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Grant Details

Grant Number: 5R01CA205146-04 Interpret this number
Primary Investigator: Wang, Xin
Organization: University Of Tx Md Anderson Can Ctr
Project Title: Improving Recovery After Major Cancer Surgery Using Patient-Reported Outcomes
Fiscal Year: 2019


Abstract

PROJECT SUMMARY/ABSTRACT Increasing utilization of patient-reported outcomes (PROs) in clinical practice may lead to better postop- erative outcomes, with pain assessment and management as an excellent example. Although PROs are widely accepted in clinical research in medical and radiation oncology and are endorsed by the US Food & Drug Ad- ministration, the introduction of subjective outcomes is relatively novel in perioperative care practice― despite the fact that PROs are the best resource for defining and measuring the patient’s perspective of symp- tomatic and functional recovery after major cancer surgery and that the information they provide could poten- tially guide care during recovery. A major knowledge gap is that, although validated PRO tools exist, there are no established, user-friendly clinical methods for understanding and responding to symptom and function- al-status reports from patients after complex major surgery. The goal of our study is to establish a framework for clinical adoption of PROs, to define methods needed to interpret PRO data from the MD Anderson Symp- tom Inventory (MDASI), and to examine the MDASI’s clinical utility and patient and professional perspectives on using it in future practice. If we are successful, PROs could be added to well-defined, traditional metrics in perioperative care, such as decreased 30-day mortality, fewer complications, shortened hospital stays, and few- er hospital readmissions. The increasing inclusion of PRO portals in electronic medical record systems (such as EPIC) that can longitudinally track patient report away from the hospital make this approach feasible. Given EPIC’s decision to include the MDASI nationwide (also at MD Anderson Cancer Center), we believe we have a timely opportunity to provide the first evidence-based package to support implementation of the MDASI in perioperative care. At MD Anderson, perioperative recovery is being further improved by incorporation of an Enhanced Recovery Program (ERP) that challenges traditional surgical practices. The need to effectively com- pare ERP and traditional surgery outcomes exemplifies the urgency of this project. We propose a longitudinal clinical study, plus a survey of professionals to identify/address barriers to the use of PROs. We have assem- bled a strong multidisciplinary team from symptom research, surgical nursing, surgery, and anesthesiology to study patients undergoing surgery for gastrointestinal, gynecologic, or genitourinary cancer. Aim 1: Establish PRO-based methods to determine clinically meaningful postoperative symptom burden. Gap addressed: lack of quantitatively defined, procedure-specific symptom profiles and severity thresholds for managing moderate to severe symptoms, especially postdischarge. Aim 2: Establish PRO-based methods to evaluate postoperative functional recovery. Gap addressed: lack of empirical data on self-reported functional recovery to indicate readiness to resume planned oncology care or return to normal activities. Aim 3: Examine the utility of PROs as a postoperative outcome measure through a PRO study in patients and a “probe” observational study of cli- nicians. Gap addressed: lack of evidence about how the availability of PROs might alter clinical practice.



