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Walls GM, Mistry H, Barlesi F, Bezjak A, Pechoux CL, O'Brien M, Van Meerbeeck JP, Blackhall F, Faivre-Finn C. Long-Term Outcomes After Concurrent Once- or Twice-Daily Chemoradiation in Limited-Stage Small Cell Lung Cancer: A Brief Report From the CONVERT Trial. Int J Radiat Oncol Biol Phys 2024; 119:1386-1390. [PMID: 38521132 DOI: 10.1016/j.ijrobp.2024.02.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/24/2024] [Accepted: 02/08/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE CONVERT was a phase 3 international randomized clinical trial comparing once-daily (OD) and twice-daily (BD) radiation therapy (RT). This updated analysis describes the 6.5-year outcomes of these regimens delivered with conformal techniques. METHODS AND MATERIALS CONVERT (NCT00433563) randomized patients 1:1 between OD RT (66 Gy/33 fractions/6.5 weeks) and BD RT (45 Gy/30 fractions/3 weeks), both delivered with concurrent cisplatin/etoposide. Three-dimensional conformal RT was mandatory, intensity-modulated RT was permitted, and elective nodal irradiation was not allowed. Prophylactic cranial irradiation was delivered at the discretion of treating clinicians. RT treatment planning was subject to central quality assurance. RESULTS Five hundred forty-seven patients were recruited at 73 centers. The median follow-up for the surviving cohort (n = 164) was 81.2 months. The median survival for the OD and BD arms were 25.4 months (95% CI, 21.1-30.9) and 30.0 months (95% CI, 25.3-36.5; hazard ratio, 1.13; 95% CI, 0.92-1.38; P = .247). Performance status and tumor volume were associated with survival on multivariate analysis. No treatment-related deaths occurred subsequent to the initial analysis performed in 2017. Regarding late toxicity, 7 patients in the OD arm developed grade 3 esophagitis, 4 of which went on to develop stricture or fistulation, compared with no patients in the BD arm. Grade 3 pulmonary fibrosis occurred in 2 and 3 patients in the OD and BD arms, respectively. CONCLUSIONS As the CONVERT trial did not demonstrate the superiority of OD RT and this regimen had a slightly worse toxicity profile after 80 months of follow-up, 45 Gy BD should remain the standard of care in limited stage small cell lung cancer.
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Affiliation(s)
- Gerard M Walls
- Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom; Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom.
| | - Hitesh Mistry
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Fabrice Barlesi
- Multidisciplinary Oncology & Therapeutic Innovations Department, Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Marseille, France; Paris Saclay University, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Andrea Bezjak
- Canadian Cancer Trials Group, Princess Margaret Cancer Center, Toronto, Canada
| | | | - Mary O'Brien
- Department of Medicine, Royal Marsden NHS Foundation Trust, Surrey, United Kingdom
| | | | - Fiona Blackhall
- Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Molecular and Clinical Cancer Sciences, University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Molecular and Clinical Cancer Sciences, University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom
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Jung W, Ahn A, Lee G, Kong S, Kang D, Lee D, Kim TE, Shim YM, Kim HK, Cho J, Cho J, Shin DW. Supporting Life Adjustment in Patients With Lung Cancer Through a Comprehensive Care Program: Protocol for a Controlled Before-and-After Trial. JMIR Res Protoc 2024; 13:e54707. [PMID: 38349712 PMCID: PMC10900087 DOI: 10.2196/54707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Lung cancer diagnosis affects an individual's quality of life as well as physical and emotional functioning. Information on survivorship care tends to be introduced at the end of treatment, but early intervention may affect posttreatment adjustment. However, to the best of our knowledge, no study has explored the effect of early information intervention on the return to work, family, and societal roles of lung cancer survivors. OBJECTIVE We report the study protocol of a comprehensive care prehabilitation intervention designed to facilitate lung cancer survivors' psychological adjustment after treatment. METHODS A comprehensive care program was developed based on a literature review and a qualitative study of patients with lung cancer and health professionals. The Lung Cancer Comprehensive Care Program consists of educational videos and follow-up visits by a family medicine physician. To prevent contamination, the control group received routine education, whereas the intervention group received routine care and intervention. Both groups completed questionnaires before surgery (T0) and at 1-month (T1), 6-month (T2), and 1-year (T3) follow-up visits after surgery. The primary outcome was survivors' psychological adjustment to cancer 6 months after pulmonary resection. RESULTS The historical control group (n=441) was recruited from September 8, 2021, to April 20, 2022, and the intervention group (n=350) was recruited from April 22, 2022, to October 17, 2022. All statistical analyses will be performed upon completion of the study. CONCLUSIONS This study examined the effectiveness of an intervention that provided general and tailored informational support to lung cancer survivors, ranging from before to the end of treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT05078918; https://clinicaltrials.gov/ct2/show/NCT05078918. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54707.
