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Kim M, Gilliland JL, Parnes MF, Bruce C, Stern CS, Allen RJ, Pusic AL, Tadros AB, Nelson JA. BREAST-Q REACT: Qualitative Assessment of the Design, Functionality, and Clinical Utility of a New Score Interpretation Tool. Ann Surg Oncol 2024; 31:4498-4511. [PMID: 38570377 DOI: 10.1245/s10434-024-15185-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/01/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND The BREAST-Q real-time engagement and communication tool (REACT) was developed to aid with BREAST-Q score interpretation and guide patient-centered care. OBJECTIVE The purpose of this qualitative study was to examine the perspectives of patients and providers on the design, functionality, and clinical utility of REACT and refine the REACT based on their recommendations. METHODS We conducted three patient focus groups with women who were at least 6 postoperative months from their postmastectomy breast reconstruction, and two provider focus groups with plastic surgeons, breast surgeons, and advanced practice providers. Focus groups were audio-taped, transcribed verbatim, and analyzed thematically. RESULTS A total of 18 breast reconstruction patients and 14 providers participated in the focus groups. Themes identified by thematic analysis were organized into two categories: (1) design and functionality, and (2) clinical utility. On the design and functionality of REACT, four major themes were identified: visual appeal and usefulness; contextualizing results; ability to normalize patients' experiences, noting participants' concerns; and suggested modifications. On the clinical utility of REACT, three major themes were identified: potential to empower patients to communicate with their providers; increase patient and provider motivation to engage with the BREAST-Q; and effective integration into clinical workflow. CONCLUSION Patients and providers in this qualitative study indicated that with some modifications, REACT has a great potential to elevate the clinical utility of the BREAST-Q by enhancing patient-provider communication that can lead to patient-centered, clinically relevant action recommendations based on longitudinal BREAST-Q scores.
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Affiliation(s)
- Minji Kim
- Division of Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jaime L Gilliland
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mei-Fan Parnes
- Division of Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cayla Bruce
- Division of Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carrie S Stern
- Division of Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert J Allen
- Division of Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Audree B Tadros
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas A Nelson
- Division of Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Mols F, Schoormans D, Netea-Maier R, Husson O, Beijer S, Van Deun K, Zandee W, Kars M, Wouters van Poppel PCM, Simsek S, van Battum P, Kisters JMH, de Boer JP, Massolt E, van Leeuwaarde R, Oranje W, Roerink S, Vermeulen M, van de Poll-Franse L. Determinants and mediating mechanisms of quality of life and disease-specific symptoms among thyroid cancer patients: the design of the WaTCh study. Thyroid Res 2023; 16:23. [PMID: 37424010 DOI: 10.1186/s13044-023-00165-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/23/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Thyroid cancer (TC) patients are understudied but appear to be at risk for poor physical and psychosocial outcomes. Knowledge of the course and determinants of these deteriorated outcomes is lacking. Furthermore, little is known about mediating biological mechanisms. OBJECTIVES The WaTCh-study aims to; 1. Examine the course of physical and psychosocial outcomes. 2. Examine the association of demographic, environmental, clinical, physiological, and personality characteristics to those outcomes. In other words, who is at risk? 3. Reveal the association of mediating biological mechanisms (inflammation, kynurenine pathway) with poor physical and psychological outcomes. In other words, why is a person at risk? DESIGN AND METHODS Newly diagnosed TC patients from 13 Dutch hospitals will be invited. Data collection will take place before treatment, and at 6, 12 and 24 months after diagnosis. Sociodemographic and clinical information is available from the Netherlands Cancer Registry. Patients fill-out validated questionnaires at each time-point to assess quality of life, TC-specific symptoms, physical activity, anxiety, depression, health care use, and employment. Patients are asked to donate blood three times to assess inflammation and kynurenine pathway. Optionally, at each occasion, patients can use a weighing scale with bioelectrical impedance analysis (BIA) system to assess body composition; can register food intake using an online food diary; and can wear an activity tracker to assess physical activity and sleep duration/quality. Representative Dutch normative data on the studied physical and psychosocial outcomes is already available. IMPACT WaTCh will reveal the course of physical and psychosocial outcomes among TC patients over time and answers the question who is at risk for poor outcomes, and why. This knowledge can be used to provide personalized information, to improve screening, to develop and provide tailored treatment strategies and supportive care, to optimize outcomes, and ultimately increase the number of TC survivors that live in good health.
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Affiliation(s)
- Floortje Mols
- CoRPS - Center of Research On Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.
| | - Dounya Schoormans
- CoRPS - Center of Research On Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Romana Netea-Maier
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Olga Husson
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Surgical Oncology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Sandra Beijer
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
- Maastricht University Medical Center (MUMC), Maastricht, the Netherlands
| | - Katrijn Van Deun
- Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Wouter Zandee
- Department of Endocrinology, Groningen University, University Medical Center Groningen, Groningen, The Netherlands
| | - Marleen Kars
- Maastricht University Medical Center (MUMC), Maastricht, the Netherlands
| | | | - Suat Simsek
- Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | | | | | - Jan Paul de Boer
- Antoni Van Leeuwenhoek Hospital, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Elske Massolt
- Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Rachel van Leeuwaarde
- Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | - Lonneke van de Poll-Franse
- CoRPS - Center of Research On Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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3
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Vromans RD, Hommes S, Clouth FJ, Lo-Fo-Wong DNN, Verbeek XAAM, van de Poll-Franse L, Pauws S, Krahmer E. Need for numbers: assessing cancer survivors' needs for personalized and generic statistical information. BMC Med Inform Decis Mak 2022; 22:260. [PMID: 36199092 PMCID: PMC9535944 DOI: 10.1186/s12911-022-02005-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 09/28/2022] [Indexed: 11/12/2022] Open
Abstract
Background Statistical information (e.g., on long-term survival or side effects) may be valuable for healthcare providers to share with their patients to facilitate shared decision making on treatment options. In this pre-registered study, we assessed cancer survivors’ need for generic (population-based) versus personalized (tailored towards patient/tumor characteristics) statistical information after their diagnosis. We examined how information coping style, subjective numeracy, and anxiety levels of survivors relate to these needs and identified statistical need profiles. Additionally, we qualitatively explored survivors’ considerations for (not) wanting statistical information. Methods Cancer survivors’ need for statistics regarding incidence, survival, recurrence, side effects and quality of life were assessed with an online questionnaire. For each of these topics, survivors were asked to think back to their first cancer diagnosis and to indicate their need for generic and personalized statistics on a 4-point scale (‘not at all’- ‘very much’). Associations between information coping style, subjective numeracy, and anxiety with need for generic and personalized statistics were examined with Pearson’s correlations. Statistical need profiles were identified using latent class analysis. Considerations for (not) wanting statistics were analyzed qualitatively. Results Overall, cancer survivors (n = 174) had a higher need for personalized than for generic statistics (p < .001, d = 0.74). Need for personalized statistics was associated with higher subjective numeracy (r = .29) and an information-seeking coping style (r = .41). Three statistical need profiles were identified (1) a strong need for both generic and personalized statistics (34%), (2) a stronger need for personalized than for generic statistics (55%), and (3) a little need for both generic and personalized statistics (11%). Considerations for wanting personalized cancer statistics ranged from feelings of being in control to making better informed decisions about treatment. Considerations for not wanting statistics related to negative experience with statistics and to the unpredictability of future events for individual patients. Conclusions In light of the increased possibilities for using personalized statistics in clinical practice and decision aids, it appears that most cancer survivors want personalized statistical information during treatment decision-making. Subjective numeracy and information coping style seem important factors influencing this need. We encourage further development and implementation of data-driven personalized decision support technologies in oncological care to support patients in treatment decision making. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-02005-2.
