Patients' Estimation of Overall Treatment Burden: Why Not Ask the Obvious?

Bernhard, Jürg

doi:10.1200/jco.20.1.65

Cited by 48 publications

(49 citation statements)

References 37 publications

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“…In addition, those with health insurance, higher levels of education and ethnic backgrounds may be at risk of financial burden. The routine inclusion of treatment burden measures in clinical trials has been suggested as an important consideration to improve the evaluation of the treatment burden associated with health care interventions and management strategies [20]. Importantly, the development and application of appropriate measures in this context would also expand our understanding of this under-researched concept and the extent of the problem.…”

Section: Resultsmentioning

confidence: 99%

Treatment Burden and Chronic Illness: Who is at Most Risk?

Sav

Whitty

McMillan

et al. 2016

Patient

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Background: There is a need to ascertain the type and level of treatment burden experienced by people with co-morbidities. This is important to identify the characteristics of participants who are at most risk of treatment burden. Objective: The aim of this study is to identify the characteristics of participants who are at most risk of treatment burden. Methods: This cross-sectional study was part of a larger project and recruitment was conducted across four Australian regions: rural, semi-rural and metropolitan. Participants were asked about their treatment burden using an adapted version of a measure, which included the following five dimensions: medication, time and administrative, lifestyle change, social life and financial burden. Results: In total, 581 participants with various chronic health conditions reported a mean global treatment burden of 56.5 out of 150 (standard deviation = 34.5). Number of chronic conditions (β = .34, p < 0.01), age, (β = −.27, p < 0.01), the presence of an unpaid carer (β = .22, p < 0.001) and the presence of diabetes mellitus and other endocrine conditions (β = .13, p < 0.01) were significant predictors of overall treatment burden. For the five dimensions of treatment burden, social, medicine and administrative burden were predicted by the same cluster of variables: number of conditions, age, presence of an unpaid carer and diabetes. However, in addition to these variables, financial dimensions were also predicted by education level, ethnicity and health insurance. Educational level also influenced lifestyle burden. Conclusion: A substantial proportion of community-dwelling adults with chronic conditions have considerable levels of treatment burden. Specifically, health professionals should provide greater focus on managing overall treatment burden for persons who are of young age, have an endocrine condition or an unpaid carer, or a combination of these factors

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Section: Resultsmentioning

confidence: 99%

Treatment Burden and Chronic Illness: Who is at Most Risk?

Sav

Whitty

McMillan

et al. 2016

Patient

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“…A higher score for a functional scale represents a higher level of functioning, a higher score for the global health status/QL scale a better QL, and a higher score for a symptom scale or item a higher level of symptoms or problems. In addition, a global indicator for overall treatment burden (Bernhard et al, 2002) and another for coping effort (Hurny et al, 1993) were included. These two indicators were transformed accordingly (0 -100), with higher scores indicating better QL.…”

Section: à2mentioning

confidence: 99%

Capecitabine in hormone-resistant metastatic prostatic carcinoma – a phase II trial

Morant¹,

Bernhard

Dietrich

et al. 2004

Br J Cancer

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The objective of the trial is to evaluate the efficacy of capecitabine in patients with metastatic hormone-resistant prostate carcinoma (HRPC), in terms of prostate-specific antigen (PSA) response and clinical benefit (decrease of pain or analgesic score) and its safety profile. In all, 25 patients with HRPC were enrolled on a phase II trial of capecitabine (Xeloda s ) at a dose of 1250 mg m À2 orally twice daily on days 1 -14 every 21 days. The inclusion criteria were PSA serum levels 43 Â upper limit of normal, a WHO performance status 0 -2, age o85 years and adequate bone marrow, liver and renal function. In patients with grade 2 or higher haematological toxicity on day 1 of the treatment cycle, therapy was first delayed, and then continued at a lower dose. Trial end points were PSA response and clinical benefit defined by quality of life (QL) data and analgesic consumption. The median age of patients was 70 years (range 54 -85 years). A median of three cycles of capecitabine was administered (range 1 -8). PSA response was observed in three patients (12%, 95% CI 3 -31%), with times to tumour progression of 18, 21 and 35 weeks, respectively. In these patients, the response durations were 12, 17 and 32 weeks, respectively. Minor PSA regression was also seen in two further patients. The median time to tumour progression of all patients was 12 weeks (95% CI 9 -15 weeks). Haematological toxicity was minor, with leukopenia grade 3 observed in one patient. There were three deaths during trial treatment, respectively, due to sepsis following mucositis and leukopenia, presumed sepsis with mucositis induced by chemotherapy and concomitant radiotherapy and cerebral dysfunction progressing to coma. Hand -foot syndrome grades 2 and 3 were observed in four patients each. Clinical benefit was observed in five patients (20%, CI 7 -41%). Based on toxicity data, we recommend a lower starting dose of 1000 mg m À2 orally twice daily. While capecitabine has some activity in HRPC, as suggested by observed PSA responses, we conclude that it is not worthwhile to investigate capecitabine monotherapy in a phase III trial. Combinations of capecitabine with other agents, such as vinorelbine or docetaxel, may prove to be more effective.

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“…Patient-reported measures have been used to quantify aspects of BOT in various conditions such as diabetes, chronic heart failure, cancer, chronic obstructive pulmonary disease and cystic fibrosis. Types of measured BOT include time and effort spent following medication regimes, 14 side effects of treatment, 15 and out-of-pocket expenditure. 16 A recent systematic review examined patient reported measures of BOT in chronic heart failure, diabetes and chronic kidney disease and found that the majority of studies lacked direct patient input and did not show evidence of reliability of the measures used.…”

Section: The Work Of Healthcare For Patientsmentioning

confidence: 99%