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Belfer I, Chen W, Weber W, Edwards E, Langevin HM. Unmet Need: Mechanistic and Translational Studies of Sickle Cell Disease Pain as a Whole-Person Health Challenge. THE JOURNAL OF PAIN 2024; 25:104603. [PMID: 38878809 PMCID: PMC11402567 DOI: 10.1016/j.jpain.2024.104603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 06/02/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
Sickle cell disease (SCD) is a lifelong monogenic, autosomal-recessive blood disease that predominantly affects individuals of African descent and those who self-identify as Black or Hispanic. Common SCD pathophysiological processes include adhesion, hemolysis, hypoxia, ischemia, oxidative stress, and vaso-occlusion, which often lead to substantial comorbidities and complications. Pain is one of the most common and significant clinical complications for individuals with SCD. Despite advancements in understanding the pathophysiology of SCD, the ways in which SCD pathophysiological processes contribute to nociception and pain signaling, processing, and perception remain largely unclear. Pain management for individuals with SCD is complex and presents unique challenges that must be considered depending on the presenting pain type (eg, acute pain episode vs chronic pain). Racism, stigma (including stigma associated with opioid use), and limited resources present additional challenges. Limited research has been conducted on major clinical features of SCD pain such as its ischemic, inflammatory, and neuropathic components; on its transition from acute to chronic form and across the lifespan; and on factors influencing SCD pain perception. Research on and management of SCD pain requires a whole-person approach, bringing together investigators from multiple disciplines such as hematologists, organ biologists, pain experts, physiologists, neuroscientists, psychologists, geneticists, microbiologists, immunologists, behavioral scientists, and clinicians. Multidisciplinary cross-training, with different platforms for information dissemination and communication, could help promote basic, mechanistic, and translational research to inform the optimization of current treatment strategies and the development of novel therapies for SCD pain. PERSPECTIVE: This review presents the research challenges and negative impact of SCD pain, a grossly understudied condition in a highly underserved population. It also highlights the barriers and opportunities in SCD pain research and could help clinicians better understand current treatment strategies from the whole-person perspective.
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Affiliation(s)
- Inna Belfer
- Division of Extramural Research, National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health (NIH), Bethesda, Maryland.
| | - Wen Chen
- National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health (NIH), Bethesda, Maryland
| | - Wendy Weber
- National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health (NIH), Bethesda, Maryland
| | - Emmeline Edwards
- National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health (NIH), Bethesda, Maryland
| | - Helene M Langevin
- National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health (NIH), Bethesda, Maryland
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Yaya I, Pourageaud A, Derbez B, Odièvre MH, Oudin Doglioni D, Podevin M, Thomas G, Yombo-Kokule L, Godart C, Lepetit M, Cassubie-Mercier T, Galacteros F, Chassany O. Predictors of health-related quality of life in a large cohort of adult patients living with sickle cell disease in France: the DREPAtient study. Front Public Health 2024; 12:1374805. [PMID: 38832226 PMCID: PMC11144927 DOI: 10.3389/fpubh.2024.1374805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/22/2024] [Indexed: 06/05/2024] Open
Abstract
Background Sickle cell disease (SCD) is an inherited autosomal recessive disorder exhibiting a range of symptoms and acute and/or chronic complications that affect the quality of life. This study aimed to assess health-related quality of life (HRQoL) and to identify the associated factors in adult patients with SCD in France. Methods DREPAtient is a cross-sectional, multicenter study conducted from June 2020 to April 2021 in France and in certain French overseas territories where SCD is highly prevalent. Sociodemographic and clinical data were collected online. HRQoL was assessed by the French version of the 36-Item Short Form Survey (SF-36) questionnaire. HRQoL determinants were identified using multivariable linear regression analysis. Results In total, 570 participants were included, mostly women (68.9%), with a mean age of 33.3 (±10.7) years. The highest mean score HRQoL was found in the Physical functioning domain (67.5 ± 21.8) and the lowest mean score in the General Health perception domain (37.7 ± 20.3). The mean score of the physical composite (PCS) and mental composite (MCS) of SF-36 summary scores was 40.6 ± 8.9 and 45.3 ± 9.8, respectively. Participants receiving oxygen therapy (β = -3.20 [95%CI: -5.56; -0.85]), those with a history of femoral osteonecrosis (-3.09 [-4.64; -1.53]), those hospitalized for vaso-occlusive crisis (VOC) or acute chest syndrome (ACS) (-2.58 [-3.93; -1.22]), those with chronic complications (-2.33 [-4.04; -0.62]), female participants (-2.17 [-3.65; -0.69]), those with psychological follow-up (-2.13 [-3.59; -0.67]), older participants (-1.69 [-3.28; -0.09]), and those receiving painkillers (-1.61 [-3.16; -0.06]) reported worse PCS score. By contrast, those who had completed secondary or high school (4.36 [2.41; 6.31]) and those with stable financial situation (2.85 [0.94, 4.76]) reported better PCS scores. Worse MCS scores were reported among participants with psychological follow-up (-2.54 [-4.28; -0.80]) and those hospitalized for VOC/ACS in the last 12 months (-2.38 [-3.99; -0.77]), while those who had relatives' support (5.27 [1.92; 8.62]) and those with stable financial situation (4.95 [2.65; 7.26]) reported better MCS scores. Conclusion Adults with major SCD reported poor physical and mental HRQoL scores. Hospitalization for VOC/ACS, chronic complications, use of painkillers, perceived financial situation, and support from relatives are important predictors of HRQoL in SCD patients. Interventions to improve HRQoL outcomes SCD should be considered.
