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Rojas-Concha L, Arrarrás JI, Conroy T, Chalk T, Guberti M, Holzner B, Husson O, Kuliś D, Shamieh O, Piccinin C, Puga MJ, Rohde G, Groenvold M. Acceptability and usefulness of the EORTC 'Write In three Symptoms/Problems' (WISP): a brief open-ended instrument for symptom assessment in cancer patients. Health Qual Life Outcomes 2024; 22:28. [PMID: 38532393 DOI: 10.1186/s12955-024-02244-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND The use of open-ended questions supplementing static questionnaires with closed questions may facilitate the recognition of symptoms and toxicities. The open-ended 'Write In three Symptoms/Problems (WISP)' instrument permits patients to report additional symptoms/problems not covered by selected EORTC questionnaires. We evaluated the acceptability and usefulness of WISP with cancer patients receiving active and palliative care/treatment in Austria, Chile, France, Jordan, the Netherlands, Norway, Spain and the United Kingdom. METHODS We conducted a literature search on validated instruments for cancer patients including open-ended questions and analyzing their responses. WISP was translated into eight languages and pilot tested. WISP translations were pre-tested together with EORTC QLQ-C30, QLQ-C15-PAL and relevant modules, followed by patient interviews to evaluate their understanding about WISP. Proportions were used to summarize patient responses obtained from interviews and WISP. RESULTS From the seven instruments identified in the literature, only the free text collected from the PRO-CTAE has been analyzed previously. In our study, 161 cancer patients participated in the pre-testing and interviews (50% in active treatment). Qualitative interviews showed high acceptability of WISP. Among the 295 symptoms/problems reported using WISP, skin problems, sore mouth and bleeding were more prevalent in patients in active treatment, whereas numbness/tingling, dry mouth and existential problems were more prevalent in patients in palliative care/treatment. CONCLUSIONS The EORTC WISP instrument was found to be acceptable and useful for symptom assessment in cancer patients. WISP improves the identification of symptoms/problems not assessed by cancer-generic questionnaires and therefore, we recommend its use alongside the EORTC questionnaires.
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Affiliation(s)
- Leslye Rojas-Concha
- Department of Geriatrics and Palliative Medicine GP, Bispebjerg and Frederiksberg Hospitals, Palliative Care Research Unit, University of Copenhagen, Copenhagen, Denmark.
| | - Juan Ignacio Arrarrás
- Servicio Navarro de Salud, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Thierry Conroy
- Medical Oncology Department, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
- Université de Lorraine, Inserm INSPIIRE, Nancy, France
| | - Tara Chalk
- Supportive Oncology Research Team, Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, HA6 2RN, UK
| | - Monica Guberti
- Azienda Unità Sanitaria Locale -IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Bernhard Holzner
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Olga Husson
- Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Surgical Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dagmara Kuliś
- Quality of Life Department, EORTC, Brussels, Belgium
| | - Omar Shamieh
- Department of Hospice, Palliative Medicine, King Hussein Cancer Center, Amman, Jordan
| | | | - María José Puga
- Unidad Alivio del Dolor y Cuidados Paliativos, Hospital Base Valdivia, Valdivia, Chile
| | - Gudrun Rohde
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
- Department of Clinical Research, Sorlandet Hospital, Kristiansand, Norway
| | - Mogens Groenvold
- Department of Geriatrics and Palliative Medicine GP, Bispebjerg and Frederiksberg Hospitals, Palliative Care Research Unit, University of Copenhagen, Copenhagen, Denmark
- Department of Public Health, Section of Health Services Research, University of Copenhagen, Copenhagen, Denmark
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Bandyopadhyay A, Ghosh AK, Chhatui B, Das D, Basu P. Comparison of twice weekly palliative RT versus continuous hypofractionated palliative RT for painful bone metastases. Rep Pract Oncol Radiother 2023; 28:217-223. [PMID: 37456707 PMCID: PMC10348331 DOI: 10.5603/rpor.a2023.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 03/29/2023] [Indexed: 07/18/2023] Open
Abstract
Background Palliative hypofractionated radiotherapy (RT) is an effective mode of treating painful bone metastasis. While 8 Gy single fraction radiation is often effective for the same, for complicated bone metastases a protracted fractionated regimen is preferred, of which 30 Gy/10#/2weeks or 20 Gy/5#/1 week are the most common worldwide. However such schedules add to the burden of already overburdened radiation treatment facilities in a busy center, wherein alternative logistic favourable schedules with treatment on weekends are preferred. Here we compare the efficacy of a twice weekly schedule to that of standard continuous 20 Gy/5 #/1 week schedule in terms of pain relief, response and quality of life. Materials and methods A prospective non randomized study was undertaken from Jan 2018 to May 2019, wherein eligible patients of complicated bone metastases received palliative radiotherapy of 20 Gy/5#, either continuously for 5 fractions from Monday to Saturday or twice weekly, Saturday and Wednesday, starting on a Saturday over about 2 weeks. Pain relief was assessed by the Visual Analogue Scale (VAS) and FACES pain scale recorded prior to starting palliative RT and at 4 weeks, 3 months and 6 months. Results Thirteen patients received continuous Hypofractionated RT while 16 received it in a twice weekly schedule. Spine was the most common site receiving palliative Radiation (27/29), while breast cancer was the most common primary (16/29). The demographic and the baseline characteristics were comparable. The mean pain score decline at 4 weeks was 2.56 ± 1.1 and 2.71 ± 0.52 in the 5-day and the two-week schedule, respectively (p = 0.67). Conclusion A twice weekly schedule over about two weeks was found to be equivalent in pain control and response to the standard fractionated palliative radiation and, thus, can be safely employed in resource constrained, busy radiotherapy centers.
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Affiliation(s)
- Anis Bandyopadhyay
- Department of Radiotherapy, Medical College and Hospital Kolkata, Kolkata, India
- Department of Radiotherapy, Nil Retan Sircar Medical College and Hospital, Kolkata, India
| | - Arnab Kumar Ghosh
- Department of Radiotherapy, Medical College and Hospital Kolkata, Kolkata, India
| | - Bappaditya Chhatui
- Department of Radiotherapy, Medical College and Hospital Kolkata, Kolkata, India
| | - Dhiman Das
- Department of Radiotherapy, Medical College and Hospital Kolkata, Kolkata, India
| | - Poulomi Basu
- Medical College and Hospital Kolkata, Kolkata, India
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Marie L, Braik D, Abdel-Razeq N, Abu-Fares H, Al-Thunaibat A, Abdel-Razeq H. Clinical Characteristics, Prognostic Factors and Treatment Outcomes of Patients with Bone-Only Metastatic Breast Cancer. Cancer Manag Res 2022; 14:2519-2531. [PMID: 36039341 PMCID: PMC9419893 DOI: 10.2147/cmar.s369910] [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: 04/12/2022] [Accepted: 07/20/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Bone is the most frequent site of breast cancer metastasis. Differences between those who present with de novo bone-only metastasis (BOM) and those who progress to bone-only disease following a diagnosis of early-stage breast cancer are not clear. Such differences in clinical course might have an impact on the aggressiveness of treatment. This study presents the clinical and pathological features, along with treatment outcomes, of breast cancer patients with BOM in relation to the timing and type of bone metastasis. Patients and Methods Patients with breast cancer and BOM were retrospectively reviewed. De novo BOM was defined as bone metastasis diagnosed at presentation or within the first 4 months of follow-up. Treatment outcomes of patients with de novo, compared to those with subsequent BOM, are presented. Results 242 patients, median age (range) at diagnosis was 52 (27–80) years were enrolled. The majority of the patients (77.3%) had de novo BOM with multiple sites of bone involvement (82.6%). At a median follow-up of 37.7 months, the median overall survival (OS) for patients with de novo BOM disease was significantly shorter than those who developed so subsequently; 40.8 months (95% CI, 51.1–184.1) compared to 80.9 months (95% CI, 36.4–47.9), p < 0.001. Tumor grade, hormone receptor status and type of bone lesions (lytic versus sclerotic) had a significant impact on survival outcomes. Conclusion Breast cancer with de novo BOM is a distinct clinical entity with unfavorable prognosis and is associated with shorter survival. Several risk factors for poor outcomes were identified and might inform treatment plans.