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Affiliation(s)
- Ruben D Vromans
- Department of Communication and Cognition, Tilburg Center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, P.O. Box 90153, 5037 LE, Tilburg, The Netherlands. .,Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
| | - Saar Hommes
- Department of Communication and Cognition, Tilburg Center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, P.O. Box 90153, 5037 LE, Tilburg, The Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Felix J Clouth
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Department of Statistics and Methodology, Tilburg School of Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Deborah N N Lo-Fo-Wong
- Department of Medical Psychology and Psychotherapy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Xander A A M Verbeek
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Lonneke van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Department of Medical and Clinical Psychology, Tilburg School of Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Steffen Pauws
- Department of Communication and Cognition, Tilburg Center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, P.O. Box 90153, 5037 LE, Tilburg, The Netherlands.,Collaborative Care Solutions, Philips Research, Eindhoven, The Netherlands
| | - Emiel Krahmer
- Department of Communication and Cognition, Tilburg Center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, P.O. Box 90153, 5037 LE, Tilburg, The Netherlands
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4
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van den Hurk CJG, Mols F, Eicher M, Chan RJ, Becker A, Geleijnse G, Walraven I, Coolbrandt A, Lustberg M, Velikova G, Charalambous A, Koczwara B, Howell D, Basch EM, van de Poll-Franse LV. A Narrative Review on the Collection and Use of Electronic Patient-Reported Outcomes in Cancer Survivorship Care with Emphasis on Symptom Monitoring. Curr Oncol 2022; 29:4370-4385. [PMID: 35735458 PMCID: PMC9222072 DOI: 10.3390/curroncol29060349] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/11/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022] Open
Abstract
Electronic patient-reported outcome (ePRO) applications promise great added value for improving symptom management and health-related quality of life. The aim of this narrative review is to describe the collection and use of ePROs for cancer survivorship care, with an emphasis on ePRO-symptom monitoring. It offers many different perspectives from research settings, while current implementation in routine care is ongoing. ePRO collection optimizes survivorship care by providing insight into the patients' well-being and prioritizing their unmet needs during the whole trajectory from diagnosis to end-of-life. ePRO-symptom monitoring can contribute to timely health risk detection and subsequently allow earlier intervention. Detection is optimized by automatically generated alerts that vary from simple to complex and multilayered. Using ePRO-symptoms during in-hospital consultation enhances the patients' conversation with the health care provider before making informed decisions about treatments, other interventions, or self-management. ePRO(-symptoms) entail specific implementation issues and complementary ethics considerations. The latter is due to privacy concerns, digital divide, and scarcity of adequately representative data for particular groups of patients.
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Affiliation(s)
- Corina J. G. van den Hurk
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), 3511 DT Utrecht, The Netherlands; (F.M.); (G.G.); (L.V.v.d.P.-F.)
- Correspondence:
| | - Floortje Mols
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), 3511 DT Utrecht, The Netherlands; (F.M.); (G.G.); (L.V.v.d.P.-F.)
- CoRPS—Center of Research on Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, The Netherlands
| | - Manuela Eicher
- Institute of Higher Education and Research in Health Care (IUFRS), Faculty of Biology and Medicine, University of Lausanne and Lausanne University Hospital, CH-1010 Lausanne, Switzerland;
- Department of Oncology, Lausanne University Hospital, CH-1011 Lausanne, Switzerland
| | - Raymond J. Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia;
| | - Annemarie Becker
- Amsterdam UMC, Department of Pulmonary Diseases, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Gijs Geleijnse
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), 3511 DT Utrecht, The Netherlands; (F.M.); (G.G.); (L.V.v.d.P.-F.)
| | - Iris Walraven
- Radboudumc, Department for Health Evidence, 6525 GA Nijmegen, The Netherlands;
| | - Annemarie Coolbrandt
- Department of Oncology Nursing, University Hospitals Leuven, 3000 Leuven, Belgium;
- Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, 3000 Leuven, Belgium
| | - Maryam Lustberg
- Breast Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT 06520, USA;
- Breast Center at Smilow Cancer Hospital, New Haven, CT 06519, USA
| | - Galina Velikova
- Leeds Institute of Medical Research at St James’s, University of Leeds and Leeds Cancer Centre, St James’s University Hospital, Leeds LS9 7TF, UK;
| | - Andreas Charalambous
- Nursing Department, Cyprus University of Technology, Limassol 3036, Cyprus;
- Department of Nursing Science, University of Turku, 00074 CGI Turku, Finland
| | - Bogda Koczwara
- Flinders Medical Centre, Flinders University, Adelaide, SA 5042, Australia;
| | - Doris Howell
- Princess Margaret Cancer Research Institute, University of Toronto, Toronto, ON M5G 2M9, Canada;
| | - Ethan M. Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina Cancer Center, Chapel Hill, NC 27599, USA;
| | - Lonneke V. van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), 3511 DT Utrecht, The Netherlands; (F.M.); (G.G.); (L.V.v.d.P.-F.)
