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Banerjee R, Cowan AJ, Ortega M, Missimer C, Carpenter PA, Oshima MU, Salit RB, Vo PT, Lee CJ, Mehta RS, Kuderer NM, Shankaran V, Lee SJ, Su CT. Financial Toxicity, Time Toxicity, and Quality of Life in Multiple Myeloma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:446-454.e3. [PMID: 38521640 PMCID: PMC11189752 DOI: 10.1016/j.clml.2024.02.013] [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: 12/28/2023] [Accepted: 02/21/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Patients with multiple myeloma (MM) may be on therapy for years, which can lead to financial toxicity (FinTox) or time toxicity (TimeTox). The prevalence, predictors, and quality of life (QOL) impacts of FinTox and TimeTox during different phases of MM treatment have not been characterized. PATIENTS AND METHODS We conducted a single-center cross-sectional survey of patients with MM who had undergone transplantation. FinTox+ was defined as a COST-FACIT score <23, TimeTox+ as MM-related interactions (including phone calls) ≥1x weekly or ≥1x monthly in-person among far-residing patients, QOL using PROMIS Global Health, and functional status using patient-reported Karnofsky performance status (KPS). RESULTS Of 252 patients, 22% and 40% met FinTox+ and TimeTox+ criteria respectively. Respective FinTox+ and TimeTox+ proportions were 22%/37% for patients on maintenance, 22%/82% with active therapy, and 20%/14% with observation. FinTox+ predictors included annual income (P < .01) and out-of-pocket costs (P < .01). TimeTox+ predictors included disease status (P < .001), caregiver status (P = .01), far-residing status (P < .001), and out-of-pocket costs (P = .03). FinTox+ was associated with a clinically meaningful decrease in mental QOL, while TimeTox+ patients were more likely to have KPS ≤ 80. CONCLUSIONS In our large study, monetary status but not disease status predicted FinTox. Over a third of patients on maintenance reported TimeTox. FinTox+ was associated with decreased mental health, while TimeTox+ was associated with worse performance status. These two toxicities may negatively impact patient wellbeing, and studies of strategies to mitigate their impact are in development.
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Affiliation(s)
- Rahul Banerjee
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA.
| | - Andrew J Cowan
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Marivel Ortega
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | | | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Masumi Ueda Oshima
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Rachel B Salit
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Phuong T Vo
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Catherine J Lee
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Rohtesh S Mehta
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | | | - Veena Shankaran
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Stephanie J Lee
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Christopher T Su
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
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Garg T, Frank K, Johns A, Rabinowitz K, Danella JF, Kirchner HL, Nielsen ME, McMullen CK, Murphy TE, Cohen HJ. Geriatric assessment-derived deficit accumulation and patient-reported treatment burden in older adults with bladder cancer. J Am Geriatr Soc 2024; 72:490-502. [PMID: 37974546 PMCID: PMC10922080 DOI: 10.1111/jgs.18676] [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: 05/23/2023] [Revised: 10/02/2023] [Accepted: 10/13/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND When a person's workload of healthcare exceeds their resources, they experience treatment burden. At the intersection of cancer and aging, little is known about treatment burden. We evaluated the association between a geriatric assessment-derived Deficit Accumulation Index (DAI) and patient-reported treatment burden in older adults with early-stage, non-muscle-invasive bladder cancer (NMIBC). METHODS We conducted a cross-sectional survey of older adults with NMIBC (≥65 years). We calculated DAI using the Cancer and Aging Research Group's geriatric assessment and measured urinary symptoms using the Urogenital Distress Inventory-6 (UDI-6). The primary outcome was Treatment Burden Questionnaire (TBQ) score. A negative binomial regression with LASSO penalty was used to model TBQ. We further conducted qualitative thematic content analysis of responses to an open-ended survey question ("What has been your Greatest Challenge in managing medical care for your bladder cancer") and created a joint display with illustrative quotes by DAI category. RESULTS Among 119 patients, mean age was 78.9 years (SD 7) of whom 56.3% were robust, 30.3% pre-frail, and 13.4% frail. In the multivariable model, DAI and UDI-6 were significantly associated with TBQ. Individuals with DAI above the median (>0.18) had TBQ scores 1.94 times greater than those below (adjusted IRR 1.94, 95% CI 1.33-2.82). Individuals with UDI-6 greater than the median (25) had TBQ scores 1.7 times greater than those below (adjusted IRR 1.70, 95% CI 1.16-2.49). The top 5 themes in the Greatest Challenge question responses were cancer treatments (22.2%), cancer worry (19.2%), urination bother (18.2%), self-management (18.2%), and appointment time (11.1%). CONCLUSIONS DAI and worsening urinary symptoms were associated with higher treatment burden in older adults with NMIBC. These data highlight the need for a holistic approach that reconciles the burden from aging-related conditions with that resulting from cancer treatment.
