Clinical implementation of value based healthcare: Impact on outcomes for lung cancer patients

Demedts, Ingel; Himpe, Ulrike; Bossuyt, Jelle; Anthoons, Geert; Bode, H.; Bouckaert, Bernard; Carron, Kris; Dobbelaere, Stephanie; Mariën, Heidi; Haecke, P Van; Verbeke, Wim

doi:10.1016/j.lungcan.2021.10.010

Cited by 6 publications

(24 citation statements)

References 16 publications

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“…Of these, six [ 26 , 27 , 28 , 29 , 30 , 31 ] were excluded, mainly because the outcomes of interest in this review were not measured or because the types of intervention or study aims were not eligible for our study question ( Table S1 ). Overall, six studies [ 32 , 33 , 34 , 35 , 36 , 37 ] were included in our systematic review, to which two follow-up publications [ 38 , 39 ] were added for the meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Three out of the six studies [ 32 , 35 , 37 ] were multicenter. Two of the six studies [ 34 , 35 ] were set in Europe, three [ 33 , 36 , 37 ] were set in the USA and one [ 32 ] was set in in Canada. Two studies were RCTs [ 33 , 35 ], one was a population-based retrospectively matched cohort analysis [ 32 ], two used a pre–post design with historical controls [ 36 , 37 ] and one was a non-randomized controlled trial in which the controls were patients who refused the intervention [ 34 ].…”

Section: Resultsmentioning

confidence: 99%

“…Regarding included the populations, three out of the six studies [ 33 , 34 , 35 ] restricted eligibility to patients receiving active treatment, while the others recruited patients in any phase of care. Two studies [ 34 , 35 ] focused exclusively on lung cancer, two [ 33 , 36 ] focused on advanced cancers and two [ 32 , 37 ] included any type and stage of cancer.…”

Section: Resultsmentioning

confidence: 99%

“…For PRO screening instruments, three studies [ 32 , 36 , 37 ] used ESAS (Edmonton Symptom Assessment System), one study [ 37 ] screened for depression using the 9-item Patient Health Questionnaire (PHQ-9), one trial [ 33 ] employed STAR (Symptom Tracking and Reporting), one study [ 34 ] used items from the NCI’s PRO-CTCAE (Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events) and one study [ 35 ] used the e-FAB (e-follow-up) application. The mode of administration was electronic in all studies except for those by Patel et al [ 36 , 37 ], in which the interventions were telephonic.…”

Section: Resultsmentioning

confidence: 99%

“…All six studies selected for the systematic review were included in the meta-analysis as they all reported the necessary raw mortality data. The two non-randomized studies with historical controls [ 36 , 37 ] (611 patients in the intervention arms vs. 509 patients in the control arms) reported survival after 1 year as a secondary output, the population-based retrospectively matched cohort study [ 32 ] (128,893 patients in the intervention arm vs. 128,893 patients in the control arm) analyzed survival up to 5 years as a primary outcome and the non-randomized controlled study [ 34 ] (89 patients in the intervention arm vs. 115 patients in the control arm) analyzed survival up to 4 years as a secondary outcome. Two RCTs [ 33 , 35 ] (overall, 501 patients in the intervention arms vs. 386 patients in the control arms) reported survival results from post-hoc analyses [ 38 , 39 ] as a secondary outcome with a median follow-up of 7 years and the other reported the results as a primary outcome after 2 years.…”

Section: Resultsmentioning

confidence: 99%

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The Effects of Patient-Reported Outcome Screening on the Survival of People with Cancer: A Systematic Review and Meta-Analysis

Caminiti

Maglietta

Diodati

et al. 2022

Cancers

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This study examined the effects of the routine assessment of patient-reported outcomes (PROs) on the overall survival of adult patients with cancer. We included clinical trials and observational studies with a control group that compared PRO monitoring interventions in cancer clinical practice to usual care. The Cochrane risk-of-bias tools were used. In total, six studies were included in the systematic review: two randomized trials, one population-based retrospectively matched cohort study, two pre–post with historical control studies and one non-randomized controlled trial. Half were multicenter, two were conducted in Europe, three were conducted in the USA and was conducted in Canada. Two studies considered any type of cancer, two were restricted to lung cancer and two were restricted to advanced forms of cancer. PRO screening was electronic in four of the six studies. The meta-analysis included all six studies (intervention = 130.094; control = 129.903). The pooled mortality outcome at 1 year was RR = 0.77 (95%CI 0.76–0.78) as determined by the common effect model and RR = 0.82 (95%CI 0.60–1.12; p = 0.16) as determined by the random-effects model. Heterogeneity was statistically significant (I2 = 73%; p < 0.01). The overall risk of bias was rated as moderate in five studies and serious in one study. This meta-analysis seemed to indicate the survival benefits of PRO screening. As routine PRO monitoring is often challenging, more robust evidence regarding the effects of PROs on mortality would support systematic applications.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

The Effects of Patient-Reported Outcome Screening on the Survival of People with Cancer: A Systematic Review and Meta-Analysis

Caminiti

Maglietta

Diodati

et al. 2022

Cancers

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Value-based health care in heart failure: Quality of life and cost analysis

Ghisleni,

Astolfi,

Zimmermann

et al. 2023

Clinics

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Quality of life after patient-initiated vs physician-initiated response to symptom monitoring: the SYMPRO-Lung trial

Billingy,

Tromp,

Aaronson

et al. 2023

JNCI: Journal of the National Cancer Institute

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BACKGROUND Previous studies using patient-reported outcomes measures (PROMs) to monitor symptoms during and after (lung) cancer treatment used alerts that were sent to the healthcare provider (HCP), while an approach in which patients receive alerts could be more clinically feasible. The primary aim of this study was to compare the effect of weekly PROM symptom monitoring via a reactive approach (patient receives alert) or active approach (HCP receives alert) with care as usual on health-related quality of life (HRQOL) at 15 weeks after start of treatment in lung cancer patients. METHODS SYMPRO-Lung is a multicenter RCT using a stepped wedge design. Stage I-IV lung cancer patients in the reactive and the active group reported PROM symptoms weekly linked to a common alerting algorithm. HRQOL was measured by the EORTC QLQ-C30 at baseline and after 15 weeks. Linear regression analyses and effect size estimates were used to assess mean QLQ-C30 change scores between groups, accounting for confounding. RESULTS Five hundred fifteen patients were included (160 active group, 89 reactive group, 266 control group). No differences in HRQOL were observed between the reactive and active group (Summary Score B0.51, 95%CI-3.22–4.24, ES0.06, Physical functioning B-0.25, 95%CI-5.15-4.64, ES0.02). The combined intervention groups had significantly better mean change scores on the Summary score (B4.85, 95%CI1.96–7.73, ES0.57) and Physical functioning (B7.00, 95%CI2.90–11.09, ES0.71), compared to the control group. CONCLUSIONS Weekly PRO symptom monitoring significantly improves HRQOL in lung cancer patients. The logistically less intensive, reactive approach may be a better fit for implementation. TRIAL REGISTRATION the Netherlands trial register Identifier: NL7897.

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Clinical implementation of value based healthcare: Impact on outcomes for lung cancer patients

Cited by 6 publications

References 16 publications

The Effects of Patient-Reported Outcome Screening on the Survival of People with Cancer: A Systematic Review and Meta-Analysis

The Effects of Patient-Reported Outcome Screening on the Survival of People with Cancer: A Systematic Review and Meta-Analysis

Value-based health care in heart failure: Quality of life and cost analysis

Quality of life after patient-initiated vs physician-initiated response to symptom monitoring: the SYMPRO-Lung trial

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