PurposeHodgkin Lymphoma (HL) is highly curable with well-established treatment regimens; however, the impact on patient’s health-related quality of life (HRQL) from diagnosis through survivorship is unclear. This systematic review aimed to describe the available literature on HRQL in HL, assess the quality of these studies, identify gaps in the literature and recommend further areas of research.MethodsFollowing PRISMA guidelines, we performed a systematic review to include studies assessing the HRQL in HL patients. Articles identified through database searches were screened and data extracted. Quality was evaluated using a 6-point scale, adapted from published HRQL systematic reviews.ResultsSixty five articles published between 1986 and 2015 met inclusion criteria. These included 53 (82 %) cross-sectional studies; 12 (18 %) longitudinal studies, including three embedded in randomized trials; and three additional longitudinal studies that began assessment at diagnosis. Study sample sizes of HL patients varied considerably with only five (42 %) longitudinal studies including more than 50 patients. Multidimensional HRQL was assessed in 45 studies, single HRQL domains in 22 studies, and symptoms, including fatigue, in 28 studies.ConclusionsThe majority of studies employed a cross-sectional design, enrolling HL survivors at least 10 years after the completion of therapy. Emphasis on HRQL following therapy may inform initial treatment decisions and long-term survivorship goals. We recommend that future research include prospective, longitudinal randomized designs across both treatment and time.
567 Background: The Loyola University Chicago Cardinal Bernardin Cancer Center multidisciplinary Breast Oncology Center evaluates new patients (pts) for cancer-related distress using a needs-based screening tool, in accordance with Commission on Cancer (CoC) Standard 3.2. Identifying distress among newly diagnosed pre-surgical and pre-neoadjuvant pts allows for comprehensive treatment planning and establishment of a baseline for repeated assessments. Methods: Pts with newly diagnosed BC between May 2017 and June 2018 completed the “Patient Screening Questions for Supportive Care” (Coleman Supportive Oncology Collaborative, 2017), a consolidated screening tool based on validated instruments (NCCN Distress, PHQ-4, PROMIS), prior to initial provider visit. Cancer staging, demographics, and supportive oncology referrals were obtained from medical records. Descriptive statistics and chi-square were used. Results: 100 pts aged 30-94 (mean(SD) = 61.56(12.03)) completed the screening tool; 14.9% had Stage 0, 43.6% Stage I, 34.0% Stage II, 3.2% Stage III, and 4.3% Stage IV disease. 39% of pts screened positive for anxiety on the PHQ-4, and over 20% for depression. Anxiety was associated with cancer stage ( X2(df) = 12.20(4), p = .016). The most common practical concerns included living alone (19%), issues with work/school (16%), and paying for medical care (12%). Common physical concerns included difficulty with sleep (40%) and concentration/memory (17%), and tingling hands or feet (14%). Poor sleep was associated with depression ( X2(df) = 6.50(1), p = .011) and anxiety ( X2(df) = 7.17(1), p < .01). 57.7% reported at least "a little bit" of fatigue and 17.7% reported moderate to very severe pain. Nearly all pts wanted to better understand their diagnosis (87.8%), prognosis (87.8%), or treatment (91.8%). Conclusions: Pts with newly diagnosed, early stage BC experience high levels of physical and emotional distress at the earliest point in the treatment trajectory. This study captures BC patients at a unique time point and provides support for conducting routine screening for supportive oncology needs at initiation of care. Further studies should reassess needs sequentially to determine changes across the care continuum.
Background: In accordance with Commission on Cancer (CoC) Standard 3.2, the Loyola University Chicago multidisciplinary Breast Oncology Center evaluates every new patient (pt) for cancer-related concerns and makes supportive oncology referrals accordingly (CoC Standard 3.2). We previously reported that pts with newly diagnosed early-stage BC experience high levels of physical and emotional distress (Rynar 2019, ASCO abstract 269661). This study expands upon those findings by examining relationships between psychological distress and other cancer-related concerns and referrals to supportive services in a larger cohort of pts with newly diagnosed BC. Methods: The "Patient Screening Questions for Supportive Care" (Coleman Supportive Oncology Collaborative, 2017), an aggregate of validated screening tools, was implemented across 200 new pts from April 2018 thru August 2018. Demographic information and supportive oncology referrals were obtained from medical records. Descriptive statistics and chi-square were used to assess frequencies and relationships among variables. Results: 200 female pts aged 26-94 (mean (SD) = 61.39(12.90)) completed the screening tool; 16.5% had Stage 0, 40% Stage I, 34.5% Stage II, 4.5% Stage III, 2.0% Stage IV. Commonly reported psychosocial and physical complaints included concerns about work and paying for medical care, poor sleep, tingling in hands or feet, and concerns about weight gain. 47% of pts met the threshold for referral to psychology based on a positive screen for anxiety (n=65) or depression (n=28); the majority (92.8%) had at least 1 contact with a psychologist within 12 days. 51.5% of pts screened positive for a practical need triggering a referral to social work; 72.8% of consults were completed within 3 days. 27% had nutrition concerns triggering referrals to dietician services; 77.8% completed contact within 3 days. Pts who screened positive for anxiety were significantly more likely (p<.01) to also have ≥2 physical concerns, nutrition concerns, fatigue, and concerns about physical function (p=.04). Screening positive for depression was significantly associated (p<.01) with ≥2 physical concerns, family concerns, spiritual concerns, fatigue, and pain (p=.03). Conclusions: Newly diagnosed BC pts who screen positive for anxiety or depression are more likely to report concerns across multiple biopsychosocial domains. This finding lends support for CoC, NCCN, and ASCO supportive care guidelines to evaluate and address patient reported concerns beyond psychological distress. Further, we highlight the importance of assessment and triage at the start of the cancer care continuum. Future studies should reevaluate distress at pivotal points in care to determine the impact of early interventional supportive oncology services in this population. Citation Format: Lauren Z. Rynar, Blaine A. Knox, Kristen B. Wendell, Patricia B. Mumby, Kathy S. Albain, Cathy Grace-Louthen, Hahn P. Mai, Patricia A. Robinson, Shelly S. Lo. Triaging cancer-related distress at the time of breast cancer (BC) diagnosis [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-10-01.
234 Background: AlthoughHL is highly curable with well-established treatment regimens, the impact on patients' HRQL from diagnosis through survivorship is unclear. This SR aimed to: (1) describe the literature on HRQL in HL, (2) assess the quality of these studies and (3) identify gaps for future research. Methods: We performed a PRISMA-guided SR on HRQL in HL patients. Identified articles were double-screened and data extracted; quality was evaluated using a 6-point scale adapted from published HRQL SR. Results: Sixty-two articles published between 1986- 2014 met inclusion criteria. These included 50 (81%) cross-sectional studies and 12 (19%) longitudinal studies of which three were embedded in randomized trials (RTC). Only two of the RCTs followed patients from diagnosis into survivorship; three additional longitudinal studies began assessments at diagnosis. The majority (75%) of longitudinal studies were performed over the last decade. The sample size of HL patients varied considerably with only five (41%) longitudinal studies including >50 patients. On average, patients in the cross sectional studies were 10-plus years off treatment. Multidimensional HRQL was assessed in 40 studies, single HRQL domains in 21 studies, and symptoms, including fatigue, in 24 studies. Quality varied by study design. Conclusions: The number and quality of studies on HRQL in HL have increased over time. To capture HRQL trajectory from diagnosis through survivorship, we recommend that future research include prospective, longitudinal randomized design across treatment and time. [Table: see text]
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