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Affiliation(s)
- Tullika Garg
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Katie Frank
- Biostatistics Core, Geisinger, Danville, PA
- Department of Population Health Sciences, Geisinger, Danville, PA
| | - Alicia Johns
- Biostatistics Core, Geisinger, Danville, PA
- Department of Population Health Sciences, Geisinger, Danville, PA
| | | | | | | | - Matthew E. Nielsen
- Department of Urology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
- Departments of Epidemiology and Health Policy & Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC
| | | | - Terrence E. Murphy
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Harvey J. Cohen
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC
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Nicol JL, Cunningham BJ, Woodrow C, Adlard KN, Papinczak ZE, Spence RR, Boytar AN, Mollee P, Weber N, Nicol AJ, Hill MM, Skinner TL. Safety, Feasibility, and Acceptability of a Multisite Individualized Exercise Intervention for People with Multiple Myeloma. Med Sci Sports Exerc 2023; 55:2214-2227. [PMID: 37535331 DOI: 10.1249/mss.0000000000003267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
INTRODUCTION High rates of disease- and treatment-related symptoms, such as bone lesions, in people with multiple myeloma (MM) create uncertainty on the safety and feasibility of exercise. This study determined the safety, feasibility, and acceptability of an individualized exercise medicine program for people with MM at any disease stage. METHODS A multisite, randomized waitlist-controlled trial was conducted of an individualized, high-intensity aerobic, resistance, and impact-loading exercise program. The exercise sessions were supervised twice weekly by accredited exercise physiologists, with one additional unsupervised session per week, for 12 wk. Safety was determined by number of adverse and serious adverse events. Feasibility outcome measures were study eligibility, recruitment, adherence, and attrition. Acceptability was determined by qualitative interviews and subjective levels of enjoyment. RESULTS Of 203 people with MM screened, 88% were eligible, with 34% accepting participation (60 people) and 20% attrition for the between-group analysis, meeting a priori criteria (≥25% and <25%, respectively). No adverse or serious adverse events attributed to testing and/or exercise training were reported. Attendance at supervised exercise sessions was 98%, with 45% completion of the home-based exercise sessions. Adherence rates were 35%, 63%, and 34% for the aerobic, resistance, and impact-loading protocols, with 55%, 80%, and 37% of participants meeting a priori criteria (75% of protocol). Acceptability of the exercise program was high (mean, 82%; 95% confidence interval, 78%-87%) and highly supported by qualitative responses. CONCLUSIONS An individualized, high-intensity aerobic, resistance, and impact-loading exercise medicine program is safe and acceptable, and feasible by some measures for people with MM. Adherence to the prescribed exercise protocols was limited by comorbidities and disease symptoms. Strategies to improve unsupervised exercise completion are warranted in this population.
