Desarrollo, Santiago, Chile; Hospital Sótero del Río, Santiago, Chile
| | - E Stocker
- Departamento de Ortopedia y Traumatología, Clínica Alemana, Santiago, Chile; Universidad del Desarrollo, Santiago, Chile
| | - S Rocha Piedade
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP, Campinas, Brazil
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Perry MB, Taylor S, Khatoon B, Vercell A, Faivre-Finn C, Velikova G, Marsden A, Heal C, Yorke J. Examining the Effectiveness of Electronic Patient-Reported Outcomes in People With Cancer: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e49089. [PMID: 39083791 PMCID: PMC11325109 DOI: 10.2196/49089] [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: 05/17/2023] [Revised: 02/07/2024] [Accepted: 04/10/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Electronic patient-reported outcomes (ePROs) are commonly used in oncology clinical practice and have shown benefits for patients and health resource use. OBJECTIVE The aim of this study was to compare the isolated effect of administering ePROs to patients with cancer versus a control condition. METHODS The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Randomized controlled trials evaluating ePRO interventions that aimed to improve health-related outcomes among patients with cancer were included. The primary outcome was health-related quality of life (HRQOL), and the secondary outcomes were symptoms, hospital admissions, unplanned visits, chemotherapy completion, survival, and satisfaction with care. The effect sizes of ePROs on health-related outcomes were analyzed as standardized mean differences (SMDs) with 95% CIs using a random effects model. RESULTS The search identified 10,965 papers, of which 19 (0.17%) from 15 studies were included. The meta-analysis showed an improvement in HRQOL at 3 months, measured by the Functional Assessment of Cancer Therapy-General (SMD 0.28, 95% CI -1.22 to 1.78), and at 6 months, assessed using various HRQOL measures (SMD 0.07, 95% CI -1.24 to 1.39). The results should be interpreted with caution, given the wide 95% CIs. Of the 15 studies, 9 (60%) reported a positive signal on HRQOL, with two-thirds of the studies (n=6, 67%) including tailored patient advice and two-thirds (n=6, 67%) using clinician alert systems. CONCLUSIONS The meta-analysis showed a potential improvement in HRQOL at 6 months and in Functional Assessment of Cancer Therapy-General scores at 3 months for studies that included tailored advice and clinician alerts, suggesting that these elements may improve ePRO effectiveness. The findings will provide guidance for future use and help health care professionals choose the most suitable ePRO features for their patients. TRIAL REGISTRATION PROSPERO CRD42020175007; https://tinyurl.com/5cwmy3j6.
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Affiliation(s)
- Melissa Betty Perry
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Sally Taylor
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Nursing Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
| | - Binish Khatoon
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Nursing Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
| | - Amy Vercell
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- Division of Cancer Science, The University of Manchester, Manchester, United Kingdom
- Clinical Oncology Department, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Galina Velikova
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
- St James's Institute of Oncology, St James's University Hospital, Leeds, United Kingdom
| | - Antonia Marsden
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, United Kingdom
| | - Calvin Heal
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, United Kingdom
| | - Janelle Yorke
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Nursing Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, China (Hong Kong)
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Chan A, Ng DQ, Arcos D, Heshmatipour M, Lee BJ, Chen A, Duong L, Van L, Nguyen T, Green V, Hoang D. Electronic Patient-Reported Outcome-Driven Symptom Management by Oncology Pharmacists in a Majority-Minority Population: An Implementation Study. JCO Oncol Pract 2024:OP2400050. [PMID: 39008806 DOI: 10.1200/op.24.00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/02/2024] [Accepted: 05/23/2024] [Indexed: 07/17/2024] Open
Abstract
PURPOSE There is a lack of systematic solutions to manage supportive care issues in racial/ethnic minorities (REM) receiving treatment for cancer. We developed and implemented an electronic patient-reported outcome (ePRO)-driven symptom management tool led by oncology pharmacists in a majority-minority cancer center located in Southern California. This study was designed to evaluate the implementation outcomes of our multilevel intervention. METHODS This was a prospective, pragmatic, implementation study conducted between July 2021 and June 2023. Newly diagnosed adult patients with cancer receiving intravenous anticancer therapies completed symptom screening using ePRO that consists of the Patient-Reported Outcomes Measurement Information System measures at each infusion visit during the study. ePRO results were presented to an oncologist pharmacist for personalized symptom management and treatment counseling. The RE-AIM framework was used to guide implementation outcomes. Differences in symptom trajectories and clinical outcomes between groups were tested using generalized estimating equations. RESULTS We screened 388 patients of whom 250 were enrolled (acceptance rate: 64.4%), with 564 assessments being completed. The sample consisted of non-Hispanic White (NHW, 42.4%), Hispanic/Latinx (H/L, 30.8%), and non-Hispanic Asian (20.4%), with one (21.6%) of five participants preferring speaking Spanish. Compared with NHW, H/L participants had greater odds of reporting mild to severe pain interference (odds ratio [OR], 1.91 [95% CI, 1.18 to 3.08]; P = .008) and nausea and vomiting (OR, 2.08 [95% CI, 1.21 to 3.58]; P = .008), and higher rates of urgent care utilization (OR, 1.92 [95% CI, 1.04 to 3.61]; P = .04) within 30 days. Nausea and vomiting (n = 131, 23.2%), pain (n = 91, 16.1%), and fatigue (n = 72, 12.8%) were most likely to be intervened, with 90% of the participants expressing satisfaction across all visits. CONCLUSION Our multilevel ePRO-driven intervention led by oncology pharmacists helps facilitate symptom assessments and management and potentially reduce health disparities among REM.
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Affiliation(s)
- Alexandre Chan
- School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, Irvine, CA
- Department of Pharmacy, Chao Family Comprehensive Cancer Center, Orange, CA
| | - Ding Quan Ng
- School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, Irvine, CA
| | - Daniela Arcos
- School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, Irvine, CA
| | - Matthew Heshmatipour
- School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, Irvine, CA
| | - Benjamin J Lee
- School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, Irvine, CA
- Department of Pharmacy, Chao Family Comprehensive Cancer Center, Orange, CA
| | - Alison Chen
- Department of Pharmacy, Chao Family Comprehensive Cancer Center, Orange, CA
| | - Lan Duong
- Department of Pharmacy, Chao Family Comprehensive Cancer Center, Orange, CA
| | - Linda Van
- Department of Pharmacy, Chao Family Comprehensive Cancer Center, Orange, CA
| | - Thomas Nguyen
- Department of Pharmacy, Chao Family Comprehensive Cancer Center, Orange, CA
| | - Vuong Green
- Department of Pharmacy, Chao Family Comprehensive Cancer Center, Orange, CA
| | - Daniel Hoang
- School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, Irvine, CA
- Department of Pharmacy, Chao Family Comprehensive Cancer Center, Orange, CA
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Rossen S, Sandager MT, Hofland DT, Nielsen CV, Maribo T. Are all cancer survivors included when using electronically administered patient reported outcomes in primary healthcare cancer rehabilitation? A cross-sectional study. J Patient Rep Outcomes 2024; 8:67. [PMID: 38976222 PMCID: PMC11231107 DOI: 10.1186/s41687-024-00753-5] [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: 11/09/2023] [Accepted: 06/26/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND Patient reported outcomes (PROs) are being used frequently in clinical practice. PROs often serve several purposes, such as increasing patient involvement, assessing health status, and monitoring and improving the quality-of-care at an aggregated level. However, the lack of representative PRO-data may have implications for all these purposes. This study aims to assess the association of non-administration of (not sending an electronic invite to PRO) and non-response to (not responding to PRO) electronically administered PROs with social inequality in a primary healthcare cancer rehabilitation setting. Furthermore, it examines whether the workflows surrounding PRO have an impact on non-administration and non-response. METHODS This is a cross sectional study using routinely collected data from electronic health records and registers including cancer survivors (CSs) over 18 years booked for an initial consultation in a primary healthcare cancer rehabilitation setting using PROs for systematic health status assessment. During the study period two different PRO platforms were used, each associated with different workflows. Non-administration and non-response rates were calculated for sociodemographic characteristics for each PRO platform. Crude and adjusted odds ratios were calculated using univariate and multivariate logistic regression. RESULTS In total, 1868 (platform 1) and 1446 (platform 2) CSCSs were booked for an initial consultation. Of these, 233 (12.5%) (platform 1) and 283 (19.6%) (platform 2) were not sent a PRO (non-administration). Among those who received a PRO, 157 (9.6%) on platform 1 and 140 (12.0%) on platform 2 did not respond (non-response). Non-administration of and non-response to PROs were significantly associated with lower socioeconomic status. Moreover, the workflows surrounding PROs seem to have an impact on non-inclusion in and non-response to PROs. CONCLUSIONS Non-administration of and non-response to PROs in clinical practice is associated with determinants of social inequality. Clinical workflows and the PRO platforms used may potentially worsen this inequality. It is important to consider these implications when using PROs at both the individual and aggregated levels. A key aspect of implementing PROs in clinical practice is the ongoing focus on representativeness, including a focus on monitoring PRO administration and response.
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Affiliation(s)
- Sine Rossen
- Copenhagen Centre for Cancer and Health, Municipality of Copenhagen, Nørre Alle 45, Copenhagen N, DK-2200, Denmark.
| | - Mette Thønnings Sandager
- Copenhagen Centre for Cancer and Health, Municipality of Copenhagen, Nørre Alle 45, Copenhagen N, DK-2200, Denmark
| | - Dorte Thoning Hofland
- Copenhagen Centre for Cancer and Health, Municipality of Copenhagen, Nørre Alle 45, Copenhagen N, DK-2200, Denmark
| | - Claus Vinther Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Social Medicine and Rehabilitation, Region Hospital Goedstrup, Herning, Denmark
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
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9
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Watson L, Link C, Qi S, DeIure A, Chmielewski L, Hildebrand A, Barbera L. Designing and Validating a Comprehensive Patient-Reported Outcomes Measure for Ambulatory Cancer Settings: The Revised Edmonton Symptom Assessment System for Cancer. JCO Oncol Pract 2024:OP2400088. [PMID: 38954778 DOI: 10.1200/op.24.00088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/12/2024] [Accepted: 05/24/2024] [Indexed: 07/04/2024] Open
Abstract
PURPOSE Patient-reported outcomes (PROs) information has been routinely collected in Cancer Care Alberta (CCA) for years using the revised Edmonton Symptom Assessment System (ESAS-r) and Canadian Problem Checklist (CPC). There was interest in combining these into a more comprehensive single measure tailored to ambulatory cancer settings. The purpose of this study was to validate an expanded and redesigned ESAS-r called the ESAS-r Cancer. METHODS Stakeholder engagement, a review of the literature, and 2 years of CPC data collected in the cancer program informed the addition of six symptoms to the ESAS-r. To assess and validate the measure, 1,600 randomly sampled patients were mailed paper copies of the ESAS-r Cancer, ESAS-r, and a validated, comprehensive PRO measure called the Memorial System Assessment Scale-Short Form (MSAS-SF), which is often used with patients with cancer. Canonical Correlation Analysis and exploratory factor analyses were performed to assess concurrent and construct validity of the ESAS-r Cancer against ESAS-r, using MSAS-SF as the reference measure for comparison. Cronbach α was calculated to assess reliability. RESULTS Four hundred and sixty-one patients (29% response rate) completed all three questionnaires. ESAS-r Cancer showed higher numerical correlation than ESAS-r and accounted for more information included on MSAS-SF, explaining slightly more variance than ESAS-r (75.2% v 73.5%). The three-dimensional factor structure of ESAS-r Cancer outperformed the two-dimensional factor structure of ESAS-r. The reliability of ESAS-r Cancer was verified and found to be slightly higher than ESAS-r (Cronbach α = .903 v .884). CONCLUSION ESAS-r Cancer is now in use with patients throughout CCA. This valid and reliable PRO measure can be used by other cancer or specialized health care programs who wish to routinely assess common symptoms.
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Affiliation(s)
- Linda Watson
- Applied Research & Patient Experience, Supportive Care Services and Patient Experience, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Claire Link
- Applied Research & Patient Experience, Supportive Care Services and Patient Experience, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Siwei Qi
- Applied Research & Patient Experience, Supportive Care Services and Patient Experience, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Andrea DeIure
- Applied Research & Patient Experience, Supportive Care Services and Patient Experience, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Lindsi Chmielewski
- Applied Research & Patient Experience, Supportive Care Services and Patient Experience, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - April Hildebrand
- Applied Research & Patient Experience, Supportive Care Services and Patient Experience, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Lisa Barbera
- Tom Baker Cancer Centre, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Silbermann R, Laubach J, Kaufman JL, Sborov DW, Reeves B, Rodriguez C, Chari A, Costa LJ, Anderson LD, Nathwani N, Shah N, Bumma N, Holstein SA, Costello C, Jakubowiak A, Orlowski RZ, Shain KH, Cowan AJ, Gries KS, Pei H, Cortoos A, Patel S, Lin TS, Voorhees PM, Usmani SZ, Richardson PG. Health-related quality of life in transplant-eligible patients with newly diagnosed multiple myeloma treated with daratumumab, lenalidomide, bortezomib, and dexamethasone: Patient-reported outcomes from GRIFFIN. Am J Hematol 2024; 99:1257-1268. [PMID: 38622840 DOI: 10.1002/ajh.27326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/07/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024]
Abstract
In the phase 2 GRIFFIN trial (ClinicalTrials.gov identifier: NCT02874742), daratumumab added to lenalidomide, bortezomib, and dexamethasone (D-RVd) improved depth of response and progression-free survival (PFS) versus lenalidomide, bortezomib, and dexamethasone (RVd) alone in transplant-eligible (TE) patients with newly diagnosed multiple myeloma (NDMM). Here, we present patient-reported outcomes (PROs) collected using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30-item (QLQ-C30), EORTC Quality of Life Questionnaire Multiple Myeloma Module 20-item (QLQ-MY20), and EuroQol 5-Dimension 5-Level (EQ-5D-5L) tools on day 1 of cycles 1, 2, and 3; on day 21 of cycle 4 (end of induction therapy); on day 1 of cycle 5; on day 21 of cycle 6 (end of posttransplant consolidation therapy); and at months 6, 12, 18, and 24 of maintenance therapy. Meaningful improvements from baseline were seen in most of the PRO scales with both treatments after consolidation and were sustained for at least 2 years of maintenance treatment. Large reductions from baseline (~20 points) were especially observed in pain symptoms for both treatment groups, although these were numerically higher for patients receiving D-RVd during the majority of the time points. In addition, improvements in key scales, such as global health status, fatigue symptoms, and physical functioning, were also seen with both D-RVd and RVd. These improvements in health-related quality of life contribute to the totality of evidence supporting the improvement in clinical outcomes such as response rates and PFS with D-RVd in induction, consolidation, and maintenance therapy in TE patients with NDMM.
