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Billingy NE, Tromp VNMF, Aaronson NK, Hoek RJA, Bogaard HJ, Onwuteaka-Philipsen BD, van de Poll-Franse L, Hugtenburg JG, Belderbos J, Becker-Commissaris A, van den Hurk CJG, Walraven I. Quality of life after patient-initiated vs physician-initiated response to symptom monitoring: the SYMPRO-Lung trial. J Natl Cancer Inst 2023; 115:1515-1525. [PMID: 37603720 PMCID: PMC10699799 DOI: 10.1093/jnci/djad159] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/27/2023] [Accepted: 07/24/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Previous studies using patient-reported outcomes measures (PROMs) to monitor symptoms during and after (lung) cancer treatment used alerts that were sent to the health-care provider, although an approach in which patients receive alerts could be more clinically feasible. The primary aim of this study was to compare the effect of weekly PROM symptom monitoring via a reactive approach (patient receives alert) or active approach (health-care provider receives alert) with care as usual on health-related quality of life (HRQOL) at 15 weeks after start of treatment in lung cancer patients. METHODS The SYMPRO-Lung trial is a multicenter randomized controlled trial using a stepped wedge design. Stage I-IV lung cancer patients in the reactive and active groups reported PROM symptoms weekly, which were linked to a common alerting algorithm. HRQOL was measured by the EORTC QLQ-C30 at baseline and after 15 weeks. Linear regression analyses and effect size estimates were used to assess mean QOL-C30 change scores between groups, accounting for confounding. RESULTS A total of 515 patients were included (160 active group, 89 reactive group, 266 control group). No differences in HRQOL were observed between the reactive and active group (summary score: unstandardized beta [B] = 0.51, 95% confidence interval [CI] = -3.22 to 4.24, Cohen d effect size [ES] = 0.06; physical functioning: B = 0.25, 95% CI = -5.15 to 4.64, ES = 0.02). The combined intervention groups had statistically and clinically significantly better mean change scores on the summary score (B = 4.85, 95% CI = 1.96 to 7.73, ES = 0.57) and physical functioning (B = 7.00, 95% CI = 2.90 to 11.09, ES = 0.71) compared with the control group. CONCLUSIONS Weekly PRO symptom monitoring statistically and clinically significantly improves HRQOL in lung cancer patients. The logistically less intensive, reactive approach may be a better fit for implementation.
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Affiliation(s)
- Nicole E Billingy
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (UMC), Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Vashti N M F Tromp
- Department of Clinical Pharmacology and Pharmacy, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Rianne J A Hoek
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (UMC), Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Harm Jan Bogaard
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (UMC), Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Lonneke van de Poll-Franse
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
- CoRPS—Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - José Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (UMC), Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Corina J G van den Hurk
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Iris Walraven
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
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Hosman FL, Rozemeijer SCA, Zegers AD, Becker-Commissaris A, Klümpen HJ, van der Vorst MJDL, Brom L, Duijts SFA. Outcomes and Feasibility of an Occupational Care Programme (TERRA) to Support Work Ability of Rare and Advanced Cancer Patients: A Report of 7 Cases. Oncology 2023; 102:350-358. [PMID: 37827131 DOI: 10.1159/000534451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Advancements in the field of oncology are allowing patients to live longer, with enhanced quality of life (QoL). Accordingly, more patients with cancer are expressing the desire to return to work (RTW). Previous research has indicated that patients with a rare or advanced cancer can experience unique problems in the RTW process. METHODS This pilot study evaluated the outcomes and feasibility of the occupational care programme TERRA (i.e., recalibraTe lifE and woRk with and afteR cAncer) for patients with a rare or advanced cancer. Four rare cancer patients and 3 advanced cancer patients completed TERRA; a supportive occupational care programme consisting of five online group sessions over a two-month period. Pre- and post-intervention outcomes were collected using validated self-report questionnaires. The primary outcome was work ability. Secondary outcomes included QoL, anxiety and depression, fatigue, unmet needs, self-efficacy, readiness for RTW, work intention, work involvement, and work-life conflict. Feasibility was assessed using the RE-AIM model. RESULTS Changes in work ability scores were inconsistent across participants. Well-being outcomes generally improved following the intervention. Feasibility was evaluated positively by both participants and trainers. CONCLUSION A multidisciplinary approach may further improve outcomes of occupational interventions supporting rare and advanced cancer patients. An effectiveness study to evaluate the outcomes and feasibility of the programme is deemed necessary.
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Affiliation(s)
- Floortje L Hosman
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL), Utrecht, The Netherlands
| | - Sascha C A Rozemeijer
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL), Utrecht, The Netherlands
| | - Amber D Zegers
- Department of Public and Occupational Health, Amsterdam University Medical Centers, Location Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Societal Participation and Health, Amsterdam, The Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Location Vrije Universiteit, Amsterdam, The Netherlands
| | - Heinz-Josef Klümpen
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Linda Brom
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL), Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Saskia F A Duijts
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL), Utrecht, The Netherlands
- Department of Medical Psychology, Amsterdam University Medical Centers, Location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Quality of Life, Amsterdam, The Netherlands
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Beerda DCE, Zegers AD, van Andel ES, Becker-Commissaris A, van der Vorst MJDL, Tange D, Duijts SFA, Brom L. Experiences and perspectives of patients with advanced cancer regarding work resumption and work retention: a qualitative interview study. Support Care Cancer 2022; 30:9713-9721. [DOI: 10.1007/s00520-022-07436-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 10/27/2022] [Indexed: 11/27/2022]
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Schuit AS, Holtmaat K, Coupé VMH, Eerenstein SEJ, Zijlstra JM, Eeltink C, Becker-Commissaris A, van Zuylen L, van Linde ME, Menke-van der Houven van Oordt CW, Sommeijer DW, Verbeek N, Bosscha K, Nandoe Tewarie R, Sedee RJ, de Bree R, de Graeff A, de Vos F, Cuijpers P, Verdonck-de Leeuw IM, Jansen F. Cost-Utility of the eHealth Application ‘Oncokompas’, Supporting Incurably Ill Cancer Patients to Self-Manage Their Cancer-Related Symptoms: Results of a Randomized Controlled Trial. Curr Oncol 2022; 29:6186-6202. [PMID: 36135055 PMCID: PMC9497666 DOI: 10.3390/curroncol29090486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/14/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Evidence on the cost-effectiveness of eHealth in palliative care is scarce. Oncokompas, a fully automated behavioral intervention technology, aims to support self-management in cancer patients. This study aimed to assess the cost-utility of the eHealth application Oncokompas among incurably ill cancer patients, compared to care as usual. In this randomized controlled trial, patients were randomized into the intervention group (access to Oncokompas) or the waiting-list control group (access after three months). Healthcare costs, productivity losses, and health status were measured at baseline and three months. Intervention costs were also taken into account. Non-parametric bootstrapping with 5000 replications was used to obtain 95% confidence intervals around the incremental costs and quality-adjusted life years (QALYs). A probabilistic approach was used because of the skewness of cost data. Altogether, 138 patients completed the baseline questionnaire and were randomly assigned to the intervention group (69) or the control group (69). In the base case analysis, mean total costs and mean total effects were non-significantly lower in the intervention group (−€806 and −0.01 QALYs). The probability that the intervention was more effective and less costly was 4%, whereas the probability of being less effective and less costly was 74%. Among patients with incurable cancer, Oncokompas does not impact incremental costs and seems slightly less effective in terms of QALYs, compared to care as usual. Future research on the costs of eHealth in palliative cancer care is warranted to assess the generalizability of the findings of this study.
