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Gebert P, Karsten MM, Hage AM, Dordevic AD, Grittner U. Statistical analysis plan for the PRO B study: open-label, superiority randomised controlled trial of alarm-based patient-reported outcome monitoring in patients with metastatic breast cancer. Trials 2024; 25:171. [PMID: 38448904 PMCID: PMC10918931 DOI: 10.1186/s13063-024-08025-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/24/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND With an increasing collection of patient-reported outcomes (PROs) to measure health-related quality of life (HRQoL) in oncological patients, there is still a lack of standardised strategies on how to interpret and use these data in patient care. Prior research has shown support for the use of digital PRO monitoring together with alarm systems to notify clinicians when the PRO values are deteriorating. This system has demonstrated advantages in improving HRQoL and increasing survival rates among oncology patients. Hence, we designed the PRO B study, a superiority multi-centre randomised controlled trial, to investigate the effects of alarm-based monitoring in metastatic breast cancer patients in Germany. The study protocol for the PRO B study was published in September 2021, and this manuscript describes a formal statistical analysis plan (SAP) for the PRO B study to improve the transparency and quality of this trial. METHODS AND DESIGN The trial aimed to recruit 1000 patients with metastatic breast cancer. However, as of the completion of recruitment on June 15, 2023, we have successfully enrolled 924 patients from 52 breast cancer centres. Patients were 1:1 stratified randomised to the intervention and control groups. App-based PRO questionnaires are sent weekly to the intervention group and every 3 months to the control group. Only patients in the intervention group trigger an alarm if their PRO scores deteriorate, and they are subsequently contacted by the local care team within 48 h. The primary outcome is the fatigue score at 6 months, and secondary outcomes are other HRQoL and overall survival. Evaluation of the superiority of the intervention will be done using a linear mixed model with random intercepts for study centres. CONCLUSION This detailed SAP defines the main components of the statistical analysis for the PRO B study to assist the statistician and prevent bias in selecting analysis and reporting findings. Version 1 of the SAP was finalised on January 18, 2024. TRIAL REGISTRATION DRKS (German Clinical Trials Register) DRKS00024015 . Registered on February 15, 2021.
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Affiliation(s)
- Pimrapat Gebert
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany.
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany.
| | - Maria Margarete Karsten
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Anna Maria Hage
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Adam David Dordevic
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Ulrike Grittner
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
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Peipert JD, Breslin M, Basch E, Calvert M, Cella D, Smith ML, Thanarajasingam G, Roydhouse J. [Special issue PRO] Considering endpoints for comparative tolerability of cancer treatments using patient report given the estimand framework. J Biopharm Stat 2024:1-19. [PMID: 38358291 DOI: 10.1080/10543406.2024.2313060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 01/27/2024] [Indexed: 02/16/2024]
Abstract
Regulatory agencies are advancing the use of systematic approaches to collect patient experience data, including patient-reported outcomes (PROs), in cancer clinical trials to inform regulatory decision-making. Due in part to clinician under-reporting of symptomatic adverse events, there is a growing recognition that evaluation of cancer treatment tolerability should include the patient experience, both in terms of the overall side effect impact and symptomatic adverse events. Methodologies around implementation, analysis, and interpretation of "patient" reported tolerability are under development, and current approaches are largely descriptive. There is robust guidance for use of PROs as efficacy endpoints to compare cancer treatments, but it is unclear to what extent this can be relied-upon to develop tolerability endpoints. An important consideration when developing endpoints to compare tolerability between treatments is the linkage of trial design, objectives, and statistical analysis. Despite interest in and frequent collection of PRO data in oncology trials, heterogeneity in analyses and unclear PRO objectives mean that design, objectives, and analysis may not be aligned, posing substantial challenges for the interpretation of results. The recent ICH E9 (R1) estimand framework represents an opportunity to help address these challenges. Efforts to apply the estimand framework in the context of PROs have primarily focused on efficacy outcomes. In this paper, we discuss considerations for comparing the patient-reported tolerability of different treatments in an oncology trial context.
