1
|
Armstrong EP, Franic DM, Malone DC, Mellors P, Pham SV, Masseria C, Mody L, Hogea C. Patient-centric care in myelodysplastic syndromes: A global systematic literature review and gap analysis. Leuk Res 2024; 147:107592. [PMID: 39341087 DOI: 10.1016/j.leukres.2024.107592] [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: 04/21/2024] [Revised: 08/19/2024] [Accepted: 09/13/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND Disease progression and poor prognosis in higher-risk (HR) myelodysplastic syndrome (MDS) create an urgent need for interventions to improve the patient care experience in this vulnerable population. Patient-centric physician-supported strategies in conjunction with emerging therapies can help advance overall care and improve outcomes. The objective of this study was to evaluate patient-centric care (PCC) in the treatment of HR-MDS and identify opportunities to develop strategies to address care gaps for an optimal patient care experience. METHODS A global systematic literature review (SLR) was conducted by cross-referencing MDS/HR-MDS with PCC terms, using PubMed, Embase, and Cochrane Collaboration databases (2017-2022) in accordance with Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. RESULTS In all, 59 MDS articles (45 empirical, 14 reviews) met the study inclusion criteria. Of these, 6 empirical articles focused on the HR-MDS population while none of the reviews did. Identified themes fell into 2 categories: health-related quality of life (HRQoL) and disparities. HRQoL was further categorized based on findings in the literature to include groupings of patient-reported outcomes (PROs), fatigue/frailty, and patient/preferences/treatment decisions/shared decision making (SDM). CONCLUSIONS With new treatments potentially on the horizon for HR-MDS, a call to action is timely to address the overall lack of empirical PCC data. The patient-centric approach presents critical opportunities for integration of physician-supported strategies with more effective first-line therapies to help optimize the journey of patients with HR-MDS and ensure meaningful outcomes by reducing patient/caregiver burden, aligning with and respecting patient preferences, and including patients as active participants in their treatment.
Collapse
Affiliation(s)
| | | | | | - Patrick Mellors
- Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Sissi V Pham
- AESARA, Inc., PO Box 4266, Chapel Hill, NC 27517, USA.
| | | | - Lorie Mody
- AESARA, Inc., PO Box 4266, Chapel Hill, NC 27517, USA
| | | |
Collapse
|
2
|
Loh KP, Wang Y, Sanapala C, Gilmore N, Netherby-Winslow C, Mendler JH, Liesveld J, Huselton E, Williams AM, Klepin HD, Jensen-Battaglia M, Mustian K, Vertino P, Susiarjo M, Janelsins MC. Exercise and inflammatory cytokine regulation among older adults with myeloid malignancies. Exp Gerontol 2024; 187:112364. [PMID: 38266886 PMCID: PMC10923152 DOI: 10.1016/j.exger.2024.112364] [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: 11/06/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
Tumor necrosis factor (TNF)α is a major regulator of inflammation. However, the epigenetic regulation of TNFα in the context of an exercise intervention among older adults with cancer is understudied. In this exploratory analysis, we used data from a single-arm mobile health (mHealth) exercise intervention among older adults with myeloid malignancies to 1) assess changes in TNFα promoter methylation, TNFα mRNA expression, serum TNFα and other related-cytokine levels after intervention; and 2) assess correlations between blood markers and exercise levels. Twenty patients were included. From baseline to post-intervention, there was no statistical changes in TNFα promoter methylation status at seven CpG sites, TNFα mRNA expression, and serum TNFα levels. Effect sizes, however, were moderate to large for several CpG sites (-120, -147, -162, and -164; Cohen's d = 0.44-0.75). Median serum TNFα sR1 levels increased (83.63, IQR 130.58, p = 0.06; Cohen's d = 0.18) but not the other cytokines. Increases in average daily steps were correlated with increases in TNFα promoter methylation at CpG sites -147 (r = 0.48; p = 0.06) and -164 (r = 0.51; p = 0.04). Resistance training minutes were negatively correlated with TNFα promoter methylation at CpG site -120 (r = -0.62; p = 0.02). All effect sizes were moderate to large. In conclusion, after a mHealth exercise intervention, we demonstrated changes with moderate to large effect sizes in several CpG sites in the TNFα promoter region. Exercise levels were correlated with increases in TNFα promoter methylation. Larger exercise trials are needed to better evaluate TNFα regulation to inform interventions to augment TNFα regulation in order to improve outcomes in older adults with cancer.
Collapse
Affiliation(s)
- Kah Poh Loh
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Ying Wang
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
| | | | - Nikesha Gilmore
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Colleen Netherby-Winslow
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jason H Mendler
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jane Liesveld
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Eric Huselton
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - AnnaLynn M Williams
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Heidi D Klepin
- Wake Forest Baptist Comprehensive Cancer Center, Medical Center Blvd, Winston-Salem, NC, USA.
| | | | - Karen Mustian
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Paula Vertino
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Department of Biomedical Genetics, University of Rochester Medical Center, Rochester, NY, USA.
