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Ge H, Ma X, Li W, Wang P, Zhang Z, Qin Q, Li S. Development and validation of the Convalescence Symptom Assessment Scale for EsophageCtomy patients. Nurs Open 2024; 11:e2085. [PMID: 38391107 PMCID: PMC10825072 DOI: 10.1002/nop2.2085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 11/22/2023] [Accepted: 12/21/2023] [Indexed: 02/24/2024] Open
Abstract
AIM A specific, valid and reliable measure is much needed to dynamically assess the recovery of symptoms in oesophagectomy patients. This study describes developing and validating the Convalescent Symptom Assessment Scale for oesophagectomy patients (CSAS_EC). DESIGN An instrument development and cross-sectional validation study was conducted. METHODS This study consists of two components: instrument development and psychometric tests. In instrument development, the literature review, qualitative interviews, Delphi method expert consultation and face validation were used to develop and refine scale content. In psychometric tests, the clinical test version scale was used to conduct a cross-sectional in the thoracic surgery department from 17 June to 20 November 2022. The Classical Test Theory and Multidimensional Item Response Theory (MIRT) analyses examined psychometric properties. RESULTS In instrument development, literature review (n = 20), qualitative interviews (n = 21), expert consultation (n = 12) and pre-survey (n = 15) led to the development of the clinical test version scale. In psychometric tests, a total of 331 participants were enrolled. Confirmatory factor analysis and MIRT analysis verified that a model with 28 items in four dimensions was good. The four dimensions were early recovery symptoms, late recovery symptoms, persistent present symptoms and psychosocial symptoms. The Cronbach's α is 0.827. The validity and reliability were demonstrated to be acceptable. CONCLUSIONS The CSAS_EC scale can be used as a tool to evaluate the recovery status of oesophagectomy patients.
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Affiliation(s)
- Hui Ge
- School of NursingAnhui Medical UniversityHefeiChina
- School of NursingPeking UniversityBeijingChina
| | - Xuanxuan Ma
- School of NursingAnhui Medical UniversityHefeiChina
| | - Wen Li
- School of NursingAnhui Medical UniversityHefeiChina
| | - Pan Wang
- School of NursingAnhui Medical UniversityHefeiChina
| | | | - Qiaoyun Qin
- School of NursingAnhui Medical UniversityHefeiChina
| | - Shuwen Li
- School of NursingAnhui Medical UniversityHefeiChina
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2
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Livingston PM, Winter N, Ugalde A, Orellana L, Mikocka-Walus A, Jefford M, Zalcberg J, Orford N, Hutchinson AM, Barbour A, Kiss N, Smithers BM, Watson DI, McCaffrey N, White V. iCare - a self-directed, interactive online program to improve health and wellbeing for people living with upper gastrointestinal or hepato-pancreato-biliary cancers, and their informal carers: the study protocol for a Phase II randomised controlled trial. BMC Cancer 2024; 24:144. [PMID: 38287317 PMCID: PMC10826031 DOI: 10.1186/s12885-024-11861-2] [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: 10/24/2023] [Accepted: 12/20/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Up to 70% of people diagnosed with upper gastrointestinal (GI) tract or hepato-pancreato-biliary (HPB) cancers experience substantial reductions in quality of life (QoL), including high distress levels, pain, fatigue, sleep disturbances, weight loss and difficulty swallowing. With few advocacy groups and support systems for adults with upper GI or HPB cancers (i.e. pancreas, liver, stomach, bile duct and oesophageal) and their carers, online supportive care programs may represent an alternate cost-effective mechanism to support this patient group and carers. iCare is a self-directed, interactive, online program that provides information, resources, and psychological packages to patients and their carers from the treatment phase of their condition. The inception and development of iCare has been driven by consumers, advocacy groups, government and health professionals. The aims of this study are to determine the feasibility and acceptability of iCare, examine preliminary efficacy on health-related QoL and carer burden at 3- and 6-months post enrolment, and the potential cost-effectiveness of iCare, from health and societal perspectives, for both patients and carers. METHODS AND ANALYSIS A Phase II randomised controlled trial. Overall, 162 people with newly diagnosed upper GI or HPB cancers and 162 carers will be recruited via the Upper GI Cancer Registry, online advertisements, or hospital clinics. Patients and carers will be randomly allocated (1:1) to the iCare program or usual care. Participant assessments will be at enrolment, 3- and 6-months later. The primary outcomes are i) feasibility, measured by eligibility, recruitment, response and attrition rates, and ii) acceptability, measured by engagement with iCare (frequency of logins, time spent using iCare, and use of features over the intervention period). Secondary outcomes are patient changes in QoL and unmet needs, and carer burden, unmet needs and QoL. Linear mixed models will be fitted to obtain preliminary estimates of efficacy and variability for secondary outcomes. The economic analysis will include a cost-consequences analysis where all outcomes will be compared with costs. DISCUSSION iCare provides a potential model of supportive care to improve QoL, unmet needs and burden of disease among people living with upper GI or HPB cancers and their carers. AUSTRALIAN AND NEW ZEALAND CLINICAL TRIALS REGISTRY ACTRN12623001185651. This protocol reflects Version #1 26 April 2023.
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Affiliation(s)
- Patricia M Livingston
- Deakin University, Geelong, VIC, 3220, Australia.
- Faculty of Health, Deakin University, Geelong, VIC, Australia.
- School of Nursing &, Midwifery Deakin University, Geelong, VIC, Australia.
| | - Natalie Winter
- Deakin University, Geelong, VIC, 3220, Australia
- Faculty of Health, Deakin University, Geelong, VIC, Australia
- School of Nursing &, Midwifery Deakin University, Geelong, VIC, Australia
| | - Anna Ugalde
- Deakin University, Geelong, VIC, 3220, Australia
- Faculty of Health, Deakin University, Geelong, VIC, Australia
- School of Nursing &, Midwifery Deakin University, Geelong, VIC, Australia
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | | | - Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - John Zalcberg
- Department of Medical Oncology, Alfred Health and School of Public Health, Faculty of Medicine, Monash University, Melbourne, Australia
| | - Neil Orford
- Monash University, Melbourne, Australia
- Barwon Health, Geelong, VIC, Australia
- Australia and New Zealand Intensive Care Research Centre (ANZICS-RC), SPHPM, Monash University, Melbourne, Australia
| | - Alison M Hutchinson
- Deakin University, Geelong, VIC, 3220, Australia
- School of Nursing &, Midwifery Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
| | - Andrew Barbour
- Upper GI Unit, Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Nicole Kiss
- Institute for Physical Activity & Nutrition, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Bernard Mark Smithers
- Upper GI Unit, Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - David I Watson
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Nikki McCaffrey
- Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Victoria White
- School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
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3
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Katz A, Nevo Y, Ramírez García Luna JL, Anchouche S, Tankel J, Caminsky N, Mueller C, Spicer J, Cools-Lartigue J, Ferri L. Long-Term Quality of Life After Esophagectomy for Esophageal Cancer. Ann Thorac Surg 2023; 115:200-208. [PMID: 35926638 DOI: 10.1016/j.athoracsur.2022.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/21/2022] [Accepted: 07/19/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Surgery, as part of a multimodal approach, offers the greatest chance of cure for esophageal cancer. However, esophagectomy is often perceived as having a lasting impact on quality of life (QOL), biasing some physicians and patients toward nonoperative management. A comprehensive understanding of the dynamic changes in patient-centered outcomes is therefore important for decision making. Our objective was to determine the long-term QOL after esophagectomy. METHODS Data were obtained from a prospectively collected (2006-2015) esophagectomy database at a high-volume center, and patients surviving 3 or more years were identified. Health-related QOL was evaluated using the Functional Assessment of Cancer Therapy-Esophageal Module (FACT-E) at diagnosis and every 3 to 6 months, and was stratified according to operative approach, stage, and complications. In addition, QOL scores were compared with normative population values. RESULTS Of 480 patients, 47% (n = 226) survived 3 or more years and 70% (158 of 226) completed the health-related QOL assessments. Time of follow-up was 5.1 ± 2.8 years. After a reduction at 1 to 3 months, FACT-E increased from a baseline of 126 (95% CI, 121-131) to 133 (95% CI, 127-139) at 12 months, and to 147 (95% CI, 142-153) by 5 years. There was no difference in long-term FACT-E with respect to the surgical approach, clinical and pathologic stage, or postoperative complications. At long-term follow-up (more than 3 years), QOL did not differ significantly from the normative population reference values. CONCLUSIONS The long-term QOL of esophagectomy patients surviving at least 3 years is improved when compared with the time of diagnosis and does not differ from the general population.
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Affiliation(s)
- Amit Katz
- Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Yehonatan Nevo
- Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | | | - Sonia Anchouche
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - James Tankel
- Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Natasha Caminsky
- Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Carmen Mueller
- Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Jonathan Spicer
- Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Jonathan Cools-Lartigue
- Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Lorenzo Ferri
- Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada.
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Wang N, Chen J, Chen W, Shi Z, Yang H, Liu P, Wei X, Dong X, Wang C, Mao L, Li X. The effectiveness of case management for cancer patients: an umbrella review. BMC Health Serv Res 2022; 22:1247. [PMID: 36242021 PMCID: PMC9562054 DOI: 10.1186/s12913-022-08610-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 09/21/2022] [Indexed: 11/12/2022] Open
Abstract
Background Case management (CM) is widely utilized to improve health outcomes of cancer patients, enhance their experience of health care, and reduce the cost of care. While numbers of systematic reviews are available on the effectiveness of CM for cancer patients, they often arrive at discordant conclusions that may confuse or mislead the future case management development for cancer patients and relevant policy making. We aimed to summarize the existing systematic reviews on the effectiveness of CM in health-related outcomes and health care utilization outcomes for cancer patient care, and highlight the consistent and contradictory findings. Methods An umbrella review was conducted followed the Joanna Briggs Institute (JBI) Umbrella Review methodology. We searched MEDLINE (Ovid), EMBASE (Ovid), PsycINFO, CINAHL, and Scopus for reviews published up to July 8th, 2022. Quality of each review was appraised with the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. A narrative synthesis was performed, the corrected covered area was calculated as a measure of overlap for the primary studies in each review. The results were reported followed the Preferred reporting items for overviews of systematic reviews checklist. Results Eight systematic reviews were included. Average quality of the reviews was high. Overall, primary studies had a slight overlap across the eight reviews (corrected covered area = 4.5%). No universal tools were used to measure the effect of CM on each outcome. Summarized results revealed that CM were more likely to improve symptom management, cognitive function, hospital (re)admission, treatment received compliance, and provision of timely treatment for cancer patients. Overall equivocal effect was reported on cancer patients’ quality of life, self-efficacy, survivor status, and satisfaction. Rare significant effect was reported on cost and length of stay. Conclusions CM showed mixed effects in cancer patient care. Future research should use standard guidelines to clearly describe details of CM intervention and its implementation. More primary studies are needed using high-quality well-powered designs to provide solid evidence on the effectiveness of CM. Case managers should consider applying validated and reliable tools to evaluate effect of CM in multifaced outcomes of cancer patient care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08610-1.
