2
|
Islam KM, Anggondowati T, Deviany PE, Ryan JE, Fetrick A, Bagenda D, Copur MS, Tolentino A, Vaziri I, McKean HA, Dunder S, Gray JE, Huang C, Ganti AK. Patient preferences of chemotherapy treatment options and tolerance of chemotherapy side effects in advanced stage lung cancer. BMC Cancer 2019; 19:835. [PMID: 31455252 PMCID: PMC6712837 DOI: 10.1186/s12885-019-6054-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 08/19/2019] [Indexed: 11/18/2022] Open
Abstract
Background In the U.S., lung cancer accounts for 14% of cancer diagnoses and 28% of cancer deaths annually. Since no cure exists for advanced lung cancer, the main treatment goal is to prolong survival. Chemotherapy regimens produce side effects with different profiles. Coupling this with individual patient’s preferred side effects could result in patient-centered choices leading to better treatment outcomes. There are apparently no previous studies of or tools for assessing and utilizing patient chemotherapy preferences in clinical settings. The long-term goal of the study was to facilitate patients’ treatment choices for advanced-stage lung cancer. A primary aim was to determine how preferences for chemotherapy side effects relate to chemotherapy choices. Methods An observational, longitudinal, open cohort study of patients with advanced-stage non-small cell lung cancer (NSCLC) was conducted. Data sources included patient medical records and from one to three interviews per subject. Data were analyzed using Chi-square, Fisher’s Exact and McNamara’s test, and logistic regression. Results Patients identified the top three chemotherapy side effects that they would most like to avoid: shortness of breath, bleeding, and fatigue. These side effects were similar between first and last interviews, although the rank order changed after patients experienced chemotherapy. Conclusions Patients ranked drug side effects that they would most like to avoid. Patient-centered clinical care and patient-centered outcomes research are feasible and may be enhanced by stakeholder commitment. The study results are limited to patients with advanced NSCLC. Most of the subjects were White, since patients were drawn from the U.S. Midwest, a predominantly White population.
Collapse
Affiliation(s)
- K M Islam
- Medical College of Augusta, Augusta University, 1120 15th Street, CJ 2326, Augusta, GA, 30912, USA.
| | - T Anggondowati
- Department of Epidemiology, University of Nebraska Medical Center College of Public Health, Omaha, NE, USA
| | - P E Deviany
- Department of Epidemiology, University of Nebraska Medical Center College of Public Health, Omaha, NE, USA
| | - J E Ryan
- Nebraska Cancer Coalition, Lincoln, NE, USA
| | - A Fetrick
- Department of Health Services Research and Administration, University of Nebraska Medical Center College of Public Health, Omaha, NE, USA
| | - D Bagenda
- Department of Anesthesiology, University of Nebraska Medical Center College of Medicine, Omaha, NE, USA
| | - M S Copur
- Marry Lanning Healthcare System, Hastings, NE, USA
| | - A Tolentino
- Avera Cancer Institute, Sioux Falls, SD, USA.,Saint Luke's Hospital of Kansas City, Kansas City, MO, USA
| | - I Vaziri
- Callahan Cancer Center, North Platte, NE, USA
| | - H A McKean
- Avera Cancer Institute, Sioux Falls, SD, USA
| | - S Dunder
- Southeast Nebraska Cancer Center, Lincoln, NE, USA
| | - J E Gray
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - C Huang
- Department of Veterans Affairs Medical Center, Kansas City, MO, USA
| | - A K Ganti
- Veterans Administration Health Care Systems Medical Center, Omaha, NE, USA.,Department of Internal Medicine, School of Medicine, University of Nebraska Medical Center Division of Oncology-Hematology, Omaha, NE, USA
| |
Collapse
|
3
|
Leon-Ferre RA, Le-Rademacher J, Terstriep S, Glaser R, Novotni P, Giuliano A, Copur MS, Jones C, Page S, Mitchell W, Birrell SN, Loprinzi CL. Abstract P4-16-01: A randomized, double-blind, placebo-controlled trial of testosterone (T) for aromatase inhibitor-induced arthralgias (AIA) in postmenopausal women: Alliance A221102. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-16-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Aromatase inhibitors are a mainstay hormone receptor-positive breast cancer treatment. AIA occur in up to 50% of patients (pts), adversely affecting quality of life and treatment compliance. A small phase II clinical trial of oral testosterone unedeconate appeared to improve AIA over placebo (P), with no significant androgenic side effects. The current study was performed to confirm these findings.
