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Ovarian Cancer Survivorsã¢â‚¬â„¢ Quality of Life a Systematic Review

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Proactive use of PROMs in ovarian cancer survivors: a systematic review

  • Angela Coulter2,three,
  • Pernille Tine Jenseniv,5 &
  • Karina Dahl Steffensen1,2,3

Periodical of Ovarian Research volume 12, Article number:63 (2019) Cite this article

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Abstract

Introduction

The utilize of patient reported consequence measures (PROMs) has increased during the past decade, and the focus on how to use them has resulted in a more proactive awarding. Studies take shown that proactive use of PROMs during treatment improves patient-clinician communication, leads to better symptom direction and may prolong survival amid advanced cancer patients. Ovarian cancer is a serious disease in which the majority of patients experience recurrence during the follow-upwards menstruation and suffer from a number of severe symptoms from underlying disease. This systematic review was conducted to appraise the evidence on the proactive use of PROMs as a dialogue tool during follow-upward of ovarian cancer patients.

Results

The following databases were searched for relevant literature; PubMed, EMBASE, CINAHL, and the Cochrane Library. The search was conducted in April 2019 without any filters or limits. A full of 643 publications were identified, and 48 studies were found to be potentially eligible. Of the 48 papers, none met the last inclusion criterion of using PROMs proactively as a dialogue tool for ovarian cancer patients during follow-upwards.

Decision

Studies accept shown that PROMs tin identify otherwise undetected symptoms. Using PROMs proactively during the consultation has been shown to meliorate symptom management for patients with some other types of cancer. However, we found no studies that had examined the proactive employ of PROMs during follow-up of ovarian cancer patients. Future studies should evaluate if the proactive use of PROMs could facilitate a more individualized and more effective follow-up program tailored to the ovarian cancer patient's needs and preferences.

Introduction

Worldwide, every twelvemonth 240,000 women are diagnosed with fallopian tube, primary peritoneal, or ovarian cancer (OC), often in advanced phase with approximately 152,000 dying from the illness. This makes OC the leading crusade of gynecological cancer-related deaths. Generally, the initial handling is extensive surgery and chemotherapy to which most patients respond well. Nevertheless, about 80% of these tumors will recur inside a few years subsequently primary treatment and treatment of recurrence is rarely curative [1].

After handling, most patients enter a five-year follow-upwards (FU) program, including routine clinical visits, imaging, concrete examination, and measurement of the cancer biomarker CA125. The primary purpose of FU is early detection of recurrence, but at that place is no show that routine FU increases survival [2]. It may provide reassurance, simply for some routine FU may induce anxiety and fear of recurrence [iii]. The literature is sparse on this matter in OC patients which further highlights the need for inquiry on individualized follow upwards plans based on patient needs and preferences [3, 4].

Patient Reported Upshot Measures (PROMs) are divers as "whatsoever report of the condition of a patient's wellness condition that comes directly from the patient, without interpretation of the patient's response past a clinician or anyone else". Patient reported outcomes can be measured by ways of standardized and validated questionnaires designed for self-completion by patients or by interview [v]. There are several types of PROMs; generic and disease-specific. Generic PROMs are designed to collect data beyond disease groups, whereas disease-specific PROMs are designed to collect data on outcomes of specific atmospheric condition or diagnoses [half-dozen]. Some PROMs combine generic and disease-specific elements to capture a wide assessment of the patient'south health status. PROMs tin can be used to obtain information on physical, emotional, social, sexual, and cognitive functioning also evaluating side effects or late effects, global wellness status, and quality of life (QoL). They are often used in clinical trials to monitor health status and QoL before, during, and after treatments to measure patient-related, subjective outcomes secondary to primary endpoints such as survival.

During the past decade, in that location has been increased interest in using PROMs in routine practice to monitor patient symptoms during treatment. Their use for clarifying patient needs and monitoring late side effects in long-term survivors has received less attention [seven]. Testify from various cancer diagnoses suggests that the use of PROMs during a clinical visit may improve clinician-patient communication by focusing on issues of greater concern to the patient without prolonging the visit [8]. At that place is too bear witness that clinicians oft underestimate late side-effects [nine, ten]. Use of PROMs as a dialogue tool, aslope blood samples and imaging, may provide clinicians with more valid and comprehensive knowledge of the patient'south problems [xi]. A recent written report suggested that active use of PROMs during advanced cancer treatment may even prolong survival [12].