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Affiliation(s)
- Nina Wang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Jia Chen
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Wenjun Chen
- School of Nursing, University of Ottawa, Ottawa, Canada. .,Center for Research on Health and Nursing, University of Ottawa, Ottawa, Canada.
| | - Zhengkun Shi
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Huaping Yang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Peng Liu
- Intensive Care Unit of Cardiovascular Surgery Department, Xiangya Hospital, Central South University, Changsha, China
| | - Xiao Wei
- The 956th Army Hospital, Linzhi, China
| | - Xiangling Dong
- Intensive Care Unit of Cardiovascular Surgery Department, Xiangya Hospital, Central South University, Changsha, China
| | - Chen Wang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Ling Mao
- School of Nursing, Changsha Medical University, Changsha, China
| | - Xianhong Li
- Xiangya School of Nursing, Central South University, Changsha, China
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5
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Malthaner RA, Yu E, Sanatani M, Lewis D, Warner A, Dar AR, Yaremko BP, Bierer J, Palma DA, Fortin D, Inculet RI, Fréchette E, Raphael J, Gaede S, Kuruvilla S, Younus J, Vincent MD, Rodrigues GB. The quality of life in neoadjuvant versus adjuvant therapy of esophageal cancer treatment trial (QUINTETT): Randomized parallel clinical superiority trial. Thorac Cancer 2022; 13:1898-1915. [PMID: 35611396 PMCID: PMC9250846 DOI: 10.1111/1759-7714.14433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/03/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background We compared the health‐related quality of life (HRQOL) in patients undergoing trimodality therapy for resectable stage I‐III esophageal cancer. Methods A total of 96 patients were randomized to standard neoadjuvant cisplatin and 5‐fluorouracil chemotherapy plus radiotherapy (neoadjuvant) followed by surgical resection or adjuvant cisplatin, 5‐fluorouracil, and epirubicin chemotherapy with concurrent extended volume radiotherapy (adjuvant) following surgical resection. Results There was no significant difference in the functional assessment of cancer therapy‐esophageal (FACT‐E) total scores between arms at 1 year (p = 0.759) with 36% versus 41% (neoadjuvant vs. adjuvant), respectively, showing an increase of ≥15 points compared to pre‐treatment (p = 0.638). The HRQOL was significantly inferior at 2 months in the neoadjuvant arm for FACT‐E, European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ‐OG25), and EuroQol 5‐D‐3 L in the dysphagia, reflux, pain, taste, and coughing domains (p < 0.05). Half of patients were able to complete the prescribed neoadjuvant arm chemotherapy without modification compared to only 14% in the adjuvant arm (p < 0.001). Chemotherapy related adverse events of grade ≥2 occurred significantly more frequently in the neoadjuvant arm (100% vs. 69%, p < 0.001). Surgery related adverse events of grade ≥2 were similar in both arms (72% vs. 86%, p = 0.107). There were no 30‐day mortalities and 2% vs. 10% 90‐day mortalities (p = 0.204). There were no significant differences in either overall survival (OS) (5‐year: 35% vs. 32%, p = 0.409) or disease‐free survival (DFS) (5‐year: 31% vs. 30%, p = 0.710). Conclusion Trimodality therapy is challenging for patients with resectable esophageal cancer regardless of whether it is given before or after surgery. Newer and less toxic protocols are needed.
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Affiliation(s)
- Richard A Malthaner
- Department of Oncology, Divisions of Thoracic Surgery and Surgical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Edward Yu
- Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Michael Sanatani
- Medical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Debra Lewis
- Department of Oncology, Divisions of Thoracic Surgery and Surgical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Andrew Warner
- Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - A Rashid Dar
- Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Brian P Yaremko
- Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Joel Bierer
- Department of Oncology, Divisions of Thoracic Surgery and Surgical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - David A Palma
- Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Dalilah Fortin
- Department of Oncology, Divisions of Thoracic Surgery and Surgical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Richard I Inculet
- Department of Oncology, Divisions of Thoracic Surgery and Surgical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Eric Fréchette
- Department of Oncology, Divisions of Thoracic Surgery and Surgical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jacques Raphael
- Medical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Stewart Gaede
- Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Sara Kuruvilla
- Medical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jawaid Younus
- Medical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mark D Vincent
- Medical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - George B Rodrigues
- Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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6
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Doki Y, Ajani JA, Kato K, Xu J, Wyrwicz L, Motoyama S, Ogata T, Kawakami H, Hsu CH, Adenis A, El Hajbi F, Di Bartolomeo M, Braghiroli MI, Holtved E, Ostoich SA, Kim HR, Ueno M, Mansoor W, Yang WC, Liu T, Bridgewater J, Makino T, Xynos I, Liu X, Lei M, Kondo K, Patel A, Gricar J, Chau I, Kitagawa Y. Nivolumab Combination Therapy in Advanced Esophageal Squamous-Cell Carcinoma. N Engl J Med 2022; 386:449-462. [PMID: 35108470 DOI: 10.1056/nejmoa2111380] [Citation(s) in RCA: 375] [Impact Index Per Article: 187.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND First-line chemotherapy for advanced esophageal squamous-cell carcinoma results in poor outcomes. The monoclonal antibody nivolumab has shown an overall survival benefit over chemotherapy in previously treated patients with advanced esophageal squamous-cell carcinoma. METHODS In this open-label, phase 3 trial, we randomly assigned adults with previously untreated, unresectable advanced, recurrent, or metastatic esophageal squamous-cell carcinoma in a 1:1:1 ratio to receive nivolumab plus chemotherapy, nivolumab plus the monoclonal antibody ipilimumab, or chemotherapy. The primary end points were overall survival and progression-free survival, as determined by blinded independent central review. Hierarchical testing was performed first in patients with tumor-cell programmed death ligand 1 (PD-L1) expression of 1% or greater and then in the overall population (all randomly assigned patients). RESULTS A total of 970 patients underwent randomization. At a 13-month minimum follow-up, overall survival was significantly longer with nivolumab plus chemotherapy than with chemotherapy alone, both among patients with tumor-cell PD-L1 expression of 1% or greater (median, 15.4 vs. 9.1 months; hazard ratio, 0.54; 99.5% confidence interval [CI], 0.37 to 0.80; P<0.001) and in the overall population (median, 13.2 vs. 10.7 months; hazard ratio, 0.74; 99.1% CI, 0.58 to 0.96; P = 0.002). Overall survival was also significantly longer with nivolumab plus ipilimumab than with chemotherapy among patients with tumor-cell PD-L1 expression of 1% or greater (median, 13.7 vs. 9.1 months; hazard ratio, 0.64; 98.6% CI, 0.46 to 0.90; P = 0.001) and in the overall population (median, 12.7 vs. 10.7 months; hazard ratio, 0.78; 98.2% CI, 0.62 to 0.98; P = 0.01). Among patients with tumor-cell PD-L1 expression of 1% or greater, a significant progression-free survival benefit was also seen with nivolumab plus chemotherapy over chemotherapy alone (hazard ratio for disease progression or death, 0.65; 98.5% CI, 0.46 to 0.92; P = 0.002) but not with nivolumab plus ipilimumab as compared with chemotherapy. The incidence of treatment-related adverse events of grade 3 or 4 was 47% with nivolumab plus chemotherapy, 32% with nivolumab plus ipilimumab, and 36% with chemotherapy alone. CONCLUSIONS Both first-line treatment with nivolumab plus chemotherapy and first-line treatment with nivolumab plus ipilimumab resulted in significantly longer overall survival than chemotherapy alone in patients with advanced esophageal squamous-cell carcinoma, with no new safety signals identified. (Funded by Bristol Myers Squibb and Ono Pharmaceutical; CheckMate 648 ClinicalTrials.gov number, NCT03143153.).
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Affiliation(s)
- Yuichiro Doki
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Jaffer A Ajani
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Ken Kato
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Jianming Xu
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Lucjan Wyrwicz
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Satoru Motoyama
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Takashi Ogata
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Hisato Kawakami
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Chih-Hung Hsu
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Antoine Adenis
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Farid El Hajbi
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Maria Di Bartolomeo
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Maria I Braghiroli
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Eva Holtved
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Sandra A Ostoich
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Hye R Kim
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Masaki Ueno
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Wasat Mansoor
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Wen-Chi Yang
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Tianshu Liu
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - John Bridgewater
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Tomoki Makino
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Ioannis Xynos
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Xuan Liu
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Ming Lei
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Kaoru Kondo
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Apurva Patel
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Joseph Gricar
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Ian Chau
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Yuko Kitagawa
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
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7
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Moy RH, Sabwa S, Maron SB, Shcherba M, Apollo A, Janjigian YY, Ku GY, Tew WP, Wu AJ, Jones DR, Molena D, Ilson DH, Won E. A nutritional management algorithm in older patients with locally advanced esophageal cancer. J Geriatr Oncol 2022; 13:100-103. [PMID: 34393090 PMCID: PMC9549346 DOI: 10.1016/j.jgo.2021.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/17/2021] [Accepted: 06/25/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Ryan H. Moy
- Department of Medicine, Gastrointestinal Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Shalom Sabwa
- Department of Medicine, Gastrointestinal Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Steven B. Maron
- Department of Medicine, Gastrointestinal Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marina Shcherba
- Department of Medicine, Gastrointestinal Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Arlyn Apollo
- Department of Medicine, Gastrointestinal Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yelena Y. Janjigian
- Department of Medicine, Gastrointestinal Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Geoffrey Y. Ku
- Department of Medicine, Gastrointestinal Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - William P. Tew
- Department of Medicine, Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Abraham J. Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David R. Jones
- Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniela Molena
- Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David H. Ilson
- Department of Medicine, Gastrointestinal Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elizabeth Won
- Department of Medicine, Gastrointestinal Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY
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8
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Toh Y, Morita M, Yamamoto M, Nakashima Y, Sugiyama M, Uehara H, Fujimoto Y, Shin Y, Shiokawa K, Ohnishi E, Shimagaki T, Mano Y, Sugimachi K. Health-related quality of life after esophagectomy in patients with esophageal cancer. Esophagus 2022; 19:47-56. [PMID: 34467435 DOI: 10.1007/s10388-021-00874-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/27/2021] [Indexed: 02/03/2023]
Abstract
Esophageal cancer is one of the malignant tumors with the poorest prognosis. Esophagectomy, which is the mainstay of curative-intent treatments, imposes excessive surgical stress on the patients, and postoperative morbidity and mortality rates after esophagectomy remain high. On the other hand, the number of survivors after esophagectomy for esophageal cancer is increasing due to recent improvements in surgical techniques and multidisciplinary treatments for this cancer. However, esophagectomy still has a great influence on the fundamental aspect of patients' lives, that is, the health-related quality of life (HR-QOL), including their physical, emotional, and social functions in the short- and long-term postoperatively. HR-QOL is a multifactorial concept used to assess the symptoms and functional changes caused by the disease itself and treatments from the patients' perspectives. Therefore, assessing the HR-QOL of patients with esophageal cancer after esophagectomy is becoming increasingly important. However, the status of HR-QOL changes after esophagectomy has not been satisfactorily evaluated, and there is no worldwide consensus as to how the postoperative HR-QOL can be improved. This review aimed to raise awareness of healthcare providers, such as surgeons and nurses, on the importance of HR-QOL in patients with esophageal cancer after curative-intent esophagectomy by providing multifaceted information concerning the short- and long-term HR-QOLs, including the status of changes and the determinants of HR-QOL after esophagectomy, and furthermore, essential points for improvement of HR-QOL after esophagectomy.
