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Musoro JZ, Coens C, Sprangers MAG, Brandberg Y, Groenvold M, Flechtner HH, Cocks K, Velikova G, Dirven L, Greimel E, Singer S, Pogoda K, Gamper EM, Sodergren SC, Eggermont A, Koller M, Reijneveld JC, Taphoorn MJB, King MT, Bottomley A. Minimally important differences for interpreting EORTC QLQ-C30 change scores over time: A synthesis across 21 clinical trials involving nine different cancer types. Eur J Cancer 2023; 188:171-182. [PMID: 37257278 DOI: 10.1016/j.ejca.2023.04.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 02/15/2023] [Revised: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Early guidelines for minimally important differences (MIDs) for the EORTC QLQ-C30 proposed ≥10 points change as clinically meaningful for all scales. Increasing evidence that MIDs can vary by scale, direction of change, cancer type and estimation method has raised doubt about a single global standard. This paper identifies MID patterns for interpreting group-level change in EORTC QLQ-C30 scores across nine cancer types. METHODS Data were obtained from 21 published EORTC Phase III trials that enroled 13,015 patients across nine cancer types (brain, colorectal, advanced breast, head/neck, lung, mesothelioma, melanoma, ovarian, and prostate). Anchor-based MIDs for within-group change and between-group differences in change over time were obtained via mean change method and linear regression, respectively. Separate MIDs were estimated for improvements and deteriorations. Distribution-based estimates were derived and compared with anchor-based MIDs. RESULTS Anchor-based MIDs mostly ranged from 5 to 10 points. Differences in MIDs for improvement vs deterioration, for both within-group and between-group, were mostly within a 2-points range. Larger differences between within-group and between-group MIDs were observed for several scales in ovarian, lung and head/neck cancer. Most anchor-based MIDs ranged between 0.3 SD and 0.5 SD distribution-based estimates. CONCLUSIONS Our results reinforce recent claims that no single MID can be applied to all EORTC QLQ-C30 scales and disease settings. MIDs varied by scale, improvement/deterioration, within/between comparisons and by cancer type. Researchers applying commonly used rules of thumb must be aware of the risk of dismissing changes that are clinically meaningful or underpowering analyses when smaller MIDs apply.
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Affiliation(s)
- Jammbe Z Musoro
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium.
| | - Corneel Coens
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Mirjam A G Sprangers
- Amsterdam UMC Location University of Amsterdam, Medical Psychology, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Yvonne Brandberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Mogens Groenvold
- Department of Public Health, University of Copenhagen, and Bispebjerg Hospital, Copenhagen, Denmark
| | - Hans-Henning Flechtner
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany
| | - Kim Cocks
- Adelphi Values, Bollington, Cheshire, UK
| | - Galina Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, UK; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | | | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics, Division of Epidemiology and Health Services Research, University Medical Centre Mainz, Germany; University Cancer Centre Mainz, Germany
| | - Katarzyna Pogoda
- Departmenf of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Eva M Gamper
- Innsbruck Institute of Patient-centered Outcome Research (IIPCOR), Innsbruck, Austria
| | | | - Alexander Eggermont
- Princess Máxima Center, Utrecht and University Medical Center Utrecht, The Netherlands; Comprehensive Cancer Center Munich, Technical University Munich & Ludwig Maximiliaan University, Munich, Germany
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Jaap C Reijneveld
- Amsterdam University Medical Centers, location VU University Medical Center, Department of Neurology Brain Tumor Center, Amsterdam, The Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Madeleine T King
- University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia
| | - Andrew Bottomley
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
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Liu L, Choi J, Musoro JZ, Sauerbrei W, Amdal CD, Alanya A, Barbachano Y, Cappelleri JC, Falk RS, Fiero MH, Regnault A, Reijneveld JC, Sandin R, Thomassen D, Roychoudhury S, Goetghebeur E, le Cessie S. Single-arm studies involving patient-reported outcome data in oncology: a literature review on current practice. Lancet Oncol 2023; 24:e197-e206. [PMID: 37142381 DOI: 10.1016/s1470-2045(23)00110-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/08/2023] [Accepted: 03/13/2023] [Indexed: 05/06/2023]
Abstract
Patient-reported outcomes (PROs) are increasingly used in single-arm cancer studies. We reviewed 60 papers published between 2018 and 2021 of single-arm studies of cancer treatment with PRO data for current practice on design, analysis, reporting, and interpretation. We further examined the studies' handling of potential bias and how they informed decision making. Most studies (58; 97%) analysed PROs without stating a predefined research hypothesis. 13 (22%) of the 60 studies used a PRO as a primary or co-primary endpoint. Definitions of PRO objectives, study population, endpoints, and missing data strategies varied widely. 23 studies (38%) compared the PRO data with external information, most often by using a clinically important difference value; one study used a historical control group. Appropriateness of methods to handle missing data and intercurrent events (including death) were seldom discussed. Most studies (51; 85%) concluded that PRO results supported treatment. Conducting and reporting of PROs in cancer single-arm studies need standards and a critical discussion of statistical methods and possible biases. These findings will guide the Setting International Standards in Analysing Patient-Reported Outcomes and Quality of Life Data in Cancer Clinical Trials-Innovative Medicines Initiative (SISAQOL-IMI) in developing recommendations for the use of PRO-measures in single-arm studies.
