Patient versus clinician symptom reporting during chemoradiation for rectal cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 646-646 ◽  
Author(s):  
Libertad T. Flores ◽  
Antonia V Bennett ◽  
Ethel B Law ◽  
Carla Hajj ◽  
Mindy P Griffith ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Group Versus ◽  
Intensity Modulated Radiotherapy ◽  
Study Patient ◽  
Cohen’S Kappa ◽  
Paired Group ◽  
Cohen's Kappa ◽  
Patient Reported ◽  
Clinician Assessment

646 Background: Pelvic radiotherapy with concurrent 5-fluorouracil based chemotherapy (chemoradiation) is a component of standard therapy for patients with T3/T4 or node-positive rectal cancer. Chemoradiation can be associated with significant acute gastrointestinal toxicity. This study sought to retrospectively compare patient and clinician reports of acute symptoms experienced by rectal cancer patients receiving chemoradiation. Methods: The charts of 199 rectal cancer patients who received chemoradiation from 11/06 to 2/11 were reviewed. Clinicians assessed toxicity weekly using Common Terminology for Clinical Adverse Event (CTCAE) version 3.0. Patient-reported outcomes (PROs) were collected weekly, in clinic, beginning 9/09 using the 7-item Bowel Problems Scale. 197 patients had at least one clinician assessment or PRO and were eligible for this study. Patient and clinician assessments were compared among a subgroup of 65 patients (paired group) who had at least one patient and clinician assessment on the same date using descriptive statistics. Agreement between patient and clinician assessments was evaluated by Cohen’s kappa coefficient. Results: Characteristics were well-balanced between all rectal patients and the paired group, with the exception of the use of intensity modulated radiotherapy (IMRT). IMRT has been used increasingly over time, and IMRT was therefore used in a larger proportion of the paired group versus all patients (77% vs. 51%, respectively). Diarrhea and proctitis were reported more often by patients than clinicians throughout treatment. Uncorrected agreement for diarrhea and proctitis was 82% and 72%, respectively. Corrected for chance, Cohen’s kappa was .64 for diarrhea, indicating moderate agreement, and .22 for proctitis, indicating only slight agreement. Conclusions: Our findings suggest a discrepancy between clinician and patient symptom reports. Further study is warranted to discern potential benefits of including PROs in prospective studies, and to find whether PROs can help clinicians set patient expectations, and/or enhance communication for optimal symptom management.

scholarly journals Response to neoadjuvant treatment among rectal cancer patients in a population-based cohort

2020 ◽  
Vol 36 (1) ◽  
pp. 177-185
Author(s):  
Elizabeth Alwers ◽  
Lina Jansen ◽  
Jakob Kather ◽  
Efrat Amitay ◽  
Hendrik Bläker ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Tumor Response ◽  
Patient Survival ◽  
Neoadjuvant Treatment ◽  
Population Based ◽  
Pathological Examination ◽  
Study Patient ◽  
Molecular Characteristics ◽  
Tumor Characteristics

Abstract Background In rectal cancer, prediction of tumor response and pathological complete response (pCR) to neoadjuvant treatment could contribute to refine selection of patients who might benefit from a delayed- or no-surgery approach. The aim of this study was to explore the association of clinical and molecular characteristics of rectal cancer with response to neoadjuvant treatment and to compare patient survival according to level of response. Methods Resected rectal cancer patients were selected from a population-based cohort study. Molecular tumor markers were determined from the surgical specimen. Tumor response and pCR were defined as downstaging in T or N stage and absence of tumor cells upon pathological examination, respectively. The associations of patient and tumor characteristics with tumor response and pCR were explored, and patient survival was determined by degree of response to neoadjuvant treatment. Results Among 1536 patients with rectal cancer, 602 (39%) received neoadjuvant treatment. Fifty-five (9%) patients presented pCR, and 239 (49%) and 250 (53%) patients showed downstaging of the T and N stages, respectively. No statistically significant associations were observed between patient or tumor characteristics and tumor response or pCR. Patients who presented any type of response to neoadjuvant treatment had significantly better cancer-specific and overall survival compared with non-responders. Conclusion In this study, patient characteristics were not associated with response to neoadjuvant treatment, and molecular characteristics determined after surgical resection of the tumor were not predictive of pCR or tumor downstaging. Future studies should include molecular biomarkers from biopsy samples before neoadjuvant treatment.