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Affiliation(s)
- Yasushi Toh
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan.
| | - Masaru Morita
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Manabu Yamamoto
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Yuichiro Nakashima
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Masahiko Sugiyama
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Hideo Uehara
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Yoshiaki Fujimoto
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Yuki Shin
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Keiichi Shiokawa
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Emi Ohnishi
- Department of Hepato-Biliary and Pancreatic Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Tomonari Shimagaki
- Department of Hepato-Biliary and Pancreatic Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Yohei Mano
- Department of Hepato-Biliary and Pancreatic Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Keishi Sugimachi
- Department of Hepato-Biliary and Pancreatic Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
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9
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Vimolratana M, Sarkaria IS, Goldman DA, Rizk NP, Tan KS, Bains MS, Adusumilli PS, Sihag S, Isbell JM, Huang J, Park BJ, Molena D, Rusch VW, Jones DR, Bott MJ. Two-Year Quality of Life Outcomes After Robotic-Assisted Minimally Invasive and Open Esophagectomy. Ann Thorac Surg 2021; 112:880-889. [DOI: 10.1016/j.athoracsur.2020.09.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/03/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022]
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10
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Mazanec SR, Blackstone E, Daly BJ. Building family caregiver skills using a simulation-based intervention for care of patients with cancer: protocol for a randomized controlled trial. BMC Nurs 2021; 20:93. [PMID: 34107914 PMCID: PMC8188746 DOI: 10.1186/s12912-021-00612-4] [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: 05/13/2021] [Accepted: 05/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family caregivers of patients with cancer undergoing radiation therapy experience significant distress and challenges related to high symptom burden and complex care demands. This is particularly true for caregivers of patients with head and neck, esophageal, anal, rectal, and lung cancers, who are often receiving combined-modality treatment and may have tracheostomy tubes, gastrostomy tubes, or colostomies/ileostomies. This study aims to evaluate a simulation-based nursing intervention to provide information, support, and training to caregivers during radiation therapy. METHODS This randomized controlled trial will include a sample of 180 patients and their family caregivers. Caregivers assigned to the control group will receive usual care and an informational booklet from the National Cancer Institute (NCI). Those in the intervention group will receive usual care, the NCI booklet, and three meetings with a nurse interventionist during radiation treatment followed by a booster call two weeks posttreatment. Intervention sessions focus on themes consistent with the trajectory of radiation therapy: the patient experience/needs, the caregiver experience and dyad communication, and transition to survivorship. Outcomes are measured at baseline, end of treatment (T2), and 4 (T3) and 20 (T4) weeks posttreatment, with the primary outcome being caregiver anxiety at T4. DISCUSSION This trial is innovative in its use of simulation in a psychoeducational intervention for family caregivers. The intervention is administered at point-of-care and aimed at feasibility for integration into clinical practice. Patient quality of life and healthcare utilization measures will assess how providing support and training to the caregiver may impact patient outcomes. TRIAL REGISTRATION The trial was registered on 08/14/2019 at ClinicalTrials.gov (identifier NCT04055948 ).
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Affiliation(s)
- Susan R Mazanec
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA. .,Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
| | - Eric Blackstone
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Barbara J Daly
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
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11
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Perioperative Transfusions for Gastroesophageal Cancers: Risk Factors and Short- and Long-Term Outcomes. J Gastrointest Surg 2021; 25:48-57. [PMID: 33159242 DOI: 10.1007/s11605-020-04845-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/26/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Perioperative blood transfusions have been associated with increased morbidity and poorer oncologic outcomes for numerous surgical procedures. However, this issue is understudied among patients with gastroesophageal malignancies. The objective was to clarify the risk factors and impact of perioperative transfusions on quality of life and surgical and oncologic outcomes among patients undergoing gastric and esophageal cancer surgery. METHODS Patients undergoing curative-intent resections for gastroesophageal cancers between 2010 and 2018 were included. Perioperative blood transfusion was defined as any transfusion within 24 h pre-operatively, during surgery, or the primary post-operative hospitalization period. Patient and tumor characteristics, surgical and oncological outcomes, and quality of life were compared. RESULTS A total of 435 patients were included. Perioperative transfusions occurred in 184 (42%). Anemia, blood loss, female sex, open surgical approach, and operative time emerged as independent risk factors for transfusions. Factors found to be independently associated with overall survival were neoadjuvant therapy, tumor size and stage, major complications, and mortality. Transfusions did not independently impact overall survival, disease-free survival, or quality of life. CONCLUSIONS Perioperative transfusions did not impact oncologic outcomes or quality of life among patients undergoing curative-intent surgery for gastroesophageal cancers.
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12
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Ahmed M, Lau A, Hirpara DH, Kidane B. Choosing the right survey-patient reported outcomes in esophageal surgery. J Thorac Dis 2020; 12:6902-6912. [PMID: 33282393 PMCID: PMC7711431 DOI: 10.21037/jtd.2020.03.58] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Patient reported outcomes (PROs) fulfill a crucial and unique niche in patient management, providing health-care providers a glimpse into their patients’ health experience. This is of utmost importance in patients with benign and malignant disorders of esophagus requiring surgery, which carries significant morbidity, in part due to a high burden of symptoms affecting health-related quality of life (HRQOL). There are a variety of generic and disease-specific patient reported outcome measures (PROMs) available for use in esophageal surgery. This article provides a broad overview of commonly used HRQOL instruments in esophageal surgery, including their utility in comparative effectiveness research, prognostication and shared decision-making for patients undergoing surgery for benign and malignant disorders of the esophagus.
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Affiliation(s)
- Maira Ahmed
- College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Angus Lau
- College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dhruvin H Hirpara
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Biniam Kidane
- College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Section of Thoracic Surgery, Health Sciences Centre, Winnipeg, Manitoba, Canada.,Research Institute in Oncology and Hematology, Cancer Care Manitoba, Manitoba, Canada
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13
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Does it matter how we evaluate HRQOL? Longitudinal comparison of the EORTC QLQ-C30/QLQ-OG25 and FACT-E. J Cancer Surviv 2020; 15:641-650. [PMID: 33106994 DOI: 10.1007/s11764-020-00957-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/10/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE To determine whether EORTC QLQ-C30/QLQ-OG25 and FACT-E compared longitudinally provide similar reflections of health-related quality of life (HRQOL). METHODS Eighty-six esophageal cancer patients treated with curative intent, scheduled to complete both questionnaires at baseline and post-treatment time points until 36 months. A generalized estimating equation model utilizing a Gaussian family compared instruments longitudinally. The two-one-sided-test (TOST) method assessed equivalence between the instruments. RESULTS Trajectories for social domain and overall quality of life differed significantly between instruments. Also, FACT-G's functional well-being post-treatment returns to baseline 3-6 months earlier than the EORTC QLQ-C30's role functioning subscale, suggesting measurement of different components. Trajectories for physical and esophageal symptom subscales are similar and are deemed equivalent. Emotional domains are comparable and bear little resemblance to the physical domain trajectories indicating reflection of emotional experience rather than a physical proxy. EORTC QLQ-C30 subscales have a trajectory similar to its physical functioning scale except for the emotional and esophageal symptoms scales. Overall HRQOL in both instruments showed a consistent return to baseline/pre-treatment levels by 6 months post-treatment. CONCLUSIONS Overall HRQOL recovers earlier after curative-intent treatment than previously reported despite persistence of physical symptoms, with a consistent return to pre-treatment levels by 6 months after treatment. This supports the concept that HRQOL is not primarily defined by physical function. Based on this longitudinal comparison, FACT-E provides a more multidimensional assessment of HRQOL. IMPLICATIONS FOR CANCER SURVIVORS Curative intent treatment for esophageal cancer has adverse effects on HRQOL but despite intense treatment, overall HRQOL recovers within 6 months.
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14
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Simonsen C, Thorsen-Streit S, Sundberg A, Djurhuus SS, Mortensen CE, Qvortrup C, Pedersen BK, Svendsen LB, de Heer P, Christensen JF. Effects of high-intensity exercise training on physical fitness, quality of life and treatment outcomes after oesophagectomy for cancer of the gastro-oesophageal junction: PRESET pilot study. BJS Open 2020; 4:855-864. [PMID: 32856785 PMCID: PMC7528530 DOI: 10.1002/bjs5.50337] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/06/2020] [Indexed: 12/11/2022] Open
Abstract
Background Treatment for cancer of the gastro‐oesophageal junction (GOJ) can result in considerable and persistent impairment of physical fitness and health‐related quality of life (HRQoL). This controlled follow‐up study investigated the feasibility and safety of postoperative exercise training. Methods Patients with stage I–III GOJ cancer were allocated to 12 weeks of postoperative concurrent aerobic and resistance training (exercise group) or usual care (control group). Changes in cardiorespiratory fitness, muscle strength and HRQoL were evaluated. Adherence to adjuvant chemotherapy, hospitalizations and 1‐year overall survival were recorded to assess safety. Results Some 49 patients were studied. The exercise group attended a mean of 69 per cent of all prescribed sessions. After exercise, muscle strength and cardiorespiratory fitness were increased and returned to pretreatment levels. At 1‐year follow‐up, the exercise group had improved HRQoL (+13·5 points, 95 per cent c.i. 2·2 to 24·9), with no change in the control group (+3·7 points, −5·9 to 13·4), but there was no difference between the groups at this time point (+9·8 points, −5·1 to 24·8). Exercise was safe, with no differences in patients receiving adjuvant chemotherapy (14 of 16 versus 16 of 19; relative risk (RR) 1·04, 95 per cent c.i. 0·74 to 1·44), relative dose intensity of adjuvant chemotherapy (mean 57 versus 63 per cent; P = 0·479), hospitalization (7 of 19 versus 6 of 23; RR 1·41, 0·57 to 3·49) or 1‐year overall survival (80 versus 79 per cent; P = 0·839) for exercise and usual care respectively. Conclusion Exercise in the postoperative period is safe and may have the potential to improve physical fitness in patients with GOJ cancer. No differences in prognostic endpoints or HRQoL were observed. Registration number: NCT02722785 (
https://www.clinicaltrials.gov).
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Affiliation(s)
- C Simonsen
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - S Thorsen-Streit
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Sundberg
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - S S Djurhuus
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - C Qvortrup
- Departments of Oncology, Copenhagen, Denmark
| | - B K Pedersen
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - L B Svendsen
- Surgical Gastroenterology, Copenhagen University Hospital, Copenhagen, Denmark
| | - P de Heer
- Surgical Gastroenterology, Copenhagen University Hospital, Copenhagen, Denmark
| | - J F Christensen
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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15
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van den Boorn HG, Stroes CI, Zwinderman AH, Eshuis WJ, Hulshof MCCM, van Etten-Jamaludin FS, Sprangers MAG, van Laarhoven HWM. Health-related quality of life in curatively-treated patients with esophageal or gastric cancer: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2020; 154:103069. [PMID: 32818901 DOI: 10.1016/j.critrevonc.2020.103069] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/13/2020] [Accepted: 07/23/2020] [Indexed: 12/24/2022] Open
Abstract
Surgery and chemoradiotherapy can potentially cure esophageal and gastric cancer patients, although they may impact health-related quality of life (HRQoL). We aim to systemically review and meta-analyze literature to determine the effect of curative treatments on HRQoL in esophageal and gastric cancer.- A systematic search was performed identifying studies assessing HRQoL. Meta-analyses were performed on baseline and subsequent time-points.- From the 6067 articles retrieved, 49 studies were included (61 % low quality). Meta-analyses showed short-term HRQoL differences between esophageal cancer patients receiving definitive chemoradiotherapy (dCRT), neoadjuvant chemo(radio)therapy (nC(R)T), or surgery alone (p < 0.001), with better HRQoL with nC(R)T and surgery compared to dCRT. Over the course of 12 months, no HRQoL difference was identified between treatments in esophageal cancer (p = 0.633). Esophagectomy, but not gastrectomy, resulted in a clinically relevant decline in HRQoL. No long-term HRQoL differences were identified between curative treatments in esophageal and gastric cancer. More high-quality HRQoL studies are warranted.