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Affiliation(s)
- Wonyoung Jung
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Alice Ahn
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, Republic of Korea
- Department of Psychology and Philosophy, Sam Houston State University, Huntsville, TX, United States
| | - Genehee Lee
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Sunga Kong
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Danbee Kang
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
| | - Dongok Lee
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Tae Eun Kim
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jongho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Juhee Cho
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Torreggiani M, Maselli D, Costi S, Guberti M. Models of Care in Providing Comprehensive Healthcare on Cancer Survivors: A Scoping Review with a TIDieR Checklist Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:122. [PMID: 38397613 PMCID: PMC10888265 DOI: 10.3390/ijerph21020122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND The study's aim is to identify the models of care used to provide survivorship care plans (SCPs) to cancer survivors in healthcare services, describing what kind of professionals are involved, in which settings and timings, and their feasibility. METHODS The Joanna Briggs Institute methodology for scoping reviews is followed. Studies that considered the SCPs applying different models of care, in any healthcare setting on any adult cancer survivors who completed oncological treatments, have been included. Pubmed, Embase, Cochrane Library, Scopus, and Cinahal were searched from 2013 to 2023 with these keywords: "Survivorship Care Plan", "Oncology", and "Program". The study selection process was reported with the PRISMA-ScR. A total of 325 records were identified, 42 were screened, and, ultimately, 23 articles were included. RESULTS The models of care include: SCP standardization in hospitals; self-support oriented; consultation-based; primary or specialist direct referral; shared care; a multimodal approach. Multidisciplinary teams were involved in the SCP models of care. The settings were private clinics or cancer centers. One-hour SCP interventions were most frequently delivered through in-person visits, by telephone, or online. CONCLUSIONS Implementing SCPs is feasible in healthcare contexts, but with challenges, like time and resource management. Patient-centered programs promoting coordinated care are promising models of care.
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Affiliation(s)
- Martina Torreggiani
- Health Professions Department, Azienda USL-IRCCS of Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Deborah Maselli
- International Doctorate School in Clinical and Experimental Medicine, Università degli Studi di Modena e Reggio Emilia, 41125 Reggio Emilia, Italy;
| | - Stefania Costi
- Physical Medicine and Rehabilitation Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Monica Guberti
- Research and EBP Unit, Health Professions Department, Azienda USL-IRCCS of Reggio Emilia, 42123 Reggio Emilia, Italy;
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Hasson RM, Bridges CJ, Curley RJ, Erhunmwunsee L. Access to Lung Cancer Screening. Thorac Surg Clin 2023; 33:353-363. [PMID: 37806738 DOI: 10.1016/j.thorsurg.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Rural and racial/ethnic minority communities experience higher risk and mortality from lung cancer. Lung cancer screening with low-dose computed tomography reduces mortality. However, disparities persist in the uptake of lung cancer screening, especially in marginalized communities. Barriers to lung cancer screening are multilevel and include patient, provider, and system-level barriers. This discussion highlights the key barriers faced by rural and racial/ethnic minority communities.