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Affiliation(s)
- Anouk S. Schuit
- Department Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7-9, 1081 BT Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health, 1081 HV Amsterdam, The Netherlands
| | - Karen Holtmaat
- Department Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7-9, 1081 BT Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health, 1081 HV Amsterdam, The Netherlands
| | - Veerle M. H. Coupé
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Simone E. J. Eerenstein
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Josée M. Zijlstra
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Hematology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Corien Eeltink
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Hematology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Annemarie Becker-Commissaris
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Pulmonary Diseases, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Lia van Zuylen
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Medical Oncology, Amsterdam UMC, LocationVrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Myra E. van Linde
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Medical Oncology, Amsterdam UMC, LocationVrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - C. Willemien Menke-van der Houven van Oordt
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Medical Oncology, Amsterdam UMC, LocationVrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Dirkje W. Sommeijer
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Internal Medicine, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1012 WX Amsterdam, The Netherlands
- Department of Internal Medicine, Flevo Hospital, Hospitaalweg 1, 1315 RA Almere, The Netherlands
| | - Nol Verbeek
- Department of Oncology, St. Antonius Hospital, Soestwetering 1, 3543 AZ Utrecht, The Netherlands
| | - Koop Bosscha
- Department of Surgery, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ Den Bosch, The Netherlands
| | - Rishi Nandoe Tewarie
- Department of Neurosurgery, Haaglanden MC, Lijnbaan 32, 2512 VA The Hague, The Netherlands
| | - Robert-Jan Sedee
- Department of Otolaryngology, Head and Neck Surgery, Haaglanden MC, Lijnbaan 32, 2512 VA The Hague, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Filip de Vos
- Department of Medical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Pim Cuijpers
- Department Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7-9, 1081 BT Amsterdam, The Netherlands
- International Institute for Psychotherapy, Babeș-Bolyai University, Str. Mihail Kogălniceanu 1, 400084 Cluj-Napoca, Romania
| | - Irma M. Verdonck-de Leeuw
- Department Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7-9, 1081 BT Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health, 1081 HV Amsterdam, The Netherlands
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Femke Jansen
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Correspondence:
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Schuit AS, Holtmaat K, Lissenberg-Witte BI, Eerenstein SE, Zijlstra JM, Eeltink C, Becker-Commissaris A, van Zuylen L, van Linde ME, Menke-van der Houven van Oordt CW, Sommeijer DW, Verbeek N, Bosscha K, Tewarie RN, Sedee RJ, de Bree R, de Graeff A, de Vos F, Cuijpers P, Verdonck-de Leeuw IM. Efficacy of the eHealth application Oncokompas, facilitating incurably ill cancer patients to self-manage their palliative care needs: A randomized controlled trial. Lancet Reg Health Eur 2022; 18:100390. [PMID: 35496496 PMCID: PMC9046636 DOI: 10.1016/j.lanepe.2022.100390] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Many patients with incurable cancer have symptoms affecting their health-related quality of life. The eHealth application 'Oncokompas' supports patients to take an active role in managing their palliative care needs, to reduce symptoms and improve health-related quality of life (HRQOL). This randomized controlled trial was conducted to determine the efficacy of Oncokompas compared to care as usual among incurably ill cancer patients with a life expectancy of more than three months. METHODS Patients were recruited in six hospitals in the Netherlands. Eligible patients were randomly assigned to the intervention (direct access to Oncokompas) or the control group (access to Oncokompas after three months). The primary outcome measure was patient activation (i.e., patients' knowledge, skills and confidence for self-management). Secondary outcomes were general self-efficacy and HRQOL. Measures were assessed at baseline, two weeks after randomization, and three months after the baseline measurement. Linear mixed models were used to compare longitudinal changes between both groups from baseline to the three-month follow-up. FINDINGS In total, 219 patients were eligible of which 138 patients completed the baseline questionnaire (response rate 63%), and were randomized to the intervention (69) or control group (69). There were no significant differences between the intervention and control group over time in patient activation (estimated difference in change T0-T2; 1·8 (90% CI: -1·0 to 4·7)), neither in general self-efficacy and HRQOL. Of the patients in the intervention group who activated their account, 74% used Oncokompas as intended. The course of patient activation, general self-efficacy, and HRQOL was not significantly different between patients who used Oncokompas as intended versus those who did not. INTERPRETATION Among incurably ill cancer patients with a life expectancy of more than three months and recruited in the hospital setting, Oncokompas did not significantly improve patient activation, self-efficacy, or HRQOL. FUNDING ZonMw, Netherlands Organization for Health Research and Development (844001105).
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Affiliation(s)
- Anouk S. Schuit
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Karen Holtmaat
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Simone E.J. Eerenstein
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology – Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Josée M. Zijlstra
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Corien Eeltink
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Myra E. van Linde
- Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | | | - Dirkje W. Sommeijer
- Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
- Department of Internal Medicine, Flevo Hospital, Almere, the Netherlands
| | - Nol Verbeek
- Department of Oncology, St. Antonius hospital, Utrecht, the Netherlands
| | - Koop Bosscha
- Department of Surgery, Jeroen Bosch hospital, Den Bosch, the Netherlands
| | | | - Robert-Jan Sedee
- Department of Otolaryngology, Head and Neck Surgery, Haaglanden MC, The Hague, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, University Utrecht, the Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, the Netherlands
| | - Filip de Vos
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Irma M. Verdonck-de Leeuw
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology – Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam, the Netherlands
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Becker-Commissaris A, Billingy NE, Hoek R, Tromp V, van den Hurk C, Walraven I. Symptom monitoring with patient-reported outcomes using a web app with alerting algorithms among patients with lung cancer (SYMPRO-Lung). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12060 Background: The use of patient reported outcomes (PROs) to monitor symptoms during and after cancer treatment can improve symptom management, health-related quality of life (HRQoL), and overall survival, especially when linked to an alert system. Previous studies used alerts to the health care provider (HCP), but will this also work when patients receive the alerts? The aim is to compare a reactive (patient receives alert) and an active (HCP receives alert) method of PRO symptom monitoring on symptom incidence and management during the first 15 weeks of treatment. Methods: SYMPRO-Lung is a Dutch multicenter stepped wedge RCT performed among lung cancer (LC) patients to monitor symptoms, using a PRO-CTCAE LC subset. The NCI scoring algorithm assessed the symptom severity. If symptoms exceeded a predefined threshold an alert was sent by email to the HCP (active arm) or to the patient (reactive arm). Differences between both study arms in baseline characteristics, symptom incidence and management, were assessed using chi-square tests. Results: In total, 244 patients (active arm n = 155, 64%, reactive arm n = 89, 37%) completed 2412 symptom checklists during the first 15 weeks of treatment, with a mean of 10 per patient (pp) (SD 4.3). A total of 673 alerts (28%) were triggered, with a mean of 3 (SD 2.1) pp in both arms. The top 3 symptoms that caused the app to send an alert were fatigue (n = 231, 19%), pain (n = 188, 16%), and constipation (n = 144, 12%). Decreased appetite, diarrhea, and nausea were significantly higher in the reactive arm compared to the active arm (see table). For 313 alerts (74%), telephone contact with a HCP was the only intervention needed. 