1
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Budhu JA, Chukwueke UN, Jackson S, Lee EQ, McFaline-Figueroa JR, Willmarth N, Dalmage M, Kawachi I, Arons D, Chang SM, Galanis E, Hervey-Jumper SL, Wen PY, Porter AB. Defining interventions and metrics to improve diversity in CNS clinical trial participation: A SNO and RANO effort. Neuro Oncol 2024; 26:596-608. [PMID: 38071654 PMCID: PMC10995510 DOI: 10.1093/neuonc/noad242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Despite major strides in cancer research and therapy, these advances have not been equitable across race and ethnicity. Historically marginalized groups (HMG) are more likely to have inadequate preventive screening, increased delays in diagnosis, and poor representation in clinical trials. Notably, Black, Hispanic, and Indigenous people represent 30% of the population but only 9% of oncology clinical trial participants. As a result, HMGs lack equitable access to novel therapies, contradicting the principle of distributive justice, as enshrined in the Belmont report, which demands the equitable selection of subjects in research involving human subjects. The lack of clinical trial diversity also leads to low generalizability and potentially harmful medical practices. Specifically, patients with brain cancer face unique barriers to clinical trial enrollment and completion due to disease-specific neurologic and treatment-induced conditions. Collectively, the intersection of these disease-specific conditions with social determinants of health fosters a lack of diversity in clinical trials. To ameliorate this disparity in neuro-oncology clinical trial participation, we present interventions focused on improving engagement of HMGs. Proposals range from inclusive trial design, decreasing barriers to care, expanding trial eligibility, access to tumor profiling for personalized medical trials, setting reasonable metrics and goals for accrual, working with patient community stakeholders, diversifying the neuro-oncology workforce, and development of tools to overcome biases with options to incentivize equity. The diversification of participation amongst neuro-oncology clinical trials is imperative. Equitable access and inclusion of HMG patients with brain tumors will not only enhance research discoveries but will also improve patient care.
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Affiliation(s)
- Joshua A Budhu
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Neurology, Weill Cornell Medicine, Joan & Sanford I. Weill Medical College of Cornell University, New York, New York, USA
| | - Ugonma N Chukwueke
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sadhana Jackson
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Eudocia Q Lee
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - J Ricardo McFaline-Figueroa
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Mahalia Dalmage
- Division of Biological Sciences, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - David Arons
- National Brain Tumor Society, Newton, Massachusetts, USA
| | - Susan M Chang
- Division of Neuro-Oncology, University of California San Francisco and Weill Institute for Neurosciences, San Francisco, California, USA
| | | | - Shawn L Hervey-Jumper
- Department of Neurological Surgery, University of California San Francisco and Weill Institute for Neurosciences, San Francisco, California, USA
| | - Patrick Y Wen
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alyx B Porter
- Department of Neurology, Mayo Clinic Cancer Center, Phoenix, Arizona, USA
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2
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Grandhi N, Zhou AY, Johnson MO, Butt OH. Evolving Barriers to Clinical Trial Enrollment and Clinical Care in Neuro-oncology in the Face of COVID-19. Semin Neurol 2024; 44:47-52. [PMID: 38158211 DOI: 10.1055/s-0043-1777421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
The lack of treatments with durable response in neuro-oncology highlights the critical need for clinical trials to advance patient care. The intersection of relatively low incidence, evolving classification schema, and entrenched community, healthcare provider, and organizational factors have been historic challenges against successful trial enrollment and implementation. The additional need for multidisciplinary, often tertiary-level care, further magnifies latent national and international health inequities with rural and under-served populations. The COVID-19 pandemic both unveiled fundamental weaknesses in historical approaches and prompted the necessity of new approaches and systems for conducting clinical trials. Here, we provide an overview of traditional barriers to clinical trial enrollment in neuro-oncology, the effect of COVID-19 on these barriers, and the discovery of additional systemic weaknesses. Finally, we discuss future directions by reflecting on lessons learned with strategies to broaden access of care and streamline clinical trial integration into clinical practice.
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Affiliation(s)
- Nikhil Grandhi
- Division of Oncology, Department of Medicine, Siteman Cancer Center, Washington University in Saint Louis, St. Louis, Missouri
| | - Alice Y Zhou
- Division of Oncology, Department of Medicine, Siteman Cancer Center, Washington University in Saint Louis, St. Louis, Missouri
| | - Margaret O Johnson
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University, Durham, North Carolina
| | - Omar H Butt
- Division of Oncology, Department of Medicine, Siteman Cancer Center, Washington University in Saint Louis, St. Louis, Missouri
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3
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Franco-Rocha OY, Lewis KA, Longoria KD, De La Torre Schutz A, Wright ML, Kesler SR. Cancer-related cognitive impairment in racial and ethnic minority groups: a scoping review. J Cancer Res Clin Oncol 2023; 149:12561-12587. [PMID: 37432455 DOI: 10.1007/s00432-023-05088-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE Disparities in cognitive function among racial and ethnic groups have been reported in non-cancer conditions, but cancer-related cognitive impairment (CRCI) in racial and ethnic minority groups is poorly understood. We aimed to synthesize and characterize the available literature about CRCI in racial and ethnic minority populations. METHODS We conducted a scoping review in the PubMed, PsycInfo, and Cumulative Index to Nursing and Allied Health Literature databases. Articles were included if they were published in English or Spanish, reported cognitive functioning in adults diagnosed with cancer, and characterized the race or ethnicity of the participants. Literature reviews, commentaries, letters to the editor, and gray literature were excluded. RESULTS Seventy-four articles met the inclusion criteria, but only 33.8% differentiated the CRCI findings by racial or ethnic subgroups. There were associations between cognitive outcomes and the participants' race or ethnicity. Additionally, some studies found that Black and non-white individuals with cancer were more likely to experience CRCI than their white counterparts. Biological, sociocultural, and instrumentation factors were associated with CRCI differences between racial and ethnic groups. CONCLUSIONS Our findings indicate that racial and ethnic minoritized individuals may be disparately affected by CRCI. Future research should use standardized guidelines for measuring and reporting the self-identified racial and ethnic composition of the sample; differentiate CRCI findings by racial and ethnic subgroups; consider the influence of structural racism in health outcomes; and develop strategies to promote the participation of members of racial and ethnic minority groups.
