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Nieder C, Johnsen SK, Winther AM, Mannsåker B. Patient-reported symptoms before adjuvant locoregional radiotherapy for breast cancer: triple-negative histology impacts the symptom burden. Strahlenther Onkol 2024; 200:507-511. [PMID: 38530418 PMCID: PMC11111479 DOI: 10.1007/s00066-024-02224-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/25/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Multimodal breast cancer treatment may cause side effects reflected in patient-reported outcomes and/or symptom scores at the time of treatment planning for adjuvant radiotherapy. In our department, all patients have been assessed with the Edmonton Symptom Assessment System (ESAS; a questionnaire addressing 11 major symptoms and wellbeing on a numeric scale of 0-10) at the time of treatment planning since 2016. In this study, we analyzed ESAS symptom severity before locoregional radiotherapy. PATIENTS AND METHODS Retrospective review of 132 patients treated between 2016 and 2021 (all comers in breast-conserving or post-mastectomy settings, different radiotherapy fractionations) was performed. All ESAS items and the ESAS point sum were analyzed to identify subgroups with higher symptom burden and thus need for additional care measures. RESULTS The biggest patient-reported issues were fatigue, pain, and sleep problems. Patients with triple negative breast cancer reported a higher symptom burden (mean 30 versus 20, p = 0.038). Patients assigned to adjuvant endocrine therapy had the lowest point sum (mean 18), followed by those on Her-2-targeting agents without chemotherapy (mean 19), those on chemotherapy with or without other drugs (mean 26), and those without systemic therapy (mean 41), p = 0.007. Those with pathologic complete response after neoadjuvant treatment had significantly lower anxiety scores (mean 0.7 versus 1.8, p = 0.03) and a trend towards lower depression scores, p = 0.09. CONCLUSION Different surgical strategies, age, and body mass index did not impact on ESAS scores, while the type of adjuvant systemic therapy did. The effect of previous neoadjuvant treatment and unfavorable tumor biology (triple negative) emerged as important factors associated with symptom burden, albeit in different domains. ESAS data may facilitate identification of patients who should be considered for additional supportive measures to alleviate specific symptoms.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital Trust, 8092, Bodø, Norway.
- Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway.
| | - Silje K Johnsen
- Department of Oncology and Palliative Medicine, Nordland Hospital Trust, 8092, Bodø, Norway
| | - Annette M Winther
- Department of Oncology and Palliative Medicine, Nordland Hospital Trust, 8092, Bodø, Norway
| | - Bård Mannsåker
- Department of Oncology and Palliative Medicine, Nordland Hospital Trust, 8092, Bodø, Norway
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2
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Dickson NR, Beauchamp KD, Perry TS, Roush A, Goldschmidt D, Edwards ML, Blakely LJ. Real-world use and clinical impact of an electronic patient-reported outcome tool in patients with solid tumors treated with immuno-oncology therapy. J Patient Rep Outcomes 2024; 8:23. [PMID: 38416270 PMCID: PMC10899997 DOI: 10.1186/s41687-024-00700-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Utilization of electronic patient-reported outcome (ePRO) tools to monitor symptoms in patients undergoing cancer treatment has shown clinical benefits. Tennessee Oncology (TO) implemented an ePRO platform in 2019, allowing patients to report their health status online. We conducted a real-world, multicenter, observational, non-interventional cohort study to evaluate utilization of this platform in adults with solid tumors who initiated immuno-oncology (IO) therapy as monotherapy or in combination at TO clinics. METHODS Patients initiating IO therapy prior to platform implementation were included in a historical control (HC) cohort; those initiating treatment after implementation were included in the ePRO cohort, which was further divided into ePRO users (platform enrollment ≤ 45 days from IO initiation) and non-users. Data were extracted from electronic medical records; patients were followed for up to 6 months (no minimum follow up). Outcomes included patient characteristics, treatment patterns, duration of therapy (DoT), and overall survival (OS). RESULTS Data were collected for 538 patients in the HC and 1014 in the ePRO cohort; 319 in the ePRO cohort were ePRO users (uptake rate 31%). Baseline age was higher, more patients had stage IV disease at diagnosis, and more received monotherapy (82 vs 52%, respectively) in the HC vs the ePRO cohort. Median follow-up was 181.0 days (range 0.0-182.6) in the HC and 175.0 (0.0-184.0) in the ePRO cohort. Median DoT of index IO regimen was 5.1 months (95% confidence interval [CI], 4.4-NE) in the HC cohort vs not estimable (NE) in the ePRO cohort. Multivariable regression adjusting for baseline differences confirmed lower risk of treatment discontinuation in the ePRO vs HC cohort: hazard ratio (HR) 0.83 (95% CI, 0.71-0.97); p < 0.05. The estimated 6-month OS rate was 65.5% in the HC vs 72.4% in the ePRO cohort (p < 0 .01). Within the ePRO cohort, DoT of index IO regimen and OS did not differ between users and non-users. In ePRO users, patient platform use was durable over 6 months. CONCLUSION Improvements in DoT and OS were seen after ePRO platform implementation. Conclusions are limited by challenges in separating the impact of platform implementation from other changes affecting outcomes.
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Affiliation(s)
- Natalie R Dickson
- Tennessee Oncology, 2004 Hayes Street - 8th Floor, Nashville, TN, 37203, USA
| | | | | | - Ashley Roush
- Tennessee Oncology, 2004 Hayes Street - 8th Floor, Nashville, TN, 37203, USA
| | | | | | - L Johnetta Blakely
- Tennessee Oncology, 2004 Hayes Street - 8th Floor, Nashville, TN, 37203, USA.
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3
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O'Sullivan CC, Cracchiolo JR, Tevaarwerk AJ. Lessons Learned and Practice Pearls: Optimal Integration of Electronic Patient-Reported Outcomes in the Medical Oncology Clinic. JCO Oncol Pract 2023; 19:951-954. [PMID: 37733976 DOI: 10.1200/op.23.00415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/20/2023] [Indexed: 09/23/2023] Open
Abstract
This editorial reviews the many opportunities and obstacles associated with ePRO integration in oncology
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Affiliation(s)
| | - Jennifer R Cracchiolo
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Barbera L, Sutradhar R, Earle CC, Howell D, Mittman N, Li Q, Thiruchelvam D, Seow H. The impact of routine Edmonton symptom assessment system use on receiving palliative care services: results of a population-based retrospective-matched cohort analysis. BMJ Support Palliat Care 2023; 13:e144-e149. [PMID: 32943469 DOI: 10.1136/bmjspcare-2020-002220] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 06/04/2020] [Accepted: 07/31/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND In 2007, Cancer Care Ontario began standardised symptom assessment as part of routine care using the Edmonton Symptom Assessment System (ESAS). AIM The purpose of this study was to evaluate the impact of ESAS on receipt of palliative care when compared with a matched group of unexposed patients. DESIGN A retrospective-matched cohort study examined the impact of ESAS screening on initiation of palliative care services provided by physicians or homecare nurses. The study included adult patients diagnosed with cancer between 2007 and 2015. Exposure was defined as completing ≥1 ESAS during the study period. Using 4 hard and 14 propensity score-matched variables, patients with cancer exposed to ESAS were matched 1:1 to those who were not. Matched patients were followed from first ESAS until initiation of palliative care, death or end of study. RESULTS The final cohort consisted of 204 688 matched patients with no prior palliative care consult. The pairs were well matched. The cumulative incidence of receiving palliative care within the first 5 years was higher among those exposed to ESAS compared with those who were not (27.9% (95% CI: 27.5% to 28.2%) versus 27.9% (95% CI: 27.5% to 28.2%)), when death is considered as a competing event. In the adjusted cause-specific Cox proportional hazards model, ESAS assessment was associated with a 6% increase in palliative care services (HR: 1.06, 95% CI: 1.04 to 1.08). CONCLUSION We have demonstrated that patients exposed to ESAS were more likely to receive palliative care services compared with patients who were not exposed. This observation provides real-world data of the impact of routine assessment with a patient-reported outcome.
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Affiliation(s)
- Lisa Barbera
- Radiation Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
- Oncology, University of Calgary, Calgary, Alberta, Canada
- Institute for Clincal Evaluative Sciences, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Institute for Clincal Evaluative Sciences, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Craig C Earle
- Institute for Clincal Evaluative Sciences, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Doris Howell
- University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Nicole Mittman
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Qing Li
- Institute for Clincal Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Hsien Seow
- Institute for Clincal Evaluative Sciences, Toronto, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
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Huang MY, Weng CS, Kuo HL, Su YC. Using a chatbot to reduce emergency department visits and unscheduled hospitalizations among patients with gynecologic malignancies during chemotherapy: A retrospective cohort study. Heliyon 2023; 9:e15798. [PMID: 37206031 PMCID: PMC10189172 DOI: 10.1016/j.heliyon.2023.e15798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/13/2023] [Accepted: 04/21/2023] [Indexed: 05/21/2023] Open
Abstract
Background A chatbot is an automatic text-messaging tool that creates a dynamic interaction and simulates a human conversation through text or voice via smartphones or computers. A chatbot could be an effective solution for cancer patients' follow-up during treatment, and could save time for healthcare providers. Objective We conducted a retrospective cohort study to evaluate whether a chatbot-based collection of patient-reported symptoms during chemotherapy, with automated alerts to clinicians, could decrease emergency department (ED) visits and hospitalizations. A control group received usual care. Methods Self-reporting symptoms were communicated via the chatbot, a Facebook Messenger-based interface for patients with gynecologic malignancies. The chatbot included questions about common symptoms experienced during chemotherapy. Patients could also use the text-messaging feature to speak directly to the chatbot, and all reported outcomes were monitored by a cancer manager. The primary and secondary outcomes of the study were emergency department visits and unscheduled hospitalizations after initiation of chemotherapy after diagnosis of gynecologic malignancies. Multivariate Poisson regression models were applied to assess the adjusted incidence rate ratios (aIRRs) for chatbot use for ED visits and unscheduled hospitalizations after controlling for age, cancer stage, type of malignancy, diabetes, hypertension, chronic renal insufficiency, and coronary heart disease. Result Twenty patients were included in the chatbot group, and 43 in the usual-care group. Significantly lower aIRRs for chatbot use for ED visits (0.27; 95% CI 0.11-0.65; p = 0.003) and unscheduled hospitalizations (0.31; 95% CI 0.11-0.88; p = 0.028) were noted. Patients using the chatbot approach had lower aIRRs of ED visits and unscheduled hospitalizations compared to usual-care patients. Conclusions The chatbot was helpful for reducing ED visits and unscheduled hospitalizations in patients with gynecologic malignancies who were receiving chemotherapy. These findings are valuable for inspiring the future design of digital health interventions for cancer patients.
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Affiliation(s)
- Ming-Yuan Huang
- Department of Emergency, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chia-Sui Weng
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Hsiao-Li Kuo
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
- School of Nursing, Chang Gung University, New Taipei City, Taiwan
| | - Yung-Cheng Su
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
- Corresponding author.
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Gupta S, Li Q, Nathan PC, D'Agostino N, Baxter NN, Fox C, Chalifour K, Coburn N, Sutradhar R. Prevalence, severity, and predictors of symptom burden among adolescents and young adults with cancer. Cancer Med 2023. [DOI: 10.1002/cam4.5837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/23/2023] [Accepted: 03/12/2023] [Indexed: 03/29/2023] Open
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Pain and Interventions in Stage IV Non-Small Cell Lung Cancer: A Province-Wide Analysis. Curr Oncol 2023; 30:3461-3472. [PMID: 36975475 PMCID: PMC10047317 DOI: 10.3390/curroncol30030262] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/25/2023] [Accepted: 03/15/2023] [Indexed: 03/22/2023] Open
Abstract
Pain is a common symptom in stage IV non-small cell lung cancer (NSCLC). The objective of the study was to examine the use of interventions and factors associated with interventions for pain. A population-based cohort study in Ontario, Canada was conducted with patients diagnosed with stage IV NSCLC from January 2007 to September 2018. An Edmonton Symptom Assessment System (ESAS) score of ≥4 defined moderate-to-severe pain following diagnosis. The study cohort included 13,159 patients, of which 68.5% reported at least one moderate-to-severe pain score. Most patients were assessed by a palliative care team (85.4%), and the majority received radiation therapy (73.2%). The use of nerve block was rare (0.8%). For patients ≥65 years of age who had drug coverage, 59.6% received an opiate prescription. Patients with moderate-to-severe pain were more likely to receive palliative assessment or radiation therapy compared to patients with none or mild pain. Patients aged ≥70 years and with a greater comorbidity burden were associated with less likelihood to receive radiation therapy. Patients from rural/non-major urban residence and with a greater comorbidity burden were also less likely to receive palliative care assessment. Factors associated with interventions for pain are described to inform future symptom management in this population.
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Shariati S, Lou J, Milton L, Behroozian T, Zhang L, Lam E, Wong G, Karam I, Chow E. Impact of adjuvant radiotherapy on patient-reported shortness of breath in patients with breast cancer using the ESAS. J Med Imaging Radiat Sci 2023; 54:281-290. [PMID: 36804014 DOI: 10.1016/j.jmir.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND AND PURPOSE As breast cancer radiotherapy (RT) has been shown to give rise to adverse pulmonary outcomes, such as radiation pneumonitis, trends in patient-reported shortness of breath (SOB) associated with RT were investigated. Adjuvant RT is commonly administered for local and/or regional control of breast cancer and was therefore included. METHODS The Edmonton Symptom Assessment System (ESAS) was used to observe changes in SOB during RT, up to 6 weeks after RT completion, and one to three months post-RT. Patients with at least one completed ESAS were included in the analysis. Generalized linear regression analysis was performed to identify associations between demographic factors and SOB. RESULTS A total of 781 patients were included in the analysis. There was a significant association between ESAS SOB scores and adjuvant chemotherapy when compared to neoadjuvant chemotherapy (p=0.0012). Meanwhile, loco-regional RT had no significant impact on ESAS SOB scores in comparison to local RT. SOB scores were stable over time (p>0.05) from baseline to follow-up appointments. CONCLUSION The findings of this study suggest that RT was not associated with changes in SOB from baseline to 3 months post-RT. However, patients who underwent adjuvant chemotherapy reported significant higher SOB scores over time. Additional research is recommended to analyze the lasting effects of adjuvant breast cancer RT on SOB during physical activity.