57 Alerts (13%) were discussed during a planned outpatient’s consultation in the week of the alert. For 39 alerts (9%) the patients were referred to another specialty (see table). However, ‘no need to follow-up’ (FU) was requested after 237 alerts (35%). For all symptoms, the no FU request was significantly higher in the reactive arm (n = 135, 32% vs n = 102, 40%), compared to the active arm (p-values between 0.02 and < 0.001). Conclusions: In both arms an average of 3 alerts pp were triggered. In the reactive arm, significantly more patients chose not to contact their HCP compared to the active arm. Future research needs to unravel the underlying mechanisms and the potential consequences of this observed difference between study arms. Clinical trial information: Trial NL7897. [Table: see text]
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Affiliation(s)
| | - Nicole Erica Billingy
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Rianne Hoek
- Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Vashti Tromp
- Amsterdam University Medical Centers, Amsterdam, Netherlands
| | | | - Iris Walraven
- Radboud University Medical Center, Nijmegen, Netherlands
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Billingy NE, Tromp VNMF, Veldhuijzen E, Belderbos J, Aaronson NK, Feldman E, Hoek R, Bogaard HJ, Onwuteaka-Philipsen BD, van de Poll-Franse L, Hugtenburg JG, van den Hurk CJG, Becker-Commissaris A, Walraven I. SYMptom monitoring with Patient-Reported Outcomes using a web application among patients with Lung cancer in the Netherlands (SYMPRO-Lung): study protocol for a stepped-wedge randomised controlled trial. BMJ Open 2021; 11:e052494. [PMID: 34518276 PMCID: PMC8438957 DOI: 10.1136/bmjopen-2021-052494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/16/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Lung cancer and its treatment cause a wide range of symptoms impacting the patients' health-related quality of life (HRQoL). The use of patient-reported outcomes (PRO) to monitor symptoms during and after cancer treatment has been shown not only to improve symptom management but also to improve HRQoL and overall survival (OS). Collectively, these results favour implementation of PRO-symptom monitoring in daily clinical care. However, these promising outcomes have been obtained under trial conditions in which patients were selected based on stringent inclusion criteria, and in countries with a dissimilar healthcare system than in the Netherlands.The primary aim of the SYMptom monitoring with Patient-Reported Outcomes using a web application among patients with Lung cancer in the Netherlands (SYMPRO-Lung) study is to evaluate the effect of PRO-symptom monitoring during and after lung cancer treatment on HRQoL in daily clinical practice. Secondary objectives include assessing the effect of PRO-symptom monitoring on progression-free survival, OS, the incidence and grade of PRO symptoms, medication adherence, implementation fidelity and cost-effectiveness. METHODS AND ANALYSIS The SYMPRO-Lung study is a prospective, multicentre trial with a stepped wedge cluster randomised design. Study participants (n=292 intervention, n=292 controls) include patients with lung cancer (stages I-IV) starting treatment with surgery, systemic treatment, targeted treatment and/or radiotherapy.Every participating centre will consecutively switch from the control period to the intervention period, in which patients report their symptoms weekly via an online tool. In the intervention group, we evaluate two alert approaches: the active and reactive approach. If the symptoms exceed a predefined threshold, an alert is sent to the healthcare provider (active approach) or to the patient (reactive approach). Both the control and intervention group complete HRQoL questionnaires at 4 time points: at baseline, 15 weeks, 6 months and 1-year post treatment). Differences in HRQoL between the groups will be compared using linear mixed modelling analyses, accounting for within-centre clustering, potential time effects and confounding. ETHICS AND DISSEMINATION The study protocol was approved by the Institutional Review Board and the Medical Ethics Committee of the Amsterdam UMC (under number NL 68440.029.18) and the institutional review boards of the participating study sites. The dissemination of the results will be conducted through publication in peer-reviewed journals and through scientific conferences. TRIAL REGISTRATION NUMBER Trial register identifier: Netherlands Trial register Trial NL7897. Date of registration: 24 July 2019. https://www.trialregister.nl/trial/7897.
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Affiliation(s)
- Nicole E Billingy
- Department of Pulmonary Diseases, Amsterdam UMC Location VUmc, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Vashti N M F Tromp
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Evalien Veldhuijzen
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Jose Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Esther Feldman
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Rianne Hoek
- Department of Pulmonary Diseases, Amsterdam UMC Location VUmc, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Harm-Jan Bogaard
- Department of Pulmonary Diseases, Amsterdam UMC Location VUmc, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Cancer Center Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Lonneke van de Poll-Franse
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
- CoRPS - Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Noord-Brabant, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Tilburg, Noord-Brabant, The Netherlands
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Corina J G van den Hurk
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Tilburg, Noord-Brabant, The Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, Amsterdam UMC Location VUmc, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Iris Walraven
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
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8
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Billingy NE, Tromp VNMF, van den Hurk CJG, Becker-Commissaris A, Walraven I. Health-Related Quality of Life and Survival in Metastasized Non-Small Cell Lung Cancer Patients with and without a Targetable Driver Mutation. Cancers (Basel) 2021; 13:4282. [PMID: 34503092 PMCID: PMC8428358 DOI: 10.3390/cancers13174282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of this study is to compare long-term health-related quality of life (HRQOL) and survival in metastatic NSCLC patients with (M+) and without (M-) a targetable driver mutation. METHODS An observational study was performed within the prospective SYMPRO-lung study (NL7897). HRQOL questionnaires were completed at baseline, 15 weeks, and 6 months. Generalized estimating equations (GEE) were used to assess clinically significant declines in HRQOL (>10 points) over time. Kaplan-Meier survival curves were plotted for both progression-free survival (PFS) and overall survival (OS). RESULTS 81 metastatic NSCLC patients were included (M+ patients; 16 (20%)). M+ patients had a significantly better global HRQOL (mean difference 12.8, ES 0.61), physical functioning (mean difference 13.4, ES 0.63), and less appetite loss (mean difference 23.1, ES 0.73) at 15 weeks of follow-up compared to M- patients. Patients with a clinically relevant decline in HRQOL at 6 months of follow-up had a significantly shorter PFS (5 months vs. 12 months, p-value < 0.001) and OS (11 months vs. 16 months, p-value 0.002). CONCLUSIONS M- NSCLC patients have less favorable HRQOL over time compared to M+ patients. Furthermore, clinically relevant HRQOL declines over time were significantly associated with worse survival. HRQOL can therefore play an important role in in shaping patients' expectations of their prognosis.
