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Hillis C, Flynn KE, Goldman EH, Moreira-Lucas TS, Visentini J, Dorman S, Ballinger R, Byrnes HF, De Palma A, Barbier V, Machado L, Atallah E. A Survey of Patient Experience in CML: American and Canadian Perspectives. Patient Prefer Adherence 2023; 17:331-347. [PMID: 36760231 PMCID: PMC9904222 DOI: 10.2147/ppa.s394332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/25/2023] [Indexed: 02/05/2023] Open
Abstract
PURPOSE With treatment, chronic myeloid leukemia (CML) has a favorable prognosis, however, individuals with CML experience impairment to their quality of life (QoL). The aim of this study was to examine the perspectives and experiences of individuals with CML and to understand their challenges communicating with their CML physician. PATIENTS AND METHODS An online survey in adults with CML (n=100) in the US and Canada assessed QoL, patient-provider relationships, treatment satisfaction, and understanding of CML and treatment goals via the MD Anderson Symptom Inventory, the Cancer Therapy Satisfaction Questionnaire and de novo survey questions. Participants were recruited via an external patient recruiter and CML Patient Groups. RESULTS Many participants reported hardships due to CML and its treatment. The main impacts were on the ability to work (21%), engage in personal activities (e.g., hobbies, 28%), and to enjoy sexual relations (median=2.00, IQR=8.50). A substantial proportion (21-39%) wished to discuss additional topics with their providers (e.g., management of CML and/or its impacts). While participants reported satisfaction with therapy overall (median=85.71, IQR=17.86), they indicated low to moderate treatment satisfaction with specific components, including concerns regarding side effects (median=43.75, IQR=43.75). Participants generally had a good understanding of CML (97%) and its treatment goals (92%). CONCLUSION These findings advance our understanding of issues that need improvement to support QoL for individuals living with CML. Future work is needed to improve patient-provider relationships, address treatment-related side effects, and provide clinical information that is easier for patients to understand.
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Affiliation(s)
| | - Kathryn E Flynn
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | - Josie Visentini
- Medical Affairs, Pfizer Canada Inc., Kirkland, Quebec, Canada
| | | | - Rachel Ballinger
- Patient Centred Outcomes (PCO), ICON Clinical Research Inc., Reading, UK
| | - Hilary F Byrnes
- Patient Centred Outcomes (PCO), ICON Clinical Research Inc., Blue Bell, PA, USA
| | - Andrea De Palma
- Patient Centred Outcomes (PCO), ICON Clinical Research Inc., Milan, Italy
- Correspondence: Andrea De Palma, Tel +39 06 45 20 8037, Email
| | - Valentin Barbier
- Patient Centred Outcomes (PCO), ICON Clinical Research Inc., Lyon, France
| | - Lisa Machado
- The Canadian CML Network, Toronto, Ontario, Canada
| | - Ehab Atallah
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Borghi L, Rosti G, Maggi A, Breccia M, Di Bona E, Iurlo A, La Barba G, Sportoletti P, Albano F, Galimberti S, Rivellini F, Cambrin GR, Capodanno I, Cuneo A, Bonifacio M, Sica S, Arcaini L, Capochiani E, Minotto C, Ciceri F, Crugnola M, Di Caprio L, Supekar S, Elena C, Baccarani M, Vegni E. Perspectives and Emotional Experiences of Patients With Chronic Myeloid Leukemia During ENESTPath Clinical Trial and Treatment-Free Remission: Rationale and Protocol of the Italian Substudy. Front Oncol 2021; 11:638689. [PMID: 34123791 PMCID: PMC8189147 DOI: 10.3389/fonc.2021.638689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/28/2021] [Indexed: 12/02/2022] Open
Abstract
Achievement of deep molecular response following treatment with a tyrosine kinase inhibitor (TKI) allows for treatment-free remission (TFR) in many patients with chronic myeloid leukemia (CML). Successful TFR is defined as the achievement of a sustained molecular response after cessation of ongoing TKI therapy. The phase 3 ENESTPath study was designed to determine the required optimal duration of consolidation treatment with the second-generation TKI, nilotinib 300 mg twice-daily, to remain in successful TFR without relapse after entering TFR for 12 months. The purpose of this Italian 'patient's voice CML' substudy was to evaluate patients' psycho-emotional characteristics and quality of life through their experiences of stopping treatment with nilotinib and entering TFR. The purpose of the present contribution is to early present the study protocol of an ongoing study to the scientific community, in order to describe the study rationale and to extensively present the study methodology. Patients aged ≥18 years with a confirmed diagnosis of Philadelphia chromosome positive BCR-ABL1+ CML in chronic phase and treated with front-line imatinib for a minimum of 24 months from the