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Kim BK, Woo J, Lee J, Kang E, Baek SY, Lee S, Lee HJ, Lee J, Sun WY. Survival Outcomes Based on Axillary Surgery in Ductal Carcinoma In Situ: A Nationwide Study From the Korean Breast Cancer Society. J Breast Cancer 2024; 27:1-13. [PMID: 38433090 PMCID: PMC10912575 DOI: 10.4048/jbc.2023.0221] [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: 09/29/2023] [Revised: 11/20/2023] [Accepted: 01/27/2024] [Indexed: 03/05/2024] Open
Abstract
PURPOSE In total mastectomy (TM), sentinel lymph node biopsy (SLNB) is recommended but can be omitted for breast-conserving surgery (BCS) in patients with ductal carcinoma in situ (DCIS). However, concerns regarding SLNB-related complications and their impact on quality of life exist. Consequently, further research is required to evaluate the role of axillary surgeries, including SLNB, in the treatment of TM. We aimed to explore the clinicopathological factors and outcomes associated with axillary surgery in patients with a final diagnosis of pure DCIS who underwent BCS or TM. METHODS We retrospectively analyzed large-scale data from the Korean Breast Cancer Society registration database, highlighting on patients diagnosed with pure DCIS who underwent surgery and were categorized into two groups: BCS and TM. Patients were further categorized into surgery and non-surgery groups according to their axillary surgery status. The analysis compared clinicopathological factors and outcomes according to axillary surgery status between the BCS and TM groups. RESULTS Among 18,196 patients who underwent surgery for DCIS between 1981 and 2022, 11,872 underwent BCS and 6,324 underwent TM. Both groups leaned towards axillary surgery more frequently for large tumors. In the BCS group, clinical lymph node status was associated with axillary surgery (odds ratio, 11.101; p = 0.003). However, in the TM group, no significant differences in these factors were observed. Survival rates did not vary between groups according to axillary surgery performance. CONCLUSION The decision to perform axillary surgery in patients with a final diagnosis of pure DCIS does not affect the prognosis, regardless of the breast surgical method. Furthermore, regardless of the breast surgical method, axillary surgery, including SLNB, should be considered for high-risk patients, such as those with large tumors. This may reduce unnecessary axillary surgery and enhance the patients' quality of life.
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Affiliation(s)
- Bong Kyun Kim
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joohyun Woo
- Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jeeyeon Lee
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Eunhye Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Soo Yeon Baek
- Department of Surgery, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea
| | - Seokwon Lee
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hyouk Jin Lee
- Breast-Thyroid Center, Saegyaero Hospital, Busan, Korea
| | - Jina Lee
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woo Young Sun
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Chen Z, Zhuang J, Liu M, Xu X, Liu Y, Yang S, Xie J, Lin N, Lai F, He F. Longitudinal analysis of quality of life in primary lung cancer patients with chlamydia pneumoniae infection: a time-to-deterioration model. BMC Pulm Med 2024; 24:36. [PMID: 38233781 PMCID: PMC10792978 DOI: 10.1186/s12890-024-02860-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/10/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Chlamydia pneumoniae (Cpn) IgG and IgA has been strongly linked to lung cancer, but its impact on patients' quality of life remains unclear. Our objective was to investigate the relationship between pre-treatment Cpn IgG and IgA and time to deterioration (TTD) of the HRQoL in patients with primary lung cancer. METHODS A prospective hospital-based study was conducted from June 2017 to December 2018, enrolling 82 patients with primary lung cancer admitted to the First Affiliated Hospital of Fujian Medical University for questionnaire surveys. Cpn IgG and IgA was detected by microimmunofluorescence method. HRQoL was assessed at baseline and during follow-up using the EORTC Quality of Life Questionnaire version 3.0 (EORTC QLQ-C30) and EORTC Quality of Life Questionnaire-Lung Cancer (EORTC QLQ-LC13). HRQoL scores were calculated using the QoLR package, and TTD events were determined (minimum clinically significant difference = 5 points). Cox regression analysis was used to evaluate the effect of Cpn IgG and IgA on HRQoL. RESULTS We investigated the relationship between Cpn IgG and IgA and quality of life in patients with primary lung cancer. The study was found that 75.61% of cases were Cpn IgG + and 45.12% were Cpn IgA + . Cpn IgA + IgG + was 41.46%. For EORTC QLQ-C30, Physical function (PF) and Pain (PA) TTD events on the functional scale and Symptom scale were the most common during follow-up. After adjusting for gender and smoking status, Pre-treatment Cpn IgA + was found to signifcantly delay TTD of Physical functioning(HR = 0.539, 95% CI: 0.291-0.996, P = 0.048). In addition, Cpn IgG + before treatment significantly delayed TTD in Emotional functioning (HR = 0.310, 95% CI: 0.115-0.836, P = 0.021). For EORTC QLQ-LC13, deterioration of dyspnea (LC-DY) was the most common event. However, Cpn IgG and IgA before treatment had no effect on the TTD of EORTC QLQ-LC13 items. CONCLUSIONS According to EORTC QLQ-C30 and EORTC QLQ-LC13, Cpn IgA delayed TTD in Physical functioning and Cpn IgG delayed TTD in Emotional functioning.
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Affiliation(s)
- Zishan Chen
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and CancerSchool of Public Health, Fujian Medical University, Fuzhou, 350122, Fujian Province, China
| | - Jinman Zhuang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and CancerSchool of Public Health, Fujian Medical University, Fuzhou, 350122, Fujian Province, China
| | - Maolin Liu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and CancerSchool of Public Health, Fujian Medical University, Fuzhou, 350122, Fujian Province, China
| | - Xinying Xu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and CancerSchool of Public Health, Fujian Medical University, Fuzhou, 350122, Fujian Province, China
| | - Yuhang Liu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and CancerSchool of Public Health, Fujian Medical University, Fuzhou, 350122, Fujian Province, China
| | - Shuyan Yang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and CancerSchool of Public Health, Fujian Medical University, Fuzhou, 350122, Fujian Province, China
| | - Jinbao Xie
- Department of Thoracic Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Nanlong Lin
- Department of Thoracic Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Fancai Lai
- Department of Thoracic Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Fei He
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and CancerSchool of Public Health, Fujian Medical University, Fuzhou, 350122, Fujian Province, China.
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Zhuang J, Liu Y, Xu X, Cai Y, Liu M, Chen Z, Yang S, Lin J, Hu Z, Kang M, Lin M, He F. Association between physical activity and health-related quality of life: time to deterioration model analysis in lung adenocarcinoma. J Cancer Surviv 2023; 17:1769-1779. [PMID: 36192668 PMCID: PMC10539423 DOI: 10.1007/s11764-022-01259-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/15/2022] [Indexed: 10/10/2022]
Abstract
BACKGROUND AND PURPOSE : Health-related quality of life (HRQoL) is a key aspect of care for cancer survivors that can be improved by physical activity. Our aim was to explore the relationship between physical activity and time to deterioration (TTD) of the HRQoL in patients with lung adenocarcinoma (LUAD). METHODS We conducted a hospital-based prospective study. The International Physical Activity Questionnaire long-form (IPAQ-L) was used to investigate the pre-treatment physical activity levels, and the EORTC Quality of Life Questionnaire version 3.0 (EORTC QLQ-C30) and EORTC Quality of Life Questionnaire-Lung Cancer (EORTC QLQ-LC13) were used to assess HRQoL at baseline and during follow-up. The QoLR package was used to calculate the HRQoL scores and determine TTD events (minimal clinically important difference=5 points). The effect of physical activity on the HRQoL was assessed using Cox regression analysis. RESULTS For EORTC QLQ-C30, TTD events of physical functioning (PF) and dyspnea (DY) in functional scales and symptom scales were the most common during follow-up. Pre-treatment physical activity was found to significantly delay TTD of insomnia (HR=0.635, 95%CI: 0.437-0.922, P=0.017) and diarrhea (HR=0.475, 95%CI: 0.291-0.774, P=0.003). For EORTC QLQ-LC13 scales, deterioration of dyspnea (LC-DY) was the most common event. Physical activity was found to delay the TTD of dyspnea (HR=0.654, 95%CI: 0.474-0.903, P=0.010), sore mouth (HR=0.457, 95%CI: 0.244-0.856, P=0.015), and dysphagia (HR=0.315, 95%CI: 0.172-0.580, P<0.001). CONCLUSIONS Pre-treatment physical activity of LUAD patients may delay the TTD of multiple HRQoL indicators in EORTC QLQ-C30 and EORTC QLQ-LC13. IMPLICATION FOR CANCER SURVIVORS Health-related quality of life (HRQoL) is a key aspect of care for cancer survivors (someone who is living with or beyond cancer), that can be improved by physical activity. Our aim was to explore the relationship between physical activity and time to deterioration (TTD) of the HRQoL in patients with lung adenocarcinoma (LUAD).
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Affiliation(s)
- Jinman Zhuang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, 350122, Fuzhou Fujian Province, China
| | - Yuhang Liu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, 350122, Fuzhou Fujian Province, China
| | - Xinying Xu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, 350122, Fuzhou Fujian Province, China
| | - Yuxin Cai
- Department of Health Toxicology, School of Public Health, Xiamen University, Xiamen, China
| | - Maolin Liu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, 350122, Fuzhou Fujian Province, China
| | - Zishan Chen
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, 350122, Fuzhou Fujian Province, China
| | - Shuyan Yang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, 350122, Fuzhou Fujian Province, China
| | - Jianbo Lin
- Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, 350122, Fuzhou Fujian Province, China
- Fujian Provincial Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Digital Tumor Data Research Center, Fuzhou, China
| | - Mingqiang Kang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Mengxin Lin
- Department of Oncology, Fujian Medical University Union Hospital, Fujian Province, 350000, China.
| | - Fei He
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, 350122, Fuzhou Fujian Province, China.
- Fujian Provincial Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
- Fujian Digital Tumor Data Research Center, Fuzhou, China.
- Department of Pulmonary and Critical Care Medicine, Respirology Medicine Centre of Fujian Province, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
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Van Parijs H, Cecilia-Joseph E, Gorobets O, Storme G, Adriaenssens N, Heyndrickx B, Verschraegen C, Nguyen NP, De Ridder M, Vinh-Hung V. Lung-heart toxicity in a randomized clinical trial of hypofractionated image guided radiation therapy for breast cancer. Front Oncol 2023; 13:1211544. [PMID: 38053657 PMCID: PMC10694354 DOI: 10.3389/fonc.2023.1211544] [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: 04/24/2023] [Accepted: 11/02/2023] [Indexed: 12/07/2023] Open
Abstract
Background TomoBreast hypothesized that hypofractionated 15 fractions/3 weeks image-guided radiation therapy (H-IGRT) can reduce lung-heart toxicity, as compared with normofractionated 25-33 fractions/5-7 weeks conventional radiation therapy (CRT). Methods In a single center 123 women with stage I-II operated breast cancer were randomized to receive CRT (N=64) or H-IGRT (N=59). The primary endpoint used a composite four-items measure of the time to 10% alteration in any of patient-reported outcomes, physician clinical evaluation, echocardiography or lung function tests, analyzed by intention-to-treat. Results At 12 years median follow-up, overall and disease-free survivals between randomized arms were comparable, while survival time free from alteration significantly improved with H-IGRT which showed a gain of restricted mean survival time of 1.46 years over CRT, P=0.041. Discussion The finding establishes TomoBreast as a proof-of-concept that hypofractionated image-guided radiation-therapy can improve the sparing of lung-heart function in breast cancer adjuvant therapy without loss in disease-free survival. Hypofractionation is advantageous, conditional on using an advanced radiation technique. Multicenter validation may be warranted. Trial registration https://clinicaltrials.gov/ct2/show/NCT00459628. Registered 12 April 2007.
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Affiliation(s)
- Hilde Van Parijs
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Elsa Cecilia-Joseph
- Department of Oral Surgery, University Hospital of Martinique, Fort-de-France, France
| | - Olena Gorobets
- Department of Oral Surgery, University Hospital of Martinique, Fort-de-France, France
| | - Guy Storme
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nele Adriaenssens
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Claire Verschraegen
- Department of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Nam P. Nguyen
- Department of Radiation Oncology, Howard University, Washington, DC, United States
- Department of Clinical Research, International Geriatric Radiotherapy Group, Washington, DC, United States
| | - Mark De Ridder
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Vincent Vinh-Hung
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Clinical Research, International Geriatric Radiotherapy Group, Washington, DC, United States
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
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5
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Qiu T, Shen G, Xin Y, Li J, Zheng Y, Zhu Z, Zhang C, Tang Y, Wang M, Liu Z, Zhao Y, Zhao F, Ren D, Li H, Liu Y, Liu X, Zhao J. Meta-analysis of quality of life in patients with cancer treated with antibody-drug conjugates in randomized controlled trials. Future Oncol 2023; 19:2201-2212. [PMID: 37882431 DOI: 10.2217/fon-2023-0253] [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] [Indexed: 10/27/2023] Open
Abstract
Purpose: To evaluate the patient-reported outcomes of patients treated with commercially approved antibody-drug conjugates (ADC) reported in randomized controlled trials (RCT) published up to September 2023. Methods: A meta-analysis of 6430 patients from 12 randomized controlled trials was conducted. Results: No significant change was observed between the groups from baseline to end of treatment and end of follow-up, with a standardized mean difference of -0.08 (95% CI: -0.27-0.12) and 0.01 (95% CI: -0.11-0.12), respectively. Treatment with ADCs delayed the deterioration of patients' clinical condition compared with treatment with non-ADCs, with a hazard ratio of 0.78 (95% CI: 0.67-0.92). Conclusion: ADCs have a good correlation with delay of clinical deterioration in patients with cancer.
