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Ozkan EE, Serel TA, Soyupek AS, Kaymak ZA. Utilization of machine learning methods for prediction of acute and late rectal toxicity due to curative prostate radiotherapy. RADIATION PROTECTION DOSIMETRY 2024:ncae154. [PMID: 38932433 DOI: 10.1093/rpd/ncae154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 04/17/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Rectal toxicity is one of the primary dose-limiting side effects of prostate cancer radiotherapy, and consequential impairment on quality of life in these patients with long survival is an important problem. In this study, we aimed to evaluate the possibility of predicting rectal toxicity with artificial intelligence model which was including certain dosimetric parameters. MATERIALS AND METHODS One hundred and thirty-seven patients with a diagnosis of prostate cancer who received curative radiotherapy for prostate +/- pelvic lymphatics were included in the study. The association of the clinical data and dosimetric data between early and late rectal toxicity reported during follow-up was evaluated. The sample size was increased to 274 patients by synthetic data generation method. To determine suitable models, 15 models were studied with machine learning algorithms using Python 2.3, Pycaret library. Random forest classifier was used with to detect active variables. RESULTS The area under the curve and accuracy were found to be 0.89-0.97 and 95%-99%, respectively, with machine learning algorithms. The sensitivity values for acute and toxicity were found to be 0.95 and 0.99, respectively. CONCLUSION Early or late rectal toxicity can be predicted with a high probability via dosimetric and physical data and machine learning algorithms of patients who underwent prostate +/- pelvic radiotherapy. The fact that rectal toxicity can be predicted before treatment, which may result in limiting the dose and duration of treatment, makes us think that artificial intelligence can enter our daily practice in a short time in this sense.
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Affiliation(s)
- Emine Elif Ozkan
- Department of Radiation Oncology, Suleyman Demirel University, Isparta, 32260, Türkiye
| | - Tekin Ahmet Serel
- Department of Urology, Suleyman Demirel University, Isparta, 32260, Türkiye
| | - Arap Sedat Soyupek
- Department of Urology, Suleyman Demirel University, Isparta, 32260, Türkiye
| | - Zumrut Arda Kaymak
- Department of Radiation Oncology, Suleyman Demirel University, Isparta, 32260, Türkiye
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Kida K, Yamada A, Shimada K, Narui K, Sugae S, Shimizu D, Doi T, Oba M, Endo I, Ishikawa T. A prospective comparison study utilizing patient-reported outcomes of taxane-related peripheral neuropathy between nab-paclitaxel and standard paclitaxel in patients with breast cancer. Breast Cancer 2024; 31:409-416. [PMID: 38453739 DOI: 10.1007/s12282-024-01551-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 02/04/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND: Characteristics of taxane-induced peripheral neuropathy (PN) could be different between paclitaxel and nab-paclitaxel. The purpose of this prospective observational multicenter cohort study was to compare tri-weekly nab-paclitaxel to weekly standard paclitaxel regarding the severity, onset and recovery of sensory and motor PN in patients with breast cancer. METHODS Patients with histologically confirmed breast cancer who were scheduled to receive standard weekly paclitaxel (80 mg/m2) or tri-weekly nab-paclitaxel (260 mg/m2) at institutions in our multicenter group were eligible for this study. Sensory and motor PN were evaluated every 3 weeks until PN improved for up to one year using patient-reported outcome. RESULTS Between February 2011 and April 2013, 115 patients were enrolled, including 57 and 58 in the paclitaxel and nab-paclitaxel groups, respectively. The incidence of moderate or severe sensory PN was not significantly different between the two groups (p = 0.40). The incidence of moderate or higher motor PN was more frequent in the nab-paclitaxel group than in the paclitaxel group (p = 0.048). The median period for demonstrating PN were shorter in the nab-paclitaxel group than in the paclitaxel group (sensory, p = 0.003; motor, p = 0.001). The recovery of motor PN was slower in the nab-paclitaxel group than in the paclitaxel group (p = 0.035), while the recovery period of sensory PN was not statistically different. CONCLUSION Nab-paclitaxel induced sensory PN sooner than paclitaxel, and no difference was observed in the severity and recovery duration between the two agents. Motor PN was more severe, started sooner, and improved over a longer period in the nab-paclitaxel-treated patients than in the paclitaxel-treated patients.
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Affiliation(s)
- Kumiko Kida
- Department of Gastroenterological Surgery and Surgical Oncology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
- Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Akimitsu Yamada
- Department of Gastroenterological Surgery and Surgical Oncology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Kazuhiro Shimada
- Department of Breast Surgery, Yokohama Municipal Citizen's Hospital, Kanagawa, Japan
- Department of Surgery, Yokohama Saiseikai Nanbu Hospital, Kanagawa, Japan
| | - Kazutaka Narui
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, Kanagawa, Japan
| | - Sadatoshi Sugae
- Department of Gastroenterological Surgery and Surgical Oncology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
- Department of Breast Surgery, Fujisawa City Hospital, Kanagawa, Japan
| | - Daisuke Shimizu
- Department of Breast Surgery, Yokohama Minato Red Cross Hospital, Kanagawa, Japan
| | - Takako Doi
- Department of Breast Surgery, Shonan Memorial Hospital, Kanagawa, Japan
| | - Mari Oba
- Department of Medical Statistics, Toho University, Tokyo, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery and Surgical Oncology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Takashi Ishikawa
- Department of Breast Surgery and Oncology, Tokyo Medical University, Tokyo, Japan
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McGarrah P, Hubbard J, Novotny PJ, Branda ME, Sargent DS, Morton RF, Fuchs CS, Benson AB, Williamson SK, Findlay BP, Alberts SR, Goldberg RM, Sloan JA. Baseline Quality of Life is a Strong and Independent Prognostic Factor for Overall Survival in Metastatic Colorectal Cancer. Cancer Control 2023; 30:10732748231185047. [PMID: 37339926 PMCID: PMC10286175 DOI: 10.1177/10732748231185047] [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] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Previous studies have established that higher baseline quality of life (QOL) scores are associated with improved survival in patients with metastatic colorectal cancer (mCRC). We examined the relationship between overall survival (OS) and baseline QOL. PATIENTS AND METHODS A total of 1 247 patients with mCRC participating in N9741 (comparing bolus 5-FU/LV, irinotecan [IFL] vs infusional 5-FU/leucovorin [LV]/oxaliplatin [FOLFOX] vs. irinotecan/oxaliplatin [IROX]) provided data at baseline on overall QOL using a single-item linear analogue self-assessment (LASA) 0-100 point scale. The association of OS according to clinically deficient (defined as CD-QOL, score 0-50) vs not clinically deficient (nCD-QOL, score 51-100) baseline QOL scores was tested. A multivariable analysis using Cox proportional hazards modeling was performed to adjust for the effects of multiple baseline factors. An exploratory analysis was performed evaluating OS according to baseline QOL status among patients who did or did not receive second-line therapy. RESULTS Baseline QOL was a strong predictor of OS for the whole cohort (CD-QOL vs nCD-QOL: 11.2 months vs 18.4 months, P < .0001), and in each arm IFL 12.4 vs 15.1 months, FOLFOX 11.1 months vs 20.6 months, and IROX 8.9 months vs 18.1 months. Baseline QOL was associated with baseline performance status (PS) (P < .0001). After adjusting for PS and treatment arm, baseline QOL was still associated with OS (P = .017). CONCLUSIONS Baseline QOL is an independent prognostic factor for OS in patients with mCRC. The demonstration that patient-assessed QOL and PS are independent prognostic indicators suggests that these assessments provide important complementary prognostic information.
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Affiliation(s)
| | - Joleen Hubbard
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Paul J. Novotny
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Megan E. Branda
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Daniel S. Sargent
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Roscoe F. Morton
- North Central Cancer Treatment Group, Iowa Oncology Research Association, Des Moines, IA, USA
| | | | - Al B. Benson
- Division of Hematology and Medical Oncology, Northwestern University, Chicago, IL, USA; and ECOG-ACRIN Cancer Research Group, Philadelphia, PA, USA
| | - Stephen K. Williamson
- SWOG Cancer Research Network, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | | | - Jeff A. Sloan
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
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Strouse CS, Larson MC, Ehlers SL, Yost KJ, Maurer MJ, Ansell SM, Inwards DJ, Johnston PB, Micallef IN, Link BK, Farooq U, Cerhan JR, Thompson CA. Long-Term Health-Related Quality of Life of Autologous Hematopoietic Cell Transplantation Patients and Nontransplant Patients With Aggressive Lymphoma: A Prospective Cohort Analysis. JCO Oncol Pract 2022; 18:e1069-e1080. [PMID: 35594505 PMCID: PMC9287288 DOI: 10.1200/op.21.00694] [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: 09/23/2021] [Revised: 02/11/2022] [Accepted: 04/08/2022] [Indexed: 01/22/2023] Open
Abstract
PURPOSE This study assessed the long-term quality of life (QOL) of patients with aggressive lymphoma subtypes treated with autologous hematopoietic cell transplant (autoHCT) compared with those without history of transplant. METHODS Patient-reported QOL measures were prospectively gathered from patients enrolled in the Iowa/Mayo Specialized Program of Research Excellence Molecular Epidemiology Resource cohort with aggressive lymphoma subtypes. QOL was measured using the Functional Assessment of Cancer Therapy-General (FACT-G), Functional Assessment of Chronic Illness Therapy-Fatigue Scale, State-Trait Anxiety Inventory (STAI), and Profile of Mood States instruments and with a numeric rating scale for overall QOL and spiritual QOL. The autoHCT group and no HCT groups were compared at 3 years (FU3) and 6 years (FU6) after lymphoma diagnosis. RESULTS In total, 980 patients with lymphoma (106 autoHCT and 874 no HCT) diagnosed between 2002 and 2013 were included for analysis. The mean FACT-G total score was similar in the autoHCT and no HCT groups at FU3 (89.9 v 90.1, P = .64) and also at FU6 (91.5 v 89.6, P = .44). No differences between the autoHCT and no HCT groups were identified in the FACT subscales. The STAI identified lower anxiety in the autoHCT group by mean STAI1 (state) at FU3 (30.1 v 33.4, P < .01) and by mean STAI2 (trait) at FU6 (30.1 v 33.5, P = .02). No other clinically meaningful differences were identified between the two groups using the other QOL instruments. CONCLUSION Patients remaining in remission at 3 and 6 years after diagnosis had a high level of QOL with no significant differences associated with history of treatment with autoHCT.
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Affiliation(s)
- Christopher S. Strouse
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa, Iowa City, IA
| | | | - Shawna L. Ehlers
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Kathleen J. Yost
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Stephen M. Ansell
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - David J. Inwards
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Patrick B. Johnston
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Ivana N. Micallef
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Brian K. Link
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Umar Farooq
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa, Iowa City, IA
| | - James R. Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Carrie A. Thompson
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
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Caminiti C, Bryce J, Riva S, Ng D, Diodati F, Iezzi E, Sparavigna L, Novello S, Porta C, Del Mastro L, Procopio G, Cinieri S, Falzetta A, Calabrò F, Lorusso V, Cogoni AA, Tortora G, Maruzzo M, Passalacqua R, Cognetti F, Adamo V, Capelletto E, Ferrari A, Bagnalasta M, Bassi M, Nicelli A, De Persis D, D'Acunti A, Iannelli Patient E, Perrone F, Mitchell SA. Cultural adaptation of the Italian version of the Patient-Reported Outcomes Common Terminology Criteria for Adverse Event (PRO-CTCAE®). TUMORI JOURNAL 2022:3008916221099558. [PMID: 35674125 DOI: 10.1177/03008916221099558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION US National Cancer Institute's (NCI) Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE®) is a library of 78 symptom terms and 124 items enabling patient reporting of symptomatic adverse events in cancer trials. This multicenter study used mixed methods to develop an Italian language version of this widely accepted measure, and describe the content validity and reliability in a diverse sample of Italian-speaking patients. METHODS All PRO-CTCAE items were translated in accordance with international guidelines. Subsequently, the content validity of the PRO-CTCAE-Italian was explored and iteratively refined through cognitive debriefing interviews. Participants (n=96; 52% male; median age 64 years; 26% older adults; 18% lower educational attainment) completed a PRO-CTCAE survey and participated in a semi-structured interview to determine if the translation captured the concepts of the original English language PRO-CTCAE, and to evaluate comprehension, clarity and ease of judgement. Test-retest reliability of the finalized measure was explored in a second sample (n=135). RESULTS Four rounds of cognitive debriefing interviews were conducted. The majority of PRO-CTCAE symptom terms, attributes and associated response choices were well-understood, and respondents found the items easy to judge. To improve comprehension and clarity, the symptom terms for nausea and pain were rephrased and retested in subsequent interview rounds. Test-retest reliability was excellent for 41/49 items (84%); the median intraclass correlation coefficient was 0.83 (range 0.64-0.94). DISCUSSION Results support the semantic, conceptual and pragmatic equivalence of PRO-CTCAE-Italian to the original English version, and provide preliminary descriptive evidence of content validity and reliability.