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Affiliation(s)
- Issifou Yaya
- Patient-Reported Outcomes Research (PROQOL), Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Hôpital Hôtel-Dieu, AP-HP, Paris, France
- ECEVE, UMR-S 1123, Université Paris Cité, Inserm, Paris, France
| | - Adrien Pourageaud
- Patient-Reported Outcomes Research (PROQOL), Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Hôpital Hôtel-Dieu, AP-HP, Paris, France
- ECEVE, UMR-S 1123, Université Paris Cité, Inserm, Paris, France
| | | | - Marie-Hélène Odièvre
- Department of General Pediatrics, Sickle Cell Referal Center, Trousseau Hospital, AP-HP, Sorbonne Université, Paris, France
- INSERM U1134, Integrated Red Globule Biology, Paris, France
| | - Damien Oudin Doglioni
- Laboratoire Interuniversitaire de Psychologie/Personnalité, Cognition, Changement Social (LIP/PC2S), Université Grenoble Alpes, Grenoble, France
| | | | | | - Lisa Yombo-Kokule
- Patient-Reported Outcomes Research (PROQOL), Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Hôpital Hôtel-Dieu, AP-HP, Paris, France
- ECEVE, UMR-S 1123, Université Paris Cité, Inserm, Paris, France
| | - Christian Godart
- Fédération nationale des associations de Malades Drépanocytaires et Thalassémiques SOS GLOBI (FMDT SOS GLOBI), Paris, France
| | - Maryannick Lepetit
- Fédération nationale des associations de Malades Drépanocytaires et Thalassémiques SOS GLOBI (FMDT SOS GLOBI), Paris, France
| | - Tania Cassubie-Mercier
- Fédération nationale des associations de Malades Drépanocytaires et Thalassémiques SOS GLOBI (FMDT SOS GLOBI), Paris, France
| | - Frederic Galacteros
- Sickle Cell Referral Center, Internal Medicine Unit, Henri Mondor Hospital, AP-HP, U-PEC; INSERM-U955, Institut Mondor, Université Paris-Est Créteil, Team 2 Transfusion et Maladies du Globule Rouge, Créteil, France
| | - Olivier Chassany
- Patient-Reported Outcomes Research (PROQOL), Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Hôpital Hôtel-Dieu, AP-HP, Paris, France
- ECEVE, UMR-S 1123, Université Paris Cité, Inserm, Paris, France
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Lugthart S, Ginete C, Kuona P, Brito M, Inusa BPD. An update review of new therapies in sickle cell disease: the prospects for drug combinations. Expert Opin Pharmacother 2024; 25:157-170. [PMID: 38344818 DOI: 10.1080/14656566.2024.2317336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Sickle cell disease (SCD) is an inherited disorder characterised by polymerisation of deoxygenated haemoglobin S and microvascular obstruction. The cardinal feature is generalised pain referred to as vaso-occlusive crises (VOC), multi-organ damage and premature death. SCD is the most prevalent inherited life-threatening disorders in the world and over 85% of world's 400,000 annual births occur low-and-middle-income countries. Hydroxyurea remained the only approved disease modifying therapy (1998) until the FDA approved L-glutamine (2017), Crizanlizumab and Voxelotor (2019) and gene therapies (Exa-cel and Lovo-cel, 2023). AREAS COVERED Clinical trials performed in the last 10 years (November 2013 - November 2023) were selected for the review. They were divided according to the mechanisms of drug action. The following pubmed central search terms [sickle cell disease] or [sickle cell anaemia] Hydroxycarbamide/ Hydroxyurea, L-Glutamine, Voxelotor, Crizanlizumab, Mitapivat, Etavopivat, gene therapy, haematopoietic stem cell transplantation, and combination therapy. EXPERT OPINION We recommend future trials of combination therapies for specific complications such as VOCs, chronic pain and renal impairment as well as personalised medicine approach based on phenotype and patient characteristics. Following recent approval of gene therapy for SCD, the challenge is addressing the role of shared decision-making with families, global access and affordability.
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Affiliation(s)
- Sanne Lugthart
- Haematology department, University Hospitals of Bristol and Weston Foundation Trust, Bristol, UK
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Catarina Ginete
- Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Portugal
| | - Patience Kuona
- Child, Adolescent and Women's Health Department, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Miguel Brito
- Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Portugal
| | - Baba Psalm Duniya Inusa
- Paediatric Haematology, Evelina London, Guy's and St Thomas NHS Foundation Trust, London
- Women's and Children Academic health, Life Sciences and Medicine, King's College London, London
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McClish D, Okhomina V, Pascale A, Valrie C, Sisler I, Villella A, Smith W. Vaso-occlusive crisis pain intensity, frequency, and duration: which best correlates with health-related quality of life in adolescents and adults with sickle cell disease? Pain 2024; 165:135-143. [PMID: 37578485 PMCID: PMC10840919 DOI: 10.1097/j.pain.0000000000003011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 06/15/2023] [Indexed: 08/15/2023]
Abstract
ABSTRACT In a cross-sectional analysis of baseline data from a randomized clinical trial, we studied 198 adolescents and adults aged 15+ with sickle cell disease. Interest was in assessing the relative strengths of the relationship of vaso-occlusive crisis (VOC) pain domains of intensity, frequency, and duration, with health-related quality of life (HRQOL). Variation in psychosocial, physical function, and pain expression domains of HRQOL was partially explained by frequency, intensity, and duration of VOC pain, separately and together, over and above differences in age, sex, genotype, and organ system damage. However, no single domain measure accounted for more than an additional partial R2 of 12.5% alone. Vaso-occlusive crisis pain frequency explained the most variation, when simultaneously considering VOC intensity and duration, except for stiffness , where duration was most predictive. Yet VOC pain intensity, and even VOC duration, also contributed to variability in HRQOL. We recommend that for most purposes, because all 3 VOC pain domains contribute to variability in HRQOL, all 3 domains should be assessed and interventions should be targeted to improve all 3 domains to maximize HRQOL outcomes (Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02197845 ).
