Patient related outcomes in cancer patients in Croatia.

TPS6650 Background: Accurate evaluation of symptom intensities is essential for optimal cancer care and improving the quality of life of patients. An inappropriate interpretation of symptoms may lead to treatment outcomes failure, overdose of medication, or may leave the patients undertreated. However, the perception of symptoms can vary between the treating physician and patient. Physicians appear to underestimate the patient symptoms. And this variation in the perception of side effects can lead to wrong assumptions and subsequent treatment changes, affecting treatment effectiveness and quality of life. There is growing interest to enhance symptom monitoring during routine cancer care using patient-reported outcomes, leaving open the question of whether the benefits of systems to reveal self-reports outweigh their added cost. There are several tools for assessment of symptoms in oncology. In cancer treatment clinical trials, the standard source of adverse symptom data is clinician reporting by use of items from PRO-CTCAE, developed by NCI. To address these questions, we conducted a single-center prospective trial to test whether systematic tablet computer-based collection of patient-reported symptoms during chemotherapy treatment, with automated alerts to clinicians for severe adverse events (grade 3-4) will change in questionnaire score at 6 months compared with baseline. Secondary endpoints will include difference in unscheduled clinic visits frequency, and survival. Methods: Patients initiating chemotherapy at General Hospital Pula Oncology Clinic for advanced or metastatic gastrointestinal, lung, breast, genitourinary, or gynecologic cancers will be enrolled in a nonblinded, prospective trial of self-reporting of symptoms, compare with usual care. Patients receiving chemotherapy and their clinicians will be independently asked on the same day to complete 10 symptoms (including fatigue, pain, nausea, vomiting, diarrhea, dysgeusia, appetite, sleep disturbance, fever and hair loss). Participants will remain on study until discontinuation of cancer treatment, withdrawal, or death. All participants will provide written informed consent and followed for up to 28 months or until death. To compare how patient’s vs clinician’s reports relate to clinical events, a time-dependent Cox regression model adjusted for covariates including cancer type, age, sex, and education level will be used to measure associations between reaching particular grade severity thresholds with the risk of death and unscheduled clinic visits. Clinical trial information: 2019-000855-15.

Download Full-text

Prediction of all-cause mortality from 24 month trajectories in patient-reported psychological, clinical and quality of life outcomes in uveal melanoma patients

Journal of Behavioral Medicine ◽

10.1007/s10865-021-00252-8 ◽

2021 ◽

Author(s):

Stephen L. Brown ◽

Peter L. Fisher ◽

Laura Hope-Stone ◽

Heinrich Heimann ◽

Rumana Hussain ◽

...

Keyword(s):

Quality Of Life ◽

Life Expectancy ◽

Uveal Melanoma ◽

Cox Regression ◽

Multivariate Analyses ◽

Tumor Diameter ◽

Control Variables ◽

Patient Reported ◽

All Cause Mortality

AbstractA number of patient-reported outcomes (PROs) predict increased mortality after primary cancer treatment. Studies, though, are sometimes affected by methodological limitations. They often use control variables that poorly predict life expectancy, examine only one or two PROs thus not controlling potential confounding by unmeasured PROs, and observe PROs at only a single point in time. To predict all-cause mortality, this study used control variables affording good estimates of life expectancy, conducted multivariate analyses of multiple PROs to identify independent predictors, and monitored PROs two years after diagnosis. We recruited a consecutive sample of 824 patients with uveal melanoma between April 2008 and December 2014. PROs were variables shown to predict mortality in previous studies; anxiety, depression, visual and ocular symptoms, visual function impairment, worry about cancer recurrence, and physical, emotional, social and functional quality of life (QoL), measured 6, 12 and 24 months after diagnosis. We conducted Cox regression analyses with a census date of December 2018. Covariates were age, gender, marital and employment status, self-reported co-morbidities, tumor diameter and thickness, treatment modality and chromosome 3 mutation status, the latter a genetic mutation strongly associated with mortality. Single predictor analyses (with covariates), showed 6-month depression and poorer functional QoL predicting mortality, as did 6–12 month increases in anxiety and 6–12 month decreases in physical and functional QoL. Multivariate analyses using all PROs showed independent prediction by 6-month depression and decreasing QoL over 6–12 months and 12–24 months. Elevated depression scores six months post-diagnosis constituted an increased mortality risk. Early intervention for depressive symptoms may reduce mortality.

