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Bulut FD, Seydaoğlu G, Kor D, Kılavuz S, Boz A, Önenli Mungan N. Perspectives of adult patients with lysosomal storage diseases on the transition from pediatric to adult healthcare in Turkey. Arch Pediatr 2023; 30:450-454. [PMID: 37331832 DOI: 10.1016/j.arcped.2023.04.006] [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: 10/07/2022] [Revised: 03/13/2023] [Accepted: 04/29/2023] [Indexed: 06/20/2023]
Abstract
AIM In many countries, adult clinics specifically dedicated to adult patients with lysosomal storage diseases (LSDs) do not exist. In Turkey, these patients are managed either by pediatric metabolic specialists or adult physicians who do not specifically specialize in LSDs. In this study, we aimed to identify the unmet clinical needs of these adult patients and their suggestions. METHODS The focus group participants were 24 adult LSD patients. Interviews were conducted in person. RESULTS A total of 23 LSD patients and parents of a patient with mucopolysaccharidosis type-3b with intellectual deficit were interviewed, with 84.6% of patients diagnosed after the age of 18 years and 18% of patients diagnosed before the age of 18 years desiring management by adult physicians. Patients with particular physical characteristics or severe intellectual deficit declined the transition. Patients reported structural problems in the hospital and social problems associated with pediatric clinics. They made suggestions to facilitate the possible transition. CONCLUSION With improved care, more patients with LSDs survive into adulthood or receive the diagnosis in adulthood. Children with chronic diseases need to transition to the care of adult physicians when they reach adulthood. Thus, there is an increasing need for adult physicians to manage these patients. In this study, most LSD patients accepted a well-planned and organized transition. Problems were related to stigmatization and social isolation in the pediatric clinic or adult issues with which pediatricians are not familiar. There is a need for adult metabolic physicians. Thus, health authorities should adopt necessary regulations for training of physicians in this field.
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Affiliation(s)
- Fatma Derya Bulut
- Çukurova University, Pediatric Metabolism and Nutrition Department, Adana, Turkey.
| | | | - Deniz Kor
- Çukurova University, Pediatric Metabolism and Nutrition Department, Adana, Turkey
| | - Sebile Kılavuz
- Başakşehir Çam ve Sakura City Research and Education Hospital, Pediatric Metabolism Department, İstanbul, Turkey
| | - Aslı Boz
- Çukurova University, Biostatistics Department, Adana, Turkey
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Guffon N, Genevaz D, Lacombe D, Le Peillet Feuillet E, Bausson P, Noel E, Maillot F, Belmatoug N, Jaussaud R. Understanding the challenges, unmet needs, and expectations of mucopolysaccharidoses I, II and VI patients and their caregivers in France: a survey study. Orphanet J Rare Dis 2022; 17:448. [PMID: 36564803 PMCID: PMC9786416 DOI: 10.1186/s13023-022-02593-2] [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: 06/24/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Mucopolysaccharidoses (MPS) are a group of inherited lysosomal storage diseases caused by defective enzyme activity involved in the catalysis of glycosaminoglycans. Published data on adult patients with MPS remains scarce. Therefore, the present qualitative survey study was aimed at understanding knowledge of the disease, unmet needs, expectations, care, and overall medical management of adult/adolescent patients with MPS I, II and VI and their caregivers in France. RESULTS A total of 25 patients (MPS I, np = 11; MPS II, np = 9; MPS VI, np = 5) were included and about 36 in-depth interviews (caregivers alone, nc = 8; patients-caregiver pair, nc+p = 22; patients alone, np = 6) were conducted. Except one (aged 17 years), all patients were adults (median age: 29 years [17-50]) and diagnosed at median age of 4 years [0.4-30], with mainly mothers as caregivers (nc = 16/19). Patients were classified into three groups: Group A, Patients not able to answer the survey question because of a severe cognitive impairment (np = 8); Group B, Patients able to answer the survey question with low or no cognitive impairment and high motor disability (np = 10); and Group C, Patients able to answer the survey question with low or no cognitive impairment and low motor disability (np = 7). All groups were assessed for impact of disease on their daily lives based on a scale of 0-10. Caregivers in Group A were found to be most negatively affected by the disease, except for professional activity, which was most significantly impacted in Group B (4.7 vs. 5.4). The use of orthopaedic/medical equipments, was more prevalent in Groups A and B, versus Group C. Pain management was one of the global unmet need expressed by all groups. Group A caregivers expected better support from childcare facilities, disability clinics, and smooth transition from paediatric care to adult medicine. Similarly, Group B caregivers expected better specialised schools, whereas Group C caregivers expected better psychological support and greater flexibility in weekly infusion schedules for their patients. CONCLUSIONS The survey concluded that more attention must be paid to the psychosocial status of patients and caregivers. The preference for reference centre for follow-up and treatment, hospitalizations and surgeries were evident. The most significant needs expressed by the patients and caregivers include better understanding of the disease, pain management, monitoring of complications, flexibility in enzyme replacement therapy, home infusions especially for attenuated patients, and improved transitional support from paediatric to adult medicine.