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Affiliation(s)
- John Devin Peipert
- Medical Sciences, Northwestern University Feinberg School of Medical Sciences, Chicago, Illinois, USA
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Ethan Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR), Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, UK
- NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
| | - David Cella
- Medical Sciences, Northwestern University Feinberg School of Medical Sciences, Chicago, Illinois, USA
| | - Mary Lou Smith
- Department of Medical Social Sciences, Research Advocacy Network, Chicago, Illinois, USA
| | | | - Jessica Roydhouse
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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Christie LJ, Rendell R, Fearn N, Descallar J, McCluskey A, Pearce A, Wong L, Lovarini M. Increasing the delivery of upper limb constraint-induced movement therapy programs for stroke and brain injury survivors: evaluation of the ACTIveARM project. Disabil Rehabil 2023:1-13. [PMID: 38131331 DOI: 10.1080/09638288.2023.2290687] [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: 05/02/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To increase the number of constraint-induced movement therapy (CIMT) programs provided by rehabilitation services. METHODS A before-and-after implementation study involving nine rehabilitation services. The implementation package to help change practice included file audit-feedback cycles, 2-day workshops, poster reminders, a community-of-practice and drop-in support. File audits were conducted at baseline, every three months for 1.5 years, and once after support ceased to evaluate maintenance of change. CIMT participant outcomes were collected to evaluate CIMT effectiveness and maintenance (Action Research Arm Test and Motor Activity Log). Staff focus groups explored factors influencing CIMT delivery. RESULTS CIMT adoption improved from baseline where only 2% of eligible people were offered and/or received CIMT (n = 408 files) to more than 50% over 1.5 years post-implementation (n = 792 files, 52% to 73% offered CIMT, 27%-46% received CIMT). Changes were maintained at 6-month follow-up (n = 172 files, 56% offered CIMT, 40% received CIMT). CIMT participants (n = 74) demonstrated clinically significant improvements in arm function and occupational performance. Factors influencing adoption included interdisciplinary collaboration, patient support needs, intervention adaptations, a need for continued training, and clinician support. CONCLUSIONS The implementation package helped therapists overcome an evidence-practice gap and deliver CIMT more routinely.
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Affiliation(s)
- Lauren J Christie
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
- Discipline of Occupational Therapy, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
- Allied Health Research Unit, St Vincent's Health Network Sydney, Sydney, Australia
| | - Reem Rendell
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
- School of Health Sciences, Western Sydney University, Campbelltown, Australia
- Discipline of Physiotherapy, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Nicola Fearn
- Allied Health Research Unit, St Vincent's Health Network Sydney, Sydney, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Sydney, Australia
- South Western Sydney Clinical School, UNSW Sydney, Sydney, Australia
| | - Annie McCluskey
- Discipline of Occupational Therapy, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
- The StrokeEd Collaboration, Sydney, Australia
| | - Alison Pearce
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia
- The Daffodil Centre, a Joint Venture with Cancer Council NSW, The University of Sydney, Sydney, Australia
| | | | - Meryl Lovarini
- Discipline of Occupational Therapy, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
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4
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Lawrance R, Skaltsa K, Regnault A, Floden L. Reflections on estimands for patient-reported outcomes in cancer clinical trials. J Biopharm Stat 2023:1-11. [PMID: 37980609 DOI: 10.1080/10543406.2023.2280628] [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: 03/09/2023] [Accepted: 10/27/2023] [Indexed: 11/21/2023]
Abstract
It is common and important to include the patient's perspective of the impact of treatment on health-related quality of life (HRQoL) outcomes. In this commentary, we focus on applying the new addendum to ICH E9 guideline E9 (R1) relating to the estimand framework to Patient Reported Outcomes (PROs) collected in cancer clinical trials, from a statistician's viewpoint. Currently, common practice for statistical analysis of PRO endpoints of published cancer clinical trials demonstrates ambiguity, leaving critical questions unspecified, hindering conclusions about the effect of treatment on PRO endpoints as well as comparability between clinical trials. To avoid this scenario, we advocate the systematic use of the estimand framework which requires the prospective definition of clear PRO research questions. Among the five attributes of the estimands framework, the definition of the endpoint (what is the right PRO measure and timeframe to target and why?), the intercurrent event identification and management (what happens with PRO data post-disease progression, what is the impact of death?) and the population-level summary (what is an acceptable statistical summary for PRO data?) require the most attention for PRO estimands. We identify good practice and highlight discussion points including the challenges of statistical analysis in the presence of missing and/or unobservable data and in relation to death. Through this discussion we highlight that there is no "statistical magic", but that the estimand framework will help you find out what you really want to know when quantifying the benefit of treatments from the patients' perspective.