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Affiliation(s)
- Saba Shariati
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julia Lou
- McMaster University, Hamilton, Ontario, Canada
| | - Lauren Milton
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Tara Behroozian
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Emily Lam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Gina Wong
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Irene Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Edward Chow
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Girgis A, Bamgboje-Ayodele A, Rincones O, Vinod SK, Avery S, Descallar J, Smith A‘B, Arnold B, Arnold A, Bray V, Durcinoska I, Rankin NM, Chang CF, Eifler B, Elliott S, Hardy C, Ivimey B, Jansens W, Kaadan N, Koh ES, Livio N, Lozenkovski S, McErlean G, Nasser E, Ryan N, Smeal T, Thomas T, Tran T, Wiltshire J, Delaney GP. Stepping into the real world: a mixed-methods evaluation of the implementation of electronic patient reported outcomes in routine lung cancer care. J Patient Rep Outcomes 2022; 6:70. [PMID: 35723827 PMCID: PMC9207870 DOI: 10.1186/s41687-022-00475-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To realize the broader benefits of electronic patient-reported outcome measures (ePROMs) in routine care, we used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to inform the translation of a clinically effective ePROM system (hereafter referred to as the PRM system) into practice. The study aimed to evaluate the processes and success of implementing the PRM system in the routine care of patients diagnosed with lung cancer.
Method
A controlled before-and-after mixed-methods study was undertaken. Data sources included a self-report questionnaire and interviews with healthcare providers, electronic health record data for PRMs patients and historical controls, and field notes. Descriptive statistics, logistic regression modelling, negative binomial models, generalized estimating equations and repeated measures ANOVA were used to analyze quantitative data. Qualitative data was thematically analyzed.
Results
A total of 48/79 eligible people diagnosed with lung cancer completed 90 assessments during the 5-month implementation period (RE-AIM reach). Every assessment breached the pre-defined threshold and care coordinators reviewed and actioned 95.6% of breaches, resulting in 146 referrals to allied health services, most frequently for social work (25.3%), dietetics (18.5%), physiotherapy (18.5%) and occupational therapy (17.1%). PRMs patients had significantly fewer visits to the cancer assessment unit for problematic symptoms (M = 0.23 vs. M = 0.43; p = 0.035), and were significantly more likely to be offered referrals (71% vs. 29%, p < 0.0001) than historical controls (RE-AIM effect). The levels of ‘organizational readiness for implementing change’ (ORIC) did not show much differences between baseline and follow-up, though this was already high at baseline; but significantly more staff reported improved confidence when asking patients to complete assessments (64.7% at baseline vs. 88.2% at follow-up, p = 0.0046), and when describing the assessment tool to patients (64.7% at baseline vs. 76.47% at follow-up, p = 0.0018) (RE-AIM adoption). A total of 78 staff received PRM system training, and 95.6% of the PRM system alerts were actioned (RE-AIM implementation); and all lung cancer care coordinators were engaged with the PRM system beyond the end of the study period (RE-AIM maintenance).
Conclusion
This study demonstrates the potential of the PRM system in enhancing the routine care of lung cancer patients, through leveraging the capabilities of automated web-based care options.
Plain English summary
Research has shown the clear benefits of using electronically collected patient-reported outcome measures (ePROMs) for cancer patients and health services. However, we need to better understand how to implement ePROMs as part of routine care. This study evaluated the processes and outcomes of implementing an ePROMs system in the routine care of patients diagnosed with lung cancer. Key findings included: (a) a majority of eligible patients completed the scheduled assessments; (b) patient concerns were identified in every assessment, and care coordinators reviewed and actioned almost all of these, including making significantly more referrals to allied health services; (c) patients completing assessments regularly were less likely to present to the cancer assessment unit with problematic symptoms, suggesting that ePROMs identified patient concerns early and this led to a timely response to concerns; (d) staff training and engagement was high, and staff reporting increased confidence when asking patients to complete assessments and when describing the assessment tool to patients at the end of the implementation period. This study shows that implementing ePROMs in routine care is feasible and can lead to improvements in patient care.
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Bamgboje-Ayodele A, Avery S, Pearson J, Mak M, Smith K, Rincones O, Vinod S, Bray V, Ducinoska I, McCarthy K, Williamson K, Delaney GP, Girgis A. Adapting an integrated care pathway for implementing electronic patient reported outcomes assessment in routine oncology care: Lessons learned from a case study. J Eval Clin Pract 2022; 28:1072-1083. [PMID: 35470525 DOI: 10.1111/jep.13688] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 12/16/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVE Details of the development and implementation of integrated care pathways (ICPs) in the context of electronic collection of patient reported outcomes (ePROs) for cancer patients are largely lacking in the literature. This study describes what, why and how decisions were made to adapt and implement an ePROs ICP for patients with lung cancer. METHODS A consensus process was utilized, with the implementation advisory group including multidisciplinary representation from three participating hospitals, to identify local champions and adapt and incorporate the ePRO ICP into the local contexts. Engagement meetings were documented via meeting transcripts, and detailed notes from October 2019 to November 2020 were content-analysed to identify decision-making themes based on the Consolidated Framework for Implementation Research; workflows and process maps were reviewed and modified to integrate ePROs. RESULTS In total, 55 engagement activities were held (24 meetings, 20 workshops 11 educational sessions), with n = 96 staff from multiple disciplines participating in the ePROs implementation through advisory meetings, process mapping, change management and staff education. Decisions were made regarding eligible patient cohorts to include, the process for onboarding patients onto the ePRO system, and follow-up and referral pathways. Rationales for decisions included alignment with existing workflows, utilizing available staff, minimizing staff and patient burden and maximizing patient engagement. CONCLUSION Existing resources, staff input and technical and logistical reasons often guided the ICP decisions, highlighting the need for in-depth engagement across all stakeholders for optimal implementation of ePRO ICPs. The ePRO implementation required substantial dialogue and systematic resolution to reach agreement on the final processes. Adapting the local ICP through rigorous engagement facilitated the successful implementation of ePROs as business-as-usual at all three cancer centres. Involving all relevant stakeholders is critical to the successful adaptation of ICPs before their introduction into routine care.
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Affiliation(s)
- Adeola Bamgboje-Ayodele
- UNSW Medicine & Health, University of New South Wales (UNSW Sydney), Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Sandra Avery
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Macarthur Cancer Therapy Centre, South Western Sydney Local Health District, Campbelltown, New South Wales, Australia.,Bankstown Cancer Therapy Centre, South Western Sydney Local Health District, Bankstown, New South Wales, Australia
| | - Joanne Pearson
- Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Macarthur Cancer Therapy Centre, South Western Sydney Local Health District, Campbelltown, New South Wales, Australia.,Bankstown Cancer Therapy Centre, South Western Sydney Local Health District, Bankstown, New South Wales, Australia
| | - May Mak
- Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Kylie Smith
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Macarthur Cancer Therapy Centre, South Western Sydney Local Health District, Campbelltown, New South Wales, Australia.,Bankstown Cancer Therapy Centre, South Western Sydney Local Health District, Bankstown, New South Wales, Australia
| | - Orlando Rincones
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Shalini Vinod
- UNSW Medicine & Health, University of New South Wales (UNSW Sydney), Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Victoria Bray
- UNSW Medicine & Health, University of New South Wales (UNSW Sydney), Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Ivana Ducinoska
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Karina McCarthy
- Cancer Institute New South Wales (CINSW), St Leonards, New South Wales, Australia
| | - Kimberley Williamson
- Cancer Institute New South Wales (CINSW), St Leonards, New South Wales, Australia
| | - Geoff P Delaney
- UNSW Medicine & Health, University of New South Wales (UNSW Sydney), Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | | | - Afaf Girgis
- UNSW Medicine & Health, University of New South Wales (UNSW Sydney), Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
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11
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Sanna V, Fedele P, Deiana G, Alicicco MG, Ninniri C, Santoro AN, Pazzola A, Fancellu A. Edmonton Symptom Assessment Scale may reduce medical visits in patients undergoing chemotherapy for breast cancer. World J Clin Oncol 2022; 13:577-586. [PMID: 36157162 PMCID: PMC9346425 DOI: 10.5306/wjco.v13.i7.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/05/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adjuvant chemotherapy is recommended in high-risk breast cancer. However, no universally accepted guidelines exist on pre-chemotherapy assessment. In particular, the number and frequency of medical visits vary according to each institution’s policy. We hypothesised that the Edmonton Symptom Assessment Scale (ESAS) may have a favourable impact on the pre-treatment assessment in candidates for adjuvant chemotherapy.
AIM To investigate whether the ESAS can be used to safely reduce the number of medical visits in women with breast cancer undergoing adjuvant chemotherapy.
METHODS In a retrospectively prospective matched-pair analysis, 100 patients who completed the ESAS questionnaire before administration of adjuvant chemotherapy (ESAS Group) were compared with 100 patients who underwent chemotherapy according to the traditional modality, without ESAS (no-ESAS Group). Patients of the ESAS Group received additional visits before treatment if their ESAS score was > 3. The primary endpoint was the total number of medical visits during the entire duration of the chemotherapy period. The secondary endpoints were the occurrence of severe complications (grade 3-4) and the number of unplanned visits during the chemotherapy period.
RESULTS The study variables did not statistically differ between patients of the ESAS Group and no-ESAS Group (age P = 0.880; breast cancer stage P = 0.56; cancer histology P = 0.415; tumour size P = 0.258; lymph node status P = 0.883; immunohistochemical classification P = 0.754; type of surgery P = 0.157), except for premenopausal status (P = 0.015). The study variables did not statistically differ between patients of the ESAS Group and no-ESAS Group regarding age, cancer stage, histology, tumour size, lymph node status, immunohistochemical classification, and type of surgery. Unplanned visits during the entire duration of chemotherapy were 8 in the ESAS Group and 18 in the no-ESAS Group visits (P = 0.035). Grade 3-4 toxicity did not differ between the study groups (P = 0.652). Forty-eight patients of the ESAS Group received additional visits due to an ESAS score > 3. The mean number of medical visits was 4.38 ± 0.51 in the ESAS Group and 16.18 ± 1.82 in the no-ESAS group (P < 0.001). With multivariate analysis, women of the ESAS group were more likely to undergo additional visits for an ESAS score > 3 if they were aged 60 or older, received a mastectomy, or had tumour stage II/III.
CONCLUSION The ESAS score may safely reduce the number of medical visits in candidates for adjuvant chemotherapy for early breast cancer. Our results suggest that the ESAS score may be used for selecting a group of breast cancer patients for whom it is safe to reduce the number of medical visits in the setting of adjuvant chemotherapy. This may translate into several advantages, such as a more rational utilization of human resources and a possible reduction of coronavirus pandemic infection risk in oncologic patients.
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Affiliation(s)
- Valeria Sanna
- Unit of Medical Oncology, A.O.U. Sassari, Sassari 07100, Italy
| | - Palma Fedele
- Unit of Medical Oncology, Hospital “D. Camberlingio”, Francavilla Fontana 72100, Brindisi, Italy
| | - Giulia Deiana
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | | | - Chiara Ninniri
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Anna N Santoro
- Unit of Medical Oncology, Hospital “D. Camberlingio”, Francavilla Fontana 72100, Brindisi, Italy
| | - Antonio Pazzola
- Unit of Medical Oncology, A.O.U. Sassari, Sassari 07100, Italy
| | - Alessandro Fancellu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
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12
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Al-Rashdan A, Grendarova P, Yannitsos D, Quon H, Banerjee R, Barbera L. Feasibility and Acceptability of Implementing Site-Specific Patient-Reported Outcome Measure in Head and Neck Cancer Clinics: A Prospective Institutional Study. Adv Radiat Oncol 2022; 7:101036. [DOI: 10.1016/j.adro.2022.101036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/16/2022] [Indexed: 11/29/2022] Open
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13
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Bamgboje-Ayodele A, Arnold B, Durcinoska I, Avery S, Vinod S, Rincones O, Thomas T, Descallar J, Smith B, Delaney GP, Girgis A. Implementing patient-reported outcomes into routine care: an audit of cancer patients from two local health districts in New South Wales to understand their capabilities and preferences. AUST HEALTH REV 2022; 46:331-337. [PMID: 35545809 DOI: 10.1071/ah21270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/03/2022] [Indexed: 11/23/2022]
Abstract
ObjectiveIt has been established that the implementation of patient-reported outcome measures (PROMs) in routine care provides significant benefits to patients, providers and health services. However, there are patient-level barriers that must be identified and addressed for the successful implementation of PROMs. This study aimed to understand the capabilities and preferences of our cancer patient population prior to implementation of electronically collected PROMs (ePROMs). Specifically, we conducted a clinic audit to determine the proportion of patients in clinics with access to out-of-clinic internet; those preferring to complete PROMs on paper or via an electronic device; those capable of completing PROMs in English; and those anticipating requiring assistance to complete PROMs.MethodsPatients receiving cancer treatment or follow-up care at two Local Health Districts (LHDs) in New South Wales, Australia, completed a questionnaire (audit form) with items about internet and mobile access, communication preferences and assistance needed to complete PROMs. Participant demographic and treatment information were extracted from their electronic medical records.ResultsAcross both LHDs, 637 of 1668 participants (38%) completed the audit forms. Mean participant age was 65 years (range = 23-98), 53% were female, and 92% were outpatients. Patients in the two LHDs differed in their levels of internet and email access, and ability to complete PROMs independently in English, suggesting that some LHD-specific tailoring of implementation strategies is necessary to optimise ePROMs uptake.ConclusionThis study highlights the importance of understanding the specific local contexts and patient populations, including potential technology and language barriers, which can influence patient ability to complete ePROMs.