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Affiliation(s)
- Rian M Hasson
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA; The Geisel School of Medicine at Dartmouth, 1 Rope Ferry Rd, Hanover, NH 03755, USA; The Dartmouth Institute of Health Policy and Clinical Practice, Williamson Translational Research Building, Level 51 Medical Center Drive Lebanon, NH 03756, USA
| | - Connor J Bridges
- The Geisel School of Medicine at Dartmouth, 1 Rope Ferry Rd, Hanover, NH 03755, USA
| | - Richard J Curley
- Department of Surgery, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Loretta Erhunmwunsee
- Department of Surgery, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, USA; Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, 91010, USA.
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Merlo A, Carlson R, Espey J, Williams BM, Balakrishnan P, Chen S, Dawson L, Johnson D, Brickey J, Pompili C, Mody GN. Postoperative Symptom Burden in Patients Undergoing Lung Cancer Surgery. J Pain Symptom Manage 2022; 64:254-267. [PMID: 35659636 PMCID: PMC10744975 DOI: 10.1016/j.jpainsymman.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/15/2022] [Accepted: 05/24/2022] [Indexed: 11/20/2022]
Abstract
CONTEXT Previous studies on quality of life (QOL) after lung cancer surgery have identified a long duration of symptoms postoperatively. We first performed a systematic review of QOL in patients undergoing surgery for lung cancer. A subgroup analysis was conducted focusing on symptom burden and its relationship with QOL. OBJECTIVE To perform a qualitative review of articles addressing symptom burden in patients undergoing surgical resection for lung cancer. METHODS The parent systematic review utilized search terms for symptoms, functional status, and well-being as well as instruments commonly used to evaluate global QOL and symptom experiences after lung cancer surgery. The articles examining symptom burden (n = 54) were analyzed through thematic analysis of their findings and graded according to the Oxford Centre for Evidence-based Medicine rating scale. RESULTS The publication rate of studies assessing symptom burden in patients undergoing surgery for lung cancer have increased over time. The level of evidence quality was 2 or 3 for 14 articles (cohort study or case control) and level of 4 in the remaining 40 articles (case series). The most common QOL instruments used were the Short Form 36 and 12, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire, and the Hospital Anxiety and Depression Score. Thematic analysis revealed several key findings: 1) lung cancer surgery patients have a high symptom burden both before and after surgery; 2) pain, dyspnea, cough, fatigue, depression, and anxiety are the most commonly studied symptoms; 3) the presence of symptoms prior to surgery is an important risk factor for higher acuity of symptoms and persistence after surgery; and 4) symptom burden is a predictor of postoperative QOL. CONCLUSION Lung cancer patients undergoing surgery carry a high symptom burden which impacts their QOL. Measurement approaches use myriad and heterogenous instruments. More research is needed to standardize symptom burden measurement and management, with the goal to improve patient experience and overall outcomes.
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Affiliation(s)
- Aurelie Merlo
- Department of Surgery (A.M., J.E., B.M.W., G.N.M.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rebecca Carlson
- University Libraries (R.C.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John Espey
- Department of Surgery (A.M., J.E., B.M.W., G.N.M.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brittney M Williams
- Department of Surgery (A.M., J.E., B.M.W., G.N.M.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Sarah Chen
- Department of Surgery (S.C.), Medical University of South Carolina, South Carolina, USA
| | - Lauren Dawson
- University of North Carolina at Chapel Hill School of Medicine (L.D., D.J., J.B.), Chapel Hill, North Carolina, USA
| | - Daniel Johnson
- University of North Carolina at Chapel Hill School of Medicine (L.D., D.J., J.B.), Chapel Hill, North Carolina, USA
| | - Julia Brickey
- University of North Carolina at Chapel Hill School of Medicine (L.D., D.J., J.B.), Chapel Hill, North Carolina, USA
| | - Cecilia Pompili
- Section of Patient Centred Outcomes Research (C.P.), Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK
| | - Gita N Mody
- Department of Surgery (A.M., J.E., B.M.W., G.N.M.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Lineberger Comprehensive Cancer Center (G.N.M.), University of North Carolina, Chapel Hill, North Carolina, USA.
