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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.
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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
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van de Wal D, Venkatesan S, Benson C, van der Graaf WTA, Johnson CD, Husson O, Sodergren SC. A patient's perspective on the side effects of tyrosine kinase inhibitors in the treatment of advanced and metastatic gastrointestinal stromal tumors. Future Oncol 2023; 19:299-314. [PMID: 37038981 DOI: 10.2217/fon-2022-0730] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
Aim: To provide the gastrointestinal stromal tumor patient's perspective on side effects of tyrosine kinase inhibitors and compare this with that of healthcare professionals. Materials & methods: Semi-structured interviews were conducted with 19 patients with an advanced or metastatic gastrointestinal stromal tumor, as well as six healthcare professionals, and five patients participated in a focus group. Thematic analysis was used to interpret the data. Results: Most participants (n = 29) reported gastrointestinal symptoms followed by tiredness (n = 25), edema (n = 22), muscle cramps (n = 21), skin problems (n = 21), eye problems (n = 11) and trouble sleeping (n = 10). Patients, but not healthcare professionals, reported cognitive problems or symptoms of depression. Conclusion: These results underline the importance of including the patient's perspective, as there is a gap in symptom reporting between patients and healthcare professionals.
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Affiliation(s)
- Deborah van de Wal
- Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, 1066 CX, Amsterdam, The Netherlands
| | | | - Charlotte Benson
- Sarcoma Unit, The Royal Marsden National Health Service Foundation Trust, London, SW3 6JJ, UK
| | - Winette TA van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, 1066 CX, Amsterdam, The Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, 3015 GD, Rotterdam, The Netherlands
| | - Colin D Johnson
- Cancer Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Olga Husson
- Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, 1066 CX, Amsterdam, The Netherlands
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, 3015 GD, Rotterdam, The Netherlands
- Division of Clinical Studies, Institute of Cancer Research, London, SW3 6JB, UK
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3
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Amin S, Joo S, Nolte S, Yoo HK, Patel N, Byrnes HF, Costa-Cabral S, Johnson CD. Health-related quality of life scores of metastatic pancreatic cancer patients responsive to first line chemotherapy compared to newly derived EORTC QLQ-C30 reference values. BMC Cancer 2022; 22:563. [PMID: 35596182 PMCID: PMC9123808 DOI: 10.1186/s12885-022-09661-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background Metastatic pancreatic cancer (mPC) and its treatments significantly impact health-related quality of life (HRQoL). POLO, a randomized, double-blind, placebo-controlled phase 3 trial evaluated the efficacy of olaparib as maintenance therapy in germline BRCA mutated mPC patients who had not progressed during ≥16 weeks of first-line platinum-based chemotherapy. HRQoL was assessed using the EORTC QLQ-C30. To enhance score interpretation, we derived reference values for treatment-naïve mPC patients from the literature. Methods A targeted literature review identified EORTC QLQ-C30 baseline values in treatment-naïve mPC patients. Reference values were calculated by deriving means from studies meeting inclusion criteria, with scores from 0 to 100 (higher scores indicate better QoL/functioning but worse symptoms). For POLO patients, means were calculated using pooled baseline data across study arms. Results Four studies met inclusion criteria. Depending on the specific scale, sample sizes ranged from n = 466 to n = 639. Compared to newly derived reference values, POLO patients reported markedly better HRQoL scores at baseline across most scales, with eight scales showing differences of ≥10 points. POLO patients’ HRQoL scores were often close to or better than general population norm data. Conclusions This is the first study to systematically derive EORTC QLQ-C30 reference values for mPC. POLO patients had better HRQoL scores than those in the literature and similar to general population data. Comparatively high HRQoL of POLO patients are likely due to effects of prior first-line treatment and resolution of chemotherapy-related symptoms, response shift, or a combination. Newly derived reference values can enhance interpretation of mPC patients’ HRQoL. Trial registration The POLO trial was registered on 9 July 2014 with ClinicalTrials.gov as NCT 02184195. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09661-7.
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Affiliation(s)
- Suvina Amin
- AstraZeneca, One Medimmune Way, Gaithersburg, MD, 20878, USA
| | | | - Sandra Nolte
- ICON Clinical Research GmbH, Konrad-Zuse-Platz 11, 81829, Munich, Germany.,Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Medical Clinic, Berlin, Germany
| | - Hyun Kyoo Yoo
- AstraZeneca, City house, 130 Hills road, Cambridge, CB2 1RE, UK
| | - Nikunj Patel
- AstraZeneca, One Medimmune Way, Gaithersburg, MD, 20878, USA
| | - Hilary F Byrnes
- ICON plc, 731 Arbor Way, Suite 100, Blue Bell, PA, 19422, USA.
| | - Sara Costa-Cabral
- Mapi Research Trust, 27, Rue de la Villette, 3rd & 4th Floors, 69003, Lyon, France
| | - Colin D Johnson
- University of Southampton, University Road, Southampton, SO17 BJ, UK
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Helm ET, Patience JF, Romoser MR, Johnson CD, Ross JW, Gabler NK. Evaluation of increased fiber, decreased amino acids, or decreased electrolyte balance as dietary approaches to slow finishing pig growth rates. J Anim Sci 2021; 99:skab164. [PMID: 34014285 PMCID: PMC8259844 DOI: 10.1093/jas/skab164] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/17/2021] [Indexed: 12/23/2022] Open
Abstract
In swine production, pig movement restrictions or packing plant closures may create the need to slow growth rates of finishing pigs to ensure they remain at a marketable body weight when packing plant access is restored. Although dietary formulations can be successful at slowing pig growth, precision is needed regarding how to best formulate diets to achieve growth rate reductions. Thus, the objective was to evaluate three dietary experimental approaches aimed at slowing growth rates in finishing pigs. These approaches consisted of either increasing neutral detergent fiber (NDF), reducing essential amino acids, or reducing the dietary electrolyte balance through the addition of acidogenic salts. A total of 94 mixed-sex pigs (72.4 ± 11.2 kg BW) across two replicates were individually penned and assigned to 1 of 8 dietary treatments (n = 11-12 pigs/treatment): 1) Control diet representative of a typical corn-soybean meal-based finisher diet (CON); 2) diet containing 15% NDF from soybean hulls (15% NDF); 3) diet containing 20% NDF from soybean hulls (20% NDF); 4) diet containing 25% NDF from soybean hulls (25% NDF); 5) diet formulated as per CON but with 50% of the soybean meal replaced with corn (89% Corn); 6) diet containing 97% corn and no soybean meal or synthetic amino acids (97% Corn); 7) diet containing 2% anhydrous calcium chloride (2% CaCl2); and 8) diet containing 4% anhydrous calcium chloride (4% CaCl2). Over 28 d, pig body weights and performance were recorded weekly. At d 28, all pigs were ultrasound scanned and switched to the CON diet to evaluate compensatory gain from d 28 to 35. Overall, increased NDF did not impact any growth performance parameter (P > 0.05). Amino acid restriction reduced average daily gain (ADG), average daily feed intake (ADFI), and gain:feed (G:F) linearly (linear P < 0.001). Similarly, ADG, ADFI, and G:F were linearly reduced with increased CaCl2 inclusion (linear P < 0.001). ADG differed during the compensatory gain period (P < 0.001), with 4% CaCl2-fed pigs having a 47% increase in ADG compared with CON-fed pigs. Conversely, 15% and 25% NDF-fed pigs had reduced ADG compared with CON-fed pigs during the compensatory gain period. Gain efficiency differed from day 28 to 35 (P < 0.001), with 4% CaCl2-fed pigs having a 36% increase in G:F compared with CON-fed pigs. Altogether, these data demonstrate that both amino acid restriction and CaCl2 inclusion are effective at slowing pig growth, albeit at greater inclusion rates.
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Affiliation(s)
- Emma T Helm
- Department of Animal Science, Iowa State University, Ames, IA 50011, USA
| | - John F Patience
- Department of Animal Science, Iowa State University, Ames, IA 50011, USA
| | - Matthew R Romoser
- Department of Animal Science, Iowa State University, Ames, IA 50011, USA
- Iowa Pork Industry Center, Iowa State University, Ames, IA 50011, USA
| | - Colin D Johnson
- Department of Animal Science, Iowa State University, Ames, IA 50011, USA
- Iowa Pork Industry Center, Iowa State University, Ames, IA 50011, USA
| | - Jason W Ross
- Department of Animal Science, Iowa State University, Ames, IA 50011, USA
- Iowa Pork Industry Center, Iowa State University, Ames, IA 50011, USA
| | - Nicholas K Gabler
- Iowa Pork Industry Center, Iowa State University, Ames, IA 50011, USA
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Gupta N, Thiele CM, Daum JI, Egbert LK, Chiang JS, Kilgore AE, Johnson CD. Building Patient-Physician Trust: A Medical Student Perspective. Acad Med 2020; 95:980-983. [PMID: 32079958 DOI: 10.1097/acm.0000000000003201] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Public trust in physicians has declined over the last 50 years. Future physicians will need to mend the patient-physician trust relationship. In conjunction with the American Medical Association's Accelerating Change in Medical Education initiative, the Mayo Clinic Alix School of Medicine implemented the Science of Health Care Delivery (SHCD) curriculum-a 4-year curriculum that emphasizes interdisciplinary training across population-centered care; person-centered care; team-based care; high-value care; leadership; and health policy, economics, and technology-in 2015. In this medical student perspective, the authors highlight how the SHCD curriculum has the potential to address issues that have eroded patient-physician trust. The curriculum reaches this aim through didactic and/or experiential teachings in health equity, cultural humility and competence, shared decision making, patient advocacy, and safety and quality of care. It is the authors' hope that novel medical education programs such as the SHCD curriculum will allow the nation's future physicians to own their role in rebuilding and fostering public trust in physicians and the health care system.
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Affiliation(s)
- Nikita Gupta
- N. Gupta is a second-year medical student, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona. C.M. Thiele is a second-year medical student, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona. J.I. Daum is a second-year medical student, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona. L.K. Egbert is a second-year medical student, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona. J.S. Chiang is a second-year medical student, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona. A.E. Kilgore Jr is a second-year medical student, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona. C.D. Johnson is a consultant, Department of Radiology, Mayo Clinic Hospital, Scottsdale, Arizona
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Koller M, Shamieh O, Hjermstad MJ, Hornslien K, Young T, Chalk T, Ioannidis G, Harle A, Johnson CD, Tomaszewski KA, Serpentini S, Pinto M, van der Weijst L, Janssens A, Morag O, Chie WC, Arraras JI, Pompili C, Jungraithmayr W, Hechtner M, Katsochi D, Müller K, Gräfenstein L, Schulz C, Bottomley A. Psychometric properties of the updated EORTC module for assessing quality of life in patients with lung cancer (QLQ-LC29): an international, observational field study. Lancet Oncol 2020; 21:723-732. [PMID: 32213338 DOI: 10.1016/s1470-2045(20)30093-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) assesses quality of life (QOL) in patients with lung cancer and was the first EORTC module developed for use in international clinical trials. Since its publication in 1994, major treatment advances with possible effects on QOL have occurred. These changes called for an update of the module and its international psychometric validation. We aimed to investigate the scale structure and psychometric properties of the updated lung cancer module, QLQ-LC29, in patients with lung cancer. METHODS This international, observational field study was done in 19 hospitals across 12 countries. Patients aged older than 18 years with a confirmed diagnosis of lung cancer and no other previous primary tumour, and who were mentally fit with sufficient language skills to understand and complete the questionnaire were included. Patients were asked during a hospital visit to fill in the paper versions of the core questionnaire EORTC QLQ-C30 plus QLQ-LC29, and investigators selected half of these patients to complete the questionnaire again 2-4 weeks later. Our primary aim was to assess the scale structure and psychometric properties of EORTC QLQ-LC29. We analysed scale structure using confirmatory factor analysis; reliability using Cronbach's α value (internal consistency) and intra-class coefficient (test-retest reliability); sensitivity using independent t tests stratified by Karnofsky performance status; and responsiveness to change over time by ANOVA. This study is registered with ClinicalTrials.gov, NCT02745691. FINDINGS Between April 12, 2016, and Sept 26, 2018, 523 patients with a confirmed diagnosis of either non-small-cell lung cancer (n=442) or small-cell lung cancer (n=81) were recruited. Confirmatory factor analysis provided a solution composed of five multi-item scales (coughing, shortness of breath, fear of progression, hair problems, and surgery-related symptoms) plus 15 single symptom or side-effect items: χ2=370·233, root mean square error of approximation=0·075, and comparative-fit index=0·901. Cronbach's α for internal consistencies of all multi-item scales were above the threshold of 0·70. Intra-class coefficients for test-retest reliabilities ranged between 0·82 and 0·97. Three (shortness of breath, fear of progression, and hair problems) of the five multi-item scales showed responsiveness to change over time (p values <0·05), as did nine of 15 single symptom items. Four (coughing, shortness of breath, fear of progression, and surgery-related symptoms) of the five multi-item scales and ten of the 15 single symptom items were sensitive to known group differences (ie, lower vs higher Karnofsky performance status). INTERPRETATION Results determined the psychometric properties of the updated lung cancer module, which is ready for use in international clinical studies. FUNDING EORTC Quality of Life Group.
