1
|
Clarke NA, Braverman J, Worthy G, Shaw JW, Bennett B, Dhanda D, Cocks K. A Review of Meaningful Change Thresholds for EORTC QLQ-C30 and FACT-G Within Oncology. Value Health 2024; 27:458-468. [PMID: 38191023 DOI: 10.1016/j.jval.2023.12.012] [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] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/11/2023] [Accepted: 12/22/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVES This literature review provides an overview of meaningful change thresholds for the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQ-C30) and the Functional Assessment of Cancer Therapy - General (FACT-G) used across hematological cancers and solid tumors (melanoma, lung, bladder, and prostate). METHODS Embase, MEDLINE, and PubMed were searched to identify relevant oncology publications from 2016 to 2021. Label claims from the US Food and Drug Administration and the European Medicines Agency for 7 recently approved drugs (pembrolizumab, atezolizumab, glasdegib, gilteritinib, tisagenlecleucel, axicabtagene ciloleucel, and daratumumab plus hyaluronidase-fihj) were reviewed. RESULTS Publications providing guidance on meaningful change thresholds for the QLQ-C30 displayed a growing trend away from broad "legacy" thresholds of 10 points for all QLQ-C30 scales), toward deriving "contemporary" thresholds (eg, subscale specific, population specific). Contemporary publications generally provide guidance on selecting thresholds for specific scales that account for improved or worsening thresholds (eg, QLQ-C30 subscales). This trend was not clear for FACT-G, with less new guidance available. Most clinical trials used in regulatory label submissions have used thresholds of 10 points for the QLQ-C30 subscales and 3 to 7 points for the FACT-G total score. Despite the availability of more recent guidelines, contemporary meaningful change thresholds seem slow to emerge in the published literature and regulatory labels. CONCLUSIONS Trialists should consider using contemporary thresholds, rather than legacy thresholds, for QLQ-C30 endpoints. Thresholds derived for a similar patient-population should be used where available. Further work is required to provide these across a broader range of cancer sites.
Collapse
Affiliation(s)
- Nathan A Clarke
- Statistics and Programming, Adelphi Values, Bollington, Cheshire, England, UK.
| | - Julia Braverman
- Worldwide Health and Economic Outcomes Research, Bristol Myers Squib, Princeton, NJ, USA
| | - Gill Worthy
- Statistics and Programming, Adelphi Values, Bollington, Cheshire, England, UK
| | - James W Shaw
- Worldwide Health and Economic Outcomes Research, Bristol Myers Squib, Princeton, NJ, USA
| | - Bryan Bennett
- Worldwide Health and Economic Outcomes Research, Bristol Myers Squib, Uxbridge, England, UK
| | - Devender Dhanda
- Worldwide Health and Economic Outcomes Research, Bristol Myers Squib, Princeton, NJ, USA
| | - Kim Cocks
- Statistics and Programming, Adelphi Values, Bollington, Cheshire, England, UK
| |
Collapse
|
2
|
Oerlemans S, Efficace F, Shamieh O, Cardoso Borges F, de Jong C, Dong D, Lehmann J, Malak S, Petranovic D, Scholz CW, Caocci G, Molica S, Griskevicius L, Nagele E, Bredart A, Carvalho E, Xochelli A, Agelink van Rentergem J, Alrjoob W, Mueller A, Freitas AC, Cocks K, Creutzberg C, Kyriakou C, van de Poll-Franse L. International validation of a health-related quality-of-life questionnaire for Hodgkin lymphoma: the EORTC QLQ-HL27. Blood Adv 2023; 7:7045-7055. [PMID: 37738090 PMCID: PMC10694520 DOI: 10.1182/bloodadvances.2023010841] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/13/2023] [Accepted: 08/22/2023] [Indexed: 09/23/2023] Open
Abstract
Hodgkin lymphoma (HL) has become 1 of the most curable cancers. Therefore, rigorous assessment of health-related quality of life (HRQoL) and symptom burden of these patients is essential to support informed clinical decisions. The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group previously developed the EORTC Quality of Life Questionnaire (QLQ) Hodgkin Lymphoma 27. This paper reports the final results of an international study by the EORTC group to develop a HRQoL disease-specific measure for these patients: the EORTC QLQ-HL27. Patients with a confirmed diagnosis of HL (N = 381) were enrolled from 12 countries and completed the EORTC QLQ-C30, QLQ-HL27, and a debriefing questionnaire at baseline (any time after diagnosis). A subset completed a retest (n = 126) or responsiveness-to-change analyses (RCA) second measurement (n = 98). Psychometrics were evaluated. Confirmatory factor analysis showed an acceptable fit of the 27 items of the QLQ-HL27 on its 4 scales (symptom burden, physical condition/fatigue, emotional impact, and worries about health/functioning). Test-retest reliability, convergent validity, known-group comparisons, and RCA find satisfactory results. Symptom burden and fatigue was higher among patients on treatment (with 36%-83% reporting at least a few problems) compared with those who had completed treatment (19%-61% reporting at least a few problems). Prevalence of worries about health and functioning (reporting at least some worry) was similar for patients on treatment (51%-81%) vs those who had completed treatment (52%-78%). Implementation of the EORTC QLQ-HL27 in research and clinical applications will increase sensitivity of HRQoL assessment in patients with HL. High quality data generated through use of this questionnaire are expected to facilitate clinical decision making in the HL setting.
Collapse
Affiliation(s)
- Simone Oerlemans
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases Data Centre, Rome, Italy
| | - Omar Shamieh
- Department of Palliative Medicine, King Hussein Cancer Center, Amman, Jordan
- Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Fabio Cardoso Borges
- Department of Epidemiology and National Cancer Registry, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Corine de Jong
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dong Dong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jens Lehmann
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Sandra Malak
- Hôpital René Huguenin-Institut Curie- Hématologie, Saint-Cloud, France
| | - Duska Petranovic
- Clinical Hospital Center Rijeka, University of Rijeka, Rijeka, Croatia
| | | | - Giovanni Caocci
- Hematology, Businco Hospital, University of Cagliari, Cagliari, Italy
| | | | - Laimonas Griskevicius
- Hematology, Oncology and Transfusion Medicine, Vilnius University Hospital Santaros Klinikos and Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Eva Nagele
- Medical University of Graz, Graz, Austria
| | - Anne Bredart
- Institut Curie Psycho-Oncology Unit; Paris University, Psychopathology and Health Process Laboratory (UR 4057); PSL University, Paris, France
| | - Elisabete Carvalho
- Department of Epidemiology and National Cancer Registry, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
- Clinical Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Aliki Xochelli
- Institute of Applied Biosciences, Center for Research and Technology Hellas, Thessaloniki, Greece
| | - Joost Agelink van Rentergem
- Department of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Waleed Alrjoob
- Department of Palliative Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Anja Mueller
- Hematology and Oncology, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Ana Carolina Freitas
- Hematology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Kim Cocks
- York Trials Unit, University of York, York & Adelphi Values, Cheshire, United Kingdom
| | - Carien Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Lonneke van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| |
Collapse
|
3
|
Holch P, Turner G, Keetharuth AD, Gibbons E, Cocks K, Absolom KL. The impact of COVID-19 on PRO development, collection and implementation: views of UK and Ireland professionals. J Patient Rep Outcomes 2023; 7:121. [PMID: 38010558 PMCID: PMC10682296 DOI: 10.1186/s41687-023-00663-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND PROs are valuable tools in clinical care to capture patients' perspectives of their health, symptoms and quality of life. However the COVID-19 pandemic has had profound impacts on all aspects of life, in particular healthcare and research. This study explores the views of UK and Irish health professionals, third sector and pharmaceutical industry representatives and academic researchers on the impact of COVID-19 on PRO collection, use and development in clinical practice. METHODS A volunteer sample took part in a 10 question cross sectional qualitative survey, on the impact of COVID-19, administered online via Qualtrics. Demographic data was descriptively analysed, and the qualitative free text response data was subject to thematic analysis and summarised within the Strengths, Weaknesses, Opportunities and Threats (SWOT) framework. RESULTS Forty nine participants took part located in a range of UK settings and professions. Participants highlighted staff strengths during the pandemic including colleagues' flexibility and ability to work collaboratively and the adoption of novel communication tools. Weaknesses were a lack of staff capacity to continue or start PRO projects and insufficient digital infrastructure to continue studies online. Opportunities included the added interest in PROs as useful outcomes, the value of electronic PROs for staff and patients particularly in relation to integration into systems and the electronic patient records. However, these opportunities came with an understanding that digital exclusion may be an issue for patient groups. Threats identified included that the majority of PRO research was stopped or delayed and funding streams were cut. CONCLUSIONS Although most PRO research was on hold during the pandemic, the consensus from participants was that PROs as meaningful outcomes were valued more than ever. From the opportunities afforded by the pandemic the development of electronic PROs and their integration into electronic patient record systems and clinical practice could be a lasting legacy from the COVID-19 pandemic.
Collapse
Affiliation(s)
- Patricia Holch
- Department of Psychology, School of Humanities and Social Sciences, Leeds Beckett University, Portland Building, Room PD402, City Campus, Leeds, LS1 9HE, UK.
| | - Grace Turner
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Anju D Keetharuth
- School of Health and Related Research, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - E Gibbons
- Evidera Ltd, 201 Talgarth Rd, The Ark, London, W6 8BJ, UK
| | - Kim Cocks
- Adelphi Values, Patient-Centered Outcomes, Bollington, Cheshire, SK10 5JB, UK
| | - Kate L Absolom
- Leeds Institute of Medical Research, University of Leeds, St James's Hospital, Bexley Wing, Beckett Street, Leeds, LS9 7TF, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| |
Collapse
|
4
|
King-Kallimanis BL, Calvert M, Cella D, Cocks K, Coens C, Fairclough D, Howie L, Jonsson P, Mahendraratnam N, Maues J, Sarac S, Shaw J, Stigger N, Trask P, Wieseler B. Perspectives on Patient-Reported Outcome Data After Treatment Discontinuation in Cancer Clinical Trials. Value Health 2023; 26:1543-1548. [PMID: 37422075 DOI: 10.1016/j.jval.2023.06.019] [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] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES Patient-reported outcome (PRO) data are critical in understanding treatments from the patient perspective in cancer clinical trials. The potential benefits and methodological approaches to the collection of PRO data after treatment discontinuation (eg, because of progressive disease or unacceptable drug toxicity) are less clear. The purpose of this article is to describe the Food and Drug Administration's Oncology Center of Excellence and the Critical Path Institute cosponsored 2-hour virtual roundtable, held in 2020, to discuss this specific issue. METHODS We summarize key points from this discussion with 16 stakeholders representing academia, clinical practice, patients, international regulatory agencies, health technology assessment bodies/payers, industry, and PRO instrument development. RESULTS Stakeholders recognized that any PRO data collection after treatment discontinuation should have clearly defined objectives to ensure that data can be analyzed and reported. CONCLUSIONS Data collection after discontinuation without a justification for its use wastes patients' time and effort and is unethical.