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Affiliation(s)
- Tianlei Qiu
- Breast Disease Diagnosis & Treatment Center of Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, China
| | - Guoshuang Shen
- Breast Disease Diagnosis & Treatment Center of Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, China
| | - Yuanfang Xin
- Breast Disease Diagnosis & Treatment Center of Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, China
| | - Jinming Li
- Breast Disease Diagnosis & Treatment Center of Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, China
| | - Yonghui Zheng
- Breast Disease Diagnosis & Treatment Center of Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, China
| | - Zijun Zhu
- Breast Disease Diagnosis & Treatment Center of Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, China
| | - Chengrong Zhang
- Breast Disease Diagnosis & Treatment Center of Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, China
| | - Yuyao Tang
- Breast Disease Diagnosis & Treatment Center of Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, China
| | - Miaozhou Wang
- Breast Disease Diagnosis & Treatment Center of Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, China
| | - Zhen Liu
- Breast Disease Diagnosis & Treatment Center of Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, China
| | - Yi Zhao
- Breast Disease Diagnosis & Treatment Center of Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, China
| | - Fuxing Zhao
- Breast Disease Diagnosis & Treatment Center of Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, China
| | - Dengfeng Ren
- Breast Disease Diagnosis & Treatment Center of Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, China
| | - Huihui Li
- Department of Breast Medical Oncology, Shandong Cancer Hospital & Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Yaobang Liu
- Department of Surgical Oncology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, 750000, China
| | - Xinlan Liu
- Department of Surgical Oncology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, 750000, China
| | - Jiuda Zhao
- Breast Disease Diagnosis & Treatment Center of Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, China
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Bergerot C, Young Rha S, Pal S, Koralewski P, Stroyakovskiy D, Alekseev B, Parnis F, Castellano D, Lyun Lee J, Sunela K, Ciuleanu T, Heng D, Glen H, Wang J, Bennett L, Pan J, O’Hara K, Puente J. Health-Related Quality of Life Outcomes With Two Different Starting Doses of Lenvatinib in Combination With Everolimus for Previously Treated Renal Cell Carcinoma. Oncologist 2023; 28:59-71. [PMID: 35881028 PMCID: PMC9847563 DOI: 10.1093/oncolo/oyac142] [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: 03/03/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Preserving health-related quality of life (HRQOL) is an important goal during renal cell carcinoma treatment. We report HRQOL outcomes from a phase II trial (NCT03173560). PATIENTS AND METHODS HRQOL data were collected during a multicenter, randomized, open-label phase II study comparing the safety and efficacy of 2 different starting doses of lenvatinib (18 mg vs. 14 mg daily) in combination with everolimus (5 mg daily), following one prior vascular endothelial growth factor-targeted treatment. HRQOL was measured using 3 different instruments-FKSI-DRS, EORTC QLQ-C30, and EQ-5D-3L-which were all secondary endpoints. Change from baseline was assessed using linear mixed-effects models. Deterioration events for time to deterioration (TTD) analyses were defined using established thresholds for minimally important differences in the change from baseline for each scale. TTD for each treatment arm was estimated using the Kaplan-Meier method. RESULTS Baseline characteristics of the 343 participants randomly assigned to 18 mg lenvatinib (n = 171) and 14 mg lenvatinib (n = 172) were well balanced. Least-squares mean estimates for change from baseline were favorable for the 18 mg group over the 14 mg group for the FKSI-DRS and most EORTC QLQ-C30 scales, but differences between treatments did not exceed the minimally important thresholds. Median TTD was longer among participants in the 18 mg group than those in the 14 mg group for most scales. CONCLUSIONS Participants who received an 18 mg lenvatinib starting dose had favorable HRQOL scores and longer TTD on most scales compared with those who received a 14 mg starting dose.
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Affiliation(s)
- Cristiane Bergerot
- Corresponding author: Cristiane Bergerot, Instituto Unity de Ensino e Pesquisa, Centro de Câncer de Brasília.
| | - Sun Young Rha
- Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Sumanta Pal
- Department of Medical Oncology & Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | - Daniil Stroyakovskiy
- Moscow City Oncology Hospital #62 of Moscow Healthcare Department, Moscow, Russia
| | - Boris Alekseev
- P.A. Hertzen Moscow Oncological Research Institute, Moscow, Russia
| | - Francis Parnis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | - Jae Lyun Lee
- Asan Medical Center, Seoul, Republic of Korea,University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kaisa Sunela
- Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Tudor Ciuleanu
- Prof Dr Ion Chiricuta Cancer Institute and Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniel Heng
- Department of Oncology, Tom Baker Cancer Center, University of Calgary, Calgary, Alberta, Canada
| | - Hilary Glen
- Department of Medical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Jinyi Wang
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - Lee Bennett
- RTI Health Solutions, Research Triangle Park, NC, USA
| | | | | | - Javier Puente
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
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7
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Reimer T, Stachs A, Veselinovic K, Polata S, Müller T, Kühn T, Heil J, Ataseven B, Reitsamer R, Hildebrandt G, Knauer M, Golatta M, Stefek A, Zahm DM, Thill M, Nekljudova V, Krug D, Loibl S, Gerber B. Patient-reported outcomes for the Intergroup Sentinel Mamma study (INSEMA): A randomised trial with persistent impact of axillary surgery on arm and breast symptoms in patients with early breast cancer. EClinicalMedicine 2023; 55:101756. [PMID: 36457648 PMCID: PMC9706517 DOI: 10.1016/j.eclinm.2022.101756] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND In clinically node-negative breast cancer patients, the INSEMA trial (NCT02466737) assessed the non-inferiority of avoiding sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND). Here we present patient-reported outcomes (PROs) as a secondary endpoint. METHODS PROs were assessed for patients with no axillary surgery, SLNB alone, and ALND. Quality of life (QoL) questionnaire EORTC QLQ-C30 and its breast cancer module (BR23) were used at baseline (pre-surgery) and 1, 3, 6, 12, and 18 months after surgery. The QoL scores were compared using repeated measures mixed models based on the safety set. FINDINGS Between 2015 and 2019, 5502 patients were recruited for the first randomization, and 5154 were included in the intent-to-treat set (4124 SLNB versus 1030 no SLNB). In the case of one to three macrometastases after SLNB, 485 patients underwent second randomization (242 SLNB alone versus 243 ALND). Questionnaire completion response remained high throughout the trial: over 70% at all time points for the first randomization. There were significant differences for the BRBS (breast symptoms) and BRAS (arm symptoms) scores favoring the no SLNB group in all post-baseline assessments. Patients in the SLNB group showed significantly and clinically relevant higher scores for BRAS (differences in mean values ≥5.0 points at all times), including pain, arm swelling, and impaired mobility in all postoperative visits, with the highest difference at one month after surgery. Scoring of the QLQ-C30 questionnaire revealed no relevant differences between the treatment groups, although some comparisons were statistically significant. INTERPRETATION This is one of the first randomized trials investigating the omission of SLNB in clinically node-negative patients and the first to report comprehensive QoL data. Patients with no SLNB benefitted regarding arm symptoms/functioning, while no relevant differences in other scales were seen. FUNDING Supported by German Cancer Aid (Deutsche Krebshilfe, Bonn, Germany), Grant No. 110580 and Grant No. 70110580 to University Medicine Rostock.
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Affiliation(s)
- Toralf Reimer
- Department of Obstetrics and Gynecology, University of Rostock, Südring 81, 18059 Rostock, Germany
- Corresponding author. Department of Obstetrics and Gynecology, The University of Rostock, Suedring 81, 18059 Rostock, Germany.
| | - Angrit Stachs
- Department of Obstetrics and Gynecology, University of Rostock, Südring 81, 18059 Rostock, Germany
| | - Kristina Veselinovic
- Department of Obstetrics and Gynecology, University of Ulm, Prittwitzstr. 43, 89075 Ulm, Germany
| | - Silke Polata
- Breast Center, Evangelisches Waldkrankenhaus Spandau, Stadtrandstr. 555, 13589 Berlin, Germany
| | - Thomas Müller
- Women's Hospital, Klinikum Hanau GmbH, Leimenstr. 20, 63450 Hanau, Germany
| | - Thorsten Kühn
- Women's Hospital, Klinikum Esslingen, Hirschlandstr. 97, 73730 Esslingen, Germany
| | - Jörg Heil
- Breast Unit, University Hospital, University of Heidelberg, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, Henricistr. 92, 45136 Essen, Germany
- Department of Obstetrics and Gynecology, LMU University Hospital, Marchioninistr. 15, 81377 Munich, Germany
| | - Roland Reitsamer
- Breast Center, LKH Salzburg, Paracelsus Medical University Clinics, Müllner Hauptstr. 48, A-5020 Salzburg, Austria
| | - Guido Hildebrandt
- Department of Radiotherapy, University of Rostock, Südring 75, 18059 Rostock, Germany
| | - Michael Knauer
- Brustzentrum Ost, Rohrschacher Str. 286, CH-9016 St. Gallen, Switzerland
| | - Michael Golatta
- Breast Unit, Sankt Elisabeth Hospital, Max-Reger-Str. 5-7, 69121 Heidelberg, Germany
| | - Andrea Stefek
- Women's Hospital, Johanniter-Hospital Stendal, Wendstr. 31, 39576 Stendal, Germany
| | - Dirk-Michael Zahm
- Breast Center, SRH Waldklinikum Gera, Str. des Friedens 122, 07548 Gera, Germany
| | - Marc Thill
- Department of Gynecology and Gynecological Oncology, Agaplesion Markus Hospital, W.-Epstein-Str. 4, 60431 Frankfurt/Main, Germany
| | | | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Arnold-Heller-Str., 24105 Kiel, Germany
| | - Sibylle Loibl
- German Breast Group, Dornhofstr. 10, 63263 Neu-Isenburg, Germany
| | - Bernd Gerber
- Department of Obstetrics and Gynecology, University of Rostock, Südring 81, 18059 Rostock, Germany
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Pala L, Sala I, Oriecuia C, De Pas T, Queirolo P, Specchia C, Cocorocchio E, Ferrucci P, Patanè D, Saponara M, Pennacchioli E, Coppola S, Viale G, Giaccone G, Gelber RD, Bagnardi V, Conforti F. Association of Anticancer Immune Checkpoint Inhibitors With Patient-Reported Outcomes Assessed in Randomized Clinical Trials: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2226252. [PMID: 35972744 PMCID: PMC9382448 DOI: 10.1001/jamanetworkopen.2022.26252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The association of immune checkpoint inhibitors (ICIs) with patient quality of life has been poorly explored. OBJECTIVE To evaluate patient-reported outcomes (PROs) assessed in randomized clinical trials (RCTs) of immunotherapy-based treatments. DATA SOURCES This systematic review and random-effects meta-analysis used RCTs identified in PubMed, MEDLINE, Embase, and Scopus from database inception to June 1, 2021. STUDY SELECTION A total of 2259 RCTs were identified that assessed ICIs as monotherapy or in combination with chemotherapy or combined with another ICI and/or targeted therapy vs control groups not containing immunotherapy in patients with advanced solid tumors. Studies were reviewed independently by 2 authors. DATA EXTRACTION AND SYNTHESIS This meta-analysis followed the PRISMA guidelines and recommendations of the Setting International Standards in Analyzing Patient-Reported Outcomes and Quality of Life Endpoints Data Consortium. MAIN OUTCOMES AND MEASURES The coprimary aims of the meta-analysis were (1) pooled differences between treatment groups in the mean change of PRO score from baseline to 12 and 24 weeks of follow-up and (2) pooled differences between treatment groups in the time to deterioration of PRO score. For each end point, RCTs have been analyzed according to the type of treatment administered in the experimental group: ICIs given as monotherapy, ICIs combined with chemotherapy, or ICIs in association with another ICI and/or with targeted therapies. RESULTS Of the 2259 identified RCTs, 34 (18 709 patients) met the selection criteria and were analyzed. In the group of 19 RCTs testing ICIs as monotherapy, the pooled between-groups difference of mean change from baseline to 12 weeks of follow-up was 4.6 (95% CI, 2.8-6.4), and the mean change from baseline to 24 weeks of follow-up was 6.1 (95% CI, 4.2-8.1), significantly favoring ICIs. The pooled difference was 1.4 (95% CI, -0.4 to 3.2) at week 12 and 2.5 (95% CI, -0.8 to 5.9) at week 24 in the group of 8 RCTs testing ICIs combined with chemotherapy and 2.1 (95% CI, -0.8 to 5.0) at week 12 and 2.1 (95% CI, -0.4 to 4.5) at week 24 in the group of 8 RCTs testing other ICI-containing combinations. The time to deterioration was significantly longer in the immunotherapy-containing groups compared with control groups in all 3 groups of RCTs evaluated (hazard ratios of 0.80 [95% CI, 0.70-0.91] for ICIs as monotherapy, 0.89 [95% CI, 0.78-1.00] for ICIs plus chemotherapy, and 0.78 [95% CI, 0.63-0.96] for other ICI-containing combinations). CONCLUSIONS AND RELEVANCE Immune checkpoint inhibitors as monotherapy appear to have a favorable association with patient-reported quality of life and can be combined with other classes of anticancer drugs without worsening this quality of life.