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Affiliation(s)
- Oscar Y Franco-Rocha
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA.
| | - Kimberly A Lewis
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Kayla D Longoria
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA
| | - Alexa De La Torre Schutz
- Brain Health Neuroscience Lab, School of Nursing, The University of Texas at Austin, 1710 Red River St, Austin, TX, USA
| | - Michelle L Wright
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA
| | - Shelli R Kesler
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA
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4
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Marron JM, Kyi K, Appelbaum PS, Magnuson A. Medical Decision-Making in Oncology for Patients Lacking Capacity. Am Soc Clin Oncol Educ Book 2021; 40:1-11. [PMID: 32347758 DOI: 10.1200/edbk_280279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Modern oncology practice is built upon the idea that a patient with cancer has the legal and ethical right to make decisions about their medical care. There are situations in which patients might no longer be fully able to make decisions on their own behalf, however, and some patients never were able to do so. In such cases, it is critical to be aware of how to determine if a patient has the ability to make medical decisions and what should be done if they do not. In this article, we examine the concept of decision-making capacity in oncology and explore situations in which patients may have altered/diminished capacity (e.g., depression, cognitive impairment, delirium, brain tumor, brain metastases, etc.) or never had decisional capacity (e.g., minor children or developmentally disabled adults). We describe fundamental principles to consider when caring for a patient with cancer who lacks decisional capacity. We then introduce strategies for capacity assessment and discuss how clinicians might navigate scenarios in which their patients could lack capacity to make decisions about their cancer care. Finally, we explore ways in which pediatric and medical oncology can learn from one another with regard to these challenging situations.
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Affiliation(s)
- Jonathan M Marron
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA.,Harvard Medical School, Boston, MA.,Center for Bioethics, Harvard Medical School, Boston, MA
| | - Kaitlin Kyi
- Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Paul S Appelbaum
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Allison Magnuson
- Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY
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5
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Gerstenecker A, Gammon M, Marotta D, Fiveash J, Nabors B, Mulhauser K, Triebel K. Clinical correlates of the ability to consent to research participation in brain metastasis. Psychooncology 2020; 29:1655-1661. [PMID: 33463869 DOI: 10.1002/pon.5487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/30/2020] [Accepted: 07/07/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Impairment in the ability to provide informed consent is common in persons with brain metastasis. However, little is known about what factors contribute to this impairment in the patient group. Our objective is to determine if the associations between demographic, cognitive, and clinical variables correlate with the ability to provide informed consent in persons with brain metastasis. METHODS We administered a comprehensive neuropsychological battery to a group of 61 persons with brain metastasis. Demographic and clinical information was also collected. All diagnoses were made by board-certified oncologists and were verified histologically. Statistical analyses included Pearson's product-moment correlations, point biserial correlations, and linear regression. RESULTS Results indicated that combinations of education, verbal memory, executive function, whole brain radiation therapy, and chemotherapy affected various aspects of the ability to provide informed consent. Subsequent regression models demonstrated that these variables contributed a significant amount of shared variance to the ability to provide informed consent. CONCLUSION We found that the ability of persons with brain metastasis to provide informed consent is a cognitively complex ability that is also affected by education and treatment variables. This information can help clinical researchers in identifying persons with brain metastasis at risk of an impaired ability to provide informed consent and aid in the consenting process.
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Affiliation(s)
- Adam Gerstenecker
- Department of Neurology, Division of Neuropsychology, University of Alabama, Birmingham, Alabama, USA.,Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Alzheimer's Disease Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Meredith Gammon
- Department of Neurology, Division of Neuropsychology, University of Alabama, Birmingham, Alabama, USA
| | - Dario Marotta
- Department of Neurology, Division of Neuropsychology, University of Alabama, Birmingham, Alabama, USA
| | - John Fiveash
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Burt Nabors
- Department of Neurology, Division of Neuropsychology, University of Alabama, Birmingham, Alabama, USA.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kyler Mulhauser
- Department of Neurology, Division of Neuropsychology, University of Alabama, Birmingham, Alabama, USA
| | - Kristen Triebel
- Department of Neurology, Division of Neuropsychology, University of Alabama, Birmingham, Alabama, USA.,Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, Alabama, USA.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
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6
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Goswami R, Moore J, Bruera E, Hui D. Assessment of the Decision-Making Capacity for Clinical Research Participation in Patients With Advanced Cancer in the Last Weeks of Life. J Pain Symptom Manage 2020; 60:400-406. [PMID: 32105788 PMCID: PMC8641043 DOI: 10.1016/j.jpainsymman.2020.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 01/14/2023]
Abstract
CONTEXT Few studies have examined how clinicians assess decision-making capacity for research in the last weeks of life. OBJECTIVES We examined the decision-making capacity for participation in a research study and its association with clinician impression and delirium among patients with cancer with days to weeks of life expectancy. METHODS Patients admitted to our palliative and supportive care unit were approached for a prospective observational study. We assessed for their decision-making capacity based on clinical impression of physician and nurse, Memorial Delirium Assessment Scale (MDAS), and the MacArthur Competency Assessment Tool for Clinical Research (MacCAT-CR). RESULTS Among the 206 patients, 131 patients (64%) did not require MacCAT-CR assessment because they were overtly delirious or unresponsive; 37 (18%) patients were alert but did not complete the MacCAT-CR assessment for other reasons, and 38 patients (18%) completed the MacCAT-CR assessment. Among these 38 patients, five (13%) patients were incapable and had normal albeit significantly higher MDAS scores compared with those who were capable (1.8 vs. 4.2; P = 0.002). Compared against MacCAT-CR and MDAS, the overall agreement with capacity assessment with a clinician was 88% (95% CI 82-93) for physicians and 90% (95% CI 82-94) for nurses. The area under the receiver operating characteristics curve was 0.93 (95% CI 0.88-0.96) for physicians and 0.94 (95% CI 0.89-0.97) for nurses, suggesting high discrimination. CONCLUSION Most patients in the palliative and supportive care unit lacked decision-making capacity for participation in clinical research. Clinician impression had high accuracy. Few patients with normal MDAS were found to be incapable with MacCAT-CR assessment.
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Affiliation(s)
- Rachna Goswami
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Jessica Moore
- Department of Critical Care and Respiratory Care, MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA.