Collapse
Affiliation(s)
| | - Melanie Calvert
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, England, UK; Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, England, UK; National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, England, UK; NIHR Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, England, UK; Health Data Research UK, London, England, UK; NIHR Birmingham-Oxford Blood and Transplant Research Unit in Precision Transplant and Cellular Therapeutics, University of Birmingham, UK
| | - David Cella
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Kim Cocks
- Adelphi Values, Cheshire, England, UK
| | - Corneel Coens
- Quality of Life Department, EORTC HQ, Brussels, Belgium
| | | | - Lynn Howie
- Pardee Cancer Center, Hendersonville, NC, USA
| | - Pall Jonsson
- Data and Analytics, National Institute for Health and Care Excellence (NICE), Manchester, UK
| | | | | | - Sinan Sarac
- Member of CHMP (EMA), Danish Medicines Agency, Copenhagen, Denmark
| | - Jim Shaw
- Bristol-Myers Squibb, Lawrenceville, NJ, USA
| | | | - Peter Trask
- Genentech, Inc, South San Francisco, CA, USA
| | - Beate Wieseler
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| |
Collapse
|
5
|
Oerlemans S, Efficace F, Kyriakou C, Freitas AC, Shamieh O, Creutzberg CL, Lehmann J, Petranovic D, Nagele E, Bredart A, Dong D, Scholz CW, Caocci G, Molica S, Griskevicius L, Xochelli A, Kieffer JM, Agelink van Rentergem JA, Alrjoub W, Mueller A, Gomes Da Silva M, Alves da Costa F, Malak S, Cocks K, van de Poll-Franse LV. International validation of two EORTC questionnaires for assessment of health-related quality of life for patients with high-grade non-Hodgkin lymphoma (QLQ-NHL-HG29) and low-grade non-Hodgkin lymphoma (QLQ-NHL-LG20). Cancer 2023; 129:2727-2740. [PMID: 37204189 DOI: 10.1002/cncr.34822] [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: 01/24/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Health-related quality of life (HRQOL) is a critical aspect to consider when making treatment decisions for patients with non-Hodgkin-lymphoma (NHL). This international study by the European Organisation for Research and Treatment of Cancer (EORTC) tested the psychometric properties of two newly developed measures for patients with high-grade (HG)- and low-grade (LG)-NHL: the EORTC QLQ-NHL-HG29 and the EORTC QLQ-NHL-LG20 to supplement the core questionnaire (EORTC QLQ-C30). METHODS Overall, 768 patients with HG-NHL (N = 423) and LG-NHL (N = 345) from 12 countries completed the QLQ-C30, QLQ-NHL-HG29/QLQ-NHL-LG20 and a debriefing questionnaire at baseline, and a subset at follow-up for either retest (N = 125/124) or responsiveness to change (RCA; N = 98/49). RESULTS Confirmatory factor analysis showed an acceptable to good fit of the 29 items of the QLQ-NHL-HG29 on its five scales (symptom burden [SB], neuropathy, physical condition/fatigue [PF], emotional impact [EI], and worries about health/functioning [WH]), and of the 20 items of the QLQ-NHL-LG20 on its four scales (SB, PF, EI, and WH). Completion took on average 10 minutes. Test-retest reliability, convergent validity, known-group comparisons, and RCA find satisfactory results of both measures. A total of 31%-78% of patients with HG-NHL and 22%-73% of patients with LG-NHL reported symptoms and/or worries (e.g., tingling in hands/feet, lack of energy, and worries about recurrence). Patients reporting symptoms/worries had substantially lower HRQOL compared to those without. DISCUSSION The use of the EORTC QLQ-NHL-HG29 and QLQ-NHL-LG20 questionnaires in clinical research and practice will provide clinically relevant data to better inform treatment decision-making. PLAIN LANGUAGE SUMMARY The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group developed two questionnaires. These questionnaires measure health-related quality of life. The questionnaires are for patients with high-grade or low-grade non-Hodgkin lymphoma. They are called the EORTC QLQ-NHL-HG29 and QLQ-NHL-LG20. The questionnaires are now internationally validated. This study demonstrates that the questionnaires are reliably and valid, which are important aspects of a questionnaire. The questionnaires can now be used in clinical trials and practice. With the information gathered from the questionnaires, patients and clinicians can better evaluate treatments and discuss the best choice for a patient.
Collapse
Affiliation(s)
- Simone Oerlemans
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases Data Centre, Rome, Italy
| | | | - Ana Carolina Freitas
- Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Omar Shamieh
- Department of Palliative Medicine, King Hussein Cancer Center, Amman, Jordan
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Carien L Creutzberg
- Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jens Lehmann
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Duska Petranovic
- Clinical Hospital Center Rijeka, University of Rijeka, Rijeka, Croatia
| | - Eva Nagele
- Division of Haematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Anne Bredart
- Institut Curie, Psycho-Oncology Unit, Paris, France
- Psychopathology and Health Process Laboratory (UR 4057), Paris University, Paris, France
- PSL University, Paris, France
| | - Dong Dong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Giovanni Caocci
- Hematology, Businco Hospital, University of Cagliari, Cagliari, Italy
| | - Stefano Molica
- Azienda Ospedalier Ciaccio, Catanzaro, Italy
- Department of Hematology, Hull University Teaching Hospitals, NHS Trust, Hull, UK
| | - Laimonas Griskevicius
- Hematology, Oncology and Transfusion Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Aliki Xochelli
- Institute of Applied Biosciences, Center for Research and Technology Hellas, Thessaloniki, Greece
| | - Jacobien M Kieffer
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Waleed Alrjoub
- Department of Palliative Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Anja Mueller
- Hematology and Oncology, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Maria Gomes Da Silva
- Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Filipa Alves da Costa
- Department of Epidemiology and National Cancer Registry, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
- Department of Pharmacy, Pharmacology and Health Technologies, Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
- Research Institute for Medicines (iMED.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal
| | - Sandra Malak
- Hôpital René Huguenin-Institut Curie-Hématologie, Saint-Cloud, France
| | - Kim Cocks
- York Trials Unit, University of York, York, UK
- Adelphi Values, Bollington, Cheshire, UK
| | - Lonneke V van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Forde K, Cocks K, Wells JR, McMillan I, Kyriakou C. Use of the European Organisation for Research and Treatment of Cancer multiple myeloma module (EORTC QLQ-MY20): a review of the literature 25 years after development. Blood Cancer J 2023; 13:79. [PMID: 37193682 DOI: 10.1038/s41408-023-00815-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/10/2023] [Indexed: 05/18/2023] Open
Abstract
The European Organisation for Research and Treatment of Cancer Quality of Life Multiple Myeloma Questionnaire (EORTC QLQ-MY20) was developed in 1996 to assess health-related quality of life (HRQoL) in patients with multiple myeloma. Since its development new therapies have prolonged survival in patients with myeloma and new combination agents are likely to impact HRQoL outcomes and its measurement.The aim of this review was to explore the use of the QLQ-MY20 and reported methodological issues.An electronic database search was conducted (1996-June 2020) to identify clinical studies/research that used the QLQ-MY20 or assessed its psychometric properties. Data were extracted from full-text publications/conference abstracts and checked by a second rater.The search returned 65 clinical and 9 psychometric validation studies. The QLQ-MY20 was used in interventional (n = 21, 32%) and observational (n = 44, 68%) studies and the publication of QLQ-MY20 data in clinical trials increased over time. Clinical studies commonly included relapsed patients with myeloma patients (n = 15, 68%) and assessed a range of combinations therapies.QLQ-MY20 subscales (disease symptoms [DS], side effects of treatment [SE], future perspectives [FP], body image [BI]) were defined as secondary (n = 12, 55%) or exploratory (n = 7, 32%) trial endpoints, particularly DS (n = 16, 72%) and SE (n = 16, 72%). Validation articles demonstrated that all domains performed well regarding internal consistency reliability (>0.7), test-reset reliability (intraclass correlation coefficient > =0.85), internal and external convergent and discriminant validity. Four articles reported a high percentage of ceiling effects in the BI subscale; all other subscales performed well regarding floor and ceiling effects.The EORTC QLQ-MY20 remains a widely used and psychometrically robust instrument. While no specific problems were identified from the published literature, qualitative interviews are ongoing to ensure new concepts and side effects are included that may arise from patients receiving novel treatments or from longer survival with multiple lines of treatment.
Collapse
Affiliation(s)
- K Forde
- Adelphi Values, Patient-Centered Outcomes, Bollington, Cheshire, UK
| | - K Cocks
- Adelphi Values, Patient-Centered Outcomes, Bollington, Cheshire, UK
| | - J R Wells
- Previously of Adelphi Values, Patient-Centered Outcomes, Bollington, Cheshire, UK
| | - I McMillan
- Previously of Adelphi Values, Patient-Centered Outcomes, Bollington, Cheshire, UK
| | - C Kyriakou
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK.
| |
Collapse
|
8
|
Hirji I, Cocks K, Moreno-Koehler A, Sundberg A. Healthcare resource utilization of maribavir versus investigator-assigned therapy in transplant recipients with cytomegalovirus infection refractory (with or without genotypic resistance) to prior treatment: Exploratory analysis of the Phase 3 SOLSTICE trial. Transpl Infect Dis 2023:e14064. [PMID: 37154528 DOI: 10.1111/tid.14064] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/03/2023] [Accepted: 04/01/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Cytomegalovirus (CMV), a common post-transplant infection, is associated with increased healthcare resource utilization. In the Phase 3 SOLSTICE trial, maribavir was superior to investigator-assigned therapy (IAT; valganciclovir/ganciclovir, foscarnet, and cidofovir) for CMV viremia clearance at Week 8 in transplant recipients with confirmed refractory CMV infection with/without resistance. This exploratory analysis evaluated hospital admissions of patients during the SOLSTICE trial. METHODS Patients were randomized to maribavir (400 mg twice daily) or IAT for an 8-week treatment phase with a 12-week follow-up. After ≥3 weeks of treatment, patients on IAT who met pre-specified criteria could enter a maribavir rescue arm (8-week maribavir treatment, 12-week follow-up). Adjusted hospitalization rates and length of hospital stay (LOS) were estimated using negative binomial models adjusting for the time in the relevant study phase. Subgroup analysis for the maribavir rescue arm was conducted. RESULTS Overall, 352 patients were randomized (maribavir: 235; IAT: 117); 22 entered the maribavir rescue arm. After adjusting for treatment exposure, patients on maribavir had a 34.8% reduction in hospitalization rate and 53.8% reduced LOS (days/person/year) versus IAT during the treatment phase. No significant differences between treatments were observed during the follow-up phase, although in both arms, hospitalization rates were lower than in the treatment phase. In the maribavir rescue arm, hospitalizations were 60.6% lower on/after maribavir rescue versus pre-rescue treatment (p = 0.008). CONCLUSION In patients requiring post-transplant CMV treatment, hospitalization rate and LOS were lower for maribavir than IAT, and hospitalization rates were lower on/after maribavir rescue than pre-rescue. Reducing hospitalizations can alleviate the burden on patients and healthcare systems.
Collapse
Affiliation(s)
- Ishan Hirji
- Global Evidence & Outcomes, Research and Development, Takeda Development Center Americas, Inc., Lexington, Massachusetts, USA
| | - Kim Cocks
- Patient-Centered Outcomes, Adelphi Values, Bollington, UK
| | | | - Aimee Sundberg
- Clinical Science, Research and Development, Takeda Development Center Americas, Inc., Lexington, Massachusetts, USA
| |
Collapse
|
9
|
Sodergren SC, Johnson CD, Gilbert A, Darlington AS, Cocks K, Guren MG, Rivin Del Campo E, Brannan C, Christensen P, Chu W, Chung H, Dennis K, Desideri I, Gilbert DC, Glynne-Jones R, Jefford M, Johansson M, Johnsson A, Juul T, Kardamakis D, Lai-Kwon J, McFarlane V, Miguel IMC, Nugent K, Peters F, Riechelmann RP, Turhal NS, Wong S, Vassiliou V. International Validation of the EORTC QLQ-ANL27, a Field Study to Test the Anal Cancer-Specific Health-Related Quality-of-Life Questionnaire. Int J Radiat Oncol Biol Phys 2023; 115:1155-1164. [PMID: 36402360 DOI: 10.1016/j.ijrobp.2022.11.002] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE The European Organisation for Research and Treatment of Cancer (EORTC) health-related quality of life questionnaire for anal cancer (QLQ-ANL27) supplements the EORTC cancer generic measure (QLQ-C30) to measure concerns specific to people with anal cancer treated with chemoradiotherapy. This study tested the psychometric properties and acceptability of the QLQ-ANL27. METHODS AND MATERIALS People with anal cancer were recruited from 15 countries to complete the QLQ-C30 and QLQ-ANL27 and provide feedback on the QLQ-ANL27. Item responses, scale structure (multitrait scaling, factor analysis), reliability (internal consistency and reproducibility) and sensitivity (known group comparisons and responsiveness to change) of the QLQ-ANL27 were evaluated. RESULTS Data from 382 people were included in the analyses. The EORTC QLQ-ANL27 was acceptable, comprehensive, and easy to complete, taking an average 8 minutes to complete. Psychometric analyses supported the EORTC QLQ-ANL27 items and reliability (Cronbach's α ranging from 0.71-0.93 and test-retest coefficients above 0.7) and validity of the scales (particularly nonstoma bowel symptoms and pain/discomfort). Most scales distinguished people according to treatment phase and performance status. Bowel (nonstoma), pain/discomfort, and vaginal symptoms were sensitive to deteriorations over time. The stoma-related scales remained untested because of low numbers of people with a stoma. Revisions to the scoring and question ordering of the sexual items were proposed. CONCLUSIONS The QLQ-ANL27 has good psychometric properties and is available in 16 languages for people treated with chemoradiotherapy for anal cancer. It is used in clinical trials and has a potential role in clinical practice.
