1
|
de Ligt KM, de Rooij BH, Hedayati E, Karsten MM, Smaardijk VR, Velting M, Saunders C, Travado L, Cardoso F, Lopez E, Carney N, Wengström Y, Ives A, Velikova G, Sousa Fialho MDL, Seidler Y, Stamm TA, Koppert LB, van de Poll-Franse LV. International development of a patient-centered core outcome set for assessing health-related quality of life in metastatic breast cancer patients. Breast Cancer Res Treat 2023; 198:265-281. [PMID: 36662394 PMCID: PMC10020292 DOI: 10.1007/s10549-022-06827-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/30/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE For patients living with metastatic breast cancer (MBC), achieving best possible health-related quality of life, along with maximizing survival, is vital. Yet, we have no systemic way to determine if we achieve these goals. A Core Outcome Set (COS) that allows standardized measurement of outcomes important to patients, but also promotes discussing these outcomes during clinical encounters, is long overdue. METHODS An international expert group (EG) of patient advocates, researchers, medical specialists, nurse specialists, and pharmaceutical industry representatives (n = 17) reviewed a list of relevant outcomes retrieved from the literature. A broader group (n = 141: patients/patient advocates (n = 45), health care professionals/researchers (n = 64), pharmaceutical industry representatives (n = 28), and health authority representatives (n = 4)) participated in a modified Delphi procedure, scoring the relevance of outcomes in two survey rounds. The EG finalized the COS in a consensus meeting. RESULTS The final MBC COS includes 101 variables about: (1) health-related quality of life (HRQoL, n = 26) and adverse events (n = 24); (2) baseline patient characteristics (n = 9); and (3) clinical variables (n = 42). Many outcome that cover aspects of HRQoL relevant to MBC patients are included, e.g. daily functioning (including ability to work), psychosocial/emotional functioning, sexual functioning, and relationship with the medical team. CONCLUSION The COS developed in this study contains important administrative data, clinical records, and clinician-reported measures that captures the impact of cancer. The COS is important for standardization of clinical research and implementation in daily practice and has received accreditation by the International Consortium for Health Outcomes Measurement (ICHOM).
Collapse
Affiliation(s)
- K M de Ligt
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, PO Box 90203, 1006 BE, Amsterdam, The Netherlands.
| | - B H de Rooij
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - E Hedayati
- Department of Oncology-Pathology, Bioclinicum, Karolinska Institutet, Solna, Stockholm, Sweden
- Breast Cancer Center, Cancer Theme, Karolinska University Hospital and Karolinska Comprehensive Cancer Centre, Stockholm, Sweden
| | - M M Karsten
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - V R Smaardijk
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - M Velting
- Dutch Breast Cancer Patient Association (Borstkankervereniging Nederland), Utrecht, The Netherlands
| | - C Saunders
- Department of Surgery, Melbourne Medical School, Melbourne, Australia
| | - L Travado
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - F Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - E Lopez
- Department of Radiation Oncology, Vithas Hospital La Milagrosa, GenesisCare, Madrid, Spain
| | - N Carney
- F.Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Y Wengström
- Department of Oncology-Pathology, Bioclinicum, Karolinska Institutet, Solna, Stockholm, Sweden
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - A Ives
- Cancer and Palliative Care Research and Evaluation Unit, University of Western Australia, Crawley, WA, Australia
| | - G Velikova
- Leeds Institute of Medical Research at St James's, St James's University Hospital, University of Leeds, Leeds, UK
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | | | - Y Seidler
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - T A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - L B Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - L V van de Poll-Franse
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, PO Box 90203, 1006 BE, Amsterdam, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | | |
Collapse
|
2
|
