Long-term treatment risks in multiple sclerosis: risk knowledge and risk perception in a large cohort of mitoxantrone-treated patients

Background:

Balancing treatment benefits and risks is part of a shared decision-making process before initiating any treatment in multiple sclerosis (MS). Patients understand, appreciate and profit from evidence-based patient information (EBPI). While these processes are well known, long-term risk awareness and risk processing of patients has not been studied. Mitoxantrone treatment in MS is associated with long-term major potential harms – leukaemia (LK) and cardiotoxicity (CT). The risk knowledge and perception among patients currently or previously treated with mitoxantrone is unknown.

Objectives:

The objective of this article is to conduct a retrospective cohort study in greater Hamburg, Germany, to estimate risk awareness and perception in MS patients treated with mitoxantrone.

Methods:

MS patients with at least one dose of mitoxantrone between 1991 and 2010 from six major MS centres in greater Hamburg received a questionnaire assessing risk awareness and perception as well as a written EBPI about mitoxantrone-associated LK and CT.

Results:

Fifty-one per cent in the cohort of n = 575 patients returned the questionnaire. Forty per cent correctly estimated the risk of LK (CT 16%); 56% underestimated the risk (CT 82%). Reading the information increased the accuracy of LK risk estimation, and patients did not report an increase of worries. The EBPI was appreciated and recommended by 85%.

Conclusion:

Risk awareness of mitoxantrone-treated patients is insufficient, but can be increased by EBPI without increasing worries. Continued patient information during and after treatment should be implemented in management algorithms.

Outcome of sex reassignment surgery

Three independent reviews of the world literature dealing with the outcome of sex reassignment surgery in transsexualism are presented. In 10-15% of the patients who undergo sex reassignment the results end up in a failure. There are as many failures in the female to male group as in the male to female group. Optimal results from the surgical procedures are important for a successful outcome. Relatively high age when first requesting sex reassignment may be regarded as a risk factor for poor outcome. Genuine transsexuals as a group seem to have a better prognosis for successful outcome of sex reassignment than a group of secondary transsexuals (i.e. transvestites and effeminate homosexuals). On the other hand, secondary transsexuals do better than genuine transsexuals when sex reassignment is refused. It is stressed that great importance should be given to the differential diagnosis when evaluating gender dysphoric patients for sex reassignment.