Download Full-text

Recommended Patient-Reported Core Set of Symptoms and Quality-of-Life Domains to Measure in Ovarian Cancer Treatment Trials

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/dju128 ◽

2014 ◽

Vol 106 (7) ◽

Cited By ~ 24

Author(s):

Kristine A. Donovan ◽

Heidi S. Donovan ◽

David Cella ◽

Martha E. Gaines ◽

Richard T. Penson ◽

...

Keyword(s):

Quality Of Life ◽

Ovarian Cancer ◽

Cancer Treatment ◽

Life Domains ◽

Treatment Trials ◽

Core Set ◽

Patient Reported

Download Full-text

Quality-of-life outcomes for prostate cancer treatment in Australia.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.6_suppl.143 ◽

2013 ◽

Vol 31 (6_suppl) ◽

pp. 143-143

Author(s):

Jeremy L. Millar ◽

Susan M. Evans ◽

Mark Frydenberg ◽

Declan G. Murphy ◽

Damien M. Bolton ◽

...

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Cancer Treatment ◽

Public Hospital ◽

Population Based ◽

Life Outcomes ◽

Hospital Type ◽

Prostate Cancer Treatment ◽

Patient Reported

143 Background: We aimed to use a population based quality registry established in Australia, to review patient-reported health-related QOL after the diagnosis of Prostate Cancer (PCa). Methods: Prospective registry of men with PCa from statutory notifications to the canonical population-based cancer registry in Victoria. An "opt-off" mechanism used. Coverage expanded from 30%-80% of State population over time. Demographics and disease features, management, and outcomes from medical record; men phoned at 12 and 24 months (m), interviewed with script including SF12 and items from standard form (UCLA PCI) for specific QOL outcomes. Urinary, rectal, and sexual function bother (UB, RB, and SB) scores where analysed by univariate and multivariable modelling for relationship of these with presentation or management factors, adjusting for risk. Results: Men from 8/2008 - 2/2011; 1.9% of eligible opted out. Followed 1172 to 12 & 24 m. Median diagnosis age 65 yr; median PSA 6.8 ng/mL; 97.3% clinically localised with 47.7% having NCCN intermediate risk. 520 had treatment with Radical Prostatectomy (RP) (89 also with external beam-EBRT), 171 had EBRT (with or without HDR brachy), and 211 seed implant (SI). 226 had no treatment (NT) in the first 12 m. 52.5% managed in public hospitals, rest private. Univariate analysis: UB associated with management type, and hospital type, and RB and SB associated with these factors, as well as age and disease stage. On multivariate regression SB at 12 m was associated with increasing age (p=0.002) and radical treatment types (RP and EBRT/HDR, p<0.001 and 0.003 respectively)—except SI—compared to NT; RB was associated with SI (0.02) and EBRT/HDR (0.007) and treatment in a public hospital (0.006); and UB was associated with public hospital (<0.001). All associations at 12 m remained significant at 24 m. SF12 physical score had a positive association with RP vs NT (0.014), hospital type (0.001) and younger age. SF12 mental health also showed associations. Conclusions: A large scale registry in Australia assessing patient-reported quality of life outcomes after prostate cancer treatment shows patterns similar to that seen in North American reports.

Download Full-text

Compliance of subjects using electronic patient-reported outcomes (ePRO) in multinational prostate trials.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.232 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 232-232

Author(s):

Susan M. Dallabrida

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Clinical Trials ◽

Patient Reported Outcomes ◽

Short Form ◽

Quality Data ◽

Data Set ◽

Patient Reported ◽

Clinic Visits

232 Background: Patient Reported Outcomes (PRO) and electronic PRO (ePRO) are increasingly becoming an important aspect of cancer clinical trials and patient care, especially with regard to measuring drug efficacy, patient quality of life and drug safety. Subject compliance with completion of PRO/ePRO assessments is an important component for obtaining accurate and high-quality data when conducting clinical trials. It has been hypothesized that patient health status, length of time in a trial and country of origin, may affect compliance. Methods: To address this hypothesis, an operational analysis was conducted to assess oncology subject completion compliance of PRO reports using an electronic tablet to determine its suitability and performance in use. Toward this objective, the compliance of prostate cancer patients in completing three electronic questionnaires that were administered at clinic visits was evaluated. Subjects were asked to complete the Brief Pain Inventory – Short Form (BPI-SF) at every clinic visit. At some clinic visits, subjects were asked to additionally complete the Functional Assessment of Cancer Therapy – Prostate (FACT-P) and the Euro Quality of Life 5 Dimensions (EQ-5D). Questionnaires were completed electronically on the tablet. Percent completion was calculated as the number of questionnaires completed divided by the number of questionnaires expected, based on attended clinic visits compiled for this review and the administration schedule for the questionnaires. Results: This review draws on the experience of over 1,000 subjects from 21 countries, and describes the individual and overall compliance with the expected questionnaire completion, the variance between subsequent visits, and compliance by country. Conclusions: The collection of ePRO using a clinic-based tablet yielded a highly complete data set in prostate cancer subjects demonstrating that this is an effective and feasible approach for recording symptoms and quality of life assessments.