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7
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Pace A, Koekkoek JAF, van den Bent MJ, Bulbeck HJ, Fleming J, Grant R, Golla H, Henriksson R, Kerrigan S, Marosi C, Oberg I, Oberndorfer S, Oliver K, Pasman HRW, Le Rhun E, Rooney AG, Rudà R, Veronese S, Walbert T, Weller M, Wick W, Taphoorn MJB, Dirven L. Determining medical decision-making capacity in brain tumor patients: why and how? Neurooncol Pract 2020; 7:599-612. [PMID: 33312674 DOI: 10.1093/nop/npaa040] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Brain tumor patients are at high risk of impaired medical decision-making capacity (MDC), which can be ethically challenging because it limits their ability to give informed consent to medical treatments or participation in research. The European Association of Neuro-Oncology Palliative Care Multidisciplinary Task Force performed a systematic review to identify relevant evidence with respect to MDC that could be used to give recommendations on how to cope with reduced MDC in brain tumor patients. Methods A literature search in several electronic databases was conducted up to September 2019, including studies with brain tumor and other neurological patients. Information related to the following topics was extracted: tools to measure MDC, consent to treatment or research, predictive patient- and treatment-related factors, surrogate decision making, and interventions to improve MDC. Results A total of 138 articles were deemed eligible. Several structured capacity-assessment instruments are available to aid clinical decision making. These instruments revealed a high incidence of impaired MDC both in brain tumors and other neurological diseases for treatment- and research-related decisions. Incapacity appeared to be mostly determined by the level of cognitive impairment. Surrogate decision making should be considered in case a patient lacks capacity, ensuring that the patient's "best interests" and wishes are guaranteed. Several methods are available that may help to enhance patients' consent capacity. Conclusions Clinical recommendations on how to detect and manage reduced MDC in brain tumor patients were formulated, reflecting among others the timing of MDC assessments, methods to enhance patients' consent capacity, and alternative procedures, including surrogate consent.
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Affiliation(s)
- Andrea Pace
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Johan A F Koekkoek
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Martin J van den Bent
- Department of Neurology, The Brain Tumor Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Helen J Bulbeck
- Brainstrust (The Brain Cancer People), Cowes, Isle of Wight, UK
| | - Jane Fleming
- Department of Palliative Medicine, University Hospital Waterford, Waterford, Ireland
| | - Robin Grant
- Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, Scotland, UK
| | - Heidrun Golla
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany
| | - Roger Henriksson
- Department of Radiation Sciences and Oncology, Umeå University, Umeå, Sweden
| | | | - Christine Marosi
- Department of Internal Medicine I, Clinical Division of Medical Oncology, Medical University of Vienna, Vienna, Austria
| | - Ingela Oberg
- Department of Neuroscience, Cambridge University Hospitals, Cambridge, UK
| | - Stefan Oberndorfer
- Department Neurology, University Clinic St Pölten, KLPU and KLI-Neurology and Neuropsychology, St Pölten, Austria
| | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth, UK
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Emilie Le Rhun
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Alasdair G Rooney
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, Scotland, UK
| | - Roberta Rudà
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Simone Veronese
- Department of Palliative Care, Fondazione FARO, Turin, Italy
| | - Tobias Walbert
- Department of Neurology and Neurosurgery, Henry Ford Health System, Detroit, Michigan, US
| | - Michael Weller
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Wolfgang Wick
- Neurology Clinic and National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany.,German Consortium of Translational Cancer Research (DKTK), Clinical Cooperation Unit Neurooncology, German Cancer Research Center, Heidelberg, Germany
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
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8
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Mulhauser K, Marotta DA, Gerstenecker A, Wilhelm G, Myers T, Gammon M, Vance DE, Nabors B, Fiveash J, Triebel K. Capacity to consent to research participation in adults with metastatic cancer: comparisons of brain metastasis, non-CNS metastasis, and healthy controls. Neurooncol Pract 2020; 7:439-445. [PMID: 32765894 DOI: 10.1093/nop/npaa008] [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] [Indexed: 01/04/2023] Open
Abstract
Background To evaluate the ability of individuals with metastatic cancer to provide informed consent to research participation, we used a structured vignette-based interview to measure 4 consenting standards across 3 participant groups. Methods Participants included 61 individuals diagnosed with brain metastasis, 41 individuals diagnosed with non-CNS metastasis, and 17 cognitively intact healthy controls. All groups were evaluated using the Capacity to Consent to Research Instrument (CCRI), a performance-based measure of research consent capacity. The ability to provide informed consent to participate in research was evaluated across 4 consent standards: expressing choice, appreciation, reasoning, and understanding. Capacity performance ratings (intact, mild/moderate impairment, severe impairment) were identified based on control group performance. Results Results revealed that the brain metastasis group performed significantly lower than healthy controls on the consent standard of understanding, while both metastatic cancer groups performed below controls on the consent standard of reasoning. Both metastatic cancer groups performed similar to controls on the standards of appreciation and expressing choice. Approximately 60% of the brain metastasis group, 54% of the non-CNS metastasis group, and 18% of healthy controls showed impaired research consent capacity. Conclusions Our findings, using a performance-based assessment, are consistent with other research indicating that the research consent process may be overly cumbersome and confusing. This, in turn, may lead to research consent impairment not only in patient groups but also in some healthy adults with intact cognitive ability.