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Affiliation(s)
- Rachael Lawrance
- Members of the EFSPI/PSI Estimands in Oncology Special Interest Group, PRO Task Force
- Adelphi Values Ltd, Macclesfield, UK
| | - Konstantina Skaltsa
- Members of the EFSPI/PSI Estimands in Oncology Special Interest Group, PRO Task Force
- IQVIA, Barcelona, Spain
| | - Antoine Regnault
- Members of the EFSPI/PSI Estimands in Oncology Special Interest Group, PRO Task Force
- Modus Outcomes, Lyon, France
| | - Lysbeth Floden
- Members of the EFSPI/PSI Estimands in Oncology Special Interest Group, PRO Task Force
- Clinical Outcome Solutions, Tuscon, USA
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5
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Krepper D, Giesinger JM, Dirven L, Efficace F, Martini C, Thurner AMM, Al-Naesan I, Gross F, Sztankay MJ. Information about missing patient-reported outcome data in breast cancer trials is frequently not documented: a scoping review. J Clin Epidemiol 2023; 162:1-9. [PMID: 37517504 DOI: 10.1016/j.jclinepi.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES This review addresses the common problem of missing patient-reported outcome (PRO) data in clinical trials by assessing the current practice of their statistical handling as reported in publications of randomized controlled trials (RCTs) in patients with breast cancer. STUDY DESIGN AND SETTING We searched PubMed to identify RCTs evaluating biomedical treatments in breast cancer patients with at least one PRO endpoint published between January 2019 and February 2022. Two reviewers independently assessed the eligibility of the publications for this scoping review and extracted prespecified information on missing PRO data and related statistical practices. RESULTS Of 1,598 publications identified, 118 trials met the inclusion criteria. Eighty-eight (74.6%) trials reported the extent of missing data, with 11 (9.3%) not containing any missing PRO data. Twenty-one (19.6%) trials explicitly stated the statistical approach for handling missing data, with a preference for single imputation over multiple imputation approaches (57.2%/19.0%). Only six (5.6%) trials reported a sensitivity analysis to examine the extent to the results being affected by changes in assumptions made about missing PRO data. CONCLUSION International efforts to raise awareness of the importance of accurately reporting state-of-the-art handling of missing PRO data are not yet fully reflected in the current literature of breast cancer RCTs.
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Affiliation(s)
- Daniela Krepper
- Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria.
| | - Johannes Maria Giesinger
- Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Caroline Martini
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Anna Margarete Maria Thurner
- Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Imad Al-Naesan
- Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Franziska Gross
- Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Monika Judith Sztankay
- Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
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Morris M, Chye R, Liu Z, Agar M, Razmovski-Naumovski V. A Retrospective Medical Record Review of Adults with Non-Cancer Diagnoses Prescribed Medicinal Cannabis. J Clin Med 2023; 12:jcm12041483. [PMID: 36836018 PMCID: PMC9965412 DOI: 10.3390/jcm12041483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/27/2023] [Accepted: 02/03/2023] [Indexed: 02/16/2023] Open
Abstract
Research describing patients using medicinal cannabis and its effectiveness is lacking. We aimed to describe adults with non-cancer diagnoses who are prescribed medicinal cannabis via a retrospective medical record review and assess its effectiveness and safety. From 157 Australian records, most were female (63.7%; mean age 63.0 years). Most patients had neurological (58.0%) or musculoskeletal (24.8%) conditions. Medicinal cannabis was perceived beneficial by 53.5% of patients. Mixed-effects modelling and post hoc multiple comparisons analysis showed significant changes overtime for pain, bowel problems, fatigue, difficulty sleeping, mood, quality of life (all p < 0.0001), breathing problems (p = 0.0035), and appetite (p = 0.0465) Symptom Assessment Scale scores. For the conditions, neuropathic pain/peripheral neuropathy had the highest rate of perceived benefit (66.6%), followed by Parkinson's disease (60.9%), multiple sclerosis (60.0%), migraine (43.8%), chronic pain syndrome (42.1%), and spondylosis (40.0%). For the indications, medicinal cannabis had the greatest perceived effect on sleep (80.0%), followed by pain (51.5%), and muscle spasm (50%). Oral oil preparations of balanced delta-9-tetrahydrocannabinol/cannabidiol (average post-titration dose of 16.9 mg and 34.8 mg per day, respectively) were mainly prescribed. Somnolence was the most frequently reported side effect (21%). This study supports medicinal cannabis' potential to safely treat non-cancer chronic conditions and indications.
