1
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Seo A, Chang AY. A systematic review of the social impact of diseases in Nordic countries. Scand J Public Health 2024:14034948231217365. [PMID: 38166481 DOI: 10.1177/14034948231217365] [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: 01/04/2024]
Abstract
BACKGROUND We review the literature on the social impacts of diseases, defined as the social consequences of having a disease on the people around the patient, such as spouses, caregivers and offspring. The two objectives of this study are to summarise the social outcomes commonly associated with diseases and to compare the social impact across a range of diseases. METHODS A systematic review of the social impact of disease in Nordic countries was conducted using PubMed, PsycINFO and Google Scholar (PROSPERO registration number CRD42022291796). All articles that met the inclusion criteria were reviewed. We tabulated all outcomes and diseases studied, and synthesised the evidence based on the perspectives of patients, spouse/caregiver and offspring. RESULTS A total of 135 studies met the eligibility criteria, covering 76 diseases and 39 outcomes. From the patient's perspective, diseases impact divorce and marriage rates, social functioning, likelihood of committing a crime and being a victim of crime. From the caregiver's perspective, diseases affect their health-related quality of life and physical and psychological health. From the offspring's perspective, diseases impact their development, health and social adversities in later life. Diseases generally had negative social impacts, but there were some diseases associated with positive impacts. CONCLUSIONS The review provides a useful summary and gross comparison of the social impact of different diseases. The social impact of diseases can be large and significant. Thus, it should be considered when policymakers are setting priorities across disease areas.
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Affiliation(s)
- Ahreum Seo
- Department of Public Health, University of Southern Denmark, Denmark
| | - Angela Y Chang
- Danish Institute for Advanced Study, University of Southern Denmark, Denmark
- Department of Clinical Research, University of Southern Denmark, Denmark
- Interdisciplinary Centre on Population Dynamics (CPop), University of Southern Denmark, Denmark
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2
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Nicol JL, Woodrow C, Cunningham BJ, Mollee P, Weber N, Smith MD, Nicol AJ, Gordon LG, Hill MM, Skinner TL. An Individualized Exercise Intervention for People with Multiple Myeloma—Study Protocol of a Randomized Waitlist-Controlled Trial. Curr Oncol 2022; 29:901-923. [PMID: 35200576 PMCID: PMC8870457 DOI: 10.3390/curroncol29020077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
People with multiple myeloma (MM) are second only to people with lung cancer for the poorest reported health-related quality of life (HRQoL) of all cancer types. Whether exercise can improve HRQoL in MM, where bone pain and lesions are common, requires investigation. This trial aims to evaluate the efficacy of an exercise intervention compared with control on HRQoL in people with MM. Following baseline testing, people with MM (n = 60) will be randomized to an exercise (EX) or waitlist control (WT) group. EX will complete 12-weeks of supervised (24 sessions) and unsupervised (12 sessions) individualized, modular multimodal exercise training. From weeks 12–52, EX continue unsupervised training thrice weekly, with one optional supervised group-based session weekly from weeks 12–24. The WT will be asked to maintain their current activity levels for the first 12-weeks, before completing the same protocol as EX for the following 52 weeks. Primary (patient-reported HRQoL) and secondary (bone health and pain, fatigue, cardiorespiratory fitness, muscle strength, body composition, disease response, and blood biomarkers) outcomes will be assessed at baseline, 12-, 24- and 52-weeks. Adverse events, attendance, and adherence will be recorded and cost-effectiveness analysis performed. The findings will inform whether exercise should be included as part of standard myeloma care to improve the health of this unique population.
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Affiliation(s)
- Jennifer L. Nicol
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane 4072, Australia; (B.J.C.); (A.J.N.); (T.L.S.)
- QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia; (L.G.G.); (M.M.H.)
- Correspondence:
| | - Carmel Woodrow
- Haematology, Division of Cancer, Princess Alexandra Hospital, Brisbane 4102, Australia; (C.W.); (P.M.)
| | - Brent J. Cunningham
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane 4072, Australia; (B.J.C.); (A.J.N.); (T.L.S.)
| | - Peter Mollee
- Haematology, Division of Cancer, Princess Alexandra Hospital, Brisbane 4102, Australia; (C.W.); (P.M.)
- Faculty of Medicine, The University of Queensland, Brisbane 4006, Australia
| | - Nicholas Weber
- Haematology, Cancer Care Services, Royal Brisbane and Women’s Hospital, Brisbane 4006, Australia;
| | - Michelle D. Smith
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia;
| | - Andrew J. Nicol
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane 4072, Australia; (B.J.C.); (A.J.N.); (T.L.S.)
- Brisbane Clinic for Lymphoma, Myeloma and Leukaemia, Greenslopes Private Hospital, Brisbane 4120, Australia
| | - Louisa G. Gordon
- QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia; (L.G.G.); (M.M.H.)
- Faculty of Medicine, The University of Queensland, Brisbane 4006, Australia
- Palliative Care Outcomes Centre, School of Nursing and Cancer, Queensland University of Technology, Brisbane 4059, Australia
| | - Michelle M. Hill
- QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia; (L.G.G.); (M.M.H.)
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane 4006, Australia
| | - Tina L. Skinner
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane 4072, Australia; (B.J.C.); (A.J.N.); (T.L.S.)
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Pierantoni F, Maruzzo M, Bimbatti D, Finotto S, Marino D, Galiano A, Basso U, Zagonel V. High dose chemotherapy followed by autologous hematopoietic stem cell transplantation for advanced germ cell tumors: State of the art and a single-center experience. Crit Rev Oncol Hematol 2021; 169:103568. [PMID: 34890801 DOI: 10.1016/j.critrevonc.2021.103568] [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: 04/07/2021] [Revised: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Evidence for the choice of second line, standard vs high dose chemotherapy, (SDCT, HDCT) for patients with relapsed germ cell tumors (GCTs) comes mainly from retrospective studies. MATERIAL AND METHODS relevant literature was reviewed, considering as endpoints both survival and long term quality of life (QoL). Patients with metastatic GCT progressing after first-line treatment at our Institution were retrospectively evaluated. RESULTS HDCT seems to achieve a higher rate of long-term remissions. QoL data for this group of patients are lacking. Our experience on 29 patients was in line with these results. Two-year OS for the 18 patients treated with one or two HDCT/PBSCT procedures was 47.5 %, while 2-year PFS was 44 %. For the 11 receiving SDCT 2-year OS was 36.4 %, and 2-year PFS was 32.7 %. CONCLUSIONS HDCT/PBSCT confirmed to be effective in treating patients with relapsed GCT, but prospective studies are needed.
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Affiliation(s)
| | - Marco Maruzzo
- Oncologia 1, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Davide Bimbatti
- Oncologia 1, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Silvia Finotto
- Oncologia 1, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Dario Marino
- Oncologia 1, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | | | - Umberto Basso
- Oncologia 1, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
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Li X, Liu J, Chen M, Gu J, Huang B, Zheng D, Li J. Health-related quality of life of patients with multiple myeloma: A real-world study in China. Cancer Med 2020; 9:7896-7913. [PMID: 32881377 PMCID: PMC7643654 DOI: 10.1002/cam4.3391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/30/2020] [Accepted: 07/30/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose This study aimed to assess the health‐related quality of life (HRQOL) of Chinese patients with different stages of multiple myeloma (MM) who received various treatments and identify the factors associated with a lower quality of life in China. Methods A cross‐sectional, anonymous questionnaire was distributed to adults with MM. The measures of quality of life included the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ)‐C30, QLQ‐myeloma‐specific module 20 (MY20), and EuroQoL EQ‐5D. The data, including patient factors, difficulties experienced during the diagnosis and treatment processes, psychosocial factors and disease‐ or treatment‐related effects, were collected. Results Four hundred and thirty patients with MM were recruited from all 27 provinces of China, and their average age was 55.7 years. Many variables were significantly associated with the HRQOL of the patients with MM. In the multivariate analyses, performance status, psychosocial factors, disease phase, and an early diagnosis were significantly associated with the HRQOL. In the subgroup analysis, the HRQOL of the patients who underwent autologous stem cell transplantation (ASCT) was significantly higher than that of the non‐ASCT patients. Treatment‐related toxicities had a significant impact on the quality of life of the patients with MM, and 91.5% of the patients intended to stop the maintenance treatment. Conclusions The quality of life of patients with MM in China is affected by patient factors, difficulties experienced during the diagnosis and treatment processes, psychosocial factors, and disease‐ or treatment‐related effects. Efforts should be exerted to improve the overall quality of life of these patients in China.
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Affiliation(s)
- Xiaozhe Li
- Department of Haematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Junru Liu
- Department of Haematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Meilan Chen
- Department of Haematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jingli Gu
- Department of Haematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Beihui Huang
- Department of Haematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dong Zheng
- Department of Haematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Juan Li
- Department of Haematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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5
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Larsen RF, Jarden M, Minet LR, Frølund UC, Möller S, Abildgaard N. Physical function in patients newly diagnosed with multiple myeloma; a Danish cohort study. BMC Cancer 2020; 20:169. [PMID: 32126972 PMCID: PMC7055017 DOI: 10.1186/s12885-020-6637-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/17/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Multiple myeloma is a cancer in the bone marrow causing bone destruction. Patients experience various symptoms related to the disease and/or treatment, such as pain and fatigue, leading to poorer quality of life. The symptom burden might affect physical function and physical activity levels, posing a risk of physical deterioration. The aim was to investigate whether physical function in newly diagnosed patients with multiple myeloma differs from the reference values of the normal population and other cancer patients. METHODS The study is a cross sectional descriptive analysis of a prospective cohort of 100 patients newly diagnosed with multiple myeloma. Four physical function tests were carried out; Six-Minute-Walk-Test, Sit-to-Stand-Test, grip strength and knee extension strength. Age and gender specific results of physical function from the multiple myeloma population were compared to normative data and to data from other cancer populations. RESULTS Of the 100 patients included, 73% had bone disease and 55% received pain relieving medicine. Mean age was 67.7 years (SD 10.3). Patients with multiple myeloma had significantly poorer physical function compared to normative data, both regarding aerobic capacity and muscle strength, although not grip strength. No differences in physical function were found between patients with multiple myeloma and other cancer populations. CONCLUSIONS Physical function in newly diagnosed Danish patients with multiple myeloma is lower than in the normal population. Exercise intervention studies are warranted to explore the value of physical exercise on physical function. TRIAL REGISTRATION ClinicalTrials.gov, ID NCT02439112, registered 8 May 2015.