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Affiliation(s)
- Héctor G van den Boorn
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Charlotte I Stroes
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental and Molecular Medicine (CEMM), Meibergdreef 9, Amsterdam, the Netherlands.
| | - Aeilko H Zwinderman
- Amsterdam UMC, University of Amsterdam, Department of Clinical Epidemiology and Biostatistics, Meibergdreef 9, Amsterdam, the Netherlands
| | - Wietse J Eshuis
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Meibergdreef 9, Amsterdam, the Netherlands
| | - Maarten C C M Hulshof
- Amsterdam UMC, University of Amsterdam, Department of Radiotherapy, Meibergdreef 9, Amsterdam, the Netherlands
| | | | - Mirjam A G Sprangers
- Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Hanneke W M van Laarhoven
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
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16
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Tully R, Loughney L, Bolger J, Sorensen J, McAnena O, Collins CG, Carroll PA, Arumugasamy M, Murphy TJ, Robb WB. The effect of a pre- and post-operative exercise programme versus standard care on physical fitness of patients with oesophageal and gastric cancer undergoing neoadjuvant treatment prior to surgery (The PERIOP-OG Trial): Study protocol for a randomised controlled trial. Trials 2020; 21:638. [PMID: 32660526 PMCID: PMC7359259 DOI: 10.1186/s13063-020-04311-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advances in peri-operative oncological treatment, surgery and peri-operative care have improved survival for patients with oesophagogastric cancers. Neoadjuvant cancer treatment (NCT) reduces physical fitness, which may reduce both compliance and tolerance of NCT as well as compromising post-operative outcomes. This is particularly detrimental in a patient group where malnutrition is common and surgery is demanding. The aim of this trial is to assess the effect on physical fitness and clinical outcomes of a comprehensive exercise training programme in patients undergoing NCT and surgical resection for oesophagogastric malignancies. METHODS The PERIOP-OG trial is a pragmatic, multi-centre, randomised controlled trial comparing a peri-operative exercise programme with standard care in patients with oesophagogastric cancers treated with NCT and surgery. The intervention group undergo a formal exercise training programme and the usual care group receive standard clinical care (no formal exercise advice). The training programme is initiated at cancer diagnosis, continued during NCT, between NCT and surgery, and resumes after surgery. All participants undergo assessments at baseline, post-NCT, pre-surgery and at 4 and 10 weeks after surgery. The primary endpoint is cardiorespiratory fitness measured by demonstration of a 15% difference in the 6-min walk test assessed at the pre-surgery timepoint. Secondary endpoints include measures of physical health (upper and lower body strength tests), body mass index, frailty, activity behaviour, psychological and health-related quality of life outcomes. Exploratory endpoints include a health economics analysis, assessment of clinical health by post-operative morbidity scores, hospital length of stay, nutritional status, immune and inflammatory markers, and response to NCT. Rates of NCT toxicity, tolerance and compliance will also be assessed. DISCUSSION The PERIOP-OG trial will determine whether, when compared to usual care, exercise training initiated at diagnosis and continued during NCT, between NCT and surgery and then during recovery, can maintain or improve cardiorespiratory fitness and other physical, psychological and clinical health outcomes. This trial will inform both the prescription of exercise regimes as well as the design of a larger prehabilitation and rehabilitation trial to investigate whether exercise in combination with nutritional and psychological interventions elicit greater benefits. TRIAL REGISTRATION ClinicalTrials.gov: NCT03807518 . Registered on 1 January 2019.
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Affiliation(s)
- Roisin Tully
- Department of Upper GI Surgery, Beaumont Hospital, Dublin, Ireland.,The Royal College of Surgeons in Ireland, St. Stephens Green, Dublin, Ireland
| | - Lisa Loughney
- The Royal College of Surgeons in Ireland, St. Stephens Green, Dublin, Ireland.,ExWell Medical, Santry Sports Link, Dublin, Ireland
| | - Jarlath Bolger
- Department of Upper GI Surgery, Beaumont Hospital, Dublin, Ireland
| | - Jan Sorensen
- The Royal College of Surgeons in Ireland, St. Stephens Green, Dublin, Ireland
| | - Oliver McAnena
- Department of Upper GI Surgery, University Hospital, Galway, Ireland
| | - Chris G Collins
- Department of Upper GI Surgery, University Hospital, Galway, Ireland
| | - Paul A Carroll
- Department of Upper GI Surgery, University Hospital, Galway, Ireland
| | - Mayilone Arumugasamy
- Department of Upper GI Surgery, Beaumont Hospital, Dublin, Ireland.,The Royal College of Surgeons in Ireland, St. Stephens Green, Dublin, Ireland
| | - Tomas J Murphy
- Department of Upper GI Surgery, Mercy University Hospital, Cork, Ireland
| | - William B Robb
- Department of Upper GI Surgery, Beaumont Hospital, Dublin, Ireland. .,The Royal College of Surgeons in Ireland, St. Stephens Green, Dublin, Ireland.
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17
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Preliminary Normative Standards of the Mayo Clinic Esophagectomy CONDUIT Tool. Mayo Clin Proc Innov Qual Outcomes 2020; 3:429-437. [PMID: 31993561 PMCID: PMC6978604 DOI: 10.1016/j.mayocpiqo.2019.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 07/12/2019] [Indexed: 11/22/2022] Open
Abstract
Objective To collect patient-reported outcomes after esophagectomy to establish a set of preliminary normative standards to aid in symptom-score interpretation. Patients and Methods Patients undergoing esophagectomy often have little understanding about postoperative symptom management. The Mayo Clinic esophageal CONDUIT tool is a validated questionnaire comprising 5 multi-item symptom-assessment domains and 2 health-assessment domains. A prospective nonrandomized cohort study was conducted on adult patients who have had esophagectomies using the CONDUIT tool from August 17, 2015, to July 30, 2018 (NCT02530983). The Statistical Analysis System v9.4 (SAS Institute Inc., Cary, NC) was used to calculate and analyze the scores. Results Over the study period, 569 patients were assessed for eligibility, and 241 patients consented and were offered the tool. Of these, 188 patients (median age: 65 years; range: 24 to 87 years; 80% male patients) had calculable scores. Of the 188 patients, 50 (26.6%) patients were identified as potential beneficiaries for educational intervention to improve symptoms (received moderate scores for a domain), and 131 (69.7%) patients were identified as needing further testing or provider intervention (received poor scores for a domain) based on the tool. Conclusion The CONDUIT tool scores, when compared with standardized scales with established preliminary normative scores, could be used to identify and triage patients who need targeted education, further testing, or provider interventions. These score ranges will serve as the first set of normative standards to aid in the interpretation of conduit performance among providers and patients.
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18
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Singer JP, Soong A, Chen J, Shrestha P, Zhuo H, Gao Y, Greenland JR, Hays SR, Kukreja J, Golden J, Gregorich SE, Stewart AL. Development and Preliminary Validation of the Lung Transplant Quality of Life (LT-QOL) Survey. Am J Respir Crit Care Med 2020; 199:1008-1019. [PMID: 30303408 DOI: 10.1164/rccm.201806-1198oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RATIONALE Although lung transplantation aims to improve health-related quality of life (HRQL), existing instruments fail to include health domains considered important in this population. OBJECTIVES We aimed to develop a comprehensive lung transplant-specific instrument to address this shortcoming. METHODS We developed a pool of 126 candidate items addressing domains previously identified as important by lung transplant recipients. Through cognitive interviews conducted in 43 transplant recipients, items deemed irrelevant or redundant were dropped. The 84 remaining items were field tested in lung transplant recipients. Exploratory and confirmatory factor analyses were used to evaluate the factor structure, and scales were evaluated for internal consistency and construct validity. MEASUREMENTS AND MAIN RESULTS The 84-item preliminary survey was administered to 201 lung transplant recipients with a mean age of 57.9 (±12.7) years; 46% were female. After factor analyses and internal consistency evaluation, we retained 60 items comprising the Lung Transplant Quality of Life (LT-QOL) Survey. The LT-QOL contains 10 scales that measure symptoms, health perceptions, functioning, and well-being. The confirmatory factor analysis model had good approximate fit (comparative fit index = 0.990; standardized root-mean-square residual = 0.062). Cronbach αs for the 10 scales ranged from 0.75 to 0.95. Interscale correlations were consistent with hypothesized relationships. Subjects with severe chronic lung allograft dysfunction (n = 13) reported significantly worse HRQL than subjects without chronic lung allograft dysfunction (n = 168) on 6 of the 10 LT-QOL scales. CONCLUSIONS The LT-QOL is a new, multidimensional instrument that characterizes and quantifies HRQL in lung transplant recipients.
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Affiliation(s)
- Jonathan P Singer
- 1 Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine
| | - Allison Soong
- 1 Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine
| | - Joan Chen
- 1 Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine
| | - Pavan Shrestha
- 1 Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine
| | - Hanjing Zhuo
- 1 Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine
| | - Ying Gao
- 1 Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine
| | - John R Greenland
- 1 Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine
| | - Steven R Hays
- 1 Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine
| | | | - Jeffrey Golden
- 1 Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine
| | | | - Anita L Stewart
- 4 Institute for Health & Aging, University of California, San Francisco, San Francisco, California
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19
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Garant A, Whitaker TJ, Spears GM, Routman DM, Harmsen WS, Wilhite TJ, Ashman JB, Sio TT, Rule WG, Neben Wittich MA, Martenson JA, Tryggestad EJ, Yoon HH, Blackmon S, Merrell KW, Haddock MG, Hallemeier CL. A Comparison of Patient-Reported Health-Related Quality of Life During Proton Versus Photon Chemoradiation Therapy for Esophageal Cancer. Pract Radiat Oncol 2019; 9:410-417. [DOI: 10.1016/j.prro.2019.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 12/17/2022]
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20
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Sarkaria IS, Rizk NP, Goldman DA, Sima C, Tan KS, Bains MS, Adusumilli PS, Molena D, Bott M, Atkinson T, Jones DR, Rusch VW. Early Quality of Life Outcomes After Robotic-Assisted Minimally Invasive and Open Esophagectomy. Ann Thorac Surg 2019; 108:920-928. [PMID: 31026433 DOI: 10.1016/j.athoracsur.2018.11.075] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 09/25/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Minimally invasive esophagectomy may improve some perioperative outcomes over open approaches; effects on quality of life are less clear. METHODS A prospective trial of robotic-assisted minimally invasive esophagectomy (RAMIE) and open esophagectomy was initiated, measuring quality of life via the Functional Assessment of Cancer Therapy-Esophageal and Brief Pain Inventory. Mixed generalized linear models assessed associations between quality of life scores over time and by surgery type. RESULTS In total, 106 patients underwent open esophagectomy; 64 underwent minimally invasive esophagectomy (98% RAMIE). The groups did not differ in age, sex, comorbidities, histologic subtype, stage, or induction treatment (P = .42 to P > .95). Total Functional Assessment of Cancer Therapy-Esophageal scores were lower at 1 month (P < .001), returned to near baseline by 4 months, and did not differ between groups (P = .83). Brief Pain Inventory average pain severity (P = .007) and interference (P = .004) were lower for RAMIE. RAMIE had lower estimated blood loss (250 vs 350 cm3; P < .001), shorter length of stay (9 vs 11 days; P < .001), fewer intensive care unit admissions (8% vs 20%; P = .033), more lymph nodes harvested (25 vs 22; P = .05), and longer surgical time (6.4 vs 5.4 hours; P < .001). Major complications (39% for RAMIE vs 52% for open esophagectomy; P > .95), anastomotic leak (3% vs 9%; P = .41), and 90-day mortality (2% vs 4%; P = .85) did not differ between groups. Pulmonary (14% vs 34%; P = .014) and infectious (17% vs 36%; P = .029) complications were lower for RAMIE. CONCLUSIONS RAMIE is associated with lower immediate postoperative pain severity and interference and decreased pulmonary and infectious complications. Ongoing data accrual will assess mid-term and long-term outcomes in this cohort.
