Supportive care interventions for people with cancer assisted by digital technology: A systematic review (Preprint)

2020 ◽  
Author(s):  
Michael Marthick ◽  
Deborah McGregor ◽  
Jennier A. Alison ◽  
Birinder Cheema ◽  
Haryana Dhillon ◽  
...  
Keyword(s):  
Systematic Review ◽  
Supportive Care ◽  
Randomized Controlled Trials ◽  
Outcome Measures ◽  
Cancer Care ◽  
Digital Health ◽  
Health Interventions ◽  
Controlled Trials ◽  
Supportive Cancer Care ◽  
Randomized Controlled

BACKGROUND While relatively new, digital health interventions are demonstrating rapid growth due to their ability to facilitate access and overcome issues of location, time, health status, and most recently, the impact of a major pandemic. With the increased uptake of digital technologies, digital health has the potential to improve the provision of supportive cancer care. OBJECTIVE The purpose of this systematic review was to evaluate digital health interventions in supportive cancer care. METHODS Published literature between 2000 and 2020 was systematically searched in Medline, PubMed, Embase, PsycINFO, Cochrane Central Register of Controlled Trials and Scopus. Eligible publications were randomized controlled trials (RCTs) of clinician led digital health interventions to support adult cancer patients. Included interventions were determined by applying a digital health conceptual model. Studies were appraised for quality using the revised Cochrane risk of bias tool. RESULTS Twenty randomized controlled trials met the inclusion criteria for analysis. Interventions varied by duration, frequency, degree of technology use and applied outcome measures. Interventions targeting a single tumour stream, predominantly breast cancer, and studies involving the implementation of remote symptom monitoring dominated results. In most studies the digital intervention resulted in significant positive outcomes in patient reported symptoms, levels of fatigue and pain, health-related quality of life, functional capacity, and/or depression levels compared to control. CONCLUSIONS Digital health interventions are helpful and effective for the supportive care of patients with cancer. There is a need for higher quality research. Future endeavours could focus on use of valid, standardised outcome measures, maintenance of methodological rigour, and strategies to improve patient and health professional engagement in the design and delivery of supportive digital health interventions. CLINICALTRIAL

scholarly journals Virtual Care in Patients with Cancer: A Systematic Review

2021 ◽  
Vol 28 (5) ◽  
pp. 3488-3506
Author(s):  
Simron Singh ◽  
Glenn G. Fletcher ◽  
Xiaomei Yao ◽  
Jonathan Sussman
Keyword(s):  
Systematic Review ◽  
Supportive Care ◽  
Randomized Controlled Trials ◽  
Genetic Counselling ◽  
Comparative Studies ◽  
Cancer Care ◽  
Controlled Trials ◽  
Patients With Cancer ◽  
Randomized Controlled ◽  
Virtual Care

Virtual care in cancer care existed in a limited fashion globally before the COVID-19 pandemic, mostly driven by geographic constraints. The pandemic has required dramatic shifts in health care delivery, including cancer care. We conducted a systematic review of comparative studies evaluating virtual versus in-person care in patients with cancer. Embase, APA PsycInfo, Ovid MEDLINE, and the Cochrane Library were searched for literature from January 2015 to 6 August 2020. We adhered to PRISMA guidelines and used the modified GRADE approach to evaluate the data. We included 34 full-text publications of 10 randomized controlled trials, 13 non-randomized comparative studies, and 5 ongoing randomized controlled trials. Evidence was divided into studies that provide psychosocial or genetic counselling and those that provide or assess medical and supportive care. The limited data in this review support that in the general field of psychological counselling, virtual or remote counselling can be equivalent to in-person counselling. In the area of genetic counselling, telephone counselling was more convenient and noninferior to usual care for all outcomes (knowledge, decision conflict, cancer distress, perceived stress, genetic counseling satisfaction). There are few data for clinical outcomes and supportive care. Future research should assess the role of virtual care in these areas. Protocol registration: PROSPERO CRD42020202871.

scholarly journals Methods to Evaluate the Effects of Internet-Based Digital Health Interventions for Citizens: Systematic Review of Reviews (Preprint)

