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Wittich L, Tsatsaronis C, Kuklinski D, Schöner L, Steinbeck V, Busse R, Rombey T. Patient-Reported Outcome Measures as an Intervention: A Comprehensive Overview of Systematic Reviews on the Effects of Feedback. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02400-8. [PMID: 38843978 DOI: 10.1016/j.jval.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 05/30/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES Patient-reported outcome measures (PROMs) have emerged as a promising approach to involve patients in their treatment process. Beyond serving as outcome measures, PROMs can be applied to provide feedback to healthcare providers and patients, thereby offering valuable insights that can improve health outcomes and care processes. This overview offers a comprehensive synthesis of the effects of PROM feedback, contributing to the evidence-based discussion on PROMs' potential to enhance patient care. METHODS Following Cochrane Collaboration recommendations, this overview included literature reviews across diverse treatment areas, investigating the impact of PROM feedback on patient health outcomes (including quality of life, symptoms, or survival) and care process outcomes (including communication, symptom identification, or clinical practice). The methodological quality of the evidence was assessed with a modified version of A Measurement Tool to Assess Systematic Reviews 2, and the potential overlap of primary studies was quantified. Results were narratively synthesized. RESULTS Forty reviews grouped into 4 categories of treatment areas were included. Overall, their methodological quality was low. The overall overlap of primary studies was 2.2%, reaching up to 15.7% within specific treatment areas. The results indicate that PROM feedback may enhance the quality-of-care processes, whereas its effects on patient health outcomes remained less conclusive. CONCLUSIONS PROM feedback positively influences the interaction between physicians and patients across the included treatment areas. Further research is needed to comprehend the trickle-down effects of PROM feedback and how to enhance its potential in yielding health benefits for patients.
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Affiliation(s)
- Laura Wittich
- Department of Health Care Management, School of Economics and Management, Technical University Berlin, Berlin, Germany.
| | - Chrissa Tsatsaronis
- Department of Health Care Management, School of Economics and Management, Technical University Berlin, Berlin, Germany
| | - David Kuklinski
- Department of Health Care Management, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Lukas Schöner
- Department of Health Care Management, School of Economics and Management, Technical University Berlin, Berlin, Germany
| | - Viktoria Steinbeck
- Department of Health Care Management, School of Economics and Management, Technical University Berlin, Berlin, Germany
| | - Reinhard Busse
- Department of Health Care Management, School of Economics and Management, Technical University Berlin, Berlin, Germany
| | - Tanja Rombey
- Department of Health Care Management, School of Economics and Management, Technical University Berlin, Berlin, Germany
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Sorah JD, Deal AM, Stein SI, Jonsson M, Innocenti F, Turk A, Boles JC, Irvin W, Basch EM, Sanoff HK, Wood WA. Longitudinal patient-reported outcomes on genotype-guided irinotecan dosing: feasibility and clinical relevance. Oncologist 2024:oyae121. [PMID: 38828490 DOI: 10.1093/oncolo/oyae121] [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: 02/23/2024] [Accepted: 05/02/2024] [Indexed: 06/05/2024] Open
Abstract
INTRODUCTION Standard investigator-based adverse events (AE) assessment is via CTCAE for clinical trials. However, including the patient perspective through PRO (patient-reported outcomes) enhances clinicians' understanding of patient toxicity and fosters early detection of AEs. We assessed longitudinal integration of PRO-CTCAE within clinical workflow in a phase II trial. MATERIALS AND METHODS As a sub-study in a phase II trial of genotype-directed irinotecan dosing evaluating efficacy in patients with metastatic colorectal cancer receiving FOLFIRI and bevacizumab, patients reported on 13 AEs generating a PRO-CTCAE form. The primary objective was to estimate forms completed by patients and clinicians at least 80% of time. Secondary objectives were estimating concordance and time to first score of specific symptoms between patient and clinician pairs. RESULTS Feasibility of longitudinal PRO-CTCAE integration was met as 96% of patients and clinician-patient pairs completed at least 80% of PRO-CTCAE forms available to them with 79% achieving 100% completion. Concordance between patient and clinician reporting a severe symptom was 73% with 24 disconcordant pairs, 21 involved patients who reported a severe symptom that the clinician did not. Although protocol-mandated dose reductions were guided by CTCAE not PRO-CTCAE responses, the median time to dose reduction of 2.53 months, and the time-to-event curve closely approximated time to patient-reported toxicity. CONCLUSION Longitudinal integration of PRO-CTCAE paired CTCAE proved feasible. Compared to clinicians, patients reported severe symptoms more frequently and earlier. Patient-reported toxicity more closely aligned with dose decreases indicating incorporation into routine clinical practice may enhance early detection of toxicity improving patient safety and quality of life.
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Affiliation(s)
- Jonathan D Sorah
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, United States
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, United States
| | - Sophia I Stein
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, United States
| | - Mattias Jonsson
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, United States
| | - Federico Innocenti
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Anita Turk
- Division of Hematology/Oncology, Indiana University, Indianapolis, IN 46202, United States
| | | | - William Irvin
- Bon Secours Cancer Institute, Richmond, VA 23114, United States
| | - Ethan M Basch
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, United States
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Hanna K Sanoff
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, United States
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States
| | - William A Wood
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, United States
- Division of Hematology, Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States
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Young T, Velikova G, Liegl G, Rose M, Nolte S. EORTC QLQ-C30 normative data for the United Kingdom: Results of a cross-sectional survey of the general population. Eur J Cancer 2024; 204:113927. [PMID: 38429166 DOI: 10.1016/j.ejca.2024.113927] [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: 12/18/2023] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE The cancer-specific health-related quality of life (HRQoL) questionnaire of the European Organisation for Research and Treatment of Cancer (EORTC), the EORTC QLQ-C30, is a frequently applied questionnaire to assess cancer patients' self-reported health used as part of research and clinical practice. Normative data obtained from the general population can facilitate the interpretation of these data. Despite its frequent application, no detailed EORTC QLQ-C30 normative data have yet been published for the United Kingdom (UK). This study presents detailed EORTC QLQ-C30 normative data for the United Kingdom overall and by sex and age. METHODS The data are drawn from a larger published, international, cross-sectional online survey. For the recruitment, the sample was stratified by sex (males, females) and age in five age groups with a sample size of n = 100 per subgroup. RESULTS A total of N = 1026 UK respondents completed the survey (n = 517 females, n = 509 males). There were no clear subgroup patterns by sex or age; however, older patients tended to show higher (i.e., better) scores in emotional and social functioning; they also reported some of the lowest (i.e., best) scores for symptoms, such as insomnia, appetite loss, diarrhoea, nausea/vomiting or financial difficulties. CONCLUSION This paper provides EORTC QLQ-C30 general population normative data for the UK, further stratified by sex and age. These data will greatly support the interpretation of EORTC QLQ-C30 scale scores obtained from UK cancer patients, and also enable comparison with other detailed national normative datasets collected in the same project, across several other European countries and the US.
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Affiliation(s)
- Teresa Young
- East & North Hertfordshire NHS Trust including Mount Vernon Cancer Centre, Northwood, Middlesex HA6 2RN, United Kingdom.
| | - Galina Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Gregor Liegl
- Center for Patient-Centered Outcomes Research, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Matthias Rose
- Center for Patient-Centered Outcomes Research, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; German Centre for Mental Health (DZPG) - - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sandra Nolte
- Center for Patient-Centered Outcomes Research, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Melbourne Health Economics, Centre for Health Policy, The University of Melbourne, Melbourne, VIC, Australia; School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
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Haemmerle R, Paludo J, Haddad TC, Pritchett JC. The Growing Role of Digital Health Tools in the Care of Patients with Cancer: Current Use, Future Opportunities, and Barriers to Effective Implementation. Curr Oncol Rep 2024; 26:593-600. [PMID: 38652424 DOI: 10.1007/s11912-024-01534-5] [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] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW This article aims to describe the ways in which digital health technologies are currently being used to improve the delivery of cancer care, highlight opportunities to expand their use, and discuss barriers to effective and equitable implementation. RECENT FINDINGS The utilization of digital health tools and development of novel care delivery models that leverage such tools is expanding. Recent studies have shown feasibility and increased implementation in the setting of oncologic care. With technological advances and key policy changes, utilization of digital health tools has greatly increased over the past two decades and transformed how cancer care is delivered. As digital health tools are expanded and refined, there is potential for improved access to and quality and efficiency of cancer care. However, careful consideration should be given to key barriers of digital health tool adoption, such as infrastructural, patient-level, and health systems-level challenges, to ensure equitable access to care and improvement in health outcomes.
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Affiliation(s)
| | - Jonas Paludo
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Tufia C Haddad
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
- Center for Digital Health, Mayo Clinic, Rochester, USA
| | - Joshua C Pritchett
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
- Department of Oncology, Mayo Clinic, Rochester, MN, USA.
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, 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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Urretavizcaya M, Álvarez K, Olariaga O, Tames MJ, Asensio A, Cajaraville G, Riestra AC. Assessing health outcomes: a systematic review of electronic patient-reported outcomes in oncology. Eur J Hosp Pharm 2024:ejhpharm-2023-004072. [PMID: 38821720 DOI: 10.1136/ejhpharm-2023-004072] [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: 12/18/2023] [Accepted: 05/14/2024] [Indexed: 06/02/2024] Open
Abstract
PURPOSE This study investigates the clinical impact of electronic patient-reported outcome (ePRO) monitoring apps/web interfaces, aimed at symptom-management, in cancer patients undergoing outpatient systemic antineoplastic treatment. Additionally, it explores the advantages offered by these applications, including their functionalities and healthcare team-initiated follow-up programmes. METHODS A systematic literature review was conducted using a predefined search strategy in MEDLINE. Inclusion criteria encompassed primary studies assessing symptom burden through at-home ePRO surveys in adult cancer patients receiving outpatient systemic antineoplastic treatment, whenever health outcomes were evaluated. Exclusion criteria excluded telemedicine-based interventions other than ePRO questionnaires and non-primary articles or study protocols. To evaluate the potential bias in the included studies, an exhaustive quality assessment was conducted, as an additional inclusion filter. RESULTS Among 246 identified articles, 227 were excluded for non-compliance with inclusion/exclusion criteria. Of the remaining 19 articles, only eight met the rigorous validity assessment and were included for detailed examination and data extraction, presented in attached tables. CONCLUSION This review provides compelling evidence of ePRO monitoring's positive clinical impact across diverse cancer settings, encompassing various cancer types, including early and metastatic stages. These systems are crucial in enabling timely interventions and reducing communication barriers, among other functionalities. While areas for future ePRO innovation are identified, the primary limitation lies in comparing clinical outcomes of reviewed articles, due to scale variability and study population heterogeneity. To conclude, our results reaffirm the transformative potential of ePRO apps in oncology and their pivotal role in shaping the future of cancer care.
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Affiliation(s)
| | - Karen Álvarez
- Pharmacy Department, Nuestra Senora de la Candelaria University Hospital, Santa Cruz de Tenerife, Canarias, Spain
| | - Olatz Olariaga
- Pharmacy Department, Onkologikoa, San Sebastian, País Vasco, Spain
| | - Maria Jose Tames
- Pharmacy Department, Onkologikoa, San Sebastian, País Vasco, Spain
| | - Ainhoa Asensio
- Pharmacy Department, Onkologikoa, San Sebastian, País Vasco, Spain
| | | | - Ana Cristina Riestra
- Pharmacy Department, Onkologikoa, San Sebastian, País Vasco, Spain
- Medicine Department, University of Deusto, Bilbao, País Vasco, Spain
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Okuyama H, Takada F, Taira N, Nakamura S. A randomized trial of the impact of symptom monitoring using an electronic patient-reported outcome app on health-related quality of life in postmenopausal breast cancer patients receiving adjuvant endocrine therapy. Breast Cancer 2024:10.1007/s12282-024-01592-4. [PMID: 38796818 DOI: 10.1007/s12282-024-01592-4] [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: 02/11/2024] [Accepted: 05/04/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Electronic patient-reported outcomes (ePRO) monitoring is a useful communication tool for cancer patients and healthcare providers. In this study, we examined the impact of symptom monitoring using an ePRO app on quality of life (QoL) in postmenopausal breast cancer patients receiving adjuvant endocrine therapy. METHODS The free app "Welby My Carte ONC" was used in the study. Patients with breast cancer starting adjuvant endocrine therapy were randomly assigned in a 1:1 ratio to ePRO monitoring (ONC) and control groups. The ONC group reported five symptoms extracted from the Patient-Reported Outcome-Common Terminology Criteria for Adverse Events (PRO-CTCAE) (insomnia, joint pain, headache, anxiety, and hot flashes) weekly for 3 months through the app. Reported symptoms were shared with medical personnel. When serious symptoms were reported, these personnel ascertained the patient's health status and provided advice over the phone. The primary endpoint was QoL measured by the Functional Assessment of Cancer Therapy-Breast (FACT-B) at 3 months from enrollment. Differences between groups were tested using analysis of covariance. RESULTS The study included 125 subjects with mean age of 64 years in the ONC group (n = 61) and 63 years in the control group (n = 64). In the ONC group, the response rate to PRO-CTCAE was about 70% or higher until week 10. The item missing rate was 0. The ONC group reported more symptoms related to joint pain and insomnia. The difference in FACT-B total score between the groups was - 1.55 (95% confidence interval: - 5.91, 2.81), indicating no significant difference. CONCLUSIONS Symptom monitoring using ePRO early after initiation of adjuvant endocrine therapy after surgery did not improve QoL of breast cancer patients.
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Affiliation(s)
- Hiromi Okuyama
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Fuka Takada
- Division of Cancer Genetics and Pharmacotherapy, Department of Clinical Pharmacy, Showa University School of Pharmacy, Tokyo, Japan
| | - Naruto Taira
- Department of Breast and Thyroid Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama, 701-0192, Japan.
| | - Seigo Nakamura
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo, Japan
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Gebert P, Hage AM, Blohmer JU, Roehle R, Karsten MM. Longitudinal assessment of real-world patient adherence: a 12-month electronic patient-reported outcomes follow-up of women with early breast cancer undergoing treatment. Support Care Cancer 2024; 32:344. [PMID: 38740611 PMCID: PMC11090970 DOI: 10.1007/s00520-024-08547-7] [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: 01/10/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Electronic patient-reported outcomes (ePROs) assess patients' health status and quality of life, improving patient care and treatment effects, yet little is known about their use and adherence in routine patient care. AIMS We evaluated the adherence of invasive breast cancer and ductal carcinoma in situ (DCIS) patients to ePROs follow-up and whether specific patient characteristics are related to longitudinal non-adherence. METHODS Since November 2016, the Breast Center at Charité - Universitätsmedizin Berlin has implemented an ongoing prospective PRO routine program, requiring patients to complete ePROs assessments and consent to email-based follow-up in the first 12 months after therapy starts. Frequencies and summary statistics are presented. Multiple logistic regression models were performed to determine an association between patient characteristics and non-adherence. RESULTS Out of 578 patients, 239 patients (41.3%, 95%CI: 37.3-45.5%) completed baseline assessment and all five ePROs follow-up during the first 12 months after therapy. On average, above 70% of those patients responded to the ePROs follow-up assessment. Adherence to the ePROs follow-up was higher during the COVID-19 pandemic than in the time periods before (47.4% (111/234) vs. 33.6% (71/211)). Factors associated with longitudinal non-adherence were younger age, a higher number of comorbidities, no chemotherapy, and a low physical functioning score in the EORTC QLQ-C30 at baseline. CONCLUSIONS The study reveals moderate adherence to 12-month ePROs follow-up assessments in invasive early breast cancer and DCIS patients, with response rates ranging from 60 to 80%. Emphasizing the benefits for young patients and those with high disease burdens might further increase adherence.
