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Lieber SR, Jones AR, Jiang Y, Gowda P, Patel M, Lippe B, Shenoy A, Evon DM, Gurley T, Ngo V, Olumesi M, Trudeau RE, Noriega Ramirez A, Jordan-Genco L, Mufti A, Lee SC, Singal AG, VanWagner LB. Psychiatric diagnoses are common after liver transplantation and are associated with increased health care utilization and patient financial burden. Liver Transpl 2024:01445473-990000000-00373. [PMID: 38713020 DOI: 10.1097/lvt.0000000000000390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/09/2024] [Indexed: 05/08/2024]
Abstract
Psychiatric disorders after liver transplantation (LT) are associated with worse patient and graft outcomes, which may be amplified by inadequate treatment. We aimed to characterize the burden of psychiatric disorders, treatment patterns, and associated financial burden among liver transplantation recipients (LTRs). IQVIA PharMetrics (R) Plus for Academics-a large health plan claims database representative of the commercially insured US population-was used to identify psychiatric diagnoses among adult LTRs and assess treatment. Multivariable logistic regression analysis identified factors associated with post-LT psychiatric diagnoses and receipt of pharmacotherapy. Patient financial liability was estimated using adjudicated medical/pharmacy claims for LTRs with and without psychiatric diagnoses. Post-LT psychiatric diagnoses were identified in 395 (29.5%) of 1338 LTRs, of which 106 (26.8%) were incident cases. Treatment varied, with 67.3% receiving pharmacotherapy, 32.1% psychotherapy, 21.0% combination therapy, and 21.5% no treatment. Among 340 LTRs on psychotropic medications before transplant, 24% did not continue them post-LT. Post-LT psychiatric diagnoses were independently associated with female sex, alcohol-associated liver disease (ALD), prolonged LT hospitalization (>2 wk), and pre-LT psychiatric diagnosis. Incident psychiatric diagnoses were associated with female sex, ALD, and prolonged LT hospitalization. Patients with a post-LT psychiatric diagnosis had higher rates of hospitalization (89.6% vs. 81.5%, p <0.001) and financial liability (median $5.5K vs. $4.6K USD, p =0.006). Having a psychiatric diagnosis post-LT was independently associated with experiencing high financial liability >$5K. Over 1 in 4 LTRs had a psychiatric diagnosis in a large national cohort, yet nearly a quarter received no treatment. LTRs with psychiatric diagnoses experienced increased health care utilization and higher financial liability. Sociodemographic and clinical risk factors could inform high-risk subgroups who may benefit from screening and mitigation strategies.
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Affiliation(s)
- Sarah R Lieber
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Alex R Jones
- Department of Medicine, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Yue Jiang
- Department of Statistical Science, Duke University, Durham, North Carolina, USA
| | - Prajwal Gowda
- Department of Medicine, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Madhukar Patel
- Department of Surgery, Division of Surgical Transplantation, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Ben Lippe
- Department of Psychiatry, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Akhil Shenoy
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
| | - Donna M Evon
- Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Tami Gurley
- Department of Public Health, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Van Ngo
- Department of Pharmacy, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Mary Olumesi
- Department of Pharmacy, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Raelene E Trudeau
- Department of Pharmacy, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Alvaro Noriega Ramirez
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Layne Jordan-Genco
- Department of Medicine, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
- Department of Psychiatry, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Arjmand Mufti
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Simon C Lee
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Amit G Singal
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Lisa B VanWagner
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
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Petrillo LA, Jones KF, El-Jawahri A, Sanders J, Greer JA, Temel JS. Why and How to Integrate Early Palliative Care Into Cutting-Edge Personalized Cancer Care. Am Soc Clin Oncol Educ Book 2024; 44:e100038. [PMID: 38815187 DOI: 10.1200/edbk_100038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Early palliative care, palliative care integrated with oncology care early in the course of illness, has myriad benefits for patients and their caregivers, including improved quality of life, reduced physical and psychological symptom burden, enhanced prognostic awareness, and reduced health care utilization at the end of life. Although ASCO and others recommend early palliative care for all patients with advanced cancer, widespread implementation of early palliative care has not been realized because of barriers such as insufficient reimbursement and a palliative care workforce shortage. Investigators have recently tested several implementation strategies to overcome these barriers, including triggers for palliative care consultations, telehealth delivery, navigator-delivered interventions, and primary palliative care interventions. More research is needed to identify mechanisms to distribute palliative care optimally and equitably. Simultaneously, the transformation of the oncology treatment landscape has led to shifts in the supportive care needs of patients and caregivers, who may experience longer, uncertain trajectories of cancer. Now, palliative care also plays a clear role in the care of patients with hematologic malignancies and may be beneficial for patients undergoing phase I clinical trials and their caregivers. Further research and clinical guidance regarding how to balance the risks and benefits of opioid therapy and safely manage cancer-related pain across this wide range of settings are urgently needed. The strengths of early palliative care in supporting patients' and caregivers' coping and centering decisions on their goals and values remain valuable in the care of patients receiving cutting-edge personalized cancer care.