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Affiliation(s)
- Caterina Caminiti
- Research and Innovation Unit, University Hospital of Parma, Parma, Italy
| | - Jane Bryce
- Ascension St. John Clinical Research Institute, Tulsa, Oklahoma, USA
| | - Silvia Riva
- Department of Psychology, St Mary's University, London, UK
| | - Diane Ng
- Westat Inc, Rockville, Maryland, USA
| | - Francesca Diodati
- Research and Innovation Unit, University Hospital of Parma, Parma, Italy
| | - Elisa Iezzi
- Research and Innovation Unit, University Hospital of Parma, Parma, Italy
| | - Lucia Sparavigna
- Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Silvia Novello
- Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi Gonzaga, Orbassano, Italy
| | - Camillo Porta
- Division of Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy.,Department of Biomedical Sciences and Human Oncology, University of Bari A. Moro, Bari, Italy
| | - Lucia Del Mastro
- Department of Medical Oncology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy
| | - Giuseppe Procopio
- Fondazione IRCCS, Istituto Nazionale dei Tumori, Oncology Unit 1, Milan, Italy
| | - Saverio Cinieri
- Medical Oncology & Breast Unit, Antonio Perrino Hospital, Brindisi, Italy
| | | | - Fabio Calabrò
- Department of Oncology, San Camillo Forlanini Hospital, Rome, Italy
| | - Vito Lorusso
- Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Oncologico, Bari, Italy
| | | | - Giampaolo Tortora
- Department of Oncology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Marco Maruzzo
- Oncology Unit 1, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | | | - Francesco Cognetti
- Department of Clinical and Molecular Medicine, Università La Sapienza di Roma, Roma, Italy
| | - Vincenzo Adamo
- Medical Oncology Unit, A.O. Papardo & Department of Human Pathology University of Messina, Messina, Italy
| | - Enrica Capelletto
- Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi Gonzaga, Orbassano, Italy
| | - Alessandra Ferrari
- Division of Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy
| | | | | | | | - Davide De Persis
- Federazione Italiana delle Associazioni di Volontariato in Oncologia - F.A.V.O., Rome, Italy
| | - Alessia D'Acunti
- Associazione Italiana Malati di Cancro, parenti ed amici - AIMaC, Rome Italy
| | | | - Francesco Perrone
- Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Sandra A Mitchell
- Division of Cancer Control and Population Sciences, Outcomes Research Branch, National Cancer Institute, Rockville, Maryland, USA
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Shen B, Shi S, Cui H, Li Y, Chen H, Jin H, Xu J, Liu Z, Jin Y. A Study Protocol for the Management of Children With Juvenile Idiopathic Arthritis Based on ePROs. Front Pediatr 2022; 10:905182. [PMID: 35874559 PMCID: PMC9298843 DOI: 10.3389/fped.2022.905182] [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: 03/26/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is a common chronic rheumatic disease with no known cures, affecting children with the age of onset under 16 years. Patient-reported outcome (PRO) measures are an important basis for evaluating the impact of JIA and associated therapies, however, which is particular challenge in the pediatric setting. At present, no randomized controlled studies have investigated the effect and usability of ePROs symptom management for children with JIA. METHODS This longitudinal, randomized, controlled trial will be carried out at outpatient and pediatric wards of the Shanghai Children's Medical Center affiliated to Shanghai Jiao Tong University School of Medicine. A total of one hundred children with JIA diagnosed according to the International League of Associations for Rheumatology (ILAR) patients are randomized to receive individualized symptom management based on ePROs or routine management. The primary outcome is the mean C-Ped-PROMIS T-scores of patients in the ePROs-based group and the control group. The secondary outcomes are the trajectories of C-Ped-PROMIS T-scores and HRQOL scores, and changing relationship between them. Data were collected at 5 time points: at enrollment ("baseline") and at the time of follow-up visits scheduled at 1, 3, 6, and 12 months. DISCUSSION The findings are expected to conclude that the symptom management based on ePROs for children with JIA can improve the symptom of JIA, and it is a feasible and effective way to monitor and intervene children with JIA. CLINICAL TRIAL http://www.chictr.org.cn/showproj.aspx?proj=132769; (ChiCTR2100050503).
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Affiliation(s)
- Biyu Shen
- Department of Nursing, Shanghai Children's Medical Center, Shanghai, China.,School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Songsong Shi
- Department of Nursing, Shanghai Children's Medical Center, Shanghai, China
| | - Hengmei Cui
- Department of Nursing, Shanghai Children's Medical Center, Shanghai, China
| | - Yunyun Li
- Department of Nursing, Shanghai Children's Medical Center, Shanghai, China
| | - Haoyang Chen
- Department of Nursing, Shanghai Children's Medical Center, Shanghai, China
| | - Huan Jin
- Department of Rheumatology, Shanghai Children's Medical Center, Shanghai, China
| | - Jia Xu
- Department of Rheumatology, Shanghai Children's Medical Center, Shanghai, China
| | - Zuojia Liu
- Department of Rheumatology, Shanghai Children's Medical Center, Shanghai, China
| | - Yanliang Jin
- Department of Rheumatology, Shanghai Children's Medical Center, Shanghai, China
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Lee J, Jung JH, Kim WW, Kang B, Woo J, Rim HD, Chae YS, Lee SJ, Kim GH, Lee WK, Park HY. Short-term serial assessment of electronic patient-reported outcome for depression and anxiety in breast Cancer. BMC Cancer 2021; 21:1065. [PMID: 34587936 PMCID: PMC8479978 DOI: 10.1186/s12885-021-08771-y] [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: 03/10/2021] [Accepted: 09/07/2021] [Indexed: 12/09/2022] Open
Abstract
Purpose The incidence of depression and anxiety is higher in patients with breast cancer than in the general population. We evaluated the degree of depression and anxiety and investigated the changes in patients with breast cancer during the treatment period and short-term follow-up period. Methods Overall, 137 patients with breast cancer were evaluated using the Patient Health Questionnaire 9-item depression scale (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7). The scales were developed as a web-based electronic patient-reported outcome measure, and serial results were assessed before the operation, after the operation, in the post-treatment period, and in the 6-month follow-up period after surgery. Results The degree of depression and anxiety increased during treatment and decreased at 6-month follow-up, even if there were no statistical differences among the four periods (PHQ-9: p = 0.128; GAD-7: p = 0.786). However, daily fatigue (PHQ-9 Q4) and insomnia (PHQ-9 Q3) were the most serious problems encountered during treatment and at 6-month follow-up, respectively. In the GAD-7, worrying too much (Q3) consistently showed the highest scores during the treatment and follow-up periods. Of the patients, 7 (5.11%) and 11 (8.03%) patients had a worsened state of depression and anxiety, respectively, after treatment compared with before treatment. Conclusion Most factors associated with depression and anxiety improved after treatment. However, factors such as insomnia and worrying too much still disturbed patients with breast cancer, even at 6-month follow-up. Therefore, serial assessment of depression and anxiety is necessary for such patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08771-y.
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Affiliation(s)
- Jeeyeon Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, 41404, Republic of Korea
| | - Jin Hyang Jung
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, 41404, Republic of Korea
| | - Wan Wook Kim
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, 41404, Republic of Korea
| | - Byeongju Kang
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, 41404, Republic of Korea
| | - Jungmin Woo
- Department of Psychiatry, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hyo-Deog Rim
- Department of Psychiatry, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Yee Soo Chae
- Department of Oncology/Hematology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Soo Jung Lee
- Department of Oncology/Hematology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | | | - Won Kee Lee
- Department of Medical Informatics, School of Medicine, KyungPook National University, Daegu, Republic of Korea
| | - Ho Yong Park
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, 41404, Republic of Korea.
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Adjei AA, Lopez CL, Schaid DJ, Sloan JA, Le-Rademacher JG, Loprinzi CL, Norman AD, Olson JE, Couch FJ, Beutler AS, Vachon CM, Ruddy KJ. Genetic Predictors of Chemotherapy-Induced Peripheral Neuropathy from Paclitaxel, Carboplatin and Oxaliplatin: NCCTG/Alliance N08C1, N08CA and N08CB Study. Cancers (Basel) 2021; 13:1084. [PMID: 33802509 PMCID: PMC7959452 DOI: 10.3390/cancers13051084] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 12/14/2022] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common and potentially permanent adverse effect of chemotherapeutic agents including taxanes such as paclitaxel and platinum-based compounds such as oxaliplatin and carboplatin. Previous studies have suggested that genetics may impact the risk of CIPN. We conducted genome-wide association studies (GWASs) for CIPN in two independent populations who had completed European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ)-CIPN20 assessments (a CIPN-specific 20-item questionnaire which includes three scales that evaluate sensory, autonomic, and motor symptoms). The study population N08Cx included 692 participants from three clinical trials (North Central Cancer Treatment Group (NCCTG) N08C1, N08CA, and N08CB) who had been treated with paclitaxel, paclitaxel plus carboplatin, or oxaliplatin. The primary endpoint for the GWAS was the change from pre-chemotherapy CIPN20 sensory score to the worse score over the following 18 weeks. Study population The Mayo Clinic Breast Disease Registry (MCBDR) consisted of 381 Mayo Clinic Breast Disease Registry enrollees who had been treated with taxane or platinum-based chemotherapy. The primary endpoint for the GWAS assessed was the earliest CIPN20 sensory score available after the completion of chemotherapy. In multivariate model analyses, chemotherapy regimen (p = 3.0 × 10-8) and genetic ancestry (p = 0.007) were significantly associated with CIPN in the N08Cx population. Only age (p = 0.0004) was significantly associated with CIPN in the MCBDR population. The SNP most associated with CIPN was rs56360211 near PDE6C (p =7.92 × 10-8) in N08Cx and rs113807868 near TMEM150C in the MCBDR (p = 1.27 × 10-8). Due to a lack of replication, we cannot conclude that we identified any genetic predictors of CIPN.
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Affiliation(s)
- Araba A. Adjei
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA; (A.A.A.); (C.L.L.); (A.S.B.)
- Alliance Cancer Control Program, Mayo Clinic, Rochester, MN 55905, USA
| | - Camden L. Lopez
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA; (C.L.L.); (D.J.S.); (J.A.S.); (J.G.L.-R.); (J.E.O.); (C.M.V.); (A.D.N.)
| | - Daniel J. Schaid
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA; (C.L.L.); (D.J.S.); (J.A.S.); (J.G.L.-R.); (J.E.O.); (C.M.V.); (A.D.N.)
| | - Jeff A. Sloan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA; (C.L.L.); (D.J.S.); (J.A.S.); (J.G.L.-R.); (J.E.O.); (C.M.V.); (A.D.N.)
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Jennifer G. Le-Rademacher
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA; (C.L.L.); (D.J.S.); (J.A.S.); (J.G.L.-R.); (J.E.O.); (C.M.V.); (A.D.N.)
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Charles L. Loprinzi
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA; (A.A.A.); (C.L.L.); (A.S.B.)
- Alliance Cancer Control Program, Mayo Clinic, Rochester, MN 55905, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA; (C.L.L.); (D.J.S.); (J.A.S.); (J.G.L.-R.); (J.E.O.); (C.M.V.); (A.D.N.)
| | - Aaron D. Norman
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA; (C.L.L.); (D.J.S.); (J.A.S.); (J.G.L.-R.); (J.E.O.); (C.M.V.); (A.D.N.)
| | - Janet E. Olson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA; (C.L.L.); (D.J.S.); (J.A.S.); (J.G.L.-R.); (J.E.O.); (C.M.V.); (A.D.N.)
| | - Fergus J. Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Andreas S. Beutler
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA; (A.A.A.); (C.L.L.); (A.S.B.)
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA; (C.L.L.); (D.J.S.); (J.A.S.); (J.G.L.-R.); (J.E.O.); (C.M.V.); (A.D.N.)
| | - Celine M. Vachon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA; (C.L.L.); (D.J.S.); (J.A.S.); (J.G.L.-R.); (J.E.O.); (C.M.V.); (A.D.N.)
| | - Kathryn J. Ruddy
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA; (A.A.A.); (C.L.L.); (A.S.B.)
- Alliance Cancer Control Program, Mayo Clinic, Rochester, MN 55905, USA
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9
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Yang Z, Olszewski D, He C, Pintea G, Lian J, Chou T, Chen RC, Shtylla B. Machine learning and statistical prediction of patient quality-of-life after prostate radiation therapy. Comput Biol Med 2020; 129:104127. [PMID: 33333364 DOI: 10.1016/j.compbiomed.2020.104127] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 10/26/2020] [Accepted: 11/15/2020] [Indexed: 12/25/2022]
Abstract
Thanks to advancements in diagnosis and treatment, prostate cancer patients have high long-term survival rates. Currently, an important goal is to preserve quality of life during and after treatment. The relationship between the radiation a patient receives and the subsequent side effects he experiences is complex and difficult to model or predict. Here, we use machine learning algorithms and statistical models to explore the connection between radiation treatment and post-treatment gastro-urinary function. Since only a limited number of patient datasets are currently available, we used image flipping and curvature-based interpolation methods to generate more data to leverage transfer learning. Using interpolated and augmented data, we trained a convolutional autoencoder network to obtain near-optimal starting points for the weights. A convolutional neural network then analyzed the relationship between patient-reported quality-of-life and radiation doses to the bladder and rectum. We also used analysis of variance and logistic regression to explore organ sensitivity to radiation and to develop dosage thresholds for each organ region. Our findings show no statistically significant association between the bladder and quality-of-life scores. However, we found a statistically significant association between the radiation applied to posterior and anterior rectal regions and changes in quality of life. Finally, we estimated radiation therapy dose thresholds for each organ. Our analysis connects machine learning methods with organ sensitivity, thus providing a framework for informing cancer patient care using patient reported quality-of-life metrics.