Studenic P, Stamm T, Seidler Y, Dam A, Weibrecht N, Zauner G, Jakobsen TH, Hansen RL, Popper N, Wilhelmer TC, Radner H, Ramos R, Rickmann J, Urach C, Kristensen LE, Jørgensen TS. AB1393 RHEUMABUDDY4.0 LEADING THE PATH TO A PATIENT-DRIVEN ELECTRONIC SUPPORT AND MONITORING TOOL. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe use of health apps has become more popular in recent years, but it is still a small and rather unregulated market. Few apps have been designed in collaboration with patients and these mostly address patient reported symptoms. Some clinical registries have already developed patient apps to complete patient-reported outcome measures (PROMs) on smartphones, which normally would have been collected during an outpatient visit and have shown interchangeability. The next step would be providing a patient app offering possibilities not only of individual disease tracking, but to provide automated peer support, health information and behavioural advice.ObjectivesWe aimed to further develop and validate RheumaBuddy, a health app for patients with rheumatoid arthritis (RA), from a standard monitoring app to an intelligent health app tailored to the needs of the user that provides transparency to all important stakeholders in Rheumatology care.MethodsThis is an international interdisciplinary project between Austrian and Danish partners funded by the EUREKA program. Rheumatologists, health scientists, digital data experts and patients with RA joined forces in a 4 phase-program, running from 2020 to 2023. Phase 1 continues to develop the app in a co-creation approach in several iterations with patients. Phase 2 concerns developing an automated learning algorithm based on user data to identify patient strata and connect these with helpful non-pharmacological interventions. Phase 3 connects healthcare system data on diagnosis, medication prescription, healthcare facility usage with a large clinical RA database. By that we develop patient pathways that correlate high granularity data with system resources to retrieve results on socioeconomic impact. In phase 4 a randomised clinical trial will evaluate the effect of the developed RB4.0 on clinical disease activity and quality of life.ResultsCurrently, RB is regularly being used by more than 3100 patients in 35 countries and 8 languages throughout Europe. The current RheumaBuddy version offers logging of symptoms using Likert scale questions, a joint mannequin to mark painful body parts and a peer-support forum. Additionally, the user can anytime display his/her entries over time in a graphical report and also share data with the healthcare provider. This version is extended with tracking of sleep, working hours and other behaviours. A consultation compass function helps the patient to reflect on goals and issues before the rheumatologist visit.Within this project, we already established a first version of a Recommender System (RS), which computes correlations between user entries (e.g. between a user’s mood and pain), thus providing individual feedback. Through integration of information obtained from the app with claims data and clinical data from a RA registry, patterns can be identified and translated into different case models that concern the impact of common RA symptoms. By mapping these scenarios with evidence based behaviour and lifestyle advice, the “virtual coach” (advanced RS) will be developed and integrated into the RB4.0 system. During continuous data collection on app users, similarities in user behaviour can be identified, and similar entry patterns can be grouped. This will allow users to exchange and learn from each other regarding certain difficult situations (ex. “life-hack”) etc.We are creating a comprehensive system in providing feedback to both clinical and psychosocial aspects of coping and disease management, as well as everyday practicalities for living with a chronic disease. Figure 1 displays these aspects, contributing the empowerment of patients.Figure 1.RB4.0 shall support people living with RA in dealing with disease impactConclusionRheumaBuddy4.0 will provide RA patients the means to improve their quality of life on an individual level, better understand their needs and therapy which could support overcoming barriers of successful shared decision making to achieve better outcomes.Disclosure of InterestsPaul Studenic: None declared, Tanja Stamm Speakers bureau: AbbVie, Novartis, Roche, Sanofi, and Takeda, Consultant of: AbbVie and Sanofi