scholarly journals Radiologists Detect A Higher Frequency of Incidental Findings On Radiotherapy-Planning CT Scans of Breast Cancer Patients Than Oncologist

2022 ◽  
Author(s):  
Stine Nyby ◽  
Signe Hertz Hansen ◽  
Sophie Yammeni ◽  
Agnieszka Monika Delekta ◽  
Gintare Naujokaite ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Incidental Findings ◽  
Radiotherapy Planning ◽  
Ct Scans ◽  
Breast Cancer Patients ◽  
Cohen’S Kappa ◽  
Cohen's Kappa ◽  
Malignant Lesions ◽  
Planning Ct

Abstract Purpose: Breast cancer patients scheduled for postoperative radiotherapy undergo radiotherapy-planning computed tomography (CT), and incidental findings (IFs) may appear. This study investigated the interobserver variability between radiologists and oncologists when assessing IFs on radiotherapy-planning CT scans in breast cancer patients prior to adjuvant radiotherapy. Methods: We included 383 breast cancer patients who underwent planning CT at the Aalborg University Hospital between February 1, 2017 and February 28, 2018. IFs noted by the oncologists were identified from medical records. Two specialized radiologists reviewed the scans and described their IFs. IFs were classified as benign or potential malignant lesions. Cohen’s kappa statistic was used to measure interobserver agreement.Results: A total of 513 IFs were registered. The radiologists registered 433 findings, and the oncologists noted 80 (1.1 and 0.2 IFs per patient, respectively). Most potential malignant IFs were found in the liver, lungs, bones, and lymph nodes. The radiologists and oncologists detected potential malignant lesions in 94 (25%) and 34 (9%) patients, respectively. The oncologists’ sensitivity for detecting IFs in the liver and lungs were 29% and 20%, respectively. The agreements on IFs in the liver and lungs were fair (Cohen’s kappa values of 0.33 and 0.28, respectively).Conclusion: Radiologists reported a significantly higher frequency of IFs and potential malignant lesions than oncologists. Additionally, the oncologists had a low sensitivity when reporting IFs in both the liver and lungs. These results emphasize the need for specialized radiologists to scrutinize planning CT scans of breast cancer patients to ensure the intention to treat.

scholarly journals The Feasibility of Patient-Specific Circulating Tumor DNA Monitoring throughout Multi-Modality Therapy for Locally Advanced Esophageal and Rectal Cancer: A Potential Biomarker for Early Detection of Subclinical Disease

Diagnostics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 73
Author(s):  
Christopher Boniface ◽  
Christopher Deig ◽  
Carol Halsey ◽  
Taylor Kelley ◽  
Michael B. Heskett ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Cancer Patients ◽  
Feasibility Study ◽  
Locally Advanced ◽  
Circulating Tumor Dna ◽  
Study Patient ◽  
Patient Specific ◽  
Clinical Recurrence ◽  
Tumor Dna

As non-operative management (NOM) of esophageal and rectal cancer is becoming more prevalent, blood-biomarkers such as circulating tumor DNA (ctDNA) may provide clinical information in addition to endoscopy and imaging to aid in treatment decisions following chemotherapy and radiation therapy. In this feasibility study, we prospectively collected plasma samples from locally advanced esophageal (n = 3) and rectal cancer (n = 2) patients undergoing multimodal neoadjuvant therapy to assess the feasibility of serial ctDNA monitoring throughout neoadjuvant therapy. Using the Dual-Index Degenerate Adaptor-Sequencing (DIDA-Seq) error-correction method, we serially interrogated plasma cell-free DNA at 28–41 tumor-specific genomic loci throughout therapy and in surveillance with an average limit of detection of 0.016% mutant allele frequency. In both rectal cancer patients, ctDNA levels were persistently elevated following total neoadjuvant therapy with eventual detection of clinical recurrence prior to salvage surgery. Among the esophageal cancer patients, ctDNA levels closely correlated with tumor burden throughout and following neoadjuvant therapy, which was associated with a pathologic complete response in one patient. In this feasibility study, patient- and tumor-specific ctDNA levels correlated with clinical outcomes throughout multi-modality therapy suggesting that serial monitoring of patient ctDNA has the potential to serve as a highly sensitive and specific biomarker to risk-stratify esophageal and rectal cancer patients eligible for NOM. Further prospective investigation is warranted.