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Affiliation(s)
- Lina Marie
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Dina Braik
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Nayef Abdel-Razeq
- Department of Internal Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Hala Abu-Fares
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Ahmad Al-Thunaibat
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan.,School of Medicine, the University of Jordan, Amman, Jordan
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Erazo Muñoz MA, Rojas Salgado Y, Vargas OM, Colmenares Mejía CC. Validación de la escala QLQ-C15 PAL, para evaluar calidad de vida en pacientes en cuidados paliativos, al español colombiano. PSICOONCOLOGIA 2021. [DOI: 10.5209/psic.77758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objetivo: Validar la escala QLQ C15 PAL, para evaluar calidad de vida en pacientes en cuidados paliativos, al español colombiano, considerando un análisis psicométrico desde la teoría clásica de los test. Método: Muestra por conveniencia de 155 pacientes oncológicos atendidos por el Programa de Cuidados Paliativos de un grupo de centros hospitalarios en las ciudades de Bogotá y Cali en Colombia. Para estimar la validez de constructo, se utilizó el análisis factorial exploratorio (AFE) con rotación varimax; posteriormente, se usaron cargas factoriales para estimar el coeficiente Omega y posteriormente el análisis de Rash reconocido Análisis de la Teoría de la respuesta al ítem (TRI). El análisis fue realizado en Winsteps 2.80. Resultados: Todas las correlaciones son significativas entre los ítems de la escala Funcionamiento Global (FG) con el puntaje total obtenido en esta escala y el puntaje total del QLQ PAL-15; la misma situación ocurre con los ítems de la escala Funcionamiento Emocional (FE) que correlaciona de modo directamente proporcional y con una magnitud alta con el puntaje total del QLQ PAL-15. En cuanto al total de la escala, existe un adecuado ajuste para los ítems ya que sus valores Infit: (IMNSQ 0,99; ZSDT: -0,3) y Outfit (OMNSQ 1,02; ZSDT-0,2) se encuentran dentro de los rangos establecidos como parámetros de ajuste. Conclusiones: La validación del EORTC QLQ-C15-PAL demostró propiedades psicométricas satisfactorias al aplicarse en pacientes con enfermedad oncológica avanzada en Colombia. Se plantea para estudios posteriores realizar ajuste en la redacción de los ítems 7,11 y 13 para que estos discriminen de manera precisa el rasgo que pretenden medir.
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Barnadas A, Muñoz M, Margelí M, Chacón JI, Cassinello J, Antolin S, Adrover E, Ramos M, Carrasco E, Jimeno MA, Ojeda B, González X, González S, Constenla M, Florián J, Miguel A, Llombart A, Lluch A, Ruiz-Borrego M, Colomer R, Del Barco S. BOMET-QoL-10 questionnaire for breast cancer patients with bone metastasis: the prospective MABOMET GEICAM study. J Patient Rep Outcomes 2019; 3:72. [PMID: 31865481 PMCID: PMC6925605 DOI: 10.1186/s41687-019-0161-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 11/15/2019] [Indexed: 11/18/2022] Open
Abstract
Background Bone metastasis (BM) is the most common site of disease in metastatic breast cancer (MBC) patients. BM impacts health-related quality of life (HRQoL). We tested prospectively the psychometric properties of the Bone Metastasis Quality of Life (BOMET-QoL-10) measure on MBC patients with BM. Methods Patients completed the BOMET-QoL-10 questionnaire, the Visual Analogue Scale (VAS) for pain, and a self-perceived health status item at baseline and at follow-up visits. We performed psychometric tests and calculated the effect size of specific BM treatment on patients´ HRQoL. Results Almost 70% of the 172 patients reported symptoms, 23.3% experienced irruptive pain, and over half were receiving chemotherapy. BOMET-QoL-10 proved to be a quick assessment tool performing well in readability and completion time (about 10 min) with 0–1.2% of missing/invalid data. Although BOMET-QoL-10 scores remained fairly stable during study visits, differences were observed for patient subgroups (e.g., with or without skeletal-related events or adverse effects). Scores were significantly correlated with physician-reported patient status, patient-reported pain, symptoms, and perceived health status. BOMET-QoL-10 scores also varied prospectively according to changes in pain intensity. Conclusions BOMET-QoL-10 performed well as a brief, easy-to-administer, useful, and sensitive HRQoL measure for potential use for clinical practice with MBC patients. Trial registration NCT03847220. Retrospectively registered on clinicaltrials.gov (February the 20th 2019).
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Affiliation(s)
- A Barnadas
- Medical Oncology Department, Hospital de la Santa Creu I Sant Pau, C/Sant Antoni Maria Claret, 167, 08041, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain.
| | - M Muñoz
- Medical Oncology Department, Hospital Clinic i Provincial, C/ Villarroel n° 170, 08036, Barcelona, Spain
| | - M Margelí
- Medical Oncology Department, Ctra, Hospital Germans Trias i Pujol, Canyet s/n, 08916 Badalona, Barcelona, Spain
| | - J I Chacón
- Medical Oncology Department, Hospital Virgen de la Salud, Avda. Barber, n° 30, 45005, Toledo, Spain
| | - J Cassinello
- Medical Oncology Department, Hospital General de Guadalajara, C/ Donantes de Sangre, s/n, 19002, Guadalajara, Spain
| | - S Antolin
- Medical Oncology Department, Complejo Hospitalario U. A Coruña, C/ Xubias de Abaixo s/n, 15006, A Coruña, Spain
| | - E Adrover
- Medical Oncology Department, Complejo Hospitalario Universitario de Albacete, C/ Hermanos Falcó n° 37, 02006, Albacete, Spain
| | - M Ramos
- Medical Oncology Department, Centro Oncológico de Galicia, C/ Doctor Camilo Veiras s/n, 15009, A Coruña, Spain
| | - E Carrasco
- GEICAM (Spanish Breast Cancer Group), Avda. de los Pirineos n° 7, 28703 San Sebastián de los Reyes, Madrid, Spain
| | - M A Jimeno
- GEICAM (Spanish Breast Cancer Group), Avda. de los Pirineos n° 7, 28703 San Sebastián de los Reyes, Madrid, Spain
| | - B Ojeda
- Medical Oncology Department, Hospital de la Santa Creu I Sant Pau, C/Sant Antoni Maria Claret, 167, 08041, Barcelona, Spain
| | - X González
- Medical Oncology Department, Hospital General de Catalunya, Carrer de Pedro Pons 1, 08195, Sant Cugat del Valles, Barcelona, Spain
| | - S González
- Medical Oncology Department, Hospital Mutua de Terrassa, Barcelona, Plaza del Dr. Robert n°5, 08221, Terrassa, Barcelona, Spain
| | - M Constenla
- Medical Oncology Department, Complejo Hospitalario De Pontevedra, Calle Mourente s/n, 36071, Pontevedra, Galicia, Spain
| | - J Florián
- Medical Oncology Department, Hospital Comarcal de Barbastro, Ctra. Nacional 240, s/n, 22300, Barbastro, Huesca, Spain
| | - A Miguel
- Medical Oncology Department, Hospital Althaia Manresa, C/ Dr. Joan Soler, s/n, 08243, Manresa, Barcelona, Spain
| | - A Llombart
- Medical Oncology Department, Hospital Arnau de Vilanova, Avda. Alcalde Rovira Roure, 80, 25198, Lleida, Spain
| | - A Lluch
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain.,Hospital Clínico Universitario de Valencia, Biomedical Research Institute INCLIVA, Valencia, Spain
| | - M Ruiz-Borrego
- Medical Oncology Department, Hospital Virgen del Rocío, Avda. Manuel Siurot, s/n, 41013, Sevilla, Spain
| | - R Colomer
- Medical Oncology Department, Hospital Universitario La Princesa, C/ Diego de León n° 62, 28006, Madrid, Spain
| | - S Del Barco
- Medical Oncology Department, Hospital U. Josep Trueta, Avda. De França s/n, 17007, Gerona, Spain
