|
1
|
Chen Y, Zhang Y, Zheng Q, Sun L. Lived experiences and insights of Chinese patients with symptomatic osteoporosis on a patient-reported outcome (PRO) programme: a qualitative phenomenological study in Southwest China. BMJ Open 2025; 15:e087480. [PMID: 40180413 PMCID: PMC11969611 DOI: 10.1136/bmjopen-2024-087480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 02/07/2025] [Indexed: 04/05/2025] Open
Abstract
OBJECTIVES To explore the lived experiences of patients with symptomatic osteoporosis on a patient-reported outcomes (PROs) programme for symptom management and quality of life (QoL) improvement. DESIGN This is a qualitative phenomenological study. SETTING PARTICIPANTS: 14 active participants in the PROs programme were recruited and interviewed through semi-structured face-to-face interviews. Colaizzi's seven-step method was employed for thematic analysis. RESULTS Four overarching themes and two sub-themes emerged, including (1) varied perceptions of the PROs programme, where some participants found it beneficial for tracking symptoms while others cited challenges such as technological barriers and lack of actionable outcomes; (2) PROs as a tool for enhancing communication and facilitating appointments by enabling more efficient doctor-patient interactions and quicker scheduling; (3) emotional support provided by regular doctor-patient communication, with sub-themes of fostering a sense of belonging and offering psychological comfort; and (4) limitations of remote communication, highlighting challenges in addressing complex medical needs and providing immediate solutions for medication adjustments. CONCLUSIONS PROs programmes facilitate symptom tracking, enhance communication and provide emotional support for patients with osteoporosis. However, limitations such as technological barriers and reliance on remote communication must be addressed. Ethical considerations, including potential over-reporting of symptoms to expedite care, require careful management. Future research should include patients who discontinue participating in the PROs programme prematurely and the perspectives of healthcare providers to provide a more balanced, comprehensive understanding.
Collapse
Affiliation(s)
- Yao Chen
- Department of Osteoporosis, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Non-Communicable Diseases Research Center, West China-PUMC C. C. Chen Institute of Health, Chengdu, Sichuan, China
| | - Yuehua Zhang
- Department of Osteoporosis, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Non-Communicable Diseases Research Center, West China-PUMC C. C. Chen Institute of Health, Chengdu, Sichuan, China
| | - Qianlian Zheng
- Department of Osteoporosis, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Non-Communicable Diseases Research Center, West China-PUMC C. C. Chen Institute of Health, Chengdu, Sichuan, China
| | - Lei Sun
- Department of Osteoporosis, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Non-Communicable Diseases Research Center, West China-PUMC C. C. Chen Institute of Health, Chengdu, Sichuan, China
| |
Collapse
|
|
2
|
Nicola A, Adelina M, Porosnicu TM, Oancea C, Marc MS, Barata PI. Comparing Quality of Life and Psychological Changes in Benign and Malignant Lung Resections. Healthcare (Basel) 2024; 13:6. [PMID: 39791613 PMCID: PMC11719650 DOI: 10.3390/healthcare13010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2024] [Revised: 12/18/2024] [Accepted: 12/23/2024] [Indexed: 01/12/2025] Open
Abstract
Background and Objectives: Pulmonary resections are critical interventions for treating various lung pathologies, both benign and malignant. Understanding the impact of these surgeries on patients' Quality of Life (QoL) is essential for optimizing care. This study aims to compare the Health-Related Quality of Life (HRQoL) and psychological well-being in patients who underwent pulmonary resections for benign versus malignant etiologies. Methods: A cross-sectional study was conducted involving 117 patients who underwent pulmonary resection between January 2022 and June 2023. Participants were divided into two groups: 51 patients with benign lung conditions and 66 with malignant lung tumors. HRQoL was assessed using the SF-36 and WHOQOL-BREF questionnaires. Anxiety and depression levels were evaluated using the Hospital Anxiety and Depression Scale (HADS) and the Perceived Stress Scale (PSS-10). Patients were assessed pre- and post-intervention. Results: Patients with malignant etiologies were older (58.7 vs. 54.2 years) and had lower FEV1% predicted (79.1% vs. 82.5%) compared to the benign group. Malignant patients reported significantly lower scores in physical functioning (68.1 vs. 75.4), role-physical (65.0 vs. 72.3), and general health domains of the SF-36 (62.4 vs. 70.2). WHOQOL-BREF scores indicated a lower overall QoL in the malignant group, particularly in the physical health (65.3 vs. 72.1) and psychological domains (68.0 vs. 74.5). HADS scores revealed higher anxiety (9.1 vs. 7.2) and depression levels (8.5 vs. 6.8) among malignant patients. Correlation analyses showed strong associations between lower QoL scores and higher anxiety and depression levels. Conclusions: Pulmonary resections for malignant conditions are associated with a significant decline in HRQoL compared to benign conditions. Patients with malignant etiologies experience higher levels of anxiety and depression, emphasizing that clinicians should integrate specialized mental health services and tailored physical rehabilitation programs for patients undergoing pulmonary resections for malignant lung conditions to address their significantly reduced quality of life and increased psychological distress.
Collapse
Affiliation(s)
- Alin Nicola
- Department of Thoracic Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Mavrea Adelina
- Department of Internal Medicine I, Cardiology Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Tamara Mirela Porosnicu
- Department of Anesthesia and Intensive Care, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Cristian Oancea
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, Timisoara 300041, Romania; (C.O.); (M.S.M.); (P.I.B.)
| | - Monica Steluta Marc
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, Timisoara 300041, Romania; (C.O.); (M.S.M.); (P.I.B.)
| | - Paula Irina Barata
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, Timisoara 300041, Romania; (C.O.); (M.S.M.); (P.I.B.)
- Department of Physiology, Faculty of Medicine, “Vasile Goldis” Western University of Arad, 310025 Arad, Romania
| |
Collapse
|
|
3
|
Yurdakul O, Alan A, Krauter J, Korn S, Gust K, Shariat SF, Hassler MR. Impact of immigration background on feasibility of electronic patient-reported outcomes in advanced urothelial cancer patients. Health Qual Life Outcomes 2024; 22:107. [PMID: 39696509 DOI: 10.1186/s12955-024-02325-z] [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: 07/29/2023] [Accepted: 12/10/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND Electronic patient-reported outcomes (ePROs) have been shown to enhance healthcare quality by improving patient symptom management or quality of life (QoL). However, ePROs data for urothelial cancer (UC) patients receiving systemic therapies are scarce, and the application of ePROs in this patient cohort may need specific setups. This study tested the feasibility of ePROs for UC patients receiving systemic therapies in the outpatient clinic of a tertiary care center. PATIENTS AND METHODS From January 2022 to April 2023, 30 UC patients receiving systemic cancer therapies received ePROs based on the Common Terminology Criteria for Adverse Events (CTCAE) and European Organization for Research and Treatment of Cancer Core Quality of Life questionnaires (EORTC QLQ-30) to report their symptoms and QoL during systemic therapy, in total, 125 questions for every therapy cycle. The proportion of patients adherent to the ePROs was assessed to evaluate feasibility, with a preset threshold of 50%. At least half of all treatment cycles with a minimum of two consecutive ePROs (corresponding to two successive therapy cycles) had to be completed to be counted as adherent, and a maximum of six successive therapy cycles was followed by ePROs. Descriptive statistics were calculated for clinical and demographic patient characteristics. T-test and chi-square-test analyses were performed to study the association between ePROs adherence and clinical or demographic factors. The digital process was closely monitored for procedural impediments that could occur. RESULTS 21 (70%) of the included 30 patients adhered to the provided ePROs, significantly higher than the predetermined threshold of 50%. Adherence remained above 70% until the end of the observation period. A significant negative effect of immigration background on ePROs compliance was observed (p = 0.006). No other variables were significantly associated with ePROs compliance. CONCLUSIONS In this study, ePROs were a feasible method to assess symptoms and QoL during the systemic cancer therapy of UC patients at our center. The compliance of patients with immigration backgrounds was the most significant barrier to using ePROs in this setting. However, the study is limited by the exclusion of patients without email access and the lack of assessment of physician compliance with the ePROs data, which may affect the generalizability and implementation of the findings.