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Affiliation(s)
- Kyler Mulhauser
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham, US.,O'Neal Comprehensive Cancer Center at UAB, Birmingham, Alabama, US
| | - Dario A Marotta
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham, US.,O'Neal Comprehensive Cancer Center at UAB, Birmingham, Alabama, US.,Alabama College of Osteopathic Medicine, Dothan, Alabama, US
| | - Adam Gerstenecker
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham, US
| | - Gabrielle Wilhelm
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham, US.,O'Neal Comprehensive Cancer Center at UAB, Birmingham, Alabama, US
| | - Terina Myers
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham, US.,O'Neal Comprehensive Cancer Center at UAB, Birmingham, Alabama, US
| | - Meredith Gammon
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham, US.,O'Neal Comprehensive Cancer Center at UAB, Birmingham, Alabama, US
| | - David E Vance
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham, US.,O'Neal Comprehensive Cancer Center at UAB, Birmingham, Alabama, US
| | - Burt Nabors
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham, US.,O'Neal Comprehensive Cancer Center at UAB, Birmingham, Alabama, US
| | - John Fiveash
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, Alabama, US.,Department of Radiation Oncology, University of Alabama at Birmingham, US
| | - Kristen Triebel
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham, US.,O'Neal Comprehensive Cancer Center at UAB, Birmingham, Alabama, US
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9
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Lee EQ, Chukwueke UN, Hervey-Jumper SL, de Groot JF, Leone JP, Armstrong TS, Chang SM, Arons D, Oliver K, Verble K, Musella A, Willmarth N, Alexander BM, Bates A, Doherty L, Galanis E, Gaffey S, Halkin T, Friday BE, Fouladi M, Lin NU, Macdonald D, Mehta MP, Penas-Prado M, Vogelbaum MA, Sahebjam S, Sandak D, van den Bent M, Weller M, Reardon DA, Wen PY. Barriers to accrual and enrollment in brain tumor trials. Neuro Oncol 2019; 21:1100-1117. [PMID: 31175826 PMCID: PMC7594546 DOI: 10.1093/neuonc/noz104] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Many factors contribute to the poor survival of malignant brain tumor patients, some of which are not easily remedied. However, one contributor to the lack of progress that may be modifiable is poor clinical trial accrual. Surveys of brain tumor patients and neuro-oncology providers suggest that clinicians do a poor job of discussing clinical trials with patients and referring patients for clinical trials. Yet, data from the Cancer Action Network of the American Cancer Society suggest that most eligible oncology patients asked to enroll on a clinical trial will agree to do so. To this end, the Society for Neuro-Oncology (SNO) in collaboration with the Response Assessment in Neuro-Oncology (RANO) Working Group, patient advocacy groups, clinical trial cooperative groups, including the Adult Brain Tumor Consortium (ABTC), and other partners are working together with the intent to double clinical trial accrual over the next 5 years. Here we describe the factors contributing to poor clinical trial accrual in neuro-oncology and offer possible solutions.
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Affiliation(s)
- Eudocia Q Lee
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ugonma N Chukwueke
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Jose Pablo Leone
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Susan M Chang
- University of California San Francisco, San Francisco, California, USA
| | - David Arons
- National Brain Tumor Society, Newton, Massachusetts, USA
| | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth, Surrey, UK
| | - Kay Verble
- The Sontag Foundation and Brain Tumor Network, Ponte Vedre Beach, Florida, USA
| | - Al Musella
- The Musella Foundation for Brain Tumor Research and Information, Hewlett, New York, USA
| | | | | | - Amanda Bates
- National Brain Tumor Society, Newton, Massachusetts, USA
| | - Lisa Doherty
- National Brain Tumor Society, Newton, Massachusetts, USA
| | | | - Sarah Gaffey
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Thomas Halkin
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Maryam Fouladi
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nancy U Lin
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | | | - Marta Penas-Prado
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | - David Sandak
- Accelerate Brain Cancer Cure (ABC2), Washington, DC, USA
| | | | - Michael Weller
- University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Patrick Y Wen
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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10
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Hewins W, Zienius K, Rogers JL, Kerrigan S, Bernstein M, Grant R. The Effects of Brain Tumours upon Medical Decision-Making Capacity. Curr Oncol Rep 2019; 21:55. [PMID: 31049786 PMCID: PMC6495430 DOI: 10.1007/s11912-019-0793-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose of Review Informed consent is the integral part of good medical practice in patients with brain tumours. Capacity to consent may be affected by the brain disorder or its treatment. We intend to draw upon the current neuro-oncology literature to discuss the influence intracranial tumours have upon patients’ capacity to consent to treatment and research. Recent Findings We performed a systematic review of studies of capacity to consent for treatment or research in patients with intracranial tumours. The search retrieved 1597 papers of which 8 were considered eligible for review. Summary Although there are obvious inherent limitations to solely assessing cognition, most research consistently demonstrated increased risk of incapacity in brain tumour patients with cognitive impairment. Specific items in cognitive screening batteries, for example Semantic Verbal Fluency Test (SVFT), Hopkins Verbal Learning Test (HVLT-Recall), and Trail Making Test A/B (TMT), are simple, easily applied tests that may act as significant red flags to identify patients at increased risk of incapacity and who subsequently will require additional cognitive/psychiatric evaluation or more formal tests for capacity to consent for treatment or research.
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Affiliation(s)
- Will Hewins
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, EH4 2XU, Scotland.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Karolis Zienius
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, EH4 2XU, Scotland
| | | | - Simon Kerrigan
- Department of Neurology, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
| | - Mark Bernstein
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Robin Grant
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, EH4 2XU, Scotland. .,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH16 4SB, UK.
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Kolva E, Rosenfeld B, Saracino RM. Neuropsychological Predictors of Decision-Making Capacity in Terminally Ill Patients with Advanced Cancer. Arch Clin Neuropsychol 2019; 35:1-9. [PMID: 31328219 PMCID: PMC7014974 DOI: 10.1093/arclin/acz027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/15/2019] [Accepted: 05/31/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The purpose of this cross-sectional study was to identify the neuropsychological underpinnings of decision-making capacity in terminally ill patients with advanced cancer. METHOD Participants were 108 English-speaking adults. More than half (n = 58) of participants had a diagnosis of advanced cancer and were receiving inpatient palliative care; the rest were healthy adults. Participants completed a measure of decision-making capacity that assesses four legal standards of capacity (Choice, Understanding, Appreciation, and Reasoning), and several measures of neuropsychological functioning. RESULTS Patients with terminal cancer were significantly more impaired on measures of capacity and neuropsychological functioning. Surprisingly, in the terminally ill sample, there were no significant correlations between neuropsychological functioning and decision-making capacity. CONCLUSION The terminally ill sample exhibited high levels of neuropsychological impairment across multiple cognitive domains. However, few of the measures of neuropsychological functioning were significantly associated with performance on the decisional capacity subscales in the terminally ill sample. It is possible that end-of-life decisional capacity is governed by general, rather than domain-specific, cognitive abilities.
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Affiliation(s)
- Elissa Kolva
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | | | - Rebecca M Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY USA
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Malan T, Moodley K. Phase 3 Oncology Clinical Trials in South Africa: Experimentation or Therapeutic Misconception? J Empir Res Hum Res Ethics 2017; 11:47-56. [PMID: 27106890 DOI: 10.1177/1556264616637736] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although clinical research in oncology is vital to improve current understanding of cancer and to validate new treatment options, voluntary informed consent is a critical component. Oncology research participants are a particularly vulnerable population; hence, therapeutic misconception often leads to ethical and legal challenges. We conducted a qualitative study administering semi-structured questionnaires on 29 adult, Phase 3, oncology clinical trial participants at three different private oncology clinical trial sites in South Africa. A descriptive content analysis was performed to identify perceptions of these participants regarding Phase 3 clinical trials. We found that most participants provided consent to be included in the trial for self-benefit. More than half of the participants had a poor understanding of Phase 3 clinical trials, and almost half the participants believed the clinical trial did not pose any significant risk to them. The word "hope" was used frequently by participants, displaying clear optimism with regard to the clinical trial and its outcome. This indicated that therapeutic misconception does occur in the South African oncology research setting and has the potential to lead to underestimation of the risks of a Phase 3 clinical trial. Emphasizing the experimental nature of a clinical trial during the consent process is critical to address therapeutic misconception in oncology research.