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Affiliation(s)
- Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany.
| | - Omar Shamieh
- Department of Palliative Care, King Hussein Cancer Center, Amman, Jordan
| | - Marianne J Hjermstad
- Regional Advisory Unit for Palliative Care and European Palliative Care Research Centre, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Teresa Young
- East and North Hertfordshire NHS Trust, Mount Vernon Cancer Centre, London, UK
| | - Tara Chalk
- East and North Hertfordshire NHS Trust, Mount Vernon Cancer Centre, London, UK
| | | | | | | | - Krzysztof A Tomaszewski
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Samantha Serpentini
- Veneto Institute of Oncology IOV-IRCCS Comprehensive Cancer Center, Padova, Italy
| | - Monica Pinto
- Rehabilitation Medicine Unit, Department of Supportive Care, Istituto Nazionale Tumori - IRCCS- Fondazione G Pascale, Naples, Italy
| | | | - Annelies Janssens
- Department of Thoracic Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Ofir Morag
- Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Wei-Chu Chie
- Institute of Epidemiology and Preventive Medicine and Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Juan I Arraras
- Oncology Departments, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Cecilia Pompili
- Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | | | - Marlene Hechtner
- University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Despina Katsochi
- Department of Radiation Oncology, Hygeia Hospital, Athens, Greece
| | - Karolina Müller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Laura Gräfenstein
- Department of Internal Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Christian Schulz
- Department of Internal Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Andrew Bottomley
- Quality of Life Department, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
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Mayorga EJ, Kvidera SK, Seibert JT, Horst EA, Abuajamieh M, Al-Qaisi M, Lei S, Ross JW, Johnson CD, Kremer B, Ochoa L, Rhoads RP, Baumgard LH. Effects of dietary chromium propionate on growth performance, metabolism, and immune biomarkers in heat-stressed finishing pigs1. J Anim Sci 2019; 97:1185-1197. [PMID: 30590717 DOI: 10.1093/jas/sky484] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 12/24/2018] [Indexed: 01/31/2023] Open
Abstract
Study objectives were to determine the effects of chromium (Cr) propionate (Cr propionate 0.04%; 0.5 g/kg of feed to deliver 200 parts per billion Cr/d; KemTRACE Cr, Kemin Industries, Inc., Des Moines, IA) on growth performance, metabolism, and health biomarkers in heat-stressed and nutrient-restricted pigs. Crossbred barrows (n = 96; 105 ± 1 kg BW) were enlisted in an experiment conducted in two replicates, blocked by initial BW, and randomly assigned to one of six dietary-environmental treatments: (i) thermoneutral (TN) and fed ad libitum a control diet (TNCtl), (ii) TN and fed ad libitum a Cr supplemented diet (TNCr), (iii) TN and pair-fed a control diet (PFCtl), (iv) TN and pair-fed a Cr supplemented diet (PFCr), (v) heat stress (HS) and ad libitum fed a control diet (HSCtl), or (vi) HS and ad libitum fed a Cr supplemented diet (HSCr). The study consisted of three experimental periods (P). During P0 (5 d), all pigs were housed in TN conditions (21.3 ± 0.1 °C, 56.8 ± 0.3% relative humidity [RH]) and fed the control diet ad libitum. During P1 (5 d), pigs were fed their respective dietary treatments ad libitum and kept in TN conditions. During P2 (35 d), HSCtl and HSCr-treated pigs were fed ad libitum and exposed to progressive cyclical HS conditions (27 to 31 °C, 50 ± 0.3% RH), while TNCtl, TNCr, PFCtl, and PFCr pigs remained in TN conditions and were fed ad libitum or pair-fed to their respective HSCtl and HSCr counterparts to eliminate the confounding effects of dissimilar feed intake. Overall, HS pigs had increased (P < 0.01) rectal temperature, skin temperature, and respiration rate (0.3 °C, 3.8 °C, and 32 breaths per minute, respectively) relative to TN pigs. Overall, HS decreased ADFI and ADG (20 and 21%, respectively; P < 0.01) compared with TN controls. Final BW tended to be increased in HSCr (2.7 kg, P = 0.06) compared with HSCtl pigs. Similarly, ADG tended to be increased during P2 in HSCr relative to HSCtl-treatment (0.77 vs. 0.72 kg/d; P = 0.10). There were no effects of Cr on most production parameters, but ADFI tended to be increased in Cr relative to Ctl-fed pigs (3.19 vs. 3.09 kg/d; P = 0.08). No effects of Cr supplementation were detected on circulating glucose, insulin, NEFA, cholesterol, triglycerides, or lipopolysaccharide binding protein. However, blood neutrophils were increased in HSCr (37%; P < 0.01) relative to HSCtl pigs. In summary, these results suggest Cr supplementation may benefit growth performance during HS.
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Affiliation(s)
- Edith J Mayorga
- Department of Animal Science, Iowa State University, Ames, IA
| | - Sara K Kvidera
- Department of Animal Science, Iowa State University, Ames, IA
| | - Jacob T Seibert
- Department of Animal Science, Iowa State University, Ames, IA
| | - Erin A Horst
- Department of Animal Science, Iowa State University, Ames, IA
| | | | | | - Samantha Lei
- Department of Animal Science, Iowa State University, Ames, IA
| | - Jason W Ross
- Department of Animal Science, Iowa State University, Ames, IA.,Iowa Pork Industry Center, Ames, IA
| | - Colin D Johnson
- Department of Animal Science, Iowa State University, Ames, IA.,Iowa Pork Industry Center, Ames, IA
| | | | | | - Robert P Rhoads
- Department of Animal and Poultry Sciences, Virginia Tech, Blacksburg, VA
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8
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Johnson CD, Williamson N, Janssen-van Solingen G, Arbuckle R, Johnson C, Simpson S, Staab D, Dominguez-Munoz E, Levy P, Connett G, Lerch MM. Psychometric evaluation of a patient-reported outcome measure in pancreatic exocrine insufficiency (PEI). Pancreatology 2019; 19:182-190. [PMID: 30528109 DOI: 10.1016/j.pan.2018.11.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 08/30/2018] [Revised: 11/20/2018] [Accepted: 11/27/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Pancreatic exocrine insufficiency (PEI) is commonly caused by chronic pancreatitis (CP) or cystic fibrosis (CF). There are no PEI-specific patient-reported assessments of symptoms and impacts. The PEI Questionnaire (PEI-Q) was developed through qualitative research with PEI patients and expert clinical input. This study evaluated the psychometric properties of the PEI-Q. METHODS 162 PEI patients (CF = 71 and CP = 91), 62 diarrhoea-specific irritable bowel syndrome (IBS-D) patients and 60 healthy controls completed the 26-item PEI-Q and the Gastrointestinal Quality of Life Index (GIQLI) at baseline. PEI patients completed the measures again two weeks later to assess the test-retest reliability of the PEI-Q. Analyses supported item reduction and scoring algorithm development, followed by psychometric evaluation. RESULTS Over 90% of PEI patients completed at least 23 of the 26 items at baseline. Item responses and clinical relevance supported retention of 18 items. Factor analysis supported a three-factor solution (abdominal symptoms, bowel movements, impacts) with adequate model fit. PEI-Q scores had good internal consistency (Cronbach's alpha: 0.77-0.82) and test-retest reliability (ICC: 0.73-0.87). Correlations between PEI-Q and GIQLI supported convergent validity. Known-groups and receiver operating characteristic analyses demonstrated that PEI-Q scores discriminated (p < 0.001) between differing PEI severities, and PEI patients and controls. CONCLUSIONS The PEI-Q has good validity and reliability. Results indicate that the PEI-Q could be used to aid identification and diagnosis of PEI, assist in the management of patients already diagnosed with PEI, ensuring correct and optimum treatment as well as enhance patient-clinician communication.
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Affiliation(s)
- Colin D Johnson
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | | | - Rob Arbuckle
- Adelphi Values, Cheshire, England, United Kingdom
| | | | | | - Doris Staab
- Charité University Hospital, Berlin, Germany
| | | | - Phillippe Levy
- Université Denis Diderot-Paris VII Hôpital Beaujon, Clichy Cedex, France
| | - Gary Connett
- Southampton Children's Hospital, Hampshire, England, United Kingdom
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Nolte S, Liegl G, Petersen MA, Aaronson NK, Costantini A, Fayers PM, Groenvold M, Holzner B, Johnson CD, Kemmler G, Tomaszewski KA, Waldmann A, Young TE, Rose M. General population normative data for the EORTC QLQ-C30 health-related quality of life questionnaire based on 15,386 persons across 13 European countries, Canada and the Unites States. Eur J Cancer 2018; 107:153-163. [PMID: 30576971 DOI: 10.1016/j.ejca.2018.11.024] [Citation(s) in RCA: 237] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 11/10/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 health-related quality of life questionnaire is one of the most widely used cancer-specific health-related quality of life questionnaires worldwide. General population norm data can facilitate the interpretation of QLQ-C30 data obtained from cancer patients. This study aimed at systematically collecting norm data from the general population to develop European QLQ-C30 norm scores and to generate comparable norm data for individual countries in Europe and North America. METHODS We collected QLQ-C30 data from the general population across 11 European Union (EU) countries, Russia, Turkey, Canada and United States (n ≥ 1000/country). Representative samples were stratified by sex and age groups (18-39, 40-49, 50-59, 60-69 and ≥ 70 years). After applying weights based on the United Nations population distribution statistics, we calculated QLQ-C30 domain scores to generate a 'European QLQ-C30 Norm' based on the EU countries. Further, we calculated QLQ-C30 norm scores for all 15 individual countries. RESULTS A total of 15,386 respondents completed the online survey. For the EU sample, most QLQ-C30 domains showed differences by sex/age, with men scoring somewhat better health than women, while age effects varied across domains. Substantially larger differences were seen in inter-country comparisons, with Austrian and Dutch respondents reporting consistently better health compared with British and Polish respondents. CONCLUSIONS This study is the first to systematically collect EORTC QLQ-C30 general population norm data across Europe and North America applying a consistent data collection method across 15 countries. These new norm data facilitate valid intra-country as well as inter-country comparisons and QLQ-C30 score interpretation.
