1
|
Räder J, Ihorst G, Möller MD, Pahl A, Greil C, Dreyling E, Arends J, Deibert P, Wäsch R, Engelhardt M. Physical activity and exercise motivation of multiple myeloma patients: a prospective cross-sectional study. Oncologist 2024:oyae111. [PMID: 38955491 DOI: 10.1093/oncolo/oyae111] [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: 02/28/2024] [Accepted: 04/26/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Multiple myeloma (MM) is the second most common hematological malignancy with its prevalence increasing. Patients with symptomatic MM can show numerous comorbidities, affecting their quality of life (QoL). Physical activity (PA) may improve QoL but is not a standardized intervention of comprehensive cancer centers (CCCs). Since data on the PA of patients with MM are scarce, we aimed to prospectively assess fitness levels and patients' motivation to join PA-interventions at our CCC. METHODS We generated an exercise questionnaire to interview consecutive patients MM. We prospectively collected data on (a) past and current PA, defined by the World Health Organization (WHO) recommendations, (b) knowledge on exercise effects, (c) exercise motivation, and (d) willingness to participate in PA-interventions. Demographics, comorbidities, response, progression-free survival (PFS), and overall survival (OS) were assessed in 211 symptomatic patients MM. RESULTS While our patients were elderly and most showed bone involvement, their PA was similar to healthy individuals. Aerobic PA (≥ 60 minutes/week) was performed by 65%, and 25% exercised ≥ 150 minutes/week. WHO PA recommendations were fulfilled by 17% of patients. No sport activities or complete physical inactivity were observed in 35% and 16%, respectively. Notably, 38% were motivated to join MM-specific sport interventions. Self-reported knowledge of PA-induced benefits for patients cancer was high (82%), but only 27% knew which exercises were safe to perform. CONCLUSION This study provides an overview of the PA of patients MM. Our results suggest that the PA of patients MM might not be much lower than in the age-matched general population.
Collapse
Affiliation(s)
- Jan Räder
- Department of Medicine I Hematology and Oncology, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Comprehensive Cancer Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, Biometry and Statistics, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Mandy-Deborah Möller
- Department of Medicine I Hematology and Oncology, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Comprehensive Cancer Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Antonia Pahl
- Department of Medicine I Hematology and Oncology, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Christine Greil
- Department of Medicine I Hematology and Oncology, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Comprehensive Cancer Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Esther Dreyling
- Department of Medicine I Hematology and Oncology, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Comprehensive Cancer Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Jann Arends
- Department of Medicine I Hematology and Oncology, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Comprehensive Cancer Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Peter Deibert
- Department of Medicine, Medical Center University of Freiburg, Faculty of Medicine, Institute for Exercise and Occupational Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Ralph Wäsch
- Department of Medicine I Hematology and Oncology, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Comprehensive Cancer Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Monika Engelhardt
- Department of Medicine I Hematology and Oncology, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Comprehensive Cancer Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Clinical Trials Unit, Biometry and Statistics, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| |
Collapse
|
2
|
Polomeni A, Bordessoule D, Malak S. Multidisciplinary team meetings in Hematology: a national mixed-methods study. BMC Cancer 2023; 23:950. [PMID: 37805458 PMCID: PMC10560417 DOI: 10.1186/s12885-023-11431-y] [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: 12/03/2022] [Accepted: 09/21/2023] [Indexed: 10/09/2023] Open
Abstract
Multidisciplinary team meetings are a current international practice in cancer care, but to date, few data exist on the specificity of its practice in hematology.In this manuscript, we present the result of the first national study, realized with quantitative and qualitative methods in France, which brings new insights in order to improve the collegial decision-making process.To improve the effectiveness of MDTMs, the needs to focus on complex cases, to enhance patient centeredness and teamwork are relevant aspects, and a specific focus on hematological particularities is warranted to truly improve process.Background Understanding the Multidisciplinary team meetings (MDTMs) process in different medical specialties facilitates the identification of core factors supporting effective MDTM work. Our mixed-methods study explores the participants' perceptions of hematology MDTMs.Design Online questionnaires collected data concerning the decision-making process, benefits and inconveniences of MDTMs for both patients and professionals. Semi-directive phone interviews were conducted and analyzed, thereby supplying qualitative data.Results A total of 205 professionals responded to the questionnaire and 22 participated in the qualitative interviews. The data indicate the unique characteristics of hematology, including a specific definition of collegiality, the frequent solicitation of expert advice and the anticipation of treatment even prior to the occurrence of MDTMs. Additional information concerning patients' wishes and psychosocial conditions are also needed. Participants emphasize the subjective aspects and the impact of the climate of MDTMs on medical decisions.Conclusion Although MDTMs are recognized to be a valuable tool, organizational and relational issues may interfere with their efficiency.To improve the effectiveness of MDTMs, the needs to focus on complex cases, to enhance patient centeredness and teamwork are relevant aspects. A specific focus on hematological particularities might be warranted to truly improve the collegial decision-making process in the context of hematology.