Methods: This randomized P-controlled trial enrolled postmenopausal women on adjuvant anastrozole or letrozole and experiencing moderate-to-severe AIA (≥5 on 0-10 scale). Pts were initially randomized to receive a subcutaneous pellet containing T 120 mg + anastrozole 8 mg (T+AIpellet) or P at the end of the first week on study (after obtaining baseline hot flash data) and at 3 months (mo). Due to slow accrual, the protocol was amended to change the route of delivery to topical T or P applied to the skin once daily for 6 mo. Baseline and monthly questionnaires were administered, including: Modified Brief Pain Inventory for aromatase arthralgia (BPI-AIA), prolife of mood states (POMS), the menopause specific quality of life questionnaire (MENQOL), a hot flash diary, the hot flash related daily interference scale (HFRDIS) and a symptom experience questionnaire. The primary endpoint was intra-patient change in joint pain at 3 mo, compared using a two-sample t-test.
Results: 227 pts were accrued between 9/1/2013-11/29/2017. 55 pts were randomized prior to the protocol amendment and received T+AIpellet or P. Baseline characteristics were balanced between arms, with the exceptions of median weight, BMI, hemoglobin (all higher in T arm), and breast tenderness, dissatisfaction with personal life/depression, and skin changes (all higher in P arm). Compared to baseline, there were no significant differences between T and P in average pain or joint stiffness at 3 (p=0.483) or 6 mo (p=0.573). Average pain was significantly lower each month compared to baseline, irrespective of treatment arm. There were no significant differences in any other items evaluated by BPI-AIA, POMS, MENQOL, hot flash diary or HFRDIS. Similarly, there were no substantial differences in toxicity. A subset analysis of the 55 pts randomized to receive T+AIpellet or P identified significant reductions in average pain scores with T+AIpellet during the first month (p=0.038), but not thereafter. T+AIpellet pts had significantly more reduction in reported % of baseline hot flash frequency (p=0.034) and score (p=0.031), nausea (p=0.019), fatigue (p=0.042), mood swings (p=0.026), hand/feet swelling (p=0.009), stress urinary incontinence (p=0.039) and changes in appearance, texture or tone of their skin (p=0.0083), than pts on P.
Conclusions: Overall, T did not improve AIA or menopausal symptoms compared to P. While there was significant improvement in AIA over the study period, T did not facilitate this process. However, T+AIpellet was associated with improvement in short-term AIA and several menopausal symptoms compared to P, suggesting that subcutaneous T combined with anastrozole may be superior to transdermal T alone.
Support: UG1CA189823, U10CA180820, U10CA189809; ClinicalTrials.gov Identifier: NCT01573442
Citation Format: Leon-Ferre RA, Le-Rademacher J, Terstriep S, Glaser R, Novotni P, Giuliano A, Copur MS, Jones C, Page S, Mitchell W, Birrell SN, Loprinzi CL. A randomized, double-blind, placebo-controlled trial of testosterone (T) for aromatase inhibitor-induced arthralgias (AIA) in postmenopausal women: Alliance A221102 [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-16-01.