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Affiliation(s)
- Inderpal S Sarkaria
- Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Nabil P Rizk
- Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Debra A Goldman
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Camelia Sima
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kay See Tan
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Manjit S Bains
- Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Prasad S Adusumilli
- Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniela Molena
- Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew Bott
- Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Thomas Atkinson
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David R Jones
- Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Valerie W Rusch
- Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Hirpara DH, Gupta V, Brown L, Kidane B. Patient-reported outcomes in lung and esophageal cancer. J Thorac Dis 2019; 11:S509-S514. [PMID: 31032069 DOI: 10.21037/jtd.2019.01.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Carcinomas of the lung and esophagus are associated with significant disease and treatment related morbidity. Measuring patients' self-perceived notion of their health-related quality of life (HRQOL), throughout the course of illness, is central to the delivery of comprehensive, patient-centered care. This article reviews commonly used HRQOL instruments in thoracic surgery and discusses the integral role of patient-reported outcomes (PROs) in comparative effectiveness research and prognostication in the realm of lung and esophageal cancer. We also highlight challenges and future directions for widespread implementation of PROs into clinical and research practice.
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Affiliation(s)
- Dhruvin H Hirpara
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vaibhav Gupta
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Brown
- Department of Surgery, University of California, Davis, Sacramento, California, USA.,Thoracic Surgery Outcomes Research Network (ThORN)
| | - Biniam Kidane
- Thoracic Surgery Outcomes Research Network (ThORN).,Section of Thoracic Surgery, Health Sciences Center, Winnipeg, Manitoba, Canada
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22
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Doherty MK, Leung Y, Su J, Naik H, Patel D, Eng L, Kong QQ, Mohsin F, Brown MC, Espin-Garcia O, Vennettilli A, Renouf DJ, Faluyi OO, Knox JJ, MacKay H, Wong R, Howell D, Mittmann N, Darling GE, Cella D, Xu W, Liu G. Health utility scores from EQ-5D and health-related quality of life in patients with esophageal cancer: a real-world cross-sectional study. Dis Esophagus 2018; 31:5037798. [PMID: 29905764 DOI: 10.1093/dote/doy058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal cancer and its treatment can cause serious morbidity/toxicity. These effects on health-related quality of life (HRQOL) can be measured using disease-specific scales such as FACT-E, generic scales such as EQ-5D-3L, or through symptoms. In a two-year cross-sectional study, we compared HRQOL across esophageal cancer patients treated in an ambulatory clinic and across multiple disease states, among patients with all stages of esophageal cancer. Consenting patients completed FACT-E, EQ-5D, a visual analog scale, and patient reported (PR)-ECOG. Symptom complexes were constructed from FACT-E domains. Responses were categorized by disease state: pre-, during, and post-treatment, surveillance, progression, and palliative chemotherapy. Spearman correlation and multivariable linear regression characterized these associations. In total, 199 patients completed 317 questionnaires. Mean FACT-E and subscale scores dropped from baseline through treatment and recovered during post-treatment surveillance (P < 0.001); EQ-5D health utility scores (HUS) displayed a similar pattern but with smaller differences (P = 0.07), and with evidence of ceiling effect. Among patients with stage II/III esophageal cancer, mean EQ-5D HUS varied across disease states (P < 0.001), along with FACT-E and subscales (P < 0.001). Among patients with advanced disease, there was no significant difference between baseline and on-treatment total scores, but improved esophageal cancer-specific scales were noted (P = 0.003). Strong correlation was observed between EQ-5D and FACT-E (R = 0.73), along with physical and functional subscales. In addition, the association between FACT-E and EQ-5D HUS was maintained in a multivariable model (P < 0.001). We interpret these results to suggest that in a real-world clinic setting, FACT-E, EQ-5D HUS, and symptoms were strongly correlated. Most HRQOL and symptom parameters suggested that patients had worse HRQOL and symptoms during curative therapy, but recovered well afterwards. In contrast, palliative chemotherapy had a neutral to positive impact on HRQOL/symptoms when compared to their baseline pre-treatment state.
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Affiliation(s)
- M K Doherty
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Division of Medical Oncology and Hematology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Y Leung
- Department of Psychosocial Oncology, Princess Margaret Cancer Centre, British Colombia, Canada
| | - J Su
- Department of Biostatistics, Princess Margaret Cancer Centre, British Colombia, Canada
| | - H Naik
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - D Patel
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - L Eng
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Q Q Kong
- Department of Biostatistics, Princess Margaret Cancer Centre, British Colombia, Canada
| | - F Mohsin
- Department of Biostatistics, Princess Margaret Cancer Centre, British Colombia, Canada
| | - M C Brown
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - O Espin-Garcia
- Department of Biostatistics, Princess Margaret Cancer Centre, British Colombia, Canada
| | - A Vennettilli
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - D J Renouf
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,BC Cancer Agency, University of British Columbia, Vancouver, British Colombia, Canada
| | - O O Faluyi
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Medical Oncology, Clatterbridge Cancer Centre NHS Foundation Trust, UK
| | - J J Knox
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - H MacKay
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Division of Medical Oncology and Hematology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - R Wong
- Radiation Medicine Program, University of Toronto, Toronto, Ontario
| | - D Howell
- Department of Psychosocial Oncology, Princess Margaret Cancer Centre, British Colombia, Canada
| | - N Mittmann
- Cancer Care Ontario, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario
| | - G E Darling
- Department of Surgery, Princess Margaret Cancer Centre, Chicago, Illinois, USA
| | - D Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
| | - W Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, British Colombia, Canada
| | - G Liu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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23
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Frailty assessment prior to thoracic surgery for lung or esophageal cancer: a feasibility study. Support Care Cancer 2018; 27:1535-1540. [DOI: 10.1007/s00520-018-4547-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 11/07/2018] [Indexed: 12/21/2022]
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24
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Christensen JF, Simonsen C, Banck-Petersen A, Thorsen-Streit S, Herrstedt A, Djurhuus SS, Egeland C, Mortensen CE, Kofoed SC, Kristensen TS, Garbyal RS, Pedersen BK, Svendsen LB, Højman P, de Heer P. Safety and feasibility of preoperative exercise training during neoadjuvant treatment before surgery for adenocarcinoma of the gastro-oesophageal junction. BJS Open 2018; 3:74-84. [PMID: 30734018 PMCID: PMC6354184 DOI: 10.1002/bjs5.50110] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/07/2018] [Indexed: 12/20/2022] Open
Abstract
Background Neoadjuvant chemotherapy or chemoradiotherapy is used widely before tumour resection in cancer of the gastro‐oesophageal junction (GOJ). Strategies to improve treatment tolerability are warranted. This study examined the safety and feasibility of preoperative exercise training during neoadjuvant treatment in these patients. Methods Patients were allocated to a standard‐care control group or an exercise group, who were prescribed standard care plus twice‐weekly high‐intensity aerobic exercise and resistance training sessions. The primary endpoint was the incidence of serious adverse events (SAEs) that prevented surgery, including death, disease progression or physical deterioration. Preoperative hospital admission, postoperative complications, changes in patient‐reported quality of life and pathological treatment response were also recorded. In the exercise group, adherence to exercise and changes in aerobic fitness, muscle strength and body composition were measured. Results The incidence of SAEs was not increased in the exercise group. The risk of failure to reach surgery was 5 versus 21 per cent in the control group (risk ratio (RR) 0·23, 95 per cent c.i. 0·04 to 1·29), the risk of preoperative hospital admission was 15 versus 38 per cent respectively (RR 0·39, 0·12 to 1·23) and the risk of postoperative complications was 58 versus 57 per cent (RR 1·06, 0·61 to 1·73). The exercise group attended a mean of 17·5 sessions, and improved fitness, muscle strength and Functional Assessment of Cancer Therapy — Esophageal (FACT‐E) total score compared with the baseline level. Conclusion Preoperative exercise training during neoadjuvant treatment in patients with GOJ cancer is safe and feasible, with improvements in fitness, strength and quality of life. Preoperative exercise training may be associated with a lower risk of critical SAEs that preclude surgery or result in hospitalization.
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Affiliation(s)
- J F Christensen
- Centre of Inflammation and Metabolism/Centre for Physical Activity Research Copenhagen Denmark
| | - C Simonsen
- Centre of Inflammation and Metabolism/Centre for Physical Activity Research Copenhagen Denmark
| | - A Banck-Petersen
- Centre of Inflammation and Metabolism/Centre for Physical Activity Research Copenhagen Denmark
| | - S Thorsen-Streit
- Centre of Inflammation and Metabolism/Centre for Physical Activity Research Copenhagen Denmark
| | - A Herrstedt
- Centre of Inflammation and Metabolism/Centre for Physical Activity Research Copenhagen Denmark
| | - S S Djurhuus
- Centre of Inflammation and Metabolism/Centre for Physical Activity Research Copenhagen Denmark
| | - C Egeland
- Department of Surgical Gastroenterology C Copenhagen Denmark
| | | | - S C Kofoed
- Department of Surgical Gastroenterology C Copenhagen Denmark
| | | | - R S Garbyal
- Department of Pathology, Rigshospitalet Copenhagen Denmark
| | - B K Pedersen
- Centre of Inflammation and Metabolism/Centre for Physical Activity Research Copenhagen Denmark
| | - L B Svendsen
- Department of Surgical Gastroenterology C Copenhagen Denmark
| | - P Højman
- Centre of Inflammation and Metabolism/Centre for Physical Activity Research Copenhagen Denmark
| | - P de Heer
- Department of Surgical Gastroenterology C Copenhagen Denmark
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25
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Lee MK, Yost KJ, Pierson KE, Blackmon SH. Patient-reported outcome domains for the esophageal CONDUIT report card: a prospective trial to establish domains. Health Qual Life Outcomes 2018; 16:197. [PMID: 30305083 PMCID: PMC6180437 DOI: 10.1186/s12955-018-1023-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 09/21/2018] [Indexed: 02/06/2023] Open
Abstract
Background Health-related quality of life (QoL) deteriorates immediately after esophagectomy. Patients may benefit from periodic assessments to detect increased morbidity on the basis of subjective self-reports. Using input from patients and health care providers, we developed a brief prototype for the esophageal conduit questionnaire (Mayo Clinic Esophageal Conduit Outcomes Noting Dysphagia/Dumping, and Unknown outcomes with Intermittent symptoms over Time after esophageal reconstruction [CONDUIT] Report Card) and previously used it in comparative research. The present study aimed to expand its content and establish health-related QoL and symptom domains of a patient-reported postesophagectomy conduit evaluation tool. Methods We expanded tool content by selecting items measuring patient-reported symptoms from existing questionnaires or written de novo. A multidisciplinary group of clinician content-matter experts approved the draft tool, together with a designated patient advocate. The expanded tool was administered to patients postesophagectomy from March 1 to November 30, 2016. We established domains of conduit performance for score reporting through data analysis with exploratory factor analyses. We assessed psychometric properties such as dimensionality, internal consistency, and inter-item correlations in each domain and compared content coverage with other existing measures intended for this patient population. For data that were missing less than 50% of patient responses, the missing values were imputed. Results Five multi-item domains were established from data of 76 patients surveyed after esophagectomy; single items were used to assess stricture and conduit emptying. For every multi-item domain, dominance of 1 factor was present. Internal consistency reliability estimates for the domains were 0.87, 0.78, 0.75, 0.80, and 0.83 and average inter-item correlations were 0.40, 0.50, 0.40, 0.33, and 0.73 for dysphagia, reflux, dumping-gastrointestinal symptoms, dumping-hypoglycemia, and pain, respectively. Some items observed to have lower inter-item correlation were reworded or flagged for removal at future validation. For reflux and dumping-related hypoglycemia, additional items were written after these analyses. Conclusions The CONDUIT Report Card is a novel questionnaire for assessing QoL and symptoms of patients after esophageal reconstruction. It covers major symptoms of these patients and has good content validity and psychometric properties. The tool can be used to help direct patient care, guide intervention, and compare efficacy of different treatment options. Trial registration ClinicalTrials.gov identifier No. 02530983 on 8/18/2015.
