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Marvin-Peek J, Shelton V, Brassil K, Fellman B, Barr A, Chien KS, Hammond D, Swaminathan M, Jain N, Wierda W, Ferrajoli A, DiNardo C. Effect of Digital Health Coaching on Self-Efficacy and Patient-Reported Outcomes in Individuals with Acute Myeloid and Chronic Lymphocytic Leukemia: A Pilot Randomized Controlled Trial. Acta Haematol 2024:1-10. [PMID: 38861934 DOI: 10.1159/000539756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/24/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Promotion of self-efficacy can enhance engagement with health care and treatment adherence in patients with cancer. We report the outcomes of a pilot trial of a digital health coach intervention in patients with leukemia with the aim of improving self-efficacy. METHODS Adult patients with newly diagnosed acute myeloid leukemia (AML) and chronic lymphocytic leukemia (CLL) were randomized 1:1 to a digital health coach intervention or standard of care. The primary outcome of self-efficacy was measured by the Cancer Behavior Inventory (CBI) score. RESULTS A total of 147 patients (37 AML, 110 CLL) were enrolled from July 2020 to December 2022. In the AML cohort, there was a mean increase in CBI score of 7.03 in the digital health coaching arm compared to a mean decrease of -3.57 in the control arm at 30 days (p = 0.219). There were no significant associations between the intervention and other patient-reported outcomes for patients with CLL. CONCLUSION There were numerical, but not statistically significant increases in self-efficacy metrics in AML patients who received digital health coaching. Although this trial was underpowered due to enrollment limitations during a pandemic, digital health coaching may provide benefit to patients with hematologic malignancy and warrants further investigation.
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Affiliation(s)
- Jennifer Marvin-Peek
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA,
| | - Valerie Shelton
- Department of Nursing, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kelly Brassil
- Pack Health, A Quest Diagnostics Company, Birmingham, Alabama, USA
| | - Bryan Fellman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Austin Barr
- Pack Health, A Quest Diagnostics Company, Birmingham, Alabama, USA
| | - Kelly Sharon Chien
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Danielle Hammond
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mahesh Swaminathan
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nitin Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - William Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alessandra Ferrajoli
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Courtney DiNardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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El-Jawahri A, Luskin MR, Greer JA, Traeger L, Lavoie M, Vaughn DM, Andrews S, Yang D, Boateng KY, Newcomb RA, Ufere NN, Fathi AT, Hobbs G, Brunner A, Abel GA, Stone RM, DeAngelo DJ, Wadleigh M, Temel JS. Psychological mobile app for patients with acute myeloid leukemia: A pilot randomized clinical trial. Cancer 2023; 129:1075-1084. [PMID: 36655338 DOI: 10.1002/cncr.34645] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/28/2022] [Accepted: 12/08/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Patients with acute myeloid leukemia (AML) experience a substantial decline in quality of life (QoL) and mood during their hospitalization for intensive chemotherapy, yet few interventions have been developed to enhance patient-reported outcomes during treatment. METHODS We conducted a pilot randomized trial (ClinicalTrials.gov identifier NCT03372291) of DREAMLAND, a psychological mobile application for patients with a new diagnosis of AML who are receiving intensive chemotherapy. Patients were randomly assigned to DREAMLAND or usual care. DREAMLAND included four required modules focused on: (1) supportive psychotherapy to help patients deal with the initial shock of diagnosis, (2) psychoeducation to manage illness expectations, (3) psychosocial skill-building to promote effective coping, and (4) self-care. The primary end point was feasibility, which was defined as ≥60% of eligible patients enrolling and 60% of those enrolled completing ≥60% of the required modules. We assessed patient QoL (the Functional Assessment of Cancer Therapy-Leukemia), psychological distress (the Hospital Anxiety and Depression Scale and the Patient Health Questionnaire-9), symptom burden (the Edmonton Symptom Assessment Scale), and self-efficacy (the Cancer Self-Efficacy Scale) at baseline and at day 20 after postchemotherapy. RESULTS We enrolled 60 of 90 eligible patients (66.7%), and 62.1% completed ≥75% of the intervention modules. At day 20 after chemotherapy, patients who were randomized to DREAMLAND reported improved QoL scores (132.06 vs. 110.72; p =.001), lower anxiety symptoms (3.54 vs. 5.64; p = .010) and depression symptoms (Hospital Anxiety and Depression Scale: 4.76 vs. 6.29; p = .121; Patient Health Questionnaire-9: 4.62 vs. 8.35; p < .001), and improved symptom burden (24.89 vs. 40.60; p = .007) and self-efficacy (151.84 vs. 135.43; p = .004) compared with the usual care group. CONCLUSIONS A psychological mobile application for patients with newly diagnosed AML is feasible to integrate during hospitalization for intensive chemotherapy and may improve QoL, mood, symptom burden, and self-efficacy.
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Affiliation(s)
- Areej El-Jawahri
- Divsion of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Marlise R Luskin
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Joseph A Greer
- Divsion of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Lara Traeger
- Divsion of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Mitchell Lavoie
- Divsion of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dagny Marie Vaughn
- Divsion of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stephanie Andrews
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Daniel Yang
- Divsion of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kofi Y Boateng
- Divsion of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Richard A Newcomb
- Divsion of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Nneka N Ufere
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amir T Fathi
- Divsion of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Gabriela Hobbs
- Divsion of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Brunner
- Divsion of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory A Abel
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Richard M Stone
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Daniel J DeAngelo
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Martha Wadleigh
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Divsion of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Bruserud Ø, Tsykunova G, Hernandez-Valladares M, Reikvam H, Tvedt THA. Therapeutic Use of Valproic Acid and All-Trans Retinoic Acid in Acute Myeloid Leukemia-Literature Review and Discussion of Possible Use in Relapse after Allogeneic Stem Cell Transplantation. Pharmaceuticals (Basel) 2021; 14:ph14050423. [PMID: 34063204 PMCID: PMC8147490 DOI: 10.3390/ph14050423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 12/17/2022] Open
Abstract
Even though allogeneic stem cell transplantation is the most intensive treatment for acute myeloid leukemia (AML), chemo-resistant leukemia relapse is still one of the most common causes of death for these patients, as is transplant-related mortality, i.e., graft versus host disease, infections, and organ damage. These relapse patients are not always candidates for additional intensive therapy or re-transplantation, and many of them have decreased quality of life and shortened expected survival. The efficiency of azacitidine for treatment of posttransplant AML relapse has been documented in several clinical trials. Valproic acid is an antiepileptic fatty acid that exerts antileukemic activity through histone deacetylase inhibition. The combination of valproic acid and all-trans retinoic acid (ATRA) is well tolerated even by unfit or elderly AML patients, and low-toxicity chemotherapy (e.g., azacitidine) can be added to this combination. The triple combination of azacitidine, valproic acid, and ATRA may therefore represent a low-intensity and low-toxicity alternative for these patients. In the present review, we review and discuss the general experience with valproic acid/ATRA in AML therapy and we discuss its possible use in low-intensity/toxicity treatment of post-allotransplant AML relapse. Our discussion is further illustrated by four case reports where combined treatments with sequential azacitidine/hydroxyurea, valproic acid, and ATRA were used.
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Affiliation(s)
- Øystein Bruserud
- Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway;
- Department of Medicine, Haukeland University Hospital, N-5021 Bergen, Norway; (G.T.); (T.H.A.T.)
- Correspondence:
| | - Galina Tsykunova
- Department of Medicine, Haukeland University Hospital, N-5021 Bergen, Norway; (G.T.); (T.H.A.T.)
| | - Maria Hernandez-Valladares
- The Proteomics Facility of the University of Bergen (PROBE), University of Bergen, N-5021 Bergen, Norway;
| | - Hakon Reikvam
- Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway;
- Department of Medicine, Haukeland University Hospital, N-5021 Bergen, Norway; (G.T.); (T.H.A.T.)
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Salas M, Henderson M, Wientzek-Fleischmann A, Islam Z, Tu N, Bilitou A, Elsharkawy M, Stellmacher U. Validated Instruments of Quality of Life (QOL) in Patients With Acute Myeloid Leukemia (AML) and Other Cancers. Front Pharmacol 2020; 11:1109. [PMID: 32792948 PMCID: PMC7394002 DOI: 10.3389/fphar.2020.01109] [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: 05/13/2020] [Accepted: 07/08/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Acute myeloid leukemia (AML) can negatively impact quality of life (QOL). Few QOL instruments are specific to and have been validated in AML. This review aims to identify QOL instruments that have been validated in patients with AML and other cancers and summarize their psychometric properties reported in published literature. A literature review search was performed using PubMed and OVID (Biosis, Embase, MEDLINE) databases through June 25, 2020. Search terms included: QOL, health-related QOL, patient-reported outcomes and validity, reliability, validated, tools, instruments, test-retest, and leukemia myeloid acute, leukemia, myeloid, acute, acute myeloid leukemia. Articles were included if they focused on cancer and reported psychometric properties that could be extracted. Abstracts and their references were reviewed for inclusion. Results Twelve evaluating ten instruments were included. Functional Assessment of Cancer Therapy Leukemia (FACT-Leu) showed internal consistency (IC) of α = 0.86 to >0.9, correlation with EQ-5D-3L of r > 0.50, correlation with European Organisation for Research and Treatment of Cancer (EORTC) QLQ-Leu of ρ = 0.29–0.63, test-retest reliability of κ = 0.861. FACT-F showed correlations with EORTC QLQ-C30 of r = 0.40–0.83. Hematological Malignancy Patient-Reported Outcome (HM-PRO) showed intraclass correlation coefficient (ICC) of 0.94–0.98. EORTC-8D and EQ-5D-3L showed ICC = 0.595, correlations with each other of ρ = 0.137–0.634 and with EORTC QLQ-C30 of r = 0.651–0.917. EORTC QLQ-C30 showed person separation reliability of 0.47 to 0.90 and patient-observer agreement of 0.85. Life Ingredient Profile (LIP) showed IC of α = 0.29–0.77 and test-retest reliability of κ = 0.42–1.0. QOL-E showed correlation with FACT-general of R = 0.71, internal validity of α = 0.7, and test-retest reliability of standardized Cronbach’s α = 0.7–0.92. EORTC QLQ-Leu showed IC of α = 0.6–0.79. The Acute Myeloid Leukemia–Quality of Life (AML-QOL) instrument showed IC of α = 0.72, correlations with EORTC QLQ-30 of magnitudes ρ = 0.59–0.72, and test-retest reliability of ICC = 0.52–0.91. Conclusion Although several QOL instruments have been validated, more research is needed to determine the most clinically useful instruments in patients with AML.