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Affiliation(s)
- Adeola Bamgboje-Ayodele
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia; and South Western Sydney Clinical School, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; and Present address: Faculty of Medicine and Health, School of Medical Sciences, Biomedical Informatics and Digital Health, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Belinda Arnold
- Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, NSW 2500, Australia
| | - Ivana Durcinoska
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia
| | - Sandra Avery
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia; and South Western Sydney Clinical School, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; and Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW 1871, Australia
| | - Shalini Vinod
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia; and South Western Sydney Clinical School, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; and Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW 1871, Australia
| | - Orlando Rincones
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia
| | - Tien Thomas
- Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW 1871, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia; and South Western Sydney Clinical School, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia
| | - Ben Smith
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia; and South Western Sydney Clinical School, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia
| | - Geoff P Delaney
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia; and South Western Sydney Clinical School, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; and Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW 1871, Australia
| | - Afaf Girgis
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia; and South Western Sydney Clinical School, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia
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14
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Dufton PH, Gerdtz MF, Jarden R, Krishnasamy M. Methodological approaches to measuring the incidence of unplanned emergency department presentations by cancer patients receiving systemic anti-cancer therapy: a systematic review. BMC Med Res Methodol 2022; 22:75. [PMID: 35313807 PMCID: PMC8935762 DOI: 10.1186/s12874-022-01555-3] [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: 02/12/2021] [Accepted: 02/25/2022] [Indexed: 12/24/2022] Open
Abstract
Background The need to mitigate the volume of unplanned emergency department (ED) presentations is a priority for health systems globally. Current evidence on the incidence and risk factors associated with unplanned ED presentations is unclear because of substantial heterogeneity in methods reporting on this issue. The aim of this review was to examine the methodological approaches to measure the incidence of unplanned ED presentations by patients receiving systemic anti-cancer therapy in order to determine the strength of evidence and to inform future research. Methods An electronic search of Medline, Embase, CINAHL, and Cochrane was undertaken. Papers published in English language between 2000 and 2019, and papers that included patients receiving systemic anti-cancer therapy as the denominator during the study period were included. Studies were eligible if they were analytical observational studies. Data relating to the methods used to measure the incidence of ED presentations by patients receiving systemic anti-cancer therapy were extracted and assessed for methodological rigor. Findings are reported in accordance with the Synthesis Without Meta-Analysis (SWiM) guideline. Results Twenty-one articles met the inclusion criteria: 20 cohort studies, and one cross-sectional study. Overall risk of bias was moderate. There was substantial methodological and clinical heterogeneity in the papers included. Methodological rigor varied based on the description of methods such as the period of observation, loss to follow-up, reason for ED presentation and statistical methods to control for time varying events and potential confounders. Conclusions There is considerable diversity in the population and methods used in studies that measure the incidence of unplanned ED presentations by patients receiving systemic anti-cancer therapy. Recommendations to support the development of robust evidence include enrolling participants at diagnosis or initiation of treatment, providing adequate description of regular care to support patients who experience toxicities, reporting reasons for and characteristics of participants who are lost to follow-up throughout the study period, clearly defining the outcome including the observation and follow-up period, and reporting crude numbers of ED presentations and the number of at-risk days to account for variation in the length of treatment protocols. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01555-3.
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Affiliation(s)
- P H Dufton
- Department of Nursing, School of Health Sciences, University of Melbourne, Carlton, VIC, Australia.
| | - M F Gerdtz
- Department of Nursing, School of Health Sciences, University of Melbourne, Carlton, VIC, Australia
| | - R Jarden
- Department of Nursing, School of Health Sciences, University of Melbourne, Carlton, VIC, Australia
| | - M Krishnasamy
- Department of Nursing, School of Health Sciences, University of Melbourne, Carlton, VIC, Australia
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15
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Mazariego C, Jefford M, Chan RJ, Roberts N, Millar L, Anazodo A, Hayes S, Brown B, Saunders C, Webber K, Vardy J, Girgis A, Koczwara B. Priority recommendations for the implementation of patient-reported outcomes in clinical cancer care: a Delphi study. J Cancer Surviv 2022; 16:33-43. [PMID: 35107792 PMCID: PMC8881271 DOI: 10.1007/s11764-021-01135-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/06/2021] [Indexed: 12/13/2022]
Abstract
Purpose The aim of this study was to develop priority recommendations for the service level implementation of patient-reported outcomes (PROs) into clinical cancer care. Methods Development of draft guidance statements was informed by a literature review, the Knowledge to Action (KTA) implementation framework, and discussion with PRO experts and cancer survivors. A two-round modified Delphi survey with key stakeholders including cancer survivors, clinical and research experts, and Information Technology specialists was undertaken. Round 1 rated the importance of the statements and round 2 ranked statements in order of priority. Results Round 1 was completed by 70 participants with round 2 completed by 45 participants. Forty-seven statements were rated in round 2. In round 1, the highest agreement items (>90% agreement) included those that focused on the formation of strong stakeholder partnerships, ensuring ongoing communication within these partnerships, and the use of PROs for improvement and guidance in clinical care. Items ranked as the highest priorities in round 2 included assessment of current staff capabilities and service requirements, mapping of workflows and processes to enable collection, and using collected PROs to guide improved health outcomes. Conclusions This stakeholder consultation process has identified key priorities in PRO implementation into clinical cancer care that include clinical relevance, stakeholder engagement, communication, and integration within the existing processes and capabilities. Implication for Cancer Survivors Routine adoption of PRO collection by clinical cancer services requires multiple implementation steps; of highest priority is strong engagement and communication with key stakeholders including cancer survivors. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01135-2.
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Affiliation(s)
- C Mazariego
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling street, Woolloomooloo, NSW, 2011, Australia.
| | - M Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - R J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - N Roberts
- Metro North Health Service, Herston, QLD, Australia.,University of Queensland Centre for Clinical Research, Herston, QLD, Australia
| | - L Millar
- Medical School, University of Western Australia, Perth, WA, Australia
| | - A Anazodo
- School of Women's and Children's Health, University of New South Wales, Randwick, Sydney, Australia.,Kids Cancer Centre, Sydney, Sydney Children's Hospital, Randwick, Sydney, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, Australia
| | - S Hayes
- Consumer representative, Patients First: The Continuous Improvement in Care-Cancer Project, Perth, Australia
| | - B Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Brisbane, Australia
| | - C Saunders
- Medical School, University of Western Australia, Perth, WA, Australia
| | - K Webber
- School of Medical Sciences, Monash University, Clayton, Vic, Australia.,Oncology Department, Monash Health, Clayton, Vic, Australia
| | - J Vardy
- Sydney Medical School, University of Sydney, Camperdown, Australia.,Concord Cancer Centre, Concord Hospital, Concord, NSW, Australia
| | - A Girgis
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - B Koczwara
- Department of Clinical Oncology, Flinders Medical Centre, Adelaide, SA, Australia.,Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
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Ellen JG, Boele FW, Hellman B, Duprey K, Nayak L, Morris J. Pilot study of smartphone-based health outcome tracking (OurBrainBank) for glioblastoma patients. Neurooncol Pract 2021; 8:684-690. [PMID: 34777837 PMCID: PMC8579086 DOI: 10.1093/nop/npab044] [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] [Indexed: 11/25/2022] Open
Abstract
Background Patients with glioblastoma (GBM) typically have high symptom burden impacting on quality of life. Mobile apps may help patients track their condition and provide real-time data to clinicians and researchers. We developed a health outcome reporting app (OurBrainBank [OBB]) for GBM patients. Our primary aim was to explore the feasibility and take-up of OBB. Secondary aims were to examine the potential value of OBB app usage for patient well-being and clinical research. Methods Participants (or caregiver proxies) completed baseline surveys and tracked 10 health outcomes over time. We evaluated usage and engagement, and relationships between clinical/sociodemographic variables and OBB use. Participant satisfaction and feedback were described. To demonstrate usefulness for clinical research, health outcomes were compared with corresponding items on a validated measure (EQ-5D-5L). Results From March 2018 to February 2021, OBB was downloaded by 630 individuals, with 15 207 sets of 10 health outcomes submitted. Higher engagement was associated with being a patient rather than a caregiver (χ 2(2,568) = 28.6, P < .001), having higher self-rated health scores at baseline (F(2,460) = 4.8, P = .009) and more previous experience with mobile apps (χ 2(2,585) = 9.6, P = .008). Among the 66 participants who completed a feedback survey, most found health outcome tracking useful (average 7/10), and would recommend the app to others (average 8.4/10). The OBB health outcomes mapped onto corresponding EQ-5D-5L items, suggesting their validity. Conclusions OBB can efficiently collect GBM patients’ health outcomes. The long-term goal is to create a unique database of thousands of deidentified GBM patients, with open access to qualified researchers.
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Affiliation(s)
- Jacob G Ellen
- University College London Institute of Health Informatics, University College London, London, UK
| | - Florien W Boele
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.,Leeds Institute of Health Sciences, University of Leeds, Leeds,UK
| | | | | | - Lakshmi Nayak
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Gupta S, Sutradhar R, Li Q, Coburn N. The effectiveness of a provincial symptom assessment program in reaching adolescents and young adults with cancer: A population-based cohort study. Cancer Med 2021; 10:9030-9039. [PMID: 34738747 PMCID: PMC8683532 DOI: 10.1002/cam4.4401] [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: 06/22/2021] [Revised: 09/12/2021] [Accepted: 10/24/2021] [Indexed: 11/21/2022] Open
Abstract
Background Symptom control is prioritized by cancer patients and may improve overall survival. Ontario, Canada thus offers all cancer patients screening using the Edmonton Symptom Assessment System (ESAS) at outpatient cancer‐related visits. We determined whether this initiative reached adolescents and young adults (AYA) and factors associated with screening in this population. Methods We linked all Ontario AYA diagnosed with cancer 2010–2018 aged 15–29 years to population‐based databases identifying outpatient visits and ESAS screening. For each 2‐week period in the year post‐diagnosis, AYA with cancer‐related visits were categorized as “unscreened” (no ESAS score) versus “screened” (≥1 ESAS score). Demographic and disease‐related covariates were examined. Results Among 5435 AYA, 4204 (77.4%) had ≥1 ESAS screen. Within any 2‐week period, only 30%–44% of AYA attending cancer‐related visits were screened. Patients with hematologic malignancies were least likely to be screened [odds ratio (OR) vs. breast cancer 0.77, 95% confidence interval (95% CI) 0.67–0.88; p < 0.001]. AYA in remote Northern or rural areas had equivalent or higher rates of ESAS screening compared to those in high‐income urban areas. However, AYA living in the lowest income urban neighborhoods were less likely to be screened (OR 0.86, 95% CI 0.77–0.97; p = 0.01). Conclusions Within a population‐wide symptom assessment program, while AYA living in rural and remote areas had high rates of screening, than those in low‐income urban areas were substantially less likely to be screened. Though patients with hematologic cancers suffer from particularly high symptom burdens, they were also less likely to be screened. Interventions targeting AYA are required to increase uptake.
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Affiliation(s)
- Sumit Gupta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.,Cancer Research Program, ICES, Toronto, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Rinku Sutradhar
- Cancer Research Program, ICES, Toronto, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Qing Li
- Cancer Research Program, ICES, Toronto, Canada
| | - Natalie Coburn
- Cancer Research Program, ICES, Toronto, Canada.,Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada.,Sunnybrook Research Institute, Toronto, Canada
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18
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Ripamonti C, Leporati R, De Feo G, Di Pede P, Toffolatti L, Guglielmo M, La Carpia D, Miccinesi G, Chiesi F. Italian version of the Edmonton Symptom Assessment System (ESAS)-Total Care (TC): development and psychometric validation in patients undergoing cancer treatment or follow-up. Support Care Cancer 2021; 30:1923-1933. [PMID: 34623487 DOI: 10.1007/s00520-021-06594-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The routine use of patient-reported outcomes (PROs) in clinical practice improves quality of care, it helps in reducing the access to emergency services and unscheduled visits, and it can improve cancer patients' time survival. The Edmonton Symptom Assessment System (ESAS) is a PRO largely used in different care settings to monitor physical and psychological symptoms. Nonetheless, along with these symptoms, literature also highlighted the presence and effect of spiritual pain, financial distress, and social isolation on quality of care, treatment effectiveness, and survival. AIM The aims of the current study were (a) to complete the Italian version of the ESAS validation process by adding the missing symptom "insomnia" and (b) to develop and validate the ESAS-Total Care (ESAS-TC) that is intended to evaluate and screen not only physical and psychological symptoms but also spiritual pain, discomfort deriving from financial problems associated with illness, and suffering related to social isolation. METHODS A sample of Italian native outpatients, who referred to the dedicated Supportive Care Unit of the Fondazione IRCCS, Istituto Nazionale deiTumori (INT), Milano, were asked to fill the ESAS-TC to assess item properties, factorial structure, internal consistency, test-retest reliability (patients were asked to retake the scale after 2-6 weeks), and external validity. Concerning the latter, other self-administered scales were employed to assess perceived stress (Perceived Stress Scale), unmet needs (using theNeed Evaluation Questionnaire that describes informative, assistance/care, relational, needs for psycho-emotional support, material needs), and perceived social support (administering the Multidimensional Scale of Perceived Social Support that evaluates perceived support of family, friends, and significant others in the wider social field). RESULTS The scales were administered to 243 patients with solid (90%) and hematologic (10%) cancers, mean age 62.6, female 76.5%. Analysis suggested that a single factor better represents the structure of the ESAS scales, their internal consistency and test-retest reliability were good, and evidence of construct and criterion validity were provided. Additionally, incremental validity of the ESAS-TC was proved showing that the added items offer a unique contribution in predicting the patient's stress. Finally, known groups validity was confirmed testing the differences in the ESAS scores due to the Karnofsky Performance Status. CONCLUSIONS The current study allowed to complete the validation of the Italian version of the ESAS and to develop a psychometrically sound scale, the ESAS-Total Care, that potentially helps in moving cancer research toward personalized total cancer care.