2018 ◽  
Author(s):  
Paolo Zanaboni ◽  
Patrice Ngangue ◽  
Gisele Irène Claudine Mbemba ◽  
Thomas Roger Schopf ◽  
Trine Strand Bergmo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Randomized Controlled Trials ◽  
Digital Health ◽  
Behavioral Outcomes ◽  
Health Interventions ◽  
Care Utilization ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Review Of Reviews

BACKGROUND Digital health can empower citizens to manage their health and address health care system problems including poor access, uncoordinated care and increasing costs. Digital health interventions are typically complex interventions. Therefore, evaluations present methodological challenges. OBJECTIVE The objective of this study was to provide a systematic overview of the methods used to evaluate the effects of internet-based digital health interventions for citizens. Three research questions were addressed to explore methods regarding approaches (study design), effects and indicators. METHODS We conducted a systematic review of reviews of the methods used to measure the effects of internet-based digital health interventions for citizens. The protocol was developed a priori according to Preferred Reporting Items for Systematic review and Meta-Analysis Protocols and the Cochrane Collaboration methodology for overviews of reviews. Qualitative, mixed-method, and quantitative reviews published in English or French from January 2010 to October 2016 were included. We searched for published reviews in PubMed, EMBASE, The Cochrane Database of Systematic Reviews, CINHAL and Epistemonikos. We categorized the findings based on a thematic analysis of the reviews structured around study designs, indicators, types of interventions, effects and perspectives. RESULTS A total of 20 unique reviews were included. The most common digital health interventions for citizens were patient portals and patients' access to electronic health records, covered by 10/20 (50%) and 6/20 (30%) reviews, respectively. Quantitative approaches to study design included observational study (15/20 reviews, 75%), randomized controlled trial (13/20 reviews, 65%), quasi-experimental design (9/20 reviews, 45%), and pre-post studies (6/20 reviews, 30%). Qualitative studies or mixed methods were reported in 13/20 (65%) reviews. Five main categories of effects were identified: (1) health and clinical outcomes, (2) psychological and behavioral outcomes, (3) health care utilization, (4) system adoption and use, and (5) system attributes. Health and clinical outcomes were measured with both general indicators and disease-specific indicators and reported in 11/20 (55%) reviews. Patient-provider communication and patient satisfaction were the most investigated psychological and behavioral outcomes, reported in 13/20 (65%) and 12/20 (60%) reviews, respectively. Evaluation of health care utilization was included in 8/20 (40%) reviews, most of which focused on the economic effects on the health care system. CONCLUSIONS Although observational studies and surveys have provided evidence of benefits and satisfaction for patients, there is still little reliable evidence from randomized controlled trials of improved health outcomes. Future evaluations of digital health interventions for citizens should focus on specific populations or chronic conditions which are more likely to achieve clinically meaningful benefits and use high-quality approaches such as randomized controlled trials. Implementation research methods should also be considered. We identified a wide range of effects and indicators, most of which focused on patients as main end users. Implications for providers and the health system should also be included in evaluations or monitoring of digital health interventions.

scholarly journals A systematic review of reported outcomes and outcome measures in randomized controlled trials on apical prolapse surgery

2019 ◽  
Vol 145 (1) ◽  
pp. 4-11 ◽  
Author(s):  
Thais Regina Mattos Lourenço ◽  
Vasilis Pergialiotis ◽  
Constantin Durnea ◽  
Abdullatif Elfituri ◽  
Jorge Milhem Haddad ◽  
...  
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Outcome Measures ◽  
Prolapse Surgery ◽  
Controlled Trials ◽  
Apical Prolapse ◽  
Randomized Controlled

Efficacy of Hypo-Methylating Agents in the Treatment of Myelodysplastic Syndromes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3632-3632
Author(s):  
Ambuj Kumar ◽  
Alan F. List ◽  
Rahul Mhaskar ◽  
Benjamin Djulbegovic
Keyword(s):  
Systematic Review ◽  
Supportive Care ◽  
Randomized Controlled Trials ◽  
Confidence Intervals ◽  
Meta Analysis ◽  
Phase Iii ◽  
P Value ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Methylating Agents