enrollment were eligible. Patients consenting to participate the substudy will have quality of life questionnaires and in-depth qualitative interviews conducted. The substudy will include both qualitative and quantitative design aspects to evaluate the psychological outcomes as assessed via patients' emotional experience during and after stopping nilotinib therapy. Randomization is hypothesized to be a timepoint of higher psychological alert or distress when compared to consolidation and additionally any improvement in health-related quality of life (HRQoL) due to nilotinib treatment is expected across the timepoints (from consolidation, to randomization, and TFR). An association is also expected between dysfunctional coping strategies, such as detachments and certain personality traits, and psychological distress and HRQoL impairments. Better HRQoL outcomes are expected in TFR compared to the end of consolidation. This substudy is designed for in-depth assessment of all potential psycho-emotional variables and aims to determine the need for personalized patient care and counselling, and also guide clinicians to consider the psychological well-being of patients who are considering treatment termination. NCT number: NCT01743989, EudraCT number: 2012-005124-15.
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Affiliation(s)
- Lidia Borghi
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Gianantonio Rosti
- Department of Hematology-Oncology, L. and A. Seràgnoli, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Massimo Breccia
- Department of Translational and Precision Medicine, University Sapienza Rome - Azienda Policlinico Umberto I, Rome, Italy
| | - Eros Di Bona
- Department of Hematology, Vicenza Hospital, Vicenza, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gaetano La Barba
- Department of Hematology, Spirito Santo Hospital, Pescara, Italy
| | - Paolo Sportoletti
- Institute of Hematology-Centro di Ricerche Emato-Oncologiche, Department of Medicine, University of Perugia, Perugia, Italy
| | - Francesco Albano
- Department of Emergency and Organ Transplantation, Hematology Section, University of Bari, Bari, Italy
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Flavia Rivellini
- Hematology Unit, Nocera Inferiore Hospital, Nocera Inferiore, Italy
| | - Giovanna Rege Cambrin
- Division of Hematology and Internal Medicine, San Luigi Gonzaga University Hospital, Orbassano, University of Turin, Turin, Italy
| | | | - Antonio Cuneo
- Institute of Hematology, University of Ferrara, Ferrara, Italy
| | | | - Simona Sica
- Fondazione Policlinico Universitario Agostino Gemelli – IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Arcaini
- Department of Hematology Oncology, IRCCS S. Matteo Hospital Foundation, Pavia, Italy
| | | | - Claudia Minotto
- Department of Oncology and Hematology, Aulss 3 Serenissima, Venice, Italy
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Monica Crugnola
- Division of Hematology and BMT Center AOU Parma, Parma, Italy
| | | | - Sharon Supekar
- Oncology Region Europe, Novartis Farma SpA, Origgio, Italy
| | - Chiara Elena
- Department of Hematology Oncology, IRCCS S. Matteo Hospital Foundation, Pavia, Italy
| | - Michele Baccarani
- Department of Hematology and Oncology “L. and A. Seràgnoli”, University of Bologna, Bologna, Italy
| | - Elena Vegni
- Department of Health Sciences, University of Milan, Milan, Italy
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Annunziata M, Bonifacio M, Breccia M, Castagnetti F, Gozzini A, Iurlo A, Pregno P, Stagno F, Specchia G. Current Strategies and Future Directions to Achieve Deep Molecular Response and Treatment-Free Remission in Chronic Myeloid Leukemia. Front Oncol 2020; 10:883. [PMID: 32582549 PMCID: PMC7280484 DOI: 10.3389/fonc.2020.00883] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/05/2020] [Indexed: 12/21/2022] Open
Abstract
The treatment of chronic myeloid leukemia (CML) has been radically changed by the approval of tyrosine kinase inhibitors (TKIs), which target BCR-ABL1 kinase activity. CML is now managed as a chronic disease requiring long-term treatment and close molecular monitoring. It has been shown that in a substantial number of patients who have achieved a stable deep molecular response (DMR), TKI treatment can be safely discontinued without loss of response. Therefore, treatment-free remission (TFR), through the achievement of a DMR, is increasingly regarded as a feasible treatment goal in many CML patients. However, only nilotinib has approval in this setting and a number of controversial aspects remain regarding treatment choices and timings, predictive factors, patient communication, and optimal strategies to achieve successful TFR. This narrative review aims to provide a comprehensive overview on how to optimize the path to DMR and TFR in patients with CML, and discusses recent data and future directions.
