Development of a Standardized Set of Patient-centered Outcomes for Advanced Prostate Cancer: An International Effort for a Unified Approach

BACKGROUND

There are no universally monitored outcomes relevant to men with advanced prostate cancer, making it challenging to compare health outcomes between populations.

OBJECTIVE

We sought to develop a standard set of outcomes relevant to men with advanced prostate cancer to follow during routine clinical care.

DESIGN, SETTING, AND PARTICIPANTS

The International Consortium for Health Outcomes Measurement assembled a multidisciplinary working group to develop the set.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

We used a modified Delphi method to achieve consensus regarding the outcomes, measures, and case mix factors included.

RESULTS AND LIMITATIONS

The 25 members of the multidisciplinary international working group represented academic and nonacademic centers, registries, and patients. Recognizing the heterogeneity of men with advanced prostate cancer, the group defined the scope as men with all stages of incurable prostate cancer (metastatic and biochemical recurrence ineligible for further curative therapy). We defined outcomes important to all men, such as overall survival, and measures specific to subgroups, such as time to metastasis. Measures gathered from clinical data include measures of disease control. We also identified patient-reported outcome measures (PROMs), such as degree of urinary, bowel, and erectile dysfunction, mood symptoms, and pain control.

CONCLUSIONS

The international multidisciplinary group identified clinical data and PROMs that serve as a basis for international health outcome comparisons and quality-of-care assessments. The set will be revised annually.

PATIENT SUMMARY

Our international group has recommended a standardized set of patient-centered outcomes to be followed during routine care for all men with advanced prostate cancer.

Reacting to the diagnosis of prostate cancer: patient learning in a community of practice

The diagnosis of prostate cancer brings with it a number of emotional issues for the patient. These may include: fear of cancer; confronting one's own mortality; quality of life issues such as incontinence and impotence; and the question "why me?" In addition, there is burden of coping with the emotional responses from friends and loved ones which, arising from their concern, can range from fear to seeking to take charge. Added to this is the need to make choices regarding treatment and obtaining information about these. This article is based on a contribution to a symposium on prostate cancer at the Fifth International Conference on Psycho-Oncology and describes a personal experience of confronting these issues. The concept of communities of practice is used to interpret the learning experiences undertaken by the cancer patient.

Mössbauer studies in transition metal chemistry. IV. Iron(II) complexes of 2-(2'-Pyridyl)benzimidazole

Mossbauer spectra of a number of compounds containing the [Fe(pyb)3]2+ complex cation [pyb, 2-(2'-pyridyl)benzimidazole] confirm that these compounds undergo a change of spin state with temperature consistent with a 5T2-1A1 spin crossover. The nature of the Mossbauer spectra and their temperature-dependence are sensitive to the associated anion and the method of preparation. ��� The temperature-dependence of the Mossbauer parameters has been used to derive information about the distortions from octahedral symmetry and it is concluded that the dimensions of the crystal-line lattice are changing slightly with temperature.

Mossbauer studies in transition metal chemistry. II. Iron(III) methoxides and halomethoxides

M�ssbauer spectra are reported for a series of insoluble methoxide and halomethoxide complexes of tervalent iron which are known to exhibit pronounced antiferromagnetic interactions.1-3 The M�ssbauer study confirms that all the compounds contain high-spin iron(111) and that the reduced magnetic moments arise from antiferromagnetically coupled iron atoms within polymerized species. The quadrupole splittings which are due solely to lattice effects and anisotropic bonding are consistent with some of the previously proposed structures but definitely exclude others. It is concluded that the M�ssbauer data are better rationalized in terms of a three-dimensional layer structure in which the ratio of halogen to methoxide is progressively varied in a FeX3 lattice.

Mossbauer studies in transition metal chemistry. III. Compounds of iron with some sulphur-containing Schiff base ligands

M�ssbauer spectra are reported for a series of iron complexes with sulphur-containing Schiff base ligands. These tridentate ligands are based on the Schiff base formed by the condensation of dithiocarbazic acid and pyridine-2-carbaldehyde and form complexes with a metal-to-ligand ratio of 1 : 1 and 1 : 2. The M�ssbauer study confirms that most of these complexes contain iron(11) with examples of both high-and low-spin and one example of a spin crossover. Several iron(111) complexes were also studied. The quadrupole splittings show the anisotropy in bonding expected for metal atoms coordinated to different types of atoms within the same chelate ring. However, for some complexes the splittings are small, showing that low local symmetries need not produce large electric field gradients. In cases where it is applicable, the temperature dependence of the quadrupole splitting has been used to derive a splitting of the t2 and e orbitals produced by the non-cubic symmetry. For compounds of the form Fe(L)X2, where X is a halide and L the tridentate ligand, the Mossbauer results are best interpreted in terms of a five-coordinate structure rather than a six-coordinate bridged dimer.

M÷ssbauer studies in transition metal chemistry. I. Compounds of iron with Dithioacetylacetone (Pentane-2,4-dithione)

The temperature dependence of the Mossbauer spectra of some iron- containing compounds of dithioacetylacetone are reported between 4 and 293 K. ��� The quadrupole splitting ΔEq of [Fe(SacSac)3] is larger than usually observed for low-spin six-coordinated iron(III) and is ascribed to the lifting of orbital degeneracy of the 2T2 ground state by small axial and rhombic distortions. ��� The unsubstituted and phenyl-substituted dithiolium salts of [FeCl4]2- exhibit strongly temperature-dependent quadrupole splittings, which arise directly from the lifting of the orbital degeneracy of the 5E ground state due to distortion of the [FeCl4]2- tetrahedron.