Collapse
Affiliation(s)
| | | | - Alexandra Gilbert
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, United Kingdom
| | | | - Kim Cocks
- KCStats Consultancy, Cheshire, United Kingdom
| | - Marianne G Guren
- Department of Oncology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eleonor Rivin Del Campo
- Department of Radiation Oncology, Tenon University Hospital, Sorbonne University, Paris, France
| | | | | | - William Chu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Hans Chung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Kristopher Dennis
- The Ottawa Hospital Cancer Centre, Ottawa, Canada; Department of Radiology, University of Ottawa, Ottawa, Canada
| | - Isacco Desideri
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Duncan C Gilbert
- Sussex Cancer Centre, Royal Sussex County Hospital, Eastern Road, Brighton, United Kingdom
| | | | - Michael Jefford
- Departments of Medical Oncology and Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Mia Johansson
- Department of Oncology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Department of Oncology, University of Gothenburg, Gothenburg, Sweden
| | - Anders Johnsson
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Therese Juul
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Dimitrios Kardamakis
- Department of Radiation Oncology, University of Patras Medical School, Patras, Greece
| | - Julia Lai-Kwon
- Departments of Medical Oncology and Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Vicky McFarlane
- University Hospital Southampton, Southampton, United Kingdom
| | | | - Karen Nugent
- University Hospital Southampton, Southampton, United Kingdom
| | - Femke Peters
- Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | - Shun Wong
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Vassilios Vassiliou
- Department of Radiation Oncology, Bank of Cyprus Oncology Center, Nicosia, Cyprus
| |
Collapse
|
10
|
Griffiths P, Sims J, Williams A, Williamson N, Cella D, Brohan E, Cocks K. Correction: How strong should my anchor be for estimating group and individual level meaningful change? A simulation study assessing anchor correlation strength and the impact of sample size, distribution of change scores and methodology on establishing a true meaningful change threshold. Qual Life Res 2023; 32:1265. [PMID: 36759380 DOI: 10.1007/s11136-023-03356-7] [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: 02/11/2023]
Affiliation(s)
| | - Joel Sims
- Adelphi Values, Patient-Centered Outcomes, Bollington, Cheshire, UK.
| | - Abi Williams
- Adelphi Values, Patient-Centered Outcomes, Bollington, Cheshire, UK
| | | | - David Cella
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Elaine Brohan
- Adelphi Values, Patient-Centered Outcomes, Bollington, Cheshire, UK
| | - Kim Cocks
- Adelphi Values, Patient-Centered Outcomes, Bollington, Cheshire, UK
| |
Collapse
|
11
|
Leggett H, Scantlebury A, Hewitt C, Sharma H, McDaid C, Cocks K, Harwood P, Ferguson D, Hamdy R, Ferreira N. What is important to adults after lower limb reconstruction surgery: a conceptual framework. Qual Life Res 2023; 32:1671-1682. [PMID: 36611119 PMCID: PMC9825128 DOI: 10.1007/s11136-022-03340-7] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE Patient-reported outcome measures (PROMs) are used to understand the impact of lower limb reconstruction on patient's Health-Related Quality of Life (HRQL). Existing measures have not involved this group of patients and their experiences during development. This study aimed to develop a conceptual framework to reflect what is important to patients requiring, undergoing or after undergoing reconstructive surgery. METHODS Our population of interest was people requiring, undergoing or after undergoing reconstructive surgery due to trauma, malunion, nonunion, infection or congenital issues treated by internal or external fixation. We undertook semi-structured interviews with patients and orthopaedic healthcare professionals (surgeons, methodologists and patient contributors) in England. RESULTS Thirty-two patients and 22 orthopaedic healthcare professionals (surgeons, methodologists and patient contributors) were interviewed between November 2020 and June 2021. Eight domains from a previously developed preliminary conceptual framework were used as a framework around which to code the interviews using thematic analysis. Six domains important to patients (from the perspective of patients and orthopaedic healthcare professionals) were included in the final conceptual framework: pain, perception-of-self, work and finances, daily lifestyle and functioning, emotional well-being, and support. These findings, plus meetings with our advisory panel led to the refinement of the conceptual framework. CONCLUSION The first five domains relate to important outcomes for patients; they are all inter-related and their importance to patients changed throughout recovery. The final domain-support (from work, the hospital, physiotherapists and family/friends)-was vital to patients and lessened the negative impact of the other domains on their HRQL. These new data strengthen our original findings and our understanding of the domains we identified in the QES. The next step in this research is to ascertain whether current PROMs used with this group of patients adequately capture these areas of importance.
Collapse
|
12
|
Cocks K, Wells JR, Johnson C, Schmidt H, Koller M, Oerlemans S, Velikova G, Pinto M, Tomaszewski KA, Aaronson NK, Exall E, Finbow C, Fitzsimmons D, Grant L, Groenvold M, Tolley C, Wheelwright S, Bottomley A. Content validity of the EORTC quality of life questionnaire QLQ-C30 for use in cancer. Eur J Cancer 2023; 178:128-138. [PMID: 36436330 DOI: 10.1016/j.ejca.2022.10.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [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: 07/04/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022]
Abstract
AIM The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQ-C30) is among the most widely used patient-reported outcome measures in cancer research and practice. It was developed prior to guidance that content should be established directly from patients to confirm it measures concepts of interest and is appropriate and comprehensive for the intended population. This study evaluated the content validity of the QLQ-C30 for use with cancer patients. METHODS Adults undergoing cancer treatment in Europe and the USA participated in open-ended concept elicitation interviews regarding their functional health, symptoms, side-effects and impacts on health-related quality of life. Thematic analysis was conducted, and similarities across cancer types, disease stages and countries or languages were explored. RESULTS Interviews with 113 patients with cancer (85 European, 28 USA) including breast, lung, prostate, colorectal and other cancers were conducted between 2016 and 2020. Conceptual saturation was achieved. The most frequently reported concepts were included in the QLQ-C30 conceptual framework. QLQ-C30 items were widely understood across language versions and were relevant to patients across cancer types and disease stages. While several new concepts were elicited such as difficulty climbing steps or stairs, weight loss, skin problems and numbness, many were not widely experienced and/or could be considered sub-concepts of existing concepts. CONCLUSIONS The QLQ-C30 demonstrates good evidence of content validity for the assessment of functional health, symptom burden and health-related quality of life in patients with localised-to-advanced cancer.
Collapse
Affiliation(s)
- Kim Cocks
- Adelphi Values, Patient-Centered Outcomes, Bollington, Cheshire, UK.
| | - Jane R Wells
- Formerly of Adelphi Values, Patient-Centered Outcomes, Bollington, Cheshire, UK
| | - Colin Johnson
- Surgical Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Heike Schmidt
- Institute of Health and Nursing Science and University Clinic and Outpatient Clinic for Radiotherapy, Medical Faculty, Martin Luther University Halle Wittenberg, Germany
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Simone Oerlemans
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Galina Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - Monica Pinto
- Strategic Health Services Department, Istituto Nazionale Tumori - IRCCS- Fondazione G Pascale, Napoli, Italy
| | - Krzysztof A Tomaszewski
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Neil K Aaronson
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Elizabeth Exall
- Formerly of Adelphi Values, Patient-Centered Outcomes, Bollington, Cheshire, UK
| | - Chelsea Finbow
- Formerly of Adelphi Values, Patient-Centered Outcomes, Bollington, Cheshire, UK
| | | | - Laura Grant
- Adelphi Values, Patient-Centered Outcomes, Bollington, Cheshire, UK
| | - Mogens Groenvold
- The Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Chloe Tolley
- Adelphi Values, Patient-Centered Outcomes, Bollington, Cheshire, UK
| | - Sally Wheelwright
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Andrew Bottomley
- Quality of Life Department, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| |
Collapse
|
13
|
Griffiths P, Sims J, Williams A, Williamson N, Cella D, Brohan E, Cocks K. How strong should my anchor be for estimating group and individual level meaningful change? A simulation study assessing anchor correlation strength and the impact of sample size, distribution of change scores and methodology on establishing a true meaningful change threshold. Qual Life Res 2022; 32:1255-1264. [PMID: 36401757 DOI: 10.1007/s11136-022-03286-w] [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] [Accepted: 10/24/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Treatment benefit as assessed using clinical outcome assessments (COAs), is a key endpoint in many clinical trials at both the individual and group level. Anchor-based methods can aid interpretation of COA change scores beyond statistical significance, and help derive a meaningful change threshold (MCT). However, evidence-based guidance on the selection of appropriately related anchors is lacking. METHODS A simulation was conducted which varied sample size, change score variability and anchor correlation strength to assess the impact of these variables on recovering the simulated MCT for interpreting individual and group-level results. To assess MCTs derived at the individual-level (i.e. responder definitions; RDs), Receiver Operating Characteristic (ROC) curves and Predictive Modelling (PM) analyses were conducted. To assess MCTs for interpreting change at the group-level, the mean change method was conducted. RESULTS Sample sizes, change score variability and magnitude of anchor correlation affected accuracy of the estimated MCT. For individual-level RDs, ROC curves were less accurate than PM methods at recovering the true MCT. For both methods, smaller samples led to higher variability in the returned MCT, but higher variability still using ROC. Anchors with weaker correlations with COA change scores had increased variability in the estimated MCT. An anchor correlation of around 0.50-0.60 identified a true MCT cut-point under certain conditions using ROC. However, anchor correlations as low as 0.30 were appropriate when using PM under certain conditions. For interpreting group-level results, the MCT derived using the mean change method was consistently underestimated regardless of the anchor correlation. CONCLUSION Sample size and change score variability influence the necessary anchor correlation strength when recovering individual-level RDs. Often, this needs to be higher than the commonly accepted threshold of 0.30. Stronger correlations than 0.30 are required when using the mean change method. Results can assist researchers selecting and assessing the quality of anchors.
Collapse
Affiliation(s)
| | - Joel Sims
- Adelphi Values, Patient-Centered Outcomes, Bollington, Cheshire, UK.