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Affiliation(s)
- Nicole E. Billingy
- Department of Pulmonology, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, 1081 HV Amsterdam, The Netherlands; (N.E.B.); (A.B.-C.)
| | - Vashti N. M. F. Tromp
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Amsterdam Public Health Research Institute, 1081 HV Amsterdam, The Netherlands;
| | - Corina J. G. van den Hurk
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), 3511 DT Utrecht, The Netherlands;
| | - Annemarie Becker-Commissaris
- Department of Pulmonology, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, 1081 HV Amsterdam, The Netherlands; (N.E.B.); (A.B.-C.)
| | - Iris Walraven
- Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
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9
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van Vliet C, Schneiders F, Engelsman A, Hashemi S, Bahce I, Haasbeek C, Bruynzeel A, Lagerwaard F, Palacios M, Becker-Commissaris A, Slotman B, Dickhoff C, Senan S. PD-0743 Treatment patterns for adrenal metastases in the era of MR-guided stereotactic ablative radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07022-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Mieras A, Becker-Commissaris A, Klop HT, Pasman HRW, de Jong D, Pronk L, Onwuteaka-Philipsen BD. Patients with Metastatic Lung Cancer and Oncologists' Views on Achievement of Treatment Goals and Making the Right Treatment Decision: A Prospective Multicenter Study. Med Decis Making 2021; 41:515-526. [PMID: 33783264 DOI: 10.1177/0272989x21998951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Previous studies have investigated patients' treatment goals before starting a treatment for metastatic lung cancer. Data on the evaluation of treatment goals are lacking. AIM To determine if patients with metastatic lung cancer and their oncologists perceive the treatment goals they defined at the start of systemic treatment as achieved after treatment and if in hindsight they believe it was the right decision to start systemic therapy. DESIGN AND PARTICIPANTS A prospective multicenter study in 6 hospitals across the Netherlands between 2016 and 2018. Following systemic treatment, 146 patients with metastatic lung cancer and 23 oncologists completed a questionnaire on the achievement of their treatment goals and whether they made the right treatment decision. Additional interviews with 15 patients and 5 oncologists were conducted. RESULTS According to patients and oncologists, treatment goals were achieved in 30% and 37% for 'quality of life,' 49% and 41% for 'life prolongation,' 26% and 44% for 'decrease in tumor size,' and 44% for 'cure', respectively. Most patients and oncologists, in hindsight, felt they had made the right decision to start treatment even if they had not achieved their goals (72% and 93%). This was related to the feeling that they had to do 'something.' CONCLUSIONS Before deciding on treatment, the treatment options, including their benefits and side effects, and the goals patients have should be discussed. It is key that these discussions include not only systemic treatment but also palliative care as effective options for doing 'something.'
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Affiliation(s)
- Adinda Mieras
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - Hanna T Klop
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - Denise de Jong
- Department of Pulmonary Diseases, Haags Medisch Centrum, Leidschendam, Zuid-Holland, The Netherlands
| | - Lemke Pronk
- Department of Pulmonary Diseases, Flevoziekenhuis, Almere, Flevoland, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
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11
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Hashemi S, Fransen MF, Niemeijer A, Ben Taleb N, Houda I, Veltman J, Becker-Commissaris A, Daniels H, Crombag L, Radonic T, Jongeneel G, Tarasevych S, Looysen E, van Laren M, Tiemessen M, van Diepen V, Maassen-van den Brink K, Thunnissen E, Bahce I. Surprising impact of stromal TIL's on immunotherapy efficacy in a real-world lung cancer study. Lung Cancer 2021; 153:81-89. [PMID: 33465698 DOI: 10.1016/j.lungcan.2021.01.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/09/2020] [Accepted: 01/10/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICI), such as anti-PD-1 agents, have become part of the standard of care treatment of advanced non-small cell lung cancer (NSCLC). Predictive biomarkers are needed to identify patients that benefit from anti-PD-1 treatments. Tumor infiltrating lymphocytes (TILs) and PD-L1 are major players in the ICI mechanism of action. In this study, we assess the impact of real-world clinicopathological variables, including TILs and PD-L1, on anti-PD-1 efficacy. METHODS We performed a monocenter retrospective study in advanced NSCLC treated with nivolumab or pembrolizumab between January 2015 and February 2019. The impact of baseline clinical and pathological variables was assessed by univariate and multivariate models. TILs, defined as CD8+T-cells, and PD-L1 were scored in tumor and stroma, and correlated with progression free survival (PFS) and overall survival (OS). RESULTS We included 366 patients of whom 141 were assessed for tumor and stromal TILs. The median follow-up time was 487 days. In the whole cohort, PFS was associated with high tumor PD-L1, high albumin and good performance. OS was associated with low LDH, high albumin, good performance and 'first-line treatment'. In the TILs subcohort, stromal TILs had the strongest impact on PFS and OS. Stromal TILs were a stronger marker for PFS and OS than tumoral TILs, tumoral PD-L1 or stromal PD-L1. Remaining factors for PFS and OS were albumin and albumin with LDH, respectively. CONCLUSIONS This real-world study on clinicopathological features shows that stromal CD8 + TILs were the strongest predictor for PFS and OS in patients with advanced NSCLC on anti-PD-1 therapy. Other predictors for PFS and OS included albumin and albumin together with LDH, respectively. This study highlights the pivotal role of the stromal compartment in the mechanisms of action of ICI, and the need for further studies aiming to overcome this stromal firewall.
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Affiliation(s)
- S Hashemi
- Department of Pulmonology, Amsterdam UMC, Location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - M F Fransen
- Department of Pulmonology, Amsterdam UMC, Location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - A Niemeijer
- Department of Pulmonology, Amsterdam UMC, Location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - N Ben Taleb
- Department of Pulmonology, Amsterdam UMC, Location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - I Houda
- Department of Pulmonology, Amsterdam UMC, Location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - J Veltman
- Department of Pulmonology, Amsterdam UMC, Location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - A Becker-Commissaris
- Department of Pulmonology, Amsterdam UMC, Location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - H Daniels
- Department of Pulmonology, Amsterdam UMC, Location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - L Crombag
- Department of Pulmonology, Amsterdam UMC, Location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - T Radonic
- Department of Pathology, Amsterdam UMC, Location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - G Jongeneel
- Department of Epidemiology & Biostatistics, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - S Tarasevych
- Department of Pulmonology, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - E Looysen
- Department of Pulmonology, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - M van Laren
- Department of Pulmonology, Dijklander Ziekenhuis, Hoorn, The Netherlands
| | - M Tiemessen
- Department of Pulmonology, Dijklander Ziekenhuis, Hoorn, The Netherlands
| | - V van Diepen
- Department of Pulmonology, Dijklander Ziekenhuis, Purmerend, The Netherlands
| | | | - E Thunnissen
- Department of Pathology, Amsterdam UMC, Location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - I Bahce
- Department of Pulmonology, Amsterdam UMC, Location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
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12
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Mieras A, Pasman HRW, Klop HT, Onwuteaka-Philipsen BD, Tarasevych S, Tiemessen MA, Becker-Commissaris A. What Goals Do Patients and Oncologists Have When Starting Medical Treatment for Metastatic Lung Cancer? Clin Lung Cancer 2020; 22:242-251.e5. [PMID: 32698949 DOI: 10.1016/j.cllc.2020.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/27/2020] [Accepted: 06/11/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Metastatic lung cancer is an incurable disease that can be treated with systemic therapy. These treatments might prolong survival and reduce symptoms, but they may also cause serious adverse effects. We studied the treatment goals of patients with metastasized lung cancer and their oncologists before starting systemic therapy, concordance between patients' and oncologists' goals, and feasibility of these goals. PATIENTS AND METHODS This research was conducted between November 2016 and April 2018 in 1 academic and 5 nonacademic hospitals across the Netherlands. A total of 266 patients with metastatic lung cancer and their prescribing oncologists (n = 23) filled out a questionnaire about their treatment goals and the estimated feasibility of these goals before treatment was started. Additional interviews were conducted with patients and oncologists. RESULTS Patients and oncologists reported quality of life (respectively, 45% and 72%), life prolongation (45% and 55%), decrease in tumor size (39% and 66%), and cure (19% and 2%) as treatment goals. The interviews showed that the latter appeared to be often as motivation to stay alive. Concordances between patients' and oncologists' treatment goals were low (ranging from 24% to 33%). Patients had slightly higher feasibility scores than oncologists (6.8 vs. 5.8 on a 10-point scale). Educational level, age, religious views, and performance status of patients were associated with treatment goals. CONCLUSION Patients and oncologists set various goals for the treatment they receive/prescribe. Low concordance might exist because different goals are set or because the patient misunderstands something. Clear communication about treatment goals should be integrated into clinical care.
