1
|
LoCastro M, Mortaz-Hedjri S, Wang Y, Mendler JH, Norton S, Bernacki R, Carroll T, Klepin H, Liesveld J, Huselton E, Kluger B, Loh KP. Telehealth serious illness care program for older adults with hematologic malignancies: a single-arm pilot study. Blood Adv 2023; 7:7597-7607. [PMID: 38088668 PMCID: PMC10733103 DOI: 10.1182/bloodadvances.2023011046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 12/24/2023] Open
Abstract
ABSTRACT Older patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) feel shocked and bewildered when diagnosed. Serious illness conversations (SICs) may increase disease understanding and preparations for the future. However, SICs often happen late, in part because of clinician-perceived patient discomfort. Telehealth may promote patient comfort by allowing SICs to take place at home. This study assesses the feasibility and usability of a telehealth-delivered Serious Illness Care Program (SICP) for older adults with AML and MDS. We conducted a single-arm pilot study including 20 older adults with AML and MDS. Feasibility was measured using retention rate, with >80% considered feasible. Usability was measured using telehealth usability questionnaire (TUQ; range, 1-7): >5 considered usable. We collected other outcomes including acceptability and disease understanding and conducted post-visit qualitative interviews to elicit feedback. Hypothesis testing was performed at α = 0.10 owing to the pilot nature and small sample size. Retention rate was 95% (19/20); mean TUQ scores were 5.9 (standard deviation [SD], 0.9) and 5.9 (SD, 1.1) for patients and caregivers, respectively. We found the SICP to be acceptable. The majority of patients found the SICP to be very or extremely worthwhile (88.2%; 15/17), and reported it increased closeness with their clinician (75.0%; 12/16). After their visit, patient estimates of curability, and overall life expectancy aligned more closely with those of their clinicians. In qualitative interviews, most patients said that they would recommend this program to others (89.5%, 17/19). This study demonstrated that delivery of the telehealth SICP to older patients with AML and MDS is feasible, usable, and acceptable. This trial is registered at www.clinicaltrials.gov as #NCT04745676.
Collapse
Affiliation(s)
- Marissa LoCastro
- School of Medicine and Dentistry, University of Rochester, Rochester, NY
| | - Soroush Mortaz-Hedjri
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Ying Wang
- Department of Epidemiology, University of Rochester Medical Center, Rochester, NY
| | - Jason H. Mendler
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Sally Norton
- School of Nursing, University of Rochester Medical Center, Rochester, NY
| | | | - Thomas Carroll
- Divisions of General Medicine and Palliative Care, University of Rochester Medical Center, Rochester, NY
| | - Heidi Klepin
- Department of Hematology/Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jane Liesveld
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Eric Huselton
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Benzi Kluger
- Divisions of General Medicine and Palliative Care, University of Rochester Medical Center, Rochester, NY
- Department of Neurology, University of Rochester Medical Center, Rochester, NY
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| |
Collapse
|
2
|
Newcomb R, Johnson PC, Cronin K, Choe JJ, Holmbeck K, Nabily A, Lark P, Rabideau DJ, DeFilipp Z, Chen YB, El-Jawahri A. Quality of Life, Physical Functioning, and Psychological Distress of Older Adults Undergoing Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2023:S2666-6367(23)01176-4. [PMID: 36958693 DOI: 10.1016/j.jtct.2023.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND With advances in therapies for hematologic cancers, older adults increasingly undergo hematopoietic stem cell transplantation (HSCT). Older adults may potentially experience an exaggerated burden of toxicity from HSCT. Studies examining the quality of life (QOL), physical functioning, and psychological symptom trajectory for older adults undergoing HSCT are limited. OBJECTIVES Our primary aim was to describe the trajectory of QOL, physical functioning, and psychological distress of older adults undergoing HSCT. Secondarily, we aimed to compare the trajectory of QOL, physical functioning, and psychological distress of older and younger adults undergoing HSCT and to evaluate factors associated with QOL trajectory in older adults undergoing HSCT. STUDY DESIGN We conducted secondary analyses of two prospective studies conducted at Massachusetts General Hospital. From 2011 to 2016, we enrolled 250 adults undergoing allogeneic or autologous HSCT. Older age was defined as age ≥ 65 years. We collected patient reported outcomes (PROs) within 72 hours of admission for HSCT, at hematologic nadir (2 weeks), and at 6 months post HSCT. To assess QOL, physical functioning, and psychological symptoms, we used the Functional