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Affiliation(s)
- Zhijian Yang
- New York University, New York, NY, 10012, USA; Applied Mathematics and Computational Science Program, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Daniel Olszewski
- Carroll College, Helena, MT, 59625, USA; Computer, Information Science and Engineering Department, University of Florida, Gainesville, FL, 32611, USA
| | - Chujun He
- Smith College, Northampton, MA, 01063, USA
| | - Giulia Pintea
- Simmons University, Boston, MA, USA; Department of Psychology, Tufts University, Boston, MA, 02111, USA
| | - Jun Lian
- Department of Radiation Oncology, The University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Tom Chou
- Depts. of Computational Medicine and Mathematics, UCLA, Los Angeles, CA, 90095-1766, USA
| | - Ronald C Chen
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Blerta Shtylla
- Department of Mathematics, Pomona College, Claremont, CA, 91711, USA; Early Clinical Development, Pfizer Worldwide Research, Development, and Medical, Pfizer Inc, San Diego, CA, 92121, USA.
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10
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Orgel E, Freyer DR, Ullrich NJ, Hardy KK, Thomas SM, Dvorak CC, Esbenshade AJ. Assessment of provider perspectives on otoprotection research for children and adolescents: A Children's Oncology Group Cancer Control and Supportive Care Committee survey. Pediatr Blood Cancer 2020; 67:e28647. [PMID: 32886425 PMCID: PMC7808411 DOI: 10.1002/pbc.28647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cisplatin-induced hearing loss (CIHL) is a common and debilitating toxicity for childhood cancer survivors. Understanding provider perspectives is crucial to developing otoprotection studies that are both informative and feasible. Two international trials (ACCL0431 and SIOPEL6) investigated the drug sodium thiosulfate (STS) as an otoprotectant, but definitive interpretation of the findings of these trials has been challenging. Adoption of STS has therefore been uneven, and provider perspectives on its role are unknown. PROCEDURE The Children's Oncology Group (COG) Cancer Control and Supportive Care Neurotoxicity Subcommittee therefore conducted a survey of providers at COG institutions to determine perspectives on pediatric otoprotection practices and research surrounding three major themes: (1) prevalence of routine use of STS with cisplatin-based regimens, (2) application of audiometry to cisplatin therapy, and (3) preferred modalities for otoprotection research. RESULTS Survey respondents (45%, 44/98 surveyed institutions) were of diverse institutional sizes, practice settings, and geographical locations primarily in the United States and Canada. Overall, respondents considered CIHL an important toxicity and indicated strong enthusiasm for future studies (98%, 40/41). Results indicated that while STS was the current or planned standard of care in a minority of responding institutions (36%, 16/44), most sites were receptive to its inclusion in appropriate study designs. Application of audiometry for ototoxicity monitoring varied widely across sites. For otoprotection research, systemic agents were preferred (68%, 28/41) as compared with intratympanic approaches. CONCLUSION These results suggest that pediatric otoprotection trials remain of interest to providers; the emphasis of these trials should remain on systemic and not intratympanic therapy.
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Affiliation(s)
- Etan Orgel
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Los Angeles, CA,Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - David R. Freyer
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Los Angeles, CA,Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Nicole J. Ullrich
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA
| | - Kristina K. Hardy
- Children’s National Hospital, Washington, DC,George Washington University School of Medicine, Cleveland, OH
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11
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Vanovenberghe C, Van den Broeck A, Lauwerier E, Goorts K, Du Bois M. Motivation in the return to work process: a self-determination cluster approach. Disabil Rehabil 2020; 44:2053-2062. [PMID: 33016785 DOI: 10.1080/09638288.2020.1826584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Motivation may predict return to work (RTW), yet the measurement of motivation needs more scientific evidence. We adopt a dimensional approach, based on the self-determination theory (SDT), distinguishing between amotivation, controlled and autonomous motivation. We seek to explore the presence of these dimensions in sick-disabled patients, and are interested in associations with quality of life, depression, patient's predictions of RTW, and health care provider estimations of patient's motivation. MATERIALS AND METHODS A cross-sectional study in 336 patients was conducted. Motivation was assessed using the Motivation at Work Scale (MAWS) and examined in relation to patient outcomes, patient's prediction of RTW, and health care provider estimations of patients' motivation. A cluster analysis was performed, and differential associations between motivational profiles were explored. RESULTS Cluster analysis revealed four profiles. Highly controlled profiles were most prevalent, reported poorer mental quality of life, and expected a longer time before RTW, regardless of the level of autonomous motivation. Interestingly, the health care provider's estimation was not related to controlled motivation. CONCLUSIONS Our results show that SDT may help to differentiate people with a work disability regarding their motivation to RTW. Most notably, the devastating consequences of controlled motivation are discussed, and clinical implications are provided.Implications for RehabilitationAssessing the different dimensions of motivation in the context of RTW will be a significant advance as the self-report measures appear to be viable tools.Controlled motivation, which indicates that people are motivated to RTW but only because they "have to", has negative consequences yet a high prevalence and should therefore be addressed by the practitioner.Practitioners should keep in mind that employees are motivated by several motives at the same time, with some being more beneficial than others.Controlled motivation can be converted into autonomous (i.e., good quality) motivation by supporting autonomy of the patient, by supporting their relationships with colleagues, managers, and health care providers and by supporting their feeling of competence in the RTW process.
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Affiliation(s)
- Charlotte Vanovenberghe
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Department of Experimental Clinical and Health Psychology, UGent, Ghent, Belgium
| | - Anja Van den Broeck
- Department of Work and Organisation Studies, KU Leuven, Brussels, Belgium.,Optentia, North West University, Vanderbijlpark, South Africa
| | - Emelien Lauwerier
- Department of Experimental Clinical and Health Psychology, UGent, Ghent, Belgium.,Department of Public Health and Primary Care, UGent, Ghent, Belgium
| | - Kaat Goorts
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Marc Du Bois
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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12
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Pugh SL, Rodgers JP, Moughan J, Bonanni R, Boparai J, Chen RC, Dignam JJ, Bruner DW. Do reminder emails and past due notifications improve patient completion and institutional data submission for patient-reported outcome measures? Qual Life Res 2020; 30:81-89. [PMID: 32894431 DOI: 10.1007/s11136-020-02613-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE NRG Oncology, part of the National Cancer Institute's National Clinical Trials Network, took efforts to increase patient-reported outcome measures (PROMs) completion and institutional data submission rates within clinical trials. Lack of completion diminishes power to draw conclusions and can be a waste of resources. It is hypothesized that trials with automatic email reminders and past due notifications will have PROM forms submitted more timely with higher patient completion. METHODS Automatic emails sent to the research associate were added to selected NRG Oncology trials. Comparisons between trials with and without automatic emails were analyzed using Chi-square tests with respect to patient completion and timeliness of form submission rates. Multivariable analyses were conducted using repeated measures generalized estimating equations. If PROMs were not completed, a form providing the reason why was submitted and counted towards form submission. RESULTS For both disease sites, form submission was significantly higher within 1 month of the form's due date for the studies with automatic emails vs. those without (prostate: 79.7% vs. 75.7%, p < 0.001; breast: 59.2% vs. 31.3%, p < 0.001). No significant differences in patient completion were observed between the breast trials. The prostate trial with automatic emails had significantly higher patient completion but this result was not confirmed in the multivariable analysis. CONCLUSIONS Although patient completion rates were higher on trials with automatic emails, there may be confounding factors requiring future study. The automatic emails appeared to have increased the timeliness of form submission, thus supporting their continued use on NRG Oncology trials.
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Affiliation(s)
- Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, USA.
| | - Joseph P Rodgers
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, USA
| | - Jennifer Moughan
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, USA
| | - Roseann Bonanni
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, USA
| | - Jaskaran Boparai
- NRG Oncology Operations Center, American College of Radiology, Philadelphia, PA, USA
| | | | - James J Dignam
- NRG Oncology Statistics and Data Management Center, University of Chicago, Chicago, IL, USA
| | - Deborah W Bruner
- Emory University Hospital/Winship Cancer Institute, Atlanta, GA, USA
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13
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Kim HS, Courtney DM, McCarthy DM, Cella D. Patient-reported Outcome Measures in Emergency Care Research: A Primer for Researchers, Peer Reviewers, and Readers. Acad Emerg Med 2020; 27:403-418. [PMID: 31945245 DOI: 10.1111/acem.13918] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/04/2020] [Accepted: 01/06/2020] [Indexed: 01/07/2023]
Abstract
Patient-reported outcomes (PROs) are of increasing importance in clinical research because they capture patients' experience with well-being, illness, and their interactions with health care. Because PROs tend to focus on specific symptoms (e.g., pain, anxiety) or general assessments of patient functioning and quality of life that offer unique advantages compared to traditional clinical outcomes (e.g., mortality, emergency department revisits), emergency care researchers may benefit from incorporation of PRO measures into their research design as a primary or secondary outcome. Patients may also benefit from the ability of PROs to inform clinical practice and facilitate patient decision making, as PROs are obtained directly from the lived experience of other patients with similar conditions or health status. This review article introduces and defines key terminology relating to PROs, discusses reasons for utilizing PROs in clinical research, outlines basic psychometric and practical assessments that can be used to select a specific PRO measure, and highlights examples of commonly utilized PRO measures in emergency care research.
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Affiliation(s)
- Howard S. Kim
- Department of Emergency Medicine Northwestern University Feinberg School of Medicine Chicago IL
- Center for Health Services & Outcomes Research Northwestern University Feinberg School of Medicine Chicago IL
| | - D. Mark Courtney
- Department of Emergency Medicine University of Texas Southwestern Medical School Dallas TX
| | - Danielle M. McCarthy
- Department of Emergency Medicine Northwestern University Feinberg School of Medicine Chicago IL
- Center for Health Services & Outcomes Research Northwestern University Feinberg School of Medicine Chicago IL
| | - David Cella
- Department of Medical Social Sciences Northwestern University Feinberg School of Medicine Chicago IL
- Center for Patient‐Centered Outcomes Northwestern University Feinberg School of Medicine Chicago IL
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14
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Tagliaferri L, Lancellotta V, Zinicola T, Gentileschi S, Sollena P, Garganese G, Guinot JL, Rembielak A, Soror T, Autorino R, Cammelli S, Gambacorta MA, Aristei C, Valentini V, Kovacs G. Cosmetic assessment in brachytherapy (interventional radiotherapy) for breast cancer: A multidisciplinary review. Brachytherapy 2019; 18:635-644. [PMID: 31171462 DOI: 10.1016/j.brachy.2019.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/18/2019] [Accepted: 03/25/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE This review was to focus on breast brachytherapy cosmetic assessment methods state of the art and to define the advantages and disadvantages related to. METHODS AND MATERIALS We conducted a literature review of the major experience on breast brachytherapy cosmetic assessment methods in several databases (PubMed, Scopus, and Google Scholar databases). To identify the relevant works, a task force screened citations at title and abstract level to identify potentially relevant paper. An expert board reviewed and approved the text. The assessment systems were classified into three main groups: (1) the Oncological Toxicity Scales, (2) the Independent Patients Perspective Measures, (3) the Patient-Related Outcome Measures. Each cosmetic assessment method was evaluated following six parameters: (1) anatomical site, (2) advantages, (3) disadvantages, (4) subjective/objective, (5) quantitative/qualitative, (6) computers or pictures needs. RESULTS Eleven assessment methods were selected. Three methods were classified as Oncological Toxicity Scale, six in the Independent Patients Perspective Measures classification, and two as Patient-Related Outcome Measures. Six methods are subjective, while eight are objective. Four systems are classified as quantitative, four as qualitative while three both. Five systems need informatics support. Moreover, each method was discussed individually reporting the main characteristics and peculiarities. CONCLUSIONS Cosmesis is one major end point for the patient who has a malignancy of low lethal potential. In modern personalized medicine, there is a need for standardized cosmetic outcome assessments to analyze and compare the results of treatments. No gold standard methods currently exist. The result of this review is to summarize the various cosmesis methods, defining the strengths and weaknesses of each one and giving a line in research and clinical practice.
