Integrative oncology consultation and symptom palliation: Analysis of patient-reported outcomes at a comprehensive cancer center.

84 Background: Patients (pts) receiving cancer care are increasingly interested in complementary health approaches to improve symptoms and quality of life. We report on demographics and patient reported outcomes in an integrative oncology (IO) clinic. Methods: Pts presenting for IO consultation or follow-up completed: Measure Yourself Concerns and Wellbeing (MYCaW), Edmonton Symptom Assessment Scale (ESAS), Short Form 12 (SF-12) quality of life (QOL) scale, and an overall satisfaction questionnaire. Consultations were provided by medical oncologists. Results: 2,474 consultations were conducted from 9/2009 to 12/2013; 26.0% (n = 643) had ≥ 1 follow-up visit (mean 3.2; SD1.8). Most were female (69%) and white (75%); most frequent cancer types was breast (29%); 29% of pts had advanced disease. At baseline, ESAS scores were highest for Sleep (4.2; SD 2.8), Fatigue (4.0; SD 2.8), Well-Being (3.8 SD 2.6) and Anxiety (3.1; SD 2.9). Those with advanced disease had significantly higher baseline ESAS scores for pain, nausea, shortness of breath, and appetite; higher ESAS subscale scores for physical and global distress; lower SF-12 physical health scores; and were more interested in developing an integrative/holistic approach and appetite. Those with loco-regional disease were more interested in overall health, hot flashes, and dry mouth. For ESAS baseline scores ≥ 4 and follow up within 30 days of the initial consult, we observed overall improvement in ESAS symptoms (38-60% of pts with ESAS decrease ≥ 1). Overall satisfaction was high at both initial encounter (9.4; SD 1.3) and first follow up (9.5; SD 1.2). Patients were satisfied to very satisfied with how well MYCaW concern 1 and 2 were addressed: 8.0 (SD 2.2) and 9.1 (SD 1.8). No difference in overall satisfaction was observed comparing those with advanced vs loco-regional disease. Conclusions: Most pts presenting for integrative oncology consultation have early stage disease, relatively low symptom burden, and are most interested in support for overall health. Patients were overall very satisfied with how well their top concerns were addressed, with significant improvements in symptom distress.

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Physical Therapist–Led Exercise Assessment and Counseling in Integrative Cancer Care: Effects on Patient Self-reported Symptoms and Quality of Life

Integrative Cancer Therapies ◽

10.1177/1534735419832360 ◽

2019 ◽

Vol 18 ◽

pp. 153473541983236 ◽

Cited By ~ 5

Author(s):

Gabriel Lopez ◽

Carol Eddy ◽

Wenli Liu ◽

Yisheng Li ◽

Minxing Chen ◽

...

Keyword(s):

Quality Of Life ◽

Global Health ◽

Physical Therapist ◽

Comprehensive Cancer Center ◽

Exercise Counseling ◽

Patient Reported ◽

Edmonton Symptom Assessment Scale ◽

Clinically Significant

Background. Exercise - contributes to improved treatment-related outcomes. We reviewed characteristics of cancer patients referred for physical therapist–led exercise counseling at a comprehensive cancer center and its effects on self-reported symptoms and quality of life. Methods. Patients presenting for outpatient exercise counseling from February 2016 to May 2017 completed the Edmonton Symptom Assessment Scale (ESAS; 0-10 scale, 10 most severe) pre-encounter/post-encounter and Patient-Reported Outcomes Measurement Information System (PROMIS10) global health assessment pre-encounter. Counseling included assessment and education. ESAS individual items and subscales of physical distress (PHS), psychological distress, and global distress (GDS) were analyzed. We used paired t-tests to compare (1) ESAS symptoms pre-encounter/post-encounter and (2) ESAS and PROMIS10 scores at baseline (pre-encounter) and first follow-up. Results. Of 350 participants, most were female (77.7%), Caucasian (66.3%), and had breast cancer (43%). Baseline (pre-encounter) symptom scores (frequency; mean) included poor sleep (68.2%; 3.5), poor well-being (67.4%; 3.2), and fatigue (64.7%; 3.1). Comparing pre-encounter/postencounter ESAS outcomes, we observed statistically and clinically significant reduction in GDS (−3.32; SD = 6.52; P < .001). On follow-up, statistically and clinically significant improvements were observed for fatigue (−1.22; P = .01), GDS (−4.81; P = .01), PHS (−3.1; P = .03) and PROMIS10 global health, mental health, and physical health scores (all P <.05). Conclusion. Patients presenting for exercise counseling had a low to moderate symptom burden and experienced significant improvement in GDS. Longitudinal evaluation revealed improvement in global health and fatigue. Additional research is needed to learn more about patient selection and timing of exercise counseling.