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Affiliation(s)
- Carla Ripamonti
- Department of Medical Oncology and Haematology, Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy.
| | - Rita Leporati
- Medical Oncology Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy
| | - Giulia De Feo
- Department of Medical Oncology and Haematology, Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy
| | - Patricia Di Pede
- Department of Medical Oncology and Haematology, Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy
| | - Luisa Toffolatti
- Department of Medical Oncology and Haematology, Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy
| | - Mauro Guglielmo
- Department of Medical Oncology and Haematology, Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy
| | - Domenico La Carpia
- Azienda USL Toscana Centro, UDS Cure Palliative Prato Pistoia, Firenze, Italy
| | - Guido Miccinesi
- Epidemiologia Clinica e Di Supporto Al Governo Clinico, Istituto Per lo Studio, la Prevenzione e la Rete Oncologica-ISPRO, Firenze, Italy
| | - Francesca Chiesi
- Department of Neuroscience and Child's Health (NEUROFARBA), University of Florence, Florence, Italy
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Tjong MC, Doherty M, Tan H, Chan WC, Zhao H, Hallet J, Darling G, Kidane B, Wright FC, Mahar A, Davis LE, Delibasic V, Parmar A, Mittmann N, Coburn NG, Louie AV. Province-Wide Analysis of Patient-Reported Outcomes for Stage IV Non-Small Cell Lung Cancer. Oncologist 2021; 26:e1800-e1811. [PMID: 34216415 PMCID: PMC8488785 DOI: 10.1002/onco.13890] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/18/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In Ontario, Canada, patient-reported outcome (PRO) evaluation through the Edmonton Symptom Assessment System (ESAS) has been integrated into clinical workflow since 2007. As stage IV non-small cell lung cancer (NSCLC) is associated with substantial disease and treatment-related morbidity, this province-wide study investigated moderate to severe symptom burden in this population. MATERIALS AND METHODS ESAS collected from patients with stage IV NSCLC diagnosed between 2007 and 2018 linked to the Ontario provincial health care system database were studied. ESAS acquired within 12 months following diagnosis were analyzed and the proportion reporting moderate to severe scores (ESAS ≥4) in each domain was calculated. Predictors of moderate to severe scores were identified using multivariable Poisson regression models with robust error variance. RESULTS Of 22,799 patients, 13,289 (58.3%) completed ESAS (84,373 assessments) in the year following diagnosis. Patients with older age, with high comorbidity, and not receiving active cancer therapy had lower ESAS completion. The majority (94.4%) reported at least one moderate to severe symptom. The most prevalent were tiredness (84.1%), low well-being (80.7%), low appetite (71.7%), and shortness of breath (67.8%). Most symptoms peaked at diagnosis and, while declining, remained high in the following year. On multivariable analyses, comorbidity, low income, nonimmigrants, and urban residency were associated with moderate to severe symptoms. Moderate to severe scores in all ESAS domains aside from anxiety were associated with radiotherapy within 2 weeks prior, whereas drowsiness, low appetite and well-being, nausea, and tiredness were associated with systemic therapy within 2 weeks prior. CONCLUSION This province-wide PRO analysis showed moderate to severe symptoms were prevalent and persistent among patients with metastatic NSCLC, underscoring the need to address supportive measures in this population especially around treatments. IMPLICATIONS FOR PRACTICE In this largest study of lung cancer patient-reported outcomes (PROs), stage IV non-small cell lung cancer patients had worse moderate-to-severe symptoms than other metastatic malignancies such as breast or gastrointestinal cancers when assessed with similar methodology. Prevalence of moderate-to-severe symptoms peaked early and remained high during the first year of follow-up. Symptom burden was associated with recent radiation and systemic treatments. Early and sustained PRO collection is important to detect actionable symptom progression, especially around treatments. Vulnerable patients (e.g., older, high comorbidity) who face barriers in attending in-person clinic visits had lower PRO completion. Virtual PRO collection may improve completion.
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Affiliation(s)
- Michael C. Tjong
- Department of Radiation Oncology, Sunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Mark Doherty
- Division of Medical Oncology and Hematology, Sunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Hendrick Tan
- Department of Radiation Oncology, Sunnybrook Health Sciences CentreTorontoOntarioCanada
| | | | | | - Julie Hallet
- Department of Surgery, Sunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Gail Darling
- Division of Thoracic Surgery, Toronto General HospitalTorontoOntarioCanada
| | - Biniam Kidane
- Section of Thoracic Surgery, University of ManitobaWinnipegManitobaCanada
- Research Institute in Oncology & Hematology, Cancer Care ManitobaWinnipegManitobaCanada
| | - Frances C. Wright
- Department of Surgery, Sunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Alyson Mahar
- Manitoba Centre for Health Policy, University of ManitobaWinnipegManitobaCanada
| | - Laura E. Davis
- Evaluative Clinical Sciences, Sunnybrook Research InstituteTorontoOntarioCanada
| | - Victoria Delibasic
- Department of Surgery, Sunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Ambika Parmar
- Division of Medical Oncology and Hematology, Sunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Nicole Mittmann
- Canadian Agency for Drugs and Technology in HealthOttawaOntarioCanada
| | - Natalie G. Coburn
- Department of Surgery, Sunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Alexander V. Louie
- Department of Radiation Oncology, Sunnybrook Health Sciences CentreTorontoOntarioCanada
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Use of a Symptom Diary on Oncology Wards: Effect on Symptom Management and Recommendations for Implementation. Cancer Nurs 2021; 44:E209-E220. [PMID: 31990694 DOI: 10.1097/ncc.0000000000000792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Management of symptoms is essential in reducing the symptom burden of cancer patients. The effect of symptom diaries on symptom management to date has been evaluated only in ambulatory settings. OBJECTIVE The aims of this study were to identify the key facilitators for successful implementation of symptom diaries on oncology wards from patients' and professionals' perspectives and to evaluate implementation outcomes. METHODS In 2 cycles of action research, the Utrecht Symptom Diary (USD) was implemented on 3 oncology wards and a daycare unit. Key facilitators for implementation were identified by thematic coding of interviews. The effect of the implementation was evaluated in cycle II in a pretest-posttest design. We performed statistical tests (Mann-Whitney/t test/χ2) on Symptom Management Performance items in questionnaires and medical records. RESULTS We interviewed 25 patients, 8 doctors, and 25 nurses. Seven key facilitators for implementation emerged. After implementation of the USD in cycle II, Symptom Management Performance was significantly (P < .05) improved for patients (3/12 items, n = 33 pretest/26 posttest) and professionals (6/12 items, n = 21 pretest/19 posttest). Significantly more symptoms (P = .00), working hypotheses (P = .023), treatment plans (P = .00), and interventions (P = .00) were reported (n = 47 pretest/47 posttest). CONCLUSIONS Implementation of the USD significantly improved symptom management in oncology wards. We recommend (1) using a diagnosis-specific diary; (2) making clear, individualized working-arrangements; (3) training professionals; (4) using the plan-do-check-act cycle; (5) acting multidisciplinary; (6) providing guidelines and training; and (7) assuring adequate information communications technology (ICT). IMPLICATIONS Symptom diaries are increasingly used, but implementation is challenging. This study provides knowledge on their benefits and an evidence-based strategy for implementation with positive outcomes achieved in patient care.
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21
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Carla Ida R, Maurizio L. Supportive care centers: definition of excellence. Curr Opin Oncol 2021; 33:267-272. [PMID: 33756516 DOI: 10.1097/cco.0000000000000734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current review is relevant because despite significant progress in oncology, a large proportion of patients with cancer still experience morbidity and symptoms, resulting from the cancer and/or its treatment. RECENT FINDINGS The main theme concerns the definition of excellence of Supportive Care centers based on the indications of the Multinational Association Supportive Care Cancer (MASCC) because there are no data in literature on this topic. SUMMARY Supportive care centers provide assistance to cancer patients suffering for anticancer treatments-related adverse effects. This leads to patient management with immediate evaluation and treatment of symptoms and therefore with improvement of quality of life and survival. In addition, there is less use of emergency room and hospitalizations with consequent savings of resources. According to MASCC evaluation criteria, some types of centers could be excellent in supportive care in cancer. Size, number of treated patients, or academic presence are not mandatory for the certification of excellence. However, centrality of patient and assessment of patient's needs, dedicated organizational models to evaluate and treat the adverse effects of anticancer treatments, dedicated activity and multidisciplinary staff, teaching programs, and adherence to guidelines are milestones for good clinical practices and consequently the centers that practice them represent the excellence in supportive care in cancer.
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Affiliation(s)
- Ripamonti Carla Ida
- Oncology-Supportive Care Unit, Department Medical Oncology & Haematology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano
| | - Lucchesi Maurizio
- Thoracic Oncology Service in Pneumology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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22
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Zhang JC, El-Majzoub S, Li M, Ahmed T, Wu J, Lipman ML, Moussaoui G, Looper KJ, Novak M, Rej S, Mucsi I. Could symptom burden predict subsequent healthcare use in patients with end stage kidney disease on hemodialysis care? A prospective, preliminary study. Ren Fail 2021; 42:294-301. [PMID: 32506997 PMCID: PMC7144228 DOI: 10.1080/0886022x.2020.1744449] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Context Patients treated with maintenance hemodialysis experience significant symptom burden resulting in impaired quality of life. However, the association of patient reported symptom burden and the risk of healthcare use for patients with end stage kidney disease on hemodialysis has not been fully explored. Objectives To investigate if higher symptom burden, assessed by the Edmonton Symptom Assessment System-revised (ESASr), is associated with increased healthcare use in patients with end stage kidney disease on hemodialysis. Methods Prospective, single-center, study of adult patients on HD. Participants completed the ESASr questionnaire at enrollment. Baseline demographic, clinical information as well as healthcare use events during the 12-month following enrollment were extracted from medical records. The association between symptom burden and healthcare use was examined with a multivariable adjusted negative binomial model. Results Mean (SD) age of the 80 participants was 71 (13) years, 56% diabetic, and 70% male. The median (IQR) dialysis vintage was 2 (1–4) years. In multivariable adjusted models, higher global [incident rate ratio (IRR) 1.02, 95% confidence interval (CI) 1.00–1.04, p = .025] and physical symptom burden score [IRR 1.03, CI 1.00–1.05, p = .034], but not emotional symptom burden score [IRR 1.05, CI 1.00–1.10, p = .052] predicted higher subsequent healthcare use. Conclusions Our preliminary evidence suggests that higher symptom burden, assessed by ESASr may predict higher risk of healthcare use amongst patients with end stage kidney disease on hemodialysis. Future studies need to confirm the findings of this preliminary study and to assess the utility of ESASr for systematic symptom screening.
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Affiliation(s)
- Jing C Zhang
- Multi-Organ Transplant Program and Division of Nephrology, University Health Network, University of Toronto, Toronto, Canada
| | - Salam El-Majzoub
- Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, Lady-Davis Institute for Medical Research, McGill University, Montreal, Canada
| | - Madeline Li
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Tibyan Ahmed
- Multi-Organ Transplant Program and Division of Nephrology, University Health Network, University of Toronto, Toronto, Canada
| | - Joyce Wu
- Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, Lady-Davis Institute for Medical Research, McGill University, Montreal, Canada
| | - Mark L Lipman
- Department of Nephrology, Jewish General Hospital, Montreal, Canada
| | - Ghizlane Moussaoui
- Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, Lady-Davis Institute for Medical Research, McGill University, Montreal, Canada
| | - Karl J Looper
- Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, Lady-Davis Institute for Medical Research, McGill University, Montreal, Canada
| | - Marta Novak
- Centre for Mental Health, University Health Network, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Soham Rej
- Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, Lady-Davis Institute for Medical Research, McGill University, Montreal, Canada
| | - Istvan Mucsi
- Multi-Organ Transplant Program and Division of Nephrology, University Health Network, University of Toronto, Toronto, Canada
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23
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Whisenant MS, Bamidele O, Cleeland C, Williams LA. Preferences of Individuals With Cancer for Patient-Reported Outcome Measures. Oncol Nurs Forum 2021; 48:173-183. [PMID: 33600396 DOI: 10.1188/21.onf.173-183] [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] [Indexed: 11/17/2022]
Abstract
PURPOSE Symptom monitoring and management using patient-reported outcome (PRO) measures improves outcomes for individuals with cancer. The purpose of the current study was to provide a qualitative assessment of preferences of individuals with cancer for PRO measures. PARTICIPANTS & SETTING 15 patients receiving systemic therapy at the University of Texas MD Anderson Cancer Center. METHODOLOGIC APPROACH Participants completed three PRO measures. Qualitative interviews were conducted, and content analysis was used to identify relevant themes. FINDINGS Identified themes were the importance of communicating various aspects of the disease and treatment experience to the oncology team, the importance of systematic PRO assessments, congruence among PRO questionnaires and questions clinicians ask at clinic visits, concerns about the length of PRO questionnaires, the importance of the response options available in PRO questionnaires, and willingness to complete PRO measures frequently. IMPLICATIONS FOR NURSING Oncology nurses are critical facilitators of the systematic use of PRO measures across the cancer care continuum.