Collapse
Affiliation(s)
- Ozan Yurdakul
- Department of Urology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Abdulkarim Alan
- IT Systems and Communications, Medical University of Vienna, Vienna, Austria
| | - Johanna Krauter
- Department of Urology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Stephan Korn
- Department of Urology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Kilian Gust
- Department of Urology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
- European Association of Urology Research Foundation, Arnhem, Netherlands
| | - Melanie R Hassler
- Department of Urology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.
| |
Collapse
|
|
4
|
Maurer J, Saibold A, Gerl K, Koller M, Koelbl O, Pukrop T, Windschuettl S, Einhell S, Herrmann-Johns A, Raptis G, Mueller K. Systematic development of a patient-reported ONCOlogical-ROUTinE-Screening (ONCO-ROUTES) procedure at the University Cancer Center Regensburg. J Cancer Res Clin Oncol 2024; 150:435. [PMID: 39340547 PMCID: PMC11438834 DOI: 10.1007/s00432-024-05955-4] [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: 07/24/2024] [Accepted: 09/13/2024] [Indexed: 09/30/2024]
Abstract
PURPOSE The evaluation of treatment success and progression in oncology patient-reported outcomes (PROs) is playing an increasingly important role. Meanwhile, PROs are a component of the certification requirements of the German Cancer Society for oncology centers. PROs are used to provide supportive therapy. There is currently no instrument that fully covers the requirements. At the University Hospital Regensburg (UKR), a digital ONCOlogical-ROUTinE-Screening (ONCO-ROUTES) procedure was developed in order to assess the need for supportive therapy in a standardized way and to provide patients with supportive interventions tailored to their needs. METHODS On the basis of current requirements and guidelines, the development of ONCO-ROUTES was supported by experts in focus groups and interviews, and digitalization was carried out in connection with the IT infrastructure. RESULTS A Needs-based, Quality-of-life (QoL) and Symptoms Screening (NQS2) tool already established in the routine at the UKR was further developed into ONCO-ROUTES, which is made up of the domains therapy phase, nutrition, tobacco use, alcohol use, quality of life, general condition/functional status, physical activity, psychooncology, social services, and further support needs. By linking the digitized questionnaire to the hospital information system, the results are available for immediate use in routine operations and thus for the referral of patients for further supportive therapy. CONCLUSION The digital PRO application ONCO-ROUTES is designed to involve patients in monitoring additional supportive needs and thus, improves supportive interdisciplinary treatment.
Collapse
Affiliation(s)
- Julia Maurer
- University Cancer Center Regensburg, University Hospital Regensburg, Regensburg, Germany.
- Bavarian Cancer Research Center (BZKF), Regensburg, Germany.
| | - Anna Saibold
- Bavarian Cancer Research Center (BZKF), Regensburg, Germany
- Department of Information Technology, University Hospital Regensburg, Regensburg, Germany
| | | | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Oliver Koelbl
- Department of Radiation Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Tobias Pukrop
- Bavarian Cancer Research Center (BZKF), Regensburg, Germany
- Department of Internal Medicine 3, University Hospital Regensburg, Regensburg, Germany
| | - Sandra Windschuettl
- Bavarian Cancer Research Center (BZKF), Regensburg, Germany
- Department of Internal Medicine 3, University Hospital Regensburg, Regensburg, Germany
| | - Sabine Einhell
- Department of Internal Medicine 3, University Hospital Regensburg, Regensburg, Germany
| | - Anne Herrmann-Johns
- Bavarian Cancer Research Center (BZKF), Regensburg, Germany
- Department of Internal Medicine 3, University Hospital Regensburg, Regensburg, Germany
- Department for Epidemiology and Preventive Medicine, Medical Sociology, University Regensburg, Regensburg, Germany
| | | | - Karolina Mueller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
|
5
|
Billingy NE, van den Hurk CJG, N M F Tromp V, van de Poll-Franse L, Onwuteaka-Philipsen BD, Hugtenburg JG, Bogaard HJ, Belderbos J, Aaronson NK, Walraven I, Becker-Commissaris A. Patient- vs Physician-Initiated Response to Symptom Monitoring and Health-Related Quality of Life: The SYMPRO-Lung Cluster Randomized Trial. JAMA Netw Open 2024; 7:e2428975. [PMID: 39186274 DOI: 10.1001/jamanetworkopen.2024.28975] [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: 08/27/2024] Open
Abstract
Importance Online symptom monitoring through patient-reported outcomes can enhance health-related quality of life and survival. However, widespread adoption in clinical care remains limited due to various barriers including the need to reduce health care practitioners' workload. Objective To report the effects of patient-reported outcome (PRO) symptom monitoring on HRQOL and survival up to 1 year after initiation of any treatment in patients with lung cancer. Design, Setting, and Participants SYMPRO-Lung is a multicenter stepped-wedge cluster randomized trial including patients with stage I to IV lung cancer. The inclusion period was from October 24, 2019, until September 16, 2021, and data collection ended October 8, 2022. Data analysis was conducted from November 9, 2023, until March 18, 2024. Intervention Patients in the intervention group reported PRO symptoms weekly using the Patient Reported Outcomes version of the Common Toxicity Criteria for Adverse Events lung cancer subset. If symptoms exceeded a validated threshold, an alert was sent to the health care practitioner (active intervention subgroup) or to the patient (reactive intervention subgroup). Patients in the control group received standard care. Main Outcomes and Measures Health-related quality of life was measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire at baseline, 15 weeks (T1), 6 months (T2), and 1 year (T3), with the summary score (SS) and physical functioning (PF) as primary end points. Linear mixed-effects modeling was used to assess mean differences over time. Effect size (ES) of 0.40 or greater was considered clinically relevant. Cox proportional hazards regression survival analyses were performed to estimate the effect of the intervention on progression-free survival and overall survival (OS). Data were analyzed on an intention-to-treat basis. Results A total of 515 patients (266 [51.7%] men; mean [SD] age, 65.4 [9.4] years) were included in the study (266 in the control group; 249 in the pooled intervention group). Most baseline characteristics were balanced between groups; however, the most notable exception was the distribution in cancer staging: the intervention group had a higher proportion of patients with stage IV cancer compared with the control group (139 [56%] vs 118 [44%]). The pooled intervention group had a significantly better SS (mean difference T1, 5.22; 95% CI, 2.72-7.73; P < .001; ES = 0.33; mean difference T2, 6.28; 95% CI, 3.65-8.92; P < .001; ES = 0.40; mean difference T3, 3.97; 95% CI, 1.15-6.80; P = .006; ES = 0.25) compared with the control group. Group differences improved more in PF but did not meet the ES greater than or equal to 0.40 threshold (mean difference T1, 7.00; 95% CI, 3.65-10.35; P < .001; ES = 0.27; mean difference T2, 6.79; 95% CI, 3.26-10.31; P < .001; ES = 0.26; mean difference T3, 5.01; 95% CI, 1.23-8.79; P = .009; ES = 0.19). No significant differences in HRQOL were observed between the reactive (n = 89) and active (n = 160) intervention groups. The HR for progression-free survival for the active intervention group compared with the control group was 0.78 (95% CI, 0.58-1.04); the finding was not statistically significant. The HR for overall survival for both interventions groups compared with the control group were not statistically significant.(active: HR, 0.80; 95% CI, 0.55-1.15; reactive: HR, 0.69; 95% CI, 0.42-1.15). Conclusions and Relevance In this 1-year follow-up of a stepped-wedge cluster randomized trial, PRO symptom monitoring yielded improvements in long-term HRQOL in patients with lung cancer. The reactive approach proved equally effective as the active approach. A nonsignificant potential survival benefit was observed for the intervention group. These positive results provide further evidence for the usefulness of routine PRO symptom monitoring in lung cancer care. Trial Registration The Netherlands trial register Identifier: NL7897.