Genzyme, Grant/research support from: AbbVie and Roche, Yuki Seidler: None declared, Andreas Dam Speakers bureau: Gilead, Galapagos, BMS, Roche, Takeda, Merck, Consultant of: Gilead, Galapagos, BMS, Roche, Takeda, Merck, Nadine Weibrecht: None declared, Günther Zauner: None declared, Thomas H Jakobsen: None declared, Rebekka L. Hansen: None declared, Nikolas Popper Speakers bureau: Roche, Consultant of: as CSO of dwh GmbH, Tanita-Christina Wilhelmer: None declared, Helga Radner Speakers bureau: Gilead, Merck Sharp, Pfizer, Abbvie, Consultant of: Gilead, Merck Sharp, Pfizer, Abbvie, Romualdo Ramos: None declared, James Rickmann: None declared, Christoph Urach: None declared, Lars Erik Kristensen Speakers bureau: AbbVie, Pfizer Janssen, Novartis, Galapagos, UCB, Biogen and Eli Lilly, Consultant of: AbbVie, Pfizer, Janssen, Novartis, Galapagos, UCB, Biogen and Eli Lilly, Grant/research support from: IIT grants from UCB, Biogen, Eli Lilly, Novartis, Tanja Schjødt Jørgensen Speakers bureau: AbbVie, Pfizer, Roche, Novartis, UCB, Biogen and Eli Lilly, Consultant of: AbbVie, Pfizer, Roche, Novartis, UCB, Biogen and Eli Lilly
Collapse
|
3
|
Seidler Y, Jørgensen TS, Studenic P, Radner H, Nygaard T, Weibrecht N, Popper N, Kristensen LE, Wilhelmer TC, Rickmann J, Mosor E, Ritschl V, Stamm T. POS1470-HPR KNOWING WHAT TO DO WITH THE DATA - A QUALITATIVE STUDY ON CHALLENGES OF USING SMARTPHONE-BASED ePROs IN RHEUMATOID ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundUsing patient-reported outcomes (PROs) has a long tradition in rheumatology, and PRO measurement is included in many composite indices evaluating disease progression and treatment response [1]. However, little is known about patients´ and health professionals´ (HPs) perceptions of using digitally collected PROs, the so-called ePROs, with a personal smartphone app.ObjectivesTo identify main challenges in utilising ePROs for management and treatment of rheumatoid arthritis from patients’ and HPs’ perspectives.MethodsWe interviewed 25 people with rheumatoid arthritis (RA) and 17 HPs (nurses, rheumatologists, and physiotherapists) from Austria and Denmark. We used the RheumaBuddy app as a practical example to illustrate the digital data collection and the feedback that patients would get from entering their self-reported outcomes. Interviews were recorded and transcribed. We applied a qualitative thematic analysis to identify major themes using a procedure of rigorous coding. Analysis was done by two researchers, and conflicts were solved by consensus. Ethical approval was obtained in both countries.ResultsThree main themes emerged: 1) Being simple yet comprehensive; 2) Resources to interpret, use and act upon the collected data; and 3) Being reminded of the disease. Within the first theme, many valued the intuitiveness and simplicity of ePROs, especially when used as a monitoring tool in between clinical visits. HPs were concerned about not to overwhelm the patients with too many questions. On the other hand, the short ePROs asked in the app were not comprehensive enough to capture psychosocial and lifestyle aspects of the disease which were considered important both by patients and HPs. Within the second theme, patients and HPs expressed that ePROs could be the basis for shared decision making. Nevertheless, some patients had clearer ideas on making use of the feedback they could get from their self-reported data than the others. Participants from Denmark, who experienced a higher level of digital health maturity in official institutions, expressed more proactive use of the data than participants from Austria who were on average younger than their Danish counterparts. One patient in Austria even asserted having no idea what to do with the collected data but believed that the “doctor will make good use of it”. HPs in both countries, however, indicated that they needed more resources, skills, and time to make sense of the ePRO data and act accordingly. Under the third theme, patients considered the collection of ePROs to be very important when pain and disease activity were high. HPs, on the other hand, were more concerned that the regular collection of ePROs might constantly remind patients that they are living with the disease.ConclusionThe potential adoption of ePROs in practice depends on both patients and HPs’ motivations and ideas to use the feedback they would get from the collected data. This might be influenced by the