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Fairweather D, Taylor RM, Simões R. Choosing the right questions - A systematic review of patient reported outcome measures used in radiotherapy and proton beam therapy. Radiother Oncol 2024; 191:110071. [PMID: 38142933 DOI: 10.1016/j.radonc.2023.110071] [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: 10/04/2023] [Revised: 12/01/2023] [Accepted: 12/16/2023] [Indexed: 12/26/2023]
Abstract
The implementation of PROMs into clinical practice has been shown to improve quality of care. This systematic review aims to identify which PROMs are suitable for implementation within routine clinical practice in a radiotherapy or PBT service.The bibliographic databases MEDLINE, EMBASE and EMCARE were searched. Articles published between 1st January 2008 to 1st June 2023, that reported PROMs being utilised as an outcome measure were included. Inclusion criteria also included being written in English, involving human patients, aged 16 and above, receiving external beam radiotherapy or PBT for six defined tumour sites. PROMs identified within the included articles were subjected to quality assessment using the COSMIN reporting guidelines. Results are reported as per PRISMA guidelines. A total of 268 studies were identified in the search, of which 52 fulfilled the inclusion criteria. The use of 39 different PROMs was reported. The PROMs identified were mostly tumour or site-specific quality of life (n = 23) measures but also included generic cancer (n = 3), health-related quality-of-life (n = 6), and symptom specific (n = 7) measures.None of the PROMs identified received a high GRADE score for good content. There were 13 PROMs that received a moderate GRADE score. The remaining PROMs either had limited evidence of development and validation within the patient cohorts investigated, or lacked relevance or comprehensiveness needed for routine PROMs collection in a radiotherapy or PBT service.This review highlights that there are a wide variety of PROMs being utilised within radiotherapy research, but most lack specificity to radiotherapy side-effects. There is a risk that by using non-specific PROMs in clinical practice, patients might not receive the supportive care that they need.
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Affiliation(s)
- Danielle Fairweather
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK.
| | - Rachel M Taylor
- Centre for Nurse, Midwife and Allied Health Profession Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London, UK; Department of Targeted Intervention, University College London, London, UK
| | - Rita Simões
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK; The Royal Marsden Hospital, London, UK; Radiotherapy Trials Quality Assurance (RTTQA) group, Mount Vernon Hospital, Northwood, UK
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Bartula I, Tran AD, Nowak AK, Ahmed T, Morton RL, Burmeister BH, Dolven-Jacobsen K, Nobes J, Thompson JF, Fogarty GB, Lo SN, Hong AM. Longitudinal Trajectory of Quality of Life for Patients with Melanoma Brain Metastases: A Secondary Analysis from a Whole Brain Radiotherapy Randomized Clinical Trial. Clin Transl Radiat Oncol 2023. [DOI: 10.1016/j.ctro.2023.100597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Nakano T, Aoyama H, Onodera S, Igaki H, Matsumoto Y, Kanemoto A, Shimamoto S, Matsuo M, Tanaka H, Oya N, Matsuyama T, Ohta A, Maruyama K, Tanaka T, Kitamura N, Akazawa K, Maebayashi K. Reduced-dose WBRT combined with SRS for 1–4 brain metastases aiming at minimizing neurocognitive function deterioration without compromising brain tumor control. Clin Transl Radiat Oncol 2022; 37:116-129. [PMID: 36199814 PMCID: PMC9529504 DOI: 10.1016/j.ctro.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 11/29/2022] Open
Abstract
The addition of whole-brain radiotherapy (WBRT) to stereotactic radiosurgery (SRS) reduces the risk of brain tumor recurrence but standard-dose WBRT (SD-WBRT) accompanies the risk of neurocognitive decline. Reduced-dose WBRT (RD-WBRT) combined with SRS provides intracranial tumor control rate comparable to that after SD-WBRT + SRS. RD-WBRT could reduce the risk of neurocognitive decline compared to that after SD-WBRT.
Background and purpose To minimize cognitive decline without increasing brain tumor recurrence (BTR) by reduced-dose whole-brain radiotherapy (RD-WBRT) (25 Gy, 10 fractions) + stereotactic radiosurgery (SRS) in patients with ≤ 4 brain metastases. Materials and methods Eligible patients with ≤ 4 brain metastases on contrast-enhanced MRI and Karnofsky Performance Status ≥ 70. The primary endpoint was the non-inferiority of BTR at distant sites in the brain (BTR-distant)-free survival at 6 months compared to that of the standard dose (SD)-WBRT (30 Gy, 10 fractions) + SRS arm in a randomized clinical trial (JROSG99-1) of SRS with/without SD-WBRT. Secondary endpoints included BTR at any brain sites (BTR-all) and neurocognitive function assessed by a six-test standardized battery. Results Forty patients from seven institutions were enrolled (median age 69 years). The primary tumor site was a lung in 28 patients; 20 patients had a solitary brain metastasis. The median survival time was 19.0 months (95 %CI: 13.8 %–27.5 %). The BTR-distant-free survival at 6 months was 76.9 % (59.5 %–87.7 %), which is comparable to that of historical control although predetermined non-inferiority (>71 %) could not be confirmed (p = 0.16). The cumulative incidence of BTR-all at 6 months accounting for the competing risk of death was 23.0 % (11.4–37.1), which was not worse than that of historical control (p = 0.774). The frequency of the cumulative incidence of persistent cognitive decline at 6 months was 48.6 % under the [>2.0 SD in ≥ 1 test] definition. Conclusions RD-WBRT may yield comparable intracranial tumor control when combined with SRS, and may reduce the risk of neurocognitive decline compared to that after SD-WBRT.