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Affiliation(s)
- Tina Malan
- Centre for Medical Ethics and Law, University of Stellenbosch Tygerberg, South Africa
| | - Keymanthri Moodley
- Centre for Medical Ethics and Law, University of Stellenbosch Tygerberg, South Africa
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Changes in Cognition and Decision Making Capacity Following Brain Tumour Resection: Illustrated with Two Cases. Brain Sci 2017; 7:brainsci7100122. [PMID: 28946652 PMCID: PMC5664049 DOI: 10.3390/brainsci7100122] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/13/2017] [Accepted: 09/19/2017] [Indexed: 12/15/2022] Open
Abstract
Changes in cognition, behaviour and emotion frequently occur in patients with primary and secondary brain tumours. This impacts the ability to make considered decisions, especially following surgical resection, which is often overlooked in the management of patients. Moreover, the impact of cognitive deficits on decision making ability affects activities of daily living and functional independence. The assessment process to ascertain decision making capacity remains a matter of debate. One avenue for evaluating a patient’s ability to make informed decisions in the context of brain tumour resection is neuropsychological assessment. This involves the assessment of a wide range of cognitive abilities on standard measurement tools, providing a robust approach to ascertaining capacity. Evidence has shown that a comprehensive and tailored neuropsychological assessment has greater sensitivity than brief cognitive screening tools to detect subtle and/or specific cognitive deficits in brain tumours. It is the precise nature and severity of any cognitive deficits that determines any implications for decision making capacity. This paper focuses on cognitive deficits and decision making capacity following surgical resection of both benign and malignant, and primary and secondary brain tumours in adult patients, and the implications for patients’ ability to consent to future medical treatment and make decisions related to everyday activities.
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Diamond EL, Panageas KS, Dallara A, Pollock A, Applebaum AJ, Carver AC, Pentsova E, DeAngelis LM, Prigerson HG. Frequency and Predictors of Acute Hospitalization Before Death in Patients With Glioblastoma. J Pain Symptom Manage 2017; 53:257-264. [PMID: 27810565 PMCID: PMC5253315 DOI: 10.1016/j.jpainsymman.2016.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/25/2016] [Accepted: 09/06/2016] [Indexed: 11/16/2022]
Abstract
CONTEXT Glioblastoma (GBM) is a devastating and incurable neuro-oncologic disease, and issues related to the end of life are almost invariably a matter of "when," not a matter of "if." Optimizing symptom management and quality of life in later stages of disease is of the utmost priority. OBJECTIVES To examine the frequency of and factors associated with late acute hospital admission before death in patients with GBM. METHODS Case-control study comparing patients with GBM admitted to the hospital within one month of death to those without late hospital admission. RESULTS Of 385 GBM patients followed to death at Memorial Sloan Kettering Cancer Center, 164 (42.6%) were admitted within a month of death, most frequently (140, or 85%) to manage neurologic decline. Of these, 56 (34%) had intensive care unit care during this admission and 22 (13%), 18 (11%), and 2 (1%) received mechanical ventilation, enteral feeding tubes, or cardiopulmonary resuscitation, respectively. In multivariable analysis, in-hospital chaplaincy consultation, and participation in a therapeutic clinical trial, both at any time in the GBM disease course, were significantly associated with late hospital admission. CONCLUSIONS Late hospitalization is frequent in GBM and often involves intensive care unit care in the management of clinical events that are part of the GBM dying process. Patients with a tendency to use religious support and those enrolled in clinical trials may be at greater risk for late hospitalization. Dedicated prospective study is needed to determine predictors of late hospitalization and to examine the impact of late acute medical care on quality of life in GBM.
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Affiliation(s)
- Eli L Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Palliative Medicine Service, Division of Survivorship and Supportive Care, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Center for Research on End-of-Life Care, Weill Cornell Medical College, New York, New York, USA.
| | - Katherine S Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alexis Dallara
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
| | - Ariel Pollock
- Icahn School of Medicine, Mount Sinai Medical Center, New York, New York, USA
| | - Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alan C Carver
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Palliative Medicine Service, Division of Survivorship and Supportive Care, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elena Pentsova
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lisa M DeAngelis
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Holly G Prigerson
- Center for Research on End-of-Life Care, Weill Cornell Medical College, New York, New York, USA
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Marson D. Conceptual Models and Guidelines for Clinical Assessment of Financial Capacity. Arch Clin Neuropsychol 2016; 31:541-53. [PMID: 27506235 PMCID: PMC5007080 DOI: 10.1093/arclin/acw052] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2016] [Indexed: 11/13/2022] Open
Abstract
The ability to manage financial affairs is a life skill of critical importance, and neuropsychologists are increasingly asked to assess financial capacity across a variety of settings. Sound clinical assessment of financial capacity requires knowledge and appreciation of applicable clinical conceptual models and principles. However, the literature has presented relatively little conceptual guidance for clinicians concerning financial capacity and its assessment. This article seeks to address this gap. The article presents six clinical models of financial capacity : (1) the early gerontological IADL model of Lawton, (2) the clinical skills model and (3) related cognitive psychological model developed by Marson and colleagues, (4) a financial decision-making model adapting earlier decisional capacity work of Appelbaum and Grisso, (5) a person-centered model of financial decision-making developed by Lichtenberg and colleagues, and (6) a recent model of financial capacity in the real world developed through the Institute of Medicine. Accompanying presentation of the models is discussion of conceptual and practical perspectives they represent for clinician assessment. Based on the models, the article concludes by presenting a series of conceptually oriented guidelines for clinical assessment of financial capacity. In summary, sound assessment of financial capacity requires knowledge and appreciation of clinical conceptual models and principles. Awareness of such models, principles and guidelines will strengthen and advance clinical assessment of financial capacity.
