1
|
Beltran-Bless AA, Clemons M, Vandermeer L, El Emam K, Ng TL, McGee S, Awan AA, Pond G, Renaud J, Barton G, Hutton B, Savard MF. The REthinking Clinical Trials Program Retreat 2023: Creating Partnerships to Optimize Quality Cancer Care. Curr Oncol 2024; 31:1376-1388. [PMID: 38534937 PMCID: PMC10969202 DOI: 10.3390/curroncol31030104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 04/13/2024] Open
Abstract
Patients, families, healthcare providers and funders face multiple comparable treatment options without knowing which provides the best quality of care. As a step towards improving this, the REthinking Clinical Trials (REaCT) pragmatic trials program started in 2014 to break down many of the traditional barriers to performing clinical trials. However, until other innovative methodologies become widely used, the impact of this program will remain limited. These innovations include the incorporation of near equivalence analyses and the incorporation of artificial intelligence (AI) into clinical trial design. Near equivalence analyses allow for the comparison of different treatments (drug and non-drug) using quality of life, toxicity, cost-effectiveness, and pharmacokinetic/pharmacodynamic data. AI offers unique opportunities to maximize the information gleaned from clinical trials, reduces sample size estimates, and can potentially "rescue" poorly accruing trials. On 2 May 2023, the first REaCT international symposium took place to connect clinicians and scientists, set goals and identify future avenues for investigator-led clinical trials. Here, we summarize the topics presented at this meeting to promote sharing and support other similarly motivated groups to learn and share their experiences.
Collapse
Affiliation(s)
- Ana-Alicia Beltran-Bless
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (A.-A.B.-B.); (M.C.); (T.L.N.); (S.M.); (A.A.A.)
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
| | - Mark Clemons
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (A.-A.B.-B.); (M.C.); (T.L.N.); (S.M.); (A.A.A.)
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
| | - Lisa Vandermeer
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
| | | | - Terry L. Ng
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (A.-A.B.-B.); (M.C.); (T.L.N.); (S.M.); (A.A.A.)
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
| | - Sharon McGee
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (A.-A.B.-B.); (M.C.); (T.L.N.); (S.M.); (A.A.A.)
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
| | - Arif Ali Awan
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (A.-A.B.-B.); (M.C.); (T.L.N.); (S.M.); (A.A.A.)
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
| | - Gregory Pond
- Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Julie Renaud
- Champlain Regional Cancer Program, Ottawa, ON K1H 8L6, Canada;
| | - Gwen Barton
- Psychosocial Oncology, Patient Engagement/Experience, Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada;
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1N 6N, Canada
| | - Marie-France Savard
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (A.-A.B.-B.); (M.C.); (T.L.N.); (S.M.); (A.A.A.)
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
| |
Collapse
|
2
|
Wilson BE, Hay AE, Chan KKW, Cheung MC, Hanna TP. Augmenting clinical trial economic analysis by linking cancer trial data to administrative data: current landscape and future opportunities. BMJ Open 2023; 13:e073353. [PMID: 37567744 PMCID: PMC10423795 DOI: 10.1136/bmjopen-2023-073353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Economic analyses based on clinical trial data are costly and time consuming, and alternative methods for performing economic analyses should be explored. OBJECTIVE AND METHODS In this perspective, we examine the emerging role of administrative data for economic analyses in cancer. RESULTS Compared with routinely collected clinical trial data, routinely collected administrative data have several strengths including high capture rates for healthcare encounters, less resource utilisation, low rates of misclassification, long follow-up periods and the opportunity to collect data points not traditionally captured in clinical trials. However, there are also limitations including the need for accurate data linkage across multiple databases and systems, the costs and time associated with data linkage, the potential time lag between trial data collection and the availability of administrative data, and limited data on quality of life, toxicity and indirect costs. In this perspective, we identify important barriers and potential solutions to performing economic analyses for oncology using administrative data, and outline strategies to increase research in this field. CONCLUSION The use of routinely collected administrative data sets for economic analyses of clinical trials presents a unique opportunity that could complement and validate economic analyses based on trial-level data.