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Affiliation(s)
| | - Brent J Cunningham
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, AUSTRALIA
| | - Carmel Woodrow
- Haematology Department, Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, AUSTRALIA
| | - Kirsten N Adlard
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, AUSTRALIA
| | - Zoe E Papinczak
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, AUSTRALIA
| | | | - Alexander N Boytar
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, AUSTRALIA
| | | | - Nicholas Weber
- Haematology, Cancer Care Services, Royal Brisbane and Women's Hospital, Queensland, AUSTRALIA
| | - Andrew J Nicol
- Brisbane Clinic for Lymphoma, Myeloma and Leukaemia, Greenslopes Private Hospital, Brisbane, Queensland, AUSTRALIA
| | | | - Tina L Skinner
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, AUSTRALIA
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Bates-Fraser LC, Mills J, Mihas P, Wildes TM, Kent EE, Erisnor G, Adams L, Grant SJ. "A lot to manage and still have some kind of a life": How multiple myeloma impacts the function and quality-of-life of Black-White patient-caregiver dyads. J Am Geriatr Soc 2023; 71:3208-3220. [PMID: 37326501 PMCID: PMC10592551 DOI: 10.1111/jgs.18482] [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: 01/25/2023] [Revised: 05/18/2023] [Accepted: 05/30/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Multiple myeloma (MM) is an incurable debilitating blood cancer associated with the lowest health related quality of life (HRQoL) of all cancers. With nearly 88% of adults aged ≥55 years at diagnosis, age-associated physical losses, comorbidities, and social factors contribute to worsening HRQoL. This qualitative study assessed dyadic (patient-informal caregiver) perspectives on the factors contributing to HRQoL in MM survivors. METHODS We recruited 21 dyads from the UNC-Chapel Hill Lineberger Comprehensive Cancer between 11/2021 and 04/2022. Participants completed a single dyadic semistructured interview capturing broad perspectives on MM. We used ATLAS. ti v 9 for project management and to facilitate data analysis using the Sort and Sift, Think and Shift approach (ResearchTalk, Inc.). This iterative approach allowed the exploration and identification of themes within and across transcripts. RESULTS The mean age at enrollment was 71 years (median: 71, range: 57-90) for patients and 68 years (median 67, range: 37-88) for caregivers. All dyads were racially concordant (11 Black/AA and 10 White). However, we aggregated the findings due to no consistent racial differences. Six themes related to (1) physical burden, (2) treatment challenges, (3) losses of independence, (4) caregiver burden, (5) patient and caregiver perseverance, and (6) adjustment to a new normal were identified. Dyads also experienced MM together, resulting in patients and caregivers experiencing changes in their ability to engage in physical and social activities, which further contributed to poor HRQoL. Patients' increased need for social support led to shifts in the caregiver roles, resulting in caregivers feeling burdened by their responsibilities. All dyads acknowledged the need for perseverance and adaptability to a new normal with MM. CONCLUSION The functional, psychosocial, and HRQoL of older patients with MM and their caregivers remain impacted ≥6 months after a new diagnosis highlighting clinical and research opportunities to focus on preserving or improving the health of dyads living with MM.