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Digital health application for real-time patient-reported outcomes during prostate radiotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.2_suppl.157 ◽

2016 ◽

Vol 34 (2_suppl) ◽

pp. 157-157 ◽

Cited By ~ 2

Author(s):

Daniel Xiao Yang ◽

Jackson Thea ◽

Yi An ◽

James B. Yu

Keyword(s):

Quality Of Life ◽

Real Time ◽

Mobile Applications ◽

Mobile Application ◽

Patient Reported Outcomes ◽

Digital Health ◽

Prostate Radiotherapy ◽

Patient Reported

157 Background: The use of digital health technology, including mobile applications, in the clinical setting is becoming increasingly more prevalent. Such technology is currently being explored as clinical research tools. While the side effects of prostate radiotherapy are well documented after treatment, there remains a paucity of data on patient-reported outcomes and changes in quality of life (QOL) during the treatment period. Therefore, mobile applications represent a practical platform to enable patient reporting in real-time during prostate radiotherapy. Methods: Using an existing open source code framework (Apple ResearchKit), we developed a novel mobile application that enables prostate cancer patients to report, either during or immediately following daily radiation treatment, changes in urinary, bowel, sexual, and hormonal QOL domains. The mobile application utilizes validated questions from the Expanded Prostate Index Composite for Clinical Practice (EPIC-CP) Survey, and allows for survey responses to be tracked over time throughout the treatment period and at routine follow up. Results: For the initial phase of our study, we are currently piloting the mobile application at a single institution with a goal of accruing 50 patients. Study results will be compared to data from traditional surveys, which are available at follow-up but impracticable for real-time symptom reporting. By ASCO 2016 Genitourinary Cancers Symposium, we plan to begin the second phase of our study where any patient can enroll online through a mobile software distribution platform (Apple App Store). Conclusions: We demonstrate the feasibility of using a mobile application to enable patients to report quality of life changes in real-time during prostate radiotherapy. Moreover, our application facilitates clinical trials where patient data collection can be automated and completed at scale. Future prospective studies are planned to evaluate validity of clinical trial data gathered through such methodology.

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Patient-reported outcomes in congenital cardiac disease: are they as good as you think they are?

Cardiology in the Young ◽

10.1017/s1047951110001216 ◽

2010 ◽

Vol 20 (S3) ◽

pp. 143-148 ◽

Cited By ~ 10

Author(s):

Philip Moons

Keyword(s):

Quality Of Life ◽

Cardiac Disease ◽

Patient Reported Outcomes ◽

Well Being ◽

Main Question ◽

Congenital Cardiac Disease ◽

Patient Reported ◽

Satisfaction With Treatment

AbstractPatient-reported outcomes are “any outcome based on data provided by patients or patient proxy as opposed to data provided from other sources”. Examples of patient-reported outcomes are quality of life, well-being, functional status, symptoms, adherence to treatment, satisfaction with treatment, and utility or preference-based measures. The main question of this manuscript is whether patient-reported outcomes in patients with congenital cardiac disease are as good as we think they are. In general, we could say yes, because numerous studies show that patients with congenital cardiac disease have an excellent quality of life. By contrast, we could say no, because patients generally overestimate their functioning, and up to two out of three patients are not compliant with the prescribed therapy or recommendations for follow-up. However, most importantly, we have to say that we do not know whether the patient-reported outcomes are good, because research with patient-reported outcomes in congenital cardiac disease is limited. Hence, patient-reported outcomes should be a priority on the agenda for research in the domain of congenital cardiac disease.

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Assessment of patient-reported outcomes after polytrauma: protocol for a systematic review

BMJ Open ◽

10.1136/bmjopen-2017-017571 ◽

2018 ◽

Vol 8 (3) ◽

pp. e017571 ◽

Cited By ~ 2

Author(s):

Irmela Gnass ◽

Michaela Ritschel ◽

Silke Andrich ◽

Silke Kuske ◽

Kai Moschinski ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Activities Of Daily Living ◽