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Affiliation(s)
- Daniel Marson
- Department of Neurology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Satoer D, Visch-Brink E, Dirven C, Vincent A. Glioma surgery in eloquent areas: can we preserve cognition? Acta Neurochir (Wien) 2016; 158:35-50. [PMID: 26566782 PMCID: PMC4684586 DOI: 10.1007/s00701-015-2601-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/24/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cognitive preservation is crucial in glioma surgery, as it is an important aspect of daily life functioning. Several studies claimed that surgery in eloquent areas is possible without causing severe cognitive damage. However, this conclusion was relatively ungrounded due to the lack of extensive neuropsychological testing in homogenous patient groups. In this study, we aimed to elucidate the short-term and long-term effects of glioma surgery on cognition by identifying all studies who conducted neuropsychological tests preoperatively and postoperatively in glioma patients. METHODS We systematically searched the electronical databases Embase, Medline OvidSP, Web of Science, PsychINFO OvidSP, PubMed, Cochrane, Google Scholar, Scirius and Proquest aimed at cognitive performance in glioma patients preoperatively and postoperatively. RESULTS We included 17 studies with tests assessing the cognitive domains: language, memory, attention, executive functions and/or visuospatial abilities. Language was the domain most frequently examined. Immediately postoperatively, all studies except one, found deterioration in one or more cognitive domains. In the longer term (3-6/6-12 months postoperatively), the following tests showed both recovery and deterioration compared with the preoperative level: naming and verbal fluency (language), verbal word learning (memory) and Trailmaking B (executive functions). CONCLUSIONS Cognitive recovery to the preoperative level after surgery is possible to a certain extent; however, the results are too arbitrary to draw definite conclusions and not all studies investigated all cognitive domains. More studies with longer postoperative follow-up with tests for cognitive change are necessary for a better understanding of the conclusive effects of glioma surgery on cognition.
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Affiliation(s)
- Djaina Satoer
- Department of Neurosurgery, Erasmus MC-University Medical Centre, Wytemaweg 80, Room EE220, 3015 GE, Rotterdam, The Netherlands.
- Centre for Language and Cognition Groningen (CLCG), University of Groningen, Groningen, The Netherlands.
| | - Evy Visch-Brink
- Department of Neurosurgery, Erasmus MC-University Medical Centre, Wytemaweg 80, Room EE220, 3015 GE, Rotterdam, The Netherlands
| | - Clemens Dirven
- Department of Neurosurgery, Erasmus MC-University Medical Centre, Wytemaweg 80, Room EE220, 3015 GE, Rotterdam, The Netherlands
| | - Arnaud Vincent
- Department of Neurosurgery, Erasmus MC-University Medical Centre, Wytemaweg 80, Room EE220, 3015 GE, Rotterdam, The Netherlands
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Triebel KL, Gerstenecker A, Meneses K, Fiveash JB, Meyers CA, Cutter G, Marson DC, Martin RC, Eakin A, Watts O, Nabors LB. Capacity of patients with brain metastases to make treatment decisions. Psychooncology 2015; 24:1448-55. [PMID: 25613039 PMCID: PMC4512930 DOI: 10.1002/pon.3753] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 11/21/2014] [Accepted: 12/18/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to investigate medical decision-making capacity (MDC) in patients with brain metastases. METHODS Participants were 41 adults with brain metastases with Karnofsky Performance Status scores of ≥70 who were recruited from an academic medical center and 41 demographically matched controls recruited from the community. We evaluated MDC using the Capacity to Consent to Treatment Instrument and its four clinically relevant consent standards (expressing a treatment choice, appreciation, reasoning, and understanding). Capacity impairment ratings (no impairment, mild/moderate impairment, and severe impairment) on the consent standards were also assigned to each participant with brain metastasis using cutoff scores derived statistically from the performance of the control group. RESULTS The brain metastasis patient group performed significantly below controls on consent standards of understanding and reasoning. Capacity compromise was defined as performance ≤1.5 standard deviations below the control group mean. Using this definition, approximately 60% of the participants with brain metastases demonstrated capacity compromise on at least one MDC standard. CONCLUSION When defining capacity compromise as performance ≤1.5 standard deviation below the control group mean, over half of patients with brain metastases have reduced capacity to make treatment decisions. This impairment is demonstrated shortly after initial diagnosis of brain metastases and highlights the importance of routine clinical assessment of MDC following diagnosis of brain metastasis. These results also indicate a need for the development and investigation of interventions to support or improve MDC in this patient population.
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Affiliation(s)
- Kristen L. Triebel
- Department of Neurology, UAB, Birmingham, AL
- Comprehensive Cancer Center, UAB, Birmingham, AL
| | | | - Karen Meneses
- Comprehensive Cancer Center, UAB, Birmingham, AL
- School of Nursing, UAB, Birmingham, AL
| | - John B. Fiveash
- Comprehensive Cancer Center, UAB, Birmingham, AL
- Department of Radiation Oncology, UAB, Birmingham, AL
| | - Christina A. Meyers
- Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, TX (retired)
| | - Gary Cutter
- Department of Biostatistics, School of Public Health, UAB, Birmingham, AL
| | | | | | | | - Olivia Watts
- Department of Psychology, Boston University, Boston, MA
| | - Louis B. Nabors
- Department of Neurology, UAB, Birmingham, AL
- Comprehensive Cancer Center, UAB, Birmingham, AL
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Management of Gliomas: Overview of the Latest Technological Advancements and Related Behavioral Drawbacks. Behav Neurol 2015; 2015:862634. [PMID: 26346755 PMCID: PMC4546744 DOI: 10.1155/2015/862634] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 07/26/2015] [Indexed: 01/22/2023] Open
Abstract
The advancements in basic sciences and the availability of sophisticated technological aids to surgical removal of gliomas have led over the last few years to the rise of innovative surgical strategies, the identification of better prognostic/predictive biomolecular factors, and the development of novel drugs and all are meant to profoundly impact the outcome of patients diagnosed with these aggressive tumours. Unfortunately, the treatment protocols available nowadays still confer only a small survival advantage at a potentially high cost in terms of overall well-being. In this review we identified the potential and limits of the most promising research trends in the management of glioma patients, also highlighting the related externalities. Finally, we focused our attention on the imbalance between the technical and behavioral aspects pertinent to this research area, which ultimately represent the two sides of the same coin.