Assessment of Cancer Therapy - Bone Marrow Transplant (FACT-BMT), FACT-Trial Outcome Index (TOI), and Patient Health Questionnaire - 9 (PHQ9) respectively. We used the posttraumatic stress disorder (PTSD) Checklist-Civilian Version to assess PTSD symptoms. We fit linear mixed effects models to characterize trajectories of changes in PROs across timepoints and to evaluate baseline factors associated with QOL trajectories in older adults. RESULTS 30.4% (76/250) of our cohort was 65 years or older. All older adults undergoing allogeneic HSCT received a reduced intensity conditioning regimen. At two weeks post-HSCT, older patients experienced a decline in QOL (Δ = -16.6, p< 0.001), physical functioning (Δ = -15.4, p<0.001) and an increase in depression symptoms (Δ=3.8, p<0.001). At six months post-HSCT, QOL (Δ = 1.4, p = 0.7), physical functioning (Δ = 1.7, p = 0.5), and depression symptoms (Δ = 0.4, p = 0.6) recovered to baseline values. At six months post-HSCT, the proportion of older patients with PTSD symptoms increased from 5.3% (4/76) at baseline to 13.2% (10/76). There was no significant difference in slopes or trajectories of PROs between older and younger patients. In older adults, baseline psychological distress was associated with significantly worse QOL trajectory (Δ= -21.6, p = <0.001). CONCLUSION(S) Older adults experienced a sharp decline in QOL and physical functioning and an increase in depression symptoms within two weeks of HSCT hospitalization. Baseline psychological distress was associated with a pronounced worsening in post-HSCT QOL trajectory. These findings underscore the need for supportive care interventions to improve the experience of older adults undergoing HSCT.
Collapse
Affiliation(s)
- Richard Newcomb
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA 02114.
| | - P Connor Johnson
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA 02114
| | - Katherine Cronin
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA 02114
| | - Joanna J Choe
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA 02114
| | - Katherine Holmbeck
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA 02114
| | - Anisa Nabily
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA 02114
| | - Porsha Lark
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA 02114
| | - Dustin J Rabideau
- Biostatistics, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114; Department of Medicine, Harvard Medical School, Boston, MA
| | - Zachariah DeFilipp
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA 02114
| | - Yi-Bin Chen
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA 02114
| | - Areej El-Jawahri
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA 02114
| |
Collapse
|
3
|
Liang H, Feng Y, Guo Y, Jian J, Zhao L, Luo X, Tao L, Liu B. Development and validation of a novel prognosis prediction model for patients with myelodysplastic syndrome. Front Oncol 2022; 12:1014504. [PMID: 36313674 PMCID: PMC9597308 DOI: 10.3389/fonc.2022.1014504] [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] [Received: 08/08/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Somatic mutations are widespread in patients with Myelodysplastic Syndrome (MDS) and are associated with prognosis. However, a practical prognostic model for MDS that incorporates somatic mutations urgently needs to be developed. Methods A cohort of 201 MDS patients from the Gene Expression Omnibus (GEO) database was used to develop the model, and a single-center cohort of 115 MDS cohorts from Northwest China was used for external validation. Kaplan-Meier analysis was performed to compare the effects of karyotype classifications and gene mutations on the prognosis of MDS patients. Univariate and multivariate Cox regression analyses and Lasso regression were used to screen for key prognostic factors. The shinyapps website was used to create dynamic nomograms with multiple variables. The time-dependent receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA) were used to evaluate the model’s discrimination, accuracy and clinical utility. Results Six risk factors (age, bone morrow blast percentage, ETV6, TP53, EZH2, and ASXL1) were considered as predictor variables in the nomogram. The nomogram showed excellent discrimination, with respective the area under the ROC curve (AUC) values of 0.850, 0.839, 0.933 for the training cohort at 1 year, 3 years and 5 years; 0.715, 0.802 and 0.750 for the testing cohort at 1 year, 3 years and 5 years; and 0.668, 0.646 and 0.731 for the external validation cohort at 1 year, 3 years and 5 years. The calibration curves and decision curve showed that the nomogram had good consistency and clinical practical benefit. Finally, a stratified analysis showed that MDS patients with high risk had worse survival outcomes than patients with low risk. Conclusion We developed a nomogram containing six risk factors, which provides reliable and objective predictions of prognosis for MDS patients.