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Swisher AK, Kennedy-Rea S, Starkey A, Duckworth A, Burkart M, Graebe G, Harper R, Yanosik MA, Hudson A. Bridging the gap: identifying and meeting the needs of lung cancer survivors. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01332-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Electronic patient-reported outcomes monitoring during lung cancer chemotherapy: A nested cohort within the PRO-TECT pragmatic trial (AFT-39). Lung Cancer 2021; 162:1-8. [PMID: 34634754 DOI: 10.1016/j.lungcan.2021.09.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/03/2021] [Accepted: 09/25/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Patients with lung cancer have high symptom burden and diminished quality of life. Electronic patient-reported outcome (PRO) platforms deliver repeated longitudinal surveys via web or telephone to patients and alert clinicians about concerning symptoms. This study aims to determine feasibility of electronic PRO monitoring in lung cancer patients receiving treatment in community settings. METHODS Adults receiving treatment for advanced or metastatic lung cancer at 26 community sites were invited to participate in a prospective trial of weekly electronic PRO symptom monitoring for 12 months (NCT03249090). Surveys assessing patients' satisfaction with the electronic PRO system were administered at 3 months. Descriptive statistics were generated for demographics, survey completion rates, symptom occurrence, and provider PRO alert management approaches. Pairwise relationships between symptom items were evaluated using intra-individual repeated-measures correlation coefficients. RESULTS Lung cancer patients (n = 118) participating in electronic PROs were older (mean 64.4 vs 61.9 years, p = 0.03), had worse performance status (p = 0.002), more comorbidities (p = 0.02), and less technology experience than patients with other cancers. Of delivered weekly PRO surveys over 12 months, 91% were completed. Nearly all (97%) patients reported concerning (i.e., severe or worsening) symptoms during participation, with 33% of surveys including concerning symptoms. Pain was the most frequent and longest lasting symptom and was associated with reduced activity level. More than half of alerts to clinicians for concerning symptoms led to intervention. The majority (87%) would recommend using electronic PRO monitoring to other lung cancer patients. CONCLUSIONS Remote longitudinal weekly monitoring of patients with lung cancer using validated electronic PRO surveys was feasible in a multicenter, community-based pragmatic study. A high symptom burden specific to lung cancer was detected and clinician outreach in response to alerts was frequent, suggesting electronic PROs may be a beneficial strategy for identifying actionable symptoms and allow opportunities to optimize well-being in this population.
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Developing a survivorship care plan (SCP) delivery process for patients and primary care providers serving poor, rural, and minority patients with cancer. Support Care Cancer 2021; 29:5021-5028. [PMID: 33587174 PMCID: PMC7883333 DOI: 10.1007/s00520-021-06043-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/03/2021] [Indexed: 11/29/2022]
Abstract
Background Survivorship care plans (SCPs) summarize patients’ treatment and act as an education and communication tool between oncologists and primary care providers (PCPs). But creation and delivery of SCPs are challenging, labor intensive, and costly. The University of New Mexico Comprehensive Cancer Center (UNM CCC) treats a poor, rural, and minority patient population, and our purpose was to implement and evaluate a process to create and deliver SCPs to patients and PCPs. Methods Providers placed an electronic SCP order, basic information was imported, and staff compiled treatment details. Flagged SCPs were then ready for delivery, providers approved of and delivered the SCP at the next encounter, and the SCP was sent to the PCP. Results By April 2020, 283 SCPs were ordered, 241 (85.2%) were created by the designated staff, and 97 (34.2%) were given to patients after definitive therapy for breast cancer (59.1%), gynecological cancers (10.8%), prostate cancer (7.4%), colorectal cancer (5.1%), and lymphomas (4.8%). Of 97 SCPs eligible to be sent to PCPs, 75 (77.3%) were mailed or sent via EMR. Of the 41 (48.9%) SCPs sent via mail or fax, only 8 (8.3%) were received and 5 (5.2%) integrated. Conclusions This study shows that SCPs can be delivered to patients in a poor, rural, and minority patient population but that PCP receipt and integration of SCPs are poor. Future efforts need to ensure that an oncologist to PCP education and communication tool is able reach and be integrated by PCPs.