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Affiliation(s)
- Rebecca Silbermann
- Division of Hematology/Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Jacob Laubach
- Department of Medical Oncology, Dana-Farber/Partners Cancer Care, Boston, Massachusetts, USA
| | - Jonathan L Kaufman
- Department of Mematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Douglas W Sborov
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Brandi Reeves
- Division of Hematology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cesar Rodriguez
- Department of Hematology and Medical Oncology, Mount Sinai School of Medicine, New York, New York, USA
| | - Ajai Chari
- Department of Hematology and Medical Oncology, Mount Sinai School of Medicine, New York, New York, USA
| | - Luciano J Costa
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Larry D Anderson
- Division of Hematology/Oncology, Simmons Comprehensive Cancer Center, UT Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nitya Nathwani
- Division of Myeloma, Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Nina Shah
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Naresh Bumma
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Sarah A Holstein
- Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Caitlin Costello
- Division of Blood and Marrow Transplantation, Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Andrzej Jakubowiak
- Medicine- Hematology and Oncology, University of Chicago, Chicago, Illinois, USA
| | - Robert Z Orlowski
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kenneth H Shain
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Andrew J Cowan
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Huiling Pei
- Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | | | - Sharmila Patel
- Janssen Scientific Affairs, LLC, Horsham, Pennsylvania, USA
| | - Thomas S Lin
- Janssen Scientific Affairs, LLC, Horsham, Pennsylvania, USA
| | - Peter M Voorhees
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health/Wake Forest University School of Medicine, Charlotte, North Carolina, USA
| | - Saad Z Usmani
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Paul G Richardson
- Department of Medical Oncology, Dana-Farber/Partners Cancer Care, Boston, Massachusetts, USA
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11
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Bogor S, Niknam K, Less J, Andaya V, Swarup I. Automating Patient-reported Data Collection: Does it Work? J Pediatr Orthop 2024; 44:402-406. [PMID: 38606646 DOI: 10.1097/bpo.0000000000002678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
OBJECTIVE There are several electronic patient-reported outcomes (ePROs) vendors that are being used at institutions to automate data collection. However, there is little known about their success in collecting patient-reported outcomes (PROs) and it is unknown which patients are more likely to complete these surveys. In this study, we assessed rates of PRO completion, as well as determined factors that contributed to the completion of baseline and follow-up surveys. METHODS We queried our ePRO platform to assess rates of completion for baseline and follow-up surveys for patients from October 2019 to June 2022. All baseline surveys were administered before pediatric orthopaedic procedures, and follow-up surveys were sent at 3 months, 6 months, 1 year, and 2 years after surgery to patients with baseline data. Descriptive statistics were used to summarize the data. Univariate and multivariate analyses were performed to assess differences in patients who did and did not complete surveys. RESULTS This study included 1313 patients during the study period. Baseline surveys were completed by 66% of the cohort (n = 873 patients). There was a significant difference in race/ethnicity and language spoken in the patients who did and did not complete baseline surveys ( P < 0.01) with lower rates of completion in African American, Hispanic, and Spanish-speaking patients. At least one follow-up was obtained for 68% of patients with baseline surveys (n = 597 patients). There were significant differences in completion rates based on race/ethnicity ( P = 0.03) and language spoken ( P = 0.01). There were lower rates of baseline completion for patients with government insurance in our multivariate analysis (odds ratio: 0.6, P < 0.01). CONCLUSION Baseline and follow-up PRO data can be obtained from the majority of patients using automated ePRO platforms. However, additional focus is needed on collecting data from traditionally underrepresented patient groups to better understand outcomes in these patient populations. LEVEL OF EVIDENCE Level III-retrospective cohort study.
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Affiliation(s)
- Sayah Bogor
- School of Medicine, University of California, San Francisco, CA
| | - Kian Niknam
- School of Medicine, University of California, San Francisco, CA
| | - Justin Less
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Veronica Andaya
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Ishaan Swarup
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
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Kobayashi T, Igusa T, Uchida H, Tsuchiya K, Akiba T, Takahashi T, Taguchi M, Okada C, Yabuki H, Kanazawa Y, Kikuchi S, Hirao K. Reliability of the Two-dimensional Mood Scale for self-reported mood assessment by older adults with dementia. Geriatr Nurs 2024; 58:459-465. [PMID: 38941790 DOI: 10.1016/j.gerinurse.2024.06.016] [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: 03/15/2024] [Revised: 06/04/2024] [Accepted: 06/21/2024] [Indexed: 06/30/2024]
Abstract
The purpose of this study was to evaluate the reliability of the Two-dimensional Mood Scale (TDMS) for mood assessment among older adults with dementia. The study included 100 elderly patients with dementia admitted to two hospitals. For each mood state measured by the TDMS, the intraclass correlation coefficient of agreement (ICCagreement) was calculated to evaluate test-retest reliability. Scores corresponding to the minimal detectable change (MDC) in each mood state at the individual level (MDCind) was also calculated to evaluate measurement error, while McDonald's omega was calculated to evaluate internal consistency. The TDMS ICC was 0.54 for vitality, 0.74 for stability, 0.70 for pleasure, and 0.55 for arousal. The MDCind was 6.89 for vitality, 5.88 for stability, 9.96 for pleasure, and 4.11 for arousal. McDonald's omega ranged from 0.60 to 0.84. The TDMS has generally acceptable reliability for the self-assessment of mood states by older adults with dementia.
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Affiliation(s)
- Takuya Kobayashi
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan; Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Takumi Igusa
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan; Department of Rehabilitation, Medical Corporation Taiseikai, Uchida Hospital, Numata, Japan
| | - Hiroyuki Uchida
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan; Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Kenji Tsuchiya
- Department of Rehabilitation, Faculty of Health Sciences, Nagano University of Health and Medicine, Nagano, Japan
| | - Takanari Akiba
- Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Tsuyoshi Takahashi
- Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Maya Taguchi
- Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Chihiro Okada
- Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Hasumi Yabuki
- Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Yukina Kanazawa
- Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Senichiro Kikuchi
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
| | - Kazuki Hirao
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan.
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13
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An X, Xue C, Chen M, Ni M, Ma H, Tian L, Huang R, Li X, Ye Y, Qin T, Dong P, Li Z, Peng J, Yao K, Zhou F, Liu Z, Shi Y. Gemcitabine/nab-paclitaxel vs gemcitabine/carboplatin for advanced urothelial carcinoma. BJU Int 2024; 134:63-71. [PMID: 38009394 DOI: 10.1111/bju.16241] [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] [Indexed: 11/28/2023]
Abstract
OBJECTIVE To compare in a phase III trial the efficacy and safety of nanoparticle albumin-bound (nab)-paclitaxel plus gemcitabine (GA) with that of carboplatin plus gemcitabine (GCb) as a first-line treatment for patients with cisplatin-ineligible metastatic urothelial cancer (mUC). PATIENTS AND METHODS Treatment-naive, cisplatin-ineligible patients with mUC were assigned randomly to either the GA (both nab-paclitaxel 125 mg/m2 and gemcitabine 1000 mg/m2 on Days 1 and 8, every 21 days) or GCb group (carboplatin area under the free carboplatin plasma concentration versus time curve of 4.5 on Day 1, gemcitabine 1000 mg/m2 on Days 1 and 8, every 21 days). The primary endpoint was progression-free survival (PFS). Secondary endpoints included objective response rate (ORR), disease control rate (DCR), overall survival (OS), safety, and patient-reported outcomes (PROs). RESULTS The trial was terminated early because of slow accrual after 54 patients were enrolled: 26 in in the GA group and 28 in the GCb groups. The median PFS was 6.7 vs 5.9 months for the GA and GCb groups, respectively (P = 0.248). The median OS time was 12.1 vs 10.7 months for the GA and GCb groups, respectively (P = 0.837). The ORR and DCR were 40% vs 46.4% (P = 0.637) and 72% vs 68% (P = 0.188) in the GA and GCb groups, respectively. Patients treated with GA showed significantly lower incidence of Grade 3-4 thrombocytopenia and does reduction and delay. Although peripheral sensory neuropathy was higher in the GA arm, no Grade 3 neuropathy occurred. There was no difference in the PROs between the two groups. CONCLUSION While not powered for comparison, first-line GA showed similar efficacy and better tolerability and might be considered a rational alternative to GCb.
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Affiliation(s)
- Xin An
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Cong Xue
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Meiting Chen
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Mengqian Ni
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Huali Ma
- Department of Radiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Li Tian
- Department of Radiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Riqing Huang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiangdong Li
- Department of Urology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yunlin Ye
- Department of Urology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Tao Qin
- Department of Medical Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Pei Dong
- Department of Urology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhiyong Li
- Department of Urology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jing Peng
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Kai Yao
- Department of Urology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Fangjian Zhou
- Department of Urology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhuowei Liu
- Department of Urology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yanxia Shi
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
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14
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Bonini M, Barbaglia S, Camiciottoli G, Del Giacco S, Di Marco F, Matucci A, Micheletto C, Papi A, Pasqualetti P, Pelaia G, Ricciardolo FLM, Rogliani P, Senna G, Triggiani M, Vancheri C, Canonica GW. Asthma remission one, none and one-hundred thousand: the relevance of the patient's view. J Asthma 2024:1-10. [PMID: 38870405 DOI: 10.1080/02770903.2024.2366523] [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: 04/29/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE Achieving remission in severe asthma holds paramount importance in elevating patient quality of life and reducing both individual and societal burdens associated with this chronic condition. This study centers on identifying pivotal patient-relevant endpoints through standardized, reproducible methods, while also developing a patient-centric definition of remission, essential for effective disease management. METHODS A discrete choice experiment (DCE) was conducted to assess patients' perceptions on the four primary criteria for defining severe asthma remission, as outlined by the SANI survey. Additionally, it investigated the correlation between these perceptions and improvements in the doctor-patient therapeutic alliance during treatment decision-making. RESULTS 249 patients (70% aged between 31-60, 59% women and 82% without other pathologies requiring corticosteroids) prioritize the use of oral corticosteroids (OCS, 48%) and the Asthma Control Test (ACT, 27%) in defining their condition, ranking these above lung function and exacerbations. This preference for OCS stems from its direct role in treatment, tangible tracking, immediate symptom relief, and being a concrete measure of disease severity compared to the less predictable and quantifiable exacerbations. CONCLUSIONS This study explores severe asthma remission from patients' perspectives using clinician-evaluated parameters. The DCE revealed that most patients highly value OCS and the ACT, prefer moderate improvement, and avoid cortisone cycles. No definitive preference was found for lung function status. Integrating patient-reported information with professional insights is crucial for effective management and future research. Personalized treatment plans focusing on patient preferences, adherence, and alternative therapies aim to achieve remission and enhance quality of life.
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Affiliation(s)
- Matteo Bonini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | | | - Gianna Camiciottoli
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence - Severe Asthma Unit, Careggi University Hospital, Florence, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Fabiano Di Marco
- Department of Health Sciences, University of Milan, Milan, and Respiratory Disease Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Andrea Matucci
- Immunoallergology Unit, Careggi University Hospital, Florence, Italy
| | | | - Alberto Papi
- Department of Respiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Patrizio Pasqualetti
- Section of Health Statistics and Biometry, Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Fabio Luigi Massimo Ricciardolo
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, The University of Rome 'Tor Vergata', Rome, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona, and Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Disease, University Hospital "Policlinico San Marco", Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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15
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Löffeler S, Bertilsson H, Müller C, Aas K, Haugnes HS, Aksnessæther B, Pesonen M, Thon K, Tandstad T, Murtola T, Poulsen MH, Nordstrøm T, Vigmostad MN, Ottosson F, Holmsten K, Christiansen O, Slaaen M, Haug ES, Storås AH, Asphaug L, Rannikko A, Brasso K. Protocol of a randomised, controlled trial comparing immediate curative therapy with conservative treatment in men aged ≥75 years with non-metastatic high-risk prostate cancer (SPCG 19/GRand-P). BJU Int 2024; 133:680-689. [PMID: 38469686 DOI: 10.1111/bju.16314] [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] [Indexed: 03/13/2024]
Abstract
BACKGROUND Older men (aged ≥75 years) with high risk, non-metastatic prostate cancer (PCa) are increasingly treated with curative therapy (surgery or radiotherapy). However, it is unclear if curative therapy prolongs life and improves health-related quality of life (HRQoL) in this age group compared to conservative therapy, which has evolved considerably during the last decade. STUDY DESIGN The Scandinavian Prostate Cancer Group (SPCG) 19/Norwegian Get-Randomized Research Group-Prostate (GRand-P) is a randomised, two-armed, controlled, multicentre, phase III trial carried out at study centres in Norway, Denmark, Finland, and Sweden. ENDPOINTS The primary endpoints are overall survival and HRQoL (burden of disease scale, European Organisation for the Research and Treatment of Cancer [EORTC] Elderly Cancer patients). Secondary endpoints are PCa-specific survival, metastasis-free survival, role-functioning scale (EORTC quality of life questionnaire 30-item core), urinary irritative/obstructive scale (26-item Expanded Prostate Cancer Index Composite [EPIC-26]), bowel scale (EPIC-26), intervention-free survival, PCa morbidity, use of secondary and tertiary systemic therapies, mean quality-adjusted life-years (QALYs), and mean total healthcare costs. PATIENTS AND METHODS A total of 980 men (aged ≥75 years) with non-metastatic, high-risk PCa will initially be screened with Geriatric 8 (G8) health status screening tool and Mini-COG© brief cognitive test. Participants identified by G8 as 'fit' or 'frail' will be randomised (ratio 1:1) to either immediate curative therapy (radiotherapy or prostatectomy) or conservative therapy (endocrine therapy or observation). Participants who are unable or unwilling to participate in randomisation will be enrolled in a separate observation group. Randomised patients will be followed for 10 years. TRIAL REGISTRATION Ethics approval has been granted in Norway (457593), Denmark (H-22051998), Finland (R23043) and Sweden (Dnr 2023-05296-01). The trial is registered on Clinicaltrials.org (NCT05448547).
