Values and options in cancer care (VOICE): study design and rationale for a patient-centered communication and decision-making intervention for physicians, patients with advanced cancer, and their caregivers

Abstract

BackgroundCommunication about prognosis and treatment choices is essential for informed decision making in advanced cancer. This article describes an investigation designed to facilitate communication and decision making among oncologists, patients with advanced cancer, and their caregivers.Methods/designThe Values and Options in Cancer Care (VOICE) Study is a National Cancer Institute sponsored randomized controlled trial conducted in the Rochester/Buffalo, NY and Sacramento, CA regions. A total of 40 oncologists, approximately 400 patients with advanced cancer, and their family/friend caregivers (one per patient, when available) are expected to enroll in the study. Drawing upon ecological theory, the intervention uses a two-pronged approach: oncologists complete a multifaceted tailored educational intervention involving standardized patient instructors (SPIs), and patients and caregivers complete a coaching intervention to facilitate prioritizing and discussing questions and concerns. Follow-up data will be collected approximately quarterly for up to three years.DiscussionThe intervention is hypothesized to enhance patient-centered communication, quality of care, and patient outcomes. Analyses will examine the effects of the intervention on key elements of physician-patient-caregiver communication (primary outcomes), the physician-patient relationship, shared understanding of prognosis, patient well-being, and health service utilization (secondary outcomes).Trial registrationClinical Trials Identifier: NCT01485627

Perspectives on Epidermal Growth Factor Receptor Regulation in Triple-Negative Breast Cancer

“…Furthermore, it was shown that tumor-associated monocytes secrete EREG (Hoerger et al, 2013). However, subsequent analysis revealed that insignificant levels of EREG were found in human breast cancer patient plasma samples (Hoerger et al, 2013). As follows the significance of this observation remains unknown.…”

“…Recent evidence demonstrates that TAMs secrete HB-EGF and prominent HB-EGF staining was observed in human breast cancer samples (Hoerger et al, 2013). Within the same study, HB-EGF plasma levels were found to correlate with primary tumor size and lymph node dissemination of mammary breast carcinomas (Hoerger et al, 2013). Further evidence suggests that EGFR ligands are additionally produced by breast cancer cells, which participate in feedback loops that regulate expression of macrophage chemoattractants.…”

“…However, the exact range of EGFR agonists secreted by TAMs is unknown. Recent evidence demonstrates that TAMs secrete HB-EGF and prominent HB-EGF staining was observed in human breast cancer samples (Hoerger et al, 2013). Within the same study, HB-EGF plasma levels were found to correlate with primary tumor size and lymph node dissemination of mammary breast carcinomas (Hoerger et al, 2013).…”

“…Interestingly, it was demonstrated that infiltrating monocytes are able to promote angiogenesis in a xenograft-based HER2/neu-derived mouse mammary tumor model (De Palma et al, 2005). Furthermore, it was shown that tumor-associated monocytes secrete EREG (Hoerger et al, 2013). However, subsequent analysis revealed that insignificant levels of EREG were found in human breast cancer patient plasma samples (Hoerger et al, 2013).…”

Do current approaches to assessing therapy related adverse events align with the needs of long-term cancer patients and survivors?

“…This too is a challenging space as, not unexpectedly, preferences for balance of QoL versus length of life vary from patient to patient (and can vary during the course of therapy) [53,54]. As such, the measurable impact of new patient-centered interventions is an area of active study with regard to the role of patient satisfaction on therapeutic adherence and health outcome [55,56]. Although the concepts of patient-centered care are widely embraced conceptually, the way in which these elements are pragmatically incorporated into practical care decisions or data generation incentives remains loosely defined [52].…”