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      Defining a set of standardised outcome measures for newly diagnosed patients with multiple myeloma using the Delphi consensus method: the IMPORTA project

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          Abstract

          Objective

          To define a standard set of outcomes and the most appropriate instruments to measure them for managing newly diagnosed patients with multiple myeloma (MM).

          Methods

          A literature review and five discussion groups facilitated the design of two-round Delphi questionnaire. Delphi panellists (haematologists, hospital pharmacists and patients) were identified by the scientific committee, the Spanish Program of Haematology Treatments Foundation, the Spanish Society of Hospital Pharmacies and the Spanish Community of Patients with MM. Panellist’s perception about outcomes’ suitability and feasibility of use was assessed on a seven-point Likert scale. Consensus was reached when at least 75% of the respondents reached agreement or disagreement. A scientific committee led the project.

          Results

          Fifty-one and 45 panellists participated in the first and second Delphi rounds, respectively. Consensus was reached to use overall survival, progression-free survival, minimal residual disease and treatment response to assess survival and disease control. Panellists agreed to measure health-related quality of life, pain, performance status, fatigue, psychosocial status, symptoms, self-perception on body image, sexuality and preferences/satisfaction. However, panellist did not reach consensus about the feasibility of assessing in routine practice psychosocial status, symptoms, self-perception on body image and sexuality. Consensus was reached to collect patient-reported outcomes through the European Organisation for the Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ) Core questionnaire 30 (C30), three items from EORTC-QLQ-Multiple Myeloma (MY20) and EORTC-QLQ-Breast Cancer (BR23), pain Visual Analogue Scale, Morisky-Green and ad hoc questions about patients’ preferences/satisfaction.

          Conclusions

          A consensual standard set of outcomes for managing newly diagnosed patients with MM has been defined. The feasibility of its implementation in routine practice will be assessed in a future pilot study.

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          Most cited references11

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          The impact of disease-related symptoms and palliative care concerns on health-related quality of life in multiple myeloma: a multi-centre study

          Background Multiple myeloma, the second most common haematological cancer, remains incurable. Its incidence is rising due to population ageing. Despite the impact of the disease and its treatment, not much is known on who is most in need of supportive and palliative care. This study aimed to (a) assess symptom severity, palliative care concerns and health-related quality of life (HRQOL) in patients with multiple myeloma, and (b) to determine which factors are associated with a lower quality of life. We further wanted to know (c) whether general symptom level has a stronger influence on HRQOL than disease characteristics. Methods This multi-centre cross-sectional study sampled two cohorts of patients with multiple myeloma from 18 haematological cancer centres in the UK. The Myeloma Patient Outcome Scale (MyPOS) was used to measure symptoms and concerns. Measures of quality of life included the EORTC QLQ-C30, its myeloma module and the EuroQoL EQ-5D. Data were collected on socio-demographic, disease and treatment characteristics and phase of illness. Point prevalence of symptoms and concerns was determined. Multiple regression models quantified relationships between independent factors and the MyPOS, EORTC global quality of life item and EQ5D Index. Results Five-hundred-fifty-seven patients, on average 3.5 years (SD: 3.4) post-diagnosis, were recruited. 18.2 % had newly diagnosed disease, 47.9 % were in a treatment-free interval and 32.7 % had relapsed/progressive disease phase. Patients reported a mean of 7.2 symptoms (SD: 3.3) out of 15 potential symptoms. The most common symptoms were pain (72 %), fatigue (88 %) and breathlessness (61 %). Those with relapsed/progressive disease reported the highest mean number of symptoms and the highest overall palliative care concerns (F = 9.56, p < 0.001). Factors associated with high palliative care concerns were a general high symptom level, presence of pain, anxiety, low physical function, younger age, and being in the advanced stages of disease. Conclusion Patients with multiple myeloma have a high symptom burden and low HRQOL, in the advanced and the earlier stages of disease. Identification of patients in need of supportive care should focus on assessing patient-reported outcomes such as symptoms and functioning regularly in clinical practice, complementary to traditional biomedical markers. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2410-2) contains supplementary material, which is available to authorized users.
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            Quality-of-life in elderly patients with cancer: a short review.

