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Suhail M, Saulat F, Khurram H, Fatima F, Zenab A, Wasim M, Sadia NUA, Afzaal F, Latif H, Nasrullah M. Knowledge, Attitude and Practice Related to Chemotherapy Among Cancer Patients. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241246460. [PMID: 38616652 PMCID: PMC11017809 DOI: 10.1177/00469580241246460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/11/2024] [Accepted: 03/22/2024] [Indexed: 04/16/2024]
Abstract
Cancer is a leading cause of death, with a rapidly increasing global burden. Chemotherapy is the most effective cancer treatment, and with its benefits, there exist potential problems. The present study assesses cancer patients' knowledge, attitude, and practice toward chemotherapy use. A descriptive cross-sectional study was conducted in the oncology wards of various tertiary care hospitals and cancer care centers in Lahore, Pakistan. Patients were included in the study based on convenient sampling. A structured questionnaire with 25 (close-ended) questions and a demographic profile was used to collect data. Descriptive statistics was used to analyze frequencies and percentages. Independent sample t-test and ANOVA were used to calculate the mean and standard deviation. Most patients were females (54%) and married (52.6%), with an unemployment rate of 39%. Patients with higher education depicted significantly higher scores in knowledge (9.61 ± 2.65), attitude (19.37 ± 2.70), and practice (3.89 ± 1.03) domains. Surprisingly, throughout the whole KAP domain, the patient's attitude (18.42 ± 3.31) toward chemotherapy use, showed higher values, as compared to their knowledge (7.78 ± 3.26) and practice (3.66 ± 1.08) scores. The majority of the study participants had a positive attitude toward chemotherapy use, with limited knowledge, and practice.
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Affiliation(s)
- Muzna Suhail
- Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Fabeha Saulat
- Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Hira Khurram
- Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Farzeen Fatima
- Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Atia Zenab
- Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Mehak Wasim
- Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | | | - Fasiha Afzaal
- Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Hamid Latif
- Akhtar Saeed Medical and Dental College, Lahore, Pakistan
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Silberstein AE, Fiala MA, Loh KP, Cordner T, Mian H, Wildes TM. A pilot study of adherence to lenalidomide among older patients with multiple myeloma. J Geriatr Oncol 2023; 14:101560. [PMID: 37380519 PMCID: PMC10529650 DOI: 10.1016/j.jgo.2023.101560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/17/2023] [Accepted: 06/07/2023] [Indexed: 06/30/2023]
Affiliation(s)
| | - Mark A Fiala
- Washington University School of Medicine, St. Louis, MO, USA; College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Theresa Cordner
- Washington University School of Medicine, St. Louis, MO, USA
| | - Hira Mian
- McMaster University, Hamilton, ON, Canada
| | - Tanya M Wildes
- Division of Hematology/Oncology, University of Nebraska Medical Center/Nebraska Medicine, Omaha, NE, USA.
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Wreyford L, Gururajan R, Zhou X. When can cancer patient treatment nonadherence be considered intentional or unintentional? A scoping review. PLoS One 2023; 18:e0282180. [PMID: 37134109 PMCID: PMC10155980 DOI: 10.1371/journal.pone.0282180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/10/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Treatment nonadherence in cancer patients remains high with most interventions having had limited success. Most studies omit the multi-factorial aspects of treatment adherence and refer to medication adherence. The behaviour is rarely defined as intentional or unintentional. AIM The aim of this Scoping Review is to increase understanding of modifiable factors in treatment nonadherence through the relationships that physicians have with their patients. This knowledge can help define when treatment nonadherence is intentional or unintentional and can assist in predicting cancer patients at risk of nonadherence and in intervention design. The scoping review provides the basis for method triangulation in two subsequent qualitative studies: 1. Sentiment analysis of online cancer support groups in relation to treatment nonadherence; 2. A qualitative validation survey to refute / or validate claims from this scoping review. Thereafter, framework development for a future (cancer patient) online peer support intervention. METHODS A Scoping Review was performed to identify peer reviewed studies that concern treatment / medication nonadherence in cancer patients-published between 2000 to 2021 (and partial 2022). The review was registered in the Prospero database CRD42020210340 and follows the PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Searches. The principles of meta-ethnography are used in a synthesis of qualitative findings that preserve the context of primary data. An aim of meta-ethnography is to identify common and refuted themes across studies. This is not a mixed methods study, but due to a limited qualitativevidence base and to broaden findings, the qualitative elements (author interpretations) found within relevant quantitative studies have been included. RESULTS Of 7510 articles identified, 240 full texts were reviewed with 35 included. These comprise 15 qualitative and 20 quantitative studies. One major theme, that embraces 6 sub themes has emerged: 'Physician factors can influence patient factors in treatment nonadherence'. The six (6) subthemes are: 1. Suboptimal Communication; 2. The concept of Information differs between Patient and Physician; 3.Inadequate time. 4. The need for Treatment Concordance is vague or missing from concepts; 5. The importance of Trust in the physician / patient relationship is understated in papers; 6. Treatment concordance as a concept is rarely defined and largely missing from studies. LINE OF ARGUMENT WAS DRAWN Treatment (or medication) nonadherence that is intentional or unintentional is often attributed to patient factors-with far less attention to the potential influence of physician communication factors. The differentation between intentional or unintentional nonadherence is missing from most qualitative and quantitative studies. The holistic inter-dimensional / multi-factorial concept of 'treatment adherence' receives scant attention. The main focus is on medication adherence / nonadherence in the singular context. Nonadherence that is unintentional is not necessarily passive behaviour and may overlap with intentional nonadherence. The absence of treatment concordance is a barrier to treatment adherence and is rarely articulated or defined in studies. CONCLUSION This review demonstrates how cancer patient treatment nonadherence is often a shared outcome. An equal focus on physican and patient factors can increase understanding of the two main types of nonadherence (intentional or unintentional). This differentation should help improve the fundamentals of intervention design.