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Affiliation(s)
- Limin Liu
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium.
| | - Jungyeon Choi
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Jammbe Z Musoro
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Willi Sauerbrei
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Cecilie Delphin Amdal
- Research Support Services, Department of Oncology, Oslo University Hospital, Oslo, Norway; Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Ahu Alanya
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | | | | | - Ragnhild Sørum Falk
- Research Support Services, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | | | - Jaap C Reijneveld
- Department of Neurology & Brain Tumor Center, VU University Medical Center, Amsterdam, Netherlands
| | | | - Doranne Thomassen
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | | | - Els Goetghebeur
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | - Saskia le Cessie
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
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Koller M, Musoro JZ, Tomaszewski K, Coens C, King MT, Sprangers MAG, Groenvold M, Cocks K, Velikova G, Flechtner HH, Bottomley A. Corrigendum to "Minimally important differences of EORTC QLQ-C30 scales in patients with lung cancer or malignant pleural mesothelioma - Interpretation guidance derived from two randomized EORTC trials" [Lung Cancer 167C (2022) 65-72]. Lung Cancer 2022; 171:126. [PMID: 35606221 DOI: 10.1016/j.lungcan.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany.
| | - Jammbe Z Musoro
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Krzysztof Tomaszewski
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krak ́ow University, Krak ́ow, Poland
| | - Corneel Coens
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Madeleine T King
- University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Mogens Groenvold
- Department of Public Health, University of Copenhagen, and Bispebjerg Hospital, Copenhagen, Denmark
| | - Kim Cocks
- Adelphi Values, Bollington, Cheshire, UK
| | - Galina Velikova
- Leeds Institute of Medical Research at St James's University, University of Leeds and Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, St James's University, Hospital, Leeds, UK
| | - Hans-Henning Flechtner
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany
| | - Andrew Bottomley
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
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Koller M, Musoro JZ, Tomaszewski K, Coens C, King MT, Sprangers MA, Groenvold M, Cocks K, Velikova G, Flechtner HH, Bottomley A. Minimally important differences of EORTC QLQ-C30 scales in patients with lung cancer or malignant pleural mesothelioma – Interpretation guidance derived from two randomized EORTC trials. Lung Cancer 2022; 167:65-72. [DOI: 10.1016/j.lungcan.2022.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/25/2022] [Accepted: 03/27/2022] [Indexed: 12/09/2022]
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Stadler R, Romero PO, Bagot M, Quaglino P, Guenova E, Jonak C, Papadavid E, Stranzenbach R, Sartori D, Musoro JZ, Falato C, Marreaud S, Scarisbrick JJ, Knobler R. Phase II trial of atezolizumab (anti-PD-L1) in the treatment of stage IIb-IVB mycosis fungoides/Sézary syndrome patients relapsed/refractory after a previous systemic treatment (PARCT). Eur J Cancer 2021; 156 Suppl 1:S22-S23. [PMID: 34649647 DOI: 10.1016/s0959-8049(21)00668-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Pablo Ortiz Romero
- Department of Dermatology, Hospital Universitaria 12 de Cubre, Madrid, Spain
| | - Martine Bagot
- Department of Dermatology, Hôpital Saint-Louis, Paris, France
| | - Pietro Quaglino
- Department of Medical Science, University of Turin Medical School, Turin, Italy
| | - Emmanuella Guenova
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Constanze Jonak
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Evangelina Papadavid
- Department of Dermatology, National and Kapodistrian University of Athens, Athens, Greece
| | - René Stranzenbach
- Department of Dermatology, St. Josef Hospital, UK RUB, Bochum, Germany
| | | | | | | | | | | | - Robert Knobler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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Gamper EM, Musoro JZ, Coens C, Stelmes JJ, Falato C, Groenvold M, Velikova G, Cocks K, Flechtner HH, King MT, Bottomley A. Minimally important differences for the EORTC QLQ-C30 in prostate cancer clinical trials. BMC Cancer 2021; 21:1083. [PMID: 34620124 PMCID: PMC8496068 DOI: 10.1186/s12885-021-08609-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 03/26/2021] [Accepted: 07/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background The aim of the study was to estimate the minimally important difference (MID) for interpreting group-level change over time, both within a group and between groups, for the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) scores in patients with prostate cancer. Methods We used data from two published EORTC trials. Clinical anchors were selected by strength of correlations with QLQ-C30 scales. In addition, clinicians’ input was obtained with regard to plausibility of the selected anchors. The mean change method was applied for interpreting change over time within a group of patients and linear regression models were fitted to estimate MIDs for between-group differences in change over time. Distribution-based estimates were also evaluated. Results Two clinical anchors were eligible for MID estimation; performance status and the CTCAE diarrhoea domain. MIDs were developed for 7 scales (physical functioning, role functioning, social functioning, pain, fatigue, global quality of life, diarrhoea) and varied by scale and direction (improvement vs deterioration). Within-group MIDs ranged from 4 to 14 points for improvement and − 13 to − 5 points for deterioration and MIDs for between-group differences in change scores ranged from 3 to 13 for improvement and − 10 to − 5 for deterioration. Conclusions Our findings aid the meaningful interpretation of changes on a set of EORTC QLQ-C30 scale scores over time, both within and between groups, and for performing more accurate sample size calculations for clinical trials in prostate cancer. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08609-7.
