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Dance B, Dardare A, Fleming J, Siow SF, Schlub TE, Crawford H, Saunderson RB, Wong C, Berman Y. The impact of cutaneous neurofibromas on quality of life and mental health in neurofibromatosis type 1. J Dermatol 2024; 51:1050-1059. [PMID: 38923593 DOI: 10.1111/1346-8138.17276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/15/2024] [Accepted: 05/06/2024] [Indexed: 06/28/2024]
Abstract
The skin manifestations of neurofibromatosis 1 significantly reduce health-related quality-of-life. However, data on the utility of existing surveys in capturing neurofibromatosis 1 skin treatment outcomes are lacking. This quantitative study examined the relationship between clinician-rated severity and visibility and patient-rated itch and quality-of-life (QoL) to (1) establish baseline levels of skin- and condition-specific-related QoL, itch, depression and anxiety; (2) identify patient concerns to inform the development and evaluation of skin interventions; and (3) compare the sensitivity of different QoL measures. Validated scales included Skindex-29, Dermatology Life Quality Index (DLQI), Neurofibromatosis 1-adult quality-of-life (NF1-AdQOL) questionnaire, and the Hospital Anxiety and Depression Scale (HADS). We recruited 100 participants (response rate: 95%). Of these, 42% reported itch and 23% had probable clinical anxiety. Our cohort had higher levels of anxiety and total HADS scores compared to a control population. Using multivariate regression analysis, increasing visibility significantly predicted poorer QoL using the Skindex-29, NF1-AdQOL, and DLQI (p < 0.05); and itch significantly predicted worse QoL in Skindex-29 and NF1-AdQOL (p < 0.05). The highest mean scoring questions in Skindex-29 and NF1-AdQOL concerned worry about worsening skin disease and embarrassment. The highest mean scoring questions in DLQI were regarding itch, pain, and embarrassment. Items asking specifically about cutaneous neurofibromas (cNF) scored higher than comparable skin-specific questions (t-test p value <0.05). In summary, this study provides insights into the factors contributing to impaired QoL, anxiety, and mood in NF1 patients with cutaneous neurofibromas. Key factors identified for use in cNF measures include visibility, itch, anxiety, embarrassment, fears of worsening skin disease, and cNF-specific questions.
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Affiliation(s)
- Brieana Dance
- Department of Clinical Genetics, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Alice Dardare
- Northern Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Jane Fleming
- Department of Clinical Genetics, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Sue-Faye Siow
- Department of Clinical Genetics, Northern Sydney Local Health District, Sydney, New South Wales, Australia
- Northern Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Timothy E Schlub
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Hilda Crawford
- Department of Clinical Genetics, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Rebecca B Saunderson
- Department of Dermatology, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Claire Wong
- Department of Clinical Genetics, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Yemima Berman
- Department of Clinical Genetics, Northern Sydney Local Health District, Sydney, New South Wales, Australia
- Northern Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, New South Wales, Australia
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Jancic J, Zarkovic N, Nikolic B, Ivancevic N, Rovcanin B, Nesic D. Analysis of visual evoked potentials in patients with neurofibromatosis type 1: new concepts. Front Neurol 2024; 15:1410101. [PMID: 39105060 PMCID: PMC11298334 DOI: 10.3389/fneur.2024.1410101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 07/11/2024] [Indexed: 08/07/2024] Open
Abstract
Introduction Neurofibromatosis type 1 (NF type 1) is an autosomal dominant disease with typical clinical manifestations, such as skin lesions, Lisch nodules, optic pathway gliomas, and neurofibromas, caused by the mutation of the NF1 gene. Visual evoked potentials (VEP) present a measure of the electrophysiological response of visual cortex to a visual stimulus. The role of VEP in the pathophysiology of NF type 1 is very complex and requires additional research. The Aim We examined the differences between NF type 1 patients with normal and altered VEP and analyzed the correlation between the prolongation of P100 latency and disease severity. Materials and methods Two groups were formed: a control group and a study group with NF type 1 patients. Based on the control group analysis, a threshold value for a normal VEP finding of 116 ms was obtained, and it was used to divide the study group into subgroups with normal and altered VEP. We proceeded with examining the differences in clinical manifestations of the disease between the subgroups, after which we checked if there is a correlation between the prolongation of the P100 latency and the severity of the clinical picture according to the Riccardi scale. Statistical analysis was performed using the Pearson chi-square test and the Spearman correlation test in the program SPSS 28.0, with levels of statistical significance p = 0.05 and p = 0.001. Results In the group with the abnormal VEP we found a statistically significant more frequent occurrence of optic tract glioma (p = 0.008), tumors (p = 0.032), epilepsy (p = 0.043), and cognitive disorders (p = 0.028), while the other clinical signs had an equal prevalence in both groups. A moderately strong correlation (r s = 0.665) was observed between the prolongation of P100 latency and the severity of the clinical picture. Conclusion Our results showed the important role of VEP in the description of clinical phenotypes of NF type 1. The authors of the study propose VEP to be included in the diagnostic algorithms designed for patients with NF type 1.