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Affiliation(s)
- Minji K Lee
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Kathleen J Yost
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Karlyn E Pierson
- Department of Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Shanda H Blackmon
- Department of Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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26
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Iravani K, Jafari P, Akhlaghi A, Khademi B. Assessing whether EORTC QLQ-30 and FACT-G measure the same constructs of quality of life in patients with total laryngectomy. Health Qual Life Outcomes 2018; 16:183. [PMID: 30217200 PMCID: PMC6137753 DOI: 10.1186/s12955-018-1012-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 09/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The European Organization for Research and Treatment of Cancer QOL Core Questionnaire 30 (EORTC QLQ-30) and the Assessment of Cancer Therapy-General (FACT-G) are the two most widely used measures of cancer-specific health-related quality of life (HRQOL). This study aims to assess whether the two instruments measure the same constructs of HRQOL in patients with total laryngectomy. METHODS The EORTC QLQ-30 and the FACT-G was completed by 132 patients with total laryngectomy. Convergent, discriminant, and construct validity of the EORTC QLQ-C30 and the FACT-G were assessed by Spearman's correlation and explanatory factor analysis. RESULTS The results of factor analysis showed that the EORTC QLQ-C30 and the FACT-G measure different aspects of HRQOL. Moreover, both instruments showed excellent convergent and discriminant validity, except for nausea and vomiting symptom subscale in the EORTC QLQ-C30 questionnaire. The internal consistency was close or greater than 0.7 for all domains of both instruments except for functional wellbeing in FACT-G. CONCLUSIONS This study revealed that neither of the two instruments can be replaced by the other in the assessment of HRQOL in Iranian patients with total laryngectomy. Accordingly, clinicians should exactly define their research questions related to patient-reported outcomes before choosing which instrument to use.
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Affiliation(s)
- Kamyar Iravani
- Department of Otorhinolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Jafari
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Allahkaram Akhlaghi
- Department of Otorhinolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bijan Khademi
- Department of Otorhinolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
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27
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Kidane B, Ali A, Sulman J, Wong R, Knox JJ, Darling GE. Health-related quality of life measure distinguishes between low and high clinical T stages in esophageal cancer. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:270. [PMID: 30094256 DOI: 10.21037/atm.2018.06.03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background Functional Assessment of Cancer Therapy-Esophagus (FACT-E) is a health-related quality of life (HRQOL) instrument validated in patients with esophageal cancer. It is made up of both a general component and an esophageal cancer subscale (ECS). Our objective was to explore the relationship between baseline FACT-E, ECS and clinically determined T-stage in patients with stage II-IV cancer of the gastroesophageal junction or thoracic esophagus. Methods Data from four prospective studies in Canadian academic hospitals were combined. These were consecutive and eligible patients treated between 1996 and 2014 with clinical stage II-IV cancer of the gastroesophageal junction or thoracic esophagus. All patients completed pre-treatment FACT-E. Parametric (ANOVA) and non-parametric (Kruskal-Wallis) analyses were performed. Results Of the 135 patients that were deemed eligible, the T-stage distribution determined clinically was: 10 (7.4%) T1, 33 (24.4%) T2, 79 (58.5%) T3 and 13 (9.6%) T4. Parametric analysis showed no significant association between FACT-E & T-stage, although there was a trend towards significance (P=0.08). Non-parametric analysis showed a significant association between FACT-E and T-stage (P=0.05). Post-hoc tests identified that the most significant differences in FACT-E scores were between T1 and T3 patients. Both parametric (P=0.002) and non-parametric (P=0.003) analyses showed an association between ECS & T-stage. Post-hoc analyses showed significant differences in ECS scores between T1 and higher T-stages (P<0.01). Conclusions Patient-reported HRQOL scores appear to be significantly different in patients with clinical T1 esophageal cancer as compared to those with higher clinical T stages. Since distinguishing T1 from T2/T3 lesions is important in guiding the most appropriate treatment modality and since EUS appears to have difficulties reliably making such T-stage distinctions, FACT-E and ECS scores may be helpful as an adjunct to guide decision-making.
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Affiliation(s)
- Biniam Kidane
- Section of Thoracic Surgery, University of Manitoba, Winnipeg, MB, Canada.,Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada
| | - Amir Ali
- Section of Thoracic Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Joanne Sulman
- Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Rebecca Wong
- Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Jennifer J Knox
- Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Gail E Darling
- Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada.,Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada.,Division of Thoracic Surgery, Toronto General Hospital, Toronto, ON, Canada
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28
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Borean M, Shani K, Brown MC, Chen J, Liang M, Karkada J, Kooner S, Doherty MK, O'Kane GM, Jang R, Elimova E, Wong RK, Darling GE, Xu W, Howell D, Liu G. Development and evaluation of screening dysphagia tools for observational studies and routine care in cancer patients. Health Sci Rep 2018; 1:e48. [PMID: 30623085 PMCID: PMC6266365 DOI: 10.1002/hsr2.48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 03/01/2018] [Accepted: 04/05/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS Dysphagia can be associated with significant morbidity in cancer patients. We aimed to develop and evaluate dysphagia screener tools for use in observational studies (phase 1) and for routine symptom monitoring in clinical care (phase 2). METHODS Various dysphagia or odynophagia screening questions, selected after an expert panel reviewed the content, criterion, and construct validity, were compared with either functional assessment of cancer therapy - esophageal cancer (FACT-E) Swallowing Index Cut-Off Values or to questions adapted from the Patient Reported Outcomes for Common Terminology Criteria for Adverse Events. Sensitivity, specificity, and patient acceptability were assessed. RESULTS In Phase 1 (n = 178 esophageal cancer patients), the screening question "How are you currently eating?" had the highest sensitivities and specificities against various Swallowing Index Cut-Off Value cut-offs, with the best optimal cutoff associated with weight loss (80% sensitivity and 75% specificity). In phase 2 (255 head and neck, gastro-esophageal, and thoracic cancer patients), a single question screener ("Do you experience any difficulty or pain upon swallowing?") versus a Patient Reported Outcomes for Common Terminology Criteria for Adverse Events-like gold standard generated sensitivities between 86% and 94% and specificities between 93% and 100%. This screening question (+/- follow-up questions) had a median completion time of under 2 minutes, and >90% of patients were willing to complete the survey electronically, did not feel that survey made clinic visit more difficult, and did not find the questions upsetting or distressful. CONCLUSION Our results demonstrate that these screener tools ("How are you currently eating?", "Do you experience any difficulty or pain upon swallowing?") can effectively screen dysphagia symptoms without increasing cancer outpatient clinic burden, both in observational studies and for routine clinical monitoring.
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Affiliation(s)
- Michael Borean
- Division of Medical Oncology Princess Margaret Cancer Centre and Departments of Medicine and Epidemiology, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Kishan Shani
- Division of Medical Oncology Princess Margaret Cancer Centre and Departments of Medicine and Epidemiology, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - M. Catherine Brown
- Division of Medical Oncology Princess Margaret Cancer Centre and Departments of Medicine and Epidemiology, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Judy Chen
- Division of Medical Oncology Princess Margaret Cancer Centre and Departments of Medicine and Epidemiology, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Mindy Liang
- Division of Medical Oncology Princess Margaret Cancer Centre and Departments of Medicine and Epidemiology, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Joel Karkada
- Division of Medical Oncology Princess Margaret Cancer Centre and Departments of Medicine and Epidemiology, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Simranjit Kooner
- Division of Medical Oncology Princess Margaret Cancer Centre and Departments of Medicine and Epidemiology, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Mark K. Doherty
- Odette Cancer CentreUniversity of TorontoTorontoOntarioCanada
| | - Grainne M. O'Kane
- Division of Medical Oncology Princess Margaret Cancer Centre and Departments of Medicine and Epidemiology, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Raymond Jang
- Division of Medical Oncology Princess Margaret Cancer Centre and Departments of Medicine and Epidemiology, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Elena Elimova
- Division of Medical Oncology Princess Margaret Cancer Centre and Departments of Medicine and Epidemiology, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Rebecca K. Wong
- Department of Radiation Oncology, Princess Margaret HospitalUniversity of TorontoTorontoOntarioCanada
| | - Gail E. Darling
- Department of Thoracic SurgeryUniversity Health Network, University of TorontoTorontoOntarioCanada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Doris Howell
- Psychosocial Oncology, Princess Margaret Cancer Centre, Lawrence Bloomberg School of NursingUniversity of TorontoTorontoOntarioCanada
| | - Geoffrey Liu
- Division of Medical Oncology Princess Margaret Cancer Centre and Departments of Medicine and Epidemiology, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Department of Epidemiology, Dalla Lana School of Public Health, Departments of Medicine and Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
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29
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O’Neill L, Moran J, Guinan EM, Reynolds JV, Hussey J. Physical decline and its implications in the management of oesophageal and gastric cancer: a systematic review. J Cancer Surviv 2018; 12:601-618. [DOI: 10.1007/s11764-018-0696-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 05/08/2018] [Indexed: 12/14/2022]
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30
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Affiliation(s)
- Craig C Reed
- Center for Esophageal Diseases and Swallowing, Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Evan S Dellon
- Center for Esophageal Diseases and Swallowing, Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
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31
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Harada K, Yoshida N, Baba Y, Nakamura K, Kosumi K, Ishimoto T, Iwatsuki M, Miyamoto Y, Sakamoto Y, Ajani JA, Watanabe M, Baba H. Pyloroplasty may reduce weight loss 1 year after esophagectomy. Dis Esophagus 2018; 31:4944973. [PMID: 29579257 DOI: 10.1093/dote/dox127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 09/19/2017] [Indexed: 12/11/2022]
Abstract
Weight loss after esophagectomy is common and is associated with unfavorable prognosis. However, the clinical features and surgical methods that influence postesophagectomy weight loss are not well characterized. This study aims to determine those features (especially the surgical methods) that may affect postoperative weight loss. We reviewed 221 esophageal cancer patients who had undergone esophagectomy at Kumamoto University Hospital (Kumamoto, Japan) between November 2012 and June 2015. Among these, we recruited 106 patients who had undergone transthoracic esophagectomy with gastric conduit reconstruction, had no cancer recurrence within 1 year, and no missing follow-up data. We tabulated the body weight changes and risk factors associated with weight loss exceeding 10% at 1-year postesophagectomy. The mean body weights at baseline and 1-year postsurgery were 60.3 kg (standard error (SE): 0.91) and 52.6 (SE: 0.91), respectively. One year postsurgery, the body weights had changed as follows: mean: -12.2%; median: -12.9%; standard deviation: 9.06; range: -36.1-18.56%; interquartile range: -10.5 to -14.0%. In the multivariate logistic regression analysis, the absence of pyloroplasty was the sole risk factor for more than 10% weight loss (OR: 3.22; 95% CI: 1.08-11.9; P = 0.036). Our data suggest that pyloroplasty with esophagectomy can overcome the post-surgical weight loss.