Download Full-text

MO131THE SHRUNKEN PORE SYNDROME IS ASSOCIATED WITH POOR PROGNOSIS AND LOWER QUALITY OF LIFE IN HEART FAILURE PATIENTS- THE HARVEST-MALMÖ STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab092.009 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Liana Xhakollari ◽

Anders Grubb ◽

Amra Jujic ◽

Erasmus Bachus ◽

Peter M Nilsson ◽

...

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Poor Prognosis ◽

Kansas City ◽

Cox Regression ◽

Cardiorenal Syndrome ◽

Risk Of Death ◽

Increased Risk ◽

Health Related Qol

Abstract Background and Aims The cardiorenal syndrome was studied in heart failure (HF) patients with respect to the “Shrunken pore syndrome” (SPS) that is characterized by a difference in renal filtration between cystatin C and creatinine, resulting in a low eGFRcystatin C/eGFRcreatinine-ratio. Method 373 patients hospitalized for HF were retrieved from the HeARt and brain failure inVESTigation trial (HARVEST-Malmö). We used CKD-EPI formulas for estimated glomerular filtration rate (eGFR). Presence of SPS was defined as eGFRcystatinC ≤60% of eGFRcreatinine. In Cox regression multivariate models, associations between SPS, risk of death and risk of 30-day re-hospitalization were studied. Associations between SPS and impaired quality of life (QoL) were studied using multivariate logistic regressions. Results SPS was associated with all-cause mortality (124 events; hazard ratio (HR) 2.35; confidence interval (CI95%) 1.17-4.71; p=0.016 and with 30-day re-hospitalization (70 events; HR 1.82; CI95% 1.04-3.18; p=0.036). Analyses of QoL, based on a Kansas City Cardiomyopathy Questionnaire overall score <50, revealed that SPS was associated with increased risk of low health-related QoL (odds ratios (OR) 2.15 (CI95% 1.03-4.49; p=0.042). Conclusion The results of this observational study show for the first time an association between SPS and poor prognosis in HF. Further studies are needed to confirm the results in HF cohorts and experimental settings to identify pathophysiological mechanisms.

Download Full-text

A pilot study of using smartphone application versus routine follow up for patients' care in advanced non-small cell lung cancer (NSCLC).

Journal of Global Oncology ◽

10.1200/jgo.2019.5.suppl.9 ◽

2019 ◽

Vol 5 (suppl) ◽

pp. 9-9

Author(s):

Naiyarat Prasongsook ◽

Kasan Seetalarom ◽

Siriwimon Saichaemchan ◽

Kitipong Udomdamrongkul

Keyword(s):

Quality Of Life ◽

Lung Cancer ◽

Cancer Care ◽

Mobile Application ◽

Advanced Nsclc ◽

Patient Reported Outcome ◽

P Value ◽

Patient Reported

9 Background: Web-based patient reported outcome (PRO) improved quality of life (QoL), and overall survival (OS) in patients with advanced NSCLC who were treating with specific therapy. Lung Cancer Care application is a mobile application program that provides patients with individually tailored information on patient reported outcome. This study aims to invent a novel mobile application evaluating PRO for Thai NSCLC patients, and to evaluate the validity of mobile application. Methods: Our mobile application-based PRO was designed for monitoring quality of life. The validity of the application was tested following guidelines for translating, and validating a questionnaire. The quality of life score (FACT-L score). After the validated mobile application-based PRO, patients with advanced NSCLC were randomized to use mobile application-based PRO versus routine follow-up. The primary endpoint was quality of life (QoL). Secondary endpoint was OS. Results: Thirty-three patients with advanced NSCLC were enrolled. The mean of FACT-L score at baseline in mobile application-based PRO arm and routine follow up arm was similar (90.08 ± 5.66 vs 91.78 ± 5.26, p-value= 0.82). Patients with mobile application group had more FACT-L score at 3 months than patients with routine follow up arm (106 ± 5.97 vs 99.96 ± 5.74, p-value = 0.07). There was a trend towards increased in different mean of FACT-L score at baseline and 3 months in patients with mobile application compared to patients with routine follow up ( p-value = 0.05). The median follow-up time was 5.43 months, patients with mobile application had longer median OS than patients with routine follow up (4 months vs 2.9 months, p-value = 0.5). Conclusions: Lung Cancer Care application based on self-reported symptoms is a novel electronic device for real-time patient care monitoring. Our study results showed trend towards improved quality of life from using this novel mobile application. However, there was small samples for pilot testing, the relatively large sampling errors may reduce the statistical power needed to validate this tool.