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Affiliation(s)
- Eva M Gamper
- Innsbruck Institute of Patient-centered Outcome Research (IIPCOR), Innsbruck, Austria.
| | - Jammbe Z Musoro
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Corneel Coens
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Jean-Jacques Stelmes
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Claudette Falato
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Mogens Groenvold
- Department of Public Health, University of Copenhagen, and Bispebjerg Hospital, Copenhagen, Denmark
| | - Galina Velikova
- Leeds Institute of Cancer and Pathology, University of Leeds, St James's Hospital, Leeds, UK
| | - Kim Cocks
- Adelphi Value, Bollington, Cheshire, UK
| | - Hans-Henning Flechtner
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany
| | - Madeleine T King
- University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia
| | - Andrew Bottomley
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
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Dirven L, Musoro JZ, Coens C, Reijneveld JC, Taphoorn MJB, Boele FW, Groenvold M, van den Bent MJ, Stupp R, Velikova G, Cocks K, Sprangers MAG, King MT, Flechtner HH, Bottomley A. Establishing anchor-based minimally important differences for the EORTC QLQ-C30 in glioma patients. Neuro Oncol 2021; 23:1327-1336. [PMID: 33598685 PMCID: PMC8328025 DOI: 10.1093/neuonc/noab037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Minimally important differences (MIDs) allow interpretation of the clinical relevance of health-related quality of life (HRQOL) results. This study aimed to estimate MIDs for all European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) scales for interpreting group-level results in brain tumor patients. METHODS Clinical and HRQOL data from three glioma trials were used. Clinical anchors were selected for each EORTC QLQ-C30 scale, based on correlation (>0.30) and clinical plausibility of association. Changes in both HRQOL and the anchors were calculated, and for each scale and time period, patients were categorized into one of the three clinical change groups: deteriorated by one anchor category, no change, or improved by one anchor category. Mean change method and linear regression were applied to estimate MIDs for interpreting within-group change and between-group differences in change over time, respectively. Distribution-based methods were applied to generate supportive evidence. RESULTS A total of 1687 patients were enrolled in the three trials. The retained anchors were performance status and eight Common Terminology Criteria for Adverse Events (CTCAE) scales. MIDs for interpreting within-group change ranged from 4 to 12 points for improvement and -4 to -14 points for deterioration. MIDs for between-group difference in change ranged from 4 to 9 for improvement and -4 to -16 for deterioration. Most anchor-based MIDs were closest to the 0.3 SD distribution-based estimates (range: 3-10). CONCLUSIONS MIDs for the EORTC QLQ-C30 scales generally ranged between 4 and 11 points for both within-group mean change and between-group mean difference in change. These results can be used to interpret QLQ-C30 results from glioma trials.
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Affiliation(s)
- Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Jammbe Z Musoro
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Corneel Coens
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Jaap C Reijneveld
- Department of Neurology & Brain Tumor Center, Amsterdam University Medical Centers, location VU University Medical Center, Amsterdam, the Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Florien W Boele
- Leeds Institute of Medical Research at St James’s, St James’s University Hospital, Leeds, UK
- Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Mogens Groenvold
- Leeds Institute of Medical Research at St James’s, St James’s University Hospital, Leeds, UK
- Departments of Public Health and Palliative Medicine, University of Copenhagen and Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | | | - Roger Stupp
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Galina Velikova
- Leeds Institute of Medical Research at St James’s, St James’s University Hospital, Leeds, UK
| | - Kim Cocks
- Adelphi Values, Bollington, Cheshire, UK
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Cancer Center Amsterdam, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Madeleine T King
- Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Hans-Henning Flechtner
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany
| | - Andrew Bottomley
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
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Musoro JZ, Sodergren SC, Coens C, Pochesci A, Terada M, King MT, Sprangers MAG, Groenvold M, Cocks K, Velikova G, Flechtner HH, Bottomley A. Minimally important differences for interpreting the EORTC QLQ-C30 in patients with advanced colorectal cancer treated with chemotherapy. Colorectal Dis 2020; 22:2278-2287. [PMID: 32767619 DOI: 10.1111/codi.15295] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/28/2020] [Indexed: 12/13/2022]
Abstract
AIM The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) assesses the health-related quality of life of patients in cancer trials. There are currently no minimally important difference (MID) guidelines for the EORTC QLQ-C30 for colorectal cancer (CRC). This study aims to estimate MIDs for the EORTC QLQ-C30 scales in patients with advanced CRC treated with chemotherapy and enrolled in clinical trials. METHOD The data were obtained from three published EORTC trials that treated CRC patients using chemotherapy. Potential anchors were selected from clinical variables based on their correlation with EORTC QLQ-C30 scales. Anchor-based MIDs for within-group change and between-group change were estimated via the mean change method and linear regression, respectively, and summarized using weighted correlation. Distribution-based MIDs were also examined. RESULTS Anchor-based MIDs were determined for deterioration in 8 of the 14 EORTC QLQ-C30 scales and in 9 scales for improvement, and varied by scale, direction of change and anchor. MIDs for improvement (deterioration) ranged from 6 to 18 (-11 to -5) points for within-group change and 5 to 15 (-10 to -4) for between-group change. Summarized MIDs (in absolute values) per scale mostly ranged from 5 to 10 points. CONCLUSIONS These findings have clinical relevance for the interpretation of treatment efficacy and the design of clinical trials by informing sample size requirements.