level of digital health maturity of a country, as well as available resources. In addition, ePROs need to be intuitive and simple, but at the same time comprehensive and reliable enough so that they can be used for shared decision making. Challenges remain for the ePROs to be used as supporting and empowering tools, and not as reminders of the disease and pain.Table 1.Demographic data of the participants (N=42)DemographicAustriaDenmarkTotalDataPatientHPPatientHPPatientHPN14101172517Women (%)10(71)6(60)7(64)5(71)17(68)11(65)Men (%)4(29)4(40)4(36)2(29)8(32)6(35)AgeMean (Range)54(30-76)41(29-63)65(37-77)47(31-59)60(30-77)44(29-63)References[1]T Stamm, I Parodis, and P Studenic. Patient-reported outcomes with anifrolumab in patients with systemic lupus erythematosus, Lancet Rheumatol, (2022), in Press.AcknowledgementsWe would like to express our particular thank you to all those who have taken part in the interview study and for their valuable inputs.Disclosure of InterestsYuki Seidler: None declared, Tanja Schjødt Jørgensen Speakers bureau: AbbVie, Pfizer, Roche, Novartis, UCB, Biogen and Eli Lilly., Consultant of: AbbVie, Pfizer, Roche, Novartis, UCB, Biogen and Eli Lilly, Paul Studenic: None declared, Helga Radner Speakers bureau: Gilead, Merck Sharp, Pfizer, Abbvie, Consultant of: Gilead, Merck Sharp, Pfizer, Abbvie, Thomas Nygaard: None declared, Nadine Weibrecht: None declared, Nikolas Popper Speakers bureau: Roche, Consultant of: dwh GmbH (as CSO), Lars Erik Kristensen Speakers bureau: Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals, Consultant of: Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals, Grant/research support from: IIT research grants from Novo, UCB, Eli Lilly; Novartis and Abbvie, Tanita-Christina Wilhelmer: None declared, James Rickmann: None declared, Erika Mosor: None declared, Valentin Ritschl: None declared, Tanja Stamm Speakers bureau: AbbVie, Novartis, Roche, Sanofi, and Takeda., Consultant of: AbbVie and Sanofi Genzyme., Grant/research support from: AbbVie and Roche.
Collapse
|
4
|
Kaufman JD, Seidler Y, Bailey HR, Whitacre L, Bargo F, Lüersen K, Rimbach G, Pighetti GM, Ipharraguerre IR, Ríus AG. A postbiotic from Aspergillus oryzae attenuates the impact of heat stress in ectothermic and endothermic organisms. Sci Rep 2021; 11:6407. [PMID: 33742039 PMCID: PMC7979835 DOI: 10.1038/s41598-021-85707-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 11/06/2020] [Accepted: 02/28/2021] [Indexed: 01/17/2023] Open
Abstract
Heat stress is detrimental to food-producing animals and animal productivity remains suboptimal despite the use of heat abatement strategies during summer. Global warming and the increase of frequency and intensity of heatwaves are likely to continue and, thus, exacerbate the problem of heat stress. Heat stress leads to the impairment of physiological and cellular functions of ectothermic and endothermic animals. Therefore, it is critical to conceive ways of protecting animals against the pathological effects of heat stress. In experiments with endothermic animals highly sensitive to heat (Bos taurus), we have previously reported that heat-induced systemic inflammation can be ameliorated in part by nutritional interventions. The experiments conducted in this report described molecular and physiological adaptations to heat stress using Drosophila melanogaster and dairy cow models. In this report, we expand previous work by first demonstrating that the addition of a postbiotic from Aspergillus oryzae (AO) into the culture medium of ectothermic animals (Drosophila melanogaster) improved survival to heat stress from 30 to 58%. This response was associated with downregulation of genes involved in the modulation of oxidative stress and immunity, most notably metallothionein B, C, and D. In line with these results, we subsequently showed that the supplementation with the AO postbiotic to lactating dairy cows experiencing heat stress decreased plasma concentrations of serum amyloid A and lipopolysaccharide-binding protein, and the expression of interleukin-6 in white blood cells. These alterations were paralleled by increased synthesis of energy-corrected milk and milk components, suggesting enhanced nutrient partitioning to lactogenesis and increased metabolic efficiency. In summary, this work provides evidence that a postbiotic from AO enhances thermal tolerance likely through a mechanism that entails reduced inflammation.