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Affiliation(s)
- Maribel Salas
- Epidemiology and Clinical Safety and Pharmacovigilance, Daiichi Sankyo, Inc., Basking Ridge, NJ, USA.,Centers for Clinical Epidemiology and Biostatistics and Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Mackenzie Henderson
- Epidemiology and Clinical Safety and Pharmacovigilance, Daiichi Sankyo, Inc., Basking Ridge, NJ, USA.,Rutgers Institute for Pharmaceutical Industry Fellowships, Rutgers University, Piscataway, NJ, United States
| | | | - Zahidul Islam
- Epidemiology and Clinical Safety and Pharmacovigilance, Daiichi Sankyo, Inc., Basking Ridge, NJ, USA
| | - Nora Tu
- Epidemiology and Clinical Safety and Pharmacovigilance, Daiichi Sankyo, Inc., Basking Ridge, NJ, USA
| | - Aikaterini Bilitou
- HEOR/RWE: Health Economics and Outcomes Research (HEOR)/Real-World Evidence (RWE), Market Access, DSE, Munich, Germany
| | - Maggie Elsharkawy
- Epidemiology and Clinical Safety and Pharmacovigilance, Daiichi Sankyo, Inc., Basking Ridge, NJ, USA
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Comparison of quality of life and health behaviors in survivors of acute leukemia and the general population. Ann Hematol 2019; 98:2357-2366. [PMID: 31338572 DOI: 10.1007/s00277-019-03760-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/12/2019] [Indexed: 10/26/2022]
Abstract
We aimed to compare the health-related quality of life and health behaviors of acute leukemia (AL) survivors with that of the general population from two cohorts. AL survivors (n = 149) completed a set of questionnaires to evaluate quality of life, mental status, and health behaviors. AL survivors had more physical and mental difficulties (problems with usual activities, 15% vs. 5%, p < 0.001; anxiety or depression, 24% vs. 9%, p < 0.001; pain, 35% vs. 20%, p = 0.002) and more financial difficulties (p < 0.001) than the general population. Survivors who received stem cell transplantation (SCT) had significantly worse problems with role functioning, fatigue, pain, dyspnea, and insomnia, and had higher depression scores than chemotherapy group (p = 0.024). In terms of health behaviors, AL survivors had lower rates of smoking and drinking and higher influenza vaccination rates than the general population. However, only 17% of survivors had been recommended to receive screening for other cancers from health-care providers, and 67% thought their risk for other cancers was equal or lower than that of the general population. Cancer screening rates were even lower in the SCT group than in the chemotherapy group (p = 0.041). Our study indicates that clinicians should establish more appropriate survivorship care plans.
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Kayastha N, Wolf SP, Locke SC, Samsa GP, El-Jawahri A, LeBlanc TW. The impact of remission status on patients' experiences with acute myeloid leukemia (AML): an exploratory analysis of longitudinal patient-reported outcomes data. Support Care Cancer 2018; 26:1437-1445. [PMID: 29151174 PMCID: PMC5921898 DOI: 10.1007/s00520-017-3973-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Shared decision-making in acute myeloid leukemia (AML) requires understanding patients' longitudinal experiences of illness, but little is known about the impact of remission status on patient-reported outcomes (PROs). We aimed to explore the association between remission status and PROs 6-12 months following induction chemotherapy. METHODS Forty-two patients completed three validated instruments characterizing symptom burden (Patient Care Monitor v2.0), distress (NCCN Distress Thermometer), and QOL (FACT-Leu), as part of a longitudinal observational study. We used regression models to explore the relationship between remission status and PROs, and explore differences by initial disease type (de novo versus secondary/relapsed AML). RESULTS Those with secondary or relapsed AML at study onset had marked impairments in all measures compared to de novo AML patients. After 6 months, their mean distress score was 4.8 (> 4.0 warrants intervention), they reported a mean of 14.1 moderate/severe symptoms and had a mean QOL score of 113.6, compared to 1.0, 1.7, and 155.2, respectively, for those with de novo AML (p < .0001). Similarly, patients in relapse had a mean distress score of 5.3, a mean of 12.8 moderate/severe symptoms, and a mean QOL score of 113.4, compared to 1.8, 5.7, and 143.8, respectively, among those in remission (p < .005). These patterns persisted after adjusting for baseline differences (p < .0001). CONCLUSION Remission is associated with markedly better patient well-being in AML. Patients with secondary or relapsed AML face more severe symptom burden, distress, and QOL issues after induction. Interventions are needed to improve AML patients' experiences of illness.
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Affiliation(s)
- Neha Kayastha
- Duke University School of Medicine, Box: DUMC 2927, Durham, NC, 27703, USA
| | - Steven P Wolf
- Duke Cancer Institute, Box: DUMC 2715, Durham, NC, 27710, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, 2424 Erwin Road, Suite 1102 Hock Plaza Box 2721, Durham, NC, 27710, USA
| | - Susan C Locke
- Duke Cancer Institute, Box: DUMC 2715, Durham, NC, 27710, USA
| | - Gregory P Samsa
- Duke Cancer Institute, Box: DUMC 2715, Durham, NC, 27710, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, 2424 Erwin Road, Suite 1102 Hock Plaza Box 2721, Durham, NC, 27710, USA
| | - Areej El-Jawahri
- Department of Hematology and Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 9E, Boston, MA, 02114, USA
| | - Thomas W LeBlanc
- Duke University School of Medicine, Box: DUMC 2927, Durham, NC, 27703, USA.
- Duke Cancer Institute, Box: DUMC 2715, Durham, NC, 27710, USA.
- Duke University School of Medicine, Box 2715, DUMC, Durham, NC, 27710, USA.
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7
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Deckert AL, Gheihman G, Nissim R, Chung C, Schimmer AD, Zimmermann C, Rodin G. The importance of meaningful activity in people living with acute myeloid leukemia. Leuk Res 2018; 67:86-91. [PMID: 29482172 DOI: 10.1016/j.leukres.2018.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/06/2018] [Accepted: 02/13/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The symptom burden of acute myeloid leukemia (AML) and its treatment can accelerate physical deconditioning and impair mobility and quality of life. In the present study, we explore the subjective experience of functional capacity in people living with AML. METHODS A secondary qualitative analysis was performed on a subset of interviews (n = 21) obtained from an observational cohort study of people with acute leukemia. Conventional content analysis was employed to identify key themes and concepts. RESULTS Participants valued their physical function to the extent that it was required to pursue personally meaningful activities and interests. We identified Meaningful Activity as an overarching goal of participants. Three interrelated themes captured the obstacles participants reported facing when attempting to realize this goal: Compromised Body, Threatened Identity, and Shrinking World. Adaptation was common across themes, representing the strategies employed to overcome such challenges. Themes were consistent across participants, despite the variability in disease states at the time of the interview. CONCLUSIONS Dynamic interactions between physical, psychological, and environmental factors affect the pursuit and achievement of meaningful activity among people living with AML. It may be important to consider personal incentives when designing interventions for physical rehabilitation in this patient population.