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24
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Noel CW, Sutradhar R, Zhao H, Delibasic V, Forner D, Irish JC, Kim J, Husain Z, Mahar A, Karam I, Enepekides DJ, Chan KKW, Singh S, Hallet J, Coburn NG, Eskander A. Patient-Reported Symptom Burden as a Predictor of Emergency Department Use and Unplanned Hospitalization in Head and Neck Cancer: A Longitudinal Population-Based Study. J Clin Oncol 2021; 39:675-684. [PMID: 33405964 DOI: 10.1200/jco.20.01845] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To determine the association between patient-reported symptom burden and subsequent emergency department use and unplanned hospitalization (ED/Hosp) in a head and neck cancer (HNC) patient population. METHODS This was a population-based study of patients diagnosed with HNC who had completed at least one outpatient Edmonton Symptom Assessment System (ESAS) assessment between January 2007 and March 2018 in Ontario, Canada. Logistic regression models were used to determine the relationship between outpatient ESAS scores and subsequent 14-day ED/Hosp use. A generalized estimating equation approach with an exchangeable correlation structure was incorporated to account for patient-level clustering. RESULTS There were 11,761 patients identified, completing a total of 73,282 ESAS assessments and experiencing 5,203 ED/Hosp events. Six of the nine ESAS symptom scores were positively associated with ED/Hosp use, with pain, appetite, shortness of breath, and tiredness demonstrating the strongest associations. A global ESAS score was calculated by selecting the highest individual symptom score (h-ESAS). Among patients reporting a maximum h-ESAS score of 10, 15.1% had an ED/Hosp event within 14 days compared with 1.5% for those with the lowest possible score of zero. In adjusted analysis, the odds of ED/Hosp use increased with h-ESAS (1.23 per one-unit increase [95% CI, 1.22 to 1.25]). When treated as a categorical variable, patients with the maximum h-ESAS score of 10 had 9.23 (95% CI, 7.22 to 11.33) higher odds of ED/Hosp use, relative to the minimum score of zero. CONCLUSION ESAS scores are strongly associated with subsequent ED/Hosp events in patients with HNC. Clinician education around how ESAS data might inform patient care may enhance symptom detection and management.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | | | | | - David Forner
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jonathan C Irish
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jonathan Kim
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Zain Husain
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Alyson Mahar
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Irene Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Danny J Enepekides
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Simron Singh
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Hallet
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Natalie G Coburn
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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25
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Koczwara B, Bonnamy J, Briggs P, Brown B, Butow PN, Chan RJ, Cohn RJ, Girgis A, Jefford M, Jl Joske D, Licqurish S, Mackay G, Saunders CM, Webber K. Patient-reported outcomes and personalised cancer care. Med J Aust 2020; 214:406-408.e1. [PMID: 34046907 DOI: 10.5694/mja2.50893] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - Bogda Koczwara
- Flinders Medical Centre, Adelaide, SA.,Flinders University, Adelaide, SA
| | | | | | - Bena Brown
- Menzies School of Health Research, Brisbane, QLD
| | - Phyllis N Butow
- Centre for Medical Psychology and Evidence-based Decision Making, University of Sydney, Sydney, NSW
| | - Raymond J Chan
- Queensland University of Technology, Brisbane, QLD.,Princess Alexandra Hospital, Brisbane, QLD
| | - Richard J Cohn
- Long Term Follow-up Program, Sydney Children's Hospital Randwick, Sydney, NSW.,UNSW Sydney, Sydney, NSW
| | - Afaf Girgis
- Ingham Institute for Applied Medical Research, University of New South Wales, Sydney, NSW
| | | | - David Jl Joske
- Sir Charles Gairdner Hospital, Perth, WA.,University of Western Australia, Perth, WA
| | | | | | | | - Kate Webber
- Monash University, Melbourne, VIC.,Monash Health, Melbourne, VIC
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26
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Girgis A, Durcinoska I, Arnold A, Descallar J, Kaadan N, Koh ES, Miller A, Ng W, Carolan M, Della-Fiorentina SA, Avery S, Delaney GP. Web-Based Patient-Reported Outcome Measures for Personalized Treatment and Care (PROMPT-Care): Multicenter Pragmatic Nonrandomized Trial. J Med Internet Res 2020; 22:e19685. [PMID: 33118954 PMCID: PMC7661255 DOI: 10.2196/19685] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/04/2020] [Accepted: 08/18/2020] [Indexed: 12/16/2022] Open
Abstract
Background Despite the acceptability and efficacy of e–patient-reported outcome (ePRO) systems, implementation in routine clinical care remains challenging. Objective This pragmatic trial implemented the PROMPT-Care (Patient Reported Outcome Measures for Personalized Treatment and Care) web-based system into existing clinical workflows and evaluated its effectiveness among a diverse population of patients with cancer. Methods Adult patients with solid tumors receiving active treatment or follow-up care in four cancer centers were enrolled. The PROMPT-Care intervention supported patient management through (1) monthly off-site electronic PRO physical symptom and psychosocial well-being assessments, (2) automated electronic clinical alerts notifying the care team of unresolved clinical issues following two consecutive assessments, and (3) tailored online patient self-management resources. Propensity score matching was used to match controls with intervention patients in a 4:1 ratio for patient age, sex, and treatment status. The primary outcome was a reduction in emergency department presentations. Secondary outcomes were time spent on chemotherapy and the number of allied health service referrals. Results From April 2016 to October 2018, 328 patients from four public hospitals received the intervention. Matched controls (n=1312) comprised the general population of patients with cancer, seen at the participating hospitals during the study period. Emergency department visits were significantly reduced by 33% (P=.02) among patients receiving the intervention compared with patients in the matched controls. No significant associations were found in allied health referrals or time to end of chemotherapy. At baseline, the most common patient reported outcomes (above-threshold) were fatigue (39%), tiredness (38.4%), worry (32.9%), general wellbeing (32.9%), and sleep (24.1%), aligning with the most frequently accessed self-management domain pages of physical well-being (36%) and emotional well-being (23%). The majority of clinical feedback reports were reviewed by nursing staff (729/893, 82%), largely in response to the automated clinical alerts (n=877). Conclusions Algorithm-supported web-based systems utilizing patient reported outcomes in clinical practice reduced emergency department presentations among a diverse population of patients with cancer. This study also highlighted the importance of (1) automated triggers for reviewing above-threshold results in patient reports, rather than passive manual review of patient records; (2) the instrumental role nurses play in managing alerts; and (3) providing patients with resources to support guided self-management, where appropriate. Together, these factors will inform the integration of web-based PRO systems into future models of routine cancer care. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12616000615482; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370633 International Registered Report Identifier (IRRID) RR2-10.1186/s12885-018-4729-3
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Affiliation(s)
- Afaf Girgis
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Ivana Durcinoska
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Anthony Arnold
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia
| | - Joseph Descallar
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Nasreen Kaadan
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
| | - Eng-Siew Koh
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
| | - Andrew Miller
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia.,Centre for Oncology Informatics, University of Wollongong, Wollongong, Australia
| | - Weng Ng
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia.,School of Medicine, Western Sydney University, Sydney, Australia
| | - Martin Carolan
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia
| | - Stephen A Della-Fiorentina
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,School of Medicine, Western Sydney University, Sydney, Australia.,Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, Australia
| | - Sandra Avery
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
| | - Geoff P Delaney
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
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27
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Barbera L, Sutradhar R, Seow H, Mittmann N, Howell D, Earle CC, Li Q, Thiruchelvam D. The impact of routine Edmonton Symptom Assessment System (ESAS) use on overall survival in cancer patients: Results of a population-based retrospective matched cohort analysis. Cancer Med 2020; 9:7107-7115. [PMID: 32794634 PMCID: PMC7541161 DOI: 10.1002/cam4.3374] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/29/2020] [Accepted: 07/25/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The Edmonton Symptom Assessment System (ESAS) is a validated instrument whose use has been standardized in the Ontario cancer system to measure symptoms among ambulatory cancer patients. The objective was to examine the effect of ESAS exposure on overall survival. We hypothesized, a priori, that patients exposed to ESAS would have higher rates of overall survival than those who were not exposed. METHODS This was a retrospective matched cohort study of adults diagnosed with cancer between 2007 and 2015. Patients were considered exposed if they were screened with ESAS at least once during the study period. Their first ESAS screening date defined the index date. Each exposed patient was matched randomly to a cancer patient without ESAS using a combination of hard matching (4 variables) and propensity score matching (14 variables). Kaplan-Meier curves and multivariable Cox regression were used to evaluate the impact of ESAS exposure on survival. RESULTS There were 128,893 pairs well matched on all baseline characteristics. The probability of survival within the first 5 years was higher among those exposed to ESAS compared to those who were not (81.9% vs. 76.4% at 1 year, 68.3% vs. 66.1% at 3 years, 61.9% vs. 61.4% at 5 years, P-value < .0001). In the multivariable Cox regression model, ESAS was significantly associated with a decreased mortality risk (HR: 0.48, 95% CI: 0.47-0.49). CONCLUSIONS Our results show that ESAS exposure is associated with improved survival in cancer patients. This provides real world evidence of the impact of routine symptom assessment in cancer care.
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Affiliation(s)
- Lisa Barbera
- Institute for Clinical Evaluative SciencesTorontoOntarioCanada
- University of TorontoTorontoOntarioCanada
- Sunnybrook Research InstituteTorontoOntarioCanada
- Department of OncologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative SciencesTorontoOntarioCanada
- University of TorontoTorontoOntarioCanada
| | - Hsien Seow
- Institute for Clinical Evaluative SciencesTorontoOntarioCanada
- Department of OncologyMcMaster UniversityHamiltonOntarioCanada
| | | | - Doris Howell
- University Health NetworkPrincess Margaret Cancer CentreTorontoOntarioCanada
| | - Craig C. Earle
- Institute for Clinical Evaluative SciencesTorontoOntarioCanada
| | - Qing Li
- Institute for Clinical Evaluative SciencesTorontoOntarioCanada
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Milton L, Behroozian T, Coburn N, Trudeau M, Razvi Y, McKenzie E, Karam I, Lam H, Chow E. Prediction of breast cancer-related outcomes with the Edmonton Symptom Assessment Scale: A literature review. Support Care Cancer 2020; 29:595-603. [PMID: 32918128 DOI: 10.1007/s00520-020-05755-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/08/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE The Edmonton Symptom Assessment Scale (ESAS) is a validated tool used in patients with varied cancer diagnoses to measure patient symptoms. The present manuscript will review the literature assessing the ability of the ESAS to predict patient-related outcomes in breast cancer patients. METHODS A literature search was conducted of Cochrane Central Register of Controlled Trials databases, Ovid MEDLINE, and Embase for English articles that investigated the use of predictive modelling with the ESAS in the breast cancer population. Study type, publication year, sample size, patient demographics, predicted outcomes, and strongest predictive factors/symptoms were summarized for each study. RESULTS A total of nine articles were included in this review. Five articles used the ESAS in predictive models to determine patient time to death. ESAS was also used to predict emergency department visits, determine symptoms associated with decreased quality of life, and generate a Health Utility Score. Lack of appetite was the most common ESAS symptom, as it was reported in five studies to be associated with decreased survival. In four of the nine articles, an additional survey investigating physical functioning was used in combination with ESAS to strengthen the predictive models. CONCLUSIONS Included studies support the use of ESAS in predictive models, particularly for predicting survival. Using the ESAS as a predictive tool allows for more accurate time to death predictions, potentially improving symptom management and preventing overtreatment of palliative patients near the end of life.
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Affiliation(s)
- Lauren Milton
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Tara Behroozian
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Natalie Coburn
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Maureen Trudeau
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Yasmeen Razvi
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Erin McKenzie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Irene Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Henry Lam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Edward Chow
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
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29
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Barbera L, Sutradhar R, Seow H, Earle CC, Howell D, Mittmann N, Li Q, Thiruchelvam D. Impact of Standardized Edmonton Symptom Assessment System Use on Emergency Department Visits and Hospitalization: Results of a Population-Based Retrospective Matched Cohort Analysis. JCO Oncol Pract 2020; 16:e958-e965. [DOI: 10.1200/jop.19.00660] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE: The Edmonton Symptom Assessment System (ESAS) is a validated instrument whose use has been standardized in the Ontario cancer system to measure symptoms among ambulatory patients with cancer. The objective was to examine the effect of ESAS exposure on visits to the emergency department (ED) and hospitalizations. METHODS: This was a retrospective matched cohort study conducted in Ontario, Canada. The study included patients ≥ 18 years of age diagnosed with cancer between 2007 and 2015. Patients were considered exposed if they were screened with ESAS at least once during the study period, and their first ESAS screening date was defined as the index date. Each exposed patient was matched randomly to a patient with cancer without ESAS assessment using a combination of hard matching (birth year ± 2 years, cancer diagnosis date ± 1 year, cancer type, and sex) and propensity score matching (14 variables, including cancer stage, treatments received, and comorbidities). A multivariable Andersen-Gill recurrent event model was used to evaluate the effect of ESAS on the rate of health care use. RESULTS: The analysis included 128,893 matched pairs that were well balanced on baseline measures. After adjusting for other variables, patients with ESAS had lower rates of both ED visits (relative rate [RR], 0.92; 95% CI, 0.91 to 0.93) and hospitalizations (RR, 0.86; 95% CI, 0.85 to 0.87) compared with patients without ESAS. CONCLUSION: ESAS exposure is independently associated with decreased rates of ED visits and hospitalizations. This provides real-world evidence of one potential positive impact of standardized symptom assessment in cancer care.