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Affiliation(s)
- S Nolte
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Burwood, VIC, Australia.
| | - G Liegl
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - M A Petersen
- Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - N K Aaronson
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - A Costantini
- Psycho-Oncology Unit, Sant'Andrea Hospital Sapienza, University of Rome, Rome, Italy
| | - P M Fayers
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - M Groenvold
- Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - B Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Innsbruck Medical University, Innsbruck, Austria
| | - C D Johnson
- University of Southampton, Southampton, United Kingdom
| | - G Kemmler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Innsbruck Medical University, Innsbruck, Austria
| | - K A Tomaszewski
- Health Outcomes Research Unit, Department of Gerontology, Geriatrics, and Social Work, Faculty of Education, Ignatianum Academy, Krakow, Poland
| | - A Waldmann
- Institute of Social Medicine and Epidemiology, University of Luebeck, Luebeck, Germany; Ministry for Health and Consumer Protection, Hamburg Cancer Registry, Hamburg, Germany
| | - T E Young
- East & North Hertfordshire NHS Trust Including Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom
| | - M Rose
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Quantitative Health Sciences, Outcomes Measurement Science, University of Massachusetts Medical School, Worcester, MA, USA
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10
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Sztankay M, Aaronson NK, Arraras JI, Basso U, Bumbasirevic U, Efficace F, Giesinger JM, Johnson CD, van Leeuwen M, Oberguggenberger AS, Sosnowski R, Young T, Holzner B. International phase IV validation study of an EORTC quality of life questionnaire for testicular cancer patients: the EORTC QLQ-TC26. BMC Cancer 2018; 18:1104. [PMID: 30419889 PMCID: PMC6233273 DOI: 10.1186/s12885-018-5036-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 03/21/2018] [Accepted: 09/04/2018] [Indexed: 12/30/2022] Open
Abstract
Background Given the high cure-rate for testicular cancer (TC) and the patients’ young age, comprehensive evaluation of health-related quality of life (HRQOL) is an important consideration in this patient population. The EORTC QLQ-TC26 questionnaire module has been developed to supplement the EORTC QLQ-C30 in assessing TC-specific HRQOL in clinical trials and routine clinical practice. This international, multicentre phase IV validation study evaluated the psychometric properties of the new module. Methods This international, multicentre phase IV validation study enrolled testicular cancer patients from seven European countries. Patients completed the EORTC quality of life core questionnaire EORTC QLQ-C30 and the QLQ-TC26 at two consecutive time points and a debriefing questionnaire regarding the QLQ-TC26 after baseline assessment. Psychometric evaluation included examination of the hypothesized module scale structure, internal consistency and test-retest reliability, known-groups validity, responsiveness to change over time and cross-cultural acceptability. Results Data from 313 patients (mean age 38.6, SD 9.5) were analysed. All items exhibited a high completion rate with less than 2.4% missing values except for the sexuality items (up to 8.8%). The confirmatory factor analysis supported the hypothesised scale structure of the QLQ-TC26. Test-retest reliability was good for 8 of 12 scales (intraclass correlation: R t1|t2 ranged from 0.71–0.91) and four scales did not meet the acceptable criteria. Internal consistency was good for all twelve scales (Cronbach alpha = 0.79–0.90), except Communication (alpha = 0.67) and Sexual Functioning (alpha = 0.62). The module was able to distinguish clearly between patients with differing clinical status. Responsiveness to change over time was acceptable. Conclusion The EORTC QLQ-TC26 is a valid, reliable and well-accepted condition-specific questionnaire, supplementing the EORTC QLQ-C30, for the assessment of testicular cancer patients’ HRQOL in clinical trials. Electronic supplementary material The online version of this article (10.1186/s12885-018-5036-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Monika Sztankay
- Medical University of Innsbruck, University Hospital Innsbruck, Psychiatry II, Innsbruck, Austria. .,Department of Psychiatry, Psychotherapy & Psychosomatics, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria.
| | - Neil K Aaronson
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Juan I Arraras
- Medical Oncology Department, Hospital of Navarre, Navarre, Spain
| | - Umberto Basso
- Medical Oncology 1, Istituto Oncologico Veneto (IOV) IRCCS, Padova, Italy
| | - Uros Bumbasirevic
- Clinic of Urology, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Johannes M Giesinger
- Medical University of Innsbruck, University Hospital Innsbruck, Psychiatry II, Innsbruck, Austria
| | - Colin D Johnson
- University Surgical Unit, University of Southampton, Southampton University Hospitals, Southampton, UK
| | - Marieke van Leeuwen
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Anne S Oberguggenberger
- Medical University of Innsbruck, University Hospital Innsbruck, Psychiatry II, Innsbruck, Austria
| | - Roman Sosnowski
- Urooncology Department, Maria Sklodowska Curie Memorial Cancer Hospital, Warsaw, Poland
| | - Teresa Young
- Jackson Macmillan Centre, East & North Hertfordshire NHS Trust including Mount Vernon Cancer Center, Northwood Middlesex, UK
| | - Bernhard Holzner
- Medical University of Innsbruck, University Hospital Innsbruck, Psychiatry II, Innsbruck, Austria
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11
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Samim M, Mungroop TH, AbuHilal M, Isfordink CJ, Molenaar QI, van der Poel MJ, Armstrong TA, Takhar AS, Pearce NW, Primrose JN, Harris S, Verkooijen HM, van Gulik TM, Hagendoorn J, Busch OR, Johnson CD, Besselink MG. Surgeons' assessment versus risk models for predicting complications of hepato-pancreato-biliary surgery (HPB-RISC): a multicenter prospective cohort study. HPB (Oxford) 2018; 20:809-814. [PMID: 29678364 DOI: 10.1016/j.hpb.2018.02.635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Received: 01/03/2018] [Revised: 02/17/2018] [Accepted: 02/24/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Several studies advise the use of risk models when counseling patients for hepato-pancreato-biliary (HPB) surgery, but studies comparing these models to the surgeons' assessment are lacking. The aim of this study was to assess whether risk prediction models outperform surgeons' assessment for the risk of complications in HPB surgery. METHODS This prospective study included adult patients scheduled for HPB surgery in three centers in the UK and the Netherlands. Primary outcome was the rate of postoperative major complications. Surgeons assessed the risk prior to surgery while blinded for the formal risk scores. Risk prediction models were retrieved via a systematic review and risk scores were calculated. For each model, discrimination and calibration were evaluated. RESULTS Overall, 349 patients were included. The rate of major complications was 27% and in-hospital mortality 3%. Surgeons' assessment resulted in an AUC of 0.64; 0.71 for liver and 0.56 for pancreas surgery (P = 0.020). The AUCs for nine existing risk prediction models ranged between 0.57 and 0.73 for liver surgery and between 0.51 and 0.57 for pancreas surgery. CONCLUSION In HPB surgery, existing risk prediction models do not outperform surgeons' assessment. Surgeons' assessment outperforms most risk prediction models for liver surgery although both have a poor predictive performance for pancreas surgery. REGISTRATION INFORMATION REC reference number (13/SC/0135); IRAS ID (119370). TRIALREGISTER.NL: NTR4649.
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Affiliation(s)
- Morsal Samim
- Department of Surgery, University Medical Center Utrecht, The Netherlands; Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, University of Amsterdam, The Netherlands; Department of Surgery, University Hospital Southampton NHS Trust Foundation, United Kingdom
| | - Timothy H Mungroop
- Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Mohammed AbuHilal
- Department of Surgery, University Hospital Southampton NHS Trust Foundation, United Kingdom
| | - Cas J Isfordink
- Department of Surgery, University Medical Center Utrecht, The Netherlands
| | - Quintus I Molenaar
- Department of Surgery, University Medical Center Utrecht, The Netherlands
| | - Marcel J van der Poel
- Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Thomas A Armstrong
- Department of Surgery, University Hospital Southampton NHS Trust Foundation, United Kingdom
| | - Arjun S Takhar
- Department of Surgery, University Hospital Southampton NHS Trust Foundation, United Kingdom
| | - Neil W Pearce
- Department of Surgery, University Hospital Southampton NHS Trust Foundation, United Kingdom
| | - John N Primrose
- Department of Surgery, University Hospital Southampton NHS Trust Foundation, United Kingdom
| | - Scott Harris
- Department of Epidemiology, University Hospital Southampton NHS Trust Foundation, United Kingdom
| | | | - Thomas M van Gulik
- Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Jeroen Hagendoorn
- Department of Surgery, University Medical Center Utrecht, The Netherlands
| | - Olivier R Busch
- Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Colin D Johnson
- Department of Surgery, University Hospital Southampton NHS Trust Foundation, United Kingdom
| | - Marc G Besselink
- Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, University of Amsterdam, The Netherlands; Department of Surgery, University Hospital Southampton NHS Trust Foundation, United Kingdom.
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van Leeuwen M, Husson O, Alberti P, Arraras JI, Chinot OL, Costantini A, Darlington AS, Dirven L, Eichler M, Hammerlid EB, Holzner B, Johnson CD, Kontogianni M, Kjær TK, Morag O, Nolte S, Nordin A, Pace A, Pinto M, Polz K, Ramage J, Reijneveld JC, Serpentini S, Tomaszewski KA, Vassiliou V, Verdonck-de Leeuw IM, Vistad I, Young TE, Aaronson NK, van de Poll-Franse LV. Understanding the quality of life (QOL) issues in survivors of cancer: towards the development of an EORTC QOL cancer survivorship questionnaire. Health Qual Life Outcomes 2018; 16:114. [PMID: 29866185 PMCID: PMC5987570 DOI: 10.1186/s12955-018-0920-0] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [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] [Received: 12/20/2017] [Accepted: 04/30/2018] [Indexed: 11/12/2022] Open
Abstract
BACKROUND The number of cancer survivors is growing steadily and increasingly, clinical trials are being designed to include long-term follow-up to assess not only survival, but also late effects and health-related quality of life (HRQOL). Therefore it is is essential to develop patient-reported outcome measures (PROMs) that capture the full range of issues relevant to disease-free cancer survivors. The objectives of this project are: 1) to develop a European Organisation for Research and Treatment of Cancer (EORTC) questionnaire that captures the full range of physical, mental and social HRQOL issues relevant to disease-free cancer survivors; and 2) to determine at which minimal time since completion of treatment the questionnaire should be used. METHODS We reviewed 134 publications on cancer survivorship and interviewed 117 disease-free cancer survivors with 11 different types of cancer across 14 countries in Europe to generate an exhaustive, provisional list of HRQOL issues relevant to cancer survivors. The resulting issue list, the EORTC core questionnaire (QLQ-C30), and site-specific questionnaire modules were completed by a second group of 458 survivors. RESULTS We identified 116 generic survivorship issues. These issues covered body image, cognitive functioning, health behaviors, negative and positive outlook, health distress, mental health, fatigue, sleep problems, physical functioning, pain, several physical symptoms, social functioning, and sexual problems. Patients rated most of the acute symptoms of cancer and its treatment (e.g. nausea) as no longer relevant approximately one year after completion of treatment. CONCLUSIONS Compared to existing cancer survivorship questionnaires, our findings underscore the relevance of assessing issues related to chronic physical side effects of treatment such as neuropathy and joint pain. We will further develop a core survivorship questionnaire and three site-specific modules for disease-free adult cancer survivors who are at least one year post-treatment.
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Affiliation(s)
- Marieke van Leeuwen
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Olga Husson
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paola Alberti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Milan Center for Neuroscience, Milan, Italy
| | | | - Olivier L Chinot
- Pôle Neurosciences Cliniques, Service de Neuro-Oncologie, Aix-Marseille Université, Marseille, France
| | - Anna Costantini
- Departmental Psychoncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Martin Eichler
- Division of Epidemiology and Health Services Research at Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz, Germany
| | - Eva B Hammerlid
- Department of Otolaryngology Head and Neck Surgery, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Bernhard Holzner
- Department of Psychiatry and Psychotheraphy, Division of Psychooncology, Innsbruck Medical University, Innsbruck, Austria
| | - Colin D Johnson
- University Surgical Unit, University Hospitals Southampton, Southampton, UK
| | - Meropi Kontogianni
- Department of Nutrition & Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Trille Kristina Kjær
- Unit of Survivorship Research, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Ofir Morag
- Oncology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Sandra Nolte
- Department of Psychosomatic Medicine Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andrew Nordin
- East Kent Gynaecological Oncology Centre, Margate, UK
| | - Andrea Pace
- Neuroncology Unit, National Cancer Institute Regina Elena, Rome, Italy
| | - Monica Pinto
- Rehabilitation Unit, Department of Supportive Care, Istituto Nazionale Tumori - IRCCS- Fondazione G. Pascale, Naples, Italy
| | - Katja Polz
- Evangelische Kliniken Gelsenkirchen, Gelsenkirchen, Germany
| | - John Ramage
- Department of Gastroenterology and Hepatology, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Jaap C Reijneveld
- Department of Neurology and Brain Tumor Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Samantha Serpentini
- Unit of Psychoncology - Breast Unit, Istituto Oncologico Veneto (IOV)-IRCCS, Padua, Italy
| | - Krzysztof A Tomaszewski
- Health Outcomes Research Unit, Department of Geriatrics, Gerontology, and Social Work, Faculty of Education, Ignatianum Academy, Krakow, Poland
| | - Vassilios Vassiliou
- Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology / Head & Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Ingvild Vistad
- Department of Gynecology and Obstetrics, Sorlandet Hospital Kristiansand, Kristiansand, Norway
| | - Teresa E Young
- Lynda Jackson Macmillan Centre, East & North Hertfordshire NHS Trust including Mount Vernon Cancer Centre, Northwood, UK
| | - Neil K Aaronson
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lonneke V van de Poll-Franse
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Comprehensive Cancer Centre South (CCCS), Eindhoven Cancer Registry, Eindhoven, The Netherlands
- Tilburg University, Tilburg, The Netherlands
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13
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Johnson CD. Book Review: Pathology of the Pancreas. J R Soc Med 2018. [DOI: 10.1177/014107688708001233] [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: 11/16/2022] Open
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Abstract
To date, there have been no clinical investigations of the usefulness of drains following colonic anastomosis in elective operations. We report a prospective study in which 49 patients were randomized to have a corrugated silastic drain (Portex) placed next to the colonic anastomosis. These patients were compared with a control group of 57 patients who had no drain. The two groups were similar in age, sex, diagnosis and site of anastomosis. There was no difference in outcome between the two groups. Anastomotic leakage occurred in six patients in each group. Wound infections were noted in 10 patients in each group. Two patients with a drain and one patient without a drain died from leakage at the anastomosis. This study provides no evidence to support the use of a corrugated drain after anastomosis of the colon.