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Which symptoms and problems do advanced cancer patients admitted to specialized palliative care report in addition to those included in the EORTC QLQ-C15-PAL? A register-based national study. Support Care Cancer 2019; 28:1725-1735. [DOI: 10.1007/s00520-019-04976-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/28/2019] [Indexed: 11/12/2022]
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Engel M, Brinkman-Stoppelenburg A, Nieboer D, van der Heide A. Satisfaction with care of hospitalised patients with advanced cancer in the Netherlands. Eur J Cancer Care (Engl) 2018; 27:e12874. [DOI: 10.1111/ecc.12874] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/13/2018] [Accepted: 05/17/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Marijanne Engel
- Department of Public Health; Erasmus Medical Center; Rotterdam the Netherlands
| | | | - Daan Nieboer
- Department of Public Health; Erasmus Medical Center; Rotterdam the Netherlands
| | - Agnes van der Heide
- Department of Public Health; Erasmus Medical Center; Rotterdam the Netherlands
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Freire MEM, Costa SFGD, Lima RAGD, Sawada NO. QUALIDADE DE VIDA RELACIONADA À SAÚDE DE PACIENTES COM CÂNCER EM CUIDADOS PALIATIVOS. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-070720180005420016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: avaliar a qualidade de vida relacionada à saúde de pacientes com câncer em cuidados paliativos e sua associação com aspectos sociodemográficos e clínicos. Método: estudo analítico, transversal, do qual participaram 127 pacientes. Foram utilizados instrumentos de caracterização sociodemográfica e de avaliação de qualidade de vida - European Organization for Research and Treatment for Cancer. Para análise dos dados, aplicaram-se os testes Kolmogorov-Smirnov, Mann-Whitney e Kruskal-Wallis. Resultados: na avaliação de qualidade de vida, o Estado de Saúde Global e Função Desempenho de Papel tiveram pior avaliação; na Escala de Sintomas, dor, fadiga, insônia e perda do apetite tiveram destaque. Na associação dos domínios do instrumento de coleta de dados com as variáveis sociodemográficas houve associação significativa da idade e escolaridade com função cognitiva, e de renda mensal com estado geral de saúde; com as variáveis clínicas houve associação significativa de metástase com função física; radioterapia com função social, e tempo de hospitalização com Escala Funcional. A Escala de Sintomas apresentou associação significativa de fadiga com metástase, quimioterapia e tempo de hospitalização; dor com quimioterapia e tempo de hospitalização; insônia com procedimento cirúrgico e perda de apetite com quimioterapia. Conclusão: o prejuízo na capacidade funcional, decorrente do câncer, afeta a capacidade do paciente de desempenhar atividades da vida diária, as relações sociais e a situação financeira. Aspectos sociodemográficos e clínicos devem ser considerados na avaliação da qualidade de vida desses pacientes, de forma a possibilitar atenção humanizada e integralizada aos princípios do Sistema Único de Saúde vigentes no Brasil.
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Hypofractionated radiotherapy for complicated bone metastases in patients with poor performance status: a phase II international trial. TUMORI JOURNAL 2018; 105:181-187. [DOI: 10.5301/tj.5000658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose: To evaluate the efficacy and safety of hypofractionated radiotherapy (16 Gy in 2 fractions, 1 week apart) in patients with complicated bone metastases and poor performance status. Methods: A prospective single-arm phase II clinical trial was conducted from July 2014 to May 2016. The primary endpoint was pain response as defined in the International Consensus on Palliative Radiotherapy Endpoints. Secondary endpoints included quality of life as measured by quality of life questionnaire (QLQ) PAL-15 and QLQ-BM22 European Organisation for Research and Treatment of Cancer guidelines, pain flare, adverse events, re-irradiation, and skeletal complications. Results: Fifty patients were enrolled. There were 23 men with a median age of 58 years (range 26-86). Of the 50 patients, 38 had an extraosseous soft tissue component, 18 needed postsurgical radiation, 3 had neuropathic pain, and 3 had an impending fracture in a weight-bearing bone. At 2 months, 33 patients were alive (66%). Four (12.5%) had a complete response and 12 (37.5%) had a partial response. A statistically significant improvement was seen in the functional interference (p = 0.01) and psychosocial aspects (p = 0.03) of the BM22. No patient had spinal cord compression. One patient required surgery for pathologic fracture, and another re-irradiation. Conclusions: Hypofractionated radiotherapy (16 Gy in 2 fractions of 8 Gy 1 week apart) achieved satisfactory pain relief and safety results in patients with complicated bone metastases and poor performance status.
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Yavuzsen T, Sevgen Guc Z, Ugur O, Bektas M, Oztop I. Retesting the psychometric characteristics of the European cancer research and treatment organization’s quality of life questionnaire palliative care 15 Turkish version (EQRTC QLQ C15-PAL) and evaluating the influencing factors. JOURNAL OF ONCOLOGICAL SCIENCES 2018. [DOI: 10.1016/j.jons.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Chow S, Ding K, Wan BA, Brundage M, Meyer RM, Nabid A, Chabot P, Coulombe G, Ahmed S, Kuk J, Dar AR, Mahmud A, Fairchild A, Wilson CF, Wu JSY, Dennis K, DeAngelis C, Wong RKS, Zhu L, Chow E. Patient Reported Outcomes After Radiation Therapy for Bone Metastases as a Function of Age: A Secondary Analysis of the NCIC CTG SC-Twenty-Three Randomized Trial. Am J Hosp Palliat Care 2017; 35:718-723. [PMID: 28950727 DOI: 10.1177/1049909117733435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To explore the age difference in response and patient-reported outcomes in patients with cancer having bone metastases undergoing palliative radiotherapy. METHODS Patients completed the European Organisation for Research and Treatment of Cancer (EORTC) Quality-of-Life (QOL) Bone Metastases module (QLQ-BM22), EORTC QOL Core-15-Palliative (QLQ-C15-PAL), and Dexamethasone Symptom Questionnaire (DSQ) before a single 8-Gy radiation treatment, on days 10 and 42 after treatment. Patient demographics, performance status, analgesic consumption, BM22, C15, and DSQ were compared with multivariant analysis between patients under 75 years and 75 years and older. Multiple linear regression models were used to assess the differences between age-groups, adjusting for baseline demographics and primary disease sites. RESULTS There were 298 patients (170 male) with 209 (70%) less than 75 years of age. Most common primary cancer sites include lung, prostate, and breast. At baseline, younger patients had better performance status, consumed more analgesic, and reported worse scores in nausea, insomnia, and functional interference, while older patients more commonly had prostate cancer. There were no significant differences in the incidence of radiation-induced pain flare; response to radiation; changes from baseline for BM22, C15-PAL; and DSQ, nor overall survival at day 42 between the 2 groups. Responders to radiation in the elderly group reported better improvement in physical and emotional domains when compared with nonresponders. CONCLUSIONS In patients with cancer having bone metastases undergoing palliative radiotherapy, there was no significant difference in general with age in response to radiation and patient-reported outcomes. Palliative radiotherapy should be offered to elderly patients when needed.