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Affiliation(s)
- Laura Pala
- Division of Melanoma, Sarcomas, and Rare Tumors, European Institute of Oncology, Milan, Italy
- Oncology Unit, Humanitas Gavazzeni, Bergamo, Italy
| | - Isabella Sala
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Chiara Oriecuia
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Tommaso De Pas
- Division of Melanoma, Sarcomas, and Rare Tumors, European Institute of Oncology, Milan, Italy
- Oncology Unit, Humanitas Gavazzeni, Bergamo, Italy
| | - Paola Queirolo
- Division of Melanoma, Sarcomas, and Rare Tumors, European Institute of Oncology, Milan, Italy
| | - Claudia Specchia
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Emilia Cocorocchio
- Division of Medical Oncology, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Pierfrancesco Ferrucci
- Department of Experimental Oncology, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Damiano Patanè
- Division of Melanoma, Sarcomas, and Rare Tumors, European Institute of Oncology, Milan, Italy
| | - Maristella Saponara
- Division of Melanoma, Sarcomas, and Rare Tumors, European Institute of Oncology, Milan, Italy
| | - Elisabetta Pennacchioli
- Melanoma, Sarcoma, and Rare Tumors Surgery Division, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Sara Coppola
- Melanoma, Sarcoma, and Rare Tumors Surgery Division, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Giuseppe Viale
- Department of Pathology, European Institute of Oncology, Milan, Italy
- Department of Oncology and Hematology, University of Milan, Milan, Italy
| | | | - Richard D. Gelber
- Department of Data Science, Dana-Farber Cancer Institute, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Frontier Science & Technology Research Foundation, Boston, Massachusetts
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Fabio Conforti
- Division of Melanoma, Sarcomas, and Rare Tumors, European Institute of Oncology, Milan, Italy
- Oncology Unit, Humanitas Gavazzeni, Bergamo, Italy
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Smedman TM, Guren TK, Tveit KM, Thomsen M, Andersen MH, Line PD, Dueland S. Health-Related Quality of Life in Colorectal Cancer Patients Treated With Liver Transplantation Compared to Chemotherapy. Transpl Int 2022; 35:10404. [PMID: 35707633 PMCID: PMC9189292 DOI: 10.3389/ti.2022.10404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022]
Abstract
Liver transplantation (LT) for patients with non-resectable colorectal liver metastases (CRLM) offers improved survival and has gained increased interest internationally the last years. The aim of this study was to describe the health-related quality of life (HRQoL) in patients with non-resectable CRLM receiving LT and how baseline HRQoL factors affect overall survival (OS). HRQoL data in the SECA (SEcondary CAncer) LT cohort was compared to data obtained from colorectal cancer patients starting first-line chemotherapy for metastatic disease in a clinical trial and data from a Norwegian normal population. HRQoL data from the QLQ-C30 questionnaire used in the SECA LT study and the NORDIC- VII study were reported. The relationship between patient-reported symptom burden at baseline and OS was investigated. In the SECA study longitudinal HRQoL assessment was used to describe the time until definitive deterioration as well as mean values at different time points. Patients in the SECA and NORDIC-VII studies reported similar baseline HRQoL. The median time until definitive deterioration in the transplanted patients was estimated to 36 months. In the SECA study appetite loss and pain at baseline had negative impact on OS (25.3 versus 71.7 months, p = 0.002 and 39.7 versus 71.7 months, p = 0.038, respectively). Despite a relapse in most of the LT patients the Global Health Score (GHS) remained good. Pain, and especially appetite loss at time of transplantation is associated with poor outcome after LT.
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Affiliation(s)
- Tor Magnus Smedman
- Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- *Correspondence: Tor Magnus Smedman,
| | | | | | | | | | - Pål-Dag Line
- Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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10
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Gebski V, Obermair A, Janda M. Toward Incorporating Health-Related Quality of Life as Coprimary End Points in Clinical Trials: Time to Achieve Clinical Important Differences and QoL Profiles. J Clin Oncol 2022; 40:2378-2388. [PMID: 35576502 DOI: 10.1200/jco.21.02750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Besides morbidity and mortality, quality of life (QoL) is a key outcome of cancer treatments. Trials on the basis of clinical outcomes have expectations that QoL outcomes can be either tolerated or improved. Simultaneously considering QoL and clinical outcomes is challenging with lack of suitable metrics allowing incorporation of QoL as coprimary end points in clinical trial design and utilization of hierarchical hypothesis testing. METHOD We propose combining time to achieving a minimal clinically important difference (MCID) and probabilities of a MCID occurring in each QoL domain to provide QoL metrics analogous to those used for clinical end points. For QoL domains of interest, these yield QoL profiles, time to MCID, and number needed to treat. Incorporation of QoL as coprimary end points in clinical trial designs through hierarchical hypothesis testing can easily be achieved. The noninferiority designed Laparoscopic Approach to Carcinoma of the Endometrium trial, evaluating laparoscopic versus open abdominal surgery for endometrial cancer with Functional Assessment of Cancer Therapy-General QoL domains, is used to illustrate the usefulness of these metrics. RESULTS This analysis revealed that laparoscopic surgery had a significant shorter time to MCID for physical and functional well-being QoL domains (physical mean: 1.5 months, 95% CI, 0.5 to 2.6; P = .002; and functional mean: 1.4 months; 95% CI, 0.4 to 2.4; P = .003) than abdominal surgery, but little difference between the two approaches for psychologic social and emotion well-being. Probability profile plots show a consistent > 2-fold higher chance of attaining a MCID for physical and functional well-being over time for laparoscopic compared with abdominal surgery. CONCLUSION This analysis reinforces the potential value of novel MCID metrics and their usefulness in raising the profile of QoL outcomes to complement clinical end points. The methods will allow health professionals to counsel patients about QoL outcomes and clinical outcomes simultaneously.
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Affiliation(s)
- Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Andreas Obermair
- Queensland Centre for Gynaecological Cancer Research, University of Queensland, Brisbane, Queensland, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
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11
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Transarterial Radioembolization Versus Atezolizumab-Bevacizumab in Unresectable Hepatocellular Carcinoma: A Matching-Adjusted Indirect Comparison of Time to Deterioration in Quality of Life. Adv Ther 2022; 39:2035-2051. [PMID: 35279814 PMCID: PMC9056454 DOI: 10.1007/s12325-022-02099-0] [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: 01/03/2022] [Accepted: 02/15/2022] [Indexed: 12/24/2022]
Abstract
Introduction Given the relatively short life expectancy of patients with hepatocellular carcinoma (HCC), quality of life (QOL) plays a significant role in treatment selection. This analysis aimed to compare time to deterioration (TTD) in QOL with transarterial radioembolization (TARE) and atezolizumab–bevacizumab, as well as sorafenib, in advanced and unresectable HCC. Methods Patient-level data from SARAH (TARE using SIR-Spheres® Y-90 resin microspheres [SIR-Spheres] versus sorafenib) and aggregate data from IMbrave150 (atezolizumab–bevacizumab versus sorafenib) randomized controlled trials were used to conduct an anchored matching-adjusted indirect comparison (MAIC). Patients with a Child–Pugh score B in SARAH were excluded to align with exclusion criteria in IMbrave150. To identify potential effect modifiers for adjustment, the literature was searched and multivariate Cox proportional hazards models were implemented using SARAH data. Patients from SARAH were then weighted to balance with baseline characteristics from IMbrave150. Median TTD in QOL and hazard ratios (HRs) were calculated. Results Four potential effect modifiers were identified and used for adjustment: cause of disease (viral/non-viral), macrovascular invasion, Eastern Cooperative Oncology Group performance score, and alpha-fetoprotein level. The MAIC included 217 patients from SARAH (TARE = 94; sorafenib = 123). Median TTD in QOL was 11.23 and 8.64 months for atezolizumab–bevacizumab and TARE, respectively (HR = 1.06; 95% confidence interval [CI] 0.75–1.50; p = 0.725). A sensitivity analysis was conducted adjusting for cause of disease defined as hepatitis B/hepatitis C/non-viral: median TTD in QOL was higher for TARE compared with atezolizumab–bevacizumab (19.88 vs 11.23 months; HR = 0.66; 95% CI 0.36–1.19; p = 0.163). Sorafenib resulted in the shortest TTD in QOL, with statistically significant differences in both base case and sensitivity analyses. Conclusion TARE using SIR-Spheres may achieve similar TTD in QOL compared with atezolizumab–bevacizumab, as the analyses found no statistically significant differences between these two interventions. Both TARE using SIR-Spheres and atezolizumab–bevacizumab seem to be more efficacious than sorafenib in maintaining QOL. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02099-0. For patients with hepatocellular carcinoma, as well as physicians treating hepatocellular carcinoma, the quality of life that different treatments can offer represents an increasingly important aspect to consider when choosing treatments. Transarterial radioembolization and atezolizumab–bevacizumab are two potential treatments for advanced and unresectable hepatocellular carcinoma, but no clinical trials have directly compared the outcomes of these two therapeutic options. With the data available (patient-level data from a clinical trial of transarterial radioembolization using SIR-Spheres® Y-90 resin microspheres [SIR-Spheres] versus sorafenib and data from a trial of atezolizumab–bevacizumab versus sorafenib from the literature), this study indirectly compared the time to deterioration of quality of life (i.e., how long quality of life is maintained) after treatment with transarterial radioembolization and atezolizumab–bevacizumab. The study showed that quality of life may be preserved over a similar time period with transarterial radioembolization using SIR-Spheres and atezolizumab–bevacizumab; also, both transarterial radioembolization using SIR-Spheres and atezolizumab–bevacizumab seem to maintain patients’ quality of life over a longer period of time compared with sorafenib. These results are expected to enrich the existing evidence on which patients and physicians can base their decisions, allowing them to choose the most appropriate treatment by assessing the treatments’ characteristics as a whole.
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12
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Coomans MB, Dirven L, Aaronson N, Baumert BG, van den Bent M, Bottomley A, Brandes AA, Chinot O, Coens C, Gorlia T, Herrlinger U, Keime-Guibert F, Malmström A, Martinelli F, Stupp R, Talacchi A, Weller M, Wick W, Reijneveld JC, Taphoorn MJB. Factors associated with health-related quality of life (HRQoL) deterioration in glioma patients during the progression-free survival period. Neuro Oncol 2022; 24:2159-2169. [PMID: 35404443 PMCID: PMC9713503 DOI: 10.1093/neuonc/noac097] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Maintenance of functioning and well-being during the progression-free survival (PFS) period is important for glioma patients. This study aimed to determine whether health-related quality of life (HRQoL) can be maintained during progression-free time, and factors associated with HRQoL deterioration in this period. METHODS We included longitudinal HRQoL data from previously published clinical trials in glioma. The percentage of patients with stable HRQoL until progression was determined per scale and at the individual patient level (i.e. considering all scales simultaneously). We assessed time to a clinically relevant deterioration in HRQoL, expressed in deterioration-free survival and time-to-deterioration (the first including progression as an event). We also determined the association between sociodemographic and clinical factors and HRQoL deterioration in the progression-free period. RESULTS Five thousand five hundred and thirty-nine patients with at least baseline HRQoL scores had a median time from randomization to progression of 7.6 months. Between 9-29% of the patients deteriorated before disease progression on the evaluated HRQoL scales. When considering all scales simultaneously, 47% of patients deteriorated on ≥1 scale. Median deterioration-free survival period ranged between 3.8-5.4 months, and median time-to-deterioration between 8.2-11.9 months. For most scales, only poor performance status was independently associated with clinically relevant HRQoL deterioration in the progression-free period. CONCLUSIONS HRQoL was maintained in only 53% of patients in their progression-free period, and treatment was not independently associated with this deterioration in HRQoL. Routine monitoring of the patients' functioning and well-being during the entire disease course is therefore important, so that interventions can be initiated when problems are signaled.
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Affiliation(s)
- Marijke B Coomans
- Corresponding Author: Marijke Coomans, MSc, Leiden University Medical Center, Department of Neurology, PO BOX 9600, 2300 RC Leiden, the Netherlands ()
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands,Department of Neurology, Haaglanden Medical Center, Den Haag, the Netherlands
| | - Neil Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Brigitta G Baumert
- Institute of Radiation-Oncology, Kantonsspital Graubünden, Chur, Switzerland,Department of Radiation Oncology (MAASTRO Clinic), and GROW (School for Oncology and Developmental Biology), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Martin van den Bent
- The Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Andrew Bottomley
- Quality of Life Department, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Alba A Brandes
- Department of Medical Oncology, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Olivier Chinot
- Aix-Marseille Univ, APHM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service de Neuro-Oncologie, Marseille, France
| | - Corneel Coens
- Quality of Life Department, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Thierry Gorlia
- European Organization for Research and Treatment of Cancer, Headquarters, Brussels, Belgium
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Bonn, Germany
| | | | - Annika Malmström
- Department of Advanced Home Care and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Francesca Martinelli
- Quality of Life Department, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Roger Stupp
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois,USA
| | - Andrea Talacchi
- Department of Neurosciences, Azienda Ospedaliera San Giovanni Addolorata, Roma, Italia
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Wolfgang Wick
- Neurology Clinic and National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany,German Consortium of Translational Cancer Research (DKTK), Clinical Cooperation Unit Neurooncology, German Cancer Research Center, Heidelberg, Germany
| | - Jaap C Reijneveld
- Department of Neurology and Brain Tumour Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands,Department of Neurology, Haaglanden Medical Center, Den Haag, the Netherlands
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Brusniak K, Feisst M, Sebesteny L, Hartkopf A, Graf J, Engler T, Schneeweiss A, Wallwiener M, Deutsch TM. Measuring the Time to Deterioration for Health-Related Quality of Life in Patients With Metastatic Breast Cancer Using a Web-Based Monitoring Application: Longitudinal Cohort Study. JMIR Cancer 2021; 7:e25776. [PMID: 34636732 PMCID: PMC8548964 DOI: 10.2196/25776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/27/2021] [Accepted: 07/21/2021] [Indexed: 01/30/2023] Open
Abstract
Background Health-related quality of life (HRQoL) is used to evaluate the treatment of metastatic breast cancer. In a long-term therapy setting, HRQoL can be used as an important benchmark for treatment success. With the help of digital apps, HRQoL monitoring can be extended to more remote areas and be administered on a more frequent basis. Objective This study aims to evaluate 3 common HRQoL questionnaires in metastasized breast cancer in terms of TTD in a digital, web-based setting. We further aim to examine the development of the HRQoL in different systemic treatment groups in each of these evaluation instruments. Methods A total of 192 patients with metastatic breast cancer were analyzed in this bicentric prospective online cohort study at two German university hospitals. Patients completed questionnaires on HRQoL (EuroQol Visual Analog Scale [EQ-VAS], EuroQol 5 Dimension 5 Level [EQ-5D-5L], European Organization for Research and Treatment of Cancer Quality of Life Questionnaire–Core 30 item [EORTC QLQ-C30]) via an online platform over a 6-month period. Treatment schedules and medical history were retrieved from medical records. Unadjusted Cox regression analysis on treatment-related factors was performed. We conducted subgroup analyses in regard to TTD events between different treatments. Results The EQ-VAS showed a higher rate of deterioration after 8 weeks (84/179, 46.9%) than the EQ-5D-5L (47/163, 28.8%) and EORTC QLQ-C30 (65/176, 36.9%). Unadjusted Cox regression revealed significant connections between known metastases in the liver (P=.03, HR 1.64, 95% CI 1.06-2.52) and pleura (P=.04, HR 0.42, 95% CI 0.18-0.96) in the EQ-VAS. Significant relations between EQ-VAS events and single EQ-5D-5L items and the EQ-5D-5L summary score were demonstrated. All treatment groups significantly differed from the CDK4/6 inhibition subgroup in the EQ-VAS. Conclusions Compared to the EQ-5D-5L and QLQ-C30, the EQ-VAS showed a higher rate of deterioration after 8 weeks. Significant connections to certain metastatic locations were only detected in the EQ-VAS. The EQ-VAS is capable of reflecting the distinctive HRQoL profiles of different systemic treatments as well as the different aspects of HRQoL presented in the EQ-5D-5L. TTD with the EQ-VAS is an adequate mean of examining longitudinal development of HRQoL among breast cancer patients.