Collapse
Affiliation(s)
- J D Kaufman
- Department of Animal Science, University of Tennessee, 2506 River Drive, 235 Brehm Animal Science Building, Knoxville, TN, 37996, USA
| | - Y Seidler
- Institute of Human Nutrition and Food Science, University of Kiel, Kiel, Germany
| | - H R Bailey
- Department of Animal Science, University of Tennessee, 2506 River Drive, 235 Brehm Animal Science Building, Knoxville, TN, 37996, USA
| | - L Whitacre
- BioZyme, Inc., St. Joseph, MO, 64504, USA
| | - F Bargo
- Facultad de Agronomía, Universidad de Buenos Aires, Buenos Aires, Argentina
- BioZyme, Inc., St. Joseph, MO, 64504, USA
| | - K Lüersen
- Institute of Human Nutrition and Food Science, University of Kiel, Kiel, Germany
| | - G Rimbach
- Institute of Human Nutrition and Food Science, University of Kiel, Kiel, Germany
| | - G M Pighetti
- Department of Animal Science, University of Tennessee, 2506 River Drive, 235 Brehm Animal Science Building, Knoxville, TN, 37996, USA
| | - I R Ipharraguerre
- Institute of Human Nutrition and Food Science, University of Kiel, Kiel, Germany
| | - A G Ríus
- Department of Animal Science, University of Tennessee, 2506 River Drive, 235 Brehm Animal Science Building, Knoxville, TN, 37996, USA.
| |
Collapse
|
5
|
Seidler Y, Novak-Zezula S, Trummer U. “Falling off the radar” – uninsured Chinese patients in Austria. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.755] [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: 11/13/2022] Open
Abstract
Abstract
Background
Even in European welfare states with close to universal health coverage, undocumented migrants often fail to gain access to essential health services, falling “off the radar” of public health policies. Our study aimed to explore the characteristics, health problems and health care needs of undocumented Chinese migrants in Vienna, Austria.
Methods
We analysed anonymized medical records of 74 Chinese migrants utilizing the services of a non-governmental organization (NGO) providing primary care to uninsured people in Vienna during a three-month period. The medical data was then coded using the International Classification of Primary Care, 2nd version.
Results
At present, NGOs in Austria fill major gaps in access to health services that exist in the public system. The most frequently diagnosed health problems in the study sample were cardiovascular and metabolic-related diseases (hypertension and diabetes) and there was a high burden of multiple chronic non-communicable diseases.
Conclusions
NGOs can play a vital role in providing health services to underserved groups, and they can also contribute to public health surveillance and the collection of high-quality data.
Collapse
Affiliation(s)
- Y Seidler
- Center for Health and Migration, Vienna, Austria
- Medical University, Vienna, Austria
| | | | - U Trummer
- Center for Health and Migration, Vienna, Austria
| |
Collapse
|
6
|
Novak-Zezula S, Trummer U, Seidler Y. 6.10-P21Varying perspectives on “successful immigration” among “successful” female immigrants in Vienna, Austria. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.226] [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: 11/13/2022] Open
Affiliation(s)
| | - U Trummer
- Center for Health and Migration, Austria
| | - Y Seidler
- Center for Health and Migration, Austria
| |
Collapse
|
7
|
Seidler Y, Mosor E. 7.3-O5Japanese women’s experiences of prenatal screening and diagnostic testing for detecting foetal disorders in Austria. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.251] [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: 11/14/2022] Open
Affiliation(s)
- Y Seidler
- Medical University of Vienna, Center for Public Health, Austria
| | - E Mosor
- Medical University of Vienna, Center for Medical Statistics, Informatics, and Intelligent Systems, Institute for Outcome Research, Austria
| |
Collapse
|
8
|
Seidler Y, Novak-Zezula S, Trummer U. 5.3-O7Primarily health care needs of uninsured Chinese immigrants in Vienna, Austria: a descriptive study of 74 outpatient data from 2015. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.176] [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: 11/12/2022] Open
Affiliation(s)
- Y Seidler
- Centre for Health and Migration, Austria
| | | | - U Trummer
- Centre for Health and Migration, Austria
| |
Collapse
|