1
|
Chen TC, Wang SH, Ho CM, Lin HC, Tung CL, Chang CC, Tsai CF, Chen TH, Fang YC, Lin WT, Lee YT, Chang YS, Lee MY. Effectiveness of early palliative care in patients with head and neck cancer in Taiwan. J Chin Med Assoc 2024; 87:643-652. [PMID: 38838200 DOI: 10.1097/jcma.0000000000001104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Early palliative care (EPC) benefits some cancers, but its clinical outcomes differ depending on patients' racial and ethnic disparities, and customs. To determine whether EPC improves symptoms, emotional distress, and quality of life among Taiwanese patients with early or advanced-stage head and neck cancer (HNC). METHODS Based on participants' pathological stages, they were categorized as having early and advanced-stage HNC. Those willing and unwilling to undergo EPC were assigned to the EPC and standard groups, respectively. Their daily cancer-related symptoms were assessed using the Distress Thermometer (DT) and MD Anderson Symptom Inventory (MDASI), whose scores' concurrent validity was evaluated using the European Organization for Research and Treatment of Core Quality of Life (EORTC-QLQ-C30) and Head and Neck 35 (EORTC-QLQ-H&N35) questionnaires. RESULTS Patients (n = 93) diagnosed with HNC at Taiwan's Chia-Yi Christian Hospital from November 2020 to October 2022 were recruited. The patients voluntarily split into two groups: EPC groups and standard groups (23 and 11 in early-stage; 46 and 13 in advanced-stage, respectively). DT assessment showed significant emotional distress improvements for all patients with HNC who received EPC. The EORTC-QLQ-C30 questionnaire indicated that, compared to standard interventions, EPC groups significantly improved the quality of life and some symptoms for both early and advanced-stage HNC patients. However, the EORTC-QLQ-H&N35 questionnaire found no significant difference between the two groups. Furthermore, advanced-stage patients' anticancer treatment completion rates with EPC and standard interventions were 95.35% and 75%, respectively. CONCLUSION EPC improves symptoms, emotional distress, quality of life, and treatment completion rates in Taiwanese patients with early or advanced-stage HNC. Nonetheless, further extensive clinical studies are required for validation.
Collapse
Affiliation(s)
- Tzu-Chun Chen
- Cancer Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
- Min-Hwei Junior College of Health Care Management, Tainan, Taiwan, ROC
| | - Shih-Hao Wang
- Department of Otolaryngology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
- Department of otolaryngology, St. Martin De Porres Hospital, Chiayi, Taiwan, ROC
| | - Cho-Ming Ho
- Department of Oral and Maxillofacial Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
| | - Hwan-Chung Lin
- Department of Oral and Maxillofacial Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
| | - Chun-Liang Tung
- Department of Oral and Maxillofacial Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
| | - Chih-Chia Chang
- Department of Radiation Therapy and Oncology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
| | - Ching-Fang Tsai
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
| | - Tsung-Hsien Chen
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
| | - Yi-Chun Fang
- Cancer Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
| | - Wei-Ting Lin
- Department of Oral and Maxillofacial Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
| | - Yu-Ting Lee
- Department of Internal Medicine, Division of Hemato-Oncology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
| | - Yu-Sung Chang
- Department of Otolaryngology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
| | - Ming-Yang Lee
- Min-Hwei Junior College of Health Care Management, Tainan, Taiwan, ROC
- Department of Internal Medicine, Division of Hemato-Oncology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
| |
Collapse
|
2
|