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Affiliation(s)
- Katharina Brusniak
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuel Feisst
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Linda Sebesteny
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Hartkopf
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Joachim Graf
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany.,Department of Midwifery Science, Institute for Health Sciences, University Hospital Tübingen, Tübingen, Germany
| | - Tobias Engler
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany.,Department of Midwifery Science, Institute for Health Sciences, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Schneeweiss
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg, Germany.,German Cancer Research Center, Heidelberg, Germany
| | - Markus Wallwiener
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
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Health-related quality of life in locally advanced hepatocellular carcinoma treated by either radioembolisation or sorafenib (SARAH trial). Eur J Cancer 2021; 154:46-56. [PMID: 34243077 DOI: 10.1016/j.ejca.2021.05.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/17/2021] [Accepted: 05/23/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The aim of this ancillary study of the SARAH trial is to compare health-related quality of life (HRQoL) in patients with locally advanced or inoperable hepatocellular carcinoma (HCC) treated with transarterial radioembolisation (TARE) or sorafenib. METHODS This study included randomised patients who received either TARE or at least one dose of sorafenib with no major deviation in the protocol and who had at least one QoL follow-up assessment in addition to the baseline evaluation. QoL was assessed from the date of randomisation using the European Organisation for Research and Treatment of Cancer QLQ-C30 questionnaire, until disease progression or other reasons for stopping study participation. Data were analysed using linear mixed and time-dependent models. RESULTS A total of 285 patients were included (122 and 163, in the TARE and sorafenib groups, respectively). Questionnaire completion rates were similar (77.5% versus 80.4%, in the TARE and sorafenib groups, respectively, p = 0.25). Longitudinal HRQoL analysis showed a significant treatment and time effects for fatigue and global health status, and significant treatment, time and treatment by time interaction effects for appetite loss, diarrhoea and social functioning. The median time to deterioration for the global health status was 3.9 months (95% confidence interval [CI] 3.7-4.3) versus 2.6 months (95% CI 2.0-3.0) in the TARE and sorafenib groups, respectively. CONCLUSIONS HRQoL was preserved longer with TARE than with sorafenib in locally advanced HCC. These data could be used to optimise management of patients with advanced or inoperable HCC.
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Liu S, Lin Z, Lin J, Chen H, Xie Q, Rao W, Chen Y, Yu K, Hu Z. Health-related quality of life and treatment modality among esophageal squamous cell carcinoma survivors: A prospective study using time to deterioration model analysis. J Surg Oncol 2020; 123:156-163. [PMID: 33126290 DOI: 10.1002/jso.26264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/09/2020] [Accepted: 10/05/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES This study aimed to analyze the association between health-related quality of life and treatment modality among esophageal squamous cell carcinoma (ESCC) survivors. METHODS Patients completed the EORTC QLQ-C30 and EORTC QLQ-OES18 at baseline and follow-up. A time to deterioration model analysis was performed to compare longitudinal EORTC QLQ-C30/QLQ-OES18 data between surgery alone and surgery with adjuvant chemotherapy. RESULTS For EORTC QLQ-C30 scale, compared with surgery alone, significant delays in time to deterioration in role functioning (16.05 months vs. 15.00 months; p = .045), cognitive functioning (20.80 months vs. 16.26 months; p = .017), social functioning (19.09 months vs. 12.35 months; p = .001), and dyspnea (18.53 months vs. 14.62 months; p = .011) were observed for surgery with adjuvant chemotherapy. For QLQ-OES18 scale, compared with surgery alone, significant delays in time to deterioration in dysphagia (13.75 months vs. 8.16 months; p = .005), choking when swallowing (20.67 months vs. 15.08 months; p = .001), and dry mouth (21.78 months vs. 17.28 months; p = .039) were observed for surgery with adjuvant chemotherapy. CONCLUSIONS Patients who received postoperative chemotherapy had significant delay in time to deterioration in multiple ESCC-related symptoms, functions of EORTC QLQ-C30 and EORTC QLQ-OES18.
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Affiliation(s)
- Shuang Liu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Zheng Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Jianbo Lin
- Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Huilin Chen
- Department of Radiation Oncology, Anxi County Hospital, Quanzhou, China
| | - Qianwen Xie
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Wenqing Rao
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Yuanmei Chen
- Department of Thoracic Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Kaili Yu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
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16
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Time to deterioration in cancer randomized clinical trials for patient-reported outcomes data: a systematic review. Qual Life Res 2019; 29:867-878. [DOI: 10.1007/s11136-019-02367-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2019] [Indexed: 12/18/2022]
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17
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Health-related quality of life in adults with relapsed/refractory acute lymphoblastic leukemia treated with blinatumomab. Blood 2018; 131:2906-2914. [PMID: 29739753 DOI: 10.1182/blood-2017-09-804658] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 04/26/2018] [Indexed: 12/16/2022] Open
Abstract
In the phase 3 TOWER study, blinatumomab significantly improved overall survival in adults with relapsed or refractory (R/R) Philadelphia chromosome-negative (Ph-) B-cell precursor acute lymphoblastic leukemia (BCP-ALL) relative to standard-of-care chemotherapy. A secondary objective of this study was to assess the impact of blinatumomab on health-related quality of life (HRQL) as measured by the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30). This analysis included the 342 of 405 randomized patients for whom baseline and ≥1 postbaseline result were available in any EORTC multi-item scale or single-item measure. In general, patients receiving blinatumomab (n = 247) reported better posttreatment HRQL across all QLQ-C30 subscales, based on descriptive mean change from baseline, than did those receiving chemotherapy (n = 95). The hazard ratios for time to deterioration (TTD) of ≥10 points from baseline in HRQL or death ranged from 0.42 to 0.81 in favor of blinatumomab, with the upper bounds of the 95% confidence interval <1.0 across all measures, except insomnia, social functioning, and financial difficulties; sensitivity analysis of TTD in HRQL without the event of death were consistent with these findings. When treatment effect over time was tested using a restricted maximum likelihood-based mixed model for repeated measures analysis, P < .05 was reached for blinatumomab vs chemotherapy for all subscale measures except financial difficulties. The clinically meaningful benefits in overall survival and HRQL support the clinical value of blinatumomab in patients with R/R Ph- BCP-ALL when compared with chemotherapy. This trial was registered at www.clinicaltrials.gov as #NCT02013167.
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18
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Breadner D, Vincent MD, Jonker D, Cripps C, Klimo P, Biagi J, Lam W, O'Connell A, Whiston F, Stitt L, Welch S. Health related quality of life in older or frail patients with advanced colorectal cancer treated with dose reduced capecitabine. J Geriatr Oncol 2018; 9:659-664. [PMID: 29728308 DOI: 10.1016/j.jgo.2018.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/02/2018] [Accepted: 04/05/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Palliative chemotherapy's role is to prolong survival while minimizing treatment toxicities to preserve or improve quality of life. We have recently published a phase II trial of dose reduced capecitabine in older or frail patients with advanced colorectal cancer (aCRC). We herein provide a robust analysis of the health related quality of life (HRQoL) data from our trial. METHODS A single arm multi-centered phase II trial of dose reduced capecitabine (1500 or 2000 mg/m2 days one-fourteen q21 days) in older or frail patients. Participants (182 patients) were asked to complete Functional Assessment of Cancer Therapy general questionnaire (FACT-G) at enrollment, after each cycle of capecitabine, and once upon completion, if possible. RESULTS 157 patients completed a baseline questionnaire (86%), and 137 patients (75%) completed at least one subsequent questionnaire. The mean baseline score was 81.6, out of a possible 108. The mean score peaked at 92 after cycle 10. The mean change from baseline was always positive. Patients achieving the minimal clinically important difference (MCID) ranged from 30% to 45% during treatment. Higher baseline FACT-G and Physical Well-being score were independently prognostic for improved survival (p = 0.006 and p < 0.0001, respectively). Time until definitive deterioration (TUDD) was insignificantly longer in patients with a higher baseline FACT-G (p = 0.18). CONCLUSION Baseline HRQoL scores were independently prognostic for survival, supporting their importance. Compared to full dose, reduced dose capecitabine has previously demonstrated equivalent efficacy and reduced toxicity. We have reported dose reduced capecitabine improves quality of life in older or frail patients with aCRC, further supporting its use in the management of aCRC.
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Affiliation(s)
- Daniel Breadner
- London Regional Cancer Program, London, Ontario, Canada; Schulich School of Medicine and Dentistry, London, Ontario, Canada.
| | - Mark David Vincent
- London Regional Cancer Program, London, Ontario, Canada; Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Derek Jonker
- Department of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Christine Cripps
- Department of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Paul Klimo
- Medical Oncology, Lions Gate Hospital, North Vancouver, British Columbia, Canada
| | - James Biagi
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Wendy Lam
- Burnaby Hospital Cancer Centre, Burnaby, British Columbia, Canada
| | | | | | - Larry Stitt
- London Regional Cancer Program, London, Ontario, Canada
| | - Stephen Welch
- London Regional Cancer Program, London, Ontario, Canada; Schulich School of Medicine and Dentistry, London, Ontario, Canada
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19
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Bascoul-Mollevi C, Savina M, Anota A, Barbieri A, Azria D, Bonnetain F, Gourgou S. Longitudinal health-related quality of life analysis in oncology with time to event approaches, the STATA command qlqc30_TTD. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 158:153-159. [PMID: 29544781 DOI: 10.1016/j.cmpb.2018.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 02/02/2018] [Accepted: 02/16/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Health-related quality of life (HRQoL) has become one relevant and available alternative endpoint of clinical trials in cancer research to evaluate efficiency of care both for the patient and health system. HRQoL in oncology is mainly assessed using the 30-item European Organisation for Research and Treatment of Cancer Quality of Life-Questionnaire Core 30 (EORTC QLQ-C30). The EORTC QLQ-C30 questionnaire is usually assessed at different times along the clinical trials in order to analyze the kinetics of HRQoL evolution and to fully assess the impact of the treatment on the patient's HRQoL level. In this perspective, the realization of a longitudinal HRQoL analysis is essential and the time to HRQoL score deterioration approach is a method which is more and more used in clinical trials. METHOD Using the Stata software, we developed a QLQ-C30 specific command, qlqc30_TTD, which implements longitudinal strategies based on the time to event methods by considering the time to HRQoL score deterioration. This user-written command providing automatic execution of the Time To Deterioration (TTD) and Time Until Definitive Deterioration (TUDD) methods. RESULT The program implements all published definitions and provides the Kaplan-Meier curves for each dimension (by group) and a table with the Hazard Ratio and Log-Rank test. CONCLUSION The longitudinal analysis of HRQoL data in cancer clinical trials remains complex with only few programs like ours computed. This program will be of great help and will allow a more systematic and quicker analysis of the HRQoL data in clinical trials in oncology.