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Affiliation(s)
- Luca Tagliaferri
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - Valentina Lancellotta
- Department of Surgery and Biomedical Sciences, Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italia
| | - Tiziano Zinicola
- Università Cattolica del Sacro Cuore, Istituto di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia.
| | - Stefano Gentileschi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Chirurgia Plastica e Ricostruttiva, Centro di Trattamento Chirurgico del Linfedema, Roma, Italia
| | - Pietro Sollena
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Dermatologia, Roma, Italia
| | - Giorgia Garganese
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna e del Bambino, Roma, Italia
| | - José L Guinot
- Department of Radiation Oncology, Foundation Instituto Valenciano de Oncologia (I.V.O.), València, Spain
| | - Agata Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester and Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Tamer Soror
- Department of Clinical Radiation Oncology, Ernst von Bergmann Medical Center, Academic Teaching Hospital of Humboldt University Berlin (Charité), Berlin, Germany; National Cancer Institute (NCI), Radiation Oncology Department, Cairo University, Cairo, Egypt
| | - Rosa Autorino
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - Silvia Cammelli
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italia
| | - Maria A Gambacorta
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia; Università Cattolica del Sacro Cuore, Istituto di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - Cynthia Aristei
- Department of Surgery and Biomedical Sciences, Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italia
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia; Università Cattolica del Sacro Cuore, Istituto di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - György Kovacs
- Interdisciplinary Brachytherapy Unit, UKSH CL, Lübeck, Germany
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15
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A Case Management System for Integrating Patient-reported Outcome Assessment in Clinical Practice. Med Care 2019; 57 Suppl 5 Suppl 1:S73-S79. [DOI: 10.1097/mlr.0000000000001095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Pratt-Chapman M, Bhadelia A. Patient-Reported Outcomes in Health Economic Decision-Making: A Changing Landscape in Oncology. Recent Results Cancer Res 2019; 213:67-83. [PMID: 30543008 DOI: 10.1007/978-3-030-01207-6_6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cancer causes significant death and disability globally. However, costs of more personalized cancer care continue to climb, while access to basic cancer screening and treatment is not available to much of the world. This chapter provides an overview of the status of patient-reported outcomes (PROs) in cancer clinical care and research. PROs are valuable for health care and health economic decision-making at institutional, regional, national, and international levels. PRO data should be considered along with cost and survival data when approving new therapies. PRO data can also be helpful when assessing existing treatment options for patients, particularly for drugs with minor outcome and toxicity differences. Finally, PROs can be useful in reimbursement algorithms to ensure delivery of quality cancer care in value-based financing environments. The authors advocate for reframing the concept of health value, aligning PRO measures with societal values, and broadening the definition of society to extend beyond national boundaries.
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Affiliation(s)
| | - Afsan Bhadelia
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Johns Hopkins School of Public Health, Baltimore, MD, USA
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17
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Gass JD, Semrau K, Sana F, Mankar A, Singh VP, Fisher-Bowman J, Neal BJ, Tuller DE, Kumar B, Lipsitz S, Sharma N, Kodkany B, Kumar V, Gawande A, Hirschhorn LR. Evaluation of a call center to assess post-discharge maternal and early neonatal outcomes of facility-based childbirth in Uttar Pradesh, India. PLoS One 2018; 13:e0207987. [PMID: 30481209 PMCID: PMC6258538 DOI: 10.1371/journal.pone.0207987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/09/2018] [Indexed: 11/18/2022] Open
Abstract
Background Maternal and neonatal outcomes in the immediate post-delivery period are critical indicators of quality of care. Data on childbirth outcomes in low-income settings usually require home visits, which can be constrained by cost and access. We report on the use of a call center to measure post-discharge outcomes within a multi-site improvement study of facility-based childbirth in Uttar Pradesh, India. Methods Of women delivering at study sites eligible for inclusion, 97.9% (n = 157,689) consented to follow-up. All consenting women delivering at study facilities were eligible to receive a phone call between days eight and 42 post-partum to obtain outcomes for the seven-day period after birth. Women unable to be contacted via phone were visited at home. Outcomes, including maternal and early neonatal mortality and maternal morbidity, were ascertained using a standardized script developed from validated survey questions. Data Quality Assurance (DQA) included accuracy (double coding of calls) and validity (consistency between two calls to the same household). Regression models were used to identify factors associated with inconsistency. Findings Over 23 months, outcomes were obtained by the call center for 98.0% (154,494/157,689) consenting women and their neonates. 87.9% of call center-obtained outcomes were captured by phone call alone and 12.1% required the assistance of a field worker. An additional 1.7% were obtained only by a field worker, 0.3% were lost-to-follow-up, and only 0.1% retracted consent. The call center captured outcomes with a median of 1 call (IQR 1–2). DQA found 98.0% accuracy; data validation demonstrated 93.7% consistency between the first and second call. In a regression model, significant predictors of inconsistency included cases with adverse outcomes (p<0.001), and different respondents on the first and validation call (p<0.001). Conclusions In areas with widespread mobile cell phone access and coverage, a call center is a viable and efficient approach for measurement of post-discharge childbirth outcomes.
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Affiliation(s)
- Jonathon D. Gass
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Katherine Semrau
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Fatima Sana
- Population Services International- India, New Delhi, India
| | - Anup Mankar
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Jennifer Fisher-Bowman
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Brandon J. Neal
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Danielle E. Tuller
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Bharath Kumar
- Population Services International- India, New Delhi, India
| | - Stuart Lipsitz
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Bhala Kodkany
- Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | | | - Atul Gawande
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Lisa R. Hirschhorn
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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18
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Thompson CA, Yost KJ, Maurer MJ, Allmer C, Farooq U, Habermann TM, Inwards DJ, Macon WR, Link BK, Rosenthal AC, Cerhan JR. Quality of life at diagnosis predicts overall survival in patients with aggressive lymphoma. Hematol Oncol 2018; 36:749-756. [PMID: 29862550 DOI: 10.1002/hon.2522] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/02/2018] [Accepted: 04/18/2018] [Indexed: 01/06/2023]
Abstract
Our aim was to evaluate whether quality of life (QOL) scores at diagnosis predict survival among patients with aggressive lymphoma. Newly diagnosed lymphoma patients were prospectively enrolled within 9 months of diagnosis in the University of Iowa/Mayo Clinic SPORE and systematically followed for event-free and overall survival (OS). QOL was measured with the Functional Assessment of Cancer Treatment-General (FACT-G), which measures 4 domains: physical, social/family, emotional, and functional well-being (WB); a single item Linear Analogue Self-Assessment (LASA) measuring overall QOL; and a spiritual WB LASA. From 9/2002 to 12/2009, 701 patients with aggressive lymphoma who completed baseline QOL questionnaires were enrolled. At a median follow-up of 71 months (range 6-128), 316 patients (45%) had an event and 228 patients (33%) died. All baseline QOL measures but emotional WB were significantly associated with OS (all P < 0.04); of which all but LASA spiritual remained significant after adjusting for IPI and NHL subtype. The strongest associations were with total FACT-G (adjusted HR = 0.86, 95% CI: 0.79-0.94, P = 0.00062) and functional WB (adjusted HR = 0.88, 95% CI: 0.83-0.93, P < .0001). QOL LASA was associated with OS (adjusted HR = 0.92, 95% CI: 0.87-0.97, P = 0.0041). Patients with clinically deficient QOL (overall QOL ≤50) had a median OS of 92 months compared with 121 months for patients with QOL >50 (P = 0.0004). In this large sample of patients with aggressive lymphoma, we found that baseline QOL is independently predictive of OS. QOL should be assessed as a prognostic factor in patients with aggressive lymphoma.
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Affiliation(s)
- Carrie A Thompson
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Kathleen J Yost
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Matthew J Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Cristine Allmer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Umar Farooq
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa, Iowa City, IA, USA
| | - Thomas M Habermann
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - David J Inwards
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - William R Macon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Brian K Link
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa, Iowa City, IA, USA
| | - Allison C Rosenthal
- Department of Internal Medicine, Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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Changes in upper extremity function, ADL, and HRQoL in colorectal cancer patients after the first chemotherapy cycle with oxaliplatin: a prospective single-center observational study. Support Care Cancer 2018; 26:2397-2405. [PMID: 29423680 PMCID: PMC5982431 DOI: 10.1007/s00520-018-4070-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/22/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Oxaliplatin, an important chemotherapeutic agent in colorectal cancer, causes chemotherapy-induced peripheral neuropathy (CIPN), for which prophylactic or therapeutic interventions are lacking. We aimed to investigate changes in upper extremities, activities of daily living (ADL), and health-related quality of life (HRQoL) parameters after the first chemotherapy cycle. METHODS Thirty-eight colorectal cancer patients scheduled to receive the leucovorin, 5'-fluorouracil, oxaliplatin (FOLFOX) therapy or the capecitabine, oxaliplatin (CAPOX) therapy, participated. Patients underwent objective assessment of sensory function, muscular strength, and manual dexterity and answered the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) and the Disabilities of the Arm, Shoulder, and Hand-Disability/Symptom (DASH-DS) questionnaires for subjective assessment. The CIPN was assessed at baseline and prior to the second drug cycle. RESULTS Light touch sensation in both hands worsened significantly after the first drug cycle, though no significant changes were observed in muscular strength and manual dexterity. The QLQ-C30 analysis showed that Physical Functioning, Role Functioning, Nausea and Vomiting, and Dyspnea were significantly worse, whereas Emotional Functioning was improved. The DASH-DS analysis revealed significant worsening of dysfunction and subjective symptoms. CONCLUSIONS Our results suggest that light touch sensation may worsen even in the absence of multiple chemotherapy cycles. Even if arm and hand function (muscular strength and manual dexterity) is apparently intact, patients may experience dysfunction and decreased HRQoL. For preserving or improving patients' ADL and HRQoL, it is imperative to provide support at chemotherapy initiation.
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Hsiao CP, Chen MK, Meyers KJ, Saligan LN. Symptoms predicting health-related quality of life in prostate cancer patients treated with localized radiation therapy. Fam Med Community Health 2017; 5:119-128. [PMID: 30263893 PMCID: PMC6155995 DOI: 10.15212/fmch.2017.0133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective Patient-reported health-related quality-of-life (HRQOL) measures can provide guidance for treatment decision making, symptom management, and discharge planning. HRQOL is often influenced by the distress experienced by patients from disease or treatment-related symptoms. This study aimed to identify symptoms that can predict changes in HRQOL in men undergoing external beam radiation therapy (EBRT) for nonmetastatic prostate cancer (NMPC). Methods Fifty-one men with NMPC scheduled for EBRT were assessed at the baseline, at the midpoint of EBRT, and at the end of EBRT. All participants received 38–42 daily doses of EBRT (five times a week), depending on the stage of their disease. Validated questionnaires were administered to evaluate depressive symptoms, urinary and sexual functions, bowel issues, symptom-related distress, fatigue, and HRQOL. Pearson correlations, repeated-measures ANOVA, and multiple regressions examined the relationships among variables. Results Intensification of symptoms and increased symptom-related distress, with a corresponding decline in HRQOL, were observed during EBRT in men with NMPC. Changes in symptoms and symptom distress were associated with changes in HRQOL at the midpoint of EBRT (r=−0.37 to −0.6, P=0.05) and at the end of EBRT (r=−0.3 to −0.47, P=0.01) compared with the baseline. The regression model comprising age, body mass index, Gleason score, T category, androgen-deprivation therapy use, radiation dose received, symptoms (urinary/sexual/bowel problems, fatigue), and overall symptom distress explained 70% of the variance in predicting HRQOL. Urinary problems and fatigue significantly predicted the decline in HRQOL during EBRT. Conclusion Identifying specific symptoms that can influence HRQOL during EBRT for NMPC can provide feasible interventional targets to improve treatment outcomes.
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Affiliation(s)
- Chao-Pin Hsiao
- The Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Mea-Kuang Chen
- University of Arizona, 3009 E 4th St. Tucson, AZ 85716, USA
| | - Kathy J Meyers
- The Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Leorey N Saligan
- National Institute of Nursing Research, Division of Intramural Research, National Institutes of Health, 9000 Rockville Pike, Building 3, Room 5E14, Bethesda, MD 20892, USA
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Warsame R, Kumar SK, Gertz MA, Lacy MQ, Buadi FK, Hayman SR, Leung N, Dingli D, Lust JA, Lin Y, Russell S, Kapoor P, Go RS, Kourelis T, Gonsalves W, Zeldenrust SR, Kyle RA, Vincent Rajkumar S, Zemla T, Sloan J, Dispenzieri A. Hematology patient reported symptom screen to assess quality of life for AL amyloidosis. Am J Hematol 2017; 92:435-440. [PMID: 28181278 DOI: 10.1002/ajh.24676] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 01/27/2017] [Accepted: 02/03/2017] [Indexed: 11/07/2022]
Abstract
Patients with light chain amyloidosis (AL) often have delayed diagnosis and present with significant symptomatology; this may result in decreased quality of life (QOL). We prospectively employ a "Hematology Patient Reported Symptom Screen" (HPRSS), which is three questions about fatigue, pain, and QOL, scored 0-10. The aim of this study is to better understand QOL and determine if HPRSS parameters predict for clinical outcomes. From 2009 to 2014, 302 newly diagnosed AL patients were included. Baseline median scores [interquartile range] for fatigue, pain, and QOL were 6 [3,7], 2 [0,5], 5 [3,8], respectively. Median overall survival was 53 months, with 102 (34%) deaths in the first year. There were significant differences in baseline HPRSS between those that lived longer than one year and early death patients in the domains of fatigue (5 [IQR 3, 7] vs. 7 [IQR 5, 8], P < 0.0001) and QOL (6 [IQR 4, 8] vs. 5 [IQR 3, 7], P = 0.006). On univariate analysis fatigue, QOL, physician-reported performance status, autologous stem cell transplant (ASCT), and Mayo stage were prognostic for survival. On multivariate analysis Mayo stage, ASCT, and baseline fatigue remained independently prognostic. When analyses were restricted to the 125 patients with HPRSS measurements at 12 months, we found that over time QOL scores improved significantly 6 [IQR 3.5, 8] → 7 [IQR 5, 8] (P = 0.01). Asking AL patients to rate their fatigue and QOL has predictive value. Baseline patient reported fatigue is an independent prognostic factor for survival. Survival at one year was associated with significant improvement in QOL.