| | - Abi Williams
- Adelphi Values, Patient-Centered Outcomes, Bollington, Cheshire, UK
| | | | - David Cella
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Elaine Brohan
- Adelphi Values, Patient-Centered Outcomes, Bollington, Cheshire, UK
| | - Kim Cocks
- Adelphi Values, Patient-Centered Outcomes, Bollington, Cheshire, UK
| |
Collapse
|
14
|
Torkington J, Harries R, O'Connell S, Knight L, Islam S, Bashir N, Watkins A, Fegan G, Cornish J, Rees B, Cole H, Jarvis H, Jones S, Russell I, Bosanquet D, Cleves A, Sewell B, Farr A, Zbrzyzna N, Fiera N, Ellis-Owen R, Hilton Z, Parry C, Bradbury A, Wall P, Hill J, Winter D, Cocks K, Harris D, Hilton J, Vakis S, Hanratty D, Rajagopal R, Akbar F, Ben-Sassi A, Francis N, Jones L, Williamson M, Lindsey I, West R, Smart C, Ziprin P, Agarwal T, Faulkner G, Pinkney T, Vimalachandran D, Lawes D, Faiz O, Nisar P, Smart N, Wilson T, Myers A, Lund J, Smolarek S, Acheson A, Horwood J, Ansell J, Phillips S, Davies M, Davies L, Bird S, Palmer N, Williams M, Galanopoulos G, Rao PD, Jones D, Barnett R, Tate S, Wheat J, Patel N, Rahmani S, Toynton E, Smith L, Reeves N, Kealaher E, Williams G, Sekaran C, Evans M, Beynon J, Egan R, Qasem E, Khot U, Ather S, Mummigati P, Taylor G, Williamson J, Lim J, Powell A, Nageswaran H, Williams A, Padmanabhan J, Phillips K, Ford T, Edwards J, Varney N, Hicks L, Greenway C, Chesters K, Jones H, Blake P, Brown C, Roche L, Jones D, Feeney M, Shah P, Rutter C, McGrath C, Curtis N, Pippard L, Perry J, Allison J, Ockrim J, Dalton R, Allison A, Rendell J, Howard L, Beesley K, Dennison G, Burton J, Bowen G, Duberley S, Richards L, Giles J, Katebe J, Dalton S, Wood J, Courtney E, Hompes R, Poole A, Ward S, Wilkinson L, Hardstaff L, Bogden M, Al-Rashedy M, Fensom C, Lunt N, McCurrie M, Peacock R, Malik K, Burns H, Townley B, Hill P, Sadat M, Khan U, Wignall C, Murati D, Dhanaratne M, Quaid S, Gurram S, Smith D, Harris P, Pollard J, DiBenedetto G, Chadwick J, Hull R, Bach S, Morton D, Hollier K, Hardy V, Ghods M, Tyrrell D, Ashraf S, Glasbey J, Ashraf M, Garner S, Whitehouse A, Yeung D, Mohamed SN, Wilkin R, Suggett N, Lee C, Bagul A, McNeill C, Eardley N, Mahapatra R, Gabriel C, Datt P, Mahmud S, Daniels I, McDermott F, Nodolsk M, Park L, Scott H, Trickett J, Bearn P, Trivedi P, Frost V, Gray C, Croft M, Beral D, Osborne J, Pugh R, Herdman G, George R, Howell AM, Al-Shahaby S, Narendrakumar B, Mohsen Y, Ijaz S, Nasseri M, Herrod P, Brear T, Reilly JJ, Sohal A, Otieno C, Lai W, Coleman M, Platt E, Patrick A, Pitman C, Balasubramanya S, Dickson E, Warman R, Newton C, Tani S, Simpson J, Banerjee A, Siddika A, Campion D, Humes D, Randhawa N, Saunders J, Bharathan B, Hay O. Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART). Br J Surg 2022; 109:943-950. [PMID: 35979802 PMCID: PMC10364691 DOI: 10.1093/bjs/znac198] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. METHODS A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. RESULTS Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). CONCLUSION The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. REGISTRATION NUMBER ISRCTN25616490 (http://www.controlled-trials.com).
Collapse
|
15
|
Hirji I, Cocks K, Moreno-Koehler A, Sundberg A. P16.38: Healthcare Resource Utilization in Transplant Recipients With Cytomegalovirus Infection Refractory to Prior Treatment With/Without Resistance Receiving Maribavir Versus Investigatorassigned Therapy: Exploratory Analysis of the Phase 3 SOLSTICE Trial. Transplantation 2022. [DOI: 10.1097/01.tp.0000889760.53376.a2] [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: 11/25/2022]
|
16
|
Cocks K, Buchanan J. How scoring limits the usability of minimal important differences (MIDs) as responder definition (RD): an exemplary demonstration using EORTC QLQ-C30 subscales. Qual Life Res 2022; 32:1247-1253. [PMID: 35809136 DOI: 10.1007/s11136-022-03181-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Accepted: 06/18/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The recommended method for establishing a meaningful threshold for individual changes in patient-reported outcome (PRO) scores over time uses an anchor-based method. The patients assess their perceived level of change and this is used to define a threshold on the PRO score which may be considered meaningful to the patient. In practice, such an anchor may not be available. In the absence of alternative information often the meaningful change threshold for assessing between-group differences, the minimally important difference, is used to define meaningful change at the individual level too. This paper will highlight the issues with this, especially where the underlying measurement scale is not continuous. METHODS Using the EORTC QLQ-C30 as an example, plausible score increments ("state changes") are calculated for each subscale highlighting why commonly used thresholds may be misleading, including leading to sensitivity analyses that are inadvertently testing the same underlying threshold. RESULTS The minimal possible individual score change varies across subscales; 6.7 for Physical Functioning, 8.3 for Global Health Scale and Emotional Functioning, 11.1 for fatigue, 16.7 for role functioning, cognitive functioning, social functioning, nausea and vomiting, pain and 33.3 for single items. CONCLUSIONS The determination of meaningful change for an individual patient requires input from the patients but being mindful of the underlying scale ensures that these thresholds are also guided by what is a plausible change for patients to achieve on the scale.
Collapse
Affiliation(s)
- Kim Cocks
- KCStats Consultancy, Leeds, UK.
- Adelphi Values, Cheshire, UK.
| | | |
Collapse
|
17
|
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
| |
Collapse
|
18
|
Oerlemans S, Efficace F, Kieffer JM, Kyriakou C, Xochelli A, Levedahl K, Petranovic D, Borges FC, Bredart A, Shamieh O, Gziskevicius L, Lehmann J, Scholz CW, Caocci G, Molica S, Stamatopoulos K, Panteliadou AK, Papaioannou M, Alrjoob W, Baliakas P, Rosenquist R, Malak S, Miranda A, Cocks K, van de Poll-Franse L. International validation of the EORTC QLQ-CLL17 questionnaire for assessment of health-related quality of life for patients with chronic lymphocytic leukaemia. Br J Haematol 2022; 197:431-441. [PMID: 35255152 DOI: 10.1111/bjh.18072] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 11/16/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 11/26/2022]
Abstract
Selecting the most appropriate chronic lymphocytic leukaemia (CLL) treatment is challenging. Patient-reported health-related quality of life (HRQoL) is therefore a critical aspect to consider. This international study by the European Organization for Research and Treatment of Cancer (EORTC) tested the psychometric properties of a newly developed measure for CLL patients: the EORTC QLQ-CLL17 to supplement the core questionnaire (EORTC QLQ-C30). Patients with CLL (n = 341) from 12 countries completed the QLQ-C30, QLQ-CLL17 and a debriefing questionnaire. Sociodemographic and clinical data were recorded from medical records. A high percentage (30%-66%) reported symptoms and/or worries (e.g. aches/pains in muscles, lack of energy and worry/fears about health). Confirmatory factor analysis showed an acceptable to good fit of the 17 items on the three scales (i.e. symptom burden, physical condition/fatigue and worries/fears about health and functioning). Completion took on average 8 min. Test-retest and convergent validity was demonstrated. The QLQ-CLL17 differentiated between patients with an Eastern Cooperative Oncology group (ECOG) performance of 0 versus 1-3 (p's < 0.01 and clinically relevant). The newly developed EORTC QLQ-CLL17 will increase sensitivity of HRQoL assessment in patients with CLL. Implementation of this questionnaire both in clinical research and practice will help to generate unique clinically relevant data to better inform CLL treatment decision-making.
Collapse
Affiliation(s)
- Simone Oerlemans
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA) Data Centre, Rome, Italy
| | - Jacobien M Kieffer
- Department of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Aliki Xochelli
- Institute of Applied Biosciences, Center for Research and Technology Hellas, Thessaloniki, Greece
| | - Kerstin Levedahl
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Duska Petranovic
- Clinical Hospital Center Rijeka, University of Rijeka, Rijeka, Croatia
| | - Fabio Cardoso Borges
- Department of Epidemiology and National Cancer Registry (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E, Lisbon, Portugal
| | - Anne Bredart
- Institut Curie - Psycho-Oncology Unit, Paris University, Paris, France.,Psychopathology and Health Process Laboratory (LPPS) (UR 4057), PSL University, Paris, France
| | - Omar Shamieh
- Department of Palliative Medicine, King Hussein Cancer Center, Amman, Jordan
| | | | - Jens Lehmann
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Giovanni Caocci
- Hematology, Businco Hospital, University of Cagliari, Cagliari, Italy
| | | | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Center for Research and Technology Hellas, Thessaloniki, Greece
| | | | - Maria Papaioannou
- Hematology Unit, 1st Dept of Internal Medicine, AUTH, AHEPA Hospital, Thessaloniki, Greece
| | - Waleed Alrjoob
- Department of Palliative Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Panagiotis Baliakas
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Richard Rosenquist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Sandra Malak
- Hôpital René Huguenin-Institut Curie - Hématologie, Saint-Cloud, France
| | - Ana Miranda
- Department of Epidemiology and National Cancer Registry (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E, Lisbon, Portugal
| | - Kim Cocks
- York Trials Unit, University of York, York & Adelphi Values, Cheshire, UK
| | - Lonneke van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | | |
Collapse
|
19
|
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]
|
20
|
Hirji I, Cocks K, Moreno-Koehler A, Sen R, Sundberg A. Healthcare Resource Utilization in Transplant Recipients with Cytomegalovirus Infection Refractory/Resistant to Treatment Receiving Maribavir Versus Investigator Assigned Therapy: Exploratory Analysis of a Phase 3 Trial. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00213-5] [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: 11/27/2022]
|
21
|
Griffiths P, Peipert JD, Leith A, Rider A, Morgan L, Cella D, Cocks K. Validity of a single-item indicator of treatment side effect bother in a diverse sample of cancer patients. Support Care Cancer 2022; 30:3613-3623. [PMID: 35031830 PMCID: PMC8857159 DOI: 10.1007/s00520-022-06802-3] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 12/31/2021] [Indexed: 12/19/2022]
Abstract
Purpose With higher efficacy of cancer therapies, the numbers and types of side effects experienced by patients have also increased, evidencing a need for brief assessments of side effect bother. The Functional Assessment of Cancer Therapy-General (FACT-G) includes the item “I am bothered by side effects of treatment” (GP5). This study aimed to confirm GP5’s validity in a large, diverse, real-world patient sample. Methods Real-world data were drawn from 10 Adelphi Disease Specific Programmes (DSP™) conducted between 2015 and 2019 in France, Germany, Italy, Spain, the UK and the USA, covering 10 cancer sites. We examined correlations between GP5 responses and varied measures of patient-reported global health and the number of side effects experienced. We explored whether more advanced patients and those with worse Eastern Cooperative Oncology Group Performance Status Rating (ECOG PSR) reported greater side effect bother. Finally, we conducted differential item functioning (DIF) assessment using the Mantel–Haenszel approach. Results The sample included 6755 advanced cancer patients. GP5 responses were distributed similarly across most cancer sites. A moderate, negative correlation (rpolyserial = − 0.43) between GP5 responses and global health evidenced convergent validity. Known groups validity was evidenced by dichotomised distributions of GP5, showing expected results between cancer stage 2 vs. 3 and 4 and with ECOG PSR (p < 0.001). Little evidence of DIF was found. Conclusion GP5 exhibited evidence of validity across cancer sites and countries and appeared to measure the same construct across these countries. GP5 has significant promise as a summary indicator of side effect bother.
Collapse
Affiliation(s)
| | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | |
Collapse
|
22
|
Shaw JW, Bennett B, Trigg A, DeRosa M, Taylor F, Kiff C, Ntais D, Noon K, King MT, Cocks K. A Comparison of Generic and Condition-Specific Preference-Based Measures Using Data From Nivolumab Trials: EQ-5D-3L, Mapping to the EQ-5D-5L, and European Organisation for Research and Treatment of Cancer Quality of Life Utility Measure-Core 10 Dimensions. Value Health 2021; 24:1651-1659. [PMID: 34711366 DOI: 10.1016/j.jval.2021.05.022] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/02/2021] [Accepted: 05/24/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES There is growing interest in condition-specific preference measures, including the European Organisation for Research and Treatment of Cancer Quality of Life Utility Measure-Core 10 Dimensions (QLU-C10D). This research assessed the implications of using utility indices on the basis of the EQ-5D-3L, a mapping of EQ-5D-3L to the EQ-5D-5L, and the QLU-C10D, and compared their psychometric properties. METHODS Data were taken from 8 phase 3 randomized controlled trials of nivolumab with or without ipilimumab for the treatment of solid tumors. Utilities for progression-related states were calculated using the UK and English value sets and incremental quality-adjusted life-years (QALYs) derived from established UK cost-effectiveness models. The psychometric properties of the utility indices were assessed using pooled trial data. RESULTS Compared with the EQ-5D-3L index, the mapped EQ-5D-5L index yielded an average of 6% more and the QLU-C10D index an average of 2% fewer incremental QALYs for nivolumab versus comparators. All indices could differentiate between groups defined by performance status, cancer stage, or self-reported health status at baseline and detect meaningful changes in performance status, tumor response, health status, and quality of life over approximately 12 weeks of treatment. CONCLUSIONS The lower QALY yield of the QLU-C10D was balanced by evidence of greater validity and responsiveness. Benefits gained from using the QLU-C10D may be apparent when treatments affect targeted symptoms and functional aspects, including sleep, bowel function, appetite, nausea, and fatigue. The observed differences in QALYs may not be sufficiently large to affect health technology assessment decisions.