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Affiliation(s)
- C Bascoul-Mollevi
- Biometrics Unit-CTD INCa, Institut du Cancer Montpellier | Val d'Aurelle (ICM), University of Montpellier, 208, Avenue des Apothicaires, 34298 Montpellier Cedex 5, France; Institut de Recherche en Cancérologie de Montpellier INSERM U1194, Montpellier, France; French National Quality of Life in oncology Platform, France.
| | - Marion Savina
- INSERM, Clinical and Epidemiological Research Unit (CIC-1014)-CTD INCa, Institut Bergonié, Bordeaux, France
| | - Amélie Anota
- French National Quality of Life in oncology Platform, France; Methodological and Quality of Life Unit in Oncology (INSERM UMR 1098), University Hospital of Besançon, Besançon, France
| | - Antoine Barbieri
- Biometrics Unit-CTD INCa, Institut du Cancer Montpellier | Val d'Aurelle (ICM), University of Montpellier, 208, Avenue des Apothicaires, 34298 Montpellier Cedex 5, France; Institut Montpelliérain Alexander Grothendieck, University of Montpellier, Montpellier, France
| | - David Azria
- Department of Radiation Oncology, Institut du Cancer Montpellier | Val d'Aurelle (ICM), University of Montpellier, Montpellier, France
| | - Franck Bonnetain
- French National Quality of Life in oncology Platform, France; Methodological and Quality of Life Unit in Oncology (INSERM UMR 1098), University Hospital of Besançon, Besançon, France
| | - Sophie Gourgou
- Biometrics Unit-CTD INCa, Institut du Cancer Montpellier | Val d'Aurelle (ICM), University of Montpellier, 208, Avenue des Apothicaires, 34298 Montpellier Cedex 5, France; French National Quality of Life in oncology Platform, France
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20
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Efficace F, Castagnetti F, Martino B, Breccia M, D'Adda M, Angelucci E, Stagno F, Cottone F, Malato A, Trabacchi E, Capalbo SF, Gobbi M, Visani G, Salvucci M, Capodanno I, Tosi P, Tiribelli M, Scortechini AR, Levato L, Maino E, Binotto G, Gugliotta G, Vignetti M, Baccarani M, Rosti G. Health-related quality of life in patients with chronic myeloid leukemia receiving first-line therapy with nilotinib. Cancer 2018; 124:2228-2237. [DOI: 10.1002/cncr.31323] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/22/2017] [Accepted: 02/09/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Fabio Efficace
- Data Center and Health Outcomes Research Unit; Italian Group for Adult Hematologic Diseases; Rome Italy
| | - Fausto Castagnetti
- L. and A. Seràgnoli Institute of Hematology, Department of Experimental, Diagnostic, and Specialty Medicine; S. Orsola-Malpighi University Hospital, University of Bologna; Bologna Italy
| | - Bruno Martino
- Hematology Unit; Bianchi-Melacrino-Morelli Azienda Ospedaliera; Reggio Calabria Italy
| | - Massimo Breccia
- Department of Cellular Biotechnologies and Hematology; Sapienza University of Rome; Rome Italy
| | - Mariella D'Adda
- Hematology Unit; Spedali Civili Azienda Ospedaliera; Brescia Italy
| | | | - Fabio Stagno
- Department of Hematology; University of Catania; Catania Italy
| | - Francesco Cottone
- Data Center and Health Outcomes Research Unit; Italian Group for Adult Hematologic Diseases; Rome Italy
| | | | - Elena Trabacchi
- Hematology and Bone Marrow Transplantation Unit, Department of Hematology and Oncology; G. da Saliceto Hospital; Piacenza Italy
| | | | - Marco Gobbi
- Clinical Hematology, Ospedale Policlinico S. Martino; Istituto di Ricovero e Cura a Carattere Scientifico; Genoa Italy
| | - Giuseppe Visani
- Hematology and Stem Cell Transplantation Unit; Azienda Ospedaliera Ospedali Riuniti Marche Nord; Pesaro Italy
| | - Marzia Salvucci
- Hematology Unit; Santa Maria delle Croci Hospital; Ravenna Italy
| | - Isabella Capodanno
- Hematology Unit, Arcispedale Santa Maria Nuova; Istituto di Ricovero e Cura a Carattere Scientifico; Reggio Emilia Italy
| | - Patrizia Tosi
- Hematology Unit; Infermi Hospital Rimini; Rimini Italy
| | - Mario Tiribelli
- Division of Hematology and Bone Marrow Transplantation, Department of Experimental and Clinical Medical Sciences; Azienda Ospedaliero-Universitaria di Udine; Udine Italy
| | - Anna Rita Scortechini
- Clinical Hematology Laboratory, Department of Molecular and Clinical Sciences; Polytechnic University of Marche; Ancona Italy
| | - Luciano Levato
- Hematology Unit; Pugliese-Ciaccio Hospital; Catanzaro Italy
| | - Elena Maino
- Hematology Unit; Dell'Angelo Hospital; Venezia-Mestre Italy
| | - Gianni Binotto
- Hematology and Clinical Immunology, Department of Medicine; Padua School of Medicine; Padua Italy
| | - Gabriele Gugliotta
- L. and A. Seràgnoli Institute of Hematology, Department of Experimental, Diagnostic, and Specialty Medicine; S. Orsola-Malpighi University Hospital, University of Bologna; Bologna Italy
| | - Marco Vignetti
- Data Center and Health Outcomes Research Unit; Italian Group for Adult Hematologic Diseases; Rome Italy
| | - Michele Baccarani
- L. and A. Seràgnoli Institute of Hematology, Department of Experimental, Diagnostic, and Specialty Medicine; S. Orsola-Malpighi University Hospital, University of Bologna; Bologna Italy
| | - Gianantonio Rosti
- L. and A. Seràgnoli Institute of Hematology, Department of Experimental, Diagnostic, and Specialty Medicine; S. Orsola-Malpighi University Hospital, University of Bologna; Bologna Italy
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21
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Ramachandran S, Sudhakar S, Thaslim F, Kirthika SV, Padmanabhan K, Samuel AJ. Beware! Reduced Functional Capacity and Quality of Life with Increased Fatigue Level among the Breast Cancer Survivors Undergoing Chemotherapy in India. Indian J Palliat Care 2018; 24:117-118. [PMID: 29440820 PMCID: PMC5801618 DOI: 10.4103/ijpc.ijpc_170_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- S Ramachandran
- Department of Cardiopulmonary Physiotherapy, Faculty of Physiotherapy, Dr. M.G.R. Educational and Research Institute University, Chennai, Tamil Nadu, India
| | - Selvaraj Sudhakar
- Department of Sports Physiotherapy, Faculty of Physiotherapy, Dr. M.G.R. Educational and Research Institute University, Chennai, Tamil Nadu, India
| | - Fousiya Thaslim
- Department of Cardiopulmonary Physiotherapy, Faculty of Physiotherapy, Dr. M.G.R. Educational and Research Institute University, Chennai, Tamil Nadu, India
| | - S Veena Kirthika
- Department of Neuro Physiotherapy, Faculty of Physiotherapy, Dr. M.G.R. Educational and Research Institute University, Chennai, Tamil Nadu, India
| | - K Padmanabhan
- Department of Ortho Physiotherapy, Faculty of Physiotherapy, Dr. M.G.R. Educational and Research Institute University, Chennai, Tamil Nadu, India
| | - Asir John Samuel
- Department of Pediatric and Neonatal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar University, Mullana, Ambala, Haryana, India
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22
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Health-related quality of life results from the PRODIGE 5/ACCORD 17 randomised trial of FOLFOX versus fluorouracil-cisplatin regimen in oesophageal cancer. Eur J Cancer 2017; 84:239-249. [PMID: 28829992 DOI: 10.1016/j.ejca.2017.07.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/17/2017] [Accepted: 07/22/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND A recent prospective randomised trial did not reveal significant differences in median progression-free survival between two chemoradiotherapy (CRT) regimens for inoperable non-metastatic oesophageal cancer patients. This secondary analysis aimed to describe the impact of CRT on health-related quality of life (HRQOL), physical functioning, dysphagia, fatigue and pain and to evaluate whether baseline HRQOL domains can predict overall survival. PATIENTS AND METHODS A total of 267 patients were randomly assigned to receive with 50 Gy of radiotherapy in 25 fractions six cycles of FOLFOX or four cycles of fluorouracil and cisplatin on day 1. HRQOL was prospectively assessed using the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire version 3.0 with the oesophageal cancer module (QLQ-OES18). RESULTS Both groups showed high baseline compliance. Subsequently, compliance reduced to 41% at the 6-month follow-up. Baseline HRQOL scores showed no statistical differences between treatment arms. During treatment, both groups exhibited lower physical and social functioning and increased fatigue and dyspnoea, although dysphagia moderately improved in the fluorouracil-cisplatin arm only (p = 0.047). During follow-up, HRQOL scores revealed no significant differences between chemotherapy regimens. Linear mixed model exhibited a treatment-by-time interaction effect for dysphagia (p = 0.017) with a greater decrease in dysphagia in the fluorouracil-cisplatin group. Time until definitive deterioration analysis showed no significant differences in global HRQOL, functional or main symptom domains. However, time until definitive deterioration was significantly longer for the fluorouracil and cisplatin arm compared with FOLFOX for appetite loss (p = 0.002), QLQ-OES-18 pain (p = 0.008), trouble swallowing saliva (p = 0.011) and trouble talking (p = 0.020). CONCLUSION Analyses of HRQOL scores revealed no statistically significant differences between patients with inoperable non-metastatic oesophageal cancer treated by FOLFOX versus those treated with a fluorouracil-cisplatin regimen as part of definitive CRT.
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23
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Jacquinot Q, Meneveau N, Chatot M, Bonnetain F, Degano B, Bouhaddi M, Dumoulin G, Vernerey D, Pivot X, Mougin F. A phase 2 randomized trial to evaluate the impact of a supervised exercise program on cardiotoxicity at 3 months in patients with HER2 overexpressing breast cancer undergoing adjuvant treatment by trastuzumab: design of the CARDAPAC study. BMC Cancer 2017. [PMID: 28629338 PMCID: PMC5480259 DOI: 10.1186/s12885-017-3420-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background The overexpression of human epidermal growth factor receptor-2 (HER2) in breast cancer is a poor prognosis. Trastuzumab improves overall survival but is associated with cardiotoxicity, especially a decline in left ventricular ejection fraction (LVEF). In addition, chemotherapy and radiotherapy increase fatigue and pain, decrease physical capacity and health-related quality of life. To date, no study has evaluated the benefits of physical activity on the side effects of treatment in patients with HER2 positive breast cancer. The aim of this study is to evaluate the impact of 3 months’ exercise intervention on myocardial function and in particular on the rate of cardiotoxicity. Methods This multicenter, randomized clinical trial will include 112 patients treated by adjuvant trastuzumab for HER2 positive breast cancer to investigate the effects of a 3 months’ supervised exercise program (intermittent exercise, combining moderate and high intensities; 55 minutes duration, 3 times per week), on the rate of cardiotoxicity [defined by either a decrease of the LVEF under 50% or an absolute drop of LVEF of 10%] between baseline and at 3 months and on strength, aerobic capacity, metabolic, inflammatory and hormonal parameters. Health-related quality of life, fatigue, pain and level of physical activity will also be assessed. Participants are randomly allocated to one of the two groups (“training group” vs “standard oncological care”). Performance-based and self-reported outcomes are assessed at baseline, at the end of supervised exercise program and at six months follow-up. Discussion Although physical exercise is recommended to reduce the side effects of adjuvant treatments in breast cancer patients, no randomized study has been conducted to assess the benefits of a physical training program in patients with HER2 overexpressing breast cancer. Cardiac toxicity of trastuzumab may be minimized with an exercise program combining high and moderate intensities. This type of program may be safe, feasible and effective but also increase cardiorespiratory fitness and improve health-related quality of life. If these benefits are confirmed, this exercise intervention could be systematically proposed to patients during the course of treatment by trastuzumab in addition to standard oncological care. Trial registration National Clinical Trials Number (NCT02433067); Registration 28 april 2015.
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Affiliation(s)
- Quentin Jacquinot
- UPFR des Sports, Université de Franche-Comté, 31 chemin de l'Epitaphe, 25000, Besançon, France. .,EA 3920: Marqueurs pronostiques et facteurs de regulation des pathologies cardiaques et vasculaires, CHU Jean-Minjoz, 25000, Besançon, France. .,Service d'Oncologie Médicale, CHU Jean-Minjoz, 25000, Besançon, France.
| | - Nathalie Meneveau
- Service d'Oncologie Médicale, CHU Jean-Minjoz, 25000, Besançon, France
| | - Marion Chatot
- Service de Cardiologie, CHU Jean-Minjoz, 25000, Besançon, France
| | - Franck Bonnetain
- INSERM UMR 1098: Unité de méthodologie et de qualité de vie en cancérologie, CHU Jean-Minjoz, 25000, Besançon, France
| | - Bruno Degano
- EA 3920: Marqueurs pronostiques et facteurs de regulation des pathologies cardiaques et vasculaires, CHU Jean-Minjoz, 25000, Besançon, France.,Physiologie-Explorations Fonctionnelles, CHU Jean-Minjoz, 25000, Besançon, France
| | - Malika Bouhaddi
- EA 3920: Marqueurs pronostiques et facteurs de regulation des pathologies cardiaques et vasculaires, CHU Jean-Minjoz, 25000, Besançon, France.,Physiologie-Explorations Fonctionnelles, CHU Jean-Minjoz, 25000, Besançon, France
| | - Gilles Dumoulin
- EA 3920: Marqueurs pronostiques et facteurs de regulation des pathologies cardiaques et vasculaires, CHU Jean-Minjoz, 25000, Besançon, France.,Laboratoire de Biochimie Endocrinienne et Métabolique, CHU Jean-Minjoz, 25000, Besançon, France
| | - Dewi Vernerey
- INSERM UMR 1098: Unité de méthodologie et de qualité de vie en cancérologie, CHU Jean-Minjoz, 25000, Besançon, France
| | - Xavier Pivot
- Service d'Oncologie Médicale, CHU Jean-Minjoz, 25000, Besançon, France
| | - Fabienne Mougin
- UPFR des Sports, Université de Franche-Comté, 31 chemin de l'Epitaphe, 25000, Besançon, France.,EA 3920: Marqueurs pronostiques et facteurs de regulation des pathologies cardiaques et vasculaires, CHU Jean-Minjoz, 25000, Besançon, France
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24
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Bourmaud A, Anota A, Moncharmont C, Tinquaut F, Oriol M, Trillet-Lenoir V, Bajard A, Parnalland S, Rotonda C, Bonnetain F, Pérol D, Chauvin F. Cancer-related fatigue management: evaluation of a patient education program with a large-scale randomised controlled trial, the PEPs fatigue study. Br J Cancer 2017; 116:849-858. [PMID: 28196066 PMCID: PMC5379143 DOI: 10.1038/bjc.2017.31] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 12/23/2016] [Accepted: 01/21/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To assess the efficacy of a patient educational program built according to guidelines that aims at reducing cancer-related fatigue (CRF). METHODS Randomised controlled trial, multicentre, comparing a patient education program, vs the standard of care. Patients were adult cancer outpatients with any tumour site. The primary outcome was fatigue severity assessed with a visual analogical scale (VAS), between the day of randomisation and week 7. Secondary outcomes were fatigue assessed with other scales, health-related quality of life, anxiety and depression. The time to fatigue severity deterioration was assessed. Analyses were performed in a modified intent-to-treat way, that is, including all patients with at least one baseline and 1 week 7 score. RESULTS A total of 212 patients were included. Fatigue severity assessment was made on 79 patients in the experimental group and 65 in the control group. Between randomisation and week 7, the fatigue (VAS) improved by 0.96 (2.85) points in the experimental group vs 1.63 (2.63) points in the control group (P=0.15). No differences with the secondary outcomes were highlighted between two groups. No other factors were found to be associated with fatigue severity deterioration. CONCLUSIONS Despite rigorous methodology, this study failed to highlight the program efficacy in fatigue reduction for cancer patients. Other assessment tools should be developed to measure the effect of the program on CRF and behaviour. The implementation of the program should also be explored in order to identify its mechanisms and longer-term impact.