- CoRPS—Center of Research on Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, The Netherlands
- Department of Psychosocial Research, Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
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5
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Vissers PAJ, Vink GR, Koelink MR, Koopman M, Arts LPJ, Oerlemans S, May AM, van de Poll-Franse LV, van Erning FN. Evaluation of an individual feedback report on patient-reported outcomes in the Prospective Dutch ColoRectal Cancer cohort. Support Care Cancer 2022; 30:7303-7312. [PMID: 35606477 DOI: 10.1007/s00520-022-07165-5] [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: 03/16/2022] [Accepted: 05/19/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Returning patient-reported outcomes to patients might aid patients in detecting symptoms and might facilitate early intervention. This descriptive study evaluates the use of an individual feedback report on patient-reported outcomes for colorectal cancer patients and aims to assess differences in patient, tumor, and treatment characteristics and cohort retention between patients who opt and do not opt for the feedback report. METHODS Patients with colorectal cancer participating in the nationwide Prospective Dutch ColoRectal Cancer Cohort, who filled in questionnaires digitally between June 2018 and January 2019, were included. Participants were given the option to receive a feedback report at baseline, 3, 6, and 12 months. The usefulness, content, and layout of the feedback report were evaluated. Differences in patient, tumor, and treatment characteristics, patient-reported outcomes, and cohort retention at subsequent questionnaires between participants who did and did not opt for feedback were assessed. RESULTS A total of 484 participants were included of whom 293 (61%) opted for feedback. The feedback report was considered useful by 92%. No differences in patient, tumor, and treatment characteristics, and patient-reported outcomes were found between participants who did and did not opt for feedback. The response rate was higher among patients who opted for feedback compared to patients who did not opt for feedback at T3 (84 vs 74%), but not at T6 and T12. CONCLUSION The feedback report was used by 6 out of 10 patients. The feedback report was considered valuable and associated with a higher subsequent response rate.
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Affiliation(s)
- Pauline A J Vissers
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Geraldine R Vink
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Maaike R Koelink
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Lindy P J Arts
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
- Center of Research On Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Simone Oerlemans
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
- Center of Research On Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Felice N van Erning
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.
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Albers EAC, Fraterman I, Walraven I, Wilthagen E, Schagen SB, van der Ploeg IM, Wouters MWJM, van de Poll-Franse LV, de Ligt KM. Visualization formats of patient-reported outcome measures in clinical practice: a systematic review about preferences and interpretation accuracy. J Patient Rep Outcomes 2022; 6:18. [PMID: 35239055 PMCID: PMC8894516 DOI: 10.1186/s41687-022-00424-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The use of Patient-Reported Outcome Measures (PROMs) for individual patient management within clinical practice is becoming increasingly important. New evidence about graphic visualization formats for PROMs scores has become available. This systematic literature review evaluated evidence for graphic visualization formats of PROMs data in clinical practice for patients and clinicians, for both individual and group level PROMs data. METHODS Studies published between 2000 and 2020 were extracted from CINAHL, PubMed, PsychInfo, and Medline. Studies included patients ≥ 18 years old in daily clinical practice. Papers not available in English, without full-text access, or that did not specifically describe visualization of PROMs data were excluded. Outcomes were: visualization preferences; interpretation accuracy; guidance for clinical interpretation. RESULTS Twenty-five out of 789 papers were included for final analysis. Most frequently studied formats were: bar charts, line graphs, and pie charts. Patients preferred bar charts and line graphs as these were easy and quick for retrieving information about their PROMs scores over time. Clinicians' interpretation accuracy and preferences were similar among graphic visualization formats. Scores were most often compared with patients' own previous scores; to further guide clinical interpretation, scores were compared to norm population scores. Different 'add-ons' improved interpretability for patients and clinicians, e.g. using colors, descriptions of measurement scale directionality, descriptive labels, and brief definitions. CONCLUSION There was no predominant graphical visualization format approach in terms of preferences or interpretation accuracy for both patients and clinicians. Detailed clarification of graph content is essential.
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Affiliation(s)
- Elaine A C Albers
- Department of Psychosocial Research, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Itske Fraterman
- Department of Psychosocial Research, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Iris Walraven
- Department of Psychosocial Research, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department for Health Evidence, Radboudumc, Nijmegen, The Netherlands
| | - Erica Wilthagen
- Library and Scientific Information Department, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sanne B Schagen
- Department of Psychosocial Research, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Iris M van der Ploeg
- Department of Surgical Oncology, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - Michel W J M Wouters
- Department of Surgical Oncology, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Psychosocial Research, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands.,Department of Medical and Clinical Psychology, Center of Research On Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Kelly M de Ligt
- Department of Psychosocial Research, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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7
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van de Poll-Franse LV, Horevoorts N, Schoormans D, Beijer S, Ezendam NPM, Husson O, Oerlemans S, Schagen SB, Hageman GJ, Van Deun K, van den Hurk C, van Eenbergen M, Mols F. Measuring Clinical, Biological, and Behavioral Variables to Elucidate Trajectories of Patient (Reported) Outcomes: The PROFILES Registry. J Natl Cancer Inst 2022; 114:800-807. [PMID: 35201353 PMCID: PMC9194631 DOI: 10.1093/jnci/djac047] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/05/2021] [Accepted: 02/17/2022] [Indexed: 11/14/2022] Open
Abstract
To take cancer survivorship research to the next level, it's important to gain insight in trajectories of changing patient (reported) outcomes and impaired recovery after cancer. This is needed as the number of survivors is increasing and a large proportion is confronted with changing health after treatment. Mechanistic research can facilitate the development of personalized risk-stratified follow-up care and tailored interventions to promote healthy cancer survivorship. We describe how these trajectories can be studied by taking the recently extended Dutch population-based PROFILES (Patient Reported Outcomes Following Initial treatment and Long term Evaluation of Survivorship) registry as an example. PROFILES combines longitudinal assessment of patient-reported outcomes with novel, ambulatory and objective measures (e.g., activity trackers; blood draws; hair samples; online food diaries; online cognitive tests; weighing scales; online symptoms assessment), and cancer registry and pharmacy databases. Furthermore, we discuss methods to optimize the use of a multidomain data collection like return of individual results to participants which may not only improve patient empowerment but also long-term cohort retention. Also, advanced statistical methods are needed to handle high-dimensional longitudinal data (with missing values) and provide insight into trajectories of changing patient (reported) outcomes after cancer. Our coded data can be used by academic researchers around the world. Registries like PROFILES, that go beyond boundaries of disciplines and institutions, will contribute to better predictions of who will experience changes and why. This is needed to prevent and mitigate long-term and late effects of cancer (treatment) and to identify new interventions to promote health.