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Affiliation(s)
- Rikke Faebo Larsen
- Department of Physiotherapy and Occupational Therapy, Zealand University Hospital, Roskilde, Denmark. .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark. .,OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
| | - Mary Jarden
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lisbeth Rosenbek Minet
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Rehabilitation, Odense University Hospital, Odense, Denmark.,Health Science Research Centre, UCL University College, Odense, Denmark
| | | | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Niels Abildgaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Haematology, Odense University Hospital, Odense, Denmark.,The Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
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6
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Strategies to improve patient-reported outcome completion rates in longitudinal studies. Qual Life Res 2019; 29:335-346. [PMID: 31549365 PMCID: PMC6994453 DOI: 10.1007/s11136-019-02304-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2019] [Indexed: 01/01/2023]
Abstract
Purpose The quality of patient-reported outcome (PRO) data can be compromised by non-response (NR) to scheduled questionnaires, particularly if reasons for NR are related to health problems, which may lead to unintended bias. The aim was to investigate whether electronic reminders and real-time monitoring improve PRO completion rate. Methods The population-based study “Quality of life in Danish multiple myeloma patients” is a longitudinal, multicentre study with consecutive inclusion of treatment-demanding newly diagnosed or relapsed patients with multiple myeloma. Education of study nurses in the avoidance of NR, electronic reminders, 7-day response windows and real-time monitoring of NR were integrated in the study. Patients complete PRO assessments at study entry and at 12 follow-up time points using electronic or paper questionnaires. The effect of the electronic reminders and real-time monitoring were investigated by comparison of proportions of completed questionnaires before and after each intervention. Results The first 271 included patients were analysed; of those, 249 (85%) chose electronic questionnaires. Eighty-four percent of the 1441 scheduled PRO assessments were completed within the 7-day response window and 11% after real-time monitoring, achieving a final PRO completion rate of 95%. A significant higher proportion of uncompleted questionnaires were completed after the patients had received the electronic reminder and after real-time monitoring. Conclusions Electronic reminders and real-time monitoring contributed to a very high completion rate in the study. To increase the quality of PRO data, we propose integrating these strategies in PRO studies, however highlighting that an increase in staff resources is required for implementation.
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7
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Martino M, Rossi M, Ferreri A, Loteta B, Morabito A, Moscato T, Console G, Innao V, Naso V, Provenzano PF, Recchia AG, Gentile M. Quality of life outcomes in multiple myeloma patients: a summary of recent clinical trials. Expert Rev Hematol 2019; 12:665-684. [PMID: 31251688 DOI: 10.1080/17474086.2019.1634541] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Management of multiple myeloma (MM) has improved over recent years. Health-related quality of life (HRQoL) data is becoming increasingly important, owing to improved survival outcomes. Areas covered: The authors performed an expert review of the literature to identify evidence-based data available on HRQoL in frontline and relapsed/refractory MM (RRMM) patients. Expert opinion: De-novo patients should be informed that the HRQoL is expected to improve during first-line treatment with different degrees of possible deterioration during the first cycles. Achievement of a maximal response should be strongly considered, particularly in the frontline setting, but must also be balanced with tolerability, HRQoL, and patient preferences. The same degree of improvement in HRQoL cannot be expected during conventional relapse treatments, where patients should be prepared only for stabilization of HRQoL. However, focusing attention only on measures such as toxicity may provide just a partial view of overall treatment effectiveness. Nonetheless, the authors believe the added value of taking into consideration the patient's perspectives and the importance of patient-reported outcomes in the evaluation of treatment effects should be considered mandatory. The incorporation of quality of life assessment into clinical and research practice has the potential of improving treatment outcomes.
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Affiliation(s)
- Massimo Martino
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Marco Rossi
- b Department of Experimental and Clinical Medicine, Magna Græcia University , Catanzaro , Italy
| | - Anna Ferreri
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Barbara Loteta
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Antonella Morabito
- c Pharmacy Unit, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Tiziana Moscato
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Giuseppe Console
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Vanessa Innao
- d Division of Hematology, Department of Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina , Messina , Italy
| | - Virginia Naso
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Pasquale Fabio Provenzano
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Anna Grazia Recchia
- e Department of Hematology, Unità di Ricerca Biotecnologica (URB) , Cosenza , Italy
| | - Massimo Gentile
- f Hematology Unit, Department of Hemato-Oncology, Ospedale Annunziata , Cosenza , Italy
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Nair CK, Selvaraj K, Raghavan V, A M, Shenoy PK, Kurup AR, Duraisamy K, Shringarpure K, Venugopal V. Limiting factors for autologous transplantation among transplant-eligible multiple myeloma patients: Lesson from a Tertiary Cancer Centre in rural India. Leuk Res 2019; 83:106167. [PMID: 31200146 DOI: 10.1016/j.leukres.2019.106167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 12/22/2022]
Abstract
There is limited data from low and middle income countries on the exact proportion of Myeloma patients undergoing transplant even if they are eligible for the same. In this retrospective analysis of all newly diagnosed transplant eligible Myeloma treated between January 2011 to June 2017, number of patients undergoing transplant were recorded and among those not opting for transplant, reasons for the same were noted. Among 89 eligible patients, 23 (26%) patients could undergo transplantation. Most common reasons for not undergoing transplant were fear of the complications in 42 (47%) and financial reasons in 41 (46%) of patients. The transplanted group had better progression free survival when compared against the non-transplanted group (3 year PFS of 80% versus 36%, HR = 0.09, 95%CI 0.02-0.4, p = 0.001). Future studies may be conducted to arrive at measures, for correcting the transplant related concerns and fears, through psycho-social interventions.
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Affiliation(s)
- Chandran K Nair
- Department of Clinical Hematology and Medical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India.
| | - Kalaiselvi Selvaraj
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India
| | - Vineetha Raghavan
- Department of Clinical Hematology and Medical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India
| | - Manuprasad A
- Department of Clinical Hematology and Medical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India
| | - Praveen Kumar Shenoy
- Department of Clinical Hematology and Medical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India
| | - Anju R Kurup
- Department of Clinical Hematology and Medical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India
| | | | - Kalpita Shringarpure
- Department of Preventive and Social Medicine, Medical College Baroda, Vadodara, Gujarat, India
| | - Vinayagamoorthy Venugopal
- Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
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9
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Seitzler S, Finley-Oliver E, Simonelli C, Baz R. Quality of life in multiple myeloma: considerations and recommendations. Expert Rev Hematol 2019; 12:419-424. [DOI: 10.1080/17474086.2019.1613886] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Samantha Seitzler
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Elizabeth Finley-Oliver
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Christine Simonelli
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Rachid Baz
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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10
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Nielsen LK, Abildgaard N, Jarden M, Klausen TW. Methodological aspects of health-related quality of life measurement and analysis in patients with multiple myeloma. Br J Haematol 2019; 185:11-24. [PMID: 30656677 DOI: 10.1111/bjh.15759] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Multiple myeloma (MM) is an incurable but treatment-sensitive cancer. For most patients, this means treatment with multiple lines of anti-myeloma therapy and a life with disease- and treatment-related symptoms and complications. Health-related quality of life (HRQoL) issues play an important role in treatment decision-making. Methodological challenges in longitudinal HRQoL measurements and analyses have been identified, including non-responses (NR) to scheduled questionnaires. Publications were identified for inclusion in a systematic review of longitudinal HRQoL studies in MM, focussing on methodological aspects of HRQoL measurement and analysis. Diversity in timing of HRQoL data collection and applied statistical methods were noted. We observed a high rate of NR, but the impact of NR was investigated in only 8/23 studies. Thus, evidence-based knowledge of HRQoL in patients with MM is compromised. To improve quality of HRQoL results and their implementation in daily practice, future studies should follow established guidelines.
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Affiliation(s)
- Lene Kongsgaard Nielsen
- Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark.,The Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Niels Abildgaard
- Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark.,The Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Mary Jarden
- Department of Haematology, Copenhagen University Hospital, Copenhagen, Denmark
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11
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Nielsen LK, Klausen TW, Jarden M, Frederiksen H, Vangsted AJ, Do T, Kristensen IB, Frølund UC, Andersen CL, Abildgaard N, Gregersen H. Clarithromycin added to bortezomib-cyclophosphamide-dexamethasone impairs health-related quality of life in multiple myeloma patients. Eur J Haematol 2018; 102:70-78. [PMID: 30230047 DOI: 10.1111/ejh.13175] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The Danish Myeloma Study Group initiated a randomized, placebo-controlled, double-blinded phase II study to investigate the efficacy of adding clarithromycin to cyclophosphamide-bortezomib-dexamethasone (VCD) induction therapy in transplant eligible, newly diagnosed multiple myeloma patients. The study was prematurely terminated due to severe complications, and no effect of adding clarithromycin was found. The aim of this study was to compare health-related quality of life (HRQoL) between the two groups and to explore the coherence hereof with adverse event (AE) registration by clinicians. METHODS Patients completed three validated HRQoL questionnaires at inclusion, before cyclophosphamide priming, and two months after high-dose therapy (HDT). The mean score difference was interpreted by clinically relevant differences between groups. Spearman's correlation analysis was used to compare patient-reported toxicities with AEs. RESULTS Of 58 included patients, 55 participated in the HRQoL reporting. Before cyclophosphamide priming, patients in the clarithromycin group reported clinically relevant reduced HRQoL for eleven domains with persistent reduction in four domains two months after HDT. Poor correlation between patient-reported toxicities and clinician-reported AEs was observed. CONCLUSIONS Despite the premature study termination, our data demonstrate impaired HRQoL when clarithromycin was added to the VCD regimen. We found clear underreporting of toxicities by clinicians. ClinicalTrials.gov number NCT02573935.
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Affiliation(s)
- Lene Kongsgaard Nielsen
- Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark
| | | | - Mary Jarden
- Department of Haematology, University Hospital of Copenhagen at Rigshospitalet, Copenhagen, Denmark
| | - Henrik Frederiksen
- Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark.,Department of Haematology, Odense University Hospital, Odense, Denmark
| | - Annette Juul Vangsted
- Department of Haematology, University Hospital of Copenhagen at Rigshospitalet, Copenhagen, Denmark
| | - Trung Do
- Department of Haematology, University Hospital of Copenhagen at Herlev, Copenhagen, Denmark
| | | | | | | | - Niels Abildgaard
- Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark.,Department of Haematology, Odense University Hospital, Odense, Denmark
| | - Henrik Gregersen
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
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12
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Tangen JM, Tjønnfjord GE, Gulbrandsen N, Gedde-Dahl T, Stormorken E, Anderson K, Vo CD, Hellem Schjesvold F. Improved outcome in patients following autologous stem cell transplantation for multiple myeloma in south eastern Norway 2001-2010: a retrospective, population based analysis. BMC Cancer 2018; 18:801. [PMID: 30089450 PMCID: PMC6083560 DOI: 10.1186/s12885-018-4722-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 08/02/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND With the advent of novel drugs improved overall survival in patients with multiple myeloma, including patients who received up-front autologous stem cell transplantation (ASCT), has been reported from several centers. Here we report on overall survival in a population-based cohort of patients receiving ASCT as first line treatment and in whom novel agents were an option for second and later lines of treatment. METHODS Patients with multiple myeloma ≤ 65 years of age who were considered for ASCT from 01.01.2001-31.06.2005 (period 1) and from 01.07.2005 until 31.12.2009 (period 2) at Oslo University Hospital (OUH) were identified. Relevant data were collected from the patients' medical records. RESULTS Altogether, 293/355 patients received ASCT. In all, median OS was 82.9 months in patients ≤ 60 years of age and 59.0 months in patients 61-65 years. For patients ≤ 60 years of age median OS increased from 70.6 months to 87.7 months (p = 0. 22) and median survival after start of second line therapy increased from 34.5 months to 46.5 months (p = 0.015) between the two periods. For patients 61-65 years of age median OS increased from 57.3 months to 61.2 months (p = 0. 87) and median survival after start of second line therapy was practically unchanged (32.6 months vs. 33.1 months (p = 0.97) between the periods. In patients ≤ 60 years of age salvage ASCT was used in 34% of the patients while in patients 61-65 years of age salvage ASCT was used in 7.3% of the patients. The use of salvage ASCT and novel drugs, as well as the number of treatment lines, were higher in patients ≤ 60 years of age and increased during the study period. CONCLUSION In patients ≤ 60 years of age an increased median OS of 17 months between the two periods were noted, but the difference failed to reach statistical significance. However, a statistically significant difference in median survival of 12 months after start of second line therapy was found in this age group, which may be explained by a more active second line treatment. In patients 61-65 years only a slight increase of survival, not statistically significant, was noted between the periods.