Daily Living ◽

Patient Reported Outcomes ◽

Short Term ◽

Patient Reported

IntroductionSurvivors of polytrauma experience long-term and short-term burden that influences their lives. The patients’ view of relevant short-term and long-term outcomes should be captured in instruments that measure quality of life and other patient-reported outcomes (PROs) after a polytrauma. The aim of this systematic review is to (1) collect instruments that assess PROs (quality of life, social participation and activities of daily living) during follow-up after polytrauma, (2) describe the instruments’ application (eg, duration of period of follow-up) and (3) investigate other relevant PROs that are also assessed in the included studies (pain, depression, anxiety and cognitive function).Methods and analysisThe systematic review protocol is developed in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement. MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Cochrane Central Register of Controlled Trials and the trials registers ClinicalTrials.gov and WHO International Clinical Trials Registry Platform will be searched. Keywords, for example, ‘polytrauma’, ‘multiple trauma’, ‘quality of life’, ‘activities of daily living’ or ‘pain’ will be used. Publications published between January 2005 and the most recent date (currently: August 2016) will be included. In order to present the latest possible results, an update of the search is conducted before publication. The data extraction and a content analysis will be carried out systematically. A critical appraisal will be performed.Ethics and disseminationFormal ethical approval is not required as primary data will not be collected. The results will be published in a peer-reviewed publication.PROSPERO registration numberCRD42017060825.

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Exercise counseling in integrative cancer care: Effects on patient self-reported symptoms and quality of life.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.34_suppl.227 ◽

2018 ◽

Vol 36 (34_suppl) ◽

pp. 227-227

Author(s):

Gabriel Lopez ◽

Carol A Eddy ◽

Wenli Liu ◽

Yisheng Li ◽

Minxing Chen ◽

...

Keyword(s):

Quality Of Life ◽

Global Health ◽

Physical Therapist ◽

Comprehensive Cancer Center ◽

Exercise Counseling ◽

Edmonton Symptom Assessment Scale ◽

Clinically Significant ◽

Global Distress

227 Background: Exercise has shown benefits for cancer prevention and contributes to improved treatment-related outcomes. We reviewed characteristics of cancer patients referred for physical therapist-led exercise counseling at a comprehensive cancer center and its effects on self-reported symptoms and quality of life. Methods: Patients presenting for outpatient exercise counseling from February 2016 to May 2017 completed the Edmonton Symptom Assessment Scale (ESAS; 0-10 scale, 10 most severe) pre/post-encounter and PROMIS10 global health assessment pre-encounter. ESAS individual items and subscales of Physical Distress (PHS), Psychological Distress (PSS), and Global Distress (GDS) were analyzed. We used paired t-tests to compare: (1) ESAS symptoms before and after each encounter and (2) ESAS and PROMIS10 scores at baseline and first follow-up. Results: Of 350 participants, most were female (77.7%), white (66.3%), and had breast (43%) cancer; 31% had at least one follow-up visit with the physical therapist. Symptom scores at baseline (frequency; mean) included poor sleep (68.2%; 3.5), poor well-being (67.4%; 3.2), and fatigue (64.7%; 3.1). Examination of pre- to post-exercise counseling outcomes revealed statistically, and clinically significant improvement in GDS (-3.32, SD 6.52, p<0.001). On follow-up, statistically and clinically significant improvements were observed for ESAS measures of fatigue (-1.22, p=0.01), GDS (-4.81, p=0.01), and PHS (-3.1, p=0.03) and PROMIS10 global health, mental health, and physical health scores (all p’s<0.05). Conclusions: Patients presenting for exercise counseling had a low to moderate symptom burden and experienced significant improvement in global distress after one encounter. Longitudinal evaluation revealed improvement in global health and fatigue. Additional research is needed to learn more about patient selection and timing of exercise counseling interventions.

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P-BN11 Patient Reported Outcomes of Phasix™ ST Mesh for Laparoscopic Hiatal Hernia Repair

British Journal of Surgery ◽

10.1093/bjs/znab430.012 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Yan Yu Tan ◽

Sri Vishnu Thulasiraman ◽

Phanibhushana Munipalle ◽

Yirupaiahgari Viswanath

Keyword(s):