Nosotros were specifically interested in the potential use of PROMs to meliorate follow-up care for ovarian cancer survivors. We therefore undertook a systematic review to determine what is already known about proactive apply of PROMs as a dialogue tool during follow-upwardly of these patients.

Methods

Data sources and search strategy

We conducted a systematic review to assess the proactive use of PROMs as a dialog or screening tool during follow-up of patients after completion of active handling (e.g. surgery and chemotherapy) for OC. The review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) [13, 14].

During Apr 2019 a systematic search was conducted by author AK searching the following databases: PubMed, CINAHL, EMBASE, and the Cochrane Library. Relevant articles published between 1974 to April 2019 were identified. Search strategy in PubMed combining Mesh term "Ovarian Neoplasms", "Patient Reported Event Measures", "Patient Effect Cess", "Health Care Surveys" and primal words "Ovarian Cancer", "ovarian neoplasms", "patient outcome assessment" and "patient reported outcome".

The search terms derived after advice from a research librarian and an advisory group including all co-authors who also helped place additional "grayness literature" of relevance to the enquiry question. No filters were applied. The search strategy for databases PubMed, EMBASE, CINAHL and The Cochrane Library is available in Additional file 1. Titles and abstracts of studies retrieved from the search were screened by AK. Reference lists were manually screened to identify additional papers.

Study selection

Articles were considered eligible if the written report participants were OC patients and the proactive apply of one or more than PROMs during FU was involved. Proactive utilise of a PROM is defined as information reported by a patient, presented to the clinical staff, and used actively during the consultation as a dialogue tool between patient and clinician.

Studies describing the development of PROMs or PROMs used equally a main or secondary upshot in clinical trials were excluded. Studies were also excluded if PROMs were used to assess the eligibility of patients for chemotherapy, or if they were used to retrospectively place coping strategies or late side furnishings with no proactive use.

Review papers were examined for potentially eligible studies that might have been missed in the search strategy. Studies involving multiple cancer sites were excluded if information on OC were non presented separately.

Identification of relevant articles

The titles and abstracts of all retrieved papers were evaluated to make up one's mind the relevance of the study. Total texts were retrieved and examined in case the abstract lone did not provide sufficient data.

Data extraction

All potentially eligible studies were screened past reviewer AK. Data were extracted on publication details (author, year and country of study, study pattern, intervention, and sample size) and all PROM-specific data (blazon of PROM, how and when used) were entered into a pre-designed form.

Results

The search led to the identification of 643 studies, and after removal of duplicates a total of 337 abstracts were selected for detailed test (Fig. 1). Forty-eight titles/abstracts met the initial selection criteria and full texts of these were obtained for the assessment of eligibility.

Fig. 1
figure 1

Flow diagram for search and pick process

Full size epitome

Information extraction was performed on the 48 potentially eligible studies, none of which met the final inclusion benchmark of using PROMs proactively as a dialogue tool in the follow-up care of OC patients. These papers were excluded for the following reasons: literature review on the use of PROMs (due north = 10); description of PROM evolution, papers showing OC information combined with other cancers, and PROMs used to evaluate a specific intervention (northward = 19); surveys investigating clinical staff's opinion regarding the use of PROMs (due north = 3); studies where PROMs were used to assess the patient'south perspective on QoL, or for obtaining prognostic information on life expectancy where the data nerveless were not used proactively in the care of individual patients (n = sixteen). The search and selection process is shown in Fig. 1. Characteristics of the studies and reason for exclusion are summarized in Table ane.

Table 1 Characteristics of studies and reasons for exclusion

Full size tabular array

We constitute no studies that proactively used PROMs during follow-upwardly care subsequently ovarian cancer treatment and therefore no qualitative synthesis was practical.