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Affiliation(s)
- Nathalie Guffon
- grid.413852.90000 0001 2163 3825Reference Center for Inherited Metabolic Disorders of Lyon, (CERLYMM), Hospices Civils de Lyon, 69677 Bron, France
| | | | - Didier Lacombe
- grid.42399.350000 0004 0593 7118Medical Genetics Unit, University Hospital of Bordeaux, INSERM U1211, 33076 Bordeaux, France
| | | | - Pascale Bausson
- Study Department, AplusA Company, 92641 Boulogne Billancourt, France
| | - Esther Noel
- grid.412220.70000 0001 2177 138XUniversity Hospital of Strasbourg, BP 426, 67100 Strasbourg, France
| | - François Maillot
- grid.411167.40000 0004 1765 1600Department of Internal Medicine, Regional University Hospital of Tours, 37000 Tours, France
| | - Nadia Belmatoug
- grid.411599.10000 0000 8595 4540Reference Center of Lysosomal Diseases, Beaujon Hospital, 92110 Clichy, France
| | - Roland Jaussaud
- grid.410527.50000 0004 1765 1301Department of Internal Medicine and Clinical Immunology, Nancy University Hospital, 54500 Vandoeuvre-Les-Nancy, France
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Koto Y, Ueki S, Yamakawa M, Sakai N. Experiences of patients with lysosomal storage disorders who are receiving enzyme-replacement therapy and the experiences of their family members: a qualitative systematic review. JBI Evid Synth 2022; 20:1474-1510. [PMID: 34839313 DOI: 10.11124/jbies-21-00074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review was to investigate the experiences of patients with lysosomal storage disorders who are receiving enzyme-replacement therapy and the experiences of their family members. INTRODUCTION Lysosomal storage disorders are rare diseases caused by mutations in the genes that encode proteins required for lysosomal function. The age of onset of these disorders varies from infancy to adulthood, depending on the specific disease and type. Enzyme-replacement therapy is the standard treatment for some lysosomal storage disorders. However, patients' adherence to this treatment is affected not only by the resultant changes (or lack thereof) in their symptoms, but also by the scheduling of the frequent hospital visits necessary to receive this treatment. No previous qualitative systematic review has examined the experiences of these patients and their families. INCLUSION CRITERIA Qualitative studies on the experiences of patients with lysosomal storage disorders who were receiving enzyme-replacement therapy and/or the experiences of the family members of these patients were included. These experiences could include satisfaction/dissatisfaction with diagnosis, difficulties and expectations regarding continuing treatment, advantages/disadvantages concerning school and work life, the psychological burden on families, and the support provided by families. This review considered studies in all settings because relevant experiences may occur outside medical institutions. METHODS MEDLINE, CINAHL Plus, APA PsycINFO, Scopus, and Igaku Chuo Zasshi were searched for articles published between January 1991 and May 13, 2021. No language restrictions were applied. The study selection, critical appraisal, data extraction, and data synthesis were performed in accordance with the JBI methodology for systematic reviews of qualitative evidence. RESULTS Seven studies were included in this review, from which 37 findings with narrative illustrations were extracted; of these, 33 were assessed as unequivocal and four as credible. These findings were integrated into 10 categories and three synthesized findings. The first synthesized finding was encouraging awareness of the minor changes in physical symptoms caused by the treatment, which contains categories such as physical change caused by treatment. The second synthesized finding was