Collapse
Affiliation(s)
- Brooke E Wilson
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
- Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
| | - Annette E Hay
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Kelvin Kar-Wing Chan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Division of Hematology and Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Matthew C Cheung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Division of Hematology and Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Timothy P Hanna
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
- Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
| |
Collapse
|
3
|
Marrie RA, Sormani MP, Apap Mangion S, Bovis F, Cheung WY, Cutter GR, Feys P, Hill MD, Koch MW, McCreary M, Mowry EM, Park JJH, Piehl F, Salter A, Chataway J. Improving the efficiency of clinical trials in multiple sclerosis. Mult Scler 2023; 29:1136-1148. [PMID: 37555492 PMCID: PMC10413792 DOI: 10.1177/13524585231189671] [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: 03/08/2023] [Revised: 06/01/2023] [Accepted: 06/12/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Phase 3 clinical trials for disease-modifying therapies in relapsing-remitting multiple sclerosis (RRMS) have utilized a limited number of conventional designs with a high degree of success. However, these designs limit the types of questions that can be addressed, and the time and cost required. Moreover, trials involving people with progressive multiple sclerosis (MS) have been less successful. OBJECTIVE The objective of this paper is to discuss complex innovative trial designs, intermediate and composite outcomes and to improve the efficiency of trial design in MS and broaden questions that can be addressed, particularly as applied to progressive MS. METHODS We held an international workshop with experts in clinical trial design. RESULTS Recommendations include increasing the use of complex innovative designs, developing biomarkers to enrich progressive MS trial populations, prioritize intermediate outcomes for further development that target therapeutic mechanisms of action other than peripherally mediated inflammation, investigate acceptability to people with MS of data linkage for studying long-term outcomes of clinical trials, use Bayesian designs to potentially reduce sample sizes required for pediatric trials, and provide sustained funding for platform trials and registries that can support pragmatic trials. CONCLUSION Novel trial designs and further development of intermediate outcomes may improve clinical trial efficiency in MS and address novel therapeutic questions.
Collapse
Affiliation(s)
- Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Maria Pia Sormani
- Department of Health Sciences, University of Genoa, Genoa, Italy/IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sean Apap Mangion
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Francesca Bovis
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Winson Y Cheung
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Gary R Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Peter Feys
- REVAL Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium/Universitair MS Centrum, UMSC, Hasselt, Belgium
| | - Michael D Hill
- Departments of Clinical Neurosciences, Community Health Sciences, Medicine, and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marcus Werner Koch
- Departments of Clinical Neurosciences, Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Morgan McCreary
- Department of Neurology, Section on Statistical Planning and Analysis, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ellen M Mowry
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jay JH Park
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Amber Salter
- Department of Neurology, Section on Statistical Planning and Analysis, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK/National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK/Medical Research Council Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| |
Collapse
|
4
|
Shah H, Wolfe D, Clemons M, Liu M, Thavorn K, Veroniki AA, Lunny C, Pond G, McGee S, Skidmore B, Arnaout A, Hutton B. Can routinely collected administrative data effectively be used to evaluate and validate endpoints used in breast cancer clinical trials? Protocol for a scoping review of the literature. Syst Rev 2023; 12:117. [PMID: 37422656 PMCID: PMC10329388 DOI: 10.1186/s13643-023-02283-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND Randomized controlled trials (RCTs) are a critical component of evidence-based medicine and the evolution of patient care. However, the costs of conducting a RCT can be prohibitive. A promising approach toward reduction of costs and lessening of the burden of intensive and lengthy patient follow-up is the use of routinely collected healthcare data (RCHD), commonly called real-world data. We propose a scoping review to identify existing RCHD case definitions of breast cancer progression and survival and their diagnostic performance. METHODS We will search MEDLINE, EMBASE, and CINAHL to identify primary studies of women with either early-stage or metastatic breast cancer, managed with established therapies, that evaluated the diagnostic accuracy of one or more RCHD-based case definitions or algorithms of disease progression (i.e., recurrence, progression-free survival, disease-free survival, or invasive disease-free survival) or survival (i.e., breast-cancer-free survival or overall survival) compared with a reference standard measure (e.g., chart review or a clinical trial dataset). Study characteristics and descriptions of algorithms will be extracted along with measures of the diagnostic accuracy of each algorithm (e.g., sensitivity, specificity, positive predictive value, negative predictive value), which will be summarized both descriptively and in structured figures/tables. DISCUSSION Findings from this scoping review will be clinically meaningful for breast cancer researchers globally. Identification of feasible and accurate strategies to measure patient-important outcomes will potentially reduce RCT budgets as well as lessen the burden of intensive trial follow-up on patients. SYSTEMATIC REVIEW REGISTRATION Open Science Framework ( https://doi.org/10.17605/OSF.IO/6D9RS ).