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Affiliation(s)
- Jon-Magnus Tangen
- Department of Acute Medicine, Oslo University Hospital, P.O.Box 4950 Nydalen, 0424 Oslo, Norway
- Department of Haematology, Oslo University Hospital, P.O.Box 4950 Nydalen, 0424 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, P.O.Box 1171 Blindern, 0318 Oslo, Norway
| | - Geir Erland Tjønnfjord
- Department of Haematology, Oslo University Hospital, P.O.Box 4950 Nydalen, 0424 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, P.O.Box 1171 Blindern, 0318 Oslo, Norway
| | - Nina Gulbrandsen
- Department of Haematology, Oslo University Hospital, P.O.Box 4950 Nydalen, 0424 Oslo, Norway
| | - Tobias Gedde-Dahl
- Department of Haematology, Oslo University Hospital, P.O.Box 4950 Nydalen, 0424 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, P.O.Box 1171 Blindern, 0318 Oslo, Norway
| | - Espen Stormorken
- Department of Haematology, Akershus University Hospital, P.O.Box 1000, 1478 Lørenskog, Norway
| | - Kristina Anderson
- Department of Oncology, Section of Haematology, Østfold Hospital, P.O.Box 300, 1714 Grålund, Norway
| | - Camilla Dao Vo
- Department of Medicine, Innlandet Hospital, Gjøvik, P.O.Box 104, 2381 Brummundal, Norway
| | | | - For Oslo Myeloma Center
- Department of Acute Medicine, Oslo University Hospital, P.O.Box 4950 Nydalen, 0424 Oslo, Norway
- Department of Haematology, Oslo University Hospital, P.O.Box 4950 Nydalen, 0424 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, P.O.Box 1171 Blindern, 0318 Oslo, Norway
- Department of Haematology, Akershus University Hospital, P.O.Box 1000, 1478 Lørenskog, Norway
- Department of Oncology, Section of Haematology, Østfold Hospital, P.O.Box 300, 1714 Grålund, Norway
- Department of Medicine, Innlandet Hospital, Gjøvik, P.O.Box 104, 2381 Brummundal, Norway
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Islam MS. Treat patient, not just the disease: holistic needs assessment for haematological cancer patients. Oncol Rev 2018; 12:374. [PMID: 30283608 PMCID: PMC6151346 DOI: 10.4081/oncol.2018.374] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/20/2018] [Indexed: 12/25/2022] Open
Abstract
Haematological malignancies can have devastating effects on the patients' physical, emotional, psycho-sexual, educational and economic health. With the improvement of therapies patients with these malignancies are living longer, however significant proportion these patient show poor quality of life (QoL) due to various physical and psychological consequences of the disease and the treatments. Health-related QoL (HRQoL) is multi-dimensional and temporal, relating to a state of functional, physical, psychological and social/family well-being. Compared with the general population, HRQoL of these patients is worse in most dimensions. However without routine holistic need assessment (HNA), clinicians are unlikely to identify patients with clinically significant distress. Surviving cancer is a chronic life-altering condition with several factors negatively affecting their QoL, such as psychological problems, including depression and excessive fear of recurrence, as well as social aspects, such as unemployment and social isolation. These need to be adequately understood and addressed in the healthcare of long-term survivors of haematological cancer. Applying a holistic approach to patient care has many benefits and yet, only around 25% of cancer survivors in the UK receive a holistic needs assessment. The efforts of the last decade have established the importance of ensuring access to psychosocial services for haematological cancer survivors. We need to determine the most effective practices and how best to deliver them across diverse settings. Distress, like haematological cancer, is not a single entity, and one treatment does not fit all. Psychosocialoncology needs to increase its research in comparative effectiveness.
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Affiliation(s)
- Md Serajul Islam
- Department of Haematology, Guy's & St. Thomas Hospital, London.,Department of Haematology, Broomfield Hospital, Chelmsford, UK
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14
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Health-Related Quality of Life after Autologous Stem Cell Transplantation for Multiple Myeloma. Biol Blood Marrow Transplant 2018; 24:1546-1553. [PMID: 29626515 DOI: 10.1016/j.bbmt.2018.03.027] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/29/2018] [Indexed: 01/10/2023]
Abstract
Autologous stem cell transplantation (ASCT) is an integral part of the frontline therapy in eligible multiple myeloma (MM) patients. The impact of ASCT on health-related quality of life (HRQoL) in myeloma has not been well described. We performed a systematic literature search to identify studies evaluating the impact of ASCT on HRQoL. Our search retrieved 12 relevant studies: 10 manuscripts and 2 conference abstracts. There was a widespread heterogeneity across studies in instruments used to measure HRQoL, time points of measurement, and statistical analysis. Only 1 study was a randomized controlled trial with HRQoL as a prespecified secondary endpoint. The common theme that emerged from most studies is that ASCT leads to an immediate deterioration in HRQoL and increase in symptom burden. However, baseline HRQoL and symptom scores are regained as early as 1 to 2 months post-transplantation. Furthermore, an improvement in HRQoL and pain on long-term follow-up was noted in some studies. We describe opportunities for further research in this area, including routine incorporation of HRQoL as an endpoint in transplant-related clinical trials and need for trials investigating interventions that may improve short and long-term HRQoL in myeloma ASCT recipients.
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Stewart AK, Dimopoulos MA, Masszi T, Špička I, Oriol A, Hájek R, Rosiñol L, Siegel DS, Niesvizky R, Jakubowiak AJ, San-Miguel JF, Ludwig H, Buchanan J, Cocks K, Yang X, Xing B, Zojwalla N, Tonda M, Moreau P, Palumbo A. Health-Related Quality-of-Life Results From the Open-Label, Randomized, Phase III ASPIRE Trial Evaluating Carfilzomib, Lenalidomide, and Dexamethasone Versus Lenalidomide and Dexamethasone in Patients With Relapsed Multiple Myeloma. J Clin Oncol 2017; 34:3921-3930. [PMID: 27601539 DOI: 10.1200/jco.2016.66.9648] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose To determine the effects of carfilzomib, lenalidomide, and dexamethasone (KRd) versus lenalidomide and dexamethasone (Rd) on health-related quality of life (HR-QoL) in the Carfilzomib, Lenalidomide, and Dexamethasone Versus Lenalidomide and Dexamethasone for the Treatment of Patients With Relapsed Multiple Myeloma (ASPIRE) trial. Methods Patients with relapsed multiple myeloma were randomly assigned to receive KRd or Rd. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 and myeloma-specific module were administered at baseline; day 1 of cycles 3, 6, 12, and 18; and after treatment. The Global Health Status/Quality of Life (GHS/QoL) scale and seven subscales (fatigue, nausea and vomiting, pain, physical functioning, role functioning, disease symptoms, and adverse effects of treatment) were compared between groups using a mixed model for repeated measures. The percentages of responders with ≥ 5- or 15-point GHS/QoL improvement at each cycle were compared between groups. Results Baseline questionnaire compliance was excellent (94.1% of randomly assigned patients). KRd patients had higher GHS/QoL scores versus Rd patients over 18 treatment cycles (two-sided P < .001). The minimal important difference was met at cycle 12 (5.6 points) and approached at cycle 18 (4.8 points). There was no difference between groups for the other prespecified subscales from ASPIRE. A higher proportion of KRd patients met the GHS/QoL responder definition (≥ 5-point improvement) with statistical differences at cycle 12 (KRd v Rd patients, 25.5% v 17.4%, respectively) and 18 (KRd v Rd patients, 24.2% v 12.9%, respectively). Conclusion KRd improves GHS/QoL without negatively affecting patient-reported symptoms when compared with Rd. These data further support the benefit of KRd in patients with relapsed multiple myeloma.
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Affiliation(s)
- A Keith Stewart
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Meletios A Dimopoulos
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Tamás Masszi
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Ivan Špička
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Albert Oriol
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Roman Hájek
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Laura Rosiñol
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - David S Siegel
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Ruben Niesvizky
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Andrzej J Jakubowiak
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Jesus F San-Miguel
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Heinz Ludwig
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Jacqui Buchanan
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Kim Cocks
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Xinqun Yang
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Biao Xing
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Naseem Zojwalla
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Margaret Tonda
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Philippe Moreau
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Antonio Palumbo
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
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Naegele M, Kirsch M, Ihorst G, Fierz K, Engelhardt M, De Geest S. Symptom experience of multiple myeloma (syMMex) patients treated with autologous stem cell transplantation following high-dose melphalan: a descriptive longitudinal study. Support Care Cancer 2017; 26:833-841. [DOI: 10.1007/s00520-017-3897-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/11/2017] [Indexed: 12/13/2022]
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Abstract
BACKGROUND Although physical activity (PA) has significant benefits for people living with multiple myeloma (MM), participation rates are low. Examination of PA preferences will provide important information to clinicians and assist in the development of interventions to increase participation in PA for people living with MM. OBJECTIVE The aim of this study is to gain an in-depth understanding of the PA preferences for people living with MM, including the preferred role of clinicians. METHODS Semistructured interviews were conducted with patients treated for MM within the preceding 2 to 12 months. Interviews were analyzed using content analysis, where coding categories were derived directly from the text data. RESULTS Twenty-four interviews were conducted (women, 54%; age: mean [SD], 62 [8.8] years); 16 (67%) participants had an autologous stem cell transplant. Light- to moderate-intensity PA during and after treatment was feasible, with the strongest preference for a program 2 to 8 months after treatment. The timing of information delivery was important, as was input from clinicians and organizations with knowledge of MM. Preferences for location, structure, and timing of programs varied. CONCLUSIONS Low- to moderate-intensity PA after treatment is likely to interest people with MM. Programs need to be flexible and consider individual differences in PA preferences, functional status, and treatment schedules. IMPLICATIONS An individually tailored PA program should form part of clinical care, involving clinicians and organizations with expertise in MM. Options for home-based PA are also important. Further research, including a population-based study of people living with MM, is necessary to further quantify PA preferences.
