Mobile and comprehensive assessment of patient-reported outcomes (PRO) in routine inpatient cancer care: A three-arm randomized controlled feasibility study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18664-e18664
Author(s):  
Hanna Salm ◽  
Leopold Hentschel ◽  
Michael Kramer ◽  
Daniel Pink ◽  
Markus K Schuler
Keyword(s):  
Hospital Stay ◽  
Cancer Care ◽  
Symptom Burden ◽  
Satisfaction With Care ◽  
Control Group ◽  
Inpatient Setting ◽  
Daily Routine ◽  
Patients Satisfaction ◽  
Patient Reported ◽  
Group A

e18664 Background: Most of the work on PRO has been done in outpatient setting. However, cancer patients might even suffer from more severe problems when admitted to hospital for anticancer therapy. The question whether and how patients’ well-being changes during the course of the hospital stay and if electronically assessed PRO (ePRO) will bring benefit to patients and physicians remains unanswered. Implementing such a tool into routine clinical care can be considered as an additional challenge.The objectives of this study were to implement a multidimensional ePRO system to improve patient-physician interaction in inpatient cancer care and test its feasibility. A comprehensive set of PRO measures that would broadly assess the patient’s situation was developed by a multidisciplinary expert team. Before study initiation, semi-structured interviews with patients were carried out to optimize visualization and user experience. The tool included a rapid response ePRO system with a patient-tailored graphical feedback for physicians. The effect of the mobile tool on quality of life (QoL), symptom burden and patients’ satisfaction with care were explored. Methods: The study is an interventional, three-arm and multicenter inpatient trial. A self-administered questionnaire based on validated PRO-measures was applied and completed at admission, one week after and at discharge. Group A (intervention arm) and B received tablet versions while group C (control) completed the questionnaire on paper. Additional to the mere assessment of electronic patient reported outcome, results from group A were presented graphically to the treating physicians. Standardized instruments included measures of QoL (EORTC QLQ-C30), patients’ satisfaction with care (IN-PATSAT32) and adverse events (PRO-CTCAE). A feasibility questionnaire was administered to arm A and B. Results: N = 185 patients (mean age 63.5, 44.3% female) were recruited in oncology wards. 62% of patients were treated for oncological disease (33% with stage IV disease) and 37% for hematological disease. Feasibility questions revealed that the majority of patients preferred the electronic tool and believed that the tool was of high value for individualized patient care. Among others, symptom burden and global QoL did not significantly change during hospital stay. Satisfaction with care was significantly lower ( p = 0.047) in the intervention group (mean 3.55) versus the control group (mean 3.77) with scores ranging from 0-5. Conclusions: Results indicate that the intervention is feasible. Some of the results are counterintuitive and could possibly be influenced by a lack of physician compliance due to a busy daily routine. Moreover, the optimal interval and composition of questionnaires has yet to be determined in inpatient setting.

PCN224 Incorporating a Patient-Reported Symptom Burden Tool in Cancer Care Settings

2021 ◽  
Vol 24 ◽  
pp. S61-S62
Author(s):  
T. Conner ◽  
D. Raju ◽  
R. Hauser ◽  
T. Gyory
Keyword(s):  
Cancer Care ◽  
Symptom Burden ◽  
Patient Reported

scholarly journals Prescreening of Patient-reported Symptoms using the Edmonton Symptom Assessment System (ESAS) in Outpatient Palliative Cancer Care

2019 ◽  
Author(s):  
Garden Lee ◽  
Han Sang Kim ◽  
Si Won Lee ◽  
Eun Hwa Kim ◽  
Bori Lee ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Care ◽  
Severe Symptom ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Assessment System ◽  
Advanced Cancer Patients ◽  
Edmonton Symptom Assessment System ◽  
Patient Reported