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Affiliation(s)
- Selina Chow
- 1 Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Keyue Ding
- 2 Canadian Cancer Trials Group, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Bo Angela Wan
- 1 Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Michael Brundage
- 3 Department of Radiation Oncology, Queen's University, Kingston, Ontario, Canada
| | - Ralph M Meyer
- 4 Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada
| | - Abdenour Nabid
- 5 Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Pierre Chabot
- 6 Hopital Maisonneuve-Rosemont, Montreal, Québec, Canada
| | | | | | - Joda Kuk
- 9 Grand River Regional Cancer Centre, Grand River Hospital, Kitchener, Ontario, Canada
| | - A Rashid Dar
- 10 London Regional Cancer Program, London, Ontario, Canada
| | - Aamer Mahmud
- 11 Cancer Centre of Southeastern Ontario, Kingston General Hospital, Kingston, Ontario, Canada
| | | | - Carolyn F Wilson
- 2 Canadian Cancer Trials Group, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Jackson S Y Wu
- 13 Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Kristopher Dennis
- 14 The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Carlo DeAngelis
- 1 Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca K S Wong
- 15 Princess Margaret Cancer Centre, Radiation Medicine Program, Ontario Cancer Institute, University of Toronto, Toronto, Ontario, Canada
| | - Liting Zhu
- 2 Canadian Cancer Trials Group, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Edward Chow
- 1 Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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Single vs. multiple fraction regimens for palliative radiotherapy treatment of multiple myeloma : A prospective randomised study. Strahlenther Onkol 2017; 193:742-749. [PMID: 28573476 PMCID: PMC5570777 DOI: 10.1007/s00066-017-1154-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 05/11/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE To compare the impact of a single fraction (8 Gy × 1 fraction) and multifraction (3 Gy × 10 fractions) radiotherapy regimens on pain relief, recalcification and the quality of life (QoL) in patients with bone destructions due to multiple myeloma (MM). PATIENTS AND METHODS In all, 101 patients were included in a randomised prospective clinical trial: 58 patients were included in the control arm (3 Gy × 10 fractions) and 43 patients into the experimental arm (8 Gy × 1 fraction). The response rate was defined according to the International Consensus on Palliative Radiotherapy criteria. Recalcification was evaluated with radiographs. QoL questionnaires were completed before and 4 weeks after treatment. RESULTS Pain relief was obtained in 81/101 patients (80.2%): complete response in 56 (69%) and partial in 25 patients (30.9%). No significant differences were observed in analgesic response between the groups. Significant factors for pain relief were female gender, age under 65, IgG MM type, presence of recalcification at the irradiated site. Recalcification was found in 32/101 patients (33.7%): complete in 17 (53.2%) and partial in 15 (46.2%). No significant differences were observed in recalcification between the groups. Significant factors for recalcification were Karnofsky index ≥ 60%, haemoglobin level ≤ 80 g/dl, MM stage II and analgesic response at the irradiated site. The QoL after radiotherapy was improved in the control group. CONCLUSION The same analgesic and recalcification response was observed using two different radiotherapy regimens. Higher doses should be used to achieve a better QoL.
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Raman S, Ding K, Chow E, Meyer RM, Nabid A, Chabot P, Coulombe G, Ahmed S, Kuk J, Dar AR, Mahmud A, Fairchild A, Wilson CF, Wu JSY, Dennis K, DeAngelis C, Wong RKS, Zhu L, Brundage M. A prospective study validating the EORTC QLQ-BM22 bone metastases module in patients with painful bone metastases undergoing palliative radiotherapy. Radiother Oncol 2016; 119:208-12. [PMID: 27157890 DOI: 10.1016/j.radonc.2016.04.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/10/2016] [Accepted: 04/20/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE Quality of life (QOL) can be compromised in patients with bone metastases, and validated QOL instruments are required to accurately measure QOL outcomes in this population. This study investigated the validity, reliability and responsiveness of the EORTC QLQ-BM22 module with the EORTC QLQ-C15-PAL instrument in bone metastases. METHODS The studied patients underwent palliative radiotherapy to bone metastases in the randomized NCIC CTG SC 23 trial. Multi-trait scaling analysis was performed to determine convergent and divergent validity among scales. Pearson coefficients were calculated to determine the correlation between items of the two instruments. The clinical validity and responsiveness of the QLQ-BM22 was tested by known group comparisons of different performance status and response to radiotherapy. RESULTS 204 patients completed both questionnaires at baseline and 42day follow-up. On multi-trait scaling analysis, there was mixed evidence of construct validity (explained by the questionnaire format and population characteristics). There was little correlation between most QLQ-BM22 and QLQ-C15-PAL items (except for conceptually related scales) validating their complementary nature. There were statistically significant differences in all QLQ-BM22 scale scores in groups with KPS<80 vs. KPS⩾80 and three out of four QLQ-BM22 scale scores in "responders" vs. "non-responders" to radiotherapy. In patients who responded to radiotherapy, there were statistically significant differences in all QLQ-BM22 scale scores between baseline and follow-up. CONCLUSION This study further validates the use of the QLQ-BM22 as a robust and sensitive instrument to assess QOL in patients with bone metastases treated with palliative radiotherapy.
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Affiliation(s)
- Srinivas Raman
- Sunnybrook Odette Cancer Centre, University of Toronto, Canada
| | - Keyue Ding
- Canadian Clinical Trials Group, Cancer Research Institute, Queen's University, Kingston, Canada
| | - Edward Chow
- Sunnybrook Odette Cancer Centre, University of Toronto, Canada.
| | - Ralph M Meyer
- Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Canada
| | | | | | | | | | - Joda Kuk
- Grand River Regional Cancer Centre, Grand River Hospital, Kitchener, Canada
| | | | - Aamer Mahmud
- Cancer Centre of Southeastern Ontario, Kingston General Hospital, Canada
| | | | - Carolyn F Wilson
- Canadian Clinical Trials Group, Cancer Research Institute, Queen's University, Kingston, Canada
| | | | | | - Carlo DeAngelis
- Sunnybrook Odette Cancer Centre, University of Toronto, Canada
| | - Rebecca K S Wong
- Princess Margaret Hospital, Radiation Medicine Program, Ontario Cancer Institute, University of Toronto, Canada
| | - Liting Zhu
- Canadian Clinical Trials Group, Cancer Research Institute, Queen's University, Kingston, Canada
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Reliability and validity of the Turkish version of the EORTC QLQ-C15-PAL for patients with advanced cancer. Palliat Support Care 2016; 14:628-634. [PMID: 27068607 DOI: 10.1017/s1478951516000195] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Assessing quality of life, which is the main focus of palliative care, is highly important. The number of available, specific, simple, and valid assessment instruments for patients with advanced cancer in Turkey is limited. The aim of our study was to perform a psychometric evaluation of the Turkish version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-PAL (EORTC QLQ-C15-PAL). METHOD The study was conducted in İzmir with patients who had received treatment in the palliative care unit of a university hospital between November of 2011 and December of 2013. Sociodemographic and disease characteristics forms, the Karnofsky Performance Status (KPS) Scale, and the EORTC QLQ-C15-PAL Scale were employed in order to gather data. RESULTS A total of 150 patients completed the study: 55.3% of participants were female, 80.7% were married, and the average age was 52.76 ± 14.55. The value of Cronbach's α in the analyses ranged from 0.93 to 0.98. Most questionnaire areas had low to moderate correlations with the others. The moderate correlations were between fatigue and physical function (-0.41) and between insomnia and emotional function (-0.53). Conversely, weak correlations were found between nausea/vomiting and appetite loss (0.31) and between insomnia and pain (0.22). KPS scores decreased, patient physical and emotional function were diminished, global QoL declined, and patients' symptoms became more frank. SIGNIFICANCE OF RESULTS We concluded that the EORTC QLQ-C15-PAL is a valid and reliable tool to determine the quality of life of advanced cancer patients who are undergoing palliative treatment in Turkey.
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Thavarajah N, Ray S, Bedard G, Zhang L, Cella D, Wong E, Danjoux C, Tsao M, Barnes E, Sahgal A, Soliman H, Pulenzas N, Lechner B, Chow E. Psychometric validation of the Brain Symptom and Impact Questionnaire (BASIQ) version 1.0 to assess quality of life in patients with brain metastases. CNS Oncol 2015; 4:11-23. [PMID: 25586422 DOI: 10.2217/cns.14.49] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To test the reliability, clinical and psychometric validity of the Brain Symptom and Impact Questionnaire (BASIQ) in patients with brain metastases. METHODS Brain metastases patients were interviewed using the BASIQ, Functional Assessment of Cancer-Brain (FACT-Br) and FACT-General (FACT-G) at baseline, with a follow-up assessment at 1 month. RESULTS Forty patients had complete one data and the median age was 64 years. Patients with higher KPS, ECOG of 2, primary breast cancer, or >3 brain metastases, scored higher on the symptom scale of the BASIQ. All subscales showed no significant change in patient symptoms from baseline to follow-up. CONCLUSION This study supports that the reliability, clinical and psychometric validity of BASIQ to be used in brain metastases patients.