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Affiliation(s)
- A Bourmaud
- Public Health Department, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
- Quality Safety Performance in Health (HESPER) EA7425, Lyon 1 University, Lyon, France
- Inserm, Clinical Investigation Center 1408, Saint-Etienne 42055, France
| | - A Anota
- French National Platform Quality of Life and Cancer, Besançon, France
- Methodology and Quality of Life Unit in Cancer, INSERM UMR 1098, University Hospital of Besançon, Besançon, France
| | - C Moncharmont
- Public Health Department, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
- Radiotherapy Department, Lucien Neuwirth Cancer Institut, Saint Priest en Jarez, France
| | - F Tinquaut
- Public Health Department, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
- Inserm, Clinical Investigation Center 1408, Saint-Etienne 42055, France
| | - M Oriol
- Public Health Department, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
- Inserm, Clinical Investigation Center 1408, Saint-Etienne 42055, France
| | - V Trillet-Lenoir
- Medical Oncology Department, Lyon-Sud Lyon-Sud teaching hospital, Lyon, France
| | - A Bajard
- Direction of Clinical Research and of Innovation, Léon Bérard Cancer Center, Lyon, France
| | - S Parnalland
- French National Platform Quality of Life and Cancer, Besançon, France
| | - C Rotonda
- French National Platform Quality of Life and Cancer, Besançon, France
- INSERM, CIC-EC CIE6, Nancy, France CHU Nancy, Clinical Epidemiology and Evaluation Department, Nancy, France
| | - F Bonnetain
- French National Platform Quality of Life and Cancer, Besançon, France
- Methodology and Quality of Life Unit in Cancer, INSERM UMR 1098, University Hospital of Besançon, Besançon, France
| | - D Pérol
- Direction of Clinical Research and of Innovation, Léon Bérard Cancer Center, Lyon, France
| | - F Chauvin
- Public Health Department, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
- Quality Safety Performance in Health (HESPER) EA7425, Lyon 1 University, Lyon, France
- Inserm, Clinical Investigation Center 1408, Saint-Etienne 42055, France
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25
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Bonnetain F, Efficace F, Fiteni F, Anota A. Reply to B. Kurland et al. J Clin Oncol 2016; 34:4450-4451. [PMID: 27601548 DOI: 10.1200/jco.2016.69.6690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Franck Bonnetain
- Franck Bonnetain, University Hospital of Besançon, Methodology and Quality of Life in Oncology Unit; and The French National Platform Quality of Life and Cancer; Institut National de la Santé et de la Recherche Médicale UMR 1098, Besançon France; Fabio Efficace, Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases, Rome, Italy; Frédéric Fiteni, University Hospital of Besançon, Methodology and Quality of Life in Oncology Unit, Besançon, France; and Amélie Anota, University Hospital of Besançon, Methodology and Quality of Life in Oncology Unit; and The French National Platform Quality of Life and Cancer; Institut National de la Santé et de la Recherche Médicale UMR 1098, Besançon, France
| | - Fabio Efficace
- Franck Bonnetain, University Hospital of Besançon, Methodology and Quality of Life in Oncology Unit; and The French National Platform Quality of Life and Cancer; Institut National de la Santé et de la Recherche Médicale UMR 1098, Besançon France; Fabio Efficace, Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases, Rome, Italy; Frédéric Fiteni, University Hospital of Besançon, Methodology and Quality of Life in Oncology Unit, Besançon, France; and Amélie Anota, University Hospital of Besançon, Methodology and Quality of Life in Oncology Unit; and The French National Platform Quality of Life and Cancer; Institut National de la Santé et de la Recherche Médicale UMR 1098, Besançon, France
| | - Frédéric Fiteni
- Franck Bonnetain, University Hospital of Besançon, Methodology and Quality of Life in Oncology Unit; and The French National Platform Quality of Life and Cancer; Institut National de la Santé et de la Recherche Médicale UMR 1098, Besançon France; Fabio Efficace, Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases, Rome, Italy; Frédéric Fiteni, University Hospital of Besançon, Methodology and Quality of Life in Oncology Unit, Besançon, France; and Amélie Anota, University Hospital of Besançon, Methodology and Quality of Life in Oncology Unit; and The French National Platform Quality of Life and Cancer; Institut National de la Santé et de la Recherche Médicale UMR 1098, Besançon, France
| | - Amélie Anota
- Franck Bonnetain, University Hospital of Besançon, Methodology and Quality of Life in Oncology Unit; and The French National Platform Quality of Life and Cancer; Institut National de la Santé et de la Recherche Médicale UMR 1098, Besançon France; Fabio Efficace, Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases, Rome, Italy; Frédéric Fiteni, University Hospital of Besançon, Methodology and Quality of Life in Oncology Unit, Besançon, France; and Amélie Anota, University Hospital of Besançon, Methodology and Quality of Life in Oncology Unit; and The French National Platform Quality of Life and Cancer; Institut National de la Santé et de la Recherche Médicale UMR 1098, Besançon, France
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Pozet A, Lejeune C, Bonnet M, Dabakuyo S, Dion M, Fagnoni P, Gaimard M, Imbert G, Nerich V, Foubert A, Chotard M, Bonin M, Anota A, Bonnetain F. Evaluation of efficacy and efficiency of a pragmatic intervention by a social worker to support informal caregivers of elderly patients (The ICE Study): study protocol for a randomized controlled trial. Trials 2016; 17:531. [PMID: 27881145 PMCID: PMC5122007 DOI: 10.1186/s13063-016-1622-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 09/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medical progress and the lifestyle modification have prolonged life expectancy, despite the development of chronic diseases. Support and care for older subjects are often provided by a network of informal caregivers composed of family, friends and neighbors, who are essential in helping older persons to continue living at home. It has been shown that the extent and diversity of informal tasks may jeopardize the physical, mental and social wellbeing of caregivers. METHODS/DESIGN The aim of the Informal Carers of Elderly cohort is to define, through a longitudinal study, profiles of caregivers of older patients with a diagnosis of one of the following diseases: cancer (breast, prostate, colorectal), neurodegenerative diseases (Parkinson's disease, Alzheimer's disease and similar diseases), neurovascular diseases (stroke), sensory diseases (age-related macular degeneration (AMD)) and heart disease (heart failure). Patients must be at least 60 years old and living in the region of Burgundy-Franche-Comte (France). By following the different phases of the caregiving relationship from the announcement of the diagnosis, it will be possible to assess the quality of life of caregivers, coping strategies, levels of anxiety and depression, social support and the extent of their burden. We will also evaluate the efficacy and efficiency of the implementation of a pragmatic intervention by a social worker to help informal caregivers, through a randomized interventional trial nested in the cohort. Qualitative approaches aimed at studying the caregiver/patient relationship, and situations leading to breakdown of the caregiver relationship will be also undertaken. DISCUSSION Through an analytical and longitudinal definition of profiles of informal caregivers, this study will gather detailed information on their life courses and their health trajectory by identifying consequences associated with the concept of their role as carers. In addition, the randomized interventional trial will explore the relevance of the implementation of a supportive intervention by a social worker to help caregivers. These data will help to identify strategies that could be used to improve the existing sources of aid and to propose new approaches to help caregivers. This study will provide the opportunity to identify the most relevant means of support adapted to caregivers, and provide an impulse for new health care policies. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02626377 . Retrospectively registered on 9 December 2015. Protocol date/version: 23 October 2014/version 2.
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Affiliation(s)
- Astrid Pozet
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Institut National de la Santé et de la Recherche Médicale UMR 1098, Besançon, France. .,Methodology and Quality of Life in Oncology Unit, University Hospital Jean Minjoz, Boulevard Fleming, 25030, Besançon, France.
| | - Catherine Lejeune
- INSERM U866 Epidémiologie et Recherche Clinique en Oncologie Digestive, University of Burgundy, Dijon, France
| | - Magalie Bonnet
- UFR Sciences du Langage de l'Homme et de la Société, University of Franche-Comté, Besançon, France
| | | | - Michèle Dion
- Centre Georges Chevrier, UMR CNRS 7366, UFR Sciences Humaines et Sociales, Dijon, France
| | - Philippe Fagnoni
- EA 4184, Faculty of Pharmacy, University of Burgundy, Dijon, France
| | - Maryse Gaimard
- Centre Georges Chevrier, UMR CNRS 7366, UFR Sciences Humaines et Sociales, Dijon, France
| | - Geneviève Imbert
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Institut National de la Santé et de la Recherche Médicale UMR 1098, Besançon, France
| | - Virginie Nerich
- INSERM U1098. Interaction Hôte-Greffon et Ingénierie Cellulaire et Génique, Besançon, France
| | - Audrey Foubert
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Institut National de la Santé et de la Recherche Médicale UMR 1098, Besançon, France
| | - Morgane Chotard
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Institut National de la Santé et de la Recherche Médicale UMR 1098, Besançon, France
| | - Marie Bonin
- Pôle de Gérontologie Interrégional Bourgogne et Franche-Comté (PGI), Besançon, France
| | - Amélie Anota
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Institut National de la Santé et de la Recherche Médicale UMR 1098, Besançon, France.,The French National Platform Quality of Life and Cancer, Besançon, France
| | - Franck Bonnetain
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Institut National de la Santé et de la Recherche Médicale UMR 1098, Besançon, France.,The French National Platform Quality of Life and Cancer, Besançon, France
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Anota A, Boulin M, Dabakuyo-Yonli S, Hillon P, Cercueil JP, Minello A, Jouve JL, Paoletti X, Bedenne L, Guiu B, Bonnetain F. An explorative study to assess the association between health-related quality of life and the recommended phase II dose in a phase I trial: idarubicin-loaded beads for chemoembolisation of hepatocellular carcinoma. BMJ Open 2016; 6:e010696. [PMID: 27342239 PMCID: PMC4932346 DOI: 10.1136/bmjopen-2015-010696] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The objective of this study was to explore the association between health-related quality of life (HRQoL) and the recommended phase 2 dose in a phase I clinical trial according to the Time to HRQoL deterioration approach (TTD). SETTING This is a phase I dose-escalation trial of transarterial chemoembolisation (TACE) with idarubicin-loaded beads performed in cirrhotic patients with hepatocellular carcinoma. Patients had to complete the EORTC QLQ-C30 HRQoL questionnaire at baseline and at days 15, 30 and 60 after TACE. PARTICIPANTS Patients aged ≥18 years with HCC unsuitable for curative treatments were evaluated for the study (N=21). PRIMARY AND SECONDARY OUTCOME MEASUREMENTS The primary objective was to determine the maximum tolerated dose (MTD) of idarubicin loaded after a single TACE session. MTD was defined as the dose level closest to that causing dose-limiting toxicity in 20% of patients. HRQoL was the secondary end point. RESULTS Between March 2010 and March 2011, 9, 6 and 6 patients were included at idarubicin dose levels of 5, 10 and 15 mg, respectively. Calculated MTD of idarubicin was 10 mg. At the 10 mg idarubicin dose, patients presented a longer TTD than at 5 mg, for global health status (HR=0.91 (95% CI 0.18 to 4.72)), physical functioning (HR=0.38 (0.04 to 3.22)), fatigue (HR=0.67 (0.18 to 2.56)) and pain (HR=0.47 (0.05 to 4.24)). CONCLUSIONS These HRQoL results were consistent with the estimated MTD, with a median TTD for global health status of 41 days (21 to NA) at 5 mg, 23 days (20 to NA) at 10 mg and 25 days (17 to NA) at 15 mg. These results show the importance of studying HRQoL in phase I trials. TRIAL REGISTRATION NUMBER NCT01040559; Post-results.
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Affiliation(s)
- Amélie Anota
- Quality of Life in Oncology National Platform, Besançon, France
- Methodological and Quality of Life in Oncology Unit (INSERM UMR 1098), University Hospital of Besançon, Besançon, France
| | - Mathieu Boulin
- INSERM U866, University of Burgundy, Dijon, France
- Department of Pharmacy, University Hospital, Dijon, France
| | - Sandrine Dabakuyo-Yonli
- Quality of Life in Oncology National Platform, Besançon, France
- Biostatistics and Quality of Life Unit (EA 4184), Centre Georges Francois Leclerc, Dijon, France
| | - Patrick Hillon
- INSERM U866, University of Burgundy, Dijon, France
- Department of Hepatogastroenterology, University Hospital, Dijon, France
| | - Jean-Pierre Cercueil
- INSERM U866, University of Burgundy, Dijon, France
- Department of Interventional Radiology, University Hospital, Dijon, France
| | - Anne Minello
- INSERM U866, University of Burgundy, Dijon, France
- Department of Hepatogastroenterology, University Hospital, Dijon, France
| | - Jean-Louis Jouve
- INSERM U866, University of Burgundy, Dijon, France
- Department of Hepatogastroenterology, University Hospital, Dijon, France
| | - Xavier Paoletti
- Department of Biostatistics and Epidemiology, Institut Gustave Roussy, Paris, France
| | - Laurent Bedenne
- INSERM U866, University of Burgundy, Dijon, France
- Department of Hepatogastroenterology, University Hospital, Dijon, France
| | - Boris Guiu
- Department of Radiology, St-Eloi University Hospital, Montpellier, France
| | - Franck Bonnetain
- Quality of Life in Oncology National Platform, Besançon, France
- Methodological and Quality of Life in Oncology Unit (INSERM UMR 1098), University Hospital of Besançon, Besançon, France
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Fiteni F, Anota A, Bonnetain F, Oster JP, Pichon E, Wislez M, Dauba J, Debieuvre D, Souquet PJ, Bigay-Game L, Molinier O, Dansin E, Poudenx M, Milleron B, Morin F, Zalcman G, Quoix E, Westeel V. Health-related quality of life in elderly patients with advanced non-small cell lung cancer comparing carboplatin and weekly paclitaxel doublet chemotherapy with monotherapy. Eur Respir J 2016; 48:861-72. [DOI: 10.1183/13993003.01695-2015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 04/26/2016] [Indexed: 11/12/2022]
Abstract
In the Intergroupe Francophone de Cancérologie Thoracique 0501 trial the carboplatin-paclitaxel chemotherapy increased toxicity (most frequent, decreased neutrophil count, asthenia). We longitudinally compared health-related quality of life (HRQoL) of the two treatment arms.In total, 451 patients aged 70–89 years with advanced non-small cell lung cancer (NSCLC) were randomly assigned to receive carboplatin plus paclitaxel or vinorelbine or gemcitabine. HRQoL was assessed by means of the European Organisation for Research and Treatment of Cancer QLQ-C30 questionnaire at baseline, week 6 and week 18.Using a five-point decrease as the minimal clinically important difference, patients treated with the chemotherapy doublet exhibited a significant longer time until definitive deterioration (TUDD) for two HRQoL dimensions: physical functioning (median TUDD: 2.04 for the doublet versus 1.71 months for monotherapy; log-rank p=0.01) and nausea and vomiting (median: not reached versus 4.83, respectively; log-rank p=0.046). Cox multivariate analysis revealed the carboplatin and paclitaxel arm to be independently associated with longer TUDD for these two HRQoL dimensions. In addition, TUDD didn't significantly differ between the two arms for all the other HRQoL dimensions.The chemotherapy doublet did not reduce TUDD in elderly patients with advanced NSCLC. Moreover, TUDD was prolonged for two HRQoL dimensions, namely physical functioning and nausea and vomiting.