Discussion

We searched for studies involving the proactive utilise of PROMs during follow-up later ovarian cancer treatment but found none. Most studies identified were trials evaluating the effect of specific interventions of OC. PROMs accept traditionally been used in observational studies and clinical trials to measure the long-term effect of an intervention or to capture toxicity of new therapies. For some other types of cancer the awarding of PROMs is progressing from existence purely a enquiry tool to monitor side effects in clinical trials, to being used proactively in clinical do for monitoring symptoms during treatment. Past incorporating patients' assessments and priorities in care direction it has revealed a college frequency of unmet needs that otherwise might accept been un-recognized [three, 10, 61].Nonetheless, we found no prove that this awarding of PROMs has been tested with OC patients.

de Rooij et al. performed a randomized trial aiming to assess long-term impact of an automatically generated Survivorship Intendance Program (SCP) in ovarian cancer patients. The author institute that ovarian cancer patients provided with a SCP did non study increased satisfaction with information provision or care [45]. This highlights that optimal follow up plans should be individualized and tailored for each patient and non a automatically pre-defined tool for all patients.

A recent study has shown that pro-agile use of PROMs during treatment improves the QoL of cancer patients [56]. Detmar et al. conducted a randomized clinical trial with patients receiving palliative chemotherapy for dissimilar cancer types. Incorporating PROM assessments into clinical practice during treatment and actively using them during the consultation improved patient-clinician communication with the potential to increase the awareness of patient needs [23]. The bulk of participants were chest cancer patients receiving first line palliative chemotherapy. This population represents a grouping with a poor prognosis. These findings were supported by those from a randomized clinical trial involving 766 patients with solid tumors assessed by PROMs during agile cancer treatment. Routine collection of PROM data was associated with improved survival by a median of 5 months, suggesting that proactive monitoring helps the clinician to intervene earlier symptoms crusade complications [12]. The participants were recruited between 2007 and 2011, and they had different metastatic cancer types (mainly genitourinary cancer), with a poor prognosis. Such a long timeframe for enrollment may have involved a change of treatment, which could have impacted on survival and burden of symptoms. Nevertheless, the patients completing PROMs received chemotherapy for a longer catamenia than those receiving usual care. This illustrates the potential of PROMs to notice otherwise unrecognized symptoms during handling in order to forbid serious events at a later phase.

Hansen et al. found that cancer patients experienced a variety of unmet needs during treatment simply also during follow-up, and highlights that the patients indicated that they did not received the support that they needed during follow-upwardly. Unmet needs have an important influence on QoL and PROMs used as a screening tool may reveal patients' perceived unmet need. Interventions to reduce these unmet needs could enhance patient'south quality of life [62]. Ploos van Amstel et al. aimed to explore distress and quality of life in ovarian cancer patients' during and later treatment, with a mean time since surgery of three.3 years. The authors found that a tertiary of the participants' expressed distress. Almost one-half of the patients with distress indicated that they wanted a referral to a professional person [63]. Their findings indicate that ovarian cancer survivors undergo distress and feel symptoms years after they take finished treatment. If PROMs were used proactively during follow-up this could potentially address patients' needs and lead to higher satisfaction and improved QoL.

Velikova et al. found that if PROM results were shared with physicians before the clinical encounter, discussions of symptoms took place more oft compared with the control group. A 3rd of the patients were diagnosed with gynecologic cancer, and PROMs were primarily used during agile treatment. Merely 2 (1%) participants completed PROMs during follow upwardly. It is unclear if they had gynecologic cancer and the findings are not presented separately. This study adds weight to the conclusion that good communication between clinician and patient should be primal to the management of cancer patients. Further, the improved communication resulted in ameliorate QoL and emotional performance for some patients [10]. Howell et al. also reported that if the QoL score was shared with the clinician earlier the consultation, the level of word on emotional and psychosocial issues increased [64].