Abstract Background: Although early palliative care is associated with a better quality of life and improved outcomes in end-of-life cancer care, the criteria of palliative care referral are still elusive. Methods: We collected patient-reported symptoms using the Edmonton Symptom Assessment System (ESAS) at the baseline, first, and second follow-up visit. The ESAS evaluates ten symptoms: pain, fatigue, nausea, depression, anxiety, drowsiness, dyspnea, sleep disorder, appetite, and wellbeing. A total of 71 patients were evaluable, with a median age of 65 years, male (62%), and the Eastern Cooperative Oncology Group (ECOG) performance status distribution of 1/2/3 (28%/39%/33%), respectively. Results: Twenty (28%) patients had moderate/severe symptom burden with the mean ESAS ≥5. Interestingly, most of the patients with moderate/severe symptom burdens (ESAS ≥5) had globally elevated symptom expression. While the mean ESAS score was maintained in patients with mild symptom burden (ESAS<5; 2.7 at the baseline; 3.4 at the first follow-up; 3.0 at the second follow-up; P =0.117), there was significant symptom improvement in patients with moderate/severe symptom burden (ESAS≥5; 6.5 at the baseline; 4.5 at the first follow-up; 3.6 at the second follow-up; P <0.001). Conclusions: Advanced cancer patients with ESAS ≥5 may benefit from outpatient palliative cancer care. Prescreening of patient-reported symptoms using ESAS can be useful for identifying unmet palliative care needs in advanced cancer patients.

scholarly journals Smartphone-Based Meditation for Myeloproliferative Neoplasm Patients: Feasibility Study to Inform Future Trials (Preprint)

2018 ◽  
Author(s):  
Jennifer Huberty ◽  
Ryan Eckert ◽  
Linda Larkey ◽  
Jonathan Kurka ◽  
Sue A Rodríguez De Jesús ◽  
...  
Keyword(s):  
Physical Health ◽  
Sleep Disturbance ◽  
Controlled Trial ◽  
Myeloproliferative Neoplasm ◽  
Symptom Burden ◽  
Patient Reported Outcome ◽  
Pharmacologic Therapy ◽  
Control Group ◽  
Limited Efficacy ◽  
Patient Reported

BACKGROUND Myeloproliferative neoplasm (MPN) patients often report high symptom burden that persists despite the best available pharmacologic therapy. Meditation has gained popularity in recent decades as a way to manage cancer patient symptoms. OBJECTIVE The aim of this study was to examine the feasibility of 2 different consumer-based meditation smartphone apps in MPN patients and to examine the limited efficacy of smartphone-based meditation on symptoms compared with an educational control group. METHODS Patients (n=128) were recruited nationally through organizational partners and social media. Eligible and consented patients were enrolled into 1 of 4 groups, 2 of which received varying orders of 2 consumer-based apps (10% Happier and Calm) and 2 that received one of the apps alone for the second 4 weeks of the 8-week intervention after an educational control condition. Participants were asked to perform 10 min of meditation per day irrespective of the app and the order in which they received the apps. Feasibility outcomes were measured at weeks 5 and 9 with a Web-based survey. Feasibility outcomes were acceptability, demand, and limited efficacy for depression, anxiety, pain intensity, sleep disturbance, sexual function, quality of life, global health, and total symptom burden. RESULTS A total of 128 patients were enrolled across all 4 groups, with 73.4% (94/128) patients completing the intervention. Of the participants who completed the 10% Happier app, 61% (46/76) enjoyed it, 66% (50/76) were satisfied with the content, and 77% (59/76) would recommend to others. Of those who completed the Calm app, 83% (56/68) enjoyed it, 84% (57/68) were satisfied with the content, and 97% (66/68) would recommend to others. Of those who completed the educational control, 91% (56/61) read it, 87% (53/61) enjoyed it, and 71% (43/61) learned something. Participants who completed the 10% Happier app averaged 31 (SD 33) min/week; patients completing the Calm app averaged 71 (SD 74) min/week. 10% Happier app participants saw small effects on anxiety (P<.001 d=−0.43), depression (P=.02; d=−0.38), sleep disturbance (P=.01; d=−0.40), total symptom burden (P=.13; d=−0.27), and fatigue (P=.06; d=−0.30), and moderate effects on physical health (P<.001; d=0.52). Calm app participants saw small effects on anxiety (P=.29; d=−0.22), depression (P=.09; d=−0.29), sleep disturbance (P=.002; d=−0.47), physical health (P=.005; d=0.44), total symptom burden (P=.13; d=−0.27), and fatigue (P=.13; d=−0.27). Educational control participants (n=61) did not have effects on any patient-reported outcome except for a moderate effect on physical health (P<.001; d=0.77). CONCLUSIONS Delivering meditation via the Calm app is feasible and scored higher in terms of feasibility when compared with the 10% Happier app. The Calm app will be used to implement a randomized controlled trial, testing the effects of meditation on symptom burden in MPNs. CLINICALTRIAL ClinicalTrials.gov NCT03726944; https://clinicaltrials.gov/ct2/show/NCT03726944 (Archived by WebCite at http://www.webcitation.org/77MVdFJwM)