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Affiliation(s)
- Lauren C. Bates-Fraser
- Department of Allied Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jiona Mills
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Paul Mihas
- Odum Institute for Research in Social Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tanya M. Wildes
- Department of Medicine, Division of Hematology/Oncology, The University of Nebraska Medical Center/ Nebraska Medicine, Omaha, Nebraska
| | - Erin E. Kent
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gabriell Erisnor
- School of Medicine, City University of New York, New York, New York
| | - Leah Adams
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Shakira J. Grant
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Medicine, Division of Hematology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Bennink C, de Mul M, van der Klift M, Broijl A, Tick L, de Jongh E, Garvelink M, Lobbezoo D, Sonneveld P, Hazelzet J. Improving Outcome-Driven Care in Multiple Myeloma Using Patient-Reported Outcomes: A Qualitative Evaluation Study. THE PATIENT 2023; 16:255-264. [PMID: 36790557 PMCID: PMC9930010 DOI: 10.1007/s40271-023-00616-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Multiple myeloma is an incurable disease with a considerable illness and treatment burden, which negatively impacts patients' quality of life. This study aimed to evaluate the implementation of multiple myeloma care in five Dutch hospitals, related to the three objectives of outcome-driven care, which are defined as (1) providing information for shared decision making in individual patient care, (2) supporting the learning capacity of healthcare professionals and healthcare institutions through benchmarking and (3) developing outcome-driven and patient-centred contracting by health insurers. METHODS In this qualitative study, semi-structured interviews about experiences with patient-reported outcomes were conducted with patients, healthcare professionals and other stakeholders 2 years after implementation. Data were thematically analysed, and emerging topics were clustered around the three objectives of outcome-driven care. RESULTS A total of 46 interviews were held (15 with patients, 16 with professionals and 15 with other stakeholders) that showed patients with multiple myeloma were willing to complete patient-reported outcomes, although integration of patient-reported outcomes in shared decision making fell short in clinical practice. Aggregated patient-reported outcomes were considered important for improving quality of care; however, data collection and data exchange are hindered by privacy legislation, limitations of IT systems and a lack of data standards. Patient-reported outcomes were expected to contribute to cost-effective multiple myeloma treatment, yet outcome-driven reimbursement is still lacking. CONCLUSIONS Outcome-driven multiple myeloma care using patient-reported outcomes is feasible, provided that (1) patient-reported outcomes and shared decision making are integrated into clinical practice, (2) legal and technical obstacles hindering data collection are removed and (3) health insurers adjust their reimbursement plans to facilitate outcome-driven care.
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Affiliation(s)
- Christine Bennink
- Department of Haematology, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
- Department of Haematology, Amphia, Breda, The Netherlands.
| | - Marleen de Mul
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | | | - Annemiek Broijl
- Department of Haematology, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Lidwine Tick
- Department of Haematology, Maxima Medical Center, Veldhoven, Eindhoven, The Netherlands
| | - Eva de Jongh
- Department of Haematology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Mirjam Garvelink
- Department of Haematology, St. Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
| | - Dorien Lobbezoo
- Department of Oncology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Pieter Sonneveld
- Department of Haematology, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Jan Hazelzet
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Su CT, Chen JC, Sussman JB. Virtual care for multiple myeloma in the COVID-19 era: interrupted time series analysis of veterans health administration data. Leuk Lymphoma 2023; 64:1035-1039. [PMID: 36924453 PMCID: PMC10432619 DOI: 10.1080/10428194.2023.2189989] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/02/2023] [Accepted: 01/22/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Christopher T. Su
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI
| | - Jason C. Chen
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Jeremy B. Sussman
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
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Adam R, Duncan L, Maclennan SJ, Locock L. Treatment burden in survivors of prostate and colorectal cancers: a qualitative interview study. BMJ Open 2023; 13:e068997. [PMID: 36868591 PMCID: PMC9990667 DOI: 10.1136/bmjopen-2022-068997] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
OBJECTIVES Treatment burden is the workload of healthcare and the impact this has on the individual. Treatment burden is associated with poorer patient outcomes in several chronic diseases. Illness burden has been extensively studied in cancer, but little is known about treatment burden, particularly in those who have completed primary treatment for cancer. The aim of this study was to investigate treatment burden in survivors of prostate and colorectal cancers and their caregivers. DESIGN Semistructured interview study. Interviews were analysed using Framework and thematic analysis. SETTING Participants were recruited via general practices in Northeast Scotland. PARTICIPANTS Eligible participants were individuals who had been diagnosed with colorectal or prostate cancer without distant metastases within the previous 5 years and their caregivers. Thirty-five patients and six caregivers participated: 22 patients had prostate and 13 had colorectal cancers (six male, seven female). RESULTS The term 'burden' did not resonate with most survivors, who expressed gratitude that time invested in cancer care could translate into improved survival. Cancer management was time consuming, but workload reduced over time. Cancer was usually considered as a discrete episode. Individual, disease and health system factors protected against or increased treatment burden. Some factors, such as health service configuration, were potentially modifiable. Multimorbidity contributed most to treatment burden and influenced treatment decisions and engagement with follow-up. The presence of a caregiver protected against treatment burden, but caregivers also experienced burden. CONCLUSIONS Intensive cancer treatment and follow-up regimens do not necessarily lead to perceived burden. A cancer diagnosis serves as a strong motivator to engage in health management, but a careful balance exists between positive perceptions and burden. Treatment burden could lead to poorer cancer outcomes by influencing engagement with and decisions about care. Clinicians should ask about treatment burden and its impact, particularly in those with multimorbidity. TRIAL REGISTRATION NUMBER NCT04163068.