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Affiliation(s)
- Amy L Deckert
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, M5G 2M9, Canada; Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto and University Health Network, Toronto, Ontario, M5G 1Z6, Canada.
| | - Galina Gheihman
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, United States
| | - Rinat Nissim
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, M5G 2M9, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, M5T 1R8, Canada
| | - Cynthia Chung
- Department of Rehabilitation Services, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, M5G 2M9, Canada
| | - Aaron D Schimmer
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, M5G 2M9, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, M5G 1L7, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, M5G 2M9, Canada; Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto and University Health Network, Toronto, Ontario, M5G 1Z6, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, M5S 1A8, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, M5G 2M9, Canada; Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto and University Health Network, Toronto, Ontario, M5G 1Z6, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, M5T 1R8, Canada
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Lerch E, Espeli V, Zucca E, Leoncini L, Scali G, Mora O, Bordoni A, Cavalli F, Ghielmini M. Prognosis of Acute Myeloid Leukemia in the General Population: Data from Southern Switzerland. TUMORI JOURNAL 2018; 95:303-10. [DOI: 10.1177/030089160909500306] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background To evaluate the outcome of adult patients with de novo acute myeloid leukemia in the Italian-speaking part of Switzerland and to identify prognostic factors, time to progression and overall survival. Methods and study design Data of all adult patients diagnosed with acute myeloid leukemia from January 1984 to December 2003 were collected retrospectively. Univariate and multivariate analysis for time to progression and overall survival were performed. Results The incidence of acute myeloid leukemia in the adult population in southern Switzerland is 2.6/100,000 per year. Complete clinical and pathological data and follow-up information were available for 128 patients. The median age was 67 years (range, 18 to 94). The median follow-up was 97 months. Median overall survival was 6 months, with a 2-year overall survival of 16%. Median time to progression was 3 months. Thirty-five patients (median age, 80 years) were given best supportive care and/or palliative chemotherapy. The median survival in this subset was 2 months. Of the 93 patients treated with a curative intent, 48 were older than 60 years. The complete remission rate after induction chemotherapy was 80% for patients younger than 60 years and 31% for those older than 60 years (P <0.0001). Overall survival at 2 years was 40% and 12%, respectively (P <0.0005). The relapse rate was 61%, and only 28% of the patients who were given reinduction chemotherapy reached a second complete remission. Of the patients treated with curative intent, 52% were treated in a clinical trial. Their median age was significantly lower than those not included in a trial: 57 vs 66 years (P <00001). Patients treated in a trial had a significantly better prognosis than those not so treated (median survival, 12 vs 6 months). Patients treated with high-dose cytarabine as first-line therapy (given to 25 of 93 patients treated with a curative intent) had a better survival than those given standard cytarabine doses (P <0.0005). The outcome of the patients treated after 1993 was significantly better (P = 0.026) than that of the previously treated cohort. In multivariate analysis (not including cytogenetic data), only age (P = 0.005), performance status >1 (P = 0.001) and treatment given before/after 1993 (P = 0.044) were found to be independent prognostic factors for both overall survival and time to progression. Conclusions Most patients with acute myeloid leukemia are older than 60 years, and their outcome is still disappointing. For younger patients, the prognosis is better if they receive high-dose cytarabine as post-remission therapy and if they are treated in the setting of a clinical trial.
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Affiliation(s)
- Erika Lerch
- Istituto Oncologico della Svizzera Italiana (IOSI), Bellinzona, Switzerland
| | - Vittoria Espeli
- Istituto Oncologico della Svizzera Italiana (IOSI), Bellinzona, Switzerland
| | - Emanuele Zucca
- Istituto Oncologico della Svizzera Italiana (IOSI), Bellinzona, Switzerland
| | - Leda Leoncini
- Istituto Oncologico della Svizzera Italiana (IOSI), Bellinzona, Switzerland
| | | | - Oreste Mora
- Istituto Oncologico della Svizzera Italiana (IOSI), Bellinzona, Switzerland
| | - Andrea Bordoni
- Registro dei Tumori del Canton Ticino, Locarno, Switzerland
| | - Franco Cavalli
- Istituto Oncologico della Svizzera Italiana (IOSI), Bellinzona, Switzerland
| | - Michele Ghielmini
- Istituto Oncologico della Svizzera Italiana (IOSI), Bellinzona, Switzerland
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9
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Forsythe A, Brandt PS, Dolph M, Patel S, Rabe APJ, Tremblay G. Systematic review of health state utility values for acute myeloid leukemia. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:83-92. [PMID: 29416365 PMCID: PMC5790088 DOI: 10.2147/ceor.s153286] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Cost-utility analyses for acute myeloid leukemia (AML) require health state utility values (HSUVs) in order to calculate quality-adjusted life-years (QALYs) for each health state. Aim This study reviewed AML-related HSUVs that could be used in economic evaluation studies. Materials and methods EMBASE, MEDLINE, and Cochrane databases were searched from January 2000 to November 2016 for relevant studies that reported quality of life (QoL) and HSUVs in AML. Identified relevant European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 values were mapped to HSUVs. HSUVs for each health state in the AML treatment pathway were then collated. Results Ten relevant studies were identified. Six were cost-effectiveness analyses utilizing HSUVs for calculation of QALYs, one was an effectiveness analysis (incremental QALY), and two were QoL studies reporting AML-specific utilities. An additional study reported QoL for patients undergoing stem cell transplantation (SCT). Since no study reported HSUVs for relapse, values from a study of secondary AML patients who failed prior treatment for myelodysplastic syndrome were used. Where multiple HSUVs were available, collected values were given priority over assumed values. AML treatment (induction, consolidation, or SCT) was associated with decreased HSUV, while post-treatment complete remission led to increased HSUV. Conclusion There are some methodologically robust HSUVs that can be directly used in economic evaluations for AML. Careful interpretation is advised considering significant differences in methodologies and patient population (inclusion, size). We need to develop HSUVs with larger-sized studies, making greater use of condition-specific data.
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Affiliation(s)
| | | | | | - Sachin Patel
- Novartis Pharmaceuticals UK Limited, Frimley, Camberley, Surrey, UK
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10
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A Systematic Review of Psychometric Properties of Health-Related Quality-of-Life and Symptom Instruments in Adult Acute Leukemia Survivors. Cancer Nurs 2017; 39:375-82. [PMID: 26645111 DOI: 10.1097/ncc.0000000000000327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute leukemia represents 4% of cancer cases in the United States annually. There are more than 302 000 people living with acute and chronic leukemia in the United States. Treatment has been shown to have both positive and negative effects on health-related quality of life (HRQOL). OBJECTIVE The aims of this study were to examine psychometric properties of symptom and HRQOL instruments and to provide implications for the assessment in adults with acute leukemia relevant to clinical practice and future research. METHODS Systematic literature search was conducted from 1990 to 2014 using electronic databases and manual searches. Psychometric studies were considered eligible for inclusion if (1) the psychometric paper was published using at least 1 HRQOL or symptom instrument, and (2) adults with acute leukemia were included in the sample. Studies were excluded if the age groups were not adults, or if the instrument was in a language other than English. RESULTS Review identified a total of 7 instruments (1 cancer generic HRQOL, 2 symptom related, 3 HRQOL combined with symptom questions, and 1 disease specific). The most commonly used instrument was the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, followed by the Functional Assessment of Cancer Therapy-Fatigue. CONCLUSIONS An acute leukemia diagnosis can have a significant impact on HRQOL. Our recommendations include using both an HRQOL and symptom instrument to capture patient experiences during and after treatment. IMPLICATIONS FOR PRACTICE The availability of comprehensive, valid, and reliable HRQOL and symptom instruments to capture the experiences of adults with acute leukemia during and after treatment is limited.
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11
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Tomaszewski EL, Fickley CE, Maddux L, Krupnick R, Bahceci E, Paty J, van Nooten F. The Patient Perspective on Living with Acute Myeloid Leukemia. Oncol Ther 2016; 4:225-238. [PMID: 28261652 PMCID: PMC5315065 DOI: 10.1007/s40487-016-0029-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Acute myeloid leukemia (AML) imposes significant burden on patients, their families, and the healthcare system. Published literature has reported many AML signs and symptoms, as well as their impact on patients. However, there are no publications on the experience of living with AML from the patient's perspective. In this study, we performed qualitative interviews with patients with AML to understand their experience. METHODS Participants were recruited from the US and Japan. All patients were screened to assess eligibility, and were divided into four subgroups (i.e., newly-diagnosed, high-intensity chemotherapy; newly-diagnosed, low-intensity chemotherapy; relapse/refractory; and post-transplant). Patients were interviewed over the phone by a trained researcher and asked about their day-to-day experience with AML. Signs/symptoms and impacts were coded, analyzed using Atlas.ti software, and reported as frequencies, with the medians of patient-reported disturbance levels (0-10) computed for each symptom and impact. RESULTS The most commonly reported sign/symptom in the US was fatigue (95.7%), followed by bruising and weakness (both 78.3%), and in Japan, nausea (94.4%), followed by fatigue and headache (both 88.9%). The most commonly reported impact in the US was a decreased ability to maintain social/familial roles (91.3%), followed by anxiety and a decreased ability to function (both 87.0%), and most commonly reported in Japan was anxiety, a decreased ability to function, and remission uncertainty (94.4%). CONCLUSION Although the frequency of signs/symptoms and their level of disturbance varied between the US and Japan, there was remarkable consistency in the types of signs/symptoms and impacts reported across all patients. The consistency in the experience of the disease across patients suggests that measurement of AML experience can be achieved by using the same tool for most, if not all, of these patients. FUNDING Astellas Pharma Inc., Northbrook, IL, USA.