scholarly journals A Double-Blind, Randomized Controlled 12-Week Follow-Up Trial to Evaluate the Efficacy and Safety of Polycan in Combination with Glucosamine for the Treatment of Knee Osteoarthritis

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Thi Thanh Thuy Truong ◽  
Jong Min Lim ◽  
Hyung-Rae Cho ◽  
Young Suk Kim ◽  
Duc Giang Dao ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Rescue Medication ◽  
Secondary Outcome ◽  
Control Group ◽  
Efficacy And Safety ◽  
Double Blind ◽  
Randomized Controlled ◽  
Patient Reported ◽  
Group A ◽  
Group B

Aim. The aim of the present study was to examine the efficacy and safety of Polycan, a β-glucan produced from the black yeast Aureobasidium pullulans SM-2001, in combination with glucosamine in reducing knee osteoarthritis-associated symptoms. Methods. This was a double-blind, randomized controlled trial of a formulated product composed of 16.7 mg of Polycan and 250 mg of glucosamine (Group A), 16.7 mg of Polycan and 500 mg of glucosamine (Group B), or 500 mg of glucosamine (control group) per capsule, administered as three capsules once per day over a period of 12 weeks, conducted with 100 osteoarthritis patients, aged 35–80 years. The primary outcome measure was osteoarthritis symptoms assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. The secondary outcome measures included rescue medication use (according to data from a patient-reported diary) and other safety indices (body weight, blood pressure, hematological, and biochemistry markers). Results. Compared with the control group, Group B demonstrated a statistically significant reduction in the total WOMAC score after 12 weeks of treatment (p < 0.05). There was a significant reduction in the frequency of rescue medication used in Groups A and B compared with the control group (p < 0.05). There were no significant changes in hematology and biochemistry parameters or health indices between the active and the control group. Conclusion. Among patients with mild or moderate osteoarthritis, a daily oral dose of Polycan (50 mg) in combination with glucosamine (750 mg or 1500 mg; Group A or B, respectively) resulted in a better treatment outcome than treatment with glucosamine (1500 mg) alone.

Cancer patient experience: A pilot survey in Japan.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 260-260
Author(s):  
Izumi Kamiya ◽  
Ayako Okuyama ◽  
Kayoko Katayama ◽  
Natsumi Yamashita ◽  
Keizo Akuta ◽  
...  
Keyword(s):  
Decision Making ◽  
Patient Experience ◽  
Emotional Support ◽  
Cancer Care ◽  
Medical Staff ◽  
Pain Control ◽  
Cancer Control ◽  
Treatment Preferences ◽  
Inpatient Setting ◽  
Patient Reported

260 Background: Patient-reported experiences of cancer care are an important outcome of cancer control programs. To establish a nation-wide system to monitor progress in cancer control policies, we piloted a patient experience survey to six hospitals in Japan. Methods: We conducted a self-administered questionnaire survey to a total of 1,804 adult cancer patients receiving cancer treatment in six hospitals (three cancer centers, two general hospitals, and one academic institution) from July 2013 to Mar 2014. Patients were asked to answer 94 questions covering eight dimensions of cancer experience: 1) decision-making, 2) care coordination, 3) patient education, 4) pain control, 5) emotional support, 6) family support, 7) access to care, and 8) care continuity. Results: Eighty percent of the patients reported that their treatment preferences were respected in the decision-making process, but a large proportion of patients (60%) also noted that they preferred to have their treatment decisions made for them by their physicians. Many (32%) expressed difficulty in communicating their questions and concerns to their physicians at the time of diagnosis. Only one fifth of patients were informed at the time of diagnosis that they can seek for a second opinion from other providers. Average patient-reported wait time to surgery was 30 days, which was considered to be long by a third of the patients. Eighty percent of patients felt that their care was well-coordinated by a multidisciplinary team, while % also felt that they received adequate emotional support from their medical staff. Relatively small proportion of outpatients (77%) felt that they had access to medical staff when they had medical questions, compared to nearly all patients in an inpatient setting. Only 65% of inpatients and 40% of outpatients felt that they had received best available pain control during their care. Less than half of the patients were able to communicate their preferred place of care after discharge with their healthcare provider. Conclusions: Patient-reported experiences of cancer care are an important outcome measure of cancer policy performance. This pilot study served to reveal some of the important on in future nationwide surveys.