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Affiliation(s)
- K Harada
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto.,Department of Gastrointestinal Medical Oncology at the University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - N Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto
| | - Y Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto
| | - K Nakamura
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto
| | - K Kosumi
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto
| | - T Ishimoto
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto
| | - M Iwatsuki
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto
| | - Y Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto
| | - Y Sakamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto
| | - J A Ajani
- Department of Gastrointestinal Medical Oncology at the University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - M Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
| | - H Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto
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32
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Alghamedi A, Buduhan G, Tan L, Srinathan SK, Sulman J, Darling G, Kidane B. Quality of life assessment in esophagectomy patients. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:84. [PMID: 29666807 DOI: 10.21037/atm.2017.11.38] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Esophagectomy is the mainstay of curative therapy for esophageal cancer; however, it is associated with significant morbidity and mortality, with subsequent major impact on quality of life. This paper reviews the evaluation of health-related quality of life (HRQOL) in esophageal cancer patients undergoing curative intent therapy, the relationship between postoperative HRQOL and survival as well the potential utility of pre-treatment HRQOL as a prognostic tool. HRQOL assessment is valuable in helping clinicians understand the impact on patients of esophageal cancer and the various treatments thereof. HRQOL is also valuable as an end-point in studies of esophageal cancer and esophageal cancer treatment. Given the morbidity and mortality associated with the various treatments for esophageal cancer, it could be argued that HRQOL is as important an endpoint as survival, if not more so. Patient-reported pre-treatment HRQOL assessment appears to predict survival better than clinician-derived performance status assessment period. HRQOL assessment also appears to be responsive to surgical and non-surgical therapy and thus could potentially be used in trials and in practice to serve that function. Thus, HRQOL assessment could be a potentially important adjunct in shared decision-making and guiding treatment planning as well as monitoring the progress of treatment.
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Affiliation(s)
- Alla Alghamedi
- Section of General Surgery, University of Manitoba, Winnipeg, Canada.,Section of Thoracic Surgery, University of Manitoba, Winnipeg, Canada
| | - Gordon Buduhan
- Section of Thoracic Surgery, University of Manitoba, Winnipeg, Canada
| | - Lawrence Tan
- Section of Thoracic Surgery, University of Manitoba, Winnipeg, Canada
| | | | - Joanne Sulman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Gail Darling
- Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Biniam Kidane
- Section of Thoracic Surgery, University of Manitoba, Winnipeg, Canada
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Dore L, Fernandez B, Velanovich V. Patient-Centered Outcome Instruments in Esophageal and Gastric Surgery. J Gastrointest Surg 2017; 21:1515-1522. [PMID: 28560705 DOI: 10.1007/s11605-017-3451-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 05/09/2017] [Indexed: 01/31/2023]
Affiliation(s)
- Livingstone Dore
- Division of General Surgery, The University of South Florida, 5 Tampa General Circle, Suite 740, Tampa, FL, 33609, USA
| | - Blake Fernandez
- Division of General Surgery, The University of South Florida, 5 Tampa General Circle, Suite 740, Tampa, FL, 33609, USA
| | - Vic Velanovich
- Division of General Surgery, The University of South Florida, 5 Tampa General Circle, Suite 740, Tampa, FL, 33609, USA.
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Patel DA, Sharda R, Hovis KL, Nichols EE, Sathe N, Penson DF, Feurer ID, McPheeters ML, Vaezi MF, Francis DO. Patient-reported outcome measures in dysphagia: a systematic review of instrument development and validation. Dis Esophagus 2017; 30:1-23. [PMID: 28375450 PMCID: PMC5675017 DOI: 10.1093/dote/dow028] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 10/25/2016] [Accepted: 11/29/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Patient-reported outcome (PRO) measures are commonly used to capture patient experience with dysphagia and to evaluate treatment effectiveness. Inappropriate application can lead to distorted results in clinical studies. A systematic review of the literature on dysphagia-related PRO measures was performed to (1) identify all currently available measures and (2) to evaluate each for the presence of important measurement properties that would affect their applicability. DESIGN MEDLINE via the PubMed interface, the Cumulative Index of Nursing and Allied Health Literature, and the Health and Psychosocial Instrument database were searched using relevant vocabulary terms and key terms related to PRO measures and dysphagia. Three independent investigators performed abstract and full text reviews. Each study meeting criteria was evaluated using an 18-item checklist developed a priori that assessed multiple domains: (1) conceptual model, (2) content validity, (3) reliability, (4) construct validity, (6) scoring and interpretation, and (7) burden and presentation. RESULTS Of 4950 abstracts reviewed, a total of 34 dysphagia-related PRO measures (publication year 1987-2014) met criteria for extraction and analysis. Several PRO measures were of high quality (MADS for achalasia, SWAL-QOL and SSQ for oropharyngeal dysphagia, PROMIS-GI for general dysphagia, EORTC-QLQ-OG25 for esophageal cancer, ROMP-swallowing for Parkinson's Disease, DSQ-EoE for eosinophilic esophagitis, and SOAL for total laryngectomy-related dysphagia). In all, 17 met at least one criterion per domain. Thematic deficiencies in current measures were evident including: (1) direct patient involvement in content development, (2) empirically justified dimensionality, (3) demonstrable responsiveness to change, (4) plan for interpreting missing responses, and (5) literacy level assessment. CONCLUSION This is the first comprehensive systematic review assessing developmental properties of all available dysphagia-related PRO measures. We identified several instruments with robust measurement properties in multiple diseases including achalasia, oropharyngeal dysphagia, post-surgical dysphagia, esophageal cancer, and dysphagia related to neurological diseases. Findings herein can assist clinicians and researchers in making more informed decisions in selecting the most fundamentally sound PRO measure for a given clinical, research, or quality initiative.
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Affiliation(s)
- D. A. Patel
- Division of Gastroenterology, Hepatology and Nutrition
| | - R. Sharda
- Division of Gastroenterology, Hepatology and Nutrition
| | | | | | - N. Sathe
- Department of Health Policy and the Evidence-Based Practice Center
| | - D. F. Penson
- Departments of Urological Surgery, Health Policy, and Medicine and the Center for Surgical Quality and Outcomes Research
| | - I. D. Feurer
- Departments of Biostatistics and Surgery and the Center for Surgical Quality and Outcomes Research
| | - M. L. McPheeters
- Department of Health Policy and the Evidence-Based Practice Center
| | - M. F. Vaezi
- Division of Gastroenterology, Hepatology and Nutrition
| | - David O. Francis
- Department of Otolaryngology and the Evidence-Based Practice Center and the Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Straatman J, Joosten PJM, Terwee CB, Cuesta MA, Jansma EP, van der Peet DL. Systematic review of patient-reported outcome measures in the surgical treatment of patients with esophageal cancer. Dis Esophagus 2016; 29:760-772. [PMID: 26471471 DOI: 10.1111/dote.12405] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal cancer is currently the eighth most common cancer worldwide. Improvements in operative techniques and neoadjuvant therapies have led to improved outcomes. Resection of the esophagus carries a high risk of severe complications and has a negative impact on health-related quality of life (QOL). The aim of this study was to assess which patient-reported outcome measures (PROMs) are used to measure QOL after esophagectomy for cancer. A comprehensive search of original articles was conducted investigating QOL after surgery for esophageal carcinoma. Two authors independently selected relevant articles, conducted clinical appraisal, and extracted data (PJ and JS). Out of 5893 articles, 58 studies were included, consisting of 41 prospective and 17 retrospective cohort studies, including a total of 6964 patients. These studies included 11 different PROMs. The existing PROMs could be divided into generic, symptom-specific, and disease-specific questionnaires. The European Organisation for Research and Treatment of Cancer (EORTC) QOL Questionnaire Core 30 (QLQ C-30) along with the EORTC QLQ-OESophagus module OES18 was the most widely used; in 42 and 32 studies, respectively. The EORTC and the Functional Assessment of Cancer Therapy (FACT) questionnaires use an oncological module and an organ-specific module. One validation study was available, which compared the FACT and EORTC, showing moderate to poor correlation between the questionnaires. A great variety of PROMs are being used in the measurement of QOL after surgery for esophageal cancer. A questionnaire with a general module along with a disease-specific module for assessment of QOL of different treatment modalities seem to be the most desirable, such as the EORTC and the FACT with their specific modules (EORTC QLQ-OES18 and FACT-E). Both are developed in different treatment modalities, such as in surgical patients. With regard to reproducibility of current results, the EORTC is recommended.
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Affiliation(s)
- J Straatman
- Departments of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, The Netherlands.
| | - P J M Joosten
- Departments of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - C B Terwee
- Departments of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - M A Cuesta
- Departments of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - E P Jansma
- Medical library, VU University Medical Center, Amsterdam, The Netherlands
| | - D L van der Peet
- Departments of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Kidane B, Sulman J, Xu W, Kong Q, Wong R, Knox JJ, Darling GE. Pretreatment quality-of-life score is a better discriminator of oesophageal cancer survival than performance status. Eur J Cardiothorac Surg 2016; 51:148-154. [DOI: 10.1093/ejcts/ezw264] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/14/2016] [Accepted: 06/27/2016] [Indexed: 11/13/2022] Open
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Adebahr S, Schimek-Jasch T, Nestle U, Brunner TB. Oesophagus side effects related to the treatment of oesophageal cancer or radiotherapy of other thoracic malignancies. Best Pract Res Clin Gastroenterol 2016; 30:565-80. [PMID: 27644905 DOI: 10.1016/j.bpg.2016.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 07/20/2016] [Indexed: 01/31/2023]
Abstract
The oesophagus as a serial organ located in the central chest is frequent subject to "incidental" dose application in radiotherapy for several thoracic malignancies including oesophageal cancer itself. Especially due to the radiosensitive mucosa severe radiotherapy induced sequelae can occur, acute oesophagitis and strictures as late toxicity being the most frequent side-effects. In this review we focus on oesophageal side effects derived from treatment of gastrointestinal cancer and secondly provide an overview on oesophageal toxicity from conventional and stereotactic fractionated radiotherapy to the thoracic area in general. Available data on pathogenesis, frequency, onset, and severity of oesophageal side effects are summarized. Whereas for conventional radiotherapy the associations of applied doses to certain volumes of the oesophagus are well described, the tolerance dose to the mediastinal structures for hypofractionated therapy is unknown. The review provides available attempts to predict the risk of oesophageal side effects from dosimetric parameters of SBRT.
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Affiliation(s)
- Sonja Adebahr
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Germany.
| | - Tanja Schimek-Jasch
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Ursula Nestle
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Germany
| | - Thomas B Brunner
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Germany.