| | - Martha Susiarjo
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Michelle C Janelsins
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| |
Collapse
|
3
|
Khalilian P, Eskandari N, Sharifi MJ, Soltani M, Nematollahi P. Toll-Like Receptor 4, 2, and Interleukin 1 Receptor Associated Kinase4: Possible Diagnostic Biomarkers in Myelodysplastic Syndrome Patients. Adv Biomed Res 2024; 13:17. [PMID: 38525404 PMCID: PMC10958736 DOI: 10.4103/abr.abr_67_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/02/2023] [Accepted: 05/10/2023] [Indexed: 03/26/2024] Open
Abstract
Background Myelodysplastic syndrome (MDS) is a clonal hematologic disorder that requires the integration of morphologic, cytogenetic, hematologic, and clinical findings for a successful diagnosis. Trying to find ancillary tests such as biomarkers improve the diagnosis process. Several studies showed that a disordered immune system is associated with MDS. The chronic activated innate immune system, particularly the Toll-like receptors (TLRs) pathway could be involved in the induction of the inflammation. Materials and Methods In the present study, we investigated the expression of TLR2, TLR4, and IRAK4 in bone marrow (BM) of MDS patients, the leukemia group, and the healthy group. For this purpose, we assessed the expression of TLR2, TLR4, and IRAK4 by real time-PCR. Results In line with new findings, we demonstrated that the expression of TLR2, TLR4, and IRAK4 significantly increased in MDS BM compared with the healthy group. Moreover, IRAK4 expression raised significantly in MDS patients compared with other studied hematologic neoplasms. Also, the expression levels of TLR2 and TLR4 significantly increased in MDS in comparison to some studied non-MDS malignancies (P ˂ 0.05). Receiver operating characteristics (ROC) analysis and area under the curve (AUC) suggested that the expression of TLR2, TLR4, and IRAK4 (AUC = 0.702, AUC = 0.75, and AUC = 0.682, respectively) had acceptable diagnostic values to identify MDS from the other understudied leukemias. Conclusion Overall, the expression of TLR2, TLR4, and IRAK4 could be potential biomarkers for discriminating MDS from some hematologic disorders.
Collapse
Affiliation(s)
- Parvin Khalilian
- Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nahid Eskandari
- Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Applied Physiology Research Center, Isfahan Cardiovascular Research Institute, Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Jafar Sharifi
- Department of Laboratory Sciences, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Soltani
- Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pardis Nematollahi
- Department of Pathology, School of Medicine, Cancer Prevention Research Center, Seyyed Al-Shohada Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
4
|
Wang K, Consagra W, Jensen-Battaglia M, Kleckner A, Kleckner IR, Loh KP. Chemotherapy-related symptoms and exercise adherence in older patients with myeloid neoplasms. Support Care Cancer 2023; 31:572. [PMID: 37698745 PMCID: PMC10883479 DOI: 10.1007/s00520-023-08039-0] [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: 05/01/2023] [Accepted: 09/04/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE Exercise may ameliorate treatment-related symptoms, but older adults have lower exercise adherence compared to their younger counterparts due to treatment-related symptoms. METHODS We recruited older patients with myeloid neoplasms receiving chemotherapy to a pilot study of a mobile health exercise intervention. Participants entered their steps and resistance data into the app daily, and symptom data twice a week, over an 8-12 week period. In this proof-of-concept analysis, we used a linear mixed-effects model to assess the association of symptoms from the previous week with exercise adherence in the current week among older adults with myeloid neoplasms. RESULTS Mean age was 74.3 (SD = 5.0) years (N = 7). At baseline, patients on average walked 2564 daily steps (SD = 1816), which increased to 2967 (SD = 3448) post-intervention. Patients on average performed 3.5 (SD = 2.6) days of resistance training weekly, with mean duration of 21.5 min (SD = 11.6) and rated perceived exertion of 3.68 (SD = 1.78) on a 0-10 scale. Lower average steps in the current week was associated with greater interference with daily activities from pain (β = - 203.13, p = 0.05), memory (β = - 492.29, p = 0.09), numbness (β = - 353.57, p = 0.07), and sadness (β = - 403.03, p = 0.09) in the previous week. Similarly, lower average resistance minutes in the current week were associated with greater pain, sadness, and anxiety in the previous week. CONCLUSIONS We found that greater pain, sadness, and anxiety were associated with lower exercise adherence. Symptom monitoring and management in older adults with myeloid neoplasms receiving chemotherapy can promote exercise adherence and in turn improve symptoms. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04035499. Registered 7/29/2019.
Collapse
Affiliation(s)
- Katarina Wang
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - William Consagra
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | | | - Amber Kleckner
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Ian R Kleckner
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA.
| |
Collapse
|
5
|
Liu Z, Xu X, Ding K, Fu R. Quality of life considerations and management in patients with myelodysplastic syndrome. Expert Rev Hematol 2023; 16:849-860. [PMID: 37819160 DOI: 10.1080/17474086.2023.2268837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION This study aimed to identify the factors affecting the quality of life (QOL) and functional status of patients with MDS. AREAS COVERED We reviewed the literature published in PUBMED over the past 30 years and searched for keywords such as 'quality of life' and 'myelodysplastic syndromes'. By observing the influence of their symptoms, the possibility of improving patients' QOL was considered by improving these related factors. Concurrently, the effects of related clinical treatments based on the unique disease characteristics of MDS on the patients' QOL were examined, and lifestyle factors were considered in clinical practice, providing an important path to improve the QOL and functional status of patients with MDS. EXPERT OPINION This review summarized several areas that can improve the quality of survival of MDS patients and discusses them in depth. Although the clinical benefits may be minimal, we still hope to improve patients' daily life outcomes and enhance their quality of life at minimal cost. Also, we hope more researchers will focus on this area in the future to find more factors that may exist to supplement the limitations of these understanding and thinking, and to provide assistance in clinical work.
