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Hisert KB, Birket SE, Clancy JP, Downey DG, Engelhardt JF, Fajac I, Gray RD, Lachowicz-Scroggins ME, Mayer-Hamblett N, Thibodeau P, Tuggle KL, Wainwright CE, De Boeck K. Understanding and addressing the needs of people with cystic fibrosis in the era of CFTR modulator therapy. THE LANCET. RESPIRATORY MEDICINE 2023; 11:916-931. [PMID: 37699420 DOI: 10.1016/s2213-2600(23)00324-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/07/2023] [Accepted: 08/20/2023] [Indexed: 09/14/2023]
Abstract
Cystic fibrosis is a multiorgan disease caused by impaired function of the cystic fibrosis transmembrane conductance regulator (CFTR). Since the introduction of the CFTR modulator combination elexacaftor-tezacaftor-ivacaftor (ETI), which acts directly on mutant CFTR to enhance its activity, most people with cystic fibrosis (pwCF) have seen pronounced reductions in symptoms, and studies project marked increases in life expectancy for pwCF who are eligible for ETI. However, modulator therapy has not cured cystic fibrosis and the success of CFTR modulators has resulted in immediate questions about the new state of cystic fibrosis disease and clinical challenges in the care of pwCF. In this Series paper, we summarise key questions about cystic fibrosis disease in the era of modulator therapy, highlighting state-of-the-art research and clinical practices, knowledge gaps, new challenges faced by pwCF and the potential for future health-care challenges, and the pressing need for additional therapies to treat the underlying genetic or molecular causes of cystic fibrosis.
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Affiliation(s)
| | - Susan E Birket
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Damian G Downey
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - John F Engelhardt
- Department of Anatomy and Cell Biology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Isabelle Fajac
- Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Robert D Gray
- Institution of Regeneration and Repair, Centre for Inflammation Research, The University of Edinburgh, Edinburgh, UK
| | | | - Nicole Mayer-Hamblett
- Department of Pediatrics, Department of Biostatistics, Seattle Children's Research Institute, University of Washington, Seattle, WA, USA
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2
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Oates GR, Schechter MS. Aiming to Improve Equity in Pulmonary Health: Cystic Fibrosis. Clin Chest Med 2023; 44:555-573. [PMID: 37517835 PMCID: PMC10458995 DOI: 10.1016/j.ccm.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
This review summarizes the evidence of health disparities in cystic fibrosis (CF), an autosomal recessive genetic disorder with substantial variation in disease progression and outcomes. We review disparities by race, ethnicity, socioeconomic status, geographic location, gender identity, or sexual orientation documented in the literature. We outline the mechanisms that generate and perpetuate such disparities across levels and domains of influence and assess the implications of this evidence. We then recommend strategies for improving equity in CF outcomes, drawing on recommendations for the general population and considering approaches specific to people living with CF.
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Affiliation(s)
- Gabriela R Oates
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Michael S Schechter
- Division of Pulmonary Medicine, Department of Pediatrics, Virginia Commonwealth University and Children's Hospital of Richmond at VCU, Richmond, VA, USA
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3
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Basile MJ, Dhingra L, DiFiglia S, Polo J, Portenoy R, Wang J, Walker P, Middour-Oxler B, Linnemann RW, Kier C, Friedman D, Berdella M, Abdullah R, Yonker LM, Markovitz M, Hadjiliadis D, Shiffman M, Fischer F, Pollinger S, Hardcastle M, Chaudhary N, Georgiopoulos AM. Development of a Cystic Fibrosis Primary Palliative Care Intervention: Qualitative Analysis of Patient and Family Caregiver Preferences. J Patient Exp 2023; 10:23743735231161486. [PMID: 36936380 PMCID: PMC10021085 DOI: 10.1177/23743735231161486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
To prevent or mitigate chronic illness burden, people with cystic fibrosis (pwCF) and their family caregivers need primary (generalist-level) palliative care from the time of diagnosis forward. We used qualitative methods to explore their preferences about a screening-and-triage model ("Improving Life with CF") developed to standardize this care. We purposively sampled and interviewed 14 pwCF and caregivers from 5 Improving Life with CF study sites. Thematic analysis was guided by a priori codes using the National Consensus Project's Guidelines for Quality Palliative Care. Participants included 7 adults and 2 adolescents with CF (3 with advanced disease), 4 parents, 1 partner (7 women; 5 people of color). Few were familiar with palliative care. Illness burden was described in multiple domains, including physical (e.g., dyspnea, pain), psychological (e.g., anxiety), and social (e.g., family well-being; impact on work/school). Most preferred survey-based screening with care coordination by the CF team. Preferences for screening approaches varied. PwCF and caregivers experience illness burden and are receptive to a CF-team delivered primary palliative care screening-and-triage model with flexible processes.