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Affiliation(s)
- Sven Löffeler
- Department of Urology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Helena Bertilsson
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Urology, St. Olav's University Hospital, Trondheim, Norway
| | - Christoph Müller
- Department of Oncology, Sørlandet Hospital Trust, Kristiansand, Norway
| | - Kirsti Aas
- Department of Urology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hege Sagstuen Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, The Arctic University of Norway (UIT), Tromsø, Norway
| | | | - Maiju Pesonen
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Kristian Thon
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Torgrim Tandstad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Oncology, The Cancer Clinic, St Olav's University Hospital, Trondheim, Norway
| | - Teemu Murtola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Mads Hvid Poulsen
- Department of Urology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tobias Nordstrøm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Karin Holmsten
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Capio St. Göran Hospital, Stockholm, Sweden
| | | | - Marit Slaaen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | | | | | - Lars Asphaug
- Institute of Health and Society, University of Oslo, Oslo, Norway
- Clinical Trials Unit, Oslo University Hospital, Oslo, Norway
| | - Antti Rannikko
- Department of Urology and Research Program in Systems Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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16
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Drury A, Boland V, Dowling M. Patient-Reported Outcome and Experience Measures in Advanced Nursing Practice: What Are Key Considerations for Implementation and Optimized Use? Semin Oncol Nurs 2024; 40:151632. [PMID: 38658204 DOI: 10.1016/j.soncn.2024.151632] [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: 01/28/2024] [Revised: 03/10/2024] [Accepted: 03/17/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To discuss the opportunities and challenges of implementing patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) within advanced practice nursing services in cancer care. METHODS This discussion paper has been informed by an environmental scan of evidence from systematic reviews and primary studies evaluating the use and implementation of PROMs and PREMs. Literature from the contexts of cancer and chronic disease, including nursing and multidisciplinary supportive care literature, has been included. RESULTS Advanced practice nurses are well-positioned to evaluate and respond to PROMs and PREMs data; several studies have highlighted improved patient outcomes concerning quality of life, symptom distress, and functional status within nurse-led services. Nevertheless, the implementation of PROMs and PREMs in cancer care and nurse-led services is variable. Previous studies have highlighted implementation challenges, which can hinder comparability and generalizability of PROMs and PREMs instruments. Advanced practice nurses should consider these challenges, including ways to use standardized PROM instruments. Electronic PROMs, while efficient, may exclude individuals at risk of inequity. Complex, lengthy, and frequent administration of PROMs may also overburden people living with or after cancer, with people affected by cancer expressing preference for flexible use in some studies. Therefore, the involvement of people affected by cancer in planning for PROMs/PREMs implementation may overcome this challenge. Finally, organizational considerations in implementation should address financial investments, including initial costs for technology and training and consideration of the operationalization of PROMs within existing infrastructure for the seamless utilization of PROMs data. CONCLUSION Despite the potential of advanced practice nursing services to enhance patient-reported outcomes and experiences, variability in the implementation of PROMs and PREMs poses challenges. Use of validated measures, electronic or paper-based instruments, and the preferences of people affected by cancer for the use of PROMs and PREMs must be carefully considered in consultation with end users for successful implementation. IMPLICATIONS FOR PRACTICE In planning for the implementation of PROMs and PREMs within nurse-led services, implementation risks may be mitigated through establishing clear guidelines for their use, investment in the development of the required infrastructure, user education, and rigorous implementation processes, including patient involvement in PROMs/PREMs selection.
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Affiliation(s)
- Amanda Drury
- Associate Professor in General Nursing, School of Nursing, Psychotherapy and Community Health, Dublin City University, Glasnevin, Dublin, Ireland.
| | - Vanessa Boland
- Assistant Professor in General Nursing, School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Maura Dowling
- Associate Professor, School of Nursing and Midwifery, University of Galway, Ireland
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Martínez-Moragón E, Antepara Ercoreca I, Muñoz García M, Casas Maldonado F, Calvín Lamas M, Chiner Vives E, Crespo Diz C, Díaz-Pérez D, Eguiluz Gracia I, García Gil S, González-Pérez R, Habernau Mena A, Hermida Valverde T, Jornet Montaña S, López-Carrasco V, Martínez López I, Merino-Bohórquez V, Moreno-Ancillo Á, Mínguez Cabeza AC, Monte-Boquet E, Revuelta-Herrero JL, Sánchez-Cuellar S. Patient-reported outcome measures in severe asthma: an expert consensus. J Asthma 2024; 61:619-631. [PMID: 38146964 DOI: 10.1080/02770903.2023.2297372] [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: 10/16/2023] [Accepted: 12/16/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE The study aimed to reach a consensus on the most relevant patient-reported outcomes (PROs), the corresponding measures (PROMs), and measurement frequency during severe asthma patient follow-up. METHODS Two Delphi rounds were conducted. The questionnaire was developed based on a systematic literature review, a focus group with patients, and a nominal group with experts. It assessed PROs' relevance and the appropriateness (A) and feasibility (F) of PROMs using a Likert scale (1=totally agree; 9=totally disagree). The consensus was established when ≥75% of participants agreed (1-3) or disagreed (7-9). RESULTS Sixty-three professionals (25 hospital pharmacists, 14 allergists, 13 pulmonologists, and 11 nurses) and 5 patients answered the Delphi questionnaire. A consensus was reached on all PROs regarding their relevance. Experts agreed on the use of ACT (A:95.24%; F:95.24%), mini AQLQ (A:93.65; F:79.37%), mMRC dyspnea scale (A:85.71%; F:85.71%), TAI (A:92.06%; F:85.71%), MMAS (A:75.40%; F:82%), and the dispensing register (A:96.83%; F:92.06%). Also considered suitable were: SNOT-22 (A:90.48%; F:73.80%), PSQI (A:82.54; F:63.90%), HADS (A:82.54; F:64%), WPAI (A:77.78%; F:49.20%), TSQM-9 (A:79.37; F:70.50%) and knowledge of asthma questionnaire (A:77%; F:68.80%); however, their use in clinical practice was considered unfeasible. Panelists also agreed on the appropriateness of EQ-5D, which was finally included despite being considered unfeasible (A: 84.13%; F:67.20%) in clinical practice. Agreement was reached on using ACT, TAI, mMRC, and a dispensing register every three months; mini-AQLQ and MMAS every six months; and EQ-5D every twelve months. CONCLUSION This consensus paves the way toward patient-centered care, promoting the development of strategies supporting routine assessment of PROs in severe asthma management.
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Affiliation(s)
| | | | - María Muñoz García
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | | | - Marta Calvín Lamas
- Servicio de Farmacia, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Eusebi Chiner Vives
- Servicio de Neumología, Hospital Universitario San Juan de Alicante, Alicante, Spain
| | - Carlos Crespo Diz
- Servicio de Farmacia, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - David Díaz-Pérez
- Servicio de Neumología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Ibon Eguiluz Gracia
- Servicio de Alergología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Sara García Gil
- Servicio de Farmacia, Hospital Universitario de Canarias, La Laguna, Spain
| | | | | | | | | | | | - Icíar Martínez López
- Servicio de Farmacia, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | - Álvaro Moreno-Ancillo
- Servicio de Alergología, Hospital General Nuestra Señora del Prado, Talavera de la Reina, Spain
| | | | - Emilio Monte-Boquet
- Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Lai-Kwon J, Thorner E, Rutherford C, Crossnohere N, Brundage M. Integrating Patient-Reported Outcomes Into the Care of People With Advanced Cancer-A Practical Guide. Am Soc Clin Oncol Educ Book 2024; 44:e438512. [PMID: 38788184 DOI: 10.1200/edbk_438512] [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: 05/26/2024]
Abstract
Patient-reported outcomes (PROs) are being increasingly integrated into routine clinical practice to enhance individual patient care. This has been driven by recognition of the benefits of PROs in enhancing symptom management, patient satisfaction, quality of life, and overall survival, and reductions in acute health care utilization. These benefits are reflected in the emergence of value-based health care initiatives incorporating PRO symptom monitoring such as the Enhancing Oncology Model in the United States. However, implementing PROs can be challenging and it can be difficult to know where to begin to select appropriate PROs, and effectively display and appropriately interpret PRO data. This manuscript summarizes an educational session at the 2024 ASCO Annual Meeting, which provided practical guidance to clinicians seeking to incorporate PROs into the care of people with advanced cancer. We focus on why it is important to collect PROs in routine care from a patient's perspective, how to select PROs for symptom monitoring (including using static patient-reported outcome measures and newer item libraries), and highlight key pearls and pitfalls in the display and interpretation of PROs. We highlight the breadth of existing resources available to guide clinicians in PRO implementation.
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Affiliation(s)
- Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Claudia Rutherford
- Sydney Quality of Life Office, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Michael Brundage
- Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
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Dickstein DR, Edwards CR, Rowan CR, Avanessian B, Chubak BM, Wheldon CW, Simoes PK, Buckstein MH, Keefer LA, Safer JD, Sigel K, Goodman KA, Rosser BRS, Goldstone SE, Wong SY, Marshall DC. Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus. Nat Rev Gastroenterol Hepatol 2024; 21:377-405. [PMID: 38763974 DOI: 10.1038/s41575-024-00932-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/21/2024]
Abstract
The ability to experience pleasurable sexual activity is important for human health. Receptive anal intercourse (RAI) is a common, though frequently stigmatized, pleasurable sexual activity. Little is known about how diseases of the colon, rectum, and anus and their treatments affect RAI. Engaging in RAI with gastrointestinal disease can be difficult due to the unpredictability of symptoms and treatment-related toxic effects. Patients might experience sphincter hypertonicity, gastrointestinal symptom-specific anxiety, altered pelvic blood flow from structural disorders, decreased sensation from cancer-directed therapies or body image issues from stoma creation. These can result in problematic RAI - encompassing anodyspareunia (painful RAI), arousal dysfunction, orgasm dysfunction and decreased sexual desire. Therapeutic strategies for problematic RAI in patients living with gastrointestinal diseases and/or treatment-related dysfunction include pelvic floor muscle strengthening and stretching, psychological interventions, and restorative devices. Providing health-care professionals with a framework to discuss pleasurable RAI and diagnose problematic RAI can help improve patient outcomes. Normalizing RAI, affirming pleasure from RAI and acknowledging that the gastrointestinal system is involved in sexual pleasure, sexual function and sexual health will help transform the scientific paradigm of sexual health to one that is more just and equitable.
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Affiliation(s)
- Daniel R Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Collin R Edwards
- Department of Radiology, Vagelos College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Catherine R Rowan
- Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Bella Avanessian
- Center for Transgender Medicine and Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Barbara M Chubak
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher W Wheldon
- Department of Social and Behavioral Sciences, College of Public Health at Temple University, Philadelphia, PA, USA
| | - Priya K Simoes
- The Dr. Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael H Buckstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laurie A Keefer
- The Dr. Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua D Safer
- Center for Transgender Medicine and Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Endocrinology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Keith Sigel
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Karyn A Goodman
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - B R Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health at University of Minnesota, Minneapolis, MN, USA
| | - Stephen E Goldstone
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Serre-Yu Wong
- The Dr. Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Deborah C Marshall
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Eng L, Chan RJ, Chan A, Charalambous A, Darling HS, Grech L, van den Hurk CJG, Kirk D, Mitchell SA, Poprawski D, Rammant E, Ramsey I, Fitch MI, Cheung YT. Perceived Barriers Toward Patient-Reported Outcome Implementation in Cancer Care: An International Scoping Survey. JCO Oncol Pract 2024; 20:816-826. [PMID: 38457755 DOI: 10.1200/op.23.00715] [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: 11/05/2023] [Revised: 12/15/2023] [Accepted: 01/24/2024] [Indexed: 03/10/2024] Open
Abstract
PURPOSE Implementation of patient-reported outcomes (PROs) collection is an important priority in cancer care. We examined perceived barriers toward implementing PRO collection between centers with and without PRO infrastructure and administrators and nonadministrators. PATIENTS AND METHODS We performed a multinational survey of oncology practitioners on their perceived barriers to PRO implementations. Multivariable regression models evaluated for differences in perceived barriers to PRO implementation between groups, adjusted for demographic and institutional variables. RESULTS Among 358 oncology practitioners representing six geographic regions, 31% worked at centers that did not have PRO infrastructure and 26% self-reported as administrators. Administrators were more likely to perceive concerns with liability issues (aOR, 2.00 [95% CI, 1.12 to 3.57]; P = .02) while having nonsignificant trend toward less likely perceiving concerns with disruption of workflow (aOR, 0.58 [95% CI, 0.32 to 1.03]; P = .06) and nonadherence of PRO reporting (aOR, 0.53 [95% CI, 0.26 to 1.08]; P = .08) as barriers. Respondents from centers without PRO infrastructure were more likely to perceive that not having access to a local PRO expert (aOR, 6.59 [95% CI, 3.81 to 11.42]; P < .001), being unsure how to apply PROs in clinical decisions (aOR, 4.20 [95% CI, 2.32 to 7.63]; P < .001), and being unsure about selecting PRO measures (aOR, 3.36 [95% CI, 2.00 to 5.66]; P < .001) as barriers. Heat map analyses identified the largest differences between participants from centers with and without PRO infrastructure in agreed-upon barriers were (1) not having a local PRO expert, (2) being unsure about selecting PRO measures, and (3) not recognizing the role of PROs at the institutional level. CONCLUSION Perceived barriers toward PRO implementation differ between administrators and nonadministrators and practitioners at centers with and without PRO infrastructure. PRO implementation teams should consider as part of a comprehensive strategy including frontline clinicians and administrators and members with PRO experience within teams.
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Affiliation(s)
- Lawson Eng
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, ON, Canada
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Alexandre Chan
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, CA
| | - Andreas Charalambous
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
- Department of Nursing, University of Turku, Turku, Finland
| | - H S Darling
- Department of Medical Oncology, Command Hospital Air Force, Bangalore, India
| | - Lisa Grech
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Medicine Monash Health, Monash University, Melbourne, VIC, Australia
| | | | - Deborah Kirk
- School of Nursing and Midwifery, Edith Cowan University, Bunbury, WA, Australia
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
| | - Sandra A Mitchell
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Dagmara Poprawski
- Department of Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Elke Rammant
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Imogen Ramsey
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
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Günther M, Schuler M, Hentschel L, Salm H, Schmitz MT, Jaehde U. Medication Risks and Their Association with Patient-Reported Outcomes in Inpatients with Cancer. Cancers (Basel) 2024; 16:2110. [PMID: 38893228 PMCID: PMC11171248 DOI: 10.3390/cancers16112110] [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: 04/28/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND We aimed to assess medication risks and determine factors influencing the health-related quality of life (HRQOL) in cancer inpatients. METHODS A retrospective analysis was conducted to identify drug-related problems (DRPs) based on medication reviews, including patient-reported outcomes (PROs). Multiple linear regression analyses were performed to identify sociodemographic, disease-related, and drug therapy-related factors influencing changes from hospital admission to discharge in the scales of the EORTC QLQ-C30 questionnaire. RESULTS A total of 162 inpatients with various hematological and solid cancer diseases was analyzed. Patients received a mean of 11.6 drugs and 92.6% of patients exhibited polymedication resulting in a mean of 4.0 DRPs per patient. Based on PRO data, 21.5% of DRPs were identified. Multiple linear regression models described the variance of the changes in global HRQOL and physical function in a weak-to-moderate way. While drug therapy-related factors had no influence, relapse status and duration of hospital stay were identified as significant covariates for global HRQOL and physical function, respectively. CONCLUSION This analysis describes underlying DRPs in a German cancer inpatient population. PROs provided valuable information for performing medication reviews. The multiple linear regression models for global HRQOL and physical function provided explanations for changes during hospital stay.