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Affiliation(s)
| | | | - Angela Pascale
- Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - Cecelia Valrie
- Psychology, Virginia Commonwealth University, Richmond, VA, United States
- VCU Institute for Inclusion, Inquiry, and Innovation, Virginia Commonwealth University, Richmond, VA, United States
| | - India Sisler
- Division of Pediatric Haematology and Oncology, Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, United States
| | - Anthony Villella
- Children's Hospital of King's Daughter, Norfolk, VA, United States
| | - Wally Smith
- Division of General Internal Medicine, Department of Medicine, Virginia Commonwealth University, Richmond, VA, United States
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Vuong C, Moussa I, van Muilekom MM, Heijboer H, Rettenbacher E, Haverman L, Twisk J, Fijnvandraat K, Eckhardt CL. Impact of hospitalization for vaso-occlusive crisis on health-related quality of life in children with sickle cell disease. Pediatr Blood Cancer 2023; 70:e30691. [PMID: 37749772 DOI: 10.1002/pbc.30691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/18/2023] [Accepted: 09/13/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is characterized by vaso-occlusive crises (VOCs) that impair the health-related quality of life (HRQoL). The aim of this study is to evaluate the impact of hospitalization for VOCs on HRQoL in children with SCD over time. METHODS In this longitudinal cohort study, children aged 8-18 years diagnosed with SCD at the Amsterdam UMC were included between 2012 and 2021. HRQoL was annually measured as part of standard care using the Pediatric Quality of Life Inventory. The impact of hospitalization for VOC on HRQoL was evaluated using linear mixed models 3, 6, 9, and 12 months after hospitalization. The effect of frequency of hospitalization for VOC on HRQoL was evaluated over the last 12 months. RESULTS In total, 94 children with SCD were included with a median age of 11.8 years (interquartile range [IQR]: 9-14). Thirty-seven patients (39%) had been hospitalized for a VOC. Hospitalization for VOC led to a decrease of 3.2-4.8 points in total HRQoL compared to patients without hospitalization, most pronounced 3 months after hospitalization. Recurrent admission for VOC in the last 12 months was associated with a decrease of 2.3 points in total HRQoL (p = .04). The most affected subscale was physical functioning. CONCLUSION The adverse effects of hospitalization for VOC in children with SCD persist up to 12 months after hospitalization. After hospitalization for VOC, extra attention and support for its negative impact on HRQoL are recommended. This study also underlines the importance of systematically measuring HRQoL, allowing clinicians to intervene accordingly.
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Affiliation(s)
- Caroline Vuong
- Department of Pediatric Hematology, Amsterdam UMC - Emma Children's Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - Ibtissame Moussa
- Department of Pediatric Hematology, Amsterdam UMC - Emma Children's Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - Maud M van Muilekom
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC - Emma Children's Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - Harriët Heijboer
- Department of Pediatric Hematology, Amsterdam UMC - Emma Children's Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - Eva Rettenbacher
- Department of Pediatric Hematology, Amsterdam UMC - Emma Children's Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - Lotte Haverman
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC - Emma Children's Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - Jos Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Karin Fijnvandraat
- Department of Pediatric Hematology, Amsterdam UMC - Emma Children's Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - Corien L Eckhardt
- Department of Pediatric Hematology, Amsterdam UMC - Emma Children's Hospital, University of Amsterdam, Amsterdam, Netherlands
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Macey-Stewart KV, Louie K. Using an individualized pain management plan for African American adults with sickle cell disease. J Am Assoc Nurse Pract 2023; 35:434-440. [PMID: 37229519 DOI: 10.1097/jxx.0000000000000885] [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: 09/10/2022] [Accepted: 04/11/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND The increased lifespan of individuals having sickle cell disease (SCD) causes an overall increase in hospitalizations and more instances in which pain may not be well controlled. LOCAL PROBLEM The mainstay treatment for severe pain is opioids and the underlying cause. Laws affecting opioid prescribing, implicit bias, racial inequity, poor research funding, and lack of knowledge contribute to poor patient outcomes. METHOD Data were collected retrospectively using electronic medical record data from before and after the intervention. INTERVENTION The individualized pain management plan (IPMP) was initiated in collaboration with the patient, pain nurse practitioner (NP), and hematologist. RESULT The mean length of stay for the traditional pain management plan (TPMP) was 7.89 days compared with 5.66 days for the IPMP, with a mean difference of 2.23 days, t = 2.278, p = .024 ( p < .05). There was a decrease in the admission of the individuals with the IPMP, with 25% readmitted within 30 days of discharge, versus 59.0% who were readmitted using the TPMP. Chi-square showed statistical significance (χ 2 = 61.667, p = .000) in using nonpharmacological interventions with the IPMP group. CONCLUSION The IPMP with a patient-centered approach did improve patient outcomes for African American adults living with SCD.
