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Fifer S, Godsell J, Opat S, Hamad N, Lasica M, Forsyth C, Morand L, Smeaton E, Winton S, Puig A, McGeachie M. Understanding the experience, treatment preferences and goals of people living with chronic lymphocytic leukemia (CLL) in Australia. BMC Cancer 2024; 24:831. [PMID: 38992616 PMCID: PMC11241996 DOI: 10.1186/s12885-024-12589-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/02/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Listening to patient voices is critical, in terms of how people experience their condition as well as their treatment preferences. This research explored the patient journey, therapy attributes and goals among treatment experienced adults with chronic lymphocytic leukemia (CLL). We sought to understand patient experiences, needs and expectations to identify areas for improvement of treatment and care delivery. METHODS Two online surveys were developed for completion by CLL patients. In Stage 1, participants completed a best-worst scaling (BWS) task to evaluate eleven previously validated healthcare journey moments that matter (MTM). Responses were used to generate the patient experience index (PEI) score. In Stage 2, participants completed a survey that included both a discrete choice experiment (DCE) to assess drivers of treatment preferences by evaluating the relative attribute importance (RAI) of seven features and a BWS exercise which explored long-term treatment goals. RESULTS Twenty-five patients completed Stage 1 and thirty patients Stage 2. Treatment experience was balanced between oral and intravenous medication. The most important/least satisfied MTM were treatment effectiveness, access to support and other treatments as well as monitoring progress. The median PEI score was 66.2 (out of 100). DCE results demonstrated that patients most value treatments for CLL that are associated with prolonged progression free survival (PFS; RAI: 24.6%), followed by treatments that have a lower risk of severe side effects and lower out-of-pocket costs (RAI: 19.5%, 17.4%, respectively). The remainder of the weight in decision making (38.5%) was split between the remaining attributes, namely 'mild to moderate side effects' (13.4%), 'long-term risks' (12.2%), type of treatment (i.e., oral, IV or a combination of oral and IV; 8.7%) and treatment duration (i.e., ongoing versus fixed; 4.2%). Patients preferred oral to intravenous therapy. The most valued long-term treatment goal was to be physically healthy, followed by living a long life, spending time with family/friends, and avoiding hospitalization. CONCLUSION Treatment experienced patients with CLL are focused on receiving effective, safe therapies and value long PFS. Consideration and discussion of other attributes, such as once daily dosing, oral only medication, out-of-pocket costs and access to support services may affect patient treatment choices and ultimately enhance their healthcare experience and outcomes.
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Affiliation(s)
- Simon Fifer
- Community and Patient Preference Research (CaPPRe), Level 20, 50 Bligh Street, Sydney, NSW, 2000, Australia
| | - Jenni Godsell
- Community and Patient Preference Research (CaPPRe), Level 20, 50 Bligh Street, Sydney, NSW, 2000, Australia
| | - Stephen Opat
- Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital Sydney, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, High St, Kensington, NSW, 2052, Australia
- School of Medicine, University of Notre Dame Sydney, 160 Oxford St, Darlinghurst, NSW, 2010, Australia
| | - Masa Lasica
- St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Cecily Forsyth
- Central Coast Haematology, 14 - 18 Jarrett Street, Gosford, NSW, 2250, Australia
| | - Louisa Morand
- Central Coast Haematology, 14 - 18 Jarrett Street, Gosford, NSW, 2250, Australia
| | - Erica Smeaton
- Lymphoma Australia, PO Box 676, Fortitude Valley, QLD, 4006, Australia
| | - Sharon Winton
- Lymphoma Australia, PO Box 676, Fortitude Valley, QLD, 4006, Australia
| | - Andrea Puig
- Johnson and Johnson, 66 Waterloo Road, Macquarie Park, NSW, 2113, Australia.
| | - Marija McGeachie
- Johnson and Johnson, 66 Waterloo Road, Macquarie Park, NSW, 2113, Australia
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Baggio D, Chung E, Wellard C, Waters N, Cushion T, Chong G, Cochrane T, Cull G, Giri P, Hamad N, Johnston A, Lee D, Murali A, Morgan S, Mulligan S, Talaulikar D, Ratnasingam S, Wood E, Hawkes E, Opat S. Australians with chronic lymphocytic leukaemia continue to have high rates of second primary malignancies in the modern era. Intern Med J 2024; 54:1223-1227. [PMID: 38973146 DOI: 10.1111/imj.16445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/26/2024] [Indexed: 07/09/2024]
Abstract
Population-based studies have demonstrated a high risk of second cancers, especially of the skin, among patients with chronic lymphocytic leukaemia (CLL). We describe age-standardised incidence ratios (SIRs) of second primary malignancies (SPM) in Australian patients with relapsed/refractory CLL treated with at least two lines of therapy, including ibrutinib. From December 2014 to November 2017, 156 patients were identified from 13 sites enrolled in the Australasian Lymphoma and Related Diseases Registry, and 111 had follow-up data on rates of SPM. At 38.4 months from ibrutinib therapy commencement, 25% experienced any SPM. SIR for melanoma and all cancers (excluding nonmelanomatous skin cancers) were 15.8 (95% confidence interval (CI): 7.0-35.3) and 4.6 (95% CI: 3.1-6.9) respectively. These data highlight the importance of primary preventive interventions and surveillance, particularly as survival from CLL continues to improve.
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Affiliation(s)
- Diva Baggio
- Olivia Newton-John Cancer Research and Wellness Centre, Austin Health, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - Eliza Chung
- Monash University, Melbourne, Victoria, Australia
| | | | - Neil Waters
- Monash University, Melbourne, Victoria, Australia
| | - Tania Cushion
- Olivia Newton-John Cancer Research and Wellness Centre, Austin Health, Melbourne, Victoria, Australia
| | - Geoffrey Chong
- Ballarat Regional Integrated Cancer Centre, Ballarat, Victoria, Australia
| | - Tara Cochrane
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Gavin Cull
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Pratyush Giri
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Nada Hamad
- St Vincent's Health, Sydney, New South Wales, Australia
| | - Anna Johnston
- Royal Hobart Hospital, Hobart, Tasmania, Australia
- University of Tasmania, Hobart, Tasmania, Australia
| | - Denise Lee
- Eastern Health, Melbourne, Victoria, Australia
| | - Aarya Murali
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | | | - Dipti Talaulikar
- Canberra Health Services, Australian National University, Canberra, Australian Capital Territory, Australia
| | | | - Erica Wood
- Monash University, Melbourne, Victoria, Australia
| | - Eliza Hawkes
- Olivia Newton-John Cancer Research and Wellness Centre, Austin Health, Melbourne, Victoria, Australia
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Omura J, Makanji Y, Tanabe N, Yu DY, Tan JY, Lim S, Kouhkamari MH, Casorso J, Wu DBC, Bloomfield P. Comparative Treatment Persistence and Adherence to Endothelin Receptor Antagonists Among Patients with Pulmonary Arterial Hypertension in Japan: A Real-World Administrative Claims Database Study. Pulm Ther 2023; 9:511-526. [PMID: 37991630 PMCID: PMC10721767 DOI: 10.1007/s41030-023-00244-w] [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: 08/30/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Real-world data on the comparative effectiveness of endothelin receptor antagonists (ERAs; macitentan, bosentan, ambrisentan) for pulmonary arterial hypertension (PAH), particularly in Asian countries, are scarce. We evaluated the persistence of these ERAs before and after macitentan approval in Japan (2015). METHODS We used real-world data from the Japanese Medical Data Vision administrative claims database between April 2008 and November 2020. Patients with PAH were identified from the dataset. Persistence to ERA treatment before and after approval of macitentan in Japan was defined as the time between start of the index ERA and treatment discontinuation or death. Propensity score adjustment was applied to minimize confounding effects among treatment groups. RESULTS In the pre-macitentan approval cohort, 153 and 51 patients received bosentan and ambrisentan, respectively. In the post-macitentan approval cohort, 331, 284, and 91 patients received macitentan, bosentan, and ambrisentan, respectively. Unadjusted median persistence for ambrisentan- and bosentan-treated patients was 19 and 10 months, respectively (adjusted HR 0.87 [95% CI 0.61-1.24]; P = 0.434 [bosentan as reference]). In the post-macitentan approval cohort, unadjusted median persistence was 18 months for macitentan-treated patients versus 6 and 8 months for ambrisentan- and bosentan-treated patients, respectively. Adjusted HRs for ambrisentan and bosentan were 1.48 (95% CI 1.12-1.95; P = 0.006) and 1.63 (95% CI 1.30-2.04; P < 0.001 [macitentan as reference]), respectively. CONCLUSIONS Real-world data for Japanese patients with PAH showed that persistence was significantly higher for macitentan, versus ambrisentan and bosentan, since its approval.
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Affiliation(s)
| | - Yogeshwar Makanji
- Janssen Pharmaceutical Asia Pacific, 2 Science Park Dr, #07-13, Singapore, 118882, Singapore.
| | - Nobuhiro Tanabe
- Pulmonary Hypertension Center, Chibaken Saiseikai Narshino Hospital, Chiba, Japan
| | - Dae Young Yu
- Janssen Pharmaceutical Asia Pacific, 2 Science Park Dr, #07-13, Singapore, 118882, Singapore
| | - Jin Yu Tan
- Janssen Pharmaceutical Asia Pacific, 2 Science Park Dr, #07-13, Singapore, 118882, Singapore
| | | | | | | | - David Bin-Chia Wu
- Janssen Pharmaceutical Asia Pacific, 2 Science Park Dr, #07-13, Singapore, 118882, Singapore
| | - Paul Bloomfield
- Janssen Pharmaceutical Asia Pacific, 2 Science Park Dr, #07-13, Singapore, 118882, Singapore
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Salvaris R, Mulligan S, Puig A, McGeachie M, Opat S. Australian data on the utilisation and duration on treatment of ibrutinib with a proton pump inhibitor in patients with relapsed or refractory chronic lymphocytic leukaemia. Intern Med J 2023; 53:2115-2118. [PMID: 37950615 DOI: 10.1111/imj.16267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/20/2023] [Indexed: 11/13/2023]
Abstract
In Australia, over half of patients with relapsed/refractory chronic lymphocytic leukaemia treated with ibrutinib use concomitant proton pump inhibitors (PPIs). High gastric pH reduces the bioavailability of some Bruton tyrosine kinase inhibitors. There was no difference in duration on ibrutinib with or without concomitant PPI (unadjusted P = 0.61; adjusted hazard ratio: 1.23, 95% confidence interval: 0.75-2.02, P = 0.411). PPI use does not affect ibrutinib treatment persistence.
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Affiliation(s)
- Ross Salvaris
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
- Monash University, Melbourne, Victoria, Australia
| | | | - Andrea Puig
- Janssen-Cilag Pty Ltd, Sydney, New South Wales, Australia
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Mulligan SP, Opat S, Cheah CY, Kuss B, Hertzberg M, Marlton P, Poplar S, Puig A, McGeachie M, Weinkove R, Tam CS. Real-world experience of Australian and New Zealand patients with chronic lymphocytic leukemia and mantle cell lymphoma accessing ibrutinib through a Named Patient Program. Leuk Lymphoma 2023; 64:312-318. [PMID: 36423351 DOI: 10.1080/10428194.2022.2148220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ibrutinib is a small molecule inhibitor of Bruton's tyrosine kinase indicated for the treatment of relapsed/refractory (R/R) chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), and mantle cell lymphoma (MCL). The Named Patient Program in Australia and New Zealand (ANZ NPP) provided access to ibrutinib treatment to 1126 R/R CLL/SLL and 330 R/R MCL patients, prior to Pharmaceutical Benefits Scheme listing. This study aimed to assess the duration of treatment for the ANZ NPP patients, as an indicator of efficacy and tolerability of ibrutinib in the real world. Based on the NPP data, ibrutinib provided a median of 47 months clinical benefit for participants with CLL/SLL and 14 months clinical benefit for those with MCL; outcomes that are consistent with the clinical trial results and further support the well-established efficacy and safety profile of ibrutinib in the real world.
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Affiliation(s)
- Stephen P Mulligan
- Department of Haematology, Royal North Shore Hospital, Sydney, Australia
| | - Stephen Opat
- Monash Health, Monash University, Melbourne, Australia
| | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Australia.,Department of Haematology, Pathwest Laboratory Medicine, Perth, Australia.,School of Medicine, University of Western Australia, Perth, Australia
| | - Bryone Kuss
- Flinders Medical Centre and Finders University, Bedford Park, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Sydney, Australia
| | - Paula Marlton
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland School of Medicine, Brisbane, Australia
| | - Sarah Poplar
- Northland Cancer and Blood Services, Northland District Health Board, Whangarei, New Zealand
| | - Andrea Puig
- Real-world Evidence, Janssen-Cilag Pty Ltd, Sydney, Australia
| | - Marija McGeachie
- Medical and Scientific Affairs, Janssen-Cilag Pty Ltd, Sydney, Australia
| | - Robert Weinkove
- Te Rerenga Ora Blood & Cancer Centre, Wellington Hospital, Wellington, New Zealand.,Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
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