Collapse
Affiliation(s)
- Nicole E Billingy
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
- Department of IQ Health, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Corina J G van den Hurk
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Vashti N M F Tromp
- Department of Clinical Pharmacology and Pharmacy, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Lonneke van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
- Division of Psychosocial Research & Epidemiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
- CoRPS, Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Harm Jan Bogaard
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - José Belderbos
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Neil K Aaronson
- Division of Psychosocial Research & Epidemiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Iris Walraven
- Department of IQ Health, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
|
6
|
Heinzelmann A, Tewes M, Müller S, Sure U, Herrmann K, Schadendorf D, Warnecke E, Rausch R, Skoda EM, Salvador Comino MR. Determining the cut-off value for the Minimal Documentation System (MIDOS2) screening tool to initiate specialized palliative care based on patient's subjective need for palliative support and symptom burden in inpatients with advanced cancer. J Cancer Res Clin Oncol 2024; 150:360. [PMID: 39046592 PMCID: PMC11269497 DOI: 10.1007/s00432-024-05897-x] [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: 05/25/2024] [Accepted: 07/15/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE The Minimal Documentation System (MIDOS2) is recommended as a systematic screening tool for assessing symptom burden and patient needs in advanced cancer patients. Given the absence of an optimal weighting of individual symptoms and a corresponding cut-off value, this study aims to determine a threshold based on inpatient's subjective need for palliative support. Additionally, we investigate the correlation between symptom burden and subjective need for palliative support collected through a patient-reported outcome measure (PROM) with survival duration of less or more than one year. METHODS Inpatients diagnosed with advanced solid cancer completed an electronic PROM, which included the MIDOS2 questionnaire among other tools. Differences in symptom burden were analysed between patients expressing subjective need for palliative support and those with survival of less or more than one year using ANOVA, Mann-Whitney-U Test, logistic regression, Pearson and Spearman correlation tests. Cut-off analyses were performed using a ROC curve. Youden-Index, sensitivity, and specificity measures were used as well. RESULTS Between April 2020 and March 2021, 265 inpatients were included in the study. Using a ROC curve, the MIDOS2 analysis resulted in an Area under the curve (AUC) of 0.732, a corresponding cut-off value of eight points, a sensitivity of 76.36% and a specificity of 62.98% in assessing the subjective need for palliative support. The MIDOS2, with double weighting of the significant symptoms, showed a cut-off value of 14 points, achieving a sensitivity of 78.18% and a specificity of 72.38%. A total of 55 patients (20.8%) expressed a need for support from the palliative care team. This need was independent of the oncological tumour entity and increased among patients with a survival of less than one year. These patients reported significantly poorer physical (p < 0.001) or mental (p < 0.001) condition. Additionally, they reported higher intensities of pain (p = 0.002), depressive symptoms (p < 0.001), weakness (p < 0.001), anxiety (p < 0.001), and tiredness (p < 0.001). CONCLUSION Using the established MIDOS2 cut-off value with an adjusted double weighting in our study, a large proportion of inpatients may be accurately referred to SPC based on their subjective need for palliative support. Additionally, subjective reports of poor general, mental, and physical condition, as well as pain, depressive symptoms, weakness, anxiety, and tiredness, increase the subjective need for palliative support, particularly in patients with a survival prognosis of less than one year.
Collapse
Affiliation(s)
- Anna Heinzelmann
- Department of Palliative Medicine, University Hospital Essen (AöR), 45147, Essen, Germany
| | - Mitra Tewes
- Department of Palliative Medicine, University Hospital Essen (AöR), 45147, Essen, Germany
| | - Sandy Müller
- Department of Palliative Medicine, University Hospital Essen (AöR), 45147, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital Essen (AöR), 45147, Essen, Germany
| | - Ken Herrmann
- Department of Nuclearmedicine, University Hospital Essen (AöR), 45147, Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen (AöR), 45147, Essen, Germany
| | - Eva Warnecke
- Department of Palliative Medicine, University Hospital Essen (AöR), 45147, Essen, Germany
| | - Raya Rausch
- West German Cancer Center, University Hospital Essen (AöR), 45147, Essen, Germany
| | - Eva-Maria Skoda
- Department for Psychosomatic Medicine and Psychotherapy LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro-and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | | |
Collapse
|
|
7
|
Billingy NE, Tromp VNMF, Aaronson NK, Hoek RJA, Bogaard HJ, Onwuteaka-Philipsen BD, van de Poll-Franse L, Hugtenburg JG, Belderbos J, Becker-Commissaris A, van den Hurk CJG, Walraven I. Quality of life after patient-initiated vs physician-initiated response to symptom monitoring: the SYMPRO-Lung trial. J Natl Cancer Inst 2023; 115:1515-1525. [PMID: 37603720 PMCID: PMC10699799 DOI: 10.1093/jnci/djad159] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/27/2023] [Accepted: 07/24/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Previous studies using patient-reported outcomes measures (PROMs) to monitor symptoms during and after (lung) cancer treatment used alerts that were sent to the health-care provider, although an approach in which patients receive alerts could be more clinically feasible. The primary aim of this study was to compare the effect of weekly PROM symptom monitoring via a reactive approach (patient receives alert) or active approach (health-care provider receives alert) with care as usual on health-related quality of life (HRQOL) at 15 weeks after start of treatment in lung cancer patients. METHODS The SYMPRO-Lung trial is a multicenter randomized controlled trial using a stepped wedge design. Stage I-IV lung cancer patients in the reactive and active groups reported PROM symptoms weekly, which were linked to a common alerting algorithm. HRQOL was measured by the EORTC QLQ-C30 at baseline and after 15 weeks. Linear regression analyses and effect size estimates were used to assess mean QOL-C30 change scores between groups, accounting for confounding. RESULTS A total of 515 patients were included (160 active group, 89 reactive group, 266 control group). No differences in HRQOL were observed between the reactive and active group (summary score: unstandardized beta [B] = 0.51, 95% confidence interval [CI] = -3.22 to 4.24, Cohen d effect size [ES] = 0.06; physical functioning: B = 0.25, 95% CI = -5.15 to 4.64, ES = 0.02). The combined intervention groups had statistically and clinically significantly better mean change scores on the summary score (B = 4.85, 95% CI = 1.96 to 7.73, ES = 0.57) and physical functioning (B = 7.00, 95% CI = 2.90 to 11.09, ES = 0.71) compared with the control group. CONCLUSIONS Weekly PRO symptom monitoring statistically and clinically significantly improves HRQOL in lung cancer patients. The logistically less intensive, reactive approach may be a better fit for implementation.
Collapse
Affiliation(s)
- Nicole E Billingy
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (UMC), Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Vashti N M F Tromp
- Department of Clinical Pharmacology and Pharmacy, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Rianne J A Hoek
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (UMC), Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Harm Jan Bogaard
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (UMC), Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Lonneke van de Poll-Franse
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
- CoRPS—Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - José Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (UMC), Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Corina J G van den Hurk
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Iris Walraven
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
|
8
|
da Silva Lopes AM, Colomer-Lahiguera S, Darnac C, Giacomini S, Bugeia S, Gutknecht G, Spurrier-Bernard G, Cuendet M, Muet F, Aedo-Lopez V, Mederos N, Michielin O, Addeo A, Latifyan S, Eicher M. Testing a Model of Care for Patients on Immune Checkpoint Inhibitors Based on Electronic Patient-Reported Outcomes: Protocol for a Randomized Phase II Controlled Trial. JMIR Res Protoc 2023; 12:e48386. [PMID: 37851498 PMCID: PMC10620631 DOI: 10.2196/48386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/26/2023] [Accepted: 08/30/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Management of severe symptomatic immune-related adverse events (IrAEs) related to immune checkpoint inhibitors (ICIs) can be facilitated by timely detection. As patients face a heterogeneous set of symptoms outside the clinical setting, remotely monitoring and assessing symptoms by using patient-reported outcomes (PROs) may result in shorter delays between symptom onset and clinician detection. OBJECTIVE We assess the effect of a model of care for remote patient monitoring and symptom management based on PRO data on the time to detection of symptomatic IrAEs from symptom onset. The secondary objectives are to assess its effects on the time between symptomatic IrAE detection and intervention, IrAE grade (severity), health-related quality of life, self-efficacy, and overall survival at 6 months. METHODS For this study, 198 patients with cancer receiving systemic treatment comprising ICIs exclusively will be recruited from 2 Swiss university hospitals. Patients are randomized (1:1) to a digital model of care (intervention) or usual care (control group). Patients are enrolled for 6 months, and they use an electronic app to complete weekly Functional Assessment of Cancer Therapy-General questionnaire and PROMIS (PROs Measurement Information System) Self-Efficacy to Manage Symptoms questionnaires. The intervention patient group completes a standard set of 37 items in a weekly PROs version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) questionnaire, and active symptoms are reassessed daily for the first 3 months by using a modified 24-hour recall period. Patients can add items from the full PRO-CTCAE item library to their questionnaire. Nurses call patients in the event of new or worsening symptoms and manage them by using a standardized triage algorithm based on the United Kingdom Oncology Nursing Society 24-hour triage tool. This algorithm provides guidance on deciding if patients should receive in-person care, if monitoring should be increased, or if self-management education should be reinforced. RESULTS The Institut Suisse de Recherche Expérimentale sur le Cancer Foundation and Kaiku Health Ltd funded this study. Active recruitment began since November 2021 and is projected to conclude in November 2023. Trial results are expected to be published in the first quarter of 2024 and will be disseminated through publications submitted at international scientific conferences. CONCLUSIONS This trial is among the first trials to use PRO data to directly influence routine care of patients treated with ICIs and addresses some limitations in previous studies. This trial collects a wider spectrum of self-reported symptom data daily. There are some methodological limitations brought by changes in evolving treatment standards for patients with cancer. This trial's results could entail further academic discussions on the challenges of diagnosing and managing symptoms associated with treatment remotely by providing further insights into the burden symptoms represent to patients and highlight the complexity of care procedures involved in managing symptomatic IrAEs. TRIAL REGISTRATION ClinicalTrials.gov NCT05530187; https://www.clinicaltrials.gov/study/NCT05530187. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48386.