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Affiliation(s)
- Melissa J Basile
- Feinstein Institutes for Medical Research, Northwell Health, New
York, NY, USA
- Melissa J Basile, Center for Health
Innovations and Outcomes Research, Feinstein Institutes for Medical Research,
Northwell Health, New York, NY, USA.
| | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, NY,
USA
- Department of Family and Social Medicine,
Albert Einstein
College of Medicine, Bronx, NY, USA
| | | | - Jennifer Polo
- Feinstein Institutes for Medical Research, Northwell Health, New
York, NY, USA
| | - Russell Portenoy
- MJHS Institute for Innovation in Palliative Care, New York, NY,
USA
- Department of Family and Social Medicine, Department of Neurology,
Albert Einstein
College of Medicine, Bronx, NY, USA
| | - Janice Wang
- Division of Pulmonary, Critical Care and Sleep Medicine,
Donald and
Barbara Zucker School of Medicine at
Hofstra/Northwell, New Hyde Park, NY, USA
| | - Patricia Walker
- Department of Pulmonary Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Brandi Middour-Oxler
- Division of Pulmonary, Asthma, Cystic Fibrosis and Sleep, Department
of Pediatrics, Emory
University, Atlanta, GA, USA
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta,
GA, USA
| | - Rachel W Linnemann
- Division of Pulmonary, Asthma, Cystic Fibrosis and Sleep, Department
of Pediatrics, Emory
University, Atlanta, GA, USA
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta,
GA, USA
| | - Catherine Kier
- Department of Pediatrics, Stony Brook University Medical
Center, Stony Brook, NY, USA
| | - Deborah Friedman
- Department of Psychiatry, Massachusetts General
Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical
School, Boston, MA, USA
| | - Maria Berdella
- Department of Pulmonary Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Robert Abdullah
- Department of Pediatrics, Stony Brook University Medical
Center, Stony Brook, NY, USA
| | - Lael M Yonker
- Department of Psychiatry, Massachusetts General
Hospital, Boston, MA, USA
- Pulmonary Division, Massachusetts General Hospital for Children,
Boston, MA, USA
| | - Martha Markovitz
- Keck Medicine of University of Southern California, Los Angeles,
California, USA (retired)
| | - Denis Hadjiliadis
- Division of Pulmonary and Critical Care Medicine, Department of
Medicine, Hospital of
the University of Pennsylvania,
Philadelphia, PA, USA
| | | | | | - Sophie Pollinger
- Department of Pediatrics, Massachusetts General
Hospital, Boston, MA, USA
| | - Margot Hardcastle
- Department of Pediatrics, Massachusetts General
Hospital, Boston, MA, USA
| | - Nivedita Chaudhary
- Department of Pediatrics, Massachusetts General
Hospital, Boston, MA, USA
| | - Anna M Georgiopoulos
- Department of Psychiatry, Massachusetts General
Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical
School, Boston, MA, USA
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4
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Guimbellot JS, Nichols DP, Brewington JJ. Novel Applications of Biomarkers and Personalized Medicine in Cystic Fibrosis. Clin Chest Med 2022; 43:617-630. [PMID: 36344070 DOI: 10.1016/j.ccm.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
As routine care in cystic fibrosis (CF) becomes increasingly personalized, new opportunities to further focus care on the individual have emerged. These opportunities are increasingly filled through research in tools aiding drug selection, drug monitoring and titration, disease-relevant biomarkers, and evaluation of therapeutic benefits. Herein, we will discuss such research tools presently being translated into the clinic to improve the personalization of care in CF.
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Affiliation(s)
- Jennifer S Guimbellot
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham; 1600 7th Avenue South, ACC 620, Birmingham, AL 35233, USA
| | - David P Nichols
- Department of Pediatrics, Division of Pulmonary Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Building Cure, 1920 Terry Avenue, Office 4-209, Seattle, WA 98109, USA
| | - John J Brewington
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2021, Cincinnati, OH 45229, USA.