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Affiliation(s)
- Leon Wreyford
- University of Southern Queensland (USQ), Toowoomba, Qld, Australia
| | - Raj Gururajan
- University of Southern Queensland (USQ), Toowoomba, Qld, Australia
| | - Xujuan Zhou
- University of Southern Queensland (USQ), Toowoomba, Qld, Australia
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Liu T, Li N, Liu C, Miao X. A Qualitative Exploration of Medication Experience and Factors Contributing to Adherence to Oral-Targeted Therapy Among Lung Cancer Survivors. Semin Oncol Nurs 2022; 38:151352. [PMID: 36253304 DOI: 10.1016/j.soncn.2022.151352] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The introduction of oral-targeted therapy for cancer improves survival while adherence also presents as a challenge to patients. Current studies on oral anticancer agents are primarily limited to patients from developed countries with breast cancer and chronic myeloid leukemia receiving oral chemotherapy and hormonal therapy. This study explored experience of oral-targeted therapy adherence among Chinese patients with nonsmall cell lung cancer and its contributing factors by using a qualitative research. DATA SOURCES Semi-structured interviews with 16 patients and 7 family caregivers at a tertiary tumor hospital in China were conducted to understand their experience and perceptions of oral-targeted therapy. Thematic analysis was applied to generate the themes and to identify underlying factors associated with the adherence. CONCLUSION The lung cancer survivors struggled with ambivalence between survival and relief during taking targeted anticancer medication and showed diverse models of nonadherence, including intentionally or unintentionally intermittent medication and overadherence. Three main themes were identified: (1) cancer-related distresses, (2) inadequate social support, and (3) forgetfulness, together with seven subthemes, representing factors impeding patients' medication adherence. The themes demonstrate complicated and interrelated factors from personal, interpersonal, sociocultural, and structural forces contributing to patients' poor adherence. IMPLICATIONS FOR NURSING PRACTICE The findings suggest the imperativeness of reinforcing community- or home-based oral-targeted medication management in which nurses play a principal role to implement strategies of patient education, symptom management, reminder prompts, and monitoring to improve adherence.
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Affiliation(s)
- Ting Liu
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Ning Li
- Department of Thoracic Surgery, Linyi Cancer Hospital, Linyi, Shandong, China
| | - Cuiping Liu
- School of Nursing, Shandong First Medical University, Shandong Academy of Medical Sciences, Qingdao, Shandong, China
| | - Xiuxin Miao
- School of Nursing, Qingdao University, Qingdao, Shandong, China.
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Naser AY, Ofori-Asenso R, Awawdeh SA, Qadus S, Alwafi H, Liew D. Real World Adherence to and Persistence With Oral Oncolytics in Multiple Myeloma: A Systematic Review and Meta-analysis. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:760-773. [PMID: 35764491 DOI: 10.1016/j.clml.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/11/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Oral oncolytic treatments (OOTs) have improved the prognosis of patients with multiple myeloma (MM). However, the effectiveness of these therapies is undermined by poor adherence. We aimed to characterize the real-world adherence to, and persistence with, OOTs for MM. MATERIALS AND METHODS MEDLINE, EMBASE, and the International Pharmaceutical abstracts databases were searched for relevant observational studies published in English up to November 21, 2021. This was supplemented by manual searches of abstracts from the annual meetings of the American Society of Hematology, the American Society for Clinical Oncology, and the European Hematology Association as well as screening the references of included articles. Random-effects meta-analysis was performed. RESULTS Following screening of 11,557 articles, 19 studies involving 27,129 patients in 8 countries (France, the US, Germany, Italy, the UK, Brazil, South Korea, and Belgium) prescribed OOTs (lenalidomide, thalidomide, pomalidomide, panobinostat, ixazomib, and melphalan) for MM were included. The overall pooled proportion of adherent patients was 67.9% (95% confidence interval [CI]: 57.1%-77.8%). The pooled proportion of adherent patients was higher in self-reported questionnaire-based studies compared to those using prescription/dispensing data (81.6% vs. 61.0%; P-value for difference = .08). Across 5 studies involving 15,363 patients, a pooled proportion of 35.8% (95% CI: 22.0-50.9) discontinued treatment. Factors reported to be associated with nonadherence included increasing age, higher comorbidity, polypharmacy, and a lack of social support. CONCLUSION In patients with MM, adherence to and persistence with OOTs remains suboptimal. To achieve desired clinical outcomes, interventions to improve adherence and minimize discontinuation may be warranted.