Download Full-text

The association of baseline anxiety and depression with overall survival (OS) in colorectal cancer (CRC).

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.706 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 706-706

Author(s):

Pierre Y. Cheung ◽

Tian Yang Darren Liu ◽

Jason D. Kim ◽

Winson Y. Cheung

Keyword(s):

Quality Of Life ◽

Cancer Survival ◽

Cox Regression ◽

Significant Proportion ◽

Vital Statistics ◽

Anxiety And Depression ◽

Psychosocial Wellbeing ◽

Patient Reported ◽

The Impact

706 Background: Patient-reported measures such as psychosocial wellbeing and quality of life have been reported to correlate with cancer survival, but the specific factors within these constructs that associate with outcomes remains poorly defined. Our aim was to examine the effect of baseline anxiety and depression on OS in a population-based cohort of CRC patients. Methods: Patients diagnosed with CRC in 2008, referred to any 1 of 5 regional cancer centers in British Columbia, and who completed a baseline questionnaire to evaluate anxiety and depression were reviewed. We developed a scoring system based on these patient-reported survey data to characterize intensity and subsequently categorized patients as having no, mild, moderate or severe anxiety and/or depression. Vital statistics were captured by medical records. Unadjusted Kaplan-Meier methods and multivariate Cox regression models that controlled for additional socio-demographic and clinical characteristics were constructed to correlate anxiety and depression with OS. Results: A total of 449 patients were included: median age was 66 years (range 26-92), 52% were men, and 69% were white. A significant proportion of respondents reported anxiety (58%) or depression (45%) at baseline. Among them, the majority indicated their anxiety and depressive symptoms were severe (43% and 43%, respectively). Women and those who were single or unmarried were more likely to have anxiety and depression (p<0.001 and p=0.02, respectively). In unadjusted analyses, we observed a trend where increased severity of anxiety (p=0.07) and depression (p=0.04) correlated with worse outcomes. In Cox regression that considered other prognostic factors, however, this observation failed to persist, and neither anxiety nor depression associated with OS (Table). Conclusions: The impact of psychosocial wellbeing and quality of life on CRC outcomes that have been previously described in the literature are unlikely to be mediated through baseline anxiety or depression. [Table: see text]

Download Full-text

Efficacy analysis of a remote symptom management platform.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.1566 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 1566-1566

Author(s):

Paris A. Kosmidis ◽

Christie Lagogianni ◽

Thanos Kosmidis

Keyword(s):