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5
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Oubaya N, Pombet T, Delestrain C, Remus N, Douvry B, Grenet D, Corvol H, Thouvenin G, Prulière-Escabasse V, Mounir H, Argoud D, Fretigne C, Costes L, Mackiewicz MP, Jung C, Ahamada L, Lanone S, Maitre B, Bégot AC, Epaud R. Impact of the COVID-19 pandemic and associated lockdown measures on the management, health, and behavior of the cystic fibrosis population in France during 2020 (MUCONFIN). Front Public Health 2022; 10:978627. [PMID: 36452951 PMCID: PMC9703073 DOI: 10.3389/fpubh.2022.978627] [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: 06/26/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background Most of the studies on cystic fibrosis (CF) focused on SARS-CoV-2 prevalence and suggested a low incidence of infection in this population. We aimed to assess the impact of the pandemic and related lockdown measures implemented in May 2020 in response to the first wave of SARS-CoV-2 infection on healthcare access, health, and behavior in CF patients. Methods A national questionnaire opened online from May 15th, 2020 to June 11th, 2020 was completed by 751 CF-patients, aged 14 years and over. It comprised questions about access to healthcare, anxiety and depression, smoking, alcohol, drug and psychotropic drug consumption, adherence to CF treatment, and constraints. A semi-structured comprehensive interview was performed no later than 1 month after the end of the lockdown in 16 CF-patients. Results The mean age of the population was 28.0 [interquartile range (IQR) 20.0-37.0] years old. More than 75% of in-person consultations scheduled during the lockdown were canceled. Alternatively, 27% were postponed, and telehealth consultations were proposed and accepted in almost 40% of cases. More than 75% of the scheduled physiotherapy sessions were canceled and replaced mainly by self-drainage. Annual follow-up clinic visits were consistently postponed whereas required hospitalizations at CF centers for exacerbation were maintained in most cases. While 43.2% CF-patients had signs of anxiety, 51.0% presented symptoms of depression, both associated with increased use of psychotic medications and inversely correlated to COVID-19 prevalence. Among the lower and lower middle classes, very little medical information was obtained or requested by the patient, participation to sports or other activities was low, while excessive home confinement and isolation were more frequent. In contrast, in the upper middle and upper classes, individuals solicitated help to their CF centre, had more physical activities, and maintained contact with friends or families. Conclusion The first lockdown in France had only minimal impact on the management care of CF-patients but was associated with increased symptoms of anxiety and depression, together with behavioral changes that varied with social class. Trial registration NCT04463628.
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Affiliation(s)
- Nadia Oubaya
- Department of Public Health, AP-HP, Hôpitaux Henri-Mondor, Créteil, France,University Paris Est Créteil, INSERM, IMRB, Créteil, France
| | - Thibaud Pombet
- Laboratoire Interdisciplinaire de Recherche sur les Transformations des Pratiques Éducatives et des Pratiques Sociales (LIRTES)-EA7313, Université Paris-Est Créteil Val-de-Marne, Créteil, France,Faculté d'Éducation et de Formation, Institut Catholique de Paris (ICP), Paris, France
| | - Celine Delestrain
- University Paris Est Créteil, INSERM, IMRB, Créteil, France,Centre Hospitalier Intercommunal de Créteil, Service de Pédiatrie Générale, Créteil, France,Centre des Maladies Respiratoires Rares (RESPIRARE), CRCM, Créteil, France,Fédérations Hospitalo-Universitaires (FHU) Role of SENEscence in Chronic Diseases (SENEC), Créteil, France
| | - Natascha Remus
- Centre Hospitalier Intercommunal de Créteil, Service de Pédiatrie Générale, Créteil, France,Centre des Maladies Respiratoires Rares (RESPIRARE), CRCM, Créteil, France
| | - Benoit Douvry
- Centre des Maladies Respiratoires Rares (RESPIRARE), CRCM, Créteil, France,Centre Hospitalier Intercommunal de Créteil, Service de Pneumologie, Créteil, France
| | - Dominique Grenet
- Service de Pneumologie, CRCM-Centre de Transplantation Pulmonaire, Hôpital Foch, Suresnes, France
| | - Harriet Corvol
- Assistance Publique-Hôpitaux de Paris, Hôpital Trousseau, Pediatric Pulmonary Department, Paris, France,Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Centre de Recherche Saint Antoine, Paris, France
| | - Guillaume Thouvenin
- Assistance Publique-Hôpitaux de Paris, Hôpital Trousseau, Pediatric Pulmonary Department, Paris, France