Collapse
Affiliation(s)
- James W Shaw
- Worldwide Health Economics and Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA.
| | - Bryan Bennett
- Bristol Myers Squibb Pharmaceuticals Ltd, Uxbridge, England, UK
| | - Andrew Trigg
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, England, UK
| | - Michael DeRosa
- Patient-Centered Outcomes, Adelphi Values, Boston, MA, USA
| | - Fiona Taylor
- Patient-Centered Outcomes, Adelphi Values, Boston, MA, USA
| | | | - Dionysios Ntais
- Bristol Myers Squibb Pharmaceuticals Ltd, Uxbridge, England, UK
| | - Katie Noon
- Bristol Myers Squibb Pharmaceuticals Ltd, Uxbridge, England, UK
| | | | - Kim Cocks
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, England, UK
| |
Collapse
|
23
|
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.
Collapse
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
| | | |
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Trigg A, Kelly M, Iadeluca L, Chang J, Moreno-Koehler A, Yaworsky A, Krohe M, Rider A, Cappelleri JC, Cella D, Cocks K. Reliability, validity and important difference estimates for the NCCN-FACT Ovarian Symptom Index-18 (NFOSI-18). Future Oncol 2021; 17:3951-3964. [PMID: 34287020 DOI: 10.2217/fon-2021-0358] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: To evaluate psychometric performance of the NCCN-FACT Ovarian Cancer Symptom Index-18 (NFOSI-18) in advanced ovarian cancer. Methods: Cross-sectional, observational data from patients receiving treatment for ovarian cancer. Other measures included European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire core (EORTC QLQ-C30) and associated ovarian cancer module (EORTC QLQ-OV28) and Work Productivity and Activity Impairment. Internal consistency reliability, construct validity and anchor-based clinically important differences were assessed. Results: 897 patients were analyzed. Reliability was acceptable for all NFOSI-18 scores; construct validity was supported. Twelve anchors sufficiently correlated with NFOSI-18 scores and suggested clinically important differences: NFOSI-18 total score (5-7), disease-related symptoms - physical (3-4), disease-related symptoms - emotional (1), treatment side effects (2) and functional well-being (1-2). Conclusions: Results provide evidence of reliability and validity of NFOSI-18 scores. Generated CIDs will help improve interpretation of between-group treatment differences in clinical trials.
Collapse
|
26
|
Spira AI, Wilson FH, Shapiro G, Dooms C, Curioni-Fontecedro A, Esaki T, Barlesi F, Cocks K, Trigg A, Stevinson K, Matsuda T, Tran Q, Gray JE. Patient-reported outcomes (PRO) from the phase 2 CodeBreaK 100 trial evaluating sotorasib in KRAS p.G12C mutated non-small cell lung cancer (NSCLC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9057] [Citation(s) in RCA: 6] [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] [Indexed: 11/20/2022] Open
Abstract
9057 Background: In the registrational phase 2 CodeBreaK 100 trial, sotorasib demonstrated a response rate of 37.1% with median duration of 10.0 months, a median progression-free survival of 6.8 months, and a tolerable safety profile in patients with pretreated KRAS p.G12C mutated NSCLC. Patients received a median of 2 prior lines of therapy. Here, we report PRO measures of health-related quality of life (QoL), physical functioning, and key lung cancer symptoms from this trial. Methods: Eligible patients had KRAS p.G12C mutated advanced NSCLC and received prior standard therapies. Sotorasib was given at an oral daily dose of 960 mg with 21-day treatment cycles until disease progression. Disease-related symptoms and health-related QoL were evaluated as exploratory endpoints on day 1 of each cycle from baseline to discontinuation, using the European Organization for Research and Treatment of Cancer Quality-of-life Questionnaire Core 30 (EORTC QLQ-C30) and its lung cancer module, EORTC QLQ-LC13. The single item, 5-point scale GP5, of the Functional Assessment of Cancer Therapy-General version was used to evaluate the impact of side effects. Predefined analyses included change from baseline using descriptive statistics and mixed model for repeated measures for global health status/QoL, physical functioning, and key lung cancer symptoms of cough, dyspnea and chest pain. Results: Of 126 patients enrolled, compliance rates for each of the questionnaires were high throughout the study ( > 70%). Data up to cycle 11 (where n > 20) are presented. EORTC QLQ-C30 global health status/QoL and physical functioning were maintained over time (least-square mean changes ranged from -3.5 to 0.2 and 0.1 to 3.9, respectively). EORTC QLQ-C30 symptoms of fatigue, nausea/vomiting, pain, dyspnea, insomnia, appetite loss, and constipation were stable or improved. Similarly, key lung cancer-related symptoms, as measured by EORTC QLQ-LC13, remained stable or improved from baseline, with the greatest least-square mean change of -11.2 (95% Cl: -16.2, -6.1) for cough, -4.9 (95% Cl: -10.3, 0.4) for chest pain, and -3.4 (95% Cl: -7.8, 1.0) for dyspnea. Most patients reported on the GP5 that they were “not at all” (54.2%-79.2%) or “a little bit” (8.3%-33.3%) bothered by side effects from sotorasib, with 0%-7.4% reporting being bothered as “quite a bit” and 0% as “very much”. Conclusions: In patients from the single-arm phase 2 trial of sotorasib, PRO measures suggested maintenance or improvement of global health status/QoL, physical functioning, and the severity of key lung cancer-related symptoms, including cough, dyspnea, and chest pain. Self-reported side effect bother was minimal. These data, together with the encouraging efficacy and safety profiles, strongly support the use of sotorasib in this population. Clinical trial information: NCT03600883.
Collapse
Affiliation(s)
| | | | | | | | | | - Taito Esaki
- Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | | | - Kim Cocks
- Adelphi Values, Bollington, United Kingdom
| | | | | | - Tara Matsuda
- Amgen, Global Health Economics, Thousand Oaks, CA
| | | | | |
Collapse
|
27
|
Trigg A, Brohan E, Cocks K, Jones A, Tahami Monfared AA, Chabot I, Meier G, Campbell R, Li H, Ngo LY. Health-related quality of life in pediatric patients with partial onset seizures or primary generalized tonic-clonic seizures receiving adjunctive perampanel. Epilepsy Behav 2021; 118:107938. [PMID: 33839450 DOI: 10.1016/j.yebeh.2021.107938] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 11/27/2022]
Abstract
RATIONALE Study 311 (E2007-G000-311; NCT02849626) was a Phase 3, multicenter, open-label single-arm study of adjunctive perampanel oral suspension in pediatric patients (aged 4 to <12 years) with partial-onset seizures (POS) (with/without secondarily generalized tonic-clonic seizures [SGTCS]) or primary generalized tonic-clonic seizures (PGTCS). Health-related quality of life (HRQoL) was an exploratory endpoint initially analyzed through simple descriptive summaries. The aim of this post hoc analysis was to provide a more thorough assessment of HRQoL. METHODS This analysis focused on EQ-5D-Y data collected at Baseline, Week 23, and Week 52. Individual dimensions, visual analog scale (VAS) and summed misery index (MI) were evaluated at all visits and compared by seizure type (POS versus SGTCS versus PGTCS), age (4 to <7 versus 7 to <12), and use of concomitant enzyme-inducing antiepileptic drugs (EIAEDs) (yes versus no). Paretian Classification of Health Change (PCHC) analysis summarized the proportion of patients who showed improvement or deterioration in HRQoL. Waterfall plots assessed changes in EQ-5D-Y scores by treatment-emergent adverse events (TEAEs) and by reduction in seizure frequency. Health state utility values associated with differing seizure frequency states were estimated using a linear mixed model. RESULTS One hundred and fifteen patients completed EQ-5D-Y at relevant study visits (Seizure type: POS n = 84 [of which 21 had SGTCS], PGTCS n = 31; Age: 4 to <7 years n = 30, 7 to <12 years n = 85; Concomitant EIAEDs: Yes n = 35, No n = 80). Completion rates out of those expected to complete EQ-5D-Y were high at both timepoints (84.4% at Week 23 and 97.2% at Week 52). Overall, VAS/MI remained stable over time (did not exceed minimal important difference); this was similar according to seizure type, age, and EIAED usage. In patients with 'no problems' on any EQ-5D-Y dimension at Baseline, nearly all retained their full health at Week 23 (94.7%), and all retained it at Week 52 (100.0%). PCHC analysis showed fewer patients with POS experienced deterioration in EQ-5D-Y than patients with PGTCS at Week 23 (24.1% versus 42.1%). Not experiencing a TEAE, or remaining seizure-free, was associated with improvements in VAS score at Week 23 compared to those experiencing TEAEs or seizures, respectively. Health state utility values (HSUVs) were estimated as follows: seizure free (LS Mean 0.914 [95% CIs 0.587, 1.240]), ≥1 seizure per year (0.620 [0.506, 0.734]), ≥1 seizure per month (0.596 [0.338, 0.855]), ≥1 seizure per week (0.284 [-0.014, 0.582]). CONCLUSIONS An in-depth analysis of EQ-5D-Y data allowed for a more nuanced exploration of HRQoL than previous descriptive summaries. Our findings provide evidence that perampanel as adjunctive therapy did not result in deterioration of patient HRQoL. The association between TEAEs or remaining seizure-free and HRQoL warrants further exploration. Increasing seizure frequency was associated with decreasing HSUVs; these can inform cost-effectiveness modeling of perampanel and other therapies aiming to reduce seizure frequency in pediatric patients.
Collapse
Affiliation(s)
- Andrew Trigg
- Patient-Centered Outcomes, Adelphi Values Ltd., Bollington, UK.
| | - Elaine Brohan
- Patient-Centered Outcomes, Adelphi Values Ltd., Bollington, UK
| | - Kim Cocks
- Patient-Centered Outcomes, Adelphi Values Ltd., Bollington, UK
| | - Amy Jones
- Patient-Centered Outcomes, Adelphi Values Ltd., Bollington, UK
| | - Amir A Tahami Monfared
- Eisai Inc., Woodcliff Lake, NJ, USA; McGill University, Department of Epidemiology, Biostatistics and Occupational Health, Montreal, QC, Canada
| | - Isabelle Chabot
- Faculty of Pharmacy, Montreal University, Montreal, QC, Canada
| | | | | | | | | |
Collapse
|
28
|
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.
Collapse
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
| | | |
Collapse
|
29
|
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.
Collapse
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
| | | |
Collapse
|
30
|
Elghamaz A, Myat A, de Belder A, Collison D, Cocks K, Stone GW, Oldroyd K. Continuous intracoronary versus standard intravenous infusion of adenosine for fractional flow reserve assessment: the HYPEREMIC trial. EUROINTERVENTION 2020; 16:560-567. [PMID: 31289017 DOI: 10.4244/eij-d-18-01067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to evaluate the accuracy of a continuous intracoronary (IC) adenosine infusion, administered through the novel HYPEREM™IC over-the-wire microcatheter, to measure fractional flow reserve (FFR). METHODS AND RESULTS The HYPEREMIC trial was a randomised, non-inferiority, crossover study in which patients with intermediate coronary lesions were enrolled for sequential pressure wire studies. FFR was measured using intravenous (IV) (140-180 mcg/kg/min) versus continuous non-weight-adjusted IC (360 mcg/min) adenosine. Patients were randomised and blinded to the order in which they received the adenosine, separated by a washout period. The primary endpoint was the mean hyperaemic FFR. Forty-one patients were enrolled at three UK sites between June and November 2016. The mean (standard deviation) FFR was 0.82 (±0.09) after IC versus 0.84 (±0.09) after IV adenosine. The difference of -0.02 (95% confidence interval [CI]: -0.03 to -0.01) confirmed the non-inferiority (margin <0.05) of IC to IV adenosine. Intracoronary adenosine was associated with a shorter mean time to maximal hyperaemia (difference -44 [95% CI: -59 to -29] seconds; p<0.0001). Chest discomfort was reported in 32/41 (78.0%) patients during IV adenosine versus 12/41 (29.3%) patients during IC adenosine. CONCLUSIONS Continuous IC adenosine was a reliable, faster and better tolerated method of achieving maximal hyperaemia compared to IV adenosine.