Kuenzel J, Duerr S, Vester S, Zeman F, Huppertz G, Koller M, Pfleger G, Woertgen A, Salloum H, Klinkhammer-Schalke M, Pukrop T, Kummer P. The effects of Phoniatric PREhabilitation in Head and Neck Cancer patients on Aspiration and Preservation of Swallowing (PREHAPS): study protocol of a monocentric prospective randomized interventional outcome-blinded trial. Trials 2024; 25:211. [PMID: 38519961 PMCID: PMC10958950 DOI: 10.1186/s13063-024-08010-2] [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: 11/17/2023] [Accepted: 02/22/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Dysphagia, with its negative impact on life expectancy and quality of life, is a major side effect of head and neck squamous cell carcinoma (HNSCC). In a typical Head and Neck Cancer Center, more than half of patients are affected. Improving treatment, and ideally prevention respectively prehabilitation, therefore seems more than desirable. METHODS The study is planned as a monocentric, prospective, outcome-blinded, randomized interventional study comparing an advanced phoniatric-logopedic prehabilitation with a control (standard of care). Seventy patients (30 control group, 30 intervention group, 10 drop-out rate of 15%) with an initial diagnosis of invasive HNSCC and curative treatment intention will be included over a period of 17 months. In addition to the previous standard, both groups will undergo both detailed subjective assessment of swallowing function and quality of life by means of various questionnaires and objective analyses by bioelectrical impedance measurements and phoniatric endoscopic swallowing examinations. In the intervention group, risk-related nutritional counseling (face-to-face) and phoniatric-logopedic prehabilitation are provided: detailed counseling with video demonstration and exercises to strengthen and improve the range of motion of the oral, pharyngeal, and laryngeal muscles (guided by exercise diary). Controls are performed at 6 weeks, 3 and 6 months, and 9 or 12 months after the end of therapy during the regular tumor follow-up. Primary study endpoints are swallowing function and emotional distress at 6 weeks of control visit. DISCUSSION Prehabilitation measures have already proven successful in other patient groups, e.g., transplant patients. In the field of head and neck oncology, interest in such concepts has increased significantly in recent years. However, usually, only subgroups, e.g., patients with swallowing problems after radiochemotherapy alone, are in focus. Our study aims to investigate the general benefit of prehabilitation with regard to swallowing function, which is so important for protection of aspiration and quality of life. TRIAL REGISTRATION German Clinical Trials Register DRKS00029676 . International Clinical Trials Registry Platform DRKS00029676 . Registered on 19 July 2022.
Collapse
Affiliation(s)
- Julian Kuenzel
- Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, 93053, Germany.
| | - Stephan Duerr
- Department of Otorhinolaryngology, Section Phoniatrics and Pediatric Audiology, University Hospital Regensburg, Regensburg, Germany
| | - Sarah Vester
- Department of Otorhinolaryngology, Section Phoniatrics and Pediatric Audiology, University Hospital Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Gunnar Huppertz
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Gerda Pfleger
- Department of Otorhinolaryngology, Section Phoniatrics and Pediatric Audiology, University Hospital Regensburg, Regensburg, Germany
| | - Annika Woertgen
- Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, 93053, Germany
| | - Hazem Salloum
- Department of Otorhinolaryngology, Section Phoniatrics and Pediatric Audiology, University Hospital Regensburg, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Institute for Quality Management and Health Services Research, University Hospital Regensburg, Regensburg, Germany
| | - Tobias Pukrop
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Peter Kummer
- Department of Otorhinolaryngology, Section Phoniatrics and Pediatric Audiology, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
3
|
Singer S, Bergelt C, Tribius S, Laban S, Busch CJ. [Patient-reported outcomes in head and neck cancer treatment: relevance, challenges, and benefit]. HNO 2023; 71:592-598. [PMID: 37422597 DOI: 10.1007/s00106-023-01325-7] [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] [Accepted: 05/17/2023] [Indexed: 07/10/2023]
Abstract
Next to overall survival, quality of life is becoming more and more pivotal for cancer patients. The various domains of quality of life are complex and have different value to each patient. However, not only patients but also health care professionals, the pharmaceutical industry, and regulatory bodies ask: How can quality of life be reliably ascertained in clinical trials? For this purpose, carefully developed and validated specific questionnaires are needed: the patient-reported outcome measures (PROMs). A key challenge is to define how results based on PROMs can be used for shared decision-making. Next to clinical factors such as health and nutritional status, quality of life acts as a prognostic factor for overall survival in cancer. Thus, it is crucial to take quality of life into account in daily clinical practice.