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Affiliation(s)
- Rosalind Adam
- Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Lisa Duncan
- Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Sara J Maclennan
- Academic Urology Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Louise Locock
- Health Services Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Gatopoulou X, Iraqi W, Morgan K, Helme K, Spain VA, Redfearn J, Gardiner B. The Burden of a Multiple Myeloma Diagnosis on Patients and Caregivers in the First Year: Western European Findings. CLINICOECONOMICS AND OUTCOMES RESEARCH 2022; 14:731-753. [PMID: 36569430 PMCID: PMC9769147 DOI: 10.2147/ceor.s367458] [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: 04/27/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022] Open
Abstract
Background This research aimed to quantify the burden of illness (BoI) in transplant eligible (TE) and transplant non-eligible (TNE) newly diagnosed multiple myeloma (NDMM) patients and their caregivers, in the first year after diagnosis: at months 0, 3, and 12. Methods Prospective, cross-sectional, observational NDMM study of TE and TNE patients and their caregivers from France, Germany, Italy, and Spain was conducted between May 2019 and January 2021. A structured, online questionnaire measuring disease burden, direct and costs, out-of-pocket expenses, and health-related quality of life (HRQoL) was used. Descriptive statistics were performed. Results A total of 164, 160, and 190 NDMM patients [>65 years; self-described healthy; not working; living with caregiver] answered at months 0, 3, and 12. Patients lost independence to perform daily activities; mean pain intensity rose and opioid utilization increased, more significantly among TNE patients. Overall health status and HRQoL remained stable. Median 3-month direct medical costs peaked at month 3. Specialist consultations and hospital admissions were the greatest cost amongst TE and TNE patients. Home adaptations increased out-of-pocket expenditures amongst TNE patients. Patients describing themselves as working spent a median 0 hours in the office at all time points. A total of 131, 122, and 124 caregivers answered at months 0, 3, and 12. Mean self-rated burden score rose. By month 12, half of caregivers developed stress, anxiety or depression. Most employed caregivers continued working. Productivity was low at month 0 with a trend of recovering at month 12. Caregivers of TNE compared to TE patients reported greater time burden. Caregivers' HRQoL was stable over time. Conclusion NDMM is burdensome for patients and caregivers in the first year after diagnosis. TNE patients are more dependent on caregivers and incur higher care costs than TE patients. Despite the financial, physical, and emotional burden, HRQoL remains stable possibly indicating resilience and illness adjustment amongst patients and caregivers.