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Affiliation(s)
- Michael Morris
- South West Sydney Clinical Campuses, Faculty of Medicine & Health, University of New South Wales Sydney (UNSW), Sydney, NSW 2170, Australia
| | - Richard Chye
- Sacred Heart Health Service, St Vincent’s Hospital, Darlinghurst, NSW 2010, Australia
| | - Zhixin Liu
- Stats Central, University of New South Wales Sydney (UNSW), Sydney, NSW 2170, Australia
| | - Meera Agar
- South West Sydney Clinical Campuses, Faculty of Medicine & Health, University of New South Wales Sydney (UNSW), Sydney, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Valentina Razmovski-Naumovski
- South West Sydney Clinical Campuses, Faculty of Medicine & Health, University of New South Wales Sydney (UNSW), Sydney, NSW 2170, Australia
- Sacred Heart Health Service, St Vincent’s Hospital, Darlinghurst, NSW 2010, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
- Correspondence:
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Huyghe T, Alcaraz PE, Calleja-González J, Bird SP. The underpinning factors of NBA game-play performance: a systematic review (2001-2020). PHYSICIAN SPORTSMED 2022; 50:94-122. [PMID: 33724159 DOI: 10.1080/00913847.2021.1896957] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Recognizing the high stakes associated with winning and losing in the National Basketball Association (NBA), a deep understanding of the underlying mechanisms of NBA game-play performance would provide substantial benefit to all stakeholders involved with preparing NBA players and teams for competitive success. To the best of the authors' knowledge, this systematic review presents the first attempt to systematically amalgamate and appraise the scientific literature published in the XXI Century, following a constraints-led approach (CLA). In particular, two underpinning factors of NBA game-play performance were investigated: (1) NBA player constraints (internal variables) and (2) NBA contextual constraints (external variables). METHODS Databases included PubMed (MEDLINE), Web of Science (WOS), ResearchGate, SPORTDiscus, SCOPUS, Google Scholar, and the World Association of Basketball Coaches' database (WABC). This review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) model and the Population, Intervention, Comparison and Outcomes (PICOS) guidelines. RESULTS Ultimately, 43 articles met the inclusion criteria (n = 43). Promisingly, the vast majority of studies were published in recent years (>2016; n = 28; 65.1%). Topics related to 'contextual constraints' (n = 25; 58.1%) received more attention than topics related to 'player constraints' (n = 18; 41.9%). Even though the importance of longitudinal-interventional approaches to applied sports science is well-documented, descriptive-observational research emerged as the most popular method of choice (n = 27; 62.8%); interventional studies were absent; and near all researchers merely utilized secondary data sources (n = 37; 86.0%). CONCLUSIONS Taking into account the total body of evidence (2001-2020), NBA practitioners may use this systematic review as a baseline reference to enrich their current knowledge about the nature, demands, and dynamics of the modern-day NBA ecosystem. Finally, adoption of an 'Applied Science Research Framework' is encouraged, fostering clearly outlined project incentives; standardizing taxonomies; sequencing follow-up studies; embracing holistic and cross-disciplinary viewpoints; and integrating longitudinal-interventional projects to increase the reproducibility of their findings.
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Affiliation(s)
- Thomas Huyghe
- Research Center for High Performance Sport, UCAM Catholic University of Murcia, Spain
| | - Pedro E Alcaraz
- Research Center for High Performance Sport, UCAM Catholic University of Murcia, Spain
| | - Julio Calleja-González
- Department of Physical Education and Sports, Faculty of Education and Sport, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
| | - Stephen P Bird
- School of Health and Wellbeing, University of Southern Queensland, Ipswich QLD, Australia
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Sommer M, Nielsen LK, Nielsen LB, Brøndum RF, Nielsen MM, Rytter AS, Vesteghem C, Severinsen MT, El-Galaly TC, Bøgsted M, Grønkjær M, Jørgensen L. Patient-reported outcomes in patients with hematological relapse or progressive disease: a longitudinal observational study. Health Qual Life Outcomes 2021; 19:251. [PMID: 34736479 PMCID: PMC8567661 DOI: 10.1186/s12955-021-01887-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background Patients with hematological cancer who experience relapse or progressive disease often face yet another line of treatment and continued mortality risk that could increase their physical and emotional trauma and worsen their health-related quality of life. Healthcare professionals who use patient-reported outcomes to identify who will have specific sensitivities in particular health-related quality of life domains may be able to individualize and target treatment and supportive care, both features of precision medicine. Here, in a cohort of patients with relapsed or progressive hematological cancer, we sought to identify health-related quality of life domains in which they experienced deterioration after relapse treatment and to investigate health-related quality of life patterns.