Collapse
Affiliation(s)
- Zhaoyun Liu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xintong Xu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Kai Ding
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Rong Fu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| |
Collapse
|
6
|
Loh KP, Sanapala C, Jensen-Battaglia M, Rana A, Sohn MB, Watson E, Gilmore N, Klepin HD, Mendler JH, Liesveld J, Huselton E, LoCastro M, Susiarjo M, Netherby-Winslow C, Williams AM, Mustian K, Vertino P, Janelsins MC. Exercise and epigenetic ages in older adults with myeloid malignancies. Eur J Med Res 2023; 28:180. [PMID: 37254221 PMCID: PMC10227405 DOI: 10.1186/s40001-023-01145-z] [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: 12/27/2022] [Accepted: 05/19/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Older adults with myeloid malignancies are susceptible to treatment-related toxicities. Accelerated DNAm age, or the difference between DNA methylation (DNAm) age and chronological age, may be used as a biomarker of biological age to predict individuals at risk. In addition, cancer treatment can also lead to accelerated DNAm age. Exercise is a promising intervention to reduce or prevent functional, psychological, and cognitive impairments in older patients with myeloid malignancies, yet there is little evidence of the effects of exercise on DNAm age. We explored (1) the associations of accelerated DNAm age with physical, psychological, and cognitive functions at baseline; (2) changes in DNAm age from baseline to post-intervention; and (3) the associations of changes in accelerated DNAm age with changes in functions from baseline to post-intervention. METHODS We enrolled older patients with myeloid malignancies to a single-arm pilot study testing a mobile health (mHealth) exercise intervention that combines an exercise program (EXCAP©®) with a mobile application over 2 cycles of chemotherapy (8-12 weeks). Patients completed measures of physical, psychological, and cognitive functions and provided blood samples for analyses of DNAm age at baseline and post-intervention. Paired t-tests or Wilcoxon signed rank tests assessed changes in DNAm ages, and Spearman's correlation assessed the relationships between accelerated ages and functions. RESULTS We included 20 patients (mean age: 72 years, range 62-80). Accelerated GrimAge, accelerated PhenoAge, and DunedinPACE were stable from baseline to post-intervention. At baseline, DunedinPACE was correlated with worse grip strength (r = -0.41, p = 0.08). From baseline to post-intervention, decreases in accelerated GrimAge (r = -0.50, p = 0.02), accelerated PhenoAge (r = - 0.39, p = 0.09), and DunedinPace (r = - 0.43, p = 0.06) were correlated with increases in distance walked on 6-min walk test. Decreases in accelerated GrimAge (r = - 0.49, p = 0.03), accelerated PhenoAge (r = - 0.40, p = 0.08), and DunedinPace (r = - 0.41, p = 0.07) were correlated with increases in in grip strength. CONCLUSIONS Among older adults with myeloid malignancies receiving chemotherapy, GrimAge and PhenoAge on average are stable after a mHealth exercise intervention. Decreases in accelerated GrimAge, accelerated PhenoAge, and DunedinPACE over 8-12 weeks of exercise were correlated with increased physical performance. Future trials assessing the effects of exercise on treatment-related toxicities should evaluate DNAm age. Trial registration Clinicaltrials.gov identifier: NCT04981821.
Collapse
Affiliation(s)
- Kah Poh Loh
- James P. Wilmot Cancer Institute, Rochester, NY USA
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY 14642 USA
| | | | | | - Anish Rana
- School of Medicine and Dentistry, University of Rochester, Rochester, NY USA
| | - Michael B. Sohn
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY USA
| | - Erin Watson
- Department of Psychology, Princeton University, Princeton, NJ USA
| | - Nikesha Gilmore
- Division of Cancer Control, Department of Surgery, University of Rochester Medical Center, Rochester, NY USA
| | - Heidi D. Klepin
- Wake Forest Baptist Comprehensive Cancer Center, Medical Center Blvd, Winston-Salem, NC USA
| | - Jason H. Mendler
- James P. Wilmot Cancer Institute, Rochester, NY USA
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY 14642 USA
| | - Jane Liesveld
- James P. Wilmot Cancer Institute, Rochester, NY USA
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY 14642 USA
| | - Eric Huselton
- James P. Wilmot Cancer Institute, Rochester, NY USA
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY 14642 USA
| | - Marissa LoCastro
- James P. Wilmot Cancer Institute, Rochester, NY USA
- School of Medicine and Dentistry, University of Rochester, Rochester, NY USA
| | - Martha Susiarjo
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY USA
| | - Colleen Netherby-Winslow
- Division of Cancer Control, Department of Surgery, University of Rochester Medical Center, Rochester, NY USA
| | - AnnaLynn M. Williams
- Division of Cancer Control, Department of Surgery, University of Rochester Medical Center, Rochester, NY USA
| | - Karen Mustian
- James P. Wilmot Cancer Institute, Rochester, NY USA
- Division of Cancer Control, Department of Surgery, University of Rochester Medical Center, Rochester, NY USA
| | - Paula Vertino
- James P. Wilmot Cancer Institute, Rochester, NY USA