scholarly journals Optimising symptom management in children with cancer using a novel mobile phone application: protocol for a controlled hybrid effectiveness implementation trial (RESPONSE)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Natalie Bradford ◽  
Paula Condon ◽  
Erin Pitt ◽  
Zephanie Tyack ◽  
Kimberly Alexander
Keyword(s):  
Symptom Management ◽  
Controlled Trial ◽  
Intervention Group ◽  
Symptom Burden ◽  
Control Group ◽  
Children With Cancer ◽  
Randomised Study ◽  
Response System ◽  
Implementation Outcomes ◽  
Patient Reported

Abstract Background Intense and aggressive treatment regimens for most children’s cancer have achieved vast improvements in survival but are also responsible for both a high number and burden of symptoms. The use of Patient Reported Outcome Measures (PROMs) demonstrates a range of benefits for improved symptom management in adults with cancer. There are, however, multiple barriers to integrating PROMs into routine care in children and adolescents with cancer. This study aims to evaluate: (1) the effectiveness of electronic PROMs to generate stratified alerts, symptom management recommendations and graphical summaries (the RESPONSE system) to improve health outcomes and (2) the implementation of the RESPONSE system by assessing feasibility, acceptability, satisfaction, and sustainability. Methods A pragmatic hybrid II effectiveness-implementation controlled trial, using mixed methods, will be undertaken, advancing both knowledge of the effectiveness of the intervention and implementation factors. One-hundred and sixty children with cancer receiving active treatment will be recruited 1:1 to a non-randomised study involving two groups with an equal number of participants in each group. The intervention group (n = 80) will be prospectively recruited to receive the RESPONSE system intervention over eight weeks, versus the historical matched control group (n = 80) who will complete the ePROMs without access to the RESPONSE system. The primary outcome of the effectiveness trial is change between groups in total symptom burden. Secondary outcomes include child health-related quality-of-life and implementation outcomes. Trial data will be analysed using linear mixed-effects models. Formative implementation evaluation is informed by CFIR and ERIC frameworks and implementation outcomes will be mapped to the RE-AIM framework and include interviews, field notes, as well as administrative data to evaluate feasibility, acceptability, satisfaction and sustainability. Trial registration number ACTRN12621001084875. Retrospectively Registered 16 August 2021.

Comparison of patient-reported impact of COVID19 on cancer care delivery: A prospective, cross-sectional study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6551-6551
Author(s):  
Emily Hsu ◽  
Jyoti Chhabra ◽  
Oscar Serrano ◽  
Alvaro G. Menendez
Keyword(s):  
Social Media ◽  
Health Information ◽  
Cancer Care ◽  
Care Delivery ◽  
Appropriate Technology ◽  
Daily Routine ◽  
Perceived Risks ◽  
Significant Difference ◽  
Patient Reported ◽  
Sources Of Health Information