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Abstract
We have studied the outcome of 140 general surgical procedures in 112 patients known or suspected to be infected with human immunodeficiency virus (HIV) or hepatitis B virus. Forty patients had antibodies to HIV. A wide range of surgical procedures was performed, with an overall complication rate of 5.7%. Wound infection, wound haematoma and one unexplained pyrexia were the only complications seen. Some anorectal wounds in patients with HIV antibodies were noted to heal extremely slowly, but the aggressive anorectal sepsis reported by others was not seen. The postoperative course after general surgical procedures was unremarkable in patients with HIV antibodies, and in those suspected of HIV infection, but because anorectal wounds were found to heal slowly, we recommend that anorectal surgery be conservative in patients with HIV antibodies.
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Affiliation(s)
- R Wakeman
- Professorial Surgical Unit, St Stephen's Hospital, London
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Affiliation(s)
- C D Johnson
- Department of Surgery, Westminster Hospital, London
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17
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Affiliation(s)
- S F Journeaux
- Academic Surgical Unit, St Stephens Hospital, London
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18
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Affiliation(s)
- N Davies
- University Surgical Unit, Royal South Hants Hospital, Southampton
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Schmidt H, Nordhausen T, Boese S, Vordermark D, Wheelwright S, Wienke A, Johnson CD. Factors Influencing Global Health Related Quality of Life in Elderly Cancer Patients: Results of a Secondary Data Analysis. Geriatrics (Basel) 2018; 3:E5. [PMID: 31011053 PMCID: PMC6371108 DOI: 10.3390/geriatrics3010005] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 12/03/2022] Open
Abstract
Cancer treatment for elderly patients is often complicated by poor physical condition, impaired functioning and comorbidities. Patient reported health related quality of life (HRQOL) can contribute to decisions about treatment goals and supportive therapy. Knowledge about factors influencing HRQOL is therefore needed for the development of supportive measures and care pathways. An exploratory secondary data analysis on 518 assessments of the European Organisation for Research and Treatment of Cancer (EORTC) core questionnaire (EORTC QLQ-C30) and the elderly module (EORTC QLQ-ELD14) was performed to identify factors predictive for global HRQOL. Preliminary simple and multivariable regression analyses were conducted resulting in a final model comprising sociodemographic and disease specific variables and scales of the QLQ-C30 and QLQ-ELD14. Age, sex and disease related variables explained only part of the variance of global HRQOL (adjusted R2 = 0.203). In the final model (adjusted R2 = 0.504) fatigue, social function, burden of illness and joint stiffness showed possible influence on global HRQOL. Fatigue, social function and burden of illness seem to have the largest impact on global HRQOL of elderly cancer patients. Further prospective studies should examine these domains. Actionable symptoms should be given special attention to initiate targeted supportive measures aiming to maximize HRQOL of older cancer patients.
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Affiliation(s)
- Heike Schmidt
- Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - Thomas Nordhausen
- Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - Stephanie Boese
- Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - Dirk Vordermark
- Department of Radiation Oncology, University Hospital Halle (Saale), Medical Faculty, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40 06120 Halle (Saale), Germany.
| | - Sally Wheelwright
- Health Sciences, University of Southampton, SO17 1BJ Southampton, UK.
| | - Andreas Wienke
- Institute for Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - Colin D Johnson
- Cancer Sciences, University of Southampton, SO17 1BJ Southampton, UK.
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Ziwary SR, Samad D, Johnson CD, Edwards RT. Impact of place of residence on place of death in Wales: an observational study. BMC Palliat Care 2017; 16:72. [PMID: 29233123 PMCID: PMC5727930 DOI: 10.1186/s12904-017-0261-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 12/08/2016] [Accepted: 12/05/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Previous research in England showed that deprivation level of a person's place of residence affects the place of death and quality of care received at the end of life. People dying in their preferred place of death has also been shown to act as an indication for high quality of end of life care services and social equality. This study expands on current research to explore the effects of deprivation and place of residence on health related choices and place of death in Wales. METHODS We used ten years combined mortality statistics from 2005 to 2014 and Welsh Index of Multiple Deprivation rankings for each lower super output area. After accounting for the population's age, the number of deaths in Hospital, Hospice, Home, Care Home, Psychiatric Units, and Elsewhere were compared across deprivation quintiles. RESULTS Distribution of place of death was found to be concentrated in three places - hospital (60%), home (21%) and care home (13%). Results from this study shows a high number of hospital deaths, especially for more deprived areas, despite being the least preferred place of death. CONCLUSION This is the first Welsh study investigating place of death in relation to deprivation, which could be of major importance to academics, end of life care providers and policy makers interested in to reduce health care inequality in Wales.
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Affiliation(s)
- S R Ziwary
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Ardudwy Building, Bangor, LL57 2PZ, UK.
| | - D Samad
- University Malaya, Kuala Lumpur, Malaysia
| | - C D Johnson
- Speciality registrar in Public Health, Public Health Wales, Mold, UK
| | - R T Edwards
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Ardudwy Building, Bangor, LL57 2PZ, UK
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Koller M, Hjermstad MJ, Tomaszewski KA, Tomaszewska IM, Hornslien K, Harle A, Arraras JI, Morag O, Pompili C, Ioannidis G, Georgiou M, Navarra C, Chie WC, Johnson CD, Himpel A, Schulz C, Bohrer T, Janssens A, Kuliś D, Bottomley A. An international study to revise the EORTC questionnaire for assessing quality of life in lung cancer patients. Ann Oncol 2017; 28:2874-2881. [PMID: 28945875 DOI: 10.1093/annonc/mdx453] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The European Organization for Research and Treatment of Cancer (EORTC) QLQ-LC13 was the first module to be used in conjunction with the core questionnaire, the QLQ-C30. Since the publication of the LC13 in 1994, major advances have occurred in the treatment of lung cancer. Given this, an update of the EORTC QLQ-LC13 was undertaken. METHODS The study followed phases I to III of the EORTC Module Development Guidelines. Phase I generated relevant quality-of-life issues using a mix of sources including the involvement of 108 lung cancer patients. Phase II transformed issues into questionnaire items. In an international multicenter study (phase III), patients completed both the EORTC QLQ-C30 and the 48-item provisional lung cancer module generated in phases I and II. Patients rated each of the items regarding relevance, comprehensibility, and acceptance. Patient ratings were assessed against a set of prespecified statistical criteria. Descriptive statistics and basic psychometric analyses were carried out. RESULTS The phase III study enrolled 200 patients with histologically confirmed lung cancer from 12 centers in nine countries (Cyprus, Germany, Italy, Israel, Spain, Norway, Poland, Taiwan, and the UK). Mean age was 64 years (39 - 91), 59% of the patients were male, 82% had non-small-cell lung cancer, and 56% were treated with palliative intent. Twenty-nine of the 48 questions met the criteria for inclusion. CONCLUSIONS The resulting module with 29 questions, thus currently named EORTC QLQ-LC29, retained 12 of the 13 original items, supplemented with 17 items that primarily assess treatment side-effects of traditional and newer therapies.
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Affiliation(s)
- M Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany.
| | - M J Hjermstad
- Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, and European Palliative Care Research Center (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology and St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - K A Tomaszewski
- Health Outcomes Research Unit, Faculty of Education, Ignatianum Academy, Krakow, Poland
| | - I M Tomaszewska
- Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | - K Hornslien
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - A Harle
- Poole Hospital NHS Foundation Trust, and The Christie NHS Foundation Trust, Manchester, UK
| | - J I Arraras
- Oncology Departments, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - O Morag
- Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - C Pompili
- St.James's University Hospital, Leeds, UK
| | - G Ioannidis
- Oncology Department, Nicosia General Hospital Cyprus, Nicosia, Cyprus
| | - M Georgiou
- Bank of Cyprus Oncology Center, Nicosia, Cyprus
| | - C Navarra
- Azienda Ospedaliera Sant'Andrea, Rome, Italy
| | - W-C Chie
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei; Department of Public Health, College of Public Health, National Taiwan University, Taipei, Republic of Taiwan
| | - C D Johnson
- Surgical Unit, University of Southampton, Southampton, UK
| | - A Himpel
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - C Schulz
- Department of Internal Medicine, University Hospital Regensburg, Regensburg
| | - T Bohrer
- Department of Thoracic Surgery, Bamberg, Germany
| | - A Janssens
- Thoracic Oncology, MOCA, Antwerp University Hospital, Edegem
| | - D Kuliś
- Quality of Life Department, EORTC, Brussels, Belgium
| | - A Bottomley
- Quality of Life Department, EORTC, Brussels, Belgium
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22
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Wheelwright SJ, Hopkinson JB, Darlington AS, Fitzsimmons DF, Fayers P, Balstad TR, Bredart A, Hammerlid E, Kaasa S, Nicolatou-Galitis O, Pinto M, Schmidt H, Solheim TS, Strasser F, Tomaszewska IM, Johnson CD. Development of the EORTC QLQ-CAX24, A Questionnaire for Cancer Patients With Cachexia. J Pain Symptom Manage 2017; 53:232-242. [PMID: 27810567 DOI: 10.1016/j.jpainsymman.2016.09.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/26/2016] [Accepted: 09/06/2016] [Indexed: 12/12/2022]
Abstract
CONTEXT Cachexia is commonly found in cancer patients and has profound consequences; yet there is only one questionnaire that examines the patient's perspective. OBJECTIVE To report a rigorously developed module for patient self-reported impact of cancer cachexia. METHODS Module development followed published guidelines. Patients from across the cancer cachexia trajectory were included. In Phase 1, health-related quality of life (HRQOL) issues were generated from a literature review and interviews with patients in four countries. The issues were revised based on patient and health care professional (HCP) input. In Phase 2, questionnaire items were formulated and translated into the languages required for Phase 3, the pilot phase, in which patients from eight countries scored the relevance and importance of each item, and provided qualitative feedback. RESULTS A total of 39 patients and 12 HCPs took part in Phase 1. The literature review produced 68 HRQOL issues, with 22 new issues arising from the patient interviews. After patient and HCP input, 44 issues were formulated into questionnaire items in Phase 2. One hundred ten patients took part in Phase 3. One item was reworded, and 20 items were deleted as a consequence of patient feedback. CONCLUSIONS The QLQ-CAX24 is a cancer cachexia-specific questionnaire, comprising 24 items, for HRQOL assessment in clinical trials and practice. It contains five multi-item scales (food aversion, eating and weight-loss worry, eating difficulties, loss of control, and physical decline) and four single items.