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Affiliation(s)
- Lonneke V van de Poll-Franse
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,CoRPS - Center of Research on Psychological disorders and Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Department of Psychosocial Research, Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Nicole Horevoorts
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,CoRPS - Center of Research on Psychological disorders and Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Dounya Schoormans
- CoRPS - Center of Research on Psychological disorders and Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Sandra Beijer
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Nicole P M Ezendam
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,CoRPS - Center of Research on Psychological disorders and Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Olga Husson
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Simone Oerlemans
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Sanne B Schagen
- Department of Psychosocial Research, Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Geja J Hageman
- Department of Pharmacology & Toxicology, Research Institute NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Katrijn Van Deun
- Department of methodology and statistics, Tilburg University, Tilburg, The Netherlands
| | - Corina van den Hurk
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Mies van Eenbergen
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Floortje Mols
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,CoRPS - Center of Research on Psychological disorders and Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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8
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Kluger BM, Miyasaki JM. Key concepts and opportunities. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:3-15. [PMID: 36055718 DOI: 10.1016/b978-0-323-85029-2.00014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neuropalliative care is an emerging field dedicated to applying palliative care approaches to meet the needs of persons living with neurologic illness and their families. The development of this field acknowledges the unique needs of this population, including in terms of neuropsychiatric symptoms, the impact of neurologic illness on personhood, and the logistics of managing neurologic disability. In defining the goals of this field, it is important to distinguish between neuropalliative care as an approach to care, as a skillset, as a medical subspecialty, and as a public health goal as each of these constructs offers their own contributions and opportunities. As a newly emerging field, there are nearly unlimited opportunities to improve care through research, clinical care, education, and advocacy.
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Affiliation(s)
- Benzi M Kluger
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Janis M Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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9
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Oerlemans S, Arts LPJ, Kieffer JM, Prins J, Hoogendoorn M, van der Poel M, Koster A, Lensen C, Stevens WBC, Issa D, Pruijt JFM, Oosterveld M, van der Griend R, Nijziel M, Tick L, Posthuma EFM, van de Poll-Franse LV. Web-Based Return of Individual Patient-Reported Outcome Results Among Patients With Lymphoma: Randomized Controlled Trial. J Med Internet Res 2021; 23:e27886. [PMID: 34904948 PMCID: PMC8715355 DOI: 10.2196/27886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/02/2021] [Accepted: 07/27/2021] [Indexed: 12/26/2022] Open
Abstract
Background There has been a cultural shift toward patient engagement in health, with a growing demand from patients to access their results. Objective The Lymphoma Intervention (LIVE) trial is conducted to examine the impact of return of individual patient-reported outcome (PRO) results and a web-based self-management intervention on psychological distress, self-management, satisfaction with information, and health care use in a population-based setting. Methods Return of PRO results included comparison with age- and sex-matched peers and was built into the Patient-Reported Outcomes Following Initial Treatment and Long-Term Evaluation of Survivorship registry. The self-management intervention is an adaptation of a fully automated evidence-based intervention for breast cancer survivors. Patients with lymphoma who completed the web-based questionnaire were equally randomized to care as usual, return of PRO results, and return of PRO results plus self-management intervention. Patients completed questionnaires 9 to 18 months after diagnosis (T0; n=227), 4 months (T1; n=190), 12 months (T2; n=170), and 24 months (T3; n=98). Results Of all invited patients, 51.1% (456/892) responded and web-based participants (n=227) were randomly assigned to care as usual (n=76), return of PRO results (n=74), or return of PRO results and access to Living with lymphoma (n=77). Return of PRO results was viewed by 76.7% (115/150) of those with access. No statistically significant differences were observed for psychological distress, self-management, satisfaction with information provision, and health care use between patients who received PRO results and those who did not (P>.05). Use of the self-management intervention was low (2/76, 3%), and an effect could therefore not be determined. Conclusions Return of individual PRO results seems to meet patients’ wishes but had no beneficial effects on patient outcome. No negative effects were found when individual PRO results were disclosed, and the return of individual PRO results can therefore be safely implemented in daily clinical practice. Trial Registration Netherlands Trial Register NTR5953; https://www.trialregister.nl/trial/5790 International Registered Report Identifier (IRRID) RR2-10.1186/s13063-017-1943-2
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Affiliation(s)
- Simone Oerlemans
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Lindy Paulina Johanna Arts
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Jacobien M Kieffer
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Judith Prins
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Mels Hoogendoorn
- Department of Hematology, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - Marjolein van der Poel
- Department of Internal Medicine, Division of Hematology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Ad Koster
- Department of Internal Medicine, VieCuri Medical Centre, Venlo/Venray, Netherlands
| | - Chantal Lensen
- Department of Internal Medicine, Bernhoven Hospital, Uden, Netherlands
| | | | - Djamila Issa
- Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | - Johannes F M Pruijt
- Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | - Margriet Oosterveld
- Department of Internal Medicine, Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - René van der Griend
- Department of Internal Medicine, Diakonessenhuis, Utrecht/Zeist, Netherlands
| | - Marten Nijziel
- Department of Internal Medicine, Catharina Hospital, Eindhoven, Netherlands
| | - Lidwine Tick
- Department of Internal Medicine, Máxima Medical Centre, Veldhoven, Netherlands
| | - Eduardus F M Posthuma
- Department of Internal Medicine, Reinier de Graaf Group, Delft, Netherlands.,Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands.,Center of Research on Psychological and Somatic disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
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10
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Vromans RD, van Eenbergen MC, Geleijnse G, Pauws S, van de Poll-Franse LV, Krahmer EJ. Exploring Cancer Survivor Needs and Preferences for Communicating Personalized Cancer Statistics From Registry Data: Qualitative Multimethod Study. JMIR Cancer 2021; 7:e25659. [PMID: 34694237 PMCID: PMC8576563 DOI: 10.2196/25659] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/30/2021] [Accepted: 09/25/2021] [Indexed: 12/14/2022] Open
Abstract