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Affiliation(s)
- Jasna Jancic
- Clinic of Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikola Zarkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Blazo Nikolic
- Clinic of Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikola Ivancevic
- Clinic of Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branislav Rovcanin
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Center for Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Dejan Nesic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute of Medical Physiology, Belgrade, Serbia
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3
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Plunkett C, Pilkington M. Beliefs, screening attitudes and breast cancer awareness of young women with neurofibromatosis type 1: A reflexive thematic analysis. J Health Psychol 2024:13591053241255053. [PMID: 38859614 DOI: 10.1177/13591053241255053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024] Open
Abstract
Neurofibromatosis type 1 (NF1) predisposes individuals to benign and malignant tumours. Young women with NF1 (<50 years) have an up to five-fold increased risk of breast cancer. The UK adopts moderate cancer risk guidelines of NICE, advising women with NF1 to attend breast screening from 40 years. Previous results from a systematic review and meta-analysis found that breast cancer in this cohort predominantly occurs from 34 to 44 years. Without earlier screening, breast awareness is fundamental. Reflexive thematic analysis and semi-structured interview questions based on the health belief model explored whether a tailor-made breast cancer awareness intervention would be beneficial by examining beliefs, screening attitudes and breast cancer awareness of young women with NF1. Findings suggest the establishment of accessible and accurate NF1 and breast awareness information, development and implementation of a breast awareness intervention for young women with NF1, and healthcare professionals.
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John L, Singh G, Dombi E, Wolters PL, Martin S, Baldwin A, Steinberg SM, Bernstein J, Whitcomb P, Pichard DC, Dufek A, Gillespie A, Heisey K, Bornhorst M, Fisher MJ, Weiss BD, Kim A, Widemann BC, Gross AM. Development and pilot validation of a novel disfigurement severity scale for plexiform neurofibromas in children with neurofibromatosis type 1. Clin Trials 2024; 21:189-198. [PMID: 37877369 PMCID: PMC11003851 DOI: 10.1177/17407745231206402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
BACKGROUND/AIMS We developed an observer disfigurement severity scale for neurofibroma-related plexiform neurofibromas to assess change in plexiform neurofibroma-related disfigurement and evaluated its feasibility, reliability, and validity. METHODS Twenty-eight raters, divided into four cohorts based on neurofibromatosis type 1 familiarity and clinical experience, were shown photographs of children in a clinical trial (NCT01362803) at baseline and 1 year on selumetinib treatment for plexiform neurofibromas (n = 20) and of untreated participants with plexiform neurofibromas (n = 4). Raters, blinded to treatment and timepoint, completed the 0-10 disfigurement severity score for plexiform neurofibroma on each image (0 = not at all disfigured, 10 = very disfigured). Raters evaluated the ease of completing the scale, and a subset repeated the procedure to assess intra-rater reliability. RESULTS Mean baseline disfigurement severity score for plexiform neurofibroma ratings were similar for the selumetinib group (6.23) and controls (6.38). Mean paired differences between pre- and on-treatment ratings was -1.01 (less disfigurement) in the selumetinib group and 0.09 in the control (p = 0.005). For the disfigurement severity score for plexiform neurofibroma ratings, there was moderate-to-substantial agreement within rater cohorts (weighted kappa range = 0.46-0.66) and agreement between scores of the same raters at repeat sessions (p > 0.05). In the selumetinib group, change in disfigurement severity score for plexiform neurofibroma ratings was moderately correlated with change in plexiform neurofibroma volume with treatment (r = 0.60). CONCLUSION This study demonstrates that our observer-rated disfigurement severity score for plexiform neurofibroma was feasible, reliable, and documented improvement in disfigurement in participants with plexiform neurofibroma shrinkage. Prospective studies in larger samples are needed to validate this scale further.