Publications

Estimating the optimal linear combination of predictors using spherically constrained optimization.
Authors: Das P. , De D. , Maiti R. , Kamal M. , Hutcheson K.A. , Fuller C.D. , Chakraborty B. , Peterson C.B. .
Source: BMC bioinformatics, 2022-10-19; 23(Suppl 3), p. 436.
EPub date: 2022-10-19.
PMID: 36261805
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Validation and Application of MD Anderson Symptom Inventory Module for Patients with Bladder Cancer in the Perioperative Setting.
Authors: Kamal M. , Navai N. , Bree K.K. , Williams L.A. , Cleeland C.S. , Shen S.E. , Wang X.S. .
Source: Cancers, 2022-08-12; 14(16), .
EPub date: 2022-08-12.
PMID: 36010890
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Patient-reported outcomes: Is this the missing link in patient-centered perioperative care?
Authors: Wang X.S. , Gottumukkala V. .
Source: Best practice & research. Clinical anaesthesiology, 2021 Dec; 35(4), p. 565-573.
EPub date: 2020-10-31.
PMID: 34801218
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Patient-Reported Symptom and Functioning Status during the First 12 Months after Chimeric Antigen Receptor T Cell Therapy for Hematologic Malignancies.
Authors: Wang X.S. , Srour S.A. , Whisenant M. , Subbiah I.M. , Chen T.H. , Ponce D. , Gonzalez A.G. , Kamal M. , Mendoza T. , Cleland C.S. , et al. .
Source: Transplantation and cellular therapy, 2021 Nov; 27(11), p. 930.e1-930.e10.
EPub date: 2021-07-12.
PMID: 34265479
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What Women Want: Radical Cystectomy and Perioperative Sexual Function Educational Needs.
Authors: Westerman M.E. , Bree K.K. , Kokorovic A. , Frank J. , Wang X.S. , Kamat A.M. , Dinney C.P.N. , Navai N. .
Source: Urology, 2021 Nov; 157, p. 181-187.
EPub date: 2021-06-26.
PMID: 34186127
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Behavioral Economics and Ambulatory Antibiotic Stewardship: A Narrative Review.
Authors: Richards A.R. , Linder J.A. .
Source: Clinical therapeutics, 2021 Oct; 43(10), p. 1654-1667.
EPub date: 2021-10-23.
PMID: 34702589
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Impact of a tiered discharge opioid algorithm on prescriptions and patient-reported outcomes after open gynecologic surgery.
Authors: Huepenbecker S. , Hillman R.T. , Iniesta M.D. , Chen T. , Cain K. , Mena G. , Lasala J. , Wang X.S. , Williams L. , Taylor J.S. , et al. .
Source: International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2021 Jul; 31(7), p. 1052-1060.
EPub date: 2021-06-16.
PMID: 34135073
Related Citations

Development of a patient-reported outcome tool for assessing symptom burden during perioperative care in liver surgery: The MDASI-PeriOp-Hep.
Authors: Wang X.S. , Shi Q. , Williams L.A. , Lillemoe H.A. , Chen T.Y. , Gottumukkala V. , Garcia-Gonzalez A. , Malveaux D. , Kamal M. , Cleeland C.S. , et al. .
Source: European journal of oncology nursing : the official journal of European Oncology Nursing Society, 2021 Jun; 52, p. 101959.
EPub date: 2021-04-28.
PMID: 33964632
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Patient-Reported Outcomes for Cancer Patients with Hematological Malignancies Undergoing Chimeric Antigen Receptor T Cell Therapy: A Systematic Review.
Authors: Kamal M. , Joseph J. , Greenbaum U. , Hicklen R. , Kebriaei P. , Srour S.A. , Wang X.S. .
Source: Transplantation and cellular therapy, 2021 May; 27(5), p. 390.e1-390.e7.
EPub date: 2021-01-07.
PMID: 33965176
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Assessment of physical function by subjective and objective methods in patients undergoing open gynecologic surgery.
Authors: Wang X.S. , Kamal M. , Chen T.H. , Shi Q. , Garcia-Gonzalez A. , Iniesta M.D. , Cleeland C.S. , Gottumukkala V. , Meyer L.A. .
Source: Gynecologic oncology, 2021 Apr; 161(1), p. 83-88.
EPub date: 2021-01-31.
PMID: 33536127
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Longitudinal patient-reported outcomes and restrictive opioid prescribing after minimally invasive gynecologic surgery.
Authors: Hillman R.T. , Iniesta M.D. , Shi Q. , Suki T. , Chen T. , Cain K. , Williams L. , Wang X.S. , Taylor J.S. , Mena G. , et al. .
Source: International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2021 Jan; 31(1), p. 114-121.
EPub date: 2020-11-06.
PMID: 33158876
Related Citations

A prospective randomized trial comparing liposomal bupivacaine vs standard bupivacaine wound infiltration in open gynecologic surgery on an enhanced recovery pathway.
Authors: Meyer L.A. , Corzo C. , Iniesta M.D. , Munsell M. , Shi Q. , Pitcher B. , Lasala J. , Cain K.E. , Wang X.S. , Mena G. , et al. .
Source: American journal of obstetrics and gynecology, 2021 Jan; 224(1), p. 70.e1-70.e11.
EPub date: 2020-07-16.
PMID: 32682856
Related Citations