supporting acceptance of the disease and coping with associated psychological challenges, which contains categories such as concerns regarding the future. The third synthesized finding was customization of treatment plans to minimize restrictions on the lives of patients and their families, which contains categories such as restrictions on patients' lives. According to the ConQual criteria, all three synthesized findings had low confidence levels. CONCLUSION Evidence obtained through the synthesized findings produced in this review identified the primary experiences of patients with lysosomal storage disorders who are receiving enzyme-replacement therapy and their family members. These experiences concerned challenges regarding physical, psychological, and social health. When supporting patients with lysosomal storage disorders and their families, it is necessary to consider not only the symptoms and treatments but also the mental and social aspects. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019147751.
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Affiliation(s)
- Yuta Koto
- Child Healthcare and Genetic Science Laboratory, Division of Health Science, Graduate School of Medicine, Osaka University, Osaka, Japan
- Department of Nursing, Faculty of Health Science, Osaka Aoyama University, Osaka, Japan
- The Japan Centre for Evidence Based Practice: A JBI Affiliated Group, Osaka, Japan
| | - Shingo Ueki
- The Japan Centre for Evidence Based Practice: A JBI Affiliated Group, Osaka, Japan
- Faculty of Medical Sciences, Department of Health Sciences, Kyushu University, Fukuoka, Japan
| | - Miyae Yamakawa
- The Japan Centre for Evidence Based Practice: A JBI Affiliated Group, Osaka, Japan
- Department of Evidence-Based Clinical Nursing, Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Norio Sakai
- Child Healthcare and Genetic Science Laboratory, Division of Health Science, Graduate School of Medicine, Osaka University, Osaka, Japan
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Pérez-Núñez P, Lázaro E, Amayra I, López-Paz JF, Caballero P, Martínez O, Pérez M, Berrocoso S, Al-Rashaida M, García M, Rodríguez AA, Luna PM. Music therapy and Sanfilippo syndrome: an analysis of psychological and physiological variables of three case studies. Orphanet J Rare Dis 2021; 16:486. [PMID: 34801065 PMCID: PMC8605530 DOI: 10.1186/s13023-021-02123-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 11/06/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction Mucopolysaccharidosis type III (MPS III) or Sanfilippo syndrome is a neurodegenerative disease caused by the accumulation of mucopolysaccharides in the body. As the symptoms are wide ranging, it is a challenge to provide a diagnosis and psychological treatment for affected children. Method The main objective of this study was to describe a form of music therapy treatment applied to three children diagnosed with MPS III. The psychological variables were evaluated by an ad hoc observation recording template, and the physiological variables were measured with a digital meter before and after each session. The perception of the parents was also considered through a semi-structured interview. Results An improvement in the psychological variables was shown in all cases. Changes in the physiological variables were also noted, although they varied according to each child. The parents report some benefit of music therapy and they share difficulty in assessing the extent of benefits of the music therapy. Discussion Findings indicate that music therapy can be a useful form of treatment with multiple benefits for children with conditions such as MPS III or similar conditions. However, further research is needed in this area and in the development of specific ways of evaluating music therapy.