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Hamidou Z, Chibaudel B, Hebbar M, Hug de Larauze M, André T, Louvet C, Brusquant D, Garcia-Larnicol ML, de Gramont A, Bonnetain F. Time to Definitive Health-Related Quality of Life Score Deterioration in Patients with Resectable Metastatic Colorectal Cancer Treated with FOLFOX4 versus Sequential Dose-Dense FOLFOX7 followed by FOLFIRI: The MIROX Randomized Phase III Trial. PLoS One 2016; 11:e0157067. [PMID: 27310205 PMCID: PMC4910973 DOI: 10.1371/journal.pone.0157067] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/23/2016] [Indexed: 01/03/2023] Open
Abstract
Purpose We previously showed that a sequential chemotherapy with dose-dense oxaliplatin (FOLFOX7) and irinotecan (FOLFIRI; irinotecan plus 5-fluorouracil/leucovorin) is not superior to FOLFOX4 in patients at advanced stage of colorectal cancer with liver metastases. Here we aimed to determine whether time to health-related quality of life (HRQoL) score definitive deterioration (TUDD) differs by study arm. Methods HRQoL was evaluated using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 at baseline and every 4 cycles until the end of the study or death. Functional scale, symptom scale, global health status, and financial difficulties were analyzed. The TUDD was defined as the time interval between randomization and the first decrease in HRQoL score ≥ 5-point with no further improvement in HRQoL score ≥ 5 points or any further HRQoL data. TUDD was estimated using the Kaplan-Meier method and the long-rank test. Cox regression analyses were used to identify HRQoL items influencing TUDD. Sensitivity analyses were done using a multiple imputation method and different definitions of TUDD. Results Of the 284 patients, 171 (60.2%) completed HRQoL questionnaires. Cox multivariate analysis showed no statistically significant difference in TUDD for most of the QLQ-C30 scales between treatments. Patients with dyspnea and those without symptoms at baseline had a significantly longer TUDD when there was a delay >12 months between diagnosis of the primary tumor and metastases (HR 0.48 [0.26–0.89]) and when there was diarrhea (HR 0.59 [0.36–0.96]), respectively. Conclusion This study shows that TUDD does not differ significantly according to type of treatment. The TUDD method produces meaningful longitudinal HRQoL results that may facilitate effective clinical decision making in patients with mCRC. Trial Registration ClinicalTrials.gov NCT00268398
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Affiliation(s)
- Zeinab Hamidou
- National clinical research Platform for Quality of life in Oncology, Marseille, France.,Public health laboratory, College of Medicine, Marseille, France
| | - Benoist Chibaudel
- Saint-Antoine Hospital, Department of Medical Oncology, Paris, France
| | - Mohamed Hebbar
- Centre Hospitalier Régional Universitaire, Claude Huriez Hospital, Service of Medical Oncology, Lille, France
| | | | - Thierry André
- Saint-Antoine Hospital, Department of Medical Oncology, Paris, France
| | - Christophe Louvet
- Institut Mutualiste Montsouris, Department of Medical Oncology, Paris, France
| | - David Brusquant
- Groupe Coopérateur Multidisciplinaire en Oncologie (GERCOR), Paris, France
| | | | - Aimery de Gramont
- Centre Hospitalier Régional Universitaire, Claude Huriez Hospital, Service of Medical Oncology, Lille, France
| | - Franck Bonnetain
- National clinical research Platform for Quality of life in Oncology, Marseille, France.,University Hospital of Besançon, Methodology and quality of life unit in oncology (EA3181), Besançon, France
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Bonnetain F, Fiteni F, Efficace F, Anota A. Statistical Challenges in the Analysis of Health-Related Quality of Life in Cancer Clinical Trials. J Clin Oncol 2016; 34:1953-6. [DOI: 10.1200/jco.2014.56.7974] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Franck Bonnetain
- Franck Bonnetain, Frédéric Fiteni, and Amélie Anota, University Hospital of Besançon; Franck Bonnetain, Frédéric Fiteni, and Amélie Anota, INSERM U1098, University of Franche-Comté; Franck Bonnetain and Amélie Anota, The French National Platform of Quality of Life and Cancer, Besançon, France; and Fabio Efficace, Italian Group for Adult Hematologic Diseases, Rome, Italy
| | - Frédéric Fiteni
- Franck Bonnetain, Frédéric Fiteni, and Amélie Anota, University Hospital of Besançon; Franck Bonnetain, Frédéric Fiteni, and Amélie Anota, INSERM U1098, University of Franche-Comté; Franck Bonnetain and Amélie Anota, The French National Platform of Quality of Life and Cancer, Besançon, France; and Fabio Efficace, Italian Group for Adult Hematologic Diseases, Rome, Italy
| | - Fabio Efficace
- Franck Bonnetain, Frédéric Fiteni, and Amélie Anota, University Hospital of Besançon; Franck Bonnetain, Frédéric Fiteni, and Amélie Anota, INSERM U1098, University of Franche-Comté; Franck Bonnetain and Amélie Anota, The French National Platform of Quality of Life and Cancer, Besançon, France; and Fabio Efficace, Italian Group for Adult Hematologic Diseases, Rome, Italy
| | - Amélie Anota
- Franck Bonnetain, Frédéric Fiteni, and Amélie Anota, University Hospital of Besançon; Franck Bonnetain, Frédéric Fiteni, and Amélie Anota, INSERM U1098, University of Franche-Comté; Franck Bonnetain and Amélie Anota, The French National Platform of Quality of Life and Cancer, Besançon, France; and Fabio Efficace, Italian Group for Adult Hematologic Diseases, Rome, Italy
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Barbieri A, Anota A, Conroy T, Gourgou-Bourgade S, Juzyna B, Bonnetain F, Lavergne C, Bascoul-Mollevi C. Applying the Longitudinal Model from Item Response Theory to Assess Health-Related Quality of Life in the PRODIGE 4/ACCORD 11 Randomized Trial. Med Decis Making 2015; 36:615-28. [PMID: 26683246 DOI: 10.1177/0272989x15621883] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 11/16/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION A new longitudinal statistical approach was compared to the classical methods currently used to analyze health-related quality-of-life (HRQoL) data. The comparison was made using data in patients with metastatic pancreatic cancer. METHODS Three hundred forty-two patients from the PRODIGE4/ACCORD 11 study were randomly assigned to FOLFIRINOX versus gemcitabine regimens. HRQoL was evaluated using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30. The classical analysis uses a linear mixed model (LMM), considering an HRQoL score as a good representation of the true value of the HRQoL, following EORTC recommendations. In contrast, built on the item response theory (IRT), our approach considered HRQoL as a latent variable directly estimated from the raw data. For polytomous items, we extended the partial credit model to a longitudinal analysis (longitudinal partial credit model [LPCM]), thereby modeling the latent trait as a function of time and other covariates. RESULTS Both models gave the same conclusions on 11 of 15 HRQoL dimensions. HRQoL evolution was similar between the 2 treatment arms, except for the symptoms of pain. Indeed, regarding the LPCM, pain perception was significantly less important in the FOLFIRINOX arm than in the gemcitabine arm. For most of the scales, HRQoL changes over time, and no difference was found between treatments in terms of HRQoL. DISCUSSION The use of LMM to study the HRQoL score does not seem appropriate. It is an easy-to-use model, but the basic statistical assumptions do not check. Our IRT model may be more complex but shows the same qualities and gives similar results. It has the additional advantage of being more precise and suitable because of its direct use of raw data.
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Affiliation(s)
- Antoine Barbieri
- Biometrics Unit-CTD INCa, Institut régional du Cancer Montpellier (ICM) - Val d'Aurelle, Montpellier, France (AB, SG-B, CB-M),Institut Montpelliérain Alexander Grothendieck, University of Montpellier, Montpellier, France (AB, CL)
| | - Amélie Anota
- National Quality of Life in Oncology Platform, France (AA, TC, FB),Methodological and Quality of Life Unit in Oncology (EA 3181), Besançon, France (AA, FB)
| | - Thierry Conroy
- National Quality of Life in Oncology Platform, France (AA, TC, FB),Institut de Cancérologie de Lorraine, Nancy, France (TC)
| | - Sophie Gourgou-Bourgade
- Biometrics Unit-CTD INCa, Institut régional du Cancer Montpellier (ICM) - Val d'Aurelle, Montpellier, France (AB, SG-B, CB-M)
| | | | - Franck Bonnetain
- National Quality of Life in Oncology Platform, France (AA, TC, FB),Methodological and Quality of Life Unit in Oncology (EA 3181), Besançon, France (AA, FB)
| | - Christian Lavergne
- Institut Montpelliérain Alexander Grothendieck, University of Montpellier, Montpellier, France (AB, CL),Université Paul-Valéry Montpellier 3, Montpellier, France (CL)
| | - Caroline Bascoul-Mollevi
- Biometrics Unit-CTD INCa, Institut régional du Cancer Montpellier (ICM) - Val d'Aurelle, Montpellier, France (AB, SG-B, CB-M)
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Chibaudel B, Bonnetain F, Tournigand C, de Larauze MH, de Gramont A, Laurent-Puig P, Paget J, Hadengue A, Notelet D, Benetkiewicz M, André T, de Gramont A. STRATEGIC-1: A multiple-lines, randomized, open-label GERCOR phase III study in patients with unresectable wild-type RAS metastatic colorectal cancer. BMC Cancer 2015; 15:496. [PMID: 26141683 PMCID: PMC4490616 DOI: 10.1186/s12885-015-1503-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 06/19/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The management of unresectable metastatic colorectal cancer (mCRC) is a comprehensive treatment strategy involving several lines of therapy, maintenance, salvage surgery, and treatment-free intervals. Besides chemotherapy (fluoropyrimidine, oxaliplatin, irinotecan), molecular-targeted agents such as anti-angiogenic agents (bevacizumab, aflibercept, regorafenib) and anti-epidermal growth factor receptor agents (cetuximab, panitumumab) have become available. Ultimately, given the increasing cost of new active compounds, new strategy trials are needed to define the optimal use and the best sequencing of these agents. Such new clinical trials require alternative endpoints that can capture the effect of several treatment lines and be measured earlier than overall survival to help shorten the duration and reduce the size and cost of trials. METHODS/DESIGN STRATEGIC-1 is an international, open-label, randomized, multicenter phase III trial designed to determine an optimally personalized treatment sequence of the available treatment modalities in patients with unresectable RAS wild-type mCRC. Two standard treatment strategies are compared: first-line FOLFIRI-cetuximab, followed by oxaliplatin-based second-line chemotherapy with bevacizumab (Arm A) vs. first-line OPTIMOX-bevacizumab, followed by irinotecan-based second-line chemotherapy with bevacizumab, and by an anti-epidermal growth factor receptor monoclonal antibody with or without irinotecan as third-line treatment (Arm B). The primary endpoint is duration of disease control. A total of 500 patients will be randomized in a 1:1 ratio to one of the two treatment strategies. DISCUSSION The STRATEGIC-1 trial is designed to give global information on the therapeutic sequences in patients with unresectable RAS wild-type mCRC that in turn is likely to have a significant impact on the management of this patient population. The trial is open for inclusion since August 2013. TRIAL REGISTRATION STRATEGIC-1 is registered at Clinicaltrials.gov: NCT01910610, 23 July, 2013. STRATEGIC-1 is registered at EudraCT-No.: 2013-001928-19, 25 April, 2013.
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Affiliation(s)
- Benoist Chibaudel
- Division of Medical Oncology, Institut Hospitalier Franco-Britannique, 4, rue Kleber, 92300, Levallois-Perret, France.