Quality Of Life ◽

Colorectal Cancer ◽

Side Effects ◽

Cancer Patients ◽

Symptom Management ◽

Side Effect ◽

Substantial Improvement ◽

Cancer Type ◽

Patient Reported

1566 Background: Quality of life of cancer patients is a critical part of cancer care. Symptom management is evolving as a multidisciplinary approach, and is increasingly delivered through a combination of physical and remote interactions. CareAcross is an online platform offering personalized, guidelines-based support to cancer patients, that complements physicians’ support and enables remote monitoring. This analysis investigated the improvement in the quality of life of cancer patients delivered through such remote support. Methods: Patients engage with an online interactive platform to receive personalized support based on a variety of parameters, through algorithms incorporating their exact diagnoses, treatments and comorbidities, and more. For symptom management, patients report the presence of specific side-effects via brief questionnaires; for each side-effect reported, they receive tailored support (text and multimedia) to help overcome it. These online questionnaires are repeated periodically to capture the outcome of the supportive process, and provide additional support as necessary. A retrospective analysis evaluated the efficacy of the personalized support: each patient’s reported side-effects were compared before versus after receiving the support, hence calculating the reduced incidence. Results: 2203 patients from 8 countries, with breast, lung, prostate or colorectal cancer (1563, 404, 159 and 77, respectively) reported side-effects, received support, and updated their reports at least once. The median follow-up period was 4.9 months. The patient-reported outcomes on their quality of life revealed substantial improvement, regardless of cancer type (lowest recorded improvement = 25.7%). Commonly reported side-effects included sleep problems, dry mouth, constipation, changes in food taste, and more (see Table). Side-effects reported in specific cancer types also showed substantial improvement, including hot flushes (breast; 32.0% improvement), dyspnea (lung; 38.1%), bowel dysfunction (prostate; 80%) and others. The efficacy of the support to breast, prostate or colorectal cancer patients was similar; support to lung cancer patients exhibited the lowest efficacy (p < 0.05). Fatigue was the most common side-effect. It was also the most resistant to improvement compared to all others (p < 0.05). Conclusions: Digital remote support of cancer patients is a realistic option to improve quality of life. Randomized controlled trials can help quantify its impact on health economics, hospital admissions, resource utilization, and other aspects.[Table: see text]

Download Full-text

Financial toxicity in gynecologic cancer survivors and its impact on quality of life.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.53 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 53-53

Author(s):

Akhil Mehta ◽

Jukes P. Namm ◽

Ellen D'Errico ◽

Eric Lau ◽

Linda Hong ◽

...

Keyword(s):

Quality Of Life ◽

Side Effects ◽

Cancer Survivors ◽

Cancer Care ◽

Uterine Cancer ◽

Gynecologic Cancer ◽

Financial Toxicity ◽

Patient Reported ◽

The Continuum

53 Background: Financial toxicity (FT) is a critical concern for cancer survivors. There is limited data about the relationship between FT throughout the continuum of cancer care, demographics, disease factors, and quality of life (QoL) indicators in gynecologic cancer survivors. Methods: Gynecologic cancer survivors who received treatment from 2015 to 2019 at Loma Linda University Cancer Center were invited to complete an anonymous online survey. A modified version of the comprehensive score for financial toxicity (COST) survey was used to assess FT at baseline and after treatment. The patient-reported outcomes measurement information system (PROMIS) survey was used to assess QoL. Demographic data were summarized using descriptive statistics. Associations between disease factors and FT measured at baseline and after treatment were analyzed using univariable linear regression. Lower COST score coefficients indicate greater FT. Correlations between FT and QoL were evaluated using the Pearson correlation. Results: A total of 252 surveys were sent to gynecologic cancer survivors who met study criteria, of whom 28% responded. Amongst 70 patients included in this analysis, the median age was 64 (IQR 56, 70), 47% were white (n = 33), 20% were unemployed, 22% had a high school or lower level of education, and 50% had an annual income < $60,000. With respect to cancer subtype, 63% had uterine cancer (n = 44), 20% had cervical cancer (n = 14), and 17% had ovarian cancer (n = 12). The mean COST score at baseline and after treatment was 21.2 ± 9.2 and 12.9 ± 7.8, respectively. The following characteristics were associated with significantly greater FT at baseline: Hispanic ethnicity (-5.5; 95% CI: -1 to -10), Black race (-14.4; 95% CI: -3.4 to -25.4), household number > 4 (-6.9; 95% CI: -2.6 to -16.4), Medicare insurance (-6.5; 95% CI: -1.7 to -11.2), and Medicaid insurance (-11.2; 95% CI: -4.3 to -17.9) (p < 0.05). Patients who received combined modality surgery, chemotherapy, and radiation had significantly higher FT (-5.6; 95% CI: -1.3 to -9.8, p < 0.05) compared to those who received single-modality treatment. Likewise, patients with 5 or more treatment-related side effects had significantly higher FT (-6.3; 95% CI -1.13 to -11.4, p < 0.05) compared to those who reported no side effects. During treatment, 24% of patients turned down or skipped treatment, 38% quit their job, and 28% reported family members quit their job. Finally, COST scores measured after treatment correlated positively with physical and mental health (Pearson coefficient 0.57 and 0.56 respectively, p < 0.001). Conclusions: These findings support the need for assessing FT at baseline and throughout the continuum of cancer care to provide individualized assistance to patients facing financial strain. FT affects compliance to treatment which can adversely affect cancer-related outcomes and QoL. Additional policies are needed to address the increasing cost of cancer care.

Download Full-text