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Affiliation(s)
| | - Jane B Hopkinson
- Cardiff School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | | | | | - Peter Fayers
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK; European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Trude R Balstad
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Bredart
- Institut Curie, Paris, France; University Paris Descartes, Paris, France
| | - Eva Hammerlid
- Department of Otolaryngology Head & Neck Surgery, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | | | - Monica Pinto
- Istituto Nazionale Tumori "Fondazione Giovanni Pascale" - IRCCS, Naples, Italy
| | - Heike Schmidt
- Institute of Health and Nursing Sciences, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Tora S Solheim
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | | | - Iwona M Tomaszewska
- Department of Medical Education, Jagiellonian University Medical College, Cracow, Poland
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23
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Kaupp-Roberts SD, Yadegarfar G, Friend E, O'Donnell CM, Valle JW, Byrne C, Bahar I, Finch-Jones M, Gillmore R, Johnson CD, Pereira SP, Wiggers JK, Pinto M, Al-Sarireh B, Ramage JK. Validation of the EORTC QLQ-BIL21 questionnaire for measuring quality of life in patients with cholangiocarcinoma and cancer of the gallbladder. Br J Cancer 2016; 115:1032-1038. [PMID: 27673364 PMCID: PMC5117782 DOI: 10.1038/bjc.2016.284] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 07/10/2016] [Accepted: 08/15/2016] [Indexed: 01/04/2023] Open
Abstract
Background: There is no specific quality of life (QoL) measurement tool to quantify QoL in patients with biliary tract cancer. Quality of life measurement is an increasingly crucial trial end point and is now being incorporated into clinical practice. Methods: This International Multicentre Phase IV Validation Study assessed the QLQ-BIL21 module in 172 patients with cholangiocarcinoma and 91 patients with cancer of the gallbladder. Patients completed the questionnaire at baseline pretherapy and subsequently at 2 months. Following this, the psychometric properties of reliability, validity, scale structure and responsiveness to change were analysed. Results: Analysis of the QLQ-BIL21 scales showed appropriate reliability with Cronbach's α-coefficients >0.70 for all scales overall. Intraclass correlations exceeded 0.80 for all scales. Convergent validity >0.40 was demonstrated for all items within scales, and discriminant validity was confirmed with values <0.70 for all scales compared with each other. Scale scores changed in accordance with Karnofsky performance status and in response to clinical change. Conclusions: The QLQ-BIL21 is a valid tool for the assessment of QoL in patients with cholangiocarcinoma and cancer of the gallbladder.
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Affiliation(s)
- S D Kaupp-Roberts
- Department of Gastroenterology and Hepatology, Hampshire Hospitals NHS Foundation Trust, Aldermaston Road, Basingstoke RG24 9NA, UK.,Faculty of Humanities and Social Sciences, University of Winchester, Sparkford Road, Winchester SO22 4NR, UK
| | - G Yadegarfar
- School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - E Friend
- Department of Gastroenterology and Hepatology, Hampshire Hospitals NHS Foundation Trust, Aldermaston Road, Basingstoke RG24 9NA, UK
| | - C M O'Donnell
- Department of Gastroenterology and Hepatology, Hampshire Hospitals NHS Foundation Trust, Aldermaston Road, Basingstoke RG24 9NA, UK
| | - J W Valle
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester M20 4BX, UK
| | - C Byrne
- Hepatobiliary Cancer Services, Aintree University Hospital, Longmoor Lane, Liverpool, Merseyside L9 7AL, UK
| | - I Bahar
- Cachar Cancer Hospital and Research Centre, Meherpur, Silchar, Assam, India
| | - M Finch-Jones
- Department of Surgery, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - R Gillmore
- Department of Medical Oncology, Royal Free Hospital, Pond Street, London NW3 2QG, UK
| | - C D Johnson
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - S P Pereira
- UCL Institute for Liver and Digestive Health, Royal Free Hospital Campus, London NW3 2QG, UK
| | - J K Wiggers
- Academic Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, Netherlands
| | - M Pinto
- National Cancer Institute and G. Pascale Foundation of Naples, Naples, Italy
| | - B Al-Sarireh
- Morriston Hospital, ABM University Health Board, Heol Maes Eglwys, Morriston, Swansea SA6 6NL, UK
| | - J K Ramage
- Department of Gastroenterology and Hepatology, Hampshire Hospitals NHS Foundation Trust, Aldermaston Road, Basingstoke RG24 9NA, UK.,Institute of Liver Studies, King's College Hospital, Denmark Hill, London SE5 9RS, UK
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24
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Wheelwright S, Hopkinson JB, Darlington AS, Fitzsimmons D, Johnson CD. Development of a psychoeducational workshop for patients with cancer cachexia and their carers. BMJ Support Palliat Care 2016. [DOI: 10.1136/bmjspcare-2016-001204.50] [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: 11/03/2022]
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25
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Quinn JG, Tansey EA, Johnson CD, Roe SM, Montgomery LEA. Blood: tests used to assess the physiological and immunological properties of blood. Adv Physiol Educ 2016; 40:165-175. [PMID: 27068991 DOI: 10.1152/advan.00079.2015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 05/28/2015] [Accepted: 01/20/2016] [Indexed: 06/05/2023]
Abstract
The properties of blood and the relative ease of access to which it can be retrieved make it an ideal source to gauge different aspects of homeostasis within an individual, form an accurate diagnosis, and formulate an appropriate treatment regime. Tests used to determine blood parameters such as the erythrocyte sedimentation rate, hemoglobin concentration, hematocrit, bleeding and clotting times, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, mean cell volume, and determination of blood groups are routinely used clinically, and deviations outside the normal range can indicate a range of conditions such as anemia, pregnancy, dehydration, overhydration, infectious disease, cancer, thyroid disease, and autoimmune conditions, to mention a few. As these tests can be performed relatively inexpensively and do not require high levels of technical expertise, they are ideally suited for use in the teaching laboratory, enabling undergraduate students to link theory to practice. The practicals described here permit students to examine their own blood and that of their peers and compare these with clinically accepted normal ranges. At the end of the practicals, students are required to answer a number of questions about their findings and to link abnormal values to possible pathological conditions by answering a series of questions based on their findings.
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Affiliation(s)
- J G Quinn
- Centre for Biomedical Sciences Education, School of Medicine Dentistry and Biomedical Science, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - E A Tansey
- Centre for Biomedical Sciences Education, School of Medicine Dentistry and Biomedical Science, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - C D Johnson
- Centre for Biomedical Sciences Education, School of Medicine Dentistry and Biomedical Science, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - S M Roe
- Centre for Biomedical Sciences Education, School of Medicine Dentistry and Biomedical Science, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - L E A Montgomery
- Centre for Biomedical Sciences Education, School of Medicine Dentistry and Biomedical Science, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
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26
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Day-Lewis FD, Johnson CD, Slater LD, Robinson JL, Williams JH, Boyden CL, Werkema D, Lane JW. A Fractured Rock Geophysical Toolbox Method Selection Tool. Ground Water 2016; 54:315-6. [PMID: 26743439 DOI: 10.1111/gwat.12397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- F D Day-Lewis
- Office of Groundwater, Branch of Geophysics, U.S. Geological Survey, Storrs, CT 06269
| | - C D Johnson
- Office of Groundwater, Branch of Geophysics, U.S. Geological Survey, Storrs, CT 06269
| | - L D Slater
- Department of Earth & Environmental Sciences, Rutgers University Newark, Newark, NJ 07102
| | - J L Robinson
- Department of Earth & Environmental Sciences, Rutgers University Newark, Newark, NJ 07102
| | - J H Williams
- New York Water Science Center, U.S. Geological Survey, Troy, NY 12180
| | - C L Boyden
- Office of Groundwater, Branch of Geophysics, U.S. Geological Survey, Storrs, CT 06269
| | - D Werkema
- Environmental Sciences Division, Characterization and Monitoring Branch, U.S. Environmental Protection Agency, Office of Research and Development, Las Vegas, NV 89119
| | - J W Lane
- Office of Groundwater, Branch of Geophysics, U.S. Geological Survey, Storrs, CT 06269
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27
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Kleeff J, Korc M, Apte M, La Vecchia C, Johnson CD, Biankin AV, Neale RE, Tempero M, Tuveson DA, Hruban RH, Neoptolemos JP. Pancreatic cancer. Nat Rev Dis Primers 2016; 2:16022. [PMID: 27158978 DOI: 10.1038/nrdp.2016.22] [Citation(s) in RCA: 1125] [Impact Index Per Article: 140.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pancreatic cancer is a major cause of cancer-associated mortality, with a dismal overall prognosis that has remained virtually unchanged for many decades. Currently, prevention or early diagnosis at a curable stage is exceedingly difficult; patients rarely exhibit symptoms and tumours do not display sensitive and specific markers to aid detection. Pancreatic cancers also have few prevalent genetic mutations; the most commonly mutated genes are KRAS, CDKN2A (encoding p16), TP53 and SMAD4 - none of which are currently druggable. Indeed, therapeutic options are limited and progress in drug development is impeded because most pancreatic cancers are complex at the genomic, epigenetic and metabolic levels, with multiple activated pathways and crosstalk evident. Furthermore, the multilayered interplay between neoplastic and stromal cells in the tumour microenvironment challenges medical treatment. Fewer than 20% of patients have surgically resectable disease; however, neoadjuvant therapies might shift tumours towards resectability. Although newer drug combinations and multimodal regimens in this setting, as well as the adjuvant setting, appreciably extend survival, ∼80% of patients will relapse after surgery and ultimately die of their disease. Thus, consideration of quality of life and overall survival is important. In this Primer, we summarize the current understanding of the salient pathophysiological, molecular, translational and clinical aspects of this disease. In addition, we present an outline of potential future directions for pancreatic cancer research and patient management.
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Affiliation(s)
- Jorg Kleeff
- NIHR Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Duncan Building, Daulby Street, Liverpool L69 3GA, UK
- Department of General, Visceral and Pediatric Surgery, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Murray Korc
- Departments of Medicine, and Biochemistry and Molecular Biology, Indiana University School of Medicine, the Melvin and Bren Simon Cancer Center, and the Pancreatic Cancer Signature Center, Indianapolis, Indiana, USA
| | - Minoti Apte
- SWS Clinical School, University of New South Wales, and Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Colin D Johnson
- University Surgical Unit, University Hospital Southampton, Southampton, UK
| | - Andrew V Biankin
- Institute of Cancer Sciences, Wolfson Wohl Cancer Research Centre, University of Glasgow, Garscube Estate, Bearsden, Glasgow, Scotland, UK
| | - Rachel E Neale
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Margaret Tempero
- UCSF Pancreas Center, University of California San Francisco - Mission Bay Campus/Mission Hall, San Francisco, California, USA
| | - David A Tuveson
- Cold Spring Harbor Laboratory, Cold Spring Harbor, New York, New York, USA
| | - Ralph H Hruban
- The Sol Goldman Pancreatic Cancer Research Center, Departments of Pathology and Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John P Neoptolemos
- NIHR Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Duncan Building, Daulby Street, Liverpool L69 3GA, UK
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28
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Takaori K, Bassi C, Biankin A, Brunner TB, Cataldo I, Campbell F, Cunningham D, Falconi M, Frampton AE, Furuse J, Giovannini M, Jackson R, Nakamura A, Nealon W, Neoptolemos JP, Real FX, Scarpa A, Sclafani F, Windsor JA, Yamaguchi K, Wolfgang C, Johnson CD. International Association of Pancreatology (IAP)/European Pancreatic Club (EPC) consensus review of guidelines for the treatment of pancreatic cancer. Pancreatology 2016; 16:14-27. [PMID: 26699808 DOI: 10.1016/j.pan.2015.10.013] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/25/2015] [Accepted: 10/28/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pancreatic cancer is one of the most devastating diseases with an extremely high mortality. Medical organizations and scientific societies have published a number of guidelines to address active treatment of pancreatic cancer. The aim of this consensus review was to identify where there is agreement or disagreement among the existing guidelines and to help define the gaps for future studies. METHODS A panel of expert pancreatologists gathered at the 46th European Pancreatic Club Meeting combined with the 18th International Association of Pancreatology Meeting and collaborated on critical reviews of eight English language guidelines for the clinical management of pancreatic cancer. Clinical questions (CQs) of interest were proposed by specialists in each of nine areas. The recommendations for the CQs in existing guidelines, as well as the evidence on which these were based, were reviewed and compared. The evidence was graded as sufficient, mediocre or poor/absent. RESULTS Only 4 of the 36 CQs, had sufficient evidence for agreement. There was also agreement in five additional CQs despite the lack of sufficient evidence. In 22 CQs, there was disagreement regardless of the presence or absence of evidence. There were five CQs that were not addressed adequately by existing guidelines. CONCLUSION The existing guidelines provide both evidence- and consensus-based recommendations. There is also considerable disagreement about the recommendations in part due to the lack of high level evidence. Improving the clinical management of patients with pancreatic cancer, will require continuing efforts to undertake research that will provide sufficient evidence to allow agreement.