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Affiliation(s)
- Pimrapat Gebert
- Berlin Institute of Health at Charité -Universitätsmedizin Berlin, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Maria Hage
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Roehle
- Berlin Institute of Health at Charité -Universitätsmedizin Berlin, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Maria Margarete Karsten
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Huberts AS, Vrancken Peeters NJMC, Pastoor H, Paez CG, Koppert LB. Let's talk about sex! Why should healthcare professionals address sexual distress in breast cancer patients and survivors? Eur J Oncol Nurs 2024; 71:102606. [PMID: 38909440 DOI: 10.1016/j.ejon.2024.102606] [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: 11/10/2023] [Revised: 04/26/2024] [Accepted: 05/06/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE Sexual distress impacts the quality of life (QoL) of breast cancer patients but is often overlooked in standard care pathways. This study evaluated the prevalence and factors of sexual distress among Dutch breast cancer patients, compared them to the general population, and explored how sexual distress is discussed in clinical settings from the perspectives of patients and healthcare professionals (HCPs). METHODS Questionnaires containing the Female Sexual Distress Scale (FSDS) and demographic variables were distributed to women with breast cancer. The effect of breast cancer on sexual distress was assessed with a Mann-Whitney U test. Multivariable linear regression was used to analyze variables associated with FSDS. The Sexuality Attitudes and Beliefs Survey (SABS) was sent to HCPs. RESULTS Breast cancer patients reported significantly higher sexual distress compared to a Dutch non-breast cancer cohort, respectively 16.38 (SD 11.81) and 23.35 (SD 11.39). Factors associated with higher sexual distress were psychological comorbidities, the body image scale, and being diagnosed >10 years ago. Sexual distress was not discussed as often as patients needed. Barriers to addressing sexual distress were time constraints, HCPs' confidence in their ability to address sexual distress, and uncertainty about who is responsible for initiation. CONCLUSIONS Breast cancer patients showed significantly higher sexual distress compared to the Dutch population. However, it was not frequently addressed in the consultation room. While some barriers have been identified, this study highlights the importance of further exploring obstacles to integrating discussions about sexual distress into routine care to improve QoL of breast cancer patients.
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Affiliation(s)
- Anouk S Huberts
- Department of Quality and Patientcare, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Noëlle J M C Vrancken Peeters
- Academic Breast Cancer Center, Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hester Pastoor
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Cristina Guerrero Paez
- Dutch Breast Cancer Society (BVN), Godebaldkwartier 363, 3511 DTR, Utrecht, the Netherlands
| | - Linetta B Koppert
- Department of Quality and Patientcare, Erasmus University Medical Center, Rotterdam, the Netherlands; Academic Breast Cancer Center, Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
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11
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Strother M, Barlotta R, Uzzo R, Bloom E, Jazayeri SB, Bigalli AC, Schober J, Lee J, Bernstein A, Ginsburg K, Handorf E, Chen DY, Correa A, Greenberg R, Smaldone M, Viterbo R, Kutikov A. Symptomatic and functional recovery after transurethral resection of bladder tumor: Data from ecological momentary symptom assessment. Urol Oncol 2024; 42:117.e1-117.e10. [PMID: 38369443 PMCID: PMC11166544 DOI: 10.1016/j.urolonc.2023.12.007] [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: 07/04/2023] [Revised: 11/12/2023] [Accepted: 12/11/2023] [Indexed: 02/20/2024]
Abstract
OBJECTIVES To quantitatively describe the nature, severity, and duration of symptoms and functional impairment during recovery from transurethral resection of bladder tumors. MATERIALS AND METHODS All patients scheduled for transurethral resection were approached for enrollment in a text-message based ecological momentary symptom assessment platform. Nine patients reported outcomes were measured 7 days before surgery and on postoperative days 1, 2, 3, 5, 7, 10, and 14 using a 5-point Likert scale. Self-reported degree of hematuria was collected using a visual scale. Clinical data was collected via retrospective chart review. RESULTS A total of 159 patients were analyzed. Postoperative symptoms were overall mild, with the largest differences from baseline to postoperative day 1 seen in dysuria (median 0/5 vs. 3/5) and ability to work (median 5/5 vs. 4/5). Recovery was generally rapid, with 76% of patients reporting ≥4/5 agreement with the statement "I feel recovered from surgery" by postoperative day 2, although 15% of patients reported persistently lower levels of agreement on postoperative day 10 or 14. Patients undergoing larger resections (≥2cm) did take longer to return to baseline in multiple symptom domains, but the difference of medians vs. those undergoing smaller resections was less than 1 day across all domains. Multivariable analysis suggested that receiving perioperative intravesical chemotherapy was associated with longer time to recovery. 84% of patients reported clear yellow urine by postoperative day 3. CONCLUSION In this population, hematuria and negative effects on quality of life resulting from transurethral resection of bladder tumors were generally mild and short-lived, although a small number of patients experienced longer recoveries.
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Affiliation(s)
| | - Ryan Barlotta
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - Robert Uzzo
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - Evan Bloom
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - Seyed B Jazayeri
- Department of Urology, University of Florida Jacksonville, Jacksonville, FL
| | | | - Jared Schober
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - Jennifer Lee
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Adrien Bernstein
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - Kevin Ginsburg
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - Elizabeth Handorf
- Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, PA
| | - David Yt Chen
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - Andres Correa
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | | | - Marc Smaldone
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - Rosalia Viterbo
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
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12
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Dawkins B, Absolom K, Hewison J, Warrington L, Hudson E, Holch P, Carter R, Gibson A, Holmes M, Rogers Z, Dickinson S, Morris C, Woroncow B, Brown J, Hulme C, Velikova G. Cost-Effectiveness of eRAPID eHealth Intervention for Symptom Management During Chemotherapy. JCO Oncol Pract 2024; 20:581-590. [PMID: 38266205 DOI: 10.1200/op.23.00498] [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: 08/09/2023] [Revised: 10/06/2023] [Accepted: 12/05/2023] [Indexed: 01/26/2024] Open
Abstract
PURPOSE A randomized controlled trial of online symptom monitoring during chemotherapy with electronic patient self-Reporting of Adverse-events: Patient Information and aDvice (eRAPID) system found improved symptom control and patient self-efficacy, without increasing hospital admissions and visits. The aim of this study was to evaluate the cost-effectiveness of the eRAPID eHealth intervention compared with usual care for patients receiving systemic treatment for colorectal, breast, or gynecologic cancers in the United Kingdom. METHODS An embedded economic evaluation was conducted alongside the trial evaluating the effectiveness of eRAPID from health care provider and societal perspectives. Costs and quality-adjusted life-years (QALYs) of patients were compared over 18 weeks of the trial. Incremental cost-effectiveness ratios (ICERs) were estimated and compared with the National Institute for Health and Care Excellence cost-effectiveness threshold. Uncertainty around the ICER was explored using nonparametric bootstrapping and sensitivity analyses. Follow-up data were collected 12-months after random assignment for a subset of the study sample to conduct exploratory analysis of potential longer-term effects. RESULTS Patients in the eRAPID group had the highest QALY gain and lowest costs over 18 weeks. Although differences were small and not statistically significant, eRAPID had a 55%-58% probability of being more cost-effective than usual care. Patient out-of-pocket costs were lower in the eRAPID group, indicating eRAPID may help patients access support needed within the National Health Service. Exploratory 12-months analysis showed small differences in costs and QALYs, with higher QALY gains in the eRAPID group but also higher costs. Exploratory subgroup analysis by disease status indicated that the eRAPID intervention was cost-effective for patients with early-stage cancers but not for patients with metastatic disease. CONCLUSION Despite small differences in QALYs and costs, the analyses show potential cost-effectiveness of online symptom monitoring, when added to usual care, particularly during adjuvant systemic treatment for early-stage cancers.
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Affiliation(s)
- Bryony Dawkins
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Kate Absolom
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Jenny Hewison
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Lorraine Warrington
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Eleanor Hudson
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Patricia Holch
- Psychology, School of Humanities and Social Sciences, City Campus, Leeds Beckett University, Leeds, United Kingdom
| | - Robert Carter
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Andrea Gibson
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
- Psychology, School of Humanities and Social Sciences, City Campus, Leeds Beckett University, Leeds, United Kingdom
| | - Marie Holmes
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Zoe Rogers
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Sarah Dickinson
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Carolyn Morris
- Independent Cancer Patients Voices, Brighton, United Kingdom
| | - Barbara Woroncow
- Research Advisory Group to Patient-Centred Outcomes Research at Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Julia Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Claire Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
- Department of Health & Community Science, University of Exeter, St Luke's Campus, Exeter, United Kingdom
| | - Galina Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
- Psychology, School of Humanities and Social Sciences, City Campus, Leeds Beckett University, Leeds, United Kingdom
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13
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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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14
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Dou A, Bouchard-Fortier G, Han K, Milosevic M, Lukovic J, L’heureux S, Li X, Doherty MC, Croke J. Utilization and Impact of a Radiation Nursing Clinic to Address Acute Care Needs for Patients with Gynecologic Cancers. Curr Oncol 2024; 31:1645-1655. [PMID: 38534958 PMCID: PMC10969712 DOI: 10.3390/curroncol31030125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The risk factors for acute care utilization in gynecologic oncology patients are poorly understood. This study aimed to evaluate risk factors for the utilization of our centre's acute care radiation nursing clinic (RNC) by gynecologic oncology patients receiving radiotherapy (RT). METHODS This was a retrospective cohort study of gynecological cancer patients treated with RT at an academic cancer centre between 1 August 2021 and 31 January 2022. Data on socio-demographics, clinical and treatment characteristics, and RNC visits were collected and summarized by descriptive statistics. The Wilcoxon rank sum test and chi-squared test/Fisher's exact test were used for comparisons of continuous and categorical variables, respectively. RESULTS RT was delivered to 180 patients, of whom 42 (23%) received concurrent chemoradiation (CCR). Compared to those receiving RT alone, patients receiving CCR had higher rates of RNC utilization (55% vs. 19%, p < 0.001). Within the CCR cohort, patients who presented to the RNC were more likely to be unpartnered (43% vs. 11%, p = 0.04), receive a referral to Psychosocial Oncology (39% vs. 5.3%, p = 0.01), and experience treatment interruptions (52% vs. 16%, p = 0.02). There were no associations between RNC visits and age, disease site, or distance from the cancer centre. CONCLUSIONS The receipt of CCR and specific psychosocial risk factors were associated with increased RNC utilization. Targeted strategies and early intervention to better meet the supportive care and psychosocial needs of this vulnerable population are needed.
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Affiliation(s)
- Aaron Dou
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Genevieve Bouchard-Fortier
- Department of Gynecologic Oncology, Princess Margaret Hospital Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Kathy Han
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Michael Milosevic
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Jelena Lukovic
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Stephanie L’heureux
- Department of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Xuan Li
- Department of Biostatistics, Princess Margaret Hospital Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Mary C. Doherty
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Jennifer Croke
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, ON M5G 2M9, Canada
- Department of Gynecologic Oncology, Princess Margaret Hospital Cancer Centre, Toronto, ON M5G 2M9, Canada
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15
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Donhauser T, Gabes M, Özkan E, Masur C, Kamudoni P, Salek S, Abels C, Apfelbacher C. What do Hyperhidrosis Quality of Life Index (HidroQoL©) scores mean? Transferring science into practice by establishing a score banding system. Br J Dermatol 2024; 190:519-526. [PMID: 38015827 DOI: 10.1093/bjd/ljad444] [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: 03/03/2023] [Revised: 09/04/2023] [Accepted: 11/05/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND The Hyperhidrosis Quality of Life Index (HidroQoL©) is a measure of quality of life (QoL) impacts in hyperhidrosis (HH). OBJECTIVES We aimed to establish score banding systems for the HidroQoL total score for specific contexts representing different severity/impact categories by using the Dermatology Life Quality Index (DLQI) and the Hyperhidrosis Disease Severity Scale (HDSS) as anchors, including data from 357 patients from a phase III clinical trial. METHODS We used the HDSS, the established DLQI score bands and two single items (items 5 and 7) of the DLQI as anchors for the creation of banding systems for the HidroQoL. These anchors were chosen via consensus among an expert group according to relevance to patient experience. Due to the distribution of the HDSS and the single DLQI item 7, receiver operating characteristic curves were computed in order to create an optimal cut-off value of the HidroQoL total score. For the DLQI banding system and the single DLQI item 5, we created a banding system for the HidroQoL based on the distribution of their different categories. RESULTS A score of 30 and greater is proposed as the cut-off value for sweating that 'always interferes in daily activities', based on the HDSS as anchor. In terms of overall skin QoL effects, score bands of 0-6, 7-18, 19-25, 26-32 and 33-36 represent 'no effect', 'small effect', 'moderate effect', 'very large effect' and 'extremely large effect' on the patient's life, respectively. CONCLUSIONS In this study, we propose different banding systems for four different contexts: skin-specific QoL (DLQI banding), HH severity (HDSS), working and studying (single DLQI item 7) and social and leisure activities (single DLQI item 5). These banding systems and cut-off values can be used in clinical research and practice to place the patients in different severity categories.