Radical Cystectomy and Perioperative Sexual Function: A Cross-Sectional Analysis.
Authors: Westerman M.E. , Kokorovic A. , Wang X.S. , Lim A. , Garcia-Gonzalez A. , Seif M. , Wang R. , Kamat A.M. , Dinney C.P.N. , Navai N. .
Source: The journal of sexual medicine, 2020 Oct; 17(10), p. 1995-2004.
EPub date: 2020-07-23.
PMID: 32713807
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Testing Symptom Severity Thresholds and Potential Alerts for Clinical Intervention in Patients With Cancer Undergoing Chemotherapy.
Authors: Shi Q. , Lee J.W. , Wang X.S. , Fisch M.J. , Chang V.T. , Wagner L. , Cleeland C.S. .
Source: JCO oncology practice, 2020 Sep; 16(9), p. e893-e901.
EPub date: 2020-05-05.
PMID: 32369412
Related Citations

Severe Preoperative Symptoms Delay Readiness to Return to Intended Oncologic Therapy (RIOT) After Liver Resection.
Authors: Lillemoe H.A. , Marcus R.K. , Kim B.J. , Narula N. , Davis C.H. , Shi Q. , Wang X.S. , Aloia T.A. .
Source: Annals of surgical oncology, 2019 Dec; 26(13), p. 4548-4555.
EPub date: 2019-08-14.
PMID: 31414293
Related Citations

Comparison of patient reported symptom burden on an enhanced recovery after surgery (ERAS) care pathway in patients with ovarian cancer undergoing primary vs. interval tumor reductive surgery.
Authors: Meyer L.A. , Shi Q. , Lasala J. , Iniesta M.D. , Lin H.K. , Nick A.M. , Williams L. , Sun C. , Wang X.S. , Lu K.H. , et al. .
Source: Gynecologic oncology, 2019 Mar; 152(3), p. 501-508.
PMID: 30876495
Related Citations

Validation and application of a module of the MD Anderson Symptom Inventory for measuring perioperative symptom burden in patients with gynecologic cancer (the MDASI-PeriOp-GYN).
Authors: Wang X.S. , Shi Q. , Williams L.A. , Cleeland C.S. , Garcia-Gonzalez A. , Chen T.Y. , Shahid D.R. , Ramirez P.T. , Iniesta M.D. , Siverand A.M. , et al. .
Source: Gynecologic oncology, 2019 Mar; 152(3), p. 492-500.
PMID: 30876494
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Effect of an Enhanced Recovery After Surgery Program on Opioid Use and Patient-Reported Outcomes.
Authors: Meyer L.A. , Lasala J. , Iniesta M.D. , Nick A.M. , Munsell M.F. , Shi Q. , Wang X.S. , Cain K.E. , Lu K.H. , Ramirez P.T. .
Source: Obstetrics and gynecology, 2018 Aug; 132(2), p. 281-290.
PMID: 29995737
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Patient-Reported Outcomes Are Associated With Enhanced Recovery Status in Patients With Bladder Cancer Undergoing Radical Cystectomy.
Authors: Kukreja J.B. , Shi Q. , Chang C.M. , Seif M.A. , Sterling B.M. , Chen T.Y. , Creel K.M. , Kamat A.M. , Dinney C.P. , Navai N. , et al. .
Source: Surgical innovation, 2018 Jun; 25(3), p. 242-250.
EPub date: 2018-03-20.
PMID: 29557251
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A Randomized Controlled Trial of Postoperative Thoracic Epidural Analgesia Versus Intravenous Patient-controlled Analgesia After Major Hepatopancreatobiliary Surgery.
Authors: Aloia T.A. , Kim B.J. , Segraves-Chun Y.S. , Cata J.P. , Truty M.J. , Shi Q. , Holmes A. , Soliz J.M. , Popat K.U. , Rahlfs T.F. , et al. .
Source: Annals of surgery, 2017 Sep; 266(3), p. 545-554.
PMID: 28746153
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