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Brazel D, Larocca C, Shinohara MM. Assessing Health-Related Quality of Life in Mycosis Fungoides and Sézary Syndrome: Unmet Needs. Cancers (Basel) 2024; 16:2757. [PMID: 39123484 PMCID: PMC11312166 DOI: 10.3390/cancers16152757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 07/30/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
Mycosis fungoides (MF) and Sézary syndrome (SS) can impair multiple dimensions of health-related quality of life (HRQoL). Currently, there is no standardized assessment tool for measuring HRQoL in patients with MF/SS. Here, we describe the existing literature on multiple dimensions of HRQoL in MF/SS with a special focus on the gaps in the current knowledge and identify future directions necessary to assess the HRQoL of patients with this disease.
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Affiliation(s)
- Danielle Brazel
- Department of Hematology/Oncology, Scripps Clinic/Scripps Green Hospital, La Jolla, CA 92037, USA
| | - Cecilia Larocca
- Brigham and Women’s Department of Dermatology, Dana Farber Cancer Center, Boston, MA 02215, USA
| | - Michi M. Shinohara
- Department of Dermatology, University of Washington, 1959 Northeast Pacific Street BB-1353, Box 356524, Seattle, WA 98195, USA
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Schirren AEC, Albrecht JD, Melchers S, Weiß C, Büttner S, Dippel E, Gosmann J, Jonak C, Klemke CD, Laturnus-Chang M, Livingstone E, Mitteldorf C, Schummer P, Stadler R, Stranzenbach R, Weyer-Fahlbusch SS, Wobser M, Ziemer M, Nicolay JP. Health-related quality of life and its influencing factors in patients with primary cutaneous B-cell lymphomas: A multicentric study in 100 patients. J Eur Acad Dermatol Venereol 2024; 38:954-966. [PMID: 38279594 DOI: 10.1111/jdv.19799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 12/11/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Primary cutaneous B-cell lymphomas (CBCL) are a group of rare malignant skin diseases that represent approximately 20%-30% of all primary cutaneous lymphomas (PCL). Previous studies revealed impaired health-related quality of life (HRQoL) in patients diagnosed with primary cutaneous T-cell lymphoma (CTCL). Currently, only small-sized studies investigated HRQoL in CBCL patients and lacked detailed analysis of respective subtypes. OBJECTIVES This study aims to investigate HRQoL in CBCL patients to identify independent factors of HRQoL impairment in CBCL patients. METHODS One hundred CBCL patients were recruited from eight German PCL centres in this multicentric, cross-sectional study from 2021 to 2022. The patients completed the dermatologic HRQoL questionnaire Skindex-29 and an investigator-designed 'CBCL-Questionnaire' with additional questions on HRQoL and clinical characteristics. RESULTS The Skindex-29 revealed that HRQoL in CBCL patients is impaired on a mild to moderate level. The multiple regression analysis identified parameters like worries about dying, feeling prejudiced/discriminated and impairment of daily activities to be independently associated with impairment of HRQoL. Highest scores for HRQoL impairment were found in patients with primary cutaneous follicle centre lymphoma while on rituximab treatment and in patients with primary cutaneous marginal zone lymphoma while on watchful waiting. CONCLUSIONS HRQoL is impaired in CBCL patients, even though, in the face of indolent disease course and favourable prognosis in the majority of cases. Of note, our investigator-designed tool identified worries about dying, feeling prejudiced/discriminated, and the type of treatment to have a negative impact on patients' HRQoL. Our study highlights the importance of a thorough patient-doctor communication to capture overall disease burden because generic HRQoL tools might lack of disease-specific items.