Collapse
Affiliation(s)
- RA Leon-Ferre
- Mayo Clinic, Rochester, MN; Sanford Broadway Medical Center, Fargo, ND; Wright State University, Dayton, OH; Cedars-Sinai Medical Center, Los Angeles, CA; Saint Francis Cancer Treatment Center, Grand Island, NE; Georgia Cancer Specialists PC, Macon, GA; Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, KS; Novant Health Presbyterian Medical Center, Charlotte, NC; Havah Therapeutics Pty Ltd, Toorak Gardens, South Australia, Australia
| | - J Le-Rademacher
- Mayo Clinic, Rochester, MN; Sanford Broadway Medical Center, Fargo, ND; Wright State University, Dayton, OH; Cedars-Sinai Medical Center, Los Angeles, CA; Saint Francis Cancer Treatment Center, Grand Island, NE; Georgia Cancer Specialists PC, Macon, GA; Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, KS; Novant Health Presbyterian Medical Center, Charlotte, NC; Havah Therapeutics Pty Ltd, Toorak Gardens, South Australia, Australia
| | - S Terstriep
- Mayo Clinic, Rochester, MN; Sanford Broadway Medical Center, Fargo, ND; Wright State University, Dayton, OH; Cedars-Sinai Medical Center, Los Angeles, CA; Saint Francis Cancer Treatment Center, Grand Island, NE; Georgia Cancer Specialists PC, Macon, GA; Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, KS; Novant Health Presbyterian Medical Center, Charlotte, NC; Havah Therapeutics Pty Ltd, Toorak Gardens, South Australia, Australia
| | - R Glaser
- Mayo Clinic, Rochester, MN; Sanford Broadway Medical Center, Fargo, ND; Wright State University, Dayton, OH; Cedars-Sinai Medical Center, Los Angeles, CA; Saint Francis Cancer Treatment Center, Grand Island, NE; Georgia Cancer Specialists PC, Macon, GA; Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, KS; Novant Health Presbyterian Medical Center, Charlotte, NC; Havah Therapeutics Pty Ltd, Toorak Gardens, South Australia, Australia
| | - P Novotni
- Mayo Clinic, Rochester, MN; Sanford Broadway Medical Center, Fargo, ND; Wright State University, Dayton, OH; Cedars-Sinai Medical Center, Los Angeles, CA; Saint Francis Cancer Treatment Center, Grand Island, NE; Georgia Cancer Specialists PC, Macon, GA; Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, KS; Novant Health Presbyterian Medical Center, Charlotte, NC; Havah Therapeutics Pty Ltd, Toorak Gardens, South Australia, Australia
| | - A Giuliano
- Mayo Clinic, Rochester, MN; Sanford Broadway Medical Center, Fargo, ND; Wright State University, Dayton, OH; Cedars-Sinai Medical Center, Los Angeles, CA; Saint Francis Cancer Treatment Center, Grand Island, NE; Georgia Cancer Specialists PC, Macon, GA; Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, KS; Novant Health Presbyterian Medical Center, Charlotte, NC; Havah Therapeutics Pty Ltd, Toorak Gardens, South Australia, Australia
| | - MS Copur
- Mayo Clinic, Rochester, MN; Sanford Broadway Medical Center, Fargo, ND; Wright State University, Dayton, OH; Cedars-Sinai Medical Center, Los Angeles, CA; Saint Francis Cancer Treatment Center, Grand Island, NE; Georgia Cancer Specialists PC, Macon, GA; Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, KS; Novant Health Presbyterian Medical Center, Charlotte, NC; Havah Therapeutics Pty Ltd, Toorak Gardens, South Australia, Australia
| | - C Jones
- Mayo Clinic, Rochester, MN; Sanford Broadway Medical Center, Fargo, ND; Wright State University, Dayton, OH; Cedars-Sinai Medical Center, Los Angeles, CA; Saint Francis Cancer Treatment Center, Grand Island, NE; Georgia Cancer Specialists PC, Macon, GA; Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, KS; Novant Health Presbyterian Medical Center, Charlotte, NC; Havah Therapeutics Pty Ltd, Toorak Gardens, South Australia, Australia
| | - S Page
- Mayo Clinic, Rochester, MN; Sanford Broadway Medical Center, Fargo, ND; Wright State University, Dayton, OH; Cedars-Sinai Medical Center, Los Angeles, CA; Saint Francis Cancer Treatment Center, Grand Island, NE; Georgia Cancer Specialists PC, Macon, GA; Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, KS; Novant Health Presbyterian Medical Center, Charlotte, NC; Havah Therapeutics Pty Ltd, Toorak Gardens, South Australia, Australia