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King TA, King MT, White KJ. Patient Reported Outcomes in Optimizing Myeloma Patients' Health-Related Quality of Life. Semin Oncol Nurs 2017; 33:299-315. [PMID: 28711372 DOI: 10.1016/j.soncn.2017.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To review the current state of evidence for the use of patient-reported outcomes (PROs) and health-related quality of life (HRQoL) in optimizing best supportive care for patients with multiple myeloma (MM). DATA SOURCES Peer-reviewed journal articles, research reports, state of the science papers, and clinical guidelines. CONCLUSION The diagnosis and treatment of MM negatively impacts an individual's HRQoL. Validated self-report tools that assess HRQoL and other PROs provide an insight into how the treatment or disease is impacting the individual, enabling early recognition of physical and emotional concerns. There is a growing body of evidence to support the use of PROs in assessing HRQoL in MM in clinical care. IMPLICATIONS FOR NURSING PRACTICE There is a clear benefit for nurses to utilize PROs for patients with MM in order to obtain an understanding of how the treatment effects HRQoL. Thoughtful use of PRO measures can enable nurses to individualize supportive care interventions to meet the specific needs of the patient, and facilitate timely access to optimal symptom support.
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Nielsen LK, Jarden M, Andersen CL, Frederiksen H, Abildgaard N. A systematic review of health-related quality of life in longitudinal studies of myeloma patients. Eur J Haematol 2017; 99:3-17. [PMID: 28322018 DOI: 10.1111/ejh.12882] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Multiple myeloma (MM) patients report high symptom burden and reduced health-related quality of life (HRQoL) compared to patients with other haematological malignancies. The aim of this review was to analyse published longitudinal studies including MM patients according to a change in HRQoL scores, which is perceived as beneficial to the patient according to two published guidelines. METHODS A literature search was performed May 2016. Publications with longitudinal follow-up using the EORTC QLQ-C30 instrument for HRQoL measurement of physical functioning, global quality of life, fatigue and/or pain were included. An analysis of mean change from baseline was carried out according to minimal important difference (MID). RESULTS Large and medium HRQoL improvements were reported during first-line treatments. No clinically beneficial change or deteriorations in scores of global QoL or fatigue were reported during relapse treatment. HRQoL data during maintenance therapy are sparse and inconclusive. CONCLUSIONS Guidelines for interpreting changes in HRQoL including definitions of MID have been developed; however, consensus is missing. Improvements in HRQoL are far more likely to occur during first-line compared to relapsed treatment regimens. The background of these findings should be in focus in future studies, and HRQoL measurements should be integrated in maintenance studies.
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Affiliation(s)
- Lene Kongsgaard Nielsen
- Quality of Life Research Centre, Department of Haematology, Odense University Hospital, Odense, Denmark.,The Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Mary Jarden
- University Hospitals Centre for Health Research, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Henrik Frederiksen
- Quality of Life Research Centre, Department of Haematology, Odense University Hospital, Odense, Denmark.,The Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Niels Abildgaard
- Quality of Life Research Centre, Department of Haematology, Odense University Hospital, Odense, Denmark.,The Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
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20
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La IS, Yun EK. Effects of stress appraisal on the quality of life of adult patients with multiple myeloma and their primary family caregivers in Korea. Psychooncology 2017; 26:1640-1646. [DOI: 10.1002/pon.4348] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 11/01/2016] [Accepted: 12/12/2016] [Indexed: 12/23/2022]
Affiliation(s)
- In Seo La
- College of Nursing Science, Kyung Hee University; Seoul South Korea
| | - Eun Kyoung Yun
- College of Nursing Science, Kyung Hee University; Seoul South Korea
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21
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Ramsenthaler C, Kane P, Gao W, Siegert RJ, Edmonds PM, Schey SA, Higginson IJ. Prevalence of symptoms in patients with multiple myeloma: a systematic review and meta-analysis. Eur J Haematol 2016; 97:416-429. [PMID: 27528496 DOI: 10.1111/ejh.12790] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Multiple myeloma (MM) is an incurable haematological disease. Due to novel agents, overall survival has improved in this group, yet there are no systematic reviews to understand the symptom profiles resulting from disease and treatment-related toxicities. We aimed to synthesise data on the prevalence of symptoms in patients with MM. METHODS A systematic database and grey literature search were conducted in six databases. Random-effects meta-analysis with inverse variance weighting to pool prevalence data was performed. RESULTS Thirty-six studies were included of which 34 studies (N = 3023) provided data for meta-analysis. Twenty-seven distinct symptoms were reported, with the majority of studies focusing on pain (n = 27), fatigue (n = 19) and problems with functioning (n = 15). The most prevalent symptoms were fatigue (98.8%, 95% CI 98.1-99.2%), pain (73%, 39.9-91.7), constipation (65.2%, 22.9-92.2) and tingling in the hands/feet with 53.4% (0.4-99.7). The most common problems were decreased physical functioning (98.9%, 98.2-99.3), decreased cognitive functioning (80.2%, 40-96.1) and financial difficulties (78.4%, 39.1-95.4). These problems were present in newly diagnosed to advanced disease stage. CONCLUSIONS Optimal quality of life and good symptom management in this incurable disease can only be achieved by routinely assessing symptoms throughout the disease trajectory.
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Affiliation(s)
- Christina Ramsenthaler
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Faculty of Life Sciences and Medicine, King's College London, London, UK. .,Department of Palliative Medicine, Munich University Hospital, Munich, Germany.
| | - Pauline Kane
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Wei Gao
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Richard J Siegert
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Department of Psychology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Polly M Edmonds
- Department of Palliative Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Stephen A Schey
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Irene J Higginson
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Kiely F, Cran A, Finnerty D, O'Brien T. Self-Reported Quality of Life and Symptom Burden in Ambulatory Patients With Multiple Myeloma on Disease-Modifying Treatment. Am J Hosp Palliat Care 2016; 34:671-676. [PMID: 27141015 DOI: 10.1177/1049909116646337] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Knowledge of health-related quality of life (QoL) of patients with multiple myeloma on disease-modifying treatments is limited. AIM (1) Determine symptom prevalence in patients with multiple myeloma on disease-modifying treatment. Identify the range and nature of these symptoms within the dimensions of physical, psychological, social, and financial well-being. (2) Measure self-reported QoL. (3) Compare the above-mentioned parameters to the general population and patients with advanced cancer. METHOD Adults with multiple myeloma on disease-modifying treatment, attending the hematology day unit in a tertiary referral center from November 2012 to January 2013, were eligible for inclusion in a cross-sectional quantitative survey. Consenting patients completed 2 validated questionnaires, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) supplemented by the myeloma-specific module (EORTC QLQ-MY20) and the Hospital Anxiety Depression Score (HADS). RESULTS Forty-one patients were included for analysis: 59% were male and 41% were female. Mean age was 63.7 years (range 46-86, standard deviation 11.24). The QoL scores were significantly lower than the general population and comparable to those with advanced cancer. The most commonly reported physical symptoms were pain (66%), fatigue (63%), and dyspnea (51%). About 54% of the patients were burdened by financial worries. Anxiety (30%) and depression (37%) were prevalent. CONCLUSION Patients with myeloma on disease-modifying treatment have a lower QoL than the general population and are symptomatic across physical, psychological, financial, and social domains. A holistic approach to patient care is warranted, and patients may benefit from specialist palliative care input.
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Affiliation(s)
- Fiona Kiely
- 1 Department of Palliative Medicine, Marymount University Hospital & Hospice, Curraheen, Cork, Ireland.,2 Department of Haematology, Dunmanway Day Unit, Cork University Hospital, Cork, Ireland
| | - Alison Cran
- 1 Department of Palliative Medicine, Marymount University Hospital & Hospice, Curraheen, Cork, Ireland.,2 Department of Haematology, Dunmanway Day Unit, Cork University Hospital, Cork, Ireland
| | - Deirdre Finnerty
- 1 Department of Palliative Medicine, Marymount University Hospital & Hospice, Curraheen, Cork, Ireland.,2 Department of Haematology, Dunmanway Day Unit, Cork University Hospital, Cork, Ireland
| | - Tony O'Brien
- 1 Department of Palliative Medicine, Marymount University Hospital & Hospice, Curraheen, Cork, Ireland.,2 Department of Haematology, Dunmanway Day Unit, Cork University Hospital, Cork, Ireland
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Qerimi V, Kapedanovska Nestorovska A, Sterjev Z, Genadieva-Stavric S, Suturkova L. Overview of cost-effectiveness analysis and health state utilities in multiple myeloma and estimations of health state utilities from real-world macedonian data. MAKEDONSKO FARMACEVTSKI BILTEN 2016. [DOI: 10.33320/maced.pharm.bull.2016.62.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Multiple myeloma (MM) is a hematological neoplastic plasma-cell disorder in the bone marrow. Nowadays, the survival of MM patients has improved by using novel therapies (e.g., bortezomib, thalidomide). Decision-analytic models (DAM) are known to be very
useful in guiding clinical and health policy decisions by systematically evaluating expected outcomes of alternative treatments. When conducting DAM, it is recommended by National Institute for Clinical Excellence (NICE) as the preferred framework to use qualityadjusted life years as the main measure for health outcomes derived from generic preference-based instruments. The objective of our study was to identify and analyze the structural and methodological approaches of published studies that evaluated: (1) DAM for various treatment strategies in MM and (2) published health utility values (HUVs) after MM treatment. The searches were developed in the electronic literature database PubMed/MEDLINE. Additionally, we aimed to derive real-world data for HUVs from the current patients’ treatment landscape in the Hematology Clinical Center in Skopje. The survey collecting national HUVs was conducted
during the period January-November 2016, using the generic preference-based instrument EQ-5D-5L, administered at one-time point in 20 MM patients. Only five studies reported on using a DAM. Seven studies were included in the extraction of already published HUVs. The calculated national health utility score of 0.723 was comparable to the published data in the previously identified studies reporting on similar MM treatment protocols. Several modeling approaches and HUVs, developed for different treatment strategies and target groups in MM were identified. Those data could be used to parameterize a DAM for MM treatment.
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Pomalidomide and Low-Dose Dexamethasone Improves Health-Related Quality of Life and Prolongs Time to Worsening in Relapsed/Refractory Patients With Multiple Myeloma Enrolled in the MM-003 Randomized Phase III Trial. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:519-30. [PMID: 26149712 DOI: 10.1016/j.clml.2015.05.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/24/2015] [Accepted: 05/29/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) is an important element for consideration in treatment decisions in patients with relapsed/refractory multiple myeloma (RRMM). The pivotal MM-003 (A Phase 3, Multicenter, Randomized, Open-Label Study to Compare the Efficacy and Safety of Pomalidomide in Combination With Low-Dose Dexamethasone vs. High-Dose Dexamethasone in Patients With Refractory Multiple Myeloma or Relapsed and Refractory Multiple Myeloma and Companion Study [NIMBUS]) randomized, open-label, multicenter, phase III trial demonstrated improved progression-free survival (PFS) and prolonged overall survival (OS) with pomalidomide (POM) plus low-dose dexamethasone (POM + LoDEX) versus high-dose dexamethasone (HiDEX) in patients with RRMM in whom lenalidomide (LEN) and bortezomib (BORT) had failed. MM-003 also investigated HRQoL as a predefined secondary end point. PATIENTS AND METHODS Recruited patients (n = 455) were refractory to their last treatment and had failed LEN and BORT after ≥ 2 consecutive cycles of each (alone or in combination). Eight clinically relevant and validated HRQoL domains from the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30, EORTC QLQ-MY20, and EQ-5D questionnaires were selected for analysis. Time to symptom worsening based on minimally important differences (MIDs) was calculated. RESULTS Clinically meaningful improvements in HRQoL as determined by MIDs, regression analyses, and best response analyses were observed more frequently in patients receiving POM + LoDEX than in those receiving HiDEX. POM + LoDEX significantly extended median time to clinically meaningful worsening in HRQoL versus HiDEX in 4 HRQoL domains and demonstrated a trend in an additional 3 domains. Patients in the HiDEX arm experienced earlier HRQoL deterioration compared with those in the POM + LoDEX arm in each domain analyzed. CONCLUSION POM + LoDEX offer good clinical outcomes that lead to improved and prolonged HRQoL compared with HiDEX in patients with RRMM and end-stage disease.