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Affiliation(s)
| | | | - Massimo Breccia
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Fausto Castagnetti
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology “L. and A. Seràgnoli”, “S. Orsola-Malpighi” Univeristy Hospital, University of Bologna, Bologna, Italy
| | - Antonella Gozzini
- Department of Cellular Therapy and Transfusional Medicine, AUO Careggi, Florence, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Patrizia Pregno
- Hematology Division, Oncology and Hematology Department, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Fabio Stagno
- Division of Hematology and Bone Marrow Transplant, AOU Policlinico—V. Emanuele, Catania, Italy
| | - Giorgina Specchia
- Hematology Section, Department of Emergency and Organ Transplantation, University of Bari-Aldo Moro, Bari, Italy
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Borghi L, Moreschi C, Toscano A, Comber P, Vegni E. The PKU & ME study: A qualitative exploration, through co-creative sessions, of attitudes and experience of the disease among adults with phenylketonuria in Italy. Mol Genet Metab Rep 2020; 23:100585. [PMID: 32257816 PMCID: PMC7125347 DOI: 10.1016/j.ymgmr.2020.100585] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 12/22/2022] Open
Abstract
Background Phenylketonuria (PKU) is a hereditary metabolic disease that can be diagnosed and successfully treated from birth with a lifelong phenylalanine-restricted dietary regimen. However, optimal adherence to diet remains an issue and often progressively decreases after adolescence. The study aimed to explore the experience of adults living with PKU in order to gain insights related to their adherence to diet and engagement in managing their condition. Methods The study adopted a qualitative methodology in sessions that combined specifically designed co-creation exercises with focus group discussion. Adults with early-treated classic PKU were enrolled for 2 different sessions - one for adherent and one for non-adherent patients. The verbatim notes of both sessions and focus group were analyzed using content analysis. Results Twelve adherent and nine non-adherent adults with PKU participated. Besides the behavioral dictates of following a strict diet, adherent adults reported a positive mental approach and organizational rigor; they seemed aware of the consequences of high-phenylalanine levels, reporting that it can affect mood and consequently social interactions which they value highly. In the non-adherent group, the individuals seemed to not fully accept their disease: they were aware of the consequences of non-adherence in children but not in adults, they felt the management of PKU was an individual burden and they experienced a feeling of 'diversity' in the social context (related to eating) that caused emotional distress. PKU seemed a very influential element of the identity both for adherent and non-adherent adults, but with different consequences for the two groups. Finally, all participants reported the desire to be assisted in a healthcare setting dedicated to adults. Conclusions The findings expand the understanding of the psychological experience of adult patients with PKU in relation to their disease and its dietary requirements, highlighting specific factors that might drive tailored educational or psychological intervention to improve adherence and engagement in the care process.
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Affiliation(s)
- Lidia Borghi
- Clinical Psychology, Department of Health Sciences, University of Milan, Via A. di Rudinì 8, 20142 Milan, Italy
| | - Carlotta Moreschi
- Clinical Psychology, Department of Health Sciences, University of Milan, Via A. di Rudinì 8, 20142 Milan, Italy
| | - Alessandra Toscano
- Atstrat, Consulting Company focused on Co-creation sessions, Patient Support Programmes Design, Via Galllarate 105, 20151 Milan, Italy
| | - Peter Comber
- Atstrat, Consulting Company focused on Co-creation sessions, Patient Support Programmes Design, Via Galllarate 105, 20151 Milan, Italy
| | - Elena Vegni
- Clinical Psychology, Department of Health Sciences, University of Milan, Via A. di Rudinì 8, 20142 Milan, Italy
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