- Department of Biomedical Genetics, University of Rochester Medical Center, Rochester, NY USA
| | - Michelle C. Janelsins
- James P. Wilmot Cancer Institute, Rochester, NY USA
- Division of Cancer Control, Department of Surgery, University of Rochester Medical Center, Rochester, NY USA
| |
Collapse
|
7
|
Tinsley-Vance SM. Research Strategy for the Development of a Quality-of-Life Decision-Making Model for Older Patients With Acute Myeloid Leukemia. J Adv Pract Oncol 2023; 14:272-283. [PMID: 37313279 PMCID: PMC10258859 DOI: 10.6004/jadpro.2023.14.4.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Acute myeloid leukemia (AML) is a deadly cancer, especially for patients over 60 years of age who face the dilemma of choosing the best treatment during a time of crisis. Current research in the older AML population is focused on survival without addressing quality of life (QOL). Survival and QOL data are essential for patients to decide which treatment best aligns with their goals, whether for survival or improved QOL. Research aims: The aims of this study are to: (1) Describe differences in QOL among newly diagnosed older AML patients receiving intensive chemotherapy compared with nonintensive chemotherapy (at baseline, and days 30, 60, 90, and 180 post treatment); (2) Identify the individual clinical disease characteristics and patient factors of newly diagnosed AML patients that predict QOL among those receiving two treatment intensities; and (3) Design a patient decision-making model that integrates the significant clinical disease and patient factor predictors of QOL for newly diagnosed older AML patients. Methods: An exploratory observational design will be used to address aims 1 and 2. Data will be collected from 200 patients ≥ 60 years of age with newly diagnosed AML. Subjects will complete the Functional Assessment of Cancer Therapy-Leukemia, Brief Fatigue Inventory, and Memorial Symptom Assessment Short Form within 7 days of beginning new treatment and at days 30, 60, 90 and 180. Clinical disease characteristics will be completed by the health-care team. A patient decision-making model will be developed to provide survival and quality-of-life data for intensive and nonintensive chemotherapy.
Collapse
|
8
|
Loh KP, Sanapala C, Janelsins M, Klepin HD, Schnall R, Culakova E, Sohn MB, Vertino P, Susiarjo M, Jensen-Battaglia M, Becker MW, Liesveld J, Mendler JH, Huselton E, Lin PJ, Mustian K. Protocol for a pilot randomized controlled trial of a mobile health exercise intervention for older patients with myeloid neoplasms (GO-EXCAP 2). J Geriatr Oncol 2022; 13:545-553. [PMID: 34949540 PMCID: PMC9058183 DOI: 10.1016/j.jgo.2021.12.011] [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: 11/09/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION We have shown the Exercise for Cancer Patients (EXCAP©®) exercise program improved physical function and symptoms and reduced inflammatory markers in patients with cancer. However, adherence to exercise was lower in older adults compared to their younger counterparts. We then leveraged a mobile app to deliver EXCAP©® and adapted the intervention [Geriatric-Oncology (GO)-EXCAP] for older patients with myeloid neoplasms. In this pilot randomized trial, the primary goal is to determine effect sizes. We propose to assess the preliminary efficacy of GO-EXCAP compared to a behavioral placebo control on physical function, patient-reported outcomes (fatigue, mood, and quality of life), and inflammatory markers in 100 patients aged ≥60 years with myeloid neoplasms receiving outpatient chemotherapy. METHODS GO-EXCAP consists of the EXCAP©® exercise prescription (daily home-based progressive aerobic walking and resistance exercises with rated perceived exercise of 5-8), EXCAP©® kit (i.e., activity tracker, resistance bands, print manual, bag), a mobile app, and an in-person or virtual session with the exercise physiologist to deliver exercise prescription. The intervention will last for three cycles of chemotherapy (approximately 12 weeks). The primary outcome measure will be physical function (Short Physical Performance Battery). Secondary outcome measures include fatigue (Brief Fatigue Inventory), mood (Center for Epidemiologic Studies Depression Scale), and quality of life (Functional Assessment of Cancer Therapy-Leukemia). Exploratory outcome measures include inflammatory markers. DISCUSSION Older adults with myeloid neoplasms receiving outpatient chemotherapy serve as an ideal model for studying an individually tailored mobile health exercise intervention in vulnerable older patients receiving cancer treatments to prevent physical function decline and improve symptoms.
Collapse
Affiliation(s)
- Kah Poh Loh
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | | | - Michelle Janelsins
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Heidi D Klepin
- Wake Forest Baptist Comprehensive Cancer Center, Medical Center Blvd, Winston-Salem, NC, USA.
| | | | - Eva Culakova
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Michael B Sohn
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA.
| | - Paula Vertino
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Department of Biomedical Genetics, University of Rochester Medical Center, Rochester, NY, USA.