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Affiliation(s)
- J Z Musoro
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - S C Sodergren
- School of Health Sciences, University of Southampton, Southampton, UK
| | - C Coens
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - A Pochesci
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - M Terada
- Japan Clinical Oncology Group, Clinical Research Support Office, National Cancer Center Hospital, Tokyo, Japan
| | - M T King
- Faculty of Science, School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - M A G Sprangers
- Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - M Groenvold
- Department of Public Health, University of Copenhagen and Bispebjerg Hospital, Copenhagen, Denmark
| | - K Cocks
- Adelphi Values, Bollington, Cheshire, UK
| | - G Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - H-H Flechtner
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany
| | - A Bottomley
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
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Musoro JZ, Coens C, Greimel E, King MT, Sprangers MAG, Nordin A, van Dorst EBL, Groenvold M, Cocks K, Velikova G, Flechtner HH, Bottomley A. Minimally important differences for interpreting European Organisation for Research and Treatment of Cancer (EORTC) Quality of life Questionnaire core 30 scores in patients with ovarian cancer. Gynecol Oncol 2020; 159:515-521. [PMID: 32972782 DOI: 10.1016/j.ygyno.2020.09.007] [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: 04/23/2020] [Accepted: 09/05/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Minimal important differences (MIDs) are useful for interpreting changes or differences in health-related quality of life scores in terms of clinical importance. There are currently no MID guidelines for the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire core 30 (EORTC QLQ-C30) specific to ovarian cancer. This study aims to estimate MIDs for interpreting group-level change of EORTC QLQ-C30 scores in ovarian cancer. METHODS Data were derived from four EORTC published trials. Clinical anchors for each EORTC QLQ-C30 scale were selected using correlation strength and clinical plausibility. MIDs for within-group change and between-group differences in change over time were estimated via mean change method and linear regression respectively. For each EORTC QLQ-C30 scale, MID estimates from multiple anchors were summarized via weighted-correlation. Distribution-based MIDs were also examined as supportive evidence. RESULTS Anchor-based MIDs were determined for deterioration in 7 of the 14 EORTC QLQ-C30 scales assessed, and in 11 scales for improvement. Anchor-based MIDs for within-group change ranged from 4 to 19 (improvement) and - 9 to -4 (deterioration). Between-group MIDs ranged from 3 to 13 (improvement) and - 11 to -4 (deterioration). Generally, absolute anchor-based MIDs for most scales ranged from 4 to 10 points. CONCLUSIONS Our findings will aid interpretation of EORTC QLQ-C30 scores in ovarian cancer and inform sample size calculations in future ovarian cancer trials with endpoints that are based on EORTC QLQ-C30 scales.
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Affiliation(s)
- Jammbe Z Musoro
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium.
| | - Corneel Coens
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | | | - Madeleine T King
- University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Cancer Center Amsterdam, the Netherlands
| | - Andy Nordin
- East Kent Gynaecological Oncology Centre, Queen Elizabeth the Queen Mother Hospital, UK
| | - Eleonora B L van Dorst
- Department of Obstetrics and Gynecology, Academic Hospital Utrecht, Utrecht, the Netherlands
| | - Mogens Groenvold
- Department of Public Health, University of Copenhagen, and Bispebjerg Hospital, Copenhagen, Denmark
| | - Kim Cocks
- Adelphi Values, Bollington, Cheshire, UK
| | - Galina Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Hans-Henning Flechtner
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany
| | - Andrew Bottomley
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
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Musoro JZ, Coens C, Singer S, Tribius S, Oosting SF, Groenvold M, Simon C, Machiels JP, Grégoire V, Velikova G, Cocks K, Sprangers MAG, King MT, Bottomley A. Minimally important differences for interpreting European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 scores in patients with head and neck cancer. Head Neck 2020; 42:3141-3152. [PMID: 32627261 DOI: 10.1002/hed.26363] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 03/15/2019] [Revised: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We aimed to estimate minimally important difference (MID) for interpreting group-level change over time for European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire core 30 (EORTC QLQ-C30) scores in head and neck cancer. METHODS Data were derived retrospectively from two published EORTC trials. Clinical anchors were selected using correlation strength and clinical plausibility of the given anchor/QLQ-C30 scale pair. MIDs for within-group and between-group change were estimated via the mean change method and linear regression, respectively. Distribution-based MIDs were also examined. MIDs for two of the scales, dyspnea and nausea/vomiting, are more uncertain considering their low correlations with the anchors. RESULTS Anchor-based MIDs could be determined for deterioration in 7 of the 14 QLQ-C30 scales assessed, and in 3 scales for improvement. MIDs varied by scale, direction of change, and anchor. Absolute MID values ranged from 5 to 15 points for within-group change and 4 to 12 for between-group change. Most MIDs were within 4 to 10 points. CONCLUSIONS Our findings, if confirmed, will aid interpreting changes in selected QLQ-C30 scale scores over time and inform sample size calculations in future clinical trials in head and neck cancer.
