scholarly journals Patient-Reported Outcomes and Long-Term Nonadherence to Aromatase Inhibitors

2021 ◽  
Author(s):  
Dawn L Hershman ◽  
Alfred I Neugut ◽  
Anna Moseley ◽  
Kathryn B Arnold ◽  
Julie R Gralow ◽  
...  
Keyword(s):  
Aromatase Inhibitors ◽  
Text Messaging ◽  
Patient Reported Outcomes ◽  
Risk Level ◽  
Targeted Interventions ◽  
Patient Reported ◽  
Risk Patients ◽  
Baseline Characteristics ◽  
Composite Risk ◽  
Endocrine Symptoms

Abstract Background Nonadherence to aromatase inhibitors (AIs) is common and increases risk of breast cancer (BC) recurrence. We analyzed factors associated with nonadherence among patients enrolled in S1105, a randomized trial of text messaging. Methods At enrollment, patients were required to have been on an adjuvant AI for at least 30 days and were asked about financial, medication, and demographic factors. They completed patient-reported outcomes (PROs) representing pain (Brief Pain Inventory), endocrine symptoms (Functional Assessment of Cancer Therapy–Endocrine Symptoms), and beliefs about medications (Treatment Satisfaction Questionnaire for Medicine; Brief Medication Questionnaire). Our primary endpoint was AI nonadherence at 36 months, defined as urine AI metabolite assay of less than 10 ng/mL or no submitted specimen. We evaluated the association between individual baseline characteristics and nonadherence with logistic regression. A composite risk score reflecting the number of statistically significant baseline characteristics was examined. Results We analyzed data from 702 patients; median age was 60.9 years. Overall, 35.9% patients were nonadherent at 36 months. Younger patients (younger than age 65 years) were more nonadherent (38.8% vs 28.6%, odds ratio [OR] = 1.51, 95% confidence interval [CI] = 1.05 to 2.16; P = .02). Fourteen baseline PRO scales were each statistically significantly associated with nonadherence. In a composite risk model categorized into quartile levels, each increase in risk level was associated with a 46.5% increase in the odds of nonadherence (OR = 1.47, 95% CI =1.26 to 1.70; P < .001). The highest-risk patients were more than 3 times more likely to be nonadherent than the lowest-risk patients (OR = 3.14, 95% CI = 1.97 to 5.02; P < .001). Conclusions The presence of multiple baseline PRO-specified risk factors was statistically significantly associated with AI nonadherence. The use of these assessments can help identify patients for targeted interventions to improve adherence.

scholarly journals Prospective assessment of patient-reported outcomes and estradiol and drug concentrations in patients experiencing toxicity from adjuvant aromatase inhibitors

2017 ◽  
Vol 164 (2) ◽  
pp. 411-419 ◽  
Author(s):  
Kunal C. Kadakia ◽  
Kelley M. Kidwell ◽  
Nicholas J. Seewald ◽  
Claire F. Snyder ◽  
Anna Maria Storniolo ◽  
...  
Keyword(s):  
Aromatase Inhibitors ◽  
Patient Reported Outcomes ◽  
Drug Concentrations ◽  
Patient Reported ◽  
Prospective Assessment

Patient-Reported Outcomes Can Be Used to Streamline Post-Total Hip Arthroplasty Follow-Up to High-Risk Patients

2017 ◽  
Vol 32 (11) ◽  
pp. 3319-3321
Author(s):  
Jie J. Yao ◽  
Hilal Maradit Kremers ◽  
Cathy D. Schleck ◽  
Dirk R. Larson ◽  
Jasvinder A. Singh ◽  
...  
Keyword(s):  
High Risk ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Patient Reported Outcomes ◽  
Total Hip ◽  
High Risk Patients ◽  
Patient Reported ◽  
Risk Patients

Assessing the change in disease severity based on depressive symptoms in real-world psoriasis patients