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Lwin Z, Broom A, Cosman R, Livingstone A, Sawkins K, Good P, Kirby E, Koh ES, Hovey E. Culturally and linguistically diverse patient participation in glioma research. Neurooncol Pract 2014; 1:101-105. [PMID: 26034622 DOI: 10.1093/nop/npu009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Indexed: 11/14/2022] Open
Abstract
Marginal communities, such as culturally and linguistically diverse (CALD) patients, have significantly lower rates of recruitment, accrual, and retention in cancer clinical trials. A combination of language and cultural barriers means that trial participation from CALD communities remains at suboptimal levels, which in turn favors research findings that are biased towards therapeutic effects or toxicities within the context of non-CALD populations. Here we outline some key challenges and implications for CALD patient participation in glioma research in countries such as Australia, where English is the language of governance and health services implementation. We highlight multistakeholder interventions to improve both investigator recruitment and participation of CALD communities in future glioma research, particularly in this era when global migration has come of age. Enhancing research participation of CALD communities ensures not only wider understanding of genetic heterogeneity to improve glioma outcomes but also equity in access to care.
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Affiliation(s)
- Zarnie Lwin
- Department of Medical Oncology , Royal Brisbane and Women's Hospital, Brisbane, Australia (Z.L.); School of Social Science , University of Queensland, St. Lucia, Australia (A.B., E.K.); Cooperative Trials Group for Neuro-Oncology (COGNO) and NHMRC Clinical Trials Centre , University of Sydney, Sydney, Australia (R.C., A.L., K.S.,); Department of Palliative Care , Mater Health Services, South Brisbane, Australia (P.G.); Department of Radiation Oncology , Liverpool Hospital, Liverpool, Australia (E.-S.K.); University of New South Wales, Sydney, Australia (E.-S.K., E.H.); Department of Medical Oncology , Prince of Wales Hospital , Sydney, Australia (E.H.)
| | - Alexander Broom
- Department of Medical Oncology , Royal Brisbane and Women's Hospital, Brisbane, Australia (Z.L.); School of Social Science , University of Queensland, St. Lucia, Australia (A.B., E.K.); Cooperative Trials Group for Neuro-Oncology (COGNO) and NHMRC Clinical Trials Centre , University of Sydney, Sydney, Australia (R.C., A.L., K.S.,); Department of Palliative Care , Mater Health Services, South Brisbane, Australia (P.G.); Department of Radiation Oncology , Liverpool Hospital, Liverpool, Australia (E.-S.K.); University of New South Wales, Sydney, Australia (E.-S.K., E.H.); Department of Medical Oncology , Prince of Wales Hospital , Sydney, Australia (E.H.)
| | - Rasha Cosman
- Department of Medical Oncology , Royal Brisbane and Women's Hospital, Brisbane, Australia (Z.L.); School of Social Science , University of Queensland, St. Lucia, Australia (A.B., E.K.); Cooperative Trials Group for Neuro-Oncology (COGNO) and NHMRC Clinical Trials Centre , University of Sydney, Sydney, Australia (R.C., A.L., K.S.,); Department of Palliative Care , Mater Health Services, South Brisbane, Australia (P.G.); Department of Radiation Oncology , Liverpool Hospital, Liverpool, Australia (E.-S.K.); University of New South Wales, Sydney, Australia (E.-S.K., E.H.); Department of Medical Oncology , Prince of Wales Hospital , Sydney, Australia (E.H.)
| | - Ann Livingstone
- Department of Medical Oncology , Royal Brisbane and Women's Hospital, Brisbane, Australia (Z.L.); School of Social Science , University of Queensland, St. Lucia, Australia (A.B., E.K.); Cooperative Trials Group for Neuro-Oncology (COGNO) and NHMRC Clinical Trials Centre , University of Sydney, Sydney, Australia (R.C., A.L., K.S.,); Department of Palliative Care , Mater Health Services, South Brisbane, Australia (P.G.); Department of Radiation Oncology , Liverpool Hospital, Liverpool, Australia (E.-S.K.); University of New South Wales, Sydney, Australia (E.-S.K., E.H.); Department of Medical Oncology , Prince of Wales Hospital , Sydney, Australia (E.H.)
| | - Kate Sawkins
- Department of Medical Oncology , Royal Brisbane and Women's Hospital, Brisbane, Australia (Z.L.); School of Social Science , University of Queensland, St. Lucia, Australia (A.B., E.K.); Cooperative Trials Group for Neuro-Oncology (COGNO) and NHMRC Clinical Trials Centre , University of Sydney, Sydney, Australia (R.C., A.L., K.S.,); Department of Palliative Care , Mater Health Services, South Brisbane, Australia (P.G.); Department of Radiation Oncology , Liverpool Hospital, Liverpool, Australia (E.-S.K.); University of New South Wales, Sydney, Australia (E.-S.K., E.H.); Department of Medical Oncology , Prince of Wales Hospital , Sydney, Australia (E.H.)
| | - Phillip Good
- Department of Medical Oncology , Royal Brisbane and Women's Hospital, Brisbane, Australia (Z.L.); School of Social Science , University of Queensland, St. Lucia, Australia (A.B., E.K.); Cooperative Trials Group for Neuro-Oncology (COGNO) and NHMRC Clinical Trials Centre , University of Sydney, Sydney, Australia (R.C., A.L., K.S.,); Department of Palliative Care , Mater Health Services, South Brisbane, Australia (P.G.); Department of Radiation Oncology , Liverpool Hospital, Liverpool, Australia (E.-S.K.); University of New South Wales, Sydney, Australia (E.-S.K., E.H.); Department of Medical Oncology , Prince of Wales Hospital , Sydney, Australia (E.H.)
| | - Emma Kirby
- Department of Medical Oncology , Royal Brisbane and Women's Hospital, Brisbane, Australia (Z.L.); School of Social Science , University of Queensland, St. Lucia, Australia (A.B., E.K.); Cooperative Trials Group for Neuro-Oncology (COGNO) and NHMRC Clinical Trials Centre , University of Sydney, Sydney, Australia (R.C., A.L., K.S.,); Department of Palliative Care , Mater Health Services, South Brisbane, Australia (P.G.); Department of Radiation Oncology , Liverpool Hospital, Liverpool, Australia (E.-S.K.); University of New South Wales, Sydney, Australia (E.-S.K., E.H.); Department of Medical Oncology , Prince of Wales Hospital , Sydney, Australia (E.H.)