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Affiliation(s)
- Abdallah Y Naser
- Department of Applied Pharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan.
| | - Richard Ofori-Asenso
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Real World Data Enabling Platform, Roche Products Ltd, Welwyn Garden City, UK.
| | - Safaa Al Awawdeh
- Department of Basic Pharmaceutical Sciences, Isra University, Amman, Jordan
| | - Sami Qadus
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
| | - Hassan Alwafi
- Faculty of Medicine, Umm Alqura University, Saudi Arabia
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; The Adelaide Medical School, University of Adelaide, Adelaide, Australia
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Self-care behaviors in patients with cancer treated with oral anticancer agents: a systematic review. Support Care Cancer 2022; 30:8465-8483. [PMID: 35639188 DOI: 10.1007/s00520-022-07166-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW Continuous progress in cancer care has led to its increased use in oral anticancer agents that are easily managed by patients at home with fewer costs and hospitalizations. However, correct self-care behaviors are needed for the safe use of these medications. This review aimed to synthesize studies on self-care behaviors in patients treated with oral anticancer agents. METHODS This systematic review used a convergent qualitative synthesis design for mixed studies. Studies on adult patients with cancer using any kind of oral anticancer agent and describing self-care maintenance, self-care monitoring, and/or self-care management behaviors were searched on PubMed, EMBASE, and CINAHL. After data extraction, the findings were retained for qualitative synthesis. FINDINGS Of 3419 records, 19 studies were included in this review. From the qualitative synthesis, all the retrieved behaviors were synthesized in the three self-care dimensions. Five themes and 18 subthemes were identified. Self-care maintenance included "adherence to the medications" and "prevention." Self-care monitoring consisted of "health surveillance and recognition of illness changes." Self-care management included "seeking help" and "autonomous management of side effects." Overall, most of the behaviors described focused only on adherence. CONCLUSION The findings of this systematic review could guide future studies on self-care and drive future interventions aimed at improving self-care in this vulnerable population. Nurses and other healthcare professionals should provide self-care support to patients taking oral anticancer agents. In particular, they should promote behaviors aimed at improving well-being, preserving health, or managing side effects.
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Westman B, Bergkvist K, Karlsson Rosenblad A, Sharp L, Bergenmar M. Patients with low activation level report limited possibilities to participate in cancer care. Health Expect 2022; 25:914-924. [PMID: 35049103 PMCID: PMC9122461 DOI: 10.1111/hex.13438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/26/2021] [Accepted: 01/09/2022] [Indexed: 11/27/2022] Open
Abstract
Background Cancer care trajectories are often complex, with potent multimodality treatments and multiple interactions with health care providers. Communication and coordination are challenging and the patients' responsibilities to take on more active roles in their own care are increasing. Objective This study aimed to investigate associations between patient activation level and participation in cancer care, sociodemographic characteristics, clinical data, health‐related quality of life (HRQoL) and helpfulness of received information. Methods In this cross‐sectional population‐based study, patients completed questionnaires on patient activation, perceived participation, HRQoL, helpfulness of received information and sociodemographic characteristics. Responses to the patient activation measures (PAMs) were classified into four levels (higher levels indicating more activation). Data on age, sex and cancer diagnosis were collected from the Swedish Cancer Register. Results Data from 682 patients were analysed. On comparing patients at PAM levels 1 and 4, the latter reported significantly higher possibilities to influence care decisions (46.6% vs. 20.8%) and to ask questions regarding treatment and care (93.4% vs. 68.4%). Patients at PAM level 4 reported wanting to influence decision‐making to a higher extent, compared with patients at other PAM levels, and reported clinically significantly higher HRQoL. No significant differences were found regarding sociodemographic characteristics. Conclusion We found strong associations between perceived patient participation and activation levels, with limited possibility for participation among those with lower activation levels. Patient or Public Contribution Discussions with patient representatives have raised the importance of participation. The preliminary findings were presented and discussed in a workshop with representatives from 21 cancer patient advocacy groups.