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Affiliation(s)
- Liny John
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Gurbani Singh
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eva Dombi
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Pamela L Wolters
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Staci Martin
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrea Baldwin
- Clinical Research Directorate (CRD), Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Office of the Clinical Director, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jessica Bernstein
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Patricia Whitcomb
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Dominique C Pichard
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anne Dufek
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andy Gillespie
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kara Heisey
- Clinical Research Directorate (CRD), Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Miriam Bornhorst
- Center for Cancer and Blood Disorders, Children’s National Hospital, Washington, DC, USA
| | - Michael J Fisher
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brian D Weiss
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - AeRang Kim
- Center for Cancer and Blood Disorders, Children’s National Hospital, Washington, DC, USA
| | - Brigitte C Widemann
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrea M Gross
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Cieza Rivera AM, Lobato Fuertes C, Fernández-Villa T, Martín Sánchez V, Atallah I. Impact of neurofibromatosis type 1 on quality of life using the Skindex-29 questionnaire quality of life in NF1. Orphanet J Rare Dis 2024; 19:85. [PMID: 38402381 PMCID: PMC10893671 DOI: 10.1186/s13023-024-03078-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/05/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) is one of the most common RASopathies predisposing affected patients to melanic lesions and benign tumors. NF1 is associated with considerable esthetic and functional burden negatively affecting the patient's quality of life (QoL). This study aims to assess the clinical features of NF1 patients and evaluate their impact on QoL. We identified NF1 patients from a public health database of a region in Spain. All patients underwent clinical and ophthalmological evaluation for NF1 features. We measured QoL using the Spanish version of the Skindex-29. RESULTS Forty patients fulfilled the NF1 National Institute of Health criteria when we recruited patients. The median age was 42.00 years (IQR 26.5 -53.75). The median total Skindex-29 score was 12.3 (IQR 5.9-22.4); (emotion: 15.0, IQR 5.0-37.5; symptoms 8.9, IQR 0.0-17.9 and functioning 8.3; IQR 0.5-18.3). Women and NF1 patients with lower educational levels were associated with poorer QoL scores. We identified itching and sleep troubles to influence NF1 patients' QoL negatively. CONCLUSION NF1 considerably influences the psychological well-being of NF1 patients. We observed that female and low-educated patients scored higher on the emotional dimension of the Skindex-29 and could, therefore, be more at risk of depression. We also pointed out some "minor symptoms" that negatively impact NF1 patients' QoL such, as itching and sleep troubles which doctors could treat if sought by doctors.
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Affiliation(s)
- Ana M Cieza Rivera
- Faculty of Health Sciences, Department of Biomedical Sciences, Area of Preventive Medicine and Public Health, Universidad de León, León, Spain
| | | | - Tania Fernández-Villa
- Faculty of Health Sciences, Department of Biomedical Sciences, Area of Preventive Medicine and Public Health, Universidad de León, León, Spain
- Research Group in interactions gene- environmental and health (GIIGAS), Institute of Biomedicine, University of León, León, Spain
- Epidemiology and Public Health Networking Biomedical Research Centre (CIBERESP), Madrid, Spain
| | - Vicente Martín Sánchez
- Faculty of Health Sciences, Department of Biomedical Sciences, Area of Preventive Medicine and Public Health, Universidad de León, León, Spain
- Research Group in interactions gene- environmental and health (GIIGAS), Institute of Biomedicine, University of León, León, Spain
- Epidemiology and Public Health Networking Biomedical Research Centre (CIBERESP), Madrid, Spain
| | - Isis Atallah
- Faculty of Health Sciences, Department of Biomedical Sciences, Area of Preventive Medicine and Public Health, Universidad de León, León, Spain.