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Affiliation(s)
- Jammbe Z Musoro
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Corneel Coens
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Susanne Singer
- Division of Epidemiology and Health Services Research University Medical Centre, Institute of Medical Biostatistics, Epidemiology and Informatics, Mainz, Germany.,University Cancer Centre Mainz, Mainz, Germany
| | - Silke Tribius
- Department of Radiation Oncology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Sjoukje F Oosting
- University Medical Center Groningen, Department of Medical Oncology, University of Groningen, Groningen, The Netherlands
| | - Mogens Groenvold
- Department of Public Health, University of Copenhagen and Bispebjerg Hospital, Copenhagen, Denmark
| | - Christian Simon
- Department of Otolaryngology, Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Jean-Pascal Machiels
- Institut Roi Albert II, Service d'oncologie médicale, Cliniques universitaires Saint-Luc and Institut de Recherche Clinique et Expérimentale, U C Louvain, Brussels, Belgium
| | | | - Galina Velikova
- Leeds Institute of Cancer and Pathology, University of Leeds, St James's Hospital, Leeds, UK
| | - Kim Cocks
- Department of Health Sciences, University of York, York, UK.,Adelphi Values, Bollington, UK
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Cancer Center, Amsterdam, The Netherlands
| | - Madeleine T King
- Faculty of Science, School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew Bottomley
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
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Coens C, Pe M, Dueck AC, Sloan J, Basch E, Calvert M, Campbell A, Cleeland C, Cocks K, Collette L, Devlin N, Dorme L, Flechtner HH, Gotay C, Griebsch I, Groenvold M, King M, Kluetz PG, Koller M, Malone DC, Martinelli F, Mitchell SA, Musoro JZ, O'Connor D, Oliver K, Piault-Louis E, Piccart M, Quinten C, Reijneveld JC, Schürmann C, Smith AW, Soltys KM, Taphoorn MJB, Velikova G, Bottomley A. International standards for the analysis of quality-of-life and patient-reported outcome endpoints in cancer randomised controlled trials: recommendations of the SISAQOL Consortium. Lancet Oncol 2020; 21:e83-e96. [PMID: 32007209 DOI: 10.1016/s1470-2045(19)30790-9] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/12/2019] [Accepted: 11/18/2019] [Indexed: 02/03/2023]
Abstract
Patient-reported outcomes (PROs), such as symptoms, function, and other health-related quality-of-life aspects, are increasingly evaluated in cancer randomised controlled trials (RCTs) to provide information about treatment risks, benefits, and tolerability. However, expert opinion and critical review of the literature showed no consensus on optimal methods of PRO analysis in cancer RCTs, hindering interpretation of results. The Setting International Standards in Analyzing Patient-Reported Outcomes and Quality of Life Endpoints Data Consortium was formed to establish PRO analysis recommendations. Four issues were prioritised: developing a taxonomy of research objectives that can be matched with appropriate statistical methods, identifying appropriate statistical methods for PRO analysis, standardising statistical terminology related to missing data, and determining appropriate ways to manage missing data. This Policy Review presents recommendations for PRO analysis developed through critical literature reviews and a structured collaborative process with diverse international stakeholders, which provides a foundation for endorsement; ongoing developments of these recommendations are also discussed.
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Affiliation(s)
- Corneel Coens
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Madeline Pe
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.
| | - Amylou C Dueck
- Alliance Statistics and Data Center, Mayo Clinic, Scottsdale, AZ, USA
| | - Jeff Sloan
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Ethan Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research and National Institute for Health Research Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
| | | | - Charles Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kim Cocks
- Adelphi Values, Bollington, Cheshire, UK
| | - Laurence Collette
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Nancy Devlin
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Lien Dorme
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Hans-Henning Flechtner
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany
| | - Carolyn Gotay
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | - Mogens Groenvold
- Department of Public Health, Bispebjerg Hospital and University of Copenhagen, Copenhagen, Denmark
| | - Madeleine King
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Paul G Kluetz
- Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | | | | | - Sandra A Mitchell
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Jammbe Z Musoro
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Daniel O'Connor
- Medicines and Healthcare products Regulatory Agency, London, UK
| | | | | | - Martine Piccart
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Chantal Quinten
- European Centre for Disease Prevention and Control, Surveillance and Response Support Unit, Epidemiological Methods Section, Stockholm, Sweden
| | - Jaap C Reijneveld
- Department of Neurology and Brain Tumor Center, VU University Medical Center, Amsterdam, Netherlands
| | | | - Ashley Wilder Smith
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | | | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden; Department of Neurology, Haaglanden Medical Center, The Hague, Netherlands
| | - Galina Velikova
- Leeds Institute of Cancer and Pathology, University of Leeds, St James's Hospital, Leeds, UK; International Society for Quality of Life Research, Milwaukee, WI, USA
| | - Andrew Bottomley
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
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12
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Bottomley A, Reijneveld JC, Koller M, Flechtner H, Tomaszewski KA, Greimel E, Ganz PA, Ringash J, O'Connor D, Kluetz PG, Tafuri G, Grønvold M, Snyder C, Gotay C, Fallowfield DL, Apostolidis K, Wilson R, Stephens R, Schünemann H, Calvert M, Holzner B, Musoro JZ, Wheelwright S, Martinelli F, Dueck AC, Pe M, Coens C, Velikova G, Kuliś D, Taphoorn MJ, Darlington AS, Lewis I, van de Poll-Franse L. Current state of quality of life and patient-reported outcomes research. Eur J Cancer 2019; 121:55-63. [DOI: 10.1016/j.ejca.2019.08.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/08/2019] [Indexed: 12/15/2022]
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13