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Affiliation(s)
- Bodil Westman
- Regional Cancer Centre Stockholm-Gotland, Stockholm, Sweden.,Department of Care Science, Sophiahemmet University, Stockholm, Sweden
| | - Karin Bergkvist
- Department of Care Science, Sophiahemmet University, Stockholm, Sweden.,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Karlsson Rosenblad
- Regional Cancer Centre Stockholm-Gotland, Stockholm, Sweden.,Division of Clinical Diabetology and Metabolism, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Lena Sharp
- Regional Cancer Centre Stockholm-Gotland, Stockholm, Sweden.,Division of Innovative Care Research, LIME, Karolinska Institutet, Stockholm, Sweden
| | - Mia Bergenmar
- Department of Care Science, Sophiahemmet University, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Pelvic Cancer, Psychosocial Unit, Karolinska University Hospital, Stockholm, Sweden
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8
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Michiels S, Tricas-Sauras S, Dauvrin M, Bron D, Kirakoya-Samadoulougou F. A mixed method study design to explore the adherence of haematological cancer patients to oral anticancer medication in a multilingual and multicultural outpatient setting: The MADESIO protocol. PLoS One 2021; 16:e0253526. [PMID: 34166438 PMCID: PMC8224871 DOI: 10.1371/journal.pone.0253526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background Patients with haematologic malignancies are increasingly treated by oral anticancer medications, heightening the challenge of ensuring optimal adherence to treatment. However, except for chronic myelogenous leukaemia or acute lymphoid leukaemia, the extent of non-adherence has rarely been investigated in outpatient settings, particularly for migrant population. With growing numbers of migrants in Belgium, identifying potential differences in drug use is essential. Also, previous research regarding social determinants of health highlight important disparities for migrant population. Difficulties in communication between health caregivers and patients from different cultural and ethnic backgrounds has been underlined. Methods Using a sequential mixed method design, the MADESIO protocol explores the adherence to oral anticancer medications in patients with haematological malignancies and among first and second generation migrants of varied origin. Conducted in the ambulatory setting, a first quantitative strand will measure adherence rates and associated risk factors in two sub-groups of patients with haematological malignancies (group A: first and second generation migrants and group B: non-migrants). The second qualitative strand of this study uses semi-structured interviews to address address the patients’ subjective meanings and understand the statistical associations observed in the quantitative study (strand one). MADESIO aims to provide a first assessment of whether and why migrants constitute a population at risk concerning adherence to oral anticancer medications. Discussion Our protocol is designed to provide a comprehensive understanding of adherence in a specific population. The methodological choices applied allow to explore adherence among patients from diverse linguistic and cultural backgrounds. A particular emphasis has been paid to minimize the biases and increase the reliability of the data collected. Easily reproductible, the MADESIO design may help healthcare services to screen adherence to Oral anticancer medications and to guide providers in choosing the best strategies to address medication adherence of migrants or minority diverse population.
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Affiliation(s)
- Sandra Michiels
- Centre for Research in Epidemiology, Biostatistics, and Clinical Research, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
- Centre for Research in Social Approaches to Health, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
- Department of Haematology/Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
- * E-mail: ,
| | - Sandra Tricas-Sauras
- Centre for Research in Social Approaches to Health, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Marie Dauvrin
- Department of Public Health, Université Catholique de Louvain, Brussels, Belgium
- Belgian Health Care Knowledge Centre, Brussels, Belgium
- Haute Ecole Léonard de Vinci, Brussels, Belgium
| | - Dominique Bron
- Department of Haematology/Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Fati Kirakoya-Samadoulougou
- Centre for Research in Epidemiology, Biostatistics, and Clinical Research, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
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Chagas LMDO, Sabino FHO, Barbosa MH, Frizzo HCF, Andrade LF, Barichello E. Self-care related to the performance of occupational roles in patients under antineoplastic chemotherapy treatment. Rev Lat Am Enfermagem 2021; 29:e3421. [PMID: 34037118 PMCID: PMC8139385 DOI: 10.1590/1518-8345.4092.3421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 08/21/2020] [Indexed: 11/21/2022] Open
Abstract
Objective: to analyze and correlate occupational roles, symptoms and self-care capacity
in oncologic patients seen at the chemotherapy service of a university
hospital. Method: cross-sectional study, in which the instruments were applied sociodemographic
and clinical questionnaire, M.D Andersons Symptom Inventory - core,
Appraisal of Self Care Agency Scale-Revised and Occupational Paper
Identification List to oncologic patients seen in the chemotherapy service
of a university hospital. Data analysis included absolute and relative
frequency tables and multiple linear regression, adopting a significance
level of =0.05. Results: the sample showed capacity for self-care operationalized with an average of
X=57.8. In the correlation between the degree of importance of the
occupational papers and the scores of the evaluation instrument for
self-care was found statistical significance in the papers of volunteer
(r=0.26; p=0.02) and friend (r=0.33; p= <0.001). The linear regression
showed that the greater the interference of symptoms in life activities
(=0.20; p=0.05) and greater the importance of the role of friend (p=0.001;
p=0.43), the higher the rates of self-care. Conclusion: the operationalization of self-care can be directly related to the degree of
importance attributed to the performance of social roles.