Method Patients were recruited in connection with a precision medicine study at the Department of Hematology, Aalborg University Hospital. They completed the European Organization for Research and Treatment of Cancer questionnaire and the Hospital Anxiety and Depression Scale at baseline and at 3, 6, 9, and 12 months after the relapse diagnosis or progressive cancer. Modes of completion were electronically or on paper. Clinically relevant changes from baseline to 12 months were interpreted according to Cocks’ guidelines. We quantified the number of patients with moderate or severe symptoms and functional problems and the number who experienced improvements or deterioration from baseline to 12 months. Results A total of 104 patients were included, of whom 90 (87%) completed baseline questionnaires and 50 (56%) completed the 12-month assessments. The three symptoms that patients most often reported as deteriorating were fatigue (18%), insomnia (18%), and diarrhea (18%). The three functions that patients most often reported as deteriorating were role (16%) and emotional (16%) and cognitive (16%) functioning. Conclusion In this study, patient-reported outcome data were useful for identifying negatively affected health-related quality of life domains in patients with relapsed or progressive hematological cancer. We identified patients experiencing deterioration in health-related quality of life during treatment and characterized a potential role for patient-reported outcomes in precision medicine to target treatment and supportive care in this patient group. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-021-01887-6.
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Affiliation(s)
- Mia Sommer
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark. .,Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. .,Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark. .,University College Northern Denmark, Aalborg, Denmark.
| | - Lene Kongsgaard Nielsen
- Quality of Life Research Centre, Department of Hematology, Odense University Hospital, Odense, Denmark.,Department of Internal Medicine and Cardiology, Regional Hospital Viborg, Viborg, Denmark
| | | | - Rasmus Froberg Brøndum
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Charles Vesteghem
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
| | - Marianne Tang Severinsen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
| | - Tarec Christoffer El-Galaly
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
| | - Martin Bøgsted
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
| | - Mette Grønkjær
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lone Jørgensen
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Clinic for Surgery and Cancer Treatment, Aalborg University Hospital, Aalborg, Denmark
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9
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Romeiser JL, Cavalcante J, Richman DC, Singh SM, Liang X, Pei A, Sharma S, Lazarus Z, Gan TJ, Bennett-Guerrero E. Comparing Email, SMS, and Concurrent Mixed Modes Approaches to Capture Quality of Recovery in the Perioperative Period: Retrospective Longitudinal Cohort Study. JMIR Form Res 2021; 5:e25209. [PMID: 34734827 PMCID: PMC8603163 DOI: 10.2196/25209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/25/2021] [Accepted: 09/23/2021] [Indexed: 01/22/2023] Open
Abstract
Background As patients are discharged from the hospital more quickly, the ability to monitor patient recovery between hospital discharge and the first follow-up clinic visit is becoming increasingly important. Despite substantial increase in both internet use and smartphone ownership over the past 5 years, clinicians have been slow to embrace the use of these devices to capture patient recovery information in the period between hospital discharge and the first clinical follow-up appointment. Objective This study aims to investigate the generalizability of using a web-based platform to capture patient recovery in a broad surgical patient population and compare response rates for 3 different web-based strategies for delivering recovery surveys over the perioperative period: email, SMS text messaging, and a concurrent mixed approach of using both email and SMS text messaging. Methods Patients undergoing surgeries managed with an enhanced recovery after surgery pathway were asked to participate in a web-based quality assurance monitoring program at the time of their preoperative surgery appointment. Different follow-up methods were implemented over 3 sequential phases. Patients received Health Insurance Portability and Accountability Act–compliant web-based survey links via email (phase 1), SMS text messaging (phase 2), or concurrently using both email and SMS text messaging (phase 3) using REDCap and Twilio software. Recovery assessments using the established Quality of Recovery-9 instrument were performed 4 days before surgery and at 7 and 30 days postoperatively. Generalizability of the web-based system was examined by comparing characteristics of those who participated versus those who did not. Differences in response rates by the web-based collection method were analyzed using adjusted models. Results A total of 615 patients were asked to participate, with 526 (85.5%) opting for the follow-up program. Those who opted in were younger, slightly healthier, and more likely to be in a partnership. The concurrent mixed modes method was the most successful for obtaining responses at each time point compared with text or email alone (pre: 119/160, 74.4% vs 116/173, 67.1% vs 56/130, 43.1%, P<.001; 7 days: 115/172, 66.9% vs 82/164, 50.0% vs 59/126, 46.8%, P=.001; 30 days: 152/234, 65.0% vs 52/105, 49.5% vs 53/123, 43.1%, P=.001, respectively). In the adjusted model, the concurrent mixed modes method significantly predicted response compared with using email alone (odds ratio 3.4; P<.001) and SMS text messaging alone (odds ratio 1.9; P<.001). Additional significant predictors of response were race, partnership, and time. Conclusions For internet users and smartphone owners, electronic capture of recovery surveys appear to be possible through this mechanism. Discrepancies in both inclusion and response rates still exist among certain subgroups of patients, but the concurrent approach of using both email and text messages was the most effective approach to reach the largest number of patients across all subgroups.