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Affiliation(s)
- Nemica Thavarajah
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5 Canada
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16
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Kimmell KT, LaSota E, Weil RJ, Marko NF. Comparative Effectiveness Analysis of Treatment Options for Single Brain Metastasis. World Neurosurg 2015; 84:1316-32. [PMID: 26100168 DOI: 10.1016/j.wneu.2015.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Brain metastases (BMs) occur in up to 30% of patients with cancer. Treatments include surgery, whole-brain radiotherapy (WBRT), and stereotactic radiosurgery (SRS), alone or in combination. Although guidelines exist, data to inform individualized approaches to therapy remain sparse. We sought to compare semiquantitatively the effectiveness of various modalities in the treatment of single brain metastasis. METHODS We performed a comparative effectiveness analysis (CEA) that integrated efficacy, cost, and quality of life (QoL) data for alternate BM treatments. Efficacy data were obtained from a comprehensive review of current literature. Cost estimates were based on publicly available data. QoL data included the Karnofsky Performance Status (KPS) and other questionnaires. Six treatment strategies using combinations of surgery, WBRT, and SRS were compared with decision tree software. RESULTS The clinical efficacy, cost, and QoL effects of each strategy were scored semiquantitatively. We constructed a model to integrate individual preferences regarding the relative importance of efficacy, QoL, and cost to provide personalized rankings of the effectiveness of each strategy. CONCLUSION The choice of strategy must be individualized for patients with a single BM. Our CEA and decision model combines empirical data with patient priorities to produce a ranking of alternate management strategies.
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Affiliation(s)
- Kristopher T Kimmell
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA.
| | - Emily LaSota
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Robert J Weil
- Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA
| | - Nicholas F Marko
- Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA
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Alexander K, Cooper B, Paul SM, West C, Yates P, Kober KM, Aouizerat BE, Miaskowski C. Evidence of associations between cytokine gene polymorphisms and quality of life in patients with cancer and their family caregivers. Oncol Nurs Forum 2015; 41:E267-81. [PMID: 25158664 DOI: 10.1188/14.onf.e267-e281] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To identify latent classes of individuals with distinct quality-of-life (QOL) trajectories, to evaluate for differences in demographic characteristics between the latent classes, and to evaluate for variations in pro- and anti-inflammatory cytokine genes between the latent classes. DESIGN Descriptive, longitudinal study. SETTING Two radiation therapy departments located in a comprehensive cancer center and a community-based oncology program in northern California. SAMPLE 168 outpatients with prostate, breast, brain, or lung cancer and 85 of their family caregivers (FCs). METHODS Growth mixture modeling (GMM) was employed to identify latent classes of individuals based on QOL scores measured prior to, during, and for four months following completion of radiation therapy. Single nucleotide polymorphisms (SNPs) and haplotypes in 16 candidate cytokine genes were tested between the latent classes. Logistic regression was used to evaluate the relationships among genotypic and phenotypic characteristics and QOL GMM group membership. MAIN RESEARCH VARIABLES QOL latent class membership and variations in cytokine genes. FINDINGS Two latent QOL classes were found: higher and lower. Patients and FCs who were younger, identified with an ethnic minority group, had poorer functional status, or had children living at home were more likely to belong to the lower QOL class. After controlling for significant covariates, between-group differences were found in SNPs in interleukin 1 receptor 2 (IL1R2) and nuclear factor kappa beta 2 (NFKB2). For IL1R2, carrying one or two doses of the rare C allele was associated with decreased odds of belonging to the lower QOL class. For NFKB2, carriers with two doses of the rare G allele were more likely to belong to the lower QOL class. CONCLUSIONS Unique genetic markers in cytokine genes may partially explain interindividual variability in QOL. IMPLICATIONS FOR NURSING Determination of high-risk characteristics and unique genetic markers would allow for earlier identification of patients with cancer and FCs at higher risk for poorer QOL. Knowledge of these risk factors could assist in the development of more targeted clinical or supportive care interventions for those identified.
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Affiliation(s)
| | - Bruce Cooper
- School of Nursing, University of California, San Francisco (UCSF)
| | - Steven M Paul
- School of Nursing, University of California, San Francisco (UCSF)
| | - Claudia West
- School of Nursing, University of California, San Francisco (UCSF)
| | - Patsy Yates
- School of Nursing, Queensland University of Technology
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Miyashita M, Wada M, Morita T, Ishida M, Onishi H, Sasaki Y, Narabayashi M, Wada T, Matsubara M, Takigawa C, Shinjo T, Suga A, Inoue S, Ikenaga M, Kohara H, Tsuneto S, Shima Y. Independent Validation of the Japanese Version of the EORTC QLQ-C15-PAL for Patients With Advanced Cancer. J Pain Symptom Manage 2015; 49:953-9. [PMID: 25593101 DOI: 10.1016/j.jpainsymman.2014.11.299] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 11/11/2014] [Accepted: 11/13/2014] [Indexed: 11/12/2022]
Abstract
CONTEXT Although the psychometric properties of the Japanese version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care (EORTC QLQ-C15-PAL) have been examined previously, that study had several limitations, for example, small sample size. OBJECTIVES To examine the validity and reliability, including test-retest reliability, of the Japanese version of EORTC QLQ-C15-PAL for cancer patients with metastasis or recurrence. METHODS A cross-sectional anonymous questionnaire was administered to cancer patients who were being treated on an oncology inpatient ward, in an oncology outpatient clinic, and in seven inpatient palliative units in Japan, from August 2007 to March 2008. RESULTS Data from a total of 312 cancer patients were analyzed. The proportion of missing values was less than 4% for all items. The factor structure was reproduced identically with the original EORTC QLQ-C15-PAL, English version. The correlation of subscales showed a reasonable matrix. Cronbach's alpha coefficients were 0.76 to 0.86, and intraclass correlation coefficients, which indicate test-retest reliability, ranged from 0.52 to 0.77. All subscales, especially physical functioning, fatigue, and pain, were significantly correlated with self-reported Eastern Cooperative Oncology Group performance status. CONCLUSION The Japanese version of EORTC QLQ-C15-PAL has sufficient validity, acceptable reliability, and feasibility for patients with advanced cancer.
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Affiliation(s)
- Mitsunori Miyashita
- Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan.