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Affiliation(s)
| | | | | | | | - Erkut Bahceci
- Astellas Pharma Global Development Inc, Northbrook, IL USA
| | | | - Floortje van Nooten
- Astellas Pharma Europe B.V., Leiden, The Netherlands ; Dompé Farmaceutici S.p.A., Milan, Italy
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12
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Timilshina N, Breunis H, Tomlinson G, Brandwein J, Alibhai SM. Do quality of life, physical function, or the Wheatley index at diagnosis predict 1-year mortality with intensive chemotherapy in older acute myeloid leukemia patients? Leuk Res 2016; 47:142-8. [DOI: 10.1016/j.leukres.2016.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 05/21/2016] [Accepted: 06/02/2016] [Indexed: 11/25/2022]
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13
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Møller T, Moser C, Adamsen L, Rugaard G, Jarden M, Bøtcher TS, Wiedenbein L, Kjeldsen L. Early warning and prevention of pneumonia in acute leukemia by patient education, spirometry, and positive expiratory pressure: A randomized controlled trial. Am J Hematol 2016; 91:271-6. [PMID: 26661344 PMCID: PMC5067626 DOI: 10.1002/ajh.24262] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 11/19/2015] [Accepted: 11/28/2015] [Indexed: 11/13/2022]
Abstract
Long‐lasting neutropenia associated with acute myeloid leukemia (AML) and its treatment gives rise to a high risk of pneumonia. The use of broad‐spectrum antibiotic prophylaxis during outpatient management has not completely protected patients against admission due to infections and neutropenic fever, emphasizing the need to approach infection protection with complementary efforts. In a randomized controlled design, we examined the applicability of patient‐performed daily spirometry [forced expiratory volume in one second (FEV1)] as an early warning tool and explored the effectiveness of positive expiratory pressure (PEP) in preventing pneumonia among 80 AML patients. Twenty‐five incidences of pneumonia were detected among 23 patients (6 interventions, 17 controls), giving a prevalence of 28.75% during 5420 days of observation. We found a significant difference in incidence between intervention versus control group (2.17 per 1000 days vs. 6.52 per 1000 days, P = 0.021, respectively). A cross point at 80‐76% of the personal FEV1 reference value showed high sensitivity and specificity on pneumonia development. Our data demonstrate the feasibility of educating AML patients in their continuous daily measurement of FEV1 and use of PEP. Daily measures of FEV1 may be an important early warning tool for assessment of pulmonary deterioration during critical phases of neutropenia. We suggest that strategic patient education in the use of spirometry and PEP should be part of standard of care for AML patients undergoing induction chemotherapy. Am. J. Hematol. 91:271–276, 2016. © 2015 The Authors. American Journal of Hematology Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Tom Møller
- University Hospitals Centre for Health Research (UCSF)Copenhagen Denmark
| | - Claus Moser
- Department of Clinical MicrobiologyCopenhagen University HospitalRigshospitalet Denmark
| | - Lis Adamsen
- University Hospitals Centre for Health Research (UCSF)Copenhagen Denmark
| | - Grith Rugaard
- University Hospitals Centre for Health Research (UCSF)Copenhagen Denmark
| | - Mary Jarden
- University Hospitals Centre for Health Research (UCSF)Copenhagen Denmark
| | - Tina S. Bøtcher
- Department of HaematologyCopenhagen University Hospital Herlev, Copenhagen Denmark
| | - Liza Wiedenbein
- University Hospitals Centre for Health Research (UCSF)Copenhagen Denmark
| | - Lars Kjeldsen
- Department of HaematologyCopenhagen University HospitalRigshospitalet Denmark
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14
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Leak Bryant A, Lee Walton A, Shaw-Kokot J, Mayer DK, Reeve BB. Patient-reported symptoms and quality of life
in adults with acute leukemia: a systematic review. Oncol Nurs Forum 2015; 42:E91-E101. [PMID: 25806895 DOI: 10.1188/15.onf.e91-e101] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES Systematically summarize findings from research conducted on adult acute leukemia survivors as they relate to symptoms and quality of life (QOL).
DATA SOURCES Systematic review of the literature from 1990–2013 found in the PubMed, PsycINFO®, EMBASE, and CINAHL® databases, as well as manual searches.
DATA SYNTHESIS The review identified 16 quantitative studies and 1 qualitative study published from 1990–2013 that used a self-reported QOL or symptom questionnaire. Fatigue was the most commonly assessed and reported symptom, followed by depression.
CONCLUSIONS Acute leukemia and its treatment have a significant impact in all QOL domains. Future studies should include longitudinal research, more than one recruitment site, increased minority representation, and home-based exercise interventions as ways to improve all domains of QOL.
IMPLICATIONS FOR NURSING This review increases awareness of commonly reported symptoms faced by adults with acute leukemia. Oncology nurses are central in monitoring and reporting symptoms to the interdisciplinary team that may contribute to changes in function, with the overall goal of optimizing QOL over time.
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Affiliation(s)
| | | | - Julia Shaw-Kokot
- User Services in the Health Sciences Library, University of North Carolina, Chapel Hill, NC
| | - Deborah K Mayer
- School of Nursing, University of North Carolina, Chapel Hill, NC
| | - Bryce B Reeve
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
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15
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Keep your mind off negative things: coping with long-term effects of acute myeloid leukemia (AML). Support Care Cancer 2015; 24:2035-2045. [PMID: 26542270 DOI: 10.1007/s00520-015-3002-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/26/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE OF STUDY Acute myeloid leukemia (AML) is characterized by sudden onset, intensive treatment, a poor prognosis, and significant relapse risk. Quality of life (QOL) and well-being among AML survivors have been extensively studied during the 6 months of active treatment. However, it is not clear what survivors experience after active treatment. The purpose of our study was to explore how AML survivors describe their longer-term physical and psychosocial well-being and how they cope with these challenges. METHODS We conducted a prospective qualitative study and interviewed 19 adult participants (11 had completed treatment, 8 were receiving maintenance chemotherapy). Data were collected using semi-structured interviews that were audio-recorded and transcribed verbatim. The grounded theory approach was used for data analysis. RESULTS A marked improvement in physical health was reported; however, psychosocial well-being was compromised by enduring emotional distress. A range of emotion- and problem-focused coping strategies were reported. Keeping one's mind off negative things through engaging in formal work or informal activities and seeking control were the two most commonly used coping strategies. Seeking social support for reassurance was also common. Problem-focused strategies were frequently described by the ongoing treatment group to manage treatment side effects. CONCLUSION Although physical symptoms improved after completion of treatment, psychosocial distress persisted over longer period of time. In addition, essential needs of AML survivors shifted across survivorship as psychological burden gradually displaced physical concerns. The integral role of coping mechanisms in the adaptation process suggests a need for effective and ongoing psychological interventions.
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16
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Alibhai SMH, Durbano S, Breunis H, Brandwein JM, Timilshina N, Tomlinson GA, Oh PI, Culos-Reed SN. A phase II exercise randomized controlled trial for patients with acute myeloid leukemia undergoing induction chemotherapy. Leuk Res 2015; 39:S0145-2126(15)30365-9. [PMID: 26350143 DOI: 10.1016/j.leukres.2015.08.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 07/17/2015] [Accepted: 08/22/2015] [Indexed: 01/29/2023]
Abstract
Curative treatment for acute myeloid leukemia (AML) involves induction chemotherapy (IC) which is associated with bed rest and toxicities, leading to worsening quality of life (QOL), fatigue, and fitness. Exercise during IC may ameliorate declines but has not been rigorously tested. We examined the efficacy of supervised exercise during IC on QOL, fatigue, and fitness. Eighty-three inpatients age 18-80 scheduled to receive IC for newly diagnosed or relapsed AML were randomized 2:1 (exercise intervention:control group). Study measures were completed at baseline, post-IC, and following the first cycle of consolidation. The intervention consisted of a supervised mixed-modality, moderate-intensity exercise program (4-5 days per week, 30-60min per session) throughout admission. Recruitment was good (56%), retention excellent (96%), and adherence was 54%. Global QOL improved similarly in both groups from baseline to post-IC (between-group difference 3.0 points, p=0.62). Fatigue improved in the exercise group from baseline to post-IC (potentially clinically important between-group difference of 3.6 points, p=0.23). Aerobic fitness, lower body strength, and grip strength improved in the exercise group (between-group differences p=0.005, p<0.001, p=0.03, respectively). Supervised exercise for patients with AML undergoing IC is feasible, safe, and appears effective at improving fitness and possibly fatigue. A larger trial is warranted.
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Affiliation(s)
- S M H Alibhai
- Department of Medicine, University Health Network, Toronto, Canada; Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - S Durbano
- Department of Medicine, University Health Network, Toronto, Canada
| | - H Breunis
- Department of Medicine, University Health Network, Toronto, Canada
| | - J M Brandwein
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - N Timilshina
- Department of Medicine, University Health Network, Toronto, Canada
| | - G A Tomlinson
- Department of Medicine, University Health Network, Toronto, Canada; Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Department of Public Health Sciences, University of Toronto, Toronto, Canada
| | - P I Oh
- The Cardiac Rehabilitation and Secondary Prevention Program, Toronto Rehabilitation Institute, Toronto, Canada
| | - S N Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
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17
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Cannella L, Caocci G, Jacobs M, Vignetti M, Mandelli F, Efficace F. Health-related quality of life and symptom assessment in randomized controlled trials of patients with leukemia and myelodysplastic syndromes: What have we learned? Crit Rev Oncol Hematol 2015; 96:542-54. [PMID: 26324461 DOI: 10.1016/j.critrevonc.2015.07.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 06/10/2015] [Accepted: 07/28/2015] [Indexed: 01/26/2023] Open
Abstract
Health-related quality of life (HRQOL) and other patient-reported outcomes (PROs) are crucial for a comprehensive evaluation of treatment effectiveness. A systematic review of randomized controlled trials (RCTs) with a PRO endpoint conducted in patients with leukemia and myelodysplastic syndromes (MDS) was performed. Eligible studies were evaluated independently, according to a pre-defined coding scheme, by two reviewers. Thirteen RCTs, enrolling overall 3380 patients were identified. There were four RCTs involving acute myeloid leukemia patients (AML), one with acute lymphoid leukemia (ALL), five with chronic lymphocytic leukemia (CLL) and three with MDS. Six RCTs accurately documented PRO methodology assessment and were thus considered likely to robustly inform clinical decision-making. Of these, three RCTs dealt with AML, two with CLL, one with MDS. A growing number of RCTs in leukemia and MDS have included a PRO component in recent years. Inclusion of PROs in RCTs is feasible and can provide unique information to facilitate clinical decision-making.
