Feasibility and acceptability of electronic symptom surveillance with clinician feedback using the Patient-Reported Outcomes version of Common Terminology Criteria for Adverse Events (PRO-CTCAE) in Danish prostate cancer patients

Abstract Background The aim was to examine the feasibility, acceptability and clinical utility of electronic symptom surveillance with clinician feedback using a subset of items drawn from the Patient-Reported Outcomes version of Common Terminology Criteria for Adverse Events (PRO-CTCAE) in a cancer treatment setting. Methods Danish-speaking men with castration-resistant metastatic prostate cancer receiving treatment at the Department of Oncology, Rigshospitalet, Copenhagen between March 9, 2015 and June 8, 2015 were invited to participate (n = 63 eligible). Participants completed the PRO-CTCAE questionnaire on tablet computers using AmbuFlex software at each treatment visit in the outpatient clinic. In total, 22 symptomatic toxicities (41 PRO-CTCAE items), corresponding to the symptomatic adverse-events profile associated with the regimens commonly used for prostate cancer treatment (Docetaxel, Cabazitaxel, Abiraterone, Alpharadin), were selected. Participants’ PRO-CTCAE responses were presented graphically to their treating oncologists via an AmbuFlex dashboard, for real-time use to enhance the patient-clinician dialogue that occurs during the consultation prior to each treatment cycle. Technical and clinical barriers and acceptability were evaluated through semi-structured interviews with both patients and oncologists. Patients receiving active treatment at the end of the study period completed an evaluation questionnaire. Results Fifty-four out of sixty-three (86%) eligible patients were enrolled. The PRO-CTCAE questionnaire was completed a total of 168 times by 54 participants (median number per patient was 3, range 1–5). Eight surveys were missed, resulting in a compliance rate of 97%. At the end of the study period, 35 patients (65%) were still receiving active treatment and completed the evaluation questionnaire. Patients reported that their PRO-CTCAE responses served as a communication tool. Oncologists stated that the availability of the PRO-CTCAE self-reports during the consultation improved patient-clinician communication about side effects. Conclusion Electronic capture of symptomatic toxicities using PRO-CTCAE and the submission of self-reports to clinicians prior to consultation were feasible among metastatic prostate cancer patients receiving chemotherapy in an outpatient setting, and this procedure was acceptable to both patients and clinicians. Continued research, including a cluster-randomized trial, will evaluate the effects of submitting patients’ PRO-CTCAE results to clinicians prior to consultation on the quality of side-effects management and resultant clinical outcomes

Japan’s national tuberculosis control strategies with economic considerations

We made a bibliographic search for Japanese and non-Japanese literature on tuberculosis control programs to study the current public health policies for tuberculosis control in Japan especially in regard to cost-effectiveness. Then, we compared the Japanese, strategies for tuberculosis control with those in other countries including the United States, and those recommended by World Health Organization (WHO). The current trend of tuberculosis incidence in the Japanese community demonstrates major differences from the situation that had prompted installation of tuberculosis control measures several decades ago. The tuberculosis control measures should be targeted to the elderly people (over 65 years old) because of the following three aspects. (1) A continuing decline of tuberculosis in the young Japanese population, particularly children who might attain benefits from BCG immunization; (2) The enhancement of the prevalence among the elderly people who are not covered by a uniform national surveillance strategy; (3) Cost-ineffectiveness of Mass Miniature Radiography (MMR) being used as a means to screen for tuberculosis. The cost-effectiveness issue must be considered more seriously, and the WHO recommendations especially in regard with the DOTS (directly-observed treatment, short course) strategy need to be incorporated more effectively into the national program since the incidence of drug resistant tuberculosis in Japan has been recently increasing. Finally, we propose to limit BCG immunization further and to discontinue annual MMR in the young population, and instead to develop effective strategies of both active and passive case finding in the elderly through public and community health services