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Musoro JZ, Coens C, Fiteni F, Katarzyna P, Cardoso F, Russell NS, King MT, Cocks K, Sprangers MA, Groenvold M, Velikova G, Flechtner HH, Bottomley A. Minimally Important Differences for Interpreting EORTC QLQ-C30 Scores in Patients With Advanced Breast Cancer. JNCI Cancer Spectr 2019; 3:pkz037. [PMID: 32328553 PMCID: PMC7050000 DOI: 10.1093/jncics/pkz037] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/24/2019] [Accepted: 05/20/2019] [Indexed: 11/13/2022] Open
Abstract
Background We aimed to estimate the minimally important difference (MID) for interpreting group-level change over time, both within a group and between groups, for the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire core 30 (EORTC QLQ-C30) scores in patients with advanced breast cancer. Methods Data were derived from two published EORTC trials. Clinical anchors (eg, performance status [PS]) were selected using correlation strength and clinical plausibility of their association with a particular QLQ-C30 scale. Three change status groups were formed: deteriorated by one anchor category, improved by one anchor category, and no change. Patients with greater anchor changes were excluded. The mean change method was used to estimate MIDs for within-group change, and linear regression was used to estimate MIDs for between-group differences in change over time. For a given QLQ-C30 scale, MID estimates from multiple anchors were triangulated to a single value via a correlation-based weighted average. Results MIDs varied by QLQ-C30 scale, direction (improvement vs deterioration), and anchor. MIDs for within-group change ranged from 5 to 14 points (improvement) and −14 to −4 points (deterioration), and MIDs for between-group change over time ranged from 4 to 11 points and from −18 to −4 points. Correlation-weighted MIDs for most QLQ-C30 scales ranged from 4 to 10 points in absolute values. Conclusions Our findings aid interpretation of changes in EORTC QLQ-C30 scores over time, both within and between groups, and for performing more accurate sample size calculations for clinical trials in advanced breast cancer.
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Affiliation(s)
- Jammbe Z Musoro
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Corneel Coens
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Frederic Fiteni
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.,Department of Medical Oncology, University Hospital of Nîmes, France.,Institut de Recherche en Cancérologie de Montpellier, France.,University of Montpellier, France
| | - Pogoda Katarzyna
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.,Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland
| | - Fatima Cardoso
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.,Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Lisbon, Portugal
| | - Nicola S Russell
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.,Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Madeleine T King
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.,University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia
| | - Kim Cocks
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.,Department of Health Sciences, University of York, York, UK.,Adelphi Values, Bollington, Cheshire, UK
| | - Mirjam Ag Sprangers
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.,Department of Medical Psychology, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Cancer Center Amsterdam, The Netherlands
| | - Mogens Groenvold
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.,Department of Public Health, University of Copenhagen, and Bispebjerg Hospital, Copenhagen, Denmark
| | - Galina Velikova
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.,Leeds Institute of Cancer and Pathology, University of Leeds, St James's Hospital, Leeds, UK
| | - Hans-Henning Flechtner
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.,Clinic for Child and Adolescent Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany
| | - Andrew Bottomley
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
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14
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Musoro JZ, Bottomley A, Coens C, Eggermont AMM, King MT, Cocks K, Sprangers MAG, Groenvold M, Velikova G, Flechtner HH, Brandberg Y. Interpreting European Organisation for Research and Treatment for Cancer Quality of life Questionnaire core 30 scores as minimally importantly different for patients with malignant melanoma. Eur J Cancer 2018; 104:169-181. [DOI: 10.1016/j.ejca.2018.09.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/14/2018] [Accepted: 09/10/2018] [Indexed: 12/18/2022]
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15
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Bottomley A, Pe M, Sloan J, Basch E, Bonnetain F, Calvert M, Campbell A, Cleeland C, Cocks K, Collette L, Dueck AC, Devlin N, Flechtner HH, Gotay C, Greimel E, Griebsch I, Groenvold M, Hamel JF, King M, Kluetz PG, Koller M, Malone DC, Martinelli F, Mitchell SA, Moinpour CM, Musoro JZ, O’Connor D, Oliver K, Piault-Louis E, Piccart M, Pimentel FL, Quinten C, Reijneveld JC, Schürmann C, Smith AW, Soltys KM, Sridhara R, Taphoorn MJB, Velikova G, Coens C. Moving forward toward standardizing analysis of quality of life data in randomized cancer clinical trials. Clin Trials 2018; 15:624-630. [DOI: 10.1177/1740774518795637] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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]
Abstract
Background There is currently a lack of consensus on how health-related quality of life and other patient-reported outcome measures in cancer randomized clinical trials are analyzed and interpreted. This makes it difficult to compare results across randomized controlled trials (RCTs) synthesize scientific research, and use that evidence to inform product labeling, clinical guidelines, and health policy. The Setting International Standards in Analyzing Patient-Reported Outcomes and Quality of Life Endpoints Data for Cancer Clinical Trials (SISAQOL) Consortium aims to develop guidelines and recommendations to standardize analyses of patient-reported outcome data in cancer RCTs. Methods and Results Members from the SISAQOL Consortium met in January 2017 to discuss relevant issues. Data from systematic reviews of the current state of published research in patient-reported outcomes in cancer RCTs indicated a lack of clear reporting of research hypothesis and analytic strategies, and inconsistency in definitions of terms, including “missing data,”“health-related quality of life,” and “patient-reported outcome.” Based on the meeting proceedings, the Consortium will focus on three key priorities in the coming year: developing a taxonomy of research objectives, identifying appropriate statistical methods to analyze patient-reported outcome data, and determining best practices to evaluate and deal with missing data. Conclusion The quality of the Consortium guidelines and recommendations are informed and enhanced by the broad Consortium membership which includes regulators, patients, clinicians, and academics.