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Affiliation(s)
- Theresa Donhauser
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- University of Regensburg, Regensburg, Germany
| | - Michaela Gabes
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Ebru Özkan
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- University of Regensburg, Regensburg, Germany
| | - Clarissa Masur
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany
| | | | - Sam Salek
- School of Life and Medical Sciences, University of Hertfordshire, UK
- Institute of Medicines Development, Cardiff, UK
| | - Christoph Abels
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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16
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Taira N, Kikawa Y, Iwamoto T, Miyoshi Y, Hara K, Yoshitomi S, Hikino H, Takahashi H, Takabatake D, Kubo S, Ikeda M, Doihara H, Shien T, Okuyama H, Tanabe Y, Hara F, Yamanouchi K, Hagiwara Y, Sawaki M. Pilot trial of an electronic patient-reported outcome monitoring system in patients with metastatic breast cancer undergoing chemotherapy. Breast Cancer 2024; 31:283-294. [PMID: 38175422 DOI: 10.1007/s12282-023-01537-3] [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: 10/03/2023] [Accepted: 12/09/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Electronic patient-reported outcomes monitoring (ePROM) is a useful communication tool for patients and healthcare providers in cancer chemotherapy. In this study, we examined the feasibility of our newly developed ePROM system, which we refer to as "Hibilog". METHODS An ePROM app was developed by extracting 18 items from the Patient-Reported Outcome-Common Terminology Criteria for Adverse Events (PRO-CTCAE). Symptom monitoring was conducted every two weeks for patients with metastatic breast cancer undergoing chemotherapy. The primary outcome was the response rate to the ePROM system. The secondary outcomes were response time, item missing rate, and distribution of responses for each symptom. RESULTS A total of 71 cases (mean age 52.6 years) were analyzed. Performance status was 0 in 76% of the cases and 1 or higher in 24%. First-line treatment was being administered in 30% of cases, second-line treatment in 17%, and third-line or higher treatment in 53%. The response rate to the ePROM system from registration to week 40 remained high at around 80%, indicating good compliance. The average response time was 5.5 min and the missing rate for each item was below 0.4%. Among 1,093 responses, the top 3 symptoms causing interference with daily life were Fatigue (63%), Numbness and tingling (48%), and General pain (46%). CONCLUSION Our developed ePROM system was able to capture symptoms accurately in patients with metastatic breast cancer undergoing chemotherapy while maintaining a high response compliance.
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Affiliation(s)
- Naruto Taira
- Department of Breast and Thyroid Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama, 701-0192, Japan.
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan.
| | - Yuichiro Kikawa
- Department of Breast Surgery, Kansai Medical University Hospital, Osaka, Japan
| | - Takayuki Iwamoto
- Department of Breast and Thyroid Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama, 701-0192, Japan
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Yuichiro Miyoshi
- Department of Breast and Endocrine Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Kyoko Hara
- Department of Breast and Endocrine Surgery, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Seiji Yoshitomi
- Department of Breast and Endocrine Surgery, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Hajime Hikino
- Department of Breast Surgery, Japanese Red Cross Matsue Hospital, Matsue, Japan
| | - Hirotoshi Takahashi
- Department of Breast and Endocrine Surgery, National Hospital Organization Fukuyama Medical Centre, Fukuyama, Japan
| | - Daisuke Takabatake
- Department of Breast Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Shinichiro Kubo
- Department of Breast and Thyroid Surgery, Fukuyama City Hospital, Fukuyama, Japan
| | - Masahiko Ikeda
- Department of Breast and Thyroid Surgery, Fukuyama City Hospital, Fukuyama, Japan
| | - Hiroyoshi Doihara
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
- Department of Surgery, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Tadahiko Shien
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Hiromi Okuyama
- Advanced Cancer Translational Research Institute, Showa University, Tokyo, Japan
| | - Yuko Tanabe
- Department of Clinical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Fumikata Hara
- Department of Breast Medical Oncology, Japanese Foundation for Cancer Research Cancer Institute Hospital, Tokyo, Japan
| | - Kosho Yamanouchi
- Department of Breast and Endocrine Surgery, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Yasuhiro Hagiwara
- Department of Biostatistics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Masataka Sawaki
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
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17
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Bultijnck R, Van Hemelrijck M, Fonteyne V, Livi L, Jereczek-Fossa BA, Hemmatazad H, Mayinger M, Peulen H, Verbeke L, Ramella S, Castro P, Tsoutsou P, Stellamans K, Shaukat A, Orazem M, Jeene P, Braam P, Verkooijen H, Simek IM, Alongi F, Clementel E, Fortpied C, Machingura A, Boakye Oppong F, Guckenberger M, Ost P. Health-related quality of life in men with oligometastatic prostate cancer following metastases-directed stereotactic body radiotherapy: Real-world data from the E 2-RADIatE OligoCare cohort. Clin Transl Radiat Oncol 2024; 45:100715. [PMID: 38274388 PMCID: PMC10808936 DOI: 10.1016/j.ctro.2023.100715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 01/27/2024] Open
Abstract
Objective To evaluate the impact of metastases-directed stereotactic body radiotherapy (SBRT) on health-related quality of life (HRQoL) in men with oligometastatic prostate cancer (PCa) using real-world data from the OligoCare cohort. Materials and methods OligoCare is a pragmatic, observational cohort designed to assess the impact of metastases-directed SBRT on patients with oligometastatic disease (OMD). We report an interim analyses of the secondary endpoint HRQoL, assessed using the EORTC QLQ-C30, within six months of metastases-directed SBRT for oligometastatic disease in men with PCa among the first 1600 registered patients. HRQoL data collection was optional within the OligoCare cohort. To compare HRQoL between baseline and first follow-up assessment, a Wilcoxon signed-rank test was used. A multiple linear regression model was used to explore the HRQoL associations with predefined factors. Results Out of the 1600 registered patients, 658 were treated for oligometastatic PCa, of which 233 had baseline QoL data and 132 patients had both baseline and follow-up HRQoL data. At baseline, most patients had a WHO performance status of 0 or 1 (87 %), were de-novo oligometastatic (79 %), had one metastasis (90 %), and had a good overall global health status (mean 80.81, SD16.11, IQR 75-92). 51 % received hormonal therapy as concomitant systemic treatment. Patients with comorbidities as assessed by the Charlson Comorbidity index had a worse global health status at baseline (-4.88, 95 % CI:-9.35, -0.42). No clinically meaningful significant difference in global health status was observed at first assessment following SBRT (median 3.0 months) compared with baseline (mean difference 2.27, 95 % CI:-1.54, 6.08). Upon evaluating the proportions, meaningful clinically important differences (a 10-point or more difference) was observed in, 17 % and 11 % of the patients reporting deterioration and improvement of global health status, respectively. Conclusion Metastases-directed stereotactic body radiotherapy had no negative impact on global HRQoL within the first six months after treatment.
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Affiliation(s)
- Renée Bultijnck
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Mieke Van Hemelrijck
- School of Cancer and Pharmaceutical Studies, Translational Oncology and Urology Research (TOUR), King's College London, London, UK
| | - Valérie Fonteyne
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences M Serio, University of Florence, Florence, Italy
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Barbara Alicja Jereczek-Fossa
- Dept. of Oncology and Hemato-oncology, University of Milan, Milan, Italy
- Dept. of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Hossein Hemmatazad
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Michael Mayinger
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Heike Peulen
- Catharina Ziekenhuis, Radiation Oncology, Eindhoven, the Netherlands
| | - Luc Verbeke
- Onze-Lieve-Vrouw Ziekenhuis, Radiation Oncology, Aalst, Belgium
| | - Sara Ramella
- Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy
- Research Unit of Radiation Oncology, Department of Medicine and Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Pablo Castro
- Health Research Institute Hospital Universitario de La Princesa
| | - Pelagia Tsoutsou
- Hôpitaux universitaires de Genève - HUG - site de Cluse-Roseraie, Genève, Switzerland
| | | | - Adnan Shaukat
- NHS Grampian - Aberdeen Royal Infirmary, Aberdeen, Scotland
| | - Miha Orazem
- Institute of Oncology, Division of Radiation Oncology, Ljubljana, Slovenia and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Paul Jeene
- Radiotherapiegroep, Deventer, the Netherlands
| | - Pètra Braam
- Radboud University Medical Center Nijmegen, Radiation Oncology, Nijmegen, the Netherlands
| | | | - Inga-Malin Simek
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Filippo Alongi
- IRCCS Sacro Cuore Don Calabria Hospital & University of Brescia, Radiation Oncology, Verona, Italy
| | - Enrico Clementel
- European Organisation for Research and Treatment of Cancer (EORTC), Headquarters, Brussels, Belgium
| | - Catherine Fortpied
- European Organisation for Research and Treatment of Cancer (EORTC), Headquarters, Brussels, Belgium
| | - Abigirl Machingura
- European Organisation for Research and Treatment of Cancer (EORTC), Headquarters, Brussels, Belgium
| | - Felix Boakye Oppong
- European Organisation for Research and Treatment of Cancer (EORTC), Headquarters, Brussels, Belgium
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Piet Ost
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Iridium Network, Radiation Oncology, Wilrijk, Belgium
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Faye M, Manneville F, Faye A, Frimat L, Guillemin F. Quality-of-life measures and their psychometric properties used in African chronic kidney disease populations: a systematic review using COSMIN methodology. BMC Nephrol 2024; 25:50. [PMID: 38331827 PMCID: PMC10854046 DOI: 10.1186/s12882-024-03482-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND If any benefit is to be derived from the use of the health-related quality of life (HRQoL) questionnaires in chronic kidney disease (CKD) patients, they should be validated and culturally adapted to the target population. We aimed to critically appraise the psychometric properties of HRQoL questionnaires used in African populations with CKD. METHODS Web of Science, Embase, PubMed and PsycINFO databases were searched. Psychometric validation studies of HRQoL questionnaires reporting at least one psychometric property of the COSMIN checklist in CKD African population, published up to October 16, 2023 were included and independently assessed for methodological quality and level of measurement properties by using the COSMIN methodology. RESULTS From 1163 articles, 5 full-text were included. Only the Kidney Disease Quality-of-Life questionnaire was translated and cross-culturally adapted for studies of patients with CKD. Internal consistency was of doubtful quality in 4 studies and very good in 1. Its measurement was sufficient in 1 study and insufficient in 4. Test-retest reliability was of doubtful quality in 4 studies. Its measurement was sufficient in 3 studies and insufficient in 1. Structural validity was of inadequate quality in 1 study and very good quality in 1. Its measurement was sufficient in both. Construct validity was of inadequate quality in all studies. Their measurement was insufficient in 4 studies and sufficient in 1. CONCLUSIONS This review highlighted that only one HRQoL questionnaire used in studies of African populations with CKD underwent a small number of cultural adaptations and psychometric validations, generally of poor methodological quality. HRQoL validation studies in African CKD populations are needed to better take advantage of the benefits in patient care, population health management, and research.
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Affiliation(s)
- Moustapha Faye
- Service de Néphrologie, CHU Aristide Le Dantec, Université Cheikh Anta Diop, Dakar, Sénégal.
- Université de Lorraine, APEMAC, Nancy, France.
| | - Florian Manneville
- Université de Lorraine, APEMAC, Nancy, France
- CHRU-Nancy, INSERM, Université de Lorraine, CIC Epidémiologie Clinique, Nancy, 54000, France
| | - Adama Faye
- Institut Santé Et Développement (ISED), Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Luc Frimat
- Université de Lorraine, APEMAC, Nancy, France
- Service de Néphrologie, CHRU-Nancy Brabois Santé, Vandœuvre-lès-Nancy, France
| | - Francis Guillemin
- Université de Lorraine, APEMAC, Nancy, France
- CHRU-Nancy, INSERM, Université de Lorraine, CIC Epidémiologie Clinique, Nancy, 54000, France
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Rosenberg T, Kirkegaard J, Tveden MG, Hyldig N, Dieperink KB, Steffensen NH, Ulriksen SB, Lund T. Making decisions for follow-up chemotherapy based on digital patient reported outcomes data in patients with multiple myeloma and other M protein diseases - A mixed method study. Eur J Oncol Nurs 2024; 68:102455. [PMID: 37984313 DOI: 10.1016/j.ejon.2023.102455] [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: 08/08/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES To test if Patient Reported Outcomes (PRO) data can replace physical on-site consultation in determining if patients with multiple myeloma, AL amyloidosis, or plasma cell leukemia are ready for their next bortezomib treatment without dose reduction. METHODS We developed an online questionnaire addressing common side effects to bortezomib and an algorithm stratifying patients according to their responses and asked them to complete the questionnaire the day before attending the clinic. Applying a mixed-method study design of PRO data, time registrations, and interviews with patients and healthcare professionals, we tested the usability of electronic PRO data forming the basis of decision-making on whether patients are physically fit for the next treatment with an unchanged dose. RESULTS The questionnaire and the associated algorithm were able to identify patients who were physically fit for treatment without need for further consultation, with a positive predictive value of 98 %. The method proved to be feasible for all groups of patients regardless of age and educational level. Patients and healthcare professionals found the online questionnaire to be advantageous and flexible. CONCLUSION The use of PRO data to evaluate patients prior to bortezomib treatment is safe and feasible. Patients prefer to report their side effects themselves as it provides them with more freedom during their treatment.
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Affiliation(s)
- Tine Rosenberg
- Department of Hematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, 5000, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, DK-5000, Odense C, Denmark.
| | - Jannie Kirkegaard
- Department of Hematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, 5000, Odense C, Denmark
| | - Michael Gundesen Tveden
- Department of Hematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, 5000, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, DK-5000, Odense C, Denmark
| | - Nana Hyldig
- Department of Hematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, 5000, Odense C, Denmark; Research Unit of Oncology, The Academy of Geriatric Cancer Research (www.agecare.org) Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark
| | - Karin Brochstedt Dieperink
- Research Unit of Oncology, The Academy of Geriatric Cancer Research (www.agecare.org) Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, DK-5000, Odense C, Denmark
| | - Nanna Hanneberg Steffensen
- Department of Hematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, 5000, Odense C, Denmark
| | - Stine Brøgger Ulriksen
- Department of Hematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, 5000, Odense C, Denmark
| | - Thomas Lund
- Department of Hematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, 5000, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, DK-5000, Odense C, Denmark
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Rose SW, Highland KB, Kelkar AA. Clinical Utility of Patient-Reported Outcome Instruments in the Management of Pulmonary Hypertension: A Systematic Review. JACC. HEART FAILURE 2024; 12:366-376. [PMID: 37897461 DOI: 10.1016/j.jchf.2023.09.008] [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: 04/05/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Despite the greater sensitivity and specificity of disease-specific patient-reported outcome measures (PROM) to detect clinical change, only recently have such instruments been developed for pulmonary hypertension (PH), specifically pulmonary arterial hypertension (PAH) and chronic thromboembolic disease (CTEPH). Although these valuable tools are now being incorporated into clinical studies of PH, they have not yet reached widespread integration into routine clinical care. OBJECTIVES In this systematic review, the authors assess the psychometric properties of PROM developed for PH, compare PROM with other clinical outcomes in PH, and address the utility of PROM in clinical care. METHODS The authors performed a systematic search of papers published between January 1, 2006, and October 1, 2022, using the MEDLINE database to identify PROM developed and validated for PH. The identified PROM were found to have been developed only in groups with PAH and CTEPH. The authors evaluated the identified instruments according to established psychometric criteria. An additional search was performed to identify randomized controlled trials (RCTs) utilizing these PROM for comparison with clinical outcomes. RESULTS From 527 papers retrieved, a total of 35 PROM were identified. Of these, 5 disease-specific instruments were included in the final analysis. While both CAMPHOR (Cambridge Pulmonary Hypertension Outcome Review) and emPHasis-10 performed well in patients with PAH and CTEPH with regard to their psychometric properties, emPHasis-10 demonstrated superior feasibility for use in clinical practice due to its concise format. The Pulmonary Arterial Hypertension-Symptoms and Impacts Questionnaire performed well in the authors' analysis, though additional data is needed regarding interpretability and feasibility. CONCLUSIONS EmPHasis-10 demonstrated strong psychometric properties and the greatest feasibility for clinical use. Further study assessing the integration of PROM into routine clinical care for PH is needed.