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Affiliation(s)
- Laura Cannella
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Giovanni Caocci
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - Marc Jacobs
- Academic Medical Center, University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
| | - Marco Vignetti
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Franco Mandelli
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Fabio Efficace
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy.
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18
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Alibhai SM, Breunis H, Timilshina N, Brignardello-Petersen R, Tomlinson G, Mohamedali H, Gupta V, Minden MD, Li M, Buckstein R, Brandwein JM. Quality of life and physical function in adults treated with intensive chemotherapy for acute myeloid leukemia improve over time independent of age. J Geriatr Oncol 2015; 6:262-71. [DOI: 10.1016/j.jgo.2015.04.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/09/2015] [Accepted: 04/09/2015] [Indexed: 12/27/2022]
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19
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Barre VP, Padmaja G, Saxena RK, Rana S. Impact of medical intervention on stress and quality of life in patients with cancer. Indian J Palliat Care 2015; 21:203-8. [PMID: 26009675 PMCID: PMC4441183 DOI: 10.4103/0973-1075.156503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Context: Many studies have explored stress and quality of life in (QOL) patients with cancer, under several phases of disease and treatment. However, the impact of medical intervention on psychological parameters, such as stress and quality of life focusing on psychological intervention has been sparsely studied. Aims: The main aim of the study was to examine the impact of medical intervention on the level of stress and quality of life of patients with lung, breast, and head and neck cancers. Settings and Design: The study was carried out in hospital settings by following a one-group pre-test-post-test pre-experimental design. Statistical analysis used: The quantitative data were analysed by means of descriptive statistics, paired t-tests, Cohen's d, and bar graphs accordingly. Results: The effect of medical intervention was medium in case of reduction of overall stress in participants. So far as the components are concerned, the effect was high in case of psychosomatic complaints, medium in case of fear and information deficit, and low in case of everyday life restrictions. The effect of medical intervention in respect of the quality of life was found to be high in case of symptom scale (pain) and additional symptoms (constipation); medium in case of functional scale (emotional functioning, cognitive functioning) and symptoms scale (nausea, vomiting). In additional symptoms scale the effect of medical intervention was found to be medium in dyspnoea and appetite loss. Conclusions: The findings revealed that though the medical intervention reduced stress and improved the quality of life, it was not instrumental in bringing down the stress to minimal level and enhancing the quality of life to optimum level. Therefore, the findings point to the need of inclusion of psychological intervention along with the medical intervention for minimizing stress and optimizing the quality of life of patients with cancer.
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Affiliation(s)
- Vijay Prasad Barre
- Department of Clinical Psychology, Dharwad Institute of Mental Health and Neurosciences, Dharwad, Karnataka, India
| | - Gadiraju Padmaja
- Centre for Health Psychology, University of Hyderabad, Central University, Gachibowli, Hyderabad, India
| | - Ravi Kumar Saxena
- Consultant Haematologist and Medical Oncologist, Global Hospital, Khairathabad, Telangana, Andhra Pradesh, India
| | - Suvashisa Rana
- Centre for Health Psychology, University of Hyderabad, Central University, Gachibowli, Hyderabad, India
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20
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Albrecht TA. Physiologic and psychological symptoms experienced by adults with acute leukemia: an integrative literature review. Oncol Nurs Forum 2014; 41:286-95. [PMID: 24769593 DOI: 10.1188/14.onf.286-295] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To evaluate the current knowledge of symptoms experienced by adults with acute leukemia (AL) and provide evidence to inform practice and research. DATA SOURCES Literature review using an electronic search supplemented by a hand search of current literature reporting the physiologic and/or psychological symptoms of patients with AL was conducted. DATA SYNTHESIS Because of the variability found in the methods and specific aims of the articles, a rating system was applied to score how strongly the findings contributed to meeting the aims of the research. This rating system was applied to assist the authors in analyzing the findings. Therefore, the articles that scored lower ultimately contributed less during the analysis phase. CONCLUSIONS Knowledge regarding the symptoms experienced by adults undergoing treatment is being slowly evaluated. However, to better understand and subsequently manage these symptoms, longitudinal research examining the symptom trajectories in this population is needed. IMPLICATIONS FOR NURSING Additional investigation into symptom characteristics will facilitate the development of tailored interventions to manage the temporal characteristics of symptoms for this population.
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Affiliation(s)
- Tara A Albrecht
- School of Nursing, Virginia Commonwealth University, Richmond
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21
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One day at a time: improving the patient experience during and after intensive chemotherapy for younger and older AML patients. Leuk Res 2014; 39:192-7. [PMID: 25541028 DOI: 10.1016/j.leukres.2014.11.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 11/21/2014] [Accepted: 11/28/2014] [Indexed: 11/21/2022]
Abstract
Few studies have focused on survivorship issues in AML patients that have successfully completed treatment, and no study examined age-related differences in survivorship. Therefore, our purpose was to explore the survivorship issues encountered by AML survivors, and explore if these survivorship issues are different for younger and older survivors. Lastly, we explored advice for future patients provided by younger and older AML survivors on how to survive the period of intensive chemotherapy (IC). We conducted a prospective qualitative study with 26 participants (14 younger (age 18-59), 12 older (age 60 or older)) who underwent IC. Data were analyzed using Grounded Theory. Both younger and older survivors reported persistent health issues and functional limitations; however, older participants were more satisfied with their post-treatment function and quality of life. Face-to-face communication, phase-specific information, step-by-step education, and home nursing care were important factors to cope with treatment. Provision of written educational material was highlighted by younger participants. Frequent travel to hospital and long waiting times were identified as undesirable. In conclusion, although we observed that many survivorship issues during and shortly after a diagnosis are similar among younger and older survivors, some issues differ by age, pointing out the need for customized approaches.
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22
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Cheng MJ, Hourigan CS, Smith TJ. Adult Acute Myeloid Leukemia Long-term Survivors. JOURNAL OF LEUKEMIA (LOS ANGELES, CALIF.) 2014; 2:26855. [PMID: 25243197 PMCID: PMC4167020 DOI: 10.4172/2329-6917.1000135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The number of leukemia patients and survivors is growing. This review summarizes what is known regarding the health related quality of life (HRQOL) and medical complications associated with acute myeloid leukemia (AML) disease and treatment and highlights understudied aspects of adult AML survivorship care, and potential novel areas for intervention.
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Affiliation(s)
- M Jennifer Cheng
- Pain and Palliative Service, Clinical Center, National Institutes of Health (MJC), National Heart, Lung, and Blood Institute, (CSH) and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland (TJS)
| | - Christopher S Hourigan
- Pain and Palliative Service, Clinical Center, National Institutes of Health (MJC), National Heart, Lung, and Blood Institute, (CSH) and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland (TJS)
| | - Thomas J Smith
- Pain and Palliative Service, Clinical Center, National Institutes of Health (MJC), National Heart, Lung, and Blood Institute, (CSH) and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland (TJS)
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23
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Alibhai SMH, O'Neill S, Fisher-Schlombs K, Breunis H, Timilshina N, Brandwein JM, Minden MD, Tomlinson GA, Culos-Reed SN. A pilot phase II RCT of a home-based exercise intervention for survivors of AML. Support Care Cancer 2013; 22:881-9. [PMID: 24240647 DOI: 10.1007/s00520-013-2044-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 10/28/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fatigue is the most common and disabling symptom affecting quality of life (QOL) and daily function in patients who have completed treatment for acute myeloid leukemia (AML). Although trials in patients with various solid tumors have reported improved fatigue and QOL following exercise interventions, there have been no studies in AML patients post treatment. METHODS Forty patients aged ≥ 40 years who had completed treatment for AML were enrolled in a 12-week randomized phase II exercise intervention to determine feasibility (recruitment, retention, and adherence), efficacy, and safety of the intervention. Patients assigned to the exercise group received an individualized, moderate-intensity, 12-week home-based exercise program with weekly telephone support from a certified exercise physiologist. QOL, fatigue, and fitness outcomes were measured at baseline, 6 weeks, and 12 weeks. Between-group differences in 12-week change scores were calculated using linear regression adjusting for age and baseline function. RESULTS Recruitment and retention rates were 38% and 91%, respectively. Adherence was low at 28%. Analyses did not suggest statistically significant or clinically important benefits in QOL, fatigue, or physical fitness with the intervention. The level of adherence did not appear to impact outcomes. There were no adverse events. CONCLUSION A home-based exercise program for post-treatment AML patients age 40 years or older can be safely delivered with reasonable recruitment and high retention. However, feasibility was hampered by low adherence. Further research and program modification are needed to better understand and overcome barriers to exercise delivery and adherence in AML survivors.