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Affiliation(s)
- Laura A Petrillo
- Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Katie Fitzgerald Jones
- Harvard Medical School, Boston, MA
- New England Geriatrics Research, Education, and Clinical Center (GRECC), Jamaica Plain, MA
| | - Areej El-Jawahri
- Harvard Medical School, Boston, MA
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA
| | - Justin Sanders
- Division of Supportive and Palliative Care, McGill University Health Centre, Montreal, CA
- Department of Family Medicine, McGill University, Montreal, CA
| | - Joseph A Greer
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Jennifer S Temel
- Harvard Medical School, Boston, MA
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA
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Kale SS, Tosto GD, Rush LJ, Kullgren J, Russell D, Fried M, Igboeli B, Teater J, Jones KF, Check DK, Merlin J, McAlearney AS. Creating a Palliative Care Clinic for Patients with Cancer Pain and Substance Use Disorder. J Pain Symptom Manage 2024:S0885-3924(24)00720-6. [PMID: 38670295 DOI: 10.1016/j.jpainsymman.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Opioids are a first-line treatment for severe cancer pain. However, clinicians may be reluctant to prescribe opioids for patients with concurrent substance use disorders (SUD) or clinical concerns about non-prescribed substance use. MEASURES Patient volume, 60-day retention rate, and use of sublingual buprenorphine to treat opioid use disorder. INTERVENTION We created the Palliative Harm Reduction and Resiliency Clinic, a palliative care clinic founded on harm reduction principles and including formal collaboration with addiction psychiatry. OUTCOMES During the first 18 months, patient volume increased steadily; 70% of patients had at least one subsequent visit within 60 days of the initial appointment; and buprenorphine was prescribed for 55% of patients with opioid use disorder. CONCLUSIONS/LESSONS LEARNED The formal collaboration with addiction psychiatry and the integration of harm reduction principles and practices into ambulatory palliative care improved our ability to provide treatment to a previously underserved patient population with high symptom burden.
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Affiliation(s)
- Sachin S Kale
- Division of Palliative Medicine(S.S.K., J.K., D.R.), The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
| | - Gennaro Di Tosto
- Center for the Advancement of Team Science(G.D.T., L.J.R., A.S.M.), Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Laura J Rush
- Center for the Advancement of Team Science(G.D.T., L.J.R., A.S.M.), Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Justin Kullgren
- Division of Palliative Medicine(S.S.K., J.K., D.R.), The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Deborah Russell
- Division of Palliative Medicine(S.S.K., J.K., D.R.), The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Martin Fried
- Division of General Internal Medicine(M.F.), The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Blessing Igboeli
- Department of Psychiatry and Behavioral Health(B.I., J.T.), The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Julie Teater
- Department of Psychiatry and Behavioral Health(B.I., J.T.), The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Katie Fitzgerald Jones
- New England Geriatrics Research(K.F.J.), Education, and Clinical Center (GRECC), VA Boston Healthcare System, Jamaica Plain, Massachussetts, USA
| | - Devon K Check
- Department of Population Health Sciences(D.K.C.), Duke University School of Medicine, Durham, North Carolina, USA
| | - Jessica Merlin
- CHAllenges in Managing and Preventing Pain (CHAMPP) clinical research center(J.M.), Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ann Scheck McAlearney
- Center for the Advancement of Team Science(G.D.T., L.J.R., A.S.M.), Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA; Department of Family and Community Medicine(A.S.M.), College of Medicine, The Ohio State University, Columbus, Ohio, USA
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Zhao J, Zeng X, Liu J, Liu X, Liu Z, Wang B, Chen Z, Dong Y, Guo S, Cui M, Xiao H, Liu X. Marasmius androsaceus mitigates depression-exacerbated intestinal radiation injuries through reprogramming hippocampal miRNA expression. Biomed Pharmacother 2023; 165:115157. [PMID: 37454593 DOI: 10.1016/j.biopha.2023.115157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Cancer patients commonly experience high levels of psychological stress, which poses significant risks to their well-being. Radiotherapy is a primary treatment modality for cancer; however, it often leads to intestinal injuries in these patients. Nevertheless, the impact of mental stress on radiotherapy-intertwined complications remains unclear. METHODS To induce intestinal injury, we employed