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Affiliation(s)
- Rahma Warsame
- Division of HematologyMayo ClinicRochester Minnesota USA
| | - Shaji K. Kumar
- Division of HematologyMayo ClinicRochester Minnesota USA
| | - Morie A. Gertz
- Division of HematologyMayo ClinicRochester Minnesota USA
| | - Martha Q. Lacy
- Division of HematologyMayo ClinicRochester Minnesota USA
| | | | | | - Nelson Leung
- Division of HematologyMayo ClinicRochester Minnesota USA
| | - David Dingli
- Division of HematologyMayo ClinicRochester Minnesota USA
| | - John A. Lust
- Division of HematologyMayo ClinicRochester Minnesota USA
| | - Yi Lin
- Division of HematologyMayo ClinicRochester Minnesota USA
| | | | | | - Ronald S. Go
- Division of HematologyMayo ClinicRochester Minnesota USA
| | | | | | | | - Robert A. Kyle
- Division of HematologyMayo ClinicRochester Minnesota USA
| | | | - Tyler Zemla
- Department of BiostatisticsMayo ClinicRochester Minnesota USA
| | - Jeffrey Sloan
- Department of BiostatisticsMayo ClinicRochester Minnesota USA
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Patient-reported quality of life during definitive and postprostatectomy image-guided radiation therapy for prostate cancer. Pract Radiat Oncol 2017; 7:e117-e124. [DOI: 10.1016/j.prro.2016.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 11/20/2022]
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Chu SH, Lee YJ, Lee YJ, Cleeland CS. [Properties of the Measures to Assess Oxaliplatin-induced Peripheral Neuropathy: A Literature Review]. J Korean Acad Nurs 2016; 45:783-801. [PMID: 26805492 DOI: 10.4040/jkan.2015.45.6.783] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 05/27/2015] [Accepted: 09/16/2015] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study is to provide a comprehensive overview of the various measures available for assessment of oxaliplatin-induced peripheral neuropathy (OXLIPN) and to evaluate the measurement properties of each assessment tool. METHODS A systematic review was conducted to identify existing measures for OXLIPN found in the databases of PubMed, Cochrane Library, Embase, RISS and KoreaMed. The quality of the 24 identified tools was evaluated based on their properties of measurement including content validity, internal consistency, criterion validity, construct validity, reproducibility, responsiveness, floor-ceiling effects and interpretability. RESULTS Ten (41.7%) of the 24 tools were identified as specific measures for assessing OXLIPN and the most popular type of measures were clinical grading systems by clinicians (58.3%) and only 29.2% of measures were identified as patient reported outcomes. The most frequently used tool was National Cancer Institute-Common Toxicity Criteria (NCI-CTC), but the validity of NCI-CTC has not been reported appropriately. Overall, the Neuropathic Pain Symptom Inventory (NPSI) received the best psychometric scores, and the Chemotherapy-induced Peripheral Neuropathy Assessment Tool (CIPNAT) and Functional Assessment of Cancer Therapy/Gynaecologic Oncology Group-neurotoxicity-12 (FACT/GOG-Ntx-12) followed NPSI. CONCLUSION To select appropriate measure, evidences should be accumulated through the clinical use of tools. Therefore, practitioner and researchers are urged to report relevant statistics required for the validation of the currently used measures for assessment of OXLIPN.
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Affiliation(s)
- Sang Hui Chu
- College of Nursing·Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea
| | - Yoon Ju Lee
- College of Nursing, Pusan National University, Yangsan, Korea.
| | | | - Charles S Cleeland
- Department of Symptom Research, The University of Texas M.D. Anderson Cancer Center, Texas, USA
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Atherton PJ, Burger KN, Pederson LD, Kaggal S, Sloan JA. Patient-reported outcomes questionnaire compliance in Cancer Cooperative Group Trials (Alliance N0992). Clin Trials 2016; 13:612-620. [PMID: 27365012 PMCID: PMC5133154 DOI: 10.1177/1740774516655101] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS The use of patient-reported outcomes in clinical trials is a focal point for research and policy. Non-compliance with planned questionnaires and missing data can threaten both internal validity and generalizability. This retrospective analysis was conducted to determine the extent of, and characteristics associated with, missing patient-reported outcomes. METHODS Study characteristics, patient characteristics and adverse events, and reasons for non-compliance were compiled from 14 closed Alliance for Clinical Trials in Oncology, Mayo Clinic Cancer Center, or Mayo Clinic Cancer Research Consortium clinical trials. Compliance rates were calculated for each patient using the number of booklets completed while the patient was on trial divided by the number of booklets the patient was expected to complete. Frequency counts and summary statistics were compiled. Logistic regression techniques were employed. RESULTS The 1640 included patients had a median age of 58 years and were mostly White (90.8%) and female (73.8%). Compliance rates per study ranged from 84.7% to 97.2%. The primary endpoint of overall compliance rate was 93.1%. A total of 1267 patients were compliant. Those non-compliant were slightly older (mean = 58.6 vs 57.5, p = 0.03) and had different types of cancers (p < 0.01). There were no differences in compliance according to tumor status (p = 0.66), clinical stage (p = 0.81), baseline quality of life (p = 0.42 for ≥8 vs <8 and p = 0.12 for ≥6 vs <6), or maximum adverse event grade incidence (p = 0.33 for grade 2+ incidence and p = 0.36 for grade 3+ incidence). Reasons for non-compliance included patient refusal (N = 136), booklet not administered to patient (N = 199), no clinic visit at the scheduled time for booklet completion (N = 40), and at-home-completed booklet not returned (N = 224). Logistic regression indicates gender (p < 0.01), race (p < 0.01), performance score (p = 0.02), dose delay status (p = 0.01), and incidence of grade 3 or higher adverse event (p = 0.03) were correlates of compliance. CONCLUSION Patient-reported outcomes have successfully been implemented into Alliance and Mayo Clinic trials with high rates of patient compliance. Further improvement in compliance can be made with staff commitment and education. Patients are typically non-compliant only when the task at hand is burdensome, unclear, or logistically challenging. Existing tracking systems used for the other trial outcomes should be utilized to ensure successful capture of patient-reported outcomes.
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Affiliation(s)
- Pamela J Atherton
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Kelli N Burger
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Levi D Pederson
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Suneetha Kaggal
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Jeff A Sloan
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
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Wyatt G, Pugh SL, Wong RKW, Sagar S, Singh AK, Koyfman SA, Nguyen-Tân PF, Yom SS, Cardinale FS, Sultanem K, Hodson I, Krempl GA, Lukaszczyk B, Yeh AM, Berk L. Xerostomia health-related quality of life: NRG oncology RTOG 0537. Qual Life Res 2016; 25:2323-33. [PMID: 26914104 PMCID: PMC4982852 DOI: 10.1007/s11136-016-1255-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this secondary analysis was to determine change in overall health-related quality of life (HRQOL) based on patient data obtained from NRG Oncology RTOG 0537 as measured by the RTOG-modified University of Washington Head and Neck Symptom Score (RM-UWHNSS). METHODS A multi-site prospective randomized clinical trial design stratified 137 patients with post-radiation therapy xerostomia according to prior pilocarpine (PC) treatment and time after radiation therapy and/or chemotherapy and randomized patients into two groups. Patients were assigned to acupuncture or PC. Twenty-four sessions of acupuncture-like transcutaneous electrical nerve stimulation (ALTENS) were administered over 12 weeks, or oral PC (5 mg) three times daily over the same 12 weeks. The RM-UWHNSS was administered at baseline and at 4, 6, 9, and 15 months after the date of randomization. RESULTS There were no between-arm differences in change scores on the RM-UWHNSS in the individual items, total score, or factor scores. For statistical modeling, race and time were significant for all outcomes (total and factor scores), while treatment arm was not significant. The ALTENS arm showed greater yet nonsignificant improvement in outcomes compared to the PC arm. CONCLUSION Although no significant treatment differences were seen in this trial, patients receiving ALTENS consistently had lower scores, indicating better function, as compared to those receiving PC. Radiation-induced xerostomia improved over time for all patients.
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Affiliation(s)
- Gwen Wyatt
- College of Nursing, Michigan State University, 1355 Bogue St. Room C345, East Lansing, MI, 48824, USA.
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA, USA
| | | | | | | | | | - Phuc F Nguyen-Tân
- Centre Hospitalier de l'Université de Montréal-Hôpital Notre-Dame, Montreal, QC, Canada
| | - Sue S Yom
- University of California San Francisco, San Francisco, CA, USA
| | | | | | - Ian Hodson
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Greg A Krempl
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Alexander M Yeh
- Indiana University Hospital/Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA
| | - Lawrence Berk
- University of South Florida H. Lee Moffitt Cancer Center, Tampa, FL, USA
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Sloan JA, Halyard M, El Naqa I, Mayo C. Lessons From Large-Scale Collection of Patient-Reported Outcomes: Implications for Big Data Aggregation and Analytics. Int J Radiat Oncol Biol Phys 2016; 95:922-929. [PMID: 27302508 PMCID: PMC6544440 DOI: 10.1016/j.ijrobp.2016.04.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/05/2016] [Accepted: 04/05/2016] [Indexed: 11/22/2022]
Affiliation(s)
- Jeff A Sloan
- Division of Biomedical Statistics and Bioinformatics, Mayo Clinic, Rochester, Minnesota.
| | - Michele Halyard
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Issam El Naqa
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Charles Mayo
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan
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Sloan JA, Cheville AL, Liu H, Novotny PJ, Wampfler JA, Garces YI, Clark MM, Yang P. Impact of self-reported physical activity and health promotion behaviors on lung cancer survivorship. Health Qual Life Outcomes 2016; 14:66. [PMID: 27129406 PMCID: PMC4850698 DOI: 10.1186/s12955-016-0461-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 03/31/2016] [Indexed: 02/06/2023] Open
Abstract
Background There is some initial evidence that an enhanced physical activity level can improve fquality of life, and possibly survival among patients with lung cancer. The primary aim of this project was to evaluate the impact of physical activity on the quality and quantity of life of lung cancer survivors. Methods Between January 1, 1997, and December 31, 2009, a total of 1466 lung cancer survivors completed a questionnaire with patient-reported outcomes for quality of life (QOL), demographics, disease and clinical characteristics, and a measure of physical activity (Baecke Questionnaire). Chi-square tests compared lung cancer survivors who reported being physically active versus not on a variety of the other covariates. Kaplan-Meier estimates and Cox models evaluated the prognostic importance of physical activity level on Overall Survival (OS). Results Roughly half of the lung cancer survivors had advanced stage disease at the time of survey. Treatment prevalence rates were 61, 54, and 33 % for surgery, chemotherapy and radiotherapy, respectively. The majority (77 %) of survivors reported themselves as physically active. Physically active survivors reported greater activity across all individual Baecke items. Lung cancer survivor-reported QOL indicated the benefits of physical activity in all domains. Survivors receiving chemotherapy or radiation at the time of questionnaire completion were less likely to be physically active (74 and 73 % respectively). In contrast, 84 % of surgical patients were physically active. Disease recurrence rates were the same for physically active and inactive patients (81 % vs 82 %, p = 0.62). Physically active patients survived an average of 4 more years than those who were not physically active (8.4 years versus 4.4 years respectively, log rank p < 0.0001). Conclusions Being physically active was related to profound advantages in QOL and survival in a large sample of lung cancer survivors.