| | - Makoto Wada
- Department of Psycho-Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara Hospital, Shizuoka, Japan
| | - Mayumi Ishida
- Department of Psycho-Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hideki Onishi
- Department of Psycho-Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yasutsuna Sasaki
- Department of Medical Oncology, Saitama Medical University International Medical Center, Saitama, Japan; Division of Medical Oncology, Department of Medicine, Showa University, School of Medicine, Tokyo, Japan
| | - Masaru Narabayashi
- Department of Palliative Medicine, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tomomi Wada
- Department of Psycho-Oncology, Saitama Medical University International Medical Center, Saitama, Japan; Department of Psychiatry, Osaka National Hospital, Osaka, Japan
| | - Mei Matsubara
- Department of Psycho-Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Chizuko Takigawa
- KKR Department of Palliative Medicine, Sapporo Medical Center, Hokkaido, Japan
| | | | - Akihiko Suga
- Department of Palliative Medicine, Shizuoka General Hospital, Shizuoka, Japan; Department of Palliative Medicine, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Satoshi Inoue
- Department of Palliative Care, Seirei Hospice, Seirei Mikatahara Hospital, Shizuoka, Japan
| | - Masayuki Ikenaga
- Hospice & Children's Hospice Hospital, Yodogawa Christian Hospital, Osaka, Japan
| | - Hiroyuki Kohara
- Department of Palliative Care, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Satoru Tsuneto
- Department of Palliative Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Ibaraki, Japan
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19
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Nieder C, Dalhaug A, Pawinski A, Haukland E, Mannsåker B, Engljähringer K. Palliative radiotherapy with or without additional care by a multidisciplinary palliative care team in patients with newly diagnosed cancer: a retrospective matched pairs comparison. Radiat Oncol 2015; 10:61. [PMID: 25889414 PMCID: PMC4355455 DOI: 10.1186/s13014-015-0365-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 02/19/2015] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To analyze survival after early palliative radiotherapy (RT) in patients managed exclusively by regular oncology staff or a multidisciplinary palliative care team (MPCT) in addition. METHODS Retrospective matched pairs analysis. Comparison of two groups of 29 patients each: MPCT versus none. Early RT started within three months after cancer diagnosis. RESULTS Bone and brain metastases were common RT targets. No significant differences in baseline characteristics were observed between both groups. Twelve patients in each group had non-small cell lung cancer. Median performance status was 2 in each group. Twenty-seven patients in each group had distant metastases. Median survival was not significantly different. In multivariate analysis, MPCT care was not associated with survival, while performance status and liver metastases were. Rate of radiotherapy during the last month of life was comparable. Only one patient in each group failed to complete radiotherapy. CONCLUSIONS MPCT care was not associated with survival in these two matched groups of patients. The impact of MPCT care on other relevant endpoints such as symptom control, side effects and quality of life should be investigated prospectively.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, 8092, Norway. .,Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, 9037, Norway.
| | - Astrid Dalhaug
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, 8092, Norway. .,Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, 9037, Norway.
| | - Adam Pawinski
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, 8092, Norway.
| | - Ellinor Haukland
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, 8092, Norway.
| | - Bård Mannsåker
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, 8092, Norway.
| | - Kirsten Engljähringer
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, 8092, Norway.
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McDonald R, Chow E, Rowbottom L, Bedard G, Lam H, Wong E, Popovic M, Pulenzas N, Tsao M. Quality of life after palliative radiotherapy in bone metastases: A literature review. J Bone Oncol 2014; 4:24-31. [PMID: 26579481 PMCID: PMC4620945 DOI: 10.1016/j.jbo.2014.11.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 11/06/2014] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate the quality of life (QOL) following palliative radiotherapy for painful bone metastases. Methods A literature search was conducted in OvidSP Medline (1946–Jan Week 4 2014), Embase (1947–Week 5 2014), and the Cochrane Central Register of Controlled Trials (Dec 2013) databases. The search was limited to English. Subject headings and keywords included ‘palliative radiation’, ‘cancer palliative therapy’, ‘bone metastases’, ‘quality of life’, and ‘pain’. All studies (prospective or retrospective) reporting change in QOL before and after palliative radiotherapy for painful bone metastases were included. Results Eighteen articles were selected from a total of 1730. The most commonly used tool to evaluate QOL was the Brief Pain Inventory. Seventeen studies collected data prospectively. An improvement in symptoms and functional interference scores following radiotherapy was observed in all studies. The difference in changes in QOL between responders and non responders was inconsistently reported. Conclusion QOL improves in patients who respond to palliative radiotherapy for painful bone metastases.
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Affiliation(s)
- Rachel McDonald
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Edward Chow
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Leigha Rowbottom
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Gillian Bedard
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Henry Lam
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Erin Wong
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Marko Popovic
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Natalie Pulenzas
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - May Tsao
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Palliative Radiotherapy with or without Additional Care by a Multidisciplinary Palliative Care Team: A Retrospective Comparison. ISRN ONCOLOGY 2014; 2014:715396. [PMID: 25006507 PMCID: PMC4004167 DOI: 10.1155/2014/715396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 03/11/2014] [Indexed: 11/17/2022]
Abstract
Purpose. To analyze pattern of care and survival after palliative radiotherapy (RT) in patients managed exclusively by regular oncology staff or a multidisciplinary palliative care team (MPCT) in addition. Methods. Retrospective analysis of 522 RT courses. Comparison of Two Groups: MPCT versus none. Results. We analyzed 140 RT courses (27%) with MPCT care and 382 without it. The following statistically significant differences were observed: 33% of female patients had MPCT care versus only 23% of male patients and 37% of patients <65 years had MPCT care versus only 22% of older patients. MPCT patients were more likely to have poor performance status and liver metastases. In the MPCT group steroid and opioid use was significantly more common. Dose-fractionation regimens were similar. Median survival was significantly shorter in the MPCT group, 3.9 versus 6.9 months. In multivariate analysis, MPCT care was not associated with survival. Adjusted for confounders, MPCT care reduced the likelihood of incomplete RT by 33%, P > 0.05. Conclusions. Patterns of referral and care differed, for example, regarding age and medication use. It seems possible that MPCT care reduces likelihood of incomplete RT. Therefore, the impact of MPCT care on symptom control should be investigated and objective referral criteria should be developed.
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22
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Lee YJ, Suh SY, Choi YS, Shim JY, Seo AR, Choi SE, Ahn HY, Yim E. EORTC QLQ-C15-PAL quality of life score as a prognostic indicator of survival in patients with far advanced cancer. Support Care Cancer 2014; 22:1941-8. [PMID: 24577883 DOI: 10.1007/s00520-014-2173-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 02/17/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE Quality of life (QoL) and performance status predict survival in advanced cancer patients; these relationships have not been explored in the hospice palliative care setting. The aim of this study was to examine the survival predictability of patient-reported QoL using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C15-PAL questionnaire in far advanced cancer inpatients at the very end of life. METHODS This is a retrospective cohort study. Patients reported QoL using the EORTC QLQ-C15-PAL. One hundred sixty-two inpatients in hospice palliative wards of six hospitals in South Korea were followed until death or the end of the study. Additional symptoms and performance status were assessed by the MD Anderson Symptom Inventory-Korean (MDASI-K), Palliative Performance Scale (PPS) and Eastern Cooperative Oncology Group (ECOG) performance status. Correlations between EORTC QLQ-C15-PAL, MDASI-K, PPS, and ECOG were assessed. Survival analyses were performed using Cox proportional hazard models. RESULTS Patients' median survival was less than 1 month. Physician-reported PPS significantly predicted survival (hazard ratio [HR] 0.493; p<0.001). From the EORTC QLQ-C15-PAL, patient-reported physical functioning predicted survival (HR=0.65; p<0.001). Other six domains of EORTC QLQ-C15-PAL were significantly related to survival after adjustment. Those domains were global health status, emotional functioning, fatigue, nausea/vomiting, appetite loss, and constipation. CONCLUSIONS EORTC QLQ-C15-PAL can be an independent prognostic factor in inpatients with far advanced cancer. Patient-reported physical functioning showed survival predictability as good as physician-reported performance status. It is notable that the QLQ instrument is useful even for patients in their final month of life. Cancer anorexia-cachexia syndrome-related symptoms may be independent prognostic symptoms. Prospective study is warranted.