| | - Martha Susiarjo
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | | | - Michael W Becker
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jane Liesveld
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jason H Mendler
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Eric Huselton
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Po-Ju Lin
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Karen Mustian
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| |
Collapse
|
9
|
Loh KP, Sanapala C, Di Giovanni G, Klepin HD, Janelsins M, Schnall R, Culakova E, Vertino P, Susiarjo M, Mendler JH, Liesveld JL, Lin PJ, Dunne RF, Kleckner I, Mustian K, Mohile SG. Developing and adapting a mobile health exercise intervention for older patients with myeloid neoplasms: A qualitative study. J Geriatr Oncol 2021; 12:909-914. [PMID: 33676900 PMCID: PMC8260435 DOI: 10.1016/j.jgo.2021.02.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Older patients with myeloid neoplasms (MN) receiving outpatient chemotherapy are at risk of experiencing treatment-related toxicities such as functional decline. A mobile health (mHealth) exercise intervention may ameliorate these toxicities. This qualitative study aimed to inform the design of a mHealth exercise intervention for this population. METHODS This was a qualitative study of thirteen patients aged ≥60 years receiving hypomethylating agents for MN. EXCAP©® is a home-based walking and progressive resistance exercise program. We combined EXCAP©® with a mobile app; the combination (GO-EXCAP Mobile App) has not been previously tested. A brief verbal description about the intervention was provided to the participants but they did not perform it. Participants were interviewed and inductive thematic analysis was used to analyze the data. RESULTS Mean age was 71.6 (SD 8.5). Three themes were identified: 1) Perceptions of the intervention feasibility, 2) Ways to leverage the app to deliver the exercise intervention, and 3) Personalized exercise goals. Walking and resistance exercises were perceived to be feasible. Patients were comfortable initiating the intervention in cycle 2 of chemotherapy, with exercise increments occurring from week 2-4 of the cycle. Ways to leverage the app to deliver EXCAP©® include 1) Video feature for exercise demonstration and interactions, and 2) Exercise data and symptom surveys to be communicated to the exercise physiologist and primary oncology team. Preservation of existing function and activity was an important goal to participants. CONCLUSIONS Our findings provide insights about the preferences of older adults with MN for a mHealth exercise intervention.
Collapse
Affiliation(s)
- Kah Poh Loh
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | | | | | - Heidi D Klepin
- Wake Forest Baptist Comprehensive Cancer Center, Medical Center Blvd, Winston-Salem, NC, USA.
| | - Michelle Janelsins
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | | | - Eva Culakova
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Paula Vertino
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Department of Biomedical Genetics, University of Rochester Medical Center, Rochester, NY, USA.
| | - Martha Susiarjo
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jason H Mendler
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jane L Liesveld
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Po-Ju Lin
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Richard F Dunne
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Ian Kleckner
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Karen Mustian
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Supriya G Mohile
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| |
Collapse
|
10
|
AlFayyad I, Al-Tannir M, Yaqub M, Heena H, AlMukaibil N, Ghazwani M, Abu-Shaheen A. Clinically Significant Fatigue in Adult Leukemia Patients: Prevalence, Predictors, and Impact on Quality of Life. Cureus 2020; 12:e12245. [PMID: 33500864 PMCID: PMC7819426 DOI: 10.7759/cureus.12245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Cancer-related fatigue (CRF) is a common distressing symptom in leukemia patients. CRF becomes clinically significant fatigue (CSF) when adversely affects health-related quality of life (HRQoL) and warrants further workup, referrals, and treatment. Objective: To assess the prevalence and predictors of CSF and assesses its impact on HRQoL in adult leukemia patients. Method Analysis was performed on 168 leukemia patients. The primary study outcomes were CSF (score ≥4) as measured by the fatigue numerical rating scale and HRQoL using a validated Functional Assessment of Cancer Therapy-Leukemia (FACT-Leu) scale. Result The prevalence of CSF was 89 (53%), with a mean score of 6.66±2.02. About 106 (63.1%) of leukemia patients had poor Health-related quality of life (HRQoL) (102.61±23.50). Overall, FACT-Leu mean score indicated that study participants had poor HRQoL (114.70±29.67). There was a statistically significant difference in HRQoL between the patients with CSF 104.89±28.82 and Non-CSF 125.76±26.71, p<0.001. Poor appetite (odd ratio: 3.02 [95% CI: 1.33-6.85]) was statistically significant predictors (p<0.010) of CSF. Dependence on caregiver (odd ratio: 3.31 [95% CI: 0.41-0.75]) and having non-CSF (odd ratio: 5.22 [95% CI: 2.44-11.19]) were found statistically significant predictors of good HRQoL. Conclusion CSF is prevalent among leukemia patients, and adversely affects their HRQoL. Holistic assessment and supportive care are needed to reduce the burden of CSF and improve leukemia patients HRQoL.
Collapse
|
11
|
Brownstein CG, Daguenet E, Guyotat D, Millet GY. Chronic fatigue in myelodysplastic syndromes: Looking beyond anemia. Crit Rev Oncol Hematol 2020; 154:103067. [PMID: 32739782 DOI: 10.1016/j.critrevonc.2020.103067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/10/2020] [Accepted: 07/23/2020] [Indexed: 12/11/2022] Open
Abstract
Chronic fatigue is the most common and severe symptom in myelodysplastic syndromes (MDS) and has a strong negative association with health-related quality of life (HRQoL). Despite anemia being the most common objective manifestation of MDS, and the associated link between anemia and fatigue, evidence on treatments which temporarily mitigate anemia is equivocal regarding the effects on fatigue. Furthermore, previous work has found weak associations between anemia and chronic fatigue in MDS. As such, given that improving HRQoL is one of the primary treatment aims in MDS, further work is required to identify other potential contributors to chronic fatigue in these patients. In addition to anemia, MDS is associated with numerous other deviations in physiological homeostasis and has negative psychological consequences with links to chronic fatigue. Accordingly, the present review provides several potential aetiologic agents relevant to chronic fatigue in MDS which can be used to guide future research in this field.