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Affiliation(s)
- P Pérez-Núñez
- Department of Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain.
| | - E Lázaro
- Department of Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - I Amayra
- Department of Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - J F López-Paz
- Department of Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - P Caballero
- Department of Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - O Martínez
- Department of Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - M Pérez
- Department of Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - S Berrocoso
- Department of Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - M Al-Rashaida
- Department of Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - M García
- Department of Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - A A Rodríguez
- Department of Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - P M Luna
- Department of Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
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Koto Y, Ueki S, Yamakawa M, Sakai N. Experiences of patients with lysosomal storage disorders treated with enzyme replacement therapy: a qualitative systematic review protocol. JBI Evid Synth 2020; 19:702-708. [PMID: 33165172 DOI: 10.11124/jbies-20-00017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The objective of the review is to investigate the experiences of patients with lysosomal storage disorders treated with enzyme replacement therapy and the experiences of their families. INTRODUCTION Lysosomal storage disorders are rare diseases caused by mutations in genes encoding proteins required for lysosomal function. The onset of lysosomal storage disorders vary from infancy to adulthood, depending on the specific disease and disease type. Enzyme replacement therapy is the standard treatment for some lysosomal storage disorders. The adherence to the treatment by patients and their families is affected not only by the symptoms but also by the scheduling of hospital visits. No qualitative systematic review on this topic has examined the experiences of patients and their families. INCLUSION CRITERIA Qualitative studies dealing with the experiences of patients with lysosomal storage disorders receiving enzyme replacement therapy and their families will be included. These may include experiences related to satisfaction or dissatisfaction with being diagnosed, difficulties and expectations continuing treatment, the advantages or disadvantages related to school and work life, and the psychological burden and supports on families. This review will consider studies in all settings because relevant experiences of patients and their families may occur outside medical institutions. METHODS MEDLINE, CINAHL Plus, APA PsycINFO, Scopus, and Igaku Chuo Zasshi databases will be examined from 1991 to the present. Studies published in any language will be included. The study selection, critical appraisal, data extraction, and data synthesis will be performed in accordance with the guidelines for systematic reviews of qualitative evidence in the JBI Manual for Evidence Synthesis. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019147751.
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Affiliation(s)
- Yuta Koto
- Child Healthcare and Genetic Science Laboratory, Department of Children and Women's Health, Division of Health Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shingo Ueki
- Faculty of Nursing, Mukogawa Women's University, Nishinomiya, Japan.,The Japan Centre for Evidence Based Practice: A JBI Affiliated Group, Osaka, Japan
| | - Miyae Yamakawa
- The Japan Centre for Evidence Based Practice: A JBI Affiliated Group, Osaka, Japan.,Department of Evidence-Based Clinical Nursing, Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Norio Sakai
- Child Healthcare and Genetic Science Laboratory, Department of Children and Women's Health, Division of Health Science, Graduate School of Medicine, Osaka University, Osaka, Japan
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Eisengart JB, King KE, Shapiro EG, Whitley CB, Muenzer J. The nature and impact of neurobehavioral symptoms in neuronopathic Hunter syndrome. Mol Genet Metab Rep 2019; 22:100549. [PMID: 31890590 PMCID: PMC6931227 DOI: 10.1016/j.ymgmr.2019.100549] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 12/06/2019] [Accepted: 12/10/2019] [Indexed: 12/25/2022] Open
Abstract
In neuronopathic Hunter syndrome, neurobehavioral symptoms are known to be serious but have been incompletely described. While families face significant stress stemming from this complex and far-reaching array of symptoms, neither caregiver burden nor the neurobehavioral symptoms have been measured comprehensively. We delineated these neurobehavioral characteristics and their impact on the caregiver using multiple approaches. Methods: As part of the initial phase of developing a Hunter-specific behavioral assessment tool, we used multiple methods to obtain data on patient behaviors and caregiver burden, with the intention of drafting item sets for the tool. We utilized 1) caregiver descriptions from focus groups and individual interviews, 2) observations from video-recorded play of affected children, 3) descriptions from historic chart review, 4) consultation with patient advocacy groups and international experts, 5) reports from a caregiver advisory board, and 6) literature review. Results: Neurobehavioral symptoms were diverse and categorized as focus/attention, impulsivity/heightened activity, sensation seeking, emotional/behavioral function, social interaction, and sleep. A significant reported challenge was susceptibility to misinterpretation of some behaviors as defiant or aggressive, particularly if physical. Caregiver burden involved social isolation, exhaustion, stress, and financial and vocational strain. These new descriptions will aid in developing quantitative measures of change in neurobehavioral symptoms and family burden. These descriptions will be the foundation of a neurobehavioral rating scale, which is very much needed to aid in patient management and assess interventions for individuals with neuronopathic Hunter syndrome.