Collapse
Affiliation(s)
- Ahmed Elghamaz
- Cardiology Department, Northwick Park Hospital, London North West Healthcare NHS Trust, London, United Kingdom
| | | | | | | | | | | | | |
Collapse
|
31
|
Lawrance R, Degtyarev E, Griffiths P, Trask P, Lau H, D'Alessio D, Griebsch I, Wallenstein G, Cocks K, Rufibach K. What is an estimand & how does it relate to quantifying the effect of treatment on patient-reported quality of life outcomes in clinical trials? J Patient Rep Outcomes 2020; 4:68. [PMID: 32833083 PMCID: PMC7445213 DOI: 10.1186/s41687-020-00218-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 01/16/2020] [Accepted: 06/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Published in 2019, a new addendum to the ICH E9 guideline presents the estimand framework as a systematic approach to ensure alignment among clinical trial objectives, trial execution/conduct, statistical analyses, and interpretation of results. The use of the estimand framework for describing clinical trial objectives has yet to be extensively considered in the context of patient-reported outcomes (PROs). We discuss the application of the estimand framework to PRO objectives when designing clinical trials in the future, with a focus on PRO outcomes in oncology trial settings as our example. MAIN: We describe the components of an estimand and take a naïve PRO trial objective to illustrate how to apply attributes described in the estimand framework to inform construction of a detailed clinical trial objective and its related estimand. We discuss identifying potential post-randomization events that alter the interpretation of the endpoint or render its observation impossible (also defined as intercurrent events) in the context of PRO endpoints, and the implications of how to handle intercurrent events in the construction of the PRO objective. Using a simple objective statement, "What is the effect of treatment X on patient's quality of life?", we build up an example estimand statement and also use a previously published phase III oncology clinical trial to illustrate how an estimand for a PRO objective could have been written to align to the estimate framework. CONCLUSION The use of the estimand framework, as described in the new ICH E9 (R1) addendum guideline will become a key common framework for developing clinical trial objectives for evaluating effects of treatment. In the context of considering PROs, the framework provides an opportunity to more precisely specify and build the rationale for patient-focused objectives. This will help to ensure that clinical trials used for registration are designed and analysed appropriately, enabling all stakeholders to accurately interpret conclusions about the treatment effects for patient-focused outcomes.
Collapse
Affiliation(s)
| | | | | | | | - Helen Lau
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | | | | | | |
Collapse
|
32
|
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.
Collapse
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
| | | |
Collapse
|
33
|
Sharman JP, Cocks K, Nabhan C, Lamanna N, Kay NE, Grinblatt DL, Flowers CR, Davids MS, Kiselev P, Swern AS, Sullivan K, Gharibo MM, Flick ED, Trigg A, Mato A. Longitudinal health-related quality of life in first-line treated patients with chronic lymphocytic leukemia: Results from the Connect ® CLL Registry. EJHaem 2020; 1:188-198. [PMID: 35847738 PMCID: PMC9176138 DOI: 10.1002/jha2.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/10/2020] [Accepted: 07/12/2020] [Indexed: 06/15/2023]
Abstract
Health-related quality of life (HRQoL) in patients with chronic lymphocytic leukemia (CLL) is important in guiding treatment decisions. However, the impact of CLL treatment initiation on HRQoL is unclear. We assessed HRQoL using the FACT-Leu and EQ-5D-3L questionnaires in the Connect ® CLL Registry, a large, US-based, multicenter, prospective observational study of CLL patients enrolled between 2010 and 2014, prior to the introduction of novel therapies. Among 889 patients initiating first-line therapy with chemoimmunotherapy or rituximab monotherapy, questionnaire completion rates were 95.7% and 95.8% at enrollment, and 70.8% and 69.4% at 12 months, for FACT-Leu Total and EQ-5D-3L, respectively. For 849 patients completing all five FACT-Leu components, average total scores were 135.7 at enrollment and 141.6 at 12 months. Among 526 patients with FACT-Leu Total scores at enrollment and 12 months, clinically meaningful (≥11-point) improvements or reductions were observed in 179 (34.0%) and 88 (16.7%) patients, respectively. Mean EQ-5D-3L index scores were 0.87 at enrollment and 12 months. Among 513 patients completing EQ-5D-3L at enrollment and 12 months, clinically meaningful (≥0.06-point) improvements or reductions were observed in 125 (24.4%) and 116 (22.6%) patients, respectively. In the Connect® CLL Registry, HRQoL remained stable or slightly improved after 12 months of follow-up.
Collapse
Affiliation(s)
- Jeff P. Sharman
- Willamette Valley Cancer InstituteUS OncologyEugeneOregonUSA
| | | | - Chadi Nabhan
- Caris Life SciencesDallasTexasUSA
- University of South CarolinaColumbiaSouth CarolinaUSA
| | - Nicole Lamanna
- Division of Hematology and OncologyDepartment of MedicineNew York‐Presbyterian/Columbia University Medical CenterNew YorkNew YorkUSA
| | - Neil E. Kay
- Division of HematologyMayo ClinicRochesterMinnesotaUSA
| | | | | | - Matthew S. Davids
- Department of Medical OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | | | | | | | | | | | | | - Anthony Mato
- Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| |
Collapse
|
34
|
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.
Collapse
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
| | | |
Collapse
|
35
|
Edeline J, Yau T, Park JW, Kudo M, Han KH, Mathurin P, Merle P, Finn RS, Müller T, Taylor F, Greenwood M, Begic D, Tschaika M, Yip C, Pranschke E, Cocks K, Thompson G, Blum SI, Wisniewski T, Sangro B. CheckMate 459: Health-related quality of life (HRQoL) in a randomized, multicenter phase III study of nivolumab (NIVO) versus sorafenib (SOR) as first-line (1L) treatment in patients (pts) with advanced hepatocellular carcinoma (aHCC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.483] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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
483 Background: SOR is approved as 1L therapy for pts with aHCC, but there is still an unmet need to help improve or maintain HRQoL. This phase 3 study compared HRQoL of NIVO vs SOR as 1L therapy in pts with aHCC as an exploratory endpoint. Methods: FACT-Hep was administered cycle 1, day 1 and every other cycle. The effect of NIVO vs SOR on HRQoL using FACT-Hep was assessed via repeated measures mixed models (MMRM). Kaplan–Meier curves and Cox proportional-hazards models determined between-treatment differences in time to first and time until definitive deterioration (TTD/TUDD) based on prespecified thresholds for minimally important differences. The GP5 item from FACT-Hep was used to assess the burden associated with treatment side effects. Results: 743 pts with aHCC were randomized to NIVO (n = 371) or SOR (n = 372). Median OS was 16.4 mo for NIVO, 14.7 mo for SOR (HR 0.85 [95% CI 0.72–1.02]; P = 0.0752). ORR was 15% for NIVO, 7% for SOR (OR 2.41 [95% CI 1.48–3.92]). HRQoL scores were completed at baseline by 94.6% and 92.5% of participants, respectively, and were similar (FACT-Hep total: NIVO 140.7 [SD 21.5] and SOR 140. 6 [SD 19.1]. Questionnaire compliance rates exceeded 70% at most visits. MMRM analyses yielded clinically meaningful and statistically significant least squares means differences favoring NIVO on FACT-Hep total (10.1 [95% CI 7.3–13.0]), physical well-being (PWB; 2.0 [95% CI 1.4–2.6]), and functional well-being (FWB; 2.5 [95% CI 1.7–3.2]) scores. No sub-scales favored sorafenib. TTD was significantly delayed in NIVO for FACT-Hep total (HR 0.62 [95% CI 0.51–0.74]), PWB (HR 0.62 [95% CI 0.52–0.74]), FWB (HR 0.73 [95% CI 0.61–0.88]), and hepatobiliary cancer subscale (HR 0.57 [95% CI 0.48–0.69]). TUDD results were consistent with TTD. A greater proportion of NIVO pts did not experience increased burden of side effects (50%–67.7%) compared with SOR (26.8%–45%) based on the GP5 item. Conclusions: These patient-reported findings demonstrate that pts taking NIVO had superior HRQoL and reduced side effect burden, further supporting clinical data showing a treatment benefit for 1L NIVO in aHCC. Clinical trial information: NCT02576509.
Collapse
Affiliation(s)
| | - Thomas Yau
- The University at Hong Kong, Hong Kong, China
| | - Joong-Won Park
- Center for Liver Cancer, National Cancer Center Korea, Goyang-Si, South Korea
| | | | - Kwang-Hyub Han
- Severance Hospital, Yonsei University, Seoul, South Korea
| | - Philippe Mathurin
- Centre Hospitalo-Universitaire Claude Huriez, Service d'Hépatologie, Lille, France
| | | | - Richard S. Finn
- Geffen School of Medicine, UCLA Medical Center, Santa Monica, CA
| | - Tobias Müller
- Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | | | | | | | | | | | | | - Kim Cocks
- Adelphi Values, Bollington, United Kingdom
| | | | | | | | - Bruno Sangro
- Clinica Universidad de Navarra and CIBEREHD, Pamplona, Spain
| |
Collapse
|
36
|
Sahota P, Christian M, Day R, Cocks K. The feasibility and acceptability of a primary school-based programme targeting diet and physical activity: the PhunkyFoods Programme. Pilot Feasibility Stud 2019; 5:152. [PMID: 31890264 PMCID: PMC6925414 DOI: 10.1186/s40814-019-0542-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 03/05/2018] [Accepted: 12/06/2019] [Indexed: 11/25/2022] Open
Abstract
Background This study aims to evaluate the feasibility and acceptability of the PhunkyFoods Programme, a primary school-based intervention to promote healthy nutrition and physical activity knowledge and behaviours to assess outcomes to inform a phase 3 trial. Methods The cluster randomised feasibility trial recruited eight primary schools from the North of England. Elibility criteria included all primary schools in one town, excluding independent and special schools and schools that comprised of only key stage 2 pupils (years 3–6). Eight schools agreed to participate. Randomisation to intervention or control arms was in a 1:1 ratio. Intervention schools received PhunkyFoods over 17 months. Control schools continued with usual curriculum. Assessors were blinded to group assignment. Measures comprised of a Healthy Lifestyle Knowledge Questionnaire and Synchronised Nutrition and Activity Program to assess diet and physical activity, height, weight, and psychological wellbeing. Feasibility outcomes were recruitment, attrition rates, interviews with teaching staff, focus groups with pupils to explore the acceptability of outcome measures, implementation, intervention content, and programme fidelity. Results Three hundred fifty-eight pupils, aged 6–9 years from eight schools were recruited at baseline (control n = 170, intervention n = 188); 337 (94.1%) at 6 months (control n = 163, intervention n = 181); and 331 (92.5%) at 18 months (control n = 152, intervention n = 179), and 6 pupils opted out. Trends in increased knowledge of healthy lifestyle behaviours, healthier eating, and liking of fruit and vegetables were reported in the intervention compared to the control group. Year 4 intervention pupils had significantly higher healthy balanced diet knowledge scores compared to control pupils, mean difference 5.1 (95% CI 0.1 to 10.1, p=0.05). At 18 months, the mean percentage of vegetables liked was higher (intervention 53.9% vs. 43.0% control). Similarly, percentage of fruits liked was also higher (intervention 76.9% vs. 67.2% control). Qualitative data showed that delivery of the intervention was feasible and acceptable to teachers and pupils. Lessons were learned to inform the phase 3 trial around the dietary assessment measure and timing of recruitment. Conclusions Whilst the study was not powered to detect a definitive effect, results suggest a potential to increase knowledge of healthy lifestyle behaviours and dietary behaviours, suggesting that with minor changes, a phase 3 trial is likely to be deliverable. Trial registration ISRCTN, ISRCTN15641330. Registered 8 May 2015—retrospectively registered, 10.1186/ISRCTN15641330
Collapse
Affiliation(s)
- Pinki Sahota
- 1School of Clinical and Applied Sciences, Leeds Beckett University, Calverley Street, Leeds, LS1 3HE UK
| | - Meaghan Christian
- 1School of Clinical and Applied Sciences, Leeds Beckett University, Calverley Street, Leeds, LS1 3HE UK
| | - Rhiannon Day
- 1School of Clinical and Applied Sciences, Leeds Beckett University, Calverley Street, Leeds, LS1 3HE UK
| | | |
Collapse
|
37
|
Sully K, Trigg A, Bonner N, Moreno-Koehler A, Trennery C, Shah N, Yucel E, Panjabi S, Cocks K. Estimation of minimally important differences and responder definitions for EORTC QLQ-MY20 scores in multiple myeloma patients. Eur J Haematol 2019; 103:500-509. [PMID: 31444815 PMCID: PMC6852250 DOI: 10.1111/ejh.13316] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 05/23/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 02/06/2023]
Abstract
Objectives Thresholds for the minimally important difference (MID) or responder definition (RD) in health‐related quality‐of‐life (HRQoL) scores are required to interpret the impact of an intervention or change in the trajectory of the condition which is meaningful to patients. This study aimed to establish MID and RD for the European Organisation for Research and Treatment of Cancer Quality of Life Multiple Myeloma questionnaire (EORTC QLQ‐MY20). Methods A novel mixed‐methods approach was applied by utilizing both existing clinical trial data and prospective patient interviews. Anchor‐based, distribution‐based, and qualitative‐based estimates of meaningful change were triangulated to form recommended RDs for each scale of the EORTC QLQ‐MY20. Anchor‐based MIDs were summarized using weighted correlation. Results Recommended MIDs were as follows: Disease Symptoms (DS 10 points), Side Effects of Treatment (SE 10 points), Body Image (BI 13 points), and Future Perspective (FP 9 points). Recommended RDs were as follows: DS (16 improvement; 11 worsening), SE (6 improvement; 9 worsening), BI (33 improvement; 33 worsening), and FP (11 improvement; 11 worsening). Conclusions The study generated estimates of the MID and RD for each scale of the EORTC QLQ‐MY20. Published estimates will enable investigators and clinicians to adopt these as standard for interpretation and for hypothesis testing. Consequently, analyses from trials of different interventions can be more comparable.