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Affiliation(s)
- Scott W Rose
- Sections of Critical Care and Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
| | | | - Anita A Kelkar
- Section of Cardiovascular Medicine, Department of Veterans Affairs, Kernersville, North Carolina, USA.
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21
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Wicki S, Clark IC, Amann M, Christ SM, Schettle M, Hertler C, Theile G, Blum D. Acceptance of Digital Health Technologies in Palliative Care Patients. Palliat Med Rep 2024; 5:34-42. [PMID: 38249831 PMCID: PMC10797306 DOI: 10.1089/pmr.2023.0062] [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: 11/28/2023] [Indexed: 01/23/2024] Open
Abstract
Background Digital health technologies have potential to transform palliative care (PC) services. The global aging population poses unique challenges for PC, which digital health technologies may help overcome. Evaluation of attitudes and perceptions combined with quantification of prior use habits favor an understanding of psychological barriers to PC patient acceptance of digital health technologies including artificial intelligence (AI). Objectives We aimed to evaluate the attitudes and perceptions of PC patients regarding a broad range of digital health technologies used in their routine monitoring and treatment and identify barriers to use. Methods We used a 39-item questionnaire to evaluate acceptance and use of smartphone-based electronic patient report outcome measures, wearables, AI, data privacy, and virtual reality (VR) in 29 female and male PC inpatients. Results A majority of patients indicated an interest in (69.0%) and positive attitude toward (75.9%) digital health technologies. Nearly all (93.1%) patients believe that digital health technologies will become more important in medicine in the future. Most patients would consider using their smartphone (79.3%) or wearable (69.0%) more often for their health. The most feasible technologies were smartphones, wearables, and VR. Barriers to acceptance included unfamiliarity, data security, errors in data interpretation, and loss of personal interaction through AI. Conclusion In this patient survey, acceptance of new technologies in a PC patient population was high, encouraging its use also at the end-of-life.
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Affiliation(s)
- Stefan Wicki
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Ian C. Clark
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
- Department of Radiation Oncology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Manuel Amann
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Sebastian M. Christ
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
- Department of Radiation Oncology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Markus Schettle
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Caroline Hertler
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Gudrun Theile
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - David Blum
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
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Maas A, Maurice-Stam H, van den Heuvel MH, Koopman MMW, den Hartogh JG, Kremer LCM, Grootenhuis M. Monitoring health related quality of life in survivorship care of young adult survivors of childhood cancer using web-based patient-reported outcome measures: survivors' and health care practitioners' perspectives on the KLIK method. Qual Life Res 2024; 33:145-156. [PMID: 37615734 PMCID: PMC10784327 DOI: 10.1007/s11136-023-03504-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] [Accepted: 08/09/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE The KLIK method is a tool to systematically monitor and discuss Health Related Quality of Life (HRQOL) in clinical practice. It has been successfully used in clinical practice in The Netherlands, and has recently been implemented in survivorship care for young adult childhood cancer survivors (CCSs). This study evaluates implementation fidelity and satisfaction of CCSs and healthcare practitioners (HCPs) with the KLIK method in survivorship care. METHODS CCSs' HRQOL was monitored using the KLIK questionnaire (PedsQL generic 18-30 years). In a mixed-methods design, implementation fidelity was based on registrations, and user satisfaction was assessed with evaluation surveys (CCSs) and semi-structured interviews (CCSs, HCPs). Descriptive statistics and qualitative analysis methods were used. RESULTS A total of 245 CCSs were eligible for the study. Fidelity was 79.2% (194/245) for registration in the KLIK PROM portal, 89.7% (174/194) for completed KLIK questionnaires, 74.7% (130/174) for its discussion during consultation. Of the eligible CCSs, 17.6% (43/245) completed the study evaluation survey. Five CCSs and HCPs were invited for an interview and participated. CCSs (7.7/10) and HCPs (7.5/10) were satisfied with the KLIK method. Reported facilitators included increased insight into CCSs' functioning, improved preparation before, and communication during consultation, without lengthening consultation duration. Barriers included CCSs not always completing KLIK questionnaires, incomplete content of the KLIK questionnaire, and the need for customization for CCSs with cognitive disabilities. CONCLUSION The KLIK method is a feasible and valuable tool to systematically monitor and discuss HRQOL in survivorship care. Integration of the KLIK method within the organization is essential, with structural support in reminding CCSs to complete questionnaires.
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Affiliation(s)
- Anne Maas
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.
| | - Heleen Maurice-Stam
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Marloes H van den Heuvel
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Maria M W Koopman
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Jaap G den Hartogh
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Vereniging Kinderkanker Nederland, De Bilt, The Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Martha Grootenhuis
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
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Wulczyn KE, Forfang D, Kalim S. Symptom Science in Kidney Disease. ADVANCES IN KIDNEY DISEASE AND HEALTH 2024; 31:13-20. [PMID: 38403388 DOI: 10.1053/j.akdh.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/07/2023] [Indexed: 02/27/2024]
Abstract
Physical and emotional symptoms are highly prevalent among patients with kidney disease and are directly linked to impaired health-related quality of life. Symptom science is a field of research aimed at advancing knowledge of the holistic mechanisms driving symptoms, how best to assess symptoms accurately, and developing novel and patient-centered approaches to symptom management. Patients with kidney disease have identified symptom science as a top research priority, and opportunities abound for ongoing patient engagement in symptom-related research efforts and clinical care. This review describes the burden of symptoms experienced by patients with kidney disease, explores the spectrum of patient engagement in symptom care and research, and discusses approaches for symptom assessment and management, taking into consideration the multitude of factors that may contribute to symptoms.
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Affiliation(s)
- Kendra E Wulczyn
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Derek Forfang
- National Forum of ESRD Networks Kidney Patient Advisory Council, Burlingame, CA; National Kidney Foundation Public Policy Committee, New York, NY
| | - Sahir Kalim
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
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Paudel R, Tramontano AC, Cronin C, Wong SL, Dizon DS, Jenkins HH, Bian J, Osarogiagbon RU, Schrag D, Hassett MJ. Assessing Patient Readiness for an Electronic Patient-Reported Outcome-Based Symptom Management Intervention in a Multisite Study. JCO Oncol Pract 2024; 20:77-84. [PMID: 38011613 PMCID: PMC10827290 DOI: 10.1200/op.23.00339] [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: 06/05/2023] [Revised: 09/08/2023] [Accepted: 10/16/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE While the use of electronic patient-reported outcomes (ePROs) in routine clinical practice is increasing, barriers to patient engagement limit adoption. Studies have focused on technology access as a key barrier, yet other characteristics may also confound readiness to use ePROs including patients' confidence in using technology and confidence in asking clinicians questions. METHODS To assess readiness to use ePROs, adult patients from six US-based health systems who started a new oncology treatment or underwent a cancer-directed surgery were invited to complete a survey that assessed access to and confidence in the use of technology, ease of asking clinicians questions about health, and symptom management self-efficacy. Multivariable ordinal logistic regression models were fit to assess the association between technology confidence, ease of asking questions, and symptom management self-efficacy. RESULTS We contacted 3,212 individuals, and 1,043 (33%) responded. The median age was 63 years, 68% were female, and 75% reported having access to patient portals. Over 80% had two or more electronic devices. Most patients reported high technology confidence, higher ease of asking clinicians questions, and high symptom management self-efficacy (n = 692; 66%). Patients with high technology confidence also reported higher ease of asking nurses about their health (adjusted odds ratio [AOR], 4.58 [95% CI, 2.36 to 8.87]; P ≤ .001). Those who reported higher ease of asking nurses questions were more likely to report higher confidence in managing symptoms (AOR, 30.54 [95% CI, 12.91 to 72.30]; P ≤ .001). CONCLUSION Patient readiness to use ePROs likely depends on multiple factors, including technology and communication confidence, and symptom management self-efficacy. Future studies should assess interventions to address these factors.
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Affiliation(s)
| | | | | | | | - Don S. Dizon
- Lifespan Cancer Institute and Brown University, Providence, RI
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Dobrijevic E, Scholes-Robertson N, Guha C, Howell M, Jauré A, Wong G, van Zwieten A. Patient-Centered Research and Outcomes in Cancer and Kidney Transplantation. Semin Nephrol 2024; 44:151499. [PMID: 38538454 DOI: 10.1016/j.semnephrol.2024.151499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
Cancer has been identified by kidney transplant recipients as a critically important outcome. The co-occurrence of cancer and kidney transplantation represents a complex intersection of diseases, symptoms, and competing priorities for treatments. Research that focuses on biochemical parameters and clinical events may not capture the priorities of patients. Patient-centered research can improve the relevance and efficiency of research and is particularly pertinent in the setting of cancer and kidney transplantation to facilitate shared decision-making in complex clinical situations. In addition, patient-reported outcomes can facilitate the assessment of patients' experiences, symptom burden, treatment side effects, and quality of life. This review discusses patient-centered research in the context of kidney transplantation and cancer, including consumer involvement in research and patient-centered outcomes and their measures and inclusion in core outcome sets.
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Affiliation(s)
- Ellen Dobrijevic
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Westmead, Australia.
| | - Nicole Scholes-Robertson
- Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Westmead, Australia; Rural and Remote Health NT, Flinders University, Alice Springs, Australia
| | - Chandana Guha
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Westmead, Australia
| | - Martin Howell
- Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Westmead, Australia; Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney, Australia
| | - Allison Jauré
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Westmead, Australia
| | - Germaine Wong
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Westmead, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia
| | - Anita van Zwieten
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Westmead, Australia
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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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Unni E, Coles T, Lavallee DC, Freel J, Roberts N, Absolom K. Patient adherence to patient-reported outcome measure (PROM) completion in clinical care: current understanding and future recommendations. Qual Life Res 2024; 33:281-290. [PMID: 37695476 PMCID: PMC10784330 DOI: 10.1007/s11136-023-03505-y] [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: 08/11/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are increasingly being used as an assessment and monitoring tool in clinical practice. However, patient adherence to PROMs completions are typically not well documented or explained in published studies and reports. Through a collaboration between the International Society for Quality-of-Life Research (ISOQOL) Patient Engagement and QOL in Clinical Practice Special Interest Groups (SIGs) case studies were collated as a platform to explore how adherence can be evaluated and understood. Case studies were drawn from across a range of clinically and methodologically diverse PROMs activities. RESULTS The case studies identified that the influences on PROMs adherence vary. Key drivers include PROMs administeration methods within a service and wider system, patient capacity to engage and clinician engagement with PROMs information. It was identified that it is important to evaluate PROMs integration and adherence from multiple perspectives. CONCLUSION PROM completion rates are an important indicator of patient adherence. Future research prioritizing an understanding of PROMs completion rates by patients is needed.
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Affiliation(s)
| | | | | | - Jennifer Freel
- University of Pittsburgh Medical Centre, Pittsburg, PA, USA
| | - Natasha Roberts
- The University of Queensland Centre for Clinical Research, Herston, QLD, Australia.
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Herston, QLD, Australia.
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Kane K, Kennedy F, Absolom KL, Harley C, Velikova G. Quality of life support in advanced cancer-web and technological interventions: systematic review and narrative synthesis. BMJ Support Palliat Care 2023; 13:e221-e234. [PMID: 33903259 DOI: 10.1136/bmjspcare-2020-002820] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/01/2021] [Accepted: 04/04/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND As treatments continue to progress, patients with advanced cancer are living longer. However, ongoing physical side-effects and psychosocial concerns can compromise quality of life (QoL). Patients and physicians increasingly look to the internet and other technologies to address diverse supportive needs encountered across this evolving cancer trajectory. OBJECTIVES 1. To examine the features and delivery of web and technological interventions supporting patients with advanced cancer. 2. To explore their efficacy relating to QoL and psychosocial well-being. METHODS Relevant studies were identified through electronic database searches (MEDLINE, PsychINFO, Embase, CINAHL, CENTRAL, Web of Science and ProQuest) and handsearching. Findings were collated and explored through narrative synthesis. RESULTS Of 5274 identified records, 37 articles were included. Interventions were evaluated within studies targeting advanced cancer (13) or encompassing all stages (24). Five subtypes emerged: Interactive Health Communication Applications (n=12), virtual programmes of support (n=11), symptom monitoring tools (n=8), communication conduits (n=3) and information websites (n=3). Modes of delivery ranged from self-management to clinically integrated. Support largely targeted psychosocial well-being, alongside symptom management and healthy living. Most studies (78%) evidenced varying degrees of efficacy through QoL and psychosocial measures. Intervention complexity made it challenging to distinguish the most effective components. Incomplete reporting limited risk of bias assessment. CONCLUSION While complex and varied in their content, features and delivery, most interventions led to improvements in QoL or psychosocial well-being across the cancer trajectory. Ongoing development and evaluation of such innovations should specifically target patients requiring longer-term support for later-stage cancer. PROSPERO REGISTRATION NUMBER CRD42018089153.