total abdominal irradiation in our experimental model. We conducted high-throughput sequencing to analyze the expression profile of miRNAs in the hippocampus. RESULTS We observed that mice with depression exhibited more severe intestinal injuries following total abdominal irradiation. Remarkably, oral administration of Marasmius androsaceus not only alleviated the depressive phenotype but also mitigated radiation-induced intestinal toxicity. Notably, this radioprotective effect was not observed in mice without depression. Depression disrupted the hippocampal miRNA expression profile in mice subjected to local irradiation of the abdomen, leading to the accumulation of miR-139-5p and miR-184-3p in the hippocampus, serum, and small intestine tissues. However, treatment with Marasmius androsaceus reprogrammed the miRNA expression signature in mice with depression. Furthermore, intravenous injection of antagomirs targeting miR-139-5p and miR-184-3p ameliorated depression, up-regulated Spn expression, reduced radiation enteritis, and improved the integrity of the small intestine in irradiated mice. CONCLUSION Our findings demonstrate the efficacy of Marasmius androsaceus, a small mushroom, in alleviating depression-aggravated intestinal toxicity following radiotherapy by reprogramming hippocampal miRNA expression.
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Affiliation(s)
- Jiamin Zhao
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of MolecularMicrobiology and Technology of the Ministry of Education, Department of Microbiology, College of Life Sciences, Nankai University, 94 Weijin Road, Tianjin 300071, China
| | - Xiaozhou Zeng
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, 238 Baidi Road, Tianjin 300192, China
| | - Jia Liu
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of MolecularMicrobiology and Technology of the Ministry of Education, Department of Microbiology, College of Life Sciences, Nankai University, 94 Weijin Road, Tianjin 300071, China
| | - Xiaojing Liu
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of MolecularMicrobiology and Technology of the Ministry of Education, Department of Microbiology, College of Life Sciences, Nankai University, 94 Weijin Road, Tianjin 300071, China
| | - Zhihong Liu
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Dushuhu Campus, Soochow University, 199 Ren'ai Road, Suzhou 215123, China
| | - Bin Wang
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, 238 Baidi Road, Tianjin 300192, China
| | - Zhiyuan Chen
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, 238 Baidi Road, Tianjin 300192, China
| | - Yanxi Dong
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, 238 Baidi Road, Tianjin 300192, China
| | - Suping Guo
- Shanxi Institute of Medicine and Life Science, 61 Pingyang Road, Taiyuan 030012, China; Shanxi Kangxin Pharmaceutical Co., Ltd, 1 West Ring Road, Luliang 030082, China
| | - Ming Cui
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, 238 Baidi Road, Tianjin 300192, China.
| | - Huiwen Xiao
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of MolecularMicrobiology and Technology of the Ministry of Education, Department of Microbiology, College of Life Sciences, Nankai University, 94 Weijin Road, Tianjin 300071, China.
| | - Xingzhong Liu
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of MolecularMicrobiology and Technology of the Ministry of Education, Department of Microbiology, College of Life Sciences, Nankai University, 94 Weijin Road, Tianjin 300071, China.
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Deshields T, Asvat Y. The Case for Accelerating Integrated Mental Health Care in the Cancer Setting. JCO Oncol Pract 2023; 19:231-233. [PMID: 36800568 DOI: 10.1200/op.22.00840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
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Fitzgerald Jones K, Ho JJ, Merlin JS, Weimer M, Sager Z, Kapo J, Childers J. The X Waiver to Prescribe Buprenorphine: The Why and How. J Palliat Med 2022; 25:1021-1023. [PMID: 35775892 DOI: 10.1089/jpm.2022.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - J Janet Ho
- Division of Palliative Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jessica S Merlin
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Melissa Weimer
- Program of Addiction Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Zachary Sager
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer Kapo
- Palliative Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Julie Childers
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Affiliation(s)
- Natalie Moryl
- Supportive Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell College at Cornell University, New York, New York
| | - Vivek Tim Malhotra
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College at Cornell University, New York, New York
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