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24
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Koehler M, Koehler K, Koenigsmann M, Kreutzmann N, Fischer T, Frommer J. Beyond diagnosis: subjective theories of illness in adult patients with acute myeloid leukemia. Hematology 2013; 16:5-13. [DOI: 10.1179/102453311x12902908411599] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Michael Koehler
- Department of Hematology/OncologyUniversity Hospital of Magdeburg, Germany
| | - Katharina Koehler
- Department of Psychosomatic Medicine and PsychotherapyUniversity Hospital of Magdeburg, Germany
| | - Michael Koenigsmann
- Department of Hematology/OncologyUniversity Hospital of Magdeburg, Germany
- Specialty Practice for Hematology and OncologyHannover, Germany
| | - Nicole Kreutzmann
- Department of Hematology/OncologyUniversity Hospital of Magdeburg, Germany
| | - Thomas Fischer
- Department of Hematology/OncologyUniversity Hospital of Magdeburg, Germany
| | - Joerg Frommer
- Department of Psychosomatic Medicine and PsychotherapyUniversity Hospital of Magdeburg, Germany
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25
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Papadopoulou C, Johnston B, Themessl-Huber M. The experience of acute leukaemia in adult patients: A qualitative thematic synthesis. Eur J Oncol Nurs 2013; 17:640-8. [DOI: 10.1016/j.ejon.2013.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/24/2013] [Accepted: 06/27/2013] [Indexed: 10/26/2022]
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Sonneveld P, Verelst SG, Lewis P, Gray-Schopfer V, Hutchings A, Nixon A, Petrucci MT. Review of health-related quality of life data in multiple myeloma patients treated with novel agents. Leukemia 2013; 27:1959-69. [PMID: 23783393 PMCID: PMC3806249 DOI: 10.1038/leu.2013.185] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 06/11/2013] [Accepted: 06/12/2013] [Indexed: 01/09/2023]
Abstract
In multiple myeloma (MM), health-related quality of life (HRQoL) data is becoming increasingly important, owing to improved survival outcomes and the impact of treatment-related toxicity on HRQoL. Researchers are more frequently including HRQoL assessments in clinical trials, but analysis and reporting of this data has not been consistent. A systematic literature review assessed the effect of novel agents (thalidomide, bortezomib and lenalidomide) on HRQoL in MM patients, and evaluated the subsequent reporting of these HRQoL results. A relatively small body of literature addresses HRQoL data in MM patients treated with novel MM therapeutic agents: 9 manuscripts and 15 conference proceedings. The literature demonstrates the complementary value of HRQoL when assessing clinical response, progression, overall survival and toxicity. However, weaknesses and inconsistencies in analysis and presentation of HRQoL data were observed, often complicating interpretation of the impact of treatment on HRQoL in MM. Further evaluation of HRQoL in MM patients treated with novel agents is required in larger cohorts, and ideally in head-to-head comparative studies. Additionally, the development of standardised MM-specific best practice guidelines in HRQoL data collection and analysis is recommended. These would ensure that future data are more useful in guiding predictive models and clinical decisions.
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Affiliation(s)
- P Sonneveld
- Department of Hematology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - S G Verelst
- Department of Hematology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - P Lewis
- Celgene GmbH, Munich, Germany
| | | | | | - A Nixon
- Oxford Outcomes, an ICON plc. company, Oxford, UK
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Older age is associated with similar quality of life and physical function compared to younger age during intensive chemotherapy for acute myeloid leukemia. Leuk Res 2012; 36:1241-8. [DOI: 10.1016/j.leukres.2012.05.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 05/10/2012] [Accepted: 05/25/2012] [Indexed: 11/23/2022]
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28
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Alibhai SMH, O'Neill S, Fisher-Schlombs K, Breunis H, Brandwein JM, Timilshina N, Tomlinson GA, Klepin HD, Culos-Reed SN. A clinical trial of supervised exercise for adult inpatients with acute myeloid leukemia (AML) undergoing induction chemotherapy. Leuk Res 2012; 36:1255-61. [PMID: 22726923 DOI: 10.1016/j.leukres.2012.05.016] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 05/14/2012] [Accepted: 05/21/2012] [Indexed: 11/24/2022]
Abstract
Patients with acute myeloid leukemia (AML) receiving induction chemotherapy (IC) were enrolled in a supervised exercise intervention to determine safety, feasibility, and efficacy. Physical fitness measures, quality of life (QOL) and fatigue were assessed using standardized measures at baseline, post-induction, and post first consolidation. Retention was excellent, the intervention was safe, and efficacy estimates suggested benefits in physical fitness and QOL outcomes. Exercise is a safe, promising intervention for improving fitness and QOL in this patient population. These results provide a foundation for a randomized trial to better understand the impact of exercise during IC on clinically important outcomes.
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29
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Møller T, Adamsen L, Appel C, Welinder P, Stage M, Jarden M, Hjerming M, Kjeldsen L. Health related quality of life and impact of infectious comorbidity in outpatient management of patients with acute leukemia. Leuk Lymphoma 2012; 53:1896-904. [PMID: 22420948 DOI: 10.3109/10428194.2012.676169] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although survival has improved among patients with acute leukemia, there is still a considerable risk of severe complications throughout the course of treatment. This contrast increases the interest in monitoring health related quality of life (HRQOL) in these patients. This study presents a longitudinal HRQOL evaluation (European Organisation for Research and Treatment of Cancer core 30-item questionnaire; EORTC-QLQ C-30) and the impact of infectious comorbidity among 60 patients with leukemia (median age 47) treated in an outpatient management program at Copenhagen University Hospital. Significant improvement was seen on several HRQOL scores during follow-up. Explorative general linear models (GLMs) suggest that high cumulative severity of infectious comorbidity significantly reduces physical functioning and overall quality of life at treatment completion.
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Affiliation(s)
- Tom Møller
- UCSF, The University Hospital's Center for Nursing and Care Research, Copenhagen, Denmark.
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30
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Saini L, Alibhai SMH, Brandwein JM. Quality of life issues in elderly acute myeloid leukemia patients. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ahe.11.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The median age of acute myeloid leukemia (AML) is 70 years. Treatment approaches include standard chemotherapy, palliative chemotherapy and investigational agents, depending upon disease biology and patient factors. In this article, we highlight the issues involved in the treatment of AML in older patients, focusing on the quality of life changes associated with each treatment modality at different stages of their disease course. We further discuss recent insights into the biological basis of quality of life changes, and examine potential ways to improve these through pharmacological and nonpharmacological means. Finally, we explore avenues for future research into the quality of life of the older AML patient.
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Affiliation(s)
- Lalit Saini
- Department of Medical Oncology & Hematology, Princess Margaret Hospital, 610 University Avenue, Rm. 5–109, Toronto, ON M5G 2M9, Canada
| | - Shabbir MH Alibhai
- Department of Medicine, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada
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31
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Iversen PO, Ukrainchenko E, Afanasyev B, Hulbekkmo K, Choukah A, Gulbrandsen N, WislØff F, Tangen JM. Impaired nutritional status during intensive chemotherapy in Russian and Norwegian cohorts with acute myeloid leukemia. Leuk Lymphoma 2009; 49:1916-24. [DOI: 10.1080/10428190802339723] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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32
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Johnsen AT, Tholstrup D, Petersen MA, Pedersen L, Groenvold M. Health related quality of life in a nationally representative sample of haematological patients. Eur J Haematol 2009; 83:139-48. [PMID: 19284418 PMCID: PMC2730555 DOI: 10.1111/j.1600-0609.2009.01250.x] [Citation(s) in RCA: 159] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Knowledge of health related quality of life of haematological patients is limited. This study aimed at investigating the prevalence and predictors of symptoms and problems in a representative sample of haematological patients in Denmark. METHODS A random sample of patients with leukaemia, multiple myeloma and advanced lymphoma (n = 732) received the European Organisation for Research and Treatment of Cancer quality-of-life questionnaire (EORTC QLQ-C30). Mean scores were calculated. In addition, scores were dichotomised using two thresholds: patients reporting at least 'a little' of each EORTC QLQ-C30 symptom/problem were classified as having a 'symptom/problem', and patients reporting at least 'quite a bit' were classified as having a 'severe symptom/problem'. Multiple logistic regression was used to identify predictors. RESULTS In total, 470 (64%) patients participated. The most frequent symptoms/problems were fatigue (55%; severe 20%), reduced role function (49%; severe 23%), insomnia (46%; severe 15%), and pain (37%; severe 15%). Older patients and patients in active antineoplastic treatment had more symptoms and problems. There was only little evidence of social inequalities. CONCLUSION This is probably the first nationally representative study of symptoms and problems in haematological patients. These patients have symptoms/problems that deserve attention. Health related quality of life is an important issue in haematological malignancies.
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Affiliation(s)
- Anna T Johnsen
- Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen NV, Denmark.