Collapse
Affiliation(s)
- André Manuel da Silva Lopes
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Sara Colomer-Lahiguera
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Célia Darnac
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Stellio Giacomini
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Sébastien Bugeia
- Department of Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Garance Gutknecht
- Department of Oncology, Geneva University Hospital, Geneva, Switzerland
| | | | - Michel Cuendet
- Precision Oncology Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Fanny Muet
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | | | - Nuria Mederos
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Michielin
- Department of Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Alfredo Addeo
- Department of Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Sofiya Latifyan
- Precision Oncology Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Manuela Eicher
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
|
9
|
Mukherjee S, Shupo F, Wayi-Wayi G, Zibelnik N, Jones E, Mason N, Franklin M, Brazier J. Symptom burden in patients with idiopathic multicentric Castleman disease and its impact on daily life: an international patient and caregiver survey. EClinicalMedicine 2023; 64:102192. [PMID: 37727459 PMCID: PMC10505977 DOI: 10.1016/j.eclinm.2023.102192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 09/21/2023] Open
Abstract
Background Idiopathic Multicentric Castleman Disease (iMCD) is a rare inflammatory lymphoproliferative disorder with heterogenous clinical presentations. The symptomatology in iMCD patients remains poorly understood. The aim of this study was to identify the type, frequency and severity of iMCD-related symptoms and the impact of these on the daily lives of iMCD patients and informal-caregivers. Methods We conducted two bespoke 45-question online surveys for iMCD patients and informal-caregivers of patients recruited from the US, UK, Australia and Canada between April 14 and November 8, 2021. Descriptive data was collected, and a Likert scale was used to quantify the impact of symptoms on various aspects of daily life. Ordinal logistic regression analysis was used to determine associations between age, gender, employment status and symptom burden with aspects of daily life. Findings Eligible respondents included 51 iMCD patients and 11 informal-caregivers. Patients reported up to 27 unique symptoms, the mean number of symptoms experienced by a patient was 6.7 (range 0-22 symptoms). Most symptoms had a moderate to severe impact on patients' daily lives, with 'pain/discomfort', 'ability to travel', and 'sexual functioning' being the most impacted. iMCD patient characteristics such as being 40 years or older, female, and either disabled or unemployed was significantly associated with adverse impact on several aspects of daily life. Among caregivers, the aspects of daily life that were disproportionately affected was their own social life and freedom, emotional wellbeing, travel/relocation, and work. Interpretation iMCD patients have widely varied and unappreciated symptomatology. High symptom burden adversely impacts several aspects of patient daily lives as well as their caregivers. Funding Funding was provided by EUSA Pharma.
Collapse
Affiliation(s)
- Sudipto Mukherjee
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | | | | | | | - Matthew Franklin
- School of Health and Related Research, Sheffield University, Sheffield, United Kingdom
| | - John Brazier
- School of Health and Related Research, Sheffield University, Sheffield, United Kingdom
| |
Collapse
|
|
10
|
Cremante M, Pastorino A, Ponzano M, Grassi M, Martelli V, Puccini A, Catalano F, Murianni V, Iaia ML, Puglisi S, Gandini A, Fornarini G, Caprioni F, Andretta V, Pessino A, Comandini D, Sciallero MS, Mammoliti S, Sormani MP, Sobrero A. Reliability of patient-reported toxicities during adjuvant chemotherapy. Eur J Cancer 2023; 182:115-121. [PMID: 36758476 DOI: 10.1016/j.ejca.2023.01.005] [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: 11/23/2022] [Revised: 01/02/2023] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) are validated tools to assess the impact of efficacy and toxicities of cancer treatments on patients' health status. Because of the demonstrated little reliability of humans in reporting memories of painful experiences, this work explores the reliability of cancer patients in reporting chemotherapy-related toxicities. AIM This study aims to evaluate the concordance between toxicities experienced by the patients during chemotherapy and toxicities reported to the doctor at the end of the cycles. METHODS Questionnaires concerning chemotherapy-related toxicities were administered on days 2, 5, 8, 11, 14, and 17 of each chemo cycle and at the end of the same cycle to patients undergoing adjuvant chemotherapy. The co-primary end-points were Lins's concordance correlation coefficient (CCC) and mean difference between real-time and retrospective toxicity assessments. RESULTS In total, 7182 toxicity assessments were collected from 1096 questionnaires. Concordance was observed between the retrospective evaluations and the toxicity assessments at early (day 2), peak (maximum toxicity), late (day 14 or 17), and mean real-time evaluations for each chemotherapy cycle (CCC for mean ranging from 0.52 to 0.77). No systematic discrepancy was found between real-time and retrospective evaluations, except for peak, which was systematically underestimated retrospectively. CONCLUSIONS Toxicities reported by the patients to the doctor at the end of each chemotherapy cycle reflect what they actually experienced without any substantial distortion. This result is very relevant both for the clinical implications in daily patients' management and in the light of the current growing impact on digital monitoring of PROs.
Collapse
Affiliation(s)
- Malvina Cremante
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Alessandro Pastorino
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Marta Ponzano
- Department of Health Sciences (DISSAL), University of Genova, 16132 Genova, Italy
| | - Massimiliano Grassi
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Valentino Martelli
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Alberto Puccini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Fabio Catalano
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Veronica Murianni
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Maria L Iaia
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Silvia Puglisi
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Annalice Gandini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Francesco Caprioni
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Valeria Andretta
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Annamaria Pessino
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Danila Comandini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Maria S Sciallero
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Serafina Mammoliti
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Maria P Sormani
- Department of Health Sciences (DISSAL), University of Genova, 16132 Genova, Italy
| | - Alberto Sobrero
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy.
| |
Collapse
|
|
11
|
Agostinelli V, De Filippis C, Torniai M, Rocchi MBL, Pagliacci A, Ricci G, Corsi R, Luzi P, Caporossi M, Berardi R. Primum non Nocere: How to ensure continuity of care and prevent cancer patients from being overlooked during the COVID- 19 pandemic. Cancer Med 2023; 12:1821-1828. [PMID: 35754357 PMCID: PMC9350138 DOI: 10.1002/cam4.4986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has spread to all countries since December 2019, triggering a pandemic within weeks of the initial outbreak. Doctors were presented with the challenge of having to reimagine the traditional hospital organisation in order to effectively manage patients. PATIENTS AND METHODS During the months of the COVID-19 pandemic our Institution was assisted by a call-center (CC) that triaged cancer patients planned for follow-up in our outpatient clinics: C1 (for female cancers), C2 (for gastrointestinal, urogenital, and thoracic tumours), and D1 (for melanoma and for patients with tumours in over 5 years follow up). Data refers to the period between 15 April and 3 July 2020. RESULTS A total of 1054 patients have been included in our study and 1005 (95%) of the contacts were successful. The analysis showed a majority of female patients (74%) and patients affected by breast cancer (56%). Among the options provided 646 patients (92.4%) opted for online consultancy. CONCLUSION This study has shown that cancer patients valued technology-mediated follow-up visits mainly during the beginning of the pandemic because patients themselves were afraid to come to the hospital. Although telemedicine has intrinsic limitations, it is important for providing assistance and preventing cancer patients from feeling isolated during an emergency.