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Shen C, Li J, Li P, Che G. [Evaluation Index of Enhanced Recovery After Surgery: Status and Progress of Patient Report Outcomes in Thoracic Surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:161-166. [PMID: 30909996 PMCID: PMC6441120 DOI: 10.3779/j.issn.1009-3419.2019.03.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
加速康复外科临床应用的良好效果体现在降低围手术期并发症的发生率并缩短住院时间,但对围术期的患者症状管理及术后患者生活质量的关注不够高。从患者报告的资料角度评估临床疗效越来越受到重视。结合目前国内外关于病人报告结局的研究成果,本文系统论述了病人报告结局的概念内涵、研究意义及在胸外科的临床应用现状,提出借鉴国外病人报告的临床结局研究模式,开展有中国特色的结合学科特点的相关研究,并对已有的文献报告进行总结及分析。
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Affiliation(s)
- Cheng Shen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jue Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Pengfei Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Peach MS, Trifiletti DM, Vachani C, Arnold-Korzeniowski K, Bach C, Hampshire M, Metz JM, Hill-Kayser CE. Patient-reported outcomes in head and neck cancer: prospective multi-institutional patient-reported toxicity. PATIENT-RELATED OUTCOME MEASURES 2018; 9:245-252. [PMID: 30100773 PMCID: PMC6067627 DOI: 10.2147/prom.s153919] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose Head and neck cancer is occurring in an increasingly younger patient population, with treatment toxicity that can cause significant morbidity. Using a patient guided, Internet-based survivorship care plan program, we obtained and looked at patterns of patient-reported outcomes data from survivors seeking information after treatment for head and neck cancer. Methods The Internet-based OncoLife and LIVESTRONG Care Plan programs were employed, which design unique survivorship care plans based on patient-reported data. Care plans created for survivors of head and neck cancer were used in this evaluation. Demographics, treatment modality, and toxicity were included in this evaluation. Toxicity was further analyzed, grouped into system-based subsets. Results A total of 602 care plans were created from self-identified head and neck cancer survivors, from which patient-reported outcome data were attained. A majority of patients were Caucasian (96.2%) with median age at diagnosis of 55 years, living in suburban locations (39.9%), with ~50% receiving care within 20 miles of their residence. There was an equal distribution of education levels from high school only to graduate school. The majority of patients received care through cancer centers (96.7%), with a split between academic and non-academic centers. Ninety-three percent of patients had radiation therapy as part of their treatment modality, with 70.3% having chemotherapy and 60.1% having surgery. The most common system toxicities affected the oropharynx, followed by epithelium (skin/hair/nail), and then general global health. Specifically, the most common side effects were difficulty swallowing (61.5%) and changes in skin color/texture (49.7%). One third of patients experienced hearing/tinnitus/vertigo, xerostomia, loss of tissue flexibility, or fatigue. Conclusion The current work demonstrates the ability to obtain patient-reported outcomes of head and neck cancer survivors through an Internet-based survivorship care plan program. For this group dysphagia and dermatitis were the most commonly reported toxicities, as was expected; however, global effects of therapy, such as fatigue, were also significant and should be addressed in future survivorship planning.