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Affiliation(s)
- Kyoichi Takaori
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Claudio Bassi
- Department of Surgery and Oncology, Pancreas Institute, University of Verona, Verona, Italy
| | - Andrew Biankin
- Academic Unit of Surgery, University of Glasgow, Glasgow, United Kingdom
| | - Thomas B Brunner
- Department of Radiation Oncology, University Hospitals Freiburg, Germany
| | - Ivana Cataldo
- Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | - Fiona Campbell
- Department of Pathology, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - David Cunningham
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Massimo Falconi
- Pancreatic Surgery Unit, Università Vita e Salute, Milano, Italy
| | - Adam E Frampton
- HPB Surgical Unit, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital, London, United Kingdom
| | - Junji Furuse
- Department of Medical Oncology, Kyorin University School of Medicine, Tokyo, Japan
| | - Marc Giovannini
- Endoscopic Unit, Paoli-Calmettes Institute, Marseille, France
| | - Richard Jackson
- NIHR Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Akira Nakamura
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Hospital, Kyoto, Japan
| | - William Nealon
- Division of General Surgery, Yale University, New Haven, CT, United States of America
| | - John P Neoptolemos
- NIHR Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Francisco X Real
- Epithelial Carcinogenesis Group, CNIO-Spanish National Cancer Research Centre, Madrid, Spain
| | - Aldo Scarpa
- Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | - Francesco Sclafani
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - John A Windsor
- Department of Surgery, University of Auckland, HBP/Upper GI Unit, Auckland City Hospital, Auckland, New Zealand
| | - Koji Yamaguchi
- Department of Advanced Treatment of Pancreatic Disease, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Christopher Wolfgang
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, United States of America
| | - Colin D Johnson
- University Surgical Unit, Southampton General Hospital, Southampton, United Kingdom
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29
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Sodergren SC, Vassiliou V, Dennis K, Tomaszewski KA, Gilbert A, Glynne-Jones R, Nugent K, Sebag-Montefiore D, Johnson CD. Systematic review of the quality of life issues associated with anal cancer and its treatment with radiochemotherapy. Support Care Cancer 2015; 23:3613-23. [PMID: 26289529 DOI: 10.1007/s00520-015-2879-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [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: 02/19/2015] [Accepted: 07/29/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Radiochemotherapy is the standard of care for the treatment of anal carcinoma achieving good loco-regional control and sphincter preservation. This approach is however associated with acute and late toxicities including haematological, skin, bowel function and genito-urinary complications. This paper systematically reviews studies addressing the quality of life (QoL) implications of anal cancer and radiochemotherapy. The paper also evaluates how QoL is assessed in anal cancer. METHODS Medline, EMBASE, CINAHL, PsycInfo, Web of Science and the Cochrane Library were searched for publications (1996-2014) reporting the effects on patients of anal cancer and radiochemotherapy. RESULTS Of the 152 papers reporting treatment-related effects on patients, only 11 provided a formal assessment of QoL. In the absence of an anal cancer-specific measure, QoL was assessed using generic cancer instruments such as the core EORTC quality of life questionnaire (EORTC QLQ-C30) or colorectal cancer tools such as the EORTC QLQ-CR29. Bowel function, particularly diarrhoea, and sexual problems were the most commonly reported QoL concerns. The review of QoL issues of anal cancer patients treated with radiochemotherapy is limited by the QoL assessment measures used. It is argued that certain treatment-related toxicities, for example skin-induced radiation problems, are overlooked or inadequately represented in existing measures. CONCLUSIONS This review emphasises the need to develop an anal cancer-specific QoL measure and to incorporate QoL as an outcome of future trials in anal cancer. The results of this review are informative to clinicians and patients in terms of treatment decision-making.
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Affiliation(s)
| | | | - Kristopher Dennis
- Division of Radiation Oncology, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Alexandra Gilbert
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | | | - Karen Nugent
- Cancer Sciences, University of Southampton, Southampton, SO16 6YD, UK
| | | | - Colin D Johnson
- Cancer Sciences, University of Southampton, Southampton, SO16 6YD, UK
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30
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Koller M, Warncke S, Hjermstad MJ, Arraras J, Pompili C, Harle A, Johnson CD, Chie WC, Schulz C, Zeman F, van Meerbeeck JP, Kuliś D, Bottomley A. Use of the lung cancer-specific Quality of Life Questionnaire EORTC QLQ-LC13 in clinical trials: A systematic review of the literature 20 years after its development. Cancer 2015; 121:4300-23. [PMID: 26451520 DOI: 10.1002/cncr.29682] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [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: 04/14/2015] [Revised: 06/24/2015] [Accepted: 07/02/2015] [Indexed: 12/19/2022]
Abstract
The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) covers 13 typical symptoms of lung cancer patients and was the first module developed in conjunction with the EORTC core quality-of-life (QL) questionnaire. This review investigates how the module has been used and reported in cancer clinical trials in the 20 years since its publication. Thirty-six databases were searched with a prespecified algorithm. This search plus an additional hand search generated 770 hits, 240 of which were clinical studies. Two raters extracted data using a coding scheme. Analyses focused on the randomized controlled trials (RCTs). Of the 240 clinical studies that were identified using the LC13, 109 (45%) were RCTs. More than half of the RCTs were phase 3 trials (n = 58). Twenty RCTs considered QL as the primary endpoint, and 68 considered it as a secondary endpoint. QL results were addressed in the results section of the article (n = 89) or in the abstract (n = 92); and, in half of the articles, QL results were presented in the form of tables (n = 53) or figures (n = 43). Furthermore, QL results had an impact on the evaluation of the therapy that could be clearly demonstrated in the 47 RCTs that yielded QL differences between treatment and control groups. The EORTC QLQ-LC13 fulfilled its mission to be used as a standard instrument in lung cancer clinical trials. An update of the LC13 is underway to keep up with new therapeutic trends and to ensure optimized and relevant QL assessment in future trials.
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Affiliation(s)
- Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Sophie Warncke
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Marianne J Hjermstad
- Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital and European Palliative Care Research Centre, Department of Cancer and Molecular Medicine, Norwegian University of Science and Technology, Norway
| | - Juan Arraras
- Oncology Departments, Navarra Hospital Complex, Pamplona, Spain
| | - Cecilia Pompili
- Division of Thoracic Surgery, St. James's University Hospital, Leeds, United Kingdom
| | - Amelie Harle
- The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Colin D Johnson
- University Surgical Unit, University Hospital Southampton, Hampshire, United Kingdom
| | - Wei-Chu Chie
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Christian Schulz
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
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Gareen IF, Siewert B, Vanness DJ, Herman B, Johnson CD, Gatsonis C. Patient willingness for repeat screening and preference for CT colonography and optical colonoscopy in ACRIN 6664: the National CT Colonography trial. Patient Prefer Adherence 2015; 9:1043-51. [PMID: 26229451 PMCID: PMC4516344 DOI: 10.2147/ppa.s81901] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Current American Cancer Society recommendations for colon cancer screening include optical colonoscopy every 10 years or computed tomography colonography (CTC) every 5 years. Bowel preparation (BP) is currently required for both screening modalities. PURPOSE To compare ACRIN 6664: the National CT Colonography Trial (NCTCT) participant experiences with CTC and optical colonoscopy (OC), procedure preference, and willingness to return for each procedure. MATERIALS AND METHODS Participants from fifteen NCTCT sites, who underwent CTC followed by OC under sedation, were invited to complete questionnaires 2 weeks postexam, asking about procedure preference, physical discomfort, and embarrassment experienced and whether that discomfort and embarrassment was better or worse than expected during BP, CTC, and OC, as well as willingness to return for repeat CTC and OC at different time intervals. RESULTS A total of 2,310 of 2,600 patients (89%) returned their questionnaires. Of patients reporting a preference, 1,058 (46.6%) preferred CTC, 569 (25.0%) preferred OC, and 626 (27.6%) reported no preference. Participant-reported discomfort worse than expected differed significantly between CTC (32.9%) and OC (5.0%) (P<0.001). About 79.3% were willing to be screened again with CTC in 5 years, and 96.6% with OC in 10 years. Discomfort and embarrassment worse than expected with OC were associated with increased intention to adhere with CTC in the future. Conversely, embarrassment experienced during CTC and discomfort worse than expected on CTC were associated with increased intention to adhere with OC in the future. CONCLUSION While a larger proportion of participants indicated that they preferred CTC to OC, willingness to undergo repeat CTC compared to OC was limited by unanticipated exam discomfort and embarrassment and CTC's shorter screening interval.
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Affiliation(s)
- Ilana F Gareen
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Bettina Siewert
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - David J Vanness
- Population Health Sciences, University of Wisconsin, Madison, WI, USA
| | - Benjamin Herman
- Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | | | - Constantine Gatsonis
- Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
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Jupp J, Mansour S, Johnson CD, Sanderson J, Fine D, Gadola S. T-cell populations in chronic pancreatitis. Pancreatology 2015; 15:311-2. [PMID: 26003853 DOI: 10.1016/j.pan.2015.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 04/22/2015] [Indexed: 12/11/2022]
Affiliation(s)
- James Jupp
- University of Southampton, Faculty of Medicine, Clinical & Experimental Sciences, Southampton, UK; University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Salah Mansour
- University of Southampton, Faculty of Medicine, Clinical & Experimental Sciences, Southampton, UK
| | - Colin D Johnson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK; University Surgical Unit, University of Southampton, Southampton, UK
| | - Joseph Sanderson
- University of Southampton, Faculty of Medicine, Clinical & Experimental Sciences, Southampton, UK
| | - David Fine
- University of Southampton, Faculty of Medicine, Clinical & Experimental Sciences, Southampton, UK; University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stephan Gadola
- University of Southampton, Faculty of Medicine, Clinical & Experimental Sciences, Southampton, UK; University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Windsor JA, Johnson CD, Petrov MS, Layer P, Garg PK, Papachristou GI. Classifying the severity of acute pancreatitis: towards a way forward. Pancreatology 2015; 15:101-4. [PMID: 25683639 DOI: 10.1016/j.pan.2015.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/20/2015] [Accepted: 01/21/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND The recent development of two different severity classifications for acute pancreatitis has appropriately raised questions about which should be used. The aim of this paper is to review the two new severity classifications, outline their differences, review validation studies, and identify gaps in knowledge to suggest a way forward. METHODS A literature review was performed to identify the purposes and differences between the classifications. Validation studies and those comparing the two different classifications were also reviewed. RESULTS The Revised Atlanta Classification (RAC) and the Determinants Based Classification (DBC) both rely on assessment of local and systemic factors. The differences between the classifications provides opportunities for further research to improve the accuracy and utility of severity classification. This includes understanding how best to tailor severity classification to setting (e.g. secondary or tertiary hospital) and purpose (e.g. clinical management or research). A key difference is that the RAC does not consider infected pancreatic necrosis an indicator of severe disease. There is also the need to develop methods for the accurate non-invasive diagnosis of infected necrosis and evaluation of the characteristics of organ dysfunction in relation to severity and outcome. CONCLUSION Further improvement in severity classification is possible and research priorities have been identified. For now, the decision as to which classification to use should be on the basis of setting, validity, accuracy, and ease of use.