Collapse
Affiliation(s)
- Susanne Singer
- Abteilung Epidemiologie und Versorgungsforschung, Institut für Medizinische Biometrie, Epidemiologie und Informatik, Universitätsmedizin Mainz, 55101, Mainz, Deutschland.
| | - Corinna Bergelt
- Institut für Medizinische Psychologie, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Silke Tribius
- Hermann-Holthusen-Institut für Strahlentherapie, Asklepios-Klinik St. Georg, Hamburg, Deutschland
- Asklepios Tumorzentrum Hamburg, Hamburg, Deutschland
| | - Simon Laban
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsmedizin Ulm, Ulm, Deutschland
| | - Chia-Jung Busch
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsmedizin Greifswald, Greifswald, Deutschland
| |
Collapse
|
4
|
Wentzel A, Floricel C, Canahuate G, Naser MA, Mohamed AS, Fuller CD, van Dijk L, Marai GE. DASS Good: Explainable Data Mining of Spatial Cohort Data. COMPUTER GRAPHICS FORUM : JOURNAL OF THE EUROPEAN ASSOCIATION FOR COMPUTER GRAPHICS 2023; 42:283-295. [PMID: 37854026 PMCID: PMC10583718 DOI: 10.1111/cgf.14830] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Developing applicable clinical machine learning models is a difficult task when the data includes spatial information, for example, radiation dose distributions across adjacent organs at risk. We describe the co-design of a modeling system, DASS, to support the hybrid human-machine development and validation of predictive models for estimating long-term toxicities related to radiotherapy doses in head and neck cancer patients. Developed in collaboration with domain experts in oncology and data mining, DASS incorporates human-in-the-loop visual steering, spatial data, and explainable AI to augment domain knowledge with automatic data mining. We demonstrate DASS with the development of two practical clinical stratification models and report feedback from domain experts. Finally, we describe the design lessons learned from this collaborative experience.
Collapse
Affiliation(s)
- A Wentzel
- University of Illinois Chicago, Electronic Visualization Lab
| | - C Floricel
- University of Illinois Chicago, Electronic Visualization Lab
| | | | - M A Naser
- University of Texas MD Anderson Cancer Center
| | - A S Mohamed
- University of Texas MD Anderson Cancer Center
| | - C D Fuller
- University of Texas MD Anderson Cancer Center
| | - L van Dijk
- University of Texas MD Anderson Cancer Center
| | - G E Marai
- University of Illinois Chicago, Electronic Visualization Lab
| |
Collapse
|
5
|
Lopez CJ, Teggart K, Ahmed M, Borhani A, Kong J, Fazelzad R, Langelier DM, Campbell KL, Reiman T, Greenland J, Jones JM, Neil-Sztramko SE. Implementation of electronic prospective surveillance models in cancer care: a scoping review. Implement Sci 2023; 18:11. [PMID: 37101231 PMCID: PMC10134630 DOI: 10.1186/s13012-023-01265-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/19/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Electronic prospective surveillance models (ePSMs) for cancer rehabilitation include routine monitoring of the development of treatment toxicities and impairments via electronic patient-reported outcomes. Implementing ePSMs to address the knowledge-to-practice gap between the high incidence of impairments and low uptake of rehabilitation services is a top priority in cancer care. METHODS We conducted a scoping review to understand the state of the evidence concerning the implementation of ePSMs in oncology. Seven electronic databases were searched from inception to February 2021. All articles were screened and extracted by two independent reviewers. Data regarding the implementation strategies, outcomes, and determinants were extracted. The Expert Recommendations for Implementing Change taxonomy and the implementation outcomes taxonomy guided the synthesis of the implementation strategies and outcomes, respectively. The Consolidated Framework for Implementation Research guided the synthesis of determinants based on five domains (intervention characteristics, individual characteristics, inner setting, outer setting, and process). RESULTS Of the 5122 records identified, 46 interventions met inclusion criteria. The common implementation strategies employed were "conduct educational meetings," "distribute educational materials," "change record systems," and "intervene with patients to enhance uptake and adherence." Feasibility and acceptability were the prominent outcomes used to assess implementation. The complexity, relative advantage, design quality, and packaging were major implementation determinants at the intervention level. Knowledge was key at the individual level. At the inner setting level, major determinants were the implementation climate and readiness for implementation. At the outer setting level, meeting the needs of patients was the primary determinant. Engaging various stakeholders was key at the process level. CONCLUSIONS This review provides a comprehensive summary of what is known concerning the implementation of ePSMs. The results can inform future implementation and evaluation of ePSMs, including planning for key determinants, selecting implementation strategies, and considering outcomes alongside local contextual factors to guide the implementation process.