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Affiliation(s)
- Jamie L Romeiser
- Department of Anesthesiology, Stony Brook University Medical Center, Stony Brook, NY, United States
| | - James Cavalcante
- Department of Anesthesiology, Stony Brook University Medical Center, Stony Brook, NY, United States
| | - Deborah C Richman
- Department of Anesthesiology, Stony Brook University Medical Center, Stony Brook, NY, United States
| | - Sunitha M Singh
- Department of Anesthesiology, Stony Brook University Medical Center, Stony Brook, NY, United States
| | - Xiaohui Liang
- Department of Anesthesiology, Stony Brook University Medical Center, Stony Brook, NY, United States
| | - Allison Pei
- Department of Anesthesiology, Stony Brook University Medical Center, Stony Brook, NY, United States
| | - Samanvaya Sharma
- Department of Anesthesiology, Stony Brook University Medical Center, Stony Brook, NY, United States
| | - Zoe Lazarus
- Department of Anesthesiology, Stony Brook University Medical Center, Stony Brook, NY, United States
| | - Tong J Gan
- Department of Anesthesiology, Stony Brook University Medical Center, Stony Brook, NY, United States
| | - Elliott Bennett-Guerrero
- Department of Anesthesiology, Stony Brook University Medical Center, Stony Brook, NY, United States
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Brandt AE, Finnanger TG, Hypher RE, Rø TB, Skovlund E, Andersson S, Risnes K, Stubberud J. Rehabilitation of executive function in chronic paediatric brain injury: a randomized controlled trial. BMC Med 2021; 19:253. [PMID: 34724955 PMCID: PMC8561897 DOI: 10.1186/s12916-021-02129-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Impaired executive functions (EFs, i.e., purposeful, goal-directed behaviour) cause significant disability after paediatric acquired brain injury (pABI) warranting efficient interventions. Goal Management Training (GMT) is a metacognitive protocol proven effective for executive dysfunction in adults. This pre-registered, blinded, parallel-randomized controlled trial evaluated efficacy of a paediatric adaptation (pGMT) compared to a psychoeducative control (paediatric Brain Health Workshop, pBHW) to improve EF. METHODS Children aged 10 to 17 years with pABI (e.g., traumatic brain injury, brain tumour), ≥ 1 year post-onset or ended treatment, with parent-reported EF complaints were eligible. Participants were randomized (computer-algorithm) to either group-based pGMT (n = 38) or pBHW (n = 38). The active control was tailored to keep non-specific factors constant. Thus, both treatments comprised of 7 sessions at hospitals over 3 consecutive weeks, followed by 4 weeks of telephone counselling of participants, parents, and teachers. Parent-reported daily life EF, assessed by the questionnaire Behavior Rating Inventory of Executive Function (BRIEF; Behavioral Regulation Index (BRI) and Metacognition Index (MI)), were co-primary outcomes 6 months post-intervention. Secondary outcomes included neuropsychological tests and a complex naturalistic task (Children's Cooking Task). RESULTS Seventy-three participants (96%) completed allocated interventions and 71 (93%) attended the 6-month follow-up. The results demonstrated no significant difference in effectiveness for the two interventions on parent-reported EF: For BRIEFBRI, mean (SD) raw score for pGMT was 42.7 (8.8) and 38.3 (9.3) for pBHW. Estimated difference was - 2.3 (95% CI - 5.1 to 0.6). For BRIEFMI, the corresponding results were 80.9 (20.4) for GMT and 75.5 (19.3) for pBHW. Estimated difference was - 1.4 (95% CI -8.5 to 5.8). In performance-based tests, pGMT was associated with improved inhibition and executive attention, while pBHW was associated with fewer errors in the naturalistic task. CONCLUSIONS In pABI, metacognitive training (pGMT) did not demonstrate additional effectiveness on parent-reported daily life EF at 6-month follow-up, when compared to a psychoeducative control. Both interventions were well-tolerated and demonstrated distinct improvements at different EF assessment levels. To conclude on pGMT efficacy, larger studies are needed, including further investigation of appropriate assessment levels and possible differences in effect related to treatment duration, developmental factors, and injury characteristics. TRIAL REGISTRATION ClinicalTrials.gov , NCT0321534211, 11 July 2017.