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Affiliation(s)
- Lisa Barbera
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Craig C. Earle
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Doris Howell
- University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Qing Li
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Deva Thiruchelvam
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Davis LE, Gupta V, Allen-Ayodabo C, Zhao H, Hallet J, Mahar AL, Ringash J, Doherty M, Kidane B, Darling G, Coburn NG. Patient-reported symptoms following diagnosis in esophagus cancer patients treated with palliative intent. Dis Esophagus 2020; 33:5709699. [PMID: 31957801 DOI: 10.1093/dote/doz108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/24/2019] [Accepted: 11/01/2019] [Indexed: 12/11/2022]
Abstract
The majority of patients with esophagus cancer have advanced-stage disease without curative options. For these patients, treatment is focused on improving symptoms and quality of life. Despite this, little work has been done to quantify symptom burden for incurable patients. We describe symptoms using the Edmonton Symptom Assessment System (ESAS) among esophagus cancer patients treated for incurable disease. This retrospective cohort study linked administrative datasets to prospectively collected ESAS data of non-curatively treated adult esophagus cancer patients diagnosed between January 1, 2009 and September 30, 2016. ESAS measures nine common cancer-related symptoms: anxiety, depression, drowsiness, lack of appetite, nausea, pain, shortness of breath, tiredness, and impaired well-being. Frequency of severe symptoms (score ≥ 7/10) was described by month for the 6 months from diagnosis for all patients and by treatment type (chemotherapy alone, radiotherapy alone, both chemotherapy and radiotherapy, and best supportive care). A sensitivity analysis limited to patients who survived at least 6 months was performed to assess robustness of the results to proximity to death and resulting variation in follow-up time. Among 2,989 esophagus cancer patients diagnosed during the study period and meeting inclusion criteria, 2,103 reported at least one ESAS assessment in the 6 months following diagnosis and comprised the final cohort. Patients reported a median of three (IQR 2-7) ESAS assessments in the study period. Median survival was 7.6 (IQR 4.1-13.7) months. Severe lack of appetite (53.1%), tiredness (51.1%), and impaired well-being (42.7%) were the most commonly reported symptoms. Severe symptoms persisted throughout the 6 months after the diagnosis. Subgroup analysis by treatment showed no worsening of symptoms over time in those treated by either chemotherapy alone, or both chemotherapy and radiation. Results followed a similar pattern on sensitivity analysis. Patients diagnosed with incurable esophagus cancer experience considerable symptom burden in the first 6 months after diagnosis and the frequency of severe symptoms remains high throughout this period. Patients with this disease require early palliative care and psychosocial support upon diagnosis and support throughout the course of their cancer journey.
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Affiliation(s)
- Laura E Davis
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Vaibhav Gupta
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | | | - Haoyu Zhao
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Julie Hallet
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Alyson L Mahar
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jolie Ringash
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Mark Doherty
- Department of Medical Oncology, University of Toronto, Toronto, Canada
| | - Biniam Kidane
- Section of Thoracic Surgery, Department of Surgery, University of Manitoba, Winnipeg, Canada
| | - Gail Darling
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada.,Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Natalie G Coburn
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
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van der Baan FH, Koldenhof JJ, de Nijs EJ, Echteld MA, Zweers D, Hesselmann GM, Vervoort SC, Vos JB, de Graaf E, Witteveen PO, Suijkerbuijk KP, de Graeff A, Teunissen SC. Validation of the Dutch version of the Edmonton Symptom Assessment System. Cancer Med 2020; 9:6111-6121. [PMID: 32643871 PMCID: PMC7476846 DOI: 10.1002/cam4.3253] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The Utrecht Symptom Diary (USD) is a Dutch and adapted version of the Edmonton Symptom Assessment System, a patient-reported outcome measurement (PROM) tool to asses and monitor symptoms in cancer patients. This study analyses the validity and responsiveness of the USD and the cutoff points to determine the clinical significance of a symptom score. METHODS Observational longitudinal cohort study including adult in- and outpatients treated in an academic hospital in the Netherlands who completed at least one USD as part of routine care (2012-2019). The distress thermometer and problem checklist (DT&PC) was used as a reference PROM. Content, construct and criterion validity, responsiveness, and cutoff points are shown with prevalences, area under receiver operating characteristic (ROC) curve, Chi-squared test, Wilcoxon signed-rank test, and positive and negative predictive values, respectively. RESULTS A total of 3913 patients completed 22 400 USDs. Content validity was confirmed for all added USD items with prevalences of ≥22%. All USD items also present on the DT&PC demonstrated a good criterion validity (ROC >0.8). Construct validity was confirmed for the USD as a whole and for the items dry mouth, dysphagia and well-being (P < .0001). USD scores differed significantly for patients when improving or deteriorating on the DT&PC which confirmed responsiveness. Optimal cutoff points (3 or 4) differed per symptom. CONCLUSION The USD is a valid 12-item PROM for the most prevalent symptoms in cancer patients, which has content, criterion, and construct validity, and detects clinically important changes over time, in both curative and palliative phase.
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Affiliation(s)
- Frederieke H van der Baan
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Josephine J Koldenhof
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Ellen J de Nijs
- Center of Expertise Palliative Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Michael A Echteld
- Avans University of Applied Sciences, Breda/Tilburg, The Netherlands
| | - Danielle Zweers
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Ginette M Hesselmann
- Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Sigrid C Vervoort
- Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Jan B Vos
- Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Everlien de Graaf
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Petronella O Witteveen
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Karijn P Suijkerbuijk
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Saskia C Teunissen
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, The Netherlands
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Singh N, Batra A, Yang L, Boyne DJ, Harper A, Ghatage P, Cuthbert CA, Cheung WY. Patient-Reported Symptom Burden Near the End of Life in Patients With Gynaecologic Cancers. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:26-33. [PMID: 32967796 DOI: 10.1016/j.jogc.2020.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE There are limited data on patient-reported outcomes near the end of life in patients with gynaecologic cancers. This study aimed to assess the symptom burden in the last 6 months of life in a real-world cohort. METHODS Patients diagnosed with metastatic gynaecologic malignancies from 2016 to 2019 who completed the revised Edmonton Symptom Assessment System (ESASr) questionnaire within 6 months of death in a large Canadian province were identified. Patient-reported symptom scores were categorized as none to mild (0-3) and moderate to severe (4-10). Individual symptoms were subsequently grouped into physical, psychological, and total subscores. The severity of symptoms was further analyzed for any associations with age, time to death, and primary tumour site (ovarian vs. uterocervical and vulvovaginal). RESULTS We identified 107 patients with gynaecologic malignancies including 59 ovarian, 29 uterocervical, and 19 vulvovaginal cancers. The median ages at diagnosis and questionnaire completion were 64 and 65 years, respectively. The median time from completing the ESASr questionnaire to death was 65 days. Overall, physical and psychological symptoms were moderate to severe in 57.9% and 40.2% of patients, respectively. Among the individual symptoms, tiredness was the most commonly reported moderate to severe symptom (74.9%), while shortness of breath was least commonly reported (31.6%). While physical (P < 0.001) and total symptom (P = 0.009) subscores were more likely to be moderate to severe in intensity as death approached, the psychological subscore (P = 0.744) had no relationship with time to death. Longer time to death was predictive of lower physical (P = 0.002) and total symptom (P = 0.002) subscores, while a primary uterocervical cancer site was associated with a lower psychological symptom subscore (P = 0.042). CONCLUSIONS In the real-world setting, unique symptom trajectories can emerge for patients with gynaecologic cancer near the end of life. Knowledge of these specific symptom patterns can help inform the development and delivery of targeted palliative interventions to improve quality of life for these patients.
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Affiliation(s)
| | | | - Lin Yang
- Tom Baker Cancer Centre, Calgary, AB
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Sutradhar R, Barbera L. Comparing an Artificial Neural Network to Logistic Regression for Predicting ED Visit Risk Among Patients With Cancer: A Population-Based Cohort Study. J Pain Symptom Manage 2020; 60:1-9. [PMID: 32088358 DOI: 10.1016/j.jpainsymman.2020.02.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/12/2020] [Accepted: 02/12/2020] [Indexed: 02/03/2023]
Abstract
CONTEXT Prior work using symptom burden to predict emergency department (ED) visits among patients with cancer has used traditional statistical methods such as logistic regression (LR). Machine learning approaches for prediction, such as artificial neural networks (ANNs), are gaining attention but are yet to be commonly applied in practice. OBJECTIVES We will compare an artificial neural network with logistic regression for predicting ED visit risk among patients with cancer. METHODS This was a population-based study of patients diagnosed with cancer between 2007 and 2015 in Ontario, Canada. After splitting the cohort into training and test sets, an ANN model and a LR model were developed on the training cohort to predict the risk of an ED visit within seven days after an assessment of symptom burden. The predictive performance of each risk model was assessed on the test cohort and compared with respect to area under the curve and calibration. RESULTS The training cohort consisted of 170,092 patients undergoing 1,015,125 symptom assessments, and the remaining 42,523 patients undergoing 252,169 symptom assessments were set aside as the test cohort. Both models performed similarly with respect to specificity (ANN 67.0%; LR 67.3%) and accuracy (ANN 67.1%; LR 67.2%), and only minor improvement was found with respect to sensitivity (ANN 68.9%; LR 67.1%), discrimination (ANN 74.3%; LR 73.7%), and calibration under the ANN model compared with the LR model. The most notable improvement in calibration was found among patients in the highest ED visit risk percentile. CONCLUSION Although both models were similar in predictive performance using our data, ANNs have an important role in prediction because of their flexible structure and data-driven distribution-free benefits and should thus be considered as a potential modeling approach when developing a prediction tool.
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Affiliation(s)
- Rinku Sutradhar
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Lisa Barbera
- ICES, Toronto, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Canada
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Howell D, Rosberger Z, Mayer C, Faria R, Hamel M, Snider A, Lukosius DB, Montgomery N, Mozuraitis M, Li M. Personalized symptom management: a quality improvement collaborative for implementation of patient reported outcomes (PROs) in 'real-world' oncology multisite practices. J Patient Rep Outcomes 2020; 4:47. [PMID: 32556794 PMCID: PMC7300168 DOI: 10.1186/s41687-020-00212-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023] Open
Abstract
Background Little research has focused on implementation of electronic Patient Reported Outcomes (e-PROs) for meaningful use in patient management in ‘real-world’ oncology practices. Our quality improvement collaborative used multi-faceted implementation strategies including audit and feedback, disease-site champions and practice coaching, core training of clinicians in a person-centered clinical method for use of e-PROs in shared treatment planning and patient activation, ongoing educational outreach and shared collaborative learnings to facilitate integration of e-PROs data in multi-sites in Ontario and Quebec, Canada for personalized management of generic and targeted symptoms of pain, fatigue, and emotional distress (depression, anxiety). Patients and methods We used a mixed-methods (qualitative and quantitative data) program evaluation design to assess process/implementation outcomes including e-PROs completion rates, acceptability/use from the perspective of patients/clinicians, and patient experience (surveys, qualitative focus groups). We secondarily explored impact on symptom severity, patient activation and healthcare utilization (Ontario sites only) comparing a pre/post population cohort not exposed/exposed to our implementation intervention using Mann Whitney U tests. We hypothesized that the iPEHOC intervention would result in a reduction in symptom severity, healthcare utilization, and higher patient activation. We also identified key implementation strategies that sites perceived as most valuable to uptake and any barriers. Results Over 6000 patients completed e-PROs, with sites reaching 51%–95% population completion rates depending on initial readiness. e-PROs were acceptable to patients for communicating symptoms (76%) and by clinicians for treatment planning (80%). Patient experience was better than the provincial average. Compared to the pre-population, we observed a significant reduction in levels of anxiety (p = 0.008), higher levels of patient activation (p = 0.045), and reduced hospitalization rates (12.3% not exposed vs 10.1% exposed, p = 0.034). A pre/post population trend towards significance for reduced emergency department visit rates (14.8% not exposed vs 12.8% exposed, p = 0.081) was also noted. Conclusion This large-scale pragmatic quality improvement project demonstrates the impact of implementation strategies and a collaborative improvement approach on acceptability of using PROs in clinical practice and their potential for reducing anxiety and healthcare utilization; and improving patient experience and patient activation when implemented in ‘real-world’ multi-site oncology practices.
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Affiliation(s)
- Doris Howell
- University Health Network (Princess Margaret Cancer Centre), 610 University Health Network Room 15-617, Toronto, ON, M5G 2M9, Canada. .,University of Toronto, Toronto, ON, Canada.
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.,McGill University, Montreal, Quebec, Canada
| | - Carole Mayer
- Health Sciences North Research Institute, Sudbury, ON, Canada
| | - Rosanna Faria
- Montreal West Island Integrated University Health & Social Services Center, St. Mary's Hospital, Montreal, Quebec, Canada
| | - Marc Hamel
- Psychosocial Oncology Department, McGill University Health Centre, Montreal, Quebec, Canada
| | - Anne Snider
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Denise Bryant Lukosius
- Juravinski Cancer Centre, Hamilton, ON, Canada.,McMaster University, Hamilton, ON, Canada
| | | | | | - Madeline Li
- University Health Network (Princess Margaret Cancer Centre), 610 University Health Network Room 15-617, Toronto, ON, M5G 2M9, Canada.,University of Toronto, Toronto, ON, Canada
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Whisenant MS, Williams LA, Garcia Gonzalez A, Mendoza T, Shi Q, Cleeland C, Zhang J, Heymach J, Simon G. What Do Patients With Non-Small-Cell Lung Cancer Experience? Content Domain for the MD Anderson Symptom Inventory for Lung Cancer. JCO Oncol Pract 2020; 16:e1151-e1160. [PMID: 32539654 DOI: 10.1200/jop.19.00577] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Symptom monitoring has demonstrated improved outcomes in patients with cancer, including quality of life, resource utilization, ability to continue treatment, and survival. The use of disease-specific patient-reported outcome (PRO) measures facilitates symptom monitoring. While the MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC), a PRO measure of symptom burden in lung cancer, is psychometrically validated for use in patients with NSCLC, its content validity has not been verified through direct patient input. Our purpose is to describe the symptom experience of patients with NSCLC and to confirm that the MDASI-LC contains the key symptoms specific to NSCLC from the patient perspective. METHODS Patients with NSCLC described their symptom experience in single qualitative interviews. Content analysis was used to define the content domain for a PRO measure of NSCLC symptom burden. RESULTS Participants (N = 40) had a mean age of 66.1 years (standard deviation, 10.9 years); 60.0% were male, 77.5% were White, and 56.4% had stage IV disease. Thirty-two symptoms were described, with 6 reported by ≥ 20% of participants. Symptom variations were noted by treatment modality but not by stage of disease. Patients with NSCLC commonly reported shortness of breath, cough, distress, fatigue, pain, and constipation. In patients receiving chemotherapy, treatment-related symptoms, including neuropathy and sore mouth, were commonly noted. The presence of these symptoms resulted in interference with daily activities, relationships, life plans, treatment adherence, and mood. CONCLUSION The symptoms included in the MDASI-LC are important components of the content domain of an NSCLC symptom burden measure. The presence of these symptoms affect daily life and, therefore, is of clinical consequence.