- GERCOR-IRC (Groupe Coopérateur Multidisciplinaire en Oncologie-Innovative Research Consortium), 151, rue du Faubourg Saint-Antoine, 75011, Paris, France.
| | - Franck Bonnetain
- Methodology and quality of life in oncology unit (EA 3181) & Quality of life and cancer clinical research platform, Hospital Saint-Jacques, 2 place Saint Jacques, 25000, Besançon, France.
| | - Christophe Tournigand
- Division of Medical Oncology, Hospital Henri-Mondor, Assistance Publique des Hôpitaux de Paris, Université Paris Est Créteil, Paris 12, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
| | - Marine Hug de Larauze
- GERCOR-IRC (Groupe Coopérateur Multidisciplinaire en Oncologie-Innovative Research Consortium), 151, rue du Faubourg Saint-Antoine, 75011, Paris, France.
| | - Armand de Gramont
- GERCOR-IRC (Groupe Coopérateur Multidisciplinaire en Oncologie-Innovative Research Consortium), 151, rue du Faubourg Saint-Antoine, 75011, Paris, France.
- New drug Evaluation Laboratory, Centre of Experimental Therapeutics, Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
| | - Pierre Laurent-Puig
- INSERM U 775 - Faculté des Sciences Fondamentales et Biomédicales, Centre Universitaire des Saints-Pères, 45 Rue des Saints-Pères, 75006, Paris, France.
| | - Jérôme Paget
- LINCOLN, 4 rue Danjou, 92517 Cedex, Boulogne Billancourt, France.
| | - Alexandra Hadengue
- GERCOR-IRC (Groupe Coopérateur Multidisciplinaire en Oncologie-Innovative Research Consortium), 151, rue du Faubourg Saint-Antoine, 75011, Paris, France.
| | - Dominique Notelet
- GERCOR-IRC (Groupe Coopérateur Multidisciplinaire en Oncologie-Innovative Research Consortium), 151, rue du Faubourg Saint-Antoine, 75011, Paris, France.
| | - Magdalena Benetkiewicz
- GERCOR-IRC (Groupe Coopérateur Multidisciplinaire en Oncologie-Innovative Research Consortium), 151, rue du Faubourg Saint-Antoine, 75011, Paris, France.
| | - Thierry André
- Division of Medical Oncology, Hospital Saint-Antoine, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie (UPMC), Paris VI, 184, rue du Faubourg Saint-Antoine,, 75571 Cedex 12, Paris, France.
| | - Aimery de Gramont
- Division of Medical Oncology, Institut Hospitalier Franco-Britannique, 4, rue Kleber, 92300, Levallois-Perret, France.
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Anota A, Barbieri A, Savina M, Pam A, Gourgou-Bourgade S, Bonnetain F, Bascoul-Mollevi C. Comparison of three longitudinal analysis models for the health-related quality of life in oncology: a simulation study. Health Qual Life Outcomes 2014; 12:192. [PMID: 25551580 PMCID: PMC4326524 DOI: 10.1186/s12955-014-0192-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 12/12/2014] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Health-Related Quality of Life (HRQoL) is an important endpoint in oncology clinical trials aiming to investigate the clinical benefit of new therapeutic strategies for the patient. However, the longitudinal analysis of HRQoL remains complex and unstandardized. There is clearly a need to propose accessible statistical methods and meaningful results for clinicians. The objective of this study was to compare three strategies for longitudinal analyses of HRQoL data in oncology clinical trials through a simulation study. METHODS The methods proposed were: the score and mixed model (SM); a survival analysis approach based on the time to HRQoL score deterioration (TTD); and the longitudinal partial credit model (LPCM). Simulations compared the methods in terms of type I error and statistical power of the test of an interaction effect between treatment arm and time. Several simulation scenarios were explored based on the EORTC HRQoL questionnaires and varying the number of patients (100, 200 or 300), items (1, 2 or 4) and response categories per item (4 or 7). Five or 10 measurement times were considered, with correlations ranging from low to high between each measure. The impact of informative missing data on these methods was also studied to reflect the reality of most clinical trials. RESULTS With complete data, the type I error rate was close to the expected value (5%) for all methods, while the SM method was the most powerful method, followed by LPCM. The power of TTD is low for single-item dimensions, because only four possible values exist for the score. When the number of items increases, the power of the SM approach remained stable, those of the TTD method increases while the power of LPCM remained stable. With 10 measurement times, the LPCM was less efficient. With informative missing data, the statistical power of SM and TTD tended to decrease, while that of LPCM tended to increase. CONCLUSIONS To conclude, the SM model was the most powerful model, irrespective of the scenario considered, and the presence or not of missing data. The TTD method should be avoided for single-item dimensions of the EORTC questionnaire. While the LPCM model was more adapted to this kind of data, it was less efficient than the SM model. These results warrant validation through comparisons on real data.
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Affiliation(s)
- Amélie Anota
- Quality of Life in Oncology National Platform, Besançon, France. .,Methodological and Quality of Life in Oncology Unit, EA 3181, University Hospital of Besançon, Besançon, France.
| | - Antoine Barbieri
- Biostatistic unit, Institut régional du Cancer de Montpellier (ICM) - Val d'Aurelle, Montpellier, France. .,Institut de Mathématiques et de Modélisation de Montpellier, University of Montpellier 2, Montpellier, France.
| | - Marion Savina
- INSERM, Clinical and EpidemiologicalResearch Unit (CIC-EC 7) - CTD INCa, Institut Bergonié, Bordeaux, France. .,INSERM CIC-EC7 Axe Cancer, Université de Bordeaux, Bordeaux, France.
| | - Alhousseiny Pam
- Methodological and Quality of Life in Oncology Unit, EA 3181, University Hospital of Besançon, Besançon, France.
| | - Sophie Gourgou-Bourgade
- Biostatistic unit, Institut régional du Cancer de Montpellier (ICM) - Val d'Aurelle, Montpellier, France.
| | - Franck Bonnetain
- Quality of Life in Oncology National Platform, Besançon, France. .,Methodological and Quality of Life in Oncology Unit, EA 3181, University Hospital of Besançon, Besançon, France.
| | - Caroline Bascoul-Mollevi
- Biostatistic unit, Institut régional du Cancer de Montpellier (ICM) - Val d'Aurelle, Montpellier, France.
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Hamidou Z, Dabakuyo-Yonli TS, Guillemin F, Conroy T, Velten M, Jolly D, Causeret S, Graesslin O, Gauthier M, Mercier M, Bonnetain F. Impact of response shift on time to deterioration in quality of life scores in breast cancer patients. PLoS One 2014; 9:e96848. [PMID: 24828426 PMCID: PMC4020802 DOI: 10.1371/journal.pone.0096848] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 04/11/2014] [Indexed: 11/23/2022] Open
Abstract
Background This prospective multicenter study aimed to study the impact of the recalibration component of response-shift (RS) on time to deterioration (TTD) in health related quality of life (QoL) scores in breast cancer (BC) patients and the influence of baseline QoL expectations on TTD. Methods The EORTC-QLQ-C30 and BR-23 questionnaires were used to assess the QoL in a prospective multicenter study at inclusion (T0), at the end of the first hospitalization (T1) and, three (T2) and 6 months after the first hospitalization (T3). Recalibration was investigated by the then-test method. QoL expectancy was assessed at diagnosis. Deterioration was defined as a 5-point decrease in QoL scores, considered a minimal clinically important difference (MCID). TTD was estimated using the Kaplan-Meier method. Cox regression analyses were used to identify factors influencing TTD. Results From February 2006 to February 2008, 381 women were included. Recalibration of breast cancer patients' internal standards in the assessment of their QoL had an impact on TTD. Median TTD were significantly shorter when recalibration was not taken into account than when recalibration was taken into account for global health, role-functioning, social-functioning, body-image and side effects of systemic therapy. Cox multivariate analyses showed that for body image, when recalibration was taken into account, radiotherapy was associated with a shorter TTD (HR: 0.60[0.38–0.94], whereas, no significant impact of surgery type on TTD was observed. For global health, cognitive and social functioning dimensions, patients expecting a deterioration in their QoL at baseline had a significantly shorter TTD. Conclusions Our results showed that RS and baseline QoL expectations were associated with time to deterioration in breast cancer patients.
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Affiliation(s)
- Zeinab Hamidou
- Quality of life and Cancer clinical research Platform, Marseille, France
- Public health laboratory, EA 3279-College of Medicine, Marseille, France
- * E-mail:
| | - Tienhan S. Dabakuyo-Yonli
- Quality of life and Cancer clinical research Platform, Marseille, France
- Biostatistic and Quality of Life Unit, Centre Georges François Leclerc, Dijon, France
- EA 4184, College of Medicine, Dijon, France
| | - Francis Guillemin
- Quality of life and Cancer clinical research Platform, Marseille, France
- Inserm, CIC-EC, department of clinical epidemiology and evaluation, university hospital of Nancy, Nancy, France
| | - Thierry Conroy
- Medical oncology department, Centre Alexis Vautrin, Nancy, France
| | - Michel Velten
- Quality of life and Cancer clinical research Platform, Marseille, France
- Epidemiology and public health laboratory, College of Medicine, Strasbourg, France
| | - Damien Jolly
- Quality of life and Cancer clinical research Platform, Marseille, France
- University hospital of Reims, Reims, France
| | - Sylvain Causeret
- Surgery department, Centre Georges François Leclerc, Dijon, France
| | - Olivier Graesslin
- Gynecology and Obstetrics Department, Mother Child Institute, University hospital of Reims, Reims, France
| | - Mélanie Gauthier
- Quality of life and Cancer clinical research Platform, Marseille, France
- Biostatistic and Quality of Life Unit, Centre Georges François Leclerc, Dijon, France
- EA 4184, College of Medicine, Dijon, France
| | - Mariette Mercier
- Quality of life and Cancer clinical research Platform, Marseille, France
- Cellular and Molecular Biology Laboratory, University hospital of Besançon, Besançon, France
| | - Franck. Bonnetain
- Quality of life and Cancer clinical research Platform, Marseille, France
- Methodology and quality of Life in Oncology unit (EA 3181), University hospital of Besançon, Besançon, France
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Anota A, Bascoul-Mollevi C, Conroy T, Guillemin F, Velten M, Jolly D, Mercier M, Causeret S, Cuisenier J, Graesslin O, Hamidou Z, Bonnetain F. Item response theory and factor analysis as a mean to characterize occurrence of response shift in a longitudinal quality of life study in breast cancer patients. Health Qual Life Outcomes 2014; 12:32. [PMID: 24606836 PMCID: PMC4016038 DOI: 10.1186/1477-7525-12-32] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/01/2014] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The occurrence of response shift (RS) in longitudinal health-related quality of life (HRQoL) studies, reflecting patient adaptation to disease, has already been demonstrated. Several methods have been developed to detect the three different types of response shift (RS), i.e. recalibration RS, 2) reprioritization RS, and 3) reconceptualization RS. We investigated two complementary methods that characterize the occurrence of RS: factor analysis, comprising Principal Component Analysis (PCA) and Multiple Correspondence Analysis (MCA), and a method of Item Response Theory (IRT). METHODS Breast cancer patients (n = 381) completed the EORTC QLQ-C30 and EORTC QLQ-BR23 questionnaires at baseline, immediately following surgery, and three and six months after surgery, according to the "then-test/post-test" design. Recalibration was explored using MCA and a model of IRT, called the Linear Logistic Model with Relaxed Assumptions (LLRA) using the then-test method. Principal Component Analysis (PCA) was used to explore reconceptualization and reprioritization. RESULTS MCA highlighted the main profiles of recalibration: patients with high HRQoL level report a slightly worse HRQoL level retrospectively and vice versa. The LLRA model indicated a downward or upward recalibration for each dimension. At six months, the recalibration effect was statistically significant for 11/22 dimensions of the QLQ-C30 and BR23 according to the LLRA model (p ≤ 0.001). Regarding the QLQ-C30, PCA indicated a reprioritization of symptom scales and reconceptualization via an increased correlation between functional scales. CONCLUSIONS Our findings demonstrate the usefulness of these analyses in characterizing the occurrence of RS. MCA and IRT model had convergent results with then-test method to characterize recalibration component of RS. PCA is an indirect method in investigating the reprioritization and reconceptualization components of RS.
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Affiliation(s)
- Amélie Anota
- Quality of Life in Oncology Platform, Besançon, France.
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Fiteni F, Westeel V, Pivot X, Borg C, Vernerey D, Bonnetain F. Endpoints in cancer clinical trials. J Visc Surg 2014; 151:17-22. [DOI: 10.1016/j.jviscsurg.2013.10.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Time to health-related quality of life score deterioration as a modality of longitudinal analysis for health-related quality of life studies in oncology: do we need RECIST for quality of life to achieve standardization? Qual Life Res 2013; 24:5-18. [PMID: 24277234 PMCID: PMC4282717 DOI: 10.1007/s11136-013-0583-6] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2013] [Indexed: 12/19/2022]
Abstract
Purpose Longitudinal analysis of health-related quality of life (HRQoL) remains unstandardized and compromises comparison of results between trials.
In oncology, despite available statistical approaches, results are poorly used to change standards of care, mainly due to lack of standardization and the ability to propose clinical meaningful results. In this context, the time to deterioration (TTD) has been proposed as a modality of longitudinal HRQoL analysis for cancer patients. As for tumor response and progression, we propose to develop RECIST criteria for HRQoL. Methods Several definitions of TTD are investigated in this paper. We applied this approach in early breast cancer and metastatic pancreatic cancer with a 5-point minimal clinically important difference. In breast cancer, TTD was defined as compared to the baseline score or to the best previous score. In pancreatic cancer (arm 1: gemcitabine with FOLFIRI.3, arm 2: gemcitabine alone), the time until definitive deterioration (TUDD) was investigated with or without death as event. Results In the breast cancer study, 381 women were included. The median TTD was influenced by the choice of the reference score. In pancreatic cancer study, 98 patients were enrolled. Patients in Arm 1 presented longer TUDD than those in Arm 2 for most of HRQoL scores. Results of TUDD were slightly different according to the definition of deterioration applied.
Conclusion Currently, the international ARCAD group supports the idea of developing RECIST for HRQoL in pancreatic and colorectal cancer with liver metastasis, with a view to using HRQoL as a co-primary endpoint along with a tumor parameter.
Electronic supplementary material The online version of this article (doi:10.1007/s11136-013-0583-6) contains supplementary material, which is available to authorized users.
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