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Affiliation(s)
- Maximilian Günther
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Bonn, 53121 Bonn, Germany;
| | - Markus Schuler
- Onkologischer Schwerpunkt am Oskar-Helene-Heim, 14195 Berlin, Germany;
- Division of Hematology, Oncology and Stem Cell Transplantation, Medical Clinic I, Department of Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, 01307 Dresden, Germany;
| | - Leopold Hentschel
- Division of Hematology, Oncology and Stem Cell Transplantation, Medical Clinic I, Department of Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, 01307 Dresden, Germany;
| | - Hanna Salm
- Klinik und Poliklinik für Innere Medizin C, Universitätsmedizin Greifswald, 17489 Greifswald, Germany;
- Sarcoma Center Berlin-Brandenburg, Helios Hospital Bad Saarow, 15526 Bad Saarow, Germany
| | - Marie-Therese Schmitz
- Institute of Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, 53127 Bonn, Germany;
| | - Ulrich Jaehde
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Bonn, 53121 Bonn, Germany;
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Srinivasan R, Rodgers-Melnick SN, Rivard RL, Kaiser C, Vincent D, Adan F, Dusek JA. Implementing paper-based patient-reported outcome collection within outpatient integrative health and medicine. PLoS One 2024; 19:e0303985. [PMID: 38809886 PMCID: PMC11135778 DOI: 10.1371/journal.pone.0303985] [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: 01/28/2024] [Accepted: 05/04/2024] [Indexed: 05/31/2024] Open
Abstract
OBJECTIVE To investigate the feasibility of pre- and post-encounter patient-reported outcome (PRO) measure collection within an outpatient integrative health and medicine (IHM) clinic and to characterize factors associated with successful completion. METHODS We conducted a retrospective review of 27,464 outpatient IHM encounters including 9,520 chiropractic; 8,237 acupuncture; 5,847 massage; 2,345 IHM consultation; and 1,515 osteopathic manipulation treatment encounters at four clinics offering IHM over 18 months. Patients were asked to complete paper questionnaires rating pain, anxiety, and stress from 0-10 immediately pre- and post-encounter. Generalized linear mixed effect regression models were used to examine the relationship between demographic, clinical, and operational covariates and completing (1) pre-encounter and (2) paired (i.e., pre and post) PROs. RESULTS Patients (N = 5587, mean age 49 years, 74% white, 77% female) generally presented for musculoskeletal conditions (81.7%), with a chief complaint of pain (55.1%). 21,852 (79.6%) encounters were among patients who completed pre-encounter PROs; 11,709/21,852 (53.6%) completed subsequent post-encounter PROs. Odds of PRO completion were more impacted by provider, operational, and clinical-level factors than patient factors. Covariates associated with increased odds of pre-encounter PRO completion included being female, having additional IHM encounters, and having a pain or anxiety complaint. Covariates associated with increased odds of paired PRO completion included being aged 31-40 vs. 51-60 years and having additional IHM encounters. CONCLUSION Implementing a paper-based PRO collection system in outpatient IHM is feasible; however, collecting post-encounter PROs was challenging. Future endeavors should leverage the electronic health record and patient portals to optimize PRO collection and engage patients and clinical providers.
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Affiliation(s)
- Roshini Srinivasan
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States of America
- Duke University School of Medicine, Durham, NC, United States of America
| | - Samuel N. Rodgers-Melnick
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States of America
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Rachael L. Rivard
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States of America
- Center for Evaluation Survey and Research, HealthPartners Institute, Minneapolis, MN, United States of America
| | - Christine Kaiser
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States of America
| | - David Vincent
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States of America
| | - Francoise Adan
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States of America
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Jeffery A. Dusek
- Susan Samueli Integrative Health Institute, University of California Irvine, Irvine, CA, United States of America
- Department of Medicine, University of California Irvine, Irvine, CA, United States of America
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Sandhu AT, Calma J, Skye M, Kalwani N, Zheng J, Schirmer J, Din N, Brown Johnson C, Gupta A, Lan R, Yu B, Spertus JA, Heidenreich PA. Clinical Impact of Routine Assessment of Patient-Reported Health Status in Heart Failure Clinic: The PRO-HF Trial. Circulation 2024; 149:1717-1728. [PMID: 38583147 DOI: 10.1161/circulationaha.124.069624] [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: 03/13/2024] [Accepted: 03/29/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND The impact of routine clinic use of patient-reported outcome (PRO) measures on clinical outcomes in patients with heart failure (HF) has not been well-characterized. We tested if clinic-based use of a disease-specific PRO improves patient-reported quality of life at 1 year. METHODS The PRO-HF trial (Patient-Reported Outcome Measurement in Heart Failure Clinic) was an open-label, parallel, patient-level randomized clinical trial of routine PRO assessment or usual care at an academic HF clinic between August 30, 2021, and June 30, 2022, with 1 year of follow-up. In the PRO assessment arm, participants completed the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) at each HF clinic visit, and results were shared with their treating clinician. The usual care arm completed the KCCQ-12 at randomization and 1 year later, which was not shared with the treating clinician. The primary outcome was the KCCQ-12 overall summary score (OSS) between 12 and 15 months after randomization. Secondary outcomes included domains of the KCCQ-12, hospitalization and emergency department visit rates, HF medication therapy, clinic visit frequency, and testing rates. RESULTS Across 17 clinicians, 1248 participants were enrolled and randomized to PRO assessment (n=624) or usual care (n=624). The median age was 63.9 years (interquartile range [IQR], 51.8-72.8), 38.9% were women, and the median baseline KCCQ-12 OSS was 82.3 (IQR, 58.3-94.8). Final KCCQ-12 (available in 87.9% of the PRO arm and 85.1% in usual care; P=0.16) median OSS were 87.5 (IQR, 68.8-96.9) in the PRO arm and 87.6 (IQR, 69.7-96.9) in the usual care arm with a baseline-adjusted mean difference of 0.2 ([95% CI, -1.7 to 2.0]; P=0.85). The results were consistent across prespecified subgroups. A post hoc analysis demonstrated a significant interaction with greater benefit among participants with a baseline KCCQ-12 OSS of 60 to 80 but not in less or more symptomatic participants. No significant differences were found in 1-year mortality, hospitalizations, emergency department visits, medication therapy, clinic follow-up, or testing rates between arms. CONCLUSIONS Routine PRO assessment in HF clinic visits did not impact patient-reported quality of life or other clinical outcomes. Alternate strategies and settings for embedding PROs into routine clinical care should be tested. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04164004.
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Affiliation(s)
- Alexander T Sandhu
- Division of Cardiovascular Medicine (A.T.S., J.C., M.S., N.K., J.S., P.A.H.), Stanford University, CA
- Stanford Prevention Research Center (A.T.S.), Stanford University, CA
- Palo Alto Veteran's Affairs Healthcare System, CA (A.T.S., M.S., N.K., N.D., P.A.H.)
| | - Jamie Calma
- Division of Cardiovascular Medicine (A.T.S., J.C., M.S., N.K., J.S., P.A.H.), Stanford University, CA
| | - Megan Skye
- Division of Cardiovascular Medicine (A.T.S., J.C., M.S., N.K., J.S., P.A.H.), Stanford University, CA
- Palo Alto Veteran's Affairs Healthcare System, CA (A.T.S., M.S., N.K., N.D., P.A.H.)
| | - Neil Kalwani
- Division of Cardiovascular Medicine (A.T.S., J.C., M.S., N.K., J.S., P.A.H.), Stanford University, CA
- Palo Alto Veteran's Affairs Healthcare System, CA (A.T.S., M.S., N.K., N.D., P.A.H.)
| | - Jimmy Zheng
- Department of Medicine (J.Z., C.B.J., A.G., R.L., B.Y.), Stanford University, CA
| | - Jessica Schirmer
- Division of Cardiovascular Medicine (A.T.S., J.C., M.S., N.K., J.S., P.A.H.), Stanford University, CA
| | - Natasha Din
- Palo Alto Veteran's Affairs Healthcare System, CA (A.T.S., M.S., N.K., N.D., P.A.H.)
| | - Cati Brown Johnson
- Department of Medicine (J.Z., C.B.J., A.G., R.L., B.Y.), Stanford University, CA
| | - Anshal Gupta
- Department of Medicine (J.Z., C.B.J., A.G., R.L., B.Y.), Stanford University, CA
| | - Roy Lan
- Department of Medicine (J.Z., C.B.J., A.G., R.L., B.Y.), Stanford University, CA
| | - Brian Yu
- Department of Medicine (J.Z., C.B.J., A.G., R.L., B.Y.), Stanford University, CA
| | - John A Spertus
- University of Missouri-Kansas City Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.)
| | - Paul A Heidenreich
- Division of Cardiovascular Medicine (A.T.S., J.C., M.S., N.K., J.S., P.A.H.), Stanford University, CA
- Palo Alto Veteran's Affairs Healthcare System, CA (A.T.S., M.S., N.K., N.D., P.A.H.)
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24
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Plath MM, Sand M, Gruchlik MP, Cavaliere C, Friauf S, Plinkert P, Plath K, Baumann I. [Short-term quality of life assessment after sinus surgery for chronic rhinosinusitis]. Laryngorhinootologie 2024. [PMID: 38754449 DOI: 10.1055/a-2306-2702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) has a negative impact on health-related quality of life (HRQoL). Functional endoscopic sinus surgery (FESS) is the treatment of choice for those not responding to medical treatments. To date, the short-term effects of FESS on HRQoL are still unclear. OBJECTIVE Evaluation of the short-term effects of FESS on HRQoL in CRS patients using the SNOT-22 questionnaire. METHODS The results of the validated German version of the Sino-Nasal Outcome Test-22 (SNOT-22) questionnaire were analysed from 89 patients with CRS before surgery and 10-14 days (n = 77), four (n = 77), six weeks (n = 76) and 6 months (n = 71) after FESS, and compared with those of 1,000 healthy controls selected using a non-probability quota sample in accordance to the distribution of the German Microcensus. RESULTS Compared to the preoperative mean SNOT-22 score (47.35), CRS patients significantly improved in HRQoL 10-14 days (31.75, p < 0.01), 4 weeks (25.84, p < 0.01), 6 weeks (24.16, p < 0.01) and 6 months after FESS (27.16, p < 0.01). Pre- and 6 months postoperatively, the five most important SNOT-22 items were nasal obstruction, smell and taste reduction, thick, mucous nasal secretions, need to blow the nose and postnasal drip. At the 2, 4 and 6-week follow-up, the reduction in smell and taste was most frequently perceived as limiting the HRQoL. CONCLUSIONS This follow-up study shows for the first time that the reduction in smell and taste should be treated and controlled concervatively in the short term after FESS.
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Affiliation(s)
| | - Matthias Sand
- GESIS, GESIS - Leibniz-Institut für Sozialwissenschaften in Mannheim, Mannheim, Germany
| | | | - Carlo Cavaliere
- Department of Sense Organs, University of Rome La Sapienza Faculty of Pharmacy and Medicine, Roma, Italy
| | - Sara Friauf
- Hals-Nasen-Ohrenklinik, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Peter Plinkert
- Haös-Nasen-Ohrenklinik, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Karim Plath
- Hals-Nasen-Ohrenklinik, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Ingo Baumann
- Hals-Nasen-Ohrenklinik, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
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25
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Fink M, Müller S, Warnecke E, Hense J, Schuler M, Teufel M, Comino MRS, Tewes M. Relevance of Patient-Reported Outcome Measures in Patients with Cancer: Detection of Underrated Psychological Distress of Palliative Care Patients in an Outpatient Setting. Palliat Med Rep 2024; 5:194-200. [PMID: 39050775 PMCID: PMC11265614 DOI: 10.1089/pmr.2023.0075] [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: 02/22/2024] [Indexed: 07/27/2024] Open
Abstract
Background The overall level of physical and psychological symptom burden of advanced cancer patients (ACP) in an outpatient setting is notoriously difficult to assess. Therefore, more efficient and objective assessment is needed to accomplish this important task. Objectives The aim of this study was to compare the physical and psychological symptom burden rated by palliative care nurse (PCN) versus patient's self-rating. Design This retrospective German cohort study analyzed symptom burden using an electronic patient-reported outcome measure (ePROM). After referral to an outpatient specialized palliative care team, a PCN assessed the patient's symptoms both up to three months before initial presentation (IP) and at IP.Group differences were identified using analyses of variance (ANOVA). Further descriptive analysis of patient characteristics was used. Subjects The study enrolled 164 ACP who were referred to a specialized palliative care (SPC) team. Mean age was 62 (± 12.6) years. Gastrointestinal (n = 46; 28.0%), lung (n = 32; 19.5%), and breast cancer (n = 34; 20.7%) were the most common entities. Results Most frequent reasons for referral were pain (n = 55; 33.5%) and social care problems (n = 36; 22.0%). Patients reported significantly higher grades on depression (n = 144; Z = -2.8, p = 0.005), anxiety (n = 144; Z = -2.376, p = 0.018), and worsened general condition (n = 139; Z = -7.005, p < 0.001). Conclusion ACP in an outpatient setting were more frequently referred to SPC for pain management and assistance with social problems with regard to the cancer and its limitations. Psychological distress was underrated by the PCN in comparison with patient self-reporting through ePROM. This underlines the importance of self-reported outcome measurement.
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Affiliation(s)
- Madeleine Fink
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Psycho-Oncology, West German Cancer Center, National Center for Tumor Diseases (NCT), Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Sandy Müller
- Department of Palliative Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Eva Warnecke
- Department of Palliative Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jörg Hense
- Department of Medical Oncology, West German Cancer Center Essen, University Hospital Essen, Essen, Germany
- National Center for Tumor Diseases (NCT) West, Essen, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center Essen, University Hospital Essen, Essen, Germany
- National Center for Tumor Diseases (NCT) West, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Psycho-Oncology, West German Cancer Center, National Center for Tumor Diseases (NCT), Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Maria Rosa Salvador Comino
- Department of Palliative Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Mitra Tewes
- Department of Palliative Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Abstract
SUMMARY As value-based care gains traction in response to towering health care expenditures and issues of health care inequity, hospital capacity, and labor shortages, it is important to consider how a value-based approach can be achieved in plastic surgery. Value is defined as outcomes divided by costs across entire cycles of care. Drawing on previous studies and policies, this article identifies key opportunities in plastic surgery to move the levers of costs and outcomes to deliver higher value care. Specifically, outcomes in plastic surgery should include conventional measures of complication rates and patient-reported outcome measures to drive quality improvement and benchmark payments. Meanwhile, cost reduction in plastic surgery can be achieved through value-based payment reform, efficient workflows, evidence-based and cost-conscious selection of medical devices, and greater use of outpatient surgical facilities. Lastly, the authors discuss how the diminished presence of third-party payers in aesthetic surgery exemplifies the cost-conscious and patient-centered nature of value-based plastic surgery. To lead in future health policy and care delivery reform, plastic surgeons should strive for high-value care, remain open to new ways of care delivery, and understand how plastic surgery fits into overall health care delivery.