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33
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Panju AH, Danesh A, Minden MD, Kelvin DJ, Alibhai SMH. Associations between quality of life, fatigue, and cytokine levels in patients aged 50+ with acute myeloid leukemia. Support Care Cancer 2008; 17:539-46. [DOI: 10.1007/s00520-008-0512-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 09/18/2008] [Indexed: 11/28/2022]
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34
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Pamuk GE, Harmandar F, Ermantaş N, Harmandar O, Turgut B, Demir M, Vural O. EORTC QLQ-C30 assessment in Turkish patients with hematological malignancies: association with anxiety and depression. Ann Hematol 2008; 87:305-10. [PMID: 18219486 DOI: 10.1007/s00277-008-0445-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Accepted: 02/26/2007] [Indexed: 01/23/2023]
Abstract
We aimed to evaluate the prevalences of self-reported anxiety and depression symptoms in hematological malignancy patients and to determine the association between the presence of these disorders and the results of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-30 (EORTC QLQ-C30). One hundred and forty patients with a diagnosis of a hematological malignancy completed the Hospital Anxiety and Depression Scale (HADS) and the General Health Questionnaire. Patients with higher anxiety scores were more frequently inpatients, had higher EORTC general symptom scores, and they had lower cognitive, emotional, social functioning and global quality of life (QoL) scores (all p values <0.05). Patients with higher depression scores had more frequently active disease and were inpatients; they had higher mean Eastern Cooperative Oncology Group performance scores, EORTC gastrointestinal system and general symptom scores, and significantly lower physical, role, emotional, social and cognitive functioning and global QoL scores (all p values <0.01). During follow-up, it was observed that survival curves of patients with active disease who had higher HADS depression scores tended to be shorter than those with lower scores (p = 0.1). Anxiety and depression are frequent in hematological malignancy patients and associated with poor QoL and performance status. In addition, the presence of self-reported depression might have a predictive value for poor prognosis.
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Affiliation(s)
- Gülsüm Emel Pamuk
- Division of Hematology, Trakya University Medical Faculty, Edirne, Turkey.
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35
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Alibhai SMH, Leach M, Kermalli H, Gupta V, Kowgier ME, Tomlinson GA, Brandwein J, Buckstein R, Minden MD. The impact of acute myeloid leukemia and its treatment on quality of life and functional status in older adults. Crit Rev Oncol Hematol 2007; 64:19-30. [PMID: 17765568 DOI: 10.1016/j.critrevonc.2007.07.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Revised: 06/28/2007] [Accepted: 07/04/2007] [Indexed: 11/15/2022] Open
Abstract
Although intensive chemotherapy (IC) may modestly improve survival compared to supportive care in older people with acute myeloid leukemia (AML), treatment may worsen quality of life (QOL) and functional status. We assessed QOL and functional status at baseline, 1 month, 4 months, and 6 months in 65 consecutive, English-speaking, patients age 60 or older with newly diagnosed AML. At baseline, functional status was high but QOL was negatively affected in global health and most QOL domains. Over time, QOL remained stable or improved in most patients and was generally similar between IC and non-IC groups. Basic activities of daily living (ADL) scores did not change over time, whereas instrumental ADL scores declined slightly regardless of treatment. Receiving IC does not appear to lead to worse QOL or functional status than more palliative approaches. This information may aid treatment discussions in older patients with AML.
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36
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Burns DS, Azzouz F, Sledge R, Rutledge C, Hincher K, Monahan PO, Cripe LD. Music imagery for adults with acute leukemia in protective environments: a feasibility study. Support Care Cancer 2007; 16:507-13. [PMID: 17891547 DOI: 10.1007/s00520-007-0330-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Accepted: 08/21/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients receiving intensive chemotherapy can experience increased distressed related to both the cancer diagnosis and treatment isolation. If not addressed, distress can lead to anxiety, depression, and post-traumatic stress disorder. The purpose of this study was to determine the feasibility and possible benefits of a music imagery intervention for patients hospitalized in a protective environment for the treatment of acute leukemia or high-grade non-Hodgkin's lymphoma. MATERIALS AND METHODS Adults receiving intensive myelosuppressive chemotherapy in a protective environment were randomized to standard care or standard care plus music imagery. The music imagery sessions occurred twice weekly for up to eight sessions. Patients were encouraged to use the music imagery daily. RESULTS The principal criteria of feasibility were rate of consent, rate of completion of scheduled sessions, and rate of questionnaire completion. Forty-nine out of 78 patients consented, a 63% consent rate. Seventy-two percent of all scheduled music imagery sessions were completed. The rate of questionnaire completion was 60% with missing data because of illness severity and early discharge. The principal outcomes of benefit (e.g., efficacy) were positive and negative affects, fatigue, and anxiety. Both groups improved over time on all outcomes (all p < 0.001). However, a subgroup of individuals with low baseline negative affect who received the intervention reported significantly less anxiety at discharge than individuals with low baseline negative affect who did not receive the intervention. CONCLUSIONS Music imagery is feasible for adults with acute leukemia in protected environments. Patients with lower initial distress may benefit from a music imagery program in terms of reduced anxiety at discharge.
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Affiliation(s)
- Debra S Burns
- Indiana University School of Music, Indianapolis, IN 46202, USA.
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37
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Koenigsmann M, Koehler K, Regner A, Franke A, Frommer J. Facing mortality: A qualitative in-depth interview study on illness perception, lay theories and coping strategies of adult patients with acute leukemia 1 week after diagnosis. Leuk Res 2006; 30:1127-34. [PMID: 16458356 DOI: 10.1016/j.leukres.2005.12.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Revised: 12/21/2005] [Accepted: 12/23/2005] [Indexed: 11/25/2022]
Abstract
In patients with acute leukemia we investigated the illness perceptions, lay theories and coping strategies 1 week after diagnosis. Semi-structured in-depth interviews were conducted with 12 patients. The transcribed interviews were analyzed by methods of qualitative research. Dramatic narrations of overwhelming threat in younger patients contrast to rationalization in elderly patients. Feelings of helplessness and efforts of normalization become apparent. Intense descriptions of physical injury due to invasive procedures allow verbalizing the fear of the disease. While coping strategies are complex, the overall importance of trust is recognized. Mortal fears are indirectly indicated. The results have consequences for psycho-oncological training and patient education.
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Affiliation(s)
- Michael Koenigsmann
- Department of Hematology/Oncology, Medical Faculty of the Otto-von-Guericke-University, Leipziger Str. 44, 39120 Magdeburg, Germany.
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38
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Koenigsmann M, Koehler M, Franke A, Frommer J. Acute leukaemia in adults: researching the patient's perspective. Leukemia 2006; 20:206-7. [PMID: 16270040 DOI: 10.1038/sj.leu.2404005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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39
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Büchner T, Berdel WE, Wörmann B, Schoch C, Haferlach T, Schnittger S, Kern W, Aul C, Lengfelder E, Schumacher A, Reichle A, Staib P, Balleisen L, Eimermacher H, Grüneisen A, Rasche H, Sauerland MC, Heinecke A, Mesters RM, Serve HL, Kienast J, Hiddemann W. Treatment of older patients with AML. Crit Rev Oncol Hematol 2005; 56:247-59. [PMID: 16246568 DOI: 10.1016/j.critrevonc.2004.09.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2004] [Revised: 08/30/2004] [Accepted: 09/24/2004] [Indexed: 11/12/2022] Open
Abstract
Undertreatment of the older patients with AML can explain, in part, their inferior outcome when compared with that in younger patients. In analogy to the benefit of patients under the age of 60 years from high-dose AraC there are dosage related therapeutic effects in the patients over 60 years in particular for daunorubicin in the induction treatment, and for maintenance versus no maintenance in the post-remission treatment. Utilizing these effects can partly overcome the mostly unfavorable disease biology in older age AML, whereas the role of risk factors involved is not completely understood and the concept of dose-response needs to be requestioned. We recommend an adequate dosage of 60 mg/(m2day) daunorubicin for 3 days in a combination with standard dose AraC and 6-thioguanine given for induction and consolidation and followed by a prolonged monthly maintenance chemotherapy. Further improvements in supportive care may help delivering additional anti-leukemic cytotoxicity. As a novel approach, reduced toxicity preparative regimens may open up allogeneic transplantation for older patients with AML. Other new options like MDR modulators, antibody targeted therapies and tyrosine kinase inhibitors are under clinical investigation. A questionnaire study in patients with AML showed that according to patients' self-assessment intensive and prolonged treatment did not result in decreasing quality of life. This finding did not vary by age under or above 60 years. Given the actual median age in this disease being more than 60 years the adequate management of older age AML remains as the major challenge.
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Affiliation(s)
- Thomas Büchner
- University Hospital, Department of Medicine, Hematology and Oncology, Albert-Schweitzer-Str. 33, D-48129 Münster, Germany.
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40
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Abstract
It will be shown, through the presentation of recent research findings, that haematology is a neglected area in terms of sensitive care of the dying. The Australian evidence indicates that scant progress has been made in relation to even the most basic palliative care practices such as sensitive, honest information giving or appropriate referral to the palliative system. Rather, the data show that during terminal trajectory, patients from these diagnostic groups and their families remain trapped in processes within the high-tech, curative system that are not responsive to the needs of the dying.
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Affiliation(s)
- Pam McGrath
- School of History, Philosophy, Religion and Classics, University of Queensland, St. Lucia Q 4072, Australia.