Collapse
Affiliation(s)
- Hely Shah
- Department of Oncology, Ottawa Hospital, Ottawa, ON Canada
| | - Dianna Wolfe
- Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Mark Clemons
- Department of Oncology, Ottawa Hospital, Ottawa, ON Canada
- Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Michelle Liu
- Ottawa Hospital Research Institute, Ottawa, ON Canada
| | | | - Areti-Angeliki Veroniki
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON Canada
| | - Carole Lunny
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
| | - Greg Pond
- Department of Oncology, McMaster University, Hamilton, ON Canada
| | - Sharon McGee
- Department of Oncology, Ottawa Hospital, Ottawa, ON Canada
| | | | - Angel Arnaout
- Department of Oncology, Ottawa Hospital, Ottawa, ON Canada
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa, ON Canada
| |
Collapse
|
5
|
Yan MK, Adler NR, Heriot N, Shang C, Zalcberg JR, Evans S, Wolfe R, Mar VJ. Opportunities and barriers for the use of Australian cancer registries as platforms for randomized clinical trials. Asia Pac J Clin Oncol 2021; 18:344-352. [PMID: 34811922 DOI: 10.1111/ajco.13670] [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: 02/23/2021] [Accepted: 08/18/2021] [Indexed: 11/30/2022]
Abstract
It is well recognized that randomized controlled trials (RCTs) are a powerful tool to investigate causal relationships, and are considered the gold standard level of research evidence. However, RCTs can be expensive and time-consuming, and when they employ strict eligibility criteria, it results in an unrepresentative population and limited external validity. Recently, the registry-based randomized clinical trial (RRCT) has emerged as an alternative trial design. Utilizing registries to underpin such studies, RRCTs can have advantages including rapid recruitment, and enhanced generalizability. In Australia, legislated mandatory reporting of cancer diagnoses means that jurisdictional cancer registries are a rich source of systematically collected patient details, representing sound platforms for comprehensive data capture that can serve as a key tool for further research. We review the roles of cancer registries in Australia, discuss important considerations relevant to the design of RRCTs, and outline the opportunities provided by cancer registries to strengthen cancer research.
Collapse
Affiliation(s)
- Mabel K Yan
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Victorian Melanoma Service, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Nikki R Adler
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Natalie Heriot
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Catherine Shang
- Victorian Cancer Registry, The Cancer Council Victoria, Melbourne, Victoria, Australia
| | - John R Zalcberg
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sue Evans
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Victorian Cancer Registry, The Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Victoria J Mar
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Victorian Melanoma Service, The Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
6
|
Lacasse A, Gagnon V, Nguena Nguefack HL, Gosselin M, Pagé MG, Blais L, Guénette L. Chronic pain patients' willingness to share personal identifiers on the web for the linkage of medico-administrative claims and patient-reported data: The chronic pain treatment cohort. Pharmacoepidemiol Drug Saf 2021; 30:1012-1026. [PMID: 33901339 PMCID: PMC8360172 DOI: 10.1002/pds.5255] [Citation(s) in RCA: 6] [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: 08/26/2020] [Accepted: 04/20/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE The linkage between patient-reported data and medico-administrative claims is of great interest for epidemiologic research. The goal of this study was to assess the willingness of people living with chronic pain to share personal identifiers on the web for the linkage of medico-administrative and patient-reported data. METHODS This methodological investigation was achieved in the context of the implementation of the chronic pain treatment (COPE) cohort. A web-based recruitment initiative targeting adults living with chronic pain was conducted in the province of Quebec (Canada). RESULTS A total of 1935 participants completed the questionnaire (mean age: 49.86 ± 13.27; females: 83.69%), 921 (47.60%) of which agreed to data linkage and shared their personal identifiers (name, date of birth, health insurance number online). The most common reasons for refusal were: (1) concerns regarding data security/privacy (25.71%) and (2) the belief that the requested data were too personal/intrusive (13.52%). Some participants did not understand the relevance of data linkage (11.81%). Participants from the COPE cohort and those from the subsample who agreed to data linkage were comparable to other random samples of chronic pain individuals in terms of age and pain characteristics. CONCLUSIONS Although approximately half of the participants refused data linkage, our approach allowed for the implementation of a data platform that contains a diverse and substantial sample. This investigation has also led to the formulation of recommendations for web-based data linkage, including placing items designed to assess willingness to share personal identifiers at the end of the questionnaire, adding explanatory videos, and using a mixed-mode questionnaire.
Collapse
Affiliation(s)
- Anaïs Lacasse
- Département des sciences de la santéUniversité du Québec en Abitibi‐Témiscamingue (UQAT)Rouyn‐NorandaCanada
| | - Véronique Gagnon
- Département des sciences de la santéUniversité du Québec en Abitibi‐Témiscamingue (UQAT)Rouyn‐NorandaCanada
| | | | - Mélissa Gosselin
- Département des sciences de la santéUniversité du Québec en Abitibi‐Témiscamingue (UQAT)Rouyn‐NorandaCanada
| | - M. Gabrielle Pagé
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM)MontréalQuébecCanada
- Département d'anesthésiologie et de médecine de la douleur, Faculté de médecineUniversité de MontréalMontréalQuébecCanada
| | - Lucie Blais
- Faculté de pharmacieUniversité de MontréalMontréalCanada
| | - Line Guénette
- Faculté de pharmacieUniversité LavalQuébecQuébecCanada
- Centre de recherche du CHU de Québec – Université LavalQuébecQuébecCanada
| |
Collapse
|
7
|
Garcia Luna JA, López-Medina E, Maldonado-Vargas ND, Smith AD. Opportunities for the use of routinely collected data for the generation of large randomized evidence in Colombia. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.17036.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Randomized clinical trials are the cornerstone design for the evaluation of the safety and efficacy of health interventions. Furthermore, morbidity and mortality rates could be reduced if evidence of better interventions is sought and used to inform medical practice. However, only small to moderate, yet worthwhile, effects can be expected from such interventions. Therefore, moderate random error and moderate biases must be avoided during the design, conduct and analysis of trials. Routinely collected data, such as vital statistics, hospital episode statistics and surveillance data, could be used to enhance recruitment and follow-up a large number of patients, reducing both random error and moderate biases. Here, we discuss the opportunities and challenges for the use of these data for clinical studies in Colombia.