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Affiliation(s)
| | | | - Thomas C Tsai
- Boston, MA
- From the Harvard Medical School
- Divisions of General and Gastrointestinal Surgery
- Plastic Surgery, Brigham and Women's Hospital
- Harvard T.H. Chan School of Public Health
| | - Justin M Broyles
- From the Harvard Medical School
- Plastic Surgery, Brigham and Women's Hospital
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27
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Oza S, Kramer A, Ying J, Cushman DM. The relationship between patient-reported and objective measures of physical function among cancer survivors receiving rehabilitation care: A correlation analysis. PM R 2024. [PMID: 38686779 DOI: 10.1002/pmrj.13182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 01/08/2024] [Accepted: 01/23/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Physical function is associated with cancer-related quality of life and survival. The correlation of patient-reported and objective measures of physical function has not been quantified previously in the cancer rehabilitation medicine setting. OBJECTIVE To correlate patient-reported physical function with objective measures of physical function. The secondary aim is to correlate fatigue and social participation levels with objective measures of physical function. DESIGN Retrospective. SETTING Tertiary university cancer center. PARTICIPANTS A total of 226 cancer survivors referred to an outpatient cancer rehabilitation medicine clinic. INTERVENTION Not applicable. MAIN OUTCOME MEASURE Correlation of Patient-Reported Outcomes Measurement Information System (PROMIS) Cancer Function Brief 3D Profile domains with objective physical function measured by the 30-second sit-to-stand and hand grip strength. RESULTS Pearson correlation analysis revealed a moderate correlation between patient-reported physical function and the 30-second sit-to-stand test (r = 0.57; p <.001), and a weak correlation of patient-reported physical function and handgrip strength (r = 0.27; p <.001). Multivariable regression modeling controlling for age, gender, and receipt of systemic therapy demonstrated a significant association between patient-reported physical function and the 30-second sit-to-stand test (estimated confidence interval 0.76 [0.60, 0.92], p < .01), in addition to patient-reported function and handgrip strength (estimated 0.22 [0.10, 0.34], p < .01). Multiple myeloma but no other cancer type was inversely associated with lower physical function. CONCLUSIONS Patient-reported physical function correlated moderately with the 30-second sit-to-stand test, whereas hand grip strength demonstrated a weak correlation. The 30-second sit-to-stand test is a suitable substitute for patient-reported physical function. Further work evaluating how measures relate to each other across cancer populations is needed before recommending a standardized set of outcome measures.
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Affiliation(s)
- Sonal Oza
- Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia, USA
| | - Andy Kramer
- Department of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - Jian Ying
- Department of Family & Preventive Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Daniel M Cushman
- Department of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah, USA
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28
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Benton MJ, Hutchins AM. The relationship between resting metabolic rate and quality of life is moderated by age and body composition in women: a cross-sectional study. BMC Womens Health 2024; 24:235. [PMID: 38615006 PMCID: PMC11015637 DOI: 10.1186/s12905-024-03085-0] [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: 07/25/2023] [Accepted: 04/08/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Health-related quality of life (HRQOL) is related to body composition, which is also related to resting metabolic rate (RMR). RMR can be increased by exercise and diet interventions that are not dependent on changes in body composition, so a link between RMR and HRQOL may provide interventions that directly improve HRQOL in women. METHODS One hundred twenty women (median age 63.5 [IQR: 53.0-71.0] years) completed one-time measurement of body composition (multi-frequency bioelectrical impedance), RMR (handheld calorimetry), and HRQOL (RAND-36). Physical (PCS) and mental (MCS) composite scores were calculated for the RAND-36. Pearson correlations were used to identify relationships between RMR, body composition, and HRQOL. Variables at the p < .01 level were entered into multiple regression models. RESULTS Median body mass index was 26.1 [IQR: 23.2-30.9] kg/m2 and median lean mass index was 16.1 [IQR: 14.6-17.3] kg/m2. Body composition consisted of fat mass (median 27.2 [IQR: 20.3-34.7] kg) and lean mass (median 42.7 [IQR: 38.2-46.9] kg). Median RMR was 1165.0 [IQR: 1022.5-1380.0] kcal/day. Median HRQOL scores were PCS (84.0 [IQR: 74.0-93.0]) and MCS (85.0 [IQR: 74.3-90.0]). RMR was not directly related to PCS, but was directly and negatively related to MCS (p = .002). RMR was significantly and positively related to body composition (lean mass: p < .001; fat mass: p < .001), body mass index (p = .005), and lean mass index (p < .001); but only fat mass (PCS: p < .001; MCS: p < .001) and body mass index (PCS: p < .001; MCS: p < .001) were related to HRQOL, although the relationship was negative. In addition, age was found to be significantly negatively related to RMR (p < .001) and PCS (p = .003). Regression models confirmed the moderating influence of age and body composition on the relationship between RMR and HRQOL. RMR, age, fat mass, and body mass index explained 24% (p < .001) of variance in PCS; and RMR, fat mass, and body mass index explained 15% (p < .001) of variance in MCS. CONCLUSION In women, the relationship between RMR and HRQOL is moderated by age and body composition. Understanding these pathways will allow clinicians and researchers to direct interventions more effectively.
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Affiliation(s)
- Melissa J Benton
- Department of Nursing, University of Colorado Colorado Springs, Colorado Springs, CO, USA.
- Helen & Arthur E. Johnson Beth-El College of Nursing & Health Sciences, University of Colorado Colorado Springs, 1420 Austin Bluffs Parkway, Colorado Springs, CO, 80918, USA.
| | - Andrea M Hutchins
- Department of Human Physiology & Nutrition, University of Colorado Colorado Springs, Colorado Springs, CO, USA
- Helen & Arthur E. Johnson Beth-El College of Nursing & Health Sciences, University of Colorado Colorado Springs, 1420 Austin Bluffs Parkway, Colorado Springs, CO, 80918, USA
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Sikorskii A, Badger T, Segrin C, Crane TE, Cunicelli N, Chalasani P, Arslan W, Given C. Predictors of persistence of post-chemotherapy symptoms among survivors of solid tumor cancers. Qual Life Res 2024; 33:1143-1155. [PMID: 38291312 DOI: 10.1007/s11136-023-03595-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
CONTEXT Late or residual symptoms diminish quality of life for many cancer survivors after completion of treatment. OBJECTIVES Examine risk factors associated with persisting symptom burden after chemotherapy and the lack of symptom improvement over time. METHODS Survivors who completed curative-intent chemotherapy within two years for solid tumors were enrolled into a symptom management trial. There were 375 survivors with two or more comorbid conditions or one comorbid condition and elevated depressive symptoms (pre-defined risk factors in the trial design) who received interventions and 71 survivors without these risk factors who did not receive interventions. For all survivors, symptoms were assessed at intake, 4, and 13 weeks and categorized as mild, moderate, or severe based on the interference with daily life. The probabilities of moderate or severe symptoms and symptom improvement were analyzed using generalized mixed-effects models in relation to comorbidity, depressive symptoms, age, sex, race/ethnicity, employment, time since chemotherapy completion, and physical function. Multiple symptoms were treated as nested within the survivor. RESULTS Moderate or severe symptoms at baseline and the lack of improvement over time were associated with younger age and lower physical function over and above a greater number of comorbidities and elevated severity of depressive symptoms. CONCLUSION Risk factors identified in this research (younger age, lower physical function, greater comorbidity, and higher depressive symptoms) can be used to allocate resources for post-treatment symptom management for cancer survivors in order to relieve symptoms that do not necessarily resolve with time.
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Affiliation(s)
- Alla Sikorskii
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, 909 Wilson Road, Road 321, East Lansing, MI, 48824, USA.
| | - Terry Badger
- College of Nursing, Department of Psychiatry and Mel and Enid Zuckerman College of Public Health, University of Arizona, 1305 N. Martin Avenue, Tucson, AZ, 85721, USA
| | - Chris Segrin
- Department of Communication, University of Arizona, Tucson, USA
| | - Tracy E Crane
- Miller School of Medicine, Division of Medical Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Coral Gables, USA
| | | | - Pavani Chalasani
- Division of Hematology-Oncology, George Washington University, Washington, DC, USA
| | - Waqas Arslan
- College of Medicine, University of Arizona, Phoenix, AZ, USA
| | - Charles Given
- College of Nursing, Michigan State University, East Lansing, USA
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30
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de Ligt KM, Koppert LB, de Rooij BH, van de Poll-Franse LV, Velikova G, Cardoso F. Seizing the moment: The time for harnessing electronic patient-reported outcome measures for enhanced and sustainable metastatic breast cancer care is now. Breast 2024; 74:103676. [PMID: 38359564 PMCID: PMC10877629 DOI: 10.1016/j.breast.2024.103676] [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: 10/20/2023] [Revised: 12/11/2023] [Accepted: 01/31/2024] [Indexed: 02/17/2024] Open
Abstract
The sustainability of healthcare systems is under pressure. Unlike care for many other chronic diseases, cancer care has yet to empower patients in effectively self-managing both the medical and emotional consequences of their condition, including adapting to changes in lifestyle and work, which is essential to achieve optimal health and recovery. Although proposed as a potential solution for sustainable healthcare and support for optimal health and recovery already decades ago, practical implementation of digital care lags behind. We believe electronic patient reported outcome measures (ePROMs) could play an important role in creating sustainable healthcare, both to guide complex treatment pathways and to empower survivors to self-manage consequences of diagnosis and treatment. That is, ePROMs can be used for screening and monitoring of symptoms, but also for treatment decision-making and to facilitate communication about quality of life. We therefore see opportunities for improvements in quality of care, quality of life, and survival of cancer patients, as well as research opportunities, as ePROMs collection can lead to better understanding of care needs. The '10 Actions for Change report' of the Advanced Breast Cancer Global Alliance stresses a critical need for improvement of care for metastatic breast cancer (MBC) patients. We therefore in this paper focus on MBC care and research.
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Affiliation(s)
- K M de Ligt
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
| | - L B Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
| | - B H de Rooij
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands; Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Warandelaan 2, 5037 AB, Tilburg, the Netherlands.
| | - L V van de Poll-Franse
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands; Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Warandelaan 2, 5037 AB, Tilburg, the Netherlands.
| | - G Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Woodhouse Lane, LS2 9JT, Leeds, United Kingdom; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett St, Harehills, LS9 7LP, Leeds, United Kingdom.
| | - F Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Avenida Brasília s/n, 1400-038, Lisbon, Portugal.
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31
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Singhal S, Dickerson J, Glover MJ, Roy M, Chiu M, Ellis-Caleo T, Hui G, Tamayo C, Loecher N, Wong HN, Heathcote LC, Schapira L. Patient-reported outcome measurement implementation in cancer survivors: a systematic review. J Cancer Surviv 2024; 18:223-244. [PMID: 35599269 DOI: 10.1007/s11764-022-01216-w] [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: 01/18/2022] [Accepted: 05/10/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Patient-reported outcome measurements (PROMs) are increasingly used for cancer patients receiving active treatment, but little is known about the implementation and usefulness of PROMs in cancer survivorship care. This systematic review evaluates how cancer survivors and healthcare providers (HCPs) perceive PROM implementation in survivorship care, and how PROM implementation impacts cancer survivors' health outcomes. METHODS We systematically searched PubMed/MEDLINE, Embase, CINAHL, Web of Science, and Cochrane Database of Systematic Reviews from database inception to February 2022 to identify randomized and nonrandomized studies of PROM implementation in cancer survivors. RESULTS Based on prespecified eligibility criteria, we included 29 studies that reported on 26 unique PROMs. The studies were heterogeneous in study design, PROM instrument, patient demographics, and outcomes. Several studies found that cancer survivors and HCPs had favorable impressions of the utility of PROMs, and a few studies demonstrated that PROM implementation led to improvements in patient quality of life (QoL), with small to moderate effect sizes. CONCLUSIONS We found implementation of PROMs in cancer survivorship care improved health outcomes for select patient populations. Future research is needed to assess the real-world utility of PROM integration into clinical workflows and the impact of PROMs on measurable health outcomes. IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors accepted PROMs. When successfully implemented, PROMs can improve health outcomes after completion of active treatment. We identify multiple avenues to strengthen PROM implementation to support cancer survivors.
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Affiliation(s)
- Surbhi Singhal
- Department of Medicine, Division of Medical Oncology, Stanford University, Stanford, CA, USA.
| | - James Dickerson
- Department of Medicine, Division of Medical Oncology, Stanford University, Stanford, CA, USA
| | | | - Mohana Roy
- Department of Medicine, Division of Medical Oncology, Stanford University, Stanford, CA, USA
| | - Michelle Chiu
- Department of Medicine, Stanford University, Stanford, CA, USA
| | | | - Gavin Hui
- Department of Medicine, Stanford University, Stanford, CA, USA
| | | | - Nele Loecher
- Department of Mental Health Law and Policy, University of South Florida, Tampa, FL, USA
| | - Hong-Nei Wong
- Lane Medical Library & Knowledge Management Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Lidia Schapira
- Department of Medicine, Division of Medical Oncology, Stanford University, Stanford, CA, USA
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32
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Tack J, Carbone F, Chang L, Lacy BE. Patient-Reported Outcomes in Disorders of Gut-Brain Interaction. Gastroenterology 2024; 166:572-587.e1. [PMID: 38309628 DOI: 10.1053/j.gastro.2023.11.307] [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: 12/03/2022] [Revised: 11/06/2023] [Accepted: 11/11/2023] [Indexed: 02/05/2024]
Abstract
Disorders of gut-brain interaction are characterized by chronic gastrointestinal symptoms in the absence of abnormal endoscopic or radiologic findings or objective biomarkers that can be identified during routine clinical evaluation. The assessment of the symptom pattern and severity, therefore, is the key modality to evaluate the presence, impact, and evolution of these conditions, for both clinical and regulatory purposes. Patient-reported outcomes are structured symptom assessment questionnaires designed to evaluate symptom patterns, quantify severity of symptoms, and evaluate response to treatment at follow-up. This review provides an overview of currently available patient-reported outcomes for evaluating the main disorders of gut-brain interaction, specifically, functional dyspepsia; irritable bowel syndrome; and chronic constipation. It summarizes their content, level of validation for clinical practice and for research, and the regulatory approach to these conditions. Expected future developments and need for further research on patient-reported outcomes for these and other disorders of gut-brain interaction are highlighted.