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Affiliation(s)
- Kathleen Kane
- Patient Centred Outcomes Research Group, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Fiona Kennedy
- Patient Centred Outcomes Research Group, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Kate L Absolom
- Patient Centred Outcomes Research Group, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Clare Harley
- School of Healthcare, University of Leeds, Leeds, UK
| | - Galina Velikova
- Patient Centred Outcomes Research Group, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
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van Stein RM, Hendriks FJ, Retèl VP, de Kroon CD, Lok CA, Sonke GS, de Ligt KM, van Driel WJ. Health state utility and health-related quality of life measures in patients with advanced ovarian cancer. Gynecol Oncol Rep 2023; 50:101293. [PMID: 38029226 PMCID: PMC10630623 DOI: 10.1016/j.gore.2023.101293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/09/2023] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Measuring health-related quality of life (HRQoL) in ovarian cancer patients is critical to understand the impact of disease and treatment. Preference-based HRQoL measures, called health state utilities, are used specifically in health economic evaluations. Real-world patient-reported data on HRQoL and health state utilities over the long-term course of ovarian cancer are limited. This study aims to determine HRQoL and health state utilities in different health states of ovarian cancer. Methods This cross-sectional, multicenter study included patients with stage III-IV ovarian cancer in six health states: at diagnosis, during chemotherapy, after cytoreductive surgery (CRS), after chemotherapy, in remission, and at first recurrence. HRQoL was measured using the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire C30, and the ovarian cancer-specific module OV28. Health state utilities were assessed using the EuroQol five-dimension five-level (EQ-5D-5L) questionnaire. Descriptive analyses were performed for each health state. Results Two hundred thirty-two patients participated, resulting in 319 questionnaires. Median age was 66 years. The lowest HRQoL was observed during chemotherapy and shortly after CRS. Physical and role functioning were most affected and the highest symptom prevalence was observed in the fatigue, nausea, pain, dyspnea, gastrointestinal, neuropathy, attitude, and sexuality domains. Patients in remission had the best HRQoL. Mean utility values ranged from 0.709 (±0.253) at diagnosis to 0.804 (±0.185) after chemotherapy. Conclusions This study provides clinicians with a valuable resource to aid in patient counseling and clinical decision-making. The utilities, in particular, are crucial for researchers conducting economic analyses to inform policy decisions.
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Affiliation(s)
- Ruby M. van Stein
- Department of Gynecologic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Florine J. Hendriks
- Department of Gynecology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Valesca P. Retèl
- Department of Psychosocial Research and Epidemiology, Department of Psychosocial Research, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Cor D. de Kroon
- Department of Gynecology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Christianne A.R. Lok
- Department of Gynecologic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Gabe S. Sonke
- Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Kelly M. de Ligt
- Department of Psychosocial Research and Epidemiology, Department of Psychosocial Research, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Willemien J. van Driel
- Department of Gynecologic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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Terwee CB, Roorda LD. Country-specific reference values for PROMIS ® pain, physical function and participation measures compared to US reference values. Ann Med 2023; 55:1-11. [PMID: 36426680 PMCID: PMC9704075 DOI: 10.1080/07853890.2022.2149849] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Patient-Reported Outcomes Measurement Information System (PROMIS®) is commonly used across medical conditions. To facilitate interpretation of scores across countries, we calculated Dutch reference values for PROMIS Physical Function (PROMIS-PF), Pain Interference (PROMIS-PI), Pain Behavior (PROMIS-PB), Ability to Participate in Social Roles and Activities (PROMIS-APSRA), and Satisfaction with Social Roles and Activities (PROMIS-SSRA), as compared to US reference values. PATIENTS AND METHODS A panel completed full PROMIS-PF (n=1310), PROMIS-PI and PROMIS-PB (n=1052), and PROMIS-APSRA and PROMIS-SSRA (n=1002) item banks and reported their level of health per domain (no, mild, moderate, severe limitations). T-scores were calculated by sample and subgroups (age, gender, self-reported level of domain). Distribution-based and anchor-based thresholds for mild, moderate, and severe scores were determined. RESULTS Mean T-scores were close to the US mean of 50 for PROMIS-PF (49.8) and PROMIS-APSRA (50.6), lower for PROMIS-SSRA (47.5) and higher for PROMIS-PI (54.9) and PROMIS-PB (52.0). Distribution-based thresholds for mild, moderate, and severe scores were comparable to US recommended cut-off values (except for PROMIS-PI) but participants reported limitations 'earlier' than suggested thresholds. CONCLUSION Dutch reference values were close to US reference values for some PROMIS domains but not all. We recommend country-specific reference values to facilitate worldwide PROMIS use.KEY MESSAGESPROMIS offers universally applicable IRT-based efficient and patient-friendly measures to assess commonly relevant patient-reported outcomes across medical conditions.To support the use of PROMIS in daily clinical practice and research across the world, country-specific general population reference values should be obtained.More research is necessary to obtain reliable and valid cut-off values for what constitutes mild, moderate and severe scores from the patients' perspective.
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Affiliation(s)
- Caroline B Terwee
- Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Leo D Roorda
- Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, The Netherlands
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Moody K, Nieuwkerk PT, Bedert M, Nellen JF, Weijsenfeld A, Sigaloff KCE, Laan L, Bruins C, van Oers H, Haverman L, Geerlings SE, Van der Valk M. Optimising HIV care using information obtained from PROMs: protocol for an observational study. BMJ Open 2023; 13:e073758. [PMID: 38011973 PMCID: PMC10685965 DOI: 10.1136/bmjopen-2023-073758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION Successful antiviral therapy has transformed HIV infection into a chronic condition, where optimising quality of life (QoL) has become essential for successful lifelong treatment. Patient-reported outcome measures (PROMs) can signal potential physical and mental health problems related to QoL. This study aims to determine whether PROMs in routine clinical care improve quality of care as experienced by people with HIV (PWH). METHODS AND ANALYSIS We report the protocol of a multicentre longitudinal cohort studying PWH at Amsterdam University Medical Centres in the Netherlands. PROMs are offered annually to patients via the patient portal of the electronic health record. Domains include anxiety, depression, fatigue, sleep disturbances, social isolation, physical functioning, stigma, post-traumatic stress disorder, adherence, drug and alcohol use and screening questions for sexual health and issues related to finances, housing and migration status. Our intervention comprises (1) patients' completion of PROMs, (2) discussion of PROMs scores during annual consultations and (3) documentation of follow-up actions in an individualised care plan, if indicated. The primary endpoint will be patient-experienced quality of care, measured by the Patient Assessment of Chronic Illness Care, Short Form (PACIC-S). Patients will provide measurements at baseline, year 1 and year 2. We will explore change over time in PACIC-S and PROMs scores and examine the sociodemographical and HIV-specific characteristics of subgroups of patients who participated in all or only part of the intervention to ascertain whether benefit has been achieved from our intervention in all subgroups. ETHICS AND DISSEMINATION Patients provide consent for the analysis of data collected as part of routine clinical care to the AIDS Therapy Evaluation in the Netherlands study (ATHENA) cohort through mechanisms described in Boender et al. Additional ethical approval for the analysis of these data is not required under the ATHENA cohort protocol. The results will be presented at national and international academic meetings and submitted to peer-reviewed journals for publication.
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Affiliation(s)
- Kevin Moody
- Infectious Diseases and Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Pythia T Nieuwkerk
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Medical Psychology and Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten Bedert
- Infectious Diseases and Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeannine F Nellen
- Infectious Diseases and Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Kim C E Sigaloff
- Infectious Diseases and Amsterdam Institute for Infection and Immunology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Laura Laan
- Infectious Diseases, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Claire Bruins
- Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hedy van Oers
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Child and Adolescent Psychiatry and Psychological Care, Emma Children's Hospital, Amsterdam Reproduction and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lotte Haverman
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Child and Adolescent Psychiatry and Psychological Care, Emma Children's Hospital, Amsterdam Reproduction and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Suzanne E Geerlings
- Infectious Diseases and Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marc Van der Valk
- Infectious Diseases and Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- HIV Monitoring Foundation, Amsterdam, The Netherlands
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Holch P, Turner G, Keetharuth AD, Gibbons E, Cocks K, Absolom KL. The impact of COVID-19 on PRO development, collection and implementation: views of UK and Ireland professionals. J Patient Rep Outcomes 2023; 7:121. [PMID: 38010558 PMCID: PMC10682296 DOI: 10.1186/s41687-023-00663-y] [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: 02/02/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND PROs are valuable tools in clinical care to capture patients' perspectives of their health, symptoms and quality of life. However the COVID-19 pandemic has had profound impacts on all aspects of life, in particular healthcare and research. This study explores the views of UK and Irish health professionals, third sector and pharmaceutical industry representatives and academic researchers on the impact of COVID-19 on PRO collection, use and development in clinical practice. METHODS A volunteer sample took part in a 10 question cross sectional qualitative survey, on the impact of COVID-19, administered online via Qualtrics. Demographic data was descriptively analysed, and the qualitative free text response data was subject to thematic analysis and summarised within the Strengths, Weaknesses, Opportunities and Threats (SWOT) framework. RESULTS Forty nine participants took part located in a range of UK settings and professions. Participants highlighted staff strengths during the pandemic including colleagues' flexibility and ability to work collaboratively and the adoption of novel communication tools. Weaknesses were a lack of staff capacity to continue or start PRO projects and insufficient digital infrastructure to continue studies online. Opportunities included the added interest in PROs as useful outcomes, the value of electronic PROs for staff and patients particularly in relation to integration into systems and the electronic patient records. However, these opportunities came with an understanding that digital exclusion may be an issue for patient groups. Threats identified included that the majority of PRO research was stopped or delayed and funding streams were cut. CONCLUSIONS Although most PRO research was on hold during the pandemic, the consensus from participants was that PROs as meaningful outcomes were valued more than ever. From the opportunities afforded by the pandemic the development of electronic PROs and their integration into electronic patient record systems and clinical practice could be a lasting legacy from the COVID-19 pandemic.
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Affiliation(s)
- Patricia Holch
- Department of Psychology, School of Humanities and Social Sciences, Leeds Beckett University, Portland Building, Room PD402, City Campus, Leeds, LS1 9HE, UK.
| | - Grace Turner
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Anju D Keetharuth
- School of Health and Related Research, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - E Gibbons
- Evidera Ltd, 201 Talgarth Rd, The Ark, London, W6 8BJ, UK
| | - Kim Cocks
- Adelphi Values, Patient-Centered Outcomes, Bollington, Cheshire, SK10 5JB, UK
| | - Kate L Absolom
- Leeds Institute of Medical Research, University of Leeds, St James's Hospital, Bexley Wing, Beckett Street, Leeds, LS9 7TF, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
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Zhou MS, Jain T, Hardy N, Perez-Segura A, Hickman J, Leopold L, Qualliotine K, Yedidi RS, Whetsell M, Broffman L. The design, implementation, and impact of an automated patient-reported outcome data collection and adverse event surveillance tool: a randomized trial. BMC Health Serv Res 2023; 23:1277. [PMID: 37986191 PMCID: PMC10658802 DOI: 10.1186/s12913-023-10231-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/27/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Incorporating patient-reported outcome measures into routine clinical care can improve the patient experience, increase engagement, and establish a structured method for gathering adverse event (AE) data. Systematically collecting this information on a large scale can also inform new solutions for removing treatment barriers like medication nonadherence. This study evaluated whether implementing a patient-reported outcome data collection and adverse event surveillance tool would result in greater treatment continuation for patients receiving care on a telehealth platform. METHODS We used iterative plan-study-do-act cycles to evaluate how this data collection and surveillance tool-a short prompt for patients to provide information on treatment satisfaction and side effects-impacted treatment continuation, the outcome of interest. We tested two cycles in n = 2,000 patients receiving care for erectile dysfunction on a telehealth platform as a randomized controlled trial, and accounted for incidents where true randomization was not possible during implementation. The first cycle tested the tool alone, while the second cycle tested the tool in conjunction with a messaging template system that provided standardized side effect counseling. RESULTS Compared to patients in the control group, patients in the intervention group were more likely to refill their prescription over the duration of the study period (75% vs. 71%, Kaplan Meier log-rank test, p = 0.04). Receiving standardized counseling as part of the AE response system was positively associated with treatment continuation (p = 0.0005). CONCLUSIONS Prompting patients to report side effects and outcomes outside of routine clinical visits has the potential to improve quality of care in virtual treatment. TRIAL REGISTRATION This trial has been retrospectively registered as a clinical trial (ClinicalTrials.gov Identifier: NCT05895539, registered June 8, 2023).
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Affiliation(s)
- Megan S Zhou
- Roman Health Ventures Inc, 116 W 23Rd St, New York, NY, 10011, USA
| | - Tanya Jain
- Roman Health Ventures Inc, 116 W 23Rd St, New York, NY, 10011, USA
| | - Nick Hardy
- Roman Health Ventures Inc, 116 W 23Rd St, New York, NY, 10011, USA
| | - Alejandro Perez-Segura
- Roman Health Ventures Inc, 116 W 23Rd St, New York, NY, 10011, USA
- Two Sigma, New York, NY, USA
| | - Jasmine Hickman
- Roman Health Ventures Inc, 116 W 23Rd St, New York, NY, 10011, USA
| | - Laurey Leopold
- Roman Health Ventures Inc, 116 W 23Rd St, New York, NY, 10011, USA
| | | | - Raagini S Yedidi
- Roman Health Ventures Inc, 116 W 23Rd St, New York, NY, 10011, USA
- Garden City Hospital, Garden City, MI, USA
| | - Matthew Whetsell
- Roman Health Ventures Inc, 116 W 23Rd St, New York, NY, 10011, USA
- Big Whale Labs, New York, NY, USA
| | - Lauren Broffman
- Roman Health Ventures Inc, 116 W 23Rd St, New York, NY, 10011, USA.
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Smith KL, Tsai HL, Lim D, Wang C, Nunes R, Wilkinson MJ, Sheng JY, Couzi R, Fetting J, Riley C, Wolff AC, Santa-Maria CA, Papathakis K, Collins-Chase L, Hilton C, Thorner E, Montanari A, Ikejiani D, Snyder C, Stearns V. Feasibility of Symptom Monitoring During the First Year of Endocrine Therapy for Early Breast Cancer Using Patient-Reported Outcomes Collected via Smartphone App. JCO Oncol Pract 2023; 19:981-989. [PMID: 37733984 DOI: 10.1200/op.23.00038] [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: 01/21/2023] [Revised: 04/07/2023] [Accepted: 08/18/2023] [Indexed: 09/23/2023] Open
Abstract
PURPOSE Treatment-associated symptoms drive early discontinuation of adjuvant endocrine therapy (ET) for breast cancer. We hypothesized that symptom monitoring with electronic patient-reported outcomes (ePROs) during adjuvant ET will enhance symptom detection, symptom management, and persistence. METHODS Eligible patients were initiating ET for stage 0-III breast cancer. Participants completed ePRO surveys via smartphone at baseline and 1, 3, 6, and 12 months. Measures included Patient-Reported Outcomes Measurement Information System Anxiety, Depression, Fatigue, and Vaginal Discomfort; plus Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events items assessing joint pain, hot flashes, vaginal dryness, concentration problems, and memory problems. Scores surpassing prespecified thresholds triggered alerts, and recommended symptom management pathways were provided to clinicians. The primary objective was to evaluate feasibility, assessed by survey completion rates, with targets of >65% for the baseline survey and ≥1 follow-up survey during the first 6 months. Secondary objectives included 12-month ET discontinuation rate (target: ≤15%), describing symptoms and evaluating pathway implementation. RESULTS Among 250 participants, 73.2% completed the baseline survey and 69.6% completed ≥1 follow-up survey during the first 6 months. Thirty-one percent of participants had ≥1 symptom alert at baseline and 74% had ≥1 symptom alert during follow-up. The proportions of participants for whom pathway-concordant symptom management was documented at each time point ranged from 12.8% to 36.6%. Twenty-eight participants (11.2%) discontinued ET by 12 months. CONCLUSION Symptom monitoring with ePROs during adjuvant ET is feasible. Despite infrequent documentation of pathway-concordant symptom management after symptom alerts, ePROs were associated with favorable short-term ET persistence.