Collapse
|
8
|
Hutchings E, Loomes M, Butow P, Boyle FM. A systematic literature review of attitudes towards secondary use and sharing of health administrative and clinical trial data: a focus on consent. Syst Rev 2021; 10:132. [PMID: 33941282 PMCID: PMC8094598 DOI: 10.1186/s13643-021-01663-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 04/05/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND We aimed to synthesise data on issues related to stakeholder perceptions of consent for the use of secondary data. To better understand the current literature available, we conducted a systematic literature review of healthcare consumer attitudes towards the secondary use and sharing of health administrative and clinical trial data. METHODS EMBASE/MEDLINE, Cochrane Library, PubMed, CINAHL, Informit Health Collection, PROSPERO Database of Systematic Reviews, PsycINFO and ProQuest databases were searched. Eligible articles included those reporting qualitative or quantitative original research and published in English. No restrictions were placed on publication dates, study design or disease setting. One author screened articles for eligibility and two authors were involved in the full-text review process. Conflicts were resolved by consensus. Quality and bias were assessed using the QualSyst criteria for qualitative studies. RESULTS This paper focuses on a subset of 47 articles identified from the wider search and focuses on the issue of consent. Issues related to privacy, trust and transparency, and attitudes of healthcare professionals and researchers to secondary use and sharing of data have been dealt with in previous publications. Studies included a total of 216,149 respondents. Results indicate that respondents are generally supportive of using health data for research, particularly if the data is de-identified or anonymised. The requirement by participants to obtain consent prior to the use of health data for research was not universal, nor is the requirement for this always supported by legislation. Many respondents believed that either no consent or being informed of the research, but not providing additional consent, were sufficient. CONCLUSIONS These results indicate that individuals should be provided with information and choice about how their health data is used and, where feasible, a mechanism to opt-out should be provided. To increase the acceptability of using health data for research, health organisations and data custodians must provide individuals with concise information about data protection mechanisms and under what circumstances their data may be used and by whom. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018110559 (update June 2020).
Collapse
Affiliation(s)
- Elizabeth Hutchings
- Northern Clinical School, Faculty of Medicine, The University of Sydney, North Sydney, Australia.
| | - Max Loomes
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Phyllis Butow
- School of Psychology, The University of Sydney, Sydney, NSW, Australia.,Centre for Medical Psychology & Evidence-Based Decision-Making (CeMPED), Sydney, NSW, Australia.,Psycho-Oncology Co-Operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia
| | - Frances M Boyle
- Northern Clinical School, Faculty of Medicine, The University of Sydney, North Sydney, Australia.,Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital, 25 Rocklands Road North Sydney, Sydney, NSW, 2060, Australia
| |
Collapse
|
9
|
Hay AE, Mittmann N, Crump M, Cheung MC, Sleeth J, Needham J, Broekhoven M, Djurfeldt M, Shepherd LE, Meyer RM, Chen BE, Pater JL. A Canadian Prospective Study of Linkage of Randomized Clinical Trial to Cancer and Mortality Registry Data. ACTA ACUST UNITED AC 2021; 28:1153-1160. [PMID: 33800281 PMCID: PMC8025743 DOI: 10.3390/curroncol28020111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/20/2021] [Accepted: 03/03/2021] [Indexed: 01/11/2023]
Abstract
In a prospective study, we sought to determine acceptability of linkage of administrative and clinical trial data among Canadian patients and Research Ethics Boards (REBs). The goal is to develop a more harmonized approach to data, with potential to improve clinical trial conduct through enhanced data quality collected at reduced cost and inconvenience for patients. On completion of the original LY.12 randomized clinical trial in lymphoma (NCT00078949), participants were invited to enrol in the Long-term Innovative Follow-up Extension (LIFE) component. Those consenting to do so provided comprehensive identifying information to facilitate linkage with their administrative data. We prospectively designed a global assessment of this innovative approach to clinical trial follow-up including rates of REB approval and patient consent. The pre-specified benchmark for patient acceptability was 80%. Of 16 REBs who reviewed the research protocol, 14 (89%) provided approval; two in Quebec declined due to small patient numbers. Of 140 patients invited to participate, 115 (82%, 95% CI 76 to 88%) from across 9 Canadian provinces provided consent and their full name, date of birth, health insurance number and postal code to facilitate linkage with their administrative data for long-term follow-up. Linkage of clinical trial and administrative data is feasible and acceptable. Further collaborative work including many stakeholders is required to develop an optimized secure approach to research. A more coordinated national approach to health data could facilitate more rapid testing and identification of new effective treatments across multiple jurisdictions and diseases from diabetes to COVID-19.