Collapse
Affiliation(s)
- Callum G Brownstein
- Univ Lyon, UJM-Saint-Etienne, Inter-University Laboratory of Human Movement Biology, EA 7424, F-42023, Saint-Etienne, France.
| | - Elisabeth Daguenet
- Lucien Neuwirth Cancer Institute, Hematology and Cell Therapy, F-42271 Saint-Priest-en-Jarez, France; Lucien Neuwirth Cancer Institute, Research and Teaching Department, F-42271 Saint-Priest-en-Jarez, France
| | - Denis Guyotat
- Lucien Neuwirth Cancer Institute, Hematology and Cell Therapy, F-42271 Saint-Priest-en-Jarez, France; UMR 5239 Laboratoire de Biologie et Modélisation de la Cellule, Ecole Normale Supérieure, Lyon, France
| | - Guillaume Y Millet
- Univ Lyon, UJM-Saint-Etienne, Inter-University Laboratory of Human Movement Biology, EA 7424, F-42023, Saint-Etienne, France; Institut Universitaire de France (IUF), France
| |
Collapse
|
12
|
Sharplin K, Wee LYA, Singhal D, Edwards S, Danner S, Lewis I, Thomas D, Wei A, Yong ASM, Hiwase DK. Outcomes and health care utilization of older patients with acute myeloid leukemia. J Geriatr Oncol 2020; 12:243-249. [PMID: 32713804 DOI: 10.1016/j.jgo.2020.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/27/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The incidence of acute myeloid leukemia (AML) in older patients is increasing, but practice guidelines balancing quality-of-life, time outside of hospital and overall survival (OS) are not established. METHODS We conducted a retrospective analysis comparing time outside hospital, OS and end-of-life care in AML patients ≥60 years treated with intensive chemotherapy (IC), hypomethylating agents (HMA) and best supportive care (BSC) in a tertiary hospital. RESULTS Of 201 patients diagnosed between 2005 and 2015, 54% received IC while 14% and 32% were treated with HMA and BSC respectively. Median OS was significantly higher in patients treated with IC and HMA compared with BSC (11.5 versus 16.2 versus 1.3 months; p < .0001). Median number of hospital admissions for the entire cohort was 3 (1-17) and patients spent <50% of their life after the diagnosis in the hospital setting. Compared to BSC, IC (HR 0.27, p < .0001) and HMA therapy (HR 0.16, p < .0001) were associated with the lower likelihood of spending at least 25% of survival time in hospital. Although 66% patients were referred to palliative care, the interval between referral to death was 24 (1-971) days and 46% patients died in the hospital. CONCLUSION Older patients with AML, irrespective of treatment, require intensive health care resources, are more likely to die in hospital and less likely to use hospice services. Older AML patients treated with disease modifying therapy survive longer than those receiving BSC, and spend >50% of survival time outside the hospital. These data are informative for counselling older patients with AML.
Collapse
Affiliation(s)
- Kirsty Sharplin
- Haematology, Royal Adelaide Hospital, Port Road, Adelaide, Australia
| | - Li Yan A Wee
- Haematology, Royal Adelaide Hospital, Port Road, Adelaide, Australia; Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Deepak Singhal
- Haematology, Royal Adelaide Hospital, Port Road, Adelaide, Australia; School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - Suzanne Edwards
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - Silke Danner
- Haematology, Royal Adelaide Hospital, Port Road, Adelaide, Australia
| | - Ian Lewis
- School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - Daniel Thomas
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Andrew Wei
- Department of Clinical Hematology, Alfred Hospital and Monash University, Melbourne, Australia
| | - Agnes S M Yong
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia; School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - Devendra K Hiwase
- Haematology, Royal Adelaide Hospital, Port Road, Adelaide, Australia; Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia; School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia.
| |
Collapse
|
13
|
Sharman JP, Cocks K, Nabhan C, Lamanna N, Kay NE, Grinblatt DL, Flowers CR, Davids MS, Kiselev P, Swern AS, Sullivan K, Gharibo MM, Flick ED, Trigg A, Mato A. Longitudinal health-related quality of life in first-line treated patients with chronic lymphocytic leukemia: Results from the Connect ® CLL Registry. EJHAEM 2020; 1:188-198. [PMID: 35847738 PMCID: PMC9176138 DOI: 10.1002/jha2.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/10/2020] [Accepted: 07/12/2020] [Indexed: 06/15/2023]
Abstract
Health-related quality of life (HRQoL) in patients with chronic lymphocytic leukemia (CLL) is important in guiding treatment decisions. However, the impact of CLL treatment initiation on HRQoL is unclear. We assessed HRQoL using the FACT-Leu and EQ-5D-3L questionnaires in the Connect ® CLL Registry, a large, US-based, multicenter, prospective observational study of CLL patients enrolled between 2010 and 2014, prior to the introduction of novel therapies. Among 889 patients initiating first-line therapy with chemoimmunotherapy or rituximab monotherapy, questionnaire completion rates were 95.7% and 95.8% at enrollment, and 70.8% and 69.4% at 12 months, for FACT-Leu Total and EQ-5D-3L, respectively. For 849 patients completing all five FACT-Leu components, average total scores were 135.7 at enrollment and 141.6 at 12 months. Among 526 patients with FACT-Leu Total scores at enrollment and 12 months, clinically meaningful (≥11-point) improvements or reductions were observed in 179 (34.0%) and 88 (16.7%) patients, respectively. Mean EQ-5D-3L index scores were 0.87 at enrollment and 12 months. Among 513 patients completing EQ-5D-3L at enrollment and 12 months, clinically meaningful (≥0.06-point) improvements or reductions were observed in 125 (24.4%) and 116 (22.6%) patients, respectively. In the Connect® CLL Registry, HRQoL remained stable or slightly improved after 12 months of follow-up.