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Affiliation(s)
- Meagan S Whisenant
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Loretta A Williams
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Araceli Garcia Gonzalez
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tito Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Qiuling Shi
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jianjun Zhang
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - John Heymach
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - George Simon
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Kirkland SW, Garrido-Clua M, Junqueira DR, Campbell S, Rowe BH. Preventing emergency department visits among patients with cancer: a scoping review. Support Care Cancer 2020; 28:4077-4094. [DOI: 10.1007/s00520-020-05490-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/20/2020] [Indexed: 02/05/2023]
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Patient-reported symptoms in metastatic gastric cancer patients in the last 6 months of life. Support Care Cancer 2020; 29:515-524. [DOI: 10.1007/s00520-020-05501-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/27/2020] [Indexed: 12/14/2022]
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Symptom Care at Home: A Comprehensive and Pragmatic PRO System Approach to Improve Cancer Symptom Care. Med Care 2020; 57 Suppl 5 Suppl 1:S66-S72. [PMID: 30531525 DOI: 10.1097/mlr.0000000000001037] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION There is growing recognition that systematically obtaining the patient's perspective on their health experience, using patient-reported outcomes (PRO), can be used to improve patient care in real time. Few PRO systems are designed to monitor and provide symptom management support between visits. Patients are instructed to contact providers between visits with their concerns, but they rarely do, leaving patients to cope with symptoms alone at home. We developed and tested an automated system, Symptom Care at Home (SCH), to address this gap in tracking and responding to PRO data in-between clinic visits. The purpose of this paper is to describe SCH as an example of a comprehensive PRO system that addresses unmet need for symptom support outside the clinic. METHODS FOR PRO SCORE INTERPRETATION SCH uses pragmatic, single-item measures for assessing symptoms, which are commonly used and readily interpretable for both patients and providers. We established alerting values for PRO symptom data, which was particularly important for conserving oncology providers' time in responding to daily PRO data. METHODS FOR DEVELOPING RECOMMENDATIONS FOR ACTING ON PRO RESULTS The SCH system provides automated, just-in-time self-management coaching tailored to the specific symptom pattern and severity levels reported in the daily call. In addition, the SCH system includes a provider decision support system for follow-up symptom assessment and intervention strategies. DISCUSSION SCH provides PRO monitoring, tailored automated self-management coaching, and alerts the oncology team of poorly controlled symptoms with a provider dashboard that includes evidence-based decision support for follow-up to improve individual patients' symptom care. We particularly emphasize our process for PRO selection, rationale for determining alerting thresholds, and the design of the provider dashboard and decision support. Currently, we are in the process of updating the SCH system, developing both web-based and app versions in addition to interactive voice response phone access and integrating the SCH system in the electronic health record.
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Interpreting and Acting on the PRO Scores From the Patient-reported Outcomes for Personalized Treatment and Care (PROMPT-Care) eHealth System. Med Care 2020; 57 Suppl 5 Suppl 1:S85-S91. [PMID: 30985601 DOI: 10.1097/mlr.0000000000001094] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Patient-reported Outcomes for Personalized Treatment and Care (PROMPT-Care) is the first eHealth system in Australia that is fully electronically integrated into hospital oncology information systems, enabling real-time, routine collection of patient-reported outcomes (PROs) to support and enable cancer patients to achieve and maintain improved health, well-being, and cancer outcomes. Five previously published papers detail the impetus for developing this eHealth system, its development, and testing of its acceptability and feasibility, the development of algorithms to standardize the cancer care pathways which underpin patient care, and the protocol for evaluating the efficacy of PROMPT-Care. METHODS This manuscript provides "how-to" guidance to inform future system development, focusing on selecting relevant PROs and measuring them in cancer patients, score interpretation, and determining recommended care in response to scores which are above the predetermined threshold. DISCUSSION Electronic PRO systems are increasingly used in cancer clinical care settings, with the potential to support timely patient-centered care when implemented appropriately. KEY POINTS PRO selection should consider patient response burden, and prioritizing PROs that are amenable to clinical intervention. Having clear, evidence-based, care pathways, and actionable recommendations in response to above-threshold PRO scores facilitate PRO integration into the clinical workflow. Centers should determine thresholds for clinical action for each PRO which provide an acceptable balance between false positives and false negatives; and develop care pathway recommendations which consider the availability of local services and resources, are feasible in the clinical setting, clear, concise, manageable, based on evidence-based guidelines, and adaptable to local environments.
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Self-reported pain in breast cancer patients receiving adjuvant radiotherapy. Support Care Cancer 2020; 29:155-167. [PMID: 32323002 DOI: 10.1007/s00520-020-05462-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/04/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Breast cancer patients receiving radiotherapy (RT) commonly report pain, contributing to physical and emotional distress, and potentially resulting in poor quality of life. This study prospectively identified trends and risk factors in patient-reported pain associated with breast irradiation using the Edmonton Symptom Assessment Scale (ESAS) and a study-specific Skin Symptom Assessment (SSA). METHODS Before RT and once per week during RT, patients completed the ESAS and SSA. Upon RT completion, patients were contacted via telephone to complete both assessments weekly for 6 weeks, and a final assessment was conducted 1-3 months post-RT. Only data from patients who had completed both assessments before, at least once during, and at least once after RT were included in our analysis. RESULTS A total of 426 patients provided data for the analysis. Overall acute pain increased significantly at week 1-2 (p < 0.0001), week 5 (p = 0.0011), and at 1-3 months (p < 0.0001) post-RT compared with baseline, and acute breast pain increased significantly at week 1 (p < 0.001) and week 2 (p = 0.0002) post-RT compared with baseline. Previous chemotherapy (adjuvant or neoadjuvant) in mastectomy patients was associated with increased overall pain compared with mastectomy patients without previous chemotherapy (p = 0.017). Younger patients (40-49 or 50-59 years of age) reported more overall pain (p = 0.0001, p = 0.038) and breast pain (p = 0.0003, p = 0.0038) compared with patients ≥ 60 years of age. CONCLUSIONS Patient-reported pain associated with breast irradiation peaked 1 week after RT completion. Our findings provide support for closer monitoring of acute pain associated with breast RT in younger patients.
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Currow DC, Agar MR, Phillips JL. Role of Hospice Care at the End of Life for People With Cancer. J Clin Oncol 2020; 38:937-943. [DOI: 10.1200/jco.18.02235] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Patient-defined factors that are important at the end of life include being physically independent for as long as possible, good symptom control, and spending quality time with friends and family. Hospice care adds to the quality of care and these patient-centered priorities for people with cancer and their families in the last weeks and days of life. Evidence from large observational studies demonstrate that hospice care can improve outcomes directly and support better and more appropriate health care use for people in the last stages of cancer. Team-based community hospice care has measurable benefits for patients, their family caregivers, and health services. In addition to improved symptom control for patients and a greater likelihood of time spent at home, caregiver outcomes are better when hospice care is accessed: informational needs are better met, and caregivers have an improved ability to move on with life after the patient’s death compared with people who did not have access to these services. Hospice care continues to evolve as its reach expands and the needs of patients continue to broaden. This is reflected in the transition from hospice being based on excellence in nursing to teams with a broad range of health professionals to meet the complex and changing needs of patients and their families. Additional integration of cancer services with hospice care will help to provide more seamless care for patients and supporting family caregivers during their caregiving and after the death of the patient.
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Affiliation(s)
- David C. Currow
- University of Technology Sydney, Ultimo, NSW, Australia
- University of Hull, Hull, United Kingdom
| | - Meera R. Agar
- University of Technology Sydney, Ultimo, NSW, Australia
- Liverpool Hospital, Liverpool, NSW, Australia
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Hirpara DH, Gupta V, Davis LE, Zhao H, Hallet J, Mahar AL, Sutradhar R, Doherty M, Louie AV, Kidane B, Darling G, Coburn NG. Severe symptoms persist for Up to one year after diagnosis of stage I-III lung cancer: An analysis of province-wide patient reported outcomes. Lung Cancer 2020; 142:80-89. [PMID: 32120228 DOI: 10.1016/j.lungcan.2020.02.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/18/2020] [Accepted: 02/21/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Lung cancer is associated with significant disease- and treatment-related morbidity. The Edmonton Symptom Assessment System (ESAS) is a tool developed to elicit patients' own assessment of the severity of common cancer-associated symptoms. The objective of this study was to examine symptom severity in the 12 months following diagnosis of lung cancer, and to identify predictors of high symptom burden. MATERIALS AND METHODS This was a retrospective population-based cohort study, including patients with stage I-III lung cancer diagnosed between 2007-2016, and who had symptom screening in the 12 months following diagnosis. The proportion of patients reporting severe symptoms (ESAS ≥ 7) in the year following diagnosis was plotted over time. Multivariable regression models were constructed to identify factors associated with severe symptoms. RESULTS 69,440 unique symptom assessments were reported by 11,075 lung cancer patients. Tiredness was the most prevalent severe symptom (47.3 %), followed by shortness of breath (39.4 %) and poor wellbeing (36.5 %) among all disease stages. Patients diagnosed with higher stage disease reported more severe symptoms, but symptom trajectories were similar for all stages in the year following diagnosis. Disease stage (RR 1.10-2.01), comorbidity burden (RR 1.17-1.51), degree of socioeconomic marginalization (RR1.15-1.45), and female sex (RR 1.15-1.50) were associated with reporting severe symptoms in the year following diagnosis. CONCLUSION Severe physical and psychological symptoms persist throughout the first year following lung cancer diagnosis, regardless of disease stage. Those at risk of experiencing high symptom burden may benefit from targeted supportive care interventions, including psychosocial support aimed at improving health-related quality of life.
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Affiliation(s)
- Dhruvin H Hirpara
- Department of Surgery, University of Toronto, 149 College St., Toronto, ON M5T 1P5, Canada
| | - Vaibhav Gupta
- Department of Surgery, University of Toronto, 149 College St., Toronto, ON M5T 1P5, Canada
| | - Laura E Davis
- Sunnybrook Research Institute, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada
| | - Haoyu Zhao
- ICES, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada
| | - Julie Hallet
- Department of Surgery, University of Toronto, 149 College St., Toronto, ON M5T 1P5, Canada; Sunnybrook Research Institute, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada; ICES, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada
| | - Alyson L Mahar
- Manitoba Centre for Health Policy, University of Manitoba, 727 McDermot Ave., Winnipeg, MB R3B 3P5, Canada
| | - Rinku Sutradhar
- Sunnybrook Research Institute, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada; ICES, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada
| | - Mark Doherty
- Division of Medical Oncology, University of Toronto, 200 Elizabeth St., Toronto, ON M5G 2C4, Canada
| | - Alexander V Louie
- Division of Radiation Oncology, University of Toronto, 200 Elizabeth St., Toronto, ON M5G 2C4, Canada
| | - Biniam Kidane
- Section of Thoracic Surgery, University of Manitoba, 820 Sherbrook St., Winnipeg, MB R3A 1R9, Canada
| | - Gail Darling
- Division of Thoracic Surgery, Toronto General Hospital, 200 Elizabeth St., Toronto, ON M5G 2C4, Canada
| | - Natalie G Coburn
- Department of Surgery, University of Toronto, 149 College St., Toronto, ON M5T 1P5, Canada; Sunnybrook Research Institute, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada; ICES, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada.
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Howell D, Li M, Sutradhar R, Gu S, Iqbal J, O'Brien MA, Seow H, Dudgeon D, Atzema C, Earle CC, DeAngelis C, Sussman J, Barbera L. Integration of patient-reported outcomes (PROs) for personalized symptom management in "real-world" oncology practices: a population-based cohort comparison study of impact on healthcare utilization. Support Care Cancer 2020; 28:4933-4942. [PMID: 32020357 DOI: 10.1007/s00520-020-05313-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/16/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND The use of patient-reported outcomes (PROs) for routine cancer distress screening is endorsed globally as a quality-care standard. However, there is little research on the integration of PROs in "real-world" oncology practices using implementation science methods. The Improving Patient Experience and Health Outcome Collaborative (iPEHOC) intervention was established at multisite disease clinics to facilitate the use of PRO data by clinicians for precision symptom care. The aim of this study was to examine if patients exposed to the intervention differed in their healthcare utilization compared with contemporaneous controls in the same time frame. METHODS We used a PRE- and DURING-intervention population cohort comparison study design to estimate the effects of the iPEHOC intervention on the difference in difference (DID) for relative rates (RR) for emergency department (ED) visits, hospitalizations, psychosocial oncology (PSO), palliative care visits, and prescription rates for opioids and antidepressants compared with controls. RESULTS A small significantly lower Difference in Difference (DID) (- 0.223) in the RR for ED visits was noted for the intervention compared with controls over time (0.947, CI 0.900-0.996); and a DID (- 0.0329) for patients meeting ESAS symptom thresholds (0.927, CI 0.869-0.990). A lower DID in palliative care visits (- 0.0097), psychosocial oncology visits (- 0.0248), antidepressant prescriptions (- 0.0260) and an increase in opioid prescriptions (0.0456) in the exposed population compared with controls was also noted. A similar pattern was shown for ESAS as a secondary exposure variable. CONCLUSION Facilitating uptake of PROs data may impact healthcare utilization but requires examination in larger scale "real-world" trials.