Background Disclosure of cancer statistics (eg, survival or incidence rates) based on a representative group of patients can help increase cancer survivors’ understanding of their own diagnostic and prognostic situation, and care planning. More recently, there has been an increasing interest in the use of cancer registry data for disclosing and communicating personalized cancer statistics (tailored toward personal and clinical characteristics) to cancer survivors and relatives. Objective The aim of this study was to explore breast cancer (BCa) and prostate cancer (PCa) survivor needs and preferences for disclosing (what) and presenting (how) personalized statistics from a large Dutch population-based data set, the Netherlands Cancer Registry (NCR). Methods To elicit survivor needs and preferences for communicating personalized NCR statistics, we created different (non)interactive tools visualizing hypothetical scenarios and adopted a qualitative multimethod study design. We first conducted 2 focus groups (study 1; n=13) for collecting group data on BCa and PCa survivor needs and preferences, using noninteractive sketches of what a tool for communicating personalized statistics might look like. Based on these insights, we designed a revised interactive tool, which was used to further explore the needs and preferences of another group of cancer survivors during individual think-aloud observations and semistructured interviews (study 2; n=11). All sessions were audio-recorded, transcribed verbatim, analyzed using thematic (focus groups) and content analysis (think-aloud observations), and reported in compliance with qualitative research reporting criteria. Results In both studies, cancer survivors expressed the need to receive personalized statistics from a representative source, with especially a need for survival and conditional survival rates (ie, survival rate for those who have already survived for a certain period). Personalized statistics adjusted toward personal and clinical factors were deemed more relevant and useful to know than generic or average-based statistics. Participants also needed support for correctly interpreting the personalized statistics and putting them into perspective, for instance by adding contextual or comparative information. Furthermore, while thinking aloud, participants experienced a mix of positive (sense of hope) and negative emotions (feelings of distress) while viewing the personalized survival data. Overall, participants preferred simplicity and conciseness, and the ability to tailor the type of visualization and amount of (detailed) statistical information. Conclusions The majority of our sample of cancer survivors wanted to receive personalized statistics from the NCR. Given the variation in patient needs and preferences for presenting personalized statistics, designers of similar information tools may consider potential tailoring strategies on multiple levels, as well as effective ways for providing supporting information to make sure that the personalized statistics are properly understood. This is encouraging for cancer registries to address this unmet need, but also for those who are developing or implementing personalized data-driven information tools for patients and relatives.
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Affiliation(s)
- Ruben D Vromans
- Department of Communication and Cognition, Tilburg University, Tilburg, Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Mies C van Eenbergen
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Gijs Geleijnse
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Steffen Pauws
- Department of Communication and Cognition, Tilburg University, Tilburg, Netherlands.,Department of Remote Patient Management and Chronic Care, Philips Research, Eindhoven, Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands.,Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Emiel J Krahmer
- Department of Communication and Cognition, Tilburg University, Tilburg, Netherlands
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11
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Leahy AB, Schwartz LA, Li Y, Reeve BB, Bekelman JE, Aplenc R, Basch EM. Electronic symptom monitoring in pediatric patients hospitalized for chemotherapy. Cancer 2021; 127:2980-2989. [PMID: 33945640 DOI: 10.1002/cncr.33617] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Using patient-reported outcomes for symptom monitoring in oncology has resulted in significant benefits for adult patients with cancer. The feasibility of this approach has not been established in the routine care of children with cancer. METHODS The Pediatric Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (Ped-PRO-CTCAE) is an item library that enables children and caregivers to self-report symptoms. Ten symptom items from the Ped-PRO-CTCAE were uploaded to an online platform. Patients at least 7 years old and their caregivers were prompted by text/email message to electronically self-report daily during a planned hospitalization for chemotherapy administration. Symptom reports were emailed to the clinical team caring for the patient, but no instructions were given regarding the use of this information. Rates of patient participation and clinician responses to reports were systematically tracked. RESULTS The median age of the participating patients (n = 52) was 11 years (range, 7-18 years). All patients and caregivers completed an initial login, with 92% of dyads completing at least 1 additional symptom assessment during hospitalization (median, 3 assessments; range, 0-40). Eighty-one percent of participating dyads submitted symptom reports on at least half of hospital days, and 54% submitted reports on all hospital days. Clinical actions were taken in response to symptom reports 21% of the time. Most patients felt that the system was easy (73%) and important (79%). Most clinicians found symptom reports easy to understand and useful (97%). CONCLUSIONS Symptom monitoring using patient-reported outcome measures for hospitalized pediatric oncology patients is feasible and generates data valued by clinicians and patients.
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Affiliation(s)
- Allison Barz Leahy
- Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Penn Center for Cancer Care Innovation, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Lisa A Schwartz
- Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Yimei Li
- Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Bryce B Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Justin E Bekelman
- Penn Center for Cancer Care Innovation, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Richard Aplenc
- Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ethan M Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
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12
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Vromans RD, Pauws SC, Bol N, van de Poll-Franse LV, Krahmer EJ. Communicating tailored risk information of cancer treatment side effects: Only words or also numbers? BMC Med Inform Decis Mak 2020; 20:277. [PMID: 33109175 PMCID: PMC7590680 DOI: 10.1186/s12911-020-01296-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The increased availability of patient reported outcome data makes it feasible to provide patients tailored risk information of cancer treatment side effects. However, it is unclear how such information influences patients' risk interpretations compared to generic population-based risks, and which message format should be used to communicate such individualized statistics. METHODS A web-based experiment was conducted in which participants (n = 141) read a hypothetical treatment decision-making scenario about four side effect risks of adjuvant chemotherapy for advanced colon cancer. Participants were cancer patients or survivors who were recruited from an online Dutch cancer patient panel. All participants received two tailored risks (of which the reference class was based on their age, gender and tumor stage) and two generic risks conveying the likelihood of experiencing the side effects. The risks were presented either in words-only ('common' and 'very common'), or in a combination of words and corresponding numerical estimates ('common, 10 out of 100' and 'very common, 40 out of 100'). Participants' estimation of the probability, accuracy of their estimation, and perceived likelihood of occurrence were primary outcomes. Perceived personal relevance and perceived uncertainty were secondary outcomes. RESULTS Tailored risks were estimated as higher and less accurate than generic risks, but only when they were presented in words; Such differences were not found in the verbal and numerical combined condition. Although tailoring risks did not impact participants' perceived likelihood of occurrence, tailored risks were perceived as more personally relevant than generic risks in both message formats. Finally, tailored risks were perceived as less uncertain than generic risks, but only in the verbal-only condition. CONCLUSIONS Considering current interest in the use of personalized decision aids for improving shared decision-making in oncology, it is important that clinicians consider how tailored risks of treatment side effects should be communicated to patients. We recommend both clinicians who communicate probability information during consultations, and decision aid developers, that verbal descriptors of tailored risks should be supported by numerical estimates of risks levels, to avoid overestimation of risks.