6551 Background: Impact of COVID19 on cancer care delivery and outcomes remains unknown. Few trials have investigated patients’ perceived risks and benefits, and cancer care delivery (CCD) alterations related to COVID19. We sought to identify differences on behaviors and social determinants of health in Hispanics and other underrepresented populations (H/UP) compared to the general population (GP). Methods: An IRB-approved validated 27-item questionnaire was offered in English and Spanish to all pts. receiving cancer care at participating cancer centers over a 4 month period. Examined variables included demographic information, social risk and behavioral factors, preferred sources of health information, and overall satisfaction with CCD during the pandemic. Results: A total of 180 pts were enrolled in the study. Compared to GP, H/UP’s perceived risk of COVID19 was higher with 93% vs 87% more likely to cancel or avoid social gatherings and 54% vs 46% more likely to change daily routine. H/UP appeared more concerned with personal and financial safety; if unable to find work/get paid for 2 weeks, 26% H/UP vs 10% GP would struggle to keep up with expenses. 40% H/UP vs 10% GP have concerns on perceived ability to secure food on short term and consider COVID19 a major threat to their health (70% vs 46%) and financial situation (63% vs 35%). H/UP’s perceived benefits of protective measures is higher with 81% vs 60% routinely practicing social distancing (SD) and 79% vs 66% in agreement with punitive actions for not following SD. Analysis demonstrated no significant difference by age, gender, level of education, marital status, however Hispanic ethnicity and Spanish as primary language was a statistically significant variable (p = 0.025) in perceived risks and satisfaction with CCD. No major differences were noted on sources of health information although more H/UP relied on social media (33% vs 24%). H/UP appeared to be more skeptical about availability and safety of targeted vaccines (40% vs 15%). Satisfaction regarding CCD was comparable (84% vs 86%), although more H/UP perceived CCD alterations (15% vs 10%). Going forward, H/UP would prefer to incorporate virtual visits (VV) when possible (36% vs 25%). Conclusions: COVID19-related societal, financial, health and personal fears are increased in H/UP which likely negatively affects quality of life of these at-risk populations. H/UP’s trust in SD recommendations is heightened although linguistically and culturally appropriate information may be deficient. H/UP’s belief in vaccine availability and safety is comparable to GP, although recent reports suggest deeper fear and emphasize their fear of experimentation. Interventions aimed to decrease these differences could incorporate standard communications with special attention to social media. H/UP would prefer to incorporate VV into their care, although most do not possess appropriate technology to do so.

scholarly journals Effectiveness of Fibrin Sealant Patch in Reducing Drain Volume after Pelvic Lymph Node Dissection in Women with Gynecologic Malignancy

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Hwa Cheong Kim ◽  
Chahien Choi ◽  
Woo Young Kim
Keyword(s):  
Lymph Node ◽  
Hospital Stay ◽  
Fibrin Sealant ◽  
Lymphatic Drainage ◽  
Control Group ◽  
Gynecologic Malignancy ◽  
Fibrin Sealants ◽  
Group A ◽  
Group B ◽  
Control Group Group

Background. The goal of this study was to evaluate the effectiveness of fibrin sealant in decreasing postoperative lymphatic drainage in women after pelvic lymphadenectomy and/or para-aortic lymphadenectomy during gynecologic cancer surgery. Methods. This study is a retrospective case-control study. Forty-five patients who underwent staging surgery were enrolled. Twenty-seven patients were in the fibrin sealant group (group A) and 18 in the control group (group B). The two groups were compared for the total volume of drain, hospital stay, harvested lymph node, and incidence of asymptomatic lymphocele. Lymphocele formation was evaluated by computed tomography (CT) on 3 months after surgery. Results. There were no significant differences in patient demographics between group A and B with respect to age, BMI, and harvested lymph nodes. Patients who received fibrin sealants had reduced total volume of drainage from postoperative days 2 to 5 compared to the control group (group A versus group B: 994.819±745.85 ml versus 1847.89±1241.41 ml; P=0.015). However no differences were observed in hospital stay (P=0.282), duration of drain (P=0.207), and incidence of asymptomatic lymphocele at 3 months (P=0.126). Conclusion. The results of this study indicate that the application of fibrin sealants after pelvic and/or para-aortic lymphadenectomy may reduce lymphatic drainage in gynecologic malignancy.

scholarly journals Acupuncture and reflexology for patients undergoing chemotherapy: an observational study

