Skip to main content
SpringerLink
Log in

Feasibility of implementing a cervix cancer–specific patient-reported outcome measure in routine ambulatory clinics

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Objective

To evaluate the implementation of a cervix cancer–specific patient-reported outcome measure, the European Organization for Research and Treatment of Cancer Quality of Life Cervical Cancer module (EORTC QLQ-CX24), into gynecologic oncology clinics.

Methods

This was a prospective, multi-institutional, cross-sectional study involving cervix cancer patients previously treated with curative intent radiotherapy who were attending routine follow-up appointments. Between January 2017 and August 2018, eligible patients were approached to complete the EORTC QLQ-CX24 prior to their clinical encounter and then review it with their oncologist. Patient and oncologist experience was evaluated using Feedback Questionnaires following the encounter. Descriptive statistics were used to summarize the results of the EORTC QLQ-CX24 and Feedback Questionnaires. Open-ended questions within the Feedback Questionnaires were analyzed to identify themes.

Results

Eighty-four patients consented to participate in the study. Of these, 80 (95.2%) completed the EORTC QLQ-CX24 and 76 (90.4%) completed both the EORTC QLQ-CX24 and the Feedback Questionnaires. There were high rates of completion for most items within the EORTC QLQ-CX24 (93–98%), except for items pertaining to vaginal symptoms and sexual health (34–35%). All eligible oncologists participated (n = 9). Overall, patients and oncologists positively endorsed use of the questionnaire during clinical encounters. The majority of patients (80%) and oncologists (89%) reported use of the questionnaire improved communication, including discussion of sensitive topics. Interestingly, only a minority of patients and oncologists stated a perceived preference for electronic completion (18% and 44%, respectively).

Conclusion

Implementation of the EORTC QLQ-CX24 in gynecologic oncology clinics was feasible and acceptable according to patients and oncologists.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Charra-Brunaud C, Harter V, Delannes M, Haie-Meder C, Quetin P, Kerr C, Castelain B, Thomas L, Peiffert D (2012) Impact of 3D image-based PDR brachytherapy on outcome of patients treated for cervix carcinoma in France: results of the French STIC prospective study. Radiother Oncol 103(3):305–313

    Article  Google Scholar 

  2. Keys HM, Bundy BN, Stehman FB, Muderspach LI, Chafe WE, Suggs CL, Walker JL, Gersell D (1999) Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med 340:1154–1161

    Article  CAS  Google Scholar 

  3. Rose PG, Bundy BN, Watkins EB, Thigpen JT, Deppe G, Maiman MA, Clarke-Pearson DL, Insalaco S (1999) Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 340:1144–1153

    Article  CAS  Google Scholar 

  4. Peters WA, Liu PY, Barrett RJ, Stock RJ, Monk BJ, Berek JS, Souhami L, Grigsby P, Gordon W Jr, Alberts DS (2000) Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol 18:1606–1613

    Article  CAS  Google Scholar 

  5. Bjelic-Radisic V et al (2012) Quality of life characteristics inpatients with cervical cancer. Eur J Cancer 48:3009–3018

    Article  Google Scholar 

  6. Kathryn Osann SH, Nelson EL, Monk BJ, Chase D, Cella D, Wenzel L (2014) Factors associated with poor quality of life among cervical cancer survivors: implications for clinical care and clinical trials. Gynecol Oncol 135:266–272

    Article  Google Scholar 

  7. Le Borgne G et al (2013) Quality of life in long-term cervical cancer survivors: a population-based study. Gynecol Oncol 129:222–228

    Article  Google Scholar 

  8. Park SY, Bae DS, Nam JH, Park CT, Cho CH, Lee JM, Lee MK, Kim SH, Park SM, Yun YH (2007) Quality of life and sexual problems in disease-free survivors of cervical cancer compared with the general population. Cancer 110:2716–2725

    Article  Google Scholar 

  9. Greimel ER, Winter R, Kapp KS, Haas J (2009) Quality of life and sexual functioning after cervical cancer treatment: a long-term follow-up study. Psychooncology 18:476–482

    Article  Google Scholar 

  10. Chase DM, Huang HQ, Wenzel L, Cella D, McQuellon R, Long HJ, Moore DH, Monk BJ (2012) Quality of life and survival in advanced cervical cancer: a gynecologic oncology group study. Gynecol Oncol 125:315–319

    Article  Google Scholar 

  11. FDA (2006) Guidance for industry: patient-reported outcome measures: use in medical product development to support labeling claims: draft guidance. Health Qual Life Outcomes 11:79

    Google Scholar 

  12. Lipscomb J, Gotay CC, Snyder CF (2007) Patient-reported outcomes in cancer: a review of recent research and policy initiatives. CA Cancer J Clin 57:278–300