Collapse
Affiliation(s)
- Veronica Agostinelli
- Department of Medical OncologyUniversità Politecnica delle Marche, AOU Ospedali Riuniti AnconaAnconaItaly
| | - Chiara De Filippis
- Department of Medical OncologyUniversità Politecnica delle Marche, AOU Ospedali Riuniti AnconaAnconaItaly
| | - Mariangela Torniai
- Department of Medical OncologyUniversità Politecnica delle Marche, AOU Ospedali Riuniti AnconaAnconaItaly
- Department of Medical OncologyFermoItaly
| | - Marco Bruno Luigi Rocchi
- Department of Biomolecular Sciences‐Service of BiostatisticsUniversity of Urbino Carlo BoUrbinoItaly
| | - Alessandra Pagliacci
- Department of Medical OncologyUniversità Politecnica delle Marche, AOU Ospedali Riuniti AnconaAnconaItaly
| | - Giulia Ricci
- Department of Medical OncologyUniversità Politecnica delle Marche, AOU Ospedali Riuniti AnconaAnconaItaly
| | | | - Paolo Luzi
- TOPS Healthcare Communication srlRomeItaly
| | | | - Rossana Berardi
- Department of Medical OncologyUniversità Politecnica delle Marche, AOU Ospedali Riuniti AnconaAnconaItaly
| |
Collapse
|
|
12
|
AlJaffar MA, Enani SS, Almadani AH, Albuqami FH, Alsaleh KA, Alosaimi FD. Determinants of quality of life of cancer patients at a tertiary care medical city in Riyadh, Saudi Arabia. Front Psychiatry 2023; 14:1098176. [PMID: 36846221 PMCID: PMC9944126 DOI: 10.3389/fpsyt.2023.1098176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Incidences of cancer are increasing at an unprecedented rate in Saudi Arabia, making it a major public health concern. Cancer patients are faced with physical, psychological, social, and economic challenges, all of which can impact quality of life (QoL). OBJECTIVES This study aims to explore the sociodemographic, psychological, clinical, cultural, and personal factors that could affect the overall QoL of cancer patients. METHODS A total of 276 cancer patients who attended the King Saud University Medical City's oncology outpatient clinics between January 2018 to December 2019 were included. QoL was assessed with the Arabic version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30. Psychosocial factors were assessed with several validated scales. RESULTS QoL was poorer among patients who were female (p = 0.001), have visited a psychiatrist (p = 0.028); were taking psychiatric medications (p = 0.022); and had experienced anxiety (p < 0.001), depression (p < 0.001), and distress (p < 0.001). The most used method to self-treat was Islamic Ruqya (spiritual healing; 48.6%), and the most often perceived cause for developing cancer was evil eye or magic (28.6%). Good QoL outcomes were associated with biological treatment (p = 0.034) and satisfaction with health care (p = 0.001). A regression analysis showed that female sex, depression, and dissatisfaction with health care were independently associated with poor QoL. CONCLUSIONS This study demonstrates that several factors could influence cancer patients' QoL. For instance, female sex, depression, and dissatisfaction with health care were all predictors of poor QoL. Our findings support the need for more programs and interventions to improve the social services for cancer patients, along with the need to explore the social difficulties oncology patients face and address such obstacles through improving social services by expanding the scope of social workers' contribution. Larger multicenter longitudinal studies are warranted to examine the generalizability of the results.
Collapse
Affiliation(s)
- Mohammed A AlJaffar
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Psychiatry, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Sari S Enani
- Department of Psychiatry, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ahmad H Almadani
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Psychiatry, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Fay H Albuqami
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid A Alsaleh
- Oncology Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fahad D Alosaimi
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Psychiatry, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
|
13
|
Kazazian K, Ng D, Swallow CJ. Impact of the coronavirus disease 2019 pandemic on delivery of and models for supportive and palliative care for oncology patients. Curr Opin Support Palliat Care 2022; 16:130-137. [PMID: 35862890 PMCID: PMC9451606 DOI: 10.1097/spc.0000000000000606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Supportive and palliative care services have been an important component of the overall COVID-19 pandemic response. However, significant changes in the provision and models of care were needed in order to optimize the care delivered to vulnerable cancer patients. This review discusses the evolution of palliative and supportive care service in response to the pandemic, and highlights remaining challenges. RECENT FINDINGS Direct competition for resources, as well as widespread implementation of safety measures resulted in major shifts in the mode of assessment and communication with cancer patients by supportive care teams. Telemedicine/virtual consultation and follow-up visits became an integral strategy, with high uptake and satisfaction amongst patients, families and providers. However, inequities in access to the required technologies were sometimes exposed. Hospice/palliative care unit (PCU) bed occupancy declined markedly because of restrictive visitation policies. Collection of patient-reported outcome (PRO) data was suspended in many cancer centers, with resulting under-recognition of anxiety and depression in ambulatory patients. As in many other areas, disparities in delivery of supportive and palliative care were magnified by the pandemic. SUMMARY Virtual care platforms have been widely adopted and will continue to be used to include a wider circle of family/friends and care providers in the provision of palliative and supportive care. To facilitate equitable delivery of supportive care within a pandemic, further research and resources are needed to train and support generalists and palliative care providers. Strategies to successfully collect PROs from all patients in a virtual manner must be developed and implemented.
Collapse
Affiliation(s)
- Karineh Kazazian
- Department of Surgical Oncology, Princess Margaret Hospital, University Health Network and Mount Sinai Hospital
- Division of General Surgery, Mount Sinai Hospital, Sinai Health System
- Department of Surgery, University of Toronto
| | - Deanna Ng
- Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Carol J. Swallow
- Department of Surgical Oncology, Princess Margaret Hospital, University Health Network and Mount Sinai Hospital
- Division of General Surgery, Mount Sinai Hospital, Sinai Health System
- Department of Surgery, University of Toronto
- Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| |
Collapse
|
|
14
|
Di Maio M, Basch E, Denis F, Fallowfield LJ, Ganz PA, Howell D, Kowalski C, Perrone F, Stover AM, Sundaresan P, Warrington L, Zhang L, Apostolidis K, Freeman-Daily J, Ripamonti CI, Santini D. The role of patient-reported outcome measures in the continuum of cancer clinical care: ESMO Clinical Practice Guideline. Ann Oncol 2022; 33:878-892. [PMID: 35462007 DOI: 10.1016/j.annonc.2022.04.007] [Citation(s) in RCA: 228] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/05/2022] [Indexed: 12/25/2022] Open
Affiliation(s)
- M Di Maio
- Department of Oncology, University of Turin, at A.O. Ordine Mauriziano Hospital, Turin, Italy
| | - E Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA
| | - F Denis
- Institut Inter-régional de Cancérologie Jean Bernard (ELSAN), Le Mans, France; Faculté de Santé, Université de Paris, Paris, France
| | - L J Fallowfield
- Sussex Health Outcomes Research & Education in Cancer, Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton, UK
| | - P A Ganz
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles (UCLA), USA
| | - D Howell
- Department of Supportive Care, Princess Margaret Cancer Centre Research Institute, Toronto, Ontario, Canada
| | - C Kowalski
- Department of Certification - Health Services Research, German Cancer Society, Berlin, Germany
| | - F Perrone
- Clinical Trial Unit, National Cancer Institute IRCCS G. Pascale Foundation, Naples, Italy
| | - A M Stover
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA; Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - P Sundaresan
- Sydney West Radiation Oncology Network, Westmead Hospital, Westmead, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia
| | - L Warrington
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, UK
| | - L Zhang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - K Apostolidis
- European Cancer Patient Coalition, Brussels, Belgium
| | | | - C I Ripamonti
- Oncology - Supportive Care in Cancer Unit, Department Oncology-Haematology, Fondazione IRCCS Istituto Nazionale dei Tumori Milano, Milan, Italy
| | - D Santini
- Medical Oncology Department, University Campus Bio-Medico, Rome, Italy
| |
Collapse
|
|
15
|
Sanna V, Fedele P, Deiana G, Alicicco MG, Ninniri C, Santoro AN, Pazzola A, Fancellu A. Edmonton Symptom Assessment Scale may reduce medical visits in patients undergoing chemotherapy for breast cancer. World J Clin Oncol 2022; 13:577-586. [PMID: 36157162 PMCID: PMC9346425 DOI: 10.5306/wjco.v13.i7.577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/05/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adjuvant chemotherapy is recommended in high-risk breast cancer. However, no universally accepted guidelines exist on pre-chemotherapy assessment. In particular, the number and frequency of medical visits vary according to each institution’s policy. We hypothesised that the Edmonton Symptom Assessment Scale (ESAS) may have a favourable impact on the pre-treatment assessment in candidates for adjuvant chemotherapy.