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Affiliation(s)
- Anne E. Brandt
- Children’s Clinic, St. Olavs Hospital, Trondheim University Hospital, Postbox 3250 Torgarden, NO-7006 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torun G. Finnanger
- Children’s Clinic, St. Olavs Hospital, Trondheim University Hospital, Postbox 3250 Torgarden, NO-7006 Trondheim, Norway
| | - Ruth E. Hypher
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | - Torstein B. Rø
- Children’s Clinic, St. Olavs Hospital, Trondheim University Hospital, Postbox 3250 Torgarden, NO-7006 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eva Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | | | - Kari Risnes
- Children’s Clinic, St. Olavs Hospital, Trondheim University Hospital, Postbox 3250 Torgarden, NO-7006 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jan Stubberud
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
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11
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Yan L, Yao L, Zhao Q, Xiao M, Li Y, Min S. Risk Prediction Models for Inadvertent Intraoperative Hypothermia: A Systematic Review. J Perianesth Nurs 2021; 36:724-729. [PMID: 34663532 DOI: 10.1016/j.jopan.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/27/2021] [Accepted: 02/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSES Inadvertent intraoperative hypothermia (core temperature <36°C) is a common surgical complication with several adverse events. Hypothermia prediction models can be a tool for providing the healthcare staff with information on the risk of inadvertent hypothermia. Our systematic review aimed to identify, demonstrate, and evaluate the available intraoperative hypothermia risk prediction models in surgical populations. DESIGN This study is a systematic review of literature. METHODS We systematically searched multiple databases (Ovid MEDLINE, Web of Science, Embase, and Cochrane Center Register of Controlled Trials). Two reviewers independently examined abstracts and the full text for eligibility. Data collection was guided by the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS checklist), and methodological quality and applicability were assessed by the Prediction model Risk Of Bias ASsessment Tool (PROBAST). FINDINGS A total of 3,672 references were screened, of which eight articles were included in this study. All the models had a high risk of bias since most of them lacked model validation. Also, they failed to report the model performance and final model presentations, which restricted their clinical application. CONCLUSIONS The researchers should present models in a more standard way and improve the existing models to increase their predictive values for clinical application.
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Affiliation(s)
- Lupei Yan
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lili Yao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingzhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuerong Li
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Su Min
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Harvie M, Pegington M, Bundred N, Campbell A, Belcher J, Howell S, Howell A. Reply to Comment on "The effectiveness of home versus community-based weight control programmes initiated soon after breast cancer diagnosis: a randomised controlled trial". Br J Cancer 2020; 122:925-926. [PMID: 31932752 PMCID: PMC7078211 DOI: 10.1038/s41416-019-0715-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/18/2019] [Indexed: 12/03/2022] Open
Affiliation(s)
- Michelle Harvie
- Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK. .,Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, Manchester, UK.
| | - Mary Pegington
- Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK
| | - Nigel Bundred
- Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, Manchester, UK.,Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK
| | - Anna Campbell
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - John Belcher
- Department of Medical Statistics, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sacha Howell
- Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, Manchester, UK.,Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK.,The Christie NHS Foundation Trust, Manchester, UK
| | - Anthony Howell
- Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, Manchester, UK.,Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK
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