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38
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Trudel JG, Sulman J, Atenafu EG, Kidane B, Darling GE. Longitudinal Evaluation of Trial Outcome Index Scores in Patients With Esophageal Cancer. Ann Thorac Surg 2016; 102:269-75. [DOI: 10.1016/j.athoracsur.2016.01.091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/17/2016] [Accepted: 01/28/2016] [Indexed: 10/21/2022]
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39
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Nakamura M, Nakamori M, Ojima T, Katsuda M, Hayata K, Iwahashi M, Yamaue H. The effects of rikkunshito on body weight loss after esophagectomy. J Surg Res 2016; 204:130-8. [DOI: 10.1016/j.jss.2016.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 03/04/2016] [Accepted: 04/05/2016] [Indexed: 12/24/2022]
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40
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Kidane B, Sulman J, Xu W, Kong QQ, Wong R, Knox JJ, Darling GE. Baseline measure of health-related quality of life (Functional Assessment of Cancer Therapy-Esophagus) is associated with overall survival in patients with esophageal cancer. J Thorac Cardiovasc Surg 2016; 151:1571-80. [DOI: 10.1016/j.jtcvs.2016.01.052] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 12/29/2015] [Accepted: 01/17/2016] [Indexed: 11/16/2022]
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41
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Broderick SR. When in doubt … ask the patient: Patient-reported measures and prognosis in esophageal cancer. J Thorac Cardiovasc Surg 2016; 151:1448-9. [PMID: 26969130 DOI: 10.1016/j.jtcvs.2016.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 02/03/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Stephen R Broderick
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
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42
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Iwanaga A, Egashira A, Minami K, Saeki H, Yamamoto M, Morita M, Seto T, Takenoyama M, Ueda M, Okushima K, Shimokawa M, Toh Y, Okamura T. Evaluation of esophageal and airway stent placement for patients with advanced and recurrent esophageal cancer. Esophagus 2016. [DOI: 10.1007/s10388-016-0530-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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43
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A nation-wide survey of follow-up strategies for esophageal cancer patients after a curative esophagectomy or a complete response by definitive chemoradiotherapy in Japan. Esophagus 2015. [DOI: 10.1007/s10388-015-0511-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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44
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Kelsey CR, Das S, Gu L, Dunphy FR, Ready NE, Marks LB. Phase 1 Dose Escalation Study of Accelerated Radiation Therapy With Concurrent Chemotherapy for Locally Advanced Lung Cancer. Int J Radiat Oncol Biol Phys 2015; 93:997-1004. [PMID: 26581138 DOI: 10.1016/j.ijrobp.2015.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/30/2015] [Accepted: 09/08/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE To determine the maximum tolerated dose of radiation therapy (RT) given in an accelerated fashion with concurrent chemotherapy using intensity modulated RT. METHODS AND MATERIALS Patients with locally advanced lung cancer (non-small cell and small cell) with good performance status and minimal weight loss received concurrent cisplatin and etoposide with RT. Intensity modulated RT with daily image guidance was used to facilitate esophageal avoidance and delivered using 6 fractions per week (twice daily on Fridays with a 6-hour interval). The dose was escalated from 58 Gy to a planned maximum dose of 74 Gy in 4 Gy increments in a standard 3 + 3 trial design. Dose-limiting toxicity (DLT) was defined as acute grade 3-5 nonhematologic toxicity attributed to RT. RESULTS A total of 24 patients were enrolled, filling all dose cohorts, all completing RT and chemotherapy as prescribed. Dose-limiting toxicity occurred in 1 patient at 58 Gy (grade 3 esophagitis) and 1 patient at 70 Gy (grade 3 esophageal fistula). Both patients with DLTs had large tumors (12 cm and 10 cm, respectively) adjacent to the esophagus. Three additional patients were enrolled at both dose cohorts without further DLT. In the final 74-Gy cohort, no DLTs were observed (0 of 6). CONCLUSIONS Dose escalation and acceleration to 74 Gy with intensity modulated RT and concurrent chemotherapy was tolerable, with a low rate of grade ≥3 acute esophageal reactions.
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Affiliation(s)
- Chris R Kelsey
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
| | - Shiva Das
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Lin Gu
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Frank R Dunphy
- Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Neal E Ready
- Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Lawrence B Marks
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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45
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Cools-Lartigue J, Jones D, Spicer J, Zourikian T, Rousseau M, Eckert E, Alcindor T, Vanhuyse M, Asselah J, Ferri LE. Management of Dysphagia in Esophageal Adenocarcinoma Patients Undergoing Neoadjuvant Chemotherapy: Can Invasive Tube Feeding be Avoided? Ann Surg Oncol 2014; 22:1858-65. [DOI: 10.1245/s10434-014-4270-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Indexed: 12/17/2022]
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46
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Ronellenfitsch U, Najmeh S, Andalib A, Perera RM, Rousseau MC, Mulder DS, Ferri LE. Functional outcomes and quality of life after proximal gastrectomy with esophagogastrostomy using a narrow gastric conduit. Ann Surg Oncol 2014; 22:772-9. [PMID: 25212836 DOI: 10.1245/s10434-014-4078-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND The best surgical approach for tumors of the proximal stomach remains controversial. For proximal gastrectomy (PG), the evidence regarding quality of life (QoL) and functional outcomes is controversial. Moreover, there are limited data from non-Asian settings. METHODS All patients who underwent PG from September 2005 to July 2013 were identified from an institutional database. Demographic, perioperative and pathologic characteristics were retrieved. Symptom scores (0 = best/4 = worst) for reflux symptoms, dysphagia and validated QoL metrics (FACT scale, where a higher score is better) were assessed during early and late follow-up. Eligible patients for analysis were those with no evidence of recurrence. RESULTS Of 465 upper gastrointestinal cancer resections, 50 were PG for adenocarcinoma (42; 84%), neuroendocrine carcinoma (5; 10%) or other pathologies (3; 6%). R0 resection was achieved in 44 (89.8%) of 49 patients with malignant tumors. Median lymph node collection was 32 (range 7-57). QoL scores did not differ from preoperative to early follow-up but increased compared to both at late follow-up [preoperative, 125 (interquartile range 105-140); early follow-up, 122.5 (97-142); late follow-up, 147 (132-159); p < 0.05]. At early and late follow-up, 9 (21.4%) of 42 and 10 (33.3%) of 30 patients reported reflux symptoms, but most were mild. Endoscopic signs of esophagitis were found in 7 (29%) of 24 patients, but only two of these reported reflux symptoms. Conversely only three of eight patients with reflux symptoms had esophagitis on endoscopy. CONCLUSIONS Global QoL is not reduced early after PG, and increases compared to baseline at late follow-up. Although reflux symptoms are reported by a quarter of patients, most are mild, and there is little correlation with esophagitis. PG should remain a viable option in the management of proximal gastric tumors.
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Affiliation(s)
- Ulrich Ronellenfitsch
- Department of Surgery, Medical Faculty Mannheim of the University of Heidelberg, University Medical Centre Mannheim, Mannheim, Germany
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47
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Pullmer R, Linden W, Rnic K, Vodermaier A. Measuring symptoms in gastrointestinal cancer: a systematic review of assessment instruments. Support Care Cancer 2014; 22:2941-55. [PMID: 24865875 DOI: 10.1007/s00520-014-2250-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 04/09/2014] [Indexed: 01/01/2023]
Abstract
PURPOSE It is critical for gastrointestinal cancer researchers and clinicians to have access to comprehensive, sensitive and simple-to-use symptom measures that allow them to understand and quantify the subjective patient experience. Development and validation of such scales requires training in psychometrics and occasionally uses technical jargon that can be difficult to penetrate. This review evaluates existing measures of gastrointestinal cancer symptoms, provides tool descriptions, and uses predefined, objective quality criteria to rate psychometric quality and facilitate tool choices for researchers and clinicians. METHODS MEDLINE, EMBASE, CINAHL, and PsycINFO databases were systematically reviewed for scales assessing gastrointestinal cancer and gastrointestinal cancer site-specific symptoms. Evaluation criteria were the following: breadth of domain coverage (content validity), high internal consistency (α ≥ .80), sensitivity to change, and extent of validation. RESULTS In n = 36 validation studies, 26 gastrointestinal cancer symptom measures were identified. Of these, n = 13 tools met criteria for recommendation, and six in particular showed strong psychometric properties. The Functional Assessment of Cancer Therapy-Colorectal (FACT-C), European Organization for Research and Treatment of Cancer (EORTC) gastric cancer module (QLQ-STO22), FACT-Hepatobiliary (FACT-Hep), and EORTC oesophagus, oesophago-gastric junction and stomach module (QLQ OG-25) were identified as the most comprehensive and best validated scales for each of the major gastrointestinal cancer sites. The FACT-Colorectal Symptom Index (FCSI-9) and the National Comprehensive Cancer Network (NCCN) FACT-Hepatobiliary Symptom Index (FHSI-18) were specifically validated in patients with advanced colorectal and liver cancer and also demonstrated superior psychometric properties. CONCLUSIONS Several comprehensive, well-validated scales exist to adequately assess gastrointestinal cancer site-specific symptoms. Specifically, gastrointestinal cancer submodules of the FACT quality of life questionnaire represent adequate tool choices in most instances and overall, were better validated than the respective EORTC tools. Further improvement of existing, highly rated measures is recommended.
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Affiliation(s)
- Rachelle Pullmer
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada,
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48
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Macefield RC, Jacobs M, Korfage IJ, Nicklin J, Whistance RN, Brookes ST, Sprangers MAG, Blazeby JM. Developing core outcomes sets: methods for identifying and including patient-reported outcomes (PROs). Trials 2014; 15:49. [PMID: 24495582 PMCID: PMC3916696 DOI: 10.1186/1745-6215-15-49] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 01/17/2014] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Synthesis of patient-reported outcome (PRO) data is hindered by the range of available PRO measures (PROMs) composed of multiple scales and single items with differing terminology and content. The use of core outcome sets, an agreed minimum set of outcomes to be measured and reported in all trials of a specific condition, may improve this issue but methods to select core PRO domains from the many available PROMs are lacking. This study examines existing PROMs and describes methods to identify health domains to inform the development of a core outcome set, illustrated with an example. METHODS Systematic literature searches identified validated PROMs from studies evaluating radical treatment for oesophageal cancer. PROM scale/single item names were recorded verbatim and the frequency of similar names/scales documented. PROM contents (scale components/single items) were examined for conceptual meaning by an expert clinician and methodologist and categorised into health domains. A patient advocate independently checked this categorisation. RESULTS Searches identified 21 generic and disease-specific PROMs containing 116 scales and 32 single items with 94 different verbatim names. Identical names for scales were repeatedly used (for example, 'physical function' in six different measures) and others were similar (overlapping face validity) although component items were not always comparable. Based on methodological, clinical and patient expertise, 606 individual items were categorised into 32 health domains. CONCLUSION This study outlines a methodology for identifying candidate PRO domains from existing PROMs to inform a core outcome set to use in clinical trials.
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Affiliation(s)
- Rhiannon C Macefield
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Marc Jacobs
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Meibergdreef 5, Amsterdam NL 1105 AZ, Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, P.O. Box 2040, Rotterdam NL 3000 CA, Netherlands
| | - Joanna Nicklin
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Level 3, Dolphin House, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK
| | - Robert N Whistance
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Sara T Brookes
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Mirjam AG Sprangers
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Meibergdreef 5, Amsterdam NL 1105 AZ, Netherlands
| | - Jane M Blazeby
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Level 3, Dolphin House, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK
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McNair AGK, Blazeby JM. Health-related quality-of-life assessment in GI cancer randomized trials: improving the impact on clinical practice. Expert Rev Pharmacoecon Outcomes Res 2014; 9:559-67. [DOI: 10.1586/erp.09.68] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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50
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Yamashita H, Omori M, Okuma K, Kobayashi R, Igaki H, Nakagawa K. Longitudinal Assessments of Quality of Life and Late Toxicities Before and After Definitive Chemoradiation for Esophageal Cancer. Jpn J Clin Oncol 2013; 44:78-84. [DOI: 10.1093/jjco/hyt170] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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