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Affiliation(s)
- J A Windsor
- Department of Surgery, University of Auckland, New Zealand.
| | - C D Johnson
- Department of Surgery, University of Auckland, New Zealand
| | - M S Petrov
- Department of Surgery, University of Auckland, New Zealand
| | - P Layer
- Department of Surgery, University of Auckland, New Zealand
| | - P K Garg
- Department of Surgery, University of Auckland, New Zealand
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Affiliation(s)
- C D Johnson
- University Surgery, University Hospital Southampton, SO16 6YD, UK
| | - M G Besselink
- Dutch Pancreatitis Study Group, Academic Medical Center Amsterdam, Netherlands
| | - R Carter
- West of Scotland Pancreatic Unit, Glasgow Royal infirmary, Glasgow, UK
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Bakker OJ, van Brunschot S, Farre A, Johnson CD, Kalfarentzos F, Louie BE, Oláh A, O'Keefe SJ, Petrov MS, Powell JJ, Besselink MG, van Santvoort HC, Rovers MM, Gooszen HG. Timing of enteral nutrition in acute pancreatitis: meta-analysis of individuals using a single-arm of randomised trials. Pancreatology 2014; 14:340-6. [PMID: 25128270 DOI: 10.1016/j.pan.2014.07.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 06/02/2014] [Accepted: 07/14/2014] [Indexed: 12/11/2022]
Abstract
INTRODUCTION In acute pancreatitis, enteral nutrition (EN) reduces the rate of complications, such as infected pancreatic necrosis, organ failure, and mortality, as compared to parenteral nutrition (PN). Starting EN within 24 h of admission might further reduce complications. METHODS A literature search for trials of EN in acute pancreatitis was performed. Authors of eligible trials were requested to provide the data of all patients in the EN-arm of their trials. A meta-analysis of individual patient data was performed. The cohort of patients with EN was divided into patients receiving EN within 24 h or after 24 h of admission. Multivariable logistic regression, adjusting for predicted disease severity and trial, was used to study the effect of timing of EN on a composite endpoint of infected pancreatic necrosis, organ failure, or mortality. RESULTS Observational data from 165 individuals from 8 randomised trials were obtained; 100 patients with EN within 24 h and 65 patients with EN after 24 h of admission. In the multivariable model, EN started within 24 h of admission compared to EN started after 24 h of admission, reduced the composite endpoint from 45% to 19% (adjusted odds ratio [OR] of 0.44; 95% confidence interval [CI] 0.20-0.96). Within the composite endpoint, organ failure was reduced from 42% to 16% (adjusted OR 0.42; 95% CI 0.19-0.94). CONCLUSIONS In this meta-analysis of observational data from individuals with acute pancreatitis, starting EN within 24 h after hospital admission, compared with after 24 h, was associated with a reduction in complications.
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Affiliation(s)
- Olaf J Bakker
- Dept. of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Sandra van Brunschot
- Dept. of Operation Theatres and Department of Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Antoni Farre
- Dept. of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Colin D Johnson
- Dept. of Surgery, Southampton General Hospital, University of Southampton, UK
| | - Fotis Kalfarentzos
- Dept. of Surgery, Nutritional and Metabolic Unit, University of Patras, Patras, Greece
| | - Brian E Louie
- Dept. of Thoracic Surgery, Swedish Cancer Instititute and Medical Center, Seattle, WA, USA
| | - Attila Oláh
- Dept. of Surgery, Petz Aladár Teaching Hospital, Györ, Hungary
| | - Stephen J O'Keefe
- Physicians Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh, PA, USA
| | - Maxim S Petrov
- Dept. of Surgery, University of Auckland, Auckland, New Zealand
| | - James J Powell
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Marc G Besselink
- Dept. of Surgery, Amsterdam Medical Center, Amsterdam, The Netherlands
| | | | - Maroeska M Rovers
- Dept. of Operation Theatres and Department of Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Hein G Gooszen
- Dept. of Operation Theatres and Department of Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Wheelwright SJ, Darlington AS, Hopkinson JB, Fitzsimmons D, White A, Johnson CD. A systematic review to establish health-related quality-of-life domains for intervention targets in cancer cachexia. BMJ Support Palliat Care 2014; 6:307-14. [PMID: 24943495 DOI: 10.1136/bmjspcare-2014-000680] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 03/10/2014] [Accepted: 05/25/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To develop a model of the impact of cancer cachexia on patients by identifying the relevant health-related quality-of-life (HRQOL) issues, and to use the model to identify opportunities for intervention. METHODS Standard systematic review methods were followed to identify papers which included direct quotes from cancer patients with cachexia or problems with eating or weight loss. Following thematic synthesis methodology, the quotes were coded, and themes and metathemes were extracted. The metathemes were used to develop a model of the patient's experience of cachexia. RESULTS 18 relevant papers were identified which, in total, contained interviews with more than 250 patients. 226 patient quotes were extracted from the papers and 171 codes. 26 themes and 8 metathemes were formulated. The model developed from the metathemes demonstrated a direct link between eating and food problems and negative emotions and also a link mediated by the associated physical decline. These links provide opportunities for interventions. CONCLUSIONS There are a vast number of HRQOL issues associated with cancer cachexia as identified from patients' own words. The model generated from these issues indicates that relationships, coping and knowledge of the condition are important components of new psychosocial interventions.
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Affiliation(s)
- S J Wheelwright
- Department of Cancer Sciences, University of Southampton, Southampton, UK
| | - A-S Darlington
- Department of Health Sciences, University of Southampton, Southampton, UK
| | - J B Hopkinson
- Cardiff School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - D Fitzsimmons
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - A White
- Department of Cancer Sciences, University of Southampton, Southampton, UK
| | - C D Johnson
- Department of Cancer Sciences, University of Southampton, Southampton, UK
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Sodergren SC, White A, Efficace F, Sprangers M, Fitzsimmons D, Bottomley A, Johnson CD. Systematic review of the side effects associated with tyrosine kinase inhibitors used in the treatment of gastrointestinal stromal tumours on behalf of the EORTC Quality of Life Group. Crit Rev Oncol Hematol 2014; 91:35-46. [PMID: 24495942 DOI: 10.1016/j.critrevonc.2014.01.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/16/2013] [Accepted: 01/10/2014] [Indexed: 02/07/2023] Open
Abstract
Tyrosine kinase inhibitors (TKIs) have revolutionised the treatment of advanced gastrointestinal stromal tumours (GISTs). Imatinib is approved as first line therapy and sunitinib is used in cases of imatinib resistance or intolerance. Compared with conventional treatments, TKIs are delivered over longer periods of time and are more specific in their targets (i.e., molecularly targeted), thus presenting different side effect profiles. We review the safety profiles of imatinib and sunitinib, documenting a total of 95 side effects including patient based as well as medically defined outcomes. Gastrointestinal complaints, particularly diarrhoea and nausea, oedema, fatigue and haematological disorders, notably anaemia, are amongst the most prevalent side effects. While there is overlap between the side effect profiles of imatinib and sunitinib, important differences emerge in the frequencies of oedema, hypertension, thyroid functioning, muscle and joint pains, as well as skin and oral conditions. Awareness of potential side effects is informative to both clinician and patient in terms of treatment decision making and can have important implications for treatment adherence and clinical outcome.
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Affiliation(s)
| | - Alice White
- Cancer Sciences, University of Southampton, Southampton SO16 6YD, UK
| | - Fabio Efficace
- Health Outcomes Research Unit, Gimema, 00161 Rome, Italy
| | - Mirjam Sprangers
- Department of Medical Psychology, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Deborah Fitzsimmons
- Swansea Centre for Health Economics, Swansea University, Swansea SA2 8PP, UK
| | - Andrew Bottomley
- European Organisation for Research and Treatment of Cancer Quality of Life Department, 1200 Brussels, Belgium
| | - Colin D Johnson
- Cancer Sciences, University of Southampton, Southampton SO16 6YD, UK
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Hilal MA, Layfield DM, Di Fabio F, Arregui-Fresneda I, Panagiotopoulou IG, Armstrong TH, Pearce NW, Johnson CD. Postoperative Chyle Leak After Major Pancreatic Resections in Patients Who Receive Enteral Feed: Risk Factors and Management Options. World J Surg 2013; 37:2918-26. [DOI: 10.1007/s00268-013-2171-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Sarr MG, Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Tsiotos GG, Vege SS. The new revised classification of acute pancreatitis 2012. Surg Clin North Am 2013; 93:549-62. [PMID: 23632143 DOI: 10.1016/j.suc.2013.02.012] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This study aims to update the 1991 Atlanta Classification of acute pancreatitis, to standardize the reporting of and terminology of the disease and its complications. Important features of this classification have incorporated new insights into the disease learned over the last 20 years, including the recognition that acute pancreatitis and its complications involve a dynamic process involving two phases, early and late. The accurate and consistent description of acute pancreatitis will help to improve the stratification and reporting of new methods of care of acute pancreatitis across different practices, geographic areas, and countries.
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Affiliation(s)
- Michael G Sarr
- Department of Surgery, Mayo Clinic GU 10-01, 200 First Street Southwest, Rochester, MN 55905, USA.
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40
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Gurka MK, Collins SP, Slack R, Tse G, Charabaty A, Ley L, Berzcel L, Lei S, Suy S, Haddad N, Jha R, Johnson CD, Jackson P, Marshall JL, Pishvaian MJ. Stereotactic body radiation therapy with concurrent full-dose gemcitabine for locally advanced pancreatic cancer: a pilot trial demonstrating safety. Radiat Oncol 2013; 8:44. [PMID: 23452509 PMCID: PMC3607991 DOI: 10.1186/1748-717x-8-44] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 02/25/2013] [Indexed: 12/12/2022] Open
Abstract
Background Concurrent chemoradiation is a standard option for locally advanced pancreatic cancer (LAPC). Concurrent conventional radiation with full-dose gemcitabine has significant toxicity. Stereotactic body radiation therapy (SBRT) may provide the opportunity to administer radiation in a shorter time frame with similar efficacy and reduced toxicity. This Pilot study assessed the safety of concurrent full-dose gemcitabine with SBRT for LAPC. Methods Patients received gemcitabine, 1000 mg/m2 for 6 cycles. During week 4 of cycle 1, patients received SBRT (25 Gy delivered in five consecutive daily fractions of 5 Gy prescribed to the 75-83% isodose line). Acute and late toxicities were assessed using NIH CTCAE v3. Tumor response was assessed by RECIST. Patients underwent an esophagogastroduodenoscopy at baseline, 2, and 6 months to assess the duodenal mucosa. Quality of life (QoL) data was collected before and after treatment using the QLQ-C30 and QLQ-PAN26 questionnaires. Results Between September 2009 and February 2011, 11 patients enrolled with one withdrawal during radiation therapy. Patients had grade 1 to 2 gastrointestinal toxicity from the start of SBRT to 2 weeks after treatment. There were no grade 3 or greater radiation-related toxicities or delays for cycle 2 of gemcitabine. On endoscopy, there were no grade 2 or higher mucosal toxicities. Two patients had a partial response. The median progression free and overall survival were 6.8 and 12.2 months, respectively. Global QoL did not change between baseline and immediately after radiation treatment. Conclusions SBRT with concurrent full dose gemcitabine is safe when administered to patients with LAPC. There is no delay in administration of radiation or chemotherapy, and radiation is completed with minimal toxicity.
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Affiliation(s)
- Marie K Gurka
- Department of Radiation Oncology, Georgetown University Hospital, Washington, DC 20007, USA
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Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62:102-111. [PMID: 23100216 DOI: 10.1136/gutjnl-2012-302779%' and 2*3*8=6*8 and 'ps7w'!='ps7w%] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
BACKGROUND AND OBJECTIVE The Atlanta classification of acute pancreatitis enabled standardised reporting of research and aided communication between clinicians. Deficiencies identified and improved understanding of the disease make a revision necessary. METHODS A web-based consultation was undertaken in 2007 to ensure wide participation of pancreatologists. After an initial meeting, the Working Group sent a draft document to 11 national and international pancreatic associations. This working draft was forwarded to all members. Revisions were made in response to comments, and the web-based consultation was repeated three times. The final consensus was reviewed, and only statements based on published evidence were retained. RESULTS The revised classification of acute pancreatitis identified two phases of the disease: early and late. Severity is classified as mild, moderate or severe. Mild acute pancreatitis, the most common form, has no organ failure, local or systemic complications and usually resolves in the first week. Moderately severe acute pancreatitis is defined by the presence of transient organ failure, local complications or exacerbation of co-morbid disease. Severe acute pancreatitis is defined by persistent organ failure, that is, organ failure >48 h. Local complications are peripancreatic fluid collections, pancreatic and peripancreatic necrosis (sterile or infected), pseudocyst and walled-off necrosis (sterile or infected). We present a standardised template for reporting CT images. CONCLUSIONS This international, web-based consensus provides clear definitions to classify acute pancreatitis using easily identified clinical and radiologic criteria. The wide consultation among pancreatologists to reach this consensus should encourage widespread adoption.