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Affiliation(s)
- Toshimichi Nakano
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hidefumi Aoyama
- Department of Radiation Oncology, Hokkaido University Faculty of Medicine, Sapporo, Japan
- Corresponding authors at: Department of Radiation Oncology, Hokkaido University Faculty of Medicine, North 15, West 7, Sapporo 060-8638, Japan
| | - Shunsuke Onodera
- Department of Radiation Oncology, Hokkaido Cancer Center, Sapporo, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuo Matsumoto
- Department of Radiation Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Ayae Kanemoto
- Department of Radiation Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | | | - Masayuki Matsuo
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hidekazu Tanaka
- Department of Radiation Oncology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Natsuo Oya
- Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomohiko Matsuyama
- Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Atsushi Ohta
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Katsuya Maruyama
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takahiro Tanaka
- Clinical and Translational Research Center, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Nobutaka Kitamura
- Clinical and Translational Research Center, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Kohei Akazawa
- Department of Medical Informatics, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Katsuya Maebayashi
- Division of Radiation Oncology, Nippon Medical School Hospital, Tokyo, Japan
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Gao YK, Kuksis M, Id Said B, Chehade R, Kiss A, Tran W, Sickandar F, Sahgal A, Warner E, Soliman H, Jerzak KJ. Treatment Patterns and Outcomes of Women with Symptomatic and Asymptomatic Breast Cancer Brain Metastases: A Single-Center Retrospective Study. Oncologist 2021; 26:e1951-e1961. [PMID: 34506676 DOI: 10.1002/onco.13965] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 08/31/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Breast cancer is the most common cancer among women worldwide and the second leading cause of brain metastases (BrM). We assessed the treatment patterns and outcomes of women treated for breast cancer BrM at our institution in the modern era of stereotactic radiosurgery (SRS). MATERIALS AND METHODS We conducted a retrospective analysis of women (≥18 years of age) with metastatic breast cancer who were treated with surgery, whole brain radiotherapy (WBRT), or SRS to the brain at the Sunnybrook Odette Cancer Centre, Toronto, Canada, between 2008 and 2018. Patients with a history of other malignancies and those with an uncertain date of diagnosis of BrM were excluded. Descriptive statistics were generated and survival analyses were performed with subgroup analyses by breast cancer subtype. RESULTS Among 683 eligible patients, 153 (22.4%) had triple-negative breast cancer, 188 (27.5%) had HER2+, 246 (36.0%) had hormone receptor (HR)+/HER2-, and 61 (13.3%) had breast cancer of an unknown subtype. The majority of patients received first-line WBRT (n = 459, 67.2%) or SRS (n = 126, 18.4%). The median brain-specific progression-free survival and median overall survival (OS) were 4.1 months (interquartile range [IQR] 1.0-9.6 months) and 5.1 months (IQR 2.0-11.7 months) in the overall patent population, respectively. Age >60 years, presence of neurological symptoms at BrM diagnosis, first-line WBRT, and HER2- subtype were independently prognostic for shorter OS. CONCLUSION Despite the use of SRS, outcomes among patients with breast cancer BrM remain poor. Strategies for early detection of BrM and central nervous system-active systemic therapies warrant further investigation. IMPLICATIONS FOR PRACTICE Although triple-negative breast cancer and HER2+ breast cancer have a predilection for metastasis to the central nervous system (CNS), patients with hormone receptor-positive/HER2- breast cancer represent a high proportion of patients with breast cancer brain metastases (BrM). Hence, clinical trials should include patients with BrM and evaluate CNS-specific activity of novel systemic therapies when feasible, irrespective of breast cancer subtype. In addition, given that symptomatic BrM are associated with shorter survival, this study suggests that screening programs for the early detection and treatment of breast cancer BrM warrant further investigation in an era of minimally toxic stereotactic radiosurgery.
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Affiliation(s)
- Yizhuo Kelly Gao
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Markus Kuksis
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Badr Id Said
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Rania Chehade
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Alex Kiss
- Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - William Tran
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Faisal Sickandar
- Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Ellen Warner
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Hany Soliman
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Katarzyna J Jerzak
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
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