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Affiliation(s)
- Jeff A Sloan
- Department of Health Sciences Research, 200 First St SW, Rochester, MN, 55905, USA.
| | | | - Heshan Liu
- Department of Health Sciences Research, 200 First St SW, Rochester, MN, 55905, USA
| | - Paul J Novotny
- Department of Health Sciences Research, 200 First St SW, Rochester, MN, 55905, USA
| | - Jason A Wampfler
- Department of Health Sciences Research, 200 First St SW, Rochester, MN, 55905, USA
| | | | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Ping Yang
- Department of Health Sciences Research, 200 First St SW, Rochester, MN, 55905, USA
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Thomas S, Walsh D, Aktas A. Systematic bias in cancer patient-reported outcomes: symptom 'orphans' and 'champions'. BMJ Support Palliat Care 2015; 9:67-74. [PMID: 26700484 DOI: 10.1136/bmjspcare-2014-000835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 09/18/2015] [Accepted: 11/15/2015] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Patient-reported outcomes are an integral part of modern healthcare. We report a comparison of symptom item content from several validated cancer instruments to that of a published checklist, and identify the important differences this revealed. METHODS We defined orphans as any symptom not assessed in any of the six selected instruments; champions, in contrast, were present in all six. An empirically derived cancer multisymptom checklist was used.Three symptom categories were identified Orphan-absent from all 6,Champion-present in all 6,Intermediate-underreported. The contents of each validated instrument were cross-referenced against the checklist. RESULTS Eighteen (39%) checklist symptoms were orphans. Five (11%) were champions: fatigue, pain, anorexia, dyspnoea and nausea. Of the 46 checklist symptoms, 23 (50%) were inconsistently recorded. All 18 orphan symptoms were clinically important checklist symptoms. Common gastrointestinal and neuropsychological symptoms that pose great clinical management challenges were among the orphan symptoms. CONCLUSIONS Of 46 checklist cancer symptoms, over a third were orphans. All orphan symptoms were rated as clinically important and distressing by checklist. Only 5 checklist symptoms were champions: fatigue, pain, anorexia, dyspnoea and nausea. Important-but usually omitted-symptoms included early satiety (6 of 6) and weight loss (5 of 6). The bias appears to disproportionately affect gastrointestinal and neuropsychiatric symptoms. Symptom studies should specifically report the limitations and account for the inherent item bias of any instrument used.
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Affiliation(s)
- Shirley Thomas
- The Harry R Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA; A World Health Organization Demonstration Project in Palliative Medicine; European Society of Medical Oncology (ESMO) Designated Center of Integrated Oncology and Palliative Care
| | - Declan Walsh
- The Harry R Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA; A World Health Organization Demonstration Project in Palliative Medicine; European Society of Medical Oncology (ESMO) Designated Center of Integrated Oncology and Palliative Care.,Section of Palliative Medicine and Supportive Oncology.,The Harry R Horvitz Chair in Palliative Medicine
| | - Aynur Aktas
- The Harry R Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA; A World Health Organization Demonstration Project in Palliative Medicine; European Society of Medical Oncology (ESMO) Designated Center of Integrated Oncology and Palliative Care
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Salehi Z, Roayaei M. Effect of Vitamin E on Oxaliplatin-induced Peripheral Neuropathy Prevention: A Randomized Controlled Trial. Int J Prev Med 2015; 6:104. [PMID: 26682028 PMCID: PMC4671163 DOI: 10.4103/2008-7802.169021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 07/22/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Peripheral neuropathy is one of the most important limitations of oxaliplatin base regimen, which is the standard for the treatment of colorectal cancer. Evidence has shown that Vitamin E may be protective in chemotherapy-induced peripheral neuropathy. The aim of this study is to evaluate the effect of Vitamin E administration on prevention of oxaliplatin-induced peripheral neuropathy in patients with colorectal cancer. METHODS This was a prospective randomized, controlled clinical trial. Patients with colorectal cancer and scheduled to receive oxaliplatin-based regimens were enrolled in this study. Enrolled patients were randomized into two groups. The first group received Vitamin E at a dose of 400 mg daily and the second group observed, until after the sixth course of the oxaliplatin regimen. For oxaliplatin-induced peripheral neuropathy assessment, we used the symptom experience diary questionnaire that completed at baseline and after the sixth course of chemotherapy. Only patients with a score of zero at baseline were eligible for this study. RESULTS Thirty-two patients were randomized to the Vitamin E group and 33 to the control group. There was no difference in the mean peripheral neuropathy score changes (after - before) between two groups, after sixth course of the oxaliplatin base regimen (mean difference [after - before] of Vitamin E group = 6.37 ± 2.85, control group = 6.57 ± 2.94; P = 0.78). Peripheral neuropathy scores were significantly increased after intervention compared with a base line in each group (P < 0.001). CONCLUSIONS The results from this current trial demonstrate a lack of benefit for Vitamin E in preventing oxaliplatin-induced peripheral neuropathy.
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Affiliation(s)
- Zeinab Salehi
- Department of Radiotherapy and Oncology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahnaz Roayaei
- Department of Radiotherapy and Oncology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Williams AR, Mowlazadeh B, Sisler L, Williams PD. Self-reported assessment of symptoms and self-care within a cohort of U.S. veterans during outpatient care for cancer. Clin J Oncol Nurs 2015; 19:595-602. [PMID: 26414577 DOI: 10.1188/15.cjon.595-602] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study was undertaken as part of a feasibility study of the use of a symptom checklist and self-care assessment of veterans receiving oncology outpatient treatment within the U.S. Department of Veterans Affairs system. OBJECTIVES The study aimed to examine (a) symptom occurrence and severity as self-reported on the Therapy-Related Symptom Checklist (TRSC) by veterans at a cancer clinic, (b) symptom alleviation strategies and use of self-care, and (c) the relationship between symptom occurrence and severity and functional status and quality of life. METHODS Veterans (N = 100) undergoing chemotherapy and/or radiation therapy participated in a cross-sectional study. Tools used, including TRSC, Symptom Alleviation. FINDINGS Thirteen symptoms were reported by more than 35% of patients. Top-ranked symptoms by percentage occurrence and severity were feeling sluggish, taste changes, nausea, pain, constipation, loss of appetite, numbness of fingers and toes, difficulty sleeping, weight loss, hair loss, difficulty concentrating, shortness of breath, and decreased interest in sexual activity. Occurrence and severity of symptoms had significant negative correlations with functional status and with overall quality of life. Self-care (symptom alleviation) strategies that helped were medicines, diet and nutrition, and lifestyle change. Checklist use (TRSC) facilitated patient-report of symptoms during cancer treatments; self-care strategies helped relieve symptoms.
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An introduction to patient-reported outcome measures (PROMs) in physiotherapy. Physiotherapy 2015; 101:119-25. [DOI: 10.1016/j.physio.2014.11.003] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 11/21/2014] [Indexed: 11/23/2022]
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Aktas A, Walsh D, Kirkova J. The psychometric properties of cancer multisymptom assessment instruments: a clinical review. Support Care Cancer 2015; 23:2189-202. [PMID: 25894883 DOI: 10.1007/s00520-015-2732-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/29/2015] [Indexed: 01/29/2023]
Abstract
PURPOSE Various instruments are used to assess both individual and multiple cancer symptoms. We evaluated the psychometric properties of cancer multisymptom assessment instruments. METHODS An Ovid MEDLINE search was done. All searches were limited to adults and in English. All instruments published from 2005 to 2014 (and with at least one validity test) were included. We excluded those who only reported content validity. Instruments were categorized by the three major types of symptom measurement scales employed as follows: visual analogue (VAS), verbal rating (VRS), and numerical rating (NRS) scales. They were then examined in two areas: (1) psychometric thoroughness (number of tests) and (2) psychometric strength of evidence (validity, reliability, generalizability). We also assigned an empirical global psychometric quality score (which combined the concepts of thoroughness and strength of evidence) to rank the instruments. RESULTS We analyzed 57 instruments (17 original, 40 modifications). They varied in types of scales used, symptom dimensions measured, and time frames evaluated. Of the 57, 10 used VAS, 28 VRS, and 19 NRS. The Edmonton Symptom Assessment System (ESAS), ESAS-Spanish, Hospital Anxiety and Depression Scale (HADS), Profile of Mood States (POMS), Symptom Distress Scale (SDS), M.D. Anderson Symptom Inventory (MDASI)-Russian, and MDASI-Taiwanese were the most comprehensively tested for validity and reliability. The ESAS, ESAS-Spanish, ASDS-2, Memorial Symptom Assessment Scale (MSAS)-SF, POMS, SDS, MDASI (and some translations), and MDASI-Heart Failure all showed good validity and reliability. CONCLUSIONS The MDASI appeared to be the best overall from a psychometric perspective. This was followed by the ESAS, ESAS-Spanish, POMS, SDS, and some MDASI translations. VRS-based instruments were most common. There was a wide range of psychometric rigor in validation. Consequently, meta-analysis was not possible. Most cancer multisymptom assessment instruments need further extensive validation to establish the excellent reliability and validity required for clinical utility and meaningful research.
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Affiliation(s)
- Aynur Aktas
- Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA
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Liu H, Tan AD, Qin R, Sargent DJ, Grothey A, Buckner JC, Schaefer PL, Sloan JA. Comparing and Validating Simple Measures of Patient-Reported Peripheral Neuropathy for Oncology Clinical Trials: NCCTG N0897 (Alliance) A Pooled Analysis of 2440 Patients. ACTA ACUST UNITED AC 2015; 2. [PMID: 26526218 DOI: 10.15226/2374-684x/2/2/00120] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Current standard evaluation of Peripheral Neuropathy (PN) is based on an investigator-reported classification system that is commonly unable to correctly reflect the subjective symptoms for patients. Thus more reliable methods to assess PN are needed. This study assessed alternative methods of assessing patient-reported PN in 5 North Central Cancer Treatment Group (NCCTG) clinical trials. METHOD Two single-item assessments relating to numbness and tingling were used to measure PN. Patients' Quality Of Life (QOL) was also assessed using the Uniscale, Symptom Distress Scale (SDS), Profile of Mood States (POMS), Brief Pain Inventory (BPI) and Subject Global Impression of Change (SGIC). Wilcoxon tests compared QOL scores between patients with PN (score > 50) vs. no PN (score ≤ 50). Changes from baseline in QOL were compared by Wilcoxon rank sum test with a 20-point change in PN defined as clinically meaningful. Both distribution-based and anchor-based approaches were used to derive estimates of Minimal Important Differences (MID). Standardized Response Means (SRM), Effect Sizes (ES) and Guyatt's responsiveness statistic were used to measure responsiveness. RESULTS The proportion of patients reporting numbness (tingling) at baseline was 10.7% (10.0%) and 18.4% (17.8%) at last assessment. The correlation between numbness and tingling at baseline was 0.81, and at last assessment was 0.83. Patients with substantial PN reported an average of 10 points lower overall QOL, mood and worse symptom distress and 20 points lower in the BPI interference items. Patients having a ≤ 20 point worsening in PN score reported significantly worse in symptom distress and BPI worst pain, but not in POMS or overall QOL. The MID estimates were similar between numbness and tingling items but varied depending on the approach used. Responsiveness statistics indicated that the two PN assessments are sensitive and responsive instruments for cancer patients with PN. CONCLUSIONS The two PN items for numbness and tingling were redundant. Evidence of criterion validity and responsiveness indicates that these simple measures of PN can be used successfully in cancer clinical trials.
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Affiliation(s)
- Heshan Liu
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Angelina D Tan
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Rui Qin
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Daniel J Sargent
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Axel Grothey
- Department of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Jan C Buckner
- Department of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Jeff A Sloan
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN 55905, USA
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Bresnahan BW, Rundell SD. Including patient-reported outcomes and patient-reported resource-use questionnaires in studies. Acad Radiol 2014; 21:1129-37. [PMID: 25107865 DOI: 10.1016/j.acra.2014.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/24/2014] [Accepted: 05/27/2014] [Indexed: 11/30/2022]
Abstract
RATIONALE More efficient and better informed healthcare systems are expected to have improved knowledge of the impact of interventions on patient outcomes and resources used by patients and providers in specific health conditions. OBJECTIVES To describe trends related to putting patients at the center of healthcare decision making, regulatory trends and best practice recommendations for developing high-quality patient-reported outcomes (PROs), and strategic issues related to including PROs in studies. MATERIALS AND METHODS We summarize PRO concepts, definitions, and broadly-accepted scientific standards for developing, assessing, and interpreting PROs. Three conceptual models are presented as examples for assessing PROs in relation to other outcomes. We discuss different perspectives for stakeholders, including regulatory issues pertaining to formal guidance for PRO development and for use in trials. We provide examples of PROs used in studies for assessing health outcomes in oncology and resource-use outcomes in low back pain patients. RESULTS Psychometric scientists working closely with multi-disciplinary teams and regulatory authorities have greatly improved the science of collecting, assessing, and understanding patient-reported outcomes in clinical trials. A simplified framework is presented for strategic considerations for including PROs in studies, such as the appropriate timing for PRO endpoints. Asking patients about their health status and/or use of resources improves our understanding of how interventions and care processes may impact their lives and their budgets. We provide examples from a back pain trial of patient-reported resource-use questionnaires for medicines taken and other services or products used by patients. CONCLUSIONS Healthcare stakeholders are placing increased emphasis on resource use and the impact of interventions on patients, including effects associated with diagnostic tests. Patient-reported outcomes are being used in clinical practice and in clinical research, supported by formal best-practice guidelines. Radiology has a role as an engaged stakeholder in the design, conduct, and interpretation of patient-based evidence, and in its relevance to health policy implementation.