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Affiliation(s)
- Karen V Macey-Stewart
- School of Nursing, Loyola University New Orleans, New Orleans, Louisiana
- School of Nursing, William Paterson University, Wayne, New Jersey
| | - Kem Louie
- School of Nursing, William Paterson University, Wayne, New Jersey
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Bulgin D, Asnani M, Vorderstrasse A, Royal C, Pan W, Tanabe P. Stigma and quality of life in adults with sickle cell disease in Jamaica and the United States. PSYCHOL HEALTH MED 2023; 28:1133-1147. [PMID: 34957879 PMCID: PMC9647980 DOI: 10.1080/13548506.2021.2019808] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/08/2021] [Indexed: 10/19/2022]
Abstract
Sickle cell disease (SCD) is the most common inherited blood disorder in both Jamaica and the United States and is characterized by poor quality of life and debilitating complications, with the hallmark symptom being pain caused by acute and chronic conditions. Individuals with SCD often experience stigma due to their disease status, opioid use, and race. This study sought to understand the influence of perceived stigma and demographic/clinical characteristics on quality of life in adults with SCD in Jamaica (n = 50) and the United States (n = 50). Participants completed interviewer-administered surveys including demographic/clinical characteristics; the Measure of Sickle Cell Stigma (MoSCS); and the Adult Sickle Cell Quality of Life Measurement System (ASCQ-Me). A set of general linear models for each country was built to examine the influence of explanatory variables on the quality of life outcomes. Overall, stigma scores were low for both countries, with the exception of the MoSCS disclosure concerns and expected discrimination subscales, where scores averaged medium and high, respectively. In both countries, being employed was associated with better quality of life; and reports of stigma (internalized stigma and expected discrimination) was associated with worse quality of life. These findings have several implications for healthcare providers caring for individuals with SCD, policy makers, and researchers. Specifically, findings can be used to advocate for improved access to mental health care for individuals with SCD and inform stigma reduction intervention approaches in SCD.
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Affiliation(s)
- Dominique Bulgin
- Duke University School of Nursing, Duke University National Clinician Scholars Program Durham, NC
| | - Monika Asnani
- Caribbean Institute for Health Research- Sickle Cell Unit, The University of the West Indies, Mona, Kingston 7, Jamaica
| | | | - Charmaine Royal
- Departments of African & African American Studies, Biology, Global Health, and Family Medicine & Community Health, Duke University, Durham, NC, USA
| | - Wei Pan
- Duke University School of Nursing, Duke University School of Medicine, Durham, NC
| | - Paula Tanabe
- Duke University School of Nursing, Duke University School of Medicine, Durham, NC
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Ahmadi M, Beiranvand S, Poormansouri S, Matbouei M, Rohani C. Sense of coherence or self-efficacy as predictors of health-related quality of life in sickle cell disease patients. Ann Hematol 2023; 102:519-528. [PMID: 36331567 PMCID: PMC9977875 DOI: 10.1007/s00277-022-05007-2] [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: 08/11/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
Patients with sickle cell disease (SCD) suffer from impaired health-related quality of life (HRQoL). This study aimed to determine the level of HRQoL, sense of coherence (SOC), and self-efficacy (SE) in a sample of SCD patients, and to explore predictors of their physical and mental HRQoL. A cross-sectional descriptive study was conducted on 83 SCD patients of one university hospital. The data of the study was collected through Persian versions of the Short-Form Health Survey SF-36 (RAND 36-item), the Sense of Coherence Scale (SOC-13), and the Sickle Cell Self-Efficacy Scale (SCSES). The mean age of the patients was 26.34 ± 8.19 years old. Patients' mean scores for the Physical Component Summary (PCS), Mental Component Summary (MCS), SOC, and SCSES were 40.57 ± 17.18 (range: 0-100), 50.44 ± 17.95 (range: 0-100), 52.40 ± 15.35 (range: 13-91), 26.40 ± 6.96 (range: 9-45), respectively. Regression models showed that the level of the patients' SOC, was the main predictor of the MCS (β = 0.37, p < 0.001). However, the level of the patients' SE was the main predictor of the PCS (β = 0.30, p = 0.004). Also, "blood transfusion history" in patients was a common predictor for both the PCS (β = - 0.28, p = 0.008) and the MCS (β = - 0.29, p = 0.003). These results can assist nurses and clinicians to plan clinical interventions for SCD patients by focusing on increasing the level of the SOC and SE and improving SCD patients' HRQoL. Furthermore, measuring the level of the SOC and self-efficacy as screening tests are useful to find patients with a greater risk of impaired HRQoL.
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Affiliation(s)
- Mehrnaz Ahmadi
- Medical and Surgical Nursing Department, School of Nursing and Midwifery, Nursing Care Research Center in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Samira Beiranvand
- Medical and Surgical Nursing Department, School of Nursing and Midwifery, Nursing Care Research Center in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Poormansouri
- Treatment Deputy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahsa Matbouei
- Community Health Nursing Department, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,School of Nursing & Midwifery, Semnan University of Medical Sciences, Semnan, Iran
| | - Camelia Rohani
- Department of Health Care Sciences, Palliative Care Center, Marie Cederschiöld Högskola, Campus Ersta, Stigbergsgatan 30, Box 11189, SE-100 61, Stockholm, Sweden.