Abstract Background: With the FDA approval of two hypomethylating agents (HA) for the treatment of myelodysplastic syndromes (MDS), both azacitidine (AZA-C) and decitabine have shown widespread usage. These agents improved response rates (RR) in phase III registration trials, however, overall survival (OS) was not significantly improved. Furthermore, head to head comparison of AZA-C versus decitabine is lacking. We performed a systematic review of randomized controlled trials (RCTs) to assess the efficacy of AZA-C and decitabine versus supportive care (SC), and AZA-C versus decitabine for the treatment of MDS. Methods: A comprehensive literature search of MEDLINE, EMBASE and Cochrane library database was undertaken to identify all phase III randomized controlled trials (RCT) published through July 2008. Meetings abstracts from ASCO, ASH and European Society for Hematology were searched for the years 2006–2007. Data extraction and meta-analysis on benefits and harms of HA for MDS was performed as per the methods recommended by the Cochrane Collaboration. Indirect comparison of AZA-C versus decitabine was conducted according to the methods developed by Bucher et al and Glenny et al and were extended to calculate hazard ratios (HR). We created the following chain of inference: we first pooled RCTs that compared AZA-C with SC, and decitabine versus SC. We then compared the pooled estimates to obtain the unbiased estimate in treatment differences between decitabine and AZA-C. Results: We found 4 RCTs assessing the efficacy of HA for the treatment of MDS. Two RCTs compared AZA-C versus SC, and 2 compared decitabine versus SC. The results from 1 trial describing the effects of decitabine versus SC were reported as a press release stating that OS was not significant between two arms, however, data were not available for this analysis. The results for all comparisons are summarized in the table below. Meta-analysis of RCTs comparing HA versus SC showed significantly better OS, EFS, and RR in favor of HA without a significant increase in treatment-related mortality (TRM). Comparison of AZA-C versus SC also showed significantly better OS, EFS and RR favoring AZA-C without significant risk of TRM. In one RCT comparing decitabine versus SC, RR was significantly superior in the decitabine arm. However, there was no difference in OS, EFS and TRM between decitabine and SC. Evaluation of decitabine versus AZA-C showed significantly better OS and RR favoring AZA-C, whereas EFS and TRM were similar. Conclusion: This first systematic review on the efficacy of HA versus SC shows that OS, EFS and RR are superior with HA without significant TRM. Additionally, use of AZA-C is associated with significantly improved OS and RR compared to decitabine. In order to definitively confirm these findings, a prospective RCT comparing AZA-C and decitabine is warranted. Results from this systematic review on the efficacy of AZA-C and decitabine should be considered the threshold against which efficacy of future agents in MDS should be tested. Outcome Comparisons Hypo-methylating agents versus supportive care (3 RCTs; N=719) Conclusion Azacitidine versus supportive care (2 RCTs; N= 549) Conclusion Decitabine versus supportive care (1 RCT; N=170) Conclusion Azacitadine versus Decitabine (Indirect comparison) Conclusion Overall Survival Hazard ratio (HR)(95% Confidence Intervals) P-value HR=0.79 (0.67, 0.95) p=0.01 Hypo- methylating agents better HR=0.62 (0.48, 0.78) p=0.00 Azacitidine better HR=1.064 (0.82, 1.38) p=0.636 No difference HR=0.579 (0.41, 0.82) p=0.002 Azacitidine better Event-free survival Hazard ratio (HR) (95% Confidence Intervals) P-value HR=0.59 (0.46, 0.75) p=0.00 Hypo- methylating agents better HR=0.58 (0.44, 0.76) p=0.00 Azacitidine better HR=0.64 (0.35, 1.19) p=0.16 No difference HR=0.89 (0.46, 1.80) p=0.753 No difference Response rate Risk ratio (RR) (95% Confidence Intervals) P-value RR=1.28 (1.19, 1.37) p=0.00 Hypo- methylating agents better RR=1.37 (1.25, 1.52) p=0.00 Azacitidine better RR=1.2 (1.08, 1.31) p=0.00 Decitabine better RR=1.15 (1.0, 1.314) p=0.05 Azacitidine better Treatment-related mortality Risk ratio (RR) (95% Confidence Intervals) P-value RR=0.69 (0.36, 1.32) p=0.264 No difference RR=2.79 (0.12, 67.64) p=0.528 No difference RR=0.65 (0.34, 1.26) p=0.203 No difference RR=4.29 (0.16, 111.1) p=0.381 No difference

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