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Affiliation(s)
- Brian W Bresnahan
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195; Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, Washington.
| | - Sean D Rundell
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195; Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, Washington
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Hubbard JM, Grothey AF, McWilliams RR, Buckner JC, Sloan JA. Physician perspective on incorporation of oncology patient quality-of-life, fatigue, and pain assessment into clinical practice. J Oncol Pract 2014; 10:248-53. [PMID: 24667294 DOI: 10.1200/jop.2013.001276] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patient-reported outcomes (PROs) such as pain, fatigue, and quality of life (QOL) are important for morbidity and mortality in patients with cancer. Systematic approaches to collect and incorporate PROs into clinical practice are still evolving. We set out to determine the impact of PRO assessment on routine clinical practice. METHODS Beginning in July 2010, the symptom assessment questionnaire (SAQ) was administered to every patient in a solid tumor oncology practice at an academic center. The SAQ measures pain, fatigue, and QOL, each on a scale of 0 to 10 points. Results were available to providers before each visit in the electronic medical record. Eighteen months after the SAQ was implemented, an online survey was sent to 83 oncology care providers regarding the use of the SAQ and how it affected their clinical practice, including discussion with patients, duration of visits, and work burden. RESULTS A total of 53% of care providers completed the online survey, producing 44 evaluable surveys. Of these, 86% of care providers reported using information from the SAQ; > 90% of care providers indicated the SAQ did not change the length of clinic visits or contribute to increased work burden. A majority of care providers felt that the SAQ had helped or enhanced their practice. Providers endorsed the SAQ for facilitating communication with their patients. CONCLUSION This study indicates that simple single-item measures of pain, fatigue, and QOL can be incorporated into oncology clinical practice with positive implications for both patients and physicians without increasing duration of visits or work burden.
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Eton DT, Beebe TJ, Hagen PT, Halyard MY, Montori VM, Naessens JM, Sloan JA, Thompson CA, Wood DL. Harmonizing and consolidating the measurement of patient-reported information at health care institutions: a position statement of the Mayo Clinic. PATIENT-RELATED OUTCOME MEASURES 2014; 5:7-15. [PMID: 24550683 PMCID: PMC3926456 DOI: 10.2147/prom.s55069] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Patient-reported outcomes (PROs) capture how patients perceive their health and their health care; their use in clinical research is longstanding. Today, however, PROs increasingly are being used to inform the care of individual patients, and document the performance of health care entities. We recently wrote and internally distributed an institutional position statement titled “Harmonizing and Consolidating the Measurement of Patient-Reported Outcomes at Mayo Clinic: A Position Statement for the Center for the Science of Health Care Delivery”. The statement is meant to educate clinicians, clinical teams, and institutional administrators about the merits of using PROs in a systematic manner for clinical care and quality measurement throughout the institution. The present article summarizes the most important messages from the statement, describing PROs and their use, identifying practical considerations for implementing them in routine practice, elucidating potential barriers to their use, and formulating strategies to overcome these barriers. The lessons learned from our experience – including pitfalls, challenges, and successes – may inform other health care institutions that are interested in systematically using PROs in health care delivery science and practice.
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Affiliation(s)
- David T Eton
- Division of Heath Care Policy and Research, Department of Health Sciences Research, Rochester, MN, USA ; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Timothy J Beebe
- Division of Heath Care Policy and Research, Department of Health Sciences Research, Rochester, MN, USA ; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Philip T Hagen
- Department of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Victor M Montori
- Division of Heath Care Policy and Research, Department of Health Sciences Research, Rochester, MN, USA ; Knowledge and Evaluation Research Unit, Rochester, MN, USA
| | - James M Naessens
- Division of Heath Care Policy and Research, Department of Health Sciences Research, Rochester, MN, USA ; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Jeff A Sloan
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Rochester, MN, USA
| | | | - Douglas L Wood
- Division of Heath Care Policy and Research, Department of Health Sciences Research, Rochester, MN, USA ; Center for Innovation, Mayo Clinic, Rochester, MN, USA
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Hoffman KE, Pugh SL, James JL, Scarantino C, Movsas B, Valicenti RK, Fortin A, Pollock J, Kim H, Brachman DG, Berk LB, Bruner DW, Kachnic LA. The impact of concurrent granulocyte-macrophage colony-stimulating factor on quality of life in head and neck cancer patients: results of the randomized, placebo-controlled Radiation Therapy Oncology Group 9901 trial. Qual Life Res 2014; 23:1841-58. [PMID: 24492945 DOI: 10.1007/s11136-014-0628-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The Radiation Therapy Oncology Group (RTOG) conducted a randomized, placebo-controlled trial evaluating the efficacy of GM-CSF in reducing mucosal injury and symptom burden from curative radiotherapy for head and neck (H&N) cancer. METHODS Eligible patients with H&N cancer receiving radiation encompassing ≥50 % of the oral cavity or oropharynx received subcutaneous GM-CSF or placebo. Quality of life (QoL) was assessed using the RTOG-modified University of Washington H&N Symptom Questionnaire at baseline 4, 13, 26, and 48 weeks from radiation initiation. RESULTS Of 125 eligible patients, 114 were evaluable for QoL (58 GM-CSF, 56 placebo). Patient demographics, clinical characteristics, and baseline symptom scores were well balanced between the treatment arms. At the end of the acute period (13 weeks), patients in both arms reported negative change in total symptom score indicating increase in symptom burden relative to baseline (mean -18.4 GM-CSF, -20.8 placebo). There was no difference in change in total symptom score (p > 0.05) or change in mucous, pain, eating, or activity domain scores (p > 0.01) between patients in the GM-CSF and placebo arms. Analysis limited to patients treated per protocol or with an acceptable protocol deviation also found no difference in change in total symptom score (p > 0.05) or change in domain scores (p > 0.01) between treatment arms. Provider assessment of acute mucositis during treatment did not correlate with patient-reported mucous domain and total symptom scores (p > 0.05). CONCLUSION GM-CSF administered concurrently during head and neck radiation does not appear to significantly improve patient-reported QoL symptom burden.
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Affiliation(s)
- Karen E Hoffman
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1202, Houston, TX, 77030, USA,
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Zhang M, Chan SWC, You L, Wen Y, Peng L, Liu W, Zheng M. The effectiveness of a self-efficacy-enhancing intervention for Chinese patients with colorectal cancer: a randomized controlled trial with 6-month follow up. Int J Nurs Stud 2013; 51:1083-92. [PMID: 24406033 DOI: 10.1016/j.ijnurstu.2013.12.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 12/10/2013] [Accepted: 12/10/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Colorectal cancer is a major public health problem. There is growing support for colorectal cancer survivors who are experiencing problems after cancer treatment to engage in self-management programs to reduce symptom distress. However, there is inconclusive evidence as to the effectiveness of such program especially in Asian region. OBJECTIVES This study tested the effects of a six-month nurse-led self-efficacy-enhancing intervention for patients with colorectal cancer, compared with routine care over a six-month follow up. DESIGN A randomized controlled trial with repeated measures, two-group design. SETTING Three teaching hospitals in Guangzhou, China. PARTICIPANTS One hundred and fifty-two Chinese adult patients with a diagnosis of colorectal cancer were recruited. The intervention group (n=76) received self-efficacy-enhancing intervention and the control group (n=76) received standard care. METHOD The participants were randomized into either intervention or control group after baseline measures. The outcomes of the study (self-efficacy, symptom distress, anxiety, depression and quality of life) were compared at baseline, three and six months after the intervention. RESULTS Sixty-eight participants in the intervention group and 53 in the control group completed the study. Their mean age was 53 (SD=11.3). Repeated measure MANOVA found that the patients in the intervention group had significant improvement in their self-efficacy (F=7.26, p=0.003) and a reduction of symptom severity (F=5.30, p=0.01), symptom interference (F=4.06, p=0.025), anxiety (F=6.04, p=0.006) and depression (F=6.96, p=0.003) at three and six months, compared with the control group. However, no statistically significant main effect was observed in quality of life perception between the two groups. CONCLUSIONS The nurse-led self-efficacy enhancing intervention was effective in promoting self-efficacy and psychological well-being in patients with colorectal cancer, compared with standard care. The intervention can be incorporated into routine care. Future empirical work is required to determine the longer term effects of the intervention.
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Affiliation(s)
- Meifen Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Sally Wai-chi Chan
- Alice Lee Centre of Nursing Studies, National University of Singapore, Singapore.
| | - Liming You
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Yongshan Wen
- Department of Nursing, Cancer Center of Sun Yat-sen University, Guangzhou, China
| | - Lifen Peng
- Department of Nursing, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Weiyan Liu
- Department of Nursing, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Meichun Zheng
- Department of Nursing, Cancer Center of Sun Yat-sen University, Guangzhou, China
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Smith EML. Current methods for the assessment and management of taxane-related neuropathy. Clin J Oncol Nurs 2013; 17 Suppl:22-34. [PMID: 23360700 DOI: 10.1188/13.cjon.s1.22-34] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Taxane-induced peripheral neuropathy (TIPN) affects a number of patients with breast cancer. To properly manage these patients, nurses must be able to identify and assess TIPN, as well as educate patients on TIPN as a side effect of taxane therapy. This article provides practical suggestions regarding how nurses can incorporate clinically feasible measurement approaches into practice and includes examples of grading TIPN that illustrate the limitations of the current tools and techniques for assessment. For example, a shortened and revised version of the Total Neuropathy Score and the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity subscale should be considered for future use. In addition, neuropathy-related results from numerous phase III trials in breast cancer are discussed, and the latest evidence regarding pharmacologic interventions for TIPN is briefly summarized.
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Abstract
The evaluation of the outcomes of total knee arthroplasty requires measurement tools that are valid, reliable, and responsive to change. However, the accuracy of any outcome measurement is determined by the validity and reliability of the instrument used. To ensure this accuracy, it is imperative that each instrument used in orthopaedics is free of biases leading to inaccurate estimates of treatment effects. WHERE ARE WE NOW?: Many patient-derived outcome instruments have been developed and tested through the application of the standard assessments that form the basis of classical test theory: validity, reliability, and responsiveness. These assessments determine if the instrument reliably measures what it is intended to measure, and if it captures differences among groups of patients or changes over time. WHERE DO WE NEED TO GO?: Thorough evaluation of the outcome instruments used in orthopaedics is a critical prerequisite for the continued improvement of effective patient care. Additional steps of psychometric testing that are sometimes overlooked include testing for differential item functioning (DIF) and the effects of the mode of administration of the outcome instrument. The use of suitable approaches to test for these potential sources of bias would facilitate the development of more robust outcome assessment in research and clinical practice. HOW DO WE GET THERE?: Testing for DIF, including the effects of mode of administration, may be performed using several analytical approaches. This will allow optimal application of each outcome instrument with respect to patient characteristics, time and mode of the administration, and modification, as necessary.
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Quinten C, Martinelli F, Coens C, Sprangers MAG, Ringash J, Gotay C, Bjordal K, Greimel E, Reeve BB, Maringwa J, Ediebah DE, Zikos E, King MT, Osoba D, Taphoorn MJ, Flechtner H, Schmucker-Von Koch J, Weis J, Bottomley A. A global analysis of multitrial data investigating quality of life and symptoms as prognostic factors for survival in different tumor sites. Cancer 2013; 120:302-11. [PMID: 24127333 DOI: 10.1002/cncr.28382] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 07/04/2013] [Accepted: 08/02/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Chantal Quinten
- Quality of Life Department; European Organization for Research and Treatment of Cancer Headquarters; Brussels Belgium
| | - Francesca Martinelli
- Quality of Life Department; European Organization for Research and Treatment of Cancer Headquarters; Brussels Belgium
| | - Corneel Coens
- Quality of Life Department; European Organization for Research and Treatment of Cancer Headquarters; Brussels Belgium
| | | | - Jolie Ringash
- Department of Radiation Oncology, The Princess Margaret Hospital; University of Toronto; Toronto Ontario Canada
| | - Carolyn Gotay
- School of Population and Public Health; University of British Columbia; British Columbia Cancer Research Center; Vancouver British Columbia Canada
| | - Kristin Bjordal
- Oslo University Hospital; Department of Oncology, Norwegian Radium Hospital; Oslo Norway
| | - Eva Greimel
- Obstetrics and Gynecology; Medical University Graz; Graz Austria
| | - Bryce B. Reeve
- Department of Health Policy and Management; University of North Carolina; Chapel Hill North Carolina
| | - John Maringwa
- Quality of Life Department; European Organization for Research and Treatment of Cancer Headquarters; Brussels Belgium
| | - Divine E. Ediebah
- Quality of Life Department; European Organization for Research and Treatment of Cancer Headquarters; Brussels Belgium
| | - Efstathios Zikos
- Quality of Life Department; European Organization for Research and Treatment of Cancer Headquarters; Brussels Belgium
| | - Madeleine T. King
- Psycho-Oncology Cooperative Research Group; University of Sydney; Sydney New South Wales Australia
| | - David Osoba
- Quality of Life Consulting; West Vancouver British Columbia Canada
| | - Martin J. Taphoorn
- VU Medical Center/Medical Center Haaglanden; Amsterdam/the Hague Netherlands
| | - Henning Flechtner
- Child and Adolescent Psychiatry and Psychotherapy; University of Magdeburg; Magdeburg Germany
| | | | - Joachim Weis
- Tumorbiology Center at the Department of Psycho-oncology; University of Freiburg; Freiburg Germany
| | - Andrew Bottomley
- Quality of Life Department; European Organization for Research and Treatment of Cancer Headquarters; Brussels Belgium
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Brown LC, Atherton PJ, Neben-Wittich MA, Wender DB, Behrens RJ, Kozelsky TF, Loprinzi CL, Haddock MG, Martenson JA. Assessment of long-term rectal function in patients who received pelvic radiotherapy: a pooled North Central Cancer Treatment Group trial analysis, N09C1. Support Care Cancer 2013; 21:2869-77. [PMID: 23748483 PMCID: PMC3769434 DOI: 10.1007/s00520-013-1853-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 05/16/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE Pelvic radiotherapy (PRT) is known to adversely affect bowel function (BF) and patient well-being. This study characterized long-term BF and evaluated quality of life (QOL) in patients receiving PRT. METHODS Data from 252 patients were compiled from two North Central Cancer Treatment Group prospective studies, which included assessment of BF and QOL by the BF questionnaire (BFQ) and Uniscale QOL at baseline and 12 and 24 months after completion of radiotherapy. BFQ scores (sum of symptoms), Uniscale results, adverse-event incidence, and baseline demographic data were compared via t test, χ (2), Fisher exact, Wilcoxon, and correlation methodologies. RESULTS The total BFQ score was higher than baseline at 12 and 24 months (P < 0.001). More patients had five or more symptoms at 12 months (13 %) and 24 months (10 %) than at baseline (2 %). Symptoms occurring in greater than 20 % of patients at 12 and 24 months were clustering, stool-gas confusion, and urgency. Factors associated with worse BF were female sex, rectal or gynecologic primary tumors, prior anterior resection of the rectum, and 5-fluorouracil chemotherapy. Patients experiencing grade 2 or higher acute toxicity had worse 24-month BF (P values, <.001-.02). Uniscale QOL was not significantly different from baseline at 12 or 24 months, despite worse BFQ scores. CONCLUSIONS PRT was associated with worse long-term BF. Worse BFQ score was not associated with poorer QOL. Further research to characterize the subset of patients at risk of significant decline in BF is warranted.