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Affiliation(s)
- Ruben D Vromans
- Department of Communication and Cognition, Tilburg Center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands.
| | - Steffen C Pauws
- Department of Communication and Cognition, Tilburg Center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands
- Collaborative Care Solutions, Philips Research, Eindhoven, The Netherlands
| | - Nadine Bol
- Department of Communication and Cognition, Tilburg Center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Emiel J Krahmer
- Department of Communication and Cognition, Tilburg Center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands
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13
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Thieblemont C, Howlett S, Casasnovas RO, Mounier N, Perrot A, Morschhauser F, Fruchart C, Daguindau N, van Eygen K, Obéric L, Bouabdallah R, Pica GM, Nicolas-Virezelier E, Abraham J, Fitoussi O, Snauwaert S, Eisenmann JC, Lionne-Huyghe P, Bron D, Tricot S, Deeren D, Gonzalez H, Costello R, Le Du K, da Silva MG, Grosicki S, Trotman J, Catalano J, Caballero D, Greil R, Cohen AM, Gaulard P, Roulin L, Takeshita K, Casadebaig ML, Tilly H, Coiffier B. Lenalidomide maintenance for diffuse large B-cell lymphoma patients responding to R-CHOP: quality of life, dosing, and safety results from the randomised controlled REMARC study. Br J Haematol 2019; 189:84-96. [PMID: 31702836 PMCID: PMC7154674 DOI: 10.1111/bjh.16300] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/13/2019] [Indexed: 12/11/2022]
Abstract
Lenalidomide maintenance therapy prolonged progression‐free survival (PFS) versus placebo in elderly patients with diffuse large B‐cell lymphoma (DLBCL) responding to induction chemotherapy in the phase 3 REMARC study. This subpopulation analysis assessed the impact of lenalidomide maintenance and treatment‐emergent adverse events (TEAEs) on health‐related quality of life (HRQOL). Global health status (GHS), and physical functioning and fatigue subscales were evaluated in patients who completed the European Organisation for Research and Treatment of Cancer quality‐of‐life questionnaire‐C30 v3.0. The impact of TEAEs classified post hoc as subjective (patients can feel) or observable (only measurable by physicians) on dose reductions and discontinuations was assessed. Among 457 patients (lenalidomide, n = 229; placebo, n = 228), mean (standard deviation) GHS was similar between treatment arms [68·2 (20·7) Versus 72·0 (17·8)] at randomisation and remained similar during maintenance. Patients receiving lenalidomide experienced no meaningful changes in GHS, physical functioning, or fatigue. Observable TEAEs were more common (81·1% Versus 66·3%) and more likely to lead to dose reductions, than subjective TEAEs in both arms. PFS was superior in the lenalidomide arm regardless of dose reduction. Lenalidomide maintenance prolonged PFS and did not negatively impact HRQOL in patients with DLBCL despite TEAEs being more common, when compared with placebo.
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Affiliation(s)
| | | | - René-Olivier Casasnovas
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Dijon and INSERM UMR1231, Dijon, France
| | - Nicolas Mounier
- Hématologie, Centre Hospitalier Universitaire de Nice - Hôpital de l'Archet, Nice, France
| | - Aurore Perrot
- Service d'Hématologie, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Franck Morschhauser
- Institute of Hematology-Transfusion, Centre Hospitalier Universitaire Régional de Lille, Lille, France
| | - Christophe Fruchart
- Service d'Hématologie, Institut d'Hématologie de Basse-Normandie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Nicolas Daguindau
- Service d'Hématologie Clinique, Centre Hospitalier Annecy Genevois, Annecy, France
| | - Koen van Eygen
- Oncologisch Centrum, AZ Groeninge Hospital, Kortrijk, Belgium
| | - Lucie Obéric
- Hôpital de Purpan, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Reda Bouabdallah
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | | | | | - Julie Abraham
- Centre Hospitalier Universitaire Dupuytren, Limoges, France
| | - Olivier Fitoussi
- Hematology/Oncology, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | | | | | | | | | - Sabine Tricot
- Centre Hospitalier de Valenciennes, Valenciennes, France
| | | | | | | | | | | | | | - Judith Trotman
- Concord Repatriation General Hospital, University of Sydney, Concord, NSW, Australia
| | - John Catalano
- Frankston Hospital and Monash University, Frankston, Vic., Australia
| | | | - Richard Greil
- Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute, Salzburg, Austria
| | - Amos M Cohen
- Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | | | - Louise Roulin
- Lymphoid Malignancies Unit, AP-HP, Groupe Hospitalier Mondor, Créteil, France
| | | | | | - Hervé Tilly
- Department of Hematology, Centre Henri Becquerel, UNIROUEN, INSERMU1245, Rouen, France
| | - Bertrand Coiffier
- Department of Hematology, INSERM U1052 Hospices Civils de Lyon, Pierre-Bénite, France
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14
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Sztankay M, Neppl L, Wintner LM, Loth FL, Willenbacher W, Weger R, Weyrer W, Steurer M, Rumpold G, Holzner B. Complementing clinical cancer registry data with patient reported outcomes: A feasibility study on routine electronic patient-reported outcome assessment for the Austrian Myelome Registry. Eur J Cancer Care (Engl) 2019; 28:e13154. [PMID: 31465136 PMCID: PMC6900154 DOI: 10.1111/ecc.13154] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/22/2019] [Accepted: 08/01/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Routinely assessed patient-reported outcomes (PROs), such as quality of life (QOL), are important to supplement clinical cancer data but requires rigorous implementation. This study aims at depicting the implementation procedure and evaluating the feasibility of routine electronic PRO monitoring (ePRO) for collecting data supplementing the Austrian Myeloma Registry (AMR). METHODS Integration of ePRO monitoring into clinical routine was planned according to the Replicating Effective Programs framework. QOL data were assessed regularly during treatment and aftercare at the hematooncological outpatient unit at the Medical University of Innsbruck with the EORTC QLQ-C30/ +MY20 and the EQ-5D-5L. Feasibility and usability testing were performed via a multimethod approach. RESULTS Within the first year, 94.4% of the MM patients (N = 142, mean age 65.4, SD 11.8, 60% male) provided 748 PRO assessment time points overall. Patients and clinicians were satisfied with ePRO monitoring and indicated no to little disruption in clinical routine. Patient preference on assessment time points and completion frequency became evident. CONCLUSIONS Complementing the AMR with ePRO data proved to be feasible. Our findings provide useful insights for healthcare providers considering introducing ePRO monitoring to their units for informing clinical registries as well as individualised feedback to patients alike.