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Delforge M, Minuk L, Eisenmann JC, Arnulf B, Canepa L, Fragasso A, Leyvraz S, Langer C, Ezaydi Y, Vogl DT, Giraldo-Castellano P, Yoon SS, Zarnitsky C, Escoffre-Barbe M, Lemieux B, Song K, Bahlis NJ, Guo S, Monzini MS, Ervin-Haynes A, Houck V, Facon T. Health-related quality-of-life in patients with newly diagnosed multiple myeloma in the FIRST trial: lenalidomide plus low-dose dexamethasone versus melphalan, prednisone, thalidomide. Haematologica 2015; 100:826-33. [PMID: 25769541 PMCID: PMC4450629 DOI: 10.3324/haematol.2014.120121] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 03/06/2015] [Indexed: 12/17/2022] Open
Abstract
We compared the health-related quality-of-life of patients with newly diagnosed multiple myeloma aged over 65 years or transplant-ineligible in the pivotal, phase III FIRST trial. Patients received: i) continuous lenalidomide and low-dose dexamethasone until disease progression; ii) fixed cycles of lenalidomide and low-dose dexamethasone for 18 months; or iii) fixed cycles of melphalan, prednisone, thalidomide for 18 months. Data were collected using the validated questionnaires (QLQ-MY20, QLQ-C30, and EQ-5D). The analysis focused on the EQ-5D utility value and six domains pre-selected for their perceived clinical relevance. Lenalidomide and low-dose dexamethasone, and melphalan, prednisone, thalidomide improved patients' health-related quality-of-life from baseline over the duration of the study across all pre-selected domains of the QLQ-C30 and EQ-5D. In the QLQ-MY20, lenalidomide and low-dose dexamethasone demonstrated a significantly greater reduction in the Disease Symptoms domain compared with melphalan, prednisone, thalidomide at Month 3, and significantly lower scores for QLQ-MY20 Side Effects of Treatment at all post-baseline assessments except Month 18. Linear mixed-model repeated-measures analyses confirmed the results observed in the cross-sectional analysis. Continuous lenalidomide and low-dose dexamethasone delays disease progression versus melphalan, prednisone, thalidomide and has been associated with a clinically meaningful improvement in health-related quality-of-life. These results further establish continuous lenalidomide and low-dose dexamethasone as a new standard of care for initial therapy of myeloma by demonstrating superior health-related quality-of-life during treatment, compared with melphalan, prednisone, thalidomide.
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Affiliation(s)
- Michel Delforge
- Universitair Ziekenhuis Leuven, Campus Gasthuisberg, Leuven, Belgium
| | | | | | | | - Letizia Canepa
- Clinica Ematologica, A.O.U. San Martino di Genova, Italy
| | | | - Serge Leyvraz
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | | | | | - Dan T Vogl
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Pilar Giraldo-Castellano
- CIBER Enfermedades Raras (CIBERER), Translational Research Unit, Miguel Servet University Hospital, Zaragoza, Spain
| | | | | | | | | | - Kevin Song
- Vancouver General Hospital, Vancouver, BC, Canada
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Osborne TR, Ramsenthaler C, Schey SA, Siegert RJ, Edmonds PM, Higginson IJ. Improving the assessment of quality of life in the clinical care of myeloma patients: the development and validation of the Myeloma Patient Outcome Scale (MyPOS). BMC Cancer 2015; 15:280. [PMID: 25884627 PMCID: PMC4404617 DOI: 10.1186/s12885-015-1261-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/25/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Multiple myeloma is an incurable cancer with a rising incidence globally. Less toxic treatments are increasingly available, so patients are living longer and treatment decisions are increasingly guided by QOL concerns. There is no QOL assessment tool designed specifically for use in the clinical care of people with myeloma. This study aimed to develop and test the psychometric properties of a new myeloma-specific QOL questionnaire designed specifically for use in the clinical setting - the MyPOS. METHODS The MyPOS was developed using findings from a previously reported literature review and qualitative study. The prototype MyPOS was pretested using cognitive interviews in a purposive sample of myeloma patients and refined prior to field testing. The psychometric properties of the MyPOS were evaluated in a multi-centre, cross sectional survey of myeloma patients recruited from 14 hospital trusts across England. RESULTS The prototype MyPOS contained 33 structured and open questions. These were refined using cognitive interviews with 12 patients, and the final MyPOS contained 30 items taken forward for field-testing. The cross-sectional survey recruited 380 patients for the MyPOS validation. Mean time to complete was 7 minutes 19 seconds with 0.58% missing MyPOS items overall. Internal consistency was high (α = 0.89). Factor analysis confirmed three subscales: Symptoms & Function; Emotional Response and Healthcare Support. MyPOS total scores were higher (worse QOL) in those with active disease compared to those in the stable or plateau phase (F = 11.89, p < 0.001) and were worse in those currently receiving chemotherapy (t = 3.42, p = 0.001). Scores in the Symptoms & Function subscale were higher (worse QOL) in those with worse ECOG performance status (F = 31.33, p < 0.001). Good convergent and discriminant validity were demonstrated. CONCLUSIONS The MyPOS is the first myeloma-specific QOL questionnaire designed specifically for use in the clinical setting. The MyPOS is based on qualitative enquiry and the issues most important to patients. It is a brief, comprehensive and acceptable tool that is reliable and valid on psychometric testing. The MyPOS can now be used to support clinical decision making in the routine care of myeloma patients.
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Affiliation(s)
- Thomas R Osborne
- King's College London Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, London, UK.
| | - Christina Ramsenthaler
- King's College London Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, London, UK.
| | - Stephen A Schey
- Department of Haematological Medicine, King's College Hospital and King's College London, London, UK.
| | - Richard J Siegert
- King's College London Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, London, UK. .,School of Public Health and Psychosocial Studies and School of Rehabilitation and Occupation Studies, Auckland University of Technology, Auckland, New Zealand.
| | - Polly M Edmonds
- King's College London Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, London, UK. .,Department of Palliative Care, King's College Hospital, London, UK.
| | - Irene J Higginson
- King's College London Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, London, UK.
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van der Poel MWM, Oerlemans S, Schouten HC, van de Poll-Franse LV. Elderly multiple myeloma patients experience less deterioration in health-related quality of life than younger patients compared to a normative population: a study from the population-based PROFILES registry. Ann Hematol 2014; 94:651-61. [DOI: 10.1007/s00277-014-2264-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 11/22/2014] [Indexed: 01/25/2023]
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Jim HSL, Evans B, Jeong JM, Gonzalez BD, Johnston L, Nelson AM, Kesler S, Phillips KM, Barata A, Pidala J, Palesh O. Sleep disruption in hematopoietic cell transplantation recipients: prevalence, severity, and clinical management. Biol Blood Marrow Transplant 2014; 20:1465-84. [PMID: 24747335 PMCID: PMC4163090 DOI: 10.1016/j.bbmt.2014.04.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
Abstract
Sleep disruption is common among hematopoietic cell transplant (HCT) recipients, with over 50% of recipients experiencing sleep disruption pre-transplant, with up to 82% of patients experiencing moderate to severe sleep disruption during hospitalization for transplant and up to 43% after transplant. These rates of sleep disruption are substantially higher than what we see in the general population. Although sleep disruption can be distressing to patients and contribute to diminished quality of life, it is rarely discussed during clinical visits. The goal of the current review is to draw attention to sleep disruption and disorders (ie, insomnia, obstructive sleep apnea, restless legs syndrome) as a clinical problem in HCT in order to facilitate patient education, intervention, and research. We identified 35 observational studies published in the past decade that examined sleep disruption or disorders in HCT. Most studies utilized a single item measure of sleep, had small sample size, and included heterogeneous samples of patients. Six studies of the effects of psychosocial and exercise interventions on sleep in HCT have reported no significant improvements. These results highlight the need for rigorous observational and interventional studies of sleep disruption and disorders in HCT recipients..
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Affiliation(s)
| | - Bryan Evans
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Jiyeon M Jeong
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | | | - Laura Johnston
- Division of Blood and Marrow Transplantation, Stanford University School of Medicine, Stanford, California
| | - Ashley M Nelson
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Shelli Kesler
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | | | - Anna Barata
- Moffitt Cancer Center, Tampa, Florida; Psychiatry and Legal Medicine PhD Program, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joseph Pidala
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, Florida
| | - Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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Sloot S, Boland J, Snowden JA, Ezaydi Y, Foster A, Gethin A, Green T, Chopra L, Verhagen S, Vissers K, Engels Y, Ahmedzai SH. Side effects of analgesia may significantly reduce quality of life in symptomatic multiple myeloma: a cross-sectional prevalence study. Support Care Cancer 2014; 23:671-8. [PMID: 25160491 PMCID: PMC4311060 DOI: 10.1007/s00520-014-2358-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 07/21/2014] [Indexed: 12/13/2022]
Abstract
Background Pain is a common symptom in patients with multiple myeloma (MM). Many patients are dependent on analgesics and in particular opioids, but there is limited information on the impact of these drugs and their side effects on health-related quality of life (HRQoL). Method In a cross-sectional study, semi-structured interviews were performed in 21 patients attending the hospital with symptomatic MM on pain medications. HRQoL was measured using items 29 and 30 of the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30. Results Patients were able to recall a median of two (range 0–4) analgesics. They spontaneously identified a median of two (range 1–5) side effects attributable to their analgesic medications. Patients’ assessment of HRQoL based on the EORTC QLQ-C30 questions 29/30 was mean 48.3 (95 % CI; 38.7–57.9) out of 100. Patients’ assessment of their HRQoL in the hypothetical situation, in which they would not experience any side effects from analgesics, was significantly higher: 62.6 (53.5–71.7) (t test, p = 0.001). Conclusion This study provides, for the first time, evidence that side effects of analgesics are common in symptomatic MM and may result in a statistically and clinically significant reduction of self-reported HRQoL.