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Bhalla N, Bhargav A, Yadav SK, Singh AK. Allogeneic hematopoietic stem cell transplantation to cure sickle cell disease: A review. Front Med (Lausanne) 2023; 10:1036939. [PMID: 36910492 PMCID: PMC9995916 DOI: 10.3389/fmed.2023.1036939] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/24/2023] [Indexed: 02/25/2023] Open
Abstract
Sickle cell disease (SCD) had first been mentioned in the literature a century ago. Advancement in the molecular basis of the pathophysiology of the disease opens the door for various therapeutic options. Though life-extending treatments are available for treating patients with SCD, allogeneic hematopoietic stem cell transplantation (HSCT) is the only option as of yet. A major obstacle before HSCT to cure patients with SCD is the availability of donors. Matched sibling donors are available only for a small percentage of patients. To expand the donor pool, different contrasting approaches of allogeneic HSCT like T-cell replete and deplete have been tested. None of those tested approaches have been without the risk of GvHD and graft rejection. Other limitations such as transplantation-related infections and organ dysfunction caused by the harsh conditioning regimen need to be addressed on a priority basis. In this review, we will discuss available allogeneic HSCT approaches to cure SCD, as well as recent advancements to make the approach safer. The center of interest is using megadose T-cell-depleted bone marrow in conjugation with donor-derived CD8 veto T cells to achieve engraftment and tolerance across MHC barriers, under reduced intensity conditioning (RIC). This approach is in phase I/II clinical trial at the MD Anderson Cancer Centre and is open to patients with hemoglobinopathies.
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Affiliation(s)
- Nishka Bhalla
- Centre for Stem Cell Research, Christian Medical College, Vellore, Tamilnadu, India
| | - Anjali Bhargav
- Centre for Stem Cell Research, Christian Medical College, Vellore, Tamilnadu, India
| | | | - Aloukick Kumar Singh
- Centre for Stem Cell Research, Christian Medical College, Vellore, Tamilnadu, India
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Treadwell MJ, Mushiana S, Badawy SM, Preiss L, King AA, Kroner B, Chen Y, Glassberg J, Gordeuk V, Shah N, Snyder A, Wun T. An evaluation of patient-reported outcomes in sickle cell disease within a conceptual model. Qual Life Res 2022; 31:2681-2694. [PMID: 35445915 PMCID: PMC9356962 DOI: 10.1007/s11136-022-03132-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine the relations between patient-reported outcomes (PROs) within a conceptual model for adults with sickle cell disease (SCD) ages 18 - 45 years enrolled in the multi-site Sickle Cell Disease Implementation Consortium (SCDIC) registry. We hypothesized that patient and SCD-related factors, particularly pain, and barriers to care would independently contribute to functioning as measured using PRO domains. METHODS Participants (N = 2054) completed a 48-item survey including socio-demographics and PRO measures, e.g., social functioning, pain impact, emotional distress, and cognitive functioning. Participants reported on lifetime SCD complications, pain episode frequency and severity, and barriers to healthcare. RESULTS Higher pain frequency was associated with higher odds of worse outcomes in all PRO domains, controlling for age, gender and site (OR range 1.02-1.10, 95% CI range [1.004-1.12]). Reported history of treatment for depression was associated with 5 of 7 PRO measures (OR range 1.58-3.28 95% CI range [1.18-4.32]). Fewer individual barriers to care and fewer SCD complications were associated with better outcomes in the emotion domain (OR range 0.46-0.64, 95% CI range [0.34-0.86]). CONCLUSIONS Study results highlight the importance of the biopsychosocial model to enhance understanding of the needs of this complex population, and to design multi-dimensional approaches for providing more effective interventions to improve outcomes.
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Affiliation(s)
- Marsha J Treadwell
- University of California San Francisco Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA, 94609, USA.
| | | | - Sherif M Badawy
- Anne & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Liliana Preiss
- Research Triangle International, Research Triangle Park, NC, USA
| | | | - Barbara Kroner
- Research Triangle International, Research Triangle Park, NC, USA
| | - Yumei Chen
- University of California San Francisco Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA, 94609, USA
| | | | | | | | | | - Theodore Wun
- University of California Davis, Sacramento, CA, USA
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11
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Azul M, Vital EF, Lam WA, Wood DK, Beckman JD. Microfluidic methods to advance mechanistic understanding and translational research in sickle cell disease. Transl Res 2022; 246:1-14. [PMID: 35354090 PMCID: PMC9218997 DOI: 10.1016/j.trsl.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 12/15/2022]
Abstract
Sickle cell disease (SCD) is caused by a single point mutation in the β-globin gene of hemoglobin, which produces an altered sickle hemoglobin (HbS). The ability of HbS to polymerize under deoxygenated conditions gives rise to chronic hemolysis, oxidative stress, inflammation, and vaso-occlusion. Herein, we review recent findings using microfluidic technologies that have elucidated mechanisms of oxygen-dependent and -independent induction of HbS polymerization and how these mechanisms elicit the biophysical and inflammatory consequences in SCD pathophysiology. We also discuss how validation and use of microfluidics in SCD provides the opportunity to advance development of numerous therapeutic strategies, including curative gene therapies.
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Affiliation(s)
- Melissa Azul
- Department of Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - Eudorah F Vital
- Wallace H. Coulter Department of Biomedical Engineering and Institute for Electronics and Nanotechnology, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Wilbur A Lam
- Wallace H. Coulter Department of Biomedical Engineering and Institute for Electronics and Nanotechnology, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - David K Wood
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota
| | - Joan D Beckman
- Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota.