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Affiliation(s)
- Monika Sztankay
- Medical University of InnsbruckInnsbruckTirolAustria
- Psychiatry IIInnsbruck University HospitalInnsbruckTirolAustria
- University of InnsbruckInnsbruckTirolAustria
| | - Lucia Neppl
- Psychiatry IIInnsbruck University HospitalInnsbruckTirolAustria
| | - Lisa M. Wintner
- Medical University of InnsbruckInnsbruckTirolAustria
- University of InnsbruckInnsbruckTirolAustria
| | - Fanny L. Loth
- Psychiatry IIInnsbruck University HospitalInnsbruckTirolAustria
| | - Wolfgang Willenbacher
- Internal Medicine V: Haematology & OncologyInnsbruck University HospitalInnsbruckTirolAustria
- Oncotyrol–Center for Personalized Cancer MedicineInnsbruckTirolAustria
| | - Roman Weger
- Oncotyrol–Center for Personalized Cancer MedicineInnsbruckTirolAustria
| | - Walpurga Weyrer
- Internal Medicine V: Haematology & OncologyInnsbruck University HospitalInnsbruckTirolAustria
| | - Michael Steurer
- Internal Medicine V: Haematology & OncologyInnsbruck University HospitalInnsbruckTirolAustria
| | | | - Bernhard Holzner
- Medical University of InnsbruckInnsbruckTirolAustria
- Psychiatry IIInnsbruck University HospitalInnsbruckTirolAustria
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15
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Weitzman ER, Magane KM, Wisk LE. How Returning Aggregate Research Results Impacts Interest in Research Engagement and Planned Actions Relevant to Health Care Decision Making: Cohort Study. J Med Internet Res 2018; 20:e10647. [PMID: 30578228 PMCID: PMC6320417 DOI: 10.2196/10647] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 08/15/2018] [Accepted: 09/10/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Collection of patient-reported outcomes measures (PROs) may augment clinical data and inform health research, improving care, yet approaches to sustaining interest among patient cohorts in research participation are needed. One approach may involve returning aggregate research results (ARRs), which may help patients contextualize personal experiences, prompt conversations with providers or family, and encourage information seeking. This model has been demonstrated for Web-based patient-centered registries. Studies with clinical cohorts may further elucidate the model, its impacts on interest in research participation and planned actions, and potential for participants to experience this as helpful or harmful-gap areas. OBJECTIVE We sought to investigate the impacts of returning ARRs comprising summaries of PROs and clinical metrics to parents of children with rheumatic disease, assessing interest in future research participation among parents who viewed ARRs and plans for acting on returned information. Further, we sought to investigate reactions to viewing ARRs and how these reactions impacted planned actions. METHODS Clinical and PRO data were obtained about children in a national clinical disease registry, summarized, and processed into annotated infographics, comprising ARRs for children's parents. Parents who viewed ARRs (n=111) were surveyed about the information's perceived value and their reactions. Reaction patterns were summarized using principal components analysis (PCA), and associations among reaction patterns and interest in research participation and planned actions were estimated using multivariate logistic regression. RESULTS Parental endorsement of the value of ARRs for understanding their child's condition and making care decisions was high (across 10 topics for which ARRs were shared, 42.2%-77.3% of the parents reported information was "very valuable"). Most (58/111, 52.3%) parents reported being more interested in participating in research after viewing ARRs, with the remainder reporting that their interest levels were unchanged. Reactions to viewing ARRs reflected experiencing validation/affirmation and information burden based on PCA. Reactions were not associated with child demographic or clinical characteristics and PROs, except that parents from households with less education reported greater information burden than those from more educated households (P=.007). In adjusted models, parents with higher validation/affirmation scores had increased odds of reporting heightened interest in research participation (adjusted odds ratio [AOR] 1.97, 95% CI 1.18-3.30), while higher information burden scores were associated with decreased odds of planned discussions with their child (AOR 0.59, 95% CI 0.36-0.95) and increased odds of planned discussions with providers (AOR 1.75, 95% CI 1.02-3.00). CONCLUSIONS Returning ARRs may foster a "virtuous cycle" of research engagement, especially where ARRs are experienced favorably and affect plans to share and discuss ARRs in support of a child's chronic disease care and treatment. Reactions to ARRs vary with education level, underscoring the need for attention to equity for this model.
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Affiliation(s)
- Elissa R Weitzman
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Kara M Magane
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Lauren E Wisk
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
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16
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Derksen JW, Beijer S, Koopman M, Verkooijen HM, van de Poll-Franse LV, May AM. Monitoring potentially modifiable lifestyle factors in cancer survivors: A narrative review on currently available methodologies and innovations for large-scale surveillance. Eur J Cancer 2018; 103:327-340. [DOI: 10.1016/j.ejca.2018.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 05/28/2018] [Accepted: 06/05/2018] [Indexed: 12/11/2022]
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Mols F, Husson O, Oudejans M, Vlooswijk C, Horevoorts N, van de Poll-Franse LV. Reference data of the EORTC QLQ-C30 questionnaire: five consecutive annual assessments of approximately 2000 representative Dutch men and women. Acta Oncol 2018; 57:1381-1391. [PMID: 29912607 DOI: 10.1080/0284186x.2018.1481293] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Cancer and its treatment have an influence on health-related quality of life (HRQOL). Normative data could help to interpret HRQOL among cancer patients. Our aim was to generate longitudinal normative data based on sex, age and morbidity for the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire. METHODS The QLQ-C30 and the Self-administered Comorbidity Questionnaire were administered to a representative panel of the Dutch-speaking population in the Netherlands in 2009 (n = 1743), 2010 (n = 2050), 2011 (n = 2040), 2012 (n = 2194) and 2013 (n = 2333). RESULTS Regarding sex, at baseline, women scored statistically significant and clinically relevant worse on fatigue, pain and insomnia compared to men. Regarding age groups and sex, HRQoL was lower among the older age groups in men and women. For men, at baseline, significant and clinically relevant age differences were found on physical, role and cognitive functioning, global QOL scale, fatigue, pain and dyspnea. The change over 5 years was larger for older age groups. For women, at baseline, significant and clinically relevant age differences were found on physical functioning, role functioning, nausea/vomiting, pain, dyspnea and insomnia. Those without self-reported morbidities reported a better HRQoL compared to those with morbidities. Among those who completed five assessments, the summary scale scores were stable over time, were higher in men than in women, and higher in younger compared to older age groups. CONCLUSIONS Although HRQoL remains relatively stable over time, HRQoL data needs to be interpreted with care as many confounding factors can have an impact on HRQOL. Our data (which is freely available) can aid in the interpretation of QLQ-C30 scores and can help increase our understanding of the influence of age, sex, time and morbid conditions on HRQoL among cancer patients.
