Analysis of survival adjusted for quality of life using the Q-TWiST function: Interface in R

Bogart, Émilie; Jouin, A.; Behal, Hélène; Duhamel, Alain; Filleron, Thomas; Kramar, Andrew

doi:10.1016/j.cmpb.2015.11.005

Cited by 9 publications

(10 citation statements)

References 17 publications

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“…Patients' time since their presentation was divided into time with toxicity of disease (Tox), time without symptoms of disease or toxicity of treatment (TWiST), and time with relapse of the disease (Rel). 6 Tox was defined as the time spent from the beginning of symptoms, up until recovery from the amputation. Rel was defined as any time spent, where the patient developed infection, cellulitis or further gangrene, or further re-interventions and amputations (after full recovery from Tox).…”

Section: Methodsmentioning

confidence: 99%

“…Ut and Ur were arbitrarily set at 0.5, as two days with a gangrenous toe, or with re-infection were considered to be equivalent to one day without symptoms of disease. 6 TWiST automatically has a utility coefficient of 1, as the patient is considered to be in their best possible health during TWiST. 6 Statistical analysis was performed using SPSS version 22 (SPSS, IBM, New Orchard Road, Armonk, New York, USA).…”

Section: Q-twistmentioning

confidence: 99%

“…6 TWiST automatically has a utility coefficient of 1, as the patient is considered to be in their best possible health during TWiST. 6 Statistical analysis was performed using SPSS version 22 (SPSS, IBM, New Orchard Road, Armonk, New York, USA). Continuous data were analyzed using independent sample t-test or Mann-Whitney U test, as appropriate.…”

Section: Q-twistmentioning

confidence: 99%

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Quality of time spent without symptoms of disease or toxicity of treatment for transmetatarsal amputation versus digital amputation in diabetic patients with digital gangrene

et al. 2017

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Aim We aim to compare the outcome of diabetic patients with gangrenous toes who were managed initially either by digital amputation or by transmetatarsal amputation. The null hypothesis is that transmetatarsal amputation had less theatre trips and better healing. Materials and Methods A parallel observational comparative study of all diabetic patients who underwent either digital or transmetatarsal amputation in a tertiary referral center from 2002 through 2015. Comorbid conditions, subsequent amputations, hospital stay, and readmission were noted. Results A total of 223 patients underwent minor amputation during the study period, of which 147 patients were diabetic and 76 patients were non-diabetic. Seventy-seven patients had digital amputation and 70 transmetatarsal amputation in diabetic patients. Demographics were similar in both groups. The median time to major amputation was (400 ± IQR 1205 days) in the digital amputation group, compared to 690 ± IQR 891 days in the transmetatarsal amputation group ( P = 0.974). 29.9% of digital amputations and 15.7% of transmetatarsal amputations in diabetic patients, required minor amputations or revision procedures ( P = 0.04). Median length of hospital stay was (20 days, IQR 27) in the digital group and (17 days, IQR17) in the transmetatarsal amputation group ( P = 0.17). Need for re-admission was 48.1% in digital patients compared to 50% in transmetatarsal amputation patients ( P = 0.81). Quality of time spent without symptoms of disease or toxicity of treatment (Q-TWiST) was (315 days, IQR 45) in digital group and (346 days, IQR 48) in the transmetatarsal amputation patients ( P = 0.099). Conclusion Despite the lack of statistical significance, transmetatarsal amputation offered better outcome in the diabetic patients, with less re-intervention rate, shorter hospital stays, less theatre trips, and longer time without toxicity (TWiST).

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Section: Methodsmentioning

confidence: 99%

Section: Q-twistmentioning

confidence: 99%

Section: Q-twistmentioning

confidence: 99%

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Quality of time spent without symptoms of disease or toxicity of treatment for transmetatarsal amputation versus digital amputation in diabetic patients with digital gangrene

et al. 2017

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“…Patients who underwent first-line palliative systemic chemotherapy between January 2014 and April 2017 for carcinoma nasopharynx at the department of medical oncology Quality of Life without Symptom and Toxicity (QTWiST) analysis was performed. [18] Three health states, namely TOX state, TWiST state, and REL state were defined for this analysis. TOX state was defined as the calendar days spent in toxicity post start of chemotherapy but before progression or censoring for progression.…”

Section: Patient Selectionmentioning

confidence: 99%

“…Very few studies involving chemotherapy in noncurative settings have been reported, largely being retrospective or single-arm Phase II studies. [16][17][18][19][20][21][22][23] Recently, a randomized Phase III study was reported in the palliative setting by Zhang et al, comparing the classic cisplatin-5 fluorouracil regimen against gemcitabine-cisplatin regimen. [17] These limited studies have provided inadequate information and have not helped in guiding decisions when treating nasopharyngeal malignancies in palliative setting.…”