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41
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Redaelli A, Stephens JM, Brandt S, Botteman MF, Pashos CL. Short- and long-term effects of acute myeloid leukemia on patient health-related quality of life. Cancer Treat Rev 2004; 30:103-17. [PMID: 14766128 DOI: 10.1016/s0305-7372(03)00142-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Patients with acute myeloid leukemia (AML) may receive aggressive therapies (e.g., chemotherapy and bone marrow transplantation (BMT)) that are thought to significantly affect HRQL. Therefore, the goal of this study was to assess the HRQL impact on patients of AML and its treatments. MATERIALS AND METHODS An electronically assisted literature survey and synthesis was conducted of English-language literature published worldwide between 1990 and 2002. The review was enhanced by inclusion of articles, including those published before 1990, which were manually identified from the bibliographies of the electronically identified publications. Articles were analyzed with respect to HRQL instruments used, HRQL domains assessed, aspects of disease and treatment evaluated, and outcomes observed. RESULTS The survey identified 21 articles that warranted review. AML and associated treatments have a substantial negative impact on patient HRQL as has been measured by several different leukemia-specific, cancer-specific and generic instruments. The most negative HRQL burden is apparent soon after the diagnosis of the disease and during the course of therapy. Long-term survivors appear to recover HRQL almost completely with respect to physical, psychological and emotional well being, but incur continued sexual dysfunction. CONCLUSION Clinicians responsible for the care of patients with AML should be aware of the HRQL impact of the disease and its treatment, in the long-term as well as the short-term. Researchers should evaluate the HRQL impact of new and investigational therapies.
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Affiliation(s)
- Alberto Redaelli
- Global Outcomes Research-Oncology, Pharmacia Corporation, Via Robert Koch 1.2, Milan 20152, Italy.
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42
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Redaelli A, Stephens JM, Laskin BL, Pashos CL, Botteman MF. The burden and outcomes associated with four leukemias: AML, ALL, CLL and CML. Expert Rev Anticancer Ther 2003; 3:311-29. [PMID: 12820775 DOI: 10.1586/14737140.3.3.311] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Given the recent advances in the treatment of hematologic malignancies and the many other treatments on the horizon, physicians and payers will be faced with the critical decisions of when to use new treatments in the clinical pathway and how to allocate healthcare resources. This review will provide an overall context for the clinical, economic and quality of life burden of leukemia, as well as provide cross-analysis among the four major types of leukemia: acute lymphocytic leukemia, chronic lymphocytic leukemia, acute myeloid leukemia and chronic myeloid leukemia.
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MESH Headings
- Animals
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology
- Leukemia, Lymphocytic, Chronic, B-Cell/psychology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Leukemia, Lymphoid/epidemiology
- Leukemia, Lymphoid/psychology
- Leukemia, Lymphoid/therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/psychology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukemia, Myeloid/epidemiology
- Leukemia, Myeloid/psychology
- Leukemia, Myeloid/therapy
- Leukemia, Myeloid, Acute/epidemiology
- Leukemia, Myeloid, Acute/psychology
- Leukemia, Myeloid, Acute/therapy
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/epidemiology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/psychology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Quality of Life/psychology
- Treatment Outcome
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43
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Montgomery C, Pocock M, Titley K, Lloyd K. Individual quality of life in patients with leukaemia and lymphoma. Psychooncology 2002; 11:239-43. [PMID: 12112484 DOI: 10.1002/pon.557] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
With increasingly sophisticated chemotherapy regimes being prescribed the quality of life of cancer patients has become a key outcome measure. Little has been reported concerning the experience of patients with haematological malignancy receiving chemotherapy. The objective of this study was to evaluate the clinical usefulness of a novel quality of life measure-the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW) in a sample of patients with either leukaemia or lymphoma. Fifty-one patients from the haematology clinic and in-patient unit at The Royal Devon and Exeter Hospital completed the SEIQoL-DW; in addition, each patient completed the Hospital Anxiety and Depression Scale (HADS) and a ten item questionnaire covering aspects of their treatment and satisfaction with information provided. The practical application of the SEIQoL-DW is described and two patients quality of life profiles are illustrated for comparison. The relationship between quality of life, satisfaction with information provided and psychological distress as measured by the HADS is discussed.
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Affiliation(s)
- Charles Montgomery
- Department of Mental Health, University of Exeter, Wonford House Hospital, Exeter, UK.
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44
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Schumacher A, Wewers D, Heinecke A, Sauerland C, Koch OM, van de Loo J, Büchner T, Berdel WE. Fatigue as an important aspect of quality of life in patients with acute myeloid leukemia. Leuk Res 2002; 26:355-62. [PMID: 11839378 DOI: 10.1016/s0145-2126(01)00145-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Quality of life (QL) was evaluated in 101 patients with AML undergoing intensive and prolonged treatment at 12 sequential time points by using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C 30 questionnaire and the profile of mood states scale (POMS). For those patients having completed the course of inpatient treatment (n=37), QL improved from the beginning of chemotherapy to the end of inpatient treatment. Patients who subsequently went off protocol did not differ significantly in their self-assessed QL when compared with patients who completed therapy. Fatigue was more closely related to QL than nausea/emesis or appetite loss, but did not correlate with hemoglobin levels.
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Affiliation(s)
- Andrea Schumacher
- Department of Medicine/Hematology and Oncology, University of Münster, Germany.
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45
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Büchner T, Hiddemann W, Berdel W, Wörmann B, Schoch C, Löffler H, Haferlach T, Schumacher A, Staib P, Balleisen L, Grüneisen A, Rasche H, Aul C, Heyll A, Lengfelder E, Ludwig WD, Maschmeyer G, Eimermacher H, Karow J, Frickhofen N, Hirschmann WD, Sauerland MC. Acute myeloid leukemia: treatment over 60. REVIEWS IN CLINICAL AND EXPERIMENTAL HEMATOLOGY 2002; 6:46-59; discussion 86-7. [PMID: 12060483 DOI: 10.1046/j.1468-0734.2002.00059.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Undertreatment of older patients with acute myeloid leukemia (AML) can explain, in part, their inferior outcome when compared to that of younger patients. In agreement with the benefit seen by patients under age 60 from high-dose cytosine arabinoside (Ara-C), there are dose effects in the over 60s, in particular for daunorubicin, in induction treatment and for the duration of postremission treatment. The use of these effects can partly overcome the mostly unfavorable disease biology in older age AML, as expressed by the absence of favorable and the over-representation of adverse chromosomal abnormalities as well as the expression of drug resistance. We recommend an adequate dosage of 60 mg/m2 daunorubicin on 3 days in combination with standard dose Ara-C and 6-thioguanine given for induction and consolidation, and followed by a prolonged monthly maintenance chemotherapy for at least 1 year's duration. Further improvements in supportive care may help to deliver additional antileukemic cytotoxicity. As a novel approach, nonmyeloablative preparative regimens may open up the possibility of allogeneic transplantation for older patients with AML. Other new options like multidrug resistance modulators, antibody targeted therapies and molecular targeting are under clinical investigation. A questionnaire study in patients with AML showed that, according to patients' self-assessment, intensive and prolonged treatment did not result in a diminished quality of life. This finding did not vary by age, under or over 60 years. As the median age in this disease is more than 60 years, the adequate management of AML in older patients remains the major challenge.
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Affiliation(s)
- Thomas Büchner
- University of Münster, Department of Medicine, Hematology and Oncology, Germany.
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McGrath P. Qualitative findings on the experience of end-of-life care for hematological malignancies. Am J Hosp Palliat Care 2002; 19:103-11. [PMID: 11926440 DOI: 10.1177/104990910201900208] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There is a loud silence in the literature on the issues related to palliative care for hematological malignancies. This article presents information that begins to address that silence. The limited research that is available indicates that, to date, patients with a hematological malignancy and their families received scant attention with regards to the provision of palliative care. The findings presented in this article demonstrates that families are enduring considerable hardship and are left with much emotional pain and many unresolved issues when such care is not offered. It is hoped that the findings presented in this article will be used for developing effective strategies to ensure that patients with hematological malignancies and their families, no less than any others, can be afforded the dignity and respect that the appropriate provision of palliative services ensures.
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Affiliation(s)
- Pam McGrath
- Leukemia Foundation's PsychoSocial Research Program, University of Queensland, St. Lucia, Australia
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Abstract
It is increasingly acknowledged in the research literature that palliative care is not offered to patients with a hematologic malignancy. The evidence indicates that patients are not dying at home or in the comfort of the hospice setting but are more likely to end up in the high-tech care of an intensive care unit. The holistic, compassionate care of the hospice/palliative care philosophy is not routinely made available to either these patients or the families who care for them. However, little is known about what the end-of-life experience is for such patients and their families and how they are managing to negotiate their dying experience in a system that is designed to cure not to palliate. In particular, there is a dearth of information on what happens to the caregivers during what is characteristically a prolonged and difficult period of sustained caring within the high-tech system. This discussion presents findings from recent research that is beginning to document the experience of the dying trajectory for patients from these diagnostic groups and their families. The hope and expectation from such research is that the information will make a contribution to building multidisciplinary plans of care for hematologic malignancies during the dying trajectory, to ensure that patients and their families are appropriately referred to the palliative system or, at least, are given sensitive palliative care within the curative system.
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Affiliation(s)
- P McGrath
- School of History, Philosophy, Religion and Classics, University of Queensland, St Lucia Old, Australia.
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