- Division of Genetic Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Merker VL, Thompson HL, Wolters PL, Buono FD, Hingtgen CM, Rosser T, Barton B, Barnett C, Smith T, Haberkamp D, McManus ML, Baldwin A, Moss IP, Röhl C, Martin S. Recommendations for assessing appearance concerns related to plexiform and cutaneous neurofibromas in neurofibromatosis 1 clinical trials. Clin Trials 2024; 21:6-17. [PMID: 38140900 PMCID: PMC10922038 DOI: 10.1177/17407745231205577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
BACKGROUND/AIMS Individuals with neurofibromatosis 1 may experience changes in their appearance due to physical manifestations of the disorders and/or treatment sequelae. Appearance concerns related to these physical changes can lead to psychological distress and poorer quality of life. While many neurofibromatosis 1 clinical trials focus on assessing changes in tumor volume, evaluating patients' perspectives on corresponding changes in symptoms such as physical appearance can be key secondary outcomes. We aimed to determine whether any existing patient-reported outcome measures are appropriate for evaluating changes in appearance concerns within neurofibromatosis 1 clinical trials. METHODS After updating our previously published systematic review process, we used it to identify and rate existing patient-reported outcome measures related to disfigurement and appearance. Using a systematic literature search and initial triage process, we focused on identifying patient-reported outcome measures that could be used to evaluate changes in appearance concerns in plexiform or cutaneous neurofibroma clinical trials in neurofibromatosis 1. Our revised Patient-Reported Outcome Rating and Acceptance Tool for Endpoints then was used to evaluate each published patient-reported outcome measures in five domains, including (1) respondent characteristics, (2) content validity, (3) scoring format and interpretability, (4) psychometric data, and (5) feasibility. The highest-rated patient-reported outcome measures were then re-reviewed in a side-by-side comparison to generate a final consensus recommendation. RESULTS Eleven measures assessing appearance concerns were reviewed and rated; no measures were explicitly designed to assess appearance concerns related to neurofibromatosis 1. The FACE-Q Craniofacial Module-Appearance Distress scale was the top-rated measure for potential use in neurofibromatosis 1 clinical trials. Strengths of the measure included that it was rigorously developed, included individuals with neurofibromatosis 1 in the validation sample, was applicable to children and adults, covered item topics deemed important by neurofibromatosis 1 patient representatives, exhibited good psychometric properties, and was feasible for use in neurofibromatosis 1 trials. Limitations included a lack of validation in older adults, no published information regarding sensitivity to change in clinical trials, and limited availability in languages other than English. CONCLUSION The Response Evaluation in Neurofibromatosis and Schwannomatosis patient-reported outcome working group currently recommends the FACE-Q Craniofacial Module Appearance Distress scale to evaluate patient-reported changes in appearance concerns in clinical trials for neurofibromatosis 1-related plexiform or cutaneous neurofibromas. Additional research is needed to validate this measure in people with neurofibromatosis 1, including older adults and those with tumors in various body locations, and explore the effects of nontumor manifestations on appearance concerns in people with neurofibromatosis 1 and schwannomatosis.
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Affiliation(s)
- Vanessa L Merker
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - Heather L Thompson
- Department of Communication Sciences and Disorders, California State University, Sacramento, Sacramento, CA, USA
| | - Pamela L Wolters
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Frank D Buono
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - Tena Rosser
- Division of Neurology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Belinda Barton
- Faculty of Health, Discipline of Psychology, Southern Cross University, Coffs Harbour, NSW, Australia
| | - Carolina Barnett
- Division of Neurology, Department of Medicine, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Taylor Smith
- Department of Psychology and Child Development, California Polytechnic State University, San Luis Obispo, CA, USA
| | | | | | - Andrea Baldwin
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | | | - Claas Röhl
- NF Kinder, NF Patients United, Vienna, Austria
| | - Staci Martin
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA
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Fertitta L, Bergqvist C, Sarin KY, Plotkin SR, Moertel C, Petersen AK, Cannon A, Berman Y, Pichard DC, Röhl C, Lessing A, Brizion B, Peiffer B, Ravaud P, Tran VT, Armand ML, Moryousef S, Ferkal S, Jannic A, Ezzedine K, Wolkenstein P. A core outcome domain set to assess cutaneous neurofibromas related to neurofibromatosis type 1 in clinical trials. Br J Dermatol 2024; 190:216-225. [PMID: 37877514 DOI: 10.1093/bjd/ljad397] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/19/2023] [Accepted: 10/14/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Cutaneous neurofibromas (cNF) are considered one of the highest burdens of neurofibromatosis type 1 (NF1). To date, no medical treatment can cure cNF or prevent their development. In that context, there is an urgent need to prepare and standardize the methodology of future trials targeting cNF. OBJECTIVES The objective was to develop a core outcome domain set suitable for all clinical trials targeting NF1-associated cNF. METHODS The validated approach of this work consisted of a three-phase methodology: (i) generating the domains [systematic literature review (SLR) and qualitative studies]; (ii) agreeing (three-round international e-Delphi consensus process and working groups); and (iii) voting. RESULTS (i) The SLR and the qualitative studies (three types of focus groups and a French e-survey with 234 participants) resulted in a preliminary list of 31 candidate items and their corresponding definitions. (ii) A total of 229 individuals from 29 countries participated in the first round of the e-Delphi process: 71 patients, relatives or representatives (31.0%), 130 healthcare professionals (HCPs, 56.8%) and 28 researchers, representatives of a drug regulatory authority, industry or pharmaceutical company representatives or journal editors (12.2%). The overall participation rate was 74%. After round 2, five candidate items were excluded. Between rounds 2 and 3, international workshops were held to better understand the disagreements among stakeholders. This phase led to the identification of 19 items as outcome subdomains. (iii) The items were fused to create four outcome domains ('clinical assessment', 'daily life impact', 'patient satisfaction' and 'perception of health') and prioritized. The seven items that did not reach consensus were marked for the research agenda. The final core outcome domain set reached 100% of the votes of the steering committee members. CONCLUSIONS Although numerous outcomes can be explored in studies related to cNF in NF1, the present study offers four outcome domains that should be reported in all trial studies, agreed on by international patients, relatives and representatives of patients; HCPs; researchers, representatives of drug regulatory authorities or pharmaceutical companies and journal editors. The next step will include the development of a set of core outcome measurement instruments to further standardize how these outcomes should be assessed.
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Affiliation(s)
- Laura Fertitta
- Department of Dermatology
- INSERM, Centre d'Investigation Clinique 1430; National Referral Center for Neurofibromatoses, -Henri-Mondor Hospital, Assistance Publique-Hôpitaux Paris (AP-HP) , 94010 Créteil, France
- INSERM U955 , 94010, Créteil, France
| | - Christina Bergqvist
- Department of Dermatology
- INSERM, Centre d'Investigation Clinique 1430; National Referral Center for Neurofibromatoses, -Henri-Mondor Hospital, Assistance Publique-Hôpitaux Paris (AP-HP) , 94010 Créteil, France
| | - Kavita Y Sarin
- Department of Dermatology, Stanford Medicine, Stanford University, Redwood City, CA, USA
| | - Scott R Plotkin
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | | | - Andrea K Petersen
- Department of Rehabilitation and Development, Randall Children's Hospital at Legacy Emanuel Medical Center, Portland, OR, 97227, USA
| | - Ashley Cannon
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
- InformedDNA, Inc., St Petersburg, FL, USA
| | - Yemima Berman
- Clinical Genetics, Royal North Shore Hospital, St Leonards, NSW, Australia and University of Sydney, Sydney, Australia
| | - Dominique C Pichard
- Dermatology Branch, National Institutes of Arthritis, Musculoskeletal, and Skin Diseases
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute; National Institutes of Health, Bethesda, MD, USA
| | - Class Röhl
- NF Patients United - Global Network of NF Support Groups, Vienna, Austria
| | | | | | | | - Philippe Ravaud
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France
- Université de Paris, CRESS, INSERM, INRA , F-75004 Paris, France
| | - Viet-Thi Tran
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France
- Université de Paris, CRESS, INSERM, INRA , F-75004 Paris, France
| | | | | | - Salah Ferkal
- Department of Dermatology
- INSERM, Centre d'Investigation Clinique 1430; National Referral Center for Neurofibromatoses, -Henri-Mondor Hospital, Assistance Publique-Hôpitaux Paris (AP-HP) , 94010 Créteil, France
| | | | - Khaled Ezzedine
- Department of Dermatology
- INSERM, Centre d'Investigation Clinique 1430; National Referral Center for Neurofibromatoses, -Henri-Mondor Hospital, Assistance Publique-Hôpitaux Paris (AP-HP) , 94010 Créteil, France
- Université Paris-Est Créteil (UPEC), 94010 Créteil, France
| | - Pierre Wolkenstein
- Department of Dermatology
- INSERM, Centre d'Investigation Clinique 1430; National Referral Center for Neurofibromatoses, -Henri-Mondor Hospital, Assistance Publique-Hôpitaux Paris (AP-HP) , 94010 Créteil, France
- INSERM U955, 94010, Créteil, France
- Université Paris-Est Créteil (UPEC), 94010 Créteil, France
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