| | - Virginie Prulière-Escabasse
- University Paris Est Créteil, INSERM, IMRB, Créteil, France,Centre des Maladies Respiratoires Rares (RESPIRARE), CRCM, Créteil, France,Centre Hospitalier Intercommunal de Créteil, Service d'ORL, Créteil, France
| | - Hakima Mounir
- Laboratoire Interdisciplinaire de Recherche sur les Transformations des Pratiques Éducatives et des Pratiques Sociales (LIRTES)-EA7313, Université Paris-Est Créteil Val-de-Marne, Créteil, France
| | - Dominique Argoud
- Laboratoire Interdisciplinaire de Recherche sur les Transformations des Pratiques Éducatives et des Pratiques Sociales (LIRTES)-EA7313, Université Paris-Est Créteil Val-de-Marne, Créteil, France
| | - Cédric Fretigne
- Laboratoire Interdisciplinaire de Recherche sur les Transformations des Pratiques Éducatives et des Pratiques Sociales (LIRTES)-EA7313, Université Paris-Est Créteil Val-de-Marne, Créteil, France
| | - Laurence Costes
- Laboratoire Interdisciplinaire de Recherche sur les Transformations des Pratiques Éducatives et des Pratiques Sociales (LIRTES)-EA7313, Université Paris-Est Créteil Val-de-Marne, Créteil, France
| | - Marie-Pierre Mackiewicz
- Laboratoire Interdisciplinaire de Recherche sur les Transformations des Pratiques Éducatives et des Pratiques Sociales (LIRTES)-EA7313, Université Paris-Est Créteil Val-de-Marne, Créteil, France
| | - Camille Jung
- Clinical Research Centre, Intercommunal Hospital of Créteil, Créteil, France
| | - Laitissia Ahamada
- Clinical Research Centre, Intercommunal Hospital of Créteil, Créteil, France
| | - Sophie Lanone
- University Paris Est Créteil, INSERM, IMRB, Créteil, France,Centre des Maladies Respiratoires Rares (RESPIRARE), CRCM, Créteil, France,Fédérations Hospitalo-Universitaires (FHU) Role of SENEscence in Chronic Diseases (SENEC), Créteil, France
| | - Bernard Maitre
- University Paris Est Créteil, INSERM, IMRB, Créteil, France,Centre des Maladies Respiratoires Rares (RESPIRARE), CRCM, Créteil, France,Fédérations Hospitalo-Universitaires (FHU) Role of SENEscence in Chronic Diseases (SENEC), Créteil, France,Centre Hospitalier Intercommunal de Créteil, Service de Pneumologie, Créteil, France
| | - Anne-Cécile Bégot
- Laboratoire Interdisciplinaire de Recherche sur les Transformations des Pratiques Éducatives et des Pratiques Sociales (LIRTES)-EA7313, Université Paris-Est Créteil Val-de-Marne, Créteil, France
| | - Ralph Epaud
- University Paris Est Créteil, INSERM, IMRB, Créteil, France,Centre Hospitalier Intercommunal de Créteil, Service de Pédiatrie Générale, Créteil, France,Centre des Maladies Respiratoires Rares (RESPIRARE), CRCM, Créteil, France,Fédérations Hospitalo-Universitaires (FHU) Role of SENEscence in Chronic Diseases (SENEC), Créteil, France,*Correspondence: Ralph Epaud
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Integrative pan cancer analysis reveals the importance of CFTR in lung adenocarcinoma prognosis. Genomics 2022; 114:110279. [DOI: 10.1016/j.ygeno.2022.110279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/30/2021] [Accepted: 01/31/2022] [Indexed: 11/19/2022]
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Nowakowski A“XCH, Balasa G“E, Figueira MF, LaRosa F“TJ, Lawlor JMJ. Coming Full Circle: Reflections and Inspirations from a Cystic Fibrosis Patient Scientist Panel. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221086921. [PMID: 35420504 PMCID: PMC9016558 DOI: 10.1177/00469580221086921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Care for many progressive chronic diseases continues to improve, allowing
patients to survive and thrive for longer periods of time1. People
living with such conditions may now find themselves able to achieve long-term
goals in education and career development2. Many people now occupy
the dual roles of scientist and patient3. This commentary article
synthesizes experiences of scientists and advocates with the progressive genetic
disease cystic fibrosis (CF) who collaborated on a career development session
for the Cystic Fibrosis Foundation’s inaugural ResearchCon event in 2019. It
explores how such collaborations affirm and transform individual perspectives on
patient science and its importance in broader scientific research agenda
setting. We first share our own individual insights about the experience and
impact of the ResearchCon panel session before progressing to discussion and
future directions centering the shared insights from one another’s
reflections.
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Affiliation(s)
| | | | - Miriam F. Figueira
- Cystic Fibrosis Research and Treatment Center, University of North Carolina, Chapel Hill, NC, USA
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