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Affiliation(s)
- Jan Tack
- Translational Research in Gastrointestinal Disorders, University of Leuven, Leuven, Belgium; Department of Gastroenterology, Leuven University Hospitals, Leuven, Belgium.
| | - Florencia Carbone
- Department of Gastroenterology, Leuven University Hospitals, Leuven, Belgium
| | - Lin Chang
- G. Oppenheimer Center for Neurobiology of Stress at University of California, Los Angeles, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
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Griffin JM, Kroner BL, Wong SL, Preiss L, Wilder Smith A, Cheville AL, Mitchell SA, Lancki N, Hassett MJ, Schrag D, Osarogiagbon RU, Ridgeway JL, Cella D, Jensen RE, Flores AM, Austin JD, Yanez B. Disparities in electronic health record portal access and use among patients with cancer. J Natl Cancer Inst 2024; 116:476-484. [PMID: 37930884 PMCID: PMC10919330 DOI: 10.1093/jnci/djad225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/12/2023] [Accepted: 10/18/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Electronic health record-linked portals may improve health-care quality for patients with cancer. Barriers to portal access and use undermine interventions that rely on portals to reduce cancer care disparities. This study examined portal access and persistence of portal use and associations with patient and structural factors before the implementation of 3 portal-based interventions within the Improving the Management of symPtoms during And following Cancer Treatment (IMPACT) Consortium. METHODS Portal use data were extracted from electronic health records for the 12 months preceding intervention implementation. Sociodemographic factors, mode of accessing portals (web vs mobile), and number of clinical encounters before intervention implementation were also extracted. Rurality was derived using rural-urban commuting area codes. Broadband access was estimated using the 2015-2019 American Community Survey. Multiple logistic regression models tested the associations of these factors with portal access (ever accessed or never accessed) and persistence of portal use (accessed the portal ≤20 weeks vs ≥21 weeks in the 35-week study period). RESULTS Of 28 942 eligible patients, 10 061 (35%) never accessed the portal. Male sex, membership in a racial and ethnic minority group, rural dwelling, not working, and limited broadband access were associated with lower odds of portal access. Younger age and more clinical encounters were associated with higher odds of portal access. Of those with portal access, 25% were persistent users. Using multiple modalities for portal access, being middle-aged, and having more clinical encounters were associated with persistent portal use. CONCLUSION Patient and structural factors affect portal access and use and may exacerbate disparities in electronic health record-based cancer symptom surveillance and management.
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Affiliation(s)
- Joan M Griffin
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
- Robert E. and Patricia D. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Barbara L Kroner
- Center for Clinical Research, RTI International, Research Triangle Park, NC, USA
| | - Sandra L Wong
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Liliana Preiss
- Center for Clinical Research, RTI International, Research Triangle Park, NC, USA
| | - Ashley Wilder Smith
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Andrea L Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Sandra A Mitchell
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Nicola Lancki
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael J Hassett
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Deborah Schrag
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Jennifer L Ridgeway
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
- Robert E. and Patricia D. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Roxanne E Jensen
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Ann Marie Flores
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
- Department of Physical Therapy and Human Movement Science, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jessica D Austin
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Rau A, Yannitsos D, Grendarova P, Qi S, Watson L, Barbera L. High Symptom Burden in Patients Receiving Radiotherapy and Factors Associated with Being Offered an Intervention. Curr Oncol 2024; 31:1253-1265. [PMID: 38534927 PMCID: PMC10969673 DOI: 10.3390/curroncol31030094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/16/2024] [Accepted: 02/24/2024] [Indexed: 05/26/2024] Open
Abstract
Patient report outcomes are commonly collected during oncology visits to elicit symptom burden and guide management. We aimed to determine the frequency of intervention for patients undergoing radiotherapy with high symptom complexity scores and identify which factors are associated with being offered an intervention. A retrospective chart audit was completed of adult patients with cancer who had at least one radiotherapy appointment and were assigned a high symptom complexity. A total of 200 patients were included; 150 (75.0%) patients were offered an intervention for the main symptom. The most offered intervention was medications. Multivariable logistic regression showed factors associated with being offered an intervention were the following: symptom score of 9 (OR = 9.56, 95% CI 1.64-62.8) and 10 (OR = 7.90, 95% CI 1.69-38.2); palliative intent radiation (OR 3.87, 96% CI 1.46-11.1); and last review appointment (OR 6.22, 95% CI 1.84-23.3). Symptoms associated with being offered an intervention included pain (OR 22.6, 95% CI 6.47-91.1), nausea (OR 15.7, 95% CI 1.51-412), shortness of breath (OR 7.97, 95% CI 1.20-63.7), and anxiety (OR 6.69, 95% CI 1.58-31.6). This knowledge will help guide clinical practice to understand symptom burden and how we can improve our management of patients' symptoms.
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Affiliation(s)
- Allison Rau
- Division of Radiation Oncology, University of Calgary, Calgary, AB T2N 4N1, Canada; (A.R.); (D.Y.); (P.G.); (L.W.)
- Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
| | - Demetra Yannitsos
- Division of Radiation Oncology, University of Calgary, Calgary, AB T2N 4N1, Canada; (A.R.); (D.Y.); (P.G.); (L.W.)
- Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
| | - Petra Grendarova
- Division of Radiation Oncology, University of Calgary, Calgary, AB T2N 4N1, Canada; (A.R.); (D.Y.); (P.G.); (L.W.)
| | - Siwei Qi
- Cancer Care Alberta, Calgary, AB T4N 4E7, Canada;
| | - Linda Watson
- Division of Radiation Oncology, University of Calgary, Calgary, AB T2N 4N1, Canada; (A.R.); (D.Y.); (P.G.); (L.W.)
- Cancer Care Alberta, Calgary, AB T4N 4E7, Canada;
| | - Lisa Barbera
- Division of Radiation Oncology, University of Calgary, Calgary, AB T2N 4N1, Canada; (A.R.); (D.Y.); (P.G.); (L.W.)
- Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
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Wang Y, Allsop MJ, Epstein JB, Howell D, Rapoport BL, Schofield P, Van Sebille Y, Thong MSY, Walraven I, Ryan Wolf J, van den Hurk CJG. Patient-reported symptom monitoring: using (big) data to improve supportive care at the macro-, meso-, and micro-levels. Support Care Cancer 2024; 32:182. [PMID: 38386101 DOI: 10.1007/s00520-024-08373-x] [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: 04/26/2023] [Accepted: 02/11/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE This paper aims to provide a comprehensive understanding of the need for continued development of symptom monitoring (SM) implementation, utilization, and data usage at the macro-, meso-, and micro-levels. METHODS Discussions from a patient-reported SM workshop at the MASCC/ISSO 2022 annual meeting were analyzed using a macro-meso-micro analytical framework of cancer care delivery. The workshop categories "initiation and implementation, barriers to adoption and utilization, and data usage" were integrated for each level. RESULTS At the macro-level, policy development could encourage data sharing and international collaboration, including the exchange of SM methods, supportive care models, and self-management modules. At the meso-level, institutions should adjust clinical workflow and service delivery and promote a thorough technical and clinical integration of SM. At the micro-level, SM should be individualized, with timely feedback for patients, and should foster trust and understanding of AI decision support tools amongst clinicians to improve supportive care. CONCLUSIONS The workshop reached a consensus among international experts on providing guidance on SM implementation, utilization, and (big) data usage pathways in cancer survivors across the cancer continuum and on macro-meso-micro levels.
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Affiliation(s)
- Yan Wang
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA, 15261, USA
- Mckinsey & Company, 1 PPG Pl # 2350, Pittsburgh, PA, 15222, USA
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, 6 Clarendon Way, Woodhouse, Leeds, LS2 9LH, UK
| | - Joel B Epstein
- City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
- Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., Pavilion, 7th Floor, Los Angeles, CA, 90048, USA
| | - Doris Howell
- Princess Margaret Cancer Research Institute, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Bernardo L Rapoport
- The Medical Oncology Centre of Rosebank, 129 Oxford Road, Saxonwold, Johannesburg, 2196, South Africa
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Corner Doctor Savage Road and Bophelo Road, Pretoria, 0002, South Africa
| | - Penelope Schofield
- Department of Psychology, and Iverson Health Innovation Research Institute Swinburne University, John St, Hawthorn, VIC, 3122, Australia
- Health Services Research and Implementation Sciences, Peter MacCallum Cancer Centre, Melbourne, 305 Grattan Street, Melbourne, VIC, 3000, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Grattan Street, Parkville, Victoria, 3010, Australia
| | - Ysabella Van Sebille
- University of South Australia, 61-68 North Terrace, Adelaide, SA, 5000, Australia
| | - Melissa S Y Thong
- Unit of Cancer Survivorship (C071), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Iris Walraven
- Department of Health Evidence, Radboud University Nijmegen Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Julie Ryan Wolf
- Department of Dermatology, Department of Radiation Oncology, University of Rochester Medical Center, 601 Elmwood Ave, Box 697, Rochester, NY, 14642, USA
| | - Corina J G van den Hurk
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Rijnkade 5, 3511, LC, Utrecht, The Netherlands.
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Bajgain KT, Mendoza J, Naqvi F, Aghajafari F, Tang K, Zwicker J, Santana MJ. Prioritizing Patient Reported Outcome Measures (PROMs) to use in the clinical care of youth living with mental health concerns: a nominal group technique study. J Patient Rep Outcomes 2024; 8:20. [PMID: 38381258 PMCID: PMC10881912 DOI: 10.1186/s41687-024-00694-z] [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: 10/16/2023] [Accepted: 01/13/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND In the past few decades, particularly in the mental health setting, there has been growing interest in using Patient Reported Outcome Measures (PROMs) to assess the efficacy of the treatments in healthcare systems. Despite recent initiatives for global harmonization, there remains a lack of consensus on which PROMs are best practice and appropriate. Engagement of the service users, such as patients and family members/caregivers, is vital at this stage to ensure the selected PROMs are feasible, relevant, and acceptable to them. This study aimed to prioritize PROMs by youth and family/caregiver based on feasibility, relevance, and overall importance to be used in the clinical care of youth living with anxiety and/or depression. METHODS Ten validated and widely used PROMs were presented to the patients and family/caregivers. Nominal group techniques were employed to prioritize the PROMs based on feasibility, relevance, and overall importance. RESULTS For patients and families/caregivers, the PROMs, Revised Child Anxiety and Depression Scale (RCAD 25), and The Young Person's Core (YP-CORE) were the highest priorities. Both felt that RCAD 25 was comprehensive, short, easy, and quick to complete, whereas regarding YP-CORE, patients and family/caregivers thought it was also short and relevant. Due to some specific concerns, the Strength and Difficulties Questionnaire and Child Health Questionnaire were the lowest prioritized by patients and family/caregivers. CONCLUSION It is of utmost importance that patient's and family/caregivers' voices or opinions are considered while selecting and implementing PROMs in mental health settings. Our study provides practical recommendations around measures best suited to achieve this.
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Affiliation(s)
- Kalpana Thapa Bajgain
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Justino Mendoza
- General Psychology, Capella University, Minneapolis, MN, USA
| | - Farwa Naqvi
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Fariba Aghajafari
- Department of Medicine and Community Health Science, University of Calgary, Calgary, Alberta, Canada
| | - Karen Tang
- Department of Medicine and Community Health Science, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer Zwicker
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Maria-Jose Santana
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
- Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, Canada.
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Bense JE, Guilonard N, Zwaginga F, Stiggelbout AM, Louwerens M, Mekelenkamp H, Lankester AC, Pieterse AH, de Pagter APJ. The value of using patient-reported outcomes for health screening during long-term follow-up after paediatric stem cell transplantation for nonmalignant diseases. Health Expect 2024; 27:e13902. [PMID: 38102818 PMCID: PMC10768862 DOI: 10.1111/hex.13902] [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: 06/26/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION The assessment of using patient-reported outcomes (PROs) within comprehensive care follow-up programmes, specifically focused on health screening, remains largely unexplored. PROs were implemented in our late effects and comprehensive care programme after paediatric hematopoietic stem cell transplantation (HSCT) for nonmalignant diseases. The programme focuses solely on screening of physical and mental health and on discussing PROs during the consultation. METHODS The primary method of this study was semistructured interviews to explore the perspective of both patients and healthcare providers' (HCP) on the use of PROs, which were thematically analyzed. Additionally, an explorative quantitative approach with patient-reported experience measures (PREMS) was used, with a pretest-posttest design, to assess whether the use of PROs was accompanied by more patient-centred care. RESULTS From the patient-interviews (N = 15) four themes were extracted: use of PROs (1) help to discuss topics; (2) make the patients feel understood; (3) create a moment of self-reflection; and (4) make consultations more efficient. Pre- and postimplementation analysis of PREMs (N = 40) did not show significant differences in terms of patient-centeredness. CONCLUSION Our results demonstrate the added value of integrating PROs for health screening purposes within the long-term follow-up programme after paediatric HSCT, as perceived by both patient and HCP. With the active use of PROs, patients are stimulated to consciously assess their health status. PATIENT CONTRIBUTION This study included patients as participants. Caregivers were approached if patients were below a certain age. Additionally, preliminary results were shared with all patients (including nonparticipants) during a patient conference day.