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Affiliation(s)
- Sarah Sloot
- Department of General Surgery, UMCG, Groningen, Hanzeplein, PO 30.001, 9713 GZ Groningen The Netherlands
- Department of Cutaneous Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL 33612 USA
| | - Jason Boland
- Hull York Medical School, University of Hull, Hull, HU6 7RX UK
| | - John A. Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF UK
| | - Yousef Ezaydi
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF UK
| | - Andrea Foster
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF UK
| | - Alison Gethin
- North Trent Consumer Research Panel, c/o Academic Unit of Supportive Care, Department of Oncology, School of Medicine and Biomedical Science, The University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK
| | - Tracy Green
- North Trent Consumer Research Panel, c/o Academic Unit of Supportive Care, Department of Oncology, School of Medicine and Biomedical Science, The University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK
| | - Louise Chopra
- Clinical Effectiveness Unit, Sheffield Teaching Hospitals NHS Foundation Trust, 8 Beech Hill Road, Sheffield, S10 2SB UK
| | - Stans Verhagen
- Department of Anesthesiology, pain and palliative medicine, UMC St Radboud, PO 9101, 6500 HB Nijmegen, The Netherlands
| | - Kris Vissers
- Department of Anesthesiology, pain and palliative medicine, UMC St Radboud, PO 9101, 6500 HB Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, pain and palliative medicine, UMC St Radboud, PO 9101, 6500 HB Nijmegen, The Netherlands
| | - Sam H. Ahmedzai
- Academic Unit of Supportive Care, Department of Oncology, School of Medicine and Biomedical Science, The University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK
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30
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Osborne TR, Ramsenthaler C, de Wolf-Linder S, Schey SA, Siegert RJ, Edmonds PM, Higginson IJ. Understanding what matters most to people with multiple myeloma: a qualitative study of views on quality of life. BMC Cancer 2014; 14:496. [PMID: 25005145 PMCID: PMC4227056 DOI: 10.1186/1471-2407-14-496] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 06/23/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Multiple myeloma is an incurable haematological cancer that affects physical, psychological and social domains of quality of life (QOL). Treatment decisions are increasingly guided by QOL issues, creating a need to monitor QOL within clinical practice. The development of myeloma-specific QOL questionnaires has been limited by a paucity of research to fully characterise QOL in this group. Aims of the present study are to (1) explore the issues important to QOL from the perspective of people with multiple myeloma, and (2) explore the views of patients and clinical staff on existing QOL questionnaires and their use in clinical practice. METHODS The 'Issues Interviews' were semi-structured qualitative interviews to explore the issues important to QOL in a purposive sample of myeloma patients (n = 20). The 'Questionnaire Interviews' were semi-structured qualitative interviews in a separate purposive sample of myeloma patients (n = 20) to explore views on existing QOL questionnaires and their clinical use. Two patient focus groups (n = 7, n = 4) and a focus group of clinical staff (n = 6) complemented the semi-structured interviews. Thematic content analysis resulted in the development of a theoretical model of QOL in myeloma. RESULTS Main themes important to QOL were Biological Status, Treatment Factors, Symptoms Status, Activity & Participation, Emotional Status, Support Factors, Expectations, Adaptation & Coping and Spirituality. Symptoms had an indirect effect on QOL, only affecting overall QOL if they impacted upon Activity & Participation, Emotional Status or Support Factors. This indirect relationship has implications for the design of QOL questionnaires, which often focus on symptom status. Health-service factors emerged as important but are often absent from QOL questionnaires. Sexual function was important to patients and difficult for clinicians to discuss, so inclusion in clinical QOL tools may flag hidden problems and facilitate better care. Patients and staff expressed preferences for questionnaires to be no more than 2 pages long and to include a mixture of structured and open questions to focus the goals of care on what is most important to patients. CONCLUSION Existing QOL questionnaires developed and validated for use in myeloma do not capture all that is important to patients and may not be well suited to clinical use.
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Affiliation(s)
- Thomas R Osborne
- Department of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.
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Petrucci MT, Finsinger P, Chisini M, Gentilini F. Subcutaneous bortezomib for multiple myeloma treatment: patients' benefits. Patient Prefer Adherence 2014; 8:939-46. [PMID: 25045252 PMCID: PMC4094627 DOI: 10.2147/ppa.s38142] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The use of novel agents such as thalidomide, lenalidomide, and bortezomib has considerably improved the outcome of multiple myeloma patients. Besides greater biological activity, these drugs unfortunately have also been associated with greater toxicity. To evaluate the positive effect on the quality of life of patients, driven by both the tolerability and antimyeloma activity of bortezomib, we analyzed data that have been published concerning different strategies used to improve its tolerability as once weekly and/or subcutaneous administration.
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Affiliation(s)
- Maria Teresa Petrucci
- Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Italy
| | - Paola Finsinger
- Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Italy
| | - Marta Chisini
- Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Italy
| | - Fabiana Gentilini
- Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Italy
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Sonneveld P, Verelst SG, Lewis P, Gray-Schopfer V, Hutchings A, Nixon A, Petrucci MT. Review of health-related quality of life data in multiple myeloma patients treated with novel agents. Leukemia 2013; 27:1959-69. [PMID: 23783393 PMCID: PMC3806249 DOI: 10.1038/leu.2013.185] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 06/11/2013] [Accepted: 06/12/2013] [Indexed: 01/09/2023]
Abstract
In multiple myeloma (MM), health-related quality of life (HRQoL) data is becoming increasingly important, owing to improved survival outcomes and the impact of treatment-related toxicity on HRQoL. Researchers are more frequently including HRQoL assessments in clinical trials, but analysis and reporting of this data has not been consistent. A systematic literature review assessed the effect of novel agents (thalidomide, bortezomib and lenalidomide) on HRQoL in MM patients, and evaluated the subsequent reporting of these HRQoL results. A relatively small body of literature addresses HRQoL data in MM patients treated with novel MM therapeutic agents: 9 manuscripts and 15 conference proceedings. The literature demonstrates the complementary value of HRQoL when assessing clinical response, progression, overall survival and toxicity. However, weaknesses and inconsistencies in analysis and presentation of HRQoL data were observed, often complicating interpretation of the impact of treatment on HRQoL in MM. Further evaluation of HRQoL in MM patients treated with novel agents is required in larger cohorts, and ideally in head-to-head comparative studies. Additionally, the development of standardised MM-specific best practice guidelines in HRQoL data collection and analysis is recommended. These would ensure that future data are more useful in guiding predictive models and clinical decisions.
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Affiliation(s)
- P Sonneveld
- Department of Hematology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - S G Verelst
- Department of Hematology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - P Lewis
- Celgene GmbH, Munich, Germany
| | | | | | - A Nixon
- Oxford Outcomes, an ICON plc. company, Oxford, UK
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Burnette BL, Dispenzieri A, Kumar S, Harris AM, Sloan JA, Tilburt JC, Kyle RA, Rajkumar SV. Treatment trade-offs in myeloma: A survey of consecutive patients about contemporary maintenance strategies. Cancer 2013; 119:4308-15. [PMID: 24105720 DOI: 10.1002/cncr.28340] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 07/06/2013] [Accepted: 07/23/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Two randomized trials have demonstrated improved progression-free survival (PFS) with lenalidomide maintenance after autologous transplantation for multiple myeloma (MM). Overall survival (OS) results are conflicting, and quality-of-life (QOL) data are lacking. The authors conducted a systematic survey of patients with MM regarding what constitutes a meaningful benefit that would make burdens of maintenance treatments (toxicity and cost) acceptable. METHODS A self-administered survey was mailed to 1159 consecutive, living patients who were evaluated at Mayo Clinic. The survey provided background information on the standard of care for MM and data on maintenance. Patients were asked to estimate the magnitude of OS benefit that would be acceptable for various degrees of toxicity and cost. RESULTS Of 1159 surveys sent, 886 patients (83.2%) responded, and 736 patients returned a completed survey (66% raw response rate). The most worrisome potential toxicity was identified as peripheral neuropathy by 27% of patients, cytopenias by 24%, deep vein thrombosis by 20%, fatigue by 15%, nausea by 8%, and diarrhea/constipation by 7%. If treatment was free, had no toxicity, and the OS benefit was ≤1 year, then 49% of patients indicated that they would choose maintenance; with moderate toxicity, this proportion decreased to 42%. Adding a treatment cost of $25 per month decreased the proportion that would choose maintenance to 39% of patients. CONCLUSIONS The current results indicated that willingness to receive maintenance treatment declined when actual benefits were provided in concrete numeric terms compared with a general statement of PFS benefit. The authors also observed that the magnitude of benefit required to consider maintenance was affected by cost and toxicity.
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Affiliation(s)
- Brian L Burnette
- Department of Hematology, Mayo Clinic Foundation, Rochester, Minnesota
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Cömert M, Güneş AE, Sahin F, Saydam G. Quality of life and supportive care in multiple myeloma. Turk J Haematol 2013; 30:234-46. [PMID: 24385802 PMCID: PMC3878535 DOI: 10.4274/tjh.2012.0192] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 04/01/2013] [Indexed: 12/01/2022] Open
Abstract
Multiple myeloma is the second most common haematological malignancy. Novel therapies have led to improvement in survival. Current myeloma management is matching the progress made in improved survival through disease control while optimising quality of life with effective supportive care. Supportive treatment is an essential part of the therapeutic management of myeloma patients because it is directed towards improving the patient’s quality of life and also can improve survival. The aim of this review is to highlight the relationship among life of quality, supportive care, and improvement in survival. Conflict of interest:None declared.
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Affiliation(s)
- Melda Cömert
- Ege University School of Medicine, Department of Hematology, İzmir, Turkey
| | - Ajda Ersoy Güneş
- Ege University School of Medicine, Department of Hematology, İzmir, Turkey
| | - Fahri Sahin
- Ege University School of Medicine, Department of Hematology, İzmir, Turkey
| | - Güray Saydam
- Ege University School of Medicine, Department of Hematology, İzmir, Turkey
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Bortezomib consolidation after autologous stem cell transplantation in multiple myeloma: a Nordic Myeloma Study Group randomized phase 3 trial. Blood 2013; 121:4647-54. [PMID: 23616624 DOI: 10.1182/blood-2012-11-464503] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The Nordic Myeloma Study Group conducted an open randomized trial to compare bortezomib as consolidation therapy given after high-dose therapy and autologous stem cell transplantation (ASCT) with no consolidation in bortezomib-naive patients with newly diagnosed multiple myeloma. Overall, 370 patients were centrally randomly assigned 3 months after ASCT to receive 20 doses of bortezomib given during 21 weeks or no consolidation. The hypothesis was that consolidation therapy would prolong progression-free survival (PFS). The PFS after randomization was 27 months for the bortezomib group compared with 20 months for the control group (P = .05). Fifty-one of 90 patients in the treatment group compared with 32 of 90 controls improved their response after randomization (P = .007). No difference in overall survival was seen. Fatigue was reported more commonly by the bortezomib-treated patients in self-reported quality-of-life (QOL) questionnaires, whereas no other major differences in QOL were recorded between the groups. Consolidation therapy seemed to be beneficial for patients not achieving at least a very good partial response (VGPR) but not for patients in the ≥ VGPR category at randomization. Consolidation with bortezomib after ASCT in bortezomib-naive patients improves PFS without interfering with QOL. This trial was registered at www.clinicaltrials.gov as #NCT00417911.