Collapse
Affiliation(s)
- Annette E Hay
- Department of Medicine, Queen’s University, Kingston, ON K7L 2V6, Canada
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.S.); (J.N.); (M.B.); (M.D.); (L.ES.); (B.EC.); (J.LP.)
- Correspondence:
| | - Nicole Mittmann
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON M4N 3M5, Canada; (N.M.); (M.CC.)
| | - Michael Crump
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2C1, Canada;
| | - Matthew C Cheung
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON M4N 3M5, Canada; (N.M.); (M.CC.)
| | - Jessica Sleeth
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.S.); (J.N.); (M.B.); (M.D.); (L.ES.); (B.EC.); (J.LP.)
| | - Judy Needham
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.S.); (J.N.); (M.B.); (M.D.); (L.ES.); (B.EC.); (J.LP.)
| | - Mike Broekhoven
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.S.); (J.N.); (M.B.); (M.D.); (L.ES.); (B.EC.); (J.LP.)
| | - Marina Djurfeldt
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.S.); (J.N.); (M.B.); (M.D.); (L.ES.); (B.EC.); (J.LP.)
| | - Lois E Shepherd
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.S.); (J.N.); (M.B.); (M.D.); (L.ES.); (B.EC.); (J.LP.)
| | - Ralph M Meyer
- Juravinski Cancer Centre/Hamilton Health Sciences, McMaster University, Hamilton, ON L8V 5C2, Canada;
| | - Bingshu E Chen
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.S.); (J.N.); (M.B.); (M.D.); (L.ES.); (B.EC.); (J.LP.)
| | - Joseph L Pater
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.S.); (J.N.); (M.B.); (M.D.); (L.ES.); (B.EC.); (J.LP.)
| |
Collapse
|
10
|
Webster-Clark M, Jonsson Funk M, Stürmer T. Single-arm Trials With External Comparators and Confounder Misclassification: How Adjustment Can Fail. Med Care 2020; 58:1116-1121. [PMID: 32925456 PMCID: PMC7665993 DOI: 10.1097/mlr.0000000000001400] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND "Single-arm trials" with external comparators that contrast outcomes in those on experimental therapy to real-world patients have been used to evaluate efficacy and safety of experimental drugs in rare and severe diseases. Regulatory agencies are considering expanding the role these studies can play; guidance thus far has explicitly considered outcome misclassification with little discussion of misclassification of confounding variables. OBJECTIVES This work uses causal diagrams to illustrate how adjustment for a misclassified confounder can result in estimates farther from the truth than ignoring it completely. This theory is augmented with quantitative examples using plausible values for misclassification of smoking in real-world pharmaceutical claims data. A tool is also provided for calculating bias of adjusted estimates with specific input parameters. RESULTS When confounder misclassification is similar in both data sources, adjustment generally brings estimates closer to the truth. When it is not, adjustment can generate estimates that are considerably farther from the truth than the crude. While all nonrandomized studies are subject to this potential bias, single-arm studies are particularly vulnerable due to perfect alignment of confounder measurement and treatment group. This is most problematic when the prevalence of the confounder does not differ between data sources and misclassification does, but can occur even with strong confounder-data source associations. DISCUSSION Researchers should consider differential confounder misclassification when designing protocols for these types of studies. Subsample validation of confounders, followed by imputation or other bias correction methods, may be a key tool for combining trial and real-world data going forward.
Collapse
Affiliation(s)
- Michael Webster-Clark
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | |
Collapse
|
11
|
Hutchings E, Loomes M, Butow P, Boyle FM. A systematic literature review of health consumer attitudes towards secondary use and sharing of health administrative and clinical trial data: a focus on privacy, trust, and transparency. Syst Rev 2020; 9:235. [PMID: 33036664 PMCID: PMC7547503 DOI: 10.1186/s13643-020-01481-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 09/14/2020] [Indexed: 12/12/2022] Open
Abstract
We aimed to synthesise data on issues related to stakeholder perceptions of privacy, trust, and transparency in use of secondary data. A systematic literature review of healthcare consumer attitudes towards the secondary use and sharing of health administrative and clinical trial data was conducted. EMBASE/MEDLINE, Cochrane Library, PubMed, CINAHL, Informit Health Collection, PROSPERO Database of Systematic Reviews, PsycINFO, and ProQuest databases were searched. Eligible articles included those reporting qualitative or quantitative original research and published in English. No restrictions were placed on publication dates, study design or disease setting. One author screened articles for eligibility, and two authors were involved in the full text review process. Data was extracted using a pre-piloted data extraction template by one author and checked by another. Conflicts were resolved by consensus. Quality and bias were assessed using the QualSyst criteria for qualitative and quantitative studies. This paper focuses on a subset of 35 articles identified from the wider search which focus on issues of privacy, trust, and transparency. Studies included a total of 56,365 respondents. Results of this systematic literature review indicate that while respondents identified advantages in sharing health data, concerns relating to trust, transparency, and privacy remain. Organisations collecting health data and those who seek to share data or undertake secondary data analysis should continue to develop trust, transparency, and privacy with healthcare consumers through open dialogue and education. Consideration should be given to these issues at all stages of data collection including the conception, design, and implementation phases. While individuals understand the benefits of health data sharing for research purposes, ensuring a balance between public benefit and individual privacy is essential. Researchers and those undertaking secondary data analysis need to be cognisant of these key issues at all stages of their research. Systematic review registration: PROSPERO registration number CRD42018110559 (update June 2020).