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Affiliation(s)
| | | | - Maria Helena Barbosa
- Universidade Federal do Triângulo Mineiro, Instituto de Ciências da Saúde, Uberaba, MG, Brazil
| | | | | | - Elizabeth Barichello
- Universidade Federal do Triângulo Mineiro, Instituto de Ciências da Saúde, Uberaba, MG, Brazil
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Santoleri F, Lasala R, Ranucci E, Rocchi M, Pulini S, Morelli AM, Spadano A, Costantini A. Adherence to and effectiveness of lenalidomide after 1 year of treatment in a real world setting. J Oncol Pharm Pract 2020; 28:24-30. [PMID: 33349148 DOI: 10.1177/1078155220980807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In combination with dexamethasone, lenalidomide is prescribed in the oral treatment of Multiple Myeloma for patients who have received at least one previous therapy. OBJECTIVE The objective of this study is to evaluate medication adherence to lenalidomide of Multiple Myeloma patients, as well as Progression Free Survival and Overall Survival one year from the beginning of the treatment. SETTING The study was carried out in Pescara Hospital, in Italy. All Multiple Myeloma patients who began lenalidomide therapy between January 1, 2012 and June 30, 2016 were included in our study. METHODS Adherence to treatment was calculated by using the ratio between the Received Daily Dose and the Prescribed Daily Dose. Effectiveness in real world has been evaluated as Progression Free Survival and Overall Survival one year from the beginning of the treatment.Main outcomes measure: We assessed medication adherence and effectiveness of lenalidomide in the treatment of Multiple Myeloma. RESULTS Adherence to the overall mean treatment was 0.73 ± 0.15, relative to 81 patients evaluated in our study. 32% of patients achieved an adherence equal to or greater than 80%. Real-life effectiveness in terms of Progression Free Survival and Overall Survival showed values of 53.75% and 88%, respectively, one year from the beginning of treatment. CONCLUSION The analysis of adherence in Multiple Myeloma patients treated with lenalidomide one year from the beginning of therapy reveal a concerning lack of adherence. Moreover, the lack of correlation of the levels of adherence with patient-related variables shows that, in the case of Multiple Myeloma, adherence is not related to personal, social and environmental characteristics that may determine each patient's correct treatment implementation, but is directly influenced by disease evolution.
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Affiliation(s)
| | - Ruggero Lasala
- Hospital pharmacy, Pescara General Hospital, Pescara, Italy
| | - Elena Ranucci
- Hospital pharmacy, Pescara General Hospital, Pescara, Italy
| | - Marco Rocchi
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy
| | - Stefano Pulini
- Department of Haematology, Pescara General Hospital, Pescara, Italy
| | | | - Antonio Spadano
- Department of Haematology, Pescara General Hospital, Pescara, Italy
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Cransac A, Aho S, Cosme E, Chretien ML, Favennec C, Schreder L, Boutet M, Gueneau P, Giroud M, Caillot D, Boulin M. Self-management of immunomodulatory drug treatment in multiple myeloma patients. Eur J Cancer Care (Engl) 2020; 30:e13356. [PMID: 33159353 DOI: 10.1111/ecc.13356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 07/10/2020] [Accepted: 10/14/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Immunomodulatory drugs (IMIDs: thalidomide, lenalidomide and pomalidomide) are widely used in patients with multiple myeloma (MM). The aim of our study was to validate a questionnaire to evaluate the self-capacity of MM patients to manage IMID treatment including side effects. METHODS We used a method adapted from the recommendations of the European Organisation for Research and Treatment of Cancer (EORTC) to validate a French questionnaire for patients with MM treated with IMIDs. RESULTS The face validity was evaluated in 15 patients and the construct validity in 56 patients. For discriminant validity, two groups were constituted by gender and depending on whether they had a previous IMID treatment. The median questionnaire score was 11.33/16 (IQR 9.75-12.08) with a minimum of 5.2 and a maximum of 14.75. For discriminant validity, a statistically significant difference was observed for patient capacity to contact healthcare professionals in specific situations and drug intake in case of swallowing disorder. Convergent validity showed an acceptable reliability for the scores of the different questions. CONCLUSION The questionnaire has shown to be a valid tool for the assessment of the adherence and side-effect management skills for MM patients with IMID treatment.