AIM To investigate whether the ESAS can be used to safely reduce the number of medical visits in women with breast cancer undergoing adjuvant chemotherapy.
METHODS In a retrospectively prospective matched-pair analysis, 100 patients who completed the ESAS questionnaire before administration of adjuvant chemotherapy (ESAS Group) were compared with 100 patients who underwent chemotherapy according to the traditional modality, without ESAS (no-ESAS Group). Patients of the ESAS Group received additional visits before treatment if their ESAS score was > 3. The primary endpoint was the total number of medical visits during the entire duration of the chemotherapy period. The secondary endpoints were the occurrence of severe complications (grade 3-4) and the number of unplanned visits during the chemotherapy period.
RESULTS The study variables did not statistically differ between patients of the ESAS Group and no-ESAS Group (age P = 0.880; breast cancer stage P = 0.56; cancer histology P = 0.415; tumour size P = 0.258; lymph node status P = 0.883; immunohistochemical classification P = 0.754; type of surgery P = 0.157), except for premenopausal status (P = 0.015). The study variables did not statistically differ between patients of the ESAS Group and no-ESAS Group regarding age, cancer stage, histology, tumour size, lymph node status, immunohistochemical classification, and type of surgery. Unplanned visits during the entire duration of chemotherapy were 8 in the ESAS Group and 18 in the no-ESAS Group visits (P = 0.035). Grade 3-4 toxicity did not differ between the study groups (P = 0.652). Forty-eight patients of the ESAS Group received additional visits due to an ESAS score > 3. The mean number of medical visits was 4.38 ± 0.51 in the ESAS Group and 16.18 ± 1.82 in the no-ESAS group (P < 0.001). With multivariate analysis, women of the ESAS group were more likely to undergo additional visits for an ESAS score > 3 if they were aged 60 or older, received a mastectomy, or had tumour stage II/III.
CONCLUSION The ESAS score may safely reduce the number of medical visits in candidates for adjuvant chemotherapy for early breast cancer. Our results suggest that the ESAS score may be used for selecting a group of breast cancer patients for whom it is safe to reduce the number of medical visits in the setting of adjuvant chemotherapy. This may translate into several advantages, such as a more rational utilization of human resources and a possible reduction of coronavirus pandemic infection risk in oncologic patients.
Collapse
Affiliation(s)
- Valeria Sanna
- Unit of Medical Oncology, A.O.U. Sassari, Sassari 07100, Italy
| | - Palma Fedele
- Unit of Medical Oncology, Hospital “D. Camberlingio”, Francavilla Fontana 72100, Brindisi, Italy
| | - Giulia Deiana
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | | | - Chiara Ninniri
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Anna N Santoro
- Unit of Medical Oncology, Hospital “D. Camberlingio”, Francavilla Fontana 72100, Brindisi, Italy
| | - Antonio Pazzola
- Unit of Medical Oncology, A.O.U. Sassari, Sassari 07100, Italy
| | - Alessandro Fancellu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| |
Collapse
|
|
16
|
Kazazian K, Bogach J, Johnston W, Ng D, Swallow CJ. Challenges in virtual collection of patient-reported data: a prospective cohort study conducted in COVID-19 era. Support Care Cancer 2022; 30:7535-7544. [PMID: 35670865 PMCID: PMC9171486 DOI: 10.1007/s00520-022-07191-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 05/30/2022] [Indexed: 12/30/2022]
Abstract
Prior to the COVID-19 pandemic, patients attending ambulatory clinics at cancer centers in Ontario completed the Edmonton Symptom Assessment Scale (ESAS) at each visit. At our center, completion was via touchpad, with assistance from clinic volunteers. As of March 2020, clinic appointments were conducted virtually when possible and touch pads removed. We anticipated a negative impact on the collection of patient-reported outcomes (PROs) and the recognition of severe symptoms. METHODS We performed a prospective cross-sectional cohort study to investigate remote ESAS completion by patients with appointments at a weekly surgical oncology clinic. Patients in the initial study cohort were asked to complete and return the ESAS virtually (V). Given low completion rates, the ensuing cohort was asked to complete a hard-copy (HC) ESAS. For the final cohort, we provided remote, personal mentorship by a member of the care team to support virtual electronic ESAS completion (virtual-mentored (VM) cohort). RESULTS Between May and July 2020, a total of 174 patient encounters were included in the study. For the V cohort, 20/46 patients (44%) successfully completed and returned the electronic ESAS, compared to 49/50 (98%) for the HC cohort. For the VM cohort, the overall completion rate was 74% (58/78); however, 12 of these 58 patients did not independently complete a virtual ESAS. Virtual questionnaire completion was not predicted by age, sex, or tumor site, although patients who completed the ESAS were more likely to be in active management rather than surveillance (p = 0.04). Of all completed forms, 42% revealed a depression score of ≥2, and 27% an anxiety score of ≥4. CONCLUSIONS We identified significant barriers to the virtual completion of ESAS forms, with a lack of predictive variables. The severe degree of psychological distress reported by ~50% of respondents demonstrates the need for ongoing regular collection/review of these data. Innovative solutions are required to overcome barriers to the virtual collection of PROs.
Collapse
Affiliation(s)
- Karineh Kazazian
- Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Canada.,Division of General Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Jessica Bogach
- Department of Surgery, McMaster University, Hamilton, Canada
| | - Wendy Johnston
- Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Canada.,Division of General Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Deanna Ng
- Department of Surgery, University of Toronto, Toronto, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Carol J Swallow
- Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Canada. .,Division of General Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, Canada. .,Department of Surgery, University of Toronto, Toronto, Canada. .,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada.
| |
Collapse
|
|
17
|
Honma O, Watanabe C, Fukuchimoto H, Kashiwazaki J, Tateba M, Wagatsuma S, Ogata K, Maki K, Sonou H, Shiga K, Otsuka E, Hiruta M, Hirasawa Y, Hosonuma M, Murayama M, Narikawa Y, Toyoda H, Tsurui T, Kuramasu A, Kin M, Kubota Y, Sambe T, Horiike A, Ishida H, Shimada K, Umeda M, Tsunoda T, Yoshimura K. Verification of the Usefulness of an Assessment and Risk Control Sheet that Promotes Management of Cancer Drug Therapy. Front Pharmacol 2022; 13:744916. [PMID: 35222016 PMCID: PMC8864067 DOI: 10.3389/fphar.2022.744916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 01/20/2022] [Indexed: 12/22/2022] Open
Abstract
Background: Proper management of adverse events is crucial for the safe and effective implementation of anticancer drug treatment. Showa University Hospital uses our interview sheet (assessment and risk control [ARC] sheet) for the accurate evaluation of adverse events. On the day of anticancer drug treatment, a nurse conducts a face-to-face interview. As a feature of the ARC sheet, by separately describing the symptoms the day before treatment and the day of treatment and sharing the information on the medical record, it is possible to clearly determine the status of adverse events. In this study, we hypothesized that the usefulness and points for improvement of the ARC sheet would be clarified by using and evaluating a patient questionnaire. Methods: This study included 174 patients (144 at Showa University Hospital (Hatanodai Hospital) and 30 at Showa University Koto Toyosu Hospital (Toyosu Hospital) who underwent pre-examination interviews by nurses and received cancer chemotherapy at the outpatient center of Hatanodai and Toyosu Hospital. In the questionnaire survey, the ARC sheet’s content and quality, respondents’ satisfaction, structural strengths, and points for improvement were evaluated on a five-point scale. Results: The patient questionnaire received responses from 160 participants, including the ARC sheet use group (132 people) and the non-use group (28 people). Unlike the ARC sheet non-use group, the ARC sheet use group recognized that the sheet was useful to understand the adverse events of aphthous ulcers (p = 0.017) and dysgeusia (p = 0.006). In the satisfaction survey questionnaire, there was a high sense of security in the pre-examination interviews by nurses using the ARC sheet. Conclusions: The ARC sheet is considered an effective tool for comprehensively evaluating adverse events. Pre-examination interviews by nurses using ARC sheets accurately determined the adverse events experienced by patients with anxiety and tension due to confrontation with physicians.