Collapse
Affiliation(s)
- Alice Polomeni
- Clinical Hematology and Cellular Therapy Department, Hôpital Saint-Antoine - Assistance Publique- Hôpitaux de Paris, 184 Rue du Fbg Saint Antoine, 75012, Paris, France.
- Ethics Commission of the French Society of Hematology, Grenoble, France.
| | - Dominique Bordessoule
- Ethics Commission of the French Society of Hematology, Grenoble, France
- Hematology Department, Centre Hospitalo-Universitaire de Limoges, 2 Avenue Martin Luther King, 87000, Limoges, France
| | - Sandra Malak
- Ethics Commission of the French Society of Hematology, Grenoble, France
- Hematology Department of Institut Curie Hospital, Institut Curie-Saint-Cloud, 35 Rue Dailly, 92210, Saint-Cloud, France
| |
Collapse
|
3
|
Frank B, Ihorst G, Herget G, Schäfer H, Neubauer J, Calba MA, Textor D, Möller MD, Wenger S, Jung J, Waldschmidt J, Miething C, Rassner M, Greil C, Wäsch R, Engelhardt M. Multidisciplinary tumor board analysis: validation study of a central tool in tumor centers. Ann Hematol 2023; 102:603-611. [PMID: 36464695 PMCID: PMC9734518 DOI: 10.1007/s00277-022-05051-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Abstract
The established standard to ensure state-of-the-art cancer treatment is through multidisciplinary tumor boards (TBs), although resource- and time-intensive. In this validation study, the multiple myeloma (MM)-TB was reexamined, aiming to validate our previous (2012-2014) results, now using the TB data from March 2020 to February 2021. We assessed MM-TB protocols, physicians' documentation, patient, disease, remission status, progression-free survival (PFS), and overall survival (OS) as left-truncated survival times. Moreover, TB-adherence, level of evidence according to grade criteria, time requirements, study inclusion rates, and referral satisfaction were determined. Within a 1-year period, 312 discussed patients were documented in 439 TB protocols. Patient and disease characteristics were typical for comprehensive cancer centers. The percentages of patients discussed at initial diagnosis (ID), with disease recurrence or in need of interdisciplinary advice, were 39%, 28%, and 33%, respectively. Reasons for the MM-TB presentation were therapeutic challenges in 80% or staging/ID-defining questions in 20%. The numbers of presentations were mostly one in 73%, two in 20%, and three or more in 7%. The TB adherence rate was 93%. Reasons for non-adherence were related to patients' decisions or challenging inclusion criteria for clinical trials. Additionally, we demonstrate that with the initiation of TBs, that the number of interdisciplinarily discussed patients increased, that TB-questions involve advice on the best treatment, and that levels of compliance and evidence can be as high as ≥ 90%. Advantages of TBs are that they may also improve patients', referrers', and physicians' satisfaction, inclusion into clinical trials, and advance interdisciplinary projects, thereby encouraging cancer specialists to engage in them.