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Affiliation(s)
- Andrew Bottomley
- Quality of Life Department, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Madeline Pe
- Quality of Life Department, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Jeff Sloan
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Ethan Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Franck Bonnetain
- Methodology and Quality of Life Unit in Cancer, INSERM U1098, University Hospital of Besançon, Besançon, France
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Charles Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Laurence Collette
- Quality of Life Department, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Amylou C Dueck
- Alliance Statistics and Data Center, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Hans-Henning Flechtner
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany
| | - Carolyn Gotay
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Eva Greimel
- Department of Obstetrics and Gynecology, Medical University Graz, Graz, Austria
| | | | - Mogens Groenvold
- Department of Public Health, University of Copenhagen and Bispebjerg Hospital, Copenhagen, Denmark
| | - Jean-Francois Hamel
- Methodology and Biostatistics Department, University Hospital of Angers UNAM, Angers, France
| | - Madeleine King
- School of Psychology and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Paul G Kluetz
- US Food and Drug Administration, Silver Spring, MD, USA
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | | | - Francesca Martinelli
- Quality of Life Department, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Sandra A Mitchell
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | | | - Jammbe Z Musoro
- Quality of Life Department, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Daniel O’Connor
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | | | | | - Martine Piccart
- Internal Medicine/Oncology, Institut Jules Bordet, Brussels, Belgium
| | - Francisco L Pimentel
- Blueclinical Phase I, Porto, Portugal
- Centro de Estudos e Investigação em Saúde da Universidade de Coimbra, Coimbra, Portugal
| | - Chantal Quinten
- European Centre for Disease Prevention and Control, Surveillance and Response Support Unit, Epidemiological Methods Section, Stockholm, Sweden
| | - Jaap C Reijneveld
- VU University Medical Center, Department of Neurology & Brain Tumor Center, Amsterdam, The Netherlands
| | | | - Ashley Wilder Smith
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | | | | | - Martin J B Taphoorn
- Leiden University Medical Center/Haaglanden Medical Center, Leiden/The Hague, The Netherlands
| | - Galina Velikova
- Leeds Institute of Cancer and Pathology, University of Leeds, St James’s Hospital, Leeds, UK
| | - Corneel Coens
- Quality of Life Department, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
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Musoro JZ, Zwinderman AH, Abu‐Hanna A, Bosman R, Geskus RB. Dynamic prediction of mortality among patients in intensive care using the sequential organ failure assessment (SOFA) score: a joint competing risk survival and longitudinal modeling approach. STAT NEERL 2017. [DOI: 10.1111/stan.12114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jammbe Z Musoro
- Department of Clinical Epidemiology Biostatistics and Bioinformatics Academic Medical Center, University of Amsterdam Meibergdreef 9 Amsterdam 1105 AZ The Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology Biostatistics and Bioinformatics Academic Medical Center, University of Amsterdam Meibergdreef 9 Amsterdam 1105 AZ The Netherlands
| | - Ameen Abu‐Hanna
- Department of Medical Informatics Academic Medical Center, Universiteit van Amsterdam Meibergdreef 9 Amsterdam 1105 AZ The Netherlands
| | - Rob Bosman
- Department of Intensive Care Onze Lieve Vrouwe Gasthuis Oosterpark 9 1091 AC Amsterdam The Netherlands
| | - Ronald B Geskus
- Department of Clinical Epidemiology Biostatistics and Bioinformatics Academic Medical Center, University of Amsterdam Meibergdreef 9 Amsterdam 1105 AZ The Netherlands
- Nuffield Department of Medicine University of Oxford Oxford United Kingdom
- Oxford University Clinical Research Unit Wellcome Trust Major Overseas Programme Ho Chi Minh City Viet Nam
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Musoro JZ, Struijk GH, Geskus RB, ten Berge IJM, Zwinderman AH. Dynamic prediction of recurrent events data by landmarking with application to a follow-up study of patients after kidney transplant. Stat Methods Med Res 2016; 27:832-845. [DOI: 10.1177/0962280216643563] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper extends dynamic prediction by landmarking to recurrent event data. The motivating data comprised post-kidney transplantation records of repeated infections and repeated measurements of multiple markers. At each landmark time point ts, a Cox proportional hazards model with a frailty term was fitted using data of individuals who were at risk at landmark s. This model included the time-updated marker values at ts as time-fixed covariates. Based on a stacked data set that merged all landmark data sets, we considered supermodels that allow parameters to depend on the landmarks in a smooth fashion. We described and evaluated four ways to parameterize the supermodels for recurrent event data. With both the study data and simulated data sets, we compared supermodels that were fitted on stacked data sets that consisted of either overlapping or non-overlapping landmark periods. We observed that for recurrent event data, the supermodels may yield biased estimates when overlapping landmark periods are used for stacking. Using the best supermodel amongst the ones considered, we dynamically estimated the probability to remain infection free between ts and a prediction horizon thor, conditional on the information available at ts.