Collapse
Affiliation(s)
- O Honma
- Department of Nursing, Showa University Hospital, Tokyo, Japan.,Department of Nursing, Showa University School of Nursing and Rehabilitation Sciences, Kanagawa, Japan
| | - C Watanabe
- Department of Nursing, Showa University School of Nursing and Rehabilitation Sciences, Kanagawa, Japan
| | - H Fukuchimoto
- Department of Nursing, Showa University School of Nursing and Rehabilitation Sciences, Kanagawa, Japan.,Department of Nursing, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - J Kashiwazaki
- Faculty of Nursing, Kyoritsu Women's University, Tokyo, Japan
| | - M Tateba
- Department of Nursing, Showa University Hospital, Tokyo, Japan.,Department of Nursing, Showa University School of Nursing and Rehabilitation Sciences, Kanagawa, Japan
| | - S Wagatsuma
- Department of Nursing, Showa University Hospital, Tokyo, Japan.,Department of Nursing, Showa University School of Nursing and Rehabilitation Sciences, Kanagawa, Japan
| | - K Ogata
- Department of Nursing, Showa University Hospital, Tokyo, Japan
| | - K Maki
- Department of Nursing, Showa University Hospital, Tokyo, Japan
| | - H Sonou
- Department of Nursing, Showa University Hospital, Tokyo, Japan
| | - K Shiga
- Department of Nursing, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - E Otsuka
- Department of Nursing, Showa University Hospital, Tokyo, Japan
| | - M Hiruta
- Department of Nursing, Showa University Hospital, Tokyo, Japan
| | - Y Hirasawa
- Department of Medical Oncology, Showa University, Tokyo, Japan
| | - M Hosonuma
- Department of Clinical Immunology and Oncology, Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University, Tokyo, Japan
| | - M Murayama
- Department of Clinical Immunology and Oncology, Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University, Tokyo, Japan
| | - Y Narikawa
- Department of Clinical Immunology and Oncology, Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University, Tokyo, Japan
| | - H Toyoda
- Department of Clinical Immunology and Oncology, Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University, Tokyo, Japan
| | - T Tsurui
- Department of Medical Oncology, Showa University, Tokyo, Japan
| | - A Kuramasu
- Department of Clinical Immunology and Oncology, Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University, Tokyo, Japan
| | - M Kin
- Department of Pharmacy, Showa University Hospital, Tokyo, Japan
| | - Y Kubota
- Department of Medical Oncology, Showa University, Tokyo, Japan
| | - T Sambe
- Division of Clinical Pharmacology, Department of Pharmacology, Showa University School of Medicine, Shinagawa-ku, Japan
| | - A Horiike
- Department of Medical Oncology, Showa University, Tokyo, Japan
| | - H Ishida
- Division of Medical Oncology, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - K Shimada
- Division of Medical Oncology, Internal Medicine Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - M Umeda
- Family Hospice Co., Ltd., Tokyo, Japan
| | - T Tsunoda
- Department of Medical Oncology, Showa University, Tokyo, Japan
| | - K Yoshimura
- Department of Clinical Immunology and Oncology, Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University, Tokyo, Japan
| |
Collapse
|
|
18
|
Pierret T, Giaj-Levra M, Gobbini E, Toffart AC, Moro-Sibilot D. [Implication of bronchopulmonary cancer patients in thoracic oncology]. Rev Mal Respir 2021; 38:986-992. [PMID: 34782178 DOI: 10.1016/j.rmr.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022]
Abstract
Changed relationships between patient and health care provider have given patients a greater role in their care. Nowadays, they have the opportunity to be involved in decision-making regarding any diagnostic, therapeutic or monitoring intervention related to their disease. Access to international scientific data through the web, the activity of different patient associations, and the information given by their referring physician can enrich their knowledge about their disease and its possible treatments. In addition to the objective criteria usually assessed, the role currently assumed by patient associations in clinical research helps to identify their expectations. In addition, a number of new tools allow the thoracic oncologist to better understand patients' wishes. Health authorities' use of patient-reported outcomes and patients' use of digital applications contribute to improved survival without any deleterious impact on quality of life. Web applications designed to monitor a patient's toxicities during treatment are now commercially available. To meet our patients' expectations, we are called upon to incorporate these different digital tools into our daily practice.
Collapse
Affiliation(s)
- T Pierret
- Service de pneumologie et physiologie, unité d'oncologie thoracique, CHU Grenoble Alpes, CS10217, 38043 Grenoble cedex, France.
| | - M Giaj-Levra
- Service de pneumologie et physiologie, unité d'oncologie thoracique, CHU Grenoble Alpes, CS10217, 38043 Grenoble cedex, France
| | - E Gobbini
- Service de pneumologie et physiologie, unité d'oncologie thoracique, CHU Grenoble Alpes, CS10217, 38043 Grenoble cedex, France
| | - A-C Toffart
- Service de pneumologie et physiologie, unité d'oncologie thoracique, CHU Grenoble Alpes, CS10217, 38043 Grenoble cedex, France
| | - D Moro-Sibilot
- Service de pneumologie et physiologie, unité d'oncologie thoracique, CHU Grenoble Alpes, CS10217, 38043 Grenoble cedex, France
| |
Collapse
|
|
19
|
Lizán L, Pérez-Carbonell L, Comellas M. Additional Value of Patient-Reported Symptom Monitoring in Cancer Care: A Systematic Review of the Literature. Cancers (Basel) 2021; 13:cancers13184615. [PMID: 34572842 PMCID: PMC8469093 DOI: 10.3390/cancers13184615] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 09/10/2021] [Indexed: 01/28/2023] Open
Abstract
Simple Summary The additional value of patient-reported symptom monitoring in routine cancer is still under discussion. With this in mind, we have reviewed recent evidence on the benefits of this strategy. The evidence examined illustrates that bringing systematic patient feedback into the oncology consultation provides objective advantages over usual care, such as better symptom control, early detection of tumor recurrence, and extended chemotherapy use. Such care improvements ultimately entail an outstanding survival benefit for advanced cancer patients, an increase in their global quality of life, and eventually, medical cost savings. Monitoring patient-reported symptoms might also have other implications in clinical practice, such as promoting patient disease awareness or enhancing patient–physician communication and relationships. Notwithstanding these advantages, there are still logistical barriers that prevent its widespread implementation—especially in the electronic modality. In addition, the real-world effectiveness and the cost-effectiveness of this strategy are yet to be proven in different settings. Abstract Background: To describe the benefit of patient-reported symptom monitoring on clinical, other patient-reported, and economic outcomes. Methods: We conducted a systematic literature review using Medline/PubMed, limited to original articles published between 2011 and 2021 in English and Spanish, and focused on the benefit of patient-reported symptom monitoring on cancer patients. Results: We identified 16 reports that deal with the benefit of patient-reported symptom monitoring (collected mostly electronically) on different outcomes. Five studies showed that patient-reported symptom surveillance led to significantly improved survival compared with usual care—mainly through better symptom control, early detection of tumor recurrence, and extended chemotherapy use. Additionally, three evaluations demonstrated an improvement in Health-Related Quality of Life (HRQoL) associated with this monitoring strategy, specifically by reducing symptom severity. Additionally, six studies observed that this monitoring approach prevented unplanned emergency room visits and hospital readmissions, leading to a substantial decrease in healthcare usage. Conclusions: There is consistent evidence across the studies that patient-reported symptom monitoring might entail a substantial survival benefit for cancer patients, better HRQoL, and a considerable decrease in healthcare usage. Nonetheless, more studies should be conducted to demonstrate their effectiveness in addition to their cost-effectiveness in clinical practice.