Collapse
Affiliation(s)
- Elizabeth Hutchings
- Northern Clinical School, Faculty of Medicine, University of Sydney, North Sydney, NSW, Australia.
| | - Max Loomes
- Department of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Phyllis Butow
- Department of Psychology, The University of Sydney, Sydney, NSW, Australia.,Centre for Medical Psychology & Evidence-Based Decision-Making (CeMPED), Sydney, Australia.,Psycho-Oncology Co-Operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia
| | - Frances M Boyle
- Northern Clinical School, Faculty of Medicine, University of Sydney, North Sydney, NSW, Australia.,Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital, North Sydney, Sydney, Australia
| |
Collapse
|
12
|
Whiffen T, Akbari A, Paget T, Lowe S, Lyons R. How effective are population health surveys for estimating prevalence of chronic conditions compared to anonymised clinical data? Int J Popul Data Sci 2020; 5:1151. [PMID: 34232969 PMCID: PMC7473295 DOI: 10.23889/ijpds.v5i1.1151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Population health surveys are used to record person-reported outcome measures for chronic health conditions and provide a useful source of data when evaluating potential disease burdens. The reliability of survey-based prevalence estimates for chronic diseases is unclear nonetheless. This study applied methodological triangulation via a data linkage method to validate prevalence of selected chronic conditions (angina, myocardial infarction, heart failure, and asthma). METHODS Linked healthcare records were used for a combined cohort of 11,323 adults from the 2013 and 2014 sweeps of the Welsh Health Survey (WHS). The approach utilised consented survey data linked to primary and secondary care electronic health record (EHR) data back to 2002 within the Secure Anonymised Information Linkage (SAIL) Databank. RESULTS This descriptive study demonstrates validation of survey and clinical data using data linkage for selected chronic cardiovascular conditions and asthma with varied success. The results indicate that identifying cases for separate cardiovascular conditions was limited without specific medication codes for each condition, but more straightforward for asthma, where there was an extensive list of medications available. For asthma there was better agreement between prevalence estimates based on survey and clinical data as a result. CONCLUSION Whilst the results provide external validity for the WHS as an instrument for estimating the burden of chronic disease, they also indicate that a data linkage appproach can be used to produce comparable prevalence estimates using clinical data if a defined condition-specific set of clinical codes are available.
Collapse
Affiliation(s)
| | - A Akbari
- Health Data Research UK, Swansea University
- Administrative Data Research Wales
| | | | - S Lowe
- Welsh Government
- Administrative Data Research Wales
| | - R Lyons
- Health Data Research UK, Swansea University
- Administrative Data Research Wales
| |
Collapse
|
13
|
Franklin EF, Nichols HM, House L, Buzaglo J, Thiboldeaux K. Cancer Patient Perspectives on Sharing of Medical Records and Mobile Device Data for Research Purposes. J Patient Exp 2020; 7:1115-1121. [PMID: 33457553 PMCID: PMC7786788 DOI: 10.1177/2374373520923837] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Sharing data is critical to advancing science, improving health, and creating advances in the delivery of health care services. The value of sharing data for cancer research purposes is well established, and there are multiple initiatives under way that address this need. However, there has been less focus on cancer patient perspectives regarding the sharing of their health information for research purposes. This study examined cancer patient perspectives on the sharing of de-identified health data for research purposes including both data from medical records and mobile applications. This cross-sectional study used survey methodology to collect data from cancer patients/survivors (N = 677). Overall, we found that participants were largely willing (71%) to share de-identified medical data and were most motivated (88%) by a desire to help other cancer patients. Patients were less likely to be comfortable sharing mobile application data (34%). It is vital that we understand patient perspectives on data sharing and work with them as partners, valuing their unique contributions, and attending to their preferences.
