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Besle S, Schultz E, Hollebecque A, Varga A, Baldini C, Martin P, Postel-Vinay S, Bahleda R, Gazzah A, Michot JM, Marabelle A, Angevin E, Armand JP, Ribrag V, Soria JC, Massard C. Organisational factors influencing early clinical trials enrollment: Gustave Roussy experience. Eur J Cancer 2018; 98:17-22. [PMID: 29859337 DOI: 10.1016/j.ejca.2018.04.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE Enrolment process influences the likelihood of patients' inclusion in early clinical trials (ECT) through social, medical and organisational factors. PATIENTS AND METHODS All patients referred from 2008 to 2016 to the Drug Development Department (DITEP) of Gustave Roussy (GR) were reviewed. Referring physician, organisational factors, medical and socioeconomic characteristics for patients were analysed. Multivariate analysis was performed with regard to those factors. A telephone survey was conducted on a sample of referring physicians located outside GR (N = 142). RESULTS Between 2008 and 2016, 8694 requests were received with 49% from external physicians. Here, 4517 were male patients with a median age of 58 [49-66] years (range 18-85). Tumour types were gastrointestinal (28%), lung (19%), breast (9%) and gynaecologic (8%). Mean enrolment rate was 37% (ranging from 24 to 45%). From 2008 to 2016, the enrolment rate decreases from 39% to 24%. In the meantime, DITEP trials portfolio evolves with the part of precision medicine trials increase from 12% to 40%. Factors that were significantly associated with a lower likelihood of being enrolled were referral from an external physician (OR 0.15 s.16-0.21]) compared to a physician from DITEP and year of the request (2.74 [1.8-2.9] 2008 versus 2016). The enrolment rate and the number of patients addressed have a high variability regarding referring physicians, which is little explained by characteristics as training, previous experience or attitude regarding ECT. CONCLUSION Beyond patients' individual characteristics, we show that organisational and professional factors have a major impact on likelihood of enrolment in ECT.
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Affiliation(s)
- Sylvain Besle
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France; Aix Marseille Univ, INSERM, IRD, SESSTIM, 232 Bd Ste Marguerite BP 156 13273 Marseille Cedex 9 France.
| | - Emilien Schultz
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France; Aix Marseille Univ, INSERM, IRD, SESSTIM, 232 Bd Ste Marguerite BP 156 13273 Marseille Cedex 9 France
| | - Antoine Hollebecque
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Andreea Varga
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Capucine Baldini
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Patricia Martin
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Sophie Postel-Vinay
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Rastislav Bahleda
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Anas Gazzah
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Jean-Marie Michot
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Aurélien Marabelle
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Eric Angevin
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Jean-Pierre Armand
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Vincent Ribrag
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Jean-Charles Soria
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Christophe Massard
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
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Cain CL, Surbone A, Elk R, Kagawa-Singer M. Culture and Palliative Care: Preferences, Communication, Meaning, and Mutual Decision Making. J Pain Symptom Manage 2018; 55:1408-1419. [PMID: 29366913 DOI: 10.1016/j.jpainsymman.2018.01.007] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 01/11/2023]
Abstract
Palliative care is gaining acceptance across the world. However, even when palliative care resources exist, both the delivery and distribution of services too often are neither equitably nor acceptably provided to diverse population groups. The goal of this study was to illustrate tensions in the delivery of palliative care for diverse patient populations to help clinicians to improve care for all. We begin by defining and differentiating culture, race, and ethnicity, so that these terms-often used interchangeably-are not conflated and are more effectively used in caring for diverse populations. We then present examples from an integrative literature review of recent research on culture and palliative care to illustrate both how and why varied responses to pain and suffering occur in different patterns, focusing on four areas of palliative care: the formation of care preferences, communication patterns, different meanings of suffering, and decision-making processes about care. For each area, we provide international and multiethnic examples of variations that emphasize the need for personalization of care and the avoidance of stereotyping beliefs and practices without considering individual circumstances and life histories. We conclude with recommendations for improving palliative care research and practice with cultural perspectives, emphasizing the need to work in partnerships with patients, their family members, and communities to identify and negotiate culturally meaningful care, promote quality of life, and ensure the highest quality palliative care for all, both domestically and internationally.