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Affiliation(s)
- M Sean Peach
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA
| | | | - Carolyn Vachani
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA,
| | | | - Christina Bach
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA,
| | - Margaret Hampshire
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA,
| | - James M Metz
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA,
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Jacobsen PB, DeRosa AP, Henderson TO, Mayer DK, Moskowitz CS, Paskett ED, Rowland JH. Systematic Review of the Impact of Cancer Survivorship Care Plans on Health Outcomes and Health Care Delivery. J Clin Oncol 2018; 36:2088-2100. [PMID: 29775389 PMCID: PMC6036622 DOI: 10.1200/jco.2018.77.7482] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose Numerous organizations recommend that patients with cancer receive a survivorship care plan (SCP) comprising a treatment summary and follow-up care plans. Among current barriers to implementation are providers' concerns about the strength of evidence that SCPs improve outcomes. This systematic review evaluates whether delivery of SCPs has a positive impact on health outcomes and health care delivery for cancer survivors. Methods Randomized and nonrandomized studies evaluating patient-reported outcomes, health care use, and disease outcomes after delivery of SCPs were identified by searching MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library. Data extracted by independent raters were summarized on the basis of qualitative synthesis. Results Eleven nonrandomized and 13 randomized studies met inclusion criteria. Variability was evident across studies in cancer types, SCP delivery timing and method, SCP recipients and content, SCP-related counseling, and outcomes assessed. Nonrandomized study findings yielded descriptive information on satisfaction with care and reactions to SCPs. Randomized study findings were generally negative for the most commonly assessed outcomes (ie, physical, functional, and psychological well-being); findings were positive in single studies for other outcomes, including amount of information received, satisfaction with care, and physician implementation of recommended care. Conclusion Existing research provides little evidence that SCPs improve health outcomes and health care delivery. Possible explanations include heterogeneity in study designs and the low likelihood that SCP delivery alone would influence distal outcomes. Findings are limited but more positive for proximal outcomes (eg, information received) and for care delivery, particularly when SCPs are accompanied by counseling to prepare survivors for future clinical encounters. Recommendations for future research include focusing to a greater extent on evaluating ways to ensure SCP recommendations are subsequently acted on as part of ongoing care.
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Affiliation(s)
- Paul B. Jacobsen
- Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; Antonio P. DeRosa, Weill Cornell Medicine; Chaya S. Moskowitz, Memorial Sloan-Kettering Cancer Center, New York, NY; Tara O. Henderson, Pritzker School of Medicine, University of Chicago, Chicago, IL; Deborah K. Mayer, University of North Carolina at Chapel Hill, Chapel Hill, NC; Electra D. Paskett, The Ohio State University, Columbus, OH; and Julia H. Rowland, Smith Center for Healing and the Arts, Washington, DC
| | - Antonio P. DeRosa
- Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; Antonio P. DeRosa, Weill Cornell Medicine; Chaya S. Moskowitz, Memorial Sloan-Kettering Cancer Center, New York, NY; Tara O. Henderson, Pritzker School of Medicine, University of Chicago, Chicago, IL; Deborah K. Mayer, University of North Carolina at Chapel Hill, Chapel Hill, NC; Electra D. Paskett, The Ohio State University, Columbus, OH; and Julia H. Rowland, Smith Center for Healing and the Arts, Washington, DC
| | - Tara O. Henderson
- Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; Antonio P. DeRosa, Weill Cornell Medicine; Chaya S. Moskowitz, Memorial Sloan-Kettering Cancer Center, New York, NY; Tara O. Henderson, Pritzker School of Medicine, University of Chicago, Chicago, IL; Deborah K. Mayer, University of North Carolina at Chapel Hill, Chapel Hill, NC; Electra D. Paskett, The Ohio State University, Columbus, OH; and Julia H. Rowland, Smith Center for Healing and the Arts, Washington, DC
| | - Deborah K. Mayer
- Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; Antonio P. DeRosa, Weill Cornell Medicine; Chaya S. Moskowitz, Memorial Sloan-Kettering Cancer Center, New York, NY; Tara O. Henderson, Pritzker School of Medicine, University of Chicago, Chicago, IL; Deborah K. Mayer, University of North Carolina at Chapel Hill, Chapel Hill, NC; Electra D. Paskett, The Ohio State University, Columbus, OH; and Julia H. Rowland, Smith Center for Healing and the Arts, Washington, DC