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Affiliation(s)
- Karen Lisa Smith
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
- AstraZeneca, Gaithersburg, MD
| | - Hua-Ling Tsai
- Division of Biostatistics and Bioinformatics, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - David Lim
- Division of Biostatistics and Bioinformatics, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
- Division of Statistics Collaborative Inc, WCG, Washington, DC
| | - Chenguang Wang
- Division of Biostatistics and Bioinformatics, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
- Regeneron Pharmaceuticals, Tarrytown, NY
| | - Raquel Nunes
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
- AstraZeneca, Gaithersburg, MD
| | - Mary J Wilkinson
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer Y Sheng
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rima Couzi
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - John Fetting
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Carol Riley
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Antonio C Wolff
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Cesar A Santa-Maria
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Katie Papathakis
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Christie Hilton
- Division of Hematology and Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA
| | - Elissa Thorner
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amanda Montanari
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Claire Snyder
- Johns Hopkins Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vered Stearns
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
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Li D, Huang Q, Zhang W, Yuan C, Wu F. Effects of routine collection of patient-reported outcomes on patient health outcomes in oncology settings: A systematic review. Asia Pac J Oncol Nurs 2023; 10:100297. [PMID: 37885765 PMCID: PMC10597759 DOI: 10.1016/j.apjon.2023.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/18/2023] [Indexed: 10/28/2023] Open
Abstract
Objective This study aims to investigate the potential benefits of integrating patient-reported outcomes (PROs) into routine clinical practice for patients undergoing active anticancer treatment. Methods We conducted a comprehensive systematic review of randomized controlled trials involving cancer patients undergoing active anticancer treatment, spanning various cancer types and stages. The review covered four electronic databases (Medline, EMBASE, Cochrane Library, and CINAHL) up to September 2022. Key inclusion criteria focused on the incorporation of PROs as a routine intervention. Bias assessment followed the Cochrane collaboration's criteria, while the synthesis of results utilized effect size measurements (Cohen's d). The study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Out of 1549 initially screened records, 16 published randomized controlled trials encompassing 5300 patients met the inclusion criteria. The interventions involved 18 different PROs measurements, with prominent tools being EORTC QLQ-C30 (utilized in four trials) and PRO-CTCAE (utilized in four trials). Measured endpoints included overall quality of life (12 trials), physical health (11 trials), mental health (7 trials), and social health (5 trials). Overall, the study revealed a limited number of statistically significant findings, with predominantly small to moderate effect sizes associated with the interventions. Conclusions The findings suggest that the routine integration of PROs into clinical practice does not yield definitive advantages in terms of PROs. It is apparent that further efforts are necessary to ascertain the impact of these interventions on patient health. Systematic review registration The review protocol was registered on PROSPERO (ID: CRD42022365456).
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Affiliation(s)
- Danyu Li
- School of Nursing, Fudan University, Shanghai, China
| | - Qingmei Huang
- School of Nursing, Fudan University, Shanghai, China
| | - Wen Zhang
- School of Nursing, Fudan University, Shanghai, China
| | | | - Fulei Wu
- School of Nursing, Fudan University, Shanghai, China
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Li Y, Li J, Hu X. The effectiveness of symptom management interventions based on electronic patient-reported outcomes (ePROs) for symptom burden, quality of life, and overall survival among patients with cancer: A meta-analysis of randomized controlled trials. Int J Nurs Stud 2023; 147:104588. [PMID: 37690275 DOI: 10.1016/j.ijnurstu.2023.104588] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/10/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To explore the effectiveness of ePRO-based symptom management interventions on symptom burden, quality of life, and overall survival among patients with cancer for the first time and to explore the effects of different types of these interventions. BACKGROUND Since advances in screening and treatment have transformed cancer into a chronic illness rather than a fatal disease, symptom management has become increasingly critical in oncology nursing. In recent decades, ePROs have been increasingly used in the symptom management of cancer patients to improve their symptom burden, quality of life and overall survival, but the existing findings are still inconsistent and equivocal. METHODS A literature search was conducted in PubMed, Web-of-Science, CENTRAL, and CINAHL-Plus-with-Full-Text from inception to January 31, 2023. The quality of methodology and evidence were evaluated by the revised Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development, and Evaluation framework. All data were analyzed using R within the RStudio platform, and the effects of interventions were determined by calculating SMD, HR and 95 %CI. Subgroup analysis, sensitivity analysis and cumulative meta-analysis were performed, and statistical heterogeneity was examined by I2 statistic, P value, and Egger's or arcsine test. Statistical significance was defined as a two-tailed P value <0.05. RESULTS A total of 23 randomized controlled trials with 7231 patients were included. The results indicated that ePRO-based symptom management interventions could improve the symptom burden (SMD = -0.19, 95 % CI [-0.33, -0.05], P < 0.01), quality of life (SMD = 0.16, 95 % CI [0.06, 0.25], P < 0.01) and overall survival (HR = 0.84, 95 % CI [0.73, 0.97], P = 0.02) of cancer patients. Subgroup analysis showed that targeted interventions for patients undergoing specific treatments were effective in relieving the symptom burden and enhancing quality of life. Short-term (≤3 months) interventions or reporting via telephone call contributed to alleviating the symptom burden, while quality of life improved when the intervention was more than three months in duration or not reported by telephone call. The pooled results of symptom burden and quality of life were stable, and the beneficial trends of all three outcomes were steady. The overall quality of methodology and evidence was moderate. CONCLUSIONS We found that ePRO-based symptom management interventions are conducive to improving symptom burden, quality of life, and overall survival of cancer patients. In addition to encouraging the integration of ePRO-based interventions into routine oncology care, interventions with tailored plans, proper intensity and multidimensional supports need to be developed in the future to optimize the symptom management of cancer patients. REGISTRATION CRD42023393330.
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Affiliation(s)
- Yunhuan Li
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, PR China
| | - Juejin Li
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, PR China
| | - Xiaolin Hu
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, PR China.
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Garcia-Lopez E, Halvorson R, Shapiro L. Novel Tools to Approach and Measure Outcomes in Patients with Fractures. Hand Clin 2023; 39:627-639. [PMID: 37827615 DOI: 10.1016/j.hcl.2023.06.005] [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] [Indexed: 10/14/2023]
Abstract
Upper extremity fractures are prevalent and pose a great burden to patients and society. In the US alone, the annual incidence of upper extremity fractures is 67.6 fractures per 10,000 persons. While the majority of patients with upper extremity fractures demonstrate satisfactory outcomes when treated appropriately (the details of which are discussed in prior articles), the importance of follow-up and outcome measurement cannot be understated. Outcome measurement allows for accountability and improvement in clinical outcomes and research. The purpose of this article is to describe recent advances in methods and tools for assessing clinical and research outcomes in hand and upper extremity care. Three specific advances that are broadly changing the landscape of follow-up care of our patients include: 1) telemedicine, 2) patient-reported outcome measurement, and 3) wearables/remote patient monitoring.
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Affiliation(s)
- Edgar Garcia-Lopez
- Department of Orthopaedics, University of California San Francisco, 500 Parnassus Avenue, MU-320W, San Francisco, CA 94143-0728, USA
| | - Ryan Halvorson
- Department of Orthopaedics, University of California San Francisco, 500 Parnassus Avenue, MU-320W, San Francisco, CA 94143-0728, USA
| | - Lauren Shapiro
- Department of Orthopaedics, University of California San Francisco, 1500 Owens Street, San Francisco, CA 94158, USA.
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Lavan RP, Tahir M, O’Donnell C, Bellenger A, de Bock E, Koochaki P. Development and Validation of a Canine Health-Related Quality of Life Questionnaire and a Human-Canine Bond Questionnaire for Use in Veterinary Practice. Animals (Basel) 2023; 13:3255. [PMID: 37893979 PMCID: PMC10603719 DOI: 10.3390/ani13203255] [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: 08/03/2023] [Revised: 09/22/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
The use of valid questionnaires to assess dogs' health-related quality of life (HRQoL) in veterinary practice can improve canine health outcomes and communications between veterinarians and caretakers of dogs. The Canine HRQoL Questionnaire (Canine HRQoL-Q) and the Human-Canine Bond Questionnaire (HCBQ) were developed and validated to fulfill this need. A literature review, interviews with veterinarians, and focus groups with caretakers were conducted to generate questionnaire items and develop draft questionnaires, which were piloted with caretakers to establish their content validity. Measurement properties were evaluated using data from a prospective survey study (N = 327). Draft Canine HRQoL-Q and HCBQ measures were developed, including a domain structure, items, recall period, and scale/response options. Refinements were made via iterative cognitive interviews with caretakers. When no additional revisions were indicated and content validity was established, the questionnaires were psychometrically tested. Ceiling effects were observed for all items, and factor analyses indicated that the pre-specified domains are appropriate. Internal consistency was demonstrated for the HCBQ (α = 0.79-0.86) and all but the social functioning domain of the Canine HRQoL-Q (α = 0.60). Test-retest reliability for the Canine HRQoL-Q was generally moderate-to-good (with intraclass correlation coefficients (ICCs) > 0.79). Test-retest reliability for the HCBQ was moderate (ICCs: 0.70-0.79) except for the trust domain (ICC: 0.58). Known-groups validity was demonstrated via significant differences (p < 0.05) in scores for health/bonding groups. Convergent validity was supported (r > 0.40) between all domains and the total scores for both questionnaires. The Canine HRQoL-Q and the HCBQ are valid, reliable measures of canine HRQoL for use in veterinary clinics and appear to measure related but distinct concepts that contribute to canine health and wellness.
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Affiliation(s)
- Robert P. Lavan
- Merck Animal Health, Outcomes Research (CORE), Rahway, NJ 07065, USA
| | - Muna Tahir
- ICON plc, South County Business Park, Leopardstown, D18 FK72 Dublin, Ireland; (M.T.); (C.O.); (A.B.); (E.d.B.); (P.K.)
| | - Christina O’Donnell
- ICON plc, South County Business Park, Leopardstown, D18 FK72 Dublin, Ireland; (M.T.); (C.O.); (A.B.); (E.d.B.); (P.K.)
| | - Alex Bellenger
- ICON plc, South County Business Park, Leopardstown, D18 FK72 Dublin, Ireland; (M.T.); (C.O.); (A.B.); (E.d.B.); (P.K.)
| | - Elodie de Bock
- ICON plc, South County Business Park, Leopardstown, D18 FK72 Dublin, Ireland; (M.T.); (C.O.); (A.B.); (E.d.B.); (P.K.)
| | - Patricia Koochaki
- ICON plc, South County Business Park, Leopardstown, D18 FK72 Dublin, Ireland; (M.T.); (C.O.); (A.B.); (E.d.B.); (P.K.)
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Taarnhøj GA, Johansen C, Carus A, Dahlrot RH, Dohn LH, Hjøllund NH, Knudsen MB, Tolver A, Lindberg H, Pappot H. The iBLAD study: patient-reported outcomes in bladder cancer during oncological treatment: a multicenter national randomized controlled trial. J Patient Rep Outcomes 2023; 7:99. [PMID: 37812306 PMCID: PMC10562329 DOI: 10.1186/s41687-023-00640-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 09/24/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Patient-reported outcomes (PROs) are getting widely implemented, but little is known of the impact of applying PROs in specific cancer diagnoses. We report the results of a randomized controlled trial (RCT) of the active use of PROs in patients with locally advanced or metastatic bladder cancer (BC) undergoing medical oncological treatment (MOT) with focus on determining the clinical effects of using PROs during chemo- or immunotherapy compared to standard of care. METHODS We recruited patients from four departments of oncology from 2019 to 2021. Inclusion criteria were locally advanced or metastatic BC, initiating chemo- or immunotherapy. Patients were randomized 1:1 between answering selected PRO-CTCAE questions electronically once weekly with a built-in alert-algorithm instructing patients of how to handle reported symptoms as a supplement to standard of care for handling of side effects (intervention arm (IA)) vs standard procedure for handling of side effects (control arm (CA)). No real-time alerts were sent to the clinic when PROs exceeded threshold values. Clinicians were prompted to view the completed PROs in the IA at each clinical visit. The co-primary clinical endpoints were hospital admissions and treatment completion rate. Secondary endpoints were overall survival (OS), quality of life (EORTC's QLQ-C30 and QLQ-BLM30) and dose reductions. RESULTS 228 patients with BC were included, 76% were male. 141 (62%) of the patients had metastatic disease. 51% of patients in the IA completed treatment vs. 56% of patients in the CA, OR 0.83 (95% CI 0.47-1.44, p = 0.51). 41% of patients in the IA experienced hospitalization vs. 32% in the CA, OR 1.48 (95% CI 0.83-2.65, p = 0.17). OS was comparable between the two arms (IA: median 22.3mo (95% CI 17.0-NR) vs. CA: median 23.1mo (95% CI 17.7-NR). Patient and clinician compliance was high throughout the study period (80% vs 94%). CONCLUSIONS This RCT did not show an effect of PRO on completion of treatment, hospitalizations or OS for BC patients during MOT despite a high level of patient and clinician compliance. The lack of real-time response to alerts remains the greatest limitation to this study.