Collapse
Affiliation(s)
| | | | - Linda House
- Cancer Support Community, Washington, DC, USA
| | | | | |
Collapse
|
14
|
Hanna TP, Nguyen P, Pater J, O'Callaghan CJ, Mittmann N, Earle CC, Tu D, Jonker D, Hay AE. Can Administrative Data Improve the Performance of Cancer Clinical Trial Economic Analyses? J Oncol Pract 2019; 15:e807-e824. [PMID: 31306036 DOI: 10.1200/jop.18.00691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Trial economic analyses, such as cost-effectiveness analysis, often rely on trial-collected data, which are burdensome and expensive to collect and may be incomplete. In contrast, administrative databases systematically collect health system encounters. We investigated whether administrative data could improve the performance of cancer trial economic analysis. METHODS Health administrative data were probabilistically linked to Ontario patient data from the Canadian Cancer Trials Group CO.17 trial (n = 572), which evaluated cetuximab plus best supportive care (75 linked Ontario patients) versus best supportive care alone (73 patients) in previously treated metastatic colorectal cancer. Trial-collected resource utilization data and vital status were compared with administrative data. Cost effectiveness in 2007 Canadian dollars was determined with bootstrap incremental cost-effectiveness ratio (ICER) CIs. RESULTS Up to trial date of last contact, administrative data vital status was concordant in more than 96%. Twenty-nine subsequent deaths occurred. Up to trial last contact, there were 50 net additional hospitalizations in administrative data and 33 net additional emergency department visits. Total costs were $3,023,034 for the cetuximab group and $1,191,118 for the control group up to trial last contact. The ICER was $211,128 per life-year gained (90% CI, $101,396 to $694,950) up to trial last contact and $164,378 (90% CI, -$138,260 to $644,555) up to administrative data last contact. ICER estimates were similar to the analysis using trial-collected data. CONCLUSION Administrative data were more complete than trial data for hospital encounters, a key cost driver in economic analysis. There was a longer follow-up. This demonstrates the potential of administrative data to relieve the burden of collecting key data in cancer trials, which represents a considerable effort and expense.
Collapse
Affiliation(s)
- Timothy P Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, Ontario, Canada.,ICES, Ontario, Canada
| | | | - Joseph Pater
- Canadian Cancer Trials Group, Kingston, Ontario, Canada
| | | | - Nicole Mittmann
- Cancer Care Ontario, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Craig C Earle
- ICES, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Dongsheng Tu
- Canadian Cancer Trials Group, Kingston, Ontario, Canada
| | | | - Annette E Hay
- Canadian Cancer Trials Group, Kingston, Ontario, Canada.,Department of Medicine, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
15
|
Hay AE, Pater JL, Corn E, Han L, Camacho X, O'Callaghan C, Chong N, Bell EN, Tu D, Earle CC. Pilot study of the ability to probabilistically link clinical trial patients to administrative data and determine long-term outcomes. Clin Trials 2018; 16:14-17. [PMID: 30466310 DOI: 10.1177/1740774518815653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Clinical trials are important but extremely costly. Utilization of routinely collected administrative data may simplify and enhance clinical trial data collection. PURPOSE The aim of this study was to test the feasibility of use of administrative databases in Ontario, Canada, for long-term clinical trial follow-up, specifically (a) to determine whether limited patient identifiers held by the Canadian Cancer Trials Group can be used to probabilistically link with individuals in the Institute for Clinical Evaluative Sciences databases and if so, (b) the level of concordance between the two data sets. METHODS This retrospective study was conducted through collaboration of established health service (Institute for Clinical Evaluative Sciences) and clinical trial (Canadian Cancer Trials Group) research groups in the province of Ontario, Canada, where healthcare is predominantly funded by the government. Adults with pre-treated metastatic colorectal cancer previously enrolled in the Canadian Cancer Trials Group CO.17 and CO.20 randomized phase III trials were included, limited to those in Ontario. The main outcomes were rate of successful probabilistic linkage and concordance of survival data, stated a priori. RESULTS Probabilistic linkage was successful in 266/293 (90.8%) participants. In those patients for whom linkage was successful, the Canadian Cancer Trials Group (trial) and the Institute for Clinical Evaluative Sciences (administrative) data sets were concordant with regard to the occurrence of death during the period of clinical trial follow-up in 206/209 (98.6%). Death was recorded in the Institute for Clinical Evaluative Sciences, but not the Canadian Cancer Trials Group, for 57 cases, where the event occurred after the clinical trial cut-off dates. The recorded date of death matched closely between both databases. During the period of clinical trial conduct, administrative databases contained details of hospitalizations and emergency room visits not captured in the clinical trial electronic database. CONCLUSION Prospective use of administrative data could enhance clinical trial data collection, both for long-term follow-up and resource utilization for economic analyses and do so less expensively than current primary data collection. Recording a unique identifier (e.g. health insurance number) in trial databases would allow deterministic linkage for all participants.