Quality Of Life ◽

Hernia Repair ◽

Hiatal Hernia ◽

Patient Reported Outcomes ◽

Hiatal Hernia Repair ◽

Complication Rates ◽

Laparoscopic Hiatal Hernia Repair ◽

Patient Reported

Abstract Background Laparoscopic hiatal hernia repair continues to suffer from high recurrence rates, which has prompted the use of mesh reinforcement by some surgeons. Use of mesh however remains controversial due to its association with complications such as erosion, fibrosis and oesophageal stenosis. Biosynthetic Poly-4-Hydroxybutyrate Phasix™ ST mesh is an emerging technology which combines the durability of synthetic mesh with the remodelling characteristics of biologic mesh and includes an anti-adhesion hydrogel barrier. There is a paucity of patient reported outcome data for Phasix™ ST mesh. This study evaluates early patient reported outcomes following laparoscopic hiatal hernia repair with Phasix™ ST mesh. Methods Adult patients undergoing laparoscopic hiatal hernia repair with Phasix™ ST mesh between July 2020 to June 2021 at our institution were identified. Prospective data, including demographic data and complication rates, was collected from electronic and paper medical records. The 12-Item Short Form Survey (SF-12) was administered to assess quality of life pre-operatively and post-operatively with a minimum 30-day follow-up. Results Fourteen patients (12 female, one male) were included with a median age of 66 years (range 52-79). There were no intraoperative complications, mesh-related complications, re-operation, re-admission, or recurrence at a median follow-up of 4 months (IQR 4.0). Median physical health component (PHC) score was 32.7 (IQR 6.2) at baseline and increased to 41.6 (IQR 13.7) post-operatively. Median difference in PHC score was +11.4 (IQR 10.7). Median mental health component (MHC) score was 39.8 (IQR 12.5) at baseline and increased to 57.4 (IQR 8.2) post-operatively. Mean difference in MHC score was +17.7 (IQR 15.9). Conclusions To our knowledge, this is the first report of outcomes on the use of Phasix™ ST mesh for laparoscopic hiatal hernia repair in the United Kingdom. Our study found that it is associated with improvements in both physical and mental quality of life in the short-term post-operative follow-up, although there is some variation in the degree of improvement reported.

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Patient-reported outcomes of occipitocervical and atlantoaxial fusions in children

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.8.peds16286 ◽

2017 ◽

Vol 19 (1) ◽

pp. 85-90 ◽

Cited By ~ 4

Author(s):

Aditya Vedantam ◽

Daniel Hansen ◽

Valentina Briceño ◽

Alison Brayton ◽

Andrew Jea

Keyword(s):

Quality Of Life ◽

Regression Analysis ◽

Patient Reported Outcomes ◽

Pediatric Patients ◽

Linear Regression Analysis ◽

Multivariate Linear Regression Analysis ◽

Atlantoaxial Fusion ◽

Patient Reported

OBJECTIVE There is limited literature on patient-reported outcomes (PROs) and health-related quality of life (HRQOL) outcomes in pediatric patients undergoing surgery for craniovertebral junction pathology. The aim of the present study was to assess surgical and quality of life outcomes in children who had undergone occipitocervical or atlantoaxial fusion. METHODS The authors retrospectively reviewed the demographics, procedural data, and outcomes of 77 consecutive pediatric patients who underwent posterior occipitocervical or atlantoaxial fusion between 2008 and 2015 at Texas Children's Hospital. Outcome measures (collected at last follow-up) included mortality, neurological improvement, complications, Scoliosis Research Society Outcomes Measure–22 (SRS-22) score, SF-36 score, Neck Disability Index (NDI), and Pediatric Quality of Life Inventory (PedsQL). Multivariate linear regression analysis was performed to identify factors affecting PROs and HRQOL scores at follow-up. RESULTS The average age in this series was 10.6 ± 4.5 years. The median follow-up was 13.9 months (range 0.5–121.5 months). Sixty-three patients (81.8%) were treated with occipitocervical fusion, and 14 patients (18.1%) were treated with atlantoaxial fusion. The American Spinal Injury Association (ASIA) grade at discharge was unchanged in 73 patients (94.8%). The average PRO metrics at the time of last follow-up were as follows: SRS-22 score, 4.2 ± 0.8; NDI, 3.0 ± 2.6; the parent's PedsQL (ParentPedsQL) score, 69.6 ± 22.7, and child's PedsQL score, 75.5 ± 18.7. Multivariate linear regression analysis revealed that older age at surgery was significantly associated with lower SRS-22 scores at follow-up (B = −0.06, p = 0.03), and the presence of comorbidities was associated with poorer ParentPedsQL scores at follow-up (B = −19.68, p = 0.03). CONCLUSIONS This study indicates that occipitocervical and atlantoaxial fusions in children preserve neurological function and are associated with acceptable PROs and ParentPedsQL scores, considering the serious nature and potential for morbidity in this patient population. However, longer follow-up and disease-specific scales are necessary to fully elucidate the impact of occipitocervical and atlantoaxial fusions on children.

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