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12
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Jiao B, Basu A, Ramsey S, Roth J, Bender MA, Quach D, Devine B. Health State Utilities for Sickle Cell Disease: A Catalog Prepared From a Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:276-287. [PMID: 35094801 PMCID: PMC8804335 DOI: 10.1016/j.jval.2021.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/27/2021] [Accepted: 08/06/2021] [Indexed: 04/08/2024]
Abstract
OBJECTIVES Sickle cell disease (SCD) is a complex, chronic condition that impairs health-related quality of life of affected individuals and their caregivers. As curative therapies emerge, comprehensive cost-effectiveness models will inform their value. These models will require descriptions of health states and their corresponding utility values that accurately reflect health-related quality of life over the disease trajectory. The objectives of this systematic review were to develop a catalog of health state utility (HSU) values for SCD, identify research gaps, and provide future directions for preference elicitation. METHODS Records were identified through searches of PubMed and Embase, Tufts Medical Center Cost-Effectiveness Analysis Registry, reference lists of relevant articles, and consultation with SCD experts (2008-2020). We removed duplicate records and excluded ineligible studies. For included studies, we summarized the study characteristics, methods used for eliciting HSUs, and HSU values. RESULTS Five studies empirically elicited utilities using indirect methods (EQ-5D) (n = 3) and Short Form-6 Dimension (n = 2); these represent health states associated with general SCD (n = 1), SCD complications (n = 2), and SCD treatments (n = 3). Additionally, we extracted HSUs from 7 quality-adjusted life-years-based outcome research studies. The HSU among patients with general SCD without specifying complications ranged from 0.64 to 0.887. Only 36% of the HSUs used in the quality-adjusted life-year-based outcomes research studies were derived from individuals with SCD. No study estimated HSUs in caregivers. CONCLUSIONS There is a dearth of literature of HSUs for use in SCD models. Future empirical studies should elicit a comprehensive set of HSUs from individuals with SCD and their caregivers.
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Affiliation(s)
- Boshen Jiao
- The Comparative Health Outcomes, Policy, and Economics Institute, University of Washington, Seattle, WA, USA
| | - Anirban Basu
- The Comparative Health Outcomes, Policy, and Economics Institute, University of Washington, Seattle, WA, USA; Department of Health Services, University of Washington, Seattle, WA, USA
| | - Scott Ramsey
- The Comparative Health Outcomes, Policy, and Economics Institute, University of Washington, Seattle, WA, USA; Hutchinson Institute for Cancer Outcomes Research and Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Joshua Roth
- Hutchinson Institute for Cancer Outcomes Research and Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - M A Bender
- Department of Pediatrics, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Dalyna Quach
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Beth Devine
- The Comparative Health Outcomes, Policy, and Economics Institute, University of Washington, Seattle, WA, USA; Department of Health Services, University of Washington, Seattle, WA, USA; Department of Biomedical Informatics, University of Washington, Seattle, WA, USA.
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13
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Rodigari F, Brugnera G, Colombatti R. Health-related quality of life in hemoglobinopathies: A systematic review from a global perspective. Front Pediatr 2022; 10:886674. [PMID: 36090573 PMCID: PMC9452907 DOI: 10.3389/fped.2022.886674] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/18/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Sickle cell disease (SCD) and thalassemia are inherited blood disorders, which can lead to life-threatening events and chronic organ damage. Recent advances in treatments have increased life expectancy, and hemoglobinopathies have become chronic illnesses with social and emotional impairments. Thus, health-related quality of life (HRQOL) assessment has a fundamental role in disease management and treatment, and generic and disease-specific questionnaires are reliable and validated measures to estimate disease burden. The heterogeneous distribution of treatment opportunities worldwide influences physical, social, and emotional disease perception. OBJECTIVES To review publications concerning HRQOL for SCD and thalassemia in different areas of the world in order to gather a global perspective of questionnaires used and outcomes evaluated. METHODS A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Medline databases were searched on 29 September 2021. Inclusion criteria were as follows: (1) studies of HRQOL assessment in SCD and thalassemia patients by using the PROMIS, the SF-36, the SCSES, the PedsQL-SCD, the PedsQOL generic core scale, the ASCQ-Me, and the TranQoL; and (2) every article type, including non-English studies. We excluded studies that were not limited to SCD or thalassemia and studies that were not specific to hemoglobinopathies, and not consistent with the topic of HRQOL assessment. We did not include the gray literature. A total of 102 out of 124 articles from PubMed, Cochrane Library, and Google Scholar were eligible for inclusion (66 SCD articles and 36 thalassemia articles). The quality of studies was assessed through Critical Appraisal tools for use in JBI Systematic Reviews. Data extraction was conducted using a standardized data collection form (authors, year and country of publication, study design, age and number of patients, HRQOL questionnaires, questionnaire language, and clinical outcomes). RESULTS The evaluation of HRQOL was conducted on all continents, but differences in the worldwide frequency of HRQOL assessment were observed. HRQOL of SCD patients was less investigated in Europe. HRQOL of thalassemia patients was less investigated in South-East Asia and Africa. Generic HRQOL questionnaires (PROMIS, SF-36, and PedsQL) were frequently adopted, while disease-specific ones (ASCQ-Me, SCSES for SCD, and TranQoL for thalassemia) were less used. Translation into local languages has been often performed. CONCLUSION Health-related quality of life is a complex outcome that has been increasingly incorporated in clinical research and clinical practice worldwide, although with regional differences. Disease-specific outcomes (pain for SCD and transfusion burden for thalassemia) and healthcare system characteristics, particularly in low-income countries, have an impact on HRQOL and should be considered in healthcare plans.