Collapse
Affiliation(s)
- Haiping Liang
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Yue Feng
- Department of Blood Transfusion, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yuancheng Guo
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Jinli Jian
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Long Zhao
- Department of Hematology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Xingchun Luo
- Department of Hematology, Xi’an Central Hospital, Xi’an, China
| | - Lili Tao
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Bei Liu
- Department of Hematology, The First Hospital of Lanzhou University, Lanzhou, China
- *Correspondence: Bei Liu,
| |
Collapse
|
4
|
Qin Y, Jiang M, Tuerxung N, Wang H, Zhao F, Zhen Y, Hao J. Sonic hedgehog signaling pathway in Myelodysplastic Syndrome: Abnormal activation and jervine intervention. Gene 2020; 754:144881. [PMID: 32526259 DOI: 10.1016/j.gene.2020.144881] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/27/2020] [Accepted: 06/06/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVE This study aims to investigate the roles of Sonic hedgehog (Shh) signaling pathway in the occurrence and progression of Myelodysplastic Syndrome (MDS) and further evaluate using jervine as therapeutic strategy for MDS by inhibiting Shh pathway. METHODS CD34+ cells from the bone marrow of 53 MDS patients were counted by flow cytometry and isolated by magnetic bead sorting. Shh, Smo, Ptch-1 and Gli-1 (involved in Shh pathway) in CD34+ cells were examined by RT-qPCR. Besides, the relationship between Shh pathway-related genes and the clinical features or prognosis of MDS were analyzed. Further, the effects of jervine on MUTZ-1 cells regarding their proliferation, apoptosis and cell cycle as well as Shh pathway-related gene and protein expression were analyzed. RESULTS Gene expression level of Shh, Gli-1 and Smo was significantly increased in MDS patients. Herein, Smo and Gli-1 were correlated with chromosome karyotype classification and IPSS. MDS patients with high expression of Smo or Gli-1 had a poor prognosis. Jervine inhibited gene and protein expression of Shh, Smo, Ptch-1 and Gli-1. Besides, jervine suppressed the proliferation and promoted the apoptosis of MUTZ-1 cells, as well as inhibited the transition of cells from G1 to S phase. CONCLUSION Shh signaling pathway of MDS patients is abnormally activated and participated in the occurrence and progression of MDS. Jervine intervention is a potential therapeutic strategy for MDS.
Collapse
Affiliation(s)
- YuTing Qin
- Hematologic Disease Center, The First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Xinshi District, Urumqi, Xinjiang Province 830054, China
| | - Ming Jiang
- Hematologic Disease Center, The First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Xinshi District, Urumqi, Xinjiang Province 830054, China
| | - Nilupar Tuerxung
- Hematologic Disease Center, The First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Xinshi District, Urumqi, Xinjiang Province 830054, China
| | - Huan Wang
- Hematologic Disease Center, The First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Xinshi District, Urumqi, Xinjiang Province 830054, China
| | - Fang Zhao
- Hematologic Disease Center, The First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Xinshi District, Urumqi, Xinjiang Province 830054, China
| | - Yin Zhen
- Hematologic Disease Center, The First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Xinshi District, Urumqi, Xinjiang Province 830054, China
| | - Jianping Hao
- Hematologic Disease Center, The First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Xinshi District, Urumqi, Xinjiang Province 830054, China.