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Osborne TR, Ramsenthaler C, Siegert RJ, Edmonds PM, Schey SA, Higginson IJ. What issues matter most to people with multiple myeloma and how well are we measuring them? A systematic review of quality of life tools. Eur J Haematol 2012; 89:437-57. [PMID: 22985406 DOI: 10.1111/ejh.12012] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Treatment advances in multiple myeloma have increased expected survival from months to years for some patients. Alongside improved survival emerges a need to better understand and measure health-related quality of life (HRQOL), both in research and clinical settings. OBJECTIVES (i) Identify HRQOL tools validated for use in myeloma; (ii) identify issues important to HRQOL from the point of view of patients with myeloma; (iii) describe the measurement properties of each HRQOL tool; (iv) evaluate the content validity of HRQOL tools in terms of their ability to capture all issues important to patients and (v) explore the suitability of each HRQOL tool for use in different settings. METHOD Systematic literature review of six databases with no limits by date or language. RESULTS Thirty-nine studies reported validation of 13 HRQOL instruments. Seven studies identified issues important to HRQOL from the patients' perspective. No instrument was comprehensive to all issues important to patients. The EORTC-QLQ-C30 and MY24 have undergone the most comprehensive psychometric validation. Most validation occurred in trial patients and not clinically representative groups. No studies evaluated clinical utility of tools alongside routine practice. CONCLUSION The best existing HRQOL tools are designed predominantly for use in research. Reliable, valid and responsive tools exist for this purpose, but may miss issues important to patients. The design of HRQOL measures should be guided by intended utility, whether for research or clinical practice, and further validation of HRQOL tools in clinically representative groups is needed. Development and validation of HRQOL tools for clinical use may be of value.
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Affiliation(s)
- Thomas R Osborne
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, and King's College Hospital, London, UK.
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Acaster S, Gaugris S, Velikova G, Yong K, Lloyd AJ. Impact of the treatment-free interval on health-related quality of life in patients with multiple myeloma: a UK cross-sectional survey. Support Care Cancer 2012; 21:599-607. [PMID: 22886429 DOI: 10.1007/s00520-012-1548-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 07/23/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND While the impact of various treatments on myeloma patients' health-related quality of life (HRQL) has been reported, the impact of a treatment-free interval (TFI) is currently unclear. The aims of this study were to assess if (1) a TFI is associated with a better HRQL vs. other treatment phases and (2) the length of the TFI influences HRQL. METHODS A cross-sectional postal survey was conducted in the UK. The survey was sent to 605 multiple myeloma patients via the charity Myeloma UK and asked patients to rate their HRQL using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30), EORTC QLQ-MY20 and the EQ-5D. The results were analysed using ordinary least squares regression. RESULTS Surveys of 402 (67 %) were returned; 370 (61 %) were considered eligible for analysis. Results demonstrated that being in a first TFI relative to other treatment phases and experiencing a longer TFI were significantly associated with better HRQL as assessed by various domains of the QLQ-C30, MY20 and EQ-5D. CONCLUSION Patients enjoy better HRQL when in their first TFI, and the length of the TFI also positively impacts on HRQL This information may be important for patients and their physicians making treatment decisions and has implications for treatment protocols incorporating extended therapy.
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Affiliation(s)
- S Acaster
- Oxford Outcomes Ltd., 188 Embarcadero, Suite 200, San Francisco, CA 94105, USA.
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Delforge M, Dhawan R, Robinson D, Meunier J, Regnault A, Esseltine DL, Cakana A, van de Velde H, Richardson PG, San Miguel JF. Health-related quality of life in elderly, newly diagnosed multiple myeloma patients treated with VMP vs. MP: results from the VISTA trial. Eur J Haematol 2012; 89:16-27. [PMID: 22469559 DOI: 10.1111/j.1600-0609.2012.01788.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The phase 3 VISTA study (ClinicalTrials.gov NCT00111319) in transplant-ineligible myeloma patients demonstrated superior efficacy with bortezomib-melphalan-prednisone (VMP; nine 6-wk cycles) vs. melphalan-prednisone (MP) but also increased toxicity. Health-related quality of life (HRQoL; exploratory endpoint) was evaluated using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30). The phase 3 VISTA study (ClinicalTrials.gov NCT00111319) in transplant-ineligible myeloma patients demonstrated superior efficacy with bortezomib-melphalan-prednisone (VMP; nine 6-wk cycles) vs. melphalan-prednisone (MP) but also increased toxicity. Health-related quality of life (HRQoL; exploratory endpoint) was evaluated using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30). METHODS EORTC QLQ-C30 was administered at screening, on day 1 of each cycle, at the end-of-treatment visit, and every 8 wk until progression. EORTC QLQ-C30 scores were evaluated among patients with a valid baseline and at least one post-baseline HRQoL assessment. RESULTS At baseline, domain scores were similar between arms. By cycle 4, mean differences were clinically meaningful for most domains, indicating poorer health status with VMP. From cycle 5 onwards, improvements relative to baseline/MP were observed for all domains with VMP. Mean scores were generally improved by the end-of-treatment assessment vs. baseline in both arms. Among responding patients, mean scores generally improved from time of response to end-of-treatment assessment, substantially driven by patients achieving complete response (CR). Multivariate analysis showed a significant impact of duration of response/CR on improving global health status, pain, and appetite loss scores. Analyses by bortezomib dose intensity indicated better HRQoL in patients receiving lower dose intensity. CONCLUSIONS These findings demonstrate clinically meaningful, transitory HRQoL decrements with VMP and relatively lower HRQoL vs. MP during early treatment cycles, associated with the expected additional toxicities. However, HRQoL is not compromised in the long term, recovering by the end-of-treatment visit to be comparable vs. MP.
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Affiliation(s)
- Michel Delforge
- Department of Hematology, University Hospital Leuven, Leuven, Belgium.
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Hjorth M, Hjertner Ø, Knudsen LM, Gulbrandsen N, Holmberg E, Pedersen PT, Andersen NF, Andréasson B, Billström R, Carlson K, Carlsson MS, Flogegård M, Forsberg K, Gimsing P, Karlsson T, Linder O, Nahi H, Othzén A, Swedin A. Thalidomide and dexamethasone vs. bortezomib and dexamethasone for melphalan refractory myeloma: a randomized study. Eur J Haematol 2012; 88:485-96. [PMID: 22404182 PMCID: PMC3492844 DOI: 10.1111/j.1600-0609.2012.01775.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Thalidomide and bortezomib have been frequently used for second-line therapy in patients with myeloma relapsing after or refractory to initial melphalan-based treatment, but no randomized trials have been published comparing these two treatment alternatives. METHODS Thalidomide- and bortezomib-naïve patients with melphalan refractory myeloma were randomly assigned to low-dose thalidomide + dexamethasone (Thal-Dex) or bortezomib + dexamethasone (Bort-Dex). At progression on either therapy, the patients were offered crossover to the alternative drug combination. An estimated 300 patients would be needed for the trial to detect a 50% difference in median PFS between the treatment arms. RESULTS After inclusion of 131 patients, the trial was prematurely closed because of low accrual. Sixty-seven patients were randomized to Thal-Dex and 64 to Bort-Dex. Progression-free survival was similar (median, 9.0 months for Thal-Dex and 7.2 for Bort-Dex). Response rate was similar (55% for Thal-Dex and 63% for Bort-Dex), but time to response was shorter (P < 0.05) and the VGPR rate higher (P < 0.01) for Bort-Dex. Time-to-other treatment after crossover was similar (median, 13.2 months for Thal-Dex and 11.2 months for Bort-Dex), as was overall survival (22.8 months for Thal-Dex and 19.0 for Bort-Dex). Venous thromboembolism was seen in seven patients and cerebrovascular events in four patients in the Thal-Dex group. Severe neuropathy, reactivation of herpes virus infections, and mental depression were more frequently observed in the Bort-Dex group. In the quality-of-life analysis, no difference was noted for physical function, pain, and global quality of life. Fatigue and sleep disturbances were significantly more prevalent in the Bort-Dex group. CONCLUSIONS Thalidomide (50-100 mg daily) in combination with dexamethasone seems to have an efficacy comparable with that of bortezomib and dexamethasone in melphalan refractory myeloma. However, the statistical strength of the results in this study is limited by the low number of included patients.
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Affiliation(s)
- Martin Hjorth
- Department of Medicine, Lidköping Hospital, Lidköping, Sweden.
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Andresen S, Brandt J, Dietrich S, Memmer ML, Ho AD, Witzens-Harig M. The impact of high-dose chemotherapy, autologous stem cell transplant and conventional chemotherapy on quality of life of long-term survivors with follicular lymphoma. Leuk Lymphoma 2011; 53:386-93. [DOI: 10.3109/10428194.2011.613132] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kvam AK, Fayers PM, Wisloff F. Responsiveness and minimal important score differences in quality-of-life questionnaires: a comparison of the EORTC QLQ-C30 cancer-specific questionnaire to the generic utility questionnaires EQ-5D and 15D in patients with multiple myeloma. Eur J Haematol 2011; 87:330-7. [PMID: 21668504 DOI: 10.1111/j.1600-0609.2011.01665.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aims of this study were to (i) compare the responsiveness of the EORTC QLQ-C30 cancer-specific questionnaire and the generic questionnaires EQ-5D and 15D used for economic evaluation of healthcare interventions and (ii) determine the minimal important differences (MIDs) in these questionnaires. The MID is the smallest change in a quality-of-life score considered important to patients. METHODS Between 2006 and 2008, 239 patients with multiple myeloma completed the questionnaires at inclusion (T1) and after 3 months (T2). At T2, patients were asked whether they had noticed any change in their quality of life. Responsiveness and MIDs were determined by mean score changes (T2-T1) for patients who, in the interview, stated they had improved, deteriorated, or were unchanged. Responsiveness was also assessed using standardized response means. Wilcoxon tests for pair differences were used to evaluate the statistical significance of the changes. RESULTS Patients who improved had significantly (P < 0.01) higher scores at T2 in all three questionnaires. Patients who deteriorated reported lower scores at T2; however, for the 15D, the differences in score were not statistically significant. The MIDs for the QLQ-C30, EQ-5D, and 15D were 8, 0.08, and 0.03 in patients who improved and 12, 0.10 and 0.02 in patients who deteriorated, respectively. CONCLUSIONS All three questionnaires showed an acceptable responsiveness in patients who improved. However, the 15D did not respond optimally in patients who deteriorate and cannot be recommended for use in patients with myeloma.
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Affiliation(s)
- Ann Kristin Kvam
- Department of Haematology, Oslo University Hospital, Ullevaal Faculty of Medicine, University of Oslo, Oslo, Norway.