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Affiliation(s)
- Adinda Mieras
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hanna T Klop
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Svitlana Tarasevych
- Department of Pulmonary Diseases, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Marian A Tiemessen
- Department of Pulmonary Diseases, Dijklander Ziekenhuis Hoorn, Hoorn, The Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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13
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Mieras A, Onwuteaka-Philipsen BD, Becker-Commissaris A, Bos JCM, Pasman HRW. Relatives of deceased patients with metastatic lung cancer's views on the achievement of treatment goals and the choice to start treatment: a structured telephone interview study. BMC Palliat Care 2020; 19:86. [PMID: 32560645 PMCID: PMC7305592 DOI: 10.1186/s12904-020-00591-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/09/2020] [Indexed: 11/11/2022] Open
Abstract
Background Lung cancer has a high impact on both patients and relatives due to the high disease burden and short life expectancy. Previous studies looked into treatment goals patients have before starting a systemic treatment. However, studies on relatives’ perceptions of treatment at the end of life are scarce. Therefore, we studied the perspectives of relatives in hindsight on the achievement of treatment goals and the choice to start treatment for metastatic lung cancer of their loved one. Methods We conducted a structured telephone interview study in six hospitals across the Netherlands, one academic and five non-academic hospitals, between February 2017 and November 2019. We included 118 relatives of deceased patients diagnosed with metastatic lung cancer who started a systemic treatment as part of usual care (chemotherapy, immunotherapy or targeted therapy with tyrosine kinase inhibitors (TKIs) and who completed a questionnaire on their treatment goals before the start of treatment and when treatment was finished. We asked the relatives about the achievement of patients’ treatment goals and relatives’ satisfaction with the choice to start treatment. This study is part of a larger study in which 266 patients with metastatic lung cancer participated who started a systemic treatment and reported their treatment goals before start of the treatment and the achievement of these goals after the treatment. Results Relatives reported the goals ‘quality of life’, ‘decrease tumour size’ and ‘life prolongation’ as achieved in 21, 37 and 41% respectively. The majority of the relatives (78%) were satisfied with the choice to start a treatment and even when none of the goals were achieved, 70% of the relatives were satisfied. About 50% of relatives who were satisfied with the patients’ choice mentioned negative aspects of the treatment choice, such as the treatment did not work, there were side effects or it would not have been the relatives’ choice. Whereas, 80% of relatives who were not satisfied mentioned negative aspects of the treatment choice. The most mentioned positive aspects were that they tried everything and that it was the patient’s choice. Conclusion The majority of relatives reported patients’ treatment goals as not achieved. However, relatives were predominantly satisfied about the treatment choice. Satisfaction does not provide a full picture of the experience with the treatment decision considering that the majority of relatives mentioned (also) negative aspects of this decision. At the time of making the treatment decision it is important to manage expectations about the chance of success and the possible side effects of the treatment.
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Affiliation(s)
- Adinda Mieras
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam, The Netherlands. .,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research Institute, Amsterdam, The Netherlands. .,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, Netherlands. .,Public Health research Institute, Expertise Center for Palliative Care, de Boelelaan 1117, 1081 HV, Amsterdam, Netherlands.
| | - Bregje D Onwuteaka-Philipsen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research Institute, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, Netherlands
| | - Annemarie Becker-Commissaris
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, Netherlands
| | - Jose C M Bos
- Dijklander Ziekenhuis, Department of Pulmonary Diseases, Purmerend, The Netherlands
| | - H Roeline W Pasman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research Institute, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, Netherlands
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14
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Mieras A, Becker-Commissaris A, Pasman HRW, Dingemans AMMC, Kok EV, Cornelissen R, Jacobs W, van den Berg JW, Welling A, Bogaarts BAHA, Pronk L, Onwuteaka-Philipsen BD. Chemotherapy and Tyrosine Kinase Inhibitors in the last month of life in patients with metastatic lung cancer: A patient file study in the Netherlands. Eur J Cancer Care (Engl) 2019; 29:e13210. [PMID: 31863609 PMCID: PMC9285506 DOI: 10.1111/ecc.13210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 11/01/2019] [Accepted: 11/28/2019] [Indexed: 12/27/2022]
Abstract
Objective Chemotherapy in the last month of life for patients with metastatic lung cancer is often considered as aggressive end‐of‐life care. Targeted therapy with Tyrosine Kinase Inhibitors (TKIs) is a relatively new treatment of which not much is known yet about use in the last month of life. We examined what percentage of patients received chemotherapy or TKIs in the last month of life in the Netherlands. Methods Patient files were drawn from 10 hospitals across the Netherlands. Patients had to meet the following eligibility criteria: metastatic lung cancer; died between June 1, 2013 and July 31, 2015. Results From the included 1,322 patients, 39% received no treatment for metastatic lung cancer, 52% received chemotherapy and 9% received TKIs. A total of 232 patients (18%) received treatment in the last month of life (11% chemotherapy, 7% TKIs). From the patients who received chemotherapy, 145 (21%) received this in the last month of life and 79 (11%) started this treatment in the last month of life. TKIs were given and started more often in the last month of life: from the patients who received TKIs, 87 (72%) received this treatment in the last month of life and 15 (12%) started this treatment in the last month of life. Conclusion A substantial percentage of patient received and even started chemotherapy or TKIs in the last month of life. For chemotherapy, this might be seen as aggressive care. TKIs are said to have less side effects, do not lead to many hospital visits and due to the rapid response, are considered good palliation. However, it is not known, yet possible that, when patients still receiving treatment until shortly before death, this might influence preparing for death in a negative way.