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Affiliation(s)
- Francesca Rodigari
- Department of Woman's and Child's Health, University of Padova, Padua, Italy
| | - Giorgia Brugnera
- Department of Woman's and Child's Health, University of Padova, Padua, Italy
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14
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Bartlett R, Ramsay Z, Ali A, Grant J, Rankine-Mullings A, Gordon-Strachan G, Asnani M. Health-related quality of life and neuropathic pain in sickle cell disease in Jamaica. Disabil Health J 2021; 14:101107. [PMID: 33867318 DOI: 10.1016/j.dhjo.2021.101107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/02/2021] [Accepted: 04/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Health related quality of Life (HRQOL) is an important consideration when managing chronic diseases, like sickle cell disease (SCD). Assessment of neuropathic pain (NP) and its association with HRQOL in SCD are rarely reported. OBJECTIVES To examine the prevalence of NP and its association with HRQOL in adult Jamaicans with SCD. METHODS Adult SCD patients were recruited consecutively and data were collected on socio-demographics, NP using Douleur Neuropathique 4 (DN4), and HRQOL using the Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me). Means, medians, t-tests, ANOVA tests, Wilcoxon Rank-sum tests, Kruskal-Wallis tests, Pearson's correlation and multivariate linear regression analyses were performed using STATA 14.2. RESULTS There were 236 respondents, with 56.8% female, mean age 33.2 years (SD: 11.6; range: 18-67 years), and 75% had homozygous SS genotype. NP was likely present in 26.7% of the population. The standardized ASCQ-Me (mean ± SD; ordered from lowest to best HRQOL domain scores) were: emotional impact 53.3 ± 10.1; sleep impact 56.1 ± 9.7; social function 57.7 ± 10.6; pain impact 58.6 ± 7.8; and stiffness impact 61.0 ± 7.3. On multivariate analyses, NP significantly reduced emotional and social functioning and worsened sleep and stiffness. Higher acute pain scores significantly worsened all HRQOL domains, while higher disease severity worsened all except stiffness. Obesity was associated with worse sleep and greater stiffness. Females with leg ulcers reported lower social functioning and unemployed females had greater pain impact. CONCLUSIONS NP is increasingly prevalent in SCD and worsens HRQOL. Gender specific studies are needed to understand the significantly poorer HRQOL in women.
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Affiliation(s)
- Rachel Bartlett
- Caribbean Institute for Health Research, The University of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - Zachary Ramsay
- Caribbean Institute for Health Research, The University of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - Amza Ali
- Avicanna Inc., 480 University Ave, Suite 1502, Toronto, ON M5G 1V2, Canada; Department of Medicine, Kingston Public Hospital, Kingston, Jamaica
| | - Justin Grant
- Avicanna Inc., 480 University Ave, Suite 1502, Toronto, ON M5G 1V2, Canada
| | - Angela Rankine-Mullings
- Caribbean Institute for Health Research, The University of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - Georgiana Gordon-Strachan
- Caribbean Institute for Health Research, The University of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - Monika Asnani
- Caribbean Institute for Health Research, The University of the West Indies, Mona Campus, Kingston 7, Jamaica.
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15
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Singh AK, Schetzen E, Yadav SK, Lustig EB, Liu WH, Yadav RK, Gale RP, McGinnis K, Reisner Y. Correction of murine sickle cell disease by allogeneic haematopoietic cell transplantation with anti-3rd party veto cells. Bone Marrow Transplant 2021; 56:1818-1827. [PMID: 33658643 DOI: 10.1038/s41409-021-01237-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/19/2021] [Accepted: 02/02/2021] [Indexed: 11/09/2022]
Abstract
Despite advances in gene therapy allogeneic hematopoietic stem cell transplants (HSCT) remains the most effective way to cure sickle cell disease (SCD). However, there are substantial challenges including lack of suitable donors, therapy-related toxicity (TRM) and risk of graft-versus-host disease (GvHD). Perhaps the most critical question is when to do a transplant for SCD. Safer transplant protocols for HLA-disparate HSCT is needed before transplants are widely accepted for SCD. Although risk of GvHD and TRM are less with T-cell-deplete HSCT and reduced-intensity conditioning (RIC), transplant rejection is a challenge. We have reported graft rejection of T cell-depleted non-myeloablative HSCT can be overcome in wild type fully mis-matched recipient mice, using donor-derived anti-3rd party central memory CD8-positive veto cells combined with short-term low-dose rapamycin. Here, we report safety and efficacy of this approach in a murine model for SCD. Durable donor-derived chimerism was achieved using this strategy with reversal of pathological parameters of SCD, including complete conversion to normal donor-derived red cells, and correction of splenomegaly and the levels of circulating reticulocytes, hematocrit, and hemoglobin.
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Affiliation(s)
- Aloukick Kumar Singh
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elias Schetzen
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sandeep Kumar Yadav
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Esther Bachar Lustig
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wei-Hsin Liu
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Raj Kumar Yadav
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Kathryn McGinnis
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yair Reisner
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,CPRIT Scholar in Cancer Research, Houston, TX, USA.