Collapse
Affiliation(s)
- Luís Lizán
- Department of Medicine, Jaume I University, 12071 Castellón de la Plana, Spain
- Outcomes’10, Jaume I University, 12071 Castellón de la Plana, Spain; (L.P.-C.); (M.C.)
- Correspondence: ; Tel.: +34-608-262-673
| | - Lucía Pérez-Carbonell
- Outcomes’10, Jaume I University, 12071 Castellón de la Plana, Spain; (L.P.-C.); (M.C.)
| | - Marta Comellas
- Outcomes’10, Jaume I University, 12071 Castellón de la Plana, Spain; (L.P.-C.); (M.C.)
| |
Collapse
|
|
20
|
Muszalik M, Repka I, Puto G, Kowal-Skałka J, Kędziora-Kornatowska K. Assessment of Functional Status and Quality of Life of Elderly Patients Undergoing Radiotherapy and Radiotherapy Combined with Chemotherapy - A Cross-Sectional Study. Clin Interv Aging 2021; 16:9-18. [PMID: 33442241 PMCID: PMC7800427 DOI: 10.2147/cia.s281871] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/01/2020] [Indexed: 01/28/2023] Open
Abstract
Background Aging is associated with various diseases, a plethora of which are oncological. Selected treatment methods influence the performance status and the adaptability to changing circumstances. Objective The aim of the study was to assess the functional status, quality of life, and adaptation to disease of elderly patients who underwent only radiotherapy or chemotherapy combined with radiotherapy. Patients and Methods The cross-sectional study was conducted in a sample of 76 patients diagnosed with cancer, over 60 years of age (mean 69.3/SD 6.8) who were hospitalized in the Radiotherapy Department at the Ludwik Rydygier Hospital in Krakow. Standardized research tools were: Functional Assessment of Chronic Illness Therapy (FACIT-F), Mental Adjustment to Cancer Scale (Mini-MAC), Lawton Instrumental Activity of Daily Living (IADL), Yesavage Geriatric Depression Scale (GDS), an assessment scale of the post radiation reaction devised by Eastern Cooperative Oncology Group (ECOG). Results Most (n=37) patients were treated with a combination of radiotherapy and chemotherapy (48.6%), whereas 21 patients underwent only radiotherapy (27.6%). More than half of the respondents were male (68.4%, n = 52), whereas 24 (31.6%) were female. The assessment of the participants’ performance status yielded results indicating an average level of all domains. Men performed better in terms of physical condition compared to a group of women (p=0.010). Women experienced fatigue more frequently than men (p=0.012). Patients who had received radiation therapy combined with chemotherapy achieved on average better results in functional well-being (FWB) than the patients who had undergone radiotherapy only (p=0.046). Depression had a significant impact on all spheres of functioning (p<0.001) except social/family well-being. Conclusion The results pointed to the essential elements that should be taken into consideration in relation to treatment planning and providing care. Particular attention should be paid to women who suffered from depression and negative adaptation strategies that directly affect their functioning.
Collapse
Affiliation(s)
- Marta Muszalik
- Department of Geriatrics, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, Bydgoszcz, 85-094, Poland
| | - Iwona Repka
- Department of Clinical Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College Cracow, Kraków 31-501, Poland
| | - Grażyna Puto
- Department of Clinical Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College Cracow, Kraków 31-501, Poland
| | - Justyna Kowal-Skałka
- Department of Clinical Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College Cracow, Kraków 31-501, Poland
| | - Kornelia Kędziora-Kornatowska
- Department of Geriatrics, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, Bydgoszcz, 85-094, Poland
| |
Collapse
|
|
21
|
Marandino L, Necchi A, Aglietta M, Di Maio M. COVID-19 Emergency and the Need to Speed Up the Adoption of Electronic Patient-Reported Outcomes in Cancer Clinical Practice. JCO Oncol Pract 2020; 16:295-298. [PMID: 32364846 PMCID: PMC7292478 DOI: 10.1200/op.20.00237] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Laura Marandino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology, University of Turin, Turin, Italy
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Andrea Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Massimo Aglietta
- Department of Oncology, University of Turin, Turin, Italy
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Turin, Italy
- Medical Oncology, Azienda Ospedaliera Ordine Mauriziano, Turin, Italy
| |
Collapse
|
|
22
|
Point-of-care used in the treatment of older patients with cancer. The perception and experience of nurses. Appl Nurs Res 2020; 53:151268. [PMID: 32451011 DOI: 10.1016/j.apnr.2020.151268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 04/03/2020] [Accepted: 04/16/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Nursing tasks are changing as the proportion of people over the age of 65 years is increasing and is expected to double over the next four decades. New innovative solutions such as Point of Care Treatment (POCT) are being tested in oncological settings in order to optimise treatment, and this changes the nurse management in oncology. There is a need to explore oncology nurses' perception and experience when implementing the innovations in order to understand the implications for nursing and the treatment of older patients with cancer. METHODS Qualitative research with face to face interviews with nurses working in oncology. Sample size (Mean = 8). Data were recorded verbatim, transcribed, and thematic analysis used. RESULTS Three themes were identified: a, A great advantage in nursing, b, Change of practice in nursing care, c, Challenges in shifting roles. A majority of the participants had the perception that POCT treatment was an advantage not only for the nursing profession but for the older patients in cancer treatment as well. Monitoring the older patients with cancer at home would prevent them from accessing the hospital and get exposed to viral infections as well as saving them the journey to the hospital. Involvement from relatives, clear communication and management of the device and data transferred is essential. CONCLUSIONS The use of POCT in oncology will shift the nurses' tasks on the ward as well as improve treatment for older patients with cancer.
Collapse
|
|
23
|
Grosso F, Crivellari S, Bertolotti M, Lia M, De Angelis A, Cassinari A, Riccio C, Piovano PL, Cappelletti M, Maconi A. A feasibility exploratory study of a novel modality of using patient-reported outcomes (PROsEXPLOR) in the real world. TUMORI JOURNAL 2020; 106:464-470. [DOI: 10.1177/0300891620923745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Introduction: Patient-reported outcomes (PROs) can help clinicians better evaluate chemotherapy and immunotherapy toxicity based on patient perspectives. In this exploratory study, we tested a simplified PRO questionnaire (sPQ) in routine clinical practice and patient satisfaction with this tool. Methods: We included 16 items related to the main toxicities of chemotherapy and immunotherapy to be filled in by patients. A baseline sPQ was completed by patients before starting treatment and then in the interval between courses for a total of 4 sPQs. Patients communicated the results to a data manager, who alerted the referral oncologist in case of replies differing from the basal or previous sPQ. According to the severity of symptoms, the patient was then referred to the team nurse, the general practitioner, or another specialist. A satisfaction survey was also completed. Results: In a 3-month interval, 27 patients were enrolled. Fatigue and nausea were the most frequent symptoms reported as worsening during treatment. The oncologist was involved in the management of adverse events in 4 cases, home therapy variations were recommended by the dedicated nurse in 14 cases, additional visits were performed in 6 patients, and 1 patient was admitted to the oncology ward. None of the patients had unplanned visits to the emergency department or to the hospital. The sPQ was judged to be simple, useful, and satisfactory. Conclusions: Using sPQs in routine clinical practice was feasible and well-accepted by patients. PROs allowed us to recognize and promptly manage adverse events, reducing unplanned emergency department or hospital visits to zero.
Collapse
Affiliation(s)
- Federica Grosso
- SSD Mesotelioma and Rare Cancer, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Stefania Crivellari
- Infrastruttura Ricerca Formazione Innovazione, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Marinella Bertolotti
- Infrastruttura Ricerca Formazione Innovazione, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Michela Lia
- SSD Mesotelioma and Rare Cancer, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonina De Angelis
- Infrastruttura Ricerca Formazione Innovazione, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonella Cassinari
- Infrastruttura Ricerca Formazione Innovazione, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Carmela Riccio
- Department of Oncology, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Pier Luigi Piovano
- Department of Oncology, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Antonio Maconi
- Infrastruttura Ricerca Formazione Innovazione, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| |
Collapse
|
|
24
|
Patient-Reported Outcomes in Myelodysplastic Syndromes: the Move from Life Span to Health Span. Curr Hematol Malig Rep 2020; 15:149-154. [DOI: 10.1007/s11899-020-00562-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|