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Affiliation(s)
- Adinda Mieras
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anne-Marie M C Dingemans
- Department of Pulmonary Diseases, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Edith V Kok
- Department of Pulmonary Diseases, Streekziekenhuis Koning Beatrix, Winterswijk, The Netherlands
| | - Robin Cornelissen
- Department of Pulmonary Diseases, Erasmus MC, Cancer Institute, Rotterdam, The Netherlands
| | - Wouter Jacobs
- Department of Pulmonary Diseases, Martini Ziekenhuis, Groningen, The Netherlands
| | | | - Alle Welling
- Department of Pulmonary Diseases, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands.,Department of Pulmonary Diseases, Noordwest Ziekenhuisgroep Den Helder, Den Helder, The Netherlands
| | | | - Lemke Pronk
- Department of Pulmonary Diseases, Flevoziekenhuis, Almere, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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15
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Mieras A, Pasman HRW, Onwuteaka-Philipsen BD, Dingemans AMMC, Kok EV, Cornelissen R, Jacobs W, van den Berg JW, Welling A, Bogaarts BAHA, Pronk L, Becker-Commissaris A. Is In-Hospital Mortality Higher in Patients With Metastatic Lung Cancer Who Received Treatment in the Last Month of Life? A Retrospective Cohort Study. J Pain Symptom Manage 2019; 58:805-811. [PMID: 31283970 DOI: 10.1016/j.jpainsymman.2019.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 02/06/2023]
Abstract
CONTEXT Metastatic lung cancer is an incurable disease that results in a high burden of symptoms, a poor quality of life, and an expected prognosis of less than one year after diagnosis. Treatment shortly before death may result in potential burdensome and inappropriate hospital admissions and hospital deaths. Dying at home is, at a population level, considered a quality for good end-of-life care. OBJECTIVES We examined what percentage of patients with metastatic lung cancer died inside the hospital and if hospital death, or other characteristics of the patient, oncologist or health care, were associated with treatment in the last month of life. METHODS This retrospective cohort study evaluated the medical records of 1322 patients with metastatic lung cancer who received care at one of 10 hospitals across The Netherlands and died between 1/6/2013 and 31/7/2015. Demographic and clinical characteristics were obtained from the medical records. RESULTS In total, 18% of the patients died during a hospital admission. This percentage was higher for patients who received chemotherapy (42%) or targeted therapy with tyrosine kinase inhibitors (25%) in the last month of life. Patients younger than 60 years of age, patients who received chemotherapy in the last month of life, and patients in whom tyrosine kinase inhibitors were started in the last month of life were more likely to die inside the hospital. CONCLUSION In The Netherlands, fewer than one in five patients with metastatic lung cancer died in the hospital and in-hospital death was associated with the relatively late use of chemotherapy or targeted therapy. Careful selection of patients for disease-modifying therapy might enhance the opportunity for patients to die at their preferred place.
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Affiliation(s)
- Adinda Mieras
- Department of Pulmonary Diseases, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands; Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - Anne-Marie M C Dingemans
- Department of Pulmonary Diseases, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Edith V Kok
- Department of Pulmonary Diseases, Streekziekenhuis Koning Beatrix, Winterswijk, The Netherlands
| | - Robin Cornelissen
- Department of Pulmonary Diseases, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Wouter Jacobs
- Department of Pulmonary Diseases, Martini Ziekenhuis, Groningen, The Netherlands
| | | | - Alle Welling
- Department of Pulmonary Diseases, Noordwest Ziekenhuisgroep Alkmaar, Alkmaar, The Netherlands; Department of Pulmonary Diseases, Noordwest Ziekenhuisgroep Den Helder, Den Helder, The Netherlands
| | | | - Lemke Pronk
- Department of Pulmonary Diseases, Flevoziekenhuis, Almere, The Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
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Schuit AS, Holtmaat K, Hooghiemstra N, Jansen F, Lissenberg-Witte BI, Coupé VMH, van Linde ME, Becker-Commissaris A, Reijneveld JC, Zijlstra JM, Sommeijer DW, Eerenstein SEJ, Verdonck-de Leeuw IM. Efficacy and cost-utility of the eHealth application 'Oncokompas', supporting patients with incurable cancer in finding optimal palliative care, tailored to their quality of life and personal preferences: a study protocol of a randomized controlled trial. BMC Palliat Care 2019; 18:85. [PMID: 31647011 PMCID: PMC6813123 DOI: 10.1186/s12904-019-0468-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/20/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Patients with incurable cancer have to deal with a wide range of symptoms due to their disease and treatment, influencing their quality of life. Nowadays, patients are expected to adopt an active role in managing their own health and healthcare. Oncokompas is an eHealth self-management application developed to support patients in finding optimal palliative care, tailored to their quality of life and personal preferences. A randomized controlled trial will be carried out to determine the efficacy and cost-utility of Oncokompas compared to care as usual. METHODS 136 adult patients with incurable lung, breast, colorectal and head and neck cancer, lymphoma and glioma, will be included. Eligible patients have no curative treatment options and a prognosis of at least three months. Patients will be randomly assigned to the intervention group or the control group. The intervention group directly has access to Oncokompas alongside care as usual, while the waiting list control group receives care as usual and will have access to Oncokompas after three months. The primary outcome measure is patient activation, which can be described as a patient's knowledge, skills and confidence to manage his or her own health and healthcare. Secondary outcome measures comprise self-efficacy, health-related quality of life, and costs. Measures will be assessed at baseline, two weeks after randomization, and three months after the baseline measurement. DISCUSSION This study will result in knowledge on the efficacy and cost-utility of Oncokompas among patients with incurable cancer. Also, more knowledge will be generated into the need for and costs of palliative care from a societal and healthcare perspective. TRIAL REGISTRATION Netherlands Trial Register identifier: NTR 7494 . Registered on 24 September 2018.
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Affiliation(s)
- Anouk S Schuit
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.,Cancer Center Amsterdam (CCA), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Karen Holtmaat
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.,Cancer Center Amsterdam (CCA), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Nienke Hooghiemstra
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.,Cancer Center Amsterdam (CCA), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Femke Jansen
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.,Cancer Center Amsterdam (CCA), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology - Head and Neck Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, The Netherlands
| | - Veerle M H Coupé
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, The Netherlands
| | - Myra E van Linde
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, The Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, The Netherlands
| | - Jaap C Reijneveld
- Department of Neurology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, The Netherlands
| | - Josée M Zijlstra
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, The Netherlands
| | - Dirkje W Sommeijer
- Department of Internal Medicine, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Department of Internal Medicine, Flevo Hospital, Hospitaalweg 1, Almere, The Netherlands
| | - Simone E J Eerenstein
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology - Head and Neck Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands. .,Cancer Center Amsterdam (CCA), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology - Head and Neck Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, The Netherlands.
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17
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Jansen F, Lissenberg-Witte BI, Krebber AMH, Cuijpers P, de Bree R, Becker-Commissaris A, Smit EF, van Straten A, Eeckhout GM, Beekman ATF, Leemans CR, Verdonck-de Leeuw IM. Stepped care targeting psychological distress in head and neck cancer and lung cancer patients: which groups specifically benefit? Secondary analyses of a randomized controlled trial. Support Care Cancer 2019; 27:4543-4553. [PMID: 30915569 PMCID: PMC6825034 DOI: 10.1007/s00520-019-04714-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 02/22/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE Stepped care (SC), consisting of watchful waiting, guided self-help, problem-solving therapy, and psychotherapy/medication is, compared to care-as-usual (CAU), effective in improving psychological distress. This study presents secondary analyses on subgroups of patients who might specifically benefit from watchful waiting, guided self-help, or the entire SC program. METHODS In this randomized controlled trial, head and neck and lung cancer patients with distress (n = 156) were randomized to SC or CAU. Univariate logistic regression analyses were performed to investigate baseline factors associated with recovery after watchful waiting and guided self-help. Potential moderators of the effectiveness of SC compared to CAU were investigated using linear mixed models. RESULTS Patients without a psychiatric disorder, with better psychological outcomes (HADS: all scales) and better health-related quality of life (HRQOL) (EORTC QLQ-C30/H&N35: global QOL, all functioning, and several symptom domains) were more likely to recover after watchful waiting. Patients with better scores on distress, emotional functioning, and dyspnea were more likely to recover after guided self-help. Sex, time since treatment, anxiety or depressive disorder diagnosis, symptoms of anxiety, symptoms of depression, speech problems, and feeling ill at baseline moderated the efficacy of SC compared to CAU. CONCLUSIONS Patients with distress but who are relatively doing well otherwise, benefit most from watchful waiting and guided self-help. The entire SC program is more effective in women, patients in the first year after treatment, patients with a higher level of distress or anxiety or depressive disorder, patients who are feeling ill, and patients with less speech problems. TRIAL NTR1868.