Collapse
Affiliation(s)
| | | | | | | | | | - Nina Shah
- Amgen Inc, Thousand Oaks, CA, USA.,University of California, San Francisco, CA, USA
| | | | | | | |
Collapse
|
38
|
Cocks K, Contente M, Simpson S, DeRosa M, Taylor FC, Shaw JW. A Q-TWiST Analysis Comparing Nivolumab and Therapy of Investigator's Choice in Patients with Recurrent/Metastatic Platinum-Refractory Squamous Cell Carcinoma of the Head and Neck. Pharmacoeconomics 2019; 37:1041-1047. [PMID: 30972702 PMCID: PMC6830425 DOI: 10.1007/s40273-019-00798-1] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES In the CheckMate 141 trial (NCT02105636), nivolumab demonstrated survival, health-related quality of life, and healthcare resource utilization benefits vs single-agent therapy of investigator's choice (IC) (methotrexate, docetaxel or cetuximab) in patients with platinum-refractory recurrent/metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). We assessed between-treatment differences in quality-adjusted time without symptoms of disease progression or toxicity (Q-TWiST). METHODS Survival data from CheckMate 141 (nivolumab, n = 240; IC, n = 121) was partitioned into toxicity (TOX), time without symptoms or toxicity (TWiST), and relapse (REL). TOX was defined as time spent with all-cause grade 3-4 adverse events after randomization, before disease progression. TWiST was defined as time not in TOX or REL. REL was defined as time between disease progression and death. Utility values derived from three-level EuroQol five-dimensional questionnaire data from CheckMate 141 were used to calculate Q-TWiST as the utility-weighted sum of the mean duration in each health state. RESULTS The between-group difference in Q-TWiST score was 1.23 months (95% confidence interval 1.17-1.29) favoring nivolumab (p < 0.001). The nivolumab group experienced significantly longer mean time in TWiST (3.82 vs 2.78 months) and REL (4.02 vs 3.30 months) compared with the IC group (p < 0.001). Mean time in TOX was lower for nivolumab vs IC (0.30 vs 0.37 months, p < 0.001). CONCLUSIONS In CheckMate 141, nivolumab resulted in statistically significant and clinically meaningful gains (relative difference > 10%) in quality-adjusted survival vs standard of care in patients with R/M SCCHN.
Collapse
Affiliation(s)
- Kim Cocks
- Adelphi Values, Adelphi Mill, Bollington, Cheshire, SK10 5JB, UK
| | - Marta Contente
- Bristol-Myers Squibb, BMS House, Sanderson Road, Uxbridge, Middlesex, UB8 1DH, UK
| | - Sarah Simpson
- Adelphi Values, Adelphi Mill, Bollington, Cheshire, SK10 5JB, UK
| | - Michael DeRosa
- Adelphi Values, 290 Congress Street, Boston, MA, 02210, USA
| | - Fiona C Taylor
- Adelphi Values, 290 Congress Street, Boston, MA, 02210, USA
| | - James W Shaw
- Bristol-Myers Squibb, 3401, Princeton Pike, Lawrenceville, NJ, 08648, USA.
| |
Collapse
|
39
|
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.
Collapse
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
| | | |
Collapse
|
40
|
Ramchandren R, Ansell SM, Armand P, Engert A, Taylor F, Cocks K, Chen C, Bennett B, Moreno-Koehler A, Roeder A, Sumbul A, Sacchi M, Cella D. HSR19-107: Nivolumab for Newly Diagnosed Classical Hodgkin Lymphoma: Patient-Reported Outcomes From CheckMate 205 Cohort D. J Natl Compr Canc Netw 2019. [DOI: 10.6004/jnccn.2018.7210] [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: 11/17/2022]
Abstract
Background: Patients (pts) with classical Hodgkin lymphoma (cHL) frequently experience reduced health-related quality of life (HRQoL) (Oerlemans et al, Ann Hematol 2011). Nivolumab, a fully human IgG4 anti-programmed death-1 (PD-1) immune checkpoint inhibitor monoclonal antibody, demonstrated efficacy and clinically meaningful improvement in pt-reported outcomes (PROs) in pts with relapsed/refractory cHL in cohorts A, B, and C of CheckMate 205 (NCT02181738) (Armand et al, J Clin Oncol 2018; Engert et al, ASH 2017). Nivolumab monotherapy followed by nivolumab + doxorubicin, vinblastine and dacarbazine (N-AVD) demonstrated an objective response rate of 84% in newly diagnosed cHL (cohort D of CheckMate 205; Ramchandren et al, EHA 2018). We present PROs in CheckMate 205 cohort D. Methods: Pts ≥18 years of age with untreated, advanced-stage cHL, with ECOG performance status (PS) of 0–1 received 4 doses of nivolumab monotherapy (240 mg IV Q2W) followed by N-AVD for 6 cycles (12 doses). Pts then entered the follow-up (FU) period. PROs were an exploratory endpoint, assessed using the EuroQol 5 Dimensions-3 level (EQ-5D-3L) and associated visual analog scale (EQ-VAS) in all treated pts who had both a baseline (monotherapy cycle 1) and post-baseline assessment. EQ-VAS ranges from 0–100, with higher scores indicating better HRQoL. In EQ-5D-3L, pts can report no, some, or extreme problems in each of 5 dimensions (mobility, self-care, activity, pain, and anxiety). Results: 51 pts were treated. At baseline, median age was 37 years, 63% were male, 59% had ECOG PS of 0. 49 pts (96%) completed baseline EQ-VAS. Mean EQ-VAS scores exceeded the mean baseline score at the end of monotherapy, after 2 combination cycles, at the end of therapy, and during follow-up (Table 1). The proportion of pts reporting some or extreme problems in EQ-5D-3L was numerically lower than or similar to baseline after monotherapy for all dimensions, but was numerically higher than baseline (dimensions of mobility and activity) after 2 combination cycles, and remained close to or numerically below baseline during follow-up (dimensions of self-care, activity, pain, and anxiety). Conclusions: Pt-reported HRQoL, as assessed by observed mean EQ-VAS scores, did not deteriorate from baseline during treatment with nivolumab followed by N-AVD. Proportions of pts reporting problems in individual EQ-5D-3L dimensions were generally similar to baseline during treatment and follow-up.
Collapse
Affiliation(s)
| | | | | | | | | | - Kim Cocks
- fAdelphi Values, Bollington, United Kingdom
| | | | | | | | | | | | | | | |
Collapse
|
41
|
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]
|
42
|
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.
Collapse
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
| |
Collapse
|
43
|
Thyer NJ, Watson J, Jackson C, Hickson L, Maynard C, Forster A, Clark L, Bell K, Fairhurst C, Cocks K, Gardner R, Iley K, Gailey L. Randomised controlled feasibility trial of the Active Communication Education programme plus hearing aid provision versus hearing aid provision alone (ACE to HEAR): a study protocol. BMJ Open 2018; 8:e021502. [PMID: 30068614 PMCID: PMC6074637 DOI: 10.1136/bmjopen-2018-021502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Up to 30% of hearing aids fitted to new adult clients are reported to be of low benefit and used intermittently or not at all. Evidence suggests that additional interventions paired with service-delivery redesign may help improve hearing aid use and benefit. The range of interventions available is limited. In particular, the efficacy of interventions like the Active Communication Education (ACE) programme that focus on improving communication success with hearing-impaired people and significant others, has not previously been assessed. We propose that improved communication outcomes associated with the ACE intervention, lead to an increased perception of hearing aid value and more realistic expectations associated with hearing aid use and ownership, which are reported to be key barriers and facilitators for successful hearing aid use. This study will assess the feasibility of delivering ACE and undertaking a definitive randomised controlled trial to evaluate whether ACE would be a cost-effective and acceptable way of increasing quality of life through improving communication and hearing aid use in a public health service such as the National Health Service. METHODS AND ANALYSIS This will be a randomised controlled, open feasibility trial with embedded economic and process evaluations delivered in audiology departments in two UK cities. We aim to recruit 84 patients (and up to 84 significant others) aged 18 years and over, who report moderate or less than moderate benefit from their new hearing aid. The feasibility of a large-scale study and the acceptability of the ACE intervention will be measured by recruitment rates, treatment retention, follow-up rates and qualitative interviews. ETHICS AND DISSEMINATION Ethical approval granted by South East Coast-Surrey Research Ethics Committee (16/LO/2012). Dissemination of results will be via peer-reviewed research publications both online and in print, conference presentations, posters, patient forums and Trust bulletins. TRIAL REGISTRATION NUMBER ISRCTN28090877.