Collapse
Affiliation(s)
- Annette E Hay
- 1 Canadian Cancer Trials Group, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Joseph L Pater
- 1 Canadian Cancer Trials Group, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Elyse Corn
- 2 Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Lei Han
- 1 Canadian Cancer Trials Group, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Ximena Camacho
- 2 Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Chris O'Callaghan
- 1 Canadian Cancer Trials Group, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Nelson Chong
- 2 Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Erin N Bell
- 3 Clinical Trials Ontario, Toronto, ON, Canada
| | - Dongsheng Tu
- 1 Canadian Cancer Trials Group, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Craig C Earle
- 2 Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| |
Collapse
|
16
|
Avram R, Marquis-Gravel G, Simard F, Pacheco C, Couture É, Tremblay-Gravel M, Desplantie O, Malhamé I, Bibas L, Mansour S, Parent MC, Farand P, Harvey L, Lessard MG, Ly H, Liu G, Hay AE, Marc Jolicoeur E. Understanding the patient perspective on research access to national health records databases for conduct of randomized registry trials. Int J Cardiol 2018; 262:110-116. [PMID: 29706388 DOI: 10.1016/j.ijcard.2017.12.074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 11/02/2017] [Accepted: 12/20/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Use of health administrative databases is proposed for screening and monitoring of participants in randomized registry trials. However, access to these databases raises privacy concerns. We assessed patient's preferences regarding use of personal information to link their research records with national health databases, as part of a hypothetical randomized registry trial. METHODS AND RESULTS Cardiology patients were invited to complete an anonymous self-reported survey that ascertained preferences related to the concept of accessing government health databases for research, the type of personal identifiers to be shared and the type of follow-up preferred as participants in a hypothetical trial. A total of 590 responders completed the survey (90% response rate), the majority of which were Caucasians (90.4%), male (70.0%) with a median age of 65years (interquartile range, 8). The majority responders (80.3%) would grant researchers access to health administrative databases for screening and follow-up. To this end, responders endorsed the recording of their personal identifiers by researchers for future record linkage, including their name (90%), and health insurance number (83.9%), but fewer responders agreed with the recording of their social security number (61.4%, p<0.05 with date of birth as reference). Prior participation in a trial predicted agreement for granting researchers access to the administrative databases (OR: 1.69, 95% confidence interval: 1.03-2.90; p=0.04). CONCLUSION The majority of Cardiology patients surveyed were supportive of use of their personal identifiers to access administrative health databases and conduct long-term monitoring in the context of a randomized registry trial.
Collapse
Affiliation(s)
- Robert Avram
- Montreal Heart Institute, Cardiology, Montréal, Québec, Canada; Université de Montréal, Cardiology, Montréal, Québec, Canada
| | - Guillaume Marquis-Gravel
- Montreal Heart Institute, Cardiology, Montréal, Québec, Canada; Université de Montréal, Cardiology, Montréal, Québec, Canada
| | - François Simard
- Montreal Heart Institute, Cardiology, Montréal, Québec, Canada; Université de Montréal, Cardiology, Montréal, Québec, Canada
| | - Christine Pacheco
- Montreal Heart Institute, Cardiology, Montréal, Québec, Canada; Université de Montréal, Cardiology, Montréal, Québec, Canada
| | - Étienne Couture
- Centre Hospitalier Universitaire de Sherbrooke, Cardiology, Sherbrooke, Quebec, Canada; Université de Sherbrooke, Cardiology, Sherbrooke, Québec, Canada
| | - Maxime Tremblay-Gravel
- Montreal Heart Institute, Cardiology, Montréal, Québec, Canada; Université de Montréal, Cardiology, Montréal, Québec, Canada
| | - Olivier Desplantie
- Montreal Heart Institute, Cardiology, Montréal, Québec, Canada; Université de Montréal, Cardiology, Montréal, Québec, Canada
| | | | - Lior Bibas
- McGill University, Cardiology, Montreal, Québec, Canada
| | - Samer Mansour
- Centre Hospitalier Universitaire de Montréal - Hôtel Dieu Hospital, Montreal, Québec, Canada
| | - Marie-Claude Parent
- Montreal Heart Institute, Cardiology, Montréal, Québec, Canada; Université de Montréal, Cardiology, Montréal, Québec, Canada
| | - Paul Farand
- Centre Hospitalier Universitaire de Sherbrooke, Cardiology, Sherbrooke, Quebec, Canada; Université de Sherbrooke, Cardiology, Sherbrooke, Québec, Canada
| | - Luc Harvey
- Montreal Heart Institute, Cardiology, Montréal, Québec, Canada
| | | | - Hung Ly
- Montreal Heart Institute, Cardiology, Montréal, Québec, Canada; Université de Montréal, Cardiology, Montréal, Québec, Canada
| | - Geoffrey Liu
- University Hospital Network, Toronto, Ontario, Canada
| | - Annette E Hay
- Queen's University, Canadian Cancer Trials Group, Kingston, Ontario, Canada; Queen's University, Department of Medicine, Kingston, Ontario, Canada
| | | |
Collapse
|