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Affiliation(s)
- J B Eisengart
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - K E King
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - E G Shapiro
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.,Shapiro Neuropsychology Consulting, LLC, Portland, OR, USA
| | - C B Whitley
- Department of Experimental and Clinical Pharmacology and Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - J Muenzer
- Division of Genetics and Metabolism, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Morrison A, Oussoren E, Friedel T, Cruz J, Yilmaz N. Pathway to diagnosis and burden of illness in mucopolysaccharidosis type VII - a European caregiver survey. Orphanet J Rare Dis 2019; 14:254. [PMID: 31727109 PMCID: PMC6854616 DOI: 10.1186/s13023-019-1233-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 10/22/2019] [Indexed: 12/27/2022] Open
Abstract
Background Mucopolysaccharidosis type VII (Sly disease, MPS VII), is an ultra-rare, multi-symptom disease with variable clinical presentations which can present challenges with diagnosis, management and care. We believe this survey is the first to explore the patient experience through direct questioning of the caregivers of 13 individuals with MPS VII. Methods This European survey, using a specifically designed questionnaire, was conducted in order to describe the pathway to diagnosis and the burden of illness of MPS VII. Information on early symptoms, clinicians seen, and current symptoms was collected. Questions on the caregivers’ ability to work and the use and availability of health, social and educational support were included. Results Caregivers of 13 patients from Germany, Spain, The Netherlands and Turkey responded to the survey. Five patients with non-immune hydrops fetalis (NIHF) were diagnosed with MPS VII at a mean age of 1.9 years (median 0.3 years, range 0.2 to 6 years). Those without NIHF (n = 7) were diagnosed at a mean age of 6.1 years (median 6.0 years, range 1.9 to 14 years). The symptoms most likely to raise a suspicion of MPS VII, excluding NIHF, did not appear until a median age of at least three years. Over one half of patients required assistance with daily living and mobility. Reduction of the working hours of caregivers was often necessary (46.2% reduced hours, 30.8% stopped working). Patients attended frequent medical appointments (12.7/year), over 80% had surgery and 30% had been hospitalised for respiratory issues. While support for learning and behavioural needs was generally available, support for mobility was not available to 50% of patients. Half of the respondents (6/12) said they were not offered genetic counselling. Conclusions For children that do not present with NIHF, diagnosis can take several years as early symptoms can be non-specific and mistaken for other conditions. Increased awareness of the early signs of disease and more information for parents/caregivers at diagnosis are needed. MPS VII poses significant burden to patients, caregivers, healthcare, social and educational services. Access to information and support varies across Europe and the availability of genetic counselling is limited in some countries.
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Affiliation(s)
- Alexandra Morrison
- MPS Commercial, MPS House, Repton Place, White Lion Road, Amersham, HP7 9LP, UK.
| | - Esmee Oussoren
- Center for Lysosomal and Metabolic Diseases, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2060, 3000, CB, Rotterdam, The Netherlands
| | - Tabea Friedel
- Gesellschaft für Mukopolysaccharidosen e.V, Herstallstrasse 35, 63739, Aschaffenburg, Germany
| | - Jordi Cruz
- Asociación MPS España, Anslem Clavé 1, 08787 La Pobla de Claramunt, Barcelona, Spain
| | - Nalan Yilmaz
- MPS LH Derneği, Hakimiyeti Milliye cad, No: 58 Vedat Kadri Kancal iş merkezi 46/A, Űskűdar, Istanbul, Turkey
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