Many studies have investigated the QoL of OC survivors, late side effects, coping strategies, and many other outcomes over time. If PROMs are collected and used actively during treatment, a positive effect on patient-clinician advice, improved QoL, and a better symptom management during treatment is described. The electric current model for FU of OC patients is characterized past pre-scheduled visits and mainly concerns standard procedures without necessarily taking the patients' needs and preferences into account. Pre-scheduled visits may take place at a time when the patient is asymptomatic and thereby induce false reassurance. The value of the standard approach to FU is uncertain, and it is not evidence based. Considering of the poor prognosis of OC patients in instance of relapse, it is essential to optimize the FU plan to focus on what matters near to the patient. Furthermore, pro-agile employ of PROMs will assistance ensure that patients are met on their ain premises and that the fourth dimension spent during the consultation is used to help the patient with the issues that bother them the most.

Although involvement in collecting PROMs in clinical trials and using them actively as a screening or dialogue tool during treatment is growing, our literature search shows that unfortunately, there is not much experience with this for the benefit of ovarian cancer patients. If PROMs are used proactively during consultations, the visit can be tailored to friction match the private patient's preferences and needs. This may exist a new approach to routine collection of PROMs to improve patient centered care and individualized handling.

We are aware of the limitations of this review. Although nosotros used a comprehensive search strategy, information technology is still possible that some studies may have been missed. Also, information extraction was performed by only one reviewer who made all decisions about inclusion and exclusion. Lastly, it should be noted that any studies published afterwards 14th of April 2019 were not considered in this newspaper.

Determination

To our noesis, no studies have used PROMs equally a screening or dialogue tool for ovarian cancer survivors during follow-up. The utilize of PROMs with these patients may assist identify otherwise undetected symptoms and improve the management of late side effects. Proactive use of PROMs during follow-up may raise patient interest leading to increased satisfaction with care. We believe there is a potent case for further research into this approach to improve the quality of follow-upward care of ovarian cancer survivors.

Availability of data and materials

All data generated during this written report are included in this published commodity in Table ane and in supplementary material.

Abbreviations

FU:

Follow-upwards

OC:

Ovarian Cancer

PROMs:

Patient Reported Outcome Measures

QoL:

Quality of Life

SCP:

Survivorship Care Plan

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Acknowledgements

We thank Karin Larsen for linguistic editing of the manuscript.

Funding

As a PhD educatee Anette Stolberg Kargo received funding from The Danish Cancer Society. The funder played no role in the design in the undertaking of the review or in writing the manuscript.

Author information

Affiliations

  1. Department of Clinical Oncology, Sygehus Lillebalt, Vejle Sygehus, Beriderbakken four, DK-7100, Vejle, Denmark

    Anette Stolberg Kargo & Karina Dahl Steffensen

  2. Establish of Regional Health Inquiry, Academy of Southern Denmark, Winsløwparken 19, iii, 5000, Odense, Denmark

    Anette Stolberg Kargo, Angela Coulter & Karina Dahl Steffensen

  3. Heart for Shared Decision Making, Sygehus Lillebalt, Vejle Sygehus, Beriderbakken four, 7100, Vejle, Denmark

    Anette Stolberg Kargo, Angela Coulter & Karina Dahl Steffensen

  4. Department of Gynaecology and Obstetrics, Odense Academy Hospital, J. B. Winsløws Vej four, 5000, Odense, Denmark

    Pernille Tine Jensen

  5. Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3, 5000, Odense, Denmark

    Pernille Tine Jensen

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All authors were a major contributor in writing this manuscript, and all accept helped place additional "gray literature". All co-authors has read and canonical the concluding manuscript.

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Correspondence to Anette Stolberg Kargo.

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Seach strategy for databases PubMed, Embase, CINAHL and The Cochrane Library. (DOCX 21 kb)

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Kargo, A.S., Coulter, A., Jensen, P.T. et al. Proactive utilize of PROMs in ovarian cancer survivors: a systematic review. J Ovarian Res 12, 63 (2019). https://doi.org/x.1186/s13048-019-0538-9

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Keywords

  • Ovarian cancer
  • Follow-upwards
  • Patient reported outcome
  • Quality of life

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Source: https://ovarianresearch.biomedcentral.com/articles/10.1186/s13048-019-0538-9

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