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Affiliation(s)
- Floortje Mols
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Olga Husson
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | | | - Carla Vlooswijk
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Nicole Horevoorts
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Lonneke V. van de Poll-Franse
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Psychosocial Research Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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18
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de Rooij BH, Ezendam NPM, Mols F, Vissers PAJ, Thong MSY, Vlooswijk CCP, Oerlemans S, Husson O, Horevoorts NJE, van de Poll-Franse LV. Cancer survivors not participating in observational patient-reported outcome studies have a lower survival compared to participants: the population-based PROFILES registry. Qual Life Res 2018; 27:3313-3324. [PMID: 30167937 PMCID: PMC6244797 DOI: 10.1007/s11136-018-1979-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2018] [Indexed: 11/12/2022]
Abstract
Purpose The ‘Patient Reported Outcomes Following Initial treatment and Long-term Evaluation of Survivorship’ (PROFILES) registry collects patient-reported outcomes (PROs) from short- and long-term cancer survivors in the Netherlands, in a population-based setting. The aim of this analysis is to assess the generalizability of observational PRO research among cancer survivors by comparing socio-demographic and clinical characteristics, and survival of participants and non-participants in cancer survivors invited for questionnaire research through the PROFILES registry. Methods Between 2008 and 2015, cancer survivors with different cancer diagnoses (N = 14,011) were invited to participate in PROFILES registry studies, of whom 69% (N = 9684) participated. Socio-demographic and clinical characteristics and survival data, collected through the Netherlands Cancer Registry, were associated with participation versus non-participation in multivariable logistic regression analyses and cox proportional hazard regression models, respectively. Results Participants had a significantly better survival compared to non-participants (HR = 1.47, P < .01). Participation was associated with male gender, being 60–70 years old, high socio-economic status, receiving any treatment, receiving radiotherapy, having no comorbidities, and a cancer diagnosis 2–3 years before invitation. Sensitivity analysis demonstrates that the health-related quality of life (HRQoL) might be up to 1.3 points lower (scale 0–100) using hot deck imputation compared to non-imputed participant data. Conclusions Cancer survivors not participating in observational PROs research significantly differ from participants, with respect to socio-demographic and clinical characteristics, and survival. Their HRQoL scores may be systematically lower compared to participants. Therefore, even in PRO studies with relatively high participation rates, observed outcomes may represent the healthier patient with better outcomes.
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Affiliation(s)
- Belle H de Rooij
- Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE, Tilburg, The Netherlands. .,The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
| | - Nicole P M Ezendam
- Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE, Tilburg, The Netherlands.,The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Floortje Mols
- Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE, Tilburg, The Netherlands.,The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | | | - Melissa S Y Thong
- Department of Medical Psychology, Academic Medical Center University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Simone Oerlemans
- The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Olga Husson
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicole J E Horevoorts
- Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE, Tilburg, The Netherlands.,The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE, Tilburg, The Netherlands.,The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Thong MS, Mols F, Doege D, van de Poll-Franse L, Arndt V. Population-based cancer survivorship research: Experiences from Germany and the Netherlands. J Cancer Policy 2018. [DOI: 10.1016/j.jcpo.2018.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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20
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Arts LPJ, Oerlemans S, Tick L, Koster A, Roerdink HTJ, van de Poll-Franse LV. More frequent use of health care services among distressed compared with nondistressed survivors of lymphoma and chronic lymphocytic leukemia: Results from the population-based PROFILES registry. Cancer 2018; 124:3016-3024. [PMID: 29698556 PMCID: PMC6055849 DOI: 10.1002/cncr.31410] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Follow-up care for a growing population of survivors of lymphoma and chronic lymphocytic leukemia (CLL) together with the adverse effects these survivors may experience as a result of their cancer and treatment have led to more pressure being placed on health care services. The objectives of the current study were to: 1) compare the use of medical care services by survivors with that of a normative population; 2) evaluate the use of medical and psychosocial care services among distressed and nondistressed survivors; and 3) identify associated sociodemographic and clinical factors. METHODS Survivors of lymphoma and CLL diagnosed between 1999 and 2012 were selected via the population-based Netherlands Cancer Registry and completed the Hospital Anxiety and Depression Scale questionnaire and questions regarding health care. Outcomes were compared with an age-matched and sex-matched normative population. RESULTS A total of 1444 survivors responded (69%). Survivors of lymphoma and CLL contacted their general practitioner (3.8 vs 2.3; P<.001) and medical specialist (5.7 vs 1.6; P<.001) more often within the last year compared with a normative population. In addition, psychologically distressed survivors had even more medical contacts and received psychosocial care more often compared with nondistressed survivors. In addition to psychological distress, comorbidity, female sex, and older age were found to be associated with a greater use of medical services, whereas younger age was associated with receiving psychosocial care. CONCLUSIONS Survivors of lymphoma and CLL, especially those who are psychologically distressed, report an increased use of health care services compared with a normative population. Further studies are needed to explore whether the use of widely applicable psychosocial interventions could reduce the frequency of medical contacts. Cancer 2018;124:3016-24. © 2018 Netherlands Comprehensive Cancer Organisation. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.
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Affiliation(s)
- Lindy P J Arts
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Simone Oerlemans
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, the Netherlands
| | - Lidwine Tick
- Department of Internal Medicine, Maxima Medical Centre, Eindhoven and Veldhoven, the Netherlands
| | - Ad Koster
- Department of Internal Medicine, VieCuri Medical Centre, Venlo and Venray, the Netherlands
| | - Henk T J Roerdink
- Department of Internal Medicine, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, the Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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