Collapse
Affiliation(s)
- Nicholas J Thyer
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - Jude Watson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Louise Hickson
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Christina Maynard
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - Anne Forster
- Leeds Institute of Health Sciences (LIHS), University of Leeds, Leeds, UK
| | - Laura Clark
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Kerry Bell
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Kim Cocks
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Rob Gardner
- Audiology Department, Bradford Royal Infirmary, Bradford, UK
| | - Kate Iley
- Audiology Department, York Hospital, York, UK
| | | |
Collapse
|
44
|
Weisel K, Ludwig H, Dimopoulos MA, Kaiser M, Hajek R, Mikhael J, Cocks K, Panjabi S. Time to deterioration (TTD) in health-related quality of life (HRQoL) with carfilzomib plus dexamethasone (Kd56) versus bortezomib plus dexamethasone (Vd) in the ENDEAVOR trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e20011] [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: 11/20/2022] Open
Affiliation(s)
- Katja Weisel
- Universitatsklinikum Tubingen, Tubingen, Germany
| | - Heinz Ludwig
- Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria
| | | | - Martin Kaiser
- The Institute for Cancer Research, London, United Kingdom
| | - Roman Hajek
- University Hospital Ostrava, Ostrava, Czech Republic
| | | | - Kim Cocks
- KCStats Consultancy, Leeds, United Kingdom
| | | |
Collapse
|
45
|
Amrania H, Woodley-Barker L, Goddard K, Rosales B, Shousha S, Thomas G, McFarlane T, Sroya M, Wilhelm-Benartzi C, Cocks K, Coombes RC, Phillips CC. Mid-infrared imaging in breast cancer tissue: an objective measure of grading breast cancer biopsies. Converg Sci Phys Oncol 2018. [DOI: 10.1088/2057-1739/aaabc3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
46
|
Musoro ZJ, Hamel JF, Ediebah DE, Cocks K, King MT, Groenvold M, Sprangers MAG, Brandberg Y, Velikova G, Maringwa J, Flechtner HH, Bottomley A, Coens C. Establishing anchor-based minimally important differences (MID) with the EORTC quality-of-life measures: a meta-analysis protocol. BMJ Open 2018; 8:e019117. [PMID: 29326191 PMCID: PMC5781104 DOI: 10.1136/bmjopen-2017-019117] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [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: 08/11/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION As patient assessment of health-related quality of life (HRQOL) in cancer clinical trials has increased over the years, so has the need to attach meaningful interpretations to differences in HRQOL scores between groups and changes within groups. Determining what represents a minimally important difference (MID) in HRQOL scores is useful to clinicians, patients and researchers, and can be used as a benchmark for assessing the success of a healthcare intervention. Our objective is to provide an evidence-based protocol to determine MIDs for the European Organisation for Research and Treatment for Cancer Quality of life Questionnaire core 30 (EORTC QLQ-C30). We will mainly focus on MID estimation for group-level comparisons. Responder thresholds for individual-level change will also be estimated. METHODS AND ANALYSIS Data will be derived from published phase II and III EORTC trials that used the QLQ-C30 instrument, covering several cancer sites. We will use individual patient data to estimate MIDs for different cancer sites separately. Focus is on anchor-based methods. Anchors will be selected per disease site from available data. A disease-oriented and methodological panel will provide independent guidance on anchor selection. We aim to construct multiple clinical anchors per QLQ-C30 scale and also to compare with several anchor-based methods. The effects of covariates, for example, gender, age, disease stage and so on, will also be investigated. We will examine how our estimated MIDs compare with previously published guidelines, hence further contributing to robust MID guidelines for the EORTC QLQ-C30. ETHICS AND DISSEMINATION All patient data originate from completed clinical trials with mandatory written informed consent, approved by local ethical committees. Our findings will be presented at scientific conferences, disseminated via peer-reviewed publications and also compiled in a MID 'blue book' which will be made available online on the EORTC Quality of Life Group website as a free guideline document.
Collapse
Affiliation(s)
- Zebedee Jammbe Musoro
- Quality of life department, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Jean-Francois Hamel
- Department of Methodology and Biostatistics, University Hospital of Angers UNAM, Angers, France
| | - Divine Ewane Ediebah
- Brain Tumour Center Amsterdam of the VU University Medical Center, Amsterdam, The Netherlands
| | - Kim Cocks
- Adelphi Values, Bollington, UK
- Department of Health Sciences, University of York, York, UK
| | - Madeleine T King
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Mogens Groenvold
- Department of Public Health and Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Yvonne Brandberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Galina Velikova
- Leeds Institute of Cancer and Pathology, University of Leeds, St James's Hospital, Leeds, UK
| | | | - Hans-Henning Flechtner
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany
| | - Andrew Bottomley
- Quality of life department, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Corneel Coens
- Quality of life department, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| |
Collapse
|
47
|
Stewart AK, Dimopoulos MA, Masszi T, Špička I, Oriol A, Hájek R, Rosiñol L, Siegel DS, Niesvizky R, Jakubowiak AJ, San-Miguel JF, Ludwig H, Buchanan J, Cocks K, Yang X, Xing B, Zojwalla N, Tonda M, Moreau P, Palumbo A. Health-Related Quality-of-Life Results From the Open-Label, Randomized, Phase III ASPIRE Trial Evaluating Carfilzomib, Lenalidomide, and Dexamethasone Versus Lenalidomide and Dexamethasone in Patients With Relapsed Multiple Myeloma. J Clin Oncol 2017; 34:3921-3930. [PMID: 27601539 DOI: 10.1200/jco.2016.66.9648] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose To determine the effects of carfilzomib, lenalidomide, and dexamethasone (KRd) versus lenalidomide and dexamethasone (Rd) on health-related quality of life (HR-QoL) in the Carfilzomib, Lenalidomide, and Dexamethasone Versus Lenalidomide and Dexamethasone for the Treatment of Patients With Relapsed Multiple Myeloma (ASPIRE) trial. Methods Patients with relapsed multiple myeloma were randomly assigned to receive KRd or Rd. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 and myeloma-specific module were administered at baseline; day 1 of cycles 3, 6, 12, and 18; and after treatment. The Global Health Status/Quality of Life (GHS/QoL) scale and seven subscales (fatigue, nausea and vomiting, pain, physical functioning, role functioning, disease symptoms, and adverse effects of treatment) were compared between groups using a mixed model for repeated measures. The percentages of responders with ≥ 5- or 15-point GHS/QoL improvement at each cycle were compared between groups. Results Baseline questionnaire compliance was excellent (94.1% of randomly assigned patients). KRd patients had higher GHS/QoL scores versus Rd patients over 18 treatment cycles (two-sided P < .001). The minimal important difference was met at cycle 12 (5.6 points) and approached at cycle 18 (4.8 points). There was no difference between groups for the other prespecified subscales from ASPIRE. A higher proportion of KRd patients met the GHS/QoL responder definition (≥ 5-point improvement) with statistical differences at cycle 12 (KRd v Rd patients, 25.5% v 17.4%, respectively) and 18 (KRd v Rd patients, 24.2% v 12.9%, respectively). Conclusion KRd improves GHS/QoL without negatively affecting patient-reported symptoms when compared with Rd. These data further support the benefit of KRd in patients with relapsed multiple myeloma.
Collapse
Affiliation(s)
- A Keith Stewart
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Meletios A Dimopoulos
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Tamás Masszi
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Ivan Špička
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Albert Oriol
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Roman Hájek
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Laura Rosiñol
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - David S Siegel
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Ruben Niesvizky
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Andrzej J Jakubowiak
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Jesus F San-Miguel
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Heinz Ludwig
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Jacqui Buchanan
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Kim Cocks
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Xinqun Yang
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Biao Xing
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Naseem Zojwalla
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Margaret Tonda
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Philippe Moreau
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Antonio Palumbo
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| |
Collapse
|
48
|
van de Poll-Franse L, Oerlemans S, Bredart A, Kyriakou C, Sztankay M, Pallua S, Daniëls L, Creutzberg CL, Cocks K, Malak S, Caocci G, Molica S, Chie W, Efficace F. International development of four EORTC disease-specific quality of life questionnaires for patients with Hodgkin lymphoma, high- and low-grade non-Hodgkin lymphoma and chronic lymphocytic leukaemia. Qual Life Res 2017; 27:333-345. [PMID: 29127596 PMCID: PMC5846994 DOI: 10.1007/s11136-017-1718-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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] [Accepted: 10/06/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE This paper describes the international, cross-cultural development of four disease-specific EORTC QoL questionnaires, to supplement the EORTC QLQ-C30, for patients with Hodgkin lymphoma (HL), high- or low-grade non-Hodgkin lymphoma (HG/LG-NHL), and CLL. METHODS Questionnaire development was conducted according to guidelines from the EORTC Quality of Life Group. Phase I comprised generation of QoL issues relevant to patients. Phase II included operationalization and assessment of item relevance. In phase III, items were pretested in a cross-cultural sample. RESULTS In Phase I, 75 issues were identified through focus groups and systematic literature searches. Interviews with 80 health-care professionals and 245 patients resulted in a provisional module of 38 items (phase II) representing items relevant for all or at least one of the four malignancies. In Phase III, this was tested in 337 patients from five European countries and resulted in a questionnaire with 27 items for HL (EORTC QLQ-HL27), 29 items for HG-NHL (EORTC QLQ-NHL-HG29), 20 items for LG-NHL (EORTC QLQ-NHL-LG20) and 17 items for CLL (EORTC QLQ-CLL17). CONCLUSIONS This study provides four new EORTC modules for use in clinical research and routine practice in conjunction with the EORTC QLQ-C30 for assessing QoL in patients with lymphoma and CLL.
Collapse
Affiliation(s)
- Lonneke van de Poll-Franse
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Psychosocial Research, Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Simone Oerlemans
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Anne Bredart
- Psycho-Oncology Unit, Institut Curie, Paris, France
- Psycho-pathology and Health Process Laboratory Psychology Institute, University Paris Descartes, Paris, France
| | - Charalampia Kyriakou
- Royal Free and North West London Hospitals, National Health Service Trust, London, UK
| | - Monika Sztankay
- Department of Psychiatry, Psychotherapy and Psychosomatics, Innsbruck Medical University, Innsbruck, Austria
| | - Stephan Pallua
- Department of Psychiatry, Psychotherapy and Psychosomatics, Innsbruck Medical University, Innsbruck, Austria
| | - Laurien Daniëls
- Department of Radiation Oncology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Carien L. Creutzberg
- Department of Radiation Oncology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Kim Cocks
- KCStats Consultancy, York, UK
- University of York, York, UK
| | - Sandra Malak
- Hôpital René Huguenin-Institut Curie- Hématologie, Saint-Cloud, France
| | - Giovanni Caocci
- Hematology, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | | | | | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA) Data Centre, Rome, Italy
| | | |
Collapse
|
49
|
Rider A, Simpson S, Bennett B, Byrne K, Hallworth P, Desai T, Cocks K. Generating patient reported outcome norms for an EU cancer population using real world data (FACT-G). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx385.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
50
|
Lawton R, O'Hara JK, Sheard L, Armitage G, Cocks K, Buckley H, Corbacho B, Reynolds C, Marsh C, Moore S, Watt I, Wright J. Can patient involvement improve patient safety? A cluster randomised control trial of the Patient Reporting and Action for a Safe Environment (PRASE) intervention. BMJ Qual Saf 2017; 26:622-631. [PMID: 28159854 PMCID: PMC5537521 DOI: 10.1136/bmjqs-2016-005570] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [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] [Received: 04/08/2016] [Revised: 10/14/2016] [Accepted: 10/24/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the efficacy of the Patient Reporting and Action for a Safe Environment intervention. DESIGN A multicentre cluster randomised controlled trial. SETTING Clusters were 33 hospital wards within five hospitals in the UK. PARTICIPANTS All patients able to give informed consent were eligible to take part. Wards were allocated to the intervention or control condition. INTERVENTION The ward-level intervention comprised two tools: (1) a questionnaire that asked patients about factors contributing to safety (patient measure of safety (PMOS)) and (2) a proforma for patients to report both safety concerns and positive experiences (patient incident reporting tool). Feedback was considered in multidisciplinary action planning meetings. MEASUREMENTS Primary outcomes were routinely collected ward-level harm-free care (HFC) scores and patient-level feedback on safety (PMOS). RESULTS Intervention uptake and retention of wards was 100% and patient participation was high (86%). We found no significant effect of the intervention on any outcomes at 6 or 12 months. However, for new harms (ie, those for which the wards were directly accountable) intervention wards did show greater, though non-significant, improvement compared with control wards. Analyses also indicated that improvements were largest for wards that showed the greatest compliance with the intervention. LIMITATIONS Adherence to the intervention, particularly the implementation of action plans, was poor. Patient safety outcomes may represent too blunt a measure. CONCLUSIONS Patients are willing to provide feedback about the safety of their care. However, we were unable to demonstrate any overall effect of this intervention on either measure of patient safety and therefore cannot recommend this intervention for wider uptake. Findings indicate promise for increasing HFC where wards implement ≥75% of the intervention components. TRIAL REGISTRATION NUMBER ISRCTN07689702; pre-results.
Collapse
Affiliation(s)
- Rebecca Lawton
- Institute of Psychological Sciences, University of Leeds, Leeds, UK
- Department of Quality and Safety Research, Bradford Institute for Health Research, Bradford, UK
| | | | - Laura Sheard
- Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, Bradford, UK
| | - Gerry Armitage
- School of Health, University of Bradford, Bradford, Bradford, UK
| | - Kim Cocks
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | | | - Caroline Reynolds
- Department of Quality and Safety, Bradford Institute for Health Research, Bradford, UK
| | - Claire Marsh
- Department of Quality and Safety, Bradford Institute for Health Research, Bradford, UK
| | - Sally Moore
- Department of Quality and Safety Research, Bradford Institute for Health Research, Bradford, UK
| | - Ian Watt
- Department of Health Sciences, The University of York, York, North Yorkshire, UK
| | - John Wright
- Department of Epidemiology and Public Health, Royal Infirmary Bradford, Bradford, UK
| |
Collapse
|