Collapse
Affiliation(s)
- Christian J Lopez
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
- Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Kylie Teggart
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Mohammed Ahmed
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Anita Borhani
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Jeffrey Kong
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Rouhi Fazelzad
- Library and Information Services, University Health Network, Toronto, Canada
| | - David M Langelier
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Tony Reiman
- Department of Oncology, Saint John Regional Hospital, Saint John, Canada
| | - Jonathan Greenland
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Canada
| | - Jennifer M Jones
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Sarah E Neil-Sztramko
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada
| |
Collapse
|
6
|
Wald T, Zebralla V, Boege M, Kunz V, Neumuth T, Dietz A, Wichmann G, Wiegand S. Web-Based Patient-Reported Outcomes for ENT Patients-Evaluation of the Status Quo, Patients' View, and Future Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811773. [PMID: 36142048 PMCID: PMC9517261 DOI: 10.3390/ijerph191811773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/10/2022] [Accepted: 09/16/2022] [Indexed: 05/05/2023]
Abstract
BACKGROUND Patient-reported outcomes (PRO) assess disease burden and indicate unmet needs. Home-based electronic PRO measures (ePROMs) can support tumor aftercare (TAC). Creating an ePROM is the next step after implementing the software "OncoFunction" to assess PROs during TAC of head- and neck-cancer patients (HNC). Therefore, internet use and perception on ePROMs of ENT and TAC patients were evaluated. METHODS From May-July 2020, ENT patients at a high-volume outpatient department aged >18 without need for emergency treatment were invited to complete a questionnaire concerning internet use and access, hardware, and opinion on the chances, requirements, and designs of ePROMs. RESULTS 415 questionnaires were evaluated; 46.3% of the respondents visited the common consultation hour (CCH) and 44.3% TAC; 71.9% were internet users, being younger than non-internet users; and 36.4% of TAC patients were non-internet users and 16.3% of them were without a web-enabled device. Significant differences existed in age and assessment of future perspectives between internet-/non-internet users and TAC/CCH patients, respectively. Regarding the design of ePROMs, patients preferred quarterly and short surveys. Data safety and feedback were important. CONCLUSIONS ePROMs are not suitable for everyone because of missing internet access and experience. A tailored approach to implement ePROMs in TAC is needed.
Collapse
Affiliation(s)
- Theresa Wald
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Leipzig Medical Centre, 04103 Leipzig, Germany
- Correspondence:
| | - Veit Zebralla
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Leipzig Medical Centre, 04103 Leipzig, Germany
| | - Maren Boege
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Leipzig Medical Centre, 04103 Leipzig, Germany
| | - Viktor Kunz
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Leipzig Medical Centre, 04103 Leipzig, Germany
| | - Thomas Neumuth
- Innovation Center Computer Assisted Surgery, University of Leipzig, 04103 Leipzig, Germany
| | - Andreas Dietz
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Leipzig Medical Centre, 04103 Leipzig, Germany
| | - Gunnar Wichmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Leipzig Medical Centre, 04103 Leipzig, Germany
| | - Susanne Wiegand
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Leipzig Medical Centre, 04103 Leipzig, Germany
| |
Collapse
|
7
|
Floricel C, Nipu N, Biggs M, Wentzel A, Canahuate G, Van Dijk L, Mohamed A, Fuller CD, Marai GE. THALIS: Human-Machine Analysis of Longitudinal Symptoms in Cancer Therapy. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2022; 28:151-161. [PMID: 34591766 PMCID: PMC8785360 DOI: 10.1109/tvcg.2021.3114810] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Although cancer patients survive years after oncologic therapy, they are plagued with long-lasting or permanent residual symptoms, whose severity, rate of development, and resolution after treatment vary largely between survivors. The analysis and interpretation of symptoms is complicated by their partial co-occurrence, variability across populations and across time, and, in the case of cancers that use radiotherapy, by further symptom dependency on the tumor location and prescribed treatment. We describe THALIS, an environment for visual analysis and knowledge discovery from cancer therapy symptom data, developed in close collaboration with oncology experts. Our approach leverages unsupervised machine learning methodology over cohorts of patients, and, in conjunction with custom visual encodings and interactions, provides context for new patients based on patients with similar diagnostic features and symptom evolution. We evaluate this approach on data collected from a cohort of head and neck cancer patients. Feedback from our clinician collaborators indicates that THALIS supports knowledge discovery beyond the limits of machines or humans alone, and that it serves as a valuable tool in both the clinic and symptom research.
Collapse
|