2021 ◽  
Author(s):  
Neda Shahriari ◽  
Sarah Mattessich ◽  
Tin-Chi Lin ◽  
Heather J Litman ◽  
Robert R McLean ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Patient Reported Outcomes ◽  
Systemic Treatment ◽  
Disease Characteristics ◽  
Significant Difference ◽  
Patient Reported ◽  
History Of ◽  
Baseline Characteristics ◽  
History Of Depression ◽  
Systemic Therapies

Aim: To evaluate whether the presence of a history of depression hinders psoriasis response to systemic therapies and to delineate baseline characteristics of patients whose depressive symptoms improved on systemic treatment. Methods: We studied patients within the Corrona® Psoriasis Registry, a prospective, multicenter observational disease-based registry, that were enrolled through September 2018, comparing changes from enrollment to 12-month visit. Results: There was a statistically significant improvement in all disease characteristics and most patient-reported outcomes in patients reporting a history of depression and in those that did not while there was no statistically significant difference in the degree of change comparing these two cohorts. Patients who noted improvement in depressive symptoms had more severe baseline disease characteristics and reported overall worse baseline patient-reported outcomes. Conclusions: History of depression does not portend a differential response to systemic treatment. Patients with improvement in depressive symptoms had worse baseline characteristics.

scholarly journals Patient-Reported Outcomes Following Multi-Ligament Knee Injuries With or Without Internal Brace Augmentation and the Role of Patient Access to Rehabilitation (174)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0029
Author(s):  
Shane Korber ◽  
Ioanna Bolia ◽  
Neilan Benvergnu ◽  
Brian Panish ◽  
Tristan Juhan ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Postoperative Outcomes ◽  
Short Term ◽  
Postoperative Rehabilitation ◽  
Limited Access ◽  
Patient Reported ◽  
Internal Brace ◽  
The Mean ◽  
Baseline Characteristics

Objectives: (1) To compare the postoperative outcomes in patient who underwent multifilament knee reconstruction (MLKR) with or without internal brace augmentation and (2) To examine potential differences in outcomes of patients with different access to postoperative rehabilitation following MLKR. Methods: Adult patients sustaining a multifilament knee injury (MLKI) from 2007 to 2020 who were surgically treated by a single surgeon were retrospectively identified and invited to participate. Patients with incomplete follow up data were excluded. Data recorded included patient demographics, intraoperative procedure performed (with versus without use of internal brace), patient access to rehabilitation after surgery (limited versus full access) and postoperative patient reported outcomes. The last included the Multiligament Quality of Life Questionnaire (MLQOL), PROMIS Computer Adaptive Testing (CAT) for Physical Function, Mobility, and Pain Interference, and the Lysholm Knee Questionnaire. Descriptive statistics were conducted using STATA. Comparison of the postoperative outcomes was performed between patients who received or did not receive internal brace during MLKR and those who had limited versus full access to postoperative rehabilitation, using descriptive statistics (STATA). The level of statistical significance was set at <0.05. Results: A total of 85 (15 females,70 males) patients met the inclusion criteria. Of those, 62 patients (13 females, 49 males underwent MLKR without internal brace augmentation (NIB group) and 23 patients (2 females, 11 males) underwent MLKR with internal brace augmentation (IB group). Patient age and BMI were similar between the IB and NIB groups (Table 1). The mean follow-up time was 5.2+/-0.6 years on the NIB group and 1.5+/-0.1 years in the IB group (p<0.0001). The comparison of baseline characteristics and postoperative outcomes in MLKR patients in the NIB and IB groups is shown in Table 1. There was no difference in any of the postoperative outcome scores between patients in the NIB and IB groups who underwent MLKR. Access to rehabilitation data were available for 83 patients. Of those, 69 patients (12 females, 57 males) had full access to rehabilitation and 17 patients (3 females, 14 males) had limited access to postoperative rehabilitation. The mean follow- up time was similar between patients with versus limited access to rehabilitation (mean time was 2.6 years and 2.2 years respectively, p=0.96). The baseline patient characteristics were similar between the last two subgroups. However, patients with limited access to postoperative rehabilitation had significantly lower PROMIS Pain (p=0.018) and PROMIS Physical Function (p=0.025) scores compared to patients with full access to rehabilitation. The comparison of baseline characteristics and postoperative outcomes in MLKR patients with limited versus full access to postoperative rehabilitation is presented in Table 2. Conclusions: Internal bracing augmentation did not result in significant improvement of postoperative outcomes in patients undergoing MLKR, compared to the traditional technique without the use of internal brace, at short-term follow up. Postoperative rehabilitation is critical in patients who undergo MLKR, as patients with limited access to may experience worse outcomes at short term follow up in comparison to those who have full access to rehabilitation services. The socioeconomic status of the MLKR candidates should be examined preoperatively, and efforts should be made to grant these patients access to postoperative rehabilitation in order to optimize their clinical outcomes.

