Angela M. Stover

Impact of diagnosis and treatment of clinically-localized prostate cancer on health-related quality of life for older Americans: a population-based study

Few studies have measured longitudinal changes in health‐related quality of life (HRQOL) among patients with prostate cancer starting before their cancer diagnosis or have provided simultaneous comparisons with a matched noncancer cohort. In the current study, the authors addressed these gaps by providing unique estimates of the effects of a cancer diagnosis on HRQOL accounting for the confounding effects of ageing and comorbidity.

Quality of life changes during the pre‐ to postdiagnosis period and treatment‐related recovery time in older women with breast cancer

Health care providers have little population‐based evidence about health‐related quality of life (HRQOL) changes, from the pre‐ to postdiagnosis period, and treatment‐related recovery time for women aged 65 years and older diagnosed with breast cancer.

Urinary incontinence and health-related quality of life among older Americans with and without cancer: a cross-sectional study

BackgroundFew studies have investigated the impact of urinary incontinence (UI) on health-related quality of life (HRQOL) among cancer survivors. UI is prevalent in the general population and can be both an indicator of cancer and a side effect of cancer treatment. UI and cancer diagnoses have been associated with decreases in HRQOL. This study evaluates the prevalence of UI and the impact on HRQOL among older cancer survivors.MethodsThe prevalence of UI among cancer survivors (breast, prostate, bladder, colorectal, lung, and endometrial/uterine cancers) and those without cancer was estimated using the SEER-MHOS database. Factors associated with UI were investigated using logistic regression and the impact of UI on SF-36 scores was determined using linear regression.ResultsOver 36% of SEER-MHOS beneficiaries without cancer reported UI and higher prevalence was noted among cancer survivors (37%-54% depending on cancer type). History of bladder, breast, endometrial/uterine, or prostate cancer was associated with higher prevalence of UI. UI was independently associated with both lower physical component scores (PCS) (−1.27; 95%CI:-1.34,-1.20) and mental component scores (MCS) (−1.75; 95%CI −1.83, -1.68). A suggested decreasing trend in the prevalence of UI was associated with a longer time since cancer diagnosis.ConclusionsUI was highly prevalent, especially in bladder, endometrial/uterine, and prostate cancer survivors. Improved recognition of UI risk among cancer survivors will help clinicians better anticipate and mediate the effect of UI on individuals’ HRQOL.

Integrating Patient-Reported Outcome Measures into Routine Cancer Care: Cancer Patients’ and Clinicians’ Perceptions of Acceptability and Value

Introduction: Despite growing interest in integrating patient-reported outcome (PRO) measures of symptoms and functional status into routine cancer care, little attention has been paid to patients’ and clinicians’ perceptions of acceptability and value. Methods: A two-phase qualitative study was conducted to develop a web-based PRO screening system with 21 items assessing symptoms (e.g., nausea) and functional status. Phase 1 involved cognitive interviews with 35 cancer outpatients (n=9 breast chemotherapy, radiation for prostate (n=8) or head and neck cancer (n=10), and n=8 bone marrow transplant [BMT]). In Phase 2, we evaluated the acceptability and perceived value of reviewing a PRO measure during real-time clinical encounters with 39 additional outpatients (n=10 breast, n=9 head and neck, n=10 prostate, n=10 BMT) and 12 clinicians (n=3 breast, n=2 head and neck, n=4 prostate, n=3 BMT). At least 20% of patients were ≥60 years, African American, or ≤ high school. Results: Patients felt that their PRO summary of symptoms and functional status was helpful in discussing health issues with clinicians (92%), wanted to review their results with clinicians during future visits (82%), and would recommend it to other patients (87%). Clinicians found the PRO summary to be easy to interpret (83%), most helpful for documenting the Review of Symptoms (92%), and would recommend it to future patients (92%). Over 90% of clinicians reported that consultation time did not increase. Conclusion: Both cancer patients and clinicians reported that discussing a PRO summary of symptoms and functional status during an outpatient visit was useful, acceptable, and feasible.

Using patient-reported outcome measures as quality indicators in routine cancer care.

Patient-reported outcome (PRO) measures are increasingly being used in routine cancer care and may soon be used as indicators of the quality of care received. When a clinician reviews PRO measures with a patient during a visit, the patient has an opportunity to elaborate on symptoms that may need to be managed. Reviewing PRO measures with cancer patients increases communication between clinicians and patients, detection of problematic symptoms, and satisfaction with care. PROs are a critical tool for increasing patient centeredness in oncology clinical trials, comparative effectiveness research, and cost-effectiveness research. There also may be a future role for PROs in quality monitoring and improvement. Historically, PRO measures assessing symptoms and physical functioning have not been included in quality-ofcare assessments. More typically, quality of care is measured with administrative data, such as infection or hospital readmission rates. Yet symptoms and physical function decrements are far more common than hospital complications among patients with cancer, and they often go undetected by clinicians. PRO measures are the preferred approach for assessing symptoms and have the potential to provide quality assessments that are meaningful and useful to patients and other stakeholders making health care decisions contingent on differential quality at the provider, practice, and system levels. In the current issue of Cancer, Smith et al describe the rationale for national cancer PRO surveillance and an innovative methodology from the Patient Reported Outcomes Symptoms and Side Effects Study (PROSSES). PROSSES is a landmark achievement because it is the first PRO study to use the Commission on Cancer’s Rapid Quality Reporting System to identify patients and manage data flow from 17 programs participating in the National Cancer Institute’s Community Cancer Centers Program. Their novel methodology was successful, with greater than 90% eligibility and greater than 60% response rates across most clinical and demographic characteristics. Smith et al were also able to overcome privacy, feasibility, and logistical issues that plagued prior studies. This study underscores the importance of symptom management in quality assessment and provides valuable data and methodology toward future work. Although this is a significant step forward, there is more work to be done. The next steps for future research are to develop standardized methods to overcome remaining challenges:

An evaluation of physicians’ engagement of children with asthma in treatment-related discussions

Our objectives were to examine whether providers engage children with asthma in treatment-related discussions at the level children prefer (engagement concordance) and to determine whether engagement concordance is related to child, caregiver, and provider characteristics. Children with asthma (n = 296) aged 8–16 years were recruited at five pediatric practices in North Carolina. Using audiotaped medical visit transcripts, we documented the number of treatment-related questions the providers asked the children. Children reported their preferred level of provider engagement. A logistic generalized estimating equation was used to determine which variables predicted engagement concordance. Most children (96.6%) wanted to be involved in treatment-related discussions. One-third of the providers did not ask children any treatment-related questions. Only 36.1% of provider–child dyads were concordant. Most discordant dyads were under-engaged (83.1%). Better engagement concordance was observed among older children (odds ratio (OR) = 1.19, 95% confidence interval (CI) (1.07, 1.33)), male children (OR = 1.67, 95% CI (1.03, 2.70)), and among providers with fewer years in practice (OR = .97, 95% CI (.94, .99)). Providers engaged in treatment-related discussions with younger children and females less frequently than these children preferred. Providers should ask children how much they want to be involved in treatment-related discussions and then attempt to engage children at the level they prefer.

Patient-Reported Physical Function Measures in Cancer Clinical Trials

Patient-reported outcomes (PROs) are increasingly used to monitor treatment-related symptoms and physical function decrements in cancer clinical trials. As more patients enter survivorship, it is important to capture PRO physical function throughout trials to help restore pretreatment levels of function. We completed a systematic review of PRO physical function measures used in cancer clinical trials and evaluated their psychometric properties on the basis of guidelines from the US Food and Drug Administration. Five databases were searched through October 2015: PubMed/MEDLINE, EMBASE, CINAHL (Cumulative Index of Nursing and Allied Health Literature), Health and Psychosocial Instruments, and Cochrane. From an initial total of 10,233 articles, we identified 108 trials that captured PRO physical function. Within these trials, approximately 67% used the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and 25% used the Medical Outcomes Study Short Form 36. Both the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and Medical Outcomes Study Short Form 36 instruments generically satisfy most Food and Drug Administration requirements, although neither sought direct patient input as part of item development. The newer Patient-Reported Outcomes Measurement Information System physical function short form may be a brief, viable alternative. Clinicians should carefully consider the psychometric properties of these measures when incorporating PRO instrumentation into clinical trial design to provide a more comprehensive understanding of patient function.

The Potential Role of Symptom Questionnaires in Palliative and Supportive Cancer Care Delivery

Purpose of ReviewThe American Society of Clinical Oncology (ASCO) palliative care recommendations have been updated into a full guideline. Symptom questionnaires—completed and reviewed with patients during care delivery—are poised to play a large role in this guideline because they provide a more comprehensive understanding of symptoms. This article provides an overview of the guideline and describes how symptom questionnaires can be used to satisfy the guideline.Recent FindingsStandardized symptom questionnaires can be used for three purposes in care delivery: symptom management, referral to specialty palliative and supportive care, and to assess high-quality care. Challenges include necessary changes to clinic workflow to collect patient responses and respond to electronic alerts for worsening symptoms.SummarySymptom questionnaires administered as part of routine care delivery are highly informative and worth the time to enhance symptom management in routine care, to increase referrals, and to standardize performance metrics.

Survivorship care plans: are randomized controlled trials assessing outcomes that are relevant to stakeholders?

PurposeThe purpose of this study was to compare outcomes assessed in extant randomized controlled trials (RCTs) to outcomes that stakeholders expect from survivorship care plans (SCPs). To facilitate the transition from active treatment to follow-up care for the 15.5 million US cancer survivors, many organizations require SCP use. However, results of several RCTs of SCPs’ effectiveness have been null, possibly because they have evaluated outcomes on which SCPs should be expected to have limited influence. Stakeholders (e.g., survivors, oncologists) may expect outcomes that differ from RCTs’ outcomes.MethodsWe identified RCTs’ outcomes using a PubMed literature review. We identified outcomes that stakeholders expect from SCPs using semistructured interviews with stakeholders in three healthcare systems in the USA and Canada. Finally, we mapped RCTs’ outcomes onto stakeholder-identified outcomes.ResultsRCT outcomes did not fully address outcomes that stakeholders expected from SCPs, and RCTs assessed outcomes that stakeholders did not expect from SCPs. RCTs often assessed outcomes only from survivors’ perspectives.ConclusionsRCTs of SCPs’ effectiveness have not assessed outcomes that stakeholders expect. To better understand SCPs’ effectiveness, future RCTs should assess outcomes of SCP use that are relevant from the perspective of multiple stakeholders.Implications for Cancer SurvivorsSCPs’ effectiveness may be optimized when used with an eye toward outcomes that stakeholders expect from SCPs. For survivors, this means using SCPs as a map to guide them with respect to what kind of follow-up care they should seek, when they should seek it, and from whom they should seek it.

Patient perspectives on physical function after allogeneic hematopoietic stem cell transplantation: a qualitative study

Hematopoietic stem cell transplantation (HSCT) is a life-saving treatment for some patients with aggressive hematologic malignancies, but many recipients develop temporary or persistent impairments in physical functioning.1 There is increasing evidence that impaired physical functioning is prognostic for survival in transplant recipients.2, 3 Furthermore, preserved physical functioning is necessary for patients to live independently and achieve goals that support their overall quality of life.