Collapse
Affiliation(s)
- Jeff P. Sharman
- Willamette Valley Cancer InstituteUS OncologyEugeneOregonUSA
| | | | - Chadi Nabhan
- Caris Life SciencesDallasTexasUSA
- University of South CarolinaColumbiaSouth CarolinaUSA
| | - Nicole Lamanna
- Division of Hematology and OncologyDepartment of MedicineNew York‐Presbyterian/Columbia University Medical CenterNew YorkNew YorkUSA
| | - Neil E. Kay
- Division of HematologyMayo ClinicRochesterMinnesotaUSA
| | | | | | - Matthew S. Davids
- Department of Medical OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | | | | | | | | | | | | | - Anthony Mato
- Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| |
Collapse
|
14
|
Peipert JD, Yount SE, Efficace F, Loefgren C, Pierson R, He J, Cella D. Validation of the Functional Assessment of Cancer Therapy-Leukemia instrument in patients with acute myeloid leukemia who are not candidates for intensive therapy. Cancer 2020; 126:3542-3551. [PMID: 32463931 DOI: 10.1002/cncr.32977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/27/2020] [Accepted: 04/28/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND The objective of this study was to validate the Functional Assessment of Cancer Therapy-Leukemia (FACT-Leu) in patients with acute myeloid leukemia (AML) who are not candidates for intensive therapy. METHODS A sample of 317 patients with AML who were not eligible for intensive chemotherapy completed the FACT-Leu and EuroQol 5-Dimension (EQ-5D) measures (Utility Index and Visual Analogue Scale) every 28 days until the end of treatment. Internal consistency reliability was estimated with Cronbach's α. Concurrent validity was examined with correlations between FACT-Leu and EQ-5D scales, and known-groups validity was examined by determining whether FACT-Leu scales distinguished between Eastern Cooperative Oncology Group (ECOG) performance status ratings (PSRs) and between maximum adverse event toxicities at the baseline. This study examined responsiveness to change by anchoring change in the FACT-Leu scales to a 0.10 change in the EQ-5D Health Utility Index. RESULTS Cronbach's α usually exceeded the threshold for good (≥0.80) or excellent reliability (≥0.90). Correlations between FACT-Leu and EQ-5D scales were moderate (r > 0.50) or high (r > 0.70). FACT-Leu scales distinguished between ECOG PSR groups with large effect sizes for an ECOG PSR of 0 versus an ECOG PSR of 2 (0.50 ≤ d < 0.80). In addition, Functional Assessment of Cancer Therapy-General, Additional Concerns, FACT-Leu Total, and Trial Outcomes Index scales distinguished between patients with grade 3 or lower maximum adverse event toxicities and those with maximum adverse event toxicities higher than grade 3, but effect sizes were small (d < 0.50). Finally, FACT-Leu scale coefficients for a 0.10 change in the 5-level version of the EQ-5D HUI ranged between -0.01 and 4.30. CONCLUSIONS The FACT-Leu is a suitable outcome measure for AML clinical trials among patients not eligible for intensive therapy, and it may have value for clinical monitoring.
Collapse
Affiliation(s)
- John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Susan E Yount
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Fabio Efficace
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Health Outcomes Research Unit, Italian Group for Adult Hematologic Disease, Rome, Italy
| | | | - Renee Pierson
- Janssen Global Services, LLC, Raritan, New Jersey, USA
| | - Jianming He
- Janssen Global Services, LLC, Raritan, New Jersey, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
15
|
A Preliminary Study of the Comfort in Patients with Leukemia Staying in a Positive Pressure Isolation Room. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103655. [PMID: 32456113 PMCID: PMC7277353 DOI: 10.3390/ijerph17103655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 11/16/2022]
Abstract
Background and Aim: Patients with leukemia who are isolated in positive pressure rooms for infection prevention usually experience significant physical and psychological distress. This study aimed to examine changes in leukemia patients' comfort level during chemotherapy in isolation wards. Methods: A longitudinal survey was conducted with measures which were repeated four times. Data were collected before chemotherapy, on the first and second week after receiving chemotherapy in positive pressure isolation rooms, and on the third week in the non-isolated hematology ward. Each patient received six questionnaires measuring demographic data, comfort status, functional status, fatigue related to cancer therapy, anxiety level, and distress symptoms. A mixed model with repeated measure analysis was used to examine the changing trajectories in physical and psychological health. Results: Twenty-one patients completed the study. During the process, the highest score for comfort level was shown before chemotherapy, and this decreased from the second week under isolation. Anxiety and uncertainty (p < 0.05) declined over time, and emotional states improved during the recovery period in the third and fourth weeks outside isolation. Physical well-being (p < 0.01), cancer-related fatigue (p < 0.05), hemoglobin (p < 0.01) and white blood cell count (p < 0.05) began to rise two weeks after chemotherapy. Conclusion: Comfort levels declined after chemotherapy until the third week of treatment. Anxiety, fatigue and distress symptoms varied across the four time points of chemotherapy from isolation to return to the non-isolated ward. Health care professionals should be aware of psychological symptoms when patients are in isolation rooms, and interventions for promoting a humanized environment, quality of life, and comfort should be considered and provided along with the treatment stages of chemotherapy.