            Prolongation of survival and maintenance or improvement of health-related quality-of-life (HRQoL) are the two important goals within the treatment of individual patients. Due to the severity of symptoms and the toxicity of treatment, HRQoL has become a major area of concern when treating cancer patients in general and elderly patients in particular. We present a literature review of HRQoL aspects in elderly patients with cancer and especially address the topic whether impairments in the different tools of a comprehensive geriatric assessment (CGA) are associated with decreased HRQoL in elderly cancer patients. Elderly cancer patients tend to weight their HRQoL as more important than gain in survival, when compared to younger patients. An age-dependent decrease in different scales of HRQoL is reported in patients and normative samples. HRQoL is also a predictor of survival. The variation of HRQoL can be used in trials comparing different treatment options. In individual patients, regular measurement of HRQoL aims to improve patients-centred care. Age related impairments of different areas of CGA are associated with decreased HRQoL in elderly cancer patients. HRQoL is an important outcome with elderly cancer patients and should be assessed regularly and thoroughly.
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              Thresholds for clinical importance for four key domains of the EORTC QLQ-C30: physical functioning, emotional functioning, fatigue and pain

              Background The EORTC QLQ-C30 is one of the most widely used quality of life questionnaires in cancer research. Availability of thresholds for clinical importance for the individual questionnaire domains could help to increase its interpretability. The aim of our study was to identify thresholds for clinical importance for four EORTC QLQ-C30 scales: Physical Functioning (PF), Emotional Functioning (EF), Pain (PA) and Fatigue (FA). Methods We recruited adult cancer patients from Austria, the Netherlands, Poland and the UK. No restrictions were placed on diagnosis or type or stage of treatment. Patients completed the QLQ-C30 and three anchor items reflecting potential attributes of clinically important levels of PF, EF, PA and FA. We merged the anchor items assessing perceived burden, limitations in daily activities and need for help into a dichotomous external criterion to estimate thresholds for clinical importance using Receiver Operator Characteristic (ROC) analysis. Results In our sample of 548 cancer patients (mean age 60.6 years; 54 % female), the QLQ-C30 scales showed high diagnostic accuracy in identifying patients reporting burden, limitations and/or need for help related to PF, EF, PA and FA. All areas under the curve were above 0.86. Conclusions We were able to estimate thresholds for clinical importance for four QLQ-C30 scales. When used in daily clinical practice, these thresholds can help to identify patients with clinically important problems requiring further exploration and possibly intervention by health care professionals.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2018
                22 February 2018
                : 8
                : 2
                : e018850
                Affiliations
                [1 ] departmentHematology Department , Hospital Clinic, Institut d’Investigacions Biomédiques August Pi I Sunyer (IDIBAPS) , Barcelona, Spain
                [2 ] departmentPharmacy Department , Hospital Virgen Macarena , Sevilla, Spain
                [3 ] departmentHematology Department , Hospital 12 de Octubre , Madrid, Spain
                [4 ] departmentPharmacy Department , Hospital Universitario y Politécnico La Fe , Valencia, Spain
                [5 ] Outcomes'10 , Castellon, Spain
                [6 ] departmentMedicine Department , University Jaume I , Castellón, Spain
                Author notes
                [Correspondence to ] Dr Luis Lizán; lizan@ 123456outcomes10.com
                Article
                bmjopen-2017-018850
                10.1136/bmjopen-2017-018850
                5855445
                29472263
                79660ef5-254f-4eac-be4b-e3e2edcdbe92
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 01 August 2017
                : 17 October 2017
                : 03 November 2017
                Funding
                Funded by: Sociedad Española de Farmacia Hospitalaria;
                Funded by: Programa Español de Tratamientos en Hematología;
                Categories
                Haematology (Incl Blood Transfusion)
                Research
                1506
                1700
                Custom metadata
                unlocked

                Medicine
                multiple myeloma,outcome,patient‐centered,standardisation
                Medicine
                multiple myeloma, outcome, patient‐centered, standardisation

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