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Affiliation(s)
- Femke Jansen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Biostatistics, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Anna M H Krebber
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Egbert F Smit
- Department of Pulmonary Diseases, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Guus M Eeckhout
- Department of Psychiatry, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands.
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18
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Kleijn G, van Uden-Kraan CF, Bohlmeijer ET, Becker-Commissaris A, Pronk M, Willemsen V, Cuijpers P, Verdonck-de Leeuw IM. Patients’ experiences of life review therapy combined with memory specificity training (LRT-MST) targeting cancer patients in palliative care. Support Care Cancer 2019; 27:3311-3319. [DOI: 10.1007/s00520-018-4613-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 12/11/2018] [Indexed: 11/30/2022]
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19
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Jansen F, Krebber AMH, Coupé VMH, Cuijpers P, de Bree R, Becker-Commissaris A, Smit EF, van Straten A, Eeckhout GM, Beekman ATF, Leemans CR, Verdonck-de Leeuw IM. Cost-Utility of Stepped Care Targeting Psychological Distress in Patients With Head and Neck or Lung Cancer. J Clin Oncol 2016; 35:314-324. [PMID: 27918712 DOI: 10.1200/jco.2016.68.8739] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Purpose A stepped care (SC) program in which an effective yet least resource-intensive treatment is delivered to patients first and followed, when necessary, by more resource-intensive treatments was found to be effective in improving distress levels of patients with head and neck cancer or lung cancer. Information on the value of this program for its cost is now called for. Therefore, this study aimed to assess the cost-utility of the SC program compared with care-as-usual (CAU) in patients with head and neck cancer or lung cancer who have psychological distress. Patients and Methods In total, 156 patients were randomly assigned to SC or CAU. Intervention costs, direct medical costs, direct nonmedical costs, productivity losses, and health-related quality-of-life data during the intervention or control period and 12 months of follow-up were calculated by using Trimbos and Institute of Medical Technology Assessment Cost Questionnaire for Psychiatry, Productivity and Disease Questionnaire, and EuroQol-5 Dimension measures and data from the hospital information system. The SC program's value for the cost was investigated by comparing mean cumulative costs and quality-adjusted life years (QALYs). Results After imputation of missing data, mean cumulative costs were -€3,950 (95% CI, -€8,158 to -€190) lower, and mean number of QALYs was 0.116 (95% CI, 0.005 to 0.227) higher in the intervention group compared with the control group. The intervention group had a probability of 96% that cumulative QALYs were higher and cumulative costs were lower than in the control group. Four additional analyses were conducted to assess the robustness of this finding, and they found that the intervention group had a probability of 84% to 98% that cumulative QALYs were higher and a probability of 91% to 99% that costs were lower than in the control group. Conclusion SC is highly likely to be cost-effective; the number of QALYs was higher and cumulative costs were lower for SC compared with CAU.
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Affiliation(s)
- Femke Jansen
- Femke Jansen, Anna M.H. Krebber, Veerle M.H. Coupé, Annemarie Becker-Commissaris, Egbert F. Smit, Guus M. Eeckhout, Aartjan T.F. Beekman, C. René Leemans, and Irma M. Verdonck-de Leeuw, VU Medical Center; Pim Cuijpers, Annemieke van Straten, and Irma M. Verdonck-de Leeuw, Vrije Universiteit Amsterdam, Amsterdam; and Remco de Bree, University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| | - Anna M H Krebber
- Femke Jansen, Anna M.H. Krebber, Veerle M.H. Coupé, Annemarie Becker-Commissaris, Egbert F. Smit, Guus M. Eeckhout, Aartjan T.F. Beekman, C. René Leemans, and Irma M. Verdonck-de Leeuw, VU Medical Center; Pim Cuijpers, Annemieke van Straten, and Irma M. Verdonck-de Leeuw, Vrije Universiteit Amsterdam, Amsterdam; and Remco de Bree, University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| | - Veerle M H Coupé
- Femke Jansen, Anna M.H. Krebber, Veerle M.H. Coupé, Annemarie Becker-Commissaris, Egbert F. Smit, Guus M. Eeckhout, Aartjan T.F. Beekman, C. René Leemans, and Irma M. Verdonck-de Leeuw, VU Medical Center; Pim Cuijpers, Annemieke van Straten, and Irma M. Verdonck-de Leeuw, Vrije Universiteit Amsterdam, Amsterdam; and Remco de Bree, University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| | - Pim Cuijpers
- Femke Jansen, Anna M.H. Krebber, Veerle M.H. Coupé, Annemarie Becker-Commissaris, Egbert F. Smit, Guus M. Eeckhout, Aartjan T.F. Beekman, C. René Leemans, and Irma M. Verdonck-de Leeuw, VU Medical Center; Pim Cuijpers, Annemieke van Straten, and Irma M. Verdonck-de Leeuw, Vrije Universiteit Amsterdam, Amsterdam; and Remco de Bree, University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| | - Remco de Bree
- Femke Jansen, Anna M.H. Krebber, Veerle M.H. Coupé, Annemarie Becker-Commissaris, Egbert F. Smit, Guus M. Eeckhout, Aartjan T.F. Beekman, C. René Leemans, and Irma M. Verdonck-de Leeuw, VU Medical Center; Pim Cuijpers, Annemieke van Straten, and Irma M. Verdonck-de Leeuw, Vrije Universiteit Amsterdam, Amsterdam; and Remco de Bree, University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| | - Annemarie Becker-Commissaris
- Femke Jansen, Anna M.H. Krebber, Veerle M.H. Coupé, Annemarie Becker-Commissaris, Egbert F. Smit, Guus M. Eeckhout, Aartjan T.F. Beekman, C. René Leemans, and Irma M. Verdonck-de Leeuw, VU Medical Center; Pim Cuijpers, Annemieke van Straten, and Irma M. Verdonck-de Leeuw, Vrije Universiteit Amsterdam, Amsterdam; and Remco de Bree, University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| | - Egbert F Smit
- Femke Jansen, Anna M.H. Krebber, Veerle M.H. Coupé, Annemarie Becker-Commissaris, Egbert F. Smit, Guus M. Eeckhout, Aartjan T.F. Beekman, C. René Leemans, and Irma M. Verdonck-de Leeuw, VU Medical Center; Pim Cuijpers, Annemieke van Straten, and Irma M. Verdonck-de Leeuw, Vrije Universiteit Amsterdam, Amsterdam; and Remco de Bree, University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| | - Annemieke van Straten
- Femke Jansen, Anna M.H. Krebber, Veerle M.H. Coupé, Annemarie Becker-Commissaris, Egbert F. Smit, Guus M. Eeckhout, Aartjan T.F. Beekman, C. René Leemans, and Irma M. Verdonck-de Leeuw, VU Medical Center; Pim Cuijpers, Annemieke van Straten, and Irma M. Verdonck-de Leeuw, Vrije Universiteit Amsterdam, Amsterdam; and Remco de Bree, University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| | - Guus M Eeckhout
- Femke Jansen, Anna M.H. Krebber, Veerle M.H. Coupé, Annemarie Becker-Commissaris, Egbert F. Smit, Guus M. Eeckhout, Aartjan T.F. Beekman, C. René Leemans, and Irma M. Verdonck-de Leeuw, VU Medical Center; Pim Cuijpers, Annemieke van Straten, and Irma M. Verdonck-de Leeuw, Vrije Universiteit Amsterdam, Amsterdam; and Remco de Bree, University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| | - Aartjan T F Beekman
- Femke Jansen, Anna M.H. Krebber, Veerle M.H. Coupé, Annemarie Becker-Commissaris, Egbert F. Smit, Guus M. Eeckhout, Aartjan T.F. Beekman, C. René Leemans, and Irma M. Verdonck-de Leeuw, VU Medical Center; Pim Cuijpers, Annemieke van Straten, and Irma M. Verdonck-de Leeuw, Vrije Universiteit Amsterdam, Amsterdam; and Remco de Bree, University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| | - C René Leemans