Collapse
|
16
|
Klepin HD, Ritchie E, Major-Elechi B, Le-Rademacher J, Seisler D, Storrick L, Sanford BL, Marcucci G, Zhao W, Geyer SA, Ballman KV, Powell BL, Baer MR, Stock W, Cohen HJ, Stone RM, Larson RA, Uy GL. Geriatric assessment among older adults receiving intensive therapy for acute myeloid leukemia: Report of CALGB 361006 (Alliance). J Geriatr Oncol 2020; 11:107-113. [PMID: 31668825 PMCID: PMC6943189 DOI: 10.1016/j.jgo.2019.10.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/10/2019] [Accepted: 10/12/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To demonstrate feasibility of performing geriatric assessment (GA) in the National Clinical Trials Network (NCTN) and to explore the utility of GA to characterize treatment tolerance. MATERIALS AND METHODS We conducted a multisite companion study (CALGB 361006) to CALGB 11001, a phase 2 trial of adults ≥60 years old with newly diagnosed FLT3- mutated AML, testing the efficacy of adding sorafenib to intensive chemotherapy. On 361006, a GA was administered prior to induction and prior to post-remission therapy. The GA is divided into items requiring administration by a health care professional (HCP) and patient self-administered questionnaires. Feasibility outcomes were recruitment rate, time to GA completion, difficulty with GA administration, percent of patients requiring assistance, and satisfaction. Change in GA measures pre- and post-induction were compared using Wilcoxon signed rank test and McNemar's tests. RESULTS The recruitment rate was 80% (N = 43, median age 68 years). Median completion time of the GA was 30 min; (10 and 21 min for HCP and patients, respectively). HCP reported no difficulty completing assessments (100%). Most patients completed questionnaires without assistance (77%), and were satisfied with the length (89%). Self-reported physical function, mental health, social activity and nutritional parameters worsened after induction. CONCLUSION GA is feasible to administer in the setting of intensive induction for older adults with AML in the NCTN and provides evidence of the impact of induction therapy on physical and emotional health.
Collapse
Affiliation(s)
- Heidi D Klepin
- Wake Forest University Health Sciences, Winston-Salem, NC, United States of America.
| | - Ellen Ritchie
- Weill Medical College of Cornell University, New York, NY, United States of America
| | - Brittny Major-Elechi
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States of America
| | - Jennifer Le-Rademacher
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States of America
| | - Drew Seisler
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States of America
| | - Libby Storrick
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States of America
| | - Ben L Sanford
- Alliance Statistics and Data Center, Duke University, Durham, NC, United States of America
| | - Guido Marcucci
- City of Hope Comprehensive Cancer Center, Duarte, CA, United States of America
| | - Weiqiang Zhao
- The Ohio State University Cancer Center, Columbus, OH, United States of America
| | - Susan A Geyer
- Alliance Statistics and Data Center, The Ohio State University Medical Center, Columbus, OH, United States of America
| | - Karla V Ballman
- Weill Medical College of Cornell University, New York, NY, United States of America
| | - Bayard L Powell
- Wake Forest University Health Sciences, Winston-Salem, NC, United States of America
| | - Maria R Baer
- Greenebaum Cancer Center, University of Maryland, Baltimore, MD, United States of America
| | - Wendy Stock
- University of Chicago Comprehensive Cancer Center, Chicago, IL, United States of America
| | - Harvey Jay Cohen
- Duke Cancer Institute, Duke University, Durham, NC, United States of America
| | - Richard M Stone
- Dana-Farber/Partners CancerCare, Boston, MA, United States of America
| | - Richard A Larson
- University of Chicago Comprehensive Cancer Center, Chicago, IL, United States of America
| | - Geoffrey L Uy
- Washington University School of Medicine, St. Louis, MO, United States of America
| |
Collapse
|
17
|
Klepin HD, Estey E, Kadia T. More Versus Less Therapy for Older Adults With Acute Myeloid Leukemia: New Perspectives on an Old Debate. Am Soc Clin Oncol Educ Book 2019; 39:421-432. [PMID: 31099627 DOI: 10.1200/edbk_239097] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Most patients with newly diagnosed acute myeloid leukemia (AML) are at least age 65 and continue to have short survival, with many patients receiving no specific anti-AML therapy, particularly if they are older than age 75. Although consensus regarding optimal treatment of this growing population is lacking, treatment options are expanding even for the oldest patients. A fundamental question when seeing an older patient with AML is whether to recommend "more intensive" or "less intensive" induction therapy. Existing data can support more intensive treatment strategies for selected older adults, although there is growing evidence to support less intensive therapies as well. Randomized trials to provide clear comparisons between treatment strategies among well-characterized older adult populations are lacking. Reliance on age alone to determine treatment choice is problematic, as "fitness" or "unfitness" varies dramatically among patients of the same chronologic age and remains poorly characterized in existing studies. This article will provide differing perspectives on the "more" versus "less" question, with particular attention to recent drug approvals. Issues relevant to both treatment decision-making in practice and alternative trial design to inform gaps in knowledge will be discussed. Given the heterogeneity, an important conclusion will be that there is unlikely to be a single best approach and that appropriate decision-making requires considerations of many factors specific to individual patients.
Collapse
Affiliation(s)
- Heidi D Klepin
- 1 Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, NC
| | - Elihu Estey
- 2 University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Tapan Kadia
- 3 The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
18
|
Jalali, Mostafa S, Abdollahi M, Hosseini A, Bozorg DK, Ajami, Azadeh M, Moiniafshar K. The positive effects of Mediterranean-neutropenic diet on nutritional status of acute myeloid leukemia patients under chemotherapy. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s11515-018-1519-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|