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Affiliation(s)
- Peter A Banks
- Division of Gastroenterology, Hepatology, and Endoscopy, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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42
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Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62:102-111. [PMID: 23100216 DOI: 10.1136/gutjnl-2012-302779' and 2*3*8=6*8 and 'plqr'='plqr] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
BACKGROUND AND OBJECTIVE The Atlanta classification of acute pancreatitis enabled standardised reporting of research and aided communication between clinicians. Deficiencies identified and improved understanding of the disease make a revision necessary. METHODS A web-based consultation was undertaken in 2007 to ensure wide participation of pancreatologists. After an initial meeting, the Working Group sent a draft document to 11 national and international pancreatic associations. This working draft was forwarded to all members. Revisions were made in response to comments, and the web-based consultation was repeated three times. The final consensus was reviewed, and only statements based on published evidence were retained. RESULTS The revised classification of acute pancreatitis identified two phases of the disease: early and late. Severity is classified as mild, moderate or severe. Mild acute pancreatitis, the most common form, has no organ failure, local or systemic complications and usually resolves in the first week. Moderately severe acute pancreatitis is defined by the presence of transient organ failure, local complications or exacerbation of co-morbid disease. Severe acute pancreatitis is defined by persistent organ failure, that is, organ failure >48 h. Local complications are peripancreatic fluid collections, pancreatic and peripancreatic necrosis (sterile or infected), pseudocyst and walled-off necrosis (sterile or infected). We present a standardised template for reporting CT images. CONCLUSIONS This international, web-based consensus provides clear definitions to classify acute pancreatitis using easily identified clinical and radiologic criteria. The wide consultation among pancreatologists to reach this consensus should encourage widespread adoption.
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Affiliation(s)
- Peter A Banks
- Division of Gastroenterology, Hepatology, and Endoscopy, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62:102-111. [PMID: 23100216 DOI: 10.1136/gutjnl-2012-302779'||'] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
BACKGROUND AND OBJECTIVE The Atlanta classification of acute pancreatitis enabled standardised reporting of research and aided communication between clinicians. Deficiencies identified and improved understanding of the disease make a revision necessary. METHODS A web-based consultation was undertaken in 2007 to ensure wide participation of pancreatologists. After an initial meeting, the Working Group sent a draft document to 11 national and international pancreatic associations. This working draft was forwarded to all members. Revisions were made in response to comments, and the web-based consultation was repeated three times. The final consensus was reviewed, and only statements based on published evidence were retained. RESULTS The revised classification of acute pancreatitis identified two phases of the disease: early and late. Severity is classified as mild, moderate or severe. Mild acute pancreatitis, the most common form, has no organ failure, local or systemic complications and usually resolves in the first week. Moderately severe acute pancreatitis is defined by the presence of transient organ failure, local complications or exacerbation of co-morbid disease. Severe acute pancreatitis is defined by persistent organ failure, that is, organ failure >48 h. Local complications are peripancreatic fluid collections, pancreatic and peripancreatic necrosis (sterile or infected), pseudocyst and walled-off necrosis (sterile or infected). We present a standardised template for reporting CT images. CONCLUSIONS This international, web-based consensus provides clear definitions to classify acute pancreatitis using easily identified clinical and radiologic criteria. The wide consultation among pancreatologists to reach this consensus should encourage widespread adoption.
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Affiliation(s)
- Peter A Banks
- Division of Gastroenterology, Hepatology, and Endoscopy, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62:102-11. [PMID: 23100216 DOI: 10.1136/gutjnl-2012-302779] [Citation(s) in RCA: 3726] [Impact Index Per Article: 338.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVE The Atlanta classification of acute pancreatitis enabled standardised reporting of research and aided communication between clinicians. Deficiencies identified and improved understanding of the disease make a revision necessary. METHODS A web-based consultation was undertaken in 2007 to ensure wide participation of pancreatologists. After an initial meeting, the Working Group sent a draft document to 11 national and international pancreatic associations. This working draft was forwarded to all members. Revisions were made in response to comments, and the web-based consultation was repeated three times. The final consensus was reviewed, and only statements based on published evidence were retained. RESULTS The revised classification of acute pancreatitis identified two phases of the disease: early and late. Severity is classified as mild, moderate or severe. Mild acute pancreatitis, the most common form, has no organ failure, local or systemic complications and usually resolves in the first week. Moderately severe acute pancreatitis is defined by the presence of transient organ failure, local complications or exacerbation of co-morbid disease. Severe acute pancreatitis is defined by persistent organ failure, that is, organ failure >48 h. Local complications are peripancreatic fluid collections, pancreatic and peripancreatic necrosis (sterile or infected), pseudocyst and walled-off necrosis (sterile or infected). We present a standardised template for reporting CT images. CONCLUSIONS This international, web-based consensus provides clear definitions to classify acute pancreatitis using easily identified clinical and radiologic criteria. The wide consultation among pancreatologists to reach this consensus should encourage widespread adoption.
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Affiliation(s)
- Peter A Banks
- Division of Gastroenterology, Hepatology, and Endoscopy, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62:102-111. [PMID: 23100216 DOI: 10.1136/gutjnl-2012-302779" and 2*3*8=6*8 and "jm4q"="jm4q] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
BACKGROUND AND OBJECTIVE The Atlanta classification of acute pancreatitis enabled standardised reporting of research and aided communication between clinicians. Deficiencies identified and improved understanding of the disease make a revision necessary. METHODS A web-based consultation was undertaken in 2007 to ensure wide participation of pancreatologists. After an initial meeting, the Working Group sent a draft document to 11 national and international pancreatic associations. This working draft was forwarded to all members. Revisions were made in response to comments, and the web-based consultation was repeated three times. The final consensus was reviewed, and only statements based on published evidence were retained. RESULTS The revised classification of acute pancreatitis identified two phases of the disease: early and late. Severity is classified as mild, moderate or severe. Mild acute pancreatitis, the most common form, has no organ failure, local or systemic complications and usually resolves in the first week. Moderately severe acute pancreatitis is defined by the presence of transient organ failure, local complications or exacerbation of co-morbid disease. Severe acute pancreatitis is defined by persistent organ failure, that is, organ failure >48 h. Local complications are peripancreatic fluid collections, pancreatic and peripancreatic necrosis (sterile or infected), pseudocyst and walled-off necrosis (sterile or infected). We present a standardised template for reporting CT images. CONCLUSIONS This international, web-based consensus provides clear definitions to classify acute pancreatitis using easily identified clinical and radiologic criteria. The wide consultation among pancreatologists to reach this consensus should encourage widespread adoption.
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Affiliation(s)
- Peter A Banks
- Division of Gastroenterology, Hepatology, and Endoscopy, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62:102-111. [PMID: 23100216 DOI: 10.1136/gutjnl-2012-302779'||dbms_pipe.receive_message(chr(98)||chr(98)||chr(98),15)||'] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
BACKGROUND AND OBJECTIVE The Atlanta classification of acute pancreatitis enabled standardised reporting of research and aided communication between clinicians. Deficiencies identified and improved understanding of the disease make a revision necessary. METHODS A web-based consultation was undertaken in 2007 to ensure wide participation of pancreatologists. After an initial meeting, the Working Group sent a draft document to 11 national and international pancreatic associations. This working draft was forwarded to all members. Revisions were made in response to comments, and the web-based consultation was repeated three times. The final consensus was reviewed, and only statements based on published evidence were retained. RESULTS The revised classification of acute pancreatitis identified two phases of the disease: early and late. Severity is classified as mild, moderate or severe. Mild acute pancreatitis, the most common form, has no organ failure, local or systemic complications and usually resolves in the first week. Moderately severe acute pancreatitis is defined by the presence of transient organ failure, local complications or exacerbation of co-morbid disease. Severe acute pancreatitis is defined by persistent organ failure, that is, organ failure >48 h. Local complications are peripancreatic fluid collections, pancreatic and peripancreatic necrosis (sterile or infected), pseudocyst and walled-off necrosis (sterile or infected). We present a standardised template for reporting CT images. CONCLUSIONS This international, web-based consensus provides clear definitions to classify acute pancreatitis using easily identified clinical and radiologic criteria. The wide consultation among pancreatologists to reach this consensus should encourage widespread adoption.
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Affiliation(s)
- Peter A Banks
- Division of Gastroenterology, Hepatology, and Endoscopy, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Abu Hilal M, Di Fabio F, Badran A, Alsaati H, Clarke H, Fecher I, Armstrong TH, Johnson CD, Pearce NW. Implementation of enhanced recovery programme after pancreatoduodenectomy: a single-centre UK pilot study. Pancreatology 2012; 13:58-62. [PMID: 23395571 DOI: 10.1016/j.pan.2012.11.312] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [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] [Received: 09/23/2012] [Revised: 11/08/2012] [Accepted: 11/24/2012] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Data on enhanced recovery programmes after pancreatoduodenectomy (ERP-PD) is limited. The aim of this pilot study was to evaluate the feasibility, safety and clinical outcomes of ERP-PD when implemented at a high-volume UK university referral centre. METHODS This was an observational single-surgeon case-control study (before-and-after pathway). A total of 20 consecutive patients were prospectively enrolled for the ERP-PD and compared with 24 consecutive patients previously treated during an equal time frame. RESULTS Patients in the ERP-PD group had a significant shorter time to remove naso-gastric tube (median of 5 vs. 7 days, p = 0.0001), start liquid diet (median of 2 vs. 5 days, p < 0.0001), start solid food (median of 4 vs. 9 days, p < 0.0001), pass stools (median of 6 vs. 7 days, p = 0.002), and had shorter length of stay (median of 8.5 days vs. 13 days, p = 0.015) compared to the pre-pathway group. Postoperative complications were overall less frequent but not significantly different in the ERP-PD group (p = 0.077). No difference in mortality and readmission rates was found. CONCLUSIONS Our findings support the feasibility and safety of ERP-PD. Improved patients' outcomes, significant bed day savings and increase National Health Service productivity are anticipated with implementation of ERP-PD on a larger scale.
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Affiliation(s)
- Mohammed Abu Hilal
- Hepato-biliary and Pancreatic Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK.
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Clavijo A, Nikooienejad A, Esfahani MS, Metz RP, Schwartz S, Atashpaz-Gargari E, Deliberto TJ, Lutman MW, Pedersen K, Bazan LR, Koster LG, Jenkins-Moore M, Swenson SL, Zhang M, Beckham T, Johnson CD, Bounpheng M. Identification and analysis of the first 2009 pandemic H1N1 influenza virus from U.S. feral swine. Zoonoses Public Health 2012; 60:327-35. [PMID: 22978260 DOI: 10.1111/zph.12006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [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: 11/27/2022]
Abstract
The first case of pandemic H1N1 influenza (pH1N1) virus in feral swine in the United States was identified in Texas through the United States Department of Agriculture (USDA) Wildlife Services' surveillance program. Two samples were identified as pandemic influenza by reverse transcriptase quantitative PCR (RT-qPCR). Full-genome Sanger sequencing of all eight influenza segments was performed. In addition, Illumina deep sequencing of the original diagnostic samples and their respective virus isolation cultures were performed to assess the feasibility of using an unbiased whole-genome linear target amplification method and multiple sample sequencing in a single Illumina GAIIx lane. Identical sequences were obtained using both techniques. Phylogenetic analysis indicated that all gene segments belonged to the pH1N1 (2009) lineage. In conclusion, we have identified the first pH1N1 isolate in feral swine in the United States and have demonstrated the use of an easy unbiased linear amplification method for deep sequencing of multiple samples.
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Affiliation(s)
- A Clavijo
- Texas Veterinary Medical Diagnostic Laboratory, College Station, TX, USA.
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Abstract
There is mounting recognition that, to aid surgical decision making, treatment efficacy needs to be measured in a variety of ways, with health-related quality of life now widely regarded as an important outcome in pulmonary surgical populations. The aim of this review is to provide a comprehensive overview of the key issues to consider if an investigator wishes to incorporate health-related quality of life assessment into trials and studies of pulmonary surgery, drawing on recent studies of lung cancer surgery as an example.
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Affiliation(s)
- D Fitzsimmons
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, United Kingdom
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Johnson CD, Fitzsimmons D. Comment on 'differences in the birth-cohort patterns of gastric cancer and peptic ulcer'. Gut 2012; 61:165; author reply 165. [PMID: 21209125 DOI: 10.1136/gut.2010.234682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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