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Affiliation(s)
- Xenia Gatopoulou
- Health Economics, Market Access and Reimbursement EMEA, Janssen Pharmaceuticals, Athens, Greece
| | - Wafae Iraqi
- Patient Engagement, Janssen Pharmaceuticals, Issy-les-Moulineaux, France,Correspondence: Wafae Iraqi, Janssen Pharmaceuticals, 1, Rue Camille Desmoulins, TSA 91003, Issy-les-Moulineaux, 92787, France, Email
| | | | - Kawitha Helme
- Health Economics, Market Access and Reimbursement EMEA, Janssen Pharmaceuticals, High Wycombe, UK
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Su CT, Veenstra CM, Patel MR. Divergent Patterns in Care Utilization and Financial Distress between Patients with Blood Cancers and Solid Tumors: A National Health Interview Survey Study, 2014-2020. Cancers (Basel) 2022; 14:cancers14071605. [PMID: 35406377 PMCID: PMC8996850 DOI: 10.3390/cancers14071605] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: Important differences exist between the presentation, treatment, and survivorship of patients and survivors with blood cancers. Furthermore, existing research in financial toxicity has not fully addressed the relationship between medical care utilization and patient-reported outcomes of financial barriers and distress. We answered these questions by using a nationally representative survey. Methods: Respondents with blood cancers and solid tumors from the National Health Interview Survey were identified (2014−2020). We identified 23 survey questions as study outcomes and grouped them into three domains of medical care utilization, financial barriers to care, and financial distress. Associations between the three domains and associations of study outcomes between cancer types were examined using weighted univariate analyses and multivariable linear and logistic regressions. Results: The final study group consisted of 6248 respondents with solid tumors and 398 with blood cancers (diagnosed ≤ 5 years). Across all respondents with cancer, higher medical care utilization is generally associated with increased financial barriers to care. Compared to respondents with solid tumors, respondents with blood cancers had a higher level of medical care utilization (β = 0.36, p = 0.02), a lower level of financial barriers to care (β = −0.19, p < 0.0001), and a higher level of financial distress in affording care (β = 0.64, p = 0.03). Conclusions: Patients and survivors with blood cancers and solid tumors demonstrate divergent patterns in care utilization, financial barriers, and financial distress. Future research and interventions on financial toxicity should be tailored for individual cancer groups, recognizing the differences in medical care utilization, which affect the experienced financial barriers.
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Affiliation(s)
- Christopher T. Su
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, USA; (C.M.V.); (M.R.P.)
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI 48109, USA
- Correspondence: ; Tel.: +1-734-615-1623
| | - Christine M. Veenstra
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, USA; (C.M.V.); (M.R.P.)
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI 48109, USA
| | - Minal R. Patel
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, USA; (C.M.V.); (M.R.P.)
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI 48109, USA
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
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Patient-reported outcome measures are associated with health care utilization in patients with transplant ineligible multiple myeloma: a population-based study. Blood Cancer J 2022; 12:17. [PMID: 35087029 PMCID: PMC8795114 DOI: 10.1038/s41408-021-00602-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022] Open
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Hevroni G, Korde N. Examining health related quality of life outcomes in multiple myeloma: Past and future perspectives. Semin Oncol 2022; 49:94-102. [DOI: 10.1053/j.seminoncol.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/23/2021] [Accepted: 01/02/2022] [Indexed: 11/11/2022]
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Auclair D, Mansfield C, Fiala MA, Chari A, Cole CE, Kaufman JL, Orloff GJ, Siegel DS, Zonder JA, Mange B, Yesil J, Dalal M, Mikhael JR. Preferences and Priorities for Relapsed Multiple Myeloma Treatments Among Patients and Caregivers in the United States. Patient Prefer Adherence 2022; 16:573-585. [PMID: 35256844 PMCID: PMC8898176 DOI: 10.2147/ppa.s345906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/19/2022] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION/BACKGROUND This study aimed to describe patient and caregiver preferences for treatments of relapsed or refractory multiple myeloma (MM). MATERIALS AND METHODS A survey including discrete-choice experiment (DCE) and best-worst scaling (BWS) exercises was conducted among US patients with relapsed or refractory MM and their caregivers. The DCE included six attributes with varying levels including progression-free survival (PFS), toxicity, and mode and frequency of administration. In addition, the impact of treatment cost was assessed using a fixed-choice question. The BWS exercise included 18 items (modes and frequency of administration, additional treatment convenience, and toxicity items). The survey was administered online to patients recruited from the Multiple Myeloma Research Foundation CoMMpass study (NCT01454297). RESULTS The final samples consisted of 94 patients and 32 caregivers. Avoiding severe nerve damage was most important to patients, followed by longer PFS. Caregivers considered PFS to be the most important attribute. We estimate that a third or more of patients were cost-sensitive, meaning their treatment preference was altered based on cost implications. Caregivers were not cost-sensitive. The three most bothersome treatment features in the BWS exercise were risk of kidney failure, lowering white blood cell counts, and weakening the immune system. CONCLUSION Patients with relapsed or refractory MM and their caregivers consider many factors including efficacy, toxicity, mode/frequency of administration, and cost in their decisions regarding treatment options. The study provides a basis for future Research on patient and caregiver treatment preferences, which could be incorporated into shared decision-making with physicians.