- Femke Jansen, Anna M.H. Krebber, Veerle M.H. Coupé, Annemarie Becker-Commissaris, Egbert F. Smit, Guus M. Eeckhout, Aartjan T.F. Beekman, C. René Leemans, and Irma M. Verdonck-de Leeuw, VU Medical Center; Pim Cuijpers, Annemieke van Straten, and Irma M. Verdonck-de Leeuw, Vrije Universiteit Amsterdam, Amsterdam; and Remco de Bree, University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| | - Irma M Verdonck-de Leeuw
- Femke Jansen, Anna M.H. Krebber, Veerle M.H. Coupé, Annemarie Becker-Commissaris, Egbert F. Smit, Guus M. Eeckhout, Aartjan T.F. Beekman, C. René Leemans, and Irma M. Verdonck-de Leeuw, VU Medical Center; Pim Cuijpers, Annemieke van Straten, and Irma M. Verdonck-de Leeuw, Vrije Universiteit Amsterdam, Amsterdam; and Remco de Bree, University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
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Krebber AMH, van Uden-Kraan CF, Melissant HC, Cuijpers P, van Straten A, Becker-Commissaris A, Leemans CR, Verdonck-de Leeuw IM. A guided self-help intervention targeting psychological distress among head and neck cancer and lung cancer patients: motivation to start, experiences and perceived outcomes. Support Care Cancer 2016; 25:127-135. [PMID: 27585808 PMCID: PMC5127860 DOI: 10.1007/s00520-016-3393-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/23/2016] [Indexed: 12/16/2022]
Abstract
Background Recent results of a randomized clinical trial showed that a guided self-help intervention (based on problem-solving therapy) targeting psychological distress among head and neck cancer and lung cancer patients is effective. This study qualitatively explored motivation to start, experiences with and perceived outcomes of this intervention. Methods Data were collected from semi-structured interviews of 16 patients. All interviews were audio-recorded and transcribed verbatim. Data were analyzed individually by two coders and coded into key issues and themes. Results Patients participated in the intervention for intrinsic (e.g. to help oneself) and for extrinsic reasons (e.g. being asked by a care professional or to help improve health care). Participants indicated positive and negative experiences with the intervention. Several participants appreciated participating as being a pleasant way to work on oneself, while others described participating as too confrontational. Some expressed their disappointment as they felt the intervention had brought them nothing or indicated that they felt worse temporarily, but most participants perceived positive outcomes of the intervention (e.g. feeling less distressed and having learned what matters in life). Conclusions Cancer patients have various reasons to start a guided self-help intervention. Participants appreciated the guided self-help as intervention to address psychological distress, but there were also concerns. Most participants reported the intervention to be beneficial. The results suggest the need to identify patients who might benefit most from guided self-help targeting psychological distress and that interventions should be further tailored to individual cancer patients’ requirements.
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Affiliation(s)
- Anne-Marie H Krebber
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.,EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.,VUmc Cancer Center, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Cornelia F van Uden-Kraan
- EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.,VUmc Cancer Center, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.,Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, the Netherlands
| | - Heleen C Melissant
- EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.,VUmc Cancer Center, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.,Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, the Netherlands
| | - Pim Cuijpers
- EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.,Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, the Netherlands
| | - Annemieke van Straten
- EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.,Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, the Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - C René Leemans
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.,VUmc Cancer Center, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands. .,EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands. .,VUmc Cancer Center, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands. .,Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, the Netherlands.
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Krebber AMH, Jansen F, Witte BI, Cuijpers P, de Bree R, Becker-Commissaris A, Smit EF, van Straten A, Eeckhout AM, Beekman ATF, Leemans CR, Verdonck-de Leeuw IM. Stepped care targeting psychological distress in head and neck cancer and lung cancer patients: a randomized, controlled trial. Ann Oncol 2016; 27:1754-60. [PMID: 27287209 DOI: 10.1093/annonc/mdw230] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/30/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the efficacy of stepped care (SC) targeting psychological distress in head and neck cancer (HNC) and lung cancer (LC) patients. PATIENTS AND METHODS Patients with untreated distress [Hospital Anxiety and Depression Scale (HADS; HADS-D > 7, HADS-A > 7, or HADS-total > 14)] were randomized to SC (n = 75) or care-as-usual (CAU) (n = 81). SC consisted of watchful waiting, guided self-help, problem-solving therapy, and psychotherapy and/or psychotropic medication. The primary outcome measure was the HADS; secondary outcome measures were recovery rate, EORTC QLQ-C30, QLQ-HN35/QLQ-LC13, and IN-PATSAT32. Measures were assessed at baseline, after completion of care, and at 3, 6, 9, and 12 months follow-up. Linear mixed models, t-tests, and effect sizes (ES) were used to assess group differences. RESULTS Patients with untreated distress were randomized to SC (n = 75) or care-as-usual (CAU) (n = 81). The course of psychological distress was better after SC compared with CAU (HADS-total, P = 0.005; HADS-A, P = 0.046; HADS-D, P = 0.007). The SC group scored better post-treatment (HADS-total, ES = 0.56; HADS-A, ES = 0.38; HADS-D, ES = 0.64) and at 9 months follow-up (HADS-total, ES = 0.42 and HADS-A, ES = 0.40). The recovery rate post-treatment was 55% after SC compared with 29% after CAU (P = 0.002), and 46% and 37% at 12 months follow-up (P = 0.35). Within SC, 28% recovered after watchful waiting, 34% after guided self-help, 9% after problem-solving therapy, and 17% after psychotherapy and/or psychotropic medication. The effect of SC was stronger for patients with a depressive or anxiety disorder compared with patients without such a disorder (HADS-total, P = 0.001; HADS-A, P = 0.003; HADS-D, P = 0.041). CONCLUSIONS SC is effective and speeds up recovery among HNC and LC patients with untreated psychological distress. TRIAL REGISTRATION Netherlands Trial Register (NTR1868).
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Affiliation(s)
- A M H Krebber
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA)
| | - F Jansen
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA)
| | - B I Witte
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam
| | - P Cuijpers
- Department of Clinical Psychology, EMGO+ Institute for Health and Care Research, VU University, Amsterdam
| | - R de Bree
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA) Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, Utrecht
| | | | - E F Smit
- Department of Pulmonary Diseases
| | - A van Straten
- Department of Clinical Psychology, EMGO+ Institute for Health and Care Research, VU University, Amsterdam
| | - A M Eeckhout
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - A T F Beekman
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - C R Leemans
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA)
| | - I M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA) Department of Clinical Psychology, EMGO+ Institute for Health and Care Research, VU University, Amsterdam
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