| |
Collapse
|
5
|
Sakatoku K, Takeoka Y, Miura A, Araki T, Fujitani Y, Yamamura R, Nakamae H, Ohta K, Hino M. Combination of Frailty Status and Comorbidity Score Improves the Stratification of Survival in Patients With Myelodysplastic Syndrome Owing to Good Predictive Capability for Infection-related Mortality. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:799-805. [DOI: 10.1016/j.clml.2019.09.610] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 08/08/2019] [Accepted: 09/20/2019] [Indexed: 01/28/2023]
|
6
|
Salazar AS, Recinos LM, Mian HS, Stoll C, Simon LE, Sekhon S, Colditz GA, Wildes TM. Geriatric Assessment and Frailty Scores Predict Mortality in Myeloma: Systematic Review and Meta-analysis. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:488-496.e6. [DOI: 10.1016/j.clml.2019.04.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 04/29/2019] [Indexed: 11/28/2022]
|
7
|
Aguiar APN, Mendonça PDS, Ribeiro-Júnior HL, Borges DDP, Sampaio HADC, Martins MRA, Pinheiro RF, Magalhães SMM. Myelodysplastic syndromes: An analysis of non-hematological prognostic factors and its relationship to age. J Geriatr Oncol 2019; 11:125-127. [PMID: 31303462 DOI: 10.1016/j.jgo.2019.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/15/2019] [Accepted: 06/28/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Ana Patrícia Nogueira Aguiar
- Cancer Cytogenomic Laboratory, Federal University of Ceará, Fortaleza, Brazil; Post-graduate Program in Medical Science, Federal University of Ceará, Fortaleza, Brazil; Center for Research and Drug Development (NPDM), Federal University of Ceará, Fortaleza, Ceara, Brazil.
| | - Priscila da Silva Mendonça
- Cancer Cytogenomic Laboratory, Federal University of Ceará, Fortaleza, Brazil; Post-graduate Program in Medical Science, Federal University of Ceará, Fortaleza, Brazil; University Hospital Walter Cantidio, Brazilian Company of Hospital Services, Fortaleza, Ceará, Brazil.; Center for Research and Drug Development (NPDM), Federal University of Ceará, Fortaleza, Ceara, Brazil
| | - Howard Lopes Ribeiro-Júnior
- Cancer Cytogenomic Laboratory, Federal University of Ceará, Fortaleza, Brazil; Center for Research and Drug Development (NPDM), Federal University of Ceará, Fortaleza, Ceara, Brazil
| | - Daniela de Paula Borges
- Cancer Cytogenomic Laboratory, Federal University of Ceará, Fortaleza, Brazil; Post-graduate Program in Medical Science, Federal University of Ceará, Fortaleza, Brazil; Center for Research and Drug Development (NPDM), Federal University of Ceará, Fortaleza, Ceara, Brazil
| | | | - Manoel Ricardo Alves Martins
- Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil; Post-Graduate Program of Pathology, Federal University of Ceará, Fortaleza, Ceara, Brazil.; Center for Research and Drug Development (NPDM), Federal University of Ceará, Fortaleza, Ceara, Brazil
| | - Ronald Feitosa Pinheiro
- Cancer Cytogenomic Laboratory, Federal University of Ceará, Fortaleza, Brazil; Post-graduate Program in Medical Science, Federal University of Ceará, Fortaleza, Brazil; Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil; Post-Graduate Program of Pathology, Federal University of Ceará, Fortaleza, Ceara, Brazil.; Center for Research and Drug Development (NPDM), Federal University of Ceará, Fortaleza, Ceara, Brazil
| | - Silvia Maria Meira Magalhães
- Cancer Cytogenomic Laboratory, Federal University of Ceará, Fortaleza, Brazil; Post-graduate Program in Medical Science, Federal University of Ceará, Fortaleza, Brazil; Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil; Center for Research and Drug Development (NPDM), Federal University of Ceará, Fortaleza, Ceara, Brazil
| |
Collapse
|