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Affiliation(s)
- Lindsay C Brown
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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Søreide K, Søreide AH. Using patient-reported outcome measures for improved decision-making in patients with gastrointestinal cancer - the last clinical frontier in surgical oncology? Front Oncol 2013; 3:157. [PMID: 23785670 PMCID: PMC3682158 DOI: 10.3389/fonc.2013.00157] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 06/03/2013] [Indexed: 11/18/2022] Open
Abstract
The genomic era has introduced concepts of “personalized medicine” and “targeted therapy” in the field of oncology. Medicine has become increasingly complex with a plethora of potential dilemmas in diagnosis, treatment, and management. The focus on classical outcomes for clinical decision-making is now increasingly being replaced by patient-reported outcome measures (PROMs). PROMs should increasingly now be in the center of patient-centered decision-making, based on valid, reliable, and clinically useful measures delivered directly by the patient to the caregiver. Surgeons’ ability to interpret and apply PROMs and quality of life results must improve by education and further research, and has an unreleased potential to contribute to a better understanding of the patients’ well-being. A number of caveats must be addressed before this can be brought to fruition; standardization for valid items; appropriate use of instruments; correct timing of the application; missing data handling, compliance, and respondent drop-outs are but a few issues to be addressed. Based on the apparent lack of use in both research and clinical work, it should call for an educational effort to address this among surgeons caring for patients with cancer.
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Affiliation(s)
- Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital , Stavanger , Norway ; Department of Clinical Medicine, University of Bergen , Bergen , Norway
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Furman MJ, Lambert LA, Sullivan ME, Whalen GF. Rational Follow-Up After Curative Cancer Resection. J Clin Oncol 2013; 31:1130-3. [DOI: 10.1200/jco.2012.46.4438] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Atherton PJ, Halyard MY, Sloan JA, Miller RC, Deming RL, Tai THP, Stien KJ, Martenson JA. Assessment of patient-reported measures of bowel function before and after pelvic radiotherapy: an ancillary study of the North Central Cancer Treatment Group study N00CA. Support Care Cancer 2012; 21:1193-9. [PMID: 23151649 DOI: 10.1007/s00520-012-1648-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 10/30/2012] [Indexed: 01/08/2023]
Abstract
PURPOSE The Bowel Function Questionnaire (BFQ) has been used in clinical trials to assess symptoms during and after pelvic radiotherapy (RT). This study evaluated the importance of symptoms in the BFQ from a patient perspective. METHODS Patients reported presence or absence of symptoms and rated importance of symptoms at baseline, 4 weeks after completion of pelvic RT, and 12 and 24 months after RT. The BFQ measured overall quality of life (QOL) and symptoms of nocturnal bowel movements, incontinence, clustering, need for protective clothing, inability to differentiate stool from gas, liquid bowel movements, urgency, cramping, and bleeding. Bowel movement frequency also was recorded. A content validity questionnaire (CVQ) was used to rate symptoms as "not very important," "moderately unimportant," "neutral," "moderately important," or "very important." RESULTS Most of the 125 participating patients rated all symptoms as moderately or very important. Generally, patients gave similar ratings for symptom importance at all study points, and ratings were independent of whether the patient experienced the symptom. Measures of greatest importance (moderately or very important) at baseline were ability to control bowel movements (94 %), not having to wear protective clothing (90 %), and not having rectal bleeding (94 %). With the exception of need for protective clothing, the presence of a symptom at 4 weeks was associated with significantly worse QOL (P < .01 for all). CONCLUSIONS The BFQ has excellent content validity. Patients rated most symptoms as moderately or very important, indicating the BFQ is an appropriate tool for symptom assessment during and after pelvic RT.
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Affiliation(s)
- Pamela J Atherton
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
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Sikorskii A, Wyatt G, Tamkus D, Victorson D, Rahbar MH, Ahn S. Concordance between patient reports of cancer-related symptoms and medical records documentation. J Pain Symptom Manage 2012; 44:362-72. [PMID: 22699089 PMCID: PMC3432740 DOI: 10.1016/j.jpainsymman.2011.09.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 09/14/2011] [Accepted: 09/15/2011] [Indexed: 11/26/2022]
Abstract
CONTEXT Two sources of symptom data, patient report and medical records documentation, have been used in studies focusing on chronic conditions. The concordance of patient-reported cancer-related symptoms and clinician reports as documented in the medical records needs to be evaluated. OBJECTIVES To compare patient reports with medical record documentation of 12 disease- and treatment-related symptoms for women with advanced breast cancer undergoing chemotherapy or hormonal therapy for cancer control. METHODS Women (n=384) were recruited from 13 oncology clinics in the midwestern U.S. They completed telephone interviews at intake, five, and 11 weeks, where they reported the presence of 12 symptoms using a checklist. Medical records were abstracted when women completed the study. The concordance between patient reports and medical record documentation was assessed using percent agreement, kappa statistics, and McNemar's tests. Administration of medication for symptoms and patient characteristics were investigated in relation to the agreement of the two sources of data. RESULTS Poor to slight agreement was found, and disagreement was significant for all 12 symptoms. The concordance between symptom presence in the medical record and administration of medication for the management of those symptoms was moderate. Patient characteristics were not associated with agreement, except for age. The agreement was higher for older women for the symptom of mouth sores. CONCLUSION Medical records may not provide adequate documentation of symptoms, and collection of patient-reported symptom data from women with advanced breast cancer is critical to quality clinical management.
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Affiliation(s)
- Alla Sikorskii
- Department of Statistics and Probability, Michigan State University, East Lansing, Michigan 48824-1317, USA.
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Shimozuma K, Ohashi Y, Takeuchi A, Aranishi T, Morita S, Kuroi K, Ohsumi S, Makino H, Katsumata N, Kuranami M, Suemasu K, Watanabe T, Hausheer FH. Taxane-induced peripheral neuropathy and health-related quality of life in postoperative breast cancer patients undergoing adjuvant chemotherapy: N-SAS BC 02, a randomized clinical trial. Support Care Cancer 2012; 20:3355-64. [PMID: 22584733 DOI: 10.1007/s00520-012-1492-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 04/30/2012] [Indexed: 12/22/2022]
Abstract
PURPOSE To elucidate whether adjuvant taxane monotherapy is a feasible and tolerable for postoperative breast cancer patients, we evaluated the severity of chemotherapy-induced peripheral neuropathy (CIPN) and the relative tolerability of regimens by health-related quality of life (HRQOL) assessment in node-positive breast cancer patients treated with taxane-containing regimens. METHODS We evaluated CIPN and HRQOL in the first 300 patients enrolled in a larger (1,060 total) multicenter phase III trial randomized to one of four adjuvant regimens: (1) anthracycline-cyclophosphamide followed by paclitaxel (ACP), (2) AC followed by docetaxel (ACD), (3) paclitaxel alone (PTX), or (4) docetaxel alone (DTX). CIPN was assessed by the Patient Neurotoxicity Questionnaire (PNQ) and the National Cancer Institute Common Toxicity Criteria, and HRQOL by Functional Assessment of Cancer Therapy-General (FACT-G). CIPN and HRQOL scores were compared between ACP and ACD vs. PTX and DTX, and ACP and PTX vs. ACD and DTX. RESULTS PNQ sensory scores were significantly higher in patients treated with taxane monotherapy compared to treatment with AC followed by taxane (P = .003). No significant differences in PNQ sensory scores were observed between the ACP and PTX vs. ACD and DTX regimens (P = .669). Regardless of taxane regimen, PNQ severity scores for CIPN appear to be largely reversible within 1 year of adjuvant treatment. No significant difference in FACT-G scores was observed between any regimens during the study treatments. CONCLUSIONS Patient-reported CIPN was significantly more severe with single-agent adjuvant taxane compared to AC followed by taxane treatment; however, the HRQOL findings support that single-agent taxane treatment is tolerable.
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Affiliation(s)
- Kojiro Shimozuma
- Department of Biomedical Sciences, College of Life Sciences, Ritsumeikan University, 1-1-1 Noji-Higashi, Kusatsu, Shiga 525-8577, Japan.
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Sloan JA, de Andrade M, Decker P, Wampfler J, Oswold C, Clark M, Yang P. Genetic variations and patient-reported quality of life among patients with lung cancer. J Clin Oncol 2012; 30:1699-704. [PMID: 22454423 PMCID: PMC3383115 DOI: 10.1200/jco.2010.34.5629] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 12/20/2011] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Recent evidence has suggested a relationship between the baseline quality of life (QOL) self-reported by patients with cancer and genetic disposition. We report an analysis exploring relationships among baseline QOL assessments and candidate genetic variations in a large cohort of patients with lung cancer. PATIENTS AND METHODS QOL data were provided by 1,299 patients with non-small-cell lung cancer observed at the Mayo Clinic between 1997 and 2007. Overall QOL and subdomains were assessed by either Lung Cancer Symptom Scale or Linear Analog Self Assessment measures; scores were transformed to a scale of 0 to 10, with higher scores representing better status. Baseline QOL scores assessed within 1 year of diagnosis were dichotomized as clinically deficient (CD) or not. A total of 470 single nucleotide polymorphisms (SNPs) in 56 genes of three biologic pathways were assessed for association with QOL measures. Logistic regression with training/validation samples was used to test the association of SNPs with CD QOL. RESULTS Six SNPs on four genes were replicated using our split schemes. Three SNPs in the MGMT gene (adjusted analysis, rs3858300; unadjusted analysis, rs10741191 and rs3852507) from DNA repair pathway were associated with overall QOL. Two SNPs (rs2287396 [GSTZ1] and rs9524885 [ABCC4]) from glutathione metabolic pathway were associated with fatigue in unadjusted analysis. In adjusted analysis, two SNPs (rs2756109 [ABCC2] and rs9524885 [ABCC4]) from glutathione metabolic pathway were associated with pain. CONCLUSION We identified three SNPs in three glutathione metabolic pathway genes and three SNPs in two DNA repair pathway genes associated with QOL measures in patients with non-small-cell lung cancer.
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Abstract
INTRODUCTION Information is limited regarding health-related quality of life (QOL) status of long-term (greater than 5 years) lung cancer survivors (LTLCS). Obtaining knowledge about their QOL changes over time is a critical step toward improving poor and maintaining good QOL. The primary aim of this study was to conduct a 7-year longitudinal study in survivors of primary lung cancer which identified factors associated with either decline or improvement in QOL over time. METHODS Between 1997 and 2003, 447 LTLCS were identified and followed through 2007 using validated questionnaires; data on overall QOL and specific symptoms were at two periods: short-term (less than 3 years) and long-term postdiagnosis. The main analyses were of clinically significant changes (greater than 10%) and factors associated with overall QOL and symptom burden for each period and for changes over time. RESULTS Three hundred two (68%) underwent surgical resection only and 122 (27%) received surgical resection and radiation/chemotherapy. Recurrent or new lung malignancies were observed in 84 (19%) survivors. Significant decline or improvement in overall QOL over time were reported in 155 (35%) and 67 (15%) of 447 survivors, respectively. Among the 155 whose QOL declined, significantly worsened symptoms were fatigue (69%), pain (59%), dyspnea (58%), depressed appetite (49%), and coughing (42%). The symptom burden did not lessen among the 67 who reported improvement in overall QOL, suggesting that survivors had adapted to their compromised physical condition. CONCLUSIONS LTLCS suffered substantial symptom burden that significantly impaired their QOL, indicating a need for targeted interventions to alleviate their symptoms.
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