2021 ◽  
Author(s):  
Suzanne Jane Grant ◽  
Gretel Spiegel ◽  
Amanda BRAND ◽  
Ki Kyung KWON ◽  
Gillian HELLER ◽  
...  
Keyword(s):  
Observational Study ◽  
Financial Distress ◽  
Symptom Burden ◽  
Self Report ◽  
Future Research ◽  
Control Group ◽  
Patient Reported ◽  
Edmonton Symptom Assessment Scale ◽  
Clinically Significant ◽  
Multiple Symptoms

Abstract Purpose Around three quarters of individuals undergoing chemotherapy self-report multiple symptoms. There is clinical trial evidence of effectiveness for acupuncture for commonly experienced symptoms, and emerging evidence for reflexology, but little is known about the effects of these therapies on multiple symptoms when implemented in a real world setting during active chemotherapy treatment. Methods This was a single-arm observational study of participants receiving reflexology and/or acupuncture while attending chemotherapy. Participants received a 20 minute reflexology treatment or a 20 minute acupuncture treatment or a combination of both. Patient reported outcome measures were administered before and after the treatment using the Edmonton Symptom Assessment Scale (ESAS). Results During the study period, 330 unique participants with cancer received acupuncture and/or reflexology treatments. Participants had, on average, 5.3 symptoms each which they reported as moderate to severe (≥4/10) using the ESAS at baseline. Following treatment, participants reported 3.2 symptoms as moderate to severe. The symptom change for all participant encounters receiving any therapy was statistically significant for all symptoms, and clinically significant (a reduction of more than 1) for all symptoms except financial distress, appetite and memory. Clinically significant levels of global distress (<3) were reduced in 72% of all participants receiving either therapy. No adverse events were recorded. Conclusions The results indicate that acupuncture and reflexology administered alongside chemotherapy may reduce patient reported symptom burden and patient global symptom related distress. Future research would include an active control group, and consider confounding factors such as chemotherapy stage and medication.

scholarly journals A STUDY ON ROLE OF OCTREOTIDE ON OUTCOME OF PATIENTS WITH ACUTE PANCREATITIS

2020 ◽  
pp. 22-24
Author(s):  
Vishal Lodha ◽  
Rajesh Sonsale ◽  
Sandip Jadhav
Keyword(s):  
Acute Pancreatitis ◽  
Hospital Stay ◽  
Case Control Study ◽  
Case Control ◽  
Control Group ◽  
Care Hospital ◽  
Group A ◽  
Group B ◽  
Control Study

Introduction: Mild pancreatitis is a self limiting disease, while morbidity and mortality is considerably high in cases of severe necrotizing pancreatitis. Octreotide reduces secretion, release and activation of exocrine hormones; there is collection of pancreatic hormones in duct which in return causes irreversible destruction of the exocrine and endocrine pancreatic parenchyma leading to mal-digestion and diabetes. There are lot of controversies in the treatment of acute pancreatitis, so through this study we tried to evaluate whether there is a beneficial role of octreotide or not. Materials and Method: This case control study was done on patients admitted for the treatment of acute pancreatitis at a tertiary care hospital in Central India. This is retrospective study. The data of inpatient records were taken from the medical records department (MRD) of the hospital. The diagnosis of patients was established on basis of biochemical and radiological investigations. The patients were divided into two groups; cases and control, cases had received octreotide along with fluids (group A) controls received fluids without octreotide (group B). Symptomatic treatment was given in both the groups. Ages of the cases and controls were matched (±3 years). The statistical analysis of data was done and results were obtained. Results: In this retrospective case control study the records of fifty two patients were selected. The mean age in Group A was 35 ±16.45 years and in Group B 40±17.51 years in Group B (tA/B1.061; p ˂0.294). There were 22 males and 4 females in group A, while 20 males and 6 females in group B. Both the groups were comparable. All the patients in octreotide group survived while there were three deaths in control group. As far as mean hospital stay is was 10 days ± 7.10 in group A while it was 7 days ±3.65 in group B. All the p values for the criteria of study are non-significant. But when we talk about percentage, 11.53% patient died in control group. Conclusion: In our study we found that octreotide does not affect the final outcome of patients with acute pancreatitis. There is no effect on hospital stay and reduced need of analgesics in patients with acute pancreatitis. Keywords: Acute Pancreatitis; Octreotide; Hospital Stay; Mortality

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