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Affiliation(s)
- Doris Howell
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Madeline Li
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- ICES, Toronto, Ontario, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Mary Ann O'Brien
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Deborah Dudgeon
- Department of Medicine and Oncology, Queen's University, Kingston, Ontario, Canada
| | - Clare Atzema
- ICES, Toronto, Ontario, Canada.,Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Craig C Earle
- ICES, Toronto, Ontario, Canada.,Department of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Carlo DeAngelis
- Department of Pharmacy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Sussman
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Lisa Barbera
- ICES, Toronto, Ontario, Canada. .,Tom Baker Cancer Centre, Calgary, Alberta, Canada. .,Division of Radiation Oncology, University of Calgary and Tom Baker Cancer Centre, Calgary, Canada.
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Bubis LD, Davis LE, Canaj H, Gupta V, Jeong Y, Barbera L, Li Q, Moody L, Karanicolas PJ, Sutradhar R, Coburn NG, Mahar AL. Patient-Reported Symptom Severity Among 22,650 Cancer Outpatients in the Last Six Months of Life. J Pain Symptom Manage 2020; 59:58-66.e4. [PMID: 31430522 DOI: 10.1016/j.jpainsymman.2019.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/09/2019] [Accepted: 08/09/2019] [Indexed: 12/17/2022]
Abstract
CONTEXT Understanding the magnitude and risk factors for symptom burden of patients with cancer at the end of life is critical to guiding effective patient- and system-level interventions. OBJECTIVES We aimed to estimate the prevalence of severe patient-reported symptoms among cancer outpatients during the six months before death and to identify patient groups at a higher risk for reporting severe symptoms. METHODS This was a retrospective cohort study of cancer decedents at regional cancer centers from 2010 to 2016. Patient-reported Edmonton Symptom Assessment System (ESAS) scores from the last six months of life were linked to administrative databases. The proportion of patients reporting severe symptom scores (≥7) for anxiety, depression, drowsiness, lack of appetite, nausea, pain, shortness of breath, tiredness, and overall well-being during the six months before death was described. Multivariable modified Poisson regression analyses were used to identify risk factors for reporting severe symptom scores. RESULTS Of 39,084 cancer decedents, 22,650 had one or more symptom assessments recorded in the last six months of life, resulting in 92,757 ESAS assessments. Severe scores were highest for tiredness (56%), lack of appetite (46%), and impaired well-being (45%). The proportion of patients reporting severe symptom scores was stable before progressively increasing at three months before death. Elderly, women, patients with high comorbidity, immigrants, and living in urban areas or with high material deprivation were at increased risk of reporting severe scores. CONCLUSIONS Despite an integrated symptom screening program, rates of severe patient-reported symptom scores before death were high for outpatients with cancer. Patient subgroups at increased risk of severe symptom burden may benefit from targeted interventions. Ongoing review of routinely collected symptom data may be used to assess the supportive care needs and guide targeted interventions at the health-system level.
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Affiliation(s)
- Lev D Bubis
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Laura E Davis
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Hera Canaj
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Vaibhav Gupta
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Yunni Jeong
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Lisa Barbera
- Division of Radiation Oncology, University of Calgary, Calgary, Canada
| | - Qing Li
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | | | - Paul J Karanicolas
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Natalie G Coburn
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada.
| | - Alyson L Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
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Tung S, Davis LE, Hallet J, Mavros MN, Mahar AL, Bubis LD, Hammad A, Zhao H, Earle CC, Barbera L, Coburn NG, Siqqidui M, Li Q, Elmi M, Shin E, Hsieh E, Goyert N. Population-Level Symptom Assessment Following Pancreaticoduodenectomy for Adenocarcinoma. JAMA Surg 2019; 154:e193348. [PMID: 31483457 DOI: 10.1001/jamasurg.2019.3348] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Postoperative morbidity associated with pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PA) remains as high as 70%. However, to our knowledge, few studies have examined quality of life in this patient population. Objective To identify symptom burden and trajectories and factors associated with high symptom burden following PD for PA. Design, Setting, and Participants This population-based cohort study of patients undergoing PD for PA diagnosed between 2009 and 2015 linked population-level administrative health care data to routinely prospectively collected Edmonton Symptom Assessment System (ESAS) scores from 2009 to 2015, with a data analysis undertaken in 2018. Exposures Baseline characteristics, including age, sex, income quintile, rurality, immigration status, and comorbidity burden, as well as treatment characteristics, including year of surgery and receipt of chemotherapy. Main Outcome and Measures The outcome of interest was moderate to severe symptoms (defined as ESAS ≥4) for anxiety, depression, drowsiness, lack of appetite, nausea, pain, shortness of breath, tiredness, and impaired well-being. The monthly prevalence of moderate to severe symptoms was presented graphically for each symptom. Multivariable regression models identified factors associated with the reporting of moderate to severe symptoms. Results We analyzed 6058 individual symptom assessments among 615 patients with PA who underwent resection (285 women [46.3%]) with ESAS data. Tiredness (443 [72%]), impaired well-being (418 [68%]), and lack of appetite (400 [65%]) were most commonly reported as moderate to severe. The proportion of patients with moderate to severe symptoms was highest immediately after surgery (range, 14%-66% per symptom) and decreased over time, stabilizing around 3 months (range, 8%-42% per symptom). Female sex, higher comorbidity, and lower income were associated with a higher risk of reporting moderate to severe symptoms. Receipt of adjuvant chemotherapy was not associated with the risk of moderate to severe symptoms. Conclusions and Relevance There is a high prevalence of symptoms following PD for PA, with improvement over the first 3 months following surgery. In what to our knowledge is the largest cohort reporting on symptom burden for this population, we have identified factors associated with symptom severity. These findings will aid in managing patients' perioperative expectations and designing strategies to improve targeted symptom management.
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Affiliation(s)
- Stephanie Tung
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Laura E Davis
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Hallet
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michail N Mavros
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Alyson L Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lev D Bubis
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed Hammad
- Department of General Surgery, Mansoura University, Mansoura, Egypt
| | - Haoyu Zhao
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Craig C Earle
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Barbera
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Natalie G Coburn
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Mina Siqqidui
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Qing Li
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Maryam Elmi
- Division of Surgical Oncology, University of Texas Health Science Center, San Antonio
| | - Elizabeth Shin
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eugene Hsieh
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Nik Goyert
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Sutradhar R, Rostami M, Barbera L. Patient-Reported Symptoms Improve Performance of Risk Prediction Models for Emergency Department Visits Among Patients With Cancer: A Population-Wide Study in Ontario Using Administrative Data. J Pain Symptom Manage 2019; 58:745-755. [PMID: 31319103 DOI: 10.1016/j.jpainsymman.2019.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/03/2019] [Accepted: 07/08/2019] [Indexed: 01/08/2023]
Abstract
CONTEXT Prior work shows measurements of symptom severity using the Edmonton Symptom Assessment System (ESAS) which are associated with emergency department (ED) visits in patients with cancer; however, it is not known if symptom severity improves the ability to predict ED visits. OBJECTIVES To determine whether information on symptom severity improves the ability to predict ED visits among patients with cancer. METHODS This was a population-based study of patients who were diagnosed with cancer and had at least one ESAS assessment completed between 2007 and 2015 in Ontario, Canada. After splitting the cohort into training and test sets, two ED visit risk prediction models using logistic regression were developed on the training cohort, one without ESAS and one with ESAS. The predictive performance of each risk model was assessed on the test cohort and compared with respect to area under the curve and calibration. RESULTS The full cohort consisted of 212,615 unique patients with a total of 1,267,294 ESAS assessments. The risk prediction model including ESAS was superior in sensitivity, specificity, accuracy, and discrimination. The area under the curve was 73.7% under the model with ESAS, whereas it was 70.1% under the model without ESAS. The model with ESAS was also better calibrated. This improvement in calibration was particularly noticeable among patients in the higher deciles of predicted risk. CONCLUSION This study demonstrates the importance of incorporating symptom measurements when developing an ED visit risk calculator for patients with cancer. Improved predictive models for ED visits using measurements of symptom severity may serve as an important clinical tool to prompt timely interventions by the cancer care team before an ED visit is necessary.
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Affiliation(s)
- Rinku Sutradhar
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario.
| | - Mehdi Rostami
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Barbera
- ICES, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
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47
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van Egdom LSE, Oemrawsingh A, Verweij LM, Lingsma HF, Koppert LB, Verhoef C, Klazinga NS, Hazelzet JA. Implementing Patient-Reported Outcome Measures in Clinical Breast Cancer Care: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1197-1226. [PMID: 31563263 DOI: 10.1016/j.jval.2019.04.1927] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/11/2019] [Accepted: 04/16/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are increasingly being used to improve care delivery and are becoming part of routine clinical practice. OBJECTIVE This systematic review aims to give an overview of PROM administration methods and their facilitators and barriers in breast cancer clinical practice. METHODS A systematic literature search was conducted in Embase, MEDLINE, PsycINFO, Cochrane Central, CINAHL, and Web of Science for potentially relevant articles from study inception to November 2017. Reference lists of screened reviews were also checked. After inclusion of relevant articles, data were extracted and appraised by 2 investigators. RESULTS A total of 2311 articles were screened, of which 34 eligible articles were ultimately included. Method and frequency of PROM collection varied between studies. The majority of studies described a promising effect of PROM collection on patients (adherence, symptom distress, quality of life, acceptability, and satisfaction), providers (willingness to comply, clinical decision making, symptom management), and care process or system outcomes (referrals, patient-provider communication, hospital visits). A limited number of facilitators and barriers were identified, primarily of a technical and behavioral nature. CONCLUSION Although interpreting the impact of PROM collection in breast cancer care is challenging owing to considerations of synergistic (multicomponent) interventions and generalizability issues, this review found that systematic PROM collection has a promising impact on patients, providers, and care processes/ systems. Further standardization and reporting on method and frequency of PROM collection might help increase the effectiveness of PROM interventions and is warranted to enhance their overall impact.
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Affiliation(s)
| | - Arvind Oemrawsingh
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lisanne M Verweij
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Linetta B Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Niek S Klazinga
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jan A Hazelzet
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
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What symptoms are important to patients? Developing a symptom burden measure for women with breast cancer. Support Care Cancer 2019; 27:4639-4647. [PMID: 30937601 DOI: 10.1007/s00520-019-04770-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 03/21/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE The American Cancer Society predicted that 266,120 women would be diagnosed with breast cancer in 2018. Women experience significant symptom burden in response to tumor and treatment-related adverse effects, particularly in advanced disease. Use of valid and reliable patient-reported outcomes (PRO) symptom measures may assist clinicians in systematically monitoring and managing symptoms. The MD Anderson Symptom Inventory (MDASI) is a brief PRO measure of cancer symptom burden; specific symptoms can be added to the core symptoms to produce disease- and treatment-specific modules. The purpose of this study was to describe the patient symptom experience, define the content domain, and generate items for a breast cancer-specific MDASI module for measuring symptom burden in women with breast cancer. METHODS Women with breast cancer were qualitatively interviewed about their experiences of disease and treatment. Descriptive exploratory analysis identified symptoms and symptom interference to define the symptom burden of breast cancer. An expert panel rated the relevance of the identified symptoms to patients with breast cancer. RESULTS A conceptual model of breast cancer symptom burden was developed from interviews with 36 women (mean age of 57.9 years, 86.1% had stages I-III, and 52.8% were on chemotherapy and/or radiation therapy) across the breast cancer disease and treatment trajectory. Thirty-six symptoms and 6 interference categories were identified. Symptoms specific to treatment modalities and breast cancer met the criteria for inclusion in the provisional instrument for psychometric testing. CONCLUSIONS We generated an instrument with content validity for measuring symptom burden specific to women with breast cancer.
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49
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Davis LE, Fulton C, Bubis LD, Sussman J, Moody L, Barbera L, Li Q, Mahar AL, Coburn NG, Holloway CMB. Patient-reported symptoms following mastectomy alone or lumpectomy plus radiation for early stage breast cancer: a cohort study. Breast Cancer Res Treat 2019; 175:721-731. [DOI: 10.1007/s10549-019-05196-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/05/2019] [Indexed: 02/05/2023]
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50
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Mahar AL, Davis LE, Bubis LD, Li Q, Sutradhar R, Coburn NG, Barbera L. Factors associated with receipt of symptom screening in the year after cancer diagnosis in a universal health care system: a retrospective cohort study. ACTA ACUST UNITED AC 2019; 26:e8-e16. [PMID: 30853804 DOI: 10.3747/co.26.4160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose Patient-reported symptom data are collected prospectively by a provincial cancer agency to mitigate the significant symptom burden that patients with cancer experience. However, an assessment of whether such symptom screening occurs uniformly for those patients has yet to be performed. In the present study, we investigated patient, disease, and health system factors associated with receipt of symptom screening in the year after a cancer diagnosis. Methods Patients diagnosed with cancer between 2007 and 2014 were identified. We measured whether 1 or more symptom screenings were recorded in the year after diagnosis. A multivariable modified Poisson regression with robust error variance was used to identify predictors [age, comorbidity, rurality, socioeconomic status, immigration status, cancer site, registration at a regional cancer centre (cc), and year of diagnosis] of being screened for symptoms. Results Of 425,905 patients diagnosed with cancer, 163,610 (38%) had 1 or more symptom screening records in the year after diagnosis, and 75% survived at least 1 year. We identified variability in symptom screening by primary cancer site, regional cc, age, sex, comorbidity, material deprivation, rurality of residence, and immigration status. Patients who had been diagnosed with melanoma or endocrine cancers, who were not registered at a regional cc, who lived in the most urban areas, who were elderly, and who were immigrants were least likely to undergo symptom screening after diagnosis. Conclusions Our evaluation of the implementation of a population-based symptom screening program in a universal health care system identified populations who are at risk for not receiving screening and who are therefore future targets for improvements in population symptom screening and better management of cancer-related symptoms at diagnosis.
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Affiliation(s)
- A L Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB
| | - L E Davis
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON
| | - L D Bubis
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON
| | | | - R Sutradhar
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON.,Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON.,ICES, Toronto, ON
| | - N G Coburn
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON.,Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON.,ICES, Toronto, ON.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON
| | - L Barbera
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON.,ICES, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
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