    Article  Google Scholar 

  13. Chen J, Ou L, Hollis SJ (2013) A systematic review of the impact of routine collection of patient reported outcome measures on patients, providers and health organisations in an oncologic setting. BMC Health Serv Res 13:211

    Article  Google Scholar 

  14. Detmar SB, Muller MJ, Schornagel JH, Wever LD, Aaronson NK (2002) Health-related quality-of-life assessments and patient-physician communication: a randomized controlled trial. JAMA 288:3027–3034

    Article  Google Scholar 

  15. Kotronoulas G, Kearney N, Maguire R, Harrow A, Di Domenico D, Croy S, Macgillivray S (2014) What is the value of the routine use of patient-reported outcome measures toward improvement of patient outcomes, processes of care, and health service outcomes in cancer care? A systematic review of controlled trials. J Clin Oncol 32:1480–1501

    Article  Google Scholar 

  16. Howell D, Currie S, Mayo S, Jones G, Boyle M, Hack T, Green E, Hoffman L, Simpson J, Collacutt V, McLeod D, Digout CA (2009) Pan-Canadian clinical practice guideline: assessment of psychosocial health care needs of the adult cancer patient, Toronto: Canadian Partnership Against Cancer (Cancer Journey Action Group) and the Canadian Association of Psychosocial Oncology. Access to the Guideline is available on cancerview.ca and the Canadian Association of Psychosocial Oncology website (www.capo.ca). Accessed May 2009

  17. Chang VT, Hwang SS, Feuerman M (2000) Validation of the Edmonton Symptom Assessment Scale. Cancer 88:2164–2171

    Article  CAS  Google Scholar 

  18. Pereira JL et al (2016) Cancer care professionals’ attitudes toward systematic standardized symptom assessment and the Edmonton symptom assessment system after large-scale population-based implementation in Ontario, Canada. J Pain Symptom Manag 51:662–672 e668

    Article  Google Scholar 

  19. Haji F, Barbera LC, Bedford C, Nichols B, Brundage MD (2017) Standardized symptom screening: Cancer Care Ontario’s expanded prostate cancer index composite for clinical practice (EPIC-CP) provincial implementation approach. J Clin Oncol 35:100–100

    Article  Google Scholar 

  20. Greimel ER, Kuljanic Vlasic K, Waldenstrom AC, Duric VM, Jensen PT, Singer S, Chie W, Nordin A, Bjelic Radisic V, Wydra D, on behalf of the European Organization for Research and Treatment of Cancer Quality-of-Life Group (2006) The European Organization for Research and Treatment of Cancer (EORTC) quality-of-life questionnaire cervical cancer module: EORTC QLQ-CX24. Cancer 107:1812–1822

    Article  Google Scholar 

  21. Snyder CF, Herman JM, White SM, Luber BS, Blackford AL, Carducci MA, Wu AW (2014) When using patient-reported outcomes in clinical practice, the measure matters: a randomized controlled trial. J Oncol Pract 10:e299–e306

    Article  Google Scholar 

  22. Li M, Macedo A, Crawford S, Bagha S, Leung YW, Zimmermann C, Fitzgerald B, Wyatt M, Stuart-McEwan T, Rodin G (2016) Easier said than done: Keys to successful implementation of the Distress Assessment and Response Tool (DART) program. J Oncol Pract 12:e513–e526

    Article  Google Scholar 

  23. Singer S, Kuhnt S, Momenghalibaf A, Stuhr C, Dimmel-Hennersdorf U, Köhler U, Einenkel J (2010) Patients’ acceptance and psychometric properties of the EORTC QLQ-CX24 after surgery. Gynecol Oncol 116:82–87

    Article  Google Scholar 

  24. Barbera L, Fitch M, Adams L, Doyle C, DasGupta T, Blake J (2011) Improving care for women after gynecological cancer: the development of a sexuality clinic. Menopause 18:1327–1333

    Article  Google Scholar 

  25. Brundage MD, Barbera L, McCallum F, Howell DM (2019) A pilot evaluation of the expanded prostate cancer index composite for clinical practice (EPIC-CP) tool in Ontario. Qual Life Res 28:771–782

    Article  CAS  Google Scholar 

  26. Jagsi R, Chiang A, Polite BN, Medeiros BC, McNiff K, Abernethy AP, Zon R, Loehrer PJ Sr (2013) Qualitative analysis of practicing oncologists’ attitudes and experiences regarding collection of patient-reported outcomes. J Oncol Pract 9:e290–e297

    Article  Google Scholar 

  27. Berry DL, Blumenstein BA, Halpenny B, Wolpin S, Fann JR, Austin-Seymour M, Bush N, Karras BT, Lober WB, McCorkle R (2011) Enhancing patient-provider communication with the electronic self-report assessment for cancer: a randomized trial. J Clin Oncol Off J Am Soc Clin Oncol 29:1029–1035