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Affiliation(s)
- Yong Joo Lee
- College of Medicine, The Catholic University of Korea, Seoul, South Korea
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24
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Arraras JI, de la Vega FA, Asin G, Rico M, Zarandona U, Eito C, Cambra K, Barrondo M, Errasti M, Verdún J, Rivadeneira J, Dominguez MA. The EORTC QLQ-C15-PAL questionnaire: validation study for Spanish bone metastases patients. Qual Life Res 2013; 23:849-55. [PMID: 24002479 DOI: 10.1007/s11136-013-0511-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2013] [Indexed: 11/12/2022]
Abstract
PURPOSE Quality of life (QL) is a key outcome for advanced disease cancer patients. The European Organization for Research and Treatment of Cancer (EORTC) has developed the QLQ-C15-PAL questionnaire, a short version of the QLQ-C30 for palliative care. The aim of the present study is to validate the QLQ-C15-PAL for use with Spanish patients with bone metastasis. METHODS For this study, we used a consecutive sample of stage IV cancer patients with bone metastases who started radiotherapy with palliative intention. Two assessments were proposed for each patient: one on the first day of treatment and one a month after the end of the radiotherapy sessions. Psychometric evaluation of the structure, reliability, and validity was undertaken. RESULTS One hundred and sixteen patients completed the first questionnaire and seventy five completed the second. Multitrait scaling analysis showed that all items met the standards for convergent validity, and all except the fatigue scale met the standards for divergent validity. Cronbach's coefficient met the 0.7 alpha criterion on all scales except pain (second assessment). Most QLQ-C15-PAL areas had low-to-moderate correlations with the other areas. Significant differences appeared in the comparisons between groups with regard to: patients who died before the second assessment (six areas); patients receiving chemotherapy before starting radiotherapy in the two assessments (three and four areas, respectively); the performance status in the two assessments (nine and eight areas); and the number of RT sessions received (four). Quality of life was better in the second assessment in nine areas. CONCLUSION The QLQ-C15-PAL is a reliable and valid instrument when applied to a sample of Spanish patients. These results are in line with those of other validation studies.
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Affiliation(s)
- Juan Ignacio Arraras
- Radiotherapeutic Oncology Department, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Spain,
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Factors Influencing Health Related Quality of Life in Cancer Patients with Bone Metastases. J Palliat Med 2013; 16:915-21. [DOI: 10.1089/jpm.2012.0623] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lam K, Chow E, Zhang L, Wong E, Bedard G, Fairchild A, Vassiliou V, Alm El-Din M, Jesus-Garcia R, Kumar A, Forges F, Tseng LM, Hou MF, Chie WC, Bottomley A. Determinants of quality of life in advanced cancer patients with bone metastases undergoing palliative radiation treatment. Support Care Cancer 2013; 21:3021-30. [PMID: 23775156 DOI: 10.1007/s00520-013-1876-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 06/05/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Assessment of health-related quality of life (HRQOL) is critical to effective delivery of palliative care in patients with advanced cancer. The current study analyzes relationships between baseline social determinants of health and medical factors, and self-reported HRQOL in patients with bone metastases receiving palliative radiotherapy. METHODS AND MATERIALS Advanced cancer patients referred for radiotherapy treatment of bone metastases completed the EORTC QLQ-C30 questionnaire in multiple outpatient clinics internationally. Demographics and social determinants were collected as baseline information. Univariate and Bonferroni-adjusted multivariate linear regression analyses were used to detect significant correlations between baseline determinants and different HRQOL domains. RESULTS Karnofsky Performance Status (KPS) was correlated with better physical (p = 0.0002), role (p < 0.0001), emotional (p < 0.0001), and social (p < 0.0001) functioning, and global health scores (p = 0.0015) and predicted lower symptom scores for fatigue (p < 0.0001), pain (p < 0.0001), appetite loss (p < 0.0001), and constipation (p < 0.0001). Increased age was predictive of better social functioning (p < 0.0001) and less insomnia (p = 0.0036), higher education correlated with better global health status (p = 0.0043), and patients who were employed or retired had improved physical functioning (p = 0.0004 and p = 0.0030, respectively) and less financial challenges compared to patients who were unemployed (p = 0.0005). CONCLUSIONS Baseline KPS had the greatest influence on EORTC QLQ-C30 domain scores. Age, education level, and employment status had significant impacts, although on fewer domains. Further studies that investigate baseline determinants are worthwhile to clarify relationships in order to care for patients more effectively at the end of life.
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Affiliation(s)
- Kinsey Lam
- Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada, M4N 3M5
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Leppert W, Majkowicz M. Validation of the Polish version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care in patients with advanced cancer. Palliat Med 2013; 27:470-7. [PMID: 22988041 DOI: 10.1177/0269216312458823] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Limited data exist on the validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care in advanced cancer patients. AIM To adapt the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care to the Polish clinical setting and to evaluate its psychometric properties in advanced cancer patients. DESIGN Two quality-of-life measurements were performed at baseline and after 7 days. The concurrent validity of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care was established by the Pearson correlation coefficients with the modified Edmonton Symptom Assessment System, the Karnofsky Performance Status and the Brief Pain Inventory - Short Form. Reliability was assessed using Cronbach's alpha coefficients and the Spearman correlation coefficients of the baseline and of the second measurement of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care items. SETTING/PARTICIPANTS A total of 160 consecutive patients in one academic palliative medicine centre were included. RESULTS A total of 129 patients completed the study. The concurrent validity revealed significant correlations of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care pain scale with the Brief Pain Inventory - Short Form, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care symptom items with the modified Edmonton Symptom Assessment System and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care functional scales with the Karnofsky Performance Status scores. High Cronbach's alpha and standardised Cronbach's alpha values were found in the case of both functional (range: 0.830-0.925; 0.830-0.932) and symptom scales (range: 0.784-0.940; 0.794-0.941) of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care, respectively. The Spearman correlation coefficients between the first and the second measurements were significant (p < 0.0001) for all European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care items. CONCLUSIONS Polish version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care is a valid and reliable tool recommended for quality-of-life assessment and monitoring in advanced cancer patients.
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Affiliation(s)
- Wojciech Leppert
- Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland.
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28
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Zeng L, Bedard G, Cella D, Thavarajah N, Chen E, Zhang L, Bennett M, Peckham K, De Costa S, Beaumont JL, Tsao M, Danjoux C, Barnes E, Sahgal A, Chow E. Preliminary Results of the Generation of a Shortened Quality-of-Life Assessment for Patients with Advanced Cancer: The FACIT-Pal-14. J Palliat Med 2013; 16:509-15. [DOI: 10.1089/jpm.2012.0595] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Liang Zeng
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Gillian Bedard
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nemica Thavarajah
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Emily Chen
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Liying Zhang
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Margaret Bennett
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kenneth Peckham
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sandra De Costa
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer L. Beaumont
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - May Tsao
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Cyril Danjoux
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Barnes
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Edward Chow
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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29
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Lam K, Zeng L, Zhang L, Tseng LM, Hou MF, Fairchild A, Vassiliou V, Jesus-Garcia R, El-Din MAA, Kumar A, PharmD FF, Chie WC, Sahgal A, Poon M, Chow E. Predictive Factors of Overall Well-Being Using the EORTC QLQ-C15-PAL Extracted from the EORTC QLQ-C30. J Palliat Med 2013; 16:402-8. [DOI: 10.1089/jpm.2012.0398] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kinsey Lam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Liang Zeng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Liying Zhang
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ling-Ming Tseng
- Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Feng Hou
- Department of Gastroenterologic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Alysa Fairchild
- Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Vassilios Vassiliou
- Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - Reynaldo Jesus-Garcia
- Department of Orthopedic Oncology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Mohamed A. Alm El-Din
- Department of Clinical Oncology, Tanta University Hospital, Tanta Faculty of Medicine, Tanta, Egypt
| | - Aswin Kumar
- Division of Gynaecology and Genitourinary Oncology, Department of Radiation Oncology, Regional Cancer Center, Trivandrum, Kerala, India