Collapse
Affiliation(s)
- Benedikt Frank
- grid.5963.9Department of Internal Medicine I, Focus On Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstraße 53, 79106 Freiburg, Baden-Württemberg Germany
| | - Gabriele Ihorst
- grid.5963.9Clinical Trials Unit, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Georg Herget
- Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany ,grid.5963.9Clinic for Orthopedics and Trauma Surgery, Department of Surgery, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Henning Schäfer
- Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany ,grid.5963.9Clinic for Radiotherapeutics, University of Freiburg, Freiburg, Germany
| | - Jakob Neubauer
- Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany ,grid.5963.9Department of Radiology, University of Freiburg, Freiburg, Germany
| | - Marc-Antoine Calba
- Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany ,grid.5963.9Pathology, University of Freiburg, Freiburg, Germany
| | - Daniel Textor
- Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
| | - Mandy-Deborah Möller
- grid.5963.9Department of Internal Medicine I, Focus On Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstraße 53, 79106 Freiburg, Baden-Württemberg Germany ,Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
| | - Sina Wenger
- grid.5963.9Department of Internal Medicine I, Focus On Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstraße 53, 79106 Freiburg, Baden-Württemberg Germany ,Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
| | - Johannes Jung
- grid.5963.9Department of Internal Medicine I, Focus On Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstraße 53, 79106 Freiburg, Baden-Württemberg Germany ,Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
| | - Johannes Waldschmidt
- grid.5963.9Department of Internal Medicine I, Focus On Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstraße 53, 79106 Freiburg, Baden-Württemberg Germany ,Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
| | - Cornelius Miething
- grid.5963.9Department of Internal Medicine I, Focus On Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstraße 53, 79106 Freiburg, Baden-Württemberg Germany ,Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
| | - Michael Rassner
- grid.5963.9Department of Internal Medicine I, Focus On Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstraße 53, 79106 Freiburg, Baden-Württemberg Germany ,Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
| | - Christine Greil
- grid.5963.9Department of Internal Medicine I, Focus On Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstraße 53, 79106 Freiburg, Baden-Württemberg Germany ,Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
| | - Ralph Wäsch
- grid.5963.9Department of Internal Medicine I, Focus On Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstraße 53, 79106 Freiburg, Baden-Württemberg Germany ,Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
| | - Monika Engelhardt
- Department of Internal Medicine I, Focus On Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstraße 53, 79106, Freiburg, Baden-Württemberg, Germany. .,Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany.
| |
Collapse
|
4
|
Gengenbach L, Graziani G, Reinhardt H, Rösner A, Braun M, Möller MD, Greil C, Wäsch R, Engelhardt M. Choosing the Right Therapy for Patients with Relapsed/Refractory Multiple Myeloma (RRMM) in Consideration of Patient-, Disease- and Treatment-Related Factors. Cancers (Basel) 2021; 13:4320. [PMID: 34503130 PMCID: PMC8430818 DOI: 10.3390/cancers13174320] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/13/2021] [Accepted: 08/24/2021] [Indexed: 02/02/2023] Open
Abstract
Treatment of relapsed/refractory multiple myeloma (RRMM) is more complex today due to the availability of novel therapeutic options, mostly applied as combination regimens. immunotherapy options have especially increased substantially, likewise the understanding that patient-, disease- and treatment-related factors should be considered at all stages of the disease. RRMM is based on definitions of the international myeloma working group (IMWG) and includes biochemical progression, such as paraprotein increase, or symptomatic relapse with CRAB criteria (hypercalcemia, renal impairment, anemia, bone lesions). When choosing RRMM-treatment, the biochemical markers for progression and severity of the disease, dynamic of disease relapse, type and number of prior therapy lines, including toxicity and underlying health status, need to be considered, and shared decision making should be pursued. Objectively characterizing health status via geriatric assessment (GA) at each multiple myeloma (MM) treatment decision point has been shown to be a better estimate than via age and comorbidities alone. The well-established national comprehensive cancer network, IMWG, European myeloma network and other national treatment algorithms consider these issues. Ideally, GA-based clinical trials should be supported in the future to choose wisely and efficaciously from available intervention and treatment options in often-older MM adults in order to further improve morbidity and mortality.
Collapse
|