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Affiliation(s)
- Joëll E. Bense
- Department of Pediatrics, Willem‐Alexander Children's Hospital, Division of Stem Cell TransplantationLeiden University Medical CenterLeidenThe Netherlands
| | - Nicole Guilonard
- Department of Pediatrics, Willem‐Alexander Children's Hospital, Division of Stem Cell TransplantationLeiden University Medical CenterLeidenThe Netherlands
| | - Femke Zwaginga
- Department of Pediatrics, Willem‐Alexander Children's Hospital, Division of Stem Cell TransplantationLeiden University Medical CenterLeidenThe Netherlands
| | - Anne M. Stiggelbout
- Department of Biomedical Data Sciences, Medical Decision MakingLeiden University Medical CenterLeidenThe Netherlands
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Marloes Louwerens
- Department of Internal MedicineLeiden University Medical CenterLeidenThe Netherlands
| | - Hilda Mekelenkamp
- Department of Pediatrics, Willem‐Alexander Children's Hospital, Division of Stem Cell TransplantationLeiden University Medical CenterLeidenThe Netherlands
| | - Arjan C. Lankester
- Department of Pediatrics, Willem‐Alexander Children's Hospital, Division of Stem Cell TransplantationLeiden University Medical CenterLeidenThe Netherlands
| | - Arwen H. Pieterse
- Department of Biomedical Data Sciences, Medical Decision MakingLeiden University Medical CenterLeidenThe Netherlands
| | - Anne P. J. de Pagter
- Department of Pediatrics, Willem‐Alexander Children's Hospital, Division of Stem Cell TransplantationLeiden University Medical CenterLeidenThe Netherlands
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van Doeveren T, Remmers S, Atema V, van den Bergh RC, Boevé ER, Cornel EB, van der Heijden AG, Hendricksen K, Cauberg EC, Jacobs RA, Kroon BK, Leliveld AM, Meijer RP, Merks B, Oddens JR, Roelofs L, Somford DM, de Vries P, Wijsman B, Windt WA, Zwaan PJ, van Leeuwen PJ, Boormans JL, Aben KK. Short-term Changes in Health-related Quality of Life of Patients Undergoing Radical Surgery for Upper Urinary Tract Urothelial Carcinoma: Results from a Prospective Phase 2 Clinical Trial. EUR UROL SUPPL 2024; 60:15-23. [PMID: 38375344 PMCID: PMC10874848 DOI: 10.1016/j.euros.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 02/21/2024] Open
Abstract
Background and objective The possible negative impact of radical surgery on patients' health-related quality of life (HRQoL) plays an important role in preoperative counseling. Here, we analyzed the HRQoL of patients treated for upper urinary tract urothelial carcinoma (UTUC) in the context of a single-arm phase 2 multicenter study, in which the safety and efficacy of a single preoperative intravesical instillation with mitomycin C were investigated. Our objective was to investigate early changes in HRQoL in patients undergoing radical surgery for UTUC and identify factors associated with these outcomes. Methods Patients with pTanyN0-1M0 UTUC were prospectively included. HRQoL was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) questionnaire at baseline, and at 1 and 3 mo after surgery. A linear mixed model was used to evaluate the changes in HRQoL over time and identify the variables associated with these outcomes. The clinical effect size was used to assess the clinical impact and level of perceptibility of HRQoL changes for clinicians and/or patients based on given thresholds. Key findings and limitations Between 2017 and 2020, 186 patients were included. At baseline, 1 mo after surgery, and 3 mo after surgery, response rates were 91%, 84%, and 78%, respectively. One month after surgery, a statistically significant and clinically relevant deterioration was observed in physical, role, and social functioning, and for the included symptom scales: constipation, fatigue, and pain. An improvement in emotional functioning was observed. At 3 mo, HRQoL returned to baseline levels, except emotional functioning, which improved at 1 mo and persisted to be better than that before surgery. Age >70 yr was associated with worse physical functioning, but better social and emotional functioning. Male patients reported better emotional functioning than females. Postoperative complications were negatively associated with social functioning. Conclusions and clinical implications UTUC patients treated with radical surgery experienced a significant, albeit temporary, decline in HRQoL. Three months following surgery, HRQoL outcomes returned to baseline levels. This information can be used to counsel UTUC patients before undergoing radical surgery and contextualize recovery after surgery. Patient summary We investigated the changes in quality of life as reported by patients who underwent surgery for upper tract urothelial carcinoma (UTUC). We found that patients experienced a decline in quality of life 1 mo after surgery, but this was temporary, with full recovery of quality of life 3 mo after surgery. These findings can help doctors and other medical staff in counseling UTUC patients before undergoing radical surgery.
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Affiliation(s)
- Thomas van Doeveren
- Department of Urology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Vera Atema
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | | | - Egbert R. Boevé
- Department of Urology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - Erik B. Cornel
- Department of Urology, Ziekenhuis Groep Twente, Hengelo, The Netherlands
| | | | - Kees Hendricksen
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Rens A.L. Jacobs
- Department of Urology, Zuyderland Medical Center, Heerlen and Sittard, The Netherlands
| | - Bin K. Kroon
- Department of Urology, Rijnstate Medical Center, Arnhem, The Netherlands
| | - Annemarie M. Leliveld
- Department of Urology, University Medical Center Groningen, Groningen, The Netherlands
| | - Richard P. Meijer
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bob Merks
- Department of Urology, Haaglanden Medical Center, Leidschendam, The Netherlands
| | - Jorg R. Oddens
- Department of Urology, AmsterdamUMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Luc Roelofs
- Department of Urology, Treant Zorggroep, Emmen, The Netherlands
| | - Diederik M. Somford
- Department of Urology, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Peter de Vries
- Department of Urology, Treant Zorggroep, Emmen, The Netherlands
| | - Bart Wijsman
- Department of Urology, Elisabeth-Tweesteden Medical Center, Tilburg, The Netherlands
| | | | - Peter J. Zwaan
- Department of Urology, Gelre Ziekenhuis, Apeldoorn, The Netherlands
| | - Pim J. van Leeuwen
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Joost L. Boormans
- Department of Urology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Katja K.H. Aben
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
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Anderson N. Commentary: Cross-cultural validation of the Portuguese version of the Dialysis Symptom Index for haemodialysis patients. J Res Nurs 2024; 29:62-64. [PMID: 38495328 PMCID: PMC10939019 DOI: 10.1177/17449871231225439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Affiliation(s)
- Nicola Anderson
- Nicola Anderson, Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, England B15 2TT, UK.
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Sampieri G, Li H, Ataalla P, Merriman K, Noel CW, Hallet J, Coburn N, Karam I, Smoragiewicz M, Wong B, Fu R, Eskander A. Interventions for Concerning Patient-Reported Outcomes in Routine Cancer Care: A Systematic Review. Ann Surg Oncol 2024; 31:1148-1170. [PMID: 37996640 DOI: 10.1245/s10434-023-14576-z] [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: 08/24/2023] [Accepted: 10/25/2023] [Indexed: 11/25/2023]
Abstract
IMPORTANCE Collecting patient-reported outcomes (PROs) in routine cancer care improves patient-clinician communication, decision making, and overall patient satisfaction. Recommendations exist regarding standardized ways to collect, store, and interpret PRO data. However, evidence on incorporating PROs into cancer process of care, especially the type of HIs that are warranted after observing a concerning PRO and the effectiveness of these HIs are lacking. OBJECTIVE This study summarizes HIs triggered after PRO completion and their effectiveness in improving patient outcomes for adults being treated for cancer types that are resource intensive and associated with high symptom burden [i.e., gastrointestinal (GI), lung, and head and neck cancer (HNC)]. Secondary outcomes included factors associated with poor implementation of PROs. EVIDENCE REVIEW A literature search of peer-reviewed publications on MEDLINE, CINAHL Plus, APA PsycInfo, Scopus, and Cochrane was conducted following PRISMA guidelines from 1 January 2012, to 31 July 2022. Trial and real-world studies describing HIs after PRO completion for adult patients being treated for GI, lung, and HNC were included. Sixteen studies involving 144,496 patients were included. The Joanna Briggs Institute critical appraisal checklist was used to assess risk of bias. FINDINGS Of the 16 included studies, 5 included patients with HNC. Commonly used PRO measurement tools were the PRO-CTCAE and ESAS. Only three studies reported specific HIs delivered in response to concerning PROs and measured their effectiveness on patient outcomes. In all three studies, these HIs significantly improved cancer-related care. The most common HIs undertaken in response to concerning PROs were referrals to other specialists/allied healthcare professionals, medication changes, or self-management advice. Provider-related barriers to PRO measurement and delivery included the overwhelming number of alerts, the time required to address each PRO and the unclear role of healthcare providers in response to these alerts. Patient-related barriers included lower digital literacy and socioeconomic status, older age, rural living, and patients suffering from GI and HNC. CONCLUSIONS AND RELEVANCE This review highlights that PRO-triggered HIs are heterogenous and can improve patient quality of life. Further studies are necessary to determine the types of interventions with the greatest impact on patient care and outcomes.
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Affiliation(s)
- Gianluca Sampieri
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Huaqi Li
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Philopateer Ataalla
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Kaitlyn Merriman
- Insitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
- Insitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Julie Hallet
- Insitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Natalie Coburn
- Insitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Irene Karam
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Martin Smoragiewicz
- Department of Medical Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Brian Wong
- Insitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Rui Fu
- Insitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Antoine Eskander
- Insitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- ICES, Toronto, Canada.
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.
- Department of Otolaryngology-Head and Neck Surgery, Michael Garron Hospital, University of Toronto, Toronto, Canada.
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Hiraoka S, Yoshimura M, Nakajima A, Nakashima R, Mizowaki T. Long-term outcomes of stimulated salivary flow and xerostomia after definitive intensity-modulated radiation therapy for patients with head and neck cancer†. JOURNAL OF RADIATION RESEARCH 2024; 65:71-77. [PMID: 37996093 PMCID: PMC10803167 DOI: 10.1093/jrr/rrad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/12/2023] [Indexed: 11/25/2023]
Abstract
This retrospective study aimed to evaluate the time to recovery from xerostomia and analyze its predictors, along with long-term outcomes of stimulated salivary flow after intensity-modulated radiation therapy (IMRT) for head and neck cancer (HNC). We evaluated patients with HNC who had received IMRT with curative intent between 2012 and 2018 at our institution. The salivary recovery ratio (SRR) was defined as '(the stimulated salivary flow)/(pre-treatment salivary flow)'. The cutoff value of SRR in salivary recovery was estimated via the relationship between SRR and xerostomia grades. The salivary recovery time was defined as the time for SRR to exceed cutoff values from the end of radiotherapy. Fifty-seven patients were analyzed, with a 48-month median follow-up period of stimulated salivary flow. The cutoff value for SRR was 44.8%, and patients with a higher grade of xerostomia had a lower SRR (P < 0.001). The median salivary recovery time was 12 months. The cumulative incidence rates of salivary recovery at two and four years were 84 (95% confidence interval [CI]: 53-79) and 92% (95% CI: 82-97), respectively, and these were significantly lower in patients with a higher mean parotid gland dose, mean oral cavity dose and stimulated salivary flow per parotid gland volume. Stimulated salivary flow and xerostomia recover over a long period after radiotherapy.
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Affiliation(s)
- Shinya Hiraoka
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Michio Yoshimura
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Aya Nakajima
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Ryota Nakashima
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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Ruzich E, Ritchie J, Ginchereau Sowell F, Mansur A, Griffiths P, Birkett H, Harman D, Spink J, James D, Reaney M. A powerful partnership: researchers and patients working together to develop a patient-facing summary of clinical trial outcome data. J Am Med Inform Assoc 2024; 31:363-374. [PMID: 37341698 PMCID: PMC10797263 DOI: 10.1093/jamia/ocad099] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/27/2023] [Accepted: 05/31/2023] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVE Availability of easy-to-understand patient-reported outcome (PRO) trial data may help individuals make more informed healthcare decisions. Easily interpretable, patient-centric PRO data summaries and visualizations are therefore needed. This three-stage study explored graphical format preferences, understanding, and interpretability of clinical trial PRO data presented to people with prostate cancer (PC). MATERIALS AND METHODS A 7-day online survey exploring people with PC's preferences for different PRO data presentations (stage 1; n = 30) informed development of a draft plain-language resource sheet containing PRO data. After refining for clarity during cognitive debriefing interviews (stage 2; n = 18), the final resource sheet was circulated to people with PC for broader feedback (stage 3; n = 45). RESULTS Although participants expressed preferences for certain graphical formats (pie charts and bar charts), preference did not always associate with interpretability and overall message clarity. Iterative development (stages 1 and 2) led to a final resource sheet, which 91.1% of participants in stage 3 considered useful and informative, and 88.9% expressed interest in receiving similar resources in the future. DISCUSSION Findings demonstrate PRO data are relevant to people with PC and highlights that targeted resource sheets can support patient-clinician discussions. Appropriate graphical formatting and use of plain-language text is essential for conveying interpretable PRO data. Data visualization preferences are context dependent. CONCLUSION Resource sheets summarizing clinical trial PRO data can be helpful for decision-making in PC. Researchers and patients can work together to develop clear, relevant, sensitive, and understandable resource sheets, which equally consider patient priorities as well as those of scientists.
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Affiliation(s)
- Emily Ruzich
- Patient Centered Solutions, IQVIA, Boston, Massachusetts, USA
| | - Jason Ritchie
- Patient Centered Solutions, IQVIA, New York, New York, USA
| | | | | | | | | | - Diane Harman
- Patient Centered Solutions, IQVIA, New York, New York, USA
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Gunsilius CZ, Heffner J, Bruinsma S, Corinha M, Cortinez M, Dalton H, Duong E, Lu J, Omar A, Owen LLW, Roarr BN, Tang K, Petzschner FH. SOMAScience: A Novel Platform for Multidimensional, Longitudinal Pain Assessment. JMIR Mhealth Uhealth 2024; 12:e47177. [PMID: 38214952 PMCID: PMC10818247 DOI: 10.2196/47177] [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: 03/13/2023] [Revised: 10/03/2023] [Accepted: 11/30/2023] [Indexed: 01/13/2024] Open
Abstract
Chronic pain is one of the most significant health issues in the United States, affecting more than 20% of the population. Despite its contribution to the increasing health crisis, reliable predictors of disease development, progression, or treatment outcomes are lacking. Self-report remains the most effective way to assess pain, but measures are often acquired in sparse settings over short time windows, limiting their predictive ability. In this paper, we present a new mobile health platform called SOMAScience. SOMAScience serves as an easy-to-use research tool for scientists and clinicians, enabling the collection of large-scale pain datasets in single- and multicenter studies by facilitating the acquisition, transfer, and analysis of longitudinal, multidimensional, self-report pain data. Data acquisition for SOMAScience is done through a user-friendly smartphone app, SOMA, that uses experience sampling methodology to capture momentary and daily assessments of pain intensity, unpleasantness, interference, location, mood, activities, and predictions about the next day that provide personal insights into daily pain dynamics. The visualization of data and its trends over time is meant to empower individual users' self-management of their pain. This paper outlines the scientific, clinical, technological, and user considerations involved in the development of SOMAScience and how it can be used in clinical studies or for pain self-management purposes. Our goal is for SOMAScience to provide a much-needed platform for individual users to gain insight into the multidimensional features of their pain while lowering the barrier for researchers and clinicians to obtain the type of pain data that will ultimately lead to improved prevention, diagnosis, and treatment of chronic pain.