scholarly journals Strategies to reduce the use of low-value medical tests in primary care: a systematic review

2020 ◽  
Vol 70 (701) ◽  
pp. e858-e865
Author(s):  
Toshihiko Takada ◽  
Pauline Heus ◽  
Sander van Doorn ◽  
Christiana A Naaktgeboren ◽  
Jan-Willem Weenink ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Cost Effectiveness ◽  
Adverse Events ◽  
Patient Reported Outcomes ◽  
Targeted Interventions ◽  
Primary Care Settings ◽  
Medical Tests ◽  
Patient Reported ◽  
Randomised Controlled

BackgroundIt is recognised that medical tests are overused in primary care; however, it is unclear how best to reduce their use.AimTo identify which strategies are effective in reducing the use of low-value medical tests in primary care settings.Design and settingSystematic review.MethodThe databases MEDLINE, EMBASE, and Rx for Change were searched (January 1990 to November 2019) for randomised controlled trials (RCTs) that evaluated strategies to reduce the use of low-value medical tests in primary care settings. Two reviewers selected eligible RCTs, extracted data, and assessed their risk of bias.ResultsOf the 16 RCTs included in the review, 11 reported a statistically significant reduction in the use of low-value medical tests. The median of the differences between the relative reductions in the intervention and control arms was 17% (interquartile range 12% to 24%). Strategies using reminders or audit/feedback showed larger reduction than those without these components (22% versus 14%, and 22% versus 13%, respectively) and patient-targeted strategies showed larger reductions than those not targeted at patients (51% versus 17%). Very few studies investigated the sustainability of the effect, adverse events, cost-effectiveness, or patient-reported outcomes related to reducing the use of low-value tests.ConclusionThis review indicates that it is possible to reduce the use of low-value medical tests in primary care, especially by using multiple components including reminders, audit/feedback, and patient-targeted interventions. To implement these strategies widely in primary care settings, more research is needed not only to investigate their effectiveness, but also to examine adverse events, cost-effectiveness, and patient-reported outcomes.

Adherence to remote versus clinic-based collection of patient-reported outcomes in patients with advanced lung cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14109-e14109
Author(s):  
Peter Edward Gabriel ◽  
Tara L. Kaufmann ◽  
Abigail N. Blauch ◽  
Donna A. Pucci ◽  
Linda A. Jacobs ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Pilot Study ◽  
Real Time ◽  
Text Messaging ◽  
Patient Reported Outcomes ◽  
Advanced Nsclc ◽  
Text Messages ◽  
Advanced Lung Cancer ◽  
Small Pilot Study ◽  
Patient Reported