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Affiliation(s)
- Gry Assam Taarnhøj
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Christoffer Johansen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
- CASTLE: Cancer Survivorship and Treatment, Late Effects National Research Center, Blegdamsvej 58, 2100, Copehnagen Ø, Denmark
| | - Andreas Carus
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University and Clinical Cancer Research Center, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Rikke Hedegaard Dahlrot
- Department of Oncology, Odense University Hospital, Odense C, Denmark
- Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 4, 5000, Odense, Denmark
| | - Line Hammer Dohn
- Department of Oncology, Copenhagen University Hospital, Herlev Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Niels Henrik Hjøllund
- AmbuFlex - Center for Patient-Reported Outcomes, Central Denmark Region, Gødstrup Hospital, Hospitalsparken 15, 7400, Herning, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Mark Bech Knudsen
- Data Science Lab, Department of Mathematical Sciences, University of Copenhagen, Universitetsparken 5, 2100, Copenhagen Ø, Denmark
| | - Anders Tolver
- Data Science Lab, Department of Mathematical Sciences, University of Copenhagen, Universitetsparken 5, 2100, Copenhagen Ø, Denmark
| | - Henriette Lindberg
- Department of Oncology, Copenhagen University Hospital, Herlev Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Helle Pappot
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
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Barbera L, Sutradhar R, Earle CC, Howell D, Mittman N, Li Q, Thiruchelvam D, Seow H. The impact of routine Edmonton symptom assessment system use on receiving palliative care services: results of a population-based retrospective-matched cohort analysis. BMJ Support Palliat Care 2023; 13:e144-e149. [PMID: 32943469 DOI: 10.1136/bmjspcare-2020-002220] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 06/04/2020] [Accepted: 07/31/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND In 2007, Cancer Care Ontario began standardised symptom assessment as part of routine care using the Edmonton Symptom Assessment System (ESAS). AIM The purpose of this study was to evaluate the impact of ESAS on receipt of palliative care when compared with a matched group of unexposed patients. DESIGN A retrospective-matched cohort study examined the impact of ESAS screening on initiation of palliative care services provided by physicians or homecare nurses. The study included adult patients diagnosed with cancer between 2007 and 2015. Exposure was defined as completing ≥1 ESAS during the study period. Using 4 hard and 14 propensity score-matched variables, patients with cancer exposed to ESAS were matched 1:1 to those who were not. Matched patients were followed from first ESAS until initiation of palliative care, death or end of study. RESULTS The final cohort consisted of 204 688 matched patients with no prior palliative care consult. The pairs were well matched. The cumulative incidence of receiving palliative care within the first 5 years was higher among those exposed to ESAS compared with those who were not (27.9% (95% CI: 27.5% to 28.2%) versus 27.9% (95% CI: 27.5% to 28.2%)), when death is considered as a competing event. In the adjusted cause-specific Cox proportional hazards model, ESAS assessment was associated with a 6% increase in palliative care services (HR: 1.06, 95% CI: 1.04 to 1.08). CONCLUSION We have demonstrated that patients exposed to ESAS were more likely to receive palliative care services compared with patients who were not exposed. This observation provides real-world data of the impact of routine assessment with a patient-reported outcome.
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Affiliation(s)
- Lisa Barbera
- Radiation Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
- Oncology, University of Calgary, Calgary, Alberta, Canada
- Institute for Clincal Evaluative Sciences, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Institute for Clincal Evaluative Sciences, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Craig C Earle
- Institute for Clincal Evaluative Sciences, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Doris Howell
- University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Nicole Mittman
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Qing Li
- Institute for Clincal Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Hsien Seow
- Institute for Clincal Evaluative Sciences, Toronto, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
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Narra LR, Verdini N, Lapen K, Nipp R, Gillespie EF. Patient-Reported Outcomes in Clinical Trials: From an Endpoint to an Intervention in Cancer Care. Semin Radiat Oncol 2023; 33:358-366. [PMID: 37684065 DOI: 10.1016/j.semradonc.2023.07.002] [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: 09/10/2023]
Abstract
Underreporting of patient symptoms by clinicians is a common and well-documented phenomenon that has led to integrating patient-reported outcomes (PROs) as endpoints into clinical trials. While PROs are often used to measure disease symptoms, cancer therapy toxicities, and quality of life, they can also assess patients' general experiences and preferences. With the increasing use of electronic medical records and the digital health revolution in oncology, conversion from paper to electronic PROs (ePROs) has also facilitated the integration of PROs into routine care. Evidence from clinical trials is rapidly emerging to support ePROs as a care delivery innovation, given the potential for ePROs to improve patient outcomes through timely evaluation and response to patient needs. Meanwhile, work is ongoing to understand and address ePRO use and challenges to equitable integration, including technical and language barriers for patients, clinicians, and health systems. Nonetheless, the health system and regulatory bodies continue to develop stipulations to promote the use of ePROs. Herein, we review the evolution of PROs from an endpoint to an intervention in prospective clinical trials in oncology.
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Affiliation(s)
| | - Nicholas Verdini
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kaitlyn Lapen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ryan Nipp
- Division of Hematology-Oncology, University of Oklahoma, Oklahoma City, OK
| | - Erin F Gillespie
- Department of Radiation Oncology, University of Washington, Seattle, WA; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
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Peeters M, Ottenheijm G, Bienfait P, Eekers D, Gijtenbeek A, Hanse M, Koekkoek J, van Leeuwen L, Tijssen C, Dirven L, Taphoorn M. Glioma patient-reported outcomes: patients and clinicians. BMJ Support Palliat Care 2023; 13:e205-e212. [PMID: 33653735 DOI: 10.1136/bmjspcare-2020-002699] [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: 09/19/2020] [Revised: 12/23/2020] [Accepted: 01/06/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Routine assessment of patient-reported outcomes (PROs) in oncology has shown to improve the quality of the delivered care and to prolong survival. However, for successful implementation of routine assessment of PROs, more knowledge on their usability in clinical practice is needed. OBJECTIVE This study aimed to cross-sectionally assess the perspective of patients and clinicians on the practicality of routinely measuring PROs in clinical practice for glioma patients. METHODS Semistructured interviews were conducted evaluating the role of healthcare professionals (HCP) in discussing results of PRO measures (PROMs), and the preferred topics, methods and frequency of PRO assessment. Glioma patients, their proxies and HCPs involved in the treatment of glioma patients from eight centres in the Netherlands were included. RESULTS Twenty-four patients, 16 proxies and 35 HCPs were interviewed. The majority of patients, proxies and HCPs (92%, 81% and 80%, respectively) were willing to discuss PRO results during consultations. Although HCPs prefer that results are discussed with the nurse specialist, only one-third of patients/proxies agreed. Functioning of daily life was considered important in all three groups. Most participants indicated that discussion of PROM results should take place during standard follow-up visits, and completed at home about 1 week in advance. On group level, there was no preference for administration of questionnaires on paper or digitally. Lastly, all centres had staff available to send questionnaires on paper. CONCLUSION This study shows that routine assessment of PROs is desired by patients, proxies and HCP's in neuro-oncological care in Dutch hospitals.
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Affiliation(s)
- Marthe Peeters
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Germaine Ottenheijm
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul Bienfait
- Department of Neurology, Gelre Ziekenhuizen Apeldoorn, Apeldoorn, The Netherlands
| | - Daniëlle Eekers
- Department of Radiation Oncology (Maastro), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Anja Gijtenbeek
- Department of Neurology, Radboudumc, Nijmegen, The Netherlands
| | - Monique Hanse
- Department of Neurology, Catharina Hospital, Eindhoven, The Netherlands
| | - Johan Koekkoek
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Medisch Centrum Haaglanden, Den Haag, The Netherlands
| | - Leonie van Leeuwen
- Department of Neurology and Neurosurgery, UMC Utrecht, Utrecht, The Netherlands
| | - Cees Tijssen
- Department of Neurology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Medisch Centrum Haaglanden, Den Haag, The Netherlands
| | - Martin Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Medisch Centrum Haaglanden, Den Haag, The Netherlands
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Rosowicz A, Bangla VG, Johnson JW, Olson L, Chen J, Divino CM. Surgery Improves Patient-Reported Outcomes in Patients with Intestinal and Pancreatic NETs: A Prospective Analysis. Ann Surg Oncol 2023; 30:6777-6785. [PMID: 37349613 DOI: 10.1245/s10434-023-13729-4] [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: 01/25/2023] [Accepted: 05/23/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Incorporation of patient-reported outcomes such as health-related quality of life has become increasingly important in the management of chronic diseases such as cancer. In this prospective study, we examined the effect of surgical resection on quality of life in patients with intestinal and pancreatic neuroendocrine tumors (NETs). METHODS Thirty-two patients underwent NET resection at our institution from January 2020 to January 2022. All patients completed the 12-item short-form quality-of-life survey prior to surgery, as well as at the 3-, 6-, and 12-month postoperative time points. The presence and severity of specific carcinoid syndrome symptoms (diarrhea, flushing, and abdominal pain) were also recorded during pre- and postoperative appointments. RESULTS Patients experienced significant increases in both mental and physical health after surgery. Mental health scores significantly increased at all three time points (baseline: 51.33; 3-month: 53.17, p = 0.02; 6-month: 57.20, p < 0.001; 12-month: 57.34, p = 0.002), and physical health scores increased at 6 and 12 months (baseline: 50.39; 6-month: 53.16, p = 0.04; 12-month: 55.02, p = 0.003). Younger patients benefited more in terms of physical health, while older patients had more significant increases in mental health. Patients with metastatic disease, larger primary tumors, and those receiving medical therapy had lower baseline quality-of-life scores and greater improvements after surgery. The vast majority of patients in this study also experienced alleviation of carcinoid syndrome symptoms. CONCLUSIONS In addition to prolonging survival, resection of intestinal and pancreatic NETs leads to significantly improved patient-reported quality of life.
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Affiliation(s)
| | - Venu G Bangla
- Department of Surgery, General Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Laura Olson
- Department of Surgery, General Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jenny Chen
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Celia M Divino
- Department of Surgery, General Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Arditi C, Eicher M, Junod J, Peytremann-Bridevaux I. Socio-demographic and health-related determinants of patients' overall rating and experiences of cancer care. BMC Cancer 2023; 23:918. [PMID: 37773108 PMCID: PMC10540394 DOI: 10.1186/s12885-023-11445-6] [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: 11/15/2022] [Accepted: 09/25/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Understanding how patient-reported experiences of care and overall rating of care vary among patients with different characteristics is useful to help interpret results from patient experience surveys and design targeted improvement interventions. The primary objective of this paper was to identify the socio-demographic and health-related characteristics independently associated with overall rating of cancer care. The secondary objective was to explore if and how these characteristics were associated with specific experiences of cancer care. METHODS This cross-sectional multicenter study analyzed self-reported data collected from 2696 patients diagnosed with breast, prostate, lung, colorectal, skin, or hematological cancer from four large hospitals in French-speaking Switzerland. Multivariate logistic regressions with purposeful stepwise selection of independent variables were used to identify the socio-demographic and health-related characteristics independently associated with overall rating of cancer care in the primary analyses. In the secondary analyses, we ran the multivariate model from the primary analyses with specific experiences of care as outcomes to estimate the adjusted odds ratios (OR) and 95% confidence intervals (CI) of the selected characteristics. RESULTS Respondents' mean rating of overall cancer care was 8.5 on a scale from 0 to 10, with 17% categorized as reporting a low rating (0-7 rating). Being a woman (OR 1.43, 95% CI 1.12-1.83), not being Swiss (OR 1.47, 95% CI 1.12-1.94), reporting lower health literacy (OR 1.95, 95% CI 1.54-2.47), preferring making medical decisions alone (OR 1.92, 95% CI 1.38-2.67), having forgone care due to cost (OR 1.72, 95% CI 1.29-2.29), having used complementary medicine (OR 1.55, 95% CI 1.22-1.97), and reporting poorer health (OR 3.12, 95% CI 2.17-4.50) were all independently associated with a low rating of overall cancer care. Poorer health, lower health literacy, and having forgone care were the three characteristics most often associated with problematic experiences of care. CONCLUSIONS Our results identified several patient characteristics consistently associated with lower overall rating of care and specific experiences of cancer care. Among these determinants, health literacy and financial hardship emerged as key recurring factors shaping poor patient experiences that should be prioritized for attention by cancer care services.
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Affiliation(s)
- Chantal Arditi
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
| | - Manuela Eicher
- Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Julien Junod
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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Salm H, Hentschel L, Eichler M, Pink D, Fuhrmann S, Kramer M, Reichardt P, Schuler MK. Evaluation of electronic patient-reported outcome assessment in inpatient cancer care: a feasibility study. Support Care Cancer 2023; 31:575. [PMID: 37707633 PMCID: PMC10501936 DOI: 10.1007/s00520-023-08014-9] [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: 12/18/2022] [Accepted: 08/23/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE Patient-reported outcome (PRO) measures are increasingly important in evaluating medical care. The increased integration of technology within the healthcare systems allows for collection of PROs electronically. The objectives of this study were to Ashley et al. J Med Internet Res (2013) implement an electronic assessment of PROs in inpatient cancer care and test its feasibility for patients and Dawson et al. BMJ (2010) determine the equivalence of the paper and electronic assessment. METHODS We analyzed two arms from a study that was originally designed to be an interventional, three-arm, and multicenter inpatient trial. A self-administered questionnaire based on validated PRO-measures was applied and completed at admission, 1 week after, and at discharge. For this analysis - focusing on feasibility of the electronic assessment - the following groups will be considered: Group A (intervention arm) received a tablet version, while group B (control arm) completed the questionnaire on paper. A feasibility questionnaire, that was adapted from Ashley et al. J Med Internet Res (2013), was administered to group A. RESULTS We analyzed 103 patients that were recruited in oncology wards. ePRO was feasible to most patients, with 84% preferring the electronic over paper-based assessment. The feasibility questionnaire contained questions that were answered on a scale ranging from "1" (illustrating non achievement) to "5" (illustrating achieving goal). The majority (mean 4.24, SD .99) reported no difficulties handling the electronic tool and found it relatively easy finding time for filling out the questionnaire (mean 4.15, SD 1.05). There were no significant differences between the paper and the electronic assessment regarding the PROs. CONCLUSION Results indicate that electronic PRO assessment in inpatient cancer care is feasible.
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Affiliation(s)
- Hanna Salm
- Department of Internal Medicine C, University Hospital Greifswald, Greifswald, Germany.