| | - Chaya S. Moskowitz
- Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; Antonio P. DeRosa, Weill Cornell Medicine; Chaya S. Moskowitz, Memorial Sloan-Kettering Cancer Center, New York, NY; Tara O. Henderson, Pritzker School of Medicine, University of Chicago, Chicago, IL; Deborah K. Mayer, University of North Carolina at Chapel Hill, Chapel Hill, NC; Electra D. Paskett, The Ohio State University, Columbus, OH; and Julia H. Rowland, Smith Center for Healing and the Arts, Washington, DC
| | - Electra D. Paskett
- Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; Antonio P. DeRosa, Weill Cornell Medicine; Chaya S. Moskowitz, Memorial Sloan-Kettering Cancer Center, New York, NY; Tara O. Henderson, Pritzker School of Medicine, University of Chicago, Chicago, IL; Deborah K. Mayer, University of North Carolina at Chapel Hill, Chapel Hill, NC; Electra D. Paskett, The Ohio State University, Columbus, OH; and Julia H. Rowland, Smith Center for Healing and the Arts, Washington, DC
| | - Julia H. Rowland
- Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; Antonio P. DeRosa, Weill Cornell Medicine; Chaya S. Moskowitz, Memorial Sloan-Kettering Cancer Center, New York, NY; Tara O. Henderson, Pritzker School of Medicine, University of Chicago, Chicago, IL; Deborah K. Mayer, University of North Carolina at Chapel Hill, Chapel Hill, NC; Electra D. Paskett, The Ohio State University, Columbus, OH; and Julia H. Rowland, Smith Center for Healing and the Arts, Washington, DC
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Frick MA, Vachani CC, Hampshire MK, Bach C, Arnold-Korzeniowski K, Metz JM, Hill-Kayser CE. Survivorship after treatment of pancreatic cancer: insights via an Internet-based survivorship care plan tool. J Gastrointest Oncol 2017; 8:890-896. [PMID: 29184694 DOI: 10.21037/jgo.2017.08.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Pancreatic cancer survivors face a unique set of challenges in survivorship, yet structured survivorship care planning is lacking in practice. Survivorship care plans (SCPs) are an essential part of quality cancer care and can facilitate the transition following active treatment; the use of SCPs in pancreatic cancer survivors, however, has not been explored. With a convenience sample of 117 pancreatic cancer survivors and proxies who used an Internet-based SCP tool, we examined treatment details, patient-reported outcomes, and survivorship practices. Thirty-one percent of survivors were 2 years or greater from diagnosis with a median current age of 62 years. Most patients had received multimodality therapy (67%): 68%, 86%, and 43% reported surgical intervention, intravenous chemotherapy, and radiation therapy for their pancreatic cancer, respectively. Survivors commonly reported fatigue, cognitive change, neuropathy, pancreatic insufficiency, and chronic radiation dermatitis related to treatment. Most survivors are managed (47%) or co-managed (35%) by an oncology specialist; however, this percentage decreases over time with consequent increase in management by primary care providers alone. Only 5% had previously been offered an SCP. Of the 24 users who responded to a follow-up satisfaction survey, 83% indicated they would share the SCP with their healthcare team although half of respondents felt it should include more information. In all, our results demonstrate that there is a population of pancreatic cancer survivors who exist and seek survivorship support although structured survivorship care planning is lacking in practice. SCPs have a potentially valuable role for these survivors via communication of treatment-related effects and coordination across multidisciplinary healthcare teams. Further development and evaluation of SCPs is needed for this underserved survivor population.
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Affiliation(s)
- Melissa A Frick
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Carolyn C Vachani
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Margaret K Hampshire
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Christina Bach
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - James M Metz
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
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Gass J, Dupree B, Pruthi S, Radford D, Wapnir I, Antoszewska R, Curtis A, Johnson N. Breast Cancer Survivorship: Why, What and When? Ann Surg Oncol 2016; 23:3162-7. [DOI: 10.1245/s10434-016-5403-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Indexed: 11/18/2022]
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