| | - Eng-Siew Koh
- Department of Medical Oncology , Royal Brisbane and Women's Hospital, Brisbane, Australia (Z.L.); School of Social Science , University of Queensland, St. Lucia, Australia (A.B., E.K.); Cooperative Trials Group for Neuro-Oncology (COGNO) and NHMRC Clinical Trials Centre , University of Sydney, Sydney, Australia (R.C., A.L., K.S.,); Department of Palliative Care , Mater Health Services, South Brisbane, Australia (P.G.); Department of Radiation Oncology , Liverpool Hospital, Liverpool, Australia (E.-S.K.); University of New South Wales, Sydney, Australia (E.-S.K., E.H.); Department of Medical Oncology , Prince of Wales Hospital , Sydney, Australia (E.H.)
| | - Elizabeth Hovey
- Department of Medical Oncology , Royal Brisbane and Women's Hospital, Brisbane, Australia (Z.L.); School of Social Science , University of Queensland, St. Lucia, Australia (A.B., E.K.); Cooperative Trials Group for Neuro-Oncology (COGNO) and NHMRC Clinical Trials Centre , University of Sydney, Sydney, Australia (R.C., A.L., K.S.,); Department of Palliative Care , Mater Health Services, South Brisbane, Australia (P.G.); Department of Radiation Oncology , Liverpool Hospital, Liverpool, Australia (E.-S.K.); University of New South Wales, Sydney, Australia (E.-S.K., E.H.); Department of Medical Oncology , Prince of Wales Hospital , Sydney, Australia (E.H.)
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Reinert C, Kremmler L, Burock S, Bogdahn U, Wick W, Gleiter CH, Koller M, Hau P. Quantitative and qualitative analysis of study-related patient information sheets in randomised neuro-oncology phase III-trials. Eur J Cancer 2013; 50:150-8. [PMID: 24103146 DOI: 10.1016/j.ejca.2013.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 08/07/2013] [Accepted: 09/08/2013] [Indexed: 11/13/2022]
Abstract
INTRODUCTION In randomised controlled trials (RCTs), patient informed consent documents are an essential cornerstone of the study flow. However, these documents are often oversized in format and content. Clinical experience suggests that study information sheets are often not used as an aid to decision-making due to their complexity. MATERIAL AND METHODS We analysed nine patient informed consent documents from clinical neuro-oncological phase III-studies running at a German Brain Tumour Centre with the objective to investigate the quality of these documents. Text length, formal layout, readability, application of ethical and legal requirements, scientific evidence and social aspects were used as rating categories. Results were assessed quantitatively by two independents investigators and were depicted using net diagrams. RESULTS All patient informed consent documents were of insufficient quality in all categories except that ethical and legal requirements were fulfilled. Notably, graduate levels were required to read and understand five of nine consent documents. DISCUSSION Quality deficits were consistent between the individual study information texts. Irrespective of formal aspects, a document that is intended to inform and motivate patients to participate in a study needs to be well-structured and understandable. We therefore strongly mandate to re-design patient informed consent documents in a patient-friendly way. Specifically, standardised components with a scientific foundation should be provided that could be retrieved at various times, adapted to the mode of treatment and the patient's knowledge, and could weigh information dependent of the stage of treatment decision.
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Affiliation(s)
- Christiane Reinert
- Department of Neurology and Wilhelm Sander NeuroOncology Unit, University Hospital Regensburg, Franz Josef Strauß-Allee 11, 93047 Regensburg, Germany
| | - Lukas Kremmler
- Department of Neurology and Wilhelm Sander NeuroOncology Unit, University Hospital Regensburg, Franz Josef Strauß-Allee 11, 93047 Regensburg, Germany
| | - Susen Burock
- EORTC Headquarters, Avenue E. Mounier 83/11, 1200 Brussels, Belgium
| | - Ulrich Bogdahn
- Department of Neurology and Wilhelm Sander NeuroOncology Unit, University Hospital Regensburg, Franz Josef Strauß-Allee 11, 93047 Regensburg, Germany
| | - Wolfgang Wick
- Division of Neuro Oncology, University of Heidelberg and National Center for Tumor Diseases, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Christoph H Gleiter
- CenTrial GmbH, University Hospital Tübingen, Paul-Ehrlich-Str. 5, 72076 Tübingen, Germany
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander NeuroOncology Unit, University Hospital Regensburg, Franz Josef Strauß-Allee 11, 93047 Regensburg, Germany.
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Cognitive impairment in primary brain tumors outpatients: a prospective cross-sectional survey. J Neurooncol 2013; 112:455-60. [DOI: 10.1007/s11060-013-1076-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 02/05/2013] [Indexed: 10/27/2022]
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Vangeest JB, Johnson TP. Using incentives in surveys of cancer patients: do "best practices" apply? Cancer Causes Control 2012; 23:2047-52. [PMID: 23076587 DOI: 10.1007/s10552-012-0082-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 10/05/2012] [Indexed: 11/27/2022]
Abstract
PURPOSE Surveys of cancer patients are an important means of collecting data necessary to improve cancer prevention and control. However, health surveys generally are characterized by declining response rates, with incentives often employed to encourage participation. While successful, magnitude of effect is partially dependent upon situational characteristics of respondents, including health status. Given the health challenges experienced by cancer patients, it is unclear to what extent incentives can improve survey participation. In this study, we examine the effectiveness of monetary and non-monetary incentives in improving response to cancer patient surveys. METHODS We reviewed the available experimental literature regarding efforts to improve response rates among cancer patients/survivors via incentives. Relevant studies were identified through searches of the MEDLINE, PubMed, and PsychINFO databases from 1975 to 2012. Seed sources (e.g., Cancer Causes & Control, Cancer Epidemiology, Biomarkers & Prevention, and BMC Medical Research Methodology) were also referenced extensively in order to establish a comprehensive set of studies. RESULTS Although limited, evidence does suggest that token incentives may be less effective for improving survey participation among cancer patients, relative to other population groups. These results are contrary to well-established evidence regarding the efficacy of incentives in improving survey participation generally. Potential reasons why incentives may be less effective in this population are explored. CONCLUSIONS While more research is necessary, results suggest that survey research strategies targeting cancer patients be purposively designed in a manner that gives consideration to the distress associated with the condition, including selection of alternative strategies to improve response.
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Affiliation(s)
- Jonathan B Vangeest
- College of Public Health, Kent State University, P.O. Box 5190, Kent, OH 44242-0001, USA.
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Kerrigan S, Dengu F, Erridge S, Grant R, Whittle I. Recognition of mental incapacity when consenting patients with intracranial tumours for surgery: how well are we doing? Br J Neurosurg 2011; 26:28-31. [DOI: 10.3109/02688697.2011.594187] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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