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Affiliation(s)
- Daniel Auclair
- Department of Research, Multiple Myeloma Research Foundation, Norwalk, CT, USA
- Correspondence: Daniel Auclair, AstraZeneca Oncology R&D| Hematology, 35 Gatehouse Drive, Waltham, MA, 02451, USA, Email
| | | | - Mark A Fiala
- Division of Hematology & Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ajai Chari
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
| | - Craig E Cole
- Department of Medicine, MSU Breslin Cancer Center, Lansing, MI, USA
| | - Jonathan L Kaufman
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | | | - David S Siegel
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Jeffrey A Zonder
- Division of Clinical Hematology-Oncology, Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA
| | - Brennan Mange
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - Jennifer Yesil
- Department of Research, Multiple Myeloma Research Foundation, Norwalk, CT, USA
| | - Mehul Dalal
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical, Company Ltd, Cambridge, MA, USA
| | - Joseph R Mikhael
- Translational Genomic Research Institute, City of Hope Cancer Center, Phoenix, AZ, USA
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Bonello F, Grasso M, D’Agostino M, Celeghini I, Castellino A, Boccadoro M, Bringhen S. The Role of Monoclonal Antibodies in the First-Line Treatment of Transplant-Ineligible Patients with Newly Diagnosed Multiple Myeloma. Pharmaceuticals (Basel) 2020; 14:20. [PMID: 33383757 PMCID: PMC7823261 DOI: 10.3390/ph14010020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 12/16/2022] Open
Abstract
Elderly transplant-ineligible (NTE) patients represent the majority of patients affected by multiple myeloma (MM). Elderly patients are a highly heterogeneous population, with large variability in health and functional status. Thus, choosing their optimal treatment is challenging. A wide range of first-line treatments is available, and novel-agent combinations, including monoclonal antibodies (mAbs), have recently entered clinical practice. The combination of the anti-CD38 mAb daratumumab with bortezomib, melphalan and prednisone (Dara-VMP) or lenalidomide and dexamethasone (Dara-Rd) demonstrated impressive advantages in terms of progression-free survival and minimal residual disease negativity, as compared to VMP and Rd, without safety concerns. Another anti-CD38 mAb, isatuximab, is showing encouraging results, and new isatuximab-based combinations might enter clinical practice in the future. Nevertheless, available data come from clinical trials with selected patient populations and, to date, the manageability of these regimens in real-life patients or in frail patients remains unknown. Frailty-tailored treatments, including mAbs, are under evaluation in preliminary studies. In this review, we analyze recently approved mAb-based treatments for NTE newly diagnosed MM patients and new combinations under evaluation, focusing on the efficacy and safety of these regimens and on open issues regarding the choice of therapy for elderly patients.
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Affiliation(s)
- Francesca Bonello
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Mariella Grasso
- S.C. Ematologia, Azienda Ospedaliera Santa Croce-Carle, 88900 Cuneo, Italy
| | - Mattia D’Agostino
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Ivana Celeghini
- S.C. Ematologia, Azienda Ospedaliera Santa Croce-Carle, 88900 Cuneo, Italy
| | - Alessia Castellino
- S.C. Ematologia, Azienda Ospedaliera Santa Croce-Carle, 88900 Cuneo, Italy
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Sara Bringhen
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy
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