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Molassiotis A, Wilson B, Blair S, Howe T, Cavet J. Unmet supportive care needs, psychological well-being and quality of life in patients living with multiple myeloma and their partners. Psychooncology 2011; 20:88-97. [PMID: 20187072 DOI: 10.1002/pon.1710] [Citation(s) in RCA: 177] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE The aim of this project was to identify the nature and range of needs, as well as levels of quality of life (QOL), of both patients living with myeloma and their partners. METHODS A cross-sectional survey was used, recruiting patients and their partners from 4 hospitals in the United Kingdom at a mean time post-diagnosis of 5 years. Patients completed a scale exploring their Supportive Care Needs, the Hospital Anxiety and Depression Scale (HADS) and the EORTC QOL scale with its Myeloma module. The partners completed the partners' version of the Supportive Care Needs scale and HADS. RESULTS A total of 132 patients and 93 of their partners participated. One-quarter of the patients and one-third of the partners reported unmet supportive care needs. About 27.4% of patients reported signs of anxiety and 25.2% reported signs of depression. Almost half the partners (48.8%) reported signs of anxiety and 13.6% signs of depression. Anxious/depressed patients had more than double unmet needs than non-anxious/depressed patients (P<0.05). QOL was moderate, with key areas of impairment being physical, emotional, social and cognitive functioning, and patients complained of several symptoms, including tiredness (40.7%), pain (35.9%), insomnia (32.3%), peripheral neuropathies (28.3%) and memory problems (22.3%). About 40.8% were worried about their health in the future. CONCLUSION Long-term supportive care services should provide support to both patients and their partners in relation to their unmet needs, screening them for psychological disorders, referring them appropriately and timely, and optimising symptom management in order to improve the patients' QOL.
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Affiliation(s)
- Alex Molassiotis
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
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Hornberger J, Rickert J, Dhawan R, Liwing J, Aschan J, Löthgren M. The cost-effectiveness of bortezomib in relapsed/refractory multiple myeloma: Swedish perspective. Eur J Haematol 2010; 85:484-91. [PMID: 20846301 DOI: 10.1111/j.1600-0609.2010.01526.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To estimate the cost-effectiveness of bortezomib (BTZ) compared with dexamethasone (DEX) and lenalidomide plus dexamethasone (LEN/DEX) for the treatment of relapsed/refractory multiple myeloma in Sweden. METHODS We used partitioned survival analysis to assess survival data decomposed into three states: (i) alive before disease progression; (ii) alive after progression; and (iii) dead. The effects of treatment on time to progression and overall survival (OS) were obtained from published reports of the APEX, MM-009, and MM-010 randomized clinical trials. Costs included drug and administration costs, adverse events, treatment of relapses, and end-of-life costs. Utility estimates were derived from the literature. RESULTS BTZ mean OS was 57.4 months compared with 44.6 and 54.1 months for DEX and LEN/DEX, respectively. Mean lifetime direct medical costs per patient were approximately 2010 SEK 1,904,462, 1,278,854, and 2,450,588 for BTZ, DEX, and LEN/DEX, respectively. Mean incremental cost per quality-adjusted life-year of BTZ compared to DEX was 2010 SEK 902,874 (€95,073) (95% CI: 514,791, 962,416) and was dominant with respect to LEN/DEX. CONCLUSION BTZ and LEN/DEX are projected to prolong survival relative to DEX. From a Swedish perspective, BTZ is cost-effective compared to DEX and LEN/DEX.
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Frödin U, Börjeson S, Lyth J, Lotfi K. A prospective evaluation of patients' health-related quality of life during auto-SCT: a 3-year follow-up. Bone Marrow Transplant 2010; 46:1345-52. [PMID: 21113189 DOI: 10.1038/bmt.2010.304] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Few studies have evaluated long-term health-related quality of life (HRQL) in patients during auto-SCT. This prospective study examined HRQL in 96 eligible patients before, during and up to 3 years after auto-SCT. The aim of the study was to make a comprehensive assessment of the frequency and severity of different symptoms in patients undergoing auto-SCT. The European Organization for Treatment and Research of Cancer Quality of Life Questionnaire (EORTC QLQ C-30) was administered 13 times. The second week during treatment was the period when patients had the lowest HRQL regarding both total quality of life and function and symptom scales. The patients recovered quickly and just two months after transplantation the baseline values were restored. Three years after transplantation most of the items in the questionnaire had stabilized, except role function and dyspnea, which had improved. There were significant differences between multiple myeloma (MM) and lymphoma patients' physical function, quality of life, fatigue and pain during week 2. At the 3-year follow-up, lymphoma patients indicated a better HRQL than MM patients. The quick recovery of patients after transplantation suggests that treatment is well tolerated; however, the supportive care could be improved at week 2, especially for the lymphoma patients.
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Affiliation(s)
- U Frödin
- Department of Hematology, Linköping University Hospital, Linköping, Sweden.
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Abstract
Abstract
The clinical approach to older patients with myeloma has to be modified to take into account comorbidities and the likelihood of higher treatment-related toxicity. Individualization of management and adequate supportive therapy are important to obtain the best response while minimizing adverse effects. Corticosteroids, novel agents, conventional cytotoxic agents, and high-dose chemotherapy with autotransplantation (modalities used in younger patients) are also used in older patients, although the elderly undergo transplantation less frequently. The sequential use of active agents singly and in different combinations has improved response rates and survival of all patients with myeloma, including the elderly.
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Brandt J, Dietrich S, Meissner J, Neben K, Ho AD, Witzens-Harig M. Quality of life of long-term survivors with Hodgkin lymphoma after high-dose chemotherapy, autologous stem cell transplantation, and conventional chemotherapy. Leuk Lymphoma 2010; 51:2012-20. [PMID: 20858092 DOI: 10.3109/10428194.2010.513749] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In this study, we investigated the quality of life (QoL) of long-term survivors with Hodgkin lymphoma who received high-dose chemotherapy (HDCT) followed by peripheral blood stem cell transplantation (PBSCT). QoL of this group was compared with QoL of patients who were treated with conventional chemotherapy and with QoL of the healthy German population. Two standardized questionnaires, the EORTC QLQ-C30 and the EQ-5D, including the visual analogue scale (VAS) were applied. A total of 98 patients were included in the study, all of them treated in our institution. Thirty-seven patients who received HDCT with PBSCT between 1986 and 2007 were compared with 61 patients treated with conventional chemotherapy and supplementary radiation between 1998 and 2009. The median follow-up for the HDCT group was 11 years. Statistical analysis with the one-sample t-test shows a reduced QoL of both groups of patients compared to the healthy population. Compared to the group of patients who received conventional chemotherapy, there is a tendency towards reduced QoL in patients with HDCT in all of the three main categories of the EORTC-QLQ-C30. However, these differences were not statistically significant, with the exception of the subcategory of dyspnoea, which was worse in the group that was treated with BCNU containing high-dose protocols. We conclude that the negative impact of both HDCT and conventional therapy on the QoL of long-term survivors with Hodgkin lymphoma should not be underestimated and should lead to the development of less toxic therapy strategies.
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Affiliation(s)
- Juliane Brandt
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
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Kvam AK, Wisløff F, Fayers PM. Minimal important differences and response shift in health-related quality of life; a longitudinal study in patients with multiple myeloma. Health Qual Life Outcomes 2010; 8:79. [PMID: 20678240 PMCID: PMC2922103 DOI: 10.1186/1477-7525-8-79] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Accepted: 08/03/2010] [Indexed: 01/22/2023] Open
Abstract
Background We previously reported that changes of 6-17 percent in the EORTC QLQ-C30 scores are regarded important by patients with multiple myeloma and thus may be considered as Minimal Important Differences (MIDs). However, patients' internal standard of measurement may have changed over time (response shift, RS). In the present work, we evaluated whether myeloma patients experience RS and if this could affect the MID-estimates. Methods Between 2006 and 2008, 239 patients with multiple myeloma completed the EORTC QLQ-C30 at baseline (T1) and after three months (T2). At T2, patients were asked if they had noticed any change in the domains pain, fatigue, physical function and global quality of life. They were also asked to give a retrospective judgment of their baseline values on all the four domains. Results We found clear evidence of RS in myeloma patients. However, there were differences in both magnitude and direction between patients who stated that they improved and those who deteriorated. Deteriorating patients retrospectively reported better health-related quality of life at T1 for the domains pain, fatigue and physical function. In these patients, MIDs adjusted for RS were observed to increase up to 12 percentage points. In contrast, for patients stating that they improved, we only found evidence of statistically significant RS in the domain global quality of life. Conclusions MIDs estimated from pre-test/post-test data appeared to be robust against RS in patients reporting improvement over 3-months. This could indicate that RS has a minimal impact on the results in patients who respond to treatment, and that RS may not have an important impact on interpretation of changes reported in clinical trials where an improvement occurs. Although the effect sizes of the RSs were small, RS in deteriorating patients may have an important impact on the interpretation of changes reported in clinical trials. Trial registration The study is registered at clinicaltrials.gov, identifier NCT00290095.
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Affiliation(s)
- Ann K Kvam
- Department of Haematology, Oslo University Hospital, Ullevaal, Norway.
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Johnsen HE, Klausen TW, Boegsted M, Lenhoff S, Gimsing P, Christiansen I, Gedde-Dahl T, Lindås R, Mellqvist UH. Improved Survival for Multiple Myeloma in Denmark Based on Autologous Stem Cell Transplantation and Novel Drug Therapy in Collaborative Trials: Analysis of Accrual, Prognostic Variables, Selection Bias, and Clinical Behavior on Survival in More Than 1200 Patients in Trials of the Nordic Myeloma Study Group. CLINICAL LYMPHOMA MYELOMA AND LEUKEMIA 2010; 10:290-296. [DOI: 10.3816/clml.2010.n.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Reduced nutritional status among multiple myeloma patients during treatment with high-dose chemotherapy and autologous stem cell support. Clin Nutr 2010; 29:488-91. [DOI: 10.1016/j.clnu.2009.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 11/19/2009] [Accepted: 12/04/2009] [Indexed: 11/21/2022]
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Living with multiple myeloma: experiences of patients and their informal caregivers. Support Care Cancer 2009; 19:101-11. [PMID: 19998045 DOI: 10.1007/s00520-009-0793-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2009] [Accepted: 11/12/2009] [Indexed: 10/20/2022]
Abstract
GOALS OF WORK The purpose of this study was to explore the experience of living with myeloma after completion of treatments in patients and their informal caregivers. PATIENTS AND METHODS Qualitative interviews were carried out with 20 patients living with myeloma and 16 of their informal caregivers (mostly spouses), asking them through semi-structured interviews to talk about the effects of myeloma on their lives, issues and concerns, their supportive care needs and how they were coping in everyday life. MAIN RESULTS Key findings indicate the significant impact myeloma has on patients' and caregivers' emotional, role, social and work-related areas of life. While patients seemed less engaged with their illness, their informal caregivers were providing practical and emotional support to patients almost exclusively, often by neglecting their own needs. This increased engagement with the informal caring often led to experiences of a heightened illness burden and difficulties with coping. Both patients and caregivers had significant fears and uncertainty about the future, with myeloma being described as a 'time bomb'. Both patients and caregivers were concealing stressful situations related to the illness from each other in an effort to protect them, although this resulted in isolation. CONCLUSIONS While health professionals' attention has been concentrated in helping patients to get through treatments, it is imperative that psychosocial rehabilitation is offered also to those who survive many years after diagnosis and are off treatments. Caregivers are particularly vulnerable to the high demands of caring for myeloma patients, and a more concerted action by health professionals should be directed to them.
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