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Affiliation(s)
- Chloe Zimmerman Gunsilius
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, RI, United States
- Neuroscience Graduate Program, Department of Neuroscience, Brown University, Providence, RI, United States
- Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Joseph Heffner
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, RI, United States
| | - Sienna Bruinsma
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, RI, United States
- Department of Neuroscience, Brown University, Providence, RI, United States
| | - Madison Corinha
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, RI, United States
| | - Maria Cortinez
- Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Hadley Dalton
- Center for Computation and Visualization, Brown University, Providence, RI, United States
| | - Ellen Duong
- Center for Computation and Visualization, Brown University, Providence, RI, United States
| | - Joshua Lu
- Center for Computation and Visualization, Brown University, Providence, RI, United States
| | - Aisulu Omar
- Center for Computation and Visualization, Brown University, Providence, RI, United States
| | - Lucy Long Whittington Owen
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, RI, United States
| | - Bradford Nazario Roarr
- Center for Computation and Visualization, Brown University, Providence, RI, United States
| | - Kevin Tang
- Industrial Design, Rhode Island School of Design, Providence, RI, United States
| | - Frederike H Petzschner
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, United States
- Center for Digital Health, Brown University, Lifespan, Providence, RI, United States
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Stano F, Pellicciari L, La Porta F, Piscitelli D, Angilecchia D, Signorelli M, Giovannico G, Pournajaf S, Caselli S. Rasch analysis of the forgotten joint score in patients with total hip arthroplasty. J Rehabil Med 2024; 56:jrm15774. [PMID: 38197243 PMCID: PMC10795689 DOI: 10.2340/jrm.v56.15774] [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: 07/06/2023] [Accepted: 11/14/2023] [Indexed: 01/11/2024] Open
Abstract
OBJECTIVE To assess the internal construct validity, including local independence, unidimensionality, monotonicity, and invariance, reliability, and targeting of the Forgotten Joint Score within the Rasch Measurement Theory framework. DESIGN Cross-sectional study. PATIENTS A total of 111 patients with total hip arthroplasty at least 3 months after surgery. METHODS The Forgotten Joint Score was submitted to each subject during their rehabilitative treatment in an Italian centre and then to Rasch analysis. RESULTS The base Rasch analysis showed a satisfactory fit to the model with strict unidimensionality and no differential item functioning. However, monotonicity (11 out of 12 items showed disordered thresholds) and local independence were violated. After rescoring 10 items and creating 5 subtests to account for local dependence, the scale satisfied all the other Rasch model requirements (i.e. invariance, local independence, monotonicity, unidimensionality, and multi-group invariance), with reliability indexes (> 0.850) for measurement at the individual level and proper targeting. A raw-score-to-measure conversion table was provided. CONCLUSION After structural (i.e. collapsing items categories) and non-structural (i.e. creating subtests) strategies, the Forgotten Joint Score satisfied the measurement requirements of the Rasch model, and it can be used in patients with total hip arthroplasty in clinical and research settings.
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Affiliation(s)
- Flavia Stano
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | | | - Fabio La Porta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Domenico Angilecchia
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy; Rehabilitation service - ASL, Bari, Italy
| | | | - Giuseppe Giovannico
- Department of Medicine and Health Scienze "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Sanaz Pournajaf
- Neurorehabilitation Research Lab, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele, Rome, Italy
| | - Serena Caselli
- Unità Operativa Complessa di Medicina Riabilitativa, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
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Chen X, Lu D, Mu Y, Kong L, Zhang L. The clinical significance of intraoperative adverse events in laparoscopic radical hysterectomies for early-stage cervical cancer. BMC Womens Health 2024; 24:1. [PMID: 38167063 PMCID: PMC10763214 DOI: 10.1186/s12905-023-02844-9] [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: 10/02/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Surgical quality plays a vital role in the treatment of malignant tumors. We investigated the classification of intraoperative adverse events (iAE) (ClassIntra) in relation to the surgical quality control of laparoscopic radical hysterectomies. METHODS A prospective cohort of 195 patients who had undergone laparoscopic radical hysterectomies for early stage cervical cancer between July 2019 and July 2021 was enrolled. Participants were classified into either an iAE or non-iAE groups in accordance with their intraoperative status. Surgical outcomes, patient satisfaction, and quality of life were compared between the two groups. RESULTS Overall, 48 (24.6%) patients experienced 71 iAE. The iAE group was associated with significantly longer operative times (mean: 270 vs. 245 min, P < 0.001), greater blood loss (mean: 215 vs. 120 mL, P < 0.001), and longer postoperative hospital stays (median: 16 vs. 11 days). Larger tumors and poor technical performance significantly increased the risk of iAE (P < 0.05). Multivariate analysis revealed that iAE were the only independent risk factors for postoperative complications (hazard ratio, 15.100; 95% confidence interval: 4.735-48.158, P < 0.001). Moreover, patients who experienced iAE had significantly lower satisfaction scores and poorer quality of life (P < 0.05). CONCLUSIONS ClassIntra may serve as an effective adjunctive tool for surgical quality control in laparoscopic radical hysterectomies.
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Affiliation(s)
- Xiaolin Chen
- Department of Gynecology, Xingtai Third Hospital, Xingtai, 054000, China.
| | - Dongfang Lu
- Department of Gynecology, Xingtai Third Hospital, Xingtai, 054000, China
| | - Yanmin Mu
- Department of Gynecology, Xingtai Third Hospital, Xingtai, 054000, China
| | - Lingxiao Kong
- Department of Gynecology, Xingtai Third Hospital, Xingtai, 054000, China
| | - Ling Zhang
- Department of Gynecology, Xingtai Third Hospital, Xingtai, 054000, China
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Tagami K, Chiu SW, Kosugi K, Ishiki H, Hiratsuka Y, Shimizu M, Mori M, Kubo E, Ikari T, Arakawa S, Eto T, Shimoda M, Hirayama H, Nishijima K, Ouchi K, Shimoi T, Shigeno T, Yamaguchi T, Miyashita M, Morita T, Inoue A, Satomi E. Cancer Pain Management in Patients Receiving Inpatient Specialized Palliative Care Services. J Pain Symptom Manage 2024; 67:27-38.e1. [PMID: 37730073 DOI: 10.1016/j.jpainsymman.2023.09.015] [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: 06/01/2023] [Revised: 09/01/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
CONTEXT Cancer pain is a common complication that is frequently undertreated in patients with cancer. OBJECTIVES This study is aimed at assessing the time needed to achieve cancer pain management goals through specialized palliative care (SPC). METHODS This was a multicenter, prospective, longitudinal study of inpatients with cancer pain who received SPC. Patients were continuously followed up until they considered cancer pain management successful, and we estimated this duration using the Kaplan-Meier method. We investigated the effectiveness of pain management using multiple patient-reported outcomes (PROs) and quantitative measures, including pain intensity change in the Brief Pain Inventory. A paired-sample t-test was used to compare the pain intensity at the beginning and end of the observation period. RESULTS Cancer pain management based on the PROs was achieved in 87.9% (385/438) of all cases. In 94.5% (364/385) of these cases, cancer pain management was achieved within 1 week, and the median time to pain management was 3 days (95% confidence interval [CI], 2-3). The mean worst pain intensity in the last 24 h at the start and end of observation were 6.9 ± 2.2 and 4.0 ± 2.3, respectively, with a difference of -2.9 (95% CI, -3.2 to -2.6; p < 0.01). Overall, 81.6% of the patients reported satisfaction with cancer pain management, and 62 adverse events occurred. CONCLUSION SPC achieved cancer pain management over a short period with a high level of patient satisfaction resulting in significant pain reduction and few documented adverse events.
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Affiliation(s)
- Keita Tagami
- Department of Palliative Medicine (K.T., Y.H., T.I., A.I.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Shih-Wei Chiu
- Division of Biostatistics (S-W.C., M.S., T.Y.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazuhiro Kosugi
- Department of Palliative Medicine (K.K., E.K., T.E.), National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine (H.I., S.A., E.S.), National Cancer Center Hospital, Tokyo, Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine (K.T., Y.H., T.I., A.I.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizu Wakamatsu, Fukushima, Japan
| | - Masaki Shimizu
- Department of Palliative Care (M.S.), Kyoto-Katsura Hospital, Nishikyo-ku, Kyoto, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care (M.M., T.M.), Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Emi Kubo
- Department of Palliative Medicine (K.K., E.K., T.E.), National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Tomoo Ikari
- Department of Palliative Medicine (K.T., Y.H., T.I., A.I.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Sayaka Arakawa
- Department of Palliative Medicine (H.I., S.A., E.S.), National Cancer Center Hospital, Tokyo, Japan
| | - Tetsuya Eto
- Department of Palliative Medicine (K.K., E.K., T.E.), National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Mayu Shimoda
- Division of Biostatistics (S-W.C., M.S., T.Y.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hideyuki Hirayama
- Department of Palliative Nursing (H.H., T.S., M.M.), Tohoku University Graduate School of Medicine, Aoba-Ku, Sendai, Japan
| | - Kaoru Nishijima
- Department of Palliative Care (K.N.), Kyowakai Medical Corporation, Daini Kyoritsu Hospital, Kawanishi, Hyogo, Japan
| | - Kota Ouchi
- Department of Medical Oncology (K.O.), Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Tatsunori Shimoi
- Department of Medical Oncology (T.S.), National Cancer Center Hospital, Tokyo, Japan
| | - Tomoko Shigeno
- Department of Palliative Nursing (H.H., T.S., M.M.), Tohoku University Graduate School of Medicine, Aoba-Ku, Sendai, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics (S-W.C., M.S., T.Y.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing (H.H., T.S., M.M.), Tohoku University Graduate School of Medicine, Aoba-Ku, Sendai, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care (M.M., T.M.), Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan; Research Association for Community Health (T.M.), Hamamatsu, Shizuoka, Japan
| | - Akira Inoue
- Department of Palliative Medicine (K.T., Y.H., T.I., A.I.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Eriko Satomi
- Department of Palliative Medicine (H.I., S.A., E.S.), National Cancer Center Hospital, Tokyo, Japan
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Takenaga T, Kuji S, Tanabe KI, Kanamori R, Imai H, Takeuchi J, Kondo H, Ohara T, Iwatani T, Suzuki N. Prospective analysis of patient-reported outcomes and physician-reported outcomes with gynecologic cancer chemotherapy. J Obstet Gynaecol Res 2024; 50:75-85. [PMID: 37852304 DOI: 10.1111/jog.15811] [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: 08/20/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE Gynecologic cancer chemotherapy impacts the quality of life (QOL) of patients, with lasting adverse events that may require treatment adjustments or discontinuation. Consequently, real-time symptom monitoring before outpatient visits has resulted in improved QOL for patients and extended survival times. This study investigated whether there are differences between electronic patient-reported outcomes (e-PRO-CTCAE) and physician-assessed outcomes (NCI-CTCAE) evaluated in an outpatient setting in gynecologic cancer chemotherapy. METHODS The study was conducted on 50 patients who received their first chemotherapy treatment at St. Marianna University Hospital Obstetrics and Gynecology from July 1, 2021 to December 31, 2022. PRO-CTCAE and NCI-CTCAE were evaluated at each instance of chemotherapy and 2 weeks after. The PRO-CTCAE was additionally collected weekly using e-PRO. RESULTS The values for "Joint Pain," "Nausea," "Taste Disturbance," "Constipation," "Insomnia," "Fatigue," "Limb Edema," and "Concentration Impairment" were consistently higher in PRO-CTCAE than in NCI-CTCAE, indicating that physicians underestimated the severity of adverse events. In contrast, there was no significant difference in "Peripheral Neuropathy," demonstrating that physicians had a good understanding of this condition in patients. The weekly responses obtained from e-PRO revealed that symptom exacerbations peaked outside of clinic visits. CONCLUSIONS This study demonstrated physicians tend to underestimate most adverse events. Moreover, the responses using e-PRO revealed peak symptom deterioration occurred outside of outpatient visits. This suggested that e-PRO and actions taken in response to them can improve patients' QOL.
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Affiliation(s)
- Tomo Takenaga
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shiho Kuji
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ken-Ichiro Tanabe
- Pathophysiology and Bioregulation, St. Marianna University Graduate School of Medicine, Kawasaki, Japan
| | - Ryo Kanamori
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Haruka Imai
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Jun Takeuchi
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Haruhiro Kondo
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tatsuru Ohara
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tsuguo Iwatani
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
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Izmailova ES, Wagner JA, Bakker JP, Kilian R, Ellis R, Ohri N. A proposed multi-domain, digital model for capturing functional status and health-related quality of life in oncology. Clin Transl Sci 2024; 17:e13712. [PMID: 38266055 PMCID: PMC10774540 DOI: 10.1111/cts.13712] [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: 08/03/2023] [Revised: 11/22/2023] [Accepted: 12/07/2023] [Indexed: 01/26/2024] Open
Abstract
Whereas traditional oncology clinical trial endpoints remain key for assessing novel treatments, capturing patients' functional status is increasingly recognized as an important aspect for supporting clinical decisions and assessing outcomes in clinical trials. Existing functional status assessments suffer from various limitations, some of which may be addressed by adopting digital health technologies (DHTs) as a means of collecting both objective and self-reported outcomes. In this mini-review, we propose a device-agnostic multi-domain model for oncology capturing functional status, which includes physical activity data, vital signs, sleep variables, and measures related to health-related quality of life enabled by connected digital tools. By using DHTs for all aspects of data collection, our proposed model allows for high-resolution measurement of objective data as patients navigate their daily lives outside of the hospital setting. This is complemented by electronic questionnaires administered at intervals appropriate for each instrument. Preliminary testing and practical considerations to address before adoption are also discussed. Finally, we highlight multi-institutional pre-competitive collaborations as a means of successfully transitioning the proposed digitally enabled data collection model from feasibility studies to interventional trials and care management.
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Affiliation(s)
| | | | - Jessie P. Bakker
- Departments of Medicine and Neurology, Brigham and Women's HospitalBostonMassachusettsUSA
- Division of Sleep Medicine, Harvard Medical SchoolBostonMassachusettsUSA
| | - Rachel Kilian
- Koneksa HealthNew YorkNew YorkUSA
- SSI StrategyNew YorkNew YorkUSA
| | | | - Nitin Ohri
- Montefiore Medical Center, Albert Einstein College of MedicineBronxNew YorkUSA
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Casaca P, Schäfer W, Nunes AB, Sousa P. Using patient-reported outcome measures and patient-reported experience measures to elevate the quality of healthcare. Int J Qual Health Care 2023; 35:mzad098. [PMID: 38113907 PMCID: PMC10750971 DOI: 10.1093/intqhc/mzad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/18/2023] [Indexed: 12/21/2023] Open
Affiliation(s)
- Pedro Casaca
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Willemijn Schäfer
- Nivel, The Netherlands Institute for Health Services Research, Netherlands
| | - Ana Beatriz Nunes
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Paulo Sousa
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
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50
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Mazza GL. Can time to deterioration in patient-reported outcomes be a surrogate for overall survival? J Natl Cancer Inst 2023; 115:1442-1444. [PMID: 37659104 DOI: 10.1093/jnci/djad162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/29/2023] [Indexed: 09/04/2023] Open
Affiliation(s)
- Gina L Mazza
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
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