| | - W Mitchell
- Mayo Clinic, Rochester, MN; Sanford Broadway Medical Center, Fargo, ND; Wright State University, Dayton, OH; Cedars-Sinai Medical Center, Los Angeles, CA; Saint Francis Cancer Treatment Center, Grand Island, NE; Georgia Cancer Specialists PC, Macon, GA; Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, KS; Novant Health Presbyterian Medical Center, Charlotte, NC; Havah Therapeutics Pty Ltd, Toorak Gardens, South Australia, Australia
| | - SN Birrell
- Mayo Clinic, Rochester, MN; Sanford Broadway Medical Center, Fargo, ND; Wright State University, Dayton, OH; Cedars-Sinai Medical Center, Los Angeles, CA; Saint Francis Cancer Treatment Center, Grand Island, NE; Georgia Cancer Specialists PC, Macon, GA; Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, KS; Novant Health Presbyterian Medical Center, Charlotte, NC; Havah Therapeutics Pty Ltd, Toorak Gardens, South Australia, Australia
| | - CL Loprinzi
- Mayo Clinic, Rochester, MN; Sanford Broadway Medical Center, Fargo, ND; Wright State University, Dayton, OH; Cedars-Sinai Medical Center, Los Angeles, CA; Saint Francis Cancer Treatment Center, Grand Island, NE; Georgia Cancer Specialists PC, Macon, GA; Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, KS; Novant Health Presbyterian Medical Center, Charlotte, NC; Havah Therapeutics Pty Ltd, Toorak Gardens, South Australia, Australia
| |
Collapse
|
4
|
Islam KM, Opoku ST, Apenteng BA, Fetrick A, Ryan J, Copur M, Tolentino A, Vaziri I, Ganti AK. Coping with an Advanced Stage Lung Cancer Diagnosis: Patient, Caregiver, and Provider Perspectives on the Role of the Health Care System. J Cancer Educ 2016; 31:554-558. [PMID: 25900672 DOI: 10.1007/s13187-015-0840-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Although lung cancer is the leading cause of cancer death in the USA, there have been few studies on patient-centered advanced lung cancer treatment practices. As part of a larger research study on how to use a patient-inclusive approach in late-stage lung cancer treatment, this present study describes patient, caregiver, and provider perspectives on the role of the health care system in helping patients cope with an advanced stage lung cancer diagnosis. Four focus group sessions were conducted with six to eleven participants per group for a total of 36 participants. Two focus groups were held with patients and family members/caregivers and two with physicians and nurses. A major theme that emerged concerned coping with an advanced lung cancer diagnosis, which is the subject of this paper. The patients, caregivers, and providers spoke passionately about interactions with the health care system and volunteered examples of supportive and non-supportive relationships between patients and clinicians. They advocated for better patient-provider communication practices as well as the expanded use of patient navigation and new patient orientation programs. This study contributes additional knowledge by including the perspectives of caregivers and providers who live and work closely with patients with advanced lung cancer. The findings can inform the development of comprehensive patient-centered care plans for patients living with an advanced lung cancer diagnosis.
Collapse
Affiliation(s)
- K M Islam
- Department of Epidemiology, College of Public Health (CoPH), University of Nebraska Medical Center (UNMC), Omaha, NE, USA.
| | - Samuel T Opoku
- Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Bettye A Apenteng
- Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Ann Fetrick
- Department of Health Services Research, Administration, and Policy, UNMC, CoPH, Omaha, NE, USA
| | - June Ryan
- Nebraska Cancer Coalition, Lincoln, NE, USA
| | - M Copur
- Saint Francis Cancer Treatment Center of Grand Island, Grand Island, NE, USA
| | | | - Irfan Vaziri
- Callahan Cancer Center of North Platte, North Platte, NE, USA
| | - Apar K Ganti
- Veterans Healthcare Administration, Nebraska-Western Iowa Health Care System, Omaha, NE, USA
- Division of Oncology and Hematology of Omaha, UNMC, Omaha, NE, USA
| |
Collapse
|