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Affiliation(s)
- JZ Musoro
- Department of Clinical Epidemiology, Biostatistics and Bioinformatic Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - GH Struijk
- Renal Transplant Unit, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - RB Geskus
- Department of Clinical Epidemiology, Biostatistics and Bioinformatic Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - IJM ten Berge
- Renal Transplant Unit, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - AH Zwinderman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatic Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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18
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Musoro JZ, Zwinderman AH, Puhan MA, ter Riet G, Geskus RB. Validation of prediction models based on lasso regression with multiply imputed data. BMC Med Res Methodol 2014; 14:116. [PMID: 25323009 PMCID: PMC4209042 DOI: 10.1186/1471-2288-14-116] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 10/10/2014] [Indexed: 01/22/2023] Open
Abstract
Background In prognostic studies, the lasso technique is attractive since it improves the quality of predictions by shrinking regression coefficients, compared to predictions based on a model fitted via unpenalized maximum likelihood. Since some coefficients are set to zero, parsimony is achieved as well. It is unclear whether the performance of a model fitted using the lasso still shows some optimism. Bootstrap methods have been advocated to quantify optimism and generalize model performance to new subjects. It is unclear how resampling should be performed in the presence of multiply imputed data. Method The data were based on a cohort of Chronic Obstructive Pulmonary Disease patients. We constructed models to predict Chronic Respiratory Questionnaire dyspnea 6 months ahead. Optimism of the lasso model was investigated by comparing 4 approaches of handling multiply imputed data in the bootstrap procedure, using the study data and simulated data sets. In the first 3 approaches, data sets that had been completed via multiple imputation (MI) were resampled, while the fourth approach resampled the incomplete data set and then performed MI. Results The discriminative model performance of the lasso was optimistic. There was suboptimal calibration due to over-shrinkage. The estimate of optimism was sensitive to the choice of handling imputed data in the bootstrap resampling procedure. Resampling the completed data sets underestimates optimism, especially if, within a bootstrap step, selected individuals differ over the imputed data sets. Incorporating the MI procedure in the validation yields estimates of optimism that are closer to the true value, albeit slightly too larger. Conclusion Performance of prognostic models constructed using the lasso technique can be optimistic as well. Results of the internal validation are sensitive to how bootstrap resampling is performed. Electronic supplementary material The online version of this article (doi:10.1186/1471-2288-14-116) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jammbe Z Musoro
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 Amsterdam, the Netherlands.
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Musoro JZ, Geskus RB, Zwinderman AH. A joint model for repeated events of different types and multiple longitudinal outcomes with application to a follow-up study of patients after kidney transplant. Biom J 2014; 57:185-200. [PMID: 25316383 DOI: 10.1002/bimj.201300167] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 08/21/2013] [Revised: 04/01/2014] [Accepted: 04/09/2014] [Indexed: 11/12/2022]
Abstract
This paper presents an extension of the joint modeling strategy for the case of multiple longitudinal outcomes and repeated infections of different types over time, motivated by postkidney transplantation data. Our model comprises two parts linked by shared latent terms. On the one hand is a multivariate mixed linear model with random effects, where a low-rank thin-plate spline function is incorporated to collect the nonlinear behavior of the different profiles over time. On the other hand is an infection-specific Cox model, where the dependence between different types of infections and the related times of infection is through a random effect associated with each infection type to catch the within dependence and a shared frailty parameter to capture the dependence between infection types. We implemented the parameterization used in joint models which uses the fitted longitudinal measurements as time-dependent covariates in a relative risk model. Our proposed model was implemented in OpenBUGS using the MCMC approach.
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Affiliation(s)
- Jammbe Z Musoro
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Andraud M, Lejeune O, Musoro JZ, Ogunjimi B, Beutels P, Hens N. Living on three time scales: the dynamics of plasma cell and antibody populations illustrated for hepatitis a virus. PLoS Comput Biol 2012; 8:e1002418. [PMID: 22396639 PMCID: PMC3291529 DOI: 10.1371/journal.pcbi.1002418] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [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: 07/13/2011] [Accepted: 01/23/2012] [Indexed: 11/19/2022] Open
Abstract
Understanding the mechanisms involved in long-term persistence of humoral immunity after natural infection or vaccination is challenging and crucial for further research in immunology, vaccine development as well as health policy. Long-lived plasma cells, which have recently been shown to reside in survival niches in the bone marrow, are instrumental in the process of immunity induction and persistence. We developed a mathematical model, assuming two antibody-secreting cell subpopulations (short- and long-lived plasma cells), to analyze the antibody kinetics after HAV-vaccination using data from two long-term follow-up studies. Model parameters were estimated through a hierarchical nonlinear mixed-effects model analysis. Long-term individual predictions were derived from the individual empirical parameters and were used to estimate the mean time to immunity waning. We show that three life spans are essential to explain the observed antibody kinetics: that of the antibodies (around one month), the short-lived plasma cells (several months) and the long-lived plasma cells (decades). Although our model is a simplified representation of the actual mechanisms that govern individual immune responses, the level of agreement between long-term individual predictions and observed kinetics is reassuringly close. The quantitative assessment of the time scales over which plasma cells and antibodies live and interact provides a basis for further quantitative research on immunology, with direct consequences for understanding the epidemiology of infectious diseases, and for timing serum sampling in clinical trials of vaccines.
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Affiliation(s)
- Mathieu Andraud
- Centre for Health Economics Research and Modelling of Infectious Diseases-CHERMID, Vaccine & Infectious Disease Institute-VAXINFECTIO, University of Antwerp, Antwerp, Belgium.
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