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Affiliation(s)
- Cindy L Cain
- Department of Health Policy and Management, University of California-Los Angeles, Los Angeles, California.
| | - Antonella Surbone
- Department of Medicine, Division of Haematology and Medical Oncology, New York University Medical School, New York, New York
| | - Ronit Elk
- College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Marjorie Kagawa-Singer
- Department of Community Health Sciences and Asian American Studies Center, University of California-Los Angeles, Los Angeles, California
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3
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Hagan TL, Cohen SM, Rosenzweig MQ, Zorn K, Stone CA, Donovan HS. The Female Self-Advocacy in Cancer Survivorship Scale: A validation study. J Adv Nurs 2017; 74:976-987. [PMID: 29117439 DOI: 10.1111/jan.13498] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2017] [Indexed: 11/28/2022]
Abstract
AIM To develop and psychometrically test the validity of the Female Self-Advocacy in Cancer Survivorship Scale. BACKGROUND Female cancer survivors need to self-advocate to overcome challenges associated with cancer yet no valid measure of self-advocacy exists. DESIGN Instrument development. Mixed-mode cross-sectional survey design. PARTICIPANTS We recruited adult females (18+ years; N = 317) with a history of invasive cancer from local and national tumour registries and advocacy organizations to complete online or paper questionnaires. METHODS Between July 2014 - March 2015 to evaluate the construct validity based on evidence of the scale's: (1) internal structure consistent with the underlying model of self-advocacy; (2) sensitivity to differences between groups known to differ in self-advocacy skills; (3) relationships between self-advocacy and key potential predictors (openness and conscientiousness; information engagement; social support) and outcomes (symptom burden and healthcare utilization); (4) relationships between self-advocacy and related concepts (patient activation; self-advocacy within another patient population); and (5) relationships between self-advocacy and criterion measures. Analyses included an exploratory factor analysis, t tests, and bivariate correlations using validated, reliable measures for constructs. RESULTS Evidence from all five hypotheses supported the construct validity of the Female Self-Advocacy in Cancer Survivorship Scale. The factor analysis confirmed the three underlying dimensions of self-advocacy resulting in a 20-item measure with strong internal consistency that explained almost half of response variance. CONCLUSION The Female Self-Advocacy in Cancer Survivorship Scale is a valid, reliable measure of how well adult female cancer survivors can get their needs met in the face of adversity.
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Affiliation(s)
- Teresa L Hagan
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Susan M Cohen
- Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Margaret Q Rosenzweig
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Kristin Zorn
- Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Clement A Stone
- Department of Psychology in Education, University of Pittsburgh School of Education, Pittsburgh, PA, USA
| | - Heidi S Donovan
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
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You J, Lu Q, Zvolensky MJ, Meng Z, Garcia K, Cohen L. Anxiety- and Health-Related Quality of Life Among Patients With Breast Cancer: A Cross-Cultural Comparison of China and the United States. J Glob Oncol 2017; 4:1-9. [PMID: 30241191 PMCID: PMC6180812 DOI: 10.1200/jgo.2016.008763] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose Literature has documented the prevalence of anxiety and its adverse effect on
quality of life among patients with breast cancer from Western countries,
yet cross-cultural examinations with non-Western patients are rare. This
cross-cultural study investigated differences in anxiety and its association
with quality of life between US and Chinese patients with breast cancer. Methods Patients with breast cancer from the United States and China completed
measures for anxiety (Spielberger State-Trait Anxiety Inventory) and quality
of life (Functional Assessment of Cancer Therapy-Breast). Results After controlling for demographic and medical characteristics, Chinese
patients reported higher levels of trait and state anxiety than US patients.
Although there was an association between anxiety and quality of life in
both groups of patients, the association between state anxiety and quality
of life was stronger among Chinese patients than among US patients, with the
association between trait anxiety and quality of life the same between the
two cultural samples. Conclusion These findings suggest that anxiety and its association with quality of life
among patients with breast cancer varies depending on cultural context,
which reveals greater anxiety and poorer quality of life among Chinese
patients compared with US patients. This suggests greater unmet psychosocial
needs among Chinese patients and highlights the need to build comprehensive
cancer care systems for a better quality of life in Chinese populations.
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Affiliation(s)
- Jin You
- Jin You, Wuhan University, Wuhan; Zhiqiang Meng, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Qian Lu and Michael J. Zvolensky, University of Houston; and Kay Garcia and Lorenzo Cohen, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Qian Lu
- Jin You, Wuhan University, Wuhan; Zhiqiang Meng, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Qian Lu and Michael J. Zvolensky, University of Houston; and Kay Garcia and Lorenzo Cohen, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael J Zvolensky
- Jin You, Wuhan University, Wuhan; Zhiqiang Meng, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Qian Lu and Michael J. Zvolensky, University of Houston; and Kay Garcia and Lorenzo Cohen, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Zhiqiang Meng
- Jin You, Wuhan University, Wuhan; Zhiqiang Meng, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Qian Lu and Michael J. Zvolensky, University of Houston; and Kay Garcia and Lorenzo Cohen, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kay Garcia
- Jin You, Wuhan University, Wuhan; Zhiqiang Meng, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Qian Lu and Michael J. Zvolensky, University of Houston; and Kay Garcia and Lorenzo Cohen, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lorenzo Cohen
- Jin You, Wuhan University, Wuhan; Zhiqiang Meng, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Qian Lu and Michael J. Zvolensky, University of Houston; and Kay Garcia and Lorenzo Cohen, The University of Texas MD Anderson Cancer Center, Houston, TX
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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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