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16
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Rodday AM, Esham KS, Savidge N, Parsons SK. Clusters of pain trajectories among patients with sickle cell disease hospitalized for vaso-occlusive crisis: a data-driven approach. EJHAEM 2020; 1:426-437. [PMID: 33709084 PMCID: PMC7941740 DOI: 10.1002/jha2.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Vaso-occlusive crises (VOC) are the hallmark of sickle cell disease (SCD), with higher severity among hospitalized patients. Clustering hospitalizations with similar pain trajectories could identify vulnerable patient subgroups. Aims were to (1) identify clusters of hospitalizations based on pain trajectories; (2) identify factors associated with these clusters; and (3) determine the association between these clusters and 30-day readmissions. METHODS We retrospectively included 350 VOC hospitalizations from 2013-2016 among 59 patients. Finite mixture modeling identified clusters of hospitalizations from intercepts and slopes of pain trajectories during the hospitalization. Generalized estimating equations for multinomial and logistic models were used to identify factors associated with clusters of hospitalizations based on pain trajectories and 30-day readmissions, respectively, while accounting for multiple hospitalizations per patient. RESULTS Three clusters of hospitalizations based on pain trajectories were identified: slow (n=99), moderate (n=207), and rapid (n=44) decrease in pain scores. In multivariable analysis, SCD complications, female gender, and affective disorders were associated with clusters with slow or moderate decrease in pain scores (compared to rapid decrease). Although univariate analysis found that the cluster with moderate decrease in pain scores was associated with lower odds of 30-day readmissions compared to the cluster with slow decrease, it was non-significant in multivariable analysis. SCD complications were associated with higher odds of 30-day readmissions and older age was associated with lower odds of 30-day readmissions. CONCLUSIONS Our results highlight variability in pain trajectories among patients with SCD experiencing VOC and provide a novel approach for identifying subgroups of patients that could benefit from more intensive follow-up.
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Affiliation(s)
- Angie Mae Rodday
- The Institute for Clinical Research and Health Policy StudiesTufts Medical CenterBostonMassachusetts
| | - Kimberly S. Esham
- Division of Hematology/OncologyTufts Medical CenterBostonMassachusetts
| | - Nicole Savidge
- The Institute for Clinical Research and Health Policy StudiesTufts Medical CenterBostonMassachusetts
| | - Susan K. Parsons
- The Institute for Clinical Research and Health Policy StudiesTufts Medical CenterBostonMassachusetts
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Singh SA, Bakshi N, Mahajan P, Morris CR. What is the future of patient-reported outcomes in sickle-cell disease? Expert Rev Hematol 2020; 13:1165-1173. [PMID: 33034214 DOI: 10.1080/17474086.2020.1830370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Sickle cell disease (SCD) is a complex, chronic disease caused by abnormal polymerization of hemoglobin, which leads to severe pain episodes, fatigue, and end-organ damage. Patient reported outcomes (PROs) have emerged as a critical tool for measuring SCD disease severity and response to treatment. AREAS COVERED Authors review the key issues involved when deciding to use a PRO in a clinical trial. We describe the most highly recommended generic and disease-specific PRO tools in SCD and discuss the challenges of incorporating them in clinical practice. EXPERT OPINION PRO measures are essential to incorporate into SCD clinical trials either as primary or secondary outcomes. The use of PRO measures in SCD facilitates a patient-centered approach, which is likely to lead to improved outcomes. Significant challenges remain in adapting PRO tools to routine clinical use and in developing countries.
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Affiliation(s)
- Sharon A Singh
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Michigan Medical School , Ann Arbor, MI, USA
| | - Nitya Bakshi
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University School of Medicine , Atlanta, GA, USA.,Department of Pediatrics, Children's Healthcare of Atlanta , Atlanta, GA, USA
| | - Prashant Mahajan
- Department of Emergency Medicine and Pediatrics, University of Michigan Medical School , Ann Arbor, MI, USA
| | - Claudia R Morris
- Department of Pediatrics, Children's Healthcare of Atlanta , Atlanta, GA, USA.,Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine , Atlanta, GA, USA
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18
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Rodday AM, Esham KS, Savidge N, Parsons SK. Patterns of healthcare utilization among patients with sickle cell disease hospitalized with pain crises. ACTA ACUST UNITED AC 2020; 1:438-447. [PMID: 34350423 PMCID: PMC8330517 DOI: 10.1002/jha2.84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Vaso‐occlusive crises (VOC) are the hallmark of sickle cell disease (SCD). Adults experiencing VOC often have high rates of unexpected healthcare utilization. We characterized prior and future healthcare utilization among adults hospitalized with VOC at an urban, academic medical center. Methods We identified 449 VOC hospitalizations among 63 patients from 2013 to 2016. Patients were categorized based on receiving established care at the medical center and prior utilization: (a) not established (n = 21); (b) newly established (n = 10); (c) established with low utilization in past 12 months (<4 VOC hospitalizations) (n = 22); and (d) established with high utilization in past 12 months (≥4 VOC hospitalizations) (n = 10). Patient and hospitalization characteristics and future utilization were compared across categories. Results Median age was 26 years (Q1 = 22, Q3 = 29) and 55.6% were female. Established patients with high prior utilization tended to have higher median pain scores at admission (10, P = .08). Thirty‐day readmissions were highest in established patients with high prior utilization (P = .06), but 30‐day clinic visits were highest in established patients with low prior utilization (P = .08). Adjusted linear regression found that newly established patients (β = −4.6, P < .01) and established patients with low prior utilization (β = −5.6, P < .01) had fewer VOC hospitalizations in the ensuing 12 months than established patients with high prior utilization. Conclusion Among patients with SCD hospitalized for VOC, there was heterogeneity in healthcare utilization, with persistence in utilization over time for some patients. Efforts are needed to shift care from the acute setting to the outpatient clinic, which may lead to improved outcomes.
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Affiliation(s)
- Angie Mae Rodday
- Tufts Medical Center, The Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts, USA.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Kimberly S Esham
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.,Tufts Medical Center, Hematology and Oncology, Boston, Massachusetts, USA
| | - Nicole Savidge
- Tufts Medical Center, The Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts, USA
| | - Susan K Parsons
- Tufts Medical Center, The Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts, USA.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.,Tufts Medical Center, Hematology and Oncology, Boston, Massachusetts, USA
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