- Sarcoma Center Berlin-Brandenburg, Helios Hospital Bad Saarow, Bad Saarow, Germany.
| | | | - Martin Eichler
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Daniel Pink
- Department of Internal Medicine C, University Hospital Greifswald, Greifswald, Germany
- Sarcoma Center Berlin-Brandenburg, Helios Hospital Bad Saarow, Bad Saarow, Germany
| | - Stephan Fuhrmann
- Clinic for Hematology and Oncology, Helios Hospital Emil von Behring Berlin, Berlin, Germany
| | | | - Peter Reichardt
- Clinic for Oncology and Palliative Medicine, Helios Hospital Berlin Buch, Berlin, Germany
| | - Markus K Schuler
- Division of Hematology, Oncology and Stem Cell Transplantation, Medical Clinic I, Department of Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Onkologischer Schwerpunkt am Oskar-Helene-Heim, Berlin, Germany
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Borchmann O, Weis N, Hansen ABE, Storgaard M, Fetters MD, Chandanabhumma PP, Moseholm E. Patient-reported outcomes in clinical HIV care: protocol for a single-centre, multistage, mixed-methods study in Denmark. BMJ Open 2023; 13:e077303. [PMID: 37709310 PMCID: PMC10503392 DOI: 10.1136/bmjopen-2023-077303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/31/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION People with HIV-1 (PWH) have worse health-related quality of life (HRQoL) compared with the general population. Using patient-reported outcomes (PROs) may help reorient the focus of HIV care towards improving HRQoL. This study aims to develop, implement and evaluate the use of PROs in HIV care. METHODS AND ANALYSIS This is a Danish single-centre, multistage mixed-methods study consisting of four substudies (studies I-IV). Study I is a qualitative focus group interview study aiming to identify relevant PRO domains, and barriers and benefits to PRO use. Participants are 5-10 PWH and 5-10 HIV healthcare providers (HCPs). Data are thematically analysed. Results will guide the design of a PRO measure (PROM). Study II is a quantitative study aiming to assess PWH's willingness and ability to engage with PRO. All PWH are consecutively invited to complete the PROMs before their next consultations. Demographic data are collected at enrolment. Differences between PWH who do/do not complete the PROMs are assessed. Study III is a quantitative before-and-after study aiming to assess the impact of PRO use on HCP awareness. Participants are all who complete the PROMs in Study II. In contrast to study II, HCPs are notified of the PROM results. The number of problems documented by the HCP in patients' medical records during studies II and III are compared using χ2 tests. Multiple regression models are used to identify factors associated with HCP awareness. Study IV is a qualitative study aiming to explore PWH and HCP experiences of using PROs. Participants are 15-20 PWH and 10-15 HCP. Data are collected from participant observation of PRO consultations and individual interviews. Data are analysed thematically. ETHICS AND DISSEMINATION This study is approved by the Danish Data Protection Agency. Participants will provide written consent prior to participation. Results will be published in peer-reviewed journals.
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Affiliation(s)
- Olivia Borchmann
- Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | - Nina Weis
- Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Kobenhavn, Denmark
| | - Ann-Brit Eg Hansen
- Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Kobenhavn, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus Universitetshospital, Aarhus, Denmark
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Mixed Methods Program, University of Michigan, Ann Arbor, Michigan, USA
| | - P Paul Chandanabhumma
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Mixed Methods Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Ellen Moseholm
- Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Kobenhavn, Denmark
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Lai JS, Jensen SE, Peipert JD, Mitchell SA, Garcia SF, Cella D, Goldman S, Lenzen A. Using IT to Improve Outcomes for Children Living With Cancer (SyMon-SAYS): Protocol for a Single-Institution Waitlist Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e50993. [PMID: 37682593 PMCID: PMC10517385 DOI: 10.2196/50993] [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: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Children and adolescents with cancer may experience multiple disease- and treatment-related symptoms that negatively affect health-related quality of life. Routine symptom surveillance thus constitutes an important component of supportive care in pediatric oncology. The Symptom Monitoring and Systematic Assessment and Reporting System in Young Survivors (SyMon-SAYS) system will administer, score, interpret, and display the results of symptom assessments captured weekly using patient-reported outcomes presented via the electronic health record (EHR) portal between clinic visits in oncology ambulatory settings, when patients are likely to be more symptomatic. This study is testing a digital system for routine symptom surveillance that includes EHR-based reports to clinicians and alerts for severe symptoms. OBJECTIVE In this randomized trial, we are examining the effects of the SyMon-SAYS system on perceived barriers to symptom management, self-efficacy, and symptom severity. Better self-management and timely clinical intervention to address symptoms promote adherence to treatment plans, strengthen child and parent self-efficacy, improve interactions between children, parents, and their clinical providers, and optimize clinical outcomes. METHODS The SyMon-SAYS system is integrated into the EHR to streamline the presentation of symptom scores and delivery of alerts for severe symptoms to clinicians using EHR (Epic) messaging functionalities. Children (aged 8 to 17 years) complete the weekly symptom assessment and review the symptom report by logging into the patient portal (Epic MyChart). This single-institution waitlist randomized controlled trial is recruiting 200 children (aged 8-17 years) with cancer and their parents, guardians, or caregivers. Participating dyads are randomly assigned to receive the intervention over 16 weeks (Group A: 16-week SyMon-SAYS intervention; Group B: 8-week usual care and then an 8-week SyMon-SAYS intervention). Analyses will (1) evaluate the efficacy of SyMon-SAYS at week 8 and the maintenance of those effects at week 16; (2) evaluate factors associated with those efficacy outcomes, including contextual factors, adherence to the SyMon-SAYS intervention, demographic characteristics, and clinical factors; and (3) evaluate predictors of adherence to the SyMon-SAYS intervention and preference of SyMon-SAYS versus usual care. RESULTS Data collection is currently in progress. We hypothesize that at 8 weeks, those receiving the SyMon-SAYS intervention will report decreased parent-perceived barriers to managing their children's symptoms, increased parent and child self-efficacy, decreased child symptom burden, and ultimately better child health-related quality of life, compared to waitlist controls. Feasibility, acceptability, and engagement from the perspectives of the children with cancer, their parents, and their clinicians will be examined using mixed methods. CONCLUSIONS We anticipate that this system will facilitate prompt identification of problematic symptoms. Additionally, we hypothesize that with the availability of graphical symptom reports over time, and timely provider responses, children or parents will become better informed and take an active role in managing their symptoms, which will further improve clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT04789720; https://clinicaltrials.gov/study/NCT04789720. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50993.
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Affiliation(s)
- Jin-Shei Lai
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
| | - Sally E Jensen
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - John Devin Peipert
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
| | - Sandra A Mitchell
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States
| | - Sofia F Garcia
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
| | - David Cella
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
| | - Stewart Goldman
- Department of Child Health, College of Medicine - Phoenix, University of Arizona, Phoenix, AZ, United States
- Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Alicia Lenzen
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
- Division of Hematology, Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, IL, United States
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Hunt AR, Stuart CM, Gergen AK, Bang TJ, Reihman AE, Helmkamp LJ, Lin Y, Mitchell JD, Meguid RA, Scott CD, Wojcik BM. Long-Term Patient-Reported Symptom Improvement and Quality of Life after Transthoracic Diaphragm Plication in Adults. J Am Coll Surg 2023; 237:533-544. [PMID: 37194947 DOI: 10.1097/xcs.0000000000000762] [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: 05/18/2023]
Abstract
BACKGROUND Open and robotic-assisted transthoracic approaches for diaphragm plication are accepted surgical interventions for diaphragm paralysis and eventration. However, long-term patient-reported symptom improvement and quality of life (QOL) remains unclear. STUDY DESIGN A telephone-based survey was developed focusing on postoperative symptom improvement and QOL. Patients who underwent open or robotic-assisted transthoracic diaphragm plication (2008-2020) across three institutions were invited to participate. Patients who responded and provided consent were surveyed. Likert responses on symptom severity were dichotomized and rates before and after surgery were compared using McNemar's test. RESULTS Forty-one percent of patients participated (43 of 105 responded, mean age 61.0 years, 67.4% male, 37.2% robotic-assisted surgery), with an average time between surgery and survey of 4.1 ± 3.2 years. Patients reported significant improvement in dyspnea while lying flat (67.4% pre- vs 27.9% postoperative, p < 0.001), dyspnea at rest (55.8% pre- vs 11.6% postoperative, p < 0.001), dyspnea with activity (90.7% pre- vs 55.8% postoperative, p < 0.001), dyspnea while bending over (79.1% pre- vs 34.9% postoperative, p < 0.001), and fatigue (67.4% pre- vs 41.9% postoperative, p = 0.008). There was no statistical improvement in chronic cough. 86% of patients reported improved overall QOL, 79% had increased exercise capacity, and 86% would recommend surgery to a friend with a similar problem. Analysis comparing open and robotic-assisted approaches found no statistically significant differences in symptom improvement or QOL responses between the groups. CONCLUSIONS Patients report significantly improved dyspneic and fatigue symptoms after transthoracic diaphragm plication, regardless of open or robotic-assisted approach. The majority of patients report improved QOL and exercise capacity.
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Affiliation(s)
- Amanda R Hunt
- From the Division of Cardiothoracic Surgery, Department of Surgery (Hunt, Stuart, Gergen, Mitchell, Meguid), University of Colorado, Aurora, CO
| | - Christina M Stuart
- From the Division of Cardiothoracic Surgery, Department of Surgery (Hunt, Stuart, Gergen, Mitchell, Meguid), University of Colorado, Aurora, CO
| | - Anna K Gergen
- From the Division of Cardiothoracic Surgery, Department of Surgery (Hunt, Stuart, Gergen, Mitchell, Meguid), University of Colorado, Aurora, CO
| | - Tami J Bang
- Division of Cardiopulmonary Imaging, Department of Radiology (Bang), University of Colorado, Aurora, CO
| | - Anne E Reihman
- Critical Care and Pulmonary Sleep Associates, Aurora, CO (Reihman)
| | - Laura J Helmkamp
- Adult and Child Consortium for Health Outcomes Research, University of Colorado School of Medicine, Aurora, CO (Helmkamp)
| | - Yihan Lin
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA (Lin)
| | - John D Mitchell
- From the Division of Cardiothoracic Surgery, Department of Surgery (Hunt, Stuart, Gergen, Mitchell, Meguid), University of Colorado, Aurora, CO
| | - Robert A Meguid
- From the Division of Cardiothoracic Surgery, Department of Surgery (Hunt, Stuart, Gergen, Mitchell, Meguid), University of Colorado, Aurora, CO
| | - Christopher D Scott
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, VA (Scott)
| | - Brandon M Wojcik
- the Division of Cardiothoracic Surgery, Department of Surgery, Munson Medical Center, Traverse City, MI (Wojcik)
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Suzuki Y, Iwamoto T, Uno M, Hatono M, Kajiwara Y, Takahashi Y, Kochi M, Shien T, Kikawa Y, Uemura Y, Hagiwara Y, Yamamoto S, Taira N, Doihara H, Toyooka S. Development and validation of a symptom illustration scale from the patient-reported outcome common terminology criteria for adverse events for patients with breast cancer. Breast Cancer 2023; 30:856-868. [PMID: 37422608 DOI: 10.1007/s12282-023-01480-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Emojis are commonly used for daily communication and may be useful in assessing patient-reported outcomes (PROs) in breast cancer. The purpose of this study is to develop and validate a Symptom Illustration Scale (SIS) as a new PRO measurement. METHODS Eighteen original SIS items were developed from the PRO-CTCAE. In cohort one, the SIS validity and reliability were examined in patients with breast cancer, using a semi-structured five-question survey to investigate content validity. PROs with PRO-CTCAE and SIS were examined twice to determine criteria validity and test-retest reliability. In cohort two, the responsiveness of the scales were examined in patients treated with anthracycline, docetaxel, paclitaxel, and endocrine therapy. PROs with PRO-CTCAE and SIS were investigated two or three times, depending on the therapy. RESULTS Patients were enrolled from August 2019 to October 2020. In cohort one (n = 70), most patients had no difficulties with the SIS, but 16 patients indicated that it was difficult to understand severities in the SIS. For criterion validity, Spearman rank correlation coefficients (rs) between PRO-CTCAE and SIS items were ≥ 0.41, except for "Decreased appetite." For test-retest reliability, κ coefficients of the SIS were ≥ 0.41 for 16/18 items (88.9%). Response time was significantly shorter for the SIS than for PRO-CTCAE (p < 0.001). In cohort two (n = 106), score changes between PRO-CTCAE and SIS for relevant symptoms all had correlations with rs ≥ 0.41. CONCLUSION An original SIS from the PRO-CTCAE for patients with breast cancer were verified the validity, reliability, and responsiveness. Further studies to improve and validate the SIS are needed.
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Affiliation(s)
- Yoko Suzuki
- Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University, Okayama, Japan
| | - Takayuki Iwamoto
- Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan.
- Department of Breast and Thyroid Surgery, Kawasaki Medical School Hospital, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Maya Uno
- Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University, Okayama, Japan
| | - Minami Hatono
- Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Yukiko Kajiwara
- Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Yuko Takahashi
- Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Mariko Kochi
- Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Tadahiko Shien
- Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Yuichiro Kikawa
- Breast Surgery, Kansai Medical University Hospital, Osaka, Japan
| | - Yukari Uemura
- Biosciences, Department of Data Science, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasuhiro Hagiwara
- Department of Biostatistics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | | | - Naruto Taira
- Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
- Department of Breast and Thyroid Surgery, Kawasaki Medical School Hospital, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Hiroyoshi Doihara
- Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
- Department of Surgery, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University, Okayama, Japan
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50
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Oates GR, Mims C, Geurs R, Bergquist R, Hager A, Guimbellot JS, Hartzes AM, Gutierrez HH. Mobile health platform for self-management of pediatric cystic fibrosis: Impact on patient-centered care outcomes. J Cyst Fibros 2023; 22:823-829. [PMID: 37085386 DOI: 10.1016/j.jcf.2023.04.009] [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: 12/09/2022] [Revised: 03/29/2023] [Accepted: 04/15/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Previously, we adapted a mobile health platform (Genia) to the needs of patients and families in a pediatric CF center in the United States. In this feasibility study, we tested the impact of Genia on measures of patient-centered care. METHODS In a one-group pre-post study with adolescents with CF and caregivers of children with CF, we tested Genia's effect over 6 months on patient satisfaction with chronic illness care (PACIC) and shared decision-making (CollaboRate). Feasibility and acceptability were assessed with exit interviews and app analytics. RESULTS The intervention included 40 participants: 30 caregivers of children with CF age ≤14 years and 10 patients with CF age ≥15 years. The use of Genia was associated with increased satisfaction with care (p = 0.024), including delivery system and decision support (p = 0.017), goal setting (p = 0.006), and shared decision-making (p<0.001). The use of Genia was associated with nominal improvements in all QOL domains and symptom scales. The platform was feasible, with participants recording more than 4,400 observations (mean 84.2) and submitting 496 weekly reports (mean 13.8) and 70 quarterly reports (mean 1.8), and acceptable (95% retention rate). For participants, the most useful app feature was pre-visit reports (66.7%), and the top symptom trackers were those for cough (23.7%), appetite (21.1%), energy (18.4%), and medicines (18.4%). CONCLUSION The use of Genia over 6 months was feasible, acceptable, and associated with improved measures of patient-centered care. Study results support wider use of Genia in clinical settings. Efficacy for clinical outcomes should be assessed in a randomized clinical trial.
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Affiliation(s)
- Gabriela R Oates
- Pediatric Pulmonary and Sleep Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Cathy Mims
- Children's of Alabama, Birmingham, AL, USA
| | - Robin Geurs
- Pediatric Pulmonary and Sleep Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rikard Bergquist
- Motivo Management, LLC, Reno, NV, USA; Upstream Dream AB, Stockholm, Sweden
| | | | - Jennifer S Guimbellot
- Pediatric Pulmonary and Sleep Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anastasia M Hartzes
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hector H Gutierrez
- Pediatric Pulmonary and Sleep Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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