Section: Introductionmentioning

confidence: 99%

Palliative chemotherapy in carcinoma nasopharynx

Patil

Joshi

Noronha

et al. 2019

South Asian J Cancer

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Introduction: Nasopharyngeal carcinoma is a rare malignancy. We conducted an audit of systemic therapies received in palliative setting in carcinoma nasopharynx and studied their outcomes. Methods: Patients who underwent first-line palliative systemic chemotherapy between January 2014 and April 2017 for carcinoma nasopharynx at the department of medical oncology at authors’ institute were selected for this analysis. Toxicities, responses, progression-free survival (PFS), and overall survival (OS) were analyzed. In addition, a Quality-Adjusted Time without Symptoms or Toxicity analysis with threshold utility analysis was performed. Results: Fifty-one patients were included in this analysis. The indication of palliative chemotherapy was locoregionally recurrent disease in 25 (49.0%) patients and metastatic disease in 26 (51.0%) patients. The overall response rate was 62.0% ( n = 33). The median PFS was 225 days (95% confidence interval [CI]: 164–274 days) and median OS was 513 days (95% CI: 286–931 days). The restricted mean TOX state duration was 2.6 days (95% CI: 0.3–4.9), restricted mean TWiST duration was 219.2 days (95% CI: 184.0–254.4), and restricted mean REL duration was 74.3 days (95% CI: 38.1–110.4). Conclusion: Systemic cytotoxic therapy in nasopharyngeal cancers is associated with high response rates and clinically meaningful PFS; with low duration of time spent in adverse events.

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Single-Fraction Stereotactic vs Conventional Multifraction Radiotherapy for Pain Relief in Patients With Predominantly Nonspine Bone Metastases

et al. 2019

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IMPORTANCE Consensus is lacking as to the optimal radiotherapy dose and fractionation schedule for treating bone metastases.OBJECTIVE To assess the relative efficacy of high-dose, single-fraction stereotactic body radiotherapy (SBRT) vs standard multifraction radiotherapy (MFRT) for alleviation of pain in patients with mostly nonspine bone metastases. DESIGN, SETTING, AND PARTICIPANTSThis prospective, randomized, single-institution phase 2 noninferiority trial conducted at a tertiary cancer care center enrolled 160 patients with radiologically confirmed painful bone metastases from September 19, 2014, through June 19, 2018. Patients were randomly assigned in a 1:1 ratio to receive either single-fraction SBRT (12 Gy for Ն4-cm lesions or 16 Gy for <4-cm lesions) or MFRT to 30 Gy in 10 fractions. MAIN OUTCOMES AND MEASURESThe primary end point was pain response, defined by international consensus criteria as a combination of pain score and analgesic use (daily morphine-equivalent dose). Pain failure (ie, lack of response) was defined as worsening pain score (Ն2 points on a 0-to-10 scale), an increase in morphine-equivalent opioid dose of 50% or more, reirradiation, or pathologic fracture. We hypothesized that SBRT was noninferior to MFRT. RESULTSIn this phase 2 noninferiority trial of 96 men and 64 women (mean [SD] age, 62.4 [10.4] years), 81 patients received SBRT and 79 received MFRT. Among evaluable patients who received treatment per protocol, the single-fraction group had more pain responders than the MFRT group (complete response + partial response) at 2 weeks (34 of 55 [62%] vs 19 of 52 [36%]) (P = .01), 3 months (31 of 43 [72%] vs 17 of 35 [49%]) (P = .03), and 9 months (17 of 22 [77%] vs 12 of 26 [46%]) (P = .03). No differences were found in treatment-related toxic effects or quality-of-life scores after SBRT vs MFRT; local control rates at 1 and 2 years were higher in patients receiving single-fraction SBRT.CONCLUSIONS AND RELEVANCE Delivering high-dose, single-fraction SBRT seems to be an effective treatment option for patients with painful bone metastases. Among evaluable patients, SBRT had higher rates of pain response (complete response + partial response) than did MFRT and thus should be considered for patients expected to have relatively long survival.

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Analysis of survival adjusted for quality of life using the Q-TWiST function: Interface in R

Cited by 9 publications

References 17 publications

Quality of time spent without symptoms of disease or toxicity of treatment for transmetatarsal amputation versus digital amputation in diabetic patients with digital gangrene

Quality of time spent without symptoms of disease or toxicity of treatment for transmetatarsal amputation versus digital amputation in diabetic patients with digital gangrene

Palliative chemotherapy in carcinoma nasopharynx

Single-Fraction Stereotactic vs Conventional Multifraction Radiotherapy for Pain Relief in Patients With Predominantly Nonspine Bone Metastases

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