e14109 Background: Routine collection of patient-reported outcomes (PROs) is an evidence-based practice to improve communication, symptom management, and health outcomes in cancer care. However, optimal implementation strategies are poorly understood. Previous studies have mostly assessed PROs collected during clinic visits, which may be less actionable and more subject to recall bias than those collected in real time. Behavioral economics-informed digital approaches have shown increasing promise as sustainable and scalable strategies for remote patient monitoring. We compared remote text-messaging versus usual clinic-based PRO collection approaches. Methods: Between September 2018 and May 2019, we conducted a prospective pilot feasibility study of remote PRO monitoring via text-messaging among 20 patients with advanced non-small cell lung cancer (NSCLC). Pilot participants consented to enroll in a HIPAA-compliant, bidirectional text-messaging platform, which allowed for direct reporting of PRO measures at home. Data were integrated into the electronic health record in real time, and clinicians were notified of severe or escalating symptoms. We compared patient-level adherence over 12 weeks among: 1) pilot participants and 2) patients with advanced NSCLC reporting via usual clinic-based collection methods. We identified predictors of adherence using multivariable logistic regression, and surveyed pilot participants on feasibility outcomes. Results: During the study period, 20 patients with advanced NSCLC participated in the remote text-messaging pilot study (mean age, 63y; 60% male; 85% white), and 328 patients with advanced NSCLC participated in usual clinic-based PRO collection (mean age, 66y; 48% male; 69% white). Baseline characteristics were similar between groups. Mean adherence was 88.4% for remote text-messaging vs 71.2% for clinic-based collection (p < 0.001). Pilot participation predicted > 80% adherence after adjusting for age, sex, race, and marital status (OR 3.5, p = 0.029). Pilot participants reported high levels of usability (97%) and satisfaction (96%) with text-messaging, and 90% noted that text messages reminded them to report symptoms to their clinical team. Conclusions: Among patients with advanced NSCLC, remote PRO monitoring via text-messaging was feasible and enabled significantly higher adherence to reporting than usual clinic-based collection. These results are based on a small pilot study, and further research on text messaging as a PRO implementation strategy is warranted. Clinical trial information: NCT03616522.

scholarly journals Is Traditional Chinese Medicine Use Associated with Worse Patient-reported Outcomes among Chinese American Rheumatology Patients?

2019 ◽  
Vol 46 (12) ◽  
pp. 1634-1639 ◽  
Author(s):  
Kai Sun ◽  
Jackie Szymonifka ◽  
Henghe Tian ◽  
Yaju Chang ◽  
Jennifer C. Leng ◽  
...  
Keyword(s):  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Rheumatic Disease ◽  
Patient Reported Outcomes ◽  
Multivariable Analysis ◽  
Chinese American ◽  
Chinese Americans ◽  
The United States ◽  
Targeted Interventions ◽  
Patient Reported

Objective.Chinese Americans are a fast-growing immigrant group with more severe rheumatic disease manifestations than whites and often a strong cultural preference for traditional Chinese medicine (TCM). We aimed to examine TCM use patterns and association with patient-reported outcomes (PRO) among Chinese American rheumatology patients.Methods.Chinese Americans actively treated for systemic rheumatic diseases were recruited from urban Chinatown rheumatology clinics. Data on sociodemographics, acculturation, clinical factors, and TCM use (11 modalities) were gathered. Self-reported health status was assessed using Patient Reported Outcomes Measurement Information System (PROMIS) short forms. TCM users and nonusers were compared. Factors independently associated with TCM use were identified using multivariable logistic regression.Results.Among 230 participants, median age was 57 years (range 20–97), 65% were women, 71% had ≤ high school education, 70% were on Medicaid insurance, 47% lived in the United States for ≥ 20 years, and 22% spoke English fluently. Half used TCM in the past year; these participants had worse self-reported anxiety, depression, fatigue, and ability to participate in social roles and activities compared with nonusers. In multivariable analysis, TCM use was associated with belief in TCM, female sex, ≥ 20 years of US residency, reporting Western medicine as ineffective, and shorter rheumatic disease duration.Conclusion.Among these Chinese American rheumatology patients, TCM users had worse PRO in many physical and mental health domains. TCM use may be a proxy for unmet therapeutic needs. Asking about TCM use could help providers identify patients with suboptimal health-related quality of life who may benefit from targeted interventions.

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