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Affiliation(s)
- Amélie Cransac
- Department of Pharmacy, Dijon University Hospital, Dijon, France.,LNC-UMR1231, University of Burgundy and Franche Comté, Dijon, France
| | - Serge Aho
- Hospital Epidemiology and Infection Control Department, Dijon University Hospital, Dijon, France
| | - Edouard Cosme
- Department of Pharmacy, Dijon University Hospital, Dijon, France
| | - Marie-Lorraine Chretien
- Department of Clinical Hematology, Dijon University Hospital, Dijon, France.,SAPHIIR-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - Camille Favennec
- Department of Clinical Hematology, Dijon University Hospital, Dijon, France
| | - Laure Schreder
- Oncology Coordination Center, Dijon University Hospital, Dijon, France
| | - Mérédith Boutet
- Department of Pharmacy, Dijon University Hospital, Dijon, France
| | - Pauline Gueneau
- Department of Pharmacy, Dijon University Hospital, Dijon, France
| | - Maurice Giroud
- LNC-UMR1231, University of Burgundy and Franche Comté, Dijon, France.,Department of Neurology, Dijon University Hospital, Dijon, France
| | - Denis Caillot
- Department of Clinical Hematology, Dijon University Hospital, Dijon, France
| | - Mathieu Boulin
- Department of Pharmacy, Dijon University Hospital, Dijon, France.,EPICAD LNC-UMR1231, University of Burgundy and Franche Comté, Dijon, France
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Rodday AM, Hackenyos D, Masood R, Savidge N, Lin M, Weidner RA, Parsons SK. Assessment of patients' understanding of and adherence to oral anticancer medication (OAM): Results of a cross-sectional institutional pilot study. J Oncol Pharm Pract 2020; 27:1569-1577. [PMID: 33019872 DOI: 10.1177/1078155220960809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although oral anticancer medications (OAM) provide opportunity for treatment at home, challenges include prescription filling, monitoring side effects, safe handling, and adherence. We assessed understanding of and adherence to OAM in vulnerable patients. METHODS This 2018 pilot study defined vulnerable patients based on Chinese language, older age (≥65 years), and subsidized insurance. All participants had a cancer diagnosis and were taking an OAM filled through the hospital's specialty pharmacy. Participants reported on OAM taking (days per week, times per day, special instructions) and handling (handling, storage, disposal). The specialty pharmacist classified patient-reported responses about OAM taking and handling as adequate or inadequate. OAM regimens were classified by complexity. RESULTS Of 61 eligible patients, 55 participated. Mean age was 68 years (standard deviation [SD] = 12) and 53% were female. Patient subgroups were: 27% Chinese, 64% ≥65 years, and 9% subsidized insurance. Forty-nine percent were on frontline therapy and median time on OAM was 1 year (Quartile 1 = 0.4, Quartile 3 = 1.7). Adequacy of OAM taking (30%) and handling (15%) were low; 15% had adequacy in both. Adequacy of OAM taking and handling did not vary by patient subgroup or regimen complexity. Mean patient-reported adherence was high (5.4, SD = 1, possible range 1-6) and did not vary by adequacy of OAM taking or handling. CONCLUSIONS Understanding of OAM taking and handling in this group of vulnerable patients was low and did not align with patient-reported adherence. Future interventions should ensure that patients understand how to safely take and handle OAM, thereby optimizing their therapeutic potential.
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Lively A, Minard LV, Scott S, Deal H, Lambourne T, Giffin J. Exploring the perspectives of healthcare professionals in delivering optimal oncology medication education. PLoS One 2020; 15:e0228571. [PMID: 32049970 PMCID: PMC7015363 DOI: 10.1371/journal.pone.0228571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 01/17/2020] [Indexed: 11/24/2022] Open
Abstract
Background To optimize patient education, it is important to understand what healthcare professionals perceive to be ideal oncology medication education for patients to receive, and what they feel is their role and the role of others in its delivery. Education provided to patients is an important component of chemotherapy as it has been shown to benefit and positively impact patients who receive it. Educational interventions are often provided by multidisciplinary teams with the goal of improving patient care. However, few studies have explored the roles of healthcare professionals in delivering oncology medication education. Objective To explore the perspectives of healthcare professionals working in medical, gynaecological or hematological oncology to identify what they perceive to be optimal oncology medication education for patients. Methods Healthcare professionals (physicians, nurses and pharmacists) working in medical, gynaecological or hematological oncology at the Nova Scotia Health Authority, Central Zone were invited to participate in one-on-one, semi-structured interviews which were audio-recorded, transcribed and analyzed using thematic analysis. Findings Fifteen interviews, including five physicians, four nurses and six pharmacists were conducted from February to April 2018. Four major themes were identified: Delivery of oncology medication education, Facilitating the patient learning process, Multidisciplinary Approach and Understanding barriers to the healthcare professional in providing education. Conclusion The identified themes uncovered novel ideas about how healthcare professionals felt oncology medication education could ideally be delivered to patients, and supported findings in the literature. Although participants discussed barriers to their ability to deliver optimal education, they also identified ways in which they can facilitate patient learning, for example, through the reinforcement of education. Participants recognized the importance of increasing collaboration and communication with the multidisciplinary team. This research will inform the design of any new models for oncology medication education at the Nova Scotia Health Authority, Central Zone and potentially other sites.