Predictors of electronic patient-reported outcomes use in the survivorship setting.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14038-e14038
Author(s):  
Bridgette Thom ◽  
Stacie Corcoran ◽  
Jessica A. Lavery ◽  
Leon Sarpong ◽  
Alexandria Woodside ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Symptom Burden ◽  
First Year ◽  
Patient Portal ◽  
Cohen’S Kappa ◽  
Cohen's Kappa ◽  
Patient Reported ◽  
One Year ◽  
Future Work ◽  
At Home

e14038 Background: Patient-reported outcomes (PRO) offer insight into patient perception of health and symptom burden. Despite a shift toward electronic PRO (ePRO), optimal administration methods are unclear. Our institution recently began ePRO collection in survivorship clinics: patients are invited via email to complete a health survey on our online patient portal prior to annual visits, enabling clinician review of symptoms in advance of the visit. Patients who do not complete an ePRO survey at home are offered an iPad or paper survey at visit check-in. In the first year of ePRO, 87 patients inadvertently submitted multiple responses to the questionnaire, across two modalities. This study aimed to 1) assess determinants of ePRO completion across modalities (portal, iPad, paper); and, 2) among patients who submitted multiple surveys, compare consistency of responses in surveys completed within 30 days of each other. Methods: We reviewed records for 10194 patients seen in breast, thoracic, colorectal, and gynecologic survivorship clinics over one year. Demographics, disease/treatment details, and PRO responses (symptoms, health behaviors, etc.) were extracted. For aim 1, we used multivariate regression to determine predictors of completion method. For aim 2, we calculated Cohen’s kappa coefficients to compare responses based on completion modality. Results: Most patients (65.6%) completed the survey on an iPad in clinic; 16.7% on the portal, 17.7% on paper in clinic. Younger age (p < .001), white race (p < .001), less fatigue (p = .01), and English as primary language (p < .001) were associated with portal use in multivariate analyses. In general, Cohen’s Kappa analyses revealed high agreement between surveys. Conclusions: Our findings highlight demographic gaps in ePRO acceptance. Although most patients completed an ePRO (portal or iPad), few completed it at home in advance of their visit, which has implications for clinic flow and clinician preparation for visits. However, our finding of consistent symptom reporting across mode and location of completion is reassuring. Future work should seek to improve comfort with ePRO completion at home among groups less likely to accept it and explore the implications of symptom burden on ePRO acceptance.

scholarly journals Translation and cultural adaptation into Brazilian Portuguese of the Finnish Diabetes Risk Score (FINDRISC) and reliability assessment

2020 ◽  
Vol 23 ◽  
Author(s):  
Estela Maria Barim ◽  
Kátia Cristina Portero McLellan ◽  
Rogério Silicani Ribeiro ◽  
José Antonio Maluf de Carvalho ◽  
Jaana Lindström ◽  
...  
Keyword(s):  
Risk Score ◽  
Cultural Adaptation ◽  
Reliability Assessment ◽  
Brazilian Portuguese ◽  
Diabetes Risk ◽  
Cohen’S Kappa ◽  
Cohen's Kappa ◽  
Patient Reported ◽  
Translation And Cultural Adaptation ◽  
Diabetes Risk Score

ABSTRACT: Introduction: The Finnish Diabetes Risk Score (FINDRISC) is a tool that was initially developed to predict the risk of developing type 2 diabetes mellitus in adults. This tool is simple, quick to apply, non-invasive, and low-cost. The aims of this study were to perform a translation and cultural adaptation of the original version of FINDRISC into Brazilian Portuguese and to assess test-retest reliability. Methodology: This work was done following the ISPOR Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes Measures. Once the final Brazilian Portuguese version (FINDRISC-Br) was developed, the reliability assessment was performed using a non-random sample of 83 individuals attending a primary care health center. Each participant was interviewed by trained registered dieticians on two occasions with a mean interval of 14 days. The reliability assessment was performed by analyzing the level of agreement between the test-retest responses of FINDRISC-Br using Cohen’s kappa coefficient and the intraclass correlation coefficient (ICC). Results: The steps of ISPOR guidelines were consecutively followed without major problems. Regarding the reliability assessment, the questionnaire as a whole presented adequate reliability (Cohen’s kappa = 0.82, 95%CI 0.72 - 0.92 and ICC = 0.94, 95%CI 0.91 - 0.96). Conclusion: FINDRISC was translated into Brazilian Portuguese and culturally adapted following standard procedures. FINDRISC-Br has thus become available for use and has potential as a screening tool in different Brazilian settings and applications.

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