| | - Fabien Forges PharmD
- Inserm CIE3, Saint Etienne University Hospital, France
- Unit of Clinical Research, Innovation, and Pharmacology, Saint Etienne University Hospital, France
| | - Wei-Chu Chie
- Department of Public Health and Institute of Epidemiology and Preventative Medicine, National Taiwan University, Taipei, Taiwan
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Michael Poon
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Edward Chow
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Bedard G, Zeng L, Zhang L, Lauzon N, Holden L, Tsao M, Danjoux C, Barnes E, Sahgal A, Poon M, Hicks K, Chow E. Minimal important differences in the EORTC QLQ-C15-PAL to determine meaningful change in palliative advanced cancer patients. Asia Pac J Clin Oncol 2013; 12:e38-46. [DOI: 10.1111/ajco.12069] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Gillian Bedard
- Rapid Response Radiotherapy Program; Department of Radiation Oncology; Odette Cancer Centre; Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Liang Zeng
- Rapid Response Radiotherapy Program; Department of Radiation Oncology; Odette Cancer Centre; Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Liying Zhang
- Rapid Response Radiotherapy Program; Department of Radiation Oncology; Odette Cancer Centre; Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Natalie Lauzon
- Rapid Response Radiotherapy Program; Department of Radiation Oncology; Odette Cancer Centre; Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Lori Holden
- Rapid Response Radiotherapy Program; Department of Radiation Oncology; Odette Cancer Centre; Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - May Tsao
- Rapid Response Radiotherapy Program; Department of Radiation Oncology; Odette Cancer Centre; Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Cyril Danjoux
- Rapid Response Radiotherapy Program; Department of Radiation Oncology; Odette Cancer Centre; Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Elizabeth Barnes
- Rapid Response Radiotherapy Program; Department of Radiation Oncology; Odette Cancer Centre; Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Arjun Sahgal
- Rapid Response Radiotherapy Program; Department of Radiation Oncology; Odette Cancer Centre; Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Michael Poon
- Rapid Response Radiotherapy Program; Department of Radiation Oncology; Odette Cancer Centre; Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Katharine Hicks
- Rapid Response Radiotherapy Program; Department of Radiation Oncology; Odette Cancer Centre; Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Edward Chow
- Rapid Response Radiotherapy Program; Department of Radiation Oncology; Odette Cancer Centre; Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
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Bedard G, Zeng L, Zhang L, Lauzon N, Holden L, Tsao M, Danjoux C, Barnes E, Sahgal A, Poon M, Chow E. Minimal important differences in the EORTC QLQ-C30 in patients with advanced cancer. Asia Pac J Clin Oncol 2013; 10:109-17. [PMID: 23551530 DOI: 10.1111/ajco.12070] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2013] [Indexed: 11/30/2022]
Abstract
AIMS Quality of life (QOL) is important in patients with advanced cancer. The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 is a general QOL tool used in cancer patients. Often, with a large enough sample, statistical significance of changecan be reached, however the clinical significance is often unknown. This study aimed to determine the magnitude of change that is meaningful to advanced cancer patients in the EORTC QLQ-C30. METHODS Patients completed the EORTC QLQ-C30 at baseline and 1 month post-radiation to assess changes in their QOL. Minimal important differences (MID) were calculated through anchor and distribution-based methods for improvement and deterioration. The two anchors of overall health and overall QOL were used to determine meaningful change. RESULTS Statistically significant meaningful changes were seen in the use of both anchors. The overall health anchor produced a greater number of scales and symptoms that reached a statistically significant meaningful change. Meaningful change for improvement with these two anchors ranged from 9.1 units (cognitive functioning) to 23.5 units (pain), and for deterioration it ranged from 7.2 units (physical functioning) to 13.5 units (role functioning). Distribution-based estimates were closest to 0.5 SD. CONCLUSION Knowledge of meaningful change on the EORTC QLQ-C30 allows physicians to assess patients' changes over time, along with evaluating the impact of treatment on a patient's QOL. This knowledge gives insight into whether the treatment is effective and, ultimately, whether it should be continued. Knowledge of MID may assist in the determination of sample size for future trials.
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Affiliation(s)
- Gillian Bedard
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Cai B, Nickman NA, Gaffney DK. The role of palliative external beam radiation therapy in boney metastases pain management. J Pain Palliat Care Pharmacother 2013; 27:28-34. [PMID: 23394451 DOI: 10.3109/15360288.2012.757267] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Bone is the third most common organ affected by neoplastic metastases, and about 70% of patients with breast cancer or prostate cancer that develop metastases will have osseous involvement. As part of a multi-pronged approach to pain management in these patients, external beam radio therapy (EBRT) continues to be a mainstay of treatment for metastatic bone pain. This article reviews the role of radiation therapy in palliative management strategies for patients with bone metastases, including the clinical and cost-effectiveness of single fraction (SFRT) versus multiple fraction (MFRT) EBRT in pain relief. Studies indicate that SFRT is more cost-effective than MFRT, yet both are clinically effective in pain management. Therefore, EBRT use retains an important place among analgesia, bone modifying agents, chemotherapy, and hormone therapy in improving quality of life (QoL) and reducing morbidity from metastatic bone pain.
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Affiliation(s)
- Beilei Cai
- Pharmacotherapy Outcomes Research Center, College of Pharmacy, University of Utah, Salt Lake City, Utah 84112-0258, USA
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Sabur NF, Chee A, Stather DR, MacEachern P, Amjadi K, Hergott CA, Dumoulin E, Gonzalez AV, Tremblay A. The Impact of Tunneled Pleural Catheters on the Quality of Life of Patients with Malignant Pleural Effusions. Respiration 2013; 85:36-42. [DOI: 10.1159/000342343] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 07/27/2012] [Indexed: 11/19/2022] Open
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Patel A, Khalsa B, Lord B, Sandrasegaran K, Lall C. Planting the seeds of success: CT-guided gold seed fiducial marker placement to guide robotic radiosurgery. J Med Imaging Radiat Oncol 2012; 57:207-11. [PMID: 23551782 DOI: 10.1111/j.1754-9485.2012.02445.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 05/10/2012] [Indexed: 02/06/2023]
Abstract
Fiducial marker (FM)-guided stereotactic body radiation therapy (SBRT) allows for precise targeting and delivery of radiation to a tumor site. In this article, we briefly discuss SBRT, provide examples to describe CT-guided FM placement to guide SBRT, and discuss some of the associated risks and benefits. This article serves as a pictorial review for body imagers and interventional radiologists who perform CT-guided procedures and interpret diagnostic studies for oncology patients. CT-guided FMs were placed in patients who were appropriate candidates for SBRT. One week following placement, patients underwent diagnostic CT and/or MR examinations in order to include the FM data in the development of a treatment plan. From October 2007-November 2009, a total of 89 patients were implanted with FMs. Sites of implantation included lung, liver, bone, chest and abdominal wall, and peritoneum/retroperitoneum. Complications included pneumothorax and FM migration. Twenty-one patients (33%) with lung FM placement experienced at least a small pneumothorax and 6 patients (9%) required thoracostomy tubes. FM migration occurred in 5 patients (8%) with lung placement. SBRT provides a safer and more effective alternative to conventional radiotherapy, and CT-guided FM implantation of tumor sites increases the precision of SBRT. Technical improvements in FM placement can limit the complications associated with the procedure and further enable highly localized tumor therapy.
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Affiliation(s)
- Aashish Patel
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Lemke M, Lien K, Zeng L, Popovic M, Zhou M, Digiovanni J, Chen E, Chow E. New Considerations in the Design of Clinical Trials for Bone Metastases. World J Oncol 2012; 3:1-7. [PMID: 29147271 PMCID: PMC5649829 DOI: 10.4021/wjon445w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2012] [Indexed: 12/21/2022] Open
Abstract
Palliative radiotherapy (RT) is prescribed to patients with bone metastases to alleviate symptoms and improve quality of life. The lack of consistent endpoints for such trials has made cross study comparison difficult and has led to contradictory conclusions. The International Bone Metastases Consensus Working Party was established to create a standard set of endpoints and recommendations for future clinical trials. Recommendations were included regarding eligibility criteria, pain assessments, follow-up assessments, timing, as well as radiation techniques. Suggestions were also made to facilitate the ease with which different studies could be compared as well as to encourage widespread consistency in certain aspects of trial design. Investigators conducting clinical trials in bone metastases should continue to adopt these recommendations to ensure consistent guidelines based on the most recent literature.
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Affiliation(s)
- Madeline Lemke
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Karen Lien
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Liang Zeng
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Marko Popovic
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Michelle Zhou
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Julia Digiovanni
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Emily Chen
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Edward Chow
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada
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