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Affiliation(s)
- A E C Schirren
- Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim, Mannheim, Germany
- Section for Clinical and Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - J D Albrecht
- Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim, Mannheim, Germany
- Section for Clinical and Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Skin Cancer Unit, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - S Melchers
- Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim, Mannheim, Germany
- Section for Clinical and Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Skin Cancer Unit, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - C Weiß
- Department for Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim of the University of Heidelberg and University Medical Centre Mannheim, Mannheim, Germany
| | - S Büttner
- Department for Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim of the University of Heidelberg and University Medical Centre Mannheim, Mannheim, Germany
| | - E Dippel
- Department of Dermatology, Ludwigshafen Medical Centre, Ludwigshafen, Germany
| | - J Gosmann
- University Clinic for Dermatology, Johannes Wesling Medical Centre, Minden, Germany
| | - C Jonak
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - C-D Klemke
- Department of Dermatology and Skin Cancer Centre, Municipal Hospital Karlsruhe, Academic Educational Hospital of the University of Freiburg, Karlsruhe, Germany
| | - M Laturnus-Chang
- Department of Dermatology, Ludwigshafen Medical Centre, Ludwigshafen, Germany
| | - E Livingstone
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - C Mitteldorf
- Department of Dermatology, Venereology and Allergology, University Medical Centre Göttingen, Göttingen, Germany
| | - P Schummer
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | - R Stadler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - R Stranzenbach
- Department of Dermatology, Bochum Medical Centre, Bochum, Germany
| | | | - M Wobser
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | - M Ziemer
- Department of Dermatology, University Medical Centre, Leipzig, Germany
| | - J P Nicolay
- Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim, Mannheim, Germany
- Section for Clinical and Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Skin Cancer Unit, German Cancer Research Centre (DKFZ), Heidelberg, Germany
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Gandham AR, Geller S, Dusza SW, Kupper TS, Myskowski PL. Racial Disparities in Mycosis Fungoides/Sézary Syndrome-A Single-Center Observational Study of 292 Patients. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:e174-e180. [PMID: 38245472 PMCID: PMC10981557 DOI: 10.1016/j.clml.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/27/2023] [Accepted: 12/30/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Clinical presentation of Mycosis fungoides/Sézary syndrome (MF/SS) in Black and African American (AA) patients can be heterogeneous with poor survival reported in AA/black patients. In this study, we aim to characterize differences between AA/black and white patients with MF/SS. PATIENTS AND METHODS A retrospective single-center hospital-based case-control study including 292 MF/SS patients (146 AA/black matched with 146 white patients). We analyzed demographic, clinical and survival differences. RESULTS AA/black patients were diagnosed at an earlier age (9 years younger), were predominantly females, had higher rates of Medicaid/Medicare insurance and lower income compared to matched white patients (P <.001). Adjusting for age, sex, insurance type, and income bracket, AA/black patients had significantly worse overall survival (hazard ratio [HR] 2.88, 95%CI 1.21-6.85, P = .017). Association of clinical MF phenotype with survival showed that hypopigmentation was associated with survival in AA/black patients but not in white patients. Erythroderma and ulceration were associated with worse survival risk in AA/black patients. CONCLUSIONS AA/black patients with MF/SS have a significant worse survival outcome compared to white patients. The association between clinical phenotypes and survival differed between these groups. Further studies are required to investigate whether race-specific pathogenesis or genetic factors may explain these differences.
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Affiliation(s)
- Ashley R Gandham
- Dermatology Service, Division of Subspecialty Medicine, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Harvard Medical School, Boston, MA
| | - Shamir Geller
- Dermatology Service, Division of Subspecialty Medicine, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Stephen W Dusza
- Dermatology Service, Division of Subspecialty Medicine, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Thomas S Kupper
- Harvard Medical School, Boston, MA; Department of Dermatology, Brigham and Women's Hospital, Boston, MA
| | - Patricia L Myskowski
- Dermatology Service, Division of Subspecialty Medicine, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Beltraminelli H. Cutaneous T-cell lymphoma-Focus on some problems, and some solutions. Hematol Oncol 2023; 41 Suppl 1:20-24. [PMID: 37294972 DOI: 10.1002/hon.3147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 06/11/2023]
Abstract
Cutaneous lymphomas are a heterogeneous group of several distinct entities of lymphoproliferative diseases. The diagnosis of a cutaneous lymphoma is a challenge, and it is always the result of a careful analysis of several information's consisting of clinical history, clinical picture, histological and molecular analyses. For this reason, experts taking care of patients with a skin lymphoma need to know all the peculiar diagnostic elements very well, in order not to run into mistakes. In this article, we will focus the discussion on some issues as the skin biopsy (when and where). In addition, we will discuss the approach to the erythrodermic patient, whose differential diagnoses include mycosis fungoides, and Sézary syndrome, beside more frequent inflammatory conditions. Finally, we will address the issue of quality of life and the possible support of the suffering patient with a cutaneous lymphoma, well knowing that the current therapeutic possibilities are unfortunately limited.
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Affiliation(s)
- Helmut Beltraminelli
- Head of Dermatology, Responsible of Dermatopathology at Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
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Salant JA, Khan N, Nelson JE, Norton-Westbrook M, Desai AV. Top Ten Tips Palliative Care Clinicians Should Know About Caring for Patients with Cutaneous T Cell Lymphoma. J Palliat Med 2021; 25:958-963. [PMID: 34978848 DOI: 10.1089/jpm.2021.0610] [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: 11/12/2022] Open
Abstract
Cutaneous T cell lymphoma and its subtypes, mycosis fungoides (MF) and Sézary syndrome (SS), comprise a spectrum of chronic lymphoproliferative disorders in which neoplastic T cells accumulate within the skin and visceral organs. This process is frequently characterized by severe pain, nonpain symptoms, and physical disfigurement. Significant emotional, spiritual, and existential distress is also felt by many of these patients as they experience a chronic, often incurable disease. Patients suffering from these diseases, though not commonly encountered, can benefit greatly from palliative care support. In this article, a team of palliative care clinicians, critical care physicians, and an oncologist specializing in lymphoma offer 10 tips to help palliative care teams to support these vulnerable and often-distressed patients and their caregivers.
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Affiliation(s)
- Jennifer A Salant
- Pediatric Advanced Care Team, Department of Pediatrics, Weill Cornell Medical College, New York, New York, USA
| | - Niloufer Khan
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Judith E Nelson
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Supportive Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Critical Care Service, Department of Anesthesia and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Moe Norton-Westbrook
- Supportive Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anjali V Desai
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Supportive Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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