    Article  Google Scholar 

  28. Lavallee DC, Chenok KE, Love RM, Petersen C, Holve E, Segal CD, Franklin PD (2016) Incorporating patient-reported outcomes into health care to engage patients and enhance care. Health Aff 35:575–582

    Article  Google Scholar 

  29. Howell D, Currie S, May S, Jones G, Boyle M, Hack T, Green E, Hoffman L, Simpson J, Collacutt V, McLeod D, Digout C (2009) A pan-Canadian clinical practice guideline: assessment of psychosocial health care needs of the adult cancer patient, Toronto: Canadian partnership against cancer (cancer journey action group) and the Canadian association of psychosocial oncology

  30. Engelen V, Detmar S, Koopman H, Maurice-Stam H, Caron H, Hoogerbrugge P, Egeler RM, Kaspers G, Grootenhuis M (2012) Reporting health-related quality of life scores to physicians during routine follow-up visits of pediatric oncology patients: is it effective? Pediatr Blood Cancer 58:766–774

    Article  Google Scholar 

  31. Bruner DW et al (2007) Issues and challenges with integrating patient-reported outcomes in clinical trials supported by the National Cancer Institute-sponsored clinical trials networks. J Clin Oncol Off J Am Soc Clin Oncol 25:5051–5057

    Article  Google Scholar 

  32. Rotenstein LS, Huckman RS, Wagle NW (2017) Making patients and doctors happier - the potential of patient-reported outcomes. N Engl J Med 377:1309–1312

    Article  Google Scholar 

  33. Basch E, Deal AM, Dueck AC, Scher HI, Kris MG, Hudis C, Schrag D (2017) Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. JAMA 318:197–198

    Article  Google Scholar 

  34. Abernethy AP, Zafar SY, Uronis H, Wheeler JL, Coan A, Rowe K, Shelby RA, Fowler R, Herndon JE II (2010) Validation of the Patient Care Monitor (Version 2.0): a review of system assessment instrument for cancer patients. J Pain Symptom Manag 40:545–558

    Article  Google Scholar 

  35. Basch E, Artz D, Dulko D, Scher K, Sabbatini P, Hensley M, Mitra N, Speakman J, McCabe M, Schrag D (2005) Patient online self-reporting of toxicity symptoms during chemotherapy. J Clin Oncol Off J Am Soc Clin Oncol 23:3552–3561

    Article  Google Scholar 

  36. Bennett AV, Jensen RE, Basch E (2012) Electronic patient-reported outcome systems in oncology clinical practice. CA Cancer J Clin 62:337–347

    Article  Google Scholar 

  37. LeBlanc TW, Abernethy AP (2017) Patient-reported outcomes in cancer care - hearing the patient voice at greater volume. Nat Rev Clin Oncol 14:763–772

    Article  Google Scholar 

  38. Basch E, Deal AM, Kris MG, Scher HI, Hudis CA, Sabbatini P, Rogak L, Bennett AV, Dueck AC, Atkinson TM, Chou JF, Dulko D, Sit L, Barz A, Novotny P, Fruscione M, Sloan JA, Schrag D (2016) Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial. J Clin Oncol Off J Am Soc Clin Oncol 34:557–565

    Article  CAS  Google Scholar 

  39. Adler NE, Page AEK (eds) (2008) Cancer care for the whole patient: meeting psychosocial health needs. Washington (DC)

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, University of Toronto, 610 University Ave, Toronto, ON, M5G 2M9, Canada

    Soha Atallah, Lisa Barbera, Matthew Folwell & Jennifer Croke

  2. Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2M9, Canada

    Soha Atallah, Doris Howell, ZhihuiAmy Liu & Jennifer Croke

  3. Department of Radiation Oncology, University of Calgary, Calgary, Canada

    Lisa Barbera

  4. Royal Victoria Regional Health Center, Barrie, Canada

    Matthew Folwell

  5. Department of Psychosocial Oncology, University of Toronto, Toronto, Canada

    Doris Howell

  6. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

    ZhihuiAmy Liu

Authors
  1. Soha Atallah
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lisa Barbera
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthew Folwell
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Doris Howell
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. ZhihuiAmy Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jennifer Croke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jennifer Croke.

Ethics declarations

This study was approved by the Ontario Cancer Research Ethics Board (OCREB).

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

The authors have full control of all primary data and agree to allow the journal to review the data if requested.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 31.4 kb)

ESM 2

(DOCX 30.2 kb)

ESM 3

(DOCX 209 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Atallah, S., Barbera, L., Folwell, M. et al. Feasibility of implementing a cervix cancer–specific patient-reported outcome measure in routine ambulatory clinics. Support Care Cancer 29, 499–507 (2021). https://doi.org/10.1007/s00520-020-05500-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-020-05500-2

Keywords

Search

Navigation