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Affiliation(s)
- Allison Lively
- Department of Pharmacy, Nova Scotia Health Authority (Central Zone), QEII Health Sciences Centre, Halifax, NS, Canada
- * E-mail:
| | - Laura V. Minard
- Department of Pharmacy, Nova Scotia Health Authority (Central Zone), QEII Health Sciences Centre, Halifax, NS, Canada
| | - Samantha Scott
- Department of Pharmacy, Nova Scotia Health Authority (Central Zone), QEII Health Sciences Centre, Halifax, NS, Canada
| | - Heidi Deal
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada
| | - Tessa Lambourne
- Department of Pharmacy, Nova Scotia Health Authority (Northern Zone), Aberdeen Regional Hospital, New Glasgow, NS, Canada
| | - Jenn Giffin
- Nova Scotia Health Authority (Central Zone), QEII Health Sciences Centre, Halifax, NS, Canada
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Cransac A, Aho S, Chretien ML, Giroud M, Caillot D, Boulin M. Adherence to immunomodulatory drugs in patients with multiple myeloma. PLoS One 2019; 14:e0214446. [PMID: 30917164 PMCID: PMC6436707 DOI: 10.1371/journal.pone.0214446] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 03/13/2019] [Indexed: 01/08/2023] Open
Abstract
Background Immunomodulatory drugs (thalidomide, lenalidomide and pomalidomide; IMID) are widely used in the treatment of multiple myeloma patients. To date, few data are available on IMID adherence in multiple myeloma patients. The aim of our study was to evaluate IMID adherence and to compare two indirect methods to measure IMID adherence in multiple myeloma patients: a specific questionnaire and the medication possession ratio (MPR). Another aim was to explore this specific questionnaire for the assessment of IMID adherence in multiple myeloma patients. Methods All consecutive multiple myeloma patients, with at least two consecutive dispensations of thalidomide, lenalidomide or pomalidomide in our hospital were included in this prospective study. IMID adherence was measured using a specific questionnaire and the medication possession ratio. Relationship between the questionnaire scores and variables of interest was evaluated by multiple linear regression with a robust variance estimator. Findings Sixty-three patients were included in our study. The mean questionnaire score was 8.2±1.2 and the mean medication possession ratio value was 0.97±0.06. A total of 76% of patients were considered adherent according to the questionnaire (i.e. score ≥ 8), 94% according to the medication possession ratio (i.e. MPR ≥ 0.90), and 70% according to the questionnaire and the medication possession ratio. No statistically significant linear association was observed between the questionnaire score and any variables of interest including medication possession ratio. All Cronbach’s alpha were relatively low (range 0.0342–0.2443), showing a low correlation of the different questions with the questionnaire score. Conclusions Our study is the first prospective study evaluating IMID adherence in multiple myeloma patients in real life. The high adherence to IMIDs reported here, regardless of the drug, is encouraging considering the efficacy, toxicity and elevated cost of IMIDs. The specific questionnaire should be used with caution to evaluate IMID adherence.
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Affiliation(s)
- Amélie Cransac
- Department of Pharmacy, Dijon University Hospital and LNC-UMR1231, University of Burgundy & Franche Comté, Dijon, France
| | - Serge Aho
- Hospital Epidemiology and Infection Control Department, University Hospital, Dijon, France
| | - Marie-Lorraine Chretien
- Department of Clinical Hematology, University Hospital and SAPHIIR-UMR 1231, University of Burgundy & Franche Comté, Dijon, France
| | - Maurice Giroud
- Department of Neurology, Dijon University Hospital and LNC-UMR1231, University of Burgundy & Franche Comté, Dijon, France
| | - Denis Caillot
- Department of Clinical Hematology, University Hospital, Dijon, France
| | - Mathieu Boulin
- Department of Pharmacy, Dijon University Hospital and EPICAD LNC-UMR1231, University of Burgundy & Franche Comté, Dijon, France
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High adherence of patients with multiple myeloma who receive treatment with immunomodulatory drugs (IMIDS) in hematology/oncology group practices in Germany. Support Care Cancer 2019; 27:4265-4271. [PMID: 30859307 DOI: 10.1007/s00520-019-04721-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/26/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE Immunomodulatory drugs (IMIDS) have changed the treatment and outcome of patients suffering from multiple myeloma. However, with the oral administration adherence becomes an issue. Since there is no "gold standard" in measuring adherence, we assessed the adherence of myeloma patients with the help of different data sources. METHODS All patients who have been receiving IMIDS for at least 3 months were eligible. Computer assisted personal interviews of patients and, if possible, their caregivers were carried out. Attending oncologists evaluated the patient's adherence with the help of a standardized questionnaire. In addition, a retrospective analysis of prescription data was conducted. All data were analyzed statistically using SPSS. RESULTS One hundred myeloma patients, 35% female, 65% male, with a median age of 70 years (37-86) were interviewed. Prescription data could be evaluated in terms of adherence in 78 patients (78%), 56 caregivers could be questioned (56%). Ninety-seven percent of patients rated themselves as adherent in taking IMIDS. Data from treating oncologists, caregivers and prescriptions supported this result. IMID therapies were rated as very effective and significant, toxicities were acceptable and dosing regimens simple/uncomplicated. CONCLUSIONS Myeloma patients seem to be highly adherent to IMID treatments.
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Weller D. In our March 2017 issue of EJCC…. Eur J Cancer Care (Engl) 2018; 26. [PMID: 28244270 DOI: 10.1111/ecc.12678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D Weller
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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Implementation of pharmacist consultations as part of a multidisciplinary consultation program for patients with oral anticancer agent. ACTA ACUST UNITED AC 2018. [DOI: 10.1097/op9.0000000000000003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gupta S, Abouzaid S, Liebert R, Parikh K, Ung B, Rosenberg AS. Assessing the Effect of Adherence on Patient-reported Outcomes and Out of Pocket Costs Among Patients With Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:210-218. [PMID: 29429817 DOI: 10.1016/j.clml.2018.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 01/04/2018] [Accepted: 01/24/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND The present study characterized the effect of multiple myeloma (MM) on work productivity, health care resource usage, and out of pocket costs (OOPCs) and examined the association of adherence with quality of life (QoL) and productivity loss. MATERIALS AND METHODS The present cross-sectional study included 162 patients categorized by their 4-item Morisky Medication Adherence Scale (MMAS-4) score (4 vs. ≤ 3). Online surveys included the Work Productivity and Activity Impairment questionnaire, Functional Assessment of Cancer Therapy-Multiple Myeloma (FACT-MM), and MM-specific questions. RESULTS On average, patients reported FACT-MM scores of 98.5 ± 29.3, absenteeism of 18.3% ± 17.8%, presenteeism of 51.8% ± 30.2%, overall work productivity impairment of 57.3% ± 31.7%, and activity impairment of 49.9% ± 29.5% in the previous 7 days. During the previous 3 months, the mean OOPCs were $709 ± $1307; prescription medications accounted for 55% of these costs. Patients attended 4.1 ± 4.6 visits to oncologists or hematologists during that time, which accounted for 45% of the OOPCs. Patients spent an average of 6.8 ± 8.3 hours at MM-related monthly appointments, and 35.2% reported frustration while at the doctor's office. Patients with an MMAS-4 score of 4 reported higher FACT-MM scores (106.9 vs. 89.2; P < .001). Patients with an MMAS-4 score of ≤ 3 reported greater activity impairment (56.5% vs. 39.8%; P = .015) and feeling overwhelmed or frustrated with rescheduling MM appointments (64.0% vs. 26.0%; P = .002). CONCLUSION MM was associated with significant workplace and functional impairment, high OOPCs, and frequent office visits. High medication adherence was associated with better outcomes across these domains. As survival for patients with MM improves, patient QoL should be considered to enhance these outcomes.
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Affiliation(s)
- Shaloo Gupta
- Health Outcomes Practice, Kantar Health, New York, NY.
| | - Safiya Abouzaid
- US Health Economics and Outcomes Research, Celgene Corporation, Summit, NJ
| | - Ryan Liebert
- Health Outcomes Practice, Kantar Health, New York, NY
| | - Kejal Parikh
- US Health Economics and Outcomes Research, Celgene Corporation, Summit, NJ
| | - Brian Ung
- US Health Economics and Outcomes Research, Celgene Corporation, Summit, NJ
| | - Aaron S Rosenberg
- Division of Hematology and Oncology, Davis Comprehensive Cancer Center, University of California, Sacramento, CA
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Kumar SK, Vij R, Noga SJ, Berg D, Brent L, Dollar L, Chari A. Treating Multiple Myeloma Patients With Oral Therapies. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:243-251. [PMID: 28347676 DOI: 10.1016/j.clml.2017.02.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/24/2017] [Accepted: 02/28/2017] [Indexed: 11/15/2022]
Abstract
Recent advances have highlighted the importance of long-term, continuous treatment in multiple myeloma (MM) to improve survival. However, treatment burden continues to negatively impact the real-world duration of MM therapy, and strategies to limit the adverse impact of treatment on patient quality of life are therefore particularly important. Oral MM therapies include the immunomodulatory drugs lenalidomide, thalidomide, and pomalidomide; the alkylating agents melphalan and cyclophosphamide; the histone deacetylase inhibitor panobinostat; the corticosteroids prednisone and dexamethasone; and the proteasome inhibitor ixazomib. The most commonly reported adverse events with these treatments include hematologic events such as thrombocytopenia and neutropenia; the gastrointestinal events nausea, vomiting, and diarrhea; venous thrombotic events such as deep-vein thrombosis and pulmonary embolism; and events such as rash and peripheral neuropathy. It is important that patients receiving oral therapies at home report symptoms before they become difficult to manage. Appropriate management of these treatment-related adverse events, awareness of both food and drug interactions, and assisting patients with out-of-pocket costs are all important factors in providing efficacious, sustainable, and convenient MM therapy. We outline evidence-based recommendations to provide a practical guide for health care providers addressing the effective management of MM patients receiving oral therapy.
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Affiliation(s)
| | - Ravi Vij
- Division of